Endoscopic management of colonic diverticulitis with fecalith impaction: a novel suction technique

A 40-year-old man presented to our hospital with a 1-year history of recurrent left lower abdominal pain. A computed tomography (CT) scan revealed multiple colonic diverticulitis ([Fig. 1] a, [Video 1]). Colonoscopy confirmed the presence of fecalith impaction within the diverticula. Initially, we attempted to extract the fecaliths using a short transparent cap for suction ([Fig. 1] b). However, this approach proved challenging due to the narrow openings of the diverticula. Therefore, we switched to a long transparent cap, which allowed better visualization of the diverticulum openings and facilitated alignment of the fecaliths with the axis of the endoscope’s working channel for effective suction ([Fig. 1] c). The long cap enhanced suction power and provided sufficient internal space for efficient fecalith removal. Complete extraction from all diverticula was achieved without complications ([Fig. 1] d). Subsequently, endoscopic band ligation (EBL) was performed on the inverted colonic diverticulum ([Fig. 1] e). The patient reported significant improvement in abdominal pain with no adverse reactions. Follow-up colonoscopy at 1 month demonstrated complete mucosal healing at the treatment site ([Fig. 1] f).

Fig. 1 a CT scan revealed multiple colonic diverticulitis caused by calcified fecaliths. b Using a short transparent cap for suction. c Using a long transparent cap for suction. d The impacted fecaliths aspirated from diverticula. e The inverted diverticulum was exposed by suction with the transparent cap and ligated by EBL. f The colonic mucosa at the treatment site had healed completely. Abbreviation: EBL, endoscopic band ligation.

Endoscopic management of colonic diverticulitis with fecalith impaction: a novel suction technique.Video 1

Fecalith impaction is a leading cause of complicated colonic diverticulitis, often resulting in perforation or bleeding [1]. In cases where the diverticulum has a narrow opening, traditional methods such as biopsy forceps are often ineffective for fecalith removal. Based on our experience, the use of a long transparent cap significantly improves suction efficiency by exerting greater pressure and facilitating better expansion of the diverticulum opening. Furthermore, EBL is a simple, safe, and effective technique for the curative treatment of diverticula [2] [3]. No abnormalities were observed during follow-up. In conclusion, long cap-assisted suction represents a promising and minimally invasive option for managing fecalith impaction in colonic diverticula, offering a safe and effective alternative to conventional techniques.

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Publication History

Article published online:
06 May 2025

• References

• 1 Tursi A, Scarpignato C, Strate LL. et al. Colonic diverticular disease. Nat Rev Dis Primers 2020; 6: 20
• 2 Kobayashi K, Nagata N, Furumoto Y. et al. Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study. Endoscopy 2022; 54: 735-744
• 3 Li J, Zhou Y, Liu D. et al. Endoscopic band ligation: a simple, safe, and effective method for refractory diverticular bleeding (with video). Gastrointest Endosc 2025; 101: 220-221