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PubMed1990

[Motility of the sigmoid in irritable bowel syndrome and colonic diverticulosis].

The results of pressure recording in patients with irritable bowel syndrome, diverticulosis and diverticulosis with pain were compared with the results in control subjects. The motility showed variable higher values in patients with irritable bowel syndrome. The motility was clearly higher in patients with diverticulosis and in patients with diverticulosis with pain. The patients with irritable bowel syndrome were younger than the patients in the two groups with diverticulosis. These findings are consistent with the hypothesis that the irritable bowel syndrome is an aetiologic factor in diverticulosis.

Adult↗
PubMed1985

[Myenteric plexuses and colonic diverticulosis: results of a histological study].

The implication of intraluminal hyperpressure in the pathogenesis of colonic diverticulosis was investigated. Since colonic motricity depends on the anatomical integrity of the myenteric plexuses, we looked for morphological abnormalities of these plexuses in diverticulosis of the sigmoid, using the silver impregnation technique devised by Smith. Fifteen sigmoidectomy specimens (including the rectosigmoid junction) were studied in patients afflicted with diverticulosis. Operations were not performed during the acute phases of the illness. The results were compared to those obtained in 5 colectomy specimens in patients with cancer of the rectum, without colonic diverticulosis (control series). Conventional histology as well as the silver impregnation did not reveal any morphological abnormalities of the myenteric plexuses in the rectosigmoid junction or in the remaining sigmoid. The count of argyrophilic ganglion cells (10 to 15 per plexus) was identical in the colons affected with diverticulosis and in the control specimens. These results show that impairment of motricity in sigmoid diverticulosis is not a consequence of morphological abnormalities of the myenteric plexuses. They do not, however, exclude chemical or functional modifications in these plexuses.

Aged↗
PubMed1983

Jejunal diverticulosis. A heterogenous disorder caused by a variety of abnormalities of smooth muscle or myenteric plexus.

We analyzed the clinical, radiographic, esophageal manometric, and pathological features of 10 patients referred with jejunal diverticulosis. Nine patients were over age 59 yr and had symptoms of intestinal pseudoobstruction of 5-43 yr duration. Seven had surgery for mechanical obstruction, although none was found. Eight had diarrhea, steatorrhea, and weight loss. Five had Raynaud's phenomenon and heartburn, and 2 had dysphagia. At radiography, 9 had jejunal diverticula with or without duodenal or ileal diverticula, or both. Two each had abnormal structure or motility of the esophagus or stomach. At manometry, 3 of 7 had a nonspecific motor abnormality, and 1 other had low amplitude peristaltic waves. Light microscopy of small intestinal tissue in 7 patients showed that 4 had fibrosis and decreased numbers of normal-appearing muscle cells, findings consistent with progressive systemic sclerosis. Two others had fibrosis associated with degenerated smooth muscle cells, findings consistent with a visceral myopathy. The seventh patient had neuronal and axonal degeneration and neuronal intranuclear inclusions, findings consistent with a visceral neuropathy. We conclude that (a) intestinal pseudoobstruction is a major clinical manifestation of jejunal diverticulosis, (b) jejunal diverticulosis is a heterogenous disorder associated with at least three abnormalities of the smooth muscle or myenteric plexus, (c) in contrast to intestinal pseudoobstruction without diverticulosis, the esophagus, stomach, and colon are less frequently involved in jejunal diverticulosis, and (d) some patients with jejunal diverticulosis probably have clinically inapparent progressive systemic sclerosis.

Adult↗
PubMed1994

Colonic diverticulosis in India: the changing scene.

