We report about a previously healthy 72 year-old woman, presented with 6 days of left lower quadrant abdominal pain and constipation. There was no report of fever, melena, hematochezia or change in appetite. The physical exam demonstrated a distended abdomen with palpable left lower quadrant pain, without guarding. CT showed images compatible with a sigmoid diverticulitis and a calcification of the sigmoid colon. After antibiotic threatment, a colonoscopy was performed which revealed the presence of a shell in the sigmoid colon. Our case illustrates the need for a colonoscopy following an attack of diverticulitis to look for a cancer or rarely a foreign body.
A previously healthy 72-year-old woman presented with 6 days of left lower quadrant abdominal pain and constipation. There were no report of fever, melena, hematochezia or change in appetite. The physical exam demonstrated a distended abdomen with palpable left lower quadrant pain, without guarding. The blood work revealed a normal white blood cell count but an increased C-reactive protein (110 mg/L).
CT showed images compatible with a sigmoid diverticulitis and a calcification of the sigmoid colon (Figure
The patient was treated with IV antibiotics (Ceftriaxone 2 g daily and Metronidazole 500 mg three times daily), with an adequate resolution of her signs and symptoms.
A colonoscopy performed one week later revealed the presence of a shell in the sigmoid colon (at 25 cm from the anus), which was extracted without complication (Figures
Diverticulosis is a common illness in developed countries where it is present in 50% of people over the age of 60. The sigmoid colon is the most commonly affected. Approximately 10% of patients, who present with diverticulosis, will develop diverticulitis, usually caused by a fecalith.
The literature reports a few cases of diverticulitis caused by the presence of a foreign body (generally chicken or fish bones) [
Our case illustrates the need for a colonoscopy following an attack of diverticulitis to look for a cancer or rarely a foreign body. The patient left hospital after completing antibiotic treatment without complication. She remained asymptomatic three months after discharge.