Giant ascending colonic diverticulum presenting with intussusception

Abstract

Diverticular disease of the colon is a common disease, and its incidence is increasing gradually. A giant colonic diverticulum (GCD) is a rare entity and is defined as a diverticulum greater than 4 cm in size. It mainly arises from the sigmoid colon, and possible etiology is a ball-valve mechanism permitting progressive enlargement. A plain abdominal X-ray can be helpful to make a diagnosis initially, and a barium enema and abdominal computed tomography may confirm the diagnosis. Surgical intervention is a definite treatment for a GCD. We report a case of an ascending GCD presenting with intussusception in a young adult.

Keywords: Ascending colon; Giant colonic diverticulum; Intussusception; Surgical intervention.

Fig. 1

Initial abdominal computed tomographic scan from an outside hospital showing the target sign in the left mid to lower abdomen.

Fig. 2

Colonoscopic finding showing a large, smooth-surfaced, round mass lesion, mimicking a submucosal tumor, near the hepatic flexure.

Fig. 3

Follow-up abdomen computed tomographic (CT) scan. Comparing to the previous CT scan, the large high-density mass had moved to the right side of the abdomen, suggesting an ascending colonic mass.

Fig. 4

Pathophysiology. Panel A shows a large diverticulum in the gross specimen. Panel B exhibits the true diverticulum and shows the full thickness of the bowel wall from the mucosa to the serosa in a low-power field (H&E, × 100). The white arrow indicates an outpouching of the diverticulum. Panel C shows amorphous materials, consistent with a fecalith, in the diverticular lumen (H&E, × 100).