Giant Colonic Diverticulum Research Articles

Unusual Variations and Atypical Presentations of Diverticulitis

AbstractIn this article, we describe four unusual variations of diverticulitis: nonsigmoid colonic diverticulitis, giant colonic diverticulum, segmental colitis associated with diverticulosis, and small bowel diverticulitis. We discuss the epidemiology, presentation, and treatment of these types and how they differ from the presentation of typical sigmoid diverticulitis. We also review unusual presentations of typical sigmoid diverticulitis, including hematogenous liver abscess, necrotizing soft-tissue infection, and genitourinary fistula. Diverticulitis is a heterogeneous disease, and understanding the range of its presentations will facilitate early diagnosis and treatment.

S3089 A Case of a Giant Colonic Diverticulum in Patient With End Stage Renal Disease Planned for Kidney Transplantation

S3089 A Case of a Giant Colonic Diverticulum in Patient With End Stage Renal Disease Planned for Kidney Transplantation

Natural history and surgical treatment of a giant colonic diverticulum: A case report

BACKGROUND While diverticular disease is prevalent in the West, the formation of giant colonic diverticula is rare. To date, approximately 200 cases have been reported, with only a handful treated surgically using a minimally invasive approach. Furthermore, the natural history of giant colonic diverticula is not well documented. CASE SUMMARY This report describes the case of a 66-year-old man who developed a giant colonic diverticulum with primary symptoms including dull and chronic pain in the right lower quadrant at presentation. The patient had undergone several computed tomography scans of the abdomen and pelvis over the previous two years, through which the natural history of this rare entity could be retrospectively observed. The patient was successfully treated with a robot-assisted sigmoid colectomy and had an uneventful recovery with resolution of symptoms during the follow-up. CONCLUSION This rare case demonstrates the natural history of giant colonic diverticulum formation and supports the feasibility of robot-assisted surgery.

Pericardial effusion and impaired diastolic cardiac function as a result of a giant colonic diverticulum

This case report describes a Giant Colonic Diverticulum (GCD) found in association with a significant pericardial effusion and impaired cardiac function. A 63-year-old man presented to the Emergency Department with bilateral leg edema, mild dyspnea, and diarrhea. An echocardiogram demonstrated a large pericardial effusion and abnormal diastolic cardiac function. Abdominal imaging studies identified a 29 cm x 18 cm x 13 cm gas filled structure in the left upper quadrant concerning for GCD causing significant compression of the left lung and heart. Following surgical resection, the pericardial effusion resolved, cardiac function normalized, and the patient’s leg swelling improved. This is the first case report to record an association between GCD and pericardial effusion with impaired diastolic cardiac function.

Totally laparoscopic management of a giant sigmoid colon diverticulum: Case report and review of literature

The giant diverticulum of the sigmoid colon is a rare clinical condition characterized by a high risk of complications. Its etiology is multifactorial, with longstanding diverticular disease and motor dysfunction of the colon as risk factors. Even though its diagnosis could be challenging, clinicians can rely on barium enemas revealing the characteristic findings of a large, air-filled sac adjacent to the colon on a computed tomography scan and colonoscopy. The use of these tools aids in ruling out alternative diagnoses and confirming the presence of a diverticulum. Timely surgical management is essential, also in asymptomatic fit-for-surgery patients, to prevent potential complications.

Giant colonic diverticulum of the transverse colon as a rare cause of surgical acute abdomen: A case report

A colonic diverticulum larger than 4 cm in size is referred to as a giant colonic diverticulum and is an uncommon occurrence. Globally, <200 cases of large colonic diverticula have been documented. The majority of the giant colon diverticulum arises from the sigmoid colon. However, we here described a case report of a 68-year-old female who presented with acute abdominal pain, along with chronic constipation. An abdominal computed tomography scan revealed an enormous giant colonic diverticulum measuring 17 cm × 11.7 cm × 7.8 cm with a 1.3 cm neck orifice, arising from the transverse colon along the antimesenteric border of the colon. The patient underwent an exploratory laparotomy with excision of the transverse colonic giant diverticulum and stapler anastomosis.

Giant colonic diverticulum: atypical manifestation of diverticular disease

Giant Colonic Diverticulum (GCD) is a rare complication of a common disease, in which the symptomatology is nonspecific and whose diagnosis is essentially made by CT scan. A surgical ressection is the recommended treatment in order to avoid perforation or other complications. We present a case of a 74-year-old woman who went to the emergency department with complaints of intestinal obstruction and acute abdomen. An abdominal computed tomography (CT) revealed a mesenteric collection with 60 mm and air-fluid level compatible with an abscess, adjacent to a small bowel loop. An emergency laparotomy was performed, which revealed a cystic formation of 6 cm in the antimesentery border, dependant of the sigmoid colon, which was resected en bloc with the adjacent colon. The specimen classified it as type 2 diverticulum. The patient was discharged after a normal postoperative period.

