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At least 613 records · Page 34Linked to original sources
PubMed1994

Long-term outcome of patients presenting with acute complications of diverticular disease.

The immediate management of acute diverticular disease is well defined but the risk of further complications and the long-term course of the disease, after conservative or surgical treatment, is not clearly documented. Over an 8-year period, a total of 164 patients (male/female = 69/95, median age 68 years) presented with acute complications of diverticular disease and were prospectively followed up for a median of 48 months. Medical treatment of acute diverticulitis was effective in 85% of 86 patients, with a mortality of 1.3% and a recurrence rate of 2% per patient year follow-up. All 37 patients presenting with bleeding responded to conservative management without mortality and a readmission rate, with further bleeding, of 5% per patient year. Patients who required colonic resection (n = 52), either as a single or staged procedure, had a mortality of 12% but with no further admissions with complications of diverticular disease. The low risk of readmission with recurrent disease after successful conservative treatment of the acute complications of diverticular disease does not justify elective operation in this group of patients.

Acute Disease↗
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↗
PubMed1995

Cancers among patients diagnosed as having diverticular disease of the colon.

OBJECTIVE: To assess the incidence of underlying malignancy in patients with a diagnosis of diverticular disease of the colon. DESIGN: Retrospective cohort study. SETTING: University hospital, Sweden. SUBJECTS: 7159 patients discharged from hospital with a first diagnosis of diverticulosis or diverticulitis in central Sweden 1965-1983. INTERVENTION: The cohort was followed up for two years for the occurrence of cancer. MAIN OUTCOME MEASURE: Cancer incidence. RESULTS: A total of 372 cancer cases were identified standard incidence ratio = 2.4; 95% confidence interval 2.2 to 2.7). Sites at excess risk during the first year were: colon and rectum, pancreas, prostate, stomach, lymphatic and haemopoietic tissue, liver and bile ducts, ovary and lung, with the highest excess risk in the left colon (standard incidence ratio = 17.8; 95% CI 12.7 to 24.1). CONCLUSION: Malignant diseases, especially colorectal cancer, are relatively common among patients with a clinical diagnosis of diverticulosis or diverticulitis of the colon. This may indicate a need for a change in current clinical practice.

Aged↗
PubMedDate not supplied

[Use of an x-ray method in the assessment of changes in the intestinal wall in colonic diverticulosis].

The authors analyze x-ray findings in 194 patients with colonic diverticulosis and its inflammatory complications. Findings of preoperative irrigoscopy were correlated with dates of morphological investigations. Roentgenomorphological and functional changes were assessed in different clinical types of colonic diverticulosis. Correlation was received between this changes and clinical sings of disease. Authors determined risk-groups of inflammatory complications of colonic diverticulosis.

Calcinosis↗
PubMedDate not supplied

[Surgical treatment of complications in diverticular disease].

The modern approach to large bowel diverticulae is nowadays directed to localize group of patients, at risk for complications, who can be admitted to prophylactic surgery in order to avoid large number of emergency treatments. Despite this clinical attention 10% to 25% of the patients develop a minor or major complication either septic or bleeding. Surgery still remain the most common approach, and above all resection anastomosis treatment are to be preferred. Radiological and endoscopic diagnosis and care are getting more and more better in dealing with acute localised peritonitis and bleeding and can avoid invasive treatments when possible for a number of selected patients.

Adult↗
PubMed1997

[Diverticular disease and its treatment].

Diverticular disease of the colon is being seen with increasing frequency. Not infrequently, the first attack of diverticulitis may result in serious and potentially fatal complications. A period of observation and conservative management is necessary to determine the outcome of a particular attack. Approximately 30% of symptomatic patients require surgical intervention. Controversy still surrounds the appropriate operative approach to be employed in the management of diverticular disease, moreover when it presents with a complication. In general, resection is the procedure of choice for perforating diverticulitis. There is an emerging role for down-staging interventions in the recent literature; with few exception, there is no role for three-stages procedure for diverticular disease. In the setting of stage I or stage II disease (Hinchey classification) primary resection with anastomosis is safe and should be performed. Proximal colostomy formation may be carried out at the discretion of the surgeon if warranted by such local circumstances as contiguous inflammation or macroscopic contamination. For patients with stage III and stage IV disease endcolostomy with Hartmann closure of the rectum is the procedure of choice, although anastomosis with proximal stoma may prove to be an acceptable alternative. We reviewed the changing patterns in the operative treatment in 46 patients admitted to our Division for perforated diverticulitis. We performed the resection with anastomosis in 39 patients with perforation at the II stage; in 7 patients with generalized peritonitis (stage III-IV by Hinchey) we preferred Hartmann intervention in 4 cases and the three-stages procedure in 3 cases. We had no death at all. From 1979 to 1994 we noticed an increasing use of down-staging procedures.

Aged↗
PubMed1997

Is prophylactic resection valid as an indication for elective surgery in diverticular disease?

