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PubMed1980

Electrolyte transport across colonic mucosa from patients with inflammatory bowel disease.

To investigate the pathogenesis of diarrhea in inflammatory bowel disease, electrolyte transport was examined in vitro in stripped colonic mucosa taken from the sigmoid or descending colon in colectomy specimens. Compared with previously reported values from normal colon, the electrical potential difference, short circuit current, and mucosal resistance were significantly lower in diseased mucosa. This reduction was associated with a significantly lower net sodium absorption in diseased mucosa, owing to a reduced mucosa to serosa unidirectional flux. Net chloride flux was similar to normal, but unidirectional fluxes were reduced. In mucosa from patients treated with corticosteroids, fluxes were similar to normal, while in untreated patients they were markedly impaired. It is concluded that there is a defect in active sodium absorption in inflammatory bowel disease that may contribute to the diarrhea. A secretory process, inhibited by sulphasalazine, cannot be excluded however.

Adolescent↗
PubMed1998

[Nonrotation of the midgut with abnormality of the superior mesenteric artery].

This report describes an anomalous case of nonrotation of the midgut with two superior mesenteric arteries in a 74 year-old Japanese female cadaver at the anatomical laboratory of Kanazawa Medical University. The characteristics of this nonrotation case were as follows: all the small bowel shifted to the right side and all the large bowel to the left side of the abdomen; cecum and appendix vermiform were situated to the left lower abdomen; and ligament of Treiz was absent. There were three arteries originating from the abdominal aorta for blood supply of abdominal organs: 1) the celiacomesenteric trunk with the first superior mesenteric artery, 2) the second superior mesenteric artery, 3) the inferior mesenteric artery. This case had two superior mesenteric arteries. The first one arose from the celiacomesenteric trunk. The second one arose from the left wall of the abdominal aorta about 95.0 mm below the origin of the celiacomesenteric trunk and 23.0 mm above the origin of the inferior mesenteric artery. The first superior mesenteric artery with five branches supplied the inferior portion of the duodenum and the superior portion of the small bowel. The second superior mesenteric artery had five small intestinal arteries supplying the inferior portion of the small bowel, and five large intestinal arteries supplying the cecum, the ascending colon, the transverse colon and the superior portion of the descending colon. The authors believe that the existence of the two superior mesenteric arteries caused the malformation in the nonrotation of the intestinal tracts in this cadaver.

Abdomen↗
PubMed2006

Colon submucosal microdialysis: a novel in vivo approach in barrier function assessment - a pilot study in rats.

During shock, prognosis of a patient depends largely on intestinal barrier function. The potency of gut epithelium to represent an obstacle to toxins is determined by the blood supply. All established methods of mucosal function determination necessitate the functional involvement of bloodstream. Microdialysis allows monitoring of extracellular substances in the gut submucosa, but its potential use for gut barrier integrity assessment is unknown. Twelve rats underwent perfusion of the descending colon either with 20 % ethanol or control medium (vehicle). Both media contained equal amounts of a radioactive tracer substance ((51)Cr-EDTA). Mucosal permeability for (51)Cr-EDTA was assessed by microdialysate to luminal perfusate activity ratios. Sampling was performed using the colon submucosal microdialysis technique. The group subjected to ethanol treatment had profound macro- and microscopical alterations in perfused colonic segment associated with a significant increase in tracer permeability during ethanol exposure (2.354+/-0.298 % for ethanol as opposed to 0.209+/-0.102 % for control group, p 0.01), which remained elevated for 60 min after cessation of ethanol administration (3.352+/-0.188 % for ethanol compared to 0.140+/-0.0838 % for the control group, p 0.001). Submucosal microdialysis with radioactive tracer substance can be considered a feasible and advantageous alternative of gut barrier function estimation. Parallel monitoring of local tissue chemistry with this method remains a challenge in the future.

Animals↗
PubMed2006

Viscoelastic properties of isolated rat colon smooth muscle cells.

