A giant colonic diverticulum presenting as a 'phantom mass': a case report

Giant Colonic Diverticulum: Case report of a rare complication of a common disease

INTRODUCTION AND IMPORTANCE

Giant Colonic Diverticulum (GCD) is a rare but potentially life-threatening complication of diverticular disease, defined as a diverticulum larger than 4 cm, most commonly arising in the sigmoid colon. Its rarity could lead to diagnostic delays and mismanagement.

CASE PRESENTATION

A 64-year-old Caucasian female presented with persistent abdominal pain and abdominal swelling. Examination revealed a palpable mass in the left flank. A computed tomography (CT) scan demonstrated an 11x10x14 cm air-filled cavity adjacent to the sigmoid colon, initially misdiagnosed as contained perforated diverticulitis. Following a literature review, the diagnosis of GCD was considered. Definitive treatment involved a segmental sigmoid colectomy with en-bloc resection of the diverticulum. The postoperative course was uneventful, and the patient was discharged on postoperative day four with complete symptom resolution.

CLINICAL DISCUSSION

The presentation of GCD can mimic common complications of diverticular disease, making diagnosis challenging. CT imaging is critical, typically showing a large air-filled cavity connected to the colon. Surgical resection is the treatment of choice to prevent serious complications such as perforation, abscess, volvulus, or malignancy. In this case, en-bloc resection proved effective, highlighting the importance of prompt surgical management.

CONCLUSION

GCD is a rare and under-recognized clinical entity. Increased awareness is essential to ensure timely diagnosis and treatment. This case underscores the importance of integrating imaging findings, clinical judgment, and surgical intervention for optimal outcomes and emphasizes the need for further case documentation to aid in management strategies.

A Phantom of the Large Bowel

Giant colonic diverticulum (GCD) is a diverticulum that is larger than 4 cm in diameter most commonly arising from the sigmoid colon. Patients with GCD are typically asymptomatic, and clinical manifestations vary from a soft palpable abdominal mass to diarrhea, which is well described in the literature. However, few studies have demonstrated a presentation of GCD with acute diverticulitis. Herein, we report a case of a middle-aged patient presenting with sepsis due to acute diverticulitis as an initial presentation of a GCD.

Abdominal Hernias, Giant Colon Diverticulum, GIST, Intestinal Pneumatosis, Colon Ischemia, Cold Intussusception, Gallstone Ileus, and Foreign Bodies: Our Experience and Literature Review of Incidental Gastrointestinal MDCT Findings

Incidental gastrointestinal findings are commonly detected on MDCT exams performed for various medical indications. This review describes the radiological MDCT spectrum of appearances already present in the past literature and in today's experience of several gastrointestinal acute conditions such as abdominal hernia, giant colon diverticulum, GIST, intestinal pneumatosis, colon ischemia, cold intussusception, gallstone ileus, and foreign bodies which can require medical and surgical intervention or clinical follow-up. The clinical presentation of this illness is frequently nonspecific: abdominal pain, distension, nausea, fever, rectal bleeding, vomiting, constipation, or a palpable mass, depending on the disease. A proper differential diagnosis is essential in the assessment of treatment and in this case MDCT exam plays a central rule. We wish that this article will familiarize the radiologist in the diagnosis of this kind of incidental MDCT findings for better orientation of the therapy.

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 en bloc resection of the diverticulum and affected adjacent colon.

Giant colonic diverticulum: clinical presentation, diagnosis and treatment: systematic review of 166 cases

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.

Colonic diverticular abscess presenting as chronic diarrhea: a case report

INTRODUCTION

Several complications have been reported with diverticular disease of colon. Perforation of the diverticulum of colon may lead to development of abdominal abscesses which can have diverse manifestations.

CASE PRESENTATION

This report describes a 72 year-old woman presented with a one month history of non-bloody diarrhea, abdominal pain, and low grade fever. Computed tomography scan confirmed presence of a large local air-fluid level within the culdesac area. Laparotomy revealed a large pelvic abscess which was surrounded between rectosigmoid and uterus with severe tissue necrosis of rectosigmoid colon and uterus.

CONCLUSION

Although rarely reported, abdominal abscesses due to colonic diverticulitis may present as refractory chronic diarrhea.