Figure 1
Contrast-enhanced CT, axial
Contrast-enhanced CT, axial: a bubble gas collection in middle line adjacent to the sigmoid colon.
A colourachal fistula: a report of an unusual case
SectionUroradiology & genital male imaging
Case TypeClinical Cases
AuthorsUrbano Sebastian, Carrillo Colmenero Ana Mª , Rojas Vega J L, Ortiz Pegalajar C, Jiménez López Margarita
Connected authors
41 years, male
Clinical History
A 41-year-old male patient presented with a two-day history of infraumbilical pain, associated with constipation, low fever, dysuria and nausea without vomiting. There was no previous abdominal surgery or other significant medical history.
Laboratory investigations showed a C-reactive protein of 1.92 mg/dl and a white blood cell count of 17.3x109/l.
Laboratory investigations showed a C-reactive protein of 1.92 mg/dl and a white blood cell count of 17.3x109/l.
Imaging Findings
Plain radiograph of the abdomen was interpreted as normal. Acute diverticulitis was suspected and abdominal CT examination was performed.
Findings CT: air-fluid collection in urachal remnant and peridiverticular (abscess), sigmoid colon wall and bladder thickening , in continuity with a colonic diverticulum.
Findings consistent with perforated diverticulitis.
After admission and start of antibiotic treatment, percutaneous drainage was performed, (interventional radiology) which produced purulent material.
The outcome was favourable, with good general condition, so he was discharged after ultrasound control (collection 25x20 mm).
Findings CT: air-fluid collection in urachal remnant and peridiverticular (abscess), sigmoid colon wall and bladder thickening , in continuity with a colonic diverticulum.
Findings consistent with perforated diverticulitis.
After admission and start of antibiotic treatment, percutaneous drainage was performed, (interventional radiology) which produced purulent material.
The outcome was favourable, with good general condition, so he was discharged after ultrasound control (collection 25x20 mm).
Discussion
Colonic diverticular disease is a public health problem becoming more prevalent, which increases with age.
In Western populations, a relationship between diverticular disease of the left colon and the lowest fibre intake has been observed.
Diverticula can occur anywhere thoughout the colon but are most common in the sigmoid. They represent small outpouchings of the colonic mucosa and submucosa through the muscular layer of the wall.
The term for inflammation of the diverticula wall is diverticulitis. Acute diverticulitis presents as fever, leukocytosis, abdominal pain, tenderness and constipation.
At CT, diverticulitis appears as segmental wall thickening and hyperaemia with inflammatory changes in the pericolic fat. The key to distinguishing diverticulitis from other inflammatory conditions that affect the colon (e.g. inflammatory bowel disease, ischaemia,..) is the presence of diverticula in the involved segment [1] .
CT also allows detection of other complications of diverticulitis such us diverticulitis abscess, colovesical fistula, stricture and perforation. CT is more sensitive than contrast enema examination. Infrequent complications described in the literature include colouterine fistula, colovaginal [2] and colo-urachal [3-10].
Urachal anomalies are uncommon defects arising either by incomplete obliteration of the urachus during the fetal period or by its reopening after postnatal regression. Five anomalies have been described: congenital patent urachus, urachal cyst, umbilical-urachal sinus, vesico-urachal diverticulum, and alternating sinus.
Differential diagnosis of diverticulitis [1] includes other causes of colonic inflammation (colon cancer, which has similar symptoms, epiploic appendagitis, inflammatory bowel disease, ischaemic colitis, graft versus host disease, infectious colitis, pseudomembranous colitis,...)
Usually medical therapy is sufficient to resolve the inflammation. If complications appear, i.e. perforation, colonic obstruction, abscess or bleeding, surgery can be the optimal approach.
CT can provide guidance for percutaneous drainage, which can eliminate the need for emergency surgery.
In Western populations, a relationship between diverticular disease of the left colon and the lowest fibre intake has been observed.
Diverticula can occur anywhere thoughout the colon but are most common in the sigmoid. They represent small outpouchings of the colonic mucosa and submucosa through the muscular layer of the wall.
The term for inflammation of the diverticula wall is diverticulitis. Acute diverticulitis presents as fever, leukocytosis, abdominal pain, tenderness and constipation.
At CT, diverticulitis appears as segmental wall thickening and hyperaemia with inflammatory changes in the pericolic fat. The key to distinguishing diverticulitis from other inflammatory conditions that affect the colon (e.g. inflammatory bowel disease, ischaemia,..) is the presence of diverticula in the involved segment [1] .
CT also allows detection of other complications of diverticulitis such us diverticulitis abscess, colovesical fistula, stricture and perforation. CT is more sensitive than contrast enema examination. Infrequent complications described in the literature include colouterine fistula, colovaginal [2] and colo-urachal [3-10].
Urachal anomalies are uncommon defects arising either by incomplete obliteration of the urachus during the fetal period or by its reopening after postnatal regression. Five anomalies have been described: congenital patent urachus, urachal cyst, umbilical-urachal sinus, vesico-urachal diverticulum, and alternating sinus.
