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Bachelani AM. Natural history and surgical treatment of a giant colonic diverticulum: A case report. World J Clin Cases 2024; 12:3151-3155. [PMID: 38898867 PMCID: PMC11185394 DOI: 10.12998/wjcc.v12.i17.3151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND While diverticular disease is prevalent in the West, the formation of giant colonic diverticula is rare. To date, approximately 200 cases have been reported, with only a handful treated surgically using a minimally invasive approach. Furthermore, the natural history of giant colonic diverticula is not well documented. CASE SUMMARY This report describes the case of a 66-year-old man who developed a giant colonic diverticulum with primary symptoms including dull and chronic pain in the right lower quadrant at presentation. The patient had undergone several computed tomography scans of the abdomen and pelvis over the previous two years, through which the natural history of this rare entity could be retrospectively observed. The patient was successfully treated with a robot-assisted sigmoid colectomy and had an uneventful recovery with resolution of symptoms during the follow-up. CONCLUSION This rare case demonstrates the natural history of giant colonic diverticulum formation and supports the feasibility of robot-assisted surgery.
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Affiliation(s)
- Arshad M Bachelani
- Department of Surgery, Independence Health, Greensburg, PA 15601, United States
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2
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Greer D, Fernandez A. A case report of impacted fecalith within mucosal pouch: an unusual cause of colocolic intussusception. Ann Coloproctol 2024; 40:S15-S17. [PMID: 34788981 PMCID: PMC11162846 DOI: 10.3393/ac.2021.00724.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022] Open
Abstract
Intussusception involving the colon is unusual in adults and when present is managed with resection due to the risk of malignancy. We present an unusual case where the intussusceptum was impacted stool in a mucosal pouch in the transverse colon. The patient presented with bleeding per rectum and abdominal pain and was found to have a colocolic intussusception on computed tomography. Colonoscopy showed an ulcerated mass in the transverse colon. A laparoscopic right hemicolectomy was performed. Histopathology demonstrated known chronic lymphocytic leukemia, but not solid malignancy. A large fecalith impacted within a mucosal pouch had acted as the lead point. This represents a highly unusual but benign cause of intussusception.
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Affiliation(s)
- Douglas Greer
- Department of Surgery, South East Regional Hospital, Bega, NSW, Australia
| | - Adrian Fernandez
- Department of Surgery, South East Regional Hospital, Bega, NSW, Australia
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3
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Malone JC, Patel SR, Walker JP, Shabot M. Giant Colonic Diverticulum: A Rare Type of Diverticular Disease. Cureus 2024; 16:e56463. [PMID: 38638782 PMCID: PMC11025476 DOI: 10.7759/cureus.56463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Giant colonic diverticulum (GCD) is a well-recognized but infrequently encountered disease in clinical practice. GCD is its own unique entity and differs from commonly seen diverticular disease in both size and management. Initial clinical presentation is typically associated with diverticulitis and symptoms such as abdominal pain, fever, nausea, vomiting, rectal bleeding, or even a palpable abdominal mass. Surgery is the recommended treatment option largely due to the risk of associated complications including colonic perforation. We describe the case of a 56-year-old female diagnosed with a sigmoid GCD that was successfully stabilized medically and definitively treated surgically.
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Affiliation(s)
- Jordan C Malone
- Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Shiv R Patel
- John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - John P Walker
- Surgery, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Marc Shabot
- Gastroenterology and Hepatology, University of Texas Medical Branch at Galveston, Galveston, USA
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4
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Li S, Shen Z. A giant rectal diverticulum in an elderly successfully treated with laparoscopic proctectomy. Asian J Surg 2023; 46:3955-3956. [PMID: 37045633 DOI: 10.1016/j.asjsur.2023.03.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Affiliation(s)
- Sheng Li
- Department of Anorectal Surgery, Ningbo No.2 Hospital, Ningbo, Zhejiang, China
| | - Zhonglei Shen
- Department of Anorectal Surgery, Ningbo No.2 Hospital, Ningbo, Zhejiang, China.
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Alslaim H, Baysinger K. Nonoperative Management of Perforated Giant Colonic Diverticulum. Am Surg 2023; 89:314-315. [PMID: 33131288 DOI: 10.1177/0003134820953775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Hossam Alslaim
- Department of Surgery, Medical College of Georgia, 1421Augusta University, Augusta, GA, USA.,Department of Surgery, Division of Colon and Rectal surgery, University Health Care System, Augusta, GA, USA
| | - Katherine Baysinger
- Department of Surgery, Division of Colon and Rectal surgery, University Health Care System, Augusta, GA, USA
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Mohamed Ghouse MA, Ravikumar K, Maruthamuthu G, Murugan B. A rare case of colonic diverticulum in a Bitch. IRANIAN JOURNAL OF VETERINARY RESEARCH 2023; 24:157-161. [PMID: 37790114 PMCID: PMC10542875 DOI: 10.22099/ijvr.2023.46410.6663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/04/2023] [Accepted: 06/17/2023] [Indexed: 10/05/2023]
Abstract
Abstract. Background Colonic diverticulum is one of the rare findings in dogs characterized by an out-pouching of mucosal and submucosal layers through the defect in muscularis layer of the colon. Case description A five years old intact female Labrador was presented with an anamnesis of dyschezia and tenesmus. Findings/treatment and outcome Rectal examination was normal, and the survey radiograph showed an almost crescent shaped abnormal dilatation (10.52 cm × 6.21 cm) with gas and increased radiopaque material, dorsal to the urinary bladder and ventral to the descending colon suggesting fecal stasis. Ultrasonographic examination revealed gas-filled out-pouching with hyperechoic colon wall and acoustic shadowing. Exploratory celiotomy confirmed the diagnosis of colonic diverticulum, and diverticulectomy was performed. All four layers of the colonic wall were detected histopathologically in the biopsy sample and excluded neoplasia. The dog recovered uneventfully with no post-operative complications. Conclusion This surgery produced an excellent resolution of clinical signs. To our knowledge, this is one of the few cases of colonic diverticulum reported in dogs.
