Segmental Colitis Associated with Diverticular Disease (SCAD): A Case Report

Abstract

Segmental colitis associated with diverticular disease (SCAD) is a rare form of diverticular disease due to its autonomy and similarity to inflammatory bowel diseases (IBD). The prevalence of SCAD in patients with diverticulosis ranges from 0.26 to 1.5 %. Here we report the case of a 59 year old female who presented with recurrent and refractory abdominal pain. A 59 year old female presented to the ER with left lower quadrant abdominal pain, loose stools and weight loss for the past 1 year. Stools were watery and mixed with blood. Physical Exam revealed tenderness in the left lower quadrant with no guarding or rebound tenderness. Laboratory examination showed lymphocytosis and CT scan revealed thickened sigmoid colon with few adjacent diverticula. Colonoscopy was performed and it showed few diverticula surrounded by inflammatory changes with erythema, patchy mucosal friability and areas of exudate limited to the sigmoid colon. However, patient reported worsening of abdominal pain and few weeks later a repeat CT scan revealed worsening colonic wall thickening with extensive peri-colonic mesentery stranding/fluid and multiple peri-colonic mesentery lymphadenopathies. She responded to intra venous fluids, ciprofloxacin and flagyl and was discharged on oral antibiotics. She was instructed to follow a high fiber diet, however, her pain and bloody diarrhea recurred within a few weeks of being discharged. She was prescribed 5-ASA 375 mg 4 times a day and a tapering course of prednisone 40mg for one month. On the following visit the patient reported resolution of all her symptoms. The histologically features of SCAD are often indistinguishable from other IBDs on morphologic grounds alone. The correct diagnosis is of great importance, because many patients will respond to therapy aimed at diverticular disease or diverticulitis and do not require immunosuppression. Patient who are refractory to antibiotic therapy should start treatment with immunosuppressive drugs and if symptoms persist they will need a partial surgical colectomy to help relieve the symptoms.