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Abstract Background Colouterine fistula is a very rare entity because of the sturdy and muscular nature of the uterus. Due to the rarity of this condition and nonspecific clinical findings, it poses a diagnostic challenge to treating physicians. Case presentation Here, we report a case of a 64-year-old female, who presented with lower abdominal pain. Clinically, there was suspicion of a recto-vaginal fistula. However, on imaging, she was found to have a colouterine fistula secondary to sigmoid diverticulitis. Conclusion It is essential to be aware of this rare complication of sigmoid diverticulitis. The imaging plays a cardinal role in the diagnosis and guiding the management of this disease.