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CC BY 4.0 · Journal of Digestive Endoscopy
DOI: 10.1055/s-0045-1812314
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Inverted Colonic Diverticulum: Diagnostic Features on Conventional Colonoscopy and Endoscopic Ultrasound

Authors

  • Lanfan Liang   #

    1   Department of Gastroenterology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, P. R. China

  • Kui Zhao   #

    1   Department of Gastroenterology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, P. R. China

  • Xiangsheng Fu

    1   Department of Gastroenterology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, P. R. China

Funding The work was supported by the Central Government-Directed Project for Local Science and Technology Development (Grant No. 2024ZYD0144), the Science and Technology Project of Sichuan Provincial Health Commission [Grant No.24WXXT05], and the Project of “CMC Talents” Peak Plan of Chengdu Medical College [Innovation Research Team Project].
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A 63-year-old male presented with abdominal bloating and underwent diagnostic colonoscopy, revealing a 6.0 × 5.0 mm polypoid lesion at the rectosigmoid junction under white-light imaging ([Fig. 1]). Narrow-band imaging demonstrated concentric muscular folds radiating from the center ([Fig. 2]). Subsequent 20MHz mini-probe endoscopic ultrasound (EUS) revealed significant elevation of the mucosal layer, muscularis mucosae, and submucosa into the intestinal lumen. The raised area measured approximately 6 × 3 mm in cross-section, with a central hyperechoic shadow accompanied by a distinct posterior acoustic shadow, consistent with the characteristics of intraluminal gas ([Fig. 3]), confirming the diagnosis of inverted colonic diverticulum (ICD). Based on the characteristic endoscopic and EUS findings, endoscopic intervention was avoided. The patient was managed conservatively without biopsy or polypectomy and was advised to undergo routine colonoscopic surveillance.

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Fig. 1 White-light endoscopy: A protruding lesion with a smooth surface is observed at the rectosigmoid junction.
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Fig. 2 Narrow-band imaging: Demonstrates radially arranged mucosal muscle folds converging toward a central depression.
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Fig. 3 Endoscopic ultrasonography (20 MHz mini-probe) findings: Demonstrates a polypoid lesion characterized by lifting of the full mucosal and submucosal architecture. A central bright, hyperechoic focus with a clean acoustic shadow is evident, indicative of trapped gas within the lesion.

Authors' Contributions

The draft of the manuscript and data collection were written by L.F.L. and K.Z. Critical revision of the manuscript for important intellectual content was revised by X.S.F.


Patient's Consent

The authors certify that they have obtained the patient consent form.


# Contributed equally.




Publication History

Article published online:
14 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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