A 45 year-old female was admitted with small bowel obstruction. A CT scan revealed caliber change in the small bowel along with multiple diverticula in the sigmoid colon. Subsequent colonoscopy revealed colonic edema and erythema localized at the sigmoid colon. Another interesting finding was the presence of pus and oil droplets at the mesenteric margin of the bowel lumen. Our hypothesis is that a diverticulitis of the sigmoid colon was complicated by perforation into the mesenteric area adjacent to the small bowel thus leading to obstruction as well as oil droplet leakage of mesenteric fat origin. As soon as contrast was injected into the fistula extraintestinal leakage became evident in the absence of any signs indicative of intraperitoneal spread. No fistulization into the small bowel was identified. Considering that the drainage had been achieved, we opted to treat the patient conservatively.
