Large Inverted Colonic Diverticulum (LICD) Volume 1 - Issue 2

Hormati A*¹,Ghadir MR¹,Sarkeshikian SS¹,Iranikhah A² and Yousefi MH³

• ¹Assistant Professor of Gastroenterology, Gastroenterology & Hepatology Research Center, Qom University of Medical Sciences, Iran
• ²Assistant Professor of Pediatric Gastroenterology, Gastroenterology & Hepatology Research Center, Qom University of Medical Sciences, Iran
• ³Research and bio-statistics expert, Gastroenterology & Hepatology Research Center, Qom University of Medical Sciences, Iran

Received: March 15, 2018;   Published: May 21, 2018

Corresponding author: Ahmad Hormati, Gastroenterology & Hepatology Research Center , Shahid Beheshti Hospital, Qom School of Med, Qom University of Medical Sciences, Iran

DOI: 10.32474/LOJNHC.2018.01.000109

Abstract PDF

A 61 years old woman was referred to gastroenterology clinic for evaluation of abdominal pain. She complained from changeless pain in RUQ persisting for three months. She didn’t have any other symptoms, anemia, and weight loss.

Figure 1&2: Endoscopic view of 30×15mm lesion in the ascending colon.

In physical examination, patient didn’t have any abnormal sign. Laboratory test were normal. Colonoscopy of the patient showed a 30×15mm sub mucosal lesion in the Ascending colon near to hepatic flexure. In gross view the sub mucosal lesion was similar to normal mucosa with large circumferential pedicle that changed its appearance according to low and high insufflations degree (Figure 1 & 2).

CT scan revealed a well-margined intraluminal mass in proximal portion of the Ascending colon measured 31×16mm containing some small gas bubbles with suggestion of a large inverted colonic diverticulum (ICD) (Figure 3-5).

Figure 3&4: Endoscopic view of 30×15mm lesion in the ascending colon.

True colonic polyps and Gastrointestinal Stromal Tumors (GISTs) are main differential diagnosis for ICD. This differentiation is very important during colonoscopy. Polypectomy is contraindicated in ICD because of the risk of colonic perforation [1].

ICD occurred in 0.7% of population. Some maneuvers such as air insufflations [2,3], attempting to revert of the lesion with forceps [4], or water jet deformation sign [1] help colonoscopists in diagnosis of ICD.

1. Cappell MS (2009) The water jet deformation sign: a novel provocative colonoscopic maneuver to help diagnose an inverted colonic diverticulum. South med J 102(3): 295-298.
2. Adioui T, Seddik H (2014) Inverted colonic diverticulum. Ann Gastroenterol 27(4): 411.
3. Yusuf SI, Grant C (2000) Inverted colonic diverticulum: a rare finding in a common condition? Gastrointest Endosc 52(1): 111-115.
4. Triadafilopoulos G (1999) Inverted colonic diverticulum. New England Journal of Medicine 341(20): 1508.