BACKGROUND: The prevalence of colonic diverticulosis has a wide geographic and ethnic variation and has been considered to be quite low in India. This study was aimed at determining the prevalence of colonic diverticulosis in northern India based on barium enema examination in symptomatic patients. METHODS: All barium enema examinations performed between January 1985 and December 1991 were reviewed for the presence of colonic diverticulosis. Clinical data of such patients were retrieved. RESULTS: 51 (3.2%) of 1610 barium enema studies showed colonic diverticulosis. The frequency of diverticulosis in barium studies increased from 0.3% among subjects in the third decade to 32.4% in patients above 60 years. Most patients were city dwellers, vegetarians and belonged to the upper socio-economic stratum. Twenty patients (39.2%) presented with a complication; the spectrum of such patients was no different from that reported from the West. While the sigmoid colon was the commonest site of diverticuli, there was a relative preponderance of right sided diverticuli as compared to the Western experience. Seven patients with complications required surgical treatment, while the rest were managed conservatively. CONCLUSION: Colonic diverticulosis and its complications are not rare in India and should be considered in the differential diagnosis of abdominal disorders.

Adult↗
PubMed2005

Management of surgical complications of small-bowel diverticulosis.

INTRODUCTION: Diagnosis of complications of small bowel diverticulosis is difficult in the emergency setting and often delays surgical management. The aim of this study was to report our experience with seven patients presenting with a surgical complication of small-bowel diverticulosis. PATIENTS AND METHODS: From January 1, 1995 to June 30, 2001, 7 patients presenting with a complication of small-bowel diverticulosis were included in this retrospective study. The mean age of the patients was 73.1 years. Complications were bleeding in 4 cases and diverticulitis with perforation and abscess formation in 3 cases. RESULTS: The time between complication onset and its management was 20.6 days. Among paraclinical examinations small-bowel barium opacification showed diverticulosis in 4 cases. Other investigations such as endoscopy or CT-Scan imaging studies were used to eliminate other causes of acute abdomen. Patients were operated on in all cases and a segmental small bowel resection was performed in all cases while in one patient, a diversion stomy was performed. One patient died following septic peritonitis treatment. CONCLUSION: Small-bowel diverticulosis is unfrequent. In cases of gastrointestinal haemorrhage or occlusion, diagnosis is performed by eliminating other more frequent causes. If emergency surgery is not required, barium opacification seems to be the most sensitive examination.

Abscess↗
PubMed2002

[Colonic diverticulosis: A comparison between sonography and endoscopy].

AIM: To investigate the ability of sonography to diagnose diverticulosis and to demonstrate the typical appearance of normal diverticula. PATIENTS AND METHODS: Sixty consecutive patients underwent sonography for prospective evaluation of the presence of diverticulosis of the left hemicolon. Diverticula were assessed for number, diameter, echogenicity, and wall thickness. Sonographic results were compared with those of endoscopy. RESULTS: Sonography yielded positive results in 28/33 patients (85 %) with endoscopically proven diverticulosis. Sonography on average could demonstrate less diverticula per patient than endoscopy. Two sonographic results were false positive. Diverticula had a maximum average diameter of 8.7 mm and the diverticular wall measured 1 mm at most. In many cases the diverticular wall could not be demonstrated by sonography. All diverticula except for one were hyperechoic. In 39 % of patients with diverticulosis one or more diverticula showed clear acoustic shadowing indicative of a faecalith. The maximum diameter of the colonic wall was 3.3 mm on average. Sonography could demonstrate the descending colon in all cases. The sigmoid colon was not visible in 3 cases and could rarely be evaluated in its entire length. CONCLUSION: Sonography can diagnose diverticulosis of the left hemicolon in most cases. Normal diverticula present as hyperechoic protuberances of the colonic wall with acoustic shadowing of varying intensity. The diverticular wall is thin and often not demonstrable at sonography.

Adolescent↗
PubMed2000

Type I and III collagens in human colon cancer and diverticulosis.

