Sudden decline in semen volume due to seminal vesicle fistula in a patient with Crohn's disease: a case report.

CASE REPORT A 34-year-old man with a history of Crohn’s disease was referred to our department in July 2007 complaining of a decrease in ejaculated semen volume and pneumaturia for the past 2 months. He had previously undergone two perineal abscess drainage procedures (Seton’s method) in 2000 and 2007 due to perianal and ischiorectal abscesses arising from Crohn’s disease. His erectile function was normal. Physical examination revealed induration of the tail of the left epididymis. He was afebrile. Testicular size, measured with an orchidometer, was normal bilaterally (14 mL). The prostate could not be examined because of anal stricture and a Penrose drain that was indwelling from the perineum to a perianal abscess. On ejaculation, watery fluid was discharged from the perineal drain. We did not examine whether spermatozoa existed in the fluid discharged from the perineal drain. Semen analysis revealed very low semen volume (0.3 mL and 0.7 mL) and azoospermia. Serum sex hormones levels including follicle-stimulating hormone, luteinizing hormone and testosterone were within normal limits. Cystogram and cystoscopy revealed no abnormalities. Magnetic resonance imaging (MRI) before the second perineal drainage showed bilateral contracted seminal vesicles and a high-inCorresponding Author: