Reviewer ’s report  
Title: An unusual diverticulum adjacent to two large colonic polyps. A case report.  
 
Version: 2 Date: 06 Apr 2 018 
 
Reviewer: Ridhi Gupta  
 
Reviewer's report:  
Dear Authors ,  
 
This is a well written case report however I have a few comments  and need for clarifications:  
 
Abstract :  
- the conclusion is to enroll patients in long term surveillance programs but this woul d be 
standard of care for patients > 50 years of age essentially. this lady is > 50 years and would 
have/should have received a surveillance colonoscopy either way.  
 
Background:  
'Characteristically there is a long latent period before the occurrence of ca ncer and even though 
most patients subsequently underwent revisional surgery those with intact ureteric stumps also 
seem to be at risk' : please mention the already reported latent periods in this case scenario. Is 
there is a difference in the latent perio ds if they received a revisional surgery or if they continued 
to have a US.  
 
Case presentation :  
- Line 19 -20 - please mention if she had any other risks for colon cancer such as , smoking, 
obesity, etoh etc  
- line 23 -24 - would describe the endoscopic ap pearance of the polyps - what constitutes Large ? 
mention the size and other characteristics that suggested it was likely malignant or concerning. 
these were adenomas and not adenocarcinomas correct ?  
- Line 34 -35 - at Laparotomy - the right FT was adheren t to the sigmoid colon. was it the right or 
the left ? the left appears to be more likely anatomically  
- please mention the final pathology - on imaging this was noted to  be invasive disease - was it 
actually invasive disease on final pathology ?  
 
Discus sion and conclusions :  
- line 58 -60 : unclear regarding the average age of diagnosis - diagnosis of adenomas post US 
and/or other urinary diversion procedures ? what is the mean interval to ? development of 
adenomas from US ? the reported latency are a wid e range 3 years to 53 years . what in your 
opinion makes this such a wide range ? Do the patients with a short latency period like 3 years 
have other risk factors that make them have a high risk for colon cancer.  
- Page 4 - line 3 -5 : it mentions that the pathogenesis of the tumor is multifactorial in nature  but 
only one theory is mentioned. Since this is the MAIN point of your case report this portion 
needs to be emphasized more.  Also mentioned is that experimen tal data is conflicting - how is 
this conflicting ? what does experimental data suggest ? please mention  
- Line 22 -23 - 'Unfortunately such patients still appear to be at an increased risk of developing 
sigmoid tumours' - what is the % of developing tumor s ? 
- line 26 -27 - 'All patients with a US and those who have had revisional surgery but have their 
ureteosigmoidostomy sites intact should be kept under  long term annual endoscopic 
surveillance; - it appears that most of the patients that undergo US are y ounger age groups and 
epidemiologically have a lower risk of developing colon cancer.  
- final paragraph : what is the final suggested recommendation for screening these patients as 
your case report recommends. Should it be started earlier than 50 years of  age ? and should it 
be annual as is suggested in your case report mentioned in line 26 -28 ? 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments  to the authors.  
Unable to assess  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical revi ew? 
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisati on that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your repl y is yes to any, please give details below.  
 
I declare that I have no competing interests  
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for pub lication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/license s/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
Title: An unusual diverticulum adjacent to two large colonic polyps. A case report.  
 
Version: 2 Date: 06 Apr 2 018 
 
Reviewer: Ridhi Gupta  
 
Reviewer's report:  
Dear Authors ,  
 
This is a well written case report however I have a few comments  and need for clarifications:  
 
Abstract :  
- the conclusion is to enroll patients in long term surveillance programs but this woul d be 
standard of care for patients > 50 years of age essentially. this lady is > 50 years and would 
have/should have received a surveillance colonoscopy either way.  
 
Background:  
'Characteristically there is a long latent period before the occurrence of ca ncer and even though 
most patients subsequently underwent revisional surgery those with intact ureteric stumps also 
seem to be at risk' : please mention the already reported latent periods in this case scenario. Is 
there is a difference in the latent perio ds if they received a revisional surgery or if they continued 
to have a US.  
 
Case presentation :  
- Line 19 -20 - please mention if she had any other risks for colon cancer such as , smoking, 
obesity, etoh etc  
- line 23 -24 - would describe the endoscopic ap pearance of the polyps - what constitutes Large ? 
mention the size and other characteristics that suggested it was likely malignant or concerning. 
these were adenomas and not adenocarcinomas correct ?  
- Line 34 -35 - at Laparotomy - the right FT was adheren t to the sigmoid colon. was it the right or 
the left ? the left appears to be more likely anatomically  
- please mention the final pathology - on imaging this was noted to  be invasive disease - was it 
actually invasive disease on final pathology ?  
 
