ENDOSCOPIC TRASLUMINAL DRAINAGE OF ENDOLUMINAL DIVERTICULAR ABSCESS

Aim:

To describe the case of a diverticular endoluminal abscess, sucessfully endoscopically drained without any complication.

Methods:

We review the case of an endoscopic drainage performed in the endoscopic unit with a follow-up during hospitalization and after two month of having been discharged.

Case report:

A 65-year-old man who came for a colonoscopy screening due to occult blood stool and a family history of colorectal cancer. He referred a 2 week history of abdominal pain and dysthermia, without fever, nausea, vomiting or diarrhea. Colonoscopy revealed diverticulitis in the sigmoid colon and a submucosal mass of approximately 20 × 30 mm. in size with a slightly hyperemic surface mucosa. Palpation of this area with cold forces was soft and after oppression it drained a whitish discharge, with thick purulent aspect with decompression of the lesion. CT scan was later performed and showed sigmoid diverticulitis without evidence of perforation. Antibiotic therapy was given with adequate clinical response.

Conclusions:

1. The diverticular abscess in this case is an intraluminal complication of a diverticulitis but it is usually extraluminal.

2. There are only two cases in the literature described by Barkin et al and Calzolari C et al with similar presentation. This would be the third case of a diverticular abscess succesfully endoscopically drained and without any complications.

3. While colonoscopy is not recommended in episodes of acute diverticulitis, there are certain cases in which it has to be considered not only as a diagnostic tool but also as a minimally invasive therapeutic option.