Fehmer T, Citak M, Schildhauer T A
Department of Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
Acta Chir Belg. 2011 Jul-Aug;111(4):232-5.
Chronic colonic diverticulitis may be associated with typical complications such as local abscesses, stenosis, bleeding, intraperitoneal bowel perforations or fistulas to other organs. Most commonly, fistulas exist between the colon and the bladder; nevertheless, they may also extend to the small intestine, other areas of the colon, ureter, uterus, salpinx, vagina, abdominal wall, portal- and mesenterial venous system, pleura, urachus, biliary system and the hip. We report on a patient with chronic colonic diverticulitis having an unusual sigmoido-gluteal fistula along the sacrum, the piriformis muscle and sciatic nerve. The patient presented with sciatic nerve symptoms and recurrent gluteal abscess formation, but no other clinical symptoms leading to an abdominal pathology. Initially, that fact caused an unsuccessful local treatment under the differential diagnosis of a local gluteal abscess for about a year. Finally, a sigmoid colon resection with end-to-end anastomosis and a proximal diverting stoma was performed. The colostomy was closed electively five months later without any complication.
慢性结肠憩室炎可能伴有典型的并发症，如局部脓肿、狭窄、出血、肠穿孔至腹腔或与其他器官形成瘘管。最常见的是，结肠与膀胱之间形成瘘管；不过，瘘管也可能延伸至小肠、结肠其他部位、输尿管、子宫、输卵管、阴道、腹壁、门静脉和肠系膜静脉系统、胸膜、脐尿管、胆道系统及臀部。我们报告一例患有慢性结肠憩室炎的患者，其沿着骶骨、梨状肌和坐骨神经形成了罕见的乙状结肠 - 臀肌瘘。该患者表现出坐骨神经症状和反复的臀肌脓肿形成，但无其他提示腹部病变的临床症状。最初，这一情况导致在约一年的时间里，在局部臀肌脓肿的鉴别诊断下进行的局部治疗未获成功。最后，进行了乙状结肠切除并端端吻合及近端转流造口术。五个月后择期关闭结肠造口，未出现任何并发症。
