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PubMed1997

[Complicated colonic diverticulosis].

A clinical course of complicated colonic diverticulosis in 91 patients is analysed. There were marked symptoms of the disease in 35 patients, complicated clinical course--in 38 patients, and mild symptoms--in 18 patients. The complicated clinical course occurred in 12 patients with acute diverticulitis, in 6 patients with perforation of the diverticulum, in 10 patients with bleeding, in 9 patients with the ileus, in 1 patient with the enteric fistula. 2 patients died after the surgery because of peritonitis. The difficulties of the differential diagnosis, the role of roentgenologic and endoscopic methods of examination are described. Surgical policy in complicated colonic diverticulosis is discussed.

Adult↗
PubMed1998

[Proximal colostomy in multistage treatment of complicated colonic diverticulosis].

On the basis of experience in surgical treatment of 128 patients with colonic diverticulosis who had a proximal colostoma which was formed earlier for acute complications of the process, it is shown that colostomy is inadequate as an independent method for the management of complicated diverticulosis. Resection or exteriorization of the involved segment of the large intestine is necessary in such cases. The formation of entero-enterostomy is hazardous and inexpedient in that event.

Adult↗
PubMed1998

[Diverticulosis of the gallbladder. A case report and review of the literature].

We report a case of diffuse diverticulosis of the gallbladder in a 32 year old patient, who presents epigastric pains and decayed general conditions. With the suspicion of a primitive tumor of the gallbladder, we make a cholecystectomy and the intraoperative histological examination shows a "diffuse diverticulosis of the gallbladder wall"; it displays micro-stones inside diverticulums, too. The patient, after the surgical treatment, has no problem and he gets back to his normal weight. The literature shows the rarity of this disease; its etiopathogenesis is connected with congenital factors. In our opinion, the many terms used (cholecystitis glandularis proliferans, hypertrophic, adenomyomatosis) to define those conditions are not appropriate for our case but rather for the gallbladder's chronic inflammation characterized by the Rokitansky-Ashoff sinuses.

Adult↗
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

[Surgical morbidity of segmental colectomy ideally performed via laparotomy for complicated colonic diverticulosis].

OBJECTIVES: The appraisal of morbidity and mortality for one stage elective colectomy for complicated diverticulosis is difficult and often overestimated, due to the rarity of reports addressing this question. Our results for 100 patients on a recent 30 month period were studied retrospectively. METHODS: One hundred patients were electively operated in a one-stage procedure for complicated diverticulosis in a single institution from January 1993 to June 1995. There were 66 females and 34 males (range: 31-81 years) with a mean age of 61 years. Main indications for surgery were repeated attacks (34 patients), chronic inflammatory mass (26 patients) and stenosis (22 patients). Seventy-eight patients had already been admitted for diverticulitis prior to surgery. There were 13 surgeons including 6 seniors and 7 fellows. RESULTS: There was no mortality. Morbidity was 14% surgical and medical complications accounting for 8% and 6% respectively. One patient had an anastomotic fistula treated conservatively and another patient was reoperated on for early postoperative occlusion There was no perioperative bleeding requiring transfusion. There were no surgical trauma of spleen or uretera. Mean hospital stay was 10 days. CONCLUSION: This study of a collective surgical experience demonstrates that elective one stage left colectomy for benign disease is safe, without mortality and with low morbidity.

Adult↗
PubMed1998

[Jejunal diverticulosis. Presentation of a clinical case].

Jejunal diverticulosis is a rare and often asymptomatic disease, generally presenting as an occasional finding during laparotomy for other diseases. There are no established criteria for the treatment of such diverticula. Due to the possible onset of acute complications, surgical management must be considered. Personal experience on a case of jejunal diverticulosis in a woman who presented with acute complications of surgical peritoneal adhesions is described. Through examinations of small intestine discovered many diverticula, mainly in the mesenteric side; two diverticula were particularly large. Even though there appeared to be no symptoms due to the diverticula, major diverticula were considered at risk for acute complications. Because their reduction was not easily achievable, they were resected and enterotomies were stitched. Postoperative course was uneventful and after 2 years the patient is alive and well. Features of this rare entity are analyzed with regard to data reported in the literature, with special reference to some pathogenetic theories.

Diverticulum↗
PubMed2005

Diverticulosis coli: update on a "Western" disease.

