ABSTRACT Introduction Colovesical fistula is a recognized complication of diverticulitis, but progression to testicular ischaemia is, to our knowledge, an unreported phenomenon. While colovesical fistulas occur in diverticular disease, the spread of infection to the testes is rare. Case Presentation A 47‐year‐old male with recurrent diverticulitis presented with abdominal pain and was found to have a pelvic abscess. Despite conservative management, the patient developed pneumaturia, dysuria, and right testicular pain. Preoperative scrotal ultrasonography with color Doppler demonstrated globally reduced but present intratesticular arterial flow; a decision was made to prioritize definitive source control of the colovesical fistula with laparoscopic anterior resection and defunctioning ileostomy. Repeat Doppler on Day 7 demonstrated complete absence of arterial flow to the right testis, necessitating orchiectomy for inflammatory necrosis. Conclusion We report what is, to our knowledge, the first documented case. This case highlights the need for vigilance for genitourinary symptoms in diverticulitis. Prompt recognition is vital to prevent irreversible testicular loss.
Joseph et al. (Thu,) studied this question.