Giant sigmoid diverticulum

Giant colonic diverticulum is an uncommon presentation of colonic diverticular disease. It is characterised by the presence of a diverticulum exceeding 4 cm in size, with approximately 90% of the cases involving the sigmoid colon. Typically, diagnosis relies on CT of the abdomen and pelvis (CTAP). The preferred treatment approach is sigmoid resection with a primary colonic anastomosis. However, in complicated or emergency cases, proctosigmoidectomy with end colostomy (Hartmann's procedure) is often considered the safest surgical option.We present an atypical case of a symptomatic patient with a giant sigmoid diverticulum that had increased in size and symptoms over several years. Initial diagnosis by CTAP revealed an incidental 6 cm sigmoid diverticulum. Over approximately 6 years, the diverticulum enlarged substantially, reaching 20 cm in size. This caused compression of the stomach and splinting of the left hemidiaphragm, resulting in nutritional failure. He was admitted with a plan to optimise for curative surgery; however complications such as nutritional failure and frailty developed, leading to a decision for palliative care.