Colouterine fistula complicating diverticulitis: charcoal challenge test aids in diagnosis.
Fistula formation between a segment of colon and the uterus is an unusual complication of diverticulitis; only 17 cases have been reported in the world literature. We describe a 69-year-old woman with a colouterine fistula secondary to diverticulitis. She presented with a malodorous vaginal discharge that grew multiple enteric organisms on culture. A barium enema revealed colonic diverticula but no fistula tract. Orally administered activated charcoal was seen flowing from the cervical os during a pelvic examination the following day, establishing a diagnosis of colouterine fistula. Pathologic examination of the resected colon and uterus confirmed this diagnosis and determined that diverticulitis was the etiology. From a review of the literature, we conclude that radiographic and invasive procedures cannot be depended upon for diagnosis. Ingestion of activated charcoal may provide a simple, noninvasive approach to the diagnosis of enterouterine fistulas.
Huettner
P C
PC
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Finkler
N J
NJ
Welch
W R
WR
D000368:Aged; D002606:Charcoal; D003108:Colonic Diseases / Q000175:diagnosis / Q000209:etiology*; D004239:Diverticulitis, Colonic / Q000150:complications*; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology*; D014591:Uterine Diseases / Q000175:diagnosis / Q000209:etiology*
D002606:Charcoal