BACKGROUND: Collagens are major proteins in the extracellular matrix, providing tissues with tensile strength. They are also important for cell adhesion and the invasion of malignant tumours. METHODS: Thirty-nine samples of human colon (24 diverticulosis, 6 malignant tumours, 9 controls) were collected during elective surgery. Immunoassays for different domains of type I and III collagens and procollagens were used in soluble tissue extracts and trypsin digests of tissue samples. RESULTS: The contents of cross-linked type I and III collagen telopeptides and total collagen were similar in diverticulosis and healthy tissue, whereas in malignant tissue maturely cross-linked type III collagen was scarce. Furthermore, some of the cross-linked type I telopeptide antigens were exceptionally small in size, indicating that the cross-linking of type I collagen in collagen fibres is impaired in cancer. The rate of type I collagen synthesis was clearly increased in malignancy, but not significantly in diverticulosis. However, type III collagen synthesis was increased in diverticulosis, but not in malignancy. CONCLUSIONS: In colon malignancy, the collagen cross-linking process was aberrant and the synthesis of type I collagen increased. In diverticulosis, the synthesis of type III collagen was increased, suggesting only moderately increased metabolic activity.

Adult↗
PubMed1986

Acquired diverticulosis of the small intestine: case reports and literature review.

Eleven cases of small bowel diverticulosis are discussed. Four patients presented with perforation, five with other symptoms attributable to this condition and in two patients diverticulosis was considered an incidental finding. A review of the literature suggests that small bowel diverticulosis may be: present in up to 1.3% of the population; associated with symptoms in approximately 50% of patients, and associated with acute surgical complications in 10% of patients. This may be a disorder of intestinal motility associated with colonic diverticulosis and related to other disorders of smooth muscle and myenteric plexus. Small bowel diverticulosis should not be regarded as a rare, incidental and inconsequential finding.

Abdomen, Acute↗
PubMed2000

Insights into the pathophysiology and mechanisms of constipation, irritable bowel syndrome, and diverticulosis in older people.

OBJECTIVES: To review the epidemiology, pathophysiology and mechanisms of irritable bowel syndrome (IBS), constipation, and diverticulosis, for the purpose of addressing these three common conditions in older adults (>65 years of age). DESIGN: Using a MEDLINE search, we identified original English language journal articles and reviews from 1965 to December 1998. We also selected articles published before 1965 or after 1998 that were cross-referenced or pertinent to the topics researched. RESULTS: The prevalence of constipation and diverticulosis is higher in older than in younger adults. Significant risk factors for constipation in older women are failure of the anorectal angle to open or excessive perineal descent, which represent disturbances of pelvic floor function and rectal evacuation. In contrast, the prevalence of IBS is no greater than in younger adults. Nevertheless, these syndromes impact on the patient's functional status and quality of life. The mechanisms resulting in these gastrointestinal syndromes are unclear. Uncoordinated colonic activity and colonic segmentation may lead to IBS and diverticulosis, respectively, and these pathophysiological findings suggest disorders of inhibitory control of neuromuscular function. The total number of neurons in the myenteric plexus is decreased, and collagen deposited in the distal colon is increased with aging in humans. Animal studies suggest that senescent colonic muscle responds less to excitatory factors in vitro, and neural injury in older animals may result from apoptosis, defects of mitochondrial metabolism, and inadequate levels or response to neurotrophins. Future investigations will reveal whether similar mechanisms underlie human disease. Currently, treatment is aimed at relief of symptoms of IBS or constipation or dealing with the complications of diverticulosis. CONCLUSIONS: Constipation, IBS, and diverticulosis are common problems of aging. There is a need for further systematic research of the basic mechanisms in neuromuscular dysfunction with aging, including the studies of physical characteristics of the colonic wall, pelvic floor function (particularly in women with excessive perineal descent), and neurohormonal control of motility and sensation. Insights on the pathophysiology and mechanisms of neural injury may lead to more specific treatments in the future, e.g., serotonergic agents and neurotrophins. Meanwhile, collaborations between primary care physicians, geriatricians, and gastroenterologists can optimize management of these three common conditions that significantly impact the quality of life of older adults.

Age Distribution↗
PubMed2004

Prevalence and distribution of the colonic diverticulosis. Review of 417 cases from Lower Silesia in Poland.

