Acute abdomen due to a ruptured giant diverticulum of the transverse colon: a case report

Introduction: Giant colonic diverticulum, exceeding 4 cm in size, is a rare and atypical form of diverticular disease. While it predominantly occurs in the sigmoid colon, it can manifest in any colon segment. This report details a case of a patient with a ruptured giant diverticulum in the transverse colon. Case report: A 52-year-old patient with asthma presented with severe abdominal pain, vomiting, and a fever. Tests showed inflammation, and a computed tomography (CT) scan revealed a 9 cm giant diverticulum in the transverse colon with perforation. Surgery involved colectomy and ileo-colostomy, resulting in a smooth recovery with continuity restored in 4 months. Discussion: Giant colonic diverticula, often linked to colonic diverticulosis, are mainly found in the sigmoid colon but can occur elsewhere. They are typically diagnosed in the sixth decade, with a slight male predominance. Three types exist: pseudo-giant (most common), inflammatory, and true giant diverticula. Patients may either be asymptomatic or experience acute peritonitis due to complications, most commonly diverticular perforation. Other complications include pericolonic abscess, intestinal obstruction, intradiverticular adenocarcinoma, and fistulas to neighboring organs. Colonoscopy is not suitable for diagnosis; abdominal CT scans are preferred. Surgical resection is the preferred treatment, with the approach determined by the diverticulum’s location and complication status. Conclusion: Giant colonic diverticulum, often associated with diverticulosis, can remain clinically silent or lead to acute complications, primarily perforation. Surgical resection, guided by location and complication status, is the favored treatment. This case report contributes to the understanding and management of this rare condition.