The Authors report on a rare case of
diverticular disease complicated by a sigmoid-
vaginal fistula with personal considerations based on a review of literature. A 75 year old patient becomes to our observation suffering the lost of smelly vaginal secretions without
fever or abdominalgia. In anamnesis
hysterectomy cholecystectomy appendectomy and visceral adhesions lysis. Colonoscopy RX barium enema, gynaecological examination, vaginal
buffer show diverticulis of colon sigma with sigmoid-
vaginal fistula. After
laparotomy, visceral adhesions lysis, it was done sigmoid-
vaginal fistula resection with healing.
Diverticular disease is a XX century pathology with incidence (for some authors) of 50% of population. Symptomatic forms affect 30-50% of patients (variable percentage based on age); the 1% of these need surgery. The colonic anatomical-functional disorder is the principal cause of
diverticular disease that recognize the main localization in colon-sigma.
Diverticulitis with pericolic
inflammation are frequent complications; possible evolutions are local tamponed
peritonitis, mechanical intestinal occlusion,
hemorrhage from colonic wall and
fistulas. Sigmoid-
vaginal fistula is the most frequent in women previously treated with laparohysterectomy. The colonoscopy and RX barium enema are gold standard for instrumental diagnosis; the vaginography is diriment, urography excludes
urological diseases. The surgical treatment is the
fistula resection, with or without colonic resection. In consideration of the necessity of conservative surgery and on the basis of this case, the authors suggest, if it's possible, the simple
fistula resection, although the literature report an high number of relapses.