An unusual cause of bubbly urine

Abstract

A 29-year-old man with 10-year history of Crohn’s ileoolitis presented with pneumaturia, faecaluria and recurrent rinary tract infection of 3 weeks’ duration. He was afebrile. pelvic CT showed an air–fluid level in the bladder (Fig. , arrow). Crohn’s disease complicated by ileovesical fisula was diagnosed by cystoscopy and radiographic studies f the small intestine. Medical treatment did not improve he symptoms; therefore, the patient underwent laparotomy. he ileovesical fistula and stenotic ileum with concomitant leoileal fistulas were resected, and the bladder defect was losed. The fistula, demonstrated by a sound, was accomanied by Crohn’s longitudinal ulcers (Fig. 2). He has been reated with mesalazine and the fistula has not recurred during 0 years of follow-up. Enterovesical fistula (EVF), caused by transmural ssures from the affected intestinal tract to the normal ladder, is a rare complication of Crohn’s disease. Patients f EVF due to Crohn’s disease are an average of 30 years ounger than those with cancer or diverticulitis. The major rigin of Crohn’s EVF includes the ileum, sigmoid colon nd the previous anastomosis. Clinical presentations are neumaturia, dysuria, faecaluria and urinary tract infection ymptoms. The useful diagnostic studies are cystoscopy, CT nd contrast radiology of the bowel. Urinary analysis after ral or rectal administration of the dyes or barium (Bourne est) [1] can be helpful. Although anti-TNF treatment has een a valuable option [2], most medical management has een difficult to heal EVF. Thus surgery has been required o avoid urinary sepsis in the majority of patients [3].