Perez Anthony R, Chiong-Perez Mary Ellen, Arcilla Crisostomo E, Merin John Isaac
University of the Philippines College of Medicine and Philippine General Hospital, Taft Avenue, Manila, 1000, Philippines.
Manila Doctors Hospital, Kalaw Avenue, Manila, 10000, Philippines.
Int J Surg Case Rep. 2021 Feb;79:150-155. doi: 10.1016/j.ijscr.2021.01.036. Epub 2021 Jan 15.
Colouterine fistulas related to diverticulitis are very rare due to the thickness of the uterine myometrium. Other causes related to colouterine fistula formation particularly malignancy, have to be considered. Diagnosis by imaging or endoscopy may be inconclusive.
We are presenting a case of a 70-year-old female who presented with malodorous vaginal discharge and painful labial lesions. No previous history of surgery, gynecologic malignancy or other possible causes of the fistula was elicited. CT scan imaging suggested a colouterine fistula. The patient was admitted and underwent Exploratory laparotomy, Hartmann's procedure and total hysterectomy with bilateral salpingo oophorectomy. The patient was discharged without perioperative complications.
Colouterine fistulas are extremely rare complications of diverticular disease. Diagnosis entails clinical astuteness and judicious use of imaging and endoscopic modalities. Accurate diagnosis is essential to select the appropriate surgical approach, along with intraoperative findings patient status and prevailing conditions.
This case is being presented not only for the rarity of the case but also for the complexity of the management and decision making during the period of the pandemic.
由于子宫肌层的厚度，与憩室炎相关的结肠子宫瘘非常罕见。必须考虑与结肠子宫瘘形成相关的其他原因，尤其是恶性肿瘤。通过影像学或内镜检查进行诊断可能无法得出明确结论。
我们报告一例70岁女性患者，她出现恶臭的阴道分泌物和疼痛的阴唇病变。未发现既往手术史、妇科恶性肿瘤或其他可能导致瘘管的原因。CT扫描成像提示结肠子宫瘘。患者入院后接受了剖腹探查术、哈特曼手术以及全子宫切除术加双侧输卵管卵巢切除术。患者术后无围手术期并发症出院。
结肠子宫瘘是憩室病极为罕见的并发症。诊断需要临床敏锐性以及明智地使用影像学和内镜检查方法。准确诊断对于选择合适的手术方法至关重要，同时还要考虑术中发现、患者状况和当前情况。
呈现此病例不仅是因为该病例罕见，还因为在疫情期间管理和决策的复杂性。
