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Giant colonic diverticulum

Report of four cases and review of the literature

  • Case Reports
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Giant colonic diverticulum are rare, with 103 reported cases in 95 patients. The experience of any one surgeon is limited. We aimed to retrospectively review our experience and to review the literature on origin, pathology, and management of this rare and unusual problem. METHOD: Cases were identified by review of pathologic database and by computerized audit from three hospitals. RESULTS: Five giant colonic diverticulum were identified in four patients, and the pathology and management were reviewed. CONCLUSION: A definition and classification system of giant colonic diverticulum is suggested. Giant colonic diverticulum should be the universal term to cover all colonic diverticulum larger than 4 cm, and we suggest that there are two types based on histology. Literature review reveals 103 reported cases in 95 patients. Type I (87 percent) is a pseudodiverticulum, perhaps related to conventional diverticular disease, whereas Type II (13 percent) is a true diverticulum, which is probably a type of communicating cystic congenital duplication. These lesions tend to occur in the sigmoid colon (93 percent) and present with complications similar to conventional diverticular disease. In the presence of conventional diverticular disease, consideration should be given to anterior resection, and in the absence, diverticulectomy should be considered.

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References

  1. Mehta DC, Baum JA, Dave PB, Gumaste VV. Giant sigmoid diverticulum: report of two cases and endoscopic recognition. Am J Gastroentrol 1996;91:1269–71.

    Google Scholar 

  2. Naber A, Sliutz AM, Freitas H. Giant diverticulum of the sigmoid colon. Br J Surg 1995;82:985.

    Google Scholar 

  3. Ueda P, Hall D. Images in clinical medicine: giant colon diverticulum. N Engl J Med 1995;333:228.

    Article  Google Scholar 

  4. Scully RE, Mark EJ, McNeely WF, McNeely BU. Case records of the Massachusetts General Hospital. N Engl J Med 1994;330:1376–81.

    Article  PubMed  Google Scholar 

  5. Levi DM, Levi JU, Rogers AI, Bergau DK, Wenger J. Giant colonic diverticulum: an unusual manifestation of a common disease. Am J Gastroentrol 1993;88:139–42.

    Google Scholar 

  6. Ritchie AJ, Carson JG, Humphreys WG. Encysted pneumatocele: a complication of diverticular disease. Br J Surg 1991;78:683.

    PubMed  Google Scholar 

  7. Scerpella PR, Bodensteiner JA. Giant sigmoid diverticula. Arch Surg 1989;124:1244–6.

    PubMed  Google Scholar 

  8. McNutt R, Schmitt D, Schulte W. Giant colonic diverticula: three distinct entities: report of a case. Dis Colon Rectum 1988;31:624–8.

    PubMed  Google Scholar 

  9. Smith TR, Tyler IM. CT demonstration of a giant colonic diverticlum. Gastrointest Radiol 1987;12:73–5.

    Article  PubMed  Google Scholar 

  10. Fields SI, Haskell L, Libson E. CT appearance of giant colonic diverticulum. Gastrointest Radiol 1987;12:71–2.

    Article  PubMed  Google Scholar 

  11. Siskind BN, Burrell MI, Richter JO, Radin DR. CT appearances of giant sigmoid diverticulum. J Comput Assist Tomogr 1986;10:543–4.

    PubMed  Google Scholar 

  12. Van Vugt AB, Sleeboom C, Dekker LA, Mallens WM, Ten Velde J. Giant cysts in diverticular disease of the sigmoid colon. Neth J Surg 1985;37:183–6.

    PubMed  Google Scholar 

  13. Ellerbroek CJ, Lu CC. Unusual manifestations of giant colonic diverticulum. Dis Colon Rectum 1984;27:545–7.

    PubMed  Google Scholar 

  14. Cullen GM, Wepfer JF. Giant gas cysts of the sigmoid colon. Wis Med J 1984;83:17–8.

    PubMed  Google Scholar 

  15. Al-Jurf AS, Foucar E. Uncommon features of giant colonic diverticula. Dis Colon Rectum 1983;26:808–13.

    PubMed  Google Scholar 

  16. Moesgaard J, Felding C. Giant diverticulum of the sigmoid colon. Acta Chir Scand 1983;149:445–7.

    PubMed  Google Scholar 

  17. Maresca L, Maresca C, Erickson E. Giant sigmoid diverticulum: report of a case. Dis Colon Rectum 1981;24:191–5.

    PubMed  Google Scholar 

  18. Wallers KJ. Giant diverticulum arising from the transverse colon of a patient with diverticulosis. Br J Radiol 1981;54:683–4.

    PubMed  Google Scholar 

  19. Rosenburg RF, Naidich JB. Plain film recognition of giant colonic diverticulum. Am J Gastroentrol 1981;76:59–69.

    Google Scholar 

  20. Muhletaler CA, Berger JL, Robinette CL Jr. Pathogenesis of giant colonic diverticula. Gastrointest Radiol 1981;6:217–22.

