Hungarian Radiology

[Giant colonic diverticulum]

SARLÓS Géza, GARAMSZEGI Mária, GREXA Erzsébet

DECEMBER 20, 2007

Hungarian Radiology - 2007;81(07-08)

[INTRODUCTION - Very rarely do colonic diverticula grow enourmously - from 3-4 cm upto 15-20 cm in diameter - causing diagnostic difficulties. PATIENT AND METHODS - The authors present a case of an elderly male patient where the ultrasound examination accidentally revealed irregularity in a part of the sigmoid colon with thickened wall. This finding was then examined by colonoscopy, colonography (double contrast barium enema) and CT. Two giant diverticula, measuring 4-5 cm in diameter, arising from the sigmoid colon were demonstrated. Considering the old age of the patient and the lack of clinical symptoms, the affected part of the sigmoid colon had not been surgically resected. CONCLUSION - Giving a general overview on the pathogenesis, presentation and differential diagnosis of colonic diverticula, the authors emphasise the importance of colonography. Also, as far as the authors know, this is the first Hungarian report on giant colonic diverticulum.]

COMMENTS

0 comments

Related contents

Lege Artis Medicinae

[Resection of colonic polypoid cavernous hemangioma with help of rubber rings]

ÁCSNÉ Tóth Andrea, LUKOVICH Péter, LAKATOS Péter László, KARDOS Magdolna, ARANY Andrea Szilvia, HARSÁNYI László

[INTRODUCTION - Cavernous hemangioma is a benign, rare disorder, usually localized in the distal part of the gastrointestinal system. CASE REPORT - In a 19-year-old woman treated for Crohn’s disease localized to the colon, a polypoid lesion was found during routine colonoscopy. The lesion appeared to be vascularized, purple in color and could be localized 25 cm above the anal sphincter. MSCT examination confirmed vascularization of the lesion. Considering the high risk for severe bleeding, resection was performed with surgical assistance. At first, two rubber rings were placed around the polypoid lesion. Thereafter 1 ml of epinephrine was injected into the neck of the lesion above the rubber rings, followed by polypectomy with a standard hook. No complications were present during the observation period. Histological examination of the polypoid lesion confirmed it to be cavernous hemangioma. CONCLUSION - On the basis of previous cases and the present case there might be a connection between inflammatory bowel disease and the development of cavernous hemangioma. We have not found any previous reports of a similar application of rubber rings. However, in cases where the risk of bleeding is high, this method is safe and easy to apply.]

Lege Artis Medicinae

[RIGHT HEMICOLECTOMY FOR SUBMUCOUS LIPOMA CAUSING PARTIAL BOWEL OBSTRUCTION]

SVÉBIS Mihály, BORI Rita, KOCSIS Lajos, PAP-SZEKERES József, CSERNI Gábor

[INTRODUCTION - Submucous lipomas are rare tumors of the colon and may be misdiagnosed as cancer because of their exophytic, polypoid growth and threatening bowel obstruction. CASE REPORT - A protruding, ulcerated and firm tumor preventing the investigation of the coecum was found by endoscopy in the ascending colon of a 50-year-old woman, who was subsequently operated on. The preoperative biopsy revealed only necrotic debris. Right hemicolectomy was performed because of threatening bowel obstruction and the presumed diagnosis of cancer. The tumor proved to be a 4 cm-large pedunculated submucosal lipoma. CONCLUSION - Despite recent diagnostic developments and the availability of better tools for the preoperative diagnosis of colonic lipomas, these tumors may still be misdiagnosed as carcinomas. Several circumstances contradict malignant dignity, such as: the relative circumscription of the mass, the trophic and only partial ulceration of the surface which is covered by normal mucosal layer elsewhere. To avoid unnecessary radicality in treatment, colon tumors with an uncertain preoperative diagnosis should undergo further diagnostic steps in order to clarify their nature. This could allow a more optimal therapeutic planning.]

Clinical Neuroscience

[Data on the pathomechanism of ventricular diverticulus formation]

SOÓS Imre, MOHÁCSI Ildikó

[A case of a lateral ventricular diverticulum herniating into the cisterna ambiens and a case of multiple intracerebral ventricular diverticulosis were described. Cisterna ambiens diverticulum may form in adulthood on rigid hydrocephalus cerebrum, although it has also been described in children. It is essentially an infratentorial herniation of the retrosplenial gyrus in a slowly developing brain pressure gradient. A large differential between supratentorial and infratentorial pressures is a favourable condition for its development. It can be diagnosed in vivo only by ventriculography. It is to be distinguished from arachnoid cysts of the cisterna ambiens, which do not converge with the ventricular system and have no parenchyma or ependyma in their walls. Intracerebral diverticula may originate anywhere in the ventricular system of the juvenile hydrocephalus brain. The pathomechanism of their origin is due to the readiness of the severely oedematous parenchyma to infiltrate and secondary collapse into the ventricular system. (Weber and da Rugna: dissezierende intracerebrale Divertikel) The involvement of the dilated third ventricle in the cisternae is not a true diverticulum, but is notoriously common in hydrocephalus. The clinical significance of diverticulum formation is that it is a self-healing activity that eliminates obstruction to cerebrospinal fluid circulation and provides a route for the surgical resolution of occlusive hydrocephalus.]