Sigmoid colon ureteral fistula presenting with urosepsis

Abstract

_______________________________________________________________________________This 72-year-old white male presented in the emergency room with symptoms of urosepsis. He had been sick for about ten days, reporting increasing malaise, temperature elevation, left flank pain, and "foul-smelling" urine. He had three prior episodes of left lower quadrant pain associated with diarrhea; which his physician had diagnosed as diverticulitis and treated with antibiotics and dietary restrictions.At admission, vital signs of the cachectic patient were recorded as BP 160/78, pulse rate 92, respiration 22, and temperature of 38.4 Celsius. Physical exam demonstrated the lungs clear to auscultation and percussion; tenderness to percussion in the left back, and rebound tenderness in the left lower abdominal quadrant. Laboratory data were: RBC 3.8, Hb 9.4, HCT 36, WBC 24,000, BUN 28, Creatinine 2.6; K 4.2, and Na & Cl within normal limits. Urinanalysis and cytology demonstrated a murky appearance, specific gravity of 1.024, cellular debris, WBC 120/hpf, RBC 80/hpf, gram negative bacteria, and vegetable fibers. An admission chest radiograph was negative.A three-phase contrast-enhanced CT (with intravenous contrast medium reduced to 60 mL, because of elevated creatinine) was performed with both coronal and sagittal reconstructions. An axial slice showed a hugely dilated left ureter with an air fluid level (Figure-1). A coronal reconstruction ( the area of interest enlarged to156%) demonstrates gas in the fistula to the thickwalled segment of the sigmoid colon as well as at the level of the UPJ (Figure-2). Diverticula are shown in the third portion of the sigmoid colon.

A rare cause of urosepsis – answers

“…Colo-ureteric fistulas are extremely rare, but may occur as a result of obstructing renal stones, diverticulitis, malignancies, inflammatory bowel disease, extra-corporeal shock wave lithotripsy or abdominal surgery. 3 Contamination of the urinary system causes the usual presenting symptoms including recurrent urinary sepsis, pneumaturia, faecaluria or flank pain. 4 Treatment depends on aetiology, plus function of the affected kidney following decompression and resolution of sepsis, and often includes radical surgery.…”