Case 325

Clinical history

Female, 69-year-old, complains of elimination of gas and stool from the urethral ostium. She was recently hospitalized due to abdominal inflammatory disorder and received intravenous antibiotic therapy for 48 hours with home maintenance until the end of treatment 8 days ago. History of rheumatoid arthritis using etanercept. Computed tomography (CT) scan of the abdomen was performed, showing a colovesical fistula, and surgery was performed to correct the lesion.

Considering the history of the patient and the clinical examination, what is the most likely etiology for the presented picture?

Test Question

(MEDICAL RESIDENCE 2014 - MUNICIPAL HEALTH SECRETARIAT - SP) A 51-year-old man reports pelvic pain 7 days ago, accompanied by vomiting, anorexia and fever. Pain worsens with food. He refers pneumaturia, occurred two days ago. He denies weight loss. Previously healthy, there was no change in bowel habits. He never smoked. BMI = 35 kg / m². He is in regular general condition. Axillary temperature = 37.8 ° C. The abdomen is globose, with painful "mass" in the left iliac fossa. 
Main diagnostic hypothesis:

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