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PubMed1990

[Treatment of total diverticulosis of the small intestine].

Results of treatment of diverticulosis of the small intestine in 59 patients are presented. Operations for urgent indications were performed on 12 patients. In 12 patients diverticulosis was associated with other surgical diseases of organs of the abdominal cavity. Planned operations were performed on 35 patients, 3 of them having total diverticulosis. The authors describe their tactics and original methods of treatment of total diverticulosis.

Adult↗
PubMed1983

[ Pathology of the colon associated with diverticulosis of the descending colon and the sigmoid. Instrumental clinical study ].

A retrospective survey was carried out on 87 patients with diverticulosis and 223 control subjects with a view to studying the incidence of colon pathology in association with diverticulosis of the colon. All subjects were given colonoscopies of the distal section of the colon. The survey revealed that the group of diverticulosis patients was, on average, older than the control group (72 v. 59 years). There was no significant difference in the performance or totality of the endoscopic examination. Subjective and objective symptomatology revealed no a priori evidence of pathology associated with diverticulosis. There was no statistically significant difference in the incidence of polyps, neoplasias, haemorrhoids or colon melanosis in the two groups.

Aged↗
PubMedDate not supplied

Electromanometry of the rectosigmoid in colonic diverticulosis.

In order to better understand the rectosigmoid motor activity in diverticular disease of the colon, we studied 186 patients, grouped according to their intestinal habit, the presence of diverticular disease and previous crisis of sigmoid diverticulitis. The intestinal habit was classified as: normal habit, irritable colon syndrome, diarrhea and constipation. The group of diverticulosis was classified by their intestinal habit and by diverticula localization (localized or generalized). The presence of systemic diseases or drug ingestion that could modify intestinal motility, were considered criteria for exclusion. The manometric study was preceded by food stimulus, with 650 kcal meal, by mechanic intestinal cleansing, with 500 ml of saline solution enema and by one hour resting period. A manometric catheter, was introduced by rectosigmoidoscopy, with open ended orifices situated at the sigmoid and upper rectum, respectively. The catheter was perfused by a capillary infusion system and the bowel pressures were registered for 30 minutes, in a thermal paper physiograph. We analyzed the % of activity, mean amplitude and motility index, by non parametric tests. No significant difference was observed between sexes. Difference or close to it were found for the groups with constipation, with or without diverticulosis, and for the latter in its subdivisions (localized, generalized and sigmoid diverticulitis). The rectal motor activity was similar in all groups. There was no difference for diverticulosis and its subdivision, when we take into account the several kinds of intestinal habits and the diverticula localization. The motility index averages showed low values for the sigmoid diverticulitis fact that suggests some dysfunction of this segment (hypocontractility). The key factor differentiating the groups was the presence of constipation and no influence was noted regarding the localization of diverticula or previous inflammatory process on intraluminal pressures. The fact that no difference was found in the mean amplitude or % of activity among patients with or without diverticulosis, suggests that the high pressures in a colonic segment, may not be responsible for the diverticular disease, and there must be other factors, besides motility, accounting for the development of the different forms of this disease.

Adult↗
PubMed1994

Accuracy of double contrast barium enema and sigmoideoscopy in the detection of polyps in patients with diverticulosis.

The sensitivity between double contrast barium enema (DCBE) and sigmoideoscopy in diagnosing neoplastic lesions in the sigmoid colon was compared in patients with diverticulosis. In 52 patients with severe diverticulosis (> or = 15 diverticulas) the DCBE detected one out of 4 polyps found by sigmoideoscopy. In the remaining 54 patients with mild diverticulosis (< 15 diverticulas) DCBE detected 7 out of 10 polyps found by sigmoideoscopy. Successful bowel preparation did not influence the outcome of the DCBE. Sigmoideoscopy was incomplete in 17 (16%) of the patients; females were more difficult to examine than males (p = 0.012), as were those with a previous pelvic operation (p = 0.032). We conclude that neither DCBE nor sigmoideoscopy alone is sufficient to detect all neoplastic lesions in the sigmoid colon in patients with sigmoid diverticulosis of the colon.

