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PubMed1995

[Diagnostic pitfalls of complicated colonic diverticulosis].

Irritable bowel syndrome and (or) non complicated diverticulosis, associated with fever, could simulate diverticulitis. Cancer of the sigmoid colon appears the main differential diagnosis, when diverticulitis is associated with an atypical or complete colonic stenosis on opaque enema, with a vesicoenteric fistula or with a peritonitis due to a colonic perforation. Even at laparotomy, a pseudotumoral diverticulitis cannot easily be differentiated from a colonic carcinoma. Acute diverticulitis of the caecum or ascending colon is usually mistaken for acute appendicitis. When massive and life-threatening bleeding occurs, the diverticular origin is difficult to assess. Bleeding due to peptic ulcer disease and thermometric ulceration being precluded, arteriography performed on emergency is necessary to differentiate between diverticular bleeding and angiodysplasia.

Abscess↗

PubMed1994

[Complications of colonic diverticulosis and emergency surgery. Prospective study of 56 cases].

Fifty six patients, 26 men (69.7 +/- 11.2 years) and 30 women (77.4 +/- 9.2 years) were admitted in the emergency unit for diverticulosis sigmoiditis. In 75% of cases an other pathology was associated. Excepted 11 extended peritonisis, 7 criterae of operation were required to operate on 17 men and 18 women (mean age = 73.7 +/- 12.5 years) in a delay less than 8 days. Reasons were: 12 occlusive forms, 9 peri-sigmoidis abcedations, 3 hemorrhages. Surgical procedures were: 11 Hartmann procedures, 21 resections with anatomosis of the sigmoid colon with 10 non protected and 3 subtotal colectomy. Postoperative mortality was been 11.4%. The global rate of complications was 28.5 and the mean hospital stay was 18.8 +/- 6.3 days. Application of operative criteriae is usefull to shorter significantly the delay of operation and then the length of evolution of the intraperitoneal infection site.

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PubMed1994

[Complicated colonic diverticulosis. Changes in treatment and results over 22 years].

OBJECTIVES: The aim of this study was to analyse the clinical course, surgical strategy and results in patients with complicated colonic diverticular disease. METHODS: We retrospectively compared two groups of patients who underwent surgery for complicated colonic diverticulosis from 1970 to 1984 (Group A, n = 94, mean age 60 years, 49 males, 45 females) and from 1985 to 1992 (Group B, n = 76, mean age 63.5, 32 males, 44 females). RESULTS: Patients in the two groups were comparable; only the rate of peritonitis (20 vs 8%) was different (p < 0.05). The most frequent operations in Group A were colostomy-drainage (43%) and Hartman's procedure (26%) in emergency situations and resection with immediate anastomosis (63%) or resection-anastomosis with diverting stomy (19%) in elective cases. In Group B, surgical strategy led to a different pattern of operations, 4 and 56% in emergency, and 94 and 2% in elective surgery, respectively. Overall mortality was 11%, with 17% and 4% in Groups A and B respectively (p < 0.01). This major drop in mortality was particularly important in emergency cases (31 vs 4%; p < 0.02). Morbidity in emergency surgery fell from 21 to 4% (P < 0.0006). Interrupting the use of colostomy-drainage was a major factor in reducing mortality followed by a sharp fall in mortality after Hartmann's procedure (28.5 vs 0%). CONCLUSION: The marked improvement in results between the two groups was mainly due to preferring resections of pathological colonic segments over colostomy-drainage.

Abscess↗

PubMed1994

Nonmeckelian jejunal or ileal diverticulosis: an analysis of 112 cases.

BACKGROUND: Incidentally found asymptomatic disease, chronic pain or malabsorption, emergent disease with complications are the three distinct modes of presentation of nonmeckelian jejunal or ileal diverticulosis (JID). We analyzed our experience with each of these three subsets of cases to determine both the role of operative intervention and an overall management strategy. METHODS: Retrospective analysis was done of 112 clinically diagnosed cases of nonmeckelian JID between 1975 and 1990. RESULTS: JID was an incidental finding in 47 patients (42%), and 82% of those who were followed up for a mean of 4.8 years remained asymptomatic. Forty-five patients (40%) had malabsorption or chronic pain, and only 46% of those who were followed up for a mean of 6.5 years were cured with conservative therapy. Of the 20 patients (18%) who had acute complications, 11 (10%) required operation, which was associated with minimal morbidity and one death. Ninety percent remained asymptomatic for a mean of 3.9 years. CONCLUSIONS: Incidentally found JID is usually asymptomatic and should be observed. Resection for complicated JID is safe and effective. Although malabsorption or chronic pain should be treated medically initially, the significant incidence of failure warrants further study of the role of resection in this group.

Acute Disease↗

PubMedDate not supplied

[Massive hemorrhage caused by colonic diverticulosis].

Massive hemorrhage from diverticular disease of the colon is a very difficult problem in abdominal emergency surgery. The pathogenesis of bleeding colonic diverticulosis is strictly correlated to the angioarchitecture of the colonic diverticular wall. Here the vasa recta penetrate the colonic wall from the serosa to the submucosa through connective tissue septa. Injurious factors arising from the colonic or diverticular lumen can produce an eccentric damage to the luminal side with intimal thickening, segmental weakening of the artery and its rupture with massive bleeding. Conventional barium enema is not able to show the source of the hemorrhage in the majority of the bleeding patients; colonoscopy, as primary emergency procedure, has significant positive findings in 41.5%-83.7% of patients. Radionuclide bleeding scans have a sensitivity rate of 86%-94%. Emergency arteriography localizes the bleeding source in higher rates ranging from 58% to 86% and is successful after intraarterial infusion of vasopressin or embolization in 47%-92% of patients. Surgical treatment for continued bleeding from diverticular disease is controversy. Segmental resection should be performed on patients with localized bleeding sources (positive arteriogram). Laparotomy, anterograde irrigation and intraoperative colonoscopy are indicated in patients with multiple bleeding sites and negative arteriography. Because the right colon is the most common site of bleeding in same cases is necessary to perform a subtotal colectomy with ileorectal anastomosis. Blind resections particularly in the elderly patients present high rebleeding rate (> 60%) and high mortality (30%) with sepsis accounting for the majority of deaths.

