Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2018; 6(12): 538-541
Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.538
Colovesical fistula as the initial manifestation of advanced colon cancer: A case report and review of literature
Małgorzata Skierucha, Wojciech Barud, Jerzy Baraniak, Witold Krupski
Małgorzata Skierucha, Wojciech Barud, Jerzy Baraniak, Department of Internal Diseases, Medical University of Lublin, Lublin 20-081, Polen (POL), Poland
Witold Krupski, Department of Radiology, Medical University in Lublin, Lublin 20-081, Polen (POL), Poland
Author contributions: Skierucha M and Barud W made equal contribution in the study concept, collecting data and writing the paper. Baraniak J and Krupski W took part in diagnostics and provided imaging data.
Informed consent statement: Written informed consent to colostomy was obtained from the patient before the operation.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Małgorzata Skierucha, MD, Doctor, Department of Internal Diseases, Medical University of Lublin, Staszica 11, Lublin 20-081, Polen (POL), Poland. malgorzata.skierucha@gmail.com
Telephone: +48-81-5327717 Fax: +48-81-5327717
Received: July 4, 2018
Peer-review started: July 4, 2018
First decision: August 20, 2018
Revised: September 13, 2018
Accepted: October 10, 2018
Article in press: October 10, 2018
Published online: October 26, 2018
Processing time: 114 Days and 23.8 Hours
ARTICLE HIGHLIGHTS
Case characteristics

Misinterpretation of diarrhea in a female patient with a colovesical fistula (CVF) due to an advanced colon cancer.

Clinical diagnosis

Acute diarrhea, recurring fever, abdominal cramps, nausea and a lack of appetite.

Differential diagnosis

Infectious diarrhea.

Laboratory diagnosis

Hypokalemia, hypoalbuminemia, leukocytosis with a predominance of granulocytes and elevated C-reactive protein. Bacteriuria and leukocyturia in urinalysis.

Imaging diagnosis

A computed tomography scan revealed a heterogeneous tumor, enlarged lymph nodes in the pelvis and metastases in the liver and peritoneum. Cystography showed a CVF.

Pathological diagnosis

G3 poorly differentiated colorectal adenocarcinoma.

Treatment

An urgent colostomy conducted because of a bowel obstruction.

Related reports

Wei et al have described a case of a male patient with CVF, whose symptoms were comparable to those described in our case. However, to our limited knowledge, this is the first case report describing CVF in a female.

Term explanation

CVF is a pathologic junction between the bladder and colon. Approximately 20%-30% of CVFs develop as complications of advanced tumors of the abdominal or pelvic cavity.

Experiences and lessons

Diarrhea may be a misleading symptom of CVF. A basic test such as urinalysis should never be neglected. In our case, repeated urinalysis may have been very informative. Patients with diarrhea of unknown reason should be catheterized to control the renal loss of fluids and the quality of urine.