Coloarticular Fistula as a Long-Term Sequela of the Hartmann Procedure

Coloarticular fistula is a rare complication of the Hartmann procedure, reported in the literature only a few times. Risk factors may include underlying colonic malignancy and other proinflammatory conditions. Herein, we describe the case of a 78-year-old female with a recent history of total hip replacement, misdiagnosed Crohn's disease, and a Hartmann procedure for perforated diverticulitis who developed a psoas abscess. Further investigation, including gastrografin enema and computerized tomography, revealed significant fistulization between her hip prosthesis, rectal stump, adnexa, and cecum. Intervention required extensive interdisciplinary decision-making, and the patient underwent interventional radiology-guided abscess drainage, arthroplasty revision, and exploratory laparotomy.