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Granulomatous Diverticulitis: Who Would Have Thought!
Fady G Haddad1, Sandy El Bitar2, Hassan Al Moussawi3
1Gastroenterology and Hepatology, Staten Island University Hospital, New York, USA.
Insights
Diverticular disease-associated colitis (DAC) can cause granulomatous inflammation, typically in the left colon. This report details the first English literature case of DAC presenting as a right colon mass.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Pathology
Background:
- Diverticular disease (DD) encompasses various presentations, including chronic colitis.
- Diverticular disease-associated colitis (DAC) is a distinct entity characterized by inflammation.
- DAC commonly affects the left colon, mimicking Crohn's disease.
Observation:
- A patient presented with a tumor-like mass in the right colon.
- The mass was found to be a granulomatous reaction.
- This presentation is unusual as DAC typically affects the left colon.
Findings:
- The right colon mass was diagnosed as secondary to diverticular disease-associated colitis (DAC).
- This represents the first reported case of DAC involving the right colon with granulomatous inflammation in the English literature.
- The findings highlight the potential for DAC to manifest atypically.
Implications:
- This case expands the known spectrum of DAC presentations.
- It underscores the importance of considering DAC in the differential diagnosis of right colon masses, even with granulomatous features.
- Further research may clarify the pathogenesis and management of atypical DAC cases.
Abstract:
Diverticular disease (DD) can have different presentations, including chronic colitis. However, diverticular disease-associated colitis (DAC) is a separate entity that can be associated with a granulomatous inflammation. DAC usually affects the left colon with no involvement of the cecum and the ascending colon. In this setting, Crohn's disease is high in the differential diagnosis. Although granulomatous colitis associated with diverticulosis has been previously described, this is the first case affecting the right colon to be reported in the English literature according to our search of the PubMed database. The patient presented with a tumor-like mass abutting the right colon that was further diagnosed as a granulomatous reaction secondary to DAC.
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