Giant diverticulum, management and literature review from a case of complicated acute diverticulitis resolved laparoscopically with primary anastomosis

Abstract

Introduction: Giant diverticulum (GD) is a rare presentation in diverticular disease with few cases reported in Chile and nearly 200 worldwide. Aim: To update knowledge on this topic and discuss its management from a complicated case. Materials and methods: A 34-year-old patient with a history of a Hinchey 0 complicated acute diverticulitis episode and finding of a giant diverticulum on computed tomography. Five years later presents with a new Hinchey IV complicated episode. A laparoscopic sigmoidectomy with primary anastomosis without protective ileostomy is performed. Results and Discussion: The suggested treatment for all cases facing diagnosis is en bloc resection of the diverticulum and the diseased colonic segment given the risk of complications and underlying neoplasia. In complicated cases, there are no particular recommendations for DG, but it is possible to apply the same current treatment recommended for acute diverticulitis. This implies the possibility of the laparoscopic route and primary anastomosis with or without protection ileostomy, depending on the case. Diverticulectomy is not recommended and in the case of surgical contraindication, percutaneous drainage, stent or antibiotics only are valid alternatives.