Differential diagnosis of diverticulitis [1] includes other causes of colonic inflammation (colon cancer, which has similar symptoms, epiploic appendagitis, inflammatory bowel disease, ischaemic colitis, graft versus host disease, infectious colitis, pseudomembranous colitis,...)
Usually medical therapy is sufficient to resolve the inflammation. If complications appear, i.e. perforation, colonic obstruction, abscess or bleeding, surgery can be the optimal approach.
CT can provide guidance for percutaneous drainage, which can eliminate the need for emergency surgery.
Differential Diagnosis List
Colo-urachal fistula
Colon cancer
Epiploic appendangitis
Final Diagnosis
Colo-urachal fistula
References
[1] Horton KM, Corl FM, Fishman EK (2000) CT Evaluation of the Colon: Inflammatory Disease. Radiograhpics Vol.20: 399-418 (PMID: 10715339)
[2] Hjern F, Goldberg SM, Johansson C, Parker SC, Mellgren A. (2007) Management of diverticular fistulae to the female genital tract. Colorectal Dis 9(5):438-42 (PMID: 17504341)
[3] Gargouri MM, Boulma R, Sallemi A, Chlif M, Fitouri Z, Kallel Y, Nouira Y. (2013) A colourachal-cutaneous fistula: a report of an unusual case. Case Rep Urol 865852. doi: 10.1155/2013/865852. Epub 2013 Jan 31 (PMID: 23431494)
[4] Gutiérrez-Ochoa J, Lugo-Rangel M, Garibay-García JB, Velázquez-Macías R. F. , Castellanos-Hernández H. (2013) Colo-urachal-cutaneous fistula in an adult: a case report. Rev Mex Urol 73:77-9
[5] Peters AL, Kruijer MJ, Wiese H, Verbeek PC. (2012) A colo-urachal-cutaneous fistula in an 88-year-old male. Int J Surg Case Rep 3(2):55-8 (PMID: 22288045)
[6] Rebai W, Ksantini R, Abdelhedi C, Chebbi F, Gargouri M, Makni A, Ayadi S, Daghfous A, Fterich F, Bedioui H, Jouini M, Kacem M, Ben Safta Z. (2011) Colo-urachal-cutaneous fistula in an adult. Tunis Med 89(5):476-8 (PMID: 21557187)
[7] Coons BJ, Clark PE, Maynes LJ, Terhune KP, Stokes MC, Beech DJ. (2009) Sigmoid-urachal-cutaneous fistula in an adult male. Urology 73(2):444 (PMID: 18400263)
[8] Rapoport D, Ross A, Goshko V, McAuley I. (2007) Urachal-sigmoid fistula associated with diverticular disease. Can Urol Assoc J 1(1):52-4 (PMID: 18542763)
[9] Gómez Barbadillo J, Plata Rosales J, Espinosa Guzmán E, Castilla Cabezas J, Díaz López C, Soria Alvarez C, Ramos Cejudo F, Gutiérrez Sainz J. (2002) Urachal-sigmoid fistula in an adult male without urachal cyst. Rev Esp Enferm Dig 94(7):430-4 (PMID: 12432840)
[10] Flanagan DA, Mellinger JD. (1998) Urachal-sigmoid fistula in an adult male. Am Surg 64(8):762-3 (PMID: 9697908)
Case information
| URL: | https://www.eurorad.org/case/12533 |
| DOI: | 10.1594/EURORAD/CASE.12533 |
| ISSN: | 1563-4086 |
Figure 2
Contrast-enhanced CT, reformatted sagittal plane
Contrast-enhanced CT, reformatted sagittal plane: Urachal remnant abscessed with affection of bladder dome and sigmoid colon.
Figure 3
Contrast-enhanced CT, reformatted coronal plane
Contrast -nhanced CT, reformatted coronal plane: Thickening of bladder dome and abscess collection between the sigmoid colon and urachal remnant.
Figure 4
Contrast-enhanced CT, axial, portal phase
Contrast enhanced CT, axial, portal phase: Percutaneous abscess drainage guided with CT.
Contrast-enhanced CT, axial
Contrast-enhanced CT, axial: a bubble gas collection in middle line adjacent to the sigmoid colon.
Urbano S. Department of Radiology, CH.Jaén, Spain
Urbano S. Department of Radiology, CH.Jaén, Spain
Contrast-enhanced CT, reformatted sagittal plane
Contrast-enhanced CT, reformatted sagittal plane: Urachal remnant abscessed with affection of bladder dome and sigmoid colon.
Carrillo A, Department of Radiology , CH Jaén, Spain
Carrillo A, Department of Radiology , CH Jaén, Spain
Contrast-enhanced CT, reformatted coronal plane
Contrast -nhanced CT, reformatted coronal plane: Thickening of bladder dome and abscess collection between the sigmoid colon and urachal remnant.
Jimenez M, Department of Radiology CH. Jaén, Spain
Jimenez M, Department of Radiology CH. Jaén, Spain
Contrast-enhanced CT, axial, portal phase
Contrast enhanced CT, axial, portal phase: Percutaneous abscess drainage guided with CT.
Rojas JL, Department of Radiology, CH Jaén, Spain
Rojas JL, Department of Radiology, CH Jaén, Spain