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At least 325 records · Page 18Linked to original sources
PubMed1999

[Computed tomography study of the sigmoid colon: discriminating diagnostic criteria and interobserver correlations].

PURPOSE: To assess the value of pericolonic findings at CT in the evaluation of the sigmoid colon. MATERIALS AND METHODS: A total of 210 CT examinations were retrospectively reviewed by 3 blinded radiologists. Data was analyzed to determine the interobserver correlation and the value of pericolonic and colonic wall findings in diagnosis of sigmoid colon pathology. RESULTS: The interobserver correlation for pericolonic findings was equal to or superior to that for colonic wall findings. The presence of abnormal pericolonic fat was the most sensitive (88%) and specific (93%) sign to differentiate a diseased sigmoid colon from a normal one or from sigmoid diverticulosis. Wall-thickening was less sensitive (82%) and specific (76%). Findings suggesting malignancy over diverticulitis included acute zone of transition, focal fatty infiltration, and lymph nodes. Symmetrical and circumferential wall thickening, target-like enhancement, and local fatty proliferation were findings suggesting colitis over diverticulitis. Wall thickening more than 15 mm, involvement of 15 cm or less, asymmetrical involvement, acute zone of transition, and homogeneous or heterogeneous enhancement were findings suggesting malignancy over colitis. CONCLUSION: To render a diagnosis, the evaluation of the fat infiltration must prevail on the parietal thickening appreciation.

Adipose Tissue↗
PubMedDate not supplied

Predictive value of a pathophysiological score in the surgical treatment of perforated diverticular disease.

Resection is the preferred method of perforated diverticular disease treatment compared to conservative treatment. However, the immediate or deferred timing of bowel continuity restoration for advanced degrees of peritoneal contamination is debatable. This is a retrospective study designed to identify operative mortality predictors and guidelines for safe primary anastomosis. A pathophysiological score (acute physiology and chronic health evaluation, APACHE II) was applied to 135 consecutive patients who had undergone surgery for acute inflammatory complication of diverticular disease. A multivariate analysis was used to identify prognostic factors such as age, chronic diseases, neoplastic cancer, Acute Physiology Score (APS), Hinchey's classification and APACHE II scores. Seventy patients underwent primary resection and anastomosis, 35 underwent Hartmann's procedure and 15 conservative treatment. There was a significant correlation between operative mortality and increasing disease severity based on Hinchey's classification, APS and APACHE II scores. The multivariate analysis proved APACHE II scores to be the only prognostic factor of operative mortality. Both single and multivariate analysis of variance failed to identify a factor significantly associated with surgical and/or medical postoperative complications. APACHE II scores were the best predictor for operative mortality in patients with diverticular disease complications, but none of the classification criteria used was effective in predicting postoperative complication. Patients with phlegmonous sigmoiditis can be safely treated with primary resection and anastomosis. Conservative treatment should not be considered an effective method for diverticular disease. A prospective trial comparing resection with and without colostomy should be done for local and diffuse purulent peritonitis treatment. Hartmann's procedure is seen to be the only indicator for faecal peritonitis.

APACHE↗
PubMedDate not supplied

Physiological studies on nitric oxide in the right sided colon of patients with diverticular disease.

BACKGROUND/AIMS: Previously, we reported that non-adrenergic non-cholinergic (NANC) inhibitory nerves are decreased in the left-sided colon of patients with diverticular disease, contributing to their intraluminal high pressure by segmentation (1). It is established that nitric oxide (NO) is released by stimulation of NANC inhibitory nerves. Among Oriental people, including the Japanese, right-sided diverticular disease has predominated more frequently than among Western people. In order to evaluate the function of NO in the right-sided colon of patients with diverticular disease, we examined the enteric nerve responses in colonic materials from patients with this disease, using the right-sided normal colon as a control. METHODOLOGY: Colonic tissue specimens were obtained from 8 patients with diverticular disease of the right-sided colon, and normal segments of the right-sided colon were obtained from 11 patients with localized diseases. A mechanograph was used to evaluate in vitro colonic responses to electrical field stimulation (EFS) of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, N(G)-nitro-L-arginine (L-NNA), and L-arginine. RESULTS: 1) Cholinergic nerves were more dominant in the diverticular colon than in the normal colon (p<0.01). 2) NANC inhibitory nerves were found to act on the normal colon and to a lesser extent in the diverticular colon (p<0.05). 3) NO mediates the relaxation reaction of NANC inhibitory nerves in the normal colon and to a lesser extent in the diverticular colon. CONCLUSIONS: The intrinsic intestinal innervation contains excitatory and inhibitory nerves and the former, especially cholinergic nerves, are dominant in the right-sided colon with diverticula. In addition, reduction of the action of NANC inhibitory nerves by substances such as NO may be largely related to the tight intraluminal pressure by colonic segmentation observed in the right-sided colon with diverticula.

