Giant Colonic Diverticulum Research Articles

Presentation and Management of Giant Colonic Diverticula

Presentation and Management of Giant Colonic Diverticula

1553 A Phantom of the Large Bowel!

INTRODUCTION: Giant colonic diverticulum (GCD), referred to as giant colon cyst or “phantom tumor,” is a diverticulum that commonly arises from sigmoid colon and is larger than 4 cm in diameter. This occurs mostly in individuals older than 60 years and its pathogenesis is not well understood. Two theories have been proposed that could co-exist: A one-way valve mechanism at the transition point between the bowel lumen and diverticulum permitting air entry and progressive increase in intraluminal pressure with subsequent enlargement of the diverticulum. Alternatively, gas forming bacteria encased within a cyst of the colon contributing to chronic inflammation and consequent gradual distention of a diverticulum. Patients are mostly asymptomatic, otherwise common clinical manifestations range from a soft palpable abdominal mass to lower abdominal pain, constipation or rectal bleeding. However, it is uncommon for GCD to present as acute diverticulitis, and to our knowledge, this is a rare case to be reported in the literature. Herein we report a case of an elderly male who presented with sepsis due to acute diverticulitis as an initial presentation of a GCD. CASE DESCRIPTION/METHODS: A 63-year-old bed-bound male with a history of multiple sclerosis and major depression presented to our hospital with generalized abdominal pain of one-day duration. The patient was febrile at 101 F, and physical exam was remarkable for lower abdominal tenderness without guarding. He was septic with evidence of leukocytosis of 23,400/mm3, neutrophilia and lactate of 3 mmol/L (normal range: 0.5–2.2 mmol/L). A CT of the abdomen with contrast demonstrated an isolated 4.5 cm diverticulum at the sigmoid colon with evidence of acute diverticulitis. There was no evidence of a focal drainable abscess, free air or diverticulosis in other colon segments. He was considered high risk for surgery due to his sedentary status and was conservatively managed with parenteral antibiotics. His symptoms resolved and discharged three days later, without any further complications. DISCUSSION: GCD is a rare manifestation of diverticular disease and can present with a myriad of symptoms. Acute diverticulitis should be considered in those with evidence of sepsis and at risk of developing GCD. The gold standard treatment of en-bloc resection of the GCD with primary anastomosis is not always ideal for the management of this entity and a more conservative approach can be taken in high-risk surgical candidates as in our patient and may lead to a favorable outcome.

Special Considerations of Diverticulitis and Diverticular Bleeding

Diverticulitis in certain subpopulations of patients may require different treatments, especially in the elective setting. Diverticular bleeding, another complication of diverticulosis, is another source of burden on United States healthcare from diverticular disease. This chapter discusses the special circumstances of right-sided diverticulitis, diverticulitis in young patients or immunocompromised patients, recurrent diverticulitis after resection, giant colonic diverticulum, and rare presentations of diverticulitis. Atypical types of diverticulitis such as segmental colitis associated with diverticulosis (SCAD), symptomatic uncomplicated diverticular disease (SUDD), and smoldering diverticulitis are also reviewed, and indications for surgical intervention are summarized. Current controversies are reviewed, including the decision to operate in young or immunocompromised patients; management of SCAD, SUDD, or smoldering diverticulitis; and best localization method to diagnose diverticular bleeding. This review contains 6 figures, 2 tables, and 55 references. Key Words: atypical diverticulitis, diverticular bleeding, diverticular disease, diverticulosis, gastrointestinal bleeding, right-sided diverticulitis, segmental colitis associated with diverticulosis, smoldering diverticulitis, symptomatic uncomplicated diverticular disease, total abdominal colectomy

Giant colonic diverticulum: review of the literature, personal experience and proposal of decision making

Giant colonic diverticulum: review of the literature, personal experience and proposal of decision making

A Rare Case of an Asymptomatic Giant Colonic Diverticulum

A Rare Case of an Asymptomatic Giant Colonic Diverticulum

A Spectrum of Entities That May Mimic Abdominopelvic Abscesses Requiring Image-guided Drainage.

