A COLOCUTANEOUS COLOVESICAL FISTULA IN A 24 YEAR OLD MALE DUE TO DIVERTICULITIS WITH ABSCESS

Objectives: Diverticulitis is a common cause of morbidity in western countries and will usually present in females during their 6th decade of life. Patients are primarily diagnosed with CT of the abdomen and pelvis where diverticulitis of the sigmoid colon is the most common abnormal finding, however abscesses and fistula are less frequently present and constitute a complicated case of diverticulitis. Management of diverticular abscesses is primarily with percutaneous drainage if feasible, however fistula may necessitate surgical intervention in many cases. Colovesicular fistulas are the most common fistula related to diverticular disease however colocutaneous fistula are a much less frequent occurrence in this setting. Herein we have detailed an extremely rare case of a 24-year-old Hispanic male presenting with acute diverticulitis complicated by an abscess that presents as a simultaneous colovesicular and umbilical colocutaneous fistulae. This patient was managed successfully initially with open segmental resection, end colostomy diversion, and foley catheter drainage. Six weeks later he underwent a diagnostic colonoscopy for operative planning and to rule out a distal obstruction, which was followed by a colostomy reversal a few weeks thereafter. He was discharged on hospital day 4 and at subsequent follow up and two months follow up was doing well. This case demonstrates an advanced case of a diverticulitis in a young patient, successfully managed with a standard two step sequence of events.

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