Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature

Abstract

Patient: Female, 76Final Diagnosis: Complicated recurrent diverticulitisSymptoms: Abdominal pain • bloating • inability to pass stool and gasMedication: —Clinical Procedure: Hartmann’s procedureSpecialty: SurgeryObjective:Unusual clinical courseBackground:Although diverticular disease is well described and treated in daily clinical practice, there are cases that attract great interest because of their complexity and difficulty in management. Herein, we describe a rare case of colo-colonic fistula-complicated diverticulitis that necessitated urgent surgical intervention.Case Report:A 76-year-old female patient with a known history of diverticular disease of the sigmoid colon presented in the Emergency Department for evaluation of left lower quadrant abdominal pain. The clinical and radiological examinations revealed a recurrent episode of acute diverticulitis of the sigmoid colon. However, it was of great interest that we detected a sigmoido-cecal fistula in the abdominal computed tomography (CT). The patient was admitted to the hospital for conservative treatment. After 48 hours, the patient’s clinical status deteriorated, with pain aggravation, abdominal distension, bloating, and metallic bowel sounds. The simple abdominal x-ray revealed large-bowel obstruction and the CT demonstrated worsening inflammation of the sigmoid colon. An exploratory laparotomy revealed an inflamed dolichol-sigmoid colon forming a fistulous tract with the cecum and thus, mimicking a closed loop obstruction. The sigmoid colon was transected en bloc with the sigmoido-cecal fistula and a Hartmann’s procedure was performed.Conclusions:This case is extremely unusual as the patient presented at the same time two complications of diverticular disease, both obstruction and this rare formation of sigmoido-cecal fistula. It is presented in order to acquaint surgeons with the possibility of an unexpected course of this disease which indeed necessitates an individualized management.

Complicated Colonic Diverticulitis Presenting as Vaginal Bleeding: An Unusual Presentation

“…Reports have identified diverticular disease fistulas but never with symptoms of vaginal bleeding and pelvic pain. Our literature search revealed one case report that detected a sigmoido-cecal fistula in the setting of acute sigmoid diverticulitis in an individual presenting with left lower quadrant abdominal pain [ 8 ]. Furthermore, one study looked at a series of genital fistulas that resulted from diverticulitis.…”

Sigmoid–sigmoid colon fistula caused by diverticulitis

“…Fistula is one among the complications of diverticulitis, which most commonly occurs as colovesical fistula, followed by colovaginal fistula. Colocolic fistula is rare findings, accounting for about 2% [1] …”

Complex ileo‐caeco‐sigmoid fistula: a rare cause of small bowel obstruction

“…Most of the external fistulas are seen in the post‐operative period after abdominal surgeries. The common causes of internal GI fistulas include Crohn’s disease (CD), cancer, diverticulitis, iatrogenic injuries and trauma . The most common sites for internal GI fistulas are ileosigmoid, caecosigmoid, ileoileal and ileojejunal .…”

“…The treatment of internal GI fistula depends upon its aetiology. Resection of the fistula with re‐establishment of the GI continuity is the preferred treatment in most cases . However, if the cause of internal GI fistula is determined by biopsy such as CD and tuberculosis, then the patients can be offered medical therapy if the bowel complications such as obstruction, perforation and bleeding are absent.…”

“…The common causes of internal GI fistulas include Crohn's disease (CD), cancer, diverticulitis, iatrogenic injuries and trauma. [1][2][3][4][5][6] The most common sites for internal GI fistulas are ileosigmoid, caecosigmoid, ileoileal and ileojejunal. [1][2][3][4][5][6] Rarely, primary GI fistula that communicate with the other organs have also been described.…”