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Chirurgia 2019 February;32(1):25-9

DOI: 10.23736/S0394-9508.18.04817-9


language: English

Giant colonic diverticulum: review of the literature, personal experience and proposal of decision making

Andrea LOCATELLI , Pierpaolo CAPUTO, Pierluigi CARZANIGA

Unit of General Surgery, Department of Surgery, San Leopoldo Mandic Hospital - ASST Lecco, Merate, Lecco, Italy

INTRODUCTION: Giant colonic diverticulum is a rare manifestation of diverticular disease of the colon.
EVIDENCE ACQUISITION: A systematic review of the literature was performed using the Embase and PubMed databases to identify all the GCD studies. We used the PRISMA 2009 flow diagram in order to visualize the study selection process.
EVIDENCE SYNTHESIS: In total, 166 GCD cases in 138 studies were identified in the literature. The most common clinical presentation was abdominal pain, which occurred in 69% of the cases. Among the physical signs, an abdominal mass was detected in 48% of the cases, whereas 20% of the patients presented with fever and 14% with abdominal tenderness. Diagnosis is based predominantly on abdominal computed tomography. The most frequent treatment was colic resection with en-bloc resection of the diverticulum, performed in 57.2% of cases, whereas Hartmann’s procedure was followed in 11.4% of the cases and a diverticulectomy in 10.2%.
CONCLUSIONS: GCD is a rare but potentially dangerous disease. An accurate diagnosis is based on abdominal CT scan. A colectomy with en-bloc resection of the diverticulum and primary anastomosis is the preferred and the most used treatment and it is indicated in asymptomatic patients. This paper also provides the contribution of our experience in an elderly patient, with large space given to the diagnostic imaging of this rare disease. Finally we decided to achieve an algorithm that represents a personal proposal of GCD management, according to updated reviewed literature and personal experience.

KEY WORDS: Diverticulum, colon - Decision making - Review

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