A variety of entities may mimic drainable abscesses. This can lead to misdiagnosis of these entities, unnecessary percutaneous placement of a pigtail drainage catheter, other complications, and delay in appropriate treatment of the patient. Types of entities that may mimic drainable abscesses include neoplasms (lymphoma, gallbladder cancer, gastrointestinal stromal tumor, ovarian cancer, mesenteric fibromatosis, ruptured mature cystic teratoma, recurrent malignancy in a surgical bed), ischemia/infarction (liquefactive infarction of the spleen, infarcted splenule), diverticula (calyceal, Meckel, and giant colonic diverticula), and congenital variants (obstructed duplicated collecting system). Postoperative changes, including expected anatomy after urinary diversion or Roux-en-Y gastric bypass and small bowel resection, may also pose a diagnostic challenge. Nonpyogenic infections (Mycobacterium tuberculosis, Mycobacterium avium complex, echinococcal cysts) and inflammatory conditions such as xanthogranulomatous pyelonephritis and gossypiboma could also be misinterpreted as drainable fluid collections. Appropriate recognition of these entities is essential for optimal patient care. This article exposes radiologists to a variety of entities for which percutaneous drainage may be requested, but is not indicated, and highlights important imaging findings associated with these entities to facilitate greater diagnostic accuracy and treatment in their practice. ©RSNA, 2018.

Uncommon Diverticular Disease.

This article describes the epidemiology, pathogenesis, diagnosis, and treatment of three rare variants of diverticular disease: cecal and right-sided colonic diverticula, giant colonic diverticula, and small bowel diverticula.

AB154. 130. Incidental finding of giant colonic diverticulum and their management: two case reports

AB154. 130. Incidental finding of giant colonic diverticulum and their management: two case reports

Giant sigmoid colon diverticulum

Abstract Giant colonic diverticula are uncommon in all age groups and are especially rare within the pediatric population, with only one known previously reported case in a child. In this case presentation, we report a rare case of a pediatric GCD, review relevant epidemiology and histology, and discuss diagnostic and treatment options. The patient was an 11-year old female with worsening chronic constipation, abdominal pain, and vomiting. CT found a large pelvic mass that was removed via sigmoidectomy and found to be a Type 3 (true diverticula) GCD, which make up only 12% of all GCD's. Pediatric GCD's can be mistaken for the much more common enteric duplication cyst, but both pathologies require surgery. Because of the uncommon nature of GCD, the authors recommend CT as the diagnostic modality of choice because of its high sensitivity and ability to aid in preoperative planning. The authors also recommend treating pediatric GCD with segmental colectomy to avoid recurrence and even a remote risk of colonic adenocarcinoma.

