Atypical Presentation of an Enterovesical Fistula in a Nonverbal Patient With Recurrent Seizures and Diarrhea: A Case Report

TL;DR

A nonverbal patient with autism and a history of a corrected enterovesical fistula (EVF) experienced a recurrence, leading to seizures and diarrhea, highlighting the need for early diagnosis in atypical cases.

Contribution

This case report highlights the atypical presentation of EVF recurrence in a nonverbal patient with nonspecific symptoms.

Findings

Computed tomography confirmed recurrence of an enterovesical fistula at the upper bladder.

Electrolyte disturbances from the fistula exacerbated the patient's seizure activity.

The case emphasizes the importance of clinical suspicion and timely imaging in nonverbal patients with nonspecific symptoms.

Abstract

Enterovesical fistula (EVF) is a rare condition that typically presents with classical symptoms such as pneumaturia, fecaluria, or recurrent urinary tract infections (UTIs). However, diagnosis may be significantly delayed in nonverbal patients or those presenting with atypical symptoms. We report a case of a 27-year-old nonverbal female with autism and developmental delay, who presented to the ICU with recurrent seizures, profuse diarrhea, and profound electrolyte disturbances.

Her past medical history included recurrent UTIs with Klebsiella pneumoniae and Escherichia coli, as well as a seizure disorder. She also had a history of cauda equina syndrome that required neurosurgical intervention, resulting in a neurogenic bladder, and was later diagnosed with an EVF, which was surgically corrected one year prior. However, during this ICU admission, she was found to have a recurrence of the fistula. Computed tomography (CT) urography confirmed the diagnosis, revealing an EVF at the upper bladder, along with contrast-enhanced colonic air-fluid levels and reflux into the right ureter. The recurrence contributed to significant electrolyte derangements, including hypokalemia and hypocalcemia, which exacerbated her seizure activity.

This case underscores the importance of maintaining a high index of suspicion for EVF in nonverbal patients, especially when presenting with nonspecific symptoms such as seizures and diarrhea. Heightened clinical vigilance and timely imaging are essential for accurate diagnosis and effective management, helping to prevent serious complications and guide timely surgical intervention when needed.

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