Design: A case report.

Setting: A tertiary medical center.

Patients or Participants: A 63-year-old postmenopausal woman presented with persistent symptomatic diverticulitis. Emerging gynecologic symptoms, including vaginal flatulence, posed diagnostic challenges requiring a multi-specialty approach to care. Computed tomography (CT) scans revealed complicated sigmoid diverticulitis with uterine involvement. Symptom persistence despite medical management prompted surgical intervention. Laparoscopic exploration allowed diagnostic confirmation of a colo-salpingeal fistula, an anomalous complication of diverticular disease.

Interventions: Sigmoid colectomy and left salpingo-oophorectomy were successfully performed with a multi-specialty, minimally invasive surgical approach. Primary colorectal anastomosis was then completed.

Measurements and Main Results: Surgical pathology of the resected specimen revealed chronic inflammation of the fallopian tube and ovary as well as chronic sigmoid diverticulitis. The patient made an uncomplicated postoperative recovery with remission of symptoms.

Conclusion: Colo-salpingeal fistula is a rare complication of diverticulitis which may present with gynecologic symptoms. This case underscores the need to recognize gynecologic symptoms related to diverticular disease, which may be subtle, but provide important considerations to guide decision-making regarding surgical intervention. Additionally, this case emphasizes how a multidisciplinary approach to care, from diagnosis through recovery, allowed for minimally invasive surgical treatment, avoiding further complications and the need for a more invasive approach. This highlights the complexities involved in surgical management of diverticulitis-associated gynecologic fistulas, emphasizing the need for individualized treatment strategies. By sharing insights from this case, we aim to contribute to the literature on colo-salpingeal fistulas, both to facilitate clinical understanding of gynecologic manifestations of diverticular disease and to support evidence-based care.