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At least 19 recordsLinked to original sources
PubMed1988

Acute colonic diverticulitis.

Colonic diverticulosis is truly a disease of the 20th century. A direct correlation is thought to exist between the incidence of diverticular disease and the amount of dietary fiber. Acute colonic diverticulitis occurs in approximately 25 per cent of the patients with diverticula, and 20 per cent of the patients with diverticulitis will ultimately require surgical intervention. Because of the often virulent nature of the disease in younger patients and the prevalence in the geriatric population, an aggressive approach is advocated. Primary resection of the involved segment of colon is advocated in all cases requiring operation. A primary anastomosis can be constructed in stage I and some cases of stage II disease. This results in lower morbidity and mortality rates as well as fewer days of hospitalization and disability. Newer techniques such as diagnostic CT scanning, percutaneous drainage of diverticular abscess, and greater application of surgical stapling devices have done much to improve the ultimate outcome of colonic diverticulitis.

Abdomen, Acute↗
PubMedDate not supplied

Emergency surgery of complicated colonic diverticulitis.

Colon diverticular disease is an increasingly frequent disorder especially in Western populations characterized by high living standards. In 30-40% of subjects over 60 years of age barium enema detects the presence of diverticula in the sigma. 10-20% of patients affected by colon diverticular disease develop complications such as inflammation or haemorrhage and 20-30% of these patients undergo surgery (60% of patients aged less than 40). Emergency surgery is performed in 50% of cases and it is currently burdened by high mortality rates. We decided to review our cases history to clarify the indication for emergency surgery, the appropriateness to resect the diseased bowel tract and to perform colic anastomosis at the time of emergency resection.

Adult↗
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↗
PubMedDate not supplied

[Surgical treatment of colonic diverticulitis].

BACKGROUND: Colonic diverticulitis is a serious disease that may require surgical treatment. Early diagnosis and management are necessary to reduce the rates of morbidity-mortality. PURPOSE: This review article was performed in order to discuss the most recent advances in the diagnosis and management of colonic diverticulitis. RESULTS: Patients with acute diverticulitis should be categorized based upon the presence or absence of complications. Patients with complicated diverticulitis should be further categorized into I) pericolonic abscess, II) distant abscess (retroperitoneum or pelvis), III) purulent peritonitis, and IV) fecal peritonitis. In the absence of complications, elective treatment is mainly indicated in patients with recurrent episodes of diverticulitis. In complicated diverticulitis, the surgical alternatives will depend upon the clinical category. The current tendency is to attempt a percutaneous drainage of the abscess, followed by a semi-elective resection. In patients operated upon on emergency basis, resection with a diverting colostomy, with or without anastomosis, is the most widely used procedure. CONCLUSIONS: Surgical treatment for acute diverticulitis should be based upon the presence of complications and their clinical category.

Abdominal Abscess↗
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↗
PubMed1999

Transverse colon diverticulitis: successful nonoperative management in four patients. Report of four cases.

PURPOSE: Diverticulitis of the transverse colon is a rare disorder and is often confused with other conditions. Previously reported cases of transverse colon diverticulitis were diagnosed and treated by surgical exploration. Four cases are presented that were successfully managed with a nonsurgical approach. METHODS AND RESULTS: Review of the literature in English disclosed 31 cases of transverse colon diverticulitis. The clinical characteristics and management of these patients are reviewed and compared with the current series of patients. The utility of computerized tomography in the diagnosis of diverticulitis is discussed. CONCLUSIONS: Medical therapy with bowel rest and antibiotics is appropriate for transverse colon diverticulitis when free perforation and peritoneal signs are absent and the inflammation is contained, as shown by computerized tomography. Operative exploration should be reserved for patients with diffuse peritonitis or those where perforated colon cancer cannot be excluded.

Adult↗
PubMed1989

[Sonography in the diagnosis and follow-up of colonic diverticulitis].

17 patients with colonic diverticulitis of various degree were examined by conventional abdominal ultrasound in comparison to either colonoscopy or operation. The sonography of the inflammated region showed an echo-poor enlargement of the colonic wall (normal less than 3 mm) ranging from 5 to 15 mm (mean 7.8 mm) over a short distance. In cases with bowel wall enlargement of more than 11 mm a spontaneous evacuation of pus from the diverticles was endoscopically seen. A sonographic enlargement of the colonic wall of more than 15 mm is very suspicious to be a peridiverticulitis or a beginning abscess. In two patients we were able to show single inflammated diverticula by sonography. Thus ultrasonography seems to be an important noninvasive method to diagnose diverticulitis including the complications (perforation, abscess or fistulation) as well as to control the success of conservative treatment.

