Case Report: Surgical intervention of colo-pleural fistula secondary to colon diverticulosis with history of hernia diaphragmatica

Abstract

Abstract* Introduction Colopleural fistulas are rare and generally correspond to thoracic empyema alongside an acute abdomen. Early diagnosis and prompt treatment are essential to prevent recurrence of thoracic empyema. Case presentation An 18-year-old male was admitted to our hospital with dyspnea and abdominal pain. The patient had a history of a left diaphragmatic hernia repair. Physical examination revealed signs of left-sided pleural effusion and abdominal pain. Chest computed tomography (CT) revealed a left lung empyema with a suspected connection to the intra-abdominal cavity through the diaphragm. Colopleural fistula and diverticulosis were confirmed by colonoscopy. Subsequently, primary resection, transverse-descending anastomosis, and fistula suturing were performed, accompanied by empyema evacuation through thoracotomy and diverting colostomy. Clinical Discussion Colopleural fistula is an incredibly rare phenomenon that can result from diaphragmatic injury, malignancies, perforated diverticulosis, or colonic/pulmonary infections. The management of a colopleural fistula depends on anatomical, clinical, and other factors. Diverticulitis is usually treated using antibiotics and other conservative therapies. Diverticular disease usually requires surgery if there is perforation, progressive signs of sepsis or peritonitis, fistula, or failure of conservative treatment. A surgical procedure was performed in this case because of empyema arising from a colopleural fistula formation caused by diverticulosis. Conclusion Primary colon resection, colon anastomosis, fistula suturing, and decortication thoracotomy were shown to effectively treat colopleural fistula.