WHEN DIVERTICULITIS CROSSES THE DIAPHRAGM: A RARE CASE OF COLOPLEURAL FISTULA giselaoropeza@outlook.com

PE122

WHEN DIVERTICULITIS CROSSES THE DIAPHRAGM: A RARE CASE OF COLOPLEURAL FISTULA

9

Billy Jiménez Bobadilla giselaoropeza@outlook.com Hospital General de México Coloproctology Ciudad de México Mexico *

Mexico

Oral or Poster

Colopleural fistulas are mostly left-sided and are related to trauma, Crohn's disease, or gastrointestinal malignancy. Colopleural fistulas often present with respiratory symptoms ranging from mild cough and dyspnea to empyema sepsis caused by leakage of gastrointestinal contents into the pleural space.

The objective of this research is to present a case of colopleural fistula, which is a rare pathology and little reported in the literature.

Male, 44 years old, without chronic diseases, with an 8-year history of diverticular disease. Seven years prior he presented an intra-abdominal abscess with colovesical fistula that drained spontaneously through the urethra. He was admitted with intermittent nocturnal fever and dyspnea on moderate exertion, unresponsive to outpatient antibiotics. Thoracic CT revealed a 600 cc left pleural empyema communicating with the ipsilateral retroperitoneum, associated with diverticulitis of the descending colon complicated by retroperitoneal abscess and left colopleural fistula. Exploratory laparotomy was performed with left hemicolectomy, end-to-end transverse-sigmoid anastomosis, splenectomy, and resection of the colopleural fistula. Findings included fixed splenic angle with thickened walls, fistulous tract from the splenic flexure to retroperitoneum and pleural cavity, purulent collections in both spaces, and a splenic abscess. Thoracotomy with decortication showed trapped lung by visceral pleura up to 1 cm and 1000 ml of fetid purulent pleural fluid. The patient was discharged in stable condition.

It is necessary to publish more cases of this pathology to define a definite diagnosis and treatment for this type of complications associated with diverticular disease.