diverticulosis of the colon is a common clinical entity that occurs in 3035% of the general population , especially in people older than 60 years . the disease is usually limited to the sigmoid colon , with less than 1 to 2 cm in diameter . giant sigmoid diverticula ; in fact , only 113 cases of giant colonic diverticula have been reported in the literature 1 . management of the condition is various ( ranging from conservative treatment to resection ) but recommended because of a high rate of complications . we report the case of a patient seen at our institution for giant sigmoid diverticulum who underwent left hemicolectomy . a 76-year - old man presented with a 1-month history of left lower abdominal pain of increasing intensity associated with alternating diarrhea and constipation and hypocolic stools ; the patient also reported asthenia and tiredness . physical examination was normal , showing no signs of peritonitis or palpable mass , except for a mild abdominal tenderness in the left lower quadrant . blood tests were normal apart from a hypochromic anemia ( hemoglobin 10 g / dl ) and the already diagnosed monoclonal gammopathy . coloscopy showed a weakness in the colon wall through which a 10  10 cm cavity came out on the right side of the midsigmoid colon that was covered with mucus - purulent tissue . there was also evidence of diverticular disease throughout the left colon . in order to exclude perforation , gastrografin enema was performed which showed a 10  11 cm sac arising from the middle portion of the sigmoid colon and confirmed diverticular disease , but no evidence of intraperitoneal soiling ( fig . the patient underwent surgical treatment through a xifo - pubic median laparotomic access . a giant diverticulum developed from the antimesenteric side of the sigmoid colon and adherent to the upper wall of the proximal jejunum and to the transverse mesocolon . because of the presence of diverticular disease in the left colon , we performed a left hemicolectomy with an end - to - end colorectal anastomosis . histology showed chronic inflammatory disease of the entire wall of the diverticulum , with ulcers and white cells , predominantly neutrophils . giant colonic diverticulum is a rare condition related to diverticular disease ; the first literature description by bovin and bonte dates back to 1946 , while the first radiological diagnosis had been reported in 1953 by hughes and greene [ 2 , 3 ] . colonic diverticulum is a pseudodiverticulum because it is an outpouching of mucosa and submucosa of the bowel wall usually situated in the sigmoid colon ( 95% of cases ) 5 . type 1 ( pseudodiverticulum ) arises gradually , without perforation , and its wall consists of chronic granulation tissue [ 7 , 8 ] . type 2 ( inflammatory diverticulum ) is secondary to a perforation of the mucosa and submucosa which leads to a walled - off abscess cavity that communicates with lumen , allowing diverticulum to enlarge . type 3 ( true diverticulum ) consists of all 4 layers of the bowel wall . choong and frizelle suggest a new classification based on the histology of disease , and divide colonic diverticula into 2 types . type 1 is a pseudodiverticulum whose wall consists of fibrous tissue without the presence of a muscle layer ( 87% ) , and it is related to diverticular disease . diverticula incidence occurs in patients aged 3290 years , with a maximum incidence in subjects over 70 years . common symptoms include vague abdominal pain   and abdominal mass   ( 71% ) ; some patients present with diarrhea , constipation , fever , nausea and vomiting or rectal bleeding [ 14 , 15 ] . complications of giant sigmoid diverticulum ( 1535% ) are peritonitis , secondary to perforation , or abscess and volvulus . our case , as shown by histological findings , is a giant pseudodiverticulum ( type 1 , according to choong and frizelle ) . the patient presented with abdominal pain , alternating diarrhea , constipation and asthenia , specific symptoms which could also be related to a colonic neoplasm . instrumental investigations , such as gastrografin enema and coloscopy , have contributed to the differentiation of diverticular disease from neoplastic process . the aim of treatment is to alleviate symptoms and prevent complications , so surgical procedure is the most common performed treatment . hemicolectomy should be performed when we find a type 1 choong diverticula because it reduces the recurrences and the most common diverticular complications . type 2 treatment could be diverticulectomy , because the condition is congenital and usually consists of a single lesion . however , it must be considered that maximum incidence of this disease is in patients 4050 years old , so it might possibly be an associated diverticular disease , and during surgery , congenital type and type 1 diverticula are not easy to differentiate . we performed a left hemicolectomy that allowed us to prevent diverticular disease complications and to reduce the risk of recurrence of diverticula . our patient underwent a laparotomic access because of the presence of adherences to the upper wall of the proximal jejunum and the transverse mesocolon , and because of his history of heart disease . giant sigmoid diverticulum is a rare complication of sigmoid diverticulosis with high risk of complications and a variable clinical presentation . the gold standard treatment is surgery , based on symptoms , presence of complications and concomitant diverticular disease . it consists of excision of the giant diverticulum with segmental resection of adjoining colon and primary anastomosis whenever possible .
although colonic diverticulum is a common disease , affecting about 35% of patients above the age of 60 , giant sigmoid diverticulum is an uncommon variant of which only relatively few cases have been described in the literature . 
 we report on our experience with a patient affected by giant sigmoid diverticulum who was treated with diverticulectomy . 
 resection of the diverticulum is a safe surgical procedure , provided that the colon section close to the lesion presents no sign of flogosis or diverticula ; in addition , recurrences are not reported after 6-year follow - up .