Acute diarrhea and metabolic acidosis caused by tuberculous vesico-rectal fistula

Abstract

Acquired vesico-rectal fistula is an uncommon complication of pelvic malignant tumors, surgical injury, inflammatory disorders such as tuberculosis infection, radiotherapy and less commonly diverticulum of the urinary tract. The fistula is often identified by urinary tract abnormalities such as dysuria, recurrent urinary tract infection, pneumaturia, and fecaluria. Here, we report an unusual case of a patient with a vesico-rectal fistula of tuberculous origin, presenting with severe acute diarrhea, metabolic acidosis, hyperchloremia and hypokalemia while with only mild urinary tract symptoms. The patient was cured by tuberculostatic therapy.

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“…Wei et al[ 6 ] have described a case of a patient with CVF, whose symptoms were comparable to those described in our case, i.e ., chronic diarrhea with only mild urinary tract symptoms. However, their patient was a male, and the outstanding feature of our case is that the patient was a female.…”

“…From the literature, it seems that fistulas between the bladder and digestive tract are uncommon and often cause diagnostic troubles. The patients are mostly characterized by recurrent urinary tract infection, dysuria, fecaluria, and pneumaturia and less often by intestinal abnormalities such as diarrhea, melena and hematemesis[ 6 ]. Electrolyte and acid-base disturbances depend on the localization of the pathologic junction.…”