Giant Ascending Colonic Diverticulum Presenting With Intussusception
A 30-year-old female was transferred to Chosun University Hospital with a 1-month history of left lower quadrant pain. The laboratory examination at admission was unremarkable. Physical examination revealed left lower quadrant tenderness with a palpable abdominal mass. Plain abdomen X-ray presented a gas-filled cavity in the middle right abdomen. The computed tomography scan from an outside hospital showed a target sign suggesting intussusception in the mid to lower colon on the left side (). The intussusception was soon resolved spontaneously without any procedure. To evaluate the lesion, we performed a colonoscopic examination, which revealed a huge submucosal tumor (SMT)-like lesion in the ascending colon (). The abdominal computed tomographic scan was checked again for further assessment of the SMT-like lesion and showed 4.2-cm-sized encapsulated fluid of high density with a thick wall on the right side of abdomen ().\nA laparoscopic right hemicolectomy was performed because of uncertainty of the diagnosis and for a one-stage treatment. On the operation findings, the lesion which was 5 cm × 5 cm in size was located in the mid portion of the ascending colon and extended to the hepatic flexure. Also, multiple enlarged lymph nodes were found around the ileocolic and the middle colic vessel and were removed by using an en bloc resection. Gross finding of the removed specimens showed a large diverticulum on the ascending colon (). Histologic examination of the diverticulum showed the full thickness of the bowel wall from the mucosa to the serosa (). The patient made a quick recovery and was discharged 7 days after surgery without any complication.