["ACUTE ABDOMEN" CAUSED BY COLONIC DIVERTICULITIS].
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Abdomen, Acute↗
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Results for “Diverticulitis, Colonic”
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COLONIC DIVERTICULITIS IN HAWAII: A STUDY OF 414 CASES.
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Asian People↗
[Hartmann's surgery of colonic diverticulitis. An examination of the colon and the rectum for restoration by ostomy].
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Barium Sulfate↗
Giant sigmoid colonic diverticulitis: case report.
Giant colonic diverticulum is a rare condition, and the usual site is the sigmoid colon. In this report, magnetic resonance imaging was performed in a patient with lower abdominal pain. The modality was useful for the evaluation of giant sigmoid colonic diverticulitis and the differential diagnosis.
Colon, Sigmoid↗
Management of right colon diverticulitis: a 10-year experience.
BACKGROUND: Controversies abound as regards the optimal treatment for patients with diverticulitis of the right colon. METHODS: This is a retrospective review of 113 patients with a diagnosis of right colonic diverticulitis who received treatment at the China Medical University Hospital from July 1994 to June 2004. RESULTS: Medical therapy was undertaken in 56 patients diagnosed preoperatively with uncomplicated diverticulitis. All but one patient was successfully treated with bowel rest and antibiotics. Of the 51 patients with a preoperative diagnosis of acute appendicitis, 32 received appendectomy along with postoperative antibiotic therapy, 8 received diverticulectomy in addition to appendectomy, and 11 received colectomy. In all, 17 patients required right hemicolectomy or ileocecal resection due to diverticulitis-related complications or suspected malignancy. Of the 87 (56-1+32) patients who responded to conservative treatment, 11 developed recurrent diverticulitis. All 11 patients were successfully treated with medical therapy, and 2 subsequently received elective right hemicolectomy. Of the 9 patients who received medical treatment alone at the second attack, 2 suffered a third attack. Both were successfully managed with medical therapy. CONCLUSIONS: For uncomplicated diverticulitis of the right colon diagnosed preoperatively, antibiotic therapy with bowel rest is an effective treatment. Once it is encountered during surgery for presumed acute appendicitis, a conservative approach involving prophylactic appendectomy and postoperative antibiotics is recommended. For patients with recurrent diseases, medical treatment is still safe and efficient. Colectomy is indicated when complications occur or when malignancy is strongly suspected.
Adolescent↗
Right-sided colonic diverticulitis: CT findings.
Right-sided colonic diverticulitis is an uncommon but clinically significant condition as it closely mimics other common acute right-sided abdominal conditions like acute appendicitis and cholecystitis. CT can provide a rapid and accurate diagnosis of this condition and thereby prevent unnecessary laparotomy and surgical procedures since it is essentially a benign self-limiting condition requiring medical treatment. It is the aim of this pictorial essay to describe the CT findings and increase awareness among radiologists of this condition.
Acute Disease↗
Acute colonic diverticulitis in the young.
BACKGROUND: Colonic diverticulitis in the young has been considered to have a virulent course, high morbidity, and high operative rate. As a result, elective resection of the involved colonic segment after the first clinical episode has been the usual practice. PURPOSE: This study presents our experience with acute diverticulitis in the young. METHODS: In the last nine years, 63 patients younger than 45 years were treated for acute diverticulitis at our institution. A retrospective review was performed to determine the clinical course and outcome of these patients. RESULTS: Clinical presentations, radiographic tests, operative findings, and pathology results revealed that 57 patients had a pericolonic contained disease (Hinchey State I). Two patients had a large pelvic abscess (Hinchey Stage II), and four patients had a diffuse peritonitis (Hinchey Stage III). Forty-one patients (65 percent) were successfully treated medically with antibiotics and bowel rest. Of 22 patients (35 percent) who underwent emergent operations, 12 patients' diseases had been erroneously diagnosed preoperatively (9 "appendicitis"). CONCLUSION: Diverticulitis at a young age does not have a specific aggressive nature. Although, it is associated with a high rate of emergency operations, many of these are performed for a mistaken diagnosis. The recommendation for routine elective resection following the first episode of diverticulitis should be reassessed.
