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Abstract
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.
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Affiliation(s)
- Sanjay Mohanty
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Shawn P Webb
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
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2
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Cubas V, Ward ST, Dmitrewski J. Giant diverticulum- A rare complication of a common surgical condition. Clin Case Rep 2016; 4:531-2. [PMID: 27190624 PMCID: PMC4856254 DOI: 10.1002/ccr3.534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/05/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
A gentleman presented with abdominal distension and pain. CT confirmed a 20 cm sigmoid diverticulum. A giant diverticulum, typified by diverticula greater than 4 cm, often requires colonic resection. Fewer than 200 cases have been reported, most measuring 7–15 cm. I present a rare complication of a common surgical condition with images.
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Affiliation(s)
- Vanessa Cubas
- Queen Elizabeth Hospital Mindelsohn Way Birmingham B15 2TH UK
| | - Stephen T Ward
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit (BRU) University of Birmingham Vincent Drive Birmingham B15 2TT UK
| | - Jan Dmitrewski
- Queen Elizabeth Hospital Mindelsohn Way Birmingham B15 2TH UK
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3
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Cooper EA, Muhlmann MD. Giant sigmoid diverticulum. ANZ J Surg 2016; 88:E617-E618. [PMID: 26947259 DOI: 10.1111/ans.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 01/26/2016] [Accepted: 02/07/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Edward A Cooper
- Department of Colorectal Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Mark D Muhlmann
- Department of Colorectal Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
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4
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Giant colonic diverticulum: radiographic and MDCT characteristics. Insights Imaging 2015; 6:659-64. [PMID: 26385691 PMCID: PMC4656231 DOI: 10.1007/s13244-015-0433-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/26/2015] [Accepted: 09/07/2015] [Indexed: 11/03/2022] Open
Abstract
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 en bloc resection of the diverticulum and affected adjacent colon.
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Nigri G, Petrucciani N, Giannini G, Aurello P, Magistri P, Gasparrini M, Ramacciato G. Giant colonic diverticulum: clinical presentation, diagnosis and treatment: systematic review of 166 cases. World J Gastroenterol 2015; 21:360-368. [PMID: 25574112 PMCID: PMC4284356 DOI: 10.3748/wjg.v21.i1.360] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 08/19/2014] [Accepted: 09/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the clinical presentation, diagnosis, and treatment of giant colonic diverticulum (GCD, by means of a complete and updated literature review). GCD is a rare manifestation of diverticular disease of the colon. Less than 200 studies on GCD were published in the literature, predominantly case reports or small patient series. METHODS A systematic review of the literature was performed using the Embase and PubMed databases to identify all the GCD studies. The following MESH search headings were used: "giant colonic diverticulum"; "giant sigmoid diverticulum". The "related articles" function was used to broaden the search, and all of the abstracts, studies, and citations were reviewed by two authors. The following outcomes were of interest: the disease and patient characteristics, study design, indications for surgery, type of operation, and post-operative outcomes. Additionally, a subgroup analysis of cases treated in the last 5 years was performed to show the current trends in the treatment of GCD. A GCD case in an elderly patient treated in our department by a sigmoidectomy with primary anastomosis and a diverting ileostomy is presented as a typical example of the disease. RESULTS In total, 166 GCD cases in 138 studies were identified in the literature. The most common clinical presentation was abdominal pain, which occurred in 69% of the cases. Among the physical signs, an abdominal mass was detected in 48% of the cases, whereas 20% of the patients presented with fever and 14% with abdominal tenderness. Diagnosis is based predominantly on abdominal computed tomography. The most frequent treatment was colic resection with en-bloc resection of the diverticulum, performed in 57.2% of cases, whereas Hartmann's procedure was followed in 11.4% of the cases and a diverticulectomy in 10.2%. An analysis of sixteen cases reported in the last 5 years showed that the majority of patients were treated with sigmoidectomy and en-bloc resection of the diverticulum; the postoperative mortality was null, morbidity was very low (1 patient was hospitalized in the intensive care unit for postoperative hypotension), and the patients were discharged 4-14 d after surgery. CONCLUSION Giant colonic diverticulum is a rare manifestation of diverticular diseases. Surgical treatment, consisting predominantly of colonic resection with en bloc resection of the diverticulum, is the preferred option for GCD and guarantees excellent results.
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Iglesias Hidalgo G, Sánchez De La Torre R, Peña Sarnago JM. [Solution to case 36. Giant diverticulum of the sigmoid colon]. RADIOLOGIA 2011; 53:575-7. [PMID: 22074659 DOI: 10.1016/j.rx.2011.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 11/17/2010] [Indexed: 10/15/2022]
Affiliation(s)
- G Iglesias Hidalgo
- Servicio de Radiodiagnóstico, Hospital de Cruces, Barakaldo, Vizcaya, España.
