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Giant sigmoid diverticulum with coexisting metastatic rectal carcinoma: a case report.

Sasi W, Hamad I, Quinn A, Nasr AR - J Med Case Rep (2010)

Bottom Line: An en bloc anterior resection of the rectum along with sigmoid colectomy, partial hysterectomy and right salpingoophorectomy was subsequently performed due to extensive adhesions.This report shows that the presence of a co-existing distal colorectal cancer can potentially lead to progressive development of a colonic diverticulum to become a giant diverticulum by increasing colonic intra-luminal pressure and through the ball-valve mechanism.This may be of interest to practising surgeons and surgical trainees.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Louth County Hospital, Dundalk, Co Louth, Ireland. wsasi2003@yahoo.co.uk.

ABSTRACT

Introduction: Giant diverticulum of the colon is a rare but clinically significant condition, usually regarded as a complication of an already existing colonic diverticular disease. This is the first report of a giant diverticulum of the colon with a co-existing rectal carcinoma.

Case presentation: We report a case of a 66-year-old Caucasian woman who presented with lower abdominal pain, chronic constipation and abdominal swelling. Preoperative abdominal computed tomography revealed a giant diverticulum of the colon with a coexisting rectal carcinoma and pulmonary metastasis revealed on a further thoracic computed tomography. An en bloc anterior resection of the rectum along with sigmoid colectomy, partial hysterectomy and right salpingoophorectomy was subsequently performed due to extensive adhesions.

Conclusion: This report shows that the presence of a co-existing distal colorectal cancer can potentially lead to progressive development of a colonic diverticulum to become a giant diverticulum by increasing colonic intra-luminal pressure and through the ball-valve mechanism. This may be of interest to practising surgeons and surgical trainees.

No MeSH data available.


Related in: MedlinePlus

A giant colonic diverticulum on computed tomography.
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Figure 2: A giant colonic diverticulum on computed tomography.

Mentions: Clinical examination on presentation revealed a large, slightly tender, left-sided abdominal mass which was tympanic on percussion. Baseline blood tests were all normal. A plain film of the abdomen showed a large air-filled cyst displacing bowel loops (Figure 1). A chest X-ray showed an ill-defined nodular opacity projected over the posterior segment of the right lung lower lobe. Subsequently, an abdominal computed tomography (CT) scan showed a communicating GDC of 14 cm size with multiple small diverticulae in the sigmoid colon along with an irregular thickening of the upper rectal wall highly suspicious of malignancy (Figure 2). A further CT scan of her thorax revealed multiple small nodules in both lung fields which were consistent with metastatic deposits. Fine needle aspirate from one of these nodules showed evidence of metastatic mucinous adenocarcinoma, probably from the rectal site.


Giant sigmoid diverticulum with coexisting metastatic rectal carcinoma: a case report.

Sasi W, Hamad I, Quinn A, Nasr AR - J Med Case Rep (2010)

A giant colonic diverticulum on computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2967567&req=5

Figure 2: A giant colonic diverticulum on computed tomography.
Mentions: Clinical examination on presentation revealed a large, slightly tender, left-sided abdominal mass which was tympanic on percussion. Baseline blood tests were all normal. A plain film of the abdomen showed a large air-filled cyst displacing bowel loops (Figure 1). A chest X-ray showed an ill-defined nodular opacity projected over the posterior segment of the right lung lower lobe. Subsequently, an abdominal computed tomography (CT) scan showed a communicating GDC of 14 cm size with multiple small diverticulae in the sigmoid colon along with an irregular thickening of the upper rectal wall highly suspicious of malignancy (Figure 2). A further CT scan of her thorax revealed multiple small nodules in both lung fields which were consistent with metastatic deposits. Fine needle aspirate from one of these nodules showed evidence of metastatic mucinous adenocarcinoma, probably from the rectal site.

Bottom Line: An en bloc anterior resection of the rectum along with sigmoid colectomy, partial hysterectomy and right salpingoophorectomy was subsequently performed due to extensive adhesions.This report shows that the presence of a co-existing distal colorectal cancer can potentially lead to progressive development of a colonic diverticulum to become a giant diverticulum by increasing colonic intra-luminal pressure and through the ball-valve mechanism.This may be of interest to practising surgeons and surgical trainees.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Louth County Hospital, Dundalk, Co Louth, Ireland. wsasi2003@yahoo.co.uk.

ABSTRACT

Introduction: Giant diverticulum of the colon is a rare but clinically significant condition, usually regarded as a complication of an already existing colonic diverticular disease. This is the first report of a giant diverticulum of the colon with a co-existing rectal carcinoma.

Case presentation: We report a case of a 66-year-old Caucasian woman who presented with lower abdominal pain, chronic constipation and abdominal swelling. Preoperative abdominal computed tomography revealed a giant diverticulum of the colon with a coexisting rectal carcinoma and pulmonary metastasis revealed on a further thoracic computed tomography. An en bloc anterior resection of the rectum along with sigmoid colectomy, partial hysterectomy and right salpingoophorectomy was subsequently performed due to extensive adhesions.

Conclusion: This report shows that the presence of a co-existing distal colorectal cancer can potentially lead to progressive development of a colonic diverticulum to become a giant diverticulum by increasing colonic intra-luminal pressure and through the ball-valve mechanism. This may be of interest to practising surgeons and surgical trainees.

No MeSH data available.


Related in: MedlinePlus