Giant colonic diverticulum

Giant colonic
pseudo-diverticula importance of, and aids to radiological diagnosis: a case series. Spot image from barium enema demonstrates an air collection immediately adjacent to the apex of the sigmoid loop and diverticular disease in the sigmoid and descending colon.
casesjournal.biomedcentral.com • CC-by-2.0
Giant colonic
pseudo-diverticula importance of, and aids to radiological diagnosis: a case series. Plain abdominal radiograph showing homogenous radiolucency that is smoothly marginated.
casesjournal.biomedcentral.com • CC-by-2.0
Giant colonic
pseudo-diverticula importance of, and aids to radiological diagnosis: a case series. Selected axial sections from CT scan, demonstrating a large gas filled viscus.
casesjournal.biomedcentral.com • CC-by-2.0
Giant colonic
pseudo-diverticula importance of, and aids to radiological diagnosis: a case series. Selected coronal, sagittal and axial sections from CT scan demonstrating a large gas filled structure that appeared to be arising from the top of the sigmoid colon.
casesjournal.biomedcentral.com • CC-by-2.0
Giant colonic
diverticulum: radiographic and MDCT characteristics. An 83-year-old woman with type II (inflammatory type) giant sigmoid diverticulum, which developed after an episode of acute diverticulitis. Axial (a) contrast-enhanced CT image of the abdomen shows a peridiverticular abscess (arrows), which was percutaneously drained. Axial (b) contrast-enhanced CT image obtained 5 months later (follow-up CT examination) shows a gas-filled structure adjacent to the sigmoid colon (arrow), without air–fluid level or pericolic inflammatory changes, consistent with type II (inflammatory type) GCD
insightsimaging.springeropen.com • CC-by-4.0
Giant colonic
diverticulum: radiographic and MDCT characteristics. A 55-year-old man with giant sigmoid diverticulum (GSD) associated with acute diverticulitis. Abdominal radiograph (a) shows a large, round, homogenous radiolucency in the right upper quadrant that is smoothly marginated (arrows). Axial (b and c), coronal (d), and sagittal (e) contrast-enhanced CT images through the upper abdomen show a predominantly gas-filled structure in the right upper abdomen, communicating with the sigmoid colon (S) and consistent with GSD. The sigmoid colon is located in the right side of the abdomen (anatomical variant). The arrow demonstrates the neck of the GSD, which connects the diverticular cavity with the adjacent sigmoid colon; this finding is essential for correct diagnosis. The thickened wall of the diverticulum and the surrounding mesentery infiltration denote acute diverticulitis
insightsimaging.springeropen.com • CC-by-4.0
Giant colonic
diverticulum: radiographic and MDCT characteristics. A 68-year-old man with giant sigmoid diverticulum (GSD) associated with acute diverticulitis. Abdominal radiograph (a) shows a large air-filled structure throughout the right pelvis, consistent with GSD. Axial (b and c) contrast-enhanced CT images through the pelvis show a predominantly gas-filled structure with air–contrast material level arising (arrow) from the sigmoid colon (S). The thickened wall of the diverticulum and the surrounding fat infiltration denote acute diverticulitis (arrows)
insightsimaging.springeropen.com • CC-by-4.0
Giant colonic
diverticulum: radiographic and MDCT characteristics. A 63-year-old man with giant sigmoid diverticulum (GSD) presented with acute abdomen. Axial contrast-enhanced CT images through the pelvis (a) and upper abdomen (b) show the GSD complicated with acute diverticulitis, perforation, and pneumoperitoneum (arrows)
insightsimaging.springeropen.com • CC-by-4.0
A giant
colonic diverticulum presenting as a "phantom mass": a case report. Axial computed tomography image with oral and intravenous contrast at the level of S1 demonstrating a giant colonic diverticulum*. The wall of the diverticulum and the surrounding fat are thickened denoting recent inflammation. Note the relationship to the left external and internal iliac vessels (arrows A and B, respectively). The obturator nerve (L2–4) emerges from the medial aspect of the psoas muscle and runs downwards and forwards, deep into [the internal iliac vessels.
jmedicalcasereports.biomedcentral.com • CC-by-2.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Giant colonic diverticula, also referred to as giant colonic pseudodiverticula, are an uncommon form of presentation of colonic diverticulosis and are characterized by large diverticular masses, usually filled with stool and gas, that communicate with the colonic lumen.

Terminology

Although the great majority of cases are not true colonic diverticula (cf. pseudodiverticula or chronic contained perforation of the colon), this article will follow the majority of publications and the way the condition is commonly referred to in daily practice, which means grouping all types under the umbrella term of giant colonic diverticula.

Clinical presentation

The most common presentation is abdominal pain. Other presenting symptoms include constipation, abdominal masses, vomiting, diarrhea, and rectal bleeding .

Pathology

The majority (>90%) arise from the sigmoid colon , but they can occur in any part of the colon. They are divided into three different types :

  • giant pseudodiverticula (or type I)
    • the second most common type (~20% of cases)
    • the mucosa herniates through the muscular wall and becomes progressively enlarged by colonic gas via a ball-valve type mechanism
    • diverticular wall is made of remnants of both the muscularis mucosa and muscularis propria, which are permeated by chronic granulation tissue
  • inflammatory giant colonic diverticula (or type II)
    • majority of cases (~70% of cases)
    • result from perforation and formation of a persistent abscess cavity that remains in communication with the colonic lumen  
      • it can also be understood as a chronic contained colonic perforation 
    • diverticular wall is made of dense fibrous tissue containing both chronic inflammatory cells and foreign body giant cells
  • true giant colonic diverticula (or type III)
    • rare (~10% of cases)
    • contain all the colonic wall layers: serosa, muscularis, submucosa, and mucosa
    • believed to represent a duplication cyst that has communication with the colonic lumen

    • Radiographic features

    Imaging plays an important role in the diagnosis of giant colonic diverticula as they might not be identified on colonoscopy studies due to a small ostium .

    Plain radiograph

    Abdominal x-rays may show large gas-filled cysts with a gas-fluid level .

    CT

    CT is the best imaging modality for diagnosis given that colonoscopies are rarely carried out due to the risk of perforation . CT shows the diverticulum as a gas, fluid or feces-filled cavity, sometimes with calcification in the case of chronic inflammation. There is usually no contrast enhancement unless there is active inflammation .

    Treatment and prognosis

    The definitive treatment for a giant diverticulum is surgery .

    Complications
    • common
      • perforation
      • abscess formation
    • less common
    Siehe auch:
    und weiter:
    Assoziationen und Differentialdiagnosen zu Riesenpseudodivertikel des Kolons:
    Pneumoperitoneum
     
    Wikipedia • CC BY-SA 3.0
    Sigmadivertikulose
     
    Wikipedia • CC BY-SA 4.0
    Duplikationszysten
    gastrointestinal
    insightsimaging.springeropen.com • Open Access
    Dünndarmdivertikel
     
    Wikipedia • CC BY-SA 4.0
    Kolondivertikulose
     
    Wikipedia • CC BY-SA 4.0
    Kolondivertikulitis
     
    Wikipedia • CC BY-SA 3.0
    Fußballzeichen
    (Pneumoperitoneum)
    insightsimaging.springeropen.com • CC-by-4.0
    riesiges
    Sigmadivertikel
    casesjournal.biomedcentral.com • CC-by-2.0