Giant Colonic Diverticulum

Figure

a) visible and palpable spaceoccupying lesion in the left lower abdomen; b) giant colonic diverticulum with valve mechanism

A female patient in her fifties presented with a visible and tender swelling in her left lower abdomen (Figure a). The laboratory results revealed elevated inflammatory markers. Computed tomography showed an unusually large, extensive diverticulum, arising from the sigmoid colon, measuring about 9 cm with wall thickening reflecting inflammatory changes (Figure b). The complaints persisted despite initial antibiotic treatment. After three days, laparoscopic sigmoid resection with primary anastomosis was performed. The histological findings showed a type 1 GCD (giant colonic diverticulum). The patient’s recovery was uneventful, and she was discharged on the fourth postoperative day. GCD is a rare complication of diverticulosis. It is defined by a colonic diverticulum larger than 4 cm in diameter. The cause of the progressive enlargement is thought to be a ball-valve mechanism or gas production by gas-producing bacteria. According to McNutt, a distinction is made between three types: Type 1 – pseudo-diverticulum, Type 2 – postperforative cavity, and Type 3 – true diverticulum. GCD was first reported in 1946 and is still a rarity in the literature.

MUDr. Georgios Spyridonos, Dr. med. Martin Schnell, Iliana Ivanova-Mutafchieva, Allgemein- und Viszeralchirurgie, Hegau-Bodensee Klinikum Singen, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Dr Grahame Larkin.

Cite this as: Spyridonos G, Schnell M, Ivanova-Mutafchieva I: Giant colonic diverticulum. Dtsch Arztebl Int 2026; 123: 432. DOI: 10.3238/arztebl.m2026.0067