Complicated giant diverticulum of the transverse colon accompanied by right inguinal hernia of the greater omentum

Abstract

Giant colonic diverticulum is a very rare entity in colonic diverticular disease and is characterized by a high rate of complications such as perforation, abscess formation and even carcinoma. We report a case of a complicated giant diverticulum of the transverse colon accompanied by a right inguinal hernia of the greater omentum in a 52-year-old man, as demonstrated on CT.

A Rare Case Presentation of a Perforated Giant Sigmoid Diverticulum

“…Sex distribution is equal [1, 2, 7, 8, 10, 12–15]. Ninety-five percent of giant colonic diverticula are found on the antimesenteric side of the sigmoid colon [16], and in only a few cases of a true giant diverticulum was the diverticulum found on the mesenteric side of the bowel wall [5, 16]. Most giant colonic diverticulum occurs in the sigmoid colon, but several cases have been reported in the ascending, transverse, or descending colon [4, 12].…”

“…The adjacent colon is often irritable and edematous and may be compressed by the GCD [8]. The segment of colon from which the giant air cyst arises is always deformed by diverticular disease and may be simultaneously compressed by the cyst [16]. …”

“…Communication between the diverticulum and sigmoid colon is demonstrated in approximately 25% of cases [3]. Barium enema is the most commonly used investigation; however, several cases of perforation have occurred within 24 h of the study, leading to the suspicion that barium enemas may precipitate perforation [2, 3, 10, 16]. …”

Gastrointestinal Image: A True Giant Transverse Colon Diverticulum

“…Pathologically, GCD is divided into three types: type I (22%), pseudodiverticulum composed of granulation and fibrous tissue, with chronic inflammatory cells and remnants of muscularis mucosa; type II (66%), inflammatory diverticulum arising from local perforation and communicating with an abscess cavity and type III (12%), true diverticulum that contains all the layers of normal bowel wall and being in continuity with the gut lumen 2,4. Giant diverticulum located in the transverse colon is extremely rare 5–7. Only one case of a true giant diverticulum of the transverse colon that was accompanied by a right inguinal hernia of the greater omentum has been reported in the literature 5…”

“…4 A plain supine abdominal X-ray is the radiological investigation of choice for GCD diagnosis 2. Preoperative diagnosis may also include barium enema, CT scan or MRI 5,8…”