Giant diverticulum of the transverse colon mimicking gastrocolic fistula: A case report

• Published in: International journal of surgery case reports Vol. 77; pp. 809 - 812
• Main Authors: Sofii, Imam, Pua Upa, Amal Fathullah, Gunadi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2020; Elsevier
• Subjects: Case Report; Colectomy; Diverculectomy; Gastrocolic fistula; Giant transverse colon diverticulum; Colectomy; Gastrocolic fistula; Giant transverse colon diverticulum; Diverculectomy
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2020.11.076

•Differentiating giant colonic diverticulum and gastrocolic fistula with similar clinical courses may necessitate multiple investigations.•Symptoms that have been present from childhood may be related to congenital etiology.•Because of the risk of colonic closure breakdown and the possibility of recurrence of GCD, colectomy seems to be the best option. Giant transverse colonic diverticula are a rare case of giant colonic diverticulum (GCD). Instead of being asymptomatic, bleeding, inflammation, and perforation may result in fistula formation and require surgery. This type of diverticulum is thought to be closely related to the gastrocolic fistula (GCF). We report a 26-year-old female presenting severe abdominal pain accompanied by nausea and vomiting and a history of constipation since childhood. The patient felt a mass around the epigastric region and extends to the right hypochondrium. Enema contrast examination showed a large diverticulum in the transverse colon. CT scan revealed a 21.4 × 8.4 cm structure with air-filled structures visible from the transverse colon filled with contrast material, suggesting a possible gastrocolic fistula. Resection was performed on the diverticulum and 20 cm in length of the transverse colon, followed by side-to-side anastomosis. Histopathological findings were type III GCD. The patient was discharged without complications 1 week later. Giant diverticulum is characterized by a diverticulum with 4 cm or more in length. Our case was a diverticulum from the central portion of the transverse colon with 25 × 9 × 3 cm in length and type III GCD. Resection was performed on the diverticulum and 20 cm in length of the transverse colon, followed by side-to-side anastomosis. Differentiating GCD and GCF with similar clinical course may necessitate multiple investigation before establishing the correct diagnosis. We suggest colectomy followed by side-to-side anastomosis is the best option of treatment for GCD.