Acute Disease↗
Sonography of acute right side colonic diverticulitis.
BACKGROUND: To describe the prevalence and sonographic findings and ultrasound diagnostic accuracy of the right side colonic diverticulitis in patients having right lower abdominal pain with indeterminate nature. METHODS: A total of 934 patients with acute right lower abdominal pain of clinically indeterminate nature were referred for ultrasound examination (US). US studies were performed with 3.5 to 7.0 (or occasionally 10) MHz transducers using graded compression method. Twenty-three patients were finally diagnosed to have an uncomplicated acute diverticulitis of the right colon. The gray-scale sonographic images were reviewed. A retrospective study was undertaken to evaluate diagnostic contribution of US. RESULTS: The prevalence of acute right side colonic diverticulitis was 2.5% in patients with clinically indeterminate acute right lower abdominal pain. Locations of the inflamed diverticula include cecum in 6 patients, proximal ascending colon in 15 patients, and distal ascending colon in only 2 patients. Sonography detected 21 inflamed diverticula with 1 false positive and 2 false negative results. The most typical sonographic feature of an inflamed diverticulum of right side colon was a rounded or oval-shaped hypoechoic or nearly anechoic structure (52%) protruding out from the segmentally thickened colonic wall. Some of them might contain strong echoes representing gas or feces (43%), or stone in the lumen (5%). Regional pericolic or peridiverticular fat thickening was noted in 57% of patients, and segmental colon wall thickening in 38%. US examination yielded a sensitivity of 91.3%, a specificity of 99.8%, an overall accuracy of 99.5%, a positive predictive value of 95.5%, and a negative predictive value of 99.7%. A positive sonogram made the likelihood of acute right side diverticulitis 456.5 times greater compared with the pretest clinical impression. US differentiated acute right side colonic diverticulitis from acute appendicitis with a 100% accuracy. CONCLUSIONS: Ultrasound can be extremely useful in diagnosing acute right side colonic diverticulitis. Careful ultrasound evaluation of the right colon and the cecum may facilitate a correct diagnosis and help differentiate from acute appendicitis, and steer the surgeon to a more effective management.
Acute Disease↗
The role of surgical treatment in colon diverticulitis: indications and results.
PURPOSE: Colon diverticulitis is a common illness with affects 37-45% of western populations. Indications regarding therapy guidelines, operative timing and which surgical procedure to perform are still controversial. MATERIAL AND METHOD: Between January 1977 and December 1997, 239 patients, diagnosed with diverticulitis, have been admitted, on emergency, to our Department of General Surgery; 135 males (56%) and 104 females (44%), (mean age of 63 years). RESULTS AND DISCUSSION: Forty-two patients (18%), clearly diagnosed with diffuse or local peritonitis, underwent delayed emergency surgical procedure; 44 (22%) out of 197 patients, treated with medical therapy and subsequently underwent elective surgery procedures for complications (fistulas or stenosis). Among the 42 patients treated in emergency, 26 cases (62%) underwent to resection with immediate reconstruction. Among the elective surgery group 39 (89%) out of 44 underwent to resection with immediate reconstruction. Complications reached 40% in the group of emergency patients (mortality rate 12%) and 16% in the elective surgery group (mortality rate 2%). Several features possible influencing mortality rate have been analysed; age > 70 years, acute associated diseases, generalised peritonitis and surgical timing show a statistical significance. CONCLUSION: Therefore, a careful evaluation of the patients, an appropriate pre and post-operative medical treatment, with a wider use of the most recent techniques such as CT scan guided drain, intra-operative wash-out and peritoneal lavage are recommended in order to reduce morbidity and mortality.
Adult↗
Toward therapeutic guidelines for patients with acute right colonic diverticulitis.
