A 45-year-old man presented with left epididymoorchitis. Urine cultures grew Escherichia coli, and he was prescribed oral ciprofloxacin. He returned in 2 weeks with right epididymoorchitis that persisted despite another antibiotic course. History suggestive of fecaluria and abdominal pain prompted us to obtain a computed tomography scan of the abdomen, which revealed a colovesical fistula. This presentation is the third reported case of epididymitis as a presentation of colovesical fistula, but first to have epididymoorchitis as the presenting sign.
Colovesical fistulae are most commonly associated with diverticulitis. We present a case of recurrent acute epididymoorchitis resulting from a colovesical fistula.