Abstract

An inverted colonic diverticulum (ICD) is a rare yet benign feature of diverticular diseases, usually requiring no treatment. Nonetheless, for a junior endoscopist, the condition is sometimes difficult to differentiate from a colonic polyp. Aggressive biopsy or polypectomy of an ICD could result in colon perforation. Special features of an ICD include its sessile morphology, a normal appearance similar to the surrounding mucosa, and Aurora rings around its base. It could be deformed or flattened with manipulations such as forceps probing, water jet spraying or air insufflation. In this report, we describe two cases of inverted colonic diverticulum and review the literature on the prevalence, diagnostic approaches, and management of the condition. Since the prevalence of diverticular diseases and polyps both increase with age, it may be more common to encounter ICDs and polyps during colonoscopy in the elderly. It is important to consider these two conditions before taking further steps into invasive treatment.