Gas Shadow in the Abdomen - Rare Manifestation of a Common Condition

Aims: Diverticular disease is common in the ageing population, and this trend is also seen in Asians. A rare manifestation of this condition is a giant colonic diverticulum, defined as a sac-like protrusion of the colonic wall larger than 4 cm. Here we report a case of a patient who presented with an abdominal mass causing mild discomfort who was later found to have a giant colonic diverticulum on a background of known diverticular disease.

Case Presentation: A 52-year-old lady presented with bloating and a non-tender abdominal mass three months after successful medical treatment of acute diverticulitis. CT imaging revealed a 5cm contained air pocket with minimal surrounding inflammatory fat stranding. She was diagnosed to have a GCD and underwent a laparoscopic sigmoid colectomy which confirmed a giant diverticulum of the descending colon on histopathology.

Discussion: The most common aetiology of giant colonic diverticulum is post-inflammatory subsequent to focal perforation of an existing colonic diverticulum. Surgery is recommended as a GCD is usually symptomatic and there is a higher risk of complications if it is left in-situ.

Conclusion: With the rarity of this disease entity in the Asian context, a surgeon encountering giant colonic diverticulum may have limited experience in managing it. Surgery is the mainstay treatment modality and consists of resection of the giant colonic diverticulum en-bloc with the adjacent colon.