Korean J Gastroenterol.  2010 Mar;55(3):189-193. 10.4166/kjg.2010.55.3.189.

A Case of Segmental Colitis Associated with Diverticular Disease

• Ahn SB
• Han DS
• Park HS
• Kim TY
• Eun CS
• Jeon YC
• Sohn JH

• KMID: 1775901
• DOI: http://doi.org/10.4166/kjg.2010.55.3.189

Abstract

Segmental colitis associated with diverticular disease (SCAD) is a colonic inflammatory disorder with localized non-granulomatous inflammation at sigmoid colon, and associated with colonic diverticulosis. SCAD is an apparently uncommon disorder in Western. We experienced a rare case of SCAD in a 46-year-old woman who visited the hospital due to abdominal discomfort. Colonoscopic examination showed multiple sigmoid diverticula in association with a segment length colitis. Colonoscopic biopsies of the sigmoid colon demonstrated cryptitis and crypt abscess along with chronic inflammatory cells infiltration. The biopsies of the rectum was histologically normal. The patient was given the diagnosis of SCAD and treated with oral mesalamine. This is the first case of SCAD reported in Korea.

Keyword

Segmental colitis; Diverticular disease; SCAD

MeSH Terms

Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
Colitis/complications/*diagnosis/drug therapy
Colon, Sigmoid/pathology
Colonoscopy
Diverticulitis, Colonic/complications/*diagnosis/drug therapy
Female
Humans
Mesalamine/therapeutic use
Middle Aged

Figure

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  Fig. 1. Colonoscopic findings. It showed disappearance of the vascular reticulum associated with edema, erythema, and friability in 5- cm segment of sigmoid colon. Di-verticuli were seen in the region of segment colitis (A, B, C). Rectal mucosa was spared (D) (arrow: di-verticuli).

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  Fig. 2. Histologic findings of endoscopic biopsy specimen of sigmoid colon. It showed scattered mononuclear cell, neutophils, and acute cyptitis with crypt abscess formation (A: H&E, ×200, B: H&E, ×400).

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  Fig. 3. Follow-up colonoscopic findings. (A) Mild erythema of diverticular opening in the cecum (arrow). (B, C) The disappearance of the vascular reticulum associated with edema, erythema, and friability in 5-cm segment of sigmoid colon. (D) Rectal mucosa was spared.

Reference

1. Imperiali G, Meucci G, Alvisi C, et al. Segmental colitis associated with diverticula: a prospective study. Gruppo di Studio per le Malattie Infiammatorie Intestinali (GSMII). Am J Gastroenterol. 2000; 95:1014–1016.

2. Freeman HJ. Natural history and longterm clinical behavior of segmental colitis associated with diverticulosis (SCAD syndrome). Dig Dis Sci. 2008; 53:2452–2457.

3. Schmidt GT, Lennard-Jones JE, Morson BC, Young AC. Crohn's disease of the colon and its distinction from diverticulitis. Gut. 1968; 9:7–16.

4. Schmidt G. Crohn's disease of the colon and diverticulitis. Med J Aust. 1969; 2:1253–1258.

5. Marshak RH, Janowitz HD, Present DH. Granulomatous colitis in association with diverticula. N Engl J Med. 1970; 283:1080–1084.

6. Makapugay LM, Dean PJ. Diverticular disease-associated chronic colitis. Am J Surg Pathol. 1996; 20:94–102.

7. Goldstein NS, Leon-Armin C, Mani A. Crohn's colitis-like changes in sigmoid diverticulitis specimens is usually an idio-syncratic inflammatory response to the diverticulosis rather than Crohn's colitis. Am J Surg Pathol. 2000; 24:668–675.

8. Burroughs SH, Bowrey DJ, Morris-Stiff GJ, Williams GT. Granulomatous inflammation in sigmoid diverticulitis: two disease or one? Histopathology. 1998; 33:349–353.

9. Gledhill A, Dixon MF. Crohn's-like reaction in diverticular disease. Gut. 1998; 42:392–395.

10. Pereira MC. Diverticular disease-asscociated colitis: progression to severe chronic ulcerative colitis after sigmoid surgery. Gastrointest Endosc. 1998; 48:520–523.

11. Lapidus A, Bernell O, Hellers G, Lö fberg R. Clinical course of colorectal Crohn's disease: a 35-year follow-up study of 507 patients. Gastroenterology. 1998; 114:1151–1160.

12. Berman IR, Coran ML, Coller JA, Veidenheimer MC. Late onset Crohn's disease in patients with colonic diverticulitis. Dis Colon Rectum. 1979; 22:524–529.

13. McCue J, Coppen MJ, Rasbridge SA, Lock MR. Coexistent Crohn's disease and sigmoid diverticulosis. Postgrad Med J. 1989; 65:636–639.

14. Peppercorn MA. Drug-responsive chronic segmental colitis associated with diverticula: a clinical syndrome in the elderly. Am J Gastroenterol. 1992; 87:609–612.

15. Sladen GE, Filipe MI. Is segmental colitis a complication of diverticular disease? Dis Colon Rectum. 1984; 27:513–514.

16. Shepard NA. Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades. Gut. 1996; 38:801–802.

17. Ludeman L, Shepherd NA. What is diverticular colitis? Pathology. 2002; 34:568–572.