Complicated sigmoid diverticulitis with fistulation to bladder and vagina
Presentation
Left lower quadrant pain and fever and raised inflammatory markers. Passage of brown material via vagina.
Patient Data
There are features of complicated sigmoid diverticulitis with numerous diverticula, smooth circumferential muscle thickening, abnormal hyperenhancement, and fluid and air collections within the wall of the sigmoid colon. Proximally the colon is distended with solid feces indicating a degree of obstruction i.e. a diverticular stricture. Abnormal thickening of the left lateral bladder wall with loss of clear plane to the sigmoid indicates possible colovesical fistula. Similar finding in relation to left vaginal apex with gas within vaginal lumen indicating colovaginal fistula, and also to left ovary. Inflammatory change also extends around distal most portion of left ovarian vein, indicating thromphlebitis.
Case Discussion
Diverticulitis may be complicated by fistula formation, seen here between the sigmoid colon and the bladder and vagina, and adherence of the left ovary to the inflamed sigmoid. A localized abscess is present, as well as left ovarian thrombophlebitis. Finally, chronicity is indicated by the stricture formation as suggested by upstream dilatation and fecal loading.
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