Abstract

Background: 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. Patient and Methods: the patient aged 80 was admitted urgently, diagnosed with intestinal occlusion. Generally poor conditions: renal insuffiency, 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° C; dysuria; aero-hydro levels; stenosis of the sigmoid. A decision was taken to operate. Surgery: the presence of a large mass at the level of the sigmoid, which subsumed the ileal ansae, the vescica 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 descendens. Discussion: 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. Conclusions: 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.