Methods: The data of patients who were admitted to the hospital between 2015 and 2019 with the complaint of abdominal pain and then finally diagnosed with colon diverticular disease, colon diverticulitis, or acute appendicitis, analyzed retrospectively.
Results: A total of 19 cecum diverticulitis patients were detected during surgery for acute appendicitis or during clinical and radiological evaluation. 1247 appendectomies were evaluated; the final diagnosis was observed as cecal diverticulitis in 5 patients (0,4%). One hundred nineteen patients diagnosed with colonic diverticulitis at admission were evaluated, while 105 (88,2%) of them had left-sided diverticulitis, 14 (11,7%) of them had solitary cecal diverticulitis. All of the solitary cecal diverticulitis patients were treated conservatively, except one patient who has Hinchey 3 diverticulitis.
Conclusion: Differential diagnosis of cecum diverticulitis with acute appendicitis is important because cecum diverticulitis can be managed as conservatively in most cases. In order to prevent unnecessary surgical interventions, this importance has increased, especially during the COVID-19 pandemic period.},
}
@article {pmid34508065,
year = {2021},
author = {Sawada, H and Toyota, K and Ikeda, M and Hakoda, K and Hotta, R and Inoue, M and Ohmori, I and Takahashi, T},
title = {Anal Atresia in a Patient Who Had Undergone Hartmann Procedure.},
journal = {The American journal of case reports},
volume = {22},
number = {},
pages = {e932764},
pmid = {34508065},
issn = {1941-5923},
mesh = {Aged, 80 and over ; Anal Canal ; *Anus, Imperforate ; Colon, Sigmoid ; Female ; Humans ; *Rectal Neoplasms ; Rectum/surgery ; },
abstract = {BACKGROUND Hartmann procedure can be necessary for the treatment of rectal cancer and colonic perforation. The distal diverted intestinal tract is usually disregarded, while the proximal colon is diverted with a stoma. Most of the reported complications related to a diverted intestinal tract following Hartmann procedure include inflammation and intestinal tumors; however, there are only a few reports about postoperative anal complications. Herein, we report a rare case of anal atresia following Hartmann procedure. Anal atresia is generally considered as a congenital malformation; therefore, this was an extremely rare case, as there are no previous reports about anal atresia following Hartmann procedure. CASE REPORT An 84-year-old woman presented to our hospital with a persistent feeling of incomplete evacuation. She had undergone Hartmann procedure for diverticular disease of the sigmoid colon, with perforation, 5 years ago and had no major complications after the surgery. She had no history of anal disorders such as hemorrhoids or anal fissures. On examination, her anus was found to be closed by a thin skin, and computed tomography revealed stool retention in the diverted rectum. The anus was surgically opened to remove the stool, after which the feeling of incomplete evacuation resolved with no subsequent recurrence. CONCLUSIONS This is the first report of anal atresia in a patient following Hartmann procedure. The surgical intervention was effective in resolving the blockage and relieving the patient's feeling of incomplete evacuation.},
}
@article {pmid34504402,
year = {2021},
author = {Ali, F and Raskin, E},
title = {Robotic Surgery for Complicated Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {5},
pages = {297-301},
pmid = {34504402},
issn = {1531-0043},
abstract = {Diverticular disease is common, and increasing in prevalence worldwide. The treatment for acute and chronic diverticular disease has a huge clinical and economic burden. Surgery is standard for complicated diverticulitis, and there are several benefits to using robotic surgery in these cases. Complicated diverticular disease can result in fistula, fibrosis, and deranged anatomy, which present technical challenges to the surgeon. Understanding and anticipating these anatomical challenges is key to successful surgery. While fears of conversion in complicated cases may stop surgeons from using traditional laparoscopic surgery, robotic surgery is especially promising for enhancing dexterity, visualization, and facilitating completely minimally invasive surgery in these complicated cases. In this chapter, we review end-to-end technical strategies of robotic colorectal surgery for complicated diverticular disease, including cases with colovesicular, colovaginal, and colocutaneous fistulae.},
}
@article {pmid34492052,
year = {2021},
author = {van Rossen, TM and Ooijevaar, RE and Kuyvenhoven, JP and Eck, A and Bril, H and Buijsman, R and Boermeester, MA and Stockmann, HBAC and de Korte, N and Budding, AE},
title = {Microbiota composition and mucosal immunity in patients with asymptomatic diverticulosis and controls.},
journal = {PloS one},
volume = {16},
number = {9},
pages = {e0256657},
pmid = {34492052},
issn = {1932-6203},
mesh = {Aged ; Asymptomatic Diseases/*epidemiology ; Colon, Sigmoid/microbiology/pathology ; Colonoscopy ; Diverticulum/epidemiology/genetics/*immunology/*microbiology ; Female ; Gastrointestinal Microbiome/genetics ; Humans ; Immunity, Mucosal/genetics/immunology ; Inflammation/epidemiology/*microbiology/pathology ; Male ; Middle Aged ; RNA, Ribosomal, 16S/genetics/immunology ; },
abstract = {INTRODUCTION: The etiology of diverticulosis is still poorly understood. However, in patients with diverticulitis, markers of mucosal inflammation and microbiota alterations have been found. The aim of this study was to evaluate potential differences of the gut microbiota composition and mucosal immunity between patients with asymptomatic diverticulosis and controls.
METHODS: We performed a prospective study on patients who underwent routine colonoscopy for causes not related to diverticular disease or inflammatory bowel disease. Participants were grouped based on the presence or absence of diverticula. Mucosal biopsies were obtained from the sigmoid and transverse colon. Microbiota composition was analyzed with IS-pro, a 16S-23S based bacterial profiling technique. To predict if patients belonged to the asymptomatic diverticulosis or control group a partial least squares discriminant analysis (PLS-DA) regression model was used. Inflammation was assessed by neutrophil and lymphocyte counts within the taken biopsies.
RESULTS: Forty-three patients were enrolled. Intestinal microbiota profiles were highly similar within individuals for all phyla. Between individuals, microbiota profiles differed substantially but regardless of the presence (n = 19) of absence (n = 24) of diverticula. Microbiota diversity in both sigmoid and transverse colon was similar in all participants. We were not able to differentiate between diverticulosis patients and controls with a PLS-DA model. Mucosal lymphocyte counts were comparable among both groups; no neutrophils were detected in any of the studied biopsies.
CONCLUSIONS: Microbiota composition and inflammatory markers were comparable among asymptomatic diverticulosis patients and controls. This suggests that the gut microbiota and mucosal inflammation do not play a major role in the pathogenesis of diverticula formation.},
}
@article {pmid34447822,
year = {2021},
author = {Gallo, G and Ortenzi, M and Grossi, U and Di Tanna, GL and Pata, F and Guerrieri, M and Sammarco, G and Di Saverio, S},
title = {What paradigm shifts occurred in the management of acute diverticulitis during the COVID-19 pandemic? A scoping review.},
journal = {World journal of clinical cases},
volume = {9},
number = {23},
pages = {6759-6767},
pmid = {34447822},
issn = {2307-8960},
abstract = {BACKGROUND: Acute colonic diverticulitis (ACD) is common in Western countries, with its prevalence increasing throughout the world. As a result of the coronavirus disease 2019 (COVID-19), elective surgery and in-patients' visits have been cancelled or postponed worldwide.
AIM: To systematically explore the impact of the pandemic in the management of ACD.
METHODS: MEDLINE, Embase, Scopus, MedxRiv, and the Cochrane Library databases were searched to 22 December 2020. Studies which reported on the management of patients with ACD during the COVID-19 pandemic were eligible. For cross sectional studies, outcomes of interest included the number of hospital admission for ACD, as well as key features of disease severity (complicated or not) across two time periods (pre- and during lockdown).
RESULTS: A total of 69 papers were inspected, and 21 were eligible for inclusion. Ten papers were cross sectional studies from seven world countries; six were case reports; three were qualitative studies, and two review articles. A 56% overall decrease in admissions for ACD was observed during lockdown, peaking 67% in the largest series. A 4%-8% decrease in the rate of uncomplicated diverticulitis was also noted during the lockdown phase. An initial non-operative management was recommended for complicated diverticulitis, and encouraged to an out-of-hospital regimen. Despite initial concerns on the use of laparoscopy for Hinchey 3 and 4 patients to avoid aerosolized contamination, societal bodies have progressively mitigated their initial recommendations as actual risks are yet to be ascertained.
CONCLUSION: During the COVID-19 pandemic, fewer patients presented and were diagnosed with ACD. Such decline may have likely affected the spectrum of uncomplicated disease. Established outpatient management and follow up for selected cases may unburden healthcare resources in time of crisis.},
}
@article {pmid34447274,
year = {2021},
author = {Thomsen, L and Troelsen, FS and Nagy, D and Skajaa, N and Körmendiné Farkas, D and Erichsen, R},
title = {Venous Thromboembolism and Risk of Cancer in Patients with Diverticular Disease: A Danish Population-Based Cohort Study.},
journal = {Clinical epidemiology},
volume = {13},
number = {},
pages = {735-744},
pmid = {34447274},
issn = {1179-1349},
abstract = {PURPOSE: Venous thromboembolism may be a harbinger of cancer. Patients with diverticular disease are suggested to have an increased risk of developing venous thromboembolism compared with the general population, but it remains unclear whether venous thromboembolism is also a marker of occult cancer in these patients. We investigated the risk of cancer after venous thromboembolism among patients with diverticular disease.
PATIENTS AND METHODS: We used Danish health registries to conduct a nationwide, population-based cohort study during 1996-2017. We identified all venous thromboembolism patients with a diagnosis of diverticular disease and calculated absolute risks of cancer and standardized incidence ratios (SIRs) by comparing observed and expected cancer incidence based on national cancer incidence in the Danish population.
RESULTS: We followed 3406 patients with venous thromboembolism and diverticular disease for a median of 3.0 years (interquartile range: 1.0-6.0). During the first year of follow-up, we observed 212 cancer cases. The corresponding one-year risk of cancer was 6.2% (95% confidence interval [CI]: 5.5-7.1) with a SIR of 2.9 (95% CI: 2.5-3.3). The SIRs were particularly elevated for cancers of the stomach, pancreas, ovary, and kidney. During the second and subsequent years of follow-up, 337 cancers were diagnosed with a SIR of 1.1 (95% CI: 1.0-1.3).
CONCLUSION: Venous thromboembolism is a harbinger of occult cancer in patients with diverticular disease.},
}
@article {pmid34446657,
year = {2022},
author = {Ingraham, A and Schumacher, J and Fernandes-Taylor, S and Yang, DY and Godat, L and Smith, A and Barbosa, R and Cribari, C and Salim, A and Schroeppel, T and Staudenmayer, K and Crandall, M and Utter, G and , },
title = {General surgeon involvement in the care of patients designated with an American Association for the Surgery of Trauma-endorsed ICD-10-CM emergency general surgery diagnosis code in Wisconsin.},
journal = {The journal of trauma and acute care surgery},
volume = {92},
number = {1},
pages = {117-125},
pmid = {34446657},
issn = {2163-0763},
support = {K08 HS025224/HS/AHRQ HHS/United States ; UL1 TR002373/TR/NCATS NIH HHS/United States ; },
mesh = {*Critical Care/methods/statistics & numerical data ; Emergencies/*epidemiology ; Female ; General Surgery/*organization & administration ; Global Burden of Disease ; Humans ; International Classification of Diseases ; Male ; Middle Aged ; *Physician's Role ; Surgeons ; *Surgical Procedures, Operative/methods/statistics & numerical data ; Wisconsin/epidemiology ; *Wounds and Injuries/diagnosis/epidemiology/surgery ; },
abstract = {BACKGROUND: The current national burden of emergency general surgery (EGS) illnesses and the extent of surgeon involvement in the care of these patients remain largely unknown. To inform needs assessments, research, and education, we sought to: (1) translate previously developed International Classification of Diseases (ICD), 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes representing EGS conditions to ICD 10th Revision, CM (ICD-10-CM) codes and (2) determine the national burden of and assess surgeon involvement across EGS conditions.
METHODS: We converted ICD-9-CM codes to candidate ICD-10-CM codes using General Equivalence Mappings then iteratively refined the code list. We used National Inpatient Sample 2016 to 2017 data to develop a national estimate of the burden of EGS disease. To evaluate surgeon involvement, using Wisconsin Hospital Association discharge data (January 1, 2016 to June 30, 2018), we selected adult urgent/emergent encounters with an EGS condition as the principal diagnosis. Surgeon involvement was defined as a surgeon being either the attending provider or procedural physician.
RESULTS: Four hundred and eighty-five ICD-9-CM codes mapped to 1,696 ICD-10-CM codes. The final list contained 985 ICD-10-CM codes. Nationally, there were 2,977,843 adult patient encounters with an ICD-10-CM EGS diagnosis. Of 94,903 EGS patients in the Wisconsin Hospital Association data set, most encounters were inpatient as compared with observation (75,878 [80.0%] vs. 19,025 [20.0%]). There were 57,780 patients (60.9%) that underwent any procedure. Among all Wisconsin EGS patients, most had no surgeon involvement (64.9% [n = 61,616]). Of the seven most common EGS diagnoses, surgeon involvement was highest for appendicitis (96.0%) and biliary tract disease (77.1%). For the other five most common conditions (skin/soft tissue infections, gastrointestinal hemorrhage, intestinal obstruction/ileus, pancreatitis, diverticular disease), surgeons were involved in roughly 20% of patient care episodes.
CONCLUSION: Surgeon involvement for EGS conditions ranges from highly likely (appendicitis) to relatively unlikely (skin/soft tissue infections). The wide range in surgeon involvement underscores the importance of multidisciplinary collaboration in the care of EGS patients.
LEVEL OF EVIDENCE: Prognostic/epidemiological, Level III.},
}
@article {pmid34441008,
year = {2021},
author = {Piccioni, A and Franza, L and Vaccaro, V and Saviano, A and Zanza, C and Candelli, M and Covino, M and Franceschi, F and Ojetti, V},
title = {Microbiota and Probiotics: The Role of Limosilactobacillus Reuteri in Diverticulitis.},
journal = {Medicina (Kaunas, Lithuania)},
volume = {57},
number = {8},
pages = {},
pmid = {34441008},
issn = {1648-9144},
mesh = {Animals ; *Diverticulitis/therapy ; Dysbiosis ; Female ; Humans ; *Limosilactobacillus reuteri ; *Microbiota ; *Probiotics/therapeutic use ; },
abstract = {The microbiota is the set of commensal microorganisms, residing in the organism, helping proper functioning of organs and systems. The role that the microbiota plays in maintaining the health of vertebrates is widely accepted, particularly in the gastrointestinal system, where it is fundamental for immunity, development, and conversion of nutrients. Dysbiosis is an alteration of the microbiota which refers to a disturbed balance, which can cause a number of pathologies. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. In particular, Lactobacilli are a group of Gram-positive bacteria, which are able to produce lactic acid through glucose metabolism. They are present in different microenvironments, ranging from the vagina, to the mouth, to different tracts of the small intestine. In the present review, we will discuss the use of Limosilactobacillus in human health in general and more specifically in diverticulitis. In particular we analyze the role of Limosilactobacillus reuteri and its anti-inflammatory action. For this review, articles were identified using the electronic PubMed database through a comprehensive search, conducted by combining key terms such as "diverticulitis", "Limosilactobacillus reuteri", "human health and disease", "probiotics". We selected all the articles published in the last 10 years and screened 1017 papers. Articles referenced in the screened papers were evaluated if considered interesting for our topic. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. The importance of probiotics in treating diverticular disease and acute diverticulitis can be further understood if taking into consideration some pathophysiological aspects, associated to the microbiota. L. reuteri plays an important role in human health and disease. The effectiveness of L. reuteri in stimulating a correct bowl motility partly explains its effectiveness in treating diverticulitis. The most important action of L. reuteri is probably its immunomodulating activity. Levels of IL-6, IL-8, and Tumor necrosis factor (TNF-alpha) are reduced after supplementation with different strands of Lactobacilli, while T-regulatory cells increase in number and activity. Anyway, new mechanisms of action of probiotics come to light from the many investigations currently taking place in numerous centres around the world and to improve how exactly probiotic administration could make the difference in the management of diverticular disease and acute diverticulitis.},
}
@article {pmid34422552,
year = {2021},
author = {Lee, ZW and Albright, EA and Brown, BP and Markel, TA},
title = {Congenital cecal diverticulitis in a pediatric patient.},
journal = {Journal of pediatric surgery case reports},
volume = {72},
number = {},
pages = {},
pmid = {34422552},
issn = {2213-5766},
support = {K08 DK113226/DK/NIDDK NIH HHS/United States ; },
abstract = {Diverticulitis in the pediatric population is a very rare cause of abdominal pain. When present in the cecum or ascending colon, it is often incorrectly diagnosed preoperatively as acute appendicitis. This is especially true in Western countries where right-sided diverticulitis is less common. Here we detail a case of a pediatric patient with complicated congenital cecal diverticulitis and review the literature on pertinent management. An extensive work up with imaging and endoscopy was completed and definitive surgical treatment with diverticulectomy an appendectomy was performed. As the incidence of diverticular disease in younger individuals increases, right sided diverticulitis is worthy of consideration on the differential diagnosis.},
}
@article {pmid34401167,
year = {2021},
author = {Ben Ismail, I and Ben Chaabene, H and Rebii, S and Zoghlami, A},
title = {Perforated Jejunal Diverticulitis: a rare cause of acute abdominal pain.},
journal = {Clinical case reports},
volume = {9},
number = {8},
pages = {e04594},
pmid = {34401167},
issn = {2050-0904},
abstract = {It is imperative for surgeons to have a heightened awareness of complications of jejunal diverticular disease so that they can act quickly and contribute to a successful clinical outcome for their patients.},
}
@article {pmid36286892,
year = {2021},
author = {Andreev, DN and Kucheryavyy, YA},
title = {[Obesity as a risk factor for diseases of the digestive system].},
journal = {Terapevticheskii arkhiv},
volume = {93},
number = {8},
pages = {954-962},
doi = {10.26442/00403660.2021.08.200983},
pmid = {36286892},
issn = {0040-3660},
mesh = {Adult ; Humans ; Leptin ; Apelin ; Adiponectin ; C-Reactive Protein ; Fatty Acids, Nonesterified ; Superoxides ; Acute Disease ; Hydrogen Peroxide ; *Pancreatitis/complications ; *Barrett Esophagus/complications/epidemiology ; *Esophageal Neoplasms/complications/epidemiology ; Obesity/complications/epidemiology ; Risk Factors ; Adipokines ; Tumor Necrosis Factors ; Interleukin-1 ; Cytokines ; Endotoxins ; Oxygen ; Digestive System ; },
abstract = {Currently, the global prevalence of obesity among the worlds adult population is about 650 million people, which makes it possible to consider this chronic metabolic disease as a non-infectious pandemic of the 21st century. It has been proven that obesity is associated with several gastroenterological diseases, while the mechanisms of these associations are extremely heterogeneous and multifactorial. Hypertrophy and hyperplasia of adipocytes in obesity lead to a change in the profile of adipokine production (a decrease in adiponectin, an increase in leptin), an increase in the production of pro-inflammatory cytokines (interleukin-1, 6, 8, tumor necrosis factor), C-reactive protein, free fatty acids, as well as active forms of oxygen (superoxide radicals, H2O2). All the above induces the development of chronic slowly progressive inflammation, oxidative stress, and insulin resistance. In addition, peptides secreted by adipocytes (adiponectin, leptin, nesfatin-1 and apelin) can modulate gastrointestinal motility, acting both centrally and peripherally. The qualitative and quantitative changes in the intestinal microbiota observed in obese patients (increased Firmicutes and decreased Bacteroidetes) lead to a decrease in the production of short-chain fatty acids and an increase in the intestinal permeability due to disruption of intercellular tight junctions, which leads to increased translocation of bacteria and endotoxins into the systemic circulation. Numerous studies have demonstrated the association of obesity with diseases of the esophagus (gastroesophageal reflux disease, Barretts esophagus, esophageal adenocarcinoma, esophageal motility disorders), stomach (functional dyspepsia, stomach cancer), gallbladder (cholelithiasis, gallbladder cancer), pancreas (acute pancreatitis, pancreatic cancer), liver (non-alcoholic fatty liver disease, hepatocellular carcinoma), intestine (diverticular disease, irritable bowel syndrome, colorectal cancer).},
}
@article {pmid34388891,
year = {2021},
author = {Chung, D},
title = {Jejunal diverticulitis secondary to a gastrointestinal stromal tumor: A case report.},
journal = {International journal of surgery case reports},
volume = {85},
number = {},
pages = {106291},
pmid = {34388891},
issn = {2210-2612},
abstract = {INTRODUCTION: The common manifestations of gastrointestinal stromal tumors (GIST) are well established. However, jejunal diverticulosis is an uncommon phenomenon to be associated with this lesion, with its rarity compounded by the relative difficulty associated with its diagnosis. Limited literature is available on this topic. This article examines one such case of jejunal diverticulitis as a result of a GIST, and the intervention of said disease.
CASE PRESENTATION: A 69 year old lady presented with abdominal pain, vomiting, and low grade fevers, on a background of ulcerative colitis. She was peritonitic, raising concerns of an acute abdomen. Her imaging identified an intra-abdominal contained perforation, prompting a transfer to theatres overnight for a laparotomy, which identified a jejunal diverticulum, which resembled a contained perforation. This was resected, and sent for histopathological analysis, identifying the lesion as a GIST.
DISCUSSION: Unlike other forms of jejunal diverticular disease, those arising from GISTs tend to present perforated, necessitating resection. This disease displays a tendency towards formation on the anti-mesenteric border of the small bowel. Additionally, this particular form of GIST shows macroscopic and histopathological uniformity across reported cases to date despite significant geographical disparity.
CONCLUSION: A scant number of case reports worldwide have identified jejunal diverticulitis from GISTs. We suggest diverticula be excised if perforation is suspected, while incidental findings of such be left untouched. However, overall management should be undertaken at the discretion of the operating surgeon.},
}
@article {pmid34386552,
year = {2021},
author = {Chia, ML and Chan, SWY and Shelat, VG},
title = {Diverticular Disease of the Appendix Is Associated with Complicated Appendicitis.},
journal = {GE Portuguese journal of gastroenterology},
volume = {28},
number = {4},
pages = {236-242},
pmid = {34386552},
issn = {2341-4545},
abstract = {INTRODUCTION: Diverticular disease of the vermiform appendix (DDA) has an incidence of 0.004 to 2.1% in appendicectomy specimens. DDA is variably associated with perforation and malignancy. We report a single-center experience of DDA. The primary aim is to validate the association of DDA with complicated appendicitis or malignancy, and the secondary aim is to validate systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores.
METHODS: The histopathology reports of 2,305 appendicectomy specimens from January 2011 to December 2015 were reviewed. Acute appendicitis was found in 2,164 (93.9%) specimens. Histology of the remaining 141 (6.1%) patients revealed: normal appendix (n = 110), DDA (n = 22), endometriosis of appendix (n = 6), and an absent appendix (n = 3). Patient demographics, clinical profile, operative data, and perioperative outcomes of DDA patients are studied. Modified Alvarado score, Andersson score, SIRS criteria, and qSOFA scores were retrospectively calculated.
RESULTS: The incidence of DDA was 0.95%. Ten patients (45.5%) had diverticulitis. The mean age of DDA patients was 39.5 years (range 23-87), with male preponderance (n = 12, 54.5%). The median Modified Alvarado score was 8 (range 4-9), and the median Andersson score was 5 (range 2-8). Fourteen patients (63.6%) had SIRS, and none had a high qSOFA score. Eight patients (36.4%) had complicated appendicitis (perforation [n = 2] or abscess [n = 6]). Eleven (50%) patients underwent laparoscopic appendicectomy. There were three 30-day readmissions and no mortality.
CONCLUSION: DDA is a distinct clinical pathology associated with complicated appendicitis.},
}
@article {pmid34366615,
year = {2021},
author = {Isohata, N and Nagata, K and Utano, K and Nozaki, R and Nozu, S and Kato, T and Kijima, S and Matsumoto, H and Majima, K and Ryu, Y and Hirayama, M and Endo, S},
title = {Recent trends in the prevalence and distribution of colonic diverticula in Japan evaluated using computed tomography colonography.},
journal = {World journal of gastroenterology},
volume = {27},
number = {27},
pages = {4441-4452},
pmid = {34366615},
issn = {2219-2840},
mesh = {Aged ; *Colonography, Computed Tomographic ; Colonoscopy ; *Diverticulosis, Colonic/diagnostic imaging/epidemiology ; *Diverticulum, Colon/diagnostic imaging/epidemiology ; Humans ; Japan/epidemiology ; Prevalence ; Tomography ; },
abstract = {BACKGROUND: Computed tomography colonography (CTC) may be superior to colonoscopy and barium enema for detecting diverticula. However, few studies have used CTC to diagnose diverticula.
AIM: To evaluate the current prevalence and distribution of colonic diverticula in Japan using CTC.
METHODS: This study was conducted as part of the Japanese National Computed Tomographic Colonography Trial, which included 1181 participants from 14 hospitals in Japan. We analyzed the prevalence and distribution of colonic diverticula and their relationships with age and sex. The relationship between the diverticula and the length of the large intestine was also analyzed.
RESULTS: Diverticulosis was present in 48.1% of the participants. The prevalence of diverticulosis was higher in the older participants (P < 0.001 for trend). The diverticula seen in younger participants were predominantly located in the right-sided colon. Older participants had a higher frequency of bilateral type (located in the right- and left-sided colon) diverticulosis (P < 0.001 for trend). The length of the large intestine with multiple diverticula in the sigmoid colon was significantly shorter in those without diverticula (P < 0.001).
CONCLUSION: The prevalence of colonic diverticulosis in Japan is higher than that previously reported. The prevalence was higher, and the distribution tended to be bilateral in older participants.},
}
@article {pmid34354893,
year = {2021},
author = {Rim, D and Kaye, A and Ranpura, A and Verma, S},
title = {Cannabis Use Is Associated With an Increased Risk of Intestinal Obstruction in Patients Hospitalized With Diverticulitis.},
journal = {Cureus},
volume = {13},
number = {7},
pages = {e16768},
pmid = {34354893},
issn = {2168-8184},
abstract = {Objectives Diverticulitis is a common cause of hospitalization. The use of substances such as tobacco and alcohol can predispose patients to diverticulitis, and smoking is also associated with an increased risk of diverticulitis complications. Cannabis availability is growing in the United States, but there is a lack of data on the effects of cannabis use on the outcomes of diverticulitis. Thus, we investigated the effects of cannabis use on diverticulitis outcomes. Methods A retrospective analysis was conducted using 2014 data from the National Inpatient Sample. Patient demographics and outcomes of diverticulitis were compared between the groups with and without a history of cannabis use. The outcomes of interest were inpatient mortality, length of stay, total hospital charge, intestinal obstruction, shock/hypotension, colectomy, intestinal abscess, intestinal fistula, and intestinal perforation. Results Among 48,214 patients with diverticulitis, 447 patients had a history of cannabis use. Patients with a history of cannabis use were younger, more likely to be male, less likely to be White, had a lower Charlson Comorbidity Index, and had shorter hospital stays. There were no significant differences in inpatient mortality and total hospital charge. After adjusting for age, sex, race, and the Charlson Comorbidity Index, cannabis use was an independent risk factor for intestinal obstruction in patients hospitalized with diverticulitis. There were no statistically significant differences in other outcomes. Conclusions This study indicates that patients hospitalized with diverticulitis with a history of cannabis use are more likely to have an intestinal obstruction. Inhibition of gastrointestinal motility by cannabis in the setting of diverticular inflammation may explain this finding.},
}
@article {pmid34350192,
year = {2021},
author = {De Vincentis, A and Santonico, M and Del Chierico, F and Altomare, A and Marigliano, B and Laudisio, A and Reddel, S and Grasso, S and Zompanti, A and Pennazza, G and Putignani, L and Guarino, MPL and Cicala, M and Antonelli Incalzi, R},
title = {Gut Microbiota and Related Electronic Multisensorial System Changes in Subjects With Symptomatic Uncomplicated Diverticular Disease Undergoing Rifaximin Therapy.},
journal = {Frontiers in medicine},
volume = {8},
number = {},
pages = {655474},
pmid = {34350192},
issn = {2296-858X},
abstract = {Background: Intestinal dysbiosis might play a pathogenetic role in subjects with symptomatic uncomplicated diverticular disease (SUDD), but the effect of rifaximin therapy has been scantly explored with regard to gut microbiota variations in patients with SUDD. Aims: To verify to which extent rifaximin treatment affects the gut microbiota and whether an electronic multisensorial assessment of stools and breath has the potential for detecting these changes. Methods: Breath and stool samples were collected from consecutive patients with SUDD before and after a 7 days' therapy with rifaximin. Stool microbiota was assessed, and the electronic multisensorial assessment was carried out by means of the BIONOTE electronic (e-)tongue in stools and (e-)nose in breath. Results: Forty-three subjects (female 60%, median age 66 years) were included, and 20 (47%) reported clinical improvement after rifaximin therapy. Alpha and beta diversity of stool microbiota did not significantly change after treatment, while a significant variation of selected taxa was shown (i.e., Citrobacter, Coprococcus, Anaerotruncus, Blautia, Eggerthella lenta, Dehalobacterium, SMB53, and Haemophilus parainfluenzae). Overall, the electronic multisensorial system suboptimally mirrored microbiota changes, but it was able to efficiently predict patients' clinical improvement after rifaximin with accuracies ranging from 0.81 to 0.98. Conclusions: In patients with SUDD, rifaximin administration is associated with significant variation of selected taxa. While inaccurate in predicting gut microbiota change, an electronic multisensorial system, made up of e-tongue and e-nose, was able to predict clinical improvement, thus potentially qualifying as an easy and cheap tool to forecast subjects taking most likely benefit from rifaximin therapy.},
}
@article {pmid34346712,
year = {2023},
author = {Napolitano, MA and Holleran, TJ and Sparks, AD and Zimmermann, J and Brody, FJ and Duncan, JE},
title = {Outcome and Timing of Ostomy Reversal Surgery for Diverticular Disease in Veterans Administration Hospitals.},
journal = {The American surgeon},
volume = {89},
number = {4},
pages = {656-664},
doi = {10.1177/00031348211034764},
pmid = {34346712},
issn = {1555-9823},
mesh = {Humans ; United States ; United States Department of Veterans Affairs ; *Ostomy/adverse effects ; Colostomy/adverse effects ; *Diverticular Diseases/complications ; Retrospective Studies ; Hospitals ; Postoperative Complications/epidemiology/etiology ; Colectomy/adverse effects ; },
abstract = {BACKGROUND: Veterans undergoing elective surgery for diverticular disease have an ostomy creation rate of 18%. The purpose of this study was to analyze the outcomes and timing of ostomy reversal surgery, perioperative complications, and differences between colostomy and ileostomy reversal outcomes.
METHODS: A retrospective review of the Veterans Affairs Surgical Quality Improvement Project (VASQIP) database was performed. Patients undergoing elective colectomy for diverticular disease between 2004 and 2018 were identified. Demographics, comorbidities, ostomy type, time to reversal, and postoperative complications were analyzed.
RESULTS: 4,198 patients underwent elective colectomy for diverticular disease, with 751 patients (17.9%) receiving an ostomy. Of patients who received an ostomy, 407 had ostomy reversal surgery within the Veterans Health Administration system (54.2%), with 243 colostomies, 149 ileostomies, and 15 unspecified. Median time to ostomy reversal was 5.0 months (interquartile range 3.2, 7.8). Complication rate after reversal was 23.1%; surgical site infection was most common (9.1%). Patients with American Society of Anesthesiologists classification >3 (adjusted odds ratio (aOR) = .40[.22-.72]), increasing age (aOR = .98[.97-.99]), laparoscopic index procedure (aOR = .42[.27-.63]), and hypertension (aOR = .63[.46-.87]) were less likely to have their ostomy reversed. There were no differences in postoperative complication rates after ostomy vs ileostomy reversals. Reversals after 4.6 months were associated with 3.4-times higher odds of complications.
CONCLUSION: Ostomy creation and reversal rates are similar between the veteran and non-veteran populations in the United States. Delays in reversal surgery were associated with worse postoperative outcomes, which underscore the importance of close follow-up for patients with an ostomy after elective colectomy for diverticular disease.},
}
@article {pmid34346490,
year = {2022},
author = {Feakins, R and Torres, J and Borralho-Nunes, P and Burisch, J and Cúrdia Gonçalves, T and De Ridder, L and Driessen, A and Lobatón, T and Menchén, L and Mookhoek, A and Noor, N and Svrcek, M and Villanacci, V and Zidar, N and Tripathi, M},
title = {ECCO Topical Review on Clinicopathological Spectrum and Differential Diagnosis of Inflammatory Bowel Disease.},
journal = {Journal of Crohn's & colitis},
volume = {16},
number = {3},
pages = {343-368},
doi = {10.1093/ecco-jcc/jjab141},
pmid = {34346490},
issn = {1876-4479},
mesh = {*Colitis/diagnosis ; Consensus ; *Crohn Disease/diagnosis ; Diagnosis, Differential ; Humans ; *Inflammatory Bowel Diseases/diagnosis/pathology ; },
abstract = {INTRODUCTION: Many diseases can imitate inflammatory bowel disease [IBD] clinically and pathologically. This review outlines the differential diagnosis of IBD and discusses morphological pointers and ancillary techniques that assist with the distinction between IBD and its mimics.
METHODS: European Crohn's and Colitis Organisation [ECCO] Topical Reviews are the result of an expert consensus. For this review, ECCO announced an open call to its members and formed three working groups [WGs] to study clinical aspects, pathological considerations, and the value of ancillary techniques. All WGs performed a systematic literature search.
RESULTS: Each WG produced a draft text and drew up provisional Current Practice Position [CPP] statements that highlighted the most important conclusions. Discussions and a preliminary voting round took place, with subsequent revision of CPP statements and text and a further meeting to agree on final statements.
CONCLUSIONS: Clinicians and pathologists encounter a wide variety of mimics of IBD, including infection, drug-induced disease, vascular disorders, diverticular disease, diversion proctocolitis, radiation damage, and immune disorders. Reliable distinction requires a multidisciplinary approach.},
}
@article {pmid34336432,
year = {2021},
author = {Vayzband, V and Ashraf, H and Esparragoza, P},
title = {Surgically Managed Perforated Jejunal Diverticulitis.},
journal = {Cureus},
volume = {13},
number = {6},
pages = {e15930},
pmid = {34336432},
issn = {2168-8184},
abstract = {A 71-year-old male with a past medical history significant for chronic constipation presented to the emergency department for acute onset of severe abdominal pain. On presentation, the patient appeared to be in distress, exemplifying signs of peritonitis despite vital signs being grossly benign. CT scan established the diagnosis of a perforated jejunal diverticulitis. Initially, the patient was managed conservatively with IV fluids, antibiotics, and pain control medications. Diagnostic imaging in tandem with the patient's failure to improve incited surgical intervention with a jejunal resection and establishment of a primary anastomosis. This case illustrates additional differential diagnoses necessary for consideration in an elderly patient presenting with an acute abdomen.},
}
@article {pmid34336351,
year = {2021},
author = {Krischak, MK and Ord, JR and Connor, AA and Barbas, AS},
title = {Spontaneous Ureterocolic Fistula between Nonfunctioning Kidney Transplant Ureter and Colon in Setting of Diverticulitis.},
journal = {Case reports in transplantation},
volume = {2021},
number = {},
pages = {5572067},
pmid = {34336351},
issn = {2090-6943},
abstract = {Ureterocolic fistula is a rare condition that most commonly occurs in the setting of diverticular disease. The development of a ureterocolic fistula following kidney transplantation is even rarer, with no prior cases in the literature to our knowledge. We describe the case of a patient with three prior failed kidney transplants who developed a fistula between the sigmoid colon and nonfunctioning renal transplant ureter in the setting of diverticulitis.},
}
@article {pmid34312817,
year = {2022},
author = {Gallo, G and Picciariello, A and Di Tanna, GL and Santoro, GA and Perinotti, R and , and Grossi, U},
title = {E-consensus on telemedicine in colorectal surgery: a RAND/UCLA-modified study.},
journal = {Updates in surgery},
volume = {74},
number = {1},
pages = {163-170},
pmid = {34312817},
issn = {2038-3312},
mesh = {Adult ; *COVID-19 ; *Colorectal Surgery ; Consensus ; Humans ; Male ; SARS-CoV-2 ; *Telemedicine ; },
abstract = {Coronavirus disease 2019 (COVID-19) is revolutionizing healthcare delivery. The aim of the study was to reach consensus among experts on the possible applications of telemedicine in colorectal surgery. A group of 48 clinical practice recommendations (CPRs) was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Colorectal Surgery Italian Working Group included 54 colorectal surgeons affiliated to the Italian Society of Colo-Rectal Surgery (SICCR) who were involved in the evaluation of the appropriateness of each CPR, based on published RAND/UCLA methodology, in two rounds. Stakeholders' median age was 44.5 (IQR 36-60) years, and 44 (81%) were males. Agreement was obtained on the applicability of telemonitoring and telemedicine for multidisciplinary pre-operative evaluation. The panel voted against the use of telemedicine for a first consultation. 15/48 statements deemed uncertain on round 1 and were re-elaborated and assessed by 51/54 (94%) panelists on round 2. Consensus was achieved in all but one statement concerning the cost of a teleconsultation. There was strong agreement on the usefulness of teleconsultation during follow-up of patients with diverticular disease after an in-person visit. This e-consensus provides the boundaries of telemedicine in colorectal surgery in Italy. Standardization of infrastructures and costs remains to be better elucidated.},
}
@article {pmid34297280,
year = {2022},
author = {Valletta, R and Faccioli, N and Bonatti, M and Foti, G and Lombardo, F and Santi, E and Tagliamonte, M and Ferro, F},
title = {Role of CT colonography in differentiating sigmoid cancer from chronic diverticular disease.},
journal = {Japanese journal of radiology},
volume = {40},
number = {1},
pages = {48-55},
pmid = {34297280},
issn = {1867-108X},
mesh = {*Colonography, Computed Tomographic ; Colonoscopy ; *Colorectal Neoplasms/diagnostic imaging ; *Diverticulum ; Humans ; Sensitivity and Specificity ; *Sigmoid Neoplasms ; },
abstract = {PURPOSE: To evaluate the accuracy of computed tomography colonography (CTC) in differentiating chronic diverticular disease from colorectal cancer (CRC), using morphological and textural parameters.
MATERIALS AND METHODS: We included 95 consecutive patients with histologically proven chronic diverticular disease (n = 53) or CRC (n = 42) who underwent CTC. One radiologist, unaware of histological findings, evaluated CTC studies for the presence of potential discriminators including: maximum thickness, involved segment length, shouldering phenomenon, growth pattern, diverticula, fascia thickening, fat tissue edema, loco-regional lymph nodes, mucosal pattern. Another radiologist performed volumetric texture analysis on the involved segment.
RESULTS: Several qualitative imaging parameters resulted to significantly correlated with colorectal cancer, including absence of diverticula in the affected segment, straightened growth pattern and shouldering phenomenon. A maximum wall thickness/involved segment length ratio < 0.1 had 98% specificity and 47% sensitivity in identifying diverticular disease. Regarding first-order texture analysis parameters, kurtosis resulted to be significantly different between the two groups.
CONCLUSIONS: Absence of diverticula, straightened growth pattern and shouldering phenomenon are significantly associated with CRC (71-91% sensitivity; 82-91%).},
}
@article {pmid34277166,
year = {2021},
author = {Pierre, K and Gomez, NF and Bing, S and Garcia, CE and Dalton, BG},
title = {Benign Multicystic Peritoneal Mesothelioma Presenting as a Colonic Mass.},
journal = {Cureus},
volume = {13},
number = {6},
pages = {e15540},
pmid = {34277166},
issn = {2168-8184},
abstract = {Benign multicystic peritoneal mesothelioma (BMPM) is a rare neoplasm of the abdominal mesothelium (i.e., peritoneum, mesentery, and omentum). We present the case of a 74-year-old male who presented with a right paracolic gutter fluid collection and cystic mass. The patient underwent diagnostic laparoscopy with resection of the mass. The final pathology revealed BMPM. The pathogenesis may have been related to longstanding diverticular disease, which could prove to be an underrecognized risk factor for the development of BMPM. Therefore, this case suggests a broadened differential diagnosis to include BMPM in specific cases of pre-operatively diagnosed colonic masses. The patient is disease-free 11 months post-operatively.},
}
@article {pmid34271946,
year = {2021},
author = {Askani, E and Rospleszcz, S and Rothenbacher, T and Wawro, N and Messmann, H and De Cecco, CN and von Krüchten, R and Kulka, C and Kiefer, LS and Rathmann, W and Peters, A and Schlett, CL and Bamberg, F and Linseisen, J and Storz, C},
title = {Dietary habits and the presence and degree of asymptomatic diverticular disease by magnetic resonance imaging in a Western population: a population-based cohort study.},
journal = {Nutrition & metabolism},
volume = {18},
number = {1},
pages = {73},
pmid = {34271946},
issn = {1743-7075},
abstract = {BACKGROUND: Despite the worldwide burden of diverticular disease, the connections between diverticular disease and dietary habits remain poorly understood, particularly in an asymptomatic representative sample. We investigated the association between asymptomatic diverticular disease as assessed by magnetic resonance imaging (MRI) and dietary habits in a Western study cohort.
METHODS: Participants from a cross-sectional sample of a population-based cohort study underwent whole-body 3T-MRI including an isotropic VIBE-Dixon sequence. The presence and extent of diverticular disease was assessed in blinded fashion. Habitual dietary intake was recorded using a blended approach, applying 24-h food lists and a food-frequency questionnaire. Traditional cardiometabolic risk factors were obtained by interviews and medical examination. Univariate and multivariate associations were calculated.
RESULTS: A total of 308 subjects were included in this analysis (56% male, 56.4 ± 9.1 years). 39.9% had any form of diverticular disease and 15.3% had advanced asymptomatic diverticular disease. After adjustment for age, sex and total energy intake a higher intake of fiber and vegetables was associated with a lower odds for asymptomatic diverticular disease (fiber: OR 0.68 95% CI [0.48, 0.95]; vegetables: OR 0.72 95% CI [0.53, 0.97]) and an increased intake of meat was associated with an approximately two-fold higher odds for advanced asymptomatic diverticular disease (OR 1.84 95% CI [1.13, 2.99]). However, after additional adjustment for body-mass-index (BMI), alcohol consumption, smoking behavior and physical activity only a high fiber and vegetables intake remained significantly associated with lower odds of asymptomatic diverticular disease.
CONCLUSION: Our results indicate that a high-fiber diet and increased intake of vegetables is associated with lower odds of having asymptomatic diverticular disease, independent of age, sex, total energy intake, BMI and other life-style factors.},
}
@article {pmid34225052,
year = {2021},
author = {Kline, BP and Yochum, GS and Brinton, DL and Schieffer, KM and Weaver, T and Harris, L and Deiling, S and Berg, AS and Koltun, WA},
title = {COLQ and ARHGAP15 are Associated with Diverticular Disease and are Expressed in the Colon.},
journal = {The Journal of surgical research},
volume = {267},
number = {},
pages = {397-403},
doi = {10.1016/j.jss.2021.05.043},
pmid = {34225052},
issn = {1095-8673},
mesh = {*Acetylcholinesterase/biosynthesis/genetics ; Collagen ; Colon/metabolism/pathology ; *Diverticular Diseases/genetics/metabolism/pathology ; *Diverticulitis/genetics/metabolism/pathology ; *GTPase-Activating Proteins/biosynthesis/genetics ; Humans ; *Muscle Proteins/biosynthesis/genetics ; Myenteric Plexus/metabolism/pathology ; Polymorphism, Single Nucleotide ; },
abstract = {BACKGROUND: Diverticular disease is a common but poorly understood disease of the gastrointestinal tract. Recent studies have identified several single nucleotide polymorphisms (SNPs) that are associated with diverticular disease.
MATERIALS AND METHODS: The genotypes of three SNPs (rs4662344 in ARHGAP15, rs7609897 in COLQ, and rs67153654 in FAM155A) were identified by Taqman assay in 204 patients with diverticular disease. Clinical characteristics were obtained from the medical record to study association with genotype. To evaluate gene expression in colon tissue, qPCR was performed on 24 patients with diverticulitis, and COLQ was localized using immunohistochemistry.
RESULTS: The ARHGAP15 and COLQ SNPs were significantly associated with both diverticular disease and specifically diverticulitis, while the FAM155A was not associated with either. No association was found with clinical disease characteristics. Heterozygous genotypes at the ARHGAP15 SNP was associated with lower ARHGAP15 expression in colon tissues. COLQ protein localized to the myenteric plexus in the colon.
CONCLUSIONS: This study confirmed association of the ARHGAP15 and COLQ SNPs with diverticular disease in our patients but could not confirm FAM155A SNP association. Neither of these SNPs appeared to associate with more severe disease, but genotype at the ARHGAP15 SNP did impact expression of ARHGAP15 in the colon. Additionally, this study is the first to localize COLQ in the colon. Its presence in the myenteric nervous system suggests COLQ SNP variants may contribute to diverticular disease by altering motility.},
}
@article {pmid34191049,
year = {2021},
author = {Germer, CT},
title = {[Diverticular disease].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {8},
pages = {681-682},
pmid = {34191049},
issn = {1433-0385},
mesh = {*Diverticular Diseases ; *Diverticulitis, Colonic/diagnosis/surgery ; Humans ; },
}
@article {pmid34139333,
year = {2022},
author = {Yuan, S and Larsson, SC},
title = {Genetically Predicted Adiposity, Diabetes, and Lifestyle Factors in Relation to Diverticular Disease.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {20},
number = {5},
pages = {1077-1084},
doi = {10.1016/j.cgh.2021.06.013},
pmid = {34139333},
issn = {1542-7714},
mesh = {Adiposity/genetics ; Coffee/adverse effects ; *Diabetes Mellitus, Type 2/epidemiology/genetics ; *Diverticular Diseases ; Genetic Predisposition to Disease ; Genome-Wide Association Study ; Humans ; Life Style ; Mendelian Randomization Analysis ; Obesity/epidemiology/genetics ; Polymorphism, Single Nucleotide ; Risk Factors ; },
abstract = {BACKGROUND & AIMS: Adiposity, type 2 diabetes, alcohol and coffee consumption, and smoking have been examined in relation to diverticular disease in observational studies. We conducted a Mendelian randomization study to assess the causality of these associations.
METHODS: Independent genetic instruments associated with the studied exposures at genome-wide significance were obtained from published genome-wide association studies. Summary-level data for the exposure-associated single nucleotide polymorphisms with diverticular disease were available in the FinnGen consortium (10,978 cases and 149,001 noncases) and the UK Biobank study (12,662 cases and 348,532 noncases).
RESULTS: Higher genetically predicted body mass index and genetic liability to type 2 diabetes and smoking initiation were associated with an increased risk of diverticular disease in meta-analyses of results from the two studies. The combined odds ratio of diverticular disease was 1.23 (95% confidence interval [CI], 1.14-1.33; P < .001) for a 1-standard deviation (~4.8 kg/m[2]) increase in body mass index, 1.04 (95% CI, 1.01-1.07; P = .007) for a 1-unit increase in log-transformed odds ratio of type 2 diabetes, and 1.21 (95% CI, 1.12-1.30; P < .001) for a 1-standard deviation increase in prevalence of smoking initiation. Coffee consumption was not associated with diverticular disease, whereas the association for alcohol consumption largely differed between the 2 studies.
CONCLUSIONS: This study strengthens the causal associations of higher body mass index, type 2 diabetes, and smoking with an increased risk of diverticular disease. Coffee consumption is not associated with diverticular disease. Whether alcohol consumption affects the risk of diverticular disease needs further investigation.},
}
@article {pmid34137686,
year = {2021},
author = {Aiyegbeni, B and Jonnalagadda, S and Creedon, L and Teibe, A},
title = {Rare Cause of Left Upper Abdominal Pain.},
journal = {Prague medical report},
volume = {122},
number = {2},
pages = {106-111},
doi = {10.14712/23362936.2021.11},
pmid = {34137686},
issn = {1214-6994},
mesh = {Abdominal Pain/diagnosis/etiology ; Aged ; *Diabetes Mellitus, Type 2 ; *Diverticulitis/complications/diagnosis ; *Diverticulum/complications/diagnosis ; Humans ; *Jejunal Diseases ; Male ; },
abstract = {Inflamed diverticular disease of the small bowel is an uncommon cause of acute abdominal pain. Despite its low prevalence rate (0.3-2%), it is associated with a high mortality rate between 20-25% (Fisher and Fortin, 1977; Ferreira-Aparicio et al., 2012). This is due to complications including perforation, bleeding, and obstruction. This case report presents the diagnosis and management of Mr. X, a 70-year-old male with jejunal diverticulitis and a duodenal diverticulum. Mr. X has a background of type 2 diabetes mellitus and sigmoid diverticulosis, he presented with a three-day history of left upper quadrant pain radiating to the left iliac fossa. He was haemodynamically stable despite his elevated inflammatory markers (C-reactive protein 161 mg/l and neutrophils 13.3×109/l) and computerised tomography (CT) of the abdomen and pelvis showing jejunal diverticulitis and a duodenal diverticulum. Mr. X was successfully treated with intravenous antibiotics and analgesia and a follow up CT scan showed that the jejunal diverticulitis had resolved. Previous operative management of the discussed pathology has been reported, the current report is novel as the diagnosis was made early and the case managed conservatively.},
}
@article {pmid34124181,
year = {2021},
author = {Hovstadius, H and Lundgren, D and Karling, P},
title = {Elevated Faecal Calprotectin in Patients with a Normal Colonoscopy: Does It Matter in Clinical Practice? A Retrospective Observational Study.},
journal = {Inflammatory intestinal diseases},
volume = {6},
number = {2},
pages = {101-108},
pmid = {34124181},
issn = {2296-9365},
abstract = {INTRODUCTION: Faecal calprotectin (FC) is commonly used as a diagnostic tool for patients with gastrointestinal (GI) symptoms. However, there is uncertainty in daily clinical practice how to interpret an elevated FC in patients with a normal colonoscopy. We investigated if patients with a normal colonoscopy but with an elevated FC more often were diagnosed with a GI disease in a 3-year follow-up period.
METHODS: Patients referred for colonoscopy (n = 1,263) to the Umeå University Hospital endoscopy unit between 2007 and 2013 performed a FC test (CALPRO[®]) on the day before bowel preparation. A medical chart review was performed on all patients who had normal findings on their colonoscopy (n = 585, median age 64 years).
RESULTS: Thirty-four percent of the patients (n = 202) with normal colonoscopy had elevated FC (>50 μg/g), and these patients were more frequently diagnosed with upper GI disease during the follow-up period than patients with normal FC levels (9.9 vs. 4.7%; p = 0.015). The upper GI diseases were mainly benign (i.e., gastritis). In a binary logistic regression analysis controlling for age, gender, nonsteroid anti-inflammatory drug use, and proton-pump inhibitor use, there was no difference for a new diagnosis of upper GI disease in the follow-up period (multivariate OR 1.70; 95% CI: 0.77-3.74). There was no difference in a new diagnosis of lower GI disease (6.4 vs. 5.2%; p = 0.545) or cardiovascular disease/death (multivariate OR 1.68; 95% CI: 0.83-3.42) in the follow-up period between patients with elevated versus normal FC levels.
CONCLUSIONS: In patients with a normal colonoscopy, a simultaneously measured increased FC level was not associated with an increased risk for significant GI disease during a follow-up period of 3 years.},
}
@article {pmid34120857,
year = {2021},
author = {Facciorusso, A and Bertini, M and Bertoni, M and Tartaglia, N and Pacilli, M and Pavone, G and Ambrosi, A and Sacco, R},
title = {Efficacy of hemostatic powders in lower gastrointestinal bleeding: Clinical series and literature review.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {53},
number = {10},
pages = {1327-1333},
doi = {10.1016/j.dld.2021.05.026},
pmid = {34120857},
issn = {1878-3562},
mesh = {Aged ; Aged, 80 and over ; Female ; Gastrointestinal Hemorrhage/*drug therapy ; Hemostasis, Endoscopic/*methods ; Hemostatics/*administration & dosage ; Humans ; Lower Gastrointestinal Tract ; Male ; Middle Aged ; Powders/*administration & dosage ; Retrospective Studies ; },
abstract = {BACKGROUND: There is limited evidence on the efficacy of hemostatic powders in the management of lower gastrointestinal bleeding.
AIMS: to revise our series of patients with lower gastrointestinal bleeding treated with hemostatic powders and to provide a pooled estimate of their efficacy based on the current literature.
METHODS: Sixty-five patients underwent topical endoscopic application of hemostatic powder between 2016 and 2020. The primary endpoint was treatment success, with 7- and 30-day rebleeding rate, adverse events and mortality as secondary outcomes. Literature review was based on computerized bibliographic search on the main databases through December 2020. Pooled effects were calculated using a random-effects model.
RESULTS: Overall, the powder was applied as monotherapy in 37 patients (56.9%), as combination therapy in 15 patients (23.4%), and as rescue therapy in 13 cases (19.9%). Hemostasis was achieved in 100% of patients. Rebleeding rate at 7- and 30-day was 7.7% and 9.2%, respectively. A total of 10 studies with 259 patients were included in the meta-analysis. Immediate hemostasis was achieved in 96.3% (93.4%-99.2%) patients, whereas pooled 7- and 30-day rebleeding rates were 9.6% (4.5%-14.6%) and 12.9% (7.2%-18.5%), respectively.
CONCLUSION: Novel hemostatic powders represent a user-friendly and effective tool in the management of lower gastrointestinal bleeding.},
}
@article {pmid34116453,
year = {2021},
author = {Rausch, VH and Weinrich, JM and Schön, G and Sabour, L and Özden, C and Kaul, MG and Adam, G and Bannas, P and Henes, FO},
title = {Accuracy of preoperative CT staging of acute colonic diverticulitis using the classification of diverticular disease (CDD) - Is there a beneficial impact of water enema and visceral obesity?.},
journal = {European journal of radiology},
volume = {141},
number = {},
pages = {109813},
doi = {10.1016/j.ejrad.2021.109813},
pmid = {34116453},
issn = {1872-7727},
mesh = {Acute Disease ; Aged ; *Diverticulitis, Colonic/diagnostic imaging ; Enema ; Female ; Humans ; Middle Aged ; *Obesity, Abdominal ; Retrospective Studies ; Tomography, X-Ray Computed ; Water ; },
abstract = {PURPOSE: We evaluated the accuracy of preoperative CT in staging colonic diverticulitis (ACD) by using the classification of diverticular disease (CDD) and investigated the diagnostic impact of water enema (WE) and visceral obesity.
METHODS: In this retrospective study, the radiological and hospital information system was searched for patients who underwent CT for clinically suspected ACD prior to surgery between 2009 and 2019. From the initial population (n = 164), we included 155 patients (94.5 %) (85 women; mean age: 58 ± 13 years) matching the following inclusion criteria: i.) clinically suspected ACD, ii.) i.v. contrast-enhanced CT, iii.) surgery for ACD within 1 week after CT, iv.) histopathological report that proved ACD. The remaining 9 patients (5.5 %) were excluded because histopathological reports were lacking (n = 3) or CT was performed without intravenous contrast agent (n = 6). WE (+ butylscopolamine i.v.) was performed in 93 patients (group A, 60 %). 62 patients (group B, 40 %) had no WE. Visceral-to-subcutaneous fat ratio (V/S) was determined for each patient. Two radiologists blinded for final diagnosis independently staged ACD according to CDD and assessed prevalence and confidence ratings of ACD-related CT-findings: pericolonic fat stranding, covered- and free-perforation, local and generalized peritonitis, abscess. Interobserver-agreement of CT-findings were assessed and effects of WE and V/S ratio on the diagnostic accuracy of CT with surgical and histopathological findings as reference were determined by calculating a logistic regression model.
RESULTS: CT-staging showed high accuracy (94 %) and excellent interrater-correlation (ICC 0.96) for staging ACD. WE had no positive impact neither on diagnostic accuracy of staging, nor on confidence ratings of ACD-related CT-findings (all p > 0.5). Confidence ratings were significantly higher in examinations without WE for perforation, peritonitis as well as abscesses (all p < 0.5). Confidence ratings for the assessment of local peritonitis improved significantly with higher V/S (p = 0.049). The increase of V/S significantly correlated with the probability for correct CDD staging of ACD in CT (p = 0.023).
CONCLUSION: Increase of visceral obesity significantly improves accuracy of CT in preoperative staging acute colonic diverticulitis. However, independently of the degree of visceral obesity, water enema has no diagnostic benefit and may therefore be omitted. Overall, CT proves high accuracy in preoperative staging ACD using the classification of diverticular disease.
LEVEL OF EVIDENCE: Retrospective study, observational study.},
}
@article {pmid34100113,
year = {2021},
author = {Lock, J and Wiegering, A and Germer, CT},
title = {[Indications for surgical treatment of diverticular disease].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {8},
pages = {694-701},
pmid = {34100113},
issn = {1433-0385},
mesh = {Colon, Sigmoid ; *Diverticular Diseases/surgery ; *Diverticulitis ; *Diverticulitis, Colonic/surgery ; Humans ; Quality of Life ; Recurrence ; },
abstract = {BACKGROUND: The correct medical indications are the fundamental decision process for the surgical treatment and ensuring the quality.
OBJECTIVE: Description of the indications for surgical treatment of the various types of diverticular disease according to the current level of evidence.
MATERIAL AND METHODS: The narrative review is based on current national and international guidelines and a selective literature search.
RESULTS: There are basically three main indications for resection of the sigmoid colon. 1) Prophylactic for avoidance of complications after successful conservative treatment of acute complicated diverticulitis with macroabscess formation and high risk of recurrence (classification of diverticular disease, CDD, type 2b). 2) In patients with persistent symptoms and impaired quality of life resection of the sigmoid colon of various types (CDD types 1-3) can effectively enable a significant improvement in the quality of life and is therefore to be recommended in cases of individually acceptable perioperative risks. 3) Indications for urgent resection of the sigmoid colon are present for free perforation or failure of conservative treatment.
CONCLUSION: The indications for surgery should be defined by the type of diverticular disease, the aim of surgical treatment, the evaluation of the efficacy of surgical treatment in comparison to conservative treatment and an individual appraisal of the risks.},
}
@article {pmid34059533,
year = {2021},
author = {Khan, ZU and Ghuman, N and Mak, K},
title = {Rare case of diabetic neuropathic cachexia along with diabetic amyotrophy.},
journal = {BMJ case reports},
volume = {14},
number = {5},
pages = {},
pmid = {34059533},
issn = {1757-790X},
mesh = {Aged ; Cachexia/etiology ; *Diabetes Mellitus, Type 2/complications ; *Diabetic Neuropathies/complications ; Glycated Hemoglobin ; Humans ; Male ; *Wounds, Gunshot ; },
abstract = {A 65-year-old patient with background of alcohol excess and previous gunshot wounds was admitted with significant weight loss, leg cramps, dizziness and lethargy for the last 3 months. He was diagnosed with type 2 diabetes mellitus in July 2020 and was started on Metformin and Gliclazide by his in July; he was later commenced on alogliptin and empaglaflozin by diabetes specialist nurse in early August. He also had generalised muscle wasting, dorsal guttering in both hands and was cachectic when he presented to hospital. His haemoglobin A1c (HbA1c) was 124 mmol/mol in July 2020 and was 63 mmol/mol in September 2020. The patient had negative autoimmune and TB screen. CT abdomen/pelvis and CT lumbosacral spine that showed mild diverticular disease and bilateral L5 spondylolysis with L5-S1 spondylotic changes. Electrophysiological studies confirmed sensory motor peripheral neuropathy. Patient was diagnosed with diabetic neuropathic cachexia secondary to poorly controlled diabetes and was commenced on 30 units two times per day of NovoMix 30 insulin; this was adjusted to 24 units two times per day in endocrine clinic 3 months later, after gaining 10 kg in weight. Good glycaemic control is key to the management of such cases and, therefore, we recommend early referral to diabetes specialist input for consideration of insulin therapy.},
}
@article {pmid34056819,
year = {2021},
author = {Trejo-Avila, M and Vergara-Fernández, O},
title = {Open versus laparoscopic surgery for the treatment of diverticular colovesical fistulas: A systematic review and meta-analysis.},
journal = {ANZ journal of surgery},
volume = {91},
number = {9},
pages = {E570-E577},
doi = {10.1111/ans.16985},
pmid = {34056819},
issn = {1445-2197},
mesh = {Colectomy ; Humans ; *Intestinal Fistula/etiology/surgery ; *Laparoscopy ; Length of Stay ; Operative Time ; Postoperative Complications/epidemiology ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: The aim of this study was to analyze the evidence regarding open versus laparoscopic surgery for the treatment of diverticular colovesical fistula (CVF) in terms of perioperative outcomes.
METHODS: A systematic review was performed using PubMed, Cochrane, Google Scholar, and Web of Science databases for studies comparing laparoscopic versus open surgery for CVF. We pooled odds ratios (OR) and mean differences (MD) using random or fixed effects models.
RESULTS: Five non-randomized studies with 227 patients met the inclusion criteria. All were retrospective studies, published between 2014 and 2020. For laparoscopic surgery, the pooled rate for conversion to laparotomy was 36%. Laparoscopic and open procedures required similar operative time (MD: -11.62; 95% confidence interval [CI]: -51.41 to 28.16). No difference was found in terms of stoma rates between laparoscopic and open surgery (OR: 1.12; 95% CI 0.44-2.86). Overall, the rate of total postoperative complications was lower in the laparoscopic group (OR: 0.55; 95% CI: 0.30-0.99). The pooled analysis showed equivalent rates of anastomotic leaks (OR: 0.61; 95% CI 0.15-2.45), surgical site infections (OR: 0.44; 95% CI 0.19-1.01), and mortality (OR: 0.18; 95% CI 0.03-1.15). The length of stay was significantly reduced with laparoscopic surgery (MD: -2.89; 95% CI -4.20 to -1.58).
CONCLUSION: Among patients with CVF, the laparoscopic approach appears to have shorter hospital length of stay, with no differences in anastomotic leaks, surgical site infections, stoma rates, and mortality, when compared with open surgery.},
}
@article {pmid34053611,
year = {2021},
author = {Hines, JJ and Mikhitarian, MA and Patel, R and Choy, A},
title = {Spectrum and Relevance of Incidental Bowel Findings on Computed Tomography.},
journal = {Radiologic clinics of North America},
volume = {59},
number = {4},
pages = {647-660},
doi = {10.1016/j.rcl.2021.03.012},
pmid = {34053611},
issn = {1557-8275},
mesh = {Humans ; *Incidental Findings ; Intestinal Diseases/*diagnostic imaging ; Intestines/diagnostic imaging ; Tomography, X-Ray Computed/*methods ; },
abstract = {A wide spectrum of incidental bowel findings can be seen on CT, including but not limited to, pneumatosis intestinalis, diverticular disease, non-obstructive bowel dilatation, transient small bowel intussusception, and submucosal fat. Radiologists should be aware that such findings are almost always benign and of little clinical significance in the absence of associated symptoms. Conversely, vigilance must be maintained when evaluating the bowel, because malignant neoplasms occasionally come to clinical attention as incidental imaging findings. When suspicious incidental bowel wall thickening is detected, the radiologist can alert the clinical team to the finding prior to the patient becoming symptomatic, potentially leading to definitive management at an early, more curable stage.},
}
@article {pmid34046119,
year = {2021},
author = {Guediche, A and Amor, SB and Mnari, W and Abdelaali, M and Farhat, W and Ammar, H and Said, MA and Zakhama, M and Bouhlel, W and Sellem, OK and Chaabene, NB and Golli, M and Ali, AB and Safer, L},
title = {Diverticular disease of the small bowel: a rare cause of the duodenojejunal flexure obstruction (a case report).},
journal = {The Pan African medical journal},
volume = {38},
number = {},
pages = {213},
pmid = {34046119},
issn = {1937-8688},
mesh = {Diverticular Diseases/*complications ; Duodenal Obstruction/*diagnosis/etiology ; Female ; Humans ; Intestine, Small/pathology ; Jejunal Diseases/*diagnosis/etiology ; Middle Aged ; },
abstract = {The small bowel is the least common site for diverticula in the entire gastrointestinal tract. Chronic upper intestinal obstruction due to diverticula is very rare. We report a case of multiple small bowel diverticula causing mechanical obstruction of the duodenojejunal flexure.},
}
@article {pmid34031729,
year = {2021},
author = {Posabella, A and Steinemann, DC and Droeser, RA and Varathan, N and Ayçiçek, SG and Nocera, F and von Flüe, M and Rotigliano, N and Füglistaler, I},
title = {Predictive model estimating the decrease of postoperative gastrointestinal quality of life index (GIQLI) in patients after elective laparoscopic sigmoid resection for diverticular disease.},
journal = {Langenbeck's archives of surgery},
volume = {406},
number = {5},
pages = {1571-1580},
pmid = {34031729},
issn = {1435-2451},
mesh = {Aged ; Colon, Sigmoid/surgery ; *Diverticular Diseases/surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Quality of Life ; Retrospective Studies ; },
abstract = {BACKGROUND: Growing consideration in quality of life (QoL) has changed the therapeutic strategy in patients suffering from diverticular disease. Patients' well-being plays a crucial role in the decision-making process. However, there is a paucity of studies investigating patients' or surgery-related factors influencing the postoperative gastrointestinal function. The aim of this study was to investigate in a predictive model patients or surgical variables that allow better estimation of the postoperative gastrointestinal QoL.
METHODS: This observational study retrospectively analyzed patients undergoing elective laparoscopic sigmoidectomy for diverticulitis between 2004 and 2017. The one-time postoperative QoL was assessed with the gastrointestinal quality of life index (GIQLI) in 2019. A linear regression model with stepwise selection has been applied to all patients and surgery-related variables.
RESULTS: Two hundred seventy-two patients with a mean age of 62.30 ± 9.74 years showed a mean GIQLI of 116.39±18.25 at a mean follow-up time of 90.4±33.65 months. Women (n=168) reported a lower GIQLI compared to male (n=104; 112.85±18.79 vs 122.11±15.81, p<0.001). Patients with pre-operative cardiovascular disease (n=17) had a worse GIQLI (106.65 ±22.58 vs 117.08±17.66, p=0.010). Finally, patients operated less than 5 years ago (n=63) showed a worse GIQLI compared to patients operated more than 5 years ago (n=209; 111.98±19.65 vs 117.71±17.63, p=0.014).
CONCLUSIONS: Female gender and the presence of pre-operative cardiovascular disease are predictive for a decreased postoperative gastrointestinal QoL. Furthermore, patients' estimation of gastrointestinal functioning seems to improve up to 5 years after surgery.},
}
@article {pmid34014356,
year = {2021},
author = {Muse, A and Wusterbarth, E and Thompson, S and Thompson, E and Saeed, S and Deeyor, S and Lee, J and Krall, E and Hamidi, M and Nfonsam, V},
title = {The role of preoperative anemia in patients undergoing colectomy for diverticular disease: does surgical urgency matter?.},
journal = {International journal of colorectal disease},
volume = {36},
number = {11},
pages = {2463-2470},
pmid = {34014356},
issn = {1432-1262},
mesh = {Adult ; Anastomotic Leak ; *Anemia/complications ; Colectomy/adverse effects ; *Diverticulitis ; Elective Surgical Procedures ; Humans ; Postoperative Complications/etiology ; Retrospective Studies ; Treatment Outcome ; },
abstract = {PURPOSE: Surgery especially in the emergent setting carries higher rates of morbidity and mortality. The aim of our study was to evaluate the impact of preoperative anemia on outcomes for patients undergoing colectomy for acute diverticulitis in both elective and emergent settings.
METHODS: We performed a 4-year analysis of the ACS-NSQIP and included adult patients with acute diverticulitis who underwent colectomy. Patients were stratified into two groups based on preoperative hemoglobin levels, preop anemia and no-preop Anemia. Outcome measures were 30-day complications, anastomotic leaks, readmissions, mortality, and intra-/postoperative blood transfusion. We also performed a sub-analysis for patients who underwent emergent colectomy.
RESULTS: Six thousand nine hundred sixty-three patients were included in the analysis, of which 37% (n = 2571) had preoperative anemia. Patients in the anemia group were more likely to have higher ASA class and receive blood 72-h preoperatively (5.4% vs. 0.2%, p < 0.01). Patients in the anemia group had higher rates of complications (35.4% vs. 24.7%, p < 0.01), unplanned readmission (9.2% vs 7.2%, p < 0.01), mortality (4.5% vs. 1.8%, p < 0.01), and intra/postoperative transfusion requirement (21% vs. 3.8%, p < 0.01) with no difference in rate of anastomotic leaks. On sub-analysis, 39% of the cases were completed in an emergent setting, 85% of which were due to perforation. Patients with preoperative anemia that underwent colectomy in an emergent setting had higher odds of intra/postoperative blood transfusion (OR 51.6, CI 3.87-6.87, p < 0.01) with no statistical significance in 30-day complications (p = 0.51).
CONCLUSION: Preoperative anemia in patients undergoing colectomy for acute diverticular disease is associated with higher odds complications, readmissions, and intra/postoperative blood transfusions.},
}
@article {pmid33996526,
year = {2021},
author = {Ali Alzahrani, H},
title = {A Case of Self-Induced Hydrostatic Colonic Perforation.},
journal = {Qatar medical journal},
volume = {2021},
number = {1},
pages = {14},
pmid = {33996526},
issn = {0253-8253},
abstract = {INTRODUCTION: Constipation is a common complaint. The elderly are five times more prone to constipation than young people because of the effects of medication, immobility, and a blunted urge to defecate. Many of these patients are demented, have cognitive deficits, or suffer from a psychiatric disorder. Colonic perforation caused by hydrostatic pressure is rare, and this typically occurs during fluoroscopic studies resulting when there is excessive intraluminal colonic pressure. Self-induced colonic perforation is even rarer.
CASE REPORT: We report the case of a 95-year-old man who presented to the emergency department with an acute surgical abdomen and symptoms of sepsis. He had a history of longstanding constipation. He gave a history of frequent insertion of a rubber hose into his anal canal to relieve his constipation while rinsing his anus after defecation. After resuscitation, an emergency operation was performed, and sigmoid colon perforation was found in addition to pre-existing diverticular disease. Hartmann's procedure was performed after abdominal washout. Unfortunately, the patient died of multi-organ failure two days after surgery.
CONCLUSION: Self-induced hydrostatic colonic perforation is rare. The consequence is fatal, especially in the elderly or in cases of delayed presentation.},
}
@article {pmid33965198,
year = {2021},
author = {Jayaprakasam, VS and Paroder, V and Schöder, H},
title = {Variants and Pitfalls in PET/CT Imaging of Gastrointestinal Cancers.},
journal = {Seminars in nuclear medicine},
volume = {51},
number = {5},
pages = {485-501},
pmid = {33965198},
issn = {1558-4623},
support = {P30 CA008748/CA/NCI NIH HHS/United States ; },
mesh = {Fluorodeoxyglucose F18 ; *Gastrointestinal Neoplasms ; Humans ; Male ; *Positron Emission Tomography Computed Tomography ; Positron-Emission Tomography ; Radiopharmaceuticals ; Tissue Distribution ; Tomography, X-Ray Computed ; },
abstract = {In the past two decades, PET/CT has become an essential modality in oncology increasingly used in the management of gastrointestinal (GI) cancers. Most PET/CT tracers used in clinical practice show some degree of GI uptake. This uptake is quite variable and knowledge of common patterns of biodistribution of various radiotracers is helpful in clinical practice. [18]F-Fluoro-Deoxy-Glucose (FDG) is the most commonly used radiotracer and has quite a variable uptake within the bowel. [68]Ga-Prostate specific membrane antigen (PSMA) shows intense uptake within the proximal small bowel loops. [11]C-methyl-L-methionine (MET) shows high accumulation within the bowels, which makes it difficult to assess bowel or pelvic diseases. One must also be aware of technical artifacts causing difficulties in interpretations, such as high attenuation oral contrast material within the bowel lumen or misregistration artifact due to patient movements. It is imperative to know the common variants and benign diseases that can mimic malignant pathologies. Intense FDG uptake within the esophagus and stomach may be a normal variant or may be associated with benign conditions such as esophagitis, reflux disease, or gastritis. Metformin can cause diffuse intense uptake throughout the bowel loops. Intense physiologic uptake can also be seen within the anal canal. Segmental bowel uptake can be seen in inflammatory bowel disease, radiation, or medication induced enteritis/colitis or infection. Diagnosis of appendicitis or diverticular disease requires CT correlation, as normal appendix or diverticulum can show intense uptake. Certain malignant pathologies are known to have only low FDG uptake, such as early-stage esophageal adenocarcinoma, mucinous tumors, indolent lymphomas, and multicystic mesotheliomas. Response assessment, particularly in the neoadjuvant setting, can be limited by post-treatment inflammatory changes. Post-operative complications such as abscess or fistula formation can also show intense uptake and may obscure underlying malignant pathology. In the absence of clinical suspicion or rising tumor marker, the role of FDG PET/CT in routine surveillance of patients with GI malignancy is not clear.},
}
@article {pmid33960587,
year = {2022},
author = {Giang, J and Lan, X and Crichton, M and Marx, W and Marshall, S},
title = {Efficacy and safety of biophenol-rich nutraceuticals in adults with inflammatory gastrointestinal diseases or irritable bowel syndrome: A systematic literature review and meta-analysis.},
journal = {Nutrition & dietetics: the journal of the Dietitians Association of Australia},
volume = {79},
number = {1},
pages = {76-93},
pmid = {33960587},
issn = {1747-0080},
mesh = {Adult ; *Colitis, Ulcerative/therapy ; *Crohn Disease/therapy ; Dietary Supplements ; Humans ; *Irritable Bowel Syndrome/drug therapy ; Quality of Life ; },
abstract = {AIM: Biophenol-rich nutraceuticals may be an adjuvant treatment for Crohn's disease (CD), ulcerative colitis (UC), symptomatic uncomplicated diverticular disease (SUDD), and irritable bowel syndrome (IBS). This systematic review and meta-analysis aimed to determine the efficacy and safety of biophenol-rich nutraceutical supplementation on CD, UC, SUDD, and IBS on gastrointestinal symptoms (GIS), quality of life (QoL), inflammatory and oxidative stress biomarkers, and adverse events compared to usual care or placebo.
METHODS: PubMed, Embase, CINAHL, and CENTRAL were searched for randomised controlled trials until 27 April 2020. Outcomes were GIS, inflammatory and oxidative stress markers, QoL, and adverse events. The Cochrane Risk of Bias tool and GRADE were used to appraise studies. Data were pooled using Revman.
RESULTS: Twenty-three trials in CD, UC, and IBS patients were included. Compared with placebo, biophenol-rich nutraceuticals improved GIS (SMD: 0.43 [95%CI: 0.22, 0.63]; GRADE: very low) in UC, CD, and IBS participants. In UC and CD participants, biophenol-rich nutraceuticals improved CRP by 1.6 mg/L [95%CI:0.08, 3.11; GRADE: low], malondialdehyde by 1 mmol/L [95%CI:0.55, 1.38; GRADE: low]; but only resveratrol improved QoL (SMD: -0.84 [95%CI: -1.24, -0.44; GRADE: high). Resveratrol (for UC and CD participants) and peppermint oil (for IBS participants) had greater certainty in the evidence for improving GIS and QoL (GRADE: moderate to high). There was no effect on adverse events (P > .05).
CONCLUSIONS: Biophenol-rich nutraceuticals may be an effective and safe adjuvant treatment for the management of CD, UC, and IBS; with higher certainty of evidence for resveratrol for UC and CD and peppermint oil for IBS.},
}
@article {pmid33944850,
year = {2021},
author = {Mascolo, AP and Marrama, F and Mercuri, NB and Placidi, F},
title = {Efficacy and safety of lacosamide in the treatment of status epilepticus in a patient with comorbidities.},
journal = {Acta bio-medica : Atenei Parmensis},
volume = {92},
number = {S1},
pages = {e2021090},
pmid = {33944850},
issn = {2531-6745},
mesh = {Aged ; Aged, 80 and over ; Anticonvulsants/adverse effects ; Comorbidity ; Female ; Humans ; Lacosamide/therapeutic use ; Levetiracetam/therapeutic use ; *Status Epilepticus/drug therapy ; },
abstract = {Efficacy, safety and tolerability of lacosamide in the treatment of status epilepticus are well described. However, other evidence of its pharmacologic profile in elderly patients with other comorbidities seems warranted. We describe the case of an 80 year-old woman with an history of arterial hypertension, ischemic cardiomyopathy, COPD, CKD, previous laryngeal cancer, a stoma positioning for diverticular disease and previous surgery for a left frontal meningioma. Since then, the patient developed focal epilepsy and she was on levetiracetam and valproic acid therapy. The patient was admitted to our department for a focal status epilepticus characterized by non-fluent aphasia and right facio-brachial clonic movements. She also presented with aspiration pneumonia and started intravenous antibiotic treatment. After failure of a first-line antiepileptic drug, lacosamide intravenous treatment was started, with complete reversal of the clinical picture. EEG then showed focal slow waves mixed to interictal epileptiform discharges over the left fronto-temporal regions. The patient was then discharged home with an oral lacosamide treatment and at 3 months she was seizure-free. Our case report confirms the efficacy of lacosamide in status epilepticus, highlighting its safety and tolerability in an elderly and fragile patient with multiple comorbidities and drug therapy.},
}
@article {pmid33937941,
year = {2021},
author = {Loosen, SH and Paffenholz, P and Luedde, T and Kostev, K and Roderburg, C},
title = {Diverticular disease is associated with an increased incidence rate of depression and anxiety disorders.},
journal = {International journal of colorectal disease},
volume = {36},
number = {11},
pages = {2437-2443},
pmid = {33937941},
issn = {1432-1262},
support = {CRC1380/A01//Deutsche Forschungsgemeinschaft/ ; 771083//H2020 European Research Council/ ; 110043/WT_/Wellcome Trust/United Kingdom ; 110043/WT_/Wellcome Trust/United Kingdom ; },
mesh = {Anxiety Disorders/epidemiology ; *Depression/epidemiology ; *Diverticular Diseases ; Female ; Humans ; Incidence ; Male ; Proportional Hazards Models ; },
abstract = {BACKGROUND: Diverticular disease represents a gastrointestinal disorder of high prevalence in developed countries that often leads to psychological distress. Here, we aimed at evaluating a potential association between diverticular disease and depression or anxiety disorders in outpatients in Germany.
METHODS: Using the Disease Analyzer database featuring data of over 8 million patients treated in German general practices, we identified 61.556 patients with diverticular disease (ICD-10: K57) who were 1:1 matched by age, sex, index year, and the Charlson Comorbidity Index to 61.556 patients without diverticular disease. The association between diverticular disease and depression or anxiety disorders was evaluated in Cox regression models.
RESULTS: Within 5 years after the initial diagnosis of diverticular disease, 14.0% of patients with and 10.6% of individuals without diverticular disease were diagnosed with depression (HR 1.34, 95%CI 1.29-1.39, p < 0.001). Similarly, the incidence of anxiety disorder was significantly higher in patients with diverticular disease (HR 1.55, 95%CI 1.46-1.64, p < 0.001). Finally, the prescription rate for antidepressant drugs was significantly higher in diverticular disease patients compared to individuals without diverticular disease (9.4% vs. 6.1%, HR 1.56, 95%CI 1.49-1.62, p < 0.001). These associations were confirmed for different age groups and both sexes.
CONCLUSION: Our data provide evidence that diverticular disease is associated with an increased incidence of depression and anxiety disorders. Despite that fact that confounding factors such as deprivation and patient personality have to be taken into account, we suggest that patients with diverticular disease are regularly screened for symptoms of depression and anxiety disorders.},
}
@article {pmid33937291,
year = {2021},
author = {Grillo, F and Campora, M and Cornara, L and Cascini, A and Pigozzi, S and Migliora, P and Sarocchi, F and Mastracci, L},
title = {The Seeds of Doubt: Finding Seeds in Intriguing Places.},
journal = {Frontiers in medicine},
volume = {8},
number = {},
pages = {655113},
pmid = {33937291},
issn = {2296-858X},
abstract = {Introduction: Seeds may be found in gastrointestinal tissue samples, and their multifaceted appearance may be challenging. The aim is to report a rough incidence of pathology samples which show seeds, specify the most frequent sample types and show an iconography of the most commonly identified seeds. Materials and Methods: Between 2017 and 2020, all gastrointestinal pathology cases in which seeds/seed parts were found, were collected and seed type described by referencing a seed image library. Results: Fifty cases with complete seeds/seed parts were collected: 16 colonic resections for colorectal cancer and diverticulosis, 13 appendiceal resections for appendicitis, 1 gastric resection. Fifteen cases were found in polypectomy specimens and 5 cases in colorectal endoscopic biopsies. Most frequent seed types were tomato, kiwi, blueberry, and blackberry seeds. Conclusion: Seeds may be found in up to 4% of specimens; their recognition may be useful to exclude parasitic infections as well as in forensic sciences.},
}
@article {pmid33930589,
year = {2021},
author = {Cocomazzi, F and Carparelli, S and Cubisino, R and Giuliani, AP and Bossa, F and Biscaglia, G and Parente, P and Andriulli, A and Perri, F and Gentile, M},
title = {Inverted colonic diverticulum (ICD): report of two cases and literature review of a not that unusual endoscopic challenge.},
journal = {Clinics and research in hepatology and gastroenterology},
volume = {45},
number = {5},
pages = {101711},
doi = {10.1016/j.clinre.2021.101711},
pmid = {33930589},
issn = {2210-741X},
mesh = {*Diverticulum, Colon/diagnosis/therapy ; Endoscopy ; Humans ; },
abstract = {Inverted colonic diverticulum (ICD) is a rare intraluminal lesion occurring in about 0.7-1.7% of people, often endoscopically indistinguishable from polyps. Some unspecific endoscopic features may assist to distinguish polypoid ICD from true polyps. This differentiation bears relevance for the therapeutic approach, as colonic polyps require snare polypectomy, a practice which may be associated with colonic perforation in case of true ICD. The endoscopist, therefore, should be aware of the likelihood of detecting these lesions during colonoscopy. A close inspection and a gentle probing could assist in a correct diagnosis and avoid risky procedures such as biopsy or polypectomy. Rarely, a neoplasm arising over an ICD and its treatment has been described. We reported two cases, one of which with dysplasia, and their treatment, and reviewed all the ICD endoscopic cases so far reported in the literature, remarking the possibility of finding pedunculated ICDs or neoplasm arising over an ICD.},
}
@article {pmid33919818,
year = {2021},
author = {Piccioni, A and Franza, L and Brigida, M and Zanza, C and Torelli, E and Petrucci, M and Nicolò, R and Covino, M and Candelli, M and Saviano, A and Ojetti, V and Franceschi, F},
title = {Gut Microbiota and Acute Diverticulitis: Role of Probiotics in Management of This Delicate Pathophysiological Balance.},
journal = {Journal of personalized medicine},
volume = {11},
number = {4},
pages = {},
pmid = {33919818},
issn = {2075-4426},
abstract = {How can the knowledge of probiotics and their mechanisms of action be translated into clinical practice when treating patients with diverticular disease and acute diverticulitis? Changes in microbiota composition have been observed in patients who were developing acute diverticulitis, with a reduction of taxa with anti-inflammatory activity, such as Clostridium cluster IV, Lactobacilli and Bacteroides. Recent observations supported that a dysbiosis characterised by decreased presence of anti-inflammatory bacterial species might be linked to mucosal inflammation, and a vicious cycle results from a mucosal inflammation driving dysbiosis at the same time. An alteration in gut microbiota can lead to an altered activation of nerve fibres, and subsequent neuronal and muscular dysfunction, thus favoring abdominal symptoms' development. The possible role of dysbiosis and mucosal inflammation in leading to dysmotility is linked, in turn, to bacterial translocation from the lumen of the diverticulum to perivisceral area. There, a possible activation of Toll-like receptors has been described, with a subsequent inflammatory reaction at the level of the perivisceral tissues. Being aware that bacterial colonisation of diverticula is involved in the pathogenesis of acute diverticulitis, the rationale for the potential role of probiotics in the treatment of this disease becomes clearer. For this review, articles were identified using the electronic PubMed database through a comprehensive search conducted by combining key terms such as "gut microbiota", "probiotics and gut disease", "probiotics and acute diverticulitis", "probiotics and diverticular disease", "probiotics mechanism of action". However, the amount of data present on this matter is not sufficient to draw robust conclusions on the efficacy of probiotics for symptoms' management in diverticular disease.},
}
@article {pmid33919755,
year = {2021},
author = {Carabotti, M and Falangone, F and Cuomo, R and Annibale, B},
title = {Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review.},
journal = {Nutrients},
volume = {13},
number = {4},
pages = {},
pmid = {33919755},
issn = {2072-6643},
mesh = {Diet, Western/adverse effects ; Dietary Fiber/administration & dosage ; Diverticulitis/epidemiology/etiology/physiopathology/*prevention & control ; Diverticulosis, Colonic/*complications/physiopathology ; Edible Grain ; Feeding Behavior/*physiology ; Fruit ; Gastrointestinal Hemorrhage/epidemiology/etiology/physiopathology/*prevention & control ; Hospitalization/statistics & numerical data ; Humans ; Meat/adverse effects ; Recurrence ; Vegetables ; },
abstract = {Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the effect of dietary habits in the prevention of diverticula complications (i.e., acute diverticulitis and diverticula bleeding) in patients with diverticula disease. PubMed and Scopus databases were searched up to 19 January 2021, 330 records were identified, and 8 articles met the eligibility criteria and were subjected to data extraction. The quality of the studies was evaluated by the Newcastle-Ottawa quality assessment form. No study meets the criteria for being a high-quality study. A high intake of fiber was associated to a decreased risk of diverticulitis or hospitalization due to diverticular disease, with a protective effect for fruits and cereal fiber, but not for vegetable fiber; whereas, a high red meat consumption and a generally Western dietary pattern were associated with an increased risk of diverticulitis. Alcohol use seemed to be associated to diverticular bleeding, but not to recurrent diverticulitis or diverticular complications. Further high-quality studies are needed to better define these associations. It is mandatory to ascertain the role of dietary habits for the development of recurrent acute diverticulitis and diverticular bleeding.},
}
@article {pmid33917780,
year = {2021},
author = {Rocca, A and Brunese, MC and Cappuccio, M and Scacchi, A and Martucci, G and Buondonno, A and Perrotta, FM and Quarto, G and Avella, P and Amato, B},
title = {Impact of Physical Activity on Disability Risk in Elderly Patients Hospitalized for Mild Acute Diverticulitis and Diverticular Bleeding Undergone Conservative Management.},
journal = {Medicina (Kaunas, Lithuania)},
volume = {57},
number = {4},
pages = {},
pmid = {33917780},
issn = {1648-9144},
mesh = {Activities of Daily Living ; Aftercare ; Aged ; Conservative Treatment ; *Diverticular Diseases ; *Diverticulitis ; Exercise ; Female ; Humans ; Male ; Patient Discharge ; Retrospective Studies ; },
abstract = {Background and Objectives: The role of physical activity (PA) in elderly patients admitted to surgical units for mild acute diverticulitis in the development of disability has not been clarified so far. Our aim is to demonstrate the relationship between physical activity and better post-discharge outcomes on disability in elderly population affected by diverticular disease. Materials and Methods: We retrospectively reviewed data of 56 patients (32 Males-24 females) collected from October 2018 and March 2020 at Cardarelli Hospital in Campobasso. We included patients older than 65 yrs admitted for acute bleeding and acute diverticulitis stage ≤II, characterized by a good independence status, without cognitive impairment and low risk of immobilization, as evaluated by activity of daily living (ADL) and the instrumental activity of daily living (IADL) and Exton-Smith Scale. "Physical Activity Scale for the Elderly" (PASE) Score evaluated PA prior to admission and at first check up visit. Results: 30.4% of patients presented a good PA, 46.4% showed moderate PA and 23.2% a low PA score. A progressive reduction in ADL and IADL score was associated with lower physical activity (p value = 0.0038 and 0.0017). We consider cognitive performance reduction with a cut off of loss of more than 5 points in Short Port of ADL and IADL and a loss of more than 15 points on Exton-Smith Scale, (p-value 0.017 and 0.010). In the logistic regression analysis, which evaluated the independent role of PASE in disability development, statistical significance was not reached, showing an Odds Ratio of 0.51 95% CI 0.25-1.03 p value 0.062. Discussion: Reduced physical activity in everyday life in elderly is associated with increased post-hospitalization disability regarding independence, cognitive performance and immobilization. Conclusions: Poor physical performance diagnosis may allow to perform a standardized multidimensional protocol to improve PA to reduce disability incidence.},
}
@article {pmid37207071,
year = {2021},
author = {Bartel, M and Burnett, C and Barnes, D},
title = {Sigmoid Diverticulitis in an Obese Pediatric Patient Without Genetic Predisposition.},
journal = {JPGN reports},
volume = {2},
number = {2},
pages = {e078},
pmid = {37207071},
issn = {2691-171X},
abstract = {Sigmoid diverticulitis has historically been a rare cause of abdominal pain in pediatrics, with minimal cases documented in the literature. The patient studied is one of the first reported cases of acquired pediatric uncomplicated sigmoid diverticulitis in whom lifestyle was the main contributing factor, as all associated known genetic risk factors were absent. Given the rarity of the diagnosis, many pediatricians may not consider the diagnosis; however, with the increasing incidence in younger patients, consideration of diverticulitis on the differential diagnosis with lower abdominal pain, especially in patients predisposed to diverticular disease, is increasingly important to avoid misdiagnosis and potential delays in appropriate treatment.},
}
@article {pmid33915018,
year = {2021},
author = {, },
title = {Diverticulitis Management, a Snapshot Collaborative Audit Study (DAMASCUS): Protocol for an international, multicentre, prospective observational study.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {23},
number = {8},
pages = {2182-2188},
doi = {10.1111/codi.15699},
pmid = {33915018},
issn = {1463-1318},
support = {//Bowel Research Bowel Research UK/ ; },
mesh = {Adult ; *Diverticular Diseases ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Humans ; Multicenter Studies as Topic ; Observational Studies as Topic ; Prospective Studies ; },
abstract = {AIM: Diverticular disease is an increasingly common problem in Western society with a variety of treatment options for those presenting with acute diverticulitis, dependent on clinical presentation. Additionally, there is significant international variability in the index management, and few published data on real-world clinical practice. The aim of DAMASCUS is to identify areas of practice variability and their potential association with differences in short- and medium-term clinical outcomes.
METHODS AND ANALYSIS: DAMASCUS is an international, collaborative, prospective observational study, recruiting patients from over 200 sites across six continents. The study opened in October 2020, with a rolling start. Identification of new sites ceased in February 2021 and data collection will cease in August 2021. All adult patients diagnosed with acute diverticulitis (radiologically or intra-operatively) at each participating centre will be included. The primary objective of DAMASCUS is to assess for national and international variability in the presentation and index management of acute diverticulitis (medical, interventional radiology and surgical). Secondary objectives include assessing 30-day and 6-month clinical outcome data (readmission, re-intervention, morbidity and mortality) and variations in surgical procedures for those undergoing surgery. All data will be recorded and managed using a secure REDCap electronic data capture tool and analysed using Stata (SE) version 16.1. The results will be reported in accordance with the STROBE statement.
CONCLUSION: By analysing variations in the management of acute diverticulitis and the subsequent outcomes, DAMASCUS will be an important step towards identifying optimal care for patients with diverticulitis.},
}
@article {pmid33906197,
year = {2021},
author = {Gräfitsch, A and Kirchhoff, P and Soysal, SD and Däster, S and Hoffmann, H},
title = {Dynamic Serosal Perfusion Assessment during Colorectal Resection Using Visible Light Spectroscopy.},
journal = {European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes},
volume = {62},
number = {1},
pages = {25-31},
doi = {10.1159/000514921},
pmid = {33906197},
issn = {1421-9921},
mesh = {Anastomosis, Surgical ; Anastomotic Leak/etiology ; *Colorectal Neoplasms/surgery ; Humans ; Light ; Oxygen Saturation ; *Perfusion ; *Serous Membrane ; Spectrum Analysis ; },
abstract = {INTRODUCTION: Anastomotic leakage (AL) in colorectal surgery occurs with an incidence of up to 20%. Bowel perfusion is deemed to be one of the most important factors for anastomotic healing. However, not much is known about its variability during colorectal surgery and its impact on the outcome. Therefore, this study aims to evaluate serosal oxygen saturation patterns during colorectal resections with visible light spectroscopy (VLS).
MATERIALS AND METHODS: Bowel perfusion in patients undergoing left-sided colorectal resections was assessed at different timepoints during surgery using VLS on the colonic serosa. The primary outcome parameter was serosal oxygen saturation (StO2) at the anastomosis during different timepoints of surgery.
RESULTS: We included 50 patients who underwent colorectal resection for bowel cancer (58%) and diverticular disease (34%). StO2 at the proximal site of the anastomosis increased significantly throughout the surgery (mean difference 3.61%; 95% CI -6.22 to -1.00; p = 0.008). However, aberrancy from this identified perfusion pattern had no impact on the postoperative outcome.
CONCLUSION: During colorectal resections, we could demonstrate an increase of the colonic StO2 throughout surgery. Appearance of AL was not associated with lower StO2, underlining the multifactorial genesis of developing AL.},
}
@article {pmid33905404,
year = {2021},
author = {Araya-Quezada, C and Torres-Bavestrello, L and Gómez-Barbieri, G and Zárate-Castillo, A},
title = {Antibiotics for acute uncomplicated diverticulitis in hospitalized patients.},
journal = {Medwave},
volume = {21},
number = {2},
pages = {e8140},
doi = {10.5867/medwave.2021.02.8140},
pmid = {33905404},
issn = {0717-6384},
mesh = {Acute Disease ; Anti-Bacterial Agents/*therapeutic use ; Diverticulitis/*drug therapy ; Humans ; Length of Stay ; Recurrence ; Treatment Outcome ; },
abstract = {INTRODUCTION: Acute diverticulitis is one of the complications of diverticular disease. Nowadays, there is a paradigm shift regarding the use of antibiotics to manage acute uncomplicated diverticulitis in hospitalized patients, with controversial information about it.
METHODS: A search was done in Epistemonikos, the most comprehensive health-related systematic review database, maintained by screening multiple information sources including MEDLINE/PubMed, EMBASE, Cochrane, among others. Data were extracted from the identified systematic reviews, data from primary studies were analyzed, which in this work considered only randomized clinical trials, a meta-analysis was done, and a summary table of results was created using GRADE methodology.
RESULTS AND CONCLUSIONS: Eleven systematic reviews were identified that included seven primary studies in total, of which two were randomized control trials. We concluded that the use of antibiotics in acute uncomplicated diverticulitis could slightly increase complications and result in a minor or no difference in the risk of recurrence and need for urgent surgery. However, the certainty of the evidence is low. Regarding hospital stay and readmission, it was not possible to evaluate the effect due to a low certainty of evidence.},
}
@article {pmid33903930,
year = {2021},
author = {Betzler, A and Grün, J and Finze, A and Reißfelder, C},
title = {[Choice of operative procedure in diverticular disease : Taking the latest treatment strategies into consideration].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {8},
pages = {702-706},
pmid = {33903930},
issn = {1433-0385},
mesh = {Anastomosis, Surgical ; Colostomy ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Humans ; *Intestinal Perforation/surgery ; *Laparoscopy ; *Peritonitis/surgery ; Quality of Life ; *Robotic Surgical Procedures ; },
abstract = {BACKGROUND: There are various procedures to be considered in the surgical treatment of complicated diverticulitis, which must be selected depending on the classification of diverticular disease (CDD) type and the condition of the patient.
OBJECTIVE: Comparison of surgical procedures with respect to aspects such as morbidity, mortality, reconstructive surgery and postoperative quality of life.
MATERIAL AND METHODS: Evaluation, analysis and assessment of the current literature on surgical treatment of diverticular disease.
RESULTS: Laparoscopic sigmoid resection with primary anastomosis is now considered the standard procedure for complicated sigmoid diverticulitis. It is preferable to open resection because of the better results of the minimally invasive approach with respect to the incidence of wound infections, abdominal abscesses and the occurrence of fascial dehiscence. In an emergency situation with perforation and peritonitis (CDD type 2c1/2), primary anastomosis with protective ileostomy should be favored over discontinuity resection (Hartmann's procedure). In particular, it must be taken into account that in a large proportion of patients there is no restoration of continuity after Hartmann's operation. The damage control strategy can be used in perforated sigmoid diverticulitis with generalized peritonitis (CDD type 2c1/2). In individual cases, laparoscopic lavage with insertion of a drainage may be considered as a therapeutic treatment strategy for perforated sigmoid diverticulitis with purulent peritonitis (CDD type 2c1).
CONCLUSION: Selection of the surgical procedure for complicated sigmoid diverticulitis remains challenging. Randomized controlled trials of new treatment strategies as well as robotic-assisted surgery should be considered in the choice of surgical procedure in the future.},
}
@article {pmid33889950,
year = {2021},
author = {Adiamah, A and Ban, L and Otete, H and Crooks, CJ and West, J and Humes, DJ},
title = {Outcomes after non-operative management of perforated diverticular disease: a population-based cohort study.},
journal = {BJS open},
volume = {5},
number = {2},
pages = {},
pmid = {33889950},
issn = {2474-9842},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Conservative Treatment ; Databases, Factual ; Diverticular Diseases/*mortality/*therapy ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Patient Readmission/*statistics & numerical data ; Risk Factors ; Spontaneous Perforation ; Survival Analysis ; Treatment Outcome ; United Kingdom/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: The management of perforated diverticular disease has changed in the past 10 years with a move towards less surgical intervention. This population-based cohort study aimed to define the risk of death and readmission following non-operative management of perforated diverticular disease.
METHODS: Patients diagnosed with perforated diverticular disease and managed without surgery were identified from the linked Clinical Practice Research Datalink and Hospital Episode Statistics data from 2000 to 2013. The outcomes were 1-year case fatality, readmissions, and surgery at readmission.
RESULTS: In total, 880 patients with perforated diverticular disease were managed without surgery, comprising 523 women (59.4 per cent). The 1-year case fatality rate was 33.2 per cent (293 of 880). The majority of deaths occurred in the first 90 days after the index admission, with a 90-day case fatality rate of 28.8 per cent. The 90-day survival rate varied by age, and was 97.2 per cent among those aged less than 65 years, compared with 85.0 per cent for those aged between 65 and 74 years, and 47.7 per cent in those at least 75 years old. Of 767 patients discharged from hospital, 250 (32.6 per cent) were readmitted (47 elective, 6.1 per cent; 203 emergency, 26.5 per cent) during a median of 1.6 (i.q.r. 0.1-3.9) years of follow-up, with similar proportions in each age category. In the first year of follow-up, only 5.1 per cent of patients required surgery, of whom 16 of 767 (2.1 per cent) required elective and 23 (3.0 per cent) emergency operation.
CONCLUSION: Non-operative management of perforated diverticulitis in those aged less than 65 years is feasible and safe. Reintervention rates following conservative management were low across all age categories.},
}
@article {pmid33885914,
year = {2021},
author = {Schäfer, AO},
title = {[Diverticular disease: stage-related diagnostic imaging].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {8},
pages = {688-693},
pmid = {33885914},
issn = {1433-0385},
mesh = {Acute Disease ; *Diverticulitis ; *Diverticulitis, Colonic/diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Multidetector Computed Tomography ; },
abstract = {BACKGROUND: Diverticular disease frequently leads to emergency admissions. Clinical parameters are not sufficiently accurate to determine the extent of acute colonic diverticulitis, thus a quick, reproducible and valid diagnostic imaging procedure is required.
OBJECTIVE: In the following, the imaging methods commonly used for the diagnostic work-up and staging of diverticulitis are presented and classified in the context of the data situation and clinical reality.
RESULTS: Multidetector computed tomography (MDCT) is the current diagnostic gold standard for the imaging evaluation of diverticulitis and the basis for guideline-conform treatment decisions according to the classification of diverticular disease (CDD).
DISCUSSION: The role of magnetic resonance imaging (MRI) in the evaluation of diverticulitis will have to be investigated but a more profound integration of this method can already be predicted. Point-of-care ultrasound for initial diagnosis and follow-up assessment will become more important, analogous to FAST in trauma patients.},
}
@article {pmid33884606,
year = {2021},
author = {Kargın, S and Tanrıkulu, Y},
title = {Diagnostic and prognostic significance of inflammatory parameters in acute diverticulitis: A retrospective cohort study.},
journal = {Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES},
volume = {27},
number = {3},
pages = {325-330},
doi = {10.14744/tjtes.2020.92068},
pmid = {33884606},
issn = {1307-7945},
mesh = {Biomarkers/*blood ; Blood Cell Count/*statistics & numerical data ; C-Reactive Protein/analysis ; *Diverticulitis/blood/diagnosis/physiopathology ; Humans ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; },
abstract = {BACKGROUND: The optimum biochemical or hematological marker to determine diagnosis and severity of acute diverticulitis has not been established. We aimed to compare the utility of hematological parameters in the diagnosis and severity of acute diverticulitis.
METHODS: Sixty-nine patients in diverticular disease (acute diverticulitis and diverticulosis subgroups) and 36 patients in control group were included in the study. The biochemical analysis performed at the time of diagnosis included white blood cell, mean platelet volume, neutrophil count, platelet count (PLT), C-reactive protein, and calculation of neutrophil count/lymphocyte and PLT/lymphocyte ratios. Patients in the diverticulitis group were divided into four stages according to the Hinchey classification based on abdominal CT findings.
RESULTS: The mean platelet-lymphocyte ratio in the diverticulitis and diverticulosis groups was significantly lower than that in the control group (p<0.05). The best sensitivity and specificity values to distinguish acute diverticulitis and diverticulosis were 63.64% and 72.22% for the neutrophil-lymphocyte ratio (NLR) at a cutoff value of 2.78 and above and 30.30% and 86.11% for the platelet-lymphocyte ratio at a cutoff value of 87.46 and above. The diagnostic accuracy rates to distinguish between the diverticulitis and the control groups that the best sensitivity and specificity values were found to be NLR at a cutoff value of 11.55 and above and 100% and 100% for the platelet-lymphocyte ratio at a cutoff value of 12.28 and above. The NLR values were significantly lower in patients with Hinchey Stage 1 disease than those in patients with Stages 2 and 3 disease (respectively, p=0.003 and p=0.006).
CONCLUSION: NLR and platelet-lymphocyte ratio can serve as useful biomarkers for the differential diagnosis and severity in acute diverticulitis.},
}
@article {pmid33880689,
year = {2021},
author = {Mandavdhare, HS and Praveen Kumar, M and Jha, D and Kumar, A and Sharma, V and Desai, P and Shumkina, L and Gupta, P and Singh, H and Dutta, U},
title = {Diverticular per oral endoscopic myotomy (DPOEM) for esophageal diverticular disease: a systematic review and meta-analysis.},
journal = {Esophagus : official journal of the Japan Esophageal Society},
volume = {18},
number = {3},
pages = {436-450},
pmid = {33880689},
issn = {1612-9067},
mesh = {*Diverticulum/etiology ; Esophagoscopy/adverse effects/methods ; Esophagus ; Humans ; *Myotomy/adverse effects/methods ; Treatment Outcome ; *Zenker Diverticulum/surgery ; },
abstract = {The traditional way to tackle Zenker's diverticulum (ZD) has been flexible endoscopic septum division (FESD). Recently, the concept of per oral endoscopic myotomy has been found useful for managing diverticular diseases of the esophagus and has been termed DPOEM. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of D-POEM in diverticular disease of the esophagus and to compare it with FESD. We systematically searched PubMed and Embase, for studies reporting clinical success, technical success and adverse events in D-POEM alone or D-POEM comparing with FESD. We computed pooled prevalence for D-POEM alone and risk ratio for D-POEM vs FESD using random effect method with inverse variance approach. Subgroup analysis for ZD, non-ZD and mixed diverticulum was conducted. Totally 19 studies including 341 patients were identified reporting on D-POEM. The pooled clinical, technical success and adverse event rates for D-POEM were 87.07%, 95.19% and 10.22%, respectively. The clinical success was significantly better than FESD while the technical success, adverse event rate, procedure time and length of hospital stay were comparable with FESD. The recurrence rate was negligible for D-POEM compared to FESD. On subgroup analysis by dividing into three groups of ZD, non-ZD and mixed, there was no difference between clinical, technical success and adverse event rate among the three groups. D-POEM is an effective and safe technique among both ZD and non-ZD patients and has better clinical success than FESD.},
}
@article {pmid33867449,
year = {2021},
author = {Tursi, A and Elisei, W and Franceschi, M and Picchio, M and Di Mario, F and Brandimarte, G},
title = {The prevalence of symptomatic uncomplicated diverticular disease could be lower than expected: a single-center colonoscopy-based cohort study.},
journal = {European journal of gastroenterology & hepatology},
volume = {33},
number = {1S Suppl 1},
pages = {e478-e483},
doi = {10.1097/MEG.0000000000002142},
pmid = {33867449},
issn = {1473-5687},
mesh = {Abdominal Pain/epidemiology/etiology ; Cohort Studies ; Colonoscopy/adverse effects ; *Diverticular Diseases/complications/diagnosis/epidemiology ; *Diverticulum ; Humans ; *Irritable Bowel Syndrome/complications/diagnosis/epidemiology ; Prevalence ; },
abstract = {AIM: The real prevalence of symptomatic uncomplicated diverticular disease (SUDD) is still unknown. The aim of this study was to assess the prevalence of SUDD, post-diverticulitis SUDD (PD-SUDD) and irritable bowel syndrome (IBS)-like symptoms in a real-life population.
METHODS: A cohort of patients, submitted to colonoscopy from 1st January 2012 to 30th April 2018 was revised.
RESULTS: A cohort of 5451 patients with diverticulosis was identified during the study period. Abdominal pain was recorded in 1141 patients (20.93%), diarrhea in 288 (5.28%) and constipation in 536 (9.83%) patients. SUDD was recorded in 371 patients (6.81% of the patients having diverticulosis and 32.51% of the patients experiencing abdominal pain), PD-SUDD was recorded in 103 patients (1.89% of the patients having diverticulosis and 9.03% of the patients experiencing abdominal pain) and IBS-like was recorded in 348 patients (6.38% of the patients having diverticulosis and 30.5% of the patients experiencing abdominal pain). Three hundred and nineteen patients were not part of any of the previous categories (5.85% of the patients having diverticulosis and 27.96% of the patients experiencing abdominal pain). SUDD and PD-SUDD were more frequent in older ages (>60 years), while IBS-like symptoms were more frequent in younger. Nonspecific abdominal pain was equally distributed in through the ages.
CONCLUSION: The prevalence of SUDD seems to be lower than expected, and most of patients with diverticulosis and abdominal symptoms may suffer from IBS-like or other causes.},
}
@article {pmid33865277,
year = {2021},
author = {Álvarez-Salafranca, M and Bularca, EA and Rivera-Fuertes, I and Lapeña-Casado, A and Soria-Navarro, J and Espuelas-Monge, M},
title = {Multifocal pyoderma gangrenosum secondary to subclinical diverticulitis: case report and brief literature review.},
journal = {Dermatology online journal},
volume = {27},
number = {3},
pages = {},
pmid = {33865277},
issn = {1087-2108},
mesh = {Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Clindamycin/therapeutic use ; Diagnosis, Differential ; Diverticulitis, Colonic/*complications/diagnosis/drug therapy ; Drug Therapy, Combination ; Female ; Glucocorticoids/therapeutic use ; Humans ; Metronidazole/therapeutic use ; Prednisone/therapeutic use ; Pyoderma Gangrenosum/diagnosis/drug therapy/*etiology ; },
abstract = {Pyoderma gangrenosum is characteristically associated with inflammatory bowel disease. However, the association between this neutrophilic dermatosis and diverticular disease is scarcely mentioned in the literature. Diverticulitis should be included in the differential diagnosis in patients with pyoderma gangrenosum and gastrointestinal complaints, or even in asymptomatic patients, particularly in the elderly. Misdiagnosis can lead to inadequate treatments and serious complications.},
}
@article {pmid33852018,
year = {2021},
author = {Leifeld, L and Kruis, W},
title = {[Diverticular disease. Clinical appearance, conservative treatment, primary and secondary prophylaxis].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {8},
pages = {683-687},
pmid = {33852018},
issn = {1433-0385},
mesh = {Conservative Treatment ; *Diverticular Diseases/therapy ; *Diverticulitis ; *Diverticulitis, Colonic/diagnostic imaging/therapy ; *Diverticulum ; Humans ; Secondary Prevention ; },
abstract = {Diverticula of the colon are very common and usually asymptomatic but 20% of people with diverticulosis develop symptoms and sometimes also complications, such as diverticulitis with abscesses or perforation and bleeding. In the long-term stenoses or a conglomerate can occur. The treatment depends on the type of diverticular disease, on the knowledge of risk indicators and imaging with sonography or computed tomography (CT). The uncomplicated diverticular disease is treated on an outpatient and conservative basis, while complicated diverticular disease is treated on an inpatient basis and often surgically.},
}
@article {pmid33851878,
year = {2021},
author = {Gavriilidis, P and Askari, A and Gavriilidis, E and de'Angelis, N and Di Saverio, S and Wheeler, J and Davies, RJ},
title = {Appraisal of the current guidelines for the management of diverticular disease using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {103},
number = {7},
pages = {471-477},
pmid = {33851878},
issn = {1478-7083},
mesh = {Diverticular Diseases/diagnosis/*therapy ; Evidence-Based Medicine/methods/standards ; Gastroenterology/methods/*standards ; Humans ; *Practice Guidelines as Topic ; Societies, Medical/*standards ; Stakeholder Participation ; },
abstract = {INTRODUCTION: Diverticular disease is one of the most frequent reasons for attending emergency departments and surgical causes of hospital admission. In the past decade, many surgical and gastroenterological societies have published guidelines for the management of diverticular disease. The aim of the present study was to appraise the methodological quality of these guidelines using the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool.
METHODS: PubMed, Embase, Cochrane Library and Google Scholar databases were searched systematically. The methodological quality of the guidelines was appraised independently by five appraisers using the AGREE II instrument.
FINDINGS: A systematic search of the literature identified 12 guidelines. The median overall score of all guidelines was 68%. Across all guidelines, the highest score of 85% was demonstrated in the domain 'Scope and purpose'. The domains 'Clarity and presentation' and 'Editorial independence' both scored a median of 72%. The lowest scores were demonstrated in the domains 'Stakeholder involvement' and 'Applicability' at 46% and 40%, respectively. Overall, the National Institute for Health and Care Excellence (NICE) guidelines performed consistently well, scoring 100% in five of six domains; NICE was one of the few guidelines that specifically reported stakeholder involvement, scoring 97%. Generally, the domain of 'Stakeholder involvement' ranked poorly with seven of twelve guidelines scoring below 50%, with the worst score in this domain demonstrated by Danish guidelines at 25%.
CONCLUSION: Six of twelve guidelines (NICE, American Society of Colon & Rectal Surgeons (ASCRS), European Society of Coloproctology (ESCP), American Gastroenterological Association, German Society of Gastroenterology/German Society for General and Visceral Surgery (German), Netherlands Society of Surgery) scored above 70%. Only three, NICE, ASCRS and ESCP, scored above 75% and were voted unanimously by the appraisers for use as they are. Therefore, use of AGREE II may help improve the methodological quality of guidelines and their future updates.},
}
@article {pmid33849017,
year = {2022},
author = {Lenti, MV and Aronico, N and Giuffrida, P and Costa, S and Costetti, M and Musacchio, C and Pastorelli, L and Mengoli, C and Borrelli de Andreis, F and Cococcia, S and Tinelli, C and Klersy, C and Vecchi, M and Pilotto, A and Di Sabatino, A},
title = {Multidimensional Prognostic Index Predicts Clinical Outcome and Mortality in Hospitalised Older Patients with Diverticular Disease.},
journal = {Gerontology},
volume = {68},
number = {1},
pages = {44-52},
doi = {10.1159/000515161},
pmid = {33849017},
issn = {1423-0003},
mesh = {Aged ; Aged, 80 and over ; *Diverticular Diseases ; Female ; *Geriatric Assessment/methods ; Humans ; Prognosis ; },
abstract = {INTRODUCTION: The Multidimensional Prognostic Index (MPI) is a validated tool for assessing mortality risk in hospitalised patients. We aimed to evaluate whether the MPI predicted mortality and the risk of developing diverticular disease (DD) complications in older patients.
METHODS: This is a multicentre study conducted in January 2016-March 2018. All patients with DD aged 65 years and older were included. Patients were stratified into three groups according to MPI groups (1, low risk; 2, moderate risk; 3, high risk). Risk of developing DD complications and mortality rate were assessed. Bivariate models were fitted.
RESULTS: One hundred hospitalised patients with DD (mean age 77.9 ± 10.6 years, 53 female patients) were included. Patients with higher MPI groups were more likely to develop DD complications. In particular, 12 (46.2%), 21 (52.5%), and 28 (82.4%) patients with complicated DD were distributed to the MPI 1, MPI 2, and MPI 3 groups (p = 0.0063), respectively. Two patients died in the MPI 1, 4 in the MPI 2, and 29 in the MPI 3 group, with mortality rates of 4.0 per 100 person-year (95% confidence interval [CI] 1.0-15.9), 5.6 (95% CI 2.1-15.0), and 89.2 (95% CI 62-130), respectively (log-rank test p < 0.001). In bivariate analysis, after adjustment for age >80 years, Charlson Comorbidity Index >4, DD complications, and the presence of thromboembolism, higher MPI group was independently associated with higher mortality. Those in the MPI 3 group experienced a greater risk of 1-year hospital readmission (p < 0.001).
CONCLUSION: MPI predicted mortality in patients with DD and also correlated with the risk of developing DD complications. Studies focussing on possible pathophysiological mechanisms between DD complications and MPI are needed.},
}
@article {pmid33817725,
year = {2020},
author = {Val-Bernal, JF and Mayorga, MM and García-Gutierrez, FJ},
title = {Abdominal elastotic lesions. A clinicopathologic study of 23 cases.},
journal = {Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie},
volume = {61},
number = {3},
pages = {841-851},
pmid = {33817725},
issn = {2066-8279},
mesh = {Aged ; Aged, 80 and over ; Female ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Mesentery ; Middle Aged ; *Omentum ; *Soft Tissue Neoplasms ; },
abstract = {Abdominal elastotic deposits are uncommon lesions that often presents as polyps. They show three histological patterns: fibroelastosis, angioelastosis, and elastofibroma. We describe 23 cases including rare locations, such as mesentery, greater omentum, hernia sac, spleen, peripancreatic fat, and hypodermal fat. The age of the patients ranged from 49 to 93 years (mean, 76.8 years). Most lesions were discovered incidentally in the microscopic study. The most frequent locations were peritoneal subserosa (43.5%) and mesentery∕mesocolon∕greater omentum (39.1%). The most common pattern was fibroelastosis (69.6%) followed by angioelastosis (26.1%). We observed one case of omental elastofibroma. A review of the 14 abdominal elastofibromas described including our case revealed that the age of the patients ranged from 45 to 88 years (mean, 68.5 years). Female predominance is striking (M:F, 1:12). The most common site was the stomach (50%). The greater omentum (14.3%), small intestine (7.1%), and pancreas (7.1%) are very rare sites for this lesion. Only one case before ours has been published in the greater omentum. The size of the lesions ranged from 0.7 cm to 8 cm (mean 3.2 cm). In 36.4% of the cases located in the digestive tract, the mucosa did not show alterations. Ulcerations (36.4%) or polypoid excrescences (18.2%) were mostly observed. Six (42.9%) cases were asymptomatic and six (42.9%) cases simulated a neoplasm. Two cases were associated with elastofibromas in other locations. Differential diagnosis includes amyloidoma, elastofibrolipoma, mesenteric elastic vascular sclerosis in neuroendocrine tumors, diverticular disease elastosis, pseudoxanthoma elasticum, pulse granuloma, and digestive lesions in patients treated with D-Penicillamine.},
}
@article {pmid33809208,
year = {2021},
author = {Marafini, I and Salvatori, S and Rocchetti, I and Alfieri, N and Scarozza, P and Calabrese, E and Biancone, L and Monteleone, G},
title = {Natural History of Ulcerative Colitis with Coexistent Colonic Diverticulosis.},
journal = {Journal of clinical medicine},
volume = {10},
number = {6},
pages = {},
pmid = {33809208},
issn = {2077-0383},
abstract = {Ulcerative colitis (UC) and colonic diverticulosis can co-exist in some patients. However, the natural history of UC associated with colonic diverticulosis is not well known. We here compared the disease characteristics and outcome of UC patients with and without concomitant colonic diverticulosis. Medical records of 347 UC patients were included in an observational, retrospective, nested-matched case-control study. Cases were 92 patients with UC and concomitant colonic diverticulosis, while controls were 255 UC patients without concomitant colonic diverticulosis. A propensity score matching (PSM) was used to homogenate cases (n = 92) and controls (n = 153) for age. UC patients with concomitant colonic diverticulosis were less likely to have an extensive disease (25/92, 27.1%) and to experience steroid dependence (8/92, 8.6%) compared to patients without concomitant colonic diverticulosis (70/153, 45.7% and 48/153, 31.3%, respectively; p < 0.001). The use of immunosuppressants (9/92, 9.7% vs. 37/153, 24.1%; p = 0.007) or biologics (3/92, 3.2% vs. 26/153, 16.9%, p < 0.001) was significantly lower in UC patients with concomitant diverticulosis compared to the control group. On multivariate analysis, steroid dependence and extensive colitis were significantly less frequent in UC patients with concomitant colonic diverticulosis compared to UC patients without diverticula. UC patients with coexisting colonic diverticulosis are less likely to have an extensive disease and to be steroid-dependent.},
}
@article {pmid33784697,
year = {2021},
author = {Donlon, NE and Kelly, ME and Zafar, M and Boland, PA and Davis, C and Wei Teh, J and Corless, K and Khan, W and Khan, I and Waldron, R and Barry, K},
title = {The Use of Clinical Parameters as Adjuncts to Endoscopic Evaluation of Mural Thickening on Conventional Computed Tomography in Diagnosing Malignancy.},
journal = {Digestive surgery},
volume = {38},
number = {3},
pages = {230-236},
doi = {10.1159/000514777},
pmid = {33784697},
issn = {1421-9883},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Biomarkers/metabolism ; Diagnosis, Differential ; *Endoscopy, Digestive System ; Female ; Gastrointestinal Hemorrhage/diagnosis/*etiology ; Gastrointestinal Neoplasms/complications/*diagnosis/metabolism ; Hemoglobins/*metabolism ; Humans ; Male ; Middle Aged ; Retrospective Studies ; *Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Mural thickening (MT) on computed tomography (CT) poses a diagnostic dilemma in the absence of clear reporting guidelines. The aim of this study was to analyse CT reports, identifying patients in whom gastrointestinal wall MT was observed, and to correlate these reports with subsequent endoscopic evaluation.
METHODS: Patients with MT who had follow-up endoscopy were included in the study (n = 308). The cohort was subdivided into upper gastrointestinal mural thickening (UGIMT) & lower gastrointestinal mural thickening (LGIMT).
RESULTS: In total, 55.71% (n = 122) of colonoscopies and 61.8% (n = 55) of gastroscopies were found to be normal. Haemoglobin (HB) level in combination with MT was a predictor of neoplasia in both arms (p = 0.04 UGIMT cohort, p < 0.001 LGIMT cohort). In addition to this, age was a significant correlative parameter in both UGIMT and LGIMT cohorts (p = 0.003, p < 0.001 respectively). Dysphagia and weight loss were associated with UGI malignancies (38 and 63% respectively) and rectal bleeding was correlative in 20% of patients with LGI malignancies.
CONCLUSION: HB, advancing age, and red flag symptoms are potentially useful adjuncts to MT in predicting upper and lower gastrointestinal malignancies. We propose the adoption of a streamlined pathway to delineate patients who should undergo endoscopic investigation following CT identification of MT.},
}
@article {pmid33769883,
year = {2021},
author = {Burch, J},
title = {Bowel dysfunction after surgery.},
journal = {British journal of nursing (Mark Allen Publishing)},
volume = {30},
number = {6},
pages = {S12-S18},
doi = {10.12968/bjon.2021.30.6.S12},
pmid = {33769883},
issn = {0966-0461},
mesh = {*Gastrointestinal Diseases/nursing ; Humans ; *Postoperative Complications/nursing ; },
abstract = {The functions of the lower parts of the bowel, namely the colon and rectum, are predominantly the absorption of fluids and elimination of faeces and flatus. Bowel surgery may be carried out in the treatment of colorectal cancer, inflammatory bowel disease or diverticular disease, and may involve the formation of a permanent or temporary stoma. The type of colorectal surgery carried out depends on the condition and where the problem occurs. Surgery can alter not only the bowel's anatomy but also its functioning. Bowel dysfunction can manifest as constipation, faecal incontinence or diarrhoea. Nurses are well placed to assist patients to resolve many of these problems as well as stoma issues.},
}
@article {pmid33768926,
year = {2021},
author = {Noyes, JD and Mordi, IR and Zeb, Q and Lang, CC},
title = {Nicorandil-induced colovesical fistula in a patient with diverticular disease.},
journal = {Clinical case reports},
volume = {9},
number = {3},
pages = {1737-1741},
pmid = {33768926},
issn = {2050-0904},
support = {MR/T018186/1/MRC_/Medical Research Council/United Kingdom ; },
abstract = {Nicorandil's adverse effects can cause severe patient morbidity and can present to any specialty. Those with underlying diverticular disease are most susceptible. Medication reviews are vital for patients presenting with ulcer or fistula symptoms.},
}
@article {pmid33758653,
year = {2021},
author = {Tabone, R and Yuide, P and Burstow, M},
title = {Jejunal perforation secondary to migrated biliary stent.},
journal = {Journal of surgical case reports},
volume = {2021},
number = {3},
pages = {rjab057},
pmid = {33758653},
issn = {2042-8812},
abstract = {An 80-year-old female presented with acute left-sided abdominal pain. Cross-sectional imaging demonstrated a contained perforation around a migrated biliary stent within a large incisional hernia. Significant surgical background included an open cholecystectomy complicated by bile leak and insertion of a biliary stent 2.5 years prior. The stent had migrated at the time of attempted retrieval 10 weeks post-insertion. A decision was made to pursue conservative management after which time she remained asymptomatic until her acute presentation. Emergency laparotomy, adhesiolysis, stent removal, small bowel resection and abdominal wall closure were successfully performed in this case. In the setting of the biliary stent migration, it is important to consider individual patient's risk factors for acute perforation, such as intra-abdominal adhesions or diverticular disease, when deliberating conservative management versus elective surgical intervention for stent retrieval.},
}
@article {pmid33745570,
year = {2021},
author = {Di Pierro, F and Pane, M},
title = {Bifidobacterium longum W11: Uniqueness and individual or combined clinical use in association with rifaximin.},
journal = {Clinical nutrition ESPEN},
volume = {42},
number = {},
pages = {15-21},
doi = {10.1016/j.clnesp.2020.12.025},
pmid = {33745570},
issn = {2405-4577},
mesh = {Adult ; Anti-Bacterial Agents/therapeutic use ; *Bifidobacterium longum ; Humans ; *Irritable Bowel Syndrome/drug therapy ; *Probiotics ; Randomized Controlled Trials as Topic ; Rifaximin/therapeutic use ; },
abstract = {BACKGROUNDS & AIMS: Strains belonging to bifidobacteria have been documented as being helpful in adults with intestinal dysbiosis conditions, like those related to irritable bowel syndrome (IBS). This review aims to present the most relevant evidence regarding the efficacy of Bifidobacterium longum W11, a Bifidobacterium used in clinical settings for conditions such as IBS and inflammatory bowel disease.
METHODS: The following electronic databases were systematically searched up to August 2020: MEDLINE (via PubMed), EMBASE, Cochrane Central Database of Controlled Trials (via CENTRAL), Google Scholar, and Clinicaltrials.gov.
RESULTS: Data arising from pooled analysis, 7 in vitro/pharmacological studies, 7 clinical trials including 1 randomized, double-blind and placebo-controlled, showed that the probiotic strain B. longum W11 has been extensively studied for its efficacy in subjects with IBS with constipation, leading to a significant reduction in symptoms. In particular, its role in alleviating constipation was also confirmed in subjects for whom a low-calorie weight-loss diet led to the slowing down of gut motility. The probiotic characteristics of B. longum W11 were further demonstrated in the treatment of minimal hepatic encephalopathy and hepatic disease. The most remarkable trait of B. longum W11 is its non-transmissible antibiotic resistance, due to a nucleotide polymorphism mutation in the rpoB gene, making it resistant to antibiotics of the rifampicin group, including rifaximin. The co-administration of B. longum W11 and rifaximin in patients with symptomatic uncomplicated diverticular disease brought about a further significant improvement in the clinical condition compared to patients treated with rifaximin alone. B. longum W11 is a probiotic which could synergize with rifaximin as an adjuvant to antibiotic treatment.
CONCLUSIONS: Taken altogether these findings demonstrate the clinical role of the strain W11 both in some functional and in some inflammatory bowel diseases.},
}
@article {pmid33744774,
year = {2021},
author = {Khor, S and Flum, DR and Strate, LL and Hantouli, MN and Harris, HM and Lavallee, DC and Spiegel, BM and Davidson, GH},
title = {Establishing Clinically Significant Patient-reported Outcomes for Diverticular Disease.},
journal = {The Journal of surgical research},
volume = {264},
number = {},
pages = {20-29},
pmid = {33744774},
issn = {1095-8673},
support = {R01 DK103915/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Aged ; Colectomy/*standards ; Diverticulitis, Colonic/complications/diagnosis/psychology/*surgery ; Elective Surgical Procedures/*standards ; Female ; Humans ; Male ; Middle Aged ; Minimal Clinically Important Difference ; *Patient Reported Outcome Measures ; Practice Guidelines as Topic ; Prospective Studies ; *Quality of Life ; Severity of Illness Index ; Surveys and Questionnaires/statistics & numerical data ; Treatment Outcome ; },
abstract = {BACKGROUND: Diverticular disease can undermine health-related quality of life. The diverticulitis quality of life (DV-QOL) instrument was designed and validated to measure patient-reported burden of diverticular disease. However, values reflecting meaningful improvement (i.e., minimal clinically important difference [MCID]) and the patient acceptable symptom state (PASS) have yet to be established. We sought to establish the MCID and PASS of the DV-QOL and describe the characteristics of those with DV-QOL above the PASS threshold.
MATERIALS AND METHODS: We performed a prospective cohort study of adults with diverticular disease from seven centers in Washington and California (2016-2018). Patients were surveyed at baseline, then quarterly up to 30 mo. To determine the MCID and PASS for DV-QOL, we applied various previously established distribution- and anchor-based approaches and compared the resulting values.
RESULTS: The study included 177 patients (mean age 57 y, 43% women). A PASS threshold of 3.2/10 distinguished between those with and without health-related quality of life-impacting diverticulitis with acceptable accuracy (area under the curve 0.76). A change of 2.2 points in the DV-QOL was the most appropriate MCID: above the distribution-based MCIDs and corresponding to patient perception of importance of change (AUC 0.70). Patients with DV-QOL ≥ PASS were more often men, younger, had Medicaid, had more serious episodes of diverticulitis, and had an occupational degree or high-school education or less.
CONCLUSIONS: Our study is the first to define MCID and PASS for DV-QOL. These thresholds are critical for measuring the impact of diverticular disease and the evaluation of treatment effectiveness.},
}
@article {pmid33734549,
year = {2021},
author = {Tay, JYI and Hayes, I and Fisher, T and McMullin, R},
title = {Complicated diverticular disease presenting as recurrent epididymo-orchitis: a case report.},
journal = {ANZ journal of surgery},
volume = {91},
number = {11},
pages = {E703-E705},
doi = {10.1111/ans.16751},
pmid = {33734549},
issn = {1445-2197},
mesh = {*Diverticulum ; *Epididymitis/diagnosis ; Humans ; Male ; *Orchitis/diagnostic imaging/etiology ; },
}
@article {pmid33731593,
year = {2021},
author = {Nehring, P and Gromadzka, G and Giermaziak, A and Jastrzębski, M and Przybyłkowski, A},
title = {Genetic variants of tissue inhibitors of matrix metalloproteinase 1 (rs4898) and 2 (rs8179090) in diverticulosis.},
journal = {European journal of gastroenterology & hepatology},
volume = {33},
number = {1S Suppl 1},
pages = {e431-e434},
doi = {10.1097/MEG.0000000000002122},
pmid = {33731593},
issn = {1473-5687},
mesh = {Alleles ; *Diverticulum/diagnosis/epidemiology/genetics ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Humans ; Male ; *Tissue Inhibitor of Metalloproteinase-1/genetics ; *Tissue Inhibitor of Metalloproteinase-2/genetics ; },
abstract = {INTRODUCTION: Diverticulosis affects approximately 60% of population after 60th year of age. Diverticular disease is symptomatic diverticulosis characterized by abdominal pain, flatulence and bloating, and bowel habits change. Age and lifestyle are risk factors for diverticulosis, additionally genetic predisposition is postulated. The aim of the study was to assess whether tissue inhibitors of matrix metalloproteinase (TIMP) 1 rs4898 and TIMP2 rs8179090 genetic variants are related to colonic diverticulosis.
METHODS: The study included 220 patients, 100 with colon diverticulosis diagnosed on colonoscopy and 120 controls. TIMP1 rs4898 and TIMP2 rs8179090 variants were examined using PCR-restriction fragments length polymorphism from a blood sample.
RESULTS: Allele T of TIMP1 rs4898 was more frequent in male patients with diverticulosis than in controls (P < 0.01), whereas in women there were no differences in its distribution, both in heterozygotes and homozygotes or in homozygotes separately, proving a recessive effect. TIMP2 s8179090 allele G frequency was 0.95 in cases and controls, there were no CC homozygotes identified, and no associations with diverticulosis showed.
CONCLUSION: TIMP1 rs4898 allele T may be a genetic determinant of the risk of diverticulosis in men.},
}
@article {pmid33728590,
year = {2021},
author = {Sell, NM and Stafford, CE and Goldstone, RN and Kunitake, H and Francone, TD and Cauley, CE and Hodin, RA and Bordeianou, LG and Ricciardi, R},
title = {Delay to Intervention for Complicated Diverticulitis is Associated with Higher Inpatient Mortality.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {25},
number = {11},
pages = {2920-2927},
pmid = {33728590},
issn = {1873-4626},
mesh = {Abscess ; *Diverticulitis/complications/surgery ; *Diverticulitis, Colonic/complications/surgery ; Female ; Humans ; Inpatients ; *Intestinal Perforation/etiology/surgery ; },
abstract = {BACKGROUND: Patients with diverticular disease complicated by abscess and/or perforation represent the most severely afflicted with the highest mortality and poorest outcomes. This study investigated patient and operative factors associated with poor outcomes from diverticulitis complicated by abscess or perforation.
METHODS: We analyzed the National Inpatient Sample to identify inpatient discharges for colonic diverticulitis in the United States from 1/1988 to 9/2015. We identified patients with perforation and/or intestinal abscess based on ICD-9 codes. The primary outcome was inpatient mortality.
RESULTS: During the study period, a total of 993,220 patients were discharged with diverticulitis from sampled U.S. hospitals. From this group, 10.7% had an abscess and 1.0% had a perforation associated with diverticular disease. Inpatient mortality of diverticulitis patients with a perforation was 5.4% compared to 1.5% in those without a perforation (p<0.001). Patients with a perforation who underwent surgery had an inpatient mortality of 6.3% vs. 3.0% mortality amongst patients with a perforation who did not undergo an operation (p<0.001). Patients with a perforation that underwent surgery had a 31% increased mortality risk for each day after admission that a procedure was delayed (OR 1.31, CI 1.05-1.78; p=0.03). Mortality risk was increased for patients with either abscess or perforation who underwent surgery if they were female, age ≥65, higher comorbidity, were admitted urgently, underwent peritoneal lavage, or had a post-procedural complication.
CONCLUSIONS: Patients with perforated diverticular disease had substantial associated inpatient mortality compared to those with uncomplicated diverticulitis. This increased risk may be associated with performance of peritoneal lavage or because of a delay to procedural intervention.},
}
@article {pmid33727769,
year = {2021},
author = {Hanna, MH and Kaiser, AM},
title = {Update on the management of sigmoid diverticulitis.},
journal = {World journal of gastroenterology},
volume = {27},
number = {9},
pages = {760-781},
pmid = {33727769},
issn = {2219-2840},
mesh = {Aged ; Colectomy ; Colon, Sigmoid/surgery ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/diagnostic imaging/epidemiology ; Elective Surgical Procedures ; Humans ; *Laparoscopy ; },
abstract = {Diverticular disease and diverticulitis are the most common non-cancerous pathology of the colon. It has traditionally been considered a disease of the elderly and associated with cultural and dietary habits. There has been a growing evolution in our understanding and the treatment guidelines for this disease. To provide an updated review of the epidemiology, pathogenesis, classification and highlight changes in the medical and surgical management of diverticulitis. Diverticulitis is increasingly being seen in young patients (< 50 years). Genetic contributions to diverticulitis may be larger than previously thought. Potential similarities and overlap with inflammatory bowel disease and irritable bowel syndrome exist. Computed tomography imaging represents the standard to classify the severity of diverticulitis. Modifications to the traditional Hinchey classification might serve to better delineate mild and intermediate forms as well as better classify chronic presentations of diverticulitis. Non-operative management is primarily based on antibiotics and supportive measures, but antibiotics may be omitted in mild cases. Interval colonoscopy remains advisable after an acute attack, particularly after a complicated form. Acute surgery is needed for the most severe as well as refractory cases, whereas elective resections are individualized and should be considered for chronic, smoldering, or recurrent forms and respective complications (stricture, fistula, etc.) and for patients with factors highly predictive of recurrent attacks. Diverticulitis is no longer a disease of the elderly. Our evolving understanding of diverticulitis as a clinical entity has led into a more nuanced approach in both the medical and surgical management of this common disease. Non-surgical management remains the appropriate treatment for greater than 70% of patients. In individuals with non-relenting, persistent, or recurrent symptoms and those with complicated disease and sequelae, a segmental colectomy remains the most effective surgical treatment in the acute, chronic, or elective-prophylactic setting.},
}
@article {pmid33707231,
year = {2022},
author = {Wauters, L and Clarysse, M and Jochmans, I and Monbaliu, D and Ceulemans, LJ and Verbiest, A and Miserez, M and Lauwers, N and Nys, W and Pauwels, N and Hiele, M and Pirenne, J and Vanuytsel, T},
title = {Chronic small intestinal dysmotility presenting as jejunal diverticulosis with refractory malabsorption: role for partial enterectomy?.},
journal = {Gut},
volume = {71},
number = {1},
pages = {218-219},
doi = {10.1136/gutjnl-2021-324385},
pmid = {33707231},
issn = {1468-3288},
mesh = {*Diverticulum/complications/surgery ; Humans ; *Jejunal Diseases/diagnosis/etiology/surgery ; Jejunum/surgery ; },
}
@article {pmid33660190,
year = {2021},
author = {Martellotto, S and Challine, A and Peveri, V and Paolino, L and Lazzati, A},
title = {Trends in emergent diverticular disease management: a nationwide cohort study from 2009 to 2018.},
journal = {Techniques in coloproctology},
volume = {25},
number = {5},
pages = {549-558},
pmid = {33660190},
issn = {1128-045X},
mesh = {Adult ; Anastomosis, Surgical ; Cohort Studies ; *Colostomy ; *Diverticulitis, Colonic/epidemiology/surgery ; Humans ; Prospective Studies ; Retrospective Studies ; },
abstract = {BACKGROUND: Diverticular disease is a common disorder. Several guidelines report on its optimal management. The aim of this study was to describe the evolution of the prevalence of this disease, the treatment strategies, and the mortality rate on a national level.
METHODS: We conducted a retrospective study on prospective data using a nationwide database. All consecutive adult patients diagnosed with diverticular disease and admitted via the emergency department from 2009 to 2018 were included in the study. We performed a descriptive analysis for epidemiologic data, diagnosis, and treatment.
RESULTS: During the data collection period, 233,386 patients were included in the study. The number of admissions for emergent diverticular disease increased by 65.8%, from 16,754 in 2009 to 27,781 in 2018, for both uncomplicated and complicated diverticular disease. Among these patients, 19,350 (8.3%) were operated on. The rate of surgical treatment progressively decreased from 9.7% in 2009 to 7.6% in 2018. The three main interventions were Hartmann's procedure (HP, n = 9111, 47.1%), resection with primary anastomosis (RPA, n = 4335, 22.4%), and peritoneal lavage (PL, n = 4836, 25%). We observed a progressive annual increase in HPs (n = 716 in 2009 and n = 1055 in 2018) as well as a decline in PLs since 2015, while the number of RPAs remained stable.
CONCLUSIONS: Although admissions for emergent diverticular disease have increased during the study period, the rate of surgical treatment has decreased, suggesting an evolution toward more conservative management of this pathology.},
}
@article {pmid33654361,
year = {2021},
author = {Tursi, A and Franceschi, M and Elisei, W and Picchio, M and Mario, FD and Brandimarte, G},
title = {The natural history of symptomatic uncomplicated diverticular disease: a long-term follow-up study.},
journal = {Annals of gastroenterology},
volume = {34},
number = {2},
pages = {208-213},
pmid = {33654361},
issn = {1108-7471},
abstract = {BACKGROUND: Symptomatic uncomplicated diverticular disease (SUDD) affects about 20% of patients who have diverticulosis. However, the natural history of SUDD is not yet completely understood. Our aim was to assess the outcomes of a cohort of SUDD patients during a long-term follow up.
METHODS: One hundred eighty-five patients suffering from SUDD were identified from a large electronic database. Symptoms assessed were abdominal pain, bloating, bowel movement/day, each of which was scored using a visual analogic scale (VAS); the symptom score was calculated by considering the value of the worst symptom present during assessment. Another VAS was used to assess patients' quality of life (QoL). Patients were treated at the physician's discretion (with rifaximin, mesalazine, probiotics, spasmolytics) only when symptoms occurred during the follow up. Follow-up visit was performed every year or whenever patients consider it necessary.
RESULTS: During the follow up (156 months, interquartile range 9-171), 47 patients were lost to follow up. Among these, 9 died from causes not related to SUDD. Acute diverticulitis occurred in 14 patients (7.6% of the overall population): 6 patients (3.2% of the overall population) underwent surgery, and 2 patients (1.1% of the overall population) died because of peritonitis. Both the symptom score and the QoL score were substantially unmodified during the study period.
CONCLUSIONS: SUDD is an important disease able to affect patients significantly in the long term. Acute diverticulitis may sometimes occur in these patients, often leading to surgery with possible severe complications.},
}
@article {pmid33648505,
year = {2021},
author = {Papier, K and Fensom, GK and Knuppel, A and Appleby, PN and Tong, TYN and Schmidt, JA and Travis, RC and Key, TJ and Perez-Cornago, A},
title = {Meat consumption and risk of 25 common conditions: outcome-wide analyses in 475,000 men and women in the UK Biobank study.},
journal = {BMC medicine},
volume = {19},
number = {1},
pages = {53},
pmid = {33648505},
issn = {1741-7015},
support = {MC_PC_17228/MRC_/Medical Research Council/United Kingdom ; MR/M012190/1//Medical Research Foundation/ ; 205212/Z/16/Z/WT_/Wellcome Trust/United Kingdom ; MR/M012190/1/MRC_/Medical Research Council/United Kingdom ; MC_QA137853/MRC_/Medical Research Council/United Kingdom ; C8211/A19170/CRUK_/Cancer Research UK/United Kingdom ; C8221/A29017/CRUK_/Cancer Research UK/United Kingdom ; 2019/1953/CRUK_/Cancer Research UK/United Kingdom ; C60192/A28516/CRUK_/Cancer Research UK/United Kingdom ; },
mesh = {Animals ; Biological Specimen Banks ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Red Meat/*adverse effects ; Risk Factors ; United Kingdom ; },
abstract = {BACKGROUND: There is limited prospective evidence on the association between meat consumption and many common, non-cancerous health outcomes. We examined associations of meat intake with risk of 25 common conditions (other than cancer).
METHODS: We used data from 474,985 middle-aged adults recruited into the UK Biobank study between 2006 and 2010 and followed up until 2017 (mean follow-up 8.0 years) with available information on meat intake at baseline (collected via touchscreen questionnaire), and linked hospital admissions and mortality data. For a large sub-sample (~ 69,000), dietary intakes were re-measured three or more times using an online, 24-h recall questionnaire.
RESULTS: On average, participants who reported consuming meat regularly (three or more times per week) had more adverse health behaviours and characteristics than participants who consumed meat less regularly, and most of the positive associations observed for meat consumption and health risks were substantially attenuated after adjustment for body mass index (BMI). In multi-variable adjusted (including BMI) Cox regression models corrected for multiple testing, higher consumption of unprocessed red and processed meat combined was associated with higher risks of ischaemic heart disease (hazard ratio (HRs) per 70 g/day higher intake 1.15, 95% confidence intervals (CIs) 1.07-1.23), pneumonia (1.31, 1.18-1.44), diverticular disease (1.19, 1.11-1.28), colon polyps (1.10, 1.06-1.15), and diabetes (1.30, 1.20-1.42); results were similar for unprocessed red meat and processed meat intakes separately. Higher consumption of unprocessed red meat alone was associated with a lower risk of iron deficiency anaemia (IDA: HR per 50 g/day higher intake 0.80, 95% CIs 0.72-0.90). Higher poultry meat intake was associated with higher risks of gastro-oesophageal reflux disease (HR per 30 g/day higher intake 1.17, 95% CIs 1.09-1.26), gastritis and duodenitis (1.12, 1.05-1.18), diverticular disease (1.10, 1.04-1.17), gallbladder disease (1.11, 1.04-1.19), and diabetes (1.14, 1.07-1.21), and a lower IDA risk (0.83, 0.76-0.90).
CONCLUSIONS: Higher unprocessed red meat, processed meat, and poultry meat consumption was associated with higher risks of several common conditions; higher BMI accounted for a substantial proportion of these increased risks suggesting that residual confounding or mediation by adiposity might account for some of these remaining associations. Higher unprocessed red meat and poultry meat consumption was associated with lower IDA risk.},
}
@article {pmid33647346,
year = {2021},
author = {Saavedra-Perez, D and Curbelo-Peña, Y and Sampson-Davila, J and Albertos, S and Serrano, A and Ibañez, L and Errando, X and Perez, X},
title = {Management of symptomatic uncomplicated diverticular colon disease: A systematic review of diagnosis and treatment.},
journal = {Gastroenterologia y hepatologia},
volume = {44},
number = {7},
pages = {497-518},
doi = {10.1016/j.gastrohep.2020.12.016},
pmid = {33647346},
issn = {0210-5705},
mesh = {Decision Trees ; Diverticulosis, Colonic/*diagnosis/*therapy ; Humans ; },
abstract = {Symptomatic uncomplicated diverticular colon disease (SUDCD) is a highly prevalent disease in our setting, which significantly affects the quality of life of patients. Recent changes in understanding the natural history of this disease and technological and pharmacological advances have increased the available options for both diagnosis and treatment. However, consensus regarding the use of these options is scarce and sometimes lacks scientific evidence. The objective of this systematic review is to clarify the existing scientific evidence and analyse the use of the different diagnostic and therapeutic options for SUDCD, comparing their advantages and disadvantages, to finally suggest a diagnostic-therapeutic algorithm for this pathology and, at the same time, propose new research questions.},
}
@article {pmid33642952,
year = {2021},
author = {Wood, EH and Sigman, MM and Hayden, DM},
title = {Special Situations in the Management of Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {2},
pages = {121-126},
pmid = {33642952},
issn = {1531-0043},
abstract = {Diverticular disease affects a large percentage of the US population, affecting over 30% among those older than 45 years old. It is responsible for ∼300,000 hospitalizations per year in the United States and can lead to serious complications such as hemorrhage, obstruction, abscess, fistulae, or bowel perforation. 2 It is an extremely common reason for emergency room and outpatient visits and evaluations by general and colorectal surgeons. In the US, patients usually present with sigmoid diverticulitis in the setting of a normal immune system so surgeons will follow well-established practice guidelines for treatment. However, there may be special circumstances in which the management of diverticulitis is not as straightforward. In this article, we will address patients who present with multifocal disease, giant colonic diverticulum, right-sided diverticulitis, and diverticulitis in the setting of immunosuppression and hopefully provide guidance for treatment in these special circumstances.},
}
@article {pmid33642951,
year = {2021},
author = {Madiedo, A and Hall, J},
title = {Minimally Invasive Management of Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {2},
pages = {113-120},
pmid = {33642951},
issn = {1531-0043},
abstract = {Traditionally, management of complicated diverticular disease has involved open damage control operations with large definitive resections and colostomies. Studies are now showing that in a subset of patients who would typically have undergone an open Hartmann's procedure for Hinchey III/IV diverticulitis, a laparoscopic approach is equally safe, and has better outcomes. Similar patients may be good candidates for primary anastomosis to avoid the morbidity and subsequent reversal of a colostomy. While most operations for diverticulitis across the country are still performed open, there has been an incremental shift in practice toward minimally invasive approaches in the elective setting. The most recent data from large trials, most notably the SIGMA trial, found laparoscopic sigmoid colectomy is associated with fewer short-term and long-term complications, decreased pain, improvement in length of stay, and maintains better cost-effectiveness than open resections. Some studies even demonstrate that robotic sigmoid resections can maintain a similar if not more reduction in morbidity as the laparoscopic approach while still remaining cost-effective. Intraoperative approaches also factor into improving outcomes. One of the most feared complications in colorectal surgery is anastomotic leak, and many studies have sought to find ways to minimize this risk. Factors to consider to minimize incidence of leak are the creation of tension-free anastomoses, amount of contamination, adequacy of blood supply, and a patient's use of steroids. Techniques supported by data that decrease anastomotic leaks include preoperative oral antibiotic and mechanical bowel prep, intraoperative splenic flexure mobilization, low-tie ligation of the inferior mesenteric artery, and use of indocyanine green immunofluorescence to assess perfusion. In summary, the management of benign diverticular disease is shifting from open, morbid operations for a very common disease to a minimally invasive approach. In this article, we review those approaches shown to have better outcomes, greater patient satisfaction, and fewer complications.},
}
@article {pmid33642949,
year = {2021},
author = {Coakley, KM and Davis, BR and Kasten, KR},
title = {Complicated Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {2},
pages = {96-103},
pmid = {33642949},
issn = {1531-0043},
abstract = {The modern management of colonic diverticular disease involves grouping patients into uncomplicated or complicated diverticulitis, after which the correct treatment paradigm is instituted. Recent controversies suggest overlap in management strategies between these two groups. While most reports still support surgical intervention for the treatment of complicated diverticular disease, more data are forthcoming suggesting complicated diverticulitis does not merit surgical resection in all scenarios. Given the significant risk for complication in surgery for diverticulitis, careful attention should be paid to patient and procedure selection. Here, we define complicated diverticulitis, discuss options for surgical intervention, and explain strategies for avoiding operative pitfalls that result in early and late postoperative complications.},
}
@article {pmid33642947,
year = {2021},
author = {Langenfeld, SJ},
title = {Evaluation and Medical Management of Uncomplicated Diverticulitis.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {2},
pages = {86-90},
pmid = {33642947},
issn = {1531-0043},
abstract = {Uncomplicated diverticulitis is common, and its evaluation and treatment have evolved over time. Most patients present in a nontoxic manner with localized pain, leukocytosis, and reliable findings on computed tomography (CT). Healthy and stable patients are typically treated in the outpatient setting with very high rates of success. Recently, the necessity of antibiotic therapy has come into question, and several alternative agents have emerged, with the jury still out on their relative roles in diverticular disease. Currently, colonoscopy is still recommended after the resolution of an index episode of uncomplicated diverticulitis, and recurrence rates remain low. Several diet and lifestyle modifications have been shown to impact the rates of diverticulitis recurrence.},
}
@article {pmid33642946,
year = {2021},
author = {Talutis, SD and Kuhnen, FAH},
title = {Pathophysiology and Epidemiology of Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {34},
number = {2},
pages = {81-85},
pmid = {33642946},
issn = {1531-0043},
abstract = {Diverticular disease exists on a spectrum, ranging from asymptomatic diverticulosis to complicated diverticulitis. Incidence of diverticulitis in western nations has increased in recent years, although the factors that influence the progression from diverticulosis to diverticulitis are unknown. Geographic/environmental influences, lifestyle variables, and microbiota of the gastrointestinal tract are some of the factors implicated in diverticular disease.},
}
@article {pmid33607699,
year = {2021},
author = {Jerjen, F and Zaidi, T and Chan, S and Sharma, A and Mudliar, R and Soomro, K and Jimenez, Y and Reed, W},
title = {Magnetic Resonance Imaging for the diagnosis and management of acute colonic diverticulitis: a review of current and future use.},
journal = {Journal of medical radiation sciences},
volume = {68},
number = {3},
pages = {310-319},
pmid = {33607699},
issn = {2051-3909},
mesh = {Australia ; *Diverticulitis ; *Diverticulitis, Colonic/diagnostic imaging/therapy ; Humans ; Magnetic Resonance Imaging ; Prospective Studies ; },
abstract = {Diverticular disease is one of the most common causes of outpatient visits and hospitalisations across Australia, North America and Europe. According to the Gastroenterological Society of Australia (GESA, 2010), approximately 33% of Australians over 45 years of age and 66% over 85 years of age have some form of colonic diverticulosis. Patients with colonic diverticulosis are known to develop subsequent complications such as acute colonic diverticulitis (ACD), and when more than one attack of diverticulitis occurs, there is a 70-90% chance that the individual will experience ongoing problems and recurring infections throughout their lifetime. Medical imaging is fundamental in the diagnosis, treatment and ongoing management of ACD and its complications, with Computed Tomography (CT) identified as the prevailing gold standard in the last few decades. Cross-database searching highlighted a large gap in the literature regarding the effectiveness of Magnetic Resonance Imaging (MRI) as a non-ionising radiation alternative imaging tool for ACD imaging after the mid-2000s, despite ongoing technological advancements in this modality. This narrative review identified 13 key publications (11 primary prospective cohort studies, 1 systematic review and 1 meta-analysis) that evaluate MRI for ACD imaging, of which five were published within the last decade. Several existing MRI protocols are deemed suitable for ACD imaging, and it is recommended they be re-evaluated in larger cohorts. Future studies should consider the rapidly growing technological improvements of MRI, its cost efficiency and its applicability in modern day healthcare settings when addressing ACD management. This is especially important considering the gradual rise in radiation dose among the Australian population attributable to increased CT referrals, alongside increased reporting of ACD cases in younger individuals.},
}
@article {pmid33606074,
year = {2021},
author = {Wirth, U and Schardey, J and von Ahnen, T and Zimmermann, P and Kühn, F and Werner, J and Schardey, HM and Rau, BM and Gumpp, J},
title = {Oral antibiotic bowel decontamination in open and laparoscopic sigmoid resections for diverticular disease.},
journal = {International journal of colorectal disease},
volume = {36},
number = {8},
pages = {1667-1676},
pmid = {33606074},
issn = {1432-1262},
mesh = {Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis ; Decontamination ; *Diverticular Diseases ; Humans ; *Laparoscopy ; Retrospective Studies ; },
abstract = {PURPOSE: There is an ongoing debate on whether or not to use oral antibiotic bowel decontamination in colorectal surgery, despite the numerous different regimens in terms of antibiotic substances and duration of application. As we routinely use oral antibiotic bowel decontamination (selective decontamination of the digestive tract (SDD) regimen and SDD regimen plus vancomycin since 2016) in surgery for diverticular disease, our aim was to retrospectively analyze the perioperative outcome in two independent centers.
METHODS: Data from two centers with a routine use of oral antibiotic bowel decontamination for up to 20 years of experience were analyzed for the perioperative outcome of 384 patients undergoing surgery for diverticular disease.
RESULTS: Overall morbidity was 12.8%, overall mortality was 0.3%, the overall rate of anastomotic leakage (AL) was 1.0%, and surgical site infections (SSIs) were 5.5% and 7.8% of all infectious complications including urinary tract infections and pneumonia. No serious adverse events were related to use of oral antibiotic bowel decontamination. Most of the patients (93.8%) completed the perioperative regimen. Additional use of vancomycin to the SDD regimen did not show a further reduction of infectious complications, including SSI and AL.
CONCLUSION: Oral antibiotic decontamination appears to be safe and effective with low rates of AL and infectious complications in surgery for diverticular disease.},
}
@article {pmid33595203,
year = {2021},
author = {Kameyama, H and Yamazaki, T and Iwaya, A and Uehara, H and Utsumi, S and Hirai, M and Komatsu, M and Kubota, A and Katada, T and Kobayashi, K and Sato, D and Yokoyama, N and Kuwabara, S and Otani, T},
title = {Surgical approach for right-sided colonic diverticular bleeding: A single-center review of 43 consecutive cases.},
journal = {Asian journal of endoscopic surgery},
volume = {14},
number = {4},
pages = {717-723},
doi = {10.1111/ases.12929},
pmid = {33595203},
issn = {1758-5910},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; Colon/surgery ; *Diverticular Diseases ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Treatment Outcome ; },
abstract = {INTRODUCTION: While Asian populations develop colonic diverticular disease predominantly in the right colon, Western populations mainly present with left-sided disease. The present study aimed to clarify the outcomes of surgical treatment for right-sided colonic diverticular bleeding.
METHODS: Medical records of 43 patients who underwent surgery for right-sided colonic diverticular bleeding between 2010 and 2019 were reviewed. Those whose general condition became unstable underwent open surgery at our institution. Patients were then divided into two groups, the open surgery group (n = 17) and laparoscopic surgery group (n = 26), after which operative outcomes between both groups were compared.
RESULTS: This study included 36 men and seven women with a median age of 76 (range: 37-91) years. Laparoscopic surgery had a significantly longer operative time (183.5 minutes vs 110 minutes; P < .001) and significantly lower intraoperative blood transfusion rate (19.2% vs 82.4%; P < .001) than open surgery. The laparoscopic surgery group had earlier resumption of postoperative meals than open surgery group (postoperative day 3 vs postoperative day 4; P = .010). No significant difference in postoperative complications was observed between both groups. With regard to long-term outcomes, none of the cases exhibited rebleeding from the right-sided colon.
CONCLUSION: The present study revealed that laparoscopic surgery promoted lower intraoperative blood transfusion rates and earlier resumption of postoperative meals compared to open surgery for right-sided colonic diverticular bleeding. Hence, laparoscopic surgery can be feasible for right-sided colonic diverticular bleeding provided that the patient's general condition is stable.},
}
@article {pmid33594008,
year = {2021},
author = {Altomare, A and Gori, M and Cocca, S and Carotti, S and Francesconi, M and Ribolsi, M and Emerenziani, S and Perrone, G and Morini, S and Cicala, M and Guarino, MPL},
title = {Impaired Colonic Contractility and Intestinal Permeability in Symptomatic Uncomplicated Diverticular Disease.},
journal = {Journal of neurogastroenterology and motility},
volume = {27},
number = {2},
pages = {292-301},
pmid = {33594008},
issn = {2093-0879},
abstract = {BACKGROUND/AIMS: Impaired intestinal motility seems to play a crucial role in symptomatic uncomplicated diverticular disease (SUDD), although the mechanism is not clear. The aim of the present study is to explore the contractility patterns of colonic smooth muscle strips (MS) and smooth muscle cells (SMCs) and to assess mucosal integrity in SUDD patients.
METHODS: MS or SMCs were isolated from specimens of human distal colon of 18 patients undergoing surgery for non-obstructive colonic cancer, among them 9 with SUDD. Spontaneous phasic contractions on strips and morpho-functional parameters on cells were evaluated in basal conditions and in response to acetylcholine (ACh). Mucosal integrity of SUDD colonic biopsies was evaluated by the Ussing Chamber system. Immunohistochemical staining for tight junction protein complex and for Toll-like receptor 4 (TLR4) was performed.
RESULTS: Colonic MS of SUDD group showed a significant reduced basal tone and ACh-elicited contraction, compared to the control group (9.5 g and 47.0% in the SUDD group; 14.16 g and 69.0% in the control group; P < 0.05). SMCs of SUDD group showed a maximal contractile response to ACh significantly reduced compared to control group (8.8% vs 16.5%, P < 0.05). SUDD patients displayed lower transepithelial electrical resistance and increased paracellular permeability compared to control group. Immunohistochemical expression of TLR4 was not different in both groups, while tight junction protein complex expression was lower in SUDD patients compared to control group patients.
CONCLUSION: It could be hypothesized that in SUDD, in absence of severe inflammation, an increased intestinal mucosal permeability is related to altered colonic motility probably responsible for symptoms genesis.},
}
@article {pmid33592411,
year = {2021},
author = {Faye, PM and Pichvirackboth, D and Abousarhan, F and Mahfoud, A and Sirbu, V and Zaccharia, A and Khaddam, Y and Cagniet, A and Jolidon, C},
title = {Spontaneous colo-vesical and colo-cutaneous fistula complicating a sigmoid diverticulitis: A case report.},
journal = {International journal of surgery case reports},
volume = {80},
number = {},
pages = {105598},
pmid = {33592411},
issn = {2210-2612},
abstract = {INTRODUCTION: Diverticular disease is a challenge in western countries. The occurrence of fistula complicating diverticulitis is uncommon. As a result, spontaneous and synchronous colo-vesical and colo-cutaneous is an even rarer situation.
CASE PRESENTATION: We report the case of a 68 years old patient with medical history of bilateral inguinal hernia surgery and diverticular disease. He was admitted for fecal fistula through to the left inguinal area and recurrent urinary tract infections evolving for 2 months. Clinical examination revealed fecaluria and colo-cutaneous fistula. Abdominal CT scan revealed the presence of air in the bladder associated with fistula tract between the sigmoid colon and the inguinal abdominal wall. Surgical management was realized in two stages. The first stage, consisting to an end-colostomy, was performed. The second stage will be laparoscopic colectomy and is not yet realized. In the follow-up, the patient is doing well with a good quality of life.
CONCLUSION: Spontaneous colo-vesical and colo-cutaneous fistula is an uncommon complication of diverticulitis. There is no guidelines about the management and the treatment should be tailored according to each patient characteristics. Laparoscopic surgery is a feasible and safe approach in the treatment.},
}
@article {pmid33583126,
year = {2021},
author = {Skajaa, N and Schønfeldt Troelsen, F and Pedersen, L and Ekholm, O and Strate, LL and Erichsen, R and Sørensen, HT},
title = {Statins and risk of diverticular disease: Nested case-control study.},
journal = {Pharmacoepidemiology and drug safety},
volume = {30},
number = {6},
pages = {770-778},
doi = {10.1002/pds.5205},
pmid = {33583126},
issn = {1099-1557},
support = {R01 DK101495/DK/NIDDK NIH HHS/United States ; },
mesh = {Case-Control Studies ; *Diverticular Diseases ; Humans ; *Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Logistic Models ; Odds Ratio ; Risk Factors ; },
abstract = {BACKGROUND: Statins exert pleiotropic anti-inflammatory effects and may prevent diverticular disease. However, the association remains poorly understood with previous studies obtaining conflicting results.
AIMS: To examine the effect of statin on the subsequent risk of diverticular disease.
METHODS: We conducted a nested case-control study in Denmark among respondents (>18 years) of the 2010 or the 2013 Danish National Health Survey. Among these, we identified 8809 cases of hospital-diagnosed diverticular disease and risk-set sampled population controls without diverticular disease. Using complete prescription and hospital records, we used conditional logistic regression to compute odds ratios (ORs) associating statin use with diverticular disease. In adjusted analyses, we controlled for hospital-based diagnoses, medication use other than statins, and lifestyle and socioeconomic factors.
RESULTS: The fully adjusted OR for diverticular disease associated with ever use (≥1 statin prescription filling) was 1.19 (95% CI: 1.12-1.27) compared with never use. However, we observed no dose-response relation. For example, among short-term users (<5 years), the OR was 1.18 (95% CI: 1.04-1.35) for low intensity users and 1.13 (95% CI: 1.01-1.26) for high intensity users. Among long-term users (≥5 years), the respective ORs were 1.25 (95% CI: 1.13-1.38) and 1.11 (95% CI: 0.98-1.24). In analyses restricting to cases and controls with a previous colonoscopy, associations were null (OR: 1.01 [95% CI: 0.85-1.20]).
CONCLUSIONS: The observed association of a higher risk of diverticular disease associated with statins could be explained by diagnostic bias. Our study did not support a protective nor harmful effect of statins on the risk of diverticular disease.},
}
@article {pmid33554945,
year = {2020},
author = {Antropoli, M and Fusco, F and Brillantino, A and Lanza, M and Monte, G and Cricrì, AM and Scardi, F and Ciorra, FR and Marra, E and Castriconi, M},
title = {Treatment of acute diverticulitis with open abdomen technique.},
journal = {Annali italiani di chirurgia},
volume = {91},
number = {},
pages = {705-708},
pmid = {33554945},
issn = {2239-253X},
mesh = {Aged ; Anastomosis, Surgical ; Colostomy ; *Diverticulitis, Colonic/complications/surgery ; Humans ; *Open Abdomen Techniques ; Peritonitis ; },
abstract = {AIM: The aim of this study is to highlight our experience about the use of open Abdomen's technique as strategy for the management of complicated colon diverticulitis with a delayed anastomosis or colostomy.
MATERIALS AND METHODS: Thirty patients, with III and IV Hinchey stage, have been undertaken to a surgical procedure with Open Abdomen technique and application of Ab-thera device. A second surgical look was made after 48-72 hours in order to evaluate the possibility to do an anastomosis or colostomy.
RESULTS: No deaths in patients with anastomosis were reported, but one case of leakage at the 8th day and one case of micro pulmonary embolism had been displayed. Elderly patients were discharged between the 15TH /18th day. One patient affected by lymphoma was sent in haematology department for other treatment.
DISCUSSION: Today trend is to treat the diverticular disease with colic and paracolic abscess by a medical therapy and percutaneous drainage under CT scan or ultrasound view. With III and IV of Hinchey scale we perform the resection with anastomosis or colostomy. The open abdomen technique allows the surgeons to make the decision of colostomy or anastomosis in the second surgical look at 48-72 hours after the first treatment with irrigation and aspiration during AB-Thera.
CONCLUSION: The Open Abdomen technique is a valid therapeutic alternative approach for patients with acute diverticulitis disease in III and IV Hinchey grade. This therapeutic approach gives important advantages in patients with delayed colostomy.
KEY WORDS: Diverticulitis, Damage Control Surgery, Open Abdomen.},
}
@article {pmid33551820,
year = {2020},
author = {Rizea-Savu, S and Duna, SN and Sandulovici, RC},
title = {Single Dose Study Assessing the Pharmacokinetic and Metabolic Profile of Alverine Citrate in Healthy Volunteers.},
journal = {Frontiers in pharmacology},
volume = {11},
number = {},
pages = {620451},
pmid = {33551820},
issn = {1663-9812},
abstract = {Alverine citrate is a spasmolytic commonly prescribed in conditions such as irritable bowel syndrome, painful diverticular disease of the colon, and primary dysmenorrhea. While clinical efficacy data on alverine alone or in combination with simethicone is freely available, surprisingly little information regarding the pharmacokinetics and metabolism of alverine can be found in literature. The first HPLC-MS/MS analytical protocol for determination of alverine parent, 4-hydroxy alverine, N-desethyl alverine and 4-hydroxy alverine glucuronide in human plasma was developed and validated. The two validated methods were used for analyzing plasma samples collected during an open label, non-comparative, single dose, one-period, one-treatment, pharmacokinetic and metabolic profile study of Spasmonal[®] Forte 120 mg hard capsule, conducted in 12 fasting healthy male and female volunteers of Caucasian descent. The study confirmed previous suspicions that parent alverine is subject to high pharmacokinetic variability and also revealed that the metabolic process most susceptible to outlying performance in Caucasians is hydroxylation to the active metabolite 4-hydroxy alverine. Another interesting observation made is that alverine parent accounts for only 3%, whereas total 4-hydroxy alverine (free and conjugated) accounts for 94% of alverine-related moieties in circulation (based on comparisons of total exposure).},
}
@article {pmid33548127,
year = {2021},
author = {Makar, M and Pisano, TJ and Xia, W and Greenberg, P and Patel, AV},
title = {The Impact of Obesity on Mortality and Clinical Outcomes in Patients with Acute Diverticulitis in the United States.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {30},
number = {1},
pages = {73-80},
doi = {10.15403/jgld-2988},
pmid = {33548127},
issn = {1842-1121},
mesh = {Aged, 80 and over ; *Diverticular Diseases ; *Diverticulitis/diagnosis/therapy ; Hospital Mortality ; Hospitalization ; Humans ; Length of Stay ; *Obesity, Morbid ; Retrospective Studies ; United States/epidemiology ; },
abstract = {BACKGROUND AND AIMS: Diverticular disease represents a leading cause of gastrointestinal-related hospitalizations. We sought to identify the adverse consequences of obesity on acute diverticulitis (AD) hospital admissions. By age 85, approximately two-thirds of individuals will develop diverticular disease and up to 25% will develop AD. Generally, obesity confers an increased risk of morbidity and mortality; however, its impact on hospitalized patients with AD are lacking.
METHODS: Utilizing ICD-9-CM codes from the National Inpatient Sample (January 2012 - October 2015) we identified patients with a primary discharge diagnosis of AD including 660,820 hospitalizations and 115,785 with obesity. Primary outcomes were mortality, length of stay, and hospitalization cost. Secondary outcomes were AD complications and the need for surgical interventions.
RESULTS: On multivariate analysis, obesity was not associated with an increased risk of mortality (OR=1.1, 95%CI: 0.87-1.41; p= 0.43). However, morbid obesity (BMI > 40 kg/m2) showed a significant increased risk of mortality (OR=1.69, 95%CI: 1.23-2.31; p<0.001). Obesity was associated with prolonged hospitalizations length of stay by 0.61 days (0.55-0.68; p <10-6), higher hospital charges $6,320 ($ 5,500-7,140; p<10-6), increased complicated diverticulitis 1.05 (1.01-1.1; p < 0.010) and required more surgical interventions for diverticulitis (OR=1.19, 95%CI: 1.15-1.23; p<10-6).
CONCLUSION: Morbid obesity increases risk for mortality while obesity leads to longer hospitalization stays and greater healthcare cost as well as adverse clinical outcomes and more surgical interventions. Further interventions are required to address obesity and weight loss for patients with diverticulitis to improve clinical outcomes.},
}
@article {pmid33539644,
year = {2021},
author = {Serra-Aracil, X and Mora-Lopez, L and Gomez-Torres, I and Pallisera-Lloveras, A and Serra-Pla, S and Serracant, A and Garcia-Nalda, A and Pino-Perez, O and Navarro-Soto, S},
title = {Minimal invasive surgery for left colectomy adapted to the COVID-19 pandemic: laparoscopic intracorporeal resection and anastomosis, a 'don't touch the bowel' technique.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {23},
number = {6},
pages = {1562-1568},
pmid = {33539644},
issn = {1463-1318},
mesh = {Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; COVID-19/epidemiology/*prevention & control/transmission ; Colectomy/*methods ; Colonic Diseases/*surgery ; Female ; Humans ; Infectious Disease Transmission, Patient-to-Professional/*prevention & control ; Laparoscopy/*methods ; Length of Stay ; Male ; Middle Aged ; Operative Time ; },
abstract = {AIM: The COVID-19 pandemic has forced surgeons to adapt their standard procedures. The modifications introduced are designed to favour minimally invasive surgery. The positive results obtained with intracorporeal resection and anastomosis in the right colon and rectum prompt us to adapt these procedures to the left colon. We describe a 'don't touch the bowel' technique and outline the benefits to patients of the use of less surgically aggressive techniques and also to surgeons in terms of the lower emission of aerosols that might transmit the COVID-19 infection.
METHODS: This was an observational study of intracorporeal resection and anastomosis in left colectomy. We describe the technical details of intracorporeal resection, end-to-end stapled anastomosis and extraction of the specimen through mini-laparotomy in the ideal location.
RESULTS: We present preliminary results of 17 patients with left-sided colonic pathologies, 15 neoplasia and two diverticular disease, who underwent four left hemicolectomies, six sigmoidectomies and seven high anterior resections. Median operating time was 186 min (range 120-280). No patient required conversion to extracorporeal laparoscopy or open surgery. Median hospital stay was 4.7 days (range 3-12 days). There was one case of anastomotic leak managed with conservative treatment.
CONCLUSION: Intracorporeal resection and end-to-end anastomosis with the possibility of extraction of the specimen by a mini-laparotomy in the ideal location may present benefits and also adapts well to the conditions imposed by the COVID-19 pandemic. Future comparative studies are needed to demonstrate these benefits with respect to extracorporeal anastomosis.},
}
@article {pmid33535255,
year = {2021},
author = {Meyer, S and Schmidbauer, M and Wacker, FK and Ringe, KI},
title = {To Fill or Not to Fill? - Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon.},
journal = {RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin},
volume = {193},
number = {7},
pages = {804-812},
doi = {10.1055/a-1339-2157},
pmid = {33535255},
issn = {1438-9010},
mesh = {Aged ; Colonic Diseases/classification/*diagnostic imaging ; *Contrast Media ; Diverticular Diseases/classification/*diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; *Tomography, X-Ray Computed ; },
abstract = {PURPOSE: To assess the value of the administration of positive rectal contrast at CT in patients referred for suspected diverticular disease (DD) of the colon.
MATERIALS AND METHODS: 460 patients (253 male, 207 female; median age 62 years; interquartile range 24) with clinical suspicion of DD of the colon were included in this retrospective IRB-approved study. CT was performed with i. v. contrast only (n = 328, group M1), i. v. + positive rectal contrast (n = 82, group M2), neither i. v. nor rectal contrast (n = 32, group S1), or positive rectal contrast only (n = 19, group S2). Two readers in consensus evaluated all CT datasets concerning diagnosis of DD (yes/no) and categorized findings (classification of diverticular disease (CDD)). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for the diagnosis of DD were calculated for all groups, using either clinical follow-up (n = 335) or intraoperative findings (n = 125) as the reference standard. In patients undergoing surgery, radiological staging of DD was correlated with the histopathology (weighted Cohen-k).
RESULTS: 224 patients (48.7 %) were diagnosed with DD. The sensitivity, specificity, PPV, and NPV were as follows. Group M1 / M2: 92 %/92 %, 97 %/94 %, 96 %/96 %, 94 %/89 %, respectively; group S1 / S2: 94 %/86 %, 93 %/80 %, 94 %/92 %, 93 %/67 %, respectively. Radiological staging and histopathology correlated substantially in all groups (k = 0.748-0.861).
CONCLUSION: Abdominal CT had a high sensitivity and specificity for the diagnosis of DD. Disease staging correlated well with the findings at surgery. Additional positive rectal contrast administration did not have a significant advantage and may therefore be omitted in patients with suspected DD.
KEY POINTS: · CT has a high sensitivity and specificity for diagnosis of DD.. · CT staging using the CDD algorithm correlates very well with surgery.. · Positive rectal contrast administration does not improve diagnosis and radiological staging..
CITATION FORMAT: · Meyer S, Schmidbauer M, Wacker FK et al. To Fill or Not to Fill? - Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon. Fortschr Röntgenstr 2021; 193: 804 - 812.},
}
@article {pmid33506932,
year = {2021},
author = {De Bastiani, R and Sanna, G and Bertolusso, L and Casella, G and De Polo, M and Zamparella, M and Cottone, C and Tosetti, C and Mancuso, M and Pirrotta, E and Lanzarotto, L and Napoli, L and De Bastiani, M and Disclafani, G and Gambaro, P and Scoglio, R and Belvedere, A and Fasulo, S and D'Urso, M and Benedetto, E and Baldi, E and Marchesan, F and Abagnale, G and Turnava, L and Salomè, E and Ingravalle, F and Tursi, A},
title = {General practitioners' management of symptomatic uncomplicated diverticular disease of the colon by using rifaximin, a non-adsorbable antibiotic.},
journal = {European review for medical and pharmacological sciences},
volume = {25},
number = {1},
pages = {423-430},
doi = {10.26355/eurrev_202101_24410},
pmid = {33506932},
issn = {2284-0729},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Colon/*drug effects/pathology ; Diverticular Diseases/*drug therapy/pathology ; Female ; *General Practitioners ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Rifaximin/*therapeutic use ; },
abstract = {OBJECTIVE: Symptomatic uncomplicated diverticular disease of the colon (SUDD) is generally managed by gastroenterologists rather than General Practitioners (GPs). The aim of this study was to assess the efficacy of the treatment of SUDD with rifaximin, a non-absorbable antibiotic, in a primary care setting by GPs.
PATIENTS AND METHODS: This retrospective, observational study investigated the use of rifaximin at a dose of 400 mg b.i.d. for 5, 7 or 10 days monthly, up to 3 months. The symptoms were reported by the patients using a visual analogic scale (VAS) of 0-10.
RESULTS: 286 SUDD patients were enrolled (44.4% of men, average age 70.92±10.98). Respectively, 15 (5.2%) patients received the treatment for 5 days, 205 (71.7%) for 7 days and 66 (23.1%) for 10 days. After three months, a significant reduction of VAS score was observed in almost all symptoms assessed: 135 (47.2%) patients reported no abdominal pain (p<0.001) and 23 (8.1%) reported no symptom. Adverse events related to the treatment were recorded in 3 (1.04%) patients, all of them mild and not requiring interruption of the treatment. Acute diverticulitis occurred in 9 (3.1%) patients, but only 2 of them [0.7% (n=2)] underwent surgery due to complicated diverticulitis. Analysis within the different treatment groups (5, 7 and 10 days) shows that rifaximin treatment is effective in reducing the severity of symptoms in almost all groups except for the constipation in the 5-day group.
CONCLUSIONS: Rifaximin can be effectively used by GPs in real-life for the management of SUDD.},
}
@article {pmid33505462,
year = {2021},
author = {Manigrasso, M and Pesce, M and Milone, M and Anoldo, P and D'Amore, A and Galasso, G and Gennarelli, N and Maione, F and Vertaldi, S and Sarnelli, G and De Palma, GD},
title = {Long-Term Functional Results of a Modified Caudal-to-Cranial Approach in Laparoscopic Segmental Left Colectomy for Diverticular Disease.},
journal = {Gastroenterology research and practice},
volume = {2021},
number = {},
pages = {8940682},
pmid = {33505462},
issn = {1687-6121},
abstract = {A modified caudal-to-cranial approach to perform laparoscopic left colectomy for benign diseases has been recently designed to facilitate the low-tie mesenteric dissection. A chart review has been performed including all consecutive patients with uncomplicated diverticulitis who have been treated by segmental left colectomy with a caudal-to-cranial approach. A total of 34 patients were included in the study. 21 patients were male, mean age was 54.1 ± 11.3, and mean BMI was 26 ± 5.5. Patients with ASA Score I were 7, with ASA II were 9, and with ASA Score III were 5. Incontinence Score (IS) resulted in an average of 5 ± 2, 2 grade of incontinence and the CS score showed an average of 10 ± 3, 2 grade of constipation. Health status, evaluated by Short Form-36 questionnaire, was demonstrated in these patients' great physical function, role, general health, and social function. The anorectal manometry performed 6 months after surgery showed a normal value in terms of the anal resting pressure (47 ± 13 mmHg) and an increased volume to stimulate desire to defecate (197 ± 25 ml). The length of the anal sphincter was normal compared to the reference value (37 ± 5.4 mm). Although further studies are required to obtain definitive conclusions, our results are encouraging to propose low-tie segmental colectomy as the standard procedure for the treatment of uncomplicated diverticulitis, and our modified surgical approach could be considered useful to facilitate the surgical approach.},
}
@article {pmid33504050,
year = {2021},
author = {Viscido, A and Ciccone, F and Vernia, F and Gabrieli, D and Capannolo, A and Stefanelli, G and Necozione, S and Valerii, G and Ashktorab, H and Latella, G},
title = {Association of Colonic Diverticula with Colorectal Adenomas and Cancer.},
journal = {Medicina (Kaunas, Lithuania)},
volume = {57},
number = {2},
pages = {},
pmid = {33504050},
issn = {1648-9144},
support = {U54 MD007597/MD/NIMHD NIH HHS/United States ; },
mesh = {*Adenoma/complications/epidemiology ; Aged ; *Colonic Polyps/complications/epidemiology ; Colonoscopy ; *Colorectal Neoplasms/complications/epidemiology ; *Diverticulum, Colon/complications/epidemiology ; Humans ; Male ; },
abstract = {Background and Objectives: Conflicting evidence is reported regarding any association between colonic diverticula with colorectal adenomas or cancer. The present study aimed to evaluate, in a cohort of Caucasian patients, the association between colonic diverticula and colorectal polyps and cancer. Materials and Methods: All consecutive patients undergoing colonoscopy at our institution were included in the study. The presence and location of diverticula, polyps, and cancers were recorded. Histologically, polyps were classified as adenoma (with low or high dysplasia), hyperplastic, or inflammatory. The relative risk of the association of polyps and cancer with diverticula was assessed. Multiple logistic regression analyses, including age, sex, family history for colorectal cancer (CRC), and family history for diverticula, were carried out. Results: During the study period, 1490 patients were enrolled; 37.2% (n = 555) showed colonic diverticula or polyps or CRC (308 males, mean age 66 years). Particularly, 12.3% (n = 183) patients presented only diverticula, 13.7% (n = 204) only polyps or cancer, 11.3% (n = 168) both diseases, and 62.7% (n = 935) neither diverticula nor polyps and cancer. A total of 38 patients presented colorectal cancer, 17 of which had also diverticula. A significant increase in relative risk (RR 2.81, 95% CI 2.27-3.47, p < 0.0001) of colorectal adenoma and cancer in patients with colonic diverticula was found. At multivariate analysis, only diverticula resulted to be significantly associated with colorectal adenomas and cancer (Odds Ratio, OR 3.86, 95% CI 2.90-5.14, p < 0.0001). Conclusions: A significant association of colonic diverticula with colorectal adenoma or cancer was found. This implies that patients with colonic diverticula require a vigilant follow-up procedure for the prevention of colorectal cancer from those applicable to the general population.},
}
@article {pmid33497515,
year = {2021},
author = {Goh, B and Harbison, A and Sufyan, W and Thomas, S},
title = {Perforated jejunal diverticular disease: an uncommon cause of the acute surgical abdomen.},
journal = {ANZ journal of surgery},
volume = {91},
number = {9},
pages = {E608-E609},
doi = {10.1111/ans.16618},
pmid = {33497515},
issn = {1445-2197},
mesh = {Abdomen ; *Abdomen, Acute ; *Diverticulum/complications/diagnostic imaging/surgery ; Humans ; *Intestinal Perforation/diagnostic imaging/etiology ; *Jejunal Diseases/diagnostic imaging/etiology/surgery ; },
}
@article {pmid33494679,
year = {2021},
author = {BaŞtuğ, BT},
title = {Computed Tomographic Evaluation of Colonic Diverticulum Complications.},
journal = {Current medical imaging},
volume = {17},
number = {9},
pages = {1054-1058},
doi = {10.2174/1573405617666210120091547},
pmid = {33494679},
issn = {1573-4056},
mesh = {Colon ; *Diverticular Diseases/complications ; *Diverticulitis ; *Diverticulum, Colon/complications ; Humans ; Tomography, X-Ray Computed ; },
abstract = {Cases of diverticulosis of the colon continue to increase, especially in the Western countries. In these countries, two-thirds of the population older than 70 years of age are considered to experience this disease. Medical and surgical treatment for diverticulosis actually begun for the complications of diverticulitis and lower gastrointestinal hemorrhage. The first evaluation of complicated diverticular disease is based on patient's history, physical examination, and laboratory data. But all these exams and data can be inaccurate and are often questionable in the diagnoses of many features of the disease. To describe the position, severity, and presence of complications of a detected diverticulum is crucial to its appropriate treatment. The greater part of the patients have mild disease and can be successfully cured medically. Only a small number of patients admit with acute diverticulitis and need urgent surgical intervention. Determining these patients early is crucial to morbidity and mortality reduction. Radiologic examination is important for exact evaluation of the extent of the course of the disease over the last three decades. This article aims to chart the place of the Computed Tomography (CT) imaging procedure in the assessment of acute complicated diverticular disease.},
}
@article {pmid33477073,
year = {2021},
author = {Perez, AR and Chiong-Perez, ME and Arcilla, CE and Merin, JI},
title = {Colouterine fistula: A case report of a rare complication of diverticular disease managed during the pandemic.},
journal = {International journal of surgery case reports},
volume = {79},
number = {},
pages = {150-155},
pmid = {33477073},
issn = {2210-2612},
abstract = {INTRODUCTION AND IMPORTANCE: Colouterine fistulas related to diverticulitis are very rare due to the thickness of the uterine myometrium. Other causes related to colouterine fistula formation particularly malignancy, have to be considered. Diagnosis by imaging or endoscopy may be inconclusive.
CASE PRESENTATION: We are presenting a case of a 70-year-old female who presented with malodorous vaginal discharge and painful labial lesions. No previous history of surgery, gynecologic malignancy or other possible causes of the fistula was elicited. CT scan imaging suggested a colouterine fistula. The patient was admitted and underwent Exploratory laparotomy, Hartmann's procedure and total hysterectomy with bilateral salpingo oophorectomy. The patient was discharged without perioperative complications.
CLINICAL DISCUSSION: Colouterine fistulas are extremely rare complications of diverticular disease. Diagnosis entails clinical astuteness and judicious use of imaging and endoscopic modalities. Accurate diagnosis is essential to select the appropriate surgical approach, along with intraoperative findings patient status and prevailing conditions.
CONCLUSION: This case is being presented not only for the rarity of the case but also for the complexity of the management and decision making during the period of the pandemic.},
}
@article {pmid33443079,
year = {2021},
author = {Doberer, K and Duerr, M and Halloran, PF and Eskandary, F and Budde, K and Regele, H and Reeve, J and Borski, A and Kozakowski, N and Reindl-Schwaighofer, R and Waiser, J and Lachmann, N and Schranz, S and Firbas, C and Mühlbacher, J and Gelbenegger, G and Perkmann, T and Wahrmann, M and Kainz, A and Ristl, R and Halleck, F and Bond, G and Chong, E and Jilma, B and Böhmig, GA},
title = {A Randomized Clinical Trial of Anti-IL-6 Antibody Clazakizumab in Late Antibody-Mediated Kidney Transplant Rejection.},
journal = {Journal of the American Society of Nephrology : JASN},
volume = {32},
number = {3},
pages = {708-722},
pmid = {33443079},
issn = {1533-3450},
mesh = {Adult ; Allografts ; Antibodies, Monoclonal, Humanized/adverse effects/*therapeutic use ; Double-Blind Method ; Female ; Glomerular Filtration Rate ; Graft Rejection/immunology/physiopathology/*therapy ; Humans ; Infections/etiology ; Interleukin-6/*antagonists & inhibitors/immunology ; Isoantibodies/blood ; Kidney Transplantation/*adverse effects ; Male ; Middle Aged ; Tissue Donors ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: Late antibody-mediated rejection (ABMR) is a leading cause of transplant failure. Blocking IL-6 has been proposed as a promising therapeutic strategy.
METHODS: We performed a phase 2 randomized pilot trial to evaluate the safety (primary endpoint) and efficacy (secondary endpoint analysis) of the anti-IL-6 antibody clazakizumab in late ABMR. The trial included 20 kidney transplant recipients with donor-specific, antibody-positive ABMR ≥365 days post-transplantation. Patients were randomized 1:1 to receive 25 mg clazakizumab or placebo (4-weekly subcutaneous injections) for 12 weeks (part A), followed by a 40-week open-label extension (part B), during which time all participants received clazakizumab.
RESULTS: Five (25%) patients under active treatment developed serious infectious events, and two (10%) developed diverticular disease complications, leading to trial withdrawal. Those receiving clazakizumab displayed significantly decreased donor-specific antibodies and, on prolonged treatment, modulated rejection-related gene-expression patterns. In 18 patients, allograft biopsies after 51 weeks revealed a negative molecular ABMR score in seven (38.9%), disappearance of capillary C4d deposits in five (27.8%), and resolution of morphologic ABMR activity in four (22.2%). Although proteinuria remained stable, the mean eGFR decline during part A was slower with clazakizumab compared with placebo (-0.96; 95% confidence interval [95% CI], -1.96 to 0.03 versus -2.43; 95% CI, -3.40 to -1.46 ml/min per 1.73 m[2] per month, respectively, P=0.04). During part B, the slope of eGFR decline for patients who were switched from placebo to clazakizumab improved and no longer differed significantly from patients initially allocated to clazakizumab.
CONCLUSIONS: Although safety data indicate the need for careful patient selection and monitoring, our preliminary efficacy results suggest a potentially beneficial effect of clazakizumab on ABMR activity and progression.},
}
@article {pmid33433072,
year = {2021},
author = {Bracale, U and Peltrini, R and DI Nuzzo, MM and Altieri, G and Silvestri, V and Dolce, P and D'Ambra, M and Lionetti, R and Corcione, F},
title = {Risk of anastomotic bleeding after left colectomy with preservation of inferior mesenteric artery for diverticular disease: preliminary results.},
journal = {Minerva surgery},
volume = {76},
number = {4},
pages = {310-315},
doi = {10.23736/S2724-5691.20.08645-9},
pmid = {33433072},
issn = {2724-5438},
mesh = {Anastomotic Leak ; Colectomy/adverse effects ; *Diverticular Diseases ; Humans ; *Mesenteric Artery, Inferior/surgery ; Retrospective Studies ; },
abstract = {BACKGROUND: The inferior mesenteric artery (IMA) preservation in elective laparoscopic left colectomy for diverticular disease may reduce the risk of anastomotic leakage. However, an increased risk of bleeding is assumed. The aim of this study was to investigate the risk of colorectal anastomosis bleeding when IMA is resected or preserved during left colectomy.
METHODS: A retrospective study of a prospectively collected database was performed. All patients who underwent elective left colectomy, from December 2018 to September 2020 were included. Patients' data and clinical information were collected and analyzed. Patients were categorized in two groups: IMA resected (IMA-R) and IMA preserving (IMA-P) left colectomy. Perioperative outcomes between the two groups were compared.
RESULTS: Sixty-three consecutive patients who underwent left colectomy over a period of three years were enrolled: 42 in IMA-R group and 22 in the IMA-P group. There were no significant differences in demographic and intraoperative characteristics between the two groups, except for patients' age and primary disease. Six patients (9.37%) developed anastomotic bleeding during recovery, more frequently in the IMA-P than IMA-R group, although the difference is not statistically significative (13.6% and 7.3%; P=0.406). All bleedings were self-limited and only one needed red blood cells transfusion. Using the bioabsorbable staple line reinforcement (BSLR) has proved to be advantageous in preventing anastomotic bleeding in the IMA-P group.
CONCLUSIONS: IMA preserving left colectomy seems to be associated with a higher risk of mostly self-limited anastomotic bleeding during recovery. BSLR seems to be effective in this group of patients.},
}
@article {pmid33412260,
year = {2021},
author = {Brand, DH and Brüningk, SC and Wilkins, A and Fernandez, K and Naismith, O and Gao, A and Syndikus, I and Dearnaley, DP and Tree, AC and van As, N and Hall, E and Gulliford, S and , },
title = {Estimates of Alpha/Beta (α/β) Ratios for Individual Late Rectal Toxicity Endpoints: An Analysis of the CHHiP Trial.},
journal = {International journal of radiation oncology, biology, physics},
volume = {110},
number = {2},
pages = {596-608},
pmid = {33412260},
issn = {1879-355X},
support = {C1491/A15955/CRUK_/Cancer Research UK/United Kingdom ; SP2312/021/CRUK_/Cancer Research UK/United Kingdom ; C1491/A25351/CRUK_/Cancer Research UK/United Kingdom ; 10588/CRUK_/Cancer Research UK/United Kingdom ; 12518/CRUK_/Cancer Research UK/United Kingdom ; 7253/CRUK_/Cancer Research UK/United Kingdom ; C1491/A9895/CRUK_/Cancer Research UK/United Kingdom ; /DH_/Department of Health/United Kingdom ; },
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anal Canal/physiopathology/radiation effects ; Diarrhea/complications ; Dose Fractionation, Radiation ; Gastrointestinal Hemorrhage/complications ; Humans ; Linear Models ; Male ; Middle Aged ; Organs at Risk/*radiation effects ; Outcome Assessment, Health Care ; Probability ; Proctitis/complications ; Prostatic Neoplasms/*radiotherapy ; Radiation Injuries/complications ; *Radiation Tolerance ; Rectum/diagnostic imaging/*radiation effects ; Urethral Stricture/complications ; },
abstract = {PURPOSE: Changes in fraction size of external beam radiation therapy exert nonlinear effects on subsequent toxicity. Commonly described by the linear-quadratic model, fraction size sensitivity of normal tissues is expressed by the α/β ratio. We sought to study individual α/β ratios for different late rectal effects after prostate external beam radiation therapy.
METHODS AND MATERIALS: The CHHiP trial (ISRCTN97182923) randomized men with nonmetastatic prostate cancer 1:1:1 to 74 Gy/37 fractions (Fr), 60 Gy/20 Fr, or 57 Gy/19 Fr. Patients in the study had full dosimetric data and zero baseline toxicity. Toxicity scales were amalgamated to 6 bowel endpoints: bleeding, diarrhea, pain, proctitis, sphincter control, and stricture. Lyman-Kutcher-Burman models with or without equivalent dose in 2 Gy/Fr correction were log-likelihood fitted by endpoint, estimating α/β ratios. The α/β ratio estimate sensitivity was assessed using sequential inclusion of dose modifying factors (DMFs): age, diabetes, hypertension, inflammatory bowel or diverticular disease (IBD/diverticular), and hemorrhoids. 95% confidence intervals (CIs) were bootstrapped. Likelihood ratio testing of 632 estimator log-likelihoods compared the models.
RESULTS: Late rectal α/β ratio estimates (without DMF) ranged from bleeding (G1 + α/β = 1.6 Gy; 95% CI, 0.9-2.5 Gy) to sphincter control (G1 + α/β = 3.1 Gy; 95% CI, 1.4-9.1 Gy). Bowel pain modelled poorly (α/β, 3.6 Gy; 95% CI, 0.0-840 Gy). Inclusion of IBD/diverticular disease as a DMF significantly improved fits for stool frequency G2+ (P = .00041) and proctitis G1+ (P = .00046). However, the α/β ratios were similar in these no-DMF versus DMF models for both stool frequency G2+ (α/β 2.7 Gy vs 2.5 Gy) and proctitis G1+ (α/β 2.7 Gy vs 2.6 Gy). Frequency-weighted averaging of endpoint α/β ratios produced: G1 + α/β ratio = 2.4 Gy; G2 + α/β ratio = 2.3 Gy.
CONCLUSIONS: We estimated α/β ratios for several common late adverse effects of rectal radiation therapy. When comparing dose-fractionation schedules, we suggest using late a rectal α/β ratio ≤ 3 Gy.},
}
@article {pmid33409567,
year = {2021},
author = {Mastoraki, A and Schizas, D and Tousia, A and Chatzopoulos, G and Gkiala, A and Syllaios, A and Frountzas, M and Vassiliu, P and Theodoropoulos, GE and Felekouras, E},
title = {Evaluation of molecular and genetic predisposing parameters at diverticular disease of the colon.},
journal = {International journal of colorectal disease},
volume = {36},
number = {5},
pages = {903-910},
pmid = {33409567},
issn = {1432-1262},
mesh = {Colon ; *Diverticular Diseases/genetics ; *Diverticulitis ; *Diverticulitis, Colonic/genetics ; *Diverticulum ; *Gastrointestinal Microbiome ; Humans ; },
abstract = {BACKGROUND: Diverticular disease (DD) refers to the presence of diverticula throughout the gastrointestinal (GI) tract, mainly along colon. DD might evolve into diverticulitis that is accompanied by severe clinical presentation, which includes abscess formation, perforation, stricture, obstruction and/or fistula.
AIM: The aim of the present review is to summarize the role of molecular and genetic factors in DD development, as well as their possible contribution towards new prognostic indicators, diagnostic algorithms and new therapeutic approaches.
METHODS AND RESULTS: Except from common predisposing parameters, several genetic mutations, immune factors, neurotransmitters, hormones and protein dysfunctions have been associated to the early onset of DD symptoms, pathogenesis and prognosis of the disease. Specific structural changes in the colonic wall, altered matrix composition and compromised motility have been verified as possible pathogenic factors for the development of DD. Dysregulation in peristaltic activity and reduced ability of the longitudinal muscle to relax following contraction has been also associated with DD evolution. In addition, it has been suspected that genetic defects combined with alterations in intestinal microbiota might play an important role in diverticulitis presentation.},
}
@article {pmid33408751,
year = {2020},
author = {Giacosa, A and Riva, A and Petrangolini, G and Allegrini, P and Fazia, T and Bernardinelli, L and Gasparri, C and Faliva, MA and Peroni, G and Perna, S and Rondanelli, M},
title = {Symptomatic uncomplicated diverticular disease management: an innovative food-grade formulation of Curcuma longa and Boswellia serrata extracts.},
journal = {Drugs in context},
volume = {9},
number = {},
pages = {},
pmid = {33408751},
issn = {1745-1981},
abstract = {BACKGROUND: The treatment of symptomatic uncomplicated colonic diverticular disease (SUDD) is still under debate, and new data show a pathogenic role of dysbiosis and low-grade inflammation in intestinal mucosa. Recent research has highlighted the anti-inflammatory effects of botanical extracts such as Curcuma longa L. and Boswellia serrata Roxb. ex Colebr. The aim of this work is to investigate the potential role of a new delivery formulation of the association of curcumin and boswellia phytosome extracts (CBP) in SUDD.
METHODS: In a 30-day one-group longitudinal explanatory study, patients (men and women) were treated with an innovative association of CBP standardized extracts, 500 mg bid.
RESULTS: Treatment of SUDD with the association of CBP was followed by a significant decrease in abdominal pain (p<0.0001). The study group showed that CBP supplementation was efficacious within 10 days and that efficacy was maintained almost constant until the 30th day of intervention.
CONCLUSION: A phytosome of curcumin and boswellia extracts may be useful for the relief of SUDD pain. However, controlled studies should be performed for final conclusions to be drawn.},
}
@article {pmid33407154,
year = {2021},
author = {Yoshida, A and Uchima, Y and Hosaka, N and Minaga, K and Kudo, M},
title = {Transverse colonic volvulus due to mesenteric fibromatosis: a case report.},
journal = {BMC gastroenterology},
volume = {21},
number = {1},
pages = {11},
pmid = {33407154},
issn = {1471-230X},
mesh = {*Colon, Transverse/diagnostic imaging/surgery ; *Colonic Diseases ; Female ; *Fibroma ; Humans ; *Intestinal Obstruction ; *Intestinal Volvulus/diagnostic imaging/etiology/surgery ; Middle Aged ; },
abstract = {BACKGROUND: Colonic volvulus, a condition in which a colonic segment partially twists around its base, is the third leading cause of large bowel obstruction after colonic neoplasms and diverticular disease. However, volvulus of the transverse colon is the rarest type of large intestinal volvulus. Moreover, the occurrence of transverse colonic volvulus secondary to a benign tumor originating from outside the intestine has never been reported. We hereby report a case of transverse colonic volvulus caused by mesenteric fibromatosis.
CASE PRESENTATION: A 53-year-old female with a history of rheumatoid arthritis and thyroid tumor presented with abdominal pain for 1 day. Abdominal computed tomography revealed intestinal torsion at the hepatic flexure. Twisted and obstructed mucosa of the transverse colon was observed during colonoscopy, but no tumor invasion of the mucosal surface was detected. A solid mass of a mesenteric origin with involvement of the transverse colon was observed during surgery. The mass was diagnosed surgically as transverse colonic volvulus induced by a mesenteric tumor. Hence, the patient underwent a right hemicolectomy. Histopathological results indicated mesenteric desmoid-type fibromatosis. The postoperative recovery was uneventful, and the patient was discharged 8 days after surgery.
CONCLUSIONS: Although mesenteric fibromatosis is rare, this disease should be considered when managing transverse colonic volvulus resulting from nonmucosal tumors.},
}
@article {pmid33386566,
year = {2021},
author = {Kobayashi, S and Sugiura, K and Miyake, H and Yuasa, N and Yoshikawa, K and Fujino, M},
title = {Mucosal prolapse syndrome-like inflammatory polyp protruding from the appendiceal orifice masquerading as an appendiceal neoplasm: A rare case report.},
journal = {Clinical journal of gastroenterology},
volume = {14},
number = {3},
pages = {787-790},
pmid = {33386566},
issn = {1865-7265},
mesh = {*Appendiceal Neoplasms/diagnostic imaging/surgery ; *Appendix/diagnostic imaging ; *Diverticulitis ; Humans ; Inflammation ; Male ; Middle Aged ; Prolapse ; },
abstract = {We describe a case of a mucosal prolapse syndrome (MPS)-like inflammatory polyp protruding from the appendiceal orifice, mimicking an appendiceal neoplasm. A 48-year-old man presented with lower abdominal pain and elevated white blood cell count and C-reactive protein level. Computed tomography showed a swollen appendix with multiple small saccular lesions and periappendiceal fat stranding and small saccular lesions in the ascending colon and cecum. Ultrasonography showed a swollen appendix 25 mm in diameter with multiple saccular structures and a periappendiceal high-echoic area, suggesting appendiceal diverticulitis. Colonoscopy revealed an erythematous lesion protruding from the appendiceal orifice. An ileocecal resection was performed based on a preoperative diagnosis of appendiceal diverticulitis and tumor. Histopathological examination of the appendix showed multiple mucosal herniations with infiltration of inflammatory cells, indicating appendiceal diverticulitis. The tumor was characterized by glandular duct hyperplasia and stromal expansion with smooth muscle hyperplasia and was diagnosed as an inflammatory polyp resembling an MPS lesion. Although several studies have shown the macroscopic and endoscopic appearance of MPS-like inflammatory lesions associated with colonic diverticular disease, this case was the first to present an inflammatory polyp associated with appendiceal diverticulitis in which the lesion protruding from the appendiceal orifice was masquerading as an appendiceal neoplasm.},
}
@article {pmid33364886,
year = {2020},
author = {Demircioglu, MK and Demircioglu, ZG and Celayir, MF and Kaya, C and Mihmanli, M},
title = {The Effects of Diverticulum Localization and Hinchey Classification on Recurrence and Complications in Acute Colonic Diverticulitis.},
journal = {Sisli Etfal Hastanesi tip bulteni},
volume = {54},
number = {4},
pages = {451-456},
pmid = {33364886},
issn = {1302-7123},
abstract = {OBJECTIVES: Diverticular disease of the colon is a pathology that arises from outward ballooning of the mucosa due to some weakness in the muscle layer. Diverticular disease may range from symptomatic uncomplicated diverticular disease to symptomatic disease with complications, such as acute diverticulitis or diverticular bleeding. Acute colonic diverticulitis occurs in about 10- 25% of patients.
METHODS: In this study, 134 patients who were admitted to our emergency clinic with complaints of abdominal pain between 2016-2019 and hospitalized with the diagnosis of acute diverticulitis were included. Patients' sex, age, presence of additional disease, increase in leukocyte and C-reactive protein (CRP), localization of diverticulitis, Hinchey classification, mean length of hospital stay and treatment were evaluated. The effects of these parameters on complications and recurrence were statistically analyzed.
RESULTS: The length of hospital stay was statistically significantly associated positively with the Hinchey classification (p<0.001). While 18 patients who were medically treated developed recurrence later, and this rate was statistically significant (p<0.001). When one of the factors, localization, which may play a role in the severity of the disease and recurrence are examined, was evaluated concerning its results in our study, we found that rectosigmoid location is an important factor for recurrence. We found that the localization in the colon and the severity of the disease were effective in the prognosis of acute diverticulitis.
CONCLUSION: We believe that localization and the severity of the disease should be taken into consideration when planning surgery in these patients.},
}
@article {pmid33362446,
year = {2020},
author = {Sammartino, F and Selvaggio, I and Montalto, GM and Pasecinic, C and Dhimolea, S and Krizzuk, D},
title = {Acute Abdomen in a 91-Year-Old Male due to Perforated Jejunal Diverticulitis.},
journal = {Case reports in gastroenterology},
volume = {14},
number = {3},
pages = {598-603},
pmid = {33362446},
issn = {1662-0631},
abstract = {Non-Meckel small intestine diverticular disease is a rare and mostly asymptomatic condition. However, rare cases of acute and emergent complications bear a high mortality rate. We report a case of a 91-year-old male that presented with an acute abdomen due to perforated jejunal diverticulitis. A review of the literature and key points of the condition are depicted. Although jejunal diverticulosis is rare, it must be considered in the differential diagnosis, especially in the elderly with signs of ambiguous abdominal pain and peritonitis.},
}
@article {pmid33306534,
year = {2021},
author = {Hunt, CW and Chaturvedi, R and Brown, L and Stafford, C and Cauley, CE and Goldstone, RN and Francone, TD and Kunitake, H and Bordeianou, L and Ricciardi, R},
title = {Diverticular Disease Epidemiology: Rising Rates of Diverticular Disease Mortality Across Developing Nations.},
journal = {Diseases of the colon and rectum},
volume = {64},
number = {1},
pages = {81-90},
pmid = {33306534},
issn = {1530-0358},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cost of Illness ; Databases, Factual ; Developed Countries/statistics & numerical data ; Developing Countries/economics/*statistics & numerical data ; Diet/statistics & numerical data ; Diverticular Diseases/economics/*mortality ; Female ; Global Health/economics/statistics & numerical data ; Health Expenditures/statistics & numerical data ; *Health Status Disparities ; Humans ; Male ; Middle Aged ; Overweight/economics/epidemiology ; World Health Organization ; },
abstract = {BACKGROUND: The incidence of diverticular disease is growing in the Western world. However, the global burden of disease is unknown in the developing world.
OBJECTIVE: This study aimed to determine the global burden of diverticular disease as measured by disease-specific mortality while identifying indicators of rising disease rates.
DESIGN: We undertook an ecological analysis based on data from the World Health Organization Mortality Database. Then, we analyzed global age-adjusted mortality rates from diverticular disease and compared them to national rates of overweight adults, health expenditures, and dietary composition.
SETTINGS: National vital statistics data were collected.
PATIENTS: Diverticular disease deaths from January 1, 1994 through December 31, 2016 were evaluated.
MAIN OUTCOME MEASURES: The primary outcome measured was the national age-adjusted mortality rate.
RESULTS: The average age-adjusted mortality rate for diverticular disease was 0.51 ± 0.31/100,000 with a range of 0.11 to 1.75/100,000. During the study period, we noted that 57% of nations had increasing diverticular disease mortality rates, whereas only 7% had decreasing rates. More developed nations (40%) than developing nations (24%) were categorized as having high diverticular disease mortality burden over the time period of the study, and developed nations had higher percentages of overweight adults (58.9 ± 3.1%) than developing nations (50.6 ± 6.7%; p < 0.0001). However, developing nations revealed more rapid increases in diverticular disease mortality (0.027 ± 0.024/100,000 per year) than developed nations (0.005 ± 0.025/100,000 per year; p = 0.001), as well as faster expanding proportions of overweight adults (0.76 ± 0.12% per year) than in already developed nations (0.53 ± 0.10% per year; p<0.0001).
LIMITATIONS: Ecological studies cannot define cause and effect.
CONCLUSIONS: There is considerable variability in diverticular disease mortality across the globe. Developing nations were characterized by rapid increases in diverticular disease mortality and expanding percentages of overweight adults. Public health interventions in developing nations are needed to alter mortality rates from diverticular disease. See Video Abstract at http://links.lww.com/DCR/B397. EPIDEMIOLOGÍA DE LA ENFERMEDAD DIVERTICULAR: TASAS CRECIENTES DE MORTALIDAD POR ENFERMEDAD DIVERTICULAR EN LOS PAÍSES EN DESARROLLO: La incidencia de la enfermedad diverticular está creciendo en el mundo occidental. Sin embargo, la carga mundial de la enfermedad es desconocida en el mundo en desarrollo.Determinar la carga global de la enfermedad diverticular medida por la mortalidad específica de la enfermedad mientras se identifican los indicadores de aumento de las tasas de enfermedad.Realizamos un análisis ecológico basado en datos de la Base de datos de mortalidad de la Organización Mundial de la Salud. Luego, analizamos las tasas globales de mortalidad ajustadas por edad por enfermedad diverticular y las comparamos con las tasas nacionales de adultos con sobrepeso, gastos de salud y composición dietética.Datos nacionales de estadísticas vitales.Muertes por enfermedades diverticulares desde el 1 de enero de 1994 hasta el 31 de diciembre de 2016.Tasa nacional de mortalidad ajustada por edad.La tasa promedio de mortalidad ajustada por edad para la enfermedad diverticular fue de 0,51 ± 0,31 / 100,000 con un rango de 0,11 a 1,75 / 100,000. Durante el período de estudio, notamos que el 57% de las naciones tenían tasas crecientes de mortalidad por enfermedades diverticulares, mientras que solo el 7% tenían tasas decrecientes. Las naciones más desarrolladas (40%) que las naciones en desarrollo (24%) se clasificaron como que tienen una alta carga de mortalidad por enfermedad diverticular durante el período de tiempo del estudio, y las naciones desarrolladas tuvieron porcentajes más altos de adultos con sobrepeso (58.9 ± 3.1%) que las naciones en desarrollo (50,6 ± 6,7%) (p <0,0001). Sin embargo, las naciones en desarrollo revelaron aumentos más rápidos en la mortalidad por enfermedades diverticulares (0.027 ± 0.024 / 100,000 por año) que las naciones desarrolladas (0.005 ± 0.025 / 100,000 por año) (p = 0.001), así como proporciones de adultos con sobrepeso en expansión más rápida (0.76 ± 0.12% por año) que en las naciones ya desarrolladas (0.53 ± 0.10% por año) (p <0.0001).Los estudios ecológicos no pueden definir causa y efecto.Existe una considerable variabilidad en la mortalidad por enfermedad diverticular en todo el mundo. Los países en desarrollo se caracterizaron por un rápido aumento en la mortalidad por enfermedades diverticulares y porcentajes crecientes de adultos con sobrepeso. Se necesitan intervenciones de salud pública en los países en desarrollo para alterar las tasas de mortalidad por enfermedad diverticular. Consulte Video Resumen en http://links.lww.com/DCR/B397.},
}
@article {pmid33294164,
year = {2020},
author = {Ghandour, R and Khalifeh, G and Orm, NB and Rakka, M and Dbouk, S and El Sahili, R and Mcheimeche, H},
title = {Jejunal diverticular disease: a report of three cases.},
journal = {Journal of surgical case reports},
volume = {2020},
number = {11},
pages = {rjaa472},
pmid = {33294164},
issn = {2042-8812},
abstract = {Jejunal diverticula (JD) are a rare medical entity. They are often unnoticed, until complications occur. We report herein three cases of such diverticula, analyzed retrospectively, and depicting some of these complications: small bowel obstruction due to enterolith in a giant diverticulum treated surgically, incidental intraoperative finding on an anastomotic jejunal limb affecting the surgical plan and diverticulitis with anemia. In all three cases, the diagnosis of JD was unexpected, which illustrates the importance of being familiar with this disease for adequate management.},
}
@article {pmid33279517,
year = {2021},
author = {Peery, AF and Shaukat, A and Strate, LL},
title = {AGA Clinical Practice Update on Medical Management of Colonic Diverticulitis: Expert Review.},
journal = {Gastroenterology},
volume = {160},
number = {3},
pages = {906-911.e1},
pmid = {33279517},
issn = {1528-0012},
support = {K23 DK113225/DK/NIDDK NIH HHS/United States ; R01 DK094738/DK/NIDDK NIH HHS/United States ; R01 DK101495/DK/NIDDK NIH HHS/United States ; },
mesh = {Anti-Bacterial Agents/*therapeutic use ; Aspirin/therapeutic use ; Cardiovascular Diseases/etiology/prevention & control ; Colon/diagnostic imaging/drug effects/immunology/pathology ; Colonoscopy ; Diagnosis, Differential ; Diet Therapy/methods/*standards ; Diverticulitis, Colonic/complications/diagnosis/genetics/*therapy ; Evidence-Based Medicine/methods/*standards ; Gastroenterology/methods/*standards ; Humans ; Intestinal Mucosa/diagnostic imaging/drug effects/immunology/pathology ; Meta-Analysis as Topic ; Observational Studies as Topic ; Patient Education as Topic/standards ; Randomized Controlled Trials as Topic ; Secondary Prevention/methods ; Severity of Illness Index ; Societies, Medical/standards ; Systematic Reviews as Topic ; United States ; },
abstract = {Colonic diverticulitis is a painful gastrointestinal disease that recurs unpredictably and can lead to chronic gastrointestinal symptoms. Gastroenterologists commonly care for patients with this disease. The purpose of this Clinical Practice Update is to provide practical and evidence-based advice for management of diverticulitis. We reviewed systematic reviews, meta-analyses, randomized controlled trials, and observational studies to develop 14 best practices. In brief, computed tomography is often necessary to make a diagnosis. Rarely, a colon malignancy is misdiagnosed as diverticulitis. Whether patients should have a colonoscopy after an episode of diverticulitis depends on the patient's history, most recent colonoscopy, and disease severity and course. In patients with a history of diverticulitis and chronic symptoms, alternative diagnoses should be excluded with both imaging and lower endoscopy. Antibiotic treatment can be used selectively rather than routinely in immunocompetent patients with mild acute uncomplicated diverticulitis. Antibiotic treatment is strongly advised in immunocompromised patients. To reduce the risk of recurrence, patients should consume a high-quality diet, have a normal body mass index, be physically active, not smoke, and avoid nonsteroidal anti-inflammatory drug use except aspirin prescribed for secondary prevention of cardiovascular disease. At the same time, patients should understand that genetic factors also contribute to diverticulitis risk. Patients should be educated that the risk of complicated diverticulitis is highest with the first presentation. An elective segmental resection should not be advised based on the number of episodes. Instead, a discussion of elective segmental resection should be personalized to consider severity of disease, patient preferences and values, as well as risks and benefits.},
}
@article {pmid33237324,
year = {2021},
author = {Ur Rahman, A and Hussain, I and Hasan, B and Ur Rashid, M and Tandon, KS and Castro, F},
title = {Association of Complicated Diverticulitis With Development of De Novo Inflammatory Bowel Disease.},
journal = {Inflammatory bowel diseases},
volume = {27},
number = {7},
pages = {1061-1067},
doi = {10.1093/ibd/izaa299},
pmid = {33237324},
issn = {1536-4844},
mesh = {*Diverticulitis/epidemiology/etiology ; Humans ; Incidence ; *Inflammatory Bowel Diseases/complications ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND: There has been a historic similarity in the epidemiology and pathophysiology of diverticular disease and inflammatory bowel disease (IBD). Because there are limited to no data on the role of diverticulitis as a potential risk factor for de novo IBD, we aimed to evaluate the role of diverticulitis and complicated diverticulitis as a potential predictor of IBD.
METHODS: We performed a retrospective, single-center study including patients older than age 18 years who were diagnosed with diverticulitis from January 2012 until December 2018 without a prior diagnosis of IBD. These patients were then evaluated for development of IBD. Univariate and multivariate analyses were conducted to compare the characteristics and outcomes between patients who did or did not develop IBD.
RESULTS: A total of 2770 patients were diagnosed with diverticulitis from 2012 until 2018. Of these patients, 17 were diagnosed with IBD, resulting in an incidence rate of 0.23% per patient-year. The incidence rate among patients who required surgery for diverticulitis was 0.44% per patient-year, and patients with complicated diverticulitis had an incidence rate of 0.91% per patient-year. Univariate analysis showed that the need for surgery related to diverticulitis (hazard ratio [HR], 6.27; P = 0.003) and complicated diverticulitis was associated with the development of IBD (HR, 14.71; P < 0.001). Multivariate analysis showed that complicated diverticulitis was the sole factor associated with IBD (HR, 10.34; P < 0.001).
CONCLUSIONS: Patients with diverticulitis are at a higher risk of developing de novo IBD. This risk is highest in patients with complicated diverticulitis.},
}
@article {pmid33216498,
year = {2020},
author = {Sell, NM and Perez, NP and Stafford, CE and Chang, D and Bordeianou, LG and Francone, TD and Kunitake, H and Ricciardi, R},
title = {Are There Variations in Mortality From Diverticular Disease By Sex?.},
journal = {Diseases of the colon and rectum},
volume = {63},
number = {9},
pages = {1285-1292},
doi = {10.1097/DCR.0000000000001711},
pmid = {33216498},
issn = {1530-0358},
mesh = {Abdominal Abscess/epidemiology/*mortality ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Child ; Child, Preschool ; Cohort Studies ; Diverticulitis, Colonic/*mortality ; Female ; Hospices ; Hospitals ; Humans ; Intestinal Fistula/epidemiology/mortality ; Intestinal Obstruction/epidemiology/*mortality ; Intestinal Perforation/epidemiology/mortality ; Male ; Middle Aged ; Nursing Homes ; Pelvis ; Retrospective Studies ; Sepsis/epidemiology/*mortality ; Sex Distribution ; Sex Factors ; United States/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: Previous data reveal that females account for a disproportionate majority of all patients diagnosed with diverticulitis.
OBJECTIVE: This study analyzed the variation in mortality from diverticular disease by sex.
DESIGN: This was a nationwide retrospective cohort study.
SETTINGS: Data were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research national registry.
PATIENTS: All citizens of the United States who died from an underlying cause of death of diverticulitis between January 1999 and December 2016 were included.
MAIN OUTCOME MEASURES: The primary outcome addressed was overall mortality rate of diverticulitis by sex. Secondary outcomes included pattern variances in demographics and secondary causes of death.
RESULTS: During the study period, 55,096 patients (0.12%) died with an underlying cause of death of diverticulitis from a total of 44,915,066 deaths. Compared with other causes, females were disproportionally more likely to die from diverticulitis than males (0.17% females vs 0.08% males; p < 0.001). Age-adjusted incidence of death was higher for females compared with males. Female patients were less likely to die within the hospital compared with males (OR = 0.72 (95% CI, 0.69-0.75); p < 0.001). Conversely, female patients were more likely to die either at nursing homes or hospice facilities (OR = 1.64 (95% CI, 1.55-1.73); p < 0.001). In addition, females with an underlying cause of death of diverticulitis were less likely to have a surgical complication as their secondary cause of death (OR = 0.72 (95% CI, 0.66-0.78); p < 0.001) but more likely to have nonsurgical complications related to diverticulitis such as sepsis (OR = 1.04 (95% CI, 1.01-1.05); p < 0.03), nonsurgical GI disorders such as obstruction (OR = 1.16 (95% CI, 1.09-1.24); p < 0.001), or chronic pelvic fistulizing disease (OR = 1.43 (95% CI, 1.23-1.66); p < 0.001).
LIMITATIONS: The study was limited by a lack of more specific clinical data.
CONCLUSIONS: Females have a higher incidence of diverticular disease mortality. Their deaths are more commonly secondary to nonsurgical infections, obstruction, or pelvic fistulae. Female patients represent a particularly vulnerable population that may benefit from more intensive diverticulitis evaluation. See Video Abstract at http://links.lww.com/DCR/B257. ¿EXISTEN VARIACIONES EN LA MORTALIDAD POR ENFERMEDAD DIVERTICULAR POR GÉNERO?: Los datos anteriores revelan que las mujeres representan una mayoría desproporcionada de todos los pacientes diagnosticados con diverticulitis.Este estudio analizó la variación en la mortalidad por enfermedad diverticular por género.Estudio de cohorte retrospectivo a nivel nacional.Los datos se obtuvieron del registro nacional WONDER del Centro de Control de Enfermedades.Se incluyeron todos los ciudadanos de los Estados Unidos que murieron por una causa subyacente de muerte (UCOD por sus siglas en inglés) de diverticulitis del 1 / 1999-12 / 2016.El resultado primario abordado fue la tasa de mortalidad general de la diverticulitis por género. Los resultados secundarios incluyeron variaciones de patrones en la demografía y causas secundarias de muerte.Falta de datos clínicos más específicos.Durante el período de estudio, 55.096 pacientes (0,12%) murieron con un UCOD de diverticulitis de un total de 44.915.066 muertes. En comparación con otras causas, las mujeres tenían una probabilidad desproporcionadamente mayor de morir de diverticulitis que los hombres (0.17% F vs. 0.08% M, p <0.001). La incidencia de muerte ajustada por edad fue mayor para las mujeres que para los hombres. Las pacientes femeninas tenían menos probabilidades de morir en el hospital en comparación con los hombres (OR 0.72, IC 0.69-0.75, p <0.001). Por el contrario, las pacientes femeninas tenían más probabilidades de morir en asilos de ancianos o en centros de cuidados paliativos (OR 1.64, IC 1.55-1.73, p <0.001). Además, las mujeres con una UCOD de diverticulitis tenían menos probabilidades de tener una complicación quirúrgica como causa secundaria de muerte (OR 0.72, CI 0.66-0.78, p <0.001) pero más probabilidades de tener complicaciones no quirúrgicas relacionadas con la diverticulitis, como sepsis (OR 1.04, CI 1.01-1.05, p <0.03), trastornos gastrointestinales no quirúrgicos como obstrucción (OR 1.16, CI 1.09-1.24, p <0.001), o enfermedad fistulizante pélvica crónica (OR 1.43, CI 1.23-1.66, p <0,001).Las mujeres tienen una mayor incidencia de mortalidad por enfermedad diverticular. Sus muertes son más comúnmente secundarias a infecciones no quirúrgicas, obstrucción o fístulas pélvicas. Las pacientes femeninas representan una población particularmente vulnerable que puede beneficiarse de una evaluación más intensiva de diverticulitis. Consulte Video Resumen en http://links.lww.com/DCR/B257.},
}
@article {pmid33213768,
year = {2021},
author = {Wan, D and Krisko, T},
title = {Diverticulosis, Diverticulitis, and Diverticular Bleeding.},
journal = {Clinics in geriatric medicine},
volume = {37},
number = {1},
pages = {141-154},
doi = {10.1016/j.cger.2020.08.011},
pmid = {33213768},
issn = {1879-8853},
mesh = {Abdominal Pain/*etiology ; Aged ; Colon/*pathology ; *Diverticular Diseases/diagnosis/therapy ; *Diverticulum ; Humans ; },
abstract = {Diverticulosis is an anatomic change in the colon that is characterized by outpouching of the mucosa and submucosa through the muscularis. Its prevalence increases with age so most of the elderly patients have this condition. Although diverticulosis is common, diverticular disease, in which there are clinical sequelae, is rare. This collective term includes diverticulitis, diverticular hemorrhage and less well-defined entities such as segmental colitis associated with diverticulosis, and symptomatic uncomplicated diverticular disease. Diverticulitis presents as acute lower abdominal pain, and initial management traditionally includes antibiotics, with surgery reserved for complicated disease, although newer evidence questions the optimal role and timing of both interventions.},
}
@article {pmid33189181,
year = {2021},
author = {Aziz, I and Simrén, M},
title = {The overlap between irritable bowel syndrome and organic gastrointestinal diseases.},
journal = {The lancet. Gastroenterology & hepatology},
volume = {6},
number = {2},
pages = {139-148},
doi = {10.1016/S2468-1253(20)30212-0},
pmid = {33189181},
issn = {2468-1253},
mesh = {Blind Loop Syndrome/complications/*diagnosis ; Celiac Disease/complications/*diagnosis ; Colitis, Microscopic/complications/*diagnosis ; Colorectal Neoplasms/complications/*diagnosis ; Diagnosis, Differential ; Humans ; Inflammatory Bowel Diseases/complications/*diagnosis ; Irritable Bowel Syndrome/complications/*diagnosis ; },
abstract = {Irritable bowel syndrome (IBS) is a common functional bowel disorder characterised by symptoms of recurrent abdominal pain associated with a change in bowel habit. This condition is one of the most frequent reasons to seek a gastroenterology consultation in primary and secondary care. The diagnosis of IBS is made by identifying characteristic symptoms, as defined by the Rome criteria, and excluding organic gastrointestinal diseases that might otherwise explain these symptoms. Organic conditions that can be mistaken for IBS include coeliac disease, inflammatory bowel disease (IBD), colorectal cancer, and, in those with diarrhoea-predominant symptoms, chronic gastrointestinal infections, microscopic colitis, and primary bile acid diarrhoea. The concept of small intestinal bacterial overgrowth being associated with IBS is shrouded with controversy and uncertainty, mainly because of invalid tests due to poor sensitivity and specificity, potentially leading to incorrect assumptions. There is insufficient evidence to link IBS-type symptoms with exocrine pancreatic insufficiency or with symptomatic uncomplicated diverticular disease, since both are hampered by conflicting data. Finally, there is growing appreciation that IBS can present in patients with known but stable organic gastrointestinal diseases, such as quiescent IBD or coeliac disease. Recognising functional gut symptoms in these individuals is paramount so that potentially harmful escalations in immunosuppressive therapy can be avoided and attention can be focused on addressing disorders of gut-brain interaction. This Review endeavours to aid clinicians who practise adult gastroenterology in recognising the potential overlap between IBS and organic gastrointestinal diseases and highlights areas in need of further research and clarity.},
}
@article {pmid33185931,
year = {2021},
author = {Formisano, G and Giuliani, G and Salaj, A and Salvischiani, L and Ferraro, L and Luca, M and Bianchi, PP},
title = {Robotic elective colectomy for diverticular disease: short-term outcomes of 80 patients.},
journal = {The international journal of medical robotics + computer assisted surgery : MRCAS},
volume = {17},
number = {2},
pages = {e2204},
doi = {10.1002/rcs.2204},
pmid = {33185931},
issn = {1478-596X},
mesh = {Colectomy ; *Diverticular Diseases ; Humans ; *Laparoscopy ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; *Robotic Surgical Procedures ; Treatment Outcome ; },
abstract = {BACKGROUND: This study aimed to evaluate the impact of the robotic approach on the minimally invasive elective treatment of diverticular disease.
METHODS: Data from patients who underwent elective robotic colectomy for diverticular disease from January 2015 to February 2020 were prospectively collected and retrospectively analysed. Intraoperative and 30-day postoperative outcomes were the variables assessed.
RESULTS: A total of 80 patients (71% with prior complicated diverticulitis) met the inclusion criteria. Mean operative time was 241 min, one intraoperative complication (1.2%) was observed, the conversion rate was 2.5%. Mean hospital stay was 6.4 days and overall 30-day complication rate was 22.5%. Fourteen patients (17.5%) had minor complications, while major postoperative complications occurred in four patients (5%). Anastomotic leak rate was 3.9% and the 30-day readmission rate was 3.7%.
CONCLUSIONS: Robotic colectomy for diverticular disease has proven to be feasible and safe, with low intraoperative complications, conversion, and anastomotic leak rates.},
}
@article {pmid33179127,
year = {2021},
author = {Germer, CT and Reibetanz, J},
title = {[Validation of the German classification of diverticular disease (CDD)].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {92},
number = {1},
pages = {72},
doi = {10.1007/s00104-020-01311-7},
pmid = {33179127},
issn = {1433-0385},
mesh = {*Diverticular Diseases ; *Diverticulitis, Colonic/diagnosis/surgery ; Humans ; },
}
@article {pmid33162407,
year = {2020},
author = {Dobrinja, C and Bortul, M and Silvestri, M and Tretjak, M and Turoldo, A and de Manzini, N},
title = {Acute and complicated diverticulitis: are there significant differences between young and elderly patients?.},
journal = {Annali italiani di chirurgia},
volume = {91},
number = {},
pages = {378-384},
pmid = {33162407},
issn = {2239-253X},
mesh = {*Age Factors ; Aged ; Anastomosis, Surgical ; Colon, Sigmoid/surgery ; Colostomy ; *Diverticulitis, Colonic/epidemiology/surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {AIM: The aim of our study was to assess if there were any differences in clinical presentation, management, and outcome, between younger and elderly patients with acute diverticulitis (AD).
MATERIAL OF STUDY: 279 patients with diagnosis of AD treated at the General Surgery Department of Trieste from January 2007 to December 2015 were retrospectively examined and then followed for a minimum of 4 years. We divided patients in two categories: young ≤ 50 years and elderly > 50. Gender, American Society of Anesthesiologists status (ASA score), Hinchey's stage, type and timing of surgery, morbidity, length of hospital stay, recurrence, and overall mortality were retrospectively analyzed.
RESULTS: There were 279 patients, 64 (22,9 %) were young and 215 (77,1%) were elderly. Female gender was more frequent in elderly cohort (150 pts 69,7 % F vs 65 pts 30,3 % M) than in the young (16 pts, 25% F vs 48 pts, 75% M), (p<0,001). Higher ASA scores were registered in elderly patients with statistically significant correlation with Hinchey's stage. 229 patients (82,07 %) received as initial treatment antibiotic therapy (conservative treatment), 50 (17,93 %) pts underwent EM-S, and 11 underwent to DEL-S.
DISCUSSION: In our experience, none significant differences were recorded about Hinchey's stage, timing of surgery, morbidity, length of hospital stay, and recurrence; whereas, regarding the type of surgery (resection-anastomosis (R-A), Hartmann's procedures, and Lavage/Drainage) there were a significant difference (p=0,04).
CONCLUSIONS: Hartmann's procedures have been effectuated more frequently in the elderly than in the young with recanalization in less than half of elderly. These data seems to confirm that there is no significant difference in incidence or the natural course of acute and complicated colonic diverticulitis among the young or the elderly. The best surgical treatment, with the least morbidity, may be resection with primary anastomosis.
KEY WORDS: Diverticular Disease, Elderly Patients, Sigmoidectomy, Young Patients.},
}
@article {pmid33161943,
year = {2020},
author = {Lock, JF and Galata, C and Reißfelder, C and Ritz, JP and Schiedeck, T and Germer, CT},
title = {The Indications for and Timing of Surgery for Diverticular Disease.},
journal = {Deutsches Arzteblatt international},
volume = {117},
number = {35-36},
pages = {591-596},
pmid = {33161943},
issn = {1866-0452},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Diverticulitis/surgery ; *Elective Surgical Procedures ; Germany ; Humans ; Middle Aged ; *Quality of Life ; Retrospective Studies ; },
abstract = {BACKGROUND: Diverticular disease is one of the more common abdominal disorders. In 2016, approximately 130 000 patients received inpatient treatment for diverticular disease in Germany. The disease has a number of subtypes, each of which has an appropriate treatment. In this article, we present the current surgical indications and optimal timing of surgery for diverticular disease.
METHODS: This review is based on publications that were retrieved by an extensive, selective search in Medline and the Cochrane Library (1998-2018) for studies and guidelines with information on the indications for surgery in diverticular disease.
RESULTS: Studies of evidence grades 2 to 4 were available. Patients receiving a diagnosis of freely perforated diverticulitis and peritonitis (Classification of Diverticular Disease [CDD] type 2c) should be operated on at once. Covered perforated diverticulitis with a macroabscess (>1 cm, CDD type 2b) may be an indication for elective surgery after successful conservative treatment. New evidence from a randomized, controlled trial suggests that elective surgery should also be considered for patients with chronic recurrent diverticulitis (CDD type 3b). The decisive factor in such cases is the impairment of the quality of life for the individual patient. Elective surgery is indicated in chronic recurrent diverticulitis with complications (fistulae, stenoses). Asymptomatic diverticulosis (CDD type 0) and uncomplicated diverticulitis (CDD type 1) are not surgical indications. Likewise, in diverticular hemorrhage (CDD type 4), surgery is only indicated in exceptional cases, when conservative treatment fails.
CONCLUSION: The surgical indication and the proper timing of surgery depend on the type of disease that is present. Future studies should more thoroughly investigate the effect of surgery on the quality of life in patients with the various types of diverticular disease.},
}
@article {pmid33156365,
year = {2021},
author = {Zaborowski, AM and Winter, DC},
title = {Evidence-based treatment strategies for acute diverticulitis.},
journal = {International journal of colorectal disease},
volume = {36},
number = {3},
pages = {467-475},
pmid = {33156365},
issn = {1432-1262},
mesh = {Anastomosis, Surgical ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Drainage ; Humans ; *Laparoscopy ; *Surgical Stomas ; },
abstract = {PURPOSE: Diverticular disease is a common acquired condition of the lower gastrointestinal tract that may be associated with significant morbidity. The term encompasses a spectrum of pathological processes with varying clinical manifestations. The purpose of this review was to update the reader on modern evidence-based treatment strategies for acute diverticulitis.
METHODS: A literature search of the PUBMED database was performed using the keywords 'diverticulosis', 'diverticular disease' and 'diverticulitis'. Only articles published in the English language were included.
RESULTS: Evidence-based treatment strategies for acute diverticulitis have evolved over time. Data have questioned the need for antibiotic therapy for Hinchey I disease and the role of percutaneous abscess drainage for Hinchey II. Clinical trials have demonstrated laparoscopic lavage is an appropriate option for select patients with Hinchey III disease and primary resection with anastomosis and defunctioning stoma may be considered in some cases of Hinchey IV disease.
CONCLUSION: Risk-adapted treatment strategies and operative decision-making for acute diverticulitis are increasingly based on a combination of patient and disease factors.},
}
@article {pmid33155148,
year = {2021},
author = {Nascimbeni, R and Amato, A and Cirocchi, R and Serventi, A and Laghi, A and Bellini, M and Tellan, G and Zago, M and Scarpignato, C and Binda, GA},
title = {Management of perforated diverticulitis with generalized peritonitis. A multidisciplinary review and position paper.},
journal = {Techniques in coloproctology},
volume = {25},
number = {2},
pages = {153-165},
pmid = {33155148},
issn = {1128-045X},
mesh = {Anastomosis, Surgical ; Colostomy ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Humans ; *Intestinal Perforation/etiology/surgery ; Italy ; *Laparoscopy ; *Peritonitis/complications/surgery ; },
abstract = {Perforated diverticulitis is an emergent clinical condition and its management is challenging and still debated. The aim of this position paper was to critically review the available evidence on the management of perforated diverticulitis and generalized peritonitis in order to provide evidence-based suggestions for a management strategy. Four Italian scientific societies (SICCR, SICUT, SIRM, AIGO), selected experts who identified 5 clinically relevant topics in the management of perforated diverticulitis with generalized peritonitis that would benefit from a multidisciplinary review. The following 5 issues were tackled: 1) Criteria to decide between conservative and surgical treatment in case of perforated diverticulitis with peritonitis; 2) Criteria or scoring system to choose the most appropriate surgical option when diffuse peritonitis is confirmed 3); The appropriate surgical procedure in hemodynamically stable or stabilized patients with diffuse peritonitis; 4) The appropriate surgical procedure for patients with generalized peritonitis and septic shock and 5) Optimal medical therapy in patients with generalized peritonitis from diverticular perforation before and after surgery. In perforated diverticulitis surgery is indicated in case of diffuse peritonitis or failure of conservative management and the decision to operate is not based on the presence of extraluminal air. If diffuse peritonitis is confirmed the choice of surgical technique is based on intraoperative findings and the presence or risk of severe septic shock. Further prognostic factors to consider are physiological derangement, age, comorbidities, and immune status. In hemodynamically stable patients, emergency laparoscopy has benefits over open surgery. Options include resection and anastomosis, Hartmann's procedure or laparoscopic lavage. In generalized peritonitis with septic shock, an open surgical approach is preferred. Non-restorative resection and/or damage control surgery appear to be the only viable options, depending on the severity of hemodynamic instability. Multidisciplinary medical management should be applied with the main aims of controlling infection, relieving postoperative pain and preventing and/or treating postoperative ileus. In conclusion, the complexity and diversity of patients with diverticular perforation and diffuse peritonitis requires a personalized strategy, involving a thorough classification of physiological derangement, staging of intra-abdominal infection and choice of the most appropriate surgical procedure.},
}
@article {pmid33094052,
year = {2020},
author = {Lucas, JP and Roberts, CA and Gunderson, CA and Liuzzi, FJ and Rosenthal, OD},
title = {Acquired Diverticulosis of the Entire Colon in a Cadaver.},
journal = {Cureus},
volume = {12},
number = {9},
pages = {e10511},
pmid = {33094052},
issn = {2168-8184},
abstract = {Diverticulosis involving the entire colon is rare in Western society. During a routine dissection of a 74-year-old Caucasian female cadaver, who died from vascular disease complications, diverticula were observed in the ascending, transverse, and descending colon. A total of 413 diverticula were manually counted. The majority of diverticula arose from the right and transverse colon, which is atypical of the disease in Western society. Histological examination of sections from sample diverticula reveals morphology consistent with pseudodiverticula, suggestive of acquired disease. Pancolonic diverticulosis may be associated with systemic diseases such as collagen disorders, vascular complications, and increased risk of recurrent diverticulitis. This case is an example of a rare manifestation of diverticular disease that is important for clinicians to recognize when evaluating and treating patients with gastrointestinal symptoms.},
}
@article {pmid33093692,
year = {2020},
author = {Piscopo, N and Ellul, P},
title = {Diverticular Disease: A Review on Pathophysiology and Recent Evidence.},
journal = {The Ulster medical journal},
volume = {89},
number = {2},
pages = {83-88},
pmid = {33093692},
issn = {2046-4207},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Colon/surgery ; Diverticular Diseases/etiology/*physiopathology/*therapy ; Humans ; Male ; Obesity/complications ; Risk Factors ; Smoking/adverse effects ; },
abstract = {Diverticular disease is common condition globally, especially in Western countries. Diverticulitis, Symptomatic uncomplicated Diverticular disease and Segmental Colitis associated with diverticula constitute diverticular disease. Although most patients with diverticula are asymptomatic, around 25% of patients will experience symptoms whilst 5% of patients have an episode of acute diverticulitis. The prevalence increases with age with more than one theory being put forward to explain its pathogenesis. Faecolith entrapment in diverticula results in colonic mucosal damage and oedema, bacterial proliferation and toxin accumulation leading to perforation. This mechanism may explain diverticulitis in elderly patients with multiple, larger diverticula. Ischaemic damage could be the cause of acute diverticulitis in younger patients with sparse diverticula where more frequent and forceful muscular contractions in response to colonic stimuli occlude the vasculature leading to ischaemia and microperforation. Chronic colonic active inflammation in the presence of diverticular disease is termed Segmental colitis associated with diverticulosis. Its pathophysiology is still indeterminate but together with its clinical picture, may mimic Inflammatory Bowel Disease. Treatment includes a high fibre diet together with antibiotics and/or salicylates with surgery in severe cases. Indications for elective surgery in diverticular disease have changed over the past decades as this may not suggest a reduction in morbidity and mortality. Prophylaxis with probiotics, laxatives, anti-spasmotics, anticholinergic drugs and salicylates are at the centre of recent studies. Studies are also challenging previously believed facts regarding dietary fibre, nuts and seeds whilst emphasizing the effect of healthy lifestyle and smoking on the increasing incidence of DD.},
}
@article {pmid33082088,
year = {2021},
author = {Arena, R and Lisotti, A and Mussetto, A and Merighi, A and Pezzoli, A and Triossi, O},
title = {Right-sided diverticulosis is an independent risk factor for bleeding in patients admitted for diverticular disease.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {53},
number = {7},
pages = {835-840},
doi = {10.1016/j.dld.2020.09.027},
pmid = {33082088},
issn = {1878-3562},
mesh = {Age Factors ; Aged ; Databases, Factual ; Diverticular Diseases/*complications/pathology ; Diverticulum/*complications/pathology ; Female ; Fibrinolytic Agents/adverse effects ; Gastrointestinal Hemorrhage/*etiology ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Sex Factors ; },
abstract = {BACKGROUND: Diverticular bleeding is the main cause of lower gastrointestinal bleeding in both Eastern and Western countries. Several risk factors have been identified, such as comorbidities and concomitant medications. In Eastern population, the prevalence of right-side diverticulosis is higher than in Western one, and some Authors identified bilateral diverticulosis as a risk factor for bleeding.
AIMS: To identify risk factors for diverticular bleeding in patients admitted for diverticular disease (DD).
METHODS: All patients admitted for DD from January 2017 to December 2018 were retrieved from the hospital Information System. For each patient, age, gender, clinical presentation and concomitant medication were recorded. All patient underwent imaging assessment (computed tomography, ultrasound or MRI) and colonoscopy during hospitalization or within one month.
RESULTS: Among 1248 patients discharged with a diagnosis of DD during the study period, 293 (52.2% male, median age 75 years) were finally analyzed; of them, 105 (35.8%) for diverticular bleeding. On multivariate analysis, male gender (OR 4.27), age (OR 1.12), anti-thrombotic medications (OR 2.60) and right-sided DD (OR 5.70) were independently correlated to diverticular bleeding.
CONCLUSION: Our study provides evidence that, together with age, male gender and concomitant anti-thrombotic treatment, right-sided DD represents an independent risk factor for bleeding.},
}
@article {pmid33077029,
year = {2020},
author = {Hawkins, AT and Wise, PE and Chan, T and Lee, JT and Glyn, T and Wood, V and Eglinton, T and Frizelle, F and Khan, A and Hall, J and Ilyas, MIM and Michailidou, M and Nfonsam, VN and Cowan, ML and Williams, J and Steele, SR and Alavi, K and Ellis, CT and Collins, D and Winter, DC and Zaghiyan, K and Gallo, G and Carvello, M and Spinelli, A and Lightner, AL},
title = {Diverticulitis: An Update From the Age Old Paradigm.},
journal = {Current problems in surgery},
volume = {57},
number = {10},
pages = {100862},
pmid = {33077029},
issn = {1535-6337},
support = {K23 DK118192/DK/NIDDK NIH HHS/United States ; },
mesh = {Age Factors ; Colonoscopy ; Diagnostic Imaging ; *Digestive System Surgical Procedures ; *Disease Management ; Diverticulitis, Colonic/*diagnosis/*therapy ; Humans ; Risk Factors ; },
abstract = {For a disease process that affects so many, we continue to struggle to define optimal care for patients with diverticular disease. Part of this stems from the fact that diverticular disease requires different treatment strategies across the natural history- acute, chronic and recurrent. To understand where we are currently, it is worth understanding how treatment of diverticular disease has evolved. Diverticular disease was rarely described in the literature prior to the 1900’s. In the late 1960’s and early 1970’s, Painter and Burkitt popularized the theory that diverticulosis is a disease of Western civilization based on the observation that diverticulosis was rare in rural Africa but common in economically developed countries. Previous surgical guidelines focused on early operative intervention to avoid potential complicated episodes of recurrent complicated diverticulitis (e.g., with free perforation) that might necessitate emergent surgery and stoma formation. More recent data has challenged prior concerns about decreasing effectiveness of medical management with repeat episodes and the notion that the natural history of diverticulitis is progressive. It has also permitted more accurate grading of the severity of disease and permitted less invasive management options to attempt conversion of urgent operations into the elective setting, or even avoid an operation altogether. The role of diet in preventing diverticular disease has long been debated. A high fiber diet appears to decrease the likelihood of symptomatic diverticulitis. The myth of avoid eating nuts, corn, popcorn, and seeds to prevent episodes of diverticulitis has been debunked with modern data. Overall, the recommendations for “diverticulitis diets” mirror those made for overall healthy lifestyle – high fiber, with a focus on whole grains, fruits and vegetables. Diverticulosis is one of the most common incidental findings on colonoscopy and the eighth most common outpatient diagnosis in the United States. Over 50% of people over the age of 60 and over 60% of people over age 80 have colonic diverticula. Of those with diverticulosis, the lifetime risk of developing diverticulitis is estimated at 10–25%, although more recent studies estimate a 5% rate of progression to diverticulitis. Diverticulitis accounts for an estimated 371,000 emergency department visits and 200,000 inpatient admissions per year with annual cost of 2.1–2.6 billion dollars per year in the United States. The estimated total medical expenditure (inpatient and outpatient) for diverticulosis and diverticulitis in 2015 was over 5.4 billion dollars. The incidence of diverticulitis is increasing. Besides increasing age, other risk factors for diverticular disease include use of NSAIDS, aspirin, steroids, opioids, smoking and sedentary lifestyle. Diverticula most commonly occur along the mesenteric side of the antimesenteric taeniae resulting in parallel rows. These spots are thought to be relatively weak as this is the location where vasa recta penetrate the muscle to supply the mucosa. The exact mechanism that leads to diverticulitis from diverticulosis is not definitively known. The most common presenting complaint is of left lower quadrant abdominal pain with symptoms of systemic unwellness including fever and malaise, however the presentation may vary widely. The gold standard cross-sectional imaging is multi-detector CT. It is minimally invasive and has sensitivity between 98% and specificity up to 99% for diagnosing acute diverticulitis. Uncomplicated acute diverticulitis may be safely managed as an out-patient in carefully selected patients. Hospitalization is usually necessary for patients with immunosuppression, intolerance to oral intake, signs of severe sepsis, lack of social support and increased comorbidities. The role of antibiotics has been questioned in a number of randomized controlled trials and it is likely that we will see more patients with uncomplicated disease treated with observation in the future Acute diverticulitis can be further sub classified into complicated and uncomplicated presentations. Uncomplicated diverticulitis is characterized by inflammation limited to colonic wall and surrounding tissue. The management of uncomplicated diverticulitis is changing. Use of antibiotics has been questioned as it appears that antibiotic use can be avoided in select groups of patients. Surgical intervention appears to improve patient’s quality of life. The decision to proceed with surgery is recommended in an individualized manner. Complicated diverticulitis is defined as diverticulitis associated with localized or generalized perforation, localized or distant abscess, fistula, stricture or obstruction. Abscesses can be treated with percutaneous drainage if the abscess is large enough. The optimal long-term strategy for patients who undergo successful non-operative management of their diverticular abscess remains controversial. There are clearly patients who would do well with an elective colectomy and a subset who could avoid an operation all together however, the challenge is appropriate risk-stratification and patient selection. Management of patients with perforation depends greatly on the presence of feculent or purulent peritonitis, the extent of contamination and hemodynamic status and associated comorbidities. Fistulas and strictures are almost always treated with segmental colectomy. After an episode of acute diverticulitis, routine colonoscopy has been recommended by a number of societies to exclude the presence of colorectal cancer or presence of alternative diagnosis like ischemic colitis or inflammatory bowel disease for the clinical presentation. Endoscopic evaluation of the colon is normally delayed by about 6 weeks from the acute episode to reduce the risk associated with colonoscopy. Further study has questioned the need for endoscopic evaluation for every patient with acute diverticulitis. Colonoscopy should be routinely performed after complicated diverticulitis cases, when the clinical presentation is atypical or if there are any diagnostic ambiguity, or patient has other indications for colonoscopy like rectal bleeding or is above 50 years of age without recent colonoscopy. For patients in whom elective colectomy is indicated, it is imperative to identify a wide range of modifiable patient co-morbidities. Every attempt should be made to improve a patient’s chance of successful surgery. This includes optimization of patient risk factors as well as tailoring the surgical approach and perioperative management. A positive outcome depends greatly on thoughtful attention to what makes a complicated patient “complicated”. Operative management remains complex and depends on multiple factors including patient age, comorbidities, nutritional state, severity of disease, and surgeon preference and experience. Importantly, the status of surgery, elective versus urgent or emergent operation, is pivotal in decision-making, and treatment algorithms are divergent based on the acuteness of surgery. Resection of diseased bowel to healthy proximal colon and rectal margins remains a fundamental principle of treatment although the operative approach may vary. For acute diverticulitis, a number of surgical approaches exist, including loop colostomy, sigmoidectomy with colostomy (Hartmann’s procedure) and sigmoidectomy with primary colorectal anastomosis. Overall, data suggest that primary anastomosis is preferable to a Hartman’s procedure in select patients with acute diverticulitis. Patients with hemodynamic instability, immunocompromised state, feculent peritonitis, severely edematous or ischemic bowel, or significant malnutrition are poor candidates. The decision to divert after colorectal anastomosis is at the discretion of the operating surgeon. Patient factors including severity of disease, tissue quality, and comorbidities should be considered. Technical considerations for elective cases include appropriate bowel preparation, the use of a laparoscopic approach, the decision to perform a primary anastomosis, and the selected use of ureteral stents. Management of the patient with an end colostomy after a Hartmann’s procedure for acute diverticulitis can be a challenging clinical scenario. Between 20 – 50% of patients treated with sigmoid resection and an end colostomy after an initial severe bout of diverticulitis will never be reversed to their normal anatomy. The reasons for high rates of permanent colostomies are multifactorial. The debate on the best timing for a colostomy takedown continues. Six months is generally chosen as the safest time to proceed when adhesions may be at their softest allowing for a more favorable dissection. The surgical approach will be a personal decision by the operating surgeon based on his or her experience. Colostomy takedown operations are challenging surgeries. The surgeon should anticipate and appropriately plan for a long and difficult operation. The patient should undergo a full antibiotic bowel preparation. Preoperative planning is critical; review the initial operative note and defining the anatomy prior to reversal. When a complex abdominal wall closure is necessary, consider consultation with a hernia specialist. Open surgery is the preferred surgical approach for the majority of colostomy takedown operations. Finally, consider ureteral catheters, diverting loop ileostomy, and be prepared for all anastomotic options in advance. Since its inception in the late 90’s, laparoscopic lavage has been recognized as a novel treatment modality in the management of complicated diverticulitis; specifically, Hinchey III (purulent) diverticulitis. Over the last decade, it has been the subject of several randomized controlled trials, retrospective studies, systematic reviews as well as cost-efficiency analyses. Despite being the subject of much debate and controversy, there is a clear role for laparoscopic lavage in the management of acute diverticulitis with the caveat that patient selection is key. Segmental colitis associated with diverticulitis (SCAD) is an inflammatory condition affecting the colon in segments that are also affected by diverticulosis, namely, the sigmoid colon. While SCAD is considered a separate clinical entity, it is frequently confused with diverticulitis or inflammatory bowel disease (IBD). SCAD affects approximately 1.4% of the general population and 1.15 to 11.4% of those with diverticulosis and most commonly affects those in their 6th decade of life. The exact pathogenesis of SCAD is unknown, but proposed mechanisms include mucosal redundancy and prolapse occurring in diverticular segments, fecal stasis, and localized ischemia. Most case of SCAD resolve with a high-fiber diet and antibiotics, with salicylates reserved for more severe cases. Relapse is uncommon and immunosuppression with steroids is rarely needed. A relapsing clinical course may suggest a diagnosis of IBD and treatment as such should be initiated. Surgery is extremely uncommon and reserved for severe refractory disease. While sigmoid colon involvement is considered the most common site of colonic diverticulitis in Western countries, diverticular disease can be problematic in other areas of the colon. In Asian countries, right-sided diverticulitis outnumbers the left. This difference seems to be secondary to dietary and genetic factors. Differential diagnosis might be difficult because of similarity with appendicitis. However accurate imaging studies allow a precise preoperative diagnosis and management planning. Transverse colonic diverticulitis is very rare accounting for less than 1% of colonic diverticulitis with a perforation rate that has been estimated to be even more rare. Rectal diverticula are mostly asymptomatic and diagnosed incidentally in the majority of patients and rarely require treatment. Giant colonic diverticula (GCD) is a rare presentation of diverticular disease of the colon and it is defined as an air-filled cystic diverticulum larger than 4 cm in diameter. The pathogenesis of GCD is not well defined. Overall, the management of diverticular disease depends greatly on patient, disease and surgeon factors. Only by tailoring treatment to the patient in front of us can we achieve optimal outcomes.},
}
@article {pmid33029997,
year = {2020},
author = {Trubacheva, YL and Orlova, LP and Moskalev, AI and Skridlevskiy, SN and Belov, DM and Shakhmatov, DG and Achkasov, SI},
title = {[Ultrasound diagnosis of chronic paracolic inflammatory mass in diverticular disease].},
journal = {Khirurgiia},
volume = {},
number = {9},
pages = {14-19},
doi = {10.17116/hirurgia202009114},
pmid = {33029997},
issn = {0023-1207},
mesh = {Colonoscopy ; *Diverticular Diseases/diagnostic imaging ; *Diverticulosis, Colonic/diagnostic imaging ; Humans ; Tomography, X-Ray Computed ; Ultrasonography ; },
abstract = {OBJECTIVE: To evaluate the feasibility of ultrasound in diagnosis of chronic paracolic inflammatory mass in patients with diverticular disease.
MATERIAL AND METHODS: We analyzed ultrasonic findings in 216 patients with chronic inflammatory complications of colonic diverticular disease. Chronic paracolic inflammatory mass as the most common and significant chronic complication of diverticular disease was analyzed in 116 patients. Ultrasonic findings were compared with specimen assessment, intraoperative data, irrigoscopy, colonoscopy, endoscopic ultrasound and computed tomography data.
RESULTS: Sensitivity of ultrasound for diagnosis of chronic paracolic inflammatory mass was 76,7%, specificity - 100%, overall accuracy - 87,5%. CT and endoscopic ultrasound were the most informative among different diagnostic tools (sensitivity 79,6% and 77,8%, respectively).
CONCLUSION: Ultrasonic examination and computed tomography are the most valuable methods for diagnosis of chronic paracolic inflammatory mass in patients with diverticular disease. Ultrasound is a first-line method for diagnosis and follow-up of complicated diverticular disease due to its availability, safety and unnecessary special preparation of patients.},
}
@article {pmid33019419,
year = {2020},
author = {Lin, H and Zhuang, Z and Huang, X and Li, Y},
title = {The role of emergency laparoscopic surgery for complicated diverticular disease: A systematic review and meta-analysis.},
journal = {Medicine},
volume = {99},
number = {40},
pages = {e22421},
pmid = {33019419},
issn = {1536-5964},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Laparoscopy/adverse effects/*methods/mortality ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; },
abstract = {BACKGROUND: Laparoscopic surgery develops rapidly in both elective and emergency settings. The study aimed to determine the role of different laparoscopic methods for the emergency treatment of complicated diverticulitis.
METHODS: MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane database were searched up to November 2019 to identify all published articles related to the topic. Statistical analysis was performed using Stata 15.
RESULTS: Fourteen publications were included in the analysis. Laparoscopic surgery was applied in 425 patients, and 493 patients underwent open colon resection (OCR). Postoperative mortality, morbidity, severe complications, and reoperation rates were not significantly different between the laparoscopic and open surgery groups. Subgroup analysis was performed based on the different laparoscopic methods (laparoscopic colon resection [LCR] and laparoscopic lavage and drainage [LLD]). Subgroup analysis indicated that LCR was superior to OCR in terms of morbidity, while OCR was superior to LLD in terms of severe complications.
CONCLUSIONS: The safety of laparoscopic surgery for the emergency treatment of complicated diverticulitis is related to different surgical methods. LCR is suggested to be a better choice according to the postoperative outcomes. More definite conclusions can be drawn in future randomized controlled trials.},
}
@article {pmid32998474,
year = {2020},
author = {Maconi, G and Pini, A and Pasqualone, E and Ardizzone, S and Bassotti, G},
title = {Abdominal Symptoms and Colonic Diverticula in Marfan's Syndrome: A Clinical and Ultrasonographic Case Control Study.},
journal = {Journal of clinical medicine},
volume = {9},
number = {10},
pages = {},
pmid = {32998474},
issn = {2077-0383},
abstract = {BACKGROUND: Marfan's syndrome (MFS) seems to be frequently associated with colonic diverticulosis, but the prevalence of diverticula and symptoms evocative of diverticular disease in this population are still unknown.
METHODS: This prospective case control study included 90 consecutive patients with MFS, 90 unselected controls, and 90 asymptomatic subjects. The clinical characteristics, including lower gastrointestinal symptoms, and ultrasonographic features of the bowel, including diverticula and thickening of the muscularis propria of the sigmoid colon, were investigated. In addition, the genotype of MFS patients was assessed. The characteristics of patients and controls were compared using parametric tests.
RESULTS: Complaints of abdominal symptoms were made by 23 (25.6%) patients with MFS and 48 (53%) control subjects (p < 0.01). Constipation and bloating were reported less frequently by MFS patients than controls (constipation: 13.3% vs. 26.6%, p = 0.039; bloating: 3.3% vs. 41.1%, p < 0.0001), while other symptoms were not significantly different. Sigmoid diverticulosis was detected in 12 (12.3%) patients with MFS, as well as in 3 (3.3%) asymptomatic healthy subjects and 4 (4.4%) random controls (p = 0.0310). The genetic variants of MFS were not correlated with symptoms or diverticula.
CONCLUSION: Patients with MFS have a greater prevalence of diverticula, although less abdominal symptoms, compared to the general population. Symptoms and diverticula in MFS are not correlated with any genetic variant.},
}
@article {pmid32990867,
year = {2021},
author = {Ripoli, MC and Lauro, A and Vaccari, S and Mastrocola, G and Lanci-Lanci, A and D'Andrea, V and Marino, IR and Cervellera, M and Tonini, V},
title = {Popping the Balloon: A Giant Colonic Diverticulum Complicated by Bladder Neck Compression.},
journal = {Digestive diseases and sciences},
volume = {66},
number = {1},
pages = {41-44},
pmid = {32990867},
issn = {1573-2568},
mesh = {Aged ; Diverticulum, Colon/*complications/*diagnostic imaging/surgery ; Female ; Humans ; Urinary Bladder/diagnostic imaging/surgery ; Urinary Bladder Neck Obstruction/*diagnostic imaging/*etiology/surgery ; },
abstract = {Giant colonic diverticulum, defined as a single diverticulum ≤ 4 cm, is rarely encountered. Due to the high incidence of complications related to the disease, obtaining the correct diagnosis early in the disease course is essential. Diagnosis is usually reached by conventional and cross-sectional abdominal radiography. Treatment decisions should be ideally made by a multidisciplinary discussion among surgeons, interventional radiologists, and the patient. The treatment of choice is the surgical management by open or laparoscopic approach.},
}
@article {pmid32989503,
year = {2021},
author = {Longchamp, G and Abbassi, Z and Meyer, J and Toso, C and Buchs, NC and Ris, F},
title = {Surgical resection does not avoid the risk of diverticulitis recurrence-a systematic review of risk factors.},
journal = {International journal of colorectal disease},
volume = {36},
number = {2},
pages = {227-237},
pmid = {32989503},
issn = {1432-1262},
mesh = {Colectomy ; Colon, Sigmoid/surgery ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Elective Surgical Procedures/adverse effects ; Humans ; *Laparoscopy ; Recurrence ; Risk Factors ; Treatment Outcome ; },
abstract = {PURPOSE: Fifteen percent of patients undergoing elective sigmoidectomy will present a diverticulitis recurrence, which is associated with significant costs and morbidity. We aimed to systematically review the risk factors associated with recurrence after elective sigmoidectomy.
METHODS: PubMed/MEDLINE, Embase, Cochrane, and Web of Science were searched for studies published until May 1, 2020. Original studies were included if (i) they included patients undergoing sigmoidectomy for diverticular disease, (ii) they reported postoperative recurrent diverticulitis, and (iii) they analyzed ≥ 1 variable associated with recurrence. The primary outcome was the risk factors for recurrence of diverticulitis after sigmoidectomy.
RESULTS: From the 1463 studies initially screened, six studies were included. From the 1062 patients included, 62 patients recurred (5.8%), and six variables were associated with recurrence. Two were preoperative: age (HR = 0.96, p = 0.02) and irritable bowel syndrome (33.3% with recurrence versus 12.1% without recurrence, p = 0.02). Two were operative factors: uncomplicated recurrent diverticulitis as indication for surgery (73.3% with recurrence versus 49.9% without recurrence, p = 0.049) and anastomotic level (colorectal: HR = 11.4, p = 0.02, or colosigmoid: OR = 4, p = 0.033). Two were postoperative variables: the absence of active diverticulitis on pathology (39.6% with recurrence versus 26.6% without recurrence) and persistence of postoperative pain (HR = 4.8, p < 0.01).
CONCLUSION: Identification of preoperative variables that predict the occurrence of diverticulitis recurrence should help surgical decision-making for elective sigmoidectomy, while peri- and postoperative factors should be taken into account for optimal patient follow-up.},
}
@article {pmid32972892,
year = {2020},
author = {Di Buono, G and Bonventre, G and Buscemi, S and Randisi, B and Romano, G and Agrusa, A},
title = {The colovescical fistula in diverticular disease: Laparoscopic approach in two different cases.},
journal = {International journal of surgery case reports},
volume = {77S},
number = {Suppl},
pages = {S112-S115},
pmid = {32972892},
issn = {2210-2612},
abstract = {INTRODUCTION: The colovescical fistula is one of the complications of diverticular disease. It can cause significant symptoms like pneumaturia and fecaluria affecting the quality of life and sometimes leading to death, usually secondary to sepsis. We describe two cases of colovescical fistula treated by laparoscopic approach in patients with diagnosis of complicated acute diverticulitis.
CASE REPORT: We studied two patients with clinical, radiological and endoscopic diagnosis of colovescical fistula as a consequence of diverticular disease. We performed a totally laparoscopic treatment with colonic resection and colo-proctoanastomosis after the closure of the fistula with intracorporeal sutures.
DISCUSSION: Colovescical fistula should be suspected in patients who present fever with persistent dysuria, pneumaturia or fecaluria. The diagnosis is confirmed by a CT abdominal scan, a colonoscopy in order to rule out a colon cancer and a cystoscopy to assess the grade of bladder involvement.
CONCLUSION: Although colovescical fistulas caused by diverticular disease were once considered a contraindication to laparoscopic resection, nowadays they are increasingly treated by experienced surgeons using laparoscopic techniques. Compared with laparoscopic surgery for uncomplicated diverticulitis the mini-invasive treatment of colovescical fistulas requires a longer operative time and advanced surgical skills.},
}
@article {pmid32957717,
year = {2020},
author = {Darii Plopa, N and Gica, N and Gerard, M and Nollevaux, MC and Pavlovic, M and Anton, E},
title = {A Very Rare Case of Colosalpingeal Fistula Secondary to Diverticulitis: An Overview of Development, Clinical Features and Management.},
journal = {Medicina (Kaunas, Lithuania)},
volume = {56},
number = {9},
pages = {},
pmid = {32957717},
issn = {1648-9144},
mesh = {Aged ; *Diverticulitis ; Female ; Humans ; *Intestinal Fistula/diagnostic imaging/etiology/surgery ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Colosalpingeal fistula is a rare complication secondary to diverticular disease. The pathogenesis is still not clearly understood. We present the case of a colosalpingeal fistula and a review of the management of this pathology.
CASE REPORT: A 69-year-old patient with uncomplicated diverticular disease was referred to our department for recurrent vaginal discharge. The clinical examination was unremarkable, hysteroscopy revealed the presence of air in the uterine cavity in the absence of a uterine fistula. A preliminary diagnosis of colosalpingeal fistula was made and was confirmed by computed tomography (CT) scan and hysterosalpingography. A one-stage surgery via laparotomy was successfully performed with remission of the symptoms.
CONCLUSION: Colotubal fistula is a rare complication resulting from intestinal diverticular disease. The purpose of this paper was to emphasize the presence of a rare, but serious complication occurring in diverticular disease with atypical symptoms and one-stage surgery treatment.},
}
@article {pmid32941354,
year = {2020},
author = {Mari, GM and Crippa, J and Roscio, F and Scandroglio, I and Cocozza, E and Borroni, G and Berselli, M and Achilli, P and Costanzi, ATM and Maggioni, D and , },
title = {Quality of Life After Elective Laparoscopic Sigmoidectomy for Symptomatic Uncomplicated Diverticular Disease.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {31},
number = {2},
pages = {193-195},
doi = {10.1097/SLE.0000000000000860},
pmid = {32941354},
issn = {1534-4908},
mesh = {Colon, Sigmoid/surgery ; *Diverticular Diseases/surgery ; Humans ; *Laparoscopy ; Quality of Life ; Retrospective Studies ; },
abstract = {INTRODUCTION: Symptomatic uncomplicated diverticular disease (SUDD) is characterized by abdominal pain and altered bowel function and may affect quality of life. When symptoms are severe and conservative therapy is ineffective, surgical intervention becomes an option.
OBJECTIVE: This study aims to investigate quality of life after elective sigmoidectomy for patients affected by SUDD.
MATERIALS AND METHODS: Retrospective multicenter review of consecutive patients affected by SUDD that underwent elective laparoscopic sigmoidectomy from January 2015 to March 2018. SUDD was defined as the presence of diverticula with persistent localized pain and diarrhea or constipation without macroscopic inflammation. Quality of life was investigated using the Gastrointestinal Quality of Life Index questionnaire at baseline, and at 6 and 12 months after surgery. Readmissions, unplanned clinical examination, mesalazine resumption, and emergency department visit for abdominal symptoms were recorded.
RESULTS: Fifty-two patients were included in the analysis. Gastrointestinal Quality of Life Index score at 6 months from surgery did not statistically differ from baseline (96±10.2 vs. 89±11.2; P>0.05), while patients reported a better quality of life at 12 months after surgery (109±8.6; P<0.05). Within the first year of follow-up, 3 patients (5.8%) were readmitted for acute enteritis, 8 patients (15.4%) had emergency room access for abdominal pain, and 8 patients had unplanned outpatients' medical examinations for referred lower abdominal pain and bowel changes. Mesalazine was resumed in 17.3% of patients.
CONCLUSION: Elective laparoscopic sigmoidectomy for SUDD is safe and effective in improving quality of life, although in some cases symptoms may persist.},
}
@article {pmid32938529,
year = {2021},
author = {Napolitano, MA and Sparks, AD and Randall, JA and Brody, FJ and Duncan, JE},
title = {Elective surgery for diverticular disease in U.S. veterans: A VASQIP study of national trends and outcomes from 2004 to 2018.},
journal = {American journal of surgery},
volume = {221},
number = {5},
pages = {1042-1049},
doi = {10.1016/j.amjsurg.2020.08.050},
pmid = {32938529},
issn = {1879-1883},
mesh = {Colectomy/adverse effects/statistics & numerical data ; Colon/surgery ; Diverticular Diseases/*surgery ; Elective Surgical Procedures/adverse effects/*statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; United States ; Veterans/*statistics & numerical data ; },
abstract = {BACKGROUND: Treatment for diverticular disease has evolved over time. In the United States, there has been a trend towards minimally invasive surgical approaches and fewer postoperative complications, but no study has investigated this subject in the Veterans Health Administration.
METHODS: This retrospective review identified patients undergoing elective surgery for diverticular disease from 2004 to 2018. Demographics, comorbidities, operative approach, rates of ostomy creation, and 30-day outcomes were compared. The 15-year time period was divided into 3-year increments to assess changes over time.
RESULTS: 4198 patients were identified. Complication rate decreased significantly over time (28.1%-15.7%, p < 0.001), as did infectious complications (21.5-6.3%, p < 0.001). Median hospital length-of-stay decreased from 7 to 5 days (p < 0.001). Rates of laparoscopic surgery increased over time (17.7%-48.1%, p < 0.001).
CONCLUSIONS: Increased utilization of laparoscopy in veterans undergoing elective surgery for diverticular disease coincided with fewer complications and a shorter length-of-stay. These trends mirror outcomes reported in non-veterans.},
}
@article {pmid32937926,
year = {2020},
author = {Sbeit, W and Khoury, T and Kadah, A and Asadi, W and Shahin, A and Lubany, A and Safadi, M and Haddad, H and Abu Ahmad, R and Abu El Hija, S and Abboud, R and Mahamid, M and Pellicano, R and Mari, A},
title = {Proton Pump Inhibitor Use May Increase the Risk of Diverticulitis but Not It's Severity among Patients with Colonic Diverticulosis: A Multicenter Study.},
journal = {Journal of clinical medicine},
volume = {9},
number = {9},
pages = {},
pmid = {32937926},
issn = {2077-0383},
abstract = {Colonic diverticular disease, especially diverticulitis constitutes a major cause of hospitalization and an economic burden in developed countries. Proton pump inhibitors (PPIs) are among the commonest drugs used to treat several diseases affecting the upper gastrointestinal tract. A few studies have reported that the use of Proton Pump Inhibitors PPIs caused dysbiosis. In this study, we searched for a relationship between PPI use and the onset and severity of diverticulitis in patients with colonic diverticulosis. In a retrospective study, patients who were hospitalized for documented diverticulitis were enrolled as cases and compared with a control group of patients with uncomplicated diverticulosis. Overall, 613 patients who had a diagnosis of diverticulosis were included in the study, 217 of whom had diverticulitis. After multivariate analysis, the non-modifiable risk factors associated with diverticulitis included: age (p < 0.0001), hypertension (p < 0.0001), chronic renal failure (p = 0.007), diabetes mellitus (p < 0.0001), and left colon location (p = 0.02). However, among the modifiable factors, only PPI use (p < 0.0001) showed a significant association. Advanced disease severity (according to Hinchey classification of diverticulitis stages II-IV) was associated with aspirin use (p = 0.0004) and pan-colonic location (p = 0.02). PPI use was the only modifiable factor significantly associated with diverticulitis, but not with its severity, among patients with diverticulosis. This observation should be confirmed in future multicenter prospective studies.},
}
@article {pmid32919816,
year = {2021},
author = {Wu, Z and Broad, J and Sluyter, J and Waayer, D and Camargo, CA and Scragg, R},
title = {Effect of monthly vitamin D on diverticular disease hospitalization: Post-hoc analysis of a randomized controlled trial.},
journal = {Clinical nutrition (Edinburgh, Scotland)},
volume = {40},
number = {3},
pages = {839-843},
doi = {10.1016/j.clnu.2020.08.030},
pmid = {32919816},
issn = {1532-1983},
mesh = {Aged ; *Dietary Supplements ; *Diverticular Diseases ; Double-Blind Method ; Female ; *Hospitalization ; Humans ; Male ; Vitamin D/administration & dosage/*analogs & derivatives ; Vitamins/*administration & dosage ; },
abstract = {BACKGROUND & AIMS: Some studies have linked low vitamin D status and high risk of diverticular disease, but the causal relationship between vitamin D and diverticular disease remains unclear; clinical trial data are warranted. The objective was to assess the efficacy of vitamin D3 supplementation on diverticular disease hospitalization.
METHODS: Post-hoc analysis of a community-based randomized double-blind placebo-controlled trial (RCT) with 5108 participants randomized to receive monthly 100,000 IU vitamin D (n = 2558) or identical placebo (n = 2550). The outcome was time to first diverticular disease hospitalization from randomization to the end of intervention (July 2015), including a prespecified subgroup analysis in participants with baseline deseasonalized 25-hydroxyvitamin D (25(OH)D) levels < 50 nmol/L.
RESULTS: Over a median of 3.3 years follow-up, 74 participants had diverticular disease hospitalization. There was no difference in the risk of diverticular disease hospitalization between vitamin D supplementation (35/2558 = 1.4%) and placebo (39/2550 = 1.5%) groups (adjusted hazard ratio (HR) = 0.90; p = 0.65), although in participants with deseasonalized 25(OH)D < 50 nmol/L (n = 1272), the risk was significantly lower in the vitamin D group than placebo (HR = 0.08, p = 0.02).
DISCUSSION: Monthly 100,000 IU vitamin D3 does not reduce the risk of diverticular disease hospitalization in the general population. Further RCTs are required to investigate the effect of vitamin D supplementation on the diverticular disease in participants with low 25(OH)D levels.},
}
@article {pmid32902199,
year = {2020},
author = {Alexandersson, BT and Stefánsson, T},
title = {Incidence and recurrence rate of sigmoid diverticulitis in patients requiring admission to hospital in Iceland from 1985 to 2014: nationwide population-based register study.},
journal = {BJS open},
volume = {4},
number = {6},
pages = {1217-1226},
pmid = {32902199},
issn = {2474-9842},
abstract = {BACKGROUND: Diverticulitis is the most common complication of diverticular disease, affecting 10-25 per cent of patients with diverticula. A retrospective, nationwide, population-based cohort study was performed to analyse the incidence and recurrence rate of sigmoid diverticulitis requiring hospital admission.
METHODS: All patients discharged from hospital in Iceland during 1985-2014 who were diagnosed with diverticular disease were included. The χ[2] test was used to analyse the trend of the incidence in the period 2002-2014. The Kaplan-Meier method and the Cox model were used to analyse recurrence.
RESULTS: Of 8660 admissions for diverticular disease, 4746 were due to diverticulitis, of which 2939 were for diverticulitis diagnosed for the first time. After the first attack, surgery was used to treat 661 patients. Of 2278 patients not treated by resection, 537 had a second attack (23·6 per cent). There was a significant decrease in the incidence of diverticulitis in patients aged 40-89 years during the period from 2002 to 2014 (P = 0·033). The risk of recurrence was associated with younger age at first attack and female sex (P < 0·001).
CONCLUSION: There was a decline in the incidence of patients hospitalized with diverticulitis between 1995 and 2014, most prominent in older age groups. Different recurrence rates were reported in men and women, and in younger compared with older age groups.},
}
@article {pmid32886196,
year = {2021},
author = {Lauscher, JC and Lock, JF and Aschenbrenner, K and Strobel, RM and Leonhardt, M and Stroux, A and Weixler, B and Germer, CT and Kreis, ME},
title = {Validation of the German Classification of Diverticular Disease (VADIS)-a prospective bicentric observational study.},
journal = {International journal of colorectal disease},
volume = {36},
number = {1},
pages = {103-115},
pmid = {32886196},
issn = {1432-1262},
mesh = {Colectomy ; Colon, Sigmoid/surgery ; *Diverticular Diseases ; *Diverticulitis/surgery ; *Diverticulitis, Colonic/surgery ; Humans ; Prospective Studies ; Quality of Life ; Recurrence ; Treatment Outcome ; },
abstract = {PURPOSE: The German Classification of Diverticular Disease was introduced a few years ago. The aim of this study was to determine whether Classification of Diverticular Disease enables an exact stratification of different types of diverticular disease in terms of course and treatment.
METHODS: This was a prospective, bicentric observational trial. Patients aged ≥ 18 years with diverticular disease were prospectively included. The primary endpoint was the rate of recurrence within 2 year follow-up. Secondary outcome measures were Gastrointestinal Quality of Life Index, Quality of life measured by SF-36, frequency of gastrointestinal complaints, and postoperative complications.
RESULTS: A total of 172 patients were included. After conservative management, 40% of patients required surgery for recurrence in type 1b vs. 80% in type 2a/b (p = 0.04). Sixty percent of patients with type 2a (micro-abscess) were in need of surgery for recurrence vs. 100% of patients with type 2b (macro-abscess) (p = 0.11). Patients with type 2a reached 123 ± 15 points in the Gastrointestinal Quality of Life Index compared with 111 ± 14 in type 2b (p = 0.05) and higher scores in the "Mental Component Summary" scale of SF-36 (52 ± 10 vs. 43 ± 13; p = 0.04). Patients with recurrent diverticulitis without complications (type 3b) had less often painful constipation (30% vs. 73%; p = 0.006) when they were operated compared with conservative treatment.
CONCLUSION: Differentiation into type 2a and 2b based on abscess size seems reasonable as patients with type 2b required surgery while patients with type 2a may be treated conservatively. Sigmoid colectomy in patients with type 3b seems to have gastrointestinal complaints during long-term follow-up.
TRIAL REGISTRATION: https://www.drks.de ID: DRKS00005576.},
}
@article {pmid32885687,
year = {2020},
author = {Ponziani, FR and Scaldaferri, F and De Siena, M and Mangiola, F and Matteo, MV and Pecere, S and Petito, V and Sterbini, FP and Lopetuso, LR and Masucci, L and Cammarota, G and Sanguinetti, M and Gasbarrini, A},
title = {Increased Faecalibacterium abundance is associated with clinical improvement in patients receiving rifaximin treatment.},
journal = {Beneficial microbes},
volume = {11},
number = {6},
pages = {519-525},
doi = {10.3920/BM2019.0171},
pmid = {32885687},
issn = {1876-2891},
mesh = {Adult ; Bacterial Load/drug effects ; Bacteroidetes/growth & development ; Clostridiales/growth & development ; Diverticular Diseases/*drug therapy/microbiology ; Faecalibacterium/*growth & development ; Female ; Gastrointestinal Agents/*therapeutic use ; Gastrointestinal Microbiome/*drug effects ; Humans ; Inflammatory Bowel Diseases/*drug therapy/microbiology ; Irritable Bowel Syndrome/*drug therapy/microbiology ; Male ; Middle Aged ; Rifaximin/*therapeutic use ; },
abstract = {Compositional and functional alterations of the gut microbiota are involved in the pathogenesis of several gastrointestinal diseases. Rifaximin is often used to induce disease remission due to its eubiotic effects on the gut microbiota. To investigate the correlation between changes in the gut microbiota composition and symptoms improvement in patients who present a clinical response to rifaximin treatment. Patients with ulcerative colitis (UC), Crohn's disease (CD), irritable bowel syndrome (IBS) and diverticular disease (DD) undergoing rifaximin treatment for clinical indication were enrolled in the study. Rifaximin was administered at the dose of 1,200 mg/day for 10 days. Faecal samples were collected at baseline and at the end of treatment; clinical improvement was assessed by Mayo score for UC, CD Activity Index (CDAI) for CD, IBS severity scoring system (IBS-SSS) for IBS and global symptomatic score (GSS) for DD. Twenty-five patients were included in the analysis and a clinical improvement was recorded for 10/25 (40%) of them. Microbial alpha diversity showed a slight increase in clinical responders (P=0.271), while it decreased in patients who did not improved (P=0.05). A significant post-treatment increase in Faecalibacterium abundance was observed in patients with a positive response (log2FC 1.959, P=0.042). Roseburia abundance decreased in both groups, whereas Ruminococcus decreased only in patients who clinically improved. Clinical improvement consequent to rifaximin treatment is associated with an increase in Faecalibacterium abundance. Achieving a positive shift in the gut microbiota composition seems a key event to obtain a clinical benefit from treatment.},
}
@article {pmid32875409,
year = {2021},
author = {Portale, G and Cipollari, C and Zuin, M and Spolverato, Y and Fiscon, V},
title = {Prevalence of internal hernia following laparoscopic colorectal surgery: single-center report on 1300 patients.},
journal = {Surgical endoscopy},
volume = {35},
number = {8},
pages = {4315-4320},
pmid = {32875409},
issn = {1432-2218},
mesh = {Colectomy/adverse effects ; *Colorectal Surgery ; Humans ; Internal Hernia ; *Laparoscopy/adverse effects ; Postoperative Complications/epidemiology/etiology/surgery ; Prevalence ; Retrospective Studies ; },
abstract = {BACKGROUND: Internal hernia (IH) is an infrequent complication following colorectal resection with minimally invasive technique. The real prevalence is difficult to define and there are only few large series reporting data on this complication, often focusing only on left-sided resections. Aim of the study was to evaluate the occurrence of IH following laparoscopic colorectal resection (LCR), reporting clinical presentation and treatment.
METHODS: Data from 1297 patients undergoing elective LCR for cancer or benign disease in a 15-year period (June 2005-March 2020) were prospectively collected. A database query was performed to search for small bowel obstructions requiring reintervention.
RESULTS: Five patients presented symptomatic IH (prevalence = 0.38%) and required reintervention. The preceding surgical procedure was left hemicolectomy for diverticular disease in all patients. The mesenteric defect had been originally closed in 4/5 patients. The median time interval between initial surgery and the occurrence of IH was 1 (range: 0.3-10) month. In all cases a small bowel loop was found herniating through the mesocolic defect. Small bowel resection was required in one patient only. The median hospital stay following reintervention was 7 (range: 4-17) days.
CONCLUSIONS: IH following LCR is a rare but severe complication, potentially leading to death, if not promptly diagnosed and treated. Awareness of this complication, early recognition, and proper diagnostic and therapeutic management is mandatory allowing laparoscopic approach and often avoiding small bowel resection.},
}
@article {pmid32875377,
year = {2021},
author = {Duarte-Chavez, R and Stoltzfus, J and Yellapu, V and Martins, N and Nanda, S and Longo, S and Geme, B and Schneider, Y},
title = {Colonic diverticular disease in autosomal dominant polycystic kidney disease: is there really an association? A nationwide analysis.},
journal = {International journal of colorectal disease},
volume = {36},
number = {1},
pages = {83-91},
pmid = {32875377},
issn = {1432-1262},
mesh = {*Diverticular Diseases/complications/epidemiology ; *Diverticulitis/complications/epidemiology ; *Diverticulosis, Colonic ; Humans ; *Kidney Transplantation ; *Polycystic Kidney, Autosomal Dominant/complications/epidemiology ; Risk Factors ; },
abstract = {PURPOSE: Colonic diverticulosis, diverticulitis, and diverticular bleeding are reportedly more common in patients with autosomal dominant polycystic kidney disease (ADPKD). Other studies have questioned this association. The objectives of our study are to clarify this association using a larger patient population and to identify risk factors in general to develop diverticular disease.
METHODS: The Nationwide Inpatient Sample weighted discharges from 2003 to 2011 were used to assess for the prevalence of diverticular disease in the population with ADPKD compared with the general population without ADPKD. A multivariable direct logistic regression model was constructed to determine independent predictors of diverticular disease in the general population.
RESULTS: The prevalence of diverticulosis, diverticulitis, and diverticular bleeding were considerably increased in patients with ADPKD compared with the general population without ADPKD. The prevalence of colonic surgery was less in ADPKD patients with diverticulitis. In patients with kidney transplant, the prevalence of diverticulitis was increased in the ADPKD group, but colonic surgery was not significantly different between both groups. The prevalence of diverticular bleeding was slightly elevated in patients with ADPKD, but colonic surgery was significantly increased in patients with ADPKD. NSAID use, hypertension, constipation, and ADPKD had increased odds ratios for diverticular disease during multivariate analysis.
CONCLUSION: There is an increased prevalence of colonic diverticular disease in the population with ADPKD.},
}
@article {pmid32820657,
year = {2020},
author = {Abdulazeez, Z and Kukreja, N and Qureshi, N and Lascelles, S},
title = {Colonoscopy and flexible sigmoidoscopy for follow-up of patients with left-sided diverticulitis.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {102},
number = {9},
pages = {744-747},
pmid = {32820657},
issn = {1478-7083},
mesh = {Acute Disease ; Aftercare/methods ; Aged ; Aged, 80 and over ; *Colonoscopy/methods ; Diverticulitis, Colonic/*diagnosis/diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; *Sigmoidoscopy/methods ; Tomography, X-Ray Computed ; },
abstract = {INTRODUCTION: The prevalence of diverticular disease has been increasing in the western world over the last few decades, causing a growing burden on health care systems. This study compared the uses of flexible sigmoidoscopy with colonoscopy as a follow-up investigation for patients diagnosed with acute left-sided diverticulitis and to evaluate the need for using either procedure.
MATERIALS AND METHODS: A retrospective study of 327 patients diagnosed with acute diverticulitis was carried out. Of this total, 240 patients with left-sided diverticulitis diagnosed via computed tomography were included. These patients were categorised into two equal groups: the first 120 patients underwent colonoscopy and the second 120 patients underwent flexible sigmoidoscopy.
RESULTS: All colonoscopes and flexible sigmoidoscopes confirmed the computed tomography diagnosis of sigmoid diverticular disease with no major new findings. All colonoscopes and flexible sigmoidoscopes were reported as having no complications, with nine colonoscopes reported as being difficult compared with only three flexible sigmoidoscopes. All biopsies were reported as no malignancy. Full bowel preparation was required in all colonoscopes, compared with no preparation required for flexible sigmoidoscopes.
CONCLUSIONS: There is no evidence to support the routine use of endoscopic evaluation after an episode of left-sided diverticulitis diagnosed on computed tomography if no worrying radiological findings have been reported. This study supports similar findings from other studies and therefore we disagree with The Royal College of Surgeons of England (Association of Coloproctology of Great Britain and Ireland recommendations) commissioning guide, which advocates routine surveillance of the colon.},
}
@article {pmid32814626,
year = {2021},
author = {McKechnie, T and Lee, Y and Kruse, C and Qiu, Y and Springer, JE and Doumouras, AG and Hong, D and Eskicioglu, C},
title = {Operative management of colonic diverticular disease in the setting of immunosuppression: A systematic review and meta-analysis.},
journal = {American journal of surgery},
volume = {221},
number = {1},
pages = {72-85},
doi = {10.1016/j.amjsurg.2020.06.035},
pmid = {32814626},
issn = {1879-1883},
mesh = {Diverticulitis, Colonic/*surgery ; Humans ; *Immunosuppression Therapy ; Treatment Outcome ; },
abstract = {BACKGROUND: Immunosuppressed patients with diverticular disease are at higher risk of postoperative complications, however reported rates have varied. The aim of this study is to compare postoperative outcomes in immunosuppressed and immunocompetent patients undergoing surgery for diverticular disease.
METHODS: Medline, EMBASE, and CENTRAL were searched. Articles were included if they compared immunosuppressed and immunocompetent patients undergoing surgery for diverticular disease.
RESULTS: From 204 citations, 11 studies with 2,977 immunosuppressed patients and 780,630 immunocompetent patients were included. Mortality was greater in immunosuppressed patients compared to immunocompetent patients for emergent surgery (RR 1.91, 95%CI 1.24-2.95, p < 0.01), but not elective surgery (RR 1.70, 95%CI 0.14-20.47, p = 0.68). Morbidity was greater in immunosuppressed patients compared to immunocompetent patients for elective surgery (RR 2.18, 95%CI 1.02-4.65, p = 0.04), but not emergent surgery (RR 1.40, 95%CI 0.68-2.90, p = 0.37).
CONCLUSIONS: Increased consideration for elective operation may preclude the need for emergent surgery and the associated increase in postoperative mortality.},
}
@article {pmid32796358,
year = {2021},
author = {Jiang, Y and Rodgers, B and Damiris, K and Choi, C and Ahlawat, S},
title = {The effects of diabetes mellitus on clinical outcomes of hospitalized patients with acute diverticulitis.},
journal = {European journal of gastroenterology & hepatology},
volume = {33},
number = {11},
pages = {1354-1360},
doi = {10.1097/MEG.0000000000001895},
pmid = {32796358},
issn = {1473-5687},
mesh = {Adult ; Colectomy ; *Diabetes Mellitus/epidemiology ; *Diverticulitis/diagnosis/epidemiology/therapy ; *Diverticulitis, Colonic/complications/diagnosis/epidemiology ; Humans ; Retrospective Studies ; },
abstract = {OBJECTIVES: Acute diverticulitis is a common gastrointestinal illness due to diverticular inflammation and focal necrosis. Diabetes mellitus has been reported to influence the outcomes of patients with diverticular disease. Our study aimed to examine the inpatient outcomes and complications of patients with acute diverticulitis and coexisting diabetes mellitus.
METHODS: The Nationwide Inpatient Sample was used to identify adult patients in 2014 admitted for acute diverticulitis. Primary outcomes were mortality, length of stay (LOS), and total hospitalization charges. Secondary outcomes were complications of acute diverticulitis and interventions.
RESULTS: In total, 44 330 of patients with acute diverticulitis and diabetes mellitus were included in the analysis. Acute diverticulitis patients with diabetes mellitus had a higher rate of diverticular bleeding (P < 0.0001), but lower rates of abscess (P < 0.0001), obstruction (P < 0.0001) and colectomy (P < 0.0001) when compared to acute diverticulitis patients without diabetes mellitus. Complicated diabetes mellitus was associated with a longer LOS (P = 0.00003) and greater total hospitalization charges (P = 0.0021) compared to uncomplicated diabetes mellitus when coexisting with acute diverticulitis.
CONCLUSIONS: Acute diverticulitis with diabetes mellitus is associated with a higher rate of diverticular bleeding, lower rates of abscess, obstruction, and colectomy compared to acute diverticulitis without diabetes mellitus. When coexisting with acute diverticulitis, complicated diabetes mellitus is not associated with higher rates of mortality or diverticulitis-related complications compared to uncomplicated diabetes mellitus.},
}
@article {pmid32785905,
year = {2021},
author = {Storz, C and Rospleszcz, S and Askani, E and Rothenbacher, T and Linseisen, J and Messmann, H and De Cecco, CN and Machann, J and Kiefer, LS and Elser, S and Rathmann, W and Peters, A and Schlett, CL and Bamberg, F},
title = {Magnetic Resonance Imaging of Diverticular Disease and its Association with Adipose Tissue Compartments and Constitutional Risk Factors in Subjects from a Western General Population.},
journal = {RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin},
volume = {193},
number = {1},
pages = {33-41},
doi = {10.1055/a-1212-5669},
pmid = {32785905},
issn = {1438-9010},
mesh = {Adipose Tissue/*diagnostic imaging ; Aged ; Case-Control Studies ; Cross-Sectional Studies ; Diverticular Diseases/*diagnostic imaging ; Female ; Germany ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Whole Body Imaging ; },
abstract = {PURPOSE: To determine the association of asymptomatic diverticular disease as assessed by magnetic resonance imaging (MRI) with adipose tissue compartments, hepatic steatosis and constitutional risk factors within a cohort drawn from a Western general population.
MATERIALS AND METHODS: Asymptomatic subjects enrolled in a prospective case-control study underwent a 3 Tesla MRI scan, including an isotropic VIBE-Dixon sequence of the entire trunk. The presence and extent of diverticular disease were categorized according to the number of diverticula in each colonic segment in a blinded fashion. The amount of visceral, subcutaneous, and total adipose tissue (VAT, SAT, and TAT) was quantified by MRI. Additionally, the degree of hepatic steatosis, indicated as hepatic proton density fat fraction (hepatic PDFF) was determined using a multi-echo T1w sequence. Constitutional cardiometabolic risk factors were obtained and univariate and multivariate associations were calculated.
RESULTS: A total of 371 subjects were included in the analysis (58.2 % male, 56.2 ± 9.2 years). Based on MRI, 154 participants (41.5 %) had diverticular disease with 62 cases (17 %) being advanced diverticular disease. Subjects with advanced diverticular disease had a significantly higher body mass index (BMI) (BMI: 29.9 ± 5.1 vs. 27.5 ± 4.6, p < 0.001; respectively). Furthermore, all adipose tissue compartments were increased in subjects with advanced diverticular disease (e. g. VAT: 6.0 ± 2.8 vs. 4.2 ± 2.6 and SAT: 9.2 ± 3.6 vs. 7.8 ± 3.6, all p < 0.001, respectively). Similarly, subjects with advanced diverticular disease had significantly higher hepatic PDFF (4.9 [2.7, 11.4] vs. 6.1 [5.5, 14.6], p = 0.002).
CONCLUSION: Advanced diverticular disease is associated with an increased volume of adipose tissue compartments and BMI, which may suggest a metabolic role in disease development.
KEY POINTS: · Diverticular disease is associated with constitutional risk factors such as BMI.. · Excess of adipose tissue compartments and hepatic steatosis are associated with the prevalence of diverticular disease.. · Our results suggest a shared pathological pathway of cardiometabolic alterations and the prevalence of diverticular disease.. · MRI is feasible for the assessment of adipose tissue compartments, hepatic steatosis, and diverticular disease and allows identification of patients who are at risk but in an asymptomatic disease state..
