Dados do Trabalho

Título

URETERO-COLONIC FISTULA, AS A LATE COMPLICATION OF RECURRENT DIVERTICULITIS.

Descrição sucinta do(s) objetivo(s)

This article is aimed at describing a patient having uretero-colonic fistula, in the clinical context of recurrent diverticulitis.

História clínica

A 58-year-old male having a remote medical history of right lower cuadrant pain (LRQ), coming to Physician’s Office several times claiming urinary tract infection which was treated with empirical antibiotic therapy.
An echography study was carried out, which revealed a hypotrophic right kidney, heterogeneous bladder contents and pneumaturia. The laboratory results showed faecal traces in the simple urine.
Abdominal and pelvis computed tomography (CT) shows a hypotrophic right kidney with a dilated ureter and the presence of faecal contents inside it, revealing a fistulous junction between the sigmoid colon and the ureter.
Colonic diverticulosis may be seen, predominantly in the sigmoid colon.
Uretero-colonic fistula was diagnosed as a result of previous, untreated complicated acute diverticulitis.

Discussão e diagnóstico

Diverticular disease has increased, as a result of changes in the diet habits. Diverticulitis consists of a parietal inflammatory process that can be limited from subclinical local inflammation to peritonitis with perforation. Most patients experience left lower cuadrant pain, fever and leucocytosis often occur, but they are non-specific.
Complications may include abscesses, extra-luminal air, fistulas, obstructions and, less frequently, pylephlebitis.
CT has proven to be the most effective method for the diagnosis of acute diverticulitis and its complications.
Complicated diverticular disease is more common in older men in the seventh decade of life, presenting a long medical history of long-standing, silent disease. Urinary gas elimination should not be treated as a urinary tract infection caused by gas-producing germs but should motivate the search for fistulas.
In our case, the suspected diagnosis was confirmed by performing a CT scan. However, colon enema and/or retrograde ureteroscopy could also be indicated to identify the fistula.

Conclusões

The diverticular fistula is a rare pathological condition that affects more males in their seventh decade and often develops silently. The method of choice is CT scan and in selected cases colon enema and retrograde ureteroscopy.

Palavras Chave

DIVERTICULITIS; URETERO-COLONIC FISTULA

Arquivos