Ileorectal fistula after resection of perforated sigmoid tumor and Hartmann’s procedure with uterine invasion: a case report

Gastrointestinal fistulas are rare but serious postoperative complications, particularly when arising between the ileum and rectum. They are typically associated with complex intra-abdominal surgeries, malignancies, or inflammatory conditions. This case report presents a rare instance of ileorectal fistula formation following resection of a perforated sigmoid tumor with uterine invasion and subsequent Hartmann's procedure. A 40-year-old Kurdish woman with a history of diabetes mellitus presented with abdominal pain, weight loss, and diarrhea. Imaging revealed a large pelvic mass suggestive of a perforated sigmoid tumor invading the uterus. Emergency laparotomy confirmed the diagnosis, and Hartmann’s procedure was performed. Postoperative recovery included chemotherapy. Months later, the patient returned with defecation per anus despite a colostomy, suggesting a fistula. Imaging confirmed an ileorectal fistula. During reoperation, the recurrent tumor and fistulous tract between the ileum and Hartmann’s pouch were excised. Surgical repair included small bowel resection with anastomosis and ureteral reimplantation due to adjacent involvement. This case underscores the complexity of managing advanced colorectal malignancies with pelvic involvement. Ileorectal fistula is a rare but critical complication of Hartmann’s procedure, necessitating individualized surgical planning and vigilant postoperative follow-up to optimize outcomes.