Testicular Ischaemia Following Diverticulitis Complicated by Colovesical Fistula: A Case Report

Area of Science:

• Gastroenterology
• Urology
• Surgical Pathology

Background:

• Colovesical fistula is a known complication of diverticulitis.
• Infection spread from the colon to the testes is exceptionally rare.
• This case presents an unreported progression of diverticulitis to testicular ischemia.

Purpose of the Study:

• To report the first documented case of colovesical fistula progression to testicular ischemia.
• To emphasize the importance of recognizing genitourinary symptoms in diverticulitis patients.
• To highlight the need for prompt diagnosis and intervention to prevent testicular necrosis.

Main Methods:

• A 47-year-old male with recurrent diverticulitis and a pelvic abscess was treated conservatively.
• The patient developed urinary and testicular symptoms, prompting scrotal ultrasonography with Doppler.
• Surgical management involved laparoscopic anterior resection and defunctioning ileostomy for the colovesical fistula.

Main Results:

• Initial Doppler showed reduced but present testicular arterial flow.
• Post-surgery, Doppler revealed complete absence of arterial flow to the right testis.
• The patient underwent orchiectomy due to inflammatory necrosis of the testis.

Conclusions:

• This case represents the first documented instance of diverticulitis-associated colovesical fistula leading to testicular ischemia.
• Vigilance for genitourinary symptoms in patients with diverticulitis is essential.
• Early detection and management are critical to avoid permanent testicular damage.