Introduction: Diverticulosis leads to the formation of small outpouchings in the colon wall due to herniation of the mucosa and submucosa through weakness defects in the muscle layer. It can occur throughout the colon but is most common in the sigmoid. It is multifactorial and due to age, genetics, low dietary intake of fiber, intestinal motility, and structural changes. When chronic and symptomatic it becomes a diverticular disease. Only with mucosal irritation and inflammation diverticulitis occurs. Around 10-25% of individuals with diverticulosis develop diverticulitis, which can lead to abscess, perforation, fistula formation, obstruction, and sepsis. We present the case of a 75-year-old woman with acute complicated diverticulitis leading to rare left-sided hydronephrosis (LSH).
Case Description/Methods: A 75-year-old female with a history of diverticulosis and irritable bowel disease presented with severe left sided lower back pain with radiation to the flank, nausea, and emesis. CT revealed inflammatory changes at the sigmoid colon and new LSH absent on prior imaging. She was treated with IV antibiotics but, two weeks later, she presented with abdominal pain and CT findings of mass-like circumferential thickening of the sigmoid colon resulting in a high-grade distal colonic obstruction and persistent moderate LSH. She underwent laparotomy with sigmoid resection and temporary diverting loop ileostomy. Final pathology revealed complicated perforated diverticulitis without malignancy. Three months after her initial hospitalization, renal ultrasound revealed decreased hydronephrosis.
Discussion: Diverticulitis is the inflammation of diverticula with acute or chronic complications. It is complicated when CT finds abscess, peritonitis, obstruction, fistulas, and hemorrhage. Hydronephrosis is a rare type of complication and is due to the proximity of the left ureter to the sigmoid colon. A study in 1980 revealed that 5% of the patients hospitalized for diverticulitis had hydroureteronephrosis. Overall, however, the literature only details a few cases of LSH. In 2022, a male with diverticulitis was found to have a peri sigmoid abscess complicated by LSH, and in 2019 a female developed LSH secondary to segmental colitis associated with diverticulosis, a rare inflammatory condition affecting segments of the large bowel with diverticular disease. All required extensive colonic resection, which may indicate a correlation with LSH and disease severity.
Figure: Figure 1: (A) Masslike circumferential thickening of the sigmoid colon resulting in a high-grade distal colonic obstruction. (B) Moderate left-sided hydronephrosis.
Disclosures:
Jessica Sosio indicated no relevant financial relationships.
Aladdin Dahbour indicated no relevant financial relationships.
Oluwagbenga Serrano indicated no relevant financial relationships.
Jessica Sosio, DO1, Aladdin Dahbour, MD1, Oluwagbenga Serrano, FACG2. P0315 - Acute Diverticulitis Complicated by Left-Sided Hydronephrosis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
