SEARCH · PubMed Health

Results for “Diverticulitis, Colonic”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources

PubMed2001

Acute colonic diverticulitis: visualization in magnetic resonance imaging.

The incidence of acute colonic diverticulitis (ACD) is increasing. To allow rational therapeutic decisions to be made, a timely diagnosis is required. The feasibility of "on-admission-MRI" to establish the diagnosis has not yet been studied. Therefore, a prospective observational study was carried out in 20 patients with an established diagnosis of ACD. The diagnostic criteria for the MRI diagnosis of ACD were the demonstration of at least one diverticulum, pericolic exudation, and edema of the colonic wall. MRI was diagnostic in all but one patient. It is concluded that MRI has considerable diagnostic potential in ACD and should be formally evaluated.

Acute Disease↗

PubMed1985

Sonography of colonic diverticulitis.

Sonographic findings in 16 patients with diverticulitis of the colon are described. The wall of the inflamed segment of the colon appeared hypoechoic and thickened. Maximum thickness of the wall ranged from 5 to 17 mm. Length of the most severely inflamed segment of the colon ranged from 6 to 9 cm. In addition, adjacent contiguous segments of the colon, less involved with inflammation, ranging in length from 7 to 15 cm, were demonstrated on sonographic examination of five patients. Long segments of the inflamed colon could be demonstrated by oblique scanning. The appearance of the mucosal reflections, intramural abscesses, and inflamed diverticula is described. Out of 16 patients with diverticulitis, seven patients had abscesses and extravasation of barium was seen in only two of these seven patients. Ultrasonography therefore is recommended prior to barium or water-soluble contrast enema examination in patients with suspected diverticulitis. In patients with appropriate clinical findings, sonographic diagnosis of diverticulitis can be made by demonstrating hypoechoic thickening of the wall of the colon, even in the absence of intramural or intraperitoneal abscess.

Abscess↗

PubMed2001

Colonic diverticulitis: impact of imaging on surgical management -- a prospective study of 542 patients.

The aim of this study was to compare the performance of the CT and the water-soluble contrast enema (CE) in the diagnosis and the severity of acute left-colonic diverticulitis, and to recognize the impact of CT during the acute phase and after a first acute episode successfully treated medically. From 1986 to 1997, all patients admitted in our emergency center with clinically suspected left-colonic diverticulitis had a CE and a CT within 72 h of their admission, unless clinical findings required immediate laparotomy. They were prospectively included in the study if one or both radiological exams showed signs of acute diverticulitis and/or diverticulitis was surgically removed and histologically proven. Diverticulitis was considered moderate when CT showed localized thickening of the colonic wall (5 mm or more) and inflammation of pericolic fat and CE showed segmental lumen narrowing and tethered mucosa; it was considered severe when abscess and/or extraluminal air and/or contrast were observed on CT and when one or both of the latter signs were seen on CE. Five hundred forty-two patients entered the study; 465 patients (86%) had a CT exam, 439 (81%) had a CE, and 420 (77%) had both exams. The performance of CT is significantly superior to CE in terms of sensitivity (98 vs 92%, p<0.01), and in the evaluation of the severity of the inflammation (26 vs 9%, p<0.02). Moreover, of 69 patients who had an associated abscess seen on CT, only 20 (29%) had indirect signs of this complication on CE. During the acute phase the chances of medical treatment failure are statistically greater when diverticulitis is considered severe on CT than when it is considered moderate (26% for the severe diverticulitis vs 4% for the moderate ones, p<0.0001). After successful medical treatment of the acute episode, patients with severe diverticulitis on the CT had statistically greater incidence of secondary bad outcome than patients with moderate diverticulitis (36 vs 17%, p<0.0001). Computed tomography should be preferred to CE as the initial radiological exam of diverticulitis because of its statistically significant superiority in sensitivity and for its statistically much higher performance in the detection of severe infection, especially when an abscess is associated with the disease. The severity of diverticulitis on CT is statistically predictive of the risk of medical treatment failure during the acute phase and of the chances of bad secondary outcome after a successful medical treatment of the first episode.

Abscess↗

PubMed1995

[Diagnosis and surgical therapy of right-sided colonic diverticulitis].

Diverticulosis of the colon is common in the descending and sigmoid part; the right colon is rarely involved. Inflammation of perforation of a cecal diverticulum is an uncommon condition that mimics acute appendicitis. The correct diagnosis is mostly made after operative exploration. Four cases were surgically treated between 1994 and 1995. Because of the severe inflammation, ileocecal resection or right hemicolectomy was necessary; in one case we performed a local excision. After removal of the inflamed mass the postoperative healing was uncomplicated. A malignancy could be histologically excluded in all cases. As in sigmoid diverticulitis, early resection seems to be a safe operative therapy. Laparoscopy can show the correct diagnosis before the laparotomy is carried out. Preoperative diagnostic measures, differential diagnosis and possible surgical procedures are discussed.

