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CC BY 4.0 · Endoscopy 2024; 56(S 01): E484-E485
DOI: 10.1055/a-2325-2694
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Novel endoscopic management for acute diverticulitis with localized abscess

Hai-Bin Zhang‡
1   Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
,
Ben-Song Duan‡
1   Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
,
Jia-Ning Shi
1   Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
,
Yuan Chu
1   Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
,
Cheng Guo 
1   Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
› Author AffiliationsSupported by: National Natural Science Foundation of China 82200689
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The clinical spectrum of acute diverticulitis ranges from a phlegmon to limited abscesses, to free perforation with purulent or contaminated peritonitis [1]. While there is little debate about the optimal treatment for mild or very severe situations, uncertainty remains about the optimal strategy for acute diverticulitis with localized abscesses. Here, we report a successful endoscopic diverticulotomy for limited septic diverticulitis caused by a fecal stone.

A 44-year-old man experienced sudden abdominal pain 1 week earlier and computed tomography scan at a local hospital showed a high density shadow in the colon ([Fig. 1] a). Colonoscopy showed a mucosal defect in the ascending colon ([Fig. 1] b). However, after 3 days of antibiotic treatment, the patient’s abdominal pain worsened. Blood tests showed a threefold increase in C-reaction protein to 36 mg/L and a twofold increase in white blood cell counts to 18 × 109/L. The patient was then referred to our endoscopy center and underwent colonoscopy.

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Fig. 1 Limited septic diverticulitis caused by an embedded fecal stone. a Computed tomography showed a high density shadow (arrow) in the colon. b A mucosal defect was seen in the ascending colon. c The diverticular opening was congested and edematous. d X-ray showed an approximately 1-cm diverticulum (arrow). e Photograph of the yellow fecal stone.

Septic diverticulitis was considered first. The diverticular opening was congested and edematous ([Fig. 1] c), and white pus could be drawn. X-ray showed an approximately 1-cm diverticulum with inflammatory exudates, fortunately without perforation ([Fig. 1] d). Inspired by endoscopic septum division for esophageal diverticulum [2], the diverticular septum was incised carefully and a yellow fecal stone, about 0.6 cm in diameter, slipped out ([Fig. 1] e, [Video 1]). The bottom and the opening of the diverticulum were treated with electrocoagulation and closed by endoloop-assisted clip closure. Following this treatment and 3 days of antibiotic therapy, the patient’s abdominal pain resolved and blood test results returned to the normal range.


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Endoscopic diverticulotomy with stone extraction for limited septic diverticulitis.Video 1

This patient was diagnosed with a diverticular abscess caused by an embedded fecal stone in the diverticulum. Antibiotic therapy alone for septic diverticulitis is accompanied by a high risk of recurrence owing to the persistence of the etiology [3]. In this case, we endoscopically removed the fecal stone, drained the pus, destroyed the diverticulum, and sutured with endoloop-assisted clip closure, thus avoiding the need for surgery. During a 1 year follow-up period, the patient had no further acute diverticulitis. This case demonstrates novel endoscopic management for acute diverticulitis with localized abscesses.

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Publication History

Article published online:
05 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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