Chadwick Thomas, Katti Ashok, Arthur James
Department of Surgery, Colorectal Unit, University Aintree Hospital, Liverpool, UK.
Department of Radiology, University Aintree Hospital, Liverpool, UK.
J Surg Case Rep. 2017 Mar 9;2017(3):rjw237. doi: 10.1093/jscr/rjw237. eCollection 2017 Mar.
A rare complication of diverticular disease is the formation of fistulas, most commonly either colo-vesical or colo-vaginal. We present the unusual case of a perforated sigmoid diverticulum forming a colo-gluteal fistula and presenting initially as a gluteal abscess in an otherwise asymptomatic patient. After drainage of the gluteal abscess, the patient re-presented with faecal loss from the abscess drainage site. Imaging revealed fistulous communication between the sigmoid and the left obturator internus muscle, tracking to the gluteus maximus with associated abscess and cutaneous communication to the site of previous drainage. The patient underwent an emergency Hartmann's procedure with lay open/abscess drainage of the gluteal cavity. Post-operatively the patient experienced continuing discharge from the gluteal fistula despite repeated drainage and debridement causing considerable morbidity, inconvenience and misery. Clinicians should maintain a high index of suspicion when presented with a gluteal abscess and should consider the possibility of an intra-abdominal source.
憩室病的一种罕见并发症是瘘管形成,最常见的是结肠膀胱瘘或结肠阴道瘘。我们报告了一例不寻常的病例,乙状结肠憩室穿孔形成结肠臀肌瘘,最初表现为臀肌脓肿,而患者在其他方面并无症状。臀肌脓肿引流后,患者再次出现脓肿引流部位粪便流失。影像学检查显示乙状结肠与左闭孔内肌之间存在瘘管相通,瘘管延伸至臀大肌,伴有脓肿形成,并与先前引流部位存在皮肤相通。患者接受了急诊哈特曼手术,并对臀肌腔进行了敞开引流/脓肿引流。术后,尽管反复引流和清创,患者的臀肌瘘仍持续有分泌物排出,导致了相当大的发病率、不便和痛苦。临床医生在面对臀肌脓肿时应保持高度警惕,并应考虑腹腔内来源的可能性。