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
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.