Colonic Fistula Caused by Sigmoid Diverticulitis—Two Case Reports—

Abstract

Case 1 involved a 63-year-old man admitted to the hospital for bowel obstruction. The patient had a history of recurrent diverticulitis for seven years. Computed tomography (CT) revealed diverticula and wall thickening of the sigmoid colon, and dilatation of the proximal colon. An enema revealed colonic stenosis and a coloenteric fistula caused by sigmoid diverticulitis. Based on these findings, a sigmoidectomy and partial ileal resection were performed. Case 2 involved a 40-year-old male who presented with exacerbation of diverticulitis, which had repeatedly occurred over the past 10 years. CT revealed diverticula and wall thickening of the sigmoid colon, and suspected fistula formation between the ileum and the sigmoid colon. Although the fistula could not be confirmed with an enema, it was confirmed in a surgical specimen obtained after sigmoidectomy and partial ileal resection. A coloenteric fistulas caused by colorectal diverticulitis are relatively rare ; however, they often co-occur with a colovesical fistula. Although the fistulas in the two presented cases did not involve the bladder, in both patients, the sigmoid colon was adherent to the bladder close to the small bowel fistula. When treating a patient with a colovesical fistula, the possibility of a co-existing coloenteric fistula should be considered.