Intestinal tuberculosis is one of the common presentations of tuberculosis. It can manifest with various complications. However, spontaneous development of enterovesical fistula especially in association with colovesical and enterocutaneous fistulae is extremely rare in the era of highly effective Antituberculosis Treatment (ATT). This particular situation poses a management difficulty. Although initial treatment includes medical management, these patients may require some sort of surgical resection and reconstruction. Here, we report the case of a 21-year-old male patient who presented with recurrence of intestinal TB with spontaneous complex ileovesical, sigmoid colovesical and enterocutaneous fistulae. The diagnosis was established with an array of investigations including colonoscopy and biopsy, Contrast Enhanced Computed Tomography (CECT) of the abdomen with fistulogram and cystoscopy. This unusual complex fistula was successfully managed by staged surgical procedure along with ATT.
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