Subepithelial lesions (SELs) of the colon are increasingly identified during screening
colonoscopy and may represent a wide spectrum of benign or malignant conditions, including
lipomas, gastrointestinal stromal tumors, lymphomas, or cystically dilated glands.
While endoscopic resection is feasible for selected SELs, accurate diagnosis and staging
remain essential, as extrinsic compression can closely mimic intramural pathology
[1]
[2]
[3].
We present the case of a 78-year-old man referred for endoscopic resection of a suspected
subepithelial lesion in the cecum, incidentally discovered during screening colonoscopy.
A computed tomography (CT) scan was prescribed but not performed before colonoscopy.
The patient had a history of arterial hypertension and prior prostatectomy. No other
relevant medical conditions or surgeries were reported.
Endoscopic examination revealed a rounded bulge measuring approximately 7 cm on the
cecal wall ([Fig. 1]), with an intact overlying mucosa and no involvement of the appendiceal orifice
or ileocecal valve. Endoscopic submucosal dissection was initiated to access the lesion
and achieve a definitive diagnosis, although complete resection appeared difficult
to attain. An adaptative traction device (ATRACT; ATRACT Device and Co., Lyon, France)
was used to better expose the submucosal layer after incision and trimming. However,
the procedure was aborted upon recognition of an entirely extramural origin of the
mass through a small perforation. The traction device was retrieved and the resulting
mucosal defect was completely closed with endoscopic clips ([Video 1]).
Fig. 1 A rounded bulge on the cecal wall mimicking a subepithelial lesion.
Penile prosthesis mimicking a colonic subepithelial lesion.Video 1
A subsequent abdominal CT scan revealed the presence of an inflatable penile prosthesis,
with the fluid reservoir located in the right lower quadrant, directly abutting the
cecal wall ([Fig. 2]).
Fig. 2 Computed tomography scan showing an inflatable penile prosthesis, with the fluid reservoir
located in the right lower quadrant, directly abutting the cecal wall.
This unusual case underscores how some extraluminal medical devices can simulate true
SELs during colonoscopy. In inflatable penile prostheses, the reservoir is typically
placed in the lower abdomen or pelvis, often within the retropubic space. Although
rare, reservoir displacement has been reported in up to 2%–3% of cases and may result
in compression of adjacent organs, including the colon [4]
[5].
In atypical presentations, extrinsic compression from medical devices should be considered
in the differential diagnosis. Detailed history taking and cross-sectional imaging
are crucial to avoid unnecessary and potentially harmful interventions.
Endoscopy_UCTN_Code_CPL_1AH_2AZ_3AZ
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
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