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At least 19 recordsLinked to original sources
PubMed1976

[Colonic diverticulitis: diverticulitis with complications and its treatment (author's transl)].

Complications (stenosis, intestinal obstruction, abscess or fistula formation, inflammation, etc.) of colonic diverticulitis are seen in 35% of patients affected. Multiple operative procedures involve less risk than surgery performed in a single session. The mortality in emergency surgery is reported to be up to 40%, while subsequent resection of the diseased colon involves the usual mortality of surgery on the colon, i.e. 1.5-9%. The vital factor in this illness is the earliest possible surgical treatment of the diseased diverticulum, so that the extremely problematical complications can be avoided.

Colonic Diseases↗
PubMed1989

[Recommendation for primary resection with primary anastomosis in complicated sigmoid diverticulitis. Report of experiences of the Herford Surgical Clinic 1973 to 1986].

Of the 107 patients with complicated diverticulitis operated from 1973-1986 47 were females and 60 males. In 14 of the 107 patients a perforated diverticulitis with diffuse purulent/faecal peritonitis was found, a perforated diverticulitis with localized purulent peritonitis/paracolic abscess in 68 patients and an acute phlegmonous diverticulitis without perforation in 25 patients. Additional pathologic findings were internal fistulae (13 patients), necrotizing fasciitis (3 patients), obstruction (3 patients) and synchronous carcinoma (7 patients). The overall mortality of the 107 patients was 9.3% (= 10 patients) and the morbidity of the 97 survivors 34% (= 33 patients). The mortality of the 14 patients with perforated diverticulitis and diffuse purulent peritonitis was 50% of the 68 patients with perforated diverticulitis and localized purulent peritonitis 4.4% and of the 25 patients with acute phlegmonous diverticulitis 0%. Seven of the 10 patients died after operation of the perforated diverticulitis with diffuse purulent peritonitis - 1 (5) after primary resection with primary anastomosis. 3 (5) after Hartmann procedure, 3 (4) after loop colostomy alone. Three patients died after operation of the perforated diverticulitis with localized purulent peritonitis - 2 (6) after Hartmann procedure, 1 (5) after loop colostomy alone. In spite of forcing the primary resection with primary anastomosis in the years from 1980 - 1986 the mortality decreased for these operations from 35.7% in 1973 - 1979 to 0% in 1980 - 1986. The indication of primary resection with primary anastomosis is justified also for perforated diverticulitis with localized and diffuse peritonitis.

Adult↗
PubMed1992

Computed tomography in the initial management of acute left-sided diverticulitis.

Computed tomography (CT) was used in place of contrast enemas as the initial imaging study to evaluate patients with the clinical diagnosis of acute sigmoid diverticulitis. This report attempts to clarify the role of CT in the management of acute sigmoid diverticulitis by reviewing its usefulness in the diagnosis and treatment of 59 patients. CT established that three patients (5 percent) were hospitalized with an incorrect clinical diagnosis. Thirty-seven patients (62.7 percent) were identified as having uncomplicated acute diverticulitis. These patients were all treated successfully with nonsurgical therapies and were discharged in an average of 6.8 days. In the remaining 19 patients (32.2 percent), CT revealed complicated acute diverticulitis by identifying abscess, fistula, peritonitis, or obstruction. Eleven of these 19 patients required urgent surgery or CT-guided percutaneous drainage of an abscess. The four patients whose abscesses were drained percutaneously responded favorably and underwent an elective single-stage resection. The average hospital stay for patients with complicated diverticulitis was 13.6 days. Computed tomography is a useful aid in the initial management of patients with acute diverticulitis. It is a noninvasive test that recognizes and stratifies patients according to the severity of their disease. It has the further advantage of providing information about extracolonic pathology and anatomic variation useful for surgical planning. Additionally, early CT-guided needle drainage allowed downstaging of complicated diverticulitis, avoided emergent surgery, and permitted single-stage elective surgical resection.

Abscess↗
PubMed1985

Surgical management of complicated diverticulitis.