CITATION FORMAT: · Storz C, Rospleszcz S, Askani E et al. Magnetic Resonance Imaging of Diverticular Disease and its Association with Adipose Tissue Compartments and Constitutional Risk Factors in Subjects from a Western General Population. Fortschr Röntgenstr 2021; 193: 33 - 41.},
}
@article {pmid32773048,
year = {2020},
author = {Manuelyan, Z and Siomara Muñiz, K and Stein, E},
title = {Common Urinary and Bowel Disorders in the Geriatric Population.},
journal = {The Medical clinics of North America},
volume = {104},
number = {5},
pages = {827-842},
doi = {10.1016/j.mcna.2020.06.009},
pmid = {32773048},
issn = {1557-9859},
mesh = {Aged ; Constipation/epidemiology ; Fecal Incontinence/epidemiology ; Geriatric Assessment ; Humans ; *Intestinal Diseases/diagnosis/physiopathology/psychology ; Prevalence ; *Quality of Life ; Urinary Incontinence/epidemiology ; *Urologic Diseases/diagnosis/physiopathology/psychology ; },
abstract = {The prevalence of urinary incontinence and other lower urinary tract symptoms increases with older age. These symptoms are more noticeable in men after the seventh decade of life and in women after menopause. Constipation and fecal incontinence are major causes of symptoms in elderly patients and can significantly impair quality of life. This article summarizes the current literature regarding the occurrence and implications of lower urinary tract and bowel symptoms in the geriatric population.},
}
@article {pmid32772693,
year = {2020},
author = {Kohler, A and Studer, P and Brügger, L},
title = {[Update: Management of colonic diverticulitis].},
journal = {Therapeutische Umschau. Revue therapeutique},
volume = {77},
number = {4},
pages = {157-163},
doi = {10.1024/0040-5930/a001170},
pmid = {32772693},
issn = {0040-5930},
mesh = {Anti-Bacterial Agents/therapeutic use ; Diverticulitis/*drug therapy/*surgery ; Diverticulitis, Colonic/*diagnosis ; Drainage ; Elective Surgical Procedures ; Humans ; },
abstract = {Update: Management of colonic diverticulitis Abstract. Several classification systems exist for diverticulosis and diverticulitis. We preferably use the "Classification of Diverticular Disease" (CDD) to grade the severity of disease. This classification is based on imaging by CT scan or ultrasound. The CDD system divides patients into categories with a common therapeutic strategy. Acute uncomplicated diverticulitis is treated by oral or intravenous antibiotics. For the majority of patients with uncomplicated diverticulitis, antibiotic therapy might be omitted in favor of a solely symptomatic therapy. Acute diverticulitis complicated by a relevant abscess or a perforation is treated by interventional drainage or surgical therapy. Resection with primary anastomosis replaces more and more resection with end colostomy (Hartmann's procedure). For patients with sepsis, the concept of damage control surgery has been introduced. The indication for elective surgery after conservative treatment of diverticulitis shall be dictated by the degree of the patient's symptoms, rather than the number of conservatively treated episodes of diverticulitis. Persisting complications, as fistulas and stenosis, represent an indication for elective colonic resection.},
}
@article {pmid32769744,
year = {2020},
author = {Mari, G and Montroni, I and Origi, M and Crippa, J and Achilli, P and Costanzi, A and Ferrari, G and Ugolini, G and Maggioni, D and , },
title = {Functional and Short-term Outcomes in Elective Laparoscopic Colectomy for Symptomatic Diverticular Disease With Either Low Ligation or Inferior Mesenteric Artery Preservation: A Randomized Trial.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {31},
number = {1},
pages = {40-43},
doi = {10.1097/SLE.0000000000000850},
pmid = {32769744},
issn = {1534-4908},
mesh = {Colectomy ; *Diverticular Diseases ; Humans ; *Laparoscopy ; Ligation ; Mesenteric Artery, Inferior/surgery ; Quality of Life ; },
abstract = {BACKGROUND: The current treatment of symptomatic diverticular disease is left colectomy/sigmoidectomy with low ligation of the inferior mesenteric artery versus the inferior mesenteric artery preservation. Up to now, there is no strong evidence in favor of one of the 2 strategies. The aim of this study is to compare the bowel-specific quality of life and functional outcomes between these 2.
METHODS: Between June 2015 and February 2019, patients were randomly assigned to inferior mesenteric artery low ligation or inferior mesenteric artery preservation during elective laparoscopic sigmoidectomy for diverticular disease. Gastrointestinal, genitourinary functions and surgical outcomes were compared postoperatively between groups.
RESULTS: One-hundred sixty-eight patients were randomized providing 2 homogenous groups. Gastrointestinal and genitourinary functions were not significantly different between groups after 1 and 6 months postoperative. In both groups, the function was restored to the preoperative level 6 months after surgery. There was no statistically significant difference in terms of conversion rate, blood loss, length of surgery, between groups. There was no difference in the overall complication rate and the anastomotic leak rate among groups.
CONCLUSIONS: Inferior mesenteric artery low ligation or inferior mesenteric artery preservation during elective laparoscopic sigmoidectomy for a diverticular disease can be considered equivalent in affecting the postoperative bowel-related quality of life, genitourinary function, and surgical outcomes.},
}
@article {pmid32767345,
year = {2020},
author = {Stefanelli, G and Viscido, A and Valvano, M and Vernia, F and Frieri, G and Ashktorab, H and Latella, G},
title = {Is mesalazine treatment effective in the prevention of diverticulitis? A review.},
journal = {European review for medical and pharmacological sciences},
volume = {24},
number = {15},
pages = {8164-8176},
doi = {10.26355/eurrev_202008_22504},
pmid = {32767345},
issn = {2284-0729},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulitis/*prevention & control ; Humans ; Mesalamine/*therapeutic use ; Probiotics/therapeutic use ; Rifaximin/therapeutic use ; },
abstract = {Diverticulitis is the most severe form of Diverticular disease (DD). An effective treatment strategy for its prevention has not yet been defined. This review aimed to provide a viewpoint on the role of mesalazine, also note as 5-aminosalicylic acid (5-ASA), in the prevention of diverticulitis. A systematic electronic search of relevant articles was performed using PubMed, Embase, Scopus, and Cochrane. Randomized controlled trials (RCTs), open trials, and retrospective studies, published between January 1999 and January 2020, were identified. Twelve eligible studies that analyzed primary or secondary outcomes of diverticulitis were included. The population included patients with symptomatic uncomplicated diverticular disease (SUDD), or patients with a history of diverticulitis. All studies compared 5-ASA to placebo, rifaximin, or other treatments. Two studies, including 359 patients, assessed the efficacy of 5-ASA in preventing the first appearance of diverticulitis in patients with SUDD. Of these, one showed that 5-ASA was effective, and one did not. Ten studies, including 2.995 patients, assessed the efficacy of 5-ASA treatment in preventing the recurrence of diverticulitis in patients with a history of diverticulitis. Four studies showed that 5-ASA had a certain degree of efficacy. All four RCTs demonstrated that 5-ASA did not significantly reduce the rate of diverticulitis recurrence. In a retrospective trial, 5-ASA was less effective than rifaximin in preventing diverticulitis recurrence. In an open trial, there was no difference between 5-ASA and probiotic treatment. Overall, there is currently conflicting evidence regarding the efficacy of 5-ASA treatment in the prevention of diverticulitis and further RCTs are needed.},
}
@article {pmid32766000,
year = {2020},
author = {Payne, A and Than, NN and Jalan, R and Yu, D},
title = {An Unusual Case of Hematochezia.},
journal = {Cureus},
volume = {12},
number = {7},
pages = {e8957},
pmid = {32766000},
issn = {2168-8184},
abstract = {Lower gastrointestinal bleeding (LGIB) is a serious and potentially life-threatening condition warranting hospital admission. The most frequent causes include diverticular disease, colitis, hemorrhoids, neoplasm, inflammatory bowel disease, and varices. Varices usually occur secondary to liver cirrhosis and are frequently located in the gastroesophageal region. Those occurring elsewhere are known as ectopic varices. The diagnosis and management of ectopic varices is challenging, and guidelines are not currently available. We report the case of recurrent large-volume hematochezia secondary to a cecal varix in a 60-year-old female with alcoholic liver cirrhosis. Initial investigation with CT angiography and endoscopy failed to identify the source of bleeding. A second CT angiogram identified a large varix in the cecum, and the patient was successfully managed with radiological embolization and transjugular intra-hepatic porto-systemic shunt (TIPSS).},
}
@article {pmid32754697,
year = {2019},
author = {Beresneva, O and Hall, J},
title = {Influence of body mass index on outcomes in patients undergoing surgery for diverticular disease.},
journal = {Surgery open science},
volume = {1},
number = {2},
pages = {80-85},
pmid = {32754697},
issn = {2589-8450},
abstract = {BACKGROUND: We hypothesized that increasing body mass index is a risk factor for surgical complications in surgery for diverticulitis. We assessed the relationship of body mass index and surgical complications following surgery for diverticular disease.
METHODS: We used National Surgical Quality Improvement Program database from 2005 to 2015. Patients undergoing surgery for diverticular disease during that period were included and stratified into 9 groups based on their body mass index (< 18.5, 18.6-24.9, 25.0-29.9, 30.0-34.9, 35.0-39.9, 40.0-44.9, 45.0-49.9, 50.0-54.9, > 55). Outcomes of interest were complications of superficial surgical site infection, deep incisional surgical site infection, organ space surgical site infection, wound disruption complications, pneumonia, ventilator dependence > 48 hours, acute renal failure, myocardial infarction, return to operating room, and 30-day mortality.
RESULTS: Morbidly obese patients had higher rates of diabetes, hypertension, and steroid use. They had higher American Society of Anesthesiologists classification and were more likely to have emergency and open cases. Interestingly, increased body mass index was inversely associated with age. Increasing body mass index was associated with worse outcomes including superficial surgical site infection, deep incisional surgical site infection, organ space surgical site infection, wound disruption complications, ventilator dependence > 48 hours, acute renal failure, and return to operating room. Risk of developing pneumonia didn't have similar correlation with body mass index. Overweight status had protective effect on mortality. No statistically significant differences in increased rates of myocardial infarction were noted. Underweight patients also developed worse outcomes.
CONCLUSION: Obesity is associated with a number of complications following surgery for diverticulitis. Elevated body mass index adds significant risk to procedures for diverticulitis and should be accounted for in risk stratification models. Patients should be counseled on weight reduction before undergoing elective surgery for diverticular disease.},
}
@article {pmid32754291,
year = {2020},
author = {Alnzaer, AA and Mohamedahmed, AYY and Adam, YA and Eltyiep, E and Suliman, SH},
title = {Presentation and anatomical distribution of diverticular disease in four hospitals in Sudan.},
journal = {The Pan African medical journal},
volume = {36},
number = {},
pages = {64},
pmid = {32754291},
issn = {1937-8688},
mesh = {Abdominal Pain/*epidemiology/etiology ; Adult ; Aged ; Aged, 80 and over ; *Colonoscopy ; Constipation/epidemiology ; Cross-Sectional Studies ; Diverticular Diseases/*epidemiology/physiopathology ; Diverticulosis, Colonic/*epidemiology/physiopathology ; Female ; Gastrointestinal Hemorrhage/epidemiology ; Humans ; Male ; Middle Aged ; Prevalence ; Sudan ; Young Adult ; },
abstract = {INTRODUCTION: diverticular disease (DD) was thought to be more prevalent in the western countries, especially the white populations, but the recent increase in incidence among African and Asian population, was reported. Up to our knowledge, there is no previous study of DD in Sudan.
METHODS: this is a descriptive cross-sectional study conducted at the department of endoscopy in four Sudanese hospitals in the period from October 2017 to February 2019. We included all patients who underwent colonoscopy during the study period. The main objective is to study the presentation and the anatomical pattern of diverticular disease among the Sudanese population.
RESULTS: prevalence of DD in the included population was 7.5% (104/1393). The mean age was 66.4 ± 12.5 years with the percentage of males in our study is 77.1% and females were 22.9%. Presenting complains were: abdominal pain in all patients, constipation in 78.8% and rectal bleeding in 57.7%. Regarding anatomical distribution: 63.5% have left colonic DD, 19.2% in the right colon and 17.3% involving the entire colon. There was a significant correlation between the left side DD and following clinical presentations: mucus per-rectum (p = 0.015) and weight loss (p = 0.048). Other endoscopic findings of significance were internal pile in 21.2% and colo-rectal polyp in 15.4%.
CONCLUSION: the prevalence of DD in the included population, is 7.5% which is consistent with recent literature from the Middle East, Africa and Asia but still less than the prevalence in the western countries and left side colon is predominantly affected.},
}
@article {pmid32748338,
year = {2021},
author = {Perez, NP and Chang, DC and Goldstone, RN and Bordeianou, L and Ricciardi, R and Cavallaro, PM},
title = {Relationship Between Diverticular Disease and Incisional Hernia After Elective Colectomy: a Population-Based Study.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {25},
number = {5},
pages = {1297-1306},
pmid = {32748338},
issn = {1873-4626},
support = {T32 DK007754/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Colectomy/adverse effects ; Colon, Sigmoid/surgery ; *Diverticular Diseases ; Humans ; *Incisional Hernia ; *Laparoscopy/adverse effects ; New York ; Retrospective Studies ; },
abstract = {BACKGROUND: Recent genetic studies identified common mutations between diverticular disease and connective tissue disorders, some of which are associated with abdominal wall hernias. Scarce data exists, however, shedding light on the potential clinical implications of this shared etiology, particularly in the era of laparoscopic surgery.
METHODS: The New York Statewide Planning and Research Cooperative System database was used to identify adult patients undergoing elective sigmoid and left hemicolectomy (open or laparoscopic) from January 1, 2010, to December 31, 2016, for diverticulitis or descending/sigmoid colon cancer. The incidences of incisional hernia diagnosis and repair were compared using competing risks regression models, clustered by surgeon and adjusted for a host of demographic/clinical variables. Subsequent abdominal surgery and death were considered competing risks.
RESULTS: Among 8279 patients included in the study cohort, 6811 (82.2%) underwent colectomy for diverticulitis and 1468 (17.8%) for colon cancer. The overall 5-year risk of incisional hernia was 3.5% among patients with colon cancer, regardless of colectomy route, which was significantly lower than that among diverticulitis patients after both open (10.7%; p < 0.001) and laparoscopic (7.2%; p = 0.007) colectomies. Multivariable analyses demonstrated that patients with diverticulitis experienced a two-fold increase in the risk for hernia diagnosis (aHR 1.8; p < 0.001) and repair (aHR 2.1; p < 0.001), and these findings persisted after stratification by colectomy route.
CONCLUSIONS: Patients undergoing elective colectomy for diverticulitis, including via laparoscopic approach, experience higher rates of incisional hernia compared with patients undergoing similar resections for colon cancer. When performing resections for diverticulitis, surgeons should strongly consider adherence to evidence-based guidelines for fascial closure to prevent this important complication.},
}
@article {pmid32748249,
year = {2021},
author = {Flor, N and Pickhardt, PJ and Maconi, G and Panella, S and Falleni, M and Merlo, V and Di Leo, G},
title = {CT colonography followed by elective surgery in patients with acute diverticulitis: a radiological-pathological correlation study.},
journal = {Abdominal radiology (New York)},
volume = {46},
number = {2},
pages = {491-497},
pmid = {32748249},
issn = {2366-0058},
mesh = {Acute Disease ; *Colonography, Computed Tomographic ; Correlation of Data ; *Diverticulitis ; *Diverticulitis, Colonic/complications/diagnostic imaging/surgery ; Humans ; Retrospective Studies ; },
abstract = {PURPOSE: To perform a radiologic-pathologic correlation analysis of sigmoid colon in patients undergoing pre-operative CT Colonography (CTC) after an episode of acute diverticulitis (AD).
METHODS: Fifty-nine consecutive patients (31/28 M/F; 58 ± 13 years) underwent CTC 55 ± 18 days after AD, 8 ± 4 weeks before surgery. Thirty-seven patients (63%) underwent conventional abdominal CT at time of AD. An experienced blinded radiologist retrospectively analyzed all images: disease severity was graded according to the Ambrosetti classification on conventional CT and according to the diverticular disease severity score (DDSS) on CTC. A GI pathologist performed a dedicated analysis, evaluating the presence of acute and chronic inflammation, and fibrosis, using 0-3 point scale for each variable.
RESULTS: Of 59 patients, 41 (69%) had at least one previous AD episode; twenty-six patients (44%) had a complicated AD. DDSS was mild-moderate in 34/59 (58%), and severe in 25/59 (42%). All patients had chronic inflammation, while 90% had low-to-severe fibrosis. Patients with moderate/severe fibrosis were older than those with no/mild fibrosis (61 ± 13 versus 54 ± 13). We found a significant correlation between DDSS and chronic inflammation (p = 0.004), as well as DDSS and fibrosis (p = 0.005). Furthermore, fibrosis was correlated with complicated acute diverticulitis (p = 0.0.27), and with age (p = 0.067). At multivariate analysis, complicated diverticulitis was the best predictor of fibrosis (odds ratio 4.4). Patient age and DDSS were other independent predictors.
CONCLUSION: DDSS-based assessment on preoperative CTC was a good predictor of chronic colonic inflammation and fibrosis. In addition, the presence of complicated diverticulitis on CT during the acute episode was most predictive of fibrosis.},
}
@article {pmid32740245,
year = {2022},
author = {Hawkins, AT and Samuels, LR and Rothman, RL and Geiger, TM and Penson, DF and Resnick, MJ},
title = {National Variation in Elective Colon Resection for Diverticular Disease.},
journal = {Annals of surgery},
volume = {275},
number = {2},
pages = {363-370},
pmid = {32740245},
issn = {1528-1140},
support = {K23 DK118192/DK/NIDDK NIH HHS/United States ; U01 AG046830/AG/NIA NIH HHS/United States ; UL1 TR001086/TR/NCATS NIH HHS/United States ; },
mesh = {Aged ; Colectomy/*methods ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures ; Female ; Humans ; Male ; United States ; },
abstract = {OBJECTIVE: This study aims to characterize the extent of geographic variation in elective sigmoid resection for diverticulitis and to identify factors associated with observed variation.
INTRODUCTION: National guidelines for treatment of recurrent diverticulitis fail to offer strong recommendations for or against surgical intervention. We hypothesize that healthcare market factors will be significantly associated with geographic variation in colon resection for diverticulitis, a discretionary surgical intervention.
METHODS: We used Center for Medicare Services 100% inpatient Limited Data Set (LDS) files from January 2013 through September 2015 to calculate an observed to expected standardized colon resection ratio for each hospital referral region (HRR). We then analyzed patient, hospital-, and market-level factors associated with variation of colectomy. For each HRR, a Herfindahl-Hirschman index, a measure of market competition, was calculated.
RESULTS: A total of 19,557 Medicare patients underwent an elective colon resection for diverticulitis at 2462 hospitals over the study period. Standardized colon resection ratios ranged from 0 in the Tuscaloosa HRR to 3.7 in the Royal Oak, MI HRR. Few patient factors were associated with variation, but a number of hospital factors (size, area, profit status, and critical access designation) all were associated with variation. In an analysis of market factors, increased surgeon density, and decreased market competition were associated with higher predicted rates of colon resection.
CONCLUSION: We observed pronounced variation (excess of 3-fold) in standardized colon resection ratios for recurrent diverticulitis. Surgeon density and hospital level factors were strongly associated with this variation and may be the main drivers of colonic resection for diverticular disease. Further investigation and stronger national guidelines are needed to optimize patient selection for colectomy.},
}
@article {pmid32671425,
year = {2020},
author = {Galata, C and Lock, JF and Reißfelder, C and Germer, CT},
title = {[Recommendations for treatment of diverticular disease].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {91},
number = {9},
pages = {720-726},
doi = {10.1007/s00104-020-01239-y},
pmid = {32671425},
issn = {1433-0385},
mesh = {Colon, Sigmoid ; *Diverticulitis, Colonic ; Germany ; Humans ; *Laparoscopy ; Quality of Life ; },
abstract = {BACKGROUND: Diverticular disease is of major clinical and health economic importance in Germany. Treatment recommendations in many international guidelines have changed significantly in recent years. The German national S2k guidelines are currently being revised.
OBJECTIVE: To summarize the most important clinical aspects in the management of diverticular disease from a surgical perspective.
MATERIAL AND METHODS: The recommendations were compiled based on current national and international guidelines and a selective literature search.
RESULTS: Acute uncomplicated diverticulitis without risk factors can be treated on an outpatient basis without antibiotics. For patients with complicated diverticulitis, hospital admission with parenteral antibiotic treatment is recommended. In the case of abscess formation >5 cm, percutaneous drainage can be performed. The indications for immediate sigmoid resection are free perforation and failure of conservative treatment. Elective resection is indicated in chronic recurrent diverticulitis with complications; all other indications are increasingly based on the individual quality of life of the patient.
CONCLUSION: Uncomplicated diverticulitis is increasingly being treated on an outpatient basis and without antibiotics. Apart from emergency settings, the indications for surgery are increasingly dependent on the quality of life. Elective sigmoid resection should be performed as laparoscopic surgery with primary anastomosis after obtaining results of computed tomography and total colonoscopy.},
}
@article {pmid32638537,
year = {2020},
author = {Schultz, JK and Azhar, N and Binda, GA and Barbara, G and Biondo, S and Boermeester, MA and Chabok, A and Consten, ECJ and van Dijk, ST and Johanssen, A and Kruis, W and Lambrichts, D and Post, S and Ris, F and Rockall, TA and Samuelsson, A and Di Saverio, S and Tartaglia, D and Thorisson, A and Winter, DC and Bemelman, W and Angenete, E},
title = {European Society of Coloproctology: guidelines for the management of diverticular disease of the colon.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {22 Suppl 2},
number = {},
pages = {5-28},
doi = {10.1111/codi.15140},
pmid = {32638537},
issn = {1463-1318},
support = {//European Society of Coloproctology/ ; },
mesh = {Colon ; Consensus ; *Diverticular Diseases/therapy ; Humans ; },
abstract = {AIM: The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons.
METHODS: The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements.
RESULTS: This guideline contains 38 evidence based consensus statements on the management of diverticular disease.
CONCLUSION: This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.},
}
@article {pmid32635383,
year = {2020},
author = {Nasef, NA and Mehta, S},
title = {Role of Inflammation in Pathophysiology of Colonic Disease: An Update.},
journal = {International journal of molecular sciences},
volume = {21},
number = {13},
pages = {},
pmid = {32635383},
issn = {1422-0067},
mesh = {Animals ; Colitis/etiology/immunology/*physiopathology ; Colonic Diseases/etiology/immunology/*physiopathology ; Colorectal Neoplasms/physiopathology ; Disease Progression ; Diverticular Diseases/physiopathology ; Female ; Gastrointestinal Microbiome/immunology/physiology ; Humans ; Inflammation/etiology/immunology/physiopathology ; Inflammatory Bowel Diseases/physiopathology ; Irritable Bowel Syndrome/physiopathology ; Male ; Models, Biological ; Risk Factors ; },
abstract = {Diseases of the colon are a big health burden in both men and women worldwide ranging from acute infection to cancer. Environmental and genetic factors influence disease onset and outcome in multiple colonic pathologies. The importance of inflammation in the onset, progression and outcome of multiple colonic pathologies is gaining more traction as the evidence from recent research is considered. In this review, we provide an update on the literature to understand how genetics, diet, and the gut microbiota influence the crosstalk between immune and non‑immune cells resulting in inflammation observed in multiple colonic pathologies. Specifically, we focus on four colonic diseases two of which have a more established association with inflammation (inflammatory bowel disease and colorectal cancer) while the other two have a less understood relationship with inflammation (diverticular disease and irritable bowel syndrome).},
}
@article {pmid32632489,
year = {2021},
author = {Pedrazzani, C and Park, SY and Conti, C and Turri, G and Park, JS and Kim, HJ and Polati, E and Guglielmi, A and Choi, GS},
title = {Analgesic efficacy of pre-emptive local wound infiltration plus laparoscopic-assisted transversus abdominis plane block versus wound infiltration in patients undergoing laparoscopic colorectal resection: results from a randomized, multicenter, single-blind, non-inferiority trial.},
journal = {Surgical endoscopy},
volume = {35},
number = {7},
pages = {3329-3338},
pmid = {32632489},
issn = {1432-2218},
mesh = {Abdominal Muscles ; Analgesics/therapeutic use ; Analgesics, Opioid ; Anesthetics, Local ; *Colorectal Neoplasms/surgery ; Humans ; *Laparoscopy ; Pain, Postoperative/prevention & control ; Single-Blind Method ; },
abstract = {BACKGROUND: Transversus abdominis plane (TAP) block is considered a reliable locoregional technique for pain control after laparoscopic colorectal surgery. However, no clear benefit of TAP block over wound infiltration has been demonstrated by the current literature. This multicenter randomized clinical trial tested the non-inferiority of wound infiltration (WI) compared to WI plus laparoscopic-assisted TAP block (L-TAP).
METHODS: All patients with colorectal cancer and diverticular disease scheduled for laparoscopic resection at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust, Verona, Italy and at the Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University, Daegu, Korea, between April 2018 and March 2019 were considered for the trial. Patients were randomly allocated to either the WI group or the WI plus L-TAP group in a 1:1 allocation ratio. In total, 108 patients entered the study and 102 patients were analyzed; 50 patients received WI plus L-TAP and 52 patients received WI. The primary end point was the efficacy in pain control at 6 h measured according to Numeric Rating Scale (NRS). Secondary aims evaluated pain control at 12, 24, 48 and 72 h and other short-term results related to pain management.
RESULTS: Estimation of pain intensity at 6 h was comparable between the two groups (p = 0.16) with a mean (95% CI) difference in pain scores of 0.94 (- 0.13 to 2.02). No differences in pain scores were observed at other interval times or considering analgesic consumption, return of bowel function, postoperative complications and length of hospital stay.
CONCLUSION: This study suggests that adding TAP block to WI does not affect pain control, amount of analgesics and other short-term outcomes.
TRIAL REGISTRATION: NCT03376048 (https://www.clinicaltrials.gov).},
}
@article {pmid32614290,
year = {2020},
author = {Toh, PY and Parys, S and Watanabe, Y},
title = {Appendiceal Diverticular Disease: A 10-year Retrospective Study of Cases from Tertiary Hospitals in Western Australia.},
journal = {Chirurgia (Bucharest, Romania : 1990)},
volume = {115},
number = {3},
pages = {348-356},
doi = {10.21614/chirurgia.115.3.348},
pmid = {32614290},
issn = {1221-9118},
mesh = {Appendicitis ; *Diverticular Diseases ; Humans ; Retrospective Studies ; Tertiary Care Centers ; Treatment Outcome ; Western Australia ; },
abstract = {Background: Appendiceal diverticular disease (ADD) is typically a histological diagnosis. Our paper aims to investigate the implications of ADD compared to acute appendicitis (AA). Methods: We conducted a retrospective data collection of patients who had undergone an appen dicectomy in three tertiary hospitals across Western Australia between 2009-2019 and included patients with histopathological diagnoses of ADD and AA. Results: Thirty-seven patients with ADD and forty with AA were included. The mean age in the ADD group was significantly older (p 0.001) at 50.1 compared to the AA group (37.3). The mean white cell count (WCC) in the ADD group was lower than the AA group (11x109/L vs. 13.3x109/L, p 0.001), whereas the C-Reactive Protein (CRP) level was greater, although not statistically significant. The ADD group had a greater risk of major surgery (p 0.05) and complications such as appendiceal perforation and appendiceal mass (p 0.05). Post-operative colonoscopy also demon strated a higher incidence of polyps in patients with ADD (19% vs. 2.5%, p 0.001). Conclusion: ADD frequently presents with clinical features indiscernible from AA. Our study demonstrates that ADD is associated with higher rates of appendiceal perforation, polyps and malignancy. We recommend that patients with ADD be advised to have a colonoscopy post-opera tively to rule out underlying malignancy.},
}
@article {pmid32601752,
year = {2020},
author = {Meyer, DC and Hill, SS and Bebinger, DM and McDade, JA and Davids, JS and Alavi, K and Maykel, JA},
title = {Resolution of multiply recurrent and multifocal diverticulitis after fecal microbiota transplantation.},
journal = {Techniques in coloproctology},
volume = {24},
number = {9},
pages = {971-975},
pmid = {32601752},
issn = {1128-045X},
mesh = {*Clostridioides difficile ; *Clostridium Infections ; *Diverticulitis ; Fecal Microbiota Transplantation ; Feces ; Female ; Humans ; Middle Aged ; Recurrence ; Treatment Outcome ; },
abstract = {BACKGROUND: The exact pathophysiology of diverticulitis is not well understood and may be multifactorial. Recent studies highlight dysbiosis as a plausible mechanism. FMT is a safe strategy to restore commensal colon microbiota and has proven to be an effective treatment for gastrointestinal dysbiosis such as Clostridium difficile infection (CDI). There have been no studies reporting the treatment of diverticulitis with FMT. Our aim was to describe the novel application of fecal microbiota transplantation (FMT) for the treatment of recurrent diverticulitis.
CASE: We report a case of a 63-year-old woman who had a 13-year history of multiply recurrent and multifocal diverticulitis previously treated with numerous short courses of intravenous and oral antibiotics for acute flares, two segmental colon resections, and suppressive antibiotic therapy for recurrent disease. Secondary to multiple courses of antibiotics , the patient developed CDI. She was treated with a single round of FMT and subsequently stopped all antibiotics at the time of FMT.
RESULTS: In 20 months of follow-up, the patient has had no further recurrence of diverticulitis or CDI.
CONCLUSIONS: FMT could prove to be a novel therapy for refractory diverticulitis but requires further investigation.},
}
@article {pmid32595204,
year = {2020},
author = {Katerji, R and Huber, AR},
title = {Giant Inflammatory Polyps in Diverticular Disease Mimicking a Colonic Mass: A Potential Malignant Masquerader.},
journal = {The American journal of case reports},
volume = {21},
number = {},
pages = {e923242},
pmid = {32595204},
issn = {1941-5923},
mesh = {Aged ; Carcinoembryonic Antigen/analysis ; Colon, Sigmoid/diagnostic imaging ; Colonic Neoplasms/diagnosis ; Colonic Polyps/*diagnosis/surgery ; Constipation/etiology ; Diagnosis, Differential ; Diverticulum/*diagnosis/surgery ; Gastrointestinal Hemorrhage/etiology ; Humans ; Male ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND Inflammatory pseudopolyps (IPPs) are a common manifestation in inflammatory bowel disease (IBD) with more cases reported with ulcerative colitis than Crohn's disease. IPPs can grow to form large polyps which are called giant inflammatory polyps (GIPs). These polyps may cause an obstruction and form a mass-like lesion and surgical resection may be warranted. CASE REPORT A 65-year-old male without a previous history of IBD presented with abdominal discomfort, poor appetite, constipation, weight loss, and hematochezia. Due to the high suspicion of malignancy, a computed tomography (CT) scan was performed and showed a fixed lesion in the mid sigmoid colon highly concerning for a primary colon carcinoma, with scattered diverticula, and associated with elevated carcinoembryonic antigen (CEA). Colonoscopy was done but the scope could not be passed due to obstruction. Sigmoidectomy was performed which showed a huge noninvasive lesion, which looked like pseudopolypoid serpiginous mass as giant inflammatory polyp, with scattered diverticula. On microscopic examination, pathology showed a villous polyp with numerous inflammatory cells, without any dysplasia or carcinoma. CONCLUSIONS GIPs are rarely reported without a history of IBD. Diagnosis of GIPs can be very challenging, and surgery is sometimes indicated for definitive diagnosis.},
}
@article {pmid32589496,
year = {2020},
author = {Anteby, R and Zager, Y and Barash, Y and Nadler, R and Cordoba, M and Klang, E and Klein, Y and Ram, E and Gutman, M and Horesh, N},
title = {The Impact of the Coronavirus Disease 2019 Outbreak on the Attendance of Patients with Surgical Complaints at a Tertiary Hospital Emergency Department.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {30},
number = {9},
pages = {1001-1007},
doi = {10.1089/lap.2020.0465},
pmid = {32589496},
issn = {1557-9034},
mesh = {Adolescent ; Adult ; Aged ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/*epidemiology ; Emergency Service, Hospital/*statistics & numerical data ; Female ; Health Personnel ; Hospitalization ; Humans ; Intestinal Diseases/epidemiology ; Israel/epidemiology ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/*epidemiology ; Retrospective Studies ; SARS-CoV-2 ; Sex Factors ; Surgery Department, Hospital/*statistics & numerical data ; Tachycardia/epidemiology ; Tertiary Care Centers/*statistics & numerical data ; Young Adult ; },
abstract = {Introduction: Emergency departments (EDs) during the novel coronavirus disease 2019 (COVID-19) pandemic are perceived as possible sources of infection. The effects of COVID-19 on patients presenting to the hospital with surgical complaints remain uncertain. Methods: A single tertiary center retrospective study analysis compared the ED attendance rate and severity of patients with surgical complaints between March 2020 (COVID-19 outbreak) and pre-COVID-19 periods: February 2020 and the same 2 months in 2019 and 2018. Results: Overall, 6,017 patients were included. The mean daily ED visits of patients with nontrauma surgical complaints in the COVID-19 outbreak period declined by 27%-32% (P value <.01) compared with pre-COVID-19 periods. The log number of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases in Israel in March 2020 was negatively correlated with the number of ED visits (Pearson's r = -0.59, P < .01). The proportion of patients requiring hospitalization increased by up to 8% during the outbreak period (P < .01), and there was a higher proportion of tachycardic patients (20% versus 15.5%, P = .01). The percentage of visits to the ED by men declined by 5% (P < .01). The ED diagnosis distribution significantly changed during COVID-19 (P = .013), with an 84% decrease in the number of patients hospitalized for diverticular disease (P < .05). Conclusion: During the COVID-19 outbreak, the overall number of patients presenting at the ED with surgical complaints decreased significantly, and there was a higher admissions ratio. The extent to which the pandemic affects hospital ED attendance can help health care professionals prepare for future such events. ClinicalTrials.gov ID: NCT04338672.},
}
@article {pmid32567170,
year = {2020},
author = {Marek, T and Mahan, MA and Amrami, KK and Blackburn, PR and Caffes, PL and Carter, JM and Camilleri, M and Spinner, RJ},
title = {Expanding the phenotypic spectrum of lipomatosis of the sciatic nerve: Early-onset colonic diverticular disease.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {32},
number = {10},
pages = {e13917},
doi = {10.1111/nmo.13917},
pmid = {32567170},
issn = {1365-2982},
mesh = {Adult ; Diverticulitis, Colonic/*diagnostic imaging/etiology ; Female ; Humans ; Lipomatosis/complications/*diagnostic imaging ; Lumbosacral Plexus/*diagnostic imaging ; Middle Aged ; *Phenotype ; Sciatic Nerve/*diagnostic imaging ; },
abstract = {BACKGROUND: Lipomatosis of nerve (LN) is a complex peripheral nerve disorder characterized by fibrofatty nerve enlargement. MRI of this pathology is pathognomonic and obviates a diagnostic biopsy. Mutation in PIK3CA has been associated with LN cases with nerve-territory overgrowth which may occur in some cases. We evaluate an association of LN of the sciatic nerve and early-onset colonic diverticular disease and discuss the potential pathogenesis.
METHODS: Our institutional database was searched for LN cases. Available information of identified cases was reviewed, and cases with a confirmed diagnosis of LN affecting the lumbosacral plexus and/or sciatic nerve; available MRI of the affected nerve(s); and diverticular disease occurring in the area supplied by the nerve(s) affected by LN were further analyzed. PIK3CA mutation testing was performed on available tissue samples.
RESULTS: We identified 10 LN cases of lumbosacral plexus and/or sciatic nerve. Of these, three fulfilled our inclusion criteria. All three patients had concomitant colonic diverticular disease, diagnosed at a relatively young age. MRI studies of these cases showed LN involvement of the sacral nerves innervating the sigmoid colon. All three also had abnormal diagnostic workup including various GI tests and evidence of associated nerve-territory overgrowth. Colonic tissue samples for PIK3CA mutation were negative.
CONCLUSION: While the pathogenesis of the colonic diverticular disease is increasingly recognized as being multifactorial, our observations are consistent with the potential role of autonomic nervous system dysfunction affecting either the pelvic floor musculature, or the colon itself (or both) in a subset of patients with early-onset diverticular disease.},
}
@article {pmid32556770,
year = {2021},
author = {Williams, J and Stocchi, L and Aiello, A and Bhama, A and Kessler, H and Gorgun, E and Delaney, CP and Steele, S and Valente, M},
title = {No need to watch the clock: persistence during laparoscopic sigmoidectomy for diverticular disease.},
journal = {Surgical endoscopy},
volume = {35},
number = {6},
pages = {2823-2830},
pmid = {32556770},
issn = {1432-2218},
mesh = {Aged ; Colectomy ; *Colon, Sigmoid/surgery ; *Diverticular Diseases/surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {BACKGROUND: Laparoscopic sigmoidectomy is the preferred approach in the elective surgical management of diverticulitis. However, it is unclear if the benefits of laparoscopy persist when operative times are prolonged. We aimed to investigate if the recovery benefits associated with laparoscopy are retained when operative times are long.
METHODS: A retrospective review of a prospectively maintained database of patients who underwent elective laparoscopic sigmoidectomy from 2010-2015 at a single academic tertiary institution was performed. Operative times among laparoscopic completed cases were divided into quartiles, and patient outcomes were compared between the groups.
RESULTS: A total of 466 patients (median age: 58 ± 11.6 years, 58% females) underwent sigmoidectomy: 430 completed laparoscopically and 36 (7.7%) converted. Median operative time in laparoscopically completed cases was 188 min (IQR 154-230). There were no differences in morbidity (P = 0.52) or readmission rates (P = 0.22) among the quartiles. The 2nd and 4th operative time quartiles were associated with significantly longer length of stay (LOS) when compared to the fastest quartile (P = 0.003 and P = 0.002, respectively), but there was no increase in LOS as operative times progressed between the 2nd, 3rd, and 4th quartiles. LOS after conversion was longer but did not reach statistical significance when compared to laparoscopically completed operations in the longest quartile (5.0 vs 6.5 days, P = 0.075) CONCLUSIONS: Our data do not support preemptive conversion of laparoscopic sigmoidectomy to avoid prolonged operative times. As long as progress is safely being made, surgeons are justified to continue pursuing laparoscopic completion.},
}
@article {pmid32555171,
year = {2020},
author = {Tursi, A and Scarpignato, C and Strate, LL and Lanas, A and Kruis, W and Lahat, A and Danese, S},
title = {Author Correction: Colonic diverticular disease.},
journal = {Nature reviews. Disease primers},
volume = {6},
number = {1},
pages = {50},
doi = {10.1038/s41572-020-0192-y},
pmid = {32555171},
issn = {2056-676X},
abstract = {An amendment to this paper has been published and can be accessed via a link at the top of the paper.},
}
@article {pmid32554687,
year = {2020},
author = {Kiandee, M and Sripada, R},
title = {Should diverticulitis be managed in primary care? An audit on the management of diverticulitis in primary care.},
journal = {The British journal of general practice : the journal of the Royal College of General Practitioners},
volume = {70},
number = {suppl 1},
pages = {},
doi = {10.3399/bjgp20X711665},
pmid = {32554687},
issn = {1478-5242},
abstract = {BACKGROUND: The prevalence of diverticulosis and acute diverticulitis is increasing in developed countries. For those with diverticulosis the lifetime risk of developing acute diverticulitis is about 4-25%. Mild, uncomplicated diverticulitis can be, and often is, managed safely in a primary care setting, avoiding unnecessary admission.
AIM: To evaluate management of suspected diverticulitis in primary care against standards set by the National Institute for Health and Care Excellence (NICE) and review admission rates following primary care management.
METHOD: An electronic search on EMIS Web using Read codes 'diverticulitis', 'diverticulosis', and 'diverticular disease', with a specified period of 2017-2019. All consultations with suggestions of an infective flare of diverticular disease were included in the study. Clinical data from the consultations were extracted and retrospectively audited.
RESULTS: A total of 64 patients were identified with diverticular disease or diverticulosis. Of those, 42% (n = 27) presented to primary care with presenting complaints suspicious of diverticulitis. A total of 64 consultations were reviewed, as several patients presented more than once in the study period. Of the consultations reviewed, 12.5% (n = 8) resulted in referral to the surgical assessment unit. Antibiotics were prescribed after 68.4% (n = 39) of consultations. Bloods for inflammatory markers were performed after 19.3% (n = 11) of consultations. Only 3.5% (n = 2) of patients were reviewed within the recommended 48-hour timeframe. Only 3.5% (n = 2) of patients subsequently deteriorated and required admission.
CONCLUSION: The management of diverticulitis in this primary care centre is not fully concordant with NICE guidelines. There is a need to improve adherence, in particular antibiotic regimen when deciding to prescribe antibiotics.},
}
@article {pmid32553704,
year = {2021},
author = {Carabotti, M and Morselli Labate, AM and Cremon, C and Cuomo, R and Pace, F and Andreozzi, P and Falangone, F and Barbara, G and Annibale, B and , },
title = {Distinguishing features between patients with acute diverticulitis and diverticular bleeding: Results from the REMAD registry.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {53},
number = {2},
pages = {202-209},
doi = {10.1016/j.dld.2020.05.045},
pmid = {32553704},
issn = {1878-3562},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticular Diseases/*epidemiology ; Diverticulitis/*epidemiology ; Female ; Humans ; Italy/epidemiology ; *Life Style ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive/epidemiology ; Registries ; Risk Factors ; },
abstract = {BACKGROUND: Pathogenesis of acute diverticulitis and diverticular bleeding remains poorly defined, and few data compare directly risk factors for these complications.
AIMS: to assess differences in clinical features, lifestyles factors and concurrent drug use in patients with acute diverticulitis and those with diverticular bleeding.
METHODS: Data were obtained from the REMAD Registry, an ongoing 5-year prospective, observational, multicenter, cohort study conducted on 1,217 patients. Patient- and clinical- related factors were compared among patients with uncomplicated diverticular disease, patients with previous acute diverticulitis, and patients with previous diverticular bleeding.
RESULTS: Age was significantly lower (OR 0.48, 95% CI: 0.34-0.67) and family history of diverticular disease was significantly higher (OR 1.60, 95% CI: 1.11-2.31) in patients with previous diverticulitis than in patients with uncomplicated diverticular disease, respectively. Chronic obstructive pulmonary disease was significantly higher in patients with previous diverticular bleeding as compared with both uncomplicated diverticular disease (OR 8.37, 95% CI: 2.60-27.0) and diverticulitis (OR 4.23, 95% CI: 1.11-16.1).
CONCLUSION: This ancillary study from a nationwide Registry showed that some distinctive features identify patients with acute diverticulitis and diverticular bleeding. These information might improve the assessment of risk factors for diverticular complications.},
}
@article {pmid32551027,
year = {2020},
author = {Keady, C and Hechtl, D and Joyce, M},
title = {When the bowel meets the bladder: Optimal management of colorectal pathology with urological involvement.},
journal = {World journal of gastrointestinal surgery},
volume = {12},
number = {5},
pages = {208-225},
pmid = {32551027},
issn = {1948-9366},
abstract = {Fistulae between the gastrointestinal and urinary systems are rare but becoming increasingly more common in current surgical practice. They are a heterogeneous group of pathological entities that are uncommon complications of both benign and malignant processes. As the incidence of complicated diverticular disease and colorectal malignancy increases, so too does the extent of fistulous connections between the gastrointestinal and urinary systems. These complex problems will be more common as a factor of an aging population with increased life expectancy. Diverticular disease is the most commonly encountered aetiology, accounting for up to 80% of cases, followed by colorectal malignancy in up to 20%. A high index of suspicion is required in order to make the diagnosis, with ever improving imaging techniques playing an important role in the diagnostic algorithm. Management strategies vary, with most surgeons now advocating for a single-stage approach to enterovesical fistulae, particularly in the elective setting. Concomitant bladder management techniques are also disputed. Traditionally, open techniques were the standard; however, increased experience and advances in surgical technology have contributed to refined and improved laparoscopic management. Unfortunately, due to the relative rarity of these entities, no randomised studies have been performed to ascertain the most appropriate management strategy. Rectourinary fistulae have dramatically increased in incidence with advances in the non-operative management of prostate cancer. With radiotherapy being a major contributing factor in the development of these complex fistulae, optimum surgical approach and exposure has changed accordingly to optimise their management. Conservative management in the form of diversion therapy is effective in temporising the situation and allowing for the diversion of faecal contents if there is associated soiling, macerated tissues or associated co-morbidities. One may plan for definitive surgical intervention at a later stage. Less contaminated cases with no fibrosis may proceed directly to definitive surgery if the appropriate expertise is available. An abdominal approach with direct repair and omentum interposition between the repaired tissues has been well described. In low lying fistulae, a transperineal approach with the patient in a prone-jack knife position provides optimum exposure and allows for the use of interposition muscle grafts. According to recent literature, it offers a high success rate in complex cases.},
}
@article {pmid32546262,
year = {2020},
author = {Ogawa-Ochiai, K and Yoshimura, K and Shirai, A and Sakai, S and Moriyama, H and Nakamura, K and Murayama, T and Ishikawa, H},
title = {Study protocol for daiobotanpito combined with antibiotic therapy for treatment of acute diverticulitis: a study protocol for a randomized controlled trial.},
journal = {Trials},
volume = {21},
number = {1},
pages = {531},
pmid = {32546262},
issn = {1745-6215},
support = {18lk0310044h0001//Japan Agency for Medical Research and Development/ ; },
mesh = {Acute Disease ; Anti-Bacterial Agents/*therapeutic use ; Diverticulitis/*drug therapy ; Double-Blind Method ; Drug Therapy, Combination ; Drugs, Chinese Herbal/*therapeutic use ; Humans ; Japan ; Medicine, Kampo ; Multicenter Studies as Topic ; Randomized Controlled Trials as Topic ; Treatment Outcome ; },
abstract = {BACKGROUND: Colonic diverticular disease has been increasing in prevalence due to the rapidly aging global population, but standard treatment has not changed dramatically in recent years. Daiobotanpito (DBT; Da Huang Mu Dan Tang in Chinese) has been used in medical treatment of acute abdominal abscesses, such as appendicitis or diverticulitis in traditional Japanese (Kampo) medicine for many years, based on more than 3000 years of experience. Prior to this study, a retrospective open-label trial was conducted to compare patients with acute diverticulitis who received oral DBT combined with intravenous antibiotics with those who received intravenous antibiotic alone; it showed a positive effect of DBT on acute diverticulitis. We aim to investigate whether moderate to severe acute diverticulitis shows greater improvement with intravenous antibiotics plus orally administered DBT compared with intravenous antibiotics plus placebo.
METHODS: This is a two-group, randomized, double-blind, placebo-controlled, multi-center trial, which is designed to evaluate the efficacy and safety of DBT in patients with moderate to severe diverticulitis treated with intravenous antibiotics. Eligible participants will be randomized to either a treatment group receiving a 10-day oral DBT regimen plus conventional therapy or a control group receiving a 10-day placebo regimen plus conventional therapy. The primary outcome will be success in treating diverticulitis: the success rate will be defined as elimination of abdominal pain within 4 days in all patients, and in patients with fever (body temperature ≧ 37.5 °C) on inclusion into this study, fever relief with reduction in body temperature to < 37.5 °C within 3 days. Secondary endpoints will include the number of hospitalization days, changes in inflammatory response (C-reactive protein (CRP), white blood cell (WBC) and neutrophil counts), fever type, number of days before beginning food intake, recurrence rate (observation for 1 year after registration), and adverse event expression rate. Assessments will be performed at baseline and on the day of discharge. The recurrence rate will be recorded at 1 year after registration.
DISCUSSION: This study is expected to provide evidence to support the clinical benefits of DBT in the treatment of acute diverticulitis. It may also provide evidence on the efficacy and safety of DBT in the recurrence of acute diverticulitis.
TRIAL REGISTRATION: UMIN-CTR: UMIN000027381. Registered on 27 April 2017. https://upload.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000031377, and changed to jRCTs041180063, registered on 30 July 2019; as a result of the revision of the domestic law in 2018 in Japan.},
}
@article {pmid32542557,
year = {2020},
author = {Maguire, LH},
title = {Genetic Risk Factors for Diverticular Disease-Emerging Evidence.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {24},
number = {10},
pages = {2314-2317},
pmid = {32542557},
issn = {1873-4626},
support = {K08 DK124687/DK/NIDDK NIH HHS/United States ; },
mesh = {Constipation ; Diet ; *Diverticular Diseases/genetics ; *Genome-Wide Association Study ; Humans ; Risk Factors ; },
abstract = {Diverticular disease is traditionally understood as an environmental disease caused by diet and constipation. However, genes are increasing understood to play a role in pathogenesis. Twin studies suggest a substantial component of individual risk is due to heritable factors. Association of diverticular disease with other traits suggests an underlying biological mechanism and recently genome-wide association studies have described the genetic architecture underlying this complex phenotype. These studies suggest a new paradigm for understanding this common surgical disease.},
}
@article {pmid32535905,
year = {2020},
author = {Noyes, JD and Mordi, IR and Doney, AS and Palmer, CNA and Pearson, ER and Lang, CC},
title = {Genetic Risk of Diverticular Disease Predicts Early Stoppage of Nicorandil.},
journal = {Clinical pharmacology and therapeutics},
volume = {108},
number = {6},
pages = {1171-1175},
doi = {10.1002/cpt.1941},
pmid = {32535905},
issn = {1532-6535},
support = {102820/Z/13/Z/WT_/Wellcome Trust/United Kingdom ; },
mesh = {Aged ; Cardiovascular Agents/administration & dosage/*adverse effects ; Clinical Decision-Making ; Databases, Factual ; Digestive System Fistula/diagnosis/*etiology/prevention & control ; Diverticular Diseases/complications/diagnosis/*genetics ; Drug Administration Schedule ; Female ; Genetic Predisposition to Disease ; Genetic Testing ; Humans ; Male ; Middle Aged ; Nicorandil/administration & dosage/*adverse effects ; Predictive Value of Tests ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Scotland ; Time Factors ; },
abstract = {Gastrointestinal fistulation has been widely reported as an adverse effect of nicorandil therapy in Europe. People who have underlying diverticular disease are most at risk of this side effect. In Western countries, diverticular disease is highly prevalent and can be clinically silent. This study aimed to identify diverticular disease genetic risk scores (GRSs) associated with early nicorandil stoppage, a surrogate marker for drug intolerance. A case-control study was carried out on 1,077 patients from the Genetics of Diabetes Audit and Research Tayside Scotland (GoDARTS) database. Cases were defined as having < 9 nicorandil prescriptions with no identifiable reason for stopping (n = 230). Controls had either ≥ 9 prescriptions, treatment continuation to death/study end or stoppage post-myocardial infarction. Two diverticular GRSs were created and used in logistic regression models. Isosorbide mononitrate was used as a control analysis. Patients with a raised diverticular GRS, based on 23 replicable loci, had increased risk of stopping nicorandil therapy early (univariate (odds ratio (OR) 2.26; P = 0.04], multivariate (OR 3.96; P = 0.01)). Similar trends were noted when using the full 42 variant diverticular score but statistical significance was not reached. The isosorbide control analysis did not reach statistical significance. Our analysis demonstrates a novel positive association between a raised diverticular GRS and early stoppage of nicorandil therapy.},
}
@article {pmid32523619,
year = {2020},
author = {Lahat, A and Fidder, HH and Ben-Horin, S},
title = {Development and validation of a diverticular clinical score for symptomatic uncomplicated diverticular disease after acute diverticulitis in a prospective patient cohort.},
journal = {Therapeutic advances in gastroenterology},
volume = {13},
number = {},
pages = {1756284820913210},
pmid = {32523619},
issn = {1756-283X},
abstract = {BACKGROUND: Following an attack of acute diverticulitis (AD), many patients continue to suffer from a complex of symptoms, titled 'symptomatic uncomplicated diverticular disease (SUDD)'. To date, there is no validated clinical score for standardized assessment of patients with SUDD, thereby hampering the interpretation of observational studies and the conductance of clinical trials.We aimed to develop a validated SUDD clinical score.
METHODS: Data from previous prospective study of patients after AD was used to devise the score's first version. Validation was first performed using a focus group of patients after AD SUDD who underwent a structured cognitive personal interview. Thereafter, the diverticular clinical score (DICS) was applied for a second validation cohort. DICS scores of validation cohort were compared with physicians' global assessment for disease severity and inflammatory markers.
RESULTS: In DICS second validation using 48 patients prospectively recruited after AD SUDD, a correlation matrix demonstrated strong correlation between total questionnaire's score and the presence of elevated inflammatory markers (ρ = 0.84). Mean score in patients with elevated inflammatory markers compared with those without inflammation was 17.8 versus 6.2, respectively, p < 0.001. Cronbach's α for measuring internal consistency was 0.91. DICS discriminated accurately between patients with/without active disease, as gauged by the physicians global assessment (area under the curve receiver operating characteristic = 0.989).
CONCLUSIONS: Patients suffering from post-AD SUDD exhibit a wide range of symptoms. The newly developed DICS accurately and reproducibly quantitates SUDD-related symptom severity. The DICS may prove useful for monitoring SUDD in clinical practice and in research settings, as well as facilitating patient stratification and therapeutic decisions.},
}
@article {pmid32494547,
year = {2020},
author = {Elfanagely, Y and Tse, CS and Patil, P and Lueckel, S},
title = {Jejunal Diverticulosis Complicated by Diverticulitis and Small Bowel Obstruction.},
journal = {Cureus},
volume = {12},
number = {5},
pages = {e8347},
pmid = {32494547},
issn = {2168-8184},
abstract = {Diverticular disease is common in the Western population and can cause considerable morbidity. The prevalence of colonic diverticulosis reaches 60% by the age of 60 years. Small bowel diverticulosis is much rarer and, when present, most commonly occurs in the duodenum. We herein report an elderly woman with jejunal diverticulosis complicated by diverticulitis and small bowel obstruction, who subsequently underwent small bowel resection and primary anastomosis. As demonstrated by this case, jejunal diverticulitis can cause serious complications and given the possibility of recurrence and serious complications, surgical options should be discussed early in the course of medical care.},
}
@article {pmid32483125,
year = {2020},
author = {Pesce, A and Barchitta, M and Agodi, A and Salerno, M and La Greca, G and Magro, G and Latteri, S and Puleo, S},
title = {Comparison of clinical and pathological findings of patients undergoing elective colectomy for uncomplicated diverticulitis.},
journal = {Scientific reports},
volume = {10},
number = {1},
pages = {8854},
pmid = {32483125},
issn = {2045-2322},
mesh = {Age Factors ; Aged ; Colectomy ; Colonic Diseases/pathology/*surgery ; Diverticulitis/pathology/*surgery ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies ; Severity of Illness Index ; Sex Factors ; },
abstract = {Diverticular disease affects ∼5-10% people worldwide, yet the indications for elective colectomy in uncomplicated diverticulitis are unclear. As there is no strong scientific evidence regarding histology in diverticular disease, the primary outcome of the study was to analyze the degree of inflammation of colonic wall in patients that underwent elective colectomy for uncomplicated diverticulitis and to retrospectively assess the correlation between patient clinical history and pathological features of surgical specimens in order to find some predictive factors that may be strictly correlated with histology. An observational retrospective study was conducted. Patients undergoing elective colectomy for uncomplicated diverticulitis between January 2014 and January 2016 in an academic medical center were collected. The majority of patients (46.2%) had previously encountered one episode of acute diverticulitis prior to colectomy, while 21.5% and 10.8% had experienced two and three or more prior episodes respectively. Most patients had recurrent or chronic abdominal pain in the left iliac fossa (66.2%) for diverticular disease and a large proportion also experienced constipation (40.0%). Diverticulitis was identified pathologically as being "mild" in 44.6% patients and "severe" in 55.4% patients. The mean age was significantly lower in patients with severe diverticulitis (56.7 years) than in patients with mild diverticulitis (67.0 years). 71.9% of males had severe diverticulitis compared to 39.4% of females. Males have a 3.9 times higher risk of histological severe diverticulitis than females (OR = 3.932; 1.390-11.122; p = 0.008). Multivariate logistic regression analysis confirmed that age and gender were independent factors associated with histological diagnosis. Single-institution data and retrospective design were main limitations of this study. Age and gender are independent factors associated with severity inflammation index derived at histological analysis and they could be translated to clinical practice to better categorize patients with uncomplicated diverticulitis at the bedside.},
}
@article {pmid32483087,
year = {2020},
author = {Tursi, A and Violi, A and Cambie', G and Franceschi, M and Baldassarre, G and Rodriguez, KI and Miraglia, C and Brandimarte, G and Elisei, W and Picchio, M and Di Mario, F},
title = {Risk factors for endoscopic severity of diverticular disease of the colon and its outcome: a real-life case-control study.},
journal = {European journal of gastroenterology & hepatology},
volume = {32},
number = {9},
pages = {1123-1129},
doi = {10.1097/MEG.0000000000001787},
pmid = {32483087},
issn = {1473-5687},
mesh = {Case-Control Studies ; Colonoscopy ; *Diverticular Diseases/diagnosis/epidemiology ; *Diverticulosis, Colonic/diagnosis/epidemiology ; Female ; Humans ; Risk Factors ; },
abstract = {BACKGROUND: Diverticular disease is an increasing global problem.
AIMS: To assess the factors associated with the severity of diverticular disease and its outcome, analyzing a real-life population.
METHODS: A cohort of patients, submitted to colonoscopy from 1 January 2012 to 30 April 2018 was revised. The endoscopic severity of diverticular disease was scored according to the Diverticular Inflammation and Complications Assessment (DICA) classification.
RESULTS: A cohort of 11 086 patients was identified during the study period, 5635 with diverticulitis and 5451 without diverticulosis. Blood hypertension, diabetes and angiotensin receptor blocker users occurred more frequently in the study group, while the prevalence of colorectal cancer (CRC) was significantly lower. Age >70 years, BMI >30 and blood hypertension were factors independently related to the presence of diverticulosis, while diabetes and CRC were significantly associated with the absence of diverticulosis. Female sex, age, smoke, appendectomy, proton-pump inhibitors and acetyl-salicylic acid use were directly related to the severity of diverticular disease, while CRC and colonic polyp occurrence were inversely related to the severity of diverticular disease, significantly. Female sex, age >70 years and smoke were significantly related to the severity of diverticular disease. CRC and colonic polyps were significantly less in DICA 3 patients. DICA 3 patients were more often symptomatic, at higher risk of hospital admission, longer hospital stay and higher mean costs.
CONCLUSIONS: Several factors are associated with the severity of diverticular disease according to the DICA classification. The DICA classification is also predictive of the outcome of the disease in terms of hospital admission, stay and costs.},
}
@article {pmid32462452,
year = {2020},
author = {Gilshtein, H and Yellinek, S and Maenza, J and Wexner, SD},
title = {Surgical management of colovesical fistulas.},
journal = {Techniques in coloproctology},
volume = {24},
number = {8},
pages = {851-854},
pmid = {32462452},
issn = {1128-045X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; *Diverticulum/surgery ; Female ; Humans ; *Intestinal Fistula/etiology/surgery ; *Laparoscopy ; Middle Aged ; Postoperative Complications/etiology ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: The most common etiology of colovesical fistulas is complicated diverticular disease and the treatment of choice is surgical resection. There are very few reports of the application of minimally invasive approaches for these surgeries. The aim of our study was to evaluate the role of laparoscopy in this challenging surgical setting.
METHODS: A retrospective analysis of patients who underwent transabdominal surgery for colovesical fistula in 2008-2018 was performed. Patients were divided into 2 groups: patients who had open surgery and patients treated with laparoscopy. The postoperative course was reviewed for the length of stay, postoperative complications, readmission, emergency re-operation, and mortality RESULTS: Thirty-five patients were included (13 females [37%]; median age 68 [range 28-84] years) with a mean body mass index of 29 ± 7.19 kg/m[2]. The main fistula etiology was diverticulitis (91%). Seventeen patients (48.5%) had laparoscopic surgery and 2 patients in whom laparoscopy was attempted underwent conversion to laparotomy. The benefits of laparoscopy included significant reductions in morbidity including surgical site infections and medical complications following laparoscopy.
CONCLUSIONS: Laparoscopic management of colovesical fistula is both safe and feasible in a high volume laparoscopic colorectal surgery center. Laparoscopy offers potential benefits including a decreased incidence of surgical site infections and medical complications.},
}
@article {pmid32422553,
year = {2020},
author = {Sugi, MD and Sun, DC and Menias, CO and Prabhu, V and Choi, HH},
title = {Acute diverticulitis: Key features for guiding clinical management.},
journal = {European journal of radiology},
volume = {128},
number = {},
pages = {109026},
doi = {10.1016/j.ejrad.2020.109026},
pmid = {32422553},
issn = {1872-7727},
mesh = {Abscess/etiology/therapy ; Acute Disease ; Colon/diagnostic imaging ; Diagnostic Imaging/*methods ; Digestive System Surgical Procedures ; Diverticulitis, Colonic/complications/*diagnostic imaging/*therapy ; Drainage ; Fistula/etiology/therapy ; Humans ; Intestinal Obstruction/etiology/therapy ; Peritonitis/etiology/therapy ; },
abstract = {Diverticular disease of the colon and small bowel is an important cause of pathology leading to emergency department visits and urgent gastrointestinal surgery. CT is a highly sensitive and specific modality for the diagnosis of acute diverticulitis and its complications as well as for the exclusion of alternate causes of pathology. Ultrasound, MRI and virtual CT colonoscopy have important adjunct roles for screening and workup of complications in specific patient populations. While diverticular disease most commonly involves the descending and sigmoid colon, it can also affect the proximal colon and small bowel. Acute diverticulitis may be categorized as uncomplicated or complicated according to the degree of inflammatory changes and related complications it induces, although some degree of overlap exists in clinical practice. Uncomplicated diverticulitis is classically characterized by localized inflammation surrounding a diverticulum ranging from wall thickening and phlegmonous change to the development of small, localized pericolic abscesses. Complicated forms of disease manifest with larger pericolic and distant abscesses, fistulae to adjacent organs, perforation, and peritonitis. Recurrent episodes of diverticulitis may lead to muscular hypertrophy of the bowel wall and luminal narrowing, potentially leading to bowel obstruction. Several imaging features may help to differentiate diverticulitis from colonic malignancy, however this remains a diagnostic imaging challenge that often requires further evaluation with colonoscopy. In this review, we discuss the pathophysiology and key imaging features of acute diverticulitis and its complications. We explore both common and uncommon presentations of the disease involving the colon and small bowel, acute and chronic manifestations of disease, and pitfalls to recognize when imaging alone may be insufficient to distinguish benign from malignant.},
}
@article {pmid32419870,
year = {2020},
author = {Miulescu, AM},
title = {Colonic Diverticulosis. Is there a Genetic Component?.},
journal = {Maedica},
volume = {15},
number = {1},
pages = {105-110},
pmid = {32419870},
issn = {1841-9038},
abstract = {Diverticular disease is a common condition among the elderly, with a steady increase in prevalence over time. Also, it has a temporal, geographic, and ethnic variation in incidence and prevalence, the genetic component having only recently been studied. For many years, environmental factors were the main link to the etiology. Recent studies estimated the heritability in this disease and identified genetic variants associated with diverticulosis. The interaction between structural changes of the colonic wall, diet, lifestyle, and genetic factors results in the development of diverticular disease. The purpose of this article is to review the existing data about genetic influence in this disease.},
}
@article {pmid32399665,
year = {2021},
author = {Jaung, R and Varghese, C and Lin, AY and Paskaranandavadivel, N and Du, P and Rowbotham, D and Dinning, P and O'Grady, G and Bissett, I},
title = {High-Resolution Colonic Manometry Pressure Profiles Are Similar in Asymptomatic Diverticulosis and Controls.},
journal = {Digestive diseases and sciences},
volume = {66},
number = {3},
pages = {832-842},
pmid = {32399665},
issn = {1573-2568},
mesh = {Adult ; Aged ; Asymptomatic Diseases ; Case-Control Studies ; Colon, Descending/physiopathology ; Colon, Sigmoid/physiopathology ; Diverticulum/*physiopathology ; Female ; Gastrointestinal Motility/*physiology ; Humans ; Male ; Manometry/methods/*statistics & numerical data ; Meals/physiology ; Middle Aged ; Postprandial Period/physiology ; Pressure ; },
abstract = {BACKGROUND: Elevated colonic pressures and increased colonic activity have been thought to contribute to the pathophysiology of diverticulosis. However, evidence for this has been limited to low-resolution manometry, which is of limited accuracy.
AIMS: This study aimed to evaluate the contraction pressures, counts, and distance of propagation recorded by high-resolution colonic manometry in diverticulosis vs control patients.
METHODS: High-resolution colonic manometry was used to record descending and sigmoid colon activity pre- and post-meal in patients with established, asymptomatic diverticulosis and in healthy controls. Antegrade and retrograde propagating contractions, distance of propagation (mm), and mean contraction pressures (mmHg) in the descending and sigmoid colon were compared between patients and controls for all isolated propagating contractions, the cyclic motor pattern, and high-amplitude propagating contractions independently.
RESULTS: Mean manometry pressures were not different between controls and diverticulosis patients (p > 0.05 for all comparisons). In the descending colon, diverticulosis patients had lower post-meal mean distance of propagation for all propagating contractions [10.8 (SE1.5) mm vs 20.0 (2.0) mm, p = 0.003] and the cyclic motor pattern [6.0 (2.5) mm vs 17.1 (2.8) mm, p = 0.01]. In the sigmoid colon, diverticulosis patients showed lower post-meal mean distance of propagation for all propagating contractions [10.8 (1.5) mm vs 20.2 (5.9) mm, p = 0.01] and a lower post-meal increase in retrograde propagating contractions (p = 0.04).
CONCLUSIONS: In this first high-resolution colonic manometry study of patients with diverticular disease, we did not find evidence for increased manometric pressures or increased colonic activity in patients with diverticular disease.},
}
@article {pmid32384399,
year = {2020},
author = {Flum, DR and Read, TE},
title = {Evidence-Based Management of Diverticular Disease: What's New and What's Missing?.},
journal = {Diseases of the colon and rectum},
volume = {63},
number = {6},
pages = {715-717},
doi = {10.1097/DCR.0000000000001678},
pmid = {32384399},
issn = {1530-0358},
mesh = {Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Clinical Decision-Making/methods ; Colorectal Surgery/organization & administration ; Constriction, Pathologic/epidemiology/etiology ; Diverticular Diseases/classification/complications/epidemiology/*therapy ; Elective Surgical Procedures/methods ; Evidence-Based Practice/standards ; Fistula/epidemiology/etiology ; Gastrointestinal Diseases/*pathology ; Humans ; Mesalamine/therapeutic use ; Meta-Analysis as Topic ; Practice Guidelines as Topic/*standards ; Probiotics/therapeutic use ; Quality of Life ; Randomized Controlled Trials as Topic ; Rifaximin/therapeutic use ; Societies, Scientific/organization & administration ; United States/epidemiology ; },
}
@article {pmid32378533,
year = {2020},
author = {Kikuta, S and Iwanaga, J and Koga, M and Kusukawa, J},
title = {Diverticular Pouch of the Buccal Mucosa: A Rare Case Report.},
journal = {The Kurume medical journal},
volume = {66},
number = {1},
pages = {81-84},
doi = {10.2739/kurumemedj.MS661013},
pmid = {32378533},
issn = {1881-2090},
mesh = {Aged ; Cheek/pathology ; *Diverticulum/diagnosis/pathology ; Humans ; Male ; *Mouth Mucosa/pathology ; },
abstract = {Diverticular pouch in the oral cavity is a rare disease, and its etiology is unclear. The authors present a rare case of diverticular pouch in the buccal mucosa. A 79-year-old man visited our hospital with a chief complaint of food impaction in the right buccal mucosa. Intraoral examination revealed a pouch just inferior to the parotid papilla. Histopathological examination after excisional biopsy showed that the epithelial cells lining the pouch were continuous with the mucous membrane and a diagnosis was made of diverticular pouch of the buccal mucosa. Twenty-five months after the patient's initial visit no recurrence has been noted. Further clinico-pathological studies are required to understand diverticular disease in the buccal mucosa. This case might help dentists to become more aware of these lesions and collect data for further investigations.},
}
@article {pmid32374180,
year = {2020},
author = {Kong, CY and Goh, HL and Anderson, JE},
title = {Portal venous gas as a radiological sign in a sigmoid diverticular abscess and its non-surgical management: a case report.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {102},
number = {7},
pages = {e173-e175},
pmid = {32374180},
issn = {1478-7083},
mesh = {Abscess/diagnosis/etiology/*therapy ; *Colon, Sigmoid ; Conservative Treatment/*methods ; Diverticulum, Colon/*complications/diagnosis/therapy ; Humans ; Male ; Middle Aged ; Portal Vein/*diagnostic imaging ; Tomography, X-Ray Computed/*methods ; },
abstract = {A 62-year old man who presented unwell with no specific symptoms or signs was found to have portal venous circulation gas complicating a small diverticular abscess. He was successfully managed with a course of antibiotics and had full resolution of symptoms, therefore avoiding the need for surgical intervention. While most commonly associated with bowel ischaemia and therefore often warranting emergency laparotomy, portal venous gas within the context of other underlying pathology often presents opportunities for delayed surgery or more conservative management options.},
}
@article {pmid32367291,
year = {2020},
author = {Clement, EA and Rouleau-Fournier, F and Brown, CJ},
title = {Techniques for safe laparoscopic anterior resection for complicated diverticular disease.},
journal = {Techniques in coloproctology},
volume = {24},
number = {9},
pages = {979},
doi = {10.1007/s10151-020-02215-8},
pmid = {32367291},
issn = {1128-045X},
mesh = {Colectomy ; *Diverticulitis, Colonic/complications/surgery ; *Diverticulum ; Humans ; *Laparoscopy ; },
}
@article {pmid32350266,
year = {2020},
author = {Tursi, A and Scarpignato, C and Strate, LL and Lanas, A and Kruis, W and Lahat, A and Danese, S},
title = {Publisher Correction: Colonic diverticular disease.},
journal = {Nature reviews. Disease primers},
volume = {6},
number = {1},
pages = {35},
doi = {10.1038/s41572-020-0176-y},
pmid = {32350266},
issn = {2056-676X},
abstract = {An amendment to this paper has been published and can be accessed via a link at the top of the paper.},
}
@article {pmid32325012,
year = {2020},
author = {Espin Basany, E and Solís-Peña, A and Pellino, G and Kreisler, E and Fraccalvieri, D and Muinelo-Lorenzo, M and Maseda-Díaz, O and García-González, JM and Santamaría-Olabarrieta, M and Codina-Cazador, A and Biondo, S},
title = {Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial.},
journal = {The lancet. Gastroenterology & hepatology},
volume = {5},
number = {8},
pages = {729-738},
doi = {10.1016/S2468-1253(20)30075-3},
pmid = {32325012},
issn = {2468-1253},
mesh = {Administration, Intravenous ; Administration, Oral ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/administration & dosage/*therapeutic use ; Ciprofloxacin/administration & dosage/*therapeutic use ; Colectomy/adverse effects/methods ; Colon/pathology/*surgery ; Elective Surgical Procedures/adverse effects ; Female ; Humans ; Incidence ; Male ; Metronidazole/administration & dosage/*therapeutic use ; Middle Aged ; Preoperative Care/*standards ; Single-Blind Method ; Spain/epidemiology ; Surgical Wound Infection/epidemiology/*prevention & control ; },
abstract = {BACKGROUND: Previous studies have found that mechanical bowel preparation with oral antibiotics can reduce the incidence of surgical-site infections, but no randomised controlled trial has assessed oral antibiotics alone without mechanical bowel preparation. The aim of this study was to determine whether prophylaxis with oral antibiotics the day before elective colon surgery affects the incidence of postoperative surgical-site infections.
METHODS: In this multicentre, pragmatic, randomised controlled trial (ORALEV), patients undergoing colon surgery were recruited from five major hospitals in Spain and 47 colorectal surgeons at these hospitals participated. Patients were eligible for inclusion if they were diagnosed with neoplasia or diverticular disease and if a partial colon resection or total colectomy was indicated. Participants were randomly assigned (1:1) using online randomisation tables to either administration of oral antibiotics the day before surgery (experimental group) or no administration of oral antibiotics before surgery (control group). For the experimental group, ciprofloxacin 750 mg was given every 12 h (two doses at 1200 h and 0000 h) and metronidazole 250 mg every 8 h (three doses at 1200 h, 1800 h, and 0000 h) the day before surgery. All patients were given intravenous cefuroxime 1·5 g and metronidazole 1 g at the time of anaesthetic induction. The primary outcome was incidence of surgical-site infections. Patients were followed up for 1 month after surgery and all postsurgical complications were registered. This study was registered with EudraCT, 2014-002345-21, and ClinicalTrials.gov, NCT02505581, and is closed to accrual.
FINDINGS: Between May 2, 2015, and April 15, 2017, we assessed 582 patients for eligibility, of whom 565 were eligible and randomly assigned to receive either no oral antibiotics (n=282) or oral antibiotics (n=282) before surgery. 13 participants in the control group and 16 in the experimental group were subsequently excluded; 269 participants in the control group and 267 in the experimental group received their assigned intervention. The incidence of surgical-site infections in the control group (30 [11%] of 269) was significantly higher than in the experimental group (13 [5%] of 267; χ[2] test p=0·013). Oral antibiotics were associated with a significant reduction in the risk of surgical-site infections compared with no oral antibiotics (odds ratio 0·41, 95% CI 0·20-0·80; p=0·008). More complications (including surgical-site infections) were observed in the control group than in the experimental group (76 [28%] vs 51 [19%]; p=0·017), although there was no difference in severity as assessed by Clavien-Dindo score. No differences were noted between groups in terms of local complications, surgical complications, or medical complications that were not related to septic complications.
INTERPRETATION: The administration of oral antibiotics as prophylaxis the day before colon surgery significantly reduces the incidence of surgical-site infections without mechanical bowel preparation and should be routinely adopted before elective colon surgery.
FUNDING: Fundación Asociación Española de Coloproctología.},
}
@article {pmid32313744,
year = {2020},
author = {Hanna, M and Ng, C and Slater, K},
title = {Small Bowel Diverticulosis As a Cause of Chronic Pneumoperitoneum.},
journal = {Cureus},
volume = {12},
number = {3},
pages = {e7303},
pmid = {32313744},
issn = {2168-8184},
abstract = {Pneumoperitoneum, or the accumulation of free air in the peritoneal cavity, is commonly associated with visceral perforation, mandating emergent surgical intervention. Non-surgical pneumoperitoneum, where visceral perforation is not the cause, does not commonly require surgical management. Chronic pneumoperitoneum secondary to small bowel diverticulosis is rare. Of all gastrointestinal diverticular diseases, jejunoileal diverticulosis is the rarest form. We describe a case of chronic pneumoperitoneum in an 83-year-old male presenting with intermittent abdominal distension and constipation over five years resulting in many presentations to his rural hospital. There were never any associated signs of sepsis such as fever or tachycardia. A computed tomography scan revealed large volume pneumoperitoneum without evidence of perforated viscera or free fluid. An elective diagnostic laparoscopy revealed extensive small bowel diverticular disease. One of the diverticuli exhibited pneumotosis intestinalis where bubbles of gas were noted within the diverticulum wall and mesentery in the local vicinity. Given the extent of the small bowel diverticular disease, the patient's advanced age, and relative lack of symptoms, bowel resection was not undertaken and the patient was managed conservatively. This article illustrates a case of chronic pneumoperitoneum due to small bowel diverticulosis. It highlights the differential diagnoses for chronic pneumoperitoneum, increases awareness of this rare and challenging condition, and portrays the utility of conservative management avoiding major surgery and its potential complications.},
}
@article {pmid32312914,
year = {2020},
author = {Pietrzak, AM and Banasiewicz, T and Skoczylas, K and Dziki, A and Szczepkowski, M},
title = {Combined therapy: rifaximin-α and arabinogalactan with lactoferrin combination effectively prevents recurrences of symptomatic uncomplicated diverticular disease.},
journal = {Polski przeglad chirurgiczny},
volume = {92},
number = {2},
pages = {22-28},
doi = {10.5604/01.3001.0014.0946},
pmid = {32312914},
issn = {2299-2847},
mesh = {Adult ; Aged ; Diverticular Diseases/*drug therapy/prevention & control ; Drug Therapy, Combination ; Female ; Galactans/*therapeutic use ; Gastrointestinal Agents/*therapeutic use ; Humans ; Male ; Middle Aged ; Patient Compliance ; Poland ; Retrospective Studies ; Rifamycins/*therapeutic use ; Treatment Outcome ; },
abstract = {INTRODUCTION: Background: Diverticulosis is the most common finding in the GI tract. Nearly half of the people with diverticula experience symptomatic uncomplicated diverticular disease (SUDD).
AIMS: The primary endpoints of our study were to assess the effectiveness of combined therapy with rifaximin-α and arabinogalactan-lactoferrin in symptom reduction and normalization of bowel movements. The secondary endpoints were an assessment of efficacy in SUDD recurrence prevention and patients' compliance to the combined therapy.
METHODS: A retrospective observational survey study was performed in 2019 among physicians experienced in diverticular disease (DD) treatment in Poland. Patients with previous episodes of recurrences treated with combined therapy (cyclic rifaximin-α at least 400 mg b.i.d/7 days/every month and continuous arabinogalactan-lactoferrin supplementation 1 sachet daily) were assessed after 3 and 6 months regarding symptoms' resolution in the three-point scale. The patients' SUDD history, diagnostic methods, treatment, and results, as well as patients' compliance were evaluated.
RESULTS: 281 patients met inclusion criteria, and were further evaluated (67.6% women, median age 65 years). After 6 months of combined treatment, there was a statistically significant reduction in the total severity score (median from 1.7 [max 3 points] to 0.26; P < 0.0001; sum from 8.5 [max 15 points] to 1.28; P < 0.0001) and improvement in each symptom score. Stool frequency statistically normalized in every group. As many as 31.7% had complete symptom resolution. Patients' compliance with the therapy was very good and good in 92.9% of cases. C onclusions and discussion: Combination therapy with cyclic rifaximin-α and continuous arabinogalactan combined with lactoferrin are effective in SUDD treatment in terms of symptom resolution, bowel movement normalization, prevention of recurrences with very good patient's compliance.},
}
@article {pmid32309469,
year = {2019},
author = {Al-Obaid, L and McCarty, TR and Bazarbashi, AN and Wieczorek, TJ and Rangel, E and Homenko, D},
title = {Segmental Colitis Associated With Diverticulosis Causing Hydroureteronephrosis.},
journal = {ACG case reports journal},
volume = {6},
number = {11},
pages = {e00253},
pmid = {32309469},
issn = {2326-3253},
abstract = {Segmental colitis associated with diverticulosis (SCAD) is a rare inflammatory condition affecting segments of the colon with diverticular disease. We present an 85-year-old woman with flank pain, fevers, and chills found on imaging to have left colonic wall thickening and left-sided hydroureteronephrosis and workup confirming a diagnosis of SCAD. A detailed review of SCAD and discussion of the differential diagnosis are provided. This case emphasizes disease-specific clinical pearls and highlights hydroureteronephrosis as a rare complication seen in a patient with SCAD.},
}
@article {pmid32301257,
year = {2020},
author = {Azhar, N and Buchwald, P and Ansari, HZ and Schyman, T and Yaqub, S and Øresland, T and Schultz, JK},
title = {Risk of colorectal cancer following CT-verified acute diverticulitis: a nationwide population-based cohort study.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {22},
number = {10},
pages = {1406-1414},
doi = {10.1111/codi.15073},
pmid = {32301257},
issn = {1463-1318},
support = {265956//Helse Sør-Øst RHF/ ; 2719011//Helse Sør-Øst RHF/ ; },
mesh = {Acute Disease ; Cohort Studies ; Colonoscopy ; *Colorectal Neoplasms/epidemiology ; *Diverticulitis/diagnostic imaging/epidemiology ; *Diverticulitis, Colonic/diagnostic imaging/epidemiology ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed ; },
abstract = {AIM: Routine colonoscopy to exclude colorectal cancer (CRC) after CT-verified acute diverticulitis is controversial. This study aimed to compare the incidence of CRC in patients with acute diverticulitis with that in the general population.
METHOD: Patients with an emergency admission for diverticular disease to any Norwegian hospital between 1 January 2008 and 31 December 2010 were included through identification in the Norwegian Patient Registry using International Classification of Diseases (ICD-10) codes K57.1-9. To estimate the age-specific distribution of CT-verified acute uncomplicated diverticulitis (AUD) and acute complicated diverticulitis (ACD) in this nationwide study population, numbers from the largest Norwegian emergency hospital were used. Patients diagnosed with CRC within 1 year following their admission for acute diverticulitis were detected through cross-matching with the Cancer Registry of Norway. Based on both Norwegian age-specific incidence of CRC and estimated age-specific distribution of CT-verified diverticulitis, standard morbidity ratios (SMRs) were calculated.
RESULTS: A total of 7473 patients with emergency admissions for diverticular disease were identified (estimated CT-verified AUD n = 3523, ACD n = 1206); of these 155 patients were diagnosed with CRC within 1 year. Eighty had a CT-verified diverticulitis at index admission [41 AUD (51.3%); 39 ACD (49.7%)]. Compared with the general population, the SMR was 6.6 following CT-verified AUD and 16.3 following ACD, respectively.
CONCLUSION: In the first year after CT-verified acute diverticulitis, especially after ACD, the risk of CRC is higher than in the general population. This probably represents misdiagnosis of CRC as acute diverticulitis. Follow-up colonoscopy should be recommended to all patients admitted with acute diverticulitis.},
}
@article {pmid32248599,
year = {2020},
author = {Peltrini, R and Pontecorvi, E and Silvestri, V and Bartolini, C and D'Ambra, M and Bracale, U and Corcione, F},
title = {Laparoscopic sigmoid colectomy with preservation of the inferior mesenteric artery for diverticular disease - a video vignette.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {22},
number = {9},
pages = {1205-1206},
doi = {10.1111/codi.15053},
pmid = {32248599},
issn = {1463-1318},
mesh = {Colectomy ; Colon, Sigmoid/surgery ; *Diverticular Diseases/surgery ; Humans ; *Laparoscopy ; Mesenteric Artery, Inferior/surgery ; },
}
@article {pmid32218442,
year = {2020},
author = {Tursi, A and Scarpignato, C and Strate, LL and Lanas, A and Kruis, W and Lahat, A and Danese, S},
title = {Colonic diverticular disease.},
journal = {Nature reviews. Disease primers},
volume = {6},
number = {1},
pages = {20},
pmid = {32218442},
issn = {2056-676X},
support = {R01 DK101495/DK/NIDDK NIH HHS/United States ; R01 DK103915/DK/NIDDK NIH HHS/United States ; },
mesh = {Anti-Bacterial Agents/therapeutic use ; Biomarkers/analysis ; Diagnostic Imaging/methods ; Dietary Fiber/therapeutic use ; Diverticulosis, Colonic/*complications/epidemiology/*physiopathology ; Gastrointestinal Microbiome/physiology ; Gastroparesis/etiology/physiopathology ; Humans ; Probiotics/therapeutic use ; },
abstract = {Diverticula are outpouchings of the intestinal wall and are common anatomical alterations detected in the human colon. Colonic diverticulosis (the presence of diverticula in the colon; referred to as diverticulosis) remains asymptomatic in most individuals but ~25% of individuals will develop symptomatic diverticulosis, termed colonic diverticular disease (also known as diverticular disease). Diverticular disease can range in severity from symptomatic uncomplicated diverticular disease (SUDD) to symptomatic disease with complications such as acute diverticulitis or diverticular haemorrhage. Since the early 2000s, a greater understanding of the pathophysiology of diverticulosis and diverticular disease, which encompasses genetic alterations, chronic low-grade inflammation and gut dysbiosis, has led to improvements in diagnosis and management. Diagnosis of diverticular disease relies on imaging approaches, such as ultrasonography, CT and MRI, as biomarkers alone are insufficient to establish a diagnosis despite their role in determining disease severity and progression as well as in differential diagnosis. Treatments for diverticular disease include dietary fibre, pharmacological treatments such as antibiotics (rifaximin), anti-inflammatory drugs (mesalazine) and probiotics, alone or in combination, and eventually surgery. Despite being effective in treating primary disease, their effectiveness in primary and secondary prevention of complications is still uncertain.},
}
@article {pmid32218436,
year = {2020},
author = {},
title = {Colonic diverticular disease.},
journal = {Nature reviews. Disease primers},
volume = {6},
number = {1},
pages = {21},
doi = {10.1038/s41572-020-0162-4},
pmid = {32218436},
issn = {2056-676X},
}
@article {pmid32217637,
year = {2020},
author = {Sidhu, M and Tate, DJ and Bourke, MJ},
title = {Transmucosal diverticular myotomy for the treatment of oesophageal diverticula associated with spastic motility disorders.},
journal = {Gut},
volume = {69},
number = {9},
pages = {1552-1554},
doi = {10.1136/gutjnl-2019-320481},
pmid = {32217637},
issn = {1468-3288},
mesh = {*Diverticulum, Esophageal/diagnosis/physiopathology/surgery ; *Esophageal Motility Disorders/diagnosis/etiology/physiopathology ; Esophagoscopy/*methods ; Esophagus/diagnostic imaging/surgery ; Female ; Humans ; Male ; Manometry/methods ; Middle Aged ; Myotomy/*methods ; Radiography/methods ; Symptom Assessment/methods ; Treatment Outcome ; },
abstract = {Thoracic oesophageal diverticula are often associated with spastic motility disorders. Despite correction of the underlying motility disorder, in a subgroup of patients, symptoms persist, primarily regurgitation. Surgical diverticulectomy is then proposed; however, as the approach is thoracoscopic or via thoracotomy, it is associated with significant morbidity and cost. Descriptions of endoscopic techniques for the treatment of symptomatic midoesophageal diverticula are few. We propose the novel technique of diverticular myotomy (DM) to treat this disorder. In this case series, we describe two patients who successfully underwent DM with no adverse outcomes and excellent clinical results at 24-month follow-up.},
}
@article {pmid32212421,
year = {2021},
author = {Grass, F and Hübner, M and Crippa, J and Lovely, JK and Huebner, M and Larson, DW},
title = {Temporal patterns of hospital readmissions according to disease category for patients after elective colorectal surgery.},
journal = {Journal of evaluation in clinical practice},
volume = {27},
number = {2},
pages = {218-222},
doi = {10.1111/jep.13387},
pmid = {32212421},
issn = {1365-2753},
mesh = {Adult ; *Colorectal Surgery ; Humans ; Length of Stay ; *Patient Readmission ; Postoperative Complications/epidemiology ; Prospective Studies ; Retrospective Studies ; Risk Factors ; },
abstract = {RATIONALE: The aim of this study was to identify temporal readmission patterns according to baseline disease categories to provide opportunities for targeted interventions.
METHODS: Retrospective analysis of consecutive adult (≥18 years) patients who underwent elective colorectal resections (2011-2017) at Mayo Clinic Rochester, MN. A prospective administrative database including patient demographics, procedure characteristics, discharge information and specifics on 30-day readmissions (to index facility) including timing and reasons was utilized. The ICD-9 codes were regrouped into the main pathologies Cancer, Crohn's disease (CD)/chronic ulcerative colitis (CUC), and diverticular disease.
RESULTS: In total, 521 (7.2%) out of 7245 patients undergoing inpatient colorectal surgery were readmitted. In all increments of time from discharge (0-2 days: 31.3% of all readmissions, 3-7 days: 32.4% of all readmissions, 8-14 days: 18% of all readmissions, and 15-30 days: 18.3% of all readmissions), reasons for readmission differed significantly (all P < 0.001). Across all disease categories, early readmissions (within 2 days of discharge) were most likely due to ileus/obstruction (53.4% of early readmissions), whereas with 42.5%, infection was the most common cause for late readmissions (>7 days). Patients with home discharge were more likely to be readmitted earlier within the 30-day observation period (P = 0.099), whereas patients with a longer length of index hospital stay (>7 days) were readmitted later (P = 0.080).
CONCLUSIONS: Reasons for readmission appear to be universal across different disease categories. Targeted educational and collaborative measures may help to mitigate the burden of hospital readmissions to index facilities.},
}
@article {pmid32209628,
year = {2020},
author = {Sohn, M and Agha, A and Iesalnieks, I and Bremer, S and Trum, S and Di Cerbo, F and Nerlich, A and Lotz, N and Klieser, E and Hochrein, A and Schredl, P and Kalcheva, D and Emmanuel, K and Presl, J},
title = {PREDICtors for health-related quality of life after elective sigmoidectomy for DIVerticular disease: the PREDIC-DIV study protocol of a prospective multicentric transnational observational study.},
journal = {BMJ open},
volume = {10},
number = {3},
pages = {e034385},
pmid = {32209628},
issn = {2044-6055},
mesh = {Colon, Sigmoid/*surgery ; Diverticular Diseases/*surgery ; *Elective Surgical Procedures ; Humans ; *Laparoscopy ; Multicenter Studies as Topic ; Observational Studies as Topic ; Prospective Studies ; *Quality of Life ; Treatment Outcome ; },
abstract = {INTRODUCTION: Diverticulitis is among the most common abdominal disorders. The best treatment strategy for this complicated disease as well as for recurrent stages is still under debate. Moreover, little knowledge exists regarding the effect of different therapeutic strategies on the health-related quality of life (HrQoL). Therefore, the PREDIC-DIV (PREDICtors for health-related quality of life after elective sigmoidectomy for DIVerticular disease) study aims to assess predictors of a change in HrQoL in patients after elective sigmoidectomy for diverticular disease.
METHODS AND ANALYSIS: A prospective multicentre transnational observational study was started in November 2017. Patients undergoing elective sigmoid resection for diverticular disease were included. Primary outcome includes HrQoL 6 months postoperatively, staged by the Gastrointestinal Quality of Life Index (GIQLI). Secondary outcomes include HrQoL 6 months after sigmoidectomy, assessed using the Short Form 36 Questionnaire and a custom-made Visual Analogue Scale-based inventory; HrQoL after 12 and 24 months; postoperative morbidity; mortality; influence of surgical technique (conventional laparoscopic multiport operation vs robotic approach); histological grading of inflammation and morphological characteristics of the bowel wall in the resected specimen; postoperative functional changes (faecal incontinence, faecal urge, completeness of emptying, urinary incontinence, sexual function); disease-specific healthcare costs; and changes in economic productivity, measured by the iMTA Productivity Cost Questionnaire. The total follow-up will be 2 years.
ETHICS AND DISSEMINATION: The protocol was approved by the medical ethical committee of the Bavarian Medical Council (report identification number: 2017-177). The study was conducted in accordance with the Declaration of Helsinki. The findings of this study will be submitted to a peer-reviewed journal (BMJ Open, Annals of Surgery, British Journal of Surgery, Diseases of the Colon and the Rectum). Abstracts will be submitted to relevant national and international conferences.
TRIAL REGISTRATION NUMBER: The study is registered with the ClinicalTrials.gov register as NCT03527706; Pre-results.},
}
@article {pmid32202966,
year = {2020},
author = {Sigurdardottir, J and Chabok, A and Thorisson, A and Smedh, K and Nikberg, M},
title = {Elective surgery should be considered after successful conservative treatment of recurrent diverticular abscesses.},
journal = {Scandinavian journal of gastroenterology},
volume = {55},
number = {4},
pages = {454-459},
doi = {10.1080/00365521.2020.1740940},
pmid = {32202966},
issn = {1502-7708},
mesh = {Abdominal Abscess/etiology/*therapy ; Adult ; Aged ; Aged, 80 and over ; Colectomy/adverse effects/methods ; Conservative Treatment/adverse effects/methods ; Diverticular Diseases/*complications/pathology/therapy ; Drainage/adverse effects/methods ; Elective Surgical Procedures/adverse effects/methods ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Sweden ; Tomography, X-Ray Computed ; Young Adult ; },
abstract = {Purpose: The purpose of this study was to evaluate the disease pattern and treatment of diverticular abscesses.Methods: Patients treated for diverticulitis (K57) in Västmanland, Sweden were identified for this retrospective population-based study between January 2010 and December 2014. Patients with diverticular abscesses were included. The clinical and radiological data were extracted, and the computed tomography scans were reevaluated.Results: Of the 75 patients (45 women) with a median age of 62 years (range: 23-88 years), abscesses were localized pericolic in 42 patients (59%) and in the pelvis in 33 patients (41%). The median abscess size was 4.8 cm (range: 1.1-11.0 cm). Six patients (8%) required urgent surgical intervention during the index admission. The median follow-up time was 58 months (range: 0-95 months). During follow-up, 40 patients (58%) had disease recurrence and 35 of these patients (88%) presented with complicated diverticulitis. The median time until re-admission was 2 months (range: 3 days-94 months). Patients with pelvic abscesses developed fistulas more frequently, 3 versus 11 patients (p = .003). Twenty-three percent of patients with pericolic abscesses required surgery compared with 40% of patients with pelvic abscesses (p = .09). No patients had a recurrence of abscesses after a colonic resection.Conclusion: The majority of patients with diverticular abscesses had recurrences with repeated admissions regardless of abscess location. An unexpectedly high proportion of patients required surgical intervention during the follow-up period. A liberal approach regarding elective surgery for patients with recurrent diverticulitis abscesses who tolerate surgery seems justified.},
}
@article {pmid32161080,
year = {2020},
author = {Loraine, A},
title = {Bowel preparation agent inducing profound shock precolonoscopy.},
journal = {BMJ case reports},
volume = {13},
number = {3},
pages = {},
pmid = {32161080},
issn = {1757-790X},
mesh = {Aged ; Cathartics/*adverse effects ; Citrates/*adverse effects ; Colonoscopy/methods ; Fatal Outcome ; Female ; Humans ; Organometallic Compounds/*adverse effects ; Picolines/*adverse effects ; Preoperative Care/*adverse effects/methods ; Risk Factors ; Shock, Septic/*chemically induced ; },
abstract = {A 73-year-old woman was admitted to the intensive care unit following vomiting and diarrhoea onset after completing oral bowel preparation prior to colonoscopy to investigate haematochezia. She had a history of severe chronic obstructive pulmonary disease, Crohn's disease, diverticular disease, hypertension and dyslipidaemia. She was resuscitated with intravenous fluids, antibiotics and required epinephrine, norepinephrine and vasopressin infusions. She improved over her 4-day intensive care admission and was discharged to the general medical ward, but ultimately died 19 days after presentation.},
}
@article {pmid32155626,
year = {2020},
author = {Hu, H and Wang, M and Zhu, L and Zhou, P},
title = {Endoscopic Transversal Incision and Longitudinal Septostomy (TILS): An Updated Technique for Treating Esophageal Diverticulum.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {38},
number = {6},
pages = {550-554},
doi = {10.1159/000507077},
pmid = {32155626},
issn = {1421-9875},
mesh = {Diverticulum, Esophageal/diagnostic imaging/*surgery ; *Esophagoscopy ; Esophagus/diagnostic imaging/surgery ; Female ; Humans ; Zenker Diverticulum/diagnostic imaging/surgery ; },
abstract = {An esophageal diverticulum is a protruding pouch in a weak portion of the esophageal lining. Previously, our team had reported an endoscopic tunneling technique (submucosal tunneling endoscopic septum division) for diverticulum treatment. However, it does not perform well for the diverticulum located in the upper esophagus, where most diverticula are located. Herein, we report a new endoscopic technique, called endoscopic transversal incision and longitudinal septostomy (TILS). TILS provides both larger operational spaces and complete septostomy and can be performed on most types of diverticula, including Zenker's diverticulum.},
}
@article {pmid32117653,
year = {2020},
author = {Ajmal, HB and Majid, Z and Tahir, F and Sagheer, S},
title = {Axial Torsion and Gangrene: An Unusual Complication of Meckel's Diverticulum.},
journal = {Cureus},
volume = {12},
number = {1},
pages = {e6702},
pmid = {32117653},
issn = {2168-8184},
abstract = {Meckel's diverticulum (MD), a congenital abnormality of the gastrointestinal tract, is usually found in the pediatric population younger than two years of age; hence, its incidence in adults is rare. Although MD is mostly clinically silent, in adults, it may present with intestinal obstruction and diverticulitis. The complications of MD include hemorrhage, perforation, enterolith formation, torsion, Littre's hernia, ulceration and neoplasm. Among these, torsion is one of the rarely reported complications of MD. MD being attached to the ileal mesentery or umbilicus, presence of mesodiverticular band, and the length, breadth and base diameter of the diverticulum contribute as a risk factor for torsion. A similar clinical picture of acute appendicitis must be excluded. We report a case of a 25-year-old male who presented with signs of intestinal obstruction in whom intraoperative finding of a torted MD with necrotic and twisted base was found upon emergency exploratory laparotomy.},
}
@article {pmid32115815,
year = {2021},
author = {Willington, AJ and Cosgrove, S and Davison, P and Cunliffe, RN},
title = {Prevalence and characteristics of post-colonoscopy colorectal cancers in a New Zealand regional centre: a 10-year analysis.},
journal = {Internal medicine journal},
volume = {51},
number = {2},
pages = {249-253},
doi = {10.1111/imj.14811},
pmid = {32115815},
issn = {1445-5994},
mesh = {*Colonic Polyps/diagnostic imaging/epidemiology ; Colonoscopy ; *Colorectal Neoplasms/diagnosis/epidemiology ; Female ; Humans ; New Zealand/epidemiology ; Prevalence ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND: Post-colonoscopy colorectal cancers (PCCRC) are cancers that appear following a colonoscopy in which no cancer is diagnosed. The occurrence of PCCRC is thought to be multifactorial, reflecting both endoscopy quality and potential differences in tumour biology between detected colorectal cancers and PCCRC.
AIM: To identify the prevalence and characteristics of PCCRC in a New Zealand regional centre over a 10-year period.
METHOD: All cases of colorectal cancer (n = 1055) in the Bay of Plenty region between 1 February 2009 and 1 February 2019 were cross-referenced with endoscopy coding records to identify patients who had undergone colonoscopy within the preceding 6-60 months in which cancer was not identified.
RESULTS: A total of 46 patients were identified to have PCCRC, giving a prevalence of 4.4%. The majority of these patients were older (80% aged 65 years or over) and female (67%). The mean interval between index colonoscopy and diagnosis of PCCRC was 3.03 years. Most (80%) patients had existent pathology (diverticular disease or colonic polyps) at index colonoscopy, and a significant proportion (43%) developed cancer in the same colonic segment. PCCRC were evenly distributed between the left (50%) and right (50%) colon. The majority of patients (63%) had early-stage cancer.
CONCLUSIONS: The prevalence of PCCRC in a New Zealand cohort is consistent with other international reports. Most patients with PCCRC are older, female and have early-stage disease. Of interest, a high proportion of patients developed cancer within a colonic segment with existent pathology, suggesting either missed lesions or incomplete polyp resection.},
}
@article {pmid32100206,
year = {2020},
author = {Stroie, FA and Hasan, OM and Houlihan, MD and McArdle, BJ and Hollowell, CMP and Blumetti, J and Vidal, PP and Psutka, SP},
title = {Low diagnostic sensitivity of cystoscopy and cystography of surgically confirmed vesicoenteric fistulae.},
journal = {International urology and nephrology},
volume = {52},
number = {7},
pages = {1203-1208},
doi = {10.1007/s11255-020-02409-x},
pmid = {32100206},
issn = {1573-2584},
mesh = {*Cystography ; *Cystoscopy ; Female ; Humans ; Intestinal Fistula/*diagnosis/surgery ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Urinary Bladder Fistula/*diagnosis/surgery ; },
abstract = {PURPOSE: The objective of this study was to assess the accuracy of cystoscopy and cystography, as compared to other diagnostic studies, in identifying vesicoenteric fistulae (VEF) in a contemporary series of patients with surgically confirmed VEF.
METHODS: With institutional review board approval, we performed a single-center retrospective review of surgically confirmed VEF between 2002 and 2018. Demographic data, comorbidities, symptoms, and diagnostic evaluation were reviewed. The sensitivity, specificity, and accuracy of cystoscopy in diagnosis of VEF were compared to cross-sectional imaging.
RESULTS: The study cohort consisted of 51 patients with surgically confirmed VEF secondary to diverticular disease. Diagnostic evaluation included cross-sectional imaging with CT (94%), colonoscopy (82%), cystoscopy (75%), cystography (53%), and barium enema (26%). Cystoscopic evaluation definitively demonstrated evidence of VEF in 34% of patients, while 55% of patients had nonspecific urothelial changes on cystoscopy without definitively demonstrating VEF. Comparatively, the sensitivity of VEF was 25% for cystography and 84% for CT.
CONCLUSIONS: In clinical practice, the diagnostic work-up of VEF is variable. In the modern era of managed care, inclusion of cystoscopy and cystography in the evaluation of VEF does not contribute a substantial additive benefit over standard cross-sectional imaging. Cystoscopy and cystography could potentially be eliminated from the diagnostic evaluation of VEF, in the absence of a concern for malignancy, in an effort to minimize unnecessary invasive testing as well as health care expenditures.},
}
@article {pmid32077444,
year = {2020},
author = {Tursi, A and Elisei, W},
title = {Diet in colonic diverticulosis: is it useful?.},
journal = {Polish archives of internal medicine},
volume = {130},
number = {3},
pages = {232-239},
doi = {10.20452/pamw.15199},
pmid = {32077444},
issn = {1897-9483},
mesh = {*Diet ; Dietary Fiber ; Diverticulosis, Colonic/diet therapy/etiology/*prevention & control ; Humans ; Red Meat ; },
abstract = {Diverticulosis of the colon is the most common anatomic alteration of the human colon. Diet may be important in the management of diverticular disease (DD). It is known that high‑fiber diet does not prevent diverticulosis, and there are conflicting data on the prevention and treatment of DD and acute diverticulitis. No association has been reported between nut, corn, or popcorn consumption and the development of diverticulosis, DD, and acute diverticulitis. However, there seems to be a mild association between high alcohol intake and diverticulosis, whereas alcohol dependence seems to be related to a lower risk of in‑hospital mortality due to acute diverticulitis. Higher consumption of red meat was associated with a mild increase in the risk of acute diverticulitis, especially when consumed as unprocessed red meat (defined as consumption of "beef or lamb as main dish," "pork as main dish," "hamburger," and "beef, pork or lamb as a sandwich or mixed dish"). On the other hand, higher consumption of poultry (white meat) was not associated with the risk of acute diverticulitis. Finally, higher fish intake was associated with a reduced risk of diverticulitis in an age‑adjusted model but not after adjustment for other potential confounders.},
}
@article {pmid32072285,
year = {2021},
author = {Ng, ZQ and Wijesuriya, R and Misur, P and Tan, JH and Moe, KS and Theophilus, M},
title = {The role of quantitative radiological measures of visceral adiposity in diverticulitis.},
journal = {Surgical endoscopy},
volume = {35},
number = {2},
pages = {636-643},
pmid = {32072285},
issn = {1432-2218},
mesh = {Adiposity ; Aged ; Diverticulitis/*diagnostic imaging/*etiology/surgery ; Female ; Humans ; Intra-Abdominal Fat/*diagnostic imaging ; Male ; Middle Aged ; Multivariate Analysis ; Obesity, Abdominal/complications/*diagnostic imaging ; Retrospective Studies ; Subcutaneous Fat/diagnostic imaging ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Diverticular disease has been linked to obesity. Recent studies have assessed the role of visceral adiposity with diverticulitis and its complications. The aim of this study was to evaluate the association of quantitative radiological measures of visceral adiposity in patients with diverticulitis with vital signs, biochemistry results, uncomplicated versus complicated diverticulitis and its interventions.
METHODS: A retrospective analysis of all patients with diverticulitis admitted from November 2015 to April 2018 at a single institution was performed. Data collected included demographics, vital signs, biochemistry results, CT scan findings and management outcomes. The patients were divided into uncomplicated (U) and complicated diverticulitis (C) groups. Visceral fat area (VFA), subcutaneous fat area (SFA) and VFA/SFA ratio (V/S) were measured at L4/L5 level by the radiologist. Statistical analysis was performed to evaluate the association of VFA, SFA, V/S with the parameters in both U and C groups.
RESULTS: 352 patients were included in this study (U:C = 265:87). There was no significant difference in vital signs and biochemistry results in both groups. There was no significant difference in VFA, SFA, V/S ratios in both groups. In patients with V/S ratio > 0.4, they were 5.06 times more likely to undergo emergency intervention (95% CI 1.10-23.45) (p = 0.03). On multivariate analysis, a heart rate > 100 (OR 2.9, 95% CI 1.2-6.7), CRP > 50 (OR 3.4, 95% CI 1.9-6.0), WCC < 4 or > 12 (OR 2.1, 95% CI 1.2-3.6) and V/S ratio > 0.4 (OR 2.8, 95% CI 1.5-5.4) were predictive of complicated diverticulitis.
CONCLUSION: The quantitative radiological measurement of visceral adiposity is useful in prognostication in patients presenting with diverticulitis.},
}
@article {pmid32064030,
year = {2020},
author = {Fejleh, MP and Tabibian, JH},
title = {Colonoscopic management of diverticular disease.},
journal = {World journal of gastrointestinal endoscopy},
volume = {12},
number = {2},
pages = {53-59},
pmid = {32064030},
issn = {1948-5190},
abstract = {Diverticula are the most common incidental finding during routine colonoscopy, and their prevalence increases with patient age. The term "diverticular disease" encompasses the range of clinical manifestations and complications that can occur with colonic diverticula, including diverticular bleeding, diverticulitis-associated strictures, and acute diverticulitis. Colonoscopy is a vital tool in the diagnosis and management of diverticular disease and can be useful in a variety of regards. In this editorial, we concisely delineate the current approach to and practices in colonoscopic management of diverticular disease. In particular, we discuss treatment options for diverticular bleeding, propose consideration of colonic stenting as a bridge to surgery in patients with diverticulitis-associated strictures, and the need for diagnostic colonoscopy following an episode of acute diverticulitis in order to rule out underlying conditions such as colonic malignancy or inflammatory bowel disease. In addition, we offer practical tips for performing safe and successful colonoscopy in patients with dense diverticulosis coli.},
}
@article {pmid32054240,
year = {2021},
author = {De Robles, MS and Young, CJ},
title = {Triple-Staple Technique Effectively Reduces Operating Time for Rectal Anastomosis.},
journal = {Annals of coloproctology},
volume = {37},
number = {1},
pages = {16-20},
pmid = {32054240},
issn = {2287-9714},
abstract = {PURPOSE: Stapled anastomotic techniques to the distal rectum have gained widespread acceptance due to their procedural advantages. Various modifications in the stapling techniques have evolved since their inception. The triple-staple technique utilizing stapled closure of both the proximal colon and distal rectal stump provides a rapid and secure colorectal anastomosis. The aims of this study were to determine the safety and efficacy of the triple-staple technique and to compare the clinical outcomes with a historical control group for which the conventional double-staple technique had been performed.
METHODS: One hundred consecutive patients operated on by a single surgeon were included in the study; 50 patients who underwent a double-staple (DSA) procedure and 50 patients undergoing triple-staple anastomosis (TSA).
RESULTS: The most common indication for surgery in both groups was rectal cancer followed by diverticular disease and distal sigmoid cancer. There was no significant difference in number of patients requiring loop ileostomy formation in the groups (TSA, 56.0% vs. DSA, 68.0%; P = 0.621). The mean operating time for the TSA group was significantly shorter compared to that of the DSA group (TSA, 242.8 minutes vs. DSA, 306.1 minutes; P = 0.001). There was no significant difference in complication rate (TSA, 40% vs. DSA, 50%; P = 0.315) or length of hospital stay between the two groups (TSA, 11.3 days vs. DSA, 13.0 days; P = 0.246). Postoperative complications included anastomotic leak, prolonged ileus, bleeding, wound infection, and pelvic collection.
CONCLUSION: The triple-staple technique is a safe alternative to double-staple anastomosis after anterior resection and effectively shortens operating time.},
}
@article {pmid32053333,
year = {2020},
author = {Hawks, MK and Svarverud, JE},
title = {Acute Lower Gastrointestinal Bleeding: Evaluation and Management.},
journal = {American family physician},
volume = {101},
number = {4},
pages = {206-212},
pmid = {32053333},
issn = {1532-0650},
mesh = {Acute Disease ; Colonoscopy ; Computed Tomography Angiography ; Digestive System Surgical Procedures ; Embolization, Therapeutic ; Gastrointestinal Hemorrhage/*diagnosis/etiology/*therapy ; Humans ; },
abstract = {Evaluation and management of acute lower gastrointestinal bleeding focus on etiologies originating distally to the ligament of Treitz. Diverticular disease is the most common source, accounting for 40% of cases. Hemorrhoids, angiodysplasia, infectious colitis, and inflammatory bowel disease are other common sources. Initial evaluation should focus on obtaining the patient's history and performing a physical examination, including evaluation of hemodynamic status. Subsequent evaluation should be based on the suspected etiology. Most patients should undergo colonoscopy for diagnostic and therapeutic purposes once they are hemodynamically stable and have completed adequate bowel preparation. Early colonoscopy has not demonstrated improved patient-oriented outcomes. Hemodynamic stabilization using normal saline or balanced crystalloids improves mortality in critically ill patients. For persistently unstable patients or those who cannot tolerate bowel preparation, abdominal computed tomographic angiography should be considered for localization of a bleeding source. Technetium Tc 99m-labeled red blood cell scintigraphy should not be routinely used in the evaluation of lower gastrointestinal bleeding. Surgical intervention should be considered only for patients with uncontrolled severe bleeding or multiple ineffective nonsurgical treatment attempts. Percutaneous catheter embolization should be considered for patients who are poor surgical candidates. Treatment is based on the identified source of bleeding.},
}
@article {pmid32025621,
year = {2020},
author = {Del Marmol, O and Coulier, B and Pierard, F},
title = {Intravesical Protrusion of a Pedunculated Colonic Polyp through a Sigmoido-Vesical Fistula Caused by Diverticulitis.},
journal = {Journal of the Belgian Society of Radiology},
volume = {104},
number = {1},
pages = {5},
pmid = {32025621},
issn = {2514-8281},
abstract = {Teaching Point: Sigmoid diverticulitis may cause colo-vesical fistula from which intravesical protrusion of a pedunculated colonic polyp is an exceptional event that should not be regarded as a bladder cancer.},
}
@article {pmid32015353,
year = {2020},
author = {Reichert, MC and Kupcinskas, J and Schulz, A and Schramm, C and Weber, SN and Krawczyk, M and Jüngst, C and Casper, M and Grünhage, F and Appenrodt, B and Zimmer, V and Tamelis, A and Lukosiene, JI and Pauziene, N and Kiudelis, G and Jonaitis, L and Goeser, T and Malinowski, M and Glanemann, M and Kupcinskas, L and Lammert, F},
title = {Common variation in FAM155A is associated with diverticulitis but not diverticulosis.},
journal = {Scientific reports},
volume = {10},
number = {1},
pages = {1658},
pmid = {32015353},
issn = {2045-2322},
mesh = {Acetylcholinesterase/genetics ; Aged ; Cohort Studies ; Collagen/genetics ; Diverticulitis, Colonic/*genetics ; Diverticulosis, Colonic/*genetics ; Female ; GTPase-Activating Proteins/genetics ; Genetic Association Studies ; Genetic Predisposition to Disease ; Genome-Wide Association Study ; Germany ; Humans ; Lithuania ; Male ; Membrane Proteins/*genetics ; Middle Aged ; Muscle Proteins/genetics ; Polymorphism, Single Nucleotide ; Risk Factors ; },
abstract = {Colonic diverticulosis is a very common condition. Many patients develop diverticulitis or other complications of diverticular disease. Recent genome-wide association studies (GWAS) consistently identified three major genetic susceptibility factors for both conditions, but did not discriminate diverticulititis and diverticulosis in particular due the limitations of registry-based approaches. Here, we aimed to confirm the role of the identified variants for diverticulosis and diverticulitis, respectively, within a well-phenotyped cohort of patients who underwent colonoscopy. Risk variants rs4662344 in Rho GTPase-activating protein 15 (ARHGAP15), rs7609897 in collagen-like tail subunit of asymmetric acetylcholinesterase (COLQ) and rs67153654 in family with sequence similarity 155 A (FAM155A) were genotyped in 1,332 patients. Diverticulosis was assessed by colonoscopy, and diverticulitis by imaging, clinical symptoms and inflammatory markers. Risk of diverticulosis and diverticulitis was analyzed in regression models adjusted for cofactors. Overall, the variant in FAM155A was associated with diverticulitis, but not diverticulosis, when controlling for age, BMI, alcohol consumption, and smoking status (ORadjusted 0.49 [95% CI 0.27-0.89], p = 0.002). Our results contribute to the assessment specific genetic variants identified in GWAS in the predisposition to the development of diverticulitis in patients with diverticulosis.},
}
@article {pmid32011498,
year = {2020},
author = {Tseng, YJ and Lai, CY and Wang, YC and Chen, WK and Kao, CH and Chen, CH},
title = {Possible increased risk of colonic diverticular disease from alcohol intoxication or abuse.},
journal = {Medicine},
volume = {99},
number = {3},
pages = {e18840},
pmid = {32011498},
issn = {1536-5964},
mesh = {Adult ; Aged ; Alcoholic Intoxication/*complications ; Alcoholism/*complications ; Comorbidity ; Diverticulosis, Colonic/epidemiology/*etiology ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Sex Factors ; Taiwan/epidemiology ; },
abstract = {Alcohol consumption has been suggested as a potential risk factor for diverticular diseases. This study investigated the association between alcohol intoxication or abuse and colonic diverticular disease (CDD).Using the National Health Insurance Research Database of Taiwan from January 1, 2000, to December 31, 2008, 51, 866 subjects newly diagnosed with alcohol intoxication were enrolled in this study as the alcohol intoxication cohort. The control (nonalcohol intoxication) cohort was frequency-matched 1:4 by age, sex and index year. Data were analyzed using a Cox proportional hazards model.The overall incidence of CDD (per 10,000 person-years) for the alcohol intoxication and control cohorts was 16.4 and 3.46, respectively. Compared with patients in the control cohort (95% confidence interval [CI] = 2.76-3.74), those with alcohol intoxication exhibited a 3.21-fold risk of CDD; the risk was particularly higher in male patients (adjusted hazard ratio [aHR] = 3.19, 95% CI = 2.72-3.74) and in those aged <45 years (aHR = 4.95, 95% CI = 3.91-6.27). The alcohol intoxication still had higher risk of CDD than nonalcohol intoxication, regardless of subjects without comorbidity (aHR = 3.38, 95% CI = 2.77-4.11) or with (aHR = 2.85, 95% CI = 2.25-3.61).There was a significant relationship between alcohol intoxication or abuse and CDD.},
}
@article {pmid32011402,
year = {2020},
author = {Early, D and Larue, S and Weinstock, L and Kushnir, V and Gyawali, P and Sullivan, S and Thyssen, E and Hollander, T and Elsner, J and Vyhmeister, R and Bhat, T and Gaddam, S},
title = {Impact of Tilt-Down Positioning Compared With Left Lateral Positioning on Ease of Colonoscope Insertion During Colonoscopy.},
journal = {Journal of clinical gastroenterology},
volume = {54},
number = {6},
pages = {558-560},
doi = {10.1097/MCG.0000000000001318},
pmid = {32011402},
issn = {1539-2031},
mesh = {Boston ; Cecum ; *Colonoscopes ; *Colonoscopy ; Female ; Humans ; Middle Aged ; Patient Positioning ; },
abstract = {GOALS: The aim of this study was to evaluate the efficacy of tilt-down (TD) versus left lateral (LL) positioning in speed and ease of colonoscope insertion in women with risk factors for difficult colonoscopy.
BACKGROUND: Risk factors for difficult colonoscopy in women include pelvic surgery, diverticulosis, and thin body habitus.
STUDY: Female patients with body mass index (BMI) under 25, diverticulosis and history of pelvic surgery were randomized to TD or LL positioning. Five colonoscopists performed all studies at a single center. Time to splenic flexure and cecum, type and amount of medication administered, Boston Bowel Prep Score (BBPS), adverse events, and findings were recorded. The Mann-Whitney U test was used to evaluate the primary endpoint.
RESULTS: A total of 150 women were enrolled (81 TD, 69 LL). The mean age was 60.1 (SD 10.5) and the mean BMI was 23.9 (SD 3.5). In total 98 (65.3%) women had prior pelvic surgery, 94 (62.7%) had BMI <25 and 60 (40.0%) had diverticulosis. There was no statistically significant difference in time to the splenic flexure overall but insertion to the splenic flexure was significantly faster in the TD position as compared with the LL position in patients with diverticulosis (124 s for TD, 160 s for LL, P=0.022). In a linear regression analysis, lower BMI, diverticulosis and lower BBPS were significantly associated with a longer insertion time to the splenic flexure. There were no adverse events.
CONCLUSION: TD positioning represents a straightforward maneuver to facilitate advancement through the sigmoid colon and may be beneficial in women with diverticular disease.},
}
@article {pmid31993993,
year = {2020},
author = {Pellino, G and Podda, M and Wheeler, J and Davies, J and Di Saverio, S},
title = {Laparoscopy and resection with primary anastomosis for perforated diverticulitis: challenging old dogmas.},
journal = {Updates in surgery},
volume = {72},
number = {1},
pages = {21-28},
pmid = {31993993},
issn = {2038-3312},
mesh = {Anastomosis, Surgical/*methods ; Colon, Sigmoid/surgery ; Digestive System Surgical Procedures/*methods ; Diverticulitis/*surgery ; Humans ; Intestinal Perforation/*surgery ; Laparoscopy/*methods ; Prognosis ; },
abstract = {Diverticulitis is a common disease in western countries, and its incidence is likely expected to increase over years. The burden of diverticular disease on health systems and resources utilization cannot be underestimated, given the high prevalence of diverticulosis and the rate of patients requiring hospitalization and/or surgery. Minimally invasive colorectal surgery can guarantee several benefits over traditional open surgery, even more prominently in the emergency settings. However, there is moderate to low agreement regarding the use of a minimally invasive approach in patients with perforated diverticular disease (Hinchey III/IV), as well as primary anastomosis is still feared too risky versus end colostomy. Over the last years, evidence has been growing that laparoscopy can reduce the magnitude of surgical injury, and last but not least, cause less adhesions and/or incisional hernias, and lead to easier subsequent surgeries. The recently published results from the DIVA arm of the Ladies trial showed that 12-month stoma-free survival was significantly better for patients randomized to primary anastomosis compared with patients who received Hartmann's procedure, without differences in short-term morbidity and mortality after index resection. Moreover, several recent studies showed that laparoscopic sigmoidectomy in the treatment of Hinchey III-IV diverticulitis is feasible in haemodynamically stable patients. Taken together, these findings suggest that laparoscopic sigmoidectomy is at least feasible and safe in this challenging subgroup of patients. However, patient selection and additional factors, including surgeon expertise and hospital resources, are crucial and need careful consideration.},
}
@article {pmid31930230,
year = {2019},
author = {Kupcinskas, J and Strate, LL and Bassotti, G and Torti, G and Herszènyi, L and Malfertheiner, P and Cassieri, C and Walker, MM and Tursi, A},
title = {Pathogenesis of Diverticulosis and Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {7-10},
doi = {10.15403/jgld-551},
pmid = {31930230},
issn = {1842-1121},
mesh = {Colon/innervation ; Diverticular Diseases/*etiology/genetics/physiopathology ; Diverticulum/etiology/genetics/physiopathology ; Gastrointestinal Motility/physiology ; Genetic Predisposition to Disease ; Humans ; Life Style ; Obesity/complications ; Sensation/physiology ; Sensation Disorders/etiology ; Smoking/adverse effects ; },
abstract = {In this session different problems regarding the pathogenesis of diverticular disease were considered, including "Genetics", "Neuromuscular function abnormalities", "Patterns of mucosa inflammation", and "Impact of lifestyle". The patients affected by diverticular disease have clear genetic pattern, that might predispose to the occurrence of the disease as well as to its complications. Neuromuscular abnormalities may be recognized already at the stage of diverticulosis, and inflammation may explain symptoms occurrence in symptomatic uncomplicated diverticular disease (SUDD) or symptoms persistence after an episode of acute diverticulitis. Finally, lifestyle might also have an impact on symptoms' occurrence. Specifically smoking, but also obesity seem to play an important role, while the role of low-fiber diet and constipation is now under debate.},
}
@article {pmid31930229,
year = {2019},
author = {Milosavljeviĉ, T and Brandimarte, G and Stollman, N and Barbara, G and Lahat, A and Scarpignato, C and Lanas, A and Papa, V and Tursi, A and Nardone, G},
title = {Course of the Diverticular Disease: What is changing?.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {11-16},
doi = {10.15403/jgld-552},
pmid = {31930229},
issn = {1842-1121},
mesh = {Acute Disease ; Colonoscopy ; Diagnosis, Differential ; Disease Progression ; Diverticular Diseases/*diagnosis ; Diverticulitis/etiology/prevention & control ; Humans ; Irritable Bowel Syndrome/diagnosis ; Risk Factors ; Secondary Prevention/methods ; },
abstract = {In this session several critical issues in diverticular disease were considered, including "It is Symptomatic Diverticular Disease or Irritable Bowel Syndrome?", "What do determine evolution to diverticulitis, bowel habits alteration or inflammation?", and "Prevention of acute diverticulitis: Is it at all possible?". The first talking compared symptoms and laboratory findings between Symptomatic Uncomplicated Diverticular Disease (SUDD) and Irritable Bowel Syndrome (IBS). Although both disease share some symptoms, and although IBS can occur in patients having diverticulosis, SUDD and IBS can be differentiate using a combination of symptoms and laboratory tools. The second talking debated what are the most important risk factors for the evolution towards acute diverticulitis. Current data seem to exclude a significant role of bowel habits alteration, while inflammation seems to have a stronger role, especially in causing acute diverticulitis recurrence. The third talking analyzed about the acute diverticulitis prevention. Primary prevention seem to be little better when using mesalazine, while no definite conclusion can be drawn about the use of fiber and rifaximin. About the secondary prevention, no drugs can be currently advised due to lacking of definite results. At the same time, surgery should be advised on case-by-case basis.},
}
@article {pmid31930228,
year = {2019},
author = {Štimac, D and Nardone, G and Mazzari, A and Crucitti, A and Maconi, G and Elisei, W and Violi, A and Tursi, A and Di Mario, F},
title = {What's New in Diagnosing Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {17-22},
doi = {10.15403/jgld-553},
pmid = {31930228},
issn = {1842-1121},
mesh = {Acute Disease ; Biomarkers/metabolism ; Colonoscopy ; Diagnosis, Differential ; Diverticular Diseases/*diagnosis/therapy ; Diverticulitis/diagnostic imaging ; Humans ; Tomography, X-Ray Computed ; Ultrasonography ; },
abstract = {In this session different issues for the diagnosis of diverticular disease (DD) were considered including "Biomarkers", "Computer tomography", "Ultrasonography in detecting acute diverticulitis", "Endoscopy" and "The DICA classification: a new predictive tool in managing diverticular disease". Most patients affected by DD suffer from recurrent attacks of abdominal pain without evidence of an active inflammatory process, causing a difficult differential diagnosis with other intestinal conditions. Several biomarkers, serological, fecal, urinary and genetic were considered, but recent studies confirmed that only CRP and fecal calprotectin are matching with the criteria for an ideal biomarker for DD. Colonoscopy still remains the gold standard for the diagnosis of DD, playing a key role in many clinical settings, such as colonic diverticular bleeding, or to differentiate inflammatory bowel disease (IBD) and segmental colitis associated with diverticulosis (SCAD); Moreover, in 2015 has been developed the DICA (Diverticular Inflammation and Complication Assessment) endoscopic classification that considers 10 different parameters, each one with a score, and the sum of items scores represents the severity of the disease; in this way the endoscopic exam would be able to predict the outcome of DD for each patient. On the other hand, computer tomography (CT) is the gold standard for acute diverticulitis (AD) with an excellent sensitivity and specificity; recently, metanalysis of prospective studies have shown that intestinal ultrasonography (IUS) and CT have the same sensitivity for the diagnosis of an AD and the advantage is that IUS is less expensive, non-invasive and easily accessible.},
}
@article {pmid31930227,
year = {2019},
author = {Brandimarte, G and Bafutto, M and Kruis, W and Scarpignato, C and Mearin, F and Barbara, G and Štimac, D and Vranić, L and Cassieri, C and Lecca, PG and D'Avino, A and Malfertheiner, P},
title = {Hot Topics in Medical Treatment of Diverticular Disease: Evidence Pro and Cons.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {23-29},
doi = {10.15403/jgld-554},
pmid = {31930227},
issn = {1842-1121},
mesh = {Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Diverticular Diseases/complications/*drug therapy/microbiology ; Evidence-Based Medicine/methods ; Gastrointestinal Agents/*therapeutic use ; Gastrointestinal Microbiome ; Humans ; Probiotics/therapeutic use ; Rifaximin/therapeutic use ; },
abstract = {Symptomatic Uncomplicated Diverticular Disease (SUDD) is the most common clinical form of Diverticular Disease (DD). The therapy should be aimed at reducing both the intensity and frequency of symptoms as well as preventing complications. The pharmacological treatments include fibers, not absorbable antibiotics (for example rifaximin), anti-inflammatory drugs (for example 5-amino-salycilic acid) and probiotics, alone or in combination with other drugs. Although some of these treatments seem to be effective in treating SUDD, but their efficacy in preventing complications of the disease is still uncertain. It has been hypothesized that microbial imbalance associated with bacterial overgrowth of the colon, may be the key to the development of diverticular disease (DD). Therefore, drugs that can manipulate gut microbiota such as probiotics or rifaximine are considered as a potential key therapy. Rifaximine is able to modulate the intestinal ecosystem, restoring eubiosis. Traditionally, DD of the colon is thought to be related to low grade of inflammation. By analogy with other inflammatory bowel diseases mesalazine has been studied also in DD. There are several evidences that may support the use of mesalazine in the SUDD. Unfortunately, mesalazine cannot be used to prevent diverticulitis because of the paucity of high-quality studies. Currently, mesalazine has a limited place for the management of SUDD. In SUDD probiotics have been proven as an effective therapy in reducing abdominal symptoms, but unfortunately there has been limited number of relevant studies regarding efficacy of this therapy.},
}
@article {pmid31930226,
year = {2019},
author = {Binda, GA and Papa, A and Persiani, R and Escalante, R and De Oliveira, EC and Crucitti, A and Mazzari, A and Biondi, A and Papagrigoriadis, S},
title = {Hot Topics in Surgical Management of Acute Diverticulitiss.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {29-34},
doi = {10.15403/jgld-555},
pmid = {31930226},
issn = {1842-1121},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Colectomy/adverse effects/methods ; Digestive System Surgical Procedures/*methods ; Diverticulitis/drug therapy/*surgery ; Humans ; Laparoscopy/adverse effects/methods ; Peritoneal Lavage/methods ; },
abstract = {In this session different issues for the surgical management of diverticular disease DD) were considered. The first session debated about the antibiotic treatment for acute uncomplicated diverticulitis (AUD), and supports their use selectively rather than routinely in patients with AUD. The second session discussed the best surgical treatment for those patients. Open approach is a valid choice especially in acute setting, while the laparoscopic approach should be individualised according to the level of skills of the surgeon and the risk factors of the patient (such as obesity and state of health at the time of the operation). The third session debated about the peritoneal lavage and drainage, which is still a safe surgical procedure. However, it requires longer follow-up and results of other trials to draw an adequate conclusion. The last session covers the current surgical certainties in managing complicated DD: 1. urgent colectomy has higher mortality in immune-compromised patients, while in elective surgery is comparable with other populations; 2. laparoscopic peritoneal lavage (LPL) should be the choice in young/fit patients; 3. elective resection is safer in an inflammation free interval; 4. laparoscopic resection shows advantages in several outcomes (such as post-operative morbidity and lower stoma and re-operation rate); 5. in Hinchey III/fecal peritonitis, primary sigmoid resection and anastomosis (open or laparoscopic) could be proposed in young/ fit patient; 6. in case of emergency surgery, Hartmann procedure (open or laparoscopic) must be considered in critically ill/unstable patient.},
}
@article {pmid31930225,
year = {2019},
author = {Stollman, N and Picchio, M and Biondo, S and Lahat, A and Dumitrascu, DL and Regula, J and Walker, MM},
title = {Critical Issues on Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {35-38},
doi = {10.15403/jgld-557},
pmid = {31930225},
issn = {1842-1121},
mesh = {Ambulatory Care ; Colitis/etiology ; Colorectal Neoplasms/etiology ; Delivery of Health Care/organization & administration ; Diverticular Diseases/complications/*diagnosis/*therapy ; Diverticulitis/complications ; Diverticulosis, Colonic/etiology ; Humans ; Risk Factors ; },
abstract = {In this session diverse critical issues in diverticular disease were considered, including "In or outpatient management of uncomplicated diverticulitis?", "Segmental colitis associated with diverticulosis: what is it?"and "Diverticular inflammation is a risk factor for colorectal cancer?". The conclusions drawn are outlined in the statements but in summary, outpatient management is safe in selected patients, as long as correct diagnosis and stage are assured, and this can allow a cost effective treatment. Non-antibiotic management is also safe but should be confined as an outpatient treatment in carefully selected patients. Segmental colitis associated with diverticulosis (SCAD) is a defined pathological entity (only diagnosed on biopsy) characterized by an inflammatory bowel disease-like pathology, occurring principally in the sigmoid colon, with rectal and right colon sparing. The pathogenesis is unclear but may include a genetic predisposition, microbiome alteration and ischaemia. Treatment can last months, and depends on severity, options include antibiotics, 5 ASA and probiotics for mild cases. Severe disease needs systemic steroids or even anti TNFα treatment. Whether diverticular inflammation is a risk factor for colorectal cancer was debated and the conclusion that within the first eighteen months of diagnosis of diverticular disease associations with cancer are found, likely due to similar symptoms and misclassification of disease. After that time, diverticular disease does not increase the risk of colorectal cancer. Therefore, this is recommended to exclude cancer with imaging and colonoscopy after healing of the first episode of diverticulitis.},
}
@article {pmid31930224,
year = {2019},
author = {Tursi, A and Brandimarte, G and Di Mario, F and Lanas, A and Scarpignato, C and Bafutto, M and Barbara, G and Bassotti, G and Binda, GA and Biondi, A and Biondo, S and Cassieri, C and Crucitti, A and Dumitrascu, DL and Elisei, W and Escalante, R and Herszènyi, L and Kruis, W and Kupcinskas, J and Lahat, A and Lecca, PG and Maconi, G and Malfertheiner, P and Mazzari, A and Mearìn, F and Milosavljeviċ, T and Nardone, G and Chavez De Oliveira, E and Papa, A and Papagrigoriadis, S and Pera, M and Persiani, R and Picchio, M and Regula, J and Štimac, D and Stollman, N and Strate, LL and Walker, MM and , },
title = {The DICA Endoscopic Classification for Diverticular Disease of the Colon Shows a Significant Interobserver Agreement among Community Endoscopists: an International Study.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {39-44},
doi = {10.15403/jgld-558},
pmid = {31930224},
issn = {1842-1121},
mesh = {Colonic Diseases/*diagnosis ; Colonoscopy/standards ; Community Health Services/standards ; Diverticular Diseases/*diagnosis ; Diverticulosis, Colonic/diagnosis ; Humans ; Observer Variation ; Reproducibility of Results ; *Severity of Illness Index ; Video Recording ; },
abstract = {BACKGROUND AND AIMS: The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting.
METHODS: A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of interrater agreement.
RESULTS: Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal κ was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications.
CONCLUSIONS: The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD.},
}
@article {pmid31930223,
year = {2019},
author = {Tursi, A and Cassieri, C and Colucci, R and Elisei, W and Picchio, M and Brandimarte, G},
title = {Budesonide MMX Is Effective in Patients Having Persistent Symptoms and Raised Fecal Calprotectin Following Treatments for Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {45-48},
doi = {10.15403/jgld-559},
pmid = {31930223},
issn = {1842-1121},
mesh = {Aged ; Budesonide/administration & dosage/*therapeutic use ; Colonic Diseases/*drug therapy/metabolism ; Diverticular Diseases/*drug therapy/metabolism ; Drug Administration Schedule ; Drug Therapy, Combination ; Feces/chemistry ; Female ; Follow-Up Studies ; Gastrointestinal Agents/administration & dosage/*therapeutic use ; Glucocorticoids/administration & dosage/*therapeutic use ; Humans ; Leukocyte L1 Antigen Complex/*metabolism ; Male ; Mesalamine/therapeutic use ; Middle Aged ; Severity of Illness Index ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIM: Although rifaximin and mesalazine seem to be effective in treating the majority of people suffering from diverticular disease (DD), some patients still experience symptoms following those treatments. The aim of this study was to assess the efficacy of budesonide MMXTM in managing symptoms and raised fecal calprotectin (FC) in patients with endoscopic diagnosis of DD and not responding to standard treatments.
METHODS: We performed a post-hoc analysis of the patients enrolled in the DICA prospective study. All patients were at the first diagnosis of DD, scored according to DICA classification. We assessed abdominal pain, meteorism, constipation and diarrhea (scored from 0 to 10) and FC expression at baseline and after six months. Patients were treated with budesonide MMXTM for 4 weeks (9 mg/day for 2 weeks, followed by 9 mg every other day for further 2 weeks), followed by mesalazine 2.4 grams/day for further 5 months.
RESULTS: We studied 24 patients (18 females and 6 males, median age 64, inter quartile range (IQR): 57.5- 73.5), previously treated with mesalazine and/or rifaximin (equally subdivided between DICA 2 and DICA 3). At 6-month follow-up, a significant reduction of all symptoms assessed was observed (abdominal pain and meteorism: p<0.001; constipation: p=0.007; diarrhea: p=0.009). Median (IQR) FC level was 244.5 (171.5- 322.0) μg/g at baseline and 51.0 (IQR: 35.5-61.5) μg/g (p< 0.001) after 6 months. No side effects were recorded.
CONCLUSIONS: Treatment with budesonide MMXTM seems to be effective in obtaining symptoms' control and dropping of FC in patients with DD and not responding to standard treatments.},
}
@article {pmid31930222,
year = {2019},
author = {D'Amico, F and Fiorini, G and Tursi, A and Saracino, IM and Pavoni, M and Danese, S and Vaira, D},
title = {Efficacy of a New Nutraceutical Formulation in Patients with Symptomatic Uncomplicated Diverticular Disease (SUDD): a Prospective Observational Study.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {49-52},
doi = {10.15403/jgld-560},
pmid = {31930222},
issn = {1842-1121},
mesh = {Abdominal Pain/etiology/therapy ; Adult ; Aged ; Aged, 80 and over ; *Dietary Supplements/adverse effects ; Diverticulitis, Colonic/prevention & control ; Diverticulosis, Colonic/complications/pathology/*therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Remission Induction ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIM: Symptomatic uncomplicated diverticular disease (SUDD) is characterized by abdominal pain, bloating and altered bowel habits (constipation or diarrhea) attributed to diverticula in the absence of macroscopic mucosal alterations. There is no consensus about management of these patients. DIVER-100®, an association of natural active ingredients may be effective in the treatment of patients with SUDD. The aim was to evaluate the efficacy and safety of DIVER-100® in patients with SUDD.
METHODS: We conducted a prospective observational study to evaluate the efficacy of DIVER-100® in consecutive patients with SUDD, confirmed by radiology or endoscopy. All patients were treated with DIVER-100® 2 capsules/day 10 days per month, for 3 months. The primary endpoint was the clinical remission rate, defined as the reduction of abdominal pain and bloating, improvement of bowel habits and prevention of acute diverticulitis (AD). The secondary endpoint was the rate of adverse events.
RESULTS: One hundred and one patients were consecutively enrolled at the Internal Medicine and Gastroenterology Unit, Sant'Orsola Hospital, Bologna, Italy. DIVER-100® was effective in inducing remission of symptoms in 12 patients (11.9%) at 3 months and in 10 patients (9.9%) at 6 months. DIVER-100® significantly reduced abdominal pain and bloating in 45.5% and 57.4% of patients respectively (p <0.001) after 3 months. No episodes of AD and no adverse events related to DIVER--100® were recorded at month 6 in the study population.
CONCLUSIONS: DIVER-100® is a safe and effective nutraceutical compound in obtaining remission and symptom relief in SUDD patients. Further randomized, placebo-controlled clinical trials are needed to confirm these preliminary data.},
}
@article {pmid31930221,
year = {2019},
author = {Giorgetti, G and Fabiocchi, F and Brandimarte, G and Tursi, A},
title = {Acute Diverticulitis Is at Significant Risk of Malnutrition: an Analysis of Hospitalized Patients in a Medicine Department.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {53-56},
doi = {10.15403/jgld-561},
pmid = {31930221},
issn = {1842-1121},
mesh = {Acute Disease ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*complications ; Feasibility Studies ; Female ; Hospitalization ; Humans ; Length of Stay/statistics & numerical data ; Male ; Malnutrition/diagnosis/*etiology ; Mass Screening/methods ; Middle Aged ; Nutrition Assessment ; Nutritional Status ; Nutritional Support/methods ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND AND AIM: The Nutritional Risk Security (NRS2002) System is recommended for hospitalized patients in order to assess their nutritional status. However, studies assessing large-scale systematic screening policies are lacking. The aim of this study was to assess the feasibility of implementing a screening strategy concerning all admissions for diverticular disease (DD) of the colon in the Department of Medicine of a Tertiary Hospital.
METHODS: All patients suffering from acute diverticulitis (AD) and admitted to the Medicine Department from January 1st to 31 December 2017, were pre-screened by NRS2002 System by the nursing staff of the Nutritional team at the day of the admission. If the pre-screening was positive, the patients were referred to a supplementary assessment performed by a dietician.
RESULTS: The global number of admissions in the observational period was 4,667 and 133 patients suffered from AD. A positive pre-screening test was recorded in 97 (72.9%) patients: a NRS2002 score > 3, describing a severe impaired nutritional status was found in 61 patients (62.9%). All 97 patients with a NRS2002 positive screening received initial nutritional support by oral supplements (17 patients, 17.52%) or enteral nutrition (22 patients, 22.68%) or total parenteral nutrition (58 patients, 59.8%). The mean length of hospital stay for all 133 patients was 6,9 days. However, the length of hospital stay was significantly longer for patients with a positive NRS2002, with a mean of 18 days (p= 0.01) Conclusions: A large number of hospitalized patients due to AD are at nutritional risk and have a significantly longer hospital stay.},
}
@article {pmid31930220,
year = {2019},
author = {Tursi, A and Brandimarte, G and Di Mario, F and Lanas, A and Scarpignato, C and Bafutto, M and Barbara, G and Bassotti, G and Binda, GA and Biondi, A and Biondo, S and Cambiè, G and Cassieri, C and Crucitti, A and Dumitrascu, DL and Elisei, W and Escalante, R and Herszènyi, L and Kruis, W and Kupcinskas, J and Lahat, A and Lecca, PG and Maconi, G and Malfertheiner, P and Mazzari, A and Mearìn, F and Milosavljeviċ, T and Nardone, G and Chavez De Oliveira, E and Papa, A and Papagrigoriadis, S and Pera, M and Persiani, R and Picchio, M and Regula, J and Štimac, D and Stollman, N and Strate, LL and Violi, A and Walker, MM},
title = {International Consensus on Diverticulosis and Diverticular Disease. Statements from the 3rd International Symposium on Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {suppl. 4},
pages = {57-66},
doi = {10.15403/jgld-562},
pmid = {31930220},
issn = {1842-1121},
mesh = {Congresses as Topic ; Diverticular Diseases/diagnosis/etiology/*therapy ; Diverticulum/diagnosis/etiology/therapy ; Evidence-Based Medicine/methods ; Humans ; },
abstract = {The statements produced by the Chairmen and Speakers of the 3rd International Symposium on Diverticular Disease, held in Madrid on April 11th-13th 2019, are reported. Topics such as current and evolving concepts on the pathogenesis, the course of the disease, the news in diagnosing, hot topics in medical and surgical treatments, and finally, critical issues on the disease were reviewed by the Chairmen who proposed 39 statements graded according to level of evidence and strength of recommendation. Each topic was explored focusing on the more relevant clinical questions. The vote was conducted on a 6-point scale and consensus was defined a priori as 67% agreement of the participants. The voting group consisted of 124 physicians from 18 countries, and agreement with all statements was provided. Comments were added explaining some controversial areas.},
}
@article {pmid31920561,
year = {2019},
author = {Barrenschee, M and Cossais, F and Böttner, M and Egberts, JH and Becker, T and Wedel, T},
title = {Impaired Expression of Neuregulin 1 and Nicotinic Acetylcholine Receptor β4 Subunit in Diverticular Disease.},
journal = {Frontiers in cellular neuroscience},
volume = {13},
number = {},
pages = {563},
pmid = {31920561},
issn = {1662-5102},
abstract = {Neuregulin 1 (NRG1) regulates the expression of the nicotinic acetylcholine receptor (nAChR) and is suggested to promote the survival and maintenance of the enteric nervous system (ENS), since deficiency of its corresponding receptor complex ErbB2/ErbB3 leads to postnatal colonic aganglionosis. As diverticular disease (DD) is associated with intestinal hypoganglionosis, the NRG1-ErbB2/ErbB3 system and the nAChR were studied in patients with DD and controls. Samples of tunica muscularis of the sigmoid colon from patients with DD (n = 8) and controls (n = 11) were assessed for mRNA expression of NRG1, ErbB2, and ErbB3 and the nAChR subunits α3, α5, α7, β2, and β4. Site-specific gene expression levels of the NRG1-ErbB2/3 system were determined in myenteric ganglia harvested by laser microdissection (LMD). Localization studies were performed by immunohistochemistry for the NRG1-ErbB2/3 system and nAChR subunit β4. Rat enteric nerve cell cultures were stimulated with NRG1 or glial-cell line derived neurotrophic factor (GDNF) for 6 days and mRNA expression of the aforementioned nAchR was measured. NRG1, ErbB3, and nAChR subunit β4 expression was significantly down-regulated in both the tunica muscularis and myenteric ganglia of patients with DD compared to controls, whereas mRNA expression of ErbB3 and nAChR subunits β2, α3, α5, and α7 remained unaltered. NRG1, ErbB3, and nAChR subunit β4 immunoreactive signals were reduced in neuronal somata and the neuropil of myenteric ganglia from patients with DD compared to control. nAChR subunit β4 exhibited also weaker immunoreactive signals in the tunica muscularis of patients with DD. NRG1 treatment but not GDNF treatment of enteric nerve cell cultures significantly enhanced mRNA expression of nAchR β4. The down-regulation of NRG1 and ErbB3 in myenteric ganglia of patients with DD supports the hypothesis that intestinal hypoganglionosis observed in DD may be attributed to a lack of neurotrophic factors. Regulation of nAChR subunit β4 by NRG1 and decreased nAChR β4 in patients with DD provide evidence that a lack of NRG1 may affect the composition of enteric neurotransmitter receptor subunits thus contributing to the intestinal motility disorders previously reported in DD.},
}
@article {pmid31914931,
year = {2020},
author = {Moysidis, M and Paramythiotis, D and Karakatsanis, A and Amanatidou, E and Psoma, E and Mavropoulou, X and Michalopoulos, A},
title = {The challenging diagnosis and treatment of duodenal diverticulum perforation: a report of two cases.},
journal = {BMC gastroenterology},
volume = {20},
number = {1},
pages = {5},
pmid = {31914931},
issn = {1471-230X},
mesh = {Anti-Bacterial Agents/therapeutic use ; Conservative Treatment/methods ; Diagnosis, Differential ; Digestive System Surgical Procedures/methods ; Diverticulum/complications/*diagnosis/therapy ; Duodenal Diseases/*diagnosis/etiology/therapy ; Duodenum/*surgery ; Female ; Humans ; Intestinal Perforation/*diagnosis/etiology/therapy ; Middle Aged ; Treatment Outcome ; },
abstract = {BACKGROUND: The duodenum is a common site for diverticulum formation. Most of the duodenal diverticula are asymptomatic, incidental findings. Perforation is a rare but potentially lethal complication of duodenal diverticular disease. Surgery remains the mainstay of treatment for perforated duodenal diverticula. In recent years, a few cases were successfully managed either conservatively or with endoscopy.
CASE PRESENTATION: We present two cases of female patients treated in our department for duodenal diverticulum perforation. The first case was treated surgically with a diverticulectomy. The second case was managed conservatively with bowel rest and intravenous antibiotics. Both patients had an uncomplicated postoperative course and were discharged home.
CONCLUSIONS: Both surgical and conservative treatments are viable options for a perforated duodenal diverticulum in selected patients. Patients with a contained duodenal diverticular perforation can be managed conservatively at the outset. Possibly, the introduction of a classification system for duodenal diverticulum perforation may help clinicians in making essential therapeutic decisions.},
}
@article {pmid31908222,
year = {2019},
author = {Studniarek, A and Kochar, K and Warner, C and Eftaiha, S and Naffouj, S and Borsuk, DJ and Mellgren, A and Park, JJ and Cintron, J and Harrison, J},
title = {Findings on Colonoscopy after Diverticulitis: A Multicenter Review.},
journal = {The American surgeon},
volume = {85},
number = {12},
pages = {1381-1385},
pmid = {31908222},
issn = {1555-9823},
mesh = {Adenocarcinoma/diagnosis/epidemiology ; Adenoma/diagnosis/epidemiology ; Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms/*diagnosis/epidemiology ; *Colonoscopy/statistics & numerical data ; Diverticulitis/*therapy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult ; },
abstract = {Diverticular disease is a common problem where patients with diverticulosis have a 1-4 per cent risk of acute diverticulitis. Current guidelines recommend a colonoscopy after.the resolution of acute diverticulitis. The aim of this study was to evaluate the yield of significant findings on colonoscopy after an episode of diverticulitis. This is a retrospective analysis of patients who underwent colonoscopy after an episode of diverticulitis between November 2005 and August 2017 at three major teaching hospitals. Advanced adenomas were defined as adenomas ≥1 cm, serrated adenomas, and tubulovillous or villous adenomas. A total of 584 patients (298 males; 51%) underwent colonoscopy for a history of diverticulitis after resolution of acute symptoms. Colonoscopy was complete in 488 patients (84%). Among these 488 patients, 446 had diverticular disease, 31 had advanced adenomas, and four had adenocarcinomas. Colonoscopies were incomplete in 96 patients (16%). Forty-six of those patients underwent surgery. The overall incidence of advanced adenomas and adenocarcinomas was 32 (5.4%) and nine (1.5%), respectively. In our study, the prevalence of advanced adenomas and adenocarcinomas was relatively high compared with the average risk individuals. Our findings support that patients after an episode of diverticulitis should continue to get a colonoscopy.},
}
@article {pmid31907763,
year = {2021},
author = {Kearney, MB and Williams, JM and Ebell, MH},
title = {Colon Cancer and Diverticular Disease Association: a Case-Control Study.},
journal = {Journal of gastrointestinal cancer},
volume = {52},
number = {1},
pages = {120-124},
pmid = {31907763},
issn = {1941-6636},
mesh = {Aged ; Case-Control Studies ; Colon/diagnostic imaging/pathology/surgery ; Colonic Neoplasms/diagnosis/*epidemiology ; Colonic Polyps/diagnosis/*epidemiology/surgery ; Colonoscopy ; Diverticulum, Colon/diagnosis/*epidemiology ; *Exercise ; Female ; Humans ; Incidence ; Intestinal Mucosa/diagnostic imaging/pathology/surgery ; Male ; Middle Aged ; Protective Factors ; Retrospective Studies ; Risk Assessment/statistics & numerical data ; Risk Factors ; },
abstract = {PURPOSE: To determine if there is an association between diverticular disease and colon cancer diagnoses with a secondary outcome of assessing other known risk factors for colon cancer. Colon cancer and diverticular disease have many shared symptoms and risk factors; the association between the two has been debated for many years.
METHODS: 36 cases of colon cancer and 144 age- and sex-matched controls were identified from records at an outpatient endoscopy center in Georgia. These cases and controls then were subject to a retrospective chart review to obtain any known risk factor data points for both diverticular disease and colon cancer. A traditional conditional logistic regression and a stepwise conditional logistic regression model were used to analyze the data using significant data points (P < 0.05).
RESULTS: The final stepwise model found that systolic blood pressure (aOR = 1.027, 95% CI = 1.001 to 1.053), history of polyps (aOR = 0.106, 95% CI = 0.029 to 0.387), exercise (aOR = 0.311, 95% CI = 0.029 to 0.387), and history of diverticular disease (aOR = 0.269, 95% CI = 0.091 to 0.795) were protective factors significantly associated with colon cancer.
CONCLUSIONS: Presence and history of the removal of colorectal polyps, presence or history of diverticular disease, and exercise pose as protective factors against development of colon cancer.},
}
@article {pmid31892800,
year = {2020},
author = {Díaz, JJT and Asenjo, BA and Soriano, MR and Fernández, CJ and Aurusa, JOS and Rentería, JPBH},
title = {Efficacy of colonoscopy after an episode of acute diverticulitis and risk of colorectal cancer.},
journal = {Annals of gastroenterology},
volume = {33},
number = {1},
pages = {68-72},
pmid = {31892800},
issn = {1108-7471},
abstract = {BACKGROUND: Diverticular disease of the colon has a high global prevalence. The guidelines suggest performing a colonoscopy 4-6 weeks after the acute episode to exclude colorectal cancer (CRC). However, these recommendations are based on old studies, when computed tomography was not used to diagnose acute diverticulitis (AD). There are currently some studies showing that CRC incidence is low in uncomplicated AD (UAD). Therefore, we decided to perform this study to determine the CRC incidence after an AD episode and the diagnostic efficacy of colonoscopy in these patients.
METHOD: This was a retrospective cohort study that included patients with AD between July 2016 and December 2017.
RESULTS: One hundred seventy-four patients had AD. Of these, 46 patients were excluded and we analyzed 128 patients, 72 (56.3%) women and 56 (43.7%) men. Ninety (70.3%) had UAD and 38 (29.7%) complicated AD (CAD). The colonoscopy showed lesions in 18 (14.06%), 5 (3.9%) being CRC. The patients with CRC had shown CAD and were >70 years old (P=0.0001 and P=0.002 respectively).
CONCLUSIONS: Routine colonoscopy in patients with UAD appears not have many benefits as a diagnostic tool. However, it has a higher efficacy if the patients have CAD and are >70 years old.},
}
@article {pmid31890199,
year = {2020},
author = {Gorgoraptis, S and Xenaki, S and Athanasakis, E and Daskalaki, A and Lasithiotakis, K and Chrysou, E and Chrysos, E},
title = {A case of solitary rectal diverticulum presenting with a large retrorectal abscess.},
journal = {Annals of medicine and surgery (2012)},
volume = {49},
number = {},
pages = {57-60},
pmid = {31890199},
issn = {2049-0801},
abstract = {Colonic diverticular disease is a common condition, affecting 50% of the population aged above 80. In contrast, rectal diverticular disease is a rare condition with very few cases reported, while symptomatic rectal diverticular disease is even rarer. We present a case of a symptomatic large rectal diverticulum presenting with a retrorectal abscess. A 49-year-old Caucasian female was brought to the emergency department complaining of abdominal pain and weakness in the lower limbs. She was found to have obstructive uropathy and unilateral sciatic neuropathy. She rapidly developed acute abdomen and emergency laparotomy revealed a giant purulent rectal diverticulum. The patient underwent exploratory laparotomy and a loop colostomy was made to decompress the colon.},
}
@article {pmid31885846,
year = {2020},
author = {Sugimoto, H and Fujikawa, A and Kishida, A},
title = {A rare complication of the duodenal diverticulum.},
journal = {Frontline gastroenterology},
volume = {11},
number = {1},
pages = {81-82},
pmid = {31885846},
issn = {2041-4137},
abstract = {UNLABELLED: Introduction: An 80-year-old woman presented to the emergency department with severe right-sided abdominal pain that had started after her last meal. Physical examination revealed fever (38.6°C) and rebound tenderness in the right upper quadrant of the abdomen. The laboratory studies showed a leucocyte count of 11.3×10[9]/L (normal, 3.7-8.0×10[9]/L) and a C-reactive protein level of 2.34 mg/dL (normal, <0.03 mg/dL). There were no other significant findings. A CT scan of the abdomen with contrast revealed retroperitoneal air around a duodenal diverticulum (figures 1 and 2).Figure 1Computed tomography scan of the abdomen with contrast (coronal section). A diverticulum in the second portion of the duodenum (arrow) and retroperitoneal air (asterisk) are shown.Figure 2Computed tomography scan of the abdomen with contrast (axial section). The area with retroperitoneal air (asterisk) is marked.
QUESTION: What is the most likely diagnosis and the cause underlying the condition?},
}
@article {pmid31844513,
year = {2019},
author = {Albeeshi, MZ and Alwanyan, AA and Salim, AA and Albabtain, IT},
title = {Appendiceal diverticulitis presenting as acute appendicitis diagnosed postoperatively.},
journal = {Journal of surgical case reports},
volume = {2019},
number = {12},
pages = {rjz332},
pmid = {31844513},
issn = {2042-8812},
abstract = {Appendiceal diverticular disease is a rare entity. We report a case of appendiceal diverticulitis mimicking acute appendicitis and diagnosed postoperatively on histopathology. A 28-year-old female presented with a 2-day history of shifting periumbilical pain associated with nausea and anorexia. A computed tomography scan of the abdomen demonstrated acute appendicitis. She was taken to laparoscopic appendectomy. Histopathology showed appendiceal diverticulitis, and perforation of an inflamed diverticulum with periappendicitis. Diverticulosis of the appendix is classified as congenital and acquired. Diagnosis can be made preoperatively by imaging. In this case, diverticulosis was not radiologically evident, and was interpreted as acute appendicitis. Gross appearance of the resected appendix was not suggestive of diverticulitis. Other cases reported that the gross specimen had evidence of diverticular disease. Surgeons should be aware that inflamed appendixes may harbor different pathologies warranting further management.},
}
@article {pmid31828890,
year = {2020},
author = {Siddiqui, J and Young, CJ},
title = {Thirteen-year experience with hand-assisted laparoscopic surgery in colorectal patients.},
journal = {ANZ journal of surgery},
volume = {90},
number = {1-2},
pages = {113-118},
doi = {10.1111/ans.15578},
pmid = {31828890},
issn = {1445-2197},
mesh = {Aged ; Colonic Diseases/pathology/*surgery ; Conversion to Open Surgery/*statistics & numerical data ; Female ; *Hand-Assisted Laparoscopy ; Humans ; Male ; Middle Aged ; New South Wales ; Prospective Studies ; Rectal Diseases/pathology/*surgery ; },
abstract = {BACKGROUND: We report outcomes on 324 consecutive cases of hand-assisted laparoscopic surgery (HALS) in colorectal patients over 13 years performed by a single surgeon.
METHODS: A prospectively maintained database was used to identify all patients undergoing HALS colorectal procedures for benign or malignant indications from September 2004 to February 2018, at two major tertiary centres in Sydney, Australia.
RESULTS: Median age was 64 years, 51% were female and median body mass index was 26. Colorectal cancer (55%), diverticular disease (13%) and polyp related conditions (13%) were common indications. Anterior resection (65%) and right hemicolectomy (18%) were most commonly performed. Median operative time was 244 min (190-300) and 75% of Gelport incisions were Pfannenstiel. Sixty-three percent of colorectal cancer patients had a T3 or T4 cancer. Median tumour size was 35 mm (25-45). Seven percent required conversion to open and 4% a re-operation in the early post-operative period. Thirty-six percent had a post-operative complication, and 11% were major complications. Follow-up extended to 12.8 years and there were 33 late deaths. Being in a high dependency unit or intensive care unit was significant for late mortality (odds ratio 2.8, 95% confidence interval 1.06-7.78, P = 0.037). Three percent developed an incisional hernia and 6% had small bowel obstruction at long-term follow-up.
CONCLUSION: HALS is an effective technique for both benign and malignant colorectal indications with the added advantage of tactile feedback and a lower rate of conversion to open.},
}
@article {pmid31825345,
year = {2019},
author = {Groshilin, VS and Martynov, DV and Tsygankov, PV and Shvetsov, VK and Lukash, YV},
title = {[Prospects for stimulation in early rehabilitation of patients and restoration of bowel function after proctological operations].},
journal = {Khirurgiia},
volume = {},
number = {12},
pages = {66-73},
doi = {10.17116/hirurgia201912166},
pmid = {31825345},
issn = {0023-1207},
mesh = {Clinical Protocols ; Constipation/etiology/therapy ; Defecation/*physiology ; Galactans/*administration & dosage ; Gastrointestinal Agents/*administration & dosage ; Humans ; Intestines/*physiopathology/surgery ; Lactoferrin/*administration & dosage ; Laxatives/administration & dosage ; Proctectomy/adverse effects/*rehabilitation ; Prospective Studies ; Quality of Life ; Time Factors ; Treatment Outcome ; },
abstract = {RELEVANCE: The leveling of postoperative pain, early activation of patients are the leading components of the fast-track program, providing fast recovery with good quality of life, minimizing postoperative problems. In colorectal surgery, the most important factor determining the early recovery of patients is the normalization of bowel function, the restoration of defecation rhythm.
AIM: To assess the possibility of using dietary fiber (arabinogalactan) in combination with lactoferrin (the drug Fibraxin, Alfa Sigma) in the complex postoperative therapy of proctologic patients, as well as to determine the effectiveness of their influence on the dynamics of rehabilitation.
MATERIAL AND METHODS: A non-randomized cohort comparative prospective study was conducted in two clinical groups of 100 patients operated on for proctological pathology. In the first (control) group, after the operation, venotonics were prescribed for 2-3 weeks, as well as topical preparations - for 2.5 weeks. In the second (main) group, this treatment is supplemented with the use of Fibraxin, at a dosage of 6g 1 time per day, the observation period is 4 weeks. A comparative analysis of the rates of relief of postoperative defecation disorders, as well as the effect of the drug on the dynamics of the relief of leading postoperative complaints, has been carried out.
RESULTS: In the main group, the best results were obtained for the main parameters analyzed, early normalization of the frequency and rhythm of bowel movements was achieved, with adequate relief of complaints of pain during bowel movements and after it. Intolerance to the drug and pathological reactions associated with its use was not. The positive effect of Fibraxin in patients with concomitant diseases of the colon, including colitis, irritable bowel syndrome, diverticular disease and chronic colonic stasis, was noted.
CONCLUSION: The use of the drug Fibraxin at a dose of 6g per day allows a significant influence on the course of the postoperative period in proctological patients. The inclusion of Fibraxin in the scheme of rehabilitation treatment allows to stabilize the immediate results of treatment and reliably improve long-term, due to the correction of rectal dysfunction, elimination of dysbiosis, normalization of motility, as well as potentiation of reparative and restorative processes.},
}
@article {pmid31820191,
year = {2020},
author = {Jolivet, M and Trilling, B and Sage, PY and Boussat, B and Girard, E and Faucheron, JL},
title = {Prospective evaluation of functional outcomes after laparoscopic sigmoidectomy with high tie of the inferior mesenteric artery for diverticular disease in consecutive male patients.},
journal = {Techniques in coloproctology},
volume = {24},
number = {1},
pages = {33-40},
pmid = {31820191},
issn = {1128-045X},
mesh = {Colectomy ; Colon, Sigmoid/surgery ; *Diverticular Diseases/surgery ; *Diverticulitis, Colonic/surgery ; Humans ; *Laparoscopy ; Male ; Mesenteric Artery, Inferior/surgery ; Middle Aged ; Pilot Projects ; Prospective Studies ; Quality of Life ; Treatment Outcome ; },
abstract = {BACKGROUND: To date, there has been no consensus concerning the vascular approach during sigmoid colectomy for diverticular disease. The aim of this study was to determine the functional impact of elective laparoscopic sigmoidectomy performed with high ligation of the inferior mesenteric artery for diverticulitis in consecutive male patients.
METHODS: Twenty-five consecutive patients of median age 53 years were enrolled in a prospective single-centre pilot study at a tertiary teaching hospital. Main outcome measures were functional results. Patients were asked to complete standardized, validated questionnaires to evaluate preoperative and 6 months postoperative bowel symptomatology (Jorge-Wexner Incontinence Score and KESS score), urinary function (IPSS), and sexual function (IIEF). Secondary outcomes were surgical data, morbidity, and quality of life (SF-36).
RESULTS: There were no significant differences between preoperative and 6 months postoperative total scores for bowel symptomatology, urinary function, and sexual function. There were no perioperative deaths. The morbidity rate was 12% including three minor and no major events. Quality of life demonstrated statistically better general health (p < 0.01) and better medical status over the prior 4 weeks at 6 months after surgery, compared to baseline. This single-centre prospective study has a limited number of patients, relatively short follow-up time, and includes only male patients.
CONCLUSION: Laparoscopic sigmoidectomy with high tie of the inferior mesenteric artery for diverticular disease does not induce functional disorders at 6 months after surgery. The benefit of the operation for quality of life is even greater for general health and medical status.},
}
@article {pmid31810518,
year = {2020},
author = {Bastawrous, AL and Shih, IF and Li, Y and Cleary, RK},
title = {Minimally invasive sigmoidectomy for diverticular disease decreases inpatient opioid use: Results of a propensity score-matched study.},
journal = {American journal of surgery},
volume = {220},
number = {2},
pages = {421-427},
doi = {10.1016/j.amjsurg.2019.11.030},
pmid = {31810518},
issn = {1879-1883},
mesh = {Adolescent ; Adult ; Aged ; Analgesics, Opioid/*therapeutic use ; Digestive System Surgical Procedures/methods ; Diverticular Diseases/*surgery ; Drug Utilization/*statistics & numerical data ; Female ; Hospitalization ; Humans ; Laparoscopy ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Propensity Score ; Retrospective Studies ; Robotic Surgical Procedures ; Young Adult ; },
abstract = {BACKGROUND: Patients undergoing gastrointestinal surgery are at high risk for postoperative opioid use.
METHODS: We evaluated inpatient opioid use among patients undergoing sigmoidectomy for diverticular disease from the Premier Hospital Database and compared across surgical approaches using propensity score-matching analysis.
RESULTS: After the day of surgery, minimally invasive (MIS) patients were administered significantly lower doses of parenteral opioids (median daily morphine milligram equivalents [MME]: 33.3 versus 48.3, p < 0.001). Within MIS, significantly less parenteral opioids were used by the robotic-assisted (RS) than the laparoscopic (LS) group (median daily MME: 30.0 versus 36.8, p = 0.012). MIS patients were more likely than open to start oral opioids on the day of surgery (MIS vs. OS: 8.7% vs. 6.6%, p < 0.001; RS vs. LS: 12.6% vs. 10.2%, p = 0.048).
CONCLUSION: Minimally invasive sigmoidectomy for diverticular disease was associated with less postoperative parenteral opioid use and starting oral opioids sooner after surgery compared to the open approach.},
}
@article {pmid31804268,
year = {2020},
author = {Shah, N},
title = {Expert Commentary on Complicated Diverticulitis.},
journal = {Diseases of the colon and rectum},
volume = {63},
number = {1},
pages = {29},
doi = {10.1097/DCR.0000000000001553},
pmid = {31804268},
issn = {1530-0358},
mesh = {Abscess ; *Diverticular Diseases ; *Diverticulitis ; Humans ; *Peritonitis ; },
abstract = {Complicated diverticulitis encompasses a variety of clinical scenariors as outlined in the well-written and succinct review by Drs Mendez and Garcia-Henriquez. These range from acute presentations, such as abscesses and free perforations with peritonitis, to more chronic, insidious sequelae such as fistulas and strictures.The contemporary surgical management of diverticular disease has evolved considerably with better appreciation of the pathophysiology and natural history. Just as in uncomplicated diverticulitis, there has been a significant shift toward a less aggressive surgical strategy in complicated diverticulitis, aided further with improved diagnostic and interventional radiology.I would like to add a few salient points for each listed complication.},
}
@article {pmid31801775,
year = {2019},
author = {Tursi, A and Marinelli, A and Laera, F and Penna, A},
title = {Complicated diverticulitis mimicking colonic carcinoma: combined approach with endoscopy and budesonide.},
journal = {BMJ case reports},
volume = {12},
number = {12},
pages = {},
pmid = {31801775},
issn = {1757-790X},
mesh = {Anti-Inflammatory Agents/*administration & dosage ; Budesonide/*administration & dosage ; Colonic Neoplasms/*diagnosis ; Colonoscopy ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis/drug therapy ; Drug Administration Schedule ; Humans ; Male ; Middle Aged ; },
abstract = {Complicated diverticulitis is an uncommon endoscopic finding. We report an unusual case of complicated diverticulitis in a 53-year-old man suffering from chronic constipation, abdominal pain and a recent episode of subocclusion. He underwent to colonoscopy that showed left-sided diverticulosis and a 3 cm irregular mass in the sigmoid. During biopsy sampling due to the suspect of colonic carcinoma, pus and bleeding came out from the lesion. After lavage, a large diverticulum with visible vessel at the bottom was found, which was clipped with stopping bleeding. After a short course of in-hospital treatment, at discharging the patient was treated with budesonide MMX9 mg/day for 8 weeks. At that time, colonoscopy did not show sign of diverticular inflammation, and inflammatory indexes were normal. This case demonstrates that the use of a topical steroid, combined with an endoscopic approach, may easily resolve an unusual endoscopic complication in patients suffering from complicated diverticular disease.},
}
@article {pmid31744067,
year = {2019},
author = {Cirocchi, R and Popivanov, G and Corsi, A and Amato, A and Nascimbeni, R and Cuomo, R and Annibale, B and Konaktchieva, M and Binda, GA},
title = {The Trends of Complicated Acute Colonic Diverticulitis-A Systematic Review of the National Administrative Databases.},
journal = {Medicina (Kaunas, Lithuania)},
volume = {55},
number = {11},
pages = {},
pmid = {31744067},
issn = {1648-9144},
mesh = {Abscess/*classification/complications/epidemiology ; Diverticulitis, Colonic/epidemiology/*physiopathology ; Humans ; Registries ; },
abstract = {Background and Objectives: The diverticular disease includes a broad spectrum of different "clinical situations" from diverticulosis to acute diverticulitis (AD), with a full spectrum of severity ranging from self-limiting infection to abscess or fistula formation to free perforation. The present work aimed to assess the burden of complicated diverticulitis through a comparative analysis of the hospitalizations based on the national administrative databases. Materials and Methods: A review of the international and national administrative databases concerning admissions for complicated AD was performed. Results: Ten studies met the inclusion criteria and were included in the analysis. No definition of acute complicated diverticulitis was reported in any study. Complicated AD accounted for approximately 42% and 79% of the hospitalizations. The reported rates of abscess varied between 1% and 10% from all admissions for AD and 5-29% of the cases with complicated AD. An increasing temporal trend was found in one study-from 6% to 10%. The rates of diffuse peritonitis ranged from 1.6% to 10.2% of all hospitalizations and 11% and 47% of the complicated cases and were stable in the time. Conclusions: The available data precluded definitive conclusions because of the significant discrepancy between the included studies. The leading cause was the presence of heterogeneity due to coding inaccuracies in all databases, absence of ICD codes to distinguish the different type of complications, and the lack of coding data about some general conditions such as sepsis, shock, malnutrition, steroid therapy, diabetes, pulmonary, and heart failure.},
}
@article {pmid31722875,
year = {2019},
author = {Burr, NE and Derbyshire, E and Taylor, J and Whalley, S and Subramanian, V and Finan, PJ and Rutter, MD and Valori, R and Morris, EJA},
title = {Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study.},
journal = {BMJ (Clinical research ed.)},
volume = {367},
number = {},
pages = {l6090},
pmid = {31722875},
issn = {1756-1833},
support = {MR/L01629X/1/MRC_/Medical Research Council/United Kingdom ; /CRUK_/Cancer Research UK/United Kingdom ; },
mesh = {Aged ; Colonoscopy/*methods ; *Colorectal Neoplasms/diagnosis/epidemiology ; *Early Detection of Cancer/methods/standards/statistics & numerical data ; England/epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Quality Improvement/organization & administration ; Risk Factors ; State Medicine/standards ; },
abstract = {OBJECTIVES: To quantify post-colonoscopy colorectal cancer (PCCRC) rates in England by using recent World Endoscopy Organisation guidelines, compare incidence among colonoscopy providers, and explore associated factors that could benefit from quality improvement initiatives.
DESIGN: Population based cohort study.
SETTING: National Health Service in England between 2005 and 2013.
POPULATION: All people undergoing colonoscopy and subsequently diagnosed as having colorectal cancer up to three years after their investigation (PCCRC-3yr).
MAIN OUTCOME MEASURES: National trends in incidence of PCCRC (within 6-36 months of colonoscopy), univariable and multivariable analyses to explore factors associated with occurrence, and funnel plots to measure variation among providers.
RESULTS: The overall unadjusted PCCRC-3yr rate was 7.4% (9317/126 152), which decreased from 9.0% in 2005 to 6.5% in 2013 (P<0.01). Rates were lower for colonoscopies performed under the NHS bowel cancer screening programme (593/16 640, 3.6%), while they were higher for those conducted by non-NHS providers (187/2009, 9.3%). Rates were higher in women, in older age groups, and in people with inflammatory bowel disease or diverticular disease, in those with higher comorbidity scores, and in people with previous cancers. Substantial variation in rates among colonoscopy providers remained after adjustment for case mix.
CONCLUSIONS: Wide variation exists in PCCRC-3yr rates across NHS colonoscopy providers in England. The lowest incidence was seen in colonoscopies performed under the NHS bowel cancer screening programme. Quality improvement initiatives are needed to address this variation in rates and prevent colorectal cancer by enabling earlier diagnosis, removing premalignant polyps, and therefore improving outcomes.},
}
@article {pmid31712072,
year = {2020},
author = {Ma, W and Jovani, M and Nguyen, LH and Tabung, FK and Song, M and Liu, PH and Cao, Y and Tam, I and Wu, K and Giovannucci, EL and Strate, LL and Chan, AT},
title = {Association Between Inflammatory Diets, Circulating Markers of Inflammation, and Risk of Diverticulitis.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {18},
number = {10},
pages = {2279-2286.e3},
pmid = {31712072},
issn = {1542-7714},
support = {K24 DK098311/DK/NIDDK NIH HHS/United States ; R00 CA207736/CA/NCI NIH HHS/United States ; R01 DK101495/DK/NIDDK NIH HHS/United States ; U01 CA167552/CA/NCI NIH HHS/United States ; },
mesh = {Case-Control Studies ; *Diet ; *Diverticulitis/epidemiology ; Follow-Up Studies ; Humans ; Inflammation/epidemiology ; Male ; Prospective Studies ; Risk Factors ; },
abstract = {BACKGROUND & AIMS: Lifestyle and dietary risk factors for diverticulitis also have been associated with chronic inflammation. We performed a prospective study of associations among the inflammatory potential of diets, circulating markers of inflammation, and the incidence of diverticulitis.
METHODS: We followed 46,418 men, initially free of diverticulitis, from 1986 through 2014 in the Health Professionals Follow-Up Study. We collected data on empiric dietary inflammatory pattern scores, which indicate the inflammatory potential of diets, and determined their association with the risk of incident diverticulitis using Cox proportional hazards regression. We used blood samples provided by 18,225 participants from 1993 through 1995 to conduct a nested case-control study; we used conditional logistic regression to evaluate prediagnostic plasma levels of markers of inflammation, including C-reactive protein (CRP), interleukin 6 (IL6), and tumor necrosis factor-receptor superfamily member 1B, in 310 diverticulitis cases and 310 matched diverticulitis-free individuals (controls).
RESULTS: We documented 1110 cases of incident diverticulitis over 992,589 person-years of follow-up. Compared with participants in the lowest quintile of empiric dietary inflammatory pattern scores, men in the highest quintile had a multivariable-adjusted hazard ratio for diverticulitis of 1.31 (95% CI, 1.07-1.60; Ptrend = .01). The association did not differ significantly by strata of body mass index or vigorous activity (P for interaction > .05 for each). In the nested case-control study, plasma levels of CRP and IL6 were associated with risk of diverticulitis. When we compared extreme quintiles, the multivariable-adjusted relative risk for diverticulitis was 1.85 for CRP (95% CI, 1.04-3.30) and 2.04 for IL6 (95% CI, 1.09-3.84).
CONCLUSIONS: In a large prospective cohort of men, we found that the inflammatory potential of diet and prediagnostic plasma levels of markers of inflammation were associated with incident diverticulitis.},
}
@article {pmid31708198,
year = {2020},
author = {Weber, KT and Chung, PJ and La Gamma, N and Procaccino, JA and Alfonso, AE and Coppa, G and Sugiyama, G},
title = {Effect of Body Mass Index on Outcomes After Surgery for Perforated Diverticulitis.},
journal = {The Journal of surgical research},
volume = {247},
number = {},
pages = {220-226},
doi = {10.1016/j.jss.2019.10.020},
pmid = {31708198},
issn = {1095-8673},
mesh = {Adult ; Aged ; Body Mass Index ; Colostomy/*adverse effects ; Diverticulitis, Colonic/complications/mortality/*surgery ; Female ; Humans ; Intestinal Perforation/etiology/mortality/*surgery ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Obesity, Morbid/complications/*epidemiology ; Perioperative Period/mortality ; Postoperative Complications/*epidemiology/etiology ; Reoperation/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Sepsis/etiology/mortality/*surgery ; Treatment Outcome ; United States/epidemiology ; },
abstract = {BACKGROUND: Despite the increased adoption of minimally invasive techniques in colorectal surgery, an open resection with ostomy creation remains an accepted operation for perforated diverticulitis. In the United States, there is an increase in the rates of both morbid obesity and diverticular disease. Therefore, we wanted to explore whether outcomes for morbidly obese patients with diverticulitis are worse than nonmorbidly obese patients after open colectomy for diverticulitis.
MATERIALS AND METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2015, we identified adults with emergent admission for diverticulitis (International Classification of Diseases, Ninth Revision, code 562.11) with evidence of preoperative sepsis and intraoperative contaminated/dirty wound classification, in which a resection with ostomy (Current Procedural Terminology codes 44141, 44143, or 44144) was performed. We excluded cases with age >90 y, ventilator dependence, evidence of disseminated cancer and missing sex, race, body mass index, functional status, American Society of Anesthesiologists class, length of stay (LOS), or operative time data. Morbid obesity was defined as body mass index >35 kg/m[2]. Risk variables of interest included age, sex, race, medical comorbidities, requirement for preoperative transfusion, preoperative sepsis, and operative time. Outcomes of interest included LOS, 30-d postoperative complications, and mortality. Univariate and propensity scores with postmatching analyses were performed.
RESULTS: A total of 2019 patients met inclusion and exclusion criteria, of which 413 (20.5%) were morbidly obese. Morbidly obese patients tended to be younger (mean 57.2 versus 62.6 y) and female (54.5% versus 45.5%). Morbidly obese patients also had higher rates of insulin-dependent diabetes (8.0% versus 4.2%), hypertension (60.1% versus 51.3%), renal failure (3.4% versus 1.5%), and higher American Society of Anesthesiologists class (class 4: 23.5% versus 19.6% and class 5: 1.45% versus 0.87%). Morbidly obese patient had no increase in 30-d mortality or LOS, but they had higher rates of superficial wound infection (9.0% versus 5.8%; P = 0.0259), deep wound infection (4.4% versus 1.9%; P = 0.0073), acute renal failure (4.8% versus 2.4%; P = 0.0189), postoperative septic shock (17.7% versus 12.1%; P = 0.0040), and return to the operating room (11.1% versus 6.4%; P = 0.0015). We identified 397 morbidly obese patients well matched by propensity score to 397 nonmorbidly obese patients. Conditional logistic regression showed no difference in LOS (median 12.9 versus 12.4 d; P = 0.4648) and no increased risk of 30-d mortality (P = 0.947), but morbid obesity was an independent predictor for return to the operating room (adjusted odds ratio: 27.09 [95% confidence interval: 2.68-274.20]; P = 0.005).
CONCLUSIONS: This analysis of a large national clinical database demonstrates that morbidly obese patients presenting with perforated diverticulitis undergoing a Hartmann's procedure do not have increased mortality or LOS compared with nonobese patients. After adjusting for the effects of morbid obesity, morbidly obese patients had increased risk of return to operating room. Despite literature describing the many perioperative risks of obesity, our analysis showed only increased reoperation for obese patients with diverticulitis.},
}
@article {pmid31706437,
year = {2019},
author = {Eberhardt, F and Crichton, M and Dahl, C and Nucera, R and Jenkins, J and Marx, W and Marshall, S},
title = {Role of dietary fibre in older adults with asymptomatic (AS) or symptomatic uncomplicated diverticular disease (SUDD): Systematic review and meta-analysis.},
journal = {Maturitas},
volume = {130},
number = {},
pages = {57-67},
doi = {10.1016/j.maturitas.2019.10.006},
pmid = {31706437},
issn = {1873-4111},
mesh = {Aged ; Asymptomatic Diseases ; Dietary Fiber/*administration & dosage ; Diverticular Diseases/*drug therapy/epidemiology/physiopathology ; Gastrointestinal Transit ; Humans ; Middle Aged ; Probiotics/therapeutic use ; },
abstract = {Dietary fibre and probiotics may play a role in the management of diverticular disease. This systematic review synthesises the evidence on the effects of dietary fibre modifications, with or without the use of probiotics, on the incidence in older adults of asymptomatic (AS) or symptomatic uncomplicated diverticular disease (SUDD), as well as on gastrointestinal function and symptoms. Five electronic databases were searched for studies through to December 2018. The body of evidence was appraised using the Cochrane Risk of Bias tool and GRADE. Nine studies were included, with mean sample ages ranging from 57 to 70 years, and three meta-analyses were performed. Only one study, with high risk of bias, measured the effect of dietary fibre on the incidence of diverticulitis. Dietary fibre supplementation improved stool weight (MD: 42 g/day, P < 0.00001; GRADE level of evidence: low), but had no significant effect on gastrointestinal symptoms (SMD: -0.13, P = 0.16; GRADE level of evidence: low) or stool transit time (MD: -3.70, P = 0.32 GRADE level of evidence: low). There was "very low" confidence for the body of evidence supporting symbiotics for AS or SUDD. A high dietary fibre intake, in line with dietary guidelines, may improve gastrointestinal function and is recommended in patients with AS or SUDD. Dietary fibre supplementation should be considered on an individualised basis to improve bowel function, while any recommendation on symbiotic supplements requires further well-designed research. Future studies should also measure the impact on the incidence of diverticulitis.},
}
@article {pmid31700230,
year = {2019},
author = {Zullo, A and Gatta, L and Vassallo, R and Francesco, V and Manta, R and Monica, F and Fiorini, G and Vaira, D},
title = {Paradigm shift: the Copernican revolution in diverticular disease.},
journal = {Annals of gastroenterology},
volume = {32},
number = {6},
pages = {541-553},
pmid = {31700230},
issn = {1108-7471},
abstract = {Diverticular disease (DD) is an umbrella definition that includes different clinical conditions ranging from diverticulosis to severe and potentially life-threatening complications. In the last decade, new concepts regarding pathogenetic alterations have been developed, while the diagnostic, clinical and therapeutic approaches to the management of DD patients have changed. The protective role of dietary factors (i.e., fiber) has been questioned, whilst some drugs widely used in clinical practice have been found to have a deleterious effect. The use of antibiotics in all patients with acute uncomplicated diverticulitis was reconsidered, as well as the need for a surgical approach in these patients. Conflicting recommendations in different guidelines were proposed for the treatment of symptomatic uncomplicated DD. An endoscopic classification of DD was introduced, and a "curative" endoscopic approach has been pioneered. Based on these observations, which together amount to a kind of "Copernican revolution" in the management of DD patients, we performed a comprehensive and critical reappraisal of the proposed modifications, aiming to discriminate between certainties and doubts on this issue.},
}
@article {pmid31697162,
year = {2020},
author = {Yang, D and Pearson, D and Smith, D},
title = {A rare case of a diverticular perforation associated with colo-urachal fistula presenting as anaphylaxis.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {102},
number = {3},
pages = {e51-e53},
pmid = {31697162},
issn = {1478-7083},
mesh = {Anaphylaxis/*etiology ; Diverticulitis, Colonic/*complications/diagnostic imaging ; Edema/*etiology ; *Face ; Fistula/*complications ; Humans ; Intestinal Fistula/*complications ; Intestinal Perforation/diagnostic imaging/*etiology ; Male ; Middle Aged ; *Urachus ; },
abstract = {Diverticular disease is a common clinical condition among Western populations, which increases with age. It can present in a variety of manners and has myriad of potential disease complications. We present a rare case of an adult patient with an extraperitoneal complications of a diverticular perforation presenting with facial swelling due to a colo-urachal fistula associated with a patent urachal remnant. Perforation should be considered in patients presenting with surgical emphysema with background of diverticular disease.},
}
@article {pmid31686198,
year = {2019},
author = {Çakar, E and Bayrak, S and Çolak, Ş and Dal, F and Gürbulak, B and Bektaş, H and Yarıkkaya, E and Ferlengez, AG},
title = {Clinical characteristics of appendiceal diverticular disease.},
journal = {International journal of colorectal disease},
volume = {34},
number = {12},
pages = {2035-2041},
pmid = {31686198},
issn = {1432-1262},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendectomy ; Appendiceal Neoplasms/diagnostic imaging/epidemiology/*pathology/surgery ; Appendicitis/diagnostic imaging/epidemiology/*pathology/surgery ; Appendix/diagnostic imaging/*pathology/surgery ; Child ; Diagnosis, Differential ; Diverticular Diseases/diagnostic imaging/epidemiology/*pathology/surgery ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Precancerous Conditions/diagnostic imaging/epidemiology/*pathology/surgery ; Predictive Value of Tests ; Prevalence ; Retrospective Studies ; Turkey/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: Appendiceal diverticular disease (ADD) is a rare pathology which is associated with an increased mortality risk due to rapid perforation and high rates of neoplasm. In our study, we aimed to evaluate the clinical and histopathological characteristics of ADD with differences from acute appendicitis (AA) diagnosis and to determine the association with neoformative processes.
METHODS: The 4279 patients who underwent appendectomy were evaluated retrospectively. ADD patients histopathologically classified into four groups. Patients' demographic characteristics, imaging and preoperative laboratory findings, additionally postoperative histopathology results were compared between groups.
RESULTS: The prevalence of ADD was 2.29% (n = 98). In addition, the male/female ratio was 2.37 in ADD patients who were found to be significantly older than those with AA patients. Type III was the most frequently (62.2%) identified sub-group of ADD. The incidence of neoplasms, plastrone, and Littre's hernia was found statistically higher in ADD group than AA group. Mucinous adenomas (10.2%) was the most common neoplasm while the carcinoid tumor (1%) and precancerous serrated adenomas (4.1%) were also reported.
CONCLUSIONS: As a result, high neoplasm in ADD patients can be shown with incidence of perforation and plastron, and in order to avoid possible neoplasm or major complications, it is necessary to carry out new studies for the right diagnosis of ADD whether the diagnosis is done preoperatively or ıntraoperatively. We recommend surgical resection of the ADD, which may even be incidentally detected during any surgical procedure, due to its high risk of neoplasm and rapid perforation.},
}
@article {pmid31663792,
year = {2019},
author = {Abdalla, AO and Narala, SB and Abdallah, MA and Doshi, R and Gullapalli, N},
title = {The outcomes of Clostridioides difficile infection in patients with diverticular disease: a nationwide analysis.},
journal = {Scandinavian journal of gastroenterology},
volume = {54},
number = {11},
pages = {1353-1356},
doi = {10.1080/00365521.2019.1683223},
pmid = {31663792},
issn = {1502-7708},
mesh = {Aged ; Aged, 80 and over ; Bacterial Infections/*complications/epidemiology ; *Clostridiales ; Databases, Factual ; Diverticular Diseases/epidemiology/*microbiology ; Female ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Retrospective Studies ; United States ; },
abstract = {Background: Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections. It contributes to significant morbidity and mortality among hospitalized patients in the United States. Prior studies suggest worse outcomes of CDI in patients with diverticulitis and increased risk for recurrent CDI. We conducted this study to evaluate the outcomes of CDI in patients with diverticular disease from a nationwide data sample (2012-2015).Methods: The National Inpatient Sample (NIS) database between January 2012 and September 2015 was queried for CDI admissions using the International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] codes 008.45, 562.11, 562.10, 562.12, and 562.13 for diagnoses of CDI and diverticular disease.Results: The study included 1,327,595 patients who were admitted between 2012 and 2105 for CDI. Out of all of the patients, 84,170 (6.34%) had a concurrent diagnosis of diverticular disease. After adjusting for confounding variables, the in-hospital mortality was lower [odd ratio (OR): 0.48, 95% CI: 0.44-0.52, p < .001] for patients with diverticular disease. The length of stay (LOS) was longer [10.5 versus 9.3 days, p < .001] and mean cost of hospitalization was significantly higher in patients without a history of diverticular disease.Discussion: In a nationwide population study, admissions with CDI, patients with a concurrent diagnosis of diverticular disease had lower in-hospital mortality. The observed results are different from prior studies and might be attributed to a higher burden of normal flora in those patients and increased use of antibiotic stewardship program across many hospitals nationwide.},
}
@article {pmid31661949,
year = {2020},
author = {Bong, J and Kang, HW and Cho, H and Nam, JH and Jang, DK and Kim, JH and Lee, JK and Lim, YJ and Koh, MS and Lee, JH},
title = {Vegetarianism as a protective factor for asymptomatic colonic diverticulosis in Asians: a retrospective cross-sectional and case-control study.},
journal = {Intestinal research},
volume = {18},
number = {1},
pages = {121-129},
pmid = {31661949},
issn = {1598-9100},
support = {//Dongguk University/ ; },
abstract = {BACKGROUND/AIMS: Dietary fiber intake is considered a protective factor for diverticular disease such as diverticulitis. However, evidence for an inverse connection between dietary fiber consumption and asymptomatic colonic diverticulosis is lacking. Specifically, few studies have investigated this subject in Asians with different presentations of diverticulosis. Therefore, we assessed the protective effects of a vegetarian diet for asymptomatic colonic diverticulosis in Buddhist monks who are obligatory vegetarians for spiritual reasons compared with the general population.
METHODS: A retrospective, cross-sectional, case-control study was conducted in age- and sex-matched Buddhist monks and the general population who underwent colonoscopy for screening at a Korean health promotion center from August 2005 to June 2018. We compared the prevalence of asymptomatic diverticulosis between the 2 groups using a self-administered questionnaire.
RESULTS: In this study, a total of 1,316 individuals were included (Buddhist monks of 658 and general population of 658) with a mean age of 52.6±9.5 years. The prevalence of asymptomatic diverticulosis in Buddhist monks was lower compared with the general population (6.7% [44/658] vs. 10.8% [71/658], P=0.008). Buddhist monks had a higher rate of high body mass index (BMI) and metabolic syndrome. By a multivariate regression analysis model, a nonvegetarian diet (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.21-2.72, P=0.004), old age (OR, 4.53; 95% CI, 1.36-15.12; P=0.014), male sex (OR, 1.91; 95% CI, 1.28-2.85; P=0.002), and a high BMI (OR, 1.50; 95% CI, 1.01-2.23; P=0.047) were independent predictors of asymptomatic diverticulosis. Moreover, a nonvegetarian diet was associated with both right-sided and left-sided diverticulosis.
CONCLUSIONS: A nonvegetarian diet may increase a risk of asymptomatic colonic diverticulosis in Asians.},
}
@article {pmid31658807,
year = {2021},
author = {Roh, S},
title = {Foregut Diverticula.},
journal = {Korean journal of family medicine},
volume = {42},
number = {3},
pages = {191-196},
pmid = {31658807},
issn = {2005-6443},
abstract = {Diverticular disease can present anywhere along the gastrointestinal (GI) tract. It can result from various pathologies such as abnormal contraction within the GI tract or inflammation causing scar tissue and the resulting forces surrounding the GI tract. Its clinical presentation can vary from asymptomatic to severe symptoms, with significant decrease in quality of life. The treatment for various diverticula along the GI tract can also vary, depending on the severity of symptoms. This article describes diverticular disease occurring within the foregut, with emphasis on pathophysiology, clinical presentation, and treatment.},
}
@article {pmid31650125,
year = {2019},
author = {Kuan, V and Denaxas, S and Gonzalez-Izquierdo, A and Direk, K and Bhatti, O and Husain, S and Sutaria, S and Hingorani, M and Nitsch, D and Parisinos, CA and Lumbers, RT and Mathur, R and Sofat, R and Casas, JP and Wong, ICK and Hemingway, H and Hingorani, AD},
title = {A chronological map of 308 physical and mental health conditions from 4 million individuals in the English National Health Service.},
journal = {The Lancet. Digital health},
volume = {1},
number = {2},
pages = {e63-e77},
pmid = {31650125},
issn = {2589-7500},
support = {/DH_/Department of Health/United Kingdom ; MR/S003754/1/MRC_/Medical Research Council/United Kingdom ; MR/K006584/1/MRC_/Medical Research Council/United Kingdom ; 201375/Z/16/Z/WT_/Wellcome Trust/United Kingdom ; /ARC_/Arthritis Research UK/United Kingdom ; RG/10/12/28456/BHF_/British Heart Foundation/United Kingdom ; /CSO_/Chief Scientist Office/United Kingdom ; 206274/Z/17/Z/WT_/Wellcome Trust/United Kingdom ; /CRUK_/Cancer Research UK/United Kingdom ; 110284/Z/15/Z/WT_/Wellcome Trust/United Kingdom ; },
mesh = {Adolescent ; Adult ; *Age of Onset ; Aged ; Aged, 80 and over ; Algorithms ; Child ; Databases, Factual ; Electronic Health Records ; England/epidemiology ; Female ; *Forecasting ; *Health Status ; Humans ; Male ; *Mental Disorders/diagnosis ; Middle Aged ; Population Surveillance/methods ; State Medicine ; Young Adult ; },
abstract = {BACKGROUND: To effectively prevent, detect, and treat health conditions that affect people during their lifecourse, health-care professionals and researchers need to know which sections of the population are susceptible to which health conditions and at which ages. Hence, we aimed to map the course of human health by identifying the 50 most common health conditions in each decade of life and estimating the median age at first diagnosis.
METHODS: We developed phenotyping algorithms and codelists for physical and mental health conditions that involve intensive use of health-care resources. Individuals older than 1 year were included in the study if their primary-care and hospital-admission records met research standards set by the Clinical Practice Research Datalink and they had been registered in a general practice in England contributing up-to-standard data for at least 1 year during the study period. We used linked records of individuals from the CALIBER platform to calculate the sex-standardised cumulative incidence for these conditions by 10-year age groups between April 1, 2010, and March 31, 2015. We also derived the median age at diagnosis and prevalence estimates stratified by age, sex, and ethnicity (black, white, south Asian) over the study period from the primary-care and secondary-care records of patients.
FINDINGS: We developed case definitions for 308 disease phenotypes. We used records of 2 784 138 patients for the calculation of cumulative incidence and of 3 872 451 patients for the calculation of period prevalence and median age at diagnosis of these conditions. Conditions that first gained prominence at key stages of life were: atopic conditions and infections that led to hospital admission in children (<10 years); acne and menstrual disorders in the teenage years (10-19 years); mental health conditions, obesity, and migraine in individuals aged 20-29 years; soft-tissue disorders and gastro-oesophageal reflux disease in individuals aged 30-39 years; dyslipidaemia, hypertension, and erectile dysfunction in individuals aged 40-59 years; cancer, osteoarthritis, benign prostatic hyperplasia, cataract, diverticular disease, type 2 diabetes, and deafness in individuals aged 60-79 years; and atrial fibrillation, dementia, acute and chronic kidney disease, heart failure, ischaemic heart disease, anaemia, and osteoporosis in individuals aged 80 years or older. Black or south-Asian individuals were diagnosed earlier than white individuals for 258 (84%) of the 308 conditions. Bone fractures and atopic conditions were recorded earlier in male individuals, whereas female individuals were diagnosed at younger ages with nutritional anaemias, tubulointerstitial nephritis, and urinary disorders.
INTERPRETATION: We have produced the first chronological map of human health with cumulative-incidence and period-prevalence estimates for multiple morbidities in parallel from birth to advanced age. This can guide clinicians, policy makers, and researchers on how to formulate differential diagnoses, allocate resources, and target research priorities on the basis of the knowledge of who gets which diseases when. We have published our phenotyping algorithms on the CALIBER open-access Portal which will facilitate future research by providing a curated list of reusable case definitions.
FUNDING: Wellcome Trust, National Institute for Health Research, Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Department of Health and Social Care (England), Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Social Care and Health Research, and The Alan Turing Institute.},
}
@article {pmid31646852,
year = {2019},
author = {Di Pierro, F and Bertuccioli, A and Pane, M and Ivaldi, L},
title = {Effects of rifaximin-resistant Bifidobacterium longum W11 in subjects with symptomatic uncomplicated diverticular disease treated with rifaximin.},
journal = {Minerva gastroenterologica e dietologica},
volume = {65},
number = {4},
pages = {259-264},
doi = {10.23736/S1121-421X.19.02622-9},
pmid = {31646852},
issn = {1827-1642},
mesh = {Aged ; Anti-Bacterial Agents/*pharmacology/*therapeutic use ; Bifidobacterium longum/*drug effects ; Combined Modality Therapy ; Diverticular Diseases/*therapy ; Drug Resistance, Bacterial ; Female ; Humans ; Male ; Middle Aged ; Probiotics/*therapeutic use ; Retrospective Studies ; Rifaximin/*pharmacology/*therapeutic use ; Treatment Outcome ; },
abstract = {BACKGROUND: In medical practice, the use of rifaximin and a probiotic is quite common in patients with a diagnosis of symptomatic uncomplicated diverticular disease (SUDD), with the latter being administered at the end of the rifaximin cycle. The opportunity of having a probiotic strain (Bifidobacterium longum W11) described as being resistant to rifaximin has prompted us to use it routinely in subjects with SUDD, administering it concomitantly with rifaximin.
METHODS: Retrospectively, we have analyzed whether our approach conferred a real clinical advantage to patients. The results seem to confirm the logic of our approach.
RESULTS: Patients treated with rifaximin concomitantly receiving strain W11 demonstrated better clinical outcomes than subjects treated with rifaximin followed by strain W11. Moreover, we have observed that the concomitant use of a rifaximin-resistant probiotic has improved the stool consistency of most patients. Finally, the adherence to the given therapy was very different, being very high in subjects undergoing concomitant use of the W11 strain and rifaximin, and being low in the other group. This is probably because of the different duration of therapy (7 days versus 14 days) and due to the fact that after 7 days of rifaximin treatment, patients felt better and decided not to proceed with the probiotic administration.
CONCLUSIONS: Despite the many biases that our retrospective analysis presents, we believe that a probiotic strain demonstrating a strong non-transferable resistance to a particular antibiotic should be used along with that specific antibiotic, at least in cases of SUDD diagnosis.},
}
@article {pmid31634580,
year = {2020},
author = {Peery, AF and Keku, TO and Galanko, JA and Sandler, RS},
title = {Sex and Race Disparities in Diverticulosis Prevalence.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {18},
number = {9},
pages = {1980-1986},
pmid = {31634580},
issn = {1542-7714},
support = {K23 DK113225/DK/NIDDK NIH HHS/United States ; P30 DK034987/DK/NIDDK NIH HHS/United States ; P30 ES010126/ES/NIEHS NIH HHS/United States ; R01 DK094738/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; *Colonoscopy ; *Diverticulum ; Ethnicity ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Prevalence ; Risk Factors ; United States/epidemiology ; },
abstract = {BACKGROUND & AIMS: The prevalence of diverticulosis differs with demographic features of patients, but evidence is limited. Well-defined demographic studies are necessary to understand diverticulosis biology. We estimated the prevalence of diverticulosis among patients of different ages, sexes, and races and ethnicities and calculated odds ratios.
DESIGN: Using data from an endoscopic database, we identified 271,181 colonoscopy procedures performed from 2000 through 2012 at 107 sites in the United States. Our analysis included individuals 40 years and older who underwent colonoscopy examination for average-risk screening. The outcome was any reported diverticulosis on colonoscopy. Multivariate analyses were performed using logistic regression to estimate odds ratios (ORs) and 95% CI values, adjusting for confounding variables.
RESULTS: The prevalence of diverticulosis increased with age in men and women of all races and ethnicities. Women 40-49 years old had significantly lower odds of any diverticulosis (OR, 0.71; 95% CI, 0.63-0.80) compared with men 40-49 years old, after adjustment. The strength of this association decreased with age. Compared with non-Hispanic white individuals, non-Hispanic black individuals (OR, 0.80; 95% CI, 0.77-0.83) and Asian/Pacific Islanders (OR, 0.38; 95% CI, 0.35-0.41) had lower odds of any diverticulosis. However, non-Hispanic black individuals (OR, 1.53, 95% CI, 1.44-1.62) had increased odds of any proximal diverticulosis, whereas Asian/Pacific Islanders (OR, 3.12; 95% CI, 2.67-3.66) had increased odds of only proximal diverticulosis.
CONCLUSIONS: In an analysis of data from 271,181 colonoscopy procedures, diverticulosis was less prevalent in women compared with men in the same age groups, indicating that sex hormones might affect pathogenesis. Differences in the odds of diverticulosis by race and ethnicity indicate a genetic contribution to risk.},
}
@article {pmid31620490,
year = {2019},
author = {Chan, AP and Mulatinho, M and Iskander, P and Lee, H and Martinez-Agosto, JA and Yeh, J},
title = {Maternal Uniparental Disomy 14 (UPD14) Identified by Clinical Exome Sequencing in an Adolescent with Diverticulosis.},
journal = {ACG case reports journal},
volume = {6},
number = {3},
pages = {1-3},
pmid = {31620490},
issn = {2326-3253},
abstract = {Pediatric diverticular disease is extremely rare, with most cases associated with connective tissue disorders. We report an adolescent boy with syndromic features who presented with acute complicated sigmoid diverticulitis. Clinical exome sequencing analysis detected a 6.5-Mb region of homozygosity on chromosome 14, consistent with partial maternal uniparental disomy. Analysis of this region did not identify rare homozygous variants but included several imprinted genes that were candidates for the observed phenotypes. The pediatric clinical presentation of diverticulosis in this patient has not been previously described in maternal uniparental disomy of chromosome 14 and adds to the phenotypic spectrum of the syndrome.},
}
@article {pmid31604485,
year = {2020},
author = {Sapci, I and Hameed, I and Ceylan, A and Oktem, A and Rencuzogullari, A and Hull, TL and Liska, D and Delaney, CP and Gorgun, E},
title = {Predictors of ileus following colorectal resections.},
journal = {American journal of surgery},
volume = {219},
number = {3},
pages = {527-529},
doi = {10.1016/j.amjsurg.2019.10.002},
pmid = {31604485},
issn = {1879-1883},
mesh = {Age Factors ; Colonic Diseases/*surgery ; Female ; Humans ; Ileus/*etiology ; Laparoscopy ; Male ; Middle Aged ; Postoperative Complications/*etiology ; Rectal Diseases/*surgery ; Risk Factors ; Sex Factors ; },
abstract = {BACKGROUND: Ileus following colorectal surgery is a significant burden for healthcare and can be challenging to manage. This study aims to evaluate risk factors for postoperative ileus in patients undergoing colorectal surgery.
METHODS: Patients who underwent colorectal resections for any diagnosis were identified from our institutional database between 2009 and 2014. Patient demographics, pre-operative comorbidities, and operation-related variables were compared in patients with and without ileus within 30 days after surgery.
RESULTS: A total of 5369 patients were identified with a mean age of 53 years. 892 patients (16.6%) developed postoperative ileus. Males were twice as likely (p < 0.001) and patients with anastomosis were 1.4 times more likely to develop ileus compared to those without (p < 0.001). Laparoscopic surgery and younger age were associated with lower ileus risk. Patients with colorectal cancer, Crohn's disease, and ulcerative colitis diagnoses were all more likely to develop postoperative ileus compared to patients with diverticular disease.
CONCLUSIONS: Evaluation of factors such as male gender, older age, anastomosis formation, diagnosis of cancer and inflammatory bowel disease, can help facilitate earlier diagnosis of postoperative ileus and may require consideration of prophylactic therapy.},
}
@article {pmid31559365,
year = {2019},
author = {Tomizawa, K and Toda, S and Tate, T and Hanaoka, Y and Moriyama, J and Matoba, S and Kuroyanagi, H},
title = {Laparoscopic surgery for colovesical fistula associated with sigmoid colon diverticulitis: a review of 39 cases.},
journal = {Journal of the anus, rectum and colon},
volume = {3},
number = {1},
pages = {36-42},
pmid = {31559365},
issn = {2432-3853},
abstract = {OBJECTIVES: Colonic diverticular disease is widespread in Western countries and its associated with aging. In Japan, diverticulitis and colovesical fistula are also occurring more frequently. Colonic resection for diverticula-related fistulas is frequently technically demanding because of associated acute or chronic inflammation. We evaluated the safety and efficacy of a standardized laparoscopic procedure.
METHODS: Data from 39 consecutive patients who had undergone laparoscopic surgery for colovesical fistula between October 2006 and August 2017 were retrospectively reviewed.
RESULTS: The patients' median age was 60 years and comprised 35 men and four women. Sigmoidectomy was performed in 33 patients, Hartmann's procedure in four, and anterior resection in two. The median operative time was 203 minutes and estimated blood loss 15 mL. There were no intraoperative complications or conversion to open surgery. No patients required bladder repair; three had minor postoperative complications, and none had recurrent diverticulitis or fistula at a mean follow-up of 5.1 years.
CONCLUSIONS: The magnified vision and minimal invasiveness make a laparoscopic approach the ideal means of managing colovesical fistula. To our knowledge, this is the largest study of colovesical fistula managed by a standardized laparoscopic procedure.},
}
@article {pmid31523330,
year = {2019},
author = {Kamal, MU and Baiomi, A and Balar, B},
title = {Acute Diverticulitis: A Rare Cause of Abdominal Pain.},
journal = {Gastroenterology research},
volume = {12},
number = {4},
pages = {203-207},
pmid = {31523330},
issn = {1918-2805},
abstract = {There is an increasing incidence of diverticulosis and diverticulitis in the younger populations; and its occurrence in very young individual is concerning. Here we report a rare and interesting case of a 20-year-old man who presented with 3-day history of epigastric abdominal pain associated with diarrhea and nausea. His abdominal examination revealed mild tenderness in the right lower abdominal quadrant. Computed tomography (CT) scan of abdomen with intravenous contrast revealed scattered diverticula throughout the colon with focal thickening, pericolonic infiltrative changes suggestive of acute diverticulitis in the distal ascending colon. He was treated with intravenous hydration and antibiotics and discharged when his clinical status improved. He underwent colonoscopy 1 month later which showed pan diverticulosis. This case illustrates the importance of considering acute diverticulitis in the differential diagnosis of right lower quadrant pain when evaluating a young patient.},
}
@article {pmid31517330,
year = {2019},
author = {Ticinesi, A and Nouvenne, A and Corrente, V and Tana, C and Di Mario, F and Meschi, T},
title = {Diverticular Disease: a Gut Microbiota Perspective.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {3},
pages = {327-337},
doi = {10.15403/jgld-277},
pmid = {31517330},
issn = {1842-1121},
mesh = {Animals ; Bacteria/genetics/*growth & development ; Diverticulitis/epidemiology/*microbiology/therapy ; Diverticulum/epidemiology/*microbiology/therapy ; Dysbiosis ; Feces/microbiology ; *Gastrointestinal Microbiome ; Host-Pathogen Interactions ; Humans ; Intestinal Mucosa/*microbiology ; Risk Factors ; },
abstract = {Gut microbiota composition and functionality are involved in the pathophysiology of several intestinal and extraintestinal diseases, and are increasingly considered a modulator of local and systemic inflammation. However, the involvement of gut microbiota in diverticulosis and in diverticular disease is still poorly investigated. In this review, we critically analyze the existing evidence on the fecal and mucosa-associated microbiota composition and functionality across different stages of diverticular disease. We also explore the influence of risk factors for diverticulosis on gut microbiota composition, and speculate on the possible relevance of these associations for the pathogenesis of diverticula. We overview the current treatments of diverticular disease targeting the intestinal microbiome, highlighting the current areas of uncertainty and the need for future studies. Although no conclusive remarks on the relationship between microbiota and diverticular disease can be made, preliminary data suggest that abdominal symptoms are associated with reduced representation of taxa with a possible anti-inflammatory effect, such as Clostridium cluster IV, and overgrowth of Enterobacteriaceae, Bifidobacteria and Akkermansia. The role of the microbiota in the early stages of the disease is still very uncertain. Future studies should help to disentangle the role of the microbiome in the pathogenesis of diverticular disease and its progression towards more severe forms.},
}
@article {pmid31492987,
year = {2019},
author = {Sohn, M and Agha, A and Roussos, D and Bloss, F and Hochrein, A and Gundling, F and Iesalnieks, I},
title = {Disease phenotype rather than treatment strategy impacts the long-term quality of life in patients with diverticular disease.},
journal = {International journal of colorectal disease},
volume = {34},
number = {10},
pages = {1749-1756},
pmid = {31492987},
issn = {1432-1262},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticular Diseases/complications/*pathology/*therapy ; Female ; Hospitalization ; Humans ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Phenotype ; Propensity Score ; *Quality of Life ; Surveys and Questionnaires ; Time Factors ; },
abstract = {PURPOSE: To identify the impact of the severity of diverticular disease on long-term quality of life.
METHODS: Consecutive patients, hospitalized between October 2009 and November 2015 due to uncomplicated (UD) and complicated diverticulitis (CD) of the left colon, were analyzed. Patients undergoing emergent surgery for perforated disease were excluded. Primary endpoint was health-related quality of life (HrQol), measured by the Short Form 36 questionnaire (SF-36). Physical (PCS) and mental (MCS) compository scores were calculated from SF-36 subscales. To overcome bias, one-to-one propensity score matching and multivariable logistic regression analysis were performed.
RESULTS: Two hundred eighty of the overall 392 patients (Male 138, Female 142; mean age 60.5 years, range 27-91) answered the SF-36 questionnaire. The median follow-up period was 37.8 months (range 15-85). After propensity score matching, each group consisted of 51 patients. Results of the SF-36 questionnaires showed a statistically significant difference, favoring patients with CD in 5 of 8 domains. Also, PCS (56.3 vs. 52.9, p = 0.13) and MCS (53.3 vs. 46.7, p = 0.005) were higher in patients treated for CD. By a multivariate analysis, complicated disease was independently associated with a better scoring on 6 out of 8 SF-36 subscales and on MCS. Treatment strategy (surgery or conservative) did not have any impact on SF-36 subscales, MCS, or PCS on multivariate analysis.
CONCLUSION: In contrast to complicated disease, the uncomplicated diverticular disease is associated with an impaired long-term quality of life especially in domains composing mental health scores independently of chosen treatment strategy.
STUDY REGISTRATION: The study is registered with the Research Registry at June 19, 2019. Research registry UIN: researchregistry4959 .},
}
@article {pmid31481638,
year = {2019},
author = {Banasiewicz, T and Paszkowski, J and Borejsza-Wysocki, M and Bobkiewicz, A and Pietrzak, A and Szczepkowski, M and Francuzik, W},
title = {Efficacy of combined prophylactic therapy (rifaximine alpha + prebiotic arabinogalactan with lactofferin) on GUT function in patients with diagnosed symptomatic uncomplicated diverticular disease.},
journal = {Polski przeglad chirurgiczny},
volume = {91},
number = {4},
pages = {1-8},
doi = {10.5604/01.3001.0013.4115},
pmid = {31481638},
issn = {2299-2847},
mesh = {Abdominal Pain/*drug therapy/etiology ; Adult ; Child ; Combined Modality Therapy ; *Dietary Supplements ; Diverticular Diseases/*drug therapy ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Gastrointestinal Agents/*therapeutic use ; Gastrointestinal Microbiome ; Humans ; Intestine, Small/metabolism ; Male ; Middle Aged ; Mucoproteins/*therapeutic use ; Plant Proteins/therapeutic use ; Rifaximin/*therapeutic use ; },
}
@article {pmid31474787,
year = {2019},
author = {Mari, A and Baker, FA and Mahamid, M and Yacoob, A and Sbeit, W and Khoury, T},
title = {Clinical utility of fecal calprotectin: potential applications beyond inflammatory bowel disease for the primary care physician.},
journal = {Annals of gastroenterology},
volume = {32},
number = {5},
pages = {425-430},
pmid = {31474787},
issn = {1108-7471},
abstract = {Fecal calprotectin (FC) is an inflammatory marker released mainly from gastrointestinal granulocytes measured in stool samples. FC is noninvasive, economical, simple, and acceptable for patients. Levels of FC have proven reliable for intestinal inflammation, with good clinical sensitivity, and are useful in screening and monitoring inflammatory bowel disease (IBD), as well as in the differential diagnosis between IBD and irritable bowel syndrome (IBS). Given its advantages, FC represents an attractive biomarker that could be utilized in various gastrointestinal (GI) diseases apart from IBD, and is currently being studied extensively by many research groups with significant amounts of data emerging. In this current review we aim to provide an outline of the utility of FC in distinguishing between IBS and IBD, as well as an up-to-date summary of the available clinical experience concerning FC in various common conditions of the GI tract commonly encountered by gastroenterology practitioners, such as IBS, microscopic colitis, acute gastroenteritis, Clostridium difficile infection, colorectal cancer, diverticular disease, coeliac disease, and other GI conditions.},
}
@article {pmid31439460,
year = {2020},
author = {La Torre, M and Mingoli, A and Brachini, G and Lanciotti, S and Casciani, E and Speranza, A and Mastroiacovo, I and Frezza, B and Cirillo, B and Costa, G and Sapienza, P},
title = {Differences between computed tomoghaphy and surgical findings in acute complicated diverticulitis.},
journal = {Asian journal of surgery},
volume = {43},
number = {3},
pages = {476-481},
doi = {10.1016/j.asjsur.2019.07.016},
pmid = {31439460},
issn = {0219-3108},
mesh = {Acute Disease ; Aged ; Digestive System Surgical Procedures ; Diverticulitis, Colonic/classification/*diagnostic imaging/*pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; *Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {BACKGROUND/OBJECTIVE: A preoperative reliable classification system between clinical and computed tomography (CT) findings to better plan surgery in acute complicated diverticulitis (ACD) is lacking. We studied the inter-observer agreement of CT scan data and their concordance with the preoperative clinical findings and the adherence with the intraoperative status using a new classification of diverticular disease (CDD).
METHODS: 152 patients operated on for acute complicated diverticulitis (ACD) were retrospectively enrolled. All patients were studied with CT scan within 24 h before surgery and CT images were blinded reanalyzed by 2 couples of radiologists (A/B). Kappa value evaluated the inter-observer agreement between radiologists and the concordance between CDD, preoperative clinical findings and findings at operation. Univariate and multivariate analysis were used to evaluate the predicting values of CT classification and CDD stage at surgery on postoperative outcomes.
RESULTS: Overall inter-observer agreement for the CDD was high, with a kappa value of 0.905 (95% CI = 0.850-0.960) for observers A and B, while the concordance between radiological and surgical findings was weak (kappa values = 0.213 and 0,248, respectively and 95% CI = 0.106 to 0.319 and 95% CI = 0.142 to 0.355, respectively). When overall morbidity, mortality and the need of a terminal colostomy were considered as main endpoints no concordance was observed between surgical and radiological findings and the CDD (P=NS).
CONCLUSIONS: The need for a more accurate classification of ACD, able to better stage this emergency, and to provide surgeons with reliable information for the best treatment is advocated.},
}
@article {pmid31433257,
year = {2019},
author = {Beltzer, C and Knoerzer, L and Bachmann, R and Axt, S and Dippel, H and Schmidt, R},
title = {Robotic Versus Laparoscopic Sigmoid Resection for Diverticular Disease: A Single-Center Experience of 106 Cases.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {29},
number = {11},
pages = {1451-1455},
doi = {10.1089/lap.2019.0451},
pmid = {31433257},
issn = {1557-9034},
mesh = {Aged ; Anastomotic Leak/etiology ; Colectomy/adverse effects/*methods ; Colon, Sigmoid/surgery ; Conversion to Open Surgery ; Diverticulitis, Colonic/*surgery ; Enterostomy ; Female ; Humans ; Ileus/etiology ; *Laparoscopy/adverse effects ; Male ; Middle Aged ; Operative Time ; Pain, Postoperative/drug therapy/etiology ; Reoperation ; Retrospective Studies ; *Robotic Surgical Procedures/adverse effects ; },
abstract = {Background: Laparoscopic sigmoid resection is the surgical standard for the treatment of diverticulitis. Robotic sigmoid resection with the da Vinci Xi[®] platform may offer advantages over the laparoscopic approach. Materials and Methods: One hundred and six patients with uncomplicated, complicated, or recurrent diverticular disease underwent robotic (n = 60) or laparoscopic (n = 46) sigmoid resection at our institution between 2013 and 2018. Patient demographics and characteristics, perioperative measures, and complications were retrospectively analyzed. Results: There were no statistically significant differences between the robotic and laparoscopic group with regard to operative time (130 versus 118 minutes; P = .23), anastomotic leakage (6.7% versus 6.5%; P = 1.0), need for stoma (6.7% versus 4.3%; P = 1.0), conversion rate (1.7% versus 0%; P = .36), reoperation (8.3% versus 15.2%; P = .27), overall complications according to the Clavien-Dindo classification (30.0% versus 30.4%; P = .8), mortality (1.7% versus 0%; P = 1.0), and need for intravenous analgesics (3.0 versus 2.1 days; P = .21). The duration of postoperative ileus was significantly shorter in the robotic group (2.2 versus 2.8 days; P = .01). Conclusion: Robotic sigmoid resection for uncomplicated, complicated, or recurrent diverticular disease is a safe and feasible procedure. However, robotic sigmoid resection for diverticulitis is not associated with relevant clinical benefits for patients compared to laparoscopic resection except for a slightly shorter duration of postoperative ileus.},
}
@article {pmid31411846,
year = {2019},
author = {Williamson, B},
title = {Lower Gastrointestinal Conditions: Diverticular Disease.},
journal = {FP essentials},
volume = {483},
number = {},
pages = {25-29},
pmid = {31411846},
issn = {2159-3000},
mesh = {Anti-Bacterial Agents ; Colonoscopy ; *Colorectal Neoplasms ; *Diverticulitis ; Humans ; Prevalence ; },
abstract = {Diverticular disease is a spectrum of conditions related to diverticulosis and includes symptomatic uncomplicated diverticular disease, segmental colitis associated with diverticulosis, diverticular bleeding, and diverticulitis. The spectrum of pathology contributes significantly to gastrointestinal comorbidities and increases in prevalence with age. Diverticulosis is associated with low dietary fiber intake, obesity, an inactive lifestyle, and family history. Patients with diverticulitis typically present with left lower quadrant pain and an elevated white blood cell count or C-reactive protein level. The diagnosis is made by clinical examination with or without imaging. Management of diverticulitis includes intravenous fluids and antibiotics, although recent studies have shown that the latter may be avoided in select patients with uncomplicated diverticulitis. The need for hospitalization is determined by patient presentation and complications identified on imaging. Surgery is indicated in patients with frank perforation, unsuccessful conservative management of an abscess, or lack of improvement with conservative therapy. Elective interval colectomy should be considered on an individual basis. Colonoscopy should be performed 4 to 8 weeks after resolution of diverticulitis to exclude colorectal cancer. For secondary prevention, a high-fiber diet and vigorous physical activity are recommended.},
}
@article {pmid31411366,
year = {2019},
author = {De Simone, V and van Baarle, L and Matteoli, G},
title = {Neurite outgrowth in symptomatic uncomplicated diverticular disease.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {31},
number = {9},
pages = {e13680},
doi = {10.1111/nmo.13680},
pmid = {31411366},
issn = {1365-2982},
mesh = {Diverticular Diseases/*diagnosis/metabolism/*physiopathology ; Humans ; Neuronal Outgrowth/*physiology ; Neuropeptides/metabolism ; },
abstract = {Diverticulosis is the presence of small, bulging pouches in the lining of the intestinal colonic mucosal and submucosal layers. This condition is usually asymptomatic. The few patients (25%) that do develop abdominal symptoms are diagnosed with symptomatic uncomplicated diverticular disease (SUDD). Up to now it is not clear which pathophysiological events trigger the transition from asymptomatic diverticulosis to SUDD. However, data from Barbaro and colleagues published in the current issue of Neurogastroenterology and Motility showed extensive axonal sprouting and increased macrophage infiltration in SUDD compared to asymptomatic diverticulosis patients. Thereby they provide more evidence suggesting that enteric neuro-plasticity, whether or not affected by infiltrating macrophages, may underlie the development of symptoms in diverticulosis.},
}
@article {pmid33028724,
year = {2019},
author = {Khuat, D and Julkowska, A and Chamarczuk, F and Flont, A and Horbacka, K},
title = {Chest pain caused by pneumomediastinum as the first symptom of sigmoid perforation - case report.},
journal = {Polski przeglad chirurgiczny},
volume = {92},
number = {5},
pages = {1-5},
doi = {10.5604/01.3001.0013.3425},
pmid = {33028724},
issn = {2299-2847},
mesh = {Abdominal Pain/etiology ; Aged ; Chest Pain/*etiology ; Colonoscopy/*adverse effects ; Female ; Humans ; Intestinal Perforation/*complications/surgery ; Mediastinal Emphysema/*etiology/*surgery ; Pneumothorax/etiology ; Treatment Outcome ; },
abstract = {INTRODUCTION: Chest pain is one of the most common symptoms with which patients report to the doctor. The reason for this is the fear of the sick, who often equate this symptom with dangerous diseases such as heart attack. The primary source of pain does not always have to be located within the chest. Colon perforation is a rare but possible complication of colonoscopy, which may result in free gas entering the mediastinum which is accompanied by chest pain.
CASE REPORT: We present the case of a 78-year-old woman who reported to the hospital emergency department with chest pain, shortness of breath and abdominal pain. On the basis of imaging examinations, perforation of sigmoid affected by diverticulosis, complicated by pneumomediastinum and retroperitoneal emphysema, was suspected. The aforementioned ailments were caused by iatrogenic perforation of the sigmoid during diagnostic colonoscopy performed on an outpatient basis a few hours before reporting to the hospital. The patient was urgently qualified for laparotomy. Intraoperatively, perforation was confirmed at the rectosigmoid junction, which was the cause of retroperitoneal and pneumomediastinum with rightsided emphysema of the lateral neck region. No fluid or intestinal contents were found in the abdomen. The sigmoid colon and upper rectum were resected via double-stapled anastomosis performed between the descending colon and rectum. The patient was discharged home in good condition on the 7th postoperative day.
CONCLUSIONS: Colonoscopy is a diagnostic and therapeutic procedure that is considered relatively safe, but also carries complications such as bleeding or perforation of the large intestine. Diverticular disease is a common condition which most often affects the sigmoid colon. In areas of the weakest resistance, diverticulum formation occurs as a result of increased intra-abdominal pressure, which is an additional risk factor for perforation during colonoscopy. It is important to remember the possible different clinical presentation of gastrointestinal perforation, which may also manifest as chest pain. With early detection and surgical treatment, life-threatening complications associated with the development of pneumothorax can be avoided.},
}
@article {pmid31396759,
year = {2019},
author = {Broad, JB and Wu, Z and Xie, S and Bissett, IP and Connolly, MJ},
title = {Diverticular disease epidemiology: acute hospitalisations are growing fastest in young men.},
journal = {Techniques in coloproctology},
volume = {23},
number = {8},
pages = {713-721},
pmid = {31396759},
issn = {1128-045X},
support = {3709593//Faculty of Medical and Health Sciences, University of Auckland/ ; },
mesh = {Acute Disease/epidemiology ; Adult ; *Age Factors ; Aged ; Aged, 80 and over ; Diverticular Diseases/*epidemiology ; Diverticulitis/*epidemiology ; Female ; Hospitalization/*trends ; Humans ; Incidence ; Male ; Middle Aged ; New Zealand/epidemiology ; Prevalence ; *Sex Factors ; },
abstract = {BACKGROUND: Older age has long been linked to risk of diverticulitis, but the epidemiology is seldom described for a national population. The aim of this study was to investigate age- and gender differences in incidence, temporal trends, lifetime risk and prevalence related to acute diverticulitis hospitalisations in New Zealand.
METHODS: Records of all hospitalisations with diverticulitis the primary diagnosis were obtained from the Ministry of Health for the period 2000-2015. The first acute diverticulitis admission recorded for an individual was taken as an incident event; all others were classified as recurrent. Trends in age- and sex-specific and age-standardised incidence rates are described, and lifetime risk and prevalence estimated.
RESULTS: Over the 16 years from 2000 to 2015, 37,234 acute hospitalisations for diverticulitis were recorded in 28,329 people aged 30 + years (median = 66 years). Rates of incident hospitalisations rose with age, from 5/10,000 person-years at age 50-54 years to 19/10,000py by age 80-84 years. Rates for women were lower than men before age 55 years, but higher thereafter. Age-standardised rates rose 0.2/10,000py annually, but approximately doubled among men aged < 50 years. Lifetime risk was estimated at over 5%, with the prevalence pool rising to over 1.5% of the population aged 30+ in 2030.
CONCLUSIONS: Rapid increases in diverticulitis admissions among young men since 2000 correspond with increases reported elsewhere but remain unexplained; notably young women follow similar trends 5-10 years later. Increasing incidence, combined with population ageing, adds urgency to explain diverticular formation, to understand factors that trigger or provoke their inflammation/infection, and to clarify treatment and (self-)management pathways.},
}
@article {pmid31378319,
year = {2019},
author = {Raña-Garibay, R and Salgado-Nesme, N and Carmona-Sánchez, R and Remes-Troche, JM and Aguilera-Carrera, J and Alonso-Sánchez, L and Arnaud-Carreño, C and Charúa-Guindic, L and Coss-Adame, E and de la Torre-Bravo, A and Espinosa-Medina, D and Esquivel-Ayanegui, F and Jacobo-Karam, JS and Roesch-Dietlen, F and López-Colombo, A and Muñoz-Torres, JI and Noble-Lugo, A and Rojas-Mendoza, F and Suazo-Barahona, J and Stoopen-Rometti, M and Torres-Flores, E and Vallejo-Soto, M and Vergara-Fernández, O},
title = {Erratum to: The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon".},
journal = {Revista de gastroenterologia de Mexico (English)},
volume = {84},
number = {3},
pages = {423-424},
doi = {10.1016/j.rgmx.2019.07.001},
pmid = {31378319},
issn = {2255-534X},
}
@article {pmid31375994,
year = {2020},
author = {Bianchini, M and Palmeri, M and Stefanini, G and Furbetta, N and Di Franco, G},
title = {The role of robotic-assisted surgery for the treatment of diverticular disease.},
journal = {Journal of robotic surgery},
volume = {14},
number = {1},
pages = {239-240},
pmid = {31375994},
issn = {1863-2491},
mesh = {Colectomy ; *Diverticular Diseases ; *Diverticulitis ; Humans ; *Laparoscopy ; Postoperative Complications ; Propensity Score ; *Robotic Surgical Procedures ; },
}
@article {pmid31373562,
year = {2019},
author = {Cwaliński, J and Hermann, J and Banasiewicz, T and Paszlowski, J},
title = {Atypical and Life-threatening Crohn's Disease Following Colectomy: A Case Report.},
journal = {Wound management & prevention},
volume = {65},
number = {7},
pages = {36-40},
pmid = {31373562},
issn = {2640-5245},
mesh = {Colectomy/*adverse effects/methods ; Crohn Disease/*complications ; Female ; Humans ; Intestinal Fistula/etiology/physiopathology ; Middle Aged ; Surgical Wound Infection/etiology/physiopathology ; },
abstract = {UNLABELLED: Although Crohn's Disease (CD) usually occurs between the second and third decade of life, it also may develop in older adults. Treating elderly patients may be challenging due to other comorbidities, including diverticular disease or intestinal ischemia.
PURPOSE: The purpose of this case study was to describe successful treatment of atypical and life-threatening CD due to enterocutaneous fistulas with short-bowel syndrome and multiorgan failure after partial colectomy.
CASE REPORT: After an urgent colectomy for an inflammatory colon tumor, a 64-year-old woman with a history of CD and multiple comorbidities developed acute small bowel ischemia. Following an extended bowel resection, she developed a severe surgical site infection, entero- and gastrocutaneous fistulas, multiorgan failure, and short bowel syndrome. Her care included intensive medical and nutritional treatment as well as negative pressure wound therapy (NPWT) using continuous negative pressure of -80 mm Hg. She not only survived, but she also achieved complete wound closure and restoration of digestive tract continuity and metabolic control. She was discharged with a central venous catheter on total parenteral nutrition.
CONCLUSION: In this case study, a good outcome was observed using intensive medical treatment, nutritional therapy, and conservative surgical treatment that included NPWT for a patient with CD and major comorbidities who developed postoperative complications.},
}
@article {pmid31359166,
year = {2019},
author = {Pulzato, I and Boero, E and Shaipi, E and Cardinale, L},
title = {"Sigmoid diverticulitis mimicking cholecystitis" a clinical challenge.},
journal = {The ultrasound journal},
volume = {11},
number = {1},
pages = {14},
pmid = {31359166},
issn = {2524-8987},
abstract = {Diverticular disease is a common disorder and its incidence increases with ageing. Pathophysiology is multifactorial. Lifestyle, including smoking, alcohol intake, decreased dietary fibres and lack of physical activity, plays a predominant role. Genetics seems also to contribute specifically for right-sided diverticular disease (RSD). The majority of the patients with diverticular disease are asymptomatic. Diverticulitis is the inflammation of the diverticula usually presenting with abdominal pain associated to nausea, vomiting, rectal bleeding, diarrhoea and fever. When the inflammation process affects the diverticula in the ascending colon, the condition represents a clinical challenge as it can be easily misdiagnosed with other acute abdominal emergencies. We reported a case of a 70-year-old female who presented to our Emergency Department (ED) with right upper quadrant pain and an initial clinical suspicion of cholecystitis. Ultrasound (US) and Computed Tomography (CT) demonstrated an anatomical variation of the sigmoid colon diverticulitis. This clinical report demonstrates that ultrasound plays a relevant part as first-step approach to the acute abdominal conditions and its accuracy increases together with other diagnostic tools such as Computer Tomography.},
}
@article {pmid31351939,
year = {2020},
author = {Camilleri, M and Sandler, RS and Peery, AF},
title = {Etiopathogenetic Mechanisms in Diverticular Disease of the Colon.},
journal = {Cellular and molecular gastroenterology and hepatology},
volume = {9},
number = {1},
pages = {15-32},
pmid = {31351939},
issn = {2352-345X},
support = {K23 DK113225/DK/NIDDK NIH HHS/United States ; P30 DK034987/DK/NIDDK NIH HHS/United States ; R01 DK115950/DK/NIDDK NIH HHS/United States ; },
mesh = {Colon/physiopathology ; Diverticulitis, Colonic/epidemiology/*genetics/physiopathology ; *Genetic Predisposition to Disease ; Genome-Wide Association Study ; Humans ; Molecular Epidemiology ; Polymorphism, Single Nucleotide ; },
abstract = {This article reviews epidemiological evidence of heritability and putative mechanisms in diverticular disease, with greatest attention to 3 recent studies of genetic associations with diverticular disease based on genome-wide or whole-genome sequencing studies in large patient cohorts. We provide an analysis of the biological plausibility of the significant associations with gene variants reported and highlight the relevance of ANO1, CPI-17 (aka PPP1R14A), COLQ6, COL6A1, CALCB or CALCA, COL6A1, ARHGAP15, and S100A10 to colonic neuromuscular function and tissue properties that may result in altered compliance and predispose to the development of diverticular disease. Such studies also identify candidate genes for future studies.},
}
@article {pmid31346801,
year = {2019},
author = {Rezapour, M and Stollman, N},
title = {Diverticular Disease in the Elderly.},
journal = {Current gastroenterology reports},
volume = {21},
number = {9},
pages = {46},
pmid = {31346801},
issn = {1534-312X},
mesh = {*Diverticular Diseases/diagnosis/etiology/therapy ; Humans ; },
abstract = {PURPOSE OF REVIEW: While few diseases are limited solely to the elderly, diverticular disease is clearly more prevalent with increasing age and therefore the aim of this review is to focus on the clinical implications of diverticular disease in the elderly.
RECENT FINDINGS: Diverticulitis in the elderly is best managed with an individualized treatment approach including considerations for selective antibiotic usage even in uncomplicated disease. Furthermore, due to the increased prevalence of ischemic colitis in the elderly and the similarities in presentation with diverticular hemorrhage, there needs to be a high index of suspicion and appropriate evaluation for ischemic colitis in patients with hematochezia, particularly if they have abdominal pain. The elderly are a vulnerable population where the index of suspicion for complications of diverticular disease should be high.},
}
@article {pmid31346485,
year = {2019},
author = {Zeidan, Z and Lwin, Z and Iswariah, H and Manawwar, S and Karunairajah, A and Chandrasegaram, MD},
title = {Unusual Presentation of a Sigmoid Mass with Chicken Bone Impaction in the Setting of Metastatic Lung Cancer.},
journal = {Case reports in surgery},
volume = {2019},
number = {},
pages = {1016534},
pmid = {31346485},
issn = {2090-6900},
abstract = {BACKGROUND: Ingestion of foreign bodies can cause various gastrointestinal tract complications including abscess formation, bowel obstruction, fistulae, haemorrhage, and perforation. While these foreign body-related complications can occur in normal bowel, diseased bowel from inflammation, strictures, or malignancy can cause diagnostic difficulties. Endoscopy is useful in visualising the bowel from within, providing views of the mucosa and malignancies arising from here, but its ability in diagnosing extramural malignancies arising beyond or external to the mucosa of the bowel as in the case of metastatic extramural disease can be limited.
CASE SUMMARY: We present the case of a 60-year-old female with an impacted chicken bone in the sigmoid colon with formation of a sigmoid mass, on a background of metastatic lung cancer. On initial diagnosis of her lung cancer, there was mild Positron Emission Tomography (PET) avidity in the sigmoid colon which had been evaluated earlier in the year with a colonoscopy with findings of diverticular disease. Subsequent computed tomography (CT) scans demonstrated thickening of the sigmoid colon with a structure consistent with a foreign body distal to this colonic thickening. A repeat PET scan revealed an intensely fluorodeoxyglucose (FDG) avid mass in the sigmoid colon which was thought to be inflammatory. She was admitted for a flexible sigmoidoscopy and removal of the foreign body which was an impacted chicken bone. She had a fall and suffered a fractured hip. During her admission for her hip fracture, she had an exacerbation of her abdominal pain. She developed a large bowel obstruction, requiring laparotomy and Hartmann's procedure to resect the sigmoid mass. Histopathology confirmed metastatic lung cancer to the sigmoid colon.
CONCLUSION: This unusual presentation highlights the challenges of diagnosing ingested foreign bodies in patients with metastatic disease.},
}
@article {pmid31318769,
year = {2019},
author = {DeLeon, MF and Sapci, I and Akeel, NY and Holubar, SD and Stocchi, L and Hull, TL},
title = {Diverticular Colovaginal Fistulas: What Factors Contribute to Successful Surgical Management?.},
journal = {Diseases of the colon and rectum},
volume = {62},
number = {9},
pages = {1079-1084},
doi = {10.1097/DCR.0000000000001445},
pmid = {31318769},
issn = {1530-0358},
mesh = {Aged ; Colonoscopy/*methods ; Digestive System Surgical Procedures/*methods ; Diverticulum, Colon/*complications/diagnosis ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/diagnosis/etiology/*surgery ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Vaginal Fistula/diagnosis/etiology/*surgery ; },
abstract = {BACKGROUND: Diverticular disease is the leading cause of colovaginal fistulas. Surgery is challenging given the inflammatory process that makes dissection difficult. To date, studies are small and include fistula secondary to multiple etiologies.
OBJECTIVE: The objectives of this study were to examine surgical outcomes of diverticular colovaginal fistulas and to identify variables associated with successful closure.
DESIGN: This was a retrospective study of a prospectively maintained clinical database.
SETTINGS: The study was conducted at a single tertiary referral center.
PATIENTS: Women with diverticular colovaginal fistulas, who underwent surgical repair with intent to close the fistula, were included.
INTERVENTIONS: Repair of colovaginal fistula through minimally invasive or open techniques was involved.
MAIN OUTCOME MEASURES: Successful closure of fistula, defined as resolution of symptoms and no stoma, was measured.
RESULTS: Fifty-two patients underwent surgical treatment of diverticular colovaginal fistula, 23 (44%) of whom underwent a minimally invasive approach (conversion rate of 22%). Ostomy construction and omental pedicle flaps were used in 28 (54%) and 38 patients (73%). Surgery was successful in 47 patients (90%). Accounting for secondary operations, ultimate success and failure rates were 49 (94.0%) and 3 (5.7%). There was no difference in postoperative morbidity between the 2 groups (5 patients with Clavien-Dindo III/IV complications in the success group versus 2 patients in the failure group; 10.6% vs 40.0%; p = 0.44). Failure to achieve fistula closure was not associated with perioperative variables, age, BMI, diabetes mellitus, ASA grade, steroid use, previous abdominal surgery or hysterectomy, use of omentoplasty, or ostomy. Patients who failed were more likely to be smokers (60.0% vs 12.8%; p = 0.03).
LIMITATIONS: Limitations include the retrospective design and lack of power.
CONCLUSIONS: Surgery is effective in achieving successful closure of diverticular colovaginal fistula. Smokers should be encouraged to stop before embarking on an elective repair. Although the use of fecal diversion and omental pedicle flaps did not correlate with success, they should be used when clinically appropriate. See Video Abstract at http://links.lww.com/DCR/A983. FÍSTULAS COLOVAGINALES DIVERTICULARES ¿QUÉ FACTORES CONTRIBUYEN AL ÉXITO DEL TRATAMIENTO QUIRÚRGICO?: La enfermedad diverticular es la causa principal de fístulas colovaginales. La cirugía es un reto dado el proceso inflamatorio que dificulta la disección. Hasta la fecha, los estudios son pequeños e incluyen fístulas secundarias a múltiples etiologías.
OBJETIVO: 1) Examinar los resultados quirúrgicos de las fístulas colovaginales diverticulares; 2) Identificar variables asociadas a un cierre exitoso. DISEÑO:: Estudio retrospectivo de una base de datos clínicos prospectivamente mantenida. CONFIGURACIÓN:: Centro de referencia superior.
PACIENTES: Mujeres con fístulas colovaginales diverticulares, que se sometieron a una reparación quirúrgica con la intención de cerrar la fístula.
INTERVENCIONES: Reparación de la fístula colovaginal mediante técnicas mínimamente invasivas o abiertas.
Cierre exitoso de la fístula definida como resolución de los síntomas y sin estoma.
RESULTADOS: Cincuenta y dos pacientes se sometieron a tratamiento quirúrgico de la fístula colovaginal diverticular, 23 (44%) de los cuales se sometieron a un acceso mínimamente invasivo (tasa de conversión del 22%). La construcción de la ostomía y los pedículos omentales se utilizaron en 28 (54%) y 38 pacientes (73%), respectivamente. La cirugía fue exitosa en 47 pacientes (90%). Tomando en cuenta las operaciones secundarias, las tasas finales de éxito y fracaso fueron 49 (94.0%) y 3 (5.7%). No hubo diferencias en la morbilidad postoperatoria entre los dos grupos (5 pacientes con complicaciones de Clavien-Dindo III / IV en el grupo de éxito versus a 2 pacientes en el grupo de fracaso, 10.6% versus a 40.0%; p = 0.44). El fracaso para lograr el cierre de la fístula no se asoció con variables perioperatorios, edad, IMC, diabetes, grado ASA, uso de esteroides, cirugía abdominal previa o histerectomía, uso de omentoplastia u ostomía. Los pacientes que fracasaron eran más propensos a ser fumadores (60.0% versus a 12.8%; p = 0.03).
LIMITACIONES: Las limitaciones incluyen el diseño retrospectivo y la falta de poder.
CONCLUSIONES: La cirugía es efectiva para lograr el cierre exitoso de la fístula colovaginal diverticular. Se debe aconsejar a los fumadores a parar de fumar antes de embarcarse en una reparación electiva. Mientras el uso de desviación fecal y pedículos omentales no se correlacionó con el éxito, deberían utilizarse cuando sea clínicamente apropiado. Consulte el Video del Resumen en http://links.lww.com/DCR/A983.},
}
@article {pmid31316786,
year = {2019},
author = {Cremon, C and Carabotti, M and Cuomo, R and Pace, F and Andreozzi, P and Barbaro, MR and Annibale, B and Barbara, G},
title = {Italian nationwide survey of pharmacologic treatments in diverticular disease: Results from the REMAD registry.},
journal = {United European gastroenterology journal},
volume = {7},
number = {6},
pages = {815-824},
pmid = {31316786},
issn = {2050-6406},
mesh = {Aged ; Anti-Inflammatory Agents/administration & dosage/adverse effects/*therapeutic use ; Diverticular Diseases/diagnosis/*drug therapy/*epidemiology ; Female ; Health Care Surveys ; Humans ; Italy/epidemiology ; Male ; Middle Aged ; Registries ; Risk Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: Although diverticular disease is a common condition, its effective treatment is challenging in clinical practice.
OBJECTIVE: The objective of this article is to assess pharmacological management in different clinical settings of diverticular disease and factors associated with treatment using the Italian registry Registro Malattia Diverticolare (REMAD).
METHODS: At study enrolment, patients were categorised into subgroups: diverticulosis, symptomatic uncomplicated diverticular disease and previous diverticulitis. We registered demographic, clinical and lifestyle factors, quality of life and the use of treatments for diverticular disease in the last year. Logistic regression analysis assessed the association between clinical factors and treatment consumption.
RESULTS: A total of 500 of the 1206 individuals included had had at least one treatment for diverticular disease in the last year: 23.6% (166/702) of patients with diverticulosis, 55.9% (165/295) of patients with symptomatic diverticular disease, and 80.9% (169/209) of patients with previous diverticulitis (p < 0.001). In multivariate analysis, the following factors were significantly associated with treatment use: female gender, family history of colonic diverticula, organic digestive comorbidity and impaired physical quality of life components.
CONCLUSION: Individuals with diverticular disease take medications based on the different clinical settings of disease. We identified different features associated with treatment use in the distinct clinical entities of diverticular disease.ClinicalTrial.gov Identifier: NCT03325829.},
}
@article {pmid31314796,
year = {2019},
author = {Broad, JB and Wu, Z and Ng, J and Arroll, B and Connolly, MJ and Jaung, R and Oliver, F and Bissett, IP},
title = {Diverticular disease management in primary care: How do estimates from community-dispensed antibiotics inform provision of care?.},
journal = {PloS one},
volume = {14},
number = {7},
pages = {e0219818},
pmid = {31314796},
issn = {1932-6203},
mesh = {Anti-Bacterial Agents/therapeutic use ; Disease Management ; Diverticular Diseases/diagnosis/*epidemiology/etiology/therapy ; Female ; Humans ; Male ; New Zealand/epidemiology ; Population Surveillance ; *Primary Health Care ; },
abstract = {BACKGROUND: The literature regarding diverticular disease of the intestines (DDI) almost entirely concerns hospital-based care; DDI managed in primary care settings is rarely addressed.
AIM: To estimate how often DDI is managed in primary care, using antibiotics dispensing data.
DESIGN AND SETTING: Hospitalisation records of New Zealand residents aged 30+ years during 2007-2016 were individually linked to databases of community-dispensed oral antibiotics.
METHOD: Patients with an index hospital admission 2007-2016 including a DDI diagnosis (ICD-10-AM = K57) were grouped by acute/non-acute hospitalisation. We compared use of guideline-recommended oral antibiotics for the period 2007-2016 for these people with ten individually-matched non-DDI residents, taking the case's index date. Multivariable negative binomial models were used to estimate rates of antibiotic use.
RESULTS: From almost 3.5 million eligible residents, data were extracted for 51,059 index cases (20,880 acute, 30,179 non-acute) and 510,581 matched controls; mean follow-up = 8.9 years. Dispensing rates rose gradually over time among controls, from 47 per 100 person-years (/100py) prior to the index date, to 60/100py after 3 months. In comparison, dispensing was significantly higher for those with DDI: for those with acute DDI, rates were 84/100py prior to the index date, 325/100py near the index date, and 141/100py after 3 months, while for those with non-acute DDI 75/100py, 108/100py and 99/100py respectively. Following an acute DDI admission, community-dispensed antibiotics were dispensed at more than twice the rate of their non-DDI counterparts for years, and were elevated even before the index DDI hospitalisation.
CONCLUSION: DDI patients experience high use of antibiotics. Evidence is needed that covers primary-care and informs self-management of recurrent, chronic or persistent DDI.},
}
@article {pmid31297777,
year = {2019},
author = {Destek, S and Gül, VO},
title = {Effectiveness of conservative approach in right colon diverticulitis.},
journal = {Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES},
volume = {25},
number = {4},
pages = {396-402},
doi = {10.14744/tjtes.2019.47382},
pmid = {31297777},
issn = {1307-7945},
mesh = {Adult ; Aged ; Aged, 80 and over ; Appendectomy ; Cecum/surgery ; Colectomy ; *Conservative Treatment ; Diverticulitis, Colonic/classification/diagnostic imaging/surgery/*therapy ; Drainage ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {BACKGROUND: Approximately 10%-25% of patients with colon diverticular disease experience colonic diverticulitis during their lives. Right-sided diverticulosis is a rare condition in Western countries, but it is common among Asian countries. The aim of this study was to evaluate the clinical and treatment outcomes in our patients with right colon diverticulitis.
METHODS: Demographic and clinical data of 22 patients with a diagnosis of cecum and right-sided colon diverticulitis between 2014 and 2017 were analyzed. The Hinchey staging was applied according to the radiological evaluation and clinical findings. Then, the proportions of demographic and clinical features of the patients according to the Hinchey staging and its statistical significance were evaluated.
RESULTS: Our study included 22 patients who suffered from right colon diverticulitis. The female-to-male ratio was 0.69. A total of 68.1% of the patients were the Hinchey Stage I, and 31.8% were the Hinchey Stage II, all of which were evaluated by tomography. The Hinchey Stage I diverticulitis was mostly found in the right colon (66.7%) and the Hinchey Stage II diverticulitis in the cecum (57.1%). The mean age of the Hinchey Stage II patients was higher (63.6 years) and statistically significant (p<0.05). Two patients had appendectomy, and one had right hemicolectomy. Conservative treatment was applied to other 19 patients. The mean hospitalization time was 3.4 days. Four patients who received conservative treatment at the 2-year follow-up had recurrence. No recurrence was observed in patients receiving surgical treatment.
CONCLUSION: Right colon diverticulitis is usually seen in solitary men aged <50 years from Eastern societies. As a treatment option, conservative methods should be preferred, especially in uncomplicated cases. Surgical treatment is usually used in the treatment of recurrent and complicated cases.},
}
@article {pmid31292420,
year = {2019},
author = {Bonavina, L and Arini, A and Ficano, L and Iannuzziello, D and Pasquale, L and Aragona, SE and Ciprandi, G and On Digestive Disorders, ISG},
title = {Abincol® (Lactobacillus plantarum LP01, Lactobacillus lactis subspecies cremoris LLC02, Lactobacillus delbrueckii LDD01), an oral nutraceutical, pragmatic use in patients with chronic intestinal disorders.},
journal = {Acta bio-medica : Atenei Parmensis},
volume = {90},
number = {7-S},
pages = {8-12},
pmid = {31292420},
issn = {2531-6745},
mesh = {Administration, Oral ; Chronic Disease ; Dietary Supplements ; Diverticular Diseases/*therapy ; Female ; Humans ; Inflammatory Bowel Diseases/*therapy ; Irritable Bowel Syndrome/*therapy ; *Lactobacillus ; *Lactobacillus delbrueckii ; *Lactobacillus plantarum ; Male ; Middle Aged ; Probiotics/*therapeutic use ; Self Report ; },
abstract = {Chronic intestinal disorders (CID), including inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn's disease, irritable bowel syndrome (IBS), and diverticular disease (DD), are diseases that relapse episodes. There is evidence that patients with CID have intestinal dysbiosis, so probiotics may counterbalance the impaired microbiota. Therefore, the current survey evaluated the efficacy and safety of Abincol®, an oral nutraceutical containing a probiotic mixture with Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 millions of living cells), and Lactobacillus delbrueckii LDD01 (200 millions of living cells), in 3,460 outpatients (1,660 males and 1,800 females, mean age 55 years) with chronic intestinal disorders. Patients took 1 stick/daily for 8 weeks. Abincol® significantly diminished the presence and the severity of intestinal symptoms and improved stool form. In conclusion, the current survey suggests that Abincol® may be considered an effective and safe therapeutic option in the management of patients with chronic intestinal disorders.},
}
@article {pmid31286905,
year = {2019},
author = {Dziki, Ł and Włodarczyk, M and Sobolewska-Włodarczyk, A and Mik, M and Trzciński, R and Hill, AG and Dziki, A},
title = {Is suturing of the bladder defect in benign Enterovesical fistula necessary?.},
journal = {BMC surgery},
volume = {19},
number = {1},
pages = {85},
pmid = {31286905},
issn = {1471-2482},
mesh = {Adult ; Aged ; Female ; Humans ; Intestinal Fistula/*etiology ; Male ; Middle Aged ; Retrospective Studies ; Suture Techniques ; Urinary Bladder/*surgery ; Urinary Bladder Fistula/etiology/*surgery ; },
abstract = {BACKGROUND: Enterovesical fistula (EVF) is a abnormal connection between the intestine and the bladder. The aim of the study was to analyze whether closure of the defect in the bladder wall during surgery is always necessary.
METHODS: Fifty-nine patients with benign EVF undergoing surgical treatment were enrolled. A one-stage surgical procedure was performed in all patients. After the separation of the diseased bowel segment, methylene blue was introduced. Through a catheter into the bladder. Only patients with urinary bladder leakage were sutured.
RESULTS: The most common intestinal fistula involving the urinary bladder was colovesical fistula, observed in 53% of cases. Two-thirds of patients had diverticular disease as the underlying pathology. There was no relationship between suturing of the bladder and perioperative complications. Recurrent EVF was observed in one patient with bladder suturing and in two patients without suture.
CONCLUSIONS: These findings suggest that closure of the bladder defect is not necessary in cases where a leak is not demonstrated from the bladder intraoperatively. This study is limited by its retrospective design and small numbers and a randomized controlled trial is recommended to answer this question definitively.},
}
@article {pmid31279270,
year = {2019},
author = {Ogilvie, JW and Saunders, RN and Parker, J and Luchtefeld, MA},
title = {Sigmoidectomy for Diverticulitis-A Propensity-Matched Comparison of Minimally Invasive Approaches.},
journal = {The Journal of surgical research},
volume = {243},
number = {},
pages = {434-439},
doi = {10.1016/j.jss.2019.06.018},
pmid = {31279270},
issn = {1095-8673},
mesh = {Aged ; Colectomy/methods/*statistics & numerical data ; Diverticulosis, Colonic/*surgery ; Female ; Humans ; Laparoscopy/*statistics & numerical data ; Male ; Middle Aged ; Propensity Score ; Retrospective Studies ; Robotic Surgical Procedures/*statistics & numerical data ; Sigmoid Diseases/*surgery ; },
abstract = {BACKGROUND: As the availability and use of robotic surgery increases, current data suggest comparable outcomes to laparoscopic surgery but at an increased cost. Elective sigmoid resection for diverticular disease is the most common colorectal application of robotic surgery and there is limited comparative data specifically for this indication.
METHODS: We identified all elective cases of laparoscopic- and robot-assisted surgery for diverticular disease among a practice of 7 colorectal surgeons within an established enhanced recovery protocol. We performed propensity matching based on surgical indications (recurrent disease, ongoing symptoms, or fistula), stoma creation, and body mass index to create a matched cohort. Our primary outcomes were return of bowel function, length of stay, opioid use, and pain scores during the first 72 h postoperatively. Secondary outcomes were operative room and hospital charges.
RESULTS: From 2011 to 2016, 69 robotic cases were propensity matched from a group of 222 laparoscopic cases to create a 1:1 case ratio that was equivalent in terms of patient demographics and operative indications. Time to first bowel movement was slightly quicker in the robotic group (1 [1] versus 2 [1.5], P = 0.09), while length of stay (3.5 [1.6] versus 3.6 [1.4] d, P = 0.64) was equivalent. Pain scores were lower in the robotic group on day 0 (4.6 versus 6.1, P = 0.0001), but similar on day 1 and day 2 (4.3 versus 4.1, P = 0.62 and 3.8 versus 3.3, P = 0.19). There was no difference in postoperative 72-h opioid use between groups (110.8 MME [144.5] versus 97.4 MME [101.5], P = 0.70). In the robotic arm operating room charges were slightly more ($2835 ± $394 versus $2196 ± $359, P < 0.0001), but total hospital charges were over significantly increased ($41,159 [$7840] versus $25,761 [$11,689], P < 0.0001).
CONCLUSIONS: Via a carefully matched cohort of elective sigmoid resection for diverticular disease at a single community institution, we have demonstrated that laparoscopic- and robotic-assisted surgery result in clinically equivalent return of bowel function, length of stay, postoperative pain, and opioid use.},
}
@article {pmid31266529,
year = {2019},
author = {Pedrazzani, C and Park, SY and Scotton, G and Park, JS and Kim, HJ and Polati, E and Guglielmi, A and Choi, GS},
title = {Analgesic efficacy of preemptive local wound infiltration plus laparoscopic-assisted transversus abdominis plane block versus wound infiltration in patients undergoing laparoscopic colorectal resection: study protocol for a randomized, multicenter, single-blind, noninferiority trial.},
journal = {Trials},
volume = {20},
number = {1},
pages = {391},
pmid = {31266529},
issn = {1745-6215},
mesh = {Abdominal Muscles/*innervation ; Adult ; Aged ; Anesthetics, Local/*administration & dosage/adverse effects ; Colectomy/adverse effects/*methods ; Colorectal Neoplasms/*surgery ; Diverticular Diseases/*surgery ; Equivalence Trials as Topic ; Female ; Humans ; Italy ; *Laparoscopy/adverse effects ; Male ; Middle Aged ; Multicenter Studies as Topic ; Nerve Block/adverse effects/*methods ; Pain Measurement ; Pain, Postoperative/diagnosis/etiology/*prevention & control ; Republic of Korea ; Ropivacaine/*administration & dosage/adverse effects ; Single-Blind Method ; Time Factors ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: Transversus abdominis plane (TAP) block and wound infiltration (WI) are common locoregional anesthesia techniques for pain management in patients undergoing colorectal laparoscopic surgery. Comparative data between these two practices are conflicting, and a clear benefit of TAP block over WI is still debated. The main purpose of this study is to determine the efficacy in pain control of WI compared with WI plus laparoscopic TAP block (L-TAP) in cases of laparoscopic colorectal resection. Secondary aims are to evaluate other short-term results directly related to pain management: the need for rescue analgesic drugs, the incidence of postoperative nausea and vomiting, the resumption of gut functions, and the length of hospital stay.
METHODS/DESIGN: This is a prospective, randomized, controlled, two-arm, multicenter, single-blind study evaluating the efficacy of postoperative analgesic management of WI versus WI plus L-TAP in the context of laparoscopic colorectal surgery. Randomization is at the patient level, and participants are randomized 1:1 to receive either WI alone or WI plus L-TAP. Those eligible for inclusion were patients undergoing laparoscopic resection for colorectal tumor or diverticular disease at the Division of General and Hepatobiliary Surgery, Verona University, Verona, Italy, and at the Colorectal Cancer Center, Kyungpook National University, Daegu, Korea. Fifty-four patients are needed in each group to evidence a difference greater than 1 of 10 according to the numeric rating scale for pain assessment to establish that this difference would matter in practice.
DISCUSSION: The demonstration of a noninferiority of WI compared with WI plus L-TAP block would call into question TAP block usefulness in the setting of laparoscopic colorectal surgery.
TRIAL REGISTRATION: ClinicalTrials.gov, NCT03376048 . Prospectively registered on 15 December 2017.},
}
@article {pmid31250368,
year = {2020},
author = {McKenna, NP and Bews, KA and Cima, RR and Crowson, CS and Habermann, EB},
title = {Development of a Risk Score to Predict Anastomotic Leak After Left-Sided Colectomy: Which Patients Warrant Diversion?.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {24},
number = {1},
pages = {132-143},
pmid = {31250368},
issn = {1873-4626},
support = {KL2 TR002379/TR/NCATS NIH HHS/United States ; UL1 TR002377/TR/NCATS NIH HHS/United States ; UL1 TR002319/TR/NCATS NIH HHS/United States ; },
mesh = {Aged ; Anastomotic Leak/*diagnosis/epidemiology/etiology ; Colectomy/*adverse effects/methods/statistics & numerical data ; Colonic Diseases/*surgery ; Elective Surgical Procedures/adverse effects/statistics & numerical data ; Enterostomy ; Female ; *Health Status Indicators ; Humans ; Male ; Middle Aged ; Prognosis ; Quality Improvement/statistics & numerical data ; Risk Assessment/*methods/statistics & numerical data ; Risk Factors ; },
abstract = {BACKGROUND: Anastomotic leak is a feared complication after left-sided colectomy, but its risk can potentially be reduced with the use of a diverting ostomy. However, an ostomy has its own associated negative sequelae; therefore, it is critical to appropriately identify patients to divert. This is difficult in practice since many risk factors for anastomotic leak exist and outside factors bias this decision. We aimed to develop and validate a risk score to predict an individual's risk of anastomotic leak and aid in the decision.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program Colectomy Targeted PUF was queried from 2012 to 2016 for patients undergoing elective left-sided resection for malignancy, benign neoplasm, or diverticular disease. Multivariable logistic regression identified predictors of anastomotic leak in non-diverted patients, and a risk score was developed and validated.
RESULTS: 38,475 patients underwent resection with an overall anastomotic leak rate of 3%. Independent risk factors for anastomotic leak included younger age, male sex, tobacco use, and omission of combined bowel preparation. A risk score incorporating independent predictors demonstrated excellent calibration. There was strong visual correspondence between predicted and observed anastomotic leak rates. 3960 patients underwent resection with diversion, yet over half of these patients had a predicted leak rate of less than 4%.
CONCLUSION: A novel risk score can be used to stratify patients according to anastomotic leak risk after elective left-sided resection. Intraoperative calculation of scores for patients can help guide surgical decision-making in both diverting the highest risk patients and avoiding diversion in low-risk patients.},
}
@article {pmid31236301,
year = {2019},
author = {Riccardi, M and Deters, K and Jabbar, F},
title = {Sigmoid Diverticulitis and Perforation Secondary to Biliary Stent Migration.},
journal = {Case reports in surgery},
volume = {2019},
number = {},
pages = {2549170},
pmid = {31236301},
issn = {2090-6900},
abstract = {INTRODUCTION: Biliary stent migration occurs in 5-10% of patients. Generally, this is a benign process and stents pass or are retrieved endoscopically. In rare instances, intestinal perforation has occurred.
PRESENTATION OF CASE: A 79-year-old female presented with a one-day history of abdominal pain. She had undergone an ERCP four weeks previously for primary choledocholithiasis during which time a sphincterotomy and sphincteroplasty were performed, and stents were placed in the common bile duct. CT scan of the abdomen and pelvis demonstrated a biliary stent that had migrated into the sigmoid colon, appearing to perforate the colon with free air throughout the abdomen. Patient was taken for diagnostic laparoscopy and noted to have biliary stent perforating the sigmoid colon. Procedure was converted to open, and Hartmann's procedure was performed with end colostomy.
CONCLUSION: Generally, biliary stent migration is a benign process, but in rare instances, intestinal perforation has occurred. Sites of perforation include the duodenum, distal small bowel, and colon. Perforation is more common with an additional pathology present such as hernias or diverticular disease. Migration and perforation also appear more common with straight biliary stents. In patients with known diverticular disease and straight biliary stents, considerations should be made for early stent removal.},
}
@article {pmid31221028,
year = {2019},
author = {Brillantino, A and Andreano, M and Lanza, M and D'Ambrosio, V and Fusco, F and Antropoli, M and Lucia, A and Zito, ES and Forner, A and Ambrosino, F and Monte, G and Cricrì, AM and Robustelli, U and De Masi, A and Calce, R and Ciardiello, G and Renzi, A and Castriconi, M},
title = {Advantages of Damage Control Strategy With Abdominal Negative Pressure and Instillation in Patients With Diffuse Peritonitis From Perforated Diverticular Disease.},
journal = {Surgical innovation},
volume = {26},
number = {6},
pages = {656-661},
doi = {10.1177/1553350619857561},
pmid = {31221028},
issn = {1553-3514},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Digestive System Surgical Procedures/adverse effects/methods/statistics & numerical data ; Diverticulitis/*surgery ; Female ; Humans ; Intestinal Perforation/*surgery ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; *Negative-Pressure Wound Therapy/adverse effects/methods/statistics & numerical data ; Peritonitis/*surgery ; Postoperative Complications ; },
abstract = {Purpose. To evaluate the results of Damage Control Strategy (DCS) in the treatment of generalized peritonitis from perforated diverticular disease in patients with preoperative severe systemic diseases. Methods. All the patients with diffuse peritonitis (Hinchey 3 and 4) and the American Society of Anesthesiologists (ASA) score ≥3 were included and underwent DCS consisting of a 2-step procedure. The first was peritoneal lavage, perforated colon-stapled resection, and temporary abdominal closure with negative pressure wound therapy combined with instillation. The second step, 48 hours later, included the possibility of restoring intestinal continuity basing on local and general patients' conditions. Results. Thirty patients (18 [60%] women and 12 [40%] men, median age 68.5 [range = 35-84] years) were included (18 [60%] ASA III, 11 [36.7%] ASA IV, and 1 [0.03%] ASA V). Seven patients (23.3%) showed sepsis and 1 (3.33%) septic shock. At second surgery, 24 patients (80%) received a colorectal anastomosis and 6 patients (20%) underwent a Hartmann's procedure. Median hospital stay was 18 days (range = 12-62). Postoperative morbidity rate was 23.3% (7/30) and included 1 anastomotic leak treated with Hartmann's procedure. Consequently, at discharge from hospital, 23 patients (76.6%) were free of stoma. Primary fascial closure was possible in all patients. Conclusions. DCS with temporary abdominal closure by negative pressure wound therapy combined with instillation in patients with diffuse peritonitis from complicated diverticulitis could represent a feasible surgical option both in hemodynamically stable and no stable patients, showing encouraging results including a low stoma rate and an acceptable morbidity rate.},
}
@article {pmid31211706,
year = {2019},
author = {Tursi, A},
title = {Endoscopic Diagnosis of Diverticulosis and Diagnosis of Symptomatic Uncomplicated Diverticular Disease of the Colon: If You Properly Classify, You Properly Make the Diagnosis.},
journal = {The American journal of gastroenterology},
volume = {114},
number = {8},
pages = {1349-1350},
doi = {10.14309/ajg.0000000000000293},
pmid = {31211706},
issn = {1572-0241},
mesh = {Colon ; Colonoscopy ; *Diverticular Diseases ; *Diverticulum ; Humans ; Inflammation ; },
}
@article {pmid31209604,
year = {2020},
author = {Dreifuss, NH and Schlottmann, F and Piatti, JM and Bun, ME and Rotholtz, NA},
title = {Safety and feasibility of laparoscopic sigmoid resection without diversion in perforated diverticulitis.},
journal = {Surgical endoscopy},
volume = {34},
number = {3},
pages = {1336-1342},
pmid = {31209604},
issn = {1432-2218},
mesh = {*Colectomy ; Colon, Sigmoid/*surgery ; Diverticulitis/*surgery ; Feasibility Studies ; Humans ; Intestinal Perforation/*surgery ; *Laparoscopy ; Length of Stay/statistics & numerical data ; Postoperative Complications/epidemiology ; Retrospective Studies ; },
abstract = {BACKGROUND: Laparoscopic primary anastomosis (PA) without diversion for diverticulitis has historically been confined to the elective setting. Hartmann's procedure is associated with high morbidity rates that might be reduced with less invasive and one-step approaches. The aim of this study was to analyze the results of laparoscopic PA without diversion in Hinchey III perforated diverticulitis.
METHODS: We performed a retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic sigmoidectomy for diverticular disease during the period 2000-2018. The sample was divided in two groups: elective laparoscopic sigmoid resection for recurrent diverticulitis (G1) and emergent laparoscopic sigmoidectomy for Hinchey III diverticulitis (G2). Demographics, operative variables, and postoperative outcomes were compared between groups.
RESULTS: A total of 415 patients underwent laparoscopic sigmoid resection for diverticular disease. PA without diversion was performed in 351 patients; 278 (79.2%) belonged to G1 (recurrent diverticulitis) and 73 (20.8%) to G2 (perforated diverticulitis). Median age, gender, and BMI score were similar in both groups. Patients with ASA III score were more frequent in G2 (p: 0.02). Conversion rate (G1: 4% vs. G2: 18%, p < 0.001), operative time (G1: 157 min vs. G2: 183 min, p < 0.001), and median length of hospital stay (G1: 3 days vs. G2: 5 days, p < 0.001) were significantly higher in G2. Overall postoperative morbidity (G1: 22.3% vs. G2: 28.7%, p = 0.27) and anastomotic leak rate (G1: 5.7% vs. G2: 5.4%, p = 0.92) were similar between groups. There was no mortality in G1 and one patient (1.3%) died in G2 (p = 0.21).
CONCLUSION: Laparoscopic sigmoid resection without diversion is feasible and safe in patients with perforated diverticulitis. In centers with vast experience in laparoscopic colorectal surgery, patients undergoing this procedure have similar morbidity and mortality to those undergoing elective sigmoidectomy.},
}
@article {pmid31204408,
year = {2019},
author = {Tursi, A},
title = {Current and Evolving Concepts on the Pathogenesis of Diverticular Disease.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {},
pages = {225-235},
doi = {10.15403/jgld-184},
pmid = {31204408},
issn = {1842-1121},
mesh = {Colon/microbiology/physiopathology ; Diverticular Diseases/*etiology/genetics/immunology/physiopathology ; Enteric Nervous System/physiopathology ; Gastrointestinal Microbiome ; Gastrointestinal Motility/physiology ; Genetic Predisposition to Disease ; Humans ; Risk Factors ; },
abstract = {BACKGROUND AND AIMS: Diverticulosis of the colon is the most common anatomic alteration of the human colon, and it is characterized by the out-pouching of the colonic mucosa and submucosa through the muscular layer. Recurrent abdominal pain is experienced by about 20% of patients with diverticulosis, and inflammation of diverticula may lead to acute diverticulitis. In the past few years, several studies have investigated the factors predisposing or triggering diverticular disease (DD) occurrence. Moreover, new physiopathological knowledge has been acquired. The aim of this study was to review current knowledge regarding the pathogenesis of DD.
METHODS: A search of PubMed and EMBASE database was performed to identify articles relevant to the pathogenesis of DD.
RESULTS: Several papers have shown that genetic predisposition, environmental factors, and colonic dysmotility are implicated in the pathogenesis of DD. More recent studies have associated specific host immune responses, gut microbiota imbalance and therefore low-grade inflammation as contributors to symptom occurrence in DD and diverticulitis.
CONCLUSIONS: Current and evolving evidence highlighted the role of genetic susceptibility, environment, colonic motility, visceral sensitivity, immune response, and microbiota in the pathogenesis of this disease. Further studies are required to identify potential targets for medical or surgical decision-making.},
}
@article {pmid31188087,
year = {2021},
author = {Liekens, E and Mutijima Nzaramba, E and Geurde, B and Seydel, B and Jourdan, JL},
title = {Giant colonic diverticulum: case report of a rare surgical condition.},
journal = {Acta chirurgica Belgica},
volume = {121},
number = {1},
pages = {42-45},
doi = {10.1080/00015458.2019.1631627},
pmid = {31188087},
issn = {0001-5458},
mesh = {Aged ; Colectomy ; Colon ; Colon, Sigmoid/surgery ; *Diverticulum, Colon/diagnosis/surgery ; Female ; Humans ; Radiography, Abdominal ; },
abstract = {INTRODUCTION: Diverticular disease is a common disorder of the colon with an extremely rare presentation: giant colonic diverticulum (GCD). GCD is defined as a diverticulum measuring 4 cm or larger and affects the sigmoid colon in 90% of the cases.
PATIENTS: We report on a case of a 74-year-old woman with a GCD.
METHODS: We present a case report of a 74-year-old woman with a GCD. A brief review of the literature concerning clinical presentation, diagnosis, differential diagnosis, pathogenesis, histological classification and treatment of GCD will be discussed.
RESULTS: Our patient was treated according to the available information in the literature. The outcome was uneventful.
CONCLUSIONS: GCD is a rare presentation of diverticular disease. Because of the risk of serious complications, a correct diagnosis and treatment is essential. The investigations of choice include a plain abdominal X-ray and an abdominal CT scan. Surgical treatment is the treatment of choice with preferably a colectomy with en-bloc resection of the diverticulum.},
}
@article {pmid31187871,
year = {2020},
author = {Alaburda, P and Lukosiene, JI and Pauza, AG and Rysevaite-Kyguoliene, K and Kupcinskas, J and Saladzinskas, Z and Tamelis, A and Pauziene, N},
title = {Ultrastructural changes of the human enteric nervous system and interstitial cells of Cajal in diverticular disease.},
journal = {Histology and histopathology},
volume = {35},
number = {2},
pages = {147-157},
pmid = {31187871},
issn = {1699-5848},
support = {SEN-06/2015/PRM15/135//The Research Council of Lithuania/ ; },
mesh = {Adult ; Aged ; Diverticular Diseases/*pathology ; Enteric Nervous System/*pathology/*ultrastructure ; Female ; Humans ; Interstitial Cells of Cajal/*pathology/*ultrastructure ; Male ; Microscopy, Electron, Transmission ; Middle Aged ; },
abstract = {BACKGROUND: In spite of numerous advances in understanding diverticular disease, its pathogenesis remains one of the main problems to be solved. We aimed to investigate the ultrastructural changes of the enteric nervous system in unaffected individuals, in asymptomatic patients with diverticulosis and in patients with diverticular disease.
METHODS: Transmission electron microscopy was used to analyse samples of the myenteric, outer submucosal and inner submucosal plexuses from patients without diverticula (n=9), asymptomatic patients with diverticulosis (n=7) and in patients with complicated diverticular disease (n=9). We described the structure of ganglia, interstitial cells of Cajal and enteric nerves, as well as their relationship with each other. The distribution and size of nerve processes were analysed quantitatively.
RESULTS: In complicated diverticular disease, neurons exhibited larger lipofuscin-like inclusions, their membranous organelles had larger cisterns and the nucleus showed deeper indentations. Nerve remodeling occurred in every plexus, characterised by an increased percentage of swollen and fine neurites. Interstitial cells of Cajal had looser contacts with the surrounding cells and showed cytoplasmic depletion and proliferation of the rough endoplasmic reticulum. In asymptomatic patients with diverticulosis, alterations of enteric nerves and ICC were less pronounced.
CONCLUSIONS: In conclusion, the present findings suggest that most ultrastructural changes of the enteric nervous system occur in complicated diverticular disease. The changes are compatible with damage to the enteric nervous system and reactive remodeling of enteric ganglia, nerves and interstitial cells of Cajal. Disrupted architecture of enteric plexuses might explain clinical and pathophysiological changes associated with diverticular disease.},
}
@article {pmid31175421,
year = {2019},
author = {Croghan, SM and Zaborowski, A and Mohan, HM and Mulvin, D and McGuire, BB and Murphy, M and Galvin, DJ and Lennon, G and Quinlan, D and Winter, DC},
title = {The sentinel stent? A systematic review of the role of prophylactic ureteric stenting prior to colorectal resections.},
journal = {International journal of colorectal disease},
volume = {34},
number = {7},
pages = {1161-1178},
pmid = {31175421},
issn = {1432-1262},
mesh = {Aged ; Catheterization ; Colorectal Neoplasms/economics/*surgery ; Costs and Cost Analysis ; Female ; Humans ; Male ; Middle Aged ; *Stents/economics ; Time Factors ; Treatment Outcome ; Ureter/injuries/*surgery ; },
abstract = {PURPOSE: 'Prophylactic' ureteric stents potentially reduce rates, and facilitate intraoperative recognition, of iatrogenic ureteric injury (IUI) during colorectal resections. A lack of consensus surrounds the risk-benefit equation of this practice, and we aimed to assess the evidence base.
METHODS: A systematic review was performed according to PRISMA guidelines. MEDLINE, Scopus, EMBASE and Cochrane databases were searched using terms 'ureteric/ureteral/JJ/Double J stent' or 'ureteric/ureteral catheter' and 'colorectal/prophylactic/resection/diverticular disease/diverticulitis/iatrogenic injury'. Primary outcomes were rates of ureteric injuries and their intraoperative identification. Secondary outcomes included stent complication rates.
RESULTS: We identified 987 publications; 22 papers met the inclusion criteria. No randomised controlled trials were found. The total number of patients pooled for evaluation was 869,603 (102,370 with ureteric stents/catheters, 767,233 controls). The most frequent indications for prophylactic stents were diverticular disease (45.38%), neoplasia (33.45%) and inflammatory bowel disease (9.37%). Pooled results saw IUI in 1521/102,370 (1.49%) with, and in 1333/767,233 (0.17%) without, prophylactic ureteric stents. Intraoperative recognition of IUIs occurred in 10/16 injuries (62.5%) with prophylactic stents, versus 9/17 (52.94%) without stents (p = 0.579). The most serious complications of prophylactic stent use were ureteric injury (2/1716, 0.12%) and transient ureteric obstruction following stent removal (13/666, 1.95%).
CONCLUSIONS: Placement of prophylactic ureteric stents has a low complication rate. There is insufficient evidence to conclude that stents decrease ureteric injury or increase intraoperative detection of IUIs. Apparently higher rates of IUI in stented patients likely reflect use in higher risk resections. A prospective registry with harmonised data collection points and stratification of intraoperative risk is needed.},
}
@article {pmid31166613,
year = {2019},
author = {Lowes, H and Rowaiye, B and Carr, NJ and Shepherd, NA},
title = {Complicated appendiceal diverticulosis versus low-grade appendiceal mucinous neoplasms: a major diagnostic dilemma.},
journal = {Histopathology},
volume = {75},
number = {4},
pages = {478-485},
doi = {10.1111/his.13931},
pmid = {31166613},
issn = {1365-2559},
mesh = {Adenocarcinoma, Mucinous/*diagnosis/pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendiceal Neoplasms/*diagnosis/pathology ; Appendix/*pathology ; Case-Control Studies ; Diagnosis, Differential ; Diverticulum/*diagnosis/*pathology ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; },
abstract = {AIMS: To research and identify how often complicated diverticular disease of the appendix [appendiceal diverticular disease (ADD)] shows histological mimicry of low-grade appendiceal mucinous neoplasms (LAMNs) and to provide guidance on the useful histopathological features that allow the appropriate diagnosis to be made.
METHODS AND RESULTS: Seventy-four cases of complicated appendiceal diverticular disease were identified from two specialist centres. Of the second opinion/consultation cases, 71% of the ADD cases had been diagnosed by referring pathologists as LAMNs. Salient pathological features were identified and agreed upon to reach the applicable diagnosis. For a diagnosis of complicated diverticulosis, particularly when associated with mucus cysts, the following morphological features were regarded as important: relative retention of the normal mucosal architecture with lamina propria and a maintained crypt architecture, crypts arranged in regular array, epithelial hyperplasia and a lack of nuclear abnormalities extending the length of the crypts. In a formal case-control study undertaken on 30 cases with each diagnosis, ADD and LAMN, loss of lamina propria, a filiform architecture and hypermucinosis were significantly associated with low-grade appendiceal mucinous neoplasms. Mucosal neuromas were significantly associated with diverticular disease of the appendix.
CONCLUSIONS: To our knowledge, this study represents the largest series in the world literature and serves to highlight the important pathological features to distinguish complicated diverticular disease of the appendix from LAMNs, and emphasises the difficulties experienced by diagnostic pathologists in diagnosing complicated appendiceal diverticulosis. This is important, as LAMNs have a significant risk of transcoelomic spread, while complicated appendiceal diverticulosis has no such risk.},
}
@article {pmid31161448,
year = {2020},
author = {Darwich, I and Stephan, D and Klöckner-Lang, M and Scheidt, M and Friedberg, R and Willeke, F},
title = {A roadmap for robotic-assisted sigmoid resection in diverticular disease using a Senhance™ Surgical Robotic System: results and technical aspects.},
journal = {Journal of robotic surgery},
volume = {14},
number = {2},
pages = {297-304},
pmid = {31161448},
issn = {1863-2491},
mesh = {Aged ; Colon, Sigmoid/*surgery ; Digestive System Surgical Procedures/*methods ; Diverticulum, Colon/*surgery ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Robotic Surgical Procedures/*methods ; Time Factors ; Treatment Outcome ; },
abstract = {Since the turn of the century, robotic-assisted colorectal surgery has been synonymous with the da Vinci[®] robotic surgical system. We report in this study our first results in robotic-assisted sigmoid resection for diverticular disease using the Senhance™ Surgical Robotic System, while introducing a standardized roadmap for engaging the robotic arms. 12 patients underwent a sigmoid resection using the Senhance™ Surgical Robotic System. All four arms of the robotic system were engaged during all procedures according to a previously devised roadmap. A 4-trocar technique was used in all patients. Perioperative data, including those regarding technical difficulties, were collected and analyzed. Two procedures were converted into standard laparoscopy. There were no conversions to open surgery. The mean age of the patients was 62.5 years (47-79). One third of the patients were males. The mean BMI was 27 kg/m[2] (19-38). The mean operative time, the mean console time and the mean docking time were 219 min (204-305), 149 min (124-205) and 10 min (6-15), respectively. The mean length of stay was 9 days (6-15). There was one major complication (8.3%, Clavien-Dindo IIIb). There were no mortalities. No other complications were observed. No patients were readmitted after discharge. The Senhance™ Surgical Robotic System can be used safely in sigmoid resection for diverticular disease after adequate training and systematic planning of the different steps of the procedure. Further experience is needed to judge the benefit for patient and surgeon, as well as the cost and time effectiveness.},
}
@article {pmid31157135,
year = {2019},
author = {Eastment, JG and Butler, N and Slater, K},
title = {Diverticular Perforation Secondary to a Chicken Bone: Food for Thought.},
journal = {Cureus},
volume = {11},
number = {3},
pages = {e4273},
pmid = {31157135},
issn = {2168-8184},
abstract = {A 56-year-old man presented to the emergency department with a one-day history of lower abdominal pain and fever. Clinical examination revealed generalized peritonitis. A computed tomography (CT) scan identified a linear hyperdensity straddling the site of a perforated sigmoid diverticulum. The patient proceeded to emergency laparotomy, which confirmed feculent peritonitis secondary to chicken bone perforation through the sigmoid colon diverticulum. After removal of the bone, Hartmann's procedure was performed, and the patient subsequently made an excellent recovery.},
}
@article {pmid31123245,
year = {2019},
author = {Saliba, C and Rabah, H and Nicolas, G and Emmanuel, N and Sleiman, A and Hashem, M and Hussein, R and El Masri, A and Abboud, R and Fawaz, M and Haidar Ahmad, H},
title = {Recurrent Asymptomatic Sigmoid Diverticular Perforation in a Patient with Pemphigus Vulgaris on Immunosuppressive Therapy: A Case Report.},
journal = {The American journal of case reports},
volume = {20},
number = {},
pages = {735-738},
pmid = {31123245},
issn = {1941-5923},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Azathioprine/*therapeutic use ; Diverticulum, Colon/diagnosis/*etiology ; Humans ; Immunosuppressive Agents/*therapeutic use ; Intestinal Perforation/diagnosis/*etiology ; Male ; Middle Aged ; Pemphigus/complications/*drug therapy ; Recurrence ; Sigmoid Diseases/diagnosis/*etiology ; },
abstract = {BACKGROUND Perforation of the colon is associated with high mortality and requires early diagnosis. However, the diagnosis of perforation from atypical causes can be a diagnostic challenge. This report is of a rare case of recurrent sigmoid colonic perforation in a patient with diverticular disease who did not present with an acute abdomen but who had pemphigus vulgaris treated with immunosuppressive therapy. CASE REPORT A 57-year-old man with pemphigus vulgaris was treated with steroids, non-steroidal anti-inflammatory drugs (NSAIDS), and azathioprine. He had episodes of abdominal bloating but denied any other symptoms. He was diagnosed with spontaneous sigmoid diverticular perforation without presenting with an acute abdomen. CONCLUSIONS Diverticular perforation can be asymptomatic in patients on immunosuppressive therapy. Therefore, there should be a high index of suspicion for bowel perforation in patients with abdominal symptoms who are treated for skin diseases, such as pemphigus vulgaris, and are on steroids and other immunosuppressive treatments.},
}
@article {pmid31117071,
year = {2020},
author = {Mari, GM and Crippa, J and Borroni, G and Cocozza, E and Roscio, F and Scandroglio, I and Origi, M and Ferrari, G and Forgione, A and Riggio, V and Pugliese, R and Costanzi, ATM and Maggioni, D and , },
title = {Symptomatic Uncomplicated Diverticular Disease and Incidence of Unexpected Abscess during Sigmoidectomy: A Multicenter Prospective Observational Study.},
journal = {Digestive surgery},
volume = {37},
number = {3},
pages = {199-204},
doi = {10.1159/000500084},
pmid = {31117071},
issn = {1421-9883},
mesh = {Abdominal Abscess/diagnosis/*etiology/surgery/therapy ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Chronic Disease ; Colectomy ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/classification/complications/diagnosis/*therapy ; Elective Surgical Procedures ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Prospective Studies ; Symptom Assessment ; Young Adult ; },
abstract = {BACKGROUND: Symptomatic uncomplicated diverticular disease can affect patients' everyday routine. Considerable efforts have been made to identify clinical features that correlate to the severity of the disease. Unexpected intraoperative abscesses are reported in large retrospective series, showing how uncomplicated symptoms and presentations can underlie a complicated disease. The aim of this study was to investigate the incidence of pericolic or intramural abscess in patients undergoing elective sigmoidectomy for symptomatic uncomplicated diverticular disease and see if chronic symptoms correlate to the presence of an abscess.
METHODS: Between January 2016 and June 2018, we prospectively collected data of patients who were given indication to elective sigmoidectomy for symptomatic uncomplicated diverticular disease. Patients were divided into 3 groups: acute resolving, smoldering, and atypical according to a previously described classification of uncomplicated diverticular disease.
RESULTS: One hundred fifty-eight consecutive patients were enrolled in the study. The median age was 63 years (22- 88), and the mean body mass index was 26 (±7) kg/m2. There were 114 patients in the acute resolving group, 36 in the smoldering group, and 8 in the atypical group. An unexpected abscess was reported in 75 patients (47.5%) during surgery or pathological examination. The incidence of -abscess was greater for patient in the smoldering group (p = 0.0243).
CONCLUSION: Our series of patients affected by symptomatic uncomplicated diverticular disease showed an incidence of unexpected pericolic or intramural abscess of 47.5%. Patients affected by smoldering diverticular disease presented a greater abscess rate.},
}
@article {pmid31105031,
year = {2020},
author = {Aguado, A and García Del Álamo, M},
title = {[Gastrointestinal comorbidity and symptoms associated with depression in patients aged over 60 years].},
journal = {Semergen},
volume = {46},
number = {1},
pages = {27-32},
doi = {10.1016/j.semerg.2019.03.003},
pmid = {31105031},
issn = {1578-8865},
mesh = {Aged ; Aged, 80 and over ; Chronic Disease ; Cross-Sectional Studies ; Depression/*epidemiology ; Female ; Gastrointestinal Diseases/*epidemiology/physiopathology/psychology ; Humans ; Male ; Middle Aged ; Prevalence ; Primary Health Care ; },
abstract = {OBJECTIVE: A study was carried out on the prevalence of gastrointestinal diagnoses and symptoms associated with depression.
MATERIAL AND METHODS: A cross-sectional observational study was conducted in Primary Care in 2017. All patients aged 60 years or more with depression were included from the health care centre (N=2312), and were compared to the total patients that visited the centre from the same age group without depression (N=11049). The variables collected were age, gender and the codes for gastrointestinal symptoms and chronic conditions. These were obtained from the computerised medical files. The prevalence was calculated for both groups, and included the odds ratio (OR) and 95% confidence interval (CI).
RESULTS: More than one-third (38.0%) of patients with depression have chronic gastrointestinal diseases, 64.7% have gastrointestinal symptoms, and 74.7% have either of them. The conditions with strongest associations are: irritable bowel syndrome OR: 2.00 (95% CI: 1.51-2.64), congenital anomaly 1.83 (1.17-2.86), other peptic ulcers 1.75 (1.28-2.40), diverticular disease 1.73 (1.52-1.97), cholecystitis/cholelithiasis 1.59 (1.36-1.86), liver disease 1.55 (1.32-1.82), viral hepatitis 1.50 (1.12-2.02), and oesophageal diseases 1.45 (1.24-1.69). Symptoms with a statistically significant OR were: anorexia 2.81 (1.75-4.50), nausea/vomiting 2.19 (1.79-2.67), constipation 1.96 (1.77-2.18), flatulence 1.78 (1.48-2.14), dysphagia 1,72 (1.30-2.28), abdominal pain 1.69 (1.57-1.82), dyspepsia 1.56 (1.30-1.87), and heartburn 1.55 (1.26-1.92).
CONCLUSIONS: Gastrointestinal comorbidity is very common in patients over 60 years-old with depression. Three-quarters of the patients have chronic gastrointestinal diseases or symptoms. The conditions with strongest associations are irritable bowel syndrome, congenital anomalies, other peptic ulcers, and diverticular disease. The symptoms with strongest associations are anorexia, nausea/vomiting, constipation, flatulence, dysphagia, abdominal pain, dyspepsia, and heartburn.},
}
@article {pmid31094166,
year = {2019},
author = {Parfenov, AI and Krums, LM and Pavlov, MV},
title = {Small intestinal diverticula.},
journal = {Terapevticheskii arkhiv},
volume = {91},
number = {2},
pages = {4-8},
doi = {10.26442/00403660.2019.02.000080},
pmid = {31094166},
issn = {0040-3660},
mesh = {*Diverticulitis ; *Diverticulum ; Gastrointestinal Hemorrhage ; Humans ; *Malabsorption Syndromes ; *Meckel Diverticulum ; },
abstract = {The prevalence of small intestinal diverticula (SID) in the population is 0.5-2.3%, and in most cases they are asymptomatic. In the presence of small intestinal bacterial overgrowth this results in chronic diarrhea and malabsorption. When it is complicated by diverticulitis it causes pain and other symptoms of inflammatory bowel disease. Inflammatory process progression may be accompanied by bleeding, invagination, intestinal obstruction, diverticulum abscess and perforation with peritonitis development. SID include separate nosological forms such as paraphateral diverticulum and Meckel's diverticulum. In diagnosis of SID ray and endoscopic methods are crucial. The basis of small intestine diverticular disease treatment is intestinal antiseptics, antibiotics as well as surgical intervention for severe complications. Two cases are discussed, the first one confirms a possibility of development of severe malabsorption syndrome with chronic diarrhea, and the second one is a complication in a form of severe diverticulitis, abscess with perforation and peritonitis.},
}
@article {pmid31091148,
year = {2019},
author = {Guo, X and Patel, B and Han, L and Al-Dulaimi, H and Van Alstine, WG and Noblet, JN and Chambers, S and Kassab, GS},
title = {Novel swine model of colonic diverticulosis.},
journal = {American journal of physiology. Gastrointestinal and liver physiology},
volume = {317},
number = {1},
pages = {G51-G56},
doi = {10.1152/ajpgi.00408.2018},
pmid = {31091148},
issn = {1522-1547},
mesh = {Animal Feed ; Animal Nutritional Physiological Phenomena ; Animals ; *Collagenases ; Colon/*pathology ; Dietary Fiber/*deficiency ; Disease Models, Animal ; Disease Progression ; Diverticulitis, Colonic/*etiology/pathology ; Female ; Sus scrofa ; Swine ; Time Factors ; },
abstract = {The pathophysiology of colonic diverticulosis has not been completely understood. The development of appropriate animal models is essential to study diverticular disease. To date, no large animal models are available for this disease condition. The objective of this study was to develop a swine model by damaging the colon wall, combined with or without a low-fiber diet to mimic the pathogenesis of diverticulosis. To create a weakness on the colon wall, collagenase was applied in vivo to degrade the collagen in the colon wall. Three groups of Yucatan minipigs were included. Group 1 (n = 12) underwent collagenase injection (CI) with a low-fiber diet for 6 mo, group 2 (n = 8) underwent CI alone with a standard swine diet for 6 mo, and group 3 (n = 12) received a low-fiber diet alone for 6 mo. We found that diverticulosis occurred in 91.7% (11 of 12) of pigs in the CI + diet group and 100% (8 of 8) in CI-alone group. Moreover, around 30-75% of colon CI spots for each pig developed diverticular lesions. Diet alone for 6 mo did not induce diverticulosis. The endoscopic and histological examinations revealed the formation of multiple wide-mouthed diverticular lesions along the descending colon. Our results provide convincing evidence of the high efficacy of the reduced colon wall strength caused by CI in the development of a swine model of diverticulosis. Low-fiber diet consumption for 6 mo had no influence on the generation time or incidence rate of diverticulosis. In this model, digestion of the collagen in the colonic wall is sufficient to cause diverticulosis. NEW & NOTEWORTHY Effective large animal models of diverticulosis are currently lacking for the study of diverticular disease. This study marks the first time that a swine model of diverticulosis was developed by damaging colon wall structure, combined with or without a low-fiber diet. We found that a defect of colon wall could result in colon diverticular lesions within 6 mo in swine. This animal model mimicking the pathological process of diverticulosis is of great clinical value.},
}
@article {pmid31081253,
year = {2020},
author = {Nur, T and Fagan, P and Nugent, T and Kodeda, K},
title = {Giant pneumosalpinx secondary to colonic diverticular disease.},
journal = {ANZ journal of surgery},
volume = {90},
number = {3},
pages = {E61-E62},
doi = {10.1111/ans.15246},
pmid = {31081253},
issn = {1445-2197},
mesh = {Diverticulum, Colon/*complications/*diagnostic imaging/surgery ; Fallopian Tube Diseases/*diagnostic imaging/*etiology/surgery ; Female ; Humans ; Middle Aged ; },
}
@article {pmid31077829,
year = {2020},
author = {Peery, AF and Keil, A and Jicha, K and Galanko, JA and Sandler, RS},
title = {Association of Obesity With Colonic Diverticulosis in Women.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {18},
number = {1},
pages = {107-114.e1},
pmid = {31077829},
issn = {1542-7714},
support = {K23 DK113225/DK/NIDDK NIH HHS/United States ; P30 DK034987/DK/NIDDK NIH HHS/United States ; R01 DK094738/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Anthropometry ; Body Mass Index ; Body Size ; Colonoscopy/methods ; Diverticulosis, Colonic/*diagnosis/etiology ; Female ; Humans ; Male ; Middle Aged ; Obesity/*complications/diagnosis ; Prospective Studies ; Risk Factors ; Sex Factors ; },
abstract = {BACKGROUND & AIMS: Obesity has been associated with an increased risk of colonic diverticulosis. Evidence for this association is limited. We assessed whether anthropometric measures of obesity were associated with colonic diverticulosis.
