Inverted colonic diverticulum mimicking a pedonculated polyp

Inverted colonic diverticulum mimicking: a pedonculated polyp

Fouad Nejjari^1,&, Hassan Seddik²

¹Gastroenterology Unit, 5^th, Military Hospital, Guelmim, Morocco, ²Gastroenterology II Unit, Mohamed V Military Teaching Hospital, Mohamed V, Souissi University, Rabat, Morocco

^&Corresponding author
Fouad Nejjari, Gastroenterology Unit, 5^th, Military Hospital, Guelmim, Morocco

Introduction    

Colonoscopy plays an important role in colorectal cancer prevention because precancerous polyps can be detected and resected during the same exam, both adenomatous polyps and diverticular disease are common in people over 40 years old, and they frequently coexist, inverted colonic diverticulum (ICD) are rare, occurring roughly 0,7% of people [1], and can appear indistinguishable from colon polyps, Incorrect diagnosis of ICD may be responsible for serious complications such as perforation following endoscopic resection.

Patient and observation     

A 45-year-old women with no significant medical history presented for screening colonoscopy, She had no weight loss and no family history of inflammatory bowel disease, physical examination finding and routine biological exams were normal. A colonoscopy revealed some diverticula in the sigmoid, and a polypoid formation in the descending colon, with a peduncle of approximately 2cm in length (Figure 1), the polypoid structure changed appearance and reduced size by air insufflation (Figure 2), when palpated with a biopsy forceps it was soft and easily compressible, a finding consistent with a diagnosis of inverted colonic diverticulum.

Discussion     

Inverted colic diverticula (ICD) are rare, their appearance is similar to that of high polypoid lesions, but some maneuvers have been described to help diagnose ICD, such as attempting to reverse the lesion with air insufflation, or using a forceps [2, 3], the sign of water jet deformation [4]. The "radiating pillow" and, more recently, the Aurora rings (pale concentric rings surrounding the lesion) [5]. These maneuvers appear to be more successful in cases of small inverted diverticulum, but may fail in large ICD cases [6]. Incorrect diagnosis of ICD may be responsible for serious complications such as perforation following endoscopic resection. The biopsy can be dangerous because the diverticular wall consists only of a mucosa with little or no fibers covering the muscle fibers [6].

Conclusion     

The possibility of finding an inverted diverticulum mimicking colonic polyp during colonoscopy must be considered carefully for correct diagnosis and avoid dangerous procedures such as endoscopic polypectomy.

Competing interests     

The author declare no competing interest.

Authors' contributions     

All the authors have read and agreed to the final manuscript.

Figures     

Figure 1: endoscopic view of a polypoid lesion in the descending colon

Figure 2: the lesion change appearance and size according air insufflation

References     

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