The majority of patients with acute diverticulitis can be managed medically. Some will have a complication of diverticulitis such as free perforation with peritonitis, abscess formation, obstruction, or fistula formation. Perhaps even a larger number will develop recurrent diverticulitis, which is associated with an increased rate of complications. Although the preoperative diagnosis of these problems may be obvious in many patients, elderly or steroid-treated patients may have few manifestations of significant intra-abdominal disease. Of extreme importance in the management of these complications of diverticulitis is the preoperative resuscitation. Intravascular volume depletion is replaced with intravenous fluids, and intravenous antibiotics are given. At this time, with any of these complications, it is unusual to perform the classic three-stage operation, which includes an initial diverting colostomy and drainage followed by resection of the involved colon and, finally, a colostomy closure as the third stage. The usual treatment now is a two-stage operation with the initial operation being resection of the diseased segment and formation of a colostomy proximally and either a mucous fistula or a Hartmann's pouch distally. The second stage is the colostomy closure. This two-stage approach is indicated in patients with acute diverticulitis complicated by perforation, whether free or confined with abscess formation, and in patients with obstruction or fistula formation in whom a preoperative bowel preparation is not possible. Resection and primary anastomosis should not be performed in the elderly in the emergency setting for complicated diverticulitis. However, this is the procedure of choice in the elective treatment of diverticulitis and its complications in the elderly.

Abscess↗
PubMed1988

Acute diverticulitis of the cecum and ascending colon diagnosed by computed tomography.

Between June 1984 and August 1985, computed tomography (CT) was performed upon seven patients with diverticulitis of the cecum and ascending colon who presented with acute right lower quadrant symptoms of unknown origin. Three of these patients had undergone an appendectomy, while in the remaining four patients, the history and physical findings were atypical of acute appendicitis. CT findings suggestive of acute diverticulitis including thickening of the intestinal wall and pericolonic inflammation were present in all seven patients. In four patients, the colonic inflammation was limited to the segment of ascending colon superior to the ileocecal valve. In one patient, the inflammation involved both the ascending colon and the cecum, while in the two remaining patients, the inflammatory changes were limited to the cecum. An associated diverticular abscess was present in five patients and all were correctly identified preoperatively by CT. One patient in whom the diagnosis of uncomplicated diverticulitis of the ascending colon was made on the basis of the CT scan, was successfully managed nonoperatively with antibiotics. Five patients required a right hemicolectomy for perforated diverticulitis with abscess. The remaining patient underwent a right hemicolectomy for recurrent episodes of acute diverticulitis. Our experience suggests that CT is useful in the early diagnosis of diverticulitis of the cecum and ascending colon.

Acute Disease↗
PubMed1976

[Early resection in diverticulitis (author's transl)].

The danger with diverticulitis is that the disease may progress to life threatening complications. The development of diverticulitis leads from local infiltration and fibrosclerosis to final perforation. Nonresected diverticulitis favors the development of diverticulosis proximal to the affected bowel. Conservative therapy seems to be of little use in avoiding the progression of recurring diverticulitis. Signs of irreversible diverticulitis are repeated attacks, signs of local peritonitis, fixed deformation of the wall and stenosis, revelaed by barium enema. One-stage resection was performed in 101 patients for uncomplicated diverticulitis. There was one death (myocardial infarction).

Diverticulitis, Colonic↗
PubMed1992

Sonography in acute colonic diverticulitis. A prospective study.

