Digestive Diseases and Sciences, Vol. 30, No. 2 (February 1985), pp. 182-183

CASE REPORT

Sigmoid Diverticulitis in Identical Twins JULIAN H. FRIEDEN, MD, and LEON MORGENSTERN, MD

Diverticulitis of the colon is a common disease of Western civilization, particularly in older age groups. Monozygotic twinning is a rare phenome- non. The occurrence of sigmoid diverticulitis with similar clinical and pathologic findings in monozy- gotic twins in their third decade was considered worthy of a clinical report.

CASE REPORT A white male identical twin experienced his first attack

of diverticulitis at age 27. The initial diagnosis was made by contrast studies of the coion. At 31 years of age, after several intermittent attacks, he was hospitalized for per- forated diverticulitis. A sigmoidectomy was performed en

bloc with a chronic pericolic abscess. He has been symptom-free since operation.

The patient's twin experienced his first attack of diver- ticulitis at age 31. After several recurrent attacks, he underwent a partial left colectomy five years after the initial episode. The pathologic specimen showed acute suppurative diverticulitis. The patient has been symptom- free since operation.

DISCUSSION

The occurrence of diverticulitis in individuals as young as these monozygotic twins is distinctly unusual (1). The patients were of Greek-Jewish ancestry, born in the United States. Their environ- mental patterns and dietary habits were "West- ern." No foods were eliminated from their diets during their youth and young adult life. There was no fiber deficiency. The twins were known to be in good general health with no known preexisting conditions. No familial history of any intestinal disorder had been previously noted. No predisposi-

Manuscript received February 6, 1984; revised manuscript received June 19, 1984; accepted August 8, 1984.

From the Department of Surgery, Cedars-Sinai Medical Cen- ter, Los Angeles, California.

Address for reprint requests: Dr. Julian H. Frieden, 8631 West Third Street, Suite 435E, Los Angeles, California 90048.

tion could be found to account for this early presen- tation of diverticular disease.

The pathogenesis of diverticular disease is gener- ally thought to be related to degenerative changes in the colonic wall at the site of circumferential blood vessel entry (2). The associated pathologic changes of muscular hypertrophy, mucosal redundancy, and luminal narrowing are not well explained. Morson (3) believes that the disorder is basically one of muscular function, particularly of the sigmoid co- lon. Familial predisposition to diverticulosis or di- verticulitis has not been a prominent feature in the literature. Schlotthauer (4) reported diverticulosis in seven full brothers of one family. He concluded that heredity was a major causative factor in the etiology of colonic diverticulosis. Bearse (5) pre- sented similar views on the congenital factor of diverticulosis, citing structural defects in the colon as the most likely cause of diverticulosis in young adults. Diverticulitis has also been reported in two members of a family with Marfan's syndrome (6) and in the Ehlers-Danlos syndrome (7), suggesting a possible congenital role of defective collagen.

Among the disease entities described in monozy- gotic twins are hyperparathyroidism, pancreatitis, thrombocytopenic purpura, neoplasia, and degener- ative disorders of the skeletal system such as spon- dylosis, arthrosis, and discongenic disease (8-13). We could find no mention of diverticular disease in the extensive twinning literature.

The occurrence of a similar type of diverticulitis in the monozygotic twins cited in this report, both manifesting the disease at an unusually young age, suggests that there may be an inherited tendency toward this common colonic disorder, especially when it occurs in the younger age groups.

SUMMARY

Severe sigmoid diverticulitis requiring left colon resection occurred in monozygotic twins during

1 O/- Digestive Diseases and Sciences, Vol. 30, No. 2 (February 1985) 0163-2116/85/0200-0182504.50/0 �9 1985 Plenum Publishing Corporation

D I V E R T I C U L I T I S IN T W I N S

the i r th i rd d e c a d e , A n i n h e r i t e d t e n d e n c y is sug-

g e s t e d .

REFERENCES

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2. Meyers MA, Alonso DR, Gray GF et al: Gastroenterol 71:577-583, 1976

3. Morson BC: Diverticular disease of the colon. Acta Chir Belg 78:369-376, 1979

4. Schlotthauer HL: Familial diverticulosis of the colon: Re- port of seven cases in one family of nine persons. Ann Surg 124:497-502, 1946

5. Bearse C: Diverticulosis and diverticulitis of colon with particular reference to patients under 40. Rev Gastroenterol 7:318-321, 1940

6. Cook JM: Spontaneous perforation of the colon: Report of two cases in a family exhibiting Marfan stigmata. Ohio Med J 64:73, 1968

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8. Koch G: Results of the 40-year, longitudinal study of a series of twins of Berlin (450 monozygotic and dizygotic twin pairs). In Twin Research 3: Proceedings of the Third Interna- tional Congress on Twin Studies. Part C: Epidemiological and Clinical Studies. L Gedda, P Parisi, WE Nance (eds). New York, Alan R. Liss, 1981, pp 201-209

9. Pont A, Fox M, Merrell RC, Goldman E, Lee H, Oaks DD: Hyperparathyroidism in twins. Ann Intern Med 97:721-722, 1982

10. Henderson J, Ingram D, House T: Acute pancreatitis in identical twins. Med J Aust 1:432-434, 1982

11. Laster AJ, Conley CL, Kickler TS, Dorsch CA, Bias WB: Chronic immune thrombocytopenic purpura in monozygotic twins: Genetic factors predisposing to ITP. N Engl J M ed 307:1495-1498, 1982

12. Kaprio J, Teppo L, Koskenvuo M, Pukkala E: Cancer in adult same-sexed twins: A historical cohort study. In Twin Research 3: Proceedings of the Third International Congress on Twin Studiesi Part C: Epidemiological and Clinical Studies. L Gedda, P Parisi, WE Nance (eds). New York, Alan R. Liss, 1981, pp 217-223

13. Zevallos M, Snyder R, Sadoff L, Cooper JF: Testicular neoplasm in identical twins. JAMA 250:645-646, 1983

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