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Kling S, Kripalani S, Vu JV. Unusual Variations and Atypical Presentations of Diverticulitis. Clin Colon Rectal Surg 2024. [DOI: 10.1055/s-0044-1791553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
AbstractIn this article, we describe four unusual variations of diverticulitis: nonsigmoid colonic diverticulitis, giant colonic diverticulum, segmental colitis associated with diverticulosis, and small bowel diverticulitis. We discuss the epidemiology, presentation, and treatment of these types and how they differ from the presentation of typical sigmoid diverticulitis. We also review unusual presentations of typical sigmoid diverticulitis, including hematogenous liver abscess, necrotizing soft-tissue infection, and genitourinary fistula. Diverticulitis is a heterogeneous disease, and understanding the range of its presentations will facilitate early diagnosis and treatment.
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Affiliation(s)
- Sarah Kling
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Simran Kripalani
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Joceline V. Vu
- Division of Colorectal Surgery, Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
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Romero AL, Romero J, Sah A, Koomson A, Arun N. Acute Transverse Colon Diverticulitis: A Case Report and Literature Review. J Community Hosp Intern Med Perspect 2024; 14:105-110. [PMID: 39391124 PMCID: PMC11464048 DOI: 10.55729/2000-9666.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 03/24/2024] [Accepted: 04/23/2024] [Indexed: 10/12/2024] Open
Abstract
Diverticular disease is a condition that ranges from asymptomatic disease to severe complications, such as abscesses, fistulas, and perforations. It is prevalent in Western countries, with up to 60% of people aged 60 having diverticula. In Asian countries, the prevalence is lower, ranging from 13 to 25%. Diverticulitis can occur in any location of the diverticula, with increasing incidence with age. Complications occur in 12% of patients with diverticulitis, with phlegmon or abscesses being the most common. Perforation is a life-threatening complication with a 1-year mortality rate of 20%. Recent studies suggest that chronic inflammation and alteration of the gut microbiome may play a role in diverticulitis, leading to a less aggressive and conservative approach to treatment. Even though diverticular disease represents a very common clinical entity, diverticula located in the transverse colon it is an extremely rare presentation. We present the case of a 39-year-old female with a history of multiple medical conditions who presented to the Emergency Room (ER) with severe diffuse abdominal pain predominantly in the right lower quadrant associated with shortness of breath. Upon physical examination, she was found to have severe pain, bilateral rhonchi, and a diffusely tender abdomen with guarding without rebound tenderness. Lab analysis showed leukocytosis, and a CT scan of the abdomen and pelvis revealed acute transverse diverticulitis which was treated medically.
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Affiliation(s)
- Ana L. Romero
- RWJBarnabas Health, Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Jesus Romero
- RWJBarnabas Health, Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Anuraag Sah
- RWJBarnabas Health, Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Angela Koomson
- RWJBarnabas Health, Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Naik Arun
- RWJBarnabas Health, Trinitas Regional Medical Center, Elizabeth, NJ,
USA
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Vagios I, Vailas M, Vergadis C, Schizas D. Transverse colon diverticulitis mimicking acute appendicitis. BMJ Case Rep 2024; 17:e254703. [PMID: 38296506 PMCID: PMC10831436 DOI: 10.1136/bcr-2023-254703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
Diverticulitis in a solitary transverse colon diverticulum is uncommon, with only a handful of cases documented in the literature. There are various clinical manifestations of the disease, which make clinical and radiological diagnosis rather challenging. Herein, we present a case of a premenopausal female patient in her late 40s who presented to the emergency department, complaining of right lower quadrant abdominal pain, nausea, anorexia and fever. Following clinical, biochemical and radiological tests, the patient was prepared for surgical operation, with the presumed diagnosis of acute appendicitis. An appendicectomy was planned via a McBurney incision. Notably, no inflammation of the appendix was discovered. However, on further exploration, an inflammatory mass was identified in the transverse colon, which was subsequently excised and sent for histological examination. The histology results confirmed the presence of a ruptured solitary transverse colon diverticulum, accompanied by an adjacent mesenteric abscess. The patient's postoperative recovery was uneventful.
