Emergency orchidectomy: a rare complication of diverticular colovesical fistula

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.