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Affiliation(s)
- M. A. Mohamed Ghouse
- Department of Clinics, Madras Veterinary College, Tamil Nadu Veterinary and Animal Sciences University (TANUVAS), Chennai, Tamil Nadu, India
| | - K. Ravikumar
- Veterinary Dispensary, Devakottai, Sivagangai-630 302, Tamil Nadu, India
| | - G. Maruthamuthu
- Department of Clinics, Madras Veterinary College, Tamil Nadu Veterinary and Animal Sciences University (TANUVAS), Chennai, Tamil Nadu, India
| | - B. Murugan
- Department of Clinics, Madras Veterinary College, Tamil Nadu Veterinary and Animal Sciences University (TANUVAS), Chennai, Tamil Nadu, India
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Ohe H, Chang YG. Complicated giant diverticulum of rectosigmoid colon in elderly. Int J Surg Case Rep 2022; 94:107011. [PMID: 35658272 PMCID: PMC9092968 DOI: 10.1016/j.ijscr.2022.107011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 02/07/2023] Open
Abstract
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.
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8
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Difficult diagnosis of right-sided colonic diverticulitis. J Visc Surg 2022; 159:175-176. [DOI: 10.1016/j.jviscsurg.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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BUSTAMANTE-LOPEZ LA, SILVEIRA SDP, SURJAN RCT. ROBOTIC APPROACH FOR THE TREATMENT OF GIANT COLONIC DIVERTICULUM. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:154-156. [DOI: 10.1590/s0004-2803.202200001-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/03/2021] [Indexed: 11/22/2022]
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10
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Merritt CM, Xing C, Schwartz MR, Bailey HR, Van Eps JL. A rare case of multiple giant colonic diverticula successfully treated with laparoscopic sigmoidectomy. J Surg Case Rep 2021; 2021:rjab475. [PMID: 34703578 PMCID: PMC8541822 DOI: 10.1093/jscr/rjab475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022] Open
Abstract
Colonic diverticulosis is pervasive in Western society, with over half of individuals over the age of 60 carrying the diagnosis. A Giant Colonic Diverticulum (GCD) is a rare presentation of diverticulosis, involving one or more colonic diverticula that measure 4 cm or greater. Less than 200 reports of GCD have been published in the literature. Almost all GCD patients present with symptoms, with abdominal pain being the most common. Diagnosis is usually made with CT imaging and recommended treatment is segmental colectomy. We present an atypical case of GCD with an asymptomatic presentation, initial diagnosis made during endoscopy and a minimally invasive resection of multiple GCD within the same patient.
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Affiliation(s)
- Clay M Merritt
- Department of Surgery, Colon and Rectal Surgery, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Chuheng Xing
- Department of Surgery, Section of Colon and Rectal Surgery, UTHealth Science Center at McGovern Medical School, Houston, TX, USA
| | - Mary R Schwartz
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Harold R Bailey
- Department of Surgery, Section of Colon and Rectal Surgery, UTHealth Science Center at McGovern Medical School, Houston, TX, USA
| | - Jeffrey L Van Eps
- Department of Surgery, Section of Colon and Rectal Surgery, UTHealth Science Center at McGovern Medical School, Houston, TX, USA
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11
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Lee MH, Lubner MG, Mellnick VM, Menias CO, Bhalla S, Pickhardt PJ. The CT scout view: complementary value added to abdominal CT interpretation. Abdom Radiol (NY) 2021; 46:5021-5036. [PMID: 34075469 DOI: 10.1007/s00261-021-03135-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 12/30/2022]
Abstract
Computed tomography (CT) scout images, also known as CT localizer radiographs, topograms, or scanograms, are an important, albeit often overlooked part of the CT examination. Scout images may contain important findings outside of the scanned field of view on CT examinations of the abdomen and pelvis, such as unsuspected lung cancer at the lung bases. Alternatively, scout images can provide complementary information to findings within the scanned field of view, such as characterization of retained surgical foreign bodies. Assessment of scout images adds value and provides a complementary "opportunistic" review for interpretation of abdominopelvic CT examinations. Scout image review is a useful modern application of conventional abdominal radiograph interpretation that can help establish a diagnosis or narrow a differential diagnosis. This review discusses the primary purpose and intent of the CT scout images, addresses standard of care and bias related to scout image review, and presents a general systematic approach to assessing scout images with multiple illustrative examples, including potential pitfalls in interpreting scout images.
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Affiliation(s)
- Matthew H Lee
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI, 53792, USA.
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus, Box 8131, St. Louis, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus, Box 8131, St. Louis, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI, 53792, USA
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12
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González-Valverde FM, Madrid-Baños B, Ruiz-Marín M. Giant Diverticulum of the Sigmoid Colon. J Gastrointest Surg 2021; 25:1347-1349. [PMID: 33123874 DOI: 10.1007/s11605-020-04841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/17/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Francisco Miguel González-Valverde
- Department of Surgery, Pediatrics and Obstetrics and Gynecology, University of Murcia, Murcia, Spain.
- General and Digestive Surgery service. Reina Sofia General University Hospital, Avda. Intendente Jorge Palacios 1, 30.003, Murcia, Región de Murcia, Spain.
| | - Beatriz Madrid-Baños
- General and Digestive Surgery service. Reina Sofia General University Hospital, Avda. Intendente Jorge Palacios 1, 30.003, Murcia, Región de Murcia, Spain
| | - Miguel Ruiz-Marín
- General and Digestive Surgery service. Reina Sofia General University Hospital, Avda. Intendente Jorge Palacios 1, 30.003, Murcia, Región de Murcia, Spain
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13
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Ocaña J, Vivas A, Labalde M, Pelaez P, García S, García-Borda J, Ferrero E. Laparoscopic sigmoid resection for a giant colonic diverticulum - a video vignette. Colorectal Dis 2021; 23:1011. [PMID: 33421280 DOI: 10.1111/codi.15520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Juan Ocaña
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Alfredo Vivas
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - María Labalde
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Pablo Pelaez
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Sandra García
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Javier García-Borda
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Eduardo Ferrero
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
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Liekens E, Mutijima Nzaramba E, Geurde B, Seydel B, Jourdan JL. Giant colonic diverticulum: case report of a rare surgical condition. Acta Chir Belg 2021; 121:42-45. [PMID: 31188087 DOI: 10.1080/00015458.2019.1631627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Diverticular disease is a common disorder of the colon with an extremely rare presentation: giant colonic diverticulum (GCD). GCD is defined as a diverticulum measuring 4 cm or larger and affects the sigmoid colon in 90% of the cases. PATIENTS We report on a case of a 74-year-old woman with a GCD. METHODS We present a case report of a 74-year-old woman with a GCD. A brief review of the literature concerning clinical presentation, diagnosis, differential diagnosis, pathogenesis, histological classification and treatment of GCD will be discussed. RESULTS Our patient was treated according to the available information in the literature. The outcome was uneventful. CONCLUSIONS GCD is a rare presentation of diverticular disease. Because of the risk of serious complications, a correct diagnosis and treatment is essential. The investigations of choice include a plain abdominal X-ray and an abdominal CT scan. Surgical treatment is the treatment of choice with preferably a colectomy with en-bloc resection of the diverticulum.
