Retroperitoneal abscess from sigmoid colon diverticulosis aggravating the symptoms of left coxarthrosis

The treatment of diverticulitis of the colon is conservative. Surgical treatment is only needed in the case of complications, like perforation, fistula or abscess. 80% of the population above 80 years old have colon diverticulosis. Most of the diverticuli are located at the sigmoid colon. Diverticulitis is observed in 20% of the diverticulosis patients. An abscess infiltrating the retroperitoneum is rear. We demonstrate a successful treatment.

A 64-year old female patient had appendectomy, hypertension, hypothyreosis and PCP in her medical history. An orthopaedic consultation because of left hip pain revealed incipient arthrosis of the hip joint and a 4×4cm tumor in the left lower abdomen. A CT scan showed a 70×33×40mm liquid containing lesion with a thick wall, subdivided by several septa, which followed the contour of the iliac bone, involved the pelvic diaphragm, where the musculature had a thickness of 34mm. Diverticulitis and retroperitoneal abscess were diagnosed. Beside left hip pain the patient had no abdominal complaints, bowel movement was undisturbed and she had no fever. After 3 months of antibiotic and anti-inflammatory treatment CT and MRI control showed little regression. Colonoscopy did not reveal any intraluminal pathologic sign in the sigmoid colon. An exploration confirmed an infiltration on a 15cm long section of the sigma with inflammatory tissue changes in the retroperitoneium, but no abscess was found. A segmental resection of the sigmoid colon was performed. No complication was documented in the postoperative period. Hip pain ameliorated but did not cease. The patient is regularly controlled.