Colovesical fistula following sigmoid resection: A complex postoperative complication assessed by multimodal imaging.

Colovesical fistula (CVF) is an uncommon but clinically significant complication of diverticular disease and colorectal surgery, particularly in the postoperative setting. We report the case of a 49-year-old man who developed pneumaturia and fecaluria following elective sigmoid resection for diverticulitis. Sequential imaging with contrast-enhanced computed tomography (CT) and a water-soluble contrast enema documented the progression from pelvic abscess formation to a well-defined colovesical fistula, with associated extensive soft tissue involvement. Serial CT examinations were crucial for identifying the fistulous tract, evaluating disease evolution, and guiding conservative management. This case highlights the key role of longitudinal multimodal imaging in the diagnosis and management of complex postoperative CVF.