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PubMedDate not supplied

[Diverticulosis-diverticulitis].

Diverticulosis of the colon and its clinical sequelae--diverticulitis, peridiverticulitis, and pericolitis--are typical diseases of elderly people. The main causes are weakness of the connective tissue in the colonic wall increasing with age and pathologic motility pattern of the colon due to low dietary fibre consumption. In about 20% of all people with diverticula, acute or chronic-recurrent diverticulitis develops, often with serious complications as perforation, abscess or fistula formation, obstruction, inflammatory pseudotumor and intestinal bleeding. Diagnosis is mainly based on clinical examination and barium enema (double contrast, maximal spasmolysis). Colonoscopy may be helpful in excluding carcinoma of the large bowel. Patients with diverticulosis and uncomplicated diverticulitis should be managed conservatively by medical treatment. The following measures proved to be successful: high-fibre diet, unprocessed wheat bran, and hydrophilic plant colloids to regulate the bowel movements, systemic or local antibiotics if signs of inflammation are present, and antispasmodics or analgesics against abdominal pain. Prognosis depends mainly on the duration of the disease, sufficient dietary-fibre intake, and elective or semi-elective surgical intervention before the development of life-threatening complications. The question as to whether diverticula or relapsing attacks of diverticulitis can be prevented with added dietary-fibre remains open for the time being.

Abscess↗
PubMed1995

Angiographic demonstration of primary aorto-enteric fistula--a case report.

Primary aorto-enteric fistula is an uncommon but lethal disease. The key to patient survival is early diagnosis and treatment. Angiography may be diagnostic. However, angiographic documentation of this condition is rare as the patients are usually very ill when the decision for angiography is made. A case of primary aorto-enteric fistula with fatal haemorrhage is described with angiographic documentation. This is the first angiographically demonstrated case reported locally.

Aortic Aneurysm, Abdominal↗
PubMed1993

[Developments in the surgical therapy of colonic diverticulitis].

All patients admitted to our department with diverticulitis of the left sided colon between 1980 and 1990 were retrospectively evaluated. Staging was performed according to the Hinchey classification. Altogether, 263 patients were evaluated; 71% had complicated diverticulitis and 29% simple diverticulitis. Of those patients with complicated diverticulitis, 68% required surgery due to abscess formation and/or perforation, 19% because of obstruction, 10% because of fistula formation, and 3% due to intestinal hemorrhage. While primary resection (primary reanastomosis in 82% or Hartmann procedure in 13%) was carried out in 250 patients (95%), 13 patients (5%) did not obtain this result (colostomy) following the initial operation. None of the patients who presented with simple diverticulitis died in the postoperative period. The total operative mortality and mortality for complicated diverticulitis amounted to 6.5% and 9%, respectively. In comparison to a former analysis from our department, resection of the primary focus during the initial operation led to a significant decrease in morbidity and mortality. In patients with complicated diverticulitis and peritonitis, primary resection and anastomosis also achieved favourable results in 78%.

Abscess↗
PubMed1983

[Neonatal enterolithiasis (or intraluminal meconial calcifications). Apropos of 4 cases].

Calcified intraluminal meconium is rarely observed in newborn. Only 27 cases are related in litterature; the authors report 4 new cases and point out the role of intestinal obstruction (principaly anorectal malformations, but also atresia, meconium ileus or Hirschsprung disease). Pathogenesis is unknown, while intestinal urinary fistula is frequently described.

Abnormalities, Multiple↗
PubMed1987

Enterovesical fistula.

During a period of 18 months, 24 patients were identified with enterovesical fistulas. The fistulas were colovesical in 18, ileovesical in four and rectovesical and appendicovesical in one each. Fifteen of the 23 patients in whom this information was available had pneumaturia and four had fecaluria. The standard battery of diagnostic tests for enterovesical fistulas was performed. Thirteen patients with colovesical fistulas had small intestinal series; the fistula was demonstrated in only five patients. Sixteen patients had an intravenous pyelogram and the fistula was demonstrated in none. Cystoscopy was performed upon 15 patients and the fistula was demonstrated in one. A cystogram was performed upon ten patients and the fistula was demonstrated in four. In contrast, all patients had positive computed tomographic findings. The pathognomonic finding of air within the bladder was demonstrated in 20 of 23 patients without recent transurethral instrumentation. All 24 computed tomographic scans demonstrated an abnormally thickened segment of intestine in intimate contact with a thickened bladder wall at the site of the fistula. This was associated with a paravesical mass in 23 of the patients. Two of the four patients in whom bladder air was not seen had a vesical fistula of the small intestine. All 24 fistulas were confirmed by operation (22 patients) or subsequent clinical course (two patients). These findings suggest that computed tomography is the most accurate diagnostic tool available for demonstrating enterovesical fistulas. Computed tomography should supplant the use of other less sensitive diagnostic test currently included in the evaluation of patients with a suspected enterovesical fistula.

Colonic Diseases↗