The Relationship Between Colonic Diverticulosis and Soybean-Like Small Round Stool

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Although phenomena and manifestations may often be encountered in routine practice, there are often instances where the cause or identity of those phenomena and manifestations is unclear. Soybean-like small (about 1 cm) round stool (SLSRS) is often encountered during colonoscopy (CS) (Figure 1). The current study examined the causal relationship between such stools and diverticula, and the results are discussed herein.

Subjects were 78 patients who underwent CS by the authors at Kumagaya Surgery Hospital from October 2014 to June 2015. The number of diverticula in the colon, the location of diverticula, the number of bowel movements prior to CS, and the presence or absence of SLSRS were examined in these patients. The causal relationship between diverticula and SLSRS was also examined. Preparations for CS at Kumagaya Surgery Hospital were as follows.

Diverticula were present in 30 of the 78 patients (38.5%). The male:female ratio for patients with diverticula was 24:6 as compared to 28:20 for patients without diverticula. The average age of the patients with diverticula was 66.7 ± 13.2 years as compared to 60.4 ± 17.0 years in those without diverticula. Patients with diverticula had an average of 9.8 ± 3.7 bowel movements prior to CS while patients with no diverticula had an average of 9.1 ± 3.0 bowel movements. Of the 30 patients with diverticula, 12 patients had 1-5 diverticula, 11 had 6-10 diverticula, and 7 had 11 or more diverticula.

SLSRS is often encountered during CS. Such stool is often noted when diverticula are present. In light of their shape, such stool is presumably produced when feces is caught and forged in diverticula. However, no studies have reported data indicating a causal relationship between diverticula and such stool. Small and round stool is referred to as “stool in separate hard lumps,” so there is no consistent designation for these stools in practice. The cathartic and prokinetic agents taken prior to CS do not cause SLSRS to lose their shape. Such stool remains in the colon during CS, where it is often encountered. SLSRS was noted irrespective of the location and number of diverticula.