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Abstract Introduction Diverticular disease of the colon is a common benign condition. The majority of patients with diverticular disease are asymptomatic and are managed non-operatively, however complications such as perforation, bleeding, fistulation and stricture formation can necessitate surgical intervention. A giant colonic diverticulum is defined as a diverticulum larger than 4 cm in diameter. Despite the increasing incidence of colonic diverticular disease, giant colonic diverticula remain a rare clinical entity. Case presentation This is the first reported case of laparoscopic-assisted resection of a giant colonic diverticulum. We discuss the symptoms and signs of this rare complication of diverticular disease and suggest investigations and management. Reflecting on this case and those reported in the literature to date, we highlight potential diagnostic difficulties and consider the differential diagnosis of intra-abdominal gas-filled cysts. Conclusion The presence of a giant colonic diverticulum carries substantial risk of complications. Diagnosis is based on history and examination supported by abdominal X-ray and computed tomography findings. In view of the chronic course of symptoms and potential for complications, elective surgical removal is recommended. Colonic resection is the treatment of choice for this condition and, where possible, should be performed laparoscopically.

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) has become established as the gold standard in imaging of the biliary tree. Recently, magnetic resonance cholangiopancreatography (MRCP) has been introduced as a new, non-invasive imaging modality for the detection of bile-duct stones and other pathology related to the biliary tract and pancreas. The aim of this study was to determine how MRCP compared with ERCP in the diagnosis of choledocholithiasis., Design and Methods: A prospective study of 133 patients referred for either ERCP or MRCP was carried out to compare the results of both these methods in determining the presence of choledocholithiasis., Results: 18 patients were excluded from the analysis: ERCP was unsuccessful in eight of these patients and MRCP was not possible in the remaining 10 patients. There were six false negative results with MRCP; in five of these the calculi were less than 5 mm in diameter. MRCP showed a sensitivity of 84%, specificity of 96%, positive predictive value of 91%, negative predictive value of 93% and diagnostic accuracy of 92% when compared to ERCP as the gold standard., Conclusions: MRCP has high sensitivity and high specificity for stones greater than 5 mm in diameter and should be performed in preference to ERCP as the first-line investigation in patients with gallstones and abnormal liver function tests in the elective setting. Adoption of this guideline at our institution would result in a 9% reduction in the number of ERCPs performed.