Dynamic or Disappearing Diverticula of the Colon

Abstract

Diverticula can appear and disappear while under fluoroscopic observation at barium enema examination. These changing diverticula may exhibit all the various shapes that are seen with the ordinary, nondisappearing type of diverticulum. Within the past two years, roentgenograms obtained during examination of three patients, besides the case reported here, showed spontaneously appearing and disappearing diverticula (Fig. 14). Only a few references are made in the literature to spontaneously appearing or disappearing diverticula (3, 10), and no reference has been made to fluoroscopic observation of this phenomenon. Since 1925, colon diverticula coated by muscle have been described as intramural diverticula, early or “pre-” diverticula (2, 5–8), or spastic colon diverticulosis (1, 3). Recently, diverticular disease without diverticula has been documented (1, 9). It has been suggested that “early” stages of diverticula may develop into large, saccular diverticula in months or years (3, 6). That this development can take place in a matter of seconds and be reversible is apparently not generally known. The appearance of diverticula in a normal-appearing colon is often attributed to the opening of occluded ostia. Failure of redemonstration of barium-filled diverticula on subsequent examinations has been attributed to either (a) occlusion with or without diverticulitis (4) or (b) reduction of mucosal hernias through the colon wall in the manner of a hiatus hernia(3–10). A case of appearing and disappearing diverticula was studied in vivo and in vitro at the Saint Francis Memorial Hospital and at the University of California San Francisco Medical Center. Appearance and disappearance of the diverticula proved to be related to changes in intestinal muscle tone and unrelated to the volume of the colon. The diverticula did not resemble diverticulosis in a spastic colon, as described by Fleischner et al. (3). A 60-year-old female patient had a six-month history of intermittent lower abdominal pain without fever and with no known bleeding. On barium enema examination a 1.5 cm midsigmoid polyp, surrounded by diverticula in the sigmoid and descending colon, was seen. The diverticula appeared upon filling (Fig. 1) and disappeared completely upon evacuation (Fig. 2). On the second barium enema examination, performed six weeks after the first, the increase in number and size of diverticula was recorded in rapid spot-film sequence. These appeared and grew with increasing filling and volume of the colon (Fig. 3). After evacuation, fewer diverticula remained, and most of these were smaller in size (Fig. 4). Not all diverticula disappeared on the second examination as they did on the first. Upon a third filling, fewer diverticula were present at the completion of filling than at the start (Figs. 5 and 6).