Adult↗
PubMed2005

An analysis of the development of colonic diverticulosis in the Japanese.

PURPOSE: There are quite different characteristics between colonic diverticulosis in the West and that in Asia, including Japan. These differences include the predominance of a few diverticula over others, right-sidedness, young generation, male, and few complications. In Japan, colonic diverticulosis started increasing in the 1970s. This study was performed to obtain exact evidence of diverticular development in contemporary Japanese by observing changes in diverticula in the same individuals examined over a period of ten or more years. METHODS: This study included 82 subjects (56 (68 percent) males and 26 (32 percent) females) who underwent barium enema examinations repeatedly for more than ten years from 1982 to 2000. The diverticula were categorized according to their location in the colon: right, left, or bilateral. They were also categorized by whether they appeared individually, were scattered with two to nine diverticula, or were numerous with ten or more diverticula. RESULTS: At the beginning of observation, the most frequent location was the right side (55; 67 percent), followed by bilateral (20; 24 percent) and the left side (7; 9 percent). Ten or more years later, the number on the right side had decreased to 39 (48 percent). The number of bilateral diverticula had increased to 38 (46 percent), and the number on the left had barely changed, to 5 (6 percent). The number of diverticula increased from 253 to 604 (239 percent) in the right and from 380 to 929 (244 percent) in the bilateral. The initially very small number in the left increased from 9 to 48 (533 percent). The data show marked increases in the right and bilateral diverticula, and also the spread from the right side to the left side. CONCLUSION: In contemporary Japanese, although the right predominated initially, diverticulosis showed a strong tendency to increase and spread from the right to the bilateral. The number of bilateral diverticula also tended to increase. The left did not change much.

Adult↗
PubMedDate not supplied

Complicated colonic diverticulosis: surgical perspective from an Indian Centre.

INTRODUCTION: Colonic diverticulosis was previously uncommon in India but its incidence seems to have increased recently. Patients with the disease in developing countries are also underdiagnosed and are therefore more likely to present with complications needing operation. However there is a paucity of surgical data on the condition. METHOD: Between August 1996 and February 2005 we operated on 32 patients (28 males, 4 females mean age 60 years) with colonic diverticulosis and analysed their characteristics from a prospective database. We here with describe our experience. RESULTS: Operations for diverticular disease constituted 3% of all the colorectal operations we performed. The diverticula were in the sigmoid colon in 28 (88%) and also in the descending colon in 4 (12%). Twenty-four patients were symptomatic. Twenty-two patients were diagnosed before surgery, 8 at operation and the rest from resected specimens. Emergency operations were performed in 23 and elective procedures in 9 patients. Ten patients were operated on for perforation and abscess, 8 for obstruction, 8 for colovesical fistula, 3 for peritonitis and 3 for haemorrhage. Emergency procedures were performed in 2 stages (resection plus a proximal diversion) in 20; unless done for bleeding in a stable patient where a primary anastomosis was done. One patient who had had an emergency procedure died of sepsis and ketoacidosis in the post-operative period. The 8 patients with colovesical fistulae were all males, had only sigmoid involvement and had had symptoms for a longer duration than the 24 without fistulae. CONCLUSIONS: Although operations for colonic diverticulosis still form a small proportion of the total number of colorectal operations, the diagnosis is often delayed till complications ensue and thus patients usually require emergency procedures. Males with long standing symptoms and sigmoid diverticula may develop colovesical fistulae.

Adult↗
PubMed1988

Jejunal diverticulosis.

