Unusual manifestations of giant colonic diverticulum

Imaging Assessment of Gastroduodenal Perforations

Gastroduodenal perforation is an emergency situation that usually requires early recognition and well-timed surgical treatment. It can arise from different natural, iatrogenic, or traumatic causes, and it can present with various symptoms especially in the early phase. This article reviews the role of the different imaging techniques in the diagnosis of gastroduodenal perforation, focusing on the direct and indirect signs that are encountered in conventional radiography and computed tomography; our personal experience is also provided.

Giant colonic diverticulum: endoscopic, imaging, and histopathologic findings

Giant colonic diverticulum is a rare manifestation of diverticular disease. Although this entity can be discovered incidentally on imaging studies, patients can present with a variety of symptoms. This report illustrates the clinical presentation, endoscopic imaging, and histologic findings for this disorder. Surgical resection is curative and in select cases can be carried out laparoscopically.

[Giant diverticula of the colon. Apropos of 2 cases]

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.

Giant colonic diverticulum: report of four cases and review of the literature

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.

Giant diverticulum of the sigmoid colon

Giant diverticulum is a rare entity and few cases have so far been reported. It is nearly always associated with diverticular disease. There are some theories about the formation of a giant diverticulum but none is conclusive. Associated symptoms are similar to those of diverticular disease but, as with the patient reported here, the lesion may sometimes be asymptomatic. Diagnosis is easy with radiological help.

Giant diverticulum of the sigmoid colon

While diverticulosis of the colon is a relatively common disease, a solitary giant diverticulum (GD) of the sigmoid is rare. Although there exist some theories about the formation of a GD, none is really conclusive. Symptoms are similar to diverticular disease, and diagnosis is easy with the aid of radiology. Early surgical treatment is necessary since the complication rate is high (19%).

Sigmoid colon fistula complicating ovarian cystadenocarcinoma: a rare finding

A case of sigmoid colon fistula complicating ovarian cystadenocarcinoma is reported. The entity demonstrated a large air-filled, thin-walled cystic lesion during barium enema examination. The differential diagnosis of distended air-filled cystic lesions is discussed and expanded to include colonic fistula complicating ovarian neoplasms.

CT demonstration of a giant colonic diverticulum

A case of giant sigmoid colonic diverticulum (GCD) is presented in which plain films showed an unchanging persistent large gas collection that did not opacify on barium enema. The computed tomographic scan revealed the GCD in close apposition to the adjacent sigmoid diverticulosis. Its walls were thin and more irregular than noted on plain films, and there was a suggestion of intraluminal contrast within it.