Abdomen, Acute↗

PubMedDate not supplied

Surgical treatment of colonic diverticulitis: a report of 205 cases.

In a series of 205 patients treated for colonic diverticulitis, 101 presented acute complications, 35 chronic complications and 69 attacks of diverticulitis without complications. The treatment prescribed for the acute septic complications (generalized peritonitis, perisigmoidic abscess) as well as for acute occlusions consists of two-stage surgery: drainage and emergency colostomy, then secondary colectomy in elective conditions. Massive incoercible hemorrhages were treated by emergency hemostatic resection, guided by selective mesenteric arteriography. Chronic complications (inflammatory stenosing tumor, external or internal fistulas) are ideally treated by a one-stage colic resection. As postoperative mortality and morbidity rates are high and caused by acute conditions, it is justifiable to perform a prophylactic colic resection.

Abscess↗

PubMed1975

[Colonic diverticulitis. Clinical aspects, indications, operative treatment (author's transl)].

In surgical practice colonic diverticulitis and its complications are frequently met. After a brief description of the more important etiological and pathogenetic aspects which are important for the development of colonic diverticulosis, the clinical part is chiefly concerned with the complications of this disease. Clinical and differential diagnosis take into consideration the complications in particular: perforation, penetration, fistula formation and hemorrhage. Operative treatment which takes these complications into account offers the possibilities of oversuture, antelocation, drainage with or without a relieving transverse anus and resection procedures either at one or several sessions. An attempt is made to define exactly the operative tactic procedure in relation to the individual complications.

Age Factors↗

PubMed2005

Severe colonic diverticulitis in an adolescent with Williams syndrome.

Williams Syndrome (WS) is a condition with multisystemic involvement caused by a genetic deletion in chromosome 7. Colonic diverticulosis has been described in adults with WS; however, it has not previously been reported in adolescents with WS. We report an adolescent boy with WS who developed complicated colonic diverticulitis and briefly review the possible aetiology of diverticular disease.

Adolescent↗

PubMed1997

Diagnostic ultrasound of acute colonic diverticulitis by surgical residents.

BACKGROUND: Recent studies have documented the feasibility of ultrasonography (US) to diagnose acute colonic diverticulitis (ACD). This prospective observational trial determined the sonomorphology of ACD and evaluated the diagnostic accuracy of routine US performed on admission by surgeons in training. METHODS: Fifty-seven consecutive patients with a confirmed episode of ACD were entered into this study, and the sonomorphology of the involved colon was assessed. US findings were compared to the results of the clinical evaluation and correlated to the clinicopathological outcome. RESULTS: The sonomorphology of ACD was characterized by segmental inflammatory transformation of the colon averaging 9.9 +/- 3.2 cm (range, 6-20) in length and visualized as target phenomena of a mean 3.5 +/- 0.8 cm (range, 2.4-4.8) width. Targets were caused by hypoechogenic thickening of the colonic wall of an average 7.7 +/- 2. 6 mm (range, 4-18). In 40% of cases, a hyperechogenic halo representing peridiverticulitis (average width, 2.3 +/- 0.6; range, 1.2-3 cm) was noted. Diverticula were seen in almost half of the cases. Of the 57 cases with confirmed ACD, the diagnosis was made by US in 48, for a global accuracy of 84.2%. US was false negative in nine patients, suggesting perforated appendicitis in five cases and acute appendicitis in one (the final diagnoses were perforated sigmoid diverticulitis in five cases and cecal diverticulitis in one case). In three patients, US was nondiagnostic. CONCLUSION: In the hands of sonographically trained surgeons, ultrasound is a useful modality to image acute colonic diverticulitis. US reveals diagnostic sonomorphology in most cases of ACD and therefore facilitates early confirmation of the diagnosis and assessment of severity.

Acute Disease↗

PubMed1987

Diagnosis of acute colonic diverticulitis: comparison of barium enema and CT.

The contrast enema and CT studies in 102 patients with a clinical diagnosis (41%) or surgically confirmed (59%) diagnosis of colonic diverticulitis were reviewed retrospectively to determine the sensitivity of the two techniques. Combined results from all patients showed that the contrast enema was correct in 77% of patients. The contrast enema was falsely negative in 15% and was indeterminate in 7%. The CT examination was diagnostic in 41%, consistent with the diagnosis of diverticulitis in 38%, and falsely negative in 21% of patients. Both CT and contrast enemas were more accurate in patients with severe disease requiring surgery. No complications occurred from 109 enemas performed. Patient management was altered in only one patient as a result of the additional information provided by CT. The contrast enema should remain the initial and routine examination for the evaluation of patients with suspected diverticulitis. CT should be reserved for patients who are unable to have an adequate contrast enema, those with suspected distant or diffuse abdominal abscess, those who are unresponsive to medical therapy, and those who are candidates for percutaneous drainage.

