# Situation: A 63-year-old man has had steady left lower quadrant (LLQ) pain for 2 days, a temperature of 38.2 °C, and a white blood cell (WBC) count of 14,000/mm³ (normal 4,500–11,000/mm³). A computed tomography (CT) scan shows uncomplicated sigmoid diverticulitis. He is admitted for oral antibiotics and observation because he lives alone. Five weeks later at a follow-up visit, he reports that his urine has looked cloudy and that he passes air bubbles at the end of urination. He does not have diabetes. What is the MOST likely cause?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630386  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 63-year-old man has had steady left lower quadrant (LLQ) pain for 2 days, a temperature of 38.2 °C, and a white blood cell (WBC) count of 14,000/mm³ (normal 4,500–11,000/mm³). A computed tomography (CT) scan shows uncomplicated sigmoid diverticulitis. He is admitted for oral antibiotics and observation because he lives alone.

Five weeks later at a follow-up visit, he reports that his urine has looked cloudy and that he passes air bubbles at the end of urination. He does not have diabetes. What is the MOST likely cause?

## 보기

1. A fistula from the sigmoid colon to the bladder **✔ 정답**
2. A fistula from the ileum to the bladder
3. A pericolic abscess pressing on the bladder wall
4. A bladder infection with gas-forming organisms

**정답: 1**

## 해설

Pneumaturia (air in the urine) and cloudy urine after diverticulitis point to a colovesical fistula, in which the inflamed sigmoid colon erodes into the bladder and lets gas and stool enter the urine. It is confirmed by CT and usually needs elective resection.

## 심화 해설

The most likely cause
Five weeks after an attack of sigmoid diverticulitis, he reports cloudy urine and air bubbles at the end of urination, and he does not have diabetes. Pneumaturia (air in the urine) and cloudy urine after diverticulitis point to a colovesical fistula, in which the inflamed sigmoid colon erodes into the bladder and lets gas and stool enter the urine. The diagnosis is confirmed by CT, and the fistula usually needs elective surgical resection.

How the fistula forms
The sigmoid colon lies close to the dome of the bladder. In diverticulitis, inflammation can extend through the colonic wall and form a local abscess or adhesion against the bladder. Over time, this inflammatory process erodes through both walls and creates an abnormal tract. Because the colon contains gas and stool, these pass into the bladder, producing pneumaturia and fecaluria (stool particles, seen as cloudy or debris-filled urine). Recurrent urinary tract infections with mixed bowel organisms are another clue. Colovesical fistula is one of the recognized complications of diverticulitis, alongside abscess, perforation, obstruction, and bleeding. It is more common in men because in women the uterus lies between the sigmoid and the bladder.

Why the other options are less likely
An ileovesical fistula occurs mainly with Crohn's disease, which involves the small bowel; after sigmoid diverticulitis, the sigmoid colon is the source. A pericolic abscess pressing on the bladder may cause frequency or discomfort, but pressure alone does not put gas into the urine; gas requires a direct connection or gas-producing organisms. Gas-forming cystitis (emphysematous cystitis) is rare and occurs mostly in clients with diabetes, which he does not have. In this context, a colovesical fistula is far more likely.

| Finding | Suggests |
| --- | --- |
| Air in urine after diverticulitis | Colovesical fistula |
| Stool or debris in urine | Fecaluria from a bowel-bladder tract |
| Recurrent UTI with bowel organisms | Ongoing contamination through a fistula |

Nursing application
The nurse reports the findings, collects urine specimens as ordered, prepares the client for CT, and explains that elective resection of the diseased sigmoid with repair of the bladder is the usual treatment. The nurse also monitors for urinary infection and teaches the client to report fever or flank pain.

Exam takeaway
Key point Pneumaturia after diverticulitis equals colovesical fistula until proven otherwise. Link the sigmoid to the bladder, and Crohn's disease to the ileum.

## 임상 시나리오

Colovesical Fistula After DiverticulitisWhen air appears in the urine
The sigmoid colon lies beside the bladder. Inflammation from diverticulitis can erode through both walls and create a colovesical fistula, letting gas and stool enter the urine.

Clues are pneumaturia, cloudy urine or fecaluria, and recurrent urinary infections. The fistula is confirmed by CT and usually treated by elective resection.

CautionDo not dismiss air in the urine as simple cystitis in a client without diabetes; report it so the fistula can be confirmed and treated.

## 핵심 개념

- **Colovesical fistula** — An abnormal connection between the colon and the bladder, most often caused by sigmoid diverticulitis.
- **Pneumaturia** — Passage of gas or air bubbles in the urine.
- **Fecaluria** — Passage of stool particles in the urine, causing cloudy or debris-filled urine.
- **Ileovesical fistula** — A connection between the ileum and bladder, seen mainly in Crohn's disease.

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