Obstructing Giant Colonic Diverticulum
Obstructing Giant Colonic Diverticulum
We report the second case of an obstructing true colonic diverticulum. Of the 103 cases of giant sigmoid diverticulum found in the literature, 13% have been reported as true giant sigmoid diverticulum, ie, containing all layers of the colonic wall. Our 75-year-old patient had clinical symptoms for only 6 months, and endoscopy revealed an almost totally obstructing mass 20 cm from the anus. Surgical resection of the sigmoid colon with a primary anastomosis resolved all of the patient's obstructive symptoms. A flap-valve mechanism was the cause of this true giant colonic diverticulum. Microscopic examination of the diverticulum wall revealed all normal layers of colon wall.
There have been 103 cases of giant colonic diverticula reported in the literature, and two classifications of these have been described. Only two cases of giant colonic diverticulum causing complete or almost complete obstruction of the sigmoid colon have been reported. The exact cause of large colonic diverticula is not exactly known. Several authors have attributed their development to a flap-valve effect of a chronic diverticulum with a narrow neck. The true colonic diverticulum found in the following case clearly showed a flap-valve mechanism as its cause.
We report the second case of an obstructing true colonic diverticulum. Of the 103 cases of giant sigmoid diverticulum found in the literature, 13% have been reported as true giant sigmoid diverticulum, ie, containing all layers of the colonic wall. Our 75-year-old patient had clinical symptoms for only 6 months, and endoscopy revealed an almost totally obstructing mass 20 cm from the anus. Surgical resection of the sigmoid colon with a primary anastomosis resolved all of the patient's obstructive symptoms. A flap-valve mechanism was the cause of this true giant colonic diverticulum. Microscopic examination of the diverticulum wall revealed all normal layers of colon wall.
There have been 103 cases of giant colonic diverticula reported in the literature, and two classifications of these have been described. Only two cases of giant colonic diverticulum causing complete or almost complete obstruction of the sigmoid colon have been reported. The exact cause of large colonic diverticula is not exactly known. Several authors have attributed their development to a flap-valve effect of a chronic diverticulum with a narrow neck. The true colonic diverticulum found in the following case clearly showed a flap-valve mechanism as its cause.
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