Recurrent diverticulitis after sigmoid colectomy for sigmoid colon diverticulitis.
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Anastomosis, Surgical↗
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[Clinical and ultrasonic diagnosis of colon diverticulitis and its complications].
Clinical presentations and ultrasonic criteria of colon diverticulitis and its complications in 31 patients (14 men, 17 women) were analyzed. Diverticulitis of the colon was diagnosed at ultrasonic examination (USI) in 23 (74.2%) of 31 patients. USI was carried out with device "SONOLINE Elegra" (Siemens) with convex and linear multifrequency sensors (2-9 MHz). All the patients were examined in scanning regimens of grey scale, tissue harmony, color doppler and energetic Doppler. In some patients with pain syndrome and absence of diverticulitis symptoms according to trans abdominal ultrasonic examination additional transrectal and transvaginal scanning were performed. Clinical picture and ultrasonic criteria of colon diverticulitis and its complications as well as limitations of ultrasonography in diagnosis of this disease were analyzed. In 8 (25.8%) patients false-negative results were seen, there were no false-positive diagnostic mistakes.
Adult↗
Right colonic diverticulitis: US and CT findings--new insights about frequency and natural history.
PURPOSE: To evaluate how the use of ultrasonography (US) and computed tomography (CT) has changed insights on the frequency and natural history of right colonic diverticulitis. MATERIALS AND METHODS: Clinical findings, US and CT images, and clinical and surgical records in 44 patients with a final diagnosis of right colonic diverticulitis seen over 11 years were retrospectively studied. RESULTS: Of the 44 patients, three underwent diverticulectomy, and 41 were successfully treated conservatively. Follow-up US demonstrated a consistent change in the pattern of the findings of diverticulitis over time, with eventual spontaneous evacuation of the contents of the inflamed diverticulum into the colonic lumen. Five patients had recurrent symptoms; two of them underwent elective surgery. The frequency of right colonic diverticulitis was one in 34 appendectomies, which is nine times higher than that reported to date. CONCLUSION: Right colonic diverticulitis is more common than has been previously reported. US and CT findings are characteristic and show a consistent pattern of changes over time. The natural history is benign, and surgical intervention can be avoided in the vast majority of patients.
Abdomen, Acute↗
Colonic diverticulitis.
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Diverticulitis↗
Critical appraisal on the role and outcome of emergency colectomy for uncomplicated right-sided colonic diverticulitis.
BACKGROUND: Emergency colectomy is well accepted for treating complicated right-sided colonic diverticulitis. However, the role of colectomy for uncomplicated diverticulitis is not well defined. The aim of this study was to evaluate the short-term and long-term surgical outcome of uncomplicated right-sided diverticulitis in our locality. PATIENTS AND METHODS: Retrospective chart review of patients operated for right-sided diverticulitis over a 20-year period was conducted. Recurrent attacks of right-sided diverticulitis, re-operation rate and re-hospitalisation rate were the long-term parameters of interest. An updated telephone interview was carried out for all surviving patients. RESULTS: Seventy-four patients (35 males and 39 females), median age 35.5 (range 16-70) years, were operated for uncomplicated diverticulitis. Thirty patients underwent colectomy, whereas the others underwent appendectomy with diverticulectomy (n = 8) or appendectomy alone (n = 36). All short-term parameters were less favourable for the colectomy group, including higher complication rate, slower return of gastrointestinal function, higher requirement of parenteral analgesic and longer hospital stay. Without colectomy, only 2 patients developed recurrent diverticulitis necessitating hospitalisation, both of whom resolved on conservative treatment. On the other hand, 1 patient required re-operation after colectomy because of intestinal obstruction. The overall re-hospitalisation rate was comparable between the colectomy and the non-colectomy group (16.7% vs. 13.6%). CONCLUSIONS: Emergency colectomy can eradicate suspicious lesions and eliminate risk of recurrent diverticulitis but at the expense of higher morbidity rates. As the natural course of uncomplicated right-sided colonic diverticulitis is usually benign, conservative treatment with minimal surgery may be a better therapeutic option.
Adolescent↗
The out-patient management of patients with acute mild-to-moderate colonic diverticulitis.
