A 29-Year-Old Man With Pain When Urinating: Osmosis USMLE Study Question

April 17, 2020

The patient's signs and symptoms should raise suspicion for inflammatory bowel disease, due to its chronic and relapsing character. Physical examination shows extraintestinal manifestations of Crohn disease.

Fistulization between abdominal structures is common in Crohn disease because the inflammation is transmural. As many as 45% of patients with fistulas present before the diagnosis of Crohn disease is made. Enterovesical fistulization is an abnormal connection between the intestine and urinary bladder. It leads to recurrent UTI and gas bubbles in the urine.

In general, pneumaturia is indicative of a colovesical fistula or an emphysematous UTI. Aside from Crohn disease, diverticulosis is another cause of enterovesicular fistula formation.

Major Takeaway: Enterovesical fistulization may occur as a presenting symptom or complication of Crohn disease. It leads to recurrent, polymicrobial urinary tract infections and pneumaturia.

Read more on Crohn disease.


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