The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Epididymo-orchitis Secondary to Colovesical Fistula 

Andrew Waack1*, Meghana Ranabothu, M21, Neha J Patel, MD1 
1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 

*Corresponding author: Andrew.waack@rockets.utoledo.edu

Published: 05 May 2023 

Introduction: Acute epididymo-orchitis is a common cause of scrotal pain in adults. It is most often 
caused by a retrograde spread of cystitis into the epididymis and testicles via the vas deferens. 
Epididymo-orchitis is most often seen in older patients with prostate hypertrophy with increased post 
residual urine volume. In younger patients it may result as a consequence of sexual practices. We present 
a unique case of epididymo-orchitis secondary to colovesical fistula caused by chronic diverticulitis.   

Case Report: A middle aged male presented with subacute left testicular pain, back pain, and 
pneumaturia. Pertinent medical history included type II diabetes, obesity and multiple prior incidences 
of diverticulitis. Physical exam revealed a soft abdomen without tenderness, normal bowel sounds, and 
left scrotal swelling. CBC demonstrated neutrophilia with left shift. Urinalysis was urine nitrite positive, 
urine esterase 1+, WBC too numerous to count, and urine bacteria many. Urine culture was greater than 
100,00 col/mL E.coli. CT abdomen and pelvis demonstrated sigmoid diverticulitis, left sided bladder 
wall thickening, urinary bladder gas and a colovesical fistula. Scrotal US findings were consistent with 
epididymo-orchitis. Cystoscopy confirmed the presence of the fistula.The patient was admitted and 
underwent a two week course of augmentin, which resulted in pain and swelling resolution. The patient 
underwent robotic assisted sigmoidectomy and takedown of the colovesical fistula. The patient was 
subsequently discharged and was doing well at one month's follow up.   

Conclusion: We present a unique case of epididymo-orchitis and its medical and surgical management. 

https://dx.doi.org/10.46570/utjms.vol11-2023-679 

https://dx.doi.org/10.46570/utjms.vol11-2023-679
mailto:Andrew.waack@rockets.utoledo.edu