A rare case of colo-salpingeal fistula complicating acute sigmoid diverticulitis

Colo-salpingeal fistulae due to acute diverticulitis are rare entities. A 65-year-old female with a 5-day history of left iliac fossa pain, fevers and diarrhoea was seen in a metropolitan hospital. Initial computed tomography of the abdomen and pelvis characterized a left tubular adnexal structure with an air fluid level and normal-appearing colon and was reported as pyosalpingitis. Worsening sepsis despite antibiotics prompted further imaging where thickening of the sigmoid colon was noted, and the provisional diagnosis was revised to complicated acute diverticulitis with perforation into the left fallopian tube/ovary. This was managed with a laparoscopic anterior resection and en bloc left salpingo-oopherectomy, and was followed by an uneventful recovery. The presence of a gas-containing collection remains a sensitive imaging sign for the presence of an enteric fistula and a high index of suspicion should be maintained when this is encountered.