We report here a rare case of urethral
fistula and scrotal
abscess associated with
colovesical fistula due to
sigmoid colon cancer. An 84-year-old male was referred to our hospital complaining of macrohematuria, fecaluria, pneumaturia and micturitional
pain. Computed tomography (CT) showed
colovesical fistula. Other examinations, including colonoscopy and cystoscopy, did not reveal a clear cause for the
colovesical fistula. Only an elevated serum level of the
tumor marker CA19-9 suggested the possibility of
sigmoid colon cancer. Eleven days after hospitalization, bilateral scrotal contents had swollen rapidly to the size of a goose egg. CT suggested urethral
fistula with scrotal
abscess formation. Drainage of scrotal
abscess and
colostomy were performed. Intraoperatively, the
fistula of the bulbar urethra was revealed. Because increased serum CA19-9 suggested a diagnosis of
sigmoid colon cancer,
cystectomy and sigmoid
colectomy with right
nephrectomy were performed. Pathological examination revealed
adenocarcinoma of sigmoid colon with bladder invasion. His condition was improved with rehabilitation 6 months after operation.