Surgical Management of Giant Colonic Diverticulum Presenting After Laparoscopic Lavage for Diverticular Perforation and Sepsis

Abstract

Patient: Female, 74-year-old Final Diagnosis: Giant diverticulum Symptoms: Abdominal discomfort • bloating and constipation Medication:— Clinical Procedure: Laparoscopic washout • open sigmoidectomy Specialty: Surgery Objective: Rare disease Background: Diverticulosis and its complication of diverticulitis is a common condition that can be found in up to 35% of the population. Giant colonic diverticulum is a rare entity with fewer than 200 cases reported in the scientific literature. Development of a giant diverticulum as a sequelae of laparoscopic washout is an unreported event in current literature. Case Report: The patient was a 74-year-old female who had a well-known history of diverticulosis and diverticulitis. She developed perforated sigmoid diverticulitis, underwent laparoscopic washout and recovered without colon resection. Within a year after washout, she developed abdominal distention and bloating, and computed tomography (CT) imaging revealed a giant diverticulum. She went on to undergo surgery for resection of her sigmoid colon, which contained the giant diverticulum. Her recovery was otherwise uneventful. Conclusions: To our knowledge, this is the first case report of giant diverticulum presenting as a complication of abdominal washout for management of acute diverticulitis. Initial CT scan performed at the time of perforation did not demonstrate this diverticulum, indicating that it developed within the year after abdominal washout for sepsis and acute rupture, likely due to weakening of the colonic wall secondary to ongoing inflammation. The very rare presentation of giant diverticulum makes it difficult to establish a clear link to washout, however, this case establishes a groundwork for further investigation as our fund of knowledge on the subject continues to grow.

Divertículo gigante verdadero del colon izquierdo. Reporte de caso

“…No cursó con complicaciones posoperatorias y al séptimo día se le dio egreso. el rango de edad entre los 38 y 86 años, tanto en hombres como en mujeres (1,2,10) .…”

“…El tratamiento de los DGC depende de su clasificación clínica (1) , para los DGC no complicados y sintomáticos es la resección primaria del divertículo con márgenes y anastomosis primaria; en el caso de presentarse como abdomen agudo, secundario a perforación y peritonitis, el tratamiento más seguro es la resección en bloque del divertículo y del colon afectado, asociado a colostomía temporal terminal.…”

“…El divertículo gigante del colon (DGC) es una entidad clínica extraña, con menos de 200 casos reportados (1) , fue descrito por primera vez en 1946 por Bouvin y Bonet (2,3) . Es una lesión originada en el borde antimesentérico, el sigmoides es el sitio más frecuente de presentación, el tamaño fluctúa entre 4 y 30 cm y generalmente son lesiones simples y únicas, pero pueden ser múltiples.…”

A rare case of multiple giant colonic diverticula successfully treated with laparoscopic sigmoidectomy

“…Type one is the result of a normal, smaller, pseudo-diverticulum slowly increasing in size with intact mucosa in the diverticular wall. Type two describes a pseudo-diverticulum that has perforated and formed a chronic abscess cavity, as might occur after treatment of diverticulitis by laparoscopic washout without resection [ 7 ]. Type three is a true, congenital, diverticulum with all layers of the colon wall present.…”