|Year : 2000 | Volume
| Issue : 1 | Page : 60-61
Tuberculous ileo-vesical fistula with ileal obstruction
Ajay Kanbur, Arundhati Kanbur, Benazir Quraishi, Khurshid Ahmed
Surgery Division, Burhani Hospital, Anand Koliwada, Thane, India
Shivneri Hospital, Agra Road, Thane - 400 602
Source of Support: None, Conflict of Interest: None
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
| Case Report|| |
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. 
| References|| |
|1.||Vidal Sana J, Pradell Tiegell J et al. Review of 31 vesicointestinal fistula: diagnosis and management. European Urology 1986; 12(l): 21-27. |
[Figure 1], [Figure 2]