Giant colonic diverticulitis, an extremely rare presentation of a rare disease: clinical presentation and literature review

Introduction: Giant colonic diverticulum (GCD) is rare phenomenon, with less than 200 cases described in the literature. One of the complications of GCD is diverticulitis. To date, there is paucity of data addressing the diagnosis and management of GCD complicated by acute diverticulitis. Objective: To better understand the diagnostic tools, the initial management, and the long-term follow-up for this group of patients as well as to recommend a proper multidisciplinary approach to this infrequent disease. Method A systematic literature search was performed using the PubMed, Embase, and Cochrane databases to identify all the published studies on GCD complicated by diverticulitis. Two of the authors assessed the relevance of the included full-text papers. The articles were assessed independently. Results: In total, 12 cases were identified. Our results show that 10/11 (91%) of the patients who had computed tomography (CT) scans during the initial evaluation had a correct diagnosis. There was no case of failure to non-operative approach (7/7). The patients who had an emergency operation were treated so due to diffuse peritonitis (two patients), acute hemorrhage arising from ulcers within the diverticula (one patient), and misdiagnosis (one patient). Conclusion: Giant colonic diverticulitis is a very rare disease. Computed tomography scan is a valuable tool for the initial diagnosis as well as for treatment strategy planning. Non-operative management is a viable option for patients without diffuse peritonitis. Interval endoscopy is recommended if no contraindication exists. (AU)

Prevalencia de divertículos colónicos asintomáticos en población chilena como hallazgo imagenológico en tomografía de abdomen y pelvis / Prevalence of asymptomatic colonic diverticula in Chilean population as an imaging finding in abdominal and pelvic tomography

INTRODUCCIÓN: La prevalencia de diverticulosis colónica en población general varía entre 20-60% según referencias internacionales, sin embargo, hay escasos datos nacionales. Un buen método para la detección de esta entidad es la tomografía computarizada de abdomen y pelvis (TACP). OBJETIVOS: Determinar la prevalencia de diverticulosis colónica en población general como hallazgo en tomografías computarizadas de abdomen y pelvis. MATERIALES Y MÉTODO: Estudio de corte transversal con estadística observacional, seleccionando pacientes sin antecedentes de diverticulosis que se realizaron TCAP en un hospital clínico en un periodo de 3 meses. Se revisan 1.449 TCAP y se incluyen 1.177 casos. RESULTADOS: La prevalencia general de divertículos colónicos fue de 28,3%, esta cifra aumenta con la edad alcanzando un 60% en mayores de 80 años. Casi un 90% se localizan en colon izquierdo, y los casos en lado derecho se acumulan en menores de 60 años. CONCLUSIONES: La prevalencia global de diverticulosis, detectadas por TCAP en esta población, corresponde a cerca del 30% de los pacientes.

INTRODUCTION: Asymptomatic colonic diverticular prevalence varies in the general population between 20 and 60% in international references, however, we couldn't find statistics about it in national reports. A method for detection of this nosological entity is the abdomen and pelvis computed tomography. AIM: Determine the prevalence of asymptomatic colonic diverticulosis in the general population as a find in abdomen and pelvis computed tomography (TCAP). MATERIALS AND METHOD: Cross-sectional study with descriptive statistics, selecting patients with no history of diverticulosis, who underwent TCAP in our Hospital. 1,449 cases are reviewed and 1,177 are included. RESULTS: The general prevalence of colonic diverticula was 28.3%. Their presence increases with age, being close to 60% in > 80 years. Almost 90% are located in the left colon, being more frequent the right side diverticulosis in population under 60 years. CONCLUSIONS B The overall prevalence of asymptomatic colonic diverticulosis, detected as a finding in TCAP, corresponds to about one third of patients.

Prevalence Of Colonic Diverticulosis In Irritable Bowel Syndrome Patients

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder.Patients may suffer from abdominal discomfort, bloating or pain associated with disturbed defecation.The etiology has not been clear.Colonic diverticula are mucosal outpouchings through the large bowel. Recent study demonstrated more prevalence of diverticulosis in IBS.

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 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.

