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PubMedDate not supplied

[Diverticulosis of the colon: complications of surgical interest].

Diverticular disease is prevalently only of medical interest. Repeated episodes of diverticulitis, particularly in younger patients, and serious complications such as perforation, stenosis, fistula and haemorrhage demand surgical treatment. The timing and type of surgical operation are conditioned by the pathological picture and by the patient's general condition and age. The authors present a series of 586 patients admitted for diverticular disease, 84 of whom presented complicated diverticulosis. Nineteen cases (22.6%) underwent elective surgery in the form of an anterior rectal resection, while 65 of them underwent urgent surgery for complicated diverticulosis variously consisting in total colectomy, a Hartman's resection, a simple rectal resection or a left or right hemicolectomy.

Adult↗
PubMedDate not supplied

[Diverticular disease: complications and treatment].

This study reports on 10 years of experience in observing diverticular disease. The study considers 77 patients, 41 males and 36 females, aged from 50 to 88 years (mean age: 70 years), observed from January 1991 to December 2001. Sixty-two patients were admitted from the Accident and Emergency Unit and 15 were elected patients. Five patients underwent emergency surgery, while 72 received only antibiotic therapy. The overall mortality rate was 0. The morbidity rate was 22% in those patients undergoing emergency surgery. In only one of the elected patients was wound suppuration detected. Diverticular disease, in most cases, is treated by antibiotic therapy alone, but in 30% of cases surgery is necessary. Colon resection and immediate anastomosis are the first choice operation also in the emergency setting, provided local conditions (inflammation, septic contamination) make anastomosis safe. In patients with major peritoneal contamination, Hartman's operation and subsequent recanalization after 6 months are to be preferred.

Aged↗
PubMed1975

[Colon diverticulosis and complicating diverticulitis (author's transl)].

Dietary habits in the civilised countries of the West with foods low in bulk and cellulose are blamed as causes of the increase in colon diverticulosis and the complicating diverticulitis in recent times. Of all sections of the colon, the sigmoid is most frequently involved, older patients above the 5th decade being principally affected. While uncomplicated diverticulosis of the colon usually remains symptomless, complicated diverticulitis often shows very uncharacteristic symptoms. For prophylaxis and the treatment of slight complaints, conservative treatment with administration of bulky foods (bran etc.) is indicated. Threatening hemorrhages and perforative peritonitis demand emergency operations. In closed abscess formation, internal or external fistulae and incipient scarring stenosis with imminent ileus, resection of the affected part of the intestine is indicated.

Aged↗
PubMedDate not supplied

Managing the complications of diverticular disease.

This article provides an update on diverticular disease and its complications, focusing on the physical and psychological considerations in the nursing management of the disease. To illuminate the topic a case study is presented describing a patient who underwent Hartmann's procedure with temporary end colostomy. The patient subsequently developed three abscesses and a complex fistula around the stoma. Nursing care and the optimum interventions to preserve skin integrity during such complications are discussed. The article concludes with a summary of key facts regarding diverticular disease, abscess and fistula.

Abscess↗
PubMed2003

Colovaginal fistulas. Etiology and management.

OBJECTIVE: To review the diagnosis and treatment of colovaginal fistulas from various causes. DATA SOURCES: Papers on colovaginal fistulas were identified using Ovid and PubMed. The search terms used were as follows: colovaginal fistulas, rectovaginal fistulas, diverticular disease and fistulas. METHODS OF STUDY: Articles were selected based on their relevance to colovaginal fistulas and were then further subdivided into epidemiology, etiology, presentation, diagnosis and management. RESULTS: English-language papers were selected based on their relevance to all aspects of colovaginal fistulas. CONCLUSION: Optimizing nutrition is paramount prior to surgery. Medical management rarely corrects the problem. Diverticular colovaginal fistulas arise in patients who have previously undergone a hysterectomy. Radiation-related fistulas often involve the distal sigmoid colon and rectum, and recurrent cancer must be ruled out. Often symptoms are associated with radiation cystitis and terminal ileitis. When indicated, restoration of intestinal continuity is preferred. Malignant fistulas carry a poor prognosis, and when surgical removal is not practical, they are treated palliatively with fecal diversion or an endoluminal stent. Those arising from inflammatory bowel disease most frequently arise due to Crohn's disease, and extirpation of diseased bowel and associated abscess will successfully treat the condition. Fistulas arising from ulcerative colitis can be malignant. There remains a small role for colostomy as a nondefinitive procedure to alleviate symptoms. Colovaginal fistulas require a multidisciplinary approach and focused diagnostics, successful treatment can dramatically improve the patient's quality of life.

Colonic Diseases↗