Giant Colonic Diverticulum Research Articles

Obstructing Giant Colonic Diverticulum

We report the second case of an obstructing true colonic diverticulum. Of the 103 cases of giant sigmoid diverticulum found in the literature, 13% have been reported as true giant sigmoid diverticulum, ie, containing all layers of the colonic wall. Our 75-year-old patient had clinical symptoms for only 6 months, and endoscopy revealed an almost totally obstructing mass 20 cm from the anus. Surgical resection of the sigmoid colon with a primary anastomosis resolved all of the patient's obstructive symptoms. A flap-valve mechanism was the cause of this true giant colonic diverticulum. Microscopic examination of the diverticulum wall revealed all normal layers of colon wall.

Giant colonic diverticulum: a rare manifestation of a common disease

Giant colonic diverticulum is a rare manifestation of a common disease primarily affecting patients over the age of 50 years. We reviewed all 81 cases of giant colonic diverticulum reported in the medical literature and present herein an additional case in a younger patient. Published reports were summarized with regard to current epidemiology, clinical aspects, diagnosis, pathogenesis, treatment, and complications. Giant colonic diverticulum can present as an acute, chronic, or incidental condition, or with complications. There are several suggested theories for the pathogenesis of giant colonic diverticulum, but none is universally satisfactory. A diagnosis can be made with plain films, barium enema, and CT scans. A combination of sigmoid resection and primary anastomosis was successful in 75% of the cases reported after the mid-1970s. More than 90% of giant colonic diverticula are found in the sigmoid colon. Sigmoid resection with primary anastomosis is the preferred treatment, although patients presenting with complications typically should be treated with Hartmann's procedure for free perforation or percutaneous drainage for a localized abscess. Because of the high risk of complications, we recommend segmental resection of the involved colon for those found incidentally.

Giant Colonic Diverticulum: Report of a Case

Giant colonic diverticulum is a rare complication of colonic diverticulosis. It typically occurs as a single diverticulum located on the antimesenteric border of the sigmoid colon. The most widely accepted theory for its development attributes the progressive dilation to a "ball-valve" mechanism, allowing air to enter but not to exit. Patients usually present complaining of abdominal pain and/or an abdominal mass, although they may remain asymptomatic. Physical examination reveals a tympanic abdominal mass that appears as a round radiolucency on plain radiographs and CT. Barium enema demonstrates the relationship of the diverticulum to bowel and may document communication with the colonic lumen. To alleviate symptoms and prevent complications, the recommended treatment is excision of the diverticulum in continuity with the involved colonic segment. We report a case and discuss the presentation, diagnosis, and management of giant colonic diverticulum.

Giant true diverticulum of sigmoid colon

A case of giant true diverticulum of the sigmoid colon, manifesting as pain and abdominal mass is presented. The patient is asymptomatic after resection of the diverticulum and end-to-end anastomosis of the colon.

Case report: Uncommon radiological and pathological features of giant colonic diverticula

A case of multiple giant sigmoid diverticula is described in which a barium enema revealed two giant diverticula communicating with the sigmoid lumen. Both diverticula were located on the mesenteric border of the sigmoid colon, and histologic examination showed mucosal and serosal layers with no evidence of smooth muscle. The pathogenesis, pathology, radiological manifestations and differential diagnosis of this rare condition are discussed.

Tuboovarian abscess simulating giant colonic diverticulum

The plain abdominal film finding of a large air-filled cavity has a differential diagnosis that includes giant colonic diverticulum, volvulus, giant Meckel's or other small-bowel diverticulum, emphysematous cystitis, vesicoenteric fistula, bowel duplication, and mesenteric cyst. The case presented here expands this differential diagnosis to include tuboovarian abscess with fistulous communication to the bowel.

Giant solitary gas cyst of the sigmoid colon. A case report.

Agiant Solitary gas cyst within the peritoneal cavity is uncommon. Although the exact pathogenesis is obscure, these cysts are invariably found in intimate relationship to the sigmoid colon. Diverticular disease is almost always associated, and attachment of the cyst to the antimesenteric border of the colon is a common observation at surgery. Case Report L. C, a 46-year-old Caucasian female, was admitted on April 8, 1967, complaining of abdominal pain of twelve hours duration. In 1966 she had been told that she had colonic diverticulitis. On physical examination, a large, mobile, non-tender, well circumscribed cystic mass was palpated just below the umbilicus. No other significant findings were noted. An abdominal film (Fig. 1) showed a large circumscribed collection of gas situated in the mid-abdomen. There was no evidence of free intraperitoneal gas. A barium enema demonstrated diverticular disease of the sigmoid. A loop of this colon appeared fixed in a rather high position, and immediately adjacent to it was a large radio lucent gas-containing cystic structure (Fig. 2). Considered in the differential diagnosis were giant diverticulum of the sigmoid colon, gas-producing abscess, and a gas-filled duplication of the colon. At exploratory laparotomy, a large cystic mass measuring 10 X 15 cm was found in close relationship to the sigmoid colon. The mass and adjacent sigmoid colon were resected in toto. The patient made an uneventful recovery. At pathological examination one day later, a 5 X 9 cm cystic, gas-filled mass was found adherent to the resected sigmoid colon on its antimesenteric border. No communication could be demonstrated between it and the colon. On gross examination the mucosal pattern of the adjacent sigmoid was unremarkable and without evidence of diverticula, ulcerations, or polyps. The opened cyst revealed a greyish-pink inner lining, covered by a small amount of fibrinous exudate. Microscopic examination showed portions of normal-appearing sigmoid colon with intact muscular layers. The serosa and subserosa merged with the wall of the cyst. The inner wall of the cystic structure was totally devoid of any specific lining mucosa, and there was no evidence of any pre-existing colonic tissue. The deeper layers of the wall were composed of dense, hyalinized collagenous connective tissue indicating a longstanding process, and no muscular tissue was demonstrable. Discussion Several similar cases of giant solitary gas cysts of the sigmoid colon have been published in the literature. The age incidence is between the fifth and eighth decades of life. No significant difference in sex incidence is noted. Some of the cysts communicated with the sigmoid colon while others did not. Several hypotheses have been advanced to explain the pathogenesis of the gas-filled cystic structure. Fontaine et al.

Giant sigmoid diverticulum

A case of giant diverticulum of the sigmoid colon in a seventy-two year old man has been reported. Such large diverticula are rare. Because of the rather broad diameter of the neck of the diverticulum, it was completely delineated on barium enema examination. A case of giant diverticulum of the sigmoid colon in a seventy-two year old man has been reported. Such large diverticula are rare. Because of the rather broad diameter of the neck of the diverticulum, it was completely delineated on barium enema examination.

GIANT DIVERTICULUM OF THE SIGMOID COLON.

ALTHOUGH DIVERTICULA of the small intestine commonly reach a diameter of several centimeters, it is rare for those involving the colon to reach a size greater than 1 to 2 cm in diameter. 1 A small number of true diverticula of the large bowel, however, have been reported in the literature. 2-6 All of these cases involved the sigmoid colon, with diverticula ranging from 10 to 25 cm in diameter, and were associated with smaller adjacent diverticula. A definite communication between the cyst and lumen of the bowel could be demonstrated in four of the five cases, but was large enough to permit barium filling on roentgenologic examination in only one patient. Duplications of the alimentary tract, which at times have been misnamed giant diverticula, represent the main entity to be differentiated pathologically from true air-containing diverticula. The former are spherical or tubular structures which possess a well-developed smooth-muscle