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CASE REPORT
Year : 2001  |  Volume : 17  |  Issue : 2  |  Page : 180-181
 

Tuberculous ileovesical fistula


Departments of Surgery, Urology and Pathology, B. Y L. Nair Charitable Hospital, Mumbai, India

Correspondence Address:
R S Parikh
405, Manish Darshan 1, J. B. Nagar P.O., Mumbai
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Tuberculosis; Ileovesical Fistula


How to cite this article:
Parikh R S, Singh S, Imdadali N, Amarapurkar A D, Shenoy S G. Tuberculous ileovesical fistula. Indian J Urol 2001;17:180-1

How to cite this URL:
Parikh R S, Singh S, Imdadali N, Amarapurkar A D, Shenoy S G. Tuberculous ileovesical fistula. Indian J Urol [serial online] 2001 [cited 2019 Sep 15];17:180-1. Available from: http://www.indianjurol.com/text.asp?2001/17/2/180/21061



   Case Report Top


A 25-year-old female presented with pneumaturia and faecaluria for 2 months. Urine showed plenty of pus cells and culture revealed  Escherichia More Details coli.

Ultrasonography showed ascites and a 4 x 1 cm isoechoic mass near the dome of the urinary bladder. Fluid examina­tion - protein 3.7 gm/dl; total lymphocytes - 1066; adenosine deaminase - 480 IU/ml. At cystoscopy a 2 cm ulcerated le­sion at the dome of the bladder was seen. Barium meal showed an ileal stricture with a fistulous communication with the urinary bladder [Figure - 1].

At laparotomy three ileal strictures with the proximal stric­ture adhered to the bladder dome was seen. A resection anasto­mosis with closure of the bladder and suprapubic cystostomy was performed. Histology revealed multipie confluent tuber­culous granulomas surrounded by rim of lymphocytes in the ileum. No other feature suggestive of Crohn's disease was seen in the resected segment. The fistulous tract was lined by tran­sitional epithelium, and no evidence of tuberculosis in the blad­der [Figure - 2]. She received anti-tuberculous treatment and is asymptomatic at 14-months' follow-up.


   Comment Top


Ileovesical fistula is a relatively uncommon complication of Crohn's disease, appendiceal diverticulitis, Meckel's diver­ticulum and non-Hodgkin's lymphoma of the terminal ileum. [1],[2] The symptoms of terminal pneumaturia and faecaluria are pathognomic of enterovesical fistula . [3] Though Crohn's dis­ease is commoner in western literature, in India tuberculosis is the major cause of ileal stricture. The fistula is thought to be initiated by transmural tuberculous inflammation of ileal loop with subsequent perforation and extramural suppuration. Exu­dative ascites, lymphocytic predominance, elevated adenos­ine deaminase levels and tuberculous granulomas in the ileum confirm tuberculosis as the cause of an ileovesical fistula in our patient. One stage surgery followed by anti-tuberculous therapy resulted in complete recovery in our patient.

 
   References Top

1.Kawamura YJ, Sugamata Y. Yoshino K et al. Appendico-ileo-vesical fistula. J Gastroenterol 1998; 33: 868-871.  Back to cited text no. 1    
2.Paul AB, Thomas JJ. Enterovesical fistula caused by small bowel lymphoma. Br J Urol 1993: 71: 101-102.  Back to cited text no. 2    
3.Larsen A, Bjerklund Johansen TE, Solheim BM, Urnes T. Diagnosis and treatment of enterovesical fistula. Eur Urol 1996: 29: 318-321.  Back to cited text no. 3    


    Figures

  [Figure - 1], [Figure - 2]



 

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