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PubMedDate not supplied

[Pathomorphology of colonic diverticulosis].

Two clinico-morphological forms of colon diverticulosis are distinguished on the basis of post-mortem and surgical material (89 observations) studied histologically, neurohistologically and electron-microscopically. The first form is characterized by the disturbance of colon peristalsis, inflammation, segmentation of the colon wall and the presence of staged changes in the colon wall muscles. Disturbances of the vegetative innervation and regional hemodynamic disturbances play a role in the patho- and morphogenesis. The second form develops in aged persons and is characterized by weakness of the colon wall with thinning of the muscle layer. In both forms atrophy of the circular muscle layer develops with dilation of perivascular spaces and formation of "weak sites" in the colonic wall.

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PubMed1994

Vascular ectasias and diverticulosis. Common causes of lower intestinal bleeding.

Lower intestinal bleeding is an important medical problem frequently responsible for hospital admission in the United States. The two most common causes of this type of bleeding are colonic diverticula and vascular ectasias. Because ectasias are difficult to diagnose and because many older individuals have asymptomatic diverticula, it is often impossible to be certain that one of these lesions is the source of blood loss in a given patient. Fortunately, bleeding from an ectasia or a diverticulum usually stops spontaneously. A conservative approach to therapy, therefore, is strongly recommended. Should a careful evaluation fail to reveal the source of bleeding and treatment become necessary because of recurrent hemorrhage, the patient should undergo an elective right hemicolectomy. The extent of resection is not altered by the presence of diverticulosis in the left colon.

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PubMed1994

Perforated jejunal diverticulosis: radiologic diagnosis.

Jejunoileal diverticulosis, which is usually asymptomatic, is commonly found at autopsy or during small-bowel barium examination. Perforation of diverticula can cause generalized or localized intra-abdominal inflammatory disease, depending to some extent on the site of the perforation. The authors describe a patient with perforation of a jejunal diverticulum; the condition mimicked colonic inflammatory disease clinically and ultrasonographically. The correct diagnosis was made on the basis of the findings of cross-sectional imaging and barium examination.

Diverticulum↗

PubMed1993

Enterolith ileus as a complication of duodenal diverticulosis--one case report and review of the literature.

Duodenal diverticulosis is not a rare condition. Usually of little clinical significance, it can produce a variety of disorders such as malabsorption, hemorrhage, diverticulitis, and obstruction. The rarest complication appears to be enterolith formation and obstruction. The case presented is a 70-year-old woman with the chief complaints of intermittent abdominal pain and vomiting. At laparotomy, duodenal diverticulitis and one enterolith obstructing the distal ileum were found. The literature review presents the other 26 cases with small bowel obstruction due to an enterolith formed within a small bowel diverticulum. The diagnosis can be established only by documenting the normalcy of the gallbladder and the presence of duodenal or jejunal diverticula.

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PubMed1995

[Clinical aspects and diagnosis of jejunal diverticulosis].

Jejunal diverticulosis consists of multiple acquired jejunal herniations of the mucosa and submucosa with an incidence of 1.3 to 2.3%. Clinical symptoms are rare. Numerous and large diverticulae, however, can cause severe abdominal complaints. Etiologically factors always consist of a motility disorder with bacterial overgrowth and rise of intraluminal pressure. An enteroclysis helps to determine the diagnosis. Plain x-rays and a CT of the abdomen are other helpful radiological tools.

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PubMed1998

[Diverticulosis and diverticulitis in the elderly].

Diverticulosis of the colon is a disease that mainly affects the elderly, presenting in 10 to 20% of this age group. The most common complication--painful diverticular disease, is usually treated conservatively with a high-fiber diet, intermittent use of antispasmodics and possibly regulation of the stools. Diagnostic differentiation is best performed using ultrasonography of the bowel wall, supplemented where necessary by computer tomography and colonoscopy (sigmoidoscopy) or, where this latter is not possible, barium enema using Gastrografin. Conservative treatment of diverticulitis with antibiotics, bowel rest, possibly including parenteral alimentation, is usually applied for three to ten days. In the absence of a response to this treatment, frequent recurrence, immunosuppression or complications (perforation, peritonitis, enterovesicular fistula), surgery is indicated.

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PubMed1998

[Urologic complications of diverticulosis of the colon].

In this paper the complications of colonic diverticulosis are reported, on the basis of two clinical cases personally observed. In the first case, a 68 year-old man, the typical symptomatology with pneumaturia, cloudy urine and watery diarrhea suggested a uro-colonic fistula, therefore a fistula between sigma and bladder, caused by a perforate diverticulum, has been diagnosed by means of cystography and barium enema. In the second case, a 64 year-old woman, the irritative symptomatology, hematuria and endoscopic picture suggested a vesical neoplasia. An accurate examination with abdominal TAC and barium enema, showed a perforate diverticulum between uterus and bladder, without affecting the bladder lumen. The surgical treatment required, in both cases, a left hemicolectomy, a minimal bladder resection in the first case, and a greater one in the second case. During the discussion, the main etiopathogenetic causes of uro-colonic fistulae together with the variants in the onset symptomatology, have been stressed.

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PubMed1962