Divertículo gigante de colon: presentación de un caso / Giant colonic diverticulum: case report

El divertículo gigante de colon (DGC) es una rara complicación de la enfermedad diverticular. Se considera divertículo gigante cuando su diámetro supera los 4 cm. Descrito por primera vez en la literatura francesa en el año 1946, se han publicado hasta la fecha 155 casos. Nuestro paciente, de 59 años, refirió clínica de dolor abdominal leve de 4 meses de evolución. Se le solicitó un estudio de colon por enema, el que reveló una formación sacular de 15 cm en colon sigmoideo, de contenido aéreo y cuello corto, a través del cual se opacificó la cavidad con la sustancia baritada, confirmando el diagnóstico de DGC. Al paciente se le realizó, además, tomografía computada y resonancia magnética. El diagnóstico se confirmó con cirugía y estudio histopatológico. Se practicó una resección sigmoidea con DGC y anastomosis colorrectal lateroterminal. El estudio anatomopatológico informó DGC tipo II.

Giant colonic diverticulum is a rare diverticular disease complication. It is considered giant when its diameter is longer than 4 cms. It was reported the first time by french authors in 1946 and there is 155 cases reported in world literature. Our patient aged 59 years old, referred four month of abdominal pain. A barium enema was made showing a sigmoid cavity with air and fill of barium contrast with short neck continuing with the colon lumen. It was also studied with CT and MRI. The diagnosis was confirmed by surgery and histopathologic exam. The pathologic report informed giant colonic diverticulum type II.

Prevalence rates of type 2 diabetes and hypertension are elevated among middle-aged Japanese men with colonic diverticulum

<p><b>OBJECTIVE</b>To elucidate the prevalence rate of metabolic disorders among subjects with asymptomatic colonic diverticulum.</p><p><b>METHODS</b>We carried out a cross-sectional analysis of the association between colonic diverticulum and selected metabolic disorders among the male personnel of the Self-Defense Forces who underwent total colonoscopy as part of their retirement check-up (age range, 51-59 years).</p><p><b>RESULTS</b>The prevalence rate of colonic diverticulum was 10.2% among the population studied. The scores of lifestyle factors including those of cigarette smoking and alcohol consumption were similar between the subjects with colonic diverticulum and those without it. Type 2 diabetes (21.6% vs 14.0%, P=0.047) and hypertension (30.9% vs 19.8%, P=0.011) were more prevalent among the subjects with colonic diverticulum than those without it. The prevalence rates of obesity, dyslipidemia, hyperuricemia, and impaired glucose tolerance were similar between the two groups.</p><p><b>CONCLUSION</b>The prevalence rates of type 2 diabetes and hypertension are elevated among the middle-aged male subjects with asymptomatic colonic diverticulum. The results may partly explain the reported association between colonic diverticulum and cardiovascular disease.</p>

Prevalence Rates of Type 2 Diabetes and Hypertension are Elevated among Middle-aged Japanese Men with Colonic Diverticulum

Objective: To elucidate the prevalence rate of metabolic disorders among subjects with asymptomatic colonic diverticulum. Methods: We carried out a cross-sectional analysis of the association between colonic diverticulum and selected metabolic disorders among the male personnel of the Self-Defense Forces who underwent total colonoscopy as part of their retirement check-up (age range, 51-59 years). Results: The prevalence rate of colonic diverticulum was 10.2% among the population studied. The scores of lifestyle factors including those of cigarette smoking and alcohol consumption were similar between the subjects with colonic diverticulum and those without it. Type 2 diabetes (21.6% vs 14.0%, P=0.047) and hypertension (30.9% vs 19.8%, P=0.011) were more prevalent among the subjects with colonic diverticulum than those without it. The prevalence rates of obesity, dyslipidemia, hyperuricemia, and impaired glucose tolerance were similar between the two groups. Conclusion: The prevalence rates of type 2 diabetes and hypertension are elevated among the middle-aged male subjects with asymptomatic colonic diverticulum. The results may partly explain the reported association between colonic diverticulum and cardiovascular disease.

Giant Colonic Diverticulum

While diverticulosis of the colon is a relatively common disease, a solitary giant colonic diverticulum is rare. Although there exist some theories about the formation of the giant colonic diverticulum, none is really conclusive. The preoperative diagnosis of giant colonic diverticulum is made radiographically with findings of a large, smoothly marginated, round homogeneous radiolucency in the abdomen that is in close apposition to the colon on barium enema examination. Early surgical treatment is necessary since the complication rate is high. One case of giant colonic diverticulum is presented, the clinical, radiologic and pathologic findings are discussed, and the etiology and differential diagnosis, reviewe.