# Emergency orchidectomy: a rare complication of diverticular colovesical fistula

## TL;DR

A rare case of emergency orchidectomy was needed due to a colovesical fistula causing recurring epididymo-orchitis.

## Contribution

This is the first documented case linking emergency orchidectomy to a colovesical fistula.

## Key findings

- Emergency orchidectomy was performed due to intratesticular necrosis and abscess from an undiagnosed colovesical fistula.
- Laparoscopic high anterior resection with trans anal specimen extraction successfully treated the fistula.
- Delayed diagnosis of diverticular disease can lead to severe complications like testicular loss and sepsis.

## Abstract

Acute epididymo-orchitis (AEO) is an uncommon complication of colovesical fistula (CVF). We present the first documented case of a patient requiring emergency orchidectomy for recurrent AEO, complicated by intratesticular necrosis and a scrotal wall abscess, secondary to an undiagnosed diverticular CVF. Definitive management involved a laparoscopic high anterior resection, employing trans anal natural orifice specimen extraction, to cure the fistula. This case underscores the importance of maintaining a high index of suspicion for rare anatomical abnormalities such as CVF in patients presenting with recurrent bacterial AEO, across specialties for both the urologist and colorectal surgeon. Early and thorough investigation is crucial to avoid the severe complications of untreated diverticular disease—particularly in individuals with significant intra-abdominal adiposity, where classic signs of peritoneal inflammation may be absent. Delayed diagnosis can lead to serious outcomes, including testicular loss and life-threatening sepsis.