Giant sigmoid diverticulum with coexisting metastatic rectal carcinoma: a case report

Walid Sasi,Abdul Rahman Nasr,Aidan Quinn,Issam Hamad

doi:10.1186/1752-1947-4-324

Abstract

IntroductionGiant diverticulum of the colon is a rare but clinically significant condition, usually regarded as a complication of an already existing colonic diverticular disease. This is the first report of a giant diverticulum of the colon with a co-existing rectal carcinoma.Case presentationWe report a case of a 66-year-old Caucasian woman who presented with lower abdominal pain, chronic constipation and abdominal swelling. Preoperative abdominal computed tomography revealed a giant diverticulum of the colon with a coexisting rectal carcinoma and pulmonary metastasis revealed on a further thoracic computed tomography. An en bloc anterior resection of the rectum along with sigmoid colectomy, partial hysterectomy and right salpingoophorectomy was subsequently performed due to extensive adhesions.ConclusionThis report shows that the presence of a co-existing distal colorectal cancer can potentially lead to progressive development of a colonic diverticulum to become a giant diverticulum by increasing colonic intra-luminal pressure and through the ball-valve mechanism. This may be of interest to practising surgeons and surgical trainees.

Highlights

Giant diverticulum of the colon is a rare but clinically significant condition, usually regarded as a complication of an already existing colonic diverticular disease
We present the first published report of a patient with giant sigmoid diverticulum and a concomitant metastatic rectal carcinoma
Giant diverticulum of the colon (GDC) is a rare condition, with only less than 180 cases discussed in the literature since it was first reported by Bonvin and Bonte in 1946 [1]

Summary

Conclusion

Giant diverticulum of the colon is a rare condition which usually occurs in patients suffering from a preexisting diverticular disease. The best way to explain GDC progressive development is that of the ball-valve air mechanism, especially with increased colonic intraluminal pressure. The presence of a coexisting distal colorectal cancer can potentially lead to the progressive development of a colonic diverticulum which may become a GDC. This case report may be of particular interest to practising surgeons and surgical trainees. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal

Introduction

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