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CASE REPORT
Year : 2000  |  Volume : 17  |  Issue : 1  |  Page : 60-61
 

Tuberculous ileo-vesical fistula with ileal obstruction


Surgery Division, Burhani Hospital, Anand Koliwada, Thane, India

Correspondence Address:
Ajay Kanbur
Shivneri Hospital, Agra Road, Thane - 400 602
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Pneumaturia; Ileo-Vesical Fistula


How to cite this article:
Kanbur A, Kanbur A, Quraishi B, Ahmed K. Tuberculous ileo-vesical fistula with ileal obstruction. Indian J Urol 2000;17:60-1

How to cite this URL:
Kanbur A, Kanbur A, Quraishi B, Ahmed K. Tuberculous ileo-vesical fistula with ileal obstruction. Indian J Urol [serial online] 2000 [cited 2019 Oct 19];17:60-1. Available from: http://www.indianjurol.com/text.asp?2000/17/1/60/41023



   Case Report Top


A 29-year-old male presented to our emergency unit with symptoms of small bowel obstruction. He had ileo­caecal tuberculosis with strictures diagnosed 6 months ago. There was history of pneumaturia and passing undigested food particles per urethra, which continued intermittently. Past investigations revealed three soft passable strictures in the terminal ileum but no demonstrable fistulous con­nection between bladder and bowel [Figure 1]. Cystoscopy was normal, IVU showed left UPJ obstruction with calcu­lus in pelvis, with features of cystitis. He received oral Anti-Tuberculosis treatment for 6 months.

Examination revealed all features of small bowel ob­struction. Emergency investigations were as follows: Hb: 10 gm%, TC: 18,000, ESR: 82, Electrolytes: normal. Plain abdomen X-ray showed multiple air fluid levels. Ultra­sound showed dilated bowel loops, left kidney had calcu­lus with UPJ obstruction. Bladder was normal.

Under anesthesia, cystoscopy revealed congestion at dome but no fistulous connection. Exploration revealed ilea] obstruction due to three strictures, all of which were adhered to dome of bladder with a fibrous tract [Figure 2]. Strictures bearing coils and bladder cuff were removed en masse. Ileo-colic anastomosis was performed. During dis­section, rectum was accidentally opened, necessitating sigmoidostomy. Patient had uneventful recovery.

Histology confirmed ilea] tuberculosis with extensive fibrosis and strictures. Fistulous tract connected the ileum to congested bladder mucosa.

3 months later, colostomy was closed and patient is in good health.

Internet Grateful Med search revealed no case of tuber­cular ileo-vesical fistula since 1966. Vidal Sana et al stud­ies confirm a 10% to 30% incidence of actual identification of fistulous tract, as in our case. [1]

 
   References Top

1.Vidal Sana J, Pradell Tiegell J et al. Review of 31 vesicointestinal fistula: diagnosis and management. European Urology 1986; 12(l): 21-27.  Back to cited text no. 1    


    Figures

  [Figure 1], [Figure 2]



 

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