[Treatment of complicated diverticulosis of the colon by 1-step resection-anastomosis and protective colostomy].
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Results are reported for 335 patients hospitalized for diverticular disease of the symptomatic colon: bowel movement disorders, abdominal pains and/or rectorrhagia. Of 81 patients that received operative surgery, 62 presented inflammatory stenosis or perforation. Recurrence is prevented by surgical treatment combining sigmoidectomy and exeresis of the rectosigmoid junction.
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Within a period of 18 months, 387 patients were referred to the Proctologic Service at the Chaim Sheba Medical Center because of recurrent rectal bleeding. Hemorrhoids were found in 194 of these patients and further investigation showed that 45 of the 194 patients (23.2%) had other coexisting colonic pathology (12 cancers, 28 polyps, 4 inflammatory bowel diseases and 1 angiodysplasia). Sixteen of 40 patients with diverticulosis and 13 of 30 patients with hemoglobin less than 11 g/dl had additional colonic pathology. Single-contrast barium enema, which was used in this survey for screening of the colon, proved to be inaccurate. In view of the issue of cost-effectiveness, this study suggests that patients with recurrent rectal bleeding and hemorrhoids (Grades II and III) who had normal rectoscopy should be further investigated by double-contrast barium enema if they are greater than 40 years of age. All patients with anemia, diverticulosis or abnormal findings in barium enema should undergo total colonoscopy.
Findings of colon contrast examinations performed during one year are examined with regard to their incidence rate, localisation, age and sex of the patients. The x-ray findings are also compared with the results of rectoscopy and coloscopy, as well as with the results of surgery. Good agreement was found between endoscopy and trochoscopy, especially in carcinoma of the colon. The value of the colon contrast method in colon diagnosis is discussed.
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