The clinical value of high-resolution real-time sonography for the diagnosis of acute and complicated colonic diverticulitis was prospectively studied in 130 consecutive patients with abdominal complaints, because of which the disease entered into differential consideration. The results of ultrasound investigation were compared with those of clinical examination on admission. Regarding history and initial clinical evaluation, diverticulitis was graded as "highly suspected" in 19 (36.5 percent) out of a total of 52 patients with later proven colonic diverticulitis (prevalence 40 percent), as "possible but equivocal" in 24 (46.2 percent), and as "very unlikely" in the remaining nine (17.3 percent) patients. Ultrasonography enabled the diagnosis of diverticulitis with an overall accuracy of 97.7 percent, a sensitivity of 98.1 percent, and a specificity of 97.5 percent. The predictive values of positive and negative ultrasound examinations were 96.2 percent and 98.5 percent, respectively. The echomorphologic features of acute diverticulitis include visualization of a colon segment presenting with local tenderness on gradual compression, which showed hypoechogenic thickening of the wall and a targetlike appearance in transverse view due to inflammatory changes and muscular thickening. Sonographic signs of peridiverticulitis (hyperechoic halo) were found in 96 percent of patients, echogenic diverticula in 86 percent. Twelve (92 percent) of 13 abdominal abscesses were detected on initial ultrasound examination and could be treated by percutaneous drainage in seven cases, while six required surgical intervention. These results indicate that high-resolution sonography with graded compression is highly sensitive and specific for the imaging diagnoses of acute colonic diverticulitis and complicating abscess.

Abscess↗
PubMed1990

Sigmoid diverticulitis: diagnostic role of CT--comparison with barium enema studies.

The diagnostic value of computed tomography (CT) and barium enema (BE) studies was evaluated prospectively in hospitalized patients with the presumptive diagnosis of acute sigmoid diverticulitis based on the presence of left-lower-quadrant pain and tenderness, fever, and leukocytosis. Of 56 patients, 11 had sigmoid diverticulitis confirmed at surgery and 16 by clinical response to medical therapy. CT, performed in all diverticulitis patients, had positive results in 93% (25 of 27). These compared favorably with BE study results, of which 80% (20 of 25) were positive. Neither examination had false-positive results. In the 29 patients who did not have diverticulitis, an alternative diagnosis was made by means of CT in 20, but in only three by means of BE studies. Many of the extracolonic abnormalities recognized at CT were clinically unexpected and necessitated emergency surgery. The excellent sensitivity and specificity of CT coupled with its versatility in the detection of extracolonic disease give it an advantage over contrast enema studies for diagnosis of sigmoid diverticulitis. CT should be the initial study in acutely ill patients, especially when the clinical features are atypical for sigmoid diverticulitis.

Acute Disease↗
PubMed1990

Diverticulitis of the colon: role of surgery in preventing complications.

Fifty-seven patients who were treated conservatively for colonic diverticulitis between 1977 and 1979 were followed for at least 10 years. Twenty-four patients had two or more episodes of diverticulitis, but only three had surgery on a prophylactic basis because of recurrent attacks. None of the patients had any serious complications during the follow-up. During the same period, eight patients with inflammatory pseudotumour underwent elective sigmoid resection and primary anastomosis without complications. --Between 1977 and 1988, forty-eight patients had emergency surgery for septic complications of diverticulitis. The mortality was 17%. Only two patients had had one episode of diverticulitis before the actual emergency. Recurrent diverticulitis rarely causes complications that may need emergency surgery. On the other hand, serious complications of diverticulitis usually are the first clinical manifestation of the disease. Thus, the chances of preventing complications with active prophylactic surgery seem to be limited.

Adult↗
PubMed1979

[Problems of sigmoid diverticulitis in the female and its differential diagnostic delineation from the left-sided adnexal tumor].

In the last three years 42 patients with complicated diverticulitis were treated surgically. There were 18 women in all. Nine of these women were believed to have gynecologic disease because of the palbable pelvic tumor and were hospitalized at the Gynecologic Department. 2 patients underwent an exploratory operation by gynecologic surgeons based upon preoperative diagnosis of ovarian mass. The diagnosis at operation in all two cases was perforated sigmoid diverticulitis. Another three of the nine patients had initally emergency exploratory operations by gynecologic surgeons based upon diagnosis of pelvic mass. Also here the diagnosis at operations were perforated sigmoid diverticulitis and they underwent emergency primary resection of the perforated sigmoid by surgeons. In all the cases of complicated diverticulitis the surgical proceature was the primary resection; the anterior resection was combined with a temporare transverse colostomy.--Diverticulitis is an important differential diagnosis of a left pelvic tumor in women with or without clinical and laboratory indications of infections and history of diverticulitis.