Forty-seven patients with jejunal diverticulosis were identified at the University California, Davis Medical Center, Sacramento, by a review of patient medical records from 1980 to 1986. Fourteen patients had complications that could be directly attributed to the presence of diverticula. Six patients had evidence of a malabsorption syndrome and responded to administration of broad-spectrum oral antibiotics. One patient had recurrent bouts of an asymptomatic pneumoperitoneum. A total of seven patients required operative intervention for the following conditions: massive gastrointestinal tract bleeding, two patients; mechanical small-bowel obstruction, two patients; and diverticulitis with perforation, three patients. One patient died. Nineteen patients had symptoms of epigastric pain, early satiety, and bloating for which no cause other than the presence of jejunal diverticulosis was found. Jejunal diverticulosis was an incidental finding in 14 patients treated for other gastrointestinal tract problems.

Adult↗
PubMed1975

Rectosigmoidal mucosal puckering and diverticulosis.

The association of diverticulosis with a thickened muscle wall in the pelvic colon is well known. There appeared to be a possibility that this muscular thickening might give rise to the rectosigmoidal mucosal puckering often seen through a sigmoidoscope. In 278 colonic motility studies, mucosal puckering was correlated with patient age, diverticulosis, and the symptomatology of the irritable colon syndrome. The prevalence of mucosal puckering increased with age at the same rate as that of diverticulosis, but the different percentage levels were reached some 25 years earlier in life. Mucosal puckering, which persisted in all subsequent examinations, showed no correlation with the clinical characteristics of irritable colon syndrome. Resistance of the bowel wall to distention was significantly greater in association with puckered rectosigmoidal mucosa than when the mucosa appeared smooth. It is concluded that rectosigmoidal mucosal puckering is probably caused by thickening of the underlying muscle; it is a precursor of diverticulois, and patients who have it should be kept on a high-residue diet.

Adult↗
PubMed2004

The spectrum of segmental colitis associated with diverticulosis.

BACKGROUND: Segmental colitis associated with diverticulosis (SCAD) has been defined as chronic colonic inflammation surrounding diverticula with rectal sparing. Distinguishing this condition from inflammatory bowel disease may be difficult. Our aim was to evaluate the epidemiological and clinical characteristics of SCAD in our area. METHODS: Retrospective case identification with prospective follow-up was done. Patients with endoscopic findings suggestive of SCAD were enrolled. The epidemiological, clinical, and histological characteristics of these patients were analyzed. RESULTS: Out of 605 patients with diverticulosis, 23 cases of SCAD were identified (3.8%). Four patients had histological characteristics suggestive of ulcerative colitis, in 1 case the histology was suggestive of ischemic colitis, 6 patients had histology compatible with SCAD, and the remaining patients had either transitional mucosa or minimal lesions. Four cases were refractory to conservative treatment (mesalamine and antibiotics) and surgery was required. No cases of extension of colonic inflammation in diverticula-free areas were found. CONCLUSIONS: Segmental colitis associated with diverticulosis is not a rare disorder. It may occur with a spectrum of clinical and histologic features and may be confused with ulcerative colitis. The majority of the cases respond to medical therapy with antibiotics and/or mesalamine, whereas few cases are refractory and need surgery. No evolution to inflammatory bowel disease was observed.

Adult↗
PubMed1988

Etiology and pathogenesis of diverticulosis coli: a new approach.

The paper describes a hypothesis as to the etiology and pathogenesis of diverticulosis coli. Colonic diverticulosis develops as a result of excessive straining at defecation due to habitual bowel emptying in a sitting posture, which is typical of Western man. The magnitude of straining during habitual bowel emptying in a sitting posture is at least three-fold more than in a squatting posture and upon urge. The latter defecation posture is typical of latrine pit users in underdeveloped nations. The bowels of Western man are subjected to lifelong excessive pressures which result in protrusions of mucosa through the bowel wall at points of least resistance. This hypothesis is consistent with recent findings of elastosis of the bowel wall muscles, the distribution of diverticula along the colon, as well as with epidemiological data on the emergence of diverticulosis coli as a medical problem and its geographic prevalence.

Defecation↗
PubMed1976

Ureteral diverticulosis.

