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CASE REPORT |
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| Year : 2001 | Volume
: 17
| Issue : 2 | Page : 180-181 |
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Tuberculous ileovesical fistula
RS Parikh, S Singh, N Imdadali, AD Amarapurkar, SG Shenoy
Departments of Surgery, Urology and Pathology, B. Y L. Nair Charitable Hospital, Mumbai, India
Correspondence Address:
R S Parikh
405, Manish Darshan 1, J. B. Nagar P.O., Mumbai
India
 Source of Support: None, Conflict of Interest: None  | Check |
Keywords: Tuberculosis; Ileovesical Fistula
How to cite this article:
Parikh R S, Singh S, Imdadali N, Amarapurkar A D, Shenoy S G. Tuberculous ileovesical fistula. Indian J Urol 2001;17:180-1 |
 Case Report | |  |
A 25-year-old female presented with pneumaturia and faecaluria for 2 months. Urine showed plenty of pus cells and culture revealed Escherichia More Details coli.
Ultrasonography showed ascites and a 4 x 1 cm isoechoic mass near the dome of the urinary bladder. Fluid examination - protein 3.7 gm/dl; total lymphocytes - 1066; adenosine deaminase - 480 IU/ml. At cystoscopy a 2 cm ulcerated lesion at the dome of the bladder was seen. Barium meal showed an ileal stricture with a fistulous communication with the urinary bladder [Figure - 1].
At laparotomy three ileal strictures with the proximal stricture adhered to the bladder dome was seen. A resection anastomosis with closure of the bladder and suprapubic cystostomy was performed. Histology revealed multipie confluent tuberculous granulomas surrounded by rim of lymphocytes in the ileum. No other feature suggestive of Crohn's disease was seen in the resected segment. The fistulous tract was lined by transitional epithelium, and no evidence of tuberculosis in the bladder [Figure - 2]. She received anti-tuberculous treatment and is asymptomatic at 14-months' follow-up.
| Comment | | |
Ileovesical fistula is a relatively uncommon complication of Crohn's disease, appendiceal diverticulitis, Meckel's diverticulum and non-Hodgkin's lymphoma of the terminal ileum. [1],[2] The symptoms of terminal pneumaturia and faecaluria are pathognomic of enterovesical fistula . [3] Though Crohn's disease is commoner in western literature, in India tuberculosis is the major cause of ileal stricture. The fistula is thought to be initiated by transmural tuberculous inflammation of ileal loop with subsequent perforation and extramural suppuration. Exudative ascites, lymphocytic predominance, elevated adenosine deaminase levels and tuberculous granulomas in the ileum confirm tuberculosis as the cause of an ileovesical fistula in our patient. One stage surgery followed by anti-tuberculous therapy resulted in complete recovery in our patient.
| References | | |
| 1. | Kawamura YJ, Sugamata Y. Yoshino K et al. Appendico-ileo-vesical fistula. J Gastroenterol 1998; 33: 868-871.  |
| 2. | Paul AB, Thomas JJ. Enterovesical fistula caused by small bowel lymphoma. Br J Urol 1993: 71: 101-102. |
| 3. | Larsen A, Bjerklund Johansen TE, Solheim BM, Urnes T. Diagnosis and treatment of enterovesical fistula. Eur Urol 1996: 29: 318-321. |
[Figure - 1], [Figure - 2]
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