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Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature.
Am J Case Rep. 2018 Nov 22; 19:1386-1392.AJ

Abstract

BACKGROUND

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.

Authors+Show Affiliations

Third Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.Third Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.Third Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.Third Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.Third Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.Third Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.Department of Radiology, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.Department of Radiology, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.Third Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.Third Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.Third Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

30464167

Citation

Strati, Titika-Marina, et al. "Sigmoido-Cecal Fistula: a Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature." The American Journal of Case Reports, vol. 19, 2018, pp. 1386-1392.
Strati TM, Sapalidis K, Koimtzis GD, et al. Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature. Am J Case Rep. 2018;19:1386-1392.
Strati, T. M., Sapalidis, K., Koimtzis, G. D., Pavlidis, E., Atmatzidis, S., Liavas, L., Chrysogonidis, I., Samoilis, G., Zarampouka, K., Michailidou, K., Kesisoglou, I. I., & Kosmidis, C. (2018). Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature. The American Journal of Case Reports, 19, 1386-1392. https://doi.org/10.12659/AJCR.911790
Strati TM, et al. Sigmoido-Cecal Fistula: a Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature. Am J Case Rep. 2018 Nov 22;19:1386-1392. PubMed PMID: 30464167.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature. AU - Strati,Titika-Marina, AU - Sapalidis,Konstantinos, AU - Koimtzis,Georgios D, AU - Pavlidis,Efstathios, AU - Atmatzidis,Stefanos, AU - Liavas,Lazaros, AU - Chrysogonidis,Ioannis, AU - Samoilis,Georgios, AU - Zarampouka,Katerina, AU - Michailidou,Kyriaki, AU - Kesisoglou,Isaac I, AU - Kosmidis,Christoforos, Y1 - 2018/11/22/ PY - 2018/11/23/entrez PY - 2018/11/23/pubmed PY - 2019/4/4/medline SP - 1386 EP - 1392 JF - The American journal of case reports JO - Am J Case Rep VL - 19 N2 - BACKGROUND 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. SN - 1941-5923 UR - https://www.unboundmedicine.com/medline/citation/30464167/Sigmoido_Cecal_Fistula:_A_Rare_Case_of_Complicated_Recurrent_Diverticulitis_and_a_Review_of_the_Literature_ L2 - https://www.amjcaserep.com/download/index/idArt/911790 DB - PRIME DP - Unbound Medicine ER -