METHODS: We analyzed data from a prospective study of 623 patients undergoing screening colonoscopies from 2013 through 2015; colonoscopies included examinations for diverticulosis. Body measurements were made the day of the procedure. Multivariate analyses were performed using modified Poisson regression to estimate prevalence ratios (PRs) and 95% CIs while adjusting for confounding variables. All analyses were stratified by sex.
RESULTS: Among men, there was no association between any measure of obesity and diverticulosis. After adjustment, women with an obese body mass index (BMI ≥ 30) had an increased risk of any diverticulosis (PR, 1.48; 95% CI, 1.08-2.04) compared with women with a normal body mass index (BMI 18.5-24.9). The strength of this association was greater for more than 5 diverticula (PR, 2.05; 95% CI, 1.23-3.40). There was no significant association between measures of central obesity and diverticulosis in women. Stratified by sex, colonic diverticulosis was significantly less prevalent in women compared with men before the age of 51 years (29% vs 45%, P = .06). The prevalence of diverticulosis did not differ by sex in older age groups.
CONCLUSIONS: In an analysis of data from 623 patients undergoing screening colonoscopies, we found that obesity (BMI ≥30) significantly increased the risk of colonic diverticulosis in women but not men. Colonic diverticulosis was less prevalent in premenopausal-age women compared with similar-age men. These findings suggest that sex hormones may influence the development of diverticulosis.},
}
@article {pmid31067253,
year = {2019},
author = {Murray, KA and Hoad, CL and Garratt, J and Kaviani, M and Marciani, L and Smith, JK and Siegmund, B and Gowland, PA and Humes, DJ and Spiller, RC},
title = {A pilot study of visceral fat and its association with adipokines, stool calprotectin and symptoms in patients with diverticulosis.},
journal = {PloS one},
volume = {14},
number = {5},
pages = {e0216528},
pmid = {31067253},
issn = {1932-6203},
support = {PDF-2012-05-431/DH_/Department of Health/United Kingdom ; BRU 2011-2022/DH_/Department of Health/United Kingdom ; },
mesh = {Adiponectin/*blood ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; *Body Mass Index ; Diverticulum/epidemiology/metabolism/*pathology ; Feces/*chemistry ; Female ; Humans ; Insulin Resistance ; Intra-Abdominal Fat/*physiopathology ; Leukocyte L1 Antigen Complex/*analysis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pilot Projects ; Young Adult ; },
abstract = {BACKGROUND: Complications of diverticular disease are increasingly common, possibly linked to increasing obesity. Visceral fat could contribute to the development of symptomatic diverticular disease through its pro-inflammatory effects.
OBJECTIVE: The study had 2 aims. A) to develop a semi-automated algorithm to measure abdominal adipose tissue from 2-echo magnetic resonance imaging (MRI) data; B) to use this to determine if visceral fat was associated with bowel symptoms and inflammatory markers in patients with symptomatic and asymptomatic diverticular disease.
DESIGN: An observational study measuring visceral fat using MRI together with serum adiponectin, leptin, stool calprotectin and patient-reported somatisation and bowel habit.
SETTING: Medical and imaging research centres of a university hospital.
PARTICIPANTS: MRI scans were performed on 55 patients after an overnight fast measuring abdominal subcutaneous and visceral adipose tissue volumes together with small bowel water content (SBWC). Blood and stool samples were collected and patients kept a 2 week stool diary and completed a somatisation questionnaire.
MAIN OUTCOME MEASURES: Difference in the volume of visceral fat between symptomatic and asymptomatic patients.
RESULTS: There were no significant differences in visceral (p = 0.98) or subcutaneous adipose (p = 0.60) tissue between symptomatic and asymptomatic patients. However measured fat volumes were associated with serum adipokines. Adiponectin showed an inverse correlation with visceral adipose tissue (VAT) (Spearman ρ = -0.5, p = 0.0003), which correlated negatively with SBWC (ρ = -0.3, p = 0.05). Leptin correlated positively with subcutaneous adipose tissue (ρ = 0.8, p < 0.0001). Overweight patients (BMI > 25 kgm-2) showed a moderate correlation between calprotectin and VAT (ρ = 0.3, p = 0.05). Somatization scores were significantly higher in symptomatic patients (p < 0.0003).
CONCLUSIONS: Increasing visceral fat is associated with lower serum adiponectin and increased faecal calprotectin suggesting a pro-inflammatory effect which may predispose to the development of complications of diverticulosis.},
}
@article {pmid31063252,
year = {2019},
author = {Balla, A and Sosa, V and Licardie, E and Alarcón, I and Morales-Conde, S},
title = {Laparoscopic left hemicolectomy with indocyanine green fluorescence angiography for diverticular disease in a patient with intestinal malrotation - a video vignette.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {21},
number = {8},
pages = {978-979},
doi = {10.1111/codi.14670},
pmid = {31063252},
issn = {1463-1318},
mesh = {Colectomy/*methods ; Coloring Agents ; Digestive System Abnormalities/*complications ; Diverticular Diseases/etiology/*surgery ; Female ; Fluorescein Angiography/*methods ; Humans ; Indocyanine Green ; Intestinal Volvulus/*complications ; Laparoscopy/*methods ; Middle Aged ; },
}
@article {pmid31062152,
year = {2020},
author = {Bastawrous, AL and Landmann, RG and Liu, Y and Liu, E and Cleary, RK},
title = {Incidence, associated risk factors, and impact of conversion to laparotomy in elective minimally invasive sigmoidectomy for diverticular disease.},
journal = {Surgical endoscopy},
volume = {34},
number = {2},
pages = {598-609},
pmid = {31062152},
issn = {1432-2218},
mesh = {Adolescent ; Adult ; Aged ; Colon, Sigmoid/surgery ; Conversion to Open Surgery/*methods ; Diverticular Diseases/*surgery ; Elective Surgical Procedures/*methods ; Female ; Humans ; Incidence ; Laparoscopy/*methods ; Laparotomy/*methods ; Male ; Middle Aged ; Postoperative Complications/*epidemiology ; Propensity Score ; Retrospective Studies ; Risk Factors ; Robotic Surgical Procedures/*methods ; United States/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: Benefits of minimally invasive surgical approaches to diverticular disease are limited by conversion to open surgery. A comprehensive analysis that includes risk factors for conversion may improve patient outcomes.
METHODS: The US Premier Healthcare Database was used to identify patients undergoing primary elective sigmoidectomy for diverticular disease between 2013 and September 2015. Propensity-score matching was used to compare conversion rates for laparoscopic and robotic-assisted sigmoidectomy. Patient, clinical, hospital, and surgeon characteristics associated with conversion were analyzed using multivariable logistic regression, providing odds ratios for comparative risks. Clinical and economic impacts were assessed comparing surgical outcomes in minimally invasive converted, completed, and open cases.
RESULTS: The study population included 13,240 sigmoidectomy patients (8076 laparoscopic, 1301 robotic-assisted, 3863 open). Analysis of propensity-score-matched patients showed higher conversion rates in laparoscopic (13.6%) versus robotic-assisted (8.3%) surgeries (p < 0.001). Greater risk of conversion was associated with patients who were Black compared with Caucasian, were Medicaid-insured versus Commercially insured, had a Charlson Comorbidity Index ≥ 2 versus 0, were obese, had concomitant colon resection, had peritoneal abscess or fistula, or had lysis of adhesions. Significantly lower risk of conversion was associated with robotic-assisted sigmoidectomy (versus laparoscopic, OR 0.58), hand-assisted surgery, higher surgeon volume, and surgeons who were colorectal specialties. Converted cases had longer operating room time, length of stay, and more postoperative complications compared with minimally invasive completed and open cases. Readmission and blood transfusion rates were higher in converted compared with minimally invasive completed cases, and similar to open surgeries. Differences in inflation-adjusted total ($4971), direct ($2760), and overhead ($2212) costs were significantly higher for converted compared with minimally invasive completed cases.
CONCLUSIONS: Conversion from minimally invasive to open sigmoidectomy for diverticular disease results in additional morbidity and healthcare costs. Consideration of modifiable risk factors for conversion may attenuate adverse associated outcomes.},
}
@article {pmid31061646,
year = {2019},
author = {Plasencia, A and Bahna, H},
title = {Diverting Ostomy: For Whom, When, What, Where, and Why.},
journal = {Clinics in colon and rectal surgery},
volume = {32},
number = {3},
pages = {171-175},
pmid = {31061646},
issn = {1531-0043},
abstract = {Fecal diversion is an important tool in the surgical armamentarium. There is much controversy regarding which clinical scenarios warrant diversion. Throughout this article, we have analyzed the most recent literature and discussed the most common applications for the use of a diverting stoma. These include construction of diverting ileostomy or colostomy, ostomy for low colorectal/coloanal anastomosis, inflammatory bowel disease, diverticular disease, and obstructing colorectal cancer. We conclude the following: diverting loop ileostomy is preferred to loop colostomy, an ostomy should be used for a pelvic anastomosis < 5 to 6 cm including coloanal anastomosis and ileo-anal-pouch anastomosis, severe perianal Crohn's disease frequently requires diversion, a primary anastomosis with diverting ileostomy in the setting of diverticular perforation is safe, and a diverting stoma can be used as a bridge to primary resection in the setting of an obstructing malignancy.},
}
@article {pmid31060664,
year = {2019},
author = {Mari, G and Costanzi, A and Crippa, J and Berardi, V and Santurro, L and Gerosa, M and Maggioni, D},
title = {Endoscopic Treatment of Anastomotic Bleeding in Laparoscopic Colorectal Surgery.},
journal = {Chirurgia (Bucharest, Romania : 1990)},
volume = {114},
number = {2},
pages = {295-299},
doi = {10.21614/chirurgia.114.2.295},
pmid = {31060664},
issn = {1221-9118},
mesh = {Adenocarcinoma/surgery ; Aged ; Anastomosis, Surgical/*adverse effects ; Colonoscopy/*methods ; Diverticulum, Colon/surgery ; Endometriosis/surgery ; Epinephrine/administration & dosage ; Female ; Humans ; Laparoscopy ; Male ; Postoperative Hemorrhage/etiology/*therapy ; Proctectomy/*adverse effects/methods ; Rectal Diseases/*surgery ; Rectal Neoplasms/surgery ; Surgical Stapling/*adverse effects ; Therapeutic Irrigation ; Treatment Outcome ; Vasoconstrictor Agents/administration & dosage ; },
abstract = {Bleeding from the stapled line is a rare but potentially lethal complication that requires a proper and immediate management. Treatment for stapled anastomotic hemorrhage may be operative or conservative. We report three cases of anastomotic stapled line bleeding after colorectal surgery successfully treated endos-copically. Laparoscopic High Anterior Resection with a trans anal anastomosis according to Knight-Griffen with circular a stapler was performed for adenocarcinoma, rectal endometriosis and diverticular disease. All three patients had major rectal bleeding within 24 hours from surgery. 1 patients had endoscopy before the end of the surgical procedure. Endoscopic wash out with removal of the clots and infiltration of the bleeding sites along the stapled line with Adrenaline 1 : 10000 (2 ml) was performed achieving a good hemostasis. Early endoscopy is a safe and efficient treatment in colorectal anastomotic bleeding.},
}
@article {pmid31056430,
year = {2019},
author = {Scroggie, DL},
title = {Dubious answers to unimportant questions in the treatment of perforated diverticular disease.},
journal = {The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland},
volume = {17},
number = {5},
pages = {319},
doi = {10.1016/j.surge.2019.03.007},
pmid = {31056430},
issn = {1479-666X},
mesh = {*Diverticular Diseases ; *Diverticulitis ; Humans ; *Laparoscopy ; Therapeutic Irrigation ; },
}
@article {pmid31037341,
year = {2020},
author = {Aune, D and Sen, A and Norat, T and Riboli, E},
title = {Dietary fibre intake and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies.},
journal = {European journal of nutrition},
volume = {59},
number = {2},
pages = {421-432},
pmid = {31037341},
issn = {1436-6215},
mesh = {Dietary Fiber/*administration & dosage ; Diverticular Diseases/*prevention & control ; Humans ; Prospective Studies ; Risk Assessment ; },
abstract = {BACKGROUND: A high intake of dietary fibre has been associated with a reduced risk of diverticular disease in several studies; however, the dose-response relationship between fibre intake and diverticular disease risk has varied, and the available studies have not been summarised in a meta-analysis. We conducted a systematic review and meta-analysis of prospective cohort studies to clarify the association between dietary fibre intake, fibre subtypes, and the risk of diverticular disease.
METHODS: PubMed and Embase databases were searched up to August 9th 2018. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model and nonlinear associations were modelled using fractional polynomial models.
RESULTS: Five prospective cohort studies with 19,282 cases and 865,829 participants were included in the analysis of dietary fibre and diverticular disease risk. The summary RR was 0.74 (95% CI 0.71-0.78, I[2] = 0%) per 10 g/day. There was no evidence of a nonlinear association between dietary fibre intake and diverticular disease risk, pnonlinearity = 0.35, and there was a 23%, 41% and 58% reduction in risk for an intake of 20, 30, and 40 g/day, respectively, compared to 7.5 g/day. There was no evidence of publication bias with Egger's test, p = 0.58 and the association persisted in subgroup and sensitivity analyses. The summary RR per 10 g/day was 0.74 (95% CI 0.67-0.81, I[2] = 60%, n = 4) for cereal fibre, 0.56 (95% CI 0.37-0.84, I[2] = 73%, n = 2) for fruit fibre, and 0.80 (95% CI 0.45-1.44, I[2] = 87%, n = 2) for vegetable fibre.
CONCLUSIONS: These results suggest that a high fibre intake may reduce the risk of diverticular disease and individuals consuming 30 g of fibre per day have a 41% reduction in risk compared to persons with a low fibre intake. Further studies are needed on fibre types and risk of diverticular disease and diverticulitis.},
}
@article {pmid31035942,
year = {2019},
author = {Bundgaard-Nielsen, C and Baandrup, UT and Nielsen, LP and Sørensen, S},
title = {The presence of bacteria varies between colorectal adenocarcinomas, precursor lesions and non-malignant tissue.},
journal = {BMC cancer},
volume = {19},
number = {1},
pages = {399},
pmid = {31035942},
issn = {1471-2407},
mesh = {Adult ; Aged ; Aged, 80 and over ; Bacteria/classification/genetics/*growth & development ; Carcinogenesis/genetics ; Colon/*microbiology ; Colorectal Neoplasms/*microbiology/pathology ; Diverticular Diseases/*microbiology/pathology ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; RNA, Ribosomal, 16S/genetics ; Rectum/*microbiology ; },
abstract = {BACKGROUND: A causal association has been suggested between certain bacteria and colorectal cancer (CRC). Only a few studies have, however, investigated the presence of these bacteria directly in colon tissue with conflicting results. It is thus uncertain which role they may have in prognosis and carcinogenesis of CRC.
METHODS: Formalin-fixed and paraffin-embedded (FFPE) colorectal tissue samples from patients diagnosed with colorectal cancer (CRC)(tumor and paired normal tissue, n = 99), adenomas (n = 96), or diverticular disease (n = 104) were tested for the presence and bacterial load of Streptococcus gallolyticus (S. gallolyticus), Fusobacterium nucleatum (F. nucleatum), and Bacteroides fragilis (B. fragilis) using quantitative PCR. A subsequent broader search was conducted on a subset of samples using 16S ribosomal RNA gene sequencing. Finally, to evaluate the prognostic value, the bacterial status was compared to patient outcome.
RESULTS: S. gallolyticus was not detected by qPCR in any of the investigated tissue samples and F. nucleatum and B. fragilis were found to be equally distributed in tumors, paired normal tissue, and diverticula, but significantly less present in adenomas compared to both tumors and diverticula. Neither, F. nucleatum nor B. fragilis status affected the five-year prognosis of the patients. The 16S rRNA gene sequencing data revealed that tumors were associated with the Prevotella genus while conversely adenomas and diverticula were associated with Acinetobacter genus.
CONCLUSION: These findings do not support a role of F. nucleatum or B. fragilis during colorectal beginning, while S. gallolyticus was not implicated in the colorectal tissue of a Danish population. A potential role of the bacterial genera Prevotella and Acinetobacter was indicated, and requires further investigations.},
}
@article {pmid31032559,
year = {2019},
author = {Horesh, N and Klein, Y and Gutman, M},
title = {[ACUTE DIVERTICULAR DISEASE - IS IT STILL A "SURGICAL" CONDITION?].},
journal = {Harefuah},
volume = {158},
number = {4},
pages = {253-257},
pmid = {31032559},
issn = {0017-7768},
mesh = {Acute Disease ; *Diverticular Diseases/surgery ; *Diverticulitis/surgery ; Humans ; Israel ; },
abstract = {The therapeutic approach to diverticular disease has changed significantly in recent decades. From a disease treated almost exclusively by surgery, diverticulitis is nowadays treated operatively in specific indications, shifting the majority of patients towards an outpatient based treatment. Significant changes occurred not only in uncomplicated diverticular disease but also in complicated cases, treated in the past with emergency surgery. These changes have been studied relentlessly around the world, and despite the fact that the vast majority of patients presenting with acute diverticular disease are not treated with surgery, it is still considered a surgical condition. In this review article, we set out to examine whether there is still justification to consider acute diverticulitis as a surgical disease and in addition, to examine whether the changes in treatment seen around the world are compatible with the current treatment strategies implemented in Israel.},
}
@article {pmid31022679,
year = {2019},
author = {Goldwag, JL and Lyn, RV and Wilson, LR and Wilson, MZ and Ivatury, SJ},
title = {Effect of Elective Sigmoidectomy for Diverticulitis on Bowel Function Patient-Reported Outcomes.},
journal = {The Journal of surgical research},
volume = {241},
number = {},
pages = {135-140},
doi = {10.1016/j.jss.2019.03.041},
pmid = {31022679},
issn = {1095-8673},
mesh = {Aged ; Colectomy/adverse effects/*methods ; Colon, Sigmoid/physiopathology/surgery ; Diverticulitis, Colonic/physiopathology/*surgery ; Elective Surgical Procedures/adverse effects/*methods ; Female ; Humans ; Ileostomy/adverse effects/*methods ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; *Patient Reported Outcome Measures ; Patient Satisfaction/statistics & numerical data ; Postoperative Period ; Retrospective Studies ; Sigmoid Diseases/*surgery ; Treatment Outcome ; },
abstract = {INTRODUCTION: Diverticular disease is common worldwide. A subset of these patients will choose to undergo elective surgical resection because of symptoms or complicated disease. The aim of this study was to evaluate changes in bowel function after elective sigmoid resection for diverticular disease.
MATERIALS AND METHODS: We retrospectively reviewed patients seen at our institution from May 2015 to July 2018 who underwent elective sigmoid resection for diverticular disease. We used the Colorectal Functional Outcome (COREFO) questionnaire, a validated questionnaire that assesses bowel function in five domains and a global function score (scores 0-100, with higher score indicating worse function). We obtained questionnaire data at baseline, as well as at postoperative follow-up, and a paired t-test was used to compare.
RESULTS: Forty-nine patients met criteria for inclusion in this study. The median time between questionnaire completion was 70 days (interquartile range: 56 to 85). The mean age was 60 ± 12 years, with 57% female patients. Thirty-six (73%) patients underwent sigmoidectomy alone and 13 (27%) underwent sigmoidectomy with fistula repair. Six patients (12%) had a diverting loop ileostomy in addition to sigmoidectomy and underwent a subsequent reversal. Overall, there were no differences in any of the five domains or the total Colorectal Functional Outcome score from baseline to postintervention.
CONCLUSIONS: In our cohort, bowel function did not significantly change in the early postoperative period after elective sigmoid resection for diverticular disease. Surgeons should counsel patients, especially symptomatic ones, that bowel function will likely be no different at time of postoperative follow-up.},
}
@article {pmid31019703,
year = {2019},
author = {Cossais, F and Lange, C and Barrenschee, M and Möding, M and Ebsen, M and Vogel, I and Böttner, M and Wedel, T},
title = {Altered enteric expression of the homeobox transcription factor Phox2b in patients with diverticular disease.},
journal = {United European gastroenterology journal},
volume = {7},
number = {3},
pages = {349-357},
pmid = {31019703},
issn = {2050-6406},
mesh = {Aged ; Colon/metabolism/pathology ; Diverticular Diseases/*metabolism ; Dopaminergic Neurons/metabolism ; Enteric Nervous System/*metabolism/pathology ; Female ; Gene Expression ; Homeodomain Proteins/*genetics/*metabolism ; Humans ; Intestinal Pseudo-Obstruction/metabolism ; Male ; Neuroglia/metabolism ; Proto-Oncogene Proteins c-ret/metabolism ; RNA, Messenger/genetics ; Retrospective Studies ; S100 Calcium Binding Protein beta Subunit/metabolism ; Transcription Factors/*genetics/*metabolism ; Tyrosine 3-Monooxygenase/metabolism ; },
abstract = {BACKGROUND: Diverticular disease, a major gastrointestinal disorder, is associated with modifications of the enteric nervous system, encompassing alterations of neurochemical coding and of the tyrosine receptor kinase Ret/GDNF pathway. However, molecular factors underlying these changes remain to be determined.
OBJECTIVES: We aimed to characterise the expression of Phox2b, an essential regulator of Ret and of neuronal subtype development, in the adult human enteric nervous system, and to evaluate its potential involvement in acute diverticulitis.
METHODS: Site-specific gene expression of Phox2b in the adult colon was analysed by quantitative polymerase chain reaction. Colonic specimens of adult controls and patients with diverticulitis were subjected to quantitative polymerase chain reaction for Phox2b and dual-label immunochemistry for Phox2b and the neuronal markers RET and tyrosine hydroxylase or the glial marker S100β.
RESULTS: The results indicate that Phox2b is physiologically expressed in myenteric neuronal and glial subpopulations in the adult enteric nervous system. Messenger RNA expression of Phox2b was increased in patients with diverticulitis and both neuronal, and glial protein expression of Phox2b were altered in these patients.
CONCLUSIONS: Alterations of Phox2b expression may contribute to the enteric neuropathy observed in diverticular disease. Future studies are required to characterise the functions of Phox2b in the adult enteric nervous system and to determine its potential as a therapeutic target in gastrointestinal disorders.},
}
@article {pmid31014749,
year = {2019},
author = {Raña-Garibay, R and Salgado-Nesme, N and Carmona-Sánchez, R and Remes-Troche, JM and Aguilera-Carrera, J and Alonso-Sánchez, L and Arnaud-Carreño, C and Charúa-Guindic, L and Coss-Adame, E and de la Torre-Bravo, A and Espinosa-Medina, D and Esquivel-Ayanegui, F and Roesch-Dietlen, F and López-Colombo, A and Muñoz-Torres, JI and Noble-Lugo, A and Rojas-Mendoza, F and Suazo-Barahona, J and Stoopen-Rometti, M and Torres-Flores, E and Vallejo-Soto, M and Vergara-Fernández, O},
title = {The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon.},
journal = {Revista de gastroenterologia de Mexico (English)},
volume = {84},
number = {2},
pages = {220-240},
doi = {10.1016/j.rgmx.2019.01.002},
pmid = {31014749},
issn = {2255-534X},
mesh = {Colonic Diseases/*therapy ; Consensus ; Delphi Technique ; Diverticular Diseases/*therapy ; Diverticulitis/therapy ; Guidelines as Topic ; Humans ; Mexico ; },
abstract = {Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.},
}
@article {pmid31012495,
year = {2019},
author = {Sköldberg, F and Granlund, J and Discacciati, A and Hjern, F and Schmidt, PT and Olén, O},
title = {Incidence and lifetime risk of hospitalization and surgery for diverticular disease.},
journal = {The British journal of surgery},
volume = {106},
number = {7},
pages = {930-939},
doi = {10.1002/bjs.11143},
pmid = {31012495},
issn = {1365-2168},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Diverticulitis, Colonic/*epidemiology/*surgery ; Female ; Hospitalization/*statistics & numerical data ; Humans ; Incidence ; Infant ; Infant, Newborn ; Information Storage and Retrieval ; Male ; Middle Aged ; Registries ; Risk ; Sweden/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: Studies on incidence rates of first-time colonic diverticular disease are few, and population-based estimates of lifetime risk are lacking. In this observational study, the incidence, admission rates and lifetime risks of hospitalization and surgery for diverticular disease were investigated.
METHODS: Considering the entire Swedish population as an open cohort, incidence and admission rates, and lifetime risk estimates (considering death as a competing risk) of hospitalization and surgery for diverticular disease were calculated using data from cross-linked national registers and population statistics from 1987 to 2010.
RESULTS: In total, there were 144 107 hospital admissions for diverticular disease in 95 049 individual patients. Of these, 17 599 were admissions with bowel resection or stoma formation in 16 824 patients. The total number of person-years in the population during the study period was 213 949 897. Age-standardized incidence rates were 47·4 (95 per cent c.i. 47·1 to 47·7) for first-time hospitalization with diverticular disease and 8·4 (8·2 to 8·5) per 100 000 person-years for diverticular disease surgery. The corresponding admission rates (including readmissions) were 70·8 (70·4 to 71·2) and 8·7 (8·6 to 8·9) per 100 000 person-years. Following an increase in 1990-1994, rates stabilized. Based on incidence and mortality rates from 2000 to 2010, the estimated remaining lifetime risk of hospitalization from 30 years of age was 3·1 per cent in men and 5·0 per cent in women. The corresponding risk of surgery was 0·5 per cent in men and 0·8 per cent in women.
CONCLUSION: Diverticular disease is a common reason for hospital admission, particularly in women, but rates are stable and the lifetime risk of surgery is low.},
}
@article {pmid31001067,
year = {2019},
author = {Tursi, A and Elisei, W},
title = {Role of Inflammation in the Pathogenesis of Diverticular Disease.},
journal = {Mediators of inflammation},
volume = {2019},
number = {},
pages = {8328490},
pmid = {31001067},
issn = {1466-1861},
mesh = {Animals ; Diverticular Diseases/etiology/*immunology/*metabolism ; Humans ; Inflammation/complications/*immunology/*metabolism ; },
abstract = {Diverticulosis of the colon is the most common condition in Western societies and it is the most common anatomic alteration of the human colon. Recurrent abdominal pain is experienced by about 20% of patients with diverticulosis, but the pathophysiologic mechanisms of its occurrence are not completely understood. In the last years, several fine papers have showed clearly the role of low-grade inflammation both in the occurrence of symptoms in people having diverticulosis, both in symptom persistence following acute diverticulitis, even if the evidence available is not so strong. We do not know yet what the trigger of this low-grade inflammation occurrence is. However, some preliminary evidence found colonic dysbiosis linked to low-grade inflammation and therefore to symptom occurrence in those patients. The aim of this paper is to summarize current evidences about the role of inflammation in symptom occurrence in symptomatic uncomplicated diverticular disease and in symptom persistence after an episode of acute diverticulitis.},
}
@article {pmid30993858,
year = {2019},
author = {de Groof, EJ and Bruggeman, AE and Buskens, CJ and Tanis, PJ and Bemelman, WA},
title = {Selective use of cystogram following segmental bowel resection in patients with enterovesical fistula.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {21},
number = {9},
pages = {1045-1050},
doi = {10.1111/codi.14652},
pmid = {30993858},
issn = {1463-1318},
mesh = {*Cystography ; *Digestive System Surgical Procedures ; Drainage ; Female ; Humans ; Intestinal Fistula/*diagnostic imaging/*surgery ; Male ; Middle Aged ; Postoperative Complications/*diagnostic imaging/*surgery ; Recurrence ; Retrospective Studies ; Urinary Bladder Fistula/*diagnostic imaging ; },
abstract = {AIM: Patients undergoing resectional surgery for enterovesical fistulas generally have an indwelling urinary catheter postoperatively to prevent a recurrent fistula. The aim of this study was to assess the role of a cystogram as part of the postoperative follow-up of such surgery, when it should be performed and for how long the bladder should be drained after surgery.
METHOD: A retrospective single-centre study of all patients undergoing ileocaecal or sigmoid resection for surgery for enterovesical fistula with the primary end-point of recurrent urinary fistula.
RESULTS: Between 1994 and 2015, 46 patients (23 male; mean age 55.4 ± 18.3 years) underwent surgery [23 (50%) for diverticular disease, 16 (34.8%) for Crohn's disease, five (10.9%) for malignancy and two (4.3%) for previous radiotherapy]. Closure of the bladder fistula was by simple suture in 21 (46%) patients and with an omental pedicle in 16 (36%). Overall median duration of urinary drainage was 10.5 [interquartile range (IQR): 7.3-14.0] days. A postoperative cystogram was performed in 26 (57%) patients after a median of 10.0 (IQR: 8.0-13.0) days. This demonstrated persistent leakage in three patients, of whom two had undergone surgical closure of the bladder. This group required prolonged drainage (7, 19 and 40 days). One patient who had undergone surgery following radiotherapy for urothelial cancer developed a recurrent malignant fistula at 9 months, even though the postoperative cystogram had been negative.
CONCLUSION: This study suggests that a routine postoperative cystogram after surgery for enterovesical fistula may not be necessary for all patients if the bladder is drained for 1-2 weeks after bowel resection.},
}
@article {pmid30990362,
year = {2019},
author = {Davalos, G and Lan, BY and Diaz, R and Welsh, LK and Roldan, E and Portenier, D and Guerron, AD},
title = {Single-Center Experience with Magnetic Retraction in Colorectal Surgery.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {29},
number = {8},
pages = {1033-1037},
doi = {10.1089/lap.2018.0744},
pmid = {30990362},
issn = {1557-9034},
mesh = {Adenocarcinoma/*surgery ; Adult ; Aged ; Aged, 80 and over ; Colectomy/*instrumentation ; Colon, Sigmoid/*surgery ; Colorectal Neoplasms/*surgery ; Female ; Humans ; Intraoperative Complications ; Laparoscopy/*instrumentation ; *Magnetics ; Male ; Middle Aged ; Postoperative Complications ; Risk ; *Surgical Instruments ; Treatment Outcome ; },
abstract = {Background: Appropriate tissue retraction is essential in laparoscopic surgery, and colorectal operations often require an additional incision and trocar that can disturb visualization and maneuverability. Each incision carries an increased risk for complications as well as increased pain and cosmetic issues. Magnetic devices have been developed for a less invasive retraction. The objective of this study is to report our initial experience using magnet retraction. Methods: Ten consecutive patients who underwent laparoscopic colorectal procedures by a single surgeon using a magnetic retractor (Levita Magnetics[®] Surgical System, San Mateo, CA) between October 2017 and June 2018 at Duke Regional Hospital in Durham, NC, were included. Results: The cases included four single-port right colectomies, one sigmoidectomy, and five rectopexies. Nine cases were completed laparoscopically, as one right colectomy required conversion due to adhesions and bulky specimen. Indications included adenocarcinoma, diverticular disease, and rectal prolapse. The magnet was successfully used for uterus, colon, or colonic pedicle retraction. No intraoperative or 30-day complications were observed. Conclusion: Magnetic surgical retractors are a safe, dynamic, and incision-less option for surgical field exposure during laparoscopic colorectal surgery. Reduced trocars decrease tissue trauma, enhances maneuverability, and potentially improves outcomes; however, further studies are required.},
}
@article {pmid30976892,
year = {2019},
author = {Schwenk, W},
title = {[Endoscopy, angiography, surgery: diagnostic and therapeutic algorithms for diverticular bleeding].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {90},
number = {8},
pages = {621-630},
pmid = {30976892},
issn = {1433-0385},
mesh = {Algorithms ; *Angiography ; Colectomy ; Colonoscopy ; *Diverticulum/complications ; *Gastrointestinal Hemorrhage/diagnosis/surgery ; Humans ; },
abstract = {Diverticular bleeding is a complication of diverticular disease but in contrast to diverticulitis, publications concerning diverticular bleeding are less common. Diverticular bleeding is the cause of approximately 20-50% of cases of lower gastrointestinal bleeding and in rare cases can be life-threatening. The main symptom of diverticular hemorrhage is painless hematochezia and the German guidelines recommend that further diagnostics of suspected diverticular bleeding should be performed in hospital. Interdisciplinary diagnostic and therapeutic algorithms recommend primary endoscopy in acute as well as chronic recurrent diverticular bleeding. If endoscopy fails to provide an exact localization of the origin of bleeding, angiography or computed tomography (CT) angiography can be performed. The [99m]Tc erythrocyte scintigraphy should only be performed if endoscopy and angiography are unable to identify the localization of the bleeding source. More than 90% of diverticular hemorrhages stop spontaneously; however, it is general agreed that an active diverticular bleeding detected during colonoscopy should be immediately treated endoscopically. Alternative radiological techniques for hemostasis are rarely needed and attention must be paid to the complications. In the rare case of severe bleeding that cannot otherwise be stopped or if the bleeding vessel cannot be located, laparotomy and total colectomy can be recommended. If the diverticular bleeding has definitely been identified or recurrent bleeding causes chronic anemia, segmental or total colectomy may be undertaken; however, the advantages and disadvantages of both types of surgery have to be thoroughly explained to the patient.},
}
@article {pmid30976578,
year = {2019},
author = {Wetterhall, C and Mariusdottir, E and Hall, C and Jörgren, F and Buchwald, P},
title = {Low Incidence of Pelvic Sepsis after Hartmann's Procedure: Radiation Therapy May Be a Risk Factor.},
journal = {Gastrointestinal tumors},
volume = {5},
number = {3-4},
pages = {77-81},
pmid = {30976578},
issn = {2296-3774},
abstract = {PURPOSE: Hartmann's procedure is a well-established alternative in colorectal surgery when a primary anastomosis is contraindicated. However, the rectal remnant may cause complications. This study was designed to investigate the occurrence of pelvic sepsis after Hartmann's procedure and identify possible risk factors.
METHODS: All patients who underwent Hartmann's procedure between 2005 and 2012 were identified by the in-hospital registry. Information about pelvic sepsis and potential preoperative, perioperative, and postoperative risk factors was obtained by review of the medical records.
RESULTS: 172 patients were identified (97 females); they were aged 74 ± 11 years. Surgery was performed due to cancer (49%) or diverticulitis (35%) and other benign disease (16%). Rectal transection was carried out anywhere between the pelvic floor and the promontory. Pelvic sepsis developed in 6.4% (11/172) of patients. Pelvic sepsis was associated with preoperative radiotherapy (p = 0.03) and Hinchey grade III and IV (p = 0.02) in those patients who underwent Hartmann's procedure for diverticular disease.
CONCLUSION: Hartmann's procedure is a safe operation when an anastomosis is contraindicated since the incidence of pelvic sepsis is low. Preoperative radiotherapy and Hinchey grade III and IV may be risk factors for the development of pelvic sepsis.},
}
@article {pmid30967935,
year = {2019},
author = {Beh, HN and Ongso, YF},
title = {Simultaneous gastric and colonic erosions from gastric band and its tubing in the setting of recurrent intra-abdominal infection.},
journal = {Journal of surgical case reports},
volume = {2019},
number = {4},
pages = {rjz102},
pmid = {30967935},
issn = {2042-8812},
abstract = {Chronic abdominal pain is often a diagnostic dilemma. We present a 59-year-old female with chronic generalized colicky abdominal and altered bowel habits. She was investigated with colonoscopy and CT abdomen. Patient has a history of recurrent diverticulitis and insertion laparoscopic adjustable gastric band. The colonoscopy revealed a tubular foreign body and diverticular disease. The tubular structure was confirmed to be gastric band tubing on CT abdomen, also showing simultaneous gastric and colonic erosions. She denies any gastric band port related infection or previous issues with gastric band. This case suggest that the cause of the erosion is due to recurrent episodes diverticulitis. She underwent wedge resection of large bowel and laparoscopic removal of gastric band. She had uneventful post-operative recovery.},
}
@article {pmid30944680,
year = {2019},
author = {Pietrzak, AM and Dziki, A and Banasiewicz, T and Reguła, J},
title = {Cyclic rifaximin therapy effectively prevents the recurrence of symptoms after exacerbation of symptomatic uncomplicated diverticular disease: a retrospective study.},
journal = {Przeglad gastroenterologiczny},
volume = {14},
number = {1},
pages = {69-78},
pmid = {30944680},
issn = {1895-5770},
abstract = {INTRODUCTION: Symptomatic uncomplicated diverticular disease (SUDD) is the most common manifestation of diverticulosis. Data concerning the optimal treatment after SUDD exacerbation are inconsistent.
AIM: To assess the effectiveness and necessity of cyclic rifaximin treatment for recurrent SUDD symptoms and for preventing exacerbations in patients who responded to the initial treatment.
MATERIAL AND METHODS: A retrospective observational study was performed in 2017. Physicians responded to a survey on patients with recurrent SUDD during the observation period, who were cyclically treated with rifaximin 400 mg b.i.d. for 7 days per month. The patients' SUDD history, diagnostic methods, treatment, and results were evaluated.
RESULTS: In total 294 patients were included in this study (67% women, median age: 65 years (26-87)). The mean duration of diverticular disease (DD) was 4.5 years (1-20), and 88% had at least one repeated episode of SUDD exacerbation before rifaximin. A total of 267 patients were treated with rifaximin. Changes in the severity of pain, abdominal tenderness, diarrhoea, constipation, and bloating were assessed every 2 months. After 6 months of rifaximin treatment there was a statistically significant reduction in the total severity score (median from 1.8 (max. 3 points) to 0.2; p < 0.0001; sum from 9.37 (max. 18 points) to 1.35; p < 0.0001) and an improvement in individual symptom score.
CONCLUSIONS: Cyclical rifaximin is effective in treating exacerbation of SUDD. This regimen leads to a gradual cessation of symptoms over a 6-month period. In patients who responded to the initial treatment, cyclic rifaximin therapy is needed to maintain remission.},
}
@article {pmid30921802,
year = {2020},
author = {Galetin, A and Rink, AD and Vestweber, B and Vestweber, KH and Galetin, T},
title = {Single-Incision Laparoscopic versus Open Sigmoidectomy for Diverticular Disease: A Disease-Stratified Matched-Pair Analysis.},
journal = {Digestive surgery},
volume = {37},
number = {1},
pages = {56-64},
doi = {10.1159/000497449},
pmid = {30921802},
issn = {1421-9883},
mesh = {Aged ; Colectomy/*methods ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Laparoscopy ; Male ; Matched-Pair Analysis ; Middle Aged ; },
abstract = {BACKGROUND: Single-incision laparoscopic surgery (SILS) is a variant of laparoscopic surgery, especially for diverticular disease (DD), but there are very little data comparing SILS to standard surgical procedures for DD, and most studies on DD surgery do not declare the disease stage. We compared SILS to open sigmoidectomy for DD in a stage-stratified matched-pair analysis to validate the significance of SILS.
METHODS: All patients with SILS or conventional sigmoidectomy for diverticulitis of a single visceral surgery department were subject to a matched-pair analysis stratified by age, sex, body mass index, previous abdominal surgery, and the stage of DD.
RESULTS: Fifty-five pairs were included. In total, 84/110 (76%) had complicated stages of DD. ASA stages were higher in the laparotomy group; the proportion of elective operations was similar (SILS 78%, open: 71%). In the SILS group, length of hospital stay (LoS; 10.2 vs. 16.7 days) and duration of intensive or intermediate care (IMC; 1.8 vs. 3.7 days) were shorter, blood transfusions were reduced (0.1 vs. 0.4 units) and less patients received opioids postoperatively (75 vs. 98%). The day of first defecation, stoma rate, and rates of morbidity and mortality were similar.
CONCLUSIONS: SILS equals open sigmoidectomy regarding complications with advantages regarding pain, LoS, IMC/intensive care unit treatment, and blood transfusion.},
}
@article {pmid30897258,
year = {2019},
author = {Thambi, P and Borowski, DW and Sathasivam, R and Obuobi, RB and Viswanath, YKS and Gill, TS},
title = {Single-incision laparoscopic reversal of Hartmann's operation through the stoma site: comparative outcomes with conventional laparoscopic and open surgery.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {21},
number = {7},
pages = {833-840},
doi = {10.1111/codi.14617},
pmid = {30897258},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/surgery ; Colostomy/*methods ; Databases, Factual ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/*epidemiology/etiology ; Proctocolectomy, Restorative/adverse effects/*methods ; Prospective Studies ; Rectum/surgery ; Retrospective Studies ; Surgical Stomas/*statistics & numerical data ; Surgical Wound ; Treatment Outcome ; United Kingdom ; Young Adult ; },
abstract = {AIM: Restoration of bowel continuity after Hartmann's procedure (RoH) can be challenging and associated with considerable morbidity. A technique using single-incision laparoscopic surgery through the stoma site (SIL RoH) has been shown to be feasible and safe. In this study, we compared clinical outcomes of SIL RoH with conventional laparoscopic surgery (CL) and open surgery (OS).
METHODS: This was a retrospective analysis of a prospectively maintained database between 2007 and 2017 in a UK colorectal unit. The access technique was decided by the surgeon on a case by case basis.
RESULTS: A total of 106 patients underwent RoH. It was carried out for diverticular disease (n = 71, 67.6%), cancer (n = 19, 17.9%) and anastomotic leak (n = 4, 3.8%). The remainder (n = 12, 11.3%) were for miscellaneous reasons including trauma. Most RoHs were performed via OS (n = 87, 81.1%). The most common intended approaches for RoH were SIL (n = 56, 52.8%) and OS (n = 34, 32.1%) with fewer starting with CL (n = 16, 15.1%). Conversion to OS took place in five (8.9%) patients with SIL and six (37.5%) with CL (P = 0.005). Postoperative complications occurred in 17 (30.4%) for SIL, seven (43.8%) for CL and 17 (50.0%) for OS (P = 0.162). Median operating time for SIL was 146 min (range 44-389), 211 min (109-320) for CL and 211 min (85-420) for OS (P < 0.001). Median length of stay was 4 days (2-44) for SIL compared to 6 (3-34) for CL and 7 (4-34) for OS (P < 0.001). Discharge on or before day 5 was achieved in 41 (74.5%) patients for SIL compared to six (37.5%) for CL and seven (20.6%) for OS (P < 0.001).
CONCLUSION: Compared to OS and CL, SIL RoH appears to have shorter operating times and hospitalization, with no discernible difference in morbidity; this finding requires further evaluation in a randomized setting.},
}
@article {pmid30891177,
year = {2019},
author = {Wehrmann, F and Hashim, E and Mansoor, S},
title = {Ingested partial denture mimicking perforated diverticular disease.},
journal = {Journal of surgical case reports},
volume = {2019},
number = {3},
pages = {rjz071},
pmid = {30891177},
issn = {2042-8812},
abstract = {Denture ingestion is a rare clinical entity among foreign body ingestions. The caveat is that there is often no recollection of the event and that dentures are radiolucent and as such hard to identify on conventional imaging. To date not all dentures contain radiopaque marker. Here we present the case of a 52-year-old male who was admitted with clinical and radiological signs of perforated diverticular disease. A curvilinear metallic foreign body was picked up on repeat CT imaging at day 3, which was part of an unknowingly swallowed partial denture that became impacted and perforated the sigmoid colon. The patient underwent an uneventful laparoscopic anterior resection and was discharged home a week later. We conclude that all dentures should contain a radiopaque marker in order to avoid failure in radiological detection and thus prevent misdiagnosis and inappropriate treatment.},
}
@article {pmid30884376,
year = {2019},
author = {Almalki, MA and Yaseen, WY and Baatiyyah, M},
title = {Small bowel diverticulum complicated by enterocutaneous fistula and abdominal wall abscess - Case report.},
journal = {International journal of surgery case reports},
volume = {57},
number = {},
pages = {39-41},
pmid = {30884376},
issn = {2210-2612},
abstract = {INTRODUCTION: Small bowel diverticular disease is uncommon, representing 1-2% of general population. The ileum diverticulum is very rare, especially if it is complicated by enterocutaneous fistula with abdominal wall abscess.
PRESENTATION OF THE CASE: Here, we report a case of small bowel diverticulum, ileum diverticulum with enterocutaneous fistula in a 65-year man presented with lower abdominal pain and an irreducible swelling for 5 days.
DISSECTION: Diverticulosis has no exact cause, but theoretically the diverticula result from peristalsis abnormalities, intestinal dyskinesia, or high segmental intraluminal pressures. Complications of small intestinal diverticulum include bleeding, diverticulitis and its complication (e.g. fistula formation, and intra-abdominal abscess) [5].
CONCLUSION: This is considered rare and serious complication of small bowel diverticulum could occur if diagnosis is delayed.},
}
@article {pmid30868321,
year = {2019},
author = {Grass, F and Crippa, J and Mathis, KL and Kelley, SR and Larson, DW},
title = {Feasibility and safety of robotic resection of complicated diverticular disease.},
journal = {Surgical endoscopy},
volume = {33},
number = {12},
pages = {4171-4176},
pmid = {30868321},
issn = {1432-2218},
mesh = {Diverticular Diseases/*surgery ; Feasibility Studies ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/*surgery ; Retrospective Studies ; Robotic Surgical Procedures/*methods ; Treatment Outcome ; },
abstract = {This study aimed to assess intra- and postoperative outcomes of robotic resection of left-sided complicated diverticular disease. Retrospective analysis of a prospectively maintained institutional database on consecutive patients undergoing elective robotic resection for diverticular disease (2014-2018). All procedures were performed within an enhanced recovery pathway (ERP). Demographic, surgical and ERP-related items were compared between patients with simple and complicated diverticular disease according to intra-operative presentation. Postoperative complications and length of stay were compared between the two groups. Out of 150 patients, 78 (52%) presented with complicated and the remaining 72 (48%) with uncomplicated disease. Both groups were comparable regarding demographic baseline characteristics and overall ERP compliance. Surgery for complicated disease was longer (288 ± 96 vs. 258 ± 72 min, p = 0.04) and more contaminated (≥ class 3: 57.7 vs. 23.6%, p < 0.001) with a trend to higher conversion rates (10.3 vs. 2.8%, p = 0.1). While postoperative overall complications tended to occur more often after resections for complicated disease (28.2 vs. 15.3%, p = 0.075), major, surgical and medical complications did not differ between the two groups, and median length of stay was 3 days in both settings (p = 0.19). Robotic resection of diverticular disease was feasible and safe regardless of disease presentation by the time of surgery.},
}
@article {pmid30856681,
year = {2019},
author = {Self, D and Reece, M and Dilernia, S},
title = {Predicting the need for transfer and interventional angiography for patients with acute colonic haemorrhage in a regional setting.},
journal = {ANZ journal of surgery},
volume = {89},
number = {4},
pages = {E109-E112},
doi = {10.1111/ans.15064},
pmid = {30856681},
issn = {1445-2197},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/complications/diagnosis/*therapy ; Computed Tomography Angiography/*methods ; Embolization, Therapeutic/*methods ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage/diagnosis/etiology/*therapy ; Humans ; Male ; Mesenteric Arteries/*diagnostic imaging ; Middle Aged ; Patient Transfer/*statistics & numerical data ; Retrospective Studies ; },
abstract = {BACKGROUND: Radiological angioembolization is an important strategy in management of acute colonic bleeding. Due to requirement for specialized interventional radiology, many hospitals rely on transfer for this service. This study aimed to identify patient and clinical factors associated with positive (blush) computed tomography mesenteric angiogram (CTMA) or need for invasive angiography. The secondary aim was to identify a patient population who may forego transfer and be safely managed in a regional centre.
METHODS: All presentations to Central Coast Local Health District with colonic bleeding from June 2013-June 2017 were included. A guideline for transfer of patients with positive CTMA from Central Coast Local Health District to Royal North Shore Hospital had been established prior to the study period. Demographics, medical background, transfusion requirement, presentation details and mortality data were collected on all patients.
RESULTS: Of 2378 patients presenting with colonic bleeding, 71 of 247 patients investigated with CTMA had a blush. Forty-six patients were transferred to Royal North Shore Hospital. Of these, 28 proceeded to interventional angiography with 19 undergoing angioembolization. Acute transfusion ≥5 units (odds ratio 6.78, P < 0.01) was the only significant predictor of needing interventional angiography. There was no association between age, bleeding site (right or left), use of antiplatelet or anticoagulation, diverticular disease or chronic kidney disease and identification of arterial bleeding on interventional angiography. There was no mortality or significant procedure-related morbidity.
CONCLUSION: A patient's medical background demonstrates a lack of correlation to identification of active bleeding on interventional angiography. Patients requiring ≥5 units blood transfusion should be considered for transfer and interventional angiography.},
}
@article {pmid30851168,
year = {2019},
author = {Tursi, A and Brandimarte, G and di Mario, F and Nardone, G and Scarpignato, C and Picchio, M and Elisei, W and , },
title = {The "DICA" endoscopic classification for diverticular disease of the colon shows a significant interobserver agreement among community endoscopists.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {28},
number = {1},
pages = {23-27},
doi = {10.15403/jgld.2014.1121.281.dic},
pmid = {30851168},
issn = {1842-1121},
mesh = {Colon/*pathology ; *Colonoscopy ; Diverticulitis, Colonic/classification/*pathology ; Diverticulosis, Colonic/classification/*pathology ; Humans ; Observer Variation ; Predictive Value of Tests ; Reproducibility of Results ; Retrospective Studies ; Severity of Illness Index ; *Terminology as Topic ; Video Recording ; },
abstract = {BACKGROUND AND AIM: An endoscopic classification of Diverticular Disease (DD), called DICA (Diverticular Inflammation and Complication Assessment) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement levels for this classification among an endoscopist community setting.
METHODS: A total of 66 endoscopists independently scored a set of DD endoscopic videos. The percentages of overall agreement on the DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of the inter-rater agreement.
RESULTS: The overall agreement levels were: 70.2% for DICA 1, 70.5% for DICA 2, 81.3% for DICA 3. The free marginal κ was: 0.553 for DICA 1, 0.558 for DICA 2, 0.719 for DICA 3. The agreement levels among the expert group were: 78.8% for DICA 1, 80.2% for DICA 2, 88.5% for DICA 3. The free marginal κ among the expert group were: 0.682 for DICA 1, 0.712 for DICA 2, 0.828 for DICA 3. The agreement of expert raters on the single item of the DICA classification was superior to the agreement of the overall group.
CONCLUSIONS: The overall inter-rater agreement for DICA score in this study ranges from moderate to good, with a significant improvement in the expert subgroup of raters. Diverticular Inflammation and Complication Assessment is a simple and reproducible endoscopic scoring system.},
}
@article {pmid30839393,
year = {2019},
author = {Järbrink-Sehgal, ME and Rassam, L and Jasim, A and Walker, MM and Talley, NJ and Agréus, L and Andreasson, A and Schmidt, PT},
title = {Diverticulosis, Symptoms and Colonic Inflammation: A Population-Based Colonoscopy Study.},
journal = {The American journal of gastroenterology},
volume = {114},
number = {3},
pages = {500-510},
doi = {10.14309/ajg.0000000000000113},
pmid = {30839393},
issn = {1572-0241},
mesh = {Aged ; C-Reactive Protein/immunology ; Case-Control Studies ; Cecum/immunology/*pathology ; Colitis/immunology/*pathology ; Colonoscopy ; Diverticulum/immunology/pathology/physiopathology ; Diverticulum, Colon/immunology/*pathology/physiopathology ; Female ; Humans ; Inflammation ; Linear Models ; Logistic Models ; Male ; Middle Aged ; },
abstract = {INTRODUCTION: Low-grade chronic inflammation has been suggested to play a role in uncomplicated asymptomatic and symptomatic diverticular disease. However, population-based studies are lacking. We investigated whether community participants with diverticulosis, with or without symptoms, would have colonic inflammation on histology and serology.
METHODS: In a nested case-control study of 254 participants from the population-based colonoscopy (PopCol) study, colonic histological inflammatory markers and serological C-reactive protein levels were analyzed in cases with diverticulosis and controls without diverticulosis. Statistical methods included logistic and linear regression models.
RESULTS: Background variables including age (P = 0.92), sex (P = 1.00), body mass index (P = 0.71), smoking (P = 0.34), and recent antibiotic exposure (P = 0.68) were similar between cases and controls. Cases reported more abdominal pain (P = 0.04) and diarrhea symptoms (mushy and high-frequency stools) than controls (P = 0.01 and P = 0.03, respectively) but were otherwise similar. The median C-reactive protein levels were similar among cases and controls [1.05 mg/L (0.3, 2.7) vs 0.8 (0.4, 2.2), P = 0.53]. There was a trend of increased numbers of cecal lymphoid aggregates in cases vs controls (P = 0.07), but no other associations between diverticulosis and inflammatory markers on histology were found. Similarly, no serological or mucosal inflammation was associated with symptomatic cases of diarrhea or abdominal pain vs asymptomatic controls.
CONCLUSIONS: In a general community sample, both asymptomatic and symptomatic diverticulosis are not associated with colonic mucosal inflammation. Other explanations for symptomatic colonic diverticulosis need to be identified.},
}
@article {pmid30838745,
year = {2019},
author = {Barbaro, MR and Cremon, C and Fuschi, D and Scaioli, E and Veneziano, A and Marasco, G and Festi, D and Stanghellini, V and Barbara, G},
title = {Nerve fiber overgrowth in patients with symptomatic diverticular disease.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {31},
number = {9},
pages = {e13575},
doi = {10.1111/nmo.13575},
pmid = {30838745},
issn = {1365-2982},
mesh = {Aged ; Colonoscopy/methods ; Diverticulosis, Colonic/*diagnosis/*immunology ; Enteric Nervous System/*immunology/*pathology ; Female ; Humans ; Intestinal Mucosa/immunology/pathology ; Male ; Middle Aged ; Nerve Fibers/*immunology/*pathology ; Pilot Projects ; },
abstract = {BACKGROUND: Colonic diverticulosis is a common condition in industrialized countries. Up to 25% of patients with diverticula develop symptoms, a condition termed symptomatic uncomplicated diverticular disease (SUDD). The aim of the present study was to characterize neuroimmune interactions and nerve fiber plasticity in the colonic mucosa of patients with diverticula.
METHODS: Controls, patients with diverticulosis and with SUDD were enrolled in the study. Mucosal biopsies were obtained close to diverticula (diverticular region) and in a normal mucosa (distant site), corresponding to sigmoid and descending colon in the controls. Quantitative immunohistochemistry was used to assess mast cells, T cells, macrophages, nerve fibers, and neuronal outgrowth (growth-associated protein 43, GAP43+fibers).
KEY RESULTS: No difference emerged in mast cells and T cells among the three groups. Macrophages were increased in patients with SUDD and diverticulosis as compared to controls. Nerve fibers were enhanced in patients with SUDD and diverticulosis in comparison with controls in the diverticular region. GAP43+ fibers were increased only in patients with SUDD as compared to controls and to patients with diverticulosis in the diverticular region. In patients with SUDD, GAP43 density was increased in the diverticular region compared to distant site. Macrophages close to GAP43+ fibers were increased in the diverticular region of patients with SUDD. Significant correlations were found between GAP43+ fibers and immune cells.
CONCLUSIONS AND INFERENCES: Patients with diverticula are characterized by increased macrophage counts, while nerve fiber sprouting is increased only in the diverticular region of patients with SUDD suggesting a role in symptom generation.},
}
@article {pmid30826747,
year = {2019},
author = {Weersma, RK and Parkes, M},
title = {Diverticular disease: picking pockets and population biobanks.},
journal = {Gut},
volume = {68},
number = {5},
pages = {769-770},
pmid = {30826747},
issn = {1468-3288},
support = {MR/M00533X/1/MRC_/Medical Research Council/United Kingdom ; },
mesh = {*Biological Specimen Banks ; Connective Tissue ; *Diverticular Diseases ; *Diverticulum ; Genome-Wide Association Study ; Humans ; },
}
@article {pmid30825120,
year = {2020},
author = {Schwandner, F and Klimars, U and Gock, M and Schiffmann, L and Witte, M and Schiergens, T and Rentsch, M and Klar, E and Kühn, F},
title = {The Water-Holding Procedure for Ensuring Postoperative Continence Prior Restoring Intestinal Continuity.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {24},
number = {2},
pages = {411-417},
pmid = {30825120},
issn = {1873-4626},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anal Canal/*physiopathology/surgery ; Defecation ; *Enterostomy ; Fecal Incontinence/*physiopathology ; Female ; Gastrointestinal Diseases/surgery ; Humans ; Male ; Manometry ; Middle Aged ; Pilot Projects ; Postoperative Period ; Predictive Value of Tests ; Prospective Studies ; Water ; },
abstract = {BACKGROUND: A defunctioning stoma can become necessary in a relevant number of patients undergoing gastrointestinal surgery. As a matter of course, patients seek an early closure of the stoma. However, preoperative management of these patients varies and the prediction of continence after stoma removal can become challenging. Patients might be fully continent despite low manometric pressures and vice versa. An easy and reliable way to predict continence after stoma reversal would improve patients' management and outcome. Although frequently performed in various surgical centers in Germany, there is no published data on the water-holding test. Hence, this is the first study evaluating the role of the test in clinical practice.
METHOD: We performed a prospective pilot study to evaluate the role of anorectal manometry and the water-holding procedure as a predictor of postoperative continence prior to stoma reversal. Inclusion criteria were a successfully passed water-holding test, any type of fecal diversion and the possibility of restoring intestinal continuity. Preoperative low manometric pressure levels were not an exclusion criteria for stoma reversal. Fifty-two patients with ostomy were consecutively enrolled in this study between October 2013 and February 2016. Anorectal manometry was performed in all patients prior to stoma reversal. After stoma removal, patients were followed-up for 6 months. Postoperative incontinence was determined using the Wexner incontinence score.
RESULTS: A total of 52 patients (38 males, 14 females) were included at an average age of 59 (range 33-83) years. Most frequent indications for intestinal diversion were rectal cancer surgery, IBD-related surgery, or surgery for diverticular disease. Low anterior rectal resection was performed in 17 patients (32.7%), followed by a proctocolectomy in 9 (17.3%), colectomy in 9 (17.3%), and recto-sigmoid resection in 7 patients (13.5%). Median time from stoma creation to reversal was 206 days (range 48-871 days). All patients had successfully passed the standardized water-holding test. At the same time, the majority of patients had low preoperative manometric pressure values and would normally not have been reversed at that point. The median postoperative Wexner incontinence score was at 1.5 (range 0-20), 0.5 (range 0-14), and 0 (range 0-11) at 14, 60, and 180 days after stoma reversal. Low preoperative manometric squeeze and/or resting pressure levels were not associated with a higher postoperative incontinence score at 14, 60, or 180 days after stoma reversal.
CONCLUSION: A standardized water-holding test can function as an easy and reliable method before stoma reversal to predict sufficient postoperative fecal continence. In case of a sufficient water-holding test despite low manometric pressure levels, the risk for postoperative anal incontinence seems to be low. Preoperative manometric pressure levels do not appear to predict postoperative continence.},
}
@article {pmid30809418,
year = {2018},
author = {Kadiyska, T and Tourtourikov, I and Popmihaylova, AM and Kadian, H and Chavoushian, A},
title = {Role of TNFSF15 in the intestinal inflammatory response.},
journal = {World journal of gastrointestinal pathophysiology},
volume = {9},
number = {4},
pages = {73-78},
pmid = {30809418},
issn = {2150-5330},
abstract = {Gastrointestinal diseases, specifically Crohn's disease, ulcerative colitis, diverticular disease, and primary biliary cirrhosis are all characterized by complicated inflammation of the digestive tract. Their pathology is multifactorial, and risk factors encompass both genetic and environmental factors. Recent advances in the genetic component of inflammatory bowel diseases (IBDs) have revealed that the tumor necrosis factor superfamily member 15 (TNFSF15) contains a number of risk alleles associated not only with IBD but also with other diseases such as diverticular disease and primary biliary cirrhosis. These risk alleles in TNFSF15 and the altered expression of its gene product can serve as the common ground between these disorders by explaining at least some of the underlying processes that lead to a dysregulated immune response and subsequent chronic inflammation. Here, we aim to outline how the TNFSF15 gene is involved in the proliferation and cell fate of different populations of T cells and subsequently in the control of both pro- and anti-inflammatory cytokines. Furthermore, we summarize what is currently known of TNFSF15 control region variants, how they are associated with each mentioned disease, and how these variants can explain the autoimmune pathology of said diseases through altered TNFSF15 expression.},
}
@article {pmid30793380,
year = {2019},
author = {Tague, LK and Adams, W and Young, KA and Kwon, OJ and Mahoney, E and Lowery, EM},
title = {Association between diverticular disease requiring surgical intervention and mortality in the postlung transplant population - a retrospective cohort study.},
journal = {Transplant international : official journal of the European Society for Organ Transplantation},
volume = {32},
number = {7},
pages = {739-750},
pmid = {30793380},
issn = {1432-2277},
support = {K23 AA022126/AA/NIAAA NIH HHS/United States ; T32 HL007317/HL/NHLBI NIH HHS/United States ; K23AA022126//NIH/NIAA/ ; T32HL007317-39//Washington University Division of Pulmonary and Critical Care Medicine/ ; },
mesh = {Aged ; Cystic Fibrosis/complications/mortality/surgery ; Diverticulitis/*complications/mortality/*surgery ; Female ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppression Therapy ; Lung Diseases/*complications/mortality/*surgery ; Lung Transplantation/*adverse effects ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Treatment Outcome ; alpha 1-Antitrypsin Deficiency/complications/mortality/surgery ; },
abstract = {Lung Transplant recipients are at increased risk of complicated diverticular disease. We aim to assess the rate of diverticular surgery in a postlung transplantation population and identify risk factors for surgery. We performed a retrospective cohort study of lung transplant recipients from 2007 to 2011. Demographic variables were evaluated with the Mann-Whitney U and chi-squared tests. Cox regression was performed to evaluate 1- and 2-year landmark survival, assess predictor variables of diverticular surgery and evaluate impact of surgery on CLAD development. Of 17 of 158 patients (10.7%) underwent diverticular-related surgery. Surgical patients had significantly worse survival than nonsurgical patients at 1 year [aHR 2.93 (1.05-8.21), P = 0.041] and 2 year [aHR 4.17 (1.26-13.84), P = 0.020] landmark analyses. Transplant indication of alpha-1 antitrypsin disease and cystic fibrosis were significantly associated with the need for diverticular surgery. Emergent surgery was associated with poorer survival [aHR 5.12(1.00-26.27), P = 0.050]. Lung transplant patients requiring surgery for complicated diverticular disease have significantly poorer survival than those who do not require surgery. Surgery was more common in patients transplanted for A1AT and CF. Optimal assessment and risk stratification of diverticular disease is necessary to prevent excessive morbidity and mortality following transplantation.},
}
@article {pmid30791758,
year = {2019},
author = {Bassotti, G and Usai Satta, P and Bellini, M},
title = {Prucalopride for the treatment of constipation: a view from 2015 and beyond.},
journal = {Expert review of gastroenterology & hepatology},
volume = {13},
number = {3},
pages = {257-262},
doi = {10.1080/17474124.2019.1568238},
pmid = {30791758},
issn = {1747-4132},
mesh = {Benzofurans/adverse effects/economics/*therapeutic use ; Constipation/diagnosis/*drug therapy/economics/physiopathology ; Cost-Benefit Analysis ; Defecation/*drug effects ; Drug Costs ; Gastrointestinal Motility/*drug effects ; Humans ; Intestines/*drug effects/physiopathology ; Laxatives/adverse effects/economics/*therapeutic use ; Recovery of Function ; Serotonin 5-HT4 Receptor Agonists/adverse effects/economics/*therapeutic use ; Treatment Outcome ; },
abstract = {Prucalopride is a prokinetic drug, that has been commercially available in recent years for the treatment of chronically constipated patients. In this update of a previous 2016 article, we reviewed the more recent data supporting its role in the treatment of constipation and constipation-associated conditions. Areas covered: We carried out an extensive literature review on the effects of prucalopride for the years 2012-2018 by means of scientific databases and manual research. More evidence was found on its possible therapeutic role in conditions in which constipation plays a role as an associated symptom, such as opioid-induced constipation, constipation-predominant irritable bowel syndrome, post-operative ileus, colonic diverticular disease, drug-related constipation, and chronic intestinal pseudo-obstruction. Expert opinion: Based on the added literature evidence, we feel that prucalopride is an effective, although expensive, drug for the treatment of primary and secondary forms of constipation, and of other clinical conditions associated with constipation.},
}
@article {pmid30790412,
year = {2020},
author = {Ayoubi, S and Chen, M and Ravindran, P and Gibson, K},
title = {Ischio-anal abscess as a first presentation of complicated diverticular disease.},
journal = {ANZ journal of surgery},
volume = {90},
number = {1-2},
pages = {169-171},
doi = {10.1111/ans.15042},
pmid = {30790412},
issn = {1445-2197},
mesh = {Abdominal Abscess/*etiology/surgery ; Anus Diseases/*etiology/surgery ; *Colon, Sigmoid ; Colonic Diseases/*etiology/surgery ; Cutaneous Fistula/*etiology/surgery ; Diverticulitis, Colonic/*complications/surgery ; Female ; Humans ; Intestinal Fistula/*etiology/surgery ; Ischium ; Middle Aged ; },
}
@article {pmid30781964,
year = {2019},
author = {Skála, M and Liška, V and Třeška, V},
title = {Mesenteric diverticuli as a reason of acute abdomen.},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {98},
number = {1},
pages = {27-30},
pmid = {30781964},
issn = {0035-9351},
mesh = {*Abdomen, Acute/etiology/surgery ; Aged ; *Diverticulum/complications/surgery ; Humans ; *Intestinal Diseases/complications/surgery ; Mesentery ; Retrospective Studies ; },
abstract = {INTRODUCTION: Diverticula of the small bowel are quite rare findings, frequently confirme only by necropsy. The authors describe the signs and symptoms resulting from complications of small bowel diverticula as well as the diagnostic options and treatment modalities. The paper also presents the results of treatment in the Department of Surgery at University Hospital in Pilsen.
METHOD: Our retrospective study involved 6 patients who were operated on due to complications of small bowel mesenteric diverticulum at the Department of Surgery at University Hospital in Pilsen between 1 January 2006 and 1 January 2016. We assessed the number of days in hospital, emesis or pathological stools (diarrhoea or bleeding), admission body temperature and abdominal clinical signs, operating time and postoperative complications according to the Clavien-Dindo classification. As for laboratory parameters, leukocytosis and C-reactive protein levels were evaluated.
RESULTS: The results of our study are similar to those reported in available literature. After medical history and physical examination which are ne-cessary, laboratory methods, and less frequently also imaging methods, can be used in diagnosis. The treatment of complications of small bowel diverticular disease is only surgical. The postoperative course is burdened by comorbidities of these patients as they are very often elderly.
CONCLUSION: Management of complicated small bowel diverticular disease is only surgical and consists in laparotomy with thorough lavage of the abdominal cavity and with drainage. Key words: small bowel acute abdome.},
}
@article {pmid30765881,
year = {2019},
author = {Arnold, CA and Graham, RP and Jain, D and Kakar, S and Lam-Himlin, DM and Naini, BV and Wu, TT and Yeh, MM and Torbenson, MS},
title = {Knowledge gaps in the appendix: a multi-institutional study from seven academic centers.},
journal = {Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc},
volume = {32},
number = {7},
pages = {988-996},
doi = {10.1038/s41379-019-0216-x},
pmid = {30765881},
issn = {1530-0285},
mesh = {Adenocarcinoma, Mucinous/*pathology ; Appendiceal Neoplasms/*pathology ; Appendix/*pathology ; Carcinoid Tumor/*pathology ; Humans ; },
abstract = {Appendix pathology represents uncommonly encountered specimens with unique diagnostic challenges. To delineate common knowledge gaps, extramural consults submitted to seven institutions between 2016-2017 were reviewed. All appendix consults were resections (100%, n = 43), and the majority were directed for consultation by the originating pathologist (95%, n = 41) with no additional studies performed by the consultant (65%, n = 28). This study was dominated by inquiries related to low grade appendiceal mucinous neoplasms (44%, n = 19) and goblet cell carcinoid related neoplasms (19%, n = 8). Of the 43 appendiceal consults, 19 were submitted by the contributing pathologist as low grade appendiceal mucinous neoplasm, but only half of these were diagnosed by the consultant as such (n = 9). Low grade appendiceal mucinous neoplasm-related consultation themes included diverticular disease, criteria for invasion, high grade atypia, extra-appendiceal mucin, and staging. Examples of major disagreements that were downgraded included consults submitted as low grade appendiceal mucinous neoplasm and diagnosed by the consultant as serrated polyp (n = 3), appendicitis (n = 1), and benign appendix (n = 1). Examples of major disagreements-upgraded included cases submitted as low grade appendiceal mucinous neoplasm and diagnosed by the consultant as low grade appendiceal mucinous neoplasm with high-risk features (n = 2) and mucinous adenocarcinoma (n = 2). One case contained both a major disagreement-upgrade (low grade appendiceal mucinous neoplasm changed to high grade appendiceal mucinous neoplasm) and a major disagreement-downgrade (pT3 changed to Tis). Of the 15 cases diagnosed by the consultants as low grade appendiceal mucinous neoplasm, submitted diagnoses included low grade appendiceal mucinous neoplasm (n = 9), adenocarcinoma (n = 5), and one case was submitted without a diagnosis. For goblet cell carcinoid-related consults, the usual inquiry related to distinguishing goblet cell carcinoid from goblet cell carcinoid with adenocarcinoma (adenocarcinoma ex-goblet cell carcinoid). Of the 38 overall consults with a submitted diagnosis, 53% (n = 20) were disagreements, and most of these were major disagreements-downgraded (n = 13).},
}
@article {pmid30758535,
year = {2019},
author = {Lebert, P and Ernst, O and Zins, M},
title = {Acquired diverticular disease of the jejunum and ileum: imaging features and pitfalls.},
journal = {Abdominal radiology (New York)},
volume = {44},
number = {5},
pages = {1734-1743},
doi = {10.1007/s00261-019-01928-1},
pmid = {30758535},
issn = {2366-0058},
mesh = {Diagnosis, Differential ; Diverticular Diseases/*complications/*diagnostic imaging ; Humans ; Jejunal Diseases/*complications/*diagnostic imaging ; *Tomography, X-Ray Computed ; },
abstract = {PURPOSE: To present radiological aspects of jejunoileal diverticulosis and its complications.
RESULTS: Jejunoileal diverticulosis is a relatively rare and underestimated condition, which mostly affects the elderly. It is frequently asymptomatic but it can lead to significant complications requiring surgical treatment. Jejunoileal diverticulosis is far less common than colonic diverticulosis. Acquired small bowel diverticula are often numerous but the complication rate is low. Acute diverticulitis is the most frequent complication; its classic presentation involves the jejunum and is often non-severe. Diverticular hemorrhage is the second most common complication; CT scan examination is essential to determine the accurate topography of the pathological diverticula. Small bowel obstruction can occur through several mechanisms: adhesions, enterolith, and intussusception. Extra-intestinal gas without perforation and "pseudo-ischemic" appearance are non-pathological conditions that are important to diagnose in order to avoid surgery.
CONCLUSION: Jejunoileal diverticulosis usually does not show any symptoms but can lead to diagnostic challenges requiring evaluation by CT. CT scan signs of these complications and some pitfalls must be known.},
}
@article {pmid30747633,
year = {2018},
author = {Valizadeh, N and Suradkar, K and Kiran, RP},
title = {Specific Factors Predict the Risk for Urgent and Emergent Colectomy in Patients Undergoing Surgery for Diverticulitis.},
journal = {The American surgeon},
volume = {84},
number = {11},
pages = {1781-1786},
pmid = {30747633},
issn = {1555-9823},
mesh = {Aged ; Colectomy/*methods/mortality ; Databases, Factual ; Diverticulitis/diagnosis/*surgery ; Elective Surgical Procedures/*methods/mortality ; *Emergencies ; Female ; Follow-Up Studies ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/*mortality/physiopathology ; Predictive Value of Tests ; Preoperative Care/methods ; Propensity Score ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Survival Rate ; Time Factors ; },
abstract = {The aim of this study was to identify preoperative characteristics that may determine the need for emergency surgery for diverticulitis and assess postoperative outcomes for these patients when compared with elective surgery. All patients included in the ACS-NSQIP-targeted colectomy database from 2012 to 2013 who underwent colectomy with an underlying diagnosis of diverticulitis were included. Preoperative characteristics and 30-day postoperative outcomes were evaluated for patients who underwent elective versus emergent/urgent surgery using univariable and multivariable analyses. Of 8708 patients with diverticular disease, 28.1 per cent underwent emergent/urgent colectomy. Patients who underwent emergent/urgent colectomy had greater preoperative steroid use, diabetes mellitus, disseminated cancer, chronic renal failure, hypertension, chronic heart failure, chronic liver disease, COPD, and dependent functional health status (P < 0001). There were more patients with age >65 years (P < 0001), smoking history (P < 0.05), and BMI < 18.5 kg/m[2] (P < 0001) in the emergent/urgent colectomy group. After performing multivariable analysis, preoperative steroid use, weight loss >10 per cent, BMI < 18 kg/m[2], smoking, age > 65, and comorbid conditions were associated with a higher rate of emergent/urgent surgery. Mortality (5.2% vs 0.2%) and infectious and noninfectious complications were higher after nonelective colectomy. Emergent/urgent colectomy was also associated with longer hospital stay and reoperation. Emergency and urgent colectomy for diverticulitis is associated with significantly worse outcomes than after elective surgery, and patients with comorbid conditions who develop attacks of diverticulitis may in fact be the population that might best benefit from a lower threshold for an elective colectomy.},
}
@article {pmid30740206,
year = {2019},
author = {Prough, H and Jaffe, S and Jones, B},
title = {Jejunal diverticulitis.},
journal = {Journal of surgical case reports},
volume = {2019},
number = {1},
pages = {rjz005},
pmid = {30740206},
issn = {2042-8812},
abstract = {Cases of small bowel diverticulitis, excluding Meckel's diverticulitis, are rare. Small bowel diverticular disease has been reported in approximately 0.3-1.3% cases of post mortem studies (Fisher JK, Fortin D. Partial small bowel obstruction secondary to ileal diverticulitis. Radiology 1977;122:321-322.) and in only 0.5-1.9% of contrast media study cases (Cattell RB, Mudge TJ. The surgical significance of duodenal diverticula. N Engl J Med 1952;246:317-324). Diverticula located within the small bowel may have presentations and complications similar to that of colonic diverticular disease. However, there is no consensus for the management for small bowel diverticulitis. Given that small bowel diverticulitis, like a colonic diverticulitis, can cause an acute abdomen, surgical intervention may be required. In this particular case, a patient presented with symptoms of lower abdominal pain, nausea and fever. Following an x-ray and CT scan, the patient underwent an open laparotomy and small bowel resection of a portion of jejunum that contained a symptomatic diverticulum.},
}
@article {pmid30740013,
year = {2019},
author = {Nevo, Y and Shapiro, R and Froylich, D and Meron-Eldar, S and Zippel, D and Nissan, A and Hazzan, D},
title = {Over 1-Year Followup of Laparoscopic Treatment of Enterovesical Fistula.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {23},
number = {1},
pages = {},
pmid = {30740013},
issn = {1938-3797},
mesh = {Adult ; Aged ; Anastomosis, Surgical ; Crohn Disease/complications ; Diverticular Diseases/complications ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/etiology/*surgery ; *Laparoscopy ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Urinary Bladder Fistula/etiology/*surgery ; Young Adult ; },
abstract = {BACKGROUND AND OBJECTIVE: Entero vesical fistulas (EVFs) are an uncommon complication mainly of diverticular disease (70%) and less commonly of Crohn's disease (10%). Only about 10% are caused by malignancies. At this time, it is unclear whether the laparoscopic approach can be routinely proposed as a safe procedure for patients with EVF. The aim of this study was to assess the feasibility and safety of laparoscopic surgery in the treatment of EVFs in patients with complicated diverticular and Crohn's disease.
METHODS: All patients with the diagnosis of EVF who underwent laparoscopic surgery were identified from prospective collected data based in two institutions between 2007 and 2017. Patients with malignancy were excluded. Recorded parameters included operative time, conversion to open surgery, the presence of a protective loop ileostomy, perioperative complications, number of units of blood transfused, postoperative course, and histologic findings.
RESULTS: Seventeen patients were included in the study: 10 patients with a colo-vesical fistula due to diverticular disease, and 7 patients with an ileo-vesical fistula due to Crohn's disease. There were no conversions to open surgery and none of the patients needed a protective ileostomy. The bladder was sutured in 12 patients (70%). No intra-operative complications were met, and no blood transfusions were needed; there were no anastomotic leaks, nor mortality in both groups.
CONCLUSIONS: The laparoscopic approach for benign EVF in selected patients is both feasible and safe in the hands of experienced surgeons with extensive expertise in laparoscopic surgery.},
}
@article {pmid30734381,
year = {2019},
author = {Renzi, C and Lyratzopoulos, G and Hamilton, W and Rachet, B},
title = {Opportunities for reducing emergency diagnoses of colon cancer in women and men: A data-linkage study on pre-diagnostic symptomatic presentations and benign diagnoses.},
journal = {European journal of cancer care},
volume = {28},
number = {2},
pages = {e13000},
pmid = {30734381},
issn = {1365-2354},
support = {TP Gunton research grant//British Medical Association/ ; C48748/A18667//Cancer Research UK/United Kingdom ; C8640/A23385//CanTest Collaborative, Cancer Research UK/ ; },
mesh = {Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Anemia/etiology ; Colonic Neoplasms/*diagnosis/epidemiology ; Early Detection of Cancer ; Emergencies ; Emergency Treatment/statistics & numerical data ; England/epidemiology ; Female ; Humans ; Incidental Findings ; Intestinal Diseases/etiology ; Male ; Middle Aged ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Sex Distribution ; Young Adult ; },
abstract = {OBJECTIVES: To identify opportunities for reducing emergency colon cancer diagnoses, we evaluated symptoms and benign diagnoses recorded before emergency presentations (EP).
METHODS: Cohort of 5,745 colon cancers diagnosed in England 2005-2010, with individually linked cancer registry and primary care data for the 5-year pre-diagnostic period.
RESULTS: Colon cancer was diagnosed following EP in 34% of women and 30% of men. Among emergency presenters, 20% of women and 15% of men (p = 0.002) had alarm symptoms (anaemia/rectal bleeding/change in bowel habit) 2-12 months pre-diagnosis. Women with abdominal symptoms (change in bowel habit/constipation/diarrhoea) received a benign diagnosis (irritable bowel syndrome (IBS)/diverticular disease) more frequently than men in the year before EP: 12% vs. 6% among women and men (p = 0.002). EP was more likely in women (OR = 1.20; 95% CI 1.1-1.4), independently of socio-demographic factors and symptoms. Benign diagnoses in the pre-diagnostic year (OR = 2.01; 95% CI 1.2-3.3) and anaemia 2-5 years pre-diagnosis (OR = 1.91; 95% CI 1.2-3.0) increased the risk of EP in women but not men. The risk was particularly high for women aged 40-59 with a recent benign diagnosis vs. none (OR = 4.41; 95% CI 1.3-14.9).
CONCLUSIONS: Women have an increased risk of EP, in part due to less specific symptoms and their more frequent attribution to benign diagnoses. For women aged 40-59 years with new-onset IBS/diverticular disease innovative diagnostic strategies are needed, which might include use of quantitative faecal haemoglobin testing (FIT) or other colorectal cancer investigations. One-fifth of women had alarm symptoms before EP, offering opportunities for earlier diagnosis.},
}
@article {pmid30733953,
year = {2018},
author = {Al Harakeh, H and Paily, AJ and Doughan, S and Shaikh, I},
title = {Recurrent Acute Diverticulitis: When to Operate?.},
journal = {Inflammatory intestinal diseases},
volume = {3},
number = {2},
pages = {91-99},
pmid = {30733953},
issn = {2296-9365},
abstract = {OBJECTIVE: Recurrent acute diverticulitis carries a major burden to any form of health care. Patients present repeatedly to medical centers with a multitude of symptoms and may require different modalities of treatment with significant morbidities and impact on quality of life.
METHODS: We therefore wanted to identify factors that would imply the need and time of surgery versus conservative management. The literature was thoroughly searched for major studies tackling this topic. Furthermore, studies reporting on decision making based on quality of life were included. Risks of developing recurrent diverticulitis and the potential need of surgery were identified. Relevant surgical details that would decrease recurrence were also denoted.
RESULTS: Surgery has been the mainstay of treatment for quite some time. However, the paradigms of treatment have changed over the last few years, especially when long-term population studies confirmed that not all patients require surgical treatment with its associated risk of morbidity.
CONCLUSION: Treatment now has to be patient-tailored with special attention to the subgroup of high-risk patients. These patients must be adequately selected, identifying the impact of the disease on the quality of life and weighing in the risks of the surgical intervention.},
}
@article {pmid30733951,
year = {2018},
author = {Rezapour, M and Stollman, N},
title = {Antibiotics in Uncomplicated Acute Diverticulitis: To Give or Not to Give?.},
journal = {Inflammatory intestinal diseases},
volume = {3},
number = {2},
pages = {75-79},
pmid = {30733951},
issn = {2296-9365},
abstract = {Acute uncomplicated diverticulitis (AUD) is generally felt to be caused by obstruction and inflammation of a colonic diverticulum and occurs in about 4-5% of patients with diverticulosis. The cornerstone of AUD treatment has conventionally been antibiotic therapy, but with a paradigm shift in the underlying pathogenesis of the disease from bacterial infection to more of an inflammatory process, as well as concerns about antibiotic overuse, this dogma has recently been questioned. We will review emerging data that supports more selective antibiotic use in this population, as well as newer guidelines that advocate this position as well. While there are no discrete algorithms to guide us, we will attempt to suggest clinical scenarios where antibiotics may reasonably be withheld.},
}
@article {pmid30733949,
year = {2018},
author = {Imaeda, H and Hibi, T},
title = {The Burden of Diverticular Disease and Its Complications: West versus East.},
journal = {Inflammatory intestinal diseases},
volume = {3},
number = {2},
pages = {61-68},
pmid = {30733949},
issn = {2296-9365},
abstract = {BACKGROUND: Colonic diverticulosis is prevalent and increasing not only in Western but also in Asian countries. Diverticulosis can be complicated by diverticulitis and diverticular bleeding. Diverticular disease is a burdensome digestive disease, because it is a major cause of hospital admissions and is associated with significant health-care costs.
SUMMARY: The incidence of diverticulosis increases with age. Most cases of diverticulosis in Western countries involve the left side of the colon, while diverticulosis is predominantly present on the right side of the colon in Asian countries. The incidence of diverticulitis also increases with age. Diverticulitis is predominantly located on the left side of the colon in Western countries, while it is predominantly located on the right side of the colon in Asian countries. The overall complication rate is higher in left-sided than in right-sided diverticulitis. The incidence of diverticular bleeding also increases with age. The right colon is the source of diverticular bleeding in more than 50% of patients in Western countries. In Asian countries, age greater than 70 years and both-sided diverticulosis increase the bleeding risk.
KEY MESSAGES: In Western countries, diverticulosis and diverticulitis are predominantly located on the left side of the colon, whereas they are predominantly present on the right side of the colon in Asian countries. Diverticular bleeding is predominantly located on the right side in Western countries, and both-sided diverticulosis increases the risk of bleeding in Asian countries. Diverticular disease with complications requires admission and operation; moreover, it recurs frequently. Therefore, diverticular disease is associated with a significant economic burden in terms of health-care costs and resource utilization.},
}
@article {pmid30733947,
year = {2018},
author = {Sharara, AI},
title = {Diverticular Disease of the Colon.},
journal = {Inflammatory intestinal diseases},
volume = {3},
number = {2},
pages = {53-54},
doi = {10.1159/000495019},
pmid = {30733947},
issn = {2296-9365},
}
@article {pmid30675092,
year = {2019},
author = {Raskin, ER and Keller, DS and Gorrepati, ML and Akiel-Fu, S and Mehendale, S and Cleary, RK},
title = {Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {23},
number = {1},
pages = {},
pmid = {30675092},
issn = {1938-3797},
mesh = {Adolescent ; Adult ; Aged ; Colectomy/adverse effects/methods/statistics & numerical data ; Databases, Factual ; Diverticular Diseases/*surgery ; Elective Surgical Procedures ; Female ; Humans ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/*epidemiology ; Propensity Score ; Retrospective Studies ; *Robotic Surgical Procedures ; Sigmoid Diseases/*surgery ; Treatment Outcome ; United States ; Young Adult ; },
abstract = {BACKGROUND AND OBJECTIVES: The role for the robotic-assisted approach as a minimally invasive alternative to open colorectal surgery is in the evaluation phase. While the benefits of minimally invasive colorectal surgery when compared to the open approach have been clearly demonstrated, the adoption of laparoscopy has been limited. The purpose of this study was to evaluate clinical outcomes, hospital and payer characteristics of patients undergoing robotic-assisted, laparoscopic, and open elective sigmoidectomy for diverticular disease in the United States.
METHODS: This is a retrospective propensity score-matched analysis. The Premier Healthcare Database was queried for patients with diverticular disease. Patients with diverticular disease who underwent robotic-assisted, laparoscopic, and open sigmoidectomy for diverticular disease from January 2013 through September 2015 were included. Propensity-score matching (1:1) facilitated comparison of robotic-assisted versus open approach and robotic-assisted versus laparoscopic approach. Peri-operative outcomes were assessed for both comparisons.
RESULTS: There were several outcomes advantages for the robotic-assisted approach when compared to laparoscopic and open sigmoidectomy for diverticular disease that included significantly fewer conversions to open (P = .0002), shorter hospital length of stay, fewer postoperative complications-ileus, wound complications, and acute renal failure-and more patients discharged directly to home.
CONCLUSIONS: The robotic-assisted minimally invasive approach to elective sigmoidectomy for diverticular disease results in favorable intra-operative and postoperative outcomes when compared to laparoscopic and open approaches.},
}
@article {pmid30671801,
year = {2020},
author = {Choi, KK and Martinolich, J and Canete, JJ and Valerian, BT and Chismark, DA and Ata, A and Lee, EC},
title = {Elective Laparoscopic Sigmoid Colectomy for Diverticulitis-an Updated Look at Recurrence After Surgery.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {24},
number = {2},
pages = {388-395},
pmid = {30671801},
issn = {1873-4626},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Colectomy ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/complications/*surgery ; Elective Surgical Procedures ; Female ; Follow-Up Studies ; Humans ; Irritable Bowel Syndrome/complications ; Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Recurrence ; Retrospective Studies ; Risk Factors ; Surveys and Questionnaires ; },
abstract = {BACKGROUND: Surgical management of diverticulitis is evolving and the decision to offer elective sigmoidectomy for diverticulitis has become more individualized. However, preoperative variables that may predict recurrent diverticulitis after resection and guide surgical decision-making were not well studied.
METHODS: This was a retrospective chart review with a prospective questionnaire follow-up of patients. Patients who underwent elective sigmoidectomy for diverticulitis from 2002 to 2016 at a tertiary academic colorectal surgery practice were included and their medical records reviewed. They were then contacted with a questionnaire to inquire about recurrence of diverticulitis since resection. The primary outcome was rate of recurrent diverticulitis after elective sigmoidectomy. The secondary outcome was risk factors for recurrence after sigmoidectomy.
RESULTS: Of 662 patients who underwent elective sigmoidectomy for diverticulitis, 361 had long-term follow-up data available. Mean follow-up was 86 months. Indication for surgery was uncomplicated recurrent diverticulitis in 50%. Recurrent diverticulitis developed in 15 (4.2%) patients. Mean time to recurrence was 55 (range, 6-109) months. All recurrences were confirmed by CT scan. Univariate analysis showed that preoperative diagnosis of irritable bowel syndrome and uncomplicated recurrent diverticulitis was significantly more prevalent in patients who experienced recurrent diverticulitis after sigmoidectomy (p = 0.049 and p = 0.02); however, these variables did not predict recurrence after resection.
CONCLUSIONS: Overall rate of recurrent diverticulitis after elective sigmoidectomy was 4.2%. Preoperative diagnosis of irritable bowel syndrome and uncomplicated recurrent diverticulitis was associated with but not significant predictor of recurrence after elective resection.},
}
@article {pmid30668711,
year = {2019},
author = {He, E and Alison, R and Blanks, R and Pirie, K and Reeves, G and Ward, RL and Steele, R and Patnick, J and Canfell, K and Beral, V and Green, J},
title = {Association of ten gastrointestinal and other medical conditions with positivity to faecal occult blood testing in routine screening: a large prospective study of women in England.},
journal = {International journal of epidemiology},
volume = {48},
number = {2},
pages = {549-558},
pmid = {30668711},
issn = {1464-3685},
support = {/MRC_/Medical Research Council/United Kingdom ; /CRUK_/Cancer Research UK/United Kingdom ; },
mesh = {Aged ; Colorectal Neoplasms/*diagnosis/epidemiology ; England/epidemiology ; Female ; Gastrointestinal Hemorrhage/*etiology ; Hematologic Diseases/*diagnosis/epidemiology ; Humans ; Inflammatory Bowel Diseases/*diagnosis/epidemiology ; Logistic Models ; Mass Screening/methods ; Middle Aged ; *Occult Blood ; Prospective Studies ; Time Factors ; },
abstract = {BACKGROUND: In 2006, the Bowel Cancer Screening Programme (BCSP) in England began offering biennial faecal occult blood testing (FOBt) at ages 60-69 years. Although FOBt is aimed at detecting colorectal neoplasms, other conditions can affect the result. In a large UK prospective study, we examined associations, both before and after screening, between FOBt positivity and 10 conditions that are often associated with gastrointestinal bleeding.
METHODS: By electronically linking BCSP and Million Women Study records, we identified 604 495 women without previous colorectal cancer who participated in their first routine FOBt screening between 2006 and 2012. Regression models, using linked national hospital admission records, yielded adjusted relative risks (RRs) in FOBt-positive versus FOBt-negative women for colorectal cancer, adenoma, diverticular disease, inflammatory bowel disease, haemorrhoids, upper gastrointestinal cancer, oesophagitis, peptic ulcer, anaemia and other haematological disorders.
RESULTS: RRs in FOBt-positive versus FOBt-negative women were 201.3 (95% CI 173.8-233.2) for colorectal cancer and 197.9 (95% CI 180.6-216.8) for adenoma within 12 months after screening and 3.49 (95% CI 2.31-5.26) and 4.88 (95% CI 3.80-6.26), respectively, 12-24 months after screening; P < 0.001 for all RRs. In the 12 months after screening, the RR for inflammatory bowel disease was 26.3 (95% CI 19.9-34.7), and ranged between 2 and 5 for the upper gastrointestinal or haematological disorders. The RRs of being diagnosed with any of the eight conditions other than colorectal neoplasms before screening, and in the 12-24 months after screening, were 1.81 (95% CI 1.81-2.01) and 1.92 (95% CI 1.66-2.13), respectively.
CONCLUSIONS: Whereas FOBt positivity is associated with a substantially increased risk of colorectal neoplasms after screening, eight other gastrointestinal and haematological conditions are also associated with FOBt positivity, both before and after screening.},
}
@article {pmid30661054,
year = {2019},
author = {Schafmayer, C and Harrison, JW and Buch, S and Lange, C and Reichert, MC and Hofer, P and Cossais, F and Kupcinskas, J and von Schönfels, W and Schniewind, B and Kruis, W and Tepel, J and Zobel, M and Rosendahl, J and Jacobi, T and Walther-Berends, A and Schroeder, M and Vogel, I and Sergeev, P and Boedeker, H and Hinrichsen, H and Volk, A and Erk, JU and Burmeister, G and Hendricks, A and Hinz, S and Wolff, S and Böttner, M and Wood, AR and Tyrrell, J and Beaumont, RN and Langheinrich, M and Kucharzik, T and Brezina, S and Huber-Schönauer, U and Pietsch, L and Noack, LS and Brosch, M and Herrmann, A and Thangapandi, RV and Schimming, HW and Zeissig, S and Palm, S and Focke, G and Andreasson, A and Schmidt, PT and Weitz, J and Krawczak, M and Völzke, H and Leeb, G and Michl, P and Lieb, W and Grützmann, R and Franke, A and Lammert, F and Becker, T and Kupcinskas, L and D'Amato, M and Wedel, T and Datz, C and Gsur, A and Weedon, MN and Hampe, J},
title = {Genome-wide association analysis of diverticular disease points towards neuromuscular, connective tissue and epithelial pathomechanisms.},
journal = {Gut},
volume = {68},
number = {5},
pages = {854-865},
doi = {10.1136/gutjnl-2018-317619},
pmid = {30661054},
issn = {1468-3288},
support = {MC_PC_17228/MRC_/Medical Research Council/United Kingdom ; MC_QA137853/MRC_/Medical Research Council/United Kingdom ; },
mesh = {Adult ; Aged ; Case-Control Studies ; Colonic Diseases/*genetics/pathology ; Connective Tissue/*physiology ; Databases, Genetic ; Diverticular Diseases/*genetics/pathology ; Epithelium/*physiology ; Female ; Genetic Predisposition to Disease/genetics ; *Genome-Wide Association Study ; Humans ; Male ; Middle Aged ; Neuromuscular Junction/*physiology ; United Kingdom ; },
abstract = {OBJECTIVE: Diverticular disease is a common complex disorder characterised by mucosal outpouchings of the colonic wall that manifests through complications such as diverticulitis, perforation and bleeding. We report the to date largest genome-wide association study (GWAS) to identify genetic risk factors for diverticular disease.
DESIGN: Discovery GWAS analysis was performed on UK Biobank imputed genotypes using 31 964 cases and 419 135 controls of European descent. Associations were replicated in a European sample of 3893 cases and 2829 diverticula-free controls and evaluated for risk contribution to diverticulitis and uncomplicated diverticulosis. Transcripts at top 20 replicating loci were analysed by real-time quatitative PCR in preparations of the mucosal, submucosal and muscular layer of colon. The localisation of expressed protein at selected loci was investigated by immunohistochemistry.
RESULTS: We discovered 48 risk loci, of which 12 are novel, with genome-wide significance and consistent OR in the replication sample. Nominal replication (p<0.05) was observed for 27 loci, and additional 8 in meta-analysis with a population-based cohort. The most significant novel risk variant rs9960286 is located near CTAGE1 with a p value of 2.3×10[-10] and 0.002 (ORallelic=1.14 (95% CI 1.05 to 1.24)) in the replication analysis. Four loci showed stronger effects for diverticulitis, PHGR1 (OR 1.32, 95% CI 1.12 to 1.56), FAM155A-2 (OR 1.21, 95% CI 1.04 to 1.42), CALCB (OR 1.17, 95% CI 1.03 to 1.33) and S100A10 (OR 1.17, 95% CI 1.03 to 1.33).
CONCLUSION: In silico analyses point to diverticulosis primarily as a disorder of intestinal neuromuscular function and of impaired connective fibre support, while an additional diverticulitis risk might be conferred by epithelial dysfunction.},
}
@article {pmid30647541,
year = {2019},
author = {Lightner, AL and Cima, R},
title = {Use of the Rochester Epidemiology Project for Clinical Research in Colon and Rectal Surgery.},
journal = {Clinics in colon and rectal surgery},
volume = {32},
number = {1},
pages = {8-15},
pmid = {30647541},
issn = {1531-0043},
support = {R01 AG034676/AG/NIA NIH HHS/United States ; },
abstract = {The Rochester Epidemiology Project (REP), a longitudinal population-based database, is the largest epidemiologic database in the world. Originally established at Mayo Clinic in Rochester, Minnesota, the REP has been instrumental in defining the natural history of disease states and the impact of treatment in a well-defined population. In the United States, the REP has made important contributions to the colon and rectal literature, largely because healthcare is fragmented with no unique identifier to longitudinally follow-up with a patient throughout the system over his or her lifespan. Investigation with the REP has provided insight to the economic burden associated with inflammatory bowel disease, the benefit of screening for colorectal cancer, and the natural history of Mekel's and diverticular disease. In addition to practice changing research, the REP can be used as a model for future linkage systems in the United States.},
}
@article {pmid30645917,
year = {2018},
author = {Ozturk, O and Koklu, H and Akbal, E and Aksoy, EK and Altan, E and Basar, O and Yuksel, O and Arslan, S and Koklu, S},
title = {Diverticular disease and posture during defecation : a prospective comparative study.},
journal = {Acta gastro-enterologica Belgica},
volume = {81},
number = {4},
pages = {490-495},
pmid = {30645917},
issn = {1784-3227},
mesh = {*Defecation/physiology ; Diverticulosis, Colonic/*epidemiology ; Female ; Humans ; *Posture ; Prevalence ; Prospective Studies ; },
abstract = {BACKGROUND AND STUDY AIMS: Although several factors are thought to be responsible for the development of colonic diverticulosis (CD), the underlying pathogenesis is still obscure and needs clarification. The aim of this study was to determine the prevalence, location and clinical features of CD and especially to detect whether there is an association between CD and postures during defecation.
PATIENTS AND METHODS: This prospective study enrolled 757 patients. The subjects were divided into two groups as a diverticulosis group (D group, n:95) and non-diverticulosis group (non-D group, n:662).
RESULTS: The median patient age was 54.9±13.2 years. CD frequency was 12.5% (n:95). The most commonly involved part of the colon was the sigmoid colon (56.8%). Diverticula location was on the left in 45.3% (n:43), on the right in 24.2% (n:23) and on both sides of the colon in 30.5% (n:29). Patients in the D group were older (p<0.001) and were predominantly female (p:0.04). The frequency of sitting during defecation (Western type toilet) was higher in the D group compared to the non-D group (72.2% vs 53.5%; p:0.007). The use-time of a Western-type toilet was longer in the D group compared to the non-D group (p:0.04). In multivariable logistic regression analysis, age and toilet type were independent risk factors for the development of diverticulosis.
CONCLUSION: Sitting during defecation seems to increase the risk of CD.},
}
@article {pmid30631757,
year = {2018},
author = {Sharara, AI and Ziade, N and Shayto, RH and Rustom, LBO and Chehab, H and Rimmani, HH and Hanna, K and Chalhoub, JM and Sarkis, FS and Rahal, MA and Soweid, A and Mourad, FH and Barada, K and Harb, AH},
title = {The Natural History of Incidental Colonic Diverticulosis on Screening Colonoscopy.},
journal = {Canadian journal of gastroenterology & hepatology},
volume = {2018},
number = {},
pages = {3690202},
pmid = {30631757},
issn = {2291-2797},
mesh = {Acute Disease ; Aged ; Ambulatory Care/statistics & numerical data ; Colonoscopy/*statistics & numerical data ; Cross-Sectional Studies ; Diverticular Diseases/complications/*epidemiology ; Diverticulosis, Colonic/diagnosis/*epidemiology/etiology ; Female ; Gastrointestinal Hemorrhage/complications/*epidemiology ; Humans ; Incidence ; Male ; Mass Screening/*statistics & numerical data ; Middle Aged ; Multivariate Analysis ; Prospective Studies ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND: The natural history of colonic diverticulosis is unclear.
METHODS: Patients with incidental diverticulosis identified in a previous prospective cross-sectional screening colonoscopy study were evaluated retrospectively for clinic or hospital visit(s) for diverticular disease (DD= acute diverticulitis or diverticular bleeding) using review of electronic health records and patient phone interview.
RESULTS: 826 patients were included in the screening colonoscopy study. Three were excluded for prior DD. In all, 224 patients (27.2%; mean age 62.3 ± 8.2) had incidental diverticulosis distributed in the left colon (67.4%), right colon (5.8%), or both (22.8%). Up-to-date information was available on 194 patients. Of those, 144 (74.2%) could be reached for detailed interview and constituted the study population. Over a mean follow-up of 7.0 ± 1.7 years, DD developed in 6 out of 144 patients (4.2%) (4 acute cases of diverticulitis, 1 probable case of diverticular bleeding, and 1 acute case of diverticulitis and diverticular bleeding). Two patients were hospitalized, and none required surgery. The time to event was 5.1 ± 1.6 years and the incidence rate was 5.9 per 1000 patient-years. On multivariate analysis, none of the variables collected at baseline colonoscopy including age, gender, obesity, exercise, fiber intake, alcohol use, constipation, or use of NSAIDs were associated with DD.
CONCLUSION: The natural history of incidental diverticulosis on screening colonoscopy was highly favorable in this well-defined prospectively identified cohort. The common scenario of incidental diverticulosis at screening colonoscopy makes this information clinically relevant and valuable to physicians and patients alike.},
}
@article {pmid30625484,
year = {2019},
author = {Nagata, N and Ishii, N and Manabe, N and Tomizawa, K and Urita, Y and Funabiki, T and Fujimori, S and Kaise, M},
title = {Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association.},
journal = {Digestion},
volume = {99 Suppl 1},
number = {},
pages = {1-26},
doi = {10.1159/000495282},
pmid = {30625484},
issn = {1421-9867},
mesh = {Diverticulitis, Colonic/diagnosis/therapy ; Diverticulosis, Colonic/diagnosis/*therapy ; Gastrointestinal Hemorrhage/diagnosis/*therapy ; Humans ; },
abstract = {Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.},
}
@article {pmid30620240,
year = {2019},
author = {Caso, R and Chang, H and Marshall, MB},
title = {Evolving Options in Management of Minimally Invasive Diverticular Disease: A Single Surgeon's Experience and Review of the Literature.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {29},
number = {6},
pages = {780-784},
doi = {10.1089/lap.2018.0711},
pmid = {30620240},
issn = {1557-9034},
mesh = {Adult ; Aged ; Diverticulum/surgery ; Diverticulum, Esophageal/*surgery ; Esophagus/*surgery ; Female ; Follow-Up Studies ; Fundoplication/*methods ; Herniorrhaphy ; Humans ; Length of Stay ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/*methods ; Myotomy/methods ; Retrospective Studies ; Surgeons ; Thoracic Surgery, Video-Assisted/methods ; Thoracoscopy/methods ; Thoracotomy/methods ; },
abstract = {Background: Esophageal thoracic diverticular disease is a rare condition resulting from multiple etiologies. Surgical management is recommended when symptomatic. Traditionally, a thoracotomy was considered the standard approach; however, the use of minimally invasive approaches has been associated with improved outcomes. Methods: We retrospectively reviewed a single surgeon's experience with minimally invasive esophageal diverticulectomy. Results: Fifteen patients with symptomatic esophageal diverticular disease underwent minimally invasive diverticulectomy between 2005 and 2018. Most patients (86.7%) had epiphrenic diverticula and 53.3% underwent a video-assisted thoracoscopic surgery approach. All patients had a diverticulectomy, while 14 patients (93.3%) also had an esophageal myotomy. Three patients (20%) underwent an extended myotomy, 4 patients (26.7%) underwent a concomitant fundoplication, and 2 patients (13.3%) underwent a concomitant paraesophageal hernia repair. Median length of hospital stay was 2 days (range, 1-16 days). There were no mortalities. Two patients (13.3%) were readmitted with delayed esophageal leaks. Median follow-up was 10.7 months (range, 10 days to 6.3 years). One patient presented with recurrent disease 5 years after his initial operation. Conclusions: In experienced hands, a minimally invasive diverticulectomy is safe, effective, and associated with excellent patient outcomes. A minimally invasive approach should be performed when possible and should be tailored to the individual patient's disease and preoperative workup.},
}
@article {pmid30609274,
year = {2019},
author = {Cirocchi, R and Popivanov, G and Binda, GA and Henry, BM and Tomaszewski, KA and Davies, RJ and Di Saverio, S},
title = {Sigmoid resection for diverticular disease - to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta-analysis.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {21},
number = {6},
pages = {623-631},
doi = {10.1111/codi.14547},
pmid = {30609274},
issn = {1463-1318},
mesh = {Adult ; Aged ; Anastomotic Leak/epidemiology/etiology ; Colectomy/adverse effects/*methods ; Colon, Sigmoid/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Ligation/adverse effects/*methods ; Male ; Mesenteric Artery, Inferior/*surgery ; Middle Aged ; Non-Randomized Controlled Trials as Topic ; Randomized Controlled Trials as Topic ; Treatment Outcome ; },
abstract = {AIM: In colorectal cancer, ligation of the inferior mesenteric artery (IMA) is a standard surgical approach. In contrast, ligation of the IMA is not mandatory during treatment of diverticular disease. The object of this meta-analysis was to assess if preservation of the IMA reduces the risk of anastomotic leakage.
METHOD: A search was performed up to August 2018 using the following electronic databases: MEDLINE/PubMed, ISI Web of Knowledge and Scopus. The measures of treatment effect utilized risk ratios for dichotomous variables with calculation of the 95% CI. Data analysis was performed using the meta-analysis software Review Manager 5.3.
RESULTS: Eight studies met the inclusion criteria and were included in the meta-analysis: two randomized controlled trials (RCTs) and six non-RCTs with 2190 patients (IMA preservation 1353, ligation 837). The rate of anastomotic leakage was higher in the IMA ligation group (6%) than the IMA preservation group (2.4%), but this difference was not statistically significant [risk ratio (RR) 0.59, 95% CI 0.26-1.33, I[2] = 55%]. The conversion to laparotomy was significantly lower in the IMA ligation group (5.1%) than in the IMA preservation group (9%) (RR 1.74, 95% CI 1.14-2.65, I[2] = 0%). Regarding the other outcomes (anastomotic bleeding, bowel injury and splenic damage), no significant differences between the two techniques were observed.
CONCLUSION: This meta-analysis failed to demonstrate a statistically significant difference in the anastomotic leakage rate when comparing IMA preservation with IMA ligation. Thus, to date there is insufficient evidence to recommend the IMA-preserving technique as mandatory in resection for left-sided colonic diverticular disease.},
}
@article {pmid30593541,
year = {2019},
author = {Di Mario, F and Miraglia, C and Cambiè, G and Violi, A and Nouvenne, A and Franceschi, M and Brandimarte, G and Elisei, W and Picchio, M and Tursi, A},
title = {Long-term efficacy of rifaximin to manage the symptomatic uncomplicated diverticular disease of the colon.},
journal = {Journal of investigative medicine : the official publication of the American Federation for Clinical Research},
volume = {67},
number = {4},
pages = {767-770},
doi = {10.1136/jim-2018-000901},
pmid = {30593541},
issn = {1708-8267},
mesh = {Colon/*pathology ; Diverticular Diseases/*drug therapy/surgery ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Rifaximin/*therapeutic use ; Treatment Outcome ; },
abstract = {Although rifaximin is currently advised in managing symptomatic uncomplicated diverticular disease (SUDD) of the colon, no long-term data are available. This retrospective study assessed the outcome of a large cohort of patients with SUDD, treated with rifaximin, during an 8-year follow-up. The study group (group A) included 346 patients with SUDD (median age 64 years, IQR 58-69, 62.4% females), treated with rifaximin 800 mg/d for 7 days every month. The control group (group B) included 470 patients with SUDD (median age 65 years, IQR 59-74 years, 60.8% females), taking any other treatment on demand. Two symptoms (left lower abdominal pain and bloating) were assessed by a visual analog scale (VAS), graded from 0=no symptom to 10=the most severe symptom. Daily bowel movements were also reported. Median (IQR) VAS score for pain was 6 (5-7) in group A and 6 (6-7) in group B at baseline (p=0.109); at 8-year follow-up it was 3 (3-4) and 6 (5-7), respectively (p<0.000). Both bloating and daily bowel movements were significantly reduced in group A. Acute diverticulitis occurred in 9 (2.6%) patients in group A and in 21 (4.5%) patients in group B (p=0.155). Surgery occurred in 4 (1.2%) patients in group A and 9 (1.9%) in group B (p=0.432). Disease-related mortality occurred in no patient in group A and 2 (0.4%) patients in group B (p=0.239). No side effects were recorded during the entire study period. Rifaximin is effective to relieve symptoms and reduce the risk of disease-related complications in patients with SUDD.},
}
@article {pmid30585680,
year = {2019},
author = {Grass, F and Lovely, JK and Crippa, J and Ansell, J and Hübner, M and Mathis, KL and Larson, DW},
title = {Comparison of recovery and outcome after left and right colectomy.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {21},
number = {4},
pages = {481-486},
doi = {10.1111/codi.14543},
pmid = {30585680},
issn = {1463-1318},
mesh = {Adult ; Aged ; Colectomy/adverse effects/methods/*statistics & numerical data ; Crohn Disease/surgery ; Databases, Factual ; Elective Surgical Procedures/adverse effects/methods/*statistics & numerical data ; *Enhanced Recovery After Surgery ; Female ; Humans ; Ileus/*epidemiology/etiology ; Male ; Middle Aged ; Postoperative Complications/*epidemiology/etiology ; Postoperative Period ; Prospective Studies ; Recovery of Function ; Retrospective Studies ; Risk Factors ; },
abstract = {AIM: The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies.
METHOD: Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30-day complications, were compared between left-sided and right-sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI).
RESULTS: In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left-sided resections (> 30 kg/m[2] : 33% vs 27%, P = 0.004). Malignancy (29% vs 67%, P < 0.001) and Crohn's disease (1% vs 31%, P < 0.001) were preponderant in right colectomies, whereas diverticular disease (68% vs 1%, P < 0.001) was the most common indication for left colectomy. Compliance with the enhanced recovery pathway (ERP) was comparable. While the minimally invasive approach was the preferred approach for both sides (61% vs 64%, P = 0.158), left colectomies took longer (180 ± 80 min vs 150 ± 70 min, P < 0.001), needed more perioperative fluids (3.1 ± 1.4 l vs 2.7 ± 1.5 l, P < 0.001) and resulted in greater postoperative weight gain (3.9 ± 6.5 kg vs 2.6 ± 6 kg, P = 0.025). Crohn's disease (OR = 2.64, 95% CI: 1.27-5.46) and fluid overload (OR = 2.02, 95% CI: 1.06-3.82) were independent risk factors for POI.
CONCLUSION: Despite equal ERP compliance, postoperative ileus was higher after right-sided colectomies. This finding was associated with Crohn's disease and fluid overload.},
}
@article {pmid30583721,
year = {2018},
author = {Fagkrezos, D and Manes, K and Paraskeva, K and Lenos, M and Triantopoulou, C and Apessou, D and Maniatis, P},
title = {Secondary extramedullary plasmacytoma of sigmoid colon in a patient with multiple myeloma: a case report.},
journal = {Journal of medical case reports},
volume = {12},
number = {1},
pages = {379},
pmid = {30583721},
issn = {1752-1947},
mesh = {Abdominal Pain ; Aged ; Colectomy ; Colon, Sigmoid/*pathology ; Diverticulitis/*pathology/surgery ; Female ; Humans ; Intestinal Perforation/surgery ; Multiple Myeloma/*drug therapy/*pathology ; Plasmacytoma/*pathology/surgery ; Pneumoperitoneum/diagnostic imaging/*pathology ; Radiography, Abdominal ; *Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {BACKGROUND: Extramedullary plasmacytoma is an uncommon tumor that most often involves the nasopharynx or upper respiratory tract. Extramedullary plasmacytoma is a type of plasma cell neoplasm that can present as a primary tumor or secondary to another plasma cell neoplasm, such as multiple myeloma. Secondary extramedullary plasmacytoma is usually noted in the advanced stages of the disease. Involvement of the gastrointestinal tract occurs in approximately 10% of cases.
CASE PRESENTATION: A 71-year-old Caucasian woman with known diverticular disease of the colon and multiple myeloma diagnosed 3 years previously, with monoclonal bands of immunoglobulin A, lambda light chains, and multiple osteolytic lesions, presented to our hospital with abdominal pain, abdominal discomfort, and pneumoperitoneum. She underwent left colectomy for diverticulitis with perforation, and an extramedullary secondary colonic plasmacytoma was found in histopathological examination of the sigmoid colon.
CONCLUSIONS: Plasmacytoma is known to occur in extraosseous sites. The stomach and small intestine are the most commonly involved sites in the gastrointestinal tract. Secondary extramedullary plasmacytoma of the colon is rare. Colonic plasmacytoma may have varying clinical presentations, such as inflammatory bowel disease and multiple colonic strictures. Although these cases are rare, treating physicians as well as radiologists, pathologists, and surgeons should be aware of this entity.},
}
@article {pmid30574746,
year = {2018},
author = {Laghi, L and Mastromarino, P and Elisei, W and Capobianco, D and Zhu, CL and Picchio, M and Giorgetti, G and Brandimarte, G and Tursi, A},
title = {Impact of treatments on fecal microbiota and fecal metabolome in symptomatic uncomplicated diverticular disease of the colon: a pilot study.},
journal = {Journal of biological regulators and homeostatic agents},
volume = {32},
number = {5},
pages = {1421-1432},
pmid = {30574746},
issn = {0393-974X},
mesh = {Colon/microbiology/physiopathology ; Dietary Fiber/administration & dosage ; Diverticular Diseases/*microbiology/*therapy ; Dysbiosis ; Feces/*microbiology ; Female ; Humans ; Mesalamine/therapeutic use ; *Metabolome ; *Microbiota ; Pilot Projects ; Probiotics/*therapeutic use ; Rifaximin/therapeutic use ; },
abstract = {Symptomatic uncomplicated diverticular disease (SUDD) affects 50% of people having diverticulosis. We performed a pilot study assessing the effect of current treatments on fecal microbiota and metabolome in SUDD. Thirteen consecutive females with SUDD were treated with a 2-week therapeutic trial of 30 g/day fiber supplementation (3 patients), 1.6 g/day of mesalazine (3 patients), 900 billion/day of probiotic mixture VivoMixx® (3 patients), or 800 mg/day of rifaximin (4 patients). Stool samples were collected at entry (T0), at the end of the 2-week therapeutic course (T1), and 30 (T2) and 60 days (T3) after the end of the therapeutic course. Real-time PCR quantified targeted microorganisms. Fecal metabolome patterns were studied by high-resolution proton NMR spectroscopy. At cumulative analysis, symptoms significantly decreased at each time point during follow-up (p less than 0.0001), and only left-lower quadrant pain increased again at T3. The overall bacterial quantity was not altered by the treatments. The amount of Akkermansia muciniphila species was significantly reduced at T1 (p=0.017) and at T2 (p=0.026), while at T3 the reduction was not significant in comparison to enrollment (p=0.090). Fecal molecular profile showed significant changes at T1 and T2, while at T3 it became similar to that of T0. Differences were found for 18 of the quantified molecules (tryptophan, phenylalanine, tyrosine, 4-hydroxyphenylacetate, urocanate, X-6.363, X-5.779, uridylate, galactose, X-4.197, threonine, sarcosine, methionine, 2-oxoisocaproate, 5-aminolevulinate, alanine, leucine, valerate). Metabolome and microbiota changed in patients with SUDD under treatment, confirming a possible role of dysbiosis/dysmetabolome in the pathology.},
}
@article {pmid30574685,
year = {2019},
author = {Macina, S and Imperatore, M and Feleppa, C and Sucameli, F and Talamo, G and Falco, E and Berti, S},
title = {Side-to-Side Anastomosis In Left Hemicolectomy, Why and When: A Single-Center Experience.},
journal = {Surgical technology international},
volume = {34},
number = {},
pages = {183-186},
pmid = {30574685},
issn = {1090-3941},
mesh = {Anastomosis, Surgical/adverse effects/*methods ; Anastomotic Leak/etiology ; Colectomy/*methods ; Colon/*surgery ; Colonic Diseases/*surgery ; Female ; Humans ; Laparoscopy ; },
abstract = {BACKGROUND: Laparoscopic colectomy represents a safe, effective and well-established procedure for both benign and malignant colic disease. Transanal anastomosis (TA) with a circular stapler is the most commonly performed anastomotic technique in laparoscopic left hemicolectomy (LLH). We report our experience with side-to-side anastomosis (STSA) and side-to-end anastomosis (STEA) in selected patients with both emergency and elective LLH.
METHODS: A systematic review of the PubMed database was performed on recent studies that compared different anastomotic techniques after LLH. We collected internal data from June 2014 to July 2018 and compared our experience with the literature. The primary outcome was the anastomotic complication rate.
RESULTS: During the observation period, 158 patients underwent left hemicolectomy (LH). One-hundred-nineteen patients had malignant disease; 36 underwent surgery for complicated diverticular disease, one had a large strangulated incisional hernia, one had a sigmoid volvulus, and one had a sigmoid localization of endometriosis. Thirty open left hemicolectomies were performed. In 128 cases, a minimally invasive approach was used. Since conversion to open was necessary in 10 of these cases, 118 were totally LLH. STSA was performed in 64 cases; seven in an emergency setting and 57 in elective procedures. The overall anastomotic leak rate was 3.1% (2/64) and no anastomotic leak was reported in the emergency group (0/7). TA was performed in 15 cases, 93% in an elective setting (14/15), and the anastomotic leak rate was 13.3% (2/15). In 20 cases, we performed elective STEA and no anastomotic leak was recorded. In 19 cases, it was impossible to perform anastomosis and we decided to create a definitive colostomy.
CONCLUSION: Consistent with the literature data, our experience shows that, in selected cases, STSA and STEA are both safe and effective, with a lower anastomotic complication rate than TA.},
}
@article {pmid30574635,
year = {2018},
author = {Tursi, A and Mastromarino, P and Capobianco, D and Elisei, W and Picchio, M and Brandimarte, G},
title = {No changes in Interleukin-10 expression in symptomatic uncomplicated diverticular disease of the colon.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {27},
number = {4},
pages = {476-477},
doi = {10.15403/jgld.2014.1121.274.ink},
pmid = {30574635},
issn = {1842-1121},
mesh = {Aged ; Biomarkers/metabolism ; Colon/*metabolism ; Diverticulosis, Colonic/diagnosis/*metabolism ; Feces/chemistry ; Female ; Humans ; Interleukin-10/*metabolism ; Middle Aged ; Retrospective Studies ; },
}
@article {pmid30574628,
year = {2018},
author = {Trifan, A and Gheorghe, C and Marica Sabo, C and Diculescu, M and Nedelcu, L and Singeap, AM and Sfarti, C and Gheorghe, L and Sporea, I and Tanțău, M and Scripcariu, V and Goldiș, A and Gheonea, D and Manuc, M and Stanciu, C and Scarpignato, C and Dumitrascu, DD},
title = {Diagnosis and Treatment of Colonic Diverticular Disease: Position Paper of the Romanian Society of Gastroenterology and Hepatology.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {27},
number = {4},
pages = {449-457},
doi = {10.15403/jgld.2014.1121.274.rom},
pmid = {30574628},
issn = {1842-1121},
mesh = {Consensus ; Diverticulitis, Colonic/*diagnosis/epidemiology/*therapy ; Diverticulosis, Colonic/*diagnosis/epidemiology/*therapy ; Diverticulum, Colon/*diagnosis/epidemiology/*therapy ; Evidence-Based Medicine/standards ; Gastroenterology/*standards ; Humans ; Predictive Value of Tests ; Prevalence ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIMS: Diverticular disease of the colon is a common clinical condition in developed countries, and is associated with significant (direct and indirect) economic burden. The aim of this Position Paper is to provide clinical guidance for appropriate definition, prevalence, risk factors, diagnosis, and treatment of colonic diverticular disease.
METHODS: A working group of recognized experts established by the Board of the Romanian Society of Gastroenterology and Hepatology (RSGH) screened the literature and the available guidelines on colonic diverticular disease. Statements were formulated based on literature evidence. These statements were discussed within the working group and decision for each of them was taken by consensus.
RESULTS: Thirty two statements were elaborated. The grade of recommendation, according to the level of evidence was established for each statement. Short comments with literature support accompany each statement.
CONCLUSION: This Position Paper represents a practical guide for clinicians dealing with patients affected by colonic diverticular disease.},
}
@article {pmid30574613,
year = {2018},
author = {Tursi, A and Scarpignato, C and Brandimarte, G and Di Mario, F and Lanas, A},
title = {Rifaximin for the management of colonic diverticular disease: far beyond a simple antibiotic.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {27},
number = {4},
pages = {351-355},
doi = {10.15403/jgld.2014.1121.274.rif},
pmid = {30574613},
issn = {1842-1121},
mesh = {Anti-Bacterial Agents ; *Diverticulosis, Colonic ; *Diverticulum, Colon ; Humans ; Rifaximin ; },
}
@article {pmid30574326,
year = {2018},
author = {Hussey, M and Holleran, G and Stack, R and Moran, N and Tersaruolo, C and McNamara, D},
title = {Same-day colon capsule endoscopy is a viable means to assess unexplored colonic segments after incomplete colonoscopy in selected patients.},
journal = {United European gastroenterology journal},
volume = {6},
number = {10},
pages = {1556-1562},
pmid = {30574326},
issn = {2050-6406},
abstract = {BACKGROUND: Same-day colon capsule endoscopy (CCE) immediately following incomplete optical colonoscopy (OC) would have a number of advantages for patients, while also presenting unique procedural challenges including the effect of sedation on capsule propulsion and patient tolerance of protracted preparation and fasting.
AIM: The aim of this article is to prospectively assess the efficacy of same-day CCE after incomplete OC in an unselected patient cohort.
METHODS: This was an observational, prospective, single-centre study of CCE post-incomplete colonoscopies. Patients with an incomplete OC for any reason other than obstruction or inadequate bowel preparation were recruited. CCE was performed after a minimum of a one-hour fast. Once the patient was fully alert, intravenous metoclopramide was administered after capsule ingestion when possible, and a standard CCE booster protocol was then followed. Relevant clinical information was recorded. CCE completion rates, findings and their impact, and adverse events were noted.
RESULTS: Fifty patients were recruited, mean age = 57 years and 66% (n = 32) were female. Seventy-six per cent (n = 38) of CCEs were complete; however, full colonic views were obtained in 84% (n = 42) of cases. Patients > 50 years of age were five times more likely to have an incomplete CCE and there was also a trend towards known comorbidities associated with hypomobility having reduced excretion rates. Overall diagnostic yield for CCE in the unexplored segments was 74% (n = 37), with 26% (n = 13) of patients requiring significant changes in management based on CCE findings. The overall incremental yield was 38%. CCE findings were normal 26% (n = 13), polyps 38% (n = 19), inflammation 22% (n = 11), diverticular disease 25 (n = 12), angiodysplasia 3% (n = 1) and cancer 3% (n = 1). Significant small bowel findings were found in three (6%) cases, including Crohn's disease and a neuroendocrine tumour. A major adverse event occurred in one patient (2%), related to capsule retention.
CONCLUSION: Same-day CCE is a viable alternative means to assess unexplored segments of the colon after incomplete OC in selected patients.},
}
@article {pmid30561404,
year = {2018},
author = {Cambiè, G and Violi, A and Miraglia, C and Barchi, A and Nouvenne, A and Capasso, M and Leandro, G and Meschi, T and De' Angelis, GL and Di Mario, F},
title = {Development and usefulness of the new endoscopic classification: DICA.},
journal = {Acta bio-medica : Atenei Parmensis},
volume = {89},
number = {9-S},
pages = {113-118},
pmid = {30561404},
issn = {2531-6745},
mesh = {*Colonoscopy/adverse effects ; Constriction, Pathologic ; Diverticulitis/diagnostic imaging/pathology ; Diverticulosis, Colonic/*classification/diagnostic imaging/pathology ; Gastrointestinal Hemorrhage/etiology ; Humans ; *Severity of Illness Index ; Symptom Assessment ; },
abstract = {Colonic Diverticulosis is one of the most common anatomical findings during colonoscopy. This condition has 60% incidence in the population over 60 years old. About 20% of patients will develop Diverticular Disease, and 5% of them will evolve into Diverticulitis. Until the last years there weren't any approaches for the endoscopic classification of this pathology. In 2013, in Florence, the first endoscopic classification was developed: DICA (Diverticular Inflammation and Complication Assessment). The aim of this article is to focus on the process of the development and the validation of the classification by the pool of gastroenterology experts, and, as well, its usefulness during the clinical practice.},
}
@article {pmid30561403,
year = {2018},
author = {Violi, A and Cambiè, G and Miraglia, C and Barchi, A and Nouvenne, A and Capasso, M and Leandro, G and Meschi, T and De' Angelis, GL and Di Mario, F},
title = {Epidemiology and risk factors for diverticular disease.},
journal = {Acta bio-medica : Atenei Parmensis},
volume = {89},
number = {9-S},
pages = {107-112},
pmid = {30561403},
issn = {2531-6745},
mesh = {Adult ; Age Distribution ; Aged ; Comorbidity ; Developed Countries ; Developing Countries ; Diet ; Diverticular Diseases/*epidemiology/physiopathology ; Female ; Gastrointestinal Microbiome ; Gastrointestinal Motility ; Global Health ; Humans ; Incidence ; Life Style ; Male ; Middle Aged ; Obesity/epidemiology ; Prevalence ; Risk Factors ; Serotonin/physiology ; },
abstract = {Diverticulosis of the colon is the most frequent anatomical alteration diagnosed at colonoscopy. The prevalence of the disease is higher in elderly patients over 65 years old, recent studies show an increment also in youngers over 40 years old. Even its large prevalence in the population, its pathophysiology still remain poorly understood. It's widely accepted that diverticula are likely to be the result of complex interactions among genetic factors, alteration of colonic motility, lifestyle conditions such as smoking, obesity, alcohol consumption, fiber and meat intake with diet. Recently many authors considered also alterations in colonic microbiota composition, co-morbidity with diabetes and hypertension and the chronic assumption of certain medications like PPI, ARB and aspirin, as important risk factors for the development of diverticulosis. The aim of this narrative review is to summarise current knowledges on this topic.},
}
@article {pmid30522789,
year = {2019},
author = {Lenti, MV and Pasina, L and Cococcia, S and Cortesi, L and Miceli, E and Caccia Dominioni, C and Pisati, M and Mengoli, C and Perticone, F and Nobili, A and Di Sabatino, A and Corazza, GR and , },
title = {Mortality rate and risk factors for gastrointestinal bleeding in elderly patients.},
journal = {European journal of internal medicine},
volume = {61},
number = {},
pages = {54-61},
doi = {10.1016/j.ejim.2018.11.003},
pmid = {30522789},
issn = {1879-0828},
mesh = {Aged ; Aged, 80 and over ; Female ; Gastrointestinal Hemorrhage/etiology/*mortality ; Hospital Mortality ; Humans ; Italy/epidemiology ; Length of Stay/*statistics & numerical data ; Logistic Models ; Male ; *Multimorbidity ; Multivariate Analysis ; Platelet Aggregation Inhibitors/adverse effects ; Prospective Studies ; Registries ; Risk Factors ; Severity of Illness Index ; },
abstract = {BACKGROUND: Gastrointestinal bleeding (GIB) is burdened by high mortality rate that increases with aging. Elderly patients may be exposed to multiple risk factors for GIB. We aimed at defining the impact of GIB in elderly patients.
METHODS: Since 2008, samples of elderly patients (age ≥ 65 years) with multimorbidity admitted to 101 internal medicine wards across Italy have been prospectively enrolled and followed-up (REPOSI registry). Diagnoses of GIB, length of stay (LOS), mortality rate, and possible risk factors, including drugs, index of comorbidity (Cumulative Illness Rating Scale [CIRS]), polypharmacy, and chronic diseases were assessed. Adjusted multivariate logistic regression models were computed.
RESULTS: 3872 patients were included (mean age 79 ± 7.5 years, F:M ratio 1.1:1). GIB was reported in 120 patients (mean age 79.6 ± 7.3 years, F:M 0.9:1), with a crude prevalence of 3.1%. Upper GIB occurred in 72 patients (mean age 79.3 ± 7.6 years, F:M 0.8:1), lower GIB in 51 patients (mean age 79.4 ± 7.1 years, F:M 0.9:1), and both upper/lower GIB in 3 patients. Hemorrhagic gastritis/duodenitis and colonic diverticular disease were the most common causes. The LOS of patients with GIB was 11.7 ± 8.1 days, with a 3.3% in-hospital and a 9.4% 3-month mortality rates. Liver cirrhosis (OR 5.64; CI 2.51-12.65), non-ASA antiplatelet agents (OR 2.70; CI 1.23-5.90), and CIRS index of comorbidity >3 (OR 2.41; CI 1.16-4.98) were associated with GIB (p < 0.05).
CONCLUSIONS: A high index of comorbidity is associated with high odds of GIB in elderly patients. The use of non-ASA antiplatelet agents should be discussed in patients with multimorbidity.},
}
@article {pmid30511196,
year = {2019},
author = {Kline, BP and Schieffer, KM and Choi, CS and Connelly, T and Chen, J and Harris, L and Deiling, S and Yochum, GS and Koltun, WA},
title = {Multifocal Versus Conventional Unifocal Diverticulitis: A Comparison of Clinical and Transcriptomic Characteristics.},
journal = {Digestive diseases and sciences},
volume = {64},
number = {11},
pages = {3143-3151},
pmid = {30511196},
issn = {1573-2568},
mesh = {Adult ; Cohort Studies ; Diverticulitis, Colonic/*diagnostic imaging/*genetics/surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sequence Analysis, RNA/*methods ; Transcriptome/*genetics ; },
abstract = {BACKGROUND: The management of diverticulitis is compromised by difficulty in identifying patients who require surgery for recurrent or persistent disease. Here, we introduce the concept of multifocal diverticulitis (MFD), characterized by multiple episodes of diverticulitis occurring at different locations within the colon.
AIMS: To compare clinical characteristics, success of surgical management, and colonic transcriptomes of MFD patients to patients with conventional unifocal diverticulitis (UFD).
METHODS: This retrospective study included 404 patients with CT-confirmed diverticulitis episodes. Patients with diverticulitis seen in at least two different colonic locations were classified as the MFD group and compared to the UFD group based on number of episodes, sites of disease, family history, surgeries performed, and postoperative recurrence. RNA-seq was conducted on full-thickness colonic tissues of ten MFD and 11 UFD patients.
RESULTS: Twenty-eight patients (6.9%) with MFD were identified. MFD patients had more diverticulitis episodes and were more likely to have positive family history, have right-sided disease, require surgery, and have recurrence after surgery. All MFD patients treated with segmental resection had recurrence, while recurrence was less common in patients undergoing more extensive surgery (P < 0.001). Using RNA-seq, we identified 69 genes that were differentially expressed between MFD and UFD patients. Significantly down-regulated genes were associated with immune response pathways.
CONCLUSIONS: MFD appears to be a more severe subset of diverticulitis with a possible genetic component. Transcriptomic data suggest that MFD may be associated with alteration of the immune response.},
}
@article {pmid30510761,
year = {2018},
author = {Dhadlie, S and Mehanna, D},
title = {Rates of colorectal cancer detection in screening colonoscopy post appendicectomy in patients 50 years and over.},
journal = {Annals of medicine and surgery (2012)},
volume = {36},
number = {},
pages = {239-241},
pmid = {30510761},
issn = {2049-0801},
abstract = {INTRODUCTION: Acute appendicitis in older adults is relatively uncommon and could be the first presentation of an underlying colorectal carcinoma. Colonoscopy in these individuals affords the opportunity for earlier diagnosis and treatment. The finding of increased rates of colorectal cancer (CRC) with older patients who have had appendicitis was supported by a number of small studies and case reports in the early 1980s.With the advent of CT scanning and laparoscopic appendicectomy, increased ability to visualize the caecum has been achieved.
PURPOSE: A retrospective 12-month study of all patients presenting with acute appendicitis aged 50 years and over from 1st May 2017 to 31st May 2018, and review of post operative screening colonoscopy findings.
RESULTS: Forty-three patients met inclusion criteria. The patients' median age was 62 years (range 50-85 years). 47% of the patients were male. 86% of patients had abdominal CT scans prior to surgery with acute appendicitis visualized in 97% of these cases. Acute appendicitis was found in 100% of cases with no clinical suggestion of CRC operatively or pathologically. 46% of patients had pertinent findings on colonoscopy. This included a malignant obstructing tumour at the hepatic flexure and a tubular adenoma in the transverse colon in a second patient. The remaining findings in this cohort of patients included diverticular disease and benign polyps.
CONCLUSION: Despite the advancement in visualization of anatomy with CT scan and laparoscopic appendicectomy there is still a role for screening colonoscopy in patients greater than 50 years of age with appendicitis particularly if they have associated bowel symptoms or risk factors for CRC.},
}
@article {pmid30487956,
year = {2018},
author = {Jones, K and Qassem, MG and Sains, P and Baig, MK and Sajid, MS},
title = {Robotic total meso-rectal excision for rectal cancer: A systematic review following the publication of the ROLARR trial.},
journal = {World journal of gastrointestinal oncology},
volume = {10},
number = {11},
pages = {449-464},
pmid = {30487956},
issn = {1948-5204},
abstract = {AIM: To compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision (RTME) vs laparoscopic total meso-rectal excision (LTME).
METHODS: Standard medical electronic databases such as PubMed, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in patients undergoing RTME vs LTME was analysed using the principles of meta-analysis. The operative, post-operative and oncological outcomes were evaluated to assess the effectiveness of both techniques of TME. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).
RESULTS: One RCT (ROLARR trial) and 27 other comparative studies reporting the non-oncological and oncological outcomes following RTME vs LTME were included in this review. In the random effects model analysis using the statistical software Review Manager 5.3, the RTME was associated with longer operation time (SMD, 0.46; 95%CI: 0.25, 0.67; z = 4.33; P = 0.0001), early passage of first flatus (P = 0.002), lower risk of conversion (P = 0.00001) and shorter hospitalization (P = 0.01). The statistical equivalence was seen between RTME and LTME for non-oncological variables like blood loss, morbidity, mortality and re-operation risk. The oncological variables such as recurrence (P = 0.96), number of harvested nodes (P = 0.49) and positive circumferential resection margin risk (P = 0.53) were also comparable in both groups. The length of distal resection margins was similar in both groups.
CONCLUSION: RTME is feasible and oncologically safe but failed to demonstrate any superiority over LTME for many surgical outcomes except early passage of flatus, lower risk of conversion and shorter hospitalization.},
}
@article {pmid30487459,
year = {2018},
author = {Dreher, ML},
title = {Whole Fruits and Fruit Fiber Emerging Health Effects.},
journal = {Nutrients},
volume = {10},
number = {12},
pages = {},
pmid = {30487459},
issn = {2072-6643},
support = {NA//Hass Avocado Board/ ; },
mesh = {Cardiovascular Diseases ; *Diet ; *Dietary Fiber ; *Feeding Behavior ; *Fruit ; Gastrointestinal Diseases ; *Health ; Humans ; Mental Disorders ; Metabolic Diseases ; Neoplasms ; Respiratory Tract Diseases ; },
abstract = {Less than 10% of most Western populations consume adequate levels of whole fruits and dietary fiber with typical intake being about half of the recommended levels. Evidence of the beneficial health effects of consuming adequate levels of whole fruits has been steadily growing, especially regarding their bioactive fiber prebiotic effects and role in improved weight control, wellness and healthy aging. The primary aim of this narrative review article is to examine the increasing number of health benefits which are associated with the adequate intake of whole fruits, especially fruit fiber, throughout the human lifecycle. These potential health benefits include: protecting colonic gastrointestinal health (e.g., constipation, irritable bowel syndrome, inflammatory bowel diseases, and diverticular disease); promoting long-term weight management; reducing risk of cardiovascular disease, type 2 diabetes and metabolic syndrome; defending against colorectal and lung cancers; improving odds of successful aging; reducing the severity of asthma and chronic obstructive pulmonary disease; enhancing psychological well-being and lowering the risk of depression; contributing to higher bone mineral density in children and adults; reducing risk of seborrheic dermatitis; and helping to attenuate autism spectrum disorder severity. Low whole fruit intake represents a potentially more serious global population health threat than previously recognized, especially in light of the emerging research on whole fruit and fruit fiber health benefits.},
}
@article {pmid30466667,
year = {2019},
author = {Pearlman, M and Akpotaire, O},
title = {Diet and the Role of Food in Common Gastrointestinal Diseases.},
journal = {The Medical clinics of North America},
volume = {103},
number = {1},
pages = {101-110},
doi = {10.1016/j.mcna.2018.08.008},
pmid = {30466667},
issn = {1557-9859},
mesh = {Dairy Products ; *Diet ; Food ; Gastrointestinal Diseases/*diet therapy/etiology ; Gastrointestinal Tract/physiopathology ; Humans ; Sweetening Agents ; },
abstract = {Food plays an essential role in normal cellular processes; however, certain foods may also trigger or worsen certain disease states. This article focuses particularly on the role of food in common gastrointestinal and liver diseases, and discusses the current evidence that either supports or debunks common dietary recommendations. Nutrition topics discussed include the use of artificial sweetener for weight loss, avoidance of all dairy products in the setting of lactose intolerance, dietary recommendations for diverticular disease, and dietary management in cirrhotic patients with hepatic encephalopathy.},
}
@article {pmid30464167,
year = {2018},
author = {Strati, TM and Sapalidis, K and Koimtzis, GD and Pavlidis, E and Atmatzidis, S and Liavas, L and Chrysogonidis, I and Samoilis, G and Zarampouka, K and Michailidou, K and Kesisoglou, II and Kosmidis, C},
title = {Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature.},
journal = {The American journal of case reports},
volume = {19},
number = {},
pages = {1386-1392},
pmid = {30464167},
issn = {1941-5923},
mesh = {Aged ; Cecal Diseases/diagnosis/*etiology/surgery ; Diverticulitis, Colonic/*complications/diagnosis/surgery ; Female ; Humans ; Intestinal Fistula/*diagnosis/*etiology/surgery ; Intestinal Obstruction/diagnosis/*etiology/surgery ; Sigmoid Diseases/diagnosis/*etiology/surgery ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND Although diverticular disease is well described and treated in daily clinical practice, there are cases that attract great interest because of their complexity and difficulty in management. Herein, we describe a rare case of colo-colonic fistula-complicated diverticulitis that necessitated urgent surgical intervention. CASE REPORT A 76-year-old female patient with a known history of diverticular disease of the sigmoid colon presented in the Emergency Department for evaluation of left lower quadrant abdominal pain. The clinical and radiological examinations revealed a recurrent episode of acute diverticulitis of the sigmoid colon. However, it was of great interest that we detected a sigmoido-cecal fistula in the abdominal computed tomography (CT). The patient was admitted to the hospital for conservative treatment. After 48 hours, the patient's clinical status deteriorated, with pain aggravation, abdominal distension, bloating, and metallic bowel sounds. The simple abdominal x-ray revealed large-bowel obstruction and the CT demonstrated worsening inflammation of the sigmoid colon. An exploratory laparotomy revealed an inflamed dolichol-sigmoid colon forming a fistulous tract with the cecum and thus, mimicking a closed loop obstruction. The sigmoid colon was transected en bloc with the sigmoido-cecal fistula and a Hartmann's procedure was performed. CONCLUSIONS This case is extremely unusual as the patient presented at the same time two complications of diverticular disease, both obstruction and this rare formation of sigmoido-cecal fistula. It is presented in order to acquaint surgeons with the possibility of an unexpected course of this disease which indeed necessitates an individualized management.},
}
@article {pmid30458857,
year = {2018},
author = {Partington, R and Helliwell, T and Muller, S and Abdul Sultan, A and Mallen, C},
title = {Comorbidities in polymyalgia rheumatica: a systematic review.},
journal = {Arthritis research & therapy},
volume = {20},
number = {1},
pages = {258},
pmid = {30458857},
issn = {1478-6362},
support = {RP_2014-04-026/DH_/Department of Health/United Kingdom ; },
mesh = {Age Factors ; Comorbidity ; Cross-Sectional Studies ; Giant Cell Arteritis/diagnosis/epidemiology ; Humans ; Neoplasms/diagnosis/epidemiology ; Polymyalgia Rheumatica/*diagnosis/*epidemiology ; Prospective Studies ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND AND AIM: Comorbidities are known to exist in many rheumatological conditions. Polymyalgia rheumatica (PMR) is a common inflammatory rheumatological condition affecting older people which, prior to effective treatment, causes severe disability. Our understanding of associated comorbidities in PMR is based only on case reports or series and small cohort studies. The objective of this study is to review systematically the existing literature on the comorbidities associated with PMR.
METHODS: MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched for original observational research from inception to November 2016. Papers containing the words 'Polymyalgia Rheumatica' OR 'Giant Cell Arteritis' OR the terms 'PMR' OR 'GCA' were included. Article titles were reviewed based on pre-defined criteria by two reviewers. Following selection for inclusion, studies were quality assessed using the Newcastle-Ottawa tool and data were extracted.
RESULTS: A total of 17,329 papers were reviewed and 41 were incorporated in this review, including three published after the search took place. Wide variations were found in study design, comorbidities reported and populations studied. Positive associations were found between PMR diagnosis and stroke, cardiovascular disease, peripheral arterial disease, diverticular disease and hypothyroidism. Two studies reported a positive association between PMR and overall malignancy rate. Seven studies reported an association between PMR and specific types of cancer, such as leukaemia, lymphoma, myeloproliferative disease and specified solid tumours, although nine studies found either no or negative association between cancer and PMR.
CONCLUSION: Quantification of the prevalence of comorbidities in PMR is important to accurately plan service provision and enable identification of cases of PMR which may be more difficult to treat. This review highlights that research into comorbidities in PMR is, overall, methodologically inadequate and does not comprehensively cover all comorbidities. Future studies should consider a range of comorbidities in patients with a validated diagnosis of PMR in representative populations.},
}
@article {pmid30454933,
year = {2018},
author = {Tursi, A and Scarpignato, C},
title = {Symptomatic Uncomplicated Diverticular Disease: Chronic Abdominal Pain in Diverticulosis Is Not Enough to Make the Diagnosis.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {16},
number = {12},
pages = {2001-2002},
doi = {10.1016/j.cgh.2018.06.033},
pmid = {30454933},
issn = {1542-7714},
mesh = {Abdominal Pain ; *Diverticular Diseases ; *Diverticulosis, Colonic ; *Diverticulum, Colon ; Humans ; Inflammation ; },
}
@article {pmid30447778,
year = {2019},
author = {Sen, A and Callisen, H and Libricz, S and Patel, B},
title = {Complications of Solid Organ Transplantation: Cardiovascular, Neurologic, Renal, and Gastrointestinal.},
journal = {Critical care clinics},
volume = {35},
number = {1},
pages = {169-186},
doi = {10.1016/j.ccc.2018.08.011},
pmid = {30447778},
issn = {1557-8232},
mesh = {Aged ; Cardiovascular Diseases/etiology/nursing ; Critical Care Nursing/*standards ; Female ; Gastrointestinal Diseases/etiology/nursing ; Humans ; Infection Control/*standards ; Kidney Diseases/etiology/*nursing ; Male ; Middle Aged ; Nervous System Diseases/etiology/nursing ; Organ Transplantation/*adverse effects/*nursing ; Postoperative Care/*standards ; Postoperative Complications/*etiology/*nursing ; Practice Guidelines as Topic ; },
abstract = {Despite improvements in overall graft function and patient survival rates after solid organ transplantation, complications can lead to significant morbidity and mortality. Cardiovascular complications include heart failure, arrhythmias leading to sudden death, hypertension, left ventricular hypertrophy, and allograft vasculopathy in heart transplantation. Neurologic complications include stroke, posterior reversible encephalopathy syndrome, infections, neuromuscular disease, seizure disorders, and neoplastic disease. Acute kidney injury occurs from immunosuppression with calcineurin inhibitors or as a result of graft failure after kidney transplantation. Gastrointestinal complications include infections, malignancy, mucosal ulceration, perforation, biliary tract disease, pancreatitis, and diverticular disease. Immunosuppression can predispose to infections and malignancy.},
}
@article {pmid30444482,
year = {2018},
author = {Spiridakis, KG and Intzepogazoglou, DS and Flamourakis, ME and Sfakianakis, EE and Gkionis, IG and Strataki, KG and Tsagataki, ES and Kostakis, GE and Christodoulakis, MS},
title = {Acute diverticulitis in patients under 50 years of age.},
journal = {Il Giornale di chirurgia},
volume = {34},
number = {5},
pages = {319-322},
pmid = {30444482},
issn = {0391-9005},
mesh = {Acute Disease ; Adult ; Age Distribution ; Age of Onset ; Diverticulitis/diagnostic imaging/*epidemiology/surgery ; Elective Surgical Procedures ; Emergencies ; Female ; Hospitalization/statistics & numerical data ; Humans ; Male ; Patient Readmission/statistics & numerical data ; Recurrence ; Retrospective Studies ; Sex Distribution ; Tomography, X-Ray Computed ; Young Adult ; },
abstract = {UNLABELLED: Acute diverticulitis typically occurs in patients over 80 years old. The last five years we observed an increased incidence of acute diverticulitis in patients under 50 years. The aim of this study is to evaluate the increased rate of patients under 50 years that are hospitalized due to acute diverticulitis. Also, we aim to confirm the common symptoms for this disease and the laboratory data, the changes in dietary history (Mediterranean diet) and lifestyle and to calculate the differences in the treatment and the severity in the course of the disease, between younger (<50) and older (>50) patients.
PATIENTS AND METHODS: From 2003 to 2008, 118 patients were admitted to our Surgical Department for acute diverticulitis. 32 patients were under 50 years old. In the next five year period (2008-2013) the number of patients under 50 that were admitted due to acute diverticulitis doubled to 183 with 102 patients being over 50 years and 61 patients under 50. For all these patients, the medical and dietary history, laboratory and clinical examinations, radiographic and endoscopic findings were recorded.
RESULTS: For patients aged over 50 years there is a predominance in male sex. Symptoms were the same in both groups and no difference in treatment was noted. Furthermore, readmission and recurrence rates were the same for both groups. The condition was equally aggressive in both groups. The only difference observed was increased obesity rate for patients under 50 and variation from the traditional Mediterranean diet to western diet habits.
CONCLUSIONS: Although our study has limitations it seems that new cases of diverticular disease in patients have increased due to dietary changes, but treatment and severity have remained the same.},
}
@article {pmid30425936,
year = {2018},
author = {Meyer, J and Buchs, NC and Ris, F},
title = {Risk of colorectal cancer in patients with diverticular disease.},
journal = {World journal of clinical oncology},
volume = {9},
number = {6},
pages = {119-122},
pmid = {30425936},
issn = {2218-4333},
abstract = {Colorectal cancer constitutes an important burden on the healthcare system. Screening at-risk populations to reduce colorectal cancer-related morbidity and mortality has become part of good clinical practice. However, recommendations regarding subgroups of patients with diverticular disease are subject to controversy. Herein, we review the most recent literature regarding the prevalence of colorectal cancer in patients with diverticular disease, diverticulitis and uncomplicated diverticulitis. The recent literature does not identify diverticular disease as a long-term risk factor for colorectal cancer. However, the risk of colorectal cancer is increased in the short-term period after hospitalization related to diverticular disease. According to a recent systematic review and meta-analysis, the prevalence of colorectal cancer is 1.6% in patients with acute diverticulitis who underwent colonoscopy. The risk of having colorectal cancer after an episode of acute diverticulitis is 44-fold higher than that of an age- and gender-adjusted reference population. Despite lower among patients with uncomplicated episode, the risk of colorectal cancer remains 40-fold higher in that subpopulation than that in the reference population. To conclude, the recent literature describes an increased risk of colorectal cancer among patients with acute diverticulitis compared to the reference population. Colonoscopy is therefore recommended in patients with diverticulitis to exclude colorectal cancer.},
}
@article {pmid30413459,
year = {2018},
author = {Syed, H and Syed, L and Parampalli, U and Uheba, M},
title = {Adult intussusception secondary to diverticular disease.},
journal = {BMJ case reports},
volume = {2018},
number = {},
pages = {},
pmid = {30413459},
issn = {1757-790X},
mesh = {Aged, 80 and over ; Colon, Sigmoid/diagnostic imaging/surgery ; Constriction, Pathologic/complications/diagnostic imaging/surgery ; Diagnosis, Differential ; Diverticular Diseases/*complications/diagnostic imaging/*surgery ; Humans ; Intestinal Obstruction/complications/diagnostic imaging/surgery ; Intussusception/diagnostic imaging/*etiology/*surgery ; Male ; Tomography, X-Ray Computed ; },
abstract = {Intussusception is the invagination of a proximal segment of bowel into the lumen of an adjacent distal segment. It is a common condition in the paediatric age group although it rarely occurs in adults. Organic lesions in the bowel wall are the primary cause of adult intussusceptions with malignant neoplasms being the most common. However, we present a rare case of a 92-year-old man diagnosed with an intussusception of the sigmoid-rectal colon secondary to a diverticular stricture.},
}
@article {pmid30407258,
year = {2019},
author = {Alamo, RZ and Quigley, EMM},
title = {Irritable bowel syndrome and colonic diverticular disease: overlapping symptoms and overlapping therapeutic approaches.},
journal = {Current opinion in gastroenterology},
volume = {35},
number = {1},
pages = {27-33},
doi = {10.1097/MOG.0000000000000499},
pmid = {30407258},
issn = {1531-7056},
mesh = {Abdominal Pain ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diagnosis, Differential ; Diverticulosis, Colonic/*diagnosis/therapy ; Gastrointestinal Agents/*therapeutic use ; Humans ; Irritable Bowel Syndrome/*diagnosis/therapy ; Mesalamine/*therapeutic use ; Probiotics/*therapeutic use ; Randomized Controlled Trials as Topic ; Rifaximin/*therapeutic use ; },
abstract = {PURPOSE OF REVIEW: Irritable bowel syndrome (IBS) is a common symptomatic disorder in the Western world and colonic diverticula are also prevalent; however, relationships between IBS-type symptoms and diverticula have been a source of much debate. Our goal was to reassess these relationships in the light of new data.
RECENT FINDINGS: On removing from consideration clinical scenarios which are directly related to diverticula (i.e., diverticulitis, diverticular hemorrhage, and complications of diverticulitis, such as stricture and fistula), relationships between IBS and diverticula can be seen to revolve around a number of questions. First, are IBS and symptomatic uncomplicated diverticular disease (SUDD) the same condition? Or, in other words is SUDD no more than IBS in an individual who just happens to have diverticula? Although coincident IBS and diverticula inevitably do occur there is some evidence to indicate that SUDD may be somewhat distinctive with SUDD being characterized by more frequent and severe pain. Second, and analogous to interactions between IBS and inflammatory bowel disease or celiac disease, can an episode of acute diverticulitis lead to the de novo development of IBS? There is now epidemiological and pathophysiological evidence to support this occurrence.
SUMMARY: Although relationships between uncomplicated diverticular disease and IBS have been reexamined their status remains unclear. As yet, however, none of the newer concepts related to this relationship have led to new therapeutic approaches in IBS or diverticular disease.},
}
@article {pmid30406387,
year = {2019},
author = {Cassini, D and Depalma, N and Grieco, M and Cirocchi, R and Manoochehri, F and Baldazzi, G},
title = {Robotic pelvic dissection as surgical treatment of complicated diverticulitis in elective settings: a comparative study with fully laparoscopic procedure.},
journal = {Surgical endoscopy},
volume = {33},
number = {8},
pages = {2583-2590},
pmid = {30406387},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*surgery ; Diverticulitis/*surgery ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures/methods ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/epidemiology ; *Robotic Surgical Procedures/adverse effects ; },
abstract = {BACKGROUND: Recently, minimally invasive treatment of complicated sigmoid diverticulitis is becoming a valid alternative to standard procedures. Robotic approach may be useful to allow more precise dissection in arduous pelvic dissection as in complicated diverticulitis. The aim of this study is to investigate effectiveness, potential benefits and short-term outcomes of robotic-assisted laparoscopic surgical resection, compared with fully laparoscopic resection in complicated diverticulitis.
METHODS: Between January 2009 and December 2017, 156 consecutive patients with history of complicated diverticular disease were referred to our Department of General, Mininvasive and Robotic Surgery. All patients underwent elective colonic resections performed by the same colorectal surgeon and followed a perioperative ERAS program. Demographic and clinical features, surgical data, postoperative data, 30-day morbidity and mortality, VAS for surgeon's compliance were evaluated.
RESULTS: One hundred and fifty-six consecutive patients underwent elective colonic resection: 92 fully laparoscopic (FL) colorectal resections and 64 procedures with robotic hybrid approach (RHA). Conversion rate was none in the RHA group versus 6.5% in the FL group, because of poor vision due to bowel distension, inflammatory pseudotumor and peritoneal adhesions. No 30-day mortality was observed. Mean operative time was 167.5 ± 54.4 min (80-420) in the FL group and 172.5 ± 55.64 min (110-325) in the RHA group (p 0.079), mean intraoperative blood loss was 144.6 ± 40.6 ml (40-200) with the FL technique and 138.4 ± 28.3 ml (20-185) with the RHA (p 0.295). Mean hospital stay for FL was 5 ± 4.1 days (range 3-45) and 5 ± 2.7 days (range 3-20) for RHA (p 0.974). Overall postoperative morbidity rate was 21.6% in the FL group and 12.3% in the RHA (p 0.067). Major postoperative morbidity (Clavien-Dindo 3 and 4) represented 13% and 4.6%, respectively (p 0.091). VAS for surgeon's compliance revealed a better performance in the robotic arm (p 0.059).
CONCLUSIONS: This preliminary study highlights the potential benefits of robotic-assisted laparoscopy in colorectal resections for complicated diverticular disease in terms of surgical efficacy, postoperative morbidity and better surgeon's compliance.},
}
@article {pmid30395126,
year = {2018},
author = {Mohammed Ilyas, MI and Haggstrom, DA and Maggard-Gibbons, MA and Wendel, CS and Rawl, S and Schmidt, CM and Ko, CY and Krouse, RS},
title = {Patients With Temporary Ostomies: Veterans Administration Hospitals Multi-institutional Retrospective Study.},
journal = {Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society},
volume = {45},
number = {6},
pages = {510-515},
doi = {10.1097/WON.0000000000000478},
pmid = {30395126},
issn = {1528-3976},
mesh = {Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Colorectal Neoplasms/surgery ; Colostomy/methods/statistics & numerical data ; Diverticular Diseases/surgery ; Humans ; Ileostomy/methods/statistics & numerical data ; Male ; Middle Aged ; Ostomy/*methods/*statistics & numerical data ; Psychometrics/instrumentation/methods ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; United States ; United States Department of Veterans Affairs/organization & administration/statistics & numerical data ; },
abstract = {PURPOSE: The purpose of this study was to describe clinical outcomes of patients with temporary ostomies in 3 Veterans Health Administration hospitals.
DESIGN: Retrospective descriptive study, secondary analysis.
SAMPLE AND SETTING: Veterans with temporary ostomies from 3 Veterans Health Administration hospitals who were enrolled in a previous study. The sample comprised 36 participants all were male. Their mean age was 67.05 ± 9.8 years (mean ± standard deviation). Twenty patients (55.6%) had ileostomies and 16 patients (44.4%) had colostomies.
METHODS: This was a secondary analysis of data collected using medical record data. Variables examined included etiology for creation and type of ostomy, health-related quality of life, time to reversal, reasons for nonreversal, postoperative complications after reversal, and mortality in the follow-up period.
RESULTS: Colorectal cancer and diverticular disease were the main reasons for temporary stoma formation. The reversal rate was 50%; the median time to reversal was 9 months in our sample; temporary ileostomies were reversed more often than temporary colostomies (P = .18). Comorbid conditions were identified as the main reason for nonreversal. Mortality was not significantly different between the reversal and nonreversal groups. No significant differences were reported with health-related quality-of-life parameters between reversal and nonreversal groups.
CONCLUSIONS: This study identified that the proportion of temporary ostomies was limited to 50%. Complications during the index operation, medical comorbidities, and progression of cancer are the main reasons for nonreversal of temporary stomas. Study findings should be included in the counseling of patients who are likely to get intestinal stomas with temporary intention, and during consideration for later reversal of a stoma.},
}
@article {pmid30342390,
year = {2018},
author = {Kao, EN and Liao, KH and Chen, TW and Chan, DC and Yu, JC},
title = {Colon perforation caused by swallowing a shrimp leg: A case report.},
journal = {International journal of surgery case reports},
volume = {52},
number = {},
pages = {114-116},
pmid = {30342390},
issn = {2210-2612},
abstract = {INTRODUCTION: Ingestion of a foreign body rarely results in perforation of the gastrointestinal tract. Foreign bodies such as dentures, fish bones, chicken bones, toothpicks and cocktail sticks have been known to cause bowel perforation; however, bowel perforation caused by shrimp leg has not been reported so far.
PRESENTATION OF CASE: We report a case of a 69-years-old man who presented with a 4-months epigastric pain. Laboratory data revealed inflammation at the first hospital visit. Computed tomography revealed a hypodense lesion containing a hyperdense foreign body in the abdomen. Intra-abdominal abscess caused by foreign body perforation was diagnosed.
DISCUSSION: An increased incidence of perforation has been reported in association with Meckel's diverticulum, the appendix, and diverticular disease. The abdominal abscess in this case was located beside the diverticulum of transverse colon, so the perforation most likely occurred in the diverticulum of transverse colon.
CONCLUSION: Perforation of colon by shrimp leg is very rare and not reported currently. Although some cases have been successfully treated chronic foreign-body perforation with abscess by using antibiotics alone, typical treatments remains surgical drainage of the abscess and removal of foreign body.},
}
@article {pmid30320044,
year = {2018},
author = {Iannone, A and Ruospo, M and Wong, G and Barone, M and Principi, M and Di Leo, A and Strippoli, GFM},
title = {Mesalazine for People with Diverticular Disease: A Systematic Review of Randomized Controlled Trials.},
journal = {Canadian journal of gastroenterology & hepatology},
volume = {2018},
number = {},
pages = {5437135},
pmid = {30320044},
issn = {2291-2797},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticular Diseases/diagnosis/drug therapy ; Diverticulitis/diagnosis/*drug therapy ; Diverticulum, Colon/diagnosis/*drug therapy ; Female ; Humans ; Male ; Mesalamine/*therapeutic use ; *Quality of Life ; Randomized Controlled Trials as Topic ; Risk Assessment ; Treatment Outcome ; },
abstract = {BACKGROUND: Diverticular disease treatment is limited to fibres, antibiotics, and surgery. There is conflicting evidence on mesalazine benefits and harms.
AIM: We systematically reviewed current evidence on benefits and harms of mesalazine versus all other treatments in people with diverticular disease.
METHODS: We searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov for studies published to July 2018. We estimated risk ratios (RR) for dichotomous outcomes (disease remission/recurrence, acute diverticulitis in symptomatic uncomplicated diverticular disease, need for surgery/hospitalization, all-cause/disease-related mortality, adverse events), mean differences (MD) or standardized MD (SMD) for continuous outcomes (quality of life, symptoms score, time to recurrence/remission), and their 95% confidence intervals (CI) using random-effects models. We quantified heterogeneity by Chi[2] and I[2] tests. We performed subgroup analyses by disease subtype, comparator, follow-up duration, mesalazine dose, and mode of administration.
RESULTS: We identified 13 randomized trials (n=3028 participants). There was a higher likelihood of disease remission with mesalazine than controls in acute uncomplicated diverticulitis (1 trial, 81 participants, RR=2.67, 95%CI=1.05-6.79), but not in symptomatic uncomplicated diverticular disease (1 trial, 123 participants, RR=1.04, 95%CI=0.81-1.34). There was a lower likelihood of disease recurrence with mesalazine than controls in symptomatic uncomplicated diverticular disease (2 trials, 216 participants, RR=0.52, 95%CI=0.28-0.97), but not in acute uncomplicated diverticulitis (7 trials, 2196 participants, RR=0.90, 95%CI=0.61-1.33). There was no difference in the likelihood of developing acute diverticulitis in symptomatic uncomplicated diverticular disease between the two groups (3 trials, 484 participants, RR=0.26, 95%CI=0.06-1.20). There was a higher global symptoms score reduction with mesalazine than controls in symptomatic uncomplicated diverticular disease (2 trials, 326 participants, SMD=-1.01, 95%CI=-1.51,-0.52) and acute uncomplicated diverticulitis (2 trials, 153 participants, SMD=-0.56, 95%CI=-0.88,-0.24).
CONCLUSIONS: Mesalazine may reduce recurrences in symptomatic uncomplicated diverticular disease. There is uncertainty on the effect of mesalazine in achieving diverticular disease remission. Mesalazine may not prevent acute diverticulitis in symptomatic uncomplicated diverticular disease.},
}
@article {pmid30293416,
year = {2019},
author = {Elisei, W and Brandimarte, G and Tursi, A},
title = {Diverticulosis today.},
journal = {Minerva gastroenterologica e dietologica},
volume = {65},
number = {1},
pages = {42-52},
doi = {10.23736/S1121-421X.18.02525-4},
pmid = {30293416},
issn = {1827-1642},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Dietary Fiber/administration & dosage ; Diverticulitis/therapy ; Diverticulum/diagnosis/*therapy ; Gastrointestinal Agents/therapeutic use ; Humans ; Mesalamine/therapeutic use ; Primary Prevention ; Probiotics/therapeutic use ; Rifaximin/therapeutic use ; Secondary Prevention ; Terminology as Topic ; },
abstract = {The incidence of diverticulosis and diverticular disease of the colon is increasing worldwide. Although the majority of patients remains asymptomatic long-life, the prevalence of diverticular disease of the colon, including acute diverticulitis, is substantial and is becoming a significant burden on National Health Systems in terms of direct and indirect costs. Fiber, non-absorbable antibiotics and probiotics seem to be effective in treating symptomatic and uncomplicated patients, and 5-aminosalicylic acid might help prevent acute diverticulitis. Unfortunately, robust evidence on the effectiveness of a medical strategy to prevent acute diverticulitis recurrence is still lacking. Focus is now being drawn on identifying a new endoscopic classification of the disease to evaluate the correct therapeutic approach by testing various treatments.},
}
@article {pmid30291995,
year = {2018},
author = {Cuomo, R and Cargiolli, M and Cassarano, S and Carabotti, M and Annibale, B},
title = {Treatment of diverticular disease, targeting symptoms or underlying mechanisms.},
journal = {Current opinion in pharmacology},
volume = {43},
number = {},
pages = {124-131},
doi = {10.1016/j.coph.2018.09.006},
pmid = {30291995},
issn = {1471-4973},
mesh = {Animals ; Dietary Fiber/*administration & dosage/adverse effects ; Diverticular Diseases/epidemiology/physiopathology/*prevention & control/therapy ; Gastrointestinal Agents/adverse effects/*therapeutic use ; Humans ; Primary Prevention/*methods ; Probiotics/adverse effects/*therapeutic use ; Risk Factors ; Secondary Prevention/*methods ; Treatment Outcome ; },
abstract = {Diverticular disease (DD) is a highly prevalent disease in western industrialized countries that encompasses a complex set of disorders. Because of its complexity and heterogeneity, both from a pathogenic and a clinical point of view, the management of this disease represent a challenge in clinical practice. This review aims to analyze and summarize the most recent evidence on the medical strategies for DD, considering separately the different stages of the disease, from prevention of diverticula formation to treatment of acute diverticulitis and prevention of recurrences. Based on some evidence, dietary fiber is useful to prevent diverticula formation and in diverticulosis, with no pharmacological treatment in these settings. Treatment of symptomatic uncomplicated diverticular disease as well as primary prevention of acute diverticulitis is based on probiotics, fibres, mesalazine and rifaximin, individually or as combination therapy, although a standard approach has not yet been defined. On the contrary, in acute diverticulitis (AD) recent acquisitions have clarified and standardized the role of systemic antibiotics, reserving its use only to complicated forms and in selected cases of uncomplicated disease. Secondary prevention of AD is essentially based on mesalazine and rifaximin but, despite promising results, no strong evidence have been produced. To date, grey areas remain in the medical management of DD.},
}
@article {pmid30274796,
year = {2019},
author = {Pauza, AG and Rysevaite-Kyguoliene, K and Malinauskas, M and Lukosiene, JI and Alaburda, P and Stankevicius, E and Kupcinskas, J and Saladzinskas, Z and Tamelis, A and Pauziene, N},
title = {Alterations in enteric calcitonin gene-related peptide in patients with colonic diverticular disease: CGRP in diverticular disease.},
journal = {Autonomic neuroscience : basic & clinical},
volume = {216},
number = {},
pages = {63-71},
doi = {10.1016/j.autneu.2018.09.006},
pmid = {30274796},
issn = {1872-7484},
mesh = {Adult ; Aged ; Aged, 80 and over ; Calcitonin Gene-Related Peptide/*metabolism/pharmacology ; Calcitonin Receptor-Like Protein/metabolism ; Colon, Sigmoid/metabolism ; Diverticulosis, Colonic/*metabolism ; Female ; Humans ; Male ; Middle Aged ; Muscle, Smooth/drug effects ; },
abstract = {Diverticular disease (DD) is one of the most prevalent diseases of the large bowel. Lately, imbalance of neuro-muscular transmission has been recognized as a major etiological factor for DD. Neuronal calcitonin gene-related peptide (CGRP) is a potent gastrointestinal smooth muscle relaxant shown to have a widespread effect within the alimentary tract. Nevertheless, CGRPergic innervation of the enteric ganglia has never been considered in the context of motility impairment observed in DD patients. Changes in CGRP and calcitonin receptor-like receptor (CRLR) abundance within enteric ganglia were investigated in sigmoid samples from symptomatic and asymptomatic DD patients using quantitative fluorescence microscopy. CGRP effect on gastrointestinal smooth muscle was investigated using organ bath technique. We found CGRP levels within the enteric ganglia to be declined by up to 52% in symptomatic DD patients. Conversely, CRLR within the enteric ganglia was upregulated by 41% in symptomatic DD. Longitudinal smooth muscle displayed an elevated (+10.5%) relaxant effect to the exogenous application of CGRP in colonic strips from symptomatic DD patients. Samples from asymptomatic DD patients consistently showed intermediate values across different experiments. In conclusion, the present study demonstrates that CGRPergic signaling is subject to alteration in DD. Our results suggest that a hypersensitization mechanism to gradually decreasing levels of CGRP-IR nerve fibers takes place during DD progression. Alterations to CGRPergic signaling in DD disease may have implications for physiological abnormalities associated with colonic DD.},
}
@article {pmid30265178,
year = {2018},
author = {Rosenlund, IM and Leivseth, L and Førde, OH and Revhaug, A},
title = {Regional variation in hospitalizations and outpatient appointments for diverticular disease in Norway: a nationwide cross-sectional study.},
journal = {Scandinavian journal of gastroenterology},
volume = {53},
number = {10-11},
pages = {1228-1235},
doi = {10.1080/00365521.2018.1506047},
pmid = {30265178},
issn = {1502-7708},
mesh = {Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Diverticular Diseases/*epidemiology/therapy ; Endoscopy, Gastrointestinal/statistics & numerical data ; Female ; Geography, Medical/statistics & numerical data ; Hospitalization/*statistics & numerical data/*trends ; Humans ; Male ; Middle Aged ; Norway/epidemiology ; Outpatients/*statistics & numerical data ; Sex Distribution ; Surgical Procedures, Operative/statistics & numerical data ; },
abstract = {OBJECTIVE: To investigate the use of specialized health care services for diverticular disease in different hospital referral regions in Norway.
MATERIALS AND METHODS: Nationwide cross-sectional study with data from the Norwegian Patient Registry and Statistics Norway. All Norwegian inhabitants aged 40 years and older in the years 2012-16 (2,517,938) were included. We obtained the rates (n/100,000 population) for hospitalizations, outpatient appointments, and surgery for diverticular disease for the population in each hospital referral region. We also quantified the use of lower gastrointestinal (LGI) endoscopy in hospitalizations and outpatient appointments for diverticular disease and the use of LGI endoscopy performed on any indication.
RESULTS: There were 131 hospitalizations and 381 outpatient appointments for diverticular disease per 100,000 population annually. Hospitalization rates varied 1.9-fold across regions from 94 to 175. Outpatient appointment rates varied 2.5-fold across regions from 258 to 655. Outpatient appointments were strongly correlated to hospitalizations (rs=0.75, p < .001) and outpatient LGI endoscopy for any indication (rs=0.67, p < .001). Hospitalization and surgery rates remained stable over the study period, while outpatient appointment rates increased by 37%. Concurrently, rates of outpatient LGI endoscopy performed on any indication increased by 35%.
CONCLUSION: There was considerable regional variation in both hospitalizations and outpatient appointments for diverticular disease. The extent of variation and the correlation with diagnostic intensity of LGI endoscopy indicate that the regional variation in health care utilization for diverticular disease to a large extent can be explained by regional differences in clinical practice rather than disease burden.},
}
@article {pmid33655142,
year = {2018},
author = {Ostosh, AC and Saleh, A and Boehm, KM},
title = {An Atypical Case of Transverse Diverticulitis and the Changing Management of Diverticular Disease.},
journal = {Spartan medical research journal},
volume = {3},
number = {2},
pages = {6979},
pmid = {33655142},
issn = {2474-7629},
abstract = {Diverticulitis is an inflammation of an out pouching of the lower gastrointestinal tract, particularly in the large intestine. Although the condition is taught to medical students as typically occurring in the left lower quadrant of the abdomen, right-sided and transverse forms diverticulitis can occur. Uncomplicated, e.g., non-perforated, diverticulitis is usually treated with antibiotics. Complicated, e.g. perforated, is usually treated with surgery. The purpose of this case report is to present an atypical case of perforated diverticulitis and review current recommendations for this condition. This was a case of transverse diverticulitis in a man in his late 40's who recovered with non-operative treatment. The widespread use of computerized tomography (CT) scans makes diagnosing diverticular disease relatively simple, but treatment is evolving. The case summarized here shows that less invasive measures can be used in treating both complicated and uncomplicated diverticular disease. After an uncomplicated in-patient admission for intravenous antibiotics, the patient was discharged in stable condition with a prescription for oral antibiotics and clinic follow-up. Classic medical school teaching concerning treatments for complicated and uncomplicated forms of diverticulitis have been updated but require further research testing.},
}
@article {pmid30240473,
year = {2018},
author = {Picchio, M and Elisei, W and Tursi, A},
title = {Mesalazine to treat symptomatic uncomplicated diverticular disease and to prevent acute diverticulitis occurrence. A systematic review with meta-analysis of randomized, placebo-controlled trials.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {27},
number = {3},
pages = {291-297},
doi = {10.15403/jgld.2014.1121.273.pic},
pmid = {30240473},
issn = {1842-1121},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects/*therapeutic use ; Diverticulitis, Colonic/diagnosis/epidemiology/*prevention & control ; Diverticulum, Colon/diagnosis/*drug therapy/epidemiology ; Female ; Gastrointestinal Agents/adverse effects/*therapeutic use ; Humans ; Male ; Mesalamine/adverse effects/*therapeutic use ; Middle Aged ; Primary Prevention/*methods ; Randomized Controlled Trials as Topic ; Risk Factors ; Time Factors ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND AND AIMS: Symptomatic Uncomplicated Diverticular disease (SUDD) affects about 25% of patients harboring colonic diverticula. We assessed the effectiveness of mesalazine in improving symptoms (namely abdominal pain, primary outcome) and in preventing diverticulitis occurrence (secondary outcome) in patients with SUDD.
METHODS: Pertinent studies were selected from the Medline and the Cochrane Central Register of Controlled Trials. Only randomized clinical trials (RCTs) (irrespective of language, blinding, or publication status), which compared mesalazine, irrespective of the dosage assumption, with placebo in SUDD were evaluated.
RESULTS: Four RCTs enrolled 379 patients, 197 treated with mesalazine and 182 with placebo. Two studies provided data on symptom relief according to definition: it was achieved in 97/121 (80%) patients in the mesalazine group and in 81/129 (62.7%) patients in the placebo group (OR 0.43; 95% CI 0.24-0.75; p=0.003 in favour of the mesalazine group). Two studies provided information regarding occurrence of diverticulitis during follow-up. It occurred in 23/119 (19.3%) patients in the mesalazine group and in 34/102 (33.3%) patients in the placebo group (OR 0.35; 95% CI 0.17-0.70; p=0.003 in favour of the mesalazine group).
CONCLUSIONS: Treatment with mesalazine seems to be effective in achieving symptom relief and in the primary prevention of diverticulitis in patients with SUDD.},
}
@article {pmid30228909,
year = {2018},
author = {Patel, A and Mahendran, K and Collins, M and Abdelaziz, M and Khogali, S and Luckraz, H},
title = {Incidental abnormal CT scan findings during transcatheter aortic valve implantation assessment: incidence and implications.},
journal = {Open heart},
volume = {5},
number = {2},
pages = {e000855},
pmid = {30228909},
issn = {2053-3624},
abstract = {OBJECTIVES: The aim of this retrospective series is to describe the prevalence and clinical significance of the incidental findings found during pre-transcatheter aortic valve implantation (TAVI) work-up and to ascertain the clinical course of such patients.
METHODS: Consecutive patients undergoing TAVI from 2013 to 2015 where a TAVI CT assessment was performed (n=138) were included in the study. All incidental findings that were not expected from the patient's history were discussed at the TAVI multidisciplinary meeting in order to ascertain the clinical significance of said findings and whether they would alter the proposed course of treatment. Mortality data were determined by careful retrospective case note and follow-up appointment analysis.
RESULTS: Seventy-eight patients (57%) were found to have incidental findings on pre-TAVI CT scan. The majority of patients had benign pathology with high incidence in particular of diverticular disease, pleural effusions, gallstones, hiatus hernia and degenerative spinal disease. Vascular pathology such as superior mesenteric, renal and iliac artery stenoses and abdominal aortic aneurysm was detected in seven patients. In terms of long-term mortality data, we found no significant difference between those with incidental findings and those without (p=0.48). Survival as assessed by Kaplan-Meier analysis showed no significant difference between those with and without incidental abnormal CT scan findings (p=0.98).
CONCLUSIONS: Incidental findings with potential for malignancy are common in an elderly, comorbid population. Ultimately, clinical correlation and prognosis must be swiftly ascertained in order to streamline the patients down the appropriate management pathway while avoiding unnecessary delay for treatment of their aortic stenosis.},
}
@article {pmid30223660,
year = {2018},
author = {Špičák, J and Kučera, M and Suchánková, G},
title = {Diverticular disease: diagnosis and treatment.},
journal = {Vnitrni lekarstvi},
volume = {64},
number = {6},
pages = {621-634},
pmid = {30223660},
issn = {0042-773X},
mesh = {Acute Disease ; Adult ; *Anti-Bacterial Agents/therapeutic use ; *Diverticulitis/complications/diagnosis/therapy ; Drainage ; Humans ; *Peritonitis/etiology ; },
abstract = {Diverticular disease is one of the most common gastroenterological diseases. Its morphological basis are diverticula, whose prevalence in adults nears 50 %, with 25% clinical symptomatology and 5% occurrence of complications. It is a disease of older age, however its incidence is also rising in younger individuals, where it takes a more severe course. Its incidence is ascribed to a diet with a relatively low fibre content, however studies do not yield such clear results. Further risk factors include smoking, use of opiates and corticoids, obesity, alcoholism and smoking, hypertension, polycystosis, immunosuppression and use of non-steroid antiflogistics. Patients with diverticular disease also present with abnormal intestinal motility, intestinal dysbiosis and other physiological and morphological abnormalities. The most types of diverticulosis occur in the sigmoid colon, though especially in Asia the colon ascendens is more frequently affected. There are several classification schemes among which an individual assessment of complications is gaining in importance. The diagnosis includes clinical data, routine laboratory tests for inflammation, calprotectin in stool, coloscopy, ultrasound, CT and magnetic resonance. The basis for the treatment of symptomatic uncomplicated diverticular disease consists of drugs bringing symptomatic relief, fibre, probiotics, mesalazine and non-absorbable antibiotics, nonetheless the results of a number of studies are not fully convincing. The recommended treatment should be initiated with dietary fibre and probiotics, in the case of lasting problems add a non-absorbable antibiotic rifaximine with cyclic administration. Mild diverticulitis should essentially be treated by means of hydration and adjustments in the dietary regimen, antibiotics are not necessary when its course is uncomplicated and improvement is achieved, however the decision is individual and risk factors such as immunosuppression, diabetes, old age, pregnancy etc. Antibiotics are reserved for the treatment of severe or repeated diverticulitis, sepsis and complications. As prevention of further attacks, again probiotics, mesalazine and cyclically non-absorbable antibiotics are used, e,g. for a period of 10 days at monthly intervals. The proportion of surgeries is decreasing also where acute conditions are concerned and the efficiency of conservative treatment of diverticulitis is on the increase. Abscess should primarily be treated via non-surgical drainage. Even perforation and peritonitis can be treated via laparoscopic drainage without subsequent surgery being necessary, of course considering an overall condition an individual decision needs to be made. Generalized and fecal peritonitis are treated by open surgery. Earlier, elective resection was recommended after 2 attacks of diverticulitis, currently an individual approach is emphasized with respect to age, comorbidities and a character of the complaint and it is only indicated exceptionally. The proportion of laparoscopic resections is growing. The results are basically identical for Hartmann's procedure as well as primary resection. Key words: calprotecin - diverticular disease - dietary fibre - diverticulosis - mesalazine - non-absorbable antibiotics - probiotics.},
}
@article {pmid30219818,
year = {2019},
author = {Urabe, M and Nishida, T and Shimakoshi, H and Shimoda, A and Amano, T and Sugimoto, A and Takahashi, K and Mukai, K and Matsubara, T and Yamamoto, M and Hayashi, S and Nakajima, S and Fukui, K and Tanida, T and Komori, T and Morita, S and Inada, M},
title = {Distinct Clinical Factors in Hospitalized Patients with Diverticular Bleeding and Diverticulitis.},
journal = {Digestion},
volume = {99},
number = {3},
pages = {239-246},
doi = {10.1159/000491875},
pmid = {30219818},
issn = {1421-9867},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*epidemiology/etiology/therapy ; Diverticulum/*complications/therapy ; Female ; Gastrointestinal Hemorrhage/*epidemiology/etiology/therapy ; Humans ; Japan/epidemiology ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/*adverse effects ; Prevalence ; Retrospective Studies ; Risk Factors ; Young Adult ; },
abstract = {BACKGROUND/AIMS: It is unclear why colonic diverticular bleeding and diverticulitis rarely coexist. This study compared the characteristics of these conditions.
METHODS: This single-center retrospective study examined 310 consecutive patients hospitalized with an episode of diverticular disease (cases) and outpatients without a diverticular episode (controls) from January 2012 to December 2015. We investigated distinct clinical factors in hospitalized patients with diverticular bleeding and diverticulitis.
RESULTS: We identified 183 patients with 263 episodes of diverticular bleeding and 127 patients with 135 episodes of diverticulitis during the study period. Patients with diverticular bleeding were significantly older than those with diverticulitis (median age 76 vs. 56 years) and had more cardiovascular disease, hypertension, diabetes, cerebrovascular disease, chronic kidney disease, lipid disorder, or a poorer performance status. Significantly more diverticular bleeding patients were taking antiplatelet drugs, anticoagulant drugs, proton pump inhibitors, or laxative agents. Multivariate analysis revealed that an age > 65 years (OR 5.42), and antiplatelet agent use (OR 7.29) were more significant risk factors for diverticular bleeding than for diverticulitis.
CONCLUSIONS: Elderly people using antiplatelet drugs may be more susceptible to diverticular bleeding than diverticulitis.},
}
@article {pmid30204549,
year = {2018},
author = {Huston, JM and Zuckerbraun, BS and Moore, LJ and Sanders, JM and Duane, TM},
title = {Antibiotics versus No Antibiotics for the Treatment of Acute Uncomplicated Diverticulitis: Review of the Evidence and Future Directions.},
journal = {Surgical infections},
volume = {19},
number = {7},
pages = {648-654},
doi = {10.1089/sur.2018.115},
pmid = {30204549},
issn = {1557-8674},
mesh = {Acute Disease ; Anti-Bacterial Agents/*therapeutic use ; Diverticulitis/*drug therapy ; Humans ; Treatment Outcome ; },
abstract = {BACKGROUND: Acute diverticulitis occurs in 25% of individuals with diverticular disease and is associated with significant morbidity and mortality rates. Disease severity is classified as uncomplicated or complicated, with the latter including perforation, fistula, obstruction, or distant abscess. Uncomplicated diverticulitis often improves without surgery or invasive therapies. Administration of antibiotics is a standard of care for treatment of acute uncomplicated diverticulitis. However, recent data suggest antibiotics do not influence outcomes significantly. To address these conflicting approaches, the Surgical Infection Society hosted an Update Symposium at its 37[th] Annual Meeting examining the role of antibiotics in the treatment of acute uncomplicated diverticulitis. Here, we provide a synopsis of the symposium's findings and a brief review of recent prospective and randomized clinical trials on the topic.
METHODS: A search of Embase, MEDLINE, and the Cochrane Library was performed for prospective series and randomized clinical trials published between January 1, 2010, and January 1, 2018, comparing outcomes of antibiotic versus no antibiotic therapy for acute uncomplicated diverticulitis.
RESULTS: We identified two single-center prospective series and two randomized clinical trials comparing outcomes for patients with acute uncomplicated diverticulitis treated with antibiotics versus no antibiotics.
CONCLUSION: Current evidence does not support administration of antibiotics to improve outcomes in carefully selected healthy patients with acute uncomplicated left-sided diverticulitis. Further studies should help identify specific subpopulations of patients who would derive benefit from antibiotic therapy and help define appropriate antibiotic regimens and treatment durations that minimize cost, adverse effects, and risk of anti-microbial resistance.},
}
@article {pmid30177863,
year = {2018},
author = {Maguire, LH and Handelman, SK and Du, X and Chen, Y and Pers, TH and Speliotes, EK},
title = {Genome-wide association analyses identify 39 new susceptibility loci for diverticular disease.},
journal = {Nature genetics},
volume = {50},
number = {10},
pages = {1359-1365},
pmid = {30177863},
issn = {1546-1718},
support = {R01 DK106621/DK/NIDDK NIH HHS/United States ; MC_QA137853/MRC_/Medical Research Council/United Kingdom ; P30 DK034933/DK/NIDDK NIH HHS/United States ; R01 DK107904/DK/NIDDK NIH HHS/United States ; MC_PC_17228/MRC_/Medical Research Council/United Kingdom ; },
mesh = {Adult ; Aged ; Case-Control Studies ; Diverticular Diseases/epidemiology/*genetics ; Female ; Genetic Loci ; Genetic Predisposition to Disease ; *Genome-Wide Association Study/methods/statistics & numerical data ; Humans ; Male ; Middle Aged ; *Polymorphism, Single Nucleotide ; *Quantitative Trait Loci ; United Kingdom/epidemiology ; },
abstract = {Diverticular disease is common and has a high morbidity. Treatments are limited owing to the poor understanding of its pathophysiology. Here, to elucidate its etiology, we performed a genome-wide association study of diverticular disease (27,444 cases; 382,284 controls) from the UK Biobank and tested for replication in the Michigan Genomics Initiative (2,572 cases; 28,649 controls). We identified 42 loci associated with diverticular disease; 39 of these loci are novel. Using data-driven expression-prioritized integration for complex traits (DEPICT), we show that genes in these associated regions are significantly enriched for expression in mesenchymal stem cells and multiple connective tissue cell types and are co-expressed with genes that have a role in vascular and mesenchymal biology. Genes in these associated loci have roles in immunity, extracellular matrix biology, cell adhesion, membrane transport and intestinal motility. Phenome-wide association analysis of the 42 variants shows a common etiology of diverticular disease with obesity and hernia. These analyses shed light on the genomic landscape of diverticular disease.},
}
@article {pmid30169396,
year = {2020},
author = {McKenna, NP and Bews, KA and Behm, KT and Mathis, KL and Lightner, AL and Habermann, EB},
title = {Do Patients With Inflammatory Bowel Disease Have a Higher Postoperative Risk of Venous Thromboembolism or Do They Undergo More High-risk Operations?.},
journal = {Annals of surgery},
volume = {271},
number = {2},
pages = {325-331},
doi = {10.1097/SLA.0000000000003017},
pmid = {30169396},
issn = {1528-1140},
mesh = {Adult ; Aged ; *Digestive System Surgical Procedures ; Female ; Humans ; Inflammatory Bowel Diseases/*surgery ; Male ; Middle Aged ; Postoperative Complications/*epidemiology/prevention & control ; Risk Factors ; United States ; Venous Thromboembolism/*epidemiology/prevention & control ; },
abstract = {OBJECTIVE: To determine the relative or combined effects of Crohn disease (CD) and ulcerative colitis (UC) and the operation performed on postoperative venous thromboembolism (VTE) to better guide recommendations on extended VTE prophylaxis.
SUMMARY BACKGROUND DATA: There is growing evidence to suggest patients with inflammatory bowel disease have an increased risk of postoperative VTE, but prior studies have not accounted for the operation performed nor acknowledged differences between CD and UC.
METHODS: The American College of Surgeons National Surgical Quality Improvement Project database from 2005 to 2016 was queried for patients with a diagnosis of CD, UC, malignancy, or benign disease (diverticular disease, Clostridium difficile) undergoing major abdominal surgery. Operations with a VTE rate >3% were designated high risk. Operation-specific univariate and multivariable logistic regression analyses were conducted.
RESULTS: A total of 231,718 operations were analyzed with 4426 patients experiencing a VTE (1.9%). The overall rate of VTE ranged widely based on the operation performed from 0.7% for enterostomy closure to 5.3% for open subtotal colectomy. Seven operations met our threshold of 3% to be considered high risk. For each operation, postoperative VTE rates were similar regardless of diagnostic indication when performed in the elective setting. However, when performed emergently, the same operations had significantly higher VTE rates. Compared with the malignancy and benign disease groups, neither CD nor UC was associated with increased odds of VTE after any operation.
CONCLUSIONS: Postoperative VTE risk varies widely by the operation performed, and a diagnostic indication of CD or UC does not play a role. Extended duration VTE prophylaxis should be considered in all patients undergoing high-risk operations, regardless of their underlying diagnosis.},
}
@article {pmid30155336,
year = {2018},
author = {Kuhn, G and Lekeufack, JB and Chilcott, M and Mbaidjol, Z},
title = {Subcutaneous Emphysema Caused by an Extraperitoneal Diverticulum Perforation: Description of Two Rare Cases and Review of the Literature.},
journal = {Case reports in surgery},
volume = {2018},
number = {},
pages = {3030869},
pmid = {30155336},
issn = {2090-6900},
abstract = {The onset of colon diverticular disease is a frequent event, with a prevalence that increases with age. Amongst possible complications, free peritoneal perforation with abscess formation may occur. We herein describe two rare presentations of an extraperitoneal sigmoid diverticulum perforation. Our first patient, an 89-year-old female with no signs of distress, developed a subcutaneous abscess and emphysema in an incisional hernia following an appendectomy through a McBurney incision. The second patient, an 82-year-old female, was in general distress at the time of her admission and had a more advanced infection following the occurrence of a sigmoid perforation in a hernial sac. Complicated diverticulitis has a known course and evolution, but with an extraperitoneal presentation, this etiology is not expected. A computed tomography (CT) scan should be completed if the patient is hemodynamically stable, and wide debridement should be performed. Subcutaneous emphysema with an acute abdomen may be a sign of sigmoid perforation. Clinicians should keep this etiology in mind, regardless of the initial presentation.},
}
@article {pmid30151643,
year = {2019},
author = {Storz, C and Rothenbacher, T and Rospleszcz, S and Linseisen, J and Messmann, H and De Cecco, CN and Machann, J and Lorbeer, R and Kiefer, LS and Wintermeyer, E and Rado, SD and Nikolaou, K and Elser, S and Rathmann, W and Reiser, MF and Peters, A and Schlett, CL and Bamberg, F},
title = {Characteristics and associated risk factors of diverticular disease assessed by magnetic resonance imaging in subjects from a Western general population.},
journal = {European radiology},
volume = {29},
number = {3},
pages = {1094-1103},
pmid = {30151643},
issn = {1432-1084},
mesh = {Aged ; Body Mass Index ; Cohort Studies ; Colon/*pathology ; Diverticular Diseases/*diagnosis/epidemiology ; Female ; Germany/epidemiology ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Reproducibility of Results ; Risk Factors ; },
abstract = {OBJECTIVES: Diverticular disease represents an increasing pathology and healthcare burden worldwide. Our aim was to study the prevalence, extent and distribution of asymptomatic diverticular disease assessed by magnetic resonance imaging (MRI) in a sample of a Western population.
METHODS: Subjects from a population-based cohort study who underwent 3-T MRI were analyzed for the prevalence and extent of diverticula of the colon using an isotropic VIBE-Dixon gradient-echo sequence. The extent of diverticular disease was categorized according to the number of diverticula in each colonic segment. Univariate and adjusted analyses were performed to assess associated characteristics and risk factors.
RESULTS: Among 393 subjects included in the analysis (56.4 ± 9.2 years, 57.5% males), 164 (42%) had diverticular disease, with the highest prevalence in the left-sided colonic segments (93% diverticular disease in the descending and sigmoid segment). Subjects with advanced diverticular disease were older (62.1 vs. 54.4 years) and had a higher body mass index (BMI), LDL cholesterol levels and systolic blood pressure (30.2 ± 5.1 vs. 27.8 ± 4.9 kg/m[2], 149.8 ± 29.3 vs. 135.2 ± 32.9 mg/dl and 128.2 ± 14.1 vs. 118.4 ± 16.1 mmHg, respectively; all p > 0.003) compared with subjects without diverticular disease. In contrast, no significant correlation could be found for gender, physical activity, smoking status and alcohol consumption (all p > 0.31). Intra-rater reliability was excellent for all colonic segments (intra-class correlation [ICC] = 0.99-1.00), and inter-rater reliability was excellent for left- and right-sided colonic segments (ICC = 0.84-0.97).
CONCLUSIONS: These findings provide insights into the disease mechanism of asymptomatic diverticular disease and may help to improve prevention of diverticulosis and its associated complications.
KEY POINTS: • Overall prevalence of asymptomatic diverticular disease assessed by MRI was 42%, affecting predominantly the left-sided colon. • Asymptomatic diverticular disease was associated with age and cardiometabolic risk factors. • Magnetic resonance imaging reveals insights into the pathophysiologic mechanism of asymptomatic diverticular disease.},
}
@article {pmid30143468,
year = {2019},
author = {Ubaldi, E and Grattagliano, I and Lapi, F and Pecchioli, S and Cricelli, C},
title = {Overview on the management of diverticular disease by Italian General Practitioners.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {51},
number = {1},
pages = {63-67},
doi = {10.1016/j.dld.2018.07.015},
pmid = {30143468},
issn = {1878-3562},
mesh = {Adult ; Age Distribution ; Aged ; Anti-Bacterial Agents/therapeutic use ; Comorbidity ; Cross-Sectional Studies ; Databases, Factual ; *Diverticulitis, Colonic/classification/drug therapy/epidemiology ; Female ; Gastrointestinal Agents/therapeutic use ; General Practice/*methods ; Hospitalization/statistics & numerical data ; Humans ; Italy/epidemiology ; Male ; Middle Aged ; Prevalence ; Risk Factors ; },
abstract = {BACKGROUND: Although very common in Western countries, poor epidemiological data on diverticular disease (DD) is available from the family practice.
AIMS: To evaluate the behavior of Italian General Practitioners (GPs) on approaching DD.
METHODS: Health Search Database was analyzed retrospectively.
RESULTS: On a population of 975,523 individuals, 33,597 patients had a registered diagnosis of DD ("lifetime" prevalence = 3.4%, M = 3.2%, F = 3.7%; higher values are found in females over-65 years old; low rates of complications: diverticulitis = 0.3%, bleeding = 0.002%). As risk factors, NSAIDs and ASA were taken by 14.8% and 26.5% respectively, opioids by 7.5%, corticosteroids by 5.2%; as protective factors, 30.4% were under statins and 17.7% under calcium-antagonists. Approximately 13% of patients were referred to specialists. Colonoscopy and abdominal CT were prescribed to 48.5% and to 13% of already diagnosed patients. Among DD sufferers, 27% experienced hospitalization, but only 3.4% of cases were for a DD-linked problem. Treatment included rifaximin (61%), mesalazine (14.7%), probiotics (12.4%), ciprofloxacin (7.6%).
CONCLUSION: DD has a large impact in general practice with a higher prevalence in the elderly. GPs are required to pay particular attention to risk factors both for disease development and for its complications in order to reduce the costs deriving from diagnostic procedures, referral and hospitalization.},
}
@article {pmid30116674,
year = {2018},
author = {Haddad, FG and El Bitar, S and Al Moussawi, H and Deeb, L},
title = {Granulomatous Diverticulitis: Who Would Have Thought!.},
journal = {Cureus},
volume = {10},
number = {6},
pages = {e2795},
pmid = {30116674},
issn = {2168-8184},
abstract = {Diverticular disease (DD) can have different presentations, including chronic colitis. However, diverticular disease-associated colitis (DAC) is a separate entity that can be associated with a granulomatous inflammation. DAC usually affects the left colon with no involvement of the cecum and the ascending colon. In this setting, Crohn's disease is high in the differential diagnosis. Although granulomatous colitis associated with diverticulosis has been previously described, this is the first case affecting the right colon to be reported in the English literature according to our search of the PubMed database. The patient presented with a tumor-like mass abutting the right colon that was further diagnosed as a granulomatous reaction secondary to DAC.},
}
@article {pmid30112933,
year = {2018},
author = {Bakopoulos, A and Tsilimigras, DI and Syriga, M and Koliakos, N and Ntomi, V and Moris, D and Bistarakis, D and Schizas, D},
title = {Diverticulitis of the transverse colon manifesting as colocutaneous fistula.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {100},
number = {8},
pages = {e1-e3},
pmid = {30112933},
issn = {1478-7083},
abstract = {The transverse colon is a particularly rare site for a diverticulum to develop, with only few reports of solitary diverticula described in the literature. Among the reported complications, colocutaneous fistulas appear relatively infrequently. We describe the case of an 80-year-old woman with a solitary diverticulum of the transverse colon presenting as acute diverticulitis with abscess formation in the epigastric region. A fistulous tract was found between the inflamed colon and the skin. A wedge resection of the inflamed colon together with the fistula and the solitary diverticulum was performed followed by primary suturing of the healthy colonic tissue. Despite the sufficient treatment and thorough clearance of the area, the patient died ten days later from ventilator associated pneumonia. Although rare, in patients presenting with a subcutaneous abscess in the abdominal region, there should be a high level of suspicion for active intraperitoneal inflammation derived from complicated diverticular disease given the continuously elevated prevalence of the condition in Western societies. The decision regarding proper management of this clinical state should be based on thorough clinical examination and imaging.},
}
@article {pmid30091821,
year = {2018},
author = {Hamilton, AER and Warren, CD and Stevenson, ARL},
title = {Neurovascular sparing during anterior resections for diverticular disease: the century-long debate.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {20},
number = {10},
pages = {932-933},
doi = {10.1111/codi.14368},
pmid = {30091821},
issn = {1463-1318},
mesh = {Diverticular Diseases/*surgery ; Humans ; Mesenteric Artery, Inferior/*surgery ; Organ Sparing Treatments/*methods ; Proctectomy/*methods ; Rectum/surgery ; Vascular Surgical Procedures/*methods ; },
}
@article {pmid30084005,
year = {2019},
author = {Mahmood, MW and Abraham-Nordling, M and Håkansson, N and Wolk, A and Hjern, F},
title = {High intake of dietary fibre from fruit and vegetables reduces the risk of hospitalisation for diverticular disease.},
journal = {European journal of nutrition},
volume = {58},
number = {6},
pages = {2393-2400},
pmid = {30084005},
issn = {1436-6215},
mesh = {Aged ; Aged, 80 and over ; Cohort Studies ; Dietary Fiber/administration & dosage/*pharmacology ; Diverticular Diseases/*diet therapy/prevention & control ; Female ; *Fruit ; Hospitalization/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Sweden ; *Vegetables ; },
abstract = {BACKGROUNDS AND AIMS: High intake of dietary fibres has been associated with a reduced risk of DD. However, reports on which type of dietary fibre intake that is most beneficial have been conflicting. The aim of this study was to investigate the association between different dietary fibres and hospitalisation due to diverticular disease (DD) of the colon.
METHODS: This was a major cohort study. The Swedish Mammography Cohort and the Cohort of Swedish Men were linked to the Swedish Inpatient Register and the Causes of Death Register. Data on the intake of dietary fibre were collected through questionnaires. The effect of intake (in quartiles) of different types of dietary fibre on the incidence of hospitalisation due to DD was investigated using multivariable Cox regression. Estimates were adjusted according to age, BMI, physical activity, co-morbidity, intake of corticosteroids, smoking, alcohol intake and education level.
RESULTS: Women with intake of fruit and vegetable fibres in the highest quartile (median 12.6 g/day) had a 30% decreased risk of hospitalisation compared to those with the lowest intake (4.1 g/day). Men within the highest quartile (10.3 g/day) had a 32% decreased risk compared to those with a low intake (2.9 g/day). High intake of fibres from cereals did not affect the risk.
CONCLUSION: A high intake of fruits and vegetables may reduce the risk of hospitalisation due to DD. Intake of cereals did not influence the risk.},
}
@article {pmid30064583,
year = {2018},
author = {Simmerman, EL and King, RS and Ham, PB and Hooks, VH},
title = {Feasibility and Safety of Intraoperative Colonoscopy after Segmental Colectomy and Primary Anastomosis.},
journal = {The American surgeon},
volume = {84},
number = {7},
pages = {1175-1179},
pmid = {30064583},
issn = {1555-9823},
mesh = {Adenomatous Polyps/complications/surgery ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; *Colectomy/methods ; Colitis/surgery ; Colonic Neoplasms/surgery ; *Colonoscopy/methods ; Colorectal Neoplasms/surgery ; Feasibility Studies ; Female ; Hospitals, University ; Humans ; Intestinal Obstruction/etiology/surgery ; *Intraoperative Care/methods ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Reproducibility of Results ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; },
abstract = {Patients presenting with near-obstructing colon lesions requiring segmental colectomy may benefit from intraoperative colonoscopy (IOC) after primary anastomosis for a more timely and accurate diagnosis of synchronous lesions. The aim of this study is to demonstrate the feasibility and safety of this technique. A retrospective cohort study of patients undergoing single-stage segmental colectomy and anastomosis at a single tertiary care institution from 2011 to 2013 was performed. One Hundred and sixty-eight consecutive patients underwent segmental colectomy and primary anastomosis of which 78 (46%) were unable to receive preoperative colonoscopy (POC) because of near-obstructing lesions and received IOC after the anastomosis. IOC detected synchronous adenomatous polyps in 24.4 per cent, diverticular disease in 19 per cent, and colitis/proctitis in 2.5 per cent. The IOC group was not significantly different from the POC group with regard to overall morbidity (31% vs 39% P = 0.45), anastomotic leakage (1.3% vs 0%, P = 0.46), or wound infection (5.1% vs 1.1%, P = 0.18). Operation time was 19 minutes longer in the intraoperative group, but overall length of hospital stay was not significantly different (6.4 ± 2.9 days vs 7.3 ± 4.6 days). In patients unable to receive POC because of partial obstruction, IOC after primary anastomosis is both feasible and safe for detecting proximal synchronous lesions.},
}
@article {pmid30062801,
year = {2018},
author = {De Nardi, P and Gazzetta, P},
title = {Does inferior mesenteric artery ligation affect outcome in elective colonic resection for diverticular disease?.},
journal = {ANZ journal of surgery},
volume = {88},
number = {11},
pages = {E778-E781},
doi = {10.1111/ans.14724},
pmid = {30062801},
issn = {1445-2197},
mesh = {Adult ; Aged ; Anastomotic Leak/epidemiology/etiology/*prevention & control ; Colectomy/*methods ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures/*methods ; Female ; Humans ; Laparoscopy ; Ligation ; Male ; Mesenteric Artery, Inferior/*surgery ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: The aim of our study was to analyse the role of inferior mesenteric artery (IMA) ligation during elective colonic resection for diverticular disease (DD) with respect to surgical outcome.
METHODS: All patients who underwent elective laparoscopic or open colonic resection for DD from January 2006 to December 2012 were studied. The patients were divided into two groups based on IMA ligation or preservation. The primary end point was to compare anastomotic leakage in the two groups. The secondary end points were operative time, stoma formation, overall post-operative complications, restoration of bowel function and length of post-operative hospital stay.
RESULTS: During the study period, 219 elective colonic resections with primary anastomosis for DD were performed. A laparoscopic technique was employed in 132 (60.3%) cases. IMA ligation was performed in 66 patients (30.1%). Overall anastomotic leakage rate was 4.1%, 4.5% in IMA ligation and 3.9% in IMA preservation group, respectively (P = ns). Mean operative time was 225 ± 43.4 and 191 ± 41.7 min in IMA ligation and preservation group, respectively (P = 0.002). No differences were observed in the rate of overall complications, stoma formation, restoration of bowel function and post-operative length of hospital stay.
CONCLUSIONS: No differences were observed in surgical outcome in IMA ligation and preservation groups, particularly preservation or ligation of the IMA did not affect leakage rate.},
}
@article {pmid30056095,
year = {2018},
author = {Vajravelu, RK and Mamtani, R and Scott, FI and Waxman, A and Lewis, JD},
title = {Incidence, Risk Factors, and Clinical Effects of Recurrent Diverticular Hemorrhage: A Large Cohort Study.},
journal = {Gastroenterology},
volume = {155},
number = {5},
pages = {1416-1427},
pmid = {30056095},
issn = {1528-0012},
support = {K08 DK095951/DK/NIDDK NIH HHS/United States ; K23 CA187185/CA/NCI NIH HHS/United States ; K24 DK078228/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Aged ; Aged, 80 and over ; Anticoagulants/adverse effects ; Diverticulum/*epidemiology/etiology ; Female ; Gastrointestinal Hemorrhage/*epidemiology/etiology ; Humans ; Incidence ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND & AIMS: Although recurrent diverticular hemorrhage is common, its incidence and risk factors have not been measured outside of small institutional cohorts. We analyzed the incidence of and risk factors for recurrent diverticular hemorrhage and whether discontinuing anticoagulation after diverticular hemorrhage is associated with ischemic stroke.
METHODS: We performed a retrospective cohort study of patients enrolled in the OptumInsight Clinformatics database from 2000 through 2016. Incidence rates for initial and recurrent diverticular hemorrhage were calculated by identifying patients who had hospitalizations with a primary discharge diagnosis consistent with diverticular hemorrhage. The hazard ratios of second diverticular hemorrhage associated with anticoagulants or platelet aggregation inhibitors were calculated using Cox proportional hazards regression adjusted for demographics, comorbidities, and medication use. The hazard ratio for ischemic stroke among patients who discontinued anticoagulation after diverticular hemorrhage was calculated similarly.
RESULTS: In the cohort analyzed, 14,925 patients had an initial diverticular hemorrhage; 1368 of these patients had a second episode. The unstandardized incidence rates of initial and second diverticular hemorrhage were 10.9 per 100,000 person-years (95% confidence interval [CI] 10.7-11.0) and 3625.6 per 100,000 person-years (95% CI 3436.0-3823.0). Platelet aggregation inhibitors were associated with second episodes of diverticular hemorrhage (hazard ratio 1.47; 95% CI 1.15-1.88), whereas all classes of anticoagulation agents were not associated. Among patients with a potential indication for stroke prophylaxis, those who discontinued anticoagulation after the diverticular hemorrhage had an increased hazard of ischemic stroke (hazard ratio 1.93; 95% CI 1.17-3.19).
CONCLUSIONS: In this retrospective cohort study, platelet aggregation inhibitors, but not anticoagulants, were associated with recurrent diverticular hemorrhage. Discontinuing anticoagulation was associated with increased hazard for ischemic stroke.},
}
@article {pmid30048723,
year = {2018},
author = {Singh, S and Singh, G and Arya, SK},
title = {Mannans: An overview of properties and application in food products.},
journal = {International journal of biological macromolecules},
volume = {119},
number = {},
pages = {79-95},
doi = {10.1016/j.ijbiomac.2018.07.130},
pmid = {30048723},
issn = {1879-0003},
mesh = {Animal Feed/analysis ; Animals ; Biological Products/chemistry ; *Food ; Food Analysis ; Humans ; Hydrolysis ; Mannans/*chemistry/classification ; Mannosidases/chemistry ; Polysaccharides/chemistry ; },
abstract = {This review aims to emphasize the occurrence and abundant presence of mannans in nature, their classification, structural differences and significance in food and feed industry. With rising demand from the consumers' end for novel natural foods, usage of galactomannan and glucomannan has also increased alternatively. Non toxicity of mannans permits their usage in the pharmaceutical, biomedical, cosmetics, and textile industries. In the food industry, mannans have various applications such as edible films/coating, gel formation, stiffeners, viscosity modifiers, stabilizers, texture improvers, water absorbants, as prebiotics in dairy products and bakery, seasonings, diet foods, coffee whiteners etc. Applications and functions of these commonly used commercially available mannans have therefore, been highlighted. Mannans improve the texture and appeal of food products and provide numerous health benefits like controlling obesity and body weight control, prebiotic benefits, constipation alleviaton, prevent occurrence of diarrhea, check inflammation due to gut related diseases, management of diverticular disease management, balance intestinal microbiota, immune system modulator, reduced risk of colorectal cancer etc. Mannan degrading enzymes are the key enzymes involved in degradation and are useful in various industrial processes such as fruit juice clarification, viscosity reduction of coffee extracts etc. besides facilitating the process steps and improving process quality.},
}
@article {pmid30046356,
year = {2018},
author = {Lanas, A and Abad-Baroja, D and Lanas-Gimeno, A},
title = {Progress and challenges in the management of diverticular disease: which treatment?.},
journal = {Therapeutic advances in gastroenterology},
volume = {11},
number = {},
pages = {1756284818789055},
pmid = {30046356},
issn = {1756-283X},
abstract = {Diverticular disease of the colon (DDC) includes a spectrum of conditions from asymptomatic diverticulosis to symptomatic uncomplicated diverticulosis, segmental colitis associated with diverticulosis, and acute diverticulitis without or with complications that may have serious consequences. Clinical and scientific interest in DDC is increasing because of the rising incidence of all conditions within the DDC spectrum, a better, although still limited understanding of the pathogenic mechanisms involved; the increasing socioeconomic burden; and the new therapeutic options being tested. The goals of treatment in DDC are symptom and inflammation relief and preventing disease progression or recurrence. The basis for preventing disease progression remains a high-fiber diet and physical exercise, although evidence is poor. Other current strategies do not meet expectations or lack a solid mechanistic foundation; these strategies include modulation of gut microbiota or dysbiosis with rifaximin or probiotics, or using mesalazine for low-grade inflammation in uncomplicated symptomatic diverticulosis. Most acute diverticulitis is uncomplicated, and the trend is to avoid hospitalization and unnecessary antibiotic therapy, but patients with comorbidities, sepsis, or immunodeficiency should receive broad spectrum and appropriate antibiotics. Complicated acute diverticulitis may require interventional radiology or surgery, although the best surgical approach (open versus laparoscopic) remains a matter of discussion. Prevention of acute diverticulitis recurrence remains undefined, as do therapeutic strategies. Mesalazine with or without probiotics has failed to prevent diverticulitis recurrence, whereas new studies are needed to validate preliminary positive results with rifaximin. Surgery is another option, but the number of acute events cannot guide this indication. We need to identify risk factors and disease progression or recurrence mechanisms to implement appropriate preventive strategies.},
}
@article {pmid30039786,
year = {2018},
author = {Cochetti, G and Del Zingaro, M and Boni, A and Cocca, D and Panciarola, M and Tiezzi, A and Gaudio, G and Balzarini, F and Ursi, P and Mearini, E},
title = {Colovesical fistula: review on conservative management, surgical techniques and minimally invasive approaches.},
journal = {Il Giornale di chirurgia},
volume = {39},
number = {4},
pages = {195-207},
pmid = {30039786},
issn = {0391-9005},
mesh = {Colectomy/methods ; Colonic Neoplasms/complications/surgery ; *Conservative Treatment ; Cystectomy/methods ; Humans ; Intestinal Fistula/diagnostic imaging/mortality/*surgery/therapy ; Laparoscopy/methods ; Minimally Invasive Surgical Procedures ; Postoperative Complications ; Recurrence ; Robotic Surgical Procedures/methods ; Surgical Flaps ; Urinary Bladder Fistula/diagnostic imaging/mortality/*surgery/therapy ; Urinary Bladder Neoplasms/complications/surgery ; },
abstract = {Colovesical fistula (CVF) is an abnormal communication between bowel and urinary bladder. Main causes are represented by complicated diverticular disease, colonic and bladder cancer and iatrogenic complications. Diagnosis is often based on patognomonic signs: faecaluria, pneumaturia and recurrent urinary tract infections. Treatment of CVF includes non-surgical and surgical strategy. The non-surgical treatment is reserved to selected patients who are unfit for surgery. Surgery of CVFs is determined by the site of the colonic lesion and patient's comorbidity. However the surgical one-stage approach should be preferred, reserving the multi-stage procedure in patients with a pelvic abscess, or with advanced malignancy, or previous radiation therapy. The sole defunctioning stoma may be an option to improve the quality of life in patients unfit for bowel resection. In open surgery the standard operative management consists in resection and anastomosis of the involved bowel segment and closure of the bladder. Laparoscopic treatment of CVFs is feasible and safe if performed by skilled surgeons. Robotic surgery for CVF treatment is safe and feasible similarly to laparoscopic one and it seems to reduce the conversion rate with respect to laparoscopy. However, further studies are needed to evaluate the advantages of robotic surgery over laparoscopy in the management of CVF. Currently, in Literature it is still debated which is the best surgical approach for CFV treatment due to the lack of RCTs and CCTs, the small sample size and the short follow-up. Further studies with higher quality and larger sample size are necessary to state the gold standard surgical treatment of CVFs.},
}
@article {pmid30023071,
year = {2018},
author = {Carabotti, M and Cuomo, R and Barbara, G and Pace, F and Andreozzi, P and Cremon, C and Annibale, B},
title = {Demographic and clinical features distinguish subgroups of diverticular disease patients: Results from an Italian nationwide registry.},
journal = {United European gastroenterology journal},
volume = {6},
number = {6},
pages = {926-934},
pmid = {30023071},
issn = {2050-6406},
abstract = {BACKGROUND: Clinical features and lifestyle factors associated with diverticulosis compared to diverticular disease (DD), either symptomatic uncomplicated diverticular disease (SUDD) or in patients who have had previous diverticulitis (PD), are unclear.
OBJECTIVE: The objective of this article is to compare cross-sectionally demographic and clinical features and quality of life (QoL) in diverticulosis, SUDD and PD patients.
METHODS: The REMAD Registry is a prospective, observational, multicentre, cohort study. Patients were categorised according to: diverticulosis; SUDD (recurrent abdominal symptoms attributed to diverticula in absence of overt inflammation) and PD (≥1 previous diverticulitis).
RESULTS: A total of 1217 patients (57.9% diverticulosis, 24.7% SUDD and 17.4% PD) were included. Compared to diverticulosis, female gender was associated to SUDD (OR 1.94; 95% CI: 1.43-2.62) and PD (OR 1.79; 95% CI: 1.24-2.56); age ≤ 60 years was associated to PD (OR 2.10; 95% CI: 1.42-3.08 vs diverticulosis, OR 1.57; 95% CI: 1.01-2.45 vs SUDD). PD patients showed an association with past bleeding (OR 29.29; 95% CI: 8.17-104.98 vs diverticulosis, OR 16.84; 95% CI: 3.77-75.25 vs SUDD). Compared to diverticulosis, family history for diverticula was associated to PD (OR 1.88; 95% CI: 1.27-2.78). Patients with diverticulosis showed higher QoL scores, both physical (p = 0.0001 and 0.0257) and mental (p < 0.0001 and 0.0038), in comparison to SUDD and PD.
CONCLUSION: Family history for diverticula and history of bleeding distinguish diverticulosis from DD. These clinical features should be kept in mind in the management of DD.},
}
@article {pmid30020228,
year = {2018},
author = {Ramsay, G and Wohlgemut, JM and Jansen, JO},
title = {Emergency general surgery in the United Kingdom: A lot of general, not many emergencies, and not much surgery.},
journal = {The journal of trauma and acute care surgery},
volume = {85},
number = {3},
pages = {500-506},
doi = {10.1097/TA.0000000000002010},
pmid = {30020228},
issn = {2163-0763},
mesh = {Comorbidity ; Cross-Sectional Studies ; Diagnosis-Related Groups/trends ; Emergencies ; Emergency Medical Services/*statistics & numerical data/trends ; Emergency Service, Hospital/*standards ; Female ; Health Workforce/statistics & numerical data ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; National Health Programs/organization & administration ; Patient Discharge/standards ; Scotland/epidemiology ; Surgeons/*statistics & numerical data ; United Kingdom/epidemiology ; Workload ; },
abstract = {BACKGROUND: The provision of emergency general surgery services is a global issue, with important implications for patients and workforce. The aim of this study was to analyze the characteristics of emergency general surgical patients in the United Kingdom, with reference to diagnostic case mix, operative workload, comorbidity, discharge destination, and outcomes, to facilitate comparisons and future service development.
METHODS: This is a cross-sectional population-based study based in the National Health Service in Scotland, one of the home nations of the United Kingdom. All patients aged 16 or older admitted under the care of a general surgeon, as an emergency, to a National Health Service hospital in Scotland, in 2016, were included.
RESULTS: There were 81,446 emergency general surgery admissions by 66,498 patients. Median episode age was 53 years. There were more female patients than male (55% vs 45%, p < 0.0001). The most common diagnoses were nonspecific abdominal pain (20.2%), cholecystitis (7.2%), constipation (3.4%), pancreatitis (3.1%), diverticular disease (3.1%), and appendicitis (3.1%). Only 25% of patients had operations (n = 20,292). The most frequent procedures were appendicectomy (13.1%), endoscopy (11.3%), and drainage of skin lesions (9.7%). Diagnoses and operations differed with age. Overall median length of stay was 1 day. With a 6-month follow-up, patients older than 75 years had a 19.8% mortality rate.
CONCLUSIONS: Emergency general surgery in the United Kingdom is a high-volume, diagnostically diverse, and low-operative volume specialty with high short-term mortality rate in elderly patients. Consideration should be given to alternative service delivery models, which make better use of surgeons' skills while also ensuring optimal care for patients who are increasingly elderly and have complex chronic health problems.
LEVEL OF EVIDENCE: Epidemiologic study, level III.},
}
@article {pmid29980885,
year = {2018},
author = {Emile, SH and Elfeki, H and Sakr, A and Shalaby, M},
title = {Management of acute uncomplicated diverticulitis without antibiotics: a systematic review, meta-analysis, and meta-regression of predictors of treatment failure.},
journal = {Techniques in coloproctology},
volume = {22},
number = {7},
pages = {499-509},
pmid = {29980885},
issn = {1128-045X},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Conservative Treatment/*methods ; Diverticulitis, Colonic/etiology/*therapy ; Female ; Humans ; Male ; Middle Aged ; Patient Readmission/statistics & numerical data ; Recurrence ; Regression Analysis ; Treatment Failure ; },
abstract = {BACKGROUND: Diverticulitis is a common complication of diverticular disease of the colon. While complicated diverticulitis often warrants intervention, acute uncomplicated diverticulitis (AUD) is usually managed conservatively. The aim of the present review was to evaluate the efficacy and safety of conservative treatment of AUD without antibiotics compared to standard antibiotic treatment.
METHODS: A systematic literature review in compliance with PRISMA guidelines was conducted. Electronic databases including PubMed/Medline, Scopus, Embase and Cochrane central register of controlled trials were searched. Studies that assessed efficacy and safety of treatment of AUD without antibiotics were included. Outcome parameters were rates of treatment failure, recurrence of diverticulitis, complications and mortality, readmission to hospital, and need for surgery.
RESULTS: Nine studies including 2565 patients were included to the review. Of these patients, 65.1% were treated conservatively without antibiotics. Treatment failure was observed in 5.1% of patients not-given-antibiotic treatment versus 3.4% of those given antibiotic treatment. Recurrent diverticulitis occurred in 9.3% of patients in the non-antibiotic group versus 12.1% of patients in the antibiotic group. On meta-analysis of the studies, there were no significant differences between non-antibiotic and antibiotic treatment groups regarding rates of treatment failure (OR = 1.5, p = 0.06), recurrence of diverticulitis (OR = 0.81, p = 0.2), complications (OR = 0.56, p = 0.25), readmission rates (OR = 0.97, p = 0.91), need for surgery (OR = 0.59, p = 0.28), and mortality (OR = 0.64, p = 0.47). The only variable that was significantly associated with treatment failure in the non-antibiotic treatment group was associated comorbidities (standard error (SE) = - 0.07, 95% CI - 0.117 - 0.032; p < 0.001).
CONCLUSIONS: Treatment of AUD without antibiotics is feasible, safe, and effective. Adding broad-spectrum antibiotics to the treatment regimen did not serve to decrease treatment failure, recurrence, complications, hospital readmissions, and need for surgery significantly compared to non-antibiotic treatment.},
}
@article {pmid29971261,
year = {2018},
author = {Hebbar, M and Riaz, W and Sains, P and Baig, MK and Sajid, MS},
title = {Meta-analysis of randomized controlled trials only exploring the role of single incision laparoscopic surgery versus conventional multiport laparoscopic surgery for colorectal resections.},
journal = {Translational gastroenterology and hepatology},
volume = {3},
number = {},
pages = {30},
pmid = {29971261},
issn = {2415-1289},
abstract = {BACKGROUND: The objective of this article is to evaluate the surgical outcomes in patients undergoing single incision laparoscopic surgery (SILS) versus conventional multi-incision laparoscopic surgery (MILS) for colorectal resections.
METHODS: The data retrieved from the published randomized controlled trials (RCTs) reporting the surgical outcomes in patients undergoing SILS versus MILS for colorectal resections was analysed using the principles of meta-analysis. The combined outcome of dichotomous data was represented as risk ratio (RR) and continuous data was shown as standardized mean difference (SMD).
RESULTS: Five RCTs on 525 patients reported the colorectal resections by SILS versus MILS technique. In the random effects model analysis using the statistical software Review Manager 5.3, the operation time (SMD, 0.20; 95% CI, -0.11 to 0.52; z=1.28; P=0.20), length of in-patient stay (SMD, -0.18; 95% CI, -0.51 to 0.14; z=1.10; P=0.27) and lymph node harvesting (SMD, 0.09; 95% CI, -0.14 to 0.33; z=0.76; P=0.45) were comparable between both techniques. Furthermore, post-operative complications (RR, 1.00; 95% CI, 0.65-1.54; z=0.02; P=0.99), post-operative mortality, surgical site infection rate (RR, 3.00; 95% CI, 0.13-70.92; z=0.68; P=0.50), anastomotic leak rate (RR, 0.43; 95% CI, 0.11-1.63; z=1.24; P=0.21), conversion rate (P=0.13) and re-operation rate (P=0.43) were also statistically similar following SILS and MILS.
CONCLUSIONS: SILS failed to demonstrate any superiority over MILS for colorectal resections in all post-operative surgical outcomes.},
}
@article {pmid29953098,
year = {2018},
author = {Okhotnikov, OI and Yakovleva, MV and Shevchenko, NI and Grigoriyev, SN and Pakhomov, VI},
title = {[X-ray-surgery of diverticular disease complicated by abscess formation].},
journal = {Khirurgiia},
volume = {},
number = {6},
pages = {35-40},
doi = {10.17116/hirurgia2018635-40},
pmid = {29953098},
issn = {0023-1207},
mesh = {*Abdominal Abscess/etiology/surgery ; *Diverticular Diseases/complications/surgery ; *Drainage/adverse effects/methods ; Emergency Treatment/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment, Health Care ; Postoperative Complications/diagnosis/etiology/*prevention & control ; Russia ; Surgery, Computer-Assisted/*methods ; Tomography, X-Ray Computed/*methods ; Ultrasonography/*methods ; },
abstract = {PURPOSE: Show the possibility of an alternative use of interventional radiology techniques in complex treatment of patients with inflammatory complications of the diverticular disease of the colon.
MATERIAL AND METHODS: In 2012-2016, there were 87 patients under our supervision with complicated diverticular disease. In 57 (65.5%) cases were diagnosed infiltrate, in 24 (27.6%) cases - abscess of paracolon area (Ib-II type by Hinchey), in 6 (6.9%) cases (III-IV type according Hinchey) generalized peritonitis have been identified.
RESULTS: Emergency laparotomy was performed in 13 patients. Abscesses of paracolon (Ib-II type by Hinchey) area were diagnosed sonographically during the initial examination in 17 patients. 26 percutaneous drainage of diverticulogenous abscesses of different localizations self-locking drainage #8Fr 'pig tail' was carried out under the combined ultrasonic and X-ray control in this group of patients. The technical success of percutaneous drainaging of the abscesses was achieved in all manipulations. 13 patients had a single drainaging, and for diverticular disease - disease-free during the observation period of 1 year to 5 years. Resection of the colon in a planned manner after percutaneous drainage of recurrent abscess of paracolon area was performed in 4 patients. Complications related with the technique of installing drainage were not reported, mortality in the group of drained patients was absent.
CONCLUSION: Ultrasound examination of patients with suspected inflammatory complications of diverticular disease - a necessary and sufficient method for initial diagnosis of the disease. Percutaneous drainage of diverticulogenous abscesses (Hinchey Ib-II) is represented by the pragmatic 'first line' choice in patients with complicated diverticular disease, that allows to treat the pathology steadfastly in most of the cases.},
}
@article {pmid29945147,
year = {2018},
author = {Ramphal, W and Schreinemakers, JMJ and Seerden, TCJ and Gobardhan, PD},
title = {Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {36},
number = {5},
pages = {362-368},
doi = {10.1159/000489926},
pmid = {29945147},
issn = {1421-9875},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; Colorectal Neoplasms/diagnosis/*etiology/*pathology ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: The association between diverticulitis and colorectal cancer (CRC) remains unclear, though both share epidemiological characteristics. The aim of this study was to investigate whether there is higher risk for CRC after an episode of uncomplicated diverticulitis. Furthermore, in cases of CRC, we sought to determine specific tumour characteristics.
METHODS: This retrospective observational study includes patients with acute diverticulitis (Hinchey 0 and 1) who were conservatively treated with or without antibiotics between 2008 and 2013. Patients with endoscopic follow-up were included for analysis. Tumour characteristics of patients diagnosed with CRC during colonoscopic follow-up according to patients' presentation of alarm symptoms were considered to be the primary endpoint.
RESULTS: A total of 977 patients were conservatively treated for an episode of acute diverticulitis, 645 of whom underwent colonoscopy during follow-up. Ten patients were diagnosed with CRC, nine of whom exhibited alarm symptoms. One patient was diagnosed with stage I disease, 4 had stage II, and 5 had stage III disease.
CONCLUSIONS: This study strongly suggests that even though CRC is rare after uncomplicated diverticulitis, in cases of alarm symptoms, a colonoscopy is indicated. In cases where CRC is diagnosed, it is often advanced with a higher TNM stage and poor prognosis.},
}
@article {pmid29942217,
year = {2018},
author = {Mohanty, S and Webb, SP},
title = {Uncommon Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {258-262},
pmid = {29942217},
issn = {1531-0043},
abstract = {This article describes the epidemiology, pathogenesis, diagnosis, and treatment of three rare variants of diverticular disease: cecal and right-sided colonic diverticula, giant colonic diverticula, and small bowel diverticula.},
}
@article {pmid29942216,
year = {2018},
author = {Lin, M and Raman, SR},
title = {Evaluation of Quality of Life and Surgical Outcomes for Treatment of Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {251-257},
pmid = {29942216},
issn = {1531-0043},
abstract = {The prevalence of diverticular disease in the Western and industrialized nations has increased over the last century, and our understanding of this disease and its management continues to evolve. In this article, we review the literature regarding the postoperative quality of life (QOL) and functional outcomes following surgical management of diverticulitis, including information regarding bowel function, recurrence of symptoms, and other postoperative sequelae. While objective parameters, such as attacks of diverticulitis, complications, and clinical episodes have been studied, there is a paucity of data on less objective factors, such as overall patient satisfaction after operative management of diverticular disease. The literature shows improvement in QOL following surgical intervention for diverticulitis if preoperative QOL was significantly low, secondary to severe/complicated diverticulitis. However, a subset of patients does continue to have symptoms following surgical intervention for diverticulitis. Often neglected in the literature, there remains a need for prospective data evaluating preoperative function to ascertain the impact of surgery on patients' QOL and postoperative function.},
}
@article {pmid29942214,
year = {2018},
author = {Neale, JA},
title = {Surgical Management of Diverticular Disease in the Elective Setting.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {236-242},
pmid = {29942214},
issn = {1531-0043},
abstract = {Diverticulosis is a common condition that has increased in prevalence in industrialized countries over the past century. Estimates of developing diverticular disease in the United states range from 5% by 40 years of age up, to over 80% by age 80. It is estimated that approximately 20% of patients with diverticulosis develop diverticulitis over the course of their lifetime. Diverticular disease can be divided into simple and chronic diverticulitis with various sub categories. There are various instances and circumstances where elective resection is indicated for both complex and simple forms of this disease process. When planning surgery there are general preoperative considerations that are important to be reviewed prior to surgery. There are also more specific considerations depending on secondary problem attributed to diverticulitis, that is, fistula vs stricture. Today, treatment for elective resection includes open, laparoscopic and robotic surgery. Over the last several years we have moved away from open surgery to laparoscopic surgery for elective resection. With the advent of robotic surgery and introduction of 3D laparoscopic surgery the discussion of superiority, equivalence between these modalities, is and should remain an important discussion topic.},
}
@article {pmid29942213,
year = {2018},
author = {Theodoropoulos, D},
title = {Current Options for the Emergency Management of Diverticular Disease and Options to Reduce the Need for Colostomy.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {229-235},
pmid = {29942213},
issn = {1531-0043},
abstract = {This article reviews the current options and recommendations for the emergency management of acute diverticulitis, including the spectrum of antibiotics, percutaneous drainage, laparoscopic lavage, and surgical options for resection with the restoration of bowel continuity.},
}
@article {pmid29942212,
year = {2018},
author = {Ghalyaie, N},
title = {Management of Diverticular Disease in the Setting of Other Colorectal Pathology: Data on Simultaneous Issues in Segmental Colitis, Inflammatory Bowel Disease, Cancer, and Complications.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {226-228},
pmid = {29942212},
issn = {1531-0043},
abstract = {Diverticulosis of the colon is a very common anatomical condition. In the Western world, it affects more than 70% of over 65 years old population and represents the fifth most important gastrointestinal disease in terms of health care costs in Western countries. The diagnosis of diverticular disease and diverticulitis can be challenging. Often, there is overlap with other colonic pathologies, such as segmental colitis, ischemia, inflammatory bowel disease, cancer, or infectious colitis. Management of diverticular disease in these settings might be different.},
}
@article {pmid29942211,
year = {2018},
author = {Kucejko, RJ and Poggio, JL},
title = {Considerations and Changes in the Evaluation, Management, and Outcomes in the Management of Diverticular Disease: The Diagnosis, Pathology, and Treatment of Diverticular Colitis.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {221-225},
pmid = {29942211},
issn = {1531-0043},
abstract = {Diverticular colitis, also known as segmental colitis associated with diverticulosis, is a colonic inflammatory disorder on the spectrum of inflammatory bowel disease (IBD). The disease consists of macroscopic and microscopic inflammation affecting inter-diverticular mucosa, sparing peri-diverticular mucosa, with inflammation confined to the descending and sigmoid colon. The disease likely arises from the altered immune response of an individual, genetically susceptible to the IBD spectrum of diseases. Patients with segmental colitis associated with diverticulosis (SCAD) are typically older, and likely represent a subgroup of IBD-susceptible patients who lacked an environmental trigger until that point in their life. Most patients remain in remission with initial treatments of mesalamine or topical steroids, and maintenance mesalamine afterwards. Only the most severe form of the disease necessitates immunomodulatory therapy and the consideration of surgery.},
}
@article {pmid29942210,
year = {2018},
author = {Kandagatla, PG and Stefanou, AJ},
title = {Current Status of the Radiologic Assessment of Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {217-220},
pmid = {29942210},
issn = {1531-0043},
abstract = {Radiologic assessment plays a vital role in the management of diverticulitis. It not only helps in the diagnosis, but also helps to guide the management. As technology has progressed, different modalities have offered insight into the treatment of this disease process. Through various trials and studies, certain modalities stand above the rest in terms of sensitivity and specificity. Computed tomography (CT) imaging has also proved to help us guide the management through a grading system. Newer studies show us the advantages of other modalities such as ultrasound and magnetic resonance imaging (MRI). Though there is much research yet to be done with these modalities, they do show a lot of potential.},
}
@article {pmid29942209,
year = {2018},
author = {Knott, L and Reickert, CA},
title = {Medical Management of Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {214-216},
pmid = {29942209},
issn = {1531-0043},
abstract = {This article reviews the current literature supporting the non-surgical options for treatment in acute uncomplicated diverticulitis, complicated diverticulitis, and options for prevention of recurrent diverticulitis.},
}
@article {pmid29942208,
year = {2018},
author = {Munie, ST and Nalamati, SPM},
title = {Epidemiology and Pathophysiology of Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {209-213},
pmid = {29942208},
issn = {1531-0043},
abstract = {Colonic diverticular disease is a common health care issue which has historically been attributed to western countries and older age population. Recent studies have shown a rise in incidence among developing countries that have adopted western diets as well as rise in prevalence among younger patients. In this article, the authors discuss the incidence, epidemiology, and pathophysiology of colonic diverticular disease.},
}
@article {pmid29942207,
year = {2018},
author = {Reickert, CA},
title = {Diverticular Disease.},
journal = {Clinics in colon and rectal surgery},
volume = {31},
number = {4},
pages = {207-208},
doi = {10.1055/s-0037-1607463},
pmid = {29942207},
issn = {1531-0043},
}
@article {pmid29925917,
year = {2018},
author = {Peery, AF},
title = {It's Actually a Little Complicated: Antibiotics for Uncomplicated Diverticulitis.},
journal = {The American journal of gastroenterology},
volume = {113},
number = {7},
pages = {949-950},
doi = {10.1038/s41395-018-0159-8},
pmid = {29925917},
issn = {1572-0241},
support = {K23 DK113225/DK/NIDDK NIH HHS/United States ; },
mesh = {Acute Disease ; *Anti-Bacterial Agents ; Colon, Sigmoid ; *Diverticulitis ; Elective Surgical Procedures ; Humans ; },
abstract = {The assumption that acute uncomplicated diverticulitis requires antibiotics has been challenged. In this issue, the Dutch Diverticular Disease Collaborative Study Group report the 2-year follow-up to their trial of observation vs. treatment with amoxicillin-clavulanic acid for acute uncomplicated diverticulitis. The new study provides useful insights on the natural history of acute uncomplicated diverticulitis. The most intriguing data compared rates of elective sigmoid resection between the groups. There was a trend toward more elective surgery in the observation group compared to those in the antibiotic group. It might be too soon to abandon antibiotics for uncomplicated diverticulitis.},
}
@article {pmid29922766,
year = {2018},
author = {Tursi, A and Brandimarte, G and Di Mario, F and Elisei, W and Picchio, M},
title = {Efficacy and safety of a new nutraceutical formulation in managing patients with symptomatic uncomplicated diverticular disease: a 12-month, prospective, pilot study.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {27},
number = {2},
pages = {201-202},
doi = {10.15403/jgld.2014.1121.272.fef},
pmid = {29922766},
issn = {1842-1121},
mesh = {Aged ; *Dietary Supplements ; Diverticulosis, Colonic/*drug therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pilot Projects ; Prospective Studies ; Treatment Outcome ; },
}
@article {pmid29902524,
year = {2018},
author = {El-Haddad, HM and Kassem, MI and Sabry, AA and Abouelfotouh, A},
title = {Surgical protocol and outcome for sigmoidovesical fistula secondary to diverticular disease of the left colon: A retrospective cohort study.},
journal = {International journal of surgery (London, England)},
volume = {56},
number = {},
pages = {115-123},
doi = {10.1016/j.ijsu.2018.05.742},
pmid = {29902524},
issn = {1743-9159},
mesh = {Adult ; Aged ; Anastomosis, Surgical ; Colon, Sigmoid/*surgery ; Colonoscopy/*methods ; Diverticulum, Colon/*complications/surgery ; Female ; Humans ; Intestinal Fistula/*etiology/surgery ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/*etiology/surgery ; Treatment Outcome ; },
abstract = {BACKGROUND: Diverticular disease of sigmoid colon can rarely be complicated by a connective track to urinary bladder. Pneumaturia and fecaluria are the pathognomonic symptoms. Resection surgery is the preferred treatment to overcome the renal sequellae of the disease. The purpose of this study is to propose a guiding classification to help general surgeons during surgical management of diverticular disease complicated by sigmoidovesical fistula (SVF).
PATIENTS AND METHODS: The data of 40 cases with colovesical fistula due to diverticular disease of sigmoid colon were retrospectively analyzed. Clinicopathological variables, imaging reports, types of treatment and patient outcome were evaluated.
RESULTS: There were 36 men (90%) and four women (10%) in which the ages ranged from 32 to 79 with a mean of 58.1 years. Pneumaturia was the most common presenting symptom in 38 cases (95%) followed by urinary symptoms in 35 cases (87.5%) then fecaluria in 33 cases (82.5%). 37 patients underwent surgical resection while three patients were in poor general condition to withstand major resection. 16 patients underwent one stage resection and anastomosis, 16 patients were managed by two stage procedure and the remaining 5 patients were treated by three stages operation.
CONCLUSIONS: Adequately performed CT followed by colonoscopy is the mainstay for diagnosis. Type 1 SVF should be treated in a single stage by complete resection and immediate anastomosis without a stoma. Type 2 cases are best managed in two stages while those with type 3 SVF are emergently managed by three stage procedure. Treatment of type 4 should be individualized.},
}
@article {pmid29900748,
year = {2018},
author = {Prieto, RG and Mahler, MA and Vidales, G},
title = {Ileal tubular adenoma as a cause of lower gastrointestinal bleeding in infants.},
journal = {Revista espanola de enfermedades digestivas},
volume = {110},
number = {8},
pages = {532-533},
doi = {10.17235/reed.2018.5571/2018},
pmid = {29900748},
issn = {1130-0108},
mesh = {Adenocarcinoma/*complications/pathology ; Female ; Gastrointestinal Hemorrhage/*etiology/pathology ; Humans ; Ileal Neoplasms/*complications/pathology ; Infant ; },
abstract = {Lower gastrointestinal bleeding is a common pathology with diverse causes depending on the patients´ age. The most common causes in adults are polyps, neoplasias, diverticular disease and angiodysplasia. In neonates, necrotizing enterocolitis and volvulus, and anal fissures and bowel intussusception in infants. Polyps are reported as a cause of bleeding only in children of preschool age.},
}
@article {pmid29888630,
year = {2018},
author = {Tursi, A},
title = {A critical appraisal of advances in the diagnosis of diverticular disease.},
journal = {Expert review of gastroenterology & hepatology},
volume = {12},
number = {8},
pages = {791-796},
doi = {10.1080/17474124.2018.1487288},
pmid = {29888630},
issn = {1747-4132},
mesh = {Abdominal Pain/etiology ; Colonoscopy ; Diagnosis, Differential ; Diverticular Diseases/complications/diagnosis/diagnostic imaging ; Diverticulosis, Colonic/blood/complications/*diagnosis/diagnostic imaging ; Feces/chemistry ; Humans ; Irritable Bowel Syndrome/diagnosis ; Leukocyte L1 Antigen Complex/analysis ; },
abstract = {Diverticulosis of the colon is a common condition, and about one-fourth of those people develop symptoms, which is called 'diverticular disease' (DD). Since there are still some concerns about the diagnosis of DD, the aim of this review was to analyze current and evolving advances in its diagnosis. Area covered: Analysis of clinical, radiology, laboratory, and endoscopic tools to pose a correct diagnosis of DD was performed according to current PubMed literature. Expert commentary: A combination of clinical characteristic of the abdominal pain and fecal calprotectin expression may help to differentiate between symptomatic uncomplicated diverticular disease and irritable bowel syndrome. Abdominal computerized tomography (CT) scan is still the gold standard in diagnosing acute diverticulitis and its complications. CT-colonography may be useful as a predicting tool on the outcome of the disease. Diverticular Inflammation and Complications Assessment (DICA) endoscopic classification shows a significant relationship between severity of DICA score inflammatory indexes, as well as with severity of abdominal pain. Moreover, it seems to be predictive of the outcome of the disease in terms of acute diverticulitis occurrence/recurrence and surgery occurrence. Finally, preliminary data found intestinal microbiota analysis is a promising tool in diagnosing and monitoring this disease.},
}
@article {pmid29885783,
year = {2018},
author = {Arabi, NA and Musaad, AM and Mohammed, FAH and Ahmed, EE and Abdelaziz, MSE},
title = {Acute lower gastrointestinal bleeding in Sudanese patients: a study on 301 patients in a specialized centre.},
journal = {Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology},
volume = {19},
number = {2},
pages = {84-87},
doi = {10.1016/j.ajg.2018.03.001},
pmid = {29885783},
issn = {2090-2387},
mesh = {Acute Disease ; Adult ; Aged ; Angiodysplasia/complications ; Colonic Neoplasms/*complications ; Colonic Polyps/complications ; Cross-Sectional Studies ; Diverticular Diseases/*complications ; Female ; *Gastroenterology ; Gastrointestinal Hemorrhage/*epidemiology/*etiology ; Hemorrhoids/*complications ; *Hospitals, Special ; Humans ; Inflammatory Bowel Diseases/complications ; Male ; Middle Aged ; Prevalence ; Sudan/epidemiology ; Ulcer/complications ; },
abstract = {BACKGROUND AND STUDY AIMS: Lower gastrointestinal bleeding originates from a site distal to the ligament of Treitz. It can present as an acute life-threatening or chronicbleeding. It is common among older patients and those with comorbidity. The common causes are diverticular disease, angiodysplasias, neoplasms, colitis, ischaemia and anorectal disorders. The aim of this study is to determine the prevalence and causes of acute lower gastrointestinal bleeding among Sudanese patients.
PATIENTS AND METHODS: In a period of 2 years we studied 301 patients with fresh rectal bleeding out of 5625 patients with gastrointestinal bleeding in Ibn Sina Specialized Hospital, Khartoum, Sudan, This is a cross sectional observational hospital based study. All patients with fresh rectal bleeding within 24 h were included and consented.
RESULT: Lower gastrointestinal bleeding constituted 5.37% of total cases of gastrointestinal bleeding. The mean age of patients was 55.43 ± 17.779, male: female ratio was 2:1. The most common cause (if upper gastrointestinal bleeding is excluded) was diverticular disease 39.6% (n = 61) followed by piles 24.1% (n = 35), colonic tumours 12.34% (n = 19), ulcerative colitis 5.19% (n = 8), Crohn's 5.19% (n = 8), colonic polyps 3,89% (n = 6), angiodysplesia 4.5% (n = 7), colonic ulcer 2.59% (n = 4), ischaemic colitis 1.3%, nonspecific colitis 1.3% (n = 2), and small bowel source in 1.3% (n = 2). The majority of those patients with diverticular disease were male and with first presentation. The commonest cause in those patients younger than 20 years was polyps, and in those between 21 and 40 was piles followed by inflammatory bowel disease, and in those between 41 and 60 years old was piles followed by diverticular disease and tumours, and in those above 60 years was diverticular disease followed by piles and tumours. The correlation between positive colonoscopy finding and diabetes and the use of nonsteroidal anti-inflammatory drugs were statistically significant. The one-month mortality rate was 2.3% CONCLUSION: Acute lower gastrointestinal bleeding is common among elderly patients and the commonest cause is diverticular disease. Colonoscopy plays an important role in the diagnosis. Most patients respond to conservative therapy.},
}
@article {pmid29884485,
year = {2018},
author = {Cálamo-Guzmán, B and De Vinatea-Serrano, L and Piscoya, A},
title = {Polypoid angiodysplasia mimicking diverticular disease.},
journal = {Gastroenterologia y hepatologia},
volume = {41},
number = {9},
pages = {574-575},
doi = {10.1016/j.gastrohep.2018.04.012},
pmid = {29884485},
issn = {0210-5705},
mesh = {Abdominal Pain/etiology ; Aged ; Angiodysplasia/*diagnosis/diagnostic imaging/pathology ; Colonic Polyps/*diagnosis/diagnostic imaging/pathology ; Diagnosis, Differential ; Diverticulitis/*diagnosis ; Emergencies ; Humans ; Ileocecal Valve/*diagnostic imaging ; Male ; },
}
@article {pmid29881303,
year = {2018},
author = {Ceresoli, M and Lo Bianco, G and Gianotti, L and Nespoli, L},
title = {Inflammation management in acute diverticulitis: current perspectives.},
journal = {Journal of inflammation research},
volume = {11},
number = {},
pages = {239-246},
pmid = {29881303},
issn = {1178-7031},
abstract = {The pathogenesis of diverticular disease and acute diverticulitis is still unclear and many different hypotheses have been formulated. Seemingly, there are several related factors such as chronic inflammation, gut microbiome, obesity and the immunogenic properties of fat tissue and diet. Inflammation plays a pivotal role in diverticular disease and acute diverticulitis. The aim of the present review is to investigate the role of inflammation in diverticular disease as well as in mild and complicated acute diverticulitis with a focus on current research and treatment perspectives.},
}
@article {pmid29878951,
year = {2018},
author = {Sköldberg, F and Olén, O and Ekbom, A and Schmidt, PT},
title = {Appendectomy and Risk of Subsequent Diverticular Disease Requiring Hospitalization: A Population-Based Case-Control Study.},
journal = {Diseases of the colon and rectum},
volume = {61},
number = {7},
pages = {830-839},
doi = {10.1097/DCR.0000000000001086},
pmid = {29878951},
issn = {1530-0358},
mesh = {Adult ; Aged ; Aged, 80 and over ; Appendectomy/*statistics & numerical data ; Appendicitis/*epidemiology/surgery ; Case-Control Studies ; Diverticulitis, Colonic/*epidemiology ; Diverticulosis, Colonic/epidemiology ; Female ; Hospitalization/statistics & numerical data ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; *Registries ; Risk Factors ; Sweden/epidemiology ; },
abstract = {BACKGROUND: Appendicitis and acute diverticulitis share clinical features and are both influenced by genetic and environmental factors. Appendectomy has been positively associated with diverticular disease in hospital-based case-control studies.
OBJECTIVE: The aim of the present study was to investigate, in a population-based setting, whether appendectomy, with or without appendicitis, is associated with an altered risk of hospitalization with diverticular disease.
DESIGN: This was a population-based case-control study.
SETTINGS: The study was based on national healthcare and population registers.
PATIENTS: We studied 41,988 individuals hospitalized between 2000 and 2010 with a first-time diagnosis of colonic diverticular disease and 413,115 matched control subjects.
MAIN OUTCOME MEASURES: The association between appendectomy with or without appendicitis and diverticular disease was investigated by conditional logistic regression, including a model adjusting for hospital use.
RESULTS: A total of 2813 cases (6.7%) and 19,037 controls (4.6%) had a previous record of appendectomy (appendectomy with acute appendicitis: adjusted OR = 1.31 (95% CI, 1.24-1.39); without appendicitis: adjusted OR = 1.30 (95% CI, 1.23-1.38)). Appendectomy was most strongly associated with an increased risk of diverticular disease within 1 year (with appendicitis: adjusted OR = 2.26 (95% CI, 1.61-3.16); without appendicitis: adjusted OR = 3.98 (95% CI, 2.71-5.83)), but the association was still present ≥20 years after appendectomy (with appendicitis: adjusted OR = 1.22 (95% CI, 1.12-1.32); without appendicitis: adjusted OR = 1.19 (95% CI, 1.10-1.28)).
LIMITATIONS: Detailed clinical information on the cases was not available. There were unmeasured potential confounders, such as smoking and dietary factors.
CONCLUSIONS: The findings are consistent with a hypothesis of appendectomy causing an increased risk of diverticular disease, for example, by affecting the mucosal immune system or the gut microbiome. However, several other mechanisms may contribute to, or account for, the positive association, including a propensity for abdominal pain increasing the risk of both the exposure and the outcome. See Video Abstract at http://links.lww.com/DCR/A604.},
}
@article {pmid29870293,
year = {2018},
author = {Suhardja, TS and Norhadi, S and Ee, E and Hodgkins, B},
title = {Comparison of the Thunderbeat and Other Energy Devices in Laparoscopic Colorectal Resection: A Single-Center Experience.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {28},
number = {12},
pages = {1417-1421},
doi = {10.1089/lap.2018.0208},
pmid = {29870293},
issn = {1557-9034},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Colorectal Neoplasms/*surgery ; Digestive System Surgical Procedures ; Electrocoagulation/*instrumentation ; Equipment Design ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Operative Time ; Prospective Studies ; Ultrasonic Surgical Procedures/*instrumentation ; Young Adult ; },
abstract = {Background: The THUNDERBEAT (TB) is a relatively novel energy device that is used in laparoscopic colorectal resection (LCR), which integrates both ultrasonic and bipolar energy. There are limited data on its use in LCR, compared with bipolar diathermy (LigaSure[™] [LS]) or ultrasonically generated heat (Harmonic ACE [HA]). The aim of this study was to compare outcomes in patients undergoing LCR with TB versus LS or HA, for both benign and malignant colorectal diseases. Methods: This study is a prospective trial using retrospective controls in patients undergoing LCR. The study period was over 6 months from June 2015, during which all elective laparoscopic colonic resections were performed using TB only. The retrospective control population included all consecutive patients who underwent LCR during the preceding 6 months, using either LS or HA. The primary outcome measure was the total operative time. Secondary outcome measures evaluated were rates of postoperative surgical complications, mortality, and length of stay. Results: A total of 114 patients were included in the study. Median operative time was not significantly different between LS/HA and TB arms (246 versus 240 minutes, P = .779). Both arms showed no device failure. There was equivalent rate of intraoperative complications (P = .755) and conversion to open surgery (P = .075). There were no statistically significant differences in postoperative morbidity (P = .938) and mortality (P = .392) observed between the two arms. There was also no difference in the length of stay between LS/HA and TB arms (6 versus 7 days, P = .085). Conclusions: Our dataset has the largest number of cases comparing TB and other energy devices in laparoscopic colorectal cancer surgery. They all appear to be equally safe and effective. Operating the TB device does not require a steep learning curve and utilizes similar techniques transferable from the use of other conventional energy devices.},
}
@article {pmid29868154,
year = {2018},
author = {Kayamba, V and Nicholls, K and Morgan, C and Kelly, P},
title = {A seven-year retrospective review of colonoscopy records from a single centre in Zambia.},
journal = {Malawi medical journal : the journal of Medical Association of Malawi},
volume = {30},
number = {1},
pages = {17-21},
pmid = {29868154},
issn = {1995-7270},
mesh = {Adult ; Colonic Neoplasms/*diagnosis/epidemiology ; Colonoscopy/*methods ; Colorectal Neoplasms/*diagnosis/epidemiology ; Female ; Humans ; Intestinal Polyps/*diagnosis/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; Zambia/epidemiology ; },
abstract = {INTRODUCTION: Colorectal disease is common throughout the world, but the spectrum of diagnoses across Africa remains largely unexplored. There is anecdotal evidence of changing colorectal disease but this has not been systematically investigated. The aim of this study was to enhance our insight into the spectrum of colonoscopic diagnoses in Zambia.
METHODS: We retrieved written colonoscopy reports from January 2008 to December 2015. Collected data were coded by experienced endoscopists and analysed by age, sex, referral source, indication and diagnosis.
RESULTS: Included in this analysis were 573 colonoscopy reports. The most common diagnosis was haemorrhoids (n=151, 26%), followed by tumours (n=96,17%). Over this time period, the proportion of normal colonoscopies decreased by 32% (P<0.001), presumably due to introduction of screening of all requests, while the rate of polyp detection increased from 5% to 10% (P=0.006). The detection of polyps was highest in patients less than 16 years (OR 8.4; 95% CI 2.4-26.2, P<0.001). Of those with colorectal tumours, 33/96 (35%) were less than 45 years although the occurrence was higher with advancing age (P=0.02). Diverticular disease was more common in older age groups (median (IQR) age 70 (60-75) years, versus 47 (34-62) years for those without the disease; P=0.0001).
CONCLUSION: This audit has shown that more than a third of colorectal tumours seen during colonoscopy are in patients below the age of 45 years, with the occurrence of polyps being highest in those below 16 years. Diverticular disease is most common in older age groups.},
}
@article {pmid29863123,
year = {2018},
author = {Tochigi, T and Kosugi, C and Shuto, K and Mori, M and Hirano, A and Koda, K},
title = {Management of complicated diverticulitis of the colon.},
journal = {Annals of gastroenterological surgery},
volume = {2},
number = {1},
pages = {22-27},
pmid = {29863123},
issn = {2475-0328},
abstract = {Diverticular disease of the colon occurs quite frequently in developed countries, and its prevalence has recently increased in Japan. The appearance of diverticulosis increases with age, although mostly remaining asymptomatic. Approximately 20% of cases require treatment. As the Western lifestyle and number of elderly people increase, the need for medical treatment also increases. Computed tomography (CT) is the gold standard for diagnosing diverticulitis. Complicated diverticulitis is classified by the size and range of abscess formation and the severity of the peritonitis. Each case should be classified based on clinical and computed tomography (CT) findings and then treated appropriately. Most patients with uncomplicated diverticulitis (stages 0-Ia) can be treated conservatively. Diverticulitis with a localized abscess (stages Ib-II) is generally resolved with conservative treatment. If the abscess is larger or conservative treatment fails, however, percutaneous drainage or surgery should be considered. Operative treatment is considered standard therapy for severe diverticulitis with perforation and generalized peritonitis (stages III-IV). Colonic diverticulitis treated conservatively frequently recurs. Elective surgery after recovery should be considered carefully and decisions made on a case-by-case basis. Because cases of colonic diverticulitis will undoubtedly increase in Japan, it is likely that we will be confronted with increasing numbers of treatment decisions. We therefore need to have a systematic strategy for treating the various stages of colonic diverticulitis appropriately. We herein review the management of complicated diverticulitis.},
}
@article {pmid29854710,
year = {2018},
author = {Shin, S and Kim, D and Kang, UR and Yang, CS},
title = {Impact of CT imaging on predicting the surgical management of acute diverticulitis.},
journal = {Annals of surgical treatment and research},
volume = {94},
number = {6},
pages = {322-329},
pmid = {29854710},
issn = {2288-6575},
abstract = {PURPOSE: The incidence of colonic diverticular disease is increasing, and several grading systems based on CT findings have been developed. The objective of this study was to define the impact of various CT findings of colonic diverticulitis and to demonstrate which factors affect the need for operative treatment.
METHODS: Three hundred fifty-seven patients diagnosed with colonic diverticulitis from January 2010 to July 2016 were retrospectively evaluated. Patients were excluded if pure diverticulosis, diverticular bleeding, colon cancer, or relevant data deficiencies, and the remaining patients (n = 178) were reviewed. Patients were categorized into a successful nonoperation group and an operation group. The operation group was then matched 1:2 with the nonoperative group based on age, gender, American Society of Anesthesiologists physical status classification, and body mass index.
RESULTS: After propensity score matching, there were no significant differences regarding patients' demographic characteristics between the 2 groups. Left location was more associated with need for operation than the right side (79.2% vs. 31.3%, P < 0.001). CT findings such as distant intraperitoneal air, pericolic air, and free fluid were significantly more apparent in the operation group. When these factors were evaluated in a multivariate analysis, distant intraperitoneal air showed statistical significance (P = 0.046) and pericolic air and left location a significant trend (P = 0.071 and P = 0.067, respectively).
CONCLUSION: This study suggests that distant intraperitoneal air is the most important factor in the need for surgery in patients with colonic diverticulitis. Further study will be able to identify more detailed CT findings and verify their significance, and will be helpful in designing practical scoring and classification systems.},
}
@article {pmid29846097,
year = {2018},
author = {Schieffer, KM and Kline, BP and Yochum, GS and Koltun, WA},
title = {Pathophysiology of diverticular disease.},
journal = {Expert review of gastroenterology & hepatology},
volume = {12},
number = {7},
pages = {683-692},
doi = {10.1080/17474124.2018.1481746},
pmid = {29846097},
issn = {1747-4132},
mesh = {Animals ; Colon/immunology/*physiopathology ; Diverticulitis, Colonic/genetics/immunology/microbiology/*physiopathology ; Diverticulosis, Colonic/genetics/immunology/microbiology/*physiopathology ; Environment ; Gastrointestinal Microbiome ; Gastrointestinal Motility ; Genetic Predisposition to Disease ; Host-Pathogen Interactions ; Humans ; Immunity, Mucosal ; Intestinal Mucosa/immunology/*physiopathology ; Prognosis ; Risk Factors ; },
abstract = {Inflammation of diverticula, or outpouchings of the colonic mucosa and submucosa through the muscularis layer, leads to diverticulitis. The development of diverticular disease, encompassing both diverticulosis and diverticulitis, is a result of genetic predisposition, lifestyle, and environmental factors, including the microbiome. Areas covered: Previous reports implicated genetic predisposition, environmental factors, and colonic dysmotility in diverticular disease. Recent studies have associated specific host immune responses and the microbiome as contributors to diverticulitis. To review pertinent literature describing pathophysiological factors associated with diverticulosis or diverticulitis, we searched the PubMed database (March 2018) for articles considering the role of colonic architecture, genetic predisposition, environment, colonic motility, immune response, and the microbiome. Expert commentary: In the recent years, research into the molecular underpinnings of diverticular disease has enhanced our understanding of diverticular disease pathogenesis. Although acute uncomplicated diverticulitis is treated with broad spectrum antibiotics, evaluation of the microbiome has been limited and requires further comprehensive studies. Evidence suggests that a deregulation of the host immune response is associated with both diverticulosis and diverticulitis. Further examining these pathways may reveal proteins that can be therapeutic targets or aid in identifying biological determinants of clinical or surgical decision making.},
}
@article {pmid29844795,
year = {2018},
author = {Scarpignato, C and Barbara, G and Lanas, A and Strate, LL},
title = {Management of colonic diverticular disease in the third millennium: Highlights from a symposium held during the United European Gastroenterology Week 2017.},
journal = {Therapeutic advances in gastroenterology},
volume = {11},
number = {},
pages = {1756284818771305},
pmid = {29844795},
issn = {1756-283X},
abstract = {Diverticulosis is a common anatomical condition, which appears to be age-dependent. Individuals who develop chronic gastrointestinal symptoms or complications are referred to as having diverticular disease. Although the diagnosis of this condition can be relatively straightforward, randomized controlled trials are scarce and management often follows tradition rather than principles of evidence-based medicine. This report deals with the topics discussed during a symposium held during the United European Gastroenterology Week (Barcelona, October 2017). During the meeting, the role of dysbiosis in the pathogenesis of diverticular disease and its treatment were thoroughly discussed, by examining the efficacy and mechanisms of action of the currently used drugs. Recent studies have shown the presence of dysbiosis in patients with diverticular disease and suggest an imbalance in favor of bacteria with pro-inflammatory and pathogenetic potential. These microbiota changes correlate with mucosal immune activation, mirrored by a marked increase of macrophages in colonic mucosa, both in the diverticular region and at distant sites. The low-grade inflammation, driven by bacteria-induced immune activation, could be involved in the pathophysiology of symptoms. As a consequence, pharmacological approaches targeting enteric bacteria (with poorly absorbed antibiotics, like rifaximin, or probiotics) or intestinal inflammation (with 5-ASA derivatives or rifaximin) have shown capability of controlling symptoms and also preventing complications, albeit more research is needed to establish the optimal regimen (daily dose and duration) of therapy. Well-designed randomized-controlled trials (RCTs), including homogeneous populations of patients, are therefore needed. The future of management of many GI diseases, including symptomatic uncomplicated diverticular disease, will rely on the so-called 'microbiota-directed therapies'.},
}
@article {pmid29809182,
year = {2018},
author = {Serrano-González, J and Artés-Caselles, M and León, LR and Plá-Sánchez, P and Sánchez-Turrión, V},
title = {[Management of jejunal diverticulitis. Experience in our center].},
journal = {Cirugia y cirujanos},
volume = {86},
number = {2},
pages = {148-151},
doi = {10.24875/CIRU.M18000024},
pmid = {29809182},
issn = {2444-054X},
mesh = {Aged ; Aged, 80 and over ; Diverticulitis/*diagnosis/*therapy ; Female ; Humans ; Jejunal Diseases/*diagnosis/*therapy ; Male ; Retrospective Studies ; },
abstract = {Jejunal diverticular disease is a very uncommon pathology often asymptomatic. Associated complications appear in less than 30% of patients and they can present as diverticulitis, refractary inflammation, obstruction, hemorrhage, perforation or intraabdominal abscess formation. Clinical manifestations are usually unspecific and high suspicion index is required to reach the diagnosis. Treatment of complications includes volume replacement, transfusions, antibiotic therapy, percutaneous drainage or surgical intervention. We present a retrospective observational study of the cases treated in our hospital between 2007 and 2016.},
}
@article {pmid29807873,
year = {2018},
author = {Bajaj, JS and Barbara, G and DuPont, HL and Mearin, F and Gasbarrini, A and Tack, J},
title = {New concepts on intestinal microbiota and the role of the non-absorbable antibiotics with special reference to rifaximin in digestive diseases.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {50},
number = {8},
pages = {741-749},
doi = {10.1016/j.dld.2018.04.020},
pmid = {29807873},
issn = {1878-3562},
mesh = {Anti-Bacterial Agents/therapeutic use ; Diverticular Diseases/drug therapy/*microbiology/physiopathology ; *Gastrointestinal Microbiome ; Hepatic Encephalopathy/drug therapy/*microbiology/physiopathology ; Humans ; Irritable Bowel Syndrome/drug therapy/*microbiology/physiopathology ; Probiotics/therapeutic use ; Randomized Controlled Trials as Topic ; Rifamycins/therapeutic use ; Rifaximin ; },
abstract = {Digestive diseases are a broad range of chronic disorders that substantially and negatively impact the patients' quality of life. Here, we review our current understanding on the pathophysiology of hepatic encephalopathy, irritable bowel syndrome, and diverticular disease, with a special focus on the gut microbiota composition associated with these disorders. Furthermore, we review the current clinical practice for their therapeutic treatments, including probiotics, diet change, non-adsorbable disaccharides, and antibiotics. We highlight that broad-spectrum non-adsorbable antibiotics, such as rifaximin, are quite effective and safe for the treatment of all essayed digestive diseases.},
}
@article {pmid29792278,
year = {2018},
author = {Dean, M and Valentino, J and Ritter, K and Church, J},
title = {A novel endoscopic grading system for prediction of disease-related outcomes in patients with diverticulosis.},
journal = {American journal of surgery},
volume = {216},
number = {5},
pages = {926-931},
doi = {10.1016/j.amjsurg.2018.05.003},
pmid = {29792278},
issn = {1879-1883},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon, Sigmoid/*diagnostic imaging ; Colonoscopy/*methods ; Diverticulum, Colon/*diagnosis ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Reproducibility of Results ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; },
abstract = {BACKGROUND: We describe a simple endoscopic grading system of diverticular disease for the assessment of disease severity and prediction of outcomes.
METHODS: A retrospective analysis of prospectively maintained colonoscopy database was conducted. A single endoscopist prospectively graded disease severity according to the number and size of diverticula, the degree of muscular hypertrophy and rigidity of the sigmoid colon.
RESULTS: 762 patients were included in the analysis. Mean patient age was 70 years (range 37-97). Endoscopic severity of diverticulosis was predictive of the need for surgery, with 2% in the mild-moderate, 12% in the severe and 33% in the acute group (p < 0001). Time to surgery showed correlation to severity grade, with mean periods of 107.5 months in the moderate group vs. 3 and 2.5 months in the severe and acute group (p < 0001). The mean follow up was 11 years.
CONCLUSION: Surgeons should consider using endoscopic grading as an adjunct to clinical management decisions.},
}
@article {pmid29755780,
year = {2018},
author = {Ng, JL and Wong, SL and Mathew, R},
title = {Appendiceal diverticulosis: a harbinger of underlying primary appendiceal adenocarcinoma?.},
journal = {Journal of gastrointestinal oncology},
volume = {9},
number = {2},
pages = {E1-E5},
pmid = {29755780},
issn = {2078-6891},
abstract = {Diagnosis of primary appendiceal adenocarcinoma (PAA) is hindered by its rarity and largely asymptomatic nature. Appendiceal diverticulosis (AD) is equally rare. We report an unusual case of PAA presenting with perforated appendiceal diverticulitis, and discuss a review of the literature about its association, and its surgical and pathological implications. A middle-aged man was admitted with right iliac fossa (RIF) pain and a corresponding tender abdominal mass for 5 days. Computerised tomography (CT) scan demonstrated a thickened appendix with 3 cm abscess at its base. During laparoscopic appendicectomy, the appendiceal phlegmon was adhered to the surrounding bowel. Histology showed a perforated diverticulum near the appendiceal tip, and a primary appendiceal well-differentiated adenocarcinoma located proximal to it with clear margins. Up to 48% of ADs are associated with appendiceal neoplasms, but its coexistence with PAA is reported in fewer than ten instances worldwide. Obstructing appendiceal tumours, by raising intraluminal pressure, can predispose to AD formation. Intestinal-type PAA is often managed like its colorectal counterpart, although controversies about management of PAA in a perforated AD remain. Recognition of the association of AD and PAA is critical to ensure meticulous oncological resection and histological examination.},
}
@article {pmid29749340,
year = {2018},
author = {Mesina, C and Dumitrescu, TV and Calota, F and Daniela, C},
title = {An uncommon abdominal fistula: Colonic diverticular disease complicated with colocutaneous fistula.},
journal = {The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology},
volume = {29},
number = {2},
pages = {248-249},
pmid = {29749340},
issn = {2148-5607},
mesh = {Colonic Diseases/*etiology ; Cutaneous Fistula/*etiology ; Diverticulum, Colon/*complications ; Humans ; Intestinal Fistula/*etiology ; Male ; Middle Aged ; },
}
@article {pmid29732494,
year = {2018},
author = {Scrivo, R and Gerardi, MC and Rutigliano, I and Sessa, P and Mipatrini, D and Stricchiola, GMG and Pacella, E and Altobelli, A and Castellani, C and Alessandri, C and Ceccarelli, F and Di Franco, M and Priori, R and Riccieri, V and Sili Scavalli, A and Spinelli, FR and La Torre, G and Conti, F and Valesini, G},
title = {Polymyalgia rheumatica and diverticular disease: just two distinct age-related disorders or more? Results from a case-control study.},
journal = {Clinical rheumatology},
volume = {37},
number = {9},
pages = {2573-2577},
pmid = {29732494},
issn = {1434-9949},
mesh = {Aged ; Case-Control Studies ; Comorbidity ; Diverticular Diseases/*complications/epidemiology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Polymyalgia Rheumatica/*etiology ; Risk Factors ; },
abstract = {In a previous report of two married cohabiting couples affected by polymyalgia rheumatica (PMR), we noticed that the wife of one couple and both members of the other couple suffered from symptomatic diverticular disease (DD), whose diagnosis was made before the onset of PMR. We investigated whether DD might be a risk factor for the development of PMR. We conducted a case-control study informed on a database containing the prospectively collected medical records of consecutive PMR patients. Among comorbidities, attention was focused on symptomatic DD, provided that the diagnosis had been made by colonoscopy and/or computed tomography scan. As controls, we identified one control per case at random among those matched by age and sex attending the ophthalmic and orthopedic outpatient clinics, as long as a PMR diagnosis had been excluded. A logistic regression model was used, following a multiplicative model, and results were presented as odds ratio (OR) and 95% confidence intervals (95% CI). The most frequent comorbidities in the two groups of patients (121 cases and 121 controls) were chronic coronary artery disease, atrial fibrillation, diabetes mellitus, hypertension, DD, hypercholesterolemia, osteoporosis, chronic obstructive pulmonary disease, gastroesophageal reflux disease, and cholelithiasis. The association between PMR and DD (OR = 4.06; 95% CI: 1.76-9.35) was by far stronger than that found comparing PMR with the other comorbidities. The chronic bowel inflammation induced by dysbiosis in patients with symptomatic DD could be a critical immunopathological mechanism supporting the development or exacerbation of PMR in susceptible individuals.},
}
@article {pmid29732139,
year = {2018},
author = {Syllaios, A and Koutras, A and Zotos, PA and Koura, S and Machairoudias, P and Papakonstantinou, A and Bourganos, N and Liakos, A},
title = {Colovaginal and colo-ovarian fistula at a patient with asymptomatic diverticular disease.},
journal = {Journal of surgical case reports},
volume = {2018},
number = {4},
pages = {rjy085},
pmid = {29732139},
issn = {2042-8812},
abstract = {Colovaginal and colo-ovarian fistulas are rare entities that could be attributed to diverticular disease after an episode of acute diverticulitis. Τhey could initially be manifested with symptoms that lead patients to the gynecologist. Gynecologists should consider them in the differential diagnosis, especially after recurrent episodes of sinusitis. We report the case of a 51-year-old woman with a colovaginal and a colo-ovarian fistula due to subclinical diverticular disease, which should be involved in the differential diagnosis in those complicated fistulas, even if the patient had never before a clinical episode of acute diverticulitis or known diverticular disease, and a successful surgical approach.},
}
@article {pmid29730604,
year = {2019},
author = {Haji, A and Plastiras, A and Ortenzi, M and Gulati, S and Emmanuel, A and Hayee, B},
title = {Elective endoscopic clipping for the treatment of symptomatic diverticular disease: a potential for 'cure'.},
journal = {Gut},
volume = {68},
number = {4},
pages = {582-584},
doi = {10.1136/gutjnl-2017-315509},
pmid = {29730604},
issn = {1468-3288},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonoscopy/*methods ; Diverticulum, Colon/*surgery ; Female ; Gastrointestinal Hemorrhage/*prevention & control ; Humans ; London ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome ; },
}
@article {pmid29722730,
year = {2018},
author = {Guerriero, L and Quero, G and Diana, M and Soler, L and Agnus, V and Marescaux, J and Corcione, F},
title = {Virtual Reality Exploration and Planning for Precision Colorectal Surgery.},
journal = {Diseases of the colon and rectum},
volume = {61},
number = {6},
pages = {719-723},
doi = {10.1097/DCR.0000000000001077},
pmid = {29722730},
issn = {1530-0358},
mesh = {Adult ; Colectomy/methods ; Colonic Neoplasms/*surgery ; Colorectal Surgery/*instrumentation/methods ; Diverticular Diseases/*surgery ; Female ; Humans ; Imaging, Three-Dimensional ; Intraoperative Care/instrumentation ; Laparoscopy/methods ; Male ; Mesenteric Artery, Inferior/diagnostic imaging/surgery ; Middle Aged ; Preoperative Care/instrumentation ; Surgery, Computer-Assisted/methods ; Tomography, X-Ray Computed/statistics & numerical data ; User-Computer Interface ; *Virtual Reality ; },
abstract = {BACKGROUND: Medical software can build a digital clone of the patient with 3-dimensional reconstruction of Digital Imaging and Communication in Medicine images. The virtual clone can be manipulated (rotations, zooms, etc), and the various organs can be selectively displayed or hidden to facilitate a virtual reality preoperative surgical exploration and planning.
OBJECTIVE: We present preliminary cases showing the potential interest of virtual reality in colorectal surgery for both cases of diverticular disease and colonic neoplasms.
DESIGN: This was a single-center feasibility study.
SETTINGS: The study was conducted at a tertiary care institution.
PATIENTS: Two patients underwent a laparoscopic left hemicolectomy for diverticular disease, and 1 patient underwent a laparoscopic right hemicolectomy for cancer. The 3-dimensional virtual models were obtained from preoperative CT scans. The virtual model was used to perform preoperative exploration and planning. Intraoperatively, one of the surgeons was manipulating the virtual reality model, using the touch screen of a tablet, which was interactively displayed to the surgical team.
MAIN OUTCOME MEASURES: The main outcome was evaluation of the precision of virtual reality in colorectal surgery planning and exploration.
RESULTS: In 1 patient undergoing laparoscopic left hemicolectomy, an abnormal origin of the left colic artery beginning as an extremely short common trunk from the inferior mesenteric artery was clearly seen in the virtual reality model. This finding was missed by the radiologist on CT scan. The precise identification of this vascular variant granted a safe and adequate surgery. In the remaining cases, the virtual reality model helped to precisely estimate the vascular anatomy, providing key landmarks for a safer dissection.
LIMITATIONS: A larger sample size would be necessary to definitively assess the efficacy of virtual reality in colorectal surgery.
CONCLUSIONS: Virtual reality can provide an enhanced understanding of crucial anatomical details, both preoperatively and intraoperatively, which could contribute to improve safety in colorectal surgery.},
}
@article {pmid29706003,
year = {2018},
author = {Bressan, A and Marini, L and Michelotto, M and Frigo, AC and Da Dalt, G and Merigliano, S and Polese, L},
title = {Risk factors including the presence of inflammation at the resection margins for colorectal anastomotic stenosis following surgery for diverticular disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {20},
number = {10},
pages = {923-930},
doi = {10.1111/codi.14240},
pmid = {29706003},
issn = {1463-1318},
mesh = {Adult ; Aged ; Anastomosis, Surgical/adverse effects ; Colon/*surgery ; Constriction, Pathologic/etiology/pathology ; Diverticular Diseases/*surgery ; Female ; Humans ; Inflammation ; Male ; Margins of Excision ; Middle Aged ; Postoperative Complications/etiology/pathology ; Rectum/*surgery ; Risk Factors ; Surgical Stomas/*adverse effects/pathology ; Young Adult ; },
abstract = {AIM: The aim of this study was to investigate risk factors for anastomotic stenosis in patients operated on for diverticular disease. Histological inflammation and diverticula at the resection margins were also considered.
METHOD: Patients' characteristics, the surgical technique and postoperative complications were collected from the medical records. Anastomotic stenoses were evaluated prospectively by rigid sigmoidoscopy during follow-up examination. Histological specimens were examined by a single pathologist who investigated inflammation and diverticula at the resection margins. Twenty patients with anastomotic colorectal stenosis from a single tertiary centre were compared with 24 consecutive patients without stenosis. They were all operated on for diverticular disease over a specified time period.
RESULTS: Histological inflammation and diverticula were found in 25% and 30% of the resection margins respectively. Univariate analysis showed that age > 71 years (P = 0.0002), female gender (P = 0.0069) and anastomoses located below 12 cm from the anal verge (P = 0.020) were risk factors for stenosis. No correlation was found between anastomotic stenosis and the presence of histological inflammation or diverticula at the resection margins. By multivariate analysis, only age > 71 years was found to be a statistically significant risk factor for stenosis (P = 0.0003, OR = 60.8, 95% CI: 6.4-575.5).
CONCLUSION: Anastomotic stenosis is a frequent, long-term complication following surgery for diverticular disease. An analysis demonstrated that age is a risk factor for colorectal stenosis and that histological inflammation and the presence of diverticula near/at the resection margins have no effect on the incidence of stenosis.},
}
@article {pmid29696102,
year = {2018},
author = {Haddad, FG and El Bitar, S and Al Moussawi, H and Chang, Q and Deeb, L},
title = {Diverticular Disease-associated Colitis: What Do We Know? A Review of Literature.},
journal = {Cureus},
volume = {10},
number = {2},
pages = {e2224},
pmid = {29696102},
issn = {2168-8184},
abstract = {Diverticular disease (DD) is a leading cause of hospitalizations in developed countries affecting 30-50% of individuals older than 60 years. Identified as a distinct entity since 1980, diverticular disease-associated colitis (DAC) describes the occurrence of mucosal inflammation in a colon segment affected with DD with relative sparing of the rectum and proximal colon. Its prevalence is suggested around 1.3-3.8%. Pathogenesis is multifactorial with multiple reports noting clinicopathological overlap between DAC and inflammatory bowel disease (IBD) especially in patients with granulomatous colitis. In this setting, caution should be exercised to avoid an inappropriate diagnosis of IBD. Recurrence rates and long-term outcomes of DAC are not well defined and could range from a benign course to an overt IBD. More studies are needed in order to further characterize this entity.},
}
@article {pmid29672283,
year = {2019},
author = {Nally, DM and Kavanagh, DO},
title = {Current Controversies in the Management of Diverticulitis: A Review.},
journal = {Digestive surgery},
volume = {36},
number = {3},
pages = {195-205},
doi = {10.1159/000488216},
pmid = {29672283},
issn = {1421-9883},
mesh = {Colonoscopy ; Diverticulitis, Colonic/classification/*diagnosis/*surgery/therapy ; Humans ; Randomized Controlled Trials as Topic ; },
abstract = {BACKGROUND: Symptomatic diverticular disease is challenging for patients, clinicians and health services. The prevalence increases with age and BMI and as such, the burden of this disease is set to increase with higher rates of acute presentations already documented. The natural history of recurrent episodes, complications and symptom progression is not fully understood. Furthermore, medical and surgical management strategies are under constant appraisal, debate and evolution.
METHODS: A review of the contemporary literature was performed to examine the emerging trend towards conservative treatment.
RESULTS: Routine use of in-patient, intravenous antibiotics may not be required and outpatient management is possible for certain patients. Universal colonoscopy examination after uncomplicated acute diverticulitis is controversial but is mandatory after complicated episodes. Recent, high-profile, clinical trials suggest that less aggressive surgical management of both acute and chronic presentations may be feasible in some cases.
CONCLUSIONS: Diverticulitis is a common yet challenging topic that demands clinicians to provide an individualised yet evidence-based approach.},
}
@article {pmid29671060,
year = {2018},
author = {Freckelton, J and Holt, D and Borsaru, A and Gwini, S and Croagh, D and Moore, G},
title = {The role of body composition in diverticular disease.},
journal = {International journal of colorectal disease},
volume = {33},
number = {9},
pages = {1299-1302},
pmid = {29671060},
issn = {1432-1262},
mesh = {*Body Composition ; Canada ; Case-Control Studies ; *Diverticular Diseases ; *Diverticulitis ; Humans ; Retrospective Studies ; },
abstract = {BACKGROUND: Diverticular disease is a common, chronic inflammatory disease of the bowel. This study investigates the differences in body composition between patients with diverticular disease and those without.
METHODS: Appropriate patients were identified using a search of the radiology database. Demographic and disease information was gathered using scanned medical records. Body composition analysis was performed at level L3 using single-slice computed tomography techniques.
RESULTS: Two hundred seventy-one patients were included in this study: 83 controls, 93 with diverticulosis and 95 with diverticulitis. Diverticulitis and diverticulosis were associated with a significantly higher visceral fat area (VFA), than the control group (p < 0.001, p < 0.001). Diverticulitis and diverticulosis were associated with a significantly higher visceral fat area to subcutaneous fat area ratio (VFA:SCFA), than the control group (p = 0.005, p = 0.019). Only diverticulosis was associated with increased levels of extramyocellular fat, when compared to the control group (p = 0.001).
CONCLUSION: Diverticular disease is associated with a higher amount and a higher proportion of visceral fat than seen in controls without diverticular disease.},
}
@article {pmid29654917,
year = {2018},
author = {Järbrink-Sehgal, ME and Schmidt, PT and Sköldberg, F and Hemmingsson, T and Hagström, H and Andreasson, A},
title = {Lifestyle Factors in Late Adolescence Associate With Later Development of Diverticular Disease Requiring Hospitalization.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {16},
number = {9},
pages = {1474-1480.e1},
doi = {10.1016/j.cgh.2018.04.006},
pmid = {29654917},
issn = {1542-7714},
mesh = {Adolescent ; *Disease Progression ; Diverticular Diseases/*epidemiology/*pathology ; Follow-Up Studies ; Hospitalization/*statistics & numerical data ; Humans ; *Life Style ; Male ; Retrospective Studies ; Risk Factors ; Surveys and Questionnaires ; Sweden/epidemiology ; Young Adult ; },
abstract = {BACKGROUND & AIMS: The burden of diverticular disease on society is high and is increasing with an aging population. It is therefore important to identify risk factors for disease development or progression. Many lifestyle behaviors during adolescence affect risk for later disease. We searched for adolescent lifestyle factors that affect risk of diverticular disease later in life.
METHODS: We performed a retrospective analysis of data from 43,772 men (age, 18-20 y) conscripted to military service in Sweden from 1969 through 1970, with a follow-up period of 39 years. All conscripts underwent an extensive mental and physical health examination and completed questionnaires covering alcohol consumption, smoking, and use of recreational drugs; cardiovascular fitness was assessed using an ergometer cycle at the time of conscription. Outcome data were collected from national registers to identify discharge diagnoses of diverticular disease until the end of 2009. We performed Cox regression analysis to determine whether body mass index, cardiovascular fitness, smoking, use of recreational drugs, alcohol consumption, and risky use of alcohol, at time of conscription are independent risk factors for development of diverticular disease.
RESULTS: Overweight and obese men had a 2-fold increased risk of diverticular disease compared to normal-weight men (hazard ratio, 2.00; P < .001). A high level of cardiovascular fitness was associated with a reduced risk of diverticular disease requiring hospitalization (P = .009). Smoking (P = .003), but not use of recreational drugs (P = .11), was associated with an increased risk of diverticular disease requiring hospitalization. Risky use of alcohol, but not alcohol consumption per se, was associated with a 43% increase in risk of diverticular disease requiring hospitalization (P = .007).
CONCLUSIONS: In a retrospective analysis of data from 43,772 men in Sweden, we associated being overweight or obese, a smoker, a high-risk user of alcohol, and/or having a low level of cardiovascular fitness in late adolescence with an increased risk of developing diverticular disease requiring hospitalization later in life. Improving lifestyle factors among adolescents might reduce the economic burden of diverticular disease decades later.},
}
@article {pmid29633119,
year = {2018},
author = {Skowron, KB and Shogan, BD and Rubin, DT and Hyman, NH},
title = {The New Frontier: the Intestinal Microbiome and Surgery.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {22},
number = {7},
pages = {1277-1285},
pmid = {29633119},
issn = {1873-4626},
mesh = {Anastomotic Leak/*microbiology ; Digestive System Surgical Procedures/*adverse effects ; *Gastrointestinal Microbiome ; Humans ; Intestinal Mucosa/microbiology ; Microbiota/*physiology ; },
abstract = {The microbiome exerts a remarkable effect on human physiology. The study of the human-microbiome relationship is a burgeoning field with great potential to improve our understanding of health and disease. In this review, we address common surgical problems influenced by the human microbiome and explore what is thus far known about this relationship. These include inflammatory bowel disease, colorectal neoplasms, and diverticular disease. We will also discuss the effect of the microbiome on surgical complications, specifically anastomotic leak. We hope that further research in this field will enlighten our management of these and other surgical problems.},
}
@article {pmid29623099,
year = {2018},
author = {Carabotti, M and Annibale, B},
title = {Treatment of diverticular disease: an update on latest evidence and clinical implications.},
journal = {Drugs in context},
volume = {7},
number = {},
pages = {212526},
pmid = {29623099},
issn = {1745-1981},
abstract = {BACKGROUND: Diverticular disease (DD) is a common condition, especially in Western countries. In about 80% of patients, colonic diverticula remain asymptomatic (diverticulosis), while approximately 20% of patients may develop abdominal symptoms (symptomatic uncomplicated diverticular disease, SUDD) and, eventually complications as acute diverticulitis (AD). The management of this condition has been improved, and in the last five years European countries and the USA have published guidelines and recommendations.
SCOPE: To summarize the latest evidence and clinical implication in treatment of DD focusing the attention either on the treatment of diverticulosis, SUDD and AD together with the primary and secondary prevention of diverticulitis.
FINDINGS: The present review was based on the latest evidence in the treatment of DD in the last 10 years. In the last 5 years, six countries issued guidelines on DD with differences regarding covered topics and recommendations regarding treatments. At present there is a lack of rationale for drug use in patients with asymptomatic diverticulosis, but there are limited indications to suggest an increase in dietary fibre to reduce risk of DD. To achieve symptomatic relief in SUDD patients, several therapeutic strategies with fibre, probiotics, rifaximin and mesalazine have been proposed even if a standard therapeutic approach remained to be defined. Agreement has been reached for the management of AD, since recent guidelines showed that antibiotics can be used selectively, rather than routinely in uncomplicated AD, although use of antibiotics remained crucial in the management of complicated cases. With regard to treatment for the primary and secondary prevention of AD, the efficacy of rifaximin and mesalazine has been proposed although with discordant recommendations among guidelines.
CONCLUSION: Treatment of DD represented an important challenge in clinical practice, especially concerning management of SUDD and the primary and secondary prevention of AD.},
}
@article {pmid29607785,
year = {2018},
author = {Ojetti, V and Petruzziello, C and Cardone, S and Saviano, L and Migneco, A and Santarelli, L and Gabrielli, M and Zaccaria, R and Lopetuso, L and Covino, M and Candelli, M and Gasbarrini, A and Franceschi, F},
title = {The Use of Probiotics in Different Phases of Diverticular Disease.},
journal = {Reviews on recent clinical trials},
volume = {13},
number = {2},
pages = {89-96},
doi = {10.2174/1574887113666180402143140},
pmid = {29607785},
issn = {1876-1038},
mesh = {Diverticular Diseases/diagnosis/etiology/*therapy ; Humans ; Probiotics/*therapeutic use ; },
abstract = {BACKGROUND & AIMS: Diverticular Disease (DD) is a common clinical condition with a dramatic increasing of the prevalence among industrialized countries. Based on the most used classification, DD may be divided into asymptomatic diverticulosis, symptomatic uncomplicated diverticular disease and complicated diverticular disease. Since recent studies pointed out the role of GUT microbiota imbalance in promoting diverticular formation and inflammation, we have designed a systematic review focusing on the possible role of probiotics in the management of this condition.
METHODS: According to PRISMA, we identified studies on DD patients treated with probiotics, by searching on Pubmed, Embase, Cochrane and ResearchGate.
RESULTS: 13 studies were included in this review based on our selection criteria: 3 double-blind randomized placebo-controlled, 6 open randomized, and 4 non-randomized open studies.
CONCLUSION: This is the first systematic review providing an updated measure of evidence on the efficacy of probiotics in a different phase of DD. Even though the majority of studies are still preliminary, current data show a possible clinical application of certain probiotic strains in all stages of DD. Further investigation is then required to better understand when and how probiotics can be used in different phases of DD.},
}
@article {pmid29602977,
year = {2018},
author = {Nascimbeni, R and Casiraghi, S and Cannatelli, R and Lanzarotto, F and Casella, C and Ricci, C and Villanacci, V and Portolani, N and Moneghini, D},
title = {Ulcerative colitis and the aging-related development of colonic diverticula.},
journal = {International journal of colorectal disease},
volume = {33},
number = {9},
pages = {1277-1283},
pmid = {29602977},
issn = {1432-1262},
mesh = {Adult ; Aged ; Case-Control Studies ; Colitis, Ulcerative/*complications/epidemiology ; Diverticulosis, Colonic/*complications/epidemiology ; Diverticulum, Colon ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {PURPOSE: Aim of this observational case-control study was to assess the prevalence, features, and risk factors of colonic diverticula in patients with ulcerative colitis (UC).
METHODS: The data of 896 UC patients aged ≥ 30 years from Brescia IBD database were retrospectively analyzed. Individuals with colonic diverticula were identified and prevalence was compared with that of control patients undergoing screening colonoscopy after gender/age matching. A nested cohort study was then conducted among UC patients in order to define eventual association of diverticula with specific clinico-pathologic parameters.
RESULTS: Prevalence of subjects with diverticula was 11.4% among 465 UC patients aged 49 years and older, significantly lower than 35.1% prevalence in control patients of same age and gender (p < 0.001). Advancing age was a significant risk factor for diverticula development in both groups. Among UC patients, a short duration and a late onset of UC were both significantly associated to the presence of diverticula. Moreover, UC patients with diverticula had a significantly lower frequency of flares per year, even if maximal flare severity and frequency of hospital admission were similar to those of subjects without diverticula. UC patients with diverticula had a trend toward more frequent extension of UC to the left colon, possibly because of their older age. The majority of those patients had few sigmoid diverticula without symptoms.
CONCLUSIONS: Development of colonic diverticula is substantially reduced in patients with UC, markedly among those with an early onset, a long history of inflammatory disease, and a high flare frequency. This study reinforces the hypothesis sustaining a protective role of UC against colonic diverticula.},
}
@article {pmid29600834,
year = {2019},
author = {Biffoni, M and Urciuoli, P and Grimaldi, G and Eberspacher, C and Santoro, A and Pironi, D and Sorrenti, S},
title = {Colovesical fistula complicating diverticular disease: diagnosis and surgical management in elderly.},
journal = {Minerva chirurgica},
volume = {74},
number = {2},
pages = {187-188},
doi = {10.23736/S0026-4733.18.07723-4},
pmid = {29600834},
issn = {1827-1626},
mesh = {Aged ; Colon/surgery ; Cystoscopy ; Diverticular Diseases/complications/surgery ; Humans ; Intestinal Fistula/*diagnosis/etiology/*surgery ; Laparoscopy ; Tomography, X-Ray Computed ; Urinary Bladder/surgery ; },
}
@article {pmid29596125,
year = {2018},
author = {},
title = {Diverticular Disease: Traditional and Evolving Paradigms.},
journal = {Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates},
volume = {41},
number = {2},
pages = {E1-E2},
doi = {10.1097/SGA.0000000000000370},
pmid = {29596125},
issn = {1538-9766},
mesh = {Disease Management ; Diverticulitis, Colonic/*diagnosis/*therapy ; Diverticulosis, Colonic/*diagnosis/*therapy ; Education, Medical, Continuing/*methods ; Female ; Humans ; Male ; Prognosis ; Risk Assessment ; },
}
@article {pmid29596124,
year = {2018},
author = {Lamanna, L and Moran, PE},
title = {Diverticular Disease: Traditional and Evolving Paradigms.},
journal = {Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates},
volume = {41},
number = {2},
pages = {111-119},
doi = {10.1097/SGA.0000000000000307},
pmid = {29596124},
issn = {1538-9766},
mesh = {Abdominal Pain/diagnosis/etiology ; Anti-Bacterial Agents/therapeutic use ; Colonoscopy/methods ; Conservative Treatment/*methods ; Dietary Fiber/*administration & dosage ; Diverticulitis, Colonic/diagnostic imaging/etiology/*therapy ; Diverticulum, Colon/*complications/diagnostic imaging ; Female ; Humans ; Middle Aged ; Prognosis ; Risk Assessment ; Severity of Illness Index ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; },
abstract = {Diverticular disease includes diverticulosis, which are sac protrusions of the intestinal mucosa, and diverticulitis, inflammation of the diverticula. Diverticular disease is listed as one of the top 10 leading physician diagnoses for gastrointestinal disorders in outpatient clinic visits in the United States. There are several classifications of diverticular disease ranging from asymptomatic diverticulosis to diverticulitis with complications. Several theories are linked to the development of diverticula which includes the physiology of the colon itself, collagen cross-linking, and recently challenged, low-fiber intake. The differential diagnoses of lower abdominal pain in addition to diverticular disease have overlapping signs and symptoms, which can make a diagnosis challenging. Identification of the distinct signs and symptoms of each classification will assist the practitioner in making the correct diagnosis and lead to appropriate management. The findings from recent studies have changed the paradigm of diverticular disease. The purpose of this article is to discuss traditional dogma and evolving concepts in the pathophysiology, prevention, and management of diverticular disease. Practitioners must be knowledgeable about diverticular disease for improved outcomes.},
}
@article {pmid29588845,
year = {2018},
author = {Iwaya, Y and Rowsell, C and Grantcharov, T and Marcon, NE},
title = {Pedunculated polyp of the ileum protruding from a large diverticulum.},
journal = {Frontline gastroenterology},
volume = {9},
number = {2},
pages = {153},
pmid = {29588845},
issn = {2041-4137},
abstract = {INTRODUCTION: A 52-year-old woman presented with iron deficiency anaemia and postprandial right lower quadrant pain. Abdominal examination was unremarkable and laboratory results showed mild anaemia (haemoglobin 11.3 g/dL). Upper and lower endoscopies did not reveal any source of bleeding. Video capsule endoscopy was performed which showed a large polypoid lesion in the mid-ileum (figure 1). Abdominal contrast enhanced CT demonstrated a heterogeneously enhancing pedunculated polyp measuring approximately 6 cm (figure 2). Retrograde double-balloon enteroscopy was performed which revealed a large pedunculated polyp with hyperplastic-like mucosa protruding from a large diverticulum located approximately 70 cm proximal to the ileocaecal valve (figure 3A). The stalk appeared to arise from the base of the diverticulum (figure 3B). A technetium-99m pertechnetate scintigraphy revealed no ectopic gastric mucosa.Figure 1Video capsule endoscopy shows a large polypoid lesion.Figure 2CT shows a heterogeneously enhancing pedunculated polyp (arrow).Figure 3Retrograde double-balloon enteroscopy images. (A) Large pedunculated polyp protruding from a large diverticulum. (B) The stalk appears to arise from the base of the diverticulum.
