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[Diverticulosis-diverticulitis].

Diverticulosis of the colon and its clinical sequelae--diverticulitis, peridiverticulitis, and pericolitis--are typical diseases of elderly people. The main causes are weakness of the connective tissue in the colonic wall increasing with age and pathologic motility pattern of the colon due to low dietary fibre consumption. In about 20% of all people with diverticula, acute or chronic-recurrent diverticulitis develops, often with serious complications as perforation, abscess or fistula formation, obstruction, inflammatory pseudotumor and intestinal bleeding. Diagnosis is mainly based on clinical examination and barium enema (double contrast, maximal spasmolysis). Colonoscopy may be helpful in excluding carcinoma of the large bowel. Patients with diverticulosis and uncomplicated diverticulitis should be managed conservatively by medical treatment. The following measures proved to be successful: high-fibre diet, unprocessed wheat bran, and hydrophilic plant colloids to regulate the bowel movements, systemic or local antibiotics if signs of inflammation are present, and antispasmodics or analgesics against abdominal pain. Prognosis depends mainly on the duration of the disease, sufficient dietary-fibre intake, and elective or semi-elective surgical intervention before the development of life-threatening complications. The question as to whether diverticula or relapsing attacks of diverticulitis can be prevented with added dietary-fibre remains open for the time being.

Abscess↗
PubMed1983

[Perforations during contrast enema].

During contrast enema, perforation into the retroperitoneal space can be differentiated from perforation into the peritoneum and perforation into the intestinal wall associated with formation of barium granulomas or submucosal spreading of the contrast medium. Other special forms are perforation with contrast medium embolism of diverticula; of the processus vermiformis; penetration of contrast medium into fistulous systems and from the operated area. Risk factors are: balloon catheter, intestinal tubes with a hard tip, preternatural anus, excessive enema pressure, contrast medium additions, preceding manipulations, intestinal diseases, advanced age and delegation of manipulations to assistants and unskilled staff. Children are particularly at risk.

Barium Sulfate↗
PubMed1983

Selective management of lower gastrointestinal bleeding.

The management of lower gastrointestinal bleeding has evolved from a number of technological advances allowing precise diagnosis and localization of the bleeding site. This study of 40 angiographically demonstrated lower gastrointestinal bleeding lesions reinforces much of the data indicating the diagnostic and therapeutic trends. Twenty-four patients had bleeding diverticula with angiographic demonstration in 11 patients. Seven cases of vascular ectasia were identified, and nine patients had a variety of significant bleeding sites other than the two main sites that were listed. Pitressin was useful for control of bleeding in six of seven diverticular patients but was less useful in the vascular ectasia group in which only one patient was actively bleeding. Total abdominal colectomy and segmental resection were successful in control of hematochezia in 24 of 25 operative cases. Sixteen patients did not require surgical treatment.

Aged↗
PubMed1983

Diverticular disease in the young patient.

The records of 115 patients less than 40 years of age with roentgenographic or operative documentation of diverticular disease were reviewed. Ninety-two patients presented with acute diverticulitis; five, with bleeding diverticulosis, and 18 were asymptomatic. An urgent operation for fistula, abscess or free perforation was necessary upon initial presentation in 16 patients. Nine patients underwent resection during the initial hospitalization after a cooling-off period. The remaining 67 patients were managed medically and discharged. Fifty-five per cent of the medically managed patients required readmission during the follow-up period, 23 per cent having a serious complication. Forty-five per cent of the medically managed patients underwent a subsequent operation. Elective resection after a cooling-off period appears to be the safest alternative for young patients.

Acute Disease↗
PubMed1983

[Complications of colonic diverticulosis and their treatment].

Diverticulosis coli is one of the commonest diseases of the colon. Its importance arises from complications. In the period of 1974-1981 a total of 661 cases of diverticulosis coli were treated at this clinic. In 75% of cases the diverticula were localized in the left colon. Differential diagnosis must aim to exclude the presence of other diseases, especially malignancies of the rectum and sigmoid colon. 165 patients (25%) underwent surgery. In elective surgery lethality was only 2,9%. The poor prognosis when complications have occurred supports the author's view, that operation should be done early in patients with chronic recurrent diverticulitis.

Adult↗
PubMed1983

[Diverticular disease of the colon. Physiopathology and medical treatment].

Almost unknown in 1900, diverticular disease has become the commonest disease of the colon and appears to be a deficiency disease caused by the removal of vegetable fibre from the diet. It occurs most commonly in the sigmoid colon and is frequently asymptomatic, but it may be symptomatic without evidence of inflammation. It may be complicated by inflammation or bleeding. A high residue diet forms the rational basis for successful therapy.

Animals↗