Abstract
A 59-year-old man had been suffering from pain on urination for 4 years. He was admitted to our hospital because of fecaluria and recurrence of cystitis. CT and MRI revealed a mass in the bladder, and colon graphy demonstrated the apple-core sign and multiple diverticula in the sigmoid colon with a fistula to the bladder. A preoperative histological diagnosis could not be obtained through biopsy examination. The operation was performed under the diagnosis of colovesical fistula-related deverticulitis or cancer of the sigmoid colon. Intraoperative findings revealed that the bladder and the sigmoid colon formed a hard lump involving the ureter. We strongly suspected that the mass was an advanced colon cancer, and performed a low anterior resection of the colon with D3 lymph node dissection, total cystectomy, and vesicostomy using the ileum. Pathologically, severe diverticulitis of the sigmoid colon was the cause of the colovesical fistula. Since the operative method of the colovesical fistula depends on the cause and the degree of its inflammation, it is necessary to make a precise diagnose and to select the operative method flexibly.
