Colo-ovarian fistula

Colo-salpingeal fistula: a rare gynecologic manifestation of diverticular disease

INTRODUCTION

Diverticulitis can be complicated by fistulas between the colon and neighboring structures, which predispose to significant morbidity and mortality. Fistulas involving the female urogenital tract often present with urogynecologic symptoms, such as vaginal discharge or recurrent urinary tract infections. While colo-vaginal fistulas, a more common variant, often present with vaginal flatulence, colo-salpingeal fistulas are exceedingly rare and have not been reported with this symptomatology. We describe a case of colo-saplingeal fistula presenting with vaginal flatulence, requiring multidisciplinary collaboration for diagnosis and management.

CASE

A 63-year-old woman presented with vaginal flatulence in the setting of persistent diverticulitis. Computed tomography (CT) scan revealed sigmoid diverticulitis, a submucosal abscess abutting the uterus, and air within the endometrial cavity, raising suspicion for a colo-uterine fistula. Following transient symptomatic relief with medical management and antibiotics, recurrence of symptoms prompted surgical intervention. Laparoscopic exploration allowed diagnosis of the colo-salpingeal fistula. Sigmoid colectomy and left salpingo-oophorectomy were performed with a minimally invasive surgical approach, resulting in an uncomplicated recovery with remission of symptoms.

DISCUSSION

This rare case highlights novel gynecologic symptoms for a colo-salpingeal fistula, contrasted with reported presentations through a comprehensive literature review. This case underscores the importance of recognizing gynecologic symptoms related to diverticular disease, which may be subtle, but provide important considerations for prognosis and treatment. A multidisciplinary approach to care from diagnosis through surgery allowed for successful recognition and minimally invasive treatment of this anomalous condition before further complications could arise. Ultimately, surgical approaches to diverticulitis-associated gynecologic fistulas should be individualized.

Asymptomatic colo-ovarian fistula amidst acute psychosis: a case report

This paper presents a rare case of an asymptomatic colo-ovarian fistula in a 45-year-old female with acute psychosis and a history of bipolar disorder, seizure disorder and substance misuse. The intricate diagnostic challenges arising from the patient's complex medical history underscore the significance of a multidisciplinary approach. The absence of typical gastrointestinal symptoms and the presence of a tubo-ovarian abscess complicated the diagnosis of acute on chronic sigmoid diverticulitis and colo-ovarian fistula. Surgical intervention, including sigmoid resection, anastomosis and left salpingo-oophorectomy, led to successful resolution. This case highlights the need for further understanding of colo-ovarian fistula pathophysiology, improved diagnostic strategies, and the nuanced interplay between medical and psychiatric conditions in complex clinical scenarios.

A Rare Case of Diverticulitis With a Colo-Adnexal Fistula

Diverticulitis is a very common cause of hospitalization in the United States with fistula formation being a common complication. However, a fistula formation between the sigmoid colon and an ovary is an exceptional rarity. We present a case of a 22-year-old female with a colo-ovarian fistula misdiagnosed as a tubo-ovarian abscess after a recent episode of diverticulitis. Initial workup, imaging studies, and treatment ending with Hartmann's procedure with eventual colostomy reversal are described. A review of similar cases within the literature and fistulas is also presented.

Colovaginal and colo-ovarian fistula at a patient with asymptomatic diverticular disease

Colovaginal and colo-ovarian fistulas are rare entities that could be attributed to diverticular disease after an episode of acute diverticulitis. Τhey could initially be manifested with symptoms that lead patients to the gynecologist. Gynecologists should consider them in the differential diagnosis, especially after recurrent episodes of sinusitis. We report the case of a 51-year-old woman with a colovaginal and a colo-ovarian fistula due to subclinical diverticular disease, which should be involved in the differential diagnosis in those complicated fistulas, even if the patient had never before a clinical episode of acute diverticulitis or known diverticular disease, and a successful surgical approach.