[Complication of acute diverticulitis: colo-vesical fistula (a clinical case)]

A patient presenting a colo-vescical fistula together with a number of other pathologies, and the absolute absence of a set scheme for the treatment of septic diverticular complications has prompted us to publish this case.

The patient aged 80 was admitted urgently, diagnosed with intestinal occlusion. Generally poor conditions: renal insufficiency, abdomen globose and hypertympanic, systaltic mass in the epigastric site. The patient had experienced abdominal pains for about 4 months; severe tenesmo during evacuation: fever temperature as high as 38.5 degrees C; dysuria; aero-hydro levels; stenosis of the sigmoid. A decision was taken to operate.

The presence of a large mass at the level of the sigmoid, which subsumed the ileal ansae, the vescical and the sigmoid itself. While isolating the pelvic anatomical structures, a purulent sac in the Douglas was uncovered, which united the bladder and the sigmoid. It was thought appropriate only to fit a colostomy, thus excluding the descendents.

Surgery must resolve the peritonitis and the fenestration itself. Due to the existing septic conditions, it was not believed advisable to perform a primary anastomosis; a Hartmann's or a simple colostomy was thought preferable.

This case underlines the difficulty in standardising operational conduct when this in turn will depend on the experience of the operator and the circumstances met at the time.