QUESTION: What is the diagnosis?},
}
@article {pmid29560954,
year = {2018},
author = {Achkasov, SI and Shelygin, YA and Moskalev, AI and Trubacheva, YL and Senashenko, SA},
title = {[Short-term outcomes of laparoscopic-assisted procedures for chronic complications of diverticular disease].},
journal = {Khirurgiia},
volume = {},
number = {3},
pages = {16-23},
doi = {10.17116/hirurgia2018316-23},
pmid = {29560954},
issn = {0023-1207},
mesh = {Anastomosis, Surgical/methods ; *Blood Loss, Surgical/prevention & control/statistics & numerical data ; *Colectomy/adverse effects/methods ; *Diverticular Diseases/complications/diagnosis/surgery ; Elective Surgical Procedures/methods ; Female ; Humans ; *Laparoscopy/adverse effects/methods ; Male ; Middle Aged ; Operative Time ; *Postoperative Complications/diagnosis/epidemiology/etiology ; Prospective Studies ; Russia/epidemiology ; },
abstract = {AIM: To estimate efficacy of laparoscopic-assisted procedures for chronic complications of diverticular disease (DD).
MATERIAL AND METHODS: It was made a prospective comparative study within 2007-2015. Inclusion criteria were verified chronic DD (>6 weeks after the first attack) and bowel resection followed by primary anastomosis.
EXCLUSION CRITERIA: contraindications for pneumoperitoneum, BMI ≥35 kg/m[2], infiltrate dimension >10 cm, preoperatively non-excluded neoplasm.
RESULTS: 233 patients with chronic DD underwent elective surgery, 136 (58.4%) of them were included in the study. There were 80 (58.8%) females aged 57.2±6.2 (24-83) years. Main group consisted of 75 patients after laparoscopic-assisted procedures, 61 were in control group (open ones). Both groups were homogeneous in age, gender, BMI, type of chronic complications, extent of inflammation, extent of bowel resection, surgery time (211.1 vs 206.3 min; p=0.16), incidence of preventive stoma (12.9 vs 19.7%; p=0.32) and complications rate (10.7 vs 14.7%; p=0.47). Maximal time of surgery was noted in case of chronic abdominal mass with statistically significance for main group (240.0±12.2 min vs 207.6±13.7 min; р=0.01). Conversion rate was 12.0% in main group. Main group showed significant higher rate of stapler anastomoses (66.7 vs 22.9%; р<0.0001), less intraoperative blood loss (100 ml vs 350 ml; р=0.001). Early postoperative period was significantly shorter in main group (9.5±0.4 days vs 12.9±1.2 days, р=0.02).
CONCLUSION: Laparoscopic-assisted procedures for diverticular disease are associated with more favorable early postoperative period with the same complication rate. Technical complexity and operative time depend on the extent of pelvic inflammatory changes.},
}
@article {pmid29536239,
year = {2018},
author = {Warwas, FB and Schneider, B},
title = {Elective vs. early elective surgery in diverticular disease: a retrospective study on the optimal timing of non-emergency treatment.},
journal = {International journal of colorectal disease},
volume = {33},
number = {5},
pages = {531-539},
pmid = {29536239},
issn = {1432-1262},
mesh = {Body Mass Index ; Colon, Sigmoid/surgery ; Demography ; Diverticulitis/*surgery ; *Elective Surgical Procedures/adverse effects ; *Emergencies ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/classification/etiology ; Retrospective Studies ; Time Factors ; },
abstract = {PURPOSE: This study set out to compare the in-hospital outcomes of early elective and elective laparoscopic sigmoidectomy due to diverticulitis.
METHODS: We examined the data for 378 diverticulitis patients who received an elective laparoscopic sigmoid resection between 2008 and 2012. We divided the patients into two groups: elective (group A, n = 278) and early elective (group B, n = 100). Patients in group A received surgery during the inflammation-free interval, and those in group B immediately after treating the attack with IV antibiotics for a mean period of 8 days (IQR = 3).
RESULTS: Overall mortality was 0%. The mean operation duration was the same in both groups being 77.5 and 80 min respectively. There was no significant difference in the outcomes between the two groups, measured using the Clavien-Dindo classification of surgical complication (CCSC; p = 0.992). A revision due to complications was necessary in 16 cases (group A) and six cases (group B) (p = 0.820). The conversion rate to open surgery was low (six individuals in group A, vs. four in group B; p = 0.331). Patients in group B suffered significantly fewer diverticulitis attacks (three in group A, vs. two in group B; p = 0.026).
CONCLUSION: Our study showed no difference in outcome between elective and early elective cases. Operation durations were optimal in both cases and were 50% shorter than those recorded in the literature. An early elective operation represents a good treatment option, especially for patients suffering from complicated diverticulitis.},
}
@article {pmid29536238,
year = {2018},
author = {Sohn, MA and Agha, A and Steiner, P and Hochrein, A and Komm, M and Ruppert, R and Ritschl, P and Aigner, F and Iesalnieks, I},
title = {Damage control surgery in perforated diverticulitis: ongoing peritonitis at second surgery predicts a worse outcome.},
journal = {International journal of colorectal disease},
volume = {33},
number = {7},
pages = {871-878},
pmid = {29536238},
issn = {1432-1262},
mesh = {Aged ; Anastomosis, Surgical ; Colostomy ; Diverticulitis/complications/*surgery ; Diverticulitis, Colonic ; Female ; Forecasting ; Humans ; Intestinal Perforation/*surgery ; Male ; Peritonitis/*complications ; Prognosis ; Retrospective Studies ; },
abstract = {PURPOSE: Damage control strategy (DCS) is a two-staged procedure for the treatment of perforated diverticular disease complicated by generalized peritonitis. The aim of this retrospective multicenter cohort study was to evaluate the prognostic impact of an ongoing peritonitis at the time of second surgery.
METHODS: Consecutive patients who underwent DCS for perforated diverticular disease of the sigmoid colon with generalized peritonitis at four surgical centers were included. Damage control strategy is a two-stage emergency procedure: limited resection of the diseased colonic segment, closure of oral and aboral colon, and application of a negative pressure assisted abdominal closure system at the initial surgery followed by second laparotomy 48 h later. Therein, decision for definite reconstruction (anastomosis or Hartmann's procedure (HP)) is made. An ongoing peritonitis at second surgery was defined as presence of visible fibrinous, purulent, or fecal peritoneal fluid. Microbiologic findings from peritoneal smear at first surgery were collected and analyzed.
RESULTS: Between 5/2011 and 7/2017, 74 patients underwent a DCS for perforated diverticular disease complicated by generalized peritonitis (female: 40, male: 34). At second surgery, 55% presented with ongoing peritonitis (OP). Patients with OP had higher rate of organ failure (32 vs. 9%, p = 0.024), higher Mannheim Peritonitis Index (25.2 vs. 18.9; p = 0.001), and increased operation time (105 vs. 84 min., p = 0.008) at first surgery. An anastomosis was constructed in all patients with no OP (nOP) at second surgery as opposed to 71% in the OP group (p < 0.001). Complication rate (44 vs. 24%, p = 0.092), mortality (12 vs. 0%, p = 0.061), overall number of surgeries (3.4 vs. 2.4, p = 0.017), enterostomy rate (76 vs. 36%, p = 0.001), and length of hospital stay (25 vs. 18.8 days, p = 0.03) were all increased in OP group. OP at second surgery occurred significantly more often in patients with Enterococcus infection (81 vs. 44%, p = 0.005) and with fungal infection (100 vs. 49%, p = 0.007). In a multivariate analysis, Enterococcus infection was associated with increased morbidity (67 vs. 21%, p < 0.001), enterostomy rate (81 vs. 48%, p = 0.017), and anastomotic leakage (29 vs. 6%, p = 0.042), whereas fungal peritonitis was associated with an increased mortality (43 vs. 4%, p = 0.014).
CONCLUSION: Ongoing peritonitis after DCS is a predictor of a worse outcome in patients with perforated diverticulitis. Enterococcal and fungal infections have a negative impact on occurrence of OP and overall outcome.},
}
@article {pmid29533249,
year = {2018},
author = {Reichert, MC and Kupcinskas, J and Krawczyk, M and Jüngst, C and Casper, M and Grünhage, F and Appenrodt, B and Zimmer, V and Weber, SN and Tamelis, A and Lukosiene, JI and Pauziene, N and Kiudelis, G and Jonaitis, L and Schramm, C and Goeser, T and Schulz, A and Malinowski, M and Glanemann, M and Kupcinskas, L and Lammert, F},
title = {A Variant of COL3A1 (rs3134646) Is Associated With Risk of Developing Diverticulosis in White Men.},
journal = {Diseases of the colon and rectum},
volume = {61},
number = {5},
pages = {604-611},
doi = {10.1097/DCR.0000000000001001},
pmid = {29533249},
issn = {1530-0358},
mesh = {Adult ; Aged ; Aged, 80 and over ; Collagen Type III/*genetics/metabolism ; Colonoscopy ; DNA/*genetics ; Diverticulitis, Colonic/ethnology/*genetics/metabolism ; Female ; Follow-Up Studies ; Genetic Association Studies ; Genotyping Techniques ; Germany/epidemiology ; Humans ; Incidence ; Lithuania/epidemiology ; Male ; Middle Aged ; *Polymorphism, Genetic ; Retrospective Studies ; Risk Factors ; White People/*ethnology ; Young Adult ; },
abstract = {BACKGROUND: Colonic diverticulosis is one of the most common gastroenterological disorders. Although diverticulosis is typically benign, many individuals develop diverticulitis or other aspects of diverticular disease. Diverticulosis is thought to stem from a complex interaction of environmental, dietary, and genetic factors; however, the contributing genetic factors remain unknown.
OBJECTIVE: The aim of our present study was to determine the role of genetic variants within genes encoding for collagens of the connective tissue in diverticulosis.
DESIGN: This was a transsectional genetic association study.
SETTINGS: This study was conducted at three tertiary referral centers in Germany and Lithuania.
PATIENTS: Single-nucleotide polymorphisms in COL3A1 (rs3134646, rs1800255) and COL1A1 (rs1800012) were genotyped in 422 patients with diverticulosis and 285 controls of white descent by using TaqMan assays.
MAIN OUTCOME MEASURES: The association of colonoscopy-proven diverticulosis with genetic polymorphisms with herniations was assessed in multivariate models.
RESULTS: The rs3134646, rs1800255, and rs1800012 variants were significantly associated with the risk of developing diverticulosis in the univariate model; however, these associations were not significant in the multivariate logistic regression analysis including additional nongenetic variables. When selectively analyzing sexes, the genotype AA (AA) in rs3134646 remained significantly associated with diverticulosis in men (OR, 1.82; 95% CI, 1.04-3.20; p = 0.04).
LIMITATIONS: Because a candidate approach was used, additional relevant variants could be missed. Within our cohort of patients with diverticulosis, only a small proportion had diverticular disease and thus, we could not examine the variants in these subgroups. Functional studies, including the analysis of the involved collagens, are also warranted.
CONCLUSIONS: Our study shows that a variant of COL3A1 (rs3134646) is associated with the risk of developing colonic diverticulosis in white men, whereas rs1800255 (COL3A1) and rs1800012 (COL1A1) were not associated with this condition after adjusting for confounding factors. Our data provide novel valuable insights in the genetic susceptibility to diverticulosis. See Video Abstract at http://links.lww.com/DCR/A504.},
}
@article {pmid29525902,
year = {2018},
author = {Polese, L and Bressan, A and Savarino, E and Vecchiato, M and Turoldo, A and Frigo, A and Sturniolo, GC and De Manzini, N and Petri, R and Merigliano, S},
title = {Quality of life after laparoscopic sigmoid resection for uncomplicated diverticular disease.},
journal = {International journal of colorectal disease},
volume = {33},
number = {5},
pages = {513-523},
pmid = {29525902},
issn = {1432-1262},
mesh = {Aged ; Case-Control Studies ; Colon, Sigmoid/*surgery ; Diverticular Diseases/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; *Quality of Life ; Reproducibility of Results ; Risk Factors ; Surveys and Questionnaires ; Translations ; },
abstract = {PURPOSE: The study aimed to evaluate the QoL in patients who underwent elective surgery for uncomplicated diverticulitis using a recently developed diverticulitis quality of life questionnaire (DV-QoL).
METHODS: All consecutive patients who underwent surgery for uncomplicated diverticulitis or who were hospitalized and treated conservatively for acute uncomplicated diverticulitis episodes in three referral centers, in a 5-year period, were included in the study. The 36-Item Short Form Survey and the DV-QoL were administered to the patients to assess their QoL before and after treatment of diverticular disease.
RESULTS: Ninety-seven patients who underwent surgery, 44 patients who were treated conservatively, and 44 healthy volunteers were included in the study. DV-QoL scores correlated with SF-36 scores (p < 0.0001). The surgically treated patients reported a worse quality of life before treatment with respect to the patients treated conservatively (mean 21.12 surgical vs 15.41 conservative, p = 0.0048). The surgically treated patients presented better post-treatment global scores with respect to the conservatively treated patients (mean: 6.90 surgical vs 10.61 conservative, p = 0.0186). Covariance analysis confirmed that the differences between the pre- and post-treatment DV-QoL scores were significantly higher in the surgical (p = 0.0002) with respect to the non-surgical patients. As far as single items were concerned, differences between the two groups were found in the pre- and post-treatment "concerns" and "behavioral changes" DV-QoL items.
CONCLUSIONS: Sigmoidectomy reduces concerns about diverticulitis and behavioral changes due to the disease. Quality of life should be considered when referring patients with uncomplicated diverticulitis to surgery. Prospective studies are required to confirm this result.},
}
@article {pmid29520987,
year = {2018},
author = {Khan, RMA and Ali, B and Hajibandeh, S and Hajibandeh, S},
title = {Effect of mesalazine on recurrence of diverticulitis in patients with symptomatic uncomplicated diverticular disease: a meta-analysis with trial sequential analysis of randomized controlled trials.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {20},
number = {6},
pages = {469-478},
doi = {10.1111/codi.14064},
pmid = {29520987},
issn = {1463-1318},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulitis, Colonic/*prevention & control ; Diverticulosis, Colonic/*drug therapy ; Humans ; Mesalamine/*therapeutic use ; Recurrence ; Secondary Prevention ; Treatment Outcome ; },
abstract = {AIM: he aim was to investigate the effect of mesalazine on the recurrence of diverticulitis in patients with symptomatic uncomplicated diverticular disease (SUDD).
METHODS: We performed a systematic review and conducted a search of electronic information sources to identify all randomized controlled trials (RCTs) investigating the effect of mesalazine on the recurrence of diverticulitis in patients with SUDD. We used the Cochrane tool to assess the quality of included studies. Random effects models were applied to calculate pooled outcome data. Trial sequential analysis was performed to assess the possibility of type I or II errors and to compute the information size required for conclusive meta-analysis.
RESULTS: We identified six RCTs which enrolled a total of 1918 patients. There was no difference in the recurrence of diverticulitis between the mesalazine and placebo groups (OR 1.20, 95% CI 0.96-1.50, P = 0.11). A low level of heterogeneity among the studies existed (I[2] = 9%, P = 0.36). When the mesalazine dose was ≤ 2 g/day, there was no difference in recurrence rate between the two groups (OR 1.10, 95% CI 0.79-1.54, P = 0.58). When the mesalazine dose was > 2 g/day, the risk of recurrence was higher in the mesalazine group (OR 1.28, 95% CI 1.02-1.62, P = 0.04). The information size was calculated as 2461 patients. Trial sequential analysis showed that the meta-analysis was conclusive and the risk of type II error was minimal.
CONCLUSIONS: Mesalazine does not prevent the recurrence of diverticulitis in patients with SUDD. Further studies are required to investigate the role of mesalazine as an adjunct to other medical agents in the prevention of diverticulitis in patients with SUDD.},
}
@article {pmid29517710,
year = {2019},
author = {Cossais, F and Leuschner, S and Barrenschee, M and Lange, C and Ebsen, M and Vogel, I and Böttner, M and Wedel, T},
title = {Persistent Increased Enteric Glial Expression of S100β is Associated With Low-grade Inflammation in Patients With Diverticular Disease.},
journal = {Journal of clinical gastroenterology},
volume = {53},
number = {6},
pages = {449-456},
doi = {10.1097/MCG.0000000000001011},
pmid = {29517710},
issn = {1539-2031},
mesh = {Aged ; Diverticular Diseases/genetics/*physiopathology ; Female ; Gene Expression Regulation ; Humans ; Immunohistochemistry ; Inflammation/genetics/*physiopathology ; Male ; Middle Aged ; Myenteric Plexus/metabolism ; Neuroglia/*metabolism ; S100 Calcium Binding Protein beta Subunit/*genetics ; },
abstract = {BACKGROUND: Diverticular disease (DD) is a common gastrointestinal inflammatory disorder associated with an enteric neuropathy. Although enteric glial cells (EGCs) are essential regulators of intestinal inflammation and motility functions, their contribution to the pathophysiology of DD remains unclear. Therefore, we analyzed the expression of specific EGC markers in patients with DD.
MATERIALS AND METHODS: Expression of the glial markers S100β, GFAP, Sox10, and Connexin 43 was analyzed by real-time quantitative PCR in colonic specimens of patients with DD and in that of controls. Protein expression levels of S100β, GFAP, and Connexin 43 were further analyzed using immunohistochemistry in the submucosal and myenteric plexus of patients with DD and in that of controls. Expression of the inflammatory cytokines tumor necrosis factor-α and interleukin-6 was quantified using qPCR, and infiltration of CD3+ lymphocytes was determined using immunohistochemistry.
RESULTS: Expression of S100β was increased in the submucosal and myenteric plexus of patients with DD compared with that in controls, whereas expression of other glial factors remained unchanged. This increased expression of S100β was correlated to CD3+ lymphocytic infiltrates in patients with DD, whereas no correlation was observed in controls.
CONCLUSIONS: DD is associated with limited but significant alterations of the enteric glial network. The increased expression of S100β is associated with a persistent low-grade inflammation reported in patients with DD, further emphasizing the role of EGCs in intestinal inflammation.},
}
@article {pmid29505648,
year = {2018},
author = {DiSiena, MS and Birk, JW},
title = {Diverticular Disease: The Old, the New, and the Ever-Changing View.},
journal = {Southern medical journal},
volume = {111},
number = {3},
pages = {144-150},
doi = {10.14423/SMJ.0000000000000780},
pmid = {29505648},
issn = {1541-8243},
mesh = {Combined Modality Therapy ; *Diverticular Diseases/diagnosis/epidemiology/etiology/therapy ; Global Health ; Humans ; Prevalence ; Risk Factors ; },
abstract = {Our understanding of diverticular disease has evolved significantly during the last 25 years, and as such, a reexamination is in order. We performed a literature search for the years 1960-2017 of PubMed, Medline, and Google Scholar for updates regarding the epidemiology, risk factors, and therapies for traditional diverticulitis as well as the recently described subtypes of diverticular disease, segmental colitis associated with diverticulosis, and symptomatic uncomplicated diverticular disease. Although the prevalence of diverticulosis is still extremely common in the general population, the literature suggests that the incidence of diverticulitis is much less than previously believed and occurrences do not necessarily increase with age. In addition, the commonly held beliefs that low-fiber diets alone contribute to the development of diverticulosis and diverticulitis have not been verified; however, the combination of a low-fiber diet and a high red meat/high-fat diet is a risk factor for diverticulitis. Surgery continues to be the treatment for severe complications of diverticulitis, but new literature suggests that it has a poor utility in preventing a recurrence of diverticulitis in the long term; therefore, elective surgery after two episodes of diverticulitis is no longer the standard.},
}
@article {pmid29500612,
year = {2018},
author = {Schreyer, AG},
title = {[Diverticular disease : Complications and differential diagnosis].},
journal = {Der Radiologe},
volume = {58},
number = {4},
pages = {334-343},
pmid = {29500612},
issn = {1432-2102},
mesh = {*Diagnosis, Differential ; *Diverticulitis/diagnosis ; Humans ; },
abstract = {BACKGROUND: Diverticular disease is becoming increasingly more common in the western world. It is clinically subdivided into uncomplicated diverticular disease and diverticular disease with a complicated course. In approximately 20% of cases the diverticula will become symptomatic during the lifetime of patients.
RESULTS: In contrast to previous medical opinions, the occurrence of diverticula cannot be prevented by a diet rich in fiber; however, the development into complicated diverticulitis can be reduced by dietary measures. Complications include perforations, abscess and fistula formation or mechanical ileus. In addition, hemorrhage can occur as a complication, which can, however, occur in diverticulosis and also diverticulitis and especially in the chronic form. For the differential diagnostics a broad spectrum of inflammatory and noninflammatory diseases of the abdomen and pelvis must be taken into consideration.
CONCLUSION: According to the new S2K guidelines the subdivision of diverticulitis should be implemented using the so-called classification of diverticular diseases (CDD). This enables a stratification of patients for outpatient or inhospital treatment.},
}
@article {pmid29487763,
year = {2018},
author = {Linninge, C and Roth, B and Erlanson-Albertsson, C and Molin, G and Toth, E and Ohlsson, B},
title = {Abundance of Enterobacteriaceae in the colon mucosa in diverticular disease.},
journal = {World journal of gastrointestinal pathophysiology},
volume = {9},
number = {1},
pages = {18-27},
pmid = {29487763},
issn = {2150-5330},
abstract = {AIM: To compare gut bacterial diversity and amount of Enterobacteriaceae in colonic mucosa between patients with and without diverticular disease (DD).
METHODS: Patients in a stable clinical condition with planned elective colonoscopy were included. Blood samples and colon mucosa biopsies were collected at the colonoscopy. Study questionnaires including questions about gastrointestinal symptoms were completed by the patients and physicians. DNA from mucosa samples was isolated and the amount of Enterobacteriaceae was estimated using PCR assay. Terminal restriction fragment length polymorphism was applied to assess microbial diversity. Diversity was estimated by calculations of richness (number of terminal restriction fragments) and Shannon-Wiener and Simpson's indices.
RESULTS: A total of 51 patients were included, 16 patients with DD [68 (62-76) years] and 35 controls [62 (40-74) years] without any diverticula. Patients with DD had significantly higher levels of Enterobacteriaceae than those without DD (P = 0.043), and there was an inverse relationship between the amount of Enterobacteriaceae and the Simpson's index (rs = -0.361, P = 0.033) and the Shannon-Wiener index (rs = -0.299, P = 0.081). The Simpson's index (P = 0.383), Shannon-Wiener index (P = 0.401) or number of restrictions fragments (P = 0.776) did not differ between DD and controls. The majority of patients experienced gastrointestinal symptoms, and 22 patients (43.1%) fulfilled the criteria for irritable bowel syndrome, with no difference between the groups (P = 0.212). Demography, socioeconomic status, lifestyle habits, inflammatory biomarkers, or symptoms were not related to the amount of Enterobacteriaceae or bacterial diversity.
CONCLUSION: Patients with DD had higher amount of Enterobacteriaceae in the colon mucosa compared to patients without diverticula.},
}
@article {pmid29484943,
year = {2018},
author = {Hallam, S and Mothe, BS and Tirumulaju, R},
title = {Hartmann's procedure, reversal and rate of stoma-free survival.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {100},
number = {4},
pages = {301-307},
pmid = {29484943},
issn = {1478-7083},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/methods/statistics & numerical data ; Colectomy/adverse effects/methods/*statistics & numerical data ; Colon, Sigmoid/surgery ; Colostomy/adverse effects/methods/*statistics & numerical data ; Diverticulitis, Colonic/complications/mortality/*surgery ; Female ; Humans ; Male ; Medical Audit/statistics & numerical data ; Middle Aged ; Operative Time ; Postoperative Complications/*epidemiology/etiology ; Rectum/surgery ; Reoperation/adverse effects/mortality/*statistics & numerical data ; Retrospective Studies ; Surgical Stomas/statistics & numerical data ; Treatment Outcome ; Young Adult ; },
abstract = {Background Hartmann's procedure is a commonly performed operation for complicated left colon diverticulitis or malignancy. The timing for reversal of Hartmann's is not well defined as it is technically challenging and carries a high complication rate. Methods This study is a retrospective audit of all patients who underwent Hartmann's procedure between 2008 and 2014. Reversal of Hartmann's rate, timing, American Society of Anesthesiologists grade, length of stay and complications (Clavien-Dindo) including 30-day mortality were recorded. Results Hartmann's procedure (n = 228) indications were complicated diverticular disease 44% (n = 100), malignancy 32% (n = 74) and other causes 24%, (n = 56). Reversal of Hartmann's rate was 47% (n = 108). Median age of patients was 58 years (range 21-84 years), American Society of Anesthesiologists grade 2 (range 1-4), length of stay was eight days (range 2-42 days). Median time to reversal of Hartmann's was 11 months (range 4-96 months). The overall complication rate from reversal of Hartmann's was 21%; 3.7% had a major complication of IIIa or above including three anastomotic leaks and one deep wound dehiscence. Failure of reversal and permanent stoma was less than 1% (n = 2). Thirty-day mortality following Hartmann's procedure was 7% (n = 15). Where Hartmann's procedure wass not reversed, for 30% (n = 31) this was the patient's choice and 70% (n = 74) were either high risk or unfit. Conclusions Hartmann's procedure is reversed less frequently than thought and consented for. Only 46% of Hartmann's procedures were stoma free at the end of the audit period. The anastomotic complication rate of 1% is also low for reversal of Hartmann's procedure in this study.},
}
@article {pmid29482080,
year = {2018},
author = {Marianne, C and Ur Rehman, M and Min Hoe, C},
title = {A case report of large gastric diverticulum with literature review.},
journal = {International journal of surgery case reports},
volume = {44},
number = {},
pages = {82-84},
pmid = {29482080},
issn = {2210-2612},
abstract = {INTRODUCTION: A gastric diverticulum is a rare form of diverticular disease due to outpouching of the gastric wall. It is equally presented within both sexes and commonly occurs in fifth and sixth decades of life. Patients mostly asymptomatic but may present with mild gastric symptoms. Surgical treatment is largely dependent on the patient's symptoms, and a laparoscopic approach is usually recommended for surgery.
CASE PRESENTATION: A 77-year-old gentleman presented to the outpatient clinic with a one-month history of passing black stools. He was arranged for an oesophagogastroduodenoscopy (OGD) which revealed a gastric body polyp and a diverticulum in the fundus of the stomach.
DISCUSSION: Gastric diverticulum is defined as an outpouching of the gastric wall. They are uncommon, with an incidence between 0.01-0.11%. Predisposing factors include: areas of weakness caused by splitting of the longitudinal muscle fibres, an absence of peritoneal membrane and perforating arterioles. The management of patients with gastric diverticulum depend largely on their symptoms. There is no specific treatment required for an asymptomatic diverticulum.
CONCLUSION: Gastric diverticula are rare conditions which are largely asymptomatic but may present with varying signs and symptoms and may require surgical intervention.},
}
@article {pmid29470473,
year = {2018},
author = {Osman, K and Srinivasa, S and Koea, J},
title = {Liver abscess: contemporary presentation and management in a Western population.},
journal = {The New Zealand medical journal},
volume = {131},
number = {1470},
pages = {65-70},
pmid = {29470473},
issn = {1175-8716},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Drainage ; Female ; Humans ; *Liver Abscess/diagnosis/epidemiology/microbiology/therapy ; Male ; Middle Aged ; New Zealand/epidemiology ; Retrospective Studies ; Young Adult ; },
abstract = {AIM: Historically, liver abscesses (LA) affected elderly, immunocompromised patients and were characterised by high morbidity and mortality, however there are no data pertaining to a New Zealand population with little information surrounding recent management trends.
METHODS: A retrospective review of demographic characteristics, clinical management and microbiological data on patients presenting with liver abscess between 2005-2014 was conducted.
RESULTS: Fifty-seven patients [37 males, median age 64 (range 15-87)] presented with LA and most patients were not comorbid. Ethnicity included European (47%), Chinese (16%) and Pacific Island (11%). Twenty-six patients had primary abscesses, 31 patients had secondary abscesses [biliary disease, appendicitis, diverticular disease]. Presenting symptoms were non-specific. Admission white cell count was raised in 50 (88%) of patients and 43 (75%) had a CRP≥200mg/L. All patients were investigated with CT scan with 34 LA located in the right lobe, 14 in the left and eight bi-lobar. Klebsiella pneumoniae was the commonest pathogen (26% of aspirates). Percutaneous drainage (PD) was used to treat 36 of 37 patients, 17 patients were treated with intravenous antibiotics alone and three patients required open drainage for loculated collections despite PD (n=1), intra-peritoneal rupture or sepsis (n=2). Thirteen patients were readmitted within 30 days for ongoing symptoms requiring intravenous antibiotics/further PD (9) or further investigations (4). The median PD duration was 10 days (range 3-53). Twenty-six patients required follow-up imaging over one month with 16 requiring follow-up over six weeks.
CONCLUSION: In a New Zealand setting, LA affect fit patients, and primary abscesses account for almost half of all presentation. PD is effective treatment in most LA although prolonged drainage and treatment with antibiotics may be necessary.},
}
@article {pmid29451517,
year = {2018},
author = {Mennini, FS and Sciattella, P and Marcellusi, A and Toraldo, B and Koch, M},
title = {[Burden of diverticular disease: an observational analysis based on Italian real-world data.].},
journal = {Recenti progressi in medicina},
volume = {109},
number = {1},
pages = {15-24},
doi = {10.1701/2848.28749},
pmid = {29451517},
issn = {2038-1840},
mesh = {Aged ; *Cost of Illness ; Cross-Sectional Studies ; Delivery of Health Care/economics ; Diverticulitis/economics/mortality/*therapy ; Female ; Health Care Costs/*statistics & numerical data ; Hemorrhage/epidemiology/etiology ; Hospital Mortality ; Hospitalization/economics/*statistics & numerical data ; Humans ; Italy ; Kaplan-Meier Estimate ; Longitudinal Studies ; Male ; Middle Aged ; },
abstract = {INTRODUCTION: Diverticular disease (DD) represent a wide variety of conditions associated with the presence of diverticula in the colon. The most serious form is an acute episode of diverticulitis which can lead to hospitalization and surgery with various types of consequences. The main aim of this study was to evaluate, from both cross-sectional and longitudinal perspective, the economic burden of diverticulitis in the real practice.
METHOD: A deterministic linkage was performed at individual user level between the different administrative sources of the Marche Region through anonymised ID number for a period of analysis between 1 January 2008 and 31 December 2014. We enrolled all patients with at least one hospitalization for "diverticulitis of the colon without mention of haemorrhage" (ICD-9-CM code 562.11) or "diverticulitis of the colon with haemorrhage" (ICD-9-CM code 562.13) as primary or secondary diagnosis. Cost and outcome were analysed considering transversally (for contemporaneous) and longitudinal (for cohort) perspective. Hospital mortality at one year after discharge was evaluated by mortality rates and Kaplan-Meier curve considering the surgery performed (or not performed) during the index hospitalization.
RESULTS: Considering the cross-sectional perspective, 427 patients per year were estimated (about 35 patients per 100,000 adult residents) with an average number of hospitalization equal to 1.14. The direct healthcare costs incurred by the Marche region for episodes of diverticulitis in 2008-2014 amounted to approximately € 11.4 million (€ 1.6 million a year), of which € 10.9 million (95.5%) for the hospitalizations, € 246,000 (2.1%) for pharmaceutical treatment and € 270,000 (2.4%) for specialist outpatient services. The cohort analysis estimates an intra-hospital mortality rate equal to 5.9 per 100 patients' year (5.5 for non-surgery patients and 8.9 for surgery patients - P<0.05). Kaplan-Meier curve demonstrate that there were no differences between intra-hospital mortality due to surgery during index hospitalization.
CONCLUSIONS: Our study is the first analysis in Italy to use real-world data to measure the burden of DD with a cross-sectional and longitudinal perspective. This study could be useful for decision maker that could quantify the economic and epidemiological burden of DD in hospital.},
}
@article {pmid29435218,
year = {2018},
author = {Syllaios, A and Daskalopoulou, D and Bourganos, N and Papakonstantinou, A and Triantafyllou, E and Koutras, A and Georgiou, C},
title = {Giant colonic diverticulum-a rare cause of acute abdomen.},
journal = {Journal of surgical case reports},
volume = {2018},
number = {2},
pages = {rjy009},
pmid = {29435218},
issn = {2042-8812},
abstract = {Giant colonic diverticulum (GCD), defined as diverticulum larger than 4 cm, is a rare entity. It is generally a manifestation of colonic diverticular disease and can have dramatic complications such as perforation, abscess, volvulus, infarction and adenocarcinoma. This report documents the case of a 63-year-old man coming to the Emergency Department with acute abdomen due to a perforation of a GCD. In the plain abdominal X-ray the 'Balloon-sign' was revealed, computed tomography scan and Hartmann's procedure were performed. Acute abdomen can occur as a manifestation of a complication of a GCD, and this report highlights the fact that GCD should be considered for patients with a high risk of diverticular disease and abdominal pain.},
}
@article {pmid29430677,
year = {2018},
author = {Bercovici, N and Russomanno, K and Santoro, F and Scola, C and Murphy, M and Elaba, Z},
title = {Cutaneous refractile foreign body microemboli with intravascular injection of oral medication.},
journal = {Journal of cutaneous pathology},
volume = {45},
number = {5},
pages = {365-368},
doi = {10.1111/cup.13125},
pmid = {29430677},
issn = {1600-0560},
mesh = {Adult ; Antiemetics/*administration & dosage/adverse effects ; Diverticulitis, Colonic/complications/surgery ; Embolism/etiology ; Foreign Bodies/*etiology/pathology ; Humans ; Injections, Intra-Arterial/*adverse effects ; Male ; Ondansetron/*administration & dosage/adverse effects ; Oxycodone/administration & dosage/adverse effects ; Postoperative Nausea and Vomiting/prevention & control ; Prescription Drug Misuse/*adverse effects ; Tablets/adverse effects ; },
abstract = {Injection drug abuse (IDA) is known to cause a spectrum of systemic and cutaneous complications. Despite the increasing incidence of IDA around the world, there is a paucity of literature discussing cutaneous complications from a dermatopathologic perspective. We present a case of a 35-year-old male with a complex medical history of Von Willebrand disease, Beçhet disease and diverticular disease. Following a sigmoidectomy/colostomy for diverticular perforation, he presented with fever and an indurated right arm displaying livedoid purpura. The right distal fingertips showed purpura with focal ulceration. A punch biopsy of the right wrist did not show evidence of inflammatory vasculitis or pyogenic infection, but instead showed a focus of polarizing, refractile material occluding a dilated arterial lumen within the mid-dermis. The patient admitted to injecting a suspension of crushed ondansetron (Zofran) tablets into the antecubital area to control post-operative nausea. It is known that direct intravascular injection of foreign material can cause distal ischemia and necrosis, either by local vasoconstriction, thrombosis, or formation of microemboli, as in this patient. Our objective is to bring awareness to this rarely reported phenomenon, and to raise clinical suspicion for IDA when confronted with such a unique vasculopathic pattern.},
}
@article {pmid29428950,
year = {2019},
author = {Ditzel, M and Vennix, S and Menon, AG and Verbeek, PCM and Bemelman, WA and Lange, JF},
title = {Severity of Diverticulitis Does Not Influence Abdominal Complaints during Long-Term Follow-Up.},
journal = {Digestive surgery},
volume = {36},
number = {2},
pages = {129-136},
pmid = {29428950},
issn = {1421-9883},
mesh = {Abdominal Pain/*etiology ; Aged ; Constipation/etiology ; Diverticulitis/*surgery ; Elective Surgical Procedures/adverse effects ; Female ; Flatulence/etiology ; Follow-Up Studies ; Heartburn/etiology ; Humans ; Laryngopharyngeal Reflux/etiology ; Male ; Postoperative Complications/*etiology ; Reoperation ; Retrospective Studies ; Severity of Illness Index ; Surveys and Questionnaires ; Symptom Assessment ; Time Factors ; },
abstract = {BACKGROUND: Diverticulitis can lead to localized or generalized peritonitis and consequently induce abdominal adhesion formation. If adhesions would lead to abdominal complaints, it might be expected that these would be more prominent after operation for perforated diverticulitis with peritonitis than after elective sigmoid resection.
AIMS: The primary outcome of the study was the incidence of abdominal complaints in the long-term after acute and elective surgery for diverticulitis.
METHODS: During the period 2003 through 2009, 269 patients were operated for diverticular disease. Two hundred eight of them were invited to fill out a questionnaire composed of the gastrointestinal quality of life index and additional questions and finally 109 were suitable for analysis with a mean follow-up of 7.5 years.
RESULTS: Analysis did not reveal any significant differences in the incidence of abdominal complaints or other parameters.
CONCLUSION: This retrospective study on patients after operation for diverticulitis shows that in the long term, the severity of the abdominal complaints is influenced neither by the stage of the disease nor by the fact of whether it was performed in an acute or elective setting.},
}
@article {pmid29420430,
year = {2018},
author = {El-Sayed, C and Radley, S and Mytton, J and Evison, F and Ward, ST},
title = {Risk of Recurrent Disease and Surgery Following an Admission for Acute Diverticulitis.},
journal = {Diseases of the colon and rectum},
volume = {61},
number = {3},
pages = {382-389},
doi = {10.1097/DCR.0000000000000939},
pmid = {29420430},
issn = {1530-0358},
mesh = {Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Cohort Studies ; Diverticulitis, Colonic/*epidemiology/surgery ; England/epidemiology ; Female ; Follow-Up Studies ; Hospitalization/*statistics & numerical data ; Humans ; Logistic Models ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Risk Factors ; Young Adult ; },
abstract = {BACKGROUND: Diverticular disease accounts for significant morbidity and mortality and may take the form of recurrent episodes of acute diverticulitis. The role of elective surgery is not clearly defined.
OBJECTIVE: This study aimed to define the rate of hospital admission for recurrent acute diverticulitis and risk factors associated with recurrence and surgery.
DESIGN: This is a retrospective population-based cohort study.
SETTINGS: National Health Service hospital admissions for acute diverticulitis in England between April 2006 and March 2011 were reviewed.
PATIENTS: Hospital Episode Statistics data identified adult patients with the first episode of acute diverticulitis (index admission), and then identified recurrent admissions and elective or emergency surgery for acute diverticulitis during a minimum follow-up period of 4 years. Exclusion criteria included previous diagnoses of acute diverticulitis, colorectal cancer, or GI bleeding, and prior colectomy or surgery or death during the index admission.
INTERVENTIONS: There were no interventions.
MAIN OUTCOME MEASURES: The primary outcomes measured were recurrent admissions for acute diverticulitis and patients requiring either elective or emergency surgery during the study period.
RESULTS: Some 65,162 patients were identified with the first episode of acute diverticulitis. The rate of hospital admission for recurrent acute diverticulitis was 11.2%. A logistic regression model examined factors associated with recurrent acute diverticulitis and surgery: patient age, female sex, smoking, obesity, comorbidity score >20, dyslipidemia, and complicated acute diverticulitis increased the risk of recurrent acute diverticulitis. There was an inverse relationship between patient age and recurrence. Similar factors were associated with elective and emergency surgery.
LIMITATIONS: The cases of acute diverticulitis required inpatient management and the use of Hospital Episode Statistics, relying on the accuracy of diagnostic coding.
CONCLUSIONS: This is the largest study assessing the rates of hospital admission for recurrent acute diverticulitis. Knowledge of the rate and risk factors for recurrent acute diverticulitis is required to aid discussion and decision making with patients regarding the need and timing of elective surgery. Some factors associated with recurrence are modifiable; therefore, weight reduction and smoking cessation can be championed. See Video Abstract at http://links.lww.com/DCR/A449.},
}
@article {pmid29413216,
year = {2018},
author = {Ellison, DL},
title = {Acute Diverticulitis Management.},
journal = {Critical care nursing clinics of North America},
volume = {30},
number = {1},
pages = {67-74},
doi = {10.1016/j.cnc.2017.10.006},
pmid = {29413216},
issn = {1558-3481},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; *Diverticulitis/diagnosis/diagnostic imaging/physiopathology/therapy ; *Hospitalization ; Humans ; *Inflammation/etiology ; United States ; },
abstract = {Diverticular disease accounts for approximately 300,000 hospitalizations per year in the United States, resulting in 1.5 million days of inpatient care. Diverticulitis is defined as an inflammation of the diverticulum, which can be asymptomatic or symptomatic. This disease is the third most common gastrointestinal illness that requires hospitalization and the leading indication for elective colon resection. Abdominal pain is the most common complaint in patients with acute diverticulitis. The pain can be described as cramping, constant, and persistent for several days. Medical management is most often provided with antibiotics and clear liquid diet.},
}
@article {pmid29411405,
year = {2018},
author = {Gordon, IO and Agrawal, N and Willis, E and Goldblum, JR and Lopez, R and Allende, D and Liu, X and Patil, DY and Yerian, L and El-Khider, F and Fiocchi, C and Rieder, F},
title = {Fibrosis in ulcerative colitis is directly linked to severity and chronicity of mucosal inflammation.},
journal = {Alimentary pharmacology & therapeutics},
volume = {47},
number = {7},
pages = {922-939},
pmid = {29411405},
issn = {1365-2036},
support = {K08 DK110415/DK/NIDDK NIH HHS/United States ; P30 DK097948/DK/NIDDK NIH HHS/United States ; T32 DK083251/DK/NIDDK NIH HHS/United States ; },
mesh = {Adolescent ; Adult ; Aged ; Biopsy ; Colitis, Ulcerative/*complications/pathology ; Crohn Disease/complications/pathology ; Cross-Sectional Studies ; Female ; Fibrosis ; Humans ; Hyperplasia/pathology ; Inflammation/*etiology/pathology ; Intestinal Mucosa/*pathology ; Male ; Middle Aged ; Mucositis/etiology/pathology ; Recurrence ; Severity of Illness Index ; Young Adult ; },
abstract = {BACKGROUND: Fibrosis in ulcerative colitis has remained largely unexplored despite its clinical implications.
AIMS: This cross-sectional study was aimed at characterising the presence, anatomical location and degree of ulcerative colitis-associated fibrosis and its possible link to clinical parameters.
METHODS: Seven hundred and six individual tissue cross-sections derived every 10 cm along the length of 89 consecutive Ulcerative colitis colectomy specimens were examined and compared to Crohn's disease colitis, diverticular disease and uninvolved areas from colorectal cancer patients. Degree of inflammation, fibrosis and morphometric measurements of all layers of the intestinal wall were evaluated. Three gastrointestinal pathologists independently assessed colon sections stained with haematoxylin and eosin, Masson trichrome and Sirius red. Clinical data were collected prospectively.
RESULTS: Submucosal fibrosis was detected in 100% of ulcerative colitis colectomy specimens, but only in areas affected by inflammation. Submucosal fibrosis was associated with the severity of intestinal inflammation (Spearman correlations rho (95% confidence interval): 0.58 (P < 0.001) and histopathological changes of chronic mucosal injury, but not active inflammation. Colectomy for refractory disease rather than presence of dysplasia was associated with increased fibrosis and a thicker muscularis mucosae, whereas a thinner muscularis mucosae was associated with anti-tumour necrosis factor therapy. No feature on endoscopic mucosal biopsies could predict the underlying amount of fibrosis or the thickness of the muscularis mucosae.
CONCLUSIONS: A significant degree of fibrosis and muscularis mucosae thickening should be considered as common complications of chronic progressive ulcerative colitis. These features may have clinical consequences such as motility abnormalities and increased wall stiffness.},
}
@article {pmid29411119,
year = {2018},
author = {Reichert, MC and Krawczyk, M and Appenrodt, B and Casper, M and Friesenhahn-Ochs, B and Grünhage, F and Jüngst, C and Zimmer, V and Lammert, F and Dauer, M},
title = {Selective association of nonaspirin NSAIDs with risk of diverticulitis.},
journal = {International journal of colorectal disease},
volume = {33},
number = {4},
pages = {423-430},
doi = {10.1007/s00384-018-2968-z},
pmid = {29411119},
issn = {1432-1262},
support = {grant T201000747//HOMFOR/ ; },
mesh = {Aged ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Cohort Studies ; Comorbidity ; Diverticulitis/*chemically induced ; Diverticulum/chemically induced ; Female ; Humans ; Male ; Risk Factors ; },
abstract = {PURPOSE: The purpose of this study is to investigate the association of intake of nonsteroidal anti-inflammatory drugs (NSAIDs) and in particular nonaspirin NSAIDs and compare it with other risk factors for the progression of diverticulosis to diverticulitis in patients who underwent colonoscopy.
METHODS: A total of 194 patients who underwent complete colonoscopy in our center between 2012 and 2016 were recruited: 144 with diverticulosis without prior diverticulitis (median age 71 years, 59.7% men) and 50 with diverticulitis (median age 64 years, 54.0% men). Data concerning current and previous medication as well as concomitant diseases were collected using a structured questionnaire and by revision of patients medical charts.
RESULTS: Patients with diverticulitis were significantly (p < 0.001) younger as compared to individuals with plain diverticulosis (median age 64 versus 71 years, respectively). The intake of NSAIDs significantly (p = 0.002) increased the risk of prior diverticulitis (OR 3.2, 95% CI 1.5-6.9). In the multivariate model, both age (p < 0.001) and NSAIDs (p = 0.03) proved to be independent determinants of diverticulitis. When analyzing aspirin intake, it was not associated with diverticulitis.
CONCLUSIONS: Our study demonstrates, in line with previous reports, that intake of NSAIDs is associated with diverticulitis. We show in particular that nonaspirin NSAIDs might be selectively associated with diverticulitis. These results point to divergent role of aspirin and nonaspirin NSAIDs in the development of diverticulitis.},
}
@article {pmid29397430,
year = {2018},
author = {Brandlhuber, M and Genzinger, C and Brandlhuber, B and Sommer, WH and Müller, MH and Kreis, ME},
title = {Long-term quality of life after conservative treatment versus surgery for different stages of acute sigmoid diverticulitis.},
journal = {International journal of colorectal disease},
volume = {33},
number = {3},
pages = {317-326},
pmid = {29397430},
issn = {1432-1262},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Colon, Sigmoid/diagnostic imaging/*pathology/*surgery ; *Conservative Treatment ; Diverticulitis/classification/diagnostic imaging/*pathology/*surgery ; Documentation ; Female ; Humans ; Interviews as Topic ; Male ; Middle Aged ; *Quality of Life ; Reproducibility of Results ; Surveys and Questionnaires ; Time Factors ; Tomography, X-Ray Computed ; Young Adult ; },
abstract = {PURPOSE: It is controversial whether patients fare better with conservative or surgical treatment in certain stages of acute diverticulitis (AD), in particular when phlegmonous inflammation or covered micro- or macro-perforation are present. The aim of this study was to determine long-term quality of life (QoL) for AD patients who received either surgery or conservative treatment in different stages.
METHODS: We included patients treated for AD at the University Hospital Grosshadern, Munich, Germany, between January 1, 2000, and December 31, 2010. Patients were classified by the Hansen and Stock (HS) classification, the modified Hinchey classification, and the German classification of diverticular disease (CDD). Pre-therapeutic staging was based on multidetector computed tomography. Long-term QoL was assessed by the Cleveland Global Quality of Life (CGQL) questionnaire, the Short Form 36 (SF-36), and the Gastrointestinal Quality of Life Index (GIQLI). Data are mean ± SEM.
RESULTS: Patients with phlegmonous AD (HS type 2a, Hinchey Ia and CDD 1b, respectively) had a better long-term QoL on the GIQLI when they were operated (78.5 ± 2.5 vs. 70.7 ± 2.1; p < 0.05). Patients with micro-abscess (CDD 2a) had a better long-term QoL on the GIQLI, CGQL, and the "Role Physical" scale of the SF-36 when they were not operated (GIQLI 86.9 ± 2.1 vs. 76.8 ± 1.0; p = 0.10; CGQL 82.8 ± 5.1 vs. 65.3 ± 11.0; p = 0.08; SF-36/Role Physical 100 ± 0.0 vs. 41.7 ± 13.9; p < 0.001). Patients with macro-abscess (CDD 2b) had a better long-term QoL when they were operated (GIQLI 89.3 ± 1.4 vs. 69.5 ± 4.5; p < 0.01; CGQL 80.3 ± 7.6 vs. 60.5 ± 5.8; p < 0.05; SF-36/Role Physical 95.8 ± 4.2 vs. 47.9 ± 13.6; p < 0.001).
CONCLUSION: Considering long-term QoL, phlegmonous AD (HS type 2a, Hinchey Ia and CDD 1b, respectively) should be treated conservatively. In patients with covered perforation, abscess size should guide the decision on whether to perform surgery later on or not. In the light of long-term quality of life, patients fare better after elective sigmoid colectomy when abscess size exceeds 1 cm.},
}
@article {pmid29392838,
year = {2018},
author = {Pitiot, A and Smith, JK and Humes, DJ and Garratt, J and Francis, ST and Gowland, PA and Spiller, RC and Marciani, L},
title = {Cortical differences in diverticular disease and correlation with symptom reports.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {30},
number = {7},
pages = {e13303},
doi = {10.1111/nmo.13303},
pmid = {29392838},
issn = {1365-2982},
support = {PDF-2012-05-431/DH_/Department of Health/United Kingdom ; },
mesh = {Adult ; Aged ; Cerebral Cortex/*diagnostic imaging/physiology ; Cross-Sectional Studies ; Diverticular Diseases/*diagnostic imaging/physiopathology/*psychology ; Female ; Humans ; Irritable Bowel Syndrome ; Male ; Middle Aged ; Pain/*diagnostic imaging/physiopathology/*psychology ; Surveys and Questionnaires ; Young Adult ; },
abstract = {BACKGROUND: Recent studies have shown that the brain of patients with gastrointestinal disease differ both structurally and functionally from that of controls. Highly somatizing diverticular disease (HSDD) patients were also shown to differ from low somatizing (LSDD) patients functionally. This study aimed to investigate how they differed structurally.
METHODS: Four diseases subgroups were studied in a cross-sectional design: 20 patients with asymptomatic diverticular disease (ADD), 18 LSDD, 16 HSDD, and 18 with irritable bowel syndrome. We divided DD patients into LSDD and HSDD using a cutoff of 6 on the Patient Health Questionnaire 12 Somatic Symptom (PHQ12-SS) scale. All patients underwent a 1-mm isotropic structural brain MRI scan and were assessed for somatization, hospital anxiety, depression, and pain catastrophizing. Whole brain volumetry, cortical thickness analysis and voxel-based morphometry were carried out using Freesurfer and SPM.
KEY RESULTS: We observed decreases in gray matter density in the left and right dorsolateral prefrontal cortex (dlPFC), and in the mid-cingulate and motor cortex, and increases in the left (19, 20) and right (19, 38) Brodmann Areas. The average cortical thickness differed overall across groups (P = .002) and regionally: HSDD > ADD in the posterior cingulate cortex (P = .03), HSDD > LSDD in the dlPFC (P = .03) and in the ventrolateral PFC (P < .001). The thickness of the anterior cingulate cortex and of the mid-prefrontal cortex were also found to correlate with Pain Catastrophizing (Spearman's ρ = 0.24, P = .043 uncorrected and Spearman's ρ = 0.25, P = .03 uncorrected).
CONCLUSION & INFERENCES: This is the first study of structural gray matter abnormalities in diverticular disease patients. The data show brain differences in the pain network.},
}
@article {pmid29382074,
year = {2018},
author = {Dahl, C and Crichton, M and Jenkins, J and Nucera, R and Mahoney, S and Marx, W and Marshall, S},
title = {Evidence for Dietary Fibre Modification in the Recovery and Prevention of Reoccurrence of Acute, Uncomplicated Diverticulitis: A Systematic Literature Review.},
journal = {Nutrients},
volume = {10},
number = {2},
pages = {},
pmid = {29382074},
issn = {2072-6643},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Diet ; Dietary Fiber/*administration & dosage ; Diverticulitis/*diet therapy/drug therapy/prevention & control ; Evidence-Based Medicine ; Humans ; Meta-Analysis as Topic ; Observational Studies as Topic ; Probiotics/administration & dosage ; Randomized Controlled Trials as Topic ; Recurrence ; Risk Factors ; },
abstract = {In practice, nutrition recommendations vary widely for inpatient and discharge management of acute, uncomplicated diverticulitis. This systematic review aims to review the evidence and develop recommendations for dietary fibre modifications, either alone or alongside probiotics or antibiotics, versus any comparator in adults in any setting with or recently recovered from acute, uncomplicated diverticulitis. Intervention and observational studies in any language were located using four databases until March 2017. The Cochrane Risk of Bias tool and GRADE were used to evaluate the overall quality of the evidence and to develop recommendations. Eight studies were included. There was "very low" quality evidence for comparing a liberalised and restricted fibre diet for inpatient management to improve hospital length of stay, recovery, gastrointestinal symptoms and reoccurrence. There was "very low" quality of evidence for using a high dietary fibre diet as opposed to a standard or low dietary fibre diet following resolution of an acute episode, to improve reoccurrence and gastrointestinal symptoms. The results of this systematic review and GRADE assessment conditionally recommend the use of liberalised diets as opposed to dietary restrictions for adults with acute, uncomplicated diverticulitis. It also strongly recommends a high dietary fibre diet aligning with dietary guidelines, with or without dietary fibre supplementation, after the acute episode has resolved.},
}
@article {pmid29364015,
year = {2018},
author = {Khan, M and Jayne, D and Saunders, R},
title = {Comparison of defecatory function after laparoscopic total colectomy and ileorectal anastomosis versus a traditional open approach.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {100},
number = {3},
pages = {235-239},
pmid = {29364015},
issn = {1478-7083},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colectomy/*methods ; Defecation/*physiology ; Fecal Incontinence/epidemiology/etiology/physiopathology/*prevention & control ; Female ; Follow-Up Studies ; Humans ; Ileum/*surgery ; *Laparoscopy ; Male ; Middle Aged ; Postoperative Complications/epidemiology/etiology/physiopathology/*prevention & control ; Rectum/*surgery ; Retrospective Studies ; Treatment Outcome ; },
abstract = {Introduction Total colectomy and ileorectal anastomosis can result in significant defecatory frequency and poor bowel function. The aim of this study was to assess whether a laparoscopic approach is associated with any improvement in this regard. Methods A single institution retrospective review was undertaken of patients undergoing elective total colectomy and ileorectal anastomosis between 2000 and 2011. Those undergoing emergency surgery and paediatric surgery were excluded. The primary outcome measure was satisfactory defecatory function after surgery. Results Forty-nine patients (24 male, 25 female) were included in the study. The median age was 48 years (range: 20-83 years). Laparoscopic total colectomy (LTC) was performed in 20 patients and open total colectomy (OTC) in 29 patients. Indications for surgery were slow colonic transit (n=17), colorectal cancer (CRC) (n=17), CRC with hereditary colorectal cancer syndrome (n=8), inflammatory bowel disease (n=4) and diverticular disease (n=3). In the LTC group, 85% had a satisfactory defecatory frequency of 1-6 motions per day compared with 45% in the OTC cohort (p=0.006). There was no statistically significant difference in bowel frequency related to primary pathology (benign vs cancer surgery, p=1.0). Postoperative complications for both groups included relaparotomy (n=3), anastomotic leak (n=2), small bowel obstruction (n=2), postoperative bleeding (n=1) and pneumonia (n=1). Conclusions This study indicates that long-term defecatory function is better following LTC than following OTC and ileorectal anastomosis. The mechanism for this improvement is unclear but it may relate to the underlying reason for surgery or possibly to reduced small bowel handling leading to fewer adhesions after laparoscopic surgery.},
}
@article {pmid29349481,
year = {2018},
author = {Galetin, T and Galetin, A and Vestweber, KH and Rink, AD},
title = {Systematic review and comparison of national and international guidelines on diverticular disease.},
journal = {International journal of colorectal disease},
volume = {33},
number = {3},
pages = {261-272},
pmid = {29349481},
issn = {1432-1262},
mesh = {Diverticular Diseases/classification/diagnosis/*pathology/therapy ; Humans ; *Practice Guidelines as Topic ; Randomized Controlled Trials as Topic ; Risk Factors ; },
abstract = {PURPOSE: Diverticular disease is common and of increasing medical and economical importance. Various practice guidelines on diagnostic and treatment on this disease exist. We compared current guidelines on the disease in order to identify concordant and discordant recommendations.
METHOD: Eleven national and international guidelines on diverticular disease published over the last 10 years have been identified by a systematic literature review on PubMed and compared in detail for 20 main and 51 subtopics.
RESULTS: The available evidence for the most aspects was rated as moderate or low. There was concordance for the following items: Diagnosis of diverticulitis should be confirmed by imaging methods (10 of 10 guidelines). Mild forms may be treated out-patient (10/10). Abscesses are treated non-surgically (9/9). Elective surgery should be indicated by individual patient-related factors, only, and be performed laparoscopically (10/10, 9/9 respectively). Main differences were found in the questions of appropriate classification, imaging diagnostic (computed-tomography versus ultra-sound), need for antibiotics in out-patient treatment and mode of surgery for diverticular perforation. Despite growing evidence that antibiotics are not needed for treating mild diverticulitis, only 3/10 guidelines have corresponding recommendations. Hartmann's procedure has been abandoned several years ago and is now recommended for feculent peritonitis by the three most recent guidelines. In contrast, laparoscopic lavage without resection is not recommended anymore.
CONCLUSION: There are dissents in the recommendations for central aspects regarding the diagnostic and treatment of diverticular disease in recently published guidelines.},
}
@article {pmid29336748,
year = {2017},
author = {Zoog, E and Giles, WH and Maxwell, RA},
title = {An Update on the Current Management of Perforated Diverticulitis.},
journal = {The American surgeon},
volume = {83},
number = {12},
pages = {1321-1328},
pmid = {29336748},
issn = {1555-9823},
mesh = {Colectomy ; Diverticulitis, Colonic/classification/diagnostic imaging/epidemiology/*surgery ; Drainage ; Humans ; Laparoscopy ; Peritoneal Lavage ; Prevalence ; Radiography, Interventional ; },
abstract = {The management of perforated diverticulitis is a challenging aspect of general surgery. The prevalence of colonic diverticular disease has increased over the last decade and will continue to increase as the baby boomers add to the elderly population. Improvements in diagnostic imaging modalities, efforts to maintain intestinal continuity, and percutaneous drainage procedures now result in several alternatives when selecting a management strategy for complicated presentations. Specifically, laparoscopic lavage and resection with primary anastomosis have emerged as options for treatment of Hinchey III and IV diverticulitis in place of diversion in the appropriately selected patient. Percutaneous drainage of Hinchey II diverticulitis in centers equipped with interventional radiology provides another minimally invasive adjunct. The objective of this paper is to provide an update on the current management of perforated diverticulitis, with a focus on the advantages and disadvantages of the surgical options for the treatment of Hinchey III and IV diverticulitis.},
}
@article {pmid29306857,
year = {2018},
author = {Subbiah, A and Mahajan, S and Yadav, RK and Agarwal, SK},
title = {Colovesical fistula: a rare complication after renal transplantation.},
journal = {BMJ case reports},
volume = {2018},
number = {},
pages = {},
pmid = {29306857},
issn = {1757-790X},
mesh = {Humans ; Intestinal Fistula/*etiology ; Kidney Transplantation/*adverse effects ; Male ; Middle Aged ; Polycystic Kidney, Autosomal Dominant/*complications/surgery ; Postoperative Complications/*etiology ; Rare Diseases/etiology ; },
abstract = {Colovesical fistula per se is a rare condition and most commonly occurs secondary to diverticular disease in normal patients. Colovesical fistula in the setting of post-renal transplantation is even rarer and very few cases have been reported in literature. Patients with autosomal-dominant polycystic kidney disease (ADPKD) are predisposed to diverticulosis and hence are at a higher risk for fistula formation. Herein, we report a case of colovesical fistula in a renal allograft recipient with ADPKD in the absence of diverticulosis. The patient was successfully operated and is stable with no complications at 1-year follow-up.},
}
@article {pmid29297793,
year = {2017},
author = {Vitali, S and Eden, P and Payne, K and Forbes, G},
title = {COLONIC DIVERTICULOSIS AND DIVERTICULAR HEMORRHAGE IN A GERIATRIC FEMALE ORANGUTAN (PONGO ABELII).},
journal = {Journal of zoo and wildlife medicine : official publication of the American Association of Zoo Veterinarians},
volume = {48},
number = {4},
pages = {1264-1266},
doi = {10.1638/2016-0190R1.1},
pmid = {29297793},
issn = {1042-7260},
mesh = {Animals ; Animals, Zoo ; Ape Diseases/*pathology ; Diverticulum/pathology/*veterinary ; Female ; Gastrointestinal Hemorrhage/pathology/*veterinary ; *Pongo abelii ; },
abstract = {A 57-yr-old female Sumatran orangutan (Pongo abelii) presented with signs of intermittent lethargy and inappetence, then subsequently developed profuse hemorrhagic diarrhea. Colonoscopy under anesthesia revealed diverticulosis of the descending colon, with multiple large diverticula containing fecoliths. There was no evidence of diverticulitis, but a regenerative anemia had developed following an acute diverticular bleed. The orangutan recovered with conservative therapy. Colonic diverticulosis has been reported in nonhuman primates and appears to have a similar clinical presentation to the condition as it occurs in humans. This is the first published report of colonic diverticulosis in a great ape.},
}
@article {pmid29278531,
year = {2018},
author = {Staudacher, HM and Kurien, M and Whelan, K},
title = {Nutritional implications of dietary interventions for managing gastrointestinal disorders.},
journal = {Current opinion in gastroenterology},
volume = {34},
number = {2},
pages = {105-111},
doi = {10.1097/MOG.0000000000000421},
pmid = {29278531},
issn = {1531-7056},
support = {//Medical Research Council/United Kingdom ; },
mesh = {Gastrointestinal Diseases/*diet therapy ; Humans ; },
abstract = {PURPOSE OF REVIEW: The aim of this review is to summarize some of the key dietary interventions recommended for common gastrointestinal disorders and to discuss recent evidence regarding their nutritional implications.
RECENT FINDINGS: The gluten-free diet has been shown to negatively influence overall diet quality. The gluten-free diet is essential in celiac disease, although it is increasingly used for other perceived health benefits for which an analysis of perceived benefit should be weighed against any nutritional risks. Evidence from short-term controlled trials of a diet low in fermentable oligosaccharides, disaccharides, monosaccharide and polyols in irritable bowel syndrome suggests compromised intake of nutrients such as fiber, iron, and calcium, although findings vary across studies. Meanwhile long-term uncontrolled trials suggest dietary adequacy improves with reintroduction and personalization. Although high-fiber diets may be beneficial in diverticular disease and constipation, it may lead to reductions in energy intake and nutrient absorption in at-risk populations.
SUMMARY: The role of therapeutic diets in the management of gastrointestinal disorders is increasingly recognized, but there are limited studies investigating their nutritional implications. The judicious use of dietetic expertise should minimize potential nutritional deficits, however further prospective trials are needed to identify the individuals and nutrients most at risk.},
}
@article {pmid29229124,
year = {2018},
author = {Bostock, IC and Hill, MV and Counihan, TC and Ivatury, SJ},
title = {Mortality after emergency Hartmann's procedure in octogenarians: a propensity score-matched analysis.},
journal = {The Journal of surgical research},
volume = {221},
number = {},
pages = {167-172},
doi = {10.1016/j.jss.2017.08.030},
pmid = {29229124},
issn = {1095-8673},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Colectomy/methods/*mortality ; Diverticulitis, Colonic/mortality/*surgery ; Emergency Treatment/mortality ; Female ; Humans ; Male ; Middle Aged ; Propensity Score ; United States/epidemiology ; },
abstract = {BACKGROUND: Complicated diverticulitis is associated with a postoperative mortality rate of 20%. We hypothesized that age ≥80 was an independent risk factor for mortality after Hartmann's procedure for diverticular disease when controlling for baseline comorbidities.
METHODS: Patients who underwent an urgent or emergent Hartmann's procedure (Current Procedural Terminology codes 44143 and 44206) for diverticular disease (International Classification of Diseases-9:562.xx) were identified using the American College of Surgeons National Surgical Quality Improvement Project 2005-2013 user file. Using propensity score matching to control for baseline comorbidities, a group of patients ≥80 years old was matched to a group of those <80 years old. Univariate and multivariable logistic regression were performed. A P value <0.05 was considered statistically significant with a confidence interval (CI) of 95%.
RESULTS: From a total of 2986 patients, 464 patients (15.5%) were ≥80 years old. Two groups of 284 patients in each study arm were matched using propensity-matching. The mean age of the ≥80 group and <80 group was 84.4 ± 3.3 versus 63.77 ± 911.8; P < 0.0001, respectively. There was no statistical difference in baseline comorbidities or operative time between the groups. There was a significant difference in mortality with 19% and 9.2% in the >80 group versus <80 groups, respectively (P = 0.001). Factors associated with mortality included ascites (odds ratio [OR] 4.95, confidence interval [CI] 1.64-14.93, P = 0.005), previous cardiac surgery (OR 3.68, CI 1.46-9.26, P = 0.006), partially dependent or fully dependent functional status (OR 2.51, CI 1.12-5.56, P = 0.02), albumin <3 (OR 2.49, CI 1.18-5.29, P = 0.01), and American Society of Anesthesiologist class >3 (OR 2.10, CI 1.10-4.46, P = 0.05).
CONCLUSIONS: Octogenarians presenting with complicated diverticulitis requiring an emergent Hartmann's procedure have a higher mortality rate compared to those <80, even after controlling for baseline comorbidities.
STUDY TYPE: This is a retrospective, descriptive study.},
}
@article {pmid29225879,
year = {2017},
author = {Peacock, J and Perkins, Z},
title = {Change in bowel habit, abdominal pain, and a palpable abdominal mass in a 58-year-old female.},
journal = {Clinical case reports},
volume = {5},
number = {12},
pages = {2155-2157},
pmid = {29225879},
issn = {2050-0904},
abstract = {Giant colonic diverticulum is a rare complication of diverticulosis, which may present in the acute or chronic setting. Colonic resection and en bloc resection of the diverticulum are the favored management, however, conservative treatment remains an option that could be considered in asymptomatic patients with minimal symptoms.},
}
@article {pmid29216685,
year = {2018},
author = {Gauci, C and Lendzion, R and Phan-Thien, KC and King, D and Perera, DS},
title = {Patient compliance with surveillance colonoscopy: patient factors and the use of a graded recall system.},
journal = {ANZ journal of surgery},
volume = {88},
number = {4},
pages = {311-315},
doi = {10.1111/ans.14296},
pmid = {29216685},
issn = {1445-2197},
mesh = {Aged ; Australia ; *Colonoscopy ; Colorectal Neoplasms/*diagnosis ; Early Detection of Cancer ; Female ; Humans ; Male ; *Patient Compliance ; *Population Surveillance ; *Reminder Systems ; Retrospective Studies ; Time Factors ; },
abstract = {BACKGROUND: Surveillance colonoscopy allows for the early detection and improved treatment outcomes in colorectal neoplasms but compliance rates and factors require further investigation.
METHODS: This is a retrospective cohort study examining 816 patients recalled for surveillance colonoscopy at an Australian colorectal practice over a 6-month period. Primary outcome was compliance with colonoscopy within 12 months of recall. The secondary outcome of this study was to identify factors affecting compliance including patient factors and the practices' graded recall system.
RESULTS: A total of 715 patients (87.6%) were compliant with recall requests for repeat colonoscopy. Significantly higher compliance rates were noted with a personal history of adenomatous polyps (90.9% versus 85.6%, P = 0.025). Those with private insurance or Department of Veterans Affairs were more likely to be compliant than those publicly funded (89.0% versus 93.3% versus 79.0%, P = 0.007). No statistically significant difference in compliance was shown with a personal history of colorectal cancer, diverticular disease, perianal disease, National Health and Medical Research Council risk category, gender, time associated with the practice or the clinician. There was a significant positive correlation between the number of letters sent and compliance with recall, with 61.8% being compliant after a single letter, and a final cumulative compliance after five letters of 87.6% (R = 0.882, P = 0.048).
CONCLUSION: A graded recall system can achieve compliance rates as high as 87.6% compared to a single letter only achieving 61.8% compliance. A history of adenomatous polyps and insurance status were the only factors shown to result in higher recall compliance.},
}
@article {pmid29215477,
year = {2018},
author = {Coakley, KM and Kasten, KR and Sims, SM and Prasad, T and Heniford, BT and Davis, BR},
title = {Prophylactic Ureteral Catheters for Colectomy: A National Surgical Quality Improvement Program-Based Analysis.},
journal = {Diseases of the colon and rectum},
volume = {61},
number = {1},
pages = {84-88},
doi = {10.1097/DCR.0000000000000976},
pmid = {29215477},
issn = {1530-0358},
mesh = {Aged ; Colectomy/*adverse effects ; Colonic Diseases/*surgery ; Humans ; Iatrogenic Disease/prevention & control ; Middle Aged ; Postoperative Complications/prevention & control ; Quality Improvement ; Retrospective Studies ; Ureter/*injuries ; Ureteral Diseases/etiology/*prevention & control ; *Urinary Catheters ; },
abstract = {BACKGROUND: Despite improvement in technique and technology, using prophylactic ureteral catheters to avoid iatrogenic ureteral injury during colectomy remains controversial.
OBJECTIVE: The aim of this study was to evaluate outcomes and costs attributable to prophylactic ureteral catheters with colectomy.
DESIGN: This was a retrospective study.
SETTINGS: The study was conducted at a single tertiary care center.
PATIENTS: The colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2014 was queried.
MAIN OUTCOME MEASURES: The primary end point was the rate of 30-day ureteral injury after colectomy. Univariate and multivariate analyses determined factors associated with ureteral injury and urinary tract infection in patients undergoing colectomy.
RESULTS: A total of 51,125 patients were identified with a mean age of 60.9 ± 14.9 years and a BMI of 28.4 ± 6.7 k/m; 4.90% (n = 2486) of colectomies were performed with prophylactic catheters, and 333 ureteral injuries (0.65%) were identified. Prophylactic ureteral catheters were most commonly used for diverticular disease (42.2%; n = 1048), with injury occurring most often during colectomy for diverticular disease (36.0%; n = 120). Univariate analysis of outcomes demonstrated higher rates of ileus, wound infection, urinary tract infection, urinary tract infection as reason for readmission, superficial site infection, and 30-day readmission in patients with prophylactic ureteral catheter placement. On multivariate analysis, prophylactic ureteral catheter placement was associated with a lower rate of ureteral injury (OR = 0.45 (95% CI, 0.25-0.81)).
LIMITATIONS: This was a retrospective study using a clinical data set.
CONCLUSIONS: Here, prophylactic ureteral catheters were used in 4.9% of colectomies and most commonly for diverticulitis. On multivariate analysis, prophylactic catheter placement was associated with a lower rate of ureteral injury. Additional research is needed to delineate patient populations most likely to benefit from prophylactic ureteral stent placement. See Video Abstract at http://links.lww.com/DCR/A482.},
}
@article {pmid29214364,
year = {2018},
author = {Bertelson, NL and Abcarian, H and Kalkbrenner, KA and Blumetti, J and Harrison, JL and Chaudhry, V and Young-Fadok, TM},
title = {Diverticular colovesical fistula: What should we really be doing?.},
journal = {Techniques in coloproctology},
volume = {22},
number = {1},
pages = {31-36},
pmid = {29214364},
issn = {1128-045X},
support = {None//None/International ; },
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/etiology/*surgery ; Diverticular Diseases/*complications ; Enzyme Inhibitors/administration & dosage ; Female ; Humans ; Intestinal Fistula/etiology/*surgery ; Intraoperative Care/methods ; Laparoscopy/*methods ; Length of Stay ; Male ; Methylene Blue/administration & dosage ; Middle Aged ; Treatment Outcome ; Urinary Bladder/surgery ; Urinary Bladder Fistula/*surgery ; Urinary Catheterization/methods ; },
abstract = {BACKGROUND: Colovesical fistula secondary to diverticular disease is increasing in incidence. Presentation and severity may differ, but a common management strategy may be applied. The aim of this study is to evaluate the characteristics and perioperative management of patients with colovesical fistulae and determine optimal management.
METHODS: From 2003 to 2012, all charts of surgical patients with diverticular colovesical fistulae at two different institutions were reviewed. Patient and presentation characteristics and perioperative management and outcomes were recorded. Patient groups with early and late catheter removal (< 8 and ≥ 8 days) were compared with significance level set at p < 0.05.
RESULTS: Seventy-eight patient charts were reviewed. The mean duration of symptoms was 7.5 months. Laparoscopic assisted surgery was carried out in 35% of patients. Complex bladder repair was performed in 27%. Mean length of stay was 8 days. Mean urinary catheter duration was 13 days. Seventy percent of patients underwent postoperative cystogram, with 4% positive for extravasation. Patients with early catheter removal were significantly older, more likely to have received intraoperative methylene blue instillation, and less likely to have had a complex bladder repair (p < 0.05). Complication rate, length of stay, postoperative cystography, and stent use were similar for both catheter removal groups.
CONCLUSIONS: Intraoperative methylene blue bladder instillation should be utilized to limit unnecessary bladder repairs. In the setting of negative methylene blue extravasation, surgeons may confidently remove urinary catheters in 7 days or less, in some cases as early as 48 h. In complex bladder repairs, cystogram is still an important adjunct, with those patients with negative studies benefiting from catheter removal at 7 days or less.},
}
@article {pmid29178125,
year = {2017},
author = {Abraha, I and Binda, GA and Montedori, A and Arezzo, A and Cirocchi, R},
title = {Laparoscopic versus open resection for sigmoid diverticulitis.},
journal = {The Cochrane database of systematic reviews},
volume = {11},
number = {11},
pages = {CD009277},
pmid = {29178125},
issn = {1469-493X},
mesh = {Acute Disease ; Aged ; Diverticulitis/*surgery ; Female ; Humans ; Laparoscopy/adverse effects/*methods/mortality ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/epidemiology/mortality ; Quality of Life ; Randomized Controlled Trials as Topic ; Reoperation/statistics & numerical data ; Sigmoid Diseases/*surgery ; },
abstract = {BACKGROUND: Diverticular disease is a common condition in Western industrialised countries. Most individuals remain asymptomatic throughout life; however, 25% experience acute diverticulitis. The standard treatment for acute diverticulitis is open surgery. Laparoscopic surgery - a minimal-access procedure - offers an alternative approach to open surgery, as it is characterised by reduced operative stress that may translate into shorter hospitalisation and more rapid recovery, as well as improved quality of life.
OBJECTIVES: To evaluate the effectiveness of laparoscopic surgical resection compared with open surgical resection for individuals with acute sigmoid diverticulitis.
SEARCH METHODS: We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 2) in the Cochrane Library; Ovid MEDLINE (1946 to 23 February 2017); Ovid Embase (1974 to 23 February 2017); clinicaltrials.gov (February 2017); and the World Health Organization (WHO) International Clinical Trials Registry (February 2017). We reviewed the bibliographies of identified trials to search for additional studies.
SELECTION CRITERIA: We included randomised controlled trials comparing elective or emergency laparoscopic sigmoid resection versus open surgical resection for acute sigmoid diverticulitis.
DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed the domains of risk of bias from each included trial, and extracted data. For dichotomous outcomes, we calculated risk ratios (RRs) with 95% confidence intervals (CIs). For continuous outcomes, we planned to calculate mean differences (MDs) with 95% CIs for outcomes such as hospital stay, and standardised mean differences (SMDs) with 95% CIs for quality of life and global rating scales, if researchers used different scales.
MAIN RESULTS: Three trials with 392 participants met the inclusion criteria. Studies were conducted in three European countries (Switzerland, Netherlands, and Germany). The median age of participants ranged from 62 to 66 years; 53% to 64% were female. Inclusion criteria differed among studies. One trial included participants with Hinchey I characteristics as well as those who underwent Hartmann's procedure; the second trial included only participants with "a proven stage II/III disease according to the classification of Stock and Hansen"; the third trial considered for inclusion patients with "diverticular disease of sigmoid colon documented by colonoscopy and 2 episodes of uncomplicated diverticulitis, one at least being documented with CT scan, 1 episode of complicated diverticulitis, with a pericolic abscess (Hinchey stage I) or pelvic abscess (Hinchey stage II) requiring percutaneous drainage."We determined that two studies were at low risk of selection bias; two that reported considerable dropouts were at high risk of attrition bias; none reported blinding of outcome assessors (unclear detection bias); and all were exposed to performance bias owing to the nature of the intervention.Available low-quality evidence suggests that laparoscopic surgical resection may lead to little or no difference in mean hospital stay compared with open surgical resection (3 studies, 360 participants; MD -0.62 (days), 95% CI -2.49 to 1.25; I² = 0%).Low-quality evidence suggests that operating time was longer in the laparoscopic surgery group than in the open surgery group (3 studies, 360 participants; MD 49.28 (minutes), 95% CI 40.64 to 57.93; I² = 0%).We are uncertain whether laparoscopic surgery improves postoperative pain between day 1 and day 3 more effectively than open surgery. Low-quality evidence suggests that laparoscopic surgery may improve postoperative pain at the fourth postoperative day more effectively than open surgery (2 studies, 250 participants; MD = -0.65, 95% CI -1.04 to -0.25).Researchers reported quality of life differently across trials, hindering the possibility of meta-analysis. Low-quality evidence from one trial using the Short Form (SF)-36 questionnaire six weeks after surgery suggests that laparoscopic intervention may improve quality of life, whereas evidence from two other trials using the European Organization for Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30) v3 and the Gastrointestinal Quality of Life Index score, respectively, suggests that laparoscopic surgery may make little or no difference in improving quality of life compared with open surgery.We are uncertain whether laparoscopic surgery improves the following outcomes: 30-day postoperative mortality, early overall morbidity, major and minor complications, surgical complications, postoperative times to liquid and solid diets, and reoperations due to anastomotic leak.
AUTHORS' CONCLUSIONS: Results from the present comprehensive review indicate that evidence to support or refute the safety and effectiveness of laparoscopic surgery versus open surgical resection for treatment of patients with acute diverticular disease is insufficient. Well-designed trials with adequate sample size are needed to investigate the efficacy of laparoscopic surgery towards important patient-oriented (e.g. postoperative pain) and health system-oriented outcomes (e.g. mean hospital stay).},
}
@article {pmid29154517,
year = {2018},
author = {Manzenreiter, L and Spaun, G and Weitzendorfer, M and Luketina, R and Antoniou, SA and Wundsam, H and Koch, OO and Emmanuel, K},
title = {A proposal for a tailored approach to diverting ostomy for colorectal anastomosis.},
journal = {Minerva chirurgica},
volume = {73},
number = {1},
pages = {29-35},
doi = {10.23736/S0026-4733.17.07486-7},
pmid = {29154517},
issn = {1827-1626},
mesh = {Acute Kidney Injury/epidemiology/etiology/prevention & control ; Adenocarcinoma/drug therapy/secondary/surgery ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Anastomotic Leak/epidemiology/prevention & control ; Chemotherapy, Adjuvant ; Colon/*surgery ; Colonic Diseases/surgery ; Colorectal Neoplasms/drug therapy/surgery ; Colostomy/*methods ; Combined Modality Therapy ; Diverticulosis, Colonic/surgery ; Emergencies ; Female ; Humans ; Ileostomy/*methods ; Male ; Middle Aged ; Postoperative Complications/epidemiology/prevention & control ; Rectum/*surgery ; Retrospective Studies ; Surgical Stomas ; Water-Electrolyte Imbalance/epidemiology/etiology/prevention & control ; },
abstract = {BACKGROUND: The use of a protective stoma represents an important issue in colorectal surgery. Although evidence suggests that loop ileostomy may be superior, the optimal method for temporary decompression of colorectal anastomosis still remains controversial. Aim of this study was to make an evidence-based proposal for a tailored approach to the use of diverting colostomy or ileostomy.
METHODS: A retrospective analysis of all patients subjected to creation and closure of a diverting loop colostomy or loop ileostomy between May 2007 and November 2014 in our institution was performed. Early and late complications, mortality and morbidity, time between formation and closure of the stoma in respect to adjuvant chemotherapy and the length of hospital stay were assessed and compared between the two groups.
RESULTS: Outcomes of 167 patients (m=95; f=72) undergoing a loop colostomy (N.=130) or ileostomy (N.=37) were analyzed. The most frequent diagnosis was malignancy (64.1%), followed by abdominal emergency operations (18.6%) and complicated diverticular disease (17.4%). There was no mortality. Adjuvant chemotherapy (26.3%) resulted in delayed stoma reversal (P<0.001). Complications following construction of the stoma such as electrolyte disorder (P<0.001), renal insufficiency (P=0.048), and skin irritation (P=0.003) occurred significantly more often within the ileostomy group. Within the colostomy group, the rate of stoma prolapse (P=0.074) tended to be higher.
CONCLUSIONS: Both methods have advantages and disadvantages. Loop transverse colostomy could be the preferred technique for older patients to avoid electrolyte disorder and renal insufficiency. Further prospective trials with documentation of electrolyte metabolism and quality of life should follow.},
}
@article {pmid29153979,
year = {2018},
author = {Benlice, C and Delaney, CP and Liska, D and Hrabe, J and Steele, S and Gorgun, E},
title = {Individual surgeon practice is the most important factor influencing diverting loop ileostomy creation for patients undergoing sigmoid colectomy for diverticulitis.},
journal = {American journal of surgery},
volume = {215},
number = {3},
pages = {442-445},
doi = {10.1016/j.amjsurg.2017.10.046},
pmid = {29153979},
issn = {1879-1883},
mesh = {Aged ; *Colectomy ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Ileostomy/*statistics & numerical data ; Logistic Models ; Male ; Middle Aged ; Practice Patterns, Physicians'/*statistics & numerical data ; Procedures and Techniques Utilization/*statistics & numerical data ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: To identify factors associated with diverting ileostomy creation (DLI) in patients undergoing sigmoid colectomy for diverticular disease in a high volume colorectal unit and to obtain information for better preoperative patient counseling.
METHODS: Patients who underwent sigmoid colectomy with colorectal anastomosis with or without DLI for diverticulitis between 01/1994-12/2014 were identified. Preoperative characteristics, surgeon practice year, individual surgeon and postoperative outcomes were compared between patients with DLI or not.
RESULTS: 1320 patients were identified and DLI was created in 204 (15.4%) patients. DLI creation was associated with older age (p < 0.001), female gender (p = 0.01), higher ASA-class (p < 0.001), hypertension (p = 0.01), DM(p < 0.001), renal comorbidities (p < 0.001), preoperative steroid use (p = 0.03), preoperative anemia (p = 0.004), and open surgery (p < 0.001). While ileostomy creation rates did not vary over the years during the study period or with increased surgeons' experience, surgeon identity had significant impact on ileostomy creation (Rate range 6.8-60.7%, p < 0.001). Multivariate logistic regression analysis revealed that individual surgeon, open approach, preoperative steroid use, and disease-related factors remained independently associated with DLI creation.
CONCLUSION: Individual surgeon's practice affects the rate of diverting ileostomy creation in patients undergoing sigmoid colectomy for diverticular disease.},
}
@article {pmid29143906,
year = {2018},
author = {Tang, ES and Robertson, DI and Whitehead, M and Xu, J and Hall, SF},
title = {Surgery for diverticular disease results in a higher hernia rate compared to colorectal cancer: a population-based study from Ontario, Canada.},
journal = {Hernia : the journal of hernias and abdominal wall surgery},
volume = {22},
number = {4},
pages = {603-609},
pmid = {29143906},
issn = {1248-9204},
mesh = {Aged ; Colectomy/*adverse effects ; Colorectal Neoplasms/*surgery ; Diverticular Diseases/*surgery ; Female ; Hernia, Ventral/*epidemiology/etiology ; Herniorrhaphy ; Humans ; Incidence ; Incisional Hernia/*epidemiology/etiology ; Male ; Middle Aged ; Ontario/epidemiology ; Registries ; Retrospective Studies ; Risk Factors ; Surgical Wound Dehiscence/etiology ; },
abstract = {BACKGROUND: Incisional hernias are a well described complication of abdominal surgery. Previous studies identified malignancy and diverticular disease as risk factors. We compared incisional hernia rates between colon resection for colorectal cancer (CRC) and diverticular disease (DD).
STUDY DESIGN: We performed a retrospective, population-based, matched cohort study. Provincial databases were linked through the Institute for Clinical Evaluative Sciences. These databases include all patients registered under the universal Ontario Health Insurance Plan. Patients aged 18-105 undergoing open colon resection, without ostomy formation between April 1, 2002 and March 31, 2009, were included. We excluded those with previous surgery, hernia, obstruction, and perforation. The primary outcomes were surgery for hernia repair, or diagnosis of hernia in clinic.
RESULTS: We identified 4660 cases of DD. These were matched 2:1 by age and gender to 8933 patients with CRC for a total of 13,593. At 5 years, incisional hernias occurred in 8.3% of patients in the CRC cohort, versus 13.1% of those undergoing surgery for DD. After adjusting for important confounders (comorbidity score, wound infection, age, diabetes, prednisone and chemotherapy), hernias were still more likely in patients with DD [HR 1.58, 95% Confidence Interval (CI) 1.43-1.76, P < 0.001]. The only significant covariate was wound infection (HR 1.63, 95% CI 1.43-1.87, P < 0.001).
CONCLUSION: Our study found that incisional hernias occur more commonly in patients with DD than CRC.},
}
@article {pmid29132526,
year = {2017},
author = {Sinclair, A},
title = {Diverticular Disease of the Gastrointestinal Tract.},
journal = {Primary care},
volume = {44},
number = {4},
pages = {643-654},
doi = {10.1016/j.pop.2017.07.007},
pmid = {29132526},
issn = {1558-299X},
mesh = {Anti-Bacterial Agents/therapeutic use ; Colectomy/methods ; Diverticular Diseases/complications/*diagnosis/*pathology/therapy ; Drainage/methods ; Endoscopy, Gastrointestinal/methods ; Esophageal Diseases/diagnosis/pathology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Diseases/diagnosis/pathology ; Primary Health Care ; Stomach Diseases/diagnosis/pathology ; },
abstract = {Almost all gastrointestinal tract diverticula require no intervention if they are asymptomatic. There is no clear diagnostic modality of choice for diagnosis and surveillance of diverticulum. Medical treatment should be attempted before surgical intervention because significant morbidity is may be associated with resection.},
}
@article {pmid29131764,
year = {2017},
author = {Shaaban, AM and Rezvani, M and Olpin, JD and Kennedy, AM and Gaballah, AH and Foster, BR and Menias, CO and Elsayes, KM},
title = {Nongynecologic Findings Seen at Pelvic US.},
journal = {Radiographics : a review publication of the Radiological Society of North America, Inc},
volume = {37},
number = {7},
pages = {2045-2062},
doi = {10.1148/rg.2017170083},
pmid = {29131764},
issn = {1527-1323},
mesh = {Diagnosis, Differential ; Digestive System Diseases/*diagnostic imaging ; Female ; Humans ; Pelvic Pain/*diagnostic imaging ; Ultrasonography/*methods ; Urologic Diseases/*diagnostic imaging ; },
abstract = {Ultrasonography (US) is frequently the first imaging modality used to examine women with symptoms involving the pelvis. It is widely available and involves no exposure to ionizing radiation. Images can be acquired with a transabdominal, endovaginal, or translabial approach, and the use of video clips and three-dimensional reconstructions can be helpful. US is excellent for assessment of the uterus, ovaries, and adnexa. Occasionally, nongynecologic pelvic diseases arising from the gastrointestinal, genitourinary, and musculoskeletal systems and the pelvic peritoneal and extraperitoneal spaces may be detected and can be a source of diagnostic dilemma. US can be helpful not only in the detection but also occasionally in the characterization of such entities. Computed tomography and magnetic resonance imaging are useful in complicated cases. In this article, the normal US appearance of the bowel and US signs of bowel disease and specific entities, including appendicitis, diverticular disease, bowel obstruction, appendiceal mucocele, and intestinal tumors, are reviewed. The lower urinary tract is included in the field of view in every pelvic US examination; commonly encountered entities related to the urinary bladder, distal ureter, and urethra are illustrated. In addition to arising in the gastrointestinal and genitourinary tracts, pathologic conditions in the pelvis can arise in the peritoneal or extraperitoneal space. Although conditions of the pelvic peritoneal and extraperitoneal spaces are rare, it is important to recognize these entities and distinguish them from the more common gynecologic diseases. Owing to the implications for diagnosis and management, radiologists and other physicians who perform pelvic US should be aware of the spectrum of nongynecologic pathologic entities that can be detected. [©]RSNA, 2017.},
}
@article {pmid29118468,
year = {2017},
author = {Pagliari, D and Gambassi, G and Piccirillo, CA and Cianci, R},
title = {The Intricate Link among Gut "Immunological Niche," Microbiota, and Xenobiotics in Intestinal Pathology.},
journal = {Mediators of inflammation},
volume = {2017},
number = {},
pages = {8390595},
pmid = {29118468},
issn = {1466-1861},
mesh = {Animals ; Humans ; Inflammatory Bowel Diseases/*drug therapy/microbiology ; Intestinal Mucosa/*metabolism ; Intestines/drug effects/*microbiology ; Microbiota/*physiology ; Xenobiotics/*therapeutic use ; },
abstract = {Inflammatory bowel diseases (IBDs) are diseases characterized by various degrees of inflammation involving the gastrointestinal tract. Ulcerative colitis and Crohn's disease are characterized by a dysregulated immune response leading to structural gut alterations in genetically predisposed individuals. Diverticular disease is characterized by abnormal immune response to normal gut microbiota. IBDs are linked to a lack of physiological tolerance of the mucosal immune system to resident gut microbiota and pathogens. The disruption of immune tolerance involves inflammatory pathways characterized by an unbalance between the anti-inflammatory regulatory T cells and the proinflammatory Th1/Th17 cells. The interaction among T cell subpopulations and their related cytokines, mediators of inflammation, gut microbiota, and the intestinal mucosa constitute the gut "immunological niche." Several evidences have shown that xenobiotics, such as rifaximin, can positively modulate the inflammatory pathways at the site of gut immunological niche, acting as anti-inflammatory agents. Xenobiotics may interfere with components of the immunological niche, leading to activation of anti-inflammatory pathways and inhibition of several mediators of inflammation. In summary, xenobiotics may reduce disease-related gut mucosal alterations and clinical symptoms. Studying the complex interplay between gut immunological niche and xenobiotics will certainly open new horizons in the knowledge and therapy of intestinal pathologies.},
}
@article {pmid29103536,
year = {2017},
author = {Choi, EK and Appelman, HD},
title = {Chronic Colitis in Biopsy Samples: Is It Inflammatory Bowel Disease or Something Else?.},
journal = {Surgical pathology clinics},
volume = {10},
number = {4},
pages = {841-861},
doi = {10.1016/j.path.2017.07.005},
pmid = {29103536},
issn = {1875-9157},
mesh = {Chronic Disease ; Colitis/diagnosis/*pathology ; Colitis, Ulcerative/diagnosis/pathology ; Colon/pathology ; Crohn Disease/diagnosis/pathology ; Diagnosis, Differential ; Humans ; Inflammatory Bowel Diseases/diagnosis/*pathology ; },
abstract = {Chronic colitis, regardless of type, is defined histologically by chronic inflammation, mainly plasmacytosis, in the lamina propria. Specific diagnosis of chronic colitides in biopsies can be challenging for practicing pathologists. This article focuses on discussing specific histologic features in biopsies of the inflammatory bowel diseases (IBDs), including ulcerative colitis, Crohn colitis, and colitis of indeterminate type. It also offers suggestions as to how to separate the IBDs from other chronic colitides, such as lymphocytic colitis, collagenous colitis, diverticular disease-associated colitis, diversion colitis, and chronic colitides that are due to drugs. Normal histology in colon biopsies is also briefly discussed.},
}
@article {pmid29101918,
year = {2017},
author = {McSweeney, W and Srinath, H},
title = {Diverticular disease practice points.},
journal = {Australian family physician},
volume = {46},
number = {11},
pages = {829-832},
pmid = {29101918},
issn = {0300-8495},
mesh = {Anti-Bacterial Agents/pharmacology/therapeutic use ; Australia ; Colonoscopy/methods ; Diet Therapy/methods ; Diverticular Diseases/*diagnosis/*physiopathology/*therapy ; Humans ; },
abstract = {BACKGROUND: Diverticular disease and its spectrum of complications are increasingly encountered in the Australian population. Accurate management of patients before and after an acute episode entails extension beyond the acute event to include dietary advice and colonoscopy.
OBJECTIVE: The objectives of this article are to evaluate the literature regarding dietary factors and diverticular disease, routine colonoscopy and antibiotic treatment in acute diverticulitis, to enable primary care physicians to manage patients and provide sound advice after hospital admission.
DISCUSSION: Diverticulitis can often be managed in the community by general practitioners, but the necessity of antibiotics may not be definitive. When patients do require hospital admission, advice and management of patient lifestyle factors after admission, and investigations to rule out red flags are crucial. These elements of patient management are the subject of debate, as it appears that standard dietary advice does not alter a patient's clinical course, and colonoscopy is not always necessary and should be used judiciously.},
}
@article {pmid29100862,
year = {2017},
author = {Mark-Christensen, A and Lindholt, JS and Diederichsen, A and Steffensen, FH and Busk, M and Frost, L and Urbonaviciene, G and Lambrechtsen, J and Egstrup, K and Laurberg, S},
title = {Association Between Diverticular Disease and Abdominal Aortic Aneurysms: Pooled Analysis of Two Population Based Screening Cohorts.},
journal = {European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery},
volume = {54},
number = {6},
pages = {772-777},
doi = {10.1016/j.ejvs.2017.10.005},
pmid = {29100862},
issn = {1532-2165},
mesh = {Aged ; Aortic Aneurysm, Abdominal/*complications/*diagnosis ; Cohort Studies ; Cross-Sectional Studies ; Denmark ; Diverticular Diseases/*complications/*diagnosis ; Female ; Humans ; Male ; Mass Screening ; Middle Aged ; Risk Factors ; },
abstract = {BACKGROUND: The aetiology of abdominal aortic aneurysms (AAA) is multifactorial, and many risk factors are shared with diverticular disease. It is unknown whether an independent association exists between these conditions.
METHODS: Individuals enrolled in two Danish population based randomised AAA screening trials and assigned to cross sectional screening and evaluation of cardiovascular risk factors were identified. Diagnoses of diverticular disease were interrogated from a national patient registry covering the period from 1977 to the screening date. Adjusted odds ratios (aOR) and hazard ratios (aHR) with 95% CI were calculated as risk measures.
RESULTS: 24,632 individuals (median age, 69 years) were included. At screening, 687 patients had pre-existing diverticular disease. Patients with diverticular disease were more likely to have AAA at screening compared with those without diverticular disease (5.2% vs. 3.3%) (OR 1.61, 95% CI 1.14-2.27). This association persisted after adjusting for potential confounders (aOR 1.49, 95% CI 1.04-2.12) and on sensitivity analyses. The association was most pronounced for those with a diagnosis of diverticular disease for at least 10 years (aOR 2.56, 95% CI 1.49-4.38). Following screening, 6.2% of patients with diverticular disease and AAA experienced aneurysm rupture, compared with 2.2% of patients with AAA without diverticular disease (aHR 4.1, 95% CI 1.6-10.8).
CONCLUSION: An association was found between diverticular disease and AAA in a large population based cohort. Biological causality remains to be established, and a potential impact of diverticular disease on the natural history of AAA needs to be explored further.},
}
@article {pmid29098095,
year = {2017},
author = {Espinosa, J and Sharma, R and Lucerna, A and Stranges, D},
title = {Medical Approach to Right Colon Diverticulitis with Perforation.},
journal = {Case reports in emergency medicine},
volume = {2017},
number = {},
pages = {2563218},
pmid = {29098095},
issn = {2090-648X},
abstract = {We report a case of a 71-year-old female who presented with right lower quadrant (RLQ) abdominal pain and was diagnosed on CT scan with right-sided diverticulitis with perforation. She was admitted under the surgical service after consultation and received intravenous fluids, intravenous antibiotics, and pain medications as needed. The patient was discharged 2 days after admission in stable condition with follow-up with gastroenterology. The differential diagnosis of right lower quadrant abdominal pain is vast. Right-sided diverticulitis often presents in a manner similar to appendicitis. In the absence of peritonitis, conservative treatment may be possible. It is predictable that as the population ages, the incidence of right-sided diverticular disease will increase and will result in more presentations of acute right-sided diverticulitis to the emergency department (ED). The aim of this case report is to increase awareness of the incidence, pathophysiology, presentation, work-up (laboratory studies and imaging), and management (medical and surgical) of right-sided diverticulitis among emergency physicians.},
}
@article {pmid29093588,
year = {2017},
author = {López Marcano, AJ and Ramia, JM and De la Plaza Llamas, R and Alonso, S and Gonzales Aguilar, JD and Kühnhardt Barrantes, AW},
title = {[Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review].},
journal = {Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru},
volume = {37},
number = {3},
pages = {240-245},
pmid = {29093588},
issn = {1609-722X},
mesh = {Aged ; Aged, 80 and over ; Diverticulitis/*complications/diagnosis/surgery ; Female ; Follow-Up Studies ; Humans ; Ileal Diseases/*complications/diagnosis/surgery ; Jejunal Diseases/*complications/diagnosis/surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; },
abstract = {OBJECTIVE: To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015.
MATERIALS AND METHODS: We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT.
RESULTS: In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1).
CONCLUSIONS: Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice.},
}
@article {pmid29089694,
year = {2017},
author = {Kurumboor, P and Kamalesh, NP and Pramil, K and George, D and Shetty, R and Ponnambathayil, S and Aikot, S},
title = {Laparoscopic Management of Colonic Diverticular Disease and its Complications: an Analysis.},
journal = {The Indian journal of surgery},
volume = {79},
number = {5},
pages = {380-383},
pmid = {29089694},
issn = {0972-2068},
abstract = {Dense inflammatory reactions, loss of tissue planes and sepsis make surgical treatment of diverticulitis complex and difficult. Experience with laparoscopic management of this disease is scanty in our country. This study aims to assess the pattern of presentation, the site of involvement and complications of diverticulitis coli. This study also aims to audit the results of laparoscopic approach for complicated colonic diverticulitis. A retrospective analysis of all patients who had laparoscopic management of complicated diverticulitis patients from August 2007 to October 2014 was done from the database. The site of involvement, extent and presence or absence of complications of diverticular disease was noted. The surgical approach, intraoperative parameters and short-term outcome measures were analysed. There were 38 (8.8 %) patients with diverticular disease out of 427 patients who had laparoscopic colorectal surgery in the study period with a median age of 59 years. Out of 38 patients, 50 % had comorbid conditions. Internal fistulae were seen in 9 (23.6 %) patients, 6 with colovesical and 3 with colovaginal fistulae. Elective laparoscopic colectomy with primary anastomosis was done in 34 (89 %) cases of which, and 10 (26 %) patients had abscess on presentation requiring drainage. Four patients required emergency laparoscopic surgery of which primary resection and anastomosis was done in 3 (7.8 %), and Hartmann's operation was done in 1 (2.6 %) patient. Two patients required stoma. The morbidity was seen in 15 % cases, and the mean hospital stay was 9.54 days. Laparoscopic approach for diverticular disease and its complication is feasible and safe. Careful selection of patients, judicious use of diverting stoma and appropriate selection of the procedure help to achieve good results even in those with septic complications and fistulising disease.},
}
@article {pmid29084074,
year = {2018},
author = {Kvasnovsky, CL and Leong, LEX and Choo, JM and Abell, GCJ and Papagrigoriadis, S and Bruce, KD and Rogers, GB},
title = {Clinical and symptom scores are significantly correlated with fecal microbiota features in patients with symptomatic uncomplicated diverticular disease: a pilot study.},
journal = {European journal of gastroenterology & hepatology},
volume = {30},
number = {1},
pages = {107-112},
doi = {10.1097/MEG.0000000000000995},
pmid = {29084074},
issn = {1473-5687},
mesh = {Abdominal Pain/microbiology ; Aged ; Aged, 80 and over ; Bacteria/classification/genetics/*isolation & purification ; Colon/*microbiology ; Diverticulitis, Colonic/complications/diagnosis/*microbiology ; Feces/*microbiology ; Female ; *Gastrointestinal Microbiome ; Humans ; Male ; Middle Aged ; Pain Measurement ; Pilot Projects ; Prognosis ; Ribotyping ; Risk Factors ; Severity of Illness Index ; },
abstract = {BACKGROUND: There is growing consensus that symptomatic uncomplicated diverticular disease is a chronic inflammatory condition, and that alterations in the fecal microbiota may contribute to its pathogenesis.
OBJECTIVE: The aim of this study was to relate the fecal microbiota composition in symptomatic uncomplicated diverticular disease to measures of inflammation, symptoms, and history of previous acute diverticulitis.
PARTICIPANTS AND METHODS: Fecal microbiota composition in 28 individuals with symptomatic uncomplicated diverticular disease was characterized by 16S RNA gene amplicon sequencing. Microbiota composition was related to clinical history, symptom and inflammation measures, and demographic variables.
RESULTS: Previous acute diverticulitis was associated with higher relative abundance of Pseudobutyrivibrio, Bifidobacterium, Christensenellaceae family, and Mollicutes RF9 order (P=0.004, 0.006, 0.010, and 0.019, respectively), but not microbiota alpha or beta diversity. A higher bloating severity score was significantly correlated with a higher relative abundance of Ruminococcus (P=0.032), and significantly inversely correlated with the relative abundance of the Roseburia (P=0.002). Fecal calprotectin levels were positively correlated with alpha diversity (Shannon index, P=0.005) and the relative abundance of Lactobacillus (P=0.004). Pain score was positively correlated with the relative abundance of Cyanobacterium (adjusted P=0.032).
CONCLUSION: Patient symptoms in symptomatic diverticular disease are significantly correlated with features of the fecal microbiota. Our findings suggest the potential utility of therapies that target intestinal microbiology, such as dietary prebiotic supplements.},
}
@article {pmid29038965,
year = {2017},
author = {Chabok, A and Andreasson, K and Nikberg, M},
title = {Low risk of complications in patients with first-time acute uncomplicated diverticulitis.},
journal = {International journal of colorectal disease},
volume = {32},
number = {12},
pages = {1699-1702},
pmid = {29038965},
issn = {1432-1262},
mesh = {Acute Disease ; Aged ; Anti-Bacterial Agents/therapeutic use ; Chi-Square Distribution ; Disease Progression ; Diverticulitis, Colonic/*complications/diagnostic imaging/drug therapy ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Sweden ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {PURPOSE: First-time acute uncomplicated diverticulitis (AUD) has been considered to have an increased risk of complication, but the level of evidence is low. The aim of the present study was to evaluate the risk of complications in patients with first-time AUD and in patients with a history of diverticulitis.
METHODS: This paper is a population-based retrospective study at Västmanland's Hospital, Västerås, Sweden, where all patients were identified with a diagnosis of colonic diverticular disease ICD-10 K57.0-9 from January 2010 to December 2014. The records of all patients were surveyed and patients with a computed tomography (CT)-verified AUD were included. Complications defined as CT-verified abscess, perforation, colonic obstruction, fistula, or sepsis within 1 month from the diagnosis of AUD were registered.
RESULTS: Of 809 patients with AUD, 642 (79%) had first-time AUD and 167 (21%) had a previous history of AUD with no differences in demographic or clinical characteristics. In total, 16 (2%) patients developed a complication within 1 month irrespective of whether they had a previous history of diverticulitis (P = 0.345). In the binary logistic regression analysis, first-time diverticulitis was not associated with increased risk of complications (OR 1.58; CI 0.52-4.81). The rate of antibiotic therapy was about 7-10% during the time period and outpatient management increased from 7% in 2010 to 61% in 2014.
CONCLUSIONS: The risk for development of complications is low in AUD with no difference between patients with first-time or recurrent diverticulitis. This result strengthens existing evidence on the benign disease course of AUD.},
}
@article {pmid29030789,
year = {2017},
author = {Ross, E and McKenna, P and Anderson, JH},
title = {Foreign bodies in sigmoid colon diverticulosis.},
journal = {Clinical journal of gastroenterology},
volume = {10},
number = {6},
pages = {491-497},
pmid = {29030789},
issn = {1865-7265},
mesh = {Aged ; Aged, 80 and over ; Animals ; Bone and Bones ; Chickens ; Colon, Sigmoid/diagnostic imaging/*surgery ; Colonoscopes ; Colonoscopy ; Computed Tomography Angiography ; Diverticulosis, Colonic/diagnostic imaging/*etiology/*surgery ; Female ; Foreign Bodies/*complications/diagnostic imaging/*surgery ; Gastrointestinal Hemorrhage/diagnostic imaging/etiology/therapy ; Hemostatic Techniques ; Humans ; },
abstract = {This review addresses the management of sigmoid colon diverticular disease associated with foreign bodies. In addition, two novel cases are presented. One case describes the management of diverticular bleeding secondary to a chicken bone and the other case reports retrieval of a retained EndoRings™ Device. The review identified 40 relevant publications including 50 subjects. Foreign bodies within sigmoid diverticular disease may be associated with inflammation, perforation, abscess and fistula. In current practice, diagnosis is often achieved with CT scan. Patients with colonic perforation or fistula generally require colonic resection. Patients with inflammation may merit conservative management, including colonoscopic foreign body retrieval. Chicken bones, tooth picks, and biliary stents have been reported in patients with inflammation, perforation and fistula, whereas all published patients with fish bone related diverticulosis complications experienced inflammation. Treatment might be best guided by the consequences of the foreign body rather than the nature of the underlying retained object. Diverticular bleeding secondary to a chicken bone was diagnosed at CT angiography and treated with colonoscopic snare retrieval of the bone and clipping of the bleeding diverticulum. The EndoRings™ Device was retrieved with a colonoscopic balloon.},
}
@article {pmid29022798,
year = {2017},
author = {Kourounis, G and Lim, QX and Rashid, T and Gurunathan, S},
title = {A rare case of simultaneous pneumoperitoneum and pneumomediastinum with a review of the literature.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {99},
number = {8},
pages = {e241-e243},
pmid = {29022798},
issn = {1478-7083},
mesh = {Accidental Falls ; Aged, 80 and over ; Fatal Outcome ; Humans ; Kidney/injuries ; Male ; *Mediastinal Emphysema/complications/diagnostic imaging/physiopathology ; *Pneumoperitoneum/complications/diagnostic imaging/physiopathology ; },
abstract = {Simultaneous pneumoperitoneum and pneumomediastinum is a rare clinical occurrence. It has been reported in the literature as a complication of various medical and dental procedures. To our knowledge, we present the first case of a non-iatrogenic and traumatic simultaneous pneumoperitoneum and pneumomediastinum in a previously independent 91-year-old man who presented to hospital with back and chest wall pain following mechanical fall from standing. A new radiological diagnosis of diverticular disease with possible perforation was made following admission. Despite appropriate management and supportive measures, the patient died 12 days after admission from a kidney injury.},
}
@article {pmid28973845,
year = {2017},
author = {Carter, F and Alsayb, M and Marshall, JK and Yuan, Y},
title = {Mesalamine (5-ASA) for the prevention of recurrent diverticulitis.},
journal = {The Cochrane database of systematic reviews},
volume = {10},
number = {10},
pages = {CD009839},
pmid = {28973845},
issn = {1469-493X},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/adverse effects/*therapeutic use ; Diverticulitis, Colonic/*prevention & control ; Humans ; Mesalamine/adverse effects/*therapeutic use ; Randomized Controlled Trials as Topic ; *Secondary Prevention ; },
abstract = {BACKGROUND: Diverticular disease is a common condition that increases in prevalence with age. Recent theories on the pathogenesis of diverticular inflammation have implicated chronic inflammation similar to that seen in ulcerative colitis. Mesalamine, or 5-aminosalicylic acid (5-ASA), is a mainstay of therapy for individuals with ulcerative colitis. Accordingly, 5-ASA has been studied for prevention of recurrent diverticulitis.
OBJECTIVES: To evaluate the efficacy of mesalamine (5-ASA) for prevention of recurrent diverticulitis.
SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 8), in the Cochrane Library; Ovid MEDLINE (from 1950 to 9 September 2017); Ovid Embase (from 1974 to 9 September 2017); and two clinical trials registries for ongoing trials - Clinicaltrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform database (9 September 2017).We also searched proceedings from major gastrointestinal conferences - Digestive Disease Week (DDW), United European Gastroenterology Week (UEGW), and the American College of Gastroenterology (ACG) Annual Scientific Meeting - from 2010 to September 2017. In addition, we scanned reference lists from eligible publications, and we contacted corresponding authors to ask about additional trials.
SELECTION CRITERIA: We included randomised controlled clinical trials comparing the efficacy of 5-ASA versus placebo or another active drug for prevention of recurrent diverticulitis.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as defined by Cochrane. Three review authors assessed eligibility for inclusion. Two review authors selected studies, extracted data, and assessed methodological quality independently. We calculated risk ratios (RRs) for prevention of diverticulitis recurrence using an intention-to-treat principle and random-effects models. We assessed heterogeneity using criteria for Chi[2] (P < 0.10) and I[2] tests (> 50%). To explore sources of heterogeneity, we conducted a priori subgroup analyses. To assess the robustness of our results, we carried out sensitivity analyses using different summary statistics (RR vs odds ratio (OR)) and meta-analytical models (fixed-effect vs random-effects).
MAIN RESULTS: We included in this review seven studies with a total of 1805 participants. We judged all seven studies to have unclear or high risk of bias. Investigators found no evidence of an effect when comparing 5-ASA versus control for prevention of recurrent diverticulitis (31.3% vs 29.8%; RR 0.69, 95% confidence interval (CI) 0.43 to 1.09); very low quality of evidence).Five of the seven studies provided data on adverse events of 5-ASA therapy. The most commonly reported side effects were gastrointestinal symptoms (epigastric pain, nausea, and diarrhoea). No significant difference was seen between 5-ASA and control (67.8% vs 64.6%; RR 0.98, 95% CI 0.91 to 1.06; P = 0.63; moderate quality of evidence), nor was significant heterogeneity observed (I[2] = 0%; P = 0.50).
AUTHORS' CONCLUSIONS: The effects of 5-ASA on recurrence of diverticulitis are uncertain owing to the small number of heterogenous trials included in this review. Rates of recurrent diverticulitis were similar among participants using 5-ASA and control participants. Effective medical strategies for prevention of recurrent diverticulitis are needed, and further randomised, double-blinded, placebo-controlled trials of rigorous design are warranted to specify the effects of 5-ASA (mesalamine) in the management of diverticulitis.},
}
@article {pmid28965236,
year = {2017},
author = {Parker, ME and Mathis, KL and Kelley, SR},
title = {Severity of diverticulitis in patients with polycystic kidney disease without transplantation.},
journal = {International journal of colorectal disease},
volume = {32},
number = {12},
pages = {1767-1770},
pmid = {28965236},
issn = {1432-1262},
mesh = {Aged ; Colectomy ; Diverticulitis, Colonic/diagnosis/*etiology/mortality/surgery ; Female ; Humans ; Kidney Transplantation ; Male ; Middle Aged ; Minnesota ; Polycystic Kidney Diseases/*complications/diagnosis/mortality/surgery ; Recurrence ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: Patients with polycystic kidney disease (PKD) who have had a kidney transplant have an increased risk of diverticular disease and complicated diverticulitis. Literature is limited regarding the severity of diverticulitis in patients with PKD who have not had a transplant. We aim to assess whether patients with PKD, with and without renal transplant, have a similar course of diverticulitis.
METHODS: A retrospective review of all adult PKD patients at our institution diagnosed with diverticulitis between 2000 and 2016 was conducted. Patients without documented PKD and diverticulitis were excluded. We compared PKD patients with and without renal transplantation.
RESULTS: A total of 41 patients were identified. Mean age was 60 (± 12), and 56% were female. Fourteen patients had undergone renal transplantation. Five (19%) non-transplant patients had complicated diverticulitis, compared to 43% (n = 6) transplanted (p = 0.33). Fifteen (56%) non-transplant and 8 (57%) transplant patients had recurrent diverticulitis (p = 1.00). Three (11%) non-transplant and 5 (36%) transplanted patients had recurrent complicated diverticulitis. Eight (30%) non-transplant and 7 (50%) transplant patients underwent surgery (p = 0.31). All 8 non-transplant patients underwent sigmoid resection with primary anastomosis without diversion. In the transplant group, 3 Hartmann procedures and 1 sigmoid resection with and 3 without diversion were performed. There was one in-hospital death in each group.
CONCLUSION: In our group of patients, there was no difference in rate of recurrent diverticulitis, diverticulitis complications, or operative intervention in patients with PKD with and without renal transplant. The renal transplant group had a higher rate of recurrent, complicated diverticulitis.},
}
@article {pmid28921825,
year = {2017},
author = {Gorgun, E and Benlice, C},
title = {Robotic sigmoidectomy for chronic complicated diverticular disease - a video vignette.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {19},
number = {11},
pages = {1035},
doi = {10.1111/codi.13890},
pmid = {28921825},
issn = {1463-1318},
mesh = {Aged ; Chronic Disease ; Colectomy/*methods ; Diverticular Diseases/*surgery ; Female ; Humans ; Robotic Surgical Procedures/*methods ; Sigmoid Diseases/*surgery ; },
}
@article {pmid28905524,
year = {2017},
author = {Spinelli, A and David, G and Gidaro, S and Carvello, M and Sacchi, M and Montorsi, M and Montroni, I},
title = {First experience in colorectal surgery with a new robotic platform with haptic feedback.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {},
number = {},
pages = {},
doi = {10.1111/codi.13882},
pmid = {28905524},
issn = {1463-1318},
abstract = {UNLABELLED: The use of robotic techniques is increasing in colorectal surgery. Recently, the Senhance[™] surgical robotic system was introduced as a novel robotic platform designed to overcome some of the limits of standard laparoscopy. This study describes the initial, single center experience, evaluating feasibility and safety of the new robotic system in performing colorectal surgical procedures.
METHODS: From June 2015 to November 2016, perioperative data of the first 45 patients who underwent robotic colorectal surgery with the SenhanceTM surgical robotic system were collected and analyzed. Indications for surgery included inflammatory bowel disease, colorectal cancer, endoscopically unresectable adenomas and complicated diverticular disease.
RESULTS: The median age was 57 years (18-92) and the median BMI was 24 Kg/m2 (16-30). Surgical indications were colorectal cancer (66%), complicated inflammatory bowel disease (18%), diverticular disease (11%) and endoscopically unresectable adenoma (4.4%). The median operative time was 256 minutes; the median docking time 10.7 min (range 2-25). There were 3 conversions to standard laparoscopy, and none to laparotomy. All patients operated on for malignancy (28 adenocarcinoma, 2 neuroendocrine tumors) underwent an appropriate oncological procedure. The median time to discharge was 5 days (range 3-19). The incidence of post-operative complications was 35.5% (Clavien-Dindo I/II-14 patients, III-2 patients). One patient was readmitted in the postoperative period. No patient required reoperation.
CONCLUSION: The results of this audit suggest that adoption of The Senhance[™] surgical robotic system in colorectal surgery is feasible and safe. More clinical data are needed to determine whether this approach can offer any other benefits over other minimally invasive surgical techniques. This article is protected by copyright. All rights reserved.},
}
@article {pmid28904712,
year = {2017},
author = {Mazine, K and Barsotti, P and Elbouhaddouti, H and Taleb, KA},
title = {[Colonic gallstone ileus: a rare cause of colonic obstruction].},
journal = {The Pan African medical journal},
volume = {27},
number = {},
pages = {187},
pmid = {28904712},
issn = {1937-8688},
mesh = {Aged, 80 and over ; Female ; Gallstones/complications/*diagnostic imaging/surgery ; Humans ; Ileus/complications/*diagnostic imaging ; Intestinal Fistula/diagnostic imaging ; Intestinal Obstruction/*diagnostic imaging/etiology/surgery ; Sigmoid Diseases/*diagnostic imaging/etiology/surgery ; Tomography, X-Ray Computed ; },
abstract = {Bile ileus with migration of the gallstone into the colon through cholecystocolonic fistula is rare. The diagnosis is difficult and often late. We here report the case of a 89-year old patient with a history of sigmoid diverticular disease presenting with colonic obstruction associated with bile ileus caused by migration of a large gallstone through cholecystocolonic fistula. Abdominal CT scan allowed the diagnosis. The patient underwent surgical extraction of the gallstone with sigmoidotomy followed by sigmoidostomy with subsequent recovery of the digestive continuity. The cholecystocolonic fistula wasn't identified.},
}
@article {pmid28898153,
year = {2017},
author = {Hayward, NM and Chong, H and Hagger, R},
title = {Diverticular disease of the terminal ileum mimics cancer.},
journal = {British journal of hospital medicine (London, England : 2005)},
volume = {78},
number = {9},
pages = {532-533},
doi = {10.12968/hmed.2017.78.9.532},
pmid = {28898153},
issn = {1750-8460},
mesh = {Aged ; Colonography, Computed Tomographic/*methods ; Colonoscopy/methods ; Diagnosis, Differential ; Digestive System Surgical Procedures/*methods ; Diverticular Diseases/*diagnosis/surgery ; *Diverticulum/diagnostic imaging/pathology/surgery ; Humans ; Ileal Neoplasms/*diagnosis ; *Ileum/diagnostic imaging/pathology/surgery ; Male ; Treatment Outcome ; },
}
@article {pmid28879552,
year = {2017},
author = {Horesh, N and Lessing, Y and Rudnicki, Y and Kent, I and Kammar, H and Ben-Yaacov, A and Dreznik, Y and Tulchinsky, H and Avital, S and Mavor, E and Wasserberg, N and Kashtan, H and Klausner, JM and Gutman, M and Zmora, O},
title = {Considerations for Hartmann's reversal and Hartmann's reversal outcomes-a multicenter study.},
journal = {International journal of colorectal disease},
volume = {32},
number = {11},
pages = {1577-1582},
pmid = {28879552},
issn = {1432-1262},
mesh = {Adult ; Aged ; *Anastomosis, Surgical/adverse effects/methods ; Cohort Studies ; Colectomy/adverse effects/methods ; Colon, Sigmoid/pathology/physiopathology/*surgery ; Colonic Diseases/*surgery ; Colostomy/adverse effects/methods ; Female ; Humans ; Israel ; Male ; Middle Aged ; *Postoperative Complications/diagnosis/etiology/surgery ; *Plastic Surgery Procedures/adverse effects/methods/statistics & numerical data ; Rectum/*surgery ; *Reoperation/adverse effects/methods/statistics & numerical data ; Retrospective Studies ; Treatment Outcome ; },
abstract = {PURPOSE: Hartmann's procedure is commonly practiced in emergent cases with the restoration of bowel continuity planned at a second stage. This study assessed the rate of restorations following Hartmann's procedure and evaluated factors affecting decision-making.
METHODS: Data on patient demographics, comorbidities, causes for Hartmann's procedure, reversal rate, and complications were collected in a multicenter retrospective cohort study of patients who underwent Hartmann's procedure in five medical centers.
RESULTS: Six hundred forty patients underwent Hartmann's procedure for diverticular disease (36.1%), obstructing malignancy (31.8%), benign obstruction (5%), and other reasons (23.1%). Overall, 260 (40.6%) patients underwent subsequent restoration of bowel continuity. One hundred twenty-one (46.5%) patients had post-reversal complications, with an average Clavien-Dindo score of 1.4 and a mortality rate of 0.77%. Decision to avoid reversal was mostly related to comorbidities (49.7%) and metastatic disease (21.6%). Factors associated with the decision to restore bowel continuity included male gender (P = 0.02), patient age (62.3 years in Hartmann's reversal patients vs 73.5 years in non-reversal patients; P < 0.0001), number of comorbidities (1.1 vs 1.58; P < 0.001), average Charlson score (1.93 vs 3.44; P < 0.001), and a neoplastic etiology (P < 0.0001). A sub-analysis excluding all patients who died in the 30 days following Hartmann's procedure showed similar factors associated with ostomy closure.
CONCLUSION: Many patients do not have restoration of bowel continuity after undergoing Hartmann's procedure. Hartmann's reversal is associated with a significant postoperative morbidity. Surgeons and patients should be aware of the possibility that the colostomy might become permanent.},
}
@article {pmid28876560,
year = {2017},
author = {Mjoli, M and Govindasamy, V and Madiba, TE},
title = {What is the diagnostic yield of colonoscopy in patients with a referral diagnosis of constipation in South Africa?.},
journal = {South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie},
volume = {55},
number = {3},
pages = {14-18},
pmid = {28876560},
issn = {0038-2361},
mesh = {Adenoma/complications/*diagnostic imaging/epidemiology ; Adult ; Aged ; Aged, 80 and over ; *Colonoscopy ; Colorectal Neoplasms/complications/*diagnostic imaging/epidemiology ; Constipation/*etiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Referral and Consultation ; Retrospective Studies ; South Africa/epidemiology ; },
abstract = {BACKGROUND: Constipation is a common problem for referral to surgical and colorectal units. Its association with colorectal cancer is controversial. Some authors have found an increased incidence while others have not. The aim of this study is to investigate the incidence of colorectal cancer (CRC) and other significant colonoscopic pathologies in patients undergoing colonoscopy for constipation.
METHOD: All colonoscopy reports for constipation were retrieved from our database from January 2011 to 30 June 2014. Data extracted included demographics, colonoscopic findings and adequacy of bowel preparation. Exclusion criteria included patients with other symptoms known to be associated with colonic neoplasia such as lower GIT bleeding, loss of weight, patients with associated anaemia, those with abnormalities on imaging, patients with personal or family history of colorectal cancers or colorectal polyps and patients with inflammatory bowel disease. The primary outcome was the presence of neoplasia at colonoscopy and the secondary outcomes were other colonoscopy findings.
RESULTS: A total of 985 colonoscopies were performed from January 2011 to June 2014 of which 144 were done for a referral diagnosis of constipation. Eighty eight (61.1%) were female. Their mean age was 58.6 + 13.8 years (range 19-95 years). There were 61 (42.4%) African patients, 38 (26.4%) White, 33 (22.9%) Asians and 12 (8.3%) Coloured patients. Eighty seven (60.4%) patients had a normal colonoscopy, 20 (13.9%) diverticular disease, 14 (9.7%) polyps of which 6 (4.2%) were neoplastic, and 9 (6.3%) had colorectal cancer.
CONCLUSION: Constipation is associated with CRC. The presence of constipation should be a criterion for colonoscopy regardless of age or any other associated clinical features.},
}
@article {pmid28861417,
year = {2017},
author = {Tursi, A and Elisei, W and Picchio, M and Nasi, G and Mastromatteo, AM and Di Mario, F and Di Rosa, E and Brandimarte, MA and Brandimarte, G},
title = {Impact of diverticular inflammation and complication assessment classification on the burden of medical therapies in preventing diverticular disease complications in Italy.},
journal = {Annals of translational medicine},
volume = {5},
number = {16},
pages = {320},
pmid = {28861417},
issn = {2305-5839},
abstract = {BACKGROUND: Several treatments are currently advised to manage diverticular disease (DD) patients, but their impact on the burden of the disease is unknown. Our aim was to assess the economic analysis of using the recent Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification on the burden of medical therapies prescribed in preventing DD complications occurrence in Italy.
METHODS: We assessed retrospectively the cost/year of treatments in estimated DICA 1, DICA 2 and DICA 3 population. Analysis of diverticulosis prevalence was estimated according to data population provided by Italian Institute of Statistics (ISTAT). Cost of treatments calculated according to data on drugs' consumption collected during the DICA study.
RESULTS: We estimated that >8 million of Italian people >60 years may have diverticulosis, and that about 75% of diverticular population are on DICA 1, about 30% on DICA 2, and about 13% on DICA 3. We estimated that >387 million of euros could be spent in DICA 1 population, >203 million of euros in DICA 2 population, and >88 million of euros in DICA 3 population. Since medical treatments did not show any significant advantage when treating DICA 1 and DICA 3 people in terms of prevention of acute diverticulitis occurrence/recurrence and surgery occurrence, we can estimated that >475 million of euros could be spent in Italy without any significant benefit in preventing DD complications occurrence.
CONCLUSIONS: DICA endoscopic classification may have a significant impact on the burden of DD in Italy, because it helps to select DD people who effectively need treatments in terms of prevention of acute diverticulitis occurrence/recurrence and surgery occurrence.},
}
@article {pmid28815036,
year = {2017},
author = {Turco, F and Andreozzi, P and Palumbo, I and Zito, FP and Cargiolli, M and Fiore, W and Gennarelli, N and De Palma, GD and Sarnelli, G and Cuomo, R},
title = {Bacterial stimuli activate nitric oxide colonic mucosal production in diverticular disease. Protective effects of L. casei DG® (Lactobacillus paracasei CNCM I-1572).},
journal = {United European gastroenterology journal},
volume = {5},
number = {5},
pages = {715-724},
pmid = {28815036},
issn = {2050-6406},
abstract = {BACKGROUND: Micro-inflammation and changes in gut microbiota may play a role in the pathogenesis of diverticular disease (DD).
OBJECTIVE: The objective of this article is to evaluate the expression of nitric oxide (NO)-related mediators and S100B in colonic mucosa of patients with DD in an ex vivo model of bacterial infection.
METHODS: Intestinal biopsies obtained from patients with diverticulosis, symptomatic uncomplicated diverticular disease (SUDD) and SUDD with previous acute diverticulitis (SUDD+AD) were stimulated with the probiotic L. casei DG® (LCDG) and/or the pathogen enteroinvasive Escherichia coli (EIEC). S100B, NO release and iNOS expression were then evaluated.
RESULTS: Basal iNOS expression was significantly increased in SUDD and SUDD+AD patients. Basal NO expression was significantly increased in SUDD+AD. No differences in S100B release were found. In all groups, iNOS expression was significantly increased by EIEC and reduced by LCDG. In all groups, except for SUDD+AD, EIEC significantly increased NO release, whereas no increase was observed when LCDG was added to biopsies. EIEC did not induce significant changes in S100B release.
CONCLUSIONS: Colonic mucosa of patients with DD is characterized by a different reactivity toward pathogenic stimuli. LCDG plays a role in counteracting the pro-inflammatory effects exerted by EIEC, suggesting a beneficial role of this probiotic in DD.},
}
@article {pmid28814777,
year = {2017},
author = {Schieffer, KM and Sabey, K and Wright, JR and Toole, DR and Drucker, R and Tokarev, V and Harris, LR and Deiling, S and Eshelman, MA and Hegarty, JP and Yochum, GS and Koltun, WA and Lamendella, R and Stewart, DB},
title = {The Microbial Ecosystem Distinguishes Chronically Diseased Tissue from Adjacent Tissue in the Sigmoid Colon of Chronic, Recurrent Diverticulitis Patients.},
journal = {Scientific reports},
volume = {7},
number = {1},
pages = {8467},
pmid = {28814777},
issn = {2045-2322},
support = {TL1 TR000125/TR/NCATS NIH HHS/United States ; TL1 TR002016/TR/NCATS NIH HHS/United States ; UL1 TR000127/TR/NCATS NIH HHS/United States ; UL1 TR002014/TR/NCATS NIH HHS/United States ; },
mesh = {Adult ; Aged ; Bacteria/classification/genetics ; Cohort Studies ; Colon, Sigmoid/*microbiology ; DNA, Fungal/analysis ; DNA, Ribosomal Spacer/analysis ; Diverticulitis/*microbiology/*pathology/surgery ; Fungi/classification/genetics ; Humans ; Metagenome ; Middle Aged ; RNA, Ribosomal, 16S/analysis ; Retrospective Studies ; },
abstract = {Diverticular disease is commonly associated with the older population in the United States. As individual's age, diverticulae, or herniation of the mucosa through the colonic wall, develop. In 10-25% of individuals, the diverticulae become inflamed, resulting in diverticulitis. The gut ecosystem relies on the interaction of bacteria and fungi to maintain homeostasis. Although bacterial dysbiosis has been implicated in the pathogenesis of diverticulitis, associations between the microbial ecosystem and diverticulitis remain largely unstudied. This study investigated how the cooperative network of bacteria and fungi differ between a diseased area of the sigmoid colon chronically affected by diverticulitis and adjacent non-affected tissue. To identify mucosa-associated microbes, bacterial 16S rRNA and fungal ITS sequencing were performed on chronically diseased sigmoid colon tissue (DT) and adjacent tissue (AT) from the same colonic segment. We found that Pseudomonas and Basidiomycota OTUs were associated with AT while Microbacteriaceae and Ascomycota were enriched in DT. Bipartite co-occurrence networks were constructed for each tissue type. The DT and AT networks were distinct for each tissue type, with no microbial relationships maintained after intersection merge of the groups. Our findings indicate that the microbial ecosystem distinguishes chronically diseased tissue from adjacent tissue.},
}
@article {pmid28808610,
year = {2017},
author = {Jaruvongvanich, V and Sanguankeo, A and Upala, S},
title = {Association between Alcohol Consumption and Diverticulosis and Diverticular Bleeding: A Systematic Review and Meta-analysis.},
journal = {Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health},
volume = {76},
number = {8},
pages = {211-219},
pmid = {28808610},
issn = {2165-8242},
mesh = {Alcohol Drinking/*physiopathology ; Diverticulum/*complications/diagnosis/*etiology ; Gastrointestinal Hemorrhage/*etiology/physiopathology ; Humans ; Risk Factors ; },
abstract = {There have been conflicting reports on the association of alcohol use and diverticular disease. We aimed to determine the odds of developing diverticular disease and diverticular bleeding in patients who consumed alcohol on a regular basis compared with those who did not. MEDLINE and PUBMED were searched up until February 2017 on observational trials, which investigated the effect of alcohol use on two outcomes of diverticular disease: diverticulosis and diverticular bleeding. Quantitative estimates (odds ratios [OR] and confidence intervals [CI]) from included studies were pooled by using a random-effects model. Heterogeneity across studies was assessed by the I[2] statistic. In 6 studies including 53,644 subjects and 6 studies including 3,404 subjects, alcohol consumption on a regular basis was not associated with either diverticulosis (OR=1.99; 95% CI 0.99-4.03, I[2]=99%) or diverticular bleeding (OR=1.39; 95% CI 0.84-2.32, I[2]=45%) compared to subjects who did not consume alcohol on a regular basis, respectively. Increased odds of diverticulosis or diverticular bleeding among individuals who consume alcohol on a regular basis were not observed in these meta-analyses.},
}
@article {pmid28805779,
year = {2017},
author = {Reznitsky, PA and Yartsev, PA and Shavrina, NV},
title = {[Treatment of inflammatory complications of colic diverticular disease at the emergency surgical care hospital].},
journal = {Khirurgiia},
volume = {},
number = {8},
pages = {51-57},
doi = {10.17116/hirurgia2017851-57},
pmid = {28805779},
issn = {0023-1207},
mesh = {*Abdominal Abscess/diagnosis/etiology/surgery ; Aged ; *Colectomy/adverse effects/methods ; *Colon/diagnostic imaging/surgery ; Colonography, Computed Tomographic/methods ; *Diverticulitis, Colonic/diagnosis/epidemiology/physiopathology/surgery ; Drainage/methods ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; *Laparoscopy/adverse effects/methods ; Male ; Middle Aged ; *Minimally Invasive Surgical Procedures/adverse effects/methods ; *Postoperative Complications/diagnosis/mortality/psychology/surgery ; *Quality of Life ; Recurrence ; Retrospective Studies ; Treatment Outcome ; },
abstract = {AIM: To assess an effectiveness of minimally invasive and laparoscopic technologies in treatment of inflammatory complications of colic diverticular disease.
MATERIAL AND METHODS: The study included 150 patients who were divided into control and main groups. Survey included ultrasound, X-ray examination and abdominal computerized tomography. In the main group standardized treatment algorithm including minimally invasive and laparoscopic technologies was used.
RESULTS: In the main group 79 patients underwent conservative treatment, minimally invasive (ultrasound-assisted percutaneous drainage of abscesses) and laparoscopic surgery that was successful in 78 (98.7%) patients.
CONCLUSION: Standardized algorithm reduces time of treatment, incidence of postoperative complications, mortality and the risk of recurrent inflammatory complications of colic diverticular disease. Also postoperative quality of life was improved.},
}
@article {pmid28795633,
year = {2017},
author = {Greuter, T and Magdeburg, B},
title = {[Not Available].},
journal = {Praxis},
volume = {106},
number = {16},
pages = {877-881},
doi = {10.1024/1661-8157/a002748},
pmid = {28795633},
issn = {1661-8157},
mesh = {Anticoagulants/administration & dosage/adverse effects ; Colonoscopy ; Emergency Service, Hospital ; Gastrointestinal Hemorrhage/classification/diagnosis/*etiology/mortality ; Gastroscopy ; Humans ; Platelet Aggregation Inhibitors/administration & dosage/adverse effects ; Risk Factors ; Survival Rate ; },
}
@article {pmid28785818,
year = {2017},
author = {Nikberg, M and Ji, J and Leppert, J and Sundquist, K and Chabok, A},
title = {Socioeconomic characteristics and comorbidities of diverticular disease in Sweden 1997-2012.},
journal = {International journal of colorectal disease},
volume = {32},
number = {11},
pages = {1591-1596},
pmid = {28785818},
issn = {1432-1262},
support = {K2012-70X-15428-08-3//Vetenskapsrådet (SE)/ ; 2016-02373//Vetenskapsrådet/ ; },
mesh = {Cardiovascular Diseases/*epidemiology ; Cohort Studies ; Comorbidity ; Diabetes Mellitus/epidemiology ; *Diverticular Diseases/epidemiology/therapy ; Female ; Hospitalization/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Risk Factors ; Socioeconomic Factors ; Sweden/epidemiology ; },
abstract = {PURPOSE: This study aimed to evaluate the association of socioeconomic status and comorbidities with uncomplicated and complicated diverticular disease (DD) in Sweden.
METHODS: We identified all individuals aged ≥30 years in Sweden diagnosed with DD between 1997 and 2012 using the Swedish National Population and Housing Census and the Hospital Discharge Register. Data were analyzed by multivariable logistic regression, with individual-level characteristics as covariates.
RESULTS: A total of 79,481 patients (median age 66 [range 30-86] years) were hospitalized for DD, 15,878 (20%) of whom for complicated DD. Admissions for both uncomplicated and complicated DD were more common in women (p < 0.001). A low education level was identified as a risk factor for uncomplicated (unadjusted hazard ratio [HR] 1.79, 95% confidence interval [CI] 1.75-1.82; adjusted HR 1.22, 95% CI 1.19-1.24) and complicated DD (unadjusted HR 1.84, 95% CI 1.77-1.92; adjusted HR 1.26, 95% CI 1.21-1.32). Patients with the lowest income had a lower risk of hospitalization for uncomplicated (adjusted HR 0.94, 95% CI 0.91-0.96) and complicated DD (adjusted HR 0.87, 95% CI 0.83-0.92) than those with the highest income. The correlation coefficient between income and education was 0.25. Diabetes and cardiovascular disease were identified as protective factors against uncomplicated DD (adjusted HR 0.68, 95% CI 0.66-0.69 and HR 0.79, 95% CI 0.74-0.84, respectively).
CONCLUSIONS: Patients with the lowest education level had an increased risk of hospitalization for DD. Further studies are needed to explore the association of diabetes and cardiovascular disease with uncomplicated DD.},
}
@article {pmid28768296,
year = {2017},
author = {Tursi, A},
title = {Dietary pattern and colonic diverticulosis.},
journal = {Current opinion in clinical nutrition and metabolic care},
volume = {20},
number = {5},
pages = {409-413},
doi = {10.1097/MCO.0000000000000403},
pmid = {28768296},
issn = {1473-6519},
mesh = {Diet/*adverse effects ; Diet, Healthy ; Diverticular Diseases/etiology/prevention & control ; Diverticulitis, Colonic/etiology/prevention & control ; Diverticulosis, Colonic/*etiology/prevention & control ; Humans ; Patient Compliance ; Reproducibility of Results ; },
abstract = {PURPOSE OF REVIEW: To assess the role of dietary pattern on the occurrence of colonic diverticulosis, diverticular disease and acute diverticulitis.
RECENT FINDINGS: High-fiber diet does not prevent diverticulosis occurrence, and results about prevention/treatment of diverticular disease and acute diverticulitis are still conflicting.No association was seen between nut, corn or popcorn consumption and occurrence of diverticulosis, diverticular disease and acute diverticulitis.It seems to be a mild association between high alcohol intake and diverticulosis occurrence, whereas alcohol dependence seems to show lower risk of in-hospital mortality due to acute diverticulitis.Higher red-meat consumption shows mild increased risk of acute diverticulitis, especially when consumed as unprocessed red meat (defined as consumption of 'beef or lamb as main dish', 'pork as main dish', 'hamburger' and 'beef, pork or lamb as a sandwich or mixed dish'); higher consumption of poultry (viz. white meat) was not associated with risk of acute diverticulitis.Finally, higher fish intake was associated with reduced risk of diverticulitis in age-adjusted model, but not after further adjustment for other potential confounders.
SUMMARY: Current literature data about the role of dietary pattern on the occurrence of colonic diverticulosis, diverticular disease and acute diverticulitis are still too conflicting.},
}
@article {pmid28764591,
year = {2017},
author = {Naraynsingh, V and Cawich, SO and Hassranah, D and Daniel, F and Maharaj, R and Harnarayan, P},
title = {Segmental colectomy for bleeding diverticular disease guided by the PEEP test.},
journal = {Tropical doctor},
volume = {47},
number = {4},
pages = {355-359},
doi = {10.1177/0049475517724690},
pmid = {28764591},
issn = {1758-1133},
mesh = {Adult ; Aged ; Cecum/*pathology ; Colectomy/*methods ; Diverticulosis, Colonic/diagnosis/*surgery ; Erythrocytes/*pathology ; Female ; Gastrointestinal Hemorrhage/diagnosis/*surgery ; Humans ; Male ; Middle Aged ; Prospective Studies ; },
abstract = {Many patients with massive lower gastrointestinal (GI) haemorrhage from diverticulosis are subjected to total colectomy when preoperative localisation is unavailable. We dissected colectomy specimens and noted that there was limited retrograde reflux in most of these cases. Therefore, we sought to assess the value of a positive endoluminal erythrocyte presence (PEEP) test (presence of fresh blood in the caecum) to direct segmental colectomies in 14 patients who required emergency operations for massive lower GI haemorrhage. Overall, 13 (93%) patients who had segmental colectomy guided by the PEEP test had successful control of bleeding. There was no mortality and a 14% postoperative morbidity after segmental resections guided by the PEEP test. One patient had persistent bleeding and required a completion colectomy on the third postoperative day. We propose that the PEEP test be added to the surgical armamentarium to guide segmental resection in the absence of localisation by conventional means. However, we advocate blind total colectomy if the PEEP test is equivocal and early completion colectomy if there is significant re-bleeding.},
}
@article {pmid28751521,
year = {2018},
author = {Rubio, CA and Puppa, G and de Petris, G and Kis, L and Schmidt, PT},
title = {The third pathway of colorectal carcinogenesis.},
journal = {Journal of clinical pathology},
volume = {71},
number = {1},
pages = {7-11},
doi = {10.1136/jclinpath-2017-204660},
pmid = {28751521},
issn = {1472-4146},
mesh = {*Carcinogenesis ; Colorectal Neoplasms/*pathology ; Humans ; Intestinal Mucosa/pathology ; Lymphoid Tissue/pathology ; },
abstract = {AIMS: The majority of the colorectal carcinomas (CRC) arise in a vast mucosal area built with columnar cells and mucus-producing goblet cells. These carcinomas evolve via the conventional (tubular/villous) adenoma-carcinoma pathway, or the serrated adenoma-carcinoma pathway. Much less frequently CRC arise in the gut-associated lymphoid tissue (GALT) mucosal domain via the third pathway of colorectal carcinogenesis.
METHODS: All publications on human colorectal GALT carcinomas in the literature were reviewed.
RESULTS: Only 23 GALT-carcinomas found in 20 patients are in record. The GALT carcinomas were detected at surveillance colonoscopic biopsy in 11 patients (four had ulcerative colitis, two were members of a Lynch syndrome family, two of a CRC family, one had familial adenomatous polyposis (FAP), one prior colon adenomas and one a submucosal tumour), or at diagnostic colonoscopic biopsy in the remaining nine patients (three had rectal bleedings, two abdominal pains, one diverticular disease and one protracted constipation. In three, no ground disease or symptoms were provided). In six of the 23 GALT carcinomas, the luminal surface showed tumour cells, ulcerations or no descriptions were given. Ten (66.7%) of the remaining 15 GALT carcinomas showed on top, adenomas (n=8) or high-grade dysplasia (n=2).
CONCLUSIONS: The low frequency of GALT carcinomas might be explained by the fact that the colorectal mucosal areas occupied by GALT domains are minute. The finding that two-thirds of the 15 remaining GALT carcinomas (vide supra) were covered by high-grade dysplasia or by conventional adenomas strongly suggest that conventional non-invasive neoplasias might have preceded the majority of the GALT carcinomas in record.},
}
@article {pmid28745709,
year = {2017},
author = {Imanaliev, MR and Nazhmudinov, ZZ and Guseynov, AG and Magomedov, MA and Saidov, MG},
title = {[Diverticular disease of small intestine complicated by perforation and advanced peritonitis].},
journal = {Khirurgiia},
volume = {},
number = {7},
pages = {59-60},
doi = {10.17116/hirurgia2017759-60},
pmid = {28745709},
issn = {0023-1207},
mesh = {Aged ; Digestive System Surgical Procedures/*methods ; Diverticular Diseases/*complications/diagnosis/physiopathology ; Female ; Humans ; *Intestinal Perforation/diagnosis/etiology/physiopathology/surgery ; Intestine, Small/pathology/*surgery ; Laparoscopy/*methods ; *Peritonitis/diagnosis/etiology/surgery ; Treatment Outcome ; },
}
@article {pmid28737647,
year = {2019},
author = {Rubin, JN and Shoag, D and Gaetano, JN and Micic, D and Sengupta, N},
title = {Risk Factors for 30-day Hospital Readmission for Diverticular Hemorrhage.},
journal = {Journal of clinical gastroenterology},
volume = {53},
number = {4},
pages = {e133-e141},
doi = {10.1097/MCG.0000000000000883},
pmid = {28737647},
issn = {1539-2031},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Databases, Factual ; Diverticulum/*epidemiology ; Female ; Gastrointestinal Hemorrhage/*epidemiology ; Hospitalization/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Patient Discharge ; Patient Protection and Affordable Care Act ; Patient Readmission/*statistics & numerical data ; Risk Factors ; Young Adult ; },
abstract = {INTRODUCTION: The 2010 Affordable Care Act introduced the Hospital Readmissions Reduction Program to reduce health care utilization. Diverticular disease and its complications remain a leading cause of hospitalization among gastrointestinal disease. We sought to determine risk factors for 30-day hospital readmissions after hospitalization for diverticular bleeding.
MATERIALS AND METHODS: We utilized the 2013 National Readmission Database sponsored by the Agency for Healthcare Research and Quality focusing on hospitalizations with the primary or secondary discharge diagnosis of diverticular hemorrhage or diverticulitis with hemorrhage. We excluded repeat readmissions, index hospitalizations during December and those resulting in death. Our primary outcome was readmission within 30 days of index hospital discharge. Secondary outcomes of interest included medical and procedural comorbid risk factors. The data were analyzed using logistic regression analysis.
RESULTS: In total, 29,090 index hospitalizations for diverticular hemorrhage were included. There were 3484 (12%) 30-day readmissions with recurrent diverticular hemorrhage diagnosed in 896 (3%).Index admissions with renal failure [odds ratio (OR), 1.31; 95% confidence interval (CI), 1.19-1.43], congestive heart failure (OR, 1.30; 95% CI, 1.17-1.43), chronic pulmonary disease (OR, 1.19; 95% CI, 1.09-1.29), coronary artery disease (OR, 1.12; 95% CI, 1.03-1.21), atrial fibrillation (OR, 1.12; 95% CI, 1.02-1.22) cirrhosis (OR, 1.95; 95% CI, 1.29-2.93, performance of blood transfusion (OR, 1.23; 95% CI, 1.15-1.33), and abdominal surgery (OR, 1.24; 95% CI, 1.03-1.49) had increased risk of 30-day readmission.
CONCLUSIONS: The 30-day readmission rate for diverticular hemorrhage was 12% with multiple identified comorbidities increasing readmission risk.},
}
@article {pmid28702105,
year = {2017},
author = {Moniuszko, A and Rydzewska, G},
title = {The effect of cyclic rifaximin therapy on symptoms of diverticular disease from the perspective of the gastroenterology outpatient clinic: a "real-life" study.},
journal = {Przeglad gastroenterologiczny},
volume = {12},
number = {2},
pages = {145-151},
pmid = {28702105},
issn = {1895-5770},
abstract = {INTRODUCTION: Symptomatic uncomplicated diverticular disease of the colon (SUDD) is one of the most common diseases with which patients present to a gastroenterologist. Mild forms of diverticulitis can also be treated using rifaximin. Although numerous randomised controlled trials have already demonstrated the efficacy of rifaximin therapy, there is still a lack of data from daily medical practice.
AIM: To assess the effect of rifaximin on the symptoms of diverticular disease (SUDD and mild diverticulitis) in patients undergoing routine treatment in gastroenterology outpatient clinics in Poland.
MATERIAL AND METHODS: The retrospective study included 142 patients with a diagnosis of SUDD and mild diverticulitis, with a mean age of 60-69 years (41%), of whom 65% were women. Patients underwent three cycles of rifaximin therapy at a dose of 2 × 400 mg daily for 7 days over 3 consecutive months. Survey data were collected during monthly clinic appointments using a questionnaire completed by 48 gastroenterologists, and in selected cases standard inflammatory parameters were also determined.
RESULTS: After just one cycle of therapy a significant reduction in disease symptoms was observed (abdominal pain, abdominal tenderness, bloating, disturbances in bowel habit), defined over a scale of 0-3 points. The mean intensity of symptoms decreased from 1.7 ±0.7 to 0.8 ±0.3 points (with a maximum symptom intensity of 3.0 points). After three cycles, the severity of symptoms decreased markedly to an average of 0.3 ±0.1, and as many as 75% of patients reported no abdominal pain (previously the percentage was only 4%). These differences were statistically significant, p < 0.001. The decrease in inflammatory parameters (white blood cell count, C-reactive protein and erythrocyte sedimentation rate) was statistically significant.
CONCLUSIONS: Rifaximin is highly effective in the symptomatic relief of uncomplicated diverticular disease of the large bowel, and it is also effective in the treatment of mild forms of diverticulitis. Although the effects were already visible after the first cycle of therapy, the highest efficacy was obtained after three cycles of therapy. Rifaximin can be successfully used in routine medical practice.},
}
@article {pmid28683448,
year = {2018},
author = {Lopetuso, LR and Petito, V and Graziani, C and Schiavoni, E and Paroni Sterbini, F and Poscia, A and Gaetani, E and Franceschi, F and Cammarota, G and Sanguinetti, M and Masucci, L and Scaldaferri, F and Gasbarrini, A},
title = {Gut Microbiota in Health, Diverticular Disease, Irritable Bowel Syndrome, and Inflammatory Bowel Diseases: Time for Microbial Marker of Gastrointestinal Disorders.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {36},
number = {1},
pages = {56-65},
doi = {10.1159/000477205},
pmid = {28683448},
issn = {1421-9875},
mesh = {Adult ; Biomarkers/*metabolism ; Diverticular Diseases/*microbiology ; Female ; *Gastrointestinal Microbiome ; *Health ; Humans ; Inflammatory Bowel Diseases/*microbiology ; Irritable Bowel Syndrome/*microbiology ; Male ; Middle Aged ; Phylogeny ; Principal Component Analysis ; Species Specificity ; },
abstract = {Few data exist on differences in gut microbiota composition among principal gastrointestinal (GI) diseases. We evaluated the differences in gut microbiota composition among uncomplicated diverticular disease (DD), irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD) patients. DD, IBS, and IBD patients along with healthy controls (CT) were enrolled in our Italian GI outpatient clinic. Stool samples were collected. Microbiota composition was evaluated through a metagenomic gene-targeted approach. GI pathology represented a continuous spectrum of diseases where IBD displayed one extreme, while CT displayed the other. Among Phyla, Biplot PC2/PC3 and dendogram plot showed major differences in samples from IBS and IBD. DD resembled species CT composition, but not for Bacteroides fragilis. In IBS, Dialister spp. and then Faecalibacterium prausnitzii were the most representative species. Ulcerative colitis showed a reduced concentration of Clostridium difficile and an increase of Bacteroides fragilis. In Crohn's disease, Parabacteroides distasonis was the most represented, while Faecalibacterium prausnitzii and Bacteroides fragilis were significantly reduced. Each disorder has its definite overall microbial signature, which produces a clear differentiation from the others. On the other hand, shared alterations constitute the "core dysbiosis" of GI diseases. The assessment of these microbial markers represents a parameter that may complete the diagnostic assessment.},
}
@article {pmid28663067,
year = {2017},
author = {Mennini, FS and Sciattella, P and Marcellusi, A and Toraldo, B and Koch, M},
title = {Economic burden of diverticular disease: An observational analysis based on real world data from an Italian region.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {49},
number = {9},
pages = {1003-1008},
doi = {10.1016/j.dld.2017.05.024},
pmid = {28663067},
issn = {1878-3562},
mesh = {Adult ; Aged ; Ambulatory Care/economics ; Databases, Factual ; Diverticulitis/*economics/*epidemiology/therapy ; Female ; Health Care Costs/*statistics & numerical data/*trends ; Hospital Mortality ; Hospitalization/economics/*statistics & numerical data ; Humans ; International Classification of Diseases ; Italy/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {INTRODUCTION: Diverticular disease (DD), a herniation of the colonic mucosa through the muscle layer, covers a wide variety of conditions associated with the presence of diverticula in the colon. The most serious form is an acute episode of diverticulitis, which can lead to hospitalization and surgery with various types of consequences. The main aim of this study is to evaluate the economic burden of hospitalizations arising from acute episodes of diverticulitis using data from the administrative databases used in the Marche region in Italy and, as a secondary objective of this real-world data analysis, to study patient outcome variables following initial hospitalization for diverticulitis.
METHOD: A deterministic linkage was performed at individual user level between the different administrative sources of the Marche region through anonymous ID number for a period of analysis between 1 January, 2008 and 31 December, 2014. We enrolled all patients with at least one hospitalization for "diverticulitis of the colon without mention of haemorrhage" (ICD-9-CM code 562.11) or "diverticulitis of the colon with haemorrhage" (ICD-9-CM code 562.13) as primary or secondary diagnosis. For each patient we assessed the cost of hospitalization, of medicines and of specialist services considering a time-scale of one year or cohort analysis 365days after first admission.
RESULTS: The total number of residents in the Marche region who had at least one hospitalization for diverticulitis in the period 2008-2014 was 2987 (427 patients a year, corresponding to about 35 patients per 100,000 adult residents); the total number of admissions was 3453 (just over 490 a year). The direct healthcare costs incurred by the Marche region for episodes of diverticulitis in 2008-2014 amounted to approximately €11.4 million (€1.6 million a year), of which €10.9 million (95.5%) for the hospitalizations, € 246,000 (2.1%) for pharmaceutical treatment and €270,000 (2.4%) for specialist outpatient services. The average annual cost per patient was €3826, of which €3653 was for hospitalization, while pharmaceutical expenditure and specialist services accounted for €83 and €90, respectively. The cohort of patients undergoing a first admission for diverticulitis between 2010 and 2013 was made up of 1729 people (54.4% women, mean age 68.9 years), of whom 1500 (86.8%) did not undergo surgery while in hospital. Hospital mortality, recorded only for the over-65 age class, averaged 1.2%; for patients not receiving surgery during the initial hospitalization it was 0.5%, reaching 5.2% in patients undergoing surgery. The percentage of patients with one or more readmissions for diverticulitis within a year of the first was on average 7.8% and in 48% of cases this resulted in surgery.
CONCLUSIONS: Our study is the first analysis in Italy to use real-world data to measure the financial impact of diverticular disease. Assuming that the diagnostic and therapeutic behaviour identified in the Marche region could be representative of the situation nationwide, the estimated annual number of hospitalizations in Italy for acute episodes of diverticulitis is 19,000. The total amount of economic resources needed to treat patients suffering from acute episodes of diverticulitis is estimated at €63.5 million a year.},
}
@article {pmid28651752,
year = {2017},
author = {Macerollo, A and Lu, MK and Huang, HC and Chen, HJ and Lin, CC and Kao, CH and Tsai, CH and Chen, JC},
title = {Colonic diverticular disease: A new risk factor for Parkinson's disease?.},
journal = {Parkinsonism & related disorders},
volume = {42},
number = {},
pages = {61-65},
doi = {10.1016/j.parkreldis.2017.06.011},
pmid = {28651752},
issn = {1873-5126},
mesh = {Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Cohort Studies ; Community Health Planning ; Diverticulitis, Colonic/complications/*epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Parkinson Disease/*epidemiology ; Risk Factors ; Taiwan/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: Colonic diverticular disease is a chronic gastrointestinal disorder. Previous studies have suggested that chronic gastrointestinal tract is involved in the pathophysiology of Parkinson's disease.
OBJECT: This study investigated the potential link between colonic diverticular disease and risk of Parkinson's disease.
METHODS: Data in this nationwide population-based cohort study were obtained from the National Health Insurance Research Database. Patients with colonic diverticular disease were identified from among 23.22 million insured Taiwanese residents who had been diagnosed between 2000 and 2005 and were aged ≥20 years (n = 23367). The comparison cohort included patients without colonic diverticular disease, matched by sex, age, and all comorbidities with the colonic diverticular disease patients cohort (n = 23367). Using univariable and multivariable Cox proportional hazard regression models, we estimated the adjusted hazard ratio (aHR) for PD with a 95% confidence interval (CI) after adjusting for age, sex, and all of comorbidities.
RESULTS: The risk of Parkinson's disease was higher in the CDD cohort than in the comparison cohort (HR = 1.27, 95%CI = 1.10-1.47). Compared with patients aged ≥65 years without CDD, the CDD patients in the equal age group had a 1.25-fold increased risk of PD (95% CI = 1.07-1.46).
CONCLUSION: Colonic diverticular disease may be associated with an increased risk of Parkinson's disease. Thus, the risk of this neurodegenerative disease should be considered in patients with colonic diverticular disease.},
}
@article {pmid28651260,
year = {2017},
author = {Pustelnik, D and Elsholtz, FHJ and Bojarski, C and Hamm, B and Niehues, SM},
title = {The CDD System in Computed Tomographic Diagnosis of Diverticular Disease.},
journal = {RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin},
volume = {189},
number = {8},
pages = {740-747},
doi = {10.1055/s-0043-110770},
pmid = {28651260},
issn = {1438-9010},
mesh = {Diagnosis, Differential ; Disease Progression ; Diverticulosis, Colonic/classification/*diagnostic imaging ; Gastrointestinal Hemorrhage/classification/*diagnostic imaging ; Humans ; International Classification of Diseases/*standards ; Radiography, Abdominal/*standards ; Tomography, X-Ray Computed/*standards ; },
abstract = {Purpose This overview sums up the Classification of Diverticular Disease (CDD) with regard to its application in computed tomographic diagnosis and briefly recapitulates its targeted advantages over preliminary systems. Primarily, application of the CDD in computed tomography diagnostics is described. Differences with respect to the categories of the older systems are pointed out on the level of each CDD type using imaging examples. Materials and Methods The presented images are derived from our institute according to the S2k criteria. Literature was researched on PubMed. Results The CDD constitutes an improvement compared to older systems for categorizing the stages of diverticular disease. It provides more discriminatory power on the descriptive-morphological level and defines as well as differentiates more courses of the disease. Furthermore, the categories translate more directly into state-of-the-art decision-making concerning hospitalization and therapy. Conclusion The CDD should be applied routinely in the computed tomographic diagnosis of diverticular disease. Typical imaging patterns are presented. Key points · The CDD is superior to its predecessors. It better stratifies categories of diverticular disease by morphology, course and modern options for treatment of the disease.. · Computed tomography is the dominant imaging modality. Different stages show typical imaging patterns.. · Non-abscessed phlegmonous peridiverticulitis is now interpreted as an uncomplicated course.. · Minimal paracolic air does not constitute a full-fledged perforation in terms of a pneumoperitoneum (CDD type 2c).. Citation Format · Pustelnik D, Elsholtz FH, Bojarski C et al. The CDD System in Computed Tomographic Diagnosis of Diverticular Disease. Fortschr Röntgenstr 2017; 189: 740 - 747.},
}
@article {pmid28634627,
year = {2017},
author = {Braunschmid, T and Hartig, N and Baumann, L and Dauser, B and Herbst, F},
title = {Influence of multiple stapler firings used for rectal division on colorectal anastomotic leak rate.},
journal = {Surgical endoscopy},
volume = {31},
number = {12},
pages = {5318-5326},
pmid = {28634627},
issn = {1432-2218},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/*adverse effects/instrumentation ; Anastomotic Leak/etiology/*surgery ; Colorectal Neoplasms/*surgery ; Female ; Humans ; Male ; Middle Aged ; Patient Safety ; Rectum/*surgery ; Retrospective Studies ; Risk Factors ; Surgical Stapling/*adverse effects/methods ; Young Adult ; },
abstract = {BACKGROUND: Anastomotic leakage following colorectal resection remains one of the most significant complications with relevant morbidity and mortality. There is evidence that a higher number of stapler firings for rectal division can affect the leak rate in double stapling anastomosis. However, there are no data concerning compression anastomosis. We present our institutional experience addressing this issue.
DESIGN: This is a retrospective review of a prospective institutional database of patients undergoing colonic and rectal resection for benign and malignant indications between January 2008 and December 2014 at the surgical department of the St. John of God Hospital, Vienna. Inclusion criteria were rectal division with linear stapling devices and construction of anastomosis to the rectal stump using a circular stapler or compression device.
RESULTS: Three hundred eighty two (196 female; 51.3%) patients were included. Mean age was 65.8 years (range: 18-95) Indications for the operation included diverticular disease (44.8%), colorectal carcinoma (51.6%), inflammatory bowel disease (1.8%), and adenoma (1.8%). A laparoscopic approach was employed in 334 cases (87.4%); in 170 patients (44.9%), a compression anastomosis was created. One, two, and three or more stapler cartridges were used for rectal division in 58.4, 33.5, and 8.1%, respectively. Male gender, neoadjuvant therapy, rectal cancer as an underlying disease, laparoscopic surgical approach, and duration of operation longer than 200 min are leading causes for the usage of more than one stapler cartridge. Overall leak rate was 4.7% (18/382). The only factor associated with the occurrence of leakage was the use of three or more stapler cartridges for the closure of the rectal stump (p = 0.002).
CONCLUSION: Our data support that multiple stapler firings for rectal division following colorectal resection has a major impact on anastomotic leak rate. Especially in laparoscopic surgery efforts should be made to minimize the number of stapler cartridges used.},
}
@article {pmid28630808,
year = {2017},
author = {Mayl, J and Marchenko, M and Frierson, E},
title = {Management of Acute Uncomplicated Diverticulitis May Exclude Antibiotic Therapy.},
journal = {Cureus},
volume = {9},
number = {5},
pages = {e1250},
pmid = {28630808},
issn = {2168-8184},
abstract = {Diverticulitis is a common ailment that is prevalent in the developed world. As such, the management of diverticulitis places a substantial economic burden on healthcare. Research is ongoing to further elucidate both the pathogenesis of the disease, as well as ways to reduce associated expenditures. One of these emerging areas of research calls into question the use of antibiotics during treatment of acute uncomplicated diverticulitis. Current guidelines are largely based on expert opinion, with little evidence supporting the standard practice of antibiotic therapy. In this literature review, we have compiled and analyzed the latest collection of evidence in managing acute uncomplicated diverticulitis. There have been two randomized controlled trials (RCTs) performed that assessed the possibility of treating acute uncomplicated diverticulitis without antibiotics. Both the Antibiotika Vid Okomplicerad Divertikulit (AVOD) study and Daniels, et al. have found that an observational approach to acute uncomplicated diverticulitis is not inferior to antibiotic treatment and does not result in increased complication or recurrence rates. We also reviewed a single-center cohort study, a prospective observational study, and two retrospective case-controlled studies comparing observational management versus antibiotic treatment in patients with acute uncomplicated diverticulitis. We found the results were comparable; there was no difference in complication rates or recurrence in any study. The consensus among the studies reviewed challenges the current practice guidelines issued by the American Gastroenterological Association. However, given the geographical difference in diverticular disease and inherent bias found in these studies, we cannot recommend a modification of the guidelines. Based on this literature review, we feel compelled to suggest, and strongly recommend, further research be conducted in the United States in order to bolster the already significant evidence against antibiotic therapy in acute uncomplicated diverticulitis.},
}
@article {pmid28630219,
year = {2017},
author = {Wadood, A and Odeh, A and Rana, K and Zaman, S},
title = {A Rare Case Of Sigmoid Colon Perforation With Subsequent Psoas Abscess Collection With Extensive Involvement Of The Sartorius Muscle.},
journal = {BMJ case reports},
volume = {2017},
number = {},
pages = {},
pmid = {28630219},
issn = {1757-790X},
mesh = {Administration, Intravenous ; Anti-Bacterial Agents/*administration & dosage/therapeutic use ; Arthralgia/diagnosis ; Colon, Sigmoid/*pathology ; Diagnosis, Differential ; Diverticular Diseases/complications/pathology ; Drainage ; Hip/diagnostic imaging/pathology ; Humans ; Intestinal Perforation/*complications/diagnostic imaging ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Psoas Abscess/*complications/diagnostic imaging/drug therapy/surgery ; Radiography/methods ; Treatment Outcome ; Ultrasonography/methods ; },
abstract = {A middle-aged man was admitted with worsening hip pain, fevers and reduced mobility. These symptoms were preceded by a mechanical fall but despite regular analgesia, symptoms did not resolve. His prior medical history included ischaemic heart disease, hypertension and hypercholesterolaemia. A trauma and orthopaedic review revealed a painful left hip with reduced range of motion. In addition, some mild tenderness in the left iliac fossa was noted. Blood tests revealed markedly raised inflammatory markers. Plain radiographs and ultrasound were normal. MRI scan found a massive left iliopsoas collection secondary to perforated diverticular disease of the sigmoid colon. The patient was managed with intravenous antibiotics and the collection was drained percutaneously. Approximately 500 mL of pus was aspirated. The patient made an excellent recovery with interval imaging showing a reduction in the collection size.},
}
@article {pmid28627445,
year = {2017},
author = {Monari, F and Cervellera, M and Pirrera, B and D'Errico, U and Vaccari, S and Alberici, L and Tonini, V},
title = {Right-sided acute diverticulitis: A single Western center experience.},
journal = {International journal of surgery (London, England)},
volume = {44},
number = {},
pages = {128-131},
doi = {10.1016/j.ijsu.2017.06.025},
pmid = {28627445},
issn = {1743-9159},
mesh = {Acute Disease ; Adult ; Aged ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; },
abstract = {INTRODUCTION: Right sided diverticular disease is a rare condition in Western countries whereas is common amongst Asian population. The aim of this study is to evaluate options and outcomes for the treatment of right colonic diverticulitis.
METHOD: We included only patients undergoing surgery with right colon diverticulitis (RCD) proven at histological specimen examination from September 2011 to December 2016.
RESULTS: We performed 18 operations for RCD. Age was lower compared to left sided disease (49 ± 16 vs 67 ± 14; P < 0.001). Three patients were Asian (16.7%). RCD was diagnosed preoperatively in 8 cases (44.4%), whereas appendicitis was suspected in 9 cases (50%) and neoplasm in one (5.6%). We performed resection with anastomosis in 13 patients (72.2%) and in 5 cases we performed a diverticulectomy. Laparoscopy was performed in 14 cases (77.8%). Postoperative morbidity occurred in 3 patients (16.7%; grade 2 or 3a according to Clavien-Dindo) with no mortality. No postoperative events occured after diverticulectomy with shorter hospital stay (4 ± 1.5 vs 11 ± 13; P = 0.022), as no recurrence or need for elective surgery after a mean follow-up of 20 months.
CONCLUSION: RCD is a rare but not irrelevant condition. Minimally invasive surgery is often feasible and complication rate is low. In selected patients, diverticulectomy can be a valid alternative to treat this condition providing improved postoperative results.},
}
@article {pmid28625560,
year = {2017},
author = {Cavalcoli, F and Zilli, A and Fraquelli, M and Conte, D and Massironi, S},
title = {Small Bowel Ultrasound beyond Inflammatory Bowel Disease: An Updated Review of the Recent Literature.},
journal = {Ultrasound in medicine & biology},
volume = {43},
number = {9},
pages = {1741-1752},
doi = {10.1016/j.ultrasmedbio.2017.04.028},
pmid = {28625560},
issn = {1879-291X},
mesh = {Gastrointestinal Diseases/*diagnostic imaging ; Humans ; Inflammatory Bowel Diseases ; Intestines/*diagnostic imaging ; Ultrasonography/*methods ; },
abstract = {The use of bowel ultrasonography (US) for the evaluation of gut diseases has increased in recent years and has been proven to provide a widely available, non-invasive and inexpensive method for the initial work-up and follow-up of different intestinal diseases, limited mostly by technical challenges posed by the patient's anatomy. The present review aims to provide an extensive overview of the main pathologic features at US examination of intestinal diseases other than inflammatory bowel disease, both acute (e.g., acute appendicitis, colonic diverticulitis, infectious diseases and ischemic conditions) and chronic (e.g., celiac disease, cystic fibrosis and other enterocolites). The identification of typical US features may help in the diagnostic process and guide the treatment approach. Therefore, the application of knowledge of the US appearance of gastrointestinal diseases is of relevance in enabling greater diagnostic performance and better patient management.},
}
@article {pmid28611560,
year = {2017},
author = {O'Brien, JW and Webb, LA and Evans, L and Speakman, C and Shaikh, I},
title = {Gallstone Ileus Caused by Cholecystocolonic Fistula and Gallstone Impaction in the Sigmoid Colon: Review of the Literature and Novel Surgical Treatment with Trephine Loop Colostomy.},
journal = {Case reports in gastroenterology},
volume = {11},
number = {1},
pages = {95-102},
pmid = {28611560},
issn = {1662-0631},
abstract = {Gallstone ileus is an uncommon cause of intestinal obstruction and occurs following the formation of a cholecystoenteric fistula, permitting passage of gallstones into the gastrointestinal tract. Impaction of a gallstone in the sigmoid colon is rare and is usually at sites of previous colonic disease. Definitive management can be challenging due to the advanced age and co-morbidity usually seen in this group of patients. We describe a patient successfully managed with on-table endoscopy and, under local anaesthetic, the formation of a left iliac fossa trephine loop colostomy, permitting an enterolithotomy to deliver the stone whilst accommodating for severe pre-existing distal sigmoid diverticular disease. A review of the literature identified various endoscopic and surgical treatments that, depending on local expertise and patient characteristics, can be considered on a case-by-case basis. We advocate the management described in this case for patients presenting with large bowel obstruction due to gallstone ileus, with a background of diverticular disease and who are not fit for general anaesthetic or formal bowel resection, as an alternative to medical palliation alone.},
}
@article {pmid28608124,
year = {2017},
author = {Böhm, S and Kruis, W},
title = {[Diverticulitis : Domain of conservative or drug therapy?].},
journal = {Der Internist},
volume = {58},
number = {7},
pages = {745-752},
pmid = {28608124},
issn = {1432-1289},
mesh = {Anti-Bacterial Agents/therapeutic use ; *Conservative Treatment ; Diverticulitis/classification/surgery/*therapy ; Humans ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; Randomized Controlled Trials as Topic ; Rifamycins/therapeutic use ; Rifaximin ; },
abstract = {Increasing interest in diverticular disease by the scientific community in the last 10-15 years has resulted in an increased number of publications. Among other things, nonevidence-based therapeutic paradigms were tested in randomized, controlled therapy studies. The importance of surgery in the therapy of diverticulitis has diminished in recent years; in particular, it has no role in the treatment of diverticulitis types 1a, 1b, and 2a according to the Classification of Diverticular Disease (CDD) treated successfully by conservative means. Surgery has only a subordinate role in recurrent type 3b diverticulitis according to the CDD. Diverticulitis is therefore increasingly treated using conservative or drug therapy. However, only the classic, established antibiotics are currently available as effective drugs for the treatment of diverticular disease. However, these are also decreasing in significance. Over 90% of patients with type 1a/1b diverticulitis can be safely treated according to current data without the use of antibiotics. It is possible that type 2a diverticulitis will also be successfully treated without antibiotics in the future. Substances such as rifaximin, mesalazine, or probiotics, which were tested above all in patients with chronic recurrent forms (CDD type 3a/3b), have not yet been established.},
}
@article {pmid28603053,
year = {2018},
author = {Peery, AF and Keku, TO and Addamo, C and McCoy, AN and Martin, CF and Galanko, JA and Sandler, RS},
title = {Colonic Diverticula Are Not Associated With Mucosal Inflammation or Chronic Gastrointestinal Symptoms.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {16},
number = {6},
pages = {884-891.e1},
pmid = {28603053},
issn = {1542-7714},
support = {KL2 TR001109/TR/NCATS NIH HHS/United States ; P30 DK034987/DK/NIDDK NIH HHS/United States ; R01 DK094738/DK/NIDDK NIH HHS/United States ; T32 DK007634/DK/NIDDK NIH HHS/United States ; K23 DK113225/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Aged ; Aged, 80 and over ; Biopsy ; Colitis/*etiology/*pathology ; Colonoscopy ; Cytokines/analysis ; Diverticulum, Colon/*complications ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Mucositis/*etiology/*pathology ; North Carolina ; Prospective Studies ; },
abstract = {BACKGROUND & AIMS: Colonic diverticulosis has been reported to be associated with low-grade mucosal inflammation, possibly leading to chronic gastrointestinal symptoms. However, there is poor evidence for this association. We aimed to determine mucosal inflammation and whether diverticula are associated with chronic gastrointestinal symptoms. We explored whether inflammation was present among symptomatic participants with and without diverticula.
METHODS: We analyzed data from a prospective study of 619 patients undergoing a screening colonoscopy from 2013 through 2015 at the University of North Carolina Hospital in Chapel Hill, North Carolina. Among our participants, 255 (41%) had colonic diverticula. Colonic mucosal biopsy specimens were analyzed for levels of interleukin 6 (IL6), IL10, and tumor necrosis factor messenger RNAs by quantitative reverse-transcriptase polymerase chain reaction, and numbers of immune cells (CD4+, CD8+, CD57+, and mast cell tryptase) by immunohistochemistry. Gastrointestinal symptoms were assessed using Rome III criteria. Proportional odds models were used to estimate odds ratios (ORs) and 95% confidence interval (CIs).
RESULTS: After adjustment for potential confounders, there was no association between diverticulosis and tumor necrosis factor (OR, 0.85; 95% CI, 0.63-1.16), and no association with CD4+ cells (OR, 1.18; 95% CI, 0.87-1.60), CD8+ cells (OR, 0.97; 95% CI, 0.71-1.32), or CD57+ cells (OR, 0.80; 95% CI, 0.59-1.09). Compared with controls without diverticulosis, biopsy specimens from individuals with diverticulosis were less likely to express the inflammatory cytokine IL6 (OR, 0.59; 95% CI, 0.36-0.96). There was no association between diverticulosis and irritable bowel syndrome (OR, 0.53; 95% CI, 0.26-1.05) or chronic abdominal pain (OR, 0.68; 95% CI, 0.38-1.23). There was no evidence for inflammation in patients with symptoms when patients with vs without diverticulosis were compared.
CONCLUSIONS: We found no evidence that colonic diverticulosis is associated with mucosal inflammation or gastrointestinal symptoms. Among patients with symptoms and diverticula, we found no mucosal inflammation.},
}
@article {pmid28585551,
year = {2017},
author = {Sigurdsson, S and Alexandersson, KF and Sulem, P and Feenstra, B and Gudmundsdottir, S and Halldorsson, GH and Olafsson, S and Sigurdsson, A and Rafnar, T and Thorgeirsson, T and Sørensen, E and Nordholm-Carstensen, A and Burcharth, J and Andersen, J and Jørgensen, HS and Possfelt-Møller, E and Ullum, H and Thorleifsson, G and Masson, G and Thorsteinsdottir, U and Melbye, M and Gudbjartsson, DF and Stefansson, T and Jonsdottir, I and Stefansson, K},
title = {Sequence variants in ARHGAP15, COLQ and FAM155A associate with diverticular disease and diverticulitis.},
journal = {Nature communications},
volume = {8},
number = {},
pages = {15789},
pmid = {28585551},
issn = {2041-1723},
support = {R01 DA017932/DA/NIDA NIH HHS/United States ; },
mesh = {Acetylcholinesterase/*genetics ; Aged ; Case-Control Studies ; Collagen/*genetics ; Denmark ; Diverticular Diseases/*genetics ; Diverticulitis/genetics ; Female ; GTPase-Activating Proteins/*genetics ; Genetic Predisposition to Disease ; Genome-Wide Association Study ; Humans ; Iceland ; Male ; Membrane Proteins/*genetics ; Middle Aged ; Muscle Proteins/*genetics ; Polymorphism, Single Nucleotide ; },
abstract = {Diverticular disease is characterized by pouches (that is, diverticulae) due to weakness in the bowel wall, which can become infected and inflamed causing diverticulitis, with potentially severe complications. Here, we test 32.4 million sequence variants identified through whole-genome sequencing (WGS) of 15,220 Icelanders for association with diverticular disease (5,426 cases) and its more severe form diverticulitis (2,764 cases). Subsequently, 16 sequence variants are followed up in a diverticular disease sample from Denmark (5,970 cases, 3,020 controls). In the combined Icelandic and Danish data sets we observe significant association of intronic variants in ARHGAP15 (Rho GTPase-activating protein 15; rs4662344-T: P=1.9 × 10[-18], odds ratio (OR)=1.23) and COLQ (collagen-like tail subunit of asymmetric acetylcholinesterase; rs7609897-T: P=1.5 × 10[-10], OR=0.87) with diverticular disease and in FAM155A (family with sequence similarity 155A; rs67153654-A: P=3.0 × 10[-11], OR=0.82) with diverticulitis. These are the first loci shown to associate with diverticular disease in a genome-wide study.},
}
@article {pmid28578700,
year = {2017},
author = {Thilakawardana, BU and De Mel, S and Abeysuriya, V and Hewavisenthi, J and De Mel, C and Chandrasena, L and Abeysuriya, V},
title = {A rare presentation of an acute abdomen: an ileal diverticular perforation.},
journal = {BMC research notes},
volume = {10},
number = {1},
pages = {190},
pmid = {28578700},
issn = {1756-0500},
mesh = {Abdomen, Acute/diagnosis/*etiology ; Adult ; Appendicitis/diagnosis ; Diagnosis, Differential ; Humans ; Ileal Diseases/*complications/diagnosis/surgery ; Intestinal Perforation/*complications/diagnosis ; Laparoscopy/methods ; Male ; Meckel Diverticulum/*complications/diagnosis ; },
abstract = {BACKGROUND: This case report highlights the value of prompt intervention of diagnostic laparoscopy in a patient suspects of having an acute abdomen due to an intestinal perforation, where there is a limitation of performing Contrast Enhanced Computed Tomography of abdomen. A previously healthy young adult presenting with an acute abdomen due to a spontaneous ileal perforation, without any associated risk factors is a rare clinical entity in a developing country. Therefore, entertaining an early diagnosis will possibly prevent a fatal consequence.
CASE PRESENTATION: A male patient, 29 years old, recently diagnosed as a young hypertensive without any associated factors, currently on antihypertensive treatment, was admitted to our hospital presenting with an acute severe abdominal pain. During initial assessment, the patient was febrile (101 °F), ill looking, tachycardic (pulse rate 121 bpm) with rapid shallow breathing. Abdominal examination reviled diffuse guarding and rigidity, more severe on right iliac fossa. Following history and clinical examination probable clinical diagnosis was made as an acute appendicitis with perforation. However, ultrasonography was found to have normal appendix. Contrast Enhanced Computed Tomography was not performed as a subsequent investigation because of the impairment of renal functions of this patient. Though, non-contrast CT would have been ascertained more diagnostic yield, given the critically ill status of this patient we decided to perform urgent diagnostic laparoscopy. It reviled pus in several abdominal cavities and dense adhesions. Therefore, the procedure was converted to a laparotomy and found to have an ileal perforation with diffuse peritoneal contamination. Diseased ileal segment was resected and anastomosed. Followed by peritoneal lavage.
CONCLUSION: Ileal perforation due to diverticular disease in a healthy young adult is rare. This case report highlights the importance of considering this clinical entity as a differential diagnosis, the value of early diagnostic laparoscopy, especially in clinical settings with limitations to CT scan, since late diagnosis can give rise to fatal outcome.},
}
@article {pmid28556447,
year = {2017},
author = {Aune, D and Sen, A and Leitzmann, MF and Tonstad, S and Norat, T and Vatten, LJ},
title = {Tobacco smoking and the risk of diverticular disease - a systematic review and meta-analysis of prospective studies.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {19},
number = {7},
pages = {621-633},
doi = {10.1111/codi.13748},
pmid = {28556447},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticular Diseases/epidemiology/*etiology ; Diverticulitis/etiology ; Diverticulum/etiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Tobacco Smoking/*adverse effects ; },
abstract = {AIM: This systematic review and meta-analysis aimed to clarify whether tobacco smoking is associated with an increased risk of diverticular disease.
METHOD: The PubMed and Embase databases were searched for studies of smoking and diverticular disease up to 19 February 2016. Prospective studies that reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of diverticular disease associated with current or previous smoking were included. Summary RRs were estimated using a random effects model.
RESULTS: We identified five prospective studies which comprised 6076 cases of incident diverticular disease (diverticulosis and diverticulitis) among 385 291 participants and three studies with 1118 cases of complications related to diverticular disease (abscess or perforation) among 292 965. The summary RR for incident diverticular disease was 1.36 (95% CI 1.15-1.61, I[2] = 84%, n = 4) for current smokers, 1.17 (95% CI 1.05-1.31, I[2] = 49%, n = 4) for former smokers and 1.29 (95% CI 1.16-1.44, I[2] = 62%, n = 5) for ever smokers. The summary RR was 1.11 (95% CI 0.99-1.25, I[2] = 82%, n = 4) per 10 cigarettes per day. Although there was some indication of nonlinearity there was a dose-dependent positive association with increasing number of cigarettes smoked per day. There was some evidence that smoking also increases the risk of complications of diverticular disease, but the number of studies was small.
CONCLUSION: The current meta-analysis provides evidence that tobacco smoking is associated with an increased incidence of diverticular disease and related complications.},
}
@article {pmid28548199,
year = {2017},
author = {Hevia, M and Quera, R and Soto, L and Regueira, T and O'Brien, A and Larach, A and Kronberg, U},
title = {[Acute small bowel diverticulitis in a patient with crohn’s disease].},
journal = {Revista medica de Chile},
volume = {145},
number = {3},
pages = {397-401},
doi = {10.4067/S0034-98872017000300016},
pmid = {28548199},
issn = {0717-6163},
mesh = {Acute Disease ; Aged ; Crohn Disease/*complications ; Diverticulitis/diagnostic imaging/*etiology ; Humans ; Jejunal Diseases/diagnostic imaging/*etiology ; Male ; },
abstract = {Diverticular disease of the small intestine is rare, especially when it is located in the jejunum. It is generally asymptomatic, but in some patients it may have complications such as acute diverticulitis with peritonitis, gastrointestinal bleeding or obstruction. In such cases, the recommended treatment is surgery. We report a 77-year-old patient with ileal Crohn’s disease with a long-standing inflammatory phenotype, who developed acute diverticulitis of the jejunum presenting a severe septic shock and secondary multiple-organ failure. It resolved with medical treatment and prolonged antibiotic therapy.},
}
@article {pmid28528364,
year = {2017},
author = {Kvasnovsky, CL and Bjarnason, I and Donaldson, AN and Sherwood, RA and Papagrigoriadis, S},
title = {A randomized double-blind placebo-controlled trial of a multi-strain probiotic in treatment of symptomatic uncomplicated diverticular disease.},
journal = {Inflammopharmacology},
volume = {},
number = {},
pages = {},
pmid = {28528364},
issn = {1568-5608},
abstract = {BACKGROUND: Diverticular disease is a significant burden on healthcare systems that is managed, surgically or medically, mainly as an emergency or acute condition. There are no standardized treatment recommendations for symptomatic uncomplicated disease. We hypothesized that a probiotic would reduce abdominal pain in such patients.
METHODS: We conducted a single-center, double-blind, placebo-controlled trial of probiotic treatment (Symprove) in adult patients with moderate-to-severe chronic, non-acute symptomatic diverticular disease. 143 patients were randomized to receive 1 mL/kg/day of probiotic liquid (N = 72) or placebo (N = 71) daily for 3 months. The primary endpoint was abdominal pain severity. Secondary endpoints consisted of the change in the frequency of eight abdominal symptoms and the level of intestinal inflammation (fecal calprotectin).
RESULTS: 120 patients completed the trial. Abdominal pain score, the primary end point, decreased in both groups, but no significant difference between the groups was found (P = 0.11). In relation to placebo, the probiotic significantly decreased the frequency of four of the eight secondary endpoints: constipation, diarrhea, mucorrhea, and back pain (P < 0.04). No significant differences were found in frequency of abdominal pain, PR bleeding, dysuria, and bloating.
CONCLUSIONS: Multi-strain liquid probiotic did not improve abdominal pain scores significantly, but significantly improved the frequency of four other symptoms associated with chronic, non-acute symptomatic diverticular disease.},
}
@article {pmid28523327,
year = {2017},
author = {TuŢă, LA and Boşoteanu, M and Dumitru, E and Deacu, M},
title = {Complicated diverticulitis in a de novo kidney transplanted patient.},
journal = {Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie},
volume = {58},
number = {1},
pages = {249-253},
pmid = {28523327},
issn = {2066-8279},
mesh = {Colonoscopy ; Diverticulitis/diagnostic imaging/*etiology/pathology ; Diverticulosis, Colonic/diagnostic imaging/pathology ; Humans ; Intestinal Mucosa/pathology ; Kidney Transplantation/*adverse effects ; Lymphoid Tissue/pathology ; Male ; Middle Aged ; },
abstract = {Diverticular disease is frequent amongst the elderly and immunosuppressed patients. It mainly presents as sigmoid diverticulitis, but severe complications, like bleedings, infections and colon perforation may occur, frequently due to immunosuppressive therapy. Moreover, antibiotherapy and hemostatics may not efficiently control evolution in such cases. Early diagnose and adequate treatment of colonic diverticulosis complicated with lower gastrointestinal bleeding and diverticulitis in immunocompromised patients. We report a 55-year-old patient who underwent de novo renal transplantation one year ago and recently developed a severe diverticular bleeding complicated by hemorrhagic shock. Colonoscopic examination revealed diverticular disease with diverticulitis and severe, diffuse bleeding, mainly in the descending colon. Due to his immunocompromised status and unfavorable evolution under hemostatics, recombinant coagulation factor VIIa (rFVIIa) was given to avoid surgery. The bleeding stopped after two doses of rFVIIa. Unfortunately, after three weeks, lower quadrant pain, tenderness, abdominal distention, and fever occurred, in spite of immunosuppressive drug changing and adequate conservative therapy. Abdominal computed tomography (CT) scan revealed complicated diverticulitis, so patient underwent surgery, with partial colectomy, followed by total recovery. In conclusion, diverticulosis coli complicated with lower gastrointestinal bleeding and diverticulitis in immunocompromised patients was for us a challenging diagnosis, as well as a therapeutic issue. Treatment options, usually based on our local resources and expertise, considered conservatory therapy as the first choice, keeping surgical maneuvers just as a rescue solution.},
}
@article {pmid28503973,
year = {2017},
author = {Freckelton, J and Evans, JA and Croagh, D and Moore, GT},
title = {Metformin use in diabetics with diverticular disease is associated with reduced incidence of diverticulitis.},
journal = {Scandinavian journal of gastroenterology},
volume = {52},
number = {9},
pages = {969-972},
doi = {10.1080/00365521.2017.1325930},
pmid = {28503973},
issn = {1502-7708},
mesh = {Acute Disease ; Aged ; Aged, 80 and over ; Australia ; Case-Control Studies ; Diabetes Mellitus, Type 2/*complications/*drug therapy ; Diverticulitis/diagnostic imaging/*epidemiology ; Female ; Glycated Hemoglobin/analysis ; Humans ; Hypoglycemic Agents/*therapeutic use ; Incidence ; Logistic Models ; Male ; Metformin/*therapeutic use ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND AND AIMS: There is no current, evidence-based therapy to prevent acute diverticulitis in patients with diverticular disease. Metformin has been shown to have anti-inflammatory effects in a number of disease states, in both animal models and in human observational studies. The potential therapeutic efficacy of metformin in diverticular disease has not been investigated. This study aims to describe the relationship between metformin use and diverticular disease in patients with diabetes mellitus.
METHODS: This was a retrospective case-control study. It compared metformin and other hypoglycaemic medication use in diabetic patients with uncomplicated diverticulosis to those with acute diverticulitis. Patients were identified using hospital International Classification of Diseases 10 (ICD-10) data, and radiology, pathology and scanned medical record databases were used to confirm diagnoses and collect all information. Chi square tests were used to determine significance of difference in categorical variables, and Mann-Whitney tests were used for continuous data.
RESULTS: There were 174 patients with uncomplicated diverticulosis and 175 patients with acute diverticulitis. A diagnosis of acute diverticulitis was associated with a significantly lower incidence of metformin use, than a diagnosis of uncomplicated diverticular disease (44% compared to 60%, respectively, p = .002). Other oral hypoglycaemic drugs and insulin were not associated with a lower incidence of diverticulitis (p = .12 and p = .24, respectively).
CONCLUSION: Metformin use is associated with reduced incidence of diverticulitis in diabetic patients with diverticular disease. The utility of metformin as a therapeutic agent to reduce the risk of diverticulitis in patients with diverticular disease warrants further randomised, prospective, interventional investigation.},
}
@article {pmid28494576,
year = {2018},
author = {Rezapour, M and Ali, S and Stollman, N},
title = {Diverticular Disease: An Update on Pathogenesis and Management.},
journal = {Gut and liver},
volume = {12},
number = {2},
pages = {125-132},
pmid = {28494576},
issn = {2005-1212},
mesh = {Colonoscopy/methods ; *Diverticular Diseases/diagnosis/etiology/physiopathology/therapy ; Humans ; Patient Care Management/*methods ; },
abstract = {Diverticular disease is one of the most common conditions in the Western world and one of the most common findings identified at colonoscopy. Recently, there has been a significant paradigm shift in our understanding of diverticular disease and its management. The pathogenesis of diverticular disease is thought to be multifactorial and include both environmental and genetic factors in addition to the historically accepted etiology of dietary fiber deficiency. Symptomatic uncomplicated diverticular disease (SUDD) is currently considered a type of chronic diverticulosis that is perhaps akin to irritable bowel syndrome. Mesalamine, rifaximin and probiotics may achieve symptomatic relief in some patients with SUDD, although their role(s) in preventing complications remain unclear. Antibiotic use for acute diverticulitis and elective prophylactic resection surgery are considered more individualized treatment modalities that take into account the clinical status, comorbidities and lifestyle of the patient. Our understanding of the pathogenesis of diverticular disease continues to evolve and is likely to be diverse and multifactorial. Paradigm shifts in several areas of the pathogenesis and management of diverticular disease are explored in this review.},
}
@article {pmid28469355,
year = {2017},
author = {Schembri, J and Bonello, J and Christodoulou, DK and Katsanos, KH and Ellul, P},
title = {Segmental colitis associated with diverticulosis: is it the coexistence of colonic diverticulosis and inflammatory bowel disease?.},
journal = {Annals of gastroenterology},
volume = {30},
number = {3},
pages = {257-261},
pmid = {28469355},
issn = {1108-7471},
abstract = {Segmental colitis associated with diverticulosis (SCAD) is an inflammatory process that affects colonic luminal mucosa in segments that are also affected by diverticulosis. Its prevalence varies between 1.15% and 11.4% amongst those suffering from diverticular disease (DD). Being closely associated with DD, it is slightly commoner in males and usually presents in the sixth decade of life. Although the exact pathogenesis of SCAD is unknown, it is probably heterogeneous and includes mechanisms that also play a part in inflammatory bowel disease (IBD). The clinical presentation is non-specific and similar to that of other pathologies involving the sigmoid colon, and its diagnosis is based on endoscopic findings in correlation with histology. Currently, there are no guidelines for its management, which is usually based on the administration of salicylates and antibiotics, with surgery being reserved for refractory cases. The rarity of SCAD may be multifactorial: whereas milder forms go undiagnosed or are attributed to DD, more severe forms can be misdiagnosed as IBD. This latter distinction is an important one to make, since SCAD and IBD differ as regards their natural history and prognosis, while very often no long-term medications are required in SCAD.},
}
@article {pmid28467330,
year = {2017},
author = {Maconi, G},
title = {Diagnosis of symptomatic uncomplicated diverticular disease and the role of Rifaximin in management.},
journal = {Acta bio-medica : Atenei Parmensis},
volume = {88},
number = {1},
pages = {25-32},
pmid = {28467330},
issn = {2531-6745},
mesh = {Abdominal Pain/drug therapy ; Biomarkers/analysis ; C-Reactive Protein/analysis ; Clinical Trials as Topic ; Constipation/drug therapy ; Diagnostic Imaging ; Diarrhea/drug therapy ; Diverticular Diseases/*diagnosis/*drug therapy ; Gastrointestinal Agents/pharmacology/*therapeutic use ; Humans ; Leukocyte L1 Antigen Complex/analysis ; Rifamycins/pharmacology/*therapeutic use ; Rifaximin ; },
abstract = {Patients with diverticulosis who develop persistent abdominal pain, bloating and changes in bowel habits not associated with overt inflammation may have symptomatic uncomplicated diverticular disease (SUDD). The severity and frequency of SUDD symptoms may have an impact on daily activities and severely affect quality of life. Effective management of SUDD should follow a three part strategy: divert, tackle and maintain. Divert to make the correct diagnosis: several symptoms of SUDD are common to other conditions that require different therapeutic approaches. However, several key differences should be used to diagnose SUDD. Pain in SUDD is normally in the iliac fossa, persistent, often lasting more than 24 hrs, and is not relieved by bowel movement, as is often the case with irritable bowel syndrome. Another difference is in the timing: the prevalence of SUDD increases with age, and patients under the age of 40 years are less likely to have diverticula. It is useful to establish whether a patient has diverticulosis, especially if the patient is relatively young; lack of diverticula excludes SUDD. Cross-sectional imaging is indicated; however, recent archival image data or ultrasonography may be useful alternatives. Laboratory tests should be ordered to exclude overt inflammation. Once the diagnosis of SUDD is made, the patient should receive effective therapy to tackle the condition. This should include dietary fibre supplementation and cyclic treatment with rifaximin 400 mg twice daily for 7 days per month. Once symptom control is achieved, it should be maintained by continuing therapy for at least 12 months.},
}
@article {pmid28466633,
year = {2017},
author = {Elisei, W and Brandimarte, G and Tursi, A},
title = {Management of diverticulosis: what's new?.},
journal = {Minerva medica},
volume = {108},
number = {5},
pages = {448-463},
doi = {10.23736/S0026-4806.17.05201-6},
pmid = {28466633},
issn = {1827-1669},
mesh = {Anti-Bacterial Agents/*therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Dietary Fiber/*therapeutic use ; Diverticulum/*drug therapy/economics/epidemiology ; Humans ; Incidence ; Italy/epidemiology ; Mesalamine/*therapeutic use ; Probiotics/*therapeutic use ; Treatment Outcome ; },
abstract = {The incidence of diverticulosis and diverticular disease (DD) of the colon, including acute diverticulitis, is increasing worldwide, and becoming a significant burden on national health systems in terms of direct and indirect costs. Thus, significant efforts are now being focused to identify the correct therapeutic approach to treat symptomatic patients and to prevent diverticulitis. Fiber, non-absorbable antibiotics, 5-aminosalicylic acid and probioticsare currently being investigated in this way. Unfortunately, current evidences on the effectiveness of some medical treatment in preventing acute diverticulitis recurrence are still lacking. The effectiveness and the future perspectives of these treatments are discussed herein.},
}
@article {pmid28463672,
year = {2017},
author = {Mari, G and Crippa, J and Costanzi, A and Mazzola, M and Magistro, C and Ferrari, G and Maggioni, D},
title = {Genito-Urinary Function and Quality of Life after Elective Totally Laparoscopic Sigmoidectomy after at Least One Episode of Complicated Diverticular Disease According to Two Different Vascular Approaches: the IMA Low Ligation or the IMA Preservation.},
journal = {Chirurgia (Bucharest, Romania : 1990)},
volume = {112},
number = {2},
pages = {136-142},
doi = {10.21614/chirurgia.112.2.136},
pmid = {28463672},
issn = {1221-9118},
mesh = {Adult ; Aged ; Blood Loss, Surgical/prevention & control ; Colon, Sigmoid/*surgery ; Diverticulum, Colon/*surgery ; *Elective Surgical Procedures/methods ; Feasibility Studies ; Female ; Female Urogenital Diseases/prevention & control ; Humans ; Italy ; *Laparoscopy/adverse effects/methods ; Ligation/methods ; Male ; Male Urogenital Diseases/prevention & control ; *Mesenteric Artery, Inferior/surgery ; Middle Aged ; Operative Time ; Organ Sparing Treatments ; Prospective Studies ; *Quality of Life ; Risk Factors ; *Sigmoidoscopy/adverse effects/methods ; Treatment Outcome ; },
abstract = {The arterial ligation during elective laparoscopic sigmoidectomy for diverticular disease can affect genito-urinary function injuring the superior hypogastric plexus, and can weaken the distal colonic stump arterial perfusion. Ligation of the inferior mesenteric artery distal to the left colic artery or the complete preservation of the inferior mesenteric artery can therefore be compared in terms of preservation of the descending sympathetic fibres running along the aorta to the rectum resulting in a different post operative genito urinary function. From January 2015 to March 2016, 66 patients underwent elective laparoscopic sigmoidectomy for diverticular disease among two enrolling hospitals. In one centre 35 patients underwent laparoscopic sigmoidectomy with the ligation of the inferior mesenteric artery distal to the left colic artery (low ligation). In the other centre 31 patient were operated on the same procedure with complete inferior mesenteric artery preservation (IMA preservation). There was no difference in terms of major complication occurred, first passage of stool and length of hospital stay between the two groups. Time of surgery was significantly shorter in LL group compared to IMA preserving group and intra operative blood loss was significantly lower in the LL group. There were no differences in the genito urinary function between the two group pre operatively, at 1 and 9 months post operatively. Genito urinary function did not significantly change across surgery in each groups. The low ligation and the IMA preserving vascular approach are safe end feasible techniques in elective laparoscopic sigmoidectomy for diverticular disease. They both prevent from genito-urinary post-operative disfunction and allow good post operative quality of life. The low ligation approach is related to shorter operative time and slower intra operative blood loss.},
}
@article {pmid28461904,
year = {2017},
author = {Broersen, LHA and Horváth-Puhó, E and Pereira, AM and Erichsen, R and Dekkers, OM and Sørensen, HT},
title = {Corticosteroid use and mortality risk in patients with perforated colonic diverticular disease: a population-based cohort study.},
journal = {BMJ open gastroenterology},
volume = {4},
number = {1},
pages = {e000136},
pmid = {28461904},
issn = {2054-4774},
abstract = {BACKGROUND: Corticosteroids are a potential risk factor for mortality in patients with perforated diverticular disease, due to blinding of disease severity, hampered wound healing or adrenal insufficiency. We examined mortality in corticosteroid users and non-users among patients with perforated diverticular disease.
METHODS: A cohort study based on medical databases including all patients ≥18 years in Denmark (source population 5 289 261 inhabitants) admitted to a hospital with incident perforated diverticular disease between 2005 and 2013. 7-day, 1-month, 3-month and 1-year mortality risks in corticosteroid users and non-users were calculated using the Kaplan-Meier method, and compared with Cox proportional hazard regression adjusted for age, sex and comorbidities.
RESULTS: The study included 4640 patients with perforated diverticular disease. Of these, 3743 (80.7%) had not used corticosteroids in the year before admission and 725 (15.6%) had been exposed to systemic corticosteroid treatment. The remaining 172 patients had been exposed to either inhaled or intestinal acting corticosteroid therapy. Mortality risk in non-users was 4.4% after 7 days and 15.6% after 1 year. This risk was doubled for corticosteroid users who filled their last prescription during the 90 days before admission, with mortality risks ranging from 14.2% after 7 days to 47.6% after 1 year. 1-year mortality risk was even higher for corticosteroid users with a first filled prescription ≤90 days before admission: 52.5%.
CONCLUSIONS: Corticosteroid use was associated with clearly increased mortality risk after perforated diverticular disease. Thus, use of corticosteroids should be regarded as an important clinical prognostic factor for mortality in patients with this condition.},
}
@article {pmid28458843,
year = {2017},
author = {Chadwick, T and Katti, A and Arthur, J},
title = {Sigmoid-gluteal fistula: a rare complication of fistulating diverticular disease.},
journal = {Journal of surgical case reports},
volume = {2017},
number = {3},
pages = {rjw237},
pmid = {28458843},
issn = {2042-8812},
abstract = {A rare complication of diverticular disease is the formation of fistulas, most commonly either colo-vesical or colo-vaginal. We present the unusual case of a perforated sigmoid diverticulum forming a colo-gluteal fistula and presenting initially as a gluteal abscess in an otherwise asymptomatic patient. After drainage of the gluteal abscess, the patient re-presented with faecal loss from the abscess drainage site. Imaging revealed fistulous communication between the sigmoid and the left obturator internus muscle, tracking to the gluteus maximus with associated abscess and cutaneous communication to the site of previous drainage. The patient underwent an emergency Hartmann's procedure with lay open/abscess drainage of the gluteal cavity. Post-operatively the patient experienced continuing discharge from the gluteal fistula despite repeated drainage and debridement causing considerable morbidity, inconvenience and misery. Clinicians should maintain a high index of suspicion when presented with a gluteal abscess and should consider the possibility of an intra-abdominal source.},
}
@article {pmid28453588,
year = {2017},
author = {Fluxá, D and Quera, R},
title = {[Diverticular disease: myths and realities].},
journal = {Revista medica de Chile},
volume = {145},
number = {2},
pages = {201-208},
doi = {10.4067/S0034-98872017000200009},
pmid = {28453588},
issn = {0717-6163},
mesh = {*Diverticulitis/classification/diagnosis/etiology/therapy ; Humans ; },
abstract = {Diverticulosis and diverticular disease of the colon are common conditions in Western countries. The incidence and prevalence of these diseases are increasing and becoming significant for health systems. A growing body of knowledge is shifting the paradigm of the pathogenesis and treatment of diverticular disease. Low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors leading to diverticular disease. The risk of developing diverticulitis among individuals with diverticulosis is lower than 10 to 25%. Studies indicate that diverticular disease may become a chronic disorder in some patients, not merely an acute illness. Contrary to the advice from international guidelines, studies have not shown that a high-fiber diet protects against diverticulosis. The evidence about the use of antibiotics in uncomplicated diverticulitis is sparse and of low quality. In relation to surgery, studies support a more conservative approach to prophylactic surgery in patients with recurrent disease or chronic symptoms. Finally, new pathophysiological knowledge suggests that other treatments may be useful (mesalamine, rifaximin and probiotics). However, more research is necessary to validate the safety, effectiveness and cost-effectiveness of these strategies.},
}
@article {pmid28438753,
year = {2017},
author = {Karas, L and Asif, M and Chun, V and Khan, FA},
title = {Complicated small bowel diverticular disease: a case series.},
journal = {BMJ case reports},
volume = {2017},
number = {},
pages = {},
pmid = {28438753},
issn = {1757-790X},
mesh = {Aged ; Aged, 80 and over ; Diagnosis, Differential ; Diagnostic Imaging ; Disease Progression ; Diverticular Diseases/*diagnosis/pathology/therapy ; Female ; Humans ; Ileal Diseases/*diagnosis/pathology/therapy ; *Intestine, Small ; Jejunal Diseases/*diagnosis/pathology/therapy ; Male ; },
abstract = {Small bowel diverticulosis of the jejunum and ileum is an uncommon finding with a prevalence rate of 0.2% to 1.3% at autopsy and 0.3% to 1.9% on small bowel studies. Diagnosis can be difficult because there are no pathognomonic features or clinical symptoms that are specific for small bowel diverticulosis. Though rare, it is critical to keep the possibility of small bowel diverticulosis in mind when evaluating cases of malabsorption, chronic abdominal pain, haemorrhage, perforation and intestinal obstruction, especially in patients with connective tissue disorders, a family history of diverticula and a personal history of colonic diverticulosis. Guidelines for the treatment of complicated small bowel diverticulosis are not clearly defined. However, the consensus in treatment is to do a small bowel resection with primary anastomosis. We report three interesting cases of jejunoileal diverticula that presented in an occult manner and later progressed to more emergent manifestations.},
}
@article {pmid28436177,
year = {2017},
author = {Jaung, R and Robertson, J and O'Grady, G and Milne, T and Rowbotham, D and Bissett, IP},
title = {Limited evidence of abnormal intra-colonic pressure profiles in diverticular disease - a systematic review.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {19},
number = {6},
pages = {O168-O176},
doi = {10.1111/codi.13692},
pmid = {28436177},
issn = {1463-1318},
mesh = {Case-Control Studies ; Colon, Sigmoid/*physiopathology ; Diverticular Diseases/*physiopathology ; Diverticulosis, Colonic/*physiopathology ; Humans ; Manometry ; *Pressure ; },
abstract = {AIM: Abnormal colonic pressure profiles and high intraluminal pressures are postulated to contribute to the formation of sigmoid colon diverticulosis and the pathophysiology of diverticular disease. This study aimed to review evidence for abnormal colonic pressure profiles in diverticulosis.
METHOD: All published studies investigating colonic pressure in patients with diverticulosis were searched in three databases (Medline, Embase, Scopus). No language restrictions were applied. Any manometry studies in which patients with diverticulosis were compared with controls were included. The Newcastle-Ottawa Quality Assessment Scale (NOS) for case-control studies was used as a measure of risk of bias. A cut-off of five or more points on the NOS (fair quality in terms of risk of bias) was chosen for inclusion in the meta-analysis.
RESULTS: Ten studies (published 1962-2005) met the inclusion criteria. The studies followed a wide variety of protocols and all used low-resolution manometry (sensor spacing range 7.5-15 cm). Six studies compared intra-sigmoid pressure, with five of six showing higher pressure in diverticulosis vs controls, but only two reached statistical significance. A meta-analysis was not performed as only two studies were above the cut-off and these did not have comparable outcomes.
CONCLUSION: This systematic review of manometry data shows that evidence for abnormal pressure in the sigmoid colon in patients with diverticulosis is weak. Existing studies utilized inconsistent methodology, showed heterogeneous results and are of limited quality. Higher quality studies using modern manometric techniques and standardized reporting methods are needed to clarify the role of colonic pressure in diverticulosis.},
}
@article {pmid28428661,
year = {2017},
author = {Muglia, VF},
title = {Diverticular disease of the colon: evolution of the therapeutic approach and the role of computed tomography in the evaluation of acute conditions.},
journal = {Radiologia brasileira},
volume = {50},
number = {2},
pages = {IX-X},
pmid = {28428661},
issn = {0100-3984},
}
@article {pmid28424872,
year = {2017},
author = {Tin, K and Sobani, ZA and Anyadike, N and Serur, A and Mayer, I and Iswara, K and Tsirlin, Y},
title = {Percutaneous endoscopic sigmoidopexy using T-fasteners for management of sigmoid volvulus.},
journal = {International journal of colorectal disease},
volume = {32},
number = {7},
pages = {1073-1076},
pmid = {28424872},
issn = {1432-1262},
mesh = {Aged ; Aged, 80 and over ; *Endoscopy ; Fatal Outcome ; Humans ; Intestinal Volvulus/*surgery ; Male ; Sigmoid Diseases/*surgery ; *Surgical Fixation Devices ; },
abstract = {BACKGROUND: Sigmoid volvulus (SV) is the third leading cause of large bowel obstruction after colonic neoplasms and diverticular disease. SV has traditionally been managed via endoscopic detorsion and decompression followed by non-emergent surgical resection owing to the high risk of recurrence. Most cases of SV occur in elderly debilitated patients with multiple comorbidities and may not be candidates for surgical resection. Endoscopic sigmoidopexy has been described as an alternative to surgical resection. Here, we describe our experience with endoscopic sigmoidopexy using T-fasteners.
METHODS: Three patients with recurrent SV that were identified as poor surgical candidates by our colorectal surgery team underwent endoscopic sigmoidopexy. The patients received preoperative bowel preparation. A colonoscope was inserted and the site of the volvulus was visualized and assessed for adequate decompression. Subsequently, four points of fixation were identified and T-fasteners were deployed.
RESULTS: Two patients underwent successful sigmoidopexy without any complications or recurrence on follow-up. One patient developed post procedure pneumoperitoneum that was successfully treated conservatively; however, he passed away from their underlying comorbidities.
CONCLUSION: Overall, preliminary results for sigmoidopexy using T-fasteners have been promising, offering a potential option to prevent recurrence in high risk patients unsuitable for surgical intervention.},
}
@article {pmid28416357,
year = {2017},
author = {Rosado-Cobián, R and Blasco-Segura, T and Ferrer-Márquez, M and Marín-Ortega, H and Pérez-Domínguez, L and Biondo, S and Roig-Vila, JV},
title = {Complicated diverticular disease: Position statement on outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage and laparoscopic approach. Consensus document of the Spanish Association of Coloproctology and the Coloproctology Section of the Spanish Association of Surgeons.},
journal = {Cirugia espanola},
volume = {95},
number = {7},
pages = {369-377},
doi = {10.1016/j.ciresp.2017.03.008},
pmid = {28416357},
issn = {1578-147X},
mesh = {Ambulatory Care ; Diverticulum, Colon/*complications/*therapy ; Humans ; Laparoscopy ; Peritoneal Lavage/methods ; },
abstract = {The Spanish Association of Coloproctology (AECP) and the Coloproctology Section of the Spanish Association of Surgeons (AEC), propose this consensus document about complicated diverticular disease that could be used for decision-making. Outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage, and the role of a laparoscopic approach in colonic resection are exposed.},
}
@article {pmid28393286,
year = {2017},
author = {Aune, D and Sen, A and Leitzmann, MF and Norat, T and Tonstad, S and Vatten, LJ},
title = {Body mass index and physical activity and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies.},
journal = {European journal of nutrition},
volume = {56},
number = {8},
pages = {2423-2438},
pmid = {28393286},
issn = {1436-6215},
mesh = {*Body Mass Index ; Diverticular Diseases/complications/*epidemiology ; *Exercise ; Humans ; Incidence ; Obesity/complications/*epidemiology ; Risk Factors ; Sensitivity and Specificity ; Waist Circumference ; Waist-Hip Ratio ; },
abstract = {PURPOSE: We conducted a systematic review and meta-analysis of prospective studies of the association between body mass index (BMI) and physical activity and diverticular disease risk.
METHODS: PubMed and Embase databases were searched up to February 7, 2017. Summary relative risks and 95% confidence intervals (95% CIs) were calculated using a random effects model and nonlinear associations were modeled using fractional polynomial models.
RESULTS: Six cohort studies of BMI and diverticular disease risk (28,915 cases, 1,636,777 participants) and five cohort studies of physical activity and diverticular disease risk (2080 cases, 147,869 participants) were included. The summary relative risk (RR) of incident diverticular disease for a 5 unit BMI increment was 1.28 (95% CI: 1.18-1.40, I [2] = 77%, n = 6) for diverticular disease, 1.31 (95% CI: 1.09-1.56, I [2] = 74%, n = 2) for diverticulitis, and 1.20 (95% CI: 1.04-1.40, I [2] = 56%, n = 3) for diverticular disease complications. There was no evidence of a nonlinear association between BMI and diverticular disease risk (p nonlinearity = 0.22), and risk increased even within the normal weight range. Compared to a BMI of 20, the summary RR for a BMI of 22.5, 25.0, 27.5, 30.0, 32.5, 35.0, 37.5, and 40.0 was 1.15 (1.07-1.23), 1.31 (1.17-1.47), 1.50 (1.31-1.71), 1.71 (1.52-1.94), 1.96 (1.77-2.18), 2.26 (2.00-2.54), 2.60 (2.11-3.21), and 3.01 (2.06-4.39), respectively. The summary RR was 0.76 (95% CI: 0.63-0.93, I [2] = 54%, n = 5) for high vs. low physical activity and 0.74 (95% CI: 0.57-0.97, I [2] = 39.5%, p heterogeneity = 0.20, n = 2) for high vs. low vigorous physical activity.
CONCLUSIONS: These results suggest that even moderate increases in BMI may increase the risk of diverticular disease as well as diverticular disease complications and that a higher level of physical activity may reduce the risk.},
}
@article {pmid28391674,
year = {2017},
author = {Annibale, B},
title = {Diverticular disease: myths and facts.},
journal = {Minerva gastroenterologica e dietologica},
volume = {63},
number = {2},
pages = {97-98},
doi = {10.23736/S1121-421X.17.02394-7},
pmid = {28391674},
issn = {1827-1642},
mesh = {Diet ; Dietary Fiber/therapeutic use ; Diverticular Diseases/complications/*therapy ; Diverticulitis/etiology/prevention & control ; Humans ; },
}
@article {pmid28387885,
year = {2017},
author = {Festa, V and Spila Alegiani, S and Chiesara, F and Moretti, A and Bianchi, M and Dezi, A and Traversa, G and Koch, M},
title = {Retrospective comparison of long-term ten-day/month rifaximin or mesalazine in prevention of relapse in acute diverticulitis.},
journal = {European review for medical and pharmacological sciences},
volume = {21},
number = {6},
pages = {1397-1404},
pmid = {28387885},
issn = {2284-0729},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis/*drug therapy ; Female ; Humans ; Male ; Mesalamine/*administration & dosage ; Middle Aged ; Recurrence ; Retrospective Studies ; Rifamycins/*administration & dosage ; Rifaximin ; Treatment Outcome ; },
abstract = {OBJECTIVE: Diverticular disease (DD) of the colon has an increasing burden on health services. The effectiveness of rifaximin for the treatment of DD, is not yet established. The aim of this study is to assess the impact of long-term treatment with rifaximin or mesalazine in a 10-day schedule for the prevention of recurrent diverticulitis.
PATIENTS AND METHODS: This is a retrospective study. We identified all consecutive patients with DD and previous acute diverticulitis (AD) in our outpatients' database; 124 patients, were included. The recommended therapy consisted of a ten-day/month treatment with either rifaximin (400 mg bid), or mesalazine (2.4 g/daily). Primary end point was AD recurrence.
RESULTS: Between 2010 and 2014, 72 patients were treated with rifaximin and 52 with mesalazine. During a median follow-up of 15 months (range 1-50), we observed 21 episodes of AD among users of either rifaximin (n=7; 0.54 per 100 person-months), or mesalazine group (n=14; 1.46 per 100 person-months). Kaplan-Meier survival estimates of recurrent AD significantly differed between rifaximin and mesalazine groups (p=0.015). The multivariate Cox regression analysis showed that AD recurrence was significantly associated with therapy (rifaximin vs. mesalazine, adjusted HR 0.27; 95% CI: 0.10 to 0.72), age and gender.
CONCLUSIONS: Long-term treatment with rifaximin in a 10-day schedule appears more effective than mesalazine in preventing recurrent AD.},
}
@article {pmid28378155,
year = {2017},
author = {Sohn, M and Schlitt, HJ and Hornung, M and Zülke, C and Hochrein, A and Moser, C and Agha, A},
title = {Preservation of the superior rectal artery: influence of surgical technique on anastomotic healing and postoperative morbidity in laparoscopic sigmoidectomy for diverticular disease.},
journal = {International journal of colorectal disease},
volume = {32},
number = {7},
pages = {955-960},
pmid = {28378155},
issn = {1432-1262},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomotic Leak/*etiology ; Cohort Studies ; Colon, Sigmoid/*surgery ; Demography ; Diverticular Diseases/*epidemiology/*surgery ; Female ; Humans ; Intraoperative Care ; Laparoscopy/*adverse effects ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/epidemiology/*etiology ; Rectum/*blood supply/*surgery ; Wound Healing ; Young Adult ; },
abstract = {PURPOSE: To evaluate the impact of superior rectal artery (SRA) sparing technique on anastomotic leakage in laparoscopic sigmoidectomy for diverticular disease.
MATERIAL AND METHODS: A retrospective multicenter analysis of all patients undergoing laparoscopic sigmoid resection for diverticular disease between 2002 and 2015 was conducted. Data were recorded in three hospitals: University Hospital Regensburg, Marienhospital Gelsenkirchen, and Städtisches Klinikum München Bogenhausen. The SRA was resected between 2002 and 2005. Since 2005, the artery was preserved in most cases.
RESULTS: Two hundred sixty-seven patients were included. One hundred sixty patients presented with complicated diverticulitis (60%). The SRA was resected in 102 patients (group 1) and preserved in 157 patients (group 2, no data in eight cases). Anastomotic leakage occurred in 7% of patients in group 1 and 1.9% of patients in group 2 (p = 0.053). Duration of surgery was significantly shorter (157 vs. 183 min, p < 0.001) in group 2 patients. Length of hospital stay was without significant difference (group 1 8.2 days; group 2 8.3 days; p = 0.83). The conversion rate was higher in group 2 patients; however, the difference was not statistically significant (9 vs. 3%, p = 0.07). There was no significant difference between both groups regarding intraoperative complications and overall complication rate. The length of the resected specimen (19 vs. 21 cm, p = 0.001) was significantly shorter in group 2 patients.
CONCLUSION: Preservation of the SRA seems to be associated with favorable outcome in patients undergoing laparoscopic sigmoid resection for diverticular disease.},
}
@article {pmid28374053,
year = {2017},
author = {Roch, PJ and Friedrich, T and Bönninghoff, R and Dinter, D and Rickert, A},
title = {[Laparoscopic resection of a giant colon diverticulum : Case report and review of the literature].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {88},
number = {8},
pages = {682-686},
pmid = {28374053},
issn = {1433-0385},
mesh = {Aged, 80 and over ; Colon, Descending/diagnostic imaging/surgery ; Diagnosis, Differential ; Diverticulum, Colon/classification/diagnostic imaging/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Giant diverticula are rare complications of diverticular disease. Current opinion regards operative therapy as the method of choice for the treatment of symptomatic giant diverticula; however, there is neither consensus about the technique nor about the necessary extent of resection. Based on a non-systematic review of the literature, an overview of giant diverticula in terms of epidemiology, pathology and classification is given. The current case is considered with respect to appropriate diagnostic procedures and possible therapeutic options.
CASE PRESENTATION: An 80-year-old female patient presented to the emergency department with abdominal pain and dyspnea. A computed tomography scan showed a large gas-filled structure in the upper left abdomen adjacent to the left colon. A giant colonic diverticulum was suspected and laparoscopy was performed. Intraoperatively, the diagnosis of a giant colon diverticulum located at the splenic flexure was confirmed. An unremarkable diverticulosis only was found in the descending colon. The giant diverticulum was treated by an atypical colon wedge resection and the postoperative course was uneventful.
DISCUSSION: This case report describes a laparoscopic atypical colon wedge resection as treatment of a giant colon diverticulum. Only four laparoscopic bowel resections in terms of sigmoid resections or hemicolectomy with primary anastomosis have been reported. Minimally invasive surgery can be a valuable alternative to open procedures. In the current case a laparoscopic atypical colon wedge resection was safely performed. This option might be considered as an alternative to extended resections of giant diverticula. Localization of the giant diverticulum and the simultaneous existence of diverticular disease are the main criteria for the decision between the different operative approaches.},
}
@article {pmid28368961,
year = {2017},
author = {Badic, B and Leroux, G and Thereaux, J and Joumond, A and Gancel, CH and Bail, JP and Meurette, G},
title = {Colovesical Fistula Complicating Diverticular Disease: A 14-Year Experience.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {27},
number = {2},
pages = {94-97},
doi = {10.1097/SLE.0000000000000375},
pmid = {28368961},
issn = {1534-4908},
mesh = {Aged ; Colectomy/methods ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Intestinal Fistula/complications/*surgery ; Laparoscopy/*methods ; Length of Stay/statistics & numerical data ; Male ; Operative Time ; Recurrence ; Treatment Outcome ; },
abstract = {OBJECTIVE: Colovesical fistulas (CVF) constitute the most common type of spontaneously occurring fistulas associated with diverticular disease. One-stage laparoscopic resection has been shown to be feasible, but studies comparing this approach to open surgery are scarce. The aim of this study was to compare the clinical outcomes of open and laparoscopic surgery for CVF of diverticular origin.
MATERIALS AND METHODS: From January 2000 to July 2014, 37 colectomies were performed for diverticular disease-related CVF. Twenty-eight patients who underwent resection and primary anastomosis were divided in 2 groups: the laparoscopic surgery group (group A) and the open surgery group (group B). We have analyzed the following parameters: operative time, complication rate, hospital stay, recurrence, and early mortality rate.
RESULTS: Groups A and B were comparable in terms of age, sex, diverticulitis episodes, previous abdominal surgery, and body mass index.The mean duration of surgery was significantly shorter in group B: 175 versus 237 minutes (P=0.011). There was a faster recovery of gastrointestinal transit in group A (2 vs. 13; P=0, 0002). However, there were no significant differences between the groups with respect to serious postoperative morbidity [(Clavien-Dindo scores of 3, 4, and 5) 4 vs. 0; P=0.098)] and with respect to hospital stay (10.5 vs. 9.5 d; P=0.537). There was no recurrence during a median follow-up of 12 months.
CONCLUSIONS: Laparoscopic resection and primary anastomosis should be considered a safe and feasible option for the management of diverticular CVF. Despite progresses in minimally invasive colorectal surgery, the conversion rate and morbidity are still high.},
}
@article {pmid28316316,
year = {2017},
author = {Rencuzogullari, A and Ozuner, G and Binboga, S and Aytac, E and Krishnamurthi, V and Gorgun, E},
title = {Colonic Diverticulosis and Diverticulitis in Renal Transplant Recipients: Management and Long-Term Outcomes.},
journal = {The American surgeon},
volume = {83},
number = {3},
pages = {303-307},
pmid = {28316316},
issn = {1555-9823},
mesh = {Colonoscopy ; Diverticulitis, Colonic/diagnostic imaging/*surgery ; Diverticulosis, Colonic/diagnostic imaging/*surgery ; Female ; Humans ; *Kidney Transplantation ; Male ; Middle Aged ; Risk Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {Data regarding management of colonic diverticulitis in renal transplant recipients (RTRs) are limited. This study aims to identify prevalence, risk factors, and outcomes in RTRs with colonic diverticulosis and diverticulitis. Between January 2004 and December 2013, all patients who underwent kidney transplantation were analyzed. Among all RTSs, patients who had a pretransplant colonoscopic diagnosis of diverticulosis and patients with a proven attack of diverticulitis were included in our analysis. There were 1578 RTRs with a mean age of 50 ± 14 years at the time of transplantation. Of these, 409 patients had colonoscopic evaluation and 174 (43%) were diagnosed with diverticular disease. Fifteen (0.9%) out of 1578 developed a primary attack of diverticulitis. Two patients underwent a Hartmann's procedure due to perforation. Among 13 patients who were initially treated nonoperatively, 4 required surgery due to refractory diverticulitis (n = 2) and recurrence (n = 2). Tobacco use (59% vs 48%, P = 0.02), increased age (58 vs 51 years, P < 0.0001), diabetes (33% vs 35%, P = 0.03), coronary artery disease (38% vs 22%, P = 0.001), and autosomal dominant polycystic kidney disease etiology (P = 0.04) were more common in RTRs with diverticulosis. Majority of RTRs with diverticulitis can be managed nonoperatively. Surgical treatment is warranted in patients with perforated, persistent, and recurrent diverticulitis. A special care and follow-up may be needed in RTRs with autosomal dominant polycystic kidney disease etiology, smoking history, and coronary artery disease due to higher risk of diverticulosis and subsequent potential diverticulitis.},
}
@article {pmid28299869,
year = {2017},
author = {Bartels, LE and Jepsen, P and Tøttrup, A and Vilstrup, H and Dahlerup, JF},
title = {Helicobacter pylori infection is associated with reduced prevalence of colonic diverticular disease.},
journal = {Helicobacter},
volume = {22},
number = {4},
pages = {},
doi = {10.1111/hel.12384},
pmid = {28299869},
issn = {1523-5378},
mesh = {Adult ; Cohort Studies ; Denmark/epidemiology ; Diverticulitis, Colonic/*epidemiology ; Female ; Helicobacter Infections/*complications ; Humans ; Incidence ; Longitudinal Studies ; Male ; Middle Aged ; Prevalence ; },
abstract = {BACKGROUND: Colonic diverticular disease is a common disorder with increasing incidence in Western societies. The intestinal microbiome may be among etiological factors. Helicobacter pylori may protect against some intestinal diseases, and incidence of H. pylori is decreasing in Western societies. Thus, we aimed to determine whether H. pylori is associated to decreased prevalence of registered colonic diverticular disease.
MATERIALS AND METHODS: In a historical cohort study, patients were enrolled from primary health care centers after urea breath test for H. pylori and then followed for a median of 6 years. The patient's diagnostic codes and country of birth were acquired from nationwide Danish administrative registries. We used logistic regression to compare prevalence and Cox regression to compare incidence of diverticular disease between H. pylori-positive and H. pylori-negative patients, adjusting for confounding variables.
RESULTS: Patients infected with H. pylori had lower prevalence of colonic diverticular disease (0.87% vs 1.14%, OR=0.62, 95% CI: 0.50-0.78). This phenomenon was observed whether we studied all registered diagnoses or only cases registered as primary diagnoses at discharge. After urea breath test, we observed no statistical difference in incidence rates of diverticular disease.
CONCLUSION: H. pylori is associated with reduced prevalence of colonic diverticular disease. The inverse association was absent after the urea breath test. Thus, we speculate that H. pylori may provide protection from colonic diverticular disease. Alternatively, H. pylori is a marker for other factors affecting disease development.},
}
@article {pmid28286055,
year = {2017},
author = {Tursi, A and Mastromarino, P and Capobianco, D and Elisei, W and Miccheli, A and Pratico', G and Picchio, M and Brandimarte, G},
title = {Urinary metabolic profiling and symptomatic uncomplicated diverticular disease of the colon.},
journal = {Clinics and research in hepatology and gastroenterology},
volume = {41},
number = {3},
pages = {344-346},
doi = {10.1016/j.clinre.2017.01.006},
pmid = {28286055},
issn = {2210-741X},
mesh = {Biomarkers/urine ; Body Mass Index ; Creatinine/urine ; Diverticulosis, Colonic/*diagnosis/metabolism/*urine ; Female ; Hippurates/*urine ; Humans ; *Metabolome ; Methanol/*urine ; *Microbiota ; Middle Aged ; Predictive Value of Tests ; Research Design ; Sensitivity and Specificity ; },
}
@article {pmid28276818,
year = {2017},
author = {Wrafter, PF and Connelly, TM and Khan, JS and Lucey, BC and Berg, A and Koltun, W and Joyce, WP},
title = {Diverticular disease is associated with benign intra-abdominal cystic disease.},
journal = {Expert review of gastroenterology & hepatology},
volume = {11},
number = {5},
pages = {487-490},
doi = {10.1080/17474124.2017.1294061},
pmid = {28276818},
issn = {1747-4132},
mesh = {Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cysts/diagnostic imaging/*epidemiology ; Diverticulum/diagnostic imaging/*epidemiology ; Female ; Humans ; Incidence ; Ireland/epidemiology ; Kidney Diseases, Cystic/diagnostic imaging/*epidemiology ; Liver Diseases/diagnostic imaging/*epidemiology ; Male ; Middle Aged ; Multidetector Computed Tomography ; Prospective Studies ; Radiography, Abdominal/methods ; },
abstract = {BACKGROUND: Diverticular disease (DD) and hepatic and renal cysts have been linked with defects in collagen and dysfunctional matrix metalloproteinases.
METHODS: Consecutive abdominal computed tomography scans between January-July 2015 were prospectively studied to determine a correlation between visceral cysts and DD. Patients with a sigmoid colectomy for pathology other than DD and scans in which DD and/or solid organs were not fully visualized were excluded. A subgroup analysis was performed on youthful DD patients (<55 years of age, n = 32) vs. older controls (>55, n = 213).
RESULTS: 238 DD patients (50.8% male) and 369 controls (40.5% male, p = .02) were included. Incidence of visceral cystic disease in DD patients vs. controls was 71.4% vs. 22.5% (p < 0.00001). Renal cysts, present in 53.4% of the DD patients and 18.7% of the controls (p < .00001), were more common than hepatic cysts in both groups. Hepatic cyst prevalence was 8.8 vs. 2.4% (p = .0008). In the subgroup analysis, cystic disease was present in 56.2% of youthful DD patients vs. 29.1% of older controls (p = .004).
CONCLUSIONS: A significant association between cystic disease and DD was demonstrated overall and in subgroup analysis inclusive of youthful DD patients and older controls. These findings suggest a global defect in connective tissue integrity in DD patients.},
}
@article {pmid28270872,
year = {2017},
author = {Dirweesh, A and Amodu, A and Khan, M and Zijoo, R and Ambreen, B and Ibrahim, M and Ijaz, M and Nawwar, A and Genena, K and Tahir, M and Kumar, N and Debari, VA and Wallach, S},
title = {Symptomatic Diverticular Disease in Patients With Severely Reduced Kidney Function: Higher Rates of Complications and Transfusion Requirement.},
journal = {Gastroenterology research},
volume = {10},
number = {1},
pages = {15-20},
pmid = {28270872},
issn = {1918-2805},
abstract = {BACKGROUND: The prevalence of diverticulosis is increasing with 5-10% of patients developing diverticulitis and 5-15% developing symptomatic bleeding. Diverticulitis can result in abscess, perforation, fistula, or obstruction. Bleeding has combined morbidity and mortality rates of 10-20%. The purpose of this study was to compare diverticulitis-related complications and transfusion requirements for diverticular bleeding in patients with normal to moderately reduced kidney function (glomerular filtration rate (GFR) ≥ 30 mL/min/1.73 m[2]) and patients with severe renal impairment (GFR < 30 mL/min/1.73 m[2]), and identify factors associated with these outcomes.
METHODS: We retrospectively reviewed records of all patients with diverticulitis and diverticular bleeding treated at our hospital from January 1, 2011 to July 31, 2016. Patients were evaluated for baseline characteristics, GFR, baseline hemoglobin, medications, comorbidities, length of stay (LOS), presence of perforations or abscesses and the need for transfusion.
RESULTS: Of the 291 patients included, males were 167 (58%). Perforations and abscesses complicating diverticulitis developed in 31/136 (23%) of patients with GFR ≥ 30 mL/min/1.73 m[2], and in 13/26 (50%) of patients with GFR < 30 mL/min/1.73 m[2] (odds ratio (OR): 3.4; 95% confidence interval (CI): 1.423 - 8.06; P = 0.0073). Mean LOS (days) was 6.3 ± 4 in the GFR ≥ 30 mL/min/1.73 m[2] group and 8.5 ± 4.4 in GFR < 30 mL/min/1.73 m[2] group (P = 0.0001). Blood transfusion for diverticular bleeding occurred in 11/78 (14%) of patients with GFR ≥ 30 mL/min/1.73 m[2] and in 22/51 (43%) of patients with GFR < 30 mL/min/1.73 m[2] (OR: 4.6; 95% CI: 1.99 - 10.76; P = 0.0004). Among patients who needed transfusion, mean LOS was 8.5 ± 2.5 in GFR ≥ 30 mL/min/1.73 m[2] group and 9 ± 5 in those with GFR < 30 mL/min/1.73 m[2] (P = 0.04). There were no differences in age, gender or race between the study groups.
CONCLUSION: There was a significant increase in complicated diverticulitis cases, transfusion requirements for diverticular bleeding and LOS in patients with severely reduced kidney function compared to patients with normal-moderately reduced renal function.},
}
@article {pmid28267692,
year = {2017},
author = {Lin, X and Li, J and Ying, M and Wei, F and Xie, X},
title = {Diabetes Increases Morbidities of Colonic Diverticular Disease and Colonic Diverticular Hemorrhage: A Systematic Review and Meta-Analysis.},
journal = {American journal of therapeutics},
volume = {24},
number = {2},
pages = {e213-e221},
doi = {10.1097/MJT.0000000000000410},
pmid = {28267692},
issn = {1536-3686},
mesh = {Colonic Diseases/epidemiology/etiology ; Comorbidity ; Diabetes Mellitus/*epidemiology ; Diverticulosis, Colonic/complications/*epidemiology ; Gastrointestinal Hemorrhage/*epidemiology/etiology ; Humans ; Incidence ; Risk Factors ; },
abstract = {Colonic diverticular disease (CDD) and colonic diverticular hemorrhage (CDH) are the most common disorders in hospital admissions and outpatient health clinic visits. However, risk factors of CDD and CDH are complicated and need to be discussed. Diabetes mellitus (DM) has been related with CDD and CDH, but the associations remain ambiguous. Therefore, we performed a literature search for studies involving the associations among DM, morbidity of CDD, and incidence of CDH. Relative risks or odds ratios with their corresponding 95% confidence intervals (CIs) were combined and weighted to produce summary effect size. Sensitivity analysis and subgroup analysis were further performed. We selected 17 studies that involved a total of 8212 patients with diabetes, 381,579 controls without diabetes. We found that patients with DM had approximately 1.201 times higher CDD morbidity in prospective studies (95% CI, 1.135-1.270) with no significant heterogeneity (Q = 0.42, P = 0.519, I = 0%). DM was associated with a 52.8% increase in risk of CDH (95% CI, 14%-104%); we did not find significant heterogeneity among these studies (Q = 12.94, P = 0.114, I = 38.2%). This meta-analysis confirms that DM is an important risk factor for morbidities of CDD and CDH.},
}
@article {pmid28253730,
year = {2017},
author = {Bustamante-Lopez, LA and Sulbaran, M and Nahas, SC and de Moura, EG and Nahas, CS and Marques, CF and Sakai, C and Cecconello, I and Sakai, P},
title = {Endoscopic colostomy with percutaneous colopexy: an animal feasibility study.},
journal = {Revista espanola de enfermedades digestivas},
volume = {109},
number = {4},
pages = {273-278},
doi = {10.17235/reed.2017.4201/2016},
pmid = {28253730},
issn = {1130-0108},
mesh = {Animals ; Colostomy/adverse effects/*methods ; Endoscopy, Gastrointestinal/adverse effects/*methods ; Feasibility Studies ; Feeding Behavior ; Female ; Postoperative Period ; Sus scrofa ; Swine ; },
abstract = {BACKGROUND: Indications for colostomy in colorectal diseases are obstruction of the large bowel, such as in cancer, diverticular disease in the acute phase, post-radiotherapy enteritis, complex perirectal fistulas, anorectal trauma and severe anal incontinence. Some critically ill patients cannot tolerate an exploratory laparotomy, and laparoscopic assisted colostomy also requires general anesthesia.
OBJECTIVE: To evaluate the feasibility, safety and efficacy of performing colostomy assisted by colonoscopy and percutaneous colopexy.
MATERIALS AND METHODS: Five pigs underwent endoscopic assisted colostomy with percutaneous colopexy. Animals were evaluated in post-operative days 1, 2, 5 and 7 for feeding acceptance and colostomy characteristics. On day 7 full colonoscopy was performed on animals followed by exploratory laparotomy.
RESULTS: Average procedure time was 27 minutes (21-54 min). Postoperative mobility and feeding of animals were immediate after anesthesia recovery. Position of the colostomy, edges color, appearance of periostomal area, as well as its function was satisfactory in four animals. Retraction of colostomy was present in one pig. The colonoscopy and laparotomy control on the seventh day were considered as normal. A bladder perforation that was successfully repaired through the colostomy incision occurred in one pig. The main limitation of this study is its experimental nature.
CONCLUSION: Endoscopic assisted colostomy with percutaneous colopexy proves to be a safe and effective method with low morbidity for performing colostomy in experimental animals, with possible clinical application in humans.},
}
@article {pmid28250979,
year = {2016},
author = {Swann, J and Kaczynski, J},
title = {An unusual radiological presentation of mucinous adenocarcinoma of the colon.},
journal = {Interventional medicine & applied science},
volume = {8},
number = {1},
pages = {26-28},
pmid = {28250979},
issn = {2061-1617},
abstract = {We report a case of an elderly patient presenting with the left iliac fossa mass. The provisional diagnosis included an inflammatory diverticular mass or sigmoid colon cancer. Interestingly, computed tomography (CT) of the abdomen and pelvis demonstrated the left incarcerated Spigelian hernia containing an inflamed loop of the colon with signs of an early strangulation. However, at operation, a mucinous tumor was found involving the descending and upper sigmoid colon. The tumor eroded through the anterior abdominal wall, which was excised "en bloc." In the presented case, CT findings suggestive of a benign etiology were misleading. This potentially could have had significant consequences if the patient was treated conservatively. This case highlights that clinical history and examination remain the core components of a safe surgical practice. Clinical judgment cannot be substituted even by the best quality imaging. Therefore, we feel that it is important to share our experience of the successful management of the presented case.},
}
@article {pmid28243433,
year = {2017},
author = {Hannoodi, F and Sabbagh, H and Kulairi, Z and Kumar, S},
title = {A Rare Case of Fusobacterium Necrophorum Liver Abscesses.},
journal = {Clinics and practice},
volume = {7},
number = {1},
pages = {928},
pmid = {28243433},
issn = {2039-7275},
abstract = {Liver abscesses are an uncommon disease that can present with vague symptoms. Fusobacterium necrophorum causing liver abscesses is a rare condition and only a few cases have been reported. An 88-year-old female presented to her primary care physician with one week of fevers, night sweats, chills, fatigue and vague right upper quadrant abdominal pain. She denied nausea, vomiting, constipation, diarrhea and unintentional weight loss. A computed tomography scan of the abdomen showed two liver abscesses in the right lobe as well as extensive diverticulosis. Percutaneous drainage was performed and draining catheters were placed in the abscesses. Culture of the abscess fluid grew Fusobacterium necrophorum. She was treated with ceftriaxone and metronidazole as per sensitivities. Rare cases of F. necrophorum hepatic abscesses have been published. The source of infection described in reported cases included hematogenous spread from dental caries/peritonsillar abscess and those involving the gastrointestinal tract resulting from inflammation of the bowel wall or from inflamed diverticuli via the portal circulation. In one study, thirteen cases of liver abscess due to F. necrophorum were studied, and two of these cases had diverticular disease without inflammation.},
}
@article {pmid28230737,
year = {2017},
author = {Carabotti, M and Annibale, B and Severi, C and Lahner, E},
title = {Role of Fiber in Symptomatic Uncomplicated Diverticular Disease: A Systematic Review.},
journal = {Nutrients},
volume = {9},
number = {2},
pages = {},
pmid = {28230737},
issn = {2072-6643},
mesh = {Databases, Factual ; Dietary Fiber/*administration & dosage ; Diverticulosis, Colonic/*diet therapy ; Humans ; Meta-Analysis as Topic ; Randomized Controlled Trials as Topic ; },
abstract = {Symptomatic uncomplicated diverticular disease (SUDD) is a syndrome characterized by recurrent abdominal symptoms in patients with colonic diverticula. There is some evidence that a high-fiber diet or supplemental fibers may reduce symptoms in SUDD patients and a high-fiber diet is commonly suggested for these patients. This systematic review aims to update the evidence on the efficacy of fiber treatment in SUDD, in terms of a reduction in symptoms and the prevention of acute diverticulitis. According to PRISMA, we identified studies on SUDD patients treated with fibers (PubMed and Scopus). The quality of these studies was evaluated by the Jadad scale. The main outcome measures were a reduction of abdominal symptoms and the prevention of acute diverticulitis. Nineteen studies were included, nine with dietary fiber and 10 with supplemental fiber, with a high heterogeneity concerning the quantity and quality of fibers employed. Single studies suggest that fibers, both dietary and supplemental, could be beneficial in SUDD, even if the quality is very low, with just one study yielding an optimal score. The presence of substantial methodological limitations, the heterogeneity of the therapeutic regimens employed, and the lack of ad hoc designed studies, did not permit a summary of the outcome measure. Thus, the benefit of dietary or supplemental fiber in SUDD patients still needs to be established.},
}
@article {pmid28220741,
year = {2017},
author = {Vally, M and Koto, MZ and Govender, M},
title = {An investigation of diverticular disease among black patients undergoing colonoscopy at Dr George Mukhari Academic Hospital, Pretoria, South Africa.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {107},
number = {2},
pages = {137-139},
doi = {10.7196/SAMJ.2017.v107i2.12007},
pmid = {28220741},
issn = {0256-9574},
abstract = {BACKGROUND: Diverticular disease was previously thought to be non-existent in the black African population. Studies over the past four decades, however, have shown a steady increase in the prevalence of the disease.
OBJECTIVE: To report on the profile and current prevalence of diverticular disease in the black South African (SA) population at Dr George Mukhari Academic Hospital, Pretoria, SA.
METHODS: A retrospective descriptive study was performed in black SA patients who were diagnosed with diverticular disease by colonoscopy between 1 January and 31 December 2015.
RESULTS: Of 348 patients who had undergone colonoscopies and who were eligible for inclusion in this study, 47 were diagnosed with diverticular disease - a prevalence of 13.50% (95% confidence interval 10.30 - 17.50). The greatest number of patients diagnosed were in their 7th and 8th decades, with an age range of 46 - 86 (mean 67) years. There was a female predominance of 57.45%. Lower gastrointestinal bleeding was the most common (65.96%) indication for colonoscopy. The left colon was most commonly involved (72.34%), followed by the right colon (55.31%). A substantial number of patients had pancolonic involvement (27.65%).
CONCLUSION: This retrospective study suggests that there has been a considerable increase in the prevalence of diverticular disease among black South Africans, possibly owing to changes in dietary habits and socioeconomic status.},
}
@article {pmid28215517,
year = {2017},
author = {Cuomo, R and Barbara, G and Annibale, B},
title = {Rifaximin and diverticular disease: Position paper of the Italian Society of Gastroenterology (SIGE).},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {49},
number = {6},
pages = {595-603},
doi = {10.1016/j.dld.2017.01.164},
pmid = {28215517},
issn = {1878-3562},
mesh = {Anti-Infective Agents/*administration & dosage ; Diverticulitis/*drug therapy/prevention & control ; Gastroenterology ; Humans ; Italy ; Practice Guidelines as Topic ; Recurrence ; Rifamycins/*administration & dosage ; Rifaximin ; Secondary Prevention ; Societies, Medical ; },
abstract = {Management of diverticular disease has significantly improved in the last decade. Antibiotic treatment is used for symptom relief and prevention of complications. In Italy, the non-absorbable antibiotic rifaximin is one of the most frequently used drugs, and it is perceived as the reference drug to treat symptomatic diverticular disease. Its non-systemic absorption and high faecal concentrations have oriented rifaximin use to the gastrointestinal tract, where rifaximin exerts eubiotic effects representing an additional value to its antibiotic activity. This position paper was commissioned by the Italian Society of Gastroenterology governing board for a panel of experts (RC, GB, BA) to highlight the indications for treatment of diverticular disease. There is a lack of rationale for drug use for the primary prevention of diverticulitis in patients with diverticulosis; thus, rifaximin use should be avoided. The cyclic use of rifaximin, in association with high-fibre intake, is safe and useful for the treatment of symptomatic uncomplicated diverticular disease, even if the cost-efficacy of long-term treatment remains to be determined. The use of rifaximin in the prevention of diverticulitis recurrence is promising, but the low therapeutic advantage needs to be verified. No evidence is available on the efficacy of rifaximin treatment on acute uncomplicated diverticulitis.},
}
@article {pmid28215096,
year = {2017},
author = {Ontanilla Clavijo, G and León Montañés, R and Sánchez Torrijos, Y and López Ruiz, T and Bozada García, JM},
title = {Colonic obstruction secondary to sigmoid fecaloma endoscopically resolved with Coca-Cola®.},
journal = {Revista espanola de enfermedades digestivas},
volume = {109},
number = {4},
pages = {306-308},
doi = {10.17235/reed.2017.4209/2016},
pmid = {28215096},
issn = {1130-0108},
mesh = {*Carbonated Beverages ; Endoscopy, Gastrointestinal ; Enema ; Fecal Impaction/diagnostic imaging/*therapy ; Feces ; Female ; Humans ; Intestinal Obstruction/diagnostic imaging/*drug therapy ; Middle Aged ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Colonic obstruction is a relatively common condition in emergency care, with a mortality rate of up to 20%. In 90% of cases it results from colonic or rectal adenocarcinoma, volvulus, or stenosis secondary to diverticular disease. When fecal impaction is the underlying cause, the condition is usually managed conservatively, but may on occasion become complicated and even require surgical intervention. Based on the proven efficacy of Coca-Cola® to dissolve gastric phytobezoars, we report a case of colonic obstruction secondary to sigmoid fecaloma.
CASE REPORT: A 58 years old woman arrived at the Emergency Room (ER) with persistent constipation for the last six days. An abdominal CT scan showed a large fecal mass at the sigmoid colon with retrograde dilated colonic loops. Cleansing enemas and oral lactulose were administered, which failed to resolve the clinical presentation, so we then proceeded to inject Coca-Cola® within the fecaloma using a sclerosing needle, and then washed the fecaloma surface also with Coca-Cola®. After a few minutes we started to fragment the fecalith, the consistency of which had been notably decreased.
DISCUSSION: The use of Coca-Cola® for gastric washes in the management of phytobezoars is well established. Since fecaliths are partly composed of these same substances than phytobezoars, the use of Coca-Cola® might well be warranted against them as in our patient, without surgery. Our case report is the second one published in the literature, in which Coca-Cola® helped solve colonic obstruction secondary to fecaloma.},
}
@article {pmid28212260,
year = {2017},
author = {Gralista, P and Moris, D and Vailas, M and Angelou, A and Petrou, A and Felekouras, E and Papalampros, A},
title = {Laparoscopic Approach in Colonic Diverticulitis: Dispelling Myths and Misperceptions.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {27},
number = {2},
pages = {73-82},
doi = {10.1097/SLE.0000000000000386},
pmid = {28212260},
issn = {1534-4908},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures/methods ; Emergency Treatment/methods ; Epidemiologic Methods ; Humans ; Laparoscopy/*methods ; Middle Aged ; Young Adult ; },
abstract = {BACKGROUND/AIM: Diverticular disease is a first-class health care problem and one of the most common gastrointestinal disorders in western industrialized countries, causing significant morbidity and mortality. In this review of the literature, we aim to assess the feasibility and effectiveness of the laparoscopic approach in both elective and emergency setting of diverticular disease.
MATERIALS AND METHODS: A bibliographic search of articles was performed using the electronic database Medline from PubMed. Of 341 articles identified, 279 were excluded, resulting in 62 full-text articles for review. Our final review included 16 articles.
RESULTS: The 16 articles included in the final review consisted of 6 retrospective studies, 5 prospective studies, 2 randomized controlled trials, 1 systematic review and meta-analysis, and 2 systematic reviews. Seven articles considered elective laparoscopic sigmoid resection, 7 articles evaluated laparoscopic peritoneal lavage, and 2 articles considered emergency laparoscopic sigmoid resection for perforated diverticulitis. The elective laparoscopic approach is feasible and safe. Laparoscopic peritoneal lavage has emerged as a safe and effective minimally invasive procedure for the treatment of perforated diverticulitis. Furthermore, in selected patients, emergency laparoscopic sigmoidectomy could also be feasible for perforated diverticulitis with generalized peritonitis.
CONCLUSIONS: Laparoscopic approach can be a safe and effective option in both elective and emergency setting of diverticular disease. Large, prospective, randomized studies should be conducted to confirm these findings.},
}
@article {pmid28197792,
year = {2017},
author = {Cirocchi, R and Di Saverio, S and Weber, DG and Taboła, R and Abraha, I and Randolph, J and Arezzo, A and Binda, GA},
title = {Laparoscopic lavage versus surgical resection for acute diverticulitis with generalised peritonitis: a systematic review and meta-analysis.},
journal = {Techniques in coloproctology},
volume = {21},
number = {2},
pages = {93-110},
pmid = {28197792},
issn = {1128-045X},
mesh = {Abdominal Abscess/etiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Diverticulitis/complications/surgery/*therapy ; Female ; Humans ; Intestinal Perforation/complications/surgery ; Intestines/surgery ; Laparoscopy/*methods ; Length of Stay ; Male ; Middle Aged ; Peritoneal Lavage/*methods ; Peritonitis/etiology/surgery/*therapy ; Postoperative Complications/*etiology ; Randomized Controlled Trials as Topic ; Reoperation/statistics & numerical data ; Severity of Illness Index ; Surgical Stomas/statistics & numerical data ; Treatment Outcome ; Young Adult ; },
abstract = {This systematic review and meta-analysis investigates current evidence on the therapeutic role of laparoscopic lavage in the management of diverticular peritonitis. A systematic review of the literature was performed on PubMed until June 2016, according to preferred reporting items for systematic reviews and meta-analyses guidelines. All randomised controlled trials comparing laparoscopic lavage with surgical resection, irrespective of anastomosis or stoma formation, were analysed. After assessment of titles and full text, 3 randomised trials fulfilled the inclusion criteria. Overall the quality of evidence was low because of serious concerns regarding the risk of bias and imprecision. In the laparoscopic lavage group, there was a statistically significant higher rate of postoperative intra-abdominal abscess (RR 2.54, 95% CI 1.34-4.83), a lower rate of postoperative wound infection (RR 0.10, 95% CI 0.02-0.51), and a shorter length of postoperative hospital stay during index admission (WMD = -2.03, 95% CI -2.59 to -1.47). There were no statistically significant differences in terms of postoperative mortality at index admission or within 30 days from intervention in all Hinchey stages and in Hinchey stage III, postoperative mortality at 12 months, surgical reintervention at index admission or within 30-90 days from index intervention, stoma rate at 12 months, or adverse events within 90 days of any Clavien-Dindo grade. The surgical reintervention rate at 12 months from index intervention was significantly lower in the laparoscopic lavage group (RR 0.57, 95% CI 0.38-0.86), but these data included emergency reintervention and planned intervention (stoma reversal). This systematic review and meta-analysis did not demonstrate any significant difference between laparoscopic peritoneal lavage and traditional surgical resection in patients with peritonitis from perforated diverticular disease, in terms of postoperative mortality and early reoperation rate. Laparoscopic lavage was associated with a lower rate of stoma formation. However, the finding of a significantly higher rate of postoperative intra-abdominal abscess in patients who underwent laparoscopic lavage compared to those who underwent surgical resection is of concern. Since the aim of surgery in patients with peritonitis is to treat the sepsis, if one technique is associated with more postoperative abscesses, then the technique is ineffective. Even so, laparoscopic lavage does not appear fundamentally inferior to traditional surgical resection and this technique may achieve reasonable outcomes with minimal invasiveness.},
}
@article {pmid28192107,
year = {2017},
author = {Camilleri, M and Malhi, H and Acosta, A},
title = {Gastrointestinal Complications of Obesity.},
journal = {Gastroenterology},
volume = {152},
number = {7},
pages = {1656-1670},
pmid = {28192107},
issn = {1528-0012},
support = {K08 DK097178/DK/NIDDK NIH HHS/United States ; R01 DK067071/DK/NIDDK NIH HHS/United States ; R01 DK111378/DK/NIDDK NIH HHS/United States ; R03 DK107402/DK/NIDDK NIH HHS/United States ; },
mesh = {Esophageal Diseases/*epidemiology/etiology ; Humans ; Intestinal Diseases/*epidemiology/etiology ; Liver Diseases/*epidemiology/etiology ; Obesity/*complications ; Pancreatic Diseases/epidemiology/etiology ; Prevalence ; Risk Factors ; Stomach Diseases/*epidemiology/etiology ; },
abstract = {Obesity usually is associated with morbidity related to diabetes mellitus and cardiovascular diseases. However, there are many gastrointestinal and hepatic diseases for which obesity is the direct cause (eg, nonalcoholic fatty liver disease) or is a significant risk factor, such as reflux esophagitis and gallstones. When obesity is a risk factor, it may interact with other mechanisms and result in earlier presentation or complicated diseases. There are increased odds ratios or relative risks of several gastrointestinal complications of obesity: gastroesophageal reflux disease, erosive esophagitis, Barrett's esophagus, esophageal adenocarcinoma, erosive gastritis, gastric cancer, diarrhea, colonic diverticular disease, polyps, cancer, liver disease including nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, gallstones, acute pancreatitis, and pancreatic cancer. Gastroenterologists are uniquely poised to participate in the multidisciplinary management of obesity as physicians caring for people with obesity-related diseases, in addition to their expertise in nutrition and endoscopic interventions.},
}
@article {pmid28188167,
year = {2017},
author = {Darji, K and Dhandha, MM and Guo, M},
title = {Hidradenitis suppurativa, neutrophilic dermatoses and diverticular disease in a young African-American patient.},
journal = {BMJ case reports},
volume = {2017},
number = {},
pages = {},
pmid = {28188167},
issn = {1757-790X},
mesh = {Abdominal Abscess/*etiology/therapy ; Adult ; Diverticulitis, Colonic/*complications/therapy ; Hidradenitis Suppurativa/*complications/therapy ; Humans ; Leg Dermatoses/*complications/pathology ; Male ; Neutrophil Infiltration ; },
abstract = {Hidradenitis suppurativa (HS) is a chronic skin disorder of the terminal follicular epithelium of apocrine sweat glands, manifesting as painful and exudative papules, pustules, cysts or nodules. This inflammatory condition often presents with other systemic and cutaneous disorders. We present the case of an African-American man with HS who was also diagnosed with neutrophilic dermatoses and diverticular disease. Neutrophilic dermatosis was identified based on histopathology findings. Our patient underwent multiple surgeries for flaring of his skin condition. Colchicine and doxycycline were started, but the patient was not able to tolerate them. Humira was planned for treatment of HS and neutrophilic dermatosis but could not be pursued because of the pericolic abscess. Colonoscopy and radiological investigation revealed multiple colonic diverticuli, for which he initially underwent percutaneous drainage followed by surgical removal of sigmoid mass and colocutaneous fistula. Culture from the specimen revealed abnormal growth of Actinomyces.},
}
@article {pmid28152033,
year = {2017},
author = {Barrenschee, M and Wedel, T and Lange, C and Hohmeier, I and Cossais, F and Ebsen, M and Vogel, I and Böttner, M},
title = {No neuronal loss, but alterations of the GDNF system in asymptomatic diverticulosis.},
journal = {PloS one},
volume = {12},
number = {2},
pages = {e0171416},
pmid = {28152033},
issn = {1932-6203},
mesh = {Aged ; Case-Control Studies ; Colon/innervation/pathology ; Diverticulum/pathology/*physiopathology ; Fluorescent Antibody Technique ; Glial Cell Line-Derived Neurotrophic Factor/*physiology ; Glial Cell Line-Derived Neurotrophic Factor Receptors/physiology ; Humans ; Laser Capture Microdissection ; Male ; Myenteric Plexus/pathology ; Proto-Oncogene Proteins c-ret/physiology ; Real-Time Polymerase Chain Reaction ; },
abstract = {BACKGROUND: Glial cell line-derived neurotrophic factor (GDNF) is a potent neurotrophic factor known to promote the survival and maintenance of neurons not only in the developing but also in the adult enteric nervous system. As diverticular disease (DD) is associated with reduced myenteric neurons, alterations of the GDNF system were studied in asymptomatic diverticulosis (diverticulosis) and DD.
METHODS: Morphometric analysis for quantifying myenteric ganglia and neurons were assessed in colonic full-thickness sections of patients with diverticulosis and controls. Samples of tunica muscularis (TM) and laser-microdissected myenteric ganglia from patients with diverticulosis, DD and controls were analyzed for mRNA expression levels of GDNF, GFRA1, and RET by RT-qPCR. Myenteric protein expression of both receptors was quantified by fluorescence-immunohistochemistry of patients with diverticulosis, DD, and controls.
RESULTS: Although no myenteric morphometric alterations were found in patients with diverticulosis, GDNF, GFRA1 and RET mRNA expression was down-regulated in the TM of patients with diverticulosis as well as DD. Furthermore GFRA1 and RET myenteric plexus mRNA expression of patients with diverticulosis and DD was down-regulated, whereas GDNF remained unaltered. Myenteric immunoreactivity of the receptors GFRα1 and RET was decreased in both asymptomatic diverticulosis and DD patients.
CONCLUSION: Our data provide evidence for an impaired GDNF system at gene and protein level not only in DD but also during early stages of diverticula formation. Thus, the results strengthen the idea of a disturbed GDNF-responsiveness as contributive factor for a primary enteric neuropathy involved in the pathogenesis and disturbed intestinal motility observed in DD.},
}
@article {pmid28150481,
year = {2017},
author = {Böhm, SK and Kruis, W},
title = {Lifestyle and other risk factors for diverticulitis.},
journal = {Minerva gastroenterologica e dietologica},
volume = {63},
number = {2},
pages = {110-118},
doi = {10.23736/S1121-421X.17.02371-6},
pmid = {28150481},
issn = {1827-1642},
mesh = {Age Distribution ; Alcohol Drinking/adverse effects ; Body Mass Index ; Colonoscopy/methods ; Diverticulitis/diagnosis/*epidemiology/*etiology ; Evidence-Based Medicine ; Exercise ; Germany/epidemiology ; Humans ; *Life Style ; Obesity/complications/epidemiology ; Prevalence ; Risk Factors ; Sex Distribution ; Smoking/adverse effects ; },
abstract = {Diverticulosis is a very common condition. Around 20% of the carriers of diverticula are believed to suffer from diverticular disease during their lifetime. This makes diverticular disease one of the clinically and economically most significant diseases in gastroenterology. The etiopathogenesis of diverticulosis and diverticular disease is not well understood. Epidemiological studies allow defining risk factors for the development of diverticulitis and its complications. A comprehensive literature search was performed and the current knowledge about risk factors for diverticulitis and associated conditions reviewed. Besides non-controllable risk factors like age and sex, lifestyle factors like food, drinks and physical activity, drugs are described to increase or decrease the risk to develop diverticulitis or to suffer from complications. The recognition of risk factors for the development of diverticular disease or even complicated disease like lifestyle habits or medication is crucial for patient management.},
}
@article {pmid28134941,
year = {2016},
author = {Salgado-Nesme, N and Vergara-Fernández, O and Espino-Urbina, LA and Luna-Torres, HA and Navarro-Navarro, A},
title = {Advantages of Minimally Invasive Surgery for the Treatment of Colovesical Fistula.},
journal = {Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion},
volume = {68},
number = {6},
pages = {229-304},
pmid = {28134941},
issn = {0034-8376},
mesh = {Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/*surgery ; Laparoscopy/*methods ; Length of Stay ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/*methods ; Retrospective Studies ; },
abstract = {BACKGROUND: Colovesical fistulas in two-thirds of the cases are due to diverticular disease. In recent years, a minimally invasive approach has shown advantages over the traditional open approach. The goal of this study was to evaluate the surgical results and safety of the laparoscopic procedure in patients with colovesical fistula.
MATERIAL AND METHODS: We retrospectively evaluated 24 patients who underwent surgery for colovesical fistula in a referral center from 2005 to 2011. Patients were divided into two groups: (i) laparoscopic approach, and (ii) open approach.
RESULTS: The laparoscopic and open groups had similar characteristics with respect to age and gender distribution. There were a higher number of bladder repairs in the open approach group (83.3 vs. 16.6%; p = 0.01). The operative time (212 ± 74 min vs. 243 ± 69 min; p = 0.313) and intraoperative bleeding (268 ± 222 ml vs. 327 ± 169 ml; p = 0.465) were similar in both groups. The conversion rate of the laparoscopic approach to open surgery was 25%. There was no difference in morbidity (41.1 vs. 25%; p = 0.414), although the laparoscopic group had a shorter hospital stay (9 ± 4 days vs. 15 ± 11 days; p = 0.083) without statistical significance.
CONCLUSIONS: The treatment of colovesical fistula by a laparoscopic approach is safe and is associated with less bladder repairs and a shorter hospital stay.},
}
@article {pmid28125785,
year = {2017},
author = {Pickhardt, PJ and Mbah, I and Pooler, BD and Chen, OT and Hinshaw, JL and Weiss, JM and Kim, DH},
title = {CT Colonographic Screening of Patients With a Family History of Colorectal Cancer: Comparison With Adults at Average Risk and Implications for Guidelines.},
journal = {AJR. American journal of roentgenology},
volume = {208},
number = {4},
pages = {794-800},
pmid = {28125785},
issn = {1546-3141},
support = {R01 CA144835/CA/NCI NIH HHS/United States ; UL1 TR000427/TR/NCATS NIH HHS/United States ; },
mesh = {Aged ; Colonography, Computed Tomographic/standards/*statistics & numerical data ; Colonoscopy/standards/*statistics & numerical data ; Colorectal Neoplasms/*diagnostic imaging/epidemiology/*genetics ; Early Detection of Cancer/standards/*statistics & numerical data ; Female ; Genetic Predisposition to Disease/epidemiology/genetics ; Humans ; Male ; Medical History Taking/statistics & numerical data ; Middle Aged ; Practice Guidelines as Topic ; Prevalence ; Reproducibility of Results ; Risk Factors ; Sensitivity and Specificity ; Wisconsin/epidemiology ; },
abstract = {OBJECTIVE: The purposes of this study were to compare rates of lesion detection at CT colonographic (CTC) screening of adults without symptoms who had and who did not have a family history of colorectal cancer according to American Cancer Society guidelines and to consider the clinical implications.
MATERIALS AND METHODS: Over 134 months, consecutively registered CTC cohorts of adults without symptoms who had (n = 156; 88 [56.4%] women; 68 [43.6%] men; mean age, 56.3 years) and who did not have (n = 8857; 4757 [53.7%] women; 4100 [46.3%] men; mean age, 56.6 years) an American Cancer Society-defined family history of colorectal cancer (first-degree relative with diagnosis before age 60 years or two first-degree relatives with diagnosis at any age) were compared for relevant colorectal findings.
RESULTS: For the family history versus no family history cohorts, the frequency of all nondiminutive polyps (≥ 6 mm) reported at CTC was 23.7% versus 15.5% (p = 0.007); small polyps (6-9 mm), 13.5% versus 9.1% (p = 0.068); and large polyps (≥ 10 mm), 10.2% versus 6.5% (p = 0.068). The rate of referral for colonoscopy was greater for the family history cohort (16.0% vs 10.5%; p = 0.035). However, the frequencies of proven advanced adenoma (4.5% vs 3.2%; p = 0.357), nonadvanced adenoma (5.1% vs 2.6%; p = 0.070), and cancer (0.0% vs 0.4%; p = 0.999) were not significantly increased. The difference in positive rates between the two cohorts (11.5% vs 4.3%; p < 0.001) was primarily due to nonneoplastic findings of no colorectal cancer relevance, such as small hyperplastic polyps, diverticular disease, and false-positive CTC findings.
CONCLUSION: Although the overall CTC-positive and colonoscopy referral rates were higher in the family history cohort, the clinically relevant frequencies of advanced neoplasia and cancer were not sufficiently increased to preclude CTC screening. These findings support the use of CTC as a front-line screening option in adults with a family history of colorectal cancer.},
}
@article {pmid28116209,
year = {2016},
author = {Shirah, BH and Mikwar, ZA and Ahmad, AN and Dahlan, YM},
title = {Laparoendoscopic Rendezvous for Concomitant Cholecystocholedocholithiasis: A Successful Modality Even in the Most Difficult Presentations Including Pregnancy.},
journal = {Case reports in surgery},
volume = {2016},
number = {},
pages = {8618512},
pmid = {28116209},
issn = {2090-6900},
abstract = {Background. Laparoendoscopic rendezvous (LERV) technique is emerging as an attractive treatment option for concomitant cholecystocholedocholithiasis. In this paper, we report our experience in performing the LERV technique in patients with unusual presentations in terms of anatomical difficulty, pregnancy, multiple comorbid diseases, and postlaparotomy. We aim to highlight the effectiveness of the LERV technique in some clinical situations where conventional methods would fail or carry high risks in adequately managing concomitant cholecystocholedocholithiasis. Methods. Four patients diagnosed to have concomitant cholecystocholedocholithiasis with associated difficult presentation or comorbid diseases were treated using the LERV technique. One patient presented with difficult anatomy where ERCP failed at initial attempts. Another patient was pregnant (first trimester). A third patient had complex comorbid diseases (bronchial asthma, hypertension, congestive heart failure, and end-stage renal disease on regular hemodialysis). A fourth patient had previous laparotomy and sigmoidectomy for diverticular disease and had severe hospital phobia. Results. All patients tolerated the LERV technique very well; no intraoperative occurrence was reported. The mean operative time was 86.3 ± 17.2 minutes; mean time of the endoscopic part was 29.4 ± 3.57 minutes. The mean blood loss was 44.3 ± 18.2 mL (range 20-85). Residual stone, postoperative complications, postoperative morbidity, and postoperative mortality were 0 (0%). Postoperative short hospital stay was reported in all patients, average 3 days (range 2-4). Conclusion. LERV procedure is a safe and effective treatment option for the management of concomitant cholecystocholedocholithiasis, even in difficult situations where other methods would fail or carry high risks, or in patients presenting with severe comorbid diseases or pregnancy. This procedure may emerge as an attractive alternative option for high-risk patients. A patient's wishes may also influence the selection of this procedure. More scientific studies recruiting more patients should be done in order to standardize the LERV procedure.},
}
@article {pmid28079347,
year = {2017},
author = {Cremon, C and Bellacosa, L and Barbaro, MR and Cogliandro, RF and Stanghellini, V and Barbara, G},
title = {Diagnostic challenges of symptomatic uncomplicated diverticular disease.},
journal = {Minerva gastroenterologica e dietologica},
volume = {63},
number = {2},
pages = {119-129},
doi = {10.23736/S1121-421X.17.02370-4},
pmid = {28079347},
issn = {1827-1642},
mesh = {Age Distribution ; Diagnosis, Differential ; Diverticular Diseases/*diagnosis/*epidemiology/etiology/therapy ; Evidence-Based Medicine ; Humans ; Incidence ; Irritable Bowel Syndrome/diagnosis ; Italy/epidemiology ; Prevalence ; Risk Factors ; },
abstract = {Colonic diverticulosis is a common condition in Western industrialized countries occurring in up to 65% of people over the age of 60 years. Only a minority of these subjects (about 10-25%) experience symptoms, fulfilling Rome III Diagnostic Criteria for irritable bowel syndrome (IBS) diagnosis (IBS-like symptoms) in 10% to 66% of cases. Symptomatic uncomplicated diverticular disease (SUDD) is a syndrome characterized by recurrent abdominal symptoms attributed to diverticula in the absence of macroscopically evident alterations other than the presence of diverticula. Due to the different peak of incidence, the overlap between SUDD and IBS is predominantly present in middle-aged or older patients. In these cases, it is very complex to establish if the symptoms are related to the presence of diverticula or due to an overlapping IBS. In fact, the link between gastrointestinal symptoms and diverticula is unclear, and the mechanism by which diverticula may induce the development of IBS-like symptoms remains to be elucidated. Currently, the etiology and pathophysiology of SUDD, particularly when IBS-like symptoms are present, are not completely understood, and thus these two entities remain a diagnostic challenge not only for the general practitioner but also for the gastroenterologist. Although many issues remain open and unresolved, some minimize the importance of a distinction of these two entities as dietary and pharmacological management may be largely overlapping.},
}
@article {pmid28070032,
year = {2016},
author = {Turoldo, A and Bortul, M and Ceglar, S and Dobrinja, C and de Manzini, N},
title = {Does sigmoidectomy for diverticular disease have a negative impact on patients' quality of life and bowel function?.},
journal = {Annali italiani di chirurgia},
volume = {87},
number = {},
pages = {564-571},
pmid = {28070032},
issn = {2239-253X},
mesh = {Aged ; *Colectomy ; Colon, Sigmoid/*surgery ; *Defecation ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; *Quality of Life ; Self Report ; },
abstract = {AIM: Aim of this study was to evaluate bowel function after colonic resection for diverticular disease and assess its impact on patients' quality of life.
MATERIAL OF STUDY: 47 patients who underwent urgent or elective surgery for diverticular disease were either personally contacted or interviewed by telephone and given a questionnaire. The Memorial Bowel functional index, the short form (36) health survey questionnaire, and the fecal incontinence severity index were used.
RESULTS: Fecal Urgency was found in 4,25% of cases, Incomplete Evacuation in 17,03%, and the Lifestyle/Diet Modification Score in 23,4% of patients. Incontinence cases were not found. After surgery we found reduction of abdominal pain (p=0.017) and improved bowel function (p=0.001). The quality of life correlated to bowel function was defined good or very good in 87.2% of cases whereas 4.3% of patients reported poor bowel function. This condition was related to female patients (p=0.02), urgent surgery (p=0.05), and to post-operative complication (p=0.05).
DISCUSSION AND CONCLUSIONS: In our experience, both bowel function and abdominal pain improved after surgery and 91.4% of patients were satisfied with the choice of surgery and would agree to do it again. The presence of not recognized inflammatory bowel syndromes can occasionally be responsible for persistent disorders after surgery.
KEY WORDS: Bowel function, Diverticular disease, Sigmoidectomy.},
}
@article {pmid28069830,
year = {2018},
author = {Cao, Y and Strate, LL and Keeley, BR and Tam, I and Wu, K and Giovannucci, EL and Chan, AT},
title = {Meat intake and risk of diverticulitis among men.},
journal = {Gut},
volume = {67},
number = {3},
pages = {466-472},
pmid = {28069830},
issn = {1468-3288},
support = {R01 DK101495/DK/NIDDK NIH HHS/United States ; R01 DK084157/DK/NIDDK NIH HHS/United States ; U01 CA167552/CA/NCI NIH HHS/United States ; K24 DK098311/DK/NIDDK NIH HHS/United States ; UM1 CA167552/CA/NCI NIH HHS/United States ; },
mesh = {Aged ; Animals ; *Diet ; Diverticulitis, Colonic/epidemiology/*etiology ; Fish Products ; Follow-Up Studies ; Humans ; Incidence ; Male ; Meat/*adverse effects ; Middle Aged ; Poultry Products ; Proportional Hazards Models ; Prospective Studies ; Red Meat/adverse effects ; Risk Factors ; },
abstract = {OBJECTIVE: Diverticulitis is a common disease with a substantial clinical and economic burden. Besides dietary fibre, the role of other foods in the prevention of diverticulitis is underexplored.
DESIGN: We prospectively examined the association between consumption of meat (total red meat, red unprocessed meat, red processed meat, poultry and fish) with risk of incident diverticulitis among 46 461 men enrolled in the Health Professionals Follow-Up Study (1986-2012). Cox proportional hazards models were used to compute relative risks (RRs) and 95% CIs.
RESULTS: During 651 970 person-years of follow-up, we documented 764 cases of incident diverticulitis. Compared with men in the lowest quintile (Q1) of total red meat consumption, men in the highest quintile (Q5) had a multivariable RR of 1.58 (95% CI 1.19 to 2.11; p for trend=0.01). The increase in risk was non-linear, plateauing after six servings per week (p for non-linearity=0.002). The association was stronger for unprocessed red meat (RR for Q5 vs Q1: 1.51; 95% CI 1.12 to 2.03; p for trend=0.03) than for processed red meat (RR for Q5 vs Q1: 1.03; 95% CI 0.78 to 1.35; p for trend=0.26). Higher consumption of poultry or fish was not associated with risk of diverticulitis. However, the substitution of poultry or fish for one serving of unprocessed red meat per day was associated with a decrease in risk of diverticulitis (multivariable RR 0.80; 95% CI 0.63 to 0.99).
CONCLUSIONS: Red meat intake, particularly unprocessed red meat, was associated with an increased risk of diverticulitis. The findings provide practical dietary guidance for patients at risk of diverticulitis.},
}
@article {pmid28065788,
year = {2017},
author = {Strate, LL and Keeley, BR and Cao, Y and Wu, K and Giovannucci, EL and Chan, AT},
title = {Western Dietary Pattern Increases, and Prudent Dietary Pattern Decreases, Risk of Incident Diverticulitis in a Prospective Cohort Study.},
journal = {Gastroenterology},
volume = {152},
number = {5},
pages = {1023-1030.e2},
pmid = {28065788},
issn = {1528-0012},
support = {K24 DK098311/DK/NIDDK NIH HHS/United States ; R01 DK084157/DK/NIDDK NIH HHS/United States ; R01 DK101495/DK/NIDDK NIH HHS/United States ; UM1 CA167552/CA/NCI NIH HHS/United States ; },
mesh = {Adult ; Aged ; Cohort Studies ; Diet/statistics & numerical data ; Diet, Western/*statistics & numerical data ; *Dietary Fiber ; Diverticulitis/*epidemiology ; Follow-Up Studies ; *Fruit ; Humans ; Incidence ; Male ; Middle Aged ; Multivariate Analysis ; Principal Component Analysis ; Proportional Hazards Models ; Prospective Studies ; *Red Meat ; Surveys and Questionnaires ; United States/epidemiology ; *Vegetables ; },
abstract = {BACKGROUND & AIMS: Dietary fiber is implicated as a risk factor for diverticulitis. Analyses of dietary patterns may provide information on risk beyond those of individual foods or nutrients. We examined whether major dietary patterns are associated with risk of incident diverticulitis.
METHODS: We performed a prospective cohort study of 46,295 men who were free of diverticulitis and known diverticulosis in 1986 (baseline) using data from the Health Professionals Follow-Up Study. Each study participant completed a detailed medical and dietary questionnaire at baseline. We sent supplemental questionnaires to men reporting incident diverticulitis on biennial follow-up questionnaires. We assessed diet every 4 years using a validated food frequency questionnaire. Western (high in red meat, refined grains, and high-fat dairy) and prudent (high in fruits, vegetables, and whole grains) dietary patterns were identified using principal component analysis. Follow-up time accrued from the date of return of the baseline questionnaire in 1986 until a diagnosis of diverticulitis, diverticulosis or diverticular bleeding; death; or December 31, 2012. The primary end point was incident diverticulitis.
RESULTS: During 894,468 person years of follow-up, we identified 1063 incident cases of diverticulitis. After adjustment for other risk factors, men in the highest quintile of Western dietary pattern score had a multivariate hazard ratio of 1.55 (95% CI, 1.20-1.99) for diverticulitis compared to men in the lowest quintile. High vs low prudent scores were associated with decreased risk of diverticulitis (multivariate hazard ratio, 0.74; 95% CI, 0.60-0.91). The association between dietary patterns and diverticulitis was predominantly attributable to intake of fiber and red meat.
CONCLUSIONS: In a prospective cohort study of 46,295 men, a Western dietary pattern was associated with increased risk of diverticulitis, and a prudent pattern was associated with decreased risk. These data can guide dietary interventions for the prevention of diverticulitis.},
}
@article {pmid28060005,
year = {2017},
author = {Knowles, SR and Tribbick, D and Connell, WR and Castle, D and Salzberg, M and Kamm, MA},
title = {Exploration of Health Status, Illness Perceptions, Coping Strategies, Psychological Morbidity, and Quality of Life in Individuals With Fecal Ostomies.},
journal = {Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society},
volume = {44},
number = {1},
pages = {69-73},
doi = {10.1097/WON.0000000000000295},
pmid = {28060005},
issn = {1528-3976},
mesh = {Adaptation, Psychological ; Adult ; Colostomy/psychology ; *Cost of Illness ; Cross-Sectional Studies ; Female ; Health Status ; Humans ; Ileostomy/psychology ; Male ; Middle Aged ; Patients/*psychology ; *Perception ; Quality of Life/psychology ; Surveys and Questionnaires ; },
abstract = {PURPOSE: In a previous paper focusing on the common sense model (CSM) for ostomies in people with inflammatory bowel disease, cancer, and diverticular disease, we reported that (1) illness perceptions were directly related to illness status, and both illness perceptions and coping strategies (maladaptive coping) directly influenced anxiety and depression; (2) self-efficacy and emotion-focused coping style ameliorated depression but not anxiety; and (3) time since surgery was associated with improved health status, a reduction in negative illness perceptions, and increased emotional-focused coping. The purpose of this article was to perform a secondary analysis with the addition of a stoma quality-of-life measure.
SUBJECTS AND SETTING: One hundred fifty adults with ostomies (54 males, and 96 females; mean age = 44 years) completed an online survey.
DESIGN: Descriptive, cross-sectional, questionnaire-based study.
METHODS: Participants completed the Health Perceptions Questionnaire, Brief Illness Perceptions Questionnaire, Carver Brief Coping Questionnaire, Stoma Self-efficacy Scale, Hospital Anxiety and Depression Scale, and the Stoma Quality-of-Life Scale.
RESULTS: Using structural equation modeling, the final model provided an excellent fit to the data (χ27 = 19.20, P = .37, χ/N = 1.08, Standardized Root Mean Square Residual (SRMR) <0.03, Steiger-Lind Root Mean Square Error of Approximation (RMSEA) <0.03, Goodness of Fit Index (GFI) >0.98). Extending upon our previous paper, self-efficacy, anxiety, and depression were found to have a significant direct influence on stoma-specific quality of life (β= .47, P < .001, β=-.25, P < .001, and β=-.35, P < .001, respectively).
CONCLUSIONS: The findings of this secondary analysis extends our previous report by identifying that, consistent with the CSM, illness status, illness perceptions, and coping influence health-related quality of life via self-efficacy, anxiety, and depression. The results suggest that to improve an individual's quality of life, psychological interventions should target the psychological processes underpinning mental illness and also help develop and maintain an individual's self-efficacy in relation to ostomy care.},
}
@article {pmid28044446,
year = {2017},
author = {Blancas Valencia, JM},
title = {Colonic diverticular bleeding. Have we identified the risk factors for massive bleeding yet?.},
journal = {Revista espanola de enfermedades digestivas},
volume = {109},
number = {1},
pages = {1-2},
doi = {10.17235/reed.2017.4821/2017},
pmid = {28044446},
issn = {1130-0108},
mesh = {Colonic Diseases ; *Diverticulosis, Colonic ; *Diverticulum, Colon ; Gastrointestinal Hemorrhage/epidemiology ; Humans ; Risk Factors ; },
abstract = {As we know, the frequency of diverticular disease (DD) increases according to age, being less than 5% in patients under 40 years of age and up to 60% after 80 years of age. The most common distribution of diverticula is in the left colon, except for the Asian population, where diverticular disease of the right colon is more frequent.},
}
@article {pmid28028368,
year = {2016},
author = {Piscaglia, AC and Laterza, L and Cesario, V and Gerardi, V and Landi, R and Lopetuso, LR and Calò, G and Fabbretti, G and Brisigotti, M and Stefanelli, ML and Gasbarrini, A},
title = {Nodular lymphoid hyperplasia: A marker of low-grade inflammation in irritable bowel syndrome?.},
journal = {World journal of gastroenterology},
volume = {22},
number = {46},
pages = {10198-10209},
pmid = {28028368},
issn = {2219-2840},
mesh = {Abdominal Pain/epidemiology ; Adult ; Aged ; Case-Control Studies ; Colon/pathology ; Colonoscopy ; Dermatitis, Allergic Contact/epidemiology/etiology ; Diarrhea/epidemiology ; Female ; Humans ; Inflammation ; Irritable Bowel Syndrome/*epidemiology/immunology ; Lactose Intolerance/epidemiology ; Lymphatic Diseases/*epidemiology/immunology/pathology ; Male ; Metals/adverse effects ; Middle Aged ; Retrospective Studies ; },
abstract = {AIM: To evaluate the prevalence of nodular lymphoid hyperplasia (NLH) in adult patients undergoing colonoscopy and its association with known diseases.
METHODS: We selected all cases showing NLH at colonoscopy in a three-year timeframe, and stratified them into symptomatic patients with irritable bowel syndrome (IBS)-type symptoms or suspected inflammatory bowel disease (IBD), and asymptomatic individuals undergoing endoscopy for colorectal cancer screening. Data collection included medical history and final diagnosis. As controls, we considered all colonoscopies performed for the aforementioned indications during the same period.
RESULTS: One thousand and one hundred fifty colonoscopies were selected. NLH was rare in asymptomatic individuals (only 3%), while it was significantly more prevalent in symptomatic cases (32%). Among organic conditions associated with NLH, the most frequent was IBD, followed by infections and diverticular disease. Interestingly, 31% of IBS patients presented diffuse colonic NLH. NLH cases shared some distinctive clinical features among IBS patients: they were younger, more often female, and had a higher frequency of abdominal pain, bloating, diarrhoea, unspecific inflammation, self-reported lactose intolerance and metal contact dermatitis.
CONCLUSION: About 1/3 of patients with IBS-type symptoms or suspected IBD presented diffuse colonic NLH, which could be a marker of low-grade inflammation in a conspicuous subset of IBS patients.},
}
@article {pmid28027808,
year = {2017},
author = {Barrón-Reyes, JE and Chávez-Galván, JC and Martínez-Peralta, JA and López-Valdés, JC},
title = {[Splenic rupture secondary to abscess: Rare cause of pneumoperitoneum. Case report].},
journal = {Cirugia y cirujanos},
volume = {85 Suppl 1},
number = {},
pages = {62-67},
doi = {10.1016/j.circir.2016.10.021},
pmid = {28027808},
issn = {2444-054X},
mesh = {Abdomen, Acute/etiology ; Abscess/*complications/diagnostic imaging/surgery ; Diagnosis, Differential ; Diverticulum/diagnosis ; Emergencies ; Hemoperitoneum/etiology ; Humans ; Laparotomy ; Male ; Middle Aged ; Peptic Ulcer Perforation/diagnosis ; Pneumoperitoneum/diagnostic imaging/*etiology ; Rupture, Spontaneous ; Splenic Diseases/*complications/diagnostic imaging/surgery ; Splenic Rupture/diagnostic imaging/*etiology ; },
abstract = {BACKGROUND: Splenic abscesses are rare entities; reports are commonly described in immunocompromised patients (72%) as: hematologic diseases, diabetes, endocarditis, acquired immunodeficiency syndrome, transplant patients and subjects who had abdominal trauma or splenic infarction. The main and most serious complication is the abscess rupture into the peritoneal cavity or adjacent organs (stomach or colon), which determines hemodynamic instability or septic state.
CLINICAL CASE: Fifty-year-old man, who was admitted at Emergency Room due eight days' progressive, oppressive, and current pain; intensity 4/10, irradiated at hemi-back, which was higher intensity during the standing and decreased at supine position. It was accompanied by nausea and vomiting in two occasions.
LABORATORY RESULTS: Hemoglobin 15.1g/dl, hematocrit 45.2%, platelets 176×10[3], 23.1×10[3] leukocytosis, neutrophils 92%. Simple abdominal radiographic studies revealed in 'ground glass' and radiopaque imagines.
CONCLUSIONS: At presence of free air inside the abdominal cavity, is usually to think of a complicated diverticular disease, intestinal perforation or perforated peptic ulcer. The actual medical literature described very few cases of splenic abscess with pneumoperitoneum as cardinal manifestation. In our case, the splenic abscess was detected during exploratory laparotomy and only in retrospective the imaging studies were interpreted.},
}
@article {pmid30363261,
year = {2017},
author = {Carnevale, A and Bassi, M and Ferrante, Z and Rizzati, R and Benea, G and Giganti, M},
title = {Computed tomographic colonography in the evaluation of a case of giant colonic diverticulum.},
journal = {BJR case reports},
volume = {3},
number = {2},
pages = {20160101},
pmid = {30363261},
issn = {2055-7159},
abstract = {The aim of this article was to present our experience with CT-colonography evaluation of a case of giant colonic diverticulum. Despite the high prevalence of diverticular disease in the Western world, giant colonic diverticula are rare entities, with fewer than 200 cases reported in literature.},
}
@article {pmid27981318,
year = {2016},
author = {Tursi, A and Elisei, W and Picchio, M and Di Mario, F and Brandimarte, G},
title = {Serum levels of vitamin D are associated with the severity of the endoscopic appearance of diverticular disease of the colon according to DICA classification.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {25},
number = {4},
pages = {567-568},
pmid = {27981318},
issn = {1842-1121},
mesh = {Aged ; Biomarkers/blood ; Colon/*pathology ; Colonoscopy ; Diverticulosis, Colonic/classification/complications/*diagnosis/pathology ; Female ; Humans ; Male ; Predictive Value of Tests ; Retrospective Studies ; Severity of Illness Index ; Vitamin D/*analogs & derivatives/blood ; Vitamin D Deficiency/*blood/complications/diagnosis ; },
}
@article {pmid27974552,
year = {2017},
author = {Spiller, RC and Sloan, TJ},
title = {Do diverticula provide a unique niche for microbiota which can lead to activation of the innate immune system?.},
journal = {Gut},
volume = {66},
number = {7},
pages = {1175-1176},
doi = {10.1136/gutjnl-2016-312928},
pmid = {27974552},
issn = {1468-3288},
mesh = {Diverticulum ; Humans ; Immune System ; Immunity, Innate ; *Inflammatory Bowel Diseases ; *Microbiota ; },
}
@article {pmid27973464,
year = {2017},
author = {Walker, MM and Harris, AK},
title = {Pathogenesis of diverticulosis and diverticular disease.},
journal = {Minerva gastroenterologica e dietologica},
volume = {63},
number = {2},
pages = {99-109},
doi = {10.23736/S1121-421X.16.02360-6},
pmid = {27973464},
issn = {1827-1642},
mesh = {Age Distribution ; Alcohol Drinking/*adverse effects ; Australia/epidemiology ; Body Mass Index ; Disease Progression ; Diverticular Diseases/diagnosis/epidemiology/*etiology ; Diverticulosis, Colonic/diagnosis/epidemiology/*etiology ; Evidence-Based Medicine ; Humans ; Incidence ; Obesity/complications ; Prevalence ; Risk Factors ; Smoking/*adverse effects ; },
abstract = {Diverticulosis is defined by the presence of diverticula due to herniation of mucosa and muscularis mucosa through the muscularis propria at sites of vascular penetration in the colon and is asymptomatic in the vast majority affected. There are global differences of distribution, in Western industrialized societies, the most common site is in the left colon, but in Asia right sided diverticulosis predominates. Whilst present in 17.5% of a general population and 42% of all comers at endoscopy it is seen in 71% of those aged ≥80 years. Diverticular disease is defined as clinically significant and symptomatic diverticulosis, which may have an absence of macroscopically overt colitis and in true diverticulitis there is macroscopic inflammation of diverticula with related acute or chronic complications. Whilst overall, diverticulitis affects only 4% of those with diverticulosis, in younger patients (aged 40-49 years) this peaks at 11%. Diverticulosis is one of the most common chronic diseases, yet research in this field on pathogenesis has lagged behind other common conditions such as diabetes mellitus. However, in the last decade there have been major advances in taxonomy that can be used to relate to patients' outcome and treatment in both medicine and surgery. It has been shown there is an association with age, diet, drugs and smoking. Genetic studies have shown a familial association and a specific gene, TNFSF 15 may predict severity of disease. The role of the microbiome has been explored and microbial and metabolomic signatures are also important in predicting disease severity. That diverticulosis is a chronic disease is shown by mucosal pathology with subtle chronic inflammation present in those with asymptomatic diverticulosis and inflammation may lead to muscular hypertrophy, enteric nerve remodeling with disordered motility. The diverticulitis quality of life instrument shows that this condition impacts markedly on patients' well-being and prevention and amelioration of complications should be the aim of treatment and further research to attain this goal is needed.},
}
@article {pmid27973463,
year = {2017},
author = {Cuomo, R and Cargiolli, M and Andreozzi, P and Zito, FP and Sarnelli, G},
title = {Rationale and evidences for treatment of symptomatic uncomplicated diverticular disease.},
journal = {Minerva gastroenterologica e dietologica},
volume = {63},
number = {2},
pages = {130-142},
doi = {10.23736/S1121-421X.16.02357-6},
pmid = {27973463},
issn = {1827-1642},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Dietary Fiber/*administration & dosage ; Diverticular Diseases/diagnosis/etiology/*therapy ; Drug Therapy, Combination ; Evidence-Based Medicine ; Gastrointestinal Agents/*therapeutic use ; Humans ; Mesalamine/therapeutic use ; Meta-Analysis as Topic ; Practice Guidelines as Topic ; Probiotics/*administration & dosage ; Randomized Controlled Trials as Topic ; Rifamycins/*therapeutic use ; Rifaximin ; Treatment Outcome ; },
abstract = {INTRODUCTION: Symptomatic uncomplicated diverticular disease (SUDD) is one of the possible clinical manifestations of diverticular disease. It is a common disorder characterized by chronic abdominal symptoms ranging from lower left abdominal pain to alteration of bowel habit, that significantly reduce quality of life of subject affected. The present article aims to review the current data for medical management of SUDD.
