Introduction
Pseudotumors of the bladder are uncommon and sometimes misdiagnosed as real tumor. We reported such a case caused by diverticulitis of the sigmoid colon without fistula which was suspected a colon or bladder cancer even after computed tomography and cystoscopy.
Case Report
Fifty-seven years old man patient was admitted to our clinic with suprapubic tenderness and dysuria. Urinary ultrasonography showed the lesion that extending to the bladder lumen from the left wall. Urinary cytology was negative. Cystoscopy detected a tumor with smooth surface at the same localization. CT showed 40x14 mm size solid contrast enhancing mass which is containing air density on the bladder left lateral wall (Figure 1). Colonoscopy demonstrated multiple diverticula orifices with inflamatory change on the mucosa. Exploration was planned to confirm primer disease. We observed at the level of the inferior segment of the sigmoid colon strongly adherent to urinary bladder. After we subsequently performed partial cystectomy, partial colectomy and colostomy (Figure 2). Pathological examination revealed no malignancy. It’s reported as chronic in?ammation in the suburothelial connective tissue and localised peritonitis due to perforation of diverticulum of sigmoid colon. Follow-up with CT scan 6 months postoperatively was normal and showed no evidence of recurrence.
Discussion
In?ammatory pseudotumor (IPT) of the genitourinary tract is a rare lesion (1) and first described by Roth (2) in 1980 in a female patient presenting with recurrent cystitis. Radiological imaging usually detect a bladder mass without metastasis (3,4). The etiology of this disease is not known. Lopez-Beltran et al. (5) have asserted that inflammatory pseudotumor is induced by proliferative cystitis because most reported cases showed non-neoplastic proliferation of fibroblasts/myofibroblasts on a background of proliferating vessels. Interestingly, a diverticulum of the sigmoid colon was found in the middle of the pseudotumor in our case. In most cases, inflammatory pseudotumors are caused by chronic infection and/or inflammation of the bladder (3). In our case, probably that chronic inflammation due to perforation of the diverticulum might have induced the inflammatory pseudotumor of the bladder. Hematuria is the most common presenting complaint, although dysuria, frequency, and suprapubic pain have also been reported (6). Although IPT is benign nature tumor, treatment is very important. Possible pathologies must be revealed before treatment because of proximity with sigmoid colon. Otherwise possible complications such as fistula may lead to sepsis. Transurethral resection or partial cystectomy has been reported as the treatment of choice. However, we suggest that transuretral resection should not be performed because of sepsis complication due to sigmoid colon fistula. In these cases we suggest that partial cystectomy is as optimal treatment with minimal morbidity. Complete local resection is sufficient for recurrence-free disease. Therefore should be avoided radical cystectomy IPT of urinary bladder due to diverticulitis of the sigmoid colon has been reported in the literature. It’s thought recurrent inflammatory reaction stimulates undifferentiated stromal cells into forming granuloma. It’s very difficult to discriminate between a true neoplasm and a postinflammatory pseudotumor. Open surgery should be performed instead of transurethral surgery because of complications in the treatment of inflammatory pseudotumor. Informed Consent: Consent form was filled out by all participants, Concept: Tarik Yonguç, Burak Arslan, Design: Tarik Yonguç, Ibrahim Halil Bozkurt, Salih Polat, Burak Arslan, Data Collection or Processing: Salih Polat, Serkan, Yarimoglu, Analysis or Interpretation: Tarik Yonguç, Süleyman Minareci, Literature Search: Salih Polat, Serkan Yarimoglu, Writing: Tarik Yonguç, Salih Polat, Süleyman Minareci, Peer-review: Internal peer-reviewed, Conflict of Interest: No conflict of interest was declared by the authors, Financial Disclosure: The authors declared that this study has received no financial support.
