A 79 year old lady who is otherwise well recently started abdominal pain. She is afebrile and complains that she passed air bubbles during urination. A urethral catheter showed fecal leakage in the urinary bag. What is the likely pathology?

The key is B. CD. [D/D is rectosigmoidal tumour. As there is no constitutional features of cancer like anorexia, weight loss, fever rectosigmoid tumour is unlikely. “Crohn’s disease can occur at any age, but is most frequently diagnosed in people ages 15 - 35. About 10% of patients are children under age 18” (http://www.nytimes.com/health/guides/disease/crohns-disease/risk-factors.html). So Crohn’s disease can occur in this age also and the feature like fistula is a common association of CD].