Ureteral diverticulosis is a rare condition found mostly in men more than 50 years old and generally requires retrograde pyelography for diagnosis. Urinary obstruction and infection are often associated. No significant morbidity occurs but the analogy of hematuria from ureteral diverticulosis to bleeding from colonic diverticulosis is present.

Adult↗
PubMed1987

Diverticulosis of the vermiform appendix in patients with cystic fibrosis.

This paper presents a study of diverticulosis of the vermiform appendix in patients with cystic fibrosis. The records of two hospitals were reviewed. A total of 39 autopsy specimens and 18 surgical specimens were obtained. Diverticulosis of the appendix was found in 14 per cent (eight of 57) of all appendices. Two of these cases also showed diverticulitis. These results stand in contrast to the incidence of diverticulosis of the appendix in the general population, which has been measured at 1 to 2 per cent in various reviews.

Adolescent↗
PubMedDate not supplied

Sigmoid colon diverticulosis adherent to mesh plug migration after open inguinal hernia repair.

PURPOSE: Tension-free hernia repair with polypropylene mesh plug and patch is currently the most popular technique for open inguinal hernioplasty. It is well tolerated by most patients with few complications. Despite these excellent results, late-onset complications may occur. METHODS: An 83-year-old man reported 2 weeks of bloody stool. His medical history was significant for a left open inguinal herniorrhaphy with the mesh plug and patch technique. Barium enema revealed a stenotic segment in the sigmoid colon and multiple diverticulosis. Because a malignant lesion could not be ruled out, the patient underwent an operation. Laparotomy revealed an inflamed sigmoid colon with diverticulosis adherent to a hard tumor, which was mesh plug used for the previous open inguinal hernia repair. After mobilization of the adhesion between the mesh plug tumor and the sigmoid colon, sigmoidectomy was performed. The patient's postoperative course was uneventful. CONCLUSIONS: We reported a case of sigmoid colon diverticulosis adherent to mesh plug migration after open inguinal hernia repair. The potential risk of plug migration should be well understood by the surgeon. To avoid this risk completely, several methods have been proposed such as suturing the plug and patch together, or using an all-in-one design such as the Prolene Hernia System (Johnson and Johnson Co., Tokyo, Japan).

Journal Article↗
PubMed2005

Alterations in colonic motility and relationship to pain in colonic diverticulosis.

BACKGROUND AND AIMS: Although the pathophysiologic basis of colonic diverticular disease is understood incompletely, there is agreement that abnormal colon motility probably plays a major role. However, several different abnormalities have been reported in such patients. The purpose of this study was to assess whether patients with diverticulosis display an abnormal duration of regular colonic contractile patterns, which has been observed in other conditions characterized by spasticity of the viscus, such as the irritable bowel syndrome. METHODS: Twelve patients with symptomatic uncomplicated diverticular disease entered the study and underwent 24-hour colonic manometric recordings using a standard technique. The duration of regular contractile patterns was compared with that recorded in 20 healthy volunteers. RESULTS: Patients with diverticulosis had a significant increase of the duration of regular patterns of phasic pressure activity compared with healthy controls (31% vs. 6.4%, P < .001). In both groups, the 2- or 3-cycles-per-minute activity represented more than 80% of such activity, especially in the sigmoid colon. More than 30% of patients, but none of the controls, reported episodes of abdominal pain (cramping lower abdominal pain with characteristics similar to those experienced at home) during the occurrence of a regular colonic contractile pattern. This was significant by symptom association probability criteria. CONCLUSIONS: Patients with symptomatic uncomplicated colonic diverticulosis displayed increased duration of rhythmic, low-frequency, contractile activity, particularly in the segments bearing diverticula. These regular rhythms are associated significantly with reporting of abdominal pain.

Abdominal Pain↗
PubMed1975

[Radiological aspects of esophageal intramural diverticulosis].

