Le complicanze chirurgiche della malattia diverticolare: un raro caso di fistola sigmoido-vaginale


COD: 287-292-1 Categorie: ,

Carlo D’Angelo, William Zuccon, Fabio Tagliabue, Valerio Balduzzi, Fabrizio Gambarini, Luigi Bonandrini

Ann. Ital. Chir., 2008; 79: 287-292

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The Authors report on a rare case of diverticular disease complicated by a sigmoid- vaginal fistula with personal considerations based on a review of literature. A 75 years old patient becomes to our observation suffering the lost of smelly vaginal secretions without fever or abdominalgia. In anamnesis hysterectomy, cholecystectomy, appendectomy and visceral adhesions lysis. Colonoscopy, RX barium enema, gynaecological examination, vaginal buffer show diverticulis of colon sigma with sigmoid-vaginal fistula. After laparotomy, visceral adhesions lysis, it was done sigmoid- vaginal fistula resection with healing. Diverticular disease is a XX century pathology with incidence (for some authors) of 50% of population. Symptomatic forms affect 30 -50 % of patients (variable percentage based on age); the 1% of these need surgery. The colonic anatomical-functional disorder is the principal cause of diverticular disease that recognize the main localization in colon-sigma. Diverticulitis with pericolic inflammation are frequent complications; possible evolutions are local tamponed peritonitis, mechanical intestinal occlusion, hemorrhage from colonic wall and fistulas. Sigmoid-vaginal fistula is the most frequent in women previously treated with laparohysterectomy. The colonoscopy and RX barium enema are gold standard for instrumental diagnosis; the vaginography is diriment, urography excludes urological diseases. The surgical treatment is the fistula resection, with or without colonic resection. In consideration of the necessity of conservative surgery and on the basis of this case, the Autors suggest, if it’s possible, the simple fistula resection, although the literature report an high number of relapses.