Case Report
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Mar 28, 2010; 16(12): 1545-1547
Published online Mar 28, 2010. doi: 10.3748/wjg.v16.i12.1545
Early colon cancer within a diverticulum treated by magnifying chromoendoscopy and laparoscopy
Kuang I Fu, Yukihiro Hamahata, Yasunobu Tsujinaka
Kuang I Fu, Yukihiro Hamahata, Yasunobu Tsujinaka, Department of Coloproctology, Tokatsu-Tsujinaka Hospital, Chiba 270-1168, Japan
Kuang I Fu, Department of Gastroenterology, Juntendo University Nerima Hospital, 3-1-10 Nerimatakanodai, Nerima, Tokyo 177-8521, Japan
Author contributions: Fu KI and Hamahata Y supplemented the data about the patient; Tsujinaka Y analyzed the data of the patient; Fu KI wrote the paper.
Correspondence to: Kuang I Fu, MD, PhD, Department of Gastroenterology, Juntendo University Nerima Hospital, 3-1-10 Nerimatakanodai, Nerima, Tokyo 177-8521, Japan. fukuangi@hotmail.com
Telephone: +81-3-59233111 Fax: +81-3-59233111
Received: November 8, 2009
Revised: November 27, 2009
Accepted: December 4, 2009
Published online: March 28, 2010
Abstract

We report a unique case of intramucosal carcinoma in a tubulovillous adenoma arising from a single diverticulum. Endoscopic mucosal resection (EMR) was carried out successfully and completely with the assistance of laparoscopy. A 71-year-old man was admitted to our hospital because of melena and anemia. Emergent colonoscopy showed diverticulosis in the right-sided colon. However, endoscopy could not exactly detect the bleeding site. A flat elevated polyp was found within a single diverticulum located in the descending colon and diagnosed as an intramucosal carcinoma, as magnifying chromoendoscopy revealed a type IV pit pattern. As his diverticular bleeding repeated, a right-sided hemicolectomy was decided for treatment, the polyp within the diverticulum was also completely removed by EMR with the assistance of laparoscopy. Although a colonic perforation was detected immediately after EMR, the perforation was closed with endoclips intraluminally and also repaired laparoscopically from the serosal side. Histologically, the resected lesion was an intramucosal well-differentiated adenocarcinoma and the surgical margin was free of tumor.

Keywords: Early colon cancer; Diverticulum; Magnifying chromoendoscopy; Endoscopic mucosal resection; Laparoscopy