Murthy Jeevan J, Engel Jake, DeFazio David, Mayers Keri
Department of Surgery, West Virginia University School of Medicine, Morgantown, USA.
Cureus. 2024 Jul 7;16(7):e64026. doi: 10.7759/cureus.64026. eCollection 2024 Jul.
Coloarticular fistula is a rare complication of the Hartmann procedure, reported in the literature only a few times. Risk factors may include underlying colonic malignancy and other proinflammatory conditions. Herein, we describe the case of a 78-year-old female with a recent history of total hip replacement, misdiagnosed Crohn's disease, and a Hartmann procedure for perforated diverticulitis who developed a psoas abscess. Further investigation, including gastrografin enema and computerized tomography, revealed significant fistulization between her hip prosthesis, rectal stump, adnexa, and cecum. Intervention required extensive interdisciplinary decision-making, and the patient underwent interventional radiology-guided abscess drainage, arthroplasty revision, and exploratory laparotomy.
结肠关节瘘是哈特曼手术罕见的并发症，文献中仅有少数几次报道。危险因素可能包括潜在的结肠恶性肿瘤和其他促炎病症。在此，我们描述了一例78岁女性病例，她近期有全髋关节置换史，曾被误诊为克罗恩病，因穿孔性憩室炎接受了哈特曼手术，之后发生了腰大肌脓肿。进一步检查，包括泛影葡胺灌肠造影和计算机断层扫描，发现其髋关节假体、直肠残端、附件和盲肠之间存在严重的瘘管形成。治疗需要广泛的多学科决策，患者接受了介入放射学引导下的脓肿引流、关节成形术翻修和剖腹探查术。
