Giant sigmoid diverticulum: A case report

Abstract

Sigmoid colon diverticulosis is commonly seen in both the surgical outpatient and emergency departments. Rarely, these sigmoid diverticulum, which usually range from 2-3mm to 2cm in size, can enlarge to more than 10 times. This is due to a ball-valve type mechanism that traps colonic gas inside the sigmoid diverticulum causing it to gradually enlarge. Patients with a giant sigmoid diverticulum (GSD) must be investigated thoroughly as two per cent of patients will present with a colonic carcinoma either within or distal to the GSD. Clinical symptoms of a GSD can range from chronic abdominal pain, altered bowel habits, abdominal distention, weight loss, bleeding, perforation, fistula formation, or bowel obstruction. CT and plain abdominal x-ray is the investigation of choice for its diagnosis. Barium enema is useful to determine the presence of a carcinoma within the GSD. Sigmoidoscopy is useful to rule out a distal colonic carcinoma. This is the first published case where nocturnal diarrhoea is the primary differentiating symptom in the patient. The treatment of choice for a GSD is complete resection of the diverticulum and/or the adjacent sigmoid colon. This can be performed with a primary anastomosis or a double-stage procedure.

Case report of a giant colonic sigmoid diverticulum causing sigmoid volvulus

“…This work has been reported in line with the SCARE criteria [5] . There have been approximately 190 cases of GCD published in the English language literature since it was first described in 1946, with sizes ranging from 4 to 40 cm [6] , [7] . GCD has been documented to cause a myriad of complications from intussusception to sequestering endoscopy capsules, but the author could find only one other case of documented volvulus due to GCD, and that reference is from 1961 and not something most surgeons are familiar with today [8] .…”

“…Although the exact pathophysiology that causes these diverticuli to grow to such large sizes is unknown, the most commonly accepted theory is that the fibrous neck above the opening of the diverticulum acts as a one-way valve which allows air entry but not exit [6] , [11] . The patient in this report had a large diverticulum off the sigmoid colon and the presence of a few additional diverticuli along the sigmoid colon as well.…”

Divertículo colónico gigante: Dos nuevos casos en la literatura

“…Por ejemplo, los pacientes ancianos, asintomáticos y con un alto riesgo quirúrgico pueden ser manejados de manera conservadora con manejo antibiótico, drenaje percutáneo o implantación de stent en el cuello diverticular con drenaje del lumen (3,8). Sin embargo, según Seenvoorde P (20) el tratamiento conservador puede traer complicaciones hasta en un 19% de los casos como obstrucción de asas delgadas, desarrollo de neoplasia maligna dentro del divertículo o una peritonitis por perforación en cualquier momento, por lo que recomienda e s t a t e r a p i a ú n i c a m e n t e p a r a p a c i e n t e s c o n contraindicaciones absolutas para el manejo quirúrgico (20,21,22).…”

Giant colonic diverticulum: radiographic and MDCT characteristics

“…Among the physical signs, the most common is abdominal mass followed by fever and tenderness [ 5 ]. A recent report documented nocturnal diarrhoea when sleeping on the right side as a symptom of GCD [ 14 ].…”