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PubMed2006

High-resolution sonographic spectrum of diverticulosis, diverticulitis, and their complications.

OBJECTIVE: The purpose of this study was to evaluate the high-resolution sonographic features of diverticulosis, diverticulitis, and their complications. METHODS: During a period of about 4 years 8 months, there were 25 patients with sonographic features of diverticulosis, uncomplicated diverticulitis, and complicated diverticulitis. The clinical symptoms, sonographic features, follow-up investigations, and management details were recorded. RESULTS: The common symptoms were pain in the left lower quadrant and fever. Sonographic features of uncomplicated diverticulitis were a varying appearance of the diverticulum with pericolic inflammation. Colonic wall thickening was not a consistent sign. Complications seen were pericolic, mesocolic, and intraperitoneal abscesses, colovesical fistulas, colouterine fistulas, perforation, and small-bowel obstruction. Uninflamed diverticula were seen in all patients with left-sided disease. They had 7 types of sonographic appearances. CONCLUSIONS: Uncomplicated diverticulitis is seen as a diverticulum of variable echogenicity with pericolic inflammation. An inflamed diverticulum is not visualized in complicated diverticulitis. Visualization of uninflamed diverticula helps reinforce the diagnosis of uncomplicated diverticulitis and predict the cause in complicated diverticulitis.

Adult↗
PubMed1976

[Diverticulosis of the sigmoid colon from the radiological point of view (author's transl)].

Diverticulosis is one of the most common diseases of the colon. Its importance arises from complications. In countries of the Western hemisphere the incidence is 10-20% beyond the age of 50. Among the natives of Africa and South-Eastern Asia it is practically unknown. It is suggested that the disease is caused by low residue diet, modern living conditions. and constitutional disorders. 500 barium enemas revealed 13,4% patients with diverticula including a 5-year-old child and a 32-year-old woman. The incidence of diverticulosis among patients over 40 years of age is 19,6%. The sex distribution is 1 : 1,9 male to female. The complications are demonstrated by case histories: Diverticulitis with ileus, foreign body trap, sub-acute perforation, sigmoid-vaginal fistula, sigmoid-bladder fistula, sigmoid-uterus fistula in a 5-year-old girl.

Aged↗
PubMed1976

[Diverticulosis - Diverticulitis from the surgical point of view (author's transl)].

Diverticulosis from surgical point of view means treatment of complications. Treatment of primarily acute and chronic diverticulitis without complications should be conservative in the beginning. Primarily or secondarily complicated cases should undergo proper surgical resection. In these cases a step-by-step procedure has to be considered. Suspicion of simultaneous diverticulosis with carcinoma demands operative clarification.

Colonic Neoplasms↗
PubMed2000

[Diverticulosis of the small bowel].

A 77-year-old man known with chronic abdominal complaints and a malabsorption syndrome presented with ileus, peritonitis and air in the abdominal cavity. Surgery showed perforation of a jejunal diverticulum and extensive small bowel diverticulosis. The pathologic segment was surgically removed but the patient died afterwards of septic shock, diffuse intravascular coagulation and multi-organ failure. Small bowel diverticulosis has a prevalence of 0.3-2.5% and symptoms are present only in the minority of the cases. Apart from bacterial overgrowth and malabsorption, complications include bleeding, mechanical obstruction, volvulus and perforation. Diagnosis is difficult and mostly made by double-contrast radiology of the small bowel or during laparotomy. Treatment can be conservative in most patients; only in case of severe and persistent symptoms or complications like ileus, bleeding, perforation or volvulus, resection of the affected bowel segment is indicated.

Abdominal Pain↗
PubMed1975

[Diverticulosis--diverticulitis].

Diverticulosis is found in approximately 5% of people living in western industrialized countries. 95% of these are without any symptoms and do not need any therapy. For prophylaxis of diverticulitis a diet containing non-digestable cellulose and swelling substances is recommended. Complications of diverticulosis like diverticulitis, perforation abscess, or stenosis can necessitate a resection of the sigmoid colon. This should be done before life-threatening complications like free perforation or massive bleeding occur.

Colonic Neoplasms↗
PubMed1976

[Diverticulosis of the large intestine].

Under observation were 47 patients with colonic diverticula. The clinical classification of diverticulosis of the colon is suggested. The principal method of treatment in patients with uncomplicated forms of the diverticulosis should be conservative. In profuse hemorrhage and intestinal obstruction as well as in perforation of the diverticulum, that would not respond to conservative therapy, surgery is indicated.

Adult↗
PubMed2000

[Diverticulosis of the small intestine--case report].

The authors describe the case of a 86-year-old female patient admitted to hospital with acute abdomen of the inflammatory type. The condition developed in the course of cca three days with sudden deterioration on the day of admission to hospital. Contrast X-ray examination revealed perforation of the distended jejunum and surgery revealed diffuse peritonitis the source of which was the mentioned perforation associated with mechanical ileus caused by malrotation and adhesions of the small intestine. An additional finding which, however, dominated on X-ray examination of the gastrointestinal tract when using contrast material and on revision of the peritoneal cavity was multiple diverticulosis of the small intestine. The uncommon finding on the small intestine and the relatively sparse data in the literature on diverticulosis of the jejunum and ileum made us submit the case-history for publication.

Aged↗
PubMed1979

[Multiple diverticulosis of the small intestine].

A case of jejunum-ileum multiple diverticulosis observed during a cholecystectomy due to cholelithiasis, is reported. Stress is laid on this unusual localization of diverticulosis in the small intestine. The clinical picture can be silent or present an acute or chronic symptomatology and radical surgical treatment can performed or not. When the disease involves all the intestine, without presenting serious inflammatory phenomena and without clinical symptoms (as in the case observed), medical and not surgical treatment can be envisaged.

Aged↗
PubMed2000

Diverticulosis of the appendix with diverticulitis: case report.

Diverticulum of the appendix is rarely encountered. A case of appendiceal diverticulosis is described. A 46-year-old male patient was sent to our hospital with presentation of acute appendicitis-like symptoms. The appendix was removed by laparoscopic appendectomy, and it showed erythematous change with local peritoneal reaction and omental shift at the tip. Pathological examination revealed three diverticula in the appendix. One of them was inflamed but the appendix itself was not. All three diverticula were pseudodiverticula, lacking muscularis propria. The appendix in this case showed only focal inflammatory change, which differs from what occurs in acute appendicitis, where diffuse inflammation of the appendix is usually noted. In cases of an appendix with only focal erythematous change, minor lesions such as diverticulitis may be revealed by pathological examination, and an appendectomy is still warranted. Diverticulitis of the appendix cannot be differentiated from acute appendicitis preoperatively. Image studies including abdominal computed tomography scan, ultrasonography, and plain film cannot improve the diagnosis. To our knowledge, diverticulosis of the appendix has never been reported in Taiwan.

Appendicitis↗
PubMed1975

Diverticulosis in an unused colon.

It has been suggested that diverticulosis is the result of uncoordinated muscle activity of the colon in response to normal physiologic stimuli such as eating, emotions and the urge to defecate. This results in spasm of the longitudinal muscle with the heaping up of circular muscle bundles, creating interhaustral folds along the colonic wall adjacent to the mesentery. Narrowing of the lumen and shortening of the colon results which is enhanced by a low residue diet and prevented by a bulky diet. Segmentation results when muscular contraction approximates these interhaustral folds. Higher intraluminal pressure is produced in the areas of segmentation which enhances the development of diverticulosis in the bowel between interhaustral folds where there is a thinning of the circular muscles and where vessels pierce the colonic wall. The case presented herein supports these hypothesis in that the patient has experienced the extreme in a low residue diet for 50 years.

Diet↗
PubMed2000

[Jejunal diverticulosis: a cause of infrequent gastrointestinal hemorrhage. Case report].

Jejunal diverticulosis is a very uncommon acquired disease. Clinical manifestations include acute life threatening complication such as perforation, obstruction and bleeding. Jejunal diverticulosis is an extremely rare site of origin of gastrointestinal bleeding, with fewer than seventy cases reported in the literature. We report a 77-year-old patient with a recurrent severe gastrointestinal bleeding manifested by melena and hematochaezia. During the hospitalization the tagged red blood cell scanning was positive for bleeding in the jejunum. At laparotomy, several large-mouthed diverticula at the proximal jejunum were identified. Approximately 30 centimeters of the involved segment was resected with primary end-to-end anastomosis. Postoperative 7 month evolution has been favorable, without any evidence of rebleeding. This report reviews the literature concerning this disease, discusses some diagnostic methods of studying small bowel bleeding and highlights the need to consider this diagnosis in old patients with a gastrointestinal hemorrhage of unknown origin (Rev Méd Chile 2000; 128: 1133-38).

Aged↗
PubMedDate not supplied

[Diverticulosis of the colon: complications of surgical interest].

Diverticular disease is prevalently only of medical interest. Repeated episodes of diverticulitis, particularly in younger patients, and serious complications such as perforation, stenosis, fistula and haemorrhage demand surgical treatment. The timing and type of surgical operation are conditioned by the pathological picture and by the patient's general condition and age. The authors present a series of 586 patients admitted for diverticular disease, 84 of whom presented complicated diverticulosis. Nineteen cases (22.6%) underwent elective surgery in the form of an anterior rectal resection, while 65 of them underwent urgent surgery for complicated diverticulosis variously consisting in total colectomy, a Hartman's resection, a simple rectal resection or a left or right hemicolectomy.

Adult↗
PubMed1975

[Colon diverticulosis and complicating diverticulitis (author's transl)].

Dietary habits in the civilised countries of the West with foods low in bulk and cellulose are blamed as causes of the increase in colon diverticulosis and the complicating diverticulitis in recent times. Of all sections of the colon, the sigmoid is most frequently involved, older patients above the 5th decade being principally affected. While uncomplicated diverticulosis of the colon usually remains symptomless, complicated diverticulitis often shows very uncharacteristic symptoms. For prophylaxis and the treatment of slight complaints, conservative treatment with administration of bulky foods (bran etc.) is indicated. Threatening hemorrhages and perforative peritonitis demand emergency operations. In closed abscess formation, internal or external fistulae and incipient scarring stenosis with imminent ileus, resection of the affected part of the intestine is indicated.

Aged↗
PubMedDate not supplied

[Surgical treatment of colonic diverticulosis: results of a series of 70 cases].

Results are reported on a series of 70 patients operated upon for colon diverticulosis, surgery being elective in only 23 (32.9%) cases. Global mortality (12.9%), was higher in patients over 70 years of age (P < 0.01) and for emergency cases (17% against 4.3% (NS) after cold surgery). Global morbidity was 20%, the onset of septic complications being influenced (p < 0.01) only by treatment with antiinflammatory drugs. Despite the absence of precise factors predictive of the course of diverticular disease, it should be possible to further improve the very poor prognosis in patients with serious septic complications (Hinchley's stages I to IV) by: prophylactic colectomy in symptomatic diverticulosis, improved evaluation by complementary examinations, notably the scanner, of localized septic complications (stages I and II), with the possible association of guided puncture to avoid the septic areas and to allow performance of a cold colectomy without the need for colostomy. Certain severe septic complications may still develop and these cannot be totally prevented by any therapy. In these cases preference is given to resection of the septic focus using mainly Hartmann's operative techniques. Further studies are needed to evaluate those cases where protected anastomotic resection provides the best results, since in the long term the incidence of re-establishment is higher.

Abscess↗
PubMed2005

Jejunal diverticulosis.

Although often incidentally found in the radiological examination of the small intestine, some patients with diverticula suffer from complications, that may lead to surgical intervention. Contrast study of the small intestine by enteroclysis is the method of choice to determine jejunal diverticula. We report a case of symptomatic proximal jejunal diverticulosis in a 74 year old patient who presented with diffuse abdominal pain. The clinical significance, diagnostic evaluation and treatment of jejunal diverticulosis are reviewed.

Aged↗
PubMed1991

A radiological survey of diverticulosis in Singapore.

Three hundred and sixty one consecutive barium enemas done at a general hospital were reviewed prospectively to determine the frequency and anatomic distribution of diverticulosis in Singapore. The frequency of 28% is comparable to previous American and European studies and higher than previous Asian studies. There was also a predominance of purely right-sided disease with the caecum and/or ascending colon involved in 71% of patients. This anatomic distribution of diverticulosis is quite different from that seen in Caucasian populations where the disease mainly involves the left side of the colon and is probably a function of genetic and racial factors.

Adult↗
PubMed1991

[Jejunal diverticulosis--a rare cause of gastrointestinal hemorrhage].

We report a case of gastro-intestinal bleeding caused by jejunal diverticulosis, in which preoperative diagnosis could be achieved by selective angiography. Even though the small bowel is a rare localisation of bleeding (1% of all cases), this part of intestine should be included into diagnostic considerations. Jejunal diverticulosis only requires operative treatment after occurrence of complications, small bowel resection is regarded as treatment of choice in these cases.

Aged↗
PubMed1990

[Total diverticulosis of the large intestine, complicated by ischemic colitis with development of multiple inflammatory polyps].

One observation of total colon diverticulosis in a male of 62 is described. Clinical signs (abdominal pains, blood in faeces, vomiting) persisted for 7 years and was aggravated by ileus. Instrumental examination revealed multiple colon diverticula, stenosing villous tumour of sigmoid colon. Besides pseudodiverticula, chronic colitis with multiple inflammatory polyps stenosing the lumen of the sigmoid colon and simulating a villous tumour was found. The conclusion is made of the ischemic nature of the colitis complicating the course of diverticulosis.

Colitis↗