Article

Giant colonic diverticula. Review of diagnostic and therapeutic options.

Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands.
Digestive Surgery (impact factor: 1.22). 02/2004; 21(1):1-6; discussion 6. DOI:10.1159/000074833 pp.1-6; discussion 6
Source: PubMed

ABSTRACT A rare complication of diverticulosis of the colon is giant colonic diverticula (GCD). The condition was first described in English literature in 1953.
A Medline search was undertaken for English, French and German language articles on 'giant colonic diverticula'.
A total of 135 patients were identified, presenting with a total of 155 GCD. With a complication rate of 28% and an operative mortality of 5%, GCD seems to have a high clinical significance. Radiological examination of choice seems to be plain abdominal X-ray and CT examination, barium enema carries the risk of perforation of the diverticulum, and should not be performed.
There are different therapeutic options, in our opinion diverticulectomy alone is not the treatment of choice. Because of the possibility of recurrence and oncological reasons, colectomy seems to be the best treatment. The creation of a protecting colostomy depends on other operative findings.

0 0
 · 
0 Bookmarks
 · 
18 Views
  • Source
    Article: A giant colonic diverticulum presenting as a 'phantom mass': a case report.
    Ayman S Abdelrazeq, Anwar E Owais, Munther I Aldoori, Ian D Botterill
    [show abstract] [hide abstract]
    ABSTRACT: Diverticulosis coli is the most common disease of the colon in Western countries. Giant colonic diverticulum, defined as a colonic diverticulum measuring 4 cm in size or larger, represents an unusual manifestation of this common clinical entity. A 68-year-old Caucasian British woman with a history of intermittent lower abdominal mass, leg swelling and focal neurological symptoms underwent extensive non-diagnostic investigations over a significant period under a number of disciplines. The reason for a diagnosis being elusive in part related to the fact that the mass was never found on clinical and ultrasound examination. As a result, the patient's validity was questioned. Ultimately, this 'phantom-mass' was diagnosed as a giant colonic diverticulum causing intermittent compression of the iliac vein and obturator nerve. Intermittent compression of the iliac vein and the obturator nerve by a colonic diverticulum has not previously been reported. A giant colonic diverticulum presenting as an intermittent mass is very rare. This case also illustrates two factors. First, the patient is often right. Second, the optimal mode of investigation for any proven or described abdominal mass with referred symptoms is cross-sectional imaging, typically a computed tomography scan, irrespective whether the mass or symptoms are constant or intermittent.
    Journal of Medical Case Reports 02/2009; 3:29.
  • Source
    Article: Giant sigmoid diverticulum with coexisting metastatic rectal carcinoma: a case report.
    Walid Sasi, Issam Hamad, Aidan Quinn, Abdul Rahman Nasr
    [show abstract] [hide abstract]
    ABSTRACT: Giant diverticulum of the colon is a rare but clinically significant condition, usually regarded as a complication of an already existing colonic diverticular disease. This is the first report of a giant diverticulum of the colon with a co-existing rectal carcinoma. We report a case of a 66-year-old Caucasian woman who presented with lower abdominal pain, chronic constipation and abdominal swelling. Preoperative abdominal computed tomography revealed a giant diverticulum of the colon with a coexisting rectal carcinoma and pulmonary metastasis revealed on a further thoracic computed tomography. An en bloc anterior resection of the rectum along with sigmoid colectomy, partial hysterectomy and right salpingoophorectomy was subsequently performed due to extensive adhesions. This report shows that the presence of a co-existing distal colorectal cancer can potentially lead to progressive development of a colonic diverticulum to become a giant diverticulum by increasing colonic intra-luminal pressure and through the ball-valve mechanism. This may be of interest to practising surgeons and surgical trainees.
    Journal of Medical Case Reports 10/2010; 4:324.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

'giant colonic diverticula'
 
barium enema
 
clinical significance
 
complication rate
 
diverticulosis
 
diverticulum
 
English literature
 
German language articles
 
Medline search
 
oncological reasons
 
opinion diverticulectomy
 
plain abdominal X-ray
 
protecting colostomy
 
rare complication