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Affiliation(s)
- Ilias Vagios
- 1st Surgical Department, Laiko General Hospital, Athens, Attica, Greece
| | - Michail Vailas
- 1st Surgical Department, Laiko General Hospital, Athens, Attica, Greece
| | - Chrysovalantis Vergadis
- Radiology, Division of Interventional Radiology, Laiko General Hospital, Athens, Attica, Greece
| | - Dimitrios Schizas
- 1st Surgical Department, Laiko General Hospital, Athens, Attica, Greece
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Shimizu A, Yoshimitsu M, Yano T, Chogahara I, Fukuhara S, Nakano K, Idani H, Okajima M, Ishida M, Satoh D, Choda Y, Shirakawa Y, Matsukawa H, Shiozaki S. Single-incision laparoscopic ileocolectomy for solitary cecal colon diverticulitis with calcified fecalith: a case report. J Surg Case Rep 2022; 2022:rjac323. [PMID: 36059436 PMCID: PMC9433124 DOI: 10.1093/jscr/rjac323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
The prevalence of colonic diverticular disease has been on the increase in Japan due to an increase in westernized diet and a rapidly aging population. However, solitary cecal diverticulum is rare and considered congenital in etiology. Solitary cecal diverticulitis with calcified fecaliths is even rarer. Herein, we report a case of cecal colon diverticulitis caused by a calcified fecalith in a 38-year-old woman treated with single-incision laparoscopic surgery. To the best of our knowledge, this report describes the first case of cecal colon diverticulitis caused by a calcified fecalith that was successfully treated with single-incision laparoscopic ileocolectomy.
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Affiliation(s)
- Akito Shimizu
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Masanori Yoshimitsu
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Takuya Yano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Ichiya Chogahara
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Sotaro Fukuhara
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Kanyu Nakano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Hitoshi Idani
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Michihiro Ishida
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Daisuke Satoh
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Yasuhiro Choda
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Yasuhiro Shirakawa
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Hiroyoshi Matsukawa
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
| | - Shigehiro Shiozaki
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital , Hiroshima, 730-8518 , Japan
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Tanabe H, Tanaka K, Goto M, Sato T, Sato K, Fujiya M, Okumura T. Rare case of fecal impaction caused by a fecalith originating in a large colonic diverticulum: A case report. World J Clin Cases 2021; 9:416-421. [PMID: 33521110 PMCID: PMC7812877 DOI: 10.12998/wjcc.v9.i2.416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fecal impaction is defined as a large mass of compacted feces in the colon and has the potential to induce a serious medical condition in elderly individuals. Fecal impaction is generally preventable, and early recognition of the typical radiological findings is important for making an early diagnosis. The factors that lead to fecal impaction are usually similar to those causing constipation. Few cases with fecal impaction associated with a diverticulum have been reported.
CASE SUMMARY We present the case of a 62-year-old woman who suffered from abdominal pain and vomiting, had a medical history of repeated acute abdomen and was diagnosed with fecal impaction in the descending colon based on X-ray and computed tomography (CT) imaging. After examination by gastrografin-enhanced colonography following colonoscopy and CT colonography, the fecalith was suspected to have been produced at the site of a large diverticulum in the transverse colon. The fecalith was surgically resected, and a histological diagnosis of pseudodiverticulum was made. There was no recurrence during 33 mo of follow-up.
CONCLUSION This case highlights the importance of accurate identification and treatment of a fecal impaction. This case indicated that the endoscopic evacuation and subsequent colonography were effective for identifying a diverticulum that might have caused fecal impaction. A fecal impaction was associated with the diverticulum. Consequently, the planned diverticulectomy was performed. Appropriate emergency medical treatment and maintenance treatments should be selected in such cases to prevent recurrence.
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Affiliation(s)
- Hiroki Tanabe
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Kazuyuki Tanaka
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Mitsuru Goto
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Tomonobu Sato
- Department of Gastro-enterology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Keisuke Sato
- Department of Pathology, Asahikawa Kousei Hospital, Asahikawa 078-8211, Hokkaido, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
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Ostosh AC, Saleh A, Boehm KM. An Atypical Case of Transverse Diverticulitis and the Changing Management of Diverticular Disease. Spartan Med Res J 2018; 3:6979. [PMID: 33655142 PMCID: PMC7746110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/15/2018] [Indexed: 09/16/2024] Open
Abstract
Diverticulitis is an inflammation of an out pouching of the lower gastrointestinal tract, particularly in the large intestine. Although the condition is taught to medical students as typically occurring in the left lower quadrant of the abdomen, right-sided and transverse forms diverticulitis can occur. Uncomplicated, e.g., non-perforated, diverticulitis is usually treated with antibiotics. Complicated, e.g. perforated, is usually treated with surgery. The purpose of this case report is to present an atypical case of perforated diverticulitis and review current recommendations for this condition. This was a case of transverse diverticulitis in a man in his late 40's who recovered with non-operative treatment. The widespread use of computerized tomography (CT) scans makes diagnosing diverticular disease relatively simple, but treatment is evolving. The case summarized here shows that less invasive measures can be used in treating both complicated and uncomplicated diverticular disease. After an uncomplicated in-patient admission for intravenous antibiotics, the patient was discharged in stable condition with a prescription for oral antibiotics and clinic follow-up. Classic medical school teaching concerning treatments for complicated and uncomplicated forms of diverticulitis have been updated but require further research testing.
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Affiliation(s)
| | - Adeeb Saleh
- St Mary Mercy Livonia; Michigan State University
| | - Kevin M Boehm
- Michigan State University; Broward Health Medical Center
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