Colopleural fistula, a rare pathological connection between the colon and the pleural cavity, is associated with high mortality and typically requires surgical management. We report the case of a 63-year-old man with colopleural fistula secondary to diverticulitis that progressed to a lung abscess. He was transferred with sepsis and metabolic acidosis in the setting of pneumonia and a left lower lobe (LLL) abscess. During intravenous antibiotic therapy at the referring hospital, he developed uncontrolled epistaxis requiring additional management. His medical history included diabetes mellitus, atrial fibrillation, and prior repair of a perforated gastric ulcer. Despite 5 days of antibiotic therapy, the infection persisted. On hospital day 6, contrast-enhanced computed tomography revealed a fistulous tract between the LLL and the splenic flexure; colonoscopy confirmed diverticulosis with a fistulous communication. Surgical management included left hemicolectomy, adhesiolysis, video-assisted thoracoscopic LLL resection, and diaphragmatic repair. Postoperatively, an intra-abdominal abscess required reoperation, and gastric ulcer bleeding was treated endoscopically. The patient was discharged without further complications. Colopleural fistula should be suspected in cases of lung abscess that are unresponsive to antibiotics; early contrast-enhanced imaging and timely surgical intervention are essential to optimize outcomes.

Small intestinal diverticula is a rare occurrence, and their surgical management remains controversial due to the lack of a recognized classification system. Complications such as perforation and obstruction are treated surgically. Their etiology remains nebulous but theories such as damage to the Auerbach’s nerve plexus have been advanced as a possible cause. The concomitant presence of a sigmoid intussusception due to diverticular disease in the same patient is truly a rare occurrence. The vast majority of colonic intussusception is due to malignancy and a benign etiology remains elusive. The reported cases of benign causes include a lipoma and benign lymphadenopathy. We believe this to be the first such case report of a colonic diverticulum causing an intussusception. Despite an exploratory laparotomy of less than sixty minutes, the patient demised in the intensive care unit following an occipital lobe stroke. We believe this case of sigmoid intussusception with concomitant small intestinal diverticula to be the first such case report of its kind in English-language scientific publications.

Citations

• Chordae Rupture Alters Tricuspid Valve Leaflet Biomechanics
  Julia Clarin, Keyvan A. Khoiy, Samuel D. Salinas, Dipankar Biswas, Kourosh T. Asgarian, Francis Loth, Rouzbeh Amini
  Cardiovascular Engineering and Technology.2026; 17(2): 223.     CrossRef