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A case of multiple lipomatosis exclusively located in the colon is reported in a young male (33 years). It is characterized by a great number of lipomas with polyposis growth appearance, multiple lipomas of peritoneal folds, and giant diverticulosis probably caused by weakened areas of colonic wall induced by the lipomas.
Neuronal colonic dysplasia is a separate clinical entity belonging to the group of congenital defects of intestinal innervation. Its enzyme-histochemical diagnosis is possible by endoscopic biopsy examination of the rectosigmoid. Enzyme-histochemically, it is characterized by dysplasia of the submucous plexus secondary to developmental defects. The principal clinical feature is weak propulsive motility. A clinical study was carried out to investigate the role of neuronal colonic dysplasia in the aetiology and pathogenesis of primary chronic constipation and diverticulosis of the sigmoid colon in adults.
BACKGROUND AND AIMS: MRI-based colonography is a new minimally invasive imaging modality to assess the colon and abdomen. This new method which is applied mainly for polyp screening could be an integrative approach for colonic diverticulitis assessment. This study evaluated the feasibility of MRI-based colonography to assess diverticulosis or diverticulitis. PATIENTS AND METHODS: Fourteen consecutive patients with clinically suspected diverticulitis were examined by MRI colonography on a 1.5-T scanner. All patients underwent abdominal CT as gold standard. N-Butyl-scopalamin was given intravenously to reduce bowel peristalsis. After rectal administration of a T1-positive enema T1- and T2-weighted acquisitions with additional intravenous contrast were obtained. A 3D FLASH sequence was acquired for virtual colonography. The results were compared with CT and biological parameters such as white blood cell count and C-reactive protein. RESULTS: Of 56 bowel segments (sigmoid colon, descending colon, transverse colon, ascending colon) in all 14 patients 54 were assessed to have good to fair image quality. Having CT as standard of reference, all sigmoid diverticula were diagnosed based on MRI. Inflammation as judged by CT was identically assessed on MRI. 3D models of the colon revealed further diverticula in the remaining colon; additionally, the 3D models gave a comprehensive image for surgical planning. CONCLUSION: In our preliminary study MRI colonography revealed the same diagnosis as CT in all patients without ionizing radiation. Additionally, 3D-rendered models and virtual colonoscopy can be performed. This comprehensive 3D models could replace presurgical planning barium enema with concurrent assessment of the residual colon.
We report a case of laparoscopic left lobectomy combined with right hemicolectomy for cystic liver tumor and hemorrhagic diverticulosis of the ascending colon. Mobilization of the right hemicolon was performed first with a complete laparoscopic method. Then the surgeon's left hand was inserted into the abdominal cavity through a 75-mm incision made in the right upper quadrant, and the hand-assisted method was used for completion after liver resection. After hepatectomy, the right hemicolon was pulled through the hand port incision. The resection and anastomosis were performed extracorporeally to avoid intra abdominal infection. As a hemihepatic inflow control technique, we used the method of en masse occlusion of Glisson's sheath of the left hemipedicle at the bifurcation. The hand facilitates proper traction and exposure of the cut surface, and hemostasis can be achieved by proper application of vascular clips or staplers. The patient had an uneventful, rapid postoperative recovery.
Spastic colon disease is a syndrome consisting of abdominal pain and abnormal bowel function associated with thickening of the circular muscle layer of the colon. The condition may be related to changes in intraluminal pressure associated with a lifelong low residue diet. Radiologic features include thickening, crowding, irregularity, and distortion of the interhaustral folds of the sigmoid colon, which in the past have been incorrectly considered to be manifestations of acute diverticulitis. Spastic colon disease leads to diverticulosis which develops because of mucosal herniations through the weakened colonic wall. When a diverticulum perforates, acute diverticulitis ensues. Depending on how the subsequent inflammatory response is contained, a mural abscess, colonic narrowing or obstruction, an intra-abdominal abscess, or a fistula may occur and be demonstrated on barium enema examination.
We present the third case of ureteral diverticulosis discovered by excretory urography alone and the twenty-sixth case reported in the world literature. Unlike previously reported cases our patient had dermatomyositis and is urologically asymptomatic.
On the basis of the results in 3 own observations the endoscopic picture of the intramural oesophageal diverticulosis has been described in detail. It is characterized by an increased tonus of the oesophagus inlet musculature, a conspicuously non-irritant oesophageal mucosa, the absence or only a slightly indicated and irregular course of the expansion peristalsis, a poor distinction of the respiratory luman variations and the occurrence of circumscribed spasms and, above them, of segmental relaxation bulging. Pathogenitically the disease is probably caused by a disturbance of the muscular activity with bulging of the functioning mucosa at points of an oesophagus wall weakness.