Endoscopic Recognition of Giant Colonic Diverticula

Introduction: Giant Colonic Diverticulum (GCD) is a rare endoscopic finding which is typically diagnosed radiologically during evaluation of abdominal pain or abdominal mass felt on exam. We present a case of GCD initially identified on colonoscopy, which was performed for iron deficiency anemia without prior abdominal imaging. Case: An 82-year-old male with a history of diverticulosis was admitted after being found down from a mechanical fall. On admission his hemoglobin was 6.9 mg/dL, which was decreased from 14.6 mg/dL eight months prior. He denied any overt gastrointestinal bleeding, but given the severity of his anemia, iron deficiency, and lack of other etiology for blood loss he underwent esophagogastroduodenoscopy and colonoscopy. Colonoscopy revealed several large diverticula, the largest of which had an approximate 3 cm os and surrounding erythematous and friable mucosa that was biopsied showing ulcer debris and evidence of diverticular colitis (Figure 1, 2). The next day a CT scan of the abdomen revealed a large 7 cm gas-filled cyst in apparent communication with the sigmoid colon (Figure 3). Eight days later he developed worsening abdominal pain and a repeat CT scan showed a rim-enhancing collection of fecal material and air in the location of the prior gas-filled cyst along with moderate pneumoperitoneum. He then underwent exploratory laparotomy with sigmoid colectomy and was found to have a thin walled large diverticula with an identified perforation. Discussion: Giant colonic diverticula are greater than 4 cm in size and 90% are found in the sigmoid colon. Pathogenesis of these lesions is incompletely understood, but one theory is that they are secondary to subserosal perforation which then forms a walled off abscess cavity in communication with the lumen of the colon. Though they are typically identified on abdominal imaging they may be encountered initially during colonoscopy as in our case. Care should be taken to avoid perforation in these cases given there is only a thin wall of fibrotic tissue without normal intestinal layers in 66% of cases.Figure: Sigmoid colon with large mouth diverticula, with heaped up friable surrounding mucosa.Figure: Image within the giant diverticulum demonstrating gross amounts of exudate and granulation tissue.Figure: CT scan with giant colonic diverticulum in communication with sigmoid colon.

An Interesting Case of Giant Colonic Diverticulum Presenting With Rectal Bleeding and Perforation Simultaneously

An Interesting Case of Giant Colonic Diverticulum Presenting With Rectal Bleeding and Perforation Simultaneously

The Lifting Balloon: Sign of a Giant Colonic Diverticulum.

The Lifting Balloon: Sign of a Giant Colonic Diverticulum.

Computed tomographic colonography in the evaluation of a case of giant colonic diverticulum

The aim of this article was to present our experience with CT-colonography evaluation of a case of giant colonic diverticulum. Despite the high prevalence of diverticular disease in the Western world, giant colonic diverticula are rare entities, with fewer than 200 cases reported in literature.

Giant colonic diverticulum: radiographic and MDCT characteristics

Giant colonic diverticulum (GCD), defined as a diverticulum larger than 4 cm, is a rare entity that is generally a manifestation of colonic diverticular disease. Because of its rarity and its variable and non-specific presentation, the diagnosis of GCD depends mainly on imaging findings. Knowledge of the spectrum of radiographic and CT features of the GCD is important in making the correct diagnosis and potentially preventing complications. This review focuses on imaging findings characteristic of GCD as well as its complications and radiographic mimics.Teaching points• Giant colonic diverticulum is a rare complication of diverticulosis.• The most common symptom is abdominal pain presenting in approximately 70 % of patients.• Diagnosis is based on imaging findings with plain abdominal radiographs and MDCT.• Treatment consists of enbloc resection of the diverticulum and affected adjacent colon.

Giant colon diverticulum

Giant colonic diverticulum is defined by a diverticulum whose diameter is greater than 4 cm. This is a rare entity, arising mainly in the sigmoid colon. The diagnosis is based on abdominal computed tomography that shows a gas-filled structure communicating with the adjacent colon, with a smooth, thin diverticular wall that does not enhance after injection of contrast. Surgical treatment is recommended even in asymptomatic diverticula, due to the high prevalence and severity of complications. The gold standard treatment is segmental colectomy. Some authors propose a diverticulectomy when the giant diverticulum is unique.

