PMC5487297_01
(a) Cystoscopy showing edematous mucosa of the posterior bladder wall and a hole in the center (arrow). (b) Endoscopy showing the guide wire passing through the colovesical fistula (arrow). (c) Roentgenoscopy showing the endoscope with a mounted OTSC clip (arrow) approaching the fistula.
gr1.jpg
PMC5487297_01_gr1.jpg
fig0005
Cystoscopic examination showed an edematous posterior bladder wall with debris flowing from a fistula in the center (Fig. 1a). A guide wire was inserted through a hole in the bladder into the sigmoid colon (Fig. 1b). The endoscope with an applicator cap attached to its tip and the mounted OTSC clip, was placed into the fistula using the guide wire (Fig. 1c).
(a) Coronal CT images showing a thickened wall of the sigmoid colon adherent to the bladder (arrow), and a suspected colovesical fistula. (b) Abdominal CT showing stomach (arrow) and pancreas (arrowhead) transposed to the right side. (c) Abdominal CT showing the spleen on the right (arrow).
gr2.jpg
PMC5487297_01_gr2.jpg
fig0010
An enhanced CT scan showed air in the bladder and diverticula adherent to it, leading to the suspicion of a fistula (Fig. 2a). The CT scan also revealed transposition of the intra-abdominal organs, viz., the stomach, spleen, and pancreas with the descending colon transferred to the middle of the pelvis (Fig. 2b and c).
(a) Common hepatic artery and left colic artery arising from the superior mesenteric artery. (CA: celiac artery, SA: splenic artery, GA: gastric artery, SMA: superior mesenteric artery, CHA: common hepatic artery, RHA: right hepatic artery, LHA: left hepatic artery, PA: pancreatic artery, LCA: left colic artery, IMA: inferior mesenteric artery, SCA: sigmoid colon artery, SRA: superior rectal artery). (b) Sigmoid artery and superior rectal artery branching from the inferior mesenteric artery (arrow).
gr3.jpg
PMC5487297_01_gr3.jpg
fig0015
Additionally, it also showed the common hepatic artery (CHA), and left colic artery (LCA) arising abnormally from the SMA, and the inferior mesenteric artery (IMA) going to the sigmoid colon and rectum without marginal vessels (Fig. 3a and b).
(a) This is a picture at the time of laparotomy. The sigmoid colon is strongly adherent to the bladder (arrow). (b) Intraoperative findings showing an adhesion and shortening at the dorsal aspect of the descending and sigmoid mesocolon (arrow). Also showing exposure of the bladder fistula (arrowhead).
gr4.jpg
PMC5487297_01_gr4.jpg
fig0020
The descending and sigmoid colon were noted to be fixed to the retroperitoneum by an adhesion of its mesocolon (Fig. 4a and b).
(a) The picture shows a resected specimen. (b) Picture of the cut surface showing acute diverticulitis and fistula.
gr5.jpg
PMC5487297_01_gr5.jpg
fig0025
Histological examination revealed a colovesical fistula with acute inflammation and fibrosis (Fig. 5a and b).