P4150 - Unique Endoscopic Variations of Asymptomatic Segmental Colitis Associated with Diverticulosis (SCAD): A Case Report

Ammad Javaid. Chaudhary, MD¹, Gokturk Tepe, BS², Taher Jamali, MD³, Muhammad Zarrar Khan, MD⁴, Muhammad Shahzil, MD⁵, Abdulmalik Saleem, MD¹, Muhammad Saad Faisal, MD¹, Sarah Russell, MD^6
1Henry Ford Health, Detroit, MI; ²Wayne State University School of Medicine / Detroit Medical Center, Detroit, MI; ³Henry Ford Hospital, Detroit, MI; ⁴Henry Ford Hospital, Royal Oak, MI; ⁵Penn State Health Milton S. Hershey Medical Center, Hershey, PA; ⁶Henry Ford Health System, Detroit, MI

Introduction: Segmental colitis associated with diverticulosis (SCAD) is a rare condition characterized by segmental circumferential thickening of the colonic wall, particularly in the sigmoid region, alongside colonic diverticulosis. We present a unique case of asymptomatic SCAD in a 69-year-old male with a significant history of peripheral artery disease (PAD), who exhibited distinctive SCAD findings on colonoscopy

Case Description/Methods: A 69-year-old male patient with an extensive history of PAD requiring multiple vascular stents and right femoral endarterectomy presented with acute right-sided leg pain. CT angiography was obtained which revealed bilateral superficial femoral artery occlusion and an incidental diffuse sigmoid wall thickening. On review of systems the patient denied any diarrhea, constipation, nausea, vomiting, or hematochezia. Physical exam findings were unremarkable, with no abdominal pain, tenderness, or distension. Despite the patient's benign presentation, given his significant vascular history and concurrent CT findings colonoscopy was performed to explore potential etiologies such as ischemia or malignancy. Colonoscopy identified multiple diverticula and polypoid lesions, without significant ulceration or inflammation in the sigmoid colon, located between 25 and 30 cm proximal to the anus. This unique endoscopic variation of SCAD has not been reported in existing literature (Figure 1A, B, C, D). Notably, the patient was asymptomatic, differing from typical SCAD presentations. Histopathology was further obtained 30 cm proximal to the anus which revealed colonic mucosa with reactive changes and no evidence of active inflammation, dysplasia, or carcinoma. Ultimately, given the patient's asymptomatic nature, active treatment was deferred and follow-up colonoscopy was scheduled in 3 years.

Discussion: The presentation of SCAD is diverse; in this case, our patient was asymptomatic and exhibited atypical findings on endoscopy. Most SCAD cases follow one of four patterns—A, B, C, or D—but our patient presented outside these typical endoscopic patterns. In addition, our patient denied any history of typical SCAD symptoms including chronic intermittent abdominal pain, non-bloody diarrhea, and hematochezia. By sharing this case, we contribute to the collective knowledge base, enhancing our understanding of atypical presentations in gastrointestinal pathology, particularly SCAD.



Disclosures:


Ammad Javaid. Chaudhary, MDsup>1, Gokturk Tepe, BS<², Taher Jamali, MD³, Muhammad Zarrar Khan, MD⁴, Muhammad Shahzil, MD⁵, Abdulmalik Saleem, MD¹, Muhammad Saad Faisal, MD¹, Sarah Russell, MD⁶. P4150 - Unique Endoscopic Variations of Asymptomatic Segmental Colitis Associated with Diverticulosis (SCAD): A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.