Segmental Colitis Associated With Diverticulosis Masquerading as Polyploid-Appearing Mucosa in the Rectosigmoid Area on Endoscopy and as Focal Thickening on Imaging.

Jill Elwing,Gebran Khneizer,Eugene C Nwankwo,Necat Havlioglu,Michael Presti,Gregory Sayuk

doi:10.7759/cureus.22930

Abstract

Segmental colitis associated with diverticulosis (SCAD) is an inflammatory disease affecting segments of the large bowel with diverticular disease. SCAD presents several challenges in diagnoses and treatment because it often mimics a range of disorders including inflammatory bowel disease and malignancy. Here, we present the case of a 72-year-old man with lower abdominal pain and bloody stools whose initial abdominal workup showed nonspecific large bowel thickening and concerns for malignancy. Ultimately, the patient was diagnosed with mild SCAD and treated conservatively with a resolution of symptoms. He had no symptoms at the three-month and 1-year follow-ups. This case highlights the importance of including SCAD in the initial differential diagnosis to allow accurate identification and treatment.

Highlights

Segmental colitis associated with diverticulosis (SCAD) is an inflammatory disease affecting segments of the large bowel with diverticular disease [1-3]
SCAD is an inflammatory disease affecting segments of the large bowel with a diverticular disease that typically involves the sigmoid colon and can mimic a malignancy or inflammatory bowel disease (IBD). It can present with a wide range of symptoms such as rectal bleeding, diarrhea, and abdominal pain
The prevalence of segmental colitis is estimated between 0.3% and 1.4% of all patients with diverticulosis

Summary

Introduction

Segmental colitis associated with diverticulosis (SCAD) is an inflammatory disease affecting segments of the large bowel with diverticular disease [1-3]. The clinical progression of the disease is benign and often managed conservatively with antibiotics and/or 5-aminosalicylic acid therapy and rarely leads to complications In this case report, we present the case of an elderly patient who reported left lower abdominal pain, fevers, and chills. We present the case of an elderly patient who reported left lower abdominal pain, fevers, and chills He was found to have evidence of left colonic diverticulitis on imaging, followed by endoscopic evaluation showing malignant-appearing polyploid mucosa in the rectosigmoid region. A 72-year-old man with a medical history of glaucoma, hyperlipidemia, and diabetes mellitus type 2 was evaluated for a one-day history of left lower abdominal pain and intermittent bloody stools His complaints were associated with progressive abdominal pressure and discomfort for the same duration. Endoscopic evaluation of the sigmoid revealed persistent stigmata of inflammation without gastrointestinal symptoms

Discussion

Conclusions

Disclosures

Guslandi M

Findings

Ghalyaie N