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Recurrent Urinary Tract Infections due to Asymptomatic Colonic Diverticulitis.

Falidas E, Anyfantakis G, Boutzouvis S, Kyriakopoulos M, Mathioulakis S, Vlachos K, Villias C - Case Rep Med (2012)

Bottom Line: Pneumaturia, fecaluria, urinary tract infections, abdominal pain, and dysuria are commonly reported.The authors report a case of colovesical fistula due to asymptomatic diverticulitis, and they emphasize the importance of deeply investigate recurrent urinary tract infection without any bowel symptoms.They also briefly review the literature.

View Article: PubMed Central - PubMed

Affiliation: 1st Department of Surgery, 417 NIMTS Veterans Hospital of Athens, Athens 11521, Greece.

ABSTRACT
Colovesical fistula is a common complication of diverticulitis. Pneumaturia, fecaluria, urinary tract infections, abdominal pain, and dysuria are commonly reported. The authors report a case of colovesical fistula due to asymptomatic diverticulitis, and they emphasize the importance of deeply investigate recurrent urinary tract infection without any bowel symptoms. They also briefly review the literature.

No MeSH data available.


Related in: MedlinePlus

Transverse abdominal CT scan demonstrating airlevel into the urinary bladder closely in contact with a thickened segment of the sigmoid colon and colon diverticula.
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fig2: Transverse abdominal CT scan demonstrating airlevel into the urinary bladder closely in contact with a thickened segment of the sigmoid colon and colon diverticula.

Mentions: A 75-year-old man came to the emergency department complaining of high fever of 4-day duration and urgency in urination. He mentioned recurrent and multiple (five) episodes of urinary tract infections over the last 3 months attributed to a recent (12 months ago) transurethral prostatectomy. These episodes were resolved with oral administration of various antibiotics. Escherichia coli was constantly found in urine cultures. However, no history of abdominal pain, fever, particular changes of defecation habits, pneumaturia, or fecaluria was referred. No diverticulosis or diverticulitis was identified in prior medical examinations. Repeated urinary tract ultrasound controls were undertaken in order to exclude prostate, urinary blabber, uretere, or kidneys abnormalities or lithiasis without particular abnormal findings. On admission, leukocytosis (17000 mm3) was the unique abnormal laboratory finding. Pyuria and hematuria were found in urinalysis. Upon palpation, no abdominal pain or positive Giordano maneuver were observed. Urine and blood cultures were taken. He received intravenously fluids and empirical wide spectrum antibiotic treatment (ciprofloxacin). Temperature was completely normalized 2 days later. Urine cultures revealed Escherichia coli and Pseudomonas aeruginosa (colony-forming units (CFU) >106/mL of urine) sensitive to ciprofloxacin. No atypical antibiotic sensitivities or resistances were observed according to the microbiologic data of our hospital. Cystoscopy demonstrated redness of the lateral wall of the bladder without any fistula identified. Cystography also did not demonstrate any fistula tract. However, abdominal computed tomography scan (CT) revealed the presence of free air within the urinary bladder in contact with perisigmoid thickening and colon diverticula (Figures 1 and 2). In addition, colonoscopy was performed in order to exclude colonic neoplasm. No neoplasm was identified; however, diffuse diverticula of the sigmoid colon with thickness, edema, and inflammation into the lumen were observed. No evident fistula tract was revealed.


Recurrent Urinary Tract Infections due to Asymptomatic Colonic Diverticulitis.

Falidas E, Anyfantakis G, Boutzouvis S, Kyriakopoulos M, Mathioulakis S, Vlachos K, Villias C - Case Rep Med (2012)

Transverse abdominal CT scan demonstrating airlevel into the urinary bladder closely in contact with a thickened segment of the sigmoid colon and colon diverticula.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3295588&req=5

fig2: Transverse abdominal CT scan demonstrating airlevel into the urinary bladder closely in contact with a thickened segment of the sigmoid colon and colon diverticula.
Mentions: A 75-year-old man came to the emergency department complaining of high fever of 4-day duration and urgency in urination. He mentioned recurrent and multiple (five) episodes of urinary tract infections over the last 3 months attributed to a recent (12 months ago) transurethral prostatectomy. These episodes were resolved with oral administration of various antibiotics. Escherichia coli was constantly found in urine cultures. However, no history of abdominal pain, fever, particular changes of defecation habits, pneumaturia, or fecaluria was referred. No diverticulosis or diverticulitis was identified in prior medical examinations. Repeated urinary tract ultrasound controls were undertaken in order to exclude prostate, urinary blabber, uretere, or kidneys abnormalities or lithiasis without particular abnormal findings. On admission, leukocytosis (17000 mm3) was the unique abnormal laboratory finding. Pyuria and hematuria were found in urinalysis. Upon palpation, no abdominal pain or positive Giordano maneuver were observed. Urine and blood cultures were taken. He received intravenously fluids and empirical wide spectrum antibiotic treatment (ciprofloxacin). Temperature was completely normalized 2 days later. Urine cultures revealed Escherichia coli and Pseudomonas aeruginosa (colony-forming units (CFU) >106/mL of urine) sensitive to ciprofloxacin. No atypical antibiotic sensitivities or resistances were observed according to the microbiologic data of our hospital. Cystoscopy demonstrated redness of the lateral wall of the bladder without any fistula identified. Cystography also did not demonstrate any fistula tract. However, abdominal computed tomography scan (CT) revealed the presence of free air within the urinary bladder in contact with perisigmoid thickening and colon diverticula (Figures 1 and 2). In addition, colonoscopy was performed in order to exclude colonic neoplasm. No neoplasm was identified; however, diffuse diverticula of the sigmoid colon with thickness, edema, and inflammation into the lumen were observed. No evident fistula tract was revealed.

Bottom Line: Pneumaturia, fecaluria, urinary tract infections, abdominal pain, and dysuria are commonly reported.The authors report a case of colovesical fistula due to asymptomatic diverticulitis, and they emphasize the importance of deeply investigate recurrent urinary tract infection without any bowel symptoms.They also briefly review the literature.

View Article: PubMed Central - PubMed

Affiliation: 1st Department of Surgery, 417 NIMTS Veterans Hospital of Athens, Athens 11521, Greece.

ABSTRACT
Colovesical fistula is a common complication of diverticulitis. Pneumaturia, fecaluria, urinary tract infections, abdominal pain, and dysuria are commonly reported. The authors report a case of colovesical fistula due to asymptomatic diverticulitis, and they emphasize the importance of deeply investigate recurrent urinary tract infection without any bowel symptoms. They also briefly review the literature.

No MeSH data available.


Related in: MedlinePlus