Left Hydronephrosis Complicated with Sigmoid Colon Diverticulitis

Hideki Sasanuma, Masanobu Hyodo, Takashi Ui, Chuji Sekiguchi and Norio Hirota*

Department of Surgery, Nasu-Minami Hospital
Hirota Institute for Surgical Pathology*

We report a rare case of left hydronephrosis secondary to sigmoid colon diverticulitis. A 70-year-old man was admitted with left lower abdominal pain, fever, appetite loss, and a palpable mass in the left iliac fossa. Hematological examination revealed anemia and an inflammatory reaction. A gastrographin contrast enema showed colonic stenosis, approximately 12 cm long, extending from the sigmoid colon to the rectum. Abdominal CT and US revealed left hydronephrosis and colonic wall thickening, with some diverticula and lymph node swelling. Colonic endoscopy showed a reddish stenotic colon and irregularities, but there no cancer cells in the biopsy tissues. Based on these findings, we conducted a surgical exploration with a preoperative diagnosis of acute diverticulitis or diffusely infiltrating carcinoma of the colon, then performed low anterior resection with ileostomy preserving the left ureter, which was involved by the inflamed tissue. Histopathologically, the resected specimen showed multiple diverticula with marked inflammation, but no evidence of malignancy. An abdominal CT scan performed 3 months after surgery showed less dilatation of the left ureter. Although hydronephrosis secondary to ureteral occlusion is usually associated with malignancy, other rare possibilities, including colonic diverticulitis, as reported in the case, must also be considered.

Key words
sigmoid diverticulitis, hydronephrosis, carcinoma

Reprint requests
Hideki Sasanuma Department of Surgery, Nasu-Minami Hospital
3-2-13 Chuo, Karasuyama-machi, Nasu-gun, 321-0621 JAPAN

Accepted
June 22, 2005

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