A CASE OF CANCER OF THE SIGMOID COLON WITH COLOVESICAL FISTULA

Abstract

A 54-year-old man was seen at the hospital because of pneumaturia, fecaluria, diarrhea, and fever, and was admitted for close examination and treatment of vesical fistula. He complained of slight lower abdominal pain. Abdominal CT scan revealed remarkable swelling of colonic and bladder walls as well as inflammatory findings in their circumferences. Barium enema and cystography visualized no fistula. Fistulography using a colonofiberscope visualized a fistula. Colonofiberscopy failed to confirm colonic cancer due to stenosis at the fistula because it was present in the back of the fistula. And diverticulitis of the colon was suspected as a cause of fistulation. At operation, a tumor was palpable in the colon at the stenosed portion, and cancer of the sigmoid colon was diagnosed. Although the colon and bladder were adhered firmly, dissection of them was possible. Operative procedures included a resection of the sigmoid colon and a partial resection of the bladder. An opening of the fistula was seen in the vicinity of anal side to the cancer. Histopathologically, infiltration of cancer into the fistula opening was confirmed, but apparent infiltration of inflammatory cells were observed in the fistula wall. It is thought that fistulation in this case might not formed from ulcer center of the cancer which directly invaded the bladder, and a possibility of association of vesical fistula due to diverticulitis of the sigmoid colon in the vicinity of the colonic cancer could not be ruled out.