Giant Colonic Diverticulum: Case report of a rare complication of a common disease

Usman Saeed; Therese Saunes; Ole Helmer Sjo; Johannes Schultz

doi:10.1016/j.ijscr.2025.110909

Giant Colonic Diverticulum: Case report of a rare complication of a common disease

Int J Surg Case Rep. 2025 Feb:127:110909. doi: 10.1016/j.ijscr.2025.110909. Epub 2025 Jan 20.

Authors

Usman Saeed¹, Therese Saunes², Ole Helmer Sjo³, Johannes Schultz⁴

Affiliations

¹ Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, 0450 Oslo, Norway. Electronic address: usmsae@ous-hf.no.
² Department of Surgery, Volda Hospital, Norway.
³ Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, 0450 Oslo, Norway.
⁴ Depertment of Gastrointestinal Surgery, Akershus University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.

Abstract

Introduction and importance: Giant Colonic Diverticulum (GCD) is a rare but potentially life-threatening complication of diverticular disease, defined as a diverticulum larger than 4 cm, most commonly arising in the sigmoid colon. Its rarity could lead to diagnostic delays and mismanagement.

Case presentation: A 64-year-old Caucasian female presented with persistent abdominal pain and abdominal swelling. Examination revealed a palpable mass in the left flank. A computed tomography (CT) scan demonstrated an 11x10x14 cm air-filled cavity adjacent to the sigmoid colon, initially misdiagnosed as contained perforated diverticulitis. Following a literature review, the diagnosis of GCD was considered. Definitive treatment involved a segmental sigmoid colectomy with en-bloc resection of the diverticulum. The postoperative course was uneventful, and the patient was discharged on postoperative day four with complete symptom resolution.

Clinical discussion: The presentation of GCD can mimic common complications of diverticular disease, making diagnosis challenging. CT imaging is critical, typically showing a large air-filled cavity connected to the colon. Surgical resection is the treatment of choice to prevent serious complications such as perforation, abscess, volvulus, or malignancy. In this case, en-bloc resection proved effective, highlighting the importance of prompt surgical management.

Conclusion: GCD is a rare and under-recognized clinical entity. Increased awareness is essential to ensure timely diagnosis and treatment. This case underscores the importance of integrating imaging findings, clinical judgment, and surgical intervention for optimal outcomes and emphasizes the need for further case documentation to aid in management strategies.

Keywords: Abdominal mass; Abdominal pain; Case report; Diverticular disease; Giant colonic diverticulum; Surgery.

Publication types

Case Reports