Abstract
Colovesical fistula is an atypical communication between the colon and the bladder. The most common causes of colovesical fistula are diverticulitis, inflammatory bowel disease, lymphoma and complication from radiation therapy. Patients with colovesical fistula present with recurrent urinary tract infections (UTI), dysuria, frequency, abdominal pain, pneumaturia, faecaluria, and hematuria. We present a case of a patient with stage IV lung adenocarcinoma presented with abdominal pain, dysuria, and faecaluria who was found to have a colovesical fistula. Although colovesical fistula may be sequelae of advanced colon or bladder cancer, it is a very uncommon presentation of metastatic cancer from distant sites. Our case is the first to show that colovesical fistula may present from metastatic lung adenocarcinoma. Clinical awareness of this very unusual presentation of metastatic cancer can lead to faster diagnosis and treatment, possibly minimizing excessive use of antibiotics.
Highlights
Colovesical fistula is an atypical communication between the lumen of the colon and the bladder
We present a case of a patient with stage IV lung adenocarcinoma presented with abdominal pain, dysuria, and faecaluria who was found to have a colovesical fistula
Our case is the first to show that colovesical fistula may present from metastatic lung adenocarcinoma
Summary
Colovesical fistula is an atypical communication between the lumen of the colon and the bladder. A colovesical fistula is formed as a result of diverticulitis which comprises approximately 60% of cases, colorectal cancer is responsible for around 20% of cases, inflammatory bowel diseases comprising nearly 10% of cases, less frequent etiologies include appendicitis, radiation therapy, and trauma [1]. The most common sites of metastatic disease in patients with lung cancer include brain, liver, adrenal glands, and bones [3,4]. CT of the abdomen and pelvis revealed a colovesical fistula between the sigmoid colon and bladder, large mesenteric lymph node just above the sigmoid colon mass and wall thickening in the sigmoid colon (Figure 1). Pathology of the tumor revealed metastatic poorly differentiated lung adenocarcinoma with an associated colovesical fistula and extensive lymphovascular invasion. Comparison of resected colovesical fistula mass to primary lung cancer biopsy showed similar morphology by Haemotoxylin and Eosin staining (H&E) and lung cancer specific thyroid transcription factor-1 (TTF1) marker consistent with the colovesical fistula mass being metastatic lung cancer (Figures 2A-D)
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