AB154. 130. Incidental finding of giant colonic diverticulum and their management: two case reports

Background: Giant diverticulum (GD) is a diverticulum measuring more than 4 centimetres. Although the true epidemiology of GD remains unknown, it is considered an extremely rare form of acquired diverticulosis and is more prone to complications. Here we present two incidental cases of GD and their management.

Methods: Case 1: a 62-year-old man underwent laparoscopic right nephrectomy for clear cell tumour. His pre-operative staging computerised tomography (CT) scan showed an incidental finding of 1.9 cm gastrointestinal stromal tumor (GIST) adjacent to the greater curvature of the stomach and significant sigmoid diverticulosis. After oesophagogastrodeudonoscopy (OGD) and colonoscopy, he was scheduled for open partial gastrectomy. During the laparotomy, a 5-cm sigmoid GD was noted, and sigmoid colectomy was performed in conjunction with the partial gastrectomy; case 2: a 77-year-old man presented with ongoing lower abdominal discomfort and diarrhoea, CT showed 6 cm × 7 cm debris filled cavity arising from sigmoid colon confirmed by barium enema as GD. A colonoscope demonstrated GD as well as a polypoidal lesion in mid rectum. Biopsy results showed tubulovillous adenoma with foci of high-grade dysplasia. After multidisciplinary team (MDT) discussion patient underwent high anterior resection. On final histology the GD measured 7.5 cm in size and contained vegetable matter and plastic stickers.

Results: Giant diverticulum is a rare entity but with increasing availability and use of diagnostic radiology such as CT scans, it is likely that more and more incidental cases of GD are identified.

Conclusions: There is currently lacking evidence to advocate surgical intervention for all cases of GD and treatment should be tailored to the needs of individual.

Keywords: Colon; diverticulum; giant; management