Fistulization of the large intestine with the female genital organs
is a frequent complication of diverticular disease complicated,
and occurs mostly in patients who have previously undergone
hysterectomy. Patients typically present with loss of material fecaloid
or gas from the vagina, preceded by abdominal pain that
resolved with the release of material vaginal. The percentage of
fistulas after an episode diverticulitis is less than 5% (1-2%): of
these, less than a quarter develops fistulas with the female genital
tract, in fact in most cases the fistulization occurs with the
bladder. Other possible causes of fistula between the intestinal
tract and the genital are: irradiation of the pelvis, neoplasms of
colon cancer, inflammatory bowel disease (especially Crohn’s
disease). Traditionally, the treatment of fistulas article-genital
surgical-type “multi-step”: there are several treatment options
guided by the “degree” of diverticular disease and basic organ
involved (fallopian tubes, uterus, vagina). Typically using
a three-step approach: proximal colostomy followed at a later
time by resection and anastomosis tract affection and finally
closing the colostomy; or two-step approach with Hartmann’s
procedure (resection with colostomy proximal and subsequent
restoration of the continuity digestive).
Key words: Diverticulitis - Vasovasostomy - Fistula.
La creazione di una fistola cologenitale è un evento molto
raro, le cause più frequenti possono essere una malattia
diverticolare del colon sinistro, una neoplasie dell’utero,
postchirurgica negli interventi di isterectomia, post irradiazione
della regione pelvica, una malattia infiammatoria
cronica intestinale o causata da traumi da corpi estranei. La
sintomatologia è caratterizzata soprattutto da dolori addominali,
con presenza di uno stato febbrile e perdite fecali
dalla vagina.
Caso clinico
Paziente donna di anni 70, con anamnesi patologica remota positiva
per ipertensione arteriosa, HBV positiva, malattia diverticolare
del colon ed isterectomia per leiomiosi (circa 20 anni prima). Viene
riferita da circa un anno la presenza di improvvisi dolori addominal