Adrenergic Fibers↗
PubMed2000

[Surgical treatment of acute sigmoiditis].

Virtually unknown at the beginning of the century, diverticulosis has become very prevalent in western countries. The natural history of the disease is notable for its acute, sometimes recurrent, attacks of diverticulitis and the significant risk of serious complications : abscess, fistula, peritonitis. CT scanning predominates in the diagnostic evaluation. It can provide both diagnostic and prognostic information. Most mild attacks of diverticulitis respond well to medical therapy while surgical treatment is indicated in the complicated forms of the disease. Surgical therapy has gradually evolved from a complicated three stage approach to two-staged, single-staged, or even minimally invasive procedures. The current trend is to intervene surgically well after the resolution of the acute attack. To achieve this, liberal use of percutaneous drainage of collections and medical treatment are advocated. The decision to perform prophylactic sigmoid resection must be based on a balance assessment of risk factors including age, severity of attacks and their recurrence.

Acute Disease↗
PubMedDate not supplied

[Surgical treatment of complicated diverticular disease of the colon].

The present study analyzes the results obtained by the AA with the different types of surgery adopted in the treatment of the complicated diverticulosis of the colon, highlighting, on the basis of data available in literature, the possible treatments in the different clinical settings. A retrospective study analyzing type of complication, the surgical technique adopted, Hinchey stage, mortality and morbidity rates and average hospital stay correlated with the kind of intervention has been carried out on 83 surgical interventions performed between 1984 and 1988. The results show that 43 R.A.P. (R.A.P. = primitive anastomosis resection) (32 cases at the I-II stage and 11 cases at the III-IV stage), 27 Hartmann (11 at the I-II and 16 at the III-IV), 9 colostomies (2 at the I-II and 7 at the III-IV), 2 esteriorizations and 2 simple drains have been carried out on a total of 44 intestinal perforations, 16 recurrent diverticulitis, 13 intestinal occlusions, 2 fistulae, 5 abscesses and 3 hemorrhages. The total mortality rate amounts to 10.6%; the morbidity rate of the R.A.P. interventions to 14.4 (I-II stage-related morbidity = 15.6%, III-IV stage = 63.6%), Hartmann's to 9.6% and that of the colostomies to 3.6%. Furthermore, in this work, we have considered the cases of riconversation after Hartmann interventions (9 cases): in the second operations the mortality and morbility rate amounts to 0 and the hospital stay to 9 days. The AA analyze on the surgical technique adopted in the different cases and the of choice criteria. According to the data obtained and to current literature, it results that the primitive anastomosis resection represents the first choice intervention at the I-II stage, although, in selected cases, it can be carried out also at the III-IV stage. Hartmann surgery confirms its effectiveness while simple colostomy is no longer accepted in literature.

Adult↗
PubMed1975

Clinical experiences with colonoscopy. A review of 100 cases.

Our experience with 100 colonoscopic examinations are described. The clinical value of the procedure is outlined and the minimal degree of attendant morbidity, when performed by a competent endoscopist, are emphasized. The indications and contraindications for this relatively recently devised diagnostic and therapeutic modality should be commonly known. The procedure should be done whenever indicated.

Abdomen↗
PubMed1975

[Diverticulosis--diverticulitis].

Diverticulosis is found in approximately 5% of people living in western industrialized countries. 95% of these are without any symptoms and do not need any therapy. For prophylaxis of diverticulitis a diet containing non-digestable cellulose and swelling substances is recommended. Complications of diverticulosis like diverticulitis, perforation abscess, or stenosis can necessitate a resection of the sigmoid colon. This should be done before life-threatening complications like free perforation or massive bleeding occur.

Colonic Neoplasms↗
PubMed1976

Diverticular disease.

Diverticular disease comprises a spectrum of illness beginning with the irritable bowel syndrome and progressing to the life-threatening complications of diverticulitis and hemorrhage. Step-wise progression of this disease may be seen but is not invariably present; many patients with diverticulosis do not have preceding symptoms of the irritable bowel syndrome. The typical complaints of irregularity of bowel habits and abdominal pain will usually respond to the relatively new treatment modality of a high fiber diet with added wheat bran. Barium enema x-ray examination remains the primary diagnostic modality in the investigation of diverticular disease, and colonoscopy should be used only in the presence of certain specific circumstances. Surgery, aimed at the treatment of complications of this disease, has progressed to the point where one-stage extirpation of the diseased bowel is recommended.

Adult↗
PubMed2001

Overview and treatment of diverticular disease.

Diverticular disease is a common medical problem seen in Western society. Outpatient management with close observation is appropriate for the majority of patients. Established criteria for hospitalization and treatment of diverticulitis can help to reduce medical costs and length of stay. Minimally invasive techniques such as computed tomography-guided drainage of diverticular abscess can expedite medical and surgical treatment.

Diverticulitis, Colonic↗