Right hydronephrosis and vesicocolic fistula complicating sigmoid colonic diverticulitis: report of a case

Segmental Colitis Associated With Diverticulosis Causing Hydroureteronephrosis

Segmental colitis associated with diverticulosis (SCAD) is a rare inflammatory condition affecting segments of the colon with diverticular disease. We present an 85-year-old woman with flank pain, fevers, and chills found on imaging to have left colonic wall thickening and left-sided hydroureteronephrosis and workup confirming a diagnosis of SCAD. A detailed review of SCAD and discussion of the differential diagnosis are provided. This case emphasizes disease-specific clinical pearls and highlights hydroureteronephrosis as a rare complication seen in a patient with SCAD.

Obstructive uropathy secondary to sigmoid diverticulitis

From a review of the literature and detailed study of 16 cases, the authors believe that ureteral obstruction in diverticulitis is more common than is apparent from the literature. They suggest that urograms be performed preoperatively in patients destined to undergo intestinal surgery. Management of the intestinal disease need not be altered from that initially planned for treatment of diverticulitis except with the proviso that the retroperitoneum be examined for the presence of a fibrotic inflammatory reaction. If this is found, they suggest that ureterolysis of the involved ureter be performed to allow relief of this obstruction.

The value of routine preoperative urological assessment in patients undergoing elective surgery for diverticular disease or carcinoma of the large bowel

A consecutive series of 176 patients was studied prospectively in order to assess the value of full urological assessment prior to elective colorectal surgery for carcinoma or diverticular disease. Fifty-one patients had urological symptoms and 29 of these had an abnormal intravenous urogram (IVU); when compared with the 125 asymptomatic patients, they were twice as likely to develop acute retention of urine and four times more likely to require prostatectomy. Twenty of the 31 patients with an abdominal mass had an abnormal intravenous urogram, and the presence of this physical sign may be regarded as an absolute indication for IVU. Forty-five patients had a urological abnormality on the preoperative IVU; of these, 1 in 6 required treatment prior to elective large bowel surgery and 1 in 3 developed acute retention of urine postoperatively (half required prostatectomy). Twenty-two patients had a disease-related abnormality on preoperative IVU and in 12 planned urological surgery was undertaken at the time of the colorectal resection. In the 91 patients with no urological symptoms, no abnormal mass and normal blood urea and mid-stream urine sample, the incidence of IVU abnormalities and of postoperative complications was low and surgical management was not altered in these patients.