P2723 - Severe Ulcerative Colitis-Like Pattern of Segmental Colitis With Diverticulosis Complicated With a Colo-Umbilical Fistula: Case Report

Luis M. Nieto, MD, Miguel A. Jara-Palacios, MD, M.D Sharma, MD, M.D L. Traub, MD
Wellstar Atlanta Medical Center, Atlanta, GA

Introduction: Colonic diverticulosis is a common disease in the Western region, being a more frequent finding in older populations but also reported in young patients. The inflammatory presentation of colonic diverticulosis is mainly classified in diverticulitis and segmental colitis associated with diverticulosis (SCAD). Patients with diverticular disease can develop SCAD, mostly in the sigmoid colon without involvement of rectum and right colon, presenting with chronic diarrhea and abdominal pain, endoscopically and histologically can mimic inflammatory bowel disease (IBD) presentations.

Case Description/Methods: A 49-year-old African American male with a history of chronic diverticulosis and recurrent episodes of diverticulitis, uncontrolled type 2 DM, uncontrolled HTN, bipolar disorder, and opioid use for chronic back pain presented to the Emergency Department (ED) with two days of abdominal pain and feculent discharge from the umbilicus. CT abdomen with IV and oral contrast showed a sinus track extending from the sigmoid colon to the umbilicus and intestinal inflammatory evaluation showed markedly elevated calprotectin levels (2,370 mcg/g [< 50]). IBD SGI diagnostic test showed results consistent with Crohn’s disease. Colonoscopy showed normal rectum mucosa and area of strictures with friable-appearing mucosa at the level of sigmoid colon preventing the passage of the colonoscope. The patient eventually required colostomy creation and colo-cutaneous fistulectomy with the goal to restore oral feeding and improve nutritional status. Biopsy showed mixed inflammation, presence of Paneth cell metaplasia, crypt distortion and cryptitis extending through the fistulous tract, per pathology, results consistent with ulcerative colitis. Eight weeks after surgery, follow-up flexible sigmoidoscopy and endoscopy through the colonostomy, showed some areas with mild erythema at the level of rectum and completely normal endoscopic appearance in the distal ileum, cecum, right and transverse colon. Random biopsies in the rectum showed mild nonspecific chronic inflammation.

Discussion: Patients with diverticular disease can develop SCAD during the natural course of the disease after several episodes of uncomplicated diverticulitis. When patients present with florid inflammatory changes can mimic IBD cases especially if develop complications such as bowel obstruction or fistula formation. Pathology reports can make its diagnosis challenging but the clinician should consider this rare colonic diverticulosis presentation.



Disclosures:


Luis M. Nieto, MD, Miguel A. Jara-Palacios, MD, M.D Sharma, MD, M.D L. Traub, MD. P2723 - Severe Ulcerative Colitis-Like Pattern of Segmental Colitis With Diverticulosis Complicated With a Colo-Umbilical Fistula: Case Report, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.