# Complicated Sigmoid Diverticulitis Mimicking Pelvic Pain in a Patient With Giant Uterine Fibroids: A Case Report

## TL;DR

A woman with large uterine fibroids developed complicated diverticulitis, highlighting how fibroids may influence gut health and diverticular disease risk.

## Contribution

The case suggests a novel link between uterine fibroids, altered gut microbiome, and increased diverticulitis risk.

## Key findings

- Large uterine fibroids may exert pressure on the colon, impairing motility and promoting diverticula formation.
- Altered gut microbiome in patients with fibroids could contribute to colonic inflammation and diverticular disease.
- The case underscores the need for further research on fibroid-related influences on diverticulitis pathophysiology.

## Abstract

This report describes the case of a woman in her late forties with a history of large uterine fibroids who presented to the Emergency Department with colicky suprapubic pain and urinary symptoms. Initial computed tomography (CT) showed uncomplicated acute diverticulitis but despite antibiotic treatment, her condition worsened, and a follow-up CT revealed sigmoid perforation, requiring high anterior resection and subtotal hysterectomy. The case highlights how large fibroids exert external pressure on the colon, impairing motility and increasing the risk of diverticula formation. Alterations in the gut microbiome may contribute to colonic mucosal inflammation, commonly seen in diverticular disease. Patients with uterine fibroids have altered microbiome composition, which could further increase the risk of diverticular disease. These findings provide a pathway for future research into the influence of uterine fibroids on the pathophysiology of diverticular disease.