Aged↗
PubMed2000

Sonographic features of acute colonic diverticulitis: the "dome sign".

PURPOSE: This study was performed to clarify the sonographic features of acute colonic diverticulitis to enable its differentiation from appendicitis. METHODS: Of 119 patients who were referred to our hospitals for lower abdominal pain between June 1997 and December 1998 and underwent sonography, 12 patients had a definitive diagnosis of acute colonic diverticulitis and 4 patients a tentative diagnosis. Seventy-eight patients were diagnosed as having acute appendicitis, confirmed by appendectomy. In the 16 patients with diagnoses of diverticulitis, the sonographic and clinical features of acute colonic diverticulitis were studied. RESULTS: Among the 12 patients with definitive diagnoses of acute colonic diverticulitis, sonographic findings included localized thickening of the colonic wall (100%) and a hemispheric mass (the "dome sign") protruding at the thickened colonic wall (100%) and consisting of a hypoechoic wall (100%) and a central echogenic area (66%). The presence of diverticula was confirmed by barium-enema x-ray study in all 12 patients. The 4 patients with tentative diagnoses of acute colonic diverticulitis all had colonic wall thickening but no dome sign. Colonoscopy revealed colitis in 3 of these patients. All 16 patients recovered with conservative treatment, without laparotomy. CONCLUSIONS: Sonography was useful for differentiating acute colonic diverticulitis from appendicitis. The sonographic finding of the dome sign seems to be specific for acute colonic diverticulitis.

Abdominal Pain↗
PubMed1992

Surgical management of right colon diverticulitis.

The infrequent occurrence of right colon diverticulitis in the developed West has led to a controversy in the management of this disease. In Singapore, we continued to avoid colectomy whenever possible because this disease is usually nonprogressive. We reviewed 68 patients treated by conservative surgery to evaluate the effectiveness of this treatment policy. Almost 70 percent of our patients were below 40 years of age, and the clinical presentation was indistinguishable from acute appendicitis. Diverticulectomy was done only for inflamed and perforated diverticula (25 cases), while the nonperforated diverticulum was left alone (40 cases). The inflammation invariably responded to antibiotic therapy. Only three patients had colonic resection since a malignant neoplasm could not be excluded. There were no adverse sequelae over a mean follow-up period of three and one-half years, except for one patient who had recurrent attacks of right colon diverticulitis necessitating colectomy. With this policy of management we encountered no mortality, and morbidity was acceptable.

Adult↗
PubMed1997

Acute colonic diverticulitis in the young.

BACKGROUND: Colonic diverticulitis in the young has been considered to have a virulent course, high morbidity, and high operative rate. As a result, elective resection of the involved colonic segment after the first clinical episode has been the usual practice. PURPOSE: This study presents our experience with acute diverticulitis in the young. METHODS: In the last nine years, 63 patients younger than 45 years were treated for acute diverticulitis at our institution. A retrospective review was performed to determine the clinical course and outcome of these patients. RESULTS: Clinical presentations, radiographic tests, operative findings, and pathology results revealed that 57 patients had a pericolonic contained disease (Hinchey State I). Two patients had a large pelvic abscess (Hinchey Stage II), and four patients had a diffuse peritonitis (Hinchey Stage III). Forty-one patients (65 percent) were successfully treated medically with antibiotics and bowel rest. Of 22 patients (35 percent) who underwent emergent operations, 12 patients' diseases had been erroneously diagnosed preoperatively (9 "appendicitis"). CONCLUSION: Diverticulitis at a young age does not have a specific aggressive nature. Although, it is associated with a high rate of emergency operations, many of these are performed for a mistaken diagnosis. The recommendation for routine elective resection following the first episode of diverticulitis should be reassessed.

Acute Disease↗
PubMed2001

Sonography of acute right side colonic diverticulitis.

