the incidence of vesicoenteric fistulas has been reported to occur in 0.01% to 0.05% of surgical admissions1 ) . in one study of 56 instances of vesicoenteric fistulas , hepatocellular carcinomas ( hccs ) account for 90% of primary liver cancers ; up to 80% of hccs occur in korea occur in patients with cirrhotic livers . according to our literature review , several malignancies have been reported as causes of ileovesical fistula , though such complications have not yet been reported to be caused by hcc . here , we report a case of ileovesical fistula caused by hcc arising from the noncirrhotic liver . a 27-year - old man was referred to our hospital for the evaluation of hepatic masses . he had consumed 30.0 g alcohol twice weekly for 8 years . on presentation , his vital signs were stable and the physical examination was normal . viral marker study showed that hbs antigen was negative , anti - hbs antibody positive , and anti - hcv negative . -fetoprotein ( fp ) was over 50,000 iu / ml and carcinoembryonic antigen ( cea ) was 4.94 ng / ml . abdominal computed tomography ( ct ) with enhancement revealed two heterogeneous hypodense masses in the right hepatic lobe of about 2.4  2 cm and 3.4  4 cm . no cirrhotic change was observed in the liver . liver magnetic resonance imaging ( mri ) revealed two relatively well - defined masses in the right hepatic lobe ( figure 1 ) . these lesions were homogeneous low signal intensity on t1-weighted image and slightly inhomogeneous high signal change on t2-weighted image . immunohistochemical stains were positive for cytokeratin ( ck ) , epithelial membrane antigen ( ema ) , fp , and hepatocyte - specific antigen ( hsa ) . however , evidence of cirrhosis and chronic injury were absent . under the diagnosis of hcc , two months later , follow - up ct scan showed a newly developed mass in the caudate lobe about 4.5  4.0 cm in size , with several daughter nodules . follow - up ct scan after 3 weeks showed defective lipiodol uptake masses in both the right hepatic lobe and the caudate lobe with remnant tumoral enhancement . several days later , the patient complained of dysuria , fecaluria , and intermittent lower abdominal pain . pelvic ct scan showed a lobulated soft tissue mass about 6 cm in size ( figure 3 ) . barium study of the small bowel showed a fistula between the small bowel loop and the urinary bladder ( figure 4 ) . there were soft tissue masses between the ileum and the bladder and multiple lymphadenopathies at the mesenteric root . adhesion and fistula were found between the ileum at 10 cm proximal to the ileocecal valve and the dome of the bladder . the distal 65 cm of ileum was segmentally resected and anastomosed end - to - end . several malignancies have been reported to be causes of ileovesical fistula . according to our literature review , these include bladder cancer , lymphoid malignancies , and others1 , 3 - 5 ) . although other various malignancies themselves were not direct causes of ileovesical fistula , radiation enteritis complicated by radiation therapy could also cause the ileovesical fistula6 ) . in korea , about 80% of hccs occur in patients with cirrhotic livers . in our case , hcc occurred in the noncirrhotic liver , and the cause remains uncertain . in one study of 403 patients with hcc , 148 patients ( 37% ) with extrahepatic metastases were identified . the lung , abdominal lymph nodes , and bone are the most common sites of extrahepatic metastatic hcc . peritoneal metastases were illustrated at ct scan in 16 ( 11% ) of 148 patients with extrahepatic metastatic hcc7 ) . ho et al . reported that 3% of patients with hccs in noncirrhotic liver involved the peritoneum8 ) . fecaluria , abdominal pain , and pneumaturia were the most common presenting symptoms of vesicoenteric fistulas . other symptoms were dysuria , gross hematuria , fever and chills , diarrhea , and urine per rectum . the diagnosis of vesicoenteric fistula can be highly indicated by the above mentioned symptoms , using various diagnostic tests to establish diagnosis . in our particular case , cystoscopic and cystographic examinations showed inflammatory mucosal changes on the dome of the urinary bladder , but could not detect a fistula . cystoscopy revealed either the fistula itself or highly suggestive , localized mucosal abnormalities ( " herald lesions " ) in 86% . ct scan revealed abnormalities , such as pelvic masses or bladder or intestinal wall thickening ( 87% ) , and revealed a fistula ( 24% ) . it should be possible to establish the diagnosis of a vesicoenteric fistula through a combination of cystoscopy , cystography , and barium study in almost all patients . other diagnostic tests for vesicoenteric fistulas include sigmoidoscopy or colonoscopy , intravenous urography , radioisotope studies , and so on . forms of treatment for vesicoenteric fistula include diverting enterostomy , single stage repair , and multi - staged repair . when secondary to radiation necrosis and recurrent tumor , fistulas have an extremely poor outlook with some palliation afforded by a diverting colostomy2 ) . multi - staged repair is limited to those patients with evidence of intestinal obstruction , uncontrolled local sepsis , and questions of intestinal viability9 ) . in summary , we experienced one case of ileovesical fistula , which was caused by hcc arising from noncirrhotic liver . the combination of cystoscopy , cystography , and barium study of the small bowel confirmed the diagnosis of ileovesical fistula , and single stage repair was performed successfully .