P3708 - Rare Case of Segmental Colitis Associated Diverticulosis Requiring Surgical Intervention

Ariel Jimenez, BS¹, Harjit Singh, MD, MBA², Alireza Meighani, MD^2
1Georgetown University School of Medicine, Washington, DC; ²MedStar Georgetown University Hospital, Washington, DC

Introduction: Segmental Colitis Associated Diverticulosis (SCAD) is a rare form of colitis affecting the interdiverticular mucosa without involvement of the diverticular orifices. Diagnosis involves colonoscopy and biopsy showing chronic inflammatory changes, and spontaneous resolution is common. We present a case of SCAD progressing to sigmoid stricture and eventual colonic resection.

Case Description/Methods: A 41-year-old male with no past medical history was admitted with a 3-week history of epigastric and left lower quadrant abdominal pain, abdominal distention, 20-lb weight loss, vomiting, and severe constipation. His vital signs were within normal limits, and his physical exam was remarkable for left lower quadrant abdominal tenderness to palpation. Labs revealed an elevated C-reactive protein at 92 and an elevated white blood cell count at 12.66. CT abdomen and pelvis with contrast showed colonic distention to 6.5 cm proximal to the sigmoid colon, mural thickening/pericolonic stranding of the sigmoid colon consistent with chronic inflammation, and diverticulosis without diverticulitis. Flexible sigmoidoscopy was done which demonstrated a 10-cm area of inflamed mucosa, as well as stenosis in the sigmoid colon with scattered diverticulosis that caused upstream colonic obstruction (Figure 1). A biopsy of the area demonstrated minimal chronic inflammation with no evidence of inflammatory bowel disease. 1.5 liters of liquid stool was suctioned during the procedure. SCAD was diagnosed clinically. Post-procedure the patient had symptomatic improvement evidenced by bowel movements and ability to tolerate oral intake. He was discharged with a 14-day course of ciprofloxacin and metronidazole; however, he returned 6 days later with the same symptoms. CT abdomen showed worsening sigmoid colitis with stricture and new abscess formation. He was readmitted, and a sigmoid colectomy with end colostomy was performed. Recovery was successful and he was discharged with a plan for colostomy reversal.

Discussion: Segmental Colitis Associated Diverticulosis (SCAD) is a form of colitis affecting the

interdiverticular mucosa with a prevalence of 0.3 to 1.3%. Diagnosis involves direct visualization and biopsy with histopathology analysis to rule out Crohn’s Disease, diverticulitis, and infectious causes. Most cases resolve spontaneously or respond well to aminosalicylate therapy and antibiotics, but rarely may

progress to complete obstruction requiring surgical intervention.



Disclosures:


Ariel Jimenez, BS¹, Harjit Singh, MD, MBA², Alireza Meighani, MD². P3708 - Rare Case of Segmental Colitis Associated Diverticulosis Requiring Surgical Intervention, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.