Acute Disease↗

PubMed1979

Suppurative pyephlebitis and multiple hepatic abscesses with silent colonic diverticulitis.

This report records the first known case in the literature of suppurative pylephlebitis associated with multiple intrahepatic and extrahepatic abscesses and gross hypoalbuminaemia, as a consequence of colonic diverticulitis.

Aged↗

PubMedDate not supplied

[Ultrasonography of acute colonic diverticulitis. Effect on surgical treatment].

The clinical diagnosis of acute colonic diverticulitis (ACD) is at times difficult and an early detection by a non-invasive method as ultrasonography (US) is required. The aim of this study is to evaluate the diagnostic sensibility of US performed on admission in patients with ACD, its value in monitoring assessment of severity and its influence on surgical decision. The Authors have carried out a retrospective study on 22 patients (8 men and 14 women, median age 58 years) admitted from January 1997 to June 1999 for ACD. In 21 cases the diagnosis was made on admission by US. The diagnostic sensibility was 95.5% (false-negative: 1 case). The true diagnosis in 2 false-positive patients was: ischemic colitis (1 case), aspecific thickening of colonic wall in patient with left renal carcinoma (1 case). The sensibility of clinical evaluation on admission was 68% (false-negative: 7 cases). The clinical diagnosis was unequivocal in only 36.4% of cases. In 14 patients, successfully treated conservatively, the US gave monitoring the reduction of hypoechogenic thickening of the colonic wall. Seven patients who underwent urgent surgery: in 3 cases for generalized peritonitis, but in 4 patients (18.2%) the immediate management was influenced by US detection of a clinical misdiagnosed abscess. The Authors conclude that, in the hands of an expert investigator, the extensive use of US in acute abdominal pain facilitate an accurate diagnosis of ACD and its appropriate management.

Adult↗

PubMed2006

Acute colonic diverticulitis in a community-based hospital: CT evaluation in 138 patients.

The purpose of this research is to retrospectively analyze computed tomography (CT) findings of patients with acute colonic diverticulitis presented to a community-based hospital. During a 1-year period from May 2004 to April 2005, CT scans of 138 patients [mean age 62.3 years (SD 14.9), range 30-100 years] with clinical diagnosis of diverticulitis were analyzed. Of the 138 patients, 136 CT scans were performed with oral and intravenous contrast administration except in two patients who received only oral contrast. Twenty-eight patients (28/138, 20.3%) had diverticulosis, 77 (77/138, 55.8%) had uncomplicated diverticulitis, and 33 (33/138, 23.9%) had complications. Left-sided diverticulitis predominated (137/138, 99.3%). Colonic diverticula were identified in almost every patient (136/138, 98.6%); the majority had moderate colonic wall thickening (82/110, 74.5%) and moderate pericolonic inflammation (65/110, 59.1%). Isolated extraluminal air bubbles (19/33, 57.6%) were the most commonly seen complication, followed by abscess (15/33, 45.5%). Bowel obstruction (2/33, 6.1%) and pylephlebitis (1/33, 3.0%) were less commonly seen but were observed as significant abnormalities. Complicated diverticulitis was less prevalent in this community hospital setting, in contrast with referral medical centers. Common CT findings of diverticulitis included presence of diverticula, moderate wall thickening, and pericolonic inflammation. Isolated air bubbles were the most commonly seen complication followed by abscess.

Acute Disease↗

PubMed1998

Diagnosis of acute left-sided colonic diverticulitis by three radiological modalities.

PURPOSE: To compare the findings at US, CT and contrast enema (CE) with the clinical, biochemical, and surgical findings in patients with suspected acute left-sided colonic diverticulitis (ALCD). MATERIAL AND METHODS: The study comprised 32 consecutive patients hospitalized with clinically diagnosed ALCD. During the first 3 days of hospitalization, they were examined by US and CT of the pelvis and abdomen, and CE. RESULTS: Of the 32 patients, 21 had ALCD according to the combined radiological, clinical, biochemical and surgical findings. Findings compatible with ALCD were verified by radiological examination alone in 12 patients (4 patients at US, 10 at CT, and 6 at CE). In 9 patients, only diverticula or tethering was found at either CE or CT, and the diagnoses were then supported by clinical and biochemical findings and clinical follow-up. The most common clinical symptoms and signs associated with ALCD were left lower quadrant pain, left-sided tenderness, and fever. Most patients showed elevations of the white blood-cell count, erythrocyte sedimentation rate, and C-reactive protein, but there was no statistical difference in the stages of severity of ALCD, or between ALCD and other abdominal disorders. CONCLUSION: Radiological examination is valuable in confirming the diagnosis of ALCD. CT was the radiological modality that best demonstrated ALCD and revealed complications (e.g. pericolic abscesses) during the course of the illness.

