Question: A 40-year-old man visited hospital due to right lower quadrant (RLQ) abdominal pain that had persisted for 8 days. Colonoscopy revealed a hard fecaloma impacted in the cecal diverticulum. We attempted endoscopic removal using alligator grasping forceps, a tripod basket, and net. This attempt failed because the fecaloma was too slippery, large, and hard to grasp (Fig. A). A few days later, the patient was admitted to the hospital emergency room due to recurrent intractable abdominal pain. Abdominal CT revealed a cecal diverticulum with a diameter of 2.7 cm, filled with fecal material and mild edematous wall thickening, and a normal appearance of the appendix (Fig. B). The abdominal pain had not been controlled by antibiotics, including ciprofloxacin, metronidazole, and cimetropium bromide, but was suboptimally controlled by nonsalicylate analgesics such as tramadol. We strongly suspected that localized RLQ abdominal pain was caused by fecaloma of the cecal diverticulum. As we had previously failed in endoscopic mechanical removal of the fecaloma, we tried another method involving a cola injection into the fecaloma. The fecaloma was softened by the cola injection and successfully removed using a net (Fig. C, D). Abdominal pain was dramatically resolved and no other complications were observed. One year later, the patient visited hospital suffering from similar abdominal pain. What do you think could be the cause of his RLQ abdominal pain? What is the next step to control his RLQ abdominal pain?