BACKGROUND: There are no management criteria for optimum out-patient care in mild-to-moderate acute colonic diverticulitis. AIM: To enable such patients to be managed in an out-patient setting, by establishing criteria and treatment protocols. METHODS: We conducted an open trial and follow-up study from 1997 to 2002. On the basis of ultrasonography, we defined and categorized mild-to-moderate acute colonic diverticulitis ranging from limited inflammation within diverticulum to an abscess < 2 cm in diameter. Subjects were treated as out-patients and followed a 10-day treatment protocol consisting of an oral antibiotic and a sports drink for the first 3 days. Physical examination and laboratory testing helped determine whether or not a patient could resume a liquid diet on day 4, and a regular diet on day 7. RESULTS: Of the 70 patients, 68 were successfully treated. Two patients required hospitalization. Of the 65 patients who were tracked over several months [median (intraquarter range) = 30.8 (11.9-44.2) months], 16 had one or more clinical recurrences. The medical cost per episode was 80% lower than in-patient treatment. CONCLUSIONS: Patients with mild-to-moderate acute colonic diverticulitis can be safely and successfully treated as out-patients using this protocol.
Acute Disease↗
Surgical management of perforated colonic diverticulitis.
Between 1960 and 1983, 116 patients had surgical treatment for acutely perforated colonic diverticulitis. Sixty-five patients had immediate or primary resection and 51 had delayed or staged resection. The two groups were comparable as to age, sex, and associated diseases. The mortality rate (12% v 20%), duration of hospital stay (36 days v 52 days), and duration of disability (81 days v 148 days) were all lower for the primary resection than the staged resection group. We believe that, whenever possible, the perforated segment of colonic diverticulitis should be resected primarily.
Acute Disease↗
Acute colonic diverticulitis: prospective comparative evaluation with US and CT.
PURPOSE: To compare the accuracy of ultrasonographic (US) and computed tomographic (CT) findings for diagnosis of acute colonic diverticulitis. MATERIALS AND METHODS: US and CT were prospectively performed in 64 consecutive patients suspected of having acute colonic diverticulitis. Images were interpreted independently in a blinded fashion. Imaging data were compared with the final diagnosis, which was based on initial clinical and follow-up examination results (n = 64) and pathologic (n = 22), endoscopic (n = 21), and contrast enema (n = 15) examination findings. RESULTS: Final diagnosis was acute colonic diverticulitis (n = 33), other acute abdominal condition (n = 24), or unknown (n = 7). Both CT and US findings yielded 84% accuracy. US and CT findings were not statistically significant different in terms of sensitivity (85% and 91%, respectively) and specificity (84% and 77%, respectively). Positive predictive value was 85% for US and 81% for CT; negative predictive value was 84% for US and 88% for CT. When determining alternative diagnoses, US and CT findings yielded sensitivity of 33% and 50%, respectively (difference not statistically significant). CT scans depicted a small pneumoperitoneum overlooked on plain radiographs and US scans. Six pericolic abscesses were depicted with both techniques; three were depicted with CT only. CONCLUSION: US and CT findings result in similar accuracy for the evaluation of patients suspected of having diverticulitis.
Acute Disease↗
[A case of sigmoidovesical and ileovesical fistula with bladder papilloma complicating colonic diverticulitis].
The clinical course of sigmoidovesical and ileovesical fistula due to rupture of colonic diverticulitis is reported. The patient, a 41-year-old male, who had been suffering from intestinocutaneous fistula for 16 months since drainage of abdominal abscess had chief complaints of cloudy urine and fecaluria. Cystoscopic examination revealed bladder papilloma land edema at the apex area of the bladder. Abscess and fistula were identified with transurethral ultrasonotomography and fistulography, respectively. Primary resection was performed after intravesical instillation of mitomycin-C and postoperative course was uneventful. Histological findings of the specimen revealed disappearance of bladder papilloma for the instillation therapy. Statistical analysis was made on 73 cases of sigmoidovesical fistula due to colonic diverticulitis reported in Japan including my own case.
Adult↗
Unusual fistulae due to colonic diverticulitis.