BACKGROUND: The prevalence of colonic diverticulosis increases with age and is the most common pathology of the large bowel in the elderly. Studies of the frequency of colon diverticulosis are performed in necroptic, radiological and endoscopic surveys. AIM: The assessment of the prevalence and distribution of colonic diverticulosis evaluated with barium enemas. MATERIAL AND METHODS: 1,912 consecutive barium enemas examinations, performed between 1999-2002 were reviewed. The patients were 1,228 females and 684 males (mean age 55.4 yrs). RESULTS: Diverticula were observed in 21.7 percent (417) of the patients (279 females /mean age 64.1/ and 138 males /mean age 64.5 yrs). The prevalence of diverticulosis among females was 22.7 percent and among males 20.2 percent. The frequency of diverticulosis in patients aged 30-39 years was 5.3 percent, 40-49 years - 8.7 percent, 50-59 years - 19.4 percent, 60-69 years - 29.6 percent, 70-79 years - 40.2 per cent, and in those aged over 80 years it was 57.9 percent. CONCLUSIONS: Diverticular disease of the colon is a significant problem in elderly patients, both females and males. The most common occurrence is in the sigmoid and descending colon.

Adolescent↗
PubMedDate not supplied

Gastrointestinal motility in normal subjects and patients with diverticulosis of the colon.

Our study included 25 subjects, ten with normal intestinal habits and 15 with colonic diverticulosis. Data was collected from X-rays of gastrointestinal transit times and from intraluminal pressures in the sigmoid and rectum, using electromanometry. A comparison of the results led to the following conclusions: 1) transit times to the cecum were essentially similar in both the control subjects and patients with diverticulosis; 2) the barium contrast arrived twice as fast in the proximal sigmoid of patients with diverticulosis compared to the control group. Therefore, there is an increase in the transit between the cecum and sigmoid in individuals with diverticulosis of the colon; 3) the mean of the total time of gastrointestinal emptying is similar in both groups; 4) under unstimulated conditions, the electromanometric study of the sigmoid and rectum was similar in both groups; 5) the sigmoid region in patients with diverticulosis has a modulating transit capacity delaying it. This modulation was not reflected in the electromanometric study as an increase in motor activity.

Adult↗
PubMed1993

[Treatment methods in colonic diverticulosis].

The authors had 662 patients with diverticulosis of the colon under observation. Nonoperative treatment for clinically manifested diverticulosis was undertaken in 226 patients. A good effect was produced in 82.2% of them. An operative intervention was conducted on 146 patients. The indication for operation was clinically manifested diverticulosis in the absence of an effect of nonoperative management in 19 (13%) patients and complicated diverticulosis in 62 (41.3%) patients. Various types of reconstructive-restorative operations in many-stage treatment of diverticulosis of the colon were conducted in 64 (43.8%) patients. Postoperative complications were encountered in 29 (19.7%) patients. Ten (6.8%) patients died. The authors conclude that the choice of the volume and method of operation should be guided by the patient's general condition, the character of the developing complications, the spread of the diverticuli along the colon, and the existence or absence of signs of an inflammatory process in the diverticuli.

Adult↗
PubMed2002

[Pathogenesis and epidemiology of sigmoid diverticulosis].

From an epidemiological point of view, left-sided diverticulosis represents a civilizational disease of Western countries. It occurs rarely during childhood and frequently in later years. A diet high in fat and meat, low in vegetables, and with insufficient fiber content apparently encourages its genesis. Physical activity seems to counteract diverticulosis while alcohol consumption, smoking, and caffeine ingestion have no effect. The extent of diverticulosis is not commensurate with the extent of complaints. Only a few patients with diverticula develop diverticulitis. Pathogenetically, several factors play a role in the development of diverticulosis. Elevated intraluminal pressure as well as acquired structural changes of the intestinal wall seem to be decisive factors, which intensify with increasing age. These changes are caused by ultrastructural alterations of the muscle and connective tissue related to collagen and elastin metabolism, which presumably can be genetically determined. Intestinal disturbances of innervation and motility also contribute to the formation of diverticula. The term "hypersegmentation" is an attempt to combine these factors into a single pathogenetic model.

Cross-Sectional Studies↗
PubMed1998

Prevalence of diverticulosis and incidence of bowel perforation after kidney transplantation in patients with polycystic kidney disease.

