Liew JJL, Lim WS, Koh FH. Unusual phenomenon-“polyp” arising from a diverticulum: A case report. World J Clin Cases 2023; 11(13): 3070-3075 [PMID: 37215427 DOI: 10.12998/wjcc.v11.i13.3070]
Corresponding Author of This Article
Frederick H Koh, FRCS (Ed), MBBS, MMed, Assistant Professor, Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang E Way, Singapore 544886, Singapore. frederickkohhx@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 6, 2023; 11(13): 3070-3075 Published online May 6, 2023. doi: 10.12998/wjcc.v11.i13.3070
Unusual phenomenon-“polyp” arising from a diverticulum: A case report
Jacqueline Jin Li Liew, Wei Shyann Lim, Frederick H Koh
Jacqueline Jin Li Liew, Wei Shyann Lim, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Frederick H Koh, Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore 544886, Singapore
Author contributions: Koh FH is responsible for research design; Liew JJL, Lim WS are responsible for research and data curation; Koh FH, Liew JJL and Lim WS analysed data; Liew JJL and Lim WS are responsible for the original draft preparation; Koh FH is responsible for reviews and editing; Liew JJL and Lim WS wrote the paper; Koh FH contributed to supervision.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Frederick H Koh, FRCS (Ed), MBBS, MMed, Assistant Professor, Colorectal Service, Department of General Surgery, Sengkang General Hospital, 110 Sengkang E Way, Singapore 544886, Singapore. frederickkohhx@gmail.com
Received: January 31, 2023 Peer-review started: January 31, 2023 First decision: February 17, 2023 Revised: March 1, 2023 Accepted: April 4, 2023 Article in press: April 4, 2023 Published online: May 6, 2023
Abstract
BACKGROUND
Sealed perforation of colonic diverticulum is a common clinical condition and may be differentiated from an underlying malignant perforation using interval endoscopy. We present an uncommon colonoscopy finding of a healed diverticular perforation, mimicking a polyp, 6 wk post-diverticulitis-something that has not been reported in literature. We aim to shed light on the likely process that resulted in the trompe l'œil after diverticulitis. This also introduces the possibility of more targeted colonic resection in the event of a similar recurrence.
CASE SUMMARY
A middle-aged Chinese female presented with a 3-d history of non-colicky left iliac fossa pain. It was associated with fever (Tmax 37.6 ºC), non-bloody diarrhoea and non-bloody, non-bilious vomiting. She had a history of Type 2 diabetes mellitus, well controlled on metformin. Tenderness was noted on the left iliac fossa region with no guarding or mass. Total white cell count (11.45 × 109/L) and C-reactive protein levels (213.9 mg/L) were elevated. Computed tomography imaging of the abdomen revealed pericolonic fat stranding and extraluminal air pockets fluid density with peritoneal thickening at the sigmoid colon, likely representing a sealed perforation. Six weeks after the episode, she underwent a follow-up colonoscopy. An exophytic polypoid lesion closely associated with a diverticulum was seen in the sigmoid colon. The lesion was easily “pinched” off without much effort using endoscopic forceps and sent for histology which revealed granulation tissue suggesting a healed diverticular perforation.
CONCLUSION
Granulation tissue associated with healed diverticular perforations resemble polyps. Tattooing around these sites may allow for future targeted colonic resections.
Core Tip: This case report aims to shed light on the possible morphology of a healed diverticular perforation. This is important as patients who have suffered from diverticular perforations are at increased risk of recurrence, with high likelihood of the previously perforated diverticulum being the offending cause. Recognising the appearance of granulation tissue from a possible sealed perforated diverticulum and marking the site with injectable tattoos may allow for targeted resections of the colon if recurrence occurs. This preserves more parenchyma, allows for a potentially faster surgery, and shortens recovery time while achieving an equivalent improvement in quality-of-life.
