Penetration of the sigmoid colon to the posterior uterine wall secondary to diverticulitis: a case report

Tomoyuki Akiyama,Kensuke Kubota,Hiroshi Iida,Hiroki Endo,Shoji Yamanaka,Koji Fujita,Masahiko Inamori,Takeshi Shimamura,Yasunobu Abe,Atsushi Nakajima,Hirokazu Takahashi,Masato Yoneda,Hiroshi Kobayashi,Noritoshi Kobayashi,Yasushi Rino

doi:10.4076/1752-1947-3-8957

Tomoyuki Akiyama, Kensuke Kubota + Show 13 more

Open Access

https://doi.org/10.4076/1752-1947-3-8957

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Abstract

IntroductionPenetration of the colon to the posterior uterine wall secondary to diverticulitis is unusual, with diagnostic methods not yet established. Non-invasive imaging, such as computed tomography and magnetic resonance imaging may help to establish a proper diagnosis, but confirmation may be reached only after surgical exploration.Case presentationWe report the case of a 78-year-old Japanese woman who presented with a low grade fever and mild diarrhea which occurred two or three times a week. Computed tomography and magnetic resonance imaging demonstrated a capsular lesion including an air structure with a diameter of 5 cm, between the posterior aspect of the uterine body and the sigmoid colon. A gastrograffin enema and colonoscopy demonstrated a giant diverticulum of the sigmoid colon with no evidence of malignancy. These data confirmed the diagnosis of diverticulitis complicated by a giant diverticulum. Because of a relapsing fever after therapy with antibiotics, the patient had en bloc surgical treatment of the uterus, fallopian tubes, ovaries and sigmoid colon, the organs involved in the diverticulitis, followed by an uneventful recovery.ConclusionThis is a rare case report of penetration of the sigmoid colon to the posterior uterine wall secondary to diverticulitis.

Highlights

Penetration of the colon to the posterior uterine wall secondary to diverticulitis is unusual, with diagnostic methods not yet established
Case presentation: We report the case of a 78-year-old Japanese woman who presented with a low grade fever and mild diarrhea which occurred two or three times a week
A gastrograffin enema and colonoscopy demonstrated a giant diverticulum of the sigmoid colon with no evidence of malignancy

Summary

Introduction

Diverticulosis is the most common colonic disease. Up to 30% of individuals are affected by the time they reach 60 and nearly 65% by the age of 80 [1]. We report a case of a patient with penetration of the sigmoid colon to the posterior wall of the uterus secondary to diverticulitis. Examination confirmed a giant diverticulum with inflammation and abscess of the sigmoid colon, penetrating to the posterior wall of the uterus (Figure 3). A gastrograffin enema and colonoscopy demonstrated a giant diverticulum of the sigmoid colon without evidence of malignancy and penetration to the wall of the uterus (Figure 2) These data confirmed the diagnosis of diverticulitis complicated by a giant diverticulum. Since these clinical manifestations, imaging findings and colon examinations did not suggest the presence of any severe complications, such as a penetration of the sigmoid colon to the posterior uterine wall, sigmoid-uterine fistula, perforation, or peritonitis, we selected a conservative therapy. A copy of the written consent is available for review by the Editor-in-Chief of this journal

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Findings

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