Sigmoid perforation due to diverticulitis is a life-threatening complication in the postoperative course of allogenic kidney transplantation. The incidence of diverticulosis is especially high among patients with autosomal dominant polycystic kidney disease (ADPKD). Thus, those who undergo allogenic kidney transplantation represent a high-risk group. The aim of this study was to evaluate the prevalence of diverticulosis in ADPKD patients awaiting renal transplantation and the incidence of bowel perforation following allogenic kidney transplantation due to ADPKD. Within the group of 1128 patients who underwent transplantation between January 1974 and January 1990, there were 46 patients (4.07%) whose indication for transplantation was ADPKD. There was one patient who developed a sigmoid perforation under postoperative immunosuppression. Surgical treatment was a discontinuity resection of the sigmoid (Hartmann's procedure). The postoperative course was favorable, the bowel continuity has already been restored, and the graft is still functioning well. Fifteen of the 28 (53.5%) ADPKD patients awaiting transplantation had colon diverticulosis (12 male and 3 female patients). No case of bowel perforation has thus far been observed in 15 of these patients who have undergone transplantation. A sigmoid resection was necessary in one patient due to diverticulitis without perforation. We did not find a higher prevalence of diverticulosis in patients with ADPKD, nor did we see a higher incidence of sigmoid perforation during post-transplant immunosuppression in this study.

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↗
PubMed1995

Cross linking of collagen is increased in colonic diverticulosis.

Development of colonic diverticulosis is a function of age and declining colonic wall mechanical strength. The latter is partly a consequence of changes in the collagen structure. Collagen from unaffected human colons (n = 20, age range 20-80 years) and those with colonic diverticulosis (n = 5, age range 67-80 years) were obtained at necropsy. The total collagen content was measured as the hydroxyproline content and cross linkage by collagen solubility in weak acid was studied. The colonic total collagen content was constant with age (mean (SD) 15.8 (0.3) mg/100 mg wet weight of tissue). The acid solubility of the collagen, however, increased after the age of 40 years: at over 60 years, colonic diverticulosis was associated with an increased acid solubility ratio compared with values in unaffected colons (15.3 (0.2); compared with 9.2 (0.2), p < 0.001). The cross linking of colonic collagen increases with age. These changes seem to be a factor in the aetiology of colonic diverticulosis.

Adult↗
PubMed2003

Occlusive ileus as a complication of large intestinal diverticulosis (contribution of two cases).

After a short literature review of diverticulosis of the colon and its complications, the authors give a thorough description of two cases treated by them for sigmoid colon diverticulosis complicated with occlusive ileus. The patients were males aged 68 and 74 years. In both cases the authors had difficulties in making the precise intraoperative diagnosis. Since exclusion of malignancy was impossible (in emergency conditions immediate histological verification was not possible). Hartman's operation ensuring oncological radicalism was performed. The intestinal passage was restored at the second stage of operation. The final histological verification detected chronic inflammatory process due to diverticulosis that had lead to stenosis and occlusion of the intestinal lumen. On the basis of the two cases described herein and the available literature data, the authors accept Hartman's operation as a method of choice in the treatment of occlusive ileus resulting from large intestinal diverticulosis in elderly patients in impaired general condition. If feasible in emergency conditions immediate histological examination should be used to exclude neoplastic process of the colon.

Aged↗
PubMed1977

[Dependence of diverticulosis on age (author's transl)].

The diverticulosis of the gastrointestinal tract is a widespread senile disease. The dependence of the diverticulosis on age is investigated on the basis of 1 000 proven cases of this disease. The importance of the anatomicomorphological lesions of the organs at old age as its cause is pointed out. The males seem to be affected by the diverticulosis somewhat more than the females, whereas its percental manifestation in the different organs is about equal for both sexes. It prevails in the colon with 48.4% and in the duodenum with 35.4% of all cases of organ diverticulosis. The existence of constitutional associations with other diseases, such as diabetes mellitus, is discussed. Finally, the therapeutic problems of the diverticulitis and their dependence on age are examined.

Adult↗