A 58-year old patient with intramural pseudo-diverticulosis of the oesophagus was observed for three and a half years. The case is described and illustrated. The pathogenesis of the disease is discussed with reference to the literature. The radiological appearances permit a definite diagnosis. The oesophagus had a stricture at the level of the bifurcation of the trachea, but in addition there were multiple intramural, sharply demarkated mucosal herniations measuring 3 x 1 mm. These could be verified endoscopically. Histologically, non-specific oesophagitis was found.
We report an asymptomatic case of diffuse intestinal diverticulosis simultaneously affecting duodenum, jejunum and colon. The patient presented signs of progressive systemic sclerosis, which supports the hypothesis in the literature of an aetiological link.
The clinical outcome and optimum classification of patients who have sigmoid resection specimens that show the histologic features of Crohn's disease (CD) and diverticulitis is not well defined. Historically, these patients were considered to have coexistent diseases, but recent studies have suggested that the CD-like changes are part of the inflammatory reaction of the diverticulitis. Sorting out these issues has been complicated by the lack of distinction between patients with and without CD in other regions of the bowel, short clinical follow-up periods, and small numbers of patients. We report on the clinical outcome and histology of 29 patients who had sigmoid resection specimens with diverticulitis and CD-like changes. Of the 25 patients who had no prior or concurrent CD at the time of surgery, 23 remained free of CD during the follow-up period (median, 6.0 yrs) and two developed CD in other regions of the bowel. All four patients with CD prior to their sigmoid resection continued to have active CD postoperatively. There were no histologic features of the sigmoid resection specimens that could be associated with the outcome of the patient. These results suggest that CD-like changes within the sigmoid resection specimen are an idiosyncratic inflammatory response to the diverticulosis rather than coexistent CD in the overwhelming majority of patients who do not have prior or concurrent CD at the time of sigmoid resection. Pathologists should be wary about making the diagnosis of sigmoid CD in the context of diverticulitis unless there is CD in other parts of the bowel.
A review of the barium enema studies in 73 patients with diverticular disease of the colon and with and without associated neoplasm leads to the conclusion that the correct radiologic recognition of an associated neoplasm in a colon with diverticulitis or diverticulosis can be made only about half the time. The limitations of the radiographic method and radiologic findings in distinguishing diverticulitis from carcinoma should be more clearly recognized by the clinician.
Jejunal diverticulosis, a marker of disordered small intestinal motility, presents varied clinical manifestations. It is important to consider this disorder in elderly patients with unexplained abdominal discomfort accompanied by signs of intermittent small bowel obstruction and malabsorption. Diagnosis can be made by a small bowel follow-through x-ray film obtained as part of the evaluation of diarrhea and obstructive symptoms. Medical therapy is helpful in controlling diarrhea and anemia, while surgical therapy can give excellent results in treating complications or refractory symptoms.
We have reported three cases of appendiceal diverticulosis diagnosed by barium enema examination, and reviewed the radiographic and clinical findings. An awareness of this lesion is important, since diverticulitis of the appendix may occur in up to two thirds of patients with DA.
Diverticulosis and diverticulitis are common disorders in modern society and represent different places on the spectrum of diverticular disease. Often called a problem of western civilization, diverticular disease is rare in developing countries. This article provides an overview of the epidemiology of diverticular disease, risk factors, and clinical presentation in varying phases. Differential diagnostic testing and comprehensive management from the medical, surgical, and wound, ostomy, and continence nursing perspectives are also addressed. Nurses play a key role in supporting people with diverticular disease and referring them for appropriate assessment, treatment, and support.
A case of diverticulosis of the appendix is described. The clinical significance is discussed.
A case of left-sided paraduodenal hernia and jejunal diverticulosis is described in 75-year-old man who presented with chronic intermittent abdominal pain, weight loss, and anemia. A brief review of the epidemiology, pathogenesis, and clinical presentation displays the variety of symptoms associated with these rare conditions.
We report on benign multicystic peritoneal mesothelioma in two siblings whose family had a history of multiple familial diseases including diverticulosis. After a genetic evaluation and a chromosomal analysis, we were not able to identify a specific genetic cause of the family's pattern of disease. We assumed that previous surgical procedures and the chronic inflammatory process from diverticulitis were the underlying etiology. Both patients had multiple recurrences with indolent courses similar to those reported in other cases. After the recurrences, one patient was treated with cystic aspiration and the other with hormones. The cysts in both cases regressed partially but the patients were relieved of their clinical symptoms, for 2 years after cystic drainage in one case and for 5 years after hormonal treatment in the other.
While barium enema is the most useful investigation in the primary diagnosis of diverticular disease of the colon, this paper presents further evidence that the terms "diverticulosis" and "diverticulitis" are unsatisfactory and shows that a radiological classification on the traditional criteria is not accurate in determining whether or not inflammation is associated with colonic diverticula.