Perforated Diverticulitis of the Transverse Colon: An Unexpected Cause of Abdominal Pain During Preoperative Bowel Preparation

Abstract

Diverticulitis affecting the transverse colon is uncommon, with perforation being exceptionally rare. It is not usually considered in the differential diagnosis of a patient with acute abdominal pain. We report a case of nonspecific abdominal pain secondary to a perforated diverticulum in the transverse colon during preoperative bowel preparation. A 74-year-old Caucasian female had sudden onset abdominal pain and nausea with routine bowel preparation. This undifferentiated acute abdomen was suggestive of a bowel perforation, which was later confirmed by a computed tomography scan. Surgical exploration determined the location of the perforation in the transverse colon. We report an unusual presentation of preoperative abdominal pain during routine bowel preparation. It is extraordinarily uncommon to see rupture of a transverse colon diverticulum in a patient with sigmoid involvement, and bowel preparation as a cause of rupture has not been previously documented. Because perforation of a transverse colon diverticulum generally has a nonspecific clinical presentation, it should be considered in the differential diagnosis for a patient with known diverticular disease who has acute onset abdominal pain and signs of peritonism.