Synopsis
Recognise chronic fistulation or fibrotic narrowing after diverticulitis, define involved organs and exclude cancer, then plan elective en-bloc sigmoid resection when continuing symptoms justify surgery.
- Pneumaturia, faecaluria and recurrent mixed enteric urinary infection strongly suggest a colovesical fistula when recent bladder instrumentation is absent.
- Passage of gas or faeces through the vagina, often after hysterectomy, can reveal a colovaginal communication.
- Progressive colic, bloating, reduced stool calibre and constipation suggest a fixed stricture, but cancer must be excluded.
Key red flags
Pneumaturia or faecaluria with fever, hypotension or flank pain indicates enterovesical contamination complicated by urinary sepsis.
Absolute constipation, vomiting and increasing distension suggest complete obstruction at a diverticular or malignant stricture.
Generalised guarding or free intraperitoneal gas indicates perforation and requires emergency rather than interval operative planning.
Investigation priorities
map fistula, inflammation and obstruction.
Management branches
A 69-year-old has pneumaturia, recurrent cultures growing Escherichia coli and Klebsiella, and CT showing thickened sigmoid adherent to a gas-containing bladder. There has been no catheterisation and renal function is stable.
- Treat the current urinary infection according to culture and check for fever, hypotension, hydronephrosis or abscess that would require urgent drainage or decompression.
- Review CT with colorectal and urology teams to map the sigmoid-bladder interface, ureteric proximity and absence of a drainable collection.