The measurement of the biomechanical properties of gastrointestinal smooth muscle cells is important for the basic understanding of digestive function and the interaction of muscle cells with the matrix. Externally applied forces will deform the cells depending upon their mechanical properties. Hence, the evoked response mediated through stretch-sensitive ion-channels in the smooth muscle cell membrane will depend upon membrane properties and the magnitude of the external force. The aim of this study was to test the hypothesis that gastrointestinal smooth muscle cells behave in a viscoelastic manner. Smooth muscle cells were dissociated from the muscle layers of the descending colon. The viscoelastic properties of the isolated cells were characterized by measuring the mechanical deflection response of the cell membrane to a negative pressure of 1cm H(2)O applied across the cell through a micropipette and fitting the response to a theoretical viscoelastic solid model. The viscoelastic mechanical constants of the isolated cells (N=9) were found to be as follows: k(1)=19.99+/-2.86 Pa, k(2)=7.19+/-1.21 Pa, mu=25.36+/-6.14 Pas and tau=4.84+/-0.95 s. This study represents, to the best of our knowledge, the first quantitative mechanical properties of isolated living smooth muscle cells from the gastrointestinal tract. The mechanical properties determined in this study will be of use in future analytical and numerical smooth muscle cell models to better predict the mechanism between the magnitude of mechanical stimuli, mechanosensitivity and the evoked afferent responses.

Animals↗
PubMed2004

Erosion of embolization coils and guidewires from the kidney to the colon: delayed complication from coil and guidewire occlusion of renal arteriovenous malformation.

Percutaneous transarterial embolization is a useful, nondrastic, valuable, and commonly used therapeutic option for the treatment of renal arteriovenous malformation (AVM). Compared with partial or total nephrectomy, transarterial embolization is more conservative and preserves renal function. However, it has some limitations and complications that could cause renal infarction and progression of hypertension, renal insufficiency, and pulmonary embolism. Large-sized AVM and multiplicity of abnormal vessels also limit the use of the embolization technique. The authors experienced erosion of the coils and guidewires that were used for embolization of renal AVM from kidney to descending colon. Coil embolization is practiced extensively, but a complication such as this does not appear to have been described.

Adult↗
PubMed1981

[Age-related surgical anatomical characteristics of the large intestine in newborn infants].

Results of anatomical-surgical and roentgeno-topographical investigation of the large intestines in 291 newborns died from diseases not connected with lesions of the intestine are described. At this age the specific features of the intestine are: poor development of the haustra, taenia, appendices epyploices. The left part of the large intestine is greater than the right one, the descending colon--than the ascending one, the sigmoid colon--than the transverse colon. The caecum is situated high, the ascending and descending occupy an oblique position, they have blund low right and acute high left bends. The sigmoid colon is characterized by a high beginning at right side position. The intestine had definite individual peculiarities in its form, size and position. Its length is within the limits of 351-765 (549 +/- 8) mm. The peculiarities mentioned make the background contributing to the development of certain pathological processes in the organ and therefore, they require a special attention. Statistically significant parameters of its form, size and position can serve as initial data for performing clinical-anatomical comparative investigations with irrigograms of the children suffering from certain congenital intestinal disorders. They should be taken into account when some surgical intervention is planned.

Aging↗
PubMed1999

Laparoscopic colectomy: indications for conversion to laparotomy.

