Sigmoid diverticulitis mimicking a urinary bladder tumor: A rare case report

Abstract

Urothelial cell carcinomas represent the vast majority of urinary bladder tumors. However, many inflammatory and non-neoplastic conditions can mimic a urinary bladder malignancy. In that matter, diverticulitis can progress into colovesical fistula formation with a bladder wall abscess that can mimic a pseudo mass. Nonetheless, the presence of a bladder wall mass, usually requires pathologic examination. We report the case of a 60 year old woman with recurrent urinary infections due to a focal bladder mass revealing a colovesical fistula as a complication of sigmoid diverticulitis.

Fig. 1

Axial CT images (A & B) at the portal phase showing diffuse bladder wall thickening (white arrow) with focal ill-defined mass (yellow arrow) of the left aspect of the dome, protruding into the bladder lumen. This mass is of soft tissue density, with a central low attenuation component and an air-fluid level (white asterisk) and surrounding fat stranding (white arrow head). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Axial (A) and sagittal (B) CT images diffuse circumferential wall thickening (white arrow) of the sigmoid colon with many diverticuli (yellow arrow), along with major paracolic fat stranding (white arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Coronal (A), sagittal (B & C), showing fat stranding with a gas locule in the inflamed tissue between the colon (yellow arrow) and bladder where the intervening fat plane between the bladder dome mass (yellow arrow head) and colon is absent (white arrow). Note the gas in the bladder (white asterisk). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

Axial (A) and sagittal (B) CT images showing no contrast the sigmoid colon at the excretory phase and after the patient was put in a prone position.