Question

You treat a 70 year old woman for acute diverticulitis who recovers without complications or need for surgery. A subsequent colonoscopy shows an area of sigmoid diverticula with scarring and a mild stricture of the involved area. Biopsies are negative for tumor. She does well at home but returns several months later with sensation of voided air when she urinates. What is the appropriate dx and management?

Answer 1

The woman's symptom of voiding air during urination suggests a colovesical fistula, likely due to her previous diverticulitis and sigmoid stricture. Diagnosis would involve imaging techniques, and management likely requires surgical intervention along with antibiotics and dietary changes.

Step-by-step explanation:

A 70-year-old woman previously treated for acute diverticulitis returns with a symptom of passing air during urination. This symptom suggests the development of a colovesical fistula, which is an abnormal connection between the colon and the bladder due to complications from diverticulitis and sigmoid stricture. The appropriate diagnosis would be "colovesical fistula," which typically requires a combination of diagnostic imaging and potentially surgical intervention for management. Broad-spectrum antibiotics may be used initially, and dietary adjustments are often recommended to help control symptoms until definitive treatment is carried out.

Management of bladder diverticulum typically involves treating the underlying cause, which in this case is the diverticulitis. In addition, bladder training exercises and medications to relax the bladder muscles may be recommended. In severe cases, surgical intervention may be required to remove the diverticulum.