Surgical Management of Giant Colonic Diverticulum with Da Vinci Robotic System: A Case Report

Surgical Management of Giant Colonic Diverticulum with Da Vinci Robotic System: A Case Report

Giant Colonic Diverticulitis, an Extremely Rare Presentation of a Rare Disease — Clinical Presentation and Literature Review

Abstract Introduction Giant colonic diverticulum (GCD) is rare phenomenon, with less than 200 cases described in the literature. One of the complications of GCD is diverticulitis. To date, there is paucity of data addressing the diagnosis and management of GCD complicated by acute diverticulitis. Objective To better understand the diagnostic tools, the initial management, and the long-term follow-up for this group of patients as well as to recommend a proper multidisciplinary approach to this infrequent disease. Method A systematic literature search was performed using the PubMed, Embase, and Cochrane databases to identify all the published studies on GCD complicated by diverticulitis. Two of the authors assessed the relevance of the included full-text papers. The articles were assessed independently. Results In total, 12 cases were identified. Our results show that 10/11 (91%) of the patients who had computed tomography (CT) scans during the initial evaluation had a correct diagnosis. There was no case of failure to non-operative approach (7/7). The patients who had an emergency operation were treated so due to diffuse peritonitis (two patients), acute hemorrhage arising from ulcers within the diverticula (one patient), and misdiagnosis (one patient). Conclusion Giant colonic diverticulitis is a very rare disease. Computed tomography scan is a valuable tool for the initial diagnosis as well as for treatment strategy planning. Non-operative management is a viable option for patients without diffuse peritonitis. Interval endoscopy is recommended if no contraindication exists.

Complicated giant diverticulum of rectosigmoid colon in elderly.

IntroductionGiant colonic diverticulum (GCD) is a rare condition defined by diverticular size over 4 cm. Its presentation is usually asymptomatic.Present of caseWe herein report a rare presentation of ruptured GCD in elderly man who suffered from abdominal pain. The patient underwent primary repair and ileostomy to shorten the operation time instead of Hartmann's operation. Post-operative CT revealed complicated GCD with rupture.DiscussionThe exact mechanism of GCD generation is questionable. Most of case is discovered by radiologic exam or computed tomography (CT) incidentally. The most common complications of GCD are perforation and abscess formation.ConclusionSymptoms of GCD are like those of usual diverticulosis. But, considering the severity of complications, it is better to prioritize surgical treatment at diagnosis.

How Fast Can a Giant Colonic Diverticulum Grow?

Background: A giant colonic diverticulum is defined as a diverticulum with a diameter over 4 cm. Previous case reports have focused on and investigated the pathophysiology, but little is known about the growth pattern. Methods: We present a case in which we retrospectively document the growth rate of a giant colonic diverticulum (GCD). Results: A 67-year-old patient was sent to our surgical department with a CT confirmed cystic, air-filled cavity of more than 7 cm. Segmental resection of the megadiverticulum was performed. The pathology showed a giant colonic diverticulum that measured 10x8x7 cm. We compared the CT images from his previous attack of diverticulitis with the actual findings: a single enlargened diverticulum had grown nearly sevenfold since this attack, implying a growth rate of 1,5 cm/month. Conclusion: Our case report supports the hypothesis that a previous diverticulitis attack and early colonoscopy can accelerate the development of a colonic megadiverticulum, and they are possible risk factors.

Giant Colon Diverticulum - Rare Condition: Case Report

A rare condition that affects patients with colonic diverticulosis is the giant colonic diverticulum (GCD), which has a diameter of over 4 cm. The giant colonic diverticulum affects men and women equally, achieving highest incidence in groups between 35 and 90 years old (average 65 years) and is usually located on the antimesenteric border of the sigmoid colon in 90% of cases. We report a case of giant colonic diverticulum diagnosed in a 76-year-old patient and describe the clinical signs and symptoms, laboratory tests, radiological findings and the therapeutic conduct performed. In this specific case, the location of the GCD in the sigmoid colon, inflammatory symptoms combined with alternative therapy based on conservative treatment, with no need for resection of the adjacent colon, are configured in a conduct of satisfactory value. The clinical presentation of GCD may remain asymptomatic for months or even years, produce nonspecific abdominal discomfort or manifest in the form of an acute abdomen. In view of the characteristics of the case, the scarce references in the world literature and because it details the conduct and follow-up of the patient affected by this disease, it is opportune to describe it.

Giant colonic diverticulum: a case report with review of the literature

Giant colonic diverticulum: a case report with review of the literature

Giant Sigmoid Diverticulum as a Lump in Left Iliac Fossa

Diverticulosis of the colon is a common clinical entity affecting 35% of individuals over the age of 65 years. It is usually limited to the sigmoid colon. When a colonic diverticulum enlarges to over 4 cm in diameter, it is defined as a giant colonic diverticulum (GCD) and it is a rare manifestation of colonic diverticulosis. There have been fewer than 200 cases reported worldwide since GCD was first described in 1946. GCD can be complicated by volvulus, bowel obstruction, perforation, abscess formation, sepsis, and rectal bleeding. Here, we report a case of a 76-year-old female presenting to the emergency department with features of acute colonic obstruction and having a large palpable mass in the left iliac fossa which was diagnosed to be a GCD. She underwent prompt surgical resection of sigmoid colon with en bloc excision of GCD and had uneventful postoperative recovery.

