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Giant diverticulum of the colon is a rare condition, mentioned only sporadically in the literature and usually presenting on an abdominal radiograph as an air-filled cyst. This poses an interesting clinical and radiological diagnostic problem. A case is presented and a radiological approach suggested.
The plain abdominal film finding of a large air-filled cavity has a differential diagnosis that includes giant colonic diverticulum, volvulus, giant Meckel's or other small-bowel diverticulum, emphysematous cystitis, vesicoenteric fistula, bowel duplication, and mesenteric cyst. The case presented here expands this differential diagnosis to include tuboovarian abscess with fistulous communication to the bowel.
Since the first case described in 1946, fewer than 100 cases of giant colonic diverticula have been reported in the literature. We discuss the clinical, radiologic, and pathologic findings in a case of giant colonic diverticulum and review the etiology and differential diagnosis.
A polypoid elevation of the colonic wall was identified on air contrast barium enema in six patients. The abnormality in each case was found to be an inverted colonic diverticulum. Inverted diverticula appeared as broad-based, smooth, sessile polyps measuring 1.5-2.0 cm. In five of the six patients a characteristic central umbilication and/or evidence of barium within the polyp could be identified. The diagnosis was confirmed in three patients by demonstrating an everted diverticulum replacing the suspected lesion. In the remaining three patients, two of whom had normal findings on colonoscopy, the diagnosis was strongly suggested by the presence of barium extending into the substance of the mass. Additional radiologic maneuvers or a second study may permit accurate diagnosis if the possibility of inverted diverticulum is considered. However, even when the diverticulum cannot be demonstrated, a central umbilication or barium within a smooth intraluminal projection should suggest inverted diverticulum and prevent unnecessary endoscopy or inadvertent diverticulectomy.
Four cases of giant colonic diverticula are presented with emphasis on plain film recognition employing the "balloon sign", a persistent, rounded lucency which is consistently seen on any abdominal scout film or survey. The importance of this finding is even greater in the absence of gastrointestinal complaints in view of the complication of torsion and perforation.
Malakoplakia of the liver is rare, only three cases having been documented in the world literature. Described here is the first case of malakoplakia of the liver as a complication of a perforated colonic diverticulum.
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Non-traumatic or spontaneous gas gangrene by Clostridium septicum is a rare infection in humans, characterised by extensive destruction of muscle tissue, a mortality rate of 100% if left untreated (1), and often associated with haematological or colorectal diseases. An associated malignancy was found in 80% of patients with Clostridium septicum infection: 34% had a colorectal carcinoma and 40% had a haematological malignancy (2); the infection usually lies in an often-ulcerated intestinal lesion (3). We report here a case of spontaneous gas gangrene by Clostridium septicum in the right thigh due to perforation of a diverticulum in the sigmoid colon.
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A mucus-secreting carcinoid tumor arising in a colonic (rectosigmoid) diverticulum is presented. Carcinoid tumors in colonic diverticula have not been previously reported. The presence of mucin and argentaffin granules in the same tumor cell is illustrated. The recognition of mucus-secreting carcinoid tumors is emphasized in order to avoid overtreatment of small colonic carcinoid tumors by extensive surgical procedures.
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