This case report illustrates complex sigmoid diverticulitis presenting as tubo-ovarian abscess and developed iliopsoas abscess as complications.  A 37-year-old female presented with lower abdominal pain, fever and diarrhoea. Initial clinical assessment and CT imaging diagnosed tubo-ovarian abscess. She underwent laparoscopic drainage. Patient represented with similar complaints. Further imaging visualised persistent tubo-ovarian abscess with a new iliopsoasabscess. Her disease progression and initial treatment failure led to clinical diagnosis of sigmoid diverticulitis. The patient underwent Hartmann’s procedure and radiological drainage and has been asymptomatic since then. A Hartmann reversal is planned. First, it demonstrates the potential for sigmoid diverticulitis to present as tuboovarian abscess and develop iliopsoas-abscess complications. Second, it signifies prudence of high degree suspicion when evaluating female patients with pelvic abscesses and gastrointestinal symptoms. Finally, it shows the value of the MDT-approach in providing optimal care.

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