Giant Sigmoid Diverticulum: A Personal Experience
J H McClenathan, D D Neal
Citation
J H McClenathan, D D Neal. Giant Sigmoid Diverticulum: A Personal Experience. The Internet Journal of Surgery. 2025 Volume 41 Number 1.
DOI: 10.5580/IJS.57247
Abstract
Giant sigmoid diverticulum was first reported in 1953 by Hughes and Green. Kempczinski reviewed 15 cases of giant diverticula in 1974. And Nigri collected 166 cases in a report in 2015. Most patients have abdominal complaints such as pain or bloating and the most common physical finding is an abdominal mass. Our own experience treating two patients with giant sigmoid diverticula was congruent with those reports. More recently, however, we treated a patient whose spectrum of complaints were systemic. Herein we submit our most recent case report and include images from all three of our cases.
Case report
An 82-year-old man was referred for evaluation of a large sigmoid colon diverticulum. The patient related that he had been unwell for over two years. He related that his spectrum of symptoms began when he had a Covid illness followed by Covid vaccinations several years earlier. He had lost over fifty pounds and had loss of appetite. He had mild abdominal pain and bloating. He complained of numbness of his feet and toes and occasional loss of balance. He had extreme fatigue, always felt cold and complained of night sweats. He was thought to be suffering from long Covid syndrome.
He had colonoscopy a year before referral which showed a small benign polyp and numerous diverticula.
In 2021, a CT scan showed a 4.5 cm diverticulum in the lower abdomen. In 2022, a repeat CT showed the diverticulum had increased in size to 8 cm and that the diverticulum was filled with stool.
A third CT scan in 2023 showed the stool-filled diverticulum had increased to 10 cm size and that there was inflammatory change in its wall.
Figure 1
He was referred to our surgery clinic where our exam revealed a frail appearing gentleman with slight fullness in his lower midline. Aside from slight abdominal fullness and occasional diarrhea, he had minimal abdominal complaints. Rather, he was more focused on his weight loss and fatigue. An operation was recommended to relieve abdominal complaints but we were uncertain whether any of his systemic complaints would be relieved by operation. Eventually, the patient had a challenging sigmoid colon resection. Specimen photographs are included here. Final pathology showed an inflammatory giant sigmoid diverticulum. Two months after his operation, all his symptoms have resolved. He is eating well and gaining weight. His energy levels are normal.
Figure 2
We speculate that stagnant material in his diverticulum may have contributed to his systemic complaints.
In addition to caring for our most current patient,
We submit radiographs and specimen photographs to illustrate two additional patients treated for symptoms related to giant sigmoid diverticula. In both patients, their complaints were abdominal. And in both of our previous patients, the diverticula were almost exclusively gas-filled.
Figure 3
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Figure 5