BACKGROUND: At present, little information is available on the outcome of medical therapy for patients with acute right colonic diverticulitis, and this has meant a gap in constructing guidelines for its treatment. METHODS: The records of patients with acute right colonic diverticulitis at Nagasaki University Graduate School and affiliated hospitals were reviewed and analyzed with the goal of establishing therapeutic guidelines. The time frame of the data analyzed was from 1984 to 2002. RESULTS: Of the 81 patients included in the data, 80 patients who were suffering a first attack were successfully treated with bowel rest and antibiotics. Two of these 80 patients underwent an elective operation at the surgeon's discretion during the original hospitalization and 1 (1.2%) needed an urgent operation. Of the 78 patients who responded to medical therapy, 16 (20.5%) developed recurrent right colonic diverticulitis. All 16 patients who had a second attack were successfully treated with medical therapy. Three of the 16 patients underwent an elective operation during this rehospitalization period. Of the 13 patients who had had a second attack and had responded to medical therapy, there was a third attack in 2 patients (15.4%). Both of these patients were again successfully treated with medical therapy. There has been no morbidity and no mortality related to recurrence to date. The average time from the first attack to us contacting the patient was 35.2 months. CONCLUSIONS: Unlike acute uncomplicated left colonic diverticulitis, our findings indicate that after two documented episodes, medical treatment alone rather than elective surgery may be considered as an effective guideline for the treatment of acute uncomplicated right colonic diverticulitis.
Acute Disease↗
[A renocolic fistula due to colonic diverticulitis associated with polycystic kidney].
Renocolic fistulae caused by colonic diverticulitis are rare. We present a case of renocolic fistula caused by colonic diverticulitis associated with polycystic kidney. A 51-year-old male with polycystic kidney on hemodialysis presented with a lasting fever and left lower abdominal pain. Under the diagnosis of the infection of a cyst in a polycystic kidney, puncture of the cyst was performed. Nine hundred ml of turbid fluid, of which culture grew Bacteroides Fragilis, was discharged. Inflammation subsided after the puncture, but soon recurred. Moreover, pneumaturia was observed, and fecaloid fluid was drainaged. Barium enema demonstrated a fistula from the diverticulum of the descending colon into the punctured cyst. The patient underwent a nephrectomy combined with hemi-colectomy.
Colonic Diseases↗
Hepatic-portal venous gas in acute colonic diverticulitis.
The diagnosis and assessment of severity of acute colonic diverticulitis may be difficult. A case is presented, in which the delayed diagnosis of diverticulitis resulted in the development of a diverticular mesocolic abscess complicated by hepatic-portal venous gas (HPVG). The utility of ultrasound as a rapid, noninvasive tool to diagnose this distinctly rare condition is outlined. The literature on HPVG associated with acute colonic diverticulitis is reviewed, and the therapeutic options are discussed.
Abscess↗
99m-technetium-HmPAO-labelled leucocytes in the diagnosis of acute colonic diverticulitis.
Eighteen patients with abdominal symptoms clinically resembling acute colonic diverticulitis were studied with 99mTc-labelled leucocytes on average 5 days after the onset of symptoms. The diagnosis of diverticular disease was confirmed in all cases by means of barium enema or sigmoidoscopy. The leucocyte scan was positive in 13 patients, nonspecific in four and unclear in one patient. The diagnostic possibilities in acute colonic diverticulitis are discussed.
Acute Disease↗
[Colonic diverticulitis--therapy concepts from the surgical viewpoint].
Colon diverticulitis showed a great variability in kind, intensity and course of disease. Time and surgical procedure are dependent on the stage of diverticulitis (emergency procedure, elective resection, early elective resection). In emergency cases non-resecting procedures should not be performed. Here the Hartmann procedure and in favorable conditions the primary resection should be chosen. Other patients with acute diverticulitis should have early elective resection after short-term medical treatment (5-7 days). Patients with a chronic-recurrent course of disease should have an elective one-sided resection. The surgical principles are mobilization of the splenic flexure as well as the widening of the distal resection limit into the upper rectum to avoid a recurrence.
