Strati Titika-Marina, Sapalidis Konstantinos, Koimtzis Georgios D, Pavlidis Efstathios, Atmatzidis Stefanos, Liavas Lazaros, Chrysogonidis Ioannis, Samoilis Georgios, Zarampouka Katerina, Michailidou Kyriaki, Kesisoglou Isaac I, Kosmidis Christoforos
Third Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.
Department of Radiology, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.
Am J Case Rep. 2018 Nov 22;19:1386-1392. doi: 10.12659/AJCR.911790.
BACKGROUND Although diverticular disease is well described and treated in daily clinical practice, there are cases that attract great interest because of their complexity and difficulty in management. Herein, we describe a rare case of colo-colonic fistula-complicated diverticulitis that necessitated urgent surgical intervention. CASE REPORT A 76-year-old female patient with a known history of diverticular disease of the sigmoid colon presented in the Emergency Department for evaluation of left lower quadrant abdominal pain. The clinical and radiological examinations revealed a recurrent episode of acute diverticulitis of the sigmoid colon. However, it was of great interest that we detected a sigmoido-cecal fistula in the abdominal computed tomography (CT). The patient was admitted to the hospital for conservative treatment. After 48 hours, the patient's clinical status deteriorated, with pain aggravation, abdominal distension, bloating, and metallic bowel sounds. The simple abdominal x-ray revealed large-bowel obstruction and the CT demonstrated worsening inflammation of the sigmoid colon. An exploratory laparotomy revealed an inflamed dolichol-sigmoid colon forming a fistulous tract with the cecum and thus, mimicking a closed loop obstruction. The sigmoid colon was transected en bloc with the sigmoido-cecal fistula and a Hartmann's procedure was performed. CONCLUSIONS This case is extremely unusual as the patient presented at the same time two complications of diverticular disease, both obstruction and this rare formation of sigmoido-cecal fistula. It is presented in order to acquaint surgeons with the possibility of an unexpected course of this disease which indeed necessitates an individualized management.
尽管憩室病在日常临床实践中已有充分描述和治疗，但仍有一些病例因其复杂性和管理难度而备受关注。在此，我们描述一例罕见的结肠-结肠瘘合并憩室炎病例，该病例需要紧急手术干预。病例报告：一名76岁女性患者，已知患有乙状结肠憩室病，因左下腹疼痛到急诊科就诊。临床和影像学检查显示乙状结肠急性憩室炎复发。然而，有趣的是，我们在腹部计算机断层扫描（CT）中发现了乙状结肠-盲肠瘘。患者入院接受保守治疗。48小时后，患者的临床状况恶化，出现疼痛加剧、腹胀、气胀和金属样肠鸣音。简单的腹部X线检查显示大肠梗阻，CT显示乙状结肠炎症加重。剖腹探查发现乙状结肠冗长且发炎，与盲肠形成瘘管，从而模拟了闭袢性肠梗阻。将乙状结肠与乙状结肠-盲肠瘘一并切除，并进行了哈特曼手术。结论：该病例极为罕见，因为患者同时出现了憩室病的两种并发症，即梗阻和这种罕见的乙状结肠-盲肠瘘形成。本文旨在让外科医生了解这种疾病可能出现的意外病程，这确实需要个体化管理。
