Sigmoid Diverticular Perforation in a 23-year-old patient: A Case Report

Document Type : Case Report

Authors

1 Department of General Surgery, Istanbul Sultanbeyli State Hospital, Istanbul, Turkey

2 Department of General Surgery, Pendik Medipol University Hospital, Istanbul, Turkey

Abstract

Introduction: Diverticulitis is inflammation of one or more adjacent diverticulums and the surrounding colon. Patients with diverticulitis typically present acute or subacute abdominal pain in the left lower quadrant. Most patients with diverticulitis are over 50; however, diverticulitis is increasingly common in the younger. Diverticulitis may present with acute abdomen by causing intra-abdominal perforation. Although it is infrequent, diverticulitis perforation should be considered in the differential diagnosis of young patients with acute abdomen.
Case Presentation: In this case, we present the acute abdomen secondary to diverticulitis perforation in a 23-year-old male patient. The patient's physical examination and computed tomography scan were interpreted as perforation. We performed explorative laparotomy. In the operation, the stomach and other lumen organs were intact. It was observed that there were diverticula in the sigmoid colon, intense inflammation in the colon serosa in the region of the diverticula, and a perforation area of 1 cm in diameter.
Conclusions: Diverticulitis usually presents with abdominal pain in the left lower quadrant of the elderly patient. However, it may present with acute abdomen by causing intra-abdominal perforation. Although it is infrequent, diverticulitis perforation should be kept in mind in the differential diagnosis of young patients presenting with acute abdomen.

Keywords


  1. Laurell H, Hansson LE, Gunnarsson U. Acute diverticulitis--clinical presentation and differential diagnostics. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2007;9(6):496-501.
  2. Wheat CL, Strate LL. Trends in Hospitalization for Diverticulitis and Diverticular Bleeding in the United States From 2000 to 2010. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2016;14(1):96-103.e1.
  3. Shahedi K, Fuller G, Bolus R, Cohen E, Vu M, Shah R, et al. Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association. 2013;11(12):1609-13.
  4. Bharucha AE, Parthasarathy G, Ditah I, Fletcher JG, Ewelukwa O, Pendlimari R, et al. Temporal Trends in the Incidence and Natural History of Diverticulitis: A Population-Based Study. The American journal of gastroenterology.
    2015;110(11):1589-96.
  5. Mayumi T, Yoshida M, Tazuma S, Furukawa A, Nishii O, Shigematsu K, et al. The Practice Guidelines for Primary Care of Acute Abdomen 2015. Japanese journal of radiology. 2016;34(1):80-115.
  6. Muham mer Ergenç TKU. Laparoscopic treatment of a rare cause of acute abdomen; primary omental torsion. Laparosc Endosc Surg Sci. 2021;28(2):125-7.
  7. Ergenç M, Uprak TK. Appendiceal Diverticulitis Presenting as Acute Appendicitis and Diagnosed After Appendectomy. Cureus. 2022;14(3):e23050.
  8. Pautrat K, Bretagnol F, Huten N, de Calan L. Acute diverticulitis in very young patients: a frequent surgical management. Diseases of the colon and rectum. 2007;50(4):472-7.
  9. Swanson SM, Strate LL. Acute Colonic Diverticulitis. Annals of internal medicine. 2018;168(9):Itc65-itc80.
  10. Regenbogen SE, Hardiman KM, Hendren S, Morris AM. Surgery for diverticulitis in the 21st century: a systematic review. JAMA surgery. 2014;149(3):292-303.
  11. Faria GR, Almeida AB, Moreira H, Pinto-de-Sousa J, Correia-da-Silva P, Pimenta AP. Acute diverticulitis in younger patients: any rationale for a different approach? World journal of gastroenterology. 2011;17(2):207-12.
  12. Lahat A, Menachem Y, Avidan B,Yanai H, Sakhnini E, Bardan E, et al. Diverticulitis in the young patient-is it different ? World journal of gastroenterology. 2006;12(18):2932-5.
  13. Koo V, Strange J, Lam CY, Epanomeritakis M. Young patients with diverticular disease: a preliminary quality of life study. International journal of surgery (London, England). 2007;5(4):244-9.