Uncommon Diverticular Disease

Case Series of Right Colon Diverticulitis in the West: A Neglected Disease?

Introduction Right colon diverticulitis (RCD) is an uncommon condition in Western populations, but its incidence has increased over the last decades. Due to its rarity, many surgeons are unfamiliar with this disease, which is often mistakenly diagnosed as acute appendicitis. The lack of data about the diagnosis and management of RCD in Western populations makes it difficult to establish the optimal therapeutic strategy.

Objective To evaluate the outcomes of patients treated for acute RCD and to propose a therapeutic algorithm for the diagnosis and treatment.

Methods A retrospective analysis of the medical records of patients treated for acute RCD between 2008 and 2020 by a single experienced colorectal surgeon was performed.

Results In total, 12 patients were identified, 8 male and 4 female subjects, with a mean age of 49.6 years; 9 of these patients were of Western origin. The median follow-up time was of 49 months (range: 12 to 144 months). The most frequent symptoms were abdominal pain (100%) and fever (66%). Diagnostic errors in imaging exams occurred in four patients. A total of 6 patients were managed clinically, and the other 6 underwent surgical treatment with right colectomy (n = 5) and total colectomy (n = 1), 2 via laparoscopy and 4 through a laparotomy. The anatomopathological examination confirmed RCD in all operated patients. There was no incidental finding of neoplasia and there were no deaths during the study period.

Conclusion Uncomplicated RCD can be treated conservatively with a high success rate. Recurrent cases that impact quality of life or complicated forms of RCD should undergo surgical treatment, preferably through a right laparoscopic colectomy. The authors present a diagnostic and therapeutic algorithm to facilitate the diagnosis and to guide the management of this uncommon disease.

Complicated giant diverticulum of rectosigmoid colon in elderly

Introduction

Giant colonic diverticulum (GCD) is a rare condition defined by diverticular size over 4 cm. Its presentation is usually asymptomatic.

Present of case

We herein report a rare presentation of ruptured GCD in elderly man who suffered from abdominal pain. The patient underwent primary repair and ileostomy to shorten the operation time instead of Hartmann's operation. Post-operative CT revealed complicated GCD with rupture.

Discussion

The exact mechanism of GCD generation is questionable. Most of case is discovered by radiologic exam or computed tomography (CT) incidentally. The most common complications of GCD are perforation and abscess formation.

Conclusion

Symptoms of GCD are like those of usual diverticulosis. But, considering the severity of complications, it is better to prioritize surgical treatment at diagnosis.

•

Giant colonic diverticulum (GCD) is a rare condition defined by diverticular size over 4 cm.

•

Most of patients are discovered by radiologic exam incidentally.

•

The most common complications of GCD are perforation following abscess formation with higher clinical significance.

•

Thus, it is better to prioritize surgical treatment at diagnosis.