A case of late-diagnosed colovesical fistula leading to complete colonic obstruction and urethral fecal diversion

BACKGROUND: Colovesical fistula (CVF) typically manifests with pneumaturia or fecaluria and is diagnosed promptly. We present an exceptionally rare and severe manifestation of CVF resulting from a 10-year diagnostic delay, which culminated in extraordinary complications, scarcely documented in contemporary literature. CASE PRESENTATION: A 42-year-old Arab male from Syria was diagnosed with a colovesical fistula (CVF) after 10-year diagnostic delay. This protracted interval resulted in the development of a fistula measuring approximately 5 cm, herniation of the affected sigmoid colon segment into the bladder, complete colonic obstruction, and total diversion of fecal matter via the urethra. Despite the diagnostic delays and associated complications, surgical intervention yielded favorable results, and the patient was discharged in good health. CONCLUSIONS: CVF diagnosis is still challenging. Profound diagnostic delay can result in significant fistula enlargement. Nevertheless, surgical intervention remains the treatment of choice even in cases of delayed presentation and demonstrates favorable outcomes.