A 62-year-old male complains of intermittent left lower quadrant pain and alternating bowel habits. He also reports passing air and occasionally fecal material from the urethra. What could be the diagnosis and what steps should be taken next?
This patient's symptoms suggest the possibility of a colovesical fistula, which is an abnormal connection between the colon and the bladder, most commonly caused by diverticulitis. To confirm the diagnosis, CT scan with oral and IV contrast or CT colonography could be used. The treatment typically requires surgical intervention to resect the fistula.