Popping the Balloon: A Giant Colonic Diverticulum Complicated by Bladder Neck Compression
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DDS–SIRC COOPERATIVE CONFERENCES
Popping the Balloon: A Giant Colonic Diverticulum Complicated by Bladder Neck Compression M. C. Ripoli1 · A. Lauro1 · S. Vaccari2 · G. Mastrocola4 · A. Lanci‑Lanci1 · V. D’Andrea2 · I. R. Marino3 · M. Cervellera1 · V. Tonini1 Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Giant colonic diverticulum, defined as a single diverticulum ≤ 4 cm, is rarely encountered. Due to the high incidence of complications related to the disease, obtaining the correct diagnosis early in the disease course is essential. Diagnosis is usually reached by conventional and cross-sectional abdominal radiography. Treatment decisions should be ideally made by a multidisciplinary discussion among surgeons, interventional radiologists, and the patient. The treatment of choice is the surgical management by open or laparoscopic approach. Keywords Giant colonic diverticulum · Diverticular disease · Surgery · Laparoscopic sigmoid resection Abbreviations GCD Giant colonic diverticulum C-RP C-reactive protein CT Scan computed tomography scan GI Gastro-intestinal GERD Gastro-esophageal reflux disease
Case Presentation and Evolution A 76-year-old Caucasian woman was admitted to the Emergency Surgery Department with abdominal pain, fever, vomiting, suspected bowel obstruction, and painful, frequent passage of small urine volumes (stranguria). Her prior medical history included hypertension, hypercholesterolemia, and colonic diverticulosis. Previous surgery included appendectomy, tonsillectomy, and repair of uterine prolapse. Examination revealed a tender palpable left abdominal mass
without signs of peritonitis or abdominal distension. Bowel obstruction was initially suspected due to the presence of vomiting but was immediately excluded after CT scan imaging. Vomiting was likely linked to pain, inflammation, and vagal stimulation. Blood tests revealed systemic inflammation with an elevated white blood cell count (15 × 103/µL) and C-RP 47 mg/dL. A CT scan with contrast demonstrated a voluminous mass (12 × 8 cm) containing fecal material and air, suggestive of complicated GCD in a patient with existing colonic diverticulosis (Fig. 1). The complicated GCD was adjacent to the bladder compressing the bladder neck, a likely cause of stranguria. An en bloc left colic resection including the GCD was performed and followed by a stapled latero-terminal colic anastomosis (Figs. 2, 3). The postoperative course was uneventful; the patient was discharged on the 10th postoperative day in good condition without complications.
Discussion * A. Lauro [email protected] 1
Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
2
Department of Surgical Sciences, La Sapienza University, Umberto I Hospital, Rome, Italy
3
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
4
Clinicas Dr Carla Barber, Madrid, Spain
Colonic diverticular disease is a common disorder that is manifest extremely rarely as a GCD. GC
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