Fecaluria

Specialty: Nephrology and urology.

• deposition of fecal matter in the urine
• urethral fecal debris

Why it occurs

• Colovesical fistula (complication of chronic diverticulitis with contained perforation into the bladder)
• Crohn's disease (transmural inflammation of the terminal ileum or colon that fistulizes into the urinary tract)
• Colon or rectal cancer (invasive neoplasm that perforates the anterior or posterior bladder wall)
• Advanced bladder neoplasia (direct invasion of the adjacent intestinal lumen)
• Previous pelvic radiotherapy (late tissue necrosis that causes complex multipath fistulas)

Initial workup

Abdominopelvic CT scan with fine-cut oral and intravenous contrast; complete colonoscopy with biopsies to differentiate neoplastic pathology from inflammatory bowel disease; cystoscopy to evaluate the bladder impact of the fistula; retrograde cystography in specific cases.

Standard management

• Meropenem — 1 g every 8 hours intravenously in the context of severe sepsis secondary to fecaluria due to multidrug-resistant microorganisms
• Octreotide — 100 mcg every 8 hours subcutaneously to reduce gastrointestinal secretions in complex enterovesical fistulas, under strict criteria of the specialist
• Scheduling colorectal and urological reconstructive surgery with defunctionalization of intestinal transit (colostomy) if required.