Giant sigmoid diverticulum: A rare entity of high clinical significance

Abstract

Affecting about 35% of patients above the age of sixty, diverticular disease represents a common entity. However, giant colonic diverticulum is a rare complication of this disease with variant clinical presentation and high complication rate. This report describes one such case and includes a short review of the literature. An 83-year-old Caucasian man was transferred to our Unit after having been hospitalized in the Department of Internal Medicine for 15 days due to high fever with chills and vague left lower abdominal pain. The clinical examination was normal and showed no signs of peritonitis or palpable mass, other than a mild abdominal tenderness in the left iliac fossa. The patient’s medical history included diabetes mellitus, hyperlipidaemia, and distal arteriopathy. The patient had undergone endovascular repair of abdominal aortic aneurysm five years earlier. Blood tests indicated hypochromic anaemia and a hemoccult test was positive for haematochezia. Blood, urine, and faeces cultures were negative. Diverticulosis of the sigmoid colon was diagnosed by colonoscopy. The abdominal CT revealed a large air density mass adjacent to the sigmoid colon and diverticulosis of the sigmoid colon was diagnosed by colonoscopy. We performed sigmoid resection followed by end-to-end colorectal anastomosis with protective loop ileostomy so as to eliminate the risk of septic complications. A giant pseudodiverticulum was confirmed by histology. Giant colonic diverticulum is a rare complication of colonic diverticular disease with unclear aetiology and variable clinical presentation. Due to the substantial risk of complications and the low mortality associated with surgical treatment, elective surgical therapy has been recommended. Conservative management of an asymptomatic giant colonic diverticulum should be reserved only for high-risk elderly patients who cannot tolerate surgery or who are unwilling to undergo surgery.