title: A gas-filled abdominal cyst in an elderly woman: A giant colonic diverticulum case report.
abstract: BACKGROUND
  Giant colonic diverticulum (GCD), a rare complication of the diverticular disease, can present with a wide range of nonspecific symptoms as abdominal pain and bowel obstruction. Its diagnosis represents a challenge that mainly depends on imaging findings.
  
  
  METHODS
  We report the case of a 79 year-old female patient that came to our emergency department complaining of 5-day history of hypogastric pain and constipation. Physical examination reveled a 15cm hypogastric round, tender and tympanic mass. Enhanced abdominal CT scan showed a large air-filled cyst adjacent to a diverticular sigmoid colon without evidence of intra-abdominal free air or fluid. Based on the radiological features, GCD was suspected and surgical treatment performed. The mass and the sigmoid colon were resected. The postoperative course was uneventful. Histopathology confirmed the preoperative diagnosis.
  
  
  CONCLUSIONS
  GCD, defined as a diverticulum larger than 4cm, represents a rare complication of the diverticular disease. Usually abdominal X-ray and computed tomography (CT) scan show a gas-filled structure, sometimes communicating with the adjacent colon. GCD resection and segmental colectomy are strongly recommended even in asymptomatic cases due to the high incidence and severity of complications.
  
  
  CONCLUSIONS
  Because of its rarity and variable and non-specific clinical presentation, the diagnosis of GCD depends mainly on imaging findings. The gold standard treatment is surgical resection of the GCD and the compromised colon with primary anastomosis when possible.
authors.affiliation: Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy. Electronic address: acdelpozo@gmail.com.
authors.forename: Ana Carolina
authors.initials: AC
authors.lastname: Del Pozo
authors.affiliation: Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bartolotta
authors.affiliation: Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy.
authors.forename: Sante
authors.initials: S
authors.lastname: Capitano
authors.affiliation: Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy.
authors.forename: Matteo De
authors.initials: MD
authors.lastname: Fusco
authors.affiliation: Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Chiodi
authors.affiliation: Department of General Surgery, Italian National Institute of Research and Ageing, Via della Montagnola, 81. Ancona, 60100, AN, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Boccoli
keywords: Air-filled cyst; Colonic diverticular disease; Giant colonic diverticulum; Giant sigmoid diverticulum