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Tanabe H, Tanaka K, Goto M, Sato T, Sato K, Fujiya M, Okumura T. Rare case of fecal impaction caused by a fecalith originating in a large colonic diverticulum: A case report. World J Clin Cases 2021; 9:416-421. [PMID: 33521110 PMCID: PMC7812877 DOI: 10.12998/wjcc.v9.i2.416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fecal impaction is defined as a large mass of compacted feces in the colon and has the potential to induce a serious medical condition in elderly individuals. Fecal impaction is generally preventable, and early recognition of the typical radiological findings is important for making an early diagnosis. The factors that lead to fecal impaction are usually similar to those causing constipation. Few cases with fecal impaction associated with a diverticulum have been reported.
CASE SUMMARY We present the case of a 62-year-old woman who suffered from abdominal pain and vomiting, had a medical history of repeated acute abdomen and was diagnosed with fecal impaction in the descending colon based on X-ray and computed tomography (CT) imaging. After examination by gastrografin-enhanced colonography following colonoscopy and CT colonography, the fecalith was suspected to have been produced at the site of a large diverticulum in the transverse colon. The fecalith was surgically resected, and a histological diagnosis of pseudodiverticulum was made. There was no recurrence during 33 mo of follow-up.
CONCLUSION This case highlights the importance of accurate identification and treatment of a fecal impaction. This case indicated that the endoscopic evacuation and subsequent colonography were effective for identifying a diverticulum that might have caused fecal impaction. A fecal impaction was associated with the diverticulum. Consequently, the planned diverticulectomy was performed. Appropriate emergency medical treatment and maintenance treatments should be selected in such cases to prevent recurrence.
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Affiliation(s)
- Hiroki Tanabe
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Kazuyuki Tanaka
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Mitsuru Goto
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Tomonobu Sato
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Keisuke Sato
- Department of Pathology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
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Popping the Balloon: A Giant Colonic Diverticulum Complicated by Bladder Neck Compression. Dig Dis Sci 2021; 66:41-44. [PMID: 32990867 DOI: 10.1007/s10620-020-06606-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 02/08/2023]
Abstract
Giant colonic diverticulum, defined as a single diverticulum ≤ 4 cm, is rarely encountered. Due to the high incidence of complications related to the disease, obtaining the correct diagnosis early in the disease course is essential. Diagnosis is usually reached by conventional and cross-sectional abdominal radiography. Treatment decisions should be ideally made by a multidisciplinary discussion among surgeons, interventional radiologists, and the patient. The treatment of choice is the surgical management by open or laparoscopic approach.
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Allué Cabañuz M, Elía M, Gonzales AG, Chóliz J. Complicated giant sigmoid diverticulum. Emergency laparoscopic approach is possible. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Manuela Elía
- General Surgery Department Lozano Blesa Clinic Universitary Hospital Zaragoza Spain
| | - Ariel G. Gonzales
- Pathology Department Lozano Blesa Clinic Universitary Hospital Zaragoza Spain
| | - Jorge Chóliz
- General Surgery Department Miguel Servet Universitary Hospital Zaragoza Spain
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Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V, Eglinton T, Frizelle F, Khan A, Hall J, Ilyas MIM, Michailidou M, Nfonsam VN, Cowan ML, Williams J, Steele SR, Alavi K, Ellis CT, Collins D, Winter DC, Zaghiyan K, Gallo G, Carvello M, Spinelli A, Lightner AL. Diverticulitis: An Update From the Age Old Paradigm. Curr Probl Surg 2020; 57:100862. [PMID: 33077029 PMCID: PMC7575828 DOI: 10.1016/j.cpsurg.2020.100862] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Abstract
For a disease process that affects so many, we continue to struggle to define optimal care for patients with diverticular disease. Part of this stems from the fact that diverticular disease requires different treatment strategies across the natural history- acute, chronic and recurrent. To understand where we are currently, it is worth understanding how treatment of diverticular disease has evolved. Diverticular disease was rarely described in the literature prior to the 1900’s. In the late 1960’s and early 1970’s, Painter and Burkitt popularized the theory that diverticulosis is a disease of Western civilization based on the observation that diverticulosis was rare in rural Africa but common in economically developed countries. Previous surgical guidelines focused on early operative intervention to avoid potential complicated episodes of recurrent complicated diverticulitis (e.g., with free perforation) that might necessitate emergent surgery and stoma formation. More recent data has challenged prior concerns about decreasing effectiveness of medical management with repeat episodes and the notion that the natural history of diverticulitis is progressive. It has also permitted more accurate grading of the severity of disease and permitted less invasive management options to attempt conversion of urgent operations into the elective setting, or even avoid an operation altogether. The role of diet in preventing diverticular disease has long been debated. A high fiber diet appears to decrease the likelihood of symptomatic diverticulitis. The myth of avoid eating nuts, corn, popcorn, and seeds to prevent episodes of diverticulitis has been debunked with modern data. Overall, the recommendations for “diverticulitis diets” mirror those made for overall healthy lifestyle – high fiber, with a focus on whole grains, fruits and vegetables. Diverticulosis is one of the most common incidental findings on colonoscopy and the eighth most common outpatient diagnosis in the United States. Over 50% of people over the age of 60 and over 60% of people over age 80 have colonic diverticula. Of those with diverticulosis, the lifetime risk of developing diverticulitis is estimated at 10–25%, although more recent studies estimate a 5% rate of progression to diverticulitis. Diverticulitis accounts for an estimated 371,000 emergency department visits and 200,000 inpatient admissions per year with annual cost of 2.1–2.6 billion dollars per year in the United States. The estimated total medical expenditure (inpatient and outpatient) for diverticulosis and diverticulitis in 2015 was over 5.4 billion dollars. The incidence of diverticulitis is increasing. Besides increasing age, other risk factors for diverticular disease include use of NSAIDS, aspirin, steroids, opioids, smoking and sedentary lifestyle. Diverticula most commonly occur along the mesenteric side of the antimesenteric taeniae resulting in parallel rows. These spots are thought to be relatively weak as this is the location where vasa recta penetrate the muscle to supply the mucosa. The exact mechanism that leads to diverticulitis from diverticulosis is not definitively known. The most common presenting complaint is of left lower quadrant abdominal pain with symptoms of systemic unwellness including fever and malaise, however the presentation may vary widely. The gold standard cross-sectional imaging is multi-detector CT. It is minimally invasive and has sensitivity between 98% and specificity up to 99% for diagnosing acute diverticulitis. Uncomplicated acute diverticulitis may be safely managed as an out-patient in carefully selected patients. Hospitalization is usually necessary for patients with immunosuppression, intolerance to oral intake, signs of severe sepsis, lack of social support and increased comorbidities. The role of antibiotics has been questioned in a number of randomized controlled trials and it is likely that we will see more patients with uncomplicated disease treated with observation in the future Acute diverticulitis can be further sub classified into complicated and uncomplicated presentations. Uncomplicated diverticulitis is characterized by inflammation limited to colonic wall and surrounding tissue. The management of uncomplicated diverticulitis is changing. Use of antibiotics has been questioned as it appears that antibiotic use can be avoided in select groups of patients. Surgical intervention appears to improve patient’s quality of life. The decision to proceed with surgery is recommended in an individualized manner. Complicated diverticulitis is defined as diverticulitis associated with localized or generalized perforation, localized or distant abscess, fistula, stricture or obstruction. Abscesses can be treated with percutaneous drainage if the abscess is large enough. The optimal long-term strategy for patients who undergo successful non-operative management of their diverticular abscess remains controversial. There are clearly patients who would do well with an elective colectomy and a subset who could avoid an operation all together however, the challenge is appropriate risk-stratification and patient selection. Management of patients with perforation depends greatly on the presence of feculent or purulent peritonitis, the extent of contamination and hemodynamic status and associated comorbidities. Fistulas and strictures are almost always treated with segmental colectomy. After an episode of acute diverticulitis, routine colonoscopy has been recommended by a number of societies to exclude the presence of colorectal cancer or presence of alternative diagnosis like ischemic colitis or inflammatory bowel disease for the clinical presentation. Endoscopic evaluation of the colon is normally delayed by about 6 weeks from the acute episode to reduce the risk associated with colonoscopy. Further study has questioned the need for endoscopic evaluation for every patient with acute diverticulitis. Colonoscopy should be routinely performed after complicated diverticulitis cases, when the clinical presentation is atypical or if there are any diagnostic ambiguity, or patient has other indications for colonoscopy like rectal bleeding or is above 50 years of age without recent colonoscopy. For patients in whom elective colectomy is indicated, it is imperative to identify a wide range of modifiable patient co-morbidities. Every attempt should be made to improve a patient’s chance of successful surgery. This includes optimization of patient risk factors as well as tailoring the surgical approach and perioperative management. A positive outcome depends greatly on thoughtful attention to what makes a complicated patient “complicated”. Operative management remains complex and depends on multiple factors including patient age, comorbidities, nutritional state, severity of disease, and surgeon preference and experience. Importantly, the status of surgery, elective versus urgent or emergent operation, is pivotal in decision-making, and treatment algorithms are divergent based on the acuteness of surgery. Resection of diseased bowel to healthy proximal colon and rectal margins remains a fundamental principle of treatment although the operative approach may vary. For acute diverticulitis, a number of surgical approaches exist, including loop colostomy, sigmoidectomy with colostomy (Hartmann’s procedure) and sigmoidectomy with primary colorectal anastomosis. Overall, data suggest that primary anastomosis is preferable to a Hartman’s procedure in select patients with acute diverticulitis. Patients with hemodynamic instability, immunocompromised state, feculent peritonitis, severely edematous or ischemic bowel, or significant malnutrition are poor candidates. The decision to divert after colorectal anastomosis is at the discretion of the operating surgeon. Patient factors including severity of disease, tissue quality, and comorbidities should be considered. Technical considerations for elective cases include appropriate bowel preparation, the use of a laparoscopic approach, the decision to perform a primary anastomosis, and the selected use of ureteral stents. Management of the patient with an end colostomy after a Hartmann’s procedure for acute diverticulitis can be a challenging clinical scenario. Between 20 – 50% of patients treated with sigmoid resection and an end colostomy after an initial severe bout of diverticulitis will never be reversed to their normal anatomy. The reasons for high rates of permanent colostomies are multifactorial. The debate on the best timing for a colostomy takedown continues. Six months is generally chosen as the safest time to proceed when adhesions may be at their softest allowing for a more favorable dissection. The surgical approach will be a personal decision by the operating surgeon based on his or her experience. Colostomy takedown operations are challenging surgeries. The surgeon should anticipate and appropriately plan for a long and difficult operation. The patient should undergo a full antibiotic bowel preparation. Preoperative planning is critical; review the initial operative note and defining the anatomy prior to reversal. When a complex abdominal wall closure is necessary, consider consultation with a hernia specialist. Open surgery is the preferred surgical approach for the majority of colostomy takedown operations. Finally, consider ureteral catheters, diverting loop ileostomy, and be prepared for all anastomotic options in advance. Since its inception in the late 90’s, laparoscopic lavage has been recognized as a novel treatment modality in the management of complicated diverticulitis; specifically, Hinchey III (purulent) diverticulitis. Over the last decade, it has been the subject of several randomized controlled trials, retrospective studies, systematic reviews as well as cost-efficiency analyses. Despite being the subject of much debate and controversy, there is a clear role for laparoscopic lavage in the management of acute diverticulitis with the caveat that patient selection is key. Segmental colitis associated with diverticulitis (SCAD) is an inflammatory condition affecting the colon in segments that are also affected by diverticulosis, namely, the sigmoid colon. While SCAD is considered a separate clinical entity, it is frequently confused with diverticulitis or inflammatory bowel disease (IBD). SCAD affects approximately 1.4% of the general population and 1.15 to 11.4% of those with diverticulosis and most commonly affects those in their 6th decade of life. The exact pathogenesis of SCAD is unknown, but proposed mechanisms include mucosal redundancy and prolapse occurring in diverticular segments, fecal stasis, and localized ischemia. Most case of SCAD resolve with a high-fiber diet and antibiotics, with salicylates reserved for more severe cases. Relapse is uncommon and immunosuppression with steroids is rarely needed. A relapsing clinical course may suggest a diagnosis of IBD and treatment as such should be initiated. Surgery is extremely uncommon and reserved for severe refractory disease. While sigmoid colon involvement is considered the most common site of colonic diverticulitis in Western countries, diverticular disease can be problematic in other areas of the colon. In Asian countries, right-sided diverticulitis outnumbers the left. This difference seems to be secondary to dietary and genetic factors. Differential diagnosis might be difficult because of similarity with appendicitis. However accurate imaging studies allow a precise preoperative diagnosis and management planning. Transverse colonic diverticulitis is very rare accounting for less than 1% of colonic diverticulitis with a perforation rate that has been estimated to be even more rare. Rectal diverticula are mostly asymptomatic and diagnosed incidentally in the majority of patients and rarely require treatment. Giant colonic diverticula (GCD) is a rare presentation of diverticular disease of the colon and it is defined as an air-filled cystic diverticulum larger than 4 cm in diameter. The pathogenesis of GCD is not well defined. Overall, the management of diverticular disease depends greatly on patient, disease and surgeon factors. Only by tailoring treatment to the patient in front of us can we achieve optimal outcomes.
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Affiliation(s)
- Alexander T Hawkins
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Paul E Wise
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Tiffany Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Janet T Lee
- Department of Surgery, University of Minnesota, Saint Paul, MN
| | - Tamara Glyn
- University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Verity Wood
- Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Timothy Eglinton
- Department of Surgery, University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Frank Frizelle
- Department of Surgery, University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Adil Khan
- Raleigh General Hospital, Beckley, WV
| | - Jason Hall
- Dempsey Center for Digestive Disorders, Department of Surgery, Boston Medical Center, Boston, MA
| | | | | | | | | | | | - Scott R Steele
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Oh
| | - Karim Alavi
- Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA
| | - C Tyler Ellis
- Department of Surgery, University of Louisville, Louisville, KY
| | | | - Des C Winter
- St. Vincent's University Hospital, Dublin, Ireland
| | | | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Michele Carvello
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center IRCCS, Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Antonino Spinelli
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center IRCCS, Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Amy L Lightner
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
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19
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Rook JM, Dworsky JQ, Curran T, Banerjee S, Kwaan MR. Elective surgical management of diverticulitis. Curr Probl Surg 2020; 58:100876. [PMID: 33933211 DOI: 10.1016/j.cpsurg.2020.100876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Jordan M Rook
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jill Q Dworsky
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Thomas Curran
- Medical University of South Carolina, Charleston, SC
| | - Sudeep Banerjee
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Mary R Kwaan
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
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20
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Chino JR, Rayhrer CS, Barrows BD, Salehpour MM. Surgical Management of Giant Colonic Diverticulum Presenting After Laparoscopic Lavage for Diverticular Perforation and Sepsis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923457. [PMID: 32719306 PMCID: PMC7414835 DOI: 10.12659/ajcr.923457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Diverticulosis and its complication of diverticulitis is a common condition that can be found in up to 35% of the population. Giant colonic diverticulum is a rare entity with fewer than 200 cases reported in the scientific literature. Development of a giant diverticulum as a sequelae of laparoscopic washout is an unreported event in current literature. CASE REPORT The patient was a 74-year-old female who had a well-known history of diverticulosis and diverticulitis. She developed perforated sigmoid diverticulitis, underwent laparoscopic washout and recovered without colon resection. Within a year after washout, she developed abdominal distention and bloating, and computed tomography (CT) imaging revealed a giant diverticulum. She went on to undergo surgery for resection of her sigmoid colon, which contained the giant diverticulum. Her recovery was otherwise uneventful. CONCLUSIONS To our knowledge, this is the first case report of giant diverticulum presenting as a complication of abdominal washout for management of acute diverticulitis. Initial CT scan performed at the time of perforation did not demonstrate this diverticulum, indicating that it developed within the year after abdominal washout for sepsis and acute rupture, likely due to weakening of the colonic wall secondary to ongoing inflammation. The very rare presentation of giant diverticulum makes it difficult to establish a clear link to washout, however, this case establishes a groundwork for further investigation as our fund of knowledge on the subject continues to grow.
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Affiliation(s)
- Jonathan R Chino
- Department of General Surgery, Community Memorial Health System, Ventura, CA, USA
| | - Constanze S Rayhrer
- Department of General Surgery, Community Memorial Health System, Ventura, CA, USA
| | - Brad D Barrows
- Department of Pathology, Community Memorial Health System, Ventura, CA, USA
| | - Michael M Salehpour
- Department of General Surgery, Community Memorial Health System, Ventura, CA, USA
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21
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Williams LC, Steinhagen RM. Presentation and Management of Giant Colonic Diverticula. Am Surg 2020. [DOI: 10.1177/000313481908501205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Randolph M. Steinhagen
- Division of Colon & Rectal Surgery Icahn School of Medicine at Mount Sinai New York, New York
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22
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Coulier B, Rezazadeh Azar A, Pierard F. Giant diverticulum of the sigmoid colon. Diagn Interv Imaging 2020; 101:761-762. [PMID: 32423619 DOI: 10.1016/j.diii.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Affiliation(s)
- B Coulier
- Department of Diagnostic Radiology, Clinique St Luc, Bouge, 5004 Namur, Belgium.
| | - A Rezazadeh Azar
- Department of Diagnostic Radiology, Clinique St Luc, Bouge, 5004 Namur, Belgium
| | - F Pierard
- Department of Visceral Surgery, Clinique St Luc, Bouge, 5004 Namur, Belgium
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23
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Arata R, Banshodani M, Yamashita M, Shintaku S, Moriishi M, Kawanishi H. Perforative peritonitis confused with peritoneal dialysis-related peritonitis: Report of three cases. Int J Surg Case Rep 2020; 70:20-23. [PMID: 32361606 PMCID: PMC7193318 DOI: 10.1016/j.ijscr.2020.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 11/30/2022] Open
Abstract
Intestinal perforation in patients on peritonitis dialysis (PD) has high mortality. Perforative peritonitis in PD patients and PD-associated peritonitis patients have similar signs. Rapid diagnosis can help exclude perforation in cases of refractory peritonitis.
Introduction Perforative peritonitis in patients on peritoneal dialysis (PD) is a serious adverse event associated with significant mortality. The signs and symptoms of perforative peritonitis in patients on PD are often confused with those of PD-related peritonitis; therefore, early diagnosis is often difficult. Presentation of cases In all three cases, antibiotic therapy was started for peritonitis. Although contrast-enhanced computed tomography (CT) was not performed, perforative peritonitis was suspected due to severe cloudiness of PD effluents, and emergency surgeries were performed 8, 5, and 6 days after therapy onset in cases 1, 2, and 3, respectively. In case 1, the ileum was perforated owing to ischemia, and partial ileal resection and divided ileostomy were performed. The patient died 18 days postoperatively. In case 2, partial ileal resection and divided ileostomy were performed for an incarcerated obturator hernia and perforated ileum. The patient was transferred for hemodialysis (HD) and discharged 117 days postoperatively. In case 3, lavage drainage was performed for peritonitis because of mesenteric penetration of a sigmoid colon diverticulum. The patient was then transferred for HD, and colostomy was subsequently performed. He was discharged 159 days postoperatively. Discussion Early diagnosis between PD-related peritonitis and perforative peritonitis is often difficult since the washing effect of the peritoneal dialysate might relieve peritoneal irritation. Conclusion In PD patients with refractory peritonitis, it is necessary to keep in mind the possibility of perforative peritonitis, and the differential diagnosis should be performed using contrast-enhanced CT within at least 5 days after antibiotic therapy.
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Affiliation(s)
- Ryosuke Arata
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Japan.
| | - Masataka Banshodani
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Japan.
| | - Masahiro Yamashita
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Japan
| | - Sadanori Shintaku
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Japan
| | - Misaki Moriishi
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Japan
| | - Hideki Kawanishi
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Japan
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24
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Abstract
Giant colonic diverticulum (GCD) is a diverticulum that is larger than 4 cm in diameter most commonly arising from the sigmoid colon. Patients with GCD are typically asymptomatic, and clinical manifestations vary from a soft palpable abdominal mass to diarrhea, which is well described in the literature. However, few studies have demonstrated a presentation of GCD with acute diverticulitis. Herein, we report a case of a middle-aged patient presenting with sepsis due to acute diverticulitis as an initial presentation of a GCD.
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Affiliation(s)
- Shivantha Amarnath
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Fady G Haddad
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Deeb Liliane
- Gatsroenterology, Staten Island University Hospital, Northwell Health, Staten Island, USA
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25
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Rodríguez-Otero Luppi C, Rodríguez Blanco M, Bollo Rodríguez J, Méndez A, Merlo Más J. Laparoscopic resection of a giant colonic diverticulum - the 'lifting balloon' sign - a video vignette. Colorectal Dis 2019; 21:1096-1098. [PMID: 31120633 DOI: 10.1111/codi.14716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/10/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | | | | | - A Méndez
- Colorectal Surgery Unit, Clínica ServiDigest, Barcelona, Spain
| | - J Merlo Más
- Colorectal Surgery Unit, Clínica ServiDigest, Barcelona, Spain
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26
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Value of non-contrast CT examination of the urinary tract (stone protocol) in the detection of incidental findings and its impact upon the management. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2015.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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Cardoso Louro H, Fonte Boa A, Lencastre L, Leão P, Vilaça J. Laparoscopic colorectal resection for a giant colonic diverticulum - a video vignette. Colorectal Dis 2019; 21:246-247. [PMID: 30496628 DOI: 10.1111/codi.14505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/26/2018] [Indexed: 02/08/2023]
Affiliation(s)
- H Cardoso Louro
- Surgery Department of Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal.,Surgery Department of Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - A Fonte Boa
- Surgery Department of Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal.,Anesthesiology Department of Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - L Lencastre
- Surgery Department of Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal.,Surgery Department of Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - P Leão
- Surgery Department of Hospital de Braga, Braga, Portugal
| | - J Vilaça
- Surgery Department of Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
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28
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Locatelli A, Caputo P, Carzaniga P. Giant colonic diverticulum: review of the literature, personal experience and proposal of decision making. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04817-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Moomjian LN, Clayton RD, Carucci LR. A Spectrum of Entities That May Mimic Abdominopelvic Abscesses Requiring Image-guided Drainage. Radiographics 2018; 38:1264-1281. [PMID: 29995617 DOI: 10.1148/rg.2018170133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of entities may mimic drainable abscesses. This can lead to misdiagnosis of these entities, unnecessary percutaneous placement of a pigtail drainage catheter, other complications, and delay in appropriate treatment of the patient. Types of entities that may mimic drainable abscesses include neoplasms (lymphoma, gallbladder cancer, gastrointestinal stromal tumor, ovarian cancer, mesenteric fibromatosis, ruptured mature cystic teratoma, recurrent malignancy in a surgical bed), ischemia/infarction (liquefactive infarction of the spleen, infarcted splenule), diverticula (calyceal, Meckel, and giant colonic diverticula), and congenital variants (obstructed duplicated collecting system). Postoperative changes, including expected anatomy after urinary diversion or Roux-en-Y gastric bypass and small bowel resection, may also pose a diagnostic challenge. Nonpyogenic infections (Mycobacterium tuberculosis, Mycobacterium avium complex, echinococcal cysts) and inflammatory conditions such as xanthogranulomatous pyelonephritis and gossypiboma could also be misinterpreted as drainable fluid collections. Appropriate recognition of these entities is essential for optimal patient care. This article exposes radiologists to a variety of entities for which percutaneous drainage may be requested, but is not indicated, and highlights important imaging findings associated with these entities to facilitate greater diagnostic accuracy and treatment in their practice. ©RSNA, 2018.
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Affiliation(s)
- Lauren N Moomjian
- From the Department of Radiology, Virginia Commonwealth University Medical Center, 1250 E Marshall St, PO Box 980615, Richmond, VA 23298
| | - Ryan D Clayton
- From the Department of Radiology, Virginia Commonwealth University Medical Center, 1250 E Marshall St, PO Box 980615, Richmond, VA 23298
| | - Laura R Carucci
- From the Department of Radiology, Virginia Commonwealth University Medical Center, 1250 E Marshall St, PO Box 980615, Richmond, VA 23298
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30
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Abstract
This article describes the epidemiology, pathogenesis, diagnosis, and treatment of three rare variants of diverticular disease: cecal and right-sided colonic diverticula, giant colonic diverticula, and small bowel diverticula.
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Affiliation(s)
- Sanjay Mohanty
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Shawn P Webb
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
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31
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Syllaios A, Daskalopoulou D, Bourganos N, Papakonstantinou A, Triantafyllou E, Koutras A, Georgiou C. Giant colonic diverticulum-a rare cause of acute abdomen. J Surg Case Rep 2018; 2018:rjy009. [PMID: 29435218 PMCID: PMC5801602 DOI: 10.1093/jscr/rjy009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/12/2018] [Indexed: 11/13/2022] Open
Abstract
Giant colonic diverticulum (GCD), defined as diverticulum larger than 4 cm, is a rare entity. It is generally a manifestation of colonic diverticular disease and can have dramatic complications such as perforation, abscess, volvulus, infarction and adenocarcinoma. This report documents the case of a 63-year-old man coming to the Emergency Department with acute abdomen due to a perforation of a GCD. In the plain abdominal X-ray the 'Balloon-sign' was revealed, computed tomography scan and Hartmann's procedure were performed. Acute abdomen can occur as a manifestation of a complication of a GCD, and this report highlights the fact that GCD should be considered for patients with a high risk of diverticular disease and abdominal pain.
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Affiliation(s)
| | | | | | | | | | - Antonios Koutras
- Department of Obstetrics and Gynecology, General Hospital of Athens 'Laiko', Athens 11527, Greece
| | - Christos Georgiou
- Department of Surgery, General Hospital of Lamia, Lamia 35100, Greece
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32
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Muneeb A, Lam S. Giant sigmoid diverticulum mimicking bowel perforation. BMJ Case Rep 2018; 2018:bcr-2017-223394. [PMID: 29301817 DOI: 10.1136/bcr-2017-223394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ahmad Muneeb
- Department of General Surgery, Wexham Park Hospital, Wexham, Slough, UK
| | - Stephen Lam
- Department of General Surgery, Wexham Park Hospital, Wexham, Slough, UK
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33
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Peacock J, Perkins Z. Change in bowel habit, abdominal pain, and a palpable abdominal mass in a 58-year-old female. Clin Case Rep 2017; 5:2155-2157. [PMID: 29225879 PMCID: PMC5715420 DOI: 10.1002/ccr3.1171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/02/2017] [Accepted: 08/07/2017] [Indexed: 11/06/2022] Open
Abstract
Giant colonic diverticulum is a rare complication of diverticulosis, which may present in the acute or chronic setting. Colonic resection and en bloc resection of the diverticulum are the favored management, however, conservative treatment remains an option that could be considered in asymptomatic patients with minimal symptoms.
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Affiliation(s)
- Julian Peacock
- Department of General Surgery The Royal London Hospital Whitechapel London E1 1BB UK
| | - Zane Perkins
- Department of General Surgery The Royal London Hospital Whitechapel London E1 1BB UK
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34
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35
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Roch PJ, Friedrich T, Bönninghoff R, Dinter D, Rickert A. [Laparoscopic resection of a giant colon diverticulum : Case report and review of the literature]. Chirurg 2017; 88:682-686. [PMID: 28374053 DOI: 10.1007/s00104-017-0412-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Giant diverticula are rare complications of diverticular disease. Current opinion regards operative therapy as the method of choice for the treatment of symptomatic giant diverticula; however, there is neither consensus about the technique nor about the necessary extent of resection. Based on a non-systematic review of the literature, an overview of giant diverticula in terms of epidemiology, pathology and classification is given. The current case is considered with respect to appropriate diagnostic procedures and possible therapeutic options. CASE PRESENTATION An 80-year-old female patient presented to the emergency department with abdominal pain and dyspnea. A computed tomography scan showed a large gas-filled structure in the upper left abdomen adjacent to the left colon. A giant colonic diverticulum was suspected and laparoscopy was performed. Intraoperatively, the diagnosis of a giant colon diverticulum located at the splenic flexure was confirmed. An unremarkable diverticulosis only was found in the descending colon. The giant diverticulum was treated by an atypical colon wedge resection and the postoperative course was uneventful. DISCUSSION This case report describes a laparoscopic atypical colon wedge resection as treatment of a giant colon diverticulum. Only four laparoscopic bowel resections in terms of sigmoid resections or hemicolectomy with primary anastomosis have been reported. Minimally invasive surgery can be a valuable alternative to open procedures. In the current case a laparoscopic atypical colon wedge resection was safely performed. This option might be considered as an alternative to extended resections of giant diverticula. Localization of the giant diverticulum and the simultaneous existence of diverticular disease are the main criteria for the decision between the different operative approaches.
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Affiliation(s)
- P J Roch
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikums Heidelberg, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - T Friedrich
- Radiologische Abteilung des St. Josefskrankenhaus Heidelberg, St. Josefskrankenhaus Heidelberg, Landhausstraße 25, 69115, Heidelberg, Deutschland
| | - R Bönninghoff
- Chirurgische Abteilung des St. Josefskrankenhaus Heidelberg, St. Josefskrankenhaus Heidelberg, Landhausstraße 25, 69115, Heidelberg, Deutschland
| | - D Dinter
- Radiologie Schwetzingen, Bodelschwinghstr. 10, 68723, Schwetzingen, Deutschland
| | - A Rickert
- Chirurgische Abteilung des St. Josefskrankenhaus Heidelberg, St. Josefskrankenhaus Heidelberg, Landhausstraße 25, 69115, Heidelberg, Deutschland.
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Molière S, Romain B, Triki E. Big gas bubble in the belly: Beware of giant sigmoid diverticulum. Surgery 2017; 162:1334-1335. [PMID: 28666684 DOI: 10.1016/j.surg.2017.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/21/2017] [Accepted: 05/23/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Sébastien Molière
- Departments of Radiology and Abdominal Surgery, University Hospital of Strasbourg, Strasbourg, France.
| | - Benoit Romain
- Departments of Radiology and Abdominal Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Elhocine Triki
- Departments of Radiology and Abdominal Surgery, University Hospital of Strasbourg, Strasbourg, France
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Carnevale A, Bassi M, Ferrante Z, Rizzati R, Benea G, Giganti M. Computed tomographic colonography in the evaluation of a case of giant colonic diverticulum. BJR Case Rep 2017; 3:20160101. [PMID: 30363261 PMCID: PMC6159260 DOI: 10.1259/bjrcr.20160101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/22/2016] [Accepted: 10/29/2016] [Indexed: 11/07/2022] Open
Abstract
The aim of this article was to present our experience with CT-colonography evaluation of a case of giant colonic diverticulum. Despite the high prevalence of diverticular disease in the Western world, giant colonic diverticula are rare entities, with fewer than 200 cases reported in literature.
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Affiliation(s)
- Aldo Carnevale
- Scuola di Specializzazione in Radiodiagnostica, University of Ferrara, Ferrara, Italy
| | - Matteo Bassi
- Scuola di Specializzazione in Radiodiagnostica, University of Ferrara, Ferrara, Italy
| | - Zairo Ferrante
- Scuola di Specializzazione in Radiodiagnostica, University of Ferrara, Ferrara, Italy
| | - Roberto Rizzati
- Department of Radiology, Arcispedale Sant’Anna, Ferrara, Italy
| | - Giorgio Benea
- Department of Radiology, Arcispedale Sant’Anna, Ferrara, Italy
| | - Melchiore Giganti
- Scuola di Specializzazione in Radiodiagnostica, University of Ferrara, Ferrara, Italy
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Abdominal Hernias, Giant Colon Diverticulum, GIST, Intestinal Pneumatosis, Colon Ischemia, Cold Intussusception, Gallstone Ileus, and Foreign Bodies: Our Experience and Literature Review of Incidental Gastrointestinal MDCT Findings. BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28638830 PMCID: PMC5468579 DOI: 10.1155/2017/5716835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Incidental gastrointestinal findings are commonly detected on MDCT exams performed for various medical indications. This review describes the radiological MDCT spectrum of appearances already present in the past literature and in today's experience of several gastrointestinal acute conditions such as abdominal hernia, giant colon diverticulum, GIST, intestinal pneumatosis, colon ischemia, cold intussusception, gallstone ileus, and foreign bodies which can require medical and surgical intervention or clinical follow-up. The clinical presentation of this illness is frequently nonspecific: abdominal pain, distension, nausea, fever, rectal bleeding, vomiting, constipation, or a palpable mass, depending on the disease. A proper differential diagnosis is essential in the assessment of treatment and in this case MDCT exam plays a central rule. We wish that this article will familiarize the radiologist in the diagnosis of this kind of incidental MDCT findings for better orientation of the therapy.
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Joyce DP, Toomey DP. Laparoscopic resection of giant pseudodiverticulum - a video vignette. Colorectal Dis 2017; 19:305-306. [PMID: 28160370 DOI: 10.1111/codi.13620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/12/2016] [Indexed: 02/08/2023]
Affiliation(s)
- D P Joyce
- Department of Surgery, Midland Regional Hospital Mullingar, County Westmeath, Ireland
| | - D P Toomey
- Department of Surgery, Midland Regional Hospital Mullingar, County Westmeath, Ireland
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Carr JA. Case report of a giant colonic sigmoid diverticulum causing sigmoid volvulus. Int J Surg Case Rep 2017; 31:197-199. [PMID: 28183049 PMCID: PMC5299141 DOI: 10.1016/j.ijscr.2017.01.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/22/2017] [Accepted: 01/22/2017] [Indexed: 01/31/2023] Open
Abstract
Giant colonic diverticulum is a rare complication of colonic diverticulosis that occurs when a single diverticulum enlarges to over 4 cm in diameter. The author presents a rare case of a giant colonic diverticulum that presented as a sigmoid volvulus. The management and pathology are discussed.
Introduction Giant colonic diverticulum is a rare complication of colonic diverticulosis that occurs when a single diverticulum enlarges to over 4 cm in diameter. There have been fewer than 200 cases reported worldwide since it was first described in 1946. Presentation of case The author presents a rare case of a giant colonic diverticulum that presented as a sigmoid volvulus. The patient underwent emergency surgery with resection of the diverticulum and reduction of the volvulus. Discussion Due to their propensity to cause complications and mechanical blockage from their large size, all authors recommend surgical resection of giant colonic diverticula. This has been documented to be safely done by diverticulectomy as was performed in this patient, but also by segmental colectomy, laparoscopic diverticulectomy, or laparoscopic colectomy. Conclusion Giant colonic diverticulum is a rare entity that tends to cause many intra-abdominal complications, including volvulus. Surgical resection is recommended once identified.
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Affiliation(s)
- John Alfred Carr
- Department of General Surgery, Huron Medical Center, Bad Axe, MI 48413, USA.
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Del Pozo AC, Bartolotta V, Capitano S, Fusco MD, Chiodi L, Boccoli G. A gas-filled abdominal cyst in an elderly woman: A giant colonic diverticulum case report. Int J Surg Case Rep 2016; 24:104-7. [PMID: 27235589 PMCID: PMC4887588 DOI: 10.1016/j.ijscr.2016.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/16/2016] [Accepted: 05/16/2016] [Indexed: 02/06/2023] Open
Abstract
Giant colonic diverticulum is a rare complication of colon diverticulosis. Diagnosis is based on imaging findings on plain abdominal X-ray and enhanced computered tomography. Treatment consists of en bloc resection of the diverticulum and affected adjacent colon.
Introduction Giant colonic diverticulum (GCD), a rare complication of the diverticular disease, can present with a wide range of nonspecific symptoms as abdominal pain and bowel obstruction. Its diagnosis represents a challenge that mainly depends on imaging findings. Presentation of case We report the case of a 79 year-old female patient that came to our emergency department complaining of 5-day history of hypogastric pain and constipation. Physical examination reveled a 15 cm hypogastric round, tender and tympanic mass. Enhanced abdominal CT scan showed a large air-filled cyst adjacent to a diverticular sigmoid colon without evidence of intra-abdominal free air or fluid. Based on the radiological features, GCD was suspected and surgical treatment performed. The mass and the sigmoid colon were resected. The postoperative course was uneventful. Histopathology confirmed the preoperative diagnosis. Discussion GCD, defined as a diverticulum larger than 4 cm, represents a rare complication of the diverticular disease. Usually abdominal X-ray and computed tomography (CT) scan show a gas-filled structure, sometimes communicating with the adjacent colon. GCD resection and segmental colectomy are strongly recommended even in asymptomatic cases due to the high incidence and severity of complications. Conclusion Because of its rarity and variable and non-specific clinical presentation, the diagnosis of GCD depends mainly on imaging findings. The gold standard treatment is surgical resection of the GCD and the compromised colon with primary anastomosis when possible.
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Affiliation(s)
- Ana Carolina Del Pozo
- Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy.
| | - Vittorio Bartolotta
- Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy
| | - Sante Capitano
- Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy
| | - Matteo De Fusco
- Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy
| | - Leonardo Chiodi
- Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy
| | - Gianfranco Boccoli
- Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy
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Giant colonic diverticulum: radiographic and MDCT characteristics. Insights Imaging 2015; 6:659-64. [PMID: 26385691 PMCID: PMC4656231 DOI: 10.1007/s13244-015-0433-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/26/2015] [Accepted: 09/07/2015] [Indexed: 11/03/2022] Open
Abstract
Giant colonic diverticulum (GCD), defined as a diverticulum larger than 4 cm, is a rare entity that is generally a manifestation of colonic diverticular disease. Because of its rarity and its variable and non-specific presentation, the diagnosis of GCD depends mainly on imaging findings. Knowledge of the spectrum of radiographic and CT features of the GCD is important in making the correct diagnosis and potentially preventing complications. This review focuses on imaging findings characteristic of GCD as well as its complications and radiographic mimics. Teaching points • Giant colonic diverticulum is a rare complication of diverticulosis.• The most common symptom is abdominal pain presenting in approximately 70 % of patients.• Diagnosis is based on imaging findings with plain abdominal radiographs and MDCT.• Treatment consists of en bloc resection of the diverticulum and affected adjacent colon.
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