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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↗
PubMedDate not supplied

[Complications of colonic diverticulosis].

From 1978 to 1993, 220 patients were admitted at the Cl. Chirurgica III of the University of Bologna because of acute colonic diverticulitis. During the same period 108 patients (58 females and 50 males; mean age 65 years) were operated on for complications of the disease; 21 acute diverticulitis, 10 pericolic or pelvic abscess, 30 purulent peritonitis, 7 fecal peritonitis, 19 obstruction, 14 hemorrhage and 7 fistula. Surgical techniques were: resection and primary anastomosis (n. = 46), two or three stage procedure (n. = 49), Hartmann's resection (n. = 13). Mortality rate was 15%, 14,2% and 7,6% respectively. The advantages or disadvantages of the various surgical approaches in relation to the type of complications were evaluated. In conclusion appropriate segmental resection of the colon with or without primary anastomosis is recommended.

Acute Disease↗
PubMed1995

[Diagnostic pitfalls of complicated colonic diverticulosis].

Irritable bowel syndrome and (or) non complicated diverticulosis, associated with fever, could simulate diverticulitis. Cancer of the sigmoid colon appears the main differential diagnosis, when diverticulitis is associated with an atypical or complete colonic stenosis on opaque enema, with a vesicoenteric fistula or with a peritonitis due to a colonic perforation. Even at laparotomy, a pseudotumoral diverticulitis cannot easily be differentiated from a colonic carcinoma. Acute diverticulitis of the caecum or ascending colon is usually mistaken for acute appendicitis. When massive and life-threatening bleeding occurs, the diverticular origin is difficult to assess. Bleeding due to peptic ulcer disease and thermometric ulceration being precluded, arteriography performed on emergency is necessary to differentiate between diverticular bleeding and angiodysplasia.

Abscess↗
PubMedDate not supplied

[Radiologic diagnosis of inflammatory complications of colonic diverticulosis].

The authors analyze x-ray findings in 194 patients with colonic diverticulosis and its inflammatory complications. Clinical, x-ray, and morphologic studies helped the authors to specify the x-ray semeiotics of diverticulitis, paraintestinal infiltrates, intestinal fistulas. An optimal complex of radiological methods to detect each of these complications has been developed. The authors claim that irrigoscopy supplemented, if necessary, with simultaneous fistulography, or oral enterography is the priority and basic method for the diagnosis of inflammatory complications of colonic diverticulosis.

Adult↗
PubMed1994

Pattern of diverticular disease among Africans.

Diverticular disease of the colon was found to be a rare but emerging clinical problem among Urban Africans where 26 patients were recorded in this 5 year retrospective study, giving a hospital prevalence of 5 per 100,000 admissions. The pattern was different from that reported in Western communities in that, while diverticula were left sided in 77% of cases, 62% were right sided and 73% presented with haemorrhage. This confirms a reported experience among African Americans. We would like to postulate that it might be the pattern during a transition from traditional to Western diet.

Adult↗
PubMed1994

[Complicated colonic diverticulosis. Changes in treatment and results over 22 years].

OBJECTIVES: The aim of this study was to analyse the clinical course, surgical strategy and results in patients with complicated colonic diverticular disease. METHODS: We retrospectively compared two groups of patients who underwent surgery for complicated colonic diverticulosis from 1970 to 1984 (Group A, n = 94, mean age 60 years, 49 males, 45 females) and from 1985 to 1992 (Group B, n = 76, mean age 63.5, 32 males, 44 females). RESULTS: Patients in the two groups were comparable; only the rate of peritonitis (20 vs 8%) was different (p < 0.05). The most frequent operations in Group A were colostomy-drainage (43%) and Hartman's procedure (26%) in emergency situations and resection with immediate anastomosis (63%) or resection-anastomosis with diverting stomy (19%) in elective cases. In Group B, surgical strategy led to a different pattern of operations, 4 and 56% in emergency, and 94 and 2% in elective surgery, respectively. Overall mortality was 11%, with 17% and 4% in Groups A and B respectively (p < 0.01). This major drop in mortality was particularly important in emergency cases (31 vs 4%; p < 0.02). Morbidity in emergency surgery fell from 21 to 4% (P < 0.0006). Interrupting the use of colostomy-drainage was a major factor in reducing mortality followed by a sharp fall in mortality after Hartmann's procedure (28.5 vs 0%). CONCLUSION: The marked improvement in results between the two groups was mainly due to preferring resections of pathological colonic segments over colostomy-drainage.

Abscess↗
PubMedDate not supplied

[Pathomorphology of colonic diverticulosis].

Two clinico-morphological forms of colon diverticulosis are distinguished on the basis of post-mortem and surgical material (89 observations) studied histologically, neurohistologically and electron-microscopically. The first form is characterized by the disturbance of colon peristalsis, inflammation, segmentation of the colon wall and the presence of staged changes in the colon wall muscles. Disturbances of the vegetative innervation and regional hemodynamic disturbances play a role in the patho- and morphogenesis. The second form develops in aged persons and is characterized by weakness of the colon wall with thinning of the muscle layer. In both forms atrophy of the circular muscle layer develops with dilation of perivascular spaces and formation of "weak sites" in the colonic wall.

Aged↗