Submucosal tumor-like protrusion - A case of terminal ileum diverticulum with incarcerated fecalith.

A 43-year-old female presented with a 4-day history of lower abdominal distention and pain. Colonoscopy revealed a 3×3cm submucosal tumor-like spherical protrusion in the ileocecal region, prolapsed from the terminal ileum to the cecum, with a smooth surface mucosa. Then EUS and contrast-enhanced abdominal CT further characterized the lesion. To identify the nature of the lesion and remove it, endoscopic submucosal dissection (ESD) was performed under general anesthesia: After resection of the mucosa on the surface of the elevated lesion, a spherical fecalith measuring about 2.0×2.0cm was found. After removal of the fecalith, the huge diverticulum was exposed. The patient received immediate postoperative management and monitoring，with no complications occurring during hospitalization. Follow-up colonoscopy performed nearly 4 months post-ESD demonstrated an uneventful recovery. No adverse reactions were observed at the 6-month follow-up.