This 67-year-old white female patient reported severe pain in the lower left abdominal quadrant associated with subfebrile temperatures and leukocytosis with left shift. Clinical examination was significant for pain on pressure and mild guarding of the lower left abdominal quadrant. There was no fever. Ultrasound revealed evidence of diverticulitis with thickening of the intestinal wall and a small amount of interenteric fluid accumulation. After a week of antibiotic therapy, the signs of inflammation resolved. Computed tomography, however, raised the suspicion of a stenosing malignant process. Colonoscopy was performed 14 days after the onset of symptoms.
The video recording shows the findings in the sigmoid colon. Beside the non-inflamed diverticula, one sees an intensely erythematous, edematous area. The sigmoid is narrowed. The tissue is soft upon contact with the biopsy forceps. The diverticular orifice is obscured by stool or purulent mucous.
If colonoscopy is performed only 14 days after treatment of diverticulitis, the procedure must be conducted with the utmost care with with the smallest possible amount of gas insufflation. If performed for ruling out malignant disease, it is better to postpone colonoscopy, if possible, to the inflammation-free interval.