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. 2018:49:126-130.
doi: 10.1016/j.ijscr.2018.06.014. Epub 2018 Jul 3.

Perforated diverticulitis in the setting of ulcerative colitis: An unusual case report

M Baimas-George  1 , L Cetrulo  1 , A Kao  1 , K R Kasten  2
Affiliations

Perforated diverticulitis in the setting of ulcerative colitis: An unusual case report

M Baimas-George et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: The association of diverticulitis with ulcerative colitis (UC) is rare and not well described. The sequelae of inflammatory bowel disease (IBD) such as perforation and fistula formation can mimic diverticular complications. Therefore, in an IBD patient, it can be difficult to distinguish the etiology of such complications and render definitive care.

Presentation of case: A 43-year-old man with a long history of UC presented with spontaneous sigmoid perforation and subsequent complications of colovesicular and colocutaneous fistulae requiring multiple procedural interventions. Ultimately, the etiology was confirmed as perforated diverticulitis superimposed on severe ulcerative colitis.

Discussion: As perforated diverticulitis superimposed on UC is a rare entity in the current literature and there are many diagnostic difficulties that complicate this scenario. It is important to rule out other entities such as misdiagnosis of IBD or segmental colitis associated with diverticula (SCAD) that may have overlapping features.

Conclusion: Although diverticulitis in the setting of UC is an uncommon presentation, it remains important for medical practitioners to consider this scenario when encountering patients who may present in a similar fashion. As such, we put forth a process to aid in a diagnosis and management such that definitive care may not be delayed.

Keywords: Case report; Colonic perforation; Diverticulitis; Inflammatory bowel disease; Ulcerative colitis.

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Figures

Figs. 1 and 2
Figs. 1 and 2
Colovesicular fistula and intra-abdominal abscess tracking towards the anterior abdominal wall.
Figs. 3 and 4
Figs. 3 and 4
Thickening of the distal descending and sigmoid colon and air near bladder tracking towards prior operative incision and drainage wound.
Fig. 5
Fig. 5
Diverticulities with peridiverticular abscess formation; H&E stain A) 0.5 magnification B) 2.0 magnification.
Fig. 6
Fig. 6
20× magnification, H&E stain; Background colonic mucosa with moderately active chronic colitis.
See this image and copyright information in PMC

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