Colectomy↗
[Colonic localization of Crohn's disease. New case reports. Rectocolic Crohn's disease. Colonic Crohn's disease and sigmoid diverticulitis. Colonic Crohn's disease].
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Adult↗
Pathogenesis of colonic diverticulitis and diverticulosis.
Colonic diverticula result from herniation of the mucosa through weak spots in the muscular wall. Clinically manifested diverticulitis has been thought to have its pathologic basis in an abscessed diverticulum obstructed by a fecalith, but studies of resected sigmoids have failed to produce evidence to support this view. Instead, the outstanding lesion was found to be a perforation in the fundus of a diverticulum, with surrounding peridiverticular or pericolic inflammation. Another surprising finding in pathologic studies was that one out of three sigmoids resected for "diverticulitis" showed no inflammation in or around the diverticula, but the wall of the sigmoid was impressively thickened. This type of diverticulosis, which is frequently symptomatic, has been referred to as painful diverticular disease or spastic colon diverticulosis. Diverticula without muscle thickening are usually asymptomatic, and the condition is referred to as diverticulosis or simple massed diverticulosis. It is uncertain whether the two types have a similar pathogenesis. High intrasigmoid pressures, abnormalities of sigmoid musculature, low-fiber diet, and psychologic stress are thought to be important factors in the formation of diverticula.
Civilization↗
Sonography in acute colonic diverticulitis. A prospective study.
The clinical value of high-resolution real-time sonography for the diagnosis of acute and complicated colonic diverticulitis was prospectively studied in 130 consecutive patients with abdominal complaints, because of which the disease entered into differential consideration. The results of ultrasound investigation were compared with those of clinical examination on admission. Regarding history and initial clinical evaluation, diverticulitis was graded as "highly suspected" in 19 (36.5 percent) out of a total of 52 patients with later proven colonic diverticulitis (prevalence 40 percent), as "possible but equivocal" in 24 (46.2 percent), and as "very unlikely" in the remaining nine (17.3 percent) patients. Ultrasonography enabled the diagnosis of diverticulitis with an overall accuracy of 97.7 percent, a sensitivity of 98.1 percent, and a specificity of 97.5 percent. The predictive values of positive and negative ultrasound examinations were 96.2 percent and 98.5 percent, respectively. The echomorphologic features of acute diverticulitis include visualization of a colon segment presenting with local tenderness on gradual compression, which showed hypoechogenic thickening of the wall and a targetlike appearance in transverse view due to inflammatory changes and muscular thickening. Sonographic signs of peridiverticulitis (hyperechoic halo) were found in 96 percent of patients, echogenic diverticula in 86 percent. Twelve (92 percent) of 13 abdominal abscesses were detected on initial ultrasound examination and could be treated by percutaneous drainage in seven cases, while six required surgical intervention. These results indicate that high-resolution sonography with graded compression is highly sensitive and specific for the imaging diagnoses of acute colonic diverticulitis and complicating abscess.
Abscess↗
Right colonic diverticulitis: MR appearance.
BACKGROUND: We evaluated the magnetic resonance (MR) features of right colonic diverticulitis. METHODS: This prospective study was based on five patients selected from a group of 156 patients admitted to the radiology department for further evaluation because of clinically suspected appendicitis. All five patients had ultrasound (US) and MR studies, and four patients also had computed tomography (CT). RESULTS: In all five patients, right-side diverticulitis was seen as an outpouching of the right colon with associated circumferential wall thickening of the colon and surrounding inflammatory changes. CONCLUSIONS: Our results suggest that MR imaging can be useful in the diagnosis of right colonic diverticulitis. An inflamed diverticulum with adjacent colonic wall thickening and surrounding inflamed fat are characteristic MR signs. MR imaging can be a valuable alternative to CT in young or pregnant patients who have suspected appendicitis and an equivocal US result.
Adult↗