Diverticulosis and polyps of the large intestine. A necropsy study of Hawaii Japanese.
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A necropsy study of polypoid lesions and diverticula of the large bowel in the Japanese prefectures of Akita and Miyagi indicated that adenomatous polyps were more numerous in Akita (30%) than Miyagi (18.3%). They also were larger and showed more severe atypia in Akita. The sigmoid colon and rectum showed the most severe atypia in both prefectures. Hyperplastic polyps and diverticula were very uncommon in both prefectures. These results are discussed in relation to the different levels of risk to colorectal carcinoma in these prefectures and in Japanese migrants to Hawaii.
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Diverticula of the colon result from myostatic contracture. In each case an asymmetric contracture leads to the formation of a gap in the wall of the bowel, through which the muscularis mucosae with the contents of the bowel slip out. Diverticulitis is compared with appendicitis.
Patients with jejunal diverticula usually are asymptomatic unless bacterial overgrowth within the diverticula is sufficient to cause vitamin B12 deficiency, by direct uptake of the vitamin by the bacteria, or malabsorption resulting from bacterial deconjugation of bile salts and impaired lipid digestion. The administration of broad-spectrum antibiotics usually constitutes effective treatment that suppresses bacterial flora, with surgery reserved for complications such as hemorrhage, perforation, and abscess formation, and acute or chronic intestinal obstruction. Our patient had many diverticula, and two courses of antibiotics failed to provide prolonged relief of symptoms. After surgical exploration to exclude the presence of partial intestinal obstruction or infiltrating disease of the terminal ileum, the segment of jejunum bearing diverticula was resected. Since operation the patient has remained asymptomatic, which suggests that in certain patients, even with many diverticula, surgical exploration and excision of the diverticula may be curative.
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