Colovesical fistula an unusual complication of cytotoxic therapy in a case of non-Hodgkin's lymphoma

An unusual presentation of non-IBD related colorectal primary extranodal diffuse large B cell lymphoma with a colo-colonic fistula

Diffuse large B cell lymphoma of the sigmoid colon and rectum is relatively uncommon and aggressive. Due to its nonspecific symptomatology, patients are often diagnosed late into the disease and present with life-threatening complications, such as hemorrhage, obstruction, or perforation, requiring emergent surgical intervention. Patients with colorectal lymphoma typically have inflammatory bowel disease or immunosuppression. We present a case of a 79-year-old male with no known inflammatory bowel disease or immunosuppression, who had significant weight loss, diarrhea, and abdominal fullness, found by CT to have irregular wall thickening of the recto-sigmoid colon along with a colo-colonic fistula, concerning for bowel perforation. Endoscopic evaluation and biopsy confirmed the diagnosis of recto-sigmoid Diffuse large B cell lymphoma, with a PET/CT scan revealing stage IV disease. He had a partial response to six cycles of palliative reduced dose R-CHOP and is currently receiving palliative radiation to the sigmoid colon and rectum. Surgery and/or chemoradiation remain the mainstay therapy for this condition. Clinicians, however, must consider patient’s functional, nutritional, and clinical status prior to choosing an optimal therapeutic regimen. This case illustrates a unique clinical presentation of this condition and the associated diagnostic and therapeutic challenges that arise in order to prevent life-threatening complications.

Enterovesical fistula caused by regressive change of non-Hodgkin's lymphoma: A case report

Enterovesical fistula (EVF) is a rare complication of diverticulitis, as well as Crohn's disease, intestinal malignancy, radiotherapy and trauma. EVF formation is associated with inflammation of the involved bowel segments. The current study presents the case of a 35-year-old man with non-Hodgkin's lymphoma who developed pneumaturia, fecaluria and recurrent urinary tract infections following chemotherapy, accompanied by regressive change of the lymphoma. Abdominal computed tomography scans revealed that the terminal ileum had adhered to the bladder wall. The patient underwent exploratory laparotomy and partial resection of the terminal ileum, and EVF was confirmed. Histological examination revealed an inflammatory response but no evidence of residual lymphoma. The diagnosis of EVF is occasionally difficult and requires appropriate radiographic examination. Surgical treatment is recommended.

Bladder paraganglioma: A report of case series and critical review of current literature

Extra-adrenal chromaffin cell-related tumours or paragangliomas are rare, especially in the bladder. In this article, we reported three different clinical cases of bladder paraganglioma, followed by a review of current literature on the pathophysiology and management of bladder paraganglioma. Case 1 involved a 23 years old female patient who complained of a 10-year history of micturition-related headaches, palpitations and diaphoresis; while in case 2, a 58 years old female patient presented with history of painless haematuria and an incidentally diagnosis of a functioning paraganglioma during endoscopic transurethral resection of bladder tumour; and lastly in case 3, a 54 years old male renal transplant recipient was referred to the urology outpatient with a suspicious bladder mass found incidentally on routine transplant workshop.

Enterovesical fistulae: aetiology, imaging, and management

Background and Study Objectives. Enterovesical fistula (EVF) is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: "enterovesical fistula," "colovesical fistula" (CVF), "pelvic fistula", and "urinary fistula". Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.

[Vesicosigmoid fistulas secondary to diverticulitis: helical CT diagnosis]

Colovesical fistulas are the most common type of vesicointestinal fistula and the most prevalent of these are vesicosigmoid fistulas. In our environment, diverticulitis is the most common cause, accounting for approximately one half of all cases. The literature describes different methods for the diagnosis of colovesical fistula, with computed tomography and cystography being the most useful. We describe two cases of vesicosigmoid fistula secondary to diverticulitis diagnosed at our center using helical computed tomography and review the clinical and radiological findings for this entity.