A 51-year-old male smoker presented with fecal discharge from the urethra for 2 years and lower abdominal pain. Examinations and tests revealed a large polypoidal growth in the sigmoid colon with diverticula, forming a colovesical fistula. A biopsy of the growth showed colonic mucosal fragments with inflammation but no dysplasia or malignancy. A retrograde urethrogram also showed strictural narrowing of the posterior urethra with no contrast flow into the bladder, indicating a colovesical fistula.

1. MULTIDISCIPLINARY TEAM
MEETING
SURGICAL UNIT -1
JINNAH HOSPITAL LAHORE
DATED : 17/01/23

2. CASE SUMMARY
• Patient Rafique 51 Y/M ,tailor by profession, non diabetic non
hypertensive ,smoker presented in OPD with c/o
Fecal discharge per urethra- 2 years
Lower abdominal pain - 2 years
• O/E
Mild tenderness in left iliac fossa ,no mass palpable, no
lymphadenopathy appreciable ,
• DRE : normal anal tone with normal prostate examination,
proctoscopy internal opening at 12 o clock position ,

3. • Primary internal hemorrhoid at 3 o clock position
• Past Surgical : no previous hx of abdominal surgery
• Past Medical : Smoker , hypertensive

4. USG KUB (05/10/22)
• Ultrasound abdomen showed right renal calculi , Vesical calculi and
cholelithiasis.Urinary bladder showed thick calcific specs.no
lymphadenopathy noted

5. CT ABDOMEN PELVIS( 01/12/22)
• Circumferential enhancing thickening of sigmoid colon with multiple
diverticula and colovesical fistula suggestive of acute sigmoid
diverticulitis.Fat planes between the lesion and bladder not preserved
with thickening of the bladder measuring 6.6mm. There is adjacent
fat stranding and subcentimetric lymphadenopathy. Left paraaortic
and left common iliac nodes appreciated.

7. COLONOSCOPY (13/12/22)
• Large polypoidal growth 13cm from anal verge involving three fourth
of the circumference of gut . Multiple diverticular openings below the
growth identified . Biopsy of growth taken.

8. BIOPSY REPORT (23/12/22)
• Colonic mucosal fragments with architectural distortion of glands and
mild to moderate acute and chronic inflammation .no dysplasia or
malignancy noted .

9. RETROGRADE URETHROGRAM
• Strictural narrowing of posterior urethra and proximal bulbar urethra
with no flow of contrast seen into the urinary bladder.