We described a rare cause of a giant vesical diverticulum causing mechanical bowel obstruction in an adult patient. We summarized the characteristics of the 12 cases of “giant bladder diverticulum’’ which we found in the literature in the Table [3–11
]. Three of the cases caused intestinal obstruction[3–5
]. The bladder is a hollow muscular organ that stores and evacuates urine. The normal bladder can store approximately 350-400 mL of urine. A diverticulum is an abnormal sac or pouch protruding from the wall of a hollow organ. Most bladder diverticula are primary, congenital, or secondary to outflow obstruction or neurogenic bladders[12–14
]. Congenital diverticula usually occur in areas where there is insufficient muscle, typically at the ureterovesical junction, or between bundles of hypertrophied muscle. They are usually asymptomatic and are discovered incidentally. Occasionally, a diverticulum may produce urinary obstruction as a result of compression of the urethra, or urinary tract infection arising from retention of urine within the diverticulum[8,15
]. In this case, only minimal obstruction caused by the pressure on the ureters was observed. No obstruction of the urethra developed. Although diverticula generally develop from the ureteral orifices in the bladder, in this case the diverticulum was located in the posterosuperior region of the bladder distant from the orifices.
A summary of 12 cases of giant vesical diverticula reported in the English medical literature from 1957 to 2009 and description of the studies
In this patient, the diverticulum was in the same location as previous trauma. Because of this and since trauma is known to be one of the etiologic factors for acquired diverticula, we believed that this diverticula had occurred as a result of the previous trauma.
The indications for surgery are persistent or recurrent urinary infection, the presence of a stone or tumor in the diverticulum[16,17
], a vesicocutaneous fistula[18
], lower urinary tract symptoms, and voiding symptoms or vesicoureteral reflux[19
] resulting from the diverticulum or ureteral obstruction[6,12
]. In this case, laparotomy was indicated by the normal IVP results and CT scan showing a mass exerting pressure on the ureters and rectum. Vesical diverticula are a common pathology of the urinary bladder, generally secondary to cervico-urethral obstruction. Shaked et al[5
] presented a case of bladder distention and diverticulum arising from obstruction caused by a prostate adenoma. In their case, they reported that colonic obstruction occurred because the colon was packed between the sacrum and bladder. In our case, although the bladder diverticulum was large, no obstruction was observed because the diverticulum developed from the posterosuperior part of the bladder. This was reflected in the PSA and transrectal ultrasonography results.
In conclusion, there are several reported cases of bladder distention and diverticula causing colonic obstruction. For this reason, although rare, bladder pathology should be considered in patients with obstruction of the rectosigmoid region.