Acute perforated transverse colon diverticulitis simulating acute cholecystitis: case report and literature review

Alberto Manuel Gonzalez Chavez, Alain Garcia Vazquez, Diego Abelardo Alvarez Hernandez, Mario Andres Gonzalez Chavez, Ricardo Ray Huacuja Blanco, Jose Miguel Ramos Delgado


Transverse colon diverticulitis is a rare entity, described for the first time in 1944 by Thompson and Fox. Even more uncommon if presented with diverticular perforation of the colon. When ranking diverticula distribution by their anatomical location site, it has been set up that transverse colon is involved in an average of 10% of the cases, but diverticulitis or inflammation of these sacculations in this anatomical region only occurs in 0.5-2.5% of the cases. Female, 44 years old, who came to emergency room with acute abdominal pain as colic of 24 hours of evolution, Acute cholecystitis was considered as a first diagnostic possibility. Pain persistence and peritoneal irritation lead to an abdominal contrasted tomography (contrast IV). Oval formations protruding from the gut lumen in ascending and transverse colon were found, corresponding to diverticula. Patient was admitted in hospital and maintained in fasting period and with a double antibiotic scheme she was discharged on the 5th day of hospital stay. Transverse colon diverticulitis is a rare entity, there exist less than 50 cases reported in worldwide literature but it has been determined that patients with transverse colon diverticulitis are 15 and 20 years younger than patients with left colon diverticulitis. That is, average age of manifestation is about 45 years old. 85% of the cases have been described in women. Reports managed it successfully with antibiotics. The present report could be achieved favourably with a double antibiotic scheme, with no need of surgery.


Abdominal pain, Diverticulitis, Diverticular disease, Transverse colon diverticulitis

Full Text:



Rezapour M, Ali S, Stollman N. Diverticular disease: an update of pathogenesis and management. Gut Liver. 2017;11(3):1-8.

Mosadeghi S, Bhuket T, Stollman N. Diverticular disease: evolving concepts in classification, presentation, and management. Curr Opin Gastroenterol. 2015;31(1):50-5.

Peery AF, Sandler RS. Diverticular disease: reconsidering conventional wisdom. Clin Gastroenterol Hepatol. 2013;11:1532-7.

Wagner DE, Zollinger RW. Diverticulitis of the cecum and ascending colon. Arch Surg. 1961;83(3):436-43.

Martel J, Baskin JB. History, Incidence, and Epidemiology of Diverticulosis. J Clin Gastroenterol. 2008;42(10):1125-7.

Jun S, Stollman N. Epidemiology of diverticular disease. Best Practice Res Clin Gastroenterol. 2002;16(4):529-42.

Stollman N, Ranskin JB. Diverticular disease of the colon. Lancet. 2004;363(9402):631-9.

Golder M, Ster IC, Babu P, Sharma A, Bayat M, Farah A. Demographic determinants of risk, colon distribution and density scores of diverticular diseases. World J Gastroenterol. 2011;17(8):1009-17.

Thompson GF, Fox PF. Perforated Solitary diverticulum of the transverse colon. Am J Surg. 1944;66(2):280-3.

Lai WL, Liu CL, Chan WF, Ho JWC. Perforated Diverticulitis of the transverse colon. Eur J Surg. 2000;166(7):579-80.

McClure ET, Welch JP. Acute diverticulitis of the transverse colon with perforation. Report of three cases and review of the literature. Arch Surg. 1979;114(9):1068-71.

Wilkinson TRV, Wilkinson AR. Perforated diverticulum of the transverse colon. Saudi J Gastroenterol. 2007;13(4):194-6.

Shperber Y, Halevy A, Oland J, Orda R. Perforated diverticulitis of the transverse colon. Dis Colon Rectum. 1986;29(7):466-8.

El-Batrawy TM, Al Ashari M, Abu-Zidan FM. Perforated solitary diverticulitis of the transverse colon in a young woman." Edited by April. ANZ J Surg. 2015. Accessed 08 16, 2017. Available at

Sibileau E, Boulay-Coletta I, Jullès MC, Benadjaoud S, Oberlin O, Zins M. Appendicitis and diverticulitis of the colon: trap forms. J Diagnostic Interventional Radiol. 2013;94(7-8):781-802.

Solak A, Solak I, Genç B, Sahin N, Yalaz S. Transverse colon diverticulitis with calcified fecalith. Euroasian J Med 2013;45(1):68-70.

Jasper DR, Weinstock LB, Balfe DM, Heiken J, Lyss CA, Silvermintz SD. Transverse colon diverticulitis: successful nonoperative management in four patients. Dis Colon Rectum. 1999;42(7):955-8.