Endoscopic management of colonic diverticulitis with fecalith impaction: a novel suction technique

Abstract

Figures

a CT scan revealed multiple colonic diverticulitis caused by calcified fecaliths. b Using a short transparent cap for suction. c Using a long transparent cap for suction. d The impacted fecaliths aspirated from diverticula. e The inverted diverticulum was exposed by suction with the transparent cap and ligated by EBL. f The colonic mucosa at the treatment site had healed completely. Abbreviation: EBL, endoscopic band ligation.

Full text

A 40-year-old man presented to our hospital with a 1-year history of recurrent left lower abdominal pain. A computed tomography (CT) scan revealed multiple colonic diverticulitis ( Fig. 1 a , Video 1 ). Colonoscopy confirmed the presence of fecalith impaction within the diverticula. Initially, we attempted to extract the fecaliths using a short transparent cap for suction ( Fig. 1 b ). However, this approach proved challenging due to the narrow openings of the diverticula. Therefore, we switched to a long transparent cap, which allowed better visualization of the diverticulum openings and facilitated alignment of the fecaliths with the axis of the endoscope’s working channel for effective suction ( Fig. 1 c ). The long cap enhanced suction power and provided sufficient internal space for efficient fecalith removal. Complete extraction from all diverticula was achieved without complications ( Fig. 1 d ). Subsequently, endoscopic band ligation (EBL) was performed on the inverted colonic diverticulum ( Fig. 1 e ). The patient reported significant improvement in abdominal pain with no adverse reactions. Follow-up colonoscopy at 1 month demonstrated complete mucosal healing at the treatment site ( Fig. 1 f ).

a CT scan revealed multiple colonic diverticulitis caused by calcified fecaliths. b Using a short transparent cap for suction. c Using a long transparent cap for suction. d The impacted fecaliths aspirated from diverticula. e The inverted diverticulum was exposed by suction with the transparent cap and ligated by EBL. f The colonic mucosa at the treatment site had healed completely. Abbreviation: EBL, endoscopic band ligation.

Endoscopic management of colonic diverticulitis with fecalith impaction: a novel suction technique.Video 1

Fecalith impaction is a leading cause of complicated colonic diverticulitis, often resulting in perforation or bleeding 1 . In cases where the diverticulum has a narrow opening, traditional methods such as biopsy forceps are often ineffective for fecalith removal. Based on our experience, the use of a long transparent cap significantly improves suction efficiency by exerting greater pressure and facilitating better expansion of the diverticulum opening. Furthermore, EBL is a simple, safe, and effective technique for the curative treatment of diverticula 2 3 . No abnormalities were observed during follow-up. In conclusion, long cap-assisted suction represents a promising and minimally invasive option for managing fecalith impaction in colonic diverticula, offering a safe and effective alternative to conventional techniques.

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