Colonic polyp and diverticular diseases are common, and their prevalence has increased in recent years.1–3
Both conditions share the same risk factors such as advanced age and western type diet.4–7
As a minimally invasive treatment with minor complications, endoscopic resection is a safe and efficient way to treat colonic polyps, which has been accepted widely. The incidence of perforation during therapeutic colonoscopies has been reported to range from 0.02–2.14%,8,9
depending on the shape of the polyps and the inexperience of the endoscopist. Colonic diverticular disease affects 35% of people over 60 years of age,10
radical treatment for which involving surgical resection has been the usual approach. To the best of our knowledge, this is the first reported case of perforation of a diverticulum in the sigmoid colon following endoscopic polypectomy within the diverticulum. There are nine reports in the literature regarding polyps and carcinomas arising within colonic diverticula.5,11–18
There has also been a report of a case of villous adenoma arising in Meckel’s diverticulum.19
Some of the reports investigated the relation between colonic polyps or carcinomas and diverticula. Some authors argued that the coexistence of diverticular disease and cancer of the large bowel was merely a chance phenomenon,15,16
while others proposed that there was a causal relationship between the two.5
We present a case involving an adenoma arising within the sigmoid diverticulum, with the aim of reminding endoscopists to take special care of such patients. The giant adenoma obstructed the cavity of the diverticulum, and consequently its presence was not detected following an earlier screening colonoscopy in another hospital. Through repeated air insufflation and absorption, the short peduncle with leukoplakia was observed. After using a snare for ligation of the large colonic adenoma, the diverticulum, residue and perforation defect were seen, which were verified by the subsequent surgery. Therefore, we suggest that special care should be taken in such patients, and the endoscopist should observe the polyp carefully through repeated air insufflation and absorption. If a polyp is discovered within the diverticulum, especially if it is large, a laparoscopic enterectomy would be preferable, as endoscopic resection of the polyp could involve the risk of perforation because of the lack of muscular coats in the diverticulum.
- Good preparation is required before endoscopy.
- Repeated air insufflation and absorption is required to ensure the position of the adenocarcinoma within the colonic diverticulum.
- Treatment may be conservative or require surgery, depending on the size of the hole if perforating.