The prevalence of diverticulosis is in 35% of the population. However, doctors report the giant colonic diverticulum in fewer than 200 cases. Furthermore, reporting the development of giant diverticulum as a sequela of laparoscopic washout is still rare. The diagnosis is based on the case presentation. Clinical history and confirmation are through colonoscopy and x-ray following barium enema. However, in case of severe abdominal pain, CT abdomen is the gold standard diagnostic test, to avoid the risk of intestinal rupture.
This case is of a 74-year-old female with a history of diverticulosis and diverticulitis. She had developed perforated sigmoid diverticulitis. She went through laparoscopic washout and recovery without colon resection.
However, a year after the washout, she developed bloating and abdominal distention. Doctors did a CT scan, which showed a giant diverticulum. They surgically resected the sigmoid colon, containing the giant diverticulum and the recovery was uneventful.
Asymptomatic Clinical Complication
Diverticulosis is a clinical complication in which multiple diverticula develop in the GI tract. The diverticula form in the walls of either the large or small intestine but occur most commonly in the sigmoid colon of the large intestine. The majority of the individuals with diverticulosis do not have any symptoms.
This is the first-ever case of giant diverticulum that presented as a complication of an abdominal washout for the management of acute diverticulitis. When the doctors did the CT scan initially at the time of the perforation, it did not reveal the presence of a diverticulum. Hence, it indicated that the development was a year after the washout for acute rupture and sepsis. It was most probably because the colonic wall had weakened due to the ongoing inflammation.
This rare presentation of giant diverticulum makes establishing a clear link to washout difficult. Further investigation can establish the definitive diagnosis with time.