EVIDENCE ACQUISITION: We analyzed the existing literature on the factors involved in the pathogenesis of SUDD and we highlighted the possible target for treatment. Treatment for SUDD should be direct to relieve chronic symptoms and prevent diverticulitis and its complications. In particular we focused on the role of probiotics, fiber-diet, mesalazine and rifaximin on these two aspects. In this setting, we conducted a PubMed search for guidelines, systematic reviews and meta-analyses and updated information to October 2016.
EVIDENCE SYNTHESIS: Each topic was evaluated according to the best evidences available. Best results seemed to be obtained with combined therapies and in particular with rifaximin associated to high fiber-diet. This regimen seems to guarantee better symptoms control compared to fiber alone and it is more effective in preventing acute diverticulitis. On the contrary, no clear evidences about the efficacy of mesalazine and probiotics are available.
CONCLUSIONS: The results of the studies available in literature are controversial and debatable, for this reason a clear and defined algorithm for treatment of SUDD has not yet been defined. Further randomized, double-blind, placebo controlled study are necessary.},
}
@article {pmid27957337,
year = {2016},
author = {Shaikh, S},
title = {National complicated acute diverticulitis (CADS) study: a protocol for a prospective observational scoping study for acute diverticulitis.},
journal = {BMJ open gastroenterology},
volume = {3},
number = {1},
pages = {e000117},
pmid = {27957337},
issn = {2054-4774},
abstract = {BACKGROUND: Diverticular disease is a widely prevalent disease in western society, and acute diverticulitis is a common acute surgical presentation. However, there is a lack of level 1 evidence addressing the multifaceted presentations associated with acute diverticulitis. There is also a lack of robust epidemiological data that could be used to meaningfully inform randomised controlled trials. The National CADS project aims to generate baseline data for a cohort of patients managed for clinically suspected acute diverticulitis and evaluate the impact of variability in the management approach on patient outcomes in the short (3 months) and long (2 years) term.
METHOD: A Unit policy questionnaire will be completed by the principal investigator from all participating centres prior to study initiation. All patients aged above 18 years admitted with clinical suspicion of acute diverticulitis will be included from UK hospitals providing acute surgical care. Demographic, clinical, inpatient stay and outpatient follow-up data will be collected for index admissions between July and September 2014, 3 months follow-up and finally a 2-year follow-up.
RESULTS: The study attracted participation from 108 centres nationally and has so far generated data on 2500 patients admitted between 1 July 2014 and 30 September 2014. Short-term follow-up data have been obtained for this cohort.
CONCLUSIONS: The National CADS study is currently ongoing with the long-term outcomes data anticipated to be submitted in autumn of 2016.},
}
@article {pmid27955857,
year = {2017},
author = {García-Gómez, MA and Belmonte-Montes, C and Cosme-Reyes, C and Aguirre Garcia, MP},
title = {[Prognostic value of the presence of pericolic air bubbles detected by computed tomography in acute diverticulitis].},
journal = {Cirugia y cirujanos},
volume = {85},
number = {6},
pages = {471-477},
doi = {10.1016/j.circir.2016.10.024},
pmid = {27955857},
issn = {2444-054X},
mesh = {Acute Disease ; Aged ; *Air ; Conservative Treatment ; Diverticulitis, Colonic/complications/*diagnostic imaging/surgery/therapy ; Enteral Nutrition ; Female ; Humans ; Length of Stay/statistics & numerical data ; Leukocytosis/etiology ; Male ; Middle Aged ; Peritoneal Cavity/diagnostic imaging ; Peritonitis/diagnosis/etiology ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; *Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Diverticular disease is common in industrialized countries. Computed tomography has been used as the preferred diagnostic method; although different scales haves been described to classify the disease, none of them encompass total disease aspects and behaviour.
OBJETIVE: To analyze the patients with acute diverticulitis confirmed by computed tomography at the ABC Medical Center Campus Observatorio from January 1, 2010 to December 31, 2012, in whom pericolic free air in the form of bubbles was identified by computed tomography and if this finding can be considered as a prognostic factor for the disease.
METHODS: A series of 124 patients was analyzed who had acute diverticulitis confirmed by computed tomography, in order to identify the presence of pericolic bubbles.
RESULTS: Of the 124 patients, 29 presented with pericolic bubbles detected by computed tomography; of these, 62.1% had localized peritoneal signs at the time of the initial assessment, (P<.001); leukocytosis (13.33 vs 11.16, P<.001) and band count (0.97 vs 0.48, P<.001) was higher in this group. Patients with pericolonic bubbles had a longer hospital stay (5.5days vs 4.3days, P<.001) and started and tolerated liquids later (4.24days vs. 3.02days, P<.001) than the group of patients without this finding.
CONCLUSIONS: The presence of pericolic bubbles in patients with acute diverticulitis can be related to a more aggressive course of the disease.},
}
@article {pmid27941344,
year = {2017},
author = {Andrade, P and Ribeiro, A and Ramalho, R and Lopes, S and Macedo, G},
title = {Routine Colonoscopy after Acute Uncomplicated Diverticulitis - Challenging a Putative Indication.},
journal = {Digestive surgery},
volume = {34},
number = {3},
pages = {197-202},
doi = {10.1159/000449259},
pmid = {27941344},
issn = {1421-9883},
mesh = {Abdominal Abscess/diagnostic imaging/etiology ; Acute Disease ; Adenoma/*diagnostic imaging/pathology ; Adult ; Age Factors ; Aged ; Carcinoma/*diagnostic imaging/pathology ; Colonic Neoplasms/*diagnostic imaging/pathology ; Colonic Polyps/*diagnostic imaging/pathology ; *Colonoscopy ; Conservative Treatment ; Diverticulitis, Colonic/complications/*diagnostic imaging/therapy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND AND AIMS: Most international guidelines recommend performing a routine colonoscopy after the conservative management of acute diverticulitis, mainly to rule out a colorectal malignancy; however, data to support these recommendations are scarce and conflicting. This study is aimed at determining the rate of advanced colonic neoplasia (ACN) found by colonoscopy, and hence the need for routine colonoscopy after CT-diagnosed acute diverticulitis.
METHODS: We retrospectively analyzed all patients hospitalized for acute diverticulitis between July 2008 and June 2013. Patients who underwent colonoscopy more than 1 year after the acute episode were excluded. Advanced adenoma (AA) was defined as an adenoma with: (i) ≥10 mm, (ii) ≥25% villous features, or (iii) high-grade dysplasia. ACN included cases of colorectal cancer (CRC) and AA.
RESULTS: Of the 364 selected patients, 252 (69%) underwent colonoscopy (51% women, median age 55 ± 11 years). Adenomatous polyps were evident in 14.7% patients; 5.1% had AA and 3.2% had CRC. Patients with complicated diverticulitis had a higher number of ACN compared to those with uncomplicated diverticulitis (20.9 vs. 5.7%, p = 0.003). On multivariate analysis, age ≥50 years (OR 8.12, 95% CI 2.463-45.112; p = 0.017) and abscess on CT (OR 3.15, 95% CI 1.586-11.586; p = 0.036) were identified as significant risk factors for ACN.
CONCLUSIONS: Patients with diverticulitis complicated with abscess have a higher risk of ACN on follow-up colonoscopy. The prevalence of ACN in patients with uncomplicated diverticulitis is quite similar to the average-risk population, and therefore an episode of CT-diagnosed uncomplicated diverticulitis, per se, does not seem to be a recommendation for colonoscopy.},
}
@article {pmid27932087,
year = {2017},
author = {Lassiter, RL and Talukder, A and Abrams, MM and Adam, BL and Albo, D and White, CQ},
title = {Racial disparities in the use of laparoscopic surgery to treat colonic diverticulitis Are not fully explained by socioeconomics or disease complexity.},
journal = {American journal of surgery},
volume = {213},
number = {4},
pages = {673-677},
doi = {10.1016/j.amjsurg.2016.11.019},
pmid = {27932087},
issn = {1879-1883},
mesh = {Black or African American ; Colectomy/*methods ; Diverticulitis, Colonic/*surgery ; Female ; Healthcare Disparities ; Humans ; Income ; Insurance Coverage ; Laparoscopy/*statistics & numerical data ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; United States ; White People ; },
abstract = {BACKGROUND: Several studies have demonstrated favorable outcomes for laparoscopic surgery over open surgery for the treatment of diverticular disease. This study was designed to analyze the relationship between race, socioeconomic status and the use of laparoscopy to address diverticulitis.
METHODS: A retrospective analysis of 53,054 diverticulitis admissions was performed using data from the 2009-2013 National Inpatient Sample (NIS). The primary outcome was the use of laparoscopic versus open colectomy. Bivariate analysis and multivariable logistic regression were used to determine the raw and adjusted odds by race, insurance status, and median household income.
RESULTS: Overall, 41.6% of colectomies involved the use of laparoscopy. Black patients were 19% less likely than White patients to undergo laparoscopic surgery. Hispanic patients were no more or less likely to undergo laparoscopic colectomy. Lacking private insurance was a strong predictor of undergoing open surgery. Lower income patients were 33% less likely to receive minimally invasive colectomies.
CONCLUSIONS: These results demonstrate disparities in surgical treatment. Further research is warranted to understand and ameliorate treatment differences which can contribute to outcome disparities.},
}
@article {pmid27928602,
year = {2017},
author = {Steinemann, DC and Zerz, A and Lamm, SH},
title = {[Implementation of hybrid-NOTES sigmoidectomy for diverticular disease : In a center for minimally invasive surgery].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {88},
number = {6},
pages = {518-524},
pmid = {27928602},
issn = {1433-0385},
mesh = {Adult ; Aged ; Combined Modality Therapy/statistics & numerical data ; Conversion to Open Surgery/statistics & numerical data ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Intraoperative Complications/surgery ; Laparoscopy/*methods/statistics & numerical data ; Male ; Middle Aged ; Natural Orifice Endoscopic Surgery/*methods/statistics & numerical data ; Operative Time ; Prospective Studies ; Sigmoid Diseases/*surgery ; },
abstract = {BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) describes surgical procedures through a natural orifice. In hybrid-NOTES small transabdominal trocars are combined with a NOTES access.
OBJECTIVE: To evaluate hybrid-NOTES sigmoidectomy as a standard procedure for diverticulitis.
MATERIAL AND METHODS: Elective laparoscopic sigmoidectomies performed between May 2011 and January 2016 were prospectively collated. Primary endpoint was the feasibility of hybrid-NOTES sigmoidectomy. The reasons for planning a laparoscopically-assisted sigmoidectomy (LAS), intraoperative change of treatment and reactive conversion were evaluated. Secondary endpoints were complications and operative time.
RESULTS: Out of 130 laparoscopic sigmoidectomies 83% were planned for hybrid-NOTES and 8 out of 52 (15%) transvaginal (TVS) and 14 out of 56 (25%) transrectal (TRS) sigmoidectomies were intraoperatively changed to LAS. The reason for the change in 64% was that the specimen was too bulky and 80% of scheduled hybrid-NOTES procedures were carried out as planned. The operative time for TVS (146.8 ± 44.5 min) was shorter compared to LAS (173.2 ± 58.8 min, P = 0.016). The morbidities of TVS (15.3%) and TRS (14.9%) were not significantly different from LAS (23.9%, P = 0.501 and P = 0.537, respectively).
CONCLUSION: Hybrid-NOTES for diverticular disease may be indicated in more than 80% of cases. In respect of intraoperative change of treatment, hybrid-NOTES is feasible in two thirds of patients. Given a high level of expertise, hybrid-NOTES can be provided as a standard procedure in sigmoidectomy for diverticular disease.},
}
@article {pmid27922517,
year = {2016},
author = {Townsend, SA and Cheung, D and Horne, E and Ransford, R},
title = {A 5-Year Follow-Up of Study Patients With Asymptomatic Iron-Deficiency Anemia Using a Nurse-Led Pathway.},
journal = {Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates},
volume = {39},
number = {6},
pages = {466-471},
doi = {10.1097/SGA.0000000000000200},
pmid = {27922517},
issn = {1538-9766},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anemia, Iron-Deficiency/*diagnosis/mortality/*therapy ; Cohort Studies ; *Critical Pathways ; Female ; Follow-Up Studies ; Gastrointestinal Neoplasms/*diagnosis/mortality/therapy ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; *Outcome Assessment, Health Care ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Survival Rate ; Time Factors ; United Kingdom ; },
abstract = {A protocol-driven, systematic pathway was developed to allow rapid and coordinated investigation of patients with iron-deficiency anemia (IDA) in a nurse-delivered outpatient setting. The study objective was to assess the safety and efficacy of the pathway by 5-year outcome data for the exclusion of gastrointestinal (GI) malignancy. This is a 5-year follow-up study of 122 patients entered onto the pathway with negative initial upper and lower GI investigations. The study was conducted at Hereford County Hospital NHS Trust (a district general hospital serving 220,00 people). Clinical outcomes of patients at 5 years and service efficiency at detecting relevant pathology were observed. A total of 272 patients were investigated through the pathway, and in 150 patients a GI cause for IDA was found. We established the outcome in 97% of the 122 patients with normal GI investigation at 5 years after their initial investigation. Of the 118 patients followed up, 92 patients were alive and well and 26 had died or developed malignancy. With the exception of diabetes (odds ratio 0.24; 95% confidence interval [0.1, 0.8]; p = .02), no features were found to be a significant risk factor for poor prognosis, including age, gender, hemoglobin level, anemia at 3 months, or other comorbidities. Three patients developed colonic malignancy; two patients had diverticular disease at barium enema and presented 4 years later with colorectal cancer. One patient declined lower GI investigation and presented with metastatic colon cancer on computed tomography scan at 1 year. No other GI cancers were diagnosed. Our nurse-delivered, protocol-driven pathway is a highly effective and safe system for the exclusion of GI cancer within 5 years of follow-up.},
}
@article {pmid27898520,
year = {2019},
author = {Dai, C and Jiang, M and Sun, MJ},
title = {Mesalazine in the Treatment of Symptomatic Uncomplicated Diverticular Disease.},
journal = {Journal of clinical gastroenterology},
volume = {53},
number = {1},
pages = {77-78},
doi = {10.1097/MCG.0000000000000748},
pmid = {27898520},
issn = {1539-2031},
mesh = {Colon ; *Diverticular Diseases ; *Diverticulitis ; Humans ; Mesalamine ; Primary Prevention ; Randomized Controlled Trials as Topic ; },
}
@article {pmid27875358,
year = {2019},
author = {Tursi, A},
title = {"Mesalazine in the Treatment of Symptomatic Uncomplicated Diverticular Disease: Reply".},
journal = {Journal of clinical gastroenterology},
volume = {53},
number = {3},
pages = {e130-e132},
doi = {10.1097/MCG.0000000000000761},
pmid = {27875358},
issn = {1539-2031},
mesh = {Colon ; *Diverticular Diseases ; *Diverticulitis ; Humans ; Mesalamine ; Primary Prevention ; Randomized Controlled Trials as Topic ; },
}
@article {pmid27867683,
year = {2016},
author = {Uno, Y and van Velkinburgh, JC},
title = {Logical hypothesis: Low FODMAP diet to prevent diverticulitis.},
journal = {World journal of gastrointestinal pharmacology and therapeutics},
volume = {7},
number = {4},
pages = {503-512},
pmid = {27867683},
issn = {2150-5349},
abstract = {Despite little evidence for the therapeutic benefits of a high-fiber diet for diverticulitis, it is commonly recommended as part of the clinical management. The ongoing uncertainty of the cause(s) of diverticulitis confounds attempts to determine the validity of this therapy. However, the features of a high-fiber diet represent a logical contradiction for colon diverticulitis. Considering that Bernoulli's principle, by which enlarged diameter of the lumen leads to increased pressure and decreased fluid velocity, might contribute to development of the diverticulum. Thus, theoretically, prevention of high pressure in the colon would be important and adoption of a low FODMAP diet (consisting of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) may help prevent recurrence of diverticulitis.},
}
@article {pmid27855604,
year = {2016},
author = {Lin, J and Zhang, X and Zhao, Z and Welker, NC and Li, Y and Liu, Y and Bronner, MP},
title = {Novel MicroRNA Signature to Differentiate Ulcerative Colitis from Crohn Disease: A Genome-Wide Study Using Next Generation Sequencing.},
journal = {MicroRNA (Shariqah, United Arab Emirates)},
volume = {5},
number = {3},
pages = {222-229},
doi = {10.2174/2211536605666161117113031},
pmid = {27855604},
issn = {2211-5374},
mesh = {Adult ; Aged ; Base Sequence ; Case-Control Studies ; Colitis, Ulcerative/*diagnosis/*genetics ; Colon/cytology/pathology ; Crohn Disease/*diagnosis/*genetics ; Diagnosis, Differential ; Female ; Genome-Wide Association Study ; High-Throughput Nucleotide Sequencing ; Humans ; Intestinal Mucosa/cytology ; Male ; MicroRNAs/*genetics/metabolism ; Middle Aged ; Real-Time Polymerase Chain Reaction ; Sequence Analysis, RNA ; },
abstract = {BACKGROUND: The diagnosis of ulcerative colitis (UC) or Crohn disease (CD) can be challenging given the overlapping features. Knowledge of microRNAs in IBD has expanded recently and supports that microRNAs play an important role. This study aimed to identify novel microRNA biomarkers through comprehensive genome-wide sequencing to distinguish UC from CD.
DESIGN: Illumina next generation sequencing was performed on nondysplastic fresh-frozen colonic mucosa of the distal-most colectomy from 19 patients (10 UC and 9 CD) and 18 patients with diverticular disease serving as controls.
RESULTS: USeq software package identified 44 microRNAs with altered expression (fold change ≥2 and false discovery rate ≤0.10) compared to controls. Among them, a panel of 11 microRNAs was aberrantly expressed between UC and CD. qRT-PCR validation assays performed on frozen tissue from additional samples of UC (n=20) and CD (n=10) confirmed specific differential expression of miR-147b, miR-194-2, miR-383, miR-615 and miR-1826 (P<0.05). In addition, pathway analysis identified target genes of epithelial adhesion junction, integrin, glycolysis and cell cycle that involve in signaling pathways of TGF-β, STAT3, IL-8 and PI3L/AKT/mTOR.
CONCLUSION: Identification of differentially expressed microRNAs in UC and CD supports the hypothesis that UC and CD are regulated by distinct pathophysiologic mechanisms. MicroRNA panels show promise as diagnostic biomarkers for the subtyping of inflammatory bowel disease.},
}
@article {pmid27830672,
year = {2016},
author = {Occhionorelli, S and Zese, M and Tartarini, D and Lacavalla, D and Maccatrozzo, S and Groppo, G and Sibilla, MG and Stano, R and Cappellari, L and Vasquez, G},
title = {An approach to complicated diverticular disease. A retrospective study in an Acute Care Surgery service recently established.},
journal = {Annali italiani di chirurgia},
volume = {87},
number = {},
pages = {553-563},
pmid = {27830672},
issn = {2239-253X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Surgicenters ; },
abstract = {AIM: Acute diverticulitis is a frequent disease in the Western Countries. The increase number of patients admitted in the Surgery Departments led the necessity of new Scores and Classifications in order to clarify, in absence of clear guidelines, the best treatments to offer in the different situations.
METHODS: A retrospective study of ninety-nine patients treated in our Department from June 2010 and March 2015.
RESULTS: In our study 41 patients were treated conservatively, the remaining 58 were operated, 56 laparotomic and 2 laparoscopic. 5 patients submitted US guided drainage of abscess which failed in 2 cases. 25 submitted Hartmann's Procedure (HP), 29 Primary Resection and Anastomosis (PRA), 3 Contemporary Closure of Perforated Diverticula (CC) and just 2 Laparoscopic Peritoneal Lavage and Drainage (LPL). We related different Hinchey groups and up-groups with the treatments approached, identifying patients risk factors, ASA score and complications.
DISCUSSION: The treatment of perforated diverticulitis is debated. CT scan is becoming an useful instrument to make a correct diagnosis. Hinchey I and II patients are preferentially treated conservatively except in cases of complicated presentations. Hinchey III and IV are necessarily treated with surgical approach. We analyze the different types of intervention currently approached.
CONCLUSION: We believe in PRA in Hinchey III and IV selected patients, HP is the gold standard in higher ASA scores patients but the low number of stoma reversal remains an open problem. Many studies are ongoing concerning LPL and now there are insufficient data to think of a widespread use of this technique. Key words: CT scan, Diverticular Disease, Hartmann's Procedure, Intr-abdominal abscess, Laparoscopic Peritoneal Lavage and Drainage (LPL), Peritonitis, Primary Resection and Anastomosis (PRAHinchey Classification, US and CT guided drainage.},
}
@article {pmid27830520,
year = {2017},
author = {Boselli, C and Gemini, A and Cirocchi, R and Grassi, V and Avenia, S and Polistena, A and Sanguinetti, A and Pironi, D and Santoro, A and Tabola, R and Burattini, MF and Avenia, N},
title = {Is it safe and useful, laparoscopic peritoneal lavage in the treatment of acute diverticulitis of octogenarian patients? A multicenter retroprospective observational study.},
journal = {Aging clinical and experimental research},
volume = {29},
number = {Suppl 1},
pages = {83-89},
doi = {10.1007/s40520-016-0644-0},
pmid = {27830520},
issn = {1720-8319},
mesh = {Aged ; Aged, 80 and over ; *Conservative Treatment/methods/statistics & numerical data ; *Diverticulitis/complications/diagnosis/therapy ; Female ; Humans ; Intestinal Perforation/etiology/prevention & control ; *Laparoscopy/methods/statistics & numerical data ; Male ; Patient Selection ; Peritoneal Lavage/*methods ; Risk Adjustment ; Treatment Outcome ; },
abstract = {BACKGROUND: Diverticular disease of the colon also affects older people. Generally, older patients with diverticulitis may be regarded as too risky to undergo surgery. This retroprospective multicentric observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage (LPL) in elderly patients with perforated sigmoid diverticulitis.
PATIENTS AND METHOD: We hospitalized in urgency 100 patients, aged over 75, for sigmoid diverticulitis. Sixty-nine patients were treated with conservative medical therapy, while 31 were treated surgically, in which the surgery was performed in urgency in 18 cases, while in election in 13 cases. Laparoscopic peritoneal lavage was made in urgency in five cases.
RESULTS: The mean age of the sample was 81.72. Thirty-one patients underwent surgery, and five patients were treated in urgency with laparoscopic peritoneal lavage. Perioperative mortality was zero. None of the patients who underwent laparoscopic peritoneal lavage showed recurrent disease.
CONCLUSION: Diagnostic laparoscopy can be useful in elderly patient, since these patients may benefit from a more conservative surgical strategy. The selection of patients to be subjected to laparoscopic lavage must be very rigorous.},
}
@article {pmid27823760,
year = {2016},
author = {Ferrara, F and Bollo, J and Vanni, LV and Targarona, EM},
title = {Diagnosis and management of right colonic diverticular disease: A review.},
journal = {Cirugia espanola},
volume = {94},
number = {10},
pages = {553-559},
doi = {10.1016/j.ciresp.2016.08.008},
pmid = {27823760},
issn = {1578-147X},
mesh = {Diverticulosis, Colonic/*diagnosis/*therapy ; Humans ; },
abstract = {The aim of this narrative review is to define the clinical-pathological characteristics and to clarify the management of right colonic diverticular disease. It is rare in Europe, USA and Australia and more common in Asia. In the recent years its incidence has increased in the West, with various distributions among populations. Many studies have reported that it is difficult to differentiate the presenting symptoms of this disease from those of appendicitis before surgery, because the signs and symptoms are similar, so misdiagnosis is not infrequent. With accurate imaging studies it is possible to reach a precise preoperative diagnosis, in order to assess an accurate treatment strategy. Currently the management of this disease is not well defined, no clear guidelines have been proposed and it is not known whether the guidelines for left colonic diverticular disease can also be applied for it. Several authors have stated that conservative management is the best approach, even in case of recurrence, and surgery should be indicated in selected cases.},
}
@article {pmid27089051,
year = {2016},
author = {Brochmann, ND and Schultz, JK and Jakobsen, GS and Øresland, T},
title = {Management of acute uncomplicated diverticulitis without antibiotics: a single-centre cohort study.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {18},
number = {11},
pages = {1101-1107},
doi = {10.1111/codi.13355},
pmid = {27089051},
issn = {1463-1318},
mesh = {Acute Disease ; Aged ; Anti-Bacterial Agents ; Conservative Treatment/*methods ; Diverticulitis/*therapy ; Female ; Follow-Up Studies ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Norway ; Retrospective Studies ; Treatment Outcome ; },
abstract = {AIM: This study aimed to evaluate the implementation of nonantibiotic management of acute uncomplicated diverticulitis at a large university hospital in Norway with regard to management failure, disease recurrence and complications.
METHOD: On 1 January 2013 we implemented a new policy for the management of acute uncomplicated diverticulitis without antibiotics. Antibiotic treatment was only provided in the case of defined criteria. All patients admitted from 1 January 2013 to 30 June 2014 with a CT-verified, left-sided, acute uncomplicated diverticulitis were included in the study and evaluated retrospectively, with 12 months' follow-up.
RESULTS: Of 244 admissions with acute uncomplicated diverticulitis, 177 (73%) were managed without antibiotics. Among these there were seven (4%) management failures, including five patients in whom a deteriorating clinical picture prompted antibiotic treatment and two readmissions within 1 month due to persisting symptoms. The only complication in this group was one fistula (< 1%). Eight (5%) patients had a recurrence of acute diverticulitis requiring hospital care and two (1%) underwent elective surgery within the first year. Twenty (8%) patients met predefined exemption criteria and received antibiotics from admission, six (30%) of whom developed complications. The recurrence rate in this group was 10% and none had surgery performed. The 47 (20%) policy violators treated with antibiotics from admission had no complications. Their recurrence rate was 11% and one (2%) patient underwent elective surgery.
CONCLUSION: This study confirms that nonantibiotic management of acute uncomplicated diverticulitis is safe and feasible. Most complications occurred in a small group of high-risk patients treated with antibiotics.},
}
@article {pmid27802156,
year = {2017},
author = {Subramanian, S and Ekbom, A and Rhodes, JM},
title = {Recent advances in clinical practice: a systematic review of isolated colonic Crohn's disease: the third IBD?.},
journal = {Gut},
volume = {66},
number = {2},
pages = {362-381},
doi = {10.1136/gutjnl-2016-312673},
pmid = {27802156},
issn = {1468-3288},
mesh = {Adalimumab/therapeutic use ; Adrenal Cortex Hormones/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Colitis/diagnosis/*epidemiology/genetics/*therapy ; Colitis, Ulcerative/diagnosis ; Colon/microbiology ; Crohn Disease/diagnosis/*epidemiology/genetics/*therapy ; Diagnosis, Differential ; Gastrointestinal Agents/therapeutic use ; Gastrointestinal Microbiome ; Humans ; Incidence ; Infliximab/therapeutic use ; Mesalamine/therapeutic use ; Risk Factors ; Sex Factors ; },
abstract = {The genetics of isolated colonic Crohn's disease place it approximately midway between Crohn's disease with small intestinal involvement and UC, making a case for considering it as a separate condition. We have therefore systematically reviewed its epidemiology, pathophysiology and treatment. Key findings include a higher incidence in females (65%) and older average age at presentation than Crohn's disease at other sites, a mucosa-associated microbiota between that found in ileal Crohn's disease and UC, no response to mesalazine, but possibly better response to antitumour necrosis factor than Crohn's disease at other sites. Diagnostic distinction from UC is often difficult and also needs to exclude other conditions including ischaemic colitis, segmental colitis associated with diverticular disease and tuberculosis. Future studies, particularly clinical trials, but also historical cohorts, should assess isolated colonic Crohn's disease separately.},
}
@article {pmid27798440,
year = {2017},
author = {Paeschke, A and Erben, U and Kredel, LI and Kühl, AA and Siegmund, B},
title = {Role of visceral fat in colonic inflammation: from Crohn's disease to diverticulitis.},
journal = {Current opinion in gastroenterology},
volume = {33},
number = {1},
pages = {53-58},
doi = {10.1097/MOG.0000000000000324},
pmid = {27798440},
issn = {1531-7056},
mesh = {Adipokines/*immunology/metabolism ; Adipose Tissue/*immunology/metabolism ; Colon/immunology/pathology ; Crohn Disease/*immunology/pathology/physiopathology ; Diverticulitis, Colonic/*immunology/pathology/physiopathology ; Humans ; Inflammation/*immunology/pathology ; Inflammatory Bowel Diseases/immunology/pathology/physiopathology ; Intra-Abdominal Fat/*immunology/pathology/physiopathology ; },
abstract = {PURPOSE OF REVIEW: The composition of activated adipose tissue with adipocytes secreting a broad spectrum of immune-modulatory adipokines next to adipose tissue-derived stromal cells and professional immune effector cells in the visceral fat creates a complex network of inflammatory processes shaping local immune responses in the adjacent inflamed intestinal mucosa.
RECENT FINDINGS: In Crohn's disease a particular phenomenon called 'creeping fat' can be observed. Here the hyperplastic mesenteric fat tissue not only grows around inflamed small intestinal segments but also furthermore affects the regulation of the mucosal immune system. Diverticular disease is highly prevalent in the western world but the knowledge about its immunopathology remains incomplete. Interestingly, adipose tissue also frequently covers the basolateral site of inflamed diverticula, hence locally reflecting the phenomenon seen in Crohn's disease.
SUMMARY: This review aims to summarize the current knowledge in which measures this intraabdominal fat participates in the regulation of intestinal inflammation with a particular focus on differences and possible parallels in Crohn's disease and diverticulitis. The available data allow for suggesting that each inflamed diverticula mechanistically reflects Crohn's disease on a miniature scale.},
}
@article {pmid27797939,
year = {2017},
author = {Fukunaga, S and Takedatsu, H and Muta, H and Mitsuyama, K and Torimura, T},
title = {An unusual cause of colonic stricture with polyps.},
journal = {Gut},
volume = {66},
number = {8},
pages = {1495},
doi = {10.1136/gutjnl-2016-312737},
pmid = {27797939},
issn = {1468-3288},
mesh = {Aged ; Colonic Polyps/*complications/diagnostic imaging/pathology ; Constriction, Pathologic/etiology ; Humans ; Intestinal Obstruction/*etiology ; Intestinal Polyposis/*complications/diagnostic imaging/pathology ; Male ; },
}
@article {pmid27796023,
year = {2016},
author = {Piscopo, G and Capolongo, G},
title = {[Clinical Manifestations in Autosomal Dominant Polycystic Kidney Disease (ADPKD)].},
journal = {Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia},
volume = {33},
number = {5},
pages = {},
pmid = {27796023},
issn = {1724-5990},
mesh = {Humans ; Polycystic Kidney, Autosomal Dominant/complications/*diagnosis ; },
abstract = {ADPKD is a systemic disorder, associated with numerous extrarenal manifestations, including polycystic liver disease (PCLD) and other gastrointestinal manifestations, as well as pancreatic cysts, diverticular disease, inguinal and ventral hernias which play a significant role in disease burden, particularly in the advanced stage of ADPKD. In most cases the natural history of ADPKD goes through a long period of stability followed by a progressive decline in renal function. The coexistence of hypertension, cyst infections and nephrolithiasis can influence and accelerate the progression of kidney failure. The early diagnosis and prevention of these conditions are of foundamental importance. Nephrologists should know how to recognize and handle other clinical manifestations related to ADPKD like haematuria, renal cell carcinoma and intracranial aneurysms (ICA).},
}
@article {pmid27005290,
year = {2016},
author = {Pedrazzani, C and Menestrina, N and Moro, M and Brazzo, G and Mantovani, G and Polati, E and Guglielmi, A},
title = {Local wound infiltration plus transversus abdominis plane (TAP) block versus local wound infiltration in laparoscopic colorectal surgery and ERAS program.},
journal = {Surgical endoscopy},
volume = {30},
number = {11},
pages = {5117-5125},
pmid = {27005290},
issn = {1432-2218},
mesh = {Abdominal Muscles/innervation ; Androstanols/administration & dosage ; Anesthesia Recovery Period ; Anesthesia, General ; Anesthetics, Local/*administration & dosage ; *Colectomy ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; *Nerve Block ; Neuromuscular Nondepolarizing Agents/administration & dosage ; Pain, Postoperative/prevention & control ; Postoperative Nausea and Vomiting/prevention & control ; Prospective Studies ; Rectum/*surgery ; Rocuronium ; },
abstract = {BACKGROUND: Few data are available on TAP block in laparoscopic colorectal surgery and ERAS program. The aim of this prospective study was to evaluate local wound infiltration plus TAP block compared to local wound infiltration in the management of postoperative pain, nausea and vomiting, ileus and use of opioids in the context of laparoscopic colorectal surgery and ERAS program.
METHODS: From March 2014 to March 2015, 48 patients were treated by laparoscopic resection and ERAS program for colorectal cancer and diverticular disease at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust. Among these, 24 patients received local wound infiltration plus TAP block (TAP block group) and 24 patients received local wound infiltration (control group).
RESULTS: No differences were observed in baseline patient characteristics, clinical variables and surgical procedures between the two groups. Local wound infiltration plus TAP block allowed to achieve pain control despite a reduced use of opioid analgesics (P = 0.009). The adoption of TAP block resulted beneficial on the prevention of postoperative nausea (P = 0.002) and improvement of essential outcomes of ERAS program as recovery of bowel function (P = 0.005), urinary catheter removal (P = 0.003) and capability to tolerate oral diet (P = 0.027).
CONCLUSIONS: TAP block plus local wound infiltration in the setting of laparoscopic colorectal surgery and ERAS program guarantees a reduced use of opioid analgesics and good pain control allowing the improvement of essential items of enhanced recovery pathways.},
}
@article {pmid27778168,
year = {2017},
author = {Docimo, S and Lee, Y and Chatani, P and Rogers, AM and Lacqua, F},
title = {Visceral to subcutaneous fat ratio predicts acuity of diverticulitis.},
journal = {Surgical endoscopy},
volume = {31},
number = {7},
pages = {2808-2812},
pmid = {27778168},
issn = {1432-2218},
mesh = {Adult ; Aged ; Decision Support Techniques ; Diverticulitis/*diagnosis/surgery ; Elective Surgical Procedures ; Emergencies ; Female ; Humans ; *Intra-Abdominal Fat ; Male ; Middle Aged ; *Patient Acuity ; Retrospective Studies ; *Subcutaneous Fat ; },
abstract = {INTRODUCTION: There is an association between obesity and more complicated diverticular disease. We hypothesize that this link may be due to an increased level of visceral fat rather than an elevated body mass index alone. Adipose tissue secretes inflammatory cytokines, and chronic inflammation may account for the link between obesity and a more severe presentation of diverticular disease. We have applied a quantitative measure of visceral fat content in a series of patients admitted with diverticulitis, comparing those who required emergent versus elective surgical procedures for diverticulitis.
METHODS: We performed a retrospective review of all adult patients who underwent emergent or elective surgery at our institution for diverticulitis from 2010 to 2014. Data were collected on demographics, comorbidities, operative findings, complications, and length of stay. Radiologic measurements of adiposity were obtained from preoperative CT scans. Visceral fat areas and subcutaneous fat areas were measured, and the V/S ratio was calculated.
RESULTS: Thirty-four patients underwent emergent and 32 patients underwent elective surgery. The mean age was 66.3 years for the emergent and 57.11 for the elective group (p = 0.04178). The perinephric, visceral, subcutaneous fat, and V/S ratio for the emergent group were 1.71, 185.22, 338.22, and 0.56 and were 1.11, 127.18, 295.28, and 0.46 for the elective group. The difference between the V/S ratio for each group was significant (p = 0.0238). The emergent group had an average LOS of 16.11 days compared to 5.15 for the elective group (p = <0.00001). The complication rate was significantly higher (p = 0.024) in the emergent group (n = 12, 35.2 %) compared to the elective group (n = 4, 12.5 %).
CONCLUSION: Our study demonstrates a clinically significant link between visceral fat and severity of presentation of diverticulitis. Patients with higher V/S fat ratios were more likely to require emergency surgery and have more complications and a longer LOS.},
}
@article {pmid27763879,
year = {2015},
author = {Krokowicz, L and Bobkiewicz, A and Borejsza-Wysocki, M and Kuczynska, B and Lisowska, A and Skowronska-Piekarska, U and Paszkowski, J and Walkowiak, J and Drews, M and Banasiewicz, T},
title = {A Prospective, Descriptive Study to Assess the Effect of Dietary and Pharmacological Strategies to Manage Constipation in Patients with a Stoma.},
journal = {Ostomy/wound management},
volume = {61},
number = {12},
pages = {14-22},
pmid = {27763879},
issn = {1943-2720},
mesh = {Aged ; Colorectal Neoplasms/complications ; Constipation/*diet therapy/*drug therapy/*etiology ; Diet/methods/*standards ; Dietary Fiber/therapeutic use ; Female ; Humans ; Laxatives/therapeutic use ; Male ; Middle Aged ; Prospective Studies ; Surgical Stomas/*adverse effects ; Sweden ; },
abstract = {The term constipation with regard to patients with a stoma is defined as impaired bowel movements associated with increased stool consistency or long periods without bowel movements that lead to discomfort, flatulence, and abdominal pain. Information about constipation in patients with a stoma is limited. A prospective, descriptive study was conducted among patients attending ostomy and proctology outpatient clinics in Poznan, Poland between January 2011 and December 2014 to assess the role of dietary and pharmacological strategies in the management of constipation in patients with a stoma. Patients were included if they experienced a 3-day period without bowel movements leading to abdominal discomfort and bloating. Patients who were terminally ill from neoplastic disease or could not provide informed consent for study participation were not eligible to participate. Patients underwent 3 evaluations 3 months apart: the first assessed problems with passing stool through the stoma, at which time patients were told to increase fiber and fluid intake. During the next 2 visits, patients were asked if their symptoms had improved. If dietary changes were not successful, first-line pharmacological interventions were suggested (laxatives, osmotic agents, and probiotics). If no improvement was reported during the third assessment, second line pharmacologic therapy (eg, stimulant laxatives) were prescribed. Of the 405 patients initially assessed for participation, 331 met the initial screening criteria and were scheduled for followup. Of those, 93 (28%) had constipation; 50 (15%) required a surgical referral for morphological stoma changes and 43 (12.9%) met the study inclusion criteria for dietary recommendations. Almost all (42) had a colostomy and most (28) had a history of stoma creation due to diverticular disease. Twenty-five (25) men and 18 women (average age 55.9 ± 9.3 years) received dietary recommendations during the first visit. Diet modifications were effective and sufficient to resolve the problem with constipation in more than half (24) of the patients. Among the remaining 19 patients, only 2 did not improve after using first-line or second-line pharmacological management strategies. One patient required emergency surgery due to complicated colonic diverticulosis (perforation). The results of this study suggest constipation among patients with a stoma can be associated with morphological stoma changes and in the absence of morphologic changes the majority of patients respond well to a change in diet. Additional studies are needed to increase understanding about the incidence and optimal management strategies of constipation in persons with a stoma.},
}
@article {pmid27658328,
year = {2016},
author = {Solakoglu, T and Sari, SO and Koseoglu, H and Basaran, M and Akar, M and Buyukasik, S and Ersoy, O},
title = {A case of hepatic portal venous gas after colonoscopy.},
journal = {Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology},
volume = {17},
number = {3},
pages = {140-142},
doi = {10.1016/j.ajg.2016.08.004},
pmid = {27658328},
issn = {2090-2387},
mesh = {Aged ; Colonoscopy/*adverse effects ; Diverticulum, Colon/complications ; Embolism, Air/diagnostic imaging/*etiology ; Female ; Gases ; Gastrointestinal Hemorrhage/*etiology ; Humans ; *Portal Vein/diagnostic imaging ; Tomography, X-Ray Computed ; },
abstract = {Hepatic portal venous gas (HPVG) is a rare radiologic finding that is usually precipitated by intestinal ischaemia, intra-abdominal abscesses, necrotising enterocolitis, abdominal trauma, infectious enteritis, and inflammatory bowel disease. In this study, we present a case of HPVG in a 66-year-old female patient who underwent colonoscopy for evaluation of haematochezia and a review of the literature focused on HPVG following colonoscopy.},
}
@article {pmid27749481,
year = {2016},
author = {Damle, RN and Flahive, JM and Davids, JS and Maykel, JA and Sturrock, PR and Alavi, K},
title = {Examination of Racial Disparities in the Receipt of Minimally Invasive Surgery Among a National Cohort of Adult Patients Undergoing Colorectal Surgery.},
journal = {Diseases of the colon and rectum},
volume = {59},
number = {11},
pages = {1055-1062},
doi = {10.1097/DCR.0000000000000692},
pmid = {27749481},
issn = {1530-0358},
mesh = {Adult ; Aged ; *Colectomy/statistics & numerical data ; *Colonic Diseases/ethnology/surgery ; *Colorectal Surgery/methods/statistics & numerical data ; Ethnicity ; Female ; *Healthcare Disparities/ethnology/statistics & numerical data ; Humans ; Insurance Coverage ; Male ; Massachusetts/epidemiology ; Middle Aged ; *Minimally Invasive Surgical Procedures/methods/statistics & numerical data ; Outcome Assessment, Health Care ; Quality Improvement ; *Rectal Diseases/ethnology/surgery ; Retrospective Studies ; United States ; },
abstract = {BACKGROUND: Racial disparities in outcomes are well described among surgical patients.
OBJECTIVE: The purpose of this work was to identify any racial disparities in the receipt of a minimally invasive approach for colorectal surgery.
DESIGN: Adults undergoing colorectal surgery were studied using the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify predictors for the receipt of a minimally invasive approach.
SETTINGS: The study was conducted at academic hospitals and their affiliates.
PATIENTS: Adults ≥18 years of age who underwent surgery for colorectal cancer, diverticular disease, IBD, or benign colorectal tumor between 2008 and 2011 were included.
MAIN OUTCOME MEASURES: The receipt of a minimally invasive surgical approach was the main measured outcome.
RESULTS: A total of 82,474 adult patients met the study inclusion criteria. Of these, 69,664 (84%) were white, 10,874 (13%) were black, and 1936 (2%) were Asian. Blacks were younger, with higher rates of public insurance and higher comorbidity burden and baseline severity of illness compared with white and Asian patients. Black patients were less likely (adjusted OR = 0.83 (95% CI, 0.79-0.87)) and Asian patients more likely (adjusted OR = 1.34 (95% CI, 1.21-1.49)) than whites to receive minimally invasive surgery. This association did not change with stratification by insurance type (public or private). Black patients had higher rates of intensive care unit admission and nonhome discharge, as well as an increased length of stay compared with white and Asian patients. No differences in complications, readmission, or mortality rates were observed with minimally invasive surgery, but black patients were more likely to be readmitted or to die with open surgery.
LIMITATIONS: The study was limited by the retrospective nature of its data.
CONCLUSIONS: We identified racial differences in the receipt of a minimally invasive approach for colorectal surgery, regardless of insurance status, as well as improved outcomes for minority races who underwent a minimally invasive technique compared with open surgery. The improved outcomes associated with minimally invasive surgery should prompt efforts to increase rates of its use among black patients.},
}
@article {pmid27745889,
year = {2017},
author = {Rosen, DR and Hwang, GS and Ault, GT and Ortega, AE and Cologne, KG},
title = {Operative management of diverticulitis in a tertiary care center.},
journal = {American journal of surgery},
volume = {214},
number = {1},
pages = {37-41},
doi = {10.1016/j.amjsurg.2016.06.026},
pmid = {27745889},
issn = {1879-1883},
mesh = {Abscess/surgery ; Constriction, Pathologic/surgery ; Cutaneous Fistula/surgery ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Intestinal Fistula/surgery ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Ostomy/statistics & numerical data ; Patient Readmission/statistics & numerical data ; Postoperative Complications ; Recurrence ; Reoperation/statistics & numerical data ; Retrospective Studies ; Tertiary Care Centers ; Vaginal Fistula/surgery ; },
abstract = {BACKGROUND: Diverticulitis has become a medically managed disease process; the indications and timing of surgical intervention have evolved.
METHODS: We retrospectively reviewed all patients who underwent surgical intervention due to diverticular disease by the Division of Colon and Rectal Surgery from 2012 to 2014.
RESULTS: Ninety-eight surgeries were performed. Indications included colovesicular fistula, multiple recurrences of diverticulitis, medically refractory diverticulitis, stricture, abscess, colocutaneous fistula, and colovaginal fistula. Average length of stay was 5.7 ± 5.9 days (range, 1 to 51). Eighteen patients (18%) required an ostomy. Postoperative complications occurred in 18% of patients, including anastomotic leak (3.3%), wound infection (7.1%), acute kidney injury (5.1%), and urinary tract infection (2.0%). Thirty-day readmission rate was 7.2%; unplanned 30-day reoperation rate was 3.1%. There were no deaths.
CONCLUSIONS: The type of patient undergoing surgery for diverticulitis has changed, with selection bias toward chronic, advanced disease due to the proliferation of medical management strategies.},
}
@article {pmid27741164,
year = {2016},
author = {Lahner, E and Annibale, B},
title = {Probiotics and Diverticular Disease: Evidence-based?.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 2, Proceedings from the 8th Probiotics, Prebiotics & New Foods for Microbiota and Human Health meeting held in Rome, Italy on September 13-15, 2015},
number = {},
pages = {S159-S160},
doi = {10.1097/MCG.0000000000000684},
pmid = {27741164},
issn = {1539-2031},
mesh = {Colon/microbiology/physiopathology ; Diverticular Diseases/microbiology/physiopathology/*therapy ; Evidence-Based Medicine/*methods ; *Gastrointestinal Microbiome ; Gastrointestinal Motility ; Humans ; *Prebiotics ; Probiotics/*therapeutic use ; },
abstract = {Diverticular disease (DD) is a common gastrointestinal condition. Clinical spectrum ranges from asymptomatic diverticulosis to symptomatic uncomplicated or complicated DD. Symptoms related to uncomplicated DD are not specific and may be indistinguishable from those of irritable bowel syndrome. Low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors potentially contributing to symptoms. Probiotics may modify the gut microbial balance leading to health benefits. Probiotics, due to their anti-inflammatory effects and ability to maintain an adequate bacterial colonization in the colon, are promising treatment options for DD. This review focuses on the available evidence on the efficacy of prebiotics in uncomplicated DD.},
}
@article {pmid27721199,
year = {2016},
author = {Yeh, TC},
title = {Laparoscopic resection of perforated duodenal diverticulum - A case report and literature review.},
journal = {International journal of surgery case reports},
volume = {28},
number = {},
pages = {204-210},
pmid = {27721199},
issn = {2210-2612},
abstract = {BACKGROUND: Duodenum diverticulum is the most common site for diverticular disease of small intestine. Most of duodenal diverticulum are asymptomatic, but complicated or perforated duodenal diverticulum is rare. Nonoperative management is attractive in selected patients, because of higher surgical complications. We suggest the use of a minimally invasive operative method as an alternative approach for the management of complicated duodenal diverticulum, especially when conservative treatment has failed.
CASE PRESENTATION: A 67-year-old female was admitted to Emergency Department with sudden onset of severe right upper abdominal pain and fever (38.2°C) lasted 8h. Abdominal computed tomographic imaging was performed and a perforated duodenal diverticulum with right-sided anterior pararenal space free air and fluid retention was identified. After assessment and resuscitation, proper treatment modality was selected taking in consideration type, location and complication of duodenal diverticulum. A emergency laparoscopic duodenal diverticulectomy with intraabdominal drainage was performed. Postoperative period was uneventful and patient was discharged on the 10th postoperative day. English literatures discussing laparoscopic management for complicated duodenal diverticulum were carefully reviewed.
CONCLUSIONS: Laparoscopic approach showed less complication, shorted hospital stay and better outcome in comparison to conservative, or open surgery. Laparoscopic approach is safe and feasible in selected cases of complicated duodenal diverticulum (laterally located and protruding duodenal diverticulum). With advances in laparoscopic instruments and techniques, complicated duodenal diverticulums can be managed safely by laparoscopically.},
}
@article {pmid27701164,
year = {2017},
author = {Balasubramanian, I and Fleming, C and Mohan, HM and Schmidt, K and Haglind, E and Winter, DC},
title = {Out-Patient Management of Mild or Uncomplicated Diverticulitis: A Systematic Review.},
journal = {Digestive surgery},
volume = {34},
number = {2},
pages = {151-160},
doi = {10.1159/000450865},
pmid = {27701164},
issn = {1421-9883},
mesh = {Acute Disease ; Ambulatory Care/economics/*statistics & numerical data ; Analgesics/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Cost Savings ; Diet ; Diverticulitis/economics/*therapy ; Health Care Costs ; Hospitalization/economics/*statistics & numerical data ; Humans ; Recurrence ; Severity of Illness Index ; Treatment Failure ; },
abstract = {BACKGROUND: Management of diverticular disease has undergone a paradigm shift, with movement towards a less invasive management strategy. In keeping with this, outpatient management of uncomplicated diverticulitis (UD) has been advocated in several studies, but concerns still remain regarding the safety of this practice.
AIM: To assess outcomes of out-patient management of acute UD.
METHODS: A comprehensive search for published studies using the search terms 'uncomplicated diverticulitis', 'mild diverticulitis' and 'out-patient' was performed. The primary outcomes were failure of medical treatment. Secondary outcomes were recurrence rate at follow up and medical cost savings.
RESULTS: The search yielded 192 publications. Of these, 10 studies met the inclusion criteria including 1 randomized controlled trial, 6 clinical controlled trials and 3 case series. There was no difference in failure rates of medical treatment (6.5 vs. 4.6%, p = 0.32) or in recurrence rates (13.0 vs. 12.1%, p = 0.81) between those receiving ambulatory care and in-patient care for UD. Ambulatory treatment is associated with an estimated daily cost savings of between 600 and 1,900 euros per patient treated. Meta-analysis of data was not possible due to heterogeneity in study designs and inclusion criteria.
CONCLUSION: Ambulatory management of acute UD is reasonable in selected patients.},
}
@article {pmid27622380,
year = {2016},
author = {Tursi, A and Picchio, M and Elisei, W and Di Mario, F and Scarpignato, C and Brandimarte, G},
title = {Current Management of Patients With Diverticulosis and Diverticular Disease: A Survey From the 2nd International Symposium on Diverticular Disease.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S97-S100},
doi = {10.1097/MCG.0000000000000645},
pmid = {27622380},
issn = {1539-2031},
mesh = {Anti-Infective Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Colonoscopy/statistics & numerical data ; Congresses as Topic ; *Disease Management ; Diverticular Diseases/*therapy ; Diverticulosis, Colonic/*therapy ; Europe ; Gastroenterologists/statistics & numerical data ; General Practitioners/statistics & numerical data ; Humans ; Mesalamine/therapeutic use ; Practice Patterns, Physicians'/*statistics & numerical data ; Probiotics/therapeutic use ; Rifamycins/therapeutic use ; Rifaximin ; Surgeons/statistics & numerical data ; Surveys and Questionnaires ; },
abstract = {BACKGROUND: Management of diverticular disease (DD) remains a point of debate.
GOALS: To investigate the current opinion of participants of the 2nd International Symposium on Diverticular Disease, on real-life management of patients with DD of the colon.
STUDY: Twelve questions were aimed at the diagnosis, treatment, and management options for diverticulosis and symptomatic DD.
RESULTS: In total, 115 surveys from 8 European Countries were filled out. High fiber diet was widely prescribed in diverticulosis (59.1%). Probiotics (25%) were the most frequent prescribed drug, whereas 29.8% of participants did not prescribe any treatment in diverticulosis. Colonoscopy was frequently prescribed in symptomatic patients (69.3%), whereas 72.9% of participants did not prescribe any instrumental tool in their follow-up. Rifaximin, probiotics, and mesalazine were the most frequent prescribed drugs both in symptomatic patients (28.1, 14.9%, and 11.4%, respectively) and to prevent recurrence of the disease (42.5%, 12.4%, and 28.2%, respectively). With respect to laboratory exams, 57.9% of participants prescribed them during follow-up. The majority of participants (64.9%) managed suspected acute diverticulitis at home. Rifaximin, probiotics, and mesalazine were the most frequent prescribed drugs to prevent recurrence of the disease (32.2%, 13.2%, and 11.4%, respectively), whereas 25.4% of participants did not prescribe any drugs. Finally, no differences were found among gastroenterologists, surgeons, and general practitioners in managing this disease.
CONCLUSIONS: This surveys shows that current management of DD is similar between different medical specialities, generally in line with current literature.},
}
@article {pmid27622379,
year = {2016},
author = {Campanini, A and De Conto, U and Cavasin, F and Bastiani, F and Camarotto, A and Gardini, L and Geremia, A and Marastoni, C and Missorini, C and Quarantelli, E and Sassi, U and Scarabello, F and Dal Bo, N and Riccò, M and Grillo, S and Landi, S and Di Mario, F},
title = {A Primary-Care Interventional Model on the Diverticular Disease: Searching for the Optimal Therapeutic Schedule.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S93-6},
doi = {10.1097/MCG.0000000000000670},
pmid = {27622379},
issn = {1539-2031},
mesh = {Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Anti-Infective Agents/*therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diet Therapy/*methods ; Dietary Fiber/therapeutic use ; Diverticular Diseases/*therapy ; Female ; Humans ; Male ; Mesalamine/therapeutic use ; Middle Aged ; Primary Health Care/methods ; Probiotics/*therapeutic use ; Prospective Studies ; Rifamycins/therapeutic use ; Rifaximin ; Treatment Outcome ; },
abstract = {INTRODUCTION: In routine colonoscopy, diverticulosis is the most commonly found feature, but only a minority of these cases show symptoms of diverticular disease.From June 2014 to December 2014, we enrolled prospectively 178 patients affected by symptomatic uncomplicated diverticular disease (Male/Female=0.47, mean age 71.7±11.5 y, range 41 to 95 y) from 15 General Pratictioners patient files. All patients were symptomatic; in all cases, diagnosis was been confirmed by a colonoscopy performed at least 1 year before. Patients with acute diverticulitis were excluded.On the basis of the predominant symptoms (abdominal complaints or constipation), patients were addressed to 4 different therapeutic approaches using mesalamine, rifaximine, probiotics (in a consortium of different species of Lactobacillus and Bifidobacterium), and fibers (Plantago Ovata Husk). All treatments lasted 3 months.
RESULTS: Sixty-three patients were enrolled in group A (rifaximine), 43 in group A1 (rifaximine+fibers+probiotics), 23 in group B (mesalamine), and 31 in group B1 (mesalamine+fibers).Analysis of variance suggested a statistically significant difference (P<0.003) among groups at the end of the observation period, with Groups A1 and B1 showing a higher number of bowel movement per week. Global linear measurement confirmed the role of treatment as a significant factor (F=2.858; P=0.039) associated with body mass index (F=6.972; P<0.009).
CONCLUSIONS: In accordance with the baseline clinical presentation, the supplementation of fiber and/or probiotics is associated with a statistically significant improvement in the clinical pattern of symptoms in patients with diverticular disease in a primary-care/family physician setting.},
}
@article {pmid27622378,
year = {2016},
author = {Tursi, A and Mastromarino, P and Capobianco, D and Elisei, W and Miccheli, A and Capuani, G and Tomassini, A and Campagna, G and Picchio, M and Giorgetti, G and Fabiocchi, F and Brandimarte, G},
title = {Assessment of Fecal Microbiota and Fecal Metabolome in Symptomatic Uncomplicated Diverticular Disease of the Colon.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S9-S12},
doi = {10.1097/MCG.0000000000000626},
pmid = {27622378},
issn = {1539-2031},
mesh = {Aged ; Case-Control Studies ; Diverticulosis, Colonic/*microbiology ; Feces/*microbiology ; Female ; *Gastrointestinal Microbiome ; Humans ; Magnetic Resonance Spectroscopy ; *Metabolome ; Metabolomics/methods ; *Microbiota ; Middle Aged ; Real-Time Polymerase Chain Reaction ; },
abstract = {GOAL: The aim of this study was to assess fecal microbiota and metabolome in a population with symptomatic uncomplicated diverticular disease (SUDD).
BACKGROUND: Whether intestinal microbiota and metabolic profiling may be altered in patients with SUDD is unknown.
PATIENTS AND METHODS: Stool samples from 44 consecutive women [15 patients with SUDD, 13 with asymptomatic diverticulosis (AD), and 16 healthy controls (HCs)] were analyzed. Real-time polymerase chain reaction was used to quantify targeted microorganisms. High-resolution proton nuclear magnetic resonance spectroscopy associated with multivariate analysis with partial least-square discriminant analysis (PLS-DA) was applied on the metabolite data set.
RESULTS: The overall bacterial quantity did not differ among the 3 groups (P=0.449), with no difference in Bacteroides/Prevotella, Clostridium coccoides, Bifidobacterium, Lactobacillus, and Escherichia coli subgroups. The amount of Akkermansia muciniphila species was significantly different between HC, AD, and SUDD subjects (P=0.017). PLS-DA analysis of nuclear magnetic resonance -based metabolomics associated with microbiological data showed significant discrimination between HCs and AD patients (R=0.733; Q=0.383; P<0.05, LV=2). PLS analysis showed lower N-acetyl compound and isovalerate levels in AD, associated with higher levels of A. municiphila, as compared with the HC group. PLS-DA applied on AD and SUDD samples showed a good discrimination between these 2 groups (R=0.69; Q=0.35; LV=2). SUDD patients were characterized by low levels of valerate, butyrate, and choline and by high levels of N-acetyl derivatives and U1.
CONCLUSIONS: SUDD and AD do not show colonic bacterial overgrowth, but a significant difference in the levels of fecal A. muciniphila was observed. Moreover, increasing expression of some metabolites as expression of different AD and SUDD metabolic activity was found.},
}
@article {pmid27622377,
year = {2016},
author = {De Bastiani, R and Sanna, G and Fracasso, P and D'Urso, M and Benedetto, E and Tursi, A},
title = {The Management of Patients With Diverticulosis and Diverticular Disease in Primary Care: An Online Survey Among Italian General Pratictioners.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S89-92},
doi = {10.1097/MCG.0000000000000580},
pmid = {27622377},
issn = {1539-2031},
mesh = {Adult ; *Disease Management ; Diverticulosis, Colonic/diagnosis/*therapy ; Female ; General Practitioners/*statistics & numerical data ; Guideline Adherence ; Humans ; Italy ; Male ; Middle Aged ; Practice Guidelines as Topic ; Practice Patterns, Physicians'/*statistics & numerical data ; Primary Health Care/methods/standards/*statistics & numerical data ; Surveys and Questionnaires ; },
abstract = {GOALS: To investigate the current opinion of Italian general practitioners (GPs) on the management of patients with diverticular disease (DD) of the colon.
BACKGROUND: The management of DD remains a point of debate, and guidelines are not uniform in their advice.
STUDY: A web-based survey was conducted among Italian GPs. Twelve questions were aimed at the diagnosis, treatment, and management options for diverticulosis and symptomatic DD.
RESULTS: In total, 245 surveys were filled out. A high-fiber diet was prescribed widely in diverticulosis (44%), together with advice to allow seeds (30%). Rifaximin (26%) and probiotics (25%) were the most frequently prescribed drugs in this population. Colonoscopy was the most prescribed instrumental tool in the diagnosis (77%) and follow-up (21%) of symptomatic uncomplicated diverticular disease patients. Rifaximin, probiotics, and mesalazine were the most frequently prescribed drugs in symptomatic uncomplicated diverticular disease patients (82.8, 59.5%, and 36.3%, respectively). Finally, 77% of the Italian GPs prescribed laboratory exams in the follow-up of these patients. The vast majority of the Italian GPs (83%) managed suspected acute diverticulitis at home, and did not consider two episodes of acute diverticulitis as a strict surgical indication (86%). Rifaximin, probiotics, and mesalazine were the most frequently prescribed drugs to prevent recurrence of the disease (42.5%, 28.2%, and 12.4%, respectively). Finally, 87% of the Italian GPs prescribed laboratory examinations in the follow-up of these patients.
CONCLUSIONS: This survey shows that the current management of DD in primary care by Italian GPs is not fully in line with current guidelines and more recent literature data.},
}
@article {pmid27622376,
year = {2016},
author = {Wensaas, KA and Hungin, AP},
title = {Diverticular Disease in the Primary Care Setting.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S86-8},
doi = {10.1097/MCG.0000000000000596},
pmid = {27622376},
issn = {1539-2031},
mesh = {Aged ; *Disease Management ; Diverticular Diseases/*diagnosis/epidemiology/*therapy ; Diverticulum, Colon/diagnosis/epidemiology/therapy ; Europe/epidemiology ; Humans ; Incidence ; Middle Aged ; Practice Guidelines as Topic ; Prevalence ; Primary Health Care/*methods/standards ; Symptom Assessment/*methods/standards ; },
abstract = {Diverticular disease is a chronic and common condition, and yet the impact of diverticular disease in primary care is largely unknown. The diagnosis of diverticular disease relies on the demonstration of diverticula in the colon, and the necessary investigations are often not available in primary care. The specificity and sensitivity of symptoms, clinical signs and laboratory tests alone are generally low and consequently the diagnostic process will be characterized by uncertainty. Also, the criteria for symptomatic uncomplicated diverticular disease in the absence of macroscopic inflammation are not clearly defined. Therefore both the prevalence of diverticular disease and the incidence of diverticulitis in primary care are unknown. Current recommendations for treatment and follow-up of patients with acute diverticulitis are based on studies where the diagnosis has been verified by computerized tomography. The results cannot be directly transferred to primary care where the diagnosis has to rely on the interpretation of symptoms and signs. Therefore, one must allow for greater diagnostic uncertainty, and safety netting in the event of unexpected development of the condition is an important aspect of the management of diverticulitis in primary care. The highest prevalence of diverticular disease is found among older patients, where multimorbidity and polypharmacy is common. The challenge is to remember the possible contribution of diverticular disease to the patient's overall condition and to foresee its implications in terms of advice and treatment in relation to other diseases.},
}
@article {pmid27622373,
year = {2016},
author = {Biondi, A and Santullo, F and Fico, V and Persiani, R},
title = {Long-term Outcomes of Elective Surgery for Diverticular Disease: A Call for Standardization.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S77-9},
doi = {10.1097/MCG.0000000000000599},
pmid = {27622373},
issn = {1539-2031},
mesh = {Colectomy/methods/*standards ; Colon, Sigmoid/surgery ; Diverticular Diseases/*surgery ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures/methods/*standards ; Humans ; Laparoscopy/methods/standards ; Practice Guidelines as Topic/*standards ; Time ; Treatment Outcome ; },
abstract = {To date, the appropriate management of diverticular disease is still controversial. The American Society of Colon and Rectal Surgeons declared that the decision between conservative or surgical approach should be taken by a case-by-case evaluation. There is still lack of evidence in literature about long-term outcomes after elective sigmoid resection for diverticular disease. Considering the potentially key role of the surgical technique in long-term outcomes, there is the need for surgeons to define strict rules to standardize the surgical technique. Currently there are 5 areas of debate in elective surgery for diverticular disease: laparoscopic versus open approach, the site of the proximal and distal colonic division, the vascular approach and the mobilization of the splenic flexure. The purpose of this paper is to review existing knowledge about technical aspects, which represent how the surgeon is able to affect the long-term results.},
}
@article {pmid27622372,
year = {2016},
author = {Oliveira, EC and Bafutto, M and Almeida, JR},
title = {Open or Laparoscopic Treatment: Differences and Outcomes.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S74-6},
doi = {10.1097/MCG.0000000000000649},
pmid = {27622372},
issn = {1539-2031},
mesh = {Anastomosis, Surgical/methods ; Colectomy/*methods ; Diverticulitis/complications/*surgery ; Drainage/methods ; Humans ; Intestinal Perforation/etiology/surgery ; Laparoscopy/*methods ; Peritonitis/etiology/surgery ; Therapeutic Irrigation/methods ; Treatment Outcome ; },
abstract = {Surgical treatment of diverticulitis is still characterized by high morbidity and mortality. Surgical approach evolved from the early 20th century with 3-stage laparotomy to colon resection with primary anastomosis. In the last 2 decades, laparoscopic colectomy has been applied to elective and emergency setting of diverticular disease. Recently, laparoscopic lavage and drainage has been used to treat purulent peritonitis. All those modalities of treatment have been discussed and pointed pros and cons.},
}
@article {pmid27622371,
year = {2016},
author = {Scarpignato, C and Bertelé, A and Tursi, A},
title = {Probiotics for the Treatment of Symptomatic Uncomplicated Diverticular Disease: Rationale and Current Evidence.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S70-3},
doi = {10.1097/MCG.0000000000000641},
pmid = {27622371},
issn = {1539-2031},
mesh = {Diverticulosis, Colonic/*microbiology/*therapy ; *Gastrointestinal Microbiome ; Humans ; Probiotics/*therapeutic use ; Treatment Outcome ; },
abstract = {Changes in the colonic microbiota are critical to the pathogenesis of diverticular complications such as diverticulitis and peridiverticular abscesses. However, more subtle changes in microbiota composition may well be important to the more chronic manifestations of diverticulosis. Some studies have shown the presence of bacterial overgrowth in subgroups of patients with diverticular disease and recent studies, using molecular biology techniques, found an increase of proteobacteria and actinobacteria in patients with symptomatic uncomplicated diverticular disease (SUDD), compared with healthy controls. The use of probiotics to modulate intestinal microecology in SUDD appears therefore rational. Although several investigations evaluating the clinical efficacy of probiotics have been performed, no definitive results have yet been achieved, mainly due to the heterogeneity of the available studies. Most of the studies used probiotics in combination with poorly absorbed antimicrobials or anti-inflammatory drugs. In only 4 studies, there was a harm using probiotics alone, but only 1 was a placebo-controlled, double-blind trial. The analysis of the available evidence reveals a poor quality of the published studies, whose design was heterogeneous, with only 2 out of 11 trials being double-blind and randomized. Therefore, available data can only suggest a benefit of probiotics in SUDD, but do not allow any evidence-based definite conclusion. As a consequence, current guidelines state that there is insufficient evidence to recommend probiotics for symptom relief in patients with diverticular disease.},
}
@article {pmid27622370,
year = {2016},
author = {Picchio, M and Elisei, W and Brandimarte, G and Di Mario, F and Malfertheiner, P and Scarpignato, C and Tursi, A},
title = {Mesalazine for the Treatment of Symptomatic Uncomplicated Diverticular Disease of the Colon and for Primary Prevention of Diverticulitis: A Systematic Review of Randomized Clinical Trials.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S64-9},
doi = {10.1097/MCG.0000000000000669},
pmid = {27622370},
issn = {1539-2031},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulitis, Colonic/etiology/*prevention & control ; Diverticulosis, Colonic/complications/*drug therapy ; Female ; Humans ; Male ; Mesalamine/*therapeutic use ; Middle Aged ; Primary Prevention/*methods ; Randomized Controlled Trials as Topic ; Treatment Outcome ; },
abstract = {BACKGROUND: Symptomatic uncomplicated diverticular disease (SUDD) is a common gastrointestinal disease, because it affects about one fourth of the patient harboring colonic diverticula.
GOAL: To assess the effectiveness of mesalazine in improving symptoms (namely abdominal pain) and in preventing diverticulitis occurrence in patients with SUDD.
STUDY: Only randomized clinical trials (irrespective of language, blinding, or publication status) that compared mesalazine with placebo or any other therapy in SUDD were evaluated. The selected endpoints were symptom relief and diverticulitis occurrence at maximal follow-up. Absolute risk reduction (ARR, with 95% confidence interval) and the number needed to treat were used as measures of the therapeutic effect.
RESULTS: Six randomized clinical trials enrolled 1021 patients: 526 patients were treated with mesalazine and 495 with placebo or other therapies. Symptom relief with mesalazine was always larger than that with placebo and other therapies. However, absolute risk reduction was significant only when mesalazine was compared with placebo, a high-fiber diet, and low-dose rifaximin. The incidence of diverticulitis with mesalazine was lower than that observed with placebo and other treatments, being significant only when compared with placebo.
CONCLUSIONS: Mesalazine is effective in achieving symptom relief and primary prevention of diverticulitis in patients with SUDD.},
}
@article {pmid27622369,
year = {2016},
author = {Barbara, G and Cremon, C and Barbaro, MR and Bellacosa, L and Stanghellini, V},
title = {Treatment of Diverticular Disease With Aminosalicylates: The Evidence.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S60-3},
doi = {10.1097/MCG.0000000000000611},
pmid = {27622369},
issn = {1539-2031},
mesh = {Aminosalicylic Acids/*therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulosis, Colonic/*drug therapy ; Humans ; Mesalamine/*therapeutic use ; Recurrence ; Treatment Outcome ; },
abstract = {Colonic diverticulosis is an increasingly common condition in Western industrialized countries. About 20% of patients develop symptoms, including abdominal pain, bloating, changes in bowel habits, and, eventually, diverticulitis or other complications. The management of symptomatic uncomplicated diverticular disease (SUDD) and the prevention of acute diverticulitis remains a challenge for the clinician. The rationale for the use of aminosalicylates, such as mesalazine, is based on the assumption of low-grade inflammation in SUDD and symptoms generation, whereas an overt inflammation may induce diverticulitis in patients with diverticular disease. Clinical scenarios in which the efficacy and safety of mesalazine have been studied include SUDD, prevention of diverticulitis, and of recurrent diverticulitis. Data from uncontrolled studies suggest a benefit of mesalazine on patients with SUDD, whereas data from randomized controlled trials showed some evidence of improvement of symptoms, although contrasting results are reported. The largest study so far published on the efficacy of mesalamine in the prevention of recurrence of diverticulitis showed that mesalamine was not superior to placebo. At this time, the role of mesalazine in the prevention of acute diverticulitis remains to be defined with many issues open and unresolved.},
}
@article {pmid27622368,
year = {2016},
author = {Bassotti, G and Villanacci, V and Bernardini, N and Dore, MP},
title = {Diverticular Disease of the Colon: Neuromuscular Function Abnormalities.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S6-8},
doi = {10.1097/MCG.0000000000000578},
pmid = {27622368},
issn = {1539-2031},
mesh = {Autonomic Nervous System/*physiopathology ; Colon/innervation/physiopathology ; Diverticulitis, Colonic/*physiopathology ; Diverticulosis, Colonic/*physiopathology ; Humans ; Intestinal Mucosa/innervation/physiopathology ; },
abstract = {Colonic diverticular disease is a frequent finding in daily clinical practice. However, its pathophysiological mechanisms are largely unknown. This condition is likely the result of several concomitant factors occurring together to cause anatomic and functional abnormalities, leading as a result to the outpouching of the colonic mucosa. A pivotal role seems to be played by an abnormal colonic neuromuscular function, as shown repeatedly in these patients, and by an altered visceral perception. There is recent evidence that these abnormalities might be related to the derangement of the enteric innervation, to an abnormal distribution of mucosal neuropeptides, and to low-grade mucosal inflammation. The latter might be responsible for the development of visceral hypersensitivity, often causing abdominal pain in a subset of these patients.},
}
@article {pmid27622367,
year = {2016},
author = {Lué, A and Laredo, V and Lanas, A},
title = {Medical Treatment of Diverticular Disease: Antibiotics.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S57-9},
doi = {10.1097/MCG.0000000000000593},
pmid = {27622367},
issn = {1539-2031},
mesh = {Abscess/drug therapy/etiology/surgery ; Acute Disease ; Anti-Bacterial Agents/*therapeutic use ; Diverticulitis, Colonic/complications/*drug therapy/microbiology ; Drainage/methods ; Gastrointestinal Microbiome/drug effects ; Humans ; Recurrence ; Rifamycins/*therapeutic use ; Rifaximin ; Treatment Outcome ; },
abstract = {Diverticular disease (DD) of the colon represents the most common disease affecting the large bowel in western countries. Its prevalence is increasing. Recent studies suggest that changes in gut microbiota could contribute to development of symptoms and complication. For this reason antibiotics play a key role in the management of both uncomplicated and complicated DD. Rifaximin has demonstrated to be effective in obtaining symptoms relief at 1 year in patients with uncomplicated DD and to improve symptoms and maintain periods of remission following acute colonic diverticulitis (AD). Despite absence of data that supports the routine use of antibiotic in uncomplicated AD, they are recommended in selected patients. In patients with AD that develop an abscess, conservative treatment with broad-spectrum antibiotics is successful in up to 70% of cases. In patients on conservative treatment where percutaneous drainage fails or peritonitis develops, surgery is considered the standard therapy. In conclusion antibiotics seem to remain the mainstay of treatment in symptomatic uncomplicated DD and AD. Inpatient management and intravenous antibiotics are necessary in complicated AD, while outpatient management is considered the best strategy in the majority of uncomplicated patients.},
}
@article {pmid27622366,
year = {2016},
author = {Floch, MH and Longo, WE},
title = {United States Guidelines for Diverticulitis Treatment.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S53-6},
doi = {10.1097/MCG.0000000000000668},
pmid = {27622366},
issn = {1539-2031},
mesh = {Colon/pathology ; Dietary Fiber/deficiency ; Diverticulitis/classification/etiology/*therapy ; Gastroenterology/*standards ; Humans ; *Practice Guidelines as Topic ; Treatment Outcome ; United States ; },
abstract = {Guidelines for diverticular disease management were last supported and published by the American Gastroenterology Association and the American College of Gastroenterology 2 decades ago. Guidelines have been published in other countries and by some societies. These guidelines are suggested as United States of America guidelines. In reality, they are what is practiced in Connecticut at Yale New Haven hospitals. The epidemiology and pathophysiology is described. This is still considered a dietary fiber-deficiency disease that results in high intracolonic pressure with resultant outpocketing of diverticula in the weakest point of the colon at the sites of vascular penetration with developing elastin deposition in the colon wall. The age and gender distribution is described. They are most common in the sigmoid. The guidelines of management are described according to accepted classification of the disease at all stages from onset, to early formation, to mild disease, to complicated disease, to rare specific states. The outcomes and mortality are discussed.},
}
@article {pmid27622365,
year = {2016},
author = {Schultz, JK and Yaqub, S and Øresland, T},
title = {Management of Diverticular Disease in Scandinavia.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S50-2},
doi = {10.1097/MCG.0000000000000642},
pmid = {27622365},
issn = {1539-2031},
mesh = {Abscess/etiology/surgery ; Anti-Bacterial Agents/therapeutic use ; Colorectal Surgery/*standards ; Colostomy/standards ; *Consensus ; Diverticulitis/complications/*therapy ; Drainage/standards ; Humans ; Intestinal Perforation/etiology/surgery ; *Practice Guidelines as Topic ; Scandinavian and Nordic Countries ; },
abstract = {Throughout the last century, the incidence of diverticular disease of the colon has increased tremendously in industrialized countries; nevertheless, the management of this condition is still controversial. Although several international guidelines for the management of diverticular disease are based on the same evidence, the recommendations differ greatly, emphasizing the lack of high-quality prospective studies. In Scandinavia, official guidelines for the management of diverticular disease exist only in Denmark. However, the treatment policies are quite similar in all Scandinavian countries. Computed tomography is the first choice for imaging of acute diverticulitis and its complications. Furthermore, the use of antibiotics in uncomplicated diverticulitis is nearly abandoned in Scandinavia, whereas several international guidelines still recommend their use. There is a broad consensus that abscesses secondary to acute diverticulitis can safely be managed with percutaneous drainage, which is in line with international recommendations. The surgical management of perforated diverticulitis with peritonitis is still as controversial in Scandinavia as elsewhere. Common surgical options are laparoscopic peritoneal lavage, primary resection with anastomosis, and primary resection with terminal colostomy (Hartmann's procedure). Elective sigmoid resection in patients with diverticular disease seems to be performed less frequently in Scandinavia than in other European countries; the right indications are a current matter of debate. Symptomatic uncomplicated diverticular disease in the absence of diverticulitis has not gained great attention in Scandinavia.},
}
@article {pmid27622364,
year = {2016},
author = {Kruis, W and Nguyen, GP and Leifeld, L},
title = {German Guidelines.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S47-9},
doi = {10.1097/MCG.0000000000000632},
pmid = {27622364},
issn = {1539-2031},
mesh = {Colorectal Surgery/*standards ; *Consensus ; *Diverticular Diseases ; Germany ; Humans ; *Practice Guidelines as Topic ; },
abstract = {Because of its frequency, diverticular disease is a burden on health care systems. Only few formal guidelines covering all aspects of the disease exist. Here, some selected statements from the German guidelines are given. The guidelines include significant recommendations for the diagnosis and management of diverticular disease. Both diagnosis and management depend definitely on clear definitions of the situation of an individual patient. Therefore, a new classification is proposed that is based on earlier suggestions. An internationally established classification would not only enable better patient care but could also lead to studies with comparable results.},
}
@article {pmid27622363,
year = {2016},
author = {Annibale, B and Carabotti, M and Cuomo, R},
title = {Italian Guidelines.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S44-6},
doi = {10.1097/MCG.0000000000000594},
pmid = {27622363},
issn = {1539-2031},
mesh = {Acute Disease ; Colorectal Surgery/*standards ; *Consensus ; *Diverticulitis ; Humans ; Italy ; *Practice Guidelines as Topic ; },
abstract = {Diverticular disease (DD) is a widespread condition, however limited evidences are available about its management and complications. In the last years, an Italian Consensus Conference promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) and a Guideline, by Italian Society of Colorectal Surgery (SICCR) were published. The aim of the Consensus was to provide clinical recommendation for appropriate definition, diagnosis, and management of DD, in particular 4 areas of interest were identified, namely: (i) definition and epidemiology, (ii) pathophysiology, (iii) diagnosis, and (iv) medical and surgical treatment. A total of 55 statements graded according to different level of evidence and strength of recommendation were approved. However, if we consider the grade of recommendation, their strength remains suboptimal, with only 3 statements with grade of evidence A in the area of diagnosis. The Clinical guidelines by SICCR focus mainly on acute diverticulitis, and surgical treatment of complicated DD. One of the main topic analyzed, is represented by the management of the acute uncomplicated diverticulitis, in particular about the use of antibiotics and need of hospitalization. Despite the presence of many recent European and western country guidelines, there is a lack of robust data on epidemiology, risk factors, and medical and surgical management of DD, calling the need of further studies aimed to obtain an evidence-based approach in this condition.},
}
@article {pmid27622362,
year = {2016},
author = {Bafutto, M and Oliveira, EC},
title = {Myths and Evidences in Diverticular Disease.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S41-3},
doi = {10.1097/MCG.0000000000000634},
pmid = {27622362},
issn = {1539-2031},
mesh = {Adult ; Aged ; *Disease Management ; Diverticular Diseases/*physiopathology/*therapy ; Humans ; Middle Aged ; *Quackery ; },
abstract = {Diverticular disease is a very common entity affecting the elders, but also a few people in the young age group. Most patients are asymptomatic, but about 30% of them will have abdominal complaints. As the pathophysiology of diverticular disease has changed since its description, we address some important points about the disease. Recent knowledge has changed the way we treat the patients with diverticular disease: conservatively or surgically.},
}
@article {pmid27622361,
year = {2016},
author = {Walker, MM},
title = {Inflammation, Genetics, Dysbiosis, and the Environment: New Paradigms for Diagnosis in Complex Chronic Gut Syndromes.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S4-5},
doi = {10.1097/MCG.0000000000000613},
pmid = {27622361},
issn = {1539-2031},
mesh = {Biomarkers/analysis ; C-Reactive Protein/analysis ; Chronic Disease ; Dysbiosis/complications/*diagnosis ; *Environment ; Feces/chemistry ; Gastrointestinal Diseases/*diagnosis/genetics/microbiology ; Gastrointestinal Microbiome ; *Genetic Predisposition to Disease ; Humans ; Inflammation/diagnosis/genetics/microbiology ; Inflammatory Bowel Diseases/*diagnosis/genetics/microbiology ; Leukocyte L1 Antigen Complex/analysis ; Syndrome ; },
abstract = {Chronic and complex gut syndromes are complex to diagnose and manage, but good clinicopathologic correlation, recognition of new entities, understanding (and understanding the limits) of genetic susceptibility and the importance of the microbiome, dysbiosis and influence of the environmental allows development of new models for diagnosis. An awareness of overlap in chronic gut syndromes has been clarified by the realization that inflammatory pathways involved in chronic gut disease can arise through variable gene expression that is influenced by the environment in susceptible individuals. Recent advances in diagnosis of inflammatory bowel disease and diverticular disease may be aided by genetic tests but at present, pathology and some simple biomarkers such as C-reactive protein and fecal calprotectin are still mainstream investigative measures. When made aware of the importance of these recent developments in chronic gut disease, histopathologists can easily recognize colonic spirochetosis and microscopic colitis. The role of the microbiome alongside interaction with the environment, are now recognized as key players in complex diseases. Integration of appropriate and cost-effective tests into new paradigms will surely advance patients' well-being and allow development of curative-targeted therapies rather than current treatments which, in many cases, merely alleviate symptoms.},
}
@article {pmid27622360,
year = {2016},
author = {Regula, J},
title = {Diverticular Disease and Colorectal Cancer: Incidental Diagnosis or Real Association? Final Answer.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S39-40},
doi = {10.1097/MCG.0000000000000643},
pmid = {27622360},
issn = {1539-2031},
mesh = {Case-Control Studies ; Colon/diagnostic imaging/pathology ; Colorectal Neoplasms/*diagnosis/etiology ; Cross-Sectional Studies ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/*diagnosis ; Diverticulum, Colon/diagnostic imaging/pathology ; Humans ; Incidental Findings ; Observational Studies as Topic ; Risk Factors ; Time Factors ; },
abstract = {Associations between diverticular disease of the colon and the colorectal cancer has been studied for >60 years. Observational, cross-sectional, and case-control studies as well as large population-based studies gave conflicting results and association was not fully proven. Obtaining the proof was difficult because both diseases share similar clinical characteristics, both increase with age, and both involve similar dietary factors. Long-term observations are difficult as diagnostic methods changed over time from barium enema 50 to 60 years ago, through endoscopy, up to CT and MR in recent years. Cancer or adenomas may be missed within diverticular segment; diverticula may be underreported in patients with colon cancer diagnosis. Most recent 2 large cohort studies have solved the dilemma. These studies have clearly shown that diverticular disease does not increase the risk of colon cancer after the first year of diagnosis. Within the first year of diagnosis the association is strong, most probably due to difficulties with differential diagnosis and misclassifications and shared symptoms. Findings of these studies have led to the conclusion that colon cancer has to be excluded using modern techniques after the first episode of suspected diverticulitis.},
}
@article {pmid27622357,
year = {2016},
author = {Spiller, R},
title = {Diverticular Disease and IBS: Overlapping or Misunderstanding?.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S29-32},
doi = {10.1097/MCG.0000000000000633},
pmid = {27622357},
issn = {1539-2031},
mesh = {Aged ; Diagnosis, Differential ; Diverticular Diseases/complications/diagnosis/*pathology ; Humans ; Irritable Bowel Syndrome/complications/diagnosis/*pathology ; Medically Unexplained Symptoms ; *Symptom Assessment ; },
abstract = {Although over half of patients over 65 years old will have diverticulosis, only a minority experience symptoms. These are often similar to those of irritable bowel syndrome with pain and disordered bowel habit, but differ in having an onset in the sixth to seventh decade. The underlying mechanisms include visceral hypersensitivity which maybe postinflammatory, but may also be due to altered central pain processing. Somatization is a useful clue to a predominantly central pathology, while its absence points to local causes including altered enteric nerves and mucosal immune activation. Treatments should be tailored to the individual patient who shows either predominantly peripheral or central abnormalities.},
}
@article {pmid27622356,
year = {2016},
author = {Gallo, A and Ianiro, G and Montalto, M and Cammarota, G},
title = {The Role of Biomarkers in Diverticular Disease.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S26-8},
doi = {10.1097/MCG.0000000000000648},
pmid = {27622356},
issn = {1539-2031},
mesh = {Acute Disease ; Biomarkers/analysis ; C-Reactive Protein/*analysis ; Diverticular Diseases/blood/*diagnosis ; Diverticulosis, Colonic/blood/*diagnosis ; Feces/chemistry ; Humans ; Leukocyte L1 Antigen Complex/*analysis ; Recurrence ; Severity of Illness Index ; },
abstract = {Diverticulosis of the colon is a common condition in western countries. Acute diverticulitis may occur in 10% to 25% of the patients, sometimes associated with the presence of complications such as abscess, fistula, and perforation. Early diagnosis and accurate assessment of acute diverticulitis are necessary to start an efficacious treatment promptly, either conservatively or by surgery. The clinical picture may mimic other abdominal conditions; therefore, imaging techniques such as ultrasound or computed tomography are usually recommended, although they are expensive, examiner dependent, and potentially harmful. Recently, there has been increasing interest about the role of biological markers in diverticular disease as noninvasive, reliable, and inexpensive tools, conceivably able to support physicians in the diagnosis, the assessment of activity, and the monitoring of acute diverticulitis. By a MEDLINE search, most of the relevant data derived from C-reactive protein showed that it strongly supported the diagnosis of acute diverticulitis at values of >50 mg/L. It also represents a stronger marker compared with other serum biomarkers, able to correlate with the histologic severity in acute diverticulitis, the risk of perforation, and the response to therapy. Regarding fecal biomarkers, an interesting role has been reported for fecal calprotectin. It significantly correlates with inflammatory infiltrate. More relevantly, it correlates with the response to therapy and may predict the recurrence of colonic diverticulitis, as it is reliable in detecting subclinical intestinal inflammation, as reported already for inflammatory bowel disease. These represent encouraging results, but need to be confirmed in further larger studies.},
}
@article {pmid27622355,
year = {2016},
author = {Flor, N and Soldi, S and Zanchetta, E and Sbaraini, S and Pesapane, F},
title = {Diverticular Disease of the Colon: News From Imaging.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S23-5},
doi = {10.1097/MCG.0000000000000597},
pmid = {27622355},
issn = {1539-2031},
mesh = {Acute Disease ; Colon/*diagnostic imaging ; Colonography, Computed Tomographic/*methods ; Diverticulosis, Colonic/*diagnostic imaging ; Diverticulum/*diagnostic imaging ; Humans ; Tomography, X-Ray Computed/*methods ; },
abstract = {Different scenarios embrace computed tomography imaging and diverticula, including asymptomatic (diverticulosis) and symptomatic patients (acute diverticulitis, follow-up of acute diverticulitis, chronic diverticulitis). If the role of computed tomography is validated and widely supported by evidence in case of acute diverticulitis, this is not the case of patients in their follow-up for acute diverticulitis or with symptoms related to diverticula, but without acute inflammation. In these settings, computed tomography colonography is gaining consensus as the preferred radiologic test.},
}
@article {pmid27622354,
year = {2016},
author = {Maconi, G and Carmagnola, S and Guzowski, T},
title = {Intestinal Ultrasonography in the Diagnosis and Management of Colonic Diverticular Disease.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S20-2},
doi = {10.1097/MCG.0000000000000657},
pmid = {27622354},
issn = {1539-2031},
mesh = {Diverticulosis, Colonic/*diagnostic imaging ; Diverticulum/*diagnostic imaging ; Humans ; Intestines/*diagnostic imaging ; Predictive Value of Tests ; Sensitivity and Specificity ; Ultrasonography/methods/*statistics & numerical data ; },
abstract = {Diverticula of the colon and their symptomatic manifestations, including acute diverticulitis (AD), are frequent complaints and the cause of an increasing burden of ambulatory visits, diagnostic procedures, and hospital admissions. Endoscopic and radiologic diagnostic procedures have a well-known role in the diagnosis and management of the disease, but recently intestinal ultrasonography has been proposed as a complementary tool in the diagnosis and follow-up of diverticular disease. This review shows the main sonographic features of diverticula and discusses the potential role of ultrasound in suggesting the presence of symptomatic uncomplicated diverticular disease of the colon. Moreover, the sonographic features of AD, diagnostic accuracy, advantages, and limitations of the technique will be discussed. We place special emphasis on the present role of intestinal ultrasonography in patients with suspected AD. Owing to its high sensitivity and high positive predictive value in assessing AD, intestinal ultrasound is currently suggested by some European national consensus guidelines as the first-line examination in this setting. In fact, to minimize false-negative findings and avoid unnecessary radiation exposure in patients with suspected AD, intestinal ultrasound might be used as the first-line examination in a sequential diagnostic strategy, followed by computed tomography only in the case of negative or inconclusive findings.},
}
@article {pmid27622353,
year = {2016},
author = {Papa, A and Papa, V},
title = {The Economic Burden of Diverticular Disease.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S2-3},
doi = {10.1097/MCG.0000000000000598},
pmid = {27622353},
issn = {1539-2031},
mesh = {*Cost of Illness ; Diverticular Diseases/*economics/epidemiology ; Diverticulitis, Colonic/*economics/epidemiology ; *Health Care Costs ; Health Resources/*economics/statistics & numerical data ; Humans ; Patient Acceptance of Health Care ; },
abstract = {Diverticular disease (DD) of the colon represents a common clinical condition affecting from one-fourth to one-third of the population in developed countries. Several epidemiological studies have clearly shown that in the last decades the rates of clinic visits and hospital admissions for DD and its complications are progressively increased. In addition, complications of DD are associated to a high mortality rate that continues unabated despite advances in surgery and intensive care. As consequence, the burden on health care resources has significantly increased over time, leading DD among the main causes of health spending for gastrointestinal diseases. In this review the most important data regarding health care resources utilization and costs for DD are analyzed and some proposals for reducing the burden on health care systems are hypothesized.},
}
@article {pmid27622352,
year = {2016},
author = {Tursi, A and Brandimarte, G and Di Mario, F and Elisei, W and Scarpignato, C and Picchio, M},
title = {Prognostic Role of the Endoscopic Classification "DICA".},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S16-9},
doi = {10.1097/MCG.0000000000000656},
pmid = {27622352},
issn = {1539-2031},
mesh = {Abdominal Pain/etiology ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; C-Reactive Protein/analysis ; Colon/*pathology ; *Colonoscopy ; Diverticulosis, Colonic/*classification/complications/drug therapy ; Diverticulum/*classification/complications/drug therapy ; Feces/chemistry ; Female ; Humans ; Leukocyte L1 Antigen Complex/analysis ; Male ; Mesalamine/therapeutic use ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Recurrence ; Retrospective Studies ; },
abstract = {Diverticular inflammation and complication assessment (DICA) endoscopic classification has been recently developed for patients suffering from diverticulosis and diverticular disease. Its predictive value in those patients was recently retrospectively assessed. For each patient, the following parameters were recorded: age, severity of DICA, presence of abdominal pain, C-reactive protein, fecal calprotectin test (if available) at the time of diagnosis, months of follow-up, therapy taken during the follow-up to maintain remission (if any), occurrence/recurrence of diverticulitis, and need of surgery. A total of 1651 patients (793 male, 858 female, mean age 66.6±11.1 y) were enrolled: 939 (56.9%) classified as DICA 1, 501 (30.3%) as DICA 2, and 211 (12.8%) as DICA 3. The median follow-up was 24 (9 to 138) months. Acute diverticulitis (AD) occurred/recurred in 263 (15.9%) patients, and surgery was necessary in 57 (21.7%) cases. DICA was the only factor significantly associated with the occurrence/recurrence of diverticulitis and surgery either at univariate (χ=405.029; P<0.0001) or multivariate analysis (hazard ratio=4.319; 95% CI, 3.639-5.126; P<0.0001). Only in DICA 2 patients scheduled therapy was effective for prevention of AD occurrence/recurrence with a hazard ratio (95% CI) of 0.598 (0.391-0.914) (P=0.006, log-rank test). Mesalazine-based therapies reduced the risk of AD occurrence/recurrence and need of surgery with a hazard ratio (95% CI) of 0.2103 (0.122-0.364) and 0.459 (0.258-0.818), respectively. DICA classification seems to be a valid parameter to predict the risk of diverticulitis occurrence/recurrence in patients suffering from diverticular disease of the colon.},
}
@article {pmid27622351,
year = {2016},
author = {Grande, G and Zulli, C and Pigò, F and Riccioni, ME and Di Mario, F and Conigliaro, RL},
title = {The Role of Colonoscopy in the Diverticular Disease.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S13-5},
doi = {10.1097/MCG.0000000000000629},
pmid = {27622351},
issn = {1539-2031},
mesh = {Colonoscopy/*methods/trends ; Diverticular Diseases/*diagnosis ; Diverticulosis, Colonic/*diagnosis ; Diverticulum, Colon/*surgery ; Humans ; },
abstract = {Colonic diverticula are one of the most frequent conditions found during the endoscopic examination of the lower digestive tract, interestingly in >70% of people after 80 years old. Of them, only a few percentage develop complications such as acute diverticulitis or diverticular bleeding. Up to now, colonoscopy represents the most important diagnostic and therapeutic tool on the hands of the clinicians. On the basis of this the need for a standardized and reproducible approach is now emerging. This short review article is tasked to point out some open issues concerning the role of colonoscopy in diverticular disease.},
}
@article {pmid27622350,
year = {2016},
author = {Tursi, A and Picchio, M and Elisei, W and Di Mario, F and Scarpignato, C and Brandimarte, G},
title = {Management of Patients With Diverticulosis and Diverticular Disease: Consensus Statements From the 2nd International Symposium on Diverticular Disease.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S101-7},
doi = {10.1097/MCG.0000000000000654},
pmid = {27622350},
issn = {1539-2031},
mesh = {*Consensus ; *Disease Management ; Diverticular Diseases/*therapy ; Diverticulum/*therapy ; Humans ; *Practice Guidelines as Topic ; },
abstract = {The statements produced by the Chairmen of the 2nd International Symposium on Diverticular Disease, held in Rome on April 8th to 9th, 2016, are reported. Topics such as epidemiology, risk factors, diagnosis, medical and surgical treatment of diverticular disease in patients with uncomplicated and complicated diverticular disease were reviewed by the Chairmen who proposed 41 statements graded according to level of evidence and strength of recommendation. Each topic was explored focusing on the more relevant clinical questions. The vote was conducted on a 6-point scale and consensus was defined a priori as 67% agreement of the participants. The voting group consisted of 80 physicians from 6 countries, and agreement with all statements was provided. Comments were added explaining some controversial areas.},
}
@article {pmid27622349,
year = {2016},
author = {Tursi, A and Brandimarte, G and Di Mario, F and Scarpignato, C},
title = {Preface to the Proceedings of the 2nd International Symposium on Diverticular Disease of the Colon.},
journal = {Journal of clinical gastroenterology},
volume = {50 Suppl 1},
number = {},
pages = {S1},
doi = {10.1097/MCG.0000000000000635},
pmid = {27622349},
issn = {1539-2031},
mesh = {*Colonic Diseases ; *Congresses as Topic ; *Diverticulosis, Colonic ; Humans ; },
}
@article {pmid27618836,
year = {2017},
author = {Barbara, G and Scaioli, E and Barbaro, MR and Biagi, E and Laghi, L and Cremon, C and Marasco, G and Colecchia, A and Picone, G and Salfi, N and Capozzi, F and Brigidi, P and Festi, D},
title = {Gut microbiota, metabolome and immune signatures in patients with uncomplicated diverticular disease.},
journal = {Gut},
volume = {66},
number = {7},
pages = {1252-1261},
doi = {10.1136/gutjnl-2016-312377},
pmid = {27618836},
issn = {1468-3288},
mesh = {Adult ; Aged ; Case-Control Studies ; Cell Count ; Colon/metabolism ; Cross-Sectional Studies ; Diverticulosis, Colonic/*metabolism/*microbiology ; Feces/microbiology ; Female ; *Gastrointestinal Microbiome ; Humans ; Macrophages/metabolism ; Male ; Mast Cells/metabolism ; *Metabolome ; Middle Aged ; Pilot Projects ; },
abstract = {OBJECTIVE: The engagement of the gut microbiota in the development of symptoms and complications of diverticular disease has been frequently hypothesised. Our aim was to explore colonic immunocytes, gut microbiota and the metabolome in patients with diverticular disease in a descriptive, cross-sectional, pilot study.
DESIGN: Following colonoscopy with biopsy and questionnaire phenotyping, patients were classified into diverticulosis or symptomatic uncomplicated diverticular disease; asymptomatic subjects served as controls. Mucosal immunocytes, in the diverticular region and in unaffected sites, were quantified with immunohistochemistry. Mucosa and faecal microbiota were analysed by the phylogenetic platform high taxonomic fingerprint (HTF)-Microbi.Array, while the metabolome was assessed by [1]H nuclear magnetic resonance.
RESULTS: Compared with controls, patients with diverticula, regardless of symptoms, had a >70% increase in colonic macrophages. Their faecal microbiota showed depletion of Clostridium cluster IV. Clostridium cluster IX, Fusobacterium and Lactobacillaceae were reduced in symptomatic versus asymptomatic patients. A negative correlation was found between macrophages and mucosal Clostridium cluster IV and Akkermansia. Urinary and faecal metabolome changes in diverticular disease involved the hippurate and kynurenine pathways. Six urinary molecules allowed to discriminate diverticular disease and control groups with >95% accuracy.
CONCLUSIONS: Patients with colonic diverticular disease show depletion of microbiota members with anti-inflammatory activity associated with mucosal macrophage infiltration. Metabolome profiles were linked to inflammatory pathways and gut neuromotor dysfunction and showed the ability to discriminate diverticular subgroups and controls. These data pave the way for further large-scale studies specifically aimed at identifying microbiota signatures with a potential diagnostic value in patients with diverticular disease.},
}
@article {pmid27604811,
year = {2016},
author = {Leganger, J and Søborg, MK and Mortensen, LQ and Gregersen, R and Rosenberg, J and Burcharth, J},
title = {Association between diverticular disease and Ehlers-Danlos syndrome: a 13-year nationwide population-based cohort study.},
journal = {International journal of colorectal disease},
volume = {31},
number = {12},
pages = {1863-1867},
pmid = {27604811},
issn = {1432-1262},
mesh = {Cohort Studies ; Denmark ; Diverticulitis/*complications ; Ehlers-Danlos Syndrome/*complications ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; },
abstract = {PURPOSE: The aim of this study was to examine occurrence and consequences of diverticular disease in patients with Ehlers-Danlos syndrome (EDS) compared with a matched cohort.
METHODS: This nationwide population-based cohort study was conducted using data from medical registers in Denmark from year 2000 to 2012. The EDS cohort was identified using the specific diagnosis code for EDS and was randomly matched in a ratio of 1:20 by sex and date of birth (±1 year) with persons from the Danish general population. The occurrence of diverticular disease and the clinical characteristics of the initial diverticular event were compared between the EDS cohort and the comparison cohort. The first admission with diverticulitis was identified, and severity of diverticulitis, treatment, colonoscopies, length of stay, and 30-day mortality were investigated.
RESULTS: We identified 1336 patients with EDS and matched a control cohort of 26,720 patients. The occurrence of diverticular disease in the EDS cohort (2.0 %) and the comparison cohort (0.68 %) differed significantly (p < 0.001). At the first diverticular event, the majority of patients were women (85 % for EDS and 87 % for the comparison cohort). Mean age, localization, and type of contact did not differ significantly. Admission with diverticulitis (1.0 % for EDS and 0.34 % for the comparison cohort) differed significantly (p < 0.001). We found no significant difference in severity of diverticulitis, treatment, length of stay, or 30-day mortality between the EDS and the comparison cohorts.
CONCLUSIONS: Patients with EDS had an increased occurrence of overall diverticular events and admissions with diverticulitis compared with the general population.},
}
@article {pmid27582782,
year = {2016},
author = {Ceresoli, M and Coccolini, F and Montori, G and Catena, F and Sartelli, M and Ansaloni, L},
title = {Laparoscopic lavage versus resection in perforated diverticulitis with purulent peritonitis: a meta-analysis of randomized controlled trials.},
journal = {World journal of emergency surgery : WJES},
volume = {11},
number = {1},
pages = {42},
pmid = {27582782},
issn = {1749-7922},
abstract = {OBJECTIVE: Purulent peritonitis from acute left colon diverticulitis is a relatively common presentation of diverticular disease; historically the treatment was the Hartmann procedure. Laparoscopic peritoneal lavage has been proposed as a lesser invasive treatment option with great interest and debate among surgeons and with contrasting results. The aim of this meta-analysis was to compare the results of sigmoid resection with laparoscopic lavage.
METHODS: A systematic review was performed to select randomized controlled trials comparing laparoscopic lavage versus resection in Hinchey III diverticulitis. Studies' selection, data extraction and risk of bias assessment were done by two independent authors; results were shown as OR with 95 % C.I.
RESULTS: Three RCT were selected for the meta-analysis including 315 patents. Laparoscopic lavage was associated with significantly more reoperations (OR 3.75, p = 0.006) and more intra-abdominal abscesses (OR 3.50, p = 0.0003) with no differences in mortality (OR 0.93, p = 0.92). At 12 months follow up laparoscopic lavage was associated with lesser reoperations (OR 0.32, p = 0.0004); there were no differences in term of stoma presence (OR 0.44 p = 0.27) and mortality (OR 0.74 p = 0.51).
CONCLUSIONS: The present meta-analysis shows that in acute perforated diverticulitis with purulent peritonitis laparoscopic lavage is comparable to sigmoid resection in term of mortality but it is associated with a significantly higher rate of reoperations and a higher rate of intra-abdominal abscess. No differences in term of mortality were demonstrated at follow-up. Further studies are needed to better define the safety and appropriateness of this treatment.},
}
@article {pmid27576504,
year = {2016},
author = {Brockhaus, AC and Politt, D and Lindlohr, C and Saad, S},
title = {[Transanal extraction vs. minilaparotomy : For laparoendoscopic left-sided colon resection].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {87},
number = {12},
pages = {1054-1062},
pmid = {27576504},
issn = {1433-0385},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/instrumentation/*methods ; Colorectal Neoplasms/*surgery ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Laparoscopy/instrumentation/*methods ; Length of Stay ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/instrumentation/*methods ; Pain, Postoperative/etiology/prevention & control ; Proctoscopy/instrumentation/*methods ; Rectal Prolapse/*surgery ; Retrospective Studies ; },
abstract = {BACKGROUND: Recent developments in classical minimally invasive surgical procedures for colon resection aimed to minimize or even eliminate abdominal wall incisions, thus improving postoperative pain, patient recovery and aesthetics. A promising approach is the total laparoendoscopic colectomy (LEC) with transanal sample extraction. The aim of this study was the comparison of total LEC with conventional laparoscopic assisted surgery (LAS) and extraction incision.
METHOD: We included 168 consecutive patients (LEC:112; LAS:56) with diverticular disease, rectal prolapse, benign or malignant tumors and analyzed retrospectively. The specimen was extracted transanally by LEC with a specially developed rectoscope; the LAS group required a minilaparotomy of 5 cm. The primary outcome was postoperative pain. Secondary outcomes included operating time, minor and major complication rates, number and length of extracted specimens, additional pain medication and duration of hospital stay.
RESULTS: The measured postoperative pain score values did not significantly differ between the two groups; however, consumption of postoperative pain medication was significantly higher in the LAS-group (p < 0.001). Due to the learning curve, the median operating time in the LEC group (120 min) was slightly longer than in the LAS group (100 min); however, it was reduced to 95 min in the last 50 operations. Patients in the LEC group were discharged from hospital one day earlier (median duration of hospital stay 6 days, p = 0.003). Compliaction rates were similar in both groups.
CONCLUSION: The technique of total LEC with transanal specimen extraction is designed to avoid a minilaparotomy and its associated morbidities. The LEC operation is feasible for a large group of patients, including overweight patients. The superiority of LEC in terms of reduced pain medication, shorter hospital stay and faster patient recovery, as shown in this study, needs to be confirmed by randomized controlled trials with longer follow-up periods.},
}
@article {pmid27574459,
year = {2016},
author = {Ambrosetti, P},
title = {Acute left-sided colonic diverticulitis: clinical expressions, therapeutic insights, and role of computed tomography.},
journal = {Clinical and experimental gastroenterology},
volume = {9},
number = {},
pages = {249-257},
pmid = {27574459},
issn = {1178-7023},
abstract = {The diagnostic approach of patients with suspected acute diverticulitis remains debated. On the one hand, a scoring system with the best predictive value in diagnosing acute diverticulitis has been developed in order to reduce the use of computed tomography (CT) scan, while, on the other hand, patients with a high probability of acute diverticulitis should benefit from CT scan from a clinical viewpoint, ensuring that they will receive the most appropriate treatment. The place and classification of CT scan for acute diverticulitis need to be reassessed. If the management of uncomplicated acute diverticulitis, abscess, and fecal peritonitis is now well codified, urgent surgical or medical treatment of hemodynamically stable patients presenting with intraperitoneal air or fluid without uncontrolled sepsis is still under discussion. Furthermore, the indications for laparoscopic lavage are not yet well established. It is known for years that episode(s) of acute uncomplicated diverticulitis may induce painful recurrent bowel symptoms, known as symptomatic uncomplicated diverticular disease and irritable bowel syndrome-like diverticular disease. These two clinical expressions of diverticular disease, that may darken quality of life, are treated medically aimed at symptom relief. The possible place of surgery should be discussed. Clinical and CT scan classifications should be separated entities.},
}
@article {pmid27567232,
year = {2016},
author = {Zuin, M and Rigatelli, G and Andreotti, AN and Fogato, L and Scaranello, F and Zuliani, G and Faggian, G and Roncon, L},
title = {Could we consider diverticular disease as a non-traditional risk factor for coronary artery disease?.},
journal = {International journal of cardiology},
volume = {223},
number = {},
pages = {649-650},
doi = {10.1016/j.ijcard.2016.08.283},
pmid = {27567232},
issn = {1874-1754},
mesh = {Coronary Artery Disease/*diagnosis/*epidemiology ; Diverticulitis/*diagnosis/*epidemiology ; Diverticulum/diagnostic imaging ; Humans ; Risk Factors ; },
}
@article {pmid27553994,
year = {2016},
author = {Rangan, GK and Tchan, MC and Tong, A and Wong, AT and Nankivell, BJ},
title = {Recent advances in autosomal-dominant polycystic kidney disease.},
journal = {Internal medicine journal},
volume = {46},
number = {8},
pages = {883-892},
doi = {10.1111/imj.13143},
pmid = {27553994},
issn = {1445-5994},
mesh = {Angiotensin Receptor Antagonists/therapeutic use ; *Disease Management ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Hypertension/epidemiology ; Mutation ; Polycystic Kidney, Autosomal Dominant/complications/*epidemiology/*therapy ; Randomized Controlled Trials as Topic ; Renal Dialysis ; Renal Insufficiency/epidemiology/therapy ; TRPP Cation Channels/genetics ; Vasopressins/therapeutic use ; },
abstract = {Autosomal-dominant polycystic kidney disease (ADPKD) is the most common genetic renal disease in adults, affecting one in every 1000 Australians. It is caused by loss-of-function heterozygous mutations in either PKD1 or PKD2 , which encode the proteins, polycystin-1 and polycystin-2 respectively. The disease hallmark is the development of hundreds of microscopic fluid-filled cysts in the kidney during early childhood, which grow exponentially and continuously through life at varying rates (between 2% and 10% per year), causing loss of normal renal tissue and up to a 50% lifetime risk of dialysis-dependent kidney failure. Other systemic complications include hypertensive cardiac disease, hepatic cysts, intracranial aneurysms, diverticular disease and hernias. Over the last two decades, advances in the genetics and pathogenesis of this disease have led to novel treatments that reduce the rate of renal cyst growth and may potentially delay the onset of kidney failure. New evidence indicates that conventional therapies (such as angiotensin inhibitors and statins) have mild attenuating effects on renal cyst growth and that systemic levels of vasopressin are critical for promoting renal cyst growth in the postnatal period. Identifying and integrating patient-centred perspectives in clinical trials is also being advocated. This review will provide an update on recent advances in the clinical management of ADPKD.},
}
@article {pmid27547007,
year = {2016},
author = {Shayto, RH and Abou Mrad, R and Sharara, AI},
title = {Use of rifaximin in gastrointestinal and liver diseases.},
journal = {World journal of gastroenterology},
volume = {22},
number = {29},
pages = {6638-6651},
pmid = {27547007},
issn = {2219-2840},
mesh = {Anti-Bacterial Agents/therapeutic use ; Diarrhea/drug therapy ; Diverticulum/drug therapy ; Drug Resistance ; Gastrointestinal Diseases/*drug therapy ; Hepatic Encephalopathy/drug therapy ; Humans ; Inflammatory Bowel Diseases/drug therapy ; Irritable Bowel Syndrome/drug therapy ; Liver Diseases/*drug therapy ; Rifamycins/*therapeutic use ; Rifaximin ; Travel ; },
abstract = {Rifaximin is a broad spectrum oral antibiotic with antimicrobial activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria. It is poorly absorbed and thus has a highly favorable safety profile. Rifaximin has been shown to be effective in the treatment of traveler's diarrhea, functional bloating and irritable bowel syndrome, small bowel bacterial overgrowth and in the prevention of recurrent overt hepatic encephalopathy. In addition, there is emerging evidence for a possible beneficial effect of rifaximin in the treatment of uncomplicated diverticular disease and in the prevention of recurrent diverticulitis. The use of rifaximin is associated with a low incidence of development, or persistence of spontaneous bacterial mutants. Moreover, the development of important drug resistance among extra-intestinal flora during rifaximin therapy is unlikely because of minimal systemic absorption and limited cross-resistance of rifaximin with other antimicrobials. This review addresses the current and emerging role of rifaximin in the treatment of gastrointestinal and liver disorders.},
}
@article {pmid27536372,
year = {2016},
author = {Tursi, A and Brandimarte, G and Di Mario, F and Annunziata, ML and Bafutto, M and Bianco, MA and Colucci, R and Conigliaro, R and Danese, S and De Bastiani, R and Elisei, W and Escalante, R and Faggiani, R and Ferrini, L and Forti, G and Latella, G and Graziani, MG and Oliveira, EC and Papa, A and Penna, A and Portincasa, P and Søreide, K and Spadaccini, A and Usai, P and Bonovas, S and Scarpignato, C and Picchio, M and , and Lecca, PG and Zampaletta, C and Cassieri, C and Damiani, A and Desserud, KF and Fiorella, S and Landi, R and Goni, E and Lai, MA and Pigò, F and Rotondano, G and Schiaccianoce, G},
title = {Predictive value of the Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification on the outcome of diverticular disease of the colon: An international study.},
journal = {United European gastroenterology journal},
volume = {4},
number = {4},
pages = {604-613},
pmid = {27536372},
issn = {2050-6406},
abstract = {BACKGROUND: Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification has been recently developed for patients suffering from diverticulosis and diverticular disease.
AIMS: We assessed retrospectively the predictive value of DICA in patients for whom endoscopic data and clinical follow-up were available.
METHODS: For each patient, we recorded: age, severity of DICA, presence of abdominal pain, C-reactive protein and faecal calprotectin test (if available) at the time of diagnosis; months of follow-up; therapy taken during the follow-up to maintain remission (if any); occurrence/recurrence of diverticulitis; need of surgery.
RESULTS: We enrolled 1651 patients (793 M, 858 F, mean age 66.6 ± 11.1 years): 939 (56.9%) patients were classified as DICA 1, 501 (30.3%) patients as DICA 2 and 211 (12.8%) patients as DICA 3. The median follow-up was 24 (9-38) months. Acute diverticulitis (AD) occurred/recurred in 263 (15.9%) patients; surgery was necessary in 57 (21.7%) cases. DICA was the only factor significantly associated to the occurrence/recurrence of diverticulitis and surgery either at univariate (χ(2 )= 405.029; p < 0.0001) or multivariate analysis (hazard ratio = 4.319, 95% confidence interval (CI) 3.639-5.126; p < 0.0001). Only in DICA 2 patients was therapy effective for prevention of AD occurrence/recurrence with a hazard ratio (95% CI) of 0.598 (0.391-0.914) (p = 0.006, log rank test). Mesalazine-based therapies reduced the risk of AD occurrence/recurrence and needs of surgery with a hazard ratio (95% CI) of 0.2103 (0.122-0.364) and 0.459 (0.258-0.818), respectively.
CONCLUSIONS: DICA classification is a valid parameter to predict the risk of diverticulitis occurrence/recurrence in patients suffering from diverticular disease of the colon.},
}
@article {pmid27494997,
year = {2016},
author = {Horesh, N and Wasserberg, N and Zbar, AP and Gravetz, A and Berger, Y and Gutman, M and Rosin, D and Zmora, O},
title = {Changing paradigms in the management of diverticulitis.},
journal = {International journal of surgery (London, England)},
volume = {33 Pt A},
number = {},
pages = {146-150},
doi = {10.1016/j.ijsu.2016.07.072},
pmid = {27494997},
issn = {1743-9159},
mesh = {*Disease Management ; Diverticulitis/*surgery ; Elective Surgical Procedures ; Humans ; Patient Selection ; },
abstract = {The management of diverticular disease has evolved in the last few decades from a structured therapeutic approach including operative management in almost all cases to a variety of medical and surgical approaches leading to a more individualized strategy. There is an ongoing debate among surgeons about the surgical management of diverticular disease, questioning not only the surgical procedure of choice, but also about who should be operated and the timing of surgery, both in complicated and uncomplicated diverticular disease. This article reviews the current treatment of diverticulitis, with a focus on the indications and methods of surgery in both the emergency and elective settings. Further investigation with good clinical data is needed for the establishment of clear guidelines.},
}
@article {pmid27458487,
year = {2016},
author = {Parisi, A and Gemini, A and Desiderio, J and Petrina, A and Trastulli, S and Grassi, V and Sani, M and Pironi, D and Santoro, A},
title = {Laparoscopic peritoneal lavage: our experience and review of the literature.},
journal = {Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques},
volume = {11},
number = {2},
pages = {83-87},
pmid = {27458487},
issn = {1895-4588},
abstract = {INTRODUCTION: Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL) appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery.
AIM: This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis.
MATERIAL AND METHODS: We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7%) patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique); 21 (30%) patients underwent peritoneal laparoscopic lavage; 4 (5.7%) patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6%) patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy.
RESULTS: The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients). In the LPL group the morbidity rate was 33.3%.
CONCLUSIONS: Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage.},
}
@article {pmid27454544,
year = {2017},
author = {Jaruvongvanich, V and Sanguankeo, A and Wijarnpreecha, K and Upala, S},
title = {Risk of colorectal adenomas, advanced adenomas and cancer in patients with colonic diverticular disease: Systematic review and meta-analysis.},
journal = {Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society},
volume = {29},
number = {1},
pages = {73-82},
doi = {10.1111/den.12701},
pmid = {27454544},
issn = {1443-1661},
mesh = {Adenoma/epidemiology/*etiology ; Colorectal Neoplasms/epidemiology/*etiology ; Diverticulum, Colon/*complications/epidemiology ; Global Health ; Humans ; Incidence ; *Risk Assessment ; Risk Factors ; },
abstract = {BACKGROUND AND AIM: Diverticular disease and colorectal neoplasia are common digestive disorders worldwide. Both diseases share epidemiological trends and certain risk factors including advancing age, physical inactivity, and Western diet and lifestyle. Studies assessing the association between these diseases reported inconsistent results. Thus, we conducted a systematic review and meta-analysis to determine the association between diverticular disease and colorectal adenomas, advanced adenomas and cancer.
METHODS: A comprehensive search of the databases MEDLINE and EMBASE was done from inception through March 2016. Inclusion criterion was the observational studies' assessment of the association between diverticular disease and colorectal neoplasia in adult participants. Pooled OR and 95% confidence interval (CI) were calculated using a random effect.
RESULTS: Data were extracted from 14 observational studies (11 cross-sectional studies, one case-control study and two cohort studies). Diverticular disease was associated with increased odds of adenomas (OR = 1.67, 95% CI 1.27-2.21, 10 studies), but not associated with advanced adenomas (OR = 1.19, 95% CI 0.88-1.62, I[2] = 52%, four studies) or colorectal cancer (OR = 1.36, 95% CI 0.47-3.92, I[2] = 98%, seven studies).
CONCLUSIONS: Our meta-analysis demonstrated that diverticular disease was associated with colorectal adenomas. Colonoscopists should be aware of this association and carefully examine the entire large bowel in individuals with diverticulosis.},
}
@article {pmid27448296,
year = {2016},
author = {Sohn, M and Agha, A and Heitland, W and Gundling, F and Steiner, P and Iesalnieks, I},
title = {Damage control strategy for the treatment of perforated diverticulitis with generalized peritonitis.},
journal = {Techniques in coloproctology},
volume = {20},
number = {8},
pages = {577-583},
pmid = {27448296},
issn = {1128-045X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects ; Colectomy/adverse effects ; Colon, Descending/*surgery ; Colon, Sigmoid ; Colostomy/adverse effects ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Ileostomy/adverse effects ; Intestinal Perforation/etiology/*surgery ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Peritonitis/*etiology ; Rectum/*surgery ; Retrospective Studies ; Second-Look Surgery ; },
abstract = {BACKGROUND: The best surgical strategy for the management of perforated diverticulitis with generalized peritonitis of the sigmoid colon is not clearly defined. The aim of this retrospective cohort study was to evaluate the value of a damage control strategy.
METHODS: All patients who underwent emergency laparotomy for perforated diverticular disease of the sigmoid colon with generalized peritonitis between 2010 and 2015 were included. The damage control strategy (study group), included a two- stage procedure: limited resection of the diseased colonic segment, closure of proximal colon and distal stump, and application of an abdominal vacuum at the initial surgery followed by second-look laparotomy 24-48 h later At this point a choice was made between anastomosis and Hartmann's procedure. The control group consisted of patients receiving definitive reconstruction (anastomosis or Hartmann's procedure) at the initial operation.
RESULTS: Thirty-seven patients were included in the study. Damage control strategy was applied in 19 patients and the control group consisted of 18 patients. Both groups were comparable in terms of demographics, severity of peritonitis, and comorbidities. The overall postoperative mortality was 11 % (n = 4). There were no statistically significant differences between both groups regarding postoperative morbidity and mortality; however, a significantly higher proportion of patients in the control group had a stoma after the initial hospital stay (83 vs. 47 %, p = 0.038). This difference was still significant after adjustment for sex, age, Mannheim Peritonitis Index, American Society of Anesthesiologists class and presence of septic shock at presentation. At the end of the follow-up period, 15 of 17 survivors in the study group and 13 of 16 survivors in the control group had their intestinal continuity restored (p = 0.66).
CONCLUSIONS: Damage control strategy in patients with generalized peritonitis due to perforated diverticulitis leads to a significantly reduced stoma rate after the initial hospital stay without an increased risk of postoperative morbidity.},
}
@article {pmid27437394,
year = {2016},
author = {Choi, JM and Lee, SH and Lee, SH and Ahn, BK and Baek, SU},
title = {Hematochezia due to Angiodysplasia of the Appendix.},
journal = {Annals of coloproctology},
volume = {32},
number = {3},
pages = {117-119},
pmid = {27437394},
issn = {2287-9714},
abstract = {Common causes of lower gastrointestinal bleeding include diverticular disease, vascular disease, inflammatory bowel disease, neoplasms, and hemorrhoids. Lower gastrointestinal bleeding of appendiceal origin is extremely rare. We report a case of lower gastrointestinal bleeding due to angiodysplasia of the appendix. A 72-year-old man presented with hematochezia. Colonoscopy showed active bleeding from the orifice of the appendix. We performed a laparoscopic appendectomy. Microscopically, dilated veins were found at the submucosal layer of the appendix. The patient was discharged uneventfully. Although lower gastrointestinal bleeding of appendiceal origin is very rare, clinicians should consider it during differential diagnosis.},
}
@article {pmid27422847,
year = {2017},
author = {Ilyas, MI and Zangbar, B and Nfonsam, VN and Maegawa, FA and Joseph, BA and Patel, JA and Wexner, SD},
title = {Are there differences in outcome after elective sigmoidectomy for diverticular disease and for cancer? A national inpatient study.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {19},
number = {3},
pages = {260-265},
doi = {10.1111/codi.13461},
pmid = {27422847},
issn = {1463-1318},
mesh = {Abdominal Abscess/epidemiology ; Adenocarcinoma/*surgery ; Aged ; Anastomotic Leak/epidemiology ; *Colectomy ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures ; Female ; Hospital Mortality ; Humans ; *Laparoscopy ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications/*epidemiology ; Reoperation ; Sigmoid Diseases/*surgery ; Sigmoid Neoplasms/*surgery ; Surgical Wound Infection/epidemiology ; },
abstract = {AIM: The postoperative outcome after elective sigmoidectomy for diverticulitis has not been compared to that for cancer. The study aimed to evaluate the differences in the postoperative outcome after sigmoidectomy for diverticular disease and cancer.
METHOD: The National Inpatient Sample Database was used to identify patients who underwent elective sigmoid resection for diverticular disease or cancer between 2004 and 2011. After excluding patients with metastatic cancer and preoperative weight loss, sigmoid cancer and diverticulitis patients were matched using propensity score, controlling for age, gender, race, type of operation (open vs laparoscopic) and comorbidities. The end-points of interest were infective complications, reoperation, anastomotic leakage, rebleeding, length of hospital stay and in-hospital mortality.
RESULTS: After propensity score matching (diverticulitis 11 192 patients, sigmoid cancer 11 192 patients), the mean age was 65 ± 12.5 years, 53.8% were male and 61.5% were Caucasian. Only 18.0% of the operations were done by laparoscopy. The overall complication rate was 17.7% and the in-hospital mortality rate was 0.9%. The diverticulitis group had a higher rate of surgical site infection (3.2% vs 2.6%, P = 0.004), intra-abdominal abscess formation (1.2% vs 0.4%, P < 0.0001) and reoperation (6.1% vs 4.1%, P < 0.0001) compared with the cancer group. The cancer group had a higher incidence of pneumonia (1.9% vs 1.5%, P = 0.01) and anastomotic leakage (9.2% vs 8.3%, P = 0.001). There was no difference in sepsis, deep vein thrombosis, respiratory failure, renal failure, rebleeding, overall complication rate or length of hospital stay. Subgroup analysis showed a higher in-hospital mortality for cancer than for diverticulitis patients whether resected by open or by laparoscopic surgery.
CONCLUSION: Although elective sigmoidectomy for diverticular disease has a higher risk of infective complications, elective sigmoidectomy for cancer has a higher risk of anastomotic leakage.},
}
@article {pmid27387455,
year = {2016},
author = {John, ES and Katz, K and Saxena, M and Chokhavatia, S and Katz, S},
title = {Management of Inflammatory Bowel Disease in the Elderly.},
journal = {Current treatment options in gastroenterology},
volume = {14},
number = {3},
pages = {285-304},
pmid = {27387455},
issn = {1092-8472},
abstract = {A substantial and growing proportion of patients with inflammatory bowel disease (IBD) are elderly, and these patients require tailored treatment strategies. However, significant challenges exist in the management of this population due to the paucity of data. Establishing the initial diagnosis and assessing the etiology of future symptoms and flares can be challenging as several other prevalent diseases can masquerade as IBD, such as ischemic colitis, diverticular disease, and infectious colitis. Important pharmacologic considerations include reduced glomerular filtration rate and drug-drug interactions in the elderly. No drug therapy is absolutely contraindicated in this population; however, special risk and benefit assessments should be made. Older patients are more susceptible to side effects of steroids such as delirium, fractures, and cataracts. Budesonide can be an appropriate alternative for mild to moderate ulcerative colitis (UC) or Crohn's disease (CD) as it has limited systemic absorption. Pill size and quantity, nephrotoxicity, and difficulty of administration of rectal preparations should be considered with 5-aminosalicylic (5-ASA) therapy. Biologics are very effective, but modestly increase the risk of infection in a susceptible group. Based on their mechanisms, integrin receptor antagonists (e.g., vedolizumab) may reduce these risks. Use of antibiotics for anorectal or fistulizing CD or pouchitis in UC increases the risk of Clostridium difficile infection. Pre-existing comorbidities, functional status, and nutrition are important indicators of surgical outcomes. Morbidity and mortality are increased among IBD patients undergoing surgery, often due to postoperative complications or sepsis. Elderly adults with IBD, particularly UC, have very high rates of venous thromboembolism (VTE). Colonoscopy appears safe, but the optimal surveillance interval has not been well defined. Should the octogenarian, nonagenarian, and centurion undergo colonoscopy? The length of surveillance should likely account for the individual's overall life expectancy. Specific health maintenance should emphasize administering non-live vaccines to patients on thiopurines or biologics and regular skin exams for those on thiopurines. Smoking cessation is crucial to overall health and response to medical therapy, even among UC patients. This article will review management of IBD in the elderly.},
}
@article {pmid27380703,
year = {2016},
author = {Tremayne, P and Harrison, P},
title = {Gastrointestinal care for older people.},
journal = {Nursing standard (Royal College of Nursing (Great Britain) : 1987)},
volume = {30},
number = {45},
pages = {53-63},
doi = {10.7748/ns.2016.e10410},
pmid = {27380703},
issn = {2047-9018},
mesh = {Aged ; Aging ; Education, Nursing, Continuing ; Gastrointestinal Diseases/*nursing/physiopathology/psychology ; Gastrointestinal Tract/anatomy & histology ; Humans ; },
abstract = {This article discusses gastrointestinal (GI) healthcare in older people. It outlines the physiological changes that occur in the GI tract as a result of ageing, and discusses common GI disorders in older people. These GI disorders include dysphagia, gastrointestinal reflux disease, colorectal cancer, diverticular disease, constipation and anaemia. Healthcare professionals should be aware of the factors that may influence gastrointestinal health in older people, including nutrition, hydration and alcohol use, which are important considerations when delivering person-centred care.},
}
@article {pmid27374006,
year = {2017},
author = {Mikolajczyk, AE and Te, HS and Chapman, AB},
title = {Gastrointestinal Manifestations of Autosomal-Dominant Polycystic Kidney Disease.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {15},
number = {1},
pages = {17-24},
doi = {10.1016/j.cgh.2016.06.017},
pmid = {27374006},
issn = {1542-7714},
mesh = {Gastrointestinal Diseases/*etiology/*pathology ; Gastrointestinal Tract/*pathology ; Humans ; Polycystic Kidney, Autosomal Dominant/*complications ; },
abstract = {Autosomal-dominant polycystic kidney disease (ADPKD) is the most commonly inherited kidney disease, and the fourth most common cause of end-stage renal disease. ADPKD is a systemic disorder, associated with numerous extrarenal manifestations, including polycystic liver disease, the most common gastrointestinal manifestation, and diverticular disease, inguinal, and ventral hernias, pancreatic cysts, and large bile duct abnormalities. All of these gastrointestinal manifestations play a significant role in disease burden in ADPKD, particularly in the later decades of life. Thus, as ADPKD becomes more recognized, it is important for gastroenterologists to be knowledgeable of this monogenic disorder's effects on the digestive system.},
}
@article {pmid27362723,
year = {2016},
author = {Koch, M and Festa, V and Chiesara, F and Moretti, A and Bianchi, M and Dezi, A},
title = {[Diverticular disease: towards 2020. An evidence-based approach].},
journal = {Recenti progressi in medicina},
volume = {107},
number = {6},
pages = {309-319},
doi = {10.1701/2296.24692},
pmid = {27362723},
issn = {2038-1840},
mesh = {Anti-Inflammatory Agents, Non-Steroidal ; *Diverticular Diseases ; Humans ; Italy ; Mesalamine ; Retrospective Studies ; },
abstract = {Diverticular disease (DD) of the colon has an increasing burden on health service resources, in terms of hospital admissions, mortality and surgery rate. We present an overview of the clinical history of DD, and of the ways that gastroenterologists have to modify it. Prevalence of the disease increases with aging. Most of diverticulosis are occasionally identified on colonscopy, and most of them remain asymptomatic for all life. Only 4% of these subjects develop diverticulitis. However, 4-25% of these patients are expected to present a second episode of diverticulitis, and 15% of them develop complications. Hospitalizations for diverticulitis and relapses of diverticulitis show strong growth (+21% 2013 vs 2003 in USA). The total annual costs for hospitalization for DD in USA are over 2,2 billion of dollars, and in Italy exceed 63 million of euros. In-hospital mortality can reach 0,5%. Diagnosis of diverticulitis is based on clinical history, lab tests and imaging (ultrasonography, CAT). Clinical diagnosis has a sensitivity of 68% and specificity around 98%. According to a meta-analysis, the performance of ultrasonograhy and CAT results very high ("pooled" sensitivity 92-94%, and specificity 90-99%; "pooled" Likelihood Ratio positive 9.6 for ultrasonography and 78.4 for CAT. Likelihood Rato negative 0.09 and 0.06 respectively). Evidences for preventing relapse are poor. Anyway, a very recent meta-analysis on 6 RCTs suggests no role for mesalazine (GRADE SCALE for evidence 3). Non absorbable antibiotics (rifaximin) have been used in two studies (one RCT, one retrospective observational). Data from the two studies suggest some evidence in favour of its use (GRADE SCALE 1). The number of admitted patients is 291. Considering a base-line risk of 19 relapses every 100 patients (5-year observation period), the absolute risk difference is minus 9 patients with relapse (CI 95% -14 a + 3) in the RCT and minus 14 patients (CI 95% -17 a -5) in the observational study. A 2020 preview suggests an exploding interest in assessing the risk factors for relapse (including aspirin and NSAIDs) and identifying the better strategy to reduce it. Further trials are requested, including the use of probiotics alone.},
}
@article {pmid27353142,
year = {2016},
author = {Järbrink-Sehgal, ME and Andreasson, A and Talley, NJ and Agréus, L and Song, JY and Schmidt, PT},
title = {Symptomatic Diverticulosis Is Characterized By Loose Stools.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {14},
number = {12},
pages = {1763-1770.e1},
doi = {10.1016/j.cgh.2016.06.014},
pmid = {27353142},
issn = {1542-7714},
mesh = {Abdominal Pain/epidemiology/etiology ; Adolescent ; Adult ; Age Factors ; Aged ; Diarrhea/*epidemiology/*etiology ; Diverticulum/complications/*epidemiology/*pathology ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Surveys and Questionnaires ; Sweden/epidemiology ; Young Adult ; },
abstract = {BACKGROUND & AIMS: Symptomatic uncomplicated diverticular disease is considered to be a discreet clinical entity distinct from irritable bowel syndrome (IBS), but population-based data are unavailable. We aimed to investigate the prevalence and location of diverticulosis in the general population, and its association with colonic symptoms and mental health. We propose that individuals with diverticulosis would report more constipation and IBS.
METHODS: We performed a population-based study of randomly selected adults born in Sweden (age, 18-70 y; 57.2% women); 745 received a gastroenterology consultation, completed validated abdominal symptom and mental health questionnaires, and were examined by colonoscopy. Logistic regression was used to calculate the associations between diverticulosis and age, sex, gastrointestinal symptoms, anxiety, depression, and self-rated health.
RESULTS: Among the 742 participants (54.6% women), 130 (17.5%) had diverticulosis. Age was the strongest predictor of diverticulosis (P < .001), and diverticulosis was rare in participants younger than 40 years (0.7%). All participants with diverticulosis had sigmoid involvement. Participants with diverticulosis were more likely to report loose stools (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.20-2.96), urgency (OR, 1.64; 95% CI, 1.02-2.63), passing mucus (OR, 2.26; 95% CI, 1.08-4.72), and a high stool frequency (OR, 2.02; 95% CI, 1.11-3.65). Diverticulosis was associated with abdominal pain (OR, 2.10; 95% CI, 1.01-4.36; P = .047) and diarrhea-predominant IBS (OR, 9.55; 95% CI, 1.08-84.08; P = .04) in participants older than 60 years. The presence of anxiety and depression and self-rated health were similar in participants with and without diverticulosis.
CONCLUSIONS: The prevalence of diverticulosis is age-dependent. Diverticulosis is associated with diarrhea in subjects across all age ranges. In subjects older than age 60, diverticulosis is associated with abdominal pain and diarrhea-predominant IBS.},
}
@article {pmid27350728,
year = {2016},
author = {Scaldaferri, F and Gerardi, V and Mangiola, F and Lopetuso, LR and Pizzoferrato, M and Petito, V and Papa, A and Stojanovic, J and Poscia, A and Cammarota, G and Gasbarrini, A},
title = {Role and mechanisms of action of Escherichia coli Nissle 1917 in the maintenance of remission in ulcerative colitis patients: An update.},
journal = {World journal of gastroenterology},
volume = {22},
number = {24},
pages = {5505-5511},
pmid = {27350728},
issn = {2219-2840},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Colitis, Ulcerative/microbiology/*therapy ; *Escherichia coli ; Humans ; Maintenance Chemotherapy ; Mesalamine/therapeutic use ; Probiotics/*therapeutic use ; },
abstract = {Ulcerative colitis (UC) is a chronic inflammatory disease, whose etiology is still unclear. Its pathogenesis involves an interaction between genetic factors, immune response and the "forgotten organ", Gut Microbiota. Several studies have been conducted to assess the role of antibiotics and probiotics as additional or alternative therapies for Ulcerative Colitis. Escherichia coli Nissle (EcN) is a nonpathogenic Gram-negative strain isolated in 1917 by Alfred Nissle and it is the active component of microbial drug Mutaflor(®) (Ardeypharm GmbH, Herdecke, Germany and EcN, Cadigroup, In Italy) used in many gastrointestinal disorder including diarrhea, uncomplicated diverticular disease and UC. It is the only probiotic recommended in ECCO guidelines as effective alternative to mesalazine in maintenance of remission in UC patients. In this review we propose an update on the role of EcN 1917 in maintenance of remission in UC patients, including data about efficacy and safety. Further studies may be helpful for this subject to further the full use of potential of EcN.},
}
@article {pmid27330495,
year = {2015},
author = {Barroso, AO and Quigley, EM},
title = {Diverticula and Diverticulitis: Time for a Reappraisal.},
journal = {Gastroenterology & hepatology},
volume = {11},
number = {10},
pages = {680-688},
pmid = {27330495},
issn = {1554-7914},
abstract = {Colonic diverticula are very common and may be associated with symptoms or complicated by diverticulitis and its associated problems. Many of the traditional concepts relating to the pathophysiology, prevention, and management of these entities have been questioned recently based on findings from high-quality prospective studies. Although dietary fiber may protect against symptoms and complications, its impact on the formation of diverticula may be limited. It is now evident that the risk for an episode of diverticulitis in an individual with diverticula is lower than previously thought. Furthermore, the necessity for antibiotic use in uncomplicated diverticulitis has been questioned and serious doubt cast upon the belief that surgery should be performed when a second attack occurs. Although data are far from conclusive, there is some evidence to suggest that diverticulosis may be associated with chronic abdominal symptoms, with or without underlying chronic inflammatory changes in the involved segment of the colon. In addition, colonoscopy is not routinely required after an attack of acute uncomplicated diverticulitis, as the risk of cancer in this population is not much higher than in the general population.},
}
@article {pmid27322150,
year = {2016},
author = {Papagrigoriadis, S},
title = {Diverticular disease and cancer: an unproven link.},
journal = {Scandinavian journal of gastroenterology},
volume = {51},
number = {10},
pages = {1145-1146},
doi = {10.1080/00365521.2016.1190865},
pmid = {27322150},
issn = {1502-7708},
mesh = {Biomarkers, Tumor/analysis ; Colorectal Neoplasms/*epidemiology ; Diverticulitis, Colonic/*epidemiology ; Diverticulum, Colon/*epidemiology ; Humans ; },
}
@article {pmid27270479,
year = {2016},
author = {Besson, R and Christidis, C and Denet, C and Bruyns, L and Levard, H and Gayet, B and Fuks, D and Perniceni, T},
title = {Management of postoperative bleeding after laparoscopic left colectomy.},
journal = {International journal of colorectal disease},
volume = {31},
number = {8},
pages = {1431-1436},
pmid = {27270479},
issn = {1432-1262},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects ; Colectomy/*adverse effects ; Colonoscopy ; Demography ; Female ; Humans ; Laparoscopy/*adverse effects ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Hemorrhage/*etiology/*therapy ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: Lower gastrointestinal bleeding after left colectomy is an uncommon complication that can lead to critical situation. Diagnostic and therapeutic manoeuvres should be performed in emergency with step-by-step strategy in order to avoid reoperation. This study aims to identify bleeding risks factors and describe a management strategy.
METHODS: This is a retrospective study of patients who underwent left colectomy with primary anastomosis, from May 2004 to December 2013. We studied their demographic characteristics, surgical procedures and postoperative courses, more specifically hemorrhagic complications, management of bleeding and outcomes.
RESULTS: Hemorrhagic anastomotic complication occurred in 47 of the 729 (6.4 %) patients after left colectomy. Neither anticoagulant nor antiaggregant treatment was associated with postoperative bleeding. Among the 47 patients with bleeding, endoscopy was performed in 37 (78.7 %). At the time of endoscopy, the bleeding was spontaneously stopped in nine (24.3 %). Therapeutic strategy used clips in 10 (27.0 %) cases, mucosal sclerosis in 11 (29.7 %) and both in 7 (18.9 %) cases. Four (8.5 %) patients required blood transfusion for treatment of this gastrointestinal bleeding. Five (10.6 %) patients with bleeding were reoperated in this group because early endoscopy showed associated anastomotic leakage. Based on a multivariate analysis, stapled anastomosis and diverticular disease were independent factors associated with anastomotic bleeding.
CONCLUSIONS: Postoperative anastomotic bleeding is not so uncommon after left colectomy. This complication should be particularly dreaded in patients who underwent stapled colorectal anastomosis for diverticular disease. With the use of clip or mucosal sclerosis, early endoscopy is a safe and efficient treatment.},
}
@article {pmid27268604,
year = {2016},
author = {Wong, ER and Idris, F and Chong, CF and Telisinghe, PU and Tan, J and Chong, VH},
title = {Diverticular Disease and Colorectal Neoplasms: Association between Left Sided Diverticular Disease with Colorectal Cancers and Right Sided with Colonic Polyps.},
journal = {Asian Pacific journal of cancer prevention : APJCP},
volume = {17},
number = {5},
pages = {2401-2405},
pmid = {27268604},
issn = {2476-762X},
mesh = {Adult ; Aged ; Brunei/epidemiology ; Colonic Polyps/diagnosis/epidemiology/*etiology ; Colonoscopy ; Colorectal Neoplasms/diagnosis/epidemiology/*etiology ; Diverticulitis, Colonic/*complications ; Early Detection of Cancer ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND: Both colorectal cancer (CRC) and diverticular disease (DD) are common in the affluent West, and their prevalence is also increasing in the rest of the world with economic development. Both diseases have common epidemiologic characteristics; increasing incidence, more common with advancing age and related to specific dietary changes. However, studies of associations between the two have generated mixed results with some showing positive correlations, whilst others have shown no or negative links. Most of these studies have been from the West with study populations that were predominantly Caucasians. Here the focus was on DD and colorectal neoplasms, including CRC, in Brunei.
MATERIALS AND METHODS: All patients who had undergone complete colonoscopy between 2011 and 2014 were identified and retrospectively reviewed. Patients under the age of 18 years old or had previous colonic surgeries (including previous CRC resection) were excluded.
RESULTS: The total number of colonoscopies included in the study was 2,766 (mean age 53.2±14.8 years old, male 51.8%), of which DD, CRC and colonic polyps were detected in 17.3%, 4.7% and 28.2% respectively. The proportions of DD, polyps and CRC increased proportionally with age (<30 years, 30-49, 50-69 and ≥70). Overall, there was no association between the presence of DD and CRC (3.6% vs. 5.0%, p=0.179) but there was a significant association between CRC and left sided DD (p=0.034 by trend). There were also a significant association between presence of DD and polyps (36.1% vs. 28.2%, p=0.001), in particular with right-sided and pan-DD (p=0.001 for trend).
CONCLUSIONS: Our study showed that the prevalence of DD, CRC and polyps increases with age. There were significant associations between presence of left-sided DD with CRC and right-sided or pan-DD with colonic polyps. This suggests shared risk factors. Further studies are required to assess links in other countries of the Asian Pacific region.},
}
@article {pmid27266228,
year = {2016},
author = {Sirinthornpunya, S},
title = {Characteristics and Treatment Outcomes of Colonic Diverticulitis in Hospitalized Patients in Thailand.},
journal = {Journal of the Medical Association of Thailand = Chotmaihet thangphaet},
volume = {99 Suppl 2},
number = {},
pages = {S136-46},
pmid = {27266228},
issn = {0125-2208},
mesh = {Adult ; Aged ; Diverticulitis, Colonic/mortality/*therapy ; Female ; Hospitalization ; Humans ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Thailand ; },
abstract = {BACKGROUND: Colonic diverticular disease exhibits mucosal outpouchings through the large intestine. Common complications of this disease are diverticular bleeding and diverticulitis. The prevalence of the disease is age-dependent, and some patients with diverticulitis develop complications especially the elderly, the obese and those with co-morbid diseases. In a retrospective study in Chiang Mai, Thailand, the mortality rate was 3.6% at 30 days and 9.2% at 1 year.
OBJECTIVE: To determine the financial burden, clinical characteristics and factors associated with severity and mortality of patients with colonic diverticulitis.
MATERIAL AND METHOD: This was a retrospective study of in-patients from hospitals nationwide, and data were retrieved from three major health care system databases in the fiscal year 2010, searching for ICD code 10. Patients diagnosed with diverticular disease of the large intestine were included in this study, and baseline characteristics and clinical outcomes were analyzed. The study was approved by the institutional ethics committee of Rajavithi Hospital.
RESULTS: One thousand seven hundred and fifty patients with colonic diverticulitis were enrolled in the study and their data were analyzed. The mean age of the patients was 61.15+16.12 years old, about 70% of patients had co-morbid diseases, and the incidence of complicated colonic diverticulitis was 14.51%. The median length of hospital stay (LOS) was 6 days, half of the patients underwent surgery, and the mortality rate was 3.26%. Multivariate regression analysis revealed that the parameters associated with disease severity were number of co-morbid diseases, the universal coverage health care system, and surgical treatment, while the parameters associated with mortality were having more than two co-morbid diseases and being in the universal coverage health care system.
CONCLUSION: Colonic diverticulitis was common in elderly patients and associated with co-morbid diseases. Most patients had mild severity but a high rate of surgery, and the mortality rate was higher than in western countries. Parameters associated with disease severity and mortality were having co-morbid disease, being in the universal coverage healthcare system and having surgical treatment.},
}
@article {pmid27241606,
year = {2016},
author = {Husnoo, N and Patil, S and Jackson, A and Khan, M},
title = {Necrotising fasciitis secondary to a colocutaneous fistula.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {98},
number = {7},
pages = {e130-2},
pmid = {27241606},
issn = {1478-7083},
mesh = {Aged ; Colonic Diseases/*complications/surgery ; Cutaneous Fistula/*complications/surgery ; Fasciitis, Necrotizing/*etiology/surgery ; Female ; Humans ; Intestinal Fistula/*complications/surgery ; },
abstract = {Colocutaneous fistulae secondary to diverticular disease are rare, especially spontaneous fistulae. We report a case of a 74-year-old lady, with no previous history of diverticular disease, presenting with necrotising fasciitis of the anterior abdominal wall in the left iliac fossa, without any other symptoms. Urgent surgery was performed. An initial diagnostic laparoscopy demonstrated a perforated sigmoid diverticulum forming a fistula to the anterior abdominal wall. Following soft tissue debridement, a sigmoid colectomy was performed through a midline laparotomy. Gastrointestinal pathology should be considered as a potential cause of abdominal wall necrotising fasciitis. Our approach of using laparoscopic visualisation to assess for intra-abdominal sources in this context (in the absence of preoperative imaging when imaging could delay treatment) has not been described before. To our knowledge, only two cases of abdominal wall necrotising fasciitis secondary to diverticular disease with a colocutaneous fistula have been reported in the English literature.},
}
@article {pmid27241190,
year = {2016},
author = {Peery, AF},
title = {Recent Advances in Diverticular Disease.},
journal = {Current gastroenterology reports},
volume = {18},
number = {7},
pages = {37},
pmid = {27241190},
issn = {1534-312X},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Colectomy ; Diverticulitis/complications/diagnosis/epidemiology/*therapy ; Diverticulosis, Colonic/complications/epidemiology/*therapy ; Humans ; Recurrence ; Risk Factors ; },
abstract = {Diverticular disease is common and accounts for substantial health care utilization in the USA. Recent publications in the areas of diverticulosis and diverticular disease have highlighted several notable advances that are now changing practice. Despite colonic diverticula being common, only 1-4 % of individuals with colonic diverticula will develop diverticulitis. After a first occurrence of acute diverticulitis, the risk of recurrence is 20 % at 5 years. Complications most commonly occur with the first occurrence of acute diverticulitis and not with recurrent episodes. After an episode of diverticulitis, many patients continue to experience chronic gastrointestinal symptoms. Prophylactic surgery is an option to reduce the risk of recurrence and its negative impact on quality of life. Importantly, the rationale for surgery is no longer to prevent complications because this risk is low. The review concludes with practical recommendations for patients with diverticulosis and diverticular disease.},
}
@article {pmid27240135,
year = {2016},
author = {Feinberg, AE and Elnahas, A and Bashir, S and Cleghorn, MC and Quereshy, FA},
title = {Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity.},
journal = {Canadian journal of surgery. Journal canadien de chirurgie},
volume = {59},
number = {4},
pages = {262-267},
pmid = {27240135},
issn = {1488-2310},
mesh = {Adult ; Aged ; Colon/*surgery ; Digestive System Surgical Procedures/adverse effects/*statistics & numerical data ; Female ; Humans ; Intraoperative Complications/*epidemiology ; Laparoscopy/adverse effects/*statistics & numerical data ; Male ; Middle Aged ; Outcome and Process Assessment, Health Care/*statistics & numerical data ; Postoperative Complications/*epidemiology ; Rectum/*surgery ; *Registries ; Robotic Surgical Procedures/adverse effects/*statistics & numerical data ; },
abstract = {BACKGROUND: Robotic surgery has emerged as a minimally invasive alternative to traditional laparoscopy. Robotic surgery addresses many of the technical and ergonomic limitations of laparoscopic surgery, but the literature regarding clinical outcomes in colorectal surgery is limited. We sought to compare robotic and laparoscopic colorectal resections with respect to 30-day perioperative outcomes.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all patients who underwent robotic or laparoscopic colorectal surgery in 2013. We performed a logistic regression analysis to compare intraoperative variables and 30-day outcomes.
RESULTS: There were 8392 patients who underwent laparoscopic colorectal surgery and 472 patients who underwent robotic colorectal surgery. The robotic cohort had a lower incidence of unplanned intraoperative conversion (9.5% v. 13.7%, p = 0.008). There were no significant differences between robotic and laparoscopic surgery with respect to other intraoperative and postoperative outcomes, such as operative duration, length of stay, postoperative ileus, anastomotic leak, venous thromboembolism, wound infection, cardiac complications and pulmonary complications. On multivariable analysis, robotic surgery was protective for unplanned conversion, while male sex, malignancy, Crohn disease and diverticular disease were all associated with open conversion.
CONCLUSION: Robotic colorectal surgery has comparable 30-day perioperative morbidity to laparoscopic surgery and may decrease the rate of intraoperative conversion in select patients.},
}
@article {pmid27235589,
year = {2016},
author = {Del Pozo, AC and Bartolotta, V and Capitano, S and Fusco, MD and Chiodi, L and Boccoli, G},
title = {A gas-filled abdominal cyst in an elderly woman: A giant colonic diverticulum case report.},
journal = {International journal of surgery case reports},
volume = {24},
number = {},
pages = {104-107},
pmid = {27235589},
issn = {2210-2612},
abstract = {INTRODUCTION: Giant colonic diverticulum (GCD), a rare complication of the diverticular disease, can present with a wide range of nonspecific symptoms as abdominal pain and bowel obstruction. Its diagnosis represents a challenge that mainly depends on imaging findings.
PRESENTATION OF CASE: We report the case of a 79 year-old female patient that came to our emergency department complaining of 5-day history of hypogastric pain and constipation. Physical examination reveled a 15cm hypogastric round, tender and tympanic mass. Enhanced abdominal CT scan showed a large air-filled cyst adjacent to a diverticular sigmoid colon without evidence of intra-abdominal free air or fluid. Based on the radiological features, GCD was suspected and surgical treatment performed. The mass and the sigmoid colon were resected. The postoperative course was uneventful. Histopathology confirmed the preoperative diagnosis.
DISCUSSION: GCD, defined as a diverticulum larger than 4cm, represents a rare complication of the diverticular disease. Usually abdominal X-ray and computed tomography (CT) scan show a gas-filled structure, sometimes communicating with the adjacent colon. GCD resection and segmental colectomy are strongly recommended even in asymptomatic cases due to the high incidence and severity of complications.
CONCLUSION: Because of its rarity and variable and non-specific clinical presentation, the diagnosis of GCD depends mainly on imaging findings. The gold standard treatment is surgical resection of the GCD and the compromised colon with primary anastomosis when possible.},
}
@article {pmid27226685,
year = {2016},
author = {Oluyemi, A and Odeghe, E},
title = {Diverticular disease at colonoscopy in Lagos State, Nigeria.},
journal = {Nigerian medical journal : journal of the Nigeria Medical Association},
volume = {57},
number = {2},
pages = {110-113},
pmid = {27226685},
issn = {0300-1652},
abstract = {BACKGROUND: The upsurge in the reported cases of diverticular disease (DD) has led to a re-appraisal of the earlier held views that it was a rare entity in Nigeria. The advent of colonoscopy has contributed in no small way to this change. We sought to determine the clinical characteristics, indications for colonoscopy, and intra-procedural findings among these patients.
MATERIALS AND METHODS: A retrospective cross-sectional study was carried out on the colonoscopy records from four private endoscopy units based in Lagos State, Nigeria. The records were drawn from a 5-year period (August 2010 to July 2015). The endoscopy logs and reports were reviewed, and the bio data, indications, and colonoscopy findings were gleaned.
RESULTS: A total of 265 colonoscopies were carried out in the stated period. Of these, 28 (10.6%) had DD. Of the patients with DD, 5 (17.9%) were females while 23 (82.1%) were males. Their ages ranged from 46 to 94 years (mean = 68.2 ± 11 years). Fifteen patients had been referred for the procedure on account of hematochezia alone (15 = 53.6%). Other reasons for referral included abdominal pain alone (2 = 7%), hematochezia plus abdominal pain (5 = 17.9%), and change in bowel habits (3 = 10.8%). Ten (35%) patients had pan-colonic involvement. Regional disease involved the right side alone in only one case (3.5%) while the other combinations of sites are as follows; 6 (21.4%) in the sigmoid colon alone, 2 (7%) in the descending colon alone, 5 (17.9%) in the sigmoid-descending colon, 4 (14.3%) in the sigmoid-descending-transverse colon, thus the sigmoid colon was involved in 25 (89.3%) cases. Five cases (17.9%) had endoscopic features suggestive of diverticulitis.
CONCLUSIONS: DD should no longer be regarded as a rare problem in the Nigerian patient. The study findings support the notion of higher prevalence among the elderly, in males, and of sigmoid colon involvement.},
}
@article {pmid27190624,
year = {2016},
author = {Cubas, V and Ward, ST and Dmitrewski, J},
title = {Giant diverticulum- A rare complication of a common surgical condition.},
journal = {Clinical case reports},
volume = {4},
number = {5},
pages = {531-532},
pmid = {27190624},
issn = {2050-0904},
abstract = {A gentleman presented with abdominal distension and pain. CT confirmed a 20 cm sigmoid diverticulum. A giant diverticulum, typified by diverticula greater than 4 cm, often requires colonic resection. Fewer than 200 cases have been reported, most measuring 7-15 cm. I present a rare complication of a common surgical condition with images.},
}
@article {pmid27182822,
year = {2016},
author = {Horesh, N and Klang, E and Gravetz, A and Nevo, Y and Amiel, I and Amitai, MM and Rosin, D and Gutman, M and Zmora, O},
title = {Jejunal Diverticulitis.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {26},
number = {8},
pages = {596-599},
doi = {10.1089/lap.2016.0066},
pmid = {27182822},
issn = {1557-9034},
mesh = {Abdominal Pain/etiology ; Aged ; Aged, 80 and over ; Colonoscopy ; *Conservative Treatment ; Diverticulitis/complications/surgery/*therapy ; Diverticulosis, Colonic/complications ; Female ; Humans ; Intestinal Perforation/*etiology ; Jejunal Diseases/complications/surgery/*therapy ; Male ; Middle Aged ; Pneumoperitoneum/etiology ; Recurrence ; Retrospective Studies ; },
abstract = {BACKGROUND: Jejunal diverticulitis is a rare clinical entity often overlooked by physicians as a cause for abdominal pain. Although diagnostic capabilities improved in recent years, there is little data about diverticular disease in the proximal small bowel. The aim of this study is to present the clinical course and management in a series of eight cases of jejunal diverticulitis and possible therapeutic interventions.
METHODS: A cohort retrospective analysis of all patients admitted for acute jejunal diverticulitis between January 2010 and June 2015 was conducted. Patient demographics, clinical, and surgical outcome were recorded and analyzed.
RESULTS: Eight patients were admitted for acute jejunal diverticulitis with a mean age of 72.1 (range 55-87) years. Clinical presentation included six patients (75%) with a sealed perforation and only one patient demonstrated distant pneumoperitoneum. All patients were treated initially without surgery and only one patient required surgery because of diverticular complications. Recurrent episodes occurred in two patients (25%). Colonoscopy was performed in all patients after hospitalization that revealed large bowel diverticulosis in all patients (100%). Median follow-up was 8.2 months (3-15 months).
CONCLUSION: Jejunal diverticulitis can be initially treated conservatively but complicated disease should be considered for surgical management. Further study is required on the relationship between small and large bowel diverticulosis.},
}
@article {pmid27177935,
year = {2016},
author = {Banky, B and Marlborough, F and MacLeod, I and Gill, TS},
title = {Single-incision laparoscopic (SIL) sigmoid colectomy and uterus-preserving repair for colo-uterine fistula secondary to severe diverticular disease: an unusual technical solution for an unusual presentation of a common disease.},
journal = {BMJ case reports},
volume = {2016},
number = {},
pages = {},
pmid = {27177935},
issn = {1757-790X},
mesh = {Aged ; Colectomy/*methods ; Colon, Sigmoid/surgery ; Colonic Diseases/etiology/*surgery ; Diverticulitis, Colonic/*complications ; Female ; Fistula/etiology/*surgery ; Humans ; Intestinal Fistula/etiology/*surgery ; Laparoscopy ; Postoperative Complications/surgery ; Uterine Diseases/etiology/*surgery ; Uterus/surgery ; },
abstract = {Colouterine fistula as a potential complication of chronic diverticulitis is a rare entity with less than 30 cases reported worldwide. Generally, patients require a multidisciplinary approach including a major laparotomy with hysterectomy and sigmoid colectomy, and, occasionally, temporary colostomy. We report the first attempt of a novel, minimally invasive technique for managing a case of benign colouterine fistula with single-incision laparoscopic (SIL) sigmoid colectomy and uterus preservation. A small, 3 cm incision site provided access for the whole operation, as well as played a role as the specimen extraction site. Malignant fistulas and large uterine defects may require hysterectomy, however, laparoscopic closure of uterine wall defects can be considered as a reasonable alternative in selected patients, avoiding the higher risks associated with hysterectomy and keeping fertility at younger ages. Single incision laparoscopy in complicated diverticular disease and fistula formation cases is a challenging but technically feasible option, in experienced hands.},
}
@article {pmid27156370,
year = {2016},
author = {Feuerstein, JD and Falchuk, KR},
title = {Diverticulosis and Diverticulitis.},
journal = {Mayo Clinic proceedings},
volume = {91},
number = {8},
pages = {1094-1104},
doi = {10.1016/j.mayocp.2016.03.012},
pmid = {27156370},
issn = {1942-5546},
mesh = {Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Dietary Fiber/*standards ; Diverticulitis, Colonic/diagnosis/epidemiology/etiology/therapy ; *Diverticulosis, Colonic/diagnosis/epidemiology/etiology/therapy ; Female ; Geography ; Humans ; Male ; Middle Aged ; Prevalence ; Protective Factors ; Risk Factors ; Sex Distribution ; },
abstract = {Diverticular disease is a common condition that is associated with variable presentations. For this review article, we performed a review of articles in PubMed through February 1, 2016, by using the following MeSH terms: colon diverticula, colonic diverticulitis, colonic diverticulosis, colonic diverticulum, colonic diverticula, and diverticula. Diverticula are structural alterations within the colonic wall that classically form "pockets" referred to as diverticula. Diverticula form from herniation of the colonic mucosa and submucosa through defects in the circular muscle layers within the colonic wall. Often this is at the sites of penetrating blood vessels in the colon. Diverticular disease is extremely common, which resulted in 2,682,168 outpatient visits and 283,355 hospitalization discharges for diverticulitis or diverticulosis in 2009. Diverticulosis is one of the most common detected conditions found incidentally on colonoscopy. Risk factors for the development of diverticulitis include obesity, smoking, nonsteroidal anti-inflammatory drugs, corticosteroids, and opiates. In contrast, fiber may be protective, but recent studies have questioned the role of fiber in developing diverticular disease. Most patients with diverticulosis will be asymptomatic, but a subset of patients may develop nonspecific abdominal pain (isolated or recurrent), diverticulitis, or segmental colitis associated with diverticulosis. Classically, the treatment of diverticulitis has included antibiotics for all patients. More recent evidence indicates that in mild to even moderate uncomplicated diverticulitis, antibiotics may not be as necessary as initially believed. In more complicated diverticulitis, intravenous antibiotics and surgery may be necessary. Once a patient has had an attack of diverticulitis, increasing fiber may help prevent future attacks. Other modalities such as 5-aminosalicylate products, antibiotics, and probiotics are still of unclear benefit in preventing future episodes of diverticulitis. Similarly, even when patients develop recurrent episodes of diverticulitis, surgery may not be necessary as a prophylactic treatment.},
}
@article {pmid27154895,
year = {2016},
author = {Peery, AF},
title = {Colonic Diverticula and Diverticular Disease: 10 Facts Clinicians Should Know.},
journal = {North Carolina medical journal},
volume = {77},
number = {3},
pages = {220-222},
pmid = {27154895},
issn = {0029-2559},
support = {KL2 TR001109/TR/NCATS NIH HHS/United States ; L30 DK103302/DK/NIDDK NIH HHS/United States ; 1KL2TR001109/TR/NCATS NIH HHS/United States ; },
mesh = {*Diverticulitis, Colonic ; *Diverticulum, Colon ; Humans ; },
abstract = {Diverticular disease accounts for substantial health care utilization and costs. Despite this public health burden, clinical practice has been largely based on poor-quality evidence. Fortunately, there is growing interest in this neglected disease. Based on recent work, clinicians should be familiar with the following 10 facts about diverticula and diverticular disease.},
}
@article {pmid27152137,
year = {2016},
author = {Rotholtz, NA and Canelas, AG and Bun, ME and Laporte, M and Sadava, EE and Ferrentino, N and Guckenheimer, SA},
title = {Laparoscopic approach in complicated diverticular disease.},
journal = {World journal of gastrointestinal surgery},
volume = {8},
number = {4},
pages = {308-314},
pmid = {27152137},
issn = {1948-9366},
abstract = {AIM: To analyze the results of laparoscopic colectomy in complicated diverticular disease.
METHODS: This was a retrospective cohort study conducted at an academic teaching hospital. Data were collected from a database established earlier, which comprise of all patients who underwent laparoscopic colectomy for diverticular disease between 2000 and 2013. The series was divided into two groups that were compared: Patients with complicated disease (abscess, perforation, fistula, or stenosis) (G1) and patients undergoing surgery for recurrent diverticulitis (G2). Recurrent diverticulitis was defined as two or more episodes of diverticulitis regardless of patient age. Data regarding patient demographics, comorbidities, prior abdominal operations, history of acute diverticulitis, classification of acute diverticulitis at index admission and intra and postoperative variables were extracted. Univariate analysis was performed in both groups.
RESULTS: Two hundred and sixty patients were included: 28% (72 patients) belonged to G1 and 72% (188 patients) to G2. The mean age was 57 (27-89) years. The average number of episodes of diverticulitis before surgery was 2.1 (r 0-10); 43 patients had no previous inflammatory pathology. There were significant differences between the two groups with respect to conversion rate and hospital stay (G1 18% vs G2 3.2%, P = 0.001; G1: 4.7 d vs G2 3.3 d, P < 0.001). The anastomotic dehiscence rate was 2.3%, with no statistical difference between the groups (G1 2.7% vs G2 2.1%, P = 0.5). There were no differences in demographic data (body mass index, American Society of Anesthesiology and previous abdominal surgery), operative time and intraoperative and postoperative complications between the groups. The mortality rate was 0.38% (1 patient), represented by a death secondary to septic shock in G2.
CONCLUSION: The results support that the laparoscopic approach in any kind of complicated diverticular disease can be performed with low morbidity and acceptable conversion rates when compared with patients undergoing laparoscopic surgery for recurrent diverticulitis.},
}
@article {pmid27124228,
year = {2016},
author = {Schwieterman, CK and Sarap, MD and Childers, J},
title = {A rare case of iron-deficiency anemia rapidly progressing to a life-threatening event.},
journal = {JAAPA : official journal of the American Academy of Physician Assistants},
volume = {29},
number = {5},
pages = {37-39},
doi = {10.1097/01.JAA.0000476209.81571.1d},
pmid = {27124228},
issn = {1547-1896},
mesh = {Anemia, Iron-Deficiency/*etiology ; Diverticulosis, Colonic ; *Diverticulum, Colon ; *Foreign Bodies ; Gastrointestinal Hemorrhage/*etiology ; Humans ; },
abstract = {Giant colonic diverticula are extremely rare; however, they should be considered in a patient with a history or susceptibility to diverticular disease because of the nonspecific presentation and life-threatening complications. Giant colonic diverticula often are overlooked because of their nonspecific gastrointestinal (GI) symptoms, leading to complications of obstruction, perforation, abscess formation, and sepsis. A rare and unusual presentation of a giant colonic diverticulum is the development of a bezoar. This case describes a patient whose GI bleeding led to the diagnosis of a giant colonic diverticulum with a bezoar.},
}
@article {pmid27120447,
year = {2016},
author = {Papageorge, CM and Kennedy, GD and Carchman, EH},
title = {National Trends in Short-term Outcomes Following Non-emergent Surgery for Diverticular Disease.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {20},
number = {7},
pages = {1376-1387},
pmid = {27120447},
issn = {1873-4626},
support = {T32 CA090217/CA/NCI NIH HHS/United States ; },
mesh = {Adult ; Aged ; Colectomy/*trends ; Diverticulitis, Colonic/complications/mortality/*surgery ; Elective Surgical Procedures/*trends ; Female ; Humans ; Laparoscopy/trends ; Male ; Middle Aged ; Retrospective Studies ; United States/epidemiology ; },
abstract = {INTRODUCTION: Elective surgery for diverticulitis has evolved over the last decade. We aimed to evaluate the impact of changing practice patterns on postoperative outcomes. We hypothesized that the increased use of laparoscopy, and other management changes, would correlate with a decrease in postoperative complications.
METHODS: Patients undergoing non-emergent surgery for diverticulitis from 2005 to 2013 were selected from the National Surgical Quality Improvement Program (NSQIP) database. We compared patient demographics, comorbidities, and operative approach by year of operation using chi-square tests and investigated temporal trends in postoperative outcomes using univariate, trend, and multivariate analyses.
RESULTS: The analytic cohort, which included 29,893 patients, had increasing rates of obesity, advanced age, and higher American Society of Anesthesiologists (ASA) class over the study period. The use of laparoscopy increased significantly from 48 % in 2005/2006 to 70 % in 2013 (p < 0.001), while the rate of stoma creation remained unchanged (10-12 %, p = 0.072). The absolute risk of any postoperative complication decreased by 5.8 % over the study period, driven primarily by a reduction in infectious complications. Year of operation was a significant independent predictor of fewer complications for 2011-2013.
CONCLUSION: Despite a trend towards increasing patient complexity, there has been a decline in postoperative morbidity following non-emergent surgery for diverticulitis. This trend coincides with the steadily increasing use of laparoscopy in this population.},
}
@article {pmid27117969,
year = {2016},
author = {Su, J and Chia, CL and Mantoo, SK},
title = {Laparoscopic Hartmann reversal: Video presentation of a case.},
journal = {Asian journal of endoscopic surgery},
volume = {9},
number = {2},
pages = {161-162},
doi = {10.1111/ases.12266},
pmid = {27117969},
issn = {1758-5910},
mesh = {Diverticulum, Colon/*surgery ; Humans ; Intestinal Obstruction/*surgery ; *Laparoscopy ; Male ; Middle Aged ; Sigmoid Diseases/*surgery ; },
abstract = {INTRODUCTION: Laparoscopic Hartmann reversal (LHR) has decreased postoperative recovery time and a lower wound infection rate compared to open HR. However its technical difficulty and high conversion rates make it a challenging procedure. We aim to demonstrate the technique of LHR via a video presentation. Our patient, a 64 year old Chinese man with no history of previous surgery underwent a Hartmann procedure for an obstructing sigmoid stricture secondary to diverticular disease. Three months later, he underwent an elective LHR.
A 10 mm port was initially inserted in the right iliac fossa under direct vision away from expected adhesions due to the previous midline incision. Additional 5mm working ports were inserted in the right flank and right hypochondrium. An additional 10mm optical port was then inserted in the epigastrium and the laparoscopic camera was switched to the epigastric port. Omental adhesions to abdominal wall were taken down. The left colon was then brought down to the pelvis to ensure adequate length of bowel for anastomosis. A colorectal side to end anastomosis was then performed. The stoma wound was closed and the patient was discharged well on post-operative day 5.
DISCUSSION: LHR can be adopted as an initial approach to visualize intra-abdominal adhesions and determine feasibility of operation. With experienced hands, LHR can achieve good patient outcomes.},
}
@article {pmid27086288,
year = {2016},
author = {Ambrosetti, P and Gervaz, P},
title = {Management of sigmoid diverticulitis: an update.},
journal = {Updates in surgery},
volume = {68},
number = {1},
pages = {25-35},
pmid = {27086288},
issn = {2038-3312},
mesh = {Colectomy/*methods ; Colon, Sigmoid/*surgery ; *Disease Management ; Diverticulitis/*surgery ; Elective Surgical Procedures ; Humans ; Laparoscopy/*methods ; },
abstract = {The role, indications and modalities of elective resection for sigmoid diverticulitis remain the cause of fierce debate. During the past two decades clinicians have increasingly recognized that: (1) young patients (<50) are no more at risk to develop more aggressive course of the disease; and (2) patients who present initially with a first uncomplicated attack are no more at risk for developing subsequent complicated diverticulitis requiring emergency surgery. Hence, the previously well-recognized indications (based upon age of the patients or the number of attacks) are no longer valid. Yet, the number of sigmoid resections performed for diverticulitis in industrialized countries is increasing, which seems to indicate that in many cases, uncomplicated sigmoid diverticulitis progressively evolves towards a chronic symptomatic condition, which significantly impacts upon the patients' quality of life. The aims of this review are twofold: (1) to identify which disease presentation still represents good indications for elective laparoscopic sigmoid resection; and (2) to summarize the technical aspects of surgery for a benign condition, such as diverticular disease.},
}
@article {pmid27086090,
year = {2016},
author = {Steinemann, DC and Zerz, A and Germann, S and Lamm, SH},
title = {Anorectal Function and Quality of Life after Transrectal Rigid-Hybrid Natural Orifice Translumenal Endoscopic Sigmoidectomy.},
journal = {Journal of the American College of Surgeons},
volume = {223},
number = {2},
pages = {299-307},
doi = {10.1016/j.jamcollsurg.2016.04.002},
pmid = {27086090},
issn = {1879-1190},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anal Canal/*physiopathology ; Colectomy/*methods ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/*surgery ; Follow-Up Studies ; Humans ; Intention to Treat Analysis ; Male ; Manometry ; Middle Aged ; Natural Orifice Endoscopic Surgery/*methods ; Postoperative Period ; Prospective Studies ; *Quality of Life ; Rectum/*physiopathology ; Sigmoid Diseases/*surgery ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: In transrectal rigid-hybrid natural orifice translumenal endoscopic sigmoidectomy (trNS), extraction-site laparotomy is avoided, which reduces postoperative pain and improves recovery time. However, current research evaluating anorectal function after trNS is limited. This study aims to evaluate clinical continence, anorectal manometry, and quality of life in patients undergoing trNS for diverticular disease.
STUDY DESIGN: Between November 2013 and October 2015, patients undergoing trNS for diverticular disease were prospectively included. Patients converted to laparoscopic resection with an extraction-site laparotomy before attempted transrectal access were excluded. Anorectal manometry, including measurement of resting pressure, squeeze pressure, and retention tests; and questionnaires on continence, defecation, quality of life, and cosmesis, were obtained before and at 3 and 6 months after surgery.
RESULTS: Twenty-five patients were enrolled in the study. Four were converted and 1 was lost to follow-up, leaving 20 patients included in the study. Mean anal resting pressure before surgery was 59.3 mmHg (95% CI, 51.81-66.79 mmHg), decreasing to 48.85 mmHg (95% CI, 43.75-53.95 mmHg) at 3 months (p = 0.015). It normalized to 53.45 mmHg (95% CI, 47.78-59.12 mmHg) at 6 months (p = 0.168). Maximum anal squeeze pressure, retention tests, and St Marks incontinence score remained unchanged during the follow-up. Gastrointestinal Quality of Life Index remained high before (124 points) and at 6 months after surgery (128.8 points; p = 0.544).
CONCLUSIONS: Six months after trNS, neither clinical continence nor manometric findings deteriorated. Quality of life after trNS for recurrent diverticulitis is excellent. Long-term implications of a temporary decline in resting pressure after 3 months remain unclear and warrant long-term follow-up.},
}
@article {pmid27082846,
year = {2016},
author = {Flor, N and Maconi, G and Cornalba, G and Pickhardt, PJ},
title = {The Current Role of Radiologic and Endoscopic Imaging in the Diagnosis and Follow-Up of Colonic Diverticular Disease.},
journal = {AJR. American journal of roentgenology},
volume = {207},
number = {1},
pages = {15-24},
doi = {10.2214/AJR.16.16138},
pmid = {27082846},
issn = {1546-3141},
mesh = {*Colonoscopy ; Contrast Media ; *Diagnostic Imaging ; Diverticulitis, Colonic/*diagnostic imaging ; Humans ; },
abstract = {OBJECTIVE: Colonic diverticular disease is among the most prevalent conditions in Western society and is a common cause for outpatient visits and hospitalizations. The role of imaging is in evolution, but it has proven useful in confirming clinically suspected disease, assessing severity and complications, and directing patient management.
CONCLUSION: This review focuses on the current role of radiologic and endoscopic imaging in distinct clinical scenarios of diverticular disease, with emphasis on diverticulitis and its follow-up.},
}
@article {pmid27071978,
year = {2017},
author = {White, CR and Jodlowski, TZ and Atkins, DT and Holland, NG},
title = {Successful Doxycycline Therapy in a Patient With Escherichia coli and Multidrug-Resistant Klebsiella pneumoniae Urinary Tract Infection.},
journal = {Journal of pharmacy practice},
volume = {30},
number = {4},
pages = {464-467},
doi = {10.1177/0897190016642362},
pmid = {27071978},
issn = {1531-1937},
mesh = {Aged ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Doxycycline/pharmacology/*therapeutic use ; Drug Resistance, Multiple, Bacterial/*drug effects/physiology ; Escherichia coli/*drug effects/isolation & purification ; Humans ; Klebsiella Infections/*drug therapy/urine ; Klebsiella pneumoniae/*drug effects/isolation & purification ; Male ; Urinary Tract Infections/*drug therapy/urine ; },
abstract = {OBJECTIVE: To report on a patient with a symptomatic, polymicrobial Escherichia coli and multidrug-resistant (MDR), extended-spectrum β-lactamase (ESBL)-positive Klebsiella pneumoniae urinary tract infection (UTI) who was successfully treated with oral doxycycline hyclate.
CASE SUMMARY: A 70-year-old white male inpatient with a history of recurrent UTI, type 2 diabetes, hypertension, obesity, and diverticular disease was diagnosed with UTI and empirically treated with oral ciprofloxacin. Symptoms persisted 2 days later, and the patient was transitioned to amoxicillin/clavulanate by a different provider. The next day, upon receipt of the urine culture and susceptibility panel revealing E coli and MDR, ESBL-positive K pneumoniae infection, treatment was switched to doxycycline hyclate, which resulted in clinical improvement.
DISCUSSION: Complicated UTI involving multiple pathogens requires careful clinical judgment to select the appropriate antimicrobial agent, improve clinical outcomes, and prevent resistance. Treatment with doxycycline was based on the susceptibility panel and local resistance patterns. Advantages of doxycycline for UTI include its oral formulation, wide spectrum of activity, ability to achieve high concentration in the urine, and low toxicity.
CONCLUSION: Doxycycline hyclate may be an effective treatment option for patients with susceptible MDR UTI.},
}
@article {pmid27062439,
year = {2017},
author = {Buchwald, P and Dixon, L and Wakeman, CJ and Eglinton, TW and Frizelle, FA},
title = {Hinchey I and II diverticular abscesses: long-term outcome of conservative treatment.},
journal = {ANZ journal of surgery},
volume = {87},
number = {12},
pages = {1011-1014},
doi = {10.1111/ans.13501},
pmid = {27062439},
issn = {1445-2197},
mesh = {Abdominal Abscess/*complications/pathology/therapy ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Colectomy/adverse effects/methods ; Colon, Sigmoid/diagnostic imaging/*pathology/surgery ; Conservative Treatment/adverse effects/methods ; Diverticular Diseases/drug therapy/*microbiology/pathology/surgery ; Diverticulitis, Colonic/drug therapy/*microbiology/pathology/surgery ; Drainage/adverse effects/methods ; Elective Surgical Procedures/adverse effects/methods ; Female ; Humans ; Male ; Middle Aged ; Outcome Assessment, Health Care ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: The management of diverticular disease and its complications are an increasing burden to the health system. The natural history of conservatively managed diverticular abscesses (Hinchey I and II) is poorly described and it remains open to debate whether subsequent sigmoid resection is indicated after conservative management. This observational study compares outcomes of patients treated with conservative management (antibiotics +/- percutaneous drainage) and surgery.
METHODS: All patients admitted at Christchurch Hospital with diverticulitis between 1 January 1998 and 31 December 2009 were recorded in a database. A retrospective analysis of patients with an abscess due to complicated diverticulitis was undertaken. Initial management, recurrence and subsequent surgery were recorded. The patients were followed until 1 January 2014.
RESULTS: Of 1044 patients with diverticulitis, 107 with diverticular abscess were included in this analysis. The median age was 66 ± 16 and 60 were male. All patients had sigmoid diverticulitis and were diagnosed with a computed tomography. The median abscess size was 4.2 ± 2.1 cm. During median follow-up of 110 months, the overall recurrence rate was 20% (21/107). Recurrence varied according to initial treatment; namely antibiotics (30%), percutaneous drainage plus antibiotics (27%) and surgery (5%) (P = 0.004). The median time to recurrence was 4 ± 11.7 months, and most recurrences were treated conservatively; four patients underwent delayed surgery.
CONCLUSION: Recurrence after diverticular abscess is higher after initial conservative treatment (antibiotics +/- percutaneous drainage) compared with surgery, however, patients with recurrent disease can be treated conservatively with similar good outcomes and few patients required further surgery.},
}
@article {pmid27054646,
year = {2015},
author = {Hot, S and Eğin, S and Gökçek, B and Yeşiltaş, M and Alemdar, A and Akan, A and Karahan, SR},
title = {Solitary caecum diverticulitis mimicking acute appendicitis.},
journal = {Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES},
volume = {21},
number = {6},
pages = {520-523},
doi = {10.5505/tjtes.2015.65188},
pmid = {27054646},
issn = {1307-7945},
mesh = {Abdomen, Acute/etiology ; Adult ; Aged ; Appendicitis/diagnosis ; Cecum/*surgery ; Colectomy ; Diverticulitis/complications/diagnosis/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Turkey/epidemiology ; Young Adult ; },
abstract = {Solitary cecum diverticulum is a benign formation, but it can be complicated with inflammation, perforation and bleeding. Cecum diverticulitis (CD) is the most common complication of caecal diverticulum and it has the highest incidence among Asians, but it is a rare condition in the western world. The incidence of colonic diverticular disease can vary according to national origin, cultural structure and nutritional habits. CD is not common in our country, but it is an important situation because of its clinical similarity with the commonly seen acute right side abdominal diseases like acute appendicitis. Preoperative diagnosis is difficult, and hence, the actual frequency is not known. The treatment of CD can vary from medical therapy to right hemi colectomy. In this study, we presented ten CD cases on whom surgical resection was performed in our surgery unit during the last 8 years. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room.},
}
@article {pmid27042756,
year = {2016},
author = {Moon, SB},
title = {Successful Conservative Management of a Retroperitoneal Abscess with a Sinus to the Colon: A Case Report.},
journal = {International surgery},
volume = {},
number = {},
pages = {},
doi = {10.9738/INTSURG-D-15-00260.1},
pmid = {27042756},
issn = {2520-2456},
abstract = {A sinus between the colon and a retroperitoneal abscess is a rare entity that usually occurs as a complication of a primary condition such as Crohn's disease, radiation enteritis, or diverticular disease. Herein, we report a 72-year-old woman with a retroperitoneal abscess and a sinus formation between the abscess and the colon after an iatrogenic injury to her left colon. The retroperitoneal abscess was detected 1 week after the patient had undergone a left nephroureterectomy for recurrent ureteral cancer. The patient's general performance status allowed conservative management with antibiotics and percutaneous drainage. The abscess resolved, and the sinus closed after 3 weeks of treatment. In the absence of surgical pathology in the colon, and if the patient's general condition is good enough to tolerate conservative management, treatment using antibiotics plus percutaneous drainage is effective for cases of retroperitoneal abscess with a sinus between the colon and abscess.},
}
@article {pmid27040663,
year = {2017},
author = {Gallegos-Sierra, C and Gutiérrez-Alfaro, C and Evaristo-Méndez, G},
title = {[Complicated diverticular disease debuting as necrotising fasciitis of pelvic limb. A case report].},
journal = {Cirugia y cirujanos},
volume = {85},
number = {3},
pages = {240-244},
doi = {10.1016/j.circir.2016.01.003},
pmid = {27040663},
issn = {2444-054X},
mesh = {Abscess/complications ; Buttocks ; Cellulitis/etiology ; Debridement ; Diverticulitis, Colonic/*complications/surgery ; Fasciitis, Necrotizing/*etiology/surgery/therapy ; Fasciotomy ; Fatal Outcome ; Female ; Humans ; Intestinal Perforation/*etiology/surgery ; Leg ; Low Back Pain/etiology ; Middle Aged ; Negative-Pressure Wound Therapy ; Systemic Inflammatory Response Syndrome/etiology ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Diverticular disease, and the diverticulitis, the main complication of it, are widely studied diseases with multiple chronic cases reported in the literature, but there are no atypical presentations with extra-abdominal symptoms coupled with seemingly unrelated entities, such as necrotising fasciitis.
CLINICAL CASE: Female 52 years old, was admitted to the emergency department with back pain of 22 days duration. History of importance: Chronic use of benzodiazepines intramuscularly. Physical examination revealed the presence of a gluteal abscess in right pelvic limb with discoloration, as well as peri-lesional cellulitis and crepitus that stretches across the back of the limb. Fasciotomy was performed with debridement of necrotic tissue. Progression was torpid with crackling in abdomen. Computed tomography showed free air in the cavity, and on being surgically explored was found to be complicated diverticular disease.
DISCUSSION: It is unusual for complicated diverticular disease to present with symptoms extra-peritoneal (< 2%) and even more so that a diverticulitis is due to necrotising fasciitis (< 1%). The absence of peritoneal manifestations delayed the timely diagnosis, which was evident with the crackling of the abdomen and abdominal computed tomography scan showing the parietal gaseous process.
CONCLUSION: All necrotising fasciitis needs an abdominal computed tomography scan to look for abdominal diseases (in this case diverticulitis), as their overlapping presentation delays the diagnosis and consequently the treatment, making a fatal outcome inevitable.},
}
@article {pmid27036672,
year = {2016},
author = {González-Contreras, QH and de Jesús-Mosso, M and Bahena-Aponte, JA and Aldana-Martínez, O and Pineda-Solís, K and Mejia-Arcadia, SN},
title = {[Colorectal anastomosis using a compression device].},
journal = {Cirugia y cirujanos},
volume = {84},
number = {6},
pages = {482-486},
doi = {10.1016/j.circir.2016.01.005},
pmid = {27036672},
issn = {2444-054X},
mesh = {Adult ; Aged ; Alloys ; Anastomosis, Surgical/*instrumentation ; Blood Loss, Surgical ; Colectomy/instrumentation/*methods ; Female ; Humans ; Male ; Middle Aged ; *Pressure ; Retrospective Studies ; Surgical Wound Dehiscence/*prevention & control ; Wound Closure Techniques/*instrumentation ; },
abstract = {BACKGROUND: The most severe complication following an intestinal anastomosis is the dehiscence with the consequent development of sepsis, fistulas, stenosis, and death. For this reason the compression anastomosis (NiTi) system was developed, with the aim of reducing these complications.
MATERIAL AND METHODS: A retrospective study was conducted, from 1 June 2012 to 30 August 2014, on total of 14 patients operated on the Humanitas Hospital Medical Group Coyoacán, the ASMED, and Clínica Médica Sur. The subjects were predominantly male 65%, a mean age of 58 years, with range 30-79 years.
RESULTS: A total of 14 patients were included. The indication for surgery was complicated diverticular disease Hinchey II-III (36%), and the procedures performed were: 6 (43%) left hemicolectomy with primary end to end compression anastomosis, 2 (14%) major complications (dehiscence wall and anastomosis), 1 (7%) minor complication (infection of the soft tissues). There was a mean 98ml (range 20-300ml) of intraoperative bleeding, with start of oral feeding on the second day, a mean hospital stay of 4 days (range 2-10), one patient with ileo-rectal anastomosis dehiscence presented on the 4th post-operative day, and performing anastomosis with stapling device and loop ileostomy. Stenosis developed in 7% during follow-up and was resolved with a new anastomosis stapler.
CONCLUSIONS: The NiTi device is an additional alternative for colorectal anastomosis, mainly in low anastomosis, obtaining good results in this study without major complications.},
}
@article {pmid27033287,
year = {2016},
author = {Bhatt, NR and Boland, MR and Abdelraheem, O and Merrigan, AB},
title = {Lower gastrointestinal bleeding in the elderly: a rare aetiology masquerading as a diverticular bleed.},
journal = {BMJ case reports},
volume = {2016},
number = {},
pages = {},
pmid = {27033287},
issn = {1757-790X},
mesh = {Aged, 80 and over ; Aneurysm, Ruptured/complications/*diagnostic imaging ; Diagnosis, Differential ; Diverticulitis/diagnosis ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Iliac Aneurysm/complications/*diagnostic imaging ; Male ; Rectal Fistula/complications ; Tomography, X-Ray Computed ; Treatment Refusal ; },
abstract = {Bleeding per rectum is a relatively common acute surgical presentation. Common causes include diverticular disease, colitis, haemorrhoids, polyps, etc. An 83-year-old man with a history of recurrent rectosigmoid diverticulitis and bilateral internal iliac artery aneurysms for 2 years presented with rectal bleeding. He was suspected to have a diverticular bleed based on history and examination. A CT scan revealed a large haematoma adjacent to the right isolated internal iliac artery aneurysm (IIIAA) almost indistinguishable from the adjacent rectosigmoid, consistent with a ruptured IIIAA and an ileorectal fistula. The fistula was of a primary vascular enteric type and was accentuated by the inflammation arising from the diverticulitis. Hence, presence of more common or apparently obvious causes should not deter clinicians from thoroughly investigating the case. Rare causes should be kept in mind while dealing with common acute presentations, especially in elderly patients with multiple comorbidities.},
}
@article {pmid27033283,
year = {2016},
author = {Maynard, W and McGlone, ER and Deguara, J},
title = {Unusual aetiology of abdominal wall abscess: cholecystocutaneous fistula presenting 20 years after open subtotal cholecystectomy.},
journal = {BMJ case reports},
volume = {2016},
number = {},
pages = {},
pmid = {27033283},
issn = {1757-790X},
mesh = {*Abdominal Wall ; Abscess/*etiology/therapy ; Aged ; Biliary Fistula/*complications/diagnostic imaging ; Cholecystectomy/*adverse effects ; Cutaneous Fistula/*complications/diagnostic imaging ; Female ; Humans ; Postoperative Complications ; Risk Factors ; Time Factors ; Treatment Outcome ; Treatment Refusal ; },
abstract = {A 68-year-old woman presented to the emergency department, with an abscess in the right upper anterior abdominal wall. She had a medical history of an open cholecystectomy 20 years prior, diabetes, obesity and a laparotomy for perforated sigmoid diverticular disease complicated by a large parastomal hernia. CT revealed this subcutaneous abscess to track intra-abdominally through the liver and communicate with the gallbladder fossa. The abscess was incised and drained. The wound initially drained pus, and then bile. Magnetic resonance cholangiopancreatogram (MRCP) demonstrated a remnant gallbladder containing 2 gallstones, a cholecystocutaneous fistula, portal vein thrombosis and cavernous transformation of the bile duct. The patient improved and was discharged. The patient's case history and imaging were discussed with the tertiary referral centre, in a multidisciplinary team. After an extensive and balanced discussion, the patient declined a completion cholecystectomy and continues to have occasional discharge from the fistula in her right upper quadrant.},
}
@article {pmid29252677,
year = {2016},
author = {Connor, MJ and Thomson, AR and Grange, S and Agarwal, T},
title = {Necrotizing Fasciitis of the Thigh and Calf: A Reminder to Exclude a Perforated Intra-Abdominal Viscus: A Case Report.},
journal = {JBJS case connector},
volume = {6},
number = {2},
pages = {e44},
doi = {10.2106/JBJS.CC.15.00217},
pmid = {29252677},
issn = {2160-3251},
abstract = {CASE: Diverticular disease and its associated complications are an increasing problem among Western populations. Perforated diverticulitis results in intra-abdominal sepsis, which rarely causes a life-threatening necrotizing soft-tissue infection. We present the case of a 70-year-old man with a sigmoid diverticulitis perforation presenting as necrotizing fasciitis of the thigh and calf requiring serial debridement and major limb reconstruction.
CONCLUSION: Clinicians should be aware of index presentations of diverticulitis and its recognized complications in this demographic group. For the orthopaedic and the general surgeon, knowledge of the dangers of the concomitant presence of these 2 conditions will substantially reduce morbidity and mortality.},
}
@article {pmid27029523,
year = {2016},
author = {Peng, YC and Lin, CL and Yeh, HZ and Tung, CF and Chang, CS and Kao, CH},
title = {Diverticular disease and additional comorbidities associated with increased risk of dementia.},
journal = {Journal of gastroenterology and hepatology},
volume = {31},
number = {11},
pages = {1816-1822},
doi = {10.1111/jgh.13389},
pmid = {27029523},
issn = {1440-1746},
mesh = {Adult ; Age Distribution ; Aged ; Cardiovascular Diseases/epidemiology ; Cohort Studies ; Comorbidity ; Databases, Factual ; Dementia/*epidemiology/etiology ; Diverticulosis, Colonic/complications/*epidemiology ; Female ; Humans ; Incidence ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Proportional Hazards Models ; Risk Factors ; Sex Distribution ; Taiwan/epidemiology ; },
abstract = {BACKGROUND AND AIM: Colonic diverticular disease may cause a chronic systemic effect, but its role in the development of dementia remains unclear. The purpose of this study was to investigate the potential increased risk for dementia in colonic diverticular disease.
METHODS: We conducted a population-based cohort study using data from Taiwan's National Health Insurance Research Database. A total of 66 377 sex-matched, age-matched, and index year-matched (1:4) pairs of patients with colonic diverticular disease and 265 508 patients without colonic diverticular disease, who served as controls, were selected from all potential participants aged 20 years or older in the database. Each subject was individually tracked from 2000 to 2011 to identify incident cases of dementia. Cox proportional hazards regression was employed to calculate the hazard ratios and 95% confidence intervals for the association between colonic diverticular disease and dementia.
RESULTS: There were 1057 dementia cases in the diverticular disease cohort during the follow-up period of 315 171 person-years; the overall incidence rate of dementia differed from that of the control group (3.35 vs 2.43 per 1000 person-years, P < 0.001). The adjusted hazard ratio for dementia was 1.24 (95% confidence interval 1.15-1.33) for diverticular disease patients after adjusting for age, sex, and comorbidities.
CONCLUSIONS: Colonic diverticular disease may be associated with increased risk for dementia.},
}
@article {pmid27026011,
year = {2016},
author = {Aktas, MN and Akturk, G and Ergul, B and Dogan, Z and Sarikaya, M and Filik, L},
title = {Is C-reactive protein elevation a common finding in colonic diverticular disease?.},
journal = {Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology},
volume = {35},
number = {2},
pages = {149},
pmid = {27026011},
issn = {0975-0711},
mesh = {Biomarkers/blood ; C-Reactive Protein/*analysis ; Diverticulum, Colon/*diagnosis ; Humans ; },
}
@article {pmid27025236,
year = {2016},
author = {Pironi, D and Vendettuoli, M and Pontone, S and Panarese, A and Arcieri, S and Filippini, A and Grimaldi, G},
title = {Use of the circular compression stapler and circular mechanical stapler in the end-to-side transanal colorectal anastomosis after left colon and rectal resections A single center experience.},
journal = {Annali italiani di chirurgia},
volume = {87},
number = {},
pages = {23-30},
pmid = {27025236},
issn = {2239-253X},
mesh = {Aged ; Aged, 80 and over ; Anastomosis, Surgical/instrumentation/methods ; Anastomotic Leak/prevention & control ; Carcinoma/surgery ; Colectomy/*methods ; Colon/pathology/*surgery ; Colorectal Neoplasms/surgery ; Constriction, Pathologic ; Diverticulosis, Colonic/surgery ; Equipment Design ; Female ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/prevention & control ; Rectum/*surgery ; Retrospective Studies ; *Surgical Staplers ; },
abstract = {AIM: The aim of our study was to compare the efficacy of the circular compression stapler and the circular mechanical stapler in transanal colorectal anastomosis after left colectomy or anterior rectal resection.
MATERIALS AND METHODS: We performed a retrospective analysis of 10 patients with disease of the, sigmoid colon or rectum (carcinoma or diverticular disease) who underwent left colectomy or anterior rectal resection with end-to-side transanal colorectal anastomosis. A follow-up was planned for all patients at 1, 3 and 6 months after surgery and the anastomosis was evaluated by colonoscopy at 1 year.
RESULTS: In all patients an end-to-side transanal colorectal anastomosis was performed using a circular compression stapler (CCS group) or circular mechanical staplers with titanium staples (CMS group). The mean distance of the anastomosis from the anal margin was 6.4 ± 1.5 cm in the CCS group and 18.2 ± 11.2 cm in the CMS group. All patients in the CCS group expelled the ring after a mean time of 8.2 postoperative days. At 12 months colonoscopy revealed that all CCS patients had a satisfactory anastomosis with mean size of the colic lumen at the level of anastomotic line of 26.3 mm.
CONCLUSIONS: In our experience the circular compression stapler a valuable alternative to the circular mechanical stapler for the creation of transanal colorectal anastomosis, in line with the relevant literature.
KEY WORDS: Anastomotic leakage, Anastomotic stenosis, Circular compression stapler, Circular mechanical stapler, Transanal colorectal anastomosis.},
}
@article {pmid27015932,
year = {2016},
author = {Forgione, A and Guraya, SY},
title = {Elective colonic resection after acute diverticulitis improves quality of life, intestinal symptoms and functional outcome: experts' perspectives and review of literature.},
journal = {Updates in surgery},
volume = {68},
number = {1},
pages = {53-58},
pmid = {27015932},
issn = {2038-3312},
mesh = {Acute Disease ; Colectomy/*methods ; Colon/*surgery ; Defecation/*physiology ; Diverticulitis/physiopathology/psychology/*surgery ; Elective Surgical Procedures/*methods ; Humans ; Laparoscopy/*methods ; *Quality of Life ; Recurrence ; Treatment Outcome ; },
abstract = {The decision whether to operate for diverticular disease and the appropriate selection of right candidates for elective colectomy after recovery from an uncomplicated episode of acute diverticulitis remains controversial. Although both the impact of symptomatic disease and occurrence of its complications are extensively studied, there is no consensus about the role of elective colonic resection in the management of symptomatic recurrent diverticulitis. In this study, the database of ERIC, the Web of Science, EMBASE, and MEDLINE were searched for the English-language published articles about the functional outcomes and symptomatic improvement in patients after elective surgery for diverticular disease. A majority of clinical trials showed that elective surgery following a successful conservative treatment of acute diverticulitis resulted in significantly better social and functional well-being. In addition, elective surgery greatly reduces the potential events of disease recurrence, thus decreasing financial burden on the national health services. However, to obtain the best functional outcome surgical intervention must be individualized and tailored to meet every single patient's specific indigenous symptomatology.},
}
@article {pmid27014782,
year = {2016},
author = {Levchenko, SV and Komissarenko, IA and Lazebnik, LB},
title = {[Prevention of complications of colonic diverticular disease in outpatient practice].},
journal = {Terapevticheskii arkhiv},
volume = {88},
number = {1},
pages = {96-100},
doi = {10.17116/terarkh201688196-100},
pmid = {27014782},
issn = {0040-3660},
mesh = {*Abdominal Pain/etiology/prevention & control ; Ambulatory Care/*methods ; *Diverticulitis, Colonic/etiology/prevention & control ; *Diverticulosis, Colonic/complications/diagnosis/physiopathology/therapy ; Humans ; Risk Factors ; Secondary Prevention/methods ; },
abstract = {The literature review gives an update on the frequency and risk factors of complications of colonic diverticular disease, the results of recent investigations, which suggest the success and safety of outpatient treatment for uncomplicated acute diverticulitis. It evaluates the efficacy of pharmacological agents from different groups in preventing complications of colonic diverticular disease.},
}
@article {pmid27014757,
year = {2016},
author = {Lahner, E and Bellisario, C and Hassan, C and Zullo, A and Esposito, G and Annibale, B},
title = {Probiotics in the Treatment of Diverticular Disease. A Systematic Review.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {25},
number = {1},
pages = {79-86},
doi = {10.15403/jgld.2014.1121.251.srw},
pmid = {27014757},
issn = {1842-1121},
mesh = {Diverticulitis/diagnosis/microbiology/*therapy ; *Gastrointestinal Microbiome ; Humans ; Intestines/*microbiology ; Probiotics/adverse effects/*therapeutic use ; Remission Induction ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIMS: Diverticular disease is a common gastrointestinal condition. Low-grade inflammation and altered intestinal microbiota have been identified as factors contributing to abdominal symptoms. Probiotics may lead to symptoms improvement by modifying the gut microbiota and are promising treatments for diverticular disease. The aim of this study was to systematically review the efficacy of probiotics in diverticular disease in terms of remission of abdominal symptoms and prevention of acute diverticulitis.
METHODS: According to PRISMA, we identified studies on diverticular disease patients treated with probiotics (Pubmed, Embase, Cochrane). The quality of these studies was evaluated by the Jadad scale. Main outcomes measures were remission of abdominal symptoms and prevention of acute diverticulitis.
RESULTS: 11 studies (2 double-blind randomized placebo-controlled, 5 open randomized, 4 non-randomized open studies) were eligible. Overall, diverticular disease patients were 764 (55.1% females, age 58-75 years). Three studies included patients with symptomatic uncomplicated diverticular disease, 4 studies with symptomatic uncomplicated diverticular disease in remission, 4 studies with complicated or acute diverticulitis. Mainly (72.7%) single probiotic strains had been used, most frequently Lactobacilli. Follow-up ranged from 1 to 24 months. Interventions were variable: in 8 studies the probiotic was administered together with antibiotic or anti-inflammatory agents and compared with the efficacy of the drug alone; in 3 studies the probiotic was compared with a high-fibre diet or used together with phytoextracts. As an outcome measure, 4 studies evaluated the occurrence rate of acute diverticulitis, 6 studies the reduction of abdominal symptoms, and 6 studies the recurrence of abdominal symptoms. Meta-analysis on the efficacy of probiotics in diverticular disease could not be performed due to the poor quality of retrieved studies.
CONCLUSION: This systematic review showed that high-quality data on the efficacy of probiotics in diverticular disease are scant: the available data do not permit conclusions. Further investigation is required to understand how probiotics can be employed in this condition.},
}
@article {pmid26995896,
year = {2016},
author = {Tracy, L and Baker, M and Pigazzi, A},
title = {Colouterine Fistula Masquerading as a Complex Adnexal Mass: A Case Report.},
journal = {The Journal of reproductive medicine},
volume = {61},
number = {1-2},
pages = {87-91},
pmid = {26995896},
issn = {0024-7758},
mesh = {*Adnexal Diseases ; Aged ; Diagnosis, Differential ; Female ; Humans ; *Intestinal Fistula ; *Uterine Diseases ; Uterine Hemorrhage ; },
abstract = {BACKGROUND: Colouterine fistula is one of the rarest complications of diverticulitis, with 23 cases reported in the world literature to our knowledge. Because of its infrequent presentation, there are no standardized diagnostic modalities for this disease, but almost all patients will require surgical treatment.
CASE: An afebrile, 66-year-old woman with known diverticulitis presented with vaginal bleeding and discharge of 1 day's duration. Based on imaging she was believed to have a complex adnexal mass. However, it was proven intraoperatively to be a colouterine fistula.
CONCLUSION: Although extremely uncommon, the diagnosis of a colouterine fistula can be made with pelvic examination, diagnostic imaging, or surgical exploration. The surgical treatment of colouterine fistulae varies on the acuity of the patient's diverticular disease and the surgeon's suspicion of malignancy.},
}
@article {pmid26990356,
year = {2016},
author = {Ali, RH and Mohammad, NM and Serra, S and Chetty, R},
title = {Colonic mucosubmucosal elongated polyp: report of a series of 14 cases and review of the literature.},
journal = {Histopathology},
volume = {69},
number = {4},
pages = {592-599},
doi = {10.1111/his.12969},
pmid = {26990356},
issn = {1365-2559},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Polyps/*pathology ; Female ; Humans ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; },
abstract = {AIMS: Most colorectal polyps can be reliably assigned to one of the known polyp categories, but a subset of polyps named colonic mucosubmucosal elongated polyps (CMSEPs) do not fall into any of these categories. First described in the Japanese literature, CMSEPs seem to be under-recognized in the Western literature. The aims of this study were to describe the clinicopathological features of 14 CMSEPs, discuss potential pathogenetic mechanisms, and increase awareness of this entity among pathologists.
METHODS AND RESULTS: Fourteen pedunculated colorectal polyps that met the histopathological criteria for CMSEP (as described by Matake et al. and Alizart et al.) were assessed (12 males and two females; mean age 59.7 years). Five polyps were located in the sigmoid colon, four in the rectum, two in the descending colon, and three in the colon not otherwise specified. Nine of 14 polyps were discovered incidentally: two of nine on routine screening colonoscopy, two of nine on surveillance colonoscopy for inflammatory bowel disease (IBD), and five of nine upon surgical intervention for carcinoma or IBD. None coexisted with diverticular disease. The polyps were long and slender, varied from 5 to 30 mm in length (mean 15.9 mm), and showed a normal-looking colonic mucosal layer and underlying loose submucosa with thick-walled and congested blood vessels and lymphatics.
CONCLUSIONS: CMSEPs show subtle but distinctive pathological features, and occur in normal and diseased colons. Pathologists need to be aware of this entity, to avoid confusion with other more commonly encountered colorectal polyps. With increasing colon cancer screening programmes and surveillance colonoscopy, it is likely that CMSEPs will be encountered more often.},
}
@article {pmid26989382,
year = {2015},
author = {Holmer, C and Kreis, ME},
title = {Management of Complications Following Emergency and Elective Surgery for Diverticulitis.},
journal = {Viszeralmedizin},
volume = {31},
number = {2},
pages = {118-123},
pmid = {26989382},
issn = {1662-6664},
abstract = {BACKGROUND: The clinical spectrum of sigmoid diverticulitis (SD) varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications. Sigmoid colectomy with restoration of continuity has been the prevailing modality for treating acute and recurrent SD, and is often performed as a laparoscopy-assisted procedure. For elective sigmoid colectomy, the postoperative morbidity rate is 15-20% whereas morbidity rates reach up to 30% in patients who undergo emergency surgery for perforated SD. Some of the more common and serious surgical complications after sigmoid colectomy are anastomotic leaks and peritonitis, wound infections, small bowel obstruction, postoperative bleeding, and injuries to the urinary tract structures. Regarding the management of complications, it makes no difference whether the complication is a result of an emergency or an elective procedure.
METHODS: The present work gives an overview of the management of complications in the surgical treatment of SD based on the current literature.
RESULTS: To achieve successful management, early diagnosis is mandatory in cases of deviation from the normal postoperative course. If diagnostic procedures fail to deliver a correlate for the clinical situation of the patient, re-laparotomy or re-laparoscopy still remain among the most important diagnostic and/or therapeutic principles in visceral surgery when a patient's clinical status deteriorates.
CONCLUSION: The ability to recognize and successfully manage complications is a crucial part of the surgical treatment of diverticular disease and should be mastered by any surgeon qualified in this field.},
}
@article {pmid26989381,
year = {2015},
author = {Jurowich, CF and Germer, CT},
title = {Elective Surgery for Sigmoid Diverticulitis - Indications, Techniques, and Results.},
journal = {Viszeralmedizin},
volume = {31},
number = {2},
pages = {112-116},
pmid = {26989381},
issn = {1662-6664},
abstract = {Diverticulitis is one of the leading indications for elective colonic resections although there is an ongoing controversial discussion about classification, stage-dependent therapeutic options, and therapy settings. As there is a rising trend towards conservative therapy for diverticular disease even in patients with a complicated form of diverticulitis, we provide a compact overview of current surgical therapy principles and the remaining questions to be answered.},
}
@article {pmid26989379,
year = {2015},
author = {Kruse, E and Leifeld, L},
title = {Prevention and Conservative Therapy of Diverticular Disease.},
journal = {Viszeralmedizin},
volume = {31},
number = {2},
pages = {103-106},
pmid = {26989379},
issn = {1662-6664},
abstract = {BACKGROUND: Diverticular disease is a common problem. Prevention and treatment of complications depend on the stage of the disease. Lifestyle modifications are suitable preventive measures, aiming to reduce obesity and to balance the diet with a high amount of fiber and a low amount of meat. However, evidence to guide the pharmacological treatment of diverticular disease and diverticulitis is limited.
METHODS: Literature review.
RESULTS: Antibiotics are not proven to be effective in patients with uncomplicated diverticulitis and without further risk factors; neither do they improve treatment nor prevent complications. Mesalazine might have an effect on pain relief in diverticular disease even though it has no significant effect on the outcome of diverticulitis. In complicated diverticulitis, inpatient treatment including antibiotics is mandatory.
CONCLUSION: Evidence for the treatment of diverticular disease is limited. Further research is needed.},
}
@article {pmid26989378,
year = {2015},
author = {Lembcke, B},
title = {Diagnosis, Differential Diagnoses, and Classification of Diverticular Disease.},
journal = {Viszeralmedizin},
volume = {31},
number = {2},
pages = {95-102},
pmid = {26989378},
issn = {1662-6664},
abstract = {BACKGROUND: While detailed history, physical examination, and laboratory tests are of great importance when examining a patient with diverticular disease, they are not sufficient to diagnose (or stratify) diverticulitis without cross-sectional imaging (ultrasonography (US), computed tomography (CT)).
METHODS: Qualified US has diagnostic value equipotent to qualified CT, follows relevant legislation for radiation exposure protection, and is frequently effectual for diagnosis. Furthermore, its unsurpassed resolution allows detailed investigation down to the histological level. Subsequently, US is considered the first choice of imaging in diverticular disease. Vice versa, CT has definite indications in unclear/discrepant situations or insufficient US performance.
RESULTS: Endoscopy is not required for the diagnosis of diverticulitis and shall not be performed in the acute attack. Colonoscopy, however, is warranted after healing of acute diverticulitis, prior to elective surgery, and in atypical cases suggesting other diagnoses. Perforation/abscess must be excluded before colonoscopy.
CONCLUSION: Reliable diagnosis is fundamental for surgical, interventional, and conservative treatment of the different presentations of diverticular disease. Not only complications of acute diverticulitis but also a number of differential diagnoses must be considered. For an adequate surgical strategy, correct stratification of complications is mandatory. Subsequently, in the light of currently validated diagnostic techniques, the consensus conference of the German Societies of Gastroenterology (DGVS) and of Visceral Surgery (DGAV) has passed a new classification of diverticulitis displaying the different facets of diverticular disease. This classification addresses different types (not stages) of the condition, and includes symptomatic diverticular disease (SUDD), largely resembling irritable bowel syndrome, as well as diverticular bleeding.},
}
@article {pmid26989377,
year = {2015},
author = {Böhm, SK},
title = {Risk Factors for Diverticulosis, Diverticulitis, Diverticular Perforation, and Bleeding: A Plea for More Subtle History Taking.},
journal = {Viszeralmedizin},
volume = {31},
number = {2},
pages = {84-94},
pmid = {26989377},
issn = {1662-6664},
abstract = {BACKGROUND: Diverticulosis is a very common condition. Around 20% of diverticula carriers are believed to suffer from diverticular disease during their lifetime. This makes diverticular disease one of the clinically and economically most significant conditions in gastroenterology. The etiopathogenesis of diverticulosis and diverticular disease is not well understood. Epidemiological studies allowed to define risk factors for the development of diverticulosis and the different disease entities associated with it, in particular diverticulitis, perforation, and diverticular bleeding.
METHODS: A comprehensive literature search was performed, and the current knowledge about risk factors for diverticulosis and associated conditions reviewed.
RESULTS: Non-controllable risk factors like age, sex, and genetics, and controllable risk factors like foods, drinks, and physical activity were identified, as well as comorbidities and drugs which increase or decrease the risk of developing diverticula or of suffering from complications. In naming risk factors, it is of utmost importance to differentiate between diverticulosis and the different disease entities.
CONCLUSION: Risk factors for diverticulosis and diverticular disease may give a clue towards the possible etiopathogenesis of the conditions. More importantly, knowledge of comorbidities and particularly drugs conferring a risk for development of complicated disease is crucial for patient management.},
}
@article {pmid26989376,
year = {2015},
author = {Wedel, T and Barrenschee, M and Lange, C and Cossais, F and Böttner, M},
title = {Morphologic Basis for Developing Diverticular Disease, Diverticulitis, and Diverticular Bleeding.},
journal = {Viszeralmedizin},
volume = {31},
number = {2},
pages = {76-82},
pmid = {26989376},
issn = {1662-6664},
abstract = {Diverticula of the colon are pseudodiverticula defined by multiple outpouchings of the mucosal and submucosal layers penetrating through weak spots of the muscle coat along intramural blood vessels. A complete prolapse consists of a diverticular opening, a narrowed neck, and a thinned diverticular dome underneath the serosal covering. The susceptibility of diverticula to inflammation is explained by local ischemia, translocation of pathogens due to retained stool, stercoral trauma by fecaliths, and microperforations. Local inflammation may lead to phlegmonous diverticulitis, paracolic/mesocolic abscess, bowel perforation, peritonitis, fistula formation, and stenotic strictures. Diverticular bleeding is due to an asymmetric rupture of distended vasa recta at the diverticular dome and not primarily linked to inflammation. Structural and functional changes of the bowel wall in diverticular disease comprise: i) Altered amount, composition, and metabolism of connective tissue; ii) Enteric myopathy with muscular thickening, deranged architecture, and altered myofilament composition; iii) Enteric neuropathy with hypoganglionosis, neurotransmitter imbalance, deficiency of neurotrophic factors and nerve fiber remodeling; and iv) Disturbed intestinal motility both in vivo (increased intraluminal pressure, motility index, high-amplitude propagated contractions) and in vitro (altered spontaneous and pharmacologically triggered contractility). Besides established etiologic factors, recent studies suggest that novel pathophysiologic concepts should be considered in the pathogenesis of diverticular disease.},
}
@article {pmid26981187,
year = {2016},
author = {Daher, R and Barouki, E and Chouillard, E},
title = {Laparoscopic treatment of complicated colonic diverticular disease: A review.},
journal = {World journal of gastrointestinal surgery},
volume = {8},
number = {2},
pages = {134-142},
pmid = {26981187},
issn = {1948-9366},
abstract = {Up to 10% of acute colonic diverticulitis may necessitate a surgical intervention. Although associated with high morbidity and mortality rates, Hartmann's procedure (HP) has been considered for many years to be the gold standard for the treatment of generalized peritonitis. To reduce the burden of surgery in these situations and as driven by the accumulated experience in colorectal and minimally-invasive surgery, laparoscopy has been increasingly adopted in the management of abdominal emergencies. Multiple case series and retrospective comparative studies confirmed that with experienced hands, the laparoscopic approach provided better outcomes than the open surgery. This technique applies to all interventions related to complicated diverticular disease, such as HP, sigmoid resection with primary anastomosis (RPA) and reversal of HP. The laparoscopic approach also provided new therapeutic possibilities with the emergence of the laparoscopic lavage drainage (LLD), particularly interesting in the context of purulent peritonitis of diverticular origin. At this stage, however, most of our knowledge in these fields relies on studies of low-level evidence. More than ever, well-built large randomized controlled trials are necessary to answer present interrogations such as the exact place of LLD or the most appropriate sigmoid resection procedure (laparoscopic HP or RPA), as well as to confirm the advantages of laparoscopy in chronic complications of diverticulitis or HP reversal.},
}
@article {pmid26970346,
year = {2016},
author = {Smith, JK and Marciani, L and Humes, DJ and Francis, ST and Gowland, P and Spiller, RC},
title = {Anticipation of thermal pain in diverticular disease.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {28},
number = {6},
pages = {900-913},
pmid = {26970346},
issn = {1365-2982},
support = {PDF-2012-05-431/DH_/Department of Health/United Kingdom ; WT086609MA//Wellcome Trust/United Kingdom ; },
mesh = {Adult ; Aged ; *Anticipation, Psychological/physiology ; Asymptomatic Diseases/*psychology ; Brain/diagnostic imaging ; Diverticular Diseases/diagnostic imaging/*psychology ; Female ; Hot Temperature/*adverse effects ; Humans ; Irritable Bowel Syndrome/diagnostic imaging/*psychology ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Pain/diagnostic imaging/*psychology ; Pain Threshold/physiology ; },
abstract = {BACKGROUND: The relative importance of peripheral nerve injury or central pain processing in painful diverticular disease (DD) is unclear. Functional magnetic resonance imaging (fMRI) has demonstrated that dysfunctional central pain processing predominates in irritable bowel syndrome (IBS). This study aims to identify anticipatory changes in symptomatic DD (SDD) compared to asymptomatic DD (ADD) and IBS patients.
METHODS: Gastrointestinal symptoms and somatization were evaluated via the Patient Health Question-12 Somatic Symptom and the SDD group divided into low (≤6 [LSDD]) and high (≥7 [HSDD]) somatization. Cued painful cutaneous thermal stimuli were delivered to the left hand and foot during fMRI. Fixed effect group analysis of the 'cued' anticipatory phase was performed.
KEY RESULTS: Within the right posterior insula, greater deactivation was found in the ADD compared to other groups. In emotion processing centers, anterior and middle insula, greater activation was identified in all patient compared to the ADD group, and in LSDD compared to IBS and HSDD groups. In comparison, amygdala deactivation was greater in ADD than the IBS and HSDD groups, and in LSDD vs HSDD groups. Descending nociceptive control centers, such as the superior medial frontal and orbitofrontal cortex, also showed greater deactivation in the ADD and LSDD compared to the HSDD and IBS groups.
CONCLUSIONS & INFERENCES: The HSDD group have altered anticipatory responses to thermal pain, similar to IBS group. The LSDD are similar to ADD group. This suggests underlying differences in pain pathophysiology, and the need for individualized treatment strategies to target the cause of their chronic pain.},
}
@article {pmid26961041,
year = {2016},
author = {Gross, M},
title = {[Diverticular disease].},
journal = {MMW Fortschritte der Medizin},
volume = {158},
number = {2},
pages = {48-50},
doi = {10.1007/s15006-016-7755-6},
pmid = {26961041},
issn = {1438-3276},
mesh = {Acute Disease ; Diverticulitis, Colonic/*diagnosis/*therapy ; Diverticulosis, Colonic/*diagnosis/*therapy ; Evidence-Based Medicine ; General Practice ; *Guideline Adherence ; Humans ; Ultrasonography ; },
}
@article {pmid26943439,
year = {2015},
author = {Dos Santos, VM and Dos Santos, LA},
title = {Comments on Saint's triad.},
journal = {Surgical case reports},
volume = {1},
number = {1},
pages = {115},
pmid = {26943439},
issn = {2198-7793},
abstract = {Yamanaka et al. described two case studies involving coexistent cholelithiasis, hiatal hernia, and umbilical hernias, and discussed clinical similarities with the classical features of the Saint's triad. Cholelithiasis, hiatal hernia, and colonic diverticulosis characterize the classical triad, but some authors have included any type of hernia due to herniosis-a developmental disorder of the extracellular matrix. The main features of this triad, which seem to be underdiagnosed and/or underreported, are discussed. Therefore, the commented manuscript contributed to better understanding the scarcely reported condition.},
}
@article {pmid26940943,
year = {2016},
author = {Gahagan, JV and Halabi, WJ and Nguyen, VQ and Carmichael, JC and Pigazzi, A and Stamos, MJ and Mills, SD},
title = {Colorectal Surgery in Patients with HIV and AIDS: Trends and Outcomes over a 10-Year Period in the USA.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {20},
number = {6},
pages = {1239-1246},
pmid = {26940943},
issn = {1873-4626},
mesh = {Acquired Immunodeficiency Syndrome/complications ; Adult ; Aged ; Colon/*surgery ; Colonic Diseases/complications/mortality/*surgery ; Databases, Factual ; Digestive System Surgical Procedures/*trends ; Female ; HIV Infections/*complications ; Hospitalization/trends ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/epidemiology/etiology ; Rectal Diseases/complications/mortality/*surgery ; Rectum/*surgery ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; United States ; },
abstract = {BACKGROUND: HIV has become a chronic disease, which may render this population more prone to developing the colorectal pathologies that typically affect older Americans.
METHODS: A retrospective review of the Nationwide Inpatient Sample was performed to identify patients who underwent colon and rectal surgery from 2001 to 2010. Multivariate analysis was used to evaluate outcomes among the general population, patients with HIV, and patients with AIDS.
RESULTS: Hospital admissions for colon and rectal procedures of patients with HIV/AIDS grew at a faster rate than all-cause admissions of patients with HIV/AIDS, with mean yearly increases of 17.8 and 2.1 %, respectively (p < 0.05). Patients with HIV/AIDS undergoing colon and rectal operations for cancer, polyps, diverticular disease, and Clostridium difficile were younger than the general population (51 vs. 65 years; p < 0.01). AIDS was independently associated with increased odds of mortality (OR 2.11; 95 % CI 1.24, 3.61), wound complications (OR 1.53; 95 % CI 1.09, 2.17), and pneumonia (OR 2.02; 95 % CI 1.33, 3.08). Risk-adjusted outcomes of colorectal surgery in patients with HIV did not differ significantly from the general population.
CONCLUSION: Postoperative outcomes in patients with HIV are similar to the general population, while patients with AIDS have a higher risk of mortality and certain complications.},
}
@article {pmid26929783,
year = {2016},
author = {Tursi, A},
title = {Diverticulosis today: unfashionable and still under-researched.},
journal = {Therapeutic advances in gastroenterology},
volume = {9},
number = {2},
pages = {213-228},
pmid = {26929783},
issn = {1756-283X},
abstract = {Diverticulosis of the colon is a widespread disease, and its prevalence is increasing especially in the developing world. The underlying pathological mechanisms that cause the formation of colonic diverticula remain unclear but are likely to be the result of complex interactions among age, diet, genetic factors, colonic motility, and changes in colonic structure. The large majority of patients remain asymptomatic throughout their life, one fifth of them become symptomatic (developing the so-called 'diverticular disease') while only a minority of these will develop acute diverticulitis. The factors predicting the development of symptoms remain to be identified. Again, it is generally recognized that diverticular disease occurrence is probably related to complex interactions among colonic motility, diet, lifestyle, and genetic features. Changes in intestinal microflora due to low-fiber diet and consequent low-grade inflammation are thought to be one of the mechanisms responsible for symptoms occurrence of both diverticular disease and acute diverticulitis. Current therapeutic approaches with rifaximin and mesalazine to treat the symptoms seem to be promising. Antibiotic treatment is currently advised only in acute complicated diverticulitis, and no treatment has currently proven effective in preventing the recurrence of acute diverticulitis. Further studies are required in order to clarify the reasons why diverticulosis occurs and the factors triggering occurrence of symptoms. Moreover, the reasons why rifaximin and mesalazine work in symptomatic diverticular disease but not in acute diverticulitis are yet to be elucidated.},
}
@article {pmid26878358,
year = {2016},
author = {Stanes, A and Mackay, S},
title = {Dieulafoy lesion of the gallbladder presenting with bleeding and a pseudo-mirizzi syndrome: A case report and review of the literature.},
journal = {International journal of surgery case reports},
volume = {21},
number = {},
pages = {12-15},
pmid = {26878358},
issn = {2210-2612},
abstract = {INTRODUCTION: Gastrointestinal bleeding can have significant morbidity and mortality. Pathological processes that cause it are diverse, and timely investigation and management are vital. Dieulafoy lesions are a rare cause of gastrointestinal bleeding and here we describe a case of a gallbladder dieulafoy lesion causing gastrointestinal bleeding.
PRESENTATION OF CASE: Recently discharged from hospital following an open anterior resection and loop ileostomy for diverticular disease, an 84-year-old female re-presented with lower abdominal pain associated with jaundice and lymphocytosis. Imaging demonstrated two possible rectal stump collections (treated with antibiotics), and heterogeneous material in the gallbladder. The patient deteriorated, developing melena, coffee ground vomitus and right upper quadrant pain. Investigation sourced the bleeding to the gallbladder that resolved following cholecystectomy, and histopathology was consistent with a dieulafoy lesion. The patient made a full recovery.
DISCUSSION: Dieulafoy lesions have rarely been reported in the gallbladder, and as such can be an occult source of massive gastrointestinal bleeding. It should be considered where gastrointestinal bleeding accompanies jaundice and abdominal pain.
CONCLUSION: This case highlights that dieulafoy lesions can occur in the gallbladder. Massive gastrointestinal bleeding can occur within the gallbladder, and a gallbladder dieulafoy lesion should be considered as a potential cause of such, especially when a source has not been identified on endoscopy. It also demonstrates the effectiveness of cholecystectomy as a definitive management strategy.},
}
@article {pmid26872402,
year = {2016},
author = {Peery, AF and Keku, TO and Martin, CF and Eluri, S and Runge, T and Galanko, JA and Sandler, RS},
title = {Distribution and Characteristics of Colonic Diverticula in a United States Screening Population.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {14},
number = {7},
pages = {980-985.e1},
pmid = {26872402},
issn = {1542-7714},
support = {KL2 TR001109/TR/NCATS NIH HHS/United States ; P30 DK034987/DK/NIDDK NIH HHS/United States ; R01 DK094738/DK/NIDDK NIH HHS/United States ; T32 DK007634/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; Demography ; Diverticulum, Colon/*epidemiology/*pathology ; Early Detection of Cancer ; Ethnicity ; Female ; Humans ; Male ; Middle Aged ; North Carolina/epidemiology ; Prevalence ; Prospective Studies ; },
abstract = {BACKGROUND & AIMS: Colonic diverticula are the most common finding from colonoscopy examinations. Little is known about the distribution of colonic diverticula, which are responsible for symptomatic and costly diverticular disease. We aimed to assess the number, location, and characteristics of colonic diverticula in a large US screening population.
METHODS: We analyzed data from a prospective study of 624 patients (mean age, 54 years) undergoing screening colonoscopy at the University of North Carolina Hospital from 2013 through 2015. The examination included a detailed assessment of colonic diverticula. To assess the association between participant characteristics and diverticula, we used logistic regression to estimate odds ratios and 95% confidence intervals.
RESULTS: Of our population, 260 patients (42%) had 1 or more diverticula (mean number, 14; range, 1-158). Participants with diverticula were more likely to be older, male, and have a higher body mass index than those without diverticula. The distribution of diverticula differed significantly by race. Among white persons, 75% of diverticula were in the sigmoid colon, 11% in the descending splenic flexure, 6% in the transverse colon, and 8% were in the ascending colon or hepatic flexure. In black persons 64% of diverticula were in the sigmoid colon, 8% in the descending colon or splenic flexure, 7% in the transverse colon, and 20% in the ascending colon or hepatic flexure (P = .0008). The proportion of patients with diverticula increased with age: 35% were 50 years or younger, 40% were 51-60 years, and 58% were older than 60 years. The proportion of patients with more than 10 diverticula increased with age: 8% were 50 years or younger, 15% were 51-60 years, and 30% were older than 60 years.
CONCLUSIONS: Older individuals not only have a higher prevalence of diverticula than younger individuals, but also a greater density, indicating that this is a progressive disease. Black persons have a greater percentage of their diverticula in the proximal colon and fewer in the distal colon compared with white persons. Understanding the distribution and determinants of diverticula is the first step in preventing diverticulosis and its complications.},
}
@article {pmid26868514,
year = {2016},
author = {Barbieux, J and Plumereau, F and Hamy, A},
title = {Current indications for the Hartmann procedure.},
journal = {Journal of visceral surgery},
volume = {153},
number = {1},
pages = {31-38},
doi = {10.1016/j.jviscsurg.2016.01.002},
pmid = {26868514},
issn = {1878-7886},
mesh = {Colectomy/*methods ; Colon, Sigmoid/*surgery ; Colonic Diseases/*surgery ; Humans ; Ileostomy/*methods ; Postoperative Complications/etiology/mortality ; Rectum/*surgery ; },
abstract = {The Hartmann procedure is used in the case of left-sided colonic disease, especially in the setting of emergency where intraoperative conditions contraindicate completion of an anastomosis. This procedure has been initially described for the management of colorectal cancer and is based on a sigmoïdectomy without restoration of intestinal continuity, including a left-sided iliac terminal stoma and closure of the rectal stump. Both procedure and underlying risk factors explain high rates of mortality and morbidity, around 15 and 50% respectively, and a low overall rate of subsequent restoration of internal continuity, less than 50%. The purpose of this review was to evaluate the value of the Hartmann procedure and its equivalents in colonic surgery, according to its indications: colorectal cancer, peritonitis from diverticular disease, anastomotic complications, ischemic colitis, left-sided colonic volvulus and abdominal trauma.},
}
@article {pmid26854496,
year = {2016},
author = {Humes, D and Spiller, RC},
title = {Colonic diverticular disease: medical treatments for acute diverticulitis.},
journal = {BMJ clinical evidence},
volume = {2016},
number = {},
pages = {},
pmid = {26854496},
issn = {1752-8526},
support = {PDF-2012-05-431/DH_/Department of Health/United Kingdom ; },
mesh = {Acute Disease ; Anti-Bacterial Agents/*therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Diverticulitis/*drug therapy ; Humans ; Mesalamine/*therapeutic use ; Treatment Outcome ; },
abstract = {INTRODUCTION: Diverticula (mucosal outpouchings through the wall of the colon) are rare before the age of 40 years, after which prevalence increases steadily and reaches over 25% by 60 years. However, only 10% to 25% of affected people will develop symptoms such as lower abdominal pain. Recurrent symptoms are common, and 5% of people with diverticula eventually develop complications such as perforation, obstruction, haemorrhage, fistulae, or abscesses.
METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of medical treatments for acute diverticulitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
RESULTS: At this update, searching of electronic databases retrieved 193 studies. After deduplication and removal of conference abstracts, 75 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 37 studies and the further review of 38 full publications. Of the 38 full articles evaluated, four systematic reviews and one RCT were added at this update. We performed a GRADE evaluation for two PICO combinations
CONCLUSIONS: In this systematic overview, we categorised the efficacy for one comparison based on information about the effectiveness and safety of medical treatment (mesalazine, antibiotics [any] only) versus placebo or no treatment.},
}
@article {pmid26841803,
year = {2016},
author = {Trilling, B and Riboud, R and Abba, J and Girard, E and Faucheron, JL},
title = {Energy vessel sealing systems versus mechanical ligature of the inferior mesenteric artery in laparoscopic sigmoidectomy.},
journal = {International journal of colorectal disease},
volume = {31},
number = {4},
pages = {903-908},
pmid = {26841803},
issn = {1432-1262},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Transfusion ; Colon, Sigmoid/*surgery ; Demography ; Female ; Hemoglobins/metabolism ; Humans ; Intraoperative Care ; *Laparoscopy ; Ligation/*methods ; Male ; Mesenteric Artery, Inferior/*surgery ; Middle Aged ; Postoperative Care ; Postoperative Complications/etiology ; Young Adult ; },
abstract = {PURPOSE: With the development of new devices, our ligation technique of the inferior mesenteric artery changed from mechanical ligature (ML) to energized vessel sealing systems (EVSS) ligature. The aim of this study was to determine if EVSS could be considered as safe and effective as the more convention ML of the inferior mesenteric vessels division during elective laparoscopic left colectomy.
METHODS: Between 2001 and 2014, 200 consecutive patients (111 males) of mean age 54.1 years were operated laparoscopically for a symptomatic sigmoid diverticulitis. Vascular interruptions were performed using mechanical ligatures including double clipping, staples or surgical thread (100 patients) or, starting from 2006, with EVSS thereafter (100 patients). Section of the inferior mesenteric artery is performed systematically at its origin in our institution for teaching purposes. Technical results were prospectively collected perioperatively and postoperatively.
RESULTS: There was no mortality. Mean operating time was 253.7 and 200.7 min in the ML and EVSS groups, respectively (p < 0.001). Mean hospital stay was 10.4 and 8.1 days (p < 0.001). Thirty-day complications occurred in 31 versus 25 % of patients (p = 0.26). Leakage with peritonitis occurred in 3 patients in the ML group. Hemorrhagic events occurred in both groups (2 in ML group versus 1 in EVSS group). Limitations of the study are its retrospective design and the bias due to the comparison of two historical cohorts.
CONCLUSIONS: EVSS for the inferior mesenteric artery are as safe and effective as ML in elective sigmoidectomy for diverticular disease with lower operative time and hospital stay.},
}
@article {pmid26823358,
year = {2016},
author = {Al Maksoud, AM and Ahmed, I},
title = {Advanced rectal cancer in a long-term Hartmann's pouch: a forgotten organ revisited.},
journal = {BMJ case reports},
volume = {2016},
number = {},
pages = {},
pmid = {26823358},
issn = {1757-790X},
mesh = {Adenocarcinoma/*pathology ; Aged ; Colon/pathology ; Colostomy/methods ; Diverticulitis, Colonic/*surgery ; Fatal Outcome ; Humans ; Male ; Postoperative Complications ; Rectal Neoplasms/*pathology ; Rectum/blood supply/*pathology ; },
abstract = {Hartmann's procedure is widely performed as a first-stage operation in cases of left colon emergencies when a one stage management is judged to be unsafe. Forty per cent of patients with Hartmann's procedure never get their stoma reversed, ending with a permanent stoma. The distal excluded Hartmann's pouch is usually forgotten compared to the proximal functioning colon. A 70-year-old man with Hartmann's procedure carried out previously for complicated diverticular disease presented with bleeding per rectum. Invasive adenocarcinoma was confirmed on histology. Subsequent staging revealed a locally advanced rectal cancer. The tumour progressed despite a course of neoadjuvant chemoradiation. The general condition of the patient deteriorated with development of renal failure. The patient died a few weeks later. By reporting this case, we are revisiting the long forgotten Hartmann's pouch to highlight the potential pathologies in the distal stump and to emphasise that a distal stump should not be forgotten even in asymptomatic patients.},
}
@article {pmid26808497,
year = {2016},
author = {Tursi, A},
title = {Prucalopride for the Treatment of Symptomatic Uncomplicated Diverticular Disease of the Colon.},
journal = {Journal of clinical gastroenterology},
volume = {50},
number = {4},
pages = {351},
doi = {10.1097/MCG.0000000000000479},
pmid = {26808497},
issn = {1539-2031},
mesh = {Aged ; Benzofurans/adverse effects/*therapeutic use ; Brazil ; Diverticulosis, Colonic/diagnosis/*drug therapy ; Europe ; Female ; Gastrointestinal Agents/adverse effects/*therapeutic use ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Venezuela ; },
}
@article {pmid26791117,
year = {2016},
author = {Okpala, AM and Joshi, M and Andrews, B},
title = {Leukocytoclastic vasculitis associated with perforated diverticular disease.},
journal = {BMJ case reports},
volume = {2016},
number = {},
pages = {},
pmid = {26791117},
issn = {1757-790X},
mesh = {Abdominal Pain/diagnosis/etiology ; Abscess/*complications/surgery ; Colon, Sigmoid/*pathology/surgery ; Diarrhea/diagnosis/etiology ; Diverticulitis, Colonic/*complications/surgery ; Diverticulum, Colon/complications/surgery ; Exanthema/diagnosis/etiology/therapy ; Humans ; Intestinal Perforation/*complications/surgery ; Male ; Middle Aged ; Peritonitis/etiology ; Skin/pathology ; Vasculitis, Leukocytoclastic, Cutaneous/diagnosis/*etiology/pathology/surgery ; },
abstract = {Leukocytoclastic vasculitis (LV) is a small vessel vasculitis associated with infections, connective tissue disease, malignancies and, rarely, gastrointestinal conditions. An association between LV and acute diverticulitis has not previously been reported. LV may be localised to the skin as a purpuric rash or might manifest with systemic involvement, such as of the joints, gastrointestinal tract or kidneys. Management of LV can be medical or surgical, based on the degree of systemic involvement. We present the case of a 56-year-old man with a 2-year history of a purpuric rash associated with diarrhoea, who presented acutely with abdominal pain. Imaging studies revealed sigmoid diverticulitis with a pericolic collection. Operative findings were purulent peritonitis secondary to perforated diverticular abscess, which was treated with a Hartmann's procedure. Postoperatively, the purpuric rash resolved rapidly on treatment with antibiotics and steroids. Histopathology of the resected bowel and skin punch biopsy confirmed sigmoid diverticulitis and LV, respectively.},
}
@article {pmid26775544,
year = {2016},
author = {Laghi, A},
title = {CT Colonography: an update on current and future indications.},
journal = {Expert review of gastroenterology & hepatology},
volume = {10},
number = {7},
pages = {785-794},
doi = {10.1586/17474124.2016.1143358},
pmid = {26775544},
issn = {1747-4132},
mesh = {Colon/*diagnostic imaging ; Colonic Diseases/*diagnostic imaging/therapy ; Colonography, Computed Tomographic/*trends ; Contraindications ; Forecasting ; Humans ; *Patient Selection ; Predictive Value of Tests ; Reproducibility of Results ; Risk Factors ; },
abstract = {Computed tomographic colonography (CTC) is a minimally invasive, patient-friendly, safe and robust colonic imaging modality. The technique is standardized and consolidated evidence from the literature shows that the diagnostic performances for the detection of colorectal cancer and large polyps are similar to colonoscopy (CS) and largely superior to alternative radiological exams, like barium enema. A clear understanding of the exact role of CTC will be beneficial to maximize the benefits and minimize the potential sources of frustration or disappointment for both referring clinicians and patients. Incomplete, failed, or unfeasible CS; investigation of elderly, and frail patients and assessment of diverticular disease are major indications supported by evidence-based data and agreed by the endoscopists. The use of CTC for symptomatic patients, colorectal cancer screening and colonic surveillance is still under debate and, thus, recommended only if CS is unfeasible or refused by patients.},
}
@article {pmid26774123,
year = {2016},
author = {Murphy, SF and Waters, PS and Waldron, RM and Bennani, F and Ryan, RS and Khan, W and Khan, IZ and Barry, K},
title = {Predictive factors for colonic resection in patients less than 49 years with symptomatic diverticular disease.},
journal = {American journal of surgery},
volume = {212},
number = {1},
pages = {47-52},
doi = {10.1016/j.amjsurg.2015.09.013},
pmid = {26774123},
issn = {1879-1883},
mesh = {Acute Disease ; Adult ; Age Factors ; C-Reactive Protein/*analysis ; Colectomy/adverse effects/*methods ; Databases, Factual ; Diverticulitis, Colonic/*diagnosis/epidemiology/*surgery ; Diverticulum, Colon/diagnosis/epidemiology/surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/physiopathology/surgery ; Prognosis ; Proportional Hazards Models ; ROC Curve ; Recurrence ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Sex Factors ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: Diverticular disease is a condition strongly associated with low-fiber intake and obesity. There have been reports of an increasing incidence in younger individuals ranging from 12% to 21% of all cases. The aim of this study was to evaluate the management of complicated diverticular disease in patients less than 49 years and attempt to identify factors predictive of a more virulent course.
METHODS: An analysis of a prospectively updated database of all patients admitted with a primary diagnosis of acute diverticulitis from 2005 to 2013 was performed. Data collected included age, length of stay, inflammatory markers on admission, use of computed tomography (CT), and Hinchey Classification. SPSS version 22 was used for statistical analysis, and a P value of .05 or less was considered significant.
RESULTS: A total of 120 (54 female and 66 male) patients less than 49 (28 to 49, 42.1) years were noted to have a diagnosis of acute diverticulitis. Twelve patients (10%) required colonic resection for complicated diverticulitis. Histological evaluation revealed 5 cases of stricture, 2 obstruction, and 5 perforations. On multivariate analysis, predictors of operative intervention and/or colonic resection included, (hazard ratio [95% confidence interval]) patients aged 40 to 49 years (.92 [.9 to .95]) and elevated C-reactive protein on index admission (1.4 [1.32 to 1.54]). Females were less likely to undergo colonic resection compared with males (1.18 [1.15 to 1.2]). Median length of stay was 4 days (1 to 48) for patients managed nonoperatively and 13 days (5 to 27) for those who underwent surgery.
CONCLUSIONS: Most younger patients with acute diverticulitis can be treated successfully by conservative means. However, a proportion of patients require aggressive surgical management.},
}
@article {pmid26752946,
year = {2016},
author = {Elisei, W and Tursi, A},
title = {Recent advances in the treatment of colonic diverticular disease and prevention of acute diverticulitis.},
journal = {Annals of gastroenterology},
volume = {29},
number = {1},
pages = {24-32},
pmid = {26752946},
issn = {1108-7471},
abstract = {The incidence of diverticulosis and diverticular disease of the colon is increasing worldwide. Although the majority of patients remains asymptomatic long-life, the prevalence of diverticular disease of the colon, including acute diverticulitis, is substantial and is becoming a significant burden on National Health Systems in terms of direct and indirect costs. Focus is now being drawn on identifying the correct therapeutic approach by testing various treatments. Fiber, non-absorbable antibiotics and probiotics seem to be effective in treating symptomatic and uncomplicated patients, and 5-aminosalicylic acid might help prevent acute diverticulitis. Unfortunately, robust evidence on the effectiveness of a medical strategy to prevent acute diverticulitis recurrence is still lacking. We herein provide a concise review on the effectiveness and future perspectives of these treatments.},
}
@article {pmid26751117,
year = {2016},
author = {Lembcke, B},
title = {Ultrasonography in acute diverticulitis - credit where credit is due.},
journal = {Zeitschrift fur Gastroenterologie},
volume = {54},
number = {1},
pages = {47-57},
doi = {10.1055/s-0041-108204},
pmid = {26751117},
issn = {1439-7803},
mesh = {Acute Disease ; Diagnosis, Differential ; Diverticulitis/*diagnostic imaging ; Evidence-Based Medicine ; Humans ; Image Enhancement/*methods ; Patient Positioning/*methods ; Ultrasonography/*methods ; },
abstract = {Diagnosing diverticulitis implies physical and laboratory examination, cross-sectional imaging (computed tomography [CT] or ultrasonography [US]), and a classification of the type of diverticular disease. This article illustrates the role of ultrasonography in view of the recently published Guidelines on diverticular disease of the Consensus Conference of the German Societies of Gastroenterology (DGVS) and Visceral Surgery (DGAV). The focus is to foster both sensitivity for pictorial analysis and improving practical accomplishments of US in diverticulitis. Based on the German classification of diverticular disease (CDD), characteristic features of each type of diverticulitis are presented and commented along with possible differential diagnoses. In the literature qualified US is equipotent to qualified CT. US is frequently effective for the diagnosis and unsurpassed resolution enables detailed imaging thereby allowing one to differentiate and stratify the relevant types of diverticular disease according to the new classification. This educational review is a guided tour through the different facettes of diverticulitis on ultrasonography thereby expanding and multiplying individual competence to more users. With expert performance, US is in the pole position for diagnosing diverticulitis, however, this does come with the price of responsibility and requires transfer of advanced standards and performance in the broad.},
}
@article {pmid26734968,
year = {2016},
author = {Humes, DJ and Ludvigsson, JF and Jarvholm, B},
title = {Smoking and the Risk of Hospitalization for Symptomatic Diverticular Disease: A Population-Based Cohort Study from Sweden.},
journal = {Diseases of the colon and rectum},
volume = {59},
number = {2},
pages = {110-114},
doi = {10.1097/DCR.0000000000000515},
pmid = {26734968},
issn = {1530-0358},
support = {PDF-2012-05-431/DH_/Department of Health/United Kingdom ; },
mesh = {*Abscess/epidemiology/etiology ; Adult ; Cohort Studies ; Diverticulitis/epidemiology/etiology ; *Diverticulum/complications/diagnosis/epidemiology ; Female ; Gastrointestinal Tract/*pathology ; Hospitalization/statistics & numerical data ; Humans ; *Intestinal Perforation/epidemiology/etiology ; Male ; Middle Aged ; Risk Factors ; *Smoking/adverse effects/epidemiology ; Sweden/epidemiology ; Time ; },
abstract = {BACKGROUND: Current studies reporting on the risk of smoking and development of symptomatic diverticular disease have reported conflicting results.
OBJECTIVE: The aim of this study was to investigate the association between smoking and symptomatic diverticular disease.
DESIGN: This is a cohort study
SETTINGS: : Information was derived from the Swedish Construction Workers Cohort 1971-1993.
PATIENTS: Patients were selected from construction workers in Sweden.
MAIN OUTCOME MEASURES: The primary outcome measured was the development of symptomatic diverticular disease and complicated diverticular disease (abscess and perforation) as identified in the Swedish Hospital Discharge Register. Adjusted relative risks of symptomatic diverticular disease according to smoking status were estimated by using negative binomial regression analysis.
RESULTS: In total, the study included 232,685 men and 14,592 women. During follow-up, 3891 men and 318 women had a diagnosis of later symptomatic diverticular disease. In men, heavy smokers (≥15 cigarettes a day) had a 1.6-fold increased risk of developing symptomatic diverticular disease compared with nonsmokers (adjusted relative risk, 1.56; 95% CI, 1.42-1.72). There was evidence of a dose-response relationship, because moderate and ex-smokers had a 1.4- and 1.2-fold increased risk compared with nonsmokers (adjusted relative risk, 1.39; 95% CI, 1.27-1.52 and adjusted relative risk, 1.14; 95% CI, 1.04-1.27). These relationships were similar in women, but the risk estimates were less precise owing to smaller numbers. Male ever-smokers had a 2.7-fold increased risk of developing complicated diverticular disease (perforation/abscess) compared with nonsmokers (adjusted relative risks, 2.73; 95% CI, 1.69-4.41).
LIMITATIONS: We were unable to account for other confounding variables such as comorbidity, prescription medication, or lifestyle factors.
CONCLUSIONS: Smoking is associated with symptomatic diverticular disease in both men and women and with an increased risk of developing complicated diverticular disease.},
}
@article {pmid30427159,
year = {2016},
author = {Pomazkin, VI and Khodakov, VV},
title = {LONG-TERM RESULTS OF SURGICAL TREATMENT OF DIVERTICULAR DISEASE OF COLON.},
journal = {Vestnik khirurgii imeni I. I. Grekova},
volume = {175},
number = {2},
pages = {101-104},
pmid = {30427159},
issn = {0042-4625},
mesh = {Adult ; Aged ; *Colectomy/adverse effects/methods ; Colonic Diseases/*surgery ; Diverticular Diseases/*surgery ; Elective Surgical Procedures/adverse effects/methods ; Female ; Humans ; *Laparoscopy/adverse effects/methods ; *Long Term Adverse Effects/diagnosis/psychology/therapy ; Male ; Middle Aged ; Outcome and Process Assessment, Health Care ; Patient Selection ; Quality of Life ; Recurrence ; },
abstract = {The work evaluated the long-term treatment results of 103 patients with complicated diverticular disease, who underwent the elective surgery in the volume of left hemicolectomy. The first group included 53 patients with recurrent diverticula. The second group consisted of 50 patients, who underwent the operation on diverticula of sigmoid colon with formation of sigmostoma on the first stage. The number of patients with functional gastro-intestinal and psyco-emotional disorders was more significant in the first group compared with the second group and it was associated with presence of these disorders before the operation. There was noted the reliable decrease of quality of life rates according to questionnaire scales MOS-SF 36 in the first group. The average indices of scales had some matching to the rates of health people in the patients of the second group. The authors came to conclusion, that indications for elective surgery should be determined very carefully in case of recurrent diverticula.},
}
@article {pmid26715947,
year = {2015},
author = {Fidan, N and Mermi, EU and Acay, MB and Murat, M and Zobaci, E},
title = {Jejunal Diverticulosis Presented with Acute Abdomen and Diverticulitis Complication: A Case Report.},
journal = {Polish journal of radiology},
volume = {80},
number = {},
pages = {532-535},
pmid = {26715947},
issn = {1733-134X},
abstract = {BACKGROUND: Jejunal diverticulosis is a rare, usually asymptomatic disease. Its incidence increases with age. If symptomatic, diverticulosis may cause life-threatening acute complications such as diverticulitis, perforation, intestinal hemorrhage and obstruction. In this report, we aimed to present a 67-year-old male patient with jejunal diverticulitis accompanying with abdominal pain and vomiting.
CASE REPORT: A 67-year-old male patient complaining of epigastric pain for a week and nausea and fever for a day presented to our emergency department. Ultrasonographic examination in our clinic revealed diverticulum-like images with thickened walls adjacent to the small intestine loops, and increase in the echogenicity of the surrounding mesenteric fat tissue. Contrast-enhanced abdominal computed tomography showed multiple diverticula, thickened walls with showing contrast enhancement and adjacent jejunum in the left middle quadrant, increased density of the surrounding mesenteric fat tissue, and mesenteric lymph nodes. The patient was hospitalized by general surgery department with the diagnosis of jejunal diverticulitis. Conservative intravenous fluid administration and antibiotic therapy were initiated. Clinical symptoms regressed and the patient was discharged from hospital after 2 weeks.
CONCLUSIONS: In cases of diverticulitis it should be kept in mind that in patients with advanced age and pain in the left quadrant of the abdomen, diverticular disease causing mortality and morbidity does not always originate from the colon but might also originate from the jejunum.},
}
@article {pmid26707634,
year = {2016},
author = {Appleby, PN and Key, TJ},
title = {The long-term health of vegetarians and vegans.},
journal = {The Proceedings of the Nutrition Society},
volume = {75},
number = {3},
pages = {287-293},
doi = {10.1017/S0029665115004334},
pmid = {26707634},
issn = {1475-2719},
support = {MR/M012190/1/MRC_/Medical Research Council/United Kingdom ; },
mesh = {Body Mass Index ; Cardiovascular Diseases/epidemiology/prevention & control ; Diabetes Mellitus, Type 2/epidemiology/prevention & control ; *Diet, Vegan ; *Diet, Vegetarian ; *Health Status ; Humans ; Neoplasms/epidemiology/prevention & control ; Obesity/epidemiology/prevention & control ; Prevalence ; Risk Factors ; Weight Gain ; },
abstract = {Vegetarians, who do not eat any meat, poultry or fish, constitute a significant minority of the world's population. Lacto-ovo-vegetarians consume dairy products and/or eggs, whereas vegans do not eat any foods derived wholly or partly from animals. Concerns over the health, environmental and economic consequences of a diet rich in meat and other animal products have focussed attention on those who exclude some or all of these foods from their diet. There has been extensive research into the nutritional adequacy of vegetarian diets, but less is known about the long-term health of vegetarians and vegans. We summarise the main findings from large cross-sectional and prospective cohort studies in western countries with a high proportion of vegetarian participants. Vegetarians have a lower prevalence of overweight and obesity and a lower risk of IHD compared with non-vegetarians from a similar background, whereas the data are equivocal for stroke. For cancer, there is some evidence that the risk for all cancer sites combined is slightly lower in vegetarians than in non-vegetarians, but findings for individual cancer sites are inconclusive. Vegetarians have also been found to have lower risks for diabetes, diverticular disease and eye cataract. Overall mortality is similar for vegetarians and comparable non-vegetarians, but vegetarian groups compare favourably with the general population. The long-term health of vegetarians appears to be generally good, and for some diseases and medical conditions it may be better than that of comparable omnivores. Much more research is needed, particularly on the long-term health of vegans.},
}
@article {pmid26702007,
year = {2015},
author = {Setyapranata, S and Holt, SG},
title = {The Gut in Older Patients on Peritoneal Dialysis.},
journal = {Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis},
volume = {35},
number = {6},
pages = {650-654},
pmid = {26702007},
issn = {1718-4304},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Aging/physiology ; Appetite/physiology ; Australia ; Comorbidity ; Constipation/epidemiology/physiopathology ; Diverticulum, Colon/*epidemiology/physiopathology ; Female ; Gastrointestinal Tract/*physiopathology ; Geriatric Assessment/methods ; Humans ; Kidney Failure, Chronic/diagnosis/mortality/*therapy ; Male ; Malnutrition/*etiology/prevention & control ; Peritoneal Dialysis/adverse effects/*methods/mortality ; Prognosis ; *Quality of Life ; Risk Assessment ; Survival Rate ; Treatment Outcome ; },
abstract = {Age-related changes in gastrointestinal symptoms need to be considered in peritoneal dialysis (PD) patients. A diminishing appetite is associated with aging and may be exacerbated by renal failure and PD treatment, meaning that attention to dietary adequacy is important in the older patient. Constipation and its treatment may increase the risk of peritonitis, but is important for comfort as well as trouble-free dialysis. Diverticulosis increases with age, and whilst there may be ethnic differences in the patterns of this condition, there is conflicting evidence regarding the risks of peritonitis associated with asymptomatic disease. Hernias, urinary incontinence, and prolapse are also common and made worse by PD, so it is important to know about these issues prior to starting. Whilst data around these topics are scant and some studies conflicting, further understanding these issues and considering mitigation strategies may improve technique survival and quality of life.},
}
@article {pmid26682834,
year = {2015},
author = {Carlsson, T and Gandhi, S},
title = {Gallstone ileus of the sigmoid colon: an extremely rare cause of large bowel obstruction detected by multiplanar CT.},
journal = {BMJ case reports},
volume = {2015},
number = {},
pages = {},
pmid = {26682834},
issn = {1757-790X},
mesh = {Aged, 80 and over ; Colostomy ; Constriction, Pathologic/complications ; Diverticulitis, Colonic/complications ; Female ; Gallbladder Diseases/complications/*diagnostic imaging ; Gallstones/complications/*diagnostic imaging ; Humans ; Intestinal Fistula/complications/*diagnostic imaging ; Intestinal Obstruction/*diagnostic imaging/etiology/surgery ; Sigmoid Diseases/*diagnostic imaging/etiology/surgery ; Tomography, X-Ray Computed ; },
abstract = {Gallstone ileus of the sigmoid colon is an important, though extremely rare, cause of large bowel obstruction. The gallstone often enters the large bowel through a fistula formation between the gallbladder and colon, and impacts at a point of narrowing, causing large bowel obstruction. We describe the case of an 80-year-old woman who presented with features of bowel obstruction. Multiplanar abdominal CT demonstrated a cholecystocolonic fistula in exquisite detail. The scan also showed obstruction of the colon due to a large gallstone impacted just proximal to a stricture in the sigmoid. Owing to inflammatory adhesions and a stricture from extensive diverticular disease, the gallstone could not be retrieved. This frail and elderly woman was treated with a loop colostomy to relieve bowel obstruction. The patient made an uneventful recovery.},
}
@article {pmid26668745,
year = {2015},
author = {Bassotti, G and Villanacci, V and Sidoni, A and Nascimbeni, R and Dore, MP and Binda, GA and Bandelloni, R and Salemme, M and Del Sordo, R and Cadei, M and Manca, A and Bernardini, N and Maurer, CA and Cathomas, G},
title = {Myenteric plexitis: A frequent feature in patients undergoing surgery for colonic diverticular disease.},
journal = {United European gastroenterology journal},
volume = {3},
number = {6},
pages = {523-528},
pmid = {26668745},
issn = {2050-6406},
abstract = {BACKGROUND: Diverticular disease of the colon is frequent in clinical practice, and a large number of patients each year undergo surgical procedures worldwide for their symptoms. Thus, there is a need for better knowledge of the basic pathophysiologic mechanisms of this disease entity.
OBJECTIVES: Because patients with colonic diverticular disease have been shown to display abnormalities of the enteric nervous system, we assessed the frequency of myenteric plexitis (i.e. the infiltration of myenteric ganglions by inflammatory cells) in patients undergoing surgery for this condition.
METHODS: We analyzed archival resection samples from the proximal resection margins of 165 patients undergoing left hemicolectomy (60 emergency and 105 elective surgeries) for colonic diverticulitis, by histology and immunochemistry.
RESULTS: Overall, plexitis was present in almost 40% of patients. It was subdivided into an eosinophilic (48%) and a lymphocytic (52%) subtype. Plexitis was more frequent in younger patients; and it was more frequent in those undergoing emergency surgery (50%), compared to elective (28%) surgery (p = 0.007). All the severe cases of plexitis displayed the lymphocytic subtype.
CONCLUSIONS: In conclusion, myenteric plexitis is frequent in patients with colonic diverticular disease needing surgery, and it might be implicated in the pathogenesis of the disease.},
}
@article {pmid26656355,
year = {2015},
author = {Tsai, MS and Lee, HM and Hsin, MC and Lin, CL and Hsu, CY and Liu, YT and Kao, CH},
title = {Increased Risk of Pyogenic Liver Abscess Among Patients With Colonic Diverticular Diseases: A Nationwide Cohort Study.},
journal = {Medicine},
volume = {94},
number = {49},
pages = {e2210},
pmid = {26656355},
issn = {1536-5964},
mesh = {Age Factors ; Aged ; Comorbidity ; Diverticulum, Colon/*epidemiology ; Female ; Humans ; Incidence ; Liver Abscess, Pyogenic/*epidemiology ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Taiwan/epidemiology ; },
abstract = {Whether patients with diverticular diseases exhibit a higher risk of developing pyogenic liver abscess (PLA) remains inconclusive.From the inpatient claims in Taiwan's National Health Insurance Research Database, we identified 54,147 patients diagnosed with diverticulosis in the 1998 to 2010 period and 216,588 controls without the disorder. The 2 cohorts were matched by age, sex, and admission year, and were followed up until the end of 2010 to estimate the risk of PLA.Overall, the incidence of PLA was 2.44-fold higher in the diverticular-disease group than in the controls (11.5 vs 4.65 per 10,000 person-year). The adjusted hazard ratio (aHR) of PLA was 2.11 (95% confidence interval [CI], 1.81-2.44) for the diverticular-disease group, according to a multivariate Cox proportional hazards regression model. The age-specific data showed that the aHR for the diverticular-disease group, compared with the controls, was the highest inpatients younger than 50 years old (aHR, 4.03; 95% CI, 2.77-5.85). Further analysis showed that the diverticular-disease group exhibited an elevated risk of PLA regardless of whether patients had diverticulitis.The patients with diverticular diseases exhibited a higher risk of PLA.},
}
@article {pmid26649154,
year = {2015},
author = {Buchs, NC and Mortensen, NJ and Ris, F and Morel, P and Gervaz, P},
title = {Natural history of uncomplicated sigmoid diverticulitis.},
journal = {World journal of gastrointestinal surgery},
volume = {7},
number = {11},
pages = {313-318},
pmid = {26649154},
issn = {1948-9366},
abstract = {While diverticular disease is extremely common, the natural history (NH) of its most frequent presentation (i.e., sigmoid diverticulitis) is poorly investigated. Relevant information is mostly restricted to population-based or retrospective studies. This comprehensive review aimed to evaluate the NH of simple sigmoid diverticulitis. While there is a clear lack of uniformity in terminology, which results in difficulties interpreting and comparing findings between studies, this review demonstrates the benign nature of simple sigmoid diverticulitis. The overall recurrence rate is relatively low, ranging from 13% to 47%, depending on the definition used by the authors. Among different risk factors for recurrence, patients with C-reactive protein > 240 mg/L are three times more likely to recur. Other risk factors include: Young age, a history of several episodes of acute diverticulitis, medical vs surgical management, male patients, radiological signs of complicated first episode, higher comorbidity index, family history of diverticulitis, and length of involved colon > 5 cm. The risk of developing a complicated second episode (and its corollary to require an emergency operation) is less than 2%-5%. In fact, the old rationale for elective surgery as a preventive treatment, based mainly on concerns that recurrence would result in a progressively increased risk of sepsis or the need for a colostomy, is not upheld by the current evidence.},
}
@article {pmid26634143,
year = {2015},
author = {McCloskey, S and Haslam, P and Price, DA and Sayer, JA},
title = {Yersinia pseudotuberculosis aortitis in a patient with diverticulosis and polycystic kidney disease.},
journal = {Oxford medical case reports},
volume = {2015},
number = {4},
pages = {269-271},
pmid = {26634143},
issn = {2053-8855},
abstract = {An 81-year-old gentleman with chronic kidney disease presented with pyrexia and a new systolic cardiac murmur. Investigations revealed infective aortitis of a pre-existing aortic aneurysm graft repair. Peripheral blood cultures were positive for Yersinia pseudotuberculosis and the patient was successfully treated with an extended course of antibiotics. Abdominal imaging also revealed progressive bilateral polycystic kidney disease with associated diverticular disease, which was postulated as the source of the Y. pseudotuberculosis. An autosomal dominant polycystic kidney disease may present late in life and extra-renal manifestations of this disease are an important cause of morbidity.},
}
@article {pmid26591654,
year = {2015},
author = {Almerie, MQ and Simpson, J},
title = {Diagnosing and treating diverticular disease.},
journal = {The Practitioner},
volume = {259},
number = {1785},
pages = {29-33, 3},
pmid = {26591654},
issn = {0032-6518},
mesh = {Acute Disease ; Chronic Disease ; *Colectomy ; *Colonoscopy ; *Dietary Fiber ; Diverticulitis, Colonic/*diagnosis/therapy ; Humans ; },
abstract = {It is important to distinguish between diverticulosis, the presence of asymptomatic diverticula, and diverticular disease which refers to symptomatic cases which can present with acute or chronic symptoms. Chronic symptoms range from mild intermittent abdominal cramps to the more severe picture of chronic abdominal pain and occasional rectal bleeding. In contrast, acute diverticulitis refers to acute inflammation in the diverticula. Low dietary fibre intake is reported to increase the risk of diverticular disease. In the UK, the prevalence rises from approximately 5% of people in their 40s to almost 50% of those above the age of 80. It is estimated that 20% of patients with diverticulosis will develop symptoms at some point in their lifetime. Diverticular disease can be confirmed radiologically or endoscopically. Referral of patients with symptomatic diverticular disease to secondary care is not indicated unless: the symptoms affect their quality of life; the pain is not controlled by paracetamol; new symptoms develop which require further investigation; there are concerns about the possibility of an alternative diagnosis or patients develop red flag symptoms. Even in patients with established diverticulosis, a change in the clinical picture with development of red flag symptoms warrants urgent referral to rule out lower gastrointestinal malignancy. Patients with suspected uncomplicated acute diverticulitis should be assessed according to their level of pain and associated systemic features of sepsis. In those where pain is controlled and there are no signs of systemic sepsis or multiple comorbidities, the patient may be treated in primary care.},
}
@article {pmid26584958,
year = {2015},
author = {Cirocchi, R and Arezzo, A and Renzi, C and Cochetti, G and D'Andrea, V and Fingerhut, A and Mearini, E and Binda, GA},
title = {Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review.},
journal = {International journal of surgery (London, England)},
volume = {24},
number = {Pt A},
pages = {95-100},
doi = {10.1016/j.ijsu.2015.11.007},
pmid = {26584958},
issn = {1743-9159},
mesh = {Colectomy/*methods ; *Colon, Sigmoid ; Diverticulitis, Colonic/*complications ; Humans ; Intestinal Fistula/etiology/*surgery ; Laparoscopy/*methods ; },
abstract = {INTRODUCTION: Laparoscopic surgery is considered in the treatment of diverticular fistula for the possible reduction of overall morbidity and complication rate if compared to open surgery. Aim of this review is to assess the possible advantages deriving from a laparoscopic approach in the treatment of diverticular fistulas of the colon.
METHODS: Studies presenting at least 10 adult patients who underwent laparoscopic surgery for sigmoid diverticular fistula were reviewed. Fistula recurrence, reintervention, Hartmann's procedure or proximal diversion, conversion to laparotomy were the outcomes considered.
RESULTS: 11 non randomized studies were included. Rates of fistula recurrence (0.8%), early reintervention (30 days) (2%) and need for Hartmann's procedure or proximal diversion (1.4%) did not show significant difference between laparoscopy and open technique.
DISCUSSION: there is still concern about which surgery in complicated diverticulitis should be preferred. Laparoscopic approach has led to less postoperative pain, shorter hospital stay, faster recovery and better cosmetic results. Laparoscopic resection and primary anastomosis is a possible approach to sigmoid fistulas but its advantages in terms of lower mortality rate and postoperative stay after colon resection with primary anastomosis should be interpreted with caution. When there is firm evidence supporting it, it is likely that minimally invasive surgery should become the standard approach for diverticular fistulas, thus achieving adequate exposure and better visualization of the surgical field.
CONCLUSION: The lack of RCTs, the small sample size, the heterogeneity of literature do not allow to draw statistically significant conclusions on the laparoscopic surgery for fistulas despite this approach is considered safe.},
}
@article {pmid26568053,
year = {2016},
author = {Dore, MP and Pes, GM and Marras, G and Soro, S and Rocchi, C and Loria, MF and Bassotti, G},
title = {Risk factors associated with colonic diverticulosis among patients from a defined geographic area.},
journal = {Techniques in coloproctology},
volume = {20},
number = {3},
pages = {177-183},
pmid = {26568053},
issn = {1128-045X},
mesh = {Adult ; Age Factors ; Aged ; Colon/pathology/surgery ; Colonoscopy/methods ; Diverticulosis, Colonic/epidemiology/*etiology/pathology ; Female ; Humans ; Italy/epidemiology ; Male ; Middle Aged ; Obesity/complications/epidemiology ; Prevalence ; Retrospective Studies ; Risk Factors ; *Sentinel Surveillance ; },
abstract = {BACKGROUND: Only a few data regarding colonic diverticulosis are available in Italy. We examined the frequency of colonic diverticulosis and its associations with risk factors in a homogeneous Northern Sardinian population undergoing colonoscopy for any reason in the last decades.
METHODS: This was a retrospective single-center study. Medical records of patients undergoing colonoscopy for any indication between 1995 and 2013 were reviewed. Demographic information including age, gender, geographic area (urban, rural), marital status, smoking habit, occupation, body mass index, and comorbidities were collected. Presence, number, and extension of diverticula were assessed by colonoscopy. The diagnosis of diverticulosis was defined by the presence of more than five diverticula.
RESULTS: A total of 4458 records were collected (39.8 % males). Analysis by birth cohorts showed a significant progressive age-related increase in the prevalence of diverticulosis. The average prevalence was 18.9 % without significant variation across the 19-year observation period. In 101 (12.1 %) subjects diverticula were single or few. Seventy-one percent of diverticula were located predominantly in the left side, 2 % in the right side, and 14.3 % were spread throughout the colon. There was a significant association with obesity but not with smoking habits, marital status, or urban versus rural environment. A strong association was observed between the presence of diverticulosis and cardiovascular and other gastrointestinal and lung disease (p < 0.0001). These associations were also confirmed by the logistic regression analysis.
CONCLUSIONS: In this endoscopic study, colonic diverticulosis in Northern Sardinia showed prevalence similar to other series in Western countries, and it was predominantly left sided and age related.},
}
@article {pmid26560431,
year = {2015},
author = {Pantaroto, M and Lopes Filho, Gde J and Pinto, CA and Antico Filho, A},
title = {Comparative study of collagen deposition in the colon wall of patients operated for sigmoid diverticular disease.},
journal = {Acta cirurgica brasileira},
volume = {30},
number = {10},
pages = {715-719},
doi = {10.1590/S0102-865020150100000010},
pmid = {26560431},
issn = {1678-2674},
mesh = {Adult ; Aged ; Collagen/analysis/*metabolism ; Colon, Sigmoid/*metabolism/*surgery ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Intestinal Mucosa/metabolism ; Male ; Middle Aged ; Muscle, Smooth/metabolism ; Reference Values ; Sigmoid Diseases/*surgery ; Statistics, Nonparametric ; Young Adult ; },
abstract = {PURPOSE: To investigate the deposition of collagen in the colon wall of patients with sigmoid diverticulitis.
METHODS: Samples of sigmoid tissue from 15 patients (disease group), seven men and eight women aged 37-77 years who underwent surgery for the treatment of diverticulitis, were selected. For the control group, specimens from five patients, three men and two women aged 19-58 years undergoing emergency surgery for sigmoid trauma were selected. These subjects had no associated diseases. The histological study of the surgical specimens was performed by staining with hematoxylin-eosin and picrosirius and using a histochemical method for collagen quantification.
RESULTS: Collagen deposition in the colon wall in terms of area (F), glandular epithelium (E) and total area was significantly higher in the disease group compared to control (p=0.003, p=0.026 and p=0.010, respectively). The collagen volume fraction (F fraction) and muscle tissue (M fraction) were also significantly higher compared to control (p=0.044 and p=0.026, respectively). The muscle (M area) and volume fraction of glandular epithelium (E fraction) did not differ significantly between the two groups, (p=0.074 and p=1.000, respectively).
CONCLUSION: In this study, collagen deposition in the colon wall of the patients operated for sigmoid diverticulitis was higher compared to patients without the disease.},
}
@article {pmid26559302,
year = {2015},
author = {Lin, JN and Lin, CL and Yang, CH and Lin, MC and Lai, CH and Lin, HH and Kao, CH},
title = {Increased Risk of Acute Coronary Syndrome in Patients With Diverticular Disease: A Nationwide Population-Based Study.},
journal = {Medicine},
volume = {94},
number = {45},
pages = {e2020},
pmid = {26559302},
issn = {1536-5964},
mesh = {Acute Coronary Syndrome/*epidemiology ; Adult ; Age Factors ; Aged ; Asian People ; Comorbidity ; Diverticulum/*epidemiology ; Female ; Health Surveys ; Humans ; Incidence ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Sex Factors ; Taiwan/epidemiology ; },
abstract = {Diverticular disease and acute coronary syndrome (ACS) are common disorders that share several risk factors. Few researchers have evaluated the association between diverticular disease and ACS. We aimed to assess the risk of ACS in patients with diverticular disease. A nationwide retrospective cohort study was conducted by analyzing data from the National Health Insurance Research Database in Taiwan. All patients aged ≥20 years with a diagnosis of diverticular disease from January 1, 2000, to December 31, 2011, were included in this study. For comparison, patients without diverticular disease were randomly selected and matched with the study cohort at a 4:1 ratio according to age, sex, and the year of the diagnosis of diverticular disease. Patients with incomplete age or sex information and a history of cardiovascular diseases were excluded from the study. All patients were followed until an ACS event, withdrawal from the insurance program, or December 31, 2011. In this study, 52,681 patients with diverticular disease and 210,724 patients without diverticular disease were included. Men accounted for 56.1% of patients and 57.8% of patients were ≥50 years old. The overall incidence density of ACS in patients with diverticular disease (45.5 per 10,000 person-years) was significantly higher than in those without diverticular disease (30.3 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.23 (95% confidence interval [CI], 1.14-1.32) after adjustment for age, sex, and comorbidities. The cumulative incidence of ACS in patients with diverticular disease was significantly higher than that in the control cohort (log-rank test, P < 0.001). The adjusted HRs for the development of ACS were 1.25 (95% CI, 1.15-1.37) and 1.19 (95% CI, 1.07-1.32) in patients with diverticulitis and diverticulosis, respectively. The adjusted HRs of ACS in patients with diverticular disease additionally increased from 1.97 (95% CI, 1.73-2.23) in patients with 1 comorbidity to 5.51 (95% CI, 3.88-7.84) in those with ≥5 comorbidities. This large population-based retrospective study revealed an association between diverticular disease and ACS. Further research is warranted to determine the exact mechanism of the link between these diseases.},
}
@article {pmid26554768,
year = {2015},
author = {Cirocchi, R and Grassi, V and Cavaliere, D and Renzi, C and Tabola, R and Poli, G and Avenia, S and Farinella, E and Arezzo, A and Vettoretto, N and D'Andrea, V and Binda, GA and Fingerhut, A},
title = {New Trends in Acute Management of Colonic Diverticular Bleeding: A Systematic Review.},
journal = {Medicine},
volume = {94},
number = {44},
pages = {e1710},
pmid = {26554768},
issn = {1536-5964},
mesh = {*Disease Management ; Diverticulum, Colon/*complications ; Gastrointestinal Hemorrhage/etiology/*therapy ; Humans ; },
abstract = {Colonic diverticular disease is the most common cause of lower gastrointestinal bleeding. In the past, this condition was usually managed with urgent colectomy. Recently, the development of endoscopy and interventional radiology has led to a change in the management of colonic diverticular bleeding.The aim of this systematic review is to define the best treatment for colonic diverticular bleeding.A systematic bibliographic research was performed on the online databases for studies (randomized controlled trials [RCTs], observational trials, case series, and case reports) published between 2005 and 2014, concerning patients admitted with a diagnosis of diverticular bleeding according to the PRISMA methodology.The outcomes of interest were: diagnosis of diverticulosis as source of bleeding; incidence of self-limiting diverticular bleeding; management of non self-limiting bleeding (endoscopy, angiography, surgery); and recurrent diverticular bleeding.Fourteen studies were retrieved for analysis. No RCTs were found. Eleven non-randomized clinical controlled trials (NRCCTs) were included in this systematic review. In all studies, the definitive diagnosis of diverticular bleeding was always made by urgent colonoscopy. The colonic diverticular bleeding stopped spontaneously in over 80% of the patients, but a re-bleeding was not rare. Recently, interventional endoscopy and angiography became the first-line approach, thus relegating emergency colectomy to patients presenting with hemodynamic instability or as a second-line treatment after failure or complications of hemostasis with less invasive treatments.Colonoscopy is effective to diagnose diverticular bleeding. Nowadays, interventional endoscopy and angiographic treatment have gained a leading role and colectomy should only be entertained in case of failure of the former.},
}
@article {pmid26547753,
year = {2016},
author = {Kaushik, M and Bhullar, JS and Bindroo, S and Singh, H and Mittal, VK},
title = {Minimally Invasive Management of Complicated Diverticular Disease: Current Status and Review of Literature.},
journal = {Digestive diseases and sciences},
volume = {61},
number = {3},
pages = {663-672},
pmid = {26547753},
issn = {1573-2568},
mesh = {Abdominal Abscess/etiology/*surgery ; Colectomy ; Disease Management ; Diverticulitis/complications/*surgery ; *Drainage ; Humans ; Intestinal Perforation/etiology/*surgery ; *Laparoscopy ; Minimally Invasive Surgical Procedures ; *Peritoneal Lavage ; Peritonitis/etiology/*surgery ; Severity of Illness Index ; Surgery, Computer-Assisted ; },
abstract = {BACKGROUND: Diverticulitis is a common condition which carries significant morbidity and socioeconomic burden (McGillicuddy et al in Arch Surg 144:1157-1162, 2009). The surgical management of diverticulitis has undergone significant changes in recent years. This article reviews the role of minimally invasive approach in management of complicated diverticulitis, with a focus on recent concepts and advances.
MATERIALS AND METHODS: A literature review of past 10 years (January 2004 to September 2014) was performed using the electronic database MEDLINE from PubMed which included articles only in English.
RESULTS: We identified total of 139 articles, out of which 50 were excluded resulting in 89 full-text articles for review 16 retrospective studies, 7 prospective cohorts, 1 case-control series and 1 systematic review were included. These suggest that urgent surgery is performed for those with sepsis and diffuse peritonitis or those who fail to improve despite medical therapy and/or percutaneous drainage. In addition, 3 randomized control trials: DILALA, LapLAND and the Scandinavian Diverticulitis trial are working towards evaluating whether laparoscopic lavage is safe in management of complicated diverticular diseases. Growing trend toward conservative or minimally invasive treatment modality even in severe acute diverticulitis was noticed.
CONCLUSIONS: Laparoscopic peritoneal lavage has evolved as a good alternative to invasive surgery, yet clear indications for its role in the management of complicated diverticulitis need to be established. Recent evidence suggests that existing guidelines for optimal management of complicated diverticulitis should be updated. Non-resectional radiographic techniques are likely to play a prominent role in the initial treatment of complicated diverticulitis in the near future.},
}
@article {pmid26544814,
year = {2015},
author = {Bliss, LA and Maguire, LH and Chau, Z and Yang, CJ and Nagle, DA and Chan, AT and Tseng, JF},
title = {Readmission After Resections of the Colon and Rectum: Predictors of a Costly and Common Outcome.},
journal = {Diseases of the colon and rectum},
volume = {58},
number = {12},
pages = {1164-1173},
pmid = {26544814},
issn = {1530-0358},
support = {K24 DK098311/DK/NIDDK NIH HHS/United States ; //Howard Hughes Medical Institute/United States ; },
mesh = {Adult ; Aged ; Aged, 80 and over ; *Colectomy ; Female ; Florida ; Hospital Costs/statistics & numerical data ; Humans ; Male ; Middle Aged ; Patient Readmission/economics/*statistics & numerical data ; Rectum/*surgery ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND: Readmission rates are a measure of surgical quality and an object of clinical and regulatory scrutiny. Despite increasing efforts to improve quality and contain cost, 6% to 25% of patients are readmitted after colorectal surgery.
OBJECTIVE: The aim of this study is to define the predictors and costs of readmission following colorectal surgery.
DESIGN: This is a retrospective cohort study of patients undergoing elective and nonelective colectomy and/or proctectomy in the Healthcare Cost and Utilization Project Florida State Inpatient Database 2007 to 2011. Readmission is defined as inpatient admission within 30 days of discharge. Univariate analyses were performed of sex, age, Elixhauser score, race, insurance type, procedure, indication, readmission diagnosis, cost, and length of stay. Multivariate analysis was performed by logistic regression. Sensitivity analysis of nonemergent admissions was conducted.
SETTINGS: This study was conducted in Florida acute-care hospitals.
PATIENTS: Patients undergoing colectomy and proctectomy from 2007 to 2011 were included.
INTERVENTION(S): There were no interventions.
MAIN OUTCOME MEASURE(S): The primary outcomes measured were readmission and the cost of readmission.
RESULTS: A total of 93,913 patients underwent colectomy; 14.7% were readmitted within 30 days. From 2007 to 2011, readmission rates remained stable (14.6%-14.2%, trend p = 0.1585). After multivariate adjustment, patient factors associated with readmission included nonwhite race, age <65, and a diagnosis code other than neoplasm or diverticular disease (p < 0.0001). Patients with Medicare or Medicaid were more likely to be readmitted than those with private insurance (p < 0.0001). Patients with longer index admissions, those with stomas, and those undergoing all procedures other than sigmoid or transverse colectomy were more likely to be readmitted (p < 0.0001). High-volume hospitals had higher rates of readmission (p < 0.0001). The most common reason for readmission was infection (32.9%). Median cost of readmission care was $7030 (intraquartile range, $4220-$13,247). Fistulas caused the most costly readmissions ($15,174; intraquartile range, $6725-$26,660).
LIMITATIONS: Administrative data and retrospective design were limitations of this study.
CONCLUSIONS: Readmissions rates after colorectal surgery remain common and costly. Nonprivate insurance, IBD, and high hospital volume are significantly associated with readmission.},
}
@article {pmid26541732,
year = {2016},
author = {Silva-Velazco, J and Stocchi, L and Costedio, M and Gorgun, E and Kessler, H and Remzi, FH},
title = {Is there anything we can modify among factors associated with morbidity following elective laparoscopic sigmoidectomy for diverticulitis?.},
journal = {Surgical endoscopy},
volume = {30},
number = {8},
pages = {3541-3551},
pmid = {26541732},
issn = {1432-2218},
mesh = {Anastomotic Leak/etiology ; Body Mass Index ; Colectomy/*adverse effects ; Colon, Sigmoid/*surgery ; Conversion to Open Surgery ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures ; Female ; Humans ; Laparoscopy/*adverse effects ; Male ; Middle Aged ; Postoperative Complications ; Risk Factors ; },
abstract = {BACKGROUND: Laparoscopic sigmoidectomy for diverticulitis is widely accepted, using either endolinear staplers or traditional linear staplers under direct vision through the extraction site to transect the rectum. The aim of this study was to assess modifiable factors affecting perioperative morbidity after elective laparoscopic sigmoidectomy for diverticulitis.
METHODS: Potential associations between perioperative morbidity and demographic, disease-related, and treatment-related factors were assessed on all consecutive patients included in a prospectively collected database undergoing elective laparoscopic sigmoidectomy for diverticulitis between 1992 and 2013. Rectal transection with a linear stapler under direct vision through the extraction site was considered compatible with laparoscopic technique.
RESULTS: There were two deaths out of 1059 patients (0.19 %). Conversion rate was 13.1 %, overall morbidity 28 %, and anastomotic leak 3.7 %. Independent factors associated with morbidity in an intent-to-treat analysis were ASA 3 (OR 1.53, p = 0.006), conversion (OR 1.71, p = 0.015), and rectal transection without endolinear stapling (traditional linear stapler: OR 1.75, p = 0.003; surgical knife: OR 2.09, p = 0.002). The same factors along with complicated diverticulitis (OR 1.56, p = 0.013) were independently associated with overall morbidity among laparoscopically completed cases. BMI ≥ 35 (OR 2.3, p = 0.017), complicated diverticulitis (OR 2.37, p = 0.002), and rectal transection with a traditional linear stapler (OR 2.19, p = 0.018) were independently associated with abdomino-pelvic infections, both in an intent-to-treat analysis and among laparoscopically completed cases. The number of endolinear stapler firings was not associated with morbidity.
CONCLUSIONS: Most factors associated with morbidity of laparoscopic sigmoidectomy for diverticulitis cannot be easily modified. With the limitation of a retrospective analysis, modifiable factors to minimize morbidity are laparoscopic completion and endolinear stapling.},
}
@article {pmid26535118,
year = {2015},
author = {Reichert, MC and Lammert, F},
title = {The genetic epidemiology of diverticulosis and diverticular disease: Emerging evidence.},
journal = {United European gastroenterology journal},
volume = {3},
number = {5},
pages = {409-418},
pmid = {26535118},
issn = {2050-6406},
abstract = {Diverticular disease (DD) is one of the most prevalent gastrointestinal disorders. The pathogenesis of diverticulosis and DD is controversially discussed. Current studies call the traditional concept of a fibre-deficient diet causing the development of diverticula into question. Data from two recent twin studies have provided conclusive evidence for a strong genetic component to diverticulosis. Although genomewide association studies have provided new insights into the polygenic architecture of human diseases, genomic research in diverticulosis and DD has just been started. This is an astonishing fact given the high morbidity and mortality of the disease, as well as the substantial economic burden on health care systems. For this review, we provide an update of the molecular pathobiology and summarise recent evidence supporting the hypothesis that distinct, yet unidentified genetic variants contribute to the development of diverticulosis and DD.},
}
@article {pmid26501705,
year = {2016},
author = {Zogg, CK and Najjar, P and Diaz, AJ and Zogg, DL and Tsai, TC and Rose, JA and Scott, JW and Gani, F and Alshaikh, H and Canner, JK and Schneider, EB and Goldberg, JE and Haider, AH},
title = {Rethinking Priorities: Cost of Complications After Elective Colectomy.},
journal = {Annals of surgery},
volume = {264},
number = {2},
pages = {312-322},
doi = {10.1097/SLA.0000000000001511},
pmid = {26501705},
issn = {1528-1140},
mesh = {Adolescent ; Adult ; Aged ; Colectomy/*adverse effects/economics ; Colonic Diseases/*surgery ; Elective Surgical Procedures/*adverse effects/economics ; Female ; *Health Care Costs ; Health Priorities ; Hospitalization ; Humans ; Laparoscopy/*adverse effects/economics ; Male ; Middle Aged ; Postoperative Complications/*economics/epidemiology ; Retrospective Studies ; United States ; Young Adult ; },
abstract = {OBJECTIVE: To compare incremental costs associated with complications of elective colectomy using nationally representative data among patients undergoing laparoscopic/open resections for the 4 most frequent diagnoses.
SUMMARY BACKGROUND DATA: Rising healthcare costs have led to increasing focus on the need to achieve a better understanding of the association between costs and quality. Among elective colectomies, a focus of surgical quality-improvement initiatives, interpretable evidence to support existing approaches is lacking.
METHODS: The 2009 to 2011 Nationwide Inpatient Sample (NIS) data were queried for adult (≥18 years) patients undergoing elective colectomy. Patients with primary diagnoses for colon cancer, diverticular disease, benign colonic neoplasm, and ulcerative colitis/regional enteritis were included. Based on system-based complications considered relevant to long-term treatment of elective colectomy, stratified differences in risk-adjusted incremental hospital costs and complications probabilities were compared.
RESULTS: A total of 68,462 patients were included, weighted to represent 337,887 patients nationwide. A total of 16.4% experienced complications. Annual risk-adjusted incremental costs amounted to >$150 million. Magnitudes of complication prevalences/costs varied by primary diagnosis, operative technique, and complication group. Infectious complications contributed the most ($55 million), followed by gastrointestinal ($53 million), pulmonary ($22 million), and cardiovascular ($11 million) complications. Total annual costs for elective colectomies amounted to >$1.7 billion: 11.3% was due to complications [1.9% due to current Centers for Medicare and Medicaid Services (CMS) complications].
CONCLUSIONS: The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way.},
}
@article {pmid26482263,
year = {2015},
author = {Flor, N and Maconi, G and Sardanelli, F and Lombardi, MA and Colombo, B and Di Leo, G and Falleni, M and Cornalba, G and Pickhardt, PJ},
title = {Prognostic Value of the Diverticular Disease Severity Score Based on CT Colonography: Follow-up in Patients Recovering from Acute Diverticulitis.},
journal = {Academic radiology},
volume = {22},
number = {12},
pages = {1503-1509},
doi = {10.1016/j.acra.2015.08.022},
pmid = {26482263},
issn = {1878-4046},
mesh = {Acute Disease ; Cohort Studies ; *Colonography, Computed Tomographic ; Diverticulitis, Colonic/*diagnostic imaging/surgery ; Elective Surgical Procedures ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prognosis ; *Severity of Illness Index ; },
abstract = {RATIONALE AND OBJECTIVES: To assess the prognostic value of a diverticular disease severity score (DDSS) based on computed tomography colonography (CTC) after acute diverticulitis (AD).
MATERIALS AND METHODS: Of 252 patients who had an AD episode, we finally selected 46 patients who underwent both conventional CT at the acute event and CTC after 9 ± 7 weeks. Of these 46 patients, 17 underwent elective surgery after CTC. Disease severity was assessed with a 0-4 modified Hinchey CT-based score and a 1-4 CTC-based DDSS. A phone survey was performed 27 months later (range 4-52) for the 29 patients not surgically treated.
RESULTS: Significant correlation was found between CTC-based DDSS and clinical follow-up (P = 0.022) or elective surgery (P = 0.007), but not between clinical follow-up and CT-based score, extraluminal gas, C-reactive protein serum level, age, gender, or first versus recurrent AD episode. CTC demonstrated relevant additional findings in five of 46 (11%) patients: two AD complications (enterocolic and enterotubal fistulae), two colon cancers, and one extracolonic (lung) cancer.
CONCLUSIONS: The CTC-based DDSS showed a prognostic value and correlated with the risk of undergoing surgery, and clinically relevant additional findings were found in more than 10% of patients. CTC could be the preferred test in patients recovering after AD.},
}
@article {pmid26458921,
year = {2016},
author = {Scaioli, E and Colecchia, A and Marasco, G and Schiumerini, R and Festi, D},
title = {Pathophysiology and Therapeutic Strategies for Symptomatic Uncomplicated Diverticular Disease of the Colon.},
journal = {Digestive diseases and sciences},
volume = {61},
number = {3},
pages = {673-683},
pmid = {26458921},
issn = {1573-2568},
mesh = {Anti-Bacterial Agents/*therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Dietary Fiber/*therapeutic use ; Diverticulitis, Colonic/*drug therapy/physiopathology ; Gastrointestinal Microbiome ; Gastrointestinal Motility ; Humans ; Hyperesthesia/physiopathology ; Inflammation ; Mesalamine/*therapeutic use ; Probiotics/*therapeutic use ; },
abstract = {Colonic diverticulosis imposes a significant burden on industrialized societies. The current accepted causes of diverticula formation include low fiber content in the western diet with decreased intestinal content and size of the lumen, leading to the transmission of muscular contraction pressure to the wall of the colon, inducing the formation of diverticula usually at the weakest point of the wall where penetration of the blood vessels occurs. Approximately 20 % of the patients with colonic diverticulosis develop abdominal symptoms (i.e., abdominal pain and discomfort, bloating, constipation, and diarrhea), a condition which is defined as symptomatic uncomplicated diverticular disease (SUDD). The pathogenesis of SUDD symptoms remains uncertain and even less is known about how to adequately manage bowel symptoms. Recently, low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors leading to symptom development, thus changing and improving the therapeutic approach. In this review, a comprehensive search of the literature regarding on SUDD pathogenetic hypotheses and pharmacological strategies was carried out. The pathogenesis of SUDD, although not completely clarified, seems to be related to an interaction between colonic microbiota alterations, and immune, enteric nerve, and muscular system dysfunction (Cuomo et al. in United Eur Gastroenterol J 2:413-442, 2014). Greater understanding of the inflammatory pathways and gut microbiota composition in subjects affected by SUDD has increased therapeutic options, including the use of gut-directed antibiotics, mesalazine, and probiotics (Bianchi et al. in Aliment Pharmacol Ther 33:902-910, 2011; Comparato et al. in Dig Dis Sci 52:2934-2941, 2007; Tursi et al. in Aliment Pharmacol Ther 38:741-751, 2013); however, more research is necessary to validate the safety, effectiveness, and cost-effectiveness of these interventions.},
}
@article {pmid26449963,
year = {2015},
author = {Bissolati, M and Orsenigo, E and Staudacher, C},
title = {Role of minimally invasive surgery in the treatment of diverticular disease: an evidence-based analysis.},
journal = {Updates in surgery},
volume = {67},
number = {4},
pages = {353-365},
pmid = {26449963},
issn = {2038-3312},
mesh = {Acute Disease ; Colectomy ; Conversion to Open Surgery ; Digestive System Fistula/surgery ; Diverticulitis/classification/*surgery ; Diverticulum, Colon/*surgery ; Gastrointestinal Hemorrhage/surgery ; Humans ; *Laparoscopy ; },
abstract = {The clinical spectrum of diverticular disease varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications, such as perforation or bleeding. While the presence of diverticula is common, symptomatic diverticulitis is relatively uncommon, occurring in an estimated 10-30 % of patients. There is continued debate as to whether patients should undergo elective resection for diverticular disease and regarding the role of minimally invasive surgery. Since the first publication on laparoscopic colorectal procedures, the interest in minimally invasive surgery has kept growing. Laparoscopic sigmoid resection with restoration of continuity is currently the prevailing modality for treating acute and recurrent sigmoid diverticulitis. However, it still remains unclear whether laparoscopy should be recommended also for complicated sigmoid diverticulitis. The potential benefits of reduced pain and analgesic requirements, smaller scars, and shorter hospital stay but longer operative times are appealing to both patients and surgeons. Nevertheless, there many concerns regarding the time and the type of surgery. Although the role of minimally invasive surgery in the treatment of colonic diseases is progressively increased, current randomized controlled trials should demonstrate whether laparoscopic lavage, Hartmann's procedure or resection and anastomosis achieve the best results for patients. This review aimed to analyze the results of laparoscopic colonic resection for patients with uncomplicated and complicated forms of sigmoid diverticular disease and to determine what stages profit from a laparoscopic procedure and whether the approach can be performed with a low complication rate even for patients with complicated forms of the disease.},
}
@article {pmid26446450,
year = {2016},
author = {Biondo, S and Miquel, J and Espin-Basany, E and Sanchez, JL and Golda, T and Ferrer-Artola, AM and Codina-Cazador, A and Frago, R and Kreisler, E},
title = {A Double-Blinded Randomized Clinical Study on the Therapeutic Effect of Gastrografin in Prolonged Postoperative Ileus After Elective Colorectal Surgery.},
journal = {World journal of surgery},
volume = {40},
number = {1},
pages = {206-214},
pmid = {26446450},
issn = {1432-2323},
mesh = {Aged ; Colorectal Surgery/*adverse effects ; Diatrizoate Meglumine/*therapeutic use ; Double-Blind Method ; Female ; Gastrointestinal Agents/*therapeutic use ; Humans ; Ileus/*drug therapy/etiology ; Intubation, Gastrointestinal ; Male ; Middle Aged ; Postoperative Care/methods ; Postoperative Complications ; Time Factors ; },
abstract = {BACKGROUND: Postoperative ileus is a common problem with significant clinical and economic consequences. We hypothesized that Gastrografin may have therapeutic utility by accelerating the recovery of postoperative ileus after colorectal surgery. The aim of this trial was to study the impact of oral Gastrografin administration on postoperative prolonged ileus (PPI) after elective colorectal surgery.
METHODS: The main endpoint of this randomized, double-blinded, controlled trial was time of resolution of PPI. The secondary endpoints were overall hospital length of stay, time to start oral intake, time to first passage of flatus or stools, time of need of nasogastric tube, and need of parenteral nutrition. Included criteria were patients older than 18 years, operated for colonic neoplasia, inflammatory bowel disease, or diverticular disease. There were two treatments: Gastrografin administration and placebo. The sample size was calculated taking into account the average length of postoperative ileus after colorectal resection until tolerance to oral intake. Statistical analysis showed that 29 subjects in each group were needed.