Giant sigmoid diverticulum: A rare entity of high clinical significance

Affecting about 35% of patients above the age of sixty, diverticular disease represents a common entity. However, giant colonic diverticulum is a rare complication of this disease with variant clinical presentation and high complication rate. This report describes one such case and includes a short review of the literature. An 83-year-old Caucasian man was transferred to our Unit after having been hospitalized in the Department of Internal Medicine for 15 days due to high fever with chills and vague left lower abdominal pain. The clinical examination was normal and showed no signs of peritonitis or palpable mass, other than a mild abdominal tenderness in the left iliac fossa. The patient’s medical history included diabetes mellitus, hyperlipidaemia, and distal arteriopathy. The patient had undergone endovascular repair of abdominal aortic aneurysm five years earlier. Blood tests indicated hypochromic anaemia and a hemoccult test was positive for haematochezia. Blood, urine, and faeces cultures were negative. Diverticulosis of the sigmoid colon was diagnosed by colonoscopy. The abdominal CT revealed a large air density mass adjacent to the sigmoid colon and diverticulosis of the sigmoid colon was diagnosed by colonoscopy. We performed sigmoid resection followed by end-to-end colorectal anastomosis with protective loop ileostomy so as to eliminate the risk of septic complications. A giant pseudodiverticulum was confirmed by histology. Giant colonic diverticulum is a rare complication of colonic diverticular disease with unclear aetiology and variable clinical presentation. Due to the substantial risk of complications and the low mortality associated with surgical treatment, elective surgical therapy has been recommended. Conservative management of an asymptomatic giant colonic diverticulum should be reserved only for high-risk elderly patients who cannot tolerate surgery or who are unwilling to undergo surgery.

Giant colon diverticulum: clinical and imaging findings in 17 patients with emphasis on CT criteria

PurposeThe purpose of the study was to review the clinical and radiologic features of giant colonic diverticulum (GCD). MethodsMedical records of 17 patients with GCD on computed tomographic (CT) examination were reviewed. ResultsCT examination revealed the GCD in all patients as a predominantly gas-filled structure communicating with the adjacent colon. Thirteen patients showed a gas-filled structure on abdominal radiograph. The mean GCD diameter was 7 cm. Most diverticula were found in the sigmoid colon. Associated diverticulosis was present in 71% of patients. ConclusionOur experience suggests that GCD can often be diagnosed on the basis of the characteristic radiographic and CT findings in these patients.

Giant Ascending Colonic Diverticulum Presenting With Intussusception

Diverticular disease of the colon is a common disease, and its incidence is increasing gradually. A giant colonic diverticulum (GCD) is a rare entity and is defined as a diverticulum greater than 4 cm in size. It mainly arises from the sigmoid colon, and possible etiology is a ball-valve mechanism permitting progressive enlargement. A plain abdominal X-ray can be helpful to make a diagnosis initially, and a barium enema and abdominal computed tomography may confirm the diagnosis. Surgical intervention is a definite treatment for a GCD. We report a case of an ascending GCD presenting with intussusception in a young adult.

Giant sigmoid diverticulitis mimicking acute appendicitis

Giant colonic diverticula are a rare manifestation of diverticular disease and there are fewer than 150 cases described in the literature. They may have an acute or chronic presentation or may remain asymptomatic and be found incidentally. As the majority (over 80%) of giant diverticula are located in the sigmoid colon, they usually present with left-sided symptoms but due to the variable location of the sigmoid loop, right-sided symptoms are possible. We describe the acute presentation of an inflamed giant sigmoid diverticulum with right iliac fossa pain. We discuss both the treatment options for this interesting condition and also the important role of computed tomography in the diagnosis and management of abdominal pain in elderly patients.

Look Out before Polypectomy in Patients with Diverticular Disease – A Case of a Large, Inverted Diverticulum of the Colon Resembling a Pedunculated Polyp

Diverticular disease of the colon may be responsible for abdominal symptoms requiring colonoscopy, which may reveal the presence of concomitant polyps. A polyp found during colonoscopy in patients with colonic diverticular disease may be removed by endoscopic polypectomy with electrosurgical snare, a procedure associated with an incidence of perforation of less than 0.05%. The risk of such a complication may be higher in the event of an inverted colonic diverticulum, which may be misinterpreted as a polypoid lesion at colonoscopy. To date, fewer than 20 cases of inverted colonic diverticula, diagnosed at colonoscopy or following air contrast barium enema, have been reported in the literature. The present report describes a 68-year-old woman who underwent a screening colonoscopy, which revealed a voluminous pedunculated polyp that was recognized to be an inverted giant colonic diverticulum before endoscopic polypectomy.