Adnexa Uteri↗
PubMed1990

Uncomplicated acute diverticulitis of the cecum and ascending colon: sonographic findings in 18 patients.

To determine the sonographic features of uncomplicated acute diverticulitis of the cecum and ascending colon, the sonographic findings in 534 patients who presented with right lower quadrant pain were reviewed. Of these, 18 patients had uncomplicated acute diverticulitis of the cecum and ascending colon. The diagnosis was confirmed by surgery (one patient), clinical course (17 patients), CT (eight patients), or contrast enema (11 patients). On sonography, a round or oval focus of varying echogenicity, which protruded from a segmentally thickened colonic wall and was surrounded by a hyperechoic area, was seen in all 18 patients. These were hypoechoic foci (12 patients), hypoechoic foci with internal strong echoes (three patients), and echogenic shadowing foci with surrounding hypoechoic bands (three patients). Extraluminal gas (one patient) and thickening of lateroconal fascia (six patients) were seen also. Findings of enlarged appendix, frank abscess, and ascites were absent. All patients, including the one who had laparotomy, were successfully treated medically for diverticulitis. Of 515 patients without diverticulitis, in only one patient with acute appendicitis did sonography show a hypoechoic protruding focus. Our experience indicates that the major sonographic finding in patients with uncomplicated acute diverticulitis of the right colon is a hypoechoic round or oval focus protruding from a segmentally thickened colonic wall.

Acute Disease↗
PubMed1991

Early water-soluble contrast enema in the diagnosis of acute colonic diverticulitis.

Acute colonic diverticulitis is usually suspected by typical clinical findings supported by laboratory tests. Investigations of the colon are usually delayed 1 to 2 months until the acute situation is resolved. We studied 53 patients with an initial clinical diagnosis of acute diverticulitis by performing early water-soluble contrast enema of the colon. The initial diagnosis proved to be uncertain, as 26 patients (49%) had acute colonic diverticulitis as their final diagnosis. There were ten patients who had diverticulosis of the colon, but without radiologic signs of acute diverticulitis. Four of these patients had some other disease responsible for their symptoms. Thirteen patients had normal findings at early water-soluble contrast enema. Three colonic carcinomas and one ischaemic colitis were diagnosed. There were no complications related to the radiologic studies. We conclude that early water-soluble contrast edema of the left colon is safe and useful in investigating patients with suspected acute colonic diverticulitis. If the finding is normal, investigations can be directed elsewhere without undue delay.

Acute Disease↗
PubMed1976

Diagnosis and differential diagnosis of colonic diverticulitis.

A patient over 40 years of age who complains of lower abdominal pain, constipation or diarrhea or both, and increased flatulence should be suspected of having diverticulosis. When pain becomes more severe and persistent, diverticulitis must be considered. Diagnosis depends on roentgen demonstration of the presence of diverticula. Sigmoidoscopy and barium enema study are essential to exclude coexisting disease but in diverticulitis may need to be postponed until severe local and systemic signs of inflammation have subsided. A number of diseases can simulate diverticulitis, and differential diagnosis may present considerable difficulty. Irritable colon syndrome and acute appendicitis may be indistinguishable clinically from diverticulitis. Differentiation from carcinoma is usually not difficult, but exclusion of coexistent carcinoma may be impossible except by resection. Ulcerative colitis is also easily distinguished except when, rarely, it coexists. Crohn's disease of the colon is less easily differentiated, especially in patients over 40, in whom the two diseases often coexist. Other colonic diseases, such as ischemic colitis, and pelvic inflammatory diseases usually show characteristic features which make them readily distinguishable from diverticulitis.

Acute Disease↗
PubMed1988

Acute diverticulitis in patients under 40 years of age: radiologic diagnosis.

