BACKGROUND: Colouterine fistula is a rare complication of diverticulitis. We report 2 cases of colouterine fistula in elderly women presenting with fever and pyuria and managed with an aggressive workup and surgical treatment. CASES: Two elderly women presented with persistent pyuria, abdominal pain and fever without a vaginal discharge. Imaging revealed diverticulitis and a fistula. One patient, 92 years of age, underwent hysterectomy, sigmoid resection and primary colorectal anastomosis. The second patient, aged 87, was treated with hysterectomy, sigmoid resection and diverting colostomy with delayed colostomy closure. CONCLUSION: Colouterine fistula may present with pyuria, fever and abdominal pain even in the absence of vaginal discharge. Patients who are elderly and fragile are more likely to be treated conservatively and inappropriately. We advocate surgical management, including resection of all involved tissue, early in the course of the disease. In elderly women, aggressive 1- or 2-stage procedures are highly successful and could save the patients' lives.
BACKGROUND: Colouterine fistula is a rare complication of diverticulitis. We report 2 cases of colouterine fistula in elderly women presenting with fever and pyuria and managed with an aggressive workup and surgical treatment. CASES: Two elderly women presented with persistent pyuria, abdominal pain and fever without a vaginal discharge. Imaging revealed diverticulitis and a fistula. One patient, 92 years of age, underwent hysterectomy, sigmoid resection and primary colorectal anastomosis. The second patient, aged 87, was treated with hysterectomy, sigmoid resection and diverting colostomy with delayed colostomy closure. CONCLUSION: Colouterine fistula may present with pyuria, fever and abdominal pain even in the absence of vaginal discharge. Patients who are elderly and fragile are more likely to be treated conservatively and inappropriately. We advocate surgical management, including resection of all involved tissue, early in the course of the disease. In elderly women, aggressive 1- or 2-stage procedures are highly successful and could save the patients' lives.