Examples of diverticulitis of the colon associated with fistulae to the left hip, inferior mesenteric vein, and portal vein resulting in the demonstration of intrahepatic abscesses, the vermiform appendix, and the skin are presented with a review of the literature. A case of a fistula to the epidural space is included.
Colon↗
[The ambulatory medical treatment of colonic diverticulitis. An open clinico-endoscopic-histological study with rifaximin, a nonaminoglycoside enteric antibiotic].
Twenty patients with mild acute diverticulitis of the colon were treated with rifaximine 400 mg b.i.d. per os per 10 days. From a clinical point of view, spontaneous and evoked abdominal pain, diarrhoea, nausea, leukocytosis and hyperthermia resulted in marked significant reduction at the end of treatment, as compared to the basal data (P less than 0.01). A significant reduction of the peridiverticular oedema, mucosal redness, submucosal haemorrhage and diffuse granular pattern was observed endoscopically at the end of treatment (P less than 0.05). Only a trend toward degrees of vasodilation and submucosa hemorrhage was observed from the histological point of view. No side-effect was observed during and after the treatment period.
Adult↗
Acute left colonic diverticulitis: a prospective analysis of 226 consecutive cases.
BACKGROUND: The purpose of this prospective study was to evaluate the immediate and late outcome of acute left colonic diverticulitis and to correlate it with age (younger and older than 50 years of age), gender, and initial computed tomography (CT) findings. METHODS: Analysis was made of data collected prospectively from all patients admitted because of acute colonic diverticulitis between October 1986 and January 1992. Diagnosis relied on results of operation, CT, and Gastrografin enema. Two hundred twenty-six patients were urgently hospitalized for acute left colonic diverticulitis; 47 were younger than 50 years of age (21%). RESULTS: Sixty-six patients (29%) were operated on during their first hospitalization. The remaining 160 patients treated conservatively underwent CT and an enema within 72 hours of admission. Fifty-nine of 179 patients (33%) older than 50 years of age required operation during their first attack, compared with 7 in 47 patients (15%) younger than 50 years of age (p = 0.02), although on CT severe diverticulitis was found in 36 of 141 patients (26%) older than 50 years of age and in 16 of 43 patients (37%) younger than 50 years of age (p = 0.13). Of the 160 patients treated conservatively, 11 of 40 patients (28%) younger than 50 years of age experienced recurrences or complications after their first discharge, compared with 16 in 120 patients (13%) older than 50 years of age (p = 0.04). CONCLUSIONS: Patients younger than 50 years of age were significantly more prone to recurrences and complications after conservative treatment of their diverticulitis, whereas older patients required operation significantly more often during their first hospitalization.
Acute Disease↗
Colonic diverticulitis in young patients with chronic renal failure and transplantation.
The association of colonic diverticulitis with chronic renal failure is well known. In those patients with "adult" autosomal dominant polycystic kidney disease, colonic diverticulitis is an especially common complication. We present two young patients (one teenager and one mid-twenties) who developed intra-abdominal abscess several years after renal transplantation. Neither patient had autosomal dominant polycystic disease nor a known history of gastrointestinal problems but both proved to have underlying, previously unsuspected colonic diverticular disease with abscess formation.
Abscess↗
[CT of acute left-sided colonic diverticulitis and its differential diagnoses].
PURPOSE: This review shows the diagnostic potential of computed tomography (CT) in the diagnosis and differential diagnosis of acute left-sided colonic diverticulitis. METHODS: Using a single detector spiral CT, standard examination of the entire abdomen is performed after oral and rectal administration of diluted iodinated contrast medium with collimation of 8 mm, pitch of 1.5, and reconstruction increment of 8 mm before and after intravenous contrast injection. Intravenous administration of spasmolytic agents, various patient positions, and the thin-section technique with 3-5 mm slices are beneficial in difficult cases. RESULTS: The differential diagnosis of acute left-sided colonic diverticulitis includes tumorous, inflammatory, and ischemic diseases of the colon as well as infarctions of epiploic appendages and the omentum majus. The knowledge of the various CT criteria of acute colonic diverticulitis and their differential diagnoses helps to establish a correct diagnosis in a wide majority of cases. CONCLUSION: At present, CT is the diagnostic procedure of choice for assessing acute diverticulitis. Distinct knowledge of the CT features helps to differentiate the various entities accurately.
