Two-step treatment with laparoscopic fistula closure for colocutaneous fistula secondary to sigmoid colon diverticulitis without colonic resection: A case report

Colocutaneous fistula is a rare complication of diverticulitis, typically requiring surgical colonic resection. However, surgery for complicated diverticulitis entails risks such as anastomotic leakage or creation of a stoma, both of which can adversely affect quality of life. Here, we present a case of a colocutaneous fistula treated with a two-step approach: cutaneous drainage with antibiotics followed by laparoscopic fistula closure to avoid colonic resection. A man in his 70 s was referred to our emergency room (ER) with a 2-day history of fever and right lower quadrant abdominal pain. A computed tomography (CT) scan revealed sigmoid diverticulitis with an intra-abdominal abscess, and percutaneous drainage was performed. Following drainage and antibiotic therapy, his symptoms improved, and he was subsequently discharged. Seven days later, he returned to the ER with recurrent symptoms and purulent discharge from the drainage site. He was readmitted, and a CT scan revealed an enlarged intra-abdominal mass. Additional drainage was performed by reopening the scar. Contrast imaging revealed a colocutaneous fistula. Following two hospitalizations for intra-abdominal abscess management, an elective laparoscopic fistula closure was undertaken. He was discharged on postoperative day 15 and continued with routine follow-up. For patients with colocutaneous fistula and diverticulitis, a two-step approach—initial cutaneous drainage with antibiotics followed by laparoscopic fistula closure—offers a viable alternative to immediate colonic resection, minimizing surgical risks and reserving resection as a future option.