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Intravesical colonic pseudotumor.

A 67-year-old male was diagnosed with stage Ta grade 1 to 2 bladder cancer 10 years previously. Following an initial resection he had recurrence at 1 and 4 years postoperatively. Bacillus Calmette-Guerin was administered at each recurrence. At 5 years a small lesion was managed with YAG laser ablation. Eight and 9 years after initial diagnosis additional Ta grade 1 to 2 lesions were resected, and each was managed with bacillus Calmette-Guerin. At 10 years following initial diagnosis the patient had recurrent Pseudomonas and Escherichia coli urinary tract infections, and complained of generalized malaise. Computerized tomography (CT) suggested diverticular disease without evidence of fistula. Cystoscopy revealed well healed scars, a freely refluxing left ureter and erythema in the posterior bladder. Urine cytology was negative. The patient was started on antibiotic prophylaxis and the symptoms improved. Seven months later he reported increased difficulty voiding and hematuria. A 2.5 cm tumor with a fine papillary surface was resected from the posterior bladder wall (fig. 1). Pathological review showed normal colonic epithelium (fig. 2). On postoperative day 1 the patient reported hematochezia. CT demonstrated no evidence of fistula, but again revealed thickening of the sigmoid wall. Cystography showed no extravasation. The patient had no further episodes of hematochezia. On postoperative day 10 he presented with an enterococcal urinary tract infection. He then underwent resection of the sigmoid colon and fistulous tract to the bladder, and omental interposition. Postoperative course was unremarkable with the exception of a superficial wound infection requiring packing. At 15 months postoperatively the patient was asymptomatic and had had no further infections.