Giant sigmoid colon diverticulum incarcerated in an inguinal hernia

Abstract

Introduction: The diverticulosis of the sigmoid colon may be congenital or acquired. The Giant Colonic Diverticulum (GCD), defined as a diverticulum larger than 4 cm, is a rare, but clinically important entity. The McNutt (1988) classification is used differentiate the three subgroups of giant diverticula. Type 1 diverticula are pulsion pseudo-diverticula, which enlarge gradually. Type 2 are inflammatory diverticula due to a previous subserosal perforation, where the abscess cavity is communicating with the bowel lumen and its wall would be gradually composed of fibrous scar tissue, lacking the intestinal histological layers. Type 3 are the real, congenital diverticula of the colon, containing all layers of the intestinal wall. We present a case of a 59-year-old male patient, who was admitted to our Dept. of Surgery in emergency with the diagnosis of strangulated left inguinal hernia. Abdominal CT demonstrated the herniation of the sigmoid colon into the hernia sac without the signs of bowel obstruction. The patient was operated on urgently; subsequent to a left inguinal incision, a Type 3 giant diverticulum of the sigmoid colon was found in the hernia sac. Laparotomy was performed, and the unusually large, 7-8 cm long strangulated diverticulum was liberated. There were no other pathological findings, the sigmoid colon was not damaged. The diverticulum was resected with a TA stapler, and the staple line was inverted with a layer of seromuscular sutures. The inguinal hernia orifices were reconstructed both intraabdominally and externally. The postoperative course was uneventful, the patient was discharged on the 7th day. The recommendations concerning the diagnosis and treatment GCD are briefly reviewed. Due to the McNutt Type 3 characteristics, we opted for the less invasive, simple diverticulectomy instead of sigmoid resection (Hartmann’s procedure). Our case was an extremely rare complication of the already uncommon GCD, resolved by an unusual surgical intervention leading to a successful cure.