ABSCESSED DIVERTICULITIS AS A DIFFERENTIAL DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE – CASE REPORT

Inflammatory bowel disease (IBD) is characterized by episodes of inflammation in the gastrointestinal tract caused by an abnormal immune response to the microflora, with Crohn's Disease (CD) and Ulcerative Colitis (UC) being the main representatives. This study is based on medical record analysis and a literature review. A 68-year-old female patient, with a previous history of obesity, was hospitalized in 2021 due to an episode of intestinal bleeding. She underwent a colonoscopy, which showed luminal stenosis of the sigmoid colon with inability to progress endoscopically, in addition to inflammatory characteristics, leading to a diagnosis of UC. After the investigation, treatment with Infliximab (IFX) combined with Azathioprine (AZA) was started, but the response and disease control were inadequate, prompting optimization of the IFX therapy. However, the stenosis persisted in follow-up exams performed in 2022 and 2023. In 2024, surgical management of the lesion was chosen after considering the possibility of neoplastic involvement, although the prolonged course of the disease was not suggestive of malignancy. The resected specimen was sent to pathology and diagnosed with an abscessed diverticulitis, an unexpected finding. Diverticular disease can present significant complications, such as inflammation (diverticulitis), abscesses, fistulas, and thickening, conditions that may also resemble a presentation of IBD. Therefore, surgical choice, both for diagnostic confirmation and therapy, should be individualized. Around 3% to 10% of patients with colon inflammation exhibit overlapping clinical and pathological features, making differentiation difficult, and approximately 10% of patients initially diagnosed with IBD (either CD or UC) may have their diagnosis changed upon re-evaluation. The discussed finding highlights not only the heterogeneity of these diseases but also the challenge of determining their diagnoses correctly. In this context, systematic monitoring is essential to prevent the condition from remaining undetermined, impacting the quality of life of patients and reducing their complications.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025