Chronic sigmoid diverticulitis causing tubo-ovarian abscess and colo-uterine fistula

Colo-uterine fistulas are rarely reported in the literature, and its presentation in the presence of a tubo-ovarian abscess secondary to chronic sigmoid diverticulitis is currently not reported. As such, its presentation may pose a diagnostic dilemma. Here, we present a 68-year-old woman who was admitted under the colorectal service with a 1 month history of mild left iliac fossa pain, with computed tomography (CT) demonstrating complicated sigmoid diverticulitis. Progress CTs, however, demonstrated a progressively enlarging left iliac fossa mass, with air fluid levels, densely adherent to the sigmoid colon. The decision was eventually made to perform a laparoscopy, which demonstrated a left tubo-ovarian abscess communicating with the uterus and sigmoid colon, illustrating a colo-uterine fistula. Open resection of the sigmoid colon and uterus was performed and the patient recovered uneventfully. This case describes an uncommon complication of chronic sigmoid diverticulitis and the importance of its judicious surgical management.