Hegde AV, Gupta S, Mohan LN, Rozario A. Unforeseen consequence of colovesical fistula in diverticulitis presenting as septic cellulitis: A case report. World J Methodol 2026; 16(2): 111784 [DOI: 10.5662/wjm.v16.i2.111784]
Corresponding Author of This Article
Sajal Gupta, Department of Urology and Renal Transplantation, Father Muller Medical College, Kankanady, Mangalore 575002, Karnātaka, India. sajal.dare@gmail.com
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Urology & Nephrology
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Case Report
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Jun 20, 2026 (publication date) through Apr 23, 2026
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World Journal of Methodology
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Hegde AV, Gupta S, Mohan LN, Rozario A. Unforeseen consequence of colovesical fistula in diverticulitis presenting as septic cellulitis: A case report. World J Methodol 2026; 16(2): 111784 [DOI: 10.5662/wjm.v16.i2.111784]
World J Methodol. Jun 20, 2026; 16(2): 111784 Published online Jun 20, 2026. doi: 10.5662/wjm.v16.i2.111784
Unforeseen consequence of colovesical fistula in diverticulitis presenting as septic cellulitis: A case report
Abheesh Varma Hegde, Sajal Gupta, L N Mohan, Anthony Rozario
Abheesh Varma Hegde, Sajal Gupta, Department of Urology and Renal Transplantation, Father Muller Medical College, Mangalore 575002, Karnātaka, India
L N Mohan, Department of General Surgery, Vydehi Medical College, Bangalore 560034, Karnātaka, India
Anthony Rozario, Department of General Surgery, St. John’s Medical College Hospital, Bangalore 560034, Karnātaka, India
Author contributions: Hegde AV, Gupta S, Mohan LN, and Rozario A contributed to case diagnosis, surgery, data collection, and manuscript drafting; Gupta S conceptualized the case report and supervised manuscript revisions. All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Sajal Gupta, Department of Urology and Renal Transplantation, Father Muller Medical College, Kankanady, Mangalore 575002, Karnātaka, India. sajal.dare@gmail.com
Received: July 9, 2025 Revised: August 5, 2025 Accepted: December 10, 2025 Published online: June 20, 2026 Processing time: 288 Days and 16.5 Hours
Abstract
BACKGROUND
Colovesical fistula (CVF) is an uncommon but serious complication most often linked to diverticular disease of the colon. Its diagnosis can be at times challenging as the symptoms are nonspecific, and timely intervention is crucial to avoid morbidity.
CASE SUMMARY
A 65-year-old Indian male was admitted with right lower limb cellulitis and was in septic shock. Despite initial management, he remained oliguric with persistent loose stools. On post-fasciotomy day 4, fecaluria was noted, prompting suspicion of a bowel-urinary tract fistula. Microscopic urine examination confirmed fecal matter. A computed tomography urogram with cystogram revealed a CVF at the sigmoid colon, likely secondary to diverticulitis. Baseline carcinoembryonic antigen levels were normal. An exploratory laparotomy was performed, which revealed dense adhesions between the sigmoid colon and bladder were noted, and the findings were consistent with diverticulitis though no discrete diverticulum was separately visualized. The fistulous tract was excised (frozen section was negative for malignancy), a two-layer bladder repair was performed, and the affected sigmoid colon segment was resected using a Hartmann’s procedure. Multiple bladder washes were also done. Postoperatively, the patient recovered well, with resolution of oliguria and diarrhea. He was discharged on postoperative day 8. Histopathology confirmed diverticulitis without malignancy. A successful stoma reversal occurred 2 months later, and he remained symptom-free at the 6-month follow-up.
CONCLUSION
CVF should be considered in cases of persistent urinary symptoms or fecaluria, particularly in patients with risk factors such as older age and diverticular disease, even in regions with low incidence of colonic diverticula. Early diagnosis using imaging modalities and prompt surgical management are key to favorable outcomes.
Core Tip: This report highlights a rare presentation of colovesical fistula (CVF) secondary to sigmoid diverticulitis, presenting as lower limb cellulitis with septic shock. Early suspicion, fecaluria recognition, and prompt imaging confirmed CVF. Laparotomy with bladder repair and Hartmann’s procedure ensured a favorable recovery. Clinicians should consider CVF in atypical presentations of sepsis, especially in elderly patients. This case emphasizes the significance of timely diagnosis and surgical planning in managing CVF.
