Detection of colovesical fistula in the emergency department: report of a case.

A case of colovesical fistula is described, revealing the pathognomonic findings of terminal pneumaturia and fecaluria. The sensitivity and specificity of various procedures that can be performed in the emergency department for confirmation of the diagnosis are evaluated. Dye studies including methylene blue, the Bourne test, the modified diatrizoate (gastrograffin) test, barium enema and cystography, cystoscopy and colocystoscopic examination, and computed tomography and nuclear medicine scans are discussed as diagnostic modalities. Surgical treatment of colovesical fistula is briefly reviewed. As colovesical fistula are thought to occur in 2% to 22% of patients with known diverticular disease, it is reasonable to question all patients with recurrent urinary tract infection, especially those with known disease of the colon, regarding symptoms of terminal pneumaturia and fecaluria.