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At least 19 recordsLinked to original sources
PubMed1991

Early water-soluble contrast enema in the diagnosis of acute colonic diverticulitis.

Acute colonic diverticulitis is usually suspected by typical clinical findings supported by laboratory tests. Investigations of the colon are usually delayed 1 to 2 months until the acute situation is resolved. We studied 53 patients with an initial clinical diagnosis of acute diverticulitis by performing early water-soluble contrast enema of the colon. The initial diagnosis proved to be uncertain, as 26 patients (49%) had acute colonic diverticulitis as their final diagnosis. There were ten patients who had diverticulosis of the colon, but without radiologic signs of acute diverticulitis. Four of these patients had some other disease responsible for their symptoms. Thirteen patients had normal findings at early water-soluble contrast enema. Three colonic carcinomas and one ischaemic colitis were diagnosed. There were no complications related to the radiologic studies. We conclude that early water-soluble contrast edema of the left colon is safe and useful in investigating patients with suspected acute colonic diverticulitis. If the finding is normal, investigations can be directed elsewhere without undue delay.

Acute Disease↗
PubMed1992

Surgical management of right colon diverticulitis.

The infrequent occurrence of right colon diverticulitis in the developed West has led to a controversy in the management of this disease. In Singapore, we continued to avoid colectomy whenever possible because this disease is usually nonprogressive. We reviewed 68 patients treated by conservative surgery to evaluate the effectiveness of this treatment policy. Almost 70 percent of our patients were below 40 years of age, and the clinical presentation was indistinguishable from acute appendicitis. Diverticulectomy was done only for inflamed and perforated diverticula (25 cases), while the nonperforated diverticulum was left alone (40 cases). The inflammation invariably responded to antibiotic therapy. Only three patients had colonic resection since a malignant neoplasm could not be excluded. There were no adverse sequelae over a mean follow-up period of three and one-half years, except for one patient who had recurrent attacks of right colon diverticulitis necessitating colectomy. With this policy of management we encountered no mortality, and morbidity was acceptable.

Adult↗
PubMed1976

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↗
PubMed1992

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↗
PubMed1978

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↗
PubMed1991

[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↗
PubMed1991

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↗
PubMed1990

[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↗
PubMed1990

Colonic diverticulitis. Recognizing and managing its presentations and complications.

Diverticulitis usually manifests as pain of abrupt onset in the lower left quadrant. Complications may occur with or without an acute attack. Plain abdominal films are crucial for initial workup and follow-up. Endoscopic examination is often indicated, but barium enema study should usually be avoided during an acute attack. Computed tomography offers the best means of determining extracolonic extension of diverticulitis. Therapy is usually medical and consists of "resting" the bowel, administering antibiotics to resolve infection, and preventing or minimizing complications. Surgery is reserved for refractory, recurrent, or complicated disease.

Anti-Bacterial Agents↗
PubMed1979

[Colonic diverticulitis and appendicitis].

A retrospective analysis of the clinical data has shown that a complicated diverticulitis can often simulate the clinical picture of acute appendicitis. The methods of diagnosis and surgery of the complicated diverticulum are recommended in which the operations in many steps (extraperitonization, colostomy, cecostomy, resection) are considered to be preferable.

Acute Disease↗