Eversion and ligation of a diverticulum: report of an inspirational case and subsequent animal study

Although most patients with colonic diverticula have no symptoms, perforation or bleeding can be troublesome. Recently, we treated an elderly patient with a diverticular perforation of the sigmoid colon who required a loop colostomy and later resection of the diseased colon. Between the operations, the colostomy resembled a sea slug with horns, which represented eversions of the diverticula. This interesting phenomenon suggests that diverticula may be everted as pseudopolyps and ligated endoscopically. Therefore, the procedure was tested on a Landrace pig, of which the large bowel wall was pulled with an endoscope at 9 different sites using forceps (n=6) or suction (n=3) and ligated. Four days later, reexamination revealed total necrosis at 8 sites and ulceration at 1. The animal was well. The bowel removed 2 weeks later showed mucosal fold convergences without perforations. Our procedure can be used for prophylactic or therapeutic treatment of patients with colonic diverticula.