Ahmad Najdat Bazarbashi, MD1, Thomas R. McCarty, MD2, Lolwa Al-Obaid, MD3, Daria Homenko, MD4
1Brigham and Women's Hospital, Somerville, MA; 2Brigham and Women's Hospital, Boston, MA; 3Lahey Hospital and Medical Center, Burlington, MA; 4Brigham and Women's Faulkner Hospital, Boston, MA
Introduction: Segmental Colitis Associated with Diverticulosis (SCAD) is a rare inflammatory condition affecting segments of bowel with diverticulosis. We present a case of a patient with imaging revealing left colonic wall thickening and left sided hydroureteronephrosis, and work-up confirming a diagnosis of SCAD.
Case Description/Methods: An 85-year-old female with a history of cognitive impairment, uterine cancer status post hysterectomy, and previous episode of diverticulitis 5 years prior presented to our institution with fevers, chills, and flank pain.
Symptoms began 3 days prior to presentation with no associated abdominal pain, nausea, vomiting, hematochezia, or changes to her bowel movements. Upon arrival, her vital signs were within normal limits and physical exam disclosed left flank tenderness. Laboratory data revealed leukocytosis to 17 K/uL with unremarkable hematocrit, basic metabolic panel, and liver chemistries. Urinalysis was positive for pyuria with nitrites and leukocytes. CT abdomen and pelvis revealed short segment of sigmoid colonic, adjacent lymphadenopathy, left psoas abscess, and moderate left hydroureteronephrosis [Figure 1].
She was initially treated with antibiotics and left-sided percutaneous nephrostomy tube placement. Colonoscopy was deferred due to concern for high risk of complications in favor of conservative management; however, repeat imaging 4 weeks later revealed unchanged thickening of the mid-sigmoid colon extending into left pelvic sidewall and interval increase in the left psoas collection with concern for fistulizing chronic diverticulitis or potential malignancy. She subsequently underwent exploratory laparotomy with lower anterior resection and ileoclonic resection for tethered and fistulizing small bowel to a left lower quadrant phlegmon. The sigmoid colon was also attached to the phlegmon and pathology revealed diverticulitis with extensive old fibrosis and reactive lymphadenopathy without evidence of malignancy or histology suggestive of IBD. As such, the final diagnosis was SCAD-associated hydroureteronephrosis, and she recovered well without complication.
Discussion: Often mistaken for IBD or colorectal cancer, SCAD is an inflammatory condition that should be considered in patients with history of diverticulosis and features suspicious for segmental colonic inflammation. This case reinforces understanding and highlights hydroureteronephrosis as a rare complication seen in a patient with SCAD.
Citation: Ahmad Najdat Bazarbashi, MD; Thomas R. McCarty, MD; Lolwa Al-Obaid, MD; Daria Homenko, MD. P0185 - SEGMENTAL COLITIS ASSOCIATED WITH DIVERTICULOSIS (SCAD): A RARE CAUSE OF HYDROURETERONEPHROSIS. Program No. P0185. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.