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Sasi W, Hamad I, Quinn A, Nasr AR. Giant sigmoid diverticulum with coexisting metastatic rectal carcinoma: a case report. J Med Case Rep 2010; 4:324. [PMID: 20955549 PMCID: PMC2967567 DOI: 10.1186/1752-1947-4-324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 10/18/2010] [Indexed: 12/12/2022] Open
Abstract
Introduction Giant diverticulum of the colon is a rare but clinically significant condition, usually regarded as a complication of an already existing colonic diverticular disease. This is the first report of a giant diverticulum of the colon with a co-existing rectal carcinoma. Case presentation We report a case of a 66-year-old Caucasian woman who presented with lower abdominal pain, chronic constipation and abdominal swelling. Preoperative abdominal computed tomography revealed a giant diverticulum of the colon with a coexisting rectal carcinoma and pulmonary metastasis revealed on a further thoracic computed tomography. An en bloc anterior resection of the rectum along with sigmoid colectomy, partial hysterectomy and right salpingoophorectomy was subsequently performed due to extensive adhesions. Conclusion This report shows that the presence of a co-existing distal colorectal cancer can potentially lead to progressive development of a colonic diverticulum to become a giant diverticulum by increasing colonic intra-luminal pressure and through the ball-valve mechanism. This may be of interest to practising surgeons and surgical trainees.
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Affiliation(s)
- Walid Sasi
- Department of Surgery, Louth County Hospital, Dundalk, Co Louth, Ireland.
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Guarnieri A, Cesaretti M, Tirone A, Francioli N, Piccolomini A, Vuolo G, Verre L, Savelli V, Di Cosmo L, Carli AF. Giant Sigmoid Diverticulum: A Rare Presentation of a Common Pathology. Case Rep Gastroenterol 2009; 3:5-9. [PMID: 20651957 PMCID: PMC2895168 DOI: 10.1159/000200014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although colonic diverticulum is a common disease, affecting about 35% of patients above the age of 60, giant sigmoid diverticulum is an uncommon variant of which only relatively few cases have been described in the literature. We report on our experience with a patient affected by giant sigmoid diverticulum who was treated with diverticulectomy. Resection of the diverticulum is a safe surgical procedure, provided that the colon section close to the lesion presents no sign of flogosis or diverticula; in addition, recurrences are not reported after 6-year follow-up.
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Affiliation(s)
- A Guarnieri
- U.O.C. Chirurgia 2, AOU Senese, Siena, Italy
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Hurreiz H, Mayes R, Humphreys G. A giant sigmoid diverticulum presenting as an upper abdominal mass. Ir J Med Sci 2007; 177:409-11. [PMID: 17909880 DOI: 10.1007/s11845-007-0090-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 09/10/2007] [Indexed: 12/16/2022]
Abstract
AIM We report a case of a giant diverticulum of the sigmoid colon presenting as a mass in the left upper quadrant of the abdomen in an elderly man. METHODS This report highlights a rare complication of diverticular disease. At operation, the giant cyst was situated in the supracolic compartment of the abdomen. The management options and a review of the literature are presented. CONCLUSION CT scan is the investigation of choice. Early surgical intervention is important in order to reduce the risk of perforation.
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Affiliation(s)
- H Hurreiz
- Department of Surgery Queen's Room, Antrim Area Hospital, 45 Bush Road, Antrim, BT41 2RL, Northern Ireland.
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Praveen BV, Suraparaju L, Jaunoo SS, Tang T, Walsh SR, Ogunbiyi OA. Giant colonic diverticulum: an unusual abdominal lump. JOURNAL OF SURGICAL EDUCATION 2007; 64:97-100. [PMID: 17462210 DOI: 10.1016/j.jsurg.2006.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 10/19/2006] [Accepted: 10/20/2006] [Indexed: 05/15/2023]
Abstract
Giant colonic diverticulum is a rare complication of diverticular disease of the colon and is thought to result, in most cases, from a "ball-valve" effect. The presentation and clinical course can be variable and confusing. The most common symptoms are abdominal pain and a palpable abdominal lump, with many patients presenting acutely with complications such as perforation and peritonitis. Preoperative diagnosis requires a high degree of suspicion and needs to be differentiated from sigmoid volvulus, caecal volvulus, intestinal duplication cyst, pneumatosis cystoidis intestinalis, and similar conditions. A plain x-ray and computed tomography (CT) scan of the abdomen shows a huge air-filled cyst termed "balloon sign" and confirms the diagnosis. The barium enema shows a communication with the bowel in most cases. In view of the high incidence of complications, treatment is advised even in asymptomatic cases and consists of excision of the cyst with resection of the adjacent colon with primary anastomosis. This treatment would, in most cases, be a sigmoid colectomy. Percutaneous drainage and Hartmann's procedure may be appropriate in some cases who present with a well-formed abscess or gross fecal peritonitis, respectively. A case is described, and the literature is reviewed.
