Colouterine Fistula Caused by Diverticulitis of the Sigmoid Colon
An 81-year-old woman was referred to the emergency department with abdominal pain and vaginal discharge that had lasted for 4 days. Medical history included right nephrectomy for a renal stone 21 years earlier and medication for arterial hypertension 4 years earlier. The pain was localized to the lower abdomen without aggravating factors. Upon admission to the department of gynecology, the patient looked ill and had a temperature of 37.4℃, a blood pressure of 134/59 mmHg, a pulse of 77 beats/min, and a respiratory rate of 18 breaths/min. The abdomen was slightly distended and tender over the lower abdomen, without signs of generalized peritoneal irritation. Pelvic examination showed an atrophied vagina and cervix, and a yellowish foul odorous vaginal discharge from the cervical os. Laboratory test results were within normal limits, except for a white blood cell count of 27,580/µL and a neutrophil fraction of 88.3%. Culture of the vaginal discharge revealed Escherichia coli and Enterococcus avium. Endovaginal sonography showed fluid collection measuring 2.7 × 2.4 cm in the endometrium, suggesting a pyometrium. Abdominopelvic computed tomography (CT) showed a myometrial abscess cavity in the uterus and diverticulosis of the sigmoid colon. Tomography also showed that the uterine had joined to the thick sigmoid wall (). However, no definite fistula tract was visible. A colouterine fistula caused by diverticulitis was suspected. Therefore, fistulography was performed. When contrast fluid was injected through the cervical os, spillage of the contrast fluid into the sigmoid colon via the left side of the abscess cavity of the uterine fundus was observed (). On colonoscopy, multiple diverticula were noted at the sigmoid colon, and a suspected lesion of the fistula opening with surrounding edema and emission of air bubbles was detected approximately 25 cm from the anal verge (). The patient was diagnosed with a colouterine fistula caused by diverticulitis and was transferred to the department of surgery for a collaborative operation.\nDuring the operation, inflammatory adhesion of the distal sigmoid colon to the posterior wall of the uterus was found (). The colon was dissected off the uterus, and a fistula between the sigmoid colon and the endometrial cavity was identified. Primary resection of the sigmoid colon, including the affected segment, with anastomosis and repair of the fistula tract of the uterus were performed. The intrauterine purulent content was drained through the cervical os. In terms of gross appearance, the excised portion showed a fistula tract in the colonic wall (). The postoperative course was uneventful, and the patient was discharged on the ninth postoperative day.