IS Case 353: Giant colonic diverticulum
2009 URMC Imaging Sciences
Publication Date: 2009-11-09
Giant diverticula are rare entities that mainly arise from the sigmoid colon. It is postulated that giant diverticula represent a complication of perforated diverticulitis in which there is a one-way-valve phenomenon that allows the cavity to enlarge. Only 13% are true diverticula, in which all the bowel wall components are present. Rather, most of these lesions are either inflammatory or pseudodiverticula, which comprise residual portions of bowel wall and granulation tissue or dense fibrotic tissue.
Giant colonic diverticula can be appreciated on plain film and CT as rounded air, fluid, or stool filled collections. Barium enema is diagnostic, with contrast filling the giant diverticula in about 60% of cases. However, it is believed that barium enema carries a risk of perforation. The main differential considerations include communicating duplication cyst and necrotic colon adenocarcinoma. However, duplication cysts tend to occur on the mesenteric aspect of the colon and necrotic carcinomas tend to have a thickened, nodular wall.
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