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Affiliation(s)
- B V Praveen
- Department of Surgery, Southend Hospital, Westcliffe-on-sea, Essex, and Cambridge Vascular Unit, Cambridge University Hospital NHS Foundation Trust, United Kingdom
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Gillion JF, Julles MC, Convard JP, Laroudie M, Balaton A, Karkouche B, Berthelot G, Bonan A, Bonnichon JM, Chollet JM, Molkhou JM. Diverticules géants du grêle et du côlon et formations pseudo kystiques sous-mésocoliques. ACTA ACUST UNITED AC 2005; 142:248-56. [PMID: 16335900 DOI: 10.1016/s0021-7697(05)80913-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Giant diverticula of the small intestine and colon are rare. Four cases treated at our institution in the last year are reported and compared to published cases; specific features and those which differentiate them from abdominal pseudocysts are described. They most commonly present a clinical tableau similar to commonplace diverticular disease. Awareness of this unusual condition and a good CT study are the keys to diagnosis. Giant diverticula may be acquired or congenital. The acquired type is simply a more spectacular version of commonplace diverticulosis while the congenital type, having a muscular wall and myenteric plexus, is more akin to intestinal duplications. Treatment is surgical and, in the case of sigmoid giant diverticula, usually requires a colon resection similar to that required for sigmoid diverticulitis.
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Affiliation(s)
- J F Gillion
- Unité de Chirurgie Digestive, Hôpital Privé d'Antony, Antony.
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Roth T, Demartines N, Gavelli A, Huguet C. [Giant diverticula of the colon. Apropos of 2 cases]. CHIRURGIE; MEMOIRES DE L'ACADEMIE DE CHIRURGIE 1999; 124:307-12. [PMID: 10429306 DOI: 10.1016/s0001-4001(99)80098-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Giant diverticulum of the colon is a rare complication of the colonic diverticulosis. It generally involves the sigmoid colon. In the chronic form, without symptoms or with only a few non-specific symptoms, an abdominal mass is frequently palpable. A plain abdominal radiogram, showing a gas-filled cyst, can suggest the diagnosis. If needed, an abdominal CT scan is appropriate and seems to be more accurate than a barium enema. The treatment of choice is a segmental resection of the colon involving the giant diverticulum, followed by a direct anastomosis. Despite the old age of these patients, both postoperative morbidity and mortality are low and justify such a radical approach. The acute clinical presentation (about 20%) is generally due to a peritonitis by perforation of the giant diverticulum and requires an emergency colectomy.
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Affiliation(s)
- T Roth
- Département de chirurgie viscérale, centre hospitalier Princesse Grace, Monaco, Principauté de Monaco
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Choong CK, Frizelle FA. Giant colonic diverticulum: report of four cases and review of the literature. Dis Colon Rectum 1998; 41:1178-85; discussion 1185-6. [PMID: 9749503 DOI: 10.1007/bf02239441] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Giant colonic diverticulum are rare, with 103 reported cases in 95 patients. The experience of any one surgeon is limited. We aimed to retrospectively review our experience and to review the literature on origin, pathology, and management of this rare and unusual problem. METHOD Cases were identified by review of pathologic database and by computerized audit from three hospitals. RESULTS Five giant colonic diverticulum were identified in four patients, and the pathology and management were reviewed. CONCLUSION A definition and classification system of giant colonic diverticulum is suggested. Giant colonic diverticulum should be the universal term to cover all colonic diverticulum larger than 4 cm, and we suggest that there are two types based on histology. Literature review reveals 103 reported cases in 95 patients. Type I (87 percent) is a pseudodiverticulum, perhaps related to conventional diverticular disease, whereas Type II (13 percent) is a true diverticulum, which is probably a type of communicating cystic congenital duplication. These lesions tend to occur in the sigmoid colon (93 percent) and present with complications similar to conventional diverticular disease. In the presence of conventional diverticular disease, consideration should be given to anterior resection, and in the absence, diverticulectomy should be considered.
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Affiliation(s)
- C K Choong
- University Department of Surgery, Christchurch Hospital, New Zealand
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