Acute Disease↗

PubMed1976

[Colonic diverticulitis: diverticulitis with complications and its treatment (author's transl)].

Complications (stenosis, intestinal obstruction, abscess or fistula formation, inflammation, etc.) of colonic diverticulitis are seen in 35% of patients affected. Multiple operative procedures involve less risk than surgery performed in a single session. The mortality in emergency surgery is reported to be up to 40%, while subsequent resection of the diseased colon involves the usual mortality of surgery on the colon, i.e. 1.5-9%. The vital factor in this illness is the earliest possible surgical treatment of the diseased diverticulum, so that the extremely problematical complications can be avoided.

Colonic Diseases↗

PubMed2002

Acute colonic diverticulitis in patients under 50 years of age.

BACKGROUND: There is ongoing controversy concerning the virulence and management of diverticulitis in young patients. This study reports on the management of acute diverticulitis with reference to the virulence and outcome of the disease with respect to age. METHODS: Between January 1994 and June 1999, 327 patients were treated for acute left colonic diverticulitis. Patients were divided in two groups: those aged 50 years or less (group 1, 72 patients) and those older than 50 years (group 2, 255 patients). The diagnosis was confirmed histologically or radiologically in all patients. RESULTS: There were differences in gender distribution related to age (P < 0.001). During the first hospital stay, 226 patients (69.1 per cent) had successful conservative treatment, 78 (23.9 per cent) needed emergency surgery and 23 (7.0 per cent) had a semielective operation (P = 0.47). The recurrence rate was 25.5 per cent in group 1 and 22.3 per cent in group 2 (P = 0.93). The type of surgical procedure and grade of peritonitis in emergency patients were similar in the two groups. Overall the mortality rate in patients who underwent an operation was 16.3 per cent. The mortality rate was zero in group 1 and 2.2 per cent in group 2 after elective or semielective operation (P = 1.0), and zero in group 1 and 34.9 per cent in group 2 after emergency operation (P < 0.001). CONCLUSION: Diverticulitis in young patients does not have a particularly aggressive course and the risk of recurrence is similar to that of older patients.

Acute Disease↗

PubMed1998

[Primary delayed indication for single-step continence resection in 300 patients with acute colonic diverticulitis].

Since 1980, a total of 300 patients with colonic diverticulitis have undergone surgery. A vital indication forced us to do an emergency colostomy or Hartmann procedure in 22 cases. Except for 3 patients, the indication for resection was intentionally delayed by means of conservative treatment and a primary anastomosis was performed. Histological findings verified an inflammatory tumor, and abscess, a fistula or perforation in 50% and circumscript inflammation in 37%. The main complications were drainage problems (infection/retention of secretion, n = 18) and anastomosis insufficiency (n = 5), lethality was less than 2%. In general, we think that multistep surgery is not mandatory--even in advanced cases.

Adult↗

PubMed1998

Ureterocolic fistula secondary to colonic diverticulitis.

We describe the case of a 45-year-old woman with a ureterocolic fistula caused by colonic diverticulitis. She had a 10-year history of intermittent left flank pain that had not been treated. The fistulous tract between the left ureter and sigmoid colon was confirmed by retrograde urography and a barium enema. A nephroureterectomy was successfully performed.

Barium Sulfate↗

PubMed2006

The metabolism of mesalamine and its possible use in colonic diverticulitis as an anti-inflammatory agent.

5-Aminosalicylic acid (5-ASA) is the mainstay of therapy for inflammatory bowel disease (IBD), particularly ulcerative colitis. 5-ASA is the active moiety in sulfasalazine, which was initially developed for the treatment of rheumatoid arthritis more than 60 years ago, by linking 5-ASA with sulfapyridine Because many of the side effects related to sulfasalazine were found to be due to sulfapyridine, several drugs that contain 5-ASA, and lack the side-effect profile of sulfasalazine, have been developed during the last 2 decades. These drugs have proven to be quite effective in treating mild-to-moderate symptoms of IBD, as well as inducing and maintaining remission. Although they exert anti-inflammatory effects, their exact mechanism of action remains elusive. Nonetheless, their success in treating IBD has led to studies using this class of drugs for novel indications. Several recent studies have evaluated the use of 5-ASA drugs (mesalamine) for the treatment of uncomplicated acute diverticulitis. In this review, we will briefly discuss the development of 5-ASA releasing drugs, their metabolism, side effects, indications, mechanisms of action, and the rationale for the clinical use of mesalamine in colonic diverticulitis.

Acute Disease↗