Right-Sided Epididymo-Orchitis as a Presentation of Diverticular Colovesical Fistula

Abstract

A colovesical fistula is a recognized complication of diverticulitis. Although the underlying pathology is usually of colonic origin, the majority of patients present with urological symptoms, classically pneumaturia, and urinary tract infection. Epididymo-orchitis is a rare presentation. It is important to identify elderly males who present with recurrent urosepsis and/or epididymo-orchitis refractory to medical treatment as they may have an underlying benign or malignant etiology. The diagnostic challenge in these cases is to confirm the presence of a fistula, exclude malignancy, and determine the underlying pathology.We present a case of diverticular colovesical fistula in an elderly male who presented with symptoms of epididymo-orchitis on a background of recurrent urinary tract infections. The presence of intravesical gas within the left posterolateral bladder wall and soft tissue thickening continuous with the mid-sigmoid colon was consistent with a colovesical fistula. This patient underwent elective laparoscopic anterior resection and repair of colovesical fistula.

An Overview of Emphysematous Epididymo-Orchitis: A Systematic Review of Case Reports

“…In this context, it is essential to recognize the clinical features and risk factors associated with EEO, and to ensure that patients receive timely and appropriate management. This may involve a combination of antibiotics, surgical drainage, and supportive care [ 6 , 7 ].…”