OBJECTIVE: To determine whether interval resection in asymptomatic patients after 1 or 2 episodes of acute diverticulitis (prophylactic resection) is justified as a means of preventing late inflammatory complications of diverticular disease. DESIGN: A retrospective analysis. SETTING: A university-affiliated tertiary care hospital. PATIENTS: Those requiring hospitalization from 1987 to 1995 for treatment of acquired diverticular disease of the colon. Twenty-eight patients underwent elective resection and 154 were treated for inflammatory complications (perforation, fistula, complete large-bowel obstruction). INTERVENTIONS: Standard surgical management for diverticular disease, but only 3 prophylactic resections were undertaken during this period. OUTCOME MEASURES: Type of operation, stoma creation and closure, hospital death. In those treated for complicated disease, the effects on outcome of all previous outpatient treatment and hospitalizations. RESULTS: Only 10% of those presenting with complications had been treated conservatively for acute diverticulitis and only 5% had been hospitalized for this reason. CONCLUSIONS: Prophylactic resection is unlikely to prevent late major complications of diverticular disease; therefore, as an elective indication for surgery in this disease its use is questionable.

Aged↗
PubMed1998

[Diverticulosis and diverticulitis in the elderly].

Diverticulosis of the colon is a disease that mainly affects the elderly, presenting in 10 to 20% of this age group. The most common complication--painful diverticular disease, is usually treated conservatively with a high-fiber diet, intermittent use of antispasmodics and possibly regulation of the stools. Diagnostic differentiation is best performed using ultrasonography of the bowel wall, supplemented where necessary by computer tomography and colonoscopy (sigmoidoscopy) or, where this latter is not possible, barium enema using Gastrografin. Conservative treatment of diverticulitis with antibiotics, bowel rest, possibly including parenteral alimentation, is usually applied for three to ten days. In the absence of a response to this treatment, frequent recurrence, immunosuppression or complications (perforation, peritonitis, enterovesicular fistula), surgery is indicated.

Aged↗
PubMed1976

Findings in patients with diverticulosis and diverticulitis of the colon.

During the period from 1957 up to and including December 1975, the surgical clinic of Nijmegen admitted 82 patients with the diagnoses of diverticulosis and diverticulitis of the colon: the diagnosis of diverticulosis was made in 16 cases; in 17 diverticulitis was diagnosed and these patients were treated by conservative methods. Forty-nine patients were subjected to operation for diverticulitis. Of the patients treated conservatively, none died; of those treated by operation, three (6%) died. There were nine patients with peritonitis and three with ileus who required emergency surgery. As a matter of principle these patients were treated in several stages; none of them died.

Adult↗
PubMed1998

Clinical characteristics of polycystic kidney disease with end-stage renal disease. The Kanazawa Renal Disease Study Group.

AIMS: Polycystic kidney disease (PKD) is one of important causes of end-stage renal disease (ESRD). However, there have been few detailed reports on PKD patients with ESRD. The present study was designed to clarify the clinical characteristics of PKD patients with ESRD. SUBJECTS AND METHODS: We collected data from 22 renal divisions in our region, where 63 of 1246 patients with ESRD (male/female: 31/32) were proven to suffer from PKD (5.06%). RESULTS: The average age at the induction of renal replacement therapy was 52.4 +/- 10.0 years. Of these patients, 32 (50.8%) had some family members with apparent PKD. Three (4.8%) and 4 (6.3%) had a history of subarachnoidal hemorrhage and intracerebral hemorrhage, respectively. One (1.6%) suffered from tuberous sclerosis. The prevalence of hypertension treated with antihypertensives, anemia treated with rHuEPO, hepatic cyst, pancreatic cyst, intracranial aneurysm and colonic diverticulum were 66.7%, 58.7%, 85.7%, 16.0%, 33.3% and 50.0%, respectively. CONCLUSION: There was no marked difference in general characteristics or history between the present subjects and those described in previous reports. However, the prevalence of complications seemed to be higher than previously estimated.

Female↗
PubMedDate not supplied

[Does there exist a current indication for myotomy in diverticular disease of the colon?].

Thanks to advances of gastroenterological and dietary regimen of patient with more complicated diverticular disease of the colon, the surgical indications to myotomy are nowadays very low, if not more at all. The insurgence of complications is naturally a precise indication to demolitive surgery actually with low postoperative morbidity and mortality.

Adult↗
PubMedDate not supplied

[The indications for prophylactic colectomy in diverticular disease].

Still controversial is the role of surgery in symptomatic colon diverticular disease, outside the major complications. In such circumstances the surgeon has to comfort himself with diagnostic and then with operative choices, and also the preventive colectomy has to be considered. To make a correct decision very important is the global evaluation of the patient, for age, sex life habits, other existing pathologies, general condition. Also unsolved doubt for a neoplastic evolution has its worth.

Colectomy↗