A Case of Diverticulitis of the Sigmoid Colon with Pyometra

Abstract

A 77-year-old woman complaining of lower abdominal pain was referred to our hospital following unsuccessful treatment with antimicrobial agents. On admission, there was tenderness in the lower abdomen but muscle guarding was absent. The WBC count was 21,900/μl and the CRP level was 20.58mg/dl, showing elevated inflammatory response. An abdominal contrast-enhanced CT scan showed multiple diverticula and surrounding low density areas in the sigmoid colon. Intraabdominal abscess due to sigmoid colon diverticulitis was diagnosed. We performed operation because no symptomatic remission was gained. Upon laparotomy, we confirmed that the sigmoid colon was firmly adhered to the uterine and left adnexa and the uterine had swollen. Compression of the uterine produced defluxion of pus between the sigmoid colon and the uterine. Accordingly association of pyometra was determined, and sigmoidectomy, hysterectomy and left adnexectomy were performed. Histopathological study revealed an abscess cavity and the left adnexa with severe inflammation between the sigmoid colon and the uterine ; but it did not reveal colouterine fistula. From these findings, it is etiologically considered that intraabdominal abscess formation occurred due to sigmoid diverticulitis, followed by formation of the pyometra via the fallopian tube. Here we present a case of diverticulitis of the sigmoid colon associated with pyometra.