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Based on an analysis of results of treatment of 556 patients the authors think operative measures to be indicated in cases with the perforation of diverticula, chronic peridiverticular infiltration and failure of the conservative therapy. In noncomplicated diverticulosis resection of the altered segment of the intestine should be added by serosomyotomy by an original authors' method.
Small bowel diverticula may cause abdominal pain, diarrhoea, malabsorption and weight loss. The same symptoms are also seen in Crohn's disease. Two elderly sisters with simultaneous small bowel diverticulosis and Crohn's disease are presented.
Multiple diverticulosis of the small bowel is a rare sickness and a rare radiological finding. Positive diagnosis can be made with radiological examination or laparatomy of patients.
An investigation of the formal patho-genesis of the so-called intramural esophagus diverticulosis is carried out on a case confirmed by autopsy. The roentgenological diagnosis corresponded morphologically with a proliferation of sub-mucous esophagus glands and a dilatation of their outlets, a portion of which displayed platelet epithelial metaplasia. Diverticle formation is feigned by widening, predominantly of the outlets, which could be traced into the muscular wall layers. In the present case esophagitis with attendant inflammation along the outlets lead to fistula formation into the anterior mediastinum with attendant mediastinitis. Aspirations were due to constrictions of the esophagus lumen. The patient came to exitus as a result of purulent abscessing aspiration pneumonia complicated by pulmonary artery emboli.
We report here two new cases of ureteral diverticulosis. This condition is found usually in the man of the fifties who has most frequently an urinary tract infection or a prostatic adenoma. The roentgen findings are multiple out-poutchings of the lumbar ureter. Several factors are combined (constitutionnal, urinary tract infection, disordered ureteral-motility) to explain the creation of diverticules in the areas of weakness of ureteral wall, where penetrate the vessels.
Diverticulosis of the jejunum is an uncommon condition. We found four patients with such diverticula among 40,341 hospital admissions. All four patients presented with acute volvulus of the small bowel. It is suggested that the diverticula bearing segment becomes heavier due to the diverticula and the semisolid jejunal contents consisting of roughage, millet and cereals in the staple diet of our patients. Both factors contribute to small bowel volvulus. Jejunal diverticula may be missed because they are buried between the leaves of mesentery or adherent loops of jejunum. With a patient has vague abdominal symptoms, the possibility of jejunal diverticula should be considered.
Issuing from an own observation the clinical picture of the adenomyomatosis and the intramural diverticulosis of the gall bladder is considered from the clinical, radiological and pathologo-anatomical point of view. The opinions which are not homogeneous are explained and discussed. Also abortive forms may radiologically be proved with probability.
Colonic diverticula in reality are herniations of the mucosa through a thickened musculature of the bowel wall where it is penetrated by the vasa recta. Their prevalence increases with western food and with age. Low-residue diet and increased intraluminal pressure are considered to be etiologic factors. Diverticular disease is characterised by inflammatory and bleeding complications. Diverticulitis may lead to peridiverticulitis and pericolitis with frank peritonitis. Uncomplicated diverticulosis warrants observation only under dietary guidance. Repeated complications indicate elective operation by one-stage-resection. Perforation, abscess and massive bleeding necessitate immediate operative treatment aimed at elimination of the involved segment.
Diverticulosis of the vermiform appendix is not a common entity. Due to possible complications resulting from this lesion the discovery of an appendiceal diverticulum on barium studies should not be overlooked and may be an indication for appendectomy.
Two cases of acute jejunal diverticulitis are presented and confronted to data found in the literature. Acquired jejunal diverticulosis is a rare disease; its complications occur in a small percentage of cases. Chronic complications (malabsorption, megaloblastic anemia) should be treated medically. Acute complications (diverticulitis, perforation, haemorrhage, obstruction) require an emergency operation. Preoperative diagnosis is rarely made. Radiological or peroperative discovering of asymptomatic jejunal diverticula does not justify surgical treatment.
Jejunal diverticulosis is an uncommon condition, but it is often associated with a number of symptoms including postprandial abdominal pain, distension, flatulence, borborygmus, nausea, vomiting, diarrhea and constipation and with complications such as vomiting blood or coffee grounds material, melena and shock. The authors report such a condition in a 71-year-old man. Resection is the treatment of choice for relieving symptoms, and for preventing or treating complications.
In the course of evaluating an infant with recurrent episodes of bronchiolitis, the esophagus was radiologically examined. A totally unexpected finding was the presence of intramural diverticulosis of the upper part of the esophagus. On reexamination four months later, the diverticula had disappeared.
Case report of diverticulosis of the small bowel complicated by diverticulitis. Radiography is the method of choice to demonstrate this finding preoperatively. This entity should be included in the differential diagnosis of right lower quadrant abdominal pain.
The first case report of a patient with intramural diverticulosis was given in 1960 by Mendl et al. Since then at least 32 cases have been described. In this paper another case report is given, whose clinical symptomatology differs from most other cases described. The etiology and the pathogenetic significance of candidiasis in this disorder still remains unclear. Differential diagnosis and etiology are discussed.
Intramural pseudo-diverticulosis of the oesophagus is the result of an anomaly of the deep glands of the oesophagus, the pathogenicity of which is open to debate. A rare lesion, it is often unrecognised on endoscopy, but presents characteristic features on double-contrast examination.
The authors report a case of giant diverticulum of the sigmoid colon, a very rare complication of diverticulosis of the colon, since only 38 cases have been reported in the literature. The diverticulum was seen at barium enema in a 66-year-old man complaining of digestive symptoms consisting of lower abdominal pain, tenesmus, diarrhea and fever. Segmental resection of the sigmoid colon including the site of implantation of the diverticulum with end-to-end anastomosis at the same operative stage led to definitive cure. On the basis of a study of the literature, the authors define the clinical, diagnostic and pathogenic characteristics of the condition.
Jejunal diverticulosis is an unusual finding. We present the case of 70-year-old man with bacterial overgrowth secondary to multiple diverticula of the small intestine. The diagnosis was based on clinical events, x-ray films and mainly on the optimal answer to antibiotic treatment.
About half of the carcinomas and polyps of the large intestine is placed in the descendent colon and in the sigma, where most frequently the diverticula are found. Literature refers to them as varying percentage of association diverticulosis-carcinoma between 2 to 8 percent. The increase of the frequency of neoplasms and diverticula in the same population classes may indicate common factors in their development. The study includes 1149 cases of colo-rectal neoplasms examined in the Department of Scienze Chirurgiche--University of Siena, from january 1981 to december 1993. The association of carcinomas and diverticula has been found in 8.96% of the cases (103 pts) and the tumours with stenosis in 59,2% of the cases. The colonoscopy is very important for a more precise differential diagnosis especially in occlusive forms, in which a multiple biopsy is indispensable. Referring to the data of literature, the authors consider that patients with symptomatic diverticular disease have a major general risk for cancer of the large intestine; the existence of certain common symptoms in either disease (especially the bleeding) may not exclude the presence of a tumor in patients with diverticular disease.