Rectovesical Fistula + Hairiest Ballbag Ever!!

Sharon · #1 ● 04-07-2012, 08:35 PM

An 84-year-old man presented with a foreign body hanging from his rectum.

Eleven years earlier, he had undergone a radical prostatectomy for prostate cancer.

One week before presentation, he underwent incision and dilation of a urethral stricture, at which time a Foley catheter was placed. He reported no history of chronic urinary tract infections or pneumaturia but did report recent suprapubic pain. There was no contamination of the Foley bag with blood or stool. The patient was having a bowel movement when he noted passage of the foreign body.

Physical examination revealed a Foley catheter balloon prolapsing out of the patient's rectum and the presence of a rectovesical fistula. There was no evidence of hemorrhage or infection.

The patient underwent surgical extraction of the catheter. During the surgery, a small defect in the posterior bladder wall and a corresponding rectal perforation were found and repaired. At follow-up 2 weeks later, the patient was doing well, with no evidence of formation of another fistula.

The most common source of rectovesical fistulas is adherence of abnormal bowel to the bladder. Typical causes include diverticulitis, inflammatory bowel disease, and gastrointestinal neoplasm. Fistulas may also occur after trauma, radiation therapy, or pelvic surgery, particularly after prostatectomy.