INTRODUCTION: Giant colonic diverticulum (GCD), defined as a diverticulum >4 cm, is a rare manifestation of diverticular disease with less than 200 reported case reports. CT imaging is the preferred imaging modality to identify and confirm the presence of a GCD, which provides an accurate depiction of the size, location, and contents of the diverticulum GCD can present with nonspecific abdominal symptoms, abdominal pain, bloody stools, or an enlarging mass. Given the risk of serious complications, including diverticulitis, bowel obstruction, and perforation, early recognition and management are essential to prevent further complications. Surgical management with diverticulectomy or partial colectomy is the first-line management for definitive management of GCD.
CASE PRESENTATION: A 57-year-old male presented with an enlarging abdominal mass and was found to have a 10 cm giant colonic diverticulum in the sigmoid colon. The patient was successfully managed with an open partial colectomy and primary colonic anastomosis.
LEARNING POINTS: Giant colonic diverticula remain a rare but clinically significant presentation of diverticulosis. While laparoscopic or robotic technique is often preferred, there is a concern of increased risk of bowel perforation with instrument manipulation. Open partial colectomy is a reasonable alternative for patients with high risk of diverticular rupture to prevent intraoperative complications while offering definitive management of GCD.