Discus sion and conclusions :  
- line 58 -60 : unclear regarding the average age of diagnosis - diagnosis of adenomas post US 
and/or other urinary diversion procedures ? what is the mean interval to ? development of 
adenomas from US ? the reported latency are a wid e range 3 years to 53 years . what in your 
opinion makes this such a wide range ? Do the patients with a short latency period like 3 years 
have other risk factors that make them have a high risk for colon cancer.  
- Page 4 - line 3 -5 : it mentions that the pathogenesis of the tumor is multifactorial in nature  but 
only one theory is mentioned. Since this is the MAIN point of your case report this portion 
needs to be emphasized more.  Also mentioned is that experimen tal data is conflicting - how is 
this conflicting ? what does experimental data suggest ? please mention  
- Line 22 -23 - 'Unfortunately such patients still appear to be at an increased risk of developing 
sigmoid tumours' - what is the % of developing tumor s ? 
- line 26 -27 - 'All patients with a US and those who have had revisional surgery but have their 
ureteosigmoidostomy sites intact should be kept under  long term annual endoscopic 
surveillance; - it appears that most of the patients that undergo US are y ounger age groups and 
epidemiologically have a lower risk of developing colon cancer.  
- final paragraph : what is the final suggested recommendation for screening these patients as 
your case report recommends. Should it be started earlier than 50 years of  age ? and should it 
be annual as is suggested in your case report mentioned in line 26 -28 ? 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments  to the authors.  
Unable to assess  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical revi ew? 
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisati on that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your repl y is yes to any, please give details below.  
 
I declare that I have no competing interests  
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for pub lication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/license s/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
Title: An unusual diverticulum adjacent to two large colonic polyps. A case report.  
 
Version: 2 Date: 06 Apr 2 018 
 
Reviewer: Ridhi Gupta  
 
Reviewer's report:  
Dear Authors ,  
 
This is a well written case report however I have a few comments  and need for clarifications:  
 
Abstract :  
- the conclusion is to enroll patients in long term surveillance programs but this woul d be 
standard of care for patients > 50 years of age essentially. this lady is > 50 years and would 
have/should have received a surveillance colonoscopy either way.  
 
Background:  
'Characteristically there is a long latent period before the occurrence of ca ncer and even though 
most patients subsequently underwent revisional surgery those with intact ureteric stumps also 
seem to be at risk' : please mention the already reported latent periods in this case scenario. Is 
there is a difference in the latent perio ds if they received a revisional surgery or if they continued 
to have a US.  
 
Case presentation :  
- Line 19 -20 - please mention if she had any other risks for colon cancer such as , smoking, 
obesity, etoh etc  
- line 23 -24 - would describe the endoscopic ap pearance of the polyps - what constitutes Large ? 
mention the size and other characteristics that suggested it was likely malignant or concerning. 
these were adenomas and not adenocarcinomas correct ?  
- Line 34 -35 - at Laparotomy - the right FT was adheren t to the sigmoid colon. was it the right or 
the left ? the left appears to be more likely anatomically  
- please mention the final pathology - on imaging this was noted to  be invasive disease - was it 
actually invasive disease on final pathology ?  
 
Discus sion and conclusions :  
- line 58 -60 : unclear regarding the average age of diagnosis - diagnosis of adenomas post US 
and/or other urinary diversion procedures ? what is the mean interval to ? development of 
adenomas from US ? the reported latency are a wid e range 3 years to 53 years . what in your 
opinion makes this such a wide range ? Do the patients with a short latency period like 3 years 
have other risk factors that make them have a high risk for colon cancer.  
- Page 4 - line 3 -5 : it mentions that the pathogenesis of the tumor is multifactorial in nature  but 
only one theory is mentioned. Since this is the MAIN point of your case report this portion 
needs to be emphasized more.  Also mentioned is that experimen tal data is conflicting - how is 
this conflicting ? what does experimental data suggest ? please mention  
- Line 22 -23 - 'Unfortunately such patients still appear to be at an increased risk of developing 
sigmoid tumours' - what is the % of developing tumor s ? 
- line 26 -27 - 'All patients with a US and those who have had revisional surgery but have their 
ureteosigmoidostomy sites intact should be kept under  long term annual endoscopic 
surveillance; - it appears that most of the patients that undergo US are y ounger age groups and 
epidemiologically have a lower risk of developing colon cancer.  
- final paragraph : what is the final suggested recommendation for screening these patients as 
your case report recommends. Should it be started earlier than 50 years of  age ? and should it 
be annual as is suggested in your case report mentioned in line 26 -28 ? 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments  to the authors.  
Unable to assess  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical revi ew? 
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisati on that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your repl y is yes to any, please give details below.  
 
I declare that I have no competing interests  
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for pub lication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/license s/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant