title: Perforated diverticulitis of the sigmoid colon revealed by a perianal fistula.
abstract: BACKGROUND
  Diverticular disease of the colon is a frequent pathology; however, perforated diverticulitis with a spontaneous sigmoidocutaneous fistula revealed by a perianal abscess is an uncommon presentation. We present this extremely rare case of a perforated sigmoid diverticulum in the perianal area, which is the first case that we have encountered in our practice and in the literature, along with the accompanying diagnostic and therapeutic issues and a review of the literature.
  
  
  METHODS
  We report the case of a 47-year-old man who was admitted to the emergency room due to a perianal abscess. The patient was taken to the operating room on an emergency basis. In the lithotomy position, the abscess was located at the 4 o'clock position. Incision and drainage was performed. Intraoperatively, the abscess was found to be deep, and considered an ischiorectal abscess. No fistulous tract was identified. An MRI of the pelvis was performed one month postoperatively which revealed a perforated diverticulitis of the sigmoid colon causing a perianal fistula. After the abscess was successfully treated, a sigmoidectomy was performed. Fifteen centimeters of the colon were resected. No postoperative complications occurred.
  
  
  CONCLUSIONS
  Perianal fistula is an obvious physical sign but its etiology is complex to determine. The pathophysiological mechanism involved is the emergence of a pressure gradient between the peritoneum and surrounding structures, causing rupture of the perianal tissue, allowing gas from a perforation to diffuse along tissue planes.
  
  
  CONCLUSIONS
  General surgeons should bear in mind this rare presentation of a sigmoid diverticulitis.
authors: Department of General Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France.
authors: Imed Ben
authors: IB
authors: Amor
authors: Department of General Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond 42270, Saint Etienne, France. Electronic address: Radwankassir42@hotmail.Fr.
authors: Radwan
authors: R
authors: Kassir
authors: Department of Digestive Surgery, Centre Hospitalier Régional Metz-Thionville, Thionville, France.
authors: Elias
authors: E
authors: Bachir
authors: Department of General Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France.
authors: Hufschmidt
authors: H
authors: Katharina
authors: Department of General Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France.
authors: Tarek
authors: T
authors: Debs
authors: Department of General Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France.
authors: Jean
authors: J
authors: Gugenheim
keywords: Colonic diverticulosis; Perforation; Perianal fistula; Surgery
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