Colo-cutaneous fistula in the setting of complicated sigmoid diverticulitis previously managed with percutaneous drainage: a case report

Colo-cutaneous fistulas are a rare complication of diverticular disease. Percutaneous drainage offers a promising alternative to surgical intervention in the management of complicated diverticular disease with abscess formation. Recent case studies and literature reviews support its efficacy in achieving abscess resolution and reducing the need for surgery. However, careful patient selection, technical proficiency, and multidisciplinary management are critical to optimizing outcomes. As the body of evidence grows, percutaneous drainage is likely to play an increasingly important role in the therapeutic arsenal against complicated diverticular disease; however, the risk of complications, particularly fistula formation, must be carefully considered. Our case presents a rare incident of a colo-cutaneous fistula occurring after CT-guided percutaneous drainage of a pericolic abscess secondary to perforated sigmoid diverticulitis that failed medical management. The patient ultimately underwent Hartmann's procedure where the diseased sigmoid colon, adhered small bowel, and fistula tract were excised with an end colostomy creation.