Coloarticular Fistula: A Rare but Potentially Fatal Complication

Abstract

Introduction: Coloarticular fistula is a very rare entity and is a potential complication after total hip arthroplasty. Discussions surrounding coloarticular fistulas is presented mainly as case reports in the literature. Case: A 66-year-old Caucasian female evaluated at our institution for left hip pain and weakness. Radiologic evaluation showed periprosthetic infection with further discovery of air in the hip joint. Abdominal exploration by general surgery did not show any intraoperative findings concerning for coloarticular fistula. Diagnosis of coloarticular fistula was later made with a gastrograffin enema study following negative findings from MRI of pelvis with contrast. She was treated with distal transverse colostomy. The patient had a difficult post-operative course with sepsis and multi-organ failure that resulted in death. Conclusion: Coloarticular fistula is a rare complication of hip arthroplasty and is associated with high morbidity and mortality rates. This complication should be taken into consideration during evaluation of hip joint infections in patients with history of hip arthroplasty. Despite prompt diagnosis and treatment final outcome may be fatal.