A unique presentation of Colovesical fistula

Why is this man's urine flaky?

“…Enterovesical fistulas have several types, including rectovesical, ileovesical, appendicovesical, and the most common type, colovesical fistula (about 95% of cases) 1. These abnormal connections form between the colon and the bladder, leading to diagnostic challenges due to nonspecific symptoms.…”

“…A fistula can develop from diverticulum rupture, leading to inflammation, abscess formation, and erosion into the bladder. Other causes of colovesical fistulas include malignancy, Crohn disease, pelvic radiation, and pelvic surgery 1,3…”

An unusual cause of small bowel obstruction: Migration of Foley catheter through enterovesicular fistula into the small bowel

“…Fecaluria and pneumaturia, the pathognomonic features of enterovesical fistula, occur in 50%-100% of patients. 5,6 The most utilized and most sensitive imaging modality for diagnosing enterovesical fistulas is computed tomography, which enables visualization of bladder wall thickening, air or contrast in the bladder, or a catheter passing through the fistula, as in our case. Cystoscopy has also been demonstrated to be a reliable diagnostic procedure, allowing for direct visualization of the fistula.…”

“…The most common presentation that leads individuals with enterovesical fistulas to seek medical care is recurrent urinary tract infection, which has been reported in 80% of patients. Fecaluria and pneumaturia, the pathognomonic features of enterovesical fistula, occur in 50%–100% of patients 5,6 …”

Laparoscopic bladder diverticulectomy in a child with situs inversus totalis: A case report and literature review

“…Giant bladder diverticulum oppressing the intestine and inverted bladder diverticulum can cause ileus and abdominal pain (29). The sigmoid diverticulum is the most common cause of colovesical fistula which is a pathological communication between the bladder and the colon that can lead to unremitting intestinal and urinary symptoms, such as fecaluria, pneumaturia, urinary tract infection, dysuria, and frequent urination (30,31). Voiding cystourethrography and imaging urodynamic examination are the "gold standard" for diagnosis (32).…”