A Case Report of Rectal Diverticulosis with Severe Rectal Stenosis

Tetsuo Ishikawa, Kouichi Ohishi, Takafumi Ohshiro, Mari Kimura, Takayuki Kadoya, Toshiyuki Itamoto, Issei Tanaka, Taiji Yamamoto, Hisashi Ohshiro

The First Department of Surgery, Hiroshima Prefectural Hospital

We report a case of rectal diverticulosis accompanied by severe rectal stenosis. A 65-year-old male patient complained of a sensation of abdominal fullness. Upon proctoscopic examination, a tumorous lesion and severe stenosis were recognized in the rectum. Although pathological examination of the tissue biopsy specimen showed no malignancy, the condition of this lesion was recognized as being consistent with a rectal carcinoma. Thus abdominoperineal resection of the rectum (Miles' operation) was performed. The elastic hard tumor was approximately 8 cm in length, producing remarkable stenosis and extensive attachment to other pelvic structures. Pathological examination of the specimen revealed acute and chronic diverticulitis of the rectum with no malignancy. The post-operative course was uneventful and the patient was discharged 24 days after the operation. Compared to other forms of colonic diverticulosis, there are few reports in the literature regarding rectal involvement and only 15 cases, including our case, with pertinent clinical symptoms have been reported in Japan. Among these 15, 9 cases underwent relatively aggressive surgical treatment against the rectal lesions, as follows: 3 cases of Miles' operation, 3 of single barrelled colostomy (Hartmann's operation), 1 of low anterior resection, 1 using the pull-through method and 1 of total pelvic exenteration. Concerning rectal diverticulosis, accurate preoperative diagnosis may be difficult when an inflammatory mass in the lower pelvic cavity and severe rectal stenosis have developed, especially in the terms of the differential diagnosis from rectal carcinoma.

Key words
rectal diverticulosis, rectal stenosis, abdominoperineal resection

Reprint requests
Tetsuo Ishikawa Department of Surgery, Matsuyama Red Cross Hospital
1 Bunkyou-Machi, Matsuyama, 790 JAPAN

Accepted
February 12, 1997

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