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CLINICAL OUTCOMES OF COMPLICATED SIGMOID DIVERTICULITIS WITH ASSOCIATED TUBO-OVARIAN ABSCESS
V. Prasad Poola*, Maria L. Rossi, Jan Rakinic
Department of Surgery, SIU School of Medicine, Springfield, IL
Introduction:
Presentation of complicated sigmoid diverticulitis with associated tubo-ovarian abscess is rare. Hence, there is limited literature available guiding treatment and prognosis. We would like to report our clinical outcomes in a series of patients who presented emergently with complicated sigmoid colon diverticulitis with associated tubo-ovarian abscess.
Methods:
This is a retrospective observational study conducted at a tertiary level university teaching hospital between 2014 -2017. We included all patients who presented with abdominal pain to emergency room and found to have complicated sigmoid colon diverticulitis with associated tubo-ovarian abscess on diagnostic imaging.( Image 1) Variables including patient demographics, co-morbidities, and details of imaging, percutaneous drainage procedures, and subsequent operative interventions are retrieved and studied. Specific emphasis is given to type of operation, stoma creation and subsequent stoma reversal.
Results:
Four patients are identified during the study period. Three out of four (75%) are admitted and treated initially with percutaneous drain placement, and in one patient (25%) operative intervention is considered without percutaneous drainage. Colorectal surgery and Gynecology consulted on all patients. All the patients underwent partial colectomy and oophorectomy within two months. Involved segment of colon and ovary required resection in all patients after percutaneous drainage. Details of CT findings and operations are shown in Table 1.
Conclusion:
Management of complicated sigmoid diverticulitis with associated tubo-ovarian abscess has very high failure rate, in contrast to historical success in diverticular abscesses with percutaneous drainage. Partial colectomy and oophorectomy with high chance of stoma is noted in our study.
Table 1
| Patient | Age | Prior Hysterectomy | CT findings | Duration of Percutaneous drainage (days) | Operation | | 1 | 46 | yes | 10.4 x 7.1 x 7.5 cm left ovarian abscess; multiloculated with multiple air-fluid levels and mild rim enhancement. | 46 | Hartmann resection with bilateral salphingo- oophorectomy | | 2 | 37 | no | 4.5 cm diameter parasigmoid abscess involving the left fallopian tube and left broad ligament with resultant hydrosalpinx | 7 | Hartmann resection with left oophorectomy | | 3 | 69 | no | Proximal sigmoid colon diverticulitis with pericolonic abscess measuring 6.7cm in diameter and free pelvic fluid | 0 | Hartmann resection with left oophorectomy | | 4 | 44 | no | 6.5 x 6 x 8.1 cm left ovary abscess with acute Diverticulitis with sigmoid perforation. | 48 | Left colectomy with primary anastomosis; total abdominal hysterectomy and bilateral salphingo- oopharectomy |
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