BACKGROUND: To describe the prevalence and sonographic findings and ultrasound diagnostic accuracy of the right side colonic diverticulitis in patients having right lower abdominal pain with indeterminate nature. METHODS: A total of 934 patients with acute right lower abdominal pain of clinically indeterminate nature were referred for ultrasound examination (US). US studies were performed with 3.5 to 7.0 (or occasionally 10) MHz transducers using graded compression method. Twenty-three patients were finally diagnosed to have an uncomplicated acute diverticulitis of the right colon. The gray-scale sonographic images were reviewed. A retrospective study was undertaken to evaluate diagnostic contribution of US. RESULTS: The prevalence of acute right side colonic diverticulitis was 2.5% in patients with clinically indeterminate acute right lower abdominal pain. Locations of the inflamed diverticula include cecum in 6 patients, proximal ascending colon in 15 patients, and distal ascending colon in only 2 patients. Sonography detected 21 inflamed diverticula with 1 false positive and 2 false negative results. The most typical sonographic feature of an inflamed diverticulum of right side colon was a rounded or oval-shaped hypoechoic or nearly anechoic structure (52%) protruding out from the segmentally thickened colonic wall. Some of them might contain strong echoes representing gas or feces (43%), or stone in the lumen (5%). Regional pericolic or peridiverticular fat thickening was noted in 57% of patients, and segmental colon wall thickening in 38%. US examination yielded a sensitivity of 91.3%, a specificity of 99.8%, an overall accuracy of 99.5%, a positive predictive value of 95.5%, and a negative predictive value of 99.7%. A positive sonogram made the likelihood of acute right side diverticulitis 456.5 times greater compared with the pretest clinical impression. US differentiated acute right side colonic diverticulitis from acute appendicitis with a 100% accuracy. CONCLUSIONS: Ultrasound can be extremely useful in diagnosing acute right side colonic diverticulitis. Careful ultrasound evaluation of the right colon and the cecum may facilitate a correct diagnosis and help differentiate from acute appendicitis, and steer the surgeon to a more effective management.

Acute Disease↗
PubMedDate not supplied

The role of surgical treatment in colon diverticulitis: indications and results.

PURPOSE: Colon diverticulitis is a common illness with affects 37-45% of western populations. Indications regarding therapy guidelines, operative timing and which surgical procedure to perform are still controversial. MATERIAL AND METHOD: Between January 1977 and December 1997, 239 patients, diagnosed with diverticulitis, have been admitted, on emergency, to our Department of General Surgery; 135 males (56%) and 104 females (44%), (mean age of 63 years). RESULTS AND DISCUSSION: Forty-two patients (18%), clearly diagnosed with diffuse or local peritonitis, underwent delayed emergency surgical procedure; 44 (22%) out of 197 patients, treated with medical therapy and subsequently underwent elective surgery procedures for complications (fistulas or stenosis). Among the 42 patients treated in emergency, 26 cases (62%) underwent to resection with immediate reconstruction. Among the elective surgery group 39 (89%) out of 44 underwent to resection with immediate reconstruction. Complications reached 40% in the group of emergency patients (mortality rate 12%) and 16% in the elective surgery group (mortality rate 2%). Several features possible influencing mortality rate have been analysed; age > 70 years, acute associated diseases, generalised peritonitis and surgical timing show a statistical significance. CONCLUSION: Therefore, a careful evaluation of the patients, an appropriate pre and post-operative medical treatment, with a wider use of the most recent techniques such as CT scan guided drain, intra-operative wash-out and peritoneal lavage are recommended in order to reduce morbidity and mortality.

Adult↗
PubMed1998

Hepatic-portal venous gas in acute colonic diverticulitis.

The diagnosis and assessment of severity of acute colonic diverticulitis may be difficult. A case is presented, in which the delayed diagnosis of diverticulitis resulted in the development of a diverticular mesocolic abscess complicated by hepatic-portal venous gas (HPVG). The utility of ultrasound as a rapid, noninvasive tool to diagnose this distinctly rare condition is outlined. The literature on HPVG associated with acute colonic diverticulitis is reviewed, and the therapeutic options are discussed.

Abscess↗
PubMed1989

99m-technetium-HmPAO-labelled leucocytes in the diagnosis of acute colonic diverticulitis.

Eighteen patients with abdominal symptoms clinically resembling acute colonic diverticulitis were studied with 99mTc-labelled leucocytes on average 5 days after the onset of symptoms. The diagnosis of diverticular disease was confirmed in all cases by means of barium enema or sigmoidoscopy. The leucocyte scan was positive in 13 patients, nonspecific in four and unclear in one patient. The diagnostic possibilities in acute colonic diverticulitis are discussed.

Acute Disease↗
PubMed1998

[Colonic diverticulitis--therapy concepts from the surgical viewpoint].

Colon diverticulitis showed a great variability in kind, intensity and course of disease. Time and surgical procedure are dependent on the stage of diverticulitis (emergency procedure, elective resection, early elective resection). In emergency cases non-resecting procedures should not be performed. Here the Hartmann procedure and in favorable conditions the primary resection should be chosen. Other patients with acute diverticulitis should have early elective resection after short-term medical treatment (5-7 days). Patients with a chronic-recurrent course of disease should have an elective one-sided resection. The surgical principles are mobilization of the splenic flexure as well as the widening of the distal resection limit into the upper rectum to avoid a recurrence.

Colectomy↗