During a 4-year period, eight patients 40 years old or younger had surgically proved diverticulitis at our institution. None of these patients had connective-tissue diseases or were on medication (i.e., steroids) that would predispose them to diverticulosis. The presenting clinical symptoms in this group of patients were often misleading, and in only one of the eight cases was the correct clinical diagnosis made at the time of admission. Of the three diagnostic studies that were performed (barium enema, sonography, and CT), barium enema was the most accurate, yielding evidence for diverticulitis in six of seven cases. The degree and extent of diverticulosis in these patients was minimal compared with that in the older patients. CT showed abdominal abscesses in two patients; in one, a mistaken diagnosis of Crohn disease was made; in the other, diverticulitis was correctly identified. In the three patients in whom sonography was performed, the findings were negative for diverticulitis. Our experience suggests that the diagnosis of acute diverticulitis should be considered in patients with abdominal pain who are less than 40 years old.

Acute Disease↗
PubMed1990

The value of sonography in the diagnosis of acute diverticulitis of the colon.

To assess the value of sonography as the initial imaging procedure in patients suspected of having acute diverticulitis of the colon, we evaluated the sonograms of 71 patients who had clinical signs and symptoms of the disease. Identification of diverticula on sonograms was taken as evidence of acute diverticulitis. Fifty-four patients had sonographic findings consistent with this diagnosis. These included gut wall thickening (53), diverticula (34), pericolic (21) and intramural (two) fluid collections, edema of the pericolic fat (22), and intramural sinus tract (one). The final diagnosis was based on the clinical impression (all cases); pathologic interpretation of a surgical specimen (33 cases); findings on contrast enema (40 cases), CT scan (14 cases), and colonoscopy (18 cases); and a favorable clinical outcome in the absence of therapy (17 cases). Forty-six of the 54 patients with positive sonograms had acute diverticulitis, six had pericolic inflammatory masses caused by other colonic diseases, and two had surgically confirmed diverticulosis without active inflammation. All 17 patients with normal sonograms were treated conservatively. Diverticulitis was not confirmed in any of these patients. Our study suggests that sonography is a valuable imaging technique in the patient with signs and symptoms of acute diverticulitis.

Acute Disease↗
PubMed1989

[Sonography in the diagnosis of acute colonic diverticulitis].

Acute colonic diverticulitis is mainly diagnosed clinically, as endoscopy or coloncontrast enema might be dangerous. In this study diagnostic criteria and typical sonographic findings of acute diverticulitis are summarized. The comparison of these findings - in stadium IIa of diverticulitis - to other sonographic colon findings shows high sensitivity (0.96), specificity (0.98) and predictive values (pV +0.85, pV -0.99) for sonographic findings of acute colonic diverticulitis. Thus sonography can improve diagnostic and follow-up controls of acute diverticulitis.

Acute Disease↗
PubMed1992

Prognostic factors from computed tomography in acute left colonic diverticulitis.

This prospective study examined factors which may predict a poor outcome (complications and recurrence) after a first attack of diverticulitis which has been successfully managed conservatively. Twenty-four of 107 patients who entered the study had a poor outcome: persistent diverticulitis (nine cases), recurrence (seven cases), colonic stenosis (six cases), residual parasigmoid abscess (one case) and colovesical fistula (one case). Eight of the 18 men aged 50 years or less had a poor outcome compared with 16 of the remaining 89 patients (P = 0.032). Twelve of 76 patients (16 per cent) with mild findings on computed tomography (CT) (localized thickening of colonic wall and inflammation of pericolic fat) had a poor outcome compared with 11 of 23 patients (48 per cent) whose CT was estimated as severe (abscess and/or extraluminal air and/or extraluminal Gastrografin) (P = 0.004). These results suggest that elective colectomy can be proposed after a first attack of acute left diverticulitis in men up to 50 years of age and/or in patients whose initial CT reveals findings of severe diverticulitis.

Acute Disease↗