Pulsion diverticula of the rectum: Radiological diagnosis and clinical implications

Abstract

Introduction: The aim of this study was to investigate the appearance of acquired rectal diverticula on barium enema and computed tomography (CT) and to review the pertinent clinical data about this entity. Methods: This series included 3 men and 6 women, who ranged in age from 47 to 82 years (average: 64 years). Air-contrast barium enema in 6 patients with history of anorectal disease or obstructed defecation demonstrated rectal diverticula. In these cases, multiple radiographs of the rectosigmoid region were obtained in upright position while the patient was relaxing or straining without any attempt to evacuate the barium. In 3 cases, the lateral rectal diverticula were incidental finding on CT studies that were performed for various unrelated abdominal complaints. Results: Pulsion type of diverticulum presenting as a wide-neck outpouching was detected on the lateral rectal wall in 5 and on the posterior wall in 4 patients. They measured 2-3 cm in diameter when filled with contrast material or gas, and became even larger when the intraluminal pressure was increased by straining. Conclusion: Pulsion diverticula of the rectum present as a wide-neck outpouching of the lateral or posterior rectal wall in adult patients. This acquired abnormality is usually associated with coexisting anorectal lesions or defecation disorders. The practising radiologists and colorectal surgeons should be aware of this uncommon condition, its appearance on barium enema and other imaging studies, and its clinical implications.

Large rectal diverticulum in the setting of pelvic organ prolapse treated with robotic ventral mesh rectopexy: a case report

“…Rectal diverticulosis is a rare entity with only several reported cases in the literature (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Most cases are asymptomatic, diagnosed incidentally, and require no specific treatment.…”

“…It is postulated, however, that the lateral aspects of the longitudinal muscle layer are thinner than the anterior and posterior aspects. Ghahremani et al ( 15 ) investigated acquired rectal diverticula using barium enema and computed tomography and concluded that these pulsion type rectal diverticula present as wide-neck outpouchings of the lateral or posterior rectal wall and are often associated with coexisting anorectal lesions or disorders of defecation. A study analyzed barium enema examinations of 7,200 patients and identified 5 patients with rectal diverticula (prevalence of 0.07%), two of whom had scleroderma with no other colonic diverticula ( 2 ).…”

“…It is important to note that diverticula of the lateral rectal wall can be missed if only conventional lateral views are obtained. Instead, anterior-posterior views are necessary ( 15 ). In cases of abscess formation, computed tomography scans can aid in diagnosis.…”