Complicated diverticulitis with rectovaginal fistula

Abstract

Objective: To report the evolution of a case of diverticulitis complicated with rectal, vaginal and bladder fistula corrected by Hartmann surgery and closure of the fistula. Case details: The diagnosis was made after a history of the disease and physical examination of the chronic abdominal pain and complementary tests to the clinical investigation (barium enema, abdominal tomography, rectosigmoidoscopy and abdominal magnetic resonance imaging). The therapeutic plan consisted of mechanical colon cleansing with mannitol with rectosigmoidectomy with primary anastomosis with the rectum, but this procedure was impossible due to intestinal obstruction and the impossibility of mechanical colon cleansing. Therefore, rectosigmoidectomy was performed using the Hartmann technique. The surgical specimen removed during the operation was sent for anatomopathological study to confirm the clinical diagnosis and differential diagnosis (the main cause was the sigmoid colon tumor). The histopathological result showed chronic diverticulitis aggravated with granulomatous lymphadenitis in seven lymph nodes, without evidence of a neoplastic process. Final considerations: The case report described here pointed to the consolidation of the diagnosis of diverticulitis complicated with vaginal rectal fistula, based on the clinical and laboratory study, and how the therapeutic plan changed due to the conditions observed during the exploratory laparotomy.