HYPOTHESIS: Although experience with laparoscopic colectomy continues to accumulate, criteria for patient selection for the procedure have yet to be developed. We propose that review of indications for conversion to laparotomy during laparoscopic colectomy should define some of the current technical limitations of the procedure. This information may facilitate development of selection criteria for laparoscopic colon and rectal surgery. DESIGN: Single-institution retrospective medical records review. SETTING: Tertiary referral center. PATIENTS: Two hundred patients who underwent laparoscopic colon surgery, in 47 (23.5%) of whom the procedure was converted to laparotomy. INTERVENTIONS: A registry of 200 patients who have undergone laparoscopic colon surgery was analyzed. Medical records of 47 patients whose procedure was converted were reviewed to assess indications for conversion and identify factors contributing to the need for conversion. RESULTS: Between July 1, 1991, and September 30, 1998, 200 laparoscopic colon procedures were performed: 78 ascending colectomies, 74 descending or sigmoid colectomies, 14 diverting stomas, and 34 "other procedures." The 200 patients were divided into 4 cohorts of 50 consecutive patients to analyze changes with time. The conversion rate was statistically greater in the first quarter (18 patients [36.0%]) than in subsequent quarters (16.0%; P <.05). The rate of conversion to laparotomy for segmental resection of the ascending and descending colon (31/153 [20.3%]) has been equivalent and less than the conversion rate for other procedures (16/33 [48.5%]; P <.05). The distribution of patients by operative indication has been fairly constant. The indication for operation has not influenced the need for conversion. The indications for conversion were technical problems in 15 patients (hypercarbia, unclear anatomy, and stapler misfire), laparoscopic complications in 9 patients (bleeding, cystotomy, and enterotomy), and problems that exceeded the limits of laparoscopic dissection in 23 patients (phlegmon, adhesions, obesity, and adjacent organ involvement by cancer). CONCLUSIONS: Our conversion rate has decreased during our experience, and currently the need for conversion to laparotomy is most frequently caused by situations such as excessive tumor bulk, adhesions, and diverticular phlegmon that exceed the technical limitations of laparoscopic dissection. Colorectal reanastomosis following a Hartmann resection and procedures involving resection of the distal rectum are unlikely to be successfully completed. Although obesity accentuates the technical limitations of laparoscopic dissection, it is an infrequent cause for conversion to laparotomy.

Colectomy↗
PubMed1998

Intraoperative bowel irrigation improves anastomotic collagen metabolism in the left-sided colonic obstruction but not covering colostomy.

This study investigated the effects of intraoperative colonic irrigation and proximal diverting end colostomy after segmental bowel resection in experimental left-colonic obstruction on anastomotic healing. Simple obstruction of descending colon was performed in male Sprague-Dawley rats. After 24 h we performed segmental colonic resection and anastomosis in the control group (n = 15); resection, anastomosis, and covering colostomy in the colostomy group (n = 14); resection and anastomosis after antegrade colonic lavage through cecum by using isotonic saline solution in the irrigation group (n = 13). In rats that were killed 7 days later anastomotic dehiscence and bursting pressure and tissue hydroxyproline concentration at the anastomosis were measured. No significant differences were observed between groups in terms of anastomotic dehiscence, bursting site, or pressure. The hydroxyproline concentration was significantly higher in the irrigation group than the control group (P = 0.025) and the colostomy group (P = 0.029), but no difference was noted between the control group and the colostomy group. These findings suggest that intraoperative antegrade colonic irrigation in the acute left-sided colonic obstruction positively affects collagen metabolism at the anastomotic site; if the anastomosis is performed without bowel cleansing, covering colostomy does not improve collagen metabolism.

Anastomosis, Surgical↗
PubMed1991

Scintigraphic measurement of regional gut transit in idiopathic constipation.

In this study, total gut transit and regional colonic transit in patients with idiopathic constipation were measured scintigraphically. Eight patients with severe constipation were studied, none of whom had evidence of abnormal function of the pelvic floor. 99mTc-radiolabeled Amberlite resin particles (average diameter, 1 mm; Sigma Chemical Co., St. Louis, MO) with a mixed meal were used to assess gastric emptying and small bowel transit; similar particles labeled with 111In were ingested in a coated capsule that dispersed in the ileocecal region. These were used to quantify colonic transit. Five healthy volunteers were also studied. Two patients showed delayed gastric emptying and two had slow small bowel transit. Seven of the eight patients had slow colonic transit. In five, delay affected the whole colon ("pancolonic inertia"); in two, transit in the ascending and transverse colon was normal, but solids moved through the left colon slowly. Mean colonic transit was also measured using radiopaque markers; this technique identified the patients with slow transit, as shown by measurements of overall colonic transit by simultaneous scintigraphy. However, estimated transit through the ascending and transverse colons was considerably shorter by the radiopaque marker technique. In conclusion, idiopathic constipation is characterized by either exaggerated reservoir functions of the ascending and transverse colons and/or impairment of propulsive function in the descending colon. Particle size may influence the result of regional colonic transit tests. Transit delays in other parts of the gut suggest that, in some patients, the condition may be a more generalized motor dysfunction.