The 9th observation of esophageal intramural diverticulosis is reported. The findings are compared with those of former publications. Clinically dysphagia is a leading symptom. Suction biopsy proved diverticulosis being the correct interpretation for radiological findings. The etiology is discussed. The change between symptom-free intervals with diverticulosis only and episods of dysphagia by secondary inflammation (reflux esophagitis, moniliasis, stenosis) stresses the importance of such secondary complications. These inflammations can hide the real diagnosis for a long time. The radiological findings are the key for diagnosis, however, they can be very small for years. During this period a diagnosis can only be achieved by knowledge of the disease and the skilful search for early symptoms.

Adult↗
PubMed1997

Addition of methyl cellulose enema to double-contrast barium imaging of sigmoid diverticulosis.

UNLABELLED: Double-contrast barium enema has a reduced sensitivity in patients with severe sigmoid diverticulosis. Therefore a carboxy methyl cellulose enema was employed after the conventional double-contrast examination in 15 patients with sigmoid diverticulosis. A significant increase in lumen diameter and a superior removal of barium residue from the diverticula facilitated the interpretation of the sigmoid loops. CONCLUSION: The addition of methyl cellulose enema to double-contrast barium imaging improves diagnostic imaging in diverticulosis by expanding the lumen and emptying the diverticula.

Aged↗
PubMed2000

Intestinal motility in small bowel diverticulosis: a case report and review of the literature.

Small bowel diverticulosis is a rare disease that is usually associated with recurrent pseudo-obstruction, bacterial overgrowth, and malabsorption. The more severe complications include hemorrhage and perforation. There is evidence to suggest that this entity is a result of small bowel motor dysfunction. For this reason, it has been associated with disorders in which a myopathic or neuropathic process is involved, such as scleroderma. The majority of patients with jejunal diverticulosis do not require surgery and can be managed medically. We report a case of jejunal diverticulosis in a 63-year-old gentleman who presented with symptoms of pseudo-obstruction. Ambulatory duodenojejunal manometry revealed several abnormalities suggestive of small bowel motor dysfunction. Enteroclysis, however, did not find evidence of mechanical obstruction, and the patient had marked improvement with cisapride and antibiotics.

Diverticulum↗
PubMed2006

Significant increase of colonic mutated crypts correlates with age in sporadic cancer and diverticulosis cases, with higher frequency in the left- than right-side colorectum.

Mild periodic acid-Schiff (mPAS) staining can discriminate non-O-acetylated (mPAS-positive) from O-acetylated (mPAS-negative) epithelial sialoglycoproteins in human colonic mucosa, allowing the three haplotypes expressed from a single polymorphic autosomal gene (oat) to be distinguished. In heterozygotes, we previously demonstrated wholly mPAS-positive (stem cell mutated) crypts and clusters of two or more mPAS-positive crypts to be significantly increased with duration of ulcerative colitis. To establish whether such an increase in the number of mutated crypts with age also occurs in normal individuals or in cases with diverticulosis, the O-acetylation phenotype in the non-cancerous colonic mucosa of 47 sporadic colorectal cancer patients who were heterozygotes for oat was tested with mild-PAS staining. PAS-positive crypts were assessed histologically in relation to age and compared between the left (sigmoid colon and rectum) and right (cecum and ascending colon) sides of the colorectum. Wholly mPAS-positive (stem cell mutated) crypts and foci in heterozygotes were found to be increased significantly (P < 0.0001) in the left side with aging (r = 0.598 and 0.643, respectively). Such a positive correlation with aging was also confirmed in 19 diverticulosis cases without cancer (r = 0.797 and 0.793, respectively). The frequency of mutated crypts and foci on the right side was significantly lower than on the left side in both spontaneous colorectal cancer and diverticulosis cases. The results provide support for an intimate relationship between accumulation of mutated crypts with aging, possibly with significance for colorectal cancer development. Furthermore, the environment in the right side of the colon may be different from that in the left side in this regard.

Adult↗