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[Gastric heterotopia and cleft palate. Deformation sequence or syndromic association?].

Gastric heterotopia is more frequently in small intestine, gall bladder, biliary tract, Meckel's diverticulum, colon and rectum, but it can be found in other locations. It is especially rare in oral cavity. We only find one case that concurs with cleft palate. We present the case of a neonate with gastric heterotopia and cleft palate in addition to other congenital malformations not related at first. We make a brief revision of literature, showing the pathogenesis of heterotopia and its possible association with the cleft palate.

Choristoma↗

[Elective surgical treatment of colonic diverticulosis].

In a retrospective study from 1978 to 1990, 143 patients had elective surgery for colonic diverticular disease. Surgical indications were: uncomplicated diverticulitis (128), functional discomfort (6), suspicion of associated neoplasia (6), bleeding (3). The overall mortality is 1/143 (0.6 p. cent). 3 patients (2.2 p. cent) had to be reoperated for anastomotic fistula with peritonitis. Definitive re-establishment of digestive continuity was done in 139 patients (98.6 p. cent). Our results suggest that surgery is to be widely indicated for diverticular disease. Resection must be performed in every patients presenting with an history of two or more acute recurrences, with a fistula, and when clinical and/or radiological abnormalities continue after a first acute crisis.

Abscess↗

Colo-rectal.

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Barium Sulfate↗

[Diverticula in the vermiform appendix].

A case of multiple appendiceal diverticula seen by barium enema is reported. Five diverticula were clearly demonstrated. The patient was asymptomatic. Most diverticula of the appendix have been found at laparotomy for complicated appendicitis. We believe that prophylactic appendectomy should be performed to prevent complications.

Adult↗

[Diverticular disease of the colon, the indications for and results of elective surgical treatment].

Precise criteria were prospectively used to indicate surgery in patients with diverticular disease of the colon: a) anatomical deformity of the sigmoid (ADS), including stenosis and fistulae with presence of contrast media extraluminally; b) recurrent acute diverticulitis (RAD); c) prior diverticulitis with perforation (DP) and d) recurrent GI bleeding (GIB). 42 patients were operated on according to these criteria, from 1978 to 1988, 26 males and 16 females, with a mean age of 61 years (range 31 to 93). ADS was the indication in 22 patients (52%), with fistulae present in 9. RAD was the indication in 16 patients (37%), DP in 9 patients (21%) and GIB in 5%. All patients were submitted to either ample sigmoid resection or left hemicolectomy. All patients were followed, with a mean of 43 months for the series. Only 1 patient died after surgery from pulmonary embolism. Late clinical evaluation revealed absence of preoperative symptoms and signs. We feel that surgical treatment of diverticular disease of the colon is warranted with the criteria described, with good immediate and longterm results.

Adult↗

Diverticular disease in the elderly.

The prevalence of diverticular disease shows a striking correlation with advancing age. The spectrum of disease ranges from the entirely asymptomatic to a life-threatening surgical emergency. The diagnosis of acute diverticulitis is often particularly difficult to make in the elderly because of muted symptoms and signs. Current concepts of diagnosis and therapy are discussed.

Abdominal Pain↗

Motility effects of anterior resection of the rectum performed for diverticular disease.

Colonic motility study was performed in fiftyfive patients with symptomatic complicated diverticular disease, who underwent semielective surgery, and in twenty healthy volunteers. The pressure sensors were positioned in the descending and the true sigmoid colon. The colonic motility index was significantly higher in patients with symptomatic complicated diverticular disease than in controls in the basal (p less than 0.001) and post-prandial periods (p less than 0.001). Three months after anterior resection of the rectum with wide resection of descending colon the motility index was significantly reduced (p less than 0.001) in comparison to that before treatment; all patients were asymptomatic. Three years and five years later, the manometric findings continued to be stable and the patients continued to be asymptomatic. These data suggest that anterior resection of the rectum (with wide resection of the descending colon) lowers intraluminal pressure significantly and this effect appears long lasting.

Colon↗

Diagnosis and control of diverticular bleeding by arteriography and vasopressin infusion. A report of 2 cases.

Large-bowel bleeding usually arises from either angiodysplasia or colonic diverticula. Diverticular bleeding is more common in the right or the transverse colon, even though diverticula are more common on the left. Arteriography in these patients may identify the bleeding site, and in some cases vasopressin infusion controls the bleeding. Embolization of the large bowel is not recommended because of the danger of necrosis.

Aged↗