Adult↗
PubMed1978

[Multiple cavernous haemangiomas of the colon (author's transl)].

Extensive involvement of the colon with cavernous haemangioma is described in a 26-year old man. Clinically the disease manifests itself by recurrent rectal bleeding and abdominal distension, leading to his admission. Double contrast examination of the colon showed involvement of the ascending, transverse and descending colon, the sigmoid and the rectum. Arteriography demonstrated vascular tumours in the territory of the jejunal artery, the left colic artery and the superior rectal artery. This is a rare condition which has been described only 53 times in the literature (1, 3, 5, 7). The diagnostic value of double contrast examination of the colon and of selective angiography for differential diagnosis is stressed.

Adult↗
PubMed1991

[The diagnostic value of the plain abdominal radiogram in differentiating rotavirus-negative and rotavirus-positive necrotizing enterocolitis].

Clinical data and radiographic findings of 32 newborn suffering from necrotising enterocolitis were analysed [12 patients with rotavirus-positive necrotising enterocolitis (RV + NEC), 20 patients with rotavirus-negative necrotising enterocolitis (RV-NEC)]. The presence and degree of pneumatosis intestinalis, portal venous gas and pneumoperitoneum on abdominal radiographs were graded after Kosloske et al. according to "mild, moderate, and severe". Pneumatosis intestinalis occurred twice as often in the ascending colon in RV-NEC compared to RV + NEC, whereas the transverse colon was involved nearly as frequently as the descending colon in both groups. Portal venous gas was present in 10% of the cases with RV-NEC and was absent in RV + NEC. Pneumoperitoneum only occurred in 8% of RV + NEC but in 20% of RV-NEC. Radiographic findings are helpful in the differentiation between both groups of NEC. Conservative therapy is preferable especially in mainly distal colon distribution of pneumatosis intestinalis without pneumoperitoneum.

Diagnosis, Differential↗
PubMed2005

Efficacy and safety of endoscopic balloon dilation of symptomatic upper and lower gastrointestinal Crohn's disease strictures.

GOALS: To evaluate efficacy and safety of endoscopic balloon dilation with or without intralesional steroid injection, of symptomatic upper gastrointestinal (UGI) and lower gastrointestinal (LGI) Crohn's disease (CD) strictures. BACKGROUND: Patients with CD commonly develop obstructive symptoms secondary to gastrointestinal strictures. When these do not resolve with medical management, surgery is usually the only alternative. Limited data are available on the safety and efficacy of endoscopic through-the-scope (TTS) balloon dilation of CD strictures. STUDY: We performed a retrospective review of TTS balloon dilations done on CD-related UGI and LGI strictures. Postdilation intralesional steroid injections were done at the discretion of the endoscopist. Stricture was defined as luminal stenosis <10 mm in diameter, through which a scope could not be passed. Technical success was defined as the ability of the scope to traverse the stricture postdilation. Long-term success rate was claimed if a patient remained asymptomatic and did not require surgery or further endoscopic dilation. RESULTS: Over 4 years, we performed 29 stricture dilations on 17 patients (10 female, 7 male) with 20 strictures. The mean follow-up period was 18.8 months (range, 5-50 months). Stricture locations were as follows: rectal, 5; sigmoid colon, 2; colo-colonic anastomosis, 3; ileocolonic anastomosis, 4; ileum, 1; descending colon, 1; cecum, 1; and distal duodenal bulb, 3 patients. Technical success was achieved in 28 of 29 stricture dilations (96.5%). Ten strictures (34.5%) were dilated to <15 mm and 19 (65.5%) to > or = 15 mm diameter. Long-term success rate in the <15 mm group was 70%, and in > or = 15 mm group was 68.4%. Four quadrant steroid injections were done on 11 strictures. The recurrence rate in this group was 10% and that in the nonsteroid group was 31.3%. The overall long-term success rate was 76.5% by intent-to-treat analysis. Three perforations occurred (all colonic) during 29 stricture dilations, a complication rate of 10% with no mortalities. CONCLUSION: We report the first series of TTS balloon dilations with or without intralesional steroid injection, of both primary and anastomotic UGI and LGI strictures in CD patients. Long-term success was achieved in 76.5% patients with a complication rate of 10%. This mode of therapy appears safe and effective and can be considered as an alternative to surgery in selected patients with medically refractory CD-associated GI strictures. Success rates were better in patients who received four quadrant steroid injections. No difference was seen in stricture recurrence rate or complications based on diameter of TTS balloon used.

