The Open Colorectal Cancer Journal, 2012, 5, 5-8 5 1876-8202/12 2012 Bentham Open Open Access Case Report: Unusual Presentation of Complicated Diverticulitis at Colostomy Site Sami Al-Asari* and Nam Kyu Kim Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu 120-752, Seoul, South Korea Abstract: we report a case of a 75 years old male diagnosed on 2006 with a low rectal cancer and operated with an ab- dominoperineal resection procedure at that time. Since then, he was doing fine with his end colostomy until 29/07/2011, when he was presented with stoma site redness, pain, tenderness and fever with loose stool; the CT scan showed a distal colon and stoma diverticulitis and abscess lateral to stoma; the patient was managed with drainage, soft diet and antibiotic till it resolved and he was discharged home in a healthy condition. Keywords: Diverticulitis, stoma, Colostomy site , CT scan. INTRODUCTION AND OVERVIEW The term diverticular disease refers to a spectrum of clinical presentations associated with the presence of diver- ticulae, or outpouchings on the colon [1]. A colonic diverticulum is a false diverticulum because it does not contain all layers of the wall [2]. The incidence of diverticulosis increases with age [1,3]. In Western countries, it is estimated to be present in ap- proximately 30% of people of age 60 and 60% of people older than age 80 [1]. It also increases with the patient who is on NSAID [3-5], low fiber diet [3,6,7], smoking [3,8] , opiates [3,9,10], alcohol [11,12] and immunocompromized [3,13]. Diverticulae most often arise in the sigmoid colon but may also be seen in all colonic segments [1,2]. The primary process is thought to be the erosion of the diverticular wall by increased intraluminal pressure or inspissated food parti- cles [1,2]. Diverticulitis refers to the presence of inflammation or infection around a colonic diverticulum. The inflammation is frequently mild, and a small perforation is walled off by pericolic fat and mesentery [2]. This may lead to a localized abscess or, if adjacent organs are involved, a fistula or ob- struction 2 in comparison to the poor containment results in free perforation and peritonitis [2]. CLINICAL CHARACTERISTICS The vast majority of patients with diverticulosis are as- ymptomatic [1,3]. When symptomatic, 10% to 30% may eventually develop a complication warranting surgical inter- vention [1]. Overall, approximately 1% of all patients with diverticular disease require surgical intervention [1]. *Address correspondence to this author at the Department of Surgery, Yon- sei University College of Medicine, 50 Yonsei-ro Seodaemun-gu 120-752, Seoul, South Korea; Tel: +966503284959; Fax: +82-2-313-8289; E-mail: sss_allah@hotmail.com INDICATIONS FOR SURGERY Emergency surgery is indicated in patients exhibiting signs of diffuse peritonitis, and deterioration/failure to im- prove with conservative therapy. Absolute [1, 2] - Perforation - Obstruction - Abscess (in patients with contraindications to surgery, percutaneous drainage may be adequate to relieve symptoms) - Fistula - Clinical deterioration or failure to improve with medical therapy - Recurrent episodes - Intractable symptoms - Inability to exclude carcinoma Relative [1,2] - Symptomatic stricture - immunosupression - Right sided diverticulitis - Young patients The most recent controversies revolve around the indications for surgery in cases of uncomplicated and complicated diver- ticulitis (Table 1) [14]. COMPLICATION OF THE DIVERTICULITIS Hinchey Classification1978 [14] Stage I- pericolic or mesenteric abscess Stage II-walled off pelvic abscess Stage III-generalized purulent peritonitis Stage IV-generalized fecal peritonitis