TWO CASES OF SIGMOID DIVERTICULITIS SHOWING APPLE CORE SIGN

Abstract

Apple core sign in barium enema is assumed to be characteristic of advanced ulcer-forming colon cancer invading the subserosa with a size of more than 3 cm in diameter. We experienced two cases of sigmoid colon diverticulitis with apple core sign on preoperative barium enema. In both cases colonoscope could not pass through the stenosis. Although biopsies taken from that region showed no malignancy, possibility of carcinoma could not be excluded and laparotomy was performed. Case 1 was a 64-year-old man. Barium enema revealed an apple core sign with diverticula at the sigmoid colon. Sigmoidectomy was performed. Histological diagnosis was inflammatory stenosis resulted from diverticulitis, and there was no malignant findings. Case 2 was a 47-year-old man. Left hemicolectomy was performed because of an apple core sign at the sigmoid colon and diverticular in the descending and sigmoid colon demonstrated on the barium enema. Histological examination of the resected colon revealed diverticulitis. These two cases suggest that colon diverticulitis can demonstrate an apple core sign due to the fibrous hyperplasia of the serosa caused by chronic inflammation in the adjacent plural diverticula.