Special Situations in the Management of Diverticular Disease.

Diverticular disease affects a large percentage of the US population, affecting over 30% among those older than 45 years old. It is responsible for ∼300,000 hospitalizations per year in the United States and can lead to serious complications such as hemorrhage, obstruction, abscess, fistulae, or bowel perforation. 2 It is an extremely common reason for emergency room and outpatient visits and evaluations by general and colorectal surgeons. In the US, patients usually present with sigmoid diverticulitis in the setting of a normal immune system so surgeons will follow well-established practice guidelines for treatment. However, there may be special circumstances in which the management of diverticulitis is not as straightforward. In this article, we will address patients who present with multifocal disease, giant colonic diverticulum, right-sided diverticulitis, and diverticulitis in the setting of immunosuppression and hopefully provide guidance for treatment in these special circumstances.

A Case of Infection of a Giant Diverticulum of the Transverse Colon

A Case of Infection of a Giant Diverticulum of the Transverse Colon

Nonoperative Management of Perforated Giant Colonic Diverticulum.

Nonoperative Management of Perforated Giant Colonic Diverticulum.

A Mature Cyst Teratoma with Malignant Transformation in Squamous Cell Carcinoma Presenting Like a Sigmoid Fistula: A Case Report of a Rare Differential Diagnosis of a Giant Colonic Diverticulum

Mature cystic teratoma is the most common form of ovarian germ cell tumor. Mature cystic teratoma is a benign tumor, mainly diagnosed in young women, with non-specific symptoms. However, the risk of malignant transformation exists (1-2%). Squamous cell carcinoma is the most frequently encountered histological form. Giant colonic diverticulum is a rare complication of diverticular disease, characterized by a diverticulum larger than 4 cm which can sometimes be confused with other digestive pathologies (appendicitis, small bowel perforation ...). We report a case of an ovarian squamous cell carcinoma arising from a mature cystic teratoma, presenting like a sigmoid fistula, with an initial doubt with the diagnosis of a giant colonic diverticulum. A 68-year-old woman was admitted for chronic hypogastric abdominal pain with a doubt concerning the diagnosis between a mature cystic teratoma and a giant colonic diverticulum. A computed tomography scan was performed revealing a perisigmoid cyst with hydro-aeric level in favor of a giant colonic diverticulum. The pelvic MRI rather suggested a left ovarian cyst, fistulated in the sigmoid colon. Finally, the colonoscopy confirmed this hypothesis with the visualization of a sigmoid fistula located 15cm from the anal margin in connection with a cavity containing hairs. Biopsies revealed a squamous cell carcinoma. After a negative extension assessment, a posterior pelvectomy was performed with pelvic and lumbo-aortic lymph node dissection. The pathological diagnosis was an ovarian pT4N1R0 squamous cell carcinoma. An adjuvant chemotherapy is still in progress.

A Mature Cyst Teratoma with Malignant Transformation in Squamous Cell Carcinoma Presenting Like a Sigmoid Fistula: A Case Report of a Rare Differential Diagnosis of a Giant Colonic Diverticulum

Mature cystic teratoma is the most common form of ovarian germ cell tumor. Mature cystic teratoma is a benign tumor, mainly diagnosed in young women, with non-specific symptoms. However, the risk of malignant transformation exists (1-2%). Squamous cell carcinoma is the most frequently encountered histological form. Giant colonic diverticulum is a rare complication of diverticular disease, characterized by a diverticulum larger than 4 cm which can sometimes be confused with other digestive pathologies (appendicitis, small bowel perforation ...). We report a case of an ovarian squamous cell carcinoma arising from a mature cystic teratoma, presenting like a sigmoid fistula, with an initial doubt with the diagnosis of a giant colonic diverticulum. A 68-year-old woman was admitted for chronic hypogastric abdominal pain with a doubt concerning the diagnosis between a mature cystic teratoma and a giant colonic diverticulum. A computed tomography scan was performed revealing a perisigmoid cyst with hydro-aeric level in favor of a giant colonic diverticulum. The pelvic MRI rather suggested a left ovarian cyst, fistulated in the sigmoid colon. Finally, the colonoscopy confirmed this hypothesis with the visualization of a sigmoid fistula located 15cm from the anal margin in connection with a cavity containing hairs. Biopsies revealed a squamous cell carcinoma. After a negative extension assessment, a posterior pelvectomy was performed with pelvic and lumbo-aortic lymph node dissection. The pathological diagnosis was an ovarian pT4N1R0 squamous cell carcinoma. An adjuvant chemotherapy is still in progress.

Giant Colonic Diverticulum after Side-to-Side Colonic Anastomosis

Giant Colonic Diverticulum after Side-to-Side Colonic Anastomosis