    Article  PubMed  Google Scholar 

  21. Heimann T, Aufses AH Jr. Giant sigmoid diverticula. Dis Colon Rectum 1981;24:468–70.

    PubMed  Google Scholar 

  22. Ona FV, Salamone RP, Mehnert PJ. Giant sigmoid diverticulitis: a cause of partial small bowel obstruction. Am J Gastroenterol 1980;73:350–2.

    PubMed  Google Scholar 

  23. Kricun R, Stasik JJ, Reither RD, Dex WJ. Giant colonic diverticulum. AJR Am J Roentgenol 1980;135:507–12.

    PubMed  Google Scholar 

  24. Cameron C. Giant sigmoid diverticulum. J R Coll Surg Edinb 1980;25:457–9.

    PubMed  Google Scholar 

  25. Gallagher JJ, Welch JP. Giant diverticula of the sigmoid colon. Arch Surg 1979;114:1079–83.

    PubMed  Google Scholar 

  26. Wetrich RM, Sidhu DS. Giant sigmoid diverticulum. West J Med 1979;128:539–41.

    Google Scholar 

  27. Wetstein L, Camera A, Trillo RA, Zamora BO. Giant sigmoidal diverticulum: report of a case and review of the literature. Dis Colon Rectum 1978;21:110–2.

    PubMed  Google Scholar 

  28. Ingram NP, Holford CP, Ellis WR. Two cases of giant intestinal gas cyst. Br J Surg 1978;65:214.

    PubMed  Google Scholar 

  29. Foster DR, Ross B. Giant sigmoid diverticulum: clinical and radiological features. Gut 1977;18:1051–3.

    PubMed  Google Scholar 

  30. Macleod DA, Jacques J. Solitary paracolic gas cyst. Md State Med J 1977;11:74–7.

    Google Scholar 

  31. Camprodan R, Guerrero JA, Mendazo CG, Crespo C. Giant diverticula of the colon. Br J Surg 1977;64:628–9.

    PubMed  Google Scholar 

  32. Johns ER, Hartley MG. Giant gas filled cysts of the sigmoid colon: a report of two cases. Br J Radiol 1976;49:930–1.

    PubMed  Google Scholar 

  33. Moss AA. Giant sigmoid diverticulum: clinical and radiological features. Dig Dis 1975;20:676–83.

    Article  Google Scholar 

  34. Harris RD, Anderson JE, Wolf EA. Giant air cyst of the sigmoid complicating diverticulitis: a report of a case. Dis Colon Rectum 1975;18:418–24.

    PubMed  Google Scholar 

  35. Kempczinski RF, Ferrucci JT. Giant sigmoid diverticula: a review. Ann Surg 1974;180:864–7.

    PubMed  Google Scholar 

  36. Rabinowitz JG, Farman J, Dallemand S, Twerskey J, Rosen Y. Giant sigmoid diverticulum. Am J Roentgenol Radium Ther Nucl Med 1974;121:338–43.

    PubMed  Google Scholar 

  37. Smulewicz JJ, Govoni AF. Giant air cysts of the colon. J Can Assoc Radiol 1974;25:245–50.

    PubMed  Google Scholar 

  38. Seaman GB. The case of the giant gas cyst. Hosp Pract 1973:38:159–60.

    Google Scholar 

  39. Sagar S. Giant solitary diverticulum of the transverse colon with diverticulosis. Br J Clin Pract 1973;27:145–6.

    PubMed  Google Scholar 

  40. Sibson DE, Edwards AJ. Giant gas-filled cysts of the sigmoid colon: report of a case and review of the literature. Postgrad Med J 1972;48:180–4.

    PubMed  Google Scholar 

  41. Schenken JR, Cochran R. An intestinal gas cyst, a rare complication of diverticulitis: report of a case. Dis Colon Rectum 1972;15:448–52.

    PubMed  Google Scholar 

  42. Swann JC, Giles KW. Giant diverticulum of the sigmoid colon. Br J Radiol 1971;44:551–3.

    PubMed  Google Scholar 

  43. Mainzer F, Minagi H. Giant sigmoid diverticulum. Am J Roentgenol Radium Ther Nucl Med 1971;113:352–4.

    PubMed  Google Scholar 

  44. Barratt JG. Giant cysts of the sigmoid colon. Australas Radiol 1971;15:38–40.

    PubMed  Google Scholar 

  45. Pazienza C. Studio radiolico di un diverticulo gigante della grandezza di un feto a termine dell'angolo destro del colon transverso. Minerva Med 1970;61:1020–5.

