Colouterine Fistula Caused by Diverticulitis of the Sigmoid Colon

Abstract

Colouterine fistula is an extremely rare condition because the uterus is a thick, muscular organ. Here, we present a case of a colouterine fistula secondary to colonic diverticulitis. An 81-year-old woman was referred to the emergency department with abdominal pain and vaginal discharge. Computed tomography showed a myometrial abscess cavity in the uterus adherent to the thick sigmoid wall. Upon contrast injection via the cervical os for fistulography, we observed spillage of the contrast into the sigmoid colon via the uterine fundus. Inflammatory adhesion of the distal sigmoid colon to the posterior wall of the uterus was found during surgery. The colon was dissected off the uterus. Resection of the sigmoid colon, primary anastomosis, and repair of the fistula tract of the uterus were performed. The postoperative course was uneventful. This case represents an unusual type of diverticulitis complication and illustrates diagnostic procedures and surgical management for a colouterine fistula.

Different etiologies of an unusual disease: Colouterine fistula – Report of two cases

“…Patients with the colouterine fistula usually present with malodorous fecal or purulent vaginal discharge as the colonic lumen and the uterus are linked by a fistula tract. [ 2 ] The most common presenting symptom of uterine metastasis is vaginal bleeding whereas in cases of diverticulitis causing fistula, patients may present with fever and recurrent abdominal pain.…”

“…Various surgical approaches have been reported. An en bloc resection,[ 2 ] according to the patient's condition, is mandatory in cases of colouterine fistula caused by malignancy. However, in benign conditions, the need for a hysterectomy has not been established.…”

“…Colouterine fistula is very rare condition with only around 25 reported cases of post-diverticulitis colouterine fistula so far. [ 1 2 3 4 5 6 ] Other causes include sigmoid malignancy, radiotherapy, and iatrogenic conditions such as insertion of intrauterine devices, endometrial curettage with uterine, and bowel perforation, or obstetrical injury.…”

Single-incision laparoscopic (SIL) sigmoid colectomy and uterus-preserving repair for colo-uterine fistula secondary to severe diverticular disease: an unusual technical solution for an unusual presentation of a common disease

“…Frequently, the patient will undergo a segmental colectomy, with or without stoma formation and abdominal hysterectomy, to deal with the uterine defect resulting from the fistula. There has been only one single attempt in the literature, of laparoscopic treatment resulting in an en bloc sigmoid colectomy and hysterectomy,11 while an organ-sparing treatment option keeping the uterus has only been reported in two other cases 8 10…”

Diverticulitis: a comprehensive review with usual and unusual complications

“…Colouterine fistula may manifest with myometrial abscess formation [31]. CT may demonstrate air bubbles within the uterine cavity, which is a highly specific finding, if detected.…”