Adult↗
PubMed2005

Intestinal perineuriomas: clinicopathologic definition of a new anatomic subset in a series of 10 cases.

Benign peripheral nerve sheath tumors are uncommon in the gastrointestinal tract, and perineuriomas have not previously been reported to occur at this anatomic location. In this study, we analyzed the clinicopathologic and immunohistochemical features of 10 perineuriomas arising in the intestine. Eight patients were female and 2 male (median age, 51 years; range, 35-72 years). Eight of the lesions were intramucosal perineuriomas presenting as small sessile polyps detected during colonoscopy; 6 of these 8 patients were asymptomatic and undergoing colorectal cancer screening. The remaining 2 cases were submucosal masses, one each located in the colon and jejunum. Of the mucosal polyps, six were located in the rectosigmoid or sigmoid colon and one each was detected in the descending colon and transverse colon. The polyps ranged from 0.2 to 0.6 cm (median, 0.4 cm) in greatest dimension. The colonic and jejunal masses measured 3 cm and 4.5 cm, respectively. Histologically, the intramucosal perineuriomas were composed of uniform bland spindle cells having ovoid to elongated nuclei and pale indistinct cytoplasm, with no cytologic atypia, pleomorphism, or mitotic activity. The lesions had a fine collagenous stroma, demonstrated irregular borders with the adjacent lamina propria, and entrapped colonic crypts. Five cases exhibited hyperplastic changes in the adjacent or entrapped epithelium. The colonic submucosal tumor was microscopically well circumscribed, whereas the jejunal perineurioma showed focal infiltration through the muscularis propria into the subserosa. The stroma was collagenous in the colonic tumor and predominantly myxoid in the jejunal tumor. The spindle cells in the submucosal perineuriomas demonstrated tapered nuclei and elongated bipolar cytoplasmic processes. All tumors except one were positive for epithelial membrane antigen (EMA); 4 of 10 expressed claudin-1 and 2 of 10 expressed CD34. All tumors were negative for S-100 protein, glial fibrillary acidic protein, neurofilament protein, smooth muscle actin, desmin, caldesmon, KIT, and pan-keratin. Electron microscopy was performed on the tumor lacking EMA expression, revealing typical features of perineurioma, namely, spindle cells with long bipolar cytoplasmic processes and prominent pinocytotic vesicles, surrounded by discontinuous basal lamina. Clinical follow-up was available for 4 patients (median, 34 months; range, 8-53 months). No tumor recurred. In summary, perineuriomas may arise in the intestine, most often as intramucosal lesions detected as colorectal polyps with distinctive histologic features including entrapment of colonic crypts. Distinguishing perineuriomas from other spindle cell neoplasms of the gastrointestinal tract can be facilitated by immunostaining for EMA and claudin-1.

Adult↗
PubMed2005

Colon emptying induced by sequential electrical stimulation in rats.

Electrical stimulation could be used to induce colon emptying. The present experiments were performed to establish a stimulation pattern to optimize the stimulation parameters and to test neural involvement in propulsion induced by electrical stimulation. Colon segments were sequentially stimulated using rectangular pulses. The resulting propulsive activity displaced intraluminal content in consecutive propulsion steps. The propulsion steps differed in displacement latency, distance, and velocity along the stimulated colon. Increasing the pulse duration or amplitude resulted in a decrease of the latency. Increasing the stimulation amplitude doubled the displacement distance. The frequencies tested in the present study did not affect propulsion. Inhibition of cholinergic and nitrergic pathways inhibited propulsion. Electrical stimulation can induce colonic propulsion. Motor differences are present along the descending colon. The most suitable combination of pulse parameters regarding colon stimulation is 0.3 ms, 5 mA, 10 Hz. Neural circuits are involved in propulsion when using these values.

