Introduction:

Pneumaturia consists of the elimination of air in the urine stream. It is nearly a pathognomonic symptom of a colovesical fistula. However, other differential diagnoses should be considered such as emphysematous cystitis, vesicovaginal fistula, iatrogenic injuries due to urinary catheterisation, or endoscopic or surgical procedures that were made recently.

Case description:

The authors describe a case of a 55-year-old man, with previous diverticular colon disease and repetitive urinary tract infections, who has said that “I have the feeling of air elimination at the end of urinating”. Suspecting pneumaturia, an abdominopelvic TC and a colonoscopy were prescribed which have shown a colovesical fistula as a complication of sigmoid diverticular disease. The patient has undergone laparoscopic anterior resection of the rectum, without complications and with a good recovery.

Comments:

In daily practice, pneumaturia is an unusual symptom and is rarely mentioned in literature. Sometimes it is the first symptom of colovesical fistula, and one should always be suspicious of this rare complication, mainly in patients with previous diverticular disease and repetitive urinary tract infections.

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