Published online Mar 24, 2017. doi: 10.5410/wjcu.v6.i1.30
Peer-review started: December 28, 2016
First decision: January 16, 2017
Revised: January 21, 2017
Accepted: February 20, 2017
Article in press: February 21, 2017
Published online: March 24, 2017
Processing time: 68 Days and 23.5 Hours
Enterovesical fistulae secondary to benign or malignant bowel disease are not uncommonly reported in the literature. However, bladder malignancy as the primary pathology is exceedingly rare. We report a case of muscle invasive urothelial carcinoma of bladder with an enterovesical fistula to a loop of small bowel. The patient first presented with signs and symptoms of per rectal bleeding, haematuria, pneumaturia, faecaluria and rectal micturition. Her initial biochemistry test revealed significant metabolic acidosis with normal anion gap and hypokalemia. A computed tomography abdomen/pelvis with rectal contrast demonstrated an enterovesical fistula from the dome of bladder to a loop of small bowel. The patient underwent radical cystectomy with en-bloc resection of a loop of involved ileum and sigmoid colon due to the intraoperative findings of the sigmoid colon adherent to the tumour. The published literature is reviewed, focusing on the incidence, diagnostic modality and treatment strategies available for this rare condition.
Core tip: A 68-year-old lady presented with per rectal bleeding and haematuria. Other important history includes her reporting diarrhea with associated weight loss over the last 3 mo and faecaluria, pneumaturia and rectal micturition. On presentation, she was found to be in severe metabolic acidosis with hypokalemia. A computed tomography scan with rectal contrast showed an enterovesical fistula from bladder to a loop of small bowel. She underwent radical cystectomy, en-bloc resection of a loop of the involved small bowel and sigmoid colon with formation of ileal conduit and end-colostomy.