A 31-year-old man with a 2-day history of periumbilical abdominal pain was evaluated
at our hospital. Abdominal computed tomography (CT) revealed ileocecal inflammation
and multiple cecal diverticula ([Fig. 1]
a). Colonoscopy identified several diverticula in the cecum, particularly one manifesting
inflamed and edematous mucosa coated in yellowish-white purulent exudate ([Fig. 1]
b). A continuous purulent discharge was noted.
Fig. 1
a Computed tomography (CT) revealed ileocecal inflammation, multiple cecal diverticula,
and fecaliths. b Colonoscopy identified the diverticula in the cecum especially one with inflamed
and edematous mucosa coated in yellowish-white purulent exudate.
Upon obtaining informed consent, we embarked upon endoscopic direct diverticulitis
therapy (EDDT), using a digital single-operator cholangioscope (DSOC) (EyeMax, 3.3
mm; Micro-Tech, Nanjing, China). This revealed a substantial volume of fecaliths in
the diverticular cavity ([Fig. 2]
a, [Video 1]). These fecaliths were meticulously fragmented, extracted, and removed using a disposable
basket ([Fig. 2]
b) and biopsy forceps ([Fig. 2]
c), following repeated lavages with metronidazole and sodium chloride. This left the
diverticular mucosa cleansed though characterized by roughness and swelling, without
evidence of perforation ([Fig. 2]
d). A 7-Fr pancreatic duct stent was strategically placed to ensure unobstructed drainage
([Fig. 3]).
Fig. 2 Endoscopic treatment of diverticulitis using a digital single-operator cholangioscope
(DSOC). a A considerable volume of fecaliths could be seen within the cecal diverticular cavity.
b The fecaliths were carefully fragmented, extracted, and removed using a disposable
basket. c Several fecaliths were extracted using a biopsy forceps. d The cleared diverticular cavity.
Initial report on the use of a digital single-operator cholangioscope for endoscopic
direct diverticulitis therapy (EDDT).Video 1
Fig. 3 A stent was strategically placed to ensure unobstructed drainage.
The patient’s postoperative course was marked by rapid alleviation of abdominal discomfort,
a decline in routine hematological and C-reactive protein (CRP) levels, and diminished
inflammation on subsequent CT imaging ([Fig. 4]).
Fig. 4 Postoperative CT demonstrated the reduction in the severity of ileocecal inflammatory
exudation compared to before the procedure.
Acute diverticulitis is mainly treated through medication and surgical intervention
[1]. The use of a DSOC has proven effective for managing inflammations in natural conduits
such as the bile duct, pancreatic duct, and appendix [2]
[3]. To the best of our knowledge, this is the first report of the use of a DSOC to
treat acute diverticulitis, illustrating its potential for precise, minimally invasive
therapy. The direct visualization and management of diverticular contents offers a
safe, efficient alternative to traditional interventions, with the promise of shorter
hospital stays and rapid recovery. This novel EDDT approach could reshape the management
of acute diverticulitis, emphasizing the importance of technological integration into
endoscopic practice.
Endoscopy_UCTN_Code_TTT_1AQ_2AF
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