0:00

Alright, again, we have a contrast

0:02

enhanced CT scan of the abdomen and pelvis.

0:05

Here we have the liver and the

0:06

spleen that are looking pretty good.

0:07

The patient's status post cholecystectomy. Here we

0:10

have the pancreas also looking within normal limits,

0:13

and the kidneys without evidence of hydronephrosis.

0:15

As we come down into the lower pelvis in this

0:18

patient with left lower quadrant pain, we'll

0:20

see a number of diverticulum coming off of that

0:22

sigmoid colon, as we've seen in prior cases.

0:25

And there's a little inflammation.

0:27

You can see some fat stranding

0:28

and some signs of diverticulitis.

0:29

But in this case, we're also seeing some extraluminal

0:33

air here extending towards the bladder with a thick

0:36

walled bladder and air within the bladder lumen.

0:40

Let's look at this on coronal, 'cause

0:41

I think that'll even be a nicer view,

0:43

where you can see your sigmoid colon here with lots

0:46

and lots of little diverticulum, and then this tract

0:48

of air extending from that region of inflammation

0:52

to the dome of the bladder to a very thick walled

0:55

bladder, consistent with a colovesicular fistula.

0:58

These patients will come in

1:00

with pneumaturia, or peeing air.

1:02

Sometimes their descriptions are pretty funny.

1:05

But this is a dreaded outcome of

1:07

diverticulitis, is the fistulization, the

1:09

opportunity to fistula to adjacent organs.

1:12

In this male patient,

1:14

the particular fistula is probably the

1:16

most likely fistulization that we may see.

1:18

At times, we can see cutaneous

1:20

fistulas, but much less common.

1:22

So here we go.

1:23

It is a diverticular colovesicular fistula.

Case: Diverticulitis With Colovesical Fistula

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