Giant Congenital Diverticulum of the Sigmoid Colon By Barbara

Barlow,

William

W.

New Congenital, common

or true,

but is known

diverticulum

Goodhue, York,

of the colon

to occur infrequently

and

John

N. Schullinger

N.Y. containing

in the cecum

all layers of the bowel

and ascending

colon

where

*all

is un-

it may pro-

duce symptoms of acute diverticulitis.‘W4 An 8-yr-old boy was recently admitted for excision of a large diverticulum of the sigmoid colon associated with chronic constipation, recurrent fecal impaction, and enuresis. At I day ot age he had undergone repair of a right diaphragmatic hernia and had done well until 4 yr later when he presented with chronic constipation. a firm suprapubic mass. and a left inguinal hernia. After disimpaction, a barium enema demonstrated a pouch-like dilatation of the anterior border of the lower sigmoid colon (Fig. I). Proctoscopy to I5 cm revealed normal mucosa. and biopsy showed normal ganglion cells. The inguinal hernia was repaired, and although it was felt that excision of the diverticulum was advisable, it was not until the child was 8 yr old that the parents agreed to operation. During the interim 4-yr period the patient required daily mlneral oil and cathartics to avoid recurrent fecal impactions. At laparotomy a 6.5 x 3.5-cm pale, thick-wailed diverticulum was found projecting from the

Fig. lateral verticu

Journal

1.

Roentgenogram view

of

show ring

barium-filled

di-

Ilum.

of Pediatric

Surgery,

Vol.

10. No.

4 (August),

1975

CASE REPORTS

Fig. 2. Operative photograph of sigmoid diverfi

antimesenteric border of the sigmoid colon between two normal taeniae and communicating widely with the gut lumen (Fig. 2). The wall of the proximal sigmoid colon appeared hypertrophied. The diverticulum was excised and the colon closed longitudinally in two layers without compromising the lumen. Pathologic examination of the specimen showed a tan. flattened mucosa with scattered petechial hemorrhages and focal punctate ulcerations. Microscopic sections revealed thickened, but normal, colonic mucosa without heterotopic tissue. Histiocytes laden with brown pigment granules were present in the lamina propria. a finding which has been reported in association with motility disturbances and obstruction of the colon.5 The muscular wall was abnormal with two prominent muscularis mucosa layers, dense collagen bundles in the submucosa enmeshing sparsely distributed ganglion cells, and a bizarre muscularis externa with up to nine muscle layers oriented in various directions (Fig. 3a. 3b). The patient had an uneventful postoperative recovery and is now having daily bowel movements. The enuresis persists unchanged.

pp 696-699 2. Gray SW, Skandalakis JE: Embryology for Surgeons. Philadelphia. Saunders, 1972, pp 192-193, I71 -172 3. Storer

EH, Lockwood

RA: In Schwartz

SI

4. Martins AG: Solitary diverticulum of the colon in childhood. Am J Dis Child 101:238, 1961 5. Yunis E. Sherman FA: Macrophages in the rectal lamina propria of children. Am J Clin Pathol 53:580, 1970

Fig. 3.

ticulum

tinctorial

(A)

wall

showing

thickened

of lipofuscin,

Photomicrograph

properties

colonic

within

an

sparsely

distributed

unremarkable

of diverticulum

otherwise

surface

rnucosa,

of luminal

cells (arrows),

and

bizarre

granular

of

pigment

(arrows), x 38.

full-thickness musculature.

Photomicrograph of underlying

(B)

containing 94. morphology

x

of histiocytes acid-Schiff.

nests Periodic

numerous

propria.

showing lamina

ganglion

wall

diver-

having