Entero-cutaneous-vesical fistula: an unusual presentation.

CASE REPORT A 75-year-old female patient presented with painless haematuria. IVP was normal and at cystoscopy a globular swelling found at the fundus of the bladder was resected. Histology revealed pan-mural inflammation with abundant submucosal oedema. The urothelium showed no evidence of dysplasia or malignancy. Two months later in the out patient clinic a periumbilical fistulous tract opened up spontaneously. On enquiry there was no history of altered bowel habit prior to or after resection of the bladder lesion. CT enema and small bowel series confirmed the presence of a fistula between the ileum, urinary bladder and the skin but the aetiology was not apparent. At laparotomy a transverse colonic mass adherent to a loop of ileum and the fundus of the bladder was found and resected. The bowel continuity was restored after dissecting offthe bladder wall and the bladder closed in two layers. Histology revealed the mass to be a poorly differentiated colonic adenocarcinoma extending throughout the fistulous tract and invading the bladder. The patient developed bronchopneumonia and died on the 10th postoperative day.