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PubMed1976

Medical therapy of colonic diverticular disease.

Treatment of asymptomatic diverticulosis is geared to the prevention of constipation, with vigilance for possible signs of complications. A bulky stool decreases colonic intraluminal pressures, probably lessening pain and the chance of development of new diverticula. Increased stool weight may be achieved by the addition of vegetables, fruits, and cereals (bran) to the diet. Foods with undigestible residues should be avoided. When dietary manipulations are not well tolerated, hydrophilic bulk laxatives are a useful alternative. Treatment of acute attacks consists of bowel rest and administration of intravenous fluids and antibiotics. Side effects of anticholinergics may outweigh their questionable usefulness. Nonabsorable oral sulfonamides have little or no place in the treatment of the acute attack (peridiverticulitis).

Acute Disease↗
PubMed1976

Surgical management of colonic diverticulitis and complicated diverticulosis.

The aim of surgery in the management of diverticulitis and complicated diverticulosis is to remove the disease process as quickly as possible. This approach reduces the likelihood of complications and often avoids the necessity of multistage procedures. Indications for resection include failure of a first attack to subside, recurrent attacks, and free perforation with spreading peritonitis. Three-stage procedures should be reserved for extremely serious disease. Other complications requiring surgery are fistula, obstruction, and massive and uncontrolled bleeding. Massive bleeding is caused by diffuse colonic diverticulosis and is rarely associated with diverticulitis. Abdominal mass, obstruction, or recurrent episodes of slight bleeding should suggest the possibility of underlying tumor and are compelling indications for early resection.

Abscess↗
PubMed1980

Lower bowel disorders. 2. Diverticular disease.

Diverticula are thought to result from high intraluminal pressures in closed segments of the sigmoid colon, causing herniation of mucosa and submucosa through muscle along the paths of the nutrient vessels. Mild diverticular disease usually can be managed with bed rest and a controlled diet, plus administration of antibiotics. Acute diverticulitis, especially recurrent bouts, may call for colonic resection.

Aged↗
PubMed1985

Diverticular disease. Current trends in therapy.

Colonic diverticulosis is a common problem in the United States, apparently related to low dietary intake of fiber. Diverticula may bleed or cause local infection or perforation. When antibiotic treatment of infection fails, surgical intervention is necessary. Currently, the most common procedures are primary resection and anastomosis for limited disease and a two-stage Hartmann procedure for severe disease or abscess. If the fiber hypothesis of diverticular formation is correct, then addition of fiber to the diet should prevent diverticular disease.

Adult↗
PubMed1987

Colonic diverticular disease. Its spectrum in a community hospital.

A retrospective study of 239 patients who were hospitalized for diverticular disease is reported. Two thirds of patients had simple diverticulosis, and the remainder had gastrointestinal bleeding, evidence of microabscess, or more serious complications. The prevalence of bleeding on the left side in this series differs from the prevalence of right-sided bleeding noted in the literature, and this difference is unexplained. Only three patients in this series died (overall mortality, 1.2%); all had other associated life-threatening diseases.

Adult↗
PubMed1992

Colonic diverticula. When complications require surgery and when they don't.

The value of a high-fiber diet in preventing and treating colonic diverticula is firmly established. Although the diagnosis of diverticulosis is usually made with colonoscopy or barium enema examination, computed tomography has become the test of choice during acute diverticulitis, when the diagnosis cannot be confidently made clinically. Recently developed surgical principles for diverticulitis include radiographically directed drainage with delayed operation for peridiverticular abscess, resection of the site of disease in patients with general peritonitis, and primary anastomosis in most cases requiring urgent intervention. Diverticulosis accompanied by abdominal pain or irregular bowel habits is by itself rarely an indication for surgery. Diverticular bleeding usually resolves spontaneously, but persistent bleeding can usually be successfully treated with segmental colectomy after localization of the bleeding site with colonoscopy or arteriography.

Abscess↗
PubMed1976

Dietary fiber and diverticular disease.

Can the regular consumption of bran and other fibrous foods help in preventing diseases of the colon? Indirect evidence supports the idea, although much remains to be learned. It seems probable that bulkier feces could increase the diameter of the colon and prevent sudden sharp rises in pressure that are believed to be responsible for the formation of diverticula. For most people, fiber is probably harmless and it may do some good.

Cellulose↗
PubMed1994

Prospective analysis of 40 initial laparoscopic colorectal resections: a plea for a randomized trial.

The experience reported herein is on our initial 40 cases of laparoscopic-assisted (LA) colorectal resection that were prospectively evaluated. The operations were performed for colonic tumors of the right segment (n = 4), sigmoid (n = 11), or rectum (n = 7), diverticular disease (n = 17), and chronic constipation (n = 1). Among 22 tumors, 11 were malignant. The operative procedures were 4 right hemicolectomies, 28 segmental left colectomies, 5 anterior resections, 2 abdominoperineal resections, and 1 total colectomy. Thirty-one patients (77.5%) had a successfully completed LA resection. The reasons for conversion in the majority of the cases (66.6%) were difficulties in dissection. In the entirely LA procedures, the mean flatus postoperative day was 3, the mean postoperative hospitalization was 10.7 days, and there were 8 complications (25%) in 7 patients. Two patients were reoperated 2 and 3 months later for adhesion and ischemic stenosis of the colon above the anastomosis. There was 1 death in the LA group (3.2%). The length of operative specimen was 19.6 cm, and the mean number of resected lymph node was six. In contrast to laparoscopic biliary surgery, the benefits of LA colorectal surgery are not obvious. A randomized trial comparing LA and open colorectal resection must be carried out.

Colectomy↗
PubMed1996

Laparoscopic-assisted reversal of Hartmann's procedure: a simplified technique and audit of twelve cases.

Laparoscopic-assisted reversal of Hartmann's procedure was performed in 12 patients over a 2-year period. The group comprised three patients with colonic carcinoma and nine with diverticular disease, their mean age being 62 years (range 40-73). In all twelve cases, intestinal continuity was successfully restored, without conversion to open surgery, in a median anesthetic time of 165 min (range 110-240). One patient required a temporary defunctioning colostomy and two other patients had three complications. The median postoperative hospital stay was 8 days (range 5-12). We report a retrospective audit of this consecutive series of 12 patients, showing that laparoscopic-assisted reversal of Hartmann's is technically feasible. We also give details of the morbidity associated with the technique.

Adult↗
PubMed1981

Changing views on diverticular disease as a cause of gastro-intestinal bleeding.

Over the past 60 years there has been continuing controversy and changing views about the relative importance of diverticular disease as a cause of gastro-intestinal haemorrhage. In the 1920s neoplasms were thought to be the commonest cause of colonic bleeding, then in the 1950s diverticulitis and subsequently diverticulosis. However, at that time the diagnosis of diverticular haemorrhage was mostly one of exclusion. In the 1960s an attempt was made to identify the site of bleeding and it was found that even though diverticula are mostly in the left colon, bleeding occurred from the right colon. A partial explanation for this came with the advent of arteriography and the discovery of caecal angiodysplasias. The relative importance of the two conditions remains uncertain but it is clear that, in patients with gastro-intestinal haemorrhage, the presence of diverticula should not stop a thorough search for other causes of bleeding.

Aged↗