Introduction: Diverticulitis is an inflammatory disease of the intestine that can lead to complications such as perforation, abscesses, and fistulas, including a colouterine fistula. Colouterine fistulas are rare, certainly in combination with a tubo-ovarian abscess (TOA), and the literature on this topic is scarce. Case presentation: We report the case of a 54-year old woman with recurrent intra-abdominal and tubo-ovarian abscesses and a colouterine fistula due to complicated sigmoid diverticulitis. The patient initially presented with left iliac fossa pain, fever, and altered bowel habits, without vaginal or urinary symptoms. Her medical history included a left-sided ectopic pregnancy and previous episodes of diverticulitis. Treatment consisted of intravenous (IV) antibiotics, radiological and surgical drainage, and eventually Hartmann’s procedure with a salpingo-oophorectomy. Histopathology confirmed the presence of a TOA and a fistula. Discussion: This case highlights the diagnostic difficulty in distinguishing complicated diverticulitis from pelvic inflammatory disease (PID) as a cause of a TOA in the presence of a colouterine fistula, especially when CT imaging shows no signs of the fistula or of active diverticulitis. A multidisciplinary approach involving gynecology, radiology and surgery contributed to achieving a successful outcome. Furthermore, this case suggests that a colouterine fistula caused by complicated diverticulitis can be managed with Hartmann’s procedure without hysterectomy. Conclusion: Clinicians should consider complicated diverticulitis as a potential cause of TOA, even in the absence of radiologic signs. Multidisciplinary collaboration and individualized surgical management are essential for optimal outcomes in these rare and complex cases.
Hers et al. (2026) studied this question.