P3746 - A Case of a Giant Colonic Diverticulum in Patient With End Stage Renal Disease Planned for Kidney Transplantation

Hyder Alikhan, BA¹, Peter J. Bross, MD², Krysta Contino, MD^3
1Cooper Medical School of Rowan University, Camden, NJ; ²Cooper Health Gastroenterology, Camden, NJ; ³Digestive Health Institute at Cooper University Hospital, Mount Laurel, NJ

Introduction: Giant colonic diverticulum (GCD) is a rare form of diverticulosis with unclear etiology, which may present on CT scan and further evaluated with colonoscopy. We present a unique case where a patient with end-stage renal disease (ESRD) with planned kidney transplantation presented with persistent colonic ulceration and was found to have a giant, ulcerated sigmoid diverticulum.

Case Description/Methods: A 65-year-old male with past medical history of ESRD on peritoneal dialysis, coronary artery disease with coronary artery bypass graft, peripheral arterial disease, diverticulosis and prior episode of diverticulitis who presents with persistent diarrhea in the setting of known colonic ulceration. Prior endoscopic evaluations had been performed, showing moderate diverticulosis and evidence of colitis with sigmoid colon ulceration. Biopsies revealed inflamed granulation tissue but no clear etiology. CT angiogram showed moderate inferior mesenteric artery stenosis and diverticulosis with enlarging giant diverticulum (5.8 x 5.5 cm) in sigmoid colon. Prior to renal transplantation, repeat colonoscopy was performed due to ongoing diarrhea that confirmed the GCD with ulceration in sigmoid colon (Figure 1). Colorectal surgery was consulted for potential resection before renal transplant; however, surgical intervention was not recommended prior to transplant due to underlying vascular disease with poor healing potential. He underwent successful living donor renal transplantation and is doing well post-operatively on immunosuppression regimen but will require close monitoring.

Discussion: GCD is usually present in the sigmoid colon and is typically identified on cross-sectional imaging measuring > 4 cm. The mainstay of management involves surgical resection. This case is unique because GCDs have been reported as cases in the literature; however, there is minimal information about GCD in a patient with planned kidney transplant with persistent colonic ulceration. The persistent ulceration posed a risk of perforation during transplant due to thin-walled GCD; however, colectomy was not advised due to surgical risk. Also, there is literature that suggests that patients on immunosuppression have increased risk of diverticular complications. After weighing all options, the GCD remained, and the patient underwent a living donor renal allograft transplant with post-transplant immunosuppression therapy. This case adds to the growing literature on GCDs and has the nuanced approach to management in a patient with GCD.



Disclosures:


Hyder Alikhan, BA¹, Peter J. Bross, MD², Krysta Contino, MD³. P3746 - A Case of a Giant Colonic Diverticulum in Patient With End Stage Renal Disease Planned for Kidney Transplantation, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.