Colonic diverticulitis with perforation to region of left hip: a rare complication
Richard G. Farmer, M.D.
Department of Gastroenterology
Frank L. Weakley, M.D.
Department of Colon and Rectal Surgery
Howard J. Klein, M.D.
Department of Hospital Radiology
Charles M. Evarts, M.D.
Department of Orthopaedic Surgery
ONE of the most severe complications of diverticulitis of the sigmoid colon is perforation with fistula formation. The urinary bladder is the most common site of colonic diverticular fistulization because of its anatomic location. Other sites as possible targets for fistulas in diverticulitis are: bowel (enterocolic or colocolic fistula); adjacent integument (colocu-taneous fistula); pelvic floor (ischeorectal abscess or perianal fistula); or vagina (rectovaginal fistula).1 In a study by Localio and Stahl2 of 164 surgically treated cases of diverticulitis, fistulas from the sigmoid colon were reported to have developed in 10 patients. Asch and Markowitz,3 reporting on 209 patients with diverticulitis in a 10-year period, found 23 with fistula formation (17 sigmoidovesical, 4 rectovaginal, 1 sigmoidocutaneous, and 1 sigmoidoretroperitoneal). Bolt and Hughes,4 describing the follow-up study of 100 patients with diverticulitis, found that seven had fistulas to the bladder or vagina. Other authors5–8 have commented on the rarity of fistulas elsewhere in the body and also on the rarity of “free” perforations of sigmoid diverticula.
Emphysematous cellulitis of the thigh and hip rarely originates from an enteric fistula secondary to colonic diverticulitis. Four cases have been reported in which a perforated diverticulum resulted in a fistulous tract extending into the hip region.9–11 Because of the rarity of this complication, we present the following case report.
Report of a case
A 65-year-old man was transferred to the Cleveland Clinic Hospital on May 30, 1969, with a diagnosis of chronic diverticulitis of the sigmoid colon. He had first been hospitalized on . . .