    PubMed  Google Scholar 

  46. Asch T, Milikow E, Gump F. Giant gas cyst of the sigmoid: report of a case and review of the literature. Radiology 1970;96:409–10.

    PubMed  Google Scholar 

  47. Vanapruks S, Fuhrman M. Giant solitary gas cysts of the sigmoid colon: a case report. Radiology 1969;92:1533–4.

    PubMed  Google Scholar 

  48. Piper JV, Thornley BA. Solitary giant diverticulum of the sigmoid colon. Br J Surg 1968;55:398–400.

    PubMed  Google Scholar 

  49. Finby N, Begg CF. Pneumocyst of the colon. N Y State J Med 1968;68:2941–3.

    PubMed  Google Scholar 

  50. Bergeron RB, Hanley PH. Giant sigmoid diverticulum. Am J Surg 1965;109:660–2.

    PubMed  Google Scholar 

  51. Macbeth WA, Riddle PR. Gas filled abscess cavity as a manifestation of diverticulitis of the colon. Br J Radiol 1964;37:861–2.

    PubMed  Google Scholar 

  52. Moore JM, Gold C. Giant diverticulum of sigmoid colon. Br J Surg 1964;51:876–8.

    PubMed  Google Scholar 

  53. Marano AJ, Bell AL, Begg CF, Fitzpatrick HF. Giant diverticulum of the sigmoid colon. JAMA 1964;188:608–9.

    PubMed  Google Scholar 

  54. Siberman EL, Thorner MC. Volvulus of giant sigmoidal diverticulum. JAMA 1961;177:782–4.

    Google Scholar 

  55. Frankenfeld RH, Waters CH, Schepeler TV. Giant air cyst of the abdomen: an unusual manifestation of diverticulitis of the sigmoid: report of a case. Gastroenterology 1959;37:103–6.

    PubMed  Google Scholar 

  56. Case 43402. Case records of Massachusetts General Hospital. N Engl J Med 1957;257:677–80.

    Google Scholar 

  57. Boijsen E. Riesendivertikel im sigmoid. Rortschr Roentgenstrahl 1956;84:760–1.

    Google Scholar 

  58. Bonvin P, Bonte G. Diverticules geants du sigmoide. Arch Mal Dig Mal Nutr 1946;35:353.

    Google Scholar 

  59. Patel D, Diab W. Giant colonic diverticulum. N Y Sate J Med 1983;83:750–4.

    Google Scholar 

  60. Castagnone D, Ranzi T. Giant sigmoid diverticula: case report and review. Panminerva Medica 1981;23:203–6.

    PubMed  Google Scholar 

  61. Barlow B, Goodhue WW, Schullinger JN. Giant congenital diverticulum of the sigmoid colon. J Pediatr Surg 1975;10:549–51.

    Article  PubMed  Google Scholar 

  62. Sutorius DJ, Bossert JE. Giant sigmoid diverticulum with perforation. Am J Surg 1974;127:745–8.

    Article  PubMed  Google Scholar 

  63. Saha SP, Roesch CB. A giant sigmoid diverticulum: report of a case. Dis Colon Rectum 1972;15:63–5.

    PubMed  Google Scholar 

  64. Ferguson WH, Bonis GA. A giant diverticulum of the colon: report of a case. Med Ann Dist Columbia 1966;35:66–8.

    PubMed  Google Scholar 

  65. Melamed M, Pantone A. Giant diverticula of the colon. Arch Surg 1960;81:723–5.

    PubMed  Google Scholar 

  66. Hughes WL, Greene RC. Solitary air cyst of peritoneal cavity. Arch Surg 1953;74:931–6.

    Google Scholar 

  67. Choong CK, Robertson RW, Beasley SW, Frizelle FA. Caecal cystic duplication. Int J Colorectal Dis 1997;12:256–8.

    Article  PubMed  Google Scholar 

  68. Naber A, Sliutz AM, Freitas H. Giant diverticulum of sigmoid colon. Int J Colorectal Dis 1995;10:169–72.

    Article  Google Scholar 

  69. Rychman FC, Glenn JD, Moazam F. Spontaneous perforation of a colonic duplication. Dis Colon Rectum 1983;26:287–9.

    PubMed  Google Scholar 

  70. Teja K, Geissinger WT, Shaw A. Duplication of the transvere colon: report of a case. Dis Colon Rectum 1975;18:430–4.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. From the University Department of Surgery, Christchurch Hospital, Christchurch, New Zealand

    C. K. Choong M.B. B.S. & F. A. Frizelle M.Med.Sci. (F.R.A.C.S.)

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  1. C. K. Choong M.B. B.S.
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  2. F. A. Frizelle M.Med.Sci.
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Choong, C.K., Frizelle, F.A. Giant colonic diverticulum. Dis Colon Rectum 41, 1178–1185 (1998). https://doi.org/10.1007/BF02239441

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