Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.538
Peer-review started: July 4, 2018
First decision: August 20, 2018
Revised: September 13, 2018
Accepted: October 10, 2018
Article in press: October 10, 2018
Published online: October 26, 2018
Processing time: 114 Days and 23.8 Hours
Misinterpretation of diarrhea in a female patient with a colovesical fistula (CVF) due to an advanced colon cancer.
Acute diarrhea, recurring fever, abdominal cramps, nausea and a lack of appetite.
Infectious diarrhea.
Hypokalemia, hypoalbuminemia, leukocytosis with a predominance of granulocytes and elevated C-reactive protein. Bacteriuria and leukocyturia in urinalysis.
A computed tomography scan revealed a heterogeneous tumor, enlarged lymph nodes in the pelvis and metastases in the liver and peritoneum. Cystography showed a CVF.
G3 poorly differentiated colorectal adenocarcinoma.
An urgent colostomy conducted because of a bowel obstruction.
Wei et al have described a case of a male patient with CVF, whose symptoms were comparable to those described in our case. However, to our limited knowledge, this is the first case report describing CVF in a female.
CVF is a pathologic junction between the bladder and colon. Approximately 20%-30% of CVFs develop as complications of advanced tumors of the abdominal or pelvic cavity.
Diarrhea may be a misleading symptom of CVF. A basic test such as urinalysis should never be neglected. In our case, repeated urinalysis may have been very informative. Patients with diarrhea of unknown reason should be catheterized to control the renal loss of fluids and the quality of urine.