Animals↗
PubMed1987

Intestinal ciliated protozoa of African rhinoceros: two new genera and five new species from the white rhino (Ceratotherium simum Burchell, 1817).

This report represents the first published information on intestinal ciliated protozoa in the African white rhinoceros (Ceratotherium simum Burchell, 1817). Two new genera which do not relate to any known ciliated protozoa from the intestines of mammals and five new species are described. The ciliates were found in the colon of three of these free-living hindgut-fermenting grazers that were shot in widely spaced districts in southern Africa. Phalodinium digitalis n. gen., n. sp., Arachnodinium noveni n. gen., n. sp., Monoposthium vulgaris n. sp., M. bracchium n. sp., and M. latus n. sp. constituted between 1% and 10% of the total ciliate population (ca. 1 X 10(5)/ml digesta) in the ascending colon. Exceedingly small numbers were observed in the descending colon, indicating temporary accommodation only.

Animals↗
PubMed2006

Retroflexion in the colon: a useful and safe technique in the evaluation and resection of sessile polyps during colonoscopy.

OBJECTIVE: Endoscopic polypectomy has become the standard management approach for colon polyps. Three factors can make endoscopic resection of colonic polyps difficult: size, configuration, and location. We describe the use of retroflexion in the colon as a useful and routine technique using a standard colonoscope for the resection of difficult sessile polyps. METHODS: Fifteen patients in whom the retroflexion technique was used for polyp removal were prospectively identified. Each polyp was visualized and resected using both a forward and retroflexed view. RESULTS: Nine women and six men were identified between the ages of 49 and 81 years. The 15 polyps were located in the cecum (3), ascending colon (3), hepatic flexure (3), splenic flexure (2), descending colon (2), and sigmoid colon (2). All the polyps were sessile and their largest diameter ranged from 20 mm to 50 mm. Retroflexion combined with forward viewing allowed for a better assessment of the size and extent of all the polyps compared with forward viewing alone. All polyps, except two, were completely resected during the first session, using both the prograde and retroflexion approaches. No complications from retroflexion of the colonoscope, including perforation or bleeding, occurred. CONCLUSION: Retroflexion complements the conventional prograde inspection of sessile polyps that are only partially visualized on prograde view alone. Retroflexion allows a complete assessment of the lesions' size and extent and aid in their complete removal.

Aged↗
PubMed2006

Comparative study of two bowel preparation regimens for colonoscopy: senna tablets vs sodium phosphate solution.

AIM: To compare the efficacy and acceptance of senna tablet and sodium phosphate solution for bowel preparation before colonoscopy. METHODS: One hundred and thirty four patients, who needed elective colonoscopy, were randomly allocated to take 180 mg senna tablet or 95 mL sodium phosphate solution on the day before colonoscopy. The efficacies of both laxatives were compared using the mean difference of colon-cleanliness score of the rectum, sigmoid segments, descending colon, transverse colon and cecum. The scores were rated by two observers who were blinded to the laxatives administered. The higher score means that the colon is cleaner. The efficacy of both laxatives were equivalent if the 95% confidence interval of the mean difference of the score of colon lie within -1 to +1. RESULTS: On intention-to-treat analysis, the mean cleanliness scores in the four segments of colon except the cecum were higher in the sodium phosphate group than those in senna group (7.9 +/- 1.7 vs 8.3 +/- 1.5, 8.0 +/- 1.8 vs 8.5 +/- 1.4, 7.9 +/- 2.0 vs 8.5 +/- 1.3, 7.9 +/- 2.0 vs 8.2 +/- 1.4 and 7.2 +/- 1.7 vs 6.9 +/- 1.4, respectively). The 95% confidence intervals (95% CI) of mean difference in each segment of colon were not found to lie within 1 point which indicated that their efficacies were not equivalent. The taste of senna was better than sodium phosphate solution. Also, senna had fewer side effects. CONCLUSION: The efficacy of senna is not equivalent to sodium phosphate solution in bowel preparation for colonoscopy, but senna may be considered an alternative laxative.

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↗