A Very Rare Case of Colosalpingeal Fistula Secondary to Diverticulitis: An Overview of Development, Clinical Features and Management

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.

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.

Colo-Fallopian Fistula: A Rare Complication of Sigmoid Colon Diverticulitis

Diverticulitis is a common colorectal disease present in Western countries that develops as infected protrusions (diverticula) along weak points in the colon due to increased intraluminal pressure. Most patients with diverticular disease can be asymptomatic; however, several complications can arise from the development of diverticulitis. Here, we discuss the diagnosis and management of a patient presenting with recurrent Escherichia coli (E. coli) vaginal infections due to sigmoid colon diverticulitis resulting in a colo-fallopian fistula that was unremarkable on diagnostic imaging. The patient was managed with minimally invasive surgery. A 65-year-old female with a medical history of hyperlipidemia and recurrent diverticulitis presented with over a year history of recurrent E. coli vaginal infections. She underwent a robotic anterior resection with extracorporeal colorectal anastomosis via a Pfannenstiel incision. Less than 48 hours following the surgery, she was discharged without complications and has remained symptom-free nine months postoperatively. Significant improvement was noted following the procedure. The patient was able to advance her diet and was discharged the next day. The patient was seen postoperatively, with no evidence of any recurrent E. coli vaginal infections. The case highlights the diagnosis and management of a rare case of colo-fallopian fistula in a situation where the patient had recurrent vaginal infections. It is quite difficult to identify the fistula radiologically. This patient was managed with a minimally invasive surgical technique that proved to be safe and beneficial to the outcome of this patient.

Spontaneous colo-vesical and colo-cutaneous fistula complicating a sigmoid diverticulitis: A case report

INTRODUCTION

Diverticular disease is a challenge in western countries. The occurrence of fistula complicating diverticulitis is uncommon. As a result, spontaneous and synchronous colo-vesical and colo-cutaneous is an even rarer situation.

CASE PRESENTATION

We report the case of a 68 years old patient with medical history of bilateral inguinal hernia surgery and diverticular disease. He was admitted for fecal fistula through to the left inguinal area and recurrent urinary tract infections evolving for 2 months. Clinical examination revealed fecaluria and colo-cutaneous fistula. Abdominal CT scan revealed the presence of air in the bladder associated with fistula tract between the sigmoid colon and the inguinal abdominal wall. Surgical management was realized in two stages. The first stage, consisting to an end-colostomy, was performed. The second stage will be laparoscopic colectomy and is not yet realized. In the follow-up, the patient is doing well with a good quality of life.

CONCLUSION

Spontaneous colo-vesical and colo-cutaneous fistula is an uncommon complication of diverticulitis. There is no guidelines about the management and the treatment should be tailored according to each patient characteristics. Laparoscopic surgery is a feasible and safe approach in the treatment.