Colonic Adenocarcinoma in a Congenital Rectourethral Fistula in Association with High Imperforate Anus and Multiple Genitourinary Anomalies

CASE REPORT A 60-year-old black male with a history of high imperforate anus, who had undergone loop transverse colostomy diversion as an infant, presented with severe abdominal pain and distention. The patient denied a history of urinary tract infections and had minimal baseline lower urinary tract symptoms. Radiographic studies demonstrated an “apple core” lesion with distal obstruction at the splenic flexure. The patient subsequently underwent left colectomy, end colostomy and mucous fistula formation. Pathological examination confirmed stage T4 adenocarcinoma of the colon at the splenic flexure. The mucous fistula was created well above the true pelvis with no visualization of the bladder. On postoperative day 1 urine output was minimal via Foley catheter. However, profuse output of urine occurred from the mucous fistula. Computerized tomography revealed right crossed fused renal ectopia, with the left renal unit showing severe hydroureteronephrosis (fig. 1, A). A bladder mass was seen posteriorly near the insertion of the dilated left ureter and a rectovesical fistula was discovered (fig. 1, B). Cystogram confirmed a filling defect with bladder wall irregularity as well as a rectourethral fistula involving the mucous fistula. Cystoscopy demonstrated a large frondose tumor emanating from the left posterior wall of the bladder as well as continuity with the mucous fistula (fig. 2, A). Histopathological examination of the lesion revealed high grade adenocarcinoma of the colon involving the congenital colovesical fistula (fig. 2, B).