RESULTS: Twenty-nine patients per group were randomized. Groups were comparable for age, gender, ASA Physical Status Classification System, stoma construction, and surgical technique. No statistical differences were observed in mean time to resolution between the two groups, 9.1 days (CI 95%, 6.51-11.68) in Gastrografin group versus 10.3 days (CI 6.96-10.29) in Placebo group (P = 0.878). Even if not statistically significant, time of resolution of PPI, overall length of stay, time of need of nasogastric tube, and time to tolerance of oral intake were shorter in the G group.
CONCLUSIONS: Gastrografin does not accelerate significantly the recovery of prolonged postoperative ileus after elective colorectal resection when compared with placebo. However, it seems to clinically improve all the analyzed variables.},
}
@article {pmid26423060,
year = {2016},
author = {Kraemer, M and Kara, D},
title = {Laparoscopic surgery of benign entero-vesical or entero-vaginal fistulae.},
journal = {International journal of colorectal disease},
volume = {31},
number = {1},
pages = {19-22},
pmid = {26423060},
issn = {1432-1262},
mesh = {Aged ; Demography ; Female ; Humans ; Intestinal Fistula/complications/*surgery ; *Laparoscopy/adverse effects ; Male ; Perioperative Care ; Postoperative Complications/etiology ; Urinary Bladder Fistula/complications/*surgery ; Vaginal Fistula/complications/*surgery ; },
abstract = {PURPOSE: Entero-vesical or entero-vaginal fistulae (EVF) are an uncommon septic complication mainly of diverticular disease. The fistulae are usually situated within extensive and dense inflammatory masses occluding the entrance of the pelvis. There are still some controversies regarding laparoscopic feasibility and treatment modalities of this disorder.
METHODS: A retrospective chart review of all patients with EVF operated at our department since 2008. Patients were identified by use of the computerized hospital information system.
RESULTS: In nineteen patients (ten males), median age 68 years, 13 patients had entero-vesical fistulae, and 6 patients had entero-vaginal fistulae. The fistulae were caused by complicated diverticular disease in 16 patients (84 %), Crohn's disease (two patients), and ulcerative colitis (one patient). All cases were attempted laparoscopically. Operative treatment involved separation of the inflammatory mass and resection of the affected colorectal segment. There were three conversions (16 %), all three requiring bladder repair considered too extensive for laparoscopic means. In two further patients small bladder defects were sutured laparoscopically, the remaining patients required no bladder repair. The inferior mesentric artery (IMA) was preserved in all cases. Median operative time was 180 min. Two patients received a protective ileostomy: one converted patient and one cachectic patient with Crohn's disease under immune-modulating therapy. Both ileostomies were closed. Altogether, there were five complications in five patients (26 %), four of them were minor (Clavien grade I and II). The cachectic patient with Crohn's disease suffered a major (grade IIIb) complication (stoma prolapse, treated by early closure of the ileostomy). There was no anastomotic leakage and no mortality. Median hospital stay was 12 days.
CONCLUSIONS: The laparoscopic approach is a safe option for the treatment of EVF of benign inflammatory origin. In most cases it offers all the advantages pertaining to minimally invasive surgery. For a definite and causal approach, the disorder belongs primarily within the therapeutic domain of the visceral surgeon. Following the separation of the inflammatory colon, most of the bladder lesions caused by EVF will heal without further surgical measures.},
}
@article {pmid28839816,
year = {2015},
author = {Vaughan-Shaw, PG and Aung, M and Knight, H and Williams, T and Borley, NR and Wheeler, JMD},
title = {Systematic analysis of missed colorectal cancer cases and common pitfalls in diagnosis.},
journal = {Frontline gastroenterology},
volume = {6},
number = {4},
pages = {232-240},
pmid = {28839816},
issn = {2041-4137},
abstract = {BACKGROUND: Missed colorectal cancer on endoscopic or radiological investigations may delay diagnosis and impact outcome. This study audits incidence of previous investigations in patients with colorectal cancer, considers outcome in 'missed' cancer cases and examines the diagnostic pathway in the derived case series to identify common pitfalls in diagnosis.
METHODS: Patients diagnosed with colorectal cancer in 2011 at a single National Health Service (NHS) Trust were reviewed. Incidence of endoscopic and radiological investigations in the 3 years preceding diagnosis and outcome data were collected. Cases of prior investigation not leading to diagnosis were considered 'missed' cancers and survival compared with 'detected' cases. The diagnostic pathway in each 'missed' case was reviewed.
RESULTS: 395 colorectal cancer cases were studied. Eighteen (4.6%) patients underwent previous investigation including colonoscopy (n=4), flexible sigmoidoscopy (n=5), barium enema (n=5) and diagnostic abdominal CT scan (n=12), median 708 days prior to diagnosis. Previous investigation predicted reduced overall and disease-free survival (HR 2.07, p=0.04 and HR 2.66, p<0.0001), after age and gender adjustment. Ten different categories termed 'pitfalls' were derived from analysis of the diagnostic pathway. These included CT scanning for abdominal pain without further investigation (n=7), rectosigmoid cancer following a previous diagnosis of diverticular disease (n=4) and incomplete diagnostic investigations without adequate follow-up (n=3).
CONCLUSIONS: A proportion of patients diagnosed with colorectal cancer have previously been investigated for gastrointestinal symptoms and survival appears reduced in these patients. Regular audit and analysis of previous investigations can identify common pitfalls in diagnosis, which should be used to inform training and improve practice.},
}
@article {pmid26385691,
year = {2015},
author = {Zeina, AR and Mahamid, A and Nachtigal, A and Ashkenazi, I and Shapira-Rootman, M},
title = {Giant colonic diverticulum: radiographic and MDCT characteristics.},
journal = {Insights into imaging},
volume = {6},
number = {6},
pages = {659-664},
pmid = {26385691},
issn = {1869-4101},
abstract = {Giant colonic diverticulum (GCD), defined as a diverticulum larger than 4 cm, is a rare entity that is generally a manifestation of colonic diverticular disease. Because of its rarity and its variable and non-specific presentation, the diagnosis of GCD depends mainly on imaging findings. Knowledge of the spectrum of radiographic and CT features of the GCD is important in making the correct diagnosis and potentially preventing complications. This review focuses on imaging findings characteristic of GCD as well as its complications and radiographic mimics. Teaching points • Giant colonic diverticulum is a rare complication of diverticulosis.• The most common symptom is abdominal pain presenting in approximately 70 % of patients.• Diagnosis is based on imaging findings with plain abdominal radiographs and MDCT.• Treatment consists of en bloc resection of the diverticulum and affected adjacent colon.},
}
@article {pmid26377584,
year = {2015},
author = {Binda, GA and Cuomo, R and Laghi, A and Nascimbeni, R and Serventi, A and Bellini, D and Gervaz, P and Annibale, B and , },
title = {Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines.},
journal = {Techniques in coloproctology},
volume = {19},
number = {10},
pages = {615-626},
pmid = {26377584},
issn = {1128-045X},
mesh = {Abscess/etiology/surgery ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Colectomy/methods ; Colon/*pathology/surgery ; Colonography, Computed Tomographic ; Colonoscopy ; Colorectal Surgery/*standards ; Diet/methods ; Dietary Fiber ; Diverticulum, Colon/complications/*diagnosis/*therapy ; Elective Surgical Procedures/methods ; Gastrointestinal Agents/therapeutic use ; Humans ; Italy ; Laparoscopy/methods ; Mesalamine/therapeutic use ; Multidetector Computed Tomography/methods ; Peritonitis/etiology/surgery ; Probiotics/therapeutic use ; Rifamycins/therapeutic use ; Rifaximin ; },
abstract = {The mission of the Italian Society of Colorectal Surgery (SICCR) is to optimize patient care. Providing evidence-based practice guidelines is therefore of key importance. About the present report it concernes the SICCR practice guidelines for the diagnosis and treatment of diverticular disease of the colon. The guidelines are not intended to define the sole standard of care but to provide evidence-based recommendations regarding the available therapeutic options.},
}
@article {pmid26369683,
year = {2015},
author = {Pavlidis, P and Bjarnason, I},
title = {Aspirin Induced Adverse Effects on the Small and Large Intestine.},
journal = {Current pharmaceutical design},
volume = {21},
number = {35},
pages = {5089-5093},
doi = {10.2174/1381612821666150915110058},
pmid = {26369683},
issn = {1873-4286},
mesh = {Animals ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/*adverse effects ; Aspirin/administration & dosage/*adverse effects ; Dose-Response Relationship, Drug ; Humans ; Intestinal Diseases/*chemically induced ; Intestine, Large/drug effects/pathology ; Intestine, Small/drug effects/pathology ; Permeability ; Species Specificity ; },
abstract = {Aspirin is in many ways a non- steroidal anti-inflammatory drug (NSAID) prototype. Similar to conventional NSAIDs the gastric side effects of aspirin are well studied. However its potential adverse effects on the small and large intestine are less well known and under- researched. Experimental studies support a pathogenic pathway leading to NSAID enteropathy involving the topical effects on the intestinal barrier (mucous layer, enterocytes) that lead to dysfunction and increased intestinal permeability followed by increased exposure to luminal triggers and acute inflammation. Although aspirin has a toxic effect in vitro, enteral or parenteral administration in vivo, in animal models, did not result to intestinal injury. In man, experimental studies have revealed changes in intestinal permeability similar to conventional NSAIDs but of lesser magnitude. The clinical implication of these changes though is not known. Population studies have associated aspirin use with occult gastrointestinal bleeding from the small or large bowel although the magnitude of this risk is difficult to estimate but certainly small. Associations to colitis flare-ups have been made in case reports and retrospective cohort studies but low dose aspirin appears safe. Complications of diverticular disease may also be more frequent with aspirin use.},
}
@article {pmid26361691,
year = {2015},
author = {Imafuku, A and Tanaka, K and Marui, Y and Sawa, N and Ubara, Y and Takaichi, K and Ishii, Y and Tomikawa, S},
title = {Colovesical Fistula After Renal Transplantation: Case Report.},
journal = {Transplantation proceedings},
volume = {47},
number = {7},
pages = {2248-2250},
doi = {10.1016/j.transproceed.2015.07.015},
pmid = {26361691},
issn = {1873-2623},
mesh = {Biopsy ; Colon, Sigmoid/surgery ; Humans ; Intestinal Fistula/*diagnosis/diagnostic imaging ; Kidney/surgery ; Kidney Transplantation/*adverse effects ; Laparoscopy/*adverse effects ; Male ; Middle Aged ; Postoperative Complications ; Recurrence ; Renal Insufficiency/complications/*surgery ; Tomography, X-Ray Computed ; Transplant Recipients ; Urinary Tract Infections/*complications ; },
abstract = {Colovesical fistula is a relatively rare condition that is primarily related to diverticular disease. There are few reports of colovesical fistula after renal transplantation. We report of a 53-year-old man who was diagnosed with colovesical fistula after recurrent urinary tract infection, 5 months after undergoing cadaveric renal transplantation. Laparoscopic partial resection of the sigmoid colon with the use of the Hartmann procedure was performed. Six months after that surgery, there was no evidence of recurrent urinary tract infection and the patient's renal graft function was preserved. Physicians should keep colovesical fistula in mind as a cause of recurrent urinary tract infection in renal transplant recipients, especially in those with a history of diverticular disease.},
}
@article {pmid26360948,
year = {2015},
author = {Hirche, Z and Willis, S},
title = {[Diverticular disease - timing of surgery in demand].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {140},
number = {18},
pages = {1360-1365},
doi = {10.1055/s-0041-105058},
pmid = {26360948},
issn = {1439-4413},
mesh = {Chronic Disease ; Colectomy ; Diverticulitis, Colonic/classification/complications/pathology/*surgery ; Diverticulum/classification/complications/pathology/*surgery ; Humans ; Practice Guidelines as Topic ; Recurrence ; },
abstract = {In preparation for operations of patients with diverticular disease an adequate medical indication has to be performed. The new classification of sigmoid diverticulitis corresponding to the German guidelines for diverticular disease classification (GGDDC) enables an appropriate strategy for evaluating the indications and selection of the time for surgery. New is, that the uncomplicated form of diverticulitis indicates an operation in exceptional case only. Furthermore the frequency of diverticulitis-exacerbation does not influence the indication for surgery any more.},
}
@article {pmid26360947,
year = {2015},
author = {Lembcke, B and Kruis, W},
title = {[Diverticular disease - clinical patterns and treatment].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {140},
number = {18},
pages = {1353-1359},
doi = {10.1055/s-0041-102396},
pmid = {26360947},
issn = {1439-4413},
mesh = {*Diverticulitis, Colonic/diagnosis/etiology/physiopathology/therapy ; *Diverticulum/diagnosis/etiology/physiopathology/therapy ; Humans ; },
abstract = {Diverticulosis, diverticular disease and diverticulitis have come into focus again because new aspects concerning diagnosis, risk factors and treatment arose only recently which prompted a new Guideline released by the DGVS and DGAV summarising the current evidence. Along with the guideline's essentials for medical practice a diagnosis of diverticulitis is considered unsatisfactory unless a cross-sectional imaging method (either ultrasonography [US] or computed tomography [CT]) has proven that the clinical findings and inflammation (CRP considered superior to WBC and temperature) are due to diverticular inflammation. For reasons of practicability and considering relevant legislation for radiation exposure protection, US is the primary - and usually effectual - diagnostic method of choice as it is equipotent to CT. While US offers better resolution and enables precise imaging exactly at the location of pain as well as reiterative application, the latter implies advantages in the case of a deep abscess or diverticulitis in difficult locations (e. g. the small pelvis). Clinical evidence and laboratory and imaging findings allow for distinguishing a large number of differential diagnoses and also form the basis of a new classification (classification of diverticular disease, CDD) which comprises all forms of diverticular disease, from diverticulosis to bleeding and to the different facettes of diverticulitis. This classification -which should be applied in any patient with the diagnosis of diverticular disease- is independent of specific diagnostic preferences and applicable both to conservative and operative treatment options. While the number of recurrent episodes is no longer a significant indicator for surgery in diverticulitis, severity and / or complications determine treatment options along with the patients preferences. According to first data, conservative treatment may waive antibiotics under certain circumstances, however they are indispensible in complicated disease or patients bearing risk factors. Spasmoanalgetics and supportive fluid supply are individually necessary, and avoidance of potentially aggravating medications (e. g. NSAIDS) appears advisable, but many suggestions (nil by mouth, bed rest, laxatives) come along without an adaequate body of evidence. Similarly medical advice concerning prevention and secondary prophylaxis relies mainly on epidemiological plausibility. Because minor perforations (CDD type 2 a) as well as recurrent episodes of uncomplicated diverticulitis and even some abscesses > 1 cm (CDD type 2 b) respond favourably to medical treatment, the timely indication for surgery in these cases requires precise classification along with a close surveillance in trustful cooperation between the gastroenterologist and the surgeon.},
}
@article {pmid26360946,
year = {2015},
author = {Wedel, T and Barrenschee, M and Cossais, F and Lange, C and Böttner, M},
title = {[Diverticular disease - new insights into pathogenesis].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {140},
number = {18},
pages = {1347-1352},
doi = {10.1055/s-0041-103915},
pmid = {26360946},
issn = {1439-4413},
mesh = {*Diverticulitis ; *Diverticulum ; Humans ; *Intestinal Diseases ; },
abstract = {Diverticular disease is associated with a high incidence, morbidity and burden of the healthcare system. However, the pathogenesis is not yet satisfactorily clarified and thought to be multifactorial. Non-influenceable risk factors include increasing age, genetic predisposition and rare congenital connective tissue diseases. Influenceable risk factors are low-fiber diet, increased meat consumption and obesity. Alterations of connective tissue lead to a weakening of preformed emergence sites of diverticula ("loci minoris resistentiae") and may explain the increased incidence of diverticular disease in diseases caused by a systematic connective tissue disorder. The impact of neuromuscular alterations and disturbed colonic motility on triggering diverticula formation has been previously underestimated. Moreover, intestinal innervation disorders are considered to be responsable for persisting recurrent pain symptoms in chronic diverticular disease.},
}
@article {pmid26360945,
year = {2015},
author = {Riemann, JF},
title = {[Diverticular disease: an everyday problem in a new light].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {140},
number = {18},
pages = {1346},
doi = {10.1055/s-0041-105749},
pmid = {26360945},
issn = {1439-4413},
mesh = {Asymptomatic Diseases ; *Diverticulitis, Colonic/pathology/physiopathology/therapy ; *Diverticulum/pathology/physiopathology/therapy ; Humans ; },
}
@article {pmid26357870,
year = {2016},
author = {Sköldberg, F and Svensson, T and Olén, O and Hjern, F and Schmidt, PT and Ljung, R},
title = {A population-based case-control study on statin exposure and risk of acute diverticular disease.},
journal = {Scandinavian journal of gastroenterology},
volume = {51},
number = {2},
pages = {203-210},
doi = {10.3109/00365521.2015.1081274},
pmid = {26357870},
issn = {1502-7708},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Diverticulitis, Colonic/epidemiology/*prevention & control/surgery ; Emergencies ; Female ; Hospitalization/statistics & numerical data ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use ; Male ; Middle Aged ; Protective Factors ; Risk Factors ; Sweden/epidemiology ; },
abstract = {OBJECTIVE: A reduced risk of perforated diverticular disease among individuals with current statin exposure has been reported. The aim of the present study was to investigate whether statins reduce the risk of acute diverticular disease.
MATERIAL AND METHODS: A nation-wide population-based case-control study was performed, including 13,127 cases hospitalised during 2006-2010 with a first-time diagnosis of colonic diverticular disease, and 128,442 control subjects (matched for sex, age, county of residence and calendar year). Emergency surgery, assumed to be a proxy for complicated diverticulitis, was performed on 906 of the cases during the index admission, with 8818 matched controls. Statin exposure was classified as "current" or "former" if a statin prescription was last dispensed ≤ 125 days or >125 days before index date, respectively. The association between statin exposure and acute diverticular disease was investigated by conditional logistic regression, including models adjusting for country of birth, educational level, marital status, comorbidities, nonsteroidal anti-inflammatory drug/steroid exposure and healthcare utilisation.
RESULTS: A total of 1959 cases (14.9%) and 16,456 controls (12.8%) were current statin users (crude OR 1.23 [95% CI 1.17-1.30]; fully adjusted OR 1.00 [0.94-1.06]). One hundred and thirty-two of the cases subjected to surgery (14.6%), and 1441 of the corresponding controls (16.3%) were current statin users (crude OR 0.89 [95% CI 0.73-1.08]; fully adjusted OR 0.70 [0.55-0.89]).
CONCLUSIONS: The results do not indicate that statins affect the development of symptomatic diverticular disease in general. However, current statin use was associated with a reduced risk of emergency surgery for diverticular disease.},
}
@article {pmid26354840,
year = {2015},
author = {Punwani, VV and Ong, E and Hii, MW},
title = {Cervical diverticulitis: a novel complication of a neonatal colonic interposition graft following oesophagectomy.},
journal = {BMJ case reports},
volume = {2015},
number = {},
pages = {},
pmid = {26354840},
issn = {1757-790X},
mesh = {Abscess/etiology/therapy ; *Colon/pathology/surgery/transplantation ; Deglutition Disorders/diagnosis/etiology ; Diverticulitis/diagnosis/*etiology/therapy ; Diverticulitis, Colonic ; Drainage ; Esophageal Atresia/*surgery ; Esophagectomy/*adverse effects ; Esophagus/*abnormalities/pathology/surgery ; Female ; Fistula/etiology/therapy ; Humans ; Infant, Newborn ; Intestinal Fistula ; Middle Aged ; Neck/*pathology ; Transplantation, Autologous/*adverse effects ; },
abstract = {A 47-year-old woman presented to a tertiary emergency department with an 8-day history of odynophagia, a 4 cm swelling on her left neck and intermittent fevers. Shortly following her birth, a congenital oesophageal atresia had been managed surgically with colonic interposition graft. Contrast CT of the neck demonstrated several large diverticula within her interposition graft at the level of the cervical vertebrae. A colocutaneous fistula was identified between the colon and left neck, with an associated abscess. The patient received intravenous meropenem followed by abscess drainage. A high output fistula developed at the drainage site, and the patient required intravenous fluids and stoma placement to manage fluid discharge. She left the hospital after a 17-day stay. At 6-month follow-up, the wound was erythematous, but the patient was otherwise well. We believe that this is the first reported case of diverticular disease arising in what was originally neonatal colon interposed for oesophageal atresia at birth.},
}
@article {pmid26347967,
year = {2015},
author = {Moghadamyeghaneh, Z and Carmichael, JC and Mills, S and Pigazzi, A and Nguyen, NT and Stamos, MJ},
title = {Variations in Laparoscopic Colectomy Utilization in the United States.},
journal = {Diseases of the colon and rectum},
volume = {58},
number = {10},
pages = {950-956},
doi = {10.1097/DCR.0000000000000448},
pmid = {26347967},
issn = {1530-0358},
mesh = {Aged ; *Colectomy/methods/statistics & numerical data ; *Colonic Neoplasms/epidemiology/surgery ; Databases, Factual ; Demography ; *Diverticulum, Colon/epidemiology/surgery ; *Elective Surgical Procedures/methods/statistics & numerical data ; Female ; Hospitals/statistics & numerical data ; Humans ; *Laparoscopy/methods/statistics & numerical data ; Male ; Middle Aged ; Multivariate Analysis ; Outcome Assessment, Health Care ; Practice Patterns, Physicians'/statistics & numerical data ; Retrospective Studies ; Socioeconomic Factors ; United States/epidemiology ; },
abstract = {BACKGROUND: Recent published articles reported a wide geographic variation in the utilization of laparoscopic colectomy in the United States.
OBJECTIVES: This study aimed to report the current rates of laparoscopic colon resection in different types of hospitals in the United States.
DESIGN: The Nationwide Inpatients Sample database was used to examine the clinical data of patients undergoing elective colon resection for the diagnosis of colon cancer or diverticular disease from 2009 to 2012.
SETTING: Multivariate regression analysis was performed to compare different hospital types and regions regarding the utilization of laparoscopy.
PATIENTS: Patients undergoing elective colon resection for the diagnosis of colon cancer or diverticular disease from 2009 to 2012 were selected.
MAIN OUTCOME MEASURES: The primary outcome measured was the rates of laparoscopic colon resection in different types of hospitals.
RESULTS: We sampled a total of 309,816 patients who underwent elective colon resection. Of these, 171,666 (55.4%) had a laparoscopic operation. The utilization of a laparoscopic approach increased from 51.3% in 2009 to 59.3% in 2012. The increased utilization of a laparoscopic approach was seen in both urban (53.6% vs 61.6%) and rural hospitals (33.4% vs 42.3%), for colon cancer (45% vs 53.5%), and diverticular disease (61.9% vs 68.2%). The conversion rate to open surgery for diverticular disease was significantly higher than for colon cancer (adjusted odds ratio (AOR), 1.23; p < 0.01). After adjustment, urban hospitals (AOR, 2.13; p < 0.01), teaching hospitals (AOR, 1.13; p < 0.01), and large hospitals (AOR, 1.33; p < 0.01) had a greater utilization of laparoscopic surgery.
LIMITATIONS: This study was limited by its retrospective nature.
CONCLUSIONS: Although we have finally reached the point where a majority of patients undergoing an elective colectomy for diverticular disease and colon cancer receive a laparoscopic operation, there is wide variation in the implementation of laparoscopic surgery in colon resection in the United States. The utilization of a laparoscopic approach has associations with hospital factors such as size, teaching status of the hospital, and geographic location (urban vs rural).},
}
@article {pmid26333625,
year = {2016},
author = {Politei, J and Thurberg, BL and Wallace, E and Warnock, D and Serebrinsky, G and Durand, C and Schenone, AB},
title = {Gastrointestinal involvement in Fabry disease. So important, yet often neglected.},
journal = {Clinical genetics},
volume = {89},
number = {1},
pages = {5-9},
doi = {10.1111/cge.12673},
pmid = {26333625},
issn = {1399-0004},
mesh = {Adolescent ; Adult ; Animals ; Biomarkers ; Brain/metabolism/pathology ; Child ; Comorbidity ; Diagnosis, Differential ; Fabry Disease/*diagnosis/etiology/*metabolism ; Female ; Gastrointestinal Diseases/*diagnosis/etiology/*metabolism ; Gastrointestinal Tract/*metabolism ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Young Adult ; },
abstract = {Fabry disease is an X-linked metabolic storage disorder due to the deficiency of lysosomal alpha-galactosidase A which causes accumulation of glycosphingolipids, primarily globotriaosylceramide, throughout the body. Gastrointestinal signs and symptoms-abdominal pain, nausea, diarrhea and diverticular disease--are some of the most frequently reported complaints in patients with Fabry disease but are often neglected. Gastrointestinal symptoms are due to intestinal dysmotility as well as impaired autonomic function, vasculopathy and myopathy. Since 2001, enzyme replacement therapy has been a mainstay in treatment of gastrointestinal symptoms of Fabry disease (FD), resulting in reduced gastrointestinal symptoms. Here, we report on four patients with Fabry disease (FD) who manifested early gastrointestinal involvement.},
}
@article {pmid26303606,
year = {2015},
author = {Alvarez-Berdugo, D and Espín, F and Arenas, C and López, I and Clavé, P and Gallego, D},
title = {Changes in the response to excitatory antagonists, agonists, and spasmolytic agents in circular colonic smooth muscle strips from patients with diverticulosis.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {27},
number = {11},
pages = {1600-1612},
doi = {10.1111/nmo.12659},
pmid = {26303606},
issn = {1365-2982},
mesh = {Adult ; Aged ; Aged, 80 and over ; Calcium Channels, L-Type/biosynthesis ; Diverticulosis, Colonic/*physiopathology ; Excitatory Amino Acid Agonists/*pharmacology ; Excitatory Amino Acid Antagonists/*pharmacology ; Female ; Humans ; Male ; Middle Aged ; Muscle Contraction/*drug effects ; Muscle, Smooth/*drug effects ; Organ Culture Techniques ; Parasympatholytics/*pharmacology ; RNA, Messenger/analysis ; Real-Time Polymerase Chain Reaction ; Receptors, Muscarinic/biosynthesis ; Receptors, Neurokinin-2/biosynthesis ; },
abstract = {BACKGROUND: Colonic samples from asymptomatic diverticulosis (DS) patients presented enhanced electrical field stimulation (EFS)-contractions, in an earlier study of ours, suggesting increased endogenous responses. The aim of this study was to explore changes in excitatory neuromuscular transmission and to assess the pharmacodynamics of spasmolytic agents in DS.
METHODS: Circular muscle strips from sigmoid colon of DS patients (n = 30; 69.5 ± 14.8 years) and controls (n = 32; 64.7 ± 16.2 years) were studied using organ baths to evaluate the direct effect of excitatory agonists (carbachol, neurokinin A [NKA] and substance P [SP]), and the effect of antagonists (atropine and NK2 antagonist GR94800) and spasmolytic drugs (otilonium bromide [OB] and N-butyl-hyoscine) on the contractions induced by EFS-stimulation of excitatory motorneurons. qRT-PCR was also performed to compare mRNA expression of M2 , M3 , NK2 receptors and L-type calcium channels.
KEY RESULTS: Contractions to carbachol (Emax : 663.7 ± 305.6% control vs 2698.0 ± 439.5% DS; p < 0.0005) and NKA (Emax : 387.8 ± 35.6% vs 1102.0 ± 190.1%; p < 0.0005) were higher in DS group, without differences for SP. Higher potency for DS patients was observed in the concentration-response curves for atropine (pIC50 = 8.56 ± 0.15 control vs pIC50 = 9.95 ± 0.18 DS group; p < 0.005) and slightly higher for GR94800 (pIC50 = 7.21 ± 0.18 control vs pIC50 = 7.97 ± 0.32 group; p < 0.0001). Lower efficacy (Emax) and potency (pIC50) was observed for spasmolytic drugs in DS, whereas no differences were found regarding the relative expression of the receptors evaluated between groups.
CONCLUSIONS & INFERENCES: The greater response to cholinergic and tachykinergic agonists and greater potency for muscarinic and NK2 antagonists observed in DS might play a role in the spasticity found in diverticular disease.},
}
@article {pmid26301109,
year = {2015},
author = {Sabanis, N and Paschou, E and Gavriilaki, E and Mourounoglou, M and Vasileiou, S},
title = {Unexpected Abscess Localization of the Anterior Abdominal Wall in an ADPKD Patient Undergoing Hemodialysis.},
journal = {Case reports in nephrology},
volume = {2015},
number = {},
pages = {982575},
pmid = {26301109},
issn = {2090-6641},
abstract = {Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most common monogenic disorders and the leading inheritable cause of end-stage renal disease worldwide. Cystic and noncystic extrarenal manifestations are correlated with variable clinical presentations so that an inherited disorder is now considered a systemic disease. Kidney and liver cystic infections are the most common infectious complications in ADPKD patients. Furthermore, it is well known that ADPKD is commonly associated with colonic diverticular disease which recently has been reported to be linked to increased risk of infection on hemodialysis patients. Herein, we present a case of anterior abdominal wall abscess caused by Enterococcus faecalis in a patient with ADPKD undergoing hemodialysis. Although the precise pathway of infection remains uncertain, the previous medical history as well as the clinical course of our patient led us to hypothesize an alternative route of infection from the gastrointestinal tract through an aberrant intestinal barrier into the bloodstream and eventually to an atypical location.},
}
@article {pmid26299627,
year = {2016},
author = {Parc, Y and Reboul-Marty, J and Lefevre, JH and Shields, C and Chafai, N and Tiret, E},
title = {Factors influencing mortality and morbidity following colorectal resection in France. Analysis of a national database (2009-2011).},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {18},
number = {2},
pages = {205-213},
doi = {10.1111/codi.13099},
pmid = {26299627},
issn = {1463-1318},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colectomy/*adverse effects/*mortality ; Databases, Factual ; Female ; France/epidemiology ; *Hospital Mortality ; Hospitals, High-Volume/*statistics & numerical data ; Hospitals, Low-Volume/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Morbidity ; Patient Transfer/statistics & numerical data ; Risk Factors ; Sex Factors ; },
abstract = {AIM: Correlation between outcome and hospital volume regarding colorectal resection (CRR) has been described, but it suggests that provider variability may have an impact. Our aim was to analyse the influence of institutional characteristics and the impact of volume [high volume (HV) or low volume (LV)] on mortality and morbidity after CRR at a national level.
METHOD: Data from 2009-2012, including patient demographics, diagnosis, procedure, mode of admission and discharge and hospital type, were obtained. Each hospital admission was classified as one of four levels of severity.
RESULTS: Of 176,444 patients included, 5408 (3.06%) died and 41,240 (23.37%) had a complication. Multivariate analysis showed that factors influencing morbidity were age over 80 years, severity level, pathology other than diverticular disease, male gender, demanding surgery, open surgery and surgery in an HV institution. Factors influencing mortality were the same except for the impact of volume. In HV centres, surgery was significantly more demanding (54.66% vs 47.17%, P < 0.0001), morbidity more frequent (26.59% vs 22.07%, P < 0.0001), but mortality was lower (2.17% vs 3.43%, P < 0.0001). In total, 6038 (3.4%) patients were transferred after surgery. Transfer rate and mortality after transfer were significantly higher in LV institutions (respectively: 4.3% vs 2.5%, P < 0.0001; and 12% vs 10.3%, P < 0.0001).
CONCLUSION: High volume centres have higher morbidity, but lower mortality. Six per cent of patients in LV centres required transfer. A national mortality rate after CRR of 3.5% can be expected. Transfer rate and mortality after transfer should be included in the evaluation of institutional mortality. Volume of institution, regardless of type, influences mortality after CRR.},
}
@article {pmid27024786,
year = {2013},
author = {},
title = {That pain in your side could be diverticular disease. Fiber and an active lifestyle prevent flare-ups, but act promptly if it hurts or bleeds.},
journal = {Harvard men's health watch},
volume = {18},
number = {4},
pages = {4-5},
pmid = {27024786},
issn = {1089-1102},
mesh = {Dietary Fiber/*administration & dosage ; Diverticulum/*physiopathology ; Humans ; *Life Style ; Pain/*diagnosis ; },
}
@article {pmid27942331,
year = {2011},
author = {Borowiec, AM and Gill, RS and Birch, DW and Karmali, S},
title = {The Utility of Lighted Ureteral Stents in Laparoscopic Colorectal Resection: A Survey of Canadian Surgeons.},
journal = {Gastroenterology research},
volume = {4},
number = {4},
pages = {143-148},
pmid = {27942331},
issn = {1918-2805},
abstract = {BACKGROUND: Establishing the exact location of the ureters is critical in preventing ureteric injury during colorectal surgery. In laparoscopic colorectal resections this identification can be facilitated by the pre-operative insertion of lighted ureteral stents (LUS). LUS may also serve as an invaluable educational aid during the teaching of colorectal surgery. However, the available evidence does not support the routine use of stents as an injury prevention measure. Furthermore, stent insertion carries inherent risks of ureteric injury. The objective of this study was to determine the frequency of use and indications for LUS in laparoscopic colorectal resections among Canadian surgeons.
METHODS: A seven-question survey was administered to Canadian surgeons through the monthly Canadian Association of General Surgeons (CAGS) e-news over a period of three months. The questions focused on surgeon demographics, experience with laparoscopic colon resections and the use of stents.
RESULTS: Seventy-five surgeons completed the survey. There was a wide range of experience among the surgeons in terms of years in practice. The majority (84%) reported performing laparoscopic colorectal resections and of those 65% reported performing less than 25 resections a year. Only 26% of surgeons used LUS during laparoscopic resections. Furthermore, 75% of LUS users did not have sub-specialty training, 69% performed less than 25 resections per year and 50% were in practice for less than five years. When used, LUS were inserted for diverticular disease (100%), left colon resection (88%) and low anterior resections (75%).
CONCLUSION: The majority of surgeons across Canada do not use LUS for laparoscopic colorectal resections. Of those performing laparoscopic colorectal resections, there may be a preference to use LUS for complex cases and by novice operators. This data suggests that proponents of LUS deem that it may have a role in diverticular disease.},
}
@article {pmid27024141,
year = {2011},
author = {Robb-Nicholson, C},
title = {Ask the doctor. I enjoyed your February 2011 article on diverticular disease and the fiber content of various foods. However, could you make some distinctions between soluble and insoluble fiber? Some fiber makes me feel very bloated.},
journal = {Harvard women's health watch},
volume = {18},
number = {10},
pages = {8},
pmid = {27024141},
issn = {1070-910X},
mesh = {*Dietary Fiber ; Edible Grain ; *Flatulence ; Happiness ; Humans ; Solubility ; },
}
@article {pmid27024069,
year = {2011},
author = {},
title = {Diverticular disease prevention and treatment. This common colon condition usually produces no symptoms, but it can result in bleeding, pain, and serious infection.},
journal = {Harvard women's health watch},
volume = {18},
number = {6},
pages = {4-5},
pmid = {27024069},
issn = {1070-910X},
mesh = {*Colon ; Humans ; *Pain ; },
}
@article {pmid26902713,
year = {2011},
author = {Charalabopoulos, A and Misiakos, E and Macheras, A},
title = {Colocutaneous fistula complicating sigmoid diverticulitis.},
journal = {International journal of surgery case reports},
volume = {2},
number = {5},
pages = {68-70},
pmid = {26902713},
issn = {2210-2612},
abstract = {Colocutaneous fistula is a very rare complication of colonic diverticular disease. Herein we describe a case with a fistula connecting the sigmoid with the left flank area complicating diverticulitis of the sigmoid colon. An 85-year-old female patient with a history of acute diverticulitis 3 months earlier, was admitted with a subcutaneous abscess in the left flank. The abscess was drained and subsequently a colocutaneous fistula was established. At operation the sigmoid colon with the fistulous tract were excised. The patient had no postoperative complications and at present, 2 years later, she fares well. Colocutaneous fistula is a serious complication of chronic diverticulitis and requires surgical excision for its definite treatment.},
}
@article {pmid27637792,
year = {2008},
author = {Huettner, F and Rawlings, AL and McVay, WB and Crawford, DL},
title = {Robot-assisted laparoscopic colectomy: 70 cases-one surgeon.},
journal = {Journal of robotic surgery},
volume = {2},
number = {4},
pages = {227-234},
pmid = {27637792},
issn = {1863-2483},
abstract = {This study reviewed the use of robot-assisted laparoscopic surgery for colon resection. We described the six-year experience of one minimally invasive fellowship-trained surgeon performing 70 consecutive colectomies using the da Vinci system. Between September 2002 and 2007, data on 70 patients undergoing robotic colectomy for diverticular disease, polyps, cancer, or carcinoid tumor were collected. Operations were right colectomy and sigmoid colectomy. A total of 38 right and 32 sigmoid colectomies were performed in 32 males and 38 females. The postoperative diagnoses were diverticular disease (19), polyps (36), cancer (13), and carcinoid (2). Times for the right colectomies were: port setup time 33.6 ± 12.1 (20-64) min, robotic time 147.2 ± 44.4 (53-306) min, and total case time 221.3 ± 43.7 (150-380) min. The estimated blood loss (EBL) was 53.9 ± 78.2 (15-500) ml, the body mass index (BMI) 27.2 ± 4.2 (17-36.8) kg/m(2), and the median length of stay (LOS) 3 (2-27) days. The robotic portion represented 66.5 % of the total case time. Times for the sigmoid colectomies were: port setup time 30.0 ± 9.8 (10-57) min, robotic time 101.8 ± 25.3 (67-165) min, and total case time 228.4 ± 40.5 (147-323) min. The EBL was 71.2 ± 47.9 (15-200) ml, the BMI 27.1 ± 4.9 (17.0-40.5) kg/m(2), and the median LOS 4 (2-27) days. The robotic portion represented 44.6% of the total case time. Eight different types of complication occurred. Eight cases were converted-five to open and three to laparoscopic. Two resulted from robot malfunction. Residents participated in 40 cases (57.1%). In the years 2002-2006, respectively, 5, 12, 10, 11, and 19 robotic colectomies were performed. In the first nine months of 2007, 13 robotic colectomies were performed. These 70 consecutive cases have demonstrated robotic colectomy to be a safe and technically feasible approach. The number of robotic colectomies performed each year has steadily increased over the last six years. This series compared favorably with other robotic series in length of hospital stay, conversion rates, and total case time.},
}
@article {pmid27726702,
year = {2007},
author = {},
title = {Primary and secondary causes of constipation in older people.},
journal = {Nursing older people},
volume = {19},
number = {6},
pages = {39},
doi = {10.7748/nop.19.6.39.s21},
pmid = {27726702},
issn = {1472-0795},
abstract = {Older people are at risk of constipation because of age-related changes that may weaken intestinal muscles, decrease peristalsis and reduce physical activity. Primary causes of constipation include decrease in fluid intake, decrease in ingestion of high fibre foods which may be associated with reduced ability to chew food, and weak abdominal muscles reducing effective evacuation. Secondary causes include disease processes such as dementia, Parkinson's, hypothryroidism, diverticular disease and prescribed medications, including narcotics, calcium channel blockers, anticholinergics and antidepressants. In this study a mixture was made up consisting of one cup of each of the following.},
}
@article {pmid27192013,
year = {1990},
author = {Ertan, A},
title = {Diverticular Disease.},
journal = {Postgraduate medicine},
volume = {88},
number = {3},
pages = {252-253},
doi = {10.1080/00325481.1990.11704745},
pmid = {27192013},
issn = {0032-5481},
}
@article {pmid29265328,
year = {1968},
author = {Lockhart-Mummery, HE},
title = {Diverticulitis: The Indications for Elective Surgery.},
journal = {The Australian and New Zealand journal of surgery},
volume = {41},
number = {2},
pages = {117-119},
doi = {10.1111/j.1445-2197.1968.tb06272.x},
pmid = {29265328},
issn = {0004-8682},
abstract = {The incidence of diverticular disease of the colon is discussed, and the indications for surgical interference, over and above those which are absolute, are considered. In the author's experience, a second attack of diverticulitis implies a greater likelihood of subsequent attacks, and a greater likelihood also of more serious complications. In an endeavour to prevent these, the routine daily administration of 250 mg of tetracycline is suggested. "Painful diverticulitis attacks" may in fact have no inflammatory background, but can be due to spastic colon syndrome and can be relieved by sigmoid resection.},
}
@article {pmid26282488,
year = {2015},
author = {Lamm, SH and Zerz, A and Efeoglou, A and Steinemann, DC},
title = {Transrectal Rigid-Hybrid Natural Orifice Translumenal Endoscopic Sigmoidectomy for Diverticular Disease: A Prospective Cohort Study.},
journal = {Journal of the American College of Surgeons},
volume = {221},
number = {4},
pages = {789-797},
doi = {10.1016/j.jamcollsurg.2015.07.012},
pmid = {26282488},
issn = {1879-1190},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colectomy/*methods ; Colon, Sigmoid/*surgery ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures/*methods ; *Endoscopes ; Equipment Design ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Natural Orifice Endoscopic Surgery/*instrumentation ; Prospective Studies ; Rectum ; },
abstract = {BACKGROUND: Our goal was to evaluate the feasibility of transrectal rigid hybrid natural orifice translumenal endoscopic surgery (NOTES) sigmoidectomy (trNS) in a series of consecutive prospective patients with diverticular disease. The NOTES for left colectomy offers patients reduced pain and easier recovery. Limited data are available for trNS, which is considered safe for various indications. However, the technique is not standardized, and patients in the reported series are highly selected.
STUDY DESIGN: Patients scheduled for trNS were entered into a prospective registry on an intention-to-treat basis. The primary endpoint was trNS feasibility, and secondary endpoints were morbidity, pain, length of stay, and inflammatory response. A medial-to-lateral dissection with full mobilization of the splenic flexure and total intracorporeal anastomosis was performed. The rectum was covered with a wound protector for transrectal extraction.
RESULTS: Of 95 elective sigmoidectomies, 81% (n = 77) were enrolled for either transvaginal NOTES resection (n = 37) or trNS (n = 40). There was no difference in body mass index or indication between patients undergoing laparoscopic-assisted sigmoidectomy (LAS), transvaginal resection, or trNS, although trNS patients were younger. Mainly because of a mismatch of bulky specimen and narrow pelvis, 17.5% of trNS were converted to LAS. Major morbidity was 10%, including 2 septic complications. During the study, the anastomosis technique was changed from double stapled end-to-end to side-to-end anastomosis.
CONCLUSIONS: Transrectal rigid hybrid natural orifice translumenal endoscopic sigmoidectomy is feasible and safe in a high proportion of unselected consecutive patients with diverticular disease undergoing elective treatment. Intracorporeal side-to-end anastomosis is the preferred technique, and trNS should be offered for elective sigmoidectomy presupposing advanced laparoscopic experience.},
}
@article {pmid26275534,
year = {2016},
author = {Bhakta, A and Tafen, M and Glotzer, O and Canete, J and Chismark, AD and Valerian, BT and Stain, SC and Lee, EC},
title = {Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies.},
journal = {Surgical endoscopy},
volume = {30},
number = {4},
pages = {1629-1634},
pmid = {26275534},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/adverse effects/*methods ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/complications/*surgery ; Diverticulum/*surgery ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/etiology ; Retrospective Studies ; Treatment Outcome ; },
abstract = {INTRODUCTION: Laparoscopic resection of diverticular disease is typically offered to selected patients. We present the outcomes of laparoscopic colectomy in consecutive patients suffering from either simple diverticulitis (SD) or complicated diverticulitis (CD).
PURPOSE: To examine the outcomes of laparoscopic sigmoid colectomy for complicated diverticulitis.
METHODS: Between December 2001 and May 2013, all patients with diverticulitis requiring elective operation were offered laparoscopic sigmoid colectomy as the initial approach. All cases were managed at a large tertiary care center on the colorectal surgery service. Preoperative, intraoperative, and postoperative variables were prospectively entered into the colorectal surgery service database (CRSD) and analyzed retrospectively.
RESULTS: Of the 576 patients in the CRSD, 139 (24.1%) had CD. The overall conversion rate was 12.8% (n = 74). The average BMI was 29.8 kg/m(2). The conversion rate for CD was 12.2%. The return of bowel function time was delayed in the CD group when compared to the SD group (3.1 vs 3.8 days, p = 0.04). The hospital length of stay (HLOS) was similar between the groups (5.1 vs 5.8 days, p = 0.08). The overall anastomotic leak rate was 2.1% (n = 12). Patients undergoing laparoscopic resection for SD had a postoperative complication rate of 10.0% (n = 38), whereas those with CD had a postoperative morbidity rate of 19.6% (n = 24). CD patients who had conversion to an open procedure had an even higher rate of postoperative complications (29.4%, n = 5, p = 0.35). On non-parsimonious multivariate adjustment, only CD (RR 1.96, 95% CI 1.11-3.46, p = 0.02) was found to be an independent risk factor for the development of postoperative complications.
CONCLUSIONS: Complicated diverticulitis did not affect the conversion rate to an open procedure. However, patients with CD are prone to postoperative complications. The laparoscopic approach to sigmoid colectomy is safe and preferable in experienced hands.},
}
@article {pmid26267774,
year = {2015},
author = {Ruiz-Roso Calvo de Mora, B},
title = {[Positive effects of wheat bran for digestive health; scientific evidence].},
journal = {Nutricion hospitalaria},
volume = {32 Suppl 1},
number = {},
pages = {41-45},
doi = {10.3305/nh.2015.32.sup1.9478},
pmid = {26267774},
issn = {1699-5198},
mesh = {Diet ; *Dietary Fiber ; *Digestive System Physiological Phenomena ; *Health Status ; Humans ; Micronutrients ; Nutritive Value ; Spain ; },
abstract = {Wheat bran (ST) is very rich in insoluble fiber, consisting mainly arabinoxylans and, to a lesser extent, cellulose and β-glucans, as well as vitamins, minerals and antioxidants polyphenolic. The ST is involved in the regulation of gastrointestinal physiology and health: delayed gastric emptying and intestinal transit speeds and increases fecal bulk. The ST has an effect on faecal bulking greater than other grains such as oats or vegetables and fruits. However, phytic acid present in the bran may reduce the absorption of certain minerals (Ca, Mg, Fe and Zn), due to formation phytate-mineral complexes. Different studies have shown that consumption of bran has protective effect against different diseases: cardiovascular, obesity and some gastrointestinal diseases, including constipation, diverticular disease and colorectal cancer, among others. In Spain the consumption of fiber (18 g/day on average) is below the recommended (30 g/day), so the increased consumption of foods with wheat bran help achieve this recommendation and reduce the incidence of diseases associated a low intake of fiber.},
}
@article {pmid26263651,
year = {2015},
author = {Borota, AV and Kukhto, AP and Baziyan-Kukhto, NK},
title = {[DIVERTICULAR DISEASE OF LARGE BOWEL: DIAGNOSIS, SURGICAL TACTICS].},
journal = {Klinichna khirurhiia},
volume = {},
number = {4},
pages = {69-72},
pmid = {26263651},
issn = {0023-2130},
mesh = {Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Colon/drug effects/microbiology/pathology/surgery ; Colonoscopy/*methods ; Diet, Carbohydrate-Restricted ; Diverticulosis, Colonic/*diagnosis/pathology/*surgery/therapy ; Diverticulum, Colon/microbiology/pathology/*surgery ; Humans ; Probiotics/administration & dosage ; Severity of Illness Index ; },
}
@article {pmid26216748,
year = {2016},
author = {Damle, RN and Alavi, K},
title = {Risk factors for 30-d readmission after colorectal surgery: a systematic review.},
journal = {The Journal of surgical research},
volume = {200},
number = {1},
pages = {200-207},
doi = {10.1016/j.jss.2015.06.052},
pmid = {26216748},
issn = {1095-8673},
mesh = {*Colectomy ; *Colostomy ; Humans ; Patient Readmission/*statistics & numerical data ; Rectum/*surgery ; Risk Factors ; },
abstract = {BACKGROUND: Readmission rates after colorectal surgery remain an ongoing clinical concern. Recent initiation of penalties for excess readmissions in medical patients has encouraged surgeons to reduce readmissions for surgical patients. We conducted a systematic review of the published literature for the purpose of identifying patient-related risk factors for 30-d readmissions after colorectal surgery.
METHODS: PubMed and Web of Science were queried for relevant English-language studies published before January 1, 2015, evaluating 30-d hospital readmissions after colorectal surgery in adult patients. Studies were included in this review only if they used a multivariable model to assess various patient-associated predictors and were excluded if the study size was less than 100 patients.
RESULTS: A total of 20 clinical research studies made up of 8 (40%) chart reviews and 12 (60%) administrative data met inclusion criteria. Most studies took place in the United States, and a variety of procedures (e.g., colectomy, rectal resection, stoma creation) and indications for surgery (e.g., cancer, inflammatory bowel disease, diverticular disease) were evaluated. The average ages of included patients was between 37 and 78 y and 36%-97% were men. Readmission rates ranged from 9%-25%. Overall, older age, comorbid conditions, preoperative immunosuppressive therapy, postoperative complications, and nonhome discharge were the most consistent and strongest predictors of readmission.
CONCLUSIONS: These identifiable risk factors highlight targets for interventions in an effort to reduce unplanned readmissions. Determining the most efficacious and cost-efficient means to reduce these preventable hospitalizations could save millions of valuable health care dollars.},
}
@article {pmid26202723,
year = {2015},
author = {Tursi, A and Papa, A and Danese, S},
title = {Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon.},
journal = {Alimentary pharmacology & therapeutics},
volume = {42},
number = {6},
pages = {664-684},
doi = {10.1111/apt.13322},
pmid = {26202723},
issn = {1365-2036},
mesh = {Anti-Bacterial Agents/therapeutic use ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/*drug therapy/*physiopathology ; Diverticulum/*physiopathology/*therapy ; Humans ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; Randomized Controlled Trials as Topic ; Recurrence ; Rifamycins/therapeutic use ; Rifaximin ; },
abstract = {BACKGROUND: The incidence of diverticulosis and diverticular disease of the colon, including diverticulitis, is increasing worldwide, and becoming a significant burden on national health systems. Treatment of patients with diverticulosis and DD is generally based on high-fibre diet and antibiotics, respectively. However, new pathophysiological knowledge suggests that further treatment may be useful.
AIM: To review the current treatment of diverticulosis and diverticular disease.
METHODS: A search of PubMed and Medline databases was performed to identify articles relevant to the management of diverticulosis and diverticular disease. Major international conferences were also reviewed.
RESULTS: Two randomised controlled trials (RCT) found the role of antibiotics in managing acute diverticulitis to be questionable, particularly in patients with no complicating comorbidities. One RCT found mesalazine to be effective in preventing acute diverticulitis in patients with symptomatic uncomplicated diverticular disease. The role of rifaximin or mesalazine in preventing diverticulitis recurrence, based on the results of 1 and 4 RCTs, respectively, remains unclear. RCTs found rifaximin and mesalazine to be effective in treating symptomatic uncomplicated diverticular disease. The use of probiotics in diverticular disease and in preventing acute diverticulitis occurrence/recurrence appears promising but unconclusive. Finally, the role of fibre in treating diverticulosis remains unclear.
CONCLUSIONS: Available evidence suggests that antibiotics have a role only in the treatment of complicated diverticulitis. It appears to be some evidence for a role for rifaximin and mesalazine in treating symptomatic uncomplicated diverticular disease. Finally, there is not currently adequate evidence to recommend any medical treatment for the prevention of diverticulitis recurrence.},
}
@article {pmid26202195,
year = {2015},
author = {Pandolfi, F and Frosali, S and Petruzziello, L and Newton, EE and Costamagna, G},
title = {Central and Mucosal Immunities are Modified by Non Adsorbable Antibiotic Treatment in Uncomplicated Diverticular Disease.},
journal = {Mini reviews in medicinal chemistry},
volume = {16},
number = {3},
pages = {218-221},
doi = {10.2174/1389557515666150722104035},
pmid = {26202195},
issn = {1875-5607},
mesh = {Diverticulitis, Colonic/*drug therapy ; Gastrointestinal Absorption/drug effects ; Gastrointestinal Microbiome/drug effects ; Humans ; Immunity/drug effects ; Immunity, Mucosal/drug effects ; Intestinal Mucosa/drug effects ; Rifamycins/pharmacology/*therapeutic use ; Rifaximin ; },
abstract = {We review our experience on Rifaximin in uncomplicated diverticular disease. Our data show that a 2 week treatment induces modifications in the immune system: local mucosal lymphocytes with TLR-4 were increased. In the peripheral blood CD103 cells, which increased before treatment, returned to normal values after Rifaximin.},
}
@article {pmid26197447,
year = {2015},
author = {Kinnucan, J and Tomal, J and Rubin, DT},
title = {U.S. Patients with Ulcerative Colitis Do Not Have a Decreased Risk of Diverticulosis.},
journal = {Inflammatory bowel diseases},
volume = {21},
number = {9},
pages = {2154-2157},
doi = {10.1097/MIB.0000000000000467},
pmid = {26197447},
issn = {1536-4844},
mesh = {Aged ; Aged, 80 and over ; Case-Control Studies ; Colitis, Ulcerative/*complications/pathology ; Colonoscopy ; Diverticulum/epidemiology/*etiology ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Smoking ; Time Factors ; United States/epidemiology ; },
abstract = {BACKGROUND: Studies outside the United States have described a lower prevalence of diverticulosis in patients with inflammatory bowel disease (IBD) than in patients without IBD. The aim of this study was to assess the prevalence of diverticulosis and associated risk factors in patients with ulcerative colitis (UC) at a U.S. tertiary care center.
METHODS: We performed a retrospective review of patients over 50 years of age who underwent screening or surveillance colonoscopy from January 2006 to December 2013. We first assessed the prevalence of diverticulosis in patients with UC compared with patients without IBD. Then, we performed a nested case-control study comparing UC patients with diverticulosis (cases) with UC patients without diverticulosis (controls).
RESULTS: We identified 544 patients with UC and 16,705 patients without IBD who underwent colonoscopy. On univariate analysis, 23.5% of patients with UC had diverticulosis, and 46.7% of patients without IBD had diverticulosis, P < 0.01 and relative risk = 0.50 (95% CI, 0.43-0.58). Multivariate analysis adjusting for age and gender found a relative risk of diverticulosis in UC = 1.02 (95% CI, 1.02-1.03). In the nested case-control study, there were no differences between UC cases and UC controls in disease duration (16.7 versus 18.7 yr; P = 0.27), extent of disease (pancolitis 50% versus 60.1%; P = 0.24), obesity (34.5% versus 29.2%; P = 0.40), or ethnicity (86.3% white versus 79.8%; P = 0.20). There was a trend toward history of smoking in patients with UC and diverticulosis (49.5% versus 35.5%; P = 0.09).
CONCLUSIONS: In this U.S.-based study, patients with UC had a slightly increased of diverticulosis compared with patients without IBD undergoing screening or surveillance colonoscopy. There were no identified predictors for diverticular disease in patients with UC, but there was a trend toward previous smoking status and development of diverticulosis. These results are different than previously reported data in patients with IBD in other countries and may represent unique dietary differences that contribute to the development of diverticulosis.},
}
@article {pmid26192969,
year = {2015},
author = {Borchert, DH and Schachtebeck, M and Schoepe, J and Federlein, M and Bunse, J and Gellert, K and Burghardt, J},
title = {Observational study on preservation of the superior rectal artery in sigmoid resection for diverticular disease.},
journal = {International journal of surgery (London, England)},
volume = {21},
number = {},
pages = {45-50},
doi = {10.1016/j.ijsu.2015.07.011},
pmid = {26192969},
issn = {1743-9159},
mesh = {Colectomy/*methods ; Colon, Sigmoid/*blood supply/surgery ; Diverticulosis, Colonic/*surgery ; Female ; Follow-Up Studies ; Humans ; Ligation ; Male ; Mesenteric Artery, Inferior/*surgery ; Middle Aged ; Postoperative Complications/*prevention & control ; Retrospective Studies ; },
abstract = {AIM: Recent investigations have shown improved patient reported outcome after preservation of the inferior mesenteric artery in sigmoid resection for diverticular disease. We report on our experience with preservation of the superior rectal artery (SRA).
METHODS: This is an observational single center study in a high-volume, level II inner city hospital from 2006 to 2008. Inclusion criteria were all patients with diverticular disease. Exclusion criteria were stoma formation, cancer, and iatrogenic perforation. Patients were investigated in group A with preservation of the SRA, and group B ligation of the SRA. Outcomes assessed, included incidence of anastomotic breakdown, intraoperative complications, hospital stay, and risk factors.
RESULTS: The patient population included 259 patients, 46 patients were excluded, leaving 100 patients in group A and 113 patients in group B. Patients in both groups were comparable regarding age, gender, co-morbidities and stage of disease. Anastomotic breakdown occurred in one patient in group A and in eight patients in group B (p = 0.038). Incidence of intraoperative bleeding, wound dehiscence, and length of stay was increased in group B (p < 0.03; p < 0.04; p = 0.05). Obesity was an independent risk factor for anastomotic dehiscence in group B (p < 0.04).
CONCLUSION: Our data comprise the largest patient population reported so far on vascular preservation in surgery for diverticular disease. The results of this study support the establishment of evidence based recommendations on the level of dissection in diverticular disease. Specifically obese patients are at risk of anastomotic breakdown with ligation of the SRA.},
}
@article {pmid26183208,
year = {2015},
author = {Ashktorab, H and Panchal, H and Shokrani, B and Paydar, M and Sanderson, A and Lee, EL and Begum, R and Haidary, T and Laiyemo, AO and McDonald-Pinkett, S and Brim, H and Nouraie, M},
title = {Association between Diverticular Disease and Pre-Neoplastic Colorectal Lesions in an Urban African-American Population.},
journal = {Digestion},
volume = {92},
number = {2},
pages = {60-65},
pmid = {26183208},
issn = {1421-9867},
support = {G12 MD007597/MD/NIMHD NIH HHS/United States ; },
mesh = {Adenoma/*epidemiology/pathology ; Black or African American/*statistics & numerical data ; Aged ; Colonic Polyps/*epidemiology/pathology ; Colonoscopy ; Cross-Sectional Studies ; Diverticulosis, Colonic/*epidemiology ; Female ; Humans ; Logistic Models ; Male ; Mass Screening/methods ; Middle Aged ; Multivariate Analysis ; Precancerous Conditions/*epidemiology/pathology ; Prevalence ; Retrospective Studies ; United States/epidemiology ; Urban Health/*statistics & numerical data ; },
abstract = {BACKGROUND: It is unclear whether there is a shared pathway in the development of diverticular disease (DD) and potentially neoplastic colorectal lesions since both diseases are found in similar age groups and populations.
AIM: To determine the association between DD and colorectal pre-neoplastic lesions in an African-American urban population.
METHODS: Data from 1986 patients who underwent colonoscopy at the Howard University Hospital from January 2012 through December 2012 were analyzed for this study. The presence of diverticula and polyps was recorded using colonoscopy reports. Polyps were further classified into adenoma or hyperplastic polyp based on histopathology reports. Multiple logistic regression was done to analyze the association between DD and colonic lesions.
RESULTS: Of the 1986 study subjects, 1,119 (56%) were females, 35% had DD and 56% had at least one polyp. There was a higher prevalence of polyps (70 vs. 49%; OR = 2.3; 95% CI: 1.9-2.8) and adenoma (43 vs. 25%; OR = 2.0; 95% CI: 1.7-2.5) in the diverticular vs. non-diverticula patients. Among patients who underwent screening colonoscopy, the presence of diverticulosis was associated with increased odds of associated polyps (OR = 9.9; 95% CI: 5.4-16.8) and adenoma (OR = 5.1; 95% CI: 3.4-7.8).
CONCLUSION: Patients with DD are more likely to harbor colorectal lesions. These findings call for more vigilance on the part of endoscopists during colonoscopy in patients known to harbor colonic diverticula.},
}
@article {pmid26175581,
year = {2015},
author = {Flor, N and Campari, A and Ravelli, A and Lombardi, MA and Pisani Ceretti, A and Maroni, N and Opocher, E and Cornalba, G},
title = {Vascular Map Combined with CT Colonography for Evaluating Candidates for Laparoscopic Colorectal Surgery.},
journal = {Korean journal of radiology},
volume = {16},
number = {4},
pages = {821-826},
pmid = {26175581},
issn = {2005-8330},
mesh = {Adult ; Aged ; Colectomy/*methods ; Colon/blood supply/diagnostic imaging/pathology ; Colonography, Computed Tomographic/*methods ; Colorectal Neoplasms/*diagnostic imaging/pathology/*surgery ; Contrast Media ; Female ; Humans ; Laparoscopy/*methods ; Lymph Node Excision/methods ; Male ; Middle Aged ; Neoplasm Staging/methods ; },
abstract = {Contrast-enhanced computed tomography colonography (CE-CTC) is a useful guide for the laparoscopic surgeon to avoid incorrectly removing the colonic segment and the failure to diagnose of synchronous colonic and extra-colonic lesions. Lymph node dissection and vessel ligation under a laparoscopic approach can be time-consuming and can damage vessels and organs. Moreover, mesenteric vessels have extreme variations in terms of their courses and numbers. We describe the benefit of using an abdominal vascular map created by CE-CTC in laparoscopic colorectal surgery candidates. We describe patients with different diseases (colorectal cancer, diverticular disease, and inflammatory bowel disease) who underwent CE-CTC just prior to laparoscopic surgery.},
}
@article {pmid26172444,
year = {2015},
author = {Ramirez-Arcos, S and Alport, T and Goldman, M},
title = {Intermittent bacteremia detected in an asymptomatic apheresis platelet donor with repeat positive culture for Escherichia coli: a case report.},
journal = {Transfusion},
volume = {55},
number = {11},
pages = {2606-2608},
doi = {10.1111/trf.13218},
pmid = {26172444},
issn = {1537-2995},
mesh = {Bacteremia/*diagnosis ; Blood Donors/statistics & numerical data ; Blood Platelets/microbiology ; Escherichia coli/*isolation & purification ; Humans ; Male ; Middle Aged ; Platelet Transfusion ; Plateletpheresis ; },
abstract = {BACKGROUND: Bacterial culture of platelet concentrates (PCs) has been implemented to reduce the risk of infectious transfusion events. Most positive cultures are for skin flora or environmental organisms with no underlying pathology associated in the donor. Less frequently, enteric organisms have been isolated from PCs indicating asymptomatic donor bacteremia. We report a case of a donor with repeat positive culture for Escherichia coli.
CASE REPORT: A 62-year-old single apheresis platelet (PLT) donor who passed all routine screening procedures had two intermittent positive BacT/ALERT cultures with E. coli. On both occasions, transfusion was prevented with the contaminated units. The donor denied any symptoms suggestive of infection and was referred to his family physician for evaluation. A barium enema revealed multiple colonic diverticula, although the donor has remained asymptomatic. Based on his history of repeat-positive cultures with the same enteric organism, the donor has been permanently deferred.
DISCUSSION: PLT screening for bacterial contamination has been an effective measure to reduce the incidence of septic transfusion reactions. Important is the capture of Gram-negative bacteria, which can be involved in septic shock due to the production of endotoxins. In addition to the safety benefit to PLT recipients, PLT culture is valuable for blood donors. The recurrence of positive cultures with the same organism allows the identification of subclinical illnesses and, if appropriate, deferral from blood donation.
CONCLUSION: This asymptomatic donor has intermittent bacteremia likely related to diverticular disease. Isolation of E. coli twice prompted further investigation and donor deferral.},
}
@article {pmid26170219,
year = {2015},
author = {Pfützer, RH and Kruis, W},
title = {Management of diverticular disease.},
journal = {Nature reviews. Gastroenterology & hepatology},
volume = {12},
number = {11},
pages = {629-638},
pmid = {26170219},
issn = {1759-5053},
mesh = {Algorithms ; Chronic Disease ; Diverticulosis, Colonic/classification/*diagnosis/*therapy ; Humans ; Life Style ; Risk Factors ; },
abstract = {Diverticular disease is a common condition in Western countries and the incidence and prevalence of the disease is increasing. The pathogenetic factors involved include structural changes in the gut that increase with age, a diet low in fibre and rich in meat, changes in intestinal motility, the concept of enteric neuropathy and an underlying genetic background. Current treatment strategies are hampered by insufficient options to stratify patients according to individual risk. One of the main reasons is the lack of an all-encompassing classification system of diverticular disease. In response, the German Society for Gastroenterology and Digestive Diseases (DGVS) has proposed a classification system as part of its new guideline for the diagnosis and management of diverticular disease. The classification system includes five main types of disease: asymptomatic diverticulosis, acute uncomplicated and complicated diverticulitis, as well as chronic diverticular disease and diverticular bleeding. Here, we review prevention and treatment strategies stratified by these five main types of disease, from prevention of the first attack of diverticulitis to the management of chronic complications and diverticular bleeding.},
}
@article {pmid26150652,
year = {2015},
author = {Almerie, MQ and Culverwell, A and Gill, J and Harrison, JD},
title = {Spontaneous right-sided ureterocolic fistula: a rare complication of colonic diverticular disease.},
journal = {BMJ case reports},
volume = {2015},
number = {},
pages = {},
pmid = {26150652},
issn = {1757-790X},
mesh = {Aged ; Colon, Sigmoid/*pathology ; Diverticulitis, Colonic/*complications ; Fistula/*etiology ; Humans ; Male ; Ureter/*pathology ; },
}
@article {pmid26150623,
year = {2015},
author = {Cargill, A and Farkas, N and Black, J and West, N},
title = {A novel surgical approach for treatment of sigmoid gallstone ileus.},
journal = {BMJ case reports},
volume = {2015},
number = {},
pages = {},
pmid = {26150623},
issn = {1757-790X},
mesh = {Abdominal Pain/*etiology ; Aged, 80 and over ; Appendectomy/methods ; Colon, Sigmoid/pathology ; Female ; Gallstones/complications/diagnostic imaging/*surgery ; Humans ; Ileus/diagnostic imaging/etiology/*surgery ; Intestinal Obstruction/diagnostic imaging/etiology/*surgery ; Sigmoid Diseases/diagnostic imaging/etiology/*surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Vomiting/*etiology ; },
abstract = {We report a rare case of large bowel obstruction secondary to a gallstone impacted within the sigmoid colon, in the presence of sigmoid diverticular disease. An 89-year-old woman presented with an 8-day history of increasing abdominal distension, pain and associated nausea. Abdominal X-ray demonstrated large bowel dilation. CT scan revealed a fistula between an inflamed gallbladder and the hepatic flexure of the colon, with a large gallstone in the sigmoid colon. Proximal dilated large bowel was evident to the caecum. Flexible sigmoidoscopy was performed as the least invasive potential treatment method with a view to basket retrieval or fragmentation of the stone. Owing to poor views and risk of diverticular perforation, the procedure was abandoned, hence laparotomy was performed. Antegrade manipulation and per-rectal evacuation were attempted but failed due to a thickened, angulated sigmoid colon. Retrograde milking of the stone to the caecum and retrieval via modified appendicectomy was successful.},
}
@article {pmid26139496,
year = {2016},
author = {Turrado-Rodriguez, V and Targarona Soler, E and Bollo Rodriguez, JM and Balagué Ponz, C and Hernández Casanovas, P and Martínez, C and Trías Folch, M},
title = {Are there differences between right and left colectomies when performed by laparoscopy?.},
journal = {Surgical endoscopy},
volume = {30},
number = {4},
pages = {1413-1418},
pmid = {26139496},
issn = {1432-2218},
mesh = {Aged ; Colectomy/*methods ; Colorectal Neoplasms/*surgery ; Female ; Humans ; Incidence ; Laparoscopy/*methods ; Male ; Operative Time ; Postoperative Complications/*epidemiology ; Retrospective Studies ; Spain/epidemiology ; },
abstract = {BACKGROUND: There is an extended belief that the laparoscopic approach to left colectomy (LC) is technically more demanding and associated with more postoperative complications than to right colectomy (RC). However, there is no consensus in the literature about whether the short-term outcomes of RC differ from those of LC. The aim of this paper was to compare the postoperative course of patients undergoing RC and LC.
METHODS: We retrospectively analyzed 1000 consecutive patients who underwent a laparoscopic RC or LC between 1998 and 2012. Factors analyzed were intraoperative complications, surgical time, postoperative complications, and length of stay. The two groups were divided into four subgroups (neoplasia, diverticular disease, polyps, and others).
RESULTS: LC was associated with more postoperative complications than RC and longer operative time both in the two main groups (postoperative complications 30 vs. 19%; operative time 139 vs. 118 min) and in the neoplasia subgroups (27 vs. 18%; 137 vs. 118 min). No differences between groups were found for rates of reintervention or death. Comparison between LC subgroups showed that the operative time was longer and the conversion rate was higher in the diverticular disease subgroup than in the neoplasia subgroup (155 vs. 137 min; 21 vs. 8%).
CONCLUSIONS: In this large cohort of patients undergoing laparoscopic colectomy, LC carried a higher risk than RC of postoperative complications. These findings provide new data on the differences between the two surgeries. Our findings strengthen the notion that right and left colectomies have a different intraoperative and postoperative course and should be analyzed as two separate entities.},
}
@article {pmid26118576,
year = {2015},
author = {Moubax, K and Urbain, D},
title = {Diverticulitis: new insights on the traditional point of view.},
journal = {Acta gastro-enterologica Belgica},
volume = {78},
number = {1},
pages = {38-48},
pmid = {26118576},
issn = {1784-3227},
mesh = {Abscess/etiology/surgery ; Anti-Bacterial Agents/*therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Dietary Fiber/*therapeutic use ; Diverticulitis/complications/*therapy ; Drainage ; Gastrointestinal Agents/*therapeutic use ; Humans ; Inflammatory Bowel Diseases ; Irritable Bowel Syndrome ; Mesalamine/*therapeutic use ; Rifamycins/*therapeutic use ; Rifaximin ; },
abstract = {Diverticulosis of the colon is a common disease with an increasing incidence in Western countries. Recent literature has shown some changes in the traditional approach of this disease. The theory that diverticulosis is caused by a reduced intake of dietary fibre, is doubtful. There might be some chemical and histological overlap between diverticulitis, inflammatory bowel disease and irritable bowel disease. High quality clinical study found no effect for antibiotics in acute, uncomplicated diverticulitis. Cyclic administration of mesalazine and rifaximin result in reduced symptoms of diverticular disease. For the treatment of diverticular abscesses, percutaneous drainage shows promising results. Recurrence of acute diverticulitis is rare and most serious complications are linked to the first episode. Recent evidence does not support the traditional recommendation for elective surgery after two episodes of acute diverticulitis any more. This review summarizes the last evidence in diverticular disease and diverticulitis.},
}
@article {pmid26116035,
year = {2015},
author = {Rodríguez-Wong, U and Cruz-Rubin, C and Pinto-Angulo, VM and García Álvarez, J},
title = {[Obesity and complicated diverticular disease of the colon].},
journal = {Cirugia y cirujanos},
volume = {83},
number = {4},
pages = {292-296},
doi = {10.1016/j.circir.2015.02.003},
pmid = {26116035},
issn = {2444-054X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Diverticulum, Colon/complications/*etiology/surgery ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Obesity/*complications ; Retrospective Studies ; },
abstract = {BACKGROUND: The incidence of diverticular disease of the colon has been rising in recent years, and the associated factors are: low ingestion of fibre, age, lack of physical activity, and obesity.
METHODS: A retrospective, descriptive, observational study was conducted on patients with the diagnosis of complicated diverticular disease requiring surgical or interventional treatment, for a period of 12 years.
RESULTS: A total of 114 patients (72 males, and 42 females), age range 28-91 years. More than three-quarters (88 patients; 77.19%) had a body mass index (BMI) between 25 and 40 kg/m(2), and 26 patients (22.8%) had a BMI between 20 and 25 kg/m(2). Among the patients with BMI less than 25 kg/m(2), 12 patients had Hinchey 1 (46%), 8 Hinchey 2 (30.7%), 4 Hinchey 3 (15.4%), and two Hinchey 4 (7.7%). Of the patients with BMI greater than 25 kg/m(2), 19 patients had Hinchey 1 (21.6%), 24 Hinchey 2 (27.3%), 27 Hinchey 3 (30.7%), and 18 Hinchey 4 (20.45%). A statistically significant difference (P<0.001) was found between groups using Mann-Whitney U test. The BMI greater than 25 kg/m(2) as risk factor for complicated diverticular disease showed Odds Ratio of 3.4884 (95% confidence interval 1.27-9.55) with Z value of 2.44 (P=0.014).
CONCLUSIONS: In this study, obesity was associated with an increased incidence and severity of complicated diverticular disease.},
}
@article {pmid26105021,
year = {2016},
author = {De Cecco, CN and Ciolina, M and Annibale, B and Rengo, M and Bellini, D and Muscogiuri, G and Maruotti, A and Saba, L and Iafrate, F and Laghi, A},
title = {Prevalence and distribution of colonic diverticula assessed with CT colonography (CTC).},
journal = {European radiology},
volume = {26},
number = {3},
pages = {639-645},
pmid = {26105021},
issn = {1432-1084},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Asymptomatic Diseases ; Cecal Diseases/diagnostic imaging/epidemiology ; Colon, Ascending/diagnostic imaging ; Colon, Descending/diagnostic imaging ; Colon, Sigmoid/diagnostic imaging ; Colon, Transverse/diagnostic imaging ; Colonography, Computed Tomographic/*statistics & numerical data ; Contrast Media ; Diverticulum, Colon/diagnostic imaging/*epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Multidetector Computed Tomography/statistics & numerical data ; Prevalence ; Retrospective Studies ; Sex Factors ; },
abstract = {OBJECTIVES: This study aimed to evaluate the prevalence of colonic diverticula according to age, gender, distribution, disease extension and symptoms with CT colonography (CTC).
METHODS: The study population included 1091 consecutive patients who underwent CTC. Patients with diverticula were retrospectively stratified according to age, gender, clinical symptoms and colonic segment involvement. Extension of colonic diverticula was evaluated using a three-point quantitative scale. Using this data, a multivariate regression analysis was applied to investigate the existence of any correlation among variables.
RESULTS: Colonic diverticula were observed in 561 patients (240 men, mean age 68 ± 12 years). Symptomatic uncomplicated diverticular disease (SUDD) was present in 47.4% of cases. In 25.6% of patients ≤40 years, at least one diverticulum in the colon was observed. Prevalence of right-sided diverticula in patients >60 years was 14.2% in caecum and 18.5% in ascending colon. No significant difference was found between symptomatic and asymptomatic patients regarding diverticula prevalence and extension. No correlation was present between diverticula extension and symptoms.
CONCLUSION: The incidence of colonic diverticula appears to be greater than expected. Right colon diverticula do not appear to be an uncommon finding, with their prevalence increasing with patient age. SUDD does not seem to be related to diverticula distribution and extension.
KEY POINTS: Incidence of colonic diverticula appears to be greater than expected. Right colon diverticula do not appear to be an uncommon finding. SUDD does not seem to be related to diverticula distribution and extension.},
}
@article {pmid26060863,
year = {2015},
author = {Lembcke, BJ and Strobel, D and Dirks, K and Becker, D and Menzel, J},
title = {Statement of the section internal medicine of the DEGUM - ultrasound obtains pole position for clinical imaging in acute diverticulitis.},
journal = {Ultraschall in der Medizin (Stuttgart, Germany : 1980)},
volume = {36},
number = {2},
pages = {191-195},
doi = {10.1055/s-0034-1369761},
pmid = {26060863},
issn = {1438-8782},
mesh = {Acute Disease ; Chronic Disease ; Colon/diagnostic imaging/pathology ; Colonic Diseases/diagnostic imaging/pathology ; Diverticulitis, Colonic/classification/*diagnostic imaging/pathology ; Germany ; Humans ; Intestinal Perforation/diagnostic imaging/pathology ; Sensitivity and Specificity ; *Societies, Medical ; Tomography, X-Ray Computed ; Ultrasonography ; },
abstract = {This paper reviews and interprets the role of ultrasonography in view of the recently published Guideline on diverticular disease of the Consensus conference of the German Societies of Gastroenterology (DGVS) and Visceral Surgery (DGAV) implying a new classification of diverticular disease (CDD). Qualified US is not only equipotent to qualified CT and frequently effectual for diagnosis but considers relevant legislation for radiation exposure protection. Unsurpassed resolution allows detailed resolution thereby allowing to differentiate and stratify the relevant types of diverticular disease. Subsequently, US is considered the first choice of imaging in diverticular disease. Vice versa, CT has definite indications in unclear / discrepant situations – or insufficient US-performance.},
}
@article {pmid26043583,
year = {2015},
author = {Jovanović, I and Jovanović, D and Uglješić, M and Milinić, N and Cvetković, M and Branković, M and Nikolić, G},
title = {Anismus as a cause of functional constipation--experience from Serbia.},
journal = {Vojnosanitetski pregled},
volume = {72},
number = {1},
pages = {9-11},
doi = {10.2298/vsp1501009j},
pmid = {26043583},
issn = {0042-8450},
mesh = {Anal Canal/*physiopathology ; Anus Diseases/*complications/epidemiology/*physiopathology ; Case-Control Studies ; Constipation/epidemiology/*etiology/*physiopathology ; Humans ; Manometry ; Predictive Value of Tests ; Serbia/epidemiology ; },
abstract = {UNLABELLED: BACKROUND/AIM: Anismus is paradoxal pressure increase or pressure decrease less than 20% of external anal sphincter during defecation straining. This study analyzed the presence of anismus as within a group of patients with the positive Rome III criteria for functional constipation. We used anorectal manometry as the determination method for anismus.
METHODS: We used anorectal water-perfused manometry in 60 patients with obstructive defecation defined by the Rome III criteria for functional constipation. We also analyzed anorectal function in 30 healthy subjects.
RESULTS: The presence of anismus is more frequent in the group of patients with obstructive defecation compared to the control group (a highly statistically significant difference, p < 0.01). Furthermore, we found that the Rome III criteria for functional constipation showed 90% accuracy in predicting obstructive defecation. We analyzed the correlation of anismus with the presence of weak external anal sphincter, rectal sensibility disorders, enlarged piles, diverticular disease and anatomic variations of colon. We found no correlation between them in any of these cases.
CONCLUSION: There is a significant correlation between anismus and positive Rome III criteria for functional constipation. Anorectal manometry should be performed in all patients with the positive Rome III criteria for functional constipation.},
}
@article {pmid26041371,
year = {2015},
author = {Subramanian, M and Chawla, A and Chokkappan, K and Liu, H},
title = {Diverticulitis of the appendix, a distinctive entity: preoperative diagnosis by computed tomography.},
journal = {Emergency radiology},
volume = {22},
number = {5},
pages = {609-612},
pmid = {26041371},
issn = {1438-1435},
mesh = {*Appendectomy ; Appendicitis/*diagnostic imaging/*surgery ; Contrast Media ; Diagnosis, Differential ; Diverticulitis/*diagnostic imaging/*surgery ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; *Tomography, X-Ray Computed ; },
abstract = {Diverticular disease of the appendix is rare and is usually diagnosed during surgery. We report a case of a 50-year-old man who presented to the emergency department with right lower quadrant pain of 1-day duration. A preoperative diagnosis of appendiceal diverticulitis was made by computed tomography of the abdomen. The patient underwent emergency laparoscopic appendectomy, which confirmed the diagnosis.},
}
@article {pmid26039719,
year = {2015},
author = {Louis, E},
title = {When it is not inflammatory bowel disease: differential diagnosis.},
journal = {Current opinion in gastroenterology},
volume = {31},
number = {4},
pages = {283-289},
doi = {10.1097/MOG.0000000000000183},
pmid = {26039719},
issn = {1531-7056},
mesh = {Age Factors ; Colitis/chemically induced/diagnosis ; Diagnosis, Differential ; Genetic Diseases, Inborn/diagnosis ; Humans ; Immune Tolerance ; Inflammatory Bowel Diseases/*diagnosis ; Opportunistic Infections/diagnosis ; Tuberculosis, Gastrointestinal/diagnosis ; },
abstract = {PURPOSE OF REVIEW: Inflammatory bowel diseases (IBDs) represent a heterogeneous entity whose diagnosis is sometimes difficult to ascertain. Many pathological processes may mimic IBD phenotypes. Among the classical differential diagnoses are enteric infections and infestations as well as drug toxicity. However, recently, more specific differential diagnoses have been included, including monogenic causes of gastrointestinal tract inflammation, particularly in young children. The purpose of the present review is to describe the differential diagnosis of IBD, putting it in a specific clinical and demographic context. This differential diagnosis will be discussed specifically for young children, elderly patients, and immunosuppressed patients.
RECENT FINDINGS: We will focus on the most recent findings and concepts, including monogenic diseases in young children, diverticular disease-associated colitis in elderly patients, and toxic colitis in patients receiving immunosuppressants such as mycophenolate mofetil or biologics such as ipilimumab.
SUMMARY: The aim of this review is to alert the clinician dealing with IBD, concerning a series of specific diagnoses that should be recognized because they may require specific treatment, different from the ones of classical idiopathic IBD.},
}
@article {pmid26036456,
year = {2015},
author = {Palladino, E and Cappiello, A and Guarino, V and Perrotta, N and Loffredo, D},
title = {Laparoscopic colostomy for acute left colon obstruction caused by diverticular disease in high risk patient: A case report.},
journal = {International journal of surgery case reports},
volume = {12},
number = {},
pages = {78-80},
pmid = {26036456},
issn = {2210-2612},
abstract = {INTRODUCTION: The colostomy is often necessary in complicated divertcular disease. The laparoscopic colostomy is not widely used for the treatment of complicated diverticular disease. Its use in patients with high operative risk is still on debate. The aim of this case report was to present the benefits of laparoscopic colostomy in patients with high peri-and postoperative risk factors.
PRESENTATION OF CASE: We present a case of 76-year-old female admitted to emergency unit for left colonic obstruction. The patient had a past history of liver cirrhosis HCV-related with a severe malnutrition, hypertrophic cardiomyopathy, diverticular disease, hiatal ernia, previous appendectomy. Patient was classified according to their preoperative risk ASA 3 (classification of the American society of Anestesia-ASA score). Contrast-enhanced abdominal CT revealed a marked thickening in the sigmoid colon and a marked circumferential stenosis in the sigmoid colon in absence of neoplasm, and/or abscess. The laparoscopic procedure is proposed as first intention.
DISCUSSION: The operation time was 50min, and the hospital stay was 4 days. Post operative complications grade I according to the Clavien Dindo Classification.
CONCLUSIONS: Laparoscopic colostomy is safe and feasible procedure in experienced hands. It is associated with low morbidity and short stay in hospital and should be considered a good alternative to a laparotomy.},
}
@article {pmid26023598,
year = {2015},
author = {Jain, M and Wagh, S and Balsarkar, DJ},
title = {Colovesical fistula: a rare complication of diverticulitis in young male.},
journal = {Journal of clinical and diagnostic research : JCDR},
volume = {9},
number = {4},
pages = {PD17-8},
pmid = {26023598},
issn = {2249-782X},
abstract = {Herniation of colonic mucosa through the circular muscles at the point of penetration of blood vessels results in diverticuli formation. It is seen most commonly in the large bowel in sigmoid colon. Common complications of diverticular disease are inflammation and bleeding per rectum and rarely fistula formation which are seen mostly in elderly patients. A case of colovesical fistula with diverticulitis in young male aged 30 years is reported.},
}
@article {pmid26021425,
year = {2014},
author = {Mahieu, J and Mansvelt, B and Veys, E},
title = {Sigmoid Resection with Primary Anastomosis for Uncomplicated Giant Colonic Diverticulum : a Report of two Cases.},
journal = {Acta chirurgica Belgica},
volume = {114},
number = {4},
pages = {280-283},
pmid = {26021425},
issn = {0001-5458},
mesh = {Adult ; Aged ; Colon, Sigmoid/*surgery ; Digestive System Surgical Procedures/*methods ; Diverticulum, Colon/diagnosis/*surgery ; Female ; Humans ; Laparoscopy ; Male ; Severity of Illness Index ; Tomography, X-Ray Computed ; },
abstract = {Giant colonic diverticulum (GCD) is a rare complication of colonic diverticulosis. A small number of cases has been reported in the literature. Patients with GCD have often few non-specific symptoms. Unfortunately, severe complications exist and may lead to surgical acute abdomen. Therefore, this complication of the diverticular disease must be known and properly treated. There is no gold standard diagnostic test, but an air-fluid or air-filled, rounded, pseudocystic image in relation with the colonic wall in a patient with colonic diverticula should suggest this diagnosis to the clinician. We report two cases of a 70-year-old male patient and a 44-year-old female patient having a giant sigmoid diverticulum. The treatment of choice of an uncomplicated GCD is an elective colonic resection, including the giant -diverticulum, with primary anastomosis ; while in case of complicated GCD (peritonitis, abscess or complex fistula), a two-stage resection should be considered.},
}
@article {pmid26019048,
year = {2015},
author = {Schreyer, AG and Layer, G and , },
title = {S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist.},
journal = {RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin},
volume = {187},
number = {8},
pages = {676-684},
doi = {10.1055/s-0034-1399526},
pmid = {26019048},
issn = {1438-9010},
mesh = {Algorithms ; Colonoscopy ; Contrast Media ; Diverticulitis, Colonic/classification/*diagnosis/*therapy ; Diverticulosis, Colonic/classification/*diagnosis/*therapy ; Germany ; Humans ; Image Enhancement ; *Magnetic Resonance Imaging ; Sensitivity and Specificity ; *Tomography, X-Ray Computed ; *Ultrasonography ; },
abstract = {UNLABELLED: Diverticular disease and diverticulitis represent an increasingly common disease especially in patients with advanced age. The German Society of Digestive and Metabolic Diseases (DGVS) as well as the German Society of General and Visceral Surgery (DGAV) in collaboration with the German Radiology Society (DRG) created and published S2k guidelines regarding this topic. Knowledge of the diagnosis and therapy of this common disease is extremely important for the radiologist for the daily clinical routine. In this article we review and discuss the most important clinical situations and algorithms of this disease focusing on radiological topics. Additionally, we introduce the new CCD (classification of diverticular disease) system regarding radiology.
KEY POINTS: For the diagnosis of a diverticular disease a sectional imaging method should be performed. First choice should be a "qualified ultrasound examination" followed by CT in uncertain situations or complicated disease. Disease classification should be done according the new CCD (Classification of diverticular disease) algorithm. Based on this new CCD patients can be stratified into outpatient, in-house patient and surgical treatment therapy.},
}
@article {pmid26005319,
year = {2015},
author = {Roscio, F and Grillone, G and Frattini, P and De Luca, A and Girardi, V and Scandroglio, I},
title = {Effectiveness of elective laparoscopic treatment for colonic diverticulitis.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {19},
number = {2},
pages = {},
pmid = {26005319},
issn = {1938-3797},
mesh = {Blood Loss, Surgical/statistics & numerical data ; *Colectomy ; Conversion to Open Surgery/statistics & numerical data ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures ; Female ; Follow-Up Studies ; Humans ; *Laparoscopy ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; Quality of Life ; Retrospective Studies ; },
abstract = {BACKGROUND AND OBJECTIVES: To analyze the short- and long-term outcomes of laparoscopic sigmoid colectomy for the elective treatment of diverticular disease.
METHODS: A consecutive unselected series of 94 patients undergoing elective laparoscopic sigmoid colectomy for diverticular disease from 2008 to 2012 was analyzed. We collected patients-, surgery- and hospital stay-related data, as well as the short- and long-term outcomes. Operative steps, instrumentation, and postoperative cares were standardized. Comorbidity was assessed by Charlson comorbidity index. Complications were classified using the Clavien-Dindo classification system. The qualitative long-term assessment was carried out by subjecting patients to the validated gastrointestinal quality of life index questionnaire before and after surgery.
RESULTS: The mean age of our cohort was 61.3 ± 11.0 years with a Charlson comorbidity index of 1.2 ± 1.5. Mean operative time was 213.5 ± 60.8 minutes and estimated blood loss was 67.2 ± 94.3 mL. We had 3 cases (3.2%) of conversion to open laparotomy. The rates of postoperative complications were 35.1%, 6.3%, 2.1%, and 1.06%, respectively, for grades 1, 2, 3b, and 5 according to the Clavien-Dindo system. Length of hospital stay was 8.1 ± 1.9 days, and we have not recorded readmissions in patients discharged within 60 days after surgery. Median follow-up was of 9.6 ± 2.7 months. We observed no recurrence of diverticular disease, but there was evidence of 3 cases of incisional hernia (3.19%). The difference between preoperative and late gastrointestinal quality of life index score was statistically significant (97.1 ± 5.8 vs 129.6 ± 8.0).
CONCLUSIONS: Elective laparoscopic treatment of colonic diverticular disease represents an effective option that produces adequate postoperative results and ensures a satisfactory functional outcome.},
}
@article {pmid26003116,
year = {2015},
author = {Connelly, TM and Berg, AS and Harris, LR and Tappouni, R and Brinton, D and Deiling, S and Koltun, WA},
title = {Surgical diverticulitis is not associated with defects in the expression of wound healing genes.},
journal = {International journal of colorectal disease},
volume = {30},
number = {9},
pages = {1247-1254},
pmid = {26003116},
issn = {1432-1262},
mesh = {Adult ; Age Factors ; Aged ; Colon, Sigmoid/*chemistry/surgery ; Diverticulitis, Colonic/*genetics/surgery ; Down-Regulation ; Extracellular Matrix/genetics ; Female ; Gene Expression ; *Genetic Predisposition to Disease ; Humans ; Male ; Middle Aged ; RNA, Messenger/analysis ; Vitronectin/genetics ; Wound Healing/*genetics ; },
abstract = {PURPOSE: The development of diverticuli may represent defects in collagen vascular tissue integrity possibly from a genetic predisposition. We evaluated the tissue expression of wound healing genes in sigmoid tissue from youthful patients undergoing surgery for diverticulitis and thus would more likely suffer from a genetic predisposition (SD mean age 39 ± 0.9) versus controls in the form of patients over the age of 50 (mean age 52.9 ± 10.5 years) without evidence of diverticular disease.
METHODS: The mRNA expression of 84 genes associated with the extracellular matrix, cellular adhesion, growth factors, inflammatory cytokines, and signal transduction was evaluated in 16 SD and 15 control tissues using a Qiagen Wound Healing Array. Vitronectin, the gene protein with the highest potential significance on raw analysis, was further investigated using a Taqman assay with an additional 11 SD (total n = 27) and four control (total n = 19) samples. Statistics were by Student's t and Mann-Whitney tests with Bonferroni correction.
RESULTS: No significant differences in mRNA expression between the SD and control tissue in the 84 measured genes were demonstrated after correction. Vitronectin mRNA expression was downregulated 2.7-fold in SD tissue vs. tissue from non-neoplastic control patients (p = 0.001 raw/0.08 corrected). However, on vitronectin TaqMan analysis, no difference in expression was seen in SD vs. all controls or in all subset comparisons.
CONCLUSIONS: The lack of significant alteration in mRNA expression of traditionally associated wound healing genes/proteins in young SD patients suggests that such genes play a minor role in the genetic predisposition to youthful diverticulitis.},
}
@article {pmid25994783,
year = {2016},
author = {Winder, A and Richter, KK},
title = {Twin sisters with perforated sigmoid diverticulitis support heredity in the pathogenesis of diverticular disease.},
journal = {International journal of colorectal disease},
volume = {31},
number = {3},
pages = {755-756},
doi = {10.1007/s00384-015-2255-1},
pmid = {25994783},
issn = {1432-1262},
mesh = {Adult ; Colon, Sigmoid/*pathology ; Diverticulitis/*complications ; Diverticulitis, Colonic/*complications/*genetics ; Female ; Heredity/*genetics ; Humans ; Intestinal Perforation/*complications ; Laparoscopy ; *Siblings ; Twins/*genetics ; },
}
@article {pmid25986059,
year = {2015},
author = {Rizzuto, A and Lacamera, U and Zittel, FU and Sacco, R},
title = {Single incision laparoscopic resection for diverticulitis.},
journal = {International journal of surgery (London, England)},
volume = {19},
number = {},
pages = {11-14},
doi = {10.1016/j.ijsu.2015.05.012},
pmid = {25986059},
issn = {1743-9159},
mesh = {Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Diverticulitis/*surgery ; Elective Surgical Procedures/adverse effects/methods ; Female ; Germany ; Humans ; Intestinal Perforation/surgery ; Intraoperative Complications ; Laparoscopy/adverse effects/*methods ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Sigmoid Diseases/*surgery ; Treatment Outcome ; Umbilicus/surgery ; },
abstract = {BACKGROUND: Laparoscopic sigmoidectomy is the standard procedure in elective surgery for recurrent diverticular disease. Recently, Single Incision Laparoscopic Surgery (SILS) have been developed as the next generation technique of minimally invasive surgery. SILS advantages include reduced surgical trauma due to reduction in the number of surgical incisions, faster recovery times, and reduced hospitalization. However, the use of SILS in colorectal surgery is technically demanding and requires expert surgeons, which has hampered the reproducibility and the diffusion of this technique.
METHODS: Between October 2009 and August 2013, 488 consecutive patients were referred to Evangelisches Hochstift Hospital (Worms, Germany) and/or Stadt Klinikum Frankental Hospital (Frankenthal, Germany) for sigmoidectomy for diverticular disease. SILS sigmoidectomy via the umbilicus was performed in 484/488 cases. Clinical outcomes such as the rate of conversion to standard laparoscopy and/or to open surgery, operation time, post-operative complications and hospitalization time were recorded.
RESULTS: SILS sigmoidectomy was successfully completed for 484 out of 488 patients. SILS was converted to standard laparoscopy in 3 patients (0.6%) and to an open procedure in 1 patient (0.2%). Median time for the procedures was 103.26 min (range, 52-156 min). No mortalities or major complications were noted. The average hospitalization period was of 5 days.
CONCLUSION: Our work demonstrates that SILS sigmoidectomy via the umbilicus is effective in the treatment of patients affected by diverticular disease on a routine basis and, moreover, is technically feasible also in patients who have been subjected to previous abdominal surgery, with high Body Mass Index and/or patients with perforation at presentation. Thus this procedure represents a valid alternative to standard laparoscopy.},
}
@article {pmid25980396,
year = {2015},
author = {Braunschmid, T and Stift, A and Mittlböck, M and Lord, A and Weiser, FA and Riss, S},
title = {Constipation is not associated with diverticular disease - Analysis of 976 patients.},
journal = {International journal of surgery (London, England)},
volume = {19},
number = {},
pages = {42-45},
doi = {10.1016/j.ijsu.2015.04.045},
pmid = {25980396},
issn = {1743-9159},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Body Mass Index ; Colonoscopy ; Constipation/*complications ; Diabetes Complications ; Diverticulosis, Colonic/*complications ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; *Quality of Life ; Surveys and Questionnaires ; Young Adult ; },
abstract = {BACKGROUND: In the light of controversial data in the literature, the present study was designed to evaluate potential associations between colonic diverticular disease, constipation and quality of life.
DESIGN: We prospectively enrolled 976 consecutive patients, who participated in the nationwide colorectal cancer screening program in four medical centers between 2008 and 2009. All patients underwent full colonoscopy and completed a standardized questionnaire. The severity of constipation was assessed by the validated Wexner constipation score. Quality of Life (QOL) was evaluated by the SF-12 health score.
RESULTS: The median age was 62 years (range 22-90) and the male to female ratio was 1:1. Colonic diverticular disease was found in 290 participants (30%). Age, body mass index and diabetes mellitus were significantly associated with the presence of diverticular disease (p < 0.0001, p = 0.0007 and p = 0.0178). The median constipation score in patients with diverticular disease was 3 (range 0-18), and comparable to patients without diverticula (p = 0.1073). The physical component summary of the SF-12 was significantly reduced in patients with diverticular disease (p = 0.0038).
CONCLUSION: This large population based study revealed no association between colonic diverticular disease and constipation. Notably, the presence of diverticular disease significantly impacts quality of life.},
}
@article {pmid25979437,
year = {2015},
author = {Gargallo Puyuelo, CJ and Sopeña, F and Lanas Arbeloa, A},
title = {Colonic diverticular disease. Treatment and prevention.},
journal = {Gastroenterologia y hepatologia},
volume = {38},
number = {10},
pages = {590-599},
doi = {10.1016/j.gastrohep.2015.03.010},
pmid = {25979437},
issn = {0210-5705},
mesh = {Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Combined Modality Therapy ; Contraindications ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/drug therapy/etiology/prevention & control/surgery ; *Diverticulosis, Colonic/complications/physiopathology/prevention & control/therapy ; Gastrointestinal Agents/therapeutic use ; Humans ; Intestinal Fistula/etiology/prevention & control ; Mesalamine/therapeutic use ; Parasympatholytics/therapeutic use ; Peritonitis/etiology/prevention & control ; Probiotics/therapeutic use ; Vitamin D/therapeutic use ; },
abstract = {Diverticular disease represents the most common disease affecting the colon in the Western world. Most cases remain asymptomatic, but some others will have symptoms or develop complications. The aims of treatment in symptomatic uncomplicated diverticular disease are to prevent complications and reduce the frequency and intensity of symptoms. Fibre, probiotics, mesalazine, rifaximin and their combinations seem to be usually an effective therapy. In the uncomplicated diverticulitis, outpatient management is considered the optimal approach in the majority of patients, and oral antibiotics remain the mainstay of treatment. Admission to hospital and intravenous antibiotic are recommended only when the patient is unable to intake food orally, affected by severe comorbidity or does not improve. However, inpatient management and intravenous antibiotics are necessary in complicated diverticulitis. The role of surgery is also changing. Most diverticulitis-associated abscesses can be treated with antibiotics and/or percutaneous drainage and emergency surgery is considered only in patients with acute peritonitis. Finally, patient related factors, and not the number of recurrences, play the most important role in selecting recipients of elective surgery to avoid recurrences.},
}
@article {pmid25975334,
year = {2015},
author = {Connelly, TM and Tappouni, R and Mathew, P and Salgado, J and Messaris, E},
title = {Risk factors for the development of an incisional hernia after sigmoid resection for diverticulitis: an analysis of 33 patients, operative and disease-associated factors.},
journal = {The American surgeon},
volume = {81},
number = {5},
pages = {492-497},
pmid = {25975334},
issn = {1555-9823},
mesh = {Diverticulitis/*surgery ; Female ; Hernia, Ventral/*epidemiology ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/*epidemiology ; Retrospective Studies ; Risk Factors ; Sigmoid Diseases/*surgery ; },
abstract = {Incisional hernia (IH) is a relatively common sequelae of sigmoidectomy for diverticulitis. The aim of this study was to investigate factors that may predict IH in diverticulitis patients. Two hundred and one diverticulitis patients undergoing sigmoidectomy between January 2002 and December 2012 were identified (mean follow-up 5.15 ± 2.33 years). Patients with wound infections were excluded. Thirteen patient-associated, three diverticular disease-related, and 17 operative variables were evaluated in patients with and without IH. Volumetric fat was measured on preoperative CTs. Fischer's exact, χ(2), and Mann-Whitney tests and multivariate regression analysis were used for statistics. Thirty-four (17%) patients had an IH. On multivariate analysis, wound packing (OR 3.4, P = 0.017), postoperative nonwound infection (OR 7.4, P = 0.014), and previous hernia (OR 3.6, P = 0.005) were as independent predictors of IH. Fifteen of 34 (44%) patients who developed a hernia had a history of prior hernia. Of 33 potential risk factors analyzed, including smoking, chronic obstructive pulmonary disease, and obesity, the only patient factor present preoperatively associated with increased risk of a postsigmoidectomy hernia after multivariate analysis was a history of a previous hernia. Preoperative identification of patients with a history of hernia offers the opportunity to employ measures to decrease the likelihood of IH.},
}
@article {pmid25972652,
year = {2015},
author = {Shrivastava, A and Shukla, YP and Gupta, A and Shrivastava, J},
title = {A rare case of large jejunal diverticulum presenting as intestinal obstruction due to small bowel volvulus.},
journal = {The Indian journal of surgery},
volume = {77},
number = {Suppl 1},
pages = {77-78},
pmid = {25972652},
issn = {0972-2068},
abstract = {Jejunal diverticula are quite rare. Furthermore, small bowel diverticular disease resulting in volvulus can lead to complications necessitating surgical intervention. In this manuscript, we report a case of large sacculated jejunal diverticulum causing small bowel volvulus in a 40-year male. The jejunal mesentery at the base of the diverticulum was adhered to the terminal ileal mesentery forming a narrow base and complete small bowel going into volvulus by rotating around the narrow base. This case highlights a large jejunal diverticulum causing small bowel volvulus as an uncommon mechanism of complete small bowel volvulus. Although a rare entity, familiarity with jejunal diverticular disease, its complications and its management should be part of every surgeon's base of knowledge when considering abdominal pathology.},
}
@article {pmid25960973,
year = {2015},
author = {Kiani, QH and George, ML and Carapeti, EA and Schizas, AM and Williams, AB},
title = {Colovesical fistula: should it be considered a single disease?.},
journal = {Annals of coloproctology},
volume = {31},
number = {2},
pages = {57-62},
pmid = {25960973},
issn = {2287-9714},
abstract = {PURPOSE: This research was conducted to compare the management and the outcome of patients with colovesical fistulae of different aetiologies.
METHODS: Retrospective data were collected from 2002 to 2012 and analyzed with SPSS ver. 17. Age, gender, aetiology, management, hospital stay, postoperative complications, and mortality were studied and compared among colovesical fistulae of different aetiologies.
RESULTS: A total of 55 patients, 46 males (84%) and 9 females (16%), with a median age of 65 years (interquartile range [IQR], 48-75 years) were studied. Diverticular disease was the most common benign cause and recto-sigmoid cancer the most common malignancy. Anterior resection and bladder repair were the most frequent operations in benign cases, as was total pelvic exenteration in the malignant group. Multiple intestinal loop involvement and subsequent resection were significantly higher in those with Crohn disease than it was in patients of colovesical fistula due to all other causes collectively (60% vs. 6%, P = 0.006). Patients with malignancy had a higher postoperative complication rate than patients who did not (12 [80%] vs. 7 [32%], P = 0.0005). Pelvic collection (11, 22%) was the most frequent early complication (predominantly in the malignant group) whereas incisional hernia (8, 22%) was the most common late complication, with a predominance in the benign group. The median hospital stay was significantly prolonged in the malignant group (32 days; IQR, 17-70 days vs. 16 days; IQR, 11-25 days; P < 0.001).
CONCLUSION: Despite their having similar clinical presentation, colovesical fistulae of various aetiologies differ significantly in management and outcome.},
}
@article {pmid25958304,
year = {2015},
author = {Venara, A and Toqué, L and Barbieux, J and Cesbron, E and Ridereau-Zins, C and Lermite, E and Hamy, A},
title = {Sigmoid stricture associated with diverticular disease should be an indication for elective surgery with lymph node clearance.},
journal = {Journal of visceral surgery},
volume = {152},
number = {4},
pages = {211-215},
doi = {10.1016/j.jviscsurg.2015.04.001},
pmid = {25958304},
issn = {1878-7886},
mesh = {Aged ; Aged, 80 and over ; *Colectomy/methods ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/*complications/surgery ; *Elective Surgical Procedures ; Female ; Follow-Up Studies ; Humans ; Intestinal Obstruction/etiology/*surgery ; Male ; Middle Aged ; Postoperative Complications/*epidemiology ; Quality of Life ; Retrospective Studies ; Sigmoid Diseases/etiology/*surgery ; Treatment Outcome ; },
abstract = {BACKGROUND: The literature concerning stricture secondary to diverticulitis is poor. Stricture in this setting should be an indication for surgery because (a) of the potential risk of cancer and (b) morbidity is not increased compared to other indications for colectomy. The goal of this report is to study the post-surgical morbidity and the quality of life in patients after sigmoidectomy for sigmoid stricture associated with diverticular disease.
METHOD: This is a monocenter retrospective observational study including patients with a preoperative diagnosis of sigmoid stricture associated with diverticular disease undergoing operation between Jan 1, 2007 and Dec 31, 2013. The GastroIntestinal Quality of Life Index was used to assess patient satisfaction.
RESULTS: Sixteen patients were included of which nine were female. Median age was 69.5 (46-84) and the median body mass index was 23.55kg/m(2) (17.2-28.4). Elective sigmoidectomy was performed in all 16 patients. Overall, complications occurred in five patients (31.2%) (4 minor complications and 1 major complication according to the Dindo and Clavien Classification); none resulted in death. Pathology identified two adenocarcinomas (12.5%). The mean GastroIntestinal Quality of Life Index was 122 (67-144) and 10/11 patients were satisfied with their surgical intervention.
CONCLUSION: Sigmoid stricture prevents endoscopic exploration of the entire colon and thus it may prove difficult to rule out a malignancy. Surgery does not impair the quality of life since morbidity is similar to other indications for sigmoidectomy. For these reasons, we recommend that stricture associated with diverticular disease should be an indication for sigmoidectomy including lymph node clearance.},
}
@article {pmid25942308,
year = {2015},
author = {Tursi, A},
title = {Diverticular disease of the colon and irritable bowel syndrome: it is time to differentiate.},
journal = {The American journal of gastroenterology},
volume = {110},
number = {5},
pages = {774-775},
pmid = {25942308},
issn = {1572-0241},
mesh = {Colon/*pathology ; Diverticulum, Colon/*epidemiology ; Female ; Humans ; Irritable Bowel Syndrome/*epidemiology ; Male ; Rectum/*pathology ; },
}
@article {pmid25938392,
year = {2015},
author = {Milewska, M and Sińska, B and Kluciński, A},
title = {[Dietary prevention and treatment of diverticular disease of the colon].},
journal = {Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego},
volume = {38},
number = {226},
pages = {228-232},
pmid = {25938392},
issn = {1426-9686},
mesh = {Dietary Fiber/administration & dosage ; Diverticulitis, Colonic/*diet therapy/prevention & control ; Drinking Behavior ; Drinking Water/administration & dosage ; Fruit ; Humans ; Vegetables ; },
abstract = {Diverticular disease is more often categorized as a civilization disease that affects both women and men, especially at an old age. The pathophysiology remains complex and arises from the interaction between dietary fiber intake, bowel motility and mucosal changes in the colon. Obesity, smoking, low physical activity, low-fiber diet (poor in vegetables, fruit, whole grain products, seeds and nuts) are among factors that increase the risk for developing diverticular disease. Additionally, the colonic outpouchings may be influenced by involutional changes of the gastrointestinal tract. Therefore, the fiber rich diet (25-40 g/day) plays an important role in prevention, as well as nonpharmacological treatment of uncomplicated diverticular disease. The successful goal of the therapy can be achieved by well-balanced diet or fiber supplements intake. Research indicate the effectiveness of probiotics in dietary management during the remission process. Moreover, drinking of appropriate water amount and excluding from the diet products decreasing colonic transit time - should be also applied.},
}
@article {pmid25925134,
year = {2015},
author = {Vather, R and Broad, JB and Jaung, R and Robertson, J and Bissett, IP},
title = {Demographics and trends in the acute presentation of diverticular disease: a national study.},
journal = {ANZ journal of surgery},
volume = {85},
number = {10},
pages = {744-748},
doi = {10.1111/ans.13147},
pmid = {25925134},
issn = {1445-2197},
mesh = {Acute Disease ; Adolescent ; Adult ; Aged ; Asian People/statistics & numerical data ; Demography/trends ; Diverticulitis, Colonic/*epidemiology/ethnology/*pathology ; Female ; Hospitalization/statistics & numerical data/trends ; Humans ; Male ; Middle Aged ; Morbidity ; Native Hawaiian or Other Pacific Islander/statistics & numerical data ; New Zealand/epidemiology ; White People/statistics & numerical data ; Young Adult ; },
abstract = {BACKGROUND: Diverticular disease (DD) is a major health problem in the Western world. The aim of this study was to describe demographics and trends in acute DD admissions in New Zealand.
METHODS: Information pertaining to acute hospital admissions between January 2000 and June 2012 for a primary diagnosis of large bowel DD was retrieved from a national database.
RESULTS: There were 25,167 admissions for acute DD. Mean age of presentation decreased from 65.9 years in 2000 to 64.1 years in 2012 (P < 0.001). Mean age was lower in men than women (61.4 versus 67.4 years, P < 0.001). Although men comprised 45.2% of the cohort they were over-represented in the 18-44 years stratum (68.6 versus 31.4%; P < 0.001). Europeans accounted for 84.8% of admissions and presented at an older age (65.8 years) than Māori (56.2 years), Pacific Islanders (58.4 years) or Asians (58.9 years) (P < 0.001). Acute DD admissions were higher in more deprived populations (P < 0.001). Mean length of hospital stay (LOS) reduced from 5.8 days in 2000 to 4.1 days in 2012 (P < 0.001). LOS increased with age (P < 0.001) and deprivation (P = 0.013), but did not differ between ethnicities (P = 0.088). Computed tomography scanning of acute admissions doubled from 2000 to 2012 (29.7-59.2%; P < 0.001) with a halving in the use of acute in-patient colonoscopy (26.1-13.2%; P < 0.001) and emergent surgery (14.8-7.2%; P < 0.001). Percutaneous drain use increased from 0.6% in 2000 to 1.1% in 2012 (P = 0.003).
CONCLUSION: Acute DD is a source of considerable morbidity in New Zealand and there have been significant changes in its admission demographics and trends over the last decade.},
}
@article {pmid25919040,
year = {2015},
author = {Chang, SS and Hu, HY},
title = {Long-term use of steroids protects from the development of symptomatic diverticulitis requiring hospitalization in the Asian population.},
journal = {PloS one},
volume = {10},
number = {4},
pages = {e0124598},
pmid = {25919040},
issn = {1932-6203},
mesh = {Acute Disease ; Adult ; Aged ; *Asian People ; Case-Control Studies ; Diverticulitis/*drug therapy/*prevention & control/surgery ; Female ; *Hospitalization ; Humans ; Male ; Middle Aged ; Steroids/*therapeutic use ; Time Factors ; Young Adult ; },
abstract = {OBJECTIVE: The pathophysiology of diverticulitis is poorly understood. Factors such as physical inactivity, constipation, obesity, smoking, and the use of nonsteroidal antiinflammatory drugs (NSAIDs) have been associated with an increased risk of diverticular disease. To evaluate whether patients exhibiting long-term steroid use are at increased risk of colonic diverticulitis.
METHOD: We conducted a population-based, nested case-control study. Data were retrospectively collected from the National Health Insurance Research Database. The study cohort comprised patients diagnosed with diverticulitis, identified using inpatient discharge records using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes (562.11 and 562.13), and those who were administered one or more prescriptions for corticosteroids for systemic use. Control patients were matched to cases by age, sex, NSAID use, laxative drug use, and index date. We enrolled 690 patients with colonic diverticulitis and 2760 in the control group. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression.
RESULTS: Compared with steroid nonusers, the adjusted ORs were 0.60 (95% CI = 0.35-1.06) and 0.80 (95% CI = 0.64-1.008) in current steroid users and previous steroid users, respectively. In addition, the adjusted ORs were 0.55 (95% CI = 0.31-0.98), 0.57 (95% CI = 0.31-0.98), and 0.44 (95% CI = 0.22-0.86) for steroid use duration more than half time by an exposure period of 90 days, 180 days, and 365 days before the claim date of colonic diverticulitis, respectively.
CONCLUSIONS: The results indicated that long-term steroid use within one year is associated with lower risk of colonic diverticulitis.},
}
@article {pmid25914730,
year = {2015},
author = {Goidescu, OC and Patrascu, T},
title = {Analysis of cases of acute occlusive abdomen in elderly patients.},
journal = {Journal of medicine and life},
volume = {8},
number = {1},
pages = {13-15},
pmid = {25914730},
issn = {1844-3117},
mesh = {Abdomen, Acute/*pathology/surgery ; Aged ; Aged, 80 and over ; Female ; Humans ; Postoperative Complications/etiology ; },
abstract = {Mechanisms of acute abdomen in the elderly patient are not different from the ones of young adults. What differs is the large number of associated diseases and specific geriatric pathology, ischemic disorders, diverticular disease. The diagnosis of acute abdomen in the elderly patient is difficult due to unclear symptoms, laboratory samples less modified and low cooperation. The article analyzed two groups of patients over 65 years, hospitalized in surgery in the last three years, with the diagnosis of acute surgical abdomen, from the point of view of the appearance of complications depending on the days of delay until surgery.},
}
@article {pmid25910885,
year = {2015},
author = {Baucom, RB and Poulose, BK and Herline, AJ and Muldoon, RL and Cone, MM and Geiger, TM},
title = {Smoking as dominant risk factor for anastomotic leak after left colon resection.},
journal = {American journal of surgery},
volume = {210},
number = {1},
pages = {1-5},
doi = {10.1016/j.amjsurg.2014.10.033},
pmid = {25910885},
issn = {1879-1883},
mesh = {Anastomotic Leak/epidemiology/*etiology ; Cohort Studies ; *Colectomy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Smoking/*adverse effects ; },
abstract = {BACKGROUND: Some risk factors for anastomotic leak have been identified, but the effect of smoking is unknown.
METHODS: This study aimed to evaluate the effect of smoking on clinical leak after left-sided anastomoses. Adult patients who underwent elective left colectomy between January 1, 2008 and December 31, 2012 were included. Those with stomas and inflammatory bowel diseases were excluded. Primary outcome was anastomotic leak requiring percutaneous drainage or operative intervention within 30 days.
RESULTS: There were 246 patients included; 56% were female. Most had a diagnosis of diverticular disease (53%) or cancer (37%). Anastomotic leak rate was 6.5% (n = 16). The rate in smokers was 17% versus 5% in nonsmokers (P = .01). Smokers had over 4 times greater chance of leak (odds ratio 4.2, 95% confidence interval 1.3 to 13.5, P = .02).
CONCLUSION: Smoking is a risk factor for leak after left colectomy. Consideration should be given to delaying elective left colectomy until smoking cessation is achieved.},
}
@article {pmid25893309,
year = {2015},
author = {Razik, R and Nguyen, GC},
title = {Diverticular disease: changing epidemiology and management.},
journal = {Drugs & aging},
volume = {32},
number = {5},
pages = {349-360},
pmid = {25893309},
issn = {1179-1969},
mesh = {Aged ; Aged, 80 and over ; Colonoscopy ; Diverticulitis/drug therapy/*epidemiology/surgery/*therapy ; Diverticulosis, Colonic/drug therapy/surgery/therapy ; Female ; Gastrointestinal Hemorrhage/drug therapy/*epidemiology/surgery/*therapy ; Humans ; Male ; Risk Factors ; },
abstract = {Diverticulosis is the most common pathological finding in routine colonoscopy. Diverticular disease comprises both diverticulitis and diverticular hemorrhage. This review examines the pathophysiological basis for disease including the importance of the elastin/collagen profile in diverticula formation. It summarizes the latest epidemiological findings with an emphasis on age- and sex-related differences. Risk factors including obesity, medications, hereditary factors, and diet are critically reviewed with the most up-to-date evidence. A detailed appraisal of therapeutic options is provided with special emphasis on 5-aminosalicylate, probiotics, mesalamine, percutaneous abscess drainage, and image-guided embolization. The role of antibiotics and surgery is discussed and compared with guideline recommendations. A more conservative approach, averting admission and even antibiotics, is explored. Finally, a careful review of the data surrounding the utility of colonoscopy in diagnosis and management is provided given the increasing number of reports citing the low incidence of colorectal neoplasia after an episode of diverticulitis. Throughout the review we focus on the older patient with diverticular disease.},
}
@article {pmid25874519,
year = {2015},
author = {Kvasnovsky, CL and Adams, K and Papagrigoriadis, S},
title = {Diverticular disease as a chronic gastrointestinal condition: experience from a specialist clinic.},
journal = {European journal of gastroenterology & hepatology},
volume = {27},
number = {4},
pages = {442-448},
doi = {10.1097/MEG.0000000000000304},
pmid = {25874519},
issn = {1473-5687},
mesh = {Adult ; Aged ; Chronic Disease ; *Diverticulitis, Colonic/diagnosis/etiology/surgery ; Female ; Humans ; Logistic Models ; Male ; Medical Audit ; Middle Aged ; Referral and Consultation/statistics & numerical data ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND: Although diverticular disease is a prevalent condition and a significant burden on the healthcare system, care is devolved across gastrointestinal, GP, and colorectal surgery clinics. We created a specialist Diverticular Disease Clinic to streamline care, enhance evidence-based practice and provide a base for research. The aim of this study was to assess patient referral sources, predictors of persistent disease and surgical outcomes.
METHODS: We retrospectively reviewed all patients attending our clinic. Patients younger than 50 years of age on initial presentation were considered 'younger' patients. Persistent symptoms lasted for at least 3 months.
RESULTS: Overall, 177 patients had confirmed diverticular disease. Patients were referred following hospital admission (82 patients, 46.3%) or from the community (95 patients, 53.7%). Ninety-five patients (53.7%) had persistent symptoms. Patients with more than two episodes of diverticulitis were more likely to have persistent symptoms (P<0.0001).Following hospitalization, younger patients were 3.98 times more likely to develop persistent symptoms (P=0.04). This was independent of the severity of the original infection, as a low peak C-reactive protein level of less than 50 mg/L was associated with persistent symptoms (odds ratio=3.62, P=0.03). Over the study period, 12 patients (6.9%) had elective surgery.
CONCLUSION: There is demand for dedicated care for patients with persistent symptoms from diverticular disease. Specialized clinics are a model for this care, provided by either gastroenterologists or surgeons, in centres with adequate demand. Our findings reinforce the hypotheses that chronic abdominal pain in diverticular disease may be related to sensation abnormalities similar to postinfective irritable bowel syndrome.},
}
@article {pmid25868159,
year = {2015},
author = {Kang, HW and Lee, JK},
title = {[Is the location of diverticular disease associated with irritable bowel syndrome?].},
journal = {The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi},
volume = {65},
number = {2},
pages = {135-137},
doi = {10.4166/kjg.2015.65.2.135},
pmid = {25868159},
issn = {2233-6869},
mesh = {*Diverticulum ; Humans ; *Irritable Bowel Syndrome ; },
}
@article {pmid25864345,
year = {2015},
author = {Osipenko, MF and Livzan, MA and Skalinskaya, MI and Lyalyukova, EA},
title = {[Fecal calprotectin concentration in the differential diagnosis of bowel diseases].},
journal = {Terapevticheskii arkhiv},
volume = {87},
number = {2},
pages = {30-33},
doi = {10.17116/terarkh201587230-33},
pmid = {25864345},
issn = {0040-3660},
mesh = {Adult ; Diagnosis, Differential ; Feces/*chemistry ; Female ; Humans ; Irritable Bowel Syndrome/*diagnosis ; *Leukocyte L1 Antigen Complex ; Male ; },
abstract = {AIM: To estimate the informative value of a noninvasive fecal (calprotectin) test in the differential diagnosis of bowel diseases.
SUBJECTS AND METHODS: One hundred and forty-two patients who had visited their physicians with intestinal disorders (a change in stool frequency and patterns, abdominal pain) were examined in an open-label multicenter cross-sectional study. The examinees' mean age was 35 ± 2.43 years. Gender- and age-matched comparison groups consisted of healthy individuals and patients with irritable bowel syndrome. Fecal calprotectin (FCP) was determined using a BUHLMANN Calprotectin ELISA kit. All the patients underwent colonoscopy.
RESULTS: In the patients with organic bowel diseases (ulcerative colitis, Crohn's disease, lymphocytic colitis, colonic diverticular disease, colonic adenomas, celiac disease), the concentration of FCP was found to be substantially higher than that in the healthy individuals and patients with irritable bowel syndrome. The highest calprotectin levels were noted in the patients with inflammatory bowel diseases.
CONCLUSION: This study demonstrated the high diagnostic value of the calprotectin test for the differential diagnosis of organic and functional bowel diseases.},
}
@article {pmid25862988,
year = {2016},
author = {Wheat, CL and Strate, LL},
title = {Trends in Hospitalization for Diverticulitis and Diverticular Bleeding in the United States From 2000 to 2010.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {14},
number = {1},
pages = {96-103.e1},
pmid = {25862988},
issn = {1542-7714},
support = {R01 DK084157/DK/NIDDK NIH HHS/United States ; R01 DK101495/DK/NIDDK NIH HHS/United States ; R01DK084157/DK/NIDDK NIH HHS/United States ; },
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Diverticulitis/complications/*epidemiology/*pathology ; Ethnicity ; Female ; Gastrointestinal Hemorrhage/*epidemiology/*pathology ; *Hospitalization ; Humans ; Male ; Middle Aged ; Prevalence ; Sex Factors ; United States/epidemiology ; Young Adult ; },
abstract = {BACKGROUND & AIMS: Most studies of trends in diverticular disease have focused on diverticulitis or on a composite outcome of diverticulitis and bleeding. We aimed to quantify and compare the prevalence of hospitalization for diverticular bleeding and diverticulitis overall and by sex and race.
METHODS: We analyzed data from the Nationwide Inpatient Sample from 2000 through 2010. We identified adult patients with a discharge diagnosis of diverticular bleeding or diverticulitis. By using yearly US intercensal data, we calculated age-, sex-, and race-specific rates, as well as age-adjusted prevalence rates.
RESULTS: The prevalence of hospitalizations per 100,000 persons for diverticular bleeding decreased over the 10-year period from 32.5 to 27.1 (-5.4; 95% confidence interval, -5.1 to -5.7). The prevalence of hospitalizations for diverticulitis peaked in 2008 (74.1/100,000 in 2000, 96.0/100,000 in 2008, and 91.9/100,000 in 2010). The prevalence of diverticulitis was higher in women than in men, whereas women and men had similar rates of diverticular bleeding. The prevalence of diverticular bleeding was highest in blacks (34.4/100,000 in 2010); whereas the prevalence of diverticulitis was highest in whites (75.5/100,000 in 2010).
CONCLUSIONS: Over the past 10 years, the prevalence of hospitalizations for diverticulitis increased and then plateaued, whereas that of diverticular bleeding decreased. The prevalence according to sex and race differed for diverticulitis and diverticular bleeding. These findings indicate different mechanisms of pathogenesis for these disorders.},
}
@article {pmid25856133,
year = {2015},
author = {Kvasnovsky, CL and Haji, A and Ryan, S and Lin, SL and Bjarnason, I and Papagrigoriadis, S},
title = {Utilization of High-frequency Mini Probe Ultrasound in the Assessment of Colonic Wall Thickness in Patients With Diverticular Disease: A Feasibility Study.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {25},
number = {3},
pages = {205-208},
doi = {10.1097/SLE.0000000000000152},
pmid = {25856133},
issn = {1534-4908},
mesh = {Colon/*diagnostic imaging ; Colonoscopy ; Diverticulosis, Colonic/*diagnostic imaging ; Feasibility Studies ; Female ; Four-Dimensional Computed Tomography ; Humans ; Male ; Middle Aged ; Ultrasonography ; },
abstract = {BACKGROUND: Assessment of diverticular disease (DD) is routinely undertaken by colonoscopy and computed tomography (CT) scan. Improvements in high-frequency ultrasound have enabled evaluation of the colon wall structure in detail. Our objective was to assess ultrasound in measuring colonic wall thickness in DD.
METHODS: High-frequency 20-MHz ultrasound was undertaken to measure individual layer and total colonic wall thickness. Case patients had symptomatic DD. Control patients underwent colonoscopy for other reasons. Select patients also underwent abdominal CT scan.
RESULTS: Thirty-three patients underwent colonoscopic ultrasound, 18 with sigmoid diverticula and 15 control patients.Total wall thickness was greater in patients with DD, 5.69 mm (1.68) versus 2.61 mm (1.29, P<0.0001). Patients with DD had significant thickening in each individual layer of the colonic wall measured (each P<0.0001).Greatest differences were in the muscularis propria, which was an average of 3.5 times thicker in patients with DD. In patients with DD, the segment of colonic wall measured was also thicker, with average mid-sigmoid thickness of 23.0 mm (SD 9.6 mm).
CONCLUSIONS: Patients with DD have increased sigmoid thickness when compared with controls, especially the muscularis propria. Unlike CT, ultrasound was also able to identify thickening in the mucosa and submucosa.},
}
@article {pmid25841661,
year = {2015},
author = {Schoepf, D and Heun, R},
title = {Alcohol dependence and physical comorbidity: Increased prevalence but reduced relevance of individual comorbidities for hospital-based mortality during a 12.5-year observation period in general hospital admissions in urban North-West England.},
journal = {European psychiatry : the journal of the Association of European Psychiatrists},
volume = {30},
number = {4},
pages = {459-468},
doi = {10.1016/j.eurpsy.2015.03.001},
pmid = {25841661},
issn = {1778-3585},
mesh = {Adult ; Aged ; Alcoholism/*mortality ; Chronic Disease/*mortality ; Comorbidity ; England/epidemiology ; Female ; *Health Status ; *Hospital Mortality ; Hospitalization/statistics & numerical data ; Hospitals, General ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Prevalence ; Risk Factors ; },
abstract = {PURPOSE: Alcohol dependence (AD) is associated with an increase in physical comorbidities. The effects of these diseases on general hospital-based mortality are unclear. Consequently, we conducted a mortality study in which we investigated if the burden of physical comorbidities and their relevance on general hospital-based mortality differs between individuals with and without AD during a 12.5-year observation period in general hospital admissions.
METHODS: During 1 January 2000 and 30 June 2012, 23,371 individuals with AD were admitted at least once to seven General Manchester Hospitals. Their physical comorbidities with a prevalence≥1% were compared to those of 233,710 randomly selected hospital controls, group-matched for age and gender (regardless of primary admission diagnosis or specialized treatments). Physical comorbidities that increased the risk of hospital-based mortality (but not outside of the hospital) during the observation period were identified using multiple logistic regression analyses.
RESULTS: Hospital-based mortality rates were 20.4% in the AD sample and 8.3% in the control sample. Individuals with AD compared to controls had a higher burden of physical comorbidities, i.e. alcoholic liver and pancreatic diseases, diseases of the conducting airways, neurological and circulatory diseases, diseases of the upper gastrointestinal tract, renal diseases, cellulitis, iron deficiency anemia, fracture neck of femur, and peripheral vascular disease. In contrast, coronary heart related diseases, risk factors of cardiovascular disease, diverticular disease and cataracts were less frequent in individuals with AD than in controls. Thirty-two individual physical comorbidities contributed to the prediction of hospital-based mortality in univariate analyses in the AD sample; alcoholic liver disease (33.7%), hypertension (16.9%), chronic obstructive pulmonary disease (14.1%), and pneumonia (13.3%) were the most frequent diagnoses in deceased individuals with AD. Multiple forward logistic regression analysis, accounting for possible associations of diseases, identified twenty-three physical comorbidities contributing to hospital-based mortality in individuals with AD. However, all these comorbidities had an equal or even lower impact on hospital-based mortality than in the comparison sample.
CONCLUSION: The excess of in-hospital deaths in general hospitals in individuals with AD is due to an increase of multiple physical comorbidities, even though individual diseases have an equal or even reduced impact on general hospital-based mortality in individuals with AD compared to controls.},
}
@article {pmid25841158,
year = {2015},
author = {Kassir, R and Boueil-Bourlier, A and Baccot, S and Abboud, K and Dubois, J and Petcu, CA and Boutet, C and Chevalier, U and Montveneur, M and Cano, MI and Ferreira, R and Debs, T and Tiffet, O},
title = {Jejuno-ileal diverticulitis: Etiopathogenicity, diagnosis and management.},
journal = {International journal of surgery case reports},
volume = {10},
number = {},
pages = {151-153},
pmid = {25841158},
issn = {2210-2612},
abstract = {INTRODUCTION: Although diverticular disease of the duodenum and colon is frequent, the jejuno-ileal diverticulosis (JOD) is an uncommon entity. The perforation of the small bowel diverticula can be fatal due to the delay in diagnosis.
PRESENTATION OF CASE: We report the case of a 79-year-old man presenting with generalized abdominal pain and altered bowel habits. Physical examination revealed a severe diffuse abdominal pain. A CT scan of the abdomen and pelvis with oral contrast showed thickening of the distal jejunal loop and thickening and infiltration of the mesenteric fat and the presence of free air in the mesentery suggesting a possible perforation adjacent to the diverticula. A midline laparotomy was performed. The jejunal diverticula were found along the mesenteric border. Forty centimeters of the jejunum were resected. Histopathology report confirmed the presence of multiple jejunual diverticula, and one of them was perforated. The patient tolerated the procedure and the postoperative period was uncomplicated.
DISCUSSION: The prevalence of small intestinal diverticula ranges from 0.06% to 1.3%. The etiopathogenesis of JOD is unclear, although the current hypothesis focuses on abnormalities in the smooth muscle or myenteric plexus, on intestinal dyskinesis and on high intraluminal pressures. Diagnosis is often difficult and delayed because clinical symptoms are not specific and mainly imaging studies performs the diagnosis.
CONCLUSION: Because of the relative rarity of acquired jejuno-ileal diverticulosis, the perforation of small bowel diverticulitis poses technical dilemmas.},
}
@article {pmid25840842,
year = {2015},
author = {Tappouni, R and Mathew, P and Connelly, TM and Luke, F and Messaris, E},
title = {Measurement of visceral fat on preoperative computed tomography predicts complications after sigmoid colectomy for diverticular disease.},
journal = {American journal of surgery},
volume = {210},
number = {2},
pages = {285-290},
doi = {10.1016/j.amjsurg.2014.10.026},
pmid = {25840842},
issn = {1879-1883},
mesh = {*Colectomy ; Diverticulitis/*surgery ; Female ; Humans ; Intra-Abdominal Fat/*anatomy & histology/*diagnostic imaging ; Male ; Middle Aged ; Organ Size ; Postoperative Complications/*epidemiology ; Predictive Value of Tests ; Preoperative Care ; Retrospective Studies ; Sigmoid Diseases/*surgery ; *Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Visceral and subcutaneous abdominal fat parameters have been associated with worse surgical outcomes in colorectal cancer but have not been investigated in diverticulitis.
METHODS: Volumetric fat parameters were measured on preoperative computed tomography scans from 211 diverticulitis patients. Primary outcome was a serious postoperative complication (Clavien-Dindo grades 2-4). Variables including age, disease duration, American Society of Anesthesiology score, ostomy, immunosuppression, body mass index, and volumetric fat parameters were examined. SPSS was used for statistics.
RESULTS: The serious postoperative complication rate was 12.7%. On univariate analysis, several factors including older age (P = .0001), ostomy creation (P = .02), higher visceral fat (VF, P = .01), emergent surgery (P = .05), and higher American Society of Anesthesiology score (P = .05) were associated with complications. On multivariate regression analysis, only VF was independently associated with complications.
CONCLUSIONS: Diverticulitis patients with high VF are more likely to develop complications after sigmoidectomy. VF measurement may potentially be used as a tool to assist in surgical decision making and prediction of outcomes.},
}
@article {pmid25830021,
year = {2015},
author = {Cristaudo, A and Pillay, P and Naidu, S},
title = {Caecal diverticulitis: Presentation and management.},
journal = {Annals of medicine and surgery (2012)},
volume = {4},
number = {1},
pages = {72-75},
pmid = {25830021},
issn = {2049-0801},
abstract = {INTRODUCTION: While left sided colonic diverticular disease is common in Western countries, right sided colonic diverticular disease is rare. With increasing migration from Asia, many western countries including Australia, are now seeing more right sided diverticular disease, of which caecal diverticulitis is the commonest. This study aims to determine the incidence of caecal diverticulitis in patients presenting with colonic diverticulitis, as well as identify the symptoms and clinical features that may aid in making a pre-operative diagnosis.
METHODS: Data was collected using the Queen Elizabeth II Hospital medical records database identifying patients diagnosed with colonic diverticulitis and, more specifically, those with caecal diverticulitis from January 2007 to December 2013. Only those patients who had confirmed caecal diverticulitis on imaging studies or at laparoscopy on their first admission were included in this study.
RESULTS: A total of 632 patients with colonic diverticulitis were admitted to our institution over a seven-year period, of which 13 patients had caecal diverticulitis (2.06%). Of the 13 patients, twelve were of Asian background and ten were considered young (≤50 years of age). The main complaints were right sided abdominal pain (n = 11, 84.6%) and diarrhoea (n = 5, 38.5%). Nine were diagnosed using computed tomography (n = 9/10, 90%), three on laparoscopy and one using ultrasound (n = 1/2, 50%). Ten patients were treated successfully by conservative means.
DISCUSSION: A high index of suspicion in Asian patients with atypical symptoms of appendicitis, especially diarrhoea, may provide the diagnosis of caecal diverticulitis.},
}
@article {pmid25829061,
year = {2016},
author = {Vestweber, B and Vestweber, KH and Paul, C and Rink, AD},
title = {Single-port laparoscopic resection for diverticular disease: experiences with more than 300 consecutive patients.},
journal = {Surgical endoscopy},
volume = {30},
number = {1},
pages = {50-58},
pmid = {25829061},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/*surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Prospective Studies ; Sigmoid Diseases/*surgery ; Treatment Outcome ; },
abstract = {BACKGROUND: Single-port laparoscopic surgery (SILS) is a new minimally invasive technique, which has been developed to minimize the surgical access trauma. For colorectal resection, the access trauma can be limited to the one incision, which is needed for specimen extraction anyways, but dissection might be more demanding than in multiport laparoscopic surgery. The aim of this study was to evaluate the usefulness of SILS for the treatment of diverticular disease of the sigmoid colon.
METHODS: Between July 2009 and December 2013, a total of 329 consecutive patients with intended SILS sigmoid colectomy for complicated or frequently recurring diverticulitis were studied. Clinical data were collected in a prospective database. Telephone follow-ups were performed to evaluate long-term morbidity and quality of life.
RESULTS: Of the 329 patients (139 male) with intended SILS sigmoid colectomy, 309 were successfully operated on in SILS technique, while 20 (6.1%) were converted to open surgery. The mean duration of surgery was 153.5 (65-434) min. Total morbidity rate was 18.3%. Anastomotic leakage was the most serious complication occurring in 13 patients (leak rate 4%) with one consecutive death (mortality rate 0.3%). Quality of life had significantly improved 6 months after surgery in comparison with the preoperative value. At a mean follow-up of 18.6 months, 16 patients (4.9%) had incisional hernia and one patient had recurrent diverticulitis.
CONCLUSION: In spite of almost 5% incisional hernia 6 months after surgery, single-incision sigmoid colectomy for diverticulitis is feasible and save and is therefore an alternative to multiport laparoscopic surgery. Further trials are necessary to evaluate its benefits over multiport laparoscopic surgery.},
}
@article {pmid25822995,
year = {2015},
author = {Loffeld, RJ and Liberov, B and Dekkers, PE},
title = {Individual polyp detection rate in routine daily endoscopy practice depends on case-mix.},
journal = {International journal of colorectal disease},
volume = {30},
number = {7},
pages = {927-932},
pmid = {25822995},
issn = {1432-1262},
mesh = {Anastomosis, Surgical ; Colonic Polyps/*diagnosis/surgery ; Colonoscopy/*methods ; *Diagnosis-Related Groups ; Epidemiological Monitoring ; Female ; Humans ; Male ; *Practice Patterns, Physicians' ; },
abstract = {INTRODUCTION: The adenoma detection rate (ADR), a marker of endoscopic quality, is confounded by selection bias. It is not known what the ADR is in normal daily practice.
AIM: To study the polyp detection rate (PDR) in different endoscopists in the course of years.
PATIENTS AND METHODS: All consecutive endoscopies of the colon done in 11 years were included. Endoscopies in the regular surveillance programme after polyp removal and after surgery because of colorectal cancer or diverticular disease were scored separately. The number of yearly procedures per endoscopist and presence of polyps, anastomoses, surveillance and cancer were noted.
RESULTS: In the period of 11 years, 14,908 consecutive endoscopies of colon and rectum were done by four endoscopists. Two endoscopists had a significantly lower PDR than the other two (p < 0.001), these two had the longest careers in endoscopy. The two younger endoscopists did significantly less often procedures in patients with anastomoses and because of surveillance (p < 0.001, respectively). One endoscopist detected significantly less colorectal cancers than the other three endoscopists (p < 0.001).
CONCLUSION: This study presents the PDR in normal routine daily endoscopy practice. It can be concluded that the PDR, implicating the ADR, in unselected patients can be lower in individual endoscopists than recommended in the literature. This highly depends on the case-mix of patients presented for endoscopy. This result debates the use of the ADR as quality indicator for individual endoscopists.},
}
@article {pmid25822438,
year = {2015},
author = {Tursi, A},
title = {The role of colonoscopy in managing diverticular disease of the colon.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {24},
number = {1},
pages = {85-93},
doi = {10.15403/jgld.2014.1121.tur},
pmid = {25822438},
issn = {1842-1121},
mesh = {*Colonoscopy ; Diverticulosis, Colonic/complications/diagnosis/*surgery ; Gastrointestinal Hemorrhage/diagnosis/etiology/*surgery ; Hemostasis, Endoscopic/*methods ; Humans ; Treatment Outcome ; },
abstract = {Diverticulosis of the colon is frequently found on routine colonoscopy, and the incidence of diverticular disease and its complications appears to be increasing. The role of colonoscopy in managing this disease is still controversial. Colonoscopy plays a key role in managing diverticular bleeding. Several techniques have been effectively used in this field, but band ligation seems to be the best in preventing rebleeding. Colonoscopy is also effective in posing a correct differential diagnosis with other forms of chronic colitis involving colon harbouring diverticula (in particular with Crohn's disease or Segmental Colitis Associated with Diverticulosis). The role of colonoscopy to confirm diagnosis of uncomplicated diverticulitis is still under debate, since the risk of advanced colonic neoplasia in patients admitted for acute uncomplicated diverticulitis is not increased as compared to the average-risk population. On the contrary, colonoscopy is mandatory if patients complain of persistent symptoms or after resolution of an episode of complicated diverticulitis. Finally, a recent endoscopic classification, called Diverticular Inflammation and Complications Assessment (DICA), has been developed and validated. This classification seems to be a promising tool for predicting the outcome of the colon harboring diverticula, but further, prospective studies have to confirm its predictive role on the outcome of the disease.},
}
@article {pmid25816854,
year = {2015},
author = {Caputo, P and Rovagnati, M and Carzaniga, PL},
title = {Is it possible to limit the use of CT scanning in acute diverticular disease without compromising outcomes? A preliminary experience.},
journal = {Annali italiani di chirurgia},
volume = {86},
number = {1},
pages = {51-55},
pmid = {25816854},
issn = {2239-253X},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Diverticulitis/complications/*diagnostic imaging/surgery ; Drainage ; Emergencies ; Female ; Humans ; Intestinal Perforation/diagnosis/etiology ; Laparoscopy ; Laparotomy ; Middle Aged ; Peritonitis/diagnosis/etiology ; Retrospective Studies ; Severity of Illness Index ; Tomography, X-Ray Computed/*statistics & numerical data ; Treatment Outcome ; Ultrasonography ; Unnecessary Procedures ; Young Adult ; },
abstract = {The aim of our study was to determine whether the use of CT scanning in the assessment of acute diverticulitis can be reduced without a negative effect on outcome. Our series consisted of 93 out of 100 patients with acute diverticulitis admitted to the Emergency Room of our institution in the period from February 2012 to March 2013.The Hinchey classification system was used to stage disease based on findings on ultrasound (US) examination and/or computed tomography (CT) scanning. We compared the patients' Hinchey stage (HS) on admission and 72 hours later. Types of treatment were defined as emergency or delayed intervention (operative approaches (OA); ultrasound-guided percutaneous drainage (UPD), and surgery. The borderline between conservative and surgical management was identified. In patients with a HS
METHOD: Systematic review of the literature with US National Library of Medicine and National Institutes of Health International PubMed Medline, using abstracts and articles available in PubMed Medline, Cochrane databases searching for ("Diverticulosis, Colonic epidemiology" [MeSH] OR"Diverticulosis, Colonic etiology" [MeSH] OR "Diverticulosis,Colonic genetics" [MeSH] OR "Diverticulosis, Colonic history" [MeSH]).
RESULTS: Even from the rise of diverticular disease as a public healthcare problem, at the end of the previous century, it was associated with a diet rich in refined sugars, lacking vegetable fibres. The higher incidence in countries like U.S.A., Canada, United Kingdom and the northern states compared with its rare occurrence in the sub-Saharan African continent, strengthen the anterior assumptions. In regions like Asia, the disease pattern is characterized by are latively low incidence of colonic diverticular disease, with distribution of diverticula mainly on the right colon. The different incidence by sex and age show the possible existence of hormonal protective factors. Studies from countries with a rich ethnic diversity, bring into question the probable genetic predisposition to diverticular disease, fact backed-up by the few studies on twins and 1st degree relatives available in the literature.
DISCUSSION: The rising incidence of colonic diverticular disease in Romania makes our country adhere the epidemiologic model existing in countries with a close socio-economic status.Although with a lower incidence than countries that have adopted a Western diet, Romania is likely to encounter a public health problem, if certain measures to identify and minimise the population exposure to risk factors are not taken.},
}
@article {pmid25777157,
year = {2015},
author = {Nagata, N and Niikura, R and Aoki, T and Shimbo, T and Sekine, K and Okubo, H and Watanabe, K and Sakurai, T and Yokoi, C and Yanase, M and Akiyama, J and Uemura, N},
title = {Association between colonic diverticulosis and bowel symptoms: A case-control study of 1629 Asian patients.},
journal = {Journal of gastroenterology and hepatology},
volume = {30},
number = {8},
pages = {1252-1259},
doi = {10.1111/jgh.12941},
pmid = {25777157},
issn = {1440-1746},
mesh = {Adult ; Aged ; Asian People ; Case-Control Studies ; Colonoscopy ; Constipation ; Diarrhea ; Diverticulosis, Colonic/*physiopathology/*psychology ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Psychometrics ; Reproducibility of Results ; Risk ; Severity of Illness Index ; Sex Characteristics ; Surveys and Questionnaires ; },
abstract = {BACKGROUND: It remains unclear whether diverticulosis, absent inflammation, is responsible for chronic bowel symptoms. We examined the association between bowel symptoms and asymptomatic diverticulosis.
METHOD: This case-control study included 543 patients with diverticulosis and 1086 age and sex-matched controls (1:2) without diverticulosis on screening colonoscopy. Eleven symptoms (abdominal discomfort, hunger discomfort, borborygmus, abdominal distension, flatus, constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) were evaluated using a gastrointestinal symptoms rating scale (GSRS) at baseline and second questionnaire. Associations between diverticulosis and symptoms were estimated using odds ratios (ORs) and 95 confidence interval (CI).
RESULTS: In multivariate analysis, constipation (OR, 0.85 [0.78-0.93]) and hard stools (OR, 0.86 [0.78-0.94]) were negatively associated with diverticulosis. The other nine symptoms showed no association with diverticulosis. Diverticulosis was negatively associated with constipation (OR, 0.93 [0.74-0.93]), hard stools (OR, 0.85 [0.76-0.96]), and incomplete evacuation (OR, 0.88 [0.79-0.99]) in males, and positively associated with diarrhea (OR, 1.39 [1.14-1.69]) and loose stools (OR, 1.28 [1.05-1.55]) in females. No bowel symptoms were positively associated with any of right-sided, left-sided, or bilateral diverticulosis. Test-retest reliability of GSRS (mean interval, 4.4 months) was moderate (Mean Kappa, 0.568) in males and good (Mean Kappa, 0.652) in females.
CONCLUSIONS: This large, colonoscopy-based, case-control study demonstrated that neither constipation nor hard stools were associated with an increased risk of diverticulosis, regardless of diverticulum location. In females, but not males, diarrhea and loose stools were positively associated with diverticulosis. Long-term test-retest reliability suggested that these symptoms remain consistent over a given period.},
}
@article {pmid25741207,
year = {2015},
author = {Virgilio, E and Pascarella, G and Scandavini, CM and Frezza, B and Bocchetti, T and Balducci, G},
title = {Colonic perforations caused by migrated plastic biliary stents.},
journal = {Korean journal of radiology},
volume = {16},
number = {2},
pages = {444-445},
pmid = {25741207},
issn = {2005-8330},
mesh = {Colon/pathology/surgery ; Colonoscopy ; Female ; Humans ; Intestinal Perforation/*etiology ; Plastics ; Stents/*adverse effects ; },
}
@article {pmid25733040,
year = {2015},
author = {Medina-Fernández, FJ and Díaz-Jiménez, N and Gallardo-Herrera, AB and Gómez-Luque, I and Garcilazo-Arsimendi, DJ and Gómez-Barbadillo, J},
title = {New trends in the management of diverticulitis and colonic diverticular disease.},
journal = {Revista espanola de enfermedades digestivas},
volume = {107},
number = {3},
pages = {162-170},
pmid = {25733040},
issn = {1130-0108},
mesh = {Anastomosis, Surgical ; Colonic Diseases/surgery/*therapy ; *Disease Management ; Diverticulitis/surgery/*therapy ; Diverticulitis, Colonic/*surgery/*therapy ; Diverticulosis, Colonic/*surgery/*therapy ; Humans ; Laparoscopy ; Peritoneal Lavage ; },
abstract = {Colonic diverticular disease is a chronic disorder presenting with a variety of abdominal symptoms and recurrent episodes of acute diverticulitis. It is close linked to age so its prevalence has risen notably during the last decades in western countries, increasing costs related to medical attention. Recently, several works have provided evidence to a series of measures that could improve the outcomes as well as reduce expenses associated to this process.The aim of the present review is to expose a view of the new trends in the management of diverticulitis and colonic diverticular disease, based on the highest clinical evidence available.},
}
@article {pmid25728670,
year = {2015},
author = {Igwe, PO and Ray-Offor, E and Allison, AB and Alufohai, EF},
title = {Volvulus complicating jejunal diverticulosis: A case report.},
journal = {International journal of surgery case reports},
volume = {9},
number = {},
pages = {61-64},
pmid = {25728670},
issn = {2210-2612},
abstract = {INTRODUCTION: Diverticular disease is uncommon among Africans though increasing number of cases is now being reported, mainly of colonic diverticulosis. This condition afflicts all parts of the gastrointestinal tract but commonly the colon. Jejunal diverticula are rare, usually asymptomatic but may lead to an acute abdomen.
CASE PRESENTATION: A 68 year old female trader, who was referred from a peripheral center with insidious onset of severe colicky, generalized abdominal pain, repeated vomiting of recently ingested meal, no hematemesis. There was constipation and abdominal distension. The working diagnosis was dynamic intestinal obstruction of small bowel origin. She had emergency exploratory laparotomy following resuscitation. The findings were: volvulus of the jejunum and multiple jejunal diverticula. A resection of 80cm of the jejunum with most of the diverticula involved in the torsion was done with an end-to-end anastomosis of the jejunum. Her out-patient follow-up has been uneventful.
DISCUSSION: Jejunal diverticular disease is rare in Africa. Our patient presented with small bowel obstruction due to volvulus. Other complications are discussed.
CONCLUSION: Intestinal obstruction from diverticular disease is not always of colonic origin. It can occur in the jejunum.},
}
@article {pmid25703217,
year = {2015},
author = {Spiller, RC},
title = {Changing views on diverticular disease: impact of aging, obesity, diet, and microbiota.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {27},
number = {3},
pages = {305-312},
doi = {10.1111/nmo.12526},
pmid = {25703217},
issn = {1365-2982},
mesh = {Aging ; Animals ; Diet ; Diverticulitis, Colonic/complications/*epidemiology/microbiology ; Diverticulosis, Colonic/complications/*epidemiology/microbiology ; Humans ; Microbiota ; Obesity/complications ; Risk Factors ; },
abstract = {The development of colonic diverticulosis is a common aging change in industrialized nations. While most patients have asymptomatic diverticulosis, around one in five develops symptomatic diverticular disease. This is characterized by recurrent abdominal pain and disturbed bowel habit. Some of the pain episodes are prolonged and are due to acute diverticulitis, which itself may be complicated by abscess, perforation, fistulation, or stricture formation. Risk factors favouring the development of symptomatic diverticular disease include obesity, smoking and diets low in fiber but high in red meat and animal fat. What determines the transition from asymptomatic diverticulosis to symptomatic diverticular disease is unclear but neuromuscular changes following acute diverticulitis may be responsible in some cases. The severity of symptoms generated depends on cerebral pain processing which is influenced by psychosocial factors. These are important considerations in deciding optimal patient management. Prior theories of the cause of diverticulosis suggested that constipation was an important cause, but new data challenge this and has provoked new ideas. Underlying mechanisms causing diverticulosis include weakening of the colonic wall and/or degenerative changes in the enteric nerves. Dietary induced changes in microbiota and the host inflammatory response may underlie the subsequent development of acute/chronic diverticulitis and its sequela.},
}
@article {pmid25698274,
year = {2015},
author = {Özçelik, Ü and Bircan, HY and Eren, E and Demiralay, E and Işıklar, İ and Demirağ, A and Moray, G},
title = {Rectal diverticulitis mimicking rectal carcinoma with intestinal obstruction: case report.},
journal = {The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology},
volume = {26},
number = {1},
pages = {60-62},
doi = {10.5152/tjg.2015.4521},
pmid = {25698274},
issn = {2148-5607},
mesh = {Carcinoma/*diagnosis ; Diagnosis, Differential ; Diverticulitis/*diagnosis ; Female ; Humans ; Intestinal Obstruction/*diagnosis/etiology ; Middle Aged ; Rectal Diseases/*diagnosis ; Rectal Neoplasms/*diagnosis ; },
abstract = {Although diverticular disease of the colon is common, the occurrence of rectal diverticula is extremely rare with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are seen even less frequently, and surgical intervention is needed for only complicated cases. Here we report the case of a 63-year-old woman presenting with rectal diverticulitis mimicking rectal carcinoma with intestinal obstruction.},
}
@article {pmid25681218,
year = {2015},
author = {Macht, R and Sheldon, HK and Fisichella, PM},
title = {Giant Colonic Diverticulum: a Rare Diagnostic and Therapeutic Challenge of Diverticular Disease.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {19},
number = {8},
pages = {1559-1560},
pmid = {25681218},
issn = {1873-4626},
mesh = {Aged ; Colon/*diagnostic imaging/pathology/surgery ; Diverticulum, Colon/*diagnosis/diagnostic imaging/surgery ; Humans ; Male ; Tomography, X-Ray Computed ; },
abstract = {A giant colonic diverticulum is a diverticulum of the colon greater than 4 cm in diameter that can present, albeit rarely, as a complication of diverticular disease. We discuss the three different histologic subtypes that have been described and the challenges in the diagnosis and treatment.},
}
@article {pmid25666316,
year = {2015},
author = {Dai, L and King, DW and Perera, DS and Lubowski, DZ and Burcher, E and Liu, L},
title = {Inverse expression of prostaglandin E2-related enzymes highlights differences between diverticulitis and inflammatory bowel disease.},
journal = {Digestive diseases and sciences},
volume = {60},
number = {5},
pages = {1236-1246},
pmid = {25666316},
issn = {1573-2568},
mesh = {Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Colitis, Ulcerative/*enzymology/genetics ; Colon/*enzymology ; Crohn Disease/*enzymology/genetics ; Cyclooxygenase 1/*analysis/genetics ; Cyclooxygenase 2/*analysis/genetics ; Dinoprostone/*metabolism ; Diverticulosis, Colonic/*enzymology/genetics ; Female ; Gene Expression Regulation, Enzymologic ; Humans ; Hydroxyprostaglandin Dehydrogenases/*analysis/genetics ; Intestinal Mucosa/*enzymology ; Male ; Middle Aged ; RNA, Messenger/analysis ; },
abstract = {BACKGROUND: Prostaglandin E2 (PGE2) is the dominant prostaglandin in the colon and is associated with colonic inflammation. PGE2 levels are regulated not only by cyclooxygenases (COX-1 and COX-2) but also by 15-hydroxyprostaglandin dehydrogenase (15-PGDH), the major PGE2-degrading enzyme. Information about the involvement of 15-PGDH in colonic inflammation is sparse.
AIM: We thus aimed to determine the gene expression and immunoreactivity (IR) of COX-1, COX-2, and 15-PGDH in colonic mucosa from patients with diverse inflammatory disorders: ulcerative colitis (UC), Crohn's disease (CD), and acute diverticular disease (DD).
METHODS: RNA from human colonic mucosa was extracted and assessed for gene expression by real-time PCR. Intact colon sections were processed for immunohistochemistry with immunostaining of the mucosal areas quantified using ImageJ.
RESULTS: In colonic mucosa of both UC and CD, COX-2 mRNA and COX-2-IR were significantly increased, whereas 15-PGDH mRNA and 15-PGDH-IR were significantly reduced. In macroscopically undamaged acute DD mucosa, the opposite findings were seen: for both gene expression and immunoreactivity, there was a significant downregulation of COX-2 and upregulation of 15-PGDH. COX-1 mRNA and COX-1-IR remained unchanged in all diseases.
CONCLUSIONS: Our study for the first time demonstrated differential expression of the PGE2-related enzymes COX-2 and 15-PGDH in colonic mucosa from UC, CD, and acute DD. The reduction of 15-PGDH in IBD provides an additional mechanism for PGE2 increase in IBD. With respect to DD, alterations of PGE2-related enzymes suggest that a low PGE2 level may precede the onset of inflammation, thus providing new insight into the pathogenesis of DD.},
}
@article {pmid25663306,
year = {2015},
author = {Vaidya, KK and Floch, MH},
title = {Diverticular disease: paradigm shifts in pathogenesis and treatment.},
journal = {Current treatment options in gastroenterology},
volume = {13},
number = {1},
pages = {143-155},
pmid = {25663306},
issn = {1092-8472},
abstract = {Colonic diverticulosis is one of the most common gastrointestinal conditions affecting the Western world and is recognized as an increasingly common condition since its first description in the 1800s. Despite its widespread prevalence, its exact pathogenesis remains unknown. Additionally, its wide spectrum of clinical manifestations has led to multiple approaches in the management of this disease. Our understanding of the condition has continued to evolve. Newer studies have challenged some long-held beliefs regarding diverticular disease (DD) and put forward some new theories. This has laid the groundwork for further research to be done in this area to improve our understanding of DD. In any individual case, diet therapy, rifaximin, mesalamine, antibiotics, or surgery may be useful depending on the clinical status.},
}
@article {pmid25655772,
year = {2015},
author = {Barrenschee, M and Böttner, M and Harde, J and Lange, C and Cossais, F and Ebsen, M and Vogel, I and Wedel, T},
title = {SNAP-25 is abundantly expressed in enteric neuronal networks and upregulated by the neurotrophic factor GDNF.},
journal = {Histochemistry and cell biology},
volume = {143},
number = {6},
pages = {611-623},
pmid = {25655772},
issn = {1432-119X},
mesh = {Aged ; Aged, 80 and over ; Animals ; Cells, Cultured ; Enteric Nervous System/*metabolism ; Glial Cell Line-Derived Neurotrophic Factor/*metabolism ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; RNA, Messenger/analysis/genetics/metabolism ; Rats ; Rats, Wistar ; Synaptosomal-Associated Protein 25/analysis/*genetics/metabolism ; *Up-Regulation ; },
abstract = {Control of intestinal motility requires an intact enteric neurotransmission. Synaptosomal-associated protein 25 (SNAP-25) is an essential component of the synaptic vesicle fusion machinery. The aim of the study was to investigate the localization and expression of SNAP-25 in the human intestine and cultured enteric neurons and to assess its regulation by the neurotrophic factor glial cell line-derived neurotrophic factor (GDNF). SNAP-25 expression and distribution were analyzed in GDNF-stimulated enteric nerve cell cultures, and synaptic vesicles were evaluated by scanning and transmission electron microscopy. Human colonic specimens were processed for site-specific SNAP-25 gene expression analysis and SNAP-25 immunohistochemistry including dual-labeling with the pan-neuronal marker PGP 9.5. Additionally, gene expression levels and distributional patterns of SNAP-25 were analyzed in colonic specimens of patients with diverticular disease (DD). GDNF-treated enteric nerve cell cultures showed abundant expression of SNAP-25 and exhibited granular staining corresponding to synaptic vesicles. SNAP-25 gene expression was detected in all colonic layers and isolated myenteric ganglia. SNAP-25 co-localized with PGP 9.5 in submucosal and myenteric ganglia and intramuscular nerve fibers. In patients with DD, both SNAP-25 mRNA expression and immunoreactive profiles were decreased compared to controls. GDNF-induced growth and differentiation of cultured enteric neurons is paralleled by increased expression of SNAP-25 and formation of synaptic vesicles reflecting enhanced synaptogenesis. The expression of SNAP-25 within the human enteric nervous system and its downregulation in DD suggest an essential role in enteric neurotransmission and render SNAP-25 as a marker for impaired synaptic plasticity in enteric neuropathies underlying intestinal motility disorders.},
}
@article {pmid25650387,
year = {2015},
author = {El-Masry, NS and Geevarghese, R},
title = {Large bowel obstruction secondary to adhesive bands.},
journal = {Journal of surgical case reports},
volume = {2015},
number = {2},
pages = {},
pmid = {25650387},
issn = {2042-8812},
abstract = {Large bowel obstruction (LBO) is most commonly due to malignancy, volvulus, hernia, diverticular disease and inflammatory bowel disease. LBO due to adhesions is unusual. A literature review was conducted which revealed that only a few such cases have been reported. We report two cases of LBO secondary to adhesions in patients, one with and one without a past abdominal surgical history. We highlight that while rare, the aetiology of LBO secondary to adhesions must be considered in the differential diagnosis in patients presenting with obstructive symptoms.},
}
@article {pmid25635602,
year = {2015},
author = {Amor, IB and Kassir, R and Bachir, E and Katharina, H and Debs, T and Gugenheim, J},
title = {Perforated diverticulitis of the sigmoid colon revealed by a perianal fistula.},
journal = {International journal of surgery case reports},
volume = {8C},
number = {},
pages = {73-75},
pmid = {25635602},
issn = {2210-2612},
abstract = {INTRODUCTION: Diverticular disease of the colon is a frequent pathology; however, perforated diverticulitis with a spontaneous sigmoidocutaneous fistula revealed by a perianal abscess is an uncommon presentation. We present this extremely rare case of a perforated sigmoid diverticulum in the perianal area, which is the first case that we have encountered in our practice and in the literature, along with the accompanying diagnostic and therapeutic issues and a review of the literature.
PRESENTATION OF CASE: We report the case of a 47-year-old man who was admitted to the emergency room due to a perianal abscess. The patient was taken to the operating room on an emergency basis. In the lithotomy position, the abscess was located at the 4 o'clock position. Incision and drainage was performed. Intraoperatively, the abscess was found to be deep, and considered an ischiorectal abscess. No fistulous tract was identified. An MRI of the pelvis was performed one month postoperatively which revealed a perforated diverticulitis of the sigmoid colon causing a perianal fistula. After the abscess was successfully treated, a sigmoidectomy was performed. Fifteen centimeters of the colon were resected. No postoperative complications occurred.
DISCUSSION: Perianal fistula is an obvious physical sign but its etiology is complex to determine. The pathophysiological mechanism involved is the emergence of a pressure gradient between the peritoneum and surrounding structures, causing rupture of the perianal tissue, allowing gas from a perforation to diffuse along tissue planes.
CONCLUSION: General surgeons should bear in mind this rare presentation of a sigmoid diverticulitis.},
}
@article {pmid25614717,
year = {2014},
author = {Welbourn, HL and Hartley, JE},
title = {Management of acute diverticulitis and its complications.},
journal = {The Indian journal of surgery},
volume = {76},
number = {6},
pages = {429-435},
pmid = {25614717},
issn = {0972-2068},
abstract = {Colonic diverticular disease is a common condition, and around a quarter of people affected by it will experience acute symptoms at some time. The most common presentation is uncomplicated acute diverticulitis that can be managed conservatively with bowel rest and antibiotics. However, some patients will present with diverticular abscesses or purulent or faeculent peritonitis due to perforated diverticular disease. Whilst most mesocolic abscesses can be managed with percutaneous drainage alone, pelvic abscesses are associated with a higher rate of future complications and usually require percutaneous drainage followed by interval sigmoid resection. Patients who require emergency surgery for complicated acute diverticulitis most commonly undergo a Hartmann's procedure, although resection with primary anastomosis and laparoscopic peritoneal lavage have emerged as alternative treatment options for patients with purulent peritonitis in recent years. However, robust evidence from randomized trials is lacking for these alternative procedures, and the studies that have reported good outcomes from them have included carefully selected patient groups. There has been a move away from recommending elective prophylactic colectomy after two episodes of acute diverticulitis in the light of evidence that most patients will not experience a significant recurrence of their symptoms; elective surgery is indicated for those with ongoing symptoms, pelvic abscesses, complications-such as fistulating disease, strictures or recurrent diverticular bleeding-and those who are at high risk of perforation during future episodes, for example, due to immunosuppression, chronic renal failure or collagen-vascular diseases.},
}
@article {pmid25600133,
year = {2014},
author = {Caputo, P and Rovagnati, M and Pakrawanan, H and Carzaniga, PL},
title = {Limiting stochastic harm when monitoring diverticular flogosis for lower Hinchey classes. Personal proposal for a selection method Reliability Ultrasound Score (RUS).},
journal = {Annali italiani di chirurgia},
volume = {85},
number = {5},
pages = {479-484},
pmid = {25600133},
issn = {2239-253X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/diagnosis/*diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; *Monitoring, Physiologic/methods ; Observer Variation ; Reproducibility of Results ; Retrospective Studies ; Severity of Illness Index ; Stochastic Processes ; *Ultrasonography, Doppler/methods ; },
abstract = {BACKGROUND: An article in the BMJ issueof May 2012 (11) tackled the issue of safeguarding health by preventing diagnostic overtreatment. An observation of the diagnostic options in clinical routine enabled us to critically assess the appropriateness or notof the use of ionising radiation in monitoring acute diverticulitis by means of CT imaging. This disease, which has alwaysbeen frequent in elderly patients, has recently assumed a new role as an endemicdiseasein the Caucasian populationaged 40 to 50 in the Western world (6).
MATERIAL AND METHOD: We considered 79 cases coming under observation in the Emergency Roomover a period of 115 months, selected from a pool of 136 according to Hinchey Score (Hs) 0-1a-1b- assigned on admission after an Ultrasound(US) examination . The choice of the first diagnostic approach depended on the severity of the patient 's clinical condition, the degree of collaboration of the same and the discretion of the radiologist, although the concerted opinion was to prefer the US test given its clearly- established advantages of being convenient and harmless. During the period of recovery we noted the tendency to subordinate the choice of instrument to the habit and discretion of the attending practitioner. Our proposal was to introduce a standardised personal criterion which took into account the problem of stochastic harm from ionising radiation. The need of exposure or not to verify the clinical condition by means of a CT as opposed to a US was thus deduced by means of an Reliability Ultrasound Score (RUS) RESULTS: Using such score we were able to schedule in 14 out of the 37 cases in one branch of the study, an effective diagnostic check-up programmein safety and with an overall saving of 32 % of the ionising radiation. During this study wequantified a total amount of miniSivertnot dispensed, in 79 cases with Hs<2deserving of hospital admission.
CONCLUSION: This choice moves in the direction of safeguarding the patient fromdiagnostic overtreatment,with a potential increase in stochastic harm. The application of a reliability assessment filterof the US examination is currently in the study phase as regards acute diverticular disease in classesHS=/>2°.},
}
@article {pmid25600131,
year = {2015},
author = {Lee, BJ and Kumar, P and Van den Bosch, R},
title = {Jejunal diverticula: a rare cause of life-threatening gastrointestinal bleeding.},
journal = {Journal of surgical case reports},
volume = {2015},
number = {1},
pages = {},
pmid = {25600131},
issn = {2042-8812},
abstract = {Jejunal diverticula are rare and the condition remains mostly asymptomatic. However, they can present with vague chronic abdominal symptoms and, in some cases, acute life-threatening complications, such as gastrointestinal (GI) bleeding, bowel obstruction and perforation. We present a case of an adult male who presented with life-threatening GI bleeding secondary to jejunal diverticular disease. Whilst there are undoubtedly more common causes of GI bleeding, this case demonstrates that jejunal diverticular disease should remain on the differential diagnosis and investigations to confirm the diagnosis should be considered. However, despite investigations, the diagnosis may remain elusive and in patients with on-going bleeding, laparotomy and surgical resection is currently the treatment of choice.},
}
@article {pmid25587474,
year = {2014},
author = {Grechukhina, O and Gressel, GM and Taylor, G and Schwartz, JI and Welsh, RJ},
title = {Unusual presentation of a rectovestibular fistula as gastrointestinal hemorrhage in a postmenopausal woman.},
journal = {Case reports in obstetrics and gynecology},
volume = {2014},
number = {},
pages = {578048},
pmid = {25587474},
issn = {2090-6684},
abstract = {Background. Anorectal malformations (ARMs) are extremely rare and are usually identified neonatally. It is unusual for these cases to present in the postmenopausal period. This case report describes a postmenopausal patient with ARM and rectovaginal hemorrhage. Case. An 86-year-old, gravida 11, para 9, presented to the emergency department complaining of profuse postmenopausal vaginal bleeding. Her gynecologic history was significant only for an unclear history of an anal abnormality that was noted at birth. Speculum examination revealed profuse rectal bleeding from a rectovestibular fistula exterior to her hymenal ring. Colonoscopic examination revealed severe diverticular disease. Conclusion. This patient was born with an imperforate anus which resolved as rectovestibular fistula and ectopic anus. This case presents a rare clinical circumstance which integrates the fields of obstetrics, gynecology, gastroenterology, and embryology alike.},
}
@article {pmid25584286,
year = {2014},
author = {Noronha, GP and Hiremath, R and K C, A and Tippani, D and C R, A},
title = {Malignant Colojejunal Fistula First Discovered on CT: A Case Report.},
journal = {Journal of clinical and diagnostic research : JCDR},
volume = {8},
number = {11},
pages = {RD01-3},
pmid = {25584286},
issn = {2249-782X},
abstract = {Benign coloenteric fistula is an uncommon condition. It may occur secondary to diverticular disease, peptic ulcer, inflammatory bowel disease and so on. Malignant coloenteric fistula is a rare occurrence. Here we present a rare case of malignant colojejunal fistula secondary to locally invading colonic malignancy.},
}
@article {pmid25574112,
year = {2015},
author = {Nigri, G and Petrucciani, N and Giannini, G and Aurello, P and Magistri, P and Gasparrini, M and Ramacciato, G},
title = {Giant colonic diverticulum: clinical presentation, diagnosis and treatment: systematic review of 166 cases.},
journal = {World journal of gastroenterology},
volume = {21},
number = {1},
pages = {360-368},
pmid = {25574112},
issn = {2219-2840},
mesh = {Aged, 80 and over ; *Colectomy ; Diverticulum, Colon/classification/complications/*diagnosis/*surgery ; Female ; Humans ; Predictive Value of Tests ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {AIM: To investigate the clinical presentation, diagnosis, and treatment of giant colonic diverticulum (GCD, by means of a complete and updated literature review). GCD is a rare manifestation of diverticular disease of the colon. Less than 200 studies on GCD were published in the literature, predominantly case reports or small patient series.
METHODS: A systematic review of the literature was performed using the Embase and PubMed databases to identify all the GCD studies. The following MESH search headings were used: "giant colonic diverticulum"; "giant sigmoid diverticulum". The "related articles" function was used to broaden the search, and all of the abstracts, studies, and citations were reviewed by two authors. The following outcomes were of interest: the disease and patient characteristics, study design, indications for surgery, type of operation, and post-operative outcomes. Additionally, a subgroup analysis of cases treated in the last 5 years was performed to show the current trends in the treatment of GCD. A GCD case in an elderly patient treated in our department by a sigmoidectomy with primary anastomosis and a diverting ileostomy is presented as a typical example of the disease.
RESULTS: In total, 166 GCD cases in 138 studies were identified in the literature. The most common clinical presentation was abdominal pain, which occurred in 69% of the cases. Among the physical signs, an abdominal mass was detected in 48% of the cases, whereas 20% of the patients presented with fever and 14% with abdominal tenderness. Diagnosis is based predominantly on abdominal computed tomography. The most frequent treatment was colic resection with en-bloc resection of the diverticulum, performed in 57.2% of cases, whereas Hartmann's procedure was followed in 11.4% of the cases and a diverticulectomy in 10.2%. An analysis of sixteen cases reported in the last 5 years showed that the majority of patients were treated with sigmoidectomy and en-bloc resection of the diverticulum; the postoperative mortality was null, morbidity was very low (1 patient was hospitalized in the intensive care unit for postoperative hypotension), and the patients were discharged 4-14 d after surgery.
CONCLUSION: Giant colonic diverticulum is a rare manifestation of diverticular diseases. Surgical treatment, consisting predominantly of colonic resection with en bloc resection of the diverticulum, is the preferred option for GCD and guarantees excellent results.},
}
@article {pmid25569649,
year = {2015},
author = {Cirocchi, R and Trastulli, S and Vettoretto, N and Milani, D and Cavaliere, D and Renzi, C and Adamenko, O and Desiderio, J and Burattini, MF and Parisi, A and Arezzo, A and Fingerhut, A},
title = {Laparoscopic peritoneal lavage: a definitive treatment for diverticular peritonitis or a "bridge" to elective laparoscopic sigmoidectomy?: a systematic review.},
journal = {Medicine},
volume = {94},
number = {1},
pages = {e334},
pmid = {25569649},
issn = {1536-5964},
mesh = {Colectomy ; Diverticulitis, Colonic/*complications ; Humans ; Laparoscopy ; *Peritoneal Lavage ; Peritonitis/etiology/*therapy ; },
abstract = {To this day, the treatment of generalized peritonitis secondary to diverticular perforation is still controversial. Recently, in patients with acute sigmoid diverticulitis, laparoscopic lavage and drainage has gained a wide interest as an alternative to resection. Based on this backdrop, we decided to perform a systematic review of the literature to evaluate the safety, feasibility, and efficacy of peritoneal lavage in perforated diverticular disease.A bibliographic search was performed in PubMed for case series and comparative studies published between January 1992 and February 2014 describing laparoscopic peritoneal lavage in patients with perforated diverticulitis.A total of 19 articles consisting of 10 cohort studies, 8 case series, and 1 controlled clinical trial met the inclusion criteria and were reviewed. In total these studies analyzed data from 871 patients. The mean follow-up time ranged from 1.5 to 96 months when reported. In 11 studies, the success rate of laparoscopic peritoneal lavage, defined as patients alive without surgical treatment for a recurrent episode of diverticulitis, was 24.3%. In patients with Hinchey stage III diverticulitis, the incidence of laparotomy conversion was 1%, whereas in patients with stage IV it was 45%. The 30-day postoperative mortality rate was 2.9%. The 30-day postoperative reintervention rate was 4.9%, whereas 2% of patients required a percutaneous drainage. Readmission rate after the first hospitalization for recurrent diverticulitis was 6%. Most patients who were readmitted (69%) required redo surgery. A 2-stage laparoscopic intervention was performed in 18.3% of patients.Laparoscopic peritoneal lavage should be considered an effective and safe option for the treatment of patients with sigmoid diverticulitis with Hinchey stage III peritonitis; it can also be consider as a "bridge" surgical step combined with a delayed and elective laparoscopic sigmoidectomy in order to avoid a Hartmann procedure. This minimally invasive staged approach should be considered for patients without systemic toxicity and in centers experienced in minimally invasive surgery techniques. Further evidence is needed, and the ongoing RCTs will better define the role of the laparoscopic peritoneal lavage/drainage in the treatment of patients with complicated diverticulitis.},
}
@article {pmid25559756,
year = {2015},
author = {Montomoli, J and Erichsen, R and Strate, LL and Pedersen, L and Nilsson, T and Sørensen, HT},
title = {Coexisting liver disease is associated with increased mortality after surgery for diverticular disease.},
journal = {Digestive diseases and sciences},
volume = {60},
number = {6},
pages = {1832-1840},
pmid = {25559756},
issn = {1573-2568},
mesh = {Aged ; Cohort Studies ; Denmark/epidemiology ; Diverticulum, Colon/*complications/*mortality/surgery ; Female ; Hospital Mortality ; Humans ; Liver Diseases/*complications/*mortality ; Male ; Middle Aged ; Recurrence ; Registries ; Reoperation/statistics & numerical data ; Risk Factors ; },
abstract = {BACKGROUND: Coexistence of liver disease in patients undergoing surgery for diverticular disease (DD) may increase the risk of postoperative complications, but the evidence is limited.
AIM: To investigate the impact of liver disease on mortality and reoperation rates following surgery for DD.
METHODS: We performed a cohort study based on medical databases of all patients undergoing surgery for DD in Denmark during 1977-2011, categorizing them into three cohorts according to history of liver disease: patients with non-cirrhotic liver disease, those with liver cirrhosis, and those without liver disease (comparison cohort). Using the Kaplan-Meier method, we computed mortality in each cohort for 0-30, 31-60, and 61-90 days following surgery for DD. We used a Cox regression model to compute hazard ratios as measures of the relative risk (RR) of death, controlling for potential confounders, including other comorbidities. In addition, we assessed the reoperation rate within 30 days of initial surgery.
RESULTS: Of 14,408 patients undergoing surgery for DD, 233 (1.6 %) had non-cirrhotic liver disease and 91 (0.6 %) had liver cirrhosis. Thirty-day mortality was 9.9 % in patients without liver disease and 14.6 % in patients with non-cirrhotic liver disease [adjusted RR = 1.64 (95 % confidence interval [CI] 1.16-2.31)]. Among patients with liver cirrhosis, mortality was 24.2 % [adjusted RR = 2.70 (95 % CI 1.73-4.22)]. Liver cirrhosis had an impact on mortality up to 60 days after surgery for DD. The reoperation rate was approximately 10 % in each cohort.
CONCLUSION: Preexisting liver disease has a major impact on postoperative mortality following surgery for DD.},
}
@article {pmid25540866,
year = {2015},
author = {Walker, MM and Talley, NJ and Inganäs, L and Engstrand, L and Jones, MP and Nyhlin, H and Agréus, L and Kjellstrom, L and Öst, Å and Andreasson, A},
title = {Colonic spirochetosis is associated with colonic eosinophilia and irritable bowel syndrome in a general population in Sweden.},
journal = {Human pathology},
volume = {46},
number = {2},
pages = {277-283},
doi = {10.1016/j.humpath.2014.10.026},
pmid = {25540866},
issn = {1532-8392},
mesh = {Adult ; Aged ; Biopsy ; Colon/*pathology ; Colonoscopy/methods ; Eosinophilia/*epidemiology ; Female ; Humans ; Irritable Bowel Syndrome/diagnosis/*epidemiology ; Male ; Middle Aged ; Prevalence ; Rectum/*pathology ; Sweden/epidemiology ; Young Adult ; },
abstract = {Irritable bowel syndrome (IBS) is a functional disorder defined by symptoms in the absence of overt pathology. Colonic spirochetosis (CS), defined by histologic observation of spirochetal strains of Brachyspira in colonic biopsies, is uncommon and considered of doubtful significance. We aimed to determine the prevalence of CS in the general population, identify subtle colon pathologies, and evaluate a link with symptoms of IBS. Colonoscopy was performed in 745 subjects (aged 19-70 years, mean age 51 years, 43% male) with biopsies (ileum and 4 colonic sites) from a random population sample, Stockholm, Sweden, who completed a validated questionnaire of gastrointestinal symptoms; IBS was identified by Rome III criteria. CS was identified by histology and immunohistochemistry. In a general population, 17 individuals (2.28%; 95% confidence interval, 1.2%-3.5%) were diagnosed as having CS by histology; 6 (35%) had IBS. CS was always present in the sigmoid colon, but only 14 rectal biopsies. Eosinophils were increased in colon biopsies in CS cases versus controls, in the transverse (P = .02), sigmoid colon (P = .001), and rectum (P = .0005) with subepithelial eosinophil clusters (P = .053). Lymphoid follicles (at any site) were present in 13 CS (P = .0003). There was a 3-fold increased risk of IBS in CS (odds ratio, 3.59; 95% confidence interval, 1.27-10.11; P = .015). Polyps and diverticular disease were similar in CS cases and controls. The prevalence of CS in a general population is 2% and associated with nonconstipating IBS. Colonic eosinophilia with lymphoid follicles may signify the presence of CS.},
}
@article {pmid25531499,
year = {2015},
author = {Tursi, A and Brandimarte, G and Di Mario, F and Andreoli, A and Annunziata, ML and Astegiano, M and Bianco, MA and Buri, L and Cammarota, G and Capezzuto, E and Chilovi, F and Cianci, M and Conigliaro, R and Del Favero, G and Di Cesare, L and Di Fonzo, M and Elisei, W and Faggiani, R and Farroni, F and Forti, G and Germanà, B and Giorgetti, GM and Giovannone, M and Lecca, PG and Loperfido, S and Marmo, R and Morucci, P and Occhigrossi, G and Penna, A and Rossi, AF and Spadaccini, A and Zampaletta, C and Zilli, M and Zullo, A and Scarpignato, C and Picchio, M},
title = {Development and validation of an endoscopic classification of diverticular disease of the colon: the DICA classification.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {33},
number = {1},
pages = {68-76},
doi = {10.1159/000366039},
pmid = {25531499},
issn = {1421-9875},
mesh = {Colon/*pathology ; Diverticulum/*classification/*complications ; Edema/complications/pathology ; *Endoscopy ; Humans ; Inflammation/*complications/*pathology ; Predictive Value of Tests ; Reproducibility of Results ; },
abstract = {BACKGROUND: A validated endoscopic classification of diverticular disease (DD) of the colon is lacking at present. Our aim was to develop a simple endoscopic score of DD: the Diverticular Inflammation and Complication Assessment (DICA) score.
METHODS: The DICA score for DD resulted in the sum of the scores for the extension of diverticulosis, the number of diverticula per region, the presence and type of inflammation, and the presence and type of complications: DICA 1 (≤ 3), DICA 2 (4-7) and DICA 3 (>7). A comparison with abdominal pain and inflammatory marker expression was also performed. A total of 50 videos of DD patients were reassessed in order to investigate the predictive role of DICA on the outcome of the disease.
RESULTS: Overall agreement in using DICA was 0.847 (95% confidence interval, CI, 0.812-0.893): 0.878 (95% CI 0.832-0.895) for DICA 1, 0.765 (95% CI 0.735-0.786) for DICA 2 and 0.891 (95% CI 0.845-0.7923) for DICA 3. Intra-observer agreement (kappa) was 0.91 (95% CI 0.886-0.947). A significant correlation was found between the DICA score and C-reactive protein values (p = 0.0001), as well as between the median pain score and the DICA score (p = 0.0001). With respect to the 50 patients retrospectively reassessed, occurrence/recurrence of disease complications was recorded in 29 patients (58%): 10 (34.5%) were classified as DICA 1 and 19 (65.5%) as DICA 2 (p = 0.036).
CONCLUSIONS: The DICA score is a simple, reproducible, validated and easy-to-use endoscopic scoring system for DD of the colon.},
}
@article {pmid25515159,
year = {2015},
author = {Prasad, J and Varma, N and Baskara, A},
title = {Omitted variable bias and the risk of incisional hernia after partial colectomy for diverticular disease.},
journal = {Journal of the American College of Surgeons},
volume = {220},
number = {1},
pages = {117},
doi = {10.1016/j.jamcollsurg.2014.10.005},
pmid = {25515159},
issn = {1879-1190},
mesh = {Colectomy/*adverse effects ; Colon, Sigmoid/*surgery ; Colonic Neoplasms/*surgery ; Female ; Hernia, Abdominal/*epidemiology ; Humans ; Male ; Sigmoid Diseases/*surgery ; },
}
@article {pmid25509691,
year = {2014},
author = {Sirinthornpunya, S and Rungjiratananon, S},
title = {Association of colonic diverticular disease and irritable bowel syndrome in Thai patients.},
journal = {Journal of the Medical Association of Thailand = Chotmaihet thangphaet},
volume = {97 Suppl 11},
number = {},
pages = {S18-24},
pmid = {25509691},
issn = {0125-2208},
mesh = {Aged ; Colonoscopy ; Cross-Sectional Studies ; Diverticulitis, Colonic/*complications/*epidemiology ; Female ; Humans ; Irritable Bowel Syndrome/*complications/*epidemiology ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Thailand/epidemiology ; },
abstract = {BACKGROUND: Colonic diverticular disease exhibits mucosal outpouchings through the large intestine. Common complications of this disease are diverticular bleeding and diverticulitis. Some patients with colonic diverticular disease have abdominal symptoms resembling irritable bowel syndrome (IBS). IBS is a functional gastrointestinal disorder with abdominal discomfort, bloating or pain associated with disturbed defecation and unclear etiology. Some studies have shown a high prevalence of colonic diverticular disease in patients with IBS.
OBJECTIVE: To determine the association, clinical characteristics and factors associated with colonic diverticular disease in IBS patients compared with a control group.
MATERIAL AND METHOD: A cross-sectional prospective study was conducted at the Gastroenterology Unit, Department of Medicine, Rajavithi Hospital, Bangkok during December 2007 to January 2009. The study collected data regarding clinical characteristics, demographics and colonoscopic findings of colonic diverticular disease comparing among IBS patients, defined by Rome III criteria and control group patients. The study was approved by the institutional ethics committee of Rajavithi Hospital. Demographic data of patients were collected. The presence of diverticula, their location and number from colonoscopic findings were recorded.
RESULTS: One hundred and fifty patients were enrolled and analyzed. The patients comprised 75 patients in the IBS group and 75 patients in the control group. The prevalence ofcolonic diverticular disease in the total population was 17.3% (26 of 150). The IBS group had a higher prevalence of colonic diverticular disease than the control group with statistical significance (18 of 75, 24.0% in the IBS group vs. 8 of 75 or 10.7% in the control group, p = 0.031). Body mass index (BMI) more than 25 kg/m2, age more than 60 years and being male were associated with colonic diverticular disease without significance (28.1% in BMI >25 kg/m2 vs. 14.3% in BMI ≤25 kg/m2, p = 0.071, 23.0% in age >60 years vs. 13.5% in age ≤60 years, p = 0.132 and 20.3% males vs. 15.1% females, p = 0.406). Type of IBS (IBS-C vs. IBS-D) did not affect the prevalence of colonic diverticular disease (25.8% in IBS-C and 23.1% in IBS-D, p = 0.791). There were no difference in the location of colonic diverticular disease and number ofdiverticuli between the IBS group and control group (p = 0.149 and 0.095).
CONCLUSION: An increased frequency of colonic diverticular disease was observed in patients with IBS. Increasing age, high BMI and being male were factors associated with colonic diverticular disease. These results suggest that IBS and colonic diverticular disease may have a common pathogenesis.},
}
@article {pmid25499509,
year = {2015},
author = {Mendall, MA},
title = {Diverticular Disease and Vascular Diseases: A Shared Responsiveness to Injury Is Likely to Be the Underlying Mechanism.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {13},
number = {7},
pages = {1375},
doi = {10.1016/j.cgh.2014.12.004},
pmid = {25499509},
issn = {1542-7714},
mesh = {Diverticulum/*complications ; Female ; Humans ; Male ; Thromboembolism/*epidemiology ; },
}
@article {pmid25497619,
year = {2014},
author = {Arsic, I and Cuk, P and Nielsen, MF and Al Karim, EB},
title = {[Jejunal diverticulitis as the cause of acute abdomen].},
journal = {Ugeskrift for laeger},
volume = {176},
number = {25A},
pages = {},
pmid = {25497619},
issn = {1603-6824},
mesh = {Abdomen, Acute/diagnostic imaging/drug therapy/*etiology ; Aged ; Anti-Bacterial Agents/therapeutic use ; Conservative Treatment ; Diverticulitis/*complications/diagnostic imaging/drug therapy ; Female ; Humans ; Jejunal Diseases/*complications/diagnostic imaging/drug therapy ; Male ; Middle Aged ; Tomography, X-Ray Computed ; },
abstract = {We present two patients with jejunal diverticulitis. Diverticula in jejunum and ileum are very rare, occurring with an incidence of 0.07-2% in the gastrointestinal tract. They are often associated with unspecific symptoms as intermittent abdominal pain, nausea and diarrhoea. The treatment of mild diverticular disease is intravenous fluids and antibiotics. If there is an occurrence of peritonitis as a complication of jejunal diverticulitis, laparatomy may be indicated. Both of the patients received a conservative treatment with intravenous fluids and antibiotics with good response.},
}
@article {pmid25497007,
year = {2015},
author = {Bugiantella, W and Rondelli, F and Longaroni, M and Mariani, E and Sanguinetti, A and Avenia, N},
title = {Left colon acute diverticulitis: an update on diagnosis, treatment and prevention.},
journal = {International journal of surgery (London, England)},
volume = {13},
number = {},
pages = {157-164},
doi = {10.1016/j.ijsu.2014.12.012},
pmid = {25497007},
issn = {1743-9159},
mesh = {Diverticulitis, Colonic/*diagnosis/epidemiology/*therapy ; Humans ; Prevalence ; Recurrence ; },
abstract = {Diverticulosis of the colon is a common disease with an increasing incidence in Western Countries. It represents a significant burden for National Health Systems in terms of costs. Most people with diverticulosis remain asymptomatic, about one quarter of them will develop an episode of symptomatic diverticular disease and up to 5% an episode of acute diverticulitis (AD). AD shows an increasing prevalence. Recently, progresses have been reached about the etiology, pathogenesis, natural course of diverticular disease and its complications; improvements about the diagnosis and treatment of AD have been achieved. However, the treatment options are not well defined because of a lack of solid evidence: there are few systematic reviews and well conducted trials to guide decision-making in the treatment of AD and in the prevention of its recurrences. This review describes the recent evidence about diagnosis, treatment and prevention of AD.},
}
@article {pmid25492999,
year = {2014},
author = {Laghi, A},
title = {Computed tomography colonography in 2014: an update on technique and indications.},
journal = {World journal of gastroenterology},
volume = {20},
number = {45},
pages = {16858-16867},
pmid = {25492999},
issn = {2219-2840},
mesh = {Colon/*diagnostic imaging ; Colonic Diseases/*diagnostic imaging ; Colonography, Computed Tomographic/*methods ; Contraindications ; Humans ; Multidetector Computed Tomography/*methods ; Patient Selection ; Predictive Value of Tests ; Prognosis ; Radiographic Image Interpretation, Computer-Assisted ; Risk Assessment ; Risk Factors ; },
abstract = {Twenty years after its introduction, computed tomographic colonography (CTC) has reached its maturity, and it can reasonably be considered the best radiological diagnostic test for imaging colorectal cancer (CRC) and polyps. This examination technique is less invasive than colonoscopy (CS), easy to perform, and standardized. Reduced bowel preparation and colonic distention using carbon dioxide favor patient compliance. Widespread implementation of a new image reconstruction algorithm has minimized radiation exposure, and the use of dedicated software with enhanced views has enabled easier image interpretation. Integration in the routine workflow of a computer-aided detection algorithm reduces perceptual errors, particularly for small polyps. Consolidated evidence from the literature shows that the diagnostic performances for the detection of CRC and large polyps in symptomatic and asymptomatic individuals are similar to CS and are largely superior to barium enema, the latter of which should be strongly discouraged. Favorable data regarding CTC performance open the possibility for many different indications, some of which are already supported by evidence-based data: incomplete, failed, or unfeasible CS; symptomatic, elderly, and frail patients; and investigation of diverticular disease. Other indications are still being debated and, thus, are recommended only if CS is unfeasible: the use of CTC in CRC screening and in surveillance after surgery for CRC or polypectomy. In order for CTC to be used appropriately, contraindications such as acute abdominal conditions (diverticulitis or the acute phase of inflammatory bowel diseases) and surveillance in patients with a long-standing history of ulcerative colitis or Crohn's disease and in those with hereditary colonic syndromes should not be overlooked. This will maximize the benefits of the technique and minimize potential sources of frustration or disappointment for both referring clinicians and patients.},
}
@article {pmid25492045,
year = {2015},
author = {Kvasnovsky, CL and Papagrigoriadis, S},
title = {Symptoms in patients with diverticular disease should not be labelled as IBS.},
journal = {International journal of colorectal disease},
volume = {30},
number = {7},
pages = {995},
pmid = {25492045},
issn = {1432-1262},
mesh = {Diverticulitis/*complications ; Female ; Humans ; Intestinal Diseases/*complications ; Irritable Bowel Syndrome/*complications/*epidemiology ; Male ; },
}
@article {pmid25484325,
year = {2015},
author = {Amato, G and Birsan, T and Granic, E and Silberhumer, G and Cassata, G and Agrusa, A and Puleio, R and Romano, G and Lang, S and Noda, W and Gasche, C},
title = {Vacuum inversion and securing of distal colonic pseudodiverticula with novel spiked O-rings.},
journal = {Gastrointestinal endoscopy},
volume = {81},
number = {3},
pages = {749-755},
doi = {10.1016/j.gie.2014.09.051},
pmid = {25484325},
issn = {1097-6779},
mesh = {Animals ; Diverticulum, Colon/*surgery ; Female ; Humans ; Laparoscopy/instrumentation/*methods ; Prospective Studies ; Swine ; Vacuum ; },
abstract = {BACKGROUND: Diverticular disease is increasingly prevalent in Western societies and is associated with significant morbidity.
OBJECTIVE: Two-stage endoscopic device development for inversion and secured ligation of colonic diverticula; first, human cadaver studies were performed to measure forces required for diverticular inversion; second, a novel set of devices (elastic spiked O-ring with delivery system) was tested in animals.
DESIGN: Prospective, observational study of human cadavers and prospective, interventional study of a porcine model.
SETTING: University hospital pathology laboratory and animal facility.
INTERVENTION: Full-thickness inversion of the colonic wall with a pipelike delivery instrument to produce an inverted pseudodiverticulum that was secured with a spiked O-ring.
MAIN OUTCOME MEASUREMENTS: The forces required for diverticular inversion, the secured closure of inverted pseudodiverticula, and the time until necrotic tissue falls off.
RESULTS: A total of 248 of 248 of cadaveric sigmoid diverticula could be inverted by means of vacuum or forceps. The forces required for inversion ranged from 0.28 to 0.47 N (median, 0.37 N). Twenty-four spiked O-rings were delivered in 6 living pigs to produce 24 inverted pseudodiverticula. One animal died the day after the procedure of a pulmonary thromboembolism. In the remaining 5 pigs, all delivered spiked O-rings remained in place for 7 to 22 days. At necropsy, none of the inverted sites showed signs of perforation but rather full-thickness reparative scarring with ingrowth of connective tissue.
LIMITATIONS: Animal model, stiff pipelike delivery instrument, variations in diverticular location, diameter, and size.
CONCLUSIONS: Endoluminal inversion and securing of colonic diverticula induces tissue necrosis, diverticular sloughing, and full-thickness scarring.},
}
@article {pmid25470583,
year = {2014},
author = {Spiller, R},
title = {Editorial: new thoughts on the association between diverticulosis and irritable bowel syndrome.},
journal = {The American journal of gastroenterology},
volume = {109},
number = {12},
pages = {1906-1908},
doi = {10.1038/ajg.2014.367},
pmid = {25470583},
issn = {1572-0241},
mesh = {Colon/*pathology ; Diverticulum, Colon/*epidemiology ; Female ; Humans ; Irritable Bowel Syndrome/*epidemiology ; Male ; Rectum/*pathology ; },
abstract = {As our population ages it is increasingly common to encounter patients with irritable bowel syndrome (IBS)-like symptoms and diverticulosis, but the nature of the association is obscure. This Editorial discusses the paper from Japan showing an association between IBS-like symptoms and left-sided but not right-sided diverticulosis. The left colon with its higher motor activity is more likely to be associated with complications of diverticulosis, including perforation and abscess formation. The underlying pathophysiology of the syndrome of post-diverticulitis IBS is discussed and clinical markers of centrally driven symptoms suggested as a means to avoid ineffective colonic resections in those with IBS-like diverticular disease.},
}
@article {pmid25457252,
year = {2015},
author = {Letarte, F and Hallet, J and Drolet, S and Boulanger-Gobeil, C and Bouchard, A and Grégoire, RC and Gagné, JP and Thibault, C and Bouchard, P},
title = {Laparoscopic versus open colonic resection for complicated diverticular disease in the emergency setting: a safe choice? A retrospective comparative cohort study.},
journal = {American journal of surgery},
volume = {209},
number = {6},
pages = {992-998},
doi = {10.1016/j.amjsurg.2014.07.017},
pmid = {25457252},
issn = {1879-1883},
mesh = {Adult ; Aged ; Cohort Studies ; Colectomy/*methods ; Conversion to Open Surgery/statistics & numerical data ; Diverticulitis, Colonic/mortality/*surgery ; Elective Surgical Procedures ; Emergencies ; Female ; Humans ; *Laparoscopy ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: We conducted a retrospective cohort study to compare the outcomes of laparoscopic colon resection (LCR) with open colon resection (OCR) for complicated diverticular disease (CDD) during emergent hospital admission.
METHODS: Charts from all patients undergoing colon resection for CDD during emergent hospital admission at a single academic institution were reviewed. The primary outcomes were overall 30-day postoperative morbidity and mortality.
RESULTS: From 2000 to 2010, 125 cases were retrieved (49 LCR and 86 OCR). Conversion rate was 5.1%. Overall morbidity significantly decreased with laparoscopic surgery compared with OCR. No mortality occurred with LCR. Prolonged ileus was less frequent (12.8% vs. 32.6%; P = .02), time to oral intake shorter (3 vs. 6 days; P < .01), and LOS shorter (5 vs. 8 days; P = .05) for LCR.
CONCLUSIONS: In our series, in the patients selected, LCR for CDD during emergent hospital admission appears to be a safe procedure associated with decreased morbidity, time to oral intake, and LOS compared with OCR.},
}
@article {pmid25448673,
year = {2014},
author = {Samdani, T and Pieracci, FM and Eachempati, SR and Benarroch-Gampel, J and Weiss, A and Pietanza, MC and Barie, PS and Nash, GM},
title = {Colonic diverticulitis in chemotherapy patients: should operative indications change? A retrospective cohort study.},
journal = {International journal of surgery (London, England)},
volume = {12},
number = {12},
pages = {1489-1494},
pmid = {25448673},
issn = {1743-9159},
support = {P30 CA008748/CA/NCI NIH HHS/United States ; },
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/therapeutic use ; Cohort Studies ; Colonic Neoplasms/*complications/drug therapy/immunology ; Diverticulitis, Colonic/complications/*surgery ; Elective Surgical Procedures ; Female ; Humans ; Immunocompromised Host ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; },
abstract = {INTRODUCTION: Management of the immunosuppressed patient with diverticular disease remains controversial. We report the largest series of colon cancer patients undergoing chemotherapy and hospitalized for acute diverticulitis, to determine whether recent treatment with systemic chemotherapy is associated with increased risk for/increased severity of recurrent diverticulitis.
METHODS: Retrospective cohort study of adult patients hospitalized for an initial episode of acute colonic diverticulitis at Memorial Sloan Kettering Cancer Center, 1988-2004. Outcomes in patients receiving systemic chemotherapy within one month of admission for diverticulitis ("Chemo") were compared to outcomes of patients not receiving chemotherapy within the past month ("No-chemo").
RESULTS: A total 131 patients met inclusion criteria. Chemo patients did not differ significantly from No-chemo group in terms of severity of acute diverticulitis at index admission (13.2% vs. 4.4%, respectively, p = 0.12), resumption of chemotherapy (median 2 months), failure of non-operative management (13.2% vs 4.4%, respectively, p = 0.12), frequency of recurrence (20.5% vs 18.5%), hospital length of stay (p = 0.08), and likelihood of interval resection (24.0% vs. 16.2%, respectively, p = 0.39). Chemo patients recurred with more severe disease, were more likely to undergo emergent surgery (75.0% vs. 23.5%, respectively, p = 0.03), and were more likely to be diverted (100.0% vs. 25.0%, respectively, p = 0.03). Chemo patients were significantly more likely to incur a postoperative complication (100% vs 9.1% p < 0.01) following interval resection. Overall mortality was significantly higher in the Chemo vs. No-chemo group. Median survival in Chemo patients was 3.4 years; in No-chemo patients, median survival was not reached at 10 years.
CONCLUSION: Our data do not support routine elective surgery for acute diverticulitis in patients receiving chemotherapy. Non-operative management in the acute or interval setting appears preferable whenever possible.},
}
@article {pmid25447088,
year = {2014},
author = {Galli, R and Schnüriger, B and Brügger, L and Inderbitzin, D},
title = {[Changes in indications for surgery in the management of diverticulitis].},
journal = {Therapeutische Umschau. Revue therapeutique},
volume = {71},
number = {12},
pages = {727-736},
doi = {10.1024/0040-5930/a000619},
pmid = {25447088},
issn = {0040-5930},
mesh = {Diverticulitis, Colonic/*diagnosis/*therapy ; Drainage/*trends ; Evidence-Based Medicine ; Humans ; Laparoscopy/*trends ; Patient Selection ; Prophylactic Surgical Procedures/*trends ; Treatment Outcome ; Unnecessary Procedures/*trends ; },
abstract = {Diverticulitis is a common disease in western countries and its incidence is increasing especially among young patients. Colonic diverticulosis, incidentally diagnosed by endoscopy or CT-scanning, has no immediate clinical consequences. Progression to diverticulitis develops in only 4 % of cases. In the last decades management of diverticular disease evolved and expectative treatment and less invasive techniques have gained importance. Elective resection has traditionally been advised after a second episode of diverticulitis or after a first episode if the patient was less than 50 years of age or complicated disease occurred. Recent changes in understanding the natural history of diverticular disease have substantially modified treatment paradigms. Elective resection in case of recurrent diverticular disease should be performed on a individual basis and in cases with complications like intestinal obstruction or fistulas. Primary anastomosis is an option even in emergency surgery due to colonic perforation, while diverting operations are indicated for selected patient groups with a high risk profile. Several prospective studies showed good results for laparoscopic drainage and lavage in the setting of perforated diverticulitis with generalized peritonitis, though this concept needs to be controlled with randomized clinical trials before application into the daily practice. This article should provide a short overview of trends in the surgical treatment of diverticulitis, help to understand the natural history of the disease and thereby explain the currently lower frequency of surgical interventions for diverticulitis.},
}
@article {pmid25440479,
year = {2014},
author = {Simorov, A and Thompson, J and Oleynikov, D},
title = {Alvimopan reduces length of stay and costs in patients undergoing segmental colonic resections: results from multicenter national administrative database.},
journal = {American journal of surgery},
volume = {208},
number = {6},
pages = {919-25; discussion 925},
doi = {10.1016/j.amjsurg.2014.08.011},
pmid = {25440479},
issn = {1879-1883},
mesh = {Adolescent ; Adult ; Aged ; Colectomy/*methods/mortality ; Critical Care/statistics & numerical data ; Female ; Gastrointestinal Agents/*therapeutic use ; Hospital Costs ; Hospital Mortality ; Humans ; Length of Stay/economics/*statistics & numerical data ; Male ; Middle Aged ; Patient Readmission/statistics & numerical data ; Piperidines/*therapeutic use ; Treatment Outcome ; },
abstract = {BACKGROUND: Alvimopan (Entereg), a peripherally acting mu-opioid receptor antagonist, has been shown to expedite recovery of bowel function after colon resection surgery. Most data are available from industry-sponsored trials. This study aims to evaluate the clinical impact of this drug on perioperative outcomes and costs in patients undergoing segmental colonic resection for diverticular disease.
METHODS: A large administrative database maintained by the University Health System Consortium, an alliance of over 200 academic and affiliate hospitals, was queried from 2008 to 2011. International Classification of Diseases, 9th Revision, Clinical Modification codes for segmental colon resection because of diverticular disease were used to identify 2 matched cohorts of adult patients. University Health System Consortium's clinical resource manager was used to access pharmacy data and compare it with patient outcomes.
RESULTS: Five thousand two hundred ninety-nine patients met the above criteria. Four hundred thirty-eight patients received alvimopan and 4,861 did not. Regardless of laparoscopic or open approach, alvimopan significantly improved the postoperative length of stay (4.43 ± 2.02 vs 5.92 ± 3.79, P < .0001), cost (9,974 ± 4,077 vs 11,303 ± 6,968, P < .0001), and intensive care unit admission rate (1.83% vs 7.20%, P < .05), with no significant difference in mortality (.0% vs .19%, P = 1.000), morbidity (5.93% vs 8.39%, P = .08), or 30-day readmission rate (4.40% vs 4.63%, P = .90).
CONCLUSIONS: Alvimopan significantly reduced length of stay, days in the intensive care unit, and hospital cost for patients undergoing colonic segmental resections. Unlike some previously reported studies, we also observed a significant reduction in the length of stay in patients undergoing laparoscopic colectomies who received the drug. Alvimopan may reduce total healthcare costs if used as part of a best care practice model for colon resections.},
}
@article {pmid25437673,
year = {2014},
author = {Kassir, R and Abboud, K and Dubois, J and Baccot, S and Debs, T and Favre, JP and Gugenheim, J and Gastaldi, P and Amor, IB and Tiffet, O},
title = {Perforated diverticulitis of the sigmoid colon causing a subcutaneous emphysema.},
journal = {International journal of surgery case reports},
volume = {5},
number = {12},
pages = {1190-1192},
pmid = {25437673},
issn = {2210-2612},
abstract = {INTRODUCTION: Although diverticular disease of the colon is frequent, perforated diverticulitis causing subcutaneous emphysema is a uncommon entity. We wish to present this extremely rare case of perforated colonic diverticulum in the subcutaneous tissue, which is the first one that we have encountered in our practice, along with the accompanying diagnostic and therapeutic issues and a review of the literature.
PRESENTATION OF CASE: We report the case of an 83-year-old man who admitted to the emergency room due to an abdominal subcutaneous emphysema. Physical examination revealed a severe subcutaneous emphysema especially in the left iliac fossa and abdominal pain. An urgent contrast enhanced abdominal CT scan showed multiple diverticula in the sigmoid colon and multiple air bubbles in the subcutaneous tissue. The exploratory laparotomy identified a perforation of diverticular in subcutaneous tissue. Forty centimeters of colon were resected. The subcutaneous emphysema resolved without specific treatment. The postoperative period was uncomplicated.
DISCUSSION: Subcutaneous emphysema of anterior abdomen wall is an obvious physical sign but its etiology is complex to determine and may be potentially lethal. The pathophysiological mechanism involved is the emergence of a pressure gradient between the peritoneum and surrounding structures, causing rupture of the anterior abdominal wall, allowing gas from a perforation to diffuse along tissue planes.
CONCLUSION: This physical sign may be of especial value in elderly patient groups amongst whom perforation may be less clinically obvious. General surgeons should bear in mind this rare complication of colonic diverticulosis.},
}
@article {pmid25426969,
year = {2015},
author = {Mosadeghi, S and Bhuket, T and Stollman, N},
title = {Diverticular disease: evolving concepts in classification, presentation, and management.},
journal = {Current opinion in gastroenterology},
volume = {31},
number = {1},
pages = {50-55},
doi = {10.1097/MOG.0000000000000145},
pmid = {25426969},
issn = {1531-7056},
mesh = {Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects/therapeutic use ; Aspirin/adverse effects ; Colonoscopy ; Dietary Fiber/adverse effects ; Diverticulosis, Colonic/diagnosis/*etiology/*therapy ; Humans ; Mesalamine/therapeutic use ; },
abstract = {PURPOSE OF REVIEW: Diverticular disease is the most commonly reported finding at the time of colonoscopy and one of the most common gastrointestinal indications for hospitalization. Much of our previous understanding of diverticular disease has recently been challenged.
RECENT FINDINGS: There is emerging evidence that the long-accepted hypothesis of diverticulosis as a consequence of fiber deficiency may be more complex than commonly thought, with recent evidence suggesting that high-fiber diet and frequent bowel movements are associated with a greater and not lower prevalence of diverticular disease. There is also emerging support for the concept of low-grade inflammation in symptomatic uncomplicated diverticular disease (SUDD), and the role of anti-inflammatory treatment with mesalamine is being actively investigated. Additionally, elective 'prophylactic' surgery after diverticulitis, previously considered after a second confirmed diverticulitis episode, is being increasingly deferred.
SUMMARY: The pathogenesis of diverticular disease is likely multifactorial and complex. More studies are needed to evaluate the role of fiber in the pathogenesis and treatment of diverticular disease. The search for an effective medical therapy for SUDD and to prevent recurrent diverticulitis is being actively investigated. The efficacy of mesalamine does not appear to be strong data supported.},
}
@article {pmid25426771,
year = {2015},
author = {Lips, LM and Cremers, PT and Pickhardt, PJ and Cremers, SE and Janssen-Heijnen, ML and de Witte, MT and Simons, PC},
title = {Sigmoid cancer versus chronic diverticular disease: differentiating features at CT colonography.},
journal = {Radiology},
volume = {275},
number = {1},
pages = {127-135},
doi = {10.1148/radiol.14132829},
pmid = {25426771},
issn = {1527-1315},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonography, Computed Tomographic/*methods ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Sigmoid Neoplasms/*diagnostic imaging ; },
abstract = {PURPOSE: To retrospectively identify morphologic findings at computed tomographic (CT) colonography that are the most reliable in the differentiation of masslike chronic diverticular disease from sigmoid carcinoma in a large patient cohort.
MATERIALS AND METHODS: This study was approved by the institutional review boards. The need for signed consent was waived for this retrospective study. The cohort consisted of 212 patients (mean age, 68 years; 113 women, 99 men) with focal masslike findings in the sigmoid colon at CT colonography, representing chronic diverticular disease (n = 97) or sigmoid carcinoma (n = 115). CT colonography studies were scored according to presence or absence of potential discriminators by a panel of four readers in consensus. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, and multivariate analysis was performed.
RESULTS: Absence of diverticula in the affected segment showed high NPV and PPV (0.95 and 0.93, respectively). Also, shoulder phenomenon showed a high NPV (0.92) and PPV (0.75). Segment length of 10 cm or less (NPV, 0.85; PPV, 0.61) and destroyed mucosal folds (NPV, 1.00; PPV, 0.62) had a high NPV but a low PPV. Although segments affected by carcinoma often showed straightened and eccentric growth patterns, no thick fascia sign, and more and larger local-regional lymph nodes (all P < .05), NPV was insufficient for discrimination (NPV ≤ 0.66). Combination of absence of diverticula and presence of shouldering showed a high diagnostic certainty (93%).
CONCLUSION: Carcinoma is best differentiated from masslike diverticular disease by the absence of diverticula in the affected segment and the presence of shoulder phenomenon.},
}
@article {pmid25423465,
year = {2014},
author = {Kruis, W},
title = {[Diverticular disease: early classification allows best treatment].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {139},
number = {49},
pages = {2532},
doi = {10.1055/s-0034-1374722},
pmid = {25423465},
issn = {1439-4413},
mesh = {Anti-Bacterial Agents/therapeutic use ; Colectomy ; Disease Progression ; Diverticulitis, Colonic/*classification/diagnosis/*therapy ; Diverticulosis, Colonic/*classification/diagnosis/*therapy ; Humans ; Prognosis ; Recurrence ; Tomography, X-Ray Computed ; Ultrasonography ; },
}
@article {pmid25417665,
year = {2014},
author = {Chelcun, JL and DʼAddario, T},
title = {Diverticular disease.},
journal = {JAAPA : official journal of the American Academy of Physician Assistants},
volume = {27},
number = {12},
pages = {44-45},
doi = {10.1097/01.JAA.0000456580.39509.e3},
pmid = {25417665},
issn = {1547-1896},
mesh = {*Diverticulosis, Colonic/diagnosis/etiology/therapy ; Humans ; Risk Factors ; },
}
@article {pmid25417122,
year = {2015},
author = {Elagili, F and Stocchi, L and Ozuner, G and Kiran, RP},
title = {Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess.},
journal = {Techniques in coloproctology},
volume = {19},
number = {2},
pages = {97-103},
pmid = {25417122},
issn = {1128-045X},
mesh = {Abdominal Abscess/*drug therapy/pathology/*surgery ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Colectomy/adverse effects ; Databases, Factual ; Diverticulitis, Colonic/*complications ; Drainage/*methods ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/mortality ; Postoperative Period ; Retrospective Studies ; Treatment Failure ; },
abstract = {BACKGROUND: There are limited data assessing the effectiveness of antibiotics as sole initial therapy in patients with large diverticular abscess. The aim of our study was to compare outcomes of selected patients treated with initial antibiotics alone versus percutaneous drainage.
METHODS: All patients with diverticular abscess ≥3 cm in diameter treated in our institution in 1994-2012 with percutaneous drainage or antibiotics alone followed by surgery were identified from an institutional diverticular disease database. Groups were compared based on patient and disease characteristics, treatment failures and postoperative outcomes.
RESULTS: Thirty-two patients were treated with antibiotics alone because of either technically impossible percutaneous drainage (n = 15) or surgeon preference (n = 17) while 114 underwent percutaneous drainage. Failure of initial treatment required urgent surgery in 8 patients with persistent symptoms during treatment with antibiotics alone (25 %) and in 21 patients (18 %) after initial percutaneous drainage (p = 0.21). Reasons for urgent surgery after percutaneous drainage were persistent symptoms (n = 16), technical failure of percutaneous drainage (n = 4) and small bowel injury (n = 1). Patients treated with antibiotics had a significantly smaller abscess diameter (5.9 vs. 7.1 cm, p = 0.001) and shorter interval from initial treatment to sigmoidectomy (mean 50 vs. 80 days, p = 0.02). The Charlson comorbidity index, initial treatment failure rates, postoperative mortality, overall morbidity, length of hospital stay during treatments, and overall and permanent stoma rates were comparable in the two groups. Postoperative complications following antibiotics alone were significantly less severe than after percutaneous drainage based on the Clavien-Dindo classification (p = 0.04).
CONCLUSIONS: Selected patients with diverticular abscess can be initially treated with antibiotics without adverse consequences on their outcomes.},
}
@article {pmid25416544,
year = {2015},
author = {Wise, KB and Merchea, A and Cima, RR and Colibaseanu, DT and Thomsen, KM and Habermann, EB},
title = {Proximal intestinal diversion is associated with increased morbidity in patients undergoing elective colectomy for diverticular disease: an ACS-NSQIP study.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {19},
number = {3},
pages = {535-542},
pmid = {25416544},
issn = {1873-4626},
mesh = {Adult ; Aged ; Colectomy/*adverse effects ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Morbidity ; Quality Improvement ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Elective colectomy for diverticular disease is common. Some patients undergo primary resection with proximal diversion in an effort to limit morbidity associated with potential anastomotic leak.
METHODS: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried. All patients undergoing a single, elective resection for diverticular disease from 2005 to 2011 were analyzed. Thirty-day outcomes were reviewed. Factors predictive of undergoing diversion and the risk-adjusted odds of postoperative morbidity with and without proximal diversion were determined by multivariable logistic regression models.
RESULTS: Fifteen thousand six hundred two patients undergoing non-emergent, elective resection were identified, of whom 348 (2.2 %) underwent proximal diversion. Variables predictive for undergoing proximal diversion included age ≥65 years, BMI ≥30, current smoking status, corticosteroid use, and serum albumin <3.0 g/dL. Multivariable analysis demonstrated that diversion was associated with significantly increased risk of surgical site infection (OR = 1.68), deep venous thrombosis (OR = 5.27), acute renal failure (OR = 5.83), sepsis or septic shock (OR = 1.75), readmission (OR = 2.57), and prolonged length of stay (OR = 3.35).
CONCLUSIONS: Proximal diversion in the setting of elective segmental colectomy for diverticular disease is uncommon. A combination of preoperative factors and intraoperative factors drives the decision for diversion. Patients who undergo diversion experience increased postoperative morbidity. Surgeons should have a low index of suspicion for postoperative complications and be prepared to mitigate their effect on the patient's outcome.},
}
@article {pmid25414061,
year = {2014},
author = {Senft, JD and Warschkow, R and Diener, MK and Tarantino, I and Steinemann, DC and Lamm, S and Simon, T and Zerz, A and Müller-Stich, BP and Linke, GR},
title = {The transvaginal hybrid NOTES versus conventionally assisted laparoscopic sigmoid resection for diverticular disease (TRANSVERSAL) trial: study protocol for a randomized controlled trial.},
journal = {Trials},
volume = {15},
number = {},
pages = {454},
pmid = {25414061},
issn = {1745-6215},
mesh = {Analgesics/therapeutic use ; Clinical Protocols ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/diagnosis/*surgery ; Elective Surgical Procedures ; Female ; Germany ; Humans ; *Laparoscopy/adverse effects ; Length of Stay ; Natural Orifice Endoscopic Surgery/adverse effects/*methods ; Pain Measurement ; Pain, Postoperative/diagnosis/drug therapy/etiology ; Quality of Life ; Recovery of Function ; *Research Design ; Sexual Behavior ; Sigmoid Diseases/diagnosis/*surgery ; Surveys and Questionnaires ; Time Factors ; Treatment Outcome ; *Vagina ; },
abstract = {BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) is the consequence of further development of minimally invasive surgery to reduce abdominal incisions and surgical trauma. The potential benefits are expected to be less postoperative pain, faster convalescence, and reduced risk for incisional hernias and wound infections compared to conventional methods. Recent clinical studies have demonstrated the feasibility and safety of transvaginal NOTES, and transvaginal access is currently the most frequent clinically applied route for NOTES procedures. However, despite increasing clinical application, no firm clinical evidence is available for objective assessment of the potential benefits and risks of transvaginal NOTES compared to the current surgical standard.
METHODS: The TRANSVERSAL trial is designed as a randomized controlled trial to compare transvaginal hybrid NOTES and laparoscopic-assisted sigmoid resection. Female patients referred to elective sigmoid resection due to complicated or reoccurring diverticulitis of the sigmoid colon are considered eligible. The primary endpoint will be pain intensity during mobilization 24 hours postoperatively as measured by the blinded patient and blinded assessor on a visual analogue scale (VAS). Secondary outcomes include daily pain intensity and analgesic use, patient mobility, intraoperative complications, morbidity, length of stay, quality of life, and sexual function. Follow-up visits are scheduled 3, 12, and 36 months after surgery. A total sample size of 58 patients was determined for the analysis of the primary endpoint. The confirmatory analysis will be performed based on the intention-to-treat (ITT) principle.
DISCUSSION: The TRANSVERSAL trial is the first study to compare transvaginal hybrid NOTES and conventionally assisted laparoscopic surgery for colonic resection in a randomized controlled setting. The results of the TRANSVERSAL trial will allow objective assessment of the potential benefits and risks of NOTES compared to the current surgical standard for sigmoid resection.
TRIAL REGISTRATION: The trial protocol was registered in the German Clinical Trials Register (DRKS00005995) on March 27, 2014.},
}
@article {pmid25413249,
year = {2014},
author = {Kruis, W and Germer, CT and Leifeld, L and , },
title = {Diverticular disease: guidelines of the german society for gastroenterology, digestive and metabolic diseases and the german society for general and visceral surgery.},
journal = {Digestion},
volume = {90},
number = {3},
pages = {190-207},
doi = {10.1159/000367625},
pmid = {25413249},
issn = {1421-9867},
mesh = {Adult ; Anti-Bacterial Agents/therapeutic use ; Colonoscopy/standards ; Diverticulitis/*classification/*diagnosis/*therapy ; Diverticulosis, Colonic/*diagnosis/drug therapy/surgery ; Female ; Gastroenterology/standards ; Germany ; Humans ; Intestinal Fistula/diagnosis ; Male ; Societies, Medical ; Urinary Bladder Fistula/diagnosis ; Vaginal Fistula/diagnosis ; },
abstract = {BACKGROUND: Diverticular disease is one of the most common disorders of the gastrointestinal tract. 28-45% of the population develop colonic diverticula, while about 25% suffer symptoms and about 5% complications.
AIM: To create formal guidelines for diagnosis and management.
METHODS: Six working groups with 44 participants analyzed key questions in subject areas assigned to them. Following a systematic literature search, 451 publications were included. Consensus was obtained by agreement within the working groups, two Delphi processes and a guideline conference.
RESULTS: Targeted management of diverticular disease requires a classificatory diagnosis. A new classification was created. In addition to the clinical examination, intestinal ultrasound or computed tomography is the determining factor. Interval colonoscopy is recommended to exclude comorbidities. A low-fiber diet, obesity, lack of exercise, smoking and immunosuppression have an adverse impact on diverticulosis. This can lead to diverticulitis. Antibiotics are no longer recommended in uncomplicated diverticulitis if no risk factors such as immunosuppression are present. If close monitoring is ensured, uncomplicated diverticulitis can be treated on an outpatient basis. Complicated diverticulitis should be treated in hospital, involving broad-spectrum antibiotic therapy, where necessary abscess drainage, and surgery, if possible laparoscopically. In the case of chronic relapsing diverticulitis, the risk of perforation decreases with each episode, so that surgery is no longer recommended after the second episode but only following individual assessment.
CONCLUSIONS: New findings on diverticular disease call into question the overuse of antibiotics and excessive indications for surgery. Targeted treatment requires a precise diagnosis and intensive interdisciplinary cooperation.},
}
@article {pmid25410040,
year = {2014},
author = {Swarbrick, K and Allin, B and Yeung, T and Sampson, M},
title = {Enterolithotomy for the treatment of large bowel obstruction secondary to gallstones.},
journal = {BMJ case reports},
volume = {2014},
number = {},
pages = {},
pmid = {25410040},
issn = {1757-790X},
mesh = {Aged, 80 and over ; Colon, Transverse/*surgery ; Colonic Diseases/diagnosis/*etiology/surgery ; Digestive System Surgical Procedures/*methods ; Female ; Gallstones/*complications/diagnosis/surgery ; Humans ; Intestinal Obstruction/diagnosis/*etiology/surgery ; Tomography, X-Ray Computed ; },
abstract = {We describe the case of an 81-year-old woman with large bowel-obstruction caused by an impacted gallstone. An 81-year-old, Caucasian, fully independent woman without significant comorbidities presented with absolute constipation, faecal vomiting and abdominal pain. Abdominal radiography revealed dilated small bowel, and a subsequent contrast CT demonstrated a 2.5 cm gallstone in the sigmoid colon. This is believed to have entered the transverse colon via a cholecyst-colonic fistula, and then migrated to a section of sigmoid colon affected by diverticular disease, where it became impacted. Two sigmoidoscopic removals were attempted but were unsuccessful as the gallstone's size prevented removal with an endoscopic basket. A laparotomy was performed and the stone extracted via a sigmoid enterotomy. No covering stoma was formed, and following 48 h on intensive trauma unit and a short ward-based stay for rehabilitation, the patient was discharged home and is currently doing well.},
}
@article {pmid25389076,
year = {2015},
author = {Hjern, F and Mahmood, MW and Abraham-Nordling, M and Wolk, A and Håkansson, N},
title = {Cohort study of corticosteroid use and risk of hospital admission for diverticular disease.},
journal = {The British journal of surgery},
volume = {102},
number = {1},
pages = {119-124},
doi = {10.1002/bjs.9686},
pmid = {25389076},
issn = {1365-2168},
mesh = {Administration, Inhalation ; Administration, Oral ; Adrenal Cortex Hormones/administration & dosage/*adverse effects ; Aged ; Aged, 80 and over ; Aspirin/administration & dosage/*adverse effects ; Cohort Studies ; Diverticulum, Colon/*chemically induced ; Female ; Hospitalization/*statistics & numerical data ; Humans ; Indomethacin/administration & dosage/*adverse effects ; Risk Factors ; },
abstract = {BACKGROUND: Medication has been suggested as a potential risk factor for diverticular disease. The objective of this study was to investigate the association between the intake of corticosteroids, indometacin or aspirin and diverticular disease.
METHOD: This was a prospective population-based cohort study of middle-aged women in the Swedish Mammography Cohort. Use of corticosteroids (oral or inhaled), indometacin or aspirin in 1997 was determined from questionnaires. Cases of diverticular disease were identified from the Swedish national registers until the end of 2010. The relative risk (RR) of diverticular disease requiring hospital admission according to the use of medication was estimated using Cox proportional hazards models, adjusted for age, body mass index, physical activity, fibre intake, diabetes, hypertension, alcohol, smoking and education.
RESULTS: A total of 36 586 middle-aged women in the Swedish Mammography Cohort were included, of whom 674 (1.8 per cent) were hospitalized with diverticular disease at least once. Some 7.2 per cent of women reported intake of oral corticosteroids and 8.5 per cent use of inhaled corticosteroids. In multivariable analysis, women who reported oral corticosteroid intake had a 37 per cent (RR 1.37, 95 per cent c.i. 1.06 to 1.78; P = 0.012) increased risk of diverticular disease compared with those who reported no intake at all. Use of inhaled corticosteroids was associated with an even more pronounced increase in risk of 71 per cent (RR 1.71, 1.36 to 2.14; P < 0.001). There was a significant dose-response relationship, with the risk increasing with longer duration of inhaled corticosteroids (P for trend < 0.001). Use of indometacin (2.5 per cent of women) or aspirin (44.2 per cent) did not influence the risk.
CONCLUSION: There was a significant relationship between corticosteroids (especially inhaled) and diverticular disease requiring hospital admission.},
}
@article {pmid25380009,
year = {2014},
author = {Damle, RN and Cherng, NB and Flahive, JM and Davids, JS and Maykel, JA and Sturrock, PR and Sweeney, WB and Alavi, K},
title = {Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs.},
journal = {Diseases of the colon and rectum},
volume = {57},
number = {12},
pages = {1421-1429},
doi = {10.1097/DCR.0000000000000251},
pmid = {25380009},
issn = {1530-0358},
mesh = {Cohort Studies ; *Colectomy/adverse effects/economics/methods/statistics & numerical data ; Comorbidity ; Cost of Illness ; Female ; Hospital Costs/statistics & numerical data ; Humans ; *Intestinal Diseases/economics/epidemiology/physiopathology/surgery ; Length of Stay ; Male ; Middle Aged ; Outcome Assessment, Health Care ; Patient Discharge ; *Patient Readmission/economics/statistics & numerical data ; *Postoperative Complications/diagnosis/epidemiology/therapy ; Reoperation/economics/methods/statistics & numerical data ; Risk Factors ; Severity of Illness Index ; Time Factors ; United States/epidemiology ; },
abstract = {BACKGROUND: After passage of the Affordable Care Act, 30 -day hospital readmissions have come under greater scrutiny. Excess readmissions for certain medical conditions and procedures now result in penalizations on all Medicare reimbursements.
OBJECTIVE: The purpose of this work was to define the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery.
DESIGN: Adults undergoing colorectal surgery were studied using data from the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify patient-related risk factors for, and 30-day outcomes of, readmission after colorectal surgery.
SETTINGS: This study was conducted at an academic hospital and its affiliates.
PATIENTS: Adults ≥18 years of age who underwent colorectal surgery for cancer, diverticular disease, IBD, or benign tumors between 2008 and 2011 were included in this study.
MAIN OUTCOME MEASURES: Readmission within 30 days of index discharge was the main outcome measured.
RESULTS: A total of 70,484 patients survived the index hospitalization after colorectal surgery; 9632 (13.7%) were readmitted within 30 days of discharge. The strongest independent predictors of readmission were length of stay ≥4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.54; 95% CI 1.46-1.51), and discharge to skilled nursing (OR 1.62; 95% CI 1.49-1.76) or rehabilitation facility (OR 2.93; 95% CI 2.53-3.40). Of those readmitted, half of the readmissions occurred within 7 days, 13% required the intensive care unit, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was more than 2 times higher ($26,917 vs $13,817; p < 0.001) for readmitted than for nonreadmitted patients.
LIMITATIONS: Follow-up was limited to 30 days after initial discharge.
CONCLUSIONS: Readmissions after colorectal resection occur frequently and incur a significant financial burden on the health-care system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating health-care costs.},
}
@article {pmid25380008,
year = {2014},
author = {Tyler, JA and Fox, JP and Dharmarajan, S and Silviera, ML and Hunt, SR and Wise, PE and Mutch, MG},
title = {Acute health care resource utilization for ileostomy patients is higher than expected.},
journal = {Diseases of the colon and rectum},
volume = {57},
number = {12},
pages = {1412-1420},
doi = {10.1097/DCR.0000000000000246},
pmid = {25380008},
issn = {1530-0358},
mesh = {Aftercare/organization & administration/statistics & numerical data ; Cohort Studies ; Colectomy/*adverse effects/methods ; Colorectal Neoplasms/surgery ; Colostomy/*adverse effects/methods ; *Dehydration/diagnosis/epidemiology/etiology/therapy ; Diverticulitis, Colonic/surgery ; Female ; Humans ; Ileostomy/*adverse effects/methods ; Male ; Middle Aged ; Needs Assessment ; Patient Discharge ; Patient Readmission/statistics & numerical data ; *Postoperative Complications/diagnosis/epidemiology/therapy ; *Renal Insufficiency/diagnosis/epidemiology/etiology/therapy ; Retrospective Studies ; *Surgical Wound Infection/diagnosis/epidemiology/etiology/therapy ; United States ; },
abstract = {BACKGROUND: Patients requiring an ileostomy following colorectal surgery are at risk for increased health-care utilization after discharge. Prior studies evaluating postoperative ileostomy care may underestimate health-care utilization by reporting only "same-institution" readmission rates.
OBJECTIVE: The aim of this study was to determine the rates of health-care utilization of new ostomates within 30 days of discharge in a multicenter environment.
DESIGN: This is a retrospective cohort study.
SETTINGS: This study was conducted at acute-care, community hospitals in California, Florida, Nebraska, and New York.
PATIENTS: Adult patients who underwent colorectal surgery with primary anastomosis, colostomy, or ileostomy between July 2009 and September 2010 were identified.
MAIN OUTCOME MEASURES: The primary outcome measured was hospital-based acute care, defined as hospital readmission or emergency department visit, at any hospital within 30 days of surgery. Multivariate regression models were used to compare the outcomes across groups.
RESULTS: Overall, 75,136 patients underwent colectomy with most receiving a primary anastomosis (79.3%), whereas colostomies were created in 12.8% and ileostomies were created in 8.0%. Diagnoses of colorectal cancer (36.1%) or diverticular disease (22.0%) were most common. Patients with a colostomy (18.8%; adjusted odds ratio [AOR], 1.23 [95% CI, 1.17-1.30]) or ileostomy (36.1%; AOR, 2.28 [95% CI 2.15-2.42]) were significantly more likely than patients with a primary anastomosis (16.2%) to have a hospital-based acute-care encounter within 30 days of discharge. Among patients undergoing ileostomy, postoperative infection, renal failure, and dehydration were the most common diagnoses for hospital-based acute-care events. Overall, 20% of these encounters occurred at hospitals other than where the index surgery occurred.
LIMITATIONS: Coding accuracy, the inability to capture events occurring in physician offices, and the retrospective study design were limitations of the study.
CONCLUSIONS: Patients undergoing colorectal surgery with an ileostomy return to the hospital after discharge twice as frequently as those with a primary anastomosis or colostomy, often to hospitals other than the primary institution. As postdischarge health-care utilization becomes a measured quality metric, it is increasingly important to help these patients to safely transition to home.},
}
@article {pmid25367183,
year = {2015},
author = {Koh, FH and Soong, J and Lieske, B and Cheong, WK and Tan, KK},
title = {Does the timing of an invasive mesenteric angiography following a positive CT mesenteric angiography make a difference?.},
journal = {International journal of colorectal disease},
volume = {30},
number = {1},
pages = {57-61},
pmid = {25367183},
issn = {1432-1262},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angiography/*methods ; Embolization, Therapeutic ; Female ; Gastrointestinal Hemorrhage/*diagnostic imaging/therapy ; Humans ; Male ; Mesentery/*diagnostic imaging ; Middle Aged ; *Multidetector Computed Tomography ; Retrospective Studies ; Time Factors ; Young Adult ; },
abstract = {BACKGROUND: Computed tomographic mesenteric angiography (CTMA) is integral in the management of patients with acute lower gastrointestinal tract bleeding (LGIB). An invasive mesenteric angiography (MA) with a view to embolize the site of bleeding is usually performed if active contrast extravasation was seen on the CTMA scans. However, the bleeding may have ceased by the time the invasive MA is performed. This study aims to identify predictors for active extravasation in invasive MA following a positive CTMA in patients with massive LGIB.
METHODOLOGY: A single-center retrospective study of all patients who underwent an invasive MA following a positive CTMA for LGIB from August 2007 to October 2013 was performed. Comparison was performed between patients who had positive and negative invasive MA after a positive CTMA.
RESULTS: Forty-eight invasive MA scans were performed in patients with LGIB following a positive CTMA scan. Twenty-three (47.9%) were due to diverticular disease while 20 (41.7%) bled from the small bowel. The median delay from a positive CTMA to invasive MA was 144 (32-587) min. Of the 48 invasive MA, 25 demonstrated active extravasation. Invasive MA scans that was performed within 90 min after a positive CTMA scan were 8.56 (95% CI 0.96-76.1, p = 0.05) times more likely to detect a positive extravasation.
CONCLUSION: Invasive MA should be executed promptly after a positive CTMA to increase the probability of detecting the site of bleed to allow superselective embolization.},
}
@article {pmid25360428,
year = {2014},
author = {Suarez Alecha, J and Amoza Pais, S and Batlle Marin, X and Oronoz Martinez, B and Balen Ribera, E and Yarnoz Irazabal, C},
title = {Safety of nonoperative management after acute diverticulitis.},
journal = {Annals of coloproctology},
volume = {30},
number = {5},
pages = {216-221},
pmid = {25360428},
issn = {2287-9714},
abstract = {PURPOSE: The role of surgery in the management of diverticular disease after an episode of acute diverticulitis (AD) managed in a conservative form is evolving. Age, number of episodes of AD, type of episode, and symptoms after the episodes are factors related to the need for elective surgery. The aim of this study is to evaluate the safety of conservative management and the risk factors for emergency surgery after a first episode of AD managed without surgery.
METHODS: We retrospectively evaluated 405 patients diagnosed as having had a first episode of AD. Sixty-nine patients underwent emergency surgery on the first admission, and 69 patients had an elective operation in the follow-up (group A). The remaining 267 patients were managed initially without surgery (group B). Thirteen of these 267 patients needed a further urgent surgical procedure. Factors involved in the decision of elective surgery and the probability of emergency surgery after the first episode of AD managed without surgery were evaluated in relation to demographic factors, risk factors, presence of recurrences, and type of the first episode.
RESULTS: Patients, mean age was 62.7 years, 71 were aged less than 51, and 151 were males. The mean follow-up for patients with nonoperative management was 91.2 months. An elective operation was performed in 69 patients. Compared to patients in group B, those in group A more frequently had a first episode of complicated acute diverticulitis (CAD) (37.1% vs. 16.4%; P = 0.000) and were more likely to be smokers (46.3% vs. 19.3%; P = 0.000) and to suffer more than one episode of AD (42% vs. 26.9%; P = 0.027). Nonoperative management was chosen for 267 patients, but 13 patients needed an emergency operation later. In the multivariate analysis, we found a significant relation between the presence of CAD in the first episode and the need for emergency surgery. There were no differences in surgical mortality between the patients in the two groups, but patients treated with elective surgery had a higher rate of stoma than patients treated non-operatively (7.2% vs. 1.4%; P = 0.028); this difference was not observed in the subgroup of patients with CAD (15.3% vs. 6.8%; P = 0.458).
CONCLUSION: After an episode of AD, nonoperative management is safe because fewer than 5% of patients will need an emergent procedure in a subsequent attack of AD. A first episode of CAD is the only risk factor for emergency surgery in patients managed conservatively.},
}
@article {pmid25360320,
year = {2014},
author = {Cuomo, R and Barbara, G and Pace, F and Annese, V and Bassotti, G and Binda, GA and Casetti, T and Colecchia, A and Festi, D and Fiocca, R and Laghi, A and Maconi, G and Nascimbeni, R and Scarpignato, C and Villanacci, V and Annibale, B},
title = {Italian consensus conference for colonic diverticulosis and diverticular disease.},
journal = {United European gastroenterology journal},
volume = {2},
number = {5},
pages = {413-442},
pmid = {25360320},
issn = {2050-6406},
abstract = {The statements produced by the Consensus Conference on Diverticular Disease promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) are reported. Topics such as epidemiology, risk factors, diagnosis, medical and surgical treatment of diverticular disease (DD) in patients with uncomplicated and complicated DD were reviewed by a scientific board of experts who proposed 55 statements graded according to level of evidence and strength of recommendation, and approved by an independent jury. Each topic was explored focusing on the more relevant clinical questions. Comparison and discussion of expert opinions, pertinent statements and replies to specific questions, were presented and approved based on a systematic literature search of the available evidence. Comments were added explaining the basis for grading the evidence, particularly for controversial areas.},
}
@article {pmid25359603,
year = {2015},
author = {Paterson, HM and Arnott, ID and Nicholls, RJ and Clark, D and Bauer, J and Bridger, PC and Crowe, AM and Knight, AD and Hodgkins, P and Solomon, D and Dunlop, MG},
title = {Diverticular disease in Scotland: 2000-2010.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {17},
number = {4},
pages = {329-334},
doi = {10.1111/codi.12811},
pmid = {25359603},
issn = {1463-1318},
support = {MC_PC_U127527198/MRC_/Medical Research Council/United Kingdom ; },
mesh = {Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Colectomy ; Colonoscopy ; Diverticulitis, Colonic/diagnosis/*epidemiology/therapy ; Female ; Hospitalization/*statistics & numerical data ; Humans ; Incidence ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Scotland/epidemiology ; Sex Distribution ; },
abstract = {AIM: Symptomatic diverticular disease (DD) may be increasing in incidence in western society particularly in younger age groups. This study aimed to describe hospital admission rates and management for DD in Scotland between 2000 and 2010.
METHOD: Data were obtained from the Scottish Morbidity Records (SMR01). The study cohort included all patients with a hospital admission and a primary diagnosis of DD of the large intestine (ICD-10 primary code K57).
RESULTS: Scottish NHS hospitals reported 90 990 admissions for DD (in 87 314 patients) from 2000 to 2010. The annual number of admissions increased by 55.2% from 6591 in 2000 to 10,228 in 2010, an average annual increase per year of 4.5%. Most of the increase attributable to DD was due to elective day cases (3618 in 2000; 6925 in 2010) a likely consequence of a greater proportion of the population accessing colonoscopy over that time period. There was an 11% increase in inpatient admissions (2973-3303), 60% of these patients being women. Admissions in younger age groups increased proportionally in the later years of the study, and there was an association between DD admissions and greater deprivation. Despite an increase in complicated DD from 22.9% in 2000 to 27.1% in 2010 and a 16.8% increase in emergency inpatient admissions, the rate of surgery fell during the period of study.
CONCLUSION: This report supports findings of other population-based studies of western countries indicating that DD is an increasing burden on health service resources, particularly in younger age groups.},
}
@article {pmid25353331,
year = {2013},
author = {Jensen, TK and Eiholm, S and Achiam, MP},
title = {[Caecal diverticulitis in a young woman with suspected acute appendicitis].},
journal = {Ugeskrift for laeger},
volume = {175},
number = {50A},
pages = {V06130356},
pmid = {25353331},
issn = {1603-6824},
mesh = {Appendicitis/diagnosis ; Cecal Diseases/*diagnosis/surgery ; Diagnosis, Differential ; Diverticulitis/*diagnosis/surgery ; Female ; Humans ; Young Adult ; },
abstract = {Colonic diverticular disease is common amongst the western population in the left hemicolon while right-sided involvement is rare. This case concerns a 20-year-old female, who was hospitalized with suspected acute appendicitis. Perioperative findings included an intramural tumour at the base of the appendix, and an ileocaecal resection was performed. Histopathological examinations revealed a single inflamed diverticulum of the caecum. The case illustrates the pre- and perioperatively differential diagnostic problems of caecal diverticulitis, which can lead to more radical surgery than needed.},
}
@article {pmid25335961,
year = {2014},
author = {Bhopal, RS and Cezard, G and Bansal, N and Ward, HJT and Bhala, N and , },
title = {Ethnic variations in five lower gastrointestinal diseases: Scottish health and ethnicity linkage study.},
journal = {BMJ open},
volume = {4},
number = {10},
pages = {e006120},
pmid = {25335961},
issn = {2044-6055},
support = {CZH/4/648/CSO_/Chief Scientist Office/United Kingdom ; },
mesh = {Adolescent ; Adult ; Africa/ethnology ; Aged ; Appendicitis/*ethnology/mortality ; Asian People ; Black People ; China/ethnology ; Cohort Studies ; Colitis, Ulcerative/*ethnology/mortality ; Crohn Disease/*ethnology/mortality ; Diverticulum/*ethnology/mortality ; England/ethnology ; Female ; Hospitalization/*statistics & numerical data ; Humans ; India/ethnology ; Ireland/ethnology ; Irritable Bowel Syndrome/*ethnology/mortality ; Male ; Middle Aged ; Odds Ratio ; Pakistan/ethnology ; Regression Analysis ; Retrospective Studies ; Scotland/epidemiology ; White People ; Young Adult ; },
abstract = {OBJECTIVES: Our objective was to augment the limited evidence mainly from local, clinical studies of ethnic differences in gastrointestinal disorders. Our question was: are there ethnic variations in hospitalisation/death for lower gastrointestinal disorders in Scotland?
SETTING: Scotland.
POPULATION: This retrospective-cohort linked 4.65 (of 4.9) million people in the 2001 census of Scotland (providing data on ethnicity, country of birth and indicators of socioeconomic deprivation) to 9 years of National Health Service hospitalisation and death records.
For appendicitis, we studied all ages; for irritable bowel syndrome, ulcerative colitis, Crohn's disease and diverticular disease, we included those ≥20 years. Using Poisson regression (robust variance) we calculated, by ethnic group and sex, first-hospitalisation/death age-adjusted rates per 100,000 person-years, and relative risks (RRs) with 95% CIs multiplied by 100, so the White Scottish reference population had an RR=100.
RESULTS: There were ethnic variations; for example, for irritable bowel syndrome, RRs (95% CIs) were comparatively high in Other White British women (128.4 (111.0 to 148.6)), and low in Pakistani women (75.1 (60.6 to 93.1)). For appendicitis, RRs were high in men in Other White British (145.2 (127.8 to 164.9)), and low in most non-White groups, for example, Pakistanis (73.8 (56.9 to 95.6)). For ulcerative colitis, RRs were high in Indian (169.8 (109.7 to 262.7)) and Pakistani (160.8 (104.2 to 248.2)) men. For Crohn's disease, the RR was high in Pakistani men (209.2 (149.6 to 292.6)). For diverticular disease, RRs were high in Irish men (176.0 (156.9 to 197.5)), and any Mixed background women (144.6 (107.4 to 194.8)), and low in most non-White groups, for example, Chinese men (47.1 (31.0 to 71.6) and women (46.0 (30.4 to 69.8)).
CONCLUSIONS: Appendicitis and diverticular disease were comparatively low in most non-White groups, while ulcerative colitis and Crohn's disease were mostly higher in South Asians. Describing and understanding such patterns may help clinical practice and research internationally.},
}
@article {pmid25331720,
year = {2015},
author = {Richards, CH and Roxburgh, CS and , },
title = {Surgical outcome in patients undergoing reversal of Hartmann's procedures: a multicentre study.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {17},
number = {3},
pages = {242-249},
doi = {10.1111/codi.12807},
pmid = {25331720},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*surgery ; Colonic Diseases/*surgery ; Colostomy/*methods ; Conversion to Open Surgery/statistics & numerical data ; Female ; Humans ; Laparoscopy/methods ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/*etiology ; Reoperation/methods/mortality ; Retrospective Studies ; Scotland ; Treatment Outcome ; Young Adult ; },
abstract = {AIM: Recent evidence has suggested that a laparoscopic rather than an open approach to reversal of Hartmann's procedure (ROH) may be associated with fewer complications. Much of the data for comparison are historical or based on small case series. The aims of this study were to determine the morbidity and mortality of ROH in 10 hospitals in the modern era and to identify risk factors for complications.
METHOD: A multicentre study of patients undergoing ROH (2007-2013) was performed. Data were collected retrospectively from perioperative health databases and casenotes where appropriate on patient demographics, laboratory investigations and operative details. Complications were classified as minor (I-II) or major (III-IV) based on the Clavien-Dindo criteria. Risk factors for complications were assessed by multivariate analysis with calculation of OR with 95% CI.
RESULTS: Ten hospitals in Scotland provided data on 252 patients undergoing ROH. Most operations were open (85%) with 15% started laparoscopically (conversion rate 64%). In the postoperative period, 35 (14%) patients had a major complication, including anastomotic leakage in 10 (4%) and postoperative death in one (0.4%). Patients with a complication stayed significantly longer in hospital (12 days vs 7 days, P < 0.001). On multivariate analysis, a wound complication after the original Hartmann's procedure (OR = 3.85, 95% CI: 1.08-13.75, P = 0.038) was associated with any complication after ROH, but only American Society of Anesthesiologists (ASA) grade (OR = 3.35, 95% CI: 1.38-8.09, P = 0.007) was independently associated with the development of a major complication.
CONCLUSION: ROH has a low postoperative mortality but significant morbidity. Most operations are still performed by open surgery, and in those attempted laparoscopically, the conversion rate is high.},
}
@article {pmid25331347,
year = {2014},
author = {Yamada, E and Inamori, M and Uchida, E and Tanida, E and Izumi, M and Takeshita, K and Fujii, T and Komatsu, K and Hamanaka, J and Maeda, S and Kanesaki, A and Matsuhashi, N and Nakajima, A},
title = {Association between the location of diverticular disease and the irritable bowel syndrome: a multicenter study in Japan.},
journal = {The American journal of gastroenterology},
volume = {109},
number = {12},
pages = {1900-1905},
pmid = {25331347},
issn = {1572-0241},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*pathology ; Colonoscopy ; Diverticulum, Colon/*epidemiology/pathology ; Female ; Humans ; Irritable Bowel Syndrome/*epidemiology/pathology ; Japan/epidemiology ; Male ; Middle Aged ; Rectum/*pathology ; Statistics as Topic ; Young Adult ; },
abstract = {OBJECTIVES: No previous reports have shown an association between location of diverticular disease (DD) and the irritable bowel syndrome (IBS).
METHODS: We included 1,009 consecutive patients undergoing total colonoscopy in seven centers in Japan from June 2013 to September 2013. IBS was diagnosed using Rome III criteria, and diverticulosis was diagnosed by colonoscopy with transparent soft-short-hood. Left-sided colon was defined as sigmoid colon, descending colon, and rectum. Right-sided colon was defined as cecum, ascending colon, and transverse colon. We divided the patients into IBS and non-IBS groups and compared characteristics.
RESULTS: Patient characteristics included mean age, 64.2±12.9 years and male:female ratio, 1.62:1. Right-sided DD was identified in 21.6% of subjects. Left-sided and bilateral DD was identified in 6.6 and 12.0% of subjects, respectively. IBS was observed in 7.5% of subjects. Multiple logistic regression analysis showed left-sided DD (odds ratio, 3.1; 95% confidence interval (CI): 1.4-7.1; P=0.0060) and bilateral DD (odds ratio, 2.6; 95% CI, 1.3-5.2; P=0.0070) were independent risk factors for IBS. Right-sided DD was not a risk factor for IBS.
CONCLUSIONS: Our data showed that the presence of left-sided and bilateral DD, but not right-sided disease, was associated with a higher risk of IBS, indicating that differences in pathological factors caused by the location of the DD are important in the development of IBS. Clarifying the specific changes associated with left-sided DD could provide a better understanding of the pathogenic mechanisms of IBS (Trial registration # R000012739).},
}
@article {pmid25309094,
year = {2014},
author = {Xu, XQ and Hong, T and Li, BL and Liu, W},
title = {Active gastrointestinal diverticulum bleeding diagnosed by computed tomography angiography.},
journal = {World journal of gastroenterology},
volume = {20},
number = {37},
pages = {13620-13624},
pmid = {25309094},
issn = {2219-2840},
mesh = {Aged, 80 and over ; Diverticulum/complications/*diagnostic imaging/surgery ; Diverticulum, Colon/complications/*diagnostic imaging/surgery ; Gastrointestinal Hemorrhage/*diagnostic imaging/etiology/surgery ; Humans ; Jejunal Diseases/complications/*diagnostic imaging/surgery ; Male ; Middle Aged ; Predictive Value of Tests ; *Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {A diverticulum is a bulging sack in any portion of the gastrointestinal tract. Small intestine diverticular disease is much less common than colonic diverticular disease. The most common symptoms include non-specific epigastric pain and a bloating sensation. Major complications include diverticulitis, gastrointestinal bleeding, acute perforation, intestinal obstruction, intestinal perforation, localized abscess, malabsorption, anemia, volvulus and bacterial overgrowth. We report one case of massive jejunal diverticula bleeding and one case of massive colonic diverticula bleeding, both diagnosed by acute abdominal computed tomography angiography and treated successfully by surgery.},
}
@article {pmid25292045,
year = {2014},
author = {Albasri, AM},
title = {Histopathological profile of benign colorectal diseases in Al- Madinah region of Saudi Arabia.},
journal = {Asian Pacific journal of cancer prevention : APJCP},
volume = {15},
number = {18},
pages = {7673-7677},
doi = {10.7314/apjcp.2014.15.18.7673},
pmid = {25292045},
issn = {2476-762X},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Colon/*pathology ; Colorectal Neoplasms/*epidemiology/*pathology ; Female ; Follow-Up Studies ; Humans ; Inflammation/*epidemiology/*pathology ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Rectum/*pathology ; Retrospective Studies ; Risk Factors ; Saudi Arabia/epidemiology ; Time Factors ; Young Adult ; },
abstract = {BACKGROUND: Patients with long-standing inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Colon cancer risk in IBD increases with longer duration and greater anatomic extent of colitis, the presence of primary sclerosing cholangitis, family history of CRC and degree of inflammation of the bowel. This study aimed to characterize the histopathological pattern of benign colorectal diseases among Saudi patients and to highlight age and gender variations of lesions as base line data for future studies to investigate the link between benign / IBD and colorectal cancers in the local population.
MATERIALS AND METHODS: The materials consisted of 684 biopsies, reported as benign (excluding malignancies and polyps) at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. Data collected and entered in MS-Excel and were analyzed using SPSS-20.
RESULTS: Of 684 colorectal tissues reviewed, 408 specimens (59.6%) were from male patients and 276 specimens (40.4%) were from females giving a male: female ratio of 1.5:1. Age of the patients ranged from 4 to 75 years with a mean of 39.6 years. The most frequent histologic diagnosis was a chronic non specific proctocolitis followed by ulcerative colitis, accounting respectively for 52.6% and 31.7% of all cases. These were followed by Crohn's disease 22 (3.2%), ischemic bowel disease 20 (2.9%), diverticular disease 14 (2%), eosinophilic colitis 12 (1.7%) and solitary rectal ulcer 12 (1.7%). A minority of 21 patients (3.1%) were cases of acute nonspecific proctocolitis, schistosomiasis, tuberculosis, volvulus and pseudomembranous colitis.
CONCLUSIONS: These data show that although chronic non specific proctocolitis and ulcerative colitis were the dominant diagnoses, Crohn's disease, ischemic bowel disease and diverticular disease also existed to a lesser extent and should be considered in the differential diagnosis of benign colorectal diseases. This study provides a base line data for future studies which would be taken up to investigate the link between benign / IBD and colorectal cancers in the local population.},
}
@article {pmid25270157,
year = {2014},
author = {Haboubi, D and Thapar, A and Bhan, C and Oshowo, A},
title = {Perforated duodenal diverticulae: importance for the surgeon and gastroenterologist.},
journal = {BMJ case reports},
volume = {2014},
number = {},
pages = {},
pmid = {25270157},
issn = {1757-790X},
mesh = {Aged ; *Colectomy ; Diverticulitis, Colonic/*surgery ; Diverticulum/*surgery ; Duodenal Diseases/*surgery ; Female ; Humans ; Intestinal Perforation/*surgery ; Postoperative Complications/*surgery ; },
abstract = {We present the case of a 78-year-old woman who was admitted for an elective left hemicolectomy for diverticular disease. Two days following the elective procedure, bilious fluid was noted in her pelvic drain. The patient returned to theatre, where a perforated duodenal diverticulum was excised and the defect primarily repaired. The patient then developed a low output enterocutaneous fistula which was treated conservatively with nasojejunal feeding and resolved spontaneously.},
}
@article {pmid25263945,
year = {2014},
author = {Del Rio, P and Rossini, M and Papadia, C and Lorenzo, V and Labonia, D and Sianesi, M},
title = {Diverticular disease and colon cancer: a real association between the two diseases?.},
journal = {Annali italiani di chirurgia},
volume = {85},
number = {4},
pages = {389-396},
pmid = {25263945},
issn = {2239-253X},
mesh = {Adenocarcinoma/*complications ; Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms/*complications ; Diverticulosis, Colonic/*complications ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; },
abstract = {BACKGROUND: During the last century the incidence of diverticular disease (DD), as well as the prevalence of colonic adenocarcinoma (ADK), recorded a marked increase in Western populations. In literature has been reported a higher incidence of sigmoid colon carcinoma associated with diverticular disease suggesting a possible sharing of risk factors and pathogens between these two pathologies.
MATERIALS AND METHODS: We prospectively examined 165 patients undergoing left colonic resection from May 2010 to December 2012 at the operating unit of General Surgery and Organ Transplantation of University Hospital of Parma , dividing them into three groups: affected by left colon cancer (120 cases), affected by complicated diverticular disease (29 cases) and affected by both diseases (16 cases). In this last group the indication for surgery has always been oncology based. All cases have been subjected to a 6 months minimum follow-up.
RESULTS: The average age of patients operated for colonic ADK was 69.91 years. The average age of patients operated for ADK and concomitant DD, compared to that of patients treated for single DD, was statistically higher (73.8 ± 6.89 VS 60.9 ± 13.5, p = 0.004). It was found instead a higher diverticular inflammation degree in patients treated for DD compared with those treated for ADK associated with DD. No patient with ADK associated with DD showed hepatic metastases, whereas among patients with just ADK, peritoneal carcinomatosis was recorded in 2.6% of cases and liver metastases, always synchronous, in 11 .5%. The lymph nodes positivity instead, has presented a prevalence of 33.5% in patients with ADK and of 7% in patients with associated DD.
CONCLUSION: In our study and its comparison with literature we found in synthesis multiple clinical evidences of a possible association between the two diseases. The role played by DD would lead to an early diagnosis of colonic ADK. It remains to be analyzed however the possible etiopathogenetic correlation over time between the two clinical entities, which actually still remains maybe under random association.},
}
@article {pmid25253951,
year = {2014},
author = {Agarwal, AK and Karanjawala, BE and Maykel, JA and Johnson, EK and Steele, SR},
title = {Routine colonic endoscopic evaluation following resolution of acute diverticulitis: is it necessary?.},
journal = {World journal of gastroenterology},
volume = {20},
number = {35},
pages = {12509-12516},
pmid = {25253951},
issn = {2219-2840},
mesh = {Acute Disease ; Colon/diagnostic imaging/*pathology ; Colonic Neoplasms/diagnostic imaging/epidemiology/*pathology/therapy ; *Colonoscopy/adverse effects/trends ; Diverticulitis, Colonic/diagnostic imaging/epidemiology/*pathology/therapy ; Humans ; Predictive Value of Tests ; Prognosis ; Risk Assessment ; Risk Factors ; Tomography, X-Ray Computed ; Unnecessary Procedures ; },
abstract = {Diverticular disease incidence is increasing up to 65% by age 85 in industrialized nations, low fiber diets, and in younger and obese patients. Twenty-five percent of patients with diverticulosis will develop acute diverticulitis. This imposes a significant burden on healthcare systems, resulting in greater than 300000 admissions per year with an estimated annual cost of $3 billion USD. Abdominal computed tomography (CT) is the diagnostic study of choice, with a sensitivity and specificity greater than 95%. Unfortunately, similar CT findings can be present in colonic neoplasia, especially when perforated or inflamed. This prompted professional societies such as the American Society of Colon Rectal Surgeons to recommend patients undergo routine colonoscopy after an episode of acute diverticulitis to rule out malignancy. Yet, the data supporting routine colonoscopy after acute diverticulitis is sparse and based small cohort studies utilizing outdated technology. While any patient with an indication for a colonoscopy should undergo appropriate endoscopic evaluation, in the era of widespread use of high-resolution computed tomography, routine colonic endoscopic evaluation following resolution of acute uncomplicated diverticulitis poses additional costs, comes with inherent risks, and may require further study. In this manuscript, we review the current data related to this recommendation.},
}
@article {pmid25245735,
year = {2014},
author = {Walklett, CL and Yeomans, NP},
title = {A retrospective case note review of laparoscopic versus open reversal of Hartmann's procedure.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {96},
number = {7},
pages = {539-542},
pmid = {25245735},
issn = {1478-7083},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/methods ; Chi-Square Distribution ; Cohort Studies ; Colectomy/*adverse effects/methods ; Colostomy/adverse effects/*methods ; Diverticulum, Colon/diagnosis/*surgery ; Female ; Follow-Up Studies ; Hospitals, Teaching ; Humans ; Laparoscopy/*methods ; Laparotomy/*methods ; Length of Stay ; Linear Models ; Male ; Middle Aged ; Postoperative Complications/epidemiology/physiopathology ; Reoperation/methods ; Retrospective Studies ; Risk Assessment ; Treatment Outcome ; Young Adult ; },
abstract = {INTRODUCTION: First described in 1921, Hartmann's procedure is the gold standard treatment for complicated sigmoid diverticular disease. It is also used commonly for other causes of perforation of the large bowel. However, the reversal rate in the UK is much lower than in comparable countries, at only 18-22%. Furthermore, laparoscopic reversal (LRH) is used far less frequently than open reversal (ORH) despite evidence that a laparoscopic technique reduces patient morbidity and decreases patient recovery time.
METHODS: This retrospective case note review undertook an analysis of all the patients who had undergone Hartmann's procedure at two centres in Leeds Teaching Hospitals NHS Trust between February 2007 and February 2012. Out of 305 patients, 235 were identified and included in the analysis. Comparisons were then drawn between LRH and ORH groups.
RESULTS: The reversal rate was 21%. Three-quarters (76%) were performed using an open technique, 20% were laparoscopic and 5% were converted to an open procedure. The mean hospital stay was longer for the ORH group (9.82 days, standard deviation [SD]: 5.85 days, 95% confidence interval [CI]: 2.99 days) than for the LRH group (7.29 days, SD: 4.65 days, 95% CI: 11.58 days) p=0.006). Seven ORH patients (21%) were reoperated but only one LRH patient (13%) had a reoperation at six months. Five factors were found to have a significant effect on the likelihood of reversal of Hartmann's procedure.
CONCLUSIONS: The overall reversal rate for Hartmann's procedure remains low. Shorter hospital stays, lower 6-month reoperation rates and reduced 30-day complication rates are associated with LRH when compared with ORH.},
}
@article {pmid25243891,
year = {2014},
author = {Kontovounisios, C and Baloyiannis, Y and Kinross, J and Tan, E and Rasheed, S and Tekkis, P},
title = {Modified right colon inversion technique as a salvage procedure for colorectal or coloanal anastomosis.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {16},
number = {12},
pages = {971-975},
doi = {10.1111/codi.12784},
pmid = {25243891},
issn = {1463-1318},
mesh = {Aged ; Anal Canal/*surgery ; Anastomosis, Surgical/adverse effects/methods ; Colon, Ascending/*surgery ; Colon, Transverse/*surgery ; Defecation ; Diverticulum, Colon/surgery ; Female ; Gulf War ; Humans ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Rectum/*surgery ; Retrospective Studies ; Salvage Therapy/*methods ; },
abstract = {AIM: A tension-free well vascularized colorectal or coloanal anastomosis is not always possible following rectal or sigmoid resection. The study reports on the short-term and long-term outcome of a modified right colon inversion technique as a means of facilitating a low colorectal or coloanal anastomosis.
METHOD: All patients who underwent right colonic inversion, a modified Deloyers' procedure, were identified retrospectively from the prospective database of the Colorectal Department of the Royal Marsden Hospital from October 2008 to December 2013.
RESULTS: There were 14 (nine male) patients of median age 58.7 (45-75) years. The main indication was extensive diverticular disease (50%) and previous colonic surgery (21.4%). A defunctioning stoma was performed in 64.3% which was reversed in all within 3-6 months. Three (21.4%) patients developed postoperative complications (Clavien-Dindo 1-2) and none required reoperation. The median duration of follow-up was 11 months. One (7.2%) patient had one bowel movement per day, 10 (71.4%) patients had two bowel movements per day and three (21.4%) patients had three per day.
CONCLUSION: The modified right colonic inversion technique is safe and achieves intestinal continuity with a tension-free well vascularized anastomosis. Good function and low morbidity show that the procedure is a credible alternative to ileorectal or ileoanal anastomosis.},
}
@article {pmid25242762,
year = {2014},
author = {Scotti, A and Santangelo, M and Federico, S and Carrano, R and La Tessa, C and Carlomagno, N and Palmieri, DG and Calogero, A and Piantadosi, M and Renda, A},
title = {Complicated diverticulitis in kidney transplanted patients: analysis of 717 cases.},
journal = {Transplantation proceedings},
volume = {46},
number = {7},
pages = {2247-2250},
doi = {10.1016/j.transproceed.2014.07.044},
pmid = {25242762},
issn = {1873-2623},
mesh = {Aged ; Diverticulitis/*etiology/surgery ; Diverticulosis, Colonic/*complications ; Female ; Glucocorticoids/adverse effects ; Humans ; Immunosuppression Therapy ; Intestinal Perforation/etiology/surgery ; *Kidney Transplantation ; Male ; Middle Aged ; Polycystic Kidney, Autosomal Dominant/diagnosis/surgery ; Risk Factors ; },
abstract = {INTRODUCTION: This study aims to investigate possible risk factors for diverticulitis in kidney transplant recipients affected by colonic diverticulosis.
METHODS AND RESULTS: We investigated 717 patients transplanted between 2000 and 2010. Diverticular disease was endoscopically diagnosed in 17 of 717 examined patients. Eight patients were diagnosed with autosomal dominant polycystic kidney disease (ADPKD); 9 of 17 patients underwent emergency surgery. We performed Hartmann's procedure on all patients, with a second stage performed at least 6 months later.
DISCUSSION: Although the incidence of colonic diverticular perforation in kidney transplanted patients is similar to that observed in the general population, perforation in immunosuppressed patients is associated with a higher morbidity/mortality rate. In our study, the incidence of perforation is 1.25% (9 of 717), with almost half of the cases observed in patients with ADPKD (4 of 9). Such an observation is consistent with published data, in which patients with ADPKD are reported to more frequently develop colonic diverticulosis and its complications. One possible explanation might be related to a belated diagnosis of diverticulitis, which could initially simulate an inflammatory disease as a consequence of renal cysts. Also, steroids seem to be a predisposing factor for colonic perforation in these patients.
CONCLUSIONS: A timely surgery can significantly reduce mortality. In cases of elective surgery, mortality and morbidity are similar to those of immunocompetent patients; accordingly, this is the goal to be pursued. Early signs and symptoms are often masked by immunosuppressive therapy. In these patients, surgeons should always perform (1) abdominal computed tomography scanning and, in the presence of diverticulitis, reduce or withdraw immunosuppressive therapy; and (2) early surgery, with Hartmann's procedure being, in our opinion, the best choice. Before transplantation, elective surgery for colonic resection should be considered in patients with ADPKD or with a history of 1 or more episodes of acute diverticulitis who then regressed with medical therapy.},
}
@article {pmid25170867,
year = {2014},
author = {Costa, G and La Torre, M and Frezza, B and Fransvea, P and Tomassini, F and Ziparo, V and Balducci, G},
title = {Changes in the surgical approach to colonic emergencies during a 15-year period.},
journal = {Digestive surgery},
volume = {31},
number = {3},
pages = {197-203},
doi = {10.1159/000365254},
pmid = {25170867},
issn = {1421-9883},
mesh = {Abdomen, Acute/etiology/*mortality/*surgery ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/methods ; Cohort Studies ; Colectomy/adverse effects/*methods/mortality ; Colonic Diseases/mortality/pathology/*surgery ; Colonic Neoplasms/mortality/pathology/surgery ; Emergency Treatment/methods/*mortality ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Italy ; Male ; Middle Aged ; Multivariate Analysis ; Patient Safety ; Postoperative Complications/mortality/surgery ; Retrospective Studies ; Survival Rate ; Time Factors ; Treatment Outcome ; },
abstract = {PURPOSE: The present study aims to determine the morbidity and mortality of emergency colonic surgery and the factors associated with adverse outcome, and to evaluate any change in incidence of the different types of pathological conditions and in the surgical approach over the last 15 years.
MATERIALS AND METHODS: A total of 319 patients who underwent emergency colonic surgery between January 1997 and December 2011 were retrospectively analyzed. Patients were divided into two groups according to the date of surgery, namely group 1, between 1997 and 2006, and group 2, between 2006 and 2011. The differences in terms of postoperative outcomes between the groups were analyzed.
RESULTS: Overall postoperative morbidity and mortality rates were 25.3 and 17.2%, respectively; no differences were found between the groups. Group 2 showed a significantly increased rate of primary resection and anastomosis (p < 0.001), as well as an increase in laparoscopic approach compared with group 1 (p < 0.001).
CONCLUSIONS: Emergency colon surgery is today primarily performed for benign diseases, of these the most common is diverticular disease followed by ischemic colitis. Age, comorbidities, and ischemic colon disease are predictors of adverse outcomes, while the surgical procedure per se is not.},
}
@article {pmid25149636,
year = {2015},
author = {Wolthuis, AM and de Buck van Overstraeten, A and Fieuws, S and Boon, K and D'Hoore, A},
title = {Standardized laparoscopic NOSE-colectomy is feasible with low morbidity.},
journal = {Surgical endoscopy},
volume = {29},
number = {5},
pages = {1167-1173},
pmid = {25149636},
issn = {1432-2218},
mesh = {Adult ; Anastomotic Leak/surgery ; Colectomy/adverse effects/*methods ; Colon/surgery ; Colonic Diseases/surgery ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Length of Stay ; Male ; Middle Aged ; Natural Orifice Endoscopic Surgery/adverse effects/*methods ; Operative Time ; Pain, Postoperative/etiology ; Postoperative Complications/etiology ; Prospective Studies ; Rectum/surgery ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: In laparoscopic colorectal surgery, extraction site laparotomy can be avoided by natural orifice specimen extraction (NOSE) resulting in less postoperative pain, shorter length of stay, and less morbidity such as wound complications. To date, short-term outcome of a large prospective cohort of patients has not been studied. The aim of this prospective cohort study was to assess short-term outcome of laparoscopic left-sided NOSE-colectomy.
METHODS: Prospectively collected data of patients who had undergone elective laparoscopic NOSE-colectomy between July 2009 and December 2013 were analyzed retrospectively. Primary endpoint was short-term morbidity.
RESULTS: A total of 110 patients were included in this study. Median age was 38 years (IQR: 32-56), median BMI was 23 kg/m(2) (IQR: 21-25), and 88% of the patients were female. Sixty-three patients (57%) underwent resection for endometriosis, 29 patients (26%) for diverticular disease, 16 patients (15%) for a tumor, and 2 patients for other indications. Median operating time was 85 min (IQR: 70-100) and median length of the extracted specimen was 20 cm (IQR: 16-25). Overall, 14 patients had a postoperative complication (13%), of which 9 were Clavien-Dindo grade 1 or 2 (8%). Four patients (3.6%) had an intraluminal bleeding from the anastomosis, which was treated endoscopically. There was 1 anastomotic leak (1%), treated by emergency laparotomy and creation of a new colorectal anastomosis (grade 3b). The median hospital stay was 5 days (IQR: 4-6).
CONCLUSION: Laparoscopic NOSE-colectomy is safe and feasible with good short-term outcome. This study concerning a standardized operative technique is the first in literature reporting on a large group of patients.},
}
@article {pmid25133198,
year = {2014},
author = {Cianci, R and Frosali, S and Pagliari, D and Cesaro, P and Petruzziello, L and Casciano, F and Landolfi, R and Costamagna, G and Pandolfi, F},
title = {Uncomplicated diverticular disease: innate and adaptive immunity in human gut mucosa before and after rifaximin.},
journal = {Journal of immunology research},
volume = {2014},
number = {},
pages = {696812},
pmid = {25133198},
issn = {2314-7156},
mesh = {*Adaptive Immunity ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Diverticulum/genetics/*immunology/metabolism/*pathology ; Female ; Gastrointestinal Agents/administration & dosage/*pharmacology ; *Gene Expression ; Humans ; *Immunity, Innate ; Immunophenotyping ; Intestinal Mucosa/drug effects/*pathology ; Lymphocyte Subsets/immunology/metabolism ; Male ; Middle Aged ; Rifamycins/administration & dosage/*pharmacology ; Rifaximin ; Risk Factors ; Toll-Like Receptors/genetics/metabolism ; Young Adult ; },
abstract = {BACKGROUND/AIM: Uncomplicated diverticular disease (UDD) is a frequent condition in adults. The pathogenesis of symptoms remains unknown. Bacteria are able to interact with Toll-like receptors (TLRs) and to induce inflammation through both innate immunity and T-cell recruitment. We investigated the pattern of TLRs 2 and 4 and the intestinal homing in patients with UDD before and after a course of Rifaximin.
METHODS: Forty consecutive patients with UDD and 20 healthy asymptomatic subjects were enrolled. Among UDD patients, 20 were assigned to a 2-month course of treatment with Rifaximin 1.2 g/day for 15 days/month and 20 received placebo. Blood sample and colonic biopsies were obtained from patients and controls. The samples were collected and analyzed at baseline and at the end of treatment. Flow cytometry was performed using monoclonal antibodies (CD3, CD4, CD8, CD103, TCR-gamma/delta, CD14, TLR2, and TLR4).
RESULTS: In UDD, TLR2 and TLR4 expression on immune cell subpopulations from blood and mucosa of the affected colon are altered as compared with controls. Rifaximin treatment induced significant modifications of altered conditions.
CONCLUSIONS: Our data show the role of TLRs in the development of inflammation in UDD. TLRs distribution is altered in UDD and these alterations are reversed after antibiotic treatment. This trial is registered with ClinicalTrials.gov: NCT02068482.},
}
@article {pmid25125064,
year = {2013},
author = {Valenzuela-Salazar, C and Orozco-Tapia, LM and de la Concha Blankenagel, E and Gallardo-Ramírez, MA and Blas-Franco, M and Cárdenas-Lailson, LE},
title = {[Sigmoid diverticulitis in adolescent. Case report].},
journal = {Cirugia y cirujanos},
volume = {81},
number = {5},
pages = {445-449},
pmid = {25125064},
issn = {2444-054X},
mesh = {Adolescent ; Age of Onset ; Appendicitis/diagnosis ; *Diagnostic Errors ; Digestive System Surgical Procedures ; Diverticulitis, Colonic/complications/*diagnosis/epidemiology/surgery ; Diverticulosis, Colonic/complications ; Female ; Humans ; Intestinal Perforation/etiology ; Peritonitis/etiology ; Sigmoid Diseases/complications/*diagnosis/epidemiology/surgery ; Therapeutic Irrigation ; },
abstract = {BACKGROUND: Few cases have been reported in children and adolescents of sigmoid diverticulitis. Most of the case reports in medical literature are associated with true congenital diverticula and genetic diseases of collagen synthesis.
CLINICAL CASE: 13 year-old female who was admitted to General and Endoscopic Surgery service with diagnosis of complicated appendicitis. Laparotomy was performed finding complicated sigmoid diverticular disease. Lavage, sigmoidectomy and primary anastomosis were performed. The histopathological findings reported a perforated pseudo-diverticulum of the sigmoid colon with peritonitis. The patient was discharged 72 hours after surgery and no complications were reported.
CONCLUSION: There are only case reports about colonic diverticulitis in children and adolescents, and its etiology has not yet been well established. This patient had sigmoid pseudo-diverticula and did not present genetic concomitant disease. This case is an exception to data reported on literature about diverticular disease in this population.},
}
@article {pmid25110438,
year = {2014},
author = {Oh, HK and Han, EC and Ha, HK and Choe, EK and Moon, SH and Ryoo, SB and Jeong, SY and Park, KJ},
title = {Surgical management of colonic diverticular disease: discrepancy between right- and left-sided diseases.},
journal = {World journal of gastroenterology},
volume = {20},
number = {29},
pages = {10115-10120},
pmid = {25110438},
issn = {2219-2840},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Colectomy/adverse effects/mortality ; Colon/pathology/*surgery ; Diverticulitis, Colonic/diagnosis/mortality/*surgery ; Diverticulosis, Colonic/diagnosis/mortality/*surgery ; Diverticulum, Colon/diagnosis/mortality/*surgery ; Female ; Hospital Mortality ; Humans ; Incidence ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/mortality/therapy ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Time Factors ; Treatment Outcome ; Young Adult ; },
abstract = {AIM: To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.
METHODS: The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed. The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology. Right-sided diverticula were classified as those arising from the cecum, ascending colon, and transverse colon, and those from the descending colon, sigmoid colon, and rectum were classified as left-sided diverticulosis. To assess the changing trend of occurrence of diverticulosis, data were compared with two previous studies of 51 patients.
RESULTS: The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001, (27.5% vs 48.1%, P < 0.05). Moreover, no differences in gender, body mass index, multiplicity of the diverticula, fever, or leukocytosis were noted between patients with right-sided and left-sided disease. However, patients with right-sided disease were significantly younger (50.9 year vs 64.0 year, P < 0.01). Furthermore, left-sided disease was significantly associated with a higher incidence of complicated diverticulitis (89.2% vs 57.5%, P < 0.01), combined resection due to extensive inflammation (21.6% vs 5.0%, P < 0.05), operative complications (51.4% vs 27.5%, P < 0.05), and in-hospital mortality (10.8% vs 0%, P < 0.05), along with longer post-operative hospitalization duration (21.3 ± 10.2 d vs 10.6 ± 8.1 d, P < 0.05).
CONCLUSION: Compared with right-sided diverticular disease, the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.},
}
@article {pmid25109425,
year = {2014},
author = {Espín, F and Rofes, L and Ortega, O and Clavé, P and Gallego, D},
title = {Nitrergic neuro-muscular transmission is up-regulated in patients with diverticulosis.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {26},
number = {10},
pages = {1458-1468},
doi = {10.1111/nmo.12407},
pmid = {25109425},
issn = {1365-2982},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulosis, Colonic/*enzymology/*physiopathology ; Enteric Nervous System/physiopathology ; Female ; Gene Expression ; Humans ; Male ; Middle Aged ; Motor Neurons/physiology ; Muscle, Smooth/enzymology/physiopathology ; Nitric Oxide Synthase Type I/*genetics ; Nitric Oxide Synthase Type II/genetics ; RNA, Messenger/metabolism ; Receptors, Purinergic P2Y1/genetics ; Signal Transduction ; Synaptic Transmission ; Ubiquitin Thiolesterase/genetics ; Up-Regulation ; },
abstract = {BACKGROUND: Neuro-transmission impairment could be associated to motility changes observed in patients with diverticular disease. Therefore, the objective was to characterize the inhibitory neuro-muscular transmission and gene expression changes of the enteric inhibitory pathways in patients with diverticulosis (DS).
METHODS: Circular muscle strips from sigmoid colon of patients with DS and controls were studied using the organ bath technique to evaluate spontaneous contractility and enteric motor neurons stimulated by electrical field and qRT-PCR to assess the expression of nNOS, iNOS, P2Y1 R and PGP9.5.
KEY RESULTS: Patients with DS presented decreased spontaneous rhythmic contractions (SRC) that were significantly enhanced after incubation with L-NNA (1 mM) and TTX (1 μM), and unaffected by the P2Y1 antagonist MRS2500 (1 μM). Stimulation on enteric motor neurons caused an increased duration of the latency of OFF-contractions in DS group (p < 0.001), antagonized by L-NNA and slightly affected by MRS2500 (1 μM). No differences in the IC50 between controls and DS patients were observed on inhibition of SRC for the NO-donor sodium nitroprusside (SNP) and the preferential P2Y agonist ADPβS. Moreover, nNOS relative expression was also up-regulated 2.3-fold in the DS group (p < 0.05) whereas there was no significant difference in relative expression of iNOS, P2Y1 R and the neuronal marker PGP9.5 between groups.
CONCLUSIONS & INFERENCES: Patients with DS presented an over-expression of nNOS with increased endogenously NO-mediated responses suggesting enhanced NO-release. Up-regulation in the nitrergic pathway in early stages of the disease might play a role in colonic motor disorders associated to diverticular disease.},
}
@article {pmid25101605,
year = {2014},
author = {Jadlowiec, CC and Mannion, EM and Thielman, MJ and Bartus, CM and Johnson, KH and Sardella, WV and Vignati, PV and Cohen, JL},
title = {Evolution of technique in performance of minimally invasive colectomies.},
journal = {Diseases of the colon and rectum},
volume = {57},
number = {9},
pages = {1090-1097},
doi = {10.1097/DCR.0000000000000178},
pmid = {25101605},
issn = {1530-0358},
mesh = {Clinical Competence ; Colectomy/*methods ; Colonic Polyps/surgery ; Colorectal Neoplasms/surgery ; Colorectal Surgery/*methods ; Diverticulum, Colon/surgery ; Female ; *Hand-Assisted Laparoscopy ; Humans ; Irritable Bowel Syndrome/surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Hand-assisted laparoscopic surgery is commonly used in colorectal surgery and provides benefit in complex cases.
OBJECTIVE: This study examined the minimally invasive surgical trends, patient characteristics, and operative variables unique to patients undergoing hand-assisted laparoscopic surgery.
DESIGN: This was a retrospective medical chart review.
SETTINGS: The study was conducted in a tertiary care medical center.
PATIENTS: Patients included in the study were those who underwent pure laparoscopic colectomies, hand-assisted laparoscopic colectomies, and traditional open surgery for elective treatment of diverticular disease, colorectal cancer, IBD, and benign polyp disease.
MAIN OUTCOME MEASURES: Primary outcomes included patient characteristics and operative variables unique to patients undergoing hand-assisted laparoscopic surgery and documentation of operative technique trends within an experienced colorectal group.
RESULTS: Diverticular disease characteristics specific to hand-assisted laparoscopic surgery included the presence of dense inflammatory adhesions (p < 0.0001), diverticular fistulas (p < 0.0001), and unresolved phlegmon (p = 0.0003). Characteristics specific for colorectal cancer included intraoperative tumor bulk (p < 0.0001) and the inability to achieve appropriate surgical resection margins (p < 0.001). Similarly, variables identified for benign polyp disease included adhesions (p < 0.0001) and the ability to gain adequate exposure (p < 0.0001). Limited use of hand-assisted laparoscopic surgery was observed in patients with IBD.
LIMITATIONS: This was a retrospective, observational study from a single center.
CONCLUSIONS: Conversion to hand-assisted laparoscopic surgery provides benefit in surgical scenarios where dense inflammatory adhesions, diverticular fistulas, and intra-abdominal postdiverticulitis phlegmon are present. In addition, benefit is observed in patients with colorectal cancer where laparoscopic dissection of bulky tumor proves to be difficult and where the technical ability to obtain margins using pure laparoscopy is compromised. Although our practice has changed to favor pure laparoscopy, hand-assisted laparoscopic surgery continues to play an important role in complex colorectal cases that otherwise would require open surgery (see video, Supplemental Digital Content 1, http://links.lww.com/DCR/A146).},
}
@article {pmid25096958,
year = {2014},
author = {Campbell, RJ and Bell, CM and Bronskill, SE and Paterson, JM and Whitehead, M and Campbell, Ede L and Gill, SS},
title = {Adverse gastrointestinal events with intravitreal injection of vascular endothelial growth factor inhibitors: nested case-control study.},
journal = {Drug safety},
volume = {37},
number = {9},
pages = {723-733},
pmid = {25096958},
issn = {1179-1942},
support = {//Canadian Institutes of Health Research/Canada ; },
mesh = {Aged ; Aged, 80 and over ; Angiogenesis Inhibitors/administration & dosage/*adverse effects ; Antibodies, Monoclonal, Humanized/administration & dosage/*adverse effects ; Bevacizumab ; Case-Control Studies ; Drug-Related Side Effects and Adverse Reactions ; Female ; Gastrointestinal Diseases/*epidemiology/etiology ; Humans ; Intravitreal Injections ; Male ; Ontario/epidemiology ; Ranibizumab ; Retinal Diseases/*drug therapy ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors ; },
abstract = {BACKGROUND: Intravenous administration of vascular endothelial growth factor (VEGF)-inhibiting drugs is associated with adverse gastrointestinal (GI) events. Clinical trials of VEGF inhibitors used for the treatment of retinal diseases have suggested higher risks of adverse GI events among patients treated with bevacizumab. However, population-based studies have been lacking.
OBJECTIVE: Our objective was to assess risks for GI adverse events associated with intravitreal injections of VEGF-inhibiting drugs.
METHODS: We conducted a population-based, nested case-control study of 114,427 older adults in Ontario, Canada, with retinal disease identified between 1 November 2005 and 30 April 2011. Of these, 3,582 cases were admitted to hospital or assessed in an emergency department for GI adverse events. Controls were matched to cases on the basis of age, sex, and outcome history.
RESULTS: Patients experiencing adverse events were equally as likely as matched controls to have been exposed to bevacizumab or ranibizumab. Adjusted odds ratios for bevacizumab were 1.05 (95 % confidence interval [CI] 0.69-1.61) for upper GI ulceration, 1.29 (95 % CI 0.86-1.96) for diverticular disease, 1.49 (95 % CI 0.84-2.63) for pancreatitis, 0.82 (95 % CI 0.53-1.29) for cholelithiasis, and 1.45 (95 % CI 0.67-3.12) for cholecystitis. For ranibizumab they were 1.25 (95 % CI 0.88-1.77) for upper GI ulceration, 1.12 (95 % CI 0.83-1.52) for diverticular disease, 0.85 (95 % CI 0.51-1.40) for pancreatitis, 0.77 (95 % CI 0.53-1.11) for cholelithiasis, and 0.83 (95 % CI 0.44-1.56) for cholecystitis. Results were similar when the analysis was restricted to patients only exposed to a single type of VEGF inhibitor.
CONCLUSIONS: In this population-based study, intravitreal injections of bevacizumab and ranibizumab were not associated with increased risks of adverse GI events.},
}
@article {pmid25083287,
year = {2014},
author = {Nagrath, N and Phull, PS},
title = {Variation in caecal intubation rates between screening and symptomatic patients.},
journal = {United European gastroenterology journal},
volume = {2},
number = {4},
pages = {295-300},
pmid = {25083287},
issn = {2050-6406},
abstract = {BACKGROUND: The caecal intubation rate (CIR) is an important quality standard for endoscopists, as well as for national bowel cancer screening programmes; however, individuals undergoing colonoscopy for bowel screening and symptomatic patients represent different groups, and their characteristics may affect colonoscopy performance.
OBJECTIVE: To compare colonoscopists' performance, as assessed by the CIR, in symptomatic patients compared to individuals undergoing colonoscopy for bowel cancer screening.
METHODS: Retrospective audit of CIRs for all patients undergoing colonoscopy at our institution during the year 2008. We retrieved the data from an endoscopy reporting software database and from the local bowel cancer screening programme database. Demographic data was extracted, as well as details of known factors that may affect completion of colonoscopy, such as poor bowel preparation, presence of diverticular disease, polyps, tumour and strictures. The unadjusted CIRs for colonoscopists participating in the screening programme were compared between the bowel screening and the symptomatic patient groups.
RESULTS: Five screening colonoscopists performed 1056 colonoscopies, of which 488 were bowel screening procedures. The overall CIR was significantly lower in the symptomatic, compared to the screening, individuals (88.5% versus 93%, P < 0.02). No significant differences were observed between the two groups for risk factors that could impair the CIR. The CIR was <90% for two of the five colonoscopists in symptomatic patients, and just under 90% for one colonoscopist in screening individuals. Multivariate analysis revealed that non-screening colonoscopy was an independent predictor for an incomplete procedure (OR 1.8; 95% CI 1.2-2.8).
CONCLUSIONS: The CIR, a key quality performance indicator for colonoscopy, is lower in symptomatic patients compared to individuals undergoing colorectal cancer screening. These results suggested that CIR should be monitored independently in screening and non-screening colonoscopies.},
}
@article {pmid25059533,
year = {2015},
author = {Spiegel, BM and Reid, MW and Bolus, R and Whitman, CB and Talley, J and Dea, S and Shahedi, K and Karsan, H and Teal, C and Melmed, GY and Cohen, E and Fuller, G and Yen, L and Hodgkins, P and Erder, MH},
title = {Development and validation of a disease-targeted quality of life instrument for chronic diverticular disease: the DV-QOL.},
journal = {Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation},
volume = {24},
number = {1},
pages = {163-179},
pmid = {25059533},
issn = {1573-2649},
mesh = {Aged ; Aged, 80 and over ; Anxiety/diagnosis ; Chronic Disease ; Cross-Sectional Studies ; *Diverticulitis, Colonic/diagnosis/physiopathology/psychology ; Diverticulum, Colon/physiopathology ; Factor Analysis, Statistical ; Female ; Focus Groups ; Humans ; Language ; Male ; Middle Aged ; Patient Outcome Assessment ; Psychometrics/*methods ; Quality of Life/*psychology ; Reproducibility of Results ; *Sickness Impact Profile ; *Surveys and Questionnaires ; },
abstract = {BACKGROUND: Colonic diverticular disease is typically conceived as acute diverticulitis attacks surrounded by periods of clinical silence. However, evolving data indicate that many patients have persistent symptoms and diminished health-related quality of life (HRQOL) long after acute attacks. We developed a disease-targeted HRQOL measure for symptomatic uncomplicated diverticular disease (SUDD)-the diverticulitis quality of life (DV-QOL) instrument.
METHODS: We conducted a systematic literature review to craft a conceptual model of SUDD HRQOL. This was complemented by three focus groups including 45 SUDD patients. We developed items based on our literature search, focus groups, and cognitive debriefings. We administered the items to SUDD patients with persistent symptoms following a confirmed diverticulitis event. We created scales based on factor analysis and evaluated the scales for reliability and validity.
RESULTS: Concept elicitation revealed a range of illness experiences attributed to SUDD. Coding of 20,490 transcribed words yielded a 52-code network with four primary, condition-related concepts: (1) physical symptoms (e.g., bloating); (2) behaviors (e.g., restrictions); (3) cognitions and concerns (e.g., fear); and (4) impact and consequences (e.g., absenteeism, anxiety). Based on patient language, we developed the 17-item DV-QOL instrument. In a cross-sectional validation sample of 197 patients, DV-QOL discriminated between patients with recent versus distant diverticulitis events and correlated highly with Short Form 36 and hospital anxiety and depression scores.
CONCLUSIONS: Patients with SUDD attribute a wide range of negative psychological, social, and physical symptoms to their condition, both during and after acute attacks; DV-QOL captures these symptoms in a valid, reliable manner.},
}
@article {pmid25058766,
year = {2014},
author = {Makarawo, TP and Eichenauer, S and Shah, U and Jaeger, A and McKendrick, A and Mittal, VK},
title = {Surgery for diverticulitis: a re-evaluation of the changing trends.},
journal = {International surgery},
volume = {99},
number = {4},
pages = {364-370},
pmid = {25058766},
issn = {2520-2456},
mesh = {Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures/*trends ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; },
abstract = {The surgical management of diverticulitis continues to evolve but recent literature has not qualified just how different current practice is compared with the previous era. This study aims to update the seminal paper by Rodkey and Welch regarding indications and operation types performed for diverticulitis by comparing their findings with present practice at a community based institution. The charts of 407 patients admitted with "diverticular disease" between 2005 and 2010 were identified. For each admission, patients' demographics, presentations and management were recorded. Direct comparisons were made with results from the study by Rodkey and Welch. Of the 407 admissions studied, the distribution was 335 emergency and 72 elective. Medical management alone treated 90% of emergency admissions, while 4% required additional radiologic intervention. Emergency surgery was necessary in only 6% of cases with Hartmann's procedure being the most common procedure. Recurrent diverticulitis was a prime indication for elective surgery with 96% of cases undergoing a 1-staged procedure. Compared with the previous era, the nonoperative approach to managing acute diverticulitis is now applied for the vast majority of admissions. Improved success in medically temporizing patients in the present era has allowed for a higher percentage of successful single-staged elective surgeries.},
}
@article {pmid25057296,
year = {2014},
author = {Rychter, J and Espín, F and Gallego, D and Vergara, P and Jiménez, M and Clavé, P},
title = {Colonic smooth muscle cells and colonic motility patterns as a target for irritable bowel syndrome therapy: mechanisms of action of otilonium bromide.},
journal = {Therapeutic advances in gastroenterology},
volume = {7},
number = {4},
pages = {156-166},
pmid = {25057296},
issn = {1756-283X},
abstract = {Otilonium bromide (OB) is a spasmolytic compound of the family of quaternary ammonium derivatives and has been successfully used in the treatment of patients with irritable bowel syndrome (IBS) due to its specific pharmacodynamic effects on motility patterns in the human colon and the contractility of colonic smooth muscle cells. This article examines how. OB inhibits the main patterns of human sigmoid motility in vitro, which are spontaneous rhythmic phasic contractions, smooth muscle tone, contractions induced by stimulation of excitatory motor neurons and contractions induced by direct effect of excitatory neurotransmitters. It does this mainly by blocking calcium influx through L-type calcium channels and interfering with mobilization of cellular calcium required for smooth muscle contraction, thereby limiting excessive intestinal contractility and abdominal cramping. OB also inhibits T-type calcium channels and muscarinic responses. Finally, OB inhibits tachykinin receptors on smooth muscle and primary afferent neurons which may have the joint effect of reducing motility and abdominal pain. All these mechanisms mediate the therapeutic effects of OB in patients with IBS and might be useful in patients with other spastic colonic motility disorders such as diverticular disease.},
}
@article {pmid25051594,
year = {2014},
author = {Fortuny, JV and Buchs, NC and Morel, P and Ris, F},
title = {[Right-sided colonic diverticular disease: quo vadis?].},
journal = {Revue medicale suisse},
volume = {10},
number = {435},
pages = {1325-1330},
pmid = {25051594},
issn = {1660-9379},
mesh = {Abdominal Pain/*etiology ; Asia/epidemiology ; Diverticulitis, Colonic/diagnosis/physiopathology/*therapy ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Practice Guidelines as Topic ; },
abstract = {Symptomatic diverticular disease of the right colon is a rare entity in our latitudes, where it represents only 1.5% of all diverticulitis. In contrary, this disease is endemic in Asian countries. Besides, it has several differences with its left counterpart. Indeed, a right-sided diverticular disease is more often symptomatic, while the risk of complicated episodes seems lower. Right-sided diverticular disease usually manifests as right iliac fossa pain or low gastrointestinal bleeding. First described on 1912, there are no clear guidelines. The approach is usually conservative in Asia; when surgery cannot be avoided, a limited resection is performed. In Western countries, a surgical approach is more often considered. We reviewed the current literature and propose a way to manage right diverticulitis.},
}
@article {pmid25038431,
year = {2014},
author = {Raskin, JB and Kamm, MA and Jamal, MM and Márquez, J and Melzer, E and Schoen, RE and Szalóki, T and Barrett, K and Streck, P},
title = {Mesalamine did not prevent recurrent diverticulitis in phase 3 controlled trials.},
journal = {Gastroenterology},
volume = {147},
number = {4},
pages = {793-802},
doi = {10.1053/j.gastro.2014.07.004},
pmid = {25038431},
issn = {1528-0012},
mesh = {Adult ; Aged ; Anti-Inflammatory Agents/adverse effects/*therapeutic use ; Colectomy ; Colonic Diseases/diagnosis/*drug therapy/surgery ; Diverticulitis/diagnosis/*drug therapy/surgery ; Female ; Gastrointestinal Agents/adverse effects/*therapeutic use ; Humans ; Male ; Mesalamine/*therapeutic use ; Middle Aged ; Secondary Prevention ; Time Factors ; Treatment Outcome ; United States ; },
abstract = {BACKGROUND & AIMS: No therapy has been proven to prevent the recurrence of diverticulitis. Mesalamine has shown efficacy in preventing relapse in inflammatory bowel disease, and there is preliminary evidence that it might be effective for diverticular disease. We investigated the efficacy of mesalamine in preventing recurrence of diverticulitis in 2 identical but separate phase 3, randomized, double-blind, placebo-controlled, multicenter trials (identical confirmatory trials were conducted for regulatory reasons).
