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PubMedDate not supplied

[Digestive tract hemorrhage secondary to jejunal angiodysplasia associated with jejunal diverticulosis].

The most important factor in the management of alimentary tract bleeding is the adequate localization of the lesion. Small bowel bleeding is a rare entity and determination of the specific anatomic site is difficult. Once stomach, duodenum, or colon origin has been discharged through endoscopy, methods such as angiography and Tc99m RBC scans are appropriate. We present a patient with lower gastrointestinal bleeding secondary to jejunal angiodysplasia associated with jejunal diverticular disease. In the present case, Tc99m RBC scans were used to identify the bleeding site. In cases of lower gastrointestinal bleeding of undetermined origin, we suggest the consideration of both diagnoses (angiodysplasia or diverticular disease) with exploratory celiotomy to resolve these pathologies, particularly in the elderly patient.

Aged↗
PubMedDate not supplied

[Colonic diverticulosis complicated with perforation. Analysis of several prognosis variables and criteria for emergency surgery].

The aim of this study was to analyse the clinical course, surgical strategy and results in patients with perforated large bowel diverticulitis. Over a 15-year period ending in January 1997, 25 patients (13 males and 12 females; mean age 64.1 years) underwent operation for perforation of acute diverticulitis. Depending on the symptoms, the spreading of the peritonitis and the patient general state, different surgical techniques were performed: primary resection and anastomosis with and without defunctioning colostomy (5), primary left hemicolectomy (1), Hartmann's resection (13), Mikulicz's procedure (4), suture and drainage with diverting colostomy (2). The overall mortality was 16%, while morbidity rate was 44%; these results were strictly related to the severity of clinical manifestations and peritoneal contamination. Therefore it must be stressed that a good surgical timing is essential. Our experience and literature data show that primary resection and anastomosis with and without colostomy have good results when the patient is fit, the sepsis is localized and satisfactory bowel preparation is achievable. By contrast, purulent and faecal peritonitis are still usually best treated by Hartamnn's procedure. Finally, it is submitted to surgeons's experience to choose, at any situation, the best procedure regarding age and general state, local findings and extent of peritonitis.

Adult↗
PubMed2000

[Results of elective segmental colectomy done with laparoscopy for complicated diverticulosis].

OBJECTIVES: To analyze a unicentric series of 100 consecutive elective laparoscopic colon resections for diverticular disease and to evaluate in intention to treat the early- and middle-term postoperative results. METHODS: From February 1993 to March 1998, 100 colon resections for complicated diverticular disease were performed through laparoscopy with systematic mobilization of the splenic flexure and resection of the rectosigmoid junction. The colorectal anastomosis was stapled or manual without proximal stoma. In 53 females and 47 males (mean age 60.4 years), indications for surgery were: one or more attacks of acute diverticulitis (n = 70), abscess (n = 17), symptomatic stenosis (n = 8), colovesical fistula (n = 4) and diverticular bleeding (n = 1). RESULTS: Mortality was nil. The conversion rate was 9%, never for anesthetic reasons. The mean operating time was 226 +/- 68 min. There was no splenic or ureteral injury. The morbidity at 30 days was 19% with fistulae rate accounting for 2%, 2 patients were reoperated on. The median time for passage of flatus was 3 days and median length of hospital stay was 7 days. Late morbidity was 10%, one patient complained of retrograde ejaculation. CONCLUSION: This study demonstrates that laparoscopy is a safe alternative to laparotomy for elective one-stage colectomy for complicated diverticular disease.

Adult↗