A Rare Case Presentation of a Perforated Giant Sigmoid Diverticulum

Abstract

Giant sigmoid diverticulum (GSD) is a rare complication of diverticulosis. These lesions arise from herniations of the mucosa through the muscle wall which progressively enlarge with colonic gas to become large air-filled cysts evident on plain X-ray and CT scans. We present a rare case of a 72-year-old female presenting with abdominal distention, abdominal tenderness, and fever who developed a type 1 giant sigmoid diverticulum (pseudodiverticulum) that subsequently formed an intra-abdominal abscess and an accompanying type 2 diverticulum as well. The patient was treated with surgical resection of the diverticulum with a primary anastomosis and abscess drainage. The patient's postoperative course was uneventful. This case helps to support the need for the consideration of GSD in patients aged 60 and older with a history of diverticulosis and presenting with abdominal discomfort and distension.

Presentation and Management of Giant Colonic Diverticula

“…2 An alternative etiology is that inflammation causes the diverticulum to become completely walled off from the colon, and it is gas-producing bacteria within the diverticulum that cause it to expand in size. 3 In our experience, however, there are some situations in which the communication between the GCD and the colon lumen is actually very large.…”

Complicated giant diverticulum of rectosigmoid colon in elderly

“…GCD first described by Bonvin & Bonte in 1946. It is rare entities with fewer than 200 cases reported in the literature [4] . It is defined that the diverticular size is over 4 cm [2] , [4] , [5] and 90% of GCD originated from the sigmoid colon [4] , [5] .…”

“…It is rare entities with fewer than 200 cases reported in the literature [4] . It is defined that the diverticular size is over 4 cm [2] , [4] , [5] and 90% of GCD originated from the sigmoid colon [4] , [5] . GCD mainly is demonstrated age at diagnosis between the ages of 32 and 90 and occurs at the higher frequency in elderly men [5] , [6] .…”

“…The diverticulum contains fibrous scar tissue (66%). Type III is a true diverticulum consisting of all the layers of the bowel (12%) [4] .…”

Giant colonic diverticulum—a rare cause of acute abdomen

“…Resection of the diverticulum and adjacent colon with primary anastomosis, with or without a temporary diverting ileostomy, is the recommended treatment for uncomplicated GCD [ 7 ], while a laparoscopic approach may be feasible in some patients [ 8 ]. In the setting of complications, Hartmann’s procedure might be performed [ 1 ].…”