Abstract
A 92-year-old woman was admitted to our hospital because of consciousness disturbance. Her conscious levels were III-300 and E1V1M1, according to the Japan Coma Scale and Glasgow Coma Scale, respectively. A blood test revealed a slightly increased level of inflammatory markers and markedly increased BUN and NH3 levels. Her urine was dark brown and had precipitates and a fecal smell. Bacteriological culture of her urine showed Escherichia coli and Bacteroides fragilis. Electroencephalography showed slow waves with triphasic-like waves. Abdominal ultrasonography (US) showed localized mural thickening of the cystic bladder and linear or pointlike hyperechoic foci in the urinary bladder, suggesting the presence of air and a vesicointestinal fistula. Computed tomography using contrast medium injected through the urethra revealed saccular bulging of the bladder and leakage into the small intestine, indicating a vesicointestinal fistula. Her consciousness disturbance was considered to be caused by hyperammonemia due to the vesicointestinal fistula. Although vesicointestinal fistula is a rare disease leading to consciousness disturbance, US helps in the diagnosis of suspected cases.
