Case Report
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World J Gastroenterol. Nov 7, 2014; 20(41): 15462-15466
Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15462
Acute diarrhea and metabolic acidosis caused by tuberculous vesico-rectal fistula
Xiu-Qing Wei, Yan Zou, Zhi-E Wu, Kodjo-Kunale Abassa, Wei Mao, Jin Tao, Zhuang Kang, Zhuo-Fu Wen, Bin Wu
Xiu-Qing Wei, Zhi-E Wu, Kodjo-Kunale Abassa, Wei Mao, Jin Tao, Zhuo-Fu Wen, Bin Wu, Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Yan Zou, Zhuang Kang, Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Wei XQ and Zou Y contributed equally to this work; Wei XQ, Zou Y, Wu ZE, Abassa KK, Mao W, Tao J, Kang Z, Wen ZF and Wu B analyzed the data and diagnosed and treated the patient; Wei XQ and Wu B wrote the paper.
Supported by National Natural Science Foundation of China, No. 81272640; Guangdong Science and Technology Program, No. 2010B031200008 and No. 2012B031800043
Correspondence to: Bin Wu, MD, PhD, Professor, Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. binwu001@hotmail.com
Telephone: +86-20-85253095 Fax: +86-20-85253336
Received: April 6, 2014
Revised: July 25, 2014
Accepted: September 29, 2014
Published online: November 7, 2014
Processing time: 218 Days and 1.8 Hours
Abstract

Acquired vesico-rectal fistula is an uncommon complication of pelvic malignant tumors, surgical injury, inflammatory disorders such as tuberculosis infection, radiotherapy and less commonly diverticulum of the urinary tract. The fistula is often identified by urinary tract abnormalities such as dysuria, recurrent urinary tract infection, pneumaturia, and fecaluria. Here, we report an unusual case of a patient with a vesico-rectal fistula of tuberculous origin, presenting with severe acute diarrhea, metabolic acidosis, hyperchloremia and hypokalemia while with only mild urinary tract symptoms. The patient was cured by tuberculostatic therapy.

Keywords: Vesico-rectal fistula; Tuberculous; Diarrhea; Acidosis; Hyperchloremia; Hypokalemia

Core tip: A tuberculous vesico-rectal fistula presenting with severe acute diarrhea, metabolic acidosis, hyperchloremia and hypokalemia while with only mild urinary tract symptoms is uncommon. Physicians should bear in mind that diarrhea and acidosis can be caused by vesico-rectal fistula as a rare cause and can be cured by tuberculostatic therapy.