METHODS: We evaluated the efficacy and safety of multimatrix mesalamine vs placebo in the prevention of recurrent diverticulitis in 590 (PREVENT1) and 592 (PREVENT2) adult patients with ≥1 episodes of acute diverticulitis in the previous 24 months that resolved without surgery. Patients received mesalamine (1.2 g, 2.4 g, or 4.8 g) or placebo once daily for 104 weeks. The primary end point was the proportion of recurrence-free patients at week 104. Diverticulitis recurrence was defined as surgical intervention at any time for diverticular disease or presence of computed tomography scan results demonstrating bowel wall thickening (>5 mm) and/or fat stranding consistent with diverticulitis. For a portion of the study, recurrence also required the presence of abdominal pain and an increase in white blood cells.
RESULTS: Mesalamine did not reduce the rate of diverticulitis recurrence at week 104. Among patients in PREVENT1, 53%-63% did not have disease recurrence, compared with 65% of those given placebo. Among patients in PREVENT2, 59%-69% of patients did not have disease recurrence, compared with 68% of those given placebo. Mesalamine did not reduce time to recurrence, and the proportions of patients requiring surgery were comparable among treatment groups. No new adverse events were identified with mesalamine administration.
CONCLUSIONS: Mesalamine was not superior to placebo in preventing recurrent diverticulitis. Mesalamine is not recommended for this indication. ClinicalTrials.gov ID: NCT00545740 and NCT00545103.},
}
@article {pmid25026009,
year = {2014},
author = {Leifeld, L and Germer, CT and Böhm, S and Dumoulin, FL and Häuser, W and Kreis, M and Labenz, J and Lembcke, B and Post, S and Reinshagen, M and Ritz, JP and Sauerbruch, T and Wedel, T and von Rahden, B and Kruis, W},
title = {[S2k guidelines diverticular disease/diverticulitis].},
journal = {Zeitschrift fur Gastroenterologie},
volume = {52},
number = {7},
pages = {663-710},
doi = {10.1055/s-0034-1366692},
pmid = {25026009},
issn = {1439-7803},
mesh = {Diverticulitis/*diagnosis/*therapy ; Diverticulum/*diagnosis/*therapy ; Gastroenterology/*standards ; Germany ; Humans ; *Practice Guidelines as Topic ; },
}
@article {pmid25022847,
year = {2016},
author = {Marcacuzco, AA and Manrique, A and Calvo, J and Loinaz, C and Justo, I and Caso, O and Cambra, F and Fakih, N and Sanabria, R and Jimenez-Romero, LC},
title = {Clinical implications of diverticular disease of the appendix. Experience over the past 10 years.},
journal = {Cirugia espanola},
volume = {94},
number = {1},
pages = {44-47},
doi = {10.1016/j.ciresp.2014.05.003},
pmid = {25022847},
issn = {1578-147X},
mesh = {Appendectomy ; Appendicitis/diagnosis ; Appendix/surgery ; *Diverticulum/diagnosis ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {BACKGROUND: Diverticular disease of the appendix is an uncommon condition, with an incidence from 0.004 to 2.1%. It usually occurs between the fourth or fifth decades of life, does not present gastrointestinal symptoms but only insidious abdominal pain. Patients usually delay consultation, leading to increased morbidity and mortality. The aim of this study was to determine the clinical features of diverticular disease of the appendix.
METHODS: A retrospective study of all patients undergoing appendectomy in a tertiary hospital between September 2003 and September 2013 was performed.
RESULTS: During this period, 7,044 appendectomies were performed, and 42 cases of diverticular disease of the appendix were found, which represents an incidence of 0.59%. A total of 27 patients were male. The mean age was 46.6±21 years. The average hospital stay was 4.5 days. A perforated appendix was identified in 46% of patients. In 80% of the cases, a complementary imaging test was performed. The incidence of neoplastic disease with diverticulum of the appendix was 7.1%.
CONCLUSIONS: Diverticular disease of the appendix is an incidental finding. In its acute phase, it presents as an acute appendicitis. The treatment of choice is appendectomy. It presents a higher risk of developing neoplastic disease of the appendix.},
}
@article {pmid25022103,
year = {2014},
author = {Holmer, C and Kreis, ME},
title = {[Diverticular disease].},
journal = {MMW Fortschritte der Medizin},
volume = {156},
number = {11},
pages = {50-3; quiz 54},
doi = {10.1007/s15006-014-2869-1},
pmid = {25022103},
issn = {1438-3276},
mesh = {Barium Sulfate ; Colon/diagnostic imaging ; Contrast Media ; Diverticulitis, Colonic/classification/complications/*diagnosis/*therapy ; Diverticulosis, Colonic/classification/complications/*diagnosis/*therapy ; Humans ; Recurrence ; Tomography, X-Ray Computed ; },
}
@article {pmid25003681,
year = {2014},
author = {Lee, SP and Ahn, YW and Lee, OY and Lee, KN},
title = {The relationship between colonic diverticulosis and abdominal visceral and subcutaneous fat accumulation measured by abdominal CT scan.},
journal = {The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology},
volume = {25},
number = {2},
pages = {192-197},
doi = {10.5152/tjg.2014.4581},
pmid = {25003681},
issn = {2148-5607},
mesh = {Adult ; *Body Mass Index ; Cholesterol/blood ; Diverticulitis, Colonic/blood ; Diverticulosis, Colonic/*blood ; Female ; Humans ; *Intra-Abdominal Fat/diagnostic imaging ; Lipoproteins, HDL/blood ; Lipoproteins, LDL/blood ; Male ; Middle Aged ; Retrospective Studies ; *Subcutaneous Fat/diagnostic imaging ; Tomography, X-Ray Computed ; Triglycerides/blood ; },
abstract = {BACKGROUND/AIMS: Besides age, risk factors for colonic diverticular disease include dietary meat intake and Western lifestyles, which are also risk factors for obesity. However, the association between obesity and colonic diverticular disease, including diverticulosis and diverticulitis, is not well established. The aim of this study was to investigate the relationship between colonic diverticulosis and obesity using abdominal fat quantified by abdominal CT scan and lipid profiles, as well as body mass index (BMI).
MATERIALS AND METHODS: In this study based on a retrospective case note review, we enrolled 133 subjects (control group (n=55), diverticulosis group (31), and diverticulitis group (47)). Abdominal fat areas (total abdominal fat, visceral fat, subcutaneous fat) were quantified by abdominal CT scan. Serum lipid profiles and BMI were checked. Statistical analysis was performed by independent t-tests, with significance set at p<0.05.
RESULTS: In the diverticulosis group, total abdominal fat area, visceral fat area, and abdominal subcutaneous fat area were all larger than those of the control and diverticulitis groups. In the diverticulitis group, total cholesterol, high density lipoprotein (HDL), low-density lipoprotein (LDL), and BMI were lower than in the control and diverticulosis groups. There were no significant differences between the three groups in visceral-to-subcutaneous abdominal fat ratios and serum triglyceride levels.
CONCLUSION: In conclusion, obesity may predispose one to occurrence of colonic diverticulosis. Abdominal fat measurement by CT scan may be a good method of assessing risk of colonic diverticular disease.},
}
@article {pmid25002983,
year = {2014},
author = {Groisman, GM and Cohen, HI},
title = {Small intestinal amyloidosis: a rare cause of diverticular disease.},
journal = {Case reports in pathology},
volume = {2014},
number = {},
pages = {362835},
pmid = {25002983},
issn = {2090-6781},
abstract = {Systemic amyloidosis frequently involves the small intestine. However, its association with diverticular disease has been seldom reported to date. To draw attention to this rare but potentially harmful association, we herein present an additional case of small bowel diverticular disease associated with amyloidosis.},
}
@article {pmid24980998,
year = {2014},
author = {Maeshiro, T and Hokama, A and Kinjo, T and Fujita, J},
title = {Diverticular colitis of the ascending colon preceding the onset of ulcerative colitis.},
journal = {BMJ case reports},
volume = {2014},
number = {},
pages = {},
pmid = {24980998},
issn = {1757-790X},
mesh = {Chronic Disease ; Colitis/*pathology ; Colitis, Ulcerative/*pathology ; Colonoscopy ; Disease Progression ; Diverticulosis, Colonic/*pathology ; Humans ; Male ; Middle Aged ; },
abstract = {We present a case of diverticular colitis of the ascending colon preceding the onset of ulcerative colitis. A 58-year-old man presented with positive faecal occult blood test. Colonoscopy disclosed diverticular colitis of the ascending colon. After a year's follow-up, typical ulcerative colitis developed and diverticular colitis improved. Diverticular colitis is a newly established disorder of chronic segmental mucosal inflammation affected by diverticular disease. There is increasing recognition of such cases with diverticular colitis preceding ulcerative colitis. There may be a possible pathogenic relationship between the two diseases.},
}
@article {pmid24979103,
year = {2014},
author = {Anania, G and Vedana, L and Santini, M and Scagliarini, L and Giaccari, S and Resta, G and Cavallesco, G},
title = {Complications of diverticular disease: surgical laparoscopic treatment.},
journal = {Il Giornale di chirurgia},
volume = {35},
number = {5-6},
pages = {126-128},
pmid = {24979103},
issn = {0391-9005},
mesh = {Abscess/*surgery ; *Colectomy/adverse effects/methods ; Colon, Sigmoid/pathology/*surgery ; Diverticulitis, Colonic/surgery ; Diverticulosis, Colonic/*surgery ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/diagnosis/etiology/*surgery ; Intestinal Perforation/diagnosis/etiology/*surgery ; *Laparoscopy/adverse effects/methods ; Male ; Middle Aged ; Reoperation ; Risk Factors ; Sigmoid Diseases/surgery ; Treatment Outcome ; },
abstract = {Surgical treatment of complicated colonic diverticular disease is still debatable. The aim of our study was to evaluate the outcome of laparoscopic colon resection in patients with diverticulitis and with complications like colon-vescical fistula, peridiverticular abscess, perforation or stricture. All patients underwent laparoscopic colectomy within 8 years period. Main data recorded were age, sex, return of bowel function, operation time, duration of hospital stay, ASA score, body mass index (BMI), early and late complications. During the study period, 33 colon resections were performed for diverticulitis and complications of diverticulitis. We performed 5 associated procedures. We had 2 postoperative complications; 1 of these required a redo operation with laparotomy for anastomotic leak and 3 patients required conversion from laparoscopic to open colectomy. The most common reasons for conversion were related to the inflammatory process with a severe adhesion syndrome. Mean operative time was 229 minutes, and average postoperative hospital stay was 9,8 days. Laparoscopic surgery for complications of diverticular disease is safe, effective and feasible. Laparoscopic colectomy has replaced open resection as standard surgery for recurrent and complicated diverticulitis in our institution.},
}
@article {pmid24973524,
year = {2014},
author = {Khanbhai, M and Hodgson, C and Mahmood, K and Parker, MC and Solkar, M},
title = {Colo-vesical fistula: Complete healing without surgical intervention.},
journal = {International journal of surgery case reports},
volume = {5},
number = {8},
pages = {448-450},
pmid = {24973524},
issn = {2210-2612},
abstract = {INTRODUCTION: Colo-vesical (CV) fistulae are the most common type of fistulae associated with diverticular disease. Surgery remains the mainstay of treatment, without which, CV fistulae rarely achieve complete healing.
PRESENTATION OF CASE: Herein, we report the case of a 62-year-old man who developed a CV fistula after reversal of Hartmann's procedure (initially for management of diverticular abscess), which healed with conservative management alone.
DISCUSSION: We discuss possibilities of the aetiology of this fistula. The CV fistula may have been initially present, which came to light only after his reversal. Or an iatrogenic fistula that developed at the time of reversal of Hartmann's.
CONCLUSION: This is the first time that such a fistula has been demonstrated clinically and radiologically to have healed spontaneously without surgery. We recommend that conservative management of CV fistulae should be considered.},
}
@article {pmid24957158,
year = {2014},
author = {Singh, S and Singh, PP and Murad, MH and Singh, H and Samadder, NJ},
title = {Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis.},
journal = {The American journal of gastroenterology},
volume = {109},
number = {9},
pages = {1375-1389},
doi = {10.1038/ajg.2014.171},
pmid = {24957158},
issn = {1572-0241},
mesh = {Age Factors ; Colon/pathology ; Colonic Polyps/diagnosis/surgery ; Colonoscopy/standards/statistics & numerical data ; Colorectal Neoplasms/diagnosis/*epidemiology/genetics/pathology ; Diverticulum, Colon/epidemiology ; Humans ; Prevalence ; Risk Factors ; Survival Rate ; Time Factors ; },
abstract = {OBJECTIVES: We performed meta-analysis to estimate pooled prevalence, risk factors, and outcomes of interval colorectal cancers (CRCs).
METHODS: Systematic literature search through October 2013, identified population-based studies, reporting prevalence of interval CRCs (CRCs diagnosed within 6-36 months of colonoscopy). We estimated the pooled prevalence, patient, endoscopist, and tumor-related risk factors, as well as outcomes of interval CRCs, as compared with detected CRCs (CRCs diagnosed at or within 6 months of colonoscopy).
RESULTS: Twelve studies reporting on 7,912 interval CRCs were included. Pooled prevalence of interval CRCs was 3.7% (95% confidence interval (CI)=2.8-4.9%). These cancers were 2.4 times more likely to arise in the proximal colon (6.5%; 95% CI=4.9-8.6%) as compared with distal colon (2.9%; 95% CI=2.0-4.2%). Patients with interval CRCs were older (age >65-70 years vs. <65-70 years: odds ratio (OR)=1.15; 95% CI=1.02-1.30), have more comorbidities (high Charlson comorbidity index: OR=2.00; 95% CI=1.77-2.27), and have diverticular disease (OR=4.25; 95% CI=2.58-7.00). There was a nonsignificant time trend of declining prevalence of interval CRCs from 4.8% in 1990s to 4.2% between 2000 and 2005 and 3.7% beyond 2005. Patients with interval CRCs were less likely to present at an advanced stage (OR=0.79; 95% CI=0.67-0.94), although there was no survival benefit. Considerable heterogeneity was observed in most of the analyses.
CONCLUSIONS: Based on meta-analysis, approximately 1 in 27 CRCs are interval CRCs, although the confidence in these estimates is low because of the heterogeneity among the studies. These are more likely to arise in the proximal colon and are diagnosed in older patients, patients with comorbidities or diverticular disease.},
}
@article {pmid24949607,
year = {2014},
author = {Pullens, HJ and Joosten, M and Siersema, PD and Brink, MA},
title = {Open-access flexible sigmoidoscopy frequently leads to additional colonoscopy in symptomatic patients over 50 years.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {23},
number = {2},
pages = {153-159},
doi = {10.15403/jgld.2014.1121.232.1hjmp},
pmid = {24949607},
issn = {1842-1121},
mesh = {Abdominal Pain/epidemiology/etiology ; Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colonic Polyps/diagnosis/epidemiology ; Colonoscopy/*statistics & numerical data ; Colorectal Neoplasms/diagnosis/epidemiology ; Diverticulum, Colon/diagnosis/epidemiology ; Family Practice/organization & administration ; Female ; Health Services Accessibility/*organization & administration ; Hemorrhoids/diagnosis/epidemiology ; Humans ; Inflammatory Bowel Diseases/diagnosis/epidemiology ; Intestinal Diseases/*diagnosis/epidemiology ; Male ; Middle Aged ; Netherlands/epidemiology ; Referral and Consultation/organization & administration/statistics & numerical data ; Retrospective Studies ; Sigmoidoscopy/statistics & numerical data ; Young Adult ; },
abstract = {BACKGROUND & AIMS: General practitioners (GPs) in the Netherlands have open access to flexible sigmoidoscopy (FS) for patients with lower gastrointestinal symptoms, but not to colonoscopy. This study was performed to investigate the yield of FS in GP-referred patients, to evaluate the proportion of patients in whom additional colonoscopy was performed and to investigate whether there was a subgroup of patients referred for symptoms with a low risk of detecting significant findings.
METHODS: All patients undergoing FS in 2008 and 2009 who were referred by GPs were analyzed. Indications for additional colonoscopy were the presence of polyps and/or colorectal cancer (CRC), polyp screening or surveillance, incomplete FS or other reasons.
RESULTS: In total, 916 patients underwent FS. A cause for the symptoms was found in 44.2% of patients. In patients aged 50 years or older, additional colonoscopy was more frequently performed than in younger patients (27.5% vs. 9.6%, OR=3.6 [95% CI 2.4-5.4]), mainly due to a higher prevalence of adenomatous polyps (29.9% vs. 10.5%, OR=3.6 [95% CI 2.4-5.4]) and CRC (7.5% vs. 1.3%, OR=6.2 [95% CI 2.2-17.5]) during FS. In 7.8% patients undergoing FS for abdominal pain as the presenting symptom, a probable cause for the symptoms was found, mainly diverticular disease.
CONCLUSION: Due to the high prevalence of polyps and CRC in symptomatic patients aged 50 years or older undergoing FS, an additional colonoscopy is performed frequently. In patients referred with abdominal pain, FS is unlikely to reveal a relevant cause for the symptoms.},
}
@article {pmid24917959,
year = {2013},
author = {Lahiri, RP and Abeles, A and Burnand, KM and Alazawi, W and Bhattacharya, S and Foster, GR and Knowles, CH},
title = {A cross sectional study of colonic diverticulosis in the London Bangladeshi population.},
journal = {United European gastroenterology journal},
volume = {1},
number = {3},
pages = {191-197},
pmid = {24917959},
issn = {2050-6406},
abstract = {BACKGROUND: Diverticular disease is the most common morphological abnormality of the colon and the fifth most important gastrointestinal disease in terms of cost in the Western world. Tower Hamlets is the poorest borough in London containing a large Bangladeshi community. We observed that emergency admissions with complications of colonic diverticulosis were minimal in the Bangladeshi community. The objective was to compare the background prevalence of colonic diverticulosis in Bangladeshis with other ethnicities in patients undergoing colonoscopy at a single centre in Tower Hamlets.
METHODS: Four thousand four hundred and fifty-four consecutive colonoscopy reports over a 2-year period were retrospectively analysed. Patients under 40 years of age and repeat colonoscopies were excluded, leaving 3151 patients (mean age: 63 years; 48% male). Demographics including ethnicity and medical background were retrieved from the electronic patient record system and findings correlated with the prevalence of other 'Western' diseases in the cohort.
RESULTS: Six hundred and thirty out of 3151 (20%) colonoscopies were performed on Bangladeshis. The prevalence of colonic diverticulosis was significantly lower in Bangladeshis (17/630: 2.7%) than Caucasians (673/1869: 36%), Indians/Pakistanis (16/161: 9.9%), Oriental (15/44: 34%) and Black (90/369: 24.4%) patient groups (χ(2) p < 0.0001 for all comparisons). The prevalence of classical sigmoid diverticulosis in the Bangladeshi cohort was only 1.0%, despite significantly more Bangladeshi patients undergoing colonoscopy for abdominal pain (p < 0.0001, χ(2)) and diarrhoea (p < 0.0034, χ(2)). There was also a significantly greater incidence of type 2 diabetes mellitus and ischaemic heart disease (p < 0.0001, χ(2)) in Bangladeshi patients.
CONCLUSIONS: There is a negligible prevalence of colonic diverticulosis in the Bangladeshi population of London who undergo colonoscopy. This is in spite of a high incidence of type 2 diabetes and ischaemic heart disease. The effect of diet and genetics on the prevalence of colonic diverticulosis in Bangladeshis is not known and merits further investigation.},
}
@article {pmid24887791,
year = {2014},
author = {Baccaro, LM and Markelov, A and Wilhelm, J and Bloch, R},
title = {Pneumoperitoneum after virtual colonoscopy: causes, risk factors, and management.},
journal = {The American surgeon},
volume = {80},
number = {6},
pages = {549-554},
pmid = {24887791},
issn = {1555-9823},
mesh = {Aged ; Colectomy/*methods ; Colon/*injuries/surgery ; Colonic Polyps/*diagnostic imaging ; Colonography, Computed Tomographic/*adverse effects ; Follow-Up Studies ; Humans ; Intestinal Perforation/*complications/diagnostic imaging/surgery ; Male ; Pneumoperitoneum/diagnosis/*etiology/surgery ; Risk Factors ; },
abstract = {Computed tomographic virtual colonoscopy (CTVC) is a safe and minimally invasive modality when compared with fiberoptic colonoscopy for evaluating the colon and rectum. We have reviewed the risks for colonic perforation by investigating the relevant literature. The objectives of this study were to assess the risk of colonic perforation during CTVC, describe risk factors, evaluate ways to reduce the incidence complications, and to review management and treatment options. A formal search of indexed publications was performed through PubMed. Search queries using keywords "CT colonography," "CT virtual colonoscopy," "virtual colonoscopy," and "perforation" yielded a total of 133 articles. A total of eight case reports and four review articles were selected. Combining case reports and review articles, a total of 25 cases of colonic perforation after CTVC have been reported. Causes include, but are not limited to, diverticular disease, irritable bowel diseases, obstructive processes, malignancies, and iatrogenic injury. Both operative and nonoperative management has been described. Nonoperative management has been proven safe and successful in minimally symptomatic and stable patients. Colonic perforation after CTVC is a rare complication and very few cases have been reported. Several risk factors are recurrent in the literature and must be acknowledged at the time of the study. Management options vary and should be tailored to each individual patient.},
}
@article {pmid24886345,
year = {2014},
author = {Pankaja, S and Rrukaj, A and Bathula, U},
title = {Diverticular disease of the colon presenting as pyometra: a case report.},
journal = {Journal of medical case reports},
volume = {8},
number = {},
pages = {135},
pmid = {24886345},
issn = {1752-1947},
mesh = {Abscess/complications/*diagnosis ; Aged ; Diverticulitis, Colonic/complications/*diagnosis ; Female ; Fistula/complications/*diagnosis ; Humans ; Pyometra/*diagnosis/etiology ; Sigmoid Diseases/complications/*diagnosis ; Uterine Diseases/complications/*diagnosis ; },
abstract = {INTRODUCTION: Pyometra can be caused by various etiologies. We present a rare case of diverticular disease of the colon presenting as pyometra. This type of presentation can be challenging even for an astute clinician.
CASE PRESENTATION: A 74-year-old Caucasian woman with a history of pyometra was referred to our gynecology clinic as an urgent case. She was obese, diabetic and hypertensive. Due to the patient profile and the clinical presentation, clinicians were misled toward a diagnosis of possible endometrial cancer. After further investigations, she was found to have colouterine fistula secondary to a diverticular abscess of the sigmoid colon.
CONCLUSIONS: Persistent vaginal discharge due to pyometra can be caused by diverticular disease of the colon. Clinicians should be aware of this important differential diagnosis.},
}
@article {pmid24866344,
year = {2014},
author = {Muhammad, A and Lamendola, O and Daas, A and Kumar, A and Vidyarthi, G},
title = {Association between colonic diverticulosis and prevalence of colorectal polyps.},
journal = {International journal of colorectal disease},
volume = {29},
number = {8},
pages = {947-951},
pmid = {24866344},
issn = {1432-1262},
mesh = {Colonic Polyps/*complications/*epidemiology/pathology ; Colonoscopy ; Diverticulosis, Colonic/*complications/pathology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Prevalence ; United States/epidemiology ; },
abstract = {INTRODUCTION: Diverticulosis and colorectal polyps increase in frequency as the population ages. Proposed common mechanisms for both include lack of dietary fiber, increased saturated fats, and slow colonic transit time. The association of diverticulosis and colorectal polyps has been previously reported with conflicting results. Despite sharing common epidemiologic predisposing factors, the association between diverticulosis and colon polyps remains unclear and needs better clarification.
AIM: The primary aim of our study is to evaluate if there is any association between diverticular disease and colorectal polyps.
MATERIALS AND METHODS: This is a retrospective cohort study. All consecutive patients who underwent colonoscopy between January 2009 and December 2011 were included, except those with history of inflammatory bowel disease, polyposis syndrome, and poor bowel preparation. Univariate and multivariate logistic regression analysis was conducted to analyze the association between colon polyps and diverticulosis. Hyperplastic polyps were excluded from the statistical analysis, and only pre-cancerous adenomas were included.
RESULTS: A total of 2,223 patients met the inclusion criteria. The prevalence of colorectal polyps in patients with diverticulosis was significantly higher than those without diverticulosis (odds ratio (OR) 1.54; 95 % confidence interval (CI) 1.27-1.80, p = 0.001). This association was found significant for all locations of polyps and all histological subtypes. There was also a statistically significant association between age, presence of diverticulosis, and colorectal polyps (OR 1.03; 95 % CI 1.02-1.04). The incidence of colorectal polyps increases as age advances in patients with diverticulosis, with the highest association in patients >70 years of age (OR 3.55; 95 % CI 2.50-5.04). There was no significant association between indication for colonoscopy and presence of colorectal polyps in patients with diverticulosis (OR 0.98; 95 % CI 0.95-1.01). The incidence of diverticulitis was low (<1 %), and there was no association between diverticulitis and colon polyps.
CONCLUSION: There is a significant association between diverticulosis and synchronous pre-cancerous colorectal polyps (adenomas). Patients with diverticulosis have a higher risk of colorectal polyps as compared to those without. This observation needs further validation by a large prospective cohort study.},
}
@article {pmid24864634,
year = {2014},
author = {Gala, T and Alvi, AR and Sheikh, GM and Habib, HY and Ghafoor, Z and Mir, TA and Mirza, M},
title = {Experience of managing complicated diverticulitis of colon: a retrospective case series from South Asian country.},
journal = {JPMA. The Journal of the Pakistan Medical Association},
volume = {64},
number = {4},
pages = {409-414},
pmid = {24864634},
issn = {0030-9982},
mesh = {Aged ; Diverticulitis, Colonic/complications/mortality/surgery/*therapy ; Female ; Humans ; Male ; Middle Aged ; Pakistan/epidemiology ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; },
abstract = {OBJECTIVE: To assess the morbidity and mortality associated with complicated diverticulitis in Pakistan.
METHODS: The retrospective case series was conducted at an urban tertiary care university hospital of Karachi, Pakistan, comprising data from December 1989 to November 2010. International Classification of Diseases codes for diverticular disease and diverticulitis with abscess, fistula, stricture, bowel obstruction and perforation were obtained from the medical record department. SPSS 19 was used for statistical analysis.
RESULTS: A total of 60 (1.9%) cases with complicated diverticulitis were located from among 3170 records reviewed. Mean age was 62.7 +/- 13 years with male-to-female ratio being 36:24. In 37 (62%) patients, the diagnosis was established on computed tomography scan of the abdomen, followed by barium enema in 12 (20%) and colonoscopy in 11 (18%). Post-operative morbidity was observed in 24 (40%) and 7 (16%) expired within 28 days of surgery. Post-operative intra-abdominal sepsis, wound dehiscence and incisional hernia were significantly associated with generalised peritonitis (p < 0.05), while admission to intensive care unit was associated with age over 60 years and faecal peritonitis. Post-operative mortality was significantly associated with high American Society of Anaesthesiologists-score III and IV and age above 60 years.
CONCLUSION: Complicated diverticulitis carries significant morbidity and mortality in Pakistani population. Since the trend is on the rise, therefore we propose a prospective multi-centre cohort study to understand the spectrum of disease, management and identification of risk factors to achieve the best possible outcomes in patients with complicated diverticulitis.},
}
@article {pmid24852339,
year = {2014},
author = {Yang, PF and Morgan, MJ},
title = {Laparoscopic versus open reversal of Hartmann's procedure: a retrospective review.},
journal = {ANZ journal of surgery},
volume = {84},
number = {12},
pages = {965-969},
doi = {10.1111/ans.12667},
pmid = {24852339},
issn = {1445-2197},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; *Colectomy ; Colon/*surgery ; Colonic Diseases/*surgery ; *Colostomy ; Female ; Humans ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Rectum/*surgery ; Reoperation ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Restoration of bowel continuity following Hartmann's procedure may be performed using a laparoscopic or open technique. This study is the first of its kind comparing laparoscopic with open reversal of Hartmann's procedure in Australasia.
METHODS: This is a retrospective review of 107 patients who underwent either a laparoscopic (n = 43) or open (n = 64) reversal of Hartmann's procedure between 2001 and 2012. Outcome measures were perioperative clinical outcomes and post-operative complications.
RESULTS: Patients in the two groups were comparable in age, body mass index, American Society of Anesthesiologists score and number of previous operations. The most common indication for the original Hartmann's operation in both groups was diverticular disease. Total theatre time was longer for the laparoscopic group (276.4 versus 242.0 min; P = 0.02). Three patients in the laparoscopic group required conversion to laparotomy (7%). Laparoscopic reversal of Hartmann's procedure was associated with shorter time to passage of flatus (2.8 versus 4.0 days; P < 0.001) and faeces (4.2 versus 5.6 days; P = 0.002), and shorter overall length of hospital stay (6.7 versus 10.8 days; P < 0.001). There were fewer patients in the laparoscopic group who had post-operative complications (14% versus 31%; P = 0.04), including fewer cases of post-operative ileus (2% versus 17%; P = 0.02). There were no cases of anastomotic leak or in-hospital mortality in either group.
CONCLUSION: Laparoscopic reversal of Hartmann's procedure is a safe and feasible alternative to open Hartmann's reversal and may be associated with significantly faster recovery time and fewer post-operative complications.},
}
@article {pmid24848529,
year = {2014},
author = {Cirocchi, R and Cochetti, G and Randolph, J and Listorti, C and Castellani, E and Renzi, C and Mearini, E and Fingerhut, A},
title = {Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review.},
journal = {Techniques in coloproctology},
volume = {18},
number = {10},
pages = {873-885},
pmid = {24848529},
issn = {1128-045X},
mesh = {Adult ; Anastomosis, Surgical/adverse effects ; Colectomy/methods ; Colon/surgery ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/*complications/surgery ; Diverticulum/surgery ; Humans ; Intestinal Fistula/*complications/*surgery ; *Laparoscopy ; Postoperative Complications ; Recurrence ; Treatment Outcome ; Urinary Bladder/surgery ; },
abstract = {Colovesical fistulas originating from complicated sigmoid diverticular disease are rare. The primary aim of this review was to evaluate the role of laparoscopic surgery in the treatment of this complication. The secondary aim was to determine the best surgical treatment for this disease. A systematic search was conducted for studies published between 1992 and 2012 in PubMed, the Cochrane Register of Controlled Clinical Trials, Scopus, and Publish or Perish. Studies enrolling adults undergoing fully laparoscopic, laparoscopic-assisted, or hand-assisted laparoscopic surgery for colovesical fistula secondary to complicated sigmoid diverticular disease were considered. Data extracted concerned the surgical technique, intraoperative outcomes, and postoperative outcomes based on the Cochrane Consumers and Communication Review Group's template. Descriptive statistics were reported according to the PRISMA statement. In all, 202 patients from 25 studies were included in this review. The standard treatment was laparoscopic colonic resection and primary anastomosis or temporary colostomy with or without resection of the bladder wall. Operative time ranged from 150 to 321 min. It was not possible to evaluate the conversion rate to open surgery because colovesical fistulas were not distinguished from other types of enteric fistulas in most of the studies. One anastomotic leak after bowel anastomosis was reported. There was zero mortality. Few studies conducted follow-up longer than 12 months. One patient required two reoperations. Laparoscopic treatment of colovesical fistulas secondary to sigmoid diverticular disease appears to be a feasible and safe approach. However, further studies are needed to establish whether laparoscopy is preferable to other surgical approaches.},
}
@article {pmid24838995,
year = {2014},
author = {Lee, JT and Dunn, TB and Sirany, AM and Melton, GB and Madoff, RD and Kwaan, MR},
title = {Colorectal surgery after kidney transplantation: characteristics of early vs. late posttransplant interventions.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {18},
number = {7},
pages = {1299-1305},
pmid = {24838995},
issn = {1873-4626},
mesh = {Adult ; Aged ; Cohort Studies ; Colitis, Ulcerative/diagnosis/surgery ; Colorectal Neoplasms/diagnosis/surgery ; Colorectal Surgery/*adverse effects/methods/mortality ; Diverticulum, Colon/diagnosis/surgery ; Female ; Follow-Up Studies ; Gastrointestinal Diseases/diagnosis/mortality/*surgery ; Graft Rejection ; Graft Survival ; Humans ; Kidney Transplantation/*methods/mortality ; Male ; Middle Aged ; Postoperative Complications/mortality/*physiopathology ; Retrospective Studies ; Risk Assessment ; Survival Rate ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: The majority of colorectal complications after kidney transplantation reportedly occur <1 year of transplant. We aimed to identify differences in complications in the early and late posttransplant period.
METHODS: We retrospectively reviewed kidney transplant recipients undergoing colorectal resection from 1 June 2000 to 1 June 2012 at a single institution, comparing patients by posttransplant year (<1 vs. >1 year). Measured outcomes included major complications, postoperative length of stay, perioperative mortality, reoperations, and readmissions.
RESULTS: We identified 45 patients aged 31-77 (median 55). Gastrointestinal malignancy (31 %), diverticular disease (24 %), and ischemic colitis (16 %) were the most common indications for surgery. The early group (n = 9) had more cases of ischemic colitis (44 vs. 6 %, p = 0.01), emergent operations (100 vs. 33 %, p = 0.0003), blood transfusion (78 vs. 31 %, p = 0.02), longer length of stay (23.2 ± 12 vs. 11.7 ± 10 days, p = 0.02), and higher mortality rate (33 vs. 6 %, p = 0.05 compared to the late group (n = 36)). There were no significant differences in major complications, reoperations, or readmissions.
CONCLUSIONS: Kidney transplant recipients undergoing colorectal resection <1 year of transplant have a higher incidence of emergency surgery and ischemic colitis compared with those with >1 year posttransplant. Despite these findings, patients with grafts <1 year had a similar postoperative complication rate to patients with grafts >1 year.},
}
@article {pmid24833140,
year = {2014},
author = {Maciel, V and Lujan, HJ and Plasencia, G and Zeichen, M and Mata, W and Jorge, I and Lee, D and Viamonte, M and Hartmann, RF},
title = {Diverticular disease complicated with colovesical fistula: laparoscopic versus robotic management.},
journal = {International surgery},
volume = {99},
number = {3},
pages = {203-210},
pmid = {24833140},
issn = {2520-2456},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intestinal Fistula/etiology/*surgery ; *Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; *Robotic Surgical Procedures ; },
}
@article {pmid24814505,
year = {2014},
author = {Connelly, TM and Berg, AS and Hegarty, JP and Deiling, S and Brinton, D and Poritz, LS and Koltun, WA},
title = {The TNFSF15 gene single nucleotide polymorphism rs7848647 is associated with surgical diverticulitis.},
journal = {Annals of surgery},
volume = {259},
number = {6},
pages = {1132-1137},
doi = {10.1097/SLA.0000000000000232},
pmid = {24814505},
issn = {1528-1140},
mesh = {Adult ; Aged ; Alleles ; Colectomy/*methods ; Colonic Diseases/*genetics/surgery ; DNA/*genetics ; Diverticulitis/*genetics/surgery ; Female ; Follow-Up Studies ; Genetic Predisposition to Disease ; Genotype ; Humans ; Male ; Middle Aged ; Pedigree ; Phenotype ; *Polymorphism, Single Nucleotide ; Retrospective Studies ; Tumor Necrosis Factor Ligand Superfamily Member 15/*genetics ; },
abstract = {OBJECTIVE: To determine if single nuclear polymorphisms (SNPs) in the TFNSF15 gene play a role in patients requiring surgery for diverticulitis.
BACKGROUND: A role for a genetic predisposition in diverticulitis is suggested by its association with hereditary connective tissue disorders, youthful onset in some patients, and the observation of families with multiple affected individuals. The TNFSF15 gene has been associated with other inflammatory diseases affecting the colon such as medically refractory ulcerative colitis (UC), aggressive Crohn's disease (CD), and pouchitis after restorative proctocolectomy.
METHODS: In the discovery phase of this study, 21 sporadic surgical diverticulitis (SD) patients (9 female, mean age = 52 ± 5) and 5 individuals from a single family with surgically managed diverticulitis [familial diverticulitis (FD), 4 female, mean age = 51.1 ± 7] were studied. SD patients were age and sex matched with 3 separate groups of healthy, CD and UC control patients. All patients were genotyped for 5 known TNFSF15-associated SNPs. The SNP discovered to be associated with diverticulitis (rs7848647) was then confirmed in a separate test group composed of 34 additional patients (20 female, mean age 57.7 ± 2) who also underwent surgical treatment for diverticulitis. These patients were age matched to a new control cohort of patients having no history of diverticulitis (26 female). Patients were genotyped using a TaqMan assay. In the discovery phase, logistical regression on matched subjects was performed to determine an association of TNFSF SNP with diverticulitis versus the control groups. In the test phase, significance for the rs7848647 SNP was assessed by the Fischer's exact test.
RESULTS: In the discovery phase, the TNFSF15 SNP rs7848647 was significantly associated with SD (p = 0.0003) versus all control groups studied. The risk allele for this SNP (G substituted for A) was found in all SD patients. The homozygous GG allele was found in 62% (13/21) of SD patients versus only 5% (1/21) of healthy controls (p = 0.001) and 24% (10/42) of all UC + CD controls (p = 0.002). All 5 members of the FD cohort were homozygous for the at-risk "G" allele. In the test group, the homozygous GG genotype was found in 56% of SD patients compared with 17% of healthy controls (p = 0.006). Risk of SD seemed to increase with number of the G alleles with 8% of SD patients having AA homozygosity, 35% of SD patients having AG heterozygosity, and 56% of SD patients having GG homozygosity.
CONCLUSIONS: The SNP rs7848647 associated with the TNFSF15 gene is associated with surgical diverticulitis. This finding suggests a fundamental role for TNFSF15, a T-cell receptor gene involved in T-cell maturation, in the pathophysiology of diverticulitis requiring surgery. This SNP may be a marker of diverticular disease severity that might assist in surgical decision making.},
}
@article {pmid24801825,
year = {2014},
author = {Vennix, S and Morton, DG and Hahnloser, D and Lange, JF and Bemelman, WA and , },
title = {Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {16},
number = {11},
pages = {866-878},
doi = {10.1111/codi.12659},
pmid = {24801825},
issn = {1463-1318},
mesh = {Combined Modality Therapy ; Consensus ; Diverticulitis, Colonic/diagnosis/etiology/*therapy ; Evidence-Based Medicine ; Humans ; Practice Guidelines as Topic ; Risk Factors ; },
abstract = {AIM: The study aimed to analyse the currently available national and international guidelines for areas of consensus and contrasting recommendations in the treatment of diverticulitis and thereby to design questions for future research.
METHOD: MEDLINE, EMBASE and PubMed were systematically searched for guidelines on diverticular disease and diverticulitis. Inclusion was confined to papers in English and those < 10 years old. The included topics were classified as consensus or controversy between guidelines, and the highest level of evidence was scored as sufficient (Oxford Centre of Evidence-Based Medicine Level of Evidence of 3a or higher) or insufficient.
RESULTS: Six guidelines were included and all topics with recommendations were compared. Overall, in 13 topics consensus was reached and 10 topics were regarded as controversial. In five topics, consensus was reached without sufficient evidence and in three topics there was no evidence and no consensus. Clinical staging, the need for intraluminal imaging, dietary restriction, duration of antibiotic treatment, the protocol for abscess treatment, the need for elective surgery in subgroups of patients, the need for surgery after abscess treatment and the level of the proximal resection margin all lack consensus or evidence.
CONCLUSION: Evidence on the diagnosis and treatment of diverticular disease and diverticulitis ranged from nonexistent to strong, regardless of consensus. The most relevant research questions were identified and proposed as topics for future research.},
}
@article {pmid24765653,
year = {2014},
author = {Coe, P and Iqbal, J and Rudralingam, V and Duff, S},
title = {Snapshot quiz 14/6. Caecal diverticular disease with an associated stricture of the ileocaecal valve.},
journal = {The British journal of surgery},
volume = {101},
number = {5},
pages = {501, 549},
pmid = {24765653},
issn = {1365-2168},
mesh = {Cecal Diseases/*etiology/pathology ; Constriction, Pathologic/pathology ; Diverticulum/*etiology/pathology ; Humans ; Ileocecal Valve/*pathology ; Intestinal Obstruction/*etiology/pathology ; Intestine, Small ; },
}
@article {pmid24759819,
year = {2013},
author = {Fesharakizadeh, M and Taheri, D and Dolatkhah, S and Wexner, SD},
title = {Postoperative ileus in colorectal surgery: is there any difference between laparoscopic and open surgery?.},
journal = {Gastroenterology report},
volume = {1},
number = {2},
pages = {138-143},
pmid = {24759819},
issn = {2052-0034},
abstract = {BACKGROUND: Postoperative ileus is a major complication of patients undergoing abdominal surgery. The purpose of this study was to determine the effects of operative time and the method of surgery on postoperative ileus.
METHODS: After institutional review board approval, 121 patients were studied in two groups. Group 1 consisted of 86 patients with colorectal cancers and Group 2 included 35 patients with diverticulitis. Various surgical procedures were performed in both groups. In all patients, the nasogastric (NG) tube was removed after termination of surgery. Clear liquids were offered commencing on the first postoperative day, followed by a regular diet as tolerated. GI-1 was the postoperative time to toleration of clear liquids, whereas GI-2 was the postoperative time to first bowel movement or flatus and toleration of a regular diet. Statistical analysis was performed using a linear regression model by disease with the first bowel movement or flatus as the dependent variable and operative time and category as explanatory variables.
RESULTS: Vomiting after oral feeding occurred in 18 (20.9%) patients with cancer and in 7 (20.0%) patients with diverticular disease. An NG tube was reinserted in 13 (15.1%) patients in the cancer group and in 3 (8.6%) patients in the diverticular disease group. In patients with cancer, the duration of operation was associated with GI-2 (P = 0.011), whereas in patients with diverticulitis, the duration of operation was associated with GI-1 (P = 0.001) and GI-2 (P = 0.044). In the diverticulitis group, a significant relationship was found between GI-2 and operative category (P = 0.03).
CONCLUSION: Longer operations led to more prolonged postoperative ileus after both laparoscopy and laparotomy, regardless of malignant or benign pathology. In anticipation of and/or following longer operations, surgeons should consider measures to shorten postoperative ileus.},
}
@article {pmid24758697,
year = {2014},
author = {Fornai, M and Colucci, R and Antonioli, L and Ippolito, C and Segnani, C and Buccianti, P and Marioni, A and Chiarugi, M and Villanacci, V and Bassotti, G and Blandizzi, C and Bernardini, N},
title = {Role of cyclooxygenase isoforms in the altered excitatory motor pathways of human colon with diverticular disease.},
journal = {British journal of pharmacology},
volume = {171},
number = {15},
pages = {3728-3740},
pmid = {24758697},
issn = {1476-5381},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/drug effects/*physiology ; Cyclooxygenase 1/*physiology ; Cyclooxygenase 2/*physiology ; Cyclooxygenase Inhibitors/pharmacology ; Diverticulitis, Colonic/*physiopathology ; Female ; Humans ; In Vitro Techniques ; Indomethacin/pharmacology ; Male ; Middle Aged ; Muscle Contraction/drug effects ; Muscle, Smooth/drug effects/physiology ; Pyrazoles/pharmacology ; },
abstract = {BACKGROUND AND PURPOSE: The COX isoforms (COX-1, COX-2) regulate human gut motility, although their role under pathological conditions remains unclear. This study examines the effects of COX inhibitors on excitatory motility in colonic tissue from patients with diverticular disease (DD).
EXPERIMENTAL APPROACH: Longitudinal muscle preparations, from patients with DD or uncomplicated cancer (controls), were set up in organ baths and connected to isotonic transducers. Indomethacin (COX-1/COX-2 inhibitor), SC-560 (COX-1 inhibitor) or DFU (COX-2 inhibitor) were assayed on electrically evoked, neurogenic, cholinergic and tachykininergic contractions, or carbachol- and substance P (SP)-induced myogenic contractions. Distribution and expression of COX isoforms in the neuromuscular compartment were assessed by RT-PCR, Western blot and immunohistochemical analysis.
KEY RESULTS: In control preparations, neurogenic cholinergic contractions were enhanced by COX inhibitors, whereas tachykininergic responses were blunted. Carbachol-evoked contractions were increased by indomethacin or SC-560, but not DFU, whereas all inhibitors reduced SP-induced motor responses. In preparations from DD patients, COX inhibitors did not affect electrically evoked cholinergic contractions. Both indomethacin and DFU, but not SC-560, decreased tachykininergic responses. COX inhibitors did not modify carbachol-evoked motor responses, whereas they counteracted SP-induced contractions. COX-1 expression was decreased in myenteric neurons, whereas COX-2 was enhanced in glial cells and smooth muscle.
CONCLUSIONS AND IMPLICATIONS: In control colon, COX-1 and COX-2 down-regulate cholinergic motility, whereas both isoforms enhance tachykininergic motor activity. In the presence of DD, there is a loss of modulation by both COX isoforms on the cholinergic system, whereas COX-2 displays an enhanced facilitatory control on tachykininergic contractile activity.},
}
@article {pmid24730069,
year = {2013},
author = {},
title = {Diverticular disease. Fiber as therapy.},
journal = {Mayo Clinic health letter (English ed.)},
volume = {31},
number = {12},
pages = {1-3},
pmid = {24730069},
issn = {0741-6245},
mesh = {Aging ; Anti-Bacterial Agents/therapeutic use ; Dietary Fiber/therapeutic use ; Diverticulum, Colon/etiology/*physiopathology/therapy ; Exercise ; Humans ; Obesity/epidemiology ; },
}
@article {pmid24718443,
year = {2014},
author = {Lembcke, B},
title = {[Diverticular disease - diagnosis and classification].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {85},
number = {4},
pages = {289-298},
pmid = {24718443},
issn = {1433-0385},
mesh = {Colonoscopy ; Consensus ; Diagnosis, Differential ; Diverticulitis, Colonic/*classification/*diagnosis/surgery ; Diverticulosis, Colonic/*classification/*diagnosis/surgery ; Germany ; Humans ; Sensitivity and Specificity ; Societies, Medical ; Tomography, X-Ray Computed ; Ultrasonography ; },
abstract = {A reliable diagnosis is fundamental for operative, interventional and conservative treatment of the different facets of diverticular disease. Not only differential diagnoses but also overlap or coincidence with other entities sharing similar symptoms must be considered. Furthermore, an adequate surgical strategy and correct stratification of complications is mandatory. Subsequently, in the light of currently validated diagnostic techniques, the consensus conference of the German Societies of Gastroenterology (DGVS) and Visceral Surgery (DGAV) has released a new classification of diverticulitis displaying the different facets of diverticular disease. This classification also comprises symptomatic uncomplicated diverticular disease (SUDD), largely resembling irritable bowel syndrome, as well as diverticular bleeding. While detailed history, physical examination and laboratory testing are of great importance for exploring a patient with diverticular disease, they are not sufficient to diagnose (or stratify) diverticulitis without cross-sectional imaging using ultrasonography (US) or computed tomography (CT). The diagnostic value of qualified US is equipotent to qualified CT, complies with relevant legislation for radiation exposure protection and is frequently effective for diagnosis. Therefore, US is considered to be the first choice for imaging in diverticular disease. In contrast, CT has definite indications in unclear, discrepant situations or insufficient US performance. Strengths and weaknesses of both methods are discussed. Endoscopy is not required for the diagnosis of diverticulitis and should not be performed in an acute attack. Colonoscopy, however, is warranted after healing of diverticulitis, prior to elective surgery and in cases of an atypical course. Prior exclusion of perforation is considered mandatory. An unequivocal indication for colonoscopy is diverticular bleeding and the rapid performance (within 12-24 h) allows better identification of sites of bleeding and endoscopic interventions.},
}
@article {pmid24718442,
year = {2014},
author = {Germer, CT},
title = {[Diverticular disease of the colon].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {85},
number = {4},
pages = {280},
pmid = {24718442},
issn = {1433-0385},
mesh = {Diverticulitis, Colonic/classification/diagnosis/*therapy ; Diverticulosis, Colonic/classification/diagnosis/*therapy ; Guideline Adherence ; Humans ; Prognosis ; },
}
@article {pmid24710221,
year = {2014},
author = {Spector, R and Bard, V and Zmora, O and Avital, S and Wasserberg, N},
title = {Hand-assisted laparoscopic colectomy for colovesical fistula associated with diverticular disease.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {24},
number = {3},
pages = {251-253},
doi = {10.1097/SLE.0b013e31828f6ce0},
pmid = {24710221},
issn = {1534-4908},
mesh = {Adult ; Aged ; Colectomy/*methods ; Diverticulum, Colon/complications/*surgery ; Feasibility Studies ; Female ; Follow-Up Studies ; Hand-Assisted Laparoscopy/*methods ; Humans ; Intestinal Fistula/etiology/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; },
abstract = {To evaluate the feasibility and short-term outcome of hand-assisted laparoscopic colectomy (HALC) for the treatment of colovesical fistula complicating diverticulitis, we reviewed the files of all 34 patients who underwent surgery for diverticular colovesical fistula in 1999 to 2010 at a major tertiary medical center. Twenty-one were treated with HALC and 13 with open colectomy. There were no differences in demographic parameters among the groups. HALC and open colectomy had similar operating time. HALC was associated with a significantly shorter hospital stay compared with open colectomy (5 vs. 8 d, P=0.001). HALC proved to be technically feasible and safe in this setting. It provided benefits of tactile feedback and manual manipulation as in open colectomy while maintaining the advantages of a minimal invasive approach.},
}
@article {pmid24684571,
year = {2014},
author = {Tursi, A},
title = {New physiopathological and therapeutic approaches to diverticular disease: an update.},
journal = {Expert opinion on pharmacotherapy},
volume = {15},
number = {7},
pages = {1005-1017},
doi = {10.1517/14656566.2014.903922},
pmid = {24684571},
issn = {1744-7666},
mesh = {Animals ; Anti-Bacterial Agents/*therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Colon/drug effects/physiopathology ; Dietary Fiber/*therapeutic use ; Diverticulosis, Colonic/*diet therapy/*drug therapy/physiopathology/prevention & control ; Humans ; Mesalamine/*therapeutic use ; Probiotics/*therapeutic use ; Recurrence ; },
abstract = {INTRODUCTION: Diverticular disease (DD) of the colon is a widespread disease, which shows worldwide increasing incidence and represents a significant burden for National Health Systems. The current guidelines claim that symptomatic uncomplicated DD (SUDD) has to be treated with spasmolithics and high-fiber diet, whereas both uncomplicated and complicated acute diverticulitis has to be treated with antibiotics. However, new physiopathological knowledge suggests that further treatment may be promising.
AREAS COVERED: Pathogenetic and treatment studies on SUDD and acute diverticulitis published in PubMed, www.clinicaltrials.gov , and in the main International Congress were reviewed.
EXPERT OPINION: Although absorbable antibiotics and 5-aminosalycilic acid seem to be effective in treating SUDD, their role in preventing diverticulitis recurrence is still under debate. Antibiotic use in managing acute diverticulitis is at least questionable, and use of probiotics seems to be promising but need further robust studies to confirm the preliminary results.},
}
@article {pmid24681094,
year = {2014},
author = {Ulmer, TF and Rosch, R and Mossdorf, A and Alizai, H and Binnebösel, M and Neumann, U},
title = {Colonic wall changes in patients with diverticular disease - is there a predisposition for a complicated course?.},
journal = {International journal of surgery (London, England)},
volume = {12},
number = {5},
pages = {426-431},
doi = {10.1016/j.ijsu.2014.03.014},
pmid = {24681094},
issn = {1743-9159},
mesh = {Aged ; Apoptosis/physiology ; Case-Control Studies ; Collagen/metabolism ; Colon/*metabolism/*pathology ; Diverticulitis, Colonic/*metabolism/*pathology ; Humans ; Ki-67 Antigen/metabolism ; Matrix Metalloproteinase 1/metabolism ; Matrix Metalloproteinase 13/metabolism ; Middle Aged ; Neuroglia/metabolism/pathology ; Rectum/metabolism/pathology ; },
abstract = {BACKGROUND: The aim of this study was to evaluate colonic wall changes and enteric neuropathy in patients with either uncomplicated (UDD) or complicated diverticular disease (CDD). Furthermore, we evaluated the presence of an anatomic sphincter at the rectosigmoid junction (RSJ).
METHODS: Samples of colonic tissue from fifteen patients with UDD, fifteen patients with CDD and fifteen patients as control were collected. Collagen quotient I/III was measured with the Sirius-red test, expression of MMP-1, MMP-13, innervation (S100), proliferation (Ki67) and apoptosis (TUNEL) in the colonic wall were investigated by immunohistochemical studies. Furthermore, measurements of the different layers were performed to investigate the RSJ.
RESULTS: Patients with either UDD or CDD had lower collagen I/III quotients compared to the control group, significant for CDD (p = 0.007). For MMP-1 and MMP-13 only a slight increase for patients with CDD was found. The percentage of proliferating (Ki67) and apoptotic (TUNEL) cells was significantly higher for patients with CDD than in the control group (p = 0.016; p = 0.037). Upon investigating the S100-expression a significant reduce in glial cells density was found in the myenteric and mucosal plexus for both groups (UDD and CDD) compared to the control group. Measurements of the different colon layers oral, aboral and at the RSJ revealed equal values.
CONCLUSIONS: This study has shown that colonic wall changes and enteric neuropathy seem to play a role in the pathogenesis of colonic diverticulosis. None of our results suggest a predisposition for a complicated diverticular disease. Furthermore, the presence of an anatomic sphincter at the rectosigmoid junction could not be detected.},
}
@article {pmid24656474,
year = {2014},
author = {Speicher, PJ and Goldsmith, ZG and Nussbaum, DP and Turley, RS and Peterson, AC and Mantyh, CR},
title = {Ureteral stenting in laparoscopic colorectal surgery.},
journal = {The Journal of surgical research},
volume = {190},
number = {1},
pages = {98-103},
doi = {10.1016/j.jss.2014.02.025},
pmid = {24656474},
issn = {1095-8673},
mesh = {Colectomy/*methods ; Female ; Humans ; Laparoscopy/*methods ; Logistic Models ; Male ; Middle Aged ; Rectum/*surgery ; *Stents ; *Ureter ; },
abstract = {BACKGROUND: Few studies have examined the current status of ureteral stent use or the indications for stenting, particularly in laparoscopic colorectal surgery. This study examines current national trends and predictors of ureteral stenting in patients undergoing major colorectal operations and the subsequent effects on perioperative outcomes.
METHODS: The 2005-2011 National Surgical Quality Improvement participant user files were used to identify patients undergoing laparoscopic segmental colectomy, low anterior resection, or proctectomy. Trends in stent use were assessed across procedure types. To estimate the predictors of stent utilization, a forward-stepwise logistic regression model was used. A 3:1 nearest neighbor propensity match with subsequent multivariable adjustment was then used to estimate the impact of stents.
RESULTS: A total of 42,311 cases were identified, of which 1795 (4.2%) underwent ureteral stent placement. Predictors of stent utilization included diverticular disease, need for radical resection (versus segmental colectomy), recent radiotherapy, and more recent calendar year. After adjustment, ureteral stenting appeared to be associated with a small increase in median operative time (44 min) and a trivial increase in length of stay (5.4%, P<0.001). However, there were no significant differences in morbidity or mortality.
CONCLUSIONS: We describe the clinical predictors of ureteral stent usage in this patient population and report that while stenting adds to operative time, it is not associated with significantly increased morbidity or mortality after adjusting for diagnosis and comorbidities. Focused institutional studies are necessary in the future to address the utility of ureteral stents in the identification and possible prevention of iatrogenic injury.},
}
@article {pmid24644029,
year = {2014},
author = {Bevan, R and Lee, TJ and Nickerson, C and Rubin, G and Rees, CJ and , },
title = {Non-neoplastic findings at colonoscopy after positive faecal occult blood testing: data from the English Bowel Cancer Screening Programme.},
journal = {Journal of medical screening},
volume = {21},
number = {2},
pages = {89-94},
doi = {10.1177/0969141314528889},
pmid = {24644029},
issn = {1475-5793},
support = {MR/K02325X/1/MRC_/Medical Research Council/United Kingdom ; },
mesh = {Aged ; Colonoscopy/*statistics & numerical data ; Colorectal Neoplasms/*diagnosis ; *Early Detection of Cancer ; Female ; Guaiac ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Male ; Mass Screening ; Middle Aged ; *Occult Blood ; Predictive Value of Tests ; Reagent Kits, Diagnostic/*standards ; },
abstract = {BACKGROUND: The aim of the English Bowel Cancer Screening Programme (BCSP) is to diagnose early colorectal cancer and advanced adenomas. However, other findings are also reported at screening colonoscopy. Small studies demonstrate findings other than cancer or adenomas (non-neoplastic findings (NNF)) in 11-25%.
OBJECTIVES AND SETTING: Describe the frequency and nature of NNF within the BSCP.
METHODS: Data were obtained from the BCSP national database for all individuals undergoing colonoscopic investigation after positive faecal occult blood testing between August 2006 and November 2011. Data included demographics, smoking status, neoplastic findings and NNF.
RESULTS: 121728 colonoscopies were analysed. ≥1 NNF were found in 26251 cases (21.6%). Diverticular disease (18875 cases) and haemorrhoids (7011) were the most frequently reported. Inflammatory bowel disease (IBD) was reported in 2152 cases. Individuals with a neoplastic diagnosis were less likely to have an NNF than those without (19.8% v 24.4%, p < 0.001). After adjustment for confounding using multivariable analysis, older age was still associated with a small but statistically significant risk of NNF.
CONCLUSIONS: The BCSP generates a significant volume of NNF. A small proportion of individuals were found to have inflammatory bowel disease (IBD) - an important diagnosis with implications for long-term management. BCSP participants should be aware that findings other than neoplasia may be detected and the relevance of these findings to that individual is not known. Reporting of NNF varies between colonoscopists, and potential underreporting is a limitation of this study. Further study is required to establish the impact of NNF on primary and secondary care.},
}
@article {pmid24626387,
year = {2014},
author = {Chaudhery, B and Newman, PA and Kelly, MD},
title = {Small bowel obstruction and perforation secondary to primary enterolithiasis in a patient with jejunal diverticulosis.},
journal = {BMJ case reports},
volume = {2014},
number = {},
pages = {},
pmid = {24626387},
issn = {1757-790X},
mesh = {Aged, 80 and over ; Diverticulum/*complications/diagnosis ; Female ; Humans ; Intestinal Obstruction/diagnosis/*etiology ; Intestinal Perforation/diagnosis/*etiology ; Jejunal Diseases/complications/*diagnosis ; Lithiasis/complications/*diagnosis ; },
abstract = {We describe a rare case of small bowel obstruction and perforation secondary to a primary enterolith in an 84-year-old female patient with jejunal diverticulosis. She underwent an emergency laparotomy, small bowel resection and primary anastomosis. Multiple jejunal diverticula and a large stone were identified at the time of operation. Analysis of the stone demonstrated mainly faecal material consistent with a true primary enterolith. A literature search of Medline and PubMed revealed three cases similar to the one described. The pathogenesis and management of enterolithiasis in jejunal diverticular disease is considered.},
}
@article {pmid24615325,
year = {2014},
author = {Jurowich, C and Seyfried, F and Germer, CT},
title = {[Sigmoid diverticulitis: indications and timing of surgery].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {85},
number = {4},
pages = {304-307},
pmid = {24615325},
issn = {1433-0385},
mesh = {Abdominal Abscess/classification/diagnosis/surgery ; Colon, Sigmoid/pathology/surgery ; Diverticulitis, Colonic/classification/diagnosis/*surgery ; Germany ; Humans ; Intestinal Fistula/classification/diagnosis/surgery ; Intestinal Perforation/classification/diagnosis/surgery ; Practice Guidelines as Topic ; Prognosis ; Sigmoid Diseases/classification/diagnosis/*surgery ; },
abstract = {BACKGROUND: Diverticular disease represents a common problem in the clinical routine. In addition to the question of who should be admitted to hospital for treatment and who can be treated as an outpatient, the questions of the indications and timing for surgery are decisive. Because the disease is internationally classified in different ways, the recommendations are also not uniform.
OBJECTIVE: In this article the essential aspects of the indications for and timing of surgery are structured and oriented to the new S2K guidelines.
RESULTS: The indications and timing of surgery can only be reasonably determined by evaluating all essential information on diverticular disease. A prerequisite is an exact, comprehensive and applicable classification of the disease before treatment. An adequate assessment cannot be made using morphological information obtained by imaging alone.
DISCUSSION: The new classification of sigmoid diverticulitis corresponding to the German guidelines for diverticular disease classification (GGDDC) enables an appropriate strategy for evaluating the indications and selection of the time for surgery.},
}
@article {pmid24610006,
year = {2014},
author = {Kruse, E and Leifeld, L},
title = {[Prevention and conservative therapy of diverticular disease].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {85},
number = {4},
pages = {299-303},
pmid = {24610006},
issn = {1433-0385},
mesh = {Anti-Bacterial Agents/therapeutic use ; Dietary Fiber/administration & dosage ; Diverticulitis, Colonic/prevention & control/*therapy ; Diverticulosis, Colonic/prevention & control/*therapy ; Evidence-Based Medicine ; Humans ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; },
abstract = {Diverticulosis and diverticular disease are a common problem in daily practice and one third of the patients with diverticulosis develop symptoms. Patients with uncomplicated diverticulitis are very often treated with antibiotics. There is growing evidence that antibiotics are not necessary in uncomplicated cases. One problem is the different classification of diverticulitis and diverticular disease. Therefore, it is not easy to compare different studies. The evidence for therapy with antibiotics, mesalamine, probiotics and fibers are initially discussed and secondly therapeutic recommendations are given for the various stages of diverticular disease.},
}
@article {pmid24608313,
year = {2014},
author = {Daniels, L and Philipszoon, LE and Boermeester, MA},
title = {A hypothesis: important role for gut microbiota in the etiopathogenesis of diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {57},
number = {4},
pages = {539-543},
doi = {10.1097/DCR.0000000000000078},
pmid = {24608313},
issn = {1530-0358},
mesh = {Diverticulitis, Colonic/microbiology ; Diverticulosis, Colonic/*microbiology ; Humans ; Inflammatory Bowel Diseases/immunology ; Intestinal Mucosa/*microbiology ; Irritable Bowel Syndrome/microbiology ; *Microbiota ; },
}
@article {pmid24599385,
year = {2014},
author = {Holmer, C and Kreis, ME},
title = {[Diverticular disease - choice of surgical procedure].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {85},
number = {4},
pages = {308-313},
pmid = {24599385},
issn = {1433-0385},
mesh = {Anastomosis, Surgical/*methods ; Colectomy/*methods ; Diverticulitis, Colonic/diagnosis/*surgery ; Diverticulosis, Colonic/diagnosis/*surgery ; Drainage ; Gastrointestinal Hemorrhage/diagnosis/surgery ; Humans ; Ileostomy/methods ; Intestinal Perforation/diagnosis/surgery ; Laparoscopy/*methods ; Peritoneal Lavage ; Recurrence ; Reoperation ; Sigmoid Diseases/diagnosis/surgery ; },
abstract = {The clinical spectrum of diverticular disease varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications, such as perforation or bleeding. Laparoscopic sigmoid resection with restoration of continuity is currently the prevailing modality for treating acute and recurrent sigmoid diverticulitis. The tenets of surgical treatment of diverticulitis are resection of the entire sigmoid and creation of a tension-free anastomosis in the upper rectum. With respect to the required extent of resection according to current data it is not necessary to remove the entire colonic segment bearing diverticula because such a strategy does not reduce the recurrence rate. In the emergency situation due to free perforation a primary anastomosis with defunctioning ileostomy should be favored because the stoma reversal rate after primary anastomosis is higher than after Hartmann's procedure. The Hartmann procedure should be reserved for perforated diverticulitis with severe septic complications; however, the final treatment decision for primary anastomosis or Hartmann's procedure should be dependent on the individual patient. There have been a number of recent publications on the use of laparoscopic peritoneal lavage for perforated sigmoid diverticulitis as an alternative to resection surgery. In cases of diverticular bleeding a subtotal colectomy should be performed if the diverticular bleeding site cannot be localized.},
}
@article {pmid24596650,
year = {2014},
author = {Bhatt, VR and Murukutla, S and Dipoce, J and Gustafson, S and Sarkany, D and Mody, K and Widmann, WD and Gottesman, A},
title = {Perforation in a patient with stercoral colitis and diverticulosis: who did it?.},
journal = {Journal of community hospital internal medicine perspectives},
volume = {4},
number = {1},
pages = {},
pmid = {24596650},
issn = {2000-9666},
abstract = {Stercoral colitis with perforation of the colon is an uncommon, yet life-threatening cause of the acute abdomen. No one defining symptom exists for stercoral colitis; it may present asymptomatically or with vague symptoms. Diagnostic delay may result in perforation of the colon resulting in complications, even death. Moreover, stercoral perforation of the colon can also present with localized left lower quadrant abdominal pain masquerading as diverticulitis. Diverticular diseases and stercoral colitis share similar pathophysiology; furthermore, they may coexist, further complicating the diagnostic dilemma. The ability to decide the cause of perforation in a patient with both stercoral colitis and diverticulosis has not been discussed. We, therefore, report this case of stercoral perforation in a patient with diverticulosis and include a discussion of the epidemiology, clinical presentation, and a review of helpful diagnostic clues for a rapid differentiation to allow for accurate diagnosis and treatment.},
}
@article {pmid24587655,
year = {2014},
author = {Bencini, L and Bernini, M and Farsi, M},
title = {Laparoscopic approach to gastrointestinal malignancies: toward the future with caution.},
journal = {World journal of gastroenterology},
volume = {20},
number = {7},
pages = {1777-1789},
pmid = {24587655},
issn = {2219-2840},
mesh = {Biliary Tract Neoplasms/surgery ; Colorectal Neoplasms/surgery ; Gallbladder Neoplasms/surgery ; Gastrointestinal Neoplasms/*therapy ; Humans ; Intestinal Neoplasms/surgery ; Laparoscopy/*methods ; Liver Neoplasms/surgery ; Pancreatic Neoplasms/surgery ; Quality of Life ; Robotics ; Stomach/pathology ; Treatment Outcome ; },
abstract = {After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts, some surgeons started to treat malignancies by the same way. However, if the limits of laparoscopy for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies. Cancerous patients represent an important group with peculiar aspects including reduced survival expectancy, worsened quality of life due to surgery itself and adjuvant therapies, and challenging psychological impact. All these issues could, potentially, receive a better management with a laparoscopic surgical approach. In order to confirm such aspects, similarly to testing the newest weapons (surgical or pharmacologic) against cancer, long-term follow-up is always recommendable to assess the real benefits in terms of overall survival, cancer-free survival and quality of life. Furthermore, it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive technologies. Therefore, laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences, as compared to those achieved for inflammatory bowel diseases, gastroesophageal reflux disease or diverticular disease. This review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district.},
}
@article {pmid24583746,
year = {2015},
author = {Tursi, A and Elisei, W and Picchio, M and Giorgetti, GM and Brandimarte, G},
title = {Moderate to severe and prolonged left lower-abdominal pain is the best symptom characterizing symptomatic uncomplicated diverticular disease of the colon: a comparison with fecal calprotectin in clinical setting.},
journal = {Journal of clinical gastroenterology},
volume = {49},
number = {3},
pages = {218-221},
doi = {10.1097/MCG.0000000000000094},
pmid = {24583746},
issn = {1539-2031},
mesh = {Abdominal Pain/*diagnosis/*etiology ; Aged ; Biomarkers/analysis ; Colonoscopy ; Diagnosis, Differential ; Diverticulosis, Colonic/*complications/*diagnosis/metabolism ; Feces/*chemistry ; Female ; Humans ; Irritable Bowel Syndrome/diagnosis ; Italy ; Leukocyte L1 Antigen Complex/*analysis ; Male ; Middle Aged ; *Pain Measurement ; Predictive Value of Tests ; Prospective Studies ; Risk Factors ; Severity of Illness Index ; },
abstract = {BACKGROUND: Left lower-abdominal pain is considered the best symptom to differentiate between symptomatic uncomplicated diverticular disease (SUDD) and irritable bowel syndrome (IBS). However, this statement has not been validated yet.
GOALS: The aim of this study was to assess whether prolonged left lower-quadrant pain is the best symptom characterizing SUDD and be able to differentiate SUDD from IBS-like symptoms in diverticulosis, and to compare the location of abdominal pain with fecal calprotectin (FC) expression.
STUDY: Seventy-two patients suffering from abdominal pain and having diverticula at colonoscopy were enrolled. Patients were classified according to SUDD definition (abdominal pain for at least 24 consecutive hours in left lower abdomen) (42 patients) and IBS-like symptoms fulfilling Rome III criteria (30 patients). Abdominal pain was assessed using a 10-point visual scale, assigning numerical values from 0 (absence of pain) to 10 (severe pain). FC expression was assessed by a rapid test in all patients enrolled.
RESULTS: FC test was positive in 27 (64.3%) patients in the SUDD group and in no patient in the IBS-like group (P<0.0001). In patients with SUDD, there was a significant correlation between the severity of the abdominal pain and the FC score (P=0.0015). Extension of diverticulosis correlated with FC score (P=0.022) and the severity of diverticulosis (P=0.005).
CONCLUSIONS: Severe and prolonged left lower-abdominal pain seems to be the best symptom characterizing SUDD, and it can differentiate these patients from those harboring diverticula but suffering from IBS-like according to Rome III criteria.},
}
@article {pmid24577203,
year = {2014},
author = {Wedel, T and Böttner, M},
title = {[Anatomy and pathogenesis of diverticular disease].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {85},
number = {4},
pages = {281-288},
pmid = {24577203},
issn = {1433-0385},
mesh = {Causality ; Colon/pathology ; Cross-Sectional Studies ; Diverticulitis, Colonic/epidemiology/*etiology/*pathology ; Diverticulosis, Colonic/epidemiology/*etiology/*pathology ; Germany ; Risk Factors ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Although diverticular disease is one of the most frequent gastrointestinal disorders the pathogenesis is not yet sufficiently clarified.
OBJECTIVES: The aim is to define the anatomy and pathogenesis of diverticular disease considering the risk factors and description of structural and functional alterations of the bowel wall.
METHODS: This article gives an appraisal of the literature, presentation and evaluation of classical etiological factors, analysis and discussion of novel pathogenetic concepts.
RESULTS: Colonic diverticulosis is defined as an acquired out-pouching of multiple and initially asymptomatic pseudodiverticula through muscular gaps in the colon wall. Diverticular disease is characterized by diverticular bleeding and/or inflammatory processes (diverticulitis) with corresponding complications (e.g. abscess formation, fistula, covered and open perforation, peritonitis and stenosis). Risk factors for diverticular disease include increasing age, genetic predisposition, congenital connective tissue diseases, low fiber diet, high meat consumption and pronounced overweight. Alterations of connective tissue cause a weakening of preformed exit sites of diverticula and rigidity of the bowel wall with reduced flexibility. It is assumed that intestinal innervation disorders and structural alterations of the musculature induce abnormal contractile patterns with increased intraluminal pressure, thereby promoting the development of diverticula. Moreover, an increased release of pain-mediating neurotransmitters is considered to be responsible for persistent pain in chronic diverticular disease.
CONCLUSIONS: According to the present data the pathogenesis of diverticular disease cannot be attributed to a single factor but should be considered as a multifactorial event.},
}
@article {pmid24500723,
year = {2014},
author = {Heianna, J and Miyauchi, T and Yamano, H and Yoshikawa, K and Hashimoto, M and Murayama, S},
title = {Management of angiogram-negative acute colonic hemorrhage: safety and efficacy of colonoscopy-guided superselective embolization.},
journal = {Techniques in coloproctology},
volume = {18},
number = {7},
pages = {647-652},
pmid = {24500723},
issn = {1128-045X},
mesh = {Acute Disease ; Adult ; Angiography/methods ; Cohort Studies ; Colectomy/methods ; Colonic Diseases/diagnostic imaging/mortality/*therapy ; Colonoscopy/*methods ; Embolization, Therapeutic/*methods ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage/diagnostic imaging/mortality/*therapy ; Humans ; Japan ; Male ; Middle Aged ; Patient Safety ; Recurrence ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Survival Rate ; Treatment Outcome ; },
abstract = {BACKGROUND: We evaluated the efficacy and safety of superselective embolization with assistance of colonoscopy for acute colonic hemorrhage.
METHODS: Of 92 cases of acute colonic hemorrhage requiring colonoscopic intervention, 11 (12 %) could not be successfully treated. Of these, 10 patients (9 men, mean age 65.5 years, range 39-75 years) underwent superselective embolization. Hemorrhage was caused by diverticular disease (n = 8), polypectomy (n = 1), and vascular malformation (n = 1). In all 10 cases, the radiopaque clips were placed at the bleeding point via colonoscopy. Microcatheters were used in all procedures, and embolization was performed at the level of the vasa recta leading to or near the clips with Gelfoam particles, microcoils, or both.
RESULTS: Immediate hemostasis was achieved in all patients. In 6 of 10 patients (60 %), selective angiograms showed no active extravasation at the time of the procedure and the embolization was performed using clips as a landmark. In the remaining four patients, selective angiograms showed active extravasation from the vasa recta leading to the clips. The mean number of embolized vessels with no active extravasation and with active extravasation was 1.83 (range 1-3) and 1.25 (range 1-2), respectively. The mean duration of clinical follow-up was 11.6 months (range 1-29 months). One patient (10 %) bled from a different site than the treated site a month after embolization, but the bleeding ceased after endoscopic intervention. All the patients (100 %) were evaluated for objective evidence of ischemia by colonoscopy. Four of the 10 patients (40 %) were found endoscopically to have small areas of ischemia involving only the mucosa, but they remained asymptomatic. There was no bowel infarction or stricture.
CONCLUSIONS: Colonoscopy-assisted superselective embolization may be a safe and useful procedure for acute colonic hemorrhage without active extravasation on angiogram.},
}
@article {pmid24485264,
year = {2014},
author = {Collins, D and Winter, DC},
title = {Laparoscopy in diverticular disease: Controversies.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {28},
number = {1},
pages = {175-182},
doi = {10.1016/j.bpg.2013.11.014},
pmid = {24485264},
issn = {1532-1916},
mesh = {Digestive System Surgical Procedures/adverse effects/*methods ; Diverticulitis/complications/diagnosis/*surgery ; Elective Surgical Procedures ; Emergencies ; Humans ; *Laparoscopy/adverse effects ; Treatment Outcome ; },
abstract = {A minimally invasive approach to the management of diverticular disease has gained acceptance over the last number of years. Certainly, in the elective setting, laparoscopic sigmoid resection compares favourably with open surgery. The use of laparoscopy in the context of emergency surgery for complicated diverticular disease remains controversial however recent studies have demonstrated a defined role for laparoscopy in the acute setting.},
}
@article {pmid24485251,
year = {2014},
author = {Navez, B and Navez, J},
title = {Laparoscopy in the acute abdomen.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {28},
number = {1},
pages = {3-17},
doi = {10.1016/j.bpg.2013.11.006},
pmid = {24485251},
issn = {1532-1916},
mesh = {Abdomen, Acute/diagnosis/etiology/*surgery ; Digestive System Surgical Procedures/adverse effects/*methods ; Emergencies ; Humans ; *Laparoscopy/adverse effects ; Patient Selection ; Postoperative Complications/prevention & control ; Risk Factors ; Treatment Outcome ; },
abstract = {Laparoscopy has become a routine procedure in the management of acute abdominal disease and can be considered both an excellent therapeutic and additional diagnostic tool in selected cases. However, a high level of expertise in laparoscopic and emergency surgery is required. Hemodynamic instability, huge abdominal distension, fecal peritonitis and perforated cancer are relative contraindications for the laparoscopic approach. In recent years, abdominal emergencies have increasingly been managed successfully by laparoscopy. In acute appendicitis, acute cholecystitis and perforated peptic ulcer, randomized controlled trials have proven that the laparoscopic approach is as safe and as effective as open surgery, with fewer complications and a quicker postoperative recovery. Other indications such as blunt and penetrating trauma to the abdomen, small bowel occlusion and perforated diverticular disease are under debate, indicating that more randomized controlled trials comparing laparoscopic and open surgery are still necessary.},
}
@article {pmid24483029,
year = {2013},
author = {Kościński, T and Szmeja, J and Meissner, W and Hermann, J},
title = {[Severe complications of total pelvic floor repair using polypropylene mesh--case report].},
journal = {Wiadomosci lekarskie (Warsaw, Poland : 1960)},
volume = {66},
number = {3},
pages = {237-240},
pmid = {24483029},
issn = {0043-5147},
mesh = {Abdominal Abscess/*etiology/surgery ; Colectomy ; Constipation/complications ; Debridement ; Diverticulitis/complications ; Fatal Outcome ; Female ; Humans ; Hysterectomy ; Intestinal Perforation/*etiology ; Mesenteric Vascular Occlusion/*etiology ; Middle Aged ; Pelvic Floor/*surgery ; Pelvic Organ Prolapse/complications/*surgery ; Polypropylenes ; Surgical Mesh/*adverse effects ; Thrombosis/etiology ; },
abstract = {The authors present a case of 58 years old woman suffering from complex pelvic floor pathology diagnosed with rectal prolapse, genitary organs prolapse, descending pelvic floor, rectocele and enterocele as well as advanced diverticular disease of the left colon. She suffered from chronic constipation. The surgery consisted of left hemicolectomy, hysterectomy, reconstruction of the pelvic floor and sacrocoloporectopexy using polypropylene mesh. The out-come complicated mesenteric vessels thrombosis, small bowel perforations and intraabdominal abscesses. Despite intensive care and subsequent ileal resections, debridement and drainage of the abscesses the patient died five months after beacause of multi organs insufficiency.},
}
@article {pmid24457980,
year = {2014},
author = {Barret, M and Cuenod, CA and Jian, R and Cellier, C and Berger, A},
title = {Coloseminal fistula complicating sigmoid diverticulitis.},
journal = {Urologia internationalis},
volume = {92},
number = {2},
pages = {250-252},
doi = {10.1159/000353351},
pmid = {24457980},
issn = {1423-0399},
mesh = {Adult ; Colon, Sigmoid/*pathology/*surgery ; Contrast Media/chemistry ; Diverticulitis/*complications/*surgery ; Fistula/*complications/*surgery ; Humans ; Lithotripsy ; Male ; Tomography, X-Ray Computed ; Treatment Outcome ; Urinary Bladder/diagnostic imaging ; },
abstract = {We report on a 32-year-old man with a history of chronic lower abdominal pain and urogenital symptoms, leading to the diagnosis of coloseminal fistula complicating diverticular disease. We reviewed the literature on this rare clinical entity and would like to stress the role of pelvic imaging with rectal contrast to investigate complicated forms of diverticular disease.},
}
@article {pmid24440219,
year = {2014},
author = {Floch, MH},
title = {Is there really anything new on dietary fiber in colonic diverticular disease?.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {12},
number = {7},
pages = {1200-1201},
doi = {10.1016/j.cgh.2014.01.015},
pmid = {24440219},
issn = {1542-7714},
mesh = {Constipation/*complications ; Dietary Fiber/*administration & dosage ; Diverticulitis/*complications/*epidemiology ; Diverticulum/*complications/*diagnosis/*epidemiology ; *Feeding Behavior ; Female ; Humans ; Irritable Bowel Syndrome/*epidemiology ; Male ; },
}
@article {pmid24437073,
year = {2013},
author = {De Magistris, L and Arru, L and De Blasi, V and Poulain, V and Lens, V and Mertens, L and Goergen, M and Azagra, JS},
title = {Management of acute diverticulitis in a tertiary care institution.},
journal = {Bulletin de la Societe des sciences medicales du Grand-Duche de Luxembourg},
volume = {},
number = {2},
pages = {25-32},
pmid = {24437073},
issn = {0037-9247},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Colon, Sigmoid/*pathology/*surgery ; Conversion to Open Surgery ; Diverticulitis, Colonic/*diagnosis/pathology/*surgery ; Elective Surgical Procedures/methods ; Female ; Hospitals, University ; Humans ; *Laparoscopy/methods ; Length of Stay ; Luxembourg ; Male ; Middle Aged ; Patient Readmission ; Reoperation ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Sigmoidoscopy ; Treatment Outcome ; },
abstract = {BACKGROUND: Diverticular disease of the left colon is a common disease, mainly in the population over 50 years of age. The surgical management of acute diverticulitis is remains controversial, especially in severe forms.
OBJECTIVE: This study aimed to evaluate the results of laparoscopic surgery for diverticular disease in a tertiary care institution with a specialist interest in minimally invasive surgery.
DESIGN: All patients who had elective laparoscopic sigmoidectomy for diverticulitis within eight years at University Hospital of Luxembourg were selected from a retrospective database to evaluate laparoscopic benefit in moderate and severe disease.
RESULTS: A total of 155 patients were divided in two groups: Moderate Acute Diverticulitis (MAD) and Severe Acute Diverticulitis (SAD) respectively. The short-term outcomes, after laparoscopic sigmoidectomy, were evaluated. There were not important differences between two groups.
CONCLUSIONS: The laparoscopic management of diverticular disease after moderate and severe crisis gives same benefits and short-term outcomes are similar. Elective Laparoscopic surgery is actually the standard of care for moderate and severe diverticular disease in our institution.},
}
@article {pmid24434163,
year = {2014},
author = {Colwell, JC},
title = {The role of obesity in the patient undergoing colorectal surgery and fecal diversion: a review of the literature.},
journal = {Ostomy/wound management},
volume = {60},
number = {1},
pages = {24-28},
pmid = {24434163},
issn = {1943-2720},
mesh = {Colon/*surgery ; *Feces ; Humans ; Obesity/*physiopathology ; Rectum/*surgery ; *Surgical Stomas ; },
abstract = {The obese colorectal surgery patient may face several challenges, including a high risk for the development of colorectal cancer, an increased risk for complications with diverticular disease, and surgical risk factors including anastomotic leaks, inability to perform a low anastomosis, and septic complications. The purpose of this literature review was to examine available data on the implications of obesity on colorectal disease and colorectal surgery, particularly stoma surgery. Obesity has been documented as a risk factor for colorectal disease, but results of studies examining surgeryrelated problems secondary to obesity are inconsistent. However, clinicians generally believe obese patients undergoing colorectal surgery may be at higher risk of complications than their non-obese counterparts. The obese patient requiring the creation of a fecal diversion may encounter stoma-related issues such as stenosis, retraction, and inability to maintain a consistent pouching system seal. Stoma site marking can be challenging because of the large shifts in subcutaneous tissue and the inability for a person with a large abdomen to be able to visualize the stoma if the stoma is placed too low on the abdomen. Additional research to elucidate complication rates and risk factors is needed to help clinicians develop optimal plans of care.},
}
@article {pmid24412017,
year = {2014},
author = {Min, M and Chua, B and Guttner, Y and Abraham, N and Aherne, NJ and Hoffmann, M and McKay, MJ and Shakespeare, TP},
title = {Is "pelvic radiation disease" always the cause of bowel symptoms following prostate cancer intensity-modulated radiotherapy?.},
journal = {Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology},
volume = {110},
number = {2},
pages = {278-283},
doi = {10.1016/j.radonc.2013.11.012},
pmid = {24412017},
issn = {1879-0887},
mesh = {Aged ; Aged, 80 and over ; Cohort Studies ; Humans ; Intestinal Diseases/*etiology ; Intestines/*radiation effects ; Male ; Middle Aged ; Occult Blood ; Pelvis/radiation effects ; Prospective Studies ; Prostatic Neoplasms/*radiotherapy ; Radiation Injuries/*etiology ; Radiotherapy, Image-Guided ; Radiotherapy, Intensity-Modulated/adverse effects/methods ; },
abstract = {BACKGROUND: Pelvic radiation disease (PRD) also widely known as "radiation proctopathy" is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer.
METHODS AND MATERIALS: A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation.
RESULTS: Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed.
CONCLUSIONS: Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines.},
}
@article {pmid24405149,
year = {2014},
author = {Gisbert, JP and Chaparro, M},
title = {Systematic review with meta-analysis: inflammatory bowel disease in the elderly.},
journal = {Alimentary pharmacology & therapeutics},
volume = {39},
number = {5},
pages = {459-477},
doi = {10.1111/apt.12616},
pmid = {24405149},
issn = {1365-2036},
mesh = {Aged ; Humans ; Inflammatory Bowel Diseases/epidemiology/*therapy ; Middle Aged ; },
abstract = {BACKGROUND: Elderly patients represent an increasing proportion of the inflammatory bowel disease (IBD) population.
AIM: To critically review available data regarding the care of elderly IBD patients.
METHODS: Bibliographic searches (MEDLINE) up to June 2013.
RESULTS: Approximately 10-15% of cases of IBD are diagnosed in patients aged >60 years, and 10-30% of the IBD population are aged >60 years. In the elderly, IBD is easily confused with other more common diseases, mainly diverticular disease and ischaemic colitis. The clinical features of IBD in older patients are generally similar to those in younger patients. Crohn's disease (CD) in elderly patients is characterised by its predominantly colonic localisation and uncomplicated course. Proctitis and left-sided ulcerative colitis are more common in patients aged >60 years. Infections are associated with age and account for significant mortality in IBD patients. The treatment of IBD in the elderly is generally similar. However, the therapeutic approach in the elderly should be 'start low-go slow'. The benefit of thiopurines in older CD patients remains debatable. Although the indications for anti-tumour necrosis factors in the elderly are generally similar to those for younger patients, lower response and higher adverse events have been reported in the elderly. Surgery in elderly patients does not generally differ. Ileal pouch-anal anastomosis can be successful, provided the patient retains good anal sphincter function.
CONCLUSIONS: Management of the older IBD patient differs from that of younger patients; therefore, conventional practice algorithms may have to be modified to account for advanced age.},
}
@article {pmid24402114,
year = {2013},
author = {Cavalcanti, NS and da Silva, LL and da Silva, LS and da Fonseca, LA and Alexandre, Cda S},
title = {[Recurrent urinary tract infection due to enterovesical fistula secondary to colon diverticular disease: a case report].},
journal = {Jornal brasileiro de nefrologia},
volume = {35},
number = {4},
pages = {341-345},
doi = {10.5935/0101-2800.20130053},
pmid = {24402114},
issn = {2175-8239},
mesh = {Diverticulosis, Colonic/*complications ; Humans ; Intestinal Fistula/*complications/etiology ; Male ; Middle Aged ; Recurrence ; Sigmoid Diseases/*complications ; Urinary Bladder Fistula/*complications/etiology ; Urinary Tract Infections/*etiology ; },
abstract = {INTRODUCTION: Enterovesical fistula are pathological connections between the bladder and pelvic intestinal segments. It consists of a rare complication of neoplastic and inflammatory pelvic disorders, in addition to iatrogenic or traumatic injuries, and correlates with both high morbidity and mortality indexes.
CASE REPORT: Male patient, 61 years old, admitted at the hospital clinics featuring abdominal pain and distension, vomiting and fecal retention. Patient's pathological precedents include high blood pressure, diabetes mellitus, vesical dysfunction and recurrent urinary tract infection on the past three years. Magnetic resonance imaging of abdomen and pelvis revealed enterovesical fistula in association with colon diverticular disease of the sigmoid. Management of choice consisted of partial colectomy with bowel lowering and partial cystectomy with surgical double-J stent insertion.
DISCUSSION: Although consisting of a gastrointestinal primary affection, patients with enterovesical fistula usually search for medical help charging urinary tract features. In this particular case, our patient was admitted with gastrointestinal symptoms, reasoned by diagnostic delay, as the patient had already attended at multiple centers with urinary symptoms.
CONCLUSION: Despite being an unusual affection, recurrent urinary tract infection associated with colon diverticular disease must always be considered at differential diagnosis of recurrent urinary tract infection as it concurs with high morbidity and mortality.},
}
@article {pmid24401879,
year = {2014},
author = {Halabi, WJ and Jafari, MD and Nguyen, VQ and Carmichael, JC and Mills, S and Pigazzi, A and Stamos, MJ},
title = {Ureteral injuries in colorectal surgery: an analysis of trends, outcomes, and risk factors over a 10-year period in the United States.},
journal = {Diseases of the colon and rectum},
volume = {57},
number = {2},
pages = {179-186},
doi = {10.1097/DCR.0000000000000033},
pmid = {24401879},
issn = {1530-0358},
mesh = {Aged ; Colectomy/*adverse effects ; Colonic Diseases/pathology/*surgery ; Female ; Humans ; Iatrogenic Disease/*epidemiology ; Incidence ; Length of Stay ; Male ; Middle Aged ; Rectal Diseases/pathology/*surgery ; Retrospective Studies ; Risk Factors ; United States ; Ureter/*injuries ; Ureteral Diseases/*epidemiology ; },
abstract = {BACKGROUND: Iatrogenic ureteral injuries during colorectal surgical procedures are rare. Little is known about their incidence, associated outcomes, and predisposing factors.
OBJECTIVE: The purpose of this study was to examine the trends of iatrogenic ureteral injuries in the United States over a decade, as well as their outcomes and risk factors.
DESIGN: This was a retrospective study.
SETTINGS: The nationwide inpatient sample from 2001 to 2010 was analyzed.
PATIENTS: Included were patients with colorectal cancer, benign polyps, diverticular disease, or inflammatory bowel disease undergoing colorectal surgery.
MAIN OUTCOME MEASURES: Trends of iatrogenic ureteral injuries occurring in colon and rectal surgical procedures were examined over a 10-year period. Mortality, morbidity, length of stay and total charge associated with ureteral injuries were analyzed on multivariate analysis. Finally, a predictive model for ureteral injuries was built using patient, hospital, and operative variables.
RESULTS: An estimated 2,165,848 colorectal surgical procedures were performed in the United States over the study period, and 6027 ureteral injuries were identified (0.28%). The rate of ureteral injuries was higher in the second half of the decade (2006-2010) compared with the first half (2001-2005; 3.1/1000 vs 2.5/1000; p < 0.001). Ureteral injuries were independently associated with higher mortality (OR, 1.45; p < 0.05), morbidity (OR, 1.66; p < 0.001), longer length of stay (mean difference, 3.65 days; p < 0.001), and higher hospital charges by $31,497 (p< 0.001). Risk factors for ureteral injuries included rectal cancer (OR, 1.85), adhesions (OR, 1.83), metastatic cancer (OR, 1.76), weight loss/malnutrition (OR, 1.08), and teaching hospitals (OR, 1.05). Protective factors included the use of laparoscopy (OR, 0.91), transverse colectomy (OR, 0.90), and right colectomy (OR, 0.43).
LIMITATIONS: This was a retrospective study from an administrative database.
CONCLUSIONS: Iatrogenic ureteral injuries are rare complications in colorectal surgery; however, their incidence appears to be rising. Ureteral injuries are associated with higher mortality, morbidity, hospital charge, and length of stay, and their incidence can be predicted by several factors.},
}
@article {pmid24385599,
year = {2014},
author = {Crowe, FL and Balkwill, A and Cairns, BJ and Appleby, PN and Green, J and Reeves, GK and Key, TJ and Beral, V and , and , },
title = {Source of dietary fibre and diverticular disease incidence: a prospective study of UK women.},
journal = {Gut},
volume = {63},
number = {9},
pages = {1450-1456},
pmid = {24385599},
issn = {1468-3288},
support = {MR/K02700X/1/MRC_/Medical Research Council/United Kingdom ; C570/A11692/CRUK_/Cancer Research UK/United Kingdom ; G0700474/MRC_/Medical Research Council/United Kingdom ; },
mesh = {Aged ; Diet Surveys ; *Dietary Fiber ; Diverticulitis/epidemiology/etiology/*prevention & control ; Diverticulum/epidemiology/etiology/*prevention & control ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intestinal Diseases/epidemiology/etiology/*prevention & control ; Middle Aged ; Prospective Studies ; Risk ; Surveys and Questionnaires ; United Kingdom/epidemiology ; },
abstract = {BACKGROUND: Previous prospective studies have found the incidence of intestinal diverticular disease decreased with increasing intakes of dietary fibre, but associations by the fibre source are less well characterised. We assessed these associations in a large UK prospective study of middle-aged women.
METHODS AND FINDINGS: During 6 (SD 1) years follow-up of 690 075 women without known diverticular disease who had not changed their diet in the last 5 years, 17 325 were admitted to hospital or died with diverticular disease. Dietary fibre intake was assessed using a validated 40-item food questionnaire and remeasured 1 year later in 4265 randomly-selected women. Mean total dietary fibre intake at baseline was 13.8 (SD 5.0) g/day, of which 42% came from cereals, 22% from fruits, 19% from vegetables (not potatoes) and 15% from potatoes. The relative risk (95% CI) for diverticular disease per 5 g/day fibre intake was 0.86 (0.84 to 0.88). There was significant heterogeneity by the four main sources of fibre (p<0.0001), with relative risks, adjusted for each of the other sources of dietary fibre of 0.84 (0.81 to 0.88) per 5 g/day for cereal, 0.81 (0.77 to 0.86) per 5 g/day for fruit, 1.03 (0.93 to 1.14) per 5 g/day for vegetable and 1.04 (1.02 to 1.07) per 1 g/day for potato fibre.
CONCLUSIONS: A higher intake of dietary fibre is associated with a reduced risk of diverticular disease. The associations with diverticular disease appear to vary by fibre source, and the reasons for this variation are unclear.},
}
@article {pmid24379590,
year = {2013},
author = {Lohsiriwat, V and Suthikeeree, W},
title = {Pattern and distribution of colonic diverticulosis: analysis of 2877 barium enemas in Thailand.},
journal = {World journal of gastroenterology},
volume = {19},
number = {46},
pages = {8709-8713},
pmid = {24379590},
issn = {2219-2840},
mesh = {Adolescent ; Adult ; Age Distribution ; Age Factors ; Aged ; Aged, 80 and over ; *Barium Sulfate/administration & dosage ; *Contrast Media/administration & dosage ; Diverticulosis, Colonic/*diagnostic imaging/*epidemiology ; Enema ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Radiography ; Risk Factors ; Sex Distribution ; Sex Factors ; Thailand/epidemiology ; Time Factors ; Young Adult ; },
abstract = {AIM: To determine the pattern and distribution of colonic diverticulosis in Thai adults.
METHODS: A review of the computerized radiology database for double contrast barium enema (DCBE) in Thai adults was performed at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Incomplete studies and DCBE examinations performed in non-Thai individuals were excluded. The pattern and distribution of colonic diverticulosis detected during DCBE studies from June 2009 to October 2011 were determined. The occurrence of solitary cecal diverticulum, rectal diverticulum and giant diverticulum were reported. Factors influencing the presence of colonic diverticulosis were evaluated.
RESULTS: A total of 2877 suitable DCBE examinations were retrospectively reviewed. The mean age of patients was 59.8 ± 14.7 years. Of these patients, 1778 (61.8%) were female and 700 (24.3%) were asymptomatic. Colonic diverticulosis was identified in 820 patients (28.5%). Right-sided diverticulosis (641 cases; 22.3%) was more frequently reported than left-sided diverticulosis (383 cases; 13.3%). Pancolonic diverticulosis was found in 98 cases (3.4%). The occurrence of solitary cecal diverticulum, rectal diverticulum and giant diverticulum were 1.5% (42 cases), 0.4% (12 cases), and 0.03% (1 case), respectively. There was no significant difference in the overall occurrence of colonic diverticulosis between male and female patients (28.3% vs 28.6%, P = 0.85). DCBE examinations performed in patients with some gastrointestinal symptoms revealed the frequent occurrence of colonic diverticulosis compared with those performed in asymptomatic individuals (29.5% vs 25.3%, P = 0.03). Change in bowel habit was strongly associated with the presence of diverticulosis (a relative risk of 1.39; P = 0.005). The presence of diverticulosis was not correlated with age in symptomatic patients or asymptomatic individuals (P > 0.05).
CONCLUSION: Colonic diverticulosis was identified in 28.5% of DCBE examinations in Thai adults. There was no association between the presence of diverticulosis and gender or age.},
}
@article {pmid24373417,
year = {2014},
author = {Knight, HJ and Daniels, IR and Smart, NJ},
title = {Response to Tsiamoulos et al. (2014): does diverticular disease protect against sigmoid colon cancer?.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {16},
number = {3},
pages = {220-221},
doi = {10.1111/codi.12547},
pmid = {24373417},
issn = {1463-1318},
mesh = {Diverticulosis, Colonic/*epidemiology ; Humans ; Sigmoid Neoplasms/*epidemiology ; },
}
@article {pmid24363521,
year = {2013},
author = {Reddy, SK and Zhan, M and Alexander, HR and El-Kamary, SS},
title = {Nonalcoholic fatty liver disease is associated with benign gastrointestinal disorders.},
journal = {World journal of gastroenterology},
volume = {19},
number = {45},
pages = {8301-8311},
pmid = {24363521},
issn = {2219-2840},
support = {K12 HD043489/HD/NICHD NIH HHS/United States ; 2K12HD043489-11/HD/NICHD NIH HHS/United States ; },
mesh = {Adult ; Aged ; Chi-Square Distribution ; Chronic Disease ; Comorbidity ; Digestive System Diseases/diagnosis/economics/*epidemiology/mortality/therapy ; Fatty Liver/diagnosis/economics/*epidemiology/mortality/therapy ; Female ; Hospital Charges ; Hospital Costs ; Hospital Mortality ; Hospitalization ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Non-alcoholic Fatty Liver Disease ; Odds Ratio ; Prevalence ; Prognosis ; Risk Factors ; Severity of Illness Index ; Time Factors ; United States/epidemiology ; },
abstract = {AIM: To explore associations between nonalcoholic fatty liver disease (NAFLD) and benign gastrointestinal and pancreato-biliary disorders.
METHODS: Patient demographics, diagnoses, and hospital outcomes from the 2010 Nationwide Inpatient Sample were analyzed. Chronic liver diseases were identified using International Classification of Diseases, the 9(th) Revision, Clinical Modification codes. Patients with NAFLD were compared to those with other chronic liver diseases for the endpoints of total hospital charges, disease severity, and hospital mortality. Multivariable stepwise logistic regression analyses to assess for the independent association of demographic, comorbidity, and diagnosis variables with the event of NAFLD (vs other chronic liver diseases) were also performed.
RESULTS: Of 7800441 discharge records, 32347 (0.4%) and 271049 (3.5%) included diagnoses of NAFLD and other chronic liver diseases, respectively. NAFLD patients were younger (average 52.3 years vs 55.3 years), more often female (58.8% vs 41.6%), less often black (9.6% vs 18.6%), and were from higher income areas (23.7% vs 17.7%) compared to counterparts with other chronic liver diseases (all P < 0.0001). Diabetes mellitus (43.4% vs 28.9%), hypertension (56.9% vs 47.6%), morbid obesity (36.9% vs 8.0%), dyslipidemia (37.9% vs 15.6%), and the metabolic syndrome (28.75% vs 8.8%) were all more common among NAFLD patients (all P < 0.0001). The average total hospital charge ($39607 vs $51665), disease severity scores, and intra-hospital mortality (0.9% vs 6.0%) were lower among NALFD patients compared to those with other chronic liver diseases (all P < 0.0001).Compared with other chronic liver diseases, NAFLD was significantly associated with diverticular disorders [OR = 4.26 (3.89-4.67)], inflammatory bowel diseases [OR = 3.64 (3.10-4.28)], gallstone related diseases [OR = 3.59 (3.40-3.79)], and benign pancreatitis [OR = 2.95 (2.79-3.12)] on multivariable logistic regression (all P < 0.0001) when the latter disorders were the principal diagnoses on hospital discharge. Similar relationships were observed when the latter disorders were associated diagnoses on hospital discharge.
CONCLUSION: NAFLD is associated with diverticular, inflammatory bowel, gallstone, and benign pancreatitis disorders. Compared with other liver diseases, patients with NAFLD have lower hospital charges and mortality.},
}
@article {pmid24361412,
year = {2014},
author = {Huang, WY and Lin, CC and Jen, YM and Chang, YJ and Hsiao, CW and Yang, MH and Lin, CS and Sung, FC and Liang, JA and Kao, CH},
title = {Association between colonic diverticular disease and colorectal cancer: a nationwide population-based study.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {12},
number = {8},
pages = {1288-1294},
doi = {10.1016/j.cgh.2013.11.039},
pmid = {24361412},
issn = {1542-7714},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Colorectal Neoplasms/*epidemiology ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment ; Taiwan/epidemiology ; },
abstract = {BACKGROUND & AIMS: We investigated whether a diagnosis of colonic diverticular disease is associated with an increased risk for subsequent development of colorectal cancer (CRC) in a nationwide population-based retrospective study.
METHODS: We identified 41,359 individuals diagnosed with colonic diverticular disease as inpatients from 2000 through 2009 from the Taiwan National Health Insurance Research Database (study cohort) and collected data for 165,436 randomly selected additional subjects, matched by sex, age, and baseline year (comparison cohort). Data were collected until individuals developed CRC or withdrew from the National Health Insurance system, or until December 31, 2010. Cumulative incidences and hazard ratios (HRs) of CRC development were determined. To assess for ascertainment bias, we conducted an analysis excluding the first 12 months of follow-up evaluation.
RESULTS: The risk of CRC was significantly higher in the study cohort than in the comparison cohort (HR adjusted for age, sex, and comorbidities, 4.54; 95% confidence interval, 4.19-4.91; P < .0001). In a sensitivity analysis, we excluded the first 12 months of follow-up evaluation after a diagnosis of colonic diverticular disease; subsequent incidence rates for CRC in the study and comparison cohorts were 15.13 and 15.74 per 10,000 person-years, respectively (adjusted HR, 0.96; 95% confidence interval, 0.83-1.11).
CONCLUSIONS: Colonic diverticular disease is not associated with an increased risk of subsequent CRC after the first year of diagnosis of colonic diverticular disease. An increased risk was observed in the first year, possibly owing to misclassification and screening effects.},
}
@article {pmid24338468,
year = {2013},
author = {Tursi, A and Di Mario, F and Brandimarte, G and Elisei, W and Picchio, M and Loperfido, S and Dal Bo', N and Ferrara, F and Marcello, R and Heras Salvat, H and Scarpignato, C},
title = {Intermittent versus every-day mesalazine therapy in preventing complications of diverticular disease: a long-term follow-up study.},
journal = {European review for medical and pharmacological sciences},
volume = {17},
number = {23},
pages = {3244-3248},
doi = {10.1016/s0016-5085(13)62897-8},
pmid = {24338468},
issn = {1128-3602},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage/adverse effects ; Chi-Square Distribution ; Diverticulitis, Colonic/diagnosis/etiology/*prevention & control ; Diverticulosis, Colonic/complications/diagnosis/*drug therapy ; Diverticulum, Colon/complications/diagnosis/*drug therapy ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Gastrointestinal Agents/*administration & dosage/adverse effects ; Humans ; Kaplan-Meier Estimate ; Male ; Mesalamine/*administration & dosage/adverse effects ; Middle Aged ; Retrospective Studies ; Secondary Prevention ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: Mesalazine seems to be effective in preventing recurrence of acute uncomplicated diverticulitis (AUD), but the optimal mesalazine scheme to achieve these results is still debated.
AIM: To assess the effectiveness of two different mesalazine-based treatments in preventing recurrence of AUD and the occurrence of other complications of diverticular disease (DD) during a long-term follow-up.
PATIENTS AND METHODS: We reviewed 311 patients suffer from recent episode of AUD and undergoing to mesalazine treatment: 207 (group A, 105 males, median age 63 years, range 47-74 years) were treated with mesalazine 1.6 g for 10 days each month, whilst 104 (group B, 55 males, median age 65 years, range 50-72 years) were treated with mesalazine 1.6 g every day. Patients were followed-up every 6 months (median 7.5 months, range 5-13 months).
RESULTS: Patients were followed-up for a mean time of 3 years (range 12-72 months). Overall, occurrence of complication recurred more frequently in group A than in group B (p = 0.030, log-rank test). Acute diverticulitis recurred in 17 (8.2%) patients in group A and in 3 (2.9%) in group B; diverticular bleeding occurred in 4 (1.9%) patients in group A and in 1 (0.96%) patient in group B; surgery was required in 3 (1.4%) patients in group A and in no (0%) patient in group B.
CONCLUSIONS: This is the first study showing that long-term mesalazine treatment is significantly better that intermittent mesalazine treatment in preventing occurrence of DD complications after an attack of acute diverticulitis.},
}
@article {pmid24337782,
year = {2014},
author = {Aytac, E and Stocchi, L and Gorgun, E and Ozuner, G},
title = {Risk of recurrence and long-term outcomes after colonic diverticular bleeding.},
journal = {International journal of colorectal disease},
volume = {29},
number = {3},
pages = {373-378},
pmid = {24337782},
issn = {1432-1262},
mesh = {Aged ; Colonoscopy ; Diverticulosis, Colonic/*complications ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage/*etiology/therapy ; Hemostasis, Endoscopic ; Humans ; Male ; Middle Aged ; Recurrence ; Risk Factors ; },
abstract = {PURPOSE: Diverticular disease is one of the most common causes of acute lower gastrointestinal bleeding. We aimed to evaluate the natural history, follow-up, and risk factors associated with re-bleeding (recurrence) in patients with colonic diverticular bleeding.
METHODS: We reviewed patients with proven colonic diverticular hemorrhage from September 1993 to June 2012 at our institution. Recurrence was the main outcome measure.
RESULTS: We identified 78 out of 95 patients with proven diverticular bleed who were treated non-operatively and were followed up for a median of 57.1 months. Thirty-seven (47 %) of these patients with a median age of 67 years developed recurrent diverticular bleed after a median time of 8.1 months. The bleeding originated from the left colon in 78 (83 %) out of 95 patients in the first bleeding episode and 31(84 %) out of 37 patients during the recurrent bleeding episode. Thirty-six patients (97 %) with recurrent diverticular bleed required surgical intervention. Old age at the time of initial bleeding was associated with recurrence (p = 0.001). Patients with diverticulitis (p < 0.0001), peripheral vascular (p = 0.01), and chronic renal diseases (p = 0.047) were found to have an increased risk for recurrent colonic diverticular bleed. We only had one perioperative mortality due to postoperative sepsis. All other mortalities were not directly associated with surgery.
CONCLUSION: Patients with a history of colonic diverticular bleed are prone to recur shortly thereafter. Certain risk factors including increased age, documented diverticulitis, history of peripheral vascular disease, and chronic renal failure may predispose to recurrence.},
}
@article {pmid24336894,
year = {2014},
author = {Halabi, WJ and Kang, CY and Nguyen, VQ and Carmichael, JC and Mills, S and Stamos, MJ and Pigazzi, A},
title = {Epidural analgesia in laparoscopic colorectal surgery: a nationwide analysis of use and outcomes.},
journal = {JAMA surgery},
volume = {149},
number = {2},
pages = {130-136},
doi = {10.1001/jamasurg.2013.3186},
pmid = {24336894},
issn = {2168-6262},
mesh = {Aged ; Analgesia, Epidural/*methods ; Colectomy/*methods ; Colorectal Neoplasms/mortality/*surgery ; Female ; Follow-Up Studies ; Humans ; Incidence ; *Laparoscopy ; Length of Stay/trends ; Male ; Middle Aged ; Pain, Postoperative/epidemiology/*prevention & control ; Postoperative Complications/epidemiology ; Retrospective Studies ; Survival Rate/trends ; United States/epidemiology ; },
abstract = {IMPORTANCE: The use of epidural analgesia in laparoscopic colorectal surgery has demonstrated superiority over conventional analgesia in controlling pain. Controversy exists, however, regarding its cost-effectiveness and its effect on postoperative outcomes.
OBJECTIVES: To examine the use of epidural analgesia in laparoscopic colorectal surgery at the national level and to compare its outcomes with those of conventional analgesia.
This is a retrospective review of laparoscopic colorectal cases performed with or without epidural analgesia for cancer, diverticular disease, and benign polyps. Patient demographic characteristics, disease and procedure types, and hospital settings were listed for patients in the epidural and conventional analgesia groups. A 1 to 4 case-matched analysis was performed, matching for patient demographic characteristics, hospital setting, indications, and procedure type. Data were obtained from the Nationwide Inpatient Sample between January 1, 2002, and December 31, 2010.
MAIN OUTCOMES AND MEASURES: Total hospital charge, length of stay, mortality, pneumonia, respiratory failure, urinary tract infection, urinary retention, anastomotic leak, and postoperative ileus.
RESULTS: A total of 191576 laparoscopic colorectal cases were identified during the study period. Epidural analgesia was used in 4102 cases (2.14%). Epidurals were more likely to be used in large teaching hospitals, cancer cases, and rectal operations. On case-matched analysis, epidural analgesia was associated with a longer hospital stay by 0.60 day (P=.003), higher hospital charges by $3732.71 (P=.02), and higher rate of urinary tract infection (odds ratio=1.81; P=.05). Epidural analgesia did not affect the incidence of respiratory failure, pneumonia, anastomotic leak, ileus, or urinary retention.
CONCLUSIONS AND RELEVANCE: The perioperative use of epidural analgesia in laparoscopic colorectal surgery is limited in the United States. While epidural analgesia appears to be safe, it comes with higher hospital charges, longer hospital stay, and a higher incidence of urinary tract infections.},
}
@article {pmid24333528,
year = {2014},
author = {Illuminati, G and Ricco, JB and Schneider, F and Caliò, FG and Ceccanei, G and Pacilè, MA and Pizzardi, G and Palumbo, P and Vietri, F},
title = {Endovascular strategy for the elective treatment of concomitant aortoiliac aneurysm and symptomatic large bowel diverticular disease.},
journal = {Annals of vascular surgery},
volume = {28},
number = {5},
pages = {1236-1242},
doi = {10.1016/j.avsg.2013.08.020},
pmid = {24333528},
issn = {1615-5947},
mesh = {Aged ; Aortic Aneurysm, Abdominal/complications/*surgery ; Blood Vessel Prosthesis Implantation/*methods/standards ; Colectomy/*methods/standards ; Diverticulum, Colon/complications/*surgery ; *Elective Surgical Procedures ; Endovascular Procedures/methods/*standards ; Female ; Follow-Up Studies ; Humans ; Male ; *Practice Guidelines as Topic ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: The purpose of this study was to evaluate the strategy for treatment of patients presenting with asymptomatic diverticular disease of the large bowel associated with an asymptomatic aortoiliac aneurysmal (AAA) disease.
METHODS: Sixty-nine patients were included in this retrospective study. The patients were divided into 5 groups according to the type and sequence of the surgical treatment: 32 patients (47%) underwent colectomy followed by a staged open AAA repair (group A); 10 patients (14%) were treated with open AAA repair followed by a staged colectomy (group B); 13 patients (18%) received endovascular aneurysm repair (EVAR) followed by a staged bowel resection (group C); 8 patients (12%) had a bowel resection followed by staged EVAR (group D); and 6 patients (9%) underwent simultaneous open AAA repair and bowel resection (group E). Primary end points were mortality and complications after any of the procedures. Secondary end point was the time interval between the staged procedures.
RESULTS: The cumulative death rate for delayed treatment of AAA was 6.5% and 0% for delayed treatment of diverticular disease [P=0.22]. The mean time interval between the staged procedures was 11 days for EVAR/colon resection (group C and group D) and 73 days for open AAA repair/colon resection (group A and group B; P<0.01).
CONCLUSIONS: EVAR allows a significant reduction in the time required between AAA repair and colon resection, but no definite rule can be established regarding the sequence of staged procedures. Combined procedures should be reserved for selected cases.},
}
@article {pmid24326872,
year = {2014},
author = {Gachoka, DN and Yu, S and Kaw, D},
title = {Caecum perforation after renal transplantation: a case report and review of literature.},
journal = {International urology and nephrology},
volume = {46},
number = {6},
pages = {1141-1144},
pmid = {24326872},
issn = {1573-2584},
mesh = {Cecal Diseases/*etiology ; Female ; Humans ; Intestinal Perforation/*etiology ; Kidney Transplantation/*adverse effects ; Middle Aged ; },
abstract = {Gastrointestinal (GI) complication used to be the second most common complication in renal transplant patients after infection (Bardaxoglou et al. in Transpl Int 6(3):148-152, 1993). Review of transplant registry reveals that GI complication is no longer the second most common type of complication after renal transplant, but that it is still a common cause of significant amount of deaths in renal transplant recipients (De Bartolomeis et al. in Transpl Proc 37(6):2504-2506, 2005). In a study of 1,515 adults with severe GI complication after renal transplant, Sarkio et al. (Transpl Int 17(9):505-510, 2004) reported that gastroduodenal ulcers followed by colon perforation were the two biggest groups of GI complications during the first year after renal transplantation. Colonic perforation is estimated to occur in about 1 % of all cases of renal transplant patients, and it does predispose to potentially fatal complication. About 50 % of all colonic perforation is due to complication of acute inflammation of diverticular disease (Bardaxoglou et al. in Transpl Int 6(3):148-152, 1993; Guice et al. in Am J Surg 138(1):43-48, 1979; Koneru et al. in Arch Surg 125(5):610-613, 1990; Coccolini et al. in Transpl Proc 41(4):1189-1190, 2009). This is particularly so because these patients were previously exposed to uremia before transplantation which alters their protein metabolism hence interfering with tissue healing there after (Carson et al. in Ann Surg 188(1):109-113, 1978). GI complications including colon perforation after renal transplantation have effect on a patient's long-term survival (Gil-Vernet et al. in Transpl Proc 39(7):2190-2193, 2007). Despite this, the role of renal transplantation medication compared to anatomic anomaly in GI complication has been equivocal.},
}
@article {pmid24320820,
year = {2014},
author = {Kvasnovsky, CL and Papagrigoriadis, S and Bjarnason, I},
title = {Increased diverticular complications with nonsteriodal anti-inflammatory drugs and other medications: a systematic review and meta-analysis.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {16},
number = {6},
pages = {O189-96},
doi = {10.1111/codi.12516},
pmid = {24320820},
issn = {1463-1318},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*adverse effects/therapeutic use ; *Colon ; Diverticulum, Colon/*drug therapy ; Gastrointestinal Hemorrhage/chemically induced/diagnosis/*epidemiology ; Global Health ; Humans ; *Intestinal Perforation/chemically induced/diagnosis/epidemiology ; Morbidity/trends ; Risk Factors ; },
abstract = {AIM: Complications of colonic diverticula, perforation and bleeding are a source of morbidity and mortality. A variety of drugs have been implicated in these complications. We present a systemic review and meta-analysis of the literature to assess the importance of this relationship.
METHOD: A systematic review of articles in PubMed, Cochrane Reviews, Embase and Google Scholar was undertaken in February 2013. An initial literature search yielded 2916 results that were assessed for study design and topicality. Twenty-three articles were included in the review. A qualitative data synthesis was conducted using forest plots of studies comparing single medication with complications.
RESULTS: Individual studies demonstrated the odds of perforation and abscess formation with nonsteridal anti-inflammatory drugs (NSAIDs) (1.46-10.30), aspirin (0.66-2.40), steroids (2.17-31.90) and opioids (1.80-4.51) and the odds of bleeding with NSAIDs (2.01-12.60), paracetamol (0-3.75), aspirin (1.14-3.70) and steroids (0.57-5.40). Pooled data showed significantly increased odds of perforation and abscess formation with NSAIDs (OR = 2.49), steroids (OR = 9.08) and opioids (OR = 2.52). They also showed increased odds of diverticular bleeding from NSAIDs (OR = 2.69), aspirin (OR = 3.24) and calcium-channel blockers (OR = 2.50). Most studies did not describe the duration or dosage of medication used and did not systematically describe the severity of diverticular complications.
CONCLUSION: Various common medications are implicated in complications of diverticular disease.},
}
@article {pmid24317937,
year = {2014},
author = {Nagata, N and Niikura, R and Aoki, T and Shimbo, T and Itoh, T and Goda, Y and Suda, R and Yano, H and Akiyama, J and Yanase, M and Mizokami, M and Uemura, N},
title = {Increase in colonic diverticulosis and diverticular hemorrhage in an aging society: lessons from a 9-year colonoscopic study of 28,192 patients in Japan.},
journal = {International journal of colorectal disease},
volume = {29},
number = {3},
pages = {379-385},
pmid = {24317937},
issn = {1432-1262},
mesh = {Adult ; Age Distribution ; Age Factors ; Aged ; Colonoscopy ; Diverticulosis, Colonic/*epidemiology/pathology ; Female ; Gastrointestinal Hemorrhage/*epidemiology ; Humans ; Japan/epidemiology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Risk Factors ; Sex Distribution ; },
abstract = {PURPOSES: Colonoscopic evidence of epidemiological trends in diverticulosis and diverticular bleeding is scarce. We evaluated trends in diverticular disease and associated factors over 9 years.
METHODS: Twenty-eight thousand one hundred ninety-two patients who underwent colonoscopy at an emergency hospital were reviewed from an electronic endoscopy database. Diverticula were classified as right-sided, left-sided, and bilateral types, and time trends in the proportion in diverticulosis, type, and diverticular bleeding were determined. Associations of age (≤39, 40-59, and ≥60 years), sex, and year increase with disease and odds ratios were estimated using logistic regression.
RESULTS: Diverticulosis was identified in 6,150 patients (20.3 %; mean age, 67.6 years) and was predominantly right-sided (48.0 %). Diverticular bleeding was found in 427 (1.5 %; mean age, 69.7 years) and was predominantly bilateral (47.0 %). Proportion of colonic diverticulosis increased significantly (P < 0.01 for trend) from 66.0 % (1,424/2,157) in 2003 to 70.1 % (2,914/4,159) in 2011 and was associated (P < 0.01) with an increased number of patients aged ≥60 years. Proportion of diverticular bleeding increased significantly (P < 0.01 for trend) from 1.02 % (22/2,157) in 2003 to 1.67 % (69/4,159) in 2011 and was associated (P = 0.04) with an increased number of patients aged 40-59 years. Diverticulosis, right and bilateral type, and diverticular bleeding were independently associated with the 9-year trend after adjustment by age and sex.
CONCLUSIONS: Colonic diverticulosis and diverticular bleeding are prevalent and increasing in Japan. Given the significant association of age with this trend, both diseases can be expected to increase for decades to come.},
}
@article {pmid24316104,
year = {2014},
author = {Strate, LL and Erichsen, R and Horváth-Puhó, E and Pedersen, L and Baron, JA and Sørensen, HT},
title = {Diverticular disease is associated with increased risk of subsequent arterial and venous thromboembolic events.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {12},
number = {10},
pages = {1695-701.e1},
doi = {10.1016/j.cgh.2013.11.026},
pmid = {24316104},
issn = {1542-7714},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biostatistics ; Cohort Studies ; Denmark/epidemiology ; Diverticulum/*complications ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Thromboembolism/*epidemiology ; Young Adult ; },
abstract = {BACKGROUND & AIMS: Diverticular disease and cardiovascular disease share several risk factors. Inflammation associated with diverticular disease could predispose to cardiovascular disease. We assessed the association between a diagnosis of diverticular disease and subsequent arterial and venous thromboembolic events, adjusting for related comorbidities to explore a possible causal relationship.
METHODS: We identified 77,065 incident cases of diverticular disease from 1980-2011 from Danish nationwide medical registries; these were matched for age and sex with 302,572 population comparison cohort members. Individuals with a history of cardiovascular disease were excluded. We used Cox proportional hazards regression to compute incidence rate ratios, comparing the incidence of acute myocardial infarction, stroke, venous thromboembolism, and subarachnoid hemorrhage in patients with diverticular disease with those of the population cohort members, adjusting for age, sex, obesity, diabetes, hyperlipidemia, chronic obstructive pulmonary disease, connective tissue disease, renal disease, and treatments and medications.
RESULTS: The adjusted incidence rate ratios for patients with diverticular disease, compared with population cohort members, were 1.11 (95% confidence interval [CI], 1.07-1.14) for acute myocardial infarction, 1.11 (95% CI, 1.08-1.15) for overall stroke, 1.36 (95% CI, 1.30-1.43) for overall venous thromboembolism, and 1.27 (95% CI, 1.09-1.48) for subarachnoid hemorrhage. The relative risk of each event remained increased after we adjusted for changes in aspirin use or for endoscopy or colorectal surgery after the diagnosis of diverticular disease. These findings also held after excluding the first year of follow-up and limiting the analysis to patients with diverticulitis.
CONCLUSIONS: On the basis of an analysis of Danish medical registries, a diagnosis of diverticular disease is associated with a modest increase in risk of arterial and venous thromboembolic events after adjustment for related disorders.},
}
@article {pmid24306080,
year = {2014},
author = {Tridente, A and Clarke, GM and Walden, A and McKechnie, S and Hutton, P and Mills, GH and Gordon, AC and Holloway, PAH and Chiche, JD and Bion, J and Stuber, F and Garrard, C and Hinds, CJ and , },
title = {Patients with faecal peritonitis admitted to European intensive care units: an epidemiological survey of the GenOSept cohort.},
journal = {Intensive care medicine},
volume = {40},
number = {2},
pages = {202-210},
pmid = {24306080},
issn = {1432-1238},
support = {NIHR/CS/009/007/DH_/Department of Health/United Kingdom ; },
mesh = {Aged ; Europe ; *Feces ; Female ; Health Surveys ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Multivariate Analysis ; Peritonitis/epidemiology/*mortality ; Prognosis ; Prospective Studies ; Risk Factors ; },
abstract = {INTRODUCTION: Faecal peritonitis (FP) is a common cause of sepsis and admission to the intensive care unit (ICU). The Genetics of Sepsis and Septic Shock in Europe (GenOSept) project is investigating the influence of genetic variation on the host response and outcomes in a large cohort of patients with sepsis admitted to ICUs across Europe. Here we report an epidemiological survey of the subset of patients with FP.
OBJECTIVES: To define the clinical characteristics, outcomes and risk factors for mortality in patients with FP admitted to ICUs across Europe.
METHODS: Data was extracted from electronic case report forms. Phenotypic data was recorded using a detailed, quality-assured clinical database. The primary outcome measure was 6-month mortality. Patients were followed for 6 months. Kaplan-Meier analysis was used to determine mortality rates. Cox proportional hazards regression analysis was employed to identify independent risk factors for mortality.
RESULTS: Data for 977 FP patients admitted to 102 centres across 16 countries between 29 September 2005 and 5 January 2011 was extracted. The median age was 69.2 years (IQR 58.3-77.1), with a male preponderance (54.3%). The most common causes of FP were perforated diverticular disease (32.1%) and surgical anastomotic breakdown (31.1%). The ICU mortality rate at 28 days was 19.1%, increasing to 31.6% at 6 months. The cause of FP, pre-existing co-morbidities and time from estimated onset of symptoms to surgery did not impact on survival. The strongest independent risk factors associated with an increased rate of death at 6 months included age, higher APACHE II score, acute renal and cardiovascular dysfunction within 1 week of admission to ICU, hypothermia, lower haematocrit and bradycardia on day 1 of ICU stay.
CONCLUSIONS: In this large cohort of patients admitted to European ICUs with FP the 6 month mortality was 31.6%. The most consistent predictors of mortality across all time points were increased age, development of acute renal dysfunction during the first week of admission, lower haematocrit and hypothermia on day 1 of ICU admission.},
}
@article {pmid24299285,
year = {2013},
author = {Zonča, P and Ihnát, P and Peteja, M and Guňková, P and Vávra, P and Martínek, L},
title = {[Laparoscopic lavage and drainage in the management of acute diverticulitis: is it time to move on?].},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {92},
number = {11},
pages = {634-639},
pmid = {24299285},
issn = {0035-9351},
mesh = {Acute Disease ; Aged ; Diverticulitis/surgery/*therapy ; Drainage/*methods ; Female ; Humans ; Laparoscopy/*methods ; Male ; Peritoneal Lavage/*methods ; Retrospective Studies ; Treatment Outcome ; },
abstract = {INTRODUCTION: Diverticular disease management represents a very topical issue with many unanswered questions as yet. Laparoscopic lavage and drainage in patients with acute diverticulitis is one of the controversial areas. Miniinvasive approach presents a possible treatment alternative for CT-guided percutaneous drainage and also for radical colon resection in the form of Hartmanns procedure or resection with primary anastomosis. MATERIAL A METHODS: The authors aim was the evaluation of patients with Hinchey II, III or IV diverticulitis treated by laparoscopic lavage and drainage, or by laparoscopic suture of the perforation, in a retrospective cohort study. The inclusion criterion for the study was laparoscopic lavage and drainage indication in patients with Hinchey II, III or IV diverticulitis. The primary aim of the study was laparoscopic treatment evaluation focused on leakage, if applicable, and on postoperative morbidity and mortality.
RESULTS: During the study period (2007-2012), 12 patients operated on at our department (with a mean age of 71.7 years) were included into the study. The group comprised 7 men and 5 women with a BMI of 28.1 kg/m2. Laparoscopic exploration, lavage and drainage of the abdominal cavity with purulent peritonitis finding were performed in 10 patients. The site of bowel perforation was not located unambiguously in these patients. Two patients with faecal peritonitis and identified place of perforation underwent laparoscopic lavage, drainage and suture of the perforation. Postoperative leakage was not detected in any of the patients. The mean operating time was 65 minutes, postoperative morbidity reaching 27.7%, and postoperative mortality 0%. The mean length of hospital stay was 8.8 days. Elective laparoscopic resection was performed 6-15 weeks after the primary operation in 8 patients.
CONCLUSION: Laparoscopic exploration with thorough lavage, suture of the perforation and drainage presents a possible alternative in modern management of acute diverticulitis. The miniinvasive approach indication should be based both on careful, highly individualised and complex patient evaluation and on the departments experience.},
}
@article {pmid24295478,
year = {2013},
author = {Adamová, Z and Slováček, R and Sankot, J},
title = {[Recurrent diverticulitis - risk factors].},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {92},
number = {10},
pages = {563-568},
pmid = {24295478},
issn = {0035-9351},
mesh = {Adult ; Colectomy/*statistics & numerical data ; Diverticulitis, Colonic/*epidemiology/surgery ; Female ; Humans ; Male ; Recurrence ; Retrospective Studies ; Risk Factors ; },
abstract = {INTRODUCTION: Colonic diverticular disease is a common illness, especially in the elderly population. It may be asymptomatic and cause chronic intestinal problems, colonic diverticular bleeding or inflammatory complications with considerable morbidity and mortality. We have attempted at finding factors that would help us identify patients with a higher risk of diverticulitis recurrence as well as patients with a higher likelihood of perforated diverticulitis.
MATERIAL AND METHODS: This retrospective study included all patients admitted to our surgical ward for inflammatory complications of diverticular disease between 2000 and 2012: 278 patients, 88 men and 190 women. We looked up the first attack of diverticulitis in our documentation as well as the relapses, if any, their number and course, and the time from the first attack to the relapse. We analyzed the influence of age, gender, comorbidities (diabetes mellitus, overweight, ischemic heart disease, chronic renal failure, gastroduodenal disease), nicotine abuse and medication (glucocorticoids and other immunosuppressive drugs, acetylsalicylic acid) on diverticulitis recurrence and its complicated course. We compared the results of conservative and surgical therapy. Statistical analysis was performed using Fishers exact test and Man-Whitney U tests.
RESULTS: We did not demonstrate any statistically significant dependence of diverticulitis recurrence on age or gender. Colectomy (both acute and elective surgery) clearly decreases the likelihood of recurrence (p=0.00007). Comorbidities, nicotine abuse and medication were not associated with an increased risk of recurrence. Steroid and immunosuppressive drugs use was significantly associated with higher perforation rates, without impacting on the likelihood of recurrence. Regular smoking of cigarettes had no impact on recurrence or on its severity.
CONCLUSION: We did not find any reliable indicator of recurrent diverticulitis. Age, gender, comorbidities, smoking and medication are not significant. Immunocompromised patients have a higher probability of perforation and a more serious course of the illness. The problem is, however, that complicated diverticulitis is often the initial clinical presentation of the disease. Surgical treatment is more effective than conservative therapy in the prophylaxis of recurrent diverticulitis, but, according to our as well as foreign data, the relapse of diverticulitis occurs in a minority of the patients (14% in our study) and the recurrence tends to have a relatively benign course. These findings should be taken into consideration when counselling patients regarding potential benefits of prophylactic colectomy.},
}
@article {pmid24294768,
year = {2013},
author = {Levchenko, SV and Lazebnik, LB and Potapova, VB and Rogozina, VA},
title = {[Clinical and morphological variants of diverticular disease in colon].},
journal = {Eksperimental'naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology},
volume = {},
number = {3},
pages = {23-30},
pmid = {24294768},
issn = {1682-8658},
mesh = {Abdominal Pain/diagnosis/pathology/physiopathology ; Adult ; Aged ; Aged, 80 and over ; *Colon/pathology/physiopathology ; *Diverticulum, Colon/diagnosis/pathology/physiopathology ; Endoscopy ; Female ; Humans ; *Intestinal Mucosa/pathology/physiopathology ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Quality of Life ; Retrospective Studies ; },
abstract = {Our own results of two-stage research are presented in the article. The first stage contains the retrospective analysis of 3682 X-ray examining of large bowel which were conducted in 2002-2004 to define the structure of colon disease and to determine gender differences. The second stage is prospective research which took place from 2003 to 2012 and 486 patients with diverticular disease were regularly observed. Following parameters were estimated: dynamics of complaints, life quality, clinical symptoms. Multiple X-ray and endoscopic examining were done with estimation of quantity and size of diverticula, changes of colon mucosa, comparison of X-ray and endoscopic methods in prognosis of complications. Two basic clinical morphological variants of diverticular disease (DD) of colon are made out as a result of our research. There are IBD-like and DD with ischemic component. The variants differ by pain characteristics, presence of accompanying diseases, life quality parameters and description of colon mucosa morphological research. We suppose that different ethiopathogenetic factors of development of both variants mentioned above influence the disease prognosis and selection of treatment.},
}
@article {pmid24294120,
year = {2012},
author = {Sawai, RS},
title = {Management of colonic obstruction: a review.},
journal = {Clinics in colon and rectal surgery},
volume = {25},
number = {4},
pages = {200-203},
pmid = {24294120},
issn = {1531-0043},
abstract = {Large bowel obstruction is a common problem with many different causes, the most common being colorectal adenocarcinoma, extracolonic adenocarcinoma, diverticular disease, volvulus, and inflammatory bowel disease. The nature of the obstruction can influence the best management. Historically, treatment of obstruction consisted of surgical removal of the obstruction if possible and decompression of the bowel with an ostomy. Other strategies for managing obstruction have evolved as alternatives to stomas, including primary resection with anastomosis and endoscopic stent placement. The choice of treatment can therefore be tailored to the individual patient with good success.},
}
@article {pmid24278860,
year = {2013},
author = {Kim, HJ and Kim, JH and Moon, OI and Kim, KJ},
title = {Giant ascending colonic diverticulum presenting with intussusception.},
journal = {Annals of coloproctology},
volume = {29},
number = {5},
pages = {209-212},
pmid = {24278860},
issn = {2287-9714},
abstract = {Diverticular disease of the colon is a common disease, and its incidence is increasing gradually. A giant colonic diverticulum (GCD) is a rare entity and is defined as a diverticulum greater than 4 cm in size. It mainly arises from the sigmoid colon, and possible etiology is a ball-valve mechanism permitting progressive enlargement. A plain abdominal X-ray can be helpful to make a diagnosis initially, and a barium enema and abdominal computed tomography may confirm the diagnosis. Surgical intervention is a definite treatment for a GCD. We report a case of an ascending GCD presenting with intussusception in a young adult.},
}
@article {pmid24278859,
year = {2013},
author = {Tan, KK and Strong, DH and Shore, T and Ahmad, MR and Waugh, R and Young, CJ},
title = {The safety and efficacy of mesenteric embolization in the management of acute lower gastrointestinal hemorrhage.},
journal = {Annals of coloproctology},
volume = {29},
number = {5},
pages = {205-208},
pmid = {24278859},
issn = {2287-9714},
abstract = {PURPOSE: Mesenteric embolization is an integral part in the management of acute lower gastrointestinal (GI) bleeding. The aim of this study was to highlight our experience after adopting mesenteric embolization in the management of acute lower GI hemorrhage.
METHODS: A retrospective review of all cases of mesenteric embolization for acute lower GI bleeding from October 2007 to August 2012 was performed.
RESULTS: Twenty-seven patients with a median age of 73 years (range, 31 to 86 years) formed the study group. More than half (n = 16, 59.3%) of the patients were on either antiplatelet and/or anticoagulant therapy. The underlying etiology included diverticular disease (n = 9), neoplasms (n = 5) and postprocedural complications (n = 6). The colon was the most common bleeding site and was seen in 21 patients (left, 10; right, 11). The median hemoglobin prior to the embolization was 8.6 g/dL (6.1 to 12.6 g/dL). A 100% technical success rate with immediate cessation of hemorrhage at the end of the session was achieved. There were three clinical failures (11.1%) in our series. Two patients re-bled, and both underwent a successful repeat embolization. The only patient who developed an infarcted bowel following embolization underwent an emergency operation and died one week later. There were no factors that predicted clinical failure.
CONCLUSION: Mesenteric embolization for acute lower GI bleeding can be safely performed and is associated with a high clinical success rate in most patients. A repeat embolization can be considered in selected cases, but postembolization ischemia is associated with bad outcomes.},
}
@article {pmid24274449,
year = {2013},
author = {Couto-Worner, I and González-Conde, B and Estévez-Prieto, E and Alonso-Aguirre, P},
title = {Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips.},
journal = {Revista espanola de enfermedades digestivas},
volume = {105},
number = {8},
pages = {495-498},
doi = {10.4321/s1130-01082013000800010},
pmid = {24274449},
issn = {1130-0108},
mesh = {Aged ; Colonic Diseases/*surgery ; Diverticulum/complications/*surgery ; Endoscopy, Gastrointestinal/*methods ; Epinephrine/*therapeutic use ; Gastrointestinal Hemorrhage/etiology/*surgery ; Humans ; Male ; Surgical Instruments ; Vasoconstrictor Agents/*therapeutic use ; },
abstract = {Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20% of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting, with correct visualization of the point of bleeding. Patients recovered well avoiding other aggressive procedures such as angiography or surgery.},
}
@article {pmid24267118,
year = {2013},
author = {Giovanni, C and Emanuele, C and Francesco, B and Emanuele, L and Andrea, B and Solajd, P and Ettore, M},
title = {Laparoscopic conservative treatment of colo-vesical fistula: a new surgical approach.},
journal = {International braz j urol : official journal of the Brazilian Society of Urology},
volume = {39},
number = {5},
pages = {752; discussion 753},
doi = {10.1590/S1677-5538.IBJU.2013.05.19},
pmid = {24267118},
issn = {1677-6119},
mesh = {Aged ; Humans ; Intestinal Fistula/*surgery ; Laparoscopy/*methods ; Male ; Operative Time ; Reproducibility of Results ; Time Factors ; Treatment Outcome ; },
abstract = {INTRODUCTION: The standard treatment of colo-vesical fistula is the exeresis of fistula, suture of bladder wall, colic resection with or without temporary colostomy. Usually the approach is open because conversion rates and morbidity are lower than laparoscopy. The aim of video is to show the steps of a new mini-invasive approach of colo-vesical fistula without colic resection.
MATERIALS AND METHODS: A 69 years old male underwent laparoscopic conservative treatment of colo-vesical fistula due to endoscopic polipectomy in sigmoid diverticulum. 12 mm trocar for the camera was placed at the umbilicus, two 10 mm trocars were placed along bisiliac line and 5 mm port was placed along left emiclavear line; Trendelenburg position was 20°. The fistulous loop was carefully isolated, clipped with Hem-o-lock clips and removed. Since diverticular disease appeared slight and no inflammation signs were evident, colon resection was not performed. We sutured and sinked the sigmoid wall; after curettage of the fistula site, the bladder wall was sutured. Fat tissue was placed between sigmoid and bladder wall to reduce the risk of fistula recurrence.
RESULTS: Operative time, estimated blood loss, catheterization time, time to flatus and hospital stay were respectively 210 minutes, 300 mL, 10 days, 48 h and 8 days. The histological examination showed colonic inflammatory and necrotic tissue. No complications or fistula recurrence occurred at 54 months follow-up.
CONCLUSIONS: The laparoscopic conservative treatment of colo-vesical fistula is a safe and feasible technique, in particular when the diverticular disease is limited and the fistula is not due to diverticulitis.},
}
@article {pmid24256160,
year = {2014},
author = {Flor, N and Sardanelli, F and Pickhardt, PJ},
title = {Diagnostic accuracy of CT colonography for the detection of polyps in the diverticular disease.},
journal = {Scandinavian journal of gastroenterology},
volume = {49},
number = {3},
pages = {383-384},
doi = {10.3109/00365521.2013.857714},
pmid = {24256160},
issn = {1502-7708},
mesh = {Adenoma/*diagnostic imaging ; Colonic Neoplasms/*diagnostic imaging ; *Colonography, Computed Tomographic ; *Colonoscopy ; Diverticulitis, Colonic/*diagnostic imaging ; Female ; Humans ; Male ; Patient Acceptance of Health Care/*statistics & numerical data ; },
}
@article {pmid24240607,
year = {2014},
author = {Stallinger, S and Eller, N and Högenauer, C},
title = {Non-interventional study evaluating efficacy and tolerability of rifaximin for treatment of uncomplicated diverticular disease.},
journal = {Wiener klinische Wochenschrift},
volume = {126},
number = {1-2},
pages = {9-14},
pmid = {24240607},
issn = {1613-7671},
mesh = {Abdominal Pain/*chemically induced/prevention & control ; Adolescent ; Adult ; Aged ; Anti-Infective Agents/administration & dosage/adverse effects ; Diverticulitis, Colonic/*drug therapy ; Female ; Flatulence/*chemically induced/prevention & control ; Gastrointestinal Agents/administration & dosage/adverse effects ; Humans ; Male ; Middle Aged ; Nausea/*chemically induced/prevention & control ; Rifamycins/*administration & dosage/*adverse effects ; Rifaximin ; Treatment Outcome ; Young Adult ; },
abstract = {Patients with symptomatic uncomplicated diverticular disease represent a spectrum of patients who report recurrent abdominal symptoms, however are lacking substantial colonic inflammation in contrast to patients with acute diverticulitis. This non-interventional study investigated the efficacy and tolerability of rifaximin, a broad-spectrum poorly absorbable antibiotic, in cyclic treatment of these patients. Adult patients with uncomplicated diverticular disease in care of physicians in private practice intended to be treated with rifaximin were included. Patients with acute diverticulitis and symptoms suggestive of more severe intestinal inflammation were excluded. Data of 1,003 patients treated in cycles of 7-10 days per month over a period of 3 months were evaluated. In total, 75 % of patients had more than three episodes of symptoms in the last year before inclusion in the study. However, two-third of patients did not receive any treatment before. Over the 3-month treatment period with rifaximin, all assessed symptoms of diverticular disease, such as abdominal pain, diarrhoea and flatulence, improved significantly. There was an overall good compliance to the scheme of cyclic drug administration of rifaximin. During the study, 24 adverse events in 20 patients were recorded, of which 6 adverse events showed a causal relationship to the use of rifaximin (0.6 %). We conclude that cyclic rifaximin shows good clinical efficacy and tolerability in patients with symptomatic uncomplicated diverticular disease treated in a routine private practice outpatient setting.},
}
@article {pmid24224778,
year = {2015},
author = {Kwok, CS and Pal, A and Sargen, K},
title = {Cystogram use and outcomes in colorectal surgery involving bladder repair: a clinical audit.},
journal = {ANZ journal of surgery},
volume = {85},
number = {10},
pages = {774-776},
doi = {10.1111/ans.12440},
pmid = {24224778},
issn = {1445-2197},
mesh = {Aged ; Clinical Audit ; Colon, Sigmoid/surgery ; Colorectal Surgery/adverse effects/methods ; Colostomy/methods ; Diverticulum/surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/surgery ; Postoperative Period ; Radiography, Abdominal/methods ; Rectum/surgery ; Retrospective Studies ; Urinary Bladder/*diagnostic imaging/pathology/*surgery ; Urography/methods ; Urologic Surgical Procedures/methods ; },
abstract = {BACKGROUND: The role of routine cystograms after bladder repair during colorectal surgery is unclear so we aimed to evaluate this in our department.
METHODS: We conducted a retrospective audit of colorectal surgical patients who had an operation and subsequent cystogram between 2006 and 2011 at the Norfolk and Norwich University Hospital. Data on patient characteristics, operative procedures and findings, and cystogram results were collected from electronic discharge summaries, operative notes and radiological records.
RESULTS: A total of 59 operations were included and 92% had documented bladder involvement. The most common indications for surgery were diverticular disease (49%) and neoplastic disease (39%). Operations evaluated included high anterior resection, anterior resection, Hartmann's procedures and sigmoid colectomy. Although all patients had at least one post-operative cystogram, only 46% of cases had instructions documented in the operative note for a cystogram to be arranged. Out of the 59 operations, 4 (7%) had cystograms that showed a leak. Repeat cystography in these cases showed no leak or smaller leak and no additional procedures were required. Two of the leaks occurred in cases that had extensive bladder involvement or bladder wall sepsis, and two occurred in cases where the operative findings revealed less major bladder pathology.
CONCLUSIONS: Our results suggest that majority of cystograms are negative. More studies are needed to evaluate if selective use of cystogram should be performed to reduce unnecessary the risks associated with radiation exposure and contrast exposure.},
}
@article {pmid24224113,
year = {2013},
author = {Al-Brahim, N and Al-Kandari, I and Munahai, M and Sharma, P},
title = {Clinicopathological study of 25 cases of diverticular disease of the appendix: experience from farwaniya hospital.},
journal = {Pathology research international},
volume = {2013},
number = {},
pages = {404308},
pmid = {24224113},
issn = {2090-8091},
abstract = {Background. Diverticular disease of the appendix (DDA) is a rare disease and it has been shown to be associated with locoregional neoplasms. This study was conducted to characterize clinicopathological features and to investigate its association with appendiceal neoplasms. Methods. We searched the records of the Department of Pathology at Farwaniya Hospital for cases of diverticular disease of the appendix between 2003 and 2011. Histological slides and patient charts were reviewed for relevant information. Consecutive cases of acute appendicitis were selected as a control group. Results. We identified 25 cases of DDA, 24 of which occurred in men. Mean age of DDA patients was 35 ± 10.1 years and was significantly greater than that of appendicitis patients (P = 0.027). The mean temperature of cases (37.9°) was significantly higher (P = 0.012) than that of the controls (37.3°). The cases had lower white blood cell (WBC) counts compared to controls (13.6 versus 16.7, P = 0.04). Pathological diagnosis identified 4 cases of diverticulosis, 5 cases of diverticulitis, 6 cases of diverticulosis with acute appendicitis, and 10 cases of diverticulitis and appendicitis. None of the cases was associated with any type of neoplasm. Conclusions. DDA is a rare disease, and clinicians and radiologists should be aware of it. Male sex and adult age seem to be risk factors associated with DDA. The disease may not have any direct association with any neoplasm.},
}
@article {pmid24215018,
year = {2014},
author = {Luciano, RL and Dahl, NK},
title = {Extra-renal manifestations of autosomal dominant polycystic kidney disease (ADPKD): considerations for routine screening and management.},
journal = {Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association},
volume = {29},
number = {2},
pages = {247-254},
doi = {10.1093/ndt/gft437},
pmid = {24215018},
issn = {1460-2385},
mesh = {Cardiovascular Diseases/*diagnosis ; Central Nervous System Diseases/*diagnosis ; Digestive System Diseases/*diagnosis ; Disease Management ; Genetic Predisposition to Disease ; Genetic Testing/methods ; Global Health ; Humans ; Male ; Mass Screening/*methods ; Morbidity ; Polycystic Kidney, Autosomal Dominant/*diagnosis/*therapy ; Survival Rate ; },
abstract = {Autosomal-dominant polycystic kidney disease (ADPKD) is a systemic disease, marked by progressive increase of bilateral renal cysts, resulting in chronic kidney disease (CKD) and often leading to end-stage renal disease (ESRD). Apart from renal cysts, patients often have extra-renal disease, involving the liver, heart and vasculature. Other less common but equally important extra-renal manifestations of ADPKD include diverticular disease, hernias, male infertility and pain. Extra-renal disease burden is often asymptomatic, but may result in increased morbidity and mortality. If the disease burden is significant, screening may prove beneficial. We review the rationale for current screening recommendations and propose some guidelines for screening and management of ADPKD patients.},
}
@article {pmid24201394,
year = {2013},
author = {Letarte, F and Hallet, J and Drolet, S and Charles Grégoire, R and Bouchard, A and Gagné, JP and Thibault, C and Bouchard, P},
title = {Laparoscopic emergency surgery for diverticular disease that failed medical treatment: a valuable option? Results of a retrospective comparative cohort study.},
journal = {Diseases of the colon and rectum},
volume = {56},
number = {12},
pages = {1395-1402},
doi = {10.1097/DCR.0b013e3182a760b6},
pmid = {24201394},
issn = {1530-0358},
mesh = {Aged ; Cohort Studies ; Colectomy/*methods ; Conversion to Open Surgery ; Diverticulitis/drug therapy/*surgery ; Emergency Treatment ; Female ; Humans ; Intestinal Diseases/drug therapy/*surgery ; Laparoscopy/*methods ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Treatment Failure ; Treatment Outcome ; },
abstract = {BACKGROUND: Laparoscopic surgery has become the standard of treatment for elective management of diverticular disease. However, its use in the acute setting remains controversial.
OBJECTIVE: The aim of this study is to compare the outcomes of laparoscopic surgery with open surgery in the acute management of complicated diverticular disease that failed initial medical treatment.
SETTINGS: This is a single-center comparative retrospective cohort study.
PATIENTS: Patients undergoing surgery for complicated diverticular disease after an attempt at medical treatment from 2000 to 2011 were selected.
INTERVENTION: Laparoscopic versus open surgery was compared.
OUTCOME MEASURES: The primary outcomes were overall 30-day morbidity and mortality. Secondary outcomes were length of stay, time to resume diet, and need for a permanent stoma.
RESULTS: Forty-two patients were identified by using medical records: 24 laparoscopic surgery and 18 open surgery. Baseline demographics, ASA classification, Acute Physiology and Chronic Health Evaluation scores, Hinchey classification, and Charlson Comorbidity Index did not differ between groups. The mean operative time was 36 minutes longer (p = 0.05) and blood loss was 460 mL less (p < 0.001) for laparoscopic surgery. Two patients (8.3%) in the laparoscopic surgery group required conversion to open surgery. There was no mortality. Overall morbidity was lower favoring laparoscopic surgery (16.7% vs 55.6%; p = 0.01). Two patients in the laparoscopic surgery group experienced an anastomotic leak compared with none in the open surgery group. Mean time to resume diet (3 vs 6.5 days; p < 0.01) and length of stay (5 vs 8 days; p = 0.04) were shorter for the laparoscopic surgery group. Rate of permanent stoma at last follow-up (median, 332 days) did not differ significantly between groups.
LIMITATIONS: This study is limited by selection bias.
CONCLUSIONS: Compared with open surgery, laparoscopic surgery for patients in whom medical treatment for complicated diverticular disease failed is associated with favorable outcomes, including a reduced rate of morbidity and a shorter length of stay. When applied to selected patients, this approach appears to be a safe procedure with a low rate of conversion.},
}
@article {pmid24160793,
year = {2013},
author = {Halabi, WJ and Jafari, MD and Nguyen, VQ and Carmichael, JC and Mills, S and Pigazzi, A and Stamos, MJ and Foster, CE},
title = {Colorectal surgery in kidney transplant recipients: a decade of trends and outcomes in the United States.},
journal = {The American surgeon},
volume = {79},
number = {10},
pages = {1026-1033},
pmid = {24160793},
issn = {1555-9823},
mesh = {Acute Kidney Injury/epidemiology/etiology ; Aged ; Colitis/etiology/mortality/*surgery ; Colon/surgery ; Colorectal Neoplasms/etiology/mortality/*surgery ; Databases, Factual ; Diverticulitis, Colonic/etiology/mortality/*surgery ; Female ; Humans ; Intestinal Polyps/etiology/mortality/*surgery ; *Kidney Transplantation ; Laparoscopy/mortality/statistics & numerical data ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/epidemiology/etiology/*surgery ; Rectum/surgery ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; United States ; },
abstract = {There is paucity of data evaluating the trends and outcomes of colorectal surgery (CRS) in kidney transplant recipients (KTRs). Using the Nationwide Inpatient Sample 2001 to 2010, a retrospective review of CRS performed in KTRs was performed. Trends, demographics, indications, and outcomes were examined for elective and emergent cases and compared with the general population (GP) on multivariate logistic regression. A total of 2616 KTRs underwent CRS, 50 per cent of which were done emergently. KTRs developed colon and rectal cancer at a younger age and had significantly higher incidence of comorbidities compared with the GP. Diverticular disease was the most common indication for surgery (48%) followed by cancer (30.6%). Compared with the GP, KTRs had higher rates of mortality (6.29 vs 3.64%), wound complications (8.02 vs 5.37%), and acute renal failure (ARF) (17.14 vs 7.10%) (all P < 0.05). No difference was seen in the incidence of anastomotic leak. On multivariate analysis, KTRs had higher associated odds of ARF (odds ratio, 2.02; P < 0.001), whereas the odds of mortality, wound, and anastomotic complications were similar to the GP. Emergency surgery in KTRs was associated with worse outcomes compared with the elective setting. KTRs undergoing CRS have unique characteristics that are different than the GP. They are at an increased risk of complications, especially acute renal failure.},
}
@article {pmid24143305,
year = {2013},
author = {Kwon, YH and Jeon, SW and Lee, YK},
title = {Endoscopic management of refractory benign colorectal strictures.},
journal = {Clinical endoscopy},
volume = {46},
number = {5},
pages = {472-475},
pmid = {24143305},
issn = {2234-2400},
abstract = {In colonoscopic study, benign colorectal strictures with or without symptomatic pain are not rarely encountered. Benign colorectal stricture can be caused by a number of problems, such as anastomotic stricture after surgery, inflammatory bowel disease, postendoscopic submucosal dissection, diverticular disease, ischemic colitis, and so on. There are various modalities for the management of benign colorectal stricture. Endoscopic balloon dilatation is generally considered as the primary treatment for benign colorectal stricture. In refractory benign colorectal strictures, several treatment sessions of balloon dilatation are needed for successful dilatation. The self-expandable metal stent and many combined techniques are performed at present. However, there is no specific algorithmic modality for refractory benign colorectal strictures.},
}
@article {pmid24128302,
year = {2014},
author = {Ambrosetti, P and Gervaz, P},
title = {Laparoscopic elective sigmoidectomy for diverticular disease: a plea for standardization of the procedure.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {16},
number = {2},
pages = {90-94},
doi = {10.1111/codi.12455},
pmid = {24128302},
issn = {1463-1318},
mesh = {Colectomy/*standards ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/surgery ; Diverticulosis, Colonic/*surgery ; Elective Surgical Procedures/standards ; Humans ; Laparoscopy/standards ; Patient Selection ; Sigmoid Diseases/*surgery ; },
}
@article {pmid24113817,
year = {2014},
author = {Hellwig, I and Böttner, M and Barrenschee, M and Harde, J and Egberts, JH and Becker, T and Wedel, T},
title = {Alterations of the enteric smooth musculature in diverticular disease.},
journal = {Journal of gastroenterology},
volume = {49},
number = {8},
pages = {1241-1252},
pmid = {24113817},
issn = {1435-5922},
mesh = {Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Diverticulitis, Colonic/genetics/*pathology ; Down-Regulation ; Female ; Gene Expression Regulation ; Humans ; Immunohistochemistry ; Male ; Microscopy, Electron, Transmission ; Middle Aged ; Muscle, Smooth/cytology/*pathology ; Myenteric Plexus/*pathology ; Myosin Heavy Chains/genetics ; Polymerase Chain Reaction/methods ; RNA, Messenger/metabolism ; Sigmoid Diseases/genetics/*pathology ; },
abstract = {BACKGROUND: The pathogenesis of diverticular disease (DD) is considered to be multifactorial and involves intestinal motor disturbances and an underlying enteric neuromuscular pathology. While an enteric neuropathy has been well documented, actual studies on concomitant alterations of the enteric musculature are limited. This study is aimed at reassessing the smooth muscle tissue by histological, ultrastructural and molecular-biological approaches.
METHODS: Full-thickness sigmoid specimens were obtained from patients with DD (n = 20) and controls (n = 19). Morphometric analysis was performed to evaluate the thickness and connective tissue index of the circular and longitudinal muscle layers as well as the myenteric plexus. Structural alterations were determined by light and transmission electron microscopy. mRNA profiles of components of the contractile smooth muscle apparatus including smooth muscle α-actin, smoothelin, histone deacetylase 8, and smooth muscle myosin heavy chain (SMMHC) were assessed by qPCR. Altered gene expression levels were confirmed at protein level by immunohistochemistry.
RESULTS: Compared to controls, patients with DD showed (1) increased thickness of the circular and longitudinal muscle layers, (2) architectural alterations of smooth muscle cells, (3) increased connective tissue index of the longitudinal muscle layer, (4) focally reduced density of myofilaments at ultrastructural level, (5) specific down-regulation of SMMHC mRNA levels, (6) decreased immunoreactivity of SMMHC, (7) oligo-neuronal hypoganglionosis.
CONCLUSIONS: DD is associated with distinct structural and functional alterations of the enteric musculature. The enteric myopathy is characterized by disturbed muscular architecture, connective tissue replacement and loss of specific myofilaments and thus may contribute to the pathogenesis and progression of DD.},
}
@article {pmid24108380,
year = {2013},
author = {Ruiz D, R and Andrade Anagua, A and Bravo Hinojosa, D},
title = {[Acute portal thrombosis and gas in the liver: a report of two cases].},
journal = {Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru},
volume = {33},
number = {3},
pages = {255-258},
pmid = {24108380},
issn = {1609-722X},
mesh = {Acute Disease ; Aged ; Embolism, Air/*diagnosis ; Female ; Gases ; Humans ; Liver Diseases/*diagnosis ; Male ; Middle Aged ; *Portal Vein ; Venous Thrombosis/*diagnosis ; },
abstract = {The presence in adults of intrahepatic portal gas is a multifactorial event in which systemic inflammatory and prothrombotic factors coexist, it is common in patients with advanced liver cirrhosis and rare in those with a healthy liver, however its frequency increases with the presence of inflammatory abdominal disorders and hypercoagulability related to systemic inflammatory response, their manifestations are unspecific and varies according to severity. We study two cases with unspecific symptoms, where imaging studies reported intrahepatic portal gas, one secondary to diverticular disease and the second related to liver abscesses, which favorably response with surgical, antibiotic and anticoagulant treatment.},
}
@article {pmid24106394,
year = {2013},
author = {Gravante, G and Yahia, S},
title = {Medical influences, surgical outcomes: role of common medications on the risk of perforation from untreated diverticular disease.},
journal = {World journal of gastroenterology},
volume = {19},
number = {36},
pages = {5947-5952},
pmid = {24106394},
issn = {2219-2840},
mesh = {Adrenal Cortex Hormones/*adverse effects ; Age Factors ; Aged ; Aged, 80 and over ; Analgesics, Opioid/*adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Calcium Channel Blockers/*adverse effects ; Diverticulum, Colon/*complications ; Frail Elderly ; Humans ; Intestinal Perforation/chemically induced/*etiology ; Prognosis ; Risk Assessment ; Risk Factors ; },
abstract = {Numerous drugs, largely used in the wards or at home, have a significant influence on patients with untreated diverticular disease. The consequences can be disastrous, may require an emergency operation, postoperative intensive care, and overall influence the patient's length of stay and the final outcomes. Bearing these considerations in mind the routine or chronic administration of pain-killers, steroids and non-steroidal anti-inflammatory should be balanced in patients with known diverticular disease as it normally happens with other conditions potentially affected by these drugs (i.e., peptic ulcer disease or chronic obstructive pulmonary disease). This is even more important in the old and frail patient where an eventual surgical treatment may not always be possible.},
}
@article {pmid24090689,
year = {2013},
author = {Naguib, N and Masoud, AG},
title = {Laparoscopic colorectal surgery for diverticular disease is not suitable for the early part of the learning curve. A retrospective cohort study.},
journal = {International journal of surgery (London, England)},
volume = {11},
number = {10},
pages = {1092-1096},
doi = {10.1016/j.ijsu.2013.09.013},
pmid = {24090689},
issn = {1743-9159},
mesh = {Aged ; Aged, 80 and over ; Chi-Square Distribution ; Digestive System Surgical Procedures/methods ; Diverticulitis, Colonic/*surgery ; Humans ; Laparoscopy/methods ; Length of Stay ; Male ; Middle Aged ; Morbidity ; Operative Time ; Retrospective Studies ; Surgical Wound Infection ; },
abstract = {AIM: We evaluate the challenges of laparoscopic colorectal surgery for diverticular disease.
METHODS: Retrospective study of elective laparoscopic colorectal procedures (LCP) performed 2002-2011. The study compares LCP for Diverticular disease (S group) with both LCP for other pathology (C1 group) and open procedures for diverticular disease (C2 group). Statistical analysis was performed using Fisher's exact test, Student "t" test and Mann Whitney U-test.
RESULTS: The study included 194 LCP out of which 22 were in S group. Conversion rate in S group was 27.3% vs 9.9% in C1 group, p = 0.017. The mean operating time was significantly higher in S group (250 min) compared with 196 min in C1 group, p = 0.0004. The median length of hospital stay was 6 days in S group and 4 days in C group, p = 0.12. Both morbidities and mortality rates were not statistically different between the two groups. In the second part of the study we compare LCP with OCP performed for diverticular disease.
CONCLUSION: LCP for Diverticular disease are technically challenging and should be attempted later in the learning curve.},
}
@article {pmid24070148,
year = {2013},
author = {Guslandi, M},
title = {Probiotics in diverticular disease: not ready for prime time?.},
journal = {Expert review of gastroenterology & hepatology},
volume = {7},
number = {7},
pages = {585-586},
doi = {10.1586/17474124.2013.832491},
pmid = {24070148},
issn = {1747-4132},
mesh = {Animals ; Colon/*microbiology ; Diverticulitis, Colonic/microbiology/*therapy ; Diverticulosis, Colonic/microbiology/*therapy ; Humans ; Probiotics/adverse effects/*therapeutic use ; Recurrence ; Treatment Outcome ; },
}
@article {pmid24051693,
year = {2014},
author = {Lin, J and Welker, NC and Zhao, Z and Li, Y and Zhang, J and Reuss, SA and Zhang, X and Lee, H and Liu, Y and Bronner, MP},
title = {Novel specific microRNA biomarkers in idiopathic inflammatory bowel disease unrelated to disease activity.},
journal = {Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc},
volume = {27},
number = {4},
pages = {602-608},
doi = {10.1038/modpathol.2013.152},
pmid = {24051693},
issn = {1530-0285},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Colitis, Ulcerative/diagnosis/*genetics ; Crohn Disease/diagnosis/*genetics ; Diagnosis, Differential ; Female ; Gene Expression Profiling ; Genetic Markers ; Genetic Predisposition to Disease ; Humans ; Male ; MicroRNAs/*analysis ; Middle Aged ; Phenotype ; Predictive Value of Tests ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis, RNA ; Severity of Illness Index ; Young Adult ; },
abstract = {The diagnosis of idiopathic inflammatory bowel disease can be challenging. MicroRNAs (miRNAs) are small, non-coding RNAs that regulate protein synthesis through post-transcriptional suppression. This study is to identify new miRNA markers in inflammatory bowel disease, and to examine whether miRNA biomarkers might assist in the diagnosis of inflammatory bowel disease. Illumina small RNA sequencing was performed on non-dysplastic fresh-frozen colonic mucosa samples of the distalmost colectomy tissue from 19 patients with inflammatory bowel disease (10 ulcerative colitis and 9 Crohn disease) and 18 patients with diverticular disease serving as controls. To determine differentially expressed miRNAs, the USeq software package identified 44 miRNAs with altered expression (fold change ≥ 2 and false discovery rate ≤ 0.10) compared with the controls. Among them, a panel of nine miRNAs was aberrantly expressed in both ulcerative colitis and Crohn disease. Validation assays performed using quantitative reverse transcription PCR (qRT-PCR) on additional frozen tissue from ulcerative colitis, Crohn disease, and control groups confirmed specific differential expression in inflammatory bowel disease for miR-31, miR-206, miR-424, and miR-146a (P<0.05). The expression of these four miRNAs was further evaluated on formalin-fixed, paraffin-embedded tissue of the distalmost colectomy mucosa from cohorts of diverticular disease controls (n=29), ulcerative colitis (n=36), Crohn disease (n=26), and the other diseases mimicking inflammatory bowel disease including infectious colitis (n=12) and chronic ischemic colitis (n=19), again confirming increased expression specific to inflammatory bowel disease (P<0.05). In summary, we demonstrate that miR-31, miR-206, miR-424, and miR-146a are novel specific biomarkers of inflammatory bowel disease. Furthermore, miR-31 is universally expressed in both ulcerative colitis and Crohn disease not only in fresh-frozen but also in formalin-fixed, paraffin-embedded tissues.},
}
@article {pmid24032118,
year = {2013},
author = {Oh, KH and Han, KH and Kim, EJ and Lee, JH and Choi, KU and Han, MS and Ahn, JH and Cheon, GJ},
title = {Colon cancer after acute diverticulitis treatment.},
journal = {Annals of coloproctology},
volume = {29},
number = {4},
pages = {167-171},
pmid = {24032118},
issn = {2287-9714},
abstract = {Diverticulitis is the most common clinical complication of diverticular disease, affecting 10-25% of the patients with diverticula. The prevalences of diverticulitis and colon cancer tend to increase with age and are higher in industrialized countries. Consequently, diverticulitis and colon cancer have been reported to have similar epidemiological characteristics. However, the relationship between these diseases remains controversial, as is the performance of routine colonoscopy after an episode of diverticulitis to exclude colon cancer. Recently, we experienced three cases of colon cancer after treating acute diverticulitis, based on which we suggest the importance of follow-up colonoscopy after acute diverticulitis.},
}
@article {pmid24010157,
year = {2013},
author = {Templeton, AW and Strate, LL},
title = {Updates in diverticular disease.},
journal = {Current gastroenterology reports},
volume = {15},
number = {8},
pages = {339},
pmid = {24010157},
issn = {1534-312X},
support = {R01 DK084157/DK/NIDDK NIH HHS/United States ; },
mesh = {Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Colonic Neoplasms/etiology ; Dietary Fiber/administration & dosage ; Diverticulitis/drug therapy/*etiology ; Diverticulum, Colon/*etiology ; Gastrointestinal Hemorrhage/etiology ; Genetic Predisposition to Disease ; Humans ; Irritable Bowel Syndrome/etiology ; Risk Factors ; },
abstract = {Diverticulosis and its major complications, diverticulitis and diverticular bleeding, are increasingly common indications for hospitalization and outpatient visits. Recent publications in the field of diverticular disease have challenged long-standing disease concepts and management strategies. This article will highlight studies which have helped to clarify the contribution of genetic factors, fiber consumption and medication use to the development of diverticular disease, the role of antibiotics in the treatment of acute diverticulitis, and the association between diverticulitis, irritable bowel syndrome, and colon cancer.},
}
@article {pmid24003883,
year = {2013},
author = {Vrbenský, L and Simša, J},
title = {[Laparoscopic resection of the sigmoid colon for the diverticular disease].},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {92},
number = {7},
pages = {414-419},
pmid = {24003883},
issn = {0035-9351},
mesh = {Colon, Sigmoid/*surgery ; Diverticulosis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Humans ; Laparoscopy ; Perioperative Care ; },
abstract = {INTRODUCTION: Laparoscopic resection of the sigmoid colon for diverticular disease is nowadays a fully accepted alternative to traditional open procedures.
AIM: The aim of this work is to summarize the indications, advantages and risks of laparoscopic sigmoid resection for diverticular disease.
METHODS: Review of the literature and recent findings concerning the significance of laparoscopic resection for diverticulosis of the sigmoid colon.
CONCLUSION: The article presents the indications, risks, techniques and perioperative care in patients after laparoscopic resection of the sigmoid colon for diverticular disease.},
}
@article {pmid24003882,
year = {2013},
author = {Levý, M and Herdegen, P and Sutoris, K and Simša, J},
title = {[Diverticular disease of the large bowel - surgical treatment].},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {92},
number = {7},
pages = {408-413},
pmid = {24003882},
issn = {0035-9351},
mesh = {Colon/*surgery ; Digestive System Surgical Procedures/*methods/rehabilitation ; Diverticulosis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures ; Humans ; },
abstract = {INTRODUCTION: Surgical treatment, despite the rapid development of the numerous modern miniinvasive intervention techniques, remains essential in the treatment of complicated diverticular disease.
AIM: The aim of this work is to summarize indications for surgical treatment in both acute and elective patients suffering from diverticular disease of the large bowel.
METHODS: Review of the literature and recent findings concerning indications for surgical intervention in patients with diverticulosis of the colon.
CONCLUSION: The article describes indications, types of procedures, techniques and postoperative care in patients undergoing surgical intervention for diverticular disease.},
}
@article {pmid24003881,
year = {2013},
author = {Sečkařová, D and Bočanová-Mlejnková, J and Votrubová, J},
title = {[Diverticular disease of the large bowel - imaging methods].},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {92},
number = {7},
pages = {402-407},
pmid = {24003881},
issn = {0035-9351},
mesh = {*Diagnostic Imaging ; Diverticulosis, Colonic/*diagnosis ; Diverticulum, Colon/*diagnosis ; Humans ; },
abstract = {INTRODUCTION: Imaging methods are fundamental for diagnosis in patients suffering from diverticular disease of the large bowel. In case of complications, radiological intervention can be helpful for treatment.
AIM: The authors aim to summarize current possibilities of imaging methods, both in diagnosis and treatment of diverticular disease.
METHODS: Review of the literature and recent findings in the diagnosis of diverticular disease.
CONCLUSION: The article presents the importance of imaging methods in the diagnosis and treatment of patients with diverticular disease.},
}
@article {pmid23992370,
year = {2013},
author = {Cuomo, R and Barbara, G and Andreozzi, P and Bassotti, G and Casetti, T and Grassini, M and Ierardi, E and Maconi, G and Marchi, S and Sarnelli, G and Savarino, V and Usai, P and Vozzella, L and Annibale, B},
title = {Symptom patterns can distinguish diverticular disease from irritable bowel syndrome.},
journal = {European journal of clinical investigation},
volume = {43},
number = {11},
pages = {1147-1155},
doi = {10.1111/eci.12152},
pmid = {23992370},
issn = {1365-2362},
mesh = {Abdominal Pain/etiology ; Adolescent ; Adult ; Aged ; Case-Control Studies ; Constipation/etiology ; Diagnosis, Differential ; Diarrhea/etiology ; Diverticulitis, Colonic/*diagnosis ; Female ; Flatulence/etiology ; Humans ; Irritable Bowel Syndrome/*diagnosis ; Male ; Middle Aged ; Young Adult ; },
abstract = {BACKGROUND: Diverticular disease (DD) and irritable bowel syndrome (IBS) share a similar symptom pattern. However, comparative studies are flawed by different age at onset of symptoms. We aimed to verify whether clinical features distinguish DD from IBS.
MATERIALS AND METHODS: Patients with DD or IBS, matched for age and gender (1/1) were consecutively recruited. Data on demographic parameters, voluptuary habits, inheritance of disease and symptoms were collected. Moreover, the association between pain > 24 h, and clinical parameters were evaluated.
RESULTS: Ninety patients with DD and 90 patients with IBS (DD: F/M: 46/44; age: 50.9 years; IBS: 46/44; 50.4) were selected from an overall population of 1275 patients. Only nine patients with DD (10%) fulfilled the criteria for IBS diagnosis. Abdominal pain > 24 h was more prevalent in SDD than in patients with IBS (20 vs. 6 patients; P < 0.01). Furthermore, compared with IBS, patients with DD showed more episodes of pain > 24 h requiring medical attention (80% vs. 33%; P < 0.01).
CONCLUSIONS: Abdominal pain lasting for more than 24 h discriminates patients with DD compared with those with IBS. Identifying this symptom could be an appropriate strategy to define the diagnosis and management.},
}
@article {pmid23983906,
year = {2013},
author = {De'angelis, N and Brunetti, F and Memeo, R and Batista da Costa, J and Schneck, AS and Carra, MC and Azoulay, D},
title = {Comparison between open and laparoscopic reversal of Hartmann's procedure for diverticulitis.},
journal = {World journal of gastrointestinal surgery},
volume = {5},
number = {8},
pages = {245-251},
pmid = {23983906},
issn = {1948-9366},
abstract = {AIM: To compare the open and laparoscopic Hartmann's reversal in patients first treated for complicated diverticulitis.
METHODS: Forty-six consecutive patients with diverticular disease were included in this retrospective, single-center study of a prospectively maintained colorectal surgery database. All patients underwent conventional Hartmann's procedures for acute complicated diverticulitis. Other indications for Hartmann's procedures were excluded. Patients underwent open (OHR) or laparoscopic Hartmann's reversal (LHR) between 2000 and 2010, and received the same pre- and post-operative protocols of cares. Operative variables, length of stay, short- (at 1 mo) and long-term (at 1 and 3 years) post-operative complications, and surgery-related costs were compared between groups.
RESULTS: The OHR group consisted of 18 patients (13 males, mean age ± SD, 61.4 ± 12.8 years), and the LHR group comprised 28 patients (16 males, mean age 54.9 ± 14.4 years). The mean operative time and the estimated blood loss were higher in the OHR group (235.8 ± 43.6 min vs 171.1 ± 27.4 min; and 301.1 ± 54.6 mL vs 225 ± 38.6 mL respectively, P = 0.001). Bowel function returned in an average of 4.3 ± 1.7 d in the OHR group, and 3 ± 1.3 d in the LHR group (P = 0.01). The length of hospital stay was significantly longer in the OHR group (11.2 ± 5.3 d vs 6.7 ± 1.9 d, P < 0.001). The 1 mo complication rate was 33.3% in the OHR (6 wound infections) and 3.6% in the LHR group (1 hemorrhage) (P = 0.004). At 12 mo, the complication rate remained significantly higher in the OHR group (27.8% vs 10.7%, P = 0.03). The anastomotic leak and mortality rates were nil. At 3 years, no patient required re-intervention for surgical complications. The OHR procedure had significantly higher costs (+56%) compared to the LHR procedure, when combining the surgery-related costs and the length of hospital stay.
CONCLUSION: LHR appears to be a safe and feasible procedure that is associated with reduced hospitality stays, complication rates, and costs compared to OHR.},
}
@article {pmid23981120,
year = {2014},
author = {Tsiamoulos, ZP and Peake, ST and Nickerson, C and Rutter, MD and Saunders, BP},
title = {Does diverticular disease protect against sigmoid colon cancer?.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {16},
number = {1},
pages = {70-71},
doi = {10.1111/codi.12390},
pmid = {23981120},
issn = {1463-1318},
mesh = {Colonoscopy ; Diverticulitis, Colonic/epidemiology ; Diverticulosis, Colonic/*epidemiology ; Humans ; Retrospective Studies ; Sigmoid Diseases/epidemiology ; Sigmoid Neoplasms/*epidemiology ; },
}
@article {pmid23957734,
year = {2013},
author = {Tursi, A and Brandimarte, G and Elisei, W and Picchio, M and Forti, G and Pianese, G and Rodino, S and D'Amico, T and Sacca, N and Portincasa, P and Capezzuto, E and Lattanzio, R and Spadaccini, A and Fiorella, S and Polimeni, F and Polimeni, N and Stoppino, V and Stoppino, G and Giorgetti, GM and Aiello, F and Danese, S},
title = {Randomised clinical trial: mesalazine and/or probiotics in maintaining remission of symptomatic uncomplicated diverticular disease--a double-blind, randomised, placebo-controlled study.},
journal = {Alimentary pharmacology & therapeutics},
volume = {38},
number = {7},
pages = {741-751},
doi = {10.1111/apt.12463},
pmid = {23957734},
issn = {1365-2036},
mesh = {Abdominal Pain/etiology ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/*therapeutic use ; Diverticulum, Colon/*drug therapy/pathology ; Double-Blind Method ; Female ; Follow-Up Studies ; Humans ; Lactobacillus ; Male ; Mesalamine/administration & dosage/*therapeutic use ; Middle Aged ; Probiotics/*therapeutic use ; Secondary Prevention ; Treatment Outcome ; },
abstract = {BACKGROUND: Placebo-controlled studies in maintaining remission of symptomatic uncomplicated diverticular disease (SUDD) of the colon are lacking.
AIM: To assess the effectiveness of mesalazine and/or probiotics in maintaining remission in SUDD.
METHODS: A multicentre, double-blind, placebo-controlled study was conducted. Two hundred and ten patients were randomly enrolled in a double-blind fashion in four groups: Group M (active mesalazine 1.6 g/day plus Lactobacillus casei subsp. DG placebo), Group L (active Lactobacillus casei subsp. DG 24 billion/day plus mesalazine placebo), Group LM (active Lactobacillus casei subsp. DG 24 billion/day plus active mesalazine), Group P (Lactobacillus casei subsp. DG placebo plus mesalazine placebo). Patients received treatment for 10 days/month for 12 months. Recurrence of SUDD was defined as the reappearance of abdominal pain during follow-up, scored as ≥5 (0: best; 10: worst) for at least 24 consecutive hours.
RESULTS: Recurrence of SUDD occurred in no (0%) patient in group LM, in 7 (13.7%) patients in group M, in 8 (14.5%) patients in group L and in 23 (46.0%) patients in group P (LM group vs. M group, P = 0.015; LM group vs. L group, P = 0.011; LM group vs. P group, P = 0.000; M group vs. P group, P = 0.000; L group vs. P group, P = 0.000). Acute diverticulitis occurred in six group P cases and in one group L case (P = 0.003).
CONCLUSION: Both cyclic mesalazine and Lactobacillus casei subsp. DG treatments, particularly when given in combination, appear to be better than placebo for maintaining remission of symptomatic uncomplicated diverticular disease. (ClinicalTrials.gov: NCT01534754).},
}
@article {pmid23951394,
year = {2013},
author = {Azzam, N and Aljebreen, AM and Alharbi, O and Almadi, MA},
title = {Prevalence and clinical features of colonic diverticulosis in a Middle Eastern population.},
journal = {World journal of gastrointestinal endoscopy},
volume = {5},
number = {8},
pages = {391-397},
pmid = {23951394},
issn = {1948-5190},
abstract = {AIM: To determine the prevalence, location, associations and clinical features of colonic-diverticulosis and its role as a cause of lower-gastroenterology-bleeding.
METHODS: We retrospectively reviewed the medical records of 3649 consecutive patients who underwent a colonoscopy for all indications between 2007 and 2011 at King Khalid University Hospital, Riyadh, Saudi Arabia. The demographic data were collected retrospectively through the hospital's information system, electronic file system, endoscopic e-reports, and manual review of the files by two research assistants. The demographic information included the age, sex, comorbidities and indication for the colonoscopy. The association among colonic polyps, comorbidities and diverticular disease was also measured.
RESULTS: A total of 270 patients out of 3649 were diagnosed with colonic diverticulosis, with a prevalence of 7.4%. The mean age was 60.82 years ± 0.833, (range 12-110). Females comprised 38.89% (95%CI: 33-44.7) of the study population. The major symptoms were rectal bleeding in 33.6%, abdominal pain in 19.3%, constipation in 12.8% and anemia in 6%. Diverticula were predominantly left-sided (sigmoid and descending colon) in 62%, right-sided in 13% and in multiple locations in 25%. There was an association between the presence of diverticulosis and adenomatous polyps (P-value < 0.001), hypertension (P-value < 0.0001) and diabetes mellitus (P-value < 0.0016). Diverticular disease was the second most common cause of lower gastrointestinal bleeding, in 33.6% (95%CI: 27.7-39.4), after internal hemorrhoids, in 44.6% (95%CI: 40.3-48.9). On multivariable logistic regression, hypertension (OR = 2.30; 95%CI: 1.29-4.10), rectal bleeding (OR = 2.57; 95%CI: 1.50-4.38), and per year increment in age (OR = 1.05; 95%CI: 1.03-1.07) were associated with diverticulosis but not with bleeding diverticular disease.
LIMITATIONS: A small proportion of the patients included had colonoscopies performed as a screening test.
CONCLUSION: Colonic-diverticulosis was found to have a low prevalence, be predominantly left-sided and associated with adenomatous-polyps. Age, hypertension and rectal bleeding predict the presence of diverticular disease.},
}
@article {pmid23929019,
year = {2013},
author = {Kwaan, MR and Vogler, SA and Sun, MY and Sirany, AM and Melton, GB and Madoff, RD and Rothenberger, DA},
title = {Readmission after colorectal surgery is related to preoperative clinical conditions and major complications.},
journal = {Diseases of the colon and rectum},
volume = {56},
number = {9},
pages = {1087-1092},
doi = {10.1097/DCR.0b013e31829aa758},
pmid = {23929019},
issn = {1530-0358},
mesh = {Adult ; Aged ; *Colectomy ; Colonic Diseases/*surgery ; Female ; Humans ; Male ; Middle Aged ; Models, Statistical ; Multivariate Analysis ; Outcome Assessment, Health Care ; Patient Readmission/*statistics & numerical data ; Postoperative Complications/epidemiology/*therapy ; *Preoperative Period ; Rectal Diseases/*surgery ; Rectum/*surgery ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND: Hospital readmission is increasingly perceived as a marker of quality and is poorly investigated in patients receiving colorectal surgery.
OBJECTIVE: The objective of this study was to describe patterns and etiology of readmission, to determine the rate of readmission, and to identify risk factors for readmission after colorectal surgery.
DESIGN: This study is a retrospective medical chart review. Significant (p < 0.1) preoperative and perioperative factors associated with readmission on univariate analysis were examined in a multivariable model.
SETTING: The investigation was conducted in a tertiary care hospital.
PATIENTS: Patients included adults undergoing major colorectal operations by colorectal surgeons at the University of Minnesota in 2008-2009.
MAIN OUTCOME MEASURES: The primary outcome measure was hospital readmission at 60 days.
RESULTS: The study included 220 patients. Common surgical indications were inflammatory bowel disease (21%), colorectal cancer (39%), and diverticular disease (13%), and 11% were emergencies. Readmissions at 60 days occurred in 25% (n = 54), mostly because of major complications (57%), nonspecific nausea, vomiting and/or pain (18%), dehydration (11%), and wound infections (11%). Predictors of readmission in multivariable analysis were major complications (OR, 13.0), female sex (OR, 5.9), prednisone use (OR, 4.3), BMI ≥30 (OR, 2.6), and preoperative weight loss (OR, 3.4). Age and comorbidity (Charlson score) were not predictors.
LIMITATIONS: This was a retrospective study at a single institution, with a small sample size.
CONCLUSIONS: Predictors of readmission were major complications and immediate preoperative condition of the patients. Comorbidity profiling does not capture readmission risk. Because most readmissions relate to complications, further efforts to prevent these will improve readmission rates.},
}
@article {pmid23923764,
year = {2013},
author = {Barret, M and Abbes, L and Zinzindohoué, F},
title = {[Follow-up and dietary advice after sigmoid diverticulitis].},
journal = {La Revue du praticien},
volume = {63},
number = {6},
pages = {830-833},
pmid = {23923764},
issn = {0035-2640},
mesh = {*Diet ; Directive Counseling/*methods ; Diverticulitis, Colonic/complications/diet therapy/prevention & control/*therapy ; Follow-Up Studies ; Humans ; Hygiene ; Patient Education as Topic ; Primary Prevention/methods ; Secondary Prevention/*methods ; Sigmoid Diseases/complications/diet therapy/prevention & control/*therapy ; },
abstract = {Currently published data do not demonstrate the benefit of any medical treatment in the prevention of the onset or the recurrence of colonic diverticular disease. No specific diet can be recommended to patients with colonic diverticula for the prevention of diverticular disease. Non steroidal anti-inflammatory drugs as well as corticosteroids should be used cautiously in patients with diverticular disease since they induce a higher rate of complications, especially diverticular haemorrhage and severe sigmoid diverticulitis. In patients over 50 years old, or if a sigmoidectomy is needed, physicians should perform a colonoscopy in order to rule out colonic polyps or neoplasm.},
}
@article {pmid23918084,
year = {2013},
author = {Zdichavsky, M and Kratt, T and Stüker, D and Meile, T and Feilitzsch, MV and Wichmann, D and Königsrainer, A},
title = {Acute and elective laparoscopic resection for complicated sigmoid diverticulitis: clinical and histological outcome.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {17},
number = {11},
pages = {1966-1971},
pmid = {23918084},
issn = {1873-4626},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; *Colectomy/adverse effects/methods ; Colon, Sigmoid/pathology/*surgery ; Diverticulitis, Colonic/pathology/*surgery ; Elective Surgical Procedures ; Female ; Health Status ; Humans ; Laparoscopy/adverse effects ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Recurrence ; Retrospective Studies ; },
abstract = {BACKGROUND: Surgical treatment of acute complicated sigmoid diverticulitis is still under debate while elective treatment of recurrent diverticulitis has proven benefits. The aim of this study was to evaluate the clinical and histological outcome of acute and elective laparoscopic sigmoid colectomy in patients with diverticulitis.
METHODS: A retrospective review was conducted where 197 patients were analyzed undergoing laparoscopic sigmoid resection for acute complicated diverticulitis and recurrent diverticulitis. Single-stage laparoscopic resection and primary anastomosis were routinely performed using a 3-trocar technique. Recorded data included age, sex, American Society of Anesthesiologists (ASA)-score, operative time, duration of hospital stay, complications, and histological results.
RESULTS: Ninety-one patients received laparoscopy for acute diverticular disease (group I) and 93 patients underwent elective laparoscopic sigmoid resection for diverticulitis (group II). M/F ratio was 49:42 for group I and 37:56 for group II. Mean operative time and hospital stay was similar in both groups. Majority of patients were ASA II in both groups. Rate of minor complications was 14.3 % in group I and 7.5 % in group II. Major complications were 2.2 % for acute treatment and 4.3 % for elective resections. No anastomotic leakage and no mortality occurred. In 32.3 % of the patients of elective group II, destruction of the colonic wall with pericolic abscess, fistulization, or fibrinoid purulent peritonitis were identified.
CONCLUSIONS: Laparoscopic surgery for acute diverticular disease is safe and effective. Continuing bowl inflammations in histological specimens justify sigmoid resection in elective patients, but more effective pre-operative parameters need to be found to identify patients that would benefit from surgery during the initial episode.},
}
@article {pmid23917777,
year = {2013},
author = {Fiori, R and Izzo, L and Forcione, A and Bolognese, A and Izzo, S and Nano, G and Di Poce, I and Simonetti, G},
title = {Colovesical fistula in sigmoid diverticulitis. A case report.},
journal = {Annali italiani di chirurgia},
volume = {84},
number = {4},
pages = {477-481},
pmid = {23917777},
issn = {2239-253X},
mesh = {Aged ; Diverticulitis/*complications ; Female ; Humans ; Intestinal Fistula/*etiology ; Sigmoid Diseases/*complications ; },
abstract = {Colonic diverticulosis has continuously increased, noticeably left-sided disease. Colovesical fistula is an uncommon complication of diverticulitis, and its most common cause is diverticular disease. Pneumaturia and fecaluria are commonly related symptoms. We present the case of a 79-year-old woman complaining pneumaturia and fecaluria. Abdominal CT showed a colovesical fistula due to sigmoid diverticulitis. After surgical adhesiolysis between the sigmoid colon and the bladder, the defect of the bladder wall was repaired by simple closure. The colonic defect was treated by segmental resection including the rectosigmoid junction. Following the operation the patient continuously improved at months 6, 12 and 18 without evidence of recurrences.},
}
@article {pmid23913315,
year = {2013},
author = {Alizai, PH and Schulze-Hagen, M and Klink, CD and Ulmer, F and Roeth, AA and Neumann, UP and Jansen, M and Rosch, R},
title = {Primary anastomosis with a defunctioning stoma versus Hartmann's procedure for perforated diverticulitis--a comparison of stoma reversal rates.},
journal = {International journal of colorectal disease},
volume = {28},
number = {12},
pages = {1681-1688},
pmid = {23913315},
issn = {1432-1262},
mesh = {Aged ; Anastomosis, Surgical ; Digestive System Surgical Procedures/*methods ; Diverticulitis/*complications/*surgery ; Diverticulum/pathology/*surgery ; Female ; Humans ; Intestinal Perforation/*complications/*surgery ; Male ; Surgical Stomas/*pathology ; },
abstract = {PURPOSE: The ideal treatment of patients with perforated diverticulitis is still controversial. Hartmann's procedure has been the treatment of choice for decades, but primary anastomosis with a defunctioning stoma has become an accepted alternative. The aim of this study was to evaluate the stoma reversal rates after these two surgical strategies.
METHODS: A retrospective review of the data from patients with perforated sigmoid diverticulitis between 2002 and 2011 undergoing a Hartmann's procedure (HP) versus a primary anastomosis with a defunctioning stoma (PA) was performed. Additionally, patients were contacted by mail or telephone in March 2012 using a standardized questionnaire.
RESULTS: A total of 98 patients were identified: 72 undergoing HP and 26 patients receiving PA. The median follow-up time was 63 months (range 4-118). Whilst 85 % of patients with PA have had their stoma reversed, only 58 % of patients with an HP had a stoma reversal (p = 0.046). The median period until stoma reversal was significantly longer for HP (19 weeks) than for PA (12 weeks; p = 0.03). The 30-day mortality for PA was 12 % as opposed to 25 % for HP (p = 0.167). According to the Clavien-Dindo classification, surgical complications occurred significantly less frequently in patients with PA (p = 0.014).
CONCLUSION: The stoma reversal rates for PA are significantly higher than for HP. Thus, depending on the overall clinical situation, primary resection and anastomosis with a proximal defunctioning stoma might be the optimal procedure for selected patients with perforated diverticular disease.},
}
@article {pmid23902791,
year = {2013},
author = {Mazzei, MA and Cioffi Squitieri, N and Guerrini, S and Stabile Ianora, AA and Cagini, L and Macarini, L and Giganti, M and Volterrani, L},
title = {Sigmoid diverticulitis: US findings.},
journal = {Critical ultrasound journal},
volume = {5 Suppl 1},
number = {Suppl 1},
pages = {S5},
pmid = {23902791},
issn = {2036-3176},
abstract = {Acute diverticulitis (AD) results from inflammation of a colonic diverticulum. It is the most common cause of acute left lower-quadrant pain in adults and represents a common reason for acute hospitalization, as it affects over half of the population over 65 years with a prevalence that increases with age. Although 85% of colonic diverticulitis will recover with a nonoperative treatment, some patients may have complications such as abscesses, fistulas, obstruction, and /or perforation at presentation. For these reasons, different classifications were introduced through times to help clinicians to develop a correct diagnosis and guide the treatment and for the same reasons imaging is used in most cases both to realise a differential diagnosis and to guide the therapeutic management. US and CT are both usefull in diagnosis of diverticolitis, and their sensibility and specificity are similar. However CT scanning is essential for investigating complicated diverticular disease especially where there are diffuse signs and clinical suspicion of secondary peritonitis; instead in most uncomplicated cases the experienced sonographer may quickly confirm a diagnosis guided by the clinical signs. US is to be recommended in premenopausal women, and in young people to reduce dose exposure.},
}
@article {pmid23899280,
year = {2013},
author = {Tursi, A},
title = {Mesalazine in treating diverticular disease of the colon.},
journal = {Expert review of gastroenterology & hepatology},
volume = {7},
number = {5},
pages = {409-412},
doi = {10.1586/17474124.2013.811029},
pmid = {23899280},
issn = {1747-4132},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulosis, Colonic/*drug therapy ; Female ; Humans ; Male ; Mesalamine/*therapeutic use ; },
abstract = {Evaluation of: Kruis W, Meier E, Schumacher M, Mickisch O, Greinwald R, Mueller R; German SAG-20 Study Group. Randomised clinical trial: mesalazine (Salofalk granules) for uncomplicated diverticular disease of the colon - a placebo-controlled study. Aliment. Pharmacol. Ther. 37(7), 680-690 (2013). Although diverticular disease (DD) is one of the commonest diseases in the western world, robust evidences about its treatment are lack so far. A recent, placebo-controlled study found mesalazine effective in obtaining pain relief in patients suffering from DD. A brief comment is provided herein in order to assess the rationale of this drug in treating DD.},
}
@article {pmid23893271,
year = {2013},
author = {Gallagher, KL},
title = {Ischaemic diverticular disease may mimic acute appendicitis.},
journal = {BMJ case reports},
volume = {2013},
number = {},
pages = {},
pmid = {23893271},
issn = {1757-790X},
mesh = {Acute Disease ; Aged, 80 and over ; Appendicitis/diagnosis ; Cecal Diseases/*diagnosis ; Cecum/*blood supply ; Diagnosis, Differential ; Diverticulum/*diagnosis ; Humans ; Ischemia/*diagnosis ; Male ; },
abstract = {An 81-year-old man with a medical history significant for diverticulosis and irritable bowel syndrome presented to the emergency department with a 1-day history of periumbilical pain that woke him from sleep and ultimately localised to his right lower quadrant. He reported nausea, anorexia and chills but denied vomiting, diarrhoea, melena, hematochezia or fever. His physical exam was notable for focal tenderness at McBurney's point. Diagnostic information included a normal white blood cell count and an abdominal CT scan that demonstrated a normal appendix with no other pathology noted. The patient opted to proceed with laparoscopy where a normal appendix was found. The caecum, however, contained a large ischaemic diverticulum not noted on CT scan. Following laparoscopic ileocecectomy, pathology demonstrated haemorrhage, inflammation, oedema and full thickness necrosis of the caecal wall. Recovery was uneventful; the patient was discharged from the hospital 3 days following surgery.},
}
@article {pmid23891924,
year = {2013},
author = {Peery, AF and Sandler, RS and Ahnen, DJ and Galanko, JA and Holm, AN and Shaukat, A and Mott, LA and Barry, EL and Fried, DA and Baron, JA},
title = {Constipation and a low-fiber diet are not associated with diverticulosis.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {11},
number = {12},
pages = {1622-1627},
pmid = {23891924},
issn = {1542-7714},
support = {R01 CA098286/CA/NCI NIH HHS/United States ; R01 DK094738/DK/NIDDK NIH HHS/United States ; T32 DK007634/DK/NIDDK NIH HHS/United States ; P30 DK034987/DK/NIDDK NIH HHS/United States ; T32 DK07634/DK/NIDDK NIH HHS/United States ; },
mesh = {Adult ; Aged ; Colonoscopy ; Constipation/*complications ; Cross-Sectional Studies ; Dietary Fiber/*administration & dosage ; Diverticulum/*epidemiology ; *Feeding Behavior ; Female ; Humans ; Male ; Middle Aged ; Motor Activity ; Risk Assessment ; },
abstract = {BACKGROUND & AIMS: Asymptomatic diverticulosis is commonly attributed to constipation caused by a low-fiber diet, although evidence for this mechanism is limited. We examined the associations between constipation and low dietary fiber intake with risk of asymptomatic diverticulosis.
METHODS: We performed a cross-sectional study that analyzed data from 539 individuals with diverticulosis and 1569 without (controls). Participants underwent colonoscopy and assessment of diet, physical activity, and bowel habits. Our analysis was limited to participants with no knowledge of their diverticular disease to reduce the risk of biased responses.
RESULTS: Constipation was not associated with an increased risk of diverticulosis. Participants with less frequent bowel movements (<7/wk) had reduced odds of diverticulosis compared with those with regular bowel movements (7/wk) (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.40-0.80). Those reporting hard stools also had reduced odds (OR, 0.75; 95% CI, 0.55-1.02). There was no association between diverticulosis and straining (OR, 0.85; 95% CI, 0.59-1.22) or incomplete bowel movement (OR, 0.85; 95% CI, 0.61-1.20). We found no association between dietary fiber intake and diverticulosis (OR, 0.96; 95% CI, 0.71-1.30) in comparing the highest quartile with the lowest (mean intake, 25 vs 8 g/day).
CONCLUSIONS: In our cross-sectional, colonoscopy-based study, neither constipation nor a low-fiber diet was associated with an increased risk of diverticulosis.},
}
@article {pmid23884746,
year = {2013},
author = {Pfützer, RH and Kruis, W},
title = {[Diverticulosis and diverticular disease].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {138},
number = {31-32},
pages = {1592-1594},
doi = {10.1055/s-0033-1343284},
pmid = {23884746},
issn = {1439-4413},
mesh = {Anti-Inflammatory Agents/administration & dosage ; Diet Therapy/*trends ; Dietary Fiber/*therapeutic use ; Diverticulum/*diagnosis/*therapy ; Gastrointestinal Diseases/*diagnosis/*therapy ; Humans ; Mesalamine/*administration & dosage ; },
}
@article {pmid23856358,
year = {2013},
author = {Shahedi, K and Fuller, G and Bolus, R and Cohen, E and Vu, M and Shah, R and Agarwal, N and Kaneshiro, M and Atia, M and Sheen, V and Kurzbard, N and van Oijen, MG and Yen, L and Hodgkins, P and Erder, MH and Spiegel, B},
title = {Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {11},
number = {12},
pages = {1609-1613},
pmid = {23856358},
issn = {1542-7714},
support = {T32 HS000046/HS/AHRQ HHS/United States ; },
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; Diverticulitis/*epidemiology ; Diverticulum/*complications/*diagnosis ; Female ; Humans ; Los Angeles/epidemiology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Risk Assessment ; Veterans ; },
abstract = {BACKGROUND & AIMS: Colonic diverticulosis is the most common finding during routine colonoscopy, and patients often question the significance of these lesions. Guidelines state that these patients have a 10% to 25% lifetime risk of developing acute diverticulitis. However, this value was determined based on limited data, collected before population-based colonoscopy, so the true number of cases of diverticulosis was not known. We measured the long-term risk of acute diverticulitis among patients with confirmed diverticulosis discovered incidentally on colonoscopy.
METHODS: We performed a retrospective study using administrative and clinical data from the Veterans Affairs Greater Los Angeles Healthcare System, collecting data on patients who underwent colonoscopies from January 1996 through January 2011. We identified patients diagnosed with diverticulosis, determined incidence rates per 1000 patient-years, and analyzed a subgroup of patients with rigorously defined events confirmed by imaging or surgery. We used a Cox proportional hazards model to identify factors associated with the development of diverticulitis.
RESULTS: We identified 2222 patients with baseline diverticulosis. Over an 11-year follow-up period, 95 patients developed diverticulitis (4.3%; 6 per 1000 patient-years); of these, 23 met the rigorous definition of diverticulitis (1%; 1.5 per 1000 patient-years). The median time-to-event was 7.1 years. Each additional decade of age at time of diagnosis reduced the risk for diverticulitis by 24% (hazard ratio, 0.76; 95% confidence interval, 0.6-0.9).
CONCLUSIONS: Based on a study of the Veterans Affairs Greater Los Angeles Healthcare System, only about 4% of patients with diverticulosis develop acute diverticulitis, contradicting the common belief that diverticulosis has a high rate of progression. We also found that younger patients have a higher risk of diverticulitis, with risk increasing per year of life. These results can help inform patients with diverticulosis about their risk of developing acute diverticulitis.},
}
@article {pmid23847809,
year = {2013},
author = {Arabadzhieva, E},
title = {The role of surgery in treatment of diverticular disease of lower gastrointestinal tract.},
journal = {Khirurgiia},
volume = {},
number = {1},
pages = {36-46},
pmid = {23847809},
issn = {0450-2167},
mesh = {Acute Disease ; Diverticulitis/complications/pathology/*surgery ; Diverticulum/complications/pathology/*surgery ; Hemorrhage/complications/pathology/surgery ; Humans ; Lower Gastrointestinal Tract/pathology/*surgery ; },
abstract = {Diverticulosis of lower gastrointestinal tract is a common disease with potentially lethal complications. Recent studies demonstrated that the number of attacks of uncomplicated diverticulitis is not necessarily an overriding factor in defining the appropriateness of surgery so the approach has to be more individualized. On the other hand, the complicated diverticular disease requires surgical treatment, often matter of urgency, and depends on localization and severity of the process. There is not sufficient evidence supporting the aggressive approach to treatment in younger patients. The available evidence suggests that surgery should be indicated after one attack of uncomplicated disease in immunocompromised individuals.},
}
@article {pmid23847804,
year = {2013},
author = {Arabadzhieva, E and Boney, S and Dimitrova, V},
title = {Surgical management of complicated small bowel diverticular disease. About 4 clinical reports.},
journal = {Khirurgiia},
volume = {},
number = {1},
pages = {8-11},
pmid = {23847804},
issn = {0450-2167},
mesh = {Aged ; Aged, 80 and over ; Diverticulitis/complications/*surgery ; Diverticulum/complications/*surgery ; Female ; Humans ; Intestinal Perforation/complications/surgery ; Intestine, Small/*surgery ; Male ; Meckel Diverticulum/complications/*surgery ; Middle Aged ; Retrospective Studies ; Young Adult ; },
abstract = {Diverticula of the small intestine are relatively rare. A retrospective analysis of 4 cases of the practice of Department of General and Hepatopancreatic surgery, University Hospital "Alexandrovska"--Sofia was performed. Two patients are with Meckel diverticulum--the first one with diverticulitis, and the second with perforation and formed abscess cavity. The third case presents a patient with an intestinal loop with diverticula accreted in hernial sack and forth one is with diverticular perforation of the small intestine. All of them underwent surgery. This is accomplished with a literature review presenting the possible diagnostic and treatment modalities applied to this disease. Complications of intestinal diverticulosis often require surgical management in urgent conditions.},
}
@article {pmid23842004,
year = {2013},
author = {Stockl, T and Ross, JS and Walter, O and Dresser, K and Lee, H},
title = {Appendiceal mucosal Schwann cell proliferation: a putative histologic marker of appendiceal diverticular disease.},
journal = {International journal of surgical pathology},
volume = {21},
number = {6},
pages = {603-609},
doi = {10.1177/1066896913494795},
pmid = {23842004},
issn = {1940-2465},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendiceal Neoplasms/pathology ; Appendix/*pathology ; *Cell Proliferation ; Child ; Child, Preschool ; Diverticulum/*pathology ; Female ; Humans ; Hyperplasia/pathology ; Immunohistochemistry ; Infant ; Infant, Newborn ; Intestinal Diseases/*pathology ; Intestinal Mucosa/*pathology ; Male ; Middle Aged ; Retrospective Studies ; Schwann Cells/*pathology ; Young Adult ; },
abstract = {Recognition of an appendiceal diverticulum is important because of its association with an appendiceal neoplasm. The incidence of mucosal Schwann cell proliferation in 24 cases of appendiceal diverticular disease, 17 serrated polyps, 4 cases of mucosal hyperplasia, and 45 normal appendices was determined. Ten (42%) of 24 cases with diverticula, 2 (50%) of 4 cases of mucosal hyperplasia with concurrent surface low-grade dysplasia, and 9 (20%) of 45 cases of normal appendices showed mucosal Schwann cell proliferation. It was not seen within the 17 cases of serrated polyps. Mucosal Schwann cell proliferation is common in appendiceal diverticular disease and may serve as a histologic marker for the presence of an appendiceal diverticulum. Thus, when routine histologic sections of a removed appendix demonstrate Schwann cell proliferation, further examination of the specimen may detect possible coexisting diverticular disease, which in turn may be associated with appendiceal neoplasms and epithelial dysplasia.},
}
@article {pmid23838742,
year = {2013},
author = {van de Wall, BJ and Draaisma, WA and van Iersel, JJ and Consten, EC and Wiezer, MJ and Broeders, IA},
title = {Elective resection for ongoing diverticular disease significantly improves quality of life.},
journal = {Digestive surgery},
volume = {30},
number = {3},
pages = {190-197},
doi = {10.1159/000346482},
pmid = {23838742},
issn = {1421-9883},
mesh = {Abdominal Pain/etiology ; Aged ; Colon, Sigmoid/*surgery ; Defecation ; Diverticulitis, Colonic/*complications/*surgery ; *Elective Surgical Procedures/adverse effects ; Fatigue/etiology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; *Quality of Life ; Recurrence ; Retrospective Studies ; Surveys and Questionnaires ; },
abstract = {BACKGROUND: Although the risks of elective resection for diverticular disease are well studied, studies on subjective improvement are scarce. This study aims to investigate subjective improvement.
METHODS: All patients who underwent elective resection for recurring or persisting complaints after an episode of diverticulitis were identified from an in-hospital database. Patients with at least 1 year of follow-up were sent visual analogue scales (VAS) to grade their quality of life (QoL) and the degree of discomfort caused by abdominal pain, abnormal defecation and fatigue before and after resection.
RESULTS: One hundred and five patients responded to the questionnaire (response rate 76.6%). The median follow-up was 33 (15-53) months. Elective resection improved general QoL (median VAS improvement 40) and reduced discomfort caused by abdominal pain (median VAS improvement 60) in up to 89.3 and 87.5% of patients, respectively. The effects of elective resection are less profound for discomfort caused by abnormal defecation (77.1%, median VAS improvement 33) and fatigue (75.2%, median VAS improvement 30).
CONCLUSION: Elective resection of the sigmoid for persisting or recurring symptoms after an episode of diverticulitis improves general QoL and discomfort caused by abdominal pain, abnormal defecation and fatigue in the vast majority of patients.},
}
@article {pmid23837101,
year = {2013},
author = {Giovanni, C and Emanuele, C and Roberto, C and Alberto, P and Emanuele, L and Alessia, C and Francesco, B and Ettore, M},
title = {Laparoscopic conservative surgery of colovesical fistula: is it the right way?.},
journal = {Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques},
volume = {8},
number = {2},
pages = {162-165},
pmid = {23837101},
issn = {1895-4588},
abstract = {Enterovesical fistula is a rare disease. The standard treatment of colovesical fistula is removal of the fistula, suture of the bladder wall, and colic resection with or without temporary colostomy. The usual approach is open because the laparoscopic one has high conversion rates and morbidity. We report the first laparoscopic conservative treatment of colovesical fistula in our knowledge and its long-term results. A 69-year-old man was affected by colovesical fistula due to endoscopic exeresis of a 2 cm adenomatous polyp in the sigmoid diverticulum. We performed a laparoscopic conservative treatment of the fistula without colic resection. Operative time was 210 min and estimated blood loss was 300 ml. The catheter was removed after 10 days. Time to first flatus was 2 days and the hospital stay was 8 days. No peri- or post-operative complications occurred. At 48-month follow-up fistula did not recur. Laparoscopic conservative surgery for colovesical fistula is safe and feasible. It could be a therapeutic option in selected cases, especially if diverticular disease and inflammation are slight.},
}
@article {pmid23836115,
year = {2013},
author = {Tan, KK and Shore, T and Strong, DH and Ahmad, MR and Waugh, RC and Young, CJ},
title = {Factors predictive for a positive invasive mesenteric angiogram following a positive CT angiogram in patients with acute lower gastrointestinal haemorrhage.},
journal = {International journal of colorectal disease},
volume = {28},
number = {12},
pages = {1715-1719},
pmid = {23836115},
issn = {1432-1262},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Angiography/*methods ; Demography ; Gastrointestinal Hemorrhage/*diagnostic imaging ; Humans ; Mesentery/*diagnostic imaging/*pathology ; Middle Aged ; Risk Factors ; Tomography, X-Ray Computed/*methods ; },
abstract = {INTRODUCTION: Computed tomographic mesenteric angiography (CTMA) is increasingly adopted in patients with massive lower gastrointestinal (LGI) bleeding. However, a positive computed tomography scan does not always translate to a positive invasive mesenteric angiography (MA) when performed. The aim of this study was to identify factors that could predict a positive invasive MA following a positive CTMA.
METHODS: A review of all patients with LGI haemorrhage who had a positive CTMA followed by an invasive MA was performed.
RESULTS: From July 2009 to October 2012, 33 positive CTMA scans from 30 patients were identified. Of the 33 bleeding points, 28 were in the colon, while 5 were in the small intestine. Diverticular disease accounted for 20 of the bleeding points. The median duration from the CTMA to the invasive MA was 165 (74-614) min. Of the 33 invasive MAs that were performed, only 14 demonstrated positive extravasation. Factors that were significant for a positive invasive MA included non-diverticular aetiology (odds ratio (OR), 6.75, 95 % confidence interval (CI), 1.43-31.90, p = 0.029) and haemoglobin <100 g/l (OR, 14.44, 95 % CI, 1.56-133.6, p = 0.009). When the invasive MA procedure was performed within <150 min of the positive CTMA scan, it was 2.89 (95 % CI, 0.69-12.12) times more likely to be associated with a positive invasive MA.
CONCLUSIONS: Patients with non-diverticular aetiologies and lower haemoglobin levels are associated with a positive invasive MA following a positive CTMA. It is prudent to consider performing the invasive MA within 150 min after a positive CTMA.},
}
@article {pmid23834748,
year = {2013},
author = {Chabok, A and Smedh, K and Nilsson, S and Stenson, M and Påhlman, L},
title = {CT-colonography in the follow-up of acute diverticulitis: patient acceptance and diagnostic accuracy.},
journal = {Scandinavian journal of gastroenterology},
volume = {48},
number = {8},
pages = {979-986},
doi = {10.3109/00365521.2013.809597},
pmid = {23834748},
issn = {1502-7708},
mesh = {Acute Disease ; Adenoma/diagnosis/*diagnostic imaging ; Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms/diagnosis/*diagnostic imaging ; *Colonography, Computed Tomographic ; *Colonoscopy ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis/*diagnostic imaging ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Acceptance of Health Care/*statistics & numerical data ; Prospective Studies ; Sensitivity and Specificity ; Single-Blind Method ; },
abstract = {OBJECTIVE: The aim of this study was to assess CT-colonography (CTC) in the follow-up of diverticulitis regarding patient acceptance and diagnostic accuracy for diverticular disease, adenomas and cancer, with colonoscopy as a reference standard.
METHODS: A prospective comparative study where half of the patients underwent colonoscopy first, followed immediately by CTC. The other half had the examinations in the reverse order. Patient experiences and findings were registered after every examination, blinded to the examiner.
RESULTS: Of a total of 110 consecutive patients, 108 were included in the study, with a median age of 56 years (range 27-84). The success rate was 91% for colonoscopy and 86% for CTC. Examination time was 25 min for both methods. The mean time for CTC evaluation was 20 min. Eighty-three per cent of the patients received sedation during colonoscopy. Despite this, patients experienced colonoscopy as more painful (p < 0.001) and uncomfortable (p < 0.001). Diverticulosis and polyps were detected in 94% and 20% with colonoscopy and in 94% and 29% with CTC, respectively. Sensitivity and specificity for CTC in the detection of diverticulosis was 99% and 67%, with a good agreement (κ = 0.71). Regarding detection of polyps, the sensitivity and specificity were 47% and 75%, with a poor agreement (κ = 0.17). No cancer was found.
CONCLUSION: CTC was less painful and unpleasant and can be used for colonic investigation in the follow-up of diverticulitis. CTC detected diverticulosis with good accuracy while the detection accuracy of small polyps was poor. CTC is a viable alternative, especially in case of incomplete colonoscopy or in a situation with limited colonoscopy resources.},
}
@article {pmid23805210,
year = {2013},
author = {Böttner, M and Barrenschee, M and Hellwig, I and Harde, J and Egberts, JH and Becker, T and Zorenkov, D and Schäfer, KH and Wedel, T},
title = {The GDNF System Is Altered in Diverticular Disease - Implications for Pathogenesis.},
journal = {PloS one},
volume = {8},
number = {6},
pages = {e66290},
pmid = {23805210},
issn = {1932-6203},
mesh = {Aged ; Cell Differentiation/drug effects ; Cells, Cultured ; Colon/cytology/drug effects/metabolism ; Diverticulum/metabolism/pathology/*physiopathology ; Down-Regulation/drug effects ; Female ; Glial Cell Line-Derived Neurotrophic Factor/genetics/*metabolism/pharmacology ; Glial Cell Line-Derived Neurotrophic Factor Receptors/genetics/metabolism ; Humans ; Laser Capture Microdissection ; Male ; Middle Aged ; Neuronal Plasticity/drug effects ; Neurons/cytology/drug effects/metabolism ; Proto-Oncogene Proteins c-ret/genetics/metabolism ; Synaptophysin/genetics/metabolism ; Transcriptome/drug effects ; },
abstract = {BACKGROUND & AIMS: Absence of glial cell line-derived neurotrophic factor (GDNF) leads to intestinal aganglionosis. We recently demonstrated that patients with diverticular disease (DD) exhibit hypoganglionosis suggesting neurotrophic factor deprivation. Thus, we screened mRNA expression pattern of the GDNF system in DD and examined the effects of GDNF on cultured enteric neurons.
METHODS: Colonic specimens obtained from patients with DD (n = 21) and controls (n = 20) were assessed for mRNA expression levels of the GDNF system (GDNF, GDNF receptors GFRα1 and RET). To identify the tissue source of GDNF and its receptors, laser-microdissected (LMD) samples of human myenteric ganglia and intestinal muscle layers were analyzed separately by qPCR. Furthermore, the effects of GDNF treatment on cultured enteric neurons (receptor expression, neuronal differentiation and plasticity) were monitored.
RESULTS: mRNA expression of GDNF and its receptors was significantly down-regulated in the muscularis propria of patients with DD. LMD samples revealed high expression of GDNF in circular and longitudinal muscle layers, whereas GDNF receptors were also expressed in myenteric ganglia. GDNF treatment of cultured enteric neurons increased mRNA expression of its receptors and promoted neuronal differentiation and plasticity revealed by synaptophysin mRNA and protein expression.
CONCLUSIONS: Our results suggest that the GDNF system is compromised in DD. In vitro studies demonstrate that GDNF enhances expression of its receptors and promotes enteric neuronal differentiation and plasticity. Since patients with DD exhibit hypoganglionosis, we propose that the observed enteric neuronal loss in DD may be due to lacking neurotrophic support mediated by the GDNF system.},
}
@article {pmid23797126,
year = {2013},
author = {Kruis, W and Morgenstern, J and Schanz, S},
title = {Appendicitis/diverticulitis: diagnostics and conservative treatment.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {31},
number = {1},
pages = {69-75},
doi = {10.1159/000347185},
pmid = {23797126},
issn = {1421-9875},
mesh = {Appendicitis/*diagnosis/diagnostic imaging/surgery/*therapy ; Chronic Disease ; Diverticulitis/*diagnosis/diagnostic imaging/surgery/*therapy ; Humans ; Recurrence ; Ultrasonography ; },
abstract = {Appendicitis and diverticulitis are very common entities that show some similarities in diagnosis and course of disease. Both are widely believed to be simple clinical diagnoses, which is in contrast to scientific evidence. An accurate diagnosis has to describe not only the initial detection, but particularly the severity of the disease. It is based mainly on cross-sectional imaging by ultrasound (US) and computed tomography (CT). Appendectomy is the standard treatment for acute appendicitis and is mandatory in complicated cases. Antibiotic therapy is similarly effective in uncomplicated appendicitis, but long-term results are not sufficiently known. Treatment of diverticulitis is related to the disease status. Complications such as perforation and bleeding require intervention. Uncomplicated diverticulitis as graded by US or CT are subject to conservative management, in the form of outpatient or hospital care. It is an unresolved debate as to whether antibiotic treatment offers benefits. Mesalazine seems at least to improve pain. The real challenge is treatment of recurrent diverticulitis. Lifestyle measures such as nutritional habits and physical activity are found to influence diverticular disease. Besides immunosuppression, obesity is a significant risk factor for complicated diverticulitis. Whether any medication such as chronic antibiotics, probiotics or mesalazine offers benefits is unclear. The indication for sigmoid resection has changed; it is no longer given by the number of attacks, but rather by structural changes as depicted by cross-sectional imaging.},
}
@article {pmid23770531,
year = {2013},
author = {Pietrzak, A and Mik, M and Bartnik, W and Dziki, A and Krokowicz, P},
title = {Interdisciplinary consensus statement on the diagnosis and treatment of diverticular disease.},
journal = {Polski przeglad chirurgiczny},
volume = {85},
number = {5},
pages = {294-310},
doi = {10.2478/pjs-2013-0045},
pmid = {23770531},
issn = {2299-2847},
mesh = {Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/epidemiology ; Causality ; Comorbidity ; Diagnosis, Differential ; Diverticulosis, Colonic/*diagnosis/epidemiology/*therapy ; Diverticulum, Colon/*diagnosis/epidemiology/*therapy ; Female ; Gastrointestinal Diseases/diagnosis/epidemiology ; Humans ; Incidence ; Intestinal Perforation/epidemiology ; Male ; Middle Aged ; Ovarian Cysts/diagnosis/epidemiology ; Pancreatitis/epidemiology ; Peritonitis/epidemiology ; Practice Guidelines as Topic ; Sex Distribution ; Urinary Tract Infections/diagnosis/epidemiology ; Young Adult ; },
}
@article {pmid23762976,
year = {2013},
author = {},
title = {I've recently had some discomfort and painful cramping on the left side of my abdomen. My wife says it could be diverticular disease. What is this?.},
journal = {DukeMedicine healthnews},
volume = {19},
number = {1},
pages = {8},
pmid = {23762976},
issn = {2153-8387},
mesh = {Abdominal Pain/etiology ; Acute Disease ; Diverticulitis, Colonic/*complications/*prevention & control ; Diverticulum, Colon/*complications/*prevention & control ; Female ; Health Status ; Humans ; Male ; },
}
@article {pmid23761526,
year = {2013},
author = {Randall, JK and Gilbert, JM},
title = {Innovations and developments in surgical coloproctology.},
journal = {Journal of the Royal Society of Medicine},
volume = {106},
number = {5},
pages = {178-183},
pmid = {23761526},
issn = {1758-1095},
mesh = {Colectomy/trends ; Colonic Diseases/*surgery ; Colorectal Neoplasms/diagnosis/*surgery ; Early Detection of Cancer/trends ; Humans ; Laparoscopy/trends ; Rectal Diseases/*surgery ; Rectal Neoplasms/surgery ; Robotics/trends ; },
abstract = {The field of coloproctology covers the treatment of both benign and cancerous disease of the colon, rectum and anus. Significant recent developments in the surgical treatment of colorectal cancer include the development of minimally invasive techniques for colorectal resections and the use of stenting for obstructed patients. The introduction of widespread screening aims to diagnose the disease at an earlier stage. Developments in chemotherapy and radiotherapy have also complimented surgical advances towards this disease. There have also been changes in the treatment of benign disease such as diverticular disease, haemorrhoids and anal fissures with a trend towards less invasive surgical techniques.},
}
@article {pmid23754545,
year = {2013},
author = {Parente, F and Bargiggia, S and Prada, A and Bortoli, A and Giacosa, A and Germanà, B and Ferrari, A and Casella, G and De Pretis, G and Miori, G and , },
title = {Intermittent treatment with mesalazine in the prevention of diverticulitis recurrence: a randomised multicentre pilot double-blind placebo-controlled study of 24-month duration.},
journal = {International journal of colorectal disease},
volume = {28},
number = {10},
pages = {1423-1431},
pmid = {23754545},
issn = {1432-1262},
mesh = {Adult ; Aged ; Aged, 80 and over ; Confidence Intervals ; Demography ; Diverticulitis/*drug therapy/*prevention & control ; Double-Blind Method ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Mesalamine/adverse effects/*therapeutic use ; Middle Aged ; Pilot Projects ; Placebos ; Recurrence ; Risk Factors ; Surveys and Questionnaires ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIM: Recurrence of diverticulitis is frequent within 5 years from the uncomplicated first attack, and its prophylaxis is still unclear. We have undertaken a multicentre, randomised, double-blind, placebo-controlled pilot study in order to evaluate the role of mesalazine in preventing diverticulitis recurrence as well as its effects on symptoms associated to diverticular disease.
METHODS: Ninety-six patients with the recent first episode of uncomplicated diverticulitis were randomised to receive mesalazine 800 mg twice daily for 10 days every month or placebo for 24 months. The primary efficacy end point was the diverticulitis recurrence at intention to treat analysis. Clinical evaluations were performed using the Therapy Impact Questionnaire (TIQ) for physical condition and quality of life at admission and at 3-month intervals. Treatment tolerability and routine biochemistry parameters as well as the use of additional drugs were also evaluated.
RESULTS: Ninety-two patients (mean age, 61.5) completed the study, 45 of whom received mesalazine, and 47, placebo. Diverticulitis relapse incidence in mesalazine-treated group was 5/45 (11%) at the 12th month and 6/45 (13%) at the 24th month; in the placebo-treated group, the correspondent rates were 13% (6/47) and 28% (13/47), respectively. Mean values of TIQ at 24 months were significantly better in mesalazine-treated group than in placebo-treated group (p = 0.02); in addition, average additional drug consumption was significantly lower (-20.4%, p < 0.03) in mesalazine than in placebo.
CONCLUSIONS: Diverticulitis recurrence occurred in as many as 28% of patients under placebo within 24 months from the initial episode. Intermittent prophylaxis with mesalazine did not significantly reduce the risk of relapse but induced a significant improvement of patients' physical conditions and significantly lowered the additional consumption of other gastrointestinal drugs.},
}
@article {pmid23715829,
year = {2013},
author = {Van Arendonk, KJ and Tymitz, KM and Gearhart, SL and Stem, M and Lidor, AO},
title = {Outcomes and costs of elective surgery for diverticular disease: a comparison with other diseases requiring colectomy.},
journal = {JAMA surgery},
volume = {148},
number = {4},
pages = {316-321},
doi = {10.1001/jamasurg.2013.1010},
pmid = {23715829},
issn = {2168-6262},
mesh = {Adolescent ; Adult ; Aged ; Chi-Square Distribution ; Colectomy/*economics ; Colonic Neoplasms/economics/surgery ; Colostomy/economics ; Comorbidity ; Diverticulitis/*economics/*surgery ; Elective Surgical Procedures/*economics ; Female ; Hospital Charges/statistics & numerical data ; Hospital Mortality ; Humans ; Inflammatory Bowel Diseases/economics/surgery ; Length of Stay/economics ; Logistic Models ; Male ; Middle Aged ; *Outcome Assessment, Health Care ; Postoperative Complications/economics/epidemiology ; Retrospective Studies ; United States/epidemiology ; },
abstract = {OBJECTIVE: To compare outcomes and costs of elective surgery for diverticular disease (DD) with those of other diseases commonly requiring colectomy.
DESIGN: Multivariable analyses using the Nationwide Inpatient Sample to compare outcomes across primary diagnosis while adjusting for age, sex, race, year of admission, and comorbid disease.
SETTING: A sample of US hospital admissions from 2003-2009.
PATIENTS: All adult patients (≥18 years) undergoing elective resection of the descending colon or subtotal colectomy who had a primary diagnosis of DD, colon cancer (CC), or inflammatory bowel disease (IBD).
MAIN OUTCOME MEASURES: In-hospital mortality, postoperative complications, ostomy placement, length of stay, and hospital charges.
RESULTS: Of the 74,879 patients, 50.52% had DD, 43.48% had CC, and 6.00% had IBD. After adjusting for other variables, patients with DD were significantly more likely than patients with CC to experience in-hospital mortality (adjusted odds ratio, 1.90; 95% CI, 1.37-2.63; P < .001), develop a postoperative infection (1.67; 1.48-1.89; P < .001), and have an ostomy placed (1.87; 1.65-2.11; P < .001). The adjusted total hospital charges for patients with DD were $6678.78 higher (95% CI, $5722.12-$7635.43; P < .001) and length of stay was 1 day longer (95% CI, 0.86-1.14; P < .001) compared with patients with CC. Patients with IBD had the highest in-hospital mortality, highest rates of complications and ostomy placement, longest length of stay, and highest hospital charges.
CONCLUSIONS: Despite undergoing the same procedure, patients with DD have significantly worse and more costly outcomes after elective colectomy compared with patients with CC but better than patients with IBD. These relatively poor outcomes should be recognized when considering routine elective colectomy after successful nonoperative management of acute diverticulitis.},
}
@article {pmid23702821,
year = {2013},
author = {Gallego, D and Espín, F and Mikulka, J and Šmirg, O and Gil, V and Faundez-Zanuy, M and Jiménez, M and Clavé, P},
title = {In vitro motor patterns and electrophysiological changes in patients with colonic diverticular disease.},
journal = {International journal of colorectal disease},
volume = {28},
number = {10},
pages = {1413-1422},
pmid = {23702821},
issn = {1432-1262},
mesh = {Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Diverticulosis, Colonic/pathology/*physiopathology ; Electric Stimulation ; *Electrophysiological Phenomena ; Female ; Humans ; In Vitro Techniques ; Male ; Membrane Potentials/physiology ; Middle Aged ; Motor Activity/*physiology ; Muscle Contraction/physiology ; Myenteric Plexus/physiopathology ; },
abstract = {PURPOSE: The underlying mechanism responsible for motility changes in colonic diverticular disease (DD) is still unknown. In the present study, our aim was to investigate the structural and in vitro motor changes in the sigmoid colon of patients with DD.
METHODS: Muscle bath, microelectrodes and immunohistochemical techniques were performed with samples obtained from the left and sigmoid colon of patients with DD and compared with those of patients without DD.
RESULTS: The amplitude and area under the curve of the spontaneous rhythmic phasic contractions were greatly reduced in patients with DD whereas their frequency and tone remained unaltered. Electrical field stimulation induced a neurally mediated, enhanced ON-contraction (amplitude) in patients with DD and increased the duration of latency of OFF-contractions. The resting membrane potential of smooth muscle cells was hyperpolarized and the amplitude of the inhibitory junction potential was increased in patients with DD. In contrast, no significant histological differences were observed in patients with DD as smooth muscle (circular and longitudinal layers), interstitial cells of Cajal, glial cells and myenteric neurons densities remained unaltered.
CONCLUSIONS: Sigmoid strips from patients with asymptomatic DD showed an altered motor pattern with reduced spontaneous motility and enhanced neurally mediated colonic responses involving both excitatory and inhibitory motor pathways. No major neural and muscular structural elements were detected at this stage of the disease. These findings could be valuable in understanding the pathophysiology of this prevalent digestive disease.},
}
@article {pmid23701143,
year = {2013},
author = {Marney, LA and Ho, YH},
title = {Laparoscopic management of diverticular colovesical fistula: experience in 15 cases and review of the literature.},
journal = {International surgery},
volume = {98},
number = {2},
pages = {101-109},
pmid = {23701143},
issn = {2520-2456},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*surgery ; Diverticulitis, Colonic/*complications ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/etiology/*surgery ; Laparoscopy/*methods ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Urinary Bladder/*surgery ; Urinary Bladder Fistula/etiology/*surgery ; },
abstract = {Colovesical fistulas secondary to diverticular disease may be considered a contraindication to the laparoscopic approach. The feasibility of laparoscopic management of complicated diverticulitis and mixed diverticular fistulas has been demonstrated. However, few studies on the laparoscopic management of diverticular colovesical fistulas exist. A retrospective analysis was performed of 15 patients with diverticular colovesical fistula, who underwent laparoscopic-assisted anterior resection and bladder repair. Median operating time was 135 minutes and median blood loss, 75 mL. Five patients were converted to an open procedure (33.3%) with an associated increase in hospital stay (P = 0.035). Median time to return of bowel function was 2 days and median length of stay, 6 days. Overall morbidity was 20% with no major complications. There was no mortality. There was no recurrence during median follow-up of 12.4 months. These results suggest that laparoscopic management of diverticular colovesical fistulas is both feasible and safe in the setting of appropriate surgical expertise.},
}
@article {pmid23697994,
year = {2013},
author = {Pappalardo, G and Frattaroli, FM and Coiro, S and Spolentini, D and Nunziale, A and Favella, L and Vestri, AR and Gualdi, GF and Casciani, E and Mobarhan, S},
title = {Effectiveness of clinical guidelines in the management of acute sigmoid diverticulitis. Results of a prospective diagnostic and therapeutic clinical trial.},
journal = {Annali italiani di chirurgia},
volume = {84},
number = {2},
pages = {171-177},
pmid = {23697994},
issn = {2239-253X},
mesh = {*Colon, Sigmoid ; *Diverticulitis/surgery ; Diverticulitis, Colonic ; Drainage ; Humans ; Prospective Studies ; },
abstract = {BACKGROUND: Evidence-based criteria in the therapeutic choice for sigmoid acute diverticulitis (AD) are lacking. It is necessary to differentiate an acute episode of diverticular disease, not complicated (NCAD) and complicated (CAD) because these stages of diverticular disease needs different approach.
METHODS: In a prospective study on 377 consecutive patients admitted for AD, 265 had NCAD and 112 CAD diagnosed with CT scan. Thirty-six of 265 with NCAD were operated on due to two or more previous episodes of AD. On 188 patients with NCAD followed-up, 35 had further episodes of NCAD and 2 had CAD. On 112 CAD patients, 61 had Hinchey I and were submitted to colonic resection. Twenty-three of 24 patients with Hinchey II were treated with percutaneous drainage. All Hinchey II patients were operated on. All the 13 patients with Hinchey III and IV had emergency surgery.
RESULTS: We had no mortality and respectively 9.8% and 30% morbidity in Hinchey I and II patients. In Hinchey II patients percutaneous drainage was successful in 21 on 23 (91.3%). In 13 Hinchey III and IV patients the mortality rate was 25%. The comparison of CT findings and pathological results showed a sensitivity of 100% and predictive positive value of respectively 94.4, 96.7, 100 and 100% for NCAD, Hinchey I, Hinchey II and Hinchey III-IV.
CONCLUSIONS: The therapeutic approach of diverticular disease needs to differentiate among an acute episode, NCAD and CAD. Evidence-based therapeutic choices can be reached only by homogeneous diagnostic criteria obtained by CT scan.},
}
@article {pmid23673391,
year = {2014},
author = {Romagnoli, F and Colaiacomo, MC and De Milito, R and Modini, C and Gualdi, G and Catani, M},
title = {The alterations of the sigmoid-rectal junction in diverticular disease of the colon revealed by MR-defecography.},
journal = {Surgical and radiologic anatomy : SRA},
volume = {36},
number = {1},
pages = {85-90},
pmid = {23673391},
issn = {1279-8517},
mesh = {Aged ; Case-Control Studies ; Colon, Sigmoid/*diagnostic imaging/physiopathology ; Defecography/methods ; Diverticulosis, Colonic/*diagnostic imaging/physiopathology ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Rectum/*diagnostic imaging/physiopathology ; },
abstract = {PURPOSE: The sigmoidorectal junction (SRJ) has been defined as an anatomical sphincter with particular physiological behavior that regulates sigmoid and rectum evacuation. Its function in clinical conditions, such as diverticular disease has been advocated. The aim of our study is to identify the SRJ and to compare the morphometric and dynamic features of the SRJ between patients with diverticular disease and healthy subjects using MR-defecography.
METHODS: Sixteen individuals, eight with uncomplicated diverticular disease and eight healthy subjects, were studied using MR-defecography to identify the SRJ and to compare the morphometric and dynamic features observed.
RESULTS: In each subject studied, MR-defecography was able to identify the SRJ. This resulted in the identification of a discrete anatomical entity with a mean length of 31.23 mm, located in front of the first sacral vertebra (S1) and at a mean distance of 15.55 cm from the anal verge, with a mean wall thickness of 4.45 mm, significantly different from the sigmoid and rectal parietal thickness. The SRJ wall was significantly thicker in patients with diverticular disease than the controls (P = 0.005), showing a unique shape and behavior in dynamic sequences.
CONCLUSION: Our findings support the hypothesis that SRJ plays a critical role in patients with symptomatic diverticular disease; further investigation may clarify whether specific SRJ analysis, such as MR-defecography, would predict inflammatory complications of this diffuse and heterogenic disease.},
}
@article {pmid23669306,
year = {2013},
author = {Peery, AF and Sandler, RS},
title = {Diverticular disease: reconsidering conventional wisdom.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {11},
number = {12},
pages = {1532-1537},
pmid = {23669306},
issn = {1542-7714},
support = {R01 DK094738/DK/NIDDK NIH HHS/United States ; T32 DK007634/DK/NIDDK NIH HHS/United States ; T32 DK07634/DK/NIDDK NIH HHS/United States ; },
mesh = {Anti-Bacterial Agents/therapeutic use ; Colectomy/methods ; Diet/methods ; Diverticulitis/*diagnosis/prevention & control/*therapy ; Diverticulosis, Colonic/*complications ; Humans ; },
abstract = {Colonic diverticula are common in developed countries and complications of colonic diverticulosis are responsible for a significant burden of disease. Several recent publications have called into question long-held beliefs about diverticular disease. Contrary to conventional wisdom, studies have not shown that a high-fiber diet protects against asymptomatic diverticulosis. The risk of developing diverticulitis among individuals with diverticulosis is lower than the 10% to 25% proportion that commonly is quoted, and may be as low as 1% over 11 years. Nuts and seeds do not increase the risk of diverticulitis or diverticular bleeding. It is unclear whether diverticulosis, absent diverticulitis, or overt colitis is responsible for chronic gastrointestinal symptoms or worse quality of life. The role of antibiotics in acute diverticulitis has been challenged by a large randomized trial that showed no benefit in selected patients. The decision to perform elective surgery should be made on a case-by-case basis and not routinely after a second episode of diverticulitis, when there has been a complication, or in young people. A colonoscopy should be performed to exclude colon cancer after an attack of acute diverticulitis but may not alter outcomes among individuals who have had a colonoscopy before the attack. Given these surprising findings, it is time to reconsider conventional wisdom about diverticular disease.},
}
@article {pmid23665087,
year = {2013},
author = {Gill, P and Chetty, R},
title = {Filiform polyps and filiform polyp-like lesions are common in defunctioned or diverted colorectum resection specimens.},
journal = {Annals of diagnostic pathology},
volume = {17},
number = {4},
pages = {341-344},
doi = {10.1016/j.anndiagpath.2013.04.001},
pmid = {23665087},
issn = {1532-8198},
mesh = {Adolescent ; Adult ; Colitis/*pathology/surgery ; Colitis, Ulcerative/*pathology/surgery ; Colonic Polyps/*pathology/surgery ; Crohn Disease/*pathology/surgery ; Diverticulum/pathology ; Female ; Humans ; Male ; Middle Aged ; Rectum/pathology ; Young Adult ; },
abstract = {We describe filiform polyps (FPs) in a series of defunctioned rectums with diversion colitis. A 6-year search of all defunctioned rectal resection specimens revealed 8 cases with 17 macroscopically observed FPs. They occurred in 4 females and 4 males aged between 12 and 64 years. Four had defunctioning colostomies for ulcerative colitis, 3 for Crohn disease and 1 for diverticular disease. Multiple lesions were seen in 6 of 8 cases: 1 case having 4 FPs, 1 patient with 3 lesions, and 4 cases with 2 lesions. The FP varied in length from 4 to 11 mm; mean length was 7.8 mm. No evidence of mucosal prolapse was seen in any of the polypoid lesions. In 65 cases without grossly observed polypoid lesions, prominent mucosal polypoid projections in keeping with FP were seen in 47 cases. These were observed in nonulcerated sections and were histologically identical to the 17 macroscopically observed FPs ranging from 3 to 8 mm, and 3 to 5 such polypoid lesions were seen in 20 cases. We suggest that FP and FP-like lesions are commonly encountered in defunctioned resection specimens.},
}
@article {pmid23662489,
year = {2013},
author = {Shelygin, IuA and Achkasov, SI and Moskalev, AI and Likhter, MS and Zarodniuk, IV and Skridlevskiĭ, SN and Trubacheva, IuL},
title = {[Colovesical fistula as a complication of diverticular disease].},
journal = {Urologiia (Moscow, Russia : 1999)},
volume = {},
number = {1},
pages = {17-23},
pmid = {23662489},
issn = {1728-2985},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum, Colon/blood/*complications/*pathology/*surgery/urine ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/blood/*etiology/*pathology/*surgery/urine ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {The results of research on the clinical picture, features of manifestation, diagnosis, and treatment of patients with diverticular disease complicated by sigmovesical fistula are presented. The study included 31 patients (19 [61.3%] men, 12 [38.7%] women), aged 32-83 (55.6 +/- 7.1) years. Diagnostic program included physical examination, laboratory blood and urine tests, endoscopic, radiological, ultrasound examinations. All patients underwent different interventions according to the severity and extent of the inflammatory process, the involvement of other organs of the abdominal cavity and the extent of diverticular lesions of the colon. Long-term results were assessed in all patients in a period of 5 months to 12 years, with a median follow-up 4.7 years. It is shown that the clinical manifestations of intestinovesical fistula did not match the severity of complications, and were subclinical. Timing for referral the patient to coloproctologist was 5 months after the occurrence of first clinical signs. In any case, conservative treatment has not led to spontaneous colovesical fistula closure. Average size of parafistulous infiltration on the wall of the bladder and perivesical tissue was 6.5 +/- 2.4 cm. All the patients underwent different types of colon resection. Postoperative complications did not requiring recurrent surgery were detected in 5 (16.1%) patients. None of these has experienced recurrence complications of diverticular disease. For the optimization the treatment strategy, physicians should follow multidisciplinary approach immediately after revealing the patient with persistent bacteriuria, pneumaturia and fecaluria. The surgery is the method of choice in the treatment of colovesical fistula as a complication of diverticular disease.},
}
@article {pmid23662238,
year = {2013},
author = {Patel, A and Joshi, HM and Kaur, C and Wilson, JM},
title = {Congenital diverticular disease of the entire colon.},
journal = {Case reports in surgery},
volume = {2013},
number = {},
pages = {319026},
pmid = {23662238},
issn = {2090-6900},
abstract = {Congenital or true colonic diverticulosis is a rare condition typified by the preservation of the colonic wall architecture within the diverticular outpouching. Cases of multiple jejunal diverticula have been reported as well as cases of solitary giant diverticula of the colon. There have been no reports in the literature of pancolonic congenital diverticulosis.},
}
@article {pmid23660775,
year = {2013},
author = {Flor, N and Rigamonti, P and Pisani Ceretti, A and Romagnoli, S and Balestra, F and Sardanelli, F and Cornalba, G and Pickhardt, PJ},
title = {Diverticular disease severity score based on CT colonography.},
journal = {European radiology},
volume = {23},
number = {10},
pages = {2723-2729},
pmid = {23660775},
issn = {1432-1084},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Algorithms ; Colonography, Computed Tomographic/*methods ; Diverticulitis, Colonic/*diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Radiographic Image Enhancement/methods ; Radiographic Image Interpretation, Computer-Assisted/*methods ; Reproducibility of Results ; Sensitivity and Specificity ; *Severity of Illness Index ; },
abstract = {OBJECTIVE: We propose a diverticular disease severity score (DDSS) based on CT colonography (CTC) findings.
METHODS: Seventy-nine patients (62 ± 14.5 years) underwent CTC after recovering from an episode of acute diverticulitis. Two independent readers classified each case using a four-point scale (DDSS), based on maximum sigmoid colon wall thickness (MSCWT) and minimum lumen diameter at CTC: 1 = MSCWT <3 mm, lumen diameter ≥15 mm; 2 = MSCWT 3-8 mm, lumen diameter ≥5 mm; 3 = MSCWT ≥8 mm, lumen diameter ≥5 mm; 4 = MSCWT ≥8 mm, lumen diameter <5 mm. Intra- and interobserver reproducibility was evaluated. Of 79 patients, 32 (40 %) underwent surgery after CTC; MSCWT was directly measured on the pathological specimen.
RESULTS: Intra- and interobserver reproducibility of DDSS were almost perfect (k = 0.90-0.84). DDSS significantly correlated with the probability of surgery (P = 0.001). After surgery, histopathology revealed acute/chronic diverticular inflammation only in 29 cases, and superimposed sigmoid cancer (n = 2) or Crohn's disease (n = 1) in 3 patients with a DDSS of 4. MSCWT at histopathology correlated with DDSS (P = 0.008).
CONCLUSION: DDSS is highly reproducible and correlates with pathological MSCWT. Nearly 1 in 3 patients with a DDSS of 4 had significant superimposed histopathology. CTC with DDSS can provide colorectal surgeons with valuable information.
KEY POINTS: • A diverticular disease severity score (DDSS) based on CT colonography is proposed. • This DDSS is based on sigmoid colon wall thickness and lumen diameter. • High scores may be associated with relevant coexisting lesions. • A CTC-based DDSS may influence therapeutic decision-making.},
}
@article {pmid23636075,
year = {2013},
author = {Ünlü, Ç and Gunadi, PM and Gerhards, MF and Boermeester, MA and Vrouenraets, BC},
title = {Outpatient treatment for acute uncomplicated diverticulitis.},
journal = {European journal of gastroenterology & hepatology},
volume = {25},
number = {9},
pages = {1038-1043},
doi = {10.1097/MEG.0b013e328361dd5b},
pmid = {23636075},
issn = {1473-5687},
mesh = {Acute Disease ; Administration, Intravenous ; Administration, Oral ; Adult ; Age Factors ; Aged ; *Ambulatory Care ; Anti-Bacterial Agents/*administration & dosage ; Chi-Square Distribution ; Diverticulitis/diagnosis/*drug therapy ; Drug Administration Schedule ; Feasibility Studies ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Patient Admission ; Patient Selection ; Registries ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: Traditionally, treatment of acute diverticulitis has mostly been based on inpatient care. The question arises whether these patients can be treated on an outpatient basis as the admissions for diverticular disease have been shown to be increasing every year. We studied whether outpatient treatment of acute uncomplicated diverticulitis is feasible and safe, and which patients could benefit from outpatient care.
MATERIALS AND METHODS: A retrospective cohort study was carried out in two teaching hospitals using hospital registry codes for diverticulitis. All patients diagnosed with acute uncomplicated diverticulitis between January 2004 and January 2012, confirmed by imaging or colonoscopy, were included. Exclusion criteria were patients with recurrent diverticulitis, complicated diverticulitis (Hinchey stages 2, 3, and 4), and right-sided diverticulitis. Inpatient care was compared with outpatient care. Primary outcome was admission for outpatient care and the complication rate in both groups. Multivariate analysis was carried out to identify potential factors for inpatient care.
RESULTS: Of 627 patients with diverticulitis, a total of 312 consecutive patients were identified with primary uncomplicated diverticulitis of the sigmoid colon; 194 patients had been treated as inpatients and 118 patients primarily as outpatients. In this last group, 91.5% had been treated successfully without diverticulitis-related complications or the need for hospital admission during a mean follow-up period of 48 months.
CONCLUSION: Despite inherent patient selection in a retrospective cohort, ambulatory treatment of patients presenting with uncomplicated acute diverticulitis seems feasible and safe. In mildly ill and younger patients, hospital admission can be avoided.},
}
@article {pmid23634185,
year = {2013},
author = {Boynton, W and Floch, M},
title = {New strategies for the management of diverticular disease: insights for the clinician.},
journal = {Therapeutic advances in gastroenterology},
volume = {6},
number = {3},
pages = {205-213},
pmid = {23634185},
issn = {1756-283X},
abstract = {Diverticulosis is one of the most common gastrointestinal conditions affecting the general population in the Western world. It is estimated that over 2.5 million people are affected by diverticular disease in the United States. The spectrum of clinical manifestations of diverticulosis ranges from asymptomatic diverticulosis to complicated diverticulitis. Treatment for symptomatic diverticular disease is largely based on symptoms. Traditional therapy includes fiber, bowel rest, antibiotics, pain control and surgery for selected cases. This review discusses recent advances in the medical treatment of diverticular disease such as the use of mesalamine, rifaximin and probiotics as our understanding of the disease evolves.},
}
@article {pmid23608869,
year = {2013},
author = {Monteiro, R and Schneble, E and Mino, J and Stallion, A},
title = {Antimesenteric jejunal diverticulosis after a remote history of necrotising enterocolitis: a case report.},
journal = {BMJ case reports},
volume = {2013},
number = {},
pages = {},
pmid = {23608869},
issn = {1757-790X},
mesh = {Adult ; Chronic Disease ; Diagnosis, Differential ; Diagnostic Imaging ; Diverticulum/diagnosis/*etiology/*surgery ; Enterocolitis, Necrotizing/*complications ; Female ; Humans ; Jejunal Diseases/diagnosis/*etiology/*surgery ; Survivors ; },
abstract = {Jejunal diverticulosis is a rare, acquired pathology of the small bowel. While most patients are asymptomatic, the condition is difficult to diagnose. It may present with chronic abdominal pain, diarrhoea, bloating and complications including malabsorption, diverticulitis, bleeding, intestinal obstruction or perforation. This is a case presentation of a 27-year-old woman with a history of necrotising enterocolitis (NEC) requiring surgical resection as a premature newborn who presented with recurrent abdominal pain and was found to have several small bowel diverticula intraoperatively. She underwent resection with complete resolution of symptoms over a 2-year follow-up. This is the first case report to suggest that small bowel diverticular disease as a long-term complication of NEC may result in chronic morbidity in long-term survivors.},
}
@article {pmid23598175,
year = {2013},
author = {Sivarajah, V and Jones, C and Pittathankal, A},
title = {Radiological evidence of subcutaneous emphysema leading to a diagnosis of retroperitoneal perforated diverticulum.},
journal = {International journal of surgery case reports},
volume = {4},
number = {6},
pages = {531-533},
pmid = {23598175},
issn = {2210-2612},
abstract = {INTRODUCTION: This case report outlines the investigation and management of a young patient presenting with left iliac fossa pain and sepsis. A CT was performed which was initially reported as not showing a perforation, however closer analysis provided evidence of subcutaneous emphysema in the anterior abdominal wall. This evidence justified urgent operative intervention. We review the evidence with regard to this presentation.
PRESENTATION OF CASE: A previously fit 24-year-old male presented with left iliac fossa pain and features of sepsis. A CT provided subtle but distinctive evidence of retroperitoneal perforation secondary to diverticulitis, in the form of surgical emphysema in the anterior abdominal wall. In view of this, urgent operation was considered justified on suspicion of visceral perforation. A diverticular perforation was confirmed intra-operatively, and a sigmoid colectomy with primary anastomosis was performed, together with a covering ileostomy. The patient made a good post-operative recovery.
DISCUSSION: Diverticular disease and its complications are becoming more common in a younger age group, in whom perforation may present late or may not be suspected. In this context special attention must be paid to any radiological evidence of perforation.
CONCLUSION: Surgical emphysema in the abdominal wall is an indicator of retroperitoneal perforation, and its presence should be excluded before the possibility of perforation is dismissed. This may be of especial value in younger age groups amongst whom perforation may be less clinically obvious.},
}
@article {pmid23579535,
year = {2013},
author = {Pitiakoudis, M and Botaitis, S and Romanidis, K and Charalampidis, D and Polychronides, A and Simopoulos, C},
title = {Single-trocar transumbilical laparoscopy-assisted management of complicated jejunal diverticula.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {23},
number = {2},
pages = {e78-80},
doi = {10.1097/SLE.0b013e31826e4816},
pmid = {23579535},
issn = {1534-4908},
mesh = {Anemia/diagnosis/etiology ; Diverticulum/complications/diagnostic imaging/*surgery ; Endoscopes ; Follow-Up Studies ; Gastrointestinal Hemorrhage/diagnostic imaging/etiology/*surgery ; Humans ; Jejunal Diseases/complications/diagnostic imaging/*surgery ; Male ; Middle Aged ; Natural Orifice Endoscopic Surgery/*methods ; Risk Assessment ; Severity of Illness Index ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; Umbilicus ; },
abstract = {Small-intestinal nonmeckelian diverticula are very uncommon and are considered to be acquired pulsion diverticula. Most of these diverticula are asymptomatic and are simply incidental findings. Complicated-acquired diverticular disease of the jejunum and ileum is a diagnostic dilemma. Small-bowel diverticulum is diagnosed with the aid of radiography techniques, such as small-bowel contrast series or enteroclysis. Laparotomy remains the gold standard for a definite diagnosis of asymptomatic and complicated diverticula, but laparoscopy is also very useful in the diagnosis and treatment of this condition. A surgical approach is the best form of treatment for complicated jejunoileal diverticula. The current report is about a patient who presented with iron deficiency anemia caused by a complicated jejunal diverticulum and managed with single-trocar transumbilical laparoscopy.},
}
@article {pmid23564216,
year = {2013},
author = {Halabi, WJ and Kang, CY and Jafari, MD and Nguyen, VQ and Carmichael, JC and Mills, S and Stamos, MJ and Pigazzi, A},
title = {Robotic-assisted colorectal surgery in the United States: a nationwide analysis of trends and outcomes.},
journal = {World journal of surgery},
volume = {37},
number = {12},
pages = {2782-2790},
pmid = {23564216},
issn = {1432-2323},
mesh = {Aged ; Colectomy/economics/*methods/trends ; Colon/*surgery ; Colonic Diseases/economics/*surgery ; Conversion to Open Surgery/statistics & numerical data ; Databases, Factual ; Female ; Hospital Charges/statistics & numerical data ; Humans ; Laparoscopy/economics/*methods/trends ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/epidemiology ; Rectal Diseases/economics/*surgery ; Rectum/*surgery ; Retrospective Studies ; Robotics/economics/*methods/trends ; Treatment Outcome ; },
abstract = {BACKGROUND: While robotic-assisted colorectal surgery (RACS) is becoming increasingly popular, data comparing its outcomes to other established techniques remain limited to small case series. Moreover, there are no large studies evaluating the trends of RACS at the national level.
METHODS: The Nationwide Inpatient Sample 2009-2010 was retrospectively reviewed for robotic-assisted and laparoscopic colorectal procedures performed for cancer, benign polyps, and diverticular disease. Trends in different settings, indications, and demographics were analyzed. Multivariate regression analysis was used to compare selected outcomes between RACS and conventional laparoscopic surgery (CLS).
RESULTS: An estimated 128,288 colorectal procedures were performed through minimally invasive techniques over the study period, and RACS was used in 2.78 % of cases. From 2009 to 2010, the use of robotics increased in all hospital settings but was still more common in large, urban, and teaching hospitals. Rectal cancer was the most common indication for RACS, with a tendency toward its selective use in male patients. On multivariate analysis, robotic surgery was associated with higher hospital charges in colonic ($11,601.39; 95 % CI 6,921.82-16,280.97) and rectal cases ($12,964.90; 95 % CI 6,534.79-19,395.01), and higher rates of postoperative bleeding in colonic cases (OR = 2.15; 95 % CI 1.27- 3.65). RACS was similar to CLS with respect to length of hospital stay, morbidity, anastomotic leak, and ileus. Conversion to open surgery was significantly lower in robotic colonic and rectal procedures (0.41; 95 % CI 0.25-0.67) and (0.10; 95 % CI 0.06-0.16), respectively.
CONCLUSIONS: The use of RACS is still limited in the United States. However, its use increased over the study period despite higher associated charges and no real advantages over laparoscopy in terms of outcome. The one advantage is lower conversion rates.},
}
@article {pmid23563467,
year = {2013},
author = {Alatise, OI and Arigbabu, AO and Lawal, OO and Adetiloye, VA and Agbakwuru, EA and Ndububa, DA},
title = {Presentation, distribution pattern, and management of diverticular disease in a Nigerian tertiary hospital.},
journal = {Nigerian journal of clinical practice},
volume = {16},
number = {2},
pages = {226-231},
doi = {10.4103/1119-3077.110152},
pmid = {23563467},
issn = {1119-3077},
mesh = {Abdominal Pain/*etiology ; Adult ; Aged ; Aged, 80 and over ; Anti-Infective Agents/therapeutic use ; Ciprofloxacin/therapeutic use ; Dietary Fiber/administration & dosage ; Diverticulosis, Colonic/complications/*diagnosis/*therapy ; Female ; Gastrointestinal Hemorrhage/*etiology/therapy ; Humans ; Male ; Metronidazole/therapeutic use ; Middle Aged ; Nigeria ; Prospective Studies ; },
abstract = {BACKGROUND: Colonic diverticular disease is one of the most common and costly gastrointestinal disorders among industrialized societies, which have recently been described among Africans. Presentations and distribution pattern of the disease among Africans appeared to be different from that described among the Western population. We embark on this study aimed at evaluating the presentation, distribution pattern, and the management of diverticulosis in our tertiary health facility.
MATERIALS AND METHODS: A prospective descriptive study of the cases of diverticular disease seen between January 2007 and December 2011 at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.
RESULTS: During the 5-year study period, 40 cases were seen. The patients were aged 41-85 years with a median age of 64 years. There were 29 (72.5%) male and 11 (27.5%) female with an average male to female ratio of 3:1. The most common presentation was bleeding per rectum in 28 (70%) patients, which mostly needed transfusion. Ten (25%) patients presented with recurring abdominal pain, whereas one (2.5%) patient presented with abdominal mass and features of intestinal obstruction. Thirty patients were diagnosed on colonoscopy, eight on barium enema, and two on computerized tomography scan. Thirty-four (85%) patients had a pancolonic disease. All the patients were placed on high fiber diet and antibiotics namely ciprofloxacin and metronidazole. Five patients had recurrence within 6 months of follow up, of which one had emergency colectomy.
CONCLUSION: Diverticular disease is no longer a rare disease in Nigeria. It is a common cause of lower gastrointestinal bleeding in elderly patients. High index of suspicion for diverticular disease of the colon and its complications should increase in the country.},
}
@article {pmid23554811,
year = {2013},
author = {Pisanu, A and Vacca, V and Reccia, I and Podda, M and Uccheddu, A},
title = {Acute diverticulitis in the young: the same disease in a different patient.},
journal = {Gastroenterology research and practice},
volume = {2013},
number = {},
pages = {867961},
pmid = {23554811},
issn = {1687-6121},
abstract = {Background. Natural history and risk factors for diverticulitis in young patients are still debatable. This study aimed to assess whether difference exists in patients aged 50 and younger when compared to older patients and to identify risk factors for acute diverticulitis in the young. Patients and Methods. From January 2006 to December 2011, 80 patients were admitted to our department for acute diverticulitis. We carried out a cross-sectional study in 23 patients (28.7%) aged 50 and younger and 57 older patients (71.3%). Results. Acute diverticulitis in the young was not more aggressive than in the older patient. Diverticulitis at patient's admission was similar with respect to Hinchey's stage and prior history of diverticulitis. No significant difference was found for both medical and surgical treatment. The rate of recurrent diverticulitis in nonoperated patients was similar. Male gender, body mass index ≥25, and assumption of alcohol were independent risk factors for the occurrence of an acute diverticulitis in the young. Conclusions. The same disease seems to be affecting young patients such as overweight or obese male individual. Current policies to prevent diverticular disease and its related complications must include obesity control together with high-fiber diet and regular exercise.},
}
@article {pmid23531175,
year = {2013},
author = {Pilgrim, SM and Hart, AR and Speakman, CT},
title = {Diverticular disease in younger patients--is it clinically more complicated and related to obesity?.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {15},
number = {10},
pages = {1205-1210},
doi = {10.1111/codi.12225},
pmid = {23531175},
issn = {1463-1318},
mesh = {Age Factors ; Diverticulitis/*complications/surgery ; Humans ; Obesity/*complications ; *Severity of Illness Index ; },
abstract = {AIM: The aims of this systematic review were to determine the presentations of diverticular disease in patients under 40 years of age and to assess whether obesity is an important factor.
METHOD: The PubMed and EMBASE databases and the Cochrane Library were searched to identify all original articles published between 1990 and 2011 on diverticular disease severity in obese patients (body mass index of ≥ 30 kg/m(2)) under 40 years of age.
RESULTS: Twenty-three clinical case series (two of which were prospective) were identified plus two large aetiological population-based studies. These reported that young patients with diverticular disease were presenting more frequently, that diverticular disease in this age group was less likely to be complicated but that emergency operation rates were higher. The majority (63.1-96.5%) of patients under 40 years of age with diverticular disease were obese.
CONCLUSION: The studies suggest that in the young, obese patient with lower abdominal pain, diverticulitis and appendicitis are included in the differential diagnosis. CT and/or laparoscopy should be considered where the diagnosis is in doubt.},
}
@article {pmid23515370,
year = {2013},
author = {Kobayashi, K and Mukae, M and Ogawa, T and Yokoyama, K and Sada, M and Koizumi, W},
title = {Clinical usefulness of single-balloon endoscopy in patients with previously incomplete colonoscopy.},
journal = {World journal of gastrointestinal endoscopy},
volume = {5},
number = {3},
pages = {117-121},
pmid = {23515370},
issn = {1948-5190},
abstract = {AIM: To evaluate the clinical usefulness of single-balloon endoscopy (SBE) in patients in whom a colonoscope was technically difficult to insert previously.
METHODS: The study group comprised 15 patients (8 men and 7 women) who underwent SBE for colonoscopy (30 sessions). The number of SBE sessions was 1 in 7 patients, 2 in 5 patients, 3 in 1 patient, 4 in 1 patient, and 6 in 1 patient. In all patients, total colonoscopy was previously unsuccessful. The reasons for difficulty in scope passage were an elongated colon in 6 patients, severe intestinal adhesions after open surgery in 4, an elongated colon and severe intestinal adhesions in 2, a left inguinal hernia in 2, and multiple diverticulosis of the sigmoid colon in 1. Three endoscopists were responsible for SBE. The technique for inserting SBE in the colon was basically similar to that in the small intestine. The effectiveness of SBE was assessed on the basis of the success rate of total colonoscopy and the presence or absence of complications. We also evaluated the diagnostic and treatment outcomes of colonoscopic examinations with SBE.
RESULTS: Total colonoscopy was successfully accomplished in all sessions. The mean insertion time to the cecum was 22.9 ± 8.9 min (range 9 to 40). Abnormalities were found during 21 sessions of SBE. The most common abnormality was colorectal polyps (20 sessions), followed by radiation colitis (3 sessions) and diverticular disease of the colon (3 sessions). Colorectal polyps were resected endoscopically in 15 sessions. A total of 42 polyps were resected endoscopically, using snare polypectomy in 32 lesions, hot biopsy in 7 lesions, and endoscopic mucosal resection in 3 lesions. Fifty-six colorectal polyps were newly diagnosed on colonoscopic examination with SBE. Histopathologically, these lesions included 2 intramucosal cancers, 42 tubular adenomas, and 2 tubulovillous adenomas. The mean examination time was 48.2 ± 20.0 min (range 25 to 90). Colonoscopic examination or endoscopic treatment with SBE was not associated with any serious complications.
CONCLUSION: SBE is a useful and safe procedure in patients in whom a colonoscope is technically difficult to insert.},
}
@article {pmid23508934,
year = {2013},
author = {Norsa, AH and Tonolini, M and Ippolito, S and Bianco, R},
title = {Water enema multidetector CT technique and imaging of diverticulitis and chronic inflammatory bowel diseases.},
journal = {Insights into imaging},
volume = {4},
number = {3},
pages = {309-320},
pmid = {23508934},
issn = {1869-4101},
abstract = {BACKGROUND: Water enema multidetector computed tomography (WE-MDCT) is currently considered the most accurate imaging modality to provide high-resolution multiplanar visualisation of the colonic wall and surrounding structures.
METHODS: This pictorial review presents our experience with WE-MDCT applications outside colorectal tumour staging, particularly for investigating diverticular disease and chronic inflammatory bowel diseases. A detailed explanation of the technique is provided, including patient preparation, the acquisition protocol, and study interpretation.
RESULTS: WE-MDCT allows accurate preoperative visualisation of diverticular disease, acute and complicated diverticulitis. Ulcerative, indeterminate, or Crohn's colitis can be assessed including longitudinal distribution, mural thickening and enhancement patterns, pseudopolyps, associated perivisceral changes, adjacent organ involvement, and features suggesting carcinoma. Elective WE-MDCT represents a useful complementary technique in patients with impossible, incomplete, or inconclusive endoscopy, can allow study of a stricture's features and the upstream bowel, and helps planning medical, endoscopic, or surgical treatments.
CONCLUSION: Urgent WE-MDCT with limited or no bowel preparation may prove useful in acutely symptomatic patients, as it may obviate a risky or contraindicated endoscopy, can determine disease severity, and allows making correct therapeutic choices.
TEACHING POINTS: • Water enema multidetector CT provides high-resolution multiplanar visualisation of the colonic wall. • WE-MDCT allows accurate visualisation of diverticular disease, acute and complicated diverticulitis. • In chronic inflammatory bowel diseases WE-MDCT depicts the distribution, mural and perivisceral changes. • Elective WE-MDCT usefully complements incomplete endoscopy to assess strictures and upstream colon. • Urgent WE-MDCT with limited or no bowel preparation in acute diseases may obviate endoscopy.},
}
@article {pmid23470669,
year = {2013},
author = {Duff, GP and Chang, KH and Peirce, C and Coffey, JC},
title = {Coexistent widespread small intestinal and colonic diverticular disease.},
journal = {BMJ case reports},
volume = {2013},
number = {},
pages = {},
pmid = {23470669},
issn = {1757-790X},
mesh = {Aged ; Colonoscopy ; Constipation/etiology/surgery ; Diagnosis, Differential ; Diverticulosis, Colonic/*complications/diagnosis/surgery ; Endoscopy, Digestive System ; Female ; Humans ; Ileostomy ; *Intestine, Small ; Tomography, X-Ray Computed ; },
abstract = {A 73-year-old woman with a history of multiple abdominal surgery and sigmoid diverticulosis presented with severe constipation refractory to conservative management. As a result, she had developed food aversion and cachexia. Patient opted for laparotomy and defunctioning ileostomy to improve quality of life. At laparotomy, extensive diverticulae involving the small and large bowels were identified. Defunctioning ileostomy was performed. The patient regained her quality of life and reinstituted normal diet. Histology revealed marked serosal fibrosis and pulsion diverticulae.},
}
@article {pmid23442832,
year = {2013},
author = {Feuerstadt, P and Das, R and Brandt, LJ},
title = {Diverticular disease of the colon does not increase risk of repeat C. difficile infection.},
journal = {Journal of clinical gastroenterology},
volume = {47},
number = {5},
pages = {426-431},
doi = {10.1097/MCG.0b013e318276beea},
pmid = {23442832},
issn = {1539-2031},
mesh = {Anti-Bacterial Agents/therapeutic use ; Case-Control Studies ; Clostridioides difficile/drug effects ; Clostridium Infections/diagnosis/drug therapy/*epidemiology/microbiology ; Colonoscopy ; Diverticulosis, Colonic/*complications/diagnostic imaging/*epidemiology ; Diverticulum, Colon/diagnostic imaging ; Enterocolitis, Pseudomembranous/diagnosis/drug therapy/*epidemiology ; Female ; Humans ; Incidence ; Male ; Radiography ; Recurrence ; Risk ; Treatment Outcome ; },
abstract = {BACKGROUND: Studies have suggested that colonic diverticulosis might increase the likelihood of repeat Clostridium difficile infection (CDI). Our study was designed to compare rates of repeat infection in patients with and without colon diverticula.
METHODS: Patients who had a positive C. difficile toxin assay and colonoscopic evidence of diverticulosis were classified as CDI and diverticulosis (CDI-D), whereas those with a positive toxin assay but no such colonoscopic evidence were classified as CDI and no diverticulosis (CDI-ND). Various clinical and epidemiologic factors were recorded for each patient. Primary outcomes were "relapse" (repeat CDI within 3 mo of initial infection) and "recurrent" infection (repeat CDI≥3 mo after initial infection). Secondary outcomes 30 days after diagnosis were mortality, intensive care unit transfer, and continuous hospitalization.
RESULTS: A total of 128 patients were classified as CDI-D, whereas 137 had CDI-ND. There were no significant differences between CDI-D and CDI-ND when comparing frequencies of repeat infection and its subclassifications, relapse or recurrence. There were, however, statistical associations seen between diverticulosis of the ascending colon and increased recurrence rates [hazard ratio (HR): 1.4±0.38, P<0.05] and decreased rates of relapse in diverticular disease of the descending (HR: 0.40±0.46, P<0.05), and sigmoid colon (HR: 0.39±0.49, P<0.05). The ascending colon association is limited by a small patient population. There were no significant differences in any of the 30-day outcomes including intensive care unit requirement, hospitalization stay, or mortality.
CONCLUSIONS: Patients with diverticular disease of the colon are not at increased risk of repeat CDI.},
}
@article {pmid23437299,
year = {2013},
author = {Mattii, L and Ippolito, C and Segnani, C and Battolla, B and Colucci, R and Dolfi, A and Bassotti, G and Blandizzi, C and Bernardini, N},
title = {Altered expression pattern of molecular factors involved in colonic smooth muscle functions: an immunohistochemical study in patients with diverticular disease.},
journal = {PloS one},
volume = {8},
number = {2},
pages = {e57023},
pmid = {23437299},
issn = {1932-6203},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*metabolism/pathology ; Connexin 26 ; Connexin 43/genetics/metabolism ; Connexins/genetics/metabolism ; Diverticulum, Colon/genetics/*metabolism/pathology ; Female ; Gene Expression Profiling ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Muscle, Smooth/*metabolism/pathology ; Protein Kinase C/genetics/metabolism ; Proto-Oncogene Proteins c-kit/genetics/metabolism ; rhoA GTP-Binding Protein/genetics/metabolism ; },
abstract = {BACKGROUND: The pathogenesis of diverticular disease (DD) is thought to result from complex interactions among dietary habits, genetic factors and coexistence of other bowel abnormalities. These conditions lead to alterations in colonic pressure and motility, facilitating the formation of diverticula. Although electrophysiological studies on smooth muscle cells (SMCs) have investigated colonic motor dysfunctions, scarce attention has been paid to their molecular abnormalities, and data on SMCs in DD are lacking. Accordingly, the main purpose of this study was to evaluate the expression patterns of molecular factors involved in the contractile functions of SMCs in the tunica muscularis of colonic specimens from patients with DD.
METHODS AND FINDINGS: By means of immunohistochemistry and image analysis, we examined the expression of Cx26 and Cx43, which are prominent components of gap junctions in human colonic SMCs, as well as pS368-Cx43, PKCps, RhoA and αSMA, all known to regulate the functions of gap junctions and the contractile activity of SMCs. The immunohistochemical analysis revealed significant abnormalities in DD samples, concerning both the expression and distribution patterns of most of the investigated molecular factors.
CONCLUSION: This study demonstrates, for the first time, that an altered pattern of factors involved in SMC contractility is present at level of the tunica muscularis of DD patients. Moreover, considering that our analysis was conducted on colonic tissues not directly affected by diverticular lesions or inflammatory reactions, it is conceivable that these molecular alterations may precede and predispose to the formation of diverticula, rather than being mere consequences of the disease.},
}
@article {pmid23426459,
year = {2013},
author = {Floch, MH},
title = {Emerging studies in diverticular disease.},
journal = {Journal of clinical gastroenterology},
volume = {47},
number = {5},
pages = {381-382},
doi = {10.1097/MCG.0b013e318282918d},
pmid = {23426459},
issn = {1539-2031},
mesh = {*Diverticulitis, Colonic ; Diverticulum, Colon/*pathology ; Female ; Humans ; Male ; },
}
@article {pmid23414061,
year = {2013},
author = {Kruis, W and Meier, E and Schumacher, M and Mickisch, O and Greinwald, R and Mueller, R and , },
title = {Randomised clinical trial: mesalazine (Salofalk granules) for uncomplicated diverticular disease of the colon--a placebo-controlled study.},
journal = {Alimentary pharmacology & therapeutics},
volume = {37},
number = {7},
pages = {680-690},
doi = {10.1111/apt.12248},
pmid = {23414061},
issn = {1365-2036},
mesh = {Abdominal Pain/diagnosis/drug therapy ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/*therapeutic use ; Diverticulosis, Colonic/*drug therapy ; Double-Blind Method ; Female ; Humans ; Male ; Mesalamine/administration & dosage/*therapeutic use ; Middle Aged ; Treatment Outcome ; },
abstract = {BACKGROUND: Robust evidence regarding medical intervention for symptomatic uncomplicated colonic diverticular disease (DD) is sparse.
AIM: To investigate mesalazine (Salofalk granules) in this setting.
METHODS: In a double-blind, placebo-controlled, multicentre, 6-week trial, patients were randomised to mesalazine 1000 mg three times daily or placebo. Primary efficacy endpoint was change in lower abdominal pain to week 4 (baseline defined using pain score from 7 days pre-treatment).
RESULTS: Median change in lower abdominal pain with mesalazine vs. placebo was -37 (n = 56) vs. -33 (n = 61) [P = 0.374; 95% CI (-11; 4)] in the intent-to-treat (ITT) population, and -41 (n = 40) vs. -33 (n = 51) [P = 0.053; 95% CI (-18; 0)] in the per-protocol (PP) population, i.e. the primary endpoint was not significantly different. Post hoc adjustment for confounding factors ('baseline pain intensity', 'baseline symptom score (Brodribb)', and 'localisation of diverticula in the descending colon') resulted in P = 0.111 [ITT, 95% CI (-15.4; 1.6)] and P = 0.005 [PP, 95% CI (-19.7; -3.5)]. Between-group differences increased using pain score on day 1 as baseline, and reached significance for the PP population [mesalazine -42, placebo -26, P = 0.010; 95% CI (-25; -3)]. Median change in combined symptom score from baseline to week 4 was 257 mm with mesalazine vs. 198 mm with placebo [P = 0.064; 95% CI (-3; 105)]. More placebo-treated patients received analgesic/spasmolytic concomitant medication (34.4% vs. mesalazine 21.4%), indicating improved pain relief with mesalazine (P = 0.119). Safety was comparable.
CONCLUSIONS: A daily dose of 3.0 g mesalazine may relieve pain during a symptomatic flare of uncomplicated DD. In this, the first placebo-controlled double-blind trial in acute uncomplicated DD, mesalazine showed promising therapeutic efficacy.},
}
@article {pmid23411679,
year = {2013},
author = {Velayos, B and Pons-Renedo, F and Fernández-Salazar, L and Muñoz, MF and Olmo, L and Almaraz, A and Beltrán-Heredia, J and Hernández-González, JM},
title = {Atmospheric pressure does not influence acute diverticular disease.},
journal = {International journal of colorectal disease},
volume = {28},
number = {12},
pages = {1725-1726},
pmid = {23411679},
issn = {1432-1262},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; *Atmospheric Pressure ; Diverticulum/*pathology ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; },
}
@article {pmid23389059,
year = {2013},
author = {Miller, S and Causey, MW and Damle, A and Maykel, J and Steele, S},
title = {Single-incision laparoscopic colectomy: training the next generation.},
journal = {Surgical endoscopy},
volume = {27},
number = {5},
pages = {1784-1790},
pmid = {23389059},
issn = {1432-2218},
mesh = {Adult ; Aged ; Colectomy/*education/instrumentation/methods ; Colon, Sigmoid/surgery ; Colonic Diseases/surgery ; Colonic Neoplasms/surgery ; Female ; Humans ; Ileum/surgery ; *Internship and Residency ; Laparoscopy/*education/instrumentation/methods ; Length of Stay/statistics & numerical data ; Male ; *Mentors ; Middle Aged ; Postoperative Complications/epidemiology ; Recovery of Function ; Reoperation/statistics & numerical data ; Teaching ; },
abstract = {BACKGROUND: Single-incision laparoscopic colectomy (SILC) is touted to be an improved approach for minimally invasive surgery although no data currently exists regarding the acquisition of skills for the safe performance of this technique. The authors report their early experience with proctoring of surgical residents in SILC by experienced colorectal surgeons.
METHODS: Data regarding patient demographics, operative data, and short-term outcomes were prospectively collected at two surgical training hospitals. Residents and staff independently rated individual components of this technique to compare them with learning standard multiport colectomy (MP).
RESULTS: A total of 31 SILC cases (15 men; mean age 53 years) were managed. The average BMI was 26.5 kg/m(2) (range 16-39 kg/m(2)). The surgical indications included cancer (n = 13), polyps (n = 8), diverticular disease (n = 4), Crohn's disease (n = 2), familial adenomatous polyposis (n = 2), volvulus (n = 1), and rectal prolapse (n = 1). The average operative time was 164 ± 86 min, and the mean blood loss was 80 ± 83 mL. The mean incision length was 4.1 ± 1.1 cm. One case required additional trocar placement (stoma creation), and three cases required conversion to open procedure because of failure to progress, difficult colorectal anastomosis, or poor visualization. The median hospital stay was 5.7 ± 1.3 days. The 30-day morbidity included minor wound infections (9.7 %), ileus (6.5 %), blood transfusion (3.2 %), and intraabdominal abscess (3.2 %). No deaths occurred. Residents rated vascular pedicle isolation, mobilization, critical structure exposure, instrument conflict/handling, and ergonomics as significantly more difficult with SILC.
CONCLUSIONS: Senior-level residents can safely perform SILC under appropriate experienced supervision. The required advanced skills reflect complex laparoscopic training occurring during residency. Opportunities exist for better preparation and training of surgical residents to perform this complex surgery independently and safely at completion of residency.},
}
@article {pmid23385677,
year = {2012},
author = {Alatise, OI and Arigbabu, AO and Agbakwuru, EA and Lawal, OO and Ndububa, DA and Ojo, OS},
title = {Spectrum of colonoscopy findings in Ile-Ife Nigeria.},
journal = {The Nigerian postgraduate medical journal},
volume = {19},
number = {4},
pages = {219-224},
pmid = {23385677},
issn = {1117-1936},
mesh = {Adult ; Age Distribution ; Aged ; *Colonoscopy/economics/methods/statistics & numerical data ; Cost-Benefit Analysis ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology ; Humans ; Intestinal Diseases/classification/complications/*diagnosis/epidemiology ; Lower Gastrointestinal Tract/*pathology ; Male ; Middle Aged ; Nigeria/epidemiology ; Prospective Studies ; Referral and Consultation/statistics & numerical data ; Reproducibility of Results ; Sex Distribution ; },
abstract = {AIMS AND OBJECTIVES: Lower gastrointestinal (LGI) diseases are the leading causes of morbidity and mortality worldwide. Colonoscopy holds an important place in screening, diagnosing and treatment of these conditions. In Nigeria, as in many other developing countries, the facility for performing colonoscopy is rarely available. This prospective report seeks to evaluate the demographic data of patients presenting for colonoscopy, the pattern and validity of referral diagnosis versus colonoscopy findings in Ile-Ife, Nigeria.
SUBJECTS AND METHODS: All patients who had colonoscopy procedure done in the Endoscopy Unit of Obafemi Awolowo University Teaching Hospital Complex between January 2007 and December 2011 were included in the study.
RESULTS: During the study period, colonoscopy was carried out in 320 patients. One hundred and eighty two (56.9%) were males, while 138 (43.1%) were females. The median age was 59.5 years. Their ages ranged from 2-87 years. The most common indications were lower gastrointestinal bleeding and change in bowel habit which together accounted for 79.0%. No abnormality was seen in 93(29.1%) patients. Abnormal endoscopic findings included 66(20.6%) patients who had haemorrhoids, 50(15.6%) cases colorectal cancer, 33 (10.3%) patients had benign polyps and (30 (9.4%) patients had diverticular disease. Other findings were colitis, inflammatory bowel disease, rectovaginal fistula, vascular ectasia and extra luminal compression. Haemorrhoids, diverticulosis and polyps were the most common findings in patients presenting with lower gastrointestinal bleeding.
CONCLUSION: This present report showed that colonoscopy is a cheap, safe and effective method of investigating lower gastrointestinal disease in Ile-Ife, Nigeria. When the indication is based on symptoms, the diagnostic yield could be as high as 90%. The common causes of lower gastrointestinal bleeding in Ile-Ife, Nigeria include haemorrhoids, diverticulosis and polyps.},
}
@article {pmid23373354,
year = {2012},
author = {Xynos, E},
title = {Functional results after surgery for overt rectal prolaps.},
journal = {Acta chirurgica Iugoslavica},
volume = {59},
number = {2},
pages = {21-24},
doi = {10.2298/aci1202021x},
pmid = {23373354},
issn = {0354-950X},
mesh = {Digestive System Surgical Procedures/adverse effects/methods ; Humans ; Postoperative Complications ; Rectal Prolapse/*surgery ; },
abstract = {Several procedures have been designed and applied to treat overt rectal prolapse (ORP). Transperineal procedures, such Altemeier and Delorme operations, are associated with less morbidity, but higher rate of recurrence and less optimal functional results. Transabdominal procedures include a variety of rectopexies with the use of prosthesis or sutures and with or without resection of the redundant sigmoid colon. Nowadays, they are all approached by laparoscopy. Traditional prosthesis rectopexies repair ORP and improve incontinence, but are associated with increased rate of constipation. Resection sutuere-rectopexy seems to be associated with the best functional results, particular in patients with slow transit constipation and diverticular disease. More recently, prosthesis ventral coloporectopexy seems to be less invasive and to offer very satisfactory results.},
}
@article {pmid23363832,
year = {2013},
author = {Hansen, SG and Skov, MN and Justesen, US},
title = {Two cases of Ruminococcus gnavus bacteremia associated with diverticulitis.},
journal = {Journal of clinical microbiology},
volume = {51},
number = {4},
pages = {1334-1336},
pmid = {23363832},
issn = {1098-660X},
mesh = {Aged ; Aged, 80 and over ; Bacteremia/complications/*diagnosis/microbiology/*pathology ; Bacterial Typing Techniques ; Cluster Analysis ; DNA, Bacterial/chemistry/genetics ; DNA, Ribosomal/chemistry/genetics ; Diverticulitis/complications/*diagnosis/microbiology/*pathology ; Gram-Positive Bacterial Infections/*diagnosis/microbiology/*pathology ; Humans ; Male ; Phylogeny ; RNA, Ribosomal, 16S/genetics ; Ruminococcus/chemistry/genetics/*isolation & purification/physiology ; Sequence Analysis, DNA ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; },
abstract = {We report two cases of bacteremia with the anaerobic bacterium Ruminococcus gnavus. In both cases, the bacteremia was associated with diverticular disease. Preliminary conventional identification suggested peptostreptococci, and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis did not produce scores high enough for species identification. Finally, the bacteria were identified by 16S rRNA gene sequencing.},
}
@article {pmid23350931,
year = {2013},
author = {Faucheron, JL and Roblin, X and Bichard, P and Heluwaert, F},
title = {The prevalence of right-sided colonic diverticulosis and diverticular haemorrhage.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {15},
number = {5},
pages = {e266-70},
doi = {10.1111/codi.12137},
pmid = {23350931},
issn = {1463-1318},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Child ; Colon, Ascending ; Colon, Transverse ; Colonoscopy ; Diverticulosis, Colonic/complications/diagnosis/*epidemiology ; Female ; France/epidemiology ; Gastrointestinal Hemorrhage/*epidemiology/etiology ; Humans ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Risk Factors ; Young Adult ; },
abstract = {AIM: The study was performed to determine the prevalence of right-sided diverticular disease in a western population and whether it is more likely to bleed than disease on the left side.
METHOD: From January 2004 to June 2005, 796 consecutive patients were referred for total colonoscopy to 17 physicians. Data obtained included age, gender, and presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding.
RESULTS: Three-hundred and eighteen (40%) of the 796 patients presented with noncomplicated diverticulosis. Of these, 103 (32.4%) had right-sided diverticula. In univariate analysis, the presence of right diverticula in patients admitted for diverticular bleeding was about twice as frequent as in patients who had diverticula with no bleeding (65.2% vs 32.4%; P = 0.0001). In multivariate analysis, the right localization of the diverticulosis was associated with a risk of bleeding, which was independent of the patients' age (P = 0.0001, OR = 3.6).
CONCLUSION: The prevalence of colonic diverticula increased from < 10% in adults under 40 years of age to about 75% in those over 75 years of age. Of these patients, nearly one-third presented with right-sided involvement. Right-sided localization was associated with a significant risk of bleeding, which was independent of the patients' age.},
}
@article {pmid23341198,
year = {2013},
author = {Parma, P and Samuelli, A and Dall'Oglio, B},
title = {[Laparoscopic repair of enterovesical fistula in patient affected by left megaureter].},
journal = {Urologia},
volume = {80 Suppl 22},
number = {},
pages = {35-38},
doi = {10.5301/RU.2013.10618},
pmid = {23341198},
issn = {1724-6075},
mesh = {Dilatation, Pathologic/complications ; Humans ; Intestinal Fistula/complications/*surgery ; *Laparoscopy ; Male ; Middle Aged ; Sigmoid Diseases/complications/*surgery ; Ureteral Diseases/complications/pathology ; Urinary Bladder Fistula/complications/*surgery ; },
abstract = {INTRODUCTION: Enterovesical fistula (EVF) is an abnormal communication between the intestine and the bladder. We present the case of EVF secondary to diverticular disease in a male with congenital megaureter. A laparoscopic repair of the colon vesical fistula was performed with colon resection.
MATERIALS AND METHODS: With the patient in the Trendelenburg position -30° degrees on the right side, 5 trocars are positioned trans-peritoneally. The exploration of the abdominal cavity shows the sigmoid diverticular disease adhering tenaciously to the posterior wall of the bladder. The intestinal loops are medialized. The inferior mesenteric vein is isolated, clipped and divided. The mesosigma is isolated and the inferior mesenteric artery is closed 2 cm from its emergence from the aorta with EndoGIA™ 45 stapler. The left colon is isolated from its splenic flexure to the mesorectum. The peritoneum between the bladder and sigmoid colon at the site of the tenacious adhesions is incised. The left megaureter is isolated from the diverticular disease and the bladder is opened on the site of the fistula, to permit a wide resection of the fistula. The posterior wall of the bladder is then closed with double running sutures. Section of the rectum with EndoGIA™ 45 stapler. Extraction of 20 cm of sigma comprising diverticular disease by a 5 cm suprapubic laparotomy. The sigma is cut and the proximal head of the circular stapler is inserted and closed with a running suture. The left colon is put back in place into the peritoneal cavity. The laparotomy is closed and the surgery is reconverted into laparoscopy. A colorectal end-to-end anastomosis according to Knight Griffen is performed with ILS 29 circular stapler. The anastomosis is tested for leakage with hydropneumatic test: no evidence of spillage. A laminar drainage is placed close to the anastomosis and the incisions are closed.
RESULTS: The operative time was 240 minutes. There were no intra- or post-operative complications. The bladder catheter was removed on day 7 after cystography. The patient was discharged asymptomatic on the 8th post-operative day.
CONCLUSIONS: Laparoscopic treatment of enterovesical fistulas for benign disease is a safe and standardized procedure. It remains a difficult procedure with a conversion rate higher than laparoscopy for uncomplicated diverticulitis or malignancy. The procedure in a single session with intracorporeal bowel anastomosis is the standard.},
}
@article {pmid23339893,
year = {2012},
author = {Okon, JB and N'dri, N and Toth'o, A and Assi, C and Diakité, M and Soro, D and Ouattara, A and Allah-Kouadio, E and Lohouès, MJ and Camara, BM},
title = {[Diagnosis of hematochezia in Abidjan Cocody University Hospital (Ivory Coast)].},
journal = {Medecine et sante tropicales},
volume = {22},
number = {4},
pages = {398-400},
doi = {10.1684/mst.2012.0109},
pmid = {23339893},
issn = {2261-2211},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Colonoscopy ; Cote d'Ivoire ; Female ; Gastrointestinal Hemorrhage/*diagnosis ; Hospitals, University ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult ; },
abstract = {AIM: To determine the prevalence of endoscopic lesions, according to age and location, in patients with rectal bleeding who underwent total colonoscopy.
METHODS: Retrospective observational study examining records from the hepatogastroenterology department at the Cocody University Hospital (Abidjan) of colonoscopies for rectal examination from September 1, 1991, through August 15, 2007. The data collected and analyzed from the records included age, sex and colonoscopy results. A p value less than 0.05 was considered statistically significant.
RESULTS: Of 1,158 colonoscopies, 270 (23.3%) were performed for hematochezia: 105 women (mean age: 48.8 years ± 19.9 years, range: 10-96 years) and 165 men (mean age: 46 ± 14.2, range: 21-83 years) with a sex-ratio (M/F) of 1.57. Because colorectal cancer seems to occur at a younger age in Africa, patients were divided into two groups (aged 45 years: 139 [51.5%] and above 45 years: 131 [48.5%]). The abnormalities found were consistent with anal pathologies (16.3%), polyps (10.4%), diverticular disease (11.1%), colorectal inflammatory lesions (21.5%) and carcinoma (7%). Diverticula were significantly more common in those older than 45 years and inflammatory lesions in the younger group (p < 10(-3)). More than two thirds of the significant lesions were found in the distal colon (p < 10(-3)).
CONCLUSION: The predominance of distal colon lesions suggests that exploration by flexible sigmoidoscopy can be performed in patients with low to moderate risk of colorectal cancer, with total colonoscopy reserved for the population at high risk.},
}
@article {pmid23328302,
year = {2013},
author = {Lahat, A and Avidan, B and Sakhnini, E and Katz, L and Fidder, HH and Meir, SB},
title = {Acute diverticulitis: a decade of prospective follow-up.},
journal = {Journal of clinical gastroenterology},
volume = {47},
number = {5},
pages = {415-419},
doi = {10.1097/MCG.0b013e3182694dbb},
pmid = {23328302},
issn = {1539-2031},
mesh = {Acute Disease ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colon, Sigmoid/surgery ; *Diverticulitis, Colonic/complications/diagnosis/diagnostic imaging/surgery ; Diverticulum, Colon/*pathology ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Male ; Middle Aged ; Prospective Studies ; Radiography ; Risk Factors ; },
abstract = {BACKGROUND: Acute diverticulitis (AD) is the most common complication of diverticular disease and affects 10% to 25% of patients. Data regarding the natural history of AD are lacking.
GOALS: Our aim was to prospectively assess the occurrence of recurrent attacks, surgeries, and accompanying symptoms in patients who were hospitalized with AD.
STUDY: All patients hospitalized with first episode of AD between January 2000 and November 2006 were enrolled. Patients were followed up both during hospitalization and after discharge. Data regarding operations and complications were collected. Special attention was paid to patients younger than 45 years of age and compared with older patients.
RESULTS: A total of 261 patients were identified-of them 103 were men. Thirty patients (11.5%) were 45 years old or younger. The mean follow-up period was 88±22 months (range, 52 to 184 mo). Younger patients experienced significantly more complications during hospitalization (37% vs. 12.5%, P=0.001) and underwent more often a sigmoidectomy in the follow-up period (42.3% vs. 18.3%, P=0.01). Older patients tended to be more often asymptomatic after discharge (P=0.053). The average time from index hospitalization to the sigmoidectomy was 18.17±23.35 months (range, 1 to 120 mo). The odds ratio for sigmoidectomy after complicated AD is 16.2 (95% confidence interval, 13.4 to 19.6). Age did not affect the risk for surgery.
CONCLUSIONS: Younger patients with AD experience more complications during hospitalization and undergo surgery after discharge more frequently. Complicated AD at index hospitalization is a risk factor for sigmoidectomy. Our data can help predict the outcome of patients suffering from AD and enable tailoring an individual treatment.},
}
@article {pmid23319717,
year = {2013},
author = {Öistämö, E and Hjern, F and Blomqvist, L and Von Heijne, A and Abraham-Nordling, M},
title = {Cancer and diverticulitis of the sigmoid colon. Differentiation with computed tomography versus magnetic resonance imaging: preliminary experiences.},
journal = {Acta radiologica (Stockholm, Sweden : 1987)},
volume = {54},
number = {3},
pages = {237-241},
doi = {10.1258/ar.2012.120543},
pmid = {23319717},
issn = {1600-0455},
mesh = {Adult ; Aged ; Aged, 80 and over ; Biopsy ; Colonoscopy ; Contrast Media ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; Diverticulitis, Colonic/*diagnosis/diagnostic imaging ; Female ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Pilot Projects ; Prospective Studies ; Sensitivity and Specificity ; Sigmoid Diseases/*diagnosis/diagnostic imaging ; Sigmoid Neoplasms/*diagnosis/diagnostic imaging ; Tomography, X-Ray Computed/*methods ; },
abstract = {BACKGROUND: Both colon cancer and diverticular disease are common in the Western world. A challenge when patients present with clinical findings is that both diseases can present with symptoms that may mimic the other.
PURPOSE: To determine whether magnetic resonance imaging (MRI) could be helpful to differentiate between diverticulitis and cancer of the sigmoid colon compared to the differentiation offered by evaluation of multidetector computed tomography (CT) in a clinical situation.
MATERIAL AND METHODS: Thirty patients were consecutively included. Fifteen patients were under work-up for a recently diagnosed sigmoid cancer and 15 patients had recently been treated in hospital due to first-time acute sigmoid diverticulitis. All patients underwent CT, T2- weighted MRI and diffusion-weighted MRI. Anonymized examinations were retrospectively presented in random order to one experienced radiologist.
RESULTS: With contrast-enhanced CT, the sensitivity and specificity for diagnosis of cancer and diverticulitis were 66.7% (10/15) and 93.3% (14/15), respectively. Using T2-weighted and diffusion-weighted MR images, the sensitivity and specificity for diagnosis of cancer and diverticulitis were 100% (14/14) and 100% (14/14), respectively.
CONCLUSION: MRI provides information that may contribute to improve the differentiation between sigmoid cancer and diverticulitis that is offered by CT. These encouraging results need to be confirmed in a larger study.},
}
@article {pmid23313967,
year = {2013},
author = {Strate, LL and Erichsen, R and Baron, JA and Mortensen, J and Pedersen, JK and Riis, AH and Christensen, K and Sørensen, HT},
title = {Heritability and familial aggregation of diverticular disease: a population-based study of twins and siblings.},
journal = {Gastroenterology},
volume = {144},
number = {4},
pages = {736-742.e1; quiz e14},
doi = {10.1053/j.gastro.2012.12.030},
pmid = {23313967},
issn = {1528-0012},
mesh = {Adult ; Age Distribution ; Cluster Analysis ; Confidence Intervals ; Denmark/epidemiology ; Diverticulum/*epidemiology/*genetics/physiopathology ; Female ; Genetic Predisposition to Disease/*epidemiology ; Humans ; Male ; Middle Aged ; Pedigree ; Prevalence ; Registries ; Retrospective Studies ; Risk Assessment ; Sex Distribution ; *Siblings ; Twins/*genetics ; Twins, Dizygotic/genetics ; Twins, Monozygotic/genetics ; },
abstract = {BACKGROUND & AIMS: Little is known about the role of heritable factors in diverticular disease. We evaluated the contribution of heritable factors to the development of diverticular disease diagnosed at a hospitalization or outpatient visit.