Diverticular disease affects upwards of 50% of the population over the age of 60 years in Western countries and is becoming more common as the population ages. Studies from the 1970s and 1980s related its occurrence to the use of low-fiber diets and to the prolonged colonic transit time and increased intraluminal pressure associated with low-volume stools. Pulsion diverticula (pseudodiverticula) emerge through the thickened circular layer of the muscularis propria of the left colon at points of penetration of the vasa recta that supply the submucosa and mucosa. Complications of diverticular disease such as hemorrhage, diverticulitis, peridiverticular abscess, fistula, and perforation are well recognized. More recently, attention has been drawn to the polypoid prolapsing mucosal folds that may develop as the affected segment of bowel (usually the sigmoid) becomes shorter and to changes in the mucosa surrounding the diverticula and in the bowel wall that may result in confusion with ulcerative colitis or Crohn disease (sigmoid colitis-associated diverticulosis [SCAD]). Distinguishing SCAD from these entities is extremely important, and pathologists should be aware of the possibility of overdiagnosing chronic inflammatory bowel disease in biopsies or resection specimens of sigmoid colon with diverticular disease.

Colitis, Ulcerative↗
PubMedDate not supplied

[Colonic diverticulosis--current issues in etiopathogenesis, diagnosis and treatment].

Diverticular disease of the colon, which is an acquired disorder caused by mucosal herniation through the colonic wall, has been termed both a "disease of the 20th century" and a "disease of Western civilization" due to its increasing prevalence in modern times and its striking geographical variability. There are complex relations between colonic structure, motility, and dietary factors, and it is likely that all of these play a role in the pathogenesis to a greater or lesser degree. Although present in two thirds of the elderly population, the large majority of patients will remain entirely asymptomatic. Nonetheless, 20% of those affected may manifest clinical illness and complications. Barium exploration indicates the extent and severity of colonic diverticular disease. Colonoscopy is preferred in positive diagnosis of uncomplicated diverticulosis. Computed tomography is especially useful in complicated diverticular disease. The use of high fibre diets in the prevention and treatment of the symptoms of diverticular disease has now become commonplace. The morbidity and mortality associated with complications, demand that this condition should receive greater attention in terms of aetiology, prevention and management.

Diagnosis, Differential↗
PubMed2006

[Diverticulitis and diverticulosis].

Over the last 100 years, the prevalence and incidence of diverticulosis and diverticular disease have increased dramatically in western industrialized countries. The main reasons for this are considered to be changes in eating habits, and the increasing age of the population. Conservative treatment of diverticulitis is an initial period of fasting and antibiotic treatment. For recurrence prevention, a fiber-rich diet is recommended. Studies providing evidence in support of the general recommendation of recurrence prophylaxis with poorly absorbed antibiotics, mesalazine or probiotics are to date not adequate. Elective prophylactic sigmoid resection is to be recommended following an episode of diverticulitis with complications, and after an episode of uncomplicated diverticulitis in long-term immunosuppressed patients who have already had an attack. Elective sigmoid resection after a healed second attack of uncomplicated diverticulitis is controversial.

Acute Disease↗
PubMed2006

Jejunal diverticulosis: sonographic diagnosis.

We report the sonographic appearance of jejunal diverticulosis in 4 cases. Jejunal diverticula appear as multiple peri-intestinal hypoechoic structures on sonographic examination. Many diverticula show communication with the bowel lumen. The diverticular neck formed by the prolapsed mucosal and submucosal layers can be seen as a parallel, echogenic structure traversing the bowel wall. Most diverticula also contain echogenic debris and air-related artifacts. Because jejunal diverticula may be encountered during a sonographic examination, sonologists should be aware of their sonographic appearance to prevent diagnostic errors.

Aged↗
PubMed1996

Complicated jejunal diverticulosis: report of a case.

The authors report a case of complicated multiple jejunal diverticulosis and review the data from the literature on this pathology. A 74-year-old man was admitted to our unit presenting with symptoms of intestinal obstruction. He had previously experienced three episodes of the same symptomatology with melena. Endoscopy excluded gastroduodenal or colonic bleeding; an X-ray of the small bowel detected multiple large jejunal diverticula. The patient underwent surgery: a jejunal resection was performed just below the Treitz angle extending about 60-70 cm. The postoperative course was uneventful and the patient was discharged on the 8th postoperative day. At present, the patient is doing well and has not since demonstrated any symptoms of either intestinal obstruction or melena.

Aged↗
PubMed1976

[The development of diverticulosis and diverticulitis (author's transl)].

The cause of colonic diverticula is myostatic spasm. A low-residue diet contributes to this state as transit time through the bowel is slowed. Information gathered in 102 cases was analysed. The smooth muscle architecture of specially prepared operative specimens of diverticulosis were examined. In every case an asymmetric contracture of the smooth musculature led to the formation of gaps. Here the mucosa and muscularis mucosae can protrude through the bowel wall. The muscular spasm is responsible for incarceration of the diverticula. Inflammatory diverticulitis is compared to appendicitis.

Appendicitis↗
PubMed1976

[Internal aspects of diverticulosis (author's transl)].

Diverticular disease of the colon is, apart from the irritable colon syndrome, by now probably the commonest disorder of the large intestine. The incidence of the disease seems to be increasing, which might be due to fundamental dietary changes during the last 60-80 years. It has been suggested that the condition may be a dietary deficiency disorder caused by an inadequate intake of fiber in the diet. Undiagnosed diverticulosis can suddenly progress to painful diverticular disease or diverticulitis with no warning. Complications are sometimes life-threatening, and they demand immediately surgical intervention. The optimal medical and surgical management of diverticular disease and diverticulitis is not well defined as no controlled clinical trials are available.

Colitis, Ulcerative↗
PubMed1986

Diverticulosis of the vermiform appendix.

Vermiform appendix is an unusual site of diverticulosis. We present 3 examples of this entity and briefly review its pathogenesis and clinical significance. As a general rule, appendiceal diverticula are multiple, acquired naturally, and rarely associated with complications.

Aged↗
PubMed1995

Diffuse colonic lipomatosis with giant hypertrophy of the epiploic appendices and diverticulosis of the colon. Report of a case and review of the literature.

PURPOSE: A case of diffuse colonic lipomatosis, dolichosigmoid, hypertrophy of the epiploic appendices and diverticulosis of the colon producing constipation, recurrent sub-occlusive episodes with diarrhea and vomiting, and weight loss is reported. METHODS: Careful preoperative assessment of clinical, radiologic, and endoscopic findings suggested the diagnosis. RESULTS: A total colectomy, followed by a lateroterminal ileoproctostomy, gave complete relief from symptoms. CONCLUSIONS: Of the 12 cases of colonic lipomatosis previously reported, only 2 have isolated involvement of the entire organ, but they do not present lipomatosis of the epiploic appendices.

Adult↗
PubMed1991

Enterolith intestinal obstruction owing to acquired and congenital diverticulosis. Report of two cases and review of the literature.

Diverticulosis of the small bowel, complicated by enterolith formation with ensuing obturation obstruction, was recently documented in two patients. One patient had an enterolith formed within a Meckel's diverticulum; the other had an enterolith dislodged from an acquired diverticulum. Both patients presented with signs and symptoms of acute small bowel obstruction. Only 20 such cases of bowel obstruction secondary to jejunal enterolithiasis and five cases secondary to Meckel's enterolithiasis have been reported. The mechanism of obstruction may involve local encroachment or enterolith expulsion with distal bowel obstruction, although the latter is much more common. Optimally, enteroliths are broken up and milked into the proximal colon without incising the bowel. Alternatively, the enterolith may be milked proximally to a less edematous portion of bowel and an enterotomy may be performed. At times, the primary diverticulum is resected with the contained enterolith.

Aged↗
PubMed1997

Clinical behavior of complicated right-sided and left-sided diverticulosis.

PURPOSE: The aim of the study was to characterize the clinical entity of multiple right-sided (RS) diverticular disease, which is uniquely common in Asians. METHODS: Patients hospitalized with proven diverticular disease from June 1989 to January 1996 were reviewed. Data were retrieved from a prospectively collected computerized database. RESULTS: One hundred eighty consecutive patients were admitted to the Department of Colorectal Surgery, Singapore General Hospital, with multiple diverticular disease. Average age was 65.1 (standard error of the mean, 13.9) years. There were 96 men and 84 women. Women presented, on average, 8.4 years later than men (P < 0.005). Eighty-five patients (47 percent) had massive rectal bleeding, 65 (36 percent) had diverticulitis, 21 (12 percent) had obstructive symptoms, and 9 (15 percent) had enteric fistulas. The diverticula were RS in 76 patients(42 percent), left-sided (LS) in 62 patients (34 percent), and on both sides in 42 patients (24 percent). RS diverticulosis tended to present with massive rectal bleeding (42/76; 55 percent) more often than LS disease (14/62; 23 percent; P < 0.005). Surgery for bleeding was also required more often for RS (17/42; 41 percent) than for LS disease (1/14; 7 percent; P < 0.05); however, diverticulitis was more common on the left (RS, 25/76, 33 percent; LS, 32/62, 52 percent; P < 0.05). Seventy-eight patients (43 percent) required surgery for these complications of diverticular disease. At a mean follow-up of 15.2 (standard error of the mean, 2) months, mortality was 2 in 78 patients who underwent surgery (3 percent), and morbidity was 15 percent. CONCLUSIONS: In comparison with LS, RS diverticular disease tended to present more often with massive bleeding than with diverticulitis and fistulation. This bleeding was often more severe and required surgical intervention.

Aged↗