Acute Disease↗
[Change in the surgical strategy in acute and complicated colonic diverticulitis].
The records of 312 patients with acute colonic diverticulitis were reviewed. 129 patients required an operation. The operative management is presented and compared to the international literature. One-stage resection was performed in 79% of all patients. In 84% of patients with a localized inflammation a one-stage resection was possible. Fifty-seven percent of patients with peritonitis due to colonic perforation required a multiple stage procedure. In 70% the preferred surgical procedure of multiple stage treatment was Hartmann's operation. These therapeutical regimens are current standard. Lethality was 1.6% for all 129 patients and the postoperative morbidity was 22%.
Acute Disease↗
Right-sided colonic diverticulitis mimicking acute cholecystitis in pregnancy: case report and laparoscopic treatment.
Right-sided colonic diverticulitis is an uncommon disorder that most frequently mimics appendicitis. During pregnancy, displacement of the diseased cecum and ascending colon into the right upper quadrant may result in symptomatology that mimics cholecystitis. A 37-year-old white woman with a history of previous benign incidental appendectomy presented at 20 weeks' gestation with right upper abdominal pain and nausea for 2 days. Significant findings included local rebound tenderness and palpable fullness over the gallbladder, leukocytosis, and low-grade fever, but otherwise unremarkable routine serum laboratory test results and sonographic evidence of biliary tract disease. Cholescintigraphy was rejected by the patient. Persistence of symptoms for 3 hospital days despite administration of broad-spectrum parenteral antibiotics prompted surgical intervention. Laparoscopy demonstrated a normal-appearing gall-bladder and an acutely infected, solitary diverticulum of the midascending colon with adhesions to the omentum and to the parietal peritoneum near the gallbladder. Adhesiolysis, omental biopsy, and peritoneal drainage were performed endoscopically. The patient recovered uneventfully and delivered vaginally at term without fetal or maternal complications. Right-sided colonic diverticulitis may present during pregnancy and may mimic symptoms of acute cholecystitis. Laparoscopic treatment of a solitary, acutely infected colonic diverticulum is feasible in this setting.
Adult↗
Can sonography diagnose acute colonic diverticulitis in patients with acute intestinal inflammation? A prospective study.
In a prospective study of 123 patients with clinical signs of acute intestinal inflammation, the sensitivity of ultrasonography in diagnosing acute colonic diverticulitis was 84.6% and the specificity 80.3%. The predictive value of a positive and a negative sonogram was 76.0% and 87.7%, respectively. Of the 52 patients with subsequently proven acute colonic diverticulitis, 44 presented sonographically with a thickened (greater than 4 mm) hypoechoic bowel wall. In 15 patients, enlarged fluid-filled bowel loops were also present. Air-containing diverticula were demonstrated in 3 patients, abscesses in 8 patients, and colovesical fistulae in 2 patients. Eight large abscesses were successfully treated without emergency surgery by percutaneous sonographically guided evacuation. The described sonographic abnormalities strongly suggest acute colonic diverticulitis, particularly when localized in the left lower abdomen.
Acute Disease↗
[Computed tomography of colonic diverticulitis].
33 patients with clinically suspected diverticulitis of the colon were studied prospectively by CT. The predictive value of symptoms, such as thickening of the colonic wall (86.6%), inflammatory changes of the pericolic fatty tissue (87.5%), the presence of diverticula (73.3%) and abscess formation (100%), were examined separately and their significance was evaluated. Our study was performed mainly on clinically less severe cases of diverticulitis. True positive results by CT were reached in 20/21 cases (sensitivity = 95.2%), true negative findings in 9/12 (specificity = 75.0%). The results of CT examinations were compared with those of contrast enemas (n = 24) and/or endoscopy (n = 6). The number of cases was too low to achieve statistic significance; the relatively high percentage of questionably positive results shows the difficulties inherent in these methods. Our study shows that CT is a good means to demonstrate even less severe forms of colonic diverticulitis with sufficient reliability.
Adult↗