Colo-Salpingeal Fistula and Secondary Tubo-Ovarian Abscess as Rare Complications of Sigmoid Diverticulitis: A Case Report.

Secondary tubo-ovarian abscess (TOA) arising from gastrointestinal pathology is a rare and diagnostically challenging condition. We report the case of a 43-year-old gravida one para one woman with a chronic pelvic abscess refractory to prolonged antibiotic therapy and multiple percutaneous drainage attempts. The patient presented with persistent lower abdominal pain, low-grade fever, and decreased output from a previously placed pelvic drain. Imaging demonstrated a complex left pelvic mass with subsequent concern for rectosigmoid colon involvement. Surgical management consisted of robotic total laparoscopic hysterectomy, bilateral salpingectomy, left salpingo-oophorectomy, extensive lysis of adhesions, and robotic-assisted sigmoid colon resection with primary anastomosis. Final pathology confirmed colonic diverticulitis with a colo-salpingeal fistula and secondary tubo-ovarian abscess. This case highlights the importance of recognizing secondary TOA as a potential complication of diverticular disease and underscores the role of multidisciplinary surgical management when conservative therapy fails.