Education and imaging. Gastrointestinal: Sigmoidocecal fistula diagnosed with colonoscopy

Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature

Patient: Female, 76

Final Diagnosis: Complicated recurrent diverticulitis

Symptoms: Abdominal pain • bloating • inability to pass stool and gas

Medication: —

Clinical Procedure: Hartmann’s procedure

Specialty: Surgery

A case of colonic pseudoobstruction related to bacterial overgrowth due to a sigmoidocecal fistula

Colocolic fistulas are usually a complication of an inflammatory or neoplastic process. Development of these abnormal bowel communications may lead to bacterial overgrowth. We report on a 71-year-old man with a one-year history of recurrent abdominal distension and irregular bowel habits. Abdominal X-rays and computed tomography showed multiple air-fluid levels and loops of distended bowel without evidence of mechanical obstruction or diverticulitis. Colonoscopy showed a fistulous tract between the sigmoid colon and cecum. Results of a lactulose breath test showed high fasting breath CH4 levels, which were thought to be the result of intestinal bacterial overgrowth. The patient was diagnosed with a colonic pseudo-obstruction associated with bacterial overgrowth due to a sigmoidocecal fistula. We recommended surgical correction of the sigmoidocecal fistula; however, the patient requested medical treatment. After antibiotic therapy, the patient still had mild symptoms but no acute exacerbations.