Colovesical fistula as the initial manifestation of advanced colon cancer: A case report and review of literature

Abstract

Colovesical fistulas (CVFs) are rare complications of very advanced cancers of the abdominal or pelvic cavity and often cause diagnostic troubles. CVFs are found more often in males, whereas females usually suffer from rectovaginal or vesicovaginal fistulas. This article presents a case of a female patient who was admitted to the hospital because of acute diarrhea, presumably of infectious origin, and with only subtle abnormalities in blood tests and urinalysis. Owing to the ineffectiveness of the performed treatment and progressive intensification of symptoms, diagnostics were extended to include a computed tomography scan, sigmoidoscopy and cystography. The imaging results revealed a large heterogeneous conglomerate of solid and fluid structures in the pelvis, which involved reproductive organs, the bladder and sigmoid colon. The excrement leaking from the digestive tract was urine, and CVF was the first manifestation of colon cancer. Shortly after the final diagnosis, the patient deteriorated and eventually died after an urgent colostomy was performed because of a bowel obstruction.

Keywords: Fecaluria, Pelvic cavity, Colovesical fistula, Colorectal cancer, Diarrhea

Core tip: Colovesical fistulas are a rare complication of very advanced cancers of the abdominal or pelvic cavity. This article presents a case of a female patient whose first manifestation of colon cancer was a misleading watery diarrhea, which was later found to be urination through a pathologic junction between the bladder and distal colon.