Abstract
Colouterine fistula as a sequela of diverticulitis is an extremely rare complication due to the extraordinarily thick layer of myometrium of the uterus. Because of this, an aggressive clinical evaluation is required to rule out other potential causes of fistula formation such as malignancy. However, imaging and laboratory techniques may be inconclusive, and surgery with pathologic analysis may be required for a definitive diagnosis. The case presented here illustrates the atypical presentation of a 63-year-old woman with acutely symptomatic, severely extensive diverticular disease with resultant colouterine fistula. The patient underwent exploratory laparotomy, sigmoidectomy with end colostomy, appendectomy, and total abdominal hysterectomy with bilateral salpingo-oophorectomy. Eventually, she was discharged with an excellent prognosis and had an uneventful recovery. This case is being presented because of the rarity of the disease course as well as the complexity of the decision-making and surgical approach that resulted in patient recovery.