Colo-ovarian Fistula complicating acute diverticulitis: Two cases and literature review

Massive serous cyst adenoma with ovarian abscess causing fatal septicaemia

Isolated unilateral ovarian tumour without obvious concomitant tubal pathology is unlikely to cause intrabdominal abscess or septicaemia. Benign serous cystadenoma is a fairly common ovarian tumour but rarely causes fatality. We present a patient in mid-30s with massive ovarian serous cystadenoma presenting with abscess and septicaemia, leading to mortality. To our knowledge, no previous serous cystadenoma causing abscess formation has been reported before.

Asymptomatic colo-ovarian fistula amidst acute psychosis: a case report

This paper presents a rare case of an asymptomatic colo-ovarian fistula in a 45-year-old female with acute psychosis and a history of bipolar disorder, seizure disorder and substance misuse. The intricate diagnostic challenges arising from the patient's complex medical history underscore the significance of a multidisciplinary approach. The absence of typical gastrointestinal symptoms and the presence of a tubo-ovarian abscess complicated the diagnosis of acute on chronic sigmoid diverticulitis and colo-ovarian fistula. Surgical intervention, including sigmoid resection, anastomosis and left salpingo-oophorectomy, led to successful resolution. This case highlights the need for further understanding of colo-ovarian fistula pathophysiology, improved diagnostic strategies, and the nuanced interplay between medical and psychiatric conditions in complex clinical scenarios.

A Rare Case of Diverticulitis With a Colo-Adnexal Fistula

Diverticulitis is a very common cause of hospitalization in the United States with fistula formation being a common complication. However, a fistula formation between the sigmoid colon and an ovary is an exceptional rarity. We present a case of a 22-year-old female with a colo-ovarian fistula misdiagnosed as a tubo-ovarian abscess after a recent episode of diverticulitis. Initial workup, imaging studies, and treatment ending with Hartmann's procedure with eventual colostomy reversal are described. A review of similar cases within the literature and fistulas is also presented.

Laparoscopic Repair of a Colo-Ovarian Fistula

OBJECTIVE

To demonstrate a laparoscopic approach to managing a colo-ovarian fistula.

DESIGN

Narrated video outlining surgical technique.

SETTING

Colo-ovarian fistulas are a rare entity with a lack of systematized evidence to guide surgical treatment.^1-3 Available case reports describe open en-bloc resection of the colon and adnexal organs with colorectal anastomosis.³ We present a case of a colo-ovarian fistula managed laparoscopically with discoid resection of the fistulous tract, a technique used for rectosigmoid endometriosis.⁴ INTERVENTION: A 51-year-old G0 presented with fevers, leukocytosis, and CT imaging showing a peripherally-enhancing adnexal complex highly suspicious for tubo-ovarian abscess that was refractory to antibiotics and interventional-radiology guided drainage. The patient elected for definitive surgery with hysterectomy, bilateral salpingo-oophorectomy, and indicated procedures. Preoperatively, there was no evidence of gastrointestinal tract involvement but intraoperatively, a colo-ovarian fistula was discovered. General surgery was consulted for en-bloc resection, but given the small size of the fistula and absence of acute inflammation, a discoid resection was deemed a possible alternative. This video highlights: 1. Lysis of adhesions to restore normal anatomy 2. Identification of avascular spaces to secure uterine arteries at the origin 3. Excision of the fistula with an advanced bipolar device enabling surgeon control of energy dispersed prior to cutting 4. Two-layer closure reapproximating bowel with bubble-test to ensure airtight repair Postoperatively, there were no complications. The final pathology confirmed tubo-ovarian abscess, endometriosis, and a fistulous tract.

CONCLUSION

Colo-ovarian fistulas are rare with little to guide surgical treatment. This video demonstrates a laparoscopic alternative to open en-bloc resection of the colon and adnexa.