METHODS: Using nationwide patient registries, we identified 142,123 incident cases of diverticular disease diagnosed at a hospitalization (1977-2011) or an outpatient hospital visit (1995-2011) in Denmark, including cases in 10,420 index siblings and 923 twins. We calculated standardized incidence ratios for siblings versus the general population and concordance rates for monozygotic versus dizygotic twin pairs as measures of relative risk (RR).
RESULTS: The RR for diverticular disease in siblings of index cases was 2.92 (95% confidence interval [CI], 2.50-3.39) compared with the general population. The RRs were similar irrespective of the sex of the sibling or index case and were particularly strong in siblings of hospitalized cases and cases that underwent surgery. The proband-wise concordance rate for monozygotic twins was double that of dizygotic twins (0.16 [95% CI, 0.11-0.22] vs 0.07 [95% CI, 0.05-0.11], respectively). The RR of diverticular disease in one twin when the other had diverticular disease was 14.5 (95% CI, 8.9-23) for monozygotic twins compared with 5.5 (95% CI, 3.3-8.6) for dizygotic twins. Associations were stronger in female monozygotic twins compared with male twins (tetrachoric correlation, 0.60 [95% CI, 0.49-0.70] vs 0.33 [95% CI, 0.13-0.51]; P = .03 in an analysis stratified by sex and zygosity). We estimate that 53% (95% CI, 45%-61%) of susceptibility to diverticular disease results from genetic factors.
CONCLUSIONS: Based on a population-based study in Denmark, genetic factors appear to contribute to development of diverticular disease.},
}
@article {pmid23303160,
year = {2013},
author = {Bordeianou, L},
title = {Sigmoid colectomy may not be causal therapy for diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {56},
number = {2},
pages = {e17},
doi = {10.1097/DCR.0b013e3182792bb6},
pmid = {23303160},
issn = {1530-0358},
mesh = {*Colectomy ; Diverticulitis, Colonic/*surgery ; Fecal Incontinence/*etiology ; Female ; Humans ; Male ; *Postoperative Complications ; Sigmoid Diseases/*surgery ; },
}
@article {pmid23303159,
year = {2013},
author = {Kraemer, M and Picke, D and Tolstych, N},
title = {Sigmoid colectomy may not be causal therapy for diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {56},
number = {2},
pages = {e17},
doi = {10.1097/DCR.0b013e318277e918},
pmid = {23303159},
issn = {1530-0358},
mesh = {*Colectomy ; Diverticulitis, Colonic/*surgery ; Fecal Incontinence/*etiology ; Female ; Humans ; Male ; *Postoperative Complications ; Sigmoid Diseases/*surgery ; },
}
@article {pmid23294948,
year = {2012},
author = {Pătraşcu, T and Doran, H and Catrina, E and Mihalache, O},
title = {Therapeutical options in sigmoid diverticulitis. When should we operate?.},
journal = {Chirurgia (Bucharest, Romania : 1990)},
volume = {107},
number = {6},
pages = {715-721},
pmid = {23294948},
issn = {1221-9118},
mesh = {Aged ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; *Colon, Sigmoid/surgery ; Diverticulitis, Colonic/complications/diagnosis/surgery/*therapy ; Drug Therapy, Combination ; Elective Surgical Procedures ; Female ; Humans ; Middle Aged ; Therapeutic Irrigation ; Treatment Outcome ; },
abstract = {Colonic diverticulosis is a benign disease whose incidence has been steadily increasing throughout the world, especially in the economically developed countries in Western Europe. This increase is connected to the population ageing process, the diverticulosis being characteristic in the elderly, and with nowadays' eating habits. Frequently, colonic diverticuli may cause complications, such as hemorrhage or diverticulitis, with pericolic abscesses or peritonitis. Consequently, efforts are being made to set up a therapeutic algorithm appropriate for the diverticular disease, the predominance of the conservative or surgical attitude being continuously adjusted. We have analyzed the therapeutic options, their advantages and their limitations, based on both the experience of the "Prof. I. Juvara" Surgical Department of the "Dr. I. Cantacuzino" Clinical Hospital and the latest data in medical literature.},
}
@article {pmid23294879,
year = {2014},
author = {Gravante, G and Rai, S and Jadhav, V},
title = {Diverticular disease of the vermiform appendix.},
journal = {Surgery},
volume = {155},
number = {5},
pages = {954-955},
doi = {10.1016/j.surg.2012.11.023},
pmid = {23294879},
issn = {1532-7361},
mesh = {Appendectomy ; *Appendix/surgery ; Cecal Diseases/*diagnosis/surgery ; Diverticulum/*diagnosis/surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome ; },
}
@article {pmid23294065,
year = {2012},
author = {Murphy, PB and Belliveau, P},
title = {Left-sided sigmoid diverticulitis presenting as right-sided thigh abscess.},
journal = {International surgery},
volume = {97},
number = {4},
pages = {285-287},
pmid = {23294065},
issn = {2520-2456},
mesh = {Abscess/*etiology ; Cutaneous Fistula/diagnosis/*etiology ; Diverticulitis, Colonic/complications/*diagnosis ; Humans ; Intestinal Fistula/diagnosis/*etiology ; Male ; Middle Aged ; Sigmoid Diseases/complications/*diagnosis ; Thigh ; },
abstract = {Acquired diverticular disease of the colon is very common in the North American population. Atypical presentations are usually due to complications and rarely the predominant complaint may be related to an associated fistula. Thigh abscesses due to colocutaneous fistula represent an uncommon complication of sigmoid diverticulitis. In rare cases, a thigh abscess may be the only symptom, but gas in the thigh should raise the index of suspicion for bowel pathology. We report the second known case of a left-sided sigmoid diverticulitis leading to an isolated right thigh abscess with no gastrointestinal symptoms.},
}
@article {pmid24964449,
year = {2013},
author = {Gary, MA and Wu, J and Bradway, M},
title = {The space between: a supralevator abscess caused by perforated diverticulitis.},
journal = {Journal of surgical case reports},
volume = {2013},
number = {6},
pages = {},
pmid = {24964449},
issn = {2042-8812},
abstract = {Supralevator abscesses are the rarest manifestation of anorectal suppurative disease. We report a supralevator abscess in a 60-year-old male whose earliest presentation included poorly localized abdominal and pelvic pain, tenesmus, urinary retention and weight loss, initially treated as diverticular disease based upon imaging and presentation. Progressive symptoms led to the discovery of a pelvic abscess with subsequent percutaneous drainage, later followed by emergent laparotomy, where a single perforated diverticulum was revealed to be the source fistulization. He underwent a Hartmann procedure with concomitant drainage of supralevator and ischiorectal collections. Perirectal pain with neurological involvement is part of a constellation of signs and symptoms that should invoke a high index of clinical suspicion for supralevator abscess formation. Percutaneous attempts at drainage are often inadequate; definitive surgical therapy is the best approach to prevent recurrence and associated morbidity.},
}
@article {pmid24964318,
year = {2013},
author = {Arthur, TI and Gillespie, CJ and Butcher, W and Lu, CT},
title = {Pseudoaneurysm of the internal iliac artery resulting in massive per-rectal bleeding.},
journal = {Journal of surgical case reports},
volume = {2013},
number = {10},
pages = {},
pmid = {24964318},
issn = {2042-8812},
abstract = {Rectal bleeding is a common reason for presentation to hospital, with large bleeds most commonly caused by diverticular disease and angiodysplasia. Here we present an unusual aetiology of massive per-rectal bleeding attributable to pseudoaneurysm of the internal iliac artery leading to an arterial fistula to the distal large bowel. It is hoped the case will serve as a reminder that rectal bleeding can have a less common aetiology.},
}
@article {pmid24772849,
year = {2013},
author = {},
title = {[Report about symposium "Colon diverticular disease", held on the 25th of October, 2013 at the State Research Center of Coloproctology Department of Healthcare, City of Moscow].},
journal = {Eksperimental'naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology},
volume = {},
number = {10},
pages = {30-31},
pmid = {24772849},
issn = {1682-8658},
mesh = {*Colon, Ascending/pathology/surgery ; *Colon, Descending/pathology/surgery ; Colonoscopy ; Diagnosis, Differential ; *Diverticulum, Colon/diagnosis/etiology/therapy ; Humans ; },
}
@article {pmid24707230,
year = {2013},
author = {Reddy, VB and Longo, WE},
title = {The burden of diverticular disease on patients and healthcare systems.},
journal = {Gastroenterology & hepatology},
volume = {9},
number = {1},
pages = {21-27},
pmid = {24707230},
issn = {1554-7914},
abstract = {Diverticulitis is a debilitating complication of diverticular disease that affects approximately 2.5 million individuals in the United States. Compared to many other gastrointestinal conditions, diverticular disease is poorly understood in terms of its burden on patients and healthcare systems. This review examines the existing literature and discusses the current knowledge of the burden of diverticular disease. Literature confirmed that bothersome symptoms (such as abdominal pain and bloating) and potentially serious, disease-related complications (such as diverticulitis and diverticular bleeding) place a significant burden on patients. Broad-spectrum antibiotic therapy and surgery are the generally accepted mainstays of treatment for acute complications of diverticular disease. Despite these options, patients frequently experience substantially reduced quality of life (particularly in terms of social and emotional functioning) and increased mortality (predominantly due to disease-related complications) compared to healthy controls. Furthermore, diverticular disease accounted for 254,179 inpatient discharges and 1,493,865 outpatient clinic visits in the United States in 2002, at an estimated cost per hospitalization of $9,742-$11,729. Enhancing the quality of life of patients with diverticular disease and reducing disease exacerbations and complications will substantially benefit patients and healthcare systems. However, long-established treatment algorithms fall short of these therapeutic goals. Research into new treatment options for patients with diverticular disease should therefore be pursued.},
}
@article {pmid23271440,
year = {2013},
author = {Bargellini, T and Martellucci, J and Tonelli, P and Valeri, A},
title = {Long-term results of treatment of acute diverticulitis: still lessons to be learned?.},
journal = {Updates in surgery},
volume = {65},
number = {2},
pages = {125-130},
pmid = {23271440},
issn = {2038-131X},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Diverticulitis/*surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Time Factors ; Treatment Outcome ; },
abstract = {The aim of the present study was to evaluate the long-term results in patients treated for diverticular disease (DD), mainly considering indication for surgery, outcome of the treatment modalities and quality of life. All consecutive patients who underwent treatment for diverticular disease since January 2003 to June 2007 were analyzed. Patients were divided into three groups: medical treatment, elective surgery and emergency surgery. The patients responded to the questions of the Cleveland Global Quality of Life (CGQL) questionnaire and to a symptoms questionnaire during a telephone interview. The long-term outcome parameters such as readmission to the hospital, further surgery for DD, current health status, and quality of life were analyzed according to possible predictors. 146 patients (72.2 %) agreed to submit to the telephone interview and were enrolled in the study. The median follow-up was 99 months. Fifty-two patients were managed with medical therapy, 36 patients received elective operations, and 58 patients underwent acute surgery. Twelve patients (12.7 %) complained episodes of persistent abdominal pain after surgical resection, compared with 6 non-surgical patients (11.5 %). No possible predictors of recurrence, reoperation or readmission were found. The CGQL total scores were found to be similar in the three groups. DD affected bowel function and quality of life of patients in the long-term follow-up regardless of the type of therapy adopted. No long-term advantages of colonic resection were found which should be considered only in patients presenting complicated DD.},
}
@article {pmid23254529,
year = {2012},
author = {Pillinger, T and Abdelrahman, M and Jones, G and D'Souza, F},
title = {Intractable metabolic acidosis in a patient with colovesical fistula.},
journal = {The New Zealand medical journal},
volume = {125},
number = {1366},
pages = {74-76},
pmid = {23254529},
issn = {1175-8716},
mesh = {Acidosis/*etiology ; Colonic Diseases/*complications/surgery ; Female ; Humans ; Intestinal Fistula/*complications/surgery ; Middle Aged ; Urinary Bladder Fistula/*complications/surgery ; },
abstract = {A 58-year-old female presented with urosepsis and faecaluria secondary to a colovesical fistula of diverticular aetiology. A plan was made for surgical repair of the fistula. Preoperatively the patient developed a hyperchloraemic metabolic acidosis, with hyperkalaemia and hyponatraemia. Renal function was normal, and a short synachten test ruled out Addison's disease. Postoperatively her acid-base physiology normalised in the absence of medical management, demonstrating that surgical intervention was responsible for resolution of the patient's metabolic acidosis. The mechanisms by which colovesical pathophysiology causes hyperchloraemic metabolic acidosis are discussed. Although diverticular disease is the most common cause of colovesical fistulae, this is the first report of such fistulae causing metabolic acidosis.},
}
@article {pmid23252053,
year = {2012},
author = {Burch, J},
title = {Enhanced recovery for patients following colorectal surgery.},
journal = {Nursing standard (Royal College of Nursing (Great Britain) : 1987)},
volume = {27},
number = {2},
pages = {37-43; quiz 44},
doi = {10.7748/ns2012.09.27.2.37.c9297},
pmid = {23252053},
issn = {0029-6570},
mesh = {Colon/*surgery ; Education, Nursing, Continuing ; Humans ; *Postanesthesia Nursing ; Rectum/*surgery ; *Surgical Procedures, Operative ; United Kingdom ; },
abstract = {The gastrointestinal tract consists of different organs that may become diseased and require surgery. Colorectal surgery is commonly undertaken for conditions such as colorectal cancer and diverticular disease. This article discusses some of the more common operations to increase the reader's understanding of colorectal surgery Enhanced recovery has been undertaken in the UK and Europe for several years. It is a way of improving the experience and wellbeing of patients following surgery by enabling faster recovery and return to normal, minimising post-operative complications such as infection, as well as reducing length of stay in hospital and readmission.},
}
@article {pmid23250639,
year = {2013},
author = {Turley, RS and Mantyh, CR and Migaly, J},
title = {Minimally invasive surgery for diverticulitis.},
journal = {Techniques in coloproctology},
volume = {17 Suppl 1},
number = {},
pages = {S11-22},
pmid = {23250639},
issn = {1128-045X},
mesh = {Colectomy/*methods ; Diverticulitis, Colonic/complications/*surgery ; Humans ; Laparoscopy/*methods ; Minimally Invasive Surgical Procedures ; },
abstract = {The realm of minimally invasive surgery now encompasses the majority of abdominal operations in the field of colorectal surgery. Diverticulitis, a common pathology seen in most colorectal practices, poses unique challenges to surgeons implementing laparoscopic surgery in their practices due to the presence of an inflammatory phlegmon and distorted anatomical planes, which increase the difficulty of the operation. Although the majority of colon resections for diverticulitis are still performed through a standard laparotomy incision, laparoscopic techniques are becoming increasingly common. A large body of literature now supports laparoscopic surgery to be safe and effective as well as to provide significant advantages over open surgery for diverticular disease. Here, we review the most current literature supporting laparoscopic surgery for elective and emergent treatment of diverticulitis.},
}
@article {pmid23242845,
year = {2013},
author = {van de Wall, BJ and Draaisma, WA and Consten, EC and van der Kaaij, RT and Wiezer, MJ and Broeders, IA},
title = {Does the presence of abscesses in diverticular disease prelude surgery?.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {17},
number = {3},
pages = {540-547},
pmid = {23242845},
issn = {1873-4626},
mesh = {Abdominal Abscess/*complications ; Adult ; Confidence Intervals ; Diverticulitis, Colonic/classification/*complications/*surgery ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Patient Readmission/*statistics & numerical data ; Proportional Hazards Models ; Retrospective Studies ; Rupture, Spontaneous/etiology ; Severity of Illness Index ; Time Factors ; },
abstract = {BACKGROUND: Information on long-term outcome of patients treated conservatively for diverticular abscess is scarce. This study aims to compare diverticulitis patients with abscess to patients without abscess with regard to readmission, complications, and surgical treatment during a follow-up period of at least 12 months.
METHODS: A chart review of all patients admitted for a primary manifestation of diverticulitis between January 2005 and January 2011 was performed.
RESULTS: Fifty-nine patients with abscess and 663 without abscess were identified. Median follow-up was 28 months (range 12-103). Initial conservative management was achieved in 54 (91.5 %) patients with diverticular abscess and 635 (96.8 %) without abscess. Readmission occurred more frequently among patients with abscess (hazard ratio (HR) 2.6; confidence interval (CI) 1.51-4.33) with a first-year risk of 27.3 versus 10.7 % and second-year risk of 8.2 versus 4.6 %. Surgery was more frequently performed in patients with diverticular abscess (HR 2.3; CI 1.42-3.66). The first-year risk was 35.1 versus 16.6 % and second-year risk was 12.9 versus 2.4 %. The most frequent indication for surgery was persisting or recurrent disease.
CONCLUSION: Patients with diverticular abscess have a higher risk of being readmitted and/or requiring surgical treatment. The pattern suggests that readmission and need for surgery are the results of an ongoing inflammation of the initial episode.},
}
@article {pmid23208010,
year = {2013},
author = {Rossetti, A and Buchs, NC and Breguet, R and Bucher, P and Terraz, S and Morel, P},
title = {Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results.},
journal = {International journal of colorectal disease},
volume = {28},
number = {6},
pages = {777-782},
pmid = {23208010},
issn = {1432-1262},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*blood supply/*pathology ; *Embolization, Therapeutic ; Female ; Gastrointestinal Hemorrhage/diagnostic imaging/*therapy ; Humans ; Male ; Middle Aged ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {BACKGROUND: Lower gastrointestinal bleeding represents 20 % of all gastrointestinal bleedings. Interventional radiology has transformed the treatment of this pathology, but the long-term outcome after selective embolization has been poorly evaluated. The aim of this study is thus to evaluate the short-term and long-term outcomes after selective embolization for colonic bleeding.
METHODS: From November 1998 to December 2010, all acute colonic embolizations for hemorrhage were retrospectively reviewed and analyzed. The risk factors for post-embolization ischemia were also assessed.
RESULTS: Twenty-four patients underwent colonic embolization. There were 6 men and 18 women with a median age of 80 years (range, 42-94 years). The underlying etiologies included diverticular disease (41.9 %), post-polypectomy bleeding (16.7 %), malignancy (8.2 %), hemorrhoid (4.1 %), and angiodysplasia (4.1 %). In 23 patients, bleeding stopped (95.8 %) after selective embolization. One patient presented a recurrence of bleeding with hemorrhagic shock and required urgent hemorrhoidal ligature. Four patients required an emergent surgical procedure because of an ischemic event (16.7 %). One patient died of ileal ischemia (mortality, 4.1 %). The level of embolization and the length of hypoperfused colon after embolization were the only risk factors for emergent operation. Mean hospital stay was 18 days (range, 9-44 days). After a mean follow-up of 28.6 months (range, 4-108 months), no other ischemic events occurred.
CONCLUSION: In our series, selective transarterial embolization for acute colonic bleeding was clinically effective with a 21 % risk of bowel ischemia. The level of embolization and the length of the hypoperfused colon after embolization should be taken into consideration for emergent operation.},
}
@article {pmid23204940,
year = {2011},
author = {Johnson, EK and Champagne, BJ},
title = {Diverticular disease and the obese patient.},
journal = {Clinics in colon and rectal surgery},
volume = {24},
number = {4},
pages = {253-258},
pmid = {23204940},
issn = {1530-9681},
abstract = {Diverticular disease is common in the Western world and is a considerable source of morbidity. Many have proposed an association between diverticular disease, its complications, and obesity. We examine this question through a review of the available literature. While it is likely that an association between diverticular disease and obesity exists, there is no evidence suggesting that obese patients should be managed any differently from the non-obese.},
}
@article {pmid23198377,
year = {2012},
author = {Balemba, GM and Pringot, J and Van Belle, K and Legrand, L and Matthys, P},
title = {Excavated mass and doubletracking in the sigmoid colon due to colocolic fistula complicating diverticulitis.},
journal = {JBR-BTR : organe de la Societe royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR)},
volume = {95},
number = {5},
pages = {325-328},
doi = {10.5334/jbr-btr.683},
pmid = {23198377},
issn = {0302-7430},
mesh = {Aged ; Barium Sulfate ; Diagnosis, Differential ; Diverticulitis, Colonic/*complications/*diagnostic imaging/surgery ; Enema ; Humans ; Intestinal Fistula/*diagnostic imaging/*etiology/surgery ; Male ; Prostatic Neoplasms/pathology ; Sigmoid Diseases/*diagnostic imaging/*etiology/surgery ; Tomography, X-Ray Computed ; },
abstract = {We report on a patient admitted for work up of prostatic carcinoma in which CT study showed an excavated mass involving the sigmoid colon and the bladder dome. Barium enema showed a double track pattern associated with diverticular disease. By surgery the mass was separated from the urinary bladder and the sigmoid resected. On pathological exam diverticulitis was evident as well as an organised colocolic fistula in the thickened fibrotic subserosal fat.The usefulness of opacifying the colon is highlighted.},
}
@article {pmid23192170,
year = {2013},
author = {Gaertner, WB and Kwaan, MR and Madoff, RD and Willis, D and Belzer, GE and Rothenberger, DA and Melton, GB},
title = {The evolving role of laparoscopy in colonic diverticular disease: a systematic review.},
journal = {World journal of surgery},
volume = {37},
number = {3},
pages = {629-638},
pmid = {23192170},
issn = {1432-2323},
mesh = {Case-Control Studies ; Colectomy/adverse effects/*methods ; Colonoscopy/adverse effects/methods ; Diverticulosis, Colonic/diagnosis/*surgery ; Elective Surgical Procedures/adverse effects/methods ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/*methods ; Laparotomy/adverse effects/*methods ; Length of Stay ; Male ; Operative Time ; Postoperative Complications/epidemiology/physiopathology ; Randomized Controlled Trials as Topic ; Risk Assessment ; Severity of Illness Index ; Treatment Outcome ; },
abstract = {BACKGROUND: A PubMed search of the biomedical literature was carried out to systematically review the role of laparoscopy in colonic diverticular disease. All original reports comparing elective laparoscopic, hand-assisted, and open colon resection for diverticular disease of the colon, as well as original reports evaluating outcomes after laparoscopic lavage for acute diverticulitis, were considered. Of the 21 articles chosen for final review, nine evaluated laparoscopic versus open elective resection, six compared hand-assisted colon resection versus conventional laparoscopic resection, and six considered laparoscopic lavage. Five were randomized controlled trials.
RESULTS: Elective laparoscopic colon resection for diverticular disease is associated with increased operative time, decreased postoperative pain, fewer postoperative complications, less paralytic ileus, and shorter hospital stay compared to open colectomy. Laparoscopic lavage and drainage appears to be a safe and effective therapy for selected patients with complicated diverticulitis.
CONCLUSIONS: Elective laparoscopic colectomy for diverticular disease is associated with decreased postoperative morbidity compared to open colectomy, leading to shorter hospital stay and fewer costs. Laparoscopic lavage has an increasing but poorly defined role in complicated diverticulitis.},
}
@article {pmid23185148,
year = {2012},
author = {Ferreira-Aparicio, FE and Gutiérrez-Vega, R and Gálvez-Molina, Y and Ontiveros-Nevares, P and Athie-Gútierrez, C and Montalvo-Javé, EE},
title = {Diverticular disease of the small bowel.},
journal = {Case reports in gastroenterology},
volume = {6},
number = {3},
pages = {668-676},
pmid = {23185148},
issn = {1662-0631},
abstract = {A diverticulum is a bulging sack in any portion of the gastrointestinal tract. The most common site for the formation of diverticula is the large intestine. Small intestine diverticular disease is much less common than colonic diverticular disease. The most common symptom is non-specific epigastric pain and a bloating sensation. Major complications include diverticulitis, gastrointestinal bleeding, acute perforation, pancreatic or biliary (in the case of duodenal diverticula) disease, intestinal obstruction, intestinal perforation, localized abscess, malabsorption, anemia, volvulus and bacterial overgrowth. We describe the clinical case of a 65-year-old female patient with a diagnosis on hospital admittance of acute appendicitis and a intraoperative finding of diverticular disease of the small intestine, accompanied by complications such as intestinal perforation, bleeding and abdominal sepsis. This was surgically treated with intestinal resection and ileostomy and a subsequent re-intervention comprising perforation of the ileostomy and stomal remodeling. The patient remained hospitalized for approximately 1 month with antibiotics and local surgical wound healing, as well as changes in her diet with food supplements and metabolic control. She showed a favorable clinical evolution and was dismissed from the hospital to her home. We include here a discussion on trends in medical and surgical aspects as well as early handling or appropriate management to reduce the risk of fatal complications.},
}
@article {pmid23173922,
year = {2012},
author = {Aprea, G and Giugliano, A and Canfora, A and Cardin, F and Ferronetti, A and Guida, F and Braun, A and Battaglini Ciciriello, M and Tovecci, F and Mastrobuoni, G and Amato, B},
title = {Diverticular disease hospital cost impact analysis: evaluation of testings and surgical procedures in inpatient and outpatient admissions.},
journal = {BMC surgery},
volume = {12 Suppl 1},
number = {Suppl 1},
pages = {S3},
pmid = {23173922},
issn = {1471-2482},
mesh = {Ambulatory Care/*economics/statistics & numerical data ; Colectomy/*economics/statistics & numerical data ; Colostomy/*economics/statistics & numerical data ; Diagnostic Techniques, Digestive System/*economics/statistics & numerical data ; Diverticulosis, Colonic/diagnosis/*economics/surgery ; Hospital Costs/*statistics & numerical data ; Hospitalization/*economics/statistics & numerical data ; Humans ; Italy ; Retrospective Studies ; },
abstract = {BACKGROUND: Diverticular Disease (DD) is a common condition in Italy and in other western countries. There is not much data concerning DD's impact on budget and activity in hospitals.
METHODS: The aim is to detect the clinical workload and the financial impact of diverticular disease in hospitals.Retrospective observational study of all patients treated for diverticular disease during the period of seven years in AOU Federico II. Analysis of inpatient and outpatient investigations, treatment, hospitalization and financial refunds.
RESULTS: A total of 738 patients were treated and 840 hospital discharge records were registered. There were a total number of 4101 hospitalization days and 753 outpatient accesses. The investigations generated were 416 endoscopies, 197 abdominal CT scans, 177 abdominal ultrasound scans, 109 X-rays tests. A total of 193 surgical operations were performed. The total cost of this activity was € 1.656.802 or 0.2% of the total budget of the hospital. € 1.346.218, were attributable to the department of general surgery, 0.9% of the department's budget .
CONCLUSIONS: The limited impact of diverticular disease on the budget and activity of AOU Federico II of Naples is mainly due to the absence of an emergency department.},
}
@article {pmid23160497,
year = {2012},
author = {Lorenzetti, R and Cardin, F and Piatto, G and Mazzalai, F and Terranova, C and Militello, C},
title = {Choices in surgical treatment of diverticulitis.},
journal = {Aging clinical and experimental research},
volume = {24},
number = {3 Suppl},
pages = {6-8},
pmid = {23160497},
issn = {1720-8319},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/*methods ; Diverticulitis/*surgery ; Humans ; Middle Aged ; Treatment Outcome ; },
abstract = {Complications after surgical treatment of diverticulitis are not very frequent, in view of the total number of patients affected by this pathology, but they do become significant in absolute terms because of the high prevalence of the disease itself. Surgeons continue to debate which option is better: Hartmann resection or combined resection and anastomosis. Since age is a crucial factor when surgery is being considered, we evaluated the outcome of surgical treatment for diverticulitis in patients treated in our unit over a six-month period, in view of the number of elderly patients generally admitted. Between January 2001 and June 2012, 77 patients underwent surgery for diverticular disease in the Geriatric Surgery Unit of the Department of Surgical and Gastroenterological Sciences, University of Padova Hospital. Gastrointestinal resection and anastomosis were performed in 75 patients (97%), resulting in an overall complication rate of 37% and a mortality rate of 1%. This surgical strategy was chosen because, when it is performed by experienced surgeons, it offers the same results in terms of mortality and morbidity as Hartmann resection, while presenting significant advantages as regards the patient's quality of life. Various factors such as the timing of surgery, severity of the disease defined according to the Hinchey classification, patient's clinical condition, and surgeon's experience and expertise can all influence the surgical choice. Several studies in the literature confirm that combined resection and anastomosis is safe and efficacious, but more research is needed to confirm these data.},
}
@article {pmid23144076,
year = {2013},
author = {Böttner, M and Barrenschee, M and Hellwig, I and Harde, J and Egberts, JH and Becker, T and Zorenkov, D and Wedel, T},
title = {The enteric serotonergic system is altered in patients with diverticular disease.},
journal = {Gut},
volume = {62},
number = {12},
pages = {1753-1762},
doi = {10.1136/gutjnl-2012-302660},
pmid = {23144076},
issn = {1468-3288},
mesh = {Aged ; Case-Control Studies ; Colon, Sigmoid/metabolism/physiopathology ; Diverticulum, Colon/metabolism/*physiopathology ; Enteric Nervous System/metabolism/*physiopathology ; Female ; Humans ; Male ; Middle Aged ; Polymerase Chain Reaction ; Receptors, Serotonin, 5-HT2/metabolism/physiology ; Receptors, Serotonin, 5-HT3/metabolism/physiology ; Receptors, Serotonin, 5-HT4/metabolism/physiology ; Serotonergic Neurons/metabolism/*physiology ; Serotonin Plasma Membrane Transport Proteins/metabolism/physiology ; Transcriptome/physiology ; Tryptophan Hydroxylase/metabolism/physiology ; },
abstract = {OBJECTIVE: Disturbances of the enteric serotonergic system have been implicated in several intestinal motility disorders. Patients with diverticular disease (DD) have been reported to exhibit abnormal intestinal motility and innervation patterns. Gene expression profiles of the serotonergic system and distribution of the serotonin type 4 receptor (5HT-4R) were thus studied in patients with DD.
DESIGN: Colonic specimens from patients with DD and controls were subjected to quantitative PCR for serotonin receptors 2B, 3A, 4, serotonin transporter and synthesising enzyme tryptophan hydroxylase. Localisation of 5HT-4R was determined by dual-label immunocytochemistry using smooth muscle actin (α-SMA) and pan-neuronal markers (PGP 9.5) and quantitative analysis was carried out. Site-specific gene expression analysis of 5HT-4R was assessed within myenteric ganglia and muscle layers. Correlation of 5HT-4R with muscarinic receptors 2 and 3 (M2R, M3R) messenger RNA expression was determined.
RESULTS: 5HT-4R mRNA expression was downregulated in the tunica muscularis and upregulated in the mucosa of patients with DD, whereas the other components of the serotonergic system remained unchanged. 5HT-4R was detected in ganglia and muscle layers, but was decreased in the circular muscle layer and myenteric ganglia of patients with DD. 5HT-4R mRNA expression correlated with M2R/M3R mRNA expression in controls, but not in patients with DD.
CONCLUSIONS: The serotonergic system is compromised in DD. Altered expression of 5HT-4R at mRNA and protein levels may contribute to intestinal motor disturbances reported in patients with DD. The findings support the hypothesis that DD is associated and possibly promoted by an enteric neuromuscular pathology.},
}
@article {pmid23139608,
year = {2012},
author = {Lahner, E and Esposito, G and Zullo, A and Hassan, C and Cannaviello, C and Paolo, MC and Pallotta, L and Garbagna, N and Grossi, E and Annibale, B},
title = {High-fibre diet and Lactobacillus paracasei B21060 in symptomatic uncomplicated diverticular disease.},
journal = {World journal of gastroenterology},
volume = {18},
number = {41},
pages = {5918-5924},
pmid = {23139608},
issn = {2219-2840},
mesh = {Abdominal Pain/etiology/therapy ; Adult ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Dietary Fiber/*administration & dosage ; Diverticulum, Colon/complications/diagnosis/*therapy ; Female ; Humans ; Italy ; Lactobacillus/*growth & development ; Male ; Middle Aged ; Pain Measurement ; *Synbiotics ; Time Factors ; Treatment Outcome ; },
abstract = {AIM: To investigate in symptomatic uncomplicated diverticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms.
METHODS: This study was a multicentre, 6-mo randomized, controlled, parallel-group intervention with a preceding 4-wk washout period. Consecutive outpatients with symptomatic uncomplicated diverticular disease, aged 40-80 years, evaluated in 4 Gastroenterology Units, were enrolled. Symptomatic uncomplicated diverticular disease patients were randomized to two treatment arms A or B. Treatment A (n = 24 patients) received 1 symbiotic sachet Flortec(©) (Lactobacillus paracasei B21060) once daily plus high-fibre diet for 6 mo. Treatment B (n = 21 patients) received high-fibre diet alone for 6 mo. The primary endpoint was regression of abdominal symptoms and change of symptom severity after 3 and 6 mo of treatment.
RESULTS: In group A, the proportion of patients with abdominal pain < 24 h decreased from 100% at baseline to 35% and 25% after 3 and 6 mo, respectively (P < 0.001). In group B the proportion of patients with this symptom decreased from 90.5% at baseline to 61.9% and 38.1% after 3 and 6 mo, respectively (P = 0.001). Symptom improvement became statistically significant at 3 and 6 mo in group A and B, respectively.The proportion of patients with abdominal pain >24 h decreased from 60% to 20% then 5% after 3 and 6 mo, respectively in group A (P < 0.001) and from 33.3% to 9.5% at both 3 and 6 mo in group B (P = 0.03). In group A the proportion of patients with abdominal bloating significantly decreased from 95% to 60% after 3 mo, and remained stable (65%) at 6-mo follow-up (P = 0.005) while in group B, no significant changes in abdominal bloating was observed (P = 0.11). After 6 mo of treatment, the mean visual analogic scale (VAS) values of both short-lasting abdominal pain (VAS, mean ± SD, group A: 4.6 ± 2.1 vs 2.2 ± 0.8, P = 0.02; group B: 4.6 ± 2.9 vs 2.0 ± 1.9, P = 0.03) and abdominal bloating (VAS, mean ± SD, group A: 5.3 ± 2.2 vs 3.0 ± 1.7, P = 0.005; group B: 5.3 ± 3.2 vs 2.3 ± 1.9, P = 0.006) decreased in both groups, whilst the VAS values of prolonged abdominal pain decreased in the Flortec(©) group, but remained unchanged in the high-fibre diet group (VAS, mean ± SD, group A: 6.5 ± 1.5 vs 4.5 ± 2.1, P = 0.052; group B: 4.5 ± 3.8 vs 5.5 ± 3.5).
CONCLUSION: A high-fibre diet is effective in relieving abdominal symptoms in symptomatic uncomplicated diverticular disease. This treatment may be implemented by combining the high-fibre diet with Flortec(©).},
}
@article {pmid23113847,
year = {2012},
author = {Rueda, JC and Jimenez, A and Caro, A and Feliu, F and Escuder, J and Gris, F and Spuch, J and Vicente, V},
title = {Home treatment of uncomplicated acute diverticulitis.},
journal = {International surgery},
volume = {97},
number = {3},
pages = {203-209},
pmid = {23113847},
issn = {2520-2456},
mesh = {Acute Disease ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/complications/diagnostic imaging/*therapy ; Female ; *Home Care Services ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Patient Readmission ; Retrospective Studies ; Tomography, X-Ray Computed ; },
abstract = {Diverticular disease of the colon is a common disease, mainly in the population over 50 years of age. In acute forms of presentation, we considered home treatment in those patients that were classified as having uncomplicated forms by means of clinical presentation and a computed tomography of the abdomen. According to these criteria, we treated 38 patients at home and admitted 18 patients to the hospital during the same period of time. No severe complications developed in the home-treatment patients. Home treatment is an effective alternative treatment for patients with uncomplicated acute diverticulitis. In uncomplicated acute diverticulitis, home treatment benefits the patient, over hospitalization, by allowing better management of resources and by keeping the patient in a familiar environment where there is no risk of a nosocomial infection.},
}
@article {pmid23075567,
year = {2012},
author = {Vermeulen, J},
title = {Evidence-based surgery for complicated diverticular disease.},
journal = {Digestive surgery},
volume = {29},
number = {4},
pages = {321-322},
doi = {10.1159/000343190},
pmid = {23075567},
issn = {1421-9883},
mesh = {Colectomy/*methods ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Male ; },
}
@article {pmid23071488,
year = {2012},
author = {Arora, G and Mannalithara, A and Mithal, A and Triadafilopoulos, G and Singh, G},
title = {Concurrent conditions in patients with chronic constipation: a population-based study.},
journal = {PloS one},
volume = {7},
number = {10},
pages = {e42910},
pmid = {23071488},
issn = {1932-6203},
mesh = {California/epidemiology ; Cohort Studies ; Constipation/*complications/epidemiology ; Fecal Impaction/complications/epidemiology ; Female ; Gastrointestinal Hemorrhage/complications/epidemiology ; Hemorrhoids/complications/epidemiology ; Hirschsprung Disease/complications/epidemiology ; Humans ; Irritable Bowel Syndrome/complications/epidemiology ; Male ; Middle Aged ; Prevalence ; Rectum ; Retrospective Studies ; },
abstract = {BACKGROUND: Chronic constipation (CC) is a common condition but its concurrent conditions are not well characterized. We measured the prevalence and risk of developing 15 pre-specified concurrent conditions in patients with CC.
METHODS: Retrospective cohort study using the Medicaid database of California, utilizing ICD-9 codes for detection of cases (CC), controls (patients with GERD) and concurrent conditions. Study period was 01/01/1995 to 06/30/2005. Index date was the date 3 months before the first physician visit for CC. Pre-index time (12 months) was compared to post-index time (12 months) to assess the association of every concurrent condition within each cohort. To account for ascertainment bias, an adjusted odds ratio was calculated by comparing the odds ratio for every concurrent condition in the CC cohort to that in the GERD cohort.
RESULTS: 147,595 patients with CC (mean age 54.2 years; 69.7% women; 36.2% white) and 142,086 patients with GERD (mean age 56.3 years; 65.3% women; 41.6% white) were evaluated. The most prevalent concurrent conditions with CC were hemorrhoids (7.6%), diverticular disease (5.9%), ano-rectal hemorrhage (4.7%), irritable bowel syndrome (3.5%) and fecal impaction (2%). When adjusted for ascertainment bias, the most notable associations with CC were Hirschsprung's disease, fecal impaction and ano-rectal conditions such as fissure, fistula, hemorrhage and ulcers.
CONCLUSION: Chronic constipation is associated with several concurrent conditions of variable risk and prevalence. To reduce the overall burden of CC, these concurrent conditions need to be addressed.},
}
@article {pmid23066346,
year = {2012},
author = {Wang, S and Shah, N and Philip, J and Caraccio, T and Feuerman, M and Malone, B},
title = {Role of alvimopan (entereg) in gastrointestinal recovery and hospital length of stay after bowel resection.},
journal = {P & T : a peer-reviewed journal for formulary management},
volume = {37},
number = {9},
pages = {518-525},
pmid = {23066346},
issn = {1052-1372},
abstract = {PURPOSE: Postoperative ileus (POI) can delay gastrointestinal (GI) recovery after bowel resection. Alvimopan (Entereg), a peripherally acting mu-opioid receptor antagonist, is thought to favorably reduce various outcome measures such as the length of stay (LOS) and time from surgery to hospital discharge following partial-bowel, large-bowel, or small-bowel resection surgery with primary anastomosis. We undertook a study to compare these outcome measures in alvimopan-treated patients undergoing laparoscopic or open-bowel resection against a control group. We also sought to determine whether any other factors-Diagnosis-Related Group (DRG) status, complications, inflammatory bowel disease, type of surgery, age, sex, intestinal cancer, diverticular disease, number of chronic conditions, and operative time-were predictive of a more favorable (shorter) time to GI recovery.
METHODS: Patients' charts were retrospectively reviewed at a large 591-bed teaching hospital in suburban New York City between June and August 2010. We applied descriptive statistics for five outcome variables to compare alvimopan-treated patients with non-users. The main outcome variable was the time from surgery to hospital discharge. Secondary outcome variables were the time to pass gas, time to a liquid diet, time to a solid diet, and total LOS. We compared the outcome variables for three groups of DRG codes (329, the most complicated cases; 330, intermediate; and 331, least complicated) to determine which variables influenced these outcome measures. Multivariate analysis with stepwise multiple linear regression analysis was performed to determine independent predictors of shorter times of outcome variables.
RESULTS: Of 80 patients, 43 received alvimopan (53.75%), and 37 (46.25%) did not. The female-to-male ratio was about 50:50 (56.25% vs. 43.75%). The mean age (standard deviation) was 66.0 (14.9) years (range, 30-92 years). In the multivariate analysis (adjusted for demographics, DRG status, type of surgery, complications, comorbidities, and operative time), for all of our outcome variables (except for time to a liquid diet), patients receiving alvimopan had shorter times to GI recovery (about 25% less) than controls did (p < 0.05). DRG status, complications, inflammatory bowel disease, type of surgery, and age were also significantly predictive of one or more outcome variables, whereas sex, intestinal cancer, diverticular disease, the number of chronic conditions, and operative time were not predictive of any outcomes.
CONCLUSION: GI recovery times were generally shorter for alvimopan-treated patients than for those who did not receive the study drug (P < 0.05). Alvimopan improved quality of life and reduced the cost of surgical care. This medication was considered to be a good choice for the perioperative management of patients requiring segmental bowel resection with primary anastomosis.},
}
@article {pmid23059807,
year = {2012},
author = {Reichert, MC and Lammert, F},
title = {[Genetic risk factors predispose to colonic diverticular disease].},
journal = {Zeitschrift fur Gastroenterologie},
volume = {50},
number = {10},
pages = {1114-1115},
doi = {10.1055/s-0032-1325331},
pmid = {23059807},
issn = {1439-7803},
mesh = {Diverticulum, Colon/*epidemiology/*genetics ; Genetic Predisposition to Disease/*epidemiology/*genetics ; Humans ; Prevalence ; Risk Factors ; Sweden/epidemiology ; },
}
@article {pmid23059503,
year = {2013},
author = {Sharma, A and Deeb, AP and Iannuzzi, JC and Rickles, AS and Monson, JR and Fleming, FJ},
title = {Tobacco smoking and postoperative outcomes after colorectal surgery.},
journal = {Annals of surgery},
volume = {258},
number = {2},
pages = {296-300},
doi = {10.1097/SLA.0b013e3182708cc5},
pmid = {23059503},
issn = {1528-1140},
mesh = {Aged ; *Colectomy/mortality ; Colorectal Neoplasms/mortality/*surgery ; Databases, Factual ; Diverticulitis, Colonic/mortality/*surgery ; Female ; Humans ; Inflammatory Bowel Diseases/mortality/*surgery ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Postoperative Complications/epidemiology/*etiology/mortality ; Rectum/*surgery ; Risk Adjustment ; Risk Factors ; Self Report ; Smoking/*adverse effects ; Treatment Outcome ; },
abstract = {OBJECTIVE: The aim of this study was to delineate the impact of smoking on postoperative outcomes after colorectal resection for malignant and benign processes.
BACKGROUND: Studies to date have implicated smoking as a risk factor for increased postoperative complications. However, there is a paucity of data on the effects of smoking after colorectal surgery and in particular for malignant compared with benign processes.
METHODS: The American College of Surgeon's National Surgical Quality Improvement Program (2005-2010) database was queried for patients undergoing elective major colorectal resection for colorectal cancer, diverticular disease, or inflammatory bowel disease. Risk-adjusted 30-day outcomes were assessed and compared between patient cohorts identified as never-smokers, ex-smokers, and current smokers. Primary outcomes of incisional infections, infectious and major complications, and mortality were evaluated using regression modeling adjusting for patient characteristics and comorbidities.
RESULTS: A total of 47,574 patients were identified, of which 26,333 had surgery for colorectal cancer, 14,019 for diverticular disease, and 7222 for inflammatory bowel disease. More than 60% of patients had never smoked, 20.4% were current smokers, and 19.2% were ex-smokers. After adjustment, current smokers were at a significantly increased risk of postoperative morbidity [odds ratio (OR), 1.3; 95% confidence interval (CI), 1.21-1.40] and mortality (OR, 1.5; 95% CI, 1.11-1.94) after colorectal surgery. This finding persisted across malignant and benign diagnoses and also demonstrated a significant dose-dependent effect when stratifying by pack-years of smoking.
CONCLUSIONS: Smoking increases the risk of complications after all types of major colorectal surgery, with the greatest risk apparent for current smokers. A concerted effort should be made toward promoting smoking cessation in all patients scheduled for elective colorectal surgery.},
}
@article {pmid23039135,
year = {2012},
author = {Smith, VM and Lyon, CC},
title = {Nicorandil: do the dermatological and gastrointestinal risks outweigh the benefits?.},
journal = {The British journal of dermatology},
volume = {167},
number = {5},
pages = {1048-1052},
doi = {10.1111/j.1365-2133.2012.11185.x},
pmid = {23039135},
issn = {1365-2133},
mesh = {Aged ; Aged, 80 and over ; Angina Pectoris/*drug therapy ; Female ; Gastrointestinal Diseases/*chemically induced ; Humans ; Intestinal Fistula/chemically induced ; Intestinal Perforation/chemically induced ; Male ; Middle Aged ; Nicorandil/*adverse effects ; Risk Assessment ; Skin Ulcer/*chemically induced ; Vasodilator Agents/*adverse effects ; },
abstract = {BACKGROUND: Nicorandil has been available in the U.K. since 1994 for the prophylaxis and treatment of angina. Since the first reported case of nicorandil-associated oral ulceration in 1997 complications elsewhere in the gastrointestinal tract have been reported.
OBJECTIVES: Our case series highlights this serious drug complication.
METHODS: We reviewed the records of all patients referred to our specialist stoma dermatology clinic who had stoma surgery for diverticular disease and all patients referred with persistent parastomal or perianal ulceration that was not attributable to Crohn's disease or pyoderma gangrenosum. Patient demographics, nicorandil ingestion, bowel involvement, stoma type, cutaneous ulceration and outcome were recorded.
RESULTS: A total of 36 patients had stoma surgery performed as a consequence of diverticular disease. The proportion of patients taking nicorandil (in all cases at a dose of 40 mg or more daily) was one third, higher than expected. There was a higher incidence of enteric fistula formation and bowel perforation among those taking nicorandil, 92% (11/12) and 50% (6/12), respectively, compared with those not on the drug, 0% and 21% (5/24), respectively. In addition, parastomal ulceration was seen more often in those taking nicorandil, 100% (12/12), compared with those not, 8% (2/24). Even without a history of diverticular disease we observed a high incidence of bowel perforation and parastomal and/or perianal ulceration among patients taking nicorandil. In the vast majority of cases ulceration healed upon cessation of nicorandil.
CONCLUSIONS: For those with diverticular disease taking nicorandil is strongly associated with fistula formation or bowel perforation; as such the risk-benefit equation for nicorandil needs careful consideration given that other nitrates are available.},
}
@article {pmid22993746,
year = {2012},
author = {Northfield, J and Beale, A and Cannon, C and Gonzalez, L},
title = {Enough to bring a lump to the throat: two emergency presentations to the acute medical take.},
journal = {Acute medicine},
volume = {11},
number = {3},
pages = {154-156},
pmid = {22993746},
issn = {1747-4892},
mesh = {Aged ; Aged, 80 and over ; *Cause of Death ; Critical Illness/therapy ; Disease Progression ; *Emergency Service, Hospital ; Emergency Treatment/methods ; Female ; Follow-Up Studies ; Hernia, Hiatal/*diagnostic imaging/*mortality/surgery ; Humans ; Radiography, Thoracic/methods ; Risk Assessment ; Sampling Studies ; Severity of Illness Index ; Survival Rate ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; },
abstract = {An eighty nine year old woman was admitted with a two day history of abdominal pain and vomiting. Two months previously she had undergone a Hartmann's procedure following a sigmoid perforation secondary to diverticular disease. A hiatus hernia had been noted on a CT undertaken prior to her recent surgery.},
}
@article {pmid22993727,
year = {2012},
author = {Brahmania, M and Park, J and Svarta, S and Tong, J and Kwok, R and Enns, R},
title = {Incomplete colonoscopy: maximizing completion rates of gastroenterologists.},
journal = {Canadian journal of gastroenterology = Journal canadien de gastroenterologie},
volume = {26},
number = {9},
pages = {589-592},
pmid = {22993727},
issn = {0835-7900},
mesh = {Adult ; Aged ; British Columbia ; Colonic Diseases/*diagnosis/*therapy ; *Colonoscopy/adverse effects/instrumentation ; Female ; *Gastroenterology ; Humans ; Male ; *Medical Errors ; Middle Aged ; Retreatment ; Retrospective Studies ; Risk Factors ; *Tertiary Healthcare ; Treatment Failure ; },
abstract = {BACKGROUND: Cecal intubation is one of the goals of a quality colonoscopy; however, many factors increasing the risk of incomplete colonoscopy have been implicated. The implications of missed pathology and the demand on health care resources for return colonoscopies pose a conundrum to many physicians. The optimal course of action after incomplete colonoscopy is unclear.
OBJECTIVES: To assess endoscopic completion rates of previously incomplete colonoscopies, the methods used to complete them and the factors that led to the previous incomplete procedure.
METHODS: All patients who previously underwent incomplete colonoscopy (2005 to 2010) and were referred to St Paul's Hospital (Vancouver, British Columbia) were evaluated. Colonoscopies were re-attempted by a single endoscopist. Patient charts were reviewed retrospectively.
RESULTS: A total of 90 patients (29 males) with a mean (± SD) age of 58 ± 13.2 years were included in the analysis. Thirty patients (33%) had their initial colonoscopy performed by a gastroenterologist. Indications for initial colonoscopy included surveillance or screening (23%), abdominal pain (15%), gastrointestinal bleeding (29%), change in bowel habits or constitutional symptoms (18%), anemia (7%) and chronic diarrhea (8%). Reasons for incomplete colonoscopy included poor preparation (11%), pain or inadequate sedation (16%), tortuous colon (30%), diverticular disease (6%), obstructing mass (6%) and stricturing disease (10%). Reasons for incomplete procedures in the remaining 21% of patients were not reported by the referring physician. Eighty-seven (97%) colonoscopies were subsequently completed in a single attempt at the institution. Seventy-six (84%) colonoscopies were performed using routine manoeuvres, patient positioning and a variable-stiffness colonoscope (either standard or pediatric). A standard 160 or 180 series Olympus gastroscope (Olympus, Japan) was used in five patients (6%) to navigate through sigmoid diverticular disease; a pediatric colonoscope was used in six patients (7%) for similar reasons. Repeat colonoscopy on the remaining three patients (3%) failed: all three required surgery for strictures (two had obstructing malignant masses and one had a severe benign obstructing sigmoid diverticular stricture).
CONCLUSION: Most patients with previous incomplete colonoscopy can undergo a successful repeat colonoscopy at a tertiary care centre with instruments that are readily available to most gastroenterologists. Other modalities for evaluation of the colon should be deferred until a second attempt is made at an expert centre.},
}
@article {pmid22982746,
year = {2012},
author = {Wick, JY},
title = {Diverticular disease: eat your fiber!.},
journal = {The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists},
volume = {27},
number = {9},
pages = {613-618},
doi = {10.4140/TCP.n.2012.613},
pmid = {22982746},
issn = {0888-5109},
mesh = {Dietary Fiber/*administration & dosage ; Diverticulum/etiology/*therapy ; Female ; Humans ; Male ; Pharmacists ; Referral and Consultation ; },
abstract = {In industrialized nations, diverticular disease affects up to 70% of individuals by 60 years of age, with symptoms that can range from mild gastrointestinal disturbance to incapacitating pain. Diverticular disease appears to be related to increasing affluence and changed diet: Current theory holds that diverticular disease's origin is low-fiber diet. This explains why its incidence is highest and accelerating in the more prosperous countries where intake of fiber has decreased and intake of milled grains and refined sugars has increased over time. Not all patients develop symptoms, but if they do, the most frequent complaints associated with diverticulosis are cramping in the left-lower quadrant, bloating, constipation, and soiling. If diverticula perforate the gut's wall into the pericolic tissue, small and large abscesses, accompanied by bleeding, can form. Fistulization, when it occurs, most often penetrates to the bladder. Treatment addresses symptoms and may require hospitalization. During symptomatic periods, patients do best on low-fiber, bland diets. Once the acute episode or highly symptomatic period resolves or chronic disease is managed, patients should gradually increase dietary fiber to 20 to 30 grams daily or take dietary fiber in the form of bulk stimulants like psyllium.},
}
@article {pmid22977817,
year = {2012},
author = {Jung, Y and Lee, SH},
title = {How do I overcome difficulties in insertion?.},
journal = {Clinical endoscopy},
volume = {45},
number = {3},
pages = {278-281},
pmid = {22977817},
issn = {2234-2443},
abstract = {Demand for colonoscopy is increasing because it is an important tool not only for screening of colorectal neoplasm but also for resection of such lesions in early stage. Cecal intubation requires expertise on shortening of the examination time and improvement of the cecal intubation rate without causing pain to the patients. About 5% to 10% of patients still experience difficulties or failure of the cecal intubation. There are number of factors that affect the difficulty of the colonoscopy such as technical skill of the endoscopist, angulated sigmoid, redundant colon, advanced age, female gender, diverticular disease, and inadequate bowel preparation. In an effort to overcome these situations and to and aiding colonoscope insertion with reducing pain, various methods have introduced. Like this review discusses ways to approach patients with technically difficult colons for achieving the successful cecal intubation.},
}
@article {pmid22977028,
year = {2012},
author = {Amzallag-Bellenger, E and Oudjit, A and Ruiz, A and Cadiot, G and Soyer, PA and Hoeffel, CC},
title = {Effectiveness of MR enterography for the assessment of small-bowel diseases beyond Crohn disease.},
journal = {Radiographics : a review publication of the Radiological Society of North America, Inc},
volume = {32},
number = {5},
pages = {1423-1444},
doi = {10.1148/rg.325115088},
pmid = {22977028},
issn = {1527-1323},
mesh = {Adult ; Aged ; Female ; Humans ; Image Enhancement/*methods ; Intestinal Diseases/*pathology ; Intestine, Small/*pathology ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; },
abstract = {The use of cross-sectional imaging techniques for the noninvasive evaluation of small-bowel disorders is increasing. The effectiveness of magnetic resonance (MR) enterography for the evaluation of Crohn disease, in particular, is well described in the literature. In addition, MR enterography has an evolving though less well documented role to play in the evaluation of other small-bowel diseases, including various benign and malignant neoplasms arising in isolation or in polyposis syndromes such as Peutz-Jeghers, inflammatory conditions such as vasculitis and treatment-induced enteritis, infectious processes, celiac disease, diverticular disease, systemic sclerosis, and bowel duplication. MR enterography may be useful also for the evaluation of intermittent and low-grade small-bowel obstructions. Advantages of MR imaging over computed tomography (CT) for enterographic evaluations include superb contrast resolution, lack of associated exposure to ionizing radiation, ability to acquire multiplanar primary image datasets, ability to acquire sequential image series over a long acquisition time, multiphasic imaging capability, and use of intravenous contrast media with better safety profiles. MR enterography also allows dynamic evaluations of small-bowel peristalsis and distensibility of areas of luminal narrowing and intraluminal masses by repeating sequences at different intervals after administering an additional amount of the oral contrast medium. Limitations of MR enterography in comparison with CT include higher cost, less availability, more variable image quality, and lower spatial resolution. The advantages and disadvantages of MR enterography performed with ingestion of the oral contrast medium relative to MR enteroclysis performed with infusion of the oral contrast medium through a nasoenteric tube are less certain.},
}
@article {pmid22974633,
year = {2012},
author = {Ignacio, RC and Klapheke, WP and Stephen, T and Bond, S},
title = {Diverticulitis in a child with Williams syndrome: a case report and review of the literature.},
journal = {Journal of pediatric surgery},
volume = {47},
number = {9},
pages = {E33-5},
doi = {10.1016/j.jpedsurg.2012.05.036},
pmid = {22974633},
issn = {1531-5037},
mesh = {Child ; Diverticulitis, Colonic/*diagnosis/etiology ; Humans ; Male ; Sigmoid Diseases/*diagnosis/etiology ; Williams Syndrome/*complications ; },
abstract = {Diverticulitis is rare in pediatric patients and often associated with a more complicated course than that seen with adult patients. Certain syndromes, such as Williams syndrome, have been associated with an increase incidence of diverticular disease. We describe a 9-year-old boy with Williams syndrome who presented with rectal bleeding secondary to sigmoid diverticulitis. This case represents the youngest known patient with diverticulitis. Patients with this disorder who present with chronic or recurrent abdominal pain should be evaluated for diverticular disease and its potential complications.},
}
@article {pmid22966940,
year = {2013},
author = {Radwan, R and Saeed, ZM and Phull, JS and Williams, GL and Carter, AC and Stephenson, BM},
title = {How safe is it to manage diverticular colovesical fistulation non-operatively?.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {15},
number = {4},
pages = {448-450},
doi = {10.1111/codi.12025},
pmid = {22966940},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum, Colon/*complications/diagnostic imaging ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/etiology/surgery/*therapy ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Treatment Outcome ; Urinary Bladder Fistula/etiology/surgery/*therapy ; },
abstract = {AIM: Colovesical fistula (CVF) is an uncommon condition. Diagnosis and management varies according to presentation and aetiology. The identification of patients suitable for conservative management and their outcome following this approach has not been well documented.
METHODS: The clinical outcomes of all patients diagnosed with a CVF over a 7-year period from an uro-radiological database were reviewed. Cases secondary to diverticular disease were analysed with respect to the approach by which they were managed: those treated surgically and those managed conservatively.
RESULTS: Sixty-two patients (32 men) were diagnosed with CVF of whom 53 (85%) had diverticular disease. Twenty-seven (mean age 69 years, range 42-90) underwent surgery (with a stoma in 59%) with a 30-day mortality of 15%. Those managed conservatively (n = 26) were older (mean age 76 years, range 39-87) and frailer (62% American Society of Anesthesiologists Grades III and IV). At 1 and 3 years following diagnosis there was no difference in mortality between these two groups and only one death was as a consequence of urosepsis.
CONCLUSION: Many patients with CVF secondary to diverticular disease can be safely managed non-operatively.},
}
@article {pmid22936232,
year = {2012},
author = {Fingerhut, A and Veyrie, N},
title = {Complicated diverticular disease: the changing paradigm for treatment.},
journal = {Revista do Colegio Brasileiro de Cirurgioes},
volume = {39},
number = {4},
pages = {322-327},
doi = {10.1590/s0100-69912012000400013},
pmid = {22936232},
issn = {1809-4546},
mesh = {Diverticulum/*complications/*surgery ; Humans ; Infections/etiology ; Intestinal Diseases/*complications/*surgery ; },
abstract = {The term "complicated" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously thanks to: 1) laparoscopic colonic resection followed or not (Hartmann's procedure) by restoration of intestinal continuity, 2) simple laparoscopic lavage (for peritonitis +/- resection). Diverticulitis (inflammation) may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II) may be initially treated by antibiotics alone and/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III) may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV), a traditional indication for Hartmann's procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures) and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies.},
}
@article {pmid22932906,
year = {2013},
author = {Dao, HE and Miller, PE and Lee, JH and Kermani, R and Hackford, AW},
title = {Transfer status is a risk factor for increased in-hospital mortality in patients with diverticular hemorrhage.},
journal = {International journal of colorectal disease},
volume = {28},
number = {2},
pages = {273-276},
pmid = {22932906},
issn = {1432-1262},
mesh = {Aged ; Diverticulitis/*mortality ; Female ; Gastrointestinal Hemorrhage/*mortality ; *Hospital Mortality ; Humans ; Male ; Multivariate Analysis ; Patient Transfer/*statistics & numerical data ; Risk Factors ; United States/epidemiology ; },
abstract = {PURPOSE: Gastrointestinal tract hemorrhage is a common problem accounting for approximately 1 % of hospital admissions. It is estimated that one third of the episodes of lower gastrointestinal hemorrhage are secondary to diverticular disease. Inter-institutional transfer has been associated with delay in care and increased in-hospital mortality. We hypothesized that patients with diverticular hemorrhage that were transferred from an acute care hospital to tertiary care institutions have increased in-hospital morbidity and mortality when compared to primarily admitted patients.
MATERIALS AND METHODS: We performed a retrospective analysis of the Nationwide Inpatient Sample for the year 2008. Patients with a primary discharge diagnosis of diverticular hemorrhage were selected. Multivariate logistic regression was used to identify the relationship between transfer status and in-hospital mortality.
RESULTS: A total of 99,415 hospitalizations for diverticular hemorrhage were identified. Transferred patients had higher in-hospital mortality rates compared to primarily admitted patients (3.5 vs. 1.8 %, p < 0.001), as well as increased length of stay (8.4 vs. 5.4 days, p < 0.001) and a higher rate of total abdominal colectomy (1.2 vs. 0.6 %, p < 0.001). Multivariate analysis indicated that transfer status was associated with increased in-hospital mortality [OR 1.8, 95 % CI 1.5-2.8, p < 0.001].
CONCLUSIONS: Inter-institutional transfer for diverticular bleeding is associated with increased in-hospital mortality, increased total abdominal colectomy rate, as well as increased economic burden including mean length of stay and total hospital charges. Further prospective studies are needed to analyze the clinical information of patients requiring transfer to another hospital in order to identify those patients who would truly benefit from inter-institutional transfer.},
}
@article {pmid22918202,
year = {2012},
author = {Miyaso, H and Iwakawa, K and Kitada, K and Kimura, Y and Isoda, K and Nishie, M and Hamano, R and Tokunaga, N and Tsunemitsu, Y and Ohtsuka, S and Inagawaki, M and Iwagaki, H},
title = {Analysis of surgical outcomes of diverticular disease of the colon.},
journal = {Acta medica Okayama},
volume = {66},
number = {4},
pages = {299-305},
doi = {10.18926/AMO/48669},
pmid = {22918202},
issn = {0386-300X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Colon/*surgery ; Diverticulosis, Colonic/*surgery ; Elective Surgical Procedures ; Female ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Male ; Middle Aged ; Multivariate Analysis ; *Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; },
abstract = {We analyzed retrospectively the surgical outcomes of diverticular diseases of the colon at the surgical division of Fukuyama Medical Center. Data were collected from 39 patients who underwent surgery for diverticular disease at Fukuyama Medical Center. Thirty-nine patients were admitted between 2005 and 2010. The mean age of the 39 patients was 63.6 years. The collected data included patient demographics, patient history, type of surgery and complications. Patients were divided into 2 groups, Elective vs. Emergent group, right vs. left colon group and laparotomy vs. laparoscopic approach. Multivariate analysis of the logistic model of morbidity revealed a significantly higher rate in the left colon and the Cox proportional hazards model clearly showed fewer postoperative hospital days with the laparoscopic approach. Surgical procedures should be decided in reference to the particular clinical and pathological features of diverticular disease to gain an acceptable morbidity and mortality rates.},
}
@article {pmid22917164,
year = {2012},
author = {Langner, C},
title = {Colorectal normal histology and histopathologic findings in patients with chronic diarrhea.},
journal = {Gastroenterology clinics of North America},
volume = {41},
number = {3},
pages = {561-580},
doi = {10.1016/j.gtc.2012.06.005},
pmid = {22917164},
issn = {1558-1942},
mesh = {Algorithms ; Biopsy ; Chronic Disease ; Colitis, Microscopic/diagnosis/etiology ; Collagen/metabolism ; Diagnosis, Differential ; Diarrhea/*etiology ; Enterocolitis/diagnosis ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Intestinal Mucosa/*pathology ; Lymphocytes/pathology ; Mast Cells/pathology ; Mucous Membrane/pathology ; },
abstract = {Collagenous and lymphocytic colitis are common causes of chronic watery diarrhea that are characterized by distinct histopathologic abnormalities without endoscopically visible lesions and are summarized as microscopic colitis. Several variants of microscopic colitis have been described, although their clinical significance still has to be defined. Preserved mucosal architecture is a histologic hallmark of microscopic colitis and distinguishes the disease from inflammatory bowel disease (IBD). In addition to architectural abnormalities, the diagnosis of IBD rests on characteristic inflammatory changes. Differential diagnosis of IBD mainly includes prolonged infection and diverticular disease-associated colitis, also known as segmental colitis associated with diverticulosis.},
}
@article {pmid22907510,
year = {2012},
author = {Kopylov, U and Ben-Horin, S and Lahat, A and Segev, S and Avidan, B and Carter, D},
title = {Obesity, metabolic syndrome and the risk of development of colonic diverticulosis.},
journal = {Digestion},
volume = {86},
number = {3},
pages = {201-205},
doi = {10.1159/000339881},
pmid = {22907510},
issn = {1421-9867},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; Diverticulosis, Colonic/diagnosis/*epidemiology/etiology ; Female ; Humans ; Incidence ; Israel/epidemiology ; Male ; Metabolic Syndrome/*complications/epidemiology ; Middle Aged ; Obesity/*complications/epidemiology ; Retrospective Studies ; Risk Factors ; },
abstract = {INTRODUCTION: Colonic diverticulosis is a common condition with obscure pathogenesis. Obesity, hyperlipidemia and hypertension have been demonstrated to increase the risk of complicated diverticular disease, but the impact of metabolic risk factors on the prevalence of uncomplicated diverticulosis has not been clearly determined.
AIMS: The aim of the study was to examine the impact of obesity and metabolic syndrome on the prevalence of colonic diverticulosis.
METHODS: This retrospective case-control study included patients aged 40-85 years who were followed up by the Institute of Medical Screening in Israel and underwent colonoscopy in 2006-2011 for indication of colorectal cancer screening. Patients with diverticulosis as detected by colonoscopy were compared to patients without diverticulosis. The comparison parameters included medical history, biometric parameters, biochemical and lipid profile.
RESULTS: The study included 3,175 patients. Diverticulosis was diagnosed in 17.4% of the cohort. On univariate analysis, age, male gender, BMI (continuous variable), obesity, systolic blood pressure, low-density lipoprotein cholesterol level, history of hypertension, ischemic heart disease, hypothyroidism, and absence of diabetes mellitus were associated with an increased risk of colonic diverticulosis. On multivariate analysis, advanced age, male gender, obesity (BMI >30), history of hypothyroidism and absence of diabetes mellitus were associated with an increased risk of diverticulosis. Prevalence of colonic polyps was similar in patients with and without diverticulosis.
CONCLUSION: Colonic diverticulosis was associated with age, male gender, obesity and hypothyroidism. Diabetes mellitus was associated with a decreased risk of colonic diverticulosis.},
}
@article {pmid22899284,
year = {2013},
author = {Lin, J and Cao, Q and Zhang, J and Li, Y and Shen, B and Zhao, Z and Chinnaiyan, AM and Bronner, MP},
title = {MicroRNA expression patterns in indeterminate inflammatory bowel disease.},
journal = {Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc},
volume = {26},
number = {1},
pages = {148-154},
doi = {10.1038/modpathol.2012.131},
pmid = {22899284},
issn = {1530-0285},
mesh = {Adult ; Aged ; Biomarkers/analysis ; Female ; Gene Expression Regulation ; Humans ; Inflammatory Bowel Diseases/*classification/*diagnosis/*genetics ; Male ; MicroRNAs/*analysis ; Middle Aged ; Reverse Transcriptase Polymerase Chain Reaction ; Young Adult ; },
abstract = {A diagnosis of idiopathic inflammatory bowel disease requires synthesis of clinical, radiographic, endoscopic, surgical, and histologic data. While most cases of inflammatory bowel disease can be specifically classified as either ulcerative colitis or Crohns disease, 5-10% of patients have equivocal features placing them into the indeterminate colitis category. This study examines whether microRNA biomarkers assist in the classification of classically diagnosed indeterminate inflammatory bowel disease. Fresh frozen colonic mucosa from the distal-most part of the colectomy from 53 patients was used (16 indeterminate colitis, 14 Crohns disease, 12 ulcerative colitis, and 11 diverticular disease controls). Total RNA extraction and quantitative reverse-transcription-PCR was performed using five pairs of microRNA primers (miR-19b, miR-23b, miR-106a, miR-191, and miR-629). Analysis of variance was performed assessing differences among the groups. A significant difference in expressions of miR-19b, miR-106a, and miR-629 was detected between ulcerative colitis and Crohns disease groups (P<0.05). The average expression level of all five microRNAs was statistically different between indeterminate colitis and Crohns disease groups (P<0.05); no significant difference was present between indeterminate and ulcerative colitis groups. Among the 16 indeterminate colitis patients, 15 showed ulcerative colitis-like and one Crohns disease-like microRNA pattern. MicroRNA expression patterns in indeterminate colitis are far more similar to those of ulcerative colitis than Crohns disease. MicroRNA expression patterns of indeterminate colitis provide molecular evidence indicating that most cases are probably ulcerative colitis-similar to the data from long-term clinical follow-up studies. Validation of microRNA results by additional long-term outcome data is needed, but the data presented show promise for improved classification of indeterminate inflammatory bowel disease.},
}
@article {pmid22898809,
year = {2012},
author = {Kamalesh, NP and Prakash, K and Pramil, K and Zacharias, P and Ramesh, GN and Philip, M},
title = {Prevalence and patterns of diverticulosis in patients undergoing colonoscopy in a southern Indian hospital.},
journal = {Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology},
volume = {31},
number = {6},
pages = {337-339},
pmid = {22898809},
issn = {0975-0711},
mesh = {Adult ; Aged ; Asymptomatic Diseases/epidemiology ; Colonoscopy ; Diverticulosis, Colonic/*complications/diagnosis/*epidemiology ; Female ; Humans ; Incidental Findings ; India/epidemiology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; },
abstract = {The prevalence of diverticular disease of colon of colon is reportedly low in Asian compared to Western countries. We analyzed the prevalence of colonic diverticulosis in a selected cohort of patients undergoing colonoscopy. Retrospective study of records of patients undergoing colonoscopy in a tertiary hospital in southern India.},
}
@article {pmid22880178,
year = {2012},
author = {Kim, DC and Hwang, JJ and Lee, WS and Lee, SA and Kim, YH and Chee, HK},
title = {Surgical treatment of killian-jamieson diverticulum.},
journal = {The Korean journal of thoracic and cardiovascular surgery},
volume = {45},
number = {4},
pages = {272-274},
pmid = {22880178},
issn = {2093-6516},
abstract = {Killian-Jamieson diverticulum is a rare diverticular disease. This disease differs from Zenker's diverticulum in its location and mechanism. Various treatment modality have been attempted, but traditional surgical treatment has been recommended for a symptomatic Killian-Jamieson diverticulum due to the concern of possible nerve injury. We performed surgical treatment by cervical incision. We report here on a case of Killian-Jamieson diverticulum and we briefly review the relevant literature.},
}
@article {pmid22866875,
year = {2012},
author = {Jiang, DL and Liu, HY and Yuan, Y and Sui, JC and Jing, CC and Jiang, KT and Wang, QC and Yuan, SA and Chen, HY and Gao, YJ},
title = {Analysis of the causes and clinical characteristics of jejunoileal hemorrhage in China: a multicenter 10 year retrospective survey.},
journal = {BMC gastroenterology},
volume = {12},
number = {},
pages = {101},
pmid = {22866875},
issn = {1471-230X},
mesh = {Abdominal Pain/diagnosis/diagnostic imaging ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; Diverticulum/complications/diagnosis/diagnostic imaging ; Endoscopy/methods ; Enteritis/complications/diagnosis/diagnostic imaging ; Female ; Gastrointestinal Hemorrhage/*diagnosis/diagnostic imaging/etiology ; Humans ; Ileal Diseases/complications/*diagnosis/diagnostic imaging ; Jejunal Diseases/complications/*diagnosis/diagnostic imaging ; Male ; Melena/diagnosis/diagnostic imaging ; Middle Aged ; Neoplasms/complications/diagnosis/diagnostic imaging ; Peripheral Vascular Diseases/complications/diagnosis/diagnostic imaging ; Radiography ; Retrospective Studies ; Young Adult ; },
abstract = {BACKGROUND: A retrospective study was performed to assess the causes, diagnostic methods for, and clinical features of, jejunoileal hemorrhage in Shandong province, China and to derive recommendations for management of this condition from these data.
METHODS: We performed a retrospective systematic collection of data from between January 1999 and December 2008 in seven cities in Shandong province, China, identified 72 patients with jejunoileal hemorrhage and analyzed the relevant clinical data.
RESULTS: Overall, tumors were the most common cause of jejunoileal hemorrhage (42 patients, 58.3%). The causes of this condition were significantly different (P < 0.05) in male and female patients. In male patients, the commonest factors were tumor (52.2%), enteritis (17.4%) and angiopathy (15.2%). However, in female patients, tumors accounted for a greater proportion of cases (18/26, 69.2%). In 38 cases (52.8%) the diagnosis was made by intraoperative enteroscopy or laparotomy, in 14 by capsule endoscopy and in the remainder by radiological methods. The most frequent presentation was melena (62.7%), followed by maroon stools (26.9%) and hematochezia (9.0%). Of the 72 patients,laparotomy is the main treatment method.
CONCLUSION: Tumor, enteritis and angiopathy and diverticular disease are the most common causes of jejunoileal hemorrhage in Shandong province, China. The main clinical manifestations are bloody stools, most commonly in the form of melena, with or without abdominal pain. We recommend that female patients over the age of 40 with jejunoileal hemorrhage accompanied by abdominal pain should undergo urgent further assessment because of the strong probability of jejunoileal tumor.},
}
@article {pmid22866369,
year = {2012},
author = {},
title = {Diverticular disease 2012 medication update.},
journal = {Journal of Christian nursing : a quarterly publication of Nurses Christian Fellowship},
volume = {29},
number = {3},
pages = {138},
pmid = {22866369},
issn = {0743-2550},
mesh = {Diverticulitis/*nursing/*therapy ; Holistic Nursing/*methods ; Humans ; *Patient Education as Topic ; *Spirituality ; },
}
@article {pmid22864621,
year = {2013},
author = {Bassotti, G and Villanacci, V and Nascimbeni, R and Antonelli, E and Cadei, M and Manenti, S and Lorenzi, L and Titi, A and Salerni, B},
title = {The role of colonic mast cells and myenteric plexitis in patients with diverticular disease.},
journal = {International journal of colorectal disease},
volume = {28},
number = {2},
pages = {267-272},
pmid = {22864621},
issn = {1432-1262},
mesh = {Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cell Degranulation ; Colon/*pathology ; Diverticulitis/*pathology ; Female ; Humans ; Male ; Mast Cells/*pathology/physiology ; Middle Aged ; Myenteric Plexus/*pathology ; Nerve Fibers/pathology ; },
abstract = {BACKGROUND: Gut mast cells represent an important cell population involved in intestinal homeostasis and inflammatory processes. However, their possible role has not to date been investigated in colonic diverticular disease.
AIMS: This study aims to evaluate colonic mast cells in patients undergoing surgery for diverticular disease.
METHODS: Surgical resection samples from 27 patients undergoing surgery for diverticular disease (12 emergency procedures for severe disease and 15 elective procedures) were evaluated. The number of mast cells was assessed in the various layers by means of a specific antibody (tryptase) and compared with those evaluated in ten controls. In patients with mast cells degranulation, double immunohistochemistry, also assessing nerve fibres, was carried out. In addition, the presence of myenteric plexitis was sought.
RESULTS: Compared with controls, the number of mast cells in diverticular patients was significantly increased, both as an overall figure and in the various layers of the large bowel. In patients in whom mast cells degranulation was present, these were always closed to nerve fibres. No differences were found between the two subgroups of patients with respect to the number and distribution of mast cells; however, all patients undergoing emergency surgery (but none of those undergoing elective procedures) had myenteric plexitis, represented by lymphocytic infiltration in 67 % and eosinophilic infiltration in 33 % of cases.
CONCLUSIONS: Patients with diverticular disease display an increase of mast cells in the large bowel. The presence of myenteric plexitis in those with complicated, severe disease, suggest that this could represent a histopathologic marker of more aggressive disease.},
}
@article {pmid25874091,
year = {2012},
author = {Korzets, A and Tsitman, I and Lev, N and Zingerman, B and Herman, M and Ben Dor, N and Gafter, U and Ori, Y},
title = {Lanthanum, constipation, bafflying X-rays and a perforated colonic diverticulum.},
journal = {Clinical kidney journal},
volume = {5},
number = {4},
pages = {331-333},
pmid = {25874091},
issn = {2048-8505},
abstract = {Lanthanum carbonate (LC) is used as a phosphate binder in dialysed patients. Abdominal pain and constipation are known side effects of its use. Furthermore, in radiological studies, LC tablets are seen as intense radio-opaque deposits within the entire gastrointestinal tract-findings which can lead to diagnostic misinterpretations. An elderly patient on peritoneal dialysis and taking LC presented with peritonitis, secondary to a perforated colonic diverticulum. The possible association between the use of LC, worsening constipation and complications arising from colonic diverticular disease, are discussed.},
}
@article {pmid22830226,
year = {2012},
author = {Komissarenko, IA and Levchenko, SV and Sil'vestrova, SIu and Kosacheva, TA and Noskova, KK},
title = {[Multipurpose psyllium monotherapy in patients with diverticular disease].},
journal = {Eksperimental'naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology},
volume = {},
number = {3},
pages = {62-67},
pmid = {22830226},
issn = {1682-8658},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Cathartics/administration & dosage/*therapeutic use ; Diverticulosis, Colonic/blood/complications/*drug therapy ; Fatty Acids, Volatile/analysis ; Feces/chemistry ; Female ; Gastrointestinal Motility/drug effects ; Humans ; Hyperlipidemias/blood/complications/*drug therapy ; Hypolipidemic Agents/administration & dosage/*therapeutic use ; Lipids/blood ; Male ; Middle Aged ; Psyllium/administration & dosage/*therapeutic use ; Treatment Outcome ; },
abstract = {The purpose of the research was the study of the prebiotic and hypolipidemic effects of 12-week treatment by psillium of patients with uncomplicated diverticular disease and hyperlipidemia. It has been established that the examined medicine has not any by-effects, normalizes intestinal motility and lowers a pain syndrome and flatulence. Prebiotic effect has proved by higher concentration of short-chain fatty acids in faeces and reduction of anaerobic index. Psillium certainly reduces levels of hyperlipidemia and could be recommended as hypolipidemic remedy for monotherapy as long as base datum of cholesterol is less than 6,4 mmol/l.},
}
@article {pmid22826513,
year = {2013},
author = {Banim, PJ and Luben, R and McTaggart, A and Welch, A and Wareham, N and Khaw, KT and Hart, AR},
title = {Dietary antioxidants and the aetiology of pancreatic cancer: a cohort study using data from food diaries and biomarkers.},
journal = {Gut},
volume = {62},
number = {10},
pages = {1489-1496},
doi = {10.1136/gutjnl-2011-301908},
pmid = {22826513},
issn = {1468-3288},
support = {G1000143/MRC_/Medical Research Council/United Kingdom ; MC_UU_12015/1/MRC_/Medical Research Council/United Kingdom ; MC_U106179471/MRC_/Medical Research Council/United Kingdom ; G0401527/MRC_/Medical Research Council/United Kingdom ; /CRUK_/Cancer Research UK/United Kingdom ; },
mesh = {Adult ; Aged ; Antioxidants/*administration & dosage ; Ascorbic Acid/administration & dosage/blood ; Biomarkers/blood ; Cohort Studies ; Diet/*statistics & numerical data ; Diet Records ; England/epidemiology ; Feeding Behavior ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/blood/epidemiology/*etiology/prevention & control ; Risk Factors ; Selenium/administration & dosage ; Vitamin E/administration & dosage ; Zinc/administration & dosage ; },
abstract = {OBJECTIVE: To investigate whether the dietary antioxidants vitamins C and E, selenium and zinc decrease the risk of developing pancreatic cancer, for the first time using 7-day food diaries, the most accurate dietary methodology in prospective work.
DESIGN: 23,658 participants, aged 40-74 years, recruited into the EPIC-Norfolk Study completed 7-day food diaries which recorded foods, brands and portion sizes. Nutrient intakes were calculated in those later diagnosed with pancreatic cancer and in 3970 controls, using a computer program with information on 11,000 foods. Vitamin C was measured in serum samples. The HRs of developing pancreatic cancer were estimated across quartiles of intake and thresholds of the lowest quartile (Q1) against a summation of the three highest (Q2-4).
RESULTS: Within 10 years, 49 participants (55% men), developed pancreatic cancer. Those eating a combination of the highest three quartiles of all of vitamins C and E and selenium had a decreased risk (HR=0.33, 95% CI 0.13 to 0.84, p<0.05). There were threshold effects (Q2-4 vs Q1) for selenium (HR=0.49, 95% CI 0.26 to 0.93, p<0.05) and vitamin E (HR=0.57, 95% CI 0.29 to 1.09, p<0.10). The HRs of quartiles for antioxidants, apart from zinc, were <1, but not statistically significant. For vitamin C, there was an inverse association with serum measurements (HR trend=0.67, 95% CI 0.49 to 0.91, p=0.01), but the threshold effect from diaries was not significant (HR=0.68, 95% CI 0.37 to 1.26).
CONCLUSION: The results support measuring antioxidants in studies investigating the aetiology of pancreatic cancer. If the association is causal, 1 in 12 cancers might be prevented by avoiding the lowest intakes.},
}
@article {pmid22806519,
year = {2013},
author = {Vestweber, B and Galetin, T and Lammerting, K and Paul, C and Giehl, J and Straub, E and Kaldowski, B and Alfes, A and Vestweber, KH},
title = {Single-incision laparoscopic surgery: outcomes from 224 colonic resections performed at a single center using SILS.},
journal = {Surgical endoscopy},
volume = {27},
number = {2},
pages = {434-442},
pmid = {22806519},
issn = {1432-2218},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Colitis, Ulcerative/*surgery ; Colonic Diseases/surgery ; Crohn Disease/*surgery ; Diverticulitis/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: Compared with single-incision laparoscopy, multiport laparoscopy is associated with greater risk of postoperative wound pain, infection, incisional hernias, and suboptimal cosmetic outcomes. The feasibility of minimally invasive single-incision laparoscopic surgery (SILS) for colorectal procedures is well-established, but outcome data remain limited.
METHODS: Patients with benign diverticular disease, Crohn's disease, or ulcerative colitis admitted to Klinikum Leverkusen, Germany, for colonic resection between July 2009 and March 2011 (n = 224) underwent single-incision laparoscopic surgery using the SILS port system. Surgeons had ≥7 years' experience in laparoscopic colon surgery but no SILS experience. Patient demographic and clinical data were collected prospectively. Pain was evaluated by using a visual analog scale (0-10). Data were analyzed by using the SPSS PASW Statistics 18 database.
RESULTS: The majority of patients underwent sigmoid colectomy with high anterior resection (AR) or left hemicolectomy (n = 150) for diverticulitis. Our conversion rate to open surgery was 6.3 %, half in patients undergoing sigmoid colectomy with high AR or left hemicolectomy, 95 % of whom had diverticulitis. Mean operating time was 166 ± 74 (range, 40-441) min in the overall population, with shorter times for single-port transanal tumor resection (SPTTR; 89 ± 51 min; range, 40-153 min) and longer times for proctocolectomy (325 min; range, 110-441 min). Mean hospital stay was approximately 10 days, longer after abdominoperineal rectal resection or proctocolectomy (12-16 days). Most complications occurred following sigmoid colectomy with high AR or left hemicolectomy [19/25 (76 %) of early and 4/5 (80 %) of late complications, respectively]. Pain was <4 on a scale of 0-10 in all cases on postoperative day 1, and typically decreased during the next 2 days.
CONCLUSIONS: Our findings support the feasibility and tolerability of colorectal surgery, conducted by experienced laparoscopic surgeons without specific training in use of the SILS port.},
}
@article {pmid22803183,
year = {2012},
author = {Potapova, VB and Levchenko, SV and Gudkova, RB and Rogozina, VA and Lazebnik, LB},
title = {Regeneration of colorectal epithelium in diverticulosis.},
journal = {Bulletin of experimental biology and medicine},
volume = {152},
number = {6},
pages = {760-763},
doi = {10.1007/s10517-012-1625-8},
pmid = {22803183},
issn = {1573-8221},
mesh = {Aged ; Biopsy ; Cell Differentiation ; Cell Proliferation ; Colon, Sigmoid/immunology/*pathology ; Cytokines/biosynthesis/immunology ; Diverticulum/immunology/*pathology ; Epithelial Cells/immunology/*pathology ; Humans ; Intestinal Mucosa/immunology/*pathology ; Lymphocyte Activation ; Macrophages/immunology/pathology ; Middle Aged ; Regeneration ; T-Lymphocytes/immunology/pathology ; },
abstract = {Excessive poorly differentiated epitheliocytes were detected in the crypts and subepithelial regions of the colorectal mucosa during the regeneration process in the majority of patients with diverticular disease. The compensatory reaction of the sigmoid mucosa decreased, which was seen from rarely detected cryptic hyperplasia. Disorders in the epitheliocyte proliferation and differentiation were paralleled by changes in tissue levels of proinflammatory cytokines (elevation of TNF-α and IFN-γ and reduction of IL-1β and IL-8) and increase of IL-4, regulating lymphocyte activation.},
}
@article {pmid22777341,
year = {2012},
author = {Strate, LL and Modi, R and Cohen, E and Spiegel, BM},
title = {Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights.},
journal = {The American journal of gastroenterology},
volume = {107},
number = {10},
pages = {1486-1493},
doi = {10.1038/ajg.2012.194},
pmid = {22777341},
issn = {1572-0241},
mesh = {Abdominal Pain/etiology ; Acute Disease ; Age Distribution ; Anti-Infective Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Chronic Disease ; Colic/etiology ; Colonoscopy ; Constipation/etiology ; Diagnosis, Differential ; Diarrhea/etiology ; Dietary Fiber/administration & dosage ; Diverticulitis/complications/*diagnosis/drug therapy/*epidemiology/physiopathology ; Diverticulitis, Colonic/diagnosis/epidemiology ; Gastrointestinal Agents/therapeutic use ; Gastrointestinal Motility ; Health Status ; Humans ; Inflammatory Bowel Diseases/diagnosis/physiopathology ; Intestines/microbiology ; Irritable Bowel Syndrome/diagnosis/physiopathology ; Mesalamine/therapeutic use ; Metagenome ; Patient Education as Topic ; Probiotics/therapeutic use ; Quality of Life ; Rifamycins/therapeutic use ; Rifaximin ; Terminology as Topic ; },
abstract = {Diverticular disease imposes a significant burden on Western and industrialized societies. The traditional pathogenesis model posits that low dietary fiber predisposes to diverticulosis, and fecalith obstruction prompts acute diverticulitis that is managed with broad-spectrum antibiotics or surgery. However, a growing body of knowledge is shifting the paradigm of diverticular disease from an acute surgical illness to a chronic bowel disorder composed of recurrent abdominal symptoms and considerable psychosocial impact. New research implicates a role for low-grade inflammation, sensory-motor nerve damage, and dysbiosis in a clinical picture that mimics irritable bowel syndrome (IBS) and even inflammatory bowel disease (IBD). Far from being an isolated event, acute diverticulitis may be the catalyst for chronic symptoms including abdominal pain, cramping, bloating, diarrhea, constipation, and "post-diverticulitis IBS." In addition, studies reveal lower health-related quality of life in patients with chronic diverticular disease vs. controls. Health-care providers should maintain a high index of suspicion for the multifaceted presentations of diverticular disease, and remain aware that it might contribute to long-term emotional distress beyond traditional diverticulitis attacks. These developments are prompting a shift in therapeutic approaches from widespread antimicrobials and supportive care to the use of probiotics, mesalamine, and gut-directed antibiotics. This review addresses the emerging literature regarding epidemiology, pathophysiology, and management of chronic, symptomatic diverticular disease, and provides current answers to common clinical questions.},
}
@article {pmid22772496,
year = {2012},
author = {Leicht, W and Thomas, C and Thüroff, J and Roos, F},
title = {[Colovesical fistula caused by diverticulitis of the sigmoid colon: diagnosis and treatment].},
journal = {Der Urologe. Ausg. A},
volume = {51},
number = {7},
pages = {971-974},
pmid = {22772496},
issn = {1433-0563},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/complications/diagnosis/*surgery ; Female ; Humans ; Intestinal Fistula/diagnosis/*etiology/*surgery ; Male ; Middle Aged ; Treatment Outcome ; },
abstract = {BACKGROUND: Colovesical fistulas caused by diverticulitis of the sigmoid colon are a rare but complex disease for which there is so far no diagnostic and therapeutic algorithm. The goal of this retrospective study including long-term follow-up was to find an algorithm for the diagnosis and therapy of colovesical fistulas caused by diverticular disease.
METHODS: Between 1982 and 2010 a total of 54 patients (46 male and 8 female) were treated in this institute for a colovesical fistula caused by diverticulitis of the sigmoid colon. The validity of the following diagnostic procedures was considered: poppy seed test, abdominal computed tomography (CT), cystoscopy, coloscopy, cystography and colon enema. The one stage operation included resection of the inflamed colon and a two-lined hand sewn end to end anastomosis of the colon without protective colostomy. After excision of the fistula a two-lined closure of the bladder defect was carried out followed by insertion of a catheter for 7 days. During follow-up patients were examined for recurrence of diverticulitis and colovesical fistula.
RESULTS: At primary clinical presentation all patients showed clinical symptoms of recurrent urinary tract infections, 74.1% had pneumaturia and 53.7% fecaluria. Fistula detection rates were 94.8% for the poppy seed test, 58.7% for CT scanning, 19.4% for cystography, 38.6% for colon enema, 15.1% for cystoscopy and 9.6% for coloscopy. Of the patients 6 (11.1%) showed perioperative morbidity (3 pneumonia and 3 superficial wound infections) and mortality was 0%. After surgical intervention no recurring diverticulitis or fistulas were detected within a median follow-up period of 62 months (range 1-164 months).
CONCLUSIONS: The poppy seed test is the most reliable diagnostic method for the detection of colovesical fistulas. The one-stage resection of the fistula of the colon and bladder segment without protective colostomy is safe and feasible.},
}
@article {pmid22761231,
year = {2012},
author = {Turner, EJ and Raza, SA},
title = {Long-term steroids and an extensive diverticular abscess.},
journal = {BMJ case reports},
volume = {2012},
number = {},
pages = {},
pmid = {22761231},
issn = {1757-790X},
mesh = {Abscess/diagnosis/*etiology ; Administration, Oral ; Aged ; Asthma/drug therapy ; *Colon ; Diagnosis, Differential ; Diverticulitis, Colonic/*complications/diagnosis ; Female ; Follow-Up Studies ; Humans ; Intestinal Perforation/*complications/diagnosis ; Steroids/administration & dosage/*adverse effects ; Time Factors ; Tomography, X-Ray Computed ; },
abstract = {The authors report a case of a 70-year-old lady who was on steroids for over 40 years for asthma and presented with a subcutaneous abscess related to diverticular disease of the colon. This case illustrates how steroids can mask the disease process and also highlights that diverticular abscess perforation is one of the many complications of corticosteroid therapy.},
}
@article {pmid22760249,
year = {2013},
author = {Patrizi, G and Giannotti, D and Anzidei, M and Pontone, S and Redler, A},
title = {Ascariasis mimicking a postoperative complication in colic resection for diverticular disease in Italy.},
journal = {Techniques in coloproctology},
volume = {17},
number = {3},
pages = {339-340},
doi = {10.1007/s10151-012-0854-1},
pmid = {22760249},
issn = {1128-045X},
mesh = {Albendazole/therapeutic use ; Anastomosis, Surgical/adverse effects ; Animals ; Antiprotozoal Agents/therapeutic use ; Ascariasis/*diagnosis/diagnostic imaging/drug therapy ; *Ascaris lumbricoides ; Colon/*microbiology/pathology ; Diverticulum, Colon/*surgery ; Endoscopy ; Humans ; Italy ; Male ; Middle Aged ; Radiography ; },
}
@article {pmid22754487,
year = {2012},
author = {Mizushima, T and Ikeda, M and Sekimoto, M and Yamamoto, H and Doki, Y and Mori, M},
title = {Laparoscopic bladder-preserving surgery for enterovesical fistula complicated with benign gastrointestinal disease.},
journal = {Case reports in gastroenterology},
volume = {6},
number = {2},
pages = {279-284},
pmid = {22754487},
issn = {1662-0631},
abstract = {Enterovesical fistula (EVF) is a relatively uncommon condition that is associated with severe morbidity. Minimally invasive and organ-preserving surgery should be performed in the case of EVF caused by benign diseases. We applied laparoscopic bladder-preserving surgery (LBPS) for EVF caused by benign gastrointestinal disease. Here, we report a surgical technique for LBPS. Patient and instrument port positioning are similar to those used in laparoscopic colorectal surgery. Dissection around the fistula is performed along the intestine as distant from the bladder as possible. If there is sufficient area around the intestinal portion of the fistula, it is isolated and resected using a linear stapler. If this approach is not possible, the intestinal fistula is sharply dissected as far away from the bladder as possible. LBPS for EVF was performed in 4 patients and included 3 direct sharp dissections and 1 stapling dissection. Three of the 4 patients did not require any further treatment for the bladder, and all procedures were feasibly accomplished under laparoscopic conditions. In conclusion, LBPS is feasible in cases of EVF caused by benign gastrointestinal disease, and we suggest that it should be the first choice of intervention in such cases.},
}
@article {pmid22749108,
year = {2013},
author = {Laghi, A and Rengo, M and Graser, A and Iafrate, F},
title = {Current status on performance of CT colonography and clinical indications.},
journal = {European journal of radiology},
volume = {82},
number = {8},
pages = {1192-1200},
doi = {10.1016/j.ejrad.2012.05.026},
pmid = {22749108},
issn = {1872-7727},
mesh = {Colonic Polyps/*diagnostic imaging ; Colonography, Computed Tomographic/*methods/*trends ; Colorectal Neoplasms/*diagnostic imaging ; *Evidence-Based Medicine ; Humans ; Radiographic Image Enhancement/*methods ; },
abstract = {CT colonography (CTC) is a robust and reliable imaging test of the colon. Accuracy for the detection of colorectal cancer (CRC) is as high as conventional colonoscopy (CC). Identification of polyp is size dependent, with large lesions (≥10mm) accurately detected and small lesions (6-9mm) identified with moderate to good sensitivity. Recent studies show good sensitivity for the identification of nonpolypoid (flat) lesions as well. Current CTC indications include the evaluation of patients who had undergone a previous incomplete CC or those who are unfit for CC (elderly and frail individuals, patients with underlying severe clinical conditions, or with contraindication to sedation). CTC can also be efficiently used in the assessment of diverticular disease (excluding patients with acute diverticulitis, where the exam should be postponed), before laparoscopic surgery for CRC (to have an accurate localization of the lesion), in the evaluation of colonic involvement in the case of deep pelvic endometriosis (replacing barium enema). CTC is also a safe procedure in patients with colostomy. For CRC screening, CTC should be considered an opportunistic screening test (not available for population, or mass screening) to be offered to asymptomatic average-risk individuals, of both genders, starting at age 50. The use in individuals with positive family history should be discussed with the patient first. Absolute contraindication is to propose CTC for surveillance of genetic syndromes and chronic inflammatory bowel diseases (in particular, ulcerative colitis). The use of CTC in the follow-up after surgery for CRC is achieving interesting evidences despite the fact that literature data are still relatively weak in terms of numerosity of the studied populations. In patients who underwent previous polypectomy CTC cannot be recommended as first test because debate is still open. It is desirable that in the future CTC would be the first-line and only diagnostic test for colonic diseases, leaving to CC only a therapeutic role.},
}
@article {pmid22744736,
year = {2012},
author = {Jeyarajah, S and Akbar, N and Moorhead, J and Haji, A and Banerjee, S and Papagrigoriadis, S},
title = {A clinicopathological study of serotonin of sigmoid colon mucosa in association with chronic symptoms in uncomplicated diverticulosis.},
journal = {International journal of colorectal disease},
volume = {27},
number = {12},
pages = {1597-1605},
pmid = {22744736},
issn = {1432-1262},
mesh = {Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Colon, Sigmoid/*metabolism/*pathology ; Diverticulitis, Colonic/*metabolism/*pathology ; Endoscopy ; Enterochromaffin Cells/metabolism/pathology ; Female ; Follow-Up Studies ; Humans ; Intestinal Mucosa/*metabolism/*pathology ; Male ; Middle Aged ; Serotonin/*metabolism ; },
abstract = {INTRODUCTION: Neurotransmitter imbalance is hypothesised as a pathogenetic mechanism in several bowel conditions. We previously reported increased 5-HT in the sigmoid mucosa of colon resected for complicated diverticular disease (DD). We aimed to identify if abnormal 5-HT expression is associated with symptoms of uncomplicated DD.
METHODS: This was a prospective, comparative study and follow-up survey of symptoms. We examined the differences in 5-HT between DD patients and controls, as well as the presence of bowel symptoms at time of endoscopy and also 2 years later. Sigmoid biopsies were collected at colonoscopy. Immunohistochemical staining for 5-HT cells was performed.
RESULTS: Eighty-seven patients were recruited, 37 (42.5 %) DD and 50 (57.5 %) controls. No patients underwent surgery. There was no significant difference in total mean number of 5-HT-positive cells in DD compared to controls or between patients and controls with abdominal symptoms. Forty-one patients (47.1 %) responded to questionnaires at median 57.8 months from biopsy. Eighteen (43.9 %) were DD and 23(56.1 %) controls. 5-HT counts showed no significant association to symptom persistence.
DISCUSSION: Although 5-HT expression has previously been found to be increased in complicated DD in whole bowel-resected specimens, the same is not confirmed on colonic mucosal biopsies. This raises the suggestion that 5-HT may be involved in the development of acute complications but may not be involved in the pathogenesis of chronic symptoms.},
}
@article {pmid22733197,
year = {2013},
author = {Masoni, L and Mari, FS and Nigri, G and Favi, F and Gasparrini, M and Dall'Oglio, A and Pindozzi, F and Pancaldi, A and Brescia, A},
title = {Preservation of the inferior mesenteric artery via laparoscopic sigmoid colectomy performed for diverticular disease: real benefit or technical challenge: a randomized controlled clinical trial.},
journal = {Surgical endoscopy},
volume = {27},
number = {1},
pages = {199-206},
pmid = {22733197},
issn = {1432-2218},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Colon, Sigmoid/*surgery ; Constipation/surgery ; Diverticulum, Colon/physiopathology/*surgery ; Fecal Incontinence/surgery ; Female ; Humans ; Laparoscopy/*methods ; Life Style ; Male ; Manometry ; *Mesenteric Artery, Inferior ; Middle Aged ; Organ Sparing Treatments/*methods ; Pressure ; Quality of Life ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: Defecatory disorders are very common complications after left hemicolectomy and anterior rectal resection. These disorders seem related primarily to colonic denervation after the resection. To evaluate the real benefits of inferior mesenteric artery (IMA) preservation via laparoscopic left hemicolectomy performed for diverticular disease in terms of reduced colonic denervation and improved postoperative intestinal functions, a randomized, single-blinded (patients) controlled clinical trial was conducted.
METHODS: From January 2004 to January 2010, patients with symptomatic diverticular disease and a surgical indication were enrolled in the study and randomly assigned to two treatment groups. The first group underwent laparoscopic left hemicolectomy, which preserved the IMA by sectioning the sigmoid arteries one by one near the colonic wall, In the second group, the IMA was sectioned immediately below the origin of left colic artery. Defecation disorders were assessed by anorectal manometry and by three questionnaires to evaluate constipation, incontinence, and quality of life 6 months after the intervention.
RESULTS: A total of 107 patients were included in the study. The 54 patients with preserved IMA showed a statistically lower incidence of defecation disorders such as fragmented evacuations, alternating bowel function, constipation, and minor incontinence, as well as less lifestyle alteration than the 53 patients with the IMA sectioned just below the left colic artery.
CONCLUSIONS: This study confirmed that preservation of the IMA should be recommended to reduce the incidence of defecatory disorders after left hemicolectomy for benign disease.},
}
@article {pmid22729060,
year = {2012},
author = {Ghuman, M and Bates, N and Moore, H},
title = {Computed tomographic colonography (CTC): a retrospective analysis of a single site experience and a review of the literature on the status of CTC.},
journal = {The New Zealand medical journal},
volume = {125},
number = {1356},
pages = {60-67},
pmid = {22729060},
issn = {1175-8716},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian People/statistics & numerical data ; Cause of Death ; Colonic Polyps/*diagnostic imaging/ethnology ; Colonography, Computed Tomographic/*statistics & numerical data ; Colorectal Neoplasms/*diagnostic imaging/ethnology ; Diagnosis, Differential ; Diverticulum, Colon/*diagnostic imaging/ethnology ; Europe/ethnology ; Female ; Humans ; Male ; Middle Aged ; New Zealand/epidemiology ; Polynesia/ethnology ; Referral and Consultation/statistics & numerical data ; Retrospective Studies ; Sensitivity and Specificity ; Young Adult ; },
abstract = {AIM: To review local CT colonography (CTC) data with regard to demographics, and both colonic and extracolonic findings. To improve performance by identifying any deficiencies that need to be addressed, in relation to a literature review of the current status of CTC.
METHOD: A retrospective observational analysis was conducted of all the patients undergoing CTC for the 3-year period from 9 August 2007 - 12 August 2010 (n=302) conducted at a single site: Greenlane Hospital (ADHB outpatients).
RESULTS: In total, 12 of the 302 patients (4%) were found to have cancer, 24 polyps (8%), and 111 diverticular disease (37%). 21 patients (7%) were referred on for optical colonoscopy following their CTC, and 34 patients (11%) had follow-up recommendations resulting from extracolonic findings, including 24 recommendations for further imaging. A trend towards under-representation of both Māori and Pacific Island groups undergoing CTC, and over-representation of Asians was identified.
CONCLUSION: This study has reported on the experience of CT colonography at Greenlane Hospital over a 3-year period. It has provided important local data on rates of detection of colonic pathology. Māori and Pacific Islanders need encouragement from primary health practitioners to present for bowel examination.},
}
@article {pmid22711236,
year = {2012},
author = {von Rahden, BH and Germer, CT},
title = {Pathogenesis of colonic diverticular disease.},
journal = {Langenbeck's archives of surgery},
volume = {397},
number = {7},
pages = {1025-1033},
pmid = {22711236},
issn = {1435-2451},
mesh = {Aging/physiology ; Anti-Bacterial Agents/therapeutic use ; Colonic Diseases, Functional/complications/physiopathology ; Diet ; Diverticulosis, Colonic/*etiology/genetics/*physiopathology/prevention & control ; Gastrointestinal Motility ; Humans ; Immunosuppressive Agents/adverse effects ; Probiotics/therapeutic use ; Risk Factors ; Steroids/adverse effects ; },
abstract = {PURPOSE: This paper aims to review the current evidence regarding pathogenesis of colonic diverticular disease and its complications, which are a major health problem in the Western world.
METHODS: Based on selective Medline searches, relevant literature was indentified regarding pathogenesis of (1) diverticulosis/formation of diverticula, (2) diverticulitis/inflammation of diverticula, (3) complicated diverticulitis/perforation, and (4) diverticular bleeding.
RESULTS: Pathogenesis of colonic diverticula is regarded as a multifactorial process, involving dietary factors (Western low-fiber diet), structural changes of the colonic wall (altered musculature, collagen, elastin, etc.) and functional changes (motility disorder, increased intraluminal pressure). Genetic changes are also discussed and aging is also a key factor. Pathogenesis of inflammation (diverticulosis) is regarded as a result of "microperforations" at the fundus of the diverticulum, and not an "abscessed diverticulum" due to an impacted fecolith. Histamine and its receptors do also seem to play a role, corresponding with the promising prophylactic approach with probiotics. Pathogenesis of complicated diverticulitis is characterized by perforation, which is the cardinal feature. Furthermore, an intensive inflammatory infiltrate with macrophages is found in surgical specimens, even after antibiotic pretreatment. Steroid intake and immunosuppression are risk factors and only recently a glucocorticoid-induced tumor necrosis factor-receptor has been suggested to resemble the molecular link. Diverticular bleeding is a distinct disease process-which does usually take place without diverticulitis-and is due to eccentric rupture of the vas rectum.
CONCLUSIONS: The pathophysiology of diverticular disease is multifactorial. Some of the current evidence has important implications for clinical practice, e.g., the suggested role of steroid intake and immunosuppression for complicated diverticulitis.},
}
@article {pmid22696044,
year = {2012},
author = {Tonolini, M and Bianco, R},
title = {Multidetector CT cystography for imaging colovesical fistulas and iatrogenic bladder leaks.},
journal = {Insights into imaging},
volume = {3},
number = {2},
pages = {181-187},
pmid = {22696044},
issn = {1869-4101},
abstract = {Multidetector computed tomography (MDCT) cystography currently represents the modality of choice to image the urinary bladder in traumatized patients. In this review we present our experience with MDCT cystography applications outside the trauma setting, particularly for diagnosing bladder fistulas and leaks. A detailed explanation is provided concerning exam preparation, acquisition technique, image reconstruction and interpretation. Colovesical fistulas most commonly occur as a complication of sigmoid diverticular disease, and often remain occult after extensive diagnostic work-up including cystoscopy and contrast-enhanced CT. We consistently achieved accurate preoperative visualization of colovesical fistulas using MDCT cystography. Urinary leaks and injuries represent a non-negligible occurrence after pelvic surgery, particularly obstetric and gynaecological procedures: in our experience MDCT cystography is useful to investigate iatrogenic bladder leaks or fistulas. In our opinion, MDCT cystography should be recommended as the first line modality for direct visualization or otherwise confident exclusion of both spontaneous enterovesical fistulas and bladder injuries following instrumentation procedures, obstetric or surgical interventions. Main Messages • Explanation of exam preparation, acquisition technique, image reconstruction and interpretation. • Preoperative visualization of colovesical fistulas, usually secondary to sigmoid diverticulitis. • Visualization or exclusion of iatrogenic bladder injuries following instrumentation or surgery.},
}
@article {pmid22684480,
year = {2013},
author = {Swan, C and Duroudier, NP and Campbell, E and Zaitoun, A and Hastings, M and Dukes, GE and Cox, J and Kelly, FM and Wilde, J and Lennon, MG and Neal, KR and Whorwell, PJ and Hall, IP and Spiller, RC},
title = {Identifying and testing candidate genetic polymorphisms in the irritable bowel syndrome (IBS): association with TNFSF15 and TNFα.},
journal = {Gut},
volume = {62},
number = {7},
pages = {985-994},
doi = {10.1136/gutjnl-2011-301213},
pmid = {22684480},
issn = {1468-3288},
support = {PB-PG-0107-12127/DH_/Department of Health/United Kingdom ; },
mesh = {Adult ; Cytokines/biosynthesis ; Female ; Gene Expression Profiling/methods ; Gene Expression Regulation ; Gene Frequency ; Genetic Association Studies/methods ; Genetic Predisposition to Disease ; Genotype ; Helicobacter Infections/complications/genetics/metabolism ; Helicobacter pylori ; Humans ; Intestinal Absorption/physiology ; Irritable Bowel Syndrome/*genetics/metabolism/microbiology ; Leukocytes, Mononuclear/metabolism ; Male ; Middle Aged ; Oligonucleotide Array Sequence Analysis/methods ; Phenotype ; *Polymorphism, Single Nucleotide ; Rectum/metabolism ; Tumor Necrosis Factor Ligand Superfamily Member 15/biosynthesis/*genetics ; Tumor Necrosis Factor-alpha/biosynthesis/*genetics ; },
abstract = {OBJECTIVES: The postinfectious irritable bowel syndrome (PI-IBS) suggests that impaired resolution of inflammation could cause IBS symptoms. The authors hypothesised that polymorphisms in genes whose expression were altered by gastroenteritis might be linked to IBS with diarrhoea (IBS-D) which closely resembles PI-IBS.
DESIGN: Part 1: 25 healthy volunteers (HVs), 21 patients 6 months after Campylobacter jejuni infection, 37 IBS-D and 19 IBS with constipation (IBS-C) underwent rectal biopsy for gene expression analysis and peripheral blood mononuclear cell cytokine production assessment. Part 2: Polymorphisms in genes whose expression was altered in Part 1 were assessed in 179 HV, 179 IBS-D, 122 IBS-C and 41 PI-IBS.
RESULTS: Part 1: Mucosal expression of seven genes was altered in IBS: CCL11, CCL13, Calpain 8 and TNFSF15 increased while NR1D1, GPR161 and GABRE decreased with similar patterns after infection with C jejuni. Part 2: The authors assessed 21 known single nucleotide polymorphisms (SNPs) in these seven genes and one SNP in each of the TNFα and IL-10 genes. Three out of five TNFSF15 SNPs (rs6478108, rs6478109 and rs7848647) showed reduced minor allele frequency (MAF) (0.28, 0.27 and 0.27) in subjects with IBS-D compared with HV (0.38, 0.36 and 0.37; p=0.007, 0.015 and 0.007, respectively) confirming others recent findings. The authors also replicated the previously reported association of the TNFα SNP rs1800629 with PI-IBS which showed an increase in the MAF at 0.30 versus 0.19 for HV (p=0.04).
CONCLUSION: IBS-D and PI-IBS patients are associated with TNFSF15 and TNFα genetic polymorphisms which also predispose to Crohn's disease suggesting possible common underlying pathogenesis.},
}
@article {pmid22680042,
year = {2012},
author = {Tursi, A and Elisei, W and Brandimarte, G and Giorgetti, GM and Inchingolo, CD and Nenna, R and Picchio, M and Giorgio, F and Ierardi, E},
title = {Mucosal expression of basic fibroblastic growth factor, Syndecan 1 and tumor necrosis factor-alpha in diverticular disease of the colon: a case-control study.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {24},
number = {9},
pages = {836-e396},
doi = {10.1111/j.1365-2982.2012.01946.x},
pmid = {22680042},
issn = {1365-2982},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Infective Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Case-Control Studies ; Colitis/metabolism ; Colitis, Ulcerative/metabolism ; Colon/metabolism ; Diverticulitis, Colonic/drug therapy/*metabolism ; Diverticulosis, Colonic/*metabolism ; Drug Therapy, Combination ; Female ; Fibroblast Growth Factor 2/*metabolism ; Humans ; Inflammation/metabolism ; Intestinal Mucosa/*metabolism ; Male ; Mesalamine/therapeutic use ; Metronidazole/therapeutic use ; Middle Aged ; Rifamycins/therapeutic use ; Rifaximin ; Syndecan-1/*metabolism ; Treatment Outcome ; Tumor Necrosis Factor-alpha/*metabolism ; },
abstract = {BACKGROUND: Inflammation may be detected in diverticular disease (DD), and fibrosis may also develop. We assessed the mucosal expression of bFGF, SD1, and TNF-α in DD according to the severity of the disease. Moreover, we assessed the response to therapy of these cytokines in acute uncomplicated diverticulitis (AUD).
METHODS: Fifteen patients affected by AUD and seven patients affected by symptomatic uncomplicated diverticular disease (SUDD) were enrolled. Patients with asymptomatic diverticulosis (AD), segmental colitis associated with diverticulosis (SCAD), ulcerative colitis (UC), and healthy subjects (HC) served as control groups.
KEY RESULTS: The expression of bFGF, SD1, and TNF-α was significantly higher in diverticulitis than in healthy controls, in diverticulosis, and in uncomplicated diverticular disease. Cytokines were significantly higher in uncomplicated diverticular disease than in healthy controls. Cytokine expression in diverticulitis did not differ significantly from that of ulcerative colitis. After treatment, TNF-α expression dropped significantly.
CONCLUSIONS & INFERENCES: Mucosal TNF-α is overexpressed only in symptomatic DD, while SD1 and bFGF are already overexpressed in AD. Finally, TNF-α but not SD1 or bFGF expression seems to be influenced by the treatment in AUD.},
}
@article {pmid22665561,
year = {2012},
author = {King, A and Peters, CJ and Shorvon, P},
title = {Acute pancreatitis with pancreatic abscess secondary to sealed jejunal diverticular perforation.},
journal = {BMJ case reports},
volume = {2012},
number = {},
pages = {},
pmid = {22665561},
issn = {1757-790X},
mesh = {Abscess/*diagnosis/diagnostic imaging/etiology ; Aged ; Diagnosis, Differential ; Diverticulum/complications/*diagnosis ; Humans ; Intestinal Perforation/complications/*diagnosis ; Jejunal Diseases/complications/*diagnosis ; Male ; Pancreatic Diseases/*diagnosis/diagnostic imaging/etiology ; Pancreatitis/*diagnosis/diagnostic imaging/etiology ; Rupture, Spontaneous ; Tomography, X-Ray Computed ; },
abstract = {Although most cases of acute pancreatitis are attributed to gallstones or alcohol, many remain idiopathic. The authors describe a case of acute pancreatitis in a 75-year-old gentleman who presented with acute epigastric pain, fevers and shortness of breath. Serum amylase was 2164. CT showed free mesenteric air, and a partly cystic/partly gas-containing mass in the uncinate lobe of the pancreas. Gastrograffin meal revealed duodenal and jejunal diverticular disease, but no contrast leak. Further CT analysis pinpointed fine tracts of air leading from a jejunal diverticulum up toward the pancreas, suggesting causation by a sealed jejunal diverticular perforation. He responded well to intravenous antibiotics and conservative management. Although small bowel diverticular disease is linked to chronic pancreatitis, evidence for association with acute pancreatitis is scarce. The authors believe this is the first reported case of jejunal diverticular disease causing acute pancreatitis, and it highlights micro-perforation as a potential disease mechanism.},
}
@article {pmid22644602,
year = {2012},
author = {Barry, BD and Leroy, J and Mutter, D and Wu, HS and Marescaux, J},
title = {Minimally invasive surgical treatment of sigmoid diverticulitis.},
journal = {Langenbeck's archives of surgery},
volume = {397},
number = {7},
pages = {1035-1041},
pmid = {22644602},
issn = {1435-2451},
mesh = {Digestive System Surgical Procedures/*methods ; Diverticulitis, Colonic/*surgery ; Humans ; *Minimally Invasive Surgical Procedures ; Sigmoid Diseases/*surgery ; },
abstract = {INTRODUCTION: Diverticular disease is very common in Western societies. However, there is a trend towards reducing indications for the surgical management of diverticulitis. Minimally invasive surgery offers many potential advantages to patients in the treatment of diverticulitis and may optimise surgical indications.
METHODS: A systematic literature review of minimally invasive techniques was carried out for the treatment of diverticulitis. The following techniques were reviewed: laparoscopic, single-port, natural orifice specimen extraction, natural orifice transluminal endoscopic surgery and laparoscopic lavage for the treatment of diverticulitis.
RESULTS: In total, 2,050 minimally invasive cases were reviewed. Of all the different minimally invasive techniques published regarding the management of diverticular disease, laparoscopic surgery is the only technique that has undergone the rigours of randomised controlled trials. The documented benefits are less blood loss, less pain and analgesic requirements, a reduction in major complications, a reduction in the frequency of drain usage, a reduction in the duration of postoperative ileus and shorter hospital stay. However, operative time does appear to be longer. It has also been demonstrated that elective laparoscopic surgery results in improved quality of life and social functioning.
CONCLUSION: Minimally invasive surgery for the treatment of diverticular disease appears feasible and safe. The result of future randomised trials will more clearly define the role each minimally invasive technique will play in the future.},
}
@article {pmid22632654,
year = {2012},
author = {Cirocchi, R and Trastulli, S and Farinella, E and Desiderio, J and Listorti, C and Parisi, A and Noya, G and Boselli, C},
title = {Is inferior mesenteric artery ligation during sigmoid colectomy for diverticular disease associated with increased anastomotic leakage? A meta-analysis of randomized and non-randomized clinical trials.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {9},
pages = {e521-9},
doi = {10.1111/j.1463-1318.2012.03103.x},
pmid = {22632654},
issn = {1463-1318},
mesh = {Anastomotic Leak/*etiology ; Colectomy/adverse effects/*methods ; Diverticulitis, Colonic/*surgery ; Humans ; Ligation/adverse effects/methods ; Mesenteric Artery, Inferior/*surgery ; Sigmoid Diseases/*surgery ; },
abstract = {AIM: A meta-analysis was conducted to compare preservation with ligation of the inferior mesenteric artery (IMA) during sigmoidectomy for diverticular disease.
METHOD: Randomized and non-randomized clinical trials were identified using the following electronic databases: Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, Science Citation Index, Greynet, SIGLE, National Technological Information Service, British Library Integrated Catalogue. The analysed end-points were the anastomotic leakage rate, overall morbidity and 30-day postoperative mortality.
RESULTS: Four studies were included involving 400 patients. The anastomotic leakage rate was 7.3% in the preservation group and 11.3% in the ligation group. There was no statistically significant difference between the groups (OR 0.72, 95% CI 0.11-4.76; P=0.73). Overall morbidity and 30-day postoperative mortality were not compared since these data were reported in only one study.
CONCLUSION: The meta-analysis did not show any advantage for preservation of the IMA during sigmoid colectomy for diverticular disease in terms of anastomotic leakage.},
}
@article {pmid22626560,
year = {2013},
author = {Vasilakis, V and Clark, CE and Liasis, L and Papaconstantinou, HT},
title = {Noncosmetic benefits of single-incision laparoscopic sigmoid colectomy for diverticular disease: a case-matched comparison with multiport laparoscopic technique.},
journal = {The Journal of surgical research},
volume = {180},
number = {2},
pages = {201-207},
doi = {10.1016/j.jss.2012.04.063},
pmid = {22626560},
issn = {1095-8673},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Colon, Sigmoid/*surgery ; Diverticulum/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Length of Stay ; Male ; Middle Aged ; Pain Measurement ; Pain, Postoperative/physiopathology ; Postoperative Care ; },
abstract = {BACKGROUND: Single-incision laparoscopic (SIL) colectomy has gained significant momentum with anticipated benefit of improved cosmesis. Feasibility and safety of SIL colectomy have been shown; however, benefits are not well defined. The purpose of this study is to directly compare outcomes of SIL sigmoid colectomy for diverticular disease with standard multiport laparoscopic (LAP) technique.
METHODS: SIL sigmoid colectomy cases performed for diverticular disease between August 2009 and July 2011 were case matched for age, gender, body mass index, American Society of Anesthesiologists score, previous abdominal operation, and need to mobilize the splenic flexure and compared with an equal number of LAP cases. Data analyzed included operative time, estimated blood loss, procedure conversion, incision length, length of hospital stay (LOS), 30-d hospital readmission, and postoperative pain scores.
RESULTS: Twenty patients were analyzed in each group with no significant differences found in the six case-matching criteria. Operative time, conversions, estimated blood loss, surgical site infection, and hospital readmissions were similar. The mean incision length for both groups was 5cm (P=0.72). LOS was 3.7d for the SIL group, which was >1d shorter than that for the LAP group (5.0d; P<0.05). Pain score at post-anesthesia care unit discharge and total amount of narcotic pain medication delivered in the post-anesthesia care unit was significantly less in the SIL group (P<0.05), as was maximum visual analog scale pain score on postoperative day 1 and postoperative day 2 (P≤0.01).
CONCLUSIONS: SIL sigmoid colectomy is associated with noncosmetic benefits, including a reduction in early postoperative pain and decreased LOS. These findings may be related to reduced abdominal wall trauma.},
}
@article {pmid22576905,
year = {2012},
author = {Unlü, C and Daniels, L and Vrouenraets, BC and Boermeester, MA},
title = {Systematic review of medical therapy to prevent recurrent diverticulitis.},
journal = {International journal of colorectal disease},
volume = {27},
number = {9},
pages = {1131-1136},
pmid = {22576905},
issn = {1432-1262},
mesh = {Anti-Bacterial Agents/therapeutic use ; Dietary Fiber/therapeutic use ; Diverticulitis/*drug therapy/*prevention & control ; Humans ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; Recurrence ; },
abstract = {AIM AND BACKGROUND: One of today's controversies remains the prevention of recurrent diverticulitis. Current guidelines advise a conservative approach, based on studies showing low recurrence rates and a high operative morbidity and mortality. Conservative measures in prevention recurrence are dietary advises and medical therapies, including probiotics and 5-aminosalicylic acid.
OBJECTIVES: The aim of this systematic review is to assess whether medical or dietary therapies can prevent recurrent diverticulitis after a primary episode of acute diverticulitis. METHOD AND SEARCH STRATEGY: We searched different databases for papers published between January 1966 and January 2011.
STUDY SELECTION: Clinical studies were eligible for inclusion if they assessed the prevention of recurrent diverticulitis with a medical or dietary therapy. Exclusion criteria were studies without a control group.
RESULTS: Three randomized controlled trials (RCT), all with a Jadad quality score of 2 out of 5, were included in this systematic review. Mesalazine results in significantly less disease recurrence and fewer symptoms after an acute episode. The use of probiotics decreases symptoms but does not reduce recurrence. No difference in effect is seen when Balsalazide is added to probiotics compared to probiotics only. No relevant studies on dietary therapy/advices or antibiotics for prevention of recurrent diverticulitis were found.
CONCLUSION: The evidence that supports medical therapy to prevent recurrent diverticulitis is of poor quality. Treatment with 5-aminosalicylic acid seems promising. Based on current data, no recommendation of any non-operative relapse prevention therapy for diverticular disease can be made.},
}
@article {pmid22574094,
year = {2012},
author = {Constantin, A and Mates, IN and Predescu, D and Hoara, P and Achim, FI and Constantinoiu, S},
title = {Principles of surgical treatment of Zenker diverticulum.},
journal = {Journal of medicine and life},
volume = {5},
number = {1},
pages = {92-97},
pmid = {22574094},
issn = {1844-3117},
mesh = {Barium ; Deglutition Disorders/*etiology/surgery ; Digestive System Surgical Procedures/*methods ; Diverticulitis/complications/*surgery ; Female ; Humans ; Male ; Manometry/methods ; Middle Aged ; Treatment Outcome ; Zenker Diverticulum/complications/*surgery ; },
abstract = {BACKGROUND: Pharyngo-esophageal diverticula are most frequently described in elderly patients, having symptoms such as dysphagia, regurgitation, chronic cough, aspiration and weight loss. The etiology remains controversial, although most of the theories are linked to structural or functional abnormalities of the crico-pharyngeal muscle. With the therapeutic attitude varying from conservative to surgical (with associated morbidity and mortality), the importance of knowing the etiopathology and clinical implications of the disease for establishing the management of the case is mandatory. The aim of the study is the reevaluation of the methods and therapeutic principles in pharyngo-esophageal diverticular disease, starting from the etio pathogeny.
MATERIALS AND METHODS: Our study group is made up of 11 patients with surgical indication for Zenker diverticulum, operated between 2001 and 2011.
RESULTS: During that period, more patients were diagnosed with this pathology, but the surgical indication was carefully established, in conformity with the actual practice guides, which involve the evaluation of the clinical manifestations determined by the diverticulum, as well as the identification and interception of the pathological mechanisms by the therapeutic gesture.
CONCLUSION: Although it has a "benign" pathology, the esophageal diverticulum requires complex surgical procedure that implies significant morbidity.},
}
@article {pmid22573297,
year = {2012},
author = {Bromage, SJ and Liew, MP and Moore, KC and Raju, B and Shackley, DC},
title = {The economic implications of unsuspected findings from CT urography performed for haematuria.},
journal = {The British journal of radiology},
volume = {85},
number = {1017},
pages = {1303-1306},
pmid = {22573297},
issn = {1748-880X},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Hematuria/*diagnostic imaging/*economics/epidemiology ; Humans ; *Incidental Findings ; Male ; Middle Aged ; Prevalence ; Tomography, X-Ray Computed/*economics/statistics & numerical data ; United Kingdom/epidemiology ; Urography/*economics/statistics & numerical data ; Young Adult ; },
abstract = {OBJECTIVES: We set out to determine the prevalence of unsuspected findings from CT urography (CTU) performed for haematuria and to evaluate the economic implications associated with the subsequent management of these findings.
METHODS: We analysed the results of 778 consecutive CTU scans performed in a haematuria clinic between 2008 and 2010. We excluded cases where diagnosis of an abnormality had been made prior to CTU. Costs incurred during the follow-up of unsuspected findings were calculated following guidance set out in the NHS Costing Manual 2009/10.
RESULTS: 778 CTU scans were performed for patients attending a haematuria clinic from 2008 to 2010. 455 men and 323 women underwent CTU scan; they had a median age of 62 years. 56% of scans were found to have unexpected extra-urinary findings (587 abnormalities in 439 scans). Common findings included diverticular disease (138, 17.7%), adrenal masses [85, 10.9%; 40 (5.1%) of which were indeterminate], lung abnormalities (67, 8.6%), gall bladders containing calculi (44, 5.7%), adnexal cysts (25, 7.7% of women) and aortic aneurysms (18, 2.3%). These findings led to a total of 136 outpatient appointments, 88 radiological investigations and 11 procedures (4 of which were major). The overall cost incurred was £47,366, or £60 per patient.
CONCLUSION: CTU is associated with a high rate of unsuspected findings. There is an economic implication to performing CT scanning in this setting, in which further unanticipated investigation and treatment cost is approximately £60 per patient.},
}
@article {pmid22573184,
year = {2012},
author = {Annibale, B and Lahner, E and Maconi, G and Usai, P and Marchi, S and Bassotti, G and Barbara, G and Cuomo, R},
title = {Clinical features of symptomatic uncomplicated diverticular disease: a multicenter Italian survey.},
journal = {International journal of colorectal disease},
volume = {27},
number = {9},
pages = {1151-1159},
pmid = {22573184},
issn = {1432-1262},
mesh = {Abdominal Pain/complications ; Adult ; Aged ; Aged, 80 and over ; Demography ; Diverticulitis/complications/*epidemiology/*pathology ; Dyspepsia/complications ; Feces ; Female ; Health Surveys/*statistics & numerical data ; Humans ; Irritable Bowel Syndrome/complications ; Italy/epidemiology ; Male ; Middle Aged ; Young Adult ; },
abstract = {PURPOSE: Clinical features of symptomatic uncomplicated diverticular disease are poorly investigated. Abdominal symptoms may be similar to those of irritable bowel syndrome. This survey aimed to assess clinical features associated with symptomatic uncomplicated diverticular disease.
METHODS: This multicenter survey included consecutive outpatients with symptomatic uncomplicated diverticular disease to whom a detailed clinical questionnaire regarding demographic, lifestyle, and clinical features was administered. Diagnosis was based on the presence of diverticula and abdominal pain/discomfort. Irritable bowel syndrome and functional dyspepsia were assessed according to Rome III criteria.
RESULTS: A total of 598 patients (50 % female, age 69 years), 71 % with newly diagnosed symptomatic uncomplicated diverticular disease and 29 % with history of colonic diverticula, were recruited. Diverticula were localized in the left colon in 78 % of the patients. Recurrent short-lived abdominal pain (<24 h) was present in 70 % (relieved by evacuation in 73 %), prolonged abdominal pain (>24 h) in 27 %, and recurrent abdominal bloating in 61 % of the patients. Normal, loose, or hard stools were reported by 58, 29, and 13 % of patients, respectively. Irritable bowel syndrome (IBS)-like and functional dyspepsia-like symptoms were recorded in 59 and 7 % of patients, respectively. IBS-like symptoms (odds ratio, 4.3) were associated in patients with prolonged abdominal pain.
CONCLUSIONS: Symptomatic uncomplicated diverticular disease is associated with a gender ratio of 1:1 and an unspecific clinical picture mainly characterized by normal stools, short-lived abdominal pain, abdominal bloating, IBS-like symptoms, while functional dyspepsia-like symptoms are not commonly present. These findings suggest that symptomatic uncomplicated diverticular disease often shows similar findings rather than overlaps IBS.},
}
@article {pmid22572700,
year = {2012},
author = {Senapati, A},
title = {The surgeon's view.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {129-134},
doi = {10.1159/000335920},
pmid = {22572700},
issn = {1421-9875},
mesh = {Decision Making ; Disease Progression ; Diverticulitis, Colonic/complications/pathology/prevention & control/*surgery ; Elective Surgical Procedures ; Humans ; *Physicians ; Recurrence ; },
abstract = {Diverticular disease affects up to 50% of people by the time they reach the age of 80. The major complications of diverticular disease (abscess, perforation, fistula, obstruction and bleeding) have their own management pathways, but the treatment of uncomplicated diverticulitis is controversial. On initial presentation, diverticulitis is always treated conservatively. Whether this should be followed by resectional surgery has been the subject of speculation for many decades. The American Society of Colon and Rectal Surgeons recommended in 2000 that an elective resection should follow two attacks of acute diverticulitis. Much of the work underpinning their policy was based on seminal studies by Parks in the 1960s and 1970s who followed cohorts of patients with diverticular disease and examined their outcomes. However, many of these studies were based on inaccurate diagnostic data where the diagnosis was made primarily on clinical grounds. Investigations such as barium enema or colonoscopy are not reliable in confirming the presence of inflammation. Since CT scanning has become routine, the diagnosis of acute diverticulitis can now be made accurately. In recent years much work has been done, such as by Ambrosetti, who has produced evidence predicting the outcome of diverticulitis based on CT findings. More recent papers, in which the diagnosis of acute diverticulitis is likely to have been made more accurately, confirm that although recurrent attacks of diverticulitis are fairly common, there is a very low incidence of serious complications after long-term follow-up. It has also become apparent that the majority of patients who present with the major complications of diverticulitis, specifically abscess, perforation and fistula, do so as their first presentation of the disease, without previous episodes of diverticulitis. The corollary of this is that patients having had acute diverticulitis do not run the risk of developing life-threatening complications without elective surgery. The complications of left-sided colonic resection are not inconsiderable with anastomotic leaks, the formation of a stoma, either temporary or permanent, as well as mortality. When these data are put alongside the very low risk of serious harm to the patient after diverticulitis, the balance of opinion has now swung heavily in favour of a more conservative approach. In addition to this there are modern and innovative medical therapeutic approaches to the treatment of diverticulitis such as 5ASAs, poorly absorbed antibiotics and probiotics.},
}
@article {pmid22572697,
year = {2012},
author = {Papagrigoriadis, S},
title = {Differences in early outcomes after open or laparoscopic surgery: what is the evidence?.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {114-117},
doi = {10.1159/000335916},
pmid = {22572697},
issn = {1421-9875},
mesh = {Colorectal Surgery ; Diverticulitis, Colonic/complications/*surgery ; Humans ; Laparoscopy/adverse effects/*methods ; Meta-Analysis as Topic ; Randomized Controlled Trials as Topic ; Treatment Outcome ; },
abstract = {Laparoscopic surgery has been widely studied in colorectal cancer and its feasibility and safety have been proven to the extent that in the UK a national laparoscopic colorectal surgery programme has been established. The advantages of laparoscopic surgery have been studied less systematically in diverticular disease. Several prospective uncontrolled studies have demonstrated that laparoscopic surgery for diverticular disease is feasible with low morbidity and mortality rates. A large population study in the USA has demonstrated elective laparoscopic surgery for diverticular disease to have reduced hospital stay by 1 day, and a lower rate of intra-operative and post-operative complications over open surgery. Some of the reported differences may be attributable to selection bias of more complex cases to open surgery. A Cochrane systematic review examining 11 non-randomized and 1 randomized study showed laparoscopic surgery to be feasible in diverticular disease, although there might be a higher minor complications rate in laparoscopic resections. Attention has been focused on surgical techniques as means to reduce complications. There is a belief that preservation of the inferior mesenteric and superior rectal artery protects from anastomotic leak, but a study from the USA looking into that point did not find a difference. The application of hand-assisted laparoscopy seems to help cope with complex diverticular masses and colovesical fistulas. New hybrid techniques incorporating specimen extraction via rectum may reduce complications further. Single incision laparoscopic surgery has recently been shown to be feasible. Although minimally invasive techniques appear superior in terms of early outcomes than open surgery the choice of minimally invasive technique seems to be less relevant to outcomes if accompanied by an appropriate level of surgical experience and expertise. Patient-related factors such as comorbidities or degree of disease complexity are more likely to be related to complication rates.},
}
@article {pmid22572694,
year = {2012},
author = {Gross, V},
title = {Aminosalicylates.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {92-99},
doi = {10.1159/000335906},
pmid = {22572694},
issn = {1421-9875},
mesh = {Aminosalicylic Acids/*therapeutic use ; Anti-Inflammatory Agents/therapeutic use ; Colitis/complications/pathology ; Diverticulitis, Colonic/complications/drug therapy/pathology/prevention & control ; Humans ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; },
abstract = {Symptomatic diverticular disease has a high prevalence in countries with a western lifestyle. Besides antibiotics for acute diverticulitis there are no established medical interventions to prevent or to treat symptomatic diverticular disease. Due to its broad spectrum of anti-inflammatory activities, mesalazine is a candidate for the treatment of symptomatic diverticular disease. A review of the literature shows that randomized open studies using various treatment designs suggest a protective role of mesalazine in preventing recurrences of diverticulitis. Currently, 5 randomized placebo-controlled trials are active which will clarify the role of mesalazine to prevent recurrence of diverticulitis in the near future. Several randomized uncontrolled studies suggest that mesalazine improves symptoms in patients with symptomatic uncomplicated diverticular disease. The analysis of secondary end points from two randomized placebo-controlled trials suggests that mesalazine improves symptoms in diverticular disease although both studies failed to show a statistically significant advantage for mesalazine for the primary study end point. In segmental colitis associated with diverticulosis no prospective systematic studies are available. However, several case reports show a high efficacy of mesalazine in segmental colitis associated with diverticulosis.},
}
@article {pmid22572690,
year = {2012},
author = {Simpson, J},
title = {Perception and the origin of symptoms in diverticular disease.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {75-79},
doi = {10.1159/000335723},
pmid = {22572690},
issn = {1421-9875},
mesh = {Animals ; Diverticulitis, Colonic/*etiology/pathology ; Humans ; Inflammation/pathology ; *Perception ; Viscera/pathology ; },
abstract = {Colonic diverticulosis is a common condition and although the majority of patients are asymptomatic up to 20% experience altered bowel habit and abdominal pain. The mechanisms underlying these symptoms are unclear but several theories now exist. This article briefly outlines a model of GI perception and then highlights past and current theories that may explain the development of symptoms in patients with diverticulosis.},
}
@article {pmid22572688,
year = {2012},
author = {Spiller, R},
title = {Is it diverticular disease or is it irritable bowel syndrome?.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {64-69},
doi = {10.1159/000335721},
pmid = {22572688},
issn = {1421-9875},
mesh = {Diagnosis, Differential ; Diverticulitis, Colonic/complications/*diagnosis/therapy ; Humans ; Irritable Bowel Syndrome/complications/*diagnosis/therapy ; Pain/etiology ; Practice Patterns, Physicians' ; Somatoform Disorders/complications ; },
abstract = {Symptomatic diverticular disease (SYMP-DD) and irritable bowel syndrome (IBS) share many features. Both are characterised by recurrent episodes of abdominal pain which may be slightly more frequent in IBS than SYMP-DD. They may also both exhibit an erratic bowel habit with diarrhoea, constipation and alternating types. It is important to assess anxiety, depression and somatisation since this can be increased in both types of patients and may be associated with visceral hypersensitivity. There are also significant differences between IBS and SYMP-DD. In particular, SYMP-DD patients are older, lack the female predominance seen in IBS and may often have fever with prolonged episodes of pain. For them, abnormalities of the gut are probably more important than cerebral factors, while for IBS the reverse is true. Treatments should be directed at the predominant abnormality which will vary in every patient.},
}
@article {pmid22572687,
year = {2012},
author = {Bar-Meir, S and Lahat, A and Melzer, E},
title = {Role of endoscopy in patients with diverticular disease.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {60-63},
doi = {10.1159/000335921},
pmid = {22572687},
issn = {1421-9875},
mesh = {Colonoscopy/adverse effects/*methods ; Diverticulitis, Colonic/*diagnosis/diagnostic imaging/epidemiology/therapy ; Humans ; Radiography ; Randomized Controlled Trials as Topic ; },
abstract = {Acute diverticulitis occurs in 10-25% of patients with diverticulosis. Colonoscopy is advised 6 weeks after an attack of acute diverticulitis in order to completely evaluate the colonic lumen and exclude a potential malignancy. We conducted several studies aimed to evaluate the feasibility and safety of early colonoscopy in patients with acute diverticulitis. Consecutive patients hospitalized for acute diverticulitis were included. In the first phase of the study, patients with adjacent peri-diverticular air/fluid on CT were excluded. In the second phase of the study, we included patients with peri-diverticular air/fluid on CT as well. During the first phase of the study, 39 patients underwent uneventful colonoscopy. During the second phase of the study, 40 patients underwent colonoscopy and 1 of 6 patients with peri-diverticular air had perforation of her sigmoid colon. Two patients had a more protracted course and were clearly those who benefited most from the early colonoscopy. Based on our study, we concluded that early colonoscopy in acute diverticulitis is feasible. It should be reserved either for all patients with no air adjacent to diverticuli on CT or just for those with a more protracted course. In the third phase, a prospective randomized study was conducted on patients with acute diverticulitis with no peri-diverticular air. Such patients were randomized into those who underwent early colonoscopy and those who underwent colonoscopy 6 weeks later. Eighty-three patients were included in both groups and in none has a significant lesion been identified (except polyps). It seems therefore that the current abdominal CT with its excellent resolution is enough to exclude colonic cancer. Colonoscopy should be reserved only for patients with a protracted unresolved course of acute diverticulitis.},
}
@article {pmid22572684,
year = {2012},
author = {Ekbom, A},
title = {Is diverticular disease associated with colonic malignancy?.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {46-50},
doi = {10.1159/000335708},
pmid = {22572684},
issn = {1421-9875},
mesh = {Colon/*pathology ; Colonic Neoplasms/*complications/diagnosis/pathology ; Diverticulosis, Colonic/*complications/epidemiology/pathology/therapy ; Humans ; },
abstract = {Colon cancer and diverticular disease have common characteristics; there are increases in the incidences in both disease entities and these diseases are more common in the westernized world. There is also an increase in the age-specific incidence with advancing age. Similar dietary features have been implicated for both diseases and already during the 1960s it was postulated by Burkitt that there is an association. Observational studies initially were able to demonstrate that patients with a history of diverticular disease of the colon had an increased risk of colon cancer, especially in the left side. However, the results from these studies have not been consistent, and problems like selection bias and confounding by indication have been major drawbacks in order to interpret the results and infer causality. Recent studies, which have had a better assessment of diverticular disease by new diagnostic methods, do not support such an association to the same extent as previously. Moreover, surveillance bias has become an increasing problem as patients with diverticular disease of the colon are subjected to a higher diagnostic intensity than other individuals in a population-based setting. A critical evaluation of the studies published so far therefore clearly indicates that the proposed association between diverticular disease and colonic malignancy is not evidence based, which should have an impact on clinical practice as well as on how to deal with these patient groups within the realms of a screening program.},
}
@article {pmid22572683,
year = {2012},
author = {Strate, LL},
title = {Lifestyle factors and the course of diverticular disease.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {35-45},
doi = {10.1159/000335707},
pmid = {22572683},
issn = {1421-9875},
mesh = {Dietary Fiber ; *Disease Progression ; Diverticulitis, Colonic/*epidemiology/*pathology ; Humans ; *Life Style ; Motor Activity ; Socioeconomic Factors ; },
abstract = {The dramatic increase in the prevalence of diverticular disease after industrialization has led to the belief that diet and lifestyle factors play a significant role in its pathogenesis. Dietary fiber deficiency has received the most attention, although data are limited and conflicting. Two recent cross-sectional studies found no association between fiber intake and diverticulosis, and one found a positive association. However, fiber may improve symptoms associated with uncomplicated diverticulosis and decrease the risk of diverticulitis. Red meat intake may also increase the risk of diverticular symptoms and complications. Contrary to a long-standing belief, a large prospective study found that nuts and corn did not increase the risk of diverticulitis or diverticular bleeding. A number of case-control and prospective studies have found positive associations between obesity and diverticular complications. Central obesity may be particularly important. Vigorous physical activity appears to reduce the risk of diverticulitis and diverticular bleeding. Findings regarding smoking and diverticular complications have been inconsistent, but suggest that smokers are at increased risk for complications, particularly perforation. Alcohol may increase the risk of asymptomatic diverticulosis and diverticulitis. Research is needed to define the role of lifestyle modification in the primary and secondary prevention of diverticulosis and its complications.},
}
@article {pmid22572682,
year = {2012},
author = {Haboubi, NY and Alqudah, M},
title = {Pathology and pathogenesis of diverticular disease and patterns of colonic mucosal changes overlying the diverticula.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {29-34},
doi = {10.1159/000335704},
pmid = {22572682},
issn = {1421-9875},
mesh = {Diverticulitis, Colonic/diagnosis/*etiology/*pathology/therapy ; Diverticulum/*complications/*pathology ; Humans ; Intestinal Mucosa/*pathology ; Treatment Outcome ; },
abstract = {The aim of this article is to review the pathology of diverticular disease and draw attention to the histological changes that affect the wall and the mucosal lining of the sigmoid colon in this common condition. We were the first group to propose a histological classification for sigmoid colitis-associated diverticular disease, and in this paper we are adding another feature to our original observation.},
}
@article {pmid22572681,
year = {2012},
author = {Bassotti, G and Villanacci, V},
title = {Colonic diverticular disease: abnormalities of neuromuscular function.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {24-28},
doi = {10.1159/000335702},
pmid = {22572681},
issn = {1421-9875},
mesh = {Colon/pathology/physiopathology ; Diverticulitis, Colonic/pathology/*physiopathology ; Gastrointestinal Motility/physiology ; Humans ; Motor Activity/physiology ; Neuromuscular Junction/*abnormalities/*physiopathology ; },
abstract = {Although diverticular disease of the colon (diverticulosis) is a frequent finding in Western countries, its pathophysiologic grounds are still only partially understood. Traditionally considered as an age-related condition, colonic diverticulosis is probably the final result of several factors concurring together to determine the anatomo-functional abnormalities eventually causing outpouching of the viscus' mucosa. Among these factors, a relevant role seems to be played by an abnormal neuromuscular function of the large bowel, as shown by abnormal myoelectrical and motor function repeatedly described in these patients, as well as by altered visceral perception. These anomalies might be related to the recent demonstration of derangement of enteric innervation (especially involving interstitial cells of Cajal and enteric glial cells), mucosal neuropeptides, and mucosal inflammation. The latter may have a role of paramount importance in the development of visceral hypersensitivity, responsible for abdominal pain in a subset of patients.},
}
@article {pmid22572680,
year = {2012},
author = {Böttner, M and Wedel, T},
title = {Abnormalities of neuromuscular anatomy in diverticular disease.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {19-23},
doi = {10.1159/000335699},
pmid = {22572680},
issn = {1421-9875},
mesh = {Diverticulitis, Colonic/etiology/*pathology/physiopathology ; Gastrointestinal Motility ; Humans ; Neuromuscular Junction/*abnormalities/*pathology ; Neurotransmitter Agents/metabolism ; },
abstract = {The pathogenesis of diverticular disease is still poorly understood and considered to be multifactorial. Whereas classical pathogenetic concepts have focused on risk factors including increasing age, low-fiber diet and connective tissue disorders, novel concepts take into account that patients with diverticular disease exhibit disturbed intestinal motility patterns (that may result in functional obstruction and painful sensations) therefore postulating an underlying enteric neuro-/myopathy. Recent studies including quantitative evaluations of the enteric nervous system (ENS) in diverticular disease yielded hypoganglionic conditions of both myenteric and submucosal plexus as well as a nerve tissue remodeling in chronic diverticular disease. The disturbed neuromuscular communication was proven by demonstrating alterations in several enteric neurotransmitter systems, exemplified for the cholinergic, serotonergic, nitrergic system as well as for vasointestinal peptide, galanin and tachykinins. Novel lines of evidence have added the involvement of neurotrophic factors such as glial cell line-derived neurotrophic factor which is supposed to regulate ENS development and maintenance and which is downregulated in patients with diverticular disease. Consistent with the hypothesis of an enteric myopathy, deficits in smooth muscle integrity and composition such as hypertrophy, fibrotic transformation and gene expression deficits could be delineated. Taken together, the structural and functional findings on alterations of the ENS and the enteric musculature in diverticular disease provide evidence to strengthen the hypothesis that an enteric neuro-/myopathy may contribute to the development of colonic diverticula and the generation of symptoms in the course of the disease.},
}
@article {pmid22572679,
year = {2012},
author = {Tursi, A},
title = {Biomarkers in diverticular diseases of the colon.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {12-18},
doi = {10.1159/000335695},
pmid = {22572679},
issn = {1421-9875},
mesh = {Biomarkers/*metabolism ; Colon/*pathology ; Diverticulitis, Colonic/*diagnosis ; Feces ; Humans ; Inflammation/pathology ; Inflammatory Bowel Diseases/diagnosis ; },
abstract = {Recent data found that diverticular disease (DD) of the colon shows similarities with inflammatory bowel diseases (IBD). In particular, the detection of microscopic inflammation and the clinical response to mesalazine seem to confirm the hypothesis that inflammation may be a key point for the appearance of symptoms and development of complications. In light of this hypothesis, several studies have recently focused their attention on the role of biomarkers in predicting and monitoring the course of the disease. C-reactive protein (CRP), white blood cell count, erythrocyte sedimentation rate, and fecal calprotectin (FC) have therefore been investigated. As in IBD, CRP seems to be the most effective marker of histological and clinical severity of the disease. In particular, CRP below 50 mg/l suggests an acute uncomplicated diverticulitis (AUD), whereas CRP higher than 200 mg/l is a strong indicator of DD complicated by perforation. As in IBD, FC seems to be a noninvasive sensitive marker of DD severity. In particular, FC may show slight increased valued already in symptomatic uncomplicated DD (SUDD) (FC value ≥15 μg/ml seems to be predictive of SUDD). As expected, FC shows higher values in AUD (FC value ≥60 μg/ml seems to be predictive of AUD). Finally, FC seems to be useful also in monitoring the therapeutic response in DD. In fact, FC values decreased significantly in patients responding to therapy, whereas they persisted to increase in patients who failed to obtain remission.},
}
@article {pmid22572678,
year = {2012},
author = {Humes, DJ},
title = {Changing epidemiology: does it increase our understanding?.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {6-11},
doi = {10.1159/000335692},
pmid = {22572678},
issn = {1421-9875},
mesh = {Diverticulitis, Colonic/complications/*epidemiology/mortality ; Humans ; },
abstract = {During the last decade there have been a number of reports using routinely collected health care administration data and from large cohort studies that have attempted to describe changes in the occurrence and identify risk factors for the development of the condition along with reporting its associated mortality. This article identified all studies reporting the occurrence and mortality associated with diverticulosis, diverticular disease and the complications of diverticular disease, notably, bleeding, perforation, fistula, stricture and abscess formation which show that there is strong evidence of an increasing health care burden associated with diverticular disease in terms of hospitalization. There is evidence of an increase in the incidence of some of the associated complications of diverticular disease, notably perforation. A number of risk factors such as body mass index, comorbidity, smoking and concurrent medications such as opiate analgesics and steroids may predispose to the development of complications. The mortality associated with hospital admission for diverticular disease is significant as is the excess mortality associated with a diagnosis of one of the complications of diverticular disease.},
}
@article {pmid22572677,
year = {2012},
author = {Kruis, W and Spiller, RC and Papagrigoriadis, S and Engel, A and Kreis, ME},
title = {Diverticular disease: a fresh approach to a neglected disease. Preface.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {30},
number = {1},
pages = {5},
doi = {10.1159/000336866},
pmid = {22572677},
issn = {1421-9875},
mesh = {Diverticulosis, Colonic/*pathology ; Humans ; International Cooperation ; Neglected Diseases/*pathology ; Physicians ; Randomized Controlled Trials as Topic ; },
}
@article {pmid22549495,
year = {2012},
author = {Andersen, JC and Bundgaard, L and Elbrønd, H and Laurberg, S and Walker, LR and Støvring, J and , },
title = {Danish national guidelines for treatment of diverticular disease.},
journal = {Danish medical journal},
volume = {59},
number = {5},
pages = {C4453},
pmid = {22549495},
issn = {2245-1919},
mesh = {Abdominal Abscess/etiology/therapy ; Acute Disease ; Chronic Disease ; Denmark ; Developing Countries ; Diverticulitis, Colonic/diagnosis/epidemiology/etiology/*therapy ; Diverticulosis, Colonic/epidemiology/etiology ; Elective Surgical Procedures ; Humans ; Intestinal Perforation/etiology/surgery ; Laparoscopy ; Recurrence ; },
abstract = {In order to elaborate evidence-based, national Danish guidelines for the treatment of diverticular disease the literature was reviewed concerning the epidemiology, staging, diagnosis and treatment of diverticular disease in all its aspects. The presence of colonic diverticula, which is considered to be a mucosal herniation through the intestinal muscle wall, is inversely correlated to the intake of dietary fibre. Other factors in the genesis of diverticular disease may be physical inactivity, obesity, and use of NSAIDs or acetaminophen. Diverticulosis is most common in Western countries with a prevalence of 5% in the population aged 30-39 years and 60% in the part of the population > 80 years. The incidence of hospitalization for acute diverticulitis is 71/100,000 and the incidence of complicated diverticulitis is 3.5-4/100,000. Acute diverticulitis is conveniently divided into uncomplicated and complicated diverticulitis. Complicated diverticulitis is staged by the Hinchey classification 1-4 (1: mesocolic/pericolic abscess, 2: pelvic abscess, 3: purulent peritonitis, 4: faecal peritonitis). Diverticulitis is suspected in case of lower left quadrant abdominal pain and tenderness associated with fever and raised WBC and/or CRP; but the clinical diagnosis is not sufficiently precise. Abdominal CT confirms the diagnosis and enables the classification of the disease according to Hinchey. The distinction between Hinchey 3 and 4 is done by laparoscopy or, when not possible, by laparotomy. Uncomplicated diverticulitis is treated by conservative means. There is no evidence of any beneficial effect of antibiotics in uncomplicated diverticulitis, but antibiotics may be used in selected cases depending on the overall condition of the patients and the severity of the infection. Abscess formation is best treated by US- or CT-guided drainage in combination with antibiotics. When the abscess is < 3 cm in diameter, drainage may be unnecessary, and only antibiotics should be instituted. The surgical treatment of acute perforated diverticulitis has interchanged between resection and non-resection strategies: The three-stage procedure dominating in the beginning of the 20th century was later replaced by the Hartmann procedure or, alternatively, resection of the sigmoid with primary anastomosis. Lately a non-resection strategy consisting of laparoscopy with peritoneal lavage and drainage has been introduced in the treatment of Hinchey stage 3 disease. Evidence so far for the lavage regime is promising, comparing favourably with resection strategies, but lacking in solid proof by randomized, controlled investigations. In recent years, morbidity has declined in complicated diverticulitis due to improved diagnostics and new treatment modalities. Recurrent diverticulitis is relatively rare and furthermore often uncomplicated than previously assumed. Elective surgery in diverticular disease should probably be limited to symptomatic cases not amenable to conservative measures, since prophylactic resection of the sigmoid, evaluated from present evidence, confers unnecessary risks in terms of morbidity and mortality to the individual as well as unnecessary costs to society. Any recommendation for routine resection following multiple cases of diverticulitis should await results of randomized studies. Laparoscopic resection is preferred in case of need for elective surgery. When malignancy is ruled out preoperatively, a sigmoid resection with preservation of the inferior mesenteric artery, oral division of colon in soft compliant tissue and anastomosis to upper rectum is recommended. Fistulae to bladder or vagina, or stenosis of the colon may be dealt with according to symptoms and comorbidity. Resection of the diseased segment of colon is preferred when possible and safe; alternatively, a diverting stoma can be the best solution.},
}
@article {pmid22549378,
year = {2012},
author = {Alberti, LR and De Lima, DC and Rodrigues, KC and Taranto, MP and Gonçalves, SH and Petroianu, A},
title = {The impact of colonoscopy for colorectal cancer screening.},
journal = {Surgical endoscopy},
volume = {26},
number = {11},
pages = {3157-3162},
pmid = {22549378},
issn = {1432-2218},
mesh = {Asymptomatic Diseases ; *Colonoscopy ; Colorectal Neoplasms/*diagnosis ; Early Detection of Cancer/*methods ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; },
abstract = {BACKGROUND: Colorectal cancer is the second leading cause of cancer-related death. Prevention of this neoplasm should be achievable by screening programs in asymptomatic patients. The objective of the present paper is to assess colonoscopic findings in asymptomatic people submitted to screening.
METHODS: A prospective study was undertaken on 153 consecutive asymptomatic people submitted to colonoscopy. Sex, age, previous diseases, and familial cases of cancer, as well as tobacco and alcohol ingestion were assessed. Patients with rectal macro- or microscopic bleeding and colorectal diseases were excluded. Bowel cleansing, polyps, angioectasias, diverticular disease, inflammation, and neoplasm were also verified. Polyps were classified according to their size, number, and location.
RESULTS: Colonoscopic alterations were detected in 99 individuals: polyps in 64.3 %, diverticular disease in 27.9 %, inflammatory mucosal alterations in 9.7 %, melanosis coli in 2.6 %, and angioectasias in 7.8 %. There was an increasing incidence of polyps in individuals older than 50 years. Multivariate logistic regression showed age and sex as predictive factors for polyps [odds ratio (OR) = 1.43; 1.19 < OR < 2.67].
CONCLUSIONS: The results of this investigation revealed a significant incidence of colonoscopic alterations in asymptomatic people submitted to colonoscopy for colorectal cancer screening.},
}
@article {pmid22538042,
year = {2012},
author = {Shahzad, N and Maqbool, A and Gauhar, TM and Azim, KM},
title = {Colonic perforation induced by short term use of slow release diclofenac.},
journal = {Journal of the College of Physicians and Surgeons--Pakistan : JCPSP},
volume = {22},
number = {5},
pages = {328-329},
pmid = {22538042},
issn = {1681-7168},
mesh = {Abdomen, Acute/diagnosis/etiology ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects/therapeutic use ; Colon/*surgery ; Delayed-Action Preparations/*adverse effects/therapeutic use ; Diclofenac/*adverse effects/therapeutic use ; Dose-Response Relationship, Drug ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Intestinal Perforation/*chemically induced/surgery ; Laparotomy/methods ; Male ; Parotitis/diagnosis/drug therapy ; Risk Assessment ; Treatment Outcome ; Young Adult ; },
abstract = {Upper gastrointestinal (GI) toxicity of non-steroidal anti-inflammatory drugs (NSAIDs) is well characterized. There is also documented data regarding their adverse effects on lower GI tract, like colonic strictures, inflammatory bowel disease and complications of diverticular disease in the form of abscess or perforation. But there are only two case reports published previously that show colonic perforation due to use of NSAIDs solely. We present here a case of colonic perforation induced by short-term use of slow release diclofenac in a young man. Colonic perforation should be considered as the possible diagnosis in patients with acute abdomen and NSAIDs to be one of the differentials if other possibilities are ruled out.},
}
@article {pmid22491590,
year = {2012},
author = {Gawlick, U and Nirula, R},
title = {Resection and primary anastomosis with proximal diversion instead of Hartmann's: evolving the management of diverticulitis using NSQIP data.},
journal = {The journal of trauma and acute care surgery},
volume = {72},
number = {4},
pages = {807-14; quiz 1124},
doi = {10.1097/TA.0b013e31824ef90b},
pmid = {22491590},
issn = {2163-0763},
mesh = {Anastomosis, Surgical/methods/statistics & numerical data ; Colostomy/methods/statistics & numerical data ; Diverticulitis/complications/*surgery ; Female ; Humans ; Ileostomy/methods/statistics & numerical data ; Intestinal Diseases/*surgery ; Intestinal Perforation/etiology/surgery ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Peritonitis/etiology/surgery ; Retrospective Studies ; Treatment Outcome ; United States ; },
abstract = {BACKGROUND: The emergency surgical treatment of acute diverticulitis with feculent or purulent peritonitis has traditionally been the Hartmann's procedure (HP). Debate continues over whether primary resection with anastomosis and proximal diversion may be performed in the setting of a high-risk anastomosis in complicated diverticular disease. In contrast to a loop ileostomy takedown, the morbidity of a Hartmann's reversal is preventative for many patients, leaving them with a permanent stoma. Our study compared the surgical outcomes of patients with perforated diverticulitis who underwent a HP to primary anastomosis with proximal diversion (PAPD).
METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 to 2009 to identify all cases of perforated diverticulitis classified as contaminated or dirty/infected. Patients were stratified into HP or PAPD, and logistic regression models were created to control for patient demographics, comorbidities, perioperative risk, and illness severity to determine the impact of surgical procedure on outcome.
RESULTS: There were 2,018 patients meeting the inclusion criteria of which 340 (17%) underwent PAPD and the remainder underwent HP. Significant independent predictors of infectious outcomes were alcohol use, preoperative sepsis, and operative time. There was no significant difference in risk of infectious complications, return to the operating room, prolonged ventilator use, death, or hospital length of stay between the two procedures. When considering only dirty/infected cases, the mortality risk was twofold greater when PAPD was performed.
CONCLUSION: The treatment of acute diverticulitis in the setting of contamination can be safely treated with resection, primary anastomosis, and proximal diversion as opposed to a HP in certain circumstances. Given the decreased morbidity of subsequent loop ileostomy takedown compared with a Hartmann's reversal, this procedure should be given consideration in the management of acute, perforated diverticulitis but may not be warranted in cases of feculent peritonitis.},
}
@article {pmid22487574,
year = {2012},
author = {Franks, I},
title = {Genetics: Genetic susceptibility has a role in the development of diverticular disease.},
journal = {Nature reviews. Gastroenterology & hepatology},
volume = {9},
number = {5},
pages = {246},
pmid = {22487574},
issn = {1759-5053},
}
@article {pmid22480080,
year = {2012},
author = {Moorman, S},
title = {Help patients defy diverticular disease.},
journal = {Journal of Christian nursing : a quarterly publication of Nurses Christian Fellowship},
volume = {29},
number = {2},
pages = {82-7; quiz 88-9},
doi = {10.1097/cnj.0b013e318245cfd2},
pmid = {22480080},
issn = {0743-2550},
mesh = {Christianity ; Diverticulitis/diagnosis/*nursing/*therapy ; Education, Nursing, Continuing ; Holistic Nursing/*methods ; Humans ; Life Style ; *Patient Education as Topic ; *Spirituality ; },
abstract = {Diverticular disease is a chronic disorder that can significantly impact quality of life, and incidence of this disease is increasing. This article outlines the history, incidence, pathophysiology, signs and symptoms, diagnosis, treatment, and nursing management of patients with diverticular disease. Tools to assist with patient education and resources for spiritual care, inner healing needs, and support with healthy lifestyle choices are provided.},
}
@article {pmid22469806,
year = {2012},
author = {Manceau, G and Karoui, M and Breton, S and Blanchet, AS and Rousseau, G and Savier, E and Siksik, JM and Vaillant, JC and Hannoun, L},
title = {Right colon to rectal anastomosis (Deloyers procedure) as a salvage technique for low colorectal or coloanal anastomosis: postoperative and long-term outcomes.},
journal = {Diseases of the colon and rectum},
volume = {55},
number = {3},
pages = {363-368},
doi = {10.1097/DCR.0b013e3182423f83},
pmid = {22469806},
issn = {1530-0358},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anal Canal/*surgery ; Anastomosis, Surgical/adverse effects/methods ; Colitis, Ischemic/surgery ; Colon/*surgery ; Colorectal Neoplasms/surgery ; Digestive System Surgical Procedures/*methods ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Rectum/*surgery ; Reoperation ; Salvage Therapy ; },
abstract = {BACKGROUND: After extended left colectomy, it may be difficult to take down a well-vascularized colon into the pelvis and perform a tension-free colorectal or coloanal anastomosis. The Deloyers procedure comprising complete mobilization and rotation of the right colon while maintaining the ileocolic artery may be used in this circumstance.
OBJECTIVE: The aim of this study is to report postoperative and long-term outcomes after the Deloyers procedure as a salvage technique for colorectal anastomosis or coloanal anastomosis.
DESIGN: From a prospective database, we retrospectively reviewed all patients who underwent a Deloyers procedure.
SETTING: This study was conducted at the Colorectal Unit in a tertiary referral teaching hospital.
PATIENTS: Between 1998 and 2011, 48 consecutive patients underwent a Deloyers procedure. Indications were as following: Hartmann reversal (n = 17), previous colorectal anastomosis-related complications (n = 11), diverticular disease (n = 6), left colon cancer (n = 6), ischemic colitis (n = 3), iterative colectomy for cancer (n = 3), rectal cancer local recurrence (n = 1), and synchronous colon cancer (n = 1).
RESULTS: There were 38 men and 10 women (median age at surgery, 67 years). Colorectal anastomosis and coloanal anastomosis were performed in 38 and 10 patients. Thirty-one patients had defunctioning stoma. Mortality and early morbidity rate was 2% and 23%. Three patients (6%) had severe complications (Dindo ≥ 3). There was no anastomotic leakage. Reoperation was required in 2 patients for intra-abdominal hemorrhage. The median hospital stay was 12 days. The median follow-up was 26 months. All patients had their ileostomy closed. Twenty-three percent of patients developed late complications. The median number of bowel movements per day was 3 (range, 1-7), but 67% of patients had fewer than 3. One patient required an ileostomy refashioning because of poor functional results, and 23% of patients routinely take loperamide-based medication.
LIMITATION: The retrospective nature of the study was a limitation.
CONCLUSIONS: The Deloyers procedure is safe, associated with low morbidity and good long-term functional results. It represents a safe alternative to total colectomy and ileorectal anastomosis.},
}
@article {pmid22469482,
year = {2012},
author = {Tursi, A and Elisei, W and Brandimarte, G and Giorgetti, GM and Inchingolo, CD and Nenna, R and Picchio, M and Giorgio, F and Ierardi, E},
title = {Musosal tumour necrosis factor α in diverticular disease of the colon is overexpressed with disease severity.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {5},
pages = {e258-63},
doi = {10.1111/j.1463-1318.2012.02926.x},
pmid = {22469482},
issn = {1463-1318},
mesh = {Aged ; Aged, 80 and over ; Colitis, Ulcerative/metabolism/pathology ; Diverticulitis, Colonic/*metabolism/pathology ; Diverticulosis, Colonic/metabolism/pathology ; Female ; Humans ; Intestinal Mucosa/*metabolism/pathology ; Lymphocyte Count ; Male ; Middle Aged ; RNA, Messenger/metabolism ; Severity of Illness Index ; Statistics, Nonparametric ; Tumor Necrosis Factor-alpha/*metabolism ; },
abstract = {AIM: Inflammation occurs in diverticular disease (DD), but there is little information on inflammatory cytokines such as tumour necrosis factor α (TNF-α). The aim of this study was to assess TNF-α expression in DD and to see whether it is related to the severity of the disease.
METHOD: Twenty-four patients with symptomatic DD were divided into those with acute uncomplicated diverticulitis (AUD) (12 patients) and those with symptomatic uncomplicated diverticular disease (SUDD) (12 patients). Twelve further patients with asymptomatic diverticulosis (AD), six with segmental colitis associated with diverticulosis (SCAD), with ulcerative colitis (UC) and six healthy individuals (HC) were enrolled as controls. TNF-α expression in the colonic mucosa was assessed by the amount of mRNA codifying for the synthesis of TNF-α.
RESULTS: TNF-α expression was significantly higher in AUD than in HC (P=0.0007), in AD (P=0.0001) and in SUDD (P=0.0179). It was significantly higher also in SUDD than in HC (P=0.0007) and in AD (P=0.0001). TNF-α expression in AUD did not differ significantly from that in UC (P=0.0678) and SCAD (P=0.0610). It was significantly higher in UC, SCAD and AUD than in SUDD (P=0.0007, P=0.0001, P=0.0179).
CONCLUSION: TNF-α expression in DD seems to be related to the severity of the disease. In particular, it appears to be overexpressed in DD with inflammation (AUD and SUDD) compared with DD without (AD).},
}
@article {pmid22461655,
year = {2012},
author = {Kallenbach, K and Hjorth, SV and Engel, U and Schlesinger, NH and Holck, S},
title = {Significance of acquired diverticular disease of the vermiform appendix: a marker of regional neoplasms?.},
journal = {Journal of clinical pathology},
volume = {65},
number = {7},
pages = {638-642},
doi = {10.1136/jclinpath-2011-200647},
pmid = {22461655},
issn = {1472-4146},
mesh = {Appendiceal Neoplasms/*epidemiology ; Appendix/*pathology ; Biomarkers, Tumor ; Cecal Diseases/*diagnosis/*epidemiology/pathology ; Colorectal Neoplasms/*epidemiology ; Comorbidity ; Data Collection ; Diverticulum/*diagnosis/*epidemiology/pathology ; Humans ; Prevalence ; Prospective Studies ; Retrospective Studies ; Risk Factors ; },
abstract = {AIM: To assess the prevalence of acquired diverticulum of the appendix (DA), including incipient forms and its possible significance as a marker of local/regional neoplasms.
MATERIALS AND METHODS: The pathology database at Hvidovre Hospital was searched for appendix specimens, received between 2001 and 2010, coded for DA or for a space-occupying lesion. Slides were reviewed to determine DA status and the nature of lesions possibly causing DA.
RESULT: Among 4413 appendix specimens, DA were identified in 39 (0.9%, CI 0.6% to 1.2%) cases, 17 (43.6%, 28.0% to 59.2%) of which additionally harboured an appendiceal neoplasm/neoplastic precursor, whereas this figure was 1.2% (CI 0.9% to 1.6%) for non-DA specimens (p<0.0001). Six of the 39 DA specimens comprised incipient DA, three of which coexisted with appendiceal neoplasms. In addition, local/regional non-neoplastic lesions (six cases) and colorectal carcinomas (four cases) coexisted with DA.
CONCLUSION: DA has significance as a putative marker of local/regional neoplasms. Therefore, a DA specimen proved significantly more likely to harbour a neoplastic growth than a non-DA counterpart. Submission for microscopy of the entire DA specimen, whether transmural or only incipient, and a comment in the pathology report on the occasional concurrence of local/regional neoplasms in this setting seem appropriate. The observation of DA may thus provide a valuable contribution in the diagnostic process.},
}
@article {pmid22432696,
year = {2012},
author = {Granlund, J and Svensson, T and Olén, O and Hjern, F and Pedersen, NL and Magnusson, PK and Schmidt, PT},
title = {The genetic influence on diverticular disease--a twin study.},
journal = {Alimentary pharmacology & therapeutics},
volume = {35},
number = {9},
pages = {1103-1107},
doi = {10.1111/j.1365-2036.2012.05069.x},
pmid = {22432696},
issn = {1365-2036},
mesh = {Aged ; Diverticulum/epidemiology/*genetics ; Female ; *Genetic Predisposition to Disease ; Humans ; Male ; Middle Aged ; Odds Ratio ; Prevalence ; Registries ; Severity of Illness Index ; Sweden/epidemiology ; Twins, Dizygotic/*genetics ; Twins, Monozygotic/*genetics ; },
abstract = {BACKGROUND: The contribution of hereditary factors to the development of diverticular disease (DD) of the colon is unknown. Prevalence and location of diverticula differ in Western world compared to in Asia and several case reports describing families with DD have been published.
AIM: To assess the heritability of DD in a large population-based sample of twins.
METHODS: The Swedish Twin Registry was cross-linked to the Swedish Inpatient Registry. All twins, born between 1886 and 1980 and not dead before 1969, with a discharge diagnosis of DD were identified. Twins with diagnoses of colon cancer, coeliac disease or non-infectious colitis were excluded to decrease bias. Co-twin odds ratio (OR), concordance rates and tetrachoric correlations were calculated for monozygotic (MZ) and same gender-dizygotic (SS-DZ) twins. Mx-analyses were used to estimate the relative contributions of genetic effects and environmental factors to susceptibility for DD. Calculations were based on both primary and secondary discharge diagnoses to provide estimates reflecting impact of severity of the disease.
RESULTS: A total of 104,452 twins met the inclusion criteria. Of these, 2296 had a diagnosis of DD. The OR of developing the disease given one's co-twin was affected was 7.15 (95% CI: 4.82-10.61) for MZ and 3.20 (95% CI: 2.21-4.63) for SS-DZ twins. Similarly, concordance rates and tetrachoric correlations were higher in MZ than those in SS-DZ twins. The heritability was estimated to 40% and the non shared environmental effects to 60%.
CONCLUSION: Genetic susceptibility is an important component, along with individual specific environmental factors, for the development of diverticular disease of the colon.},
}
@article {pmid22423344,
year = {2012},
author = {Koay, S and Jain, S and Cropley, I and Petrushkin, H and Beynon, H},
title = {Endogenous endophthalmitis and liver abscesses.},
journal = {Acute medicine},
volume = {11},
number = {1},
pages = {25-27},
pmid = {22423344},
issn = {1747-4892},
mesh = {Anti-Bacterial Agents/therapeutic use ; Bacteremia/*complications/diagnosis/drug therapy ; Drug Therapy, Combination ; Emergency Service, Hospital ; Endophthalmitis/drug therapy/*etiology/microbiology ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Liver Abscess/*complications/*diagnostic imaging/drug therapy ; Male ; Middle Aged ; Risk Assessment ; Severity of Illness Index ; Streptococcal Infections/*complications/diagnosis/drug therapy ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; Vision Disorders/diagnosis/etiology ; },
abstract = {We present a case of endogenous endophthalmitis secondary to liver abscesses, in a patient with no previous medical comorbidities or risk factors for immunosuppression. The patient presented with acute painless loss of vision and feeling generally unwell. Investigations revealed Streptococcus anginosus-constellatus bacteraemia, and evidence of diverticular disease that likely predisposed to the liver abscesses. Due to prompt diagnosis and administration of antibiotics, the patient had a good visual outcome. This case highlights the importance of being aware of endogenous endophthalmitis, as early diagnosis and prompt administration of antibiotics will optimise visual outcomes.},
}
@article {pmid22374544,
year = {2012},
author = {Torres, RA and Orban, RD and Tocaimaza, L and Vallejos Pereira, G and Arévalo, JR},
title = {Transvaginal specimen extraction after laparoscopic colectomy.},
journal = {World journal of surgery},
volume = {36},
number = {7},
pages = {1699-1702},
pmid = {22374544},
issn = {1432-2323},
mesh = {Adult ; Aged ; Colectomy/*methods ; Colon/surgery ; Female ; Humans ; Laparoscopy/*methods ; Middle Aged ; Rectum/surgery ; Specimen Handling/*methods ; Vagina ; },
abstract = {BACKGROUND: Despite the advantages of laparoscopic colon surgery, the need for an incision in the abdominal wall to remove the surgical specimen is a morbidity factor. The objective of this article is to introduce transvaginal specimen extraction after laparoscopic colectomy, in order to avoid an abdominal incision.
METHODS: Between 2008 and 2011, 21 selected women with benign and malignant colorectal pathologies underwent laparoscopic colectomy and the extraction of the surgical specimen was done through a transvaginal access route. Of these patients, 12 had symptomatic diverticular disease, four had rectal villous adenomas, two had severe chronic constipation, and three had adenocarcinomas. We describe the surgical technique and the short-term outcomes related to the transvaginal specimen extraction.
RESULTS: The procedure was successful in all cases. There were no immediate complications or mortality. At follow-up, between 2 and 34 months, there were no functional disorders associated with the transvaginal specimen extraction.
CONCLUSION: Specimen removal of laparoscopic colectomies via the transvaginal route avoids the abdominal wall incision and its potential complications. It is feasible, safe, and simple to perform, with no additional costs, and provides excellent cosmetic results.},
}
@article {pmid22366394,
year = {2012},
author = {Harries, RL and Twine, CP and Kugathasan, G and Young, H and Jones, E and Gomez, KF},
title = {Prognostic factors for survival following emergency Hartmann's procedure.},
journal = {Postgraduate medical journal},
volume = {88},
number = {1038},
pages = {205-209},
doi = {10.1136/postgradmedj-2011-130412},
pmid = {22366394},
issn = {1469-0756},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Colorectal Surgery/*methods/*mortality ; Emergency Treatment ; Female ; Hemoglobins/*adverse effects ; Humans ; Male ; Middle Aged ; Peritonitis/*surgery ; Retrospective Studies ; Treatment Outcome ; },
abstract = {INTRODUCTION: Patients presenting with peritonitis require rapid treatment initiation including laparotomy. In the older population, this often leads to Hartmann's procedure being performed. The decision to perform surgery may be a difficult, multidisciplinary decision balancing premorbid comorbidity and quality of life with knowledge of the postoperative outcome. However, the evidence for survival outcome of emergency surgery based on age is lacking. The aim of this study was therefore to assess the survival implication of age and other prognostic factors on the outcome after Hartmann's procedure.
METHODS: A retrospective review of prospectively collected data of all patients undergoing emergency (National Confidential Enquiry into Patient Outcome and Death category 1-3) Hartmann's procedure in one NHS Health Board over a 5-year period.
RESULTS: 129 patients underwent Hartmann's procedure between November 2004 and November 2009. The largest group, 61 patients (47.3%) had the procedure performed for perforated sigmoid diverticular disease. When examined at 5-year stratifications around the median, the most significant survival difference was seen at the age of 75 years (log rank χ(2) 11.246, p=0.001). Patients over 75 years had median survival significantly lower than those aged <75 years (p<0.001). However, Cox regression analysis showed that preoperative American Society of Anesthesiologists (ASA) status and haemoglobin were more significant independent predictors of mortality than this age strata (p=0.001 and 0.045 vs 0.660, respectively), adjusting for diagnosis.
DISCUSSION: ASA grade and common blood abnormalities were more predictive of mortality after Hartmann's procedure than the most significant age stratification. Furthermore, age was not independently associated with survival. It would therefore be unreasonable to refuse Hartmann's procedure based on an age alone.},
}
@article {pmid22362232,
year = {2012},
author = {Moretti, A and Spagnolo, A and Mangone, M and Chiesara, F and Aratari, A and Papi, C and Koch, M},
title = {[Role of rifaximin in the treatment of colonic diverticular disease].},
journal = {La Clinica terapeutica},
volume = {163},
number = {1},
pages = {33-38},
pmid = {22362232},
issn = {1972-6007},
mesh = {Asymptomatic Diseases ; Clinical Trials as Topic ; Dietary Fiber/administration & dosage/therapeutic use ; Diverticulitis, Colonic/*prevention & control ; Diverticulum, Colon/*drug therapy ; Double-Blind Method ; Drug Therapy, Combination ; Humans ; Mannans/administration & dosage/therapeutic use ; Multicenter Studies as Topic ; Pilot Projects ; Randomized Controlled Trials as Topic ; Rifamycins/administration & dosage/*therapeutic use ; Rifaximin ; Treatment Outcome ; },
abstract = {Diverticular disease of the colon is the fifth most important gastrointestinal disease in terms of direct and indirect healthcare costs in western countries. Although most patients with colonic diverticula remain asymptomatic for their whole life, in 20-25% of cases will develop symptoms. Antibiotics are commonly used in the treatment of inflammatory complication of diverticular disease. Several clinical observation suggest a role of rifaximin in the management of symptomatic uncomplicated diverticular disease of the colon. This is a critical review of clinical studies addressing the role of long term administration of rifaximin for the treatment of symptomatic colonic diverticular disease. The evidence from prospective controlled trials suggests that rifaximin is effective for obtaining symptomatic relief in patients with uncomplicated diverticular disease. The therapeutic gain compared with fiber supplementation only is approximately 30%. No definitive conclusion can be drawn regard a possible role of rifaximin for preventing diverticulitis.},
}
@article {pmid22356208,
year = {2012},
author = {Ince, M and Stocchi, L and Khomvilai, S and Kwon, DS and Hammel, JP and Kiran, RP},
title = {Morbidity and mortality of the Hartmann procedure for diverticular disease over 18 years in a single institution.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {8},
pages = {e492-8},
doi = {10.1111/j.1463-1318.2012.03004.x},
pmid = {22356208},
issn = {1463-1318},
mesh = {Aged ; Digestive System Surgical Procedures/*methods/mortality ; Diverticulitis, Colonic/complications/mortality/*surgery ; Female ; Humans ; Intestinal Perforation/etiology/mortality/*surgery ; Length of Stay/statistics & numerical data ; Logistic Models ; Male ; Postoperative Complications/mortality ; Risk Factors ; Treatment Outcome ; },
abstract = {AIM: Hartmann's procedure for perforated diverticulitis is associated with substantial morbidity and mortality. This study analyses factors associated with morbidity/mortality and possible changes over time.
METHOD: Patients treated by urgent Hartmann's procedure for perforated diverticulitis between 1992 and 2010 were studied, and information was collected on age, sex, perioperative details, 30-day morbidity and mortality recorded in an institutional review board approved database supplemented by chart review. Patients were divided into four groups based on the year of surgery. Univariate and multivariate logistic regression analysis was performed to identify risk factors associated with morbidity and mortality.
RESULTS: In all, 199 patients (51% female, mean age 65 years, mean body mass index 28 kg/m(2)) were identified. The American Society of Anesthesiologists (ASA) score was 4 in 30% of patients and Hinchey Stage IV in 16%. The mean length of stay was 12.5 ± 10 days. Mortality was 15% and did not change significantly over time. Overall morbidity was 52% and significantly increased over time on univariate analysis (P = 0.007) but not on multivariate analysis (P = 0.11). Independent predictors of morbidity on multivariate analysis were Hinchey IV (P < 0.001) and hypoproteinaemia (P = 0.001). Independent predictors for mortality were ASA > 3 (P = 0.01), abnormal creatinine (P = 0.007), steroid use (P = 0.007), Hinchey IV (P = 0.032), low albumin (P < 0.001) and low body mass index (P = 0.001).
CONCLUSION: Mortality after Hartmann's procedure for perforated diverticulitis has not decreased during the last 18 years. Morbidity has actually increased over time although this is related to increased disease severity and comorbidity. Future efforts should focus on the identification of patient subgroups benefiting from earlier elective surgery and alternative surgical approaches when perforated diverticulitis does occur.},
}
@article {pmid22352246,
year = {2012},
author = {Stiefelhagen, P},
title = {[Therapy of diverticular disease: from spasmolytic drug to colon resection].},
journal = {MMW Fortschritte der Medizin},
volume = {154},
number = {2},
pages = {28},
doi = {10.1007/s15006-012-0088-1},
pmid = {22352246},
issn = {1438-3276},
mesh = {*Colectomy ; Colonoscopy ; Diverticulitis, Colonic/diagnosis/*therapy ; Diverticulosis, Colonic/diagnosis/*therapy ; Humans ; Parasympatholytics/*therapeutic use ; Secondary Prevention ; Tomography, X-Ray Computed ; Ultrasonography ; },
}
@article {pmid22350172,
year = {2012},
author = {Holroyd, DJ and Banerjee, S and Beavan, M and Prentice, R and Vijay, V and Warren, SJ},
title = {Colovaginal and colovesical fistulae: the diagnostic paradigm.},
journal = {Techniques in coloproctology},
volume = {16},
number = {2},
pages = {119-126},
pmid = {22350172},
issn = {1128-045X},
mesh = {Aged ; Aged, 80 and over ; Algorithms ; Colonic Diseases/*diagnosis ; Colonoscopy ; Colorectal Neoplasms/*complications ; Crohn Disease/complications ; Cystoscopy ; Diverticulitis, Colonic/complications ; Female ; Genital Neoplasms, Female/*complications ; Humans ; Intestinal Fistula/*diagnosis/etiology/therapy ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Urinary Bladder Fistula/*diagnosis/etiology/therapy ; Vaginal Fistula/*diagnosis/etiology/therapy ; },
abstract = {BACKGROUND: Colovaginal and colovesical fistulae (CVF) are relatively uncommon conditions, most frequently resulting from diverticular disease or colorectal cancer. A high suspicion of a CVF can usually be obtained from an accurate clinical history. Demonstrating CVF radiologically is often challenging, and patients frequently undergo a multitude of investigations prior to definitive management. The aim of this study was to develop an algorithm for the investigation of suspected CVF in order to improve diagnosis and subsequent management.
METHODS: Thirty-seven patients from a single NHS Trust with a diagnosis of colovaginal or colovesical fistula were included in the study. Clinical records and imaging were reviewed retrospectively, and data on demographics, symptoms, investigations, management and outcome were collated.
RESULTS: A total of 87.5% patients with a colovesical fistula presented with pathognomic symptoms of faecaluria or pneumaturia. The commonest aetiologies were diverticular disease (72.9%), colonic and gynaecological neoplasia (10.8% each). Computerised tomography (CT) was the most frequently performed investigation (91.9%) and was most sensitive in detecting the fistula (76.5%) and underlying aetiology (94.1%). Colonoscopy was most sensitive in detecting an underlying colonic malignancy (100%). Resectional surgery was performed in 62.1% of cases, although morbidity and 1-year mortality was significant, with rates of 21.7 and 17.4%, respectively.
CONCLUSIONS: The diagnosis of CVF is predominately a clinical one, and patients with a suspected CVF are over-investigated. Investigations should be focused on determining aetiology rather than demonstrating the fistulous tract itself. We propose that, in the majority of cases, CT and lower gastrointestinal endoscopy should suffice.},
}
@article {pmid22348525,
year = {2012},
author = {Lee, JC and Bringmann, I and Aly, A},
title = {Asymptomatic splenic infarct and retroperitoneal sepsis in patient with Wegener's granulomatosis.},
journal = {International journal of surgery case reports},
volume = {3},
number = {4},
pages = {137-138},
pmid = {22348525},
issn = {2210-2612},
abstract = {INTRODUCTION: We present a patient with an unusual combination of surgical findings, complicated by both a medical condition and the treatment there of.
PRESENTATION OF CASE: A 52 year-old man with Wegener's granulomatosis presented with groin pain and sepsis while on immunosuppressive therapy. Large retroperitoneal abscesses were found on CT scanning, together with a collapsed left lower lobe of the lung, a complete infarct of the spleen, and evidence of diverticulosis. At the exploratory laparotomy, the infarcted spleen was removed and the retroperitoneal abscesses were drained via a separate lateral incision. Uncomplicated diverticular disease were also confirmed.
DISCUSSION: The left lower lobe collapse, infarcted spleen and diverticular disease were all potential sources of the sepsis, but none of them could be clearly linked to the abscesses. The splenic infarct and a post-operative myocardial infarct were likely related to his vasculitic disease.
CONCLUSION: Patients with systemic vasculitis may present with unusual pathologies, and immunosuppressive treatment may also modify clinical presentation.},
}
@article {pmid22344548,
year = {2012},
author = {Klotz, U},
title = {The pharmacological profile and clinical use of mesalazine (5-aminosalicylic acid).},
journal = {Arzneimittel-Forschung},
volume = {62},
number = {2},
pages = {53-58},
doi = {10.1055/s-0031-1299685},
pmid = {22344548},
issn = {0004-4172},
mesh = {Animals ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/adverse effects/*pharmacology/*therapeutic use ; Colorectal Neoplasms/drug therapy/prevention & control ; Crohn Disease/drug therapy ; Drug Delivery Systems ; Humans ; Inflammatory Bowel Diseases/*drug therapy ; Irritable Bowel Syndrome/drug therapy ; Mesalamine/administration & dosage/adverse effects/*pharmacology/*therapeutic use ; Meta-Analysis as Topic ; Randomized Controlled Trials as Topic ; },
abstract = {For more than 30 years mesalazine (5-aminosalicylic acid; 5-ASA) has been used for the treatment of chronic inflammatory bowel disease (IBD) especially in ulcerative colitis (UC). During this time various rectal and oral formulations have been developed. The modified drug delivery systems were designed to release sufficient 5-ASA at the sites of inflammation. Such a drug targeting strategy is needed for its topical action and especially because local concentrations in the mucosa will determine the clinical outcome. The absorbed part (20-40% of the dose) of 5-ASA is rapidly and presystemically acetylated (t1/2: 1-2.5 h; CL: 300-690 mL/min). Consequently, the systemic exposure of 5-ASA is low and adverse effects are in the range of placebo treatment. The polypotent 5-ASA has a wide spectrum of pharmacological properties and its exact mode of action is not yet clear. Recent meta-analyses of randomized placebo-controlled clinical trials provide convincing data that 5-ASA is the preferred first-line therapy for the acute treatment of mild-to-moderate UC (NNT:6) and for remission management (NNT:4). There is also some clinical benefit for patients with active Crohn's disease (NNT:7) and in the prevention of postsurgical relapse (NNT:10). There is increasing evidence that 5-ASA also has some therapeutic potential for chemoprevention of colorectal cancer, diverticular disease and irritable bowel syndrome. In all clinical studies, the side effects of 5-ASA were very low (5-10%), mild and comparable to placebo. Thus, its use is very safe and 5-ASA will remain an interesting and valuable agent. It is anticipated that more selective drug targeting, including galenic innovations and an optimized dosaging schedule, could result in some improvement of the wide use of 5-ASA.},
}
@article {pmid22329283,
year = {2011},
author = {Dolejsí, M},
title = {[New knowledge on the diverticular disease of colon].},
journal = {Casopis lekaru ceskych},
volume = {150},
number = {12},
pages = {651-655},
pmid = {22329283},
issn = {0008-7335},
mesh = {*Diverticulum, Colon/complications/diagnosis/therapy ; Humans ; },
abstract = {The article is a summary paper aimed at new knowledge, concerning the classification, diagnostics, medication and endoscopic treatment of diverticular disease of colon. Briefly mentioned are the issues of functional disorder in the field of diverticulosis--symptomatic uncomplicated diverticular disease of colon. Diverticular bleeding is explained in terms of its pathogenesis and diagnostics. The problem with estimation the ration of diverticular bleedings in the total number of bleedings into the lower digestive tract is caused by diverse criteria for selecting patients and two levels of diagnostic of diverticular bleeding (definite and presumptive). Attention is paid also to diverticular colitis. Synonyms, endoscopic and histological classification are listed. The main endoscopic findings represent areas of erythema, which are visible on the mucosa between diverticula. Diverticulitis is seen as the most significant complication and the diagnostics of diverticulitis is discussed in detail. The first recommended step in the diagnosis is an urgent abdominal ultrasound; the gold standard is a CT examination of the abdomen, in special situations, some other imaging methods should be used: MRI, colonoscopy. The article ends with an overview of modern therapeutic options in the treatment of diverticular colitis and diverticulitis, particularly the use of antibiotics, probiotics, mesalasine and antispasmodics. Negative effect of NSAIDs on the course of diverticulitis and induction diverticular bleeding is listed.},
}
@article {pmid22321525,
year = {2012},
author = {Pendlimari, R and Cima, RR and Wolff, BG and Pemberton, JH and Huebner, M},
title = {Diagnoses influence surgical site infections (SSI) in colorectal surgery: a must consideration for SSI reporting programs?.},
journal = {Journal of the American College of Surgeons},
volume = {214},
number = {4},
pages = {574-80; discussion 580-1},
doi = {10.1016/j.jamcollsurg.2011.12.023},
pmid = {22321525},
issn = {1879-1190},
mesh = {Colon/*surgery ; Colonic Diseases/diagnosis/*surgery ; Colorectal Surgery/standards ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Quality Assurance, Health Care ; Quality Improvement ; Rectal Diseases/diagnosis/*surgery ; Rectum/*surgery ; Retrospective Studies ; Risk Adjustment ; Surgical Wound Infection/epidemiology/*etiology ; },
abstract = {BACKGROUND: Colorectal surgery is associated with high rates of surgical site infection (SSI). The National Surgery Quality Improvement Program is a validated, risk-adjusted quality-improvement program for surgical patients. Patient stratification and risk adjustment are associated with Current Procedural Terminology codes and primary disease diagnosis is not considered. Our aim was to determine the association between disease diagnosis and SSI rates.
METHODS: Data from all 2009 National Surgery Quality Improvement Program institutions were analyzed. ICD-9 codes were used to differentiate patients into cancer (colon or rectal), ulcerative colitis, regional enteritis, diverticular disease, and others. Diagnosis-specific SSI rates were compared with benign neoplasm, which had the lowest rate (8.9%). Logistic regression was performed adjusting for age, body mass index, American Society of Anesthesiologists classification, wound type, and relative value unit.
RESULTS: There were 24,673 colorectal procedures, with 1,956 superficial incisional (SSSI), 398 deep incisional (DSSI), and 1,096 organ/space (O/SSSI) infections. Odds ratio (OR) and 95% confidence intervals compared with benign neoplasm diagnosis were computed after adjustment for each diagnosis category. In rectal cancer patients, significantly more SSSI (OR = 1.6; 95% CI, 1.3-2.1; p < 0.0001), DSSI (OR = 2.1; 95% CI, 1.3-3.7; p = 0.006), and O/SSSI (OR = 2.2; 95% CI, 1.6-3.0; p < 0.0001) developed. In diverticular patients, more SSSI (OR = 1.6; 95% CI, 1.3-2.0; p < 0.0001), but not DSSI or O/SSSI, developed. In ulcerative colitis patients, more DSSI (OR = 2.4; 95% CI, 1.2-4.9; p = 0.01), O/SSSI (OR = 2.1; 95% CI, 1.4-3.1; p = 0.0004), but fewer SSSIs, developed.
CONCLUSIONS: We found that SSI type is associated with the underlying disease diagnosis. To facilitate colorectal SSI-reduction efforts, the disease process must be considered to design appropriate interventions. In addition, institutional comparisons based on aggregate or stratified SSI rates can be misleading if the colorectal disease mix is not considered.},
}
@article {pmid22299325,
year = {2011},
author = {Herzog, T and Janot, M and Belyaev, O and Sülberg, D and Chromik, AM and Bergmann, U and Mueller, CA and Uhl, W},
title = {Complicated sigmoid diverticulitis--Hartmann's procedure or primary anastomosis?.},
journal = {Acta chirurgica Belgica},
volume = {111},
number = {6},
pages = {378-383},
doi = {10.1080/00015458.2011.11680777},
pmid = {22299325},
issn = {0001-5458},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; *Colostomy/adverse effects ; Digestive System Surgical Procedures/adverse effects/methods ; Diverticulitis/mortality/surgery ; Diverticulitis, Colonic/*mortality/*surgery ; Emergencies ; Female ; Follow-Up Studies ; Humans ; *Ileostomy/adverse effects ; Intestinal Perforation/complications/etiology/surgery ; Length of Stay ; Male ; Middle Aged ; Peritonitis/complications/etiology/surgery ; Reoperation ; Retrospective Studies ; Risk Factors ; Sigmoid Diseases/*surgery ; Survival Analysis ; Treatment Outcome ; },
abstract = {INTRODUCTION: Diverticular disease of the colon is a common condition in developed countries. For perforated diverticulitis Hartmann's procedure is a safe and quick treatment option. But intestinal restoration needs further interventions. This leads to high complication rates and cost. Therefore a critical evaluation of surgical treatment options is necessary.
METHODS: During a period of 18 months 88 patients underwent surgical resection for diverticulitis. Forty patients had emergency surgery. Among those a primary anastomosis was performed in 21 patients. The other 19 patients had interval colostomy. Among 21 patients with primary anastomosis major complications occurred in two patients, vs. twelve in patients with Hartmann's operation (p = 0.03). In the Hartmann group eight patients had major general complications, vs. one patient in the group with primary anastomosis (p = 0.06). The mean hospital stay was 38 days after Hartmann's procedure, vs. 13 days for patients with primary anastomosis (p < 0.01).
CONCLUSION: In emergency surgery for complicated diverticulitis primary anastomosis is not associated with an increased postoperative morbidity. A primary anastomosis reduces the need for further surgical interventions and complex re-operations. Thus, an overall reduction of morbidity, cost, complication rate and hospital stay is possible. Therefore this technique is advantageous for patients and hospitals.},
}
@article {pmid22296924,
year = {2012},
author = {Lakatos, L and Lakatos, PL},
title = {[Colonic diverticular disease: diagnosis and therapy].},
journal = {Orvosi hetilap},
volume = {153},
number = {6},
pages = {205-213},
doi = {10.1556/OH.2012.29311},
pmid = {22296924},
issn = {0030-6002},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents/therapeutic use ; Colonoscopy ; Diverticulitis, Colonic/diagnosis/therapy ; Diverticulosis, Colonic/complications/*diagnosis/drug therapy/epidemiology/pathology/surgery/*therapy ; Gastrointestinal Agents/therapeutic use ; Gastrointestinal Hemorrhage/etiology ; Humans ; Probiotics/therapeutic use ; },
abstract = {Colonic diverticular disease is one of the most common gastrointestinal disorders in the Western world, affecting approximately 50% of the population above the age of 70 years. Symptoms develop only in about one quarter of the affected individuals with complications in one-third of the symptomatic patients. Diagnosis is mostly confirmed by colonoscopy. Abdominal CT is the most sensitive for the diagnosis of complicated severe diverticulitis, while colonoscopy or in severe cases angiography may be performed in bleeding patients. Initial therapy of non-complicated symptomatic diverticulitis includes antibiotics and more recently non-absorbable antibiotics. In complicated cases should be treated with broad spectrum i.v. antibiotics, however surgery may became necessary in a minority of the cases. The proportion of patients needing acute surgical intervention has decreased in the last decades with the advancement of conservative management including medical therapy, endoscopy and imaging techniques and the indication of elective was also changed.},
}
@article {pmid22276853,
year = {2012},
author = {Humes, DJ and Simpson, J and Smith, J and Sutton, P and Zaitoun, A and Bush, D and Bennett, A and Scholefield, JH and Spiller, RC},
title = {Visceral hypersensitivity in symptomatic diverticular disease and the role of neuropeptides and low grade inflammation.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {24},
number = {4},
pages = {318-e163},
doi = {10.1111/j.1365-2982.2011.01863.x},
pmid = {22276853},
issn = {1365-2982},
mesh = {Abdominal Pain/*etiology/metabolism/pathology ; Aged ; Diverticulitis, Colonic/*complications/metabolism/pathology ; Diverticulosis, Colonic/*complications/metabolism/pathology ; Female ; Humans ; Hyperesthesia/etiology/metabolism/pathology ; Inflammation/complications/metabolism/pathology ; Male ; Middle Aged ; Neuropeptides/*biosynthesis ; Pain Threshold/physiology ; RNA, Messenger/analysis ; Real-Time Polymerase Chain Reaction ; Receptors, Neuropeptide/biosynthesis ; Reverse Transcriptase Polymerase Chain Reaction ; Viscera/metabolism/pathology ; },
abstract = {BACKGROUND: Recurrent abdominal pain is reported by a third of patients with diverticulosis, particularly those with previous episodes of acute diverticulitis. The current understanding of the etiology of this pain is poor. Our aim was to assess visceral sensitivity in patients with diverticular disease and its association with markers of previous inflammation and neuropeptides.
METHODS: Patients with asymptomatic and symptomatic diverticular disease underwent a flexible sigmoidoscopy and biopsy followed 5-10 days later by visceral sensitivity testing with barostat-mediated rectal distension. Inflammation was assessed by staining of serotonin (5HT) and CD3 positive cells. mRNA levels of tumor necrosis factor alpha (TNF α) and interleukin-6 (IL-6) were quantitated using RT-PCR. Neuropeptide expression was assessed from percentage area staining with substance P (SP) and mRNA levels of the neurokinin 1 & 2 receptors (NK1 & NK2), and galanin 1 receptor (GALR1).
KEY RESULTS: Thirteen asymptomatic and 12 symptomatic patients were recruited. The symptomatic patients had a lower first reported threshold to pain (28.4 mmHg i.q.r 25.0-36.0) than the asymptomatic patients (47 mmHg i.q.r 36.0-52.5, P < 0.001). Symptomatic patients had a higher median overall pain rating for the stimuli than the asymptomatic patients (P < 0.02). Symptomatic patients had greater median relative expression of NK1 and TNF alpha mRNA compared with asymptomatic patients. There was a significant correlation between barostat VAS pain scores and NK 1 expression (Figure 4, r(2) 0.54, P < 0.02).
CONCLUSIONS & INFERENCES: Patients with symptomatic diverticular disease exhibit visceral hypersensitivity, and this may be mediated by ongoing low grade inflammation and upregulation of tachykinins.},
}
@article {pmid22272476,
year = {2011},
author = {Adamová, Z},
title = {[Diverticular disease of colon].},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {90},
number = {8},
pages = {463-477},
pmid = {22272476},
issn = {0035-9351},
mesh = {*Diverticulosis, Colonic/diagnosis/physiopathology/therapy ; Humans ; },
abstract = {Diverticular disease of the colon is one from the most common diseases, especially in the Western world. This disease is symptomatic in only 20-30% patients, but it could be the cause of considerable morbidity and mortality. Pathogenesis is not entirely known. Presumably there are more causing factors - intestinal dysmotility, that is induced by abnormal regulation, structural changes of the colonic wall, genetic factors, diet. The aim of this article is to review the state of our nowadays knowledge in pathogenesis, symptomatology, diagnostic methods and treatment.},
}
@article {pmid22261623,
year = {2012},
author = {Cadili, A and Birch, D},
title = {Colovesical fistula secondary to diverticular disease.},
journal = {The American journal of the medical sciences},
volume = {343},
number = {4},
pages = {320},
doi = {10.1097/MAJ.0b013e31823e66c4},
pmid = {22261623},
issn = {1538-2990},
mesh = {Aged ; Diverticulitis, Colonic/*complications/*diagnosis ; Humans ; Intestinal Fistula/*diagnosis/*etiology ; Male ; },
}
@article {pmid22252183,
year = {2012},
author = {Tan, WS and Lim, JF and Tang, CL and Eu, KW},
title = {Reversal of Hartmann's procedure: experience in an Asian population.},
journal = {Singapore medical journal},
volume = {53},
number = {1},
pages = {46-51},
pmid = {22252183},
issn = {2737-5935},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Asian People ; Carcinoma/ethnology/*surgery ; Colon, Sigmoid/surgery ; Colorectal Neoplasms/ethnology/*surgery ; Female ; Humans ; Intestinal Diseases/ethnology/*surgery ; Laparoscopy/*methods ; Male ; Middle Aged ; Rectum/surgery ; Reoperation ; Reproducibility of Results ; Retrospective Studies ; Singapore ; Treatment Outcome ; },
abstract = {INTRODUCTION: With improvements in surgical techniques, instrumentation and perioperative care, Hartmann's procedure is now less frequently performed. Restoration of intestinal continuity after Hartmann's procedure has traditionally been viewed to be technically demanding and associated with significant morbidity and mortality. This is a study of outcomes after the reversal of Hartmann's procedure in an Asian population.
METHODS: A prospectively collected database showed that 255 patients had undergone Hartmann's procedure from October 1989 to October 2005. Patients who subsequently underwent Hartmann's reversal were identified and their records reviewed retrospectively.
RESULTS: Hartmann's reversal was attempted in 49 patients. The most common indication for Hartmann's procedure was colorectal carcinoma (49.0%). The median interval between resection and reversal was 23 weeks. Reversal was successful in 46 (93.9%) patients, with 79.6% experiencing no intraoperative complications. Failure of reversal was significantly associated with prior radiotherapy to the pelvis (p-value = 0.007). Anastomotic leak rates and re-bleeding rates were both 0.0%. 79.6% of patients made an uneventful recovery with no postoperative complications. There was no significant increase in the complication rate in older patients or patients with higher American Society of Anesthesiologists status. The overall incidence of 30-day morbidity and mortality was 20.4% and 0.0%, respectively.
CONCLUSION: In our population, Hartmann's procedure is more commonly performed for colorectal cancer rather than for diverticular disease, resulting in lower rates of stoma reversal. Hartmann's reversal could be performed with acceptable morbidity and minimal mortality, although prior radiotherapy and shorter rectal stump may pose challenges during reversal surgery.},
}
@article {pmid24960767,
year = {2012},
author = {Sayed, L and Mann, C and Ihedioha, U and Ratliff, D},
title = {Jejunal diverticulitis in a child.},
journal = {Journal of surgical case reports},
volume = {2012},
number = {8},
pages = {9},
pmid = {24960767},
issn = {2042-8812},
abstract = {Jejunal diverticular disease is rare and few cases have been documented in the literature. Here we report the first case of a child presenting with a perforated congenital jejunal diverticulum.},
}
@article {pmid22207389,
year = {2012},
author = {Petersen, S and Schwenk, W},
title = {Laparoscopic assisted sigmoid resection for diverticular disease.},
journal = {Langenbeck's archives of surgery},
volume = {397},
number = {3},
pages = {487-490},
pmid = {22207389},
issn = {1435-2451},
mesh = {Anastomosis, Surgical ; Colectomy/*methods ; Colon, Sigmoid/*surgery ; Diverticulosis, Colonic/*surgery ; Humans ; Laparoscopy/*methods ; Laparotomy ; Mesenteric Artery, Inferior/surgery ; Postoperative Care ; Surgical Stapling/methods ; },
abstract = {PURPOSE: Laparoscopic assisted sigmoid resection (LASR) has become a widely accepted procedure in colorectal surgery. In the last decade, numerous variations of surgical details have been established. In order to demonstrate a feasible technique, this video is provided.
METHODS: LASR is performed using four ports. The first port is inserted via open access by a minilaparotomy in the right paraumbilical region. Two ports are sited in the right lower abdomen, including one 12-mm port in the following incision above the pubic symphysis. The forth port is inserted in the left upper abdomen. The procedure starts with the removal of adhesions, the peritoneal incision is performed medially, and a medial to lateral approach to the mesocolon and the inferior mesenteric artery (IMA) is carried out. After identifying the left ureter, the IMA is either clipped or sealed about 1.5 to 2 cm from the origin in order to preserve the autonomous plexus. Then dissection is continued on Gerota's fascia. After lifting the rectosigmoid, dissection is continued in the avascular plane until the mesentery of the upper rectum is mobilized. Then the remaining lateral adhesions are dissected with preservation of the gonadal vessels and the left ureter. The distal resection line is always in the upper rectum, which is easily identified by the lack of tenia. After sealing the mesorectum, the rectum is dissected using a linear stapler. Thereafter, a minilaparotomy above the pubic symphysis is performed and a device for protection and retraction of the wound is inserted. Dissection of the mesosigmoid and the descending colon is carried out extracorporally. The anvil of a circular stapling device is inserted in the descending colon, which is then returned into the peritoneal cavity. Running sutures closes the incision, and the anastomosis is carried out laparoscopically in a "double stapling" technique.
CONCLUSION: The video describes the efficacy and technical feasibility of laparoscopic surgery for diverticular disease and demonstrates its effect regarding perioperative morbidity and functional outcome.},
}
@article {pmid22200793,
year = {2012},
author = {Pasternak, I and Wiedemann, N and Basilicata, G and Melcher, GA},
title = {Gastrointestinal quality of life after laparoscopic-assisted sigmoidectomy for diverticular disease.},
journal = {International journal of colorectal disease},
volume = {27},
number = {6},
pages = {781-787},
pmid = {22200793},
issn = {1432-1262},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon, Sigmoid/*surgery ; Digestive System Surgical Procedures/adverse effects/*methods ; Diverticulitis/*surgery ; Female ; Follow-Up Studies ; Humans ; *Laparoscopy/adverse effects ; Male ; Middle Aged ; Postoperative Complications/etiology ; *Quality of Life ; },
abstract = {PURPOSE: Laparoscopic-assisted sigmoidectomy is a widely applied technique in the operative treatment of diverticular disease. Treatment guidelines recommend operation of complicated diverticulitis and after recurrent attacks of uncomplicated diverticulitis. These guidelines have become subject to controversy. The objective of this study was to assess disease-related quality of life after laparoscopic sigmoidectomy.
METHODS: Data were collected retrospectively. Patients filled in a form describing their quality of life. All patients undergoing elective operation for diverticular disease between 1999 and 2006 at the Department of Surgery of the Uster Hospital, a regional medical center in Switzerland were included. The measurement tool we used is the Gastrointestinal Quality of Life Index (GIQLI). Wilcoxon-Mann-Whitney test or unpaired t-tests were applied to determine statistical significance of differences observed.
RESULTS: A total of 130 patients were included and 120 questionnaires were available for analysis. Mean follow-up was 40 months. Of the total, 48% reported a GIQLI >100 before the operation, which rose to 83% after the operation (p < 0.0001). Mean GIQLI was 95 before and 114 after the operation (p < 0.0001). Female patients reported lower GIQLI rates. Overall, 96% were satisfied with the operation.
CONCLUSIONS: The results in this study population show that in a majority of patients who underwent elective laparoscopic-assisted sigmoidectomy for recurrent diverticulitis gastrointestinal quality of life improved with the operation.},
}
@article {pmid22188955,
year = {2011},
author = {Ramírez-Miranda, ME and Jiménez-González, DE and Rodríguez-Campa, ME and González-Angulo, A and Hernández-Castellanos, R and Sara Arroyo-Escalante, A and Romero-Valdovinos, M and Martínez-Hernández, F and Flisser, A and Maravilla, P},
title = {[Irritable bowel syndrome: frequency and phylogenetic relationship of Blastocystis sp. from Mexican patients].},
journal = {Revista de gastroenterologia de Mexico},
volume = {76},
number = {4},
pages = {309-315},
pmid = {22188955},
issn = {0375-0906},
mesh = {Blastocystis/*classification/genetics/*isolation & purification ; Female ; Humans ; Irritable Bowel Syndrome/*parasitology ; Male ; Mexico ; Middle Aged ; Phylogeny ; },
abstract = {INTRODUCTION: Recent studies reported increased presence of Blastocystis in patients with Irritable Bowel Syndrome (IBS) and an etiologic role has been proposed. The pathogenic role of Blastocystis is controversial, because it is frequently found not only in individuals with enteric symptoms but also in healthy and asymptomatic subjects. Furthermore, there are few studies of blastocistosis in Mexico.
OBJECTIVE: To assess the frequency of Blastocystis sp. in IBS patients using molecular techniques and to describe its phylogenetic relationship with sequences of other countries.
METHODS: IBS patients according to Rome III criteria were enrolled. In all patients evaluations included: colonoscopies, coproparasitoscopic studies, coproculture, fecal virus screening. PCR and sequencing for Blastocystis sp. were also performed.
RESULTS: We recruited 11 men and 51 women with a mean age of 45.6 (SD ± 15.7) years. Eighty-six percent of the IBS patients presented a normal colonoscopy, 8% showed polyps and 6% diverticular disease. Blastocystis sp. was identified in 25% patients (all of them with normal colonoscopy), while two patients had Endolimax nana and Entamoeba histolytica/E. dispar, respectively. Phylogenetic analysis showed that major sequences of Mexican carriers clustered together with sequences of parasites from Japan and Denmark; furthermore, two sequences from IBS patients were grouped in a single cluster.
CONCLUSIONS: Blastocystis sp. was identified in 25% of the IBS patients. Our data support the hypothesis of clonal lineages in distinct geographical areas in the world.},
}
@article {pmid22182066,
year = {2012},
author = {Royds, J and O'Riordan, JM and Eguare, E and O'Riordan, D and Neary, PC},
title = {Laparoscopic surgery for complicated diverticular disease: a single-centre experience.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {10},
pages = {1248-1254},
doi = {10.1111/j.1463-1318.2011.02924.x},
pmid = {22182066},
issn = {1463-1318},
mesh = {Aged ; Anastomosis, Surgical ; *Colectomy ; Colon/*surgery ; Conversion to Open Surgery/statistics & numerical data ; Diverticulitis, Colonic/complications/*surgery ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures ; Female ; Humans ; *Laparoscopy ; Length of Stay/statistics & numerical data ; Male ; Medical Audit ; Middle Aged ; Postoperative Complications/epidemiology ; Practice Guidelines as Topic ; Rectum/*surgery ; Retrospective Studies ; Treatment Outcome ; },
abstract = {AIM: The role of laparoscopic surgery in the management of patients with diverticular disease is still not universally accepted. The aim of our study was to evaluate the results of laparoscopic surgery for diverticular disease in a centre with a specialist interest in minimally invasive surgery.
METHOD: All diverticular resections carried out between 2006 and 2010 were reviewed. Data recorded included baseline demographics, indication for surgery, operative details, length of hospital stay and complications. Complicated diverticular disease was defined as diverticulitis with associated abscess, phlegmon, fistula, stricture, obstruction, bleeding or perforation.
RESULTS: One hundred and two patients (58 men) who had surgery for diverticular disease were identified (median age 59 years, range 49-70 years). Sixty-four patients (64%) had surgery for complicated diverticular disease. The indications were recurrent acute diverticulitis (37%), colovesical fistula (21%), stricture formation (17%) and colonic perforation (16%). Sixty-nine cases (88%) were completed by elective laparoscopy. Postoperative mortality was 0%. For elective cases there was no difference in morbidity rates between patients with complicated and uncomplicated diverticular disease. The overall anastomotic leakage rate was 1% and the wound infection rate 7%. There was a nonsignificant trend to higher conversion to open surgery in the elective group in complicated (11.4%) compared with uncomplicated patients (5.2%) (P=0.67). Electively, the rate of stoma formation was higher in the complicated (31.6%) than the uncomplicated group (5.2%) (P<0.02).
CONCLUSION: Laparoscopic surgery for both complicated and uncomplicated diverticular disease is associated with low rates of postoperative morbidity and relatively low conversion rates. Laparoscopic surgery is now the standard of care for complicated and uncomplicated diverticular disease in our institution.},
}
@article {pmid22179921,
year = {2011},
author = {Houissa, F and Kchir, H and Bouzaidi, S and Salem, M and Debbeche, R and Trabelsi, S and Moussa, A and Said, Y and Najjar, T},
title = {Colonoscopy in elderly: feasibility, tolerance and indications: about 901 cases.},
journal = {La Tunisie medicale},
volume = {89},
number = {11},
pages = {848-852},
pmid = {22179921},
issn = {0041-4131},
mesh = {Adolescent ; Adult ; *Aged ; Aged, 80 and over ; Child ; Cohort Studies ; Colonoscopy/*adverse effects/*methods/*statistics & numerical data ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Pilot Projects ; Retrospective Studies ; Tunisia/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: Colonoscopy is the standard investigation for colonic disease, but clinicians often are reluctant to refer elderly patients for colonoscopy because of a perception of higher risk and a high rate of incomplete examinations.
AIMS: To evaluate feasibility and tolerance of this investigation in elderly and to review the most frequent indications of colonoscopy in these patients.
METHODS: A pilot retrospective study including 901 patients from January 2005 to December 2009; divided into two groups. Group (I) included patients 75 years old and more, group (II) included patients 45 years old or less. All those patients underwent colonoscopy at the gastroenterology department of Charles Nicole hospital.
RESULTS: The 1st group included 231 patients, and the 2nd group included 670 one. A past history of colorectal cancer was more frequent in the group I (33.3% versus 9.90%; p<0.05) however history of chronic inflammatory bowel disease was more frequent in group II (0 versus 40.6%; p<0.05). The main indication of colonoscopy was constipation in group II (6.1% versus 27%; p<0.05) and chronic diarrhoea in group I (42.9% versus 16.4%; p<0.05). Bowel preparation was poor in 30.4% cases of the group I and 12.9% of group II (p<0.05). The tolerance was similar in the two groups. The incomplete colonoscopy rate was higher in the group I (38.3% versus 23.4%; p<0.05). The most frequent cause of colonoscopy interruption was the poor preparation in group I and the bad tolerance in group II. Diverticular disease, polyps and colorectal cancers prevailed in group I, whereas inflammatory bowel disease was current in group II.
CONCLUSION: In elderly patients, colonoscopy is safe, well tolerated and offers a good diagnostic yield. Its non completion was essentially due to the poor preparation. Sedation did not seem essential. The optimisation of results of colonoscopy requires an improvement of quality preparation.},
}
@article {pmid22168077,
year = {2011},
author = {Li, IA and Lazebnik, LB},
title = {[Clinical variants post hemicolectomy syndrome].},
journal = {Eksperimental'naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology},
volume = {},
number = {6},
pages = {45-48},
pmid = {22168077},
issn = {1682-8658},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*adverse effects ; Female ; Humans ; Intestinal Diseases/*etiology/*pathology/*physiopathology ; Male ; Middle Aged ; Postoperative Complications/*pathology/*physiopathology ; Syndrome ; },
abstract = {UNLABELLED: Hemicolectomy (hemicolectomia) - the surgical removal of about half of colon, left or right half of the colon. The reasons, which can lead to surgery hemicolectomy are tumors of the colon, colon polyps, complicated diverticular disease, inflammatory bowel disease (Crohn's disease or ulcerative colitis). Intestine dysbiosis develops as a result of effects on the multiple risk factors (surgery, antibiotic therapy, reduced immune status, presence of inflammatory processes, stress, etc.) in patients with various diseases of the gastrointestinal tract. The aim of our work was to study peculiarities of clinical manifestations in patients after hemicolectomy depending on the location of colon resection.
RESULTS: We examined 365 patients who underwent surgery hemicolectomy. There were women and men the ages of 30 to 85 years, of which 151 patients after right-sided hemicolectomy and 214 patients after left-sided hemicolectomy. Right- sided post hemicolectomic syndrome clinically manifests itself as pain syndrome in parumbilpical area in 62.9% of patients, flatulence (68.9%), constipation (7.9%), diarrhea (3.9%), apetite decrease (16.5%) patients. Left- sided post hemicolectomic syndrome manifests asa pain in the right upper quadrant in 64.0% of patients with symptoms of bloating (81.8%), constipation (64.1%), diarrhea (31.3%) and appetite decrease (32.2%). Right- sided post hemicolectomic syndrome prognostically is more favorable than the left-sided post hemicolectomic syndrome.},
}
@article {pmid22156872,
year = {2012},
author = {Yeung, TM and Mortensen, NJ},
title = {Assessment of the quality of patient-orientated Internet information on surgery for diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {55},
number = {1},
pages = {85-89},
doi = {10.1097/DCR.0b013e3182351eec},
pmid = {22156872},
issn = {1530-0358},
mesh = {Consumer Health Information/*standards ; Diverticulitis, Colonic/*surgery ; Humans ; *Internet ; Postoperative Complications ; Risk ; Search Engine ; },
abstract = {BACKGROUND: The Internet is a vast resource available for patients to obtain health information.
OBJECTIVE: This study examines the quality of Web sites that provide information on diverticular disease, treatment options, and surgery.
DESIGN: Two search engines (Google and Yahoo) and the search terms "surgery and diverticular disease" and "surgery and diverticulitis" were used. The first 50 sites of each search were assessed. Sites that fulfilled the inclusion criteria were evaluated for content and scored by using the DISCERN instrument, which evaluates the quality of health information on treatment choices.
RESULTS: Two hundred sites were examined, of which 60 (30%) provided patient-orientated information. 50 sites (25%) were duplicated, 7 (3.5%) were links, 10 (5%) were advertisements, 14 (7%) were resources for clinicians, 9 (4.5%) were message forums, 27 (13.5%) were articles, and 15 (7.5%) were dead links. Of the 60 Web sites that provided patient information, only 10 (16.7%) had been updated within the past 2 years. Seventeen (28.3%) sites were affiliated with hospitals and clinics, but another 17 (28.3%) sites were associated with private companies with commercial interests. Although most Web sites contained information on symptoms, complications, investigations, and treatment options of diverticular disease, 20 (33.3%) did not describe any of the risks of surgery, and 45 (75%) did not provide information on the timescale of recovery postoperatively. Eighteen sites did not provide balanced information on treatment options; of these, 7 were biased toward medical treatment and 6 focused on laparoscopic surgery. Overall, only 22 (36.7%) were identified as being "good" or "excellent" with the use of the DISCERN criteria.
CONCLUSIONS: The quality of patient information on surgery for diverticular disease is highly variable, and Web sites that are sponsored by private companies may be biased in discussing treatment options. There is potential for the Internet to provide valuable information, and clinicians should guide patients to access high-quality Web sites.},
}
@article {pmid22149560,
year = {2011},
author = {Manzanares-Campillo, Mdel C and Pardo-García, R and Martín-Fernández, J},
title = {Appendicular pseudodiverticula and acute appendicitis. Our 12-year experience.},
journal = {Revista espanola de enfermedades digestivas},
volume = {103},
number = {11},
pages = {582-585},
doi = {10.4321/s1130-01082011001100005},
pmid = {22149560},
issn = {1130-0108},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; *Appendectomy ; Appendicitis/complications/diagnosis/surgery ; Appendix/*pathology/surgery ; Cecal Diseases/complications/*diagnosis/surgery ; Child ; Child, Preschool ; Diverticulum/complications/*diagnosis/surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult ; },
abstract = {INTRODUCTION: the presence of diverticula and their complications in the cecal appendix is an uncommon disease. We present a series of 13 patients with this condition, and perform a review of the literature.
PATIENTS AND METHOD: we carried out a retrospective study of patients undergoing appendectomy for acute appendicitis in the last twelve years in our department. The pathological examination of these episodes revealed 13 cases with a diagnosis of diverticular disease, all of them consisting of pseudodiverticula. Their clinical manifestations, laboratory results, imaging tests, and histology were analyzed, and findings were compared to those in the previous literature.
RESULTS: the incidence of diverticular disease in our setting was 13 cases (0.8%) among 1634 appendectomies for acute appendicitis. Diverticulitis was found in 8 patients (61.5%), and diverticulosis (38.5%) in 5. Appendicular perforation was more common in patients with diverticular disease (53.8%) as compared to those without this condition (31.1%).
CONCLUSIONS: complicated diverticular disease in the vermiform appendix of adult patients may result in insidious, recurrent manifestations that may confound preoperative diagnosis. A higher risk for appendicular perforation renders appendectomy the therapy of choice, even prophylactically when the condition is incidentally identified preoperatively.},
}
@article {pmid22125173,
year = {2012},
author = {Alavi, K and Cervera-Servin, JA and Sturrock, PR and Sweeney, WB and Maykel, JA},
title = {Racial differences in short-term surgical outcomes following surgery for diverticulitis.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {16},
number = {3},
pages = {613-621},
pmid = {22125173},
issn = {1873-4626},
mesh = {Colectomy/*methods ; Diverticulitis, Colonic/ethnology/*surgery ; Female ; Follow-Up Studies ; *Health Status Disparities ; *Healthcare Disparities ; Hospital Mortality/trends ; Humans ; Laparoscopy ; Male ; Middle Aged ; Morbidity/trends ; Odds Ratio ; Prognosis ; *Racial Groups ; Retrospective Studies ; Risk Factors ; Survival Rate/trends ; Time Factors ; United States/epidemiology ; },
abstract = {BACKGROUND: Diverticular disease ranks as one of the more common gastrointestinal disorders among westernized nations. Few studies have examined racial differences in the care and surgical outcomes of diverticulitis. The aim of this study was to determine if race is a predictor of peri-operative morbidity and mortality following surgery for diverticulitis.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program (2005-2008) was queried with the primary dependent variables being 30-day morbidity and mortality. Differences in morbidity and mortality between races were compared using χ (2) and Student t tests. Logistic regression was used to calculate odds ratios for morbidity and mortality. To determine if the effect of race is modified by insurance status and case complexity, additional models were developed across age subgroups (<65 vs ≥ 65) and levels of case complexity.
RESULTS: We identified 4,709 white and 360 African American patients. Despite being younger (57.6 ± 0.74 vs 59 ± 0.2, p < 0.05), African Americans were more likely to present with hypertension, diabetes, renal failure, dependent functional status, American Society of Anesthesiology class ≥ 3 (all p < 0.0001) and were more likely to require urgent surgery (p < 0.05), intra-operative blood transfusions(p < 0.0001), and undergo open colectomy (p < 0.0001). On adjusted analysis, African American race emerged as an independent predictor of morbidity (p < 0.05) and mortality (p < 0.05), without differences across insurance categories and less complex procedures. African American race remained a strong predictor of morbidity in more complex procedures (p < 0.05).
CONCLUSION: African Americans undergoing surgery for diverticulitis are more likely to have associated co-morbidities, require urgent surgery, undergo open surgery, and are at increased risk of morbidity and mortality. These findings highlight a need to address the root cause for disparities in care and outcomes after surgery.},
}
@article {pmid22125171,
year = {2012},
author = {Stewart, DB and Messaris, E},
title = {Outcomes for consecutive patients undergoing single-site laparoscopic colorectal surgery.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {16},
number = {4},
pages = {849-856},
pmid = {22125171},
issn = {1873-4626},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomotic Leak/etiology ; Chi-Square Distribution ; Colectomy ; Colon/*surgery ; Colorectal Neoplasms/*surgery ; Diverticulitis, Colonic/surgery ; Female ; Humans ; Inflammatory Bowel Diseases/surgery ; Laparoscopy/adverse effects/*methods ; Length of Stay ; Male ; Middle Aged ; Patient Readmission ; Rectum/*surgery ; Retrospective Studies ; Statistics, Nonparametric ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: Single-site laparoscopy (SSL) represents an innovation whose wider adoption may be limited by technical challenges and a current dearth of outcomes data.
METHODS: A retrospective review of prospectively collected data was performed on all consecutive laparoscopic colorectal resections, including elective and emergent surgeries. Patient demographics and operative details were collected, and outcomes were analyzed for 30 days following surgery.
RESULTS: Forty-one single-site laparoscopic procedures were performed, with 12 (29%) being nonelective. Surgeries included seven right colectomies, eight sigmoidectomies, four ileocolectomies, five total colectomies, two low anterior resections, and two abdominoperineal resections. The most frequent indication for surgery was inflammatory bowel disease (31.7%), followed by cancer (24.4%) and diverticular disease (24.4%). Thirty-seven percent of the patients had undergone previous abdominal surgery, with 64% of these having undergone previous laparotomy. One (2.5%) patient required conversion to multiple trocar laparoscopy, and five (12%) required conversion to laparotomy. Mean length of hospital stay was 4.2 days for SSL without a conversion. There was one anastomotic leak, no postoperative bleeding, no surgical site infections, and no deaths. The readmission rate was 14%.
CONCLUSIONS: SSL is safe when applied to unselected patients undergoing colorectal surgery, including those patients who have undergone a previous laparotomy.},
}
@article {pmid22113047,
year = {2011},
author = {Jung, YW and Yoo, JH and Lee, JS and Jang, BI and Kim, KO and Jung, SH},
title = {[Sigmoidovesical fistula caused by diverticulitis detected with sigmoidoscopy].},
journal = {The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi},
volume = {58},
number = {5},
pages = {284-287},
doi = {10.4166/kjg.2011.58.5.284},
pmid = {22113047},
issn = {2233-6869},
mesh = {Aged ; Colon, Sigmoid/*pathology ; Diverticulitis/complications/*surgery ; Humans ; Intestinal Fistula/*diagnosis/etiology/surgery ; Male ; Sigmoidoscopy ; Tomography, X-Ray Computed ; },
abstract = {Enterovesical fistular is an abnormal communication between the intestine and the bladder. It represents a rare complication of intestinal diverticulitis, colorectal malignancy, bladder cancer, inflammatory bowel disease, radiotherapy, and trauma. The most common etiology is diverticular disease. A 70-year-old man came to our hospital due to frequent urinary tract infection, dysuria, pneumaturia and fecaluria. Sigmoidoscopy revealed a large diverticulum with impacted stool at the sigmoid colon. When the scope was inserted into the site, the patient complained of severe urgency and pneumaturia. CT scan was performed. 1.5 cm sized fistular tract between the sigmoid colon and bladder was noted. According to the endoscopy and CT finding, the diagnosis of colovesical fistula was made. The patient underwent surgical intervention. At laparotomy, there were multiple diverticula and fistular tract was noted.},
}
@article {pmid22111457,
year = {2011},
author = {Anand, J and Ghazala, K and Chong, VH},
title = {Massive lower gastrointestinal bleeding secondary to colonic mucormycosis.},
journal = {The Medical journal of Malaysia},
volume = {66},
number = {3},
pages = {266-267},
pmid = {22111457},
issn = {0300-5283},
mesh = {Aged ; Colonic Diseases/*diagnosis/*microbiology/therapy ; Female ; Gastrointestinal Hemorrhage/diagnosis/*microbiology/therapy ; Humans ; Mucormycosis/complications/*diagnosis/therapy ; },
abstract = {Lower gastrointestinal bleeding is usually due to haemorrhoids, diverticular disease, or colorectal cancer. Infective causes of gastrointestinal bleeding are rare. A 70-year-old lady was admitted with septic shock secondary to community acquired pneumonia. She later developed massive lower gastrointestinal bleeding secondary to colonic mucormycosis. Her condition deteriorated rapidly and she died of septicemia. Mucormycosis of the colon is extremely rare and is still associated with a high mortality.},
}
@article {pmid22093049,
year = {2012},
author = {Käser, SA and Glauser, PM and Basilicata, G and Müller, DA and Maurer, CA},
title = {Timing of rectosigmoid resection for diverticular disease: the patient's view.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {3},
pages = {e111-6},
doi = {10.1111/j.1463-1318.2011.02801.x},
pmid = {22093049},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Colectomy ; Diverticulitis, Colonic/*surgery ; *Elective Surgical Procedures ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Patient Preference/*statistics & numerical data ; Rectum/*surgery ; Recurrence ; Retrospective Studies ; Sigmoid Diseases/*surgery ; Surveys and Questionnaires ; Time Factors ; Treatment Outcome ; },
abstract = {AIM: The study aimed to determine the patient's view on the timing of elective resection for sigmoid diverticulitis.
METHOD: A questionnaire was answered by 162 (69%) of 236 consecutive patients who had a resection of the rectosigmoid for diverticulitis from July 2002 to August 2005. Patients (n=45) having resection at or after the first inflammatory attack were excluded, leaving 117 eligible for analysis. Questions asked included those concerning symptoms before surgery, improvement of symptoms after surgery and the timing of surgery.
RESULTS: Patient assessment of symptoms after surgery was as follows: no improvement (2%; n=2), some improvement (10%; n=12), marked improvement (34%; n=39) and complete resolution (54%; n=63). Forty-five (38%) patients would have preferred an earlier operation. Preference for earlier surgery related to the number of previous inflammatory attacks was expressed as follows: 13 (34%) of 38 patients after two inflammatory attacks, 5 (18%) of 28 patients after three, seven (37%) of 19 patients after four, four (44%) of nine patients after five, and 16 (70%) of 23 patients after six or more inflammatory attacks would have preferred earlier surgery. Statistically significant factors influencing this potential choice were number of episodes of pain (P=0.006, OR=1.23, 95% CI: 1.060-1.430) and number of attacks of inflammation (P=0.048, OR=1.27, 95% CI: 1.002-1.598).
CONCLUSION: Surgery for recurrent diverticulitis resulted in a marked improvement or complete relief of symptoms in 88% of patients. A large proportion of patients with recurrent episodes of sigmoid diverticulitis would have preferred earlier resection.},
}
@article {pmid22089363,
year = {2011},
author = {Martin, D},
title = {Physical activity benefits and risks on the gastrointestinal system.},
journal = {Southern medical journal},
volume = {104},
number = {12},
pages = {831-837},
doi = {10.1097/SMJ.0b013e318236c263},
pmid = {22089363},
issn = {1541-8243},
mesh = {Exercise/physiology ; Gastrointestinal Diseases/etiology/*prevention & control ; Gastrointestinal Neoplasms/etiology/prevention & control ; Gastrointestinal Tract/*physiology ; Humans ; Motor Activity/*physiology ; Physical Exertion/physiology ; Risk Factors ; },
abstract = {This review evaluates the current understanding of the benefits and risks of physical activity and exercise on the gastrointestinal system. A significant portion of endurance athletes are affected by gastrointestinal symptoms, but most symptoms are transient and do not have long-term consequences. Conversely, physical activity may have a protective effect on the gastrointestinal system. There is convincing evidence that physical activity reduces the risk of colon cancer. The evidence is less convincing for gastric and pancreatic cancers, gastroesophageal reflux disease, peptic ulcer disease, nonalcoholic fatty liver disease, cholelithiasis, diverticular disease, irritable bowel syndrome, and constipation. Physical activity may reduce the risk of gastrointestinal bleeding and inflammatory bowel disease, although this has not been proven unequivocally. This article provides a critical review of the evidence-based literature concerning exercise and physical activity effects on the gastrointestinal system and provides physicians with a better understanding of the evidence behind exercise prescriptions for patients with gastrointestinal disorders. Well-designed prospective randomized trials evaluating the risks and benefits of exercise and physical activity on gastrointestinal disorders are recommended for future research.},
}
@article {pmid22085672,
year = {2011},
author = {Humes, D and Smith, JK and Spiller, RC},
title = {Colonic diverticular disease.},
journal = {American family physician},
volume = {84},
number = {10},
pages = {1163-1164},
pmid = {22085672},
issn = {1532-0650},
mesh = {Diverticulum, Colon/diagnosis/etiology/*therapy ; Humans ; Prognosis ; Risk Factors ; United Kingdom/epidemiology ; },
}
@article {pmid22067177,
year = {2011},
author = {Shapiro, R and Vogel, JD and Kiran, RP},
title = {Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach?.},
journal = {Diseases of the colon and rectum},
volume = {54},
number = {12},
pages = {1496-1502},
doi = {10.1097/DCR.0b013e31823302a1},
pmid = {22067177},
issn = {1530-0358},
mesh = {Age Factors ; Aged ; Colon/*surgery ; Digestive System Surgical Procedures/*methods ; Female ; Humans ; *Laparoscopy ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Postoperative Complications/*epidemiology ; Pulmonary Embolism/epidemiology/etiology ; Quality Improvement ; Rectum/*surgery ; Risk Factors ; Sex Factors ; Venous Thromboembolism/epidemiology/*etiology ; },
abstract = {BACKGROUND: Venous thromboembolism constitutes a major cause of morbidity associated with surgical procedures. Colorectal surgical patients are at an elevated risk for postoperative venous thromboembolism. Whether the laparoscopic approach influences this risk is not well defined.
OBJECTIVE: This study aimed to assess the risk of venous thromboembolism following major colorectal procedures. The influences of laparoscopic and open approaches on venous thromboembolism were compared while controlling for other potential confounders.
DESIGN: Patients who underwent major colorectal procedures were identified. Association between patient, disease, operation-related factors, and venous thromboembolism within 30 days of surgery was determined by the use of a logistic regression analysis.
SETTINGS: Patients were identified from the National Surgical Quality Improvement Program database (2005-2008).
PATIENTS: According to the National Surgical Quality Improvement Program database, 31,109 patients underwent colorectal surgery (open, 71%; laparoscopic, 29%) for cancer (48.3%), IBD (10.1%), diverticular disease (24.2%), and other benign conditions (17.4%).
MAIN OUTCOME MEASURES: The primary outcomes measured were deep venous thrombosis and pulmonary embolism.
RESULTS: The venous thromboembolism rate was 2.4% (laparoscopic 1.2% vs open 2.9%, P < .001). Patients who developed venous thromboembolism were older (age 65.4 vs 61.5, P < .001), more often male (52.5% vs 47.5%, P = .023), with worse functional status (P < .001), and more comorbidities (P < .001). Venous thromboembolism was associated with sepsis (7.9% vs 1.8%, P < .001), steroid use (5.4% vs 2.2%, P < .001), surgical site infection (4.8% vs 2%, P < .001), and reoperation (7% vs 2.1%, P < .001). On multivariate analysis, open surgery, older age, steroid use, sepsis, surgical site infection, reoperation, prolonged ventilation, and low albumin were independently associated with a higher venous thromboembolism rate.
LIMITATIONS: The details regarding determinants of the decision for laparoscopic surgery, conversion rates for laparoscopic procedures, and thrombosis prophylaxis regimens were not available.
CONCLUSIONS: The laparoscopic approach is associated with a lower venous thromboembolism rate in comparison with open surgery, despite controlling for other variables. This additional benefit of the minimally invasive approach further supports its use, whenever feasible, for a variety of colorectal conditions.},
}
@article {pmid22045087,
year = {2011},
author = {Shkolnik, I and Salka, S},
title = {Proximal right coronary artery diverticulum resulting in recurrent distal embolization.},
journal = {The Journal of invasive cardiology},
volume = {23},
number = {11},
pages = {E249-50},
pmid = {22045087},
issn = {1557-2501},
mesh = {Adult ; Coronary Artery Disease/*complications ; Diverticulum/*complications ; Embolism/*epidemiology/*etiology/therapy ; Humans ; Male ; Recurrence ; Stents ; Thrombectomy ; Treatment Outcome ; },
abstract = {This is a case of a right coronary artery (RCA) diverticulum. We highlight the complications of distal embolization and recurrent myocardial infarctions (MI), and the successful closure with a covered stent. A 33-year-old Khat user experienced non-ST elevation MI (non-STEMI) 3 times over 2 years. His first cardiac catheterization showed a proximal RCA ulceration. The last catheterization revealed a proximal RCA diverticulum containing a thrombus, and a thrombus at the distal PDA. A covered Jomed® stent (Jomed International AB) was placed into the proximal RCA, closing the diverticulum, and preventing future embolizations. Patient's atherosclerotic ulceration led to diverticular disease that resulted in blood flow stasis, thrombi, distal embolization, and repeat acute coronary events.},
}
@article {pmid22043229,
year = {2011},
author = {Sopeña, F and Lanas, A},
title = {Management of colonic diverticular disease with poorly absorbed antibiotics and other therapies.},
journal = {Therapeutic advances in gastroenterology},
volume = {4},
number = {6},
pages = {365-374},
pmid = {22043229},
issn = {1756-2848},
abstract = {Colonic diverticular disease is common in Western countries and its prevalence increases with age. The large majority of patients (80-85%) will remain entirely asymptomatic throughout their life. In symptomatic cases, most patients will have diverticulosis without inflammation while the remainder will have diverticulitis with or without complications. About 1-2% will require hospitalization and 0.5% will require surgery. Factors predicting the development of symptoms remain to be identified. However, it is generally recognized that diverticular disease is probably related to complex interactions between colon structure, intestinal motility, diet, and genetic features. Epidemiologic studies have demonstrated an association between diverticulosis and diets that are low in fiber and high in refined carbohydrates. Although the causes of symptom development are still unclear, it is thought that previous episodes of intestinal inflammation may play a role. Changes in intestinal microflora could be one of the putative mechanisms responsible for low-grade inflammation. In patients with uncomplicated diverticulosis, a diet abundant in fruit and vegetables is recommended. The current therapeutic approaches in preventing recurrence of symptoms are based on nonabsorbable antibiotics, mesalazine, and/or probiotics. Cyclic rifaximin administration seems to be an adequate approach to relieving symptoms and preventing acute diverticulitis in patients with symptomatic diverticulosis.},
}
@article {pmid22018264,
year = {2011},
author = {Salamone, I and Buda, C and Arcadi, T and Cutugno, G and Picciotto, M},
title = {Role of virtual colonoscopy following incomplete optical colonoscopy: our experience.},
journal = {Il Giornale di chirurgia},
volume = {32},
number = {8-9},
pages = {388-393},
pmid = {22018264},
issn = {0391-9005},
mesh = {Aged ; Colonic Polyps/diagnosis/diagnostic imaging ; *Colonography, Computed Tomographic ; Colonoscopy ; Colorectal Neoplasms/diagnosis/diagnostic imaging ; Diverticulosis, Colonic/diagnosis/diagnostic imaging ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; Retrospective Studies ; },
abstract = {AIM: To evaluate the role of Computed Tomography Colonography (CTC) in patients who failed an Optical Colonoscopy (OC).
PATIENTS AND METHODS: Sixtyeight patients (48 female, 20 male; mean age 60,4 years) with a previous incomplete OC underwent CTC.
RESULTS: A complete CTC examination was achieved in all 68 patients. We classified the detected polyps in relation to the diameter in small (<5mm), medium (from 5 to 10mm) and large (>10mm). In 19 patients (27,9%) any pathological finding was observed. In 11 patients (16,2%) one or more polyps not detected with the previous OC have been found.Only in one case the number of detected polyps corresponded to the OC findings. In 18 (26,4%) patients a diverticular disease was observed, and in 15 of them it was diagnosed by the previous OC (26,5%). In 8 patients (11,8%) the diverticular disease was associated to the presence of polyps. In 12 patients (17,6%) colonic stenosis or masses have been observed.
CONCLUSIONS: CTC was performed in all patients with a previous incomplete OC, obtaining a complete and accurate visualization of the colon whithout any patient's discomfort.},
}
@article {pmid22016581,
year = {2011},
author = {Martin, ST and Stocchi, L},
title = {New and emerging treatments for the prevention of recurrent diverticulitis.},
journal = {Clinical and experimental gastroenterology},
volume = {4},
number = {},
pages = {203-212},
pmid = {22016581},
issn = {1178-7023},
abstract = {Sigmoid diverticulitis is a common benign condition which carries significant morbidity and socioeconomic burden. This article describes the management of sigmoid diverticulitis with a focus on indications for surgical intervention. The mainstay of management of uncomplicated diverticulitis is broad-spectrum antibiotic therapy. The old surgical dictum that two episodes of sigmoid diverticulitis warranted surgical intervention has been challenged by recently published data. Surgery for diverticulitis thus needs to be tailored to suit individual presentation; patients presenting with recurrent diverticulitis, severe symptoms or debilitating disease impacting patient's quality of life mandate surgical intervention. Complicated diverticular disease typically prompts intervention to resect a diseased, strictured sigmoid colon, fistulizing disease, or a life-threatening colonic perforation. Laterally, minimally invasive surgery has been utilized in the management of this disease and recent data suggests that localized colonic perforation may be managed by laparoscopic peritoneal lavage, without resection. This review focuses discussion on available evidence for contemporary surgical and nonoperative management of diverticulitis.},
}
@article {pmid22008890,
year = {2012},
author = {Hjern, F and Wolk, A and Håkansson, N},
title = {Obesity, physical inactivity, and colonic diverticular disease requiring hospitalization in women: a prospective cohort study.},
journal = {The American journal of gastroenterology},
volume = {107},
number = {2},
pages = {296-302},
doi = {10.1038/ajg.2011.352},
pmid = {22008890},
issn = {1572-0241},
mesh = {Aged ; Aged, 80 and over ; Alcohol Drinking ; Dietary Fiber ; Diverticulitis, Colonic/*etiology ; *Exercise ; Female ; Hospitalization/*statistics & numerical data ; Humans ; Middle Aged ; Obesity/*complications ; Physical Fitness ; Prospective Studies ; Risk Factors ; *Sedentary Behavior ; Surveys and Questionnaires ; Women's Health ; },
abstract = {OBJECTIVES: Lifestyle factors other than dietary fiber intake and risk for colonic diverticular disease have only been examined in few studies. The objective of this study was to investigate the association between obesity and physical inactivity and diverticular disease in a population-based cohort of women.
METHODS: This was a prospective population-based cohort study. In all, 36,592 women, born 1914-1948, in the Swedish Mammography Cohort were followed 1997-2009. Body mass index (BMI; kg/m(2)), physical activity, diet, smoking, and other lifestyle factors were collected at baseline through questionnaires. Cases of diverticular disease were identified from the Swedish Patient and Death Registers. Relative risks (RRs) of diverticular disease requiring hospitalization (or being the cause of death) according to BMI and physical activity were estimated using Cox proportional hazards models. The multivariable models were adjusted for age; intake of dietary fiber; diabetes; hypertension; use of acetylsalicylate acid, non-steroid anti-inflammatory drug, or steroid medication; alcohol consumption; smoking; and educational level.
RESULTS: During 12 years, 626 cases of incident diverticular disease requiring hospitalization were found. Two women were registered in the National Death Register only. In multivariable analysis, women with BMI 25-29.99 had 29% increased risk (RR=1.29; 95% confidence interval (CI): 1.08, 1.54) and obese women (BMI≥30) had 33% (1.33; 95% CI: 1.03-1.72) increased risk of diverticular disease compared to women with BMI 20-24.99. Exercise ≤30 min/day increased the risk for disease with 42% (1.42; 95% CI: 1.18-1.69) compared with exercise >30 min/day in multivariable analysis. Ninety-eight subjects were hospitalized due to complications; perforation or abscess. Women with BMI≥30 had a twofold (RR=2.00; 95% CI: 1.08-3.73; P=0.028) increased risk for complicated disease.
CONCLUSIONS: Overweight, obesity, and physical inactivity among women increase diverticular disease requiring hospitalization.},
}
@article {pmid22006879,
year = {2011},
author = {Luglio, G and Pendlimari, R and Holubar, SD and Cima, RR and Nelson, H},
title = {Loop ileostomy reversal after colon and rectal surgery: a single institutional 5-year experience in 944 patients.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {146},
number = {10},
pages = {1191-1196},
doi = {10.1001/archsurg.2011.234},
pmid = {22006879},
issn = {1538-3644},
mesh = {Adult ; Aged ; Cohort Studies ; Colonic Diseases/complications/pathology/*surgery ; Databases, Factual ; Defecation ; Female ; Humans ; Ileostomy/*adverse effects ; Length of Stay ; Male ; Middle Aged ; Recovery of Function ; Rectal Diseases/complications/pathology/*surgery ; Reoperation/adverse effects ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: Diverting loop ileostomy is used to mitigate the sequelae of anastomotic dehiscence.
OBJECTIVE: To report the rate of complications after ileostomy reversal using standardized definitions to aid physicians who are deciding whether to divert anastomoses.
METHODS: Patients who underwent diverting loop ileostomy closure from January 1, 2005, through February 28, 2010, were identified using a prospective database. Perioperative variables and 30-day outcomes were reviewed. Complications were graded according to the Clavien-Dindo Classification, in which grade III, IV, or V represents major complications. Univariate analysis assessed the relationship between operative variables and surgical outcomes.
RESULTS: A total of 944 patients underwent reversal: 43.1% were women, the mean age was 47.2 years, the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 25.7, and 18.5% were American Society of Anesthesiologists class III or IV. Indications for the initial operation were ulcerative colitis (49.5%), rectal cancer (27.5%), diverticular disease (6.8%), and other (16.1%). Anastomotic technique for reversal was sutured fold-over in 466 patients (49.4%), stapled in 315 (33.4%), and handsewn end to end in 163 (17.3%). After reversal, the mean time to first bowel movement, tolerance of soft diet, and discharge from hospital was 2.6, 3.7, and 5.2 days, respectively. Handsewn cases had longer operative times and longer times to bowel movement, soft diet, and discharge. Overall, complications occurred in 203 patients (21.5%), including 45 patients (4.8%) who experienced a major complication; there were no deaths within 30 days.
CONCLUSION: Ileostomy closure is associated with a low rate of major grade III and IV complications and should be reserved for patients who have a predicted postoperative major complication rate of 5% or more without diversion.},
}
@article {pmid22006873,
year = {2011},
author = {Piessen, G and Muscari, F and Rivkine, E and Sbaï-Idrissi, MS and Lorimier, G and Fingerhut, A and Dziri, C and Hay, JM and , },
title = {Prevalence of and risk factors for morbidity after elective left colectomy: cancer vs noncomplicated diverticular disease.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {146},
number = {10},
pages = {1149-1155},
doi = {10.1001/archsurg.2011.231},
pmid = {22006873},
issn = {1538-3644},
mesh = {Aged ; Body Mass Index ; Colectomy/*adverse effects/mortality ; Colonic Neoplasms/complications/mortality/*surgery ; Diverticulum, Colon/complications/mortality/*surgery ; Elective Surgical Procedures/adverse effects ; Female ; Humans ; Laparotomy/adverse effects ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Risk Factors ; },
abstract = {HYPOTHESIS: Independent risk factors for postoperative morbidity after colectomy are most likely linked to disease characteristics.
DESIGN: Retrospective analysis.
SETTING: Twenty-eight centers of the French Federation for Surgical Research.
PATIENTS: In total, 1721 patients (1230 with colon cancer [CC] and 491 with diverticular disease [DD]) from a databank of 7 prospective, multisite, randomized trials on colorectal resection.
INTERVENTION: Elective left colectomy via laparotomy.
MAIN OUTCOME MEASURES: Preoperative and intraoperative risk factors for postoperative morbidity.
RESULTS: Overall postoperative morbidity was higher in CC than in DD (32.4% vs 30.3%) but the difference was not statistically significant (P = .40). Two independent risk factors for morbidity in CC were antecedent heart failure (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.42-6.32) (P = .003) and bothersome intraluminal fecal matter (2.08; 1.42-3.06) (P = .001). Three independent risk factors for morbidity in DD were at least 10% weight loss (OR, 2.06; 95% CI, 1.25-3.40) (P = .004), body mass index (calculated as weight in kilograms divided by height in meters squared) exceeding 30 (2.05; 1.15-3.66) (P = .02), and left hemicolectomy (vs left segmental colectomy) (2.01; 1.19-3.40) (P = .009).
CONCLUSIONS: Patients undergoing elective left colectomy for CC or for DD constitute 2 distinct populations with completely different risk factors for morbidity, which should be addressed differently. Improving colonic cleanliness (by antiseptic enema) may reduce morbidity in CC. In DD, morbidity may be reduced by appropriate preoperative nutritive support (by immunonutrition), even in patients with obesity, and by preference of left segmental colectomy over left hemicolectomy. By decreasing morbidity, mortality should be lowered as well, especially when reoperation becomes necessary.},
}
@article {pmid21989396,
year = {2011},
author = {Tursi, A},
title = {[Perspectives in the treatment of the diverticular disease of the colon].},
journal = {Recenti progressi in medicina},
volume = {102},
number = {10},
pages = {380-386},
doi = {10.1701/955.10451},
pmid = {21989396},
issn = {0034-1193},
mesh = {Decision Trees ; Diverticulum, Colon/diagnosis/*therapy ; Humans ; },
abstract = {Diverticular disease of the colon shows a progressive increasing incidence. New physiopathological knowledges have clarified the role of several pathogenetic factors in determining the development of the disease. These new informations have permitted new therapeutic approaches. We reviewed the current and novel therapeutic indications in order to treat the symptoms and preventing recurrence.},
}
@article {pmid21989340,
year = {2011},
author = {Alizart, MM and Rosty, C and Brown, IS},
title = {Colonic mucosubmucosal elongated polyp: a clinicopathologic study of 13 cases and review of the literature.},
journal = {The American journal of surgical pathology},
volume = {35},
number = {12},
pages = {1818-1822},
doi = {10.1097/PAS.0b013e31822c0688},
pmid = {21989340},
issn = {1532-0979},
mesh = {Adult ; Aged ; Colonic Polyps/*pathology ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {Colonic mucosubmucosal elongated polyp (CMSEP) is a distinctive non-neoplastic colorectal polyp characterized by pedunculated, elongated shape and is composed mainly of expanded submucosa with a normal mucosal lining. Only a small number of these polyps have been reported, exclusively from Japan. We report the clinicopathologic characteristics of 13 CMSEPs occurring in 11 patients, mostly from European ancestry. Ten of these polyps were resected during colonoscopy, and 3 were diagnosed in a patient who underwent sigmoid resection for diverticular disease. Among patients who had undergone a colonoscopy, 4 had altered bowel habit, and 1 suffered from abdominal discomfort; the other 5 patients had routine screening colonoscopy. Eight polyps were located in the sigmoid colon, 3 in the right colon, 1 in the rectosigmoid junction, and 1 in the descending colon. Polyp size ranged from 10 to 150 mm. Histologically, CMSEPs were characterized by unremarkable large bowel mucosa and submucosal stalk containing dilated thick-walled veins running parallel to the long axis of the polyp. Mucosal inflammation or fibromuscular proliferation characteristic of mucosal prolapse was absent. The pathogenesis of CMSEP may involve mechanical traction of the mucosa and the superficial submucosa during peristalsis in a fragile area of the colon. Despite the occasional large size, CMSEP is a benign lesion seldom leading to clinical complications.},
}
@article {pmid21978459,
year = {2011},
author = {Radhi, JM and Ramsay, JA and Boutross-Tadross, O},
title = {Diverticular disease of the right colon.},
journal = {BMC research notes},
volume = {4},
number = {},
pages = {383},
pmid = {21978459},
issn = {1756-0500},
abstract = {BACKGROUND: The incidence of colonic diverticular disease varies with national origin, cultural background and diet. The frequency of this disease increases with advancing age. Right-sided diverticular disease is uncommon and reported to occur in 1-2% of surgical specimens in European and American series. In contrast the disease is more prevalent and reported in 43-50% of specimens in Asian series. Various lines of evidence suggest this variation may represent hereditary differences. The aim of the study is to report all cases of right sided diverticular disease underwent surgical resection or identified during pathological examination of right hemicoloectomy specimens
METHODS: A retrospective review of all surgical specimens with right sided colonic diverticular disease selected from a larger database of all colonic diverticulosis and diverticulitis surgical specimen reported between January 1993 and December 2010 at the Pathology Department McMaster University Medical Centre Canada. The clinical and pathological features of these cases were reviewed
RESULTS: The review identified 15 cases of right colon diverticulosis. The clinical diagnoses of these cases were appendicitis, diverticulitis or adenocarcinoma. Eight cases of single congenital perforated diverticuli were identified and seven cases were incidental multiple acquired diverticuli found in specimen resected for right side colonic carcinomas/large adenomas. Laparotomy or laparoscopic assisted haemicolectomies were done for all cases. Pathological examination showed caecal wall thickening with inflammation associated with perforated diverticuli. Histology confirmed true solitary diverticuli that exhibited in two cases thick walled vessels in the submucosa and muscular layer indicating vascular malformation/angiodysplasia. Acquired diverticuli tend to be multiple and are mostly seen in specimens resected for neoplastic right colon diseases.
CONCLUSION: Single true diverticular disease of the right colon is usually of congenital type and affects younger age group and may be associated with angiodysplasia in some cases. Multiple false diverticuli are more seen in association with caecal carcinoma or large adenomas. These are usually asymptomatic and are more seen in older patients. However this study dose not reflects the true incidence of the disease in the general population.},
}
@article {pmid21976113,
year = {2012},
author = {Cianchi, F and Qirici, E and Trallori, G and Mallardi, B and Badii, B and Perigli, G},
title = {Single-incision laparoscopic colectomy: technical aspects and short-term results.},
journal = {Updates in surgery},
volume = {64},
number = {1},
pages = {19-23},
pmid = {21976113},
issn = {2038-131X},
mesh = {Adult ; Aged ; Colectomy/*methods ; Colonic Diseases/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Postoperative Complications ; Treatment Outcome ; },
abstract = {Single-incision laparoscopic surgery (SILS) is currently regarded as the next major advance in the progress of minimally invasive techniques in colorectal surgery. We describe our initial experience using SILS for the management of colorectal disease and present preliminary short-term results. Between February 2010 and April 2011, 7 patients (4 females and 3 males, mean age 55 years, range 32–74) underwent SILS for either benign or malignant colorectal disease. Preoperative diagnosis was diverticular disease of the sigmoid colon in two patients, malignant polyps of the sigmoid colon in two other patients and large villous tumor of the right colon in three patients. Surgical procedures, 4 anterior resections of the rectum and 3 right hemicolectomies, were performed through a 3 cm single umbilical incision using a SILS multi port device with conventional or articulated laparoscopic instruments. There were no intraoperative complications or conversions in the standard laparoscopic procedure. The mean operative time for anterior resections was 160.0 ± 10.6 min, whereas it was 160.6 ± 20 for right hemicolectomies. Blood loss was minimal. No postoperative complications were reported in any of the patients. The overall mean hospital stay was 4.8 ± 0.2 days (range 4–5). For the subset of patients with malignant or pre-malignant disease, the mean number of retrieved lymph nodes was 15.6 ± 4.4 (range 6–31). Cosmetic results were considered excellent by all the patients after 15 days. In conclusion, our preliminary experience shows that SILS for colorectal disease is feasible and safe with potential reproducible oncologic results.},
}
@article {pmid21960947,
year = {2011},
author = {Nonose, R and Valenciano, JS and de Souza Lima, JS and Nascimento, EF and Silva, CM and Martinez, CA},
title = {Jejunal Diverticular Perforation due to Enterolith.},
journal = {Case reports in gastroenterology},
volume = {5},
number = {2},
pages = {445-451},
pmid = {21960947},
issn = {1662-0631},
abstract = {Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life-threatening and require early surgical treatment. Small bowel perforation secondary to jejunal diverticulitis by enteroliths is rare. The aim of this study was to report a case of small intestinal perforation caused by a large jejunal enterolith. An 86-year-old woman was admitted with signs of diffuse peritonitis. After initial fluid recovery the patient underwent emergency laparotomy. The surgery showed that she had small bowel diverticular disease, mainly localized in the proximal jejunum. The peritonitis was due to intestinal perforation caused by an enterolith 12 cm in length, localized inside one of these diverticula. The intestinal segment containing the perforated diverticulum with the enterolith was removed and an end-to-end anastomosis was done to reconstruct the intestinal transit. The patient recovered well and was discharged from hospital on the 5th postoperative day. There were no signs of abdominal pain 1 year after the surgical procedure. Although jejunal diverticular disease with its complications, such as formation of enteroliths, is difficult to suspect in patients with peritonitis, it should be considered as a possible source of abdominal infection in the elderly patient when more common diagnoses have been excluded.},
}
@article {pmid21929895,
year = {2011},
author = {Anderton, M and Griffiths, B and Ferguson, G},
title = {Giant sigmoid diverticulitis mimicking acute appendicitis.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {93},
number = {6},
pages = {e89-90},
pmid = {21929895},
issn = {1478-7083},
mesh = {Abdominal Pain/etiology ; Acute Disease ; Aged ; Appendicitis/*diagnosis ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis ; Humans ; Male ; Sigmoid Diseases/*diagnosis ; },
abstract = {Giant colonic diverticula are a rare manifestation of diverticular disease and there are fewer than 150 cases described in the literature. They may have an acute or chronic presentation or may remain asymptomatic and be found incidentally. As the majority (over 80%) of giant diverticula are located in the sigmoid colon, they usually present with left-sided symptoms but due to the variable location of the sigmoid loop, right-sided symptoms are possible. We describe the acute presentation of an inflamed giant sigmoid diverticulum with right iliac fossa pain. We discuss both the treatment options for this interesting condition and also the important role of computed tomography in the diagnosis and management of abdominal pain in elderly patients.},
}
@article {pmid21928041,
year = {2012},
author = {Klarenbeek, BR and de Korte, N and van der Peet, DL and Cuesta, MA},
title = {Review of current classifications for diverticular disease and a translation into clinical practice.},
journal = {International journal of colorectal disease},
volume = {27},
number = {2},
pages = {207-214},
pmid = {21928041},
issn = {1432-1262},
mesh = {Diverticulitis/*classification/diagnostic imaging/pathology/therapy ; Humans ; Tomography, X-Ray Computed ; *Translational Research, Biomedical ; },
abstract = {INTRODUCTION: Diverticular disease of the sigmoid colon prevails in Western society. Its presentation may vary greatly per individual patient, from symptomatic diverticulosis to perforated diverticulitis. Since publication of the original Hinchey classification, several modifications and new grading systems have been developed. Yet, new insights in the natural history of the disease, the emergence of the computed tomography scan, and new treatment modalities plead for evolving classifications.
METHODS: This article reviews all current classifications for diverticular disease.
RESULT: A three-stage model is advanced for a renewed and comprehensive classification system for diverticular disease, incorporating up-to-date imaging and treatment modalities.},
}
@article {pmid21923748,
year = {2012},
author = {Evans, J and Lake, B and Harris, P},
title = {No hair? Beware. An unusual presentation of fistulating diverticular disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {4},
pages = {e206-7},
doi = {10.1111/j.1463-1318.2011.02832.x},
pmid = {21923748},
issn = {1463-1318},
mesh = {Aged, 80 and over ; Diagnosis, Differential ; Diverticulum, Colon/complications/*diagnosis ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology ; Pilonidal Sinus/*diagnosis ; Sigmoid Diseases/complications/*diagnosis ; },
}
@article {pmid21922199,
year = {2012},
author = {Ünlü, C and Daniels, L and Vrouenraets, BC and Boermeester, MA},
title = {A systematic review of high-fibre dietary therapy in diverticular disease.},
journal = {International journal of colorectal disease},
volume = {27},
number = {4},
pages = {419-427},
pmid = {21922199},
issn = {1432-1262},
mesh = {Dietary Fiber/*therapeutic use ; Diverticulum/*diet therapy/prevention & control ; Humans ; Randomized Controlled Trials as Topic ; Recurrence ; },
abstract = {PURPOSE: The exact pathogenesis of diverticular disease of the sigmoid colon is not well established. However, the hypothesis that a low-fibre diet may result in diverticulosis and a high-fibre diet will prevent symptoms or complications of diverticular disease is widely accepted. The aim of this review is to assess whether a high-fibre diet can improve symptoms and/or prevent complications of diverticular disease of the sigmoid colon and/or prevent recurrent diverticulitis after a primary episode.
METHODS: Clinical studies were eligible for inclusion if they assessed the treatment of diverticular disease or the prevention of recurrent diverticulitis with a high-fibre diet. The following exclusion criteria were used for study selection: studies without comparison of the patient group with a control group.
RESULTS: No studies concerning prevention of recurrent diverticulitis with a high-fibre diet met our inclusion criteria. Three randomised controlled trials (RCT) and one case-control study were included in this systematic review. One RCT of moderate quality showed no difference in the primary endpoints. A second RCT of moderate quality and the case-control study found a significant difference in favour of a high-fibre diet in the treatment of symptomatic diverticular disease. The third RCT of moderate quality found a significant difference in favour of methylcellulose (fibre supplement). This study also showed a placebo effect.
CONCLUSION: High-quality evidence for a high-fibre diet in the treatment of diverticular disease is lacking, and most recommendations are based on inconsistent level 2 and mostly level 3 evidence. Nevertheless, high-fibre diet is still recommended in several guidelines.},
}
@article {pmid21910819,
year = {2012},
author = {Newman, J and Fitzgerald, JE and Gupta, S and von Roon, AC and Sigurdsson, HH and Allen-Mersh, TG},
title = {Outcome predictors in acute surgical admissions for lower gastrointestinal bleeding.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {8},
pages = {1020-1026},
doi = {10.1111/j.1463-1318.2011.02824.x},
pmid = {21910819},
issn = {1463-1318},
mesh = {Area Under Curve ; Comorbidity ; Female ; Gastrointestinal Hemorrhage/epidemiology/*surgery ; Hemodynamics ; Humans ; Length of Stay/statistics & numerical data ; Logistic Models ; Male ; *Outcome Assessment, Health Care ; Predictive Value of Tests ; Prospective Studies ; Rectum ; Referral and Consultation ; Risk Factors ; Triage ; United Kingdom/epidemiology ; },
abstract = {AIM: The BLEED criterion is a triaging model for lower gastrointestinal bleeding (LGIB), which was developed and validated in the USA. We assessed the BLEED criteria in a UK population and aimed to elucidate factors that can be implemented for early risk stratification.
METHOD: Patients were identified from a prospectively maintained surgical admission database at a central London teaching hospital. Data were collected on 26 clinical factors available on initial presentation. The primary-outcome end-points included severe bleeding (persistent bleeding within the first 24 h, blood transfusion, a decrease in haematocrit of ≥ 20% or recurrent bleeding after ≥ 24 hours of stability) and adverse outcome (emergency surgery to control bleeding, intensive care unit [ITU] admission or death).
RESULTS: One hundred and eighty-four clinical episodes were identified, representing 3% of all surgical referrals. Twelve patients with upper gastrointestinal bleeding were excluded. Severe bleeding occurred in 110 (64%) patients. An adverse outcome was recorded in 20 (11.6%) patients, and 10 (5.4%) patients died during admission. The commonest aetiologies were diverticular disease, haemorrhoids and malignancy. Four prognosticators of adverse outcome were identified, these being: creatinine > 150 μm (P = 0.002); age > 60 years (P = 0.001); abnormal haemodynamic parameters on presentation (P = 0.05); persistent bleeding within the first 24 h (P = 0.05); and area under the receiver-operating characteristics curve (AUC) = 0.79. The BLEED criteria were shown to be nonpredictive (AUC = 0.60).
CONCLUSION: The BLEED criterion was not shown to have any predictive value in this patient cohort. Our study has determined an independent set of prognostic factors that could be incorporated into initial triaging of patients presenting with LGIB. This may facilitate the early identification of patients requiring more aggressive resuscitation, admission to a monitored bed and consideration for early radiological or surgical intervention.},
}
@article {pmid21904150,
year = {2011},
author = {Maconi, G and Barbara, G and Bosetti, C and Cuomo, R and Annibale, B},
title = {Treatment of diverticular disease of the colon and prevention of acute diverticulitis: a systematic review.},
journal = {Diseases of the colon and rectum},
volume = {54},
number = {10},
pages = {1326-1338},
doi = {10.1097/DCR.0b013e318223cb2b},
pmid = {21904150},
issn = {1530-0358},
mesh = {Anti-Infective Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Combined Modality Therapy ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/*prevention & control ; Diverticulum, Colon/*diet therapy/*drug therapy ; Drug Therapy, Combination ; Humans ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; Rifamycins/therapeutic use ; Rifaximin ; },
abstract = {BACKGROUND: Diverticular disease of the colon is a common disorder, characterized by recurrent symptoms and complications such as diverticulitis, requiring hospital admissions and surgery.
OBJECTIVE: This study aimed to systematically review the evidence for medical therapy of diverticular disease in reducing symptoms and preventing acute diverticulitis.
DATA SOURCES: MEDLINE and Embase databases (1966 to February 2010).
STUDY SELECTION: The studies selected were prospective clinical trials on uncomplicated diverticular disease of the colon.
INTERVENTIONS: Four investigators independently reviewed articles, extracted data, and assessed study quality according to standardized criteria.
MAIN OUTCOME MEASURES: The main outcomes measured were improvement in symptoms, complete remission of symptoms, and prevention of acute diverticulitis.
RESULTS: We identified 31 studies, including 6 placebo-controlled trials. The methodological quality of these studies was suboptimal. Only 10 trials provided a detailed description of the patient history, 8 assessed symptoms by the use of a validated questionnaire, and 14 appropriately defined inclusion and exclusion criteria. Only one long-term double-blind placebo-controlled study was identified. This reported a significant improvement in symptoms and greater prevalence of symptom-free patients at 1 year with fiber plus rifaximin in comparison with fiber alone. The efficacy of treatment in preventing acute diverticulitis was evaluated in 11 randomized trials. Four trials compared rifaximin plus fiber vs fiber alone and failed to show a significant difference between treatments. However, cumulative data from these trials revealed a significant benefit following rifaximin and fiber (1-year rate of acute diverticulitis: 11/970 (1.1%) vs 20/690 (2.9%); P = .012), but with a number needed to treat of 57, to prevent an attack of acute diverticulitis.
LIMITATIONS: : Heterogeneity of the study design, patients' characteristics, regimens and combination of studied treatment, and outcome reporting precluded the pooling of results and limited interpretation.
CONCLUSIONS: The treatment for diverticular disease relies mainly on data from uncontrolled studies. Treatment showed some evidence of improvement in symptoms, but its role in the prevention of acute diverticulitis remains to be defined.},
}
@article {pmid21887570,
year = {2011},
author = {Symeonidis, N and Psarras, K and Lalountas, M and Baltatzis, M and Micha, A and Pavlidis, E and Sakantamis, A},
title = {Clinical features of colonic diverticular disease.},
journal = {Techniques in coloproctology},
volume = {15 Suppl 1},
number = {},
pages = {S5-8},
pmid = {21887570},
issn = {1128-045X},
mesh = {Age Factors ; Colitis/etiology ; Diverticulitis, Colonic/*complications/pathology/surgery ; Fistula/*etiology ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Intestinal Obstruction/*etiology ; Recurrence ; },
abstract = {Colonic diverticular disease is extremely common in developed countries. Although the majority of patients with diverticulosis remain asymptomatic, about one-third of the patients manifest the disease with either hemorrhage or inflammation. Diverticulitis may be uncomplicated or complicated by abscess formation, perforation with peritonitis, fistula, intestinal obstruction, or stricture. Controversy exists regarding the aggressiveness of diverticulitis during recurrent attacks of the disease as well as in special groups of patients including immunocompromised patients, young patients, and patients with right-sided disease. Clinical characteristics of symptomatic uncomplicated disease can be similar to irritable bowel syndrome, while acute diverticulitis is sometimes difficult to distinguish from segmental colitis associated with diverticulosis. The considerable clinical overlap between those entities with diverticular disease demonstrates that there are still areas of uncertainty in their physiopathology.},
}
@article {pmid21887565,
year = {2011},
author = {Psarras, K and Symeonidis, NG and Pavlidis, ET and Micha, A and Baltatzis, ME and Lalountas, MA and Sakantamis, AK},
title = {Current management of diverticular disease complications.},
journal = {Techniques in coloproctology},
volume = {15 Suppl 1},
number = {},
pages = {S9-12},
pmid = {21887565},
issn = {1128-045X},
mesh = {Age Factors ; Constriction, Pathologic/etiology/surgery ; Diverticulitis, Colonic/*complications ; Fistula/etiology/*surgery ; Gastrointestinal Hemorrhage/diagnosis/etiology/*therapy ; Humans ; Intestinal Obstruction/etiology/*surgery ; Intestinal Perforation/etiology/*surgery ; Recurrence ; },
abstract = {Diverticular disease is a common problem in the western population and sometimes leads to serious complications such as hemorrhage, bowel stenosis, obstruction, abscesses, fistulae, bowel perforation, and peritonitis. The severity of these complications can differ, and it is not always clear which procedure is indicated in each case and what measures should be followed before bringing the patient into the operating room. Certain operations have high rates of morbidity and mortality, especially in compromised patients. Along with advancements in imaging and minimally invasive techniques, the indications for surgery have currently being adapted to "damage limitation" or "down-staging" protocols, which seem to offer improved results. There are still some questions to be solved in the following years by prospective studies, such as the usefulness of laparoscopic lavage in purulent peritonitis or of Hartmann's procedure in fecal peritonitis. These indications, based on current literature, are systematically discussed in the present review.},
}
@article {pmid21877479,
year = {2011},
author = {Snyder, SR and Kivlehan, SM and Collopy, KT},
title = {The immune system and immunologic complications. Our immune system is designed to protect us from harmful pathogens: here's what you need to know about how it works.},
journal = {EMS world},
volume = {40},
number = {8},
pages = {44-51},
pmid = {21877479},
issn = {2158-7833},
mesh = {Emergency Medical Technicians/education ; Humans ; Immune System/*physiopathology ; },
abstract = {Marie considers the exam and history findings and constructs her reply to the patient's statement that he does not want to go to the hospital. "Sir", she says, "I appreciate that you think this is just a stomach bug, but here's what I'm concerned about: Your lupus and the Imuran and prednisone you take to treat it weaken your immune system. And, with your history of diverticular disease, I'm worried that you may have developed diverticulitis, which your weakened immune system might struggle to fight effectively. Worst case scenario, you could be developing an infection that you cannot effectively fight. This infection could get worse, spread to other places in your abdomen or even your blood, and make you very sick. For that reason, I recommend that you go to the hospital for an evaluation." Presented with this information, the patient agrees to transport with the EMS crew to the local ED. He is placed on the cardiac monitor and IV access is initiated. He is monitored during an uncomplicated trip to the receiving ED. Later, the attending physician informs Marie and Don that the patient had diverticulitis with a perforated diverticula, was likely developing peritonitis, and had been admitted to the hospital for treatment and observation.},
}
@article {pmid21876861,
year = {2011},
author = {Weizman, AV and Nguyen, GC},
title = {Diverticular disease: epidemiology and management.},
journal = {Canadian journal of gastroenterology = Journal canadien de gastroenterologie},
volume = {25},
number = {7},
pages = {385-389},
pmid = {21876861},
issn = {0835-7900},
mesh = {Age Factors ; Anti-Bacterial Agents/therapeutic use ; Diverticulitis, Colonic/complications/diagnosis/drug therapy/epidemiology/surgery ; Diverticulosis, Colonic/diagnosis/drug therapy/*epidemiology/surgery/*therapy ; Hospitalization/statistics & numerical data ; Humans ; Recurrence ; Sex Factors ; },
abstract = {Diverticular disease of the colon is among the most prevalent conditions in western society and is among the leading reasons for outpatient visits and causes of hospitalization. While previously considered to be a disease primarily affecting the elderly, there is increasing incidence among individuals younger than 40 years of age. Diverticular disease most frequently presents as uncomplicated diverticulitis, and the cornerstone of management is antibiotic therapy and bowel rest. Segmental colitis associated with diverticula shares common histopathological features with inflammatory bowel disease and may benefit from treatment with 5-aminosalicylates. Surgical management may be required for patients with recurrent diverticulitis or one of its complications including peridiverticular abscess, perforation, fistulizing disease, and strictures and ⁄ or obstruction.},
}
@article {pmid21874764,
year = {2011},
author = {Spector, R and Bard, S and Wasserberg, N},
title = {[Hand-assisted laparoscopic colectomy (HALC)].},
journal = {Harefuah},
volume = {150},
number = {7},
pages = {568-71, 618},
pmid = {21874764},
issn = {0017-7768},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/adverse effects/*methods ; Colonic Polyps/surgery ; Colorectal Neoplasms/surgery ; Databases, Factual ; Diverticulosis, Colonic/surgery ; Female ; Follow-Up Studies ; Hand-Assisted Laparoscopy/adverse effects/*methods ; Humans ; Length of Stay ; Male ; Middle Aged ; Prospective Studies ; Time Factors ; },
abstract = {INTRODUCTION: Laparoscopic colorectal resection is not common practice, despite its proven advantages. Hand-assisted laparoscopic colectomy (HALC) combines the advantages of a format laparoscopy while minimizing its limits.
GOALS: A report of our experience in hand-assisted colorectal resections.
METHODS: A prospective database gathering information on 100 patients who underwent HALC in our department between the years 2007-2009.
RESULTS: The study group includes 60 men and 40 women. The median age is 60 years (27-88), and the median body mass index (BMI) is 25 (18-34). A total of 59% of patients were operated on due to colorectal carcinoma, 15% had a large benign polyp, and 26% colonic diverticular disease. Furthermore, 41% of patients underwent right hemicolectomy, 11% left hemicolectomy, 30% sigmoidectomy, and 18% rectal resection. The median operating time was 120 (60-220) minutes, and the average incision length was 6 +/- 0.06 cm. The conversion rate to open surgery was 5%. In the carcinoma cases, the surgical margins were free of tumor and the average lymph node number harvested was 12.3 +/- 4.3. The Learning curve stabilized after 8-12 procedures. The median time to first bowel movement was 3 days (1-8), and the median hospital stay was 5 days (3-26). Postoperative complications were observed in 19% of patients: anastomotic leak (2), ileus (2), pulmonary emboli (1), urinary retention (3), urinary tract infection (3), wound infection (7), and spontaneous pneumothorax (1). Incisional hernia was documented in 3% of patients, after an average followup of 18 +/- 4 months. One patient died due to myocardial infarction.
CONCLUSIONS: HALC is a safe and effective procedure that enables the preservation of the laparoscopy advantages, in a short operative time, and a rapid learning curve.},
}
@article {pmid21848896,
year = {2012},
author = {Biondo, S and Lopez Borao, J and Millan, M and Kreisler, E and Jaurrieta, E},
title = {Current status of the treatment of acute colonic diverticulitis: a systematic review.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {1},
pages = {e1-e11},
doi = {10.1111/j.1463-1318.2011.02766.x},
pmid = {21848896},
issn = {1463-1318},
mesh = {Acute Disease ; Clinical Trials as Topic ; Diagnostic Imaging ; Diverticulitis, Colonic/*diagnosis/*therapy ; Humans ; },
abstract = {AIM: This paper addresses the current status of the treatment of acute colonic diverticulitis by an evidence-based review.
METHOD: A systematic search in PUBMED, MEDLINE, EMBASE and Google scholar on colonic diverticulitis was performed. Diagnostic tools, randomized controlled trials, non-randomized comparative studies, observational epidemiological studies, national and international guidelines, reviews of observational studies on elective and emergency surgical treatment of diverticulitis, and studies of prognostic significance were reviewed. Criteria for eligibility of the studies were diagnosis and classification, medical treatment, inpatients and outpatients, diverticulitis in young patients, immunosuppression, recurrence, elective resection, emergency surgery, and predictive factors.
RESULTS: Some 92 publications were selected for comprehensive review. The review highlighted that computed tomography is the most effective test in the diagnosis and staging of acute diverticulitis; outpatient treatment can be performed for uncomplicated diverticulitis in patients without associated comorbidities; conservative treatment is aimed at those patients with uncomplicated acute diverticulitis; elective surgery must be done on an individual basis; laparoscopic approach for elective treatment of diverticulitis is appropriate but may be technically complex; in perforated diverticulitis, resection with primary anastomosis is a safe procedure that requires experience and should take into account strict exclusion criteria.
CONCLUSION: The heterogeneity of patients with colonic diverticular disease means that both elective and urgent treatment should be tailored on an individual basis.},
}
@article {pmid21837918,
year = {2011},
author = {Ambrosio, MR and Rocca, BJ and Ginori, A and Barone, A and Onorati, M and Lazzi, S},
title = {Long pedunculated colonic polyp with diverticulosis: case report and review of the literature.},
journal = {Pathologica},
volume = {103},
number = {1},
pages = {8-10},
pmid = {21837918},
issn = {0031-2983},
mesh = {Aged ; Colon, Sigmoid/pathology ; Colonic Polyps/diagnosis/*pathology/surgery ; Colonoscopy ; Diagnosis, Differential ; Diverticulosis, Colonic/diagnosis/*pathology ; Female ; Humans ; Intestinal Mucosa/pathology ; },
abstract = {Colonic muco-submucosal elongated polyp is a rare entity (0.39% in an endoscopic polypectomy series). It is an elongated drumstick-shaped lesion characterized by oedematous, loose connective tissue with a dense submucosal layer showing dilation of blood and lymphatic vessels. First described as a polypoid lesion associated with diverticular disease of the sigmoid colon, it was histologically characterized as a separate entity by Kelly in 1991. In that study, the author reported eight cases in which a red or brown mucosal protrusion or polyp were associated with diverticular disease, and described the syndrome as "polypoid prolapsing mucosal folds in diverticular disease". In 1994, Matake et al. described a new entity defined as colonic muco-submucosal elongated polyp. Herein, we describe another case in a 77-year-old woman with abdominal pain, followed by a review of the literature.},
}
@article {pmid21833686,
year = {2011},
author = {Gout, T and Ostör, AJ and Nisar, MK},
title = {Lower gastrointestinal perforation in rheumatoid arthritis patients treated with conventional DMARDs or tocilizumab: a systematic literature review.},
journal = {Clinical rheumatology},
volume = {30},
number = {11},
pages = {1471-1474},
pmid = {21833686},
issn = {1434-9949},
mesh = {Antibodies, Monoclonal, Humanized/*adverse effects/therapeutic use ; Antirheumatic Agents/*adverse effects/therapeutic use ; Arthritis, Rheumatoid/*drug therapy ; Humans ; Intestinal Perforation/*chemically induced ; },
abstract = {Tocilizumab, a monoclonal antibody targeting the IL-6 receptor, has recently been added to the therapeutic armamentarium against rheumatoid arthritis (RA). Despite its overall safety, concerns have been raised regarding diverticular perforation in patients receiving the drug. The aim of our research was to document the incidence of diverticular disease in RA patients treated in the pre-disease-modifying anti-rheumatic drug (DMARD) era, following treatment with conventional DMARDs, and subsequent to tocilizumab therapy. We performed a systematic literature review in MEDLINE, EMBASE, Conference Proceedings Citation Index-Science, Cochrane Central Register of Controlled Trials and Current Controlled Trials up to Nov. 2010. The publication titles and abstracts were independently assessed by two reviewers for relevance and quality, and the review was conducted following guidelines from the Centre for Reviews and Dissemination. In the pre-DMARD period of RA management, where patients were largely treated with NSAIDs and corticosteroids, gastrointestinal (GI) complications were a substantial cause of mortality with diverticulitis and colonic ulcers accounting for almost a third of GI-related deaths. In contrast, our search did not reveal any evidence of diverticular perforation in patients treated with conventional DMARDs. Eighteen cases of lower GI perforation (16 of whom had diverticulitis) have been documented in recent conference proceedings following tocilizumab treatment in clinical trials, with a lower GI perforation rate of 1.9 per 1,000 patient years (PY). This lies between the reported rate of GI perforations for corticosteroids and anti-TNF-α agents in the United Health Care database, with rates of 3.9 per 1,000 PY (95% CI 3.1-4.8) and 1.3 per 1,000 PY (95% CI 0.8-1.9), respectively. The majority of these patients were concurrently prescribed NSAIDs and/or long-term corticosteroids. Traditional DMARD therapy for RA appears not only to have modified the risk of lower GI perforation but prevented it. The risk of diverticular perforation may be slightly higher in patients treated with tocilizumab compared with conventional DMARDs or anti-TNF agents, but lower than that for corticosteroids. The mechanism of action of IL-6 antagonism in the pathophysiology of diverticular perforation has yet to be elucidated.},
}
@article {pmid21831171,
year = {2012},
author = {Farquharson, AL and Chopra, A and Ford, A and Matthews, S and Amin, SN and De Noronha, R},
title = {Incidental focal colonic lesions found on (18)Fluorodeoxyglucose positron emission tomography/computed tomography scan: further support for a national guideline on definitive management.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {2},
pages = {e56-63},
doi = {10.1111/j.1463-1318.2011.02760.x},
pmid = {21831171},
issn = {1463-1318},
mesh = {Adenocarcinoma/*diagnostic imaging/pathology/therapy ; Adenoma/*diagnostic imaging/pathology/therapy ; Aged ; Aged, 80 and over ; Algorithms ; Colonic Neoplasms/*diagnostic imaging/pathology/therapy ; Colonic Polyps/*diagnostic imaging/pathology/therapy ; Colonoscopy ; Female ; Fluorodeoxyglucose F18 ; Humans ; Incidental Findings ; Male ; Middle Aged ; *Multimodal Imaging ; *Positron-Emission Tomography ; Practice Guidelines as Topic ; Predictive Value of Tests ; Radiopharmaceuticals ; Retrospective Studies ; *Tomography, X-Ray Computed ; },
abstract = {AIM: (18)Fluorodeoxyglucose ((18)FDG) positron emission tomography/computed tomography (PET/CT) is an established part of staging in a wide variety of malignancies. Incidental abnormal uptake of (18)FDG of unknown significance is frequently encountered. Therefore, we investigated patients with abnormal colonic uptake of (18)FDG, determined by PET/CT images, using colonoscopy.
METHOD: The radiology reports of all patients referred to a tertiary referral centre for a PET/CT scan were reviewed retrospectively. Patients with abnormal colonic uptake of (18)FDG were identified and the PET/CT findings were correlated with colonoscopic findings.
RESULTS: Of 555 consecutive patients identified over a 26-month period, 53 had abnormal colonic uptake of (18)FDG, as determined by PET/CT images. Twenty-nine were not investigated following discussion in a specialist multidisciplinary (MDT) meeting, according to local protocol. Twenty out of 24 patients investigated by endoscopy had a colonic lesion correlating to the site identified on the PET/CT image: 16 patients had tubulovillous adenomas (nine of which were > 10 mm), two had invasive adenocarcinomas, two had diverticular disease and one had collagenous colitis; no colonic lesion was detected in three. These findings were incidental and not related to the primary diagnosis for which the scan was being performed. Accordingly, a positive predictive value of 83% is associated with the finding of abnormal uptake of (18)FDG on PET/CT images.
CONCLUSION: Incidental abnormal colonic uptake of (18)FDG, determined by a PET/CT scan requires definitive colonic investigation in patients suitable for further treatment because significant colonic pathology is frequently identified. The benefit of this approach should be discussed in specialist MDT meetings and tailored to each patient; however, national guidelines for management are required.},
}
@article {pmid21825886,
year = {2011},
author = {Cima, RR and Pendlimari, R and Holubar, SD and Pattana-Arun, J and Larson, DW and Dozois, EJ and Wolff, BG and Pemberton, JH},
title = {Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 1103 patients.},
journal = {Diseases of the colon and rectum},
volume = {54},
number = {9},
pages = {1076-1081},
doi = {10.1007/DCR.0b013e3182155904},
pmid = {21825886},
issn = {1530-0358},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Female ; Humans ; Laparoscopy/*methods ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Despite its introduction in 1991, laparoscopic colectomy is performed in <10% of United States patients requiring colectomy. Laparoscopic colectomy is avoided principally because of its technical difficulty, steep learning curve, and increased operative times. Hand-assisted laparoscopic colectomy is an alternative technique that addresses these problems while preserving the short-term benefits of laparoscopic colectomy.
OBJECTIVE: To describe the utility and short-term outcomes, we evaluated 1103 patients who underwent hand-assisted laparoscopic colorectal resections over a 5-year period.
DESIGN: This study was a retrospective analysis of prospectively collected data.
SETTINGS: The setting was a single tertiary care institution.
PATIENTS: A total of 1103 consecutive hand-assisted laparoscopic colorectal resections from 2004 to 2009 were identified using a prospectively maintained database.
MAIN OUTCOME MEASURES: Demographics, perioperative variables, and 30-day outcomes were reported. Data are presented as frequency (proportion) or median (interquartile range).
RESULTS: A total of 1103 hand-assisted laparoscopic colorectal resections were documented. Median age of patients was 55 years; 47% were women, and median body mass index was 26.5 (range, 23-34) kg/m. Diagnoses included inflammatory bowel disease (35%), colorectal cancer (31%), diverticular disease (23%), and "other" (11%). Forty-two percent of patients had prior abdominal surgery. Segmental colectomies were performed in 533 (48%) patients, proctocolectomy with ileal pouch-anal anastomosis in 229 (21%), proctocolectomy with end ileostomy in 114 (10%), and "other" in 227 (21%). The conversion rate was 9%. Overall median operative time was 201 (range, 145-269) minutes, and the median postoperative length of stay was 5 (range, 4-7) days. Postoperative complications occurred in 27% and readmissions in 7%; mortality was 0.3%.
LIMITATIONS: This was a single institutional retrospective study.
CONCLUSIONS: Hand-assisted laparoscopic colorectal resection can be performed for numerous indications. It preserves nearly all the benefits of laparoscopic colectomy reported in the literature. With experience, it is associated with significantly reduced operative times. Wider adoption of hand-assisted laparoscopic colorectal surgery would increase the number of patients benefiting from minimal access colorectal surgery.},
}
@article {pmid21801298,
year = {2011},
author = {Roig, JV and Cantos, M and Balciscueta, Z and Uribe, N and Espinosa, J and Roselló, V and García-Calvo, R and Hernandis, J and Landete, F and , },
title = {Hartmann's operation: how often is it reversed and at what cost? A multicentre study.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {13},
number = {12},
pages = {e396-402},
doi = {10.1111/j.1463-1318.2011.02738.x},
pmid = {21801298},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/methods/*statistics & numerical data ; Colectomy/statistics & numerical data ; Colon/surgery ; Colonic Neoplasms/*surgery ; Colostomy/*statistics & numerical data ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures/statistics & numerical data ; Emergency Treatment/statistics & numerical data ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Peritonitis/surgery ; Rectum/surgery ; Retrospective Studies ; Spain ; Surgical Wound Infection/etiology ; Wounds and Injuries/surgery ; },
abstract = {AIM: The study evaluated the rate of reversal of Hartmann's operation after the initial surgery and its morbidity.
METHOD: A multicentre retrospective study was carried out in seven hospitals in the Valencia area of patients who underwent Hartmann's operation from 2004 to 2008. The incidence of reversal was determined.
RESULTS: Four hundred and fifty-two patients of mean age 67.5 ± 15.4 years were included, of whom 78.8% had an emergency operation. The most common diagnosis was cancer (58.6%), although diverticulitis predominated in the emergency setting. At a median follow up of 44 months, 159 (35.2%) patients had undergone reversal, including 16.6% after elective surgery and 40.4% after an emergency Hartmann's procedure (P < 0.001). The most frequent reason why reversal was not done was death (74 [25%] patients). Patients undergoing reversal were younger and had a low ASA risk. Trauma was associated with a higher rate of reversal, followed by diverticular disease. Surgery was performed at a median of 10 months. An open approach with stapled anastomosis was used in most cases. The mortality was 3.5%. Complications occurred in 45.2%, with a 6.2% rate of anastomotic leakage. Complications were associated with age, diabetes mellitus, arteriosclerosis, obesity, smoking, chemotherapy and COPD.
CONCLUSION: Hartmann's reversal was performed in a small percentage of patients, mostly including those with benign disease. It had a significant morbidity.},
}
@article {pmid21790681,
year = {2011},
author = {Granlund, J and Svensson, T and Granath, F and Hjern, F and Ekbom, A and Blomqvist, P and Schmidt, PT},
title = {Diverticular disease and the risk of colon cancer - a population-based case-control study.},
journal = {Alimentary pharmacology & therapeutics},
volume = {34},
number = {6},
pages = {675-681},
doi = {10.1111/j.1365-2036.2011.04782.x},
pmid = {21790681},
issn = {1365-2036},
mesh = {Age Factors ; Aged ; Case-Control Studies ; Colonic Neoplasms/*etiology/mortality ; Diverticulum/*complications ; Female ; Humans ; Male ; Odds Ratio ; Risk Factors ; Sweden ; },
abstract = {BACKGROUND: Colon cancer and diverticular disease are most common in the Western world and their incidences tend to increase with advancing age. The association between the diseases remains unclear.
AIM: To analyse the risk of colon cancer after hospitalisation for diverticular disease.
METHODS: Nationwide case-control study. A total of 41,037 patients with colon cancer during 1992-2006, identified from the Swedish Cancer Register were included. Each case was matched with two control subjects. From the Swedish Inpatient Register, cases and control subjects hospitalised for diverticular disease were identified. Odds ratios (OR) and confidence intervals for receiving a diagnosis of colon cancer after hospital discharge for diverticular disease were calculated. Colon cancer mortality was compared between patients with or without diverticular disease.
RESULTS: Within 6months after an admission due to diverticular disease, OR of having a colon cancer diagnosis were up to 31.49 (19.00-52.21). After 12 months, there was no increased risk. The number of discharges for diverticular disease did not affect the risk. Colon cancer mortality did not differ between patients with and without diverticular disease.
CONCLUSIONS: Diverticular disease does not increase the risk of colon cancer in the long term, and a history of diverticular disease does not affect colon cancer mortality. The increased risk of colon cancer within the first 12months after diagnosing diverticular disease is most likely due to surveillance and misclassification. Examination of the colon should be recommended after a primary episode of symptomatic diverticular disease.},
}
@article {pmid21786094,
year = {2011},
author = {Ichikawa, T and Kawada, S and Hirata, S and Ikeda, S and Sato, Y and Imai, Y},
title = {Initial experience with computed tomographic colonography applied for noncolorectal cancerous conditions.},
journal = {Japanese journal of radiology},
volume = {29},
number = {6},
pages = {386-393},
pmid = {21786094},
issn = {1867-108X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/*diagnostic imaging ; Colonography, Computed Tomographic/*methods ; Female ; Humans ; Male ; Middle Aged ; Rectal Diseases/*diagnostic imaging ; Retrospective Studies ; },
abstract = {PURPOSE: The aim of this study was to asses retrospectively the performