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