Diverticular Disease in a Transposed Colon

Abstract

44 year-old man with a history of VACTERL with an esophagocoloplasty at age 8, presenting with acute dysphagia of both liquids and solids. This occurred after he swallowed a large piece of turkey. Urgent endoscopic evaluation revealed colonic type mucosa with folds and normal vascular pattern. Also noted, were multiple diverticulum, of various sizes. A food bolus was seen obstructing the lumen of the transposed colon and the impaction was relief with a Roth Net. VACTERL, described in 1972 by Quan and Smith, is an acronym that stands for bony spinal column (V), atresias in the gastrointestinal tract (A), congenital heart lesions (C), tracheoesophageal defects (TE), renal and distal urinary tract anomalies (R) and limb lesions. The frequency has been estimated between 1/ 10,000 and 1/40,000 infants with large variations as there are multiple diagnostic criteria. Diverticular disease is one of the most common GI disorders. It is the thought that its pathogenesis is multifactorial. Anomalies in motility, environmental factors such as diet and heredity are the main categories implicated in the pathogenesis of diverticulosis. If in fact these factors are involve in the pathogenesis of diverticulosis in a colon in its normal habit, what is their role in the development of diverticular disease in the transposed colon of our patient. Since he had surgery early in life, it is assumed that he did not had diverticulosis at the time when the surgery occurred. In addition, studies has shown that peristaltic contractions are absent in the interposed colon. This negates the theory that colonic motility is involve in the development of diverticuli. It is even more difficult to consider environmental factors as a cause of diverticuli since this case demonstrates that divercular disease can occur even when the habit of the colon is different as in a transposed colon. Therefore, this case provides support that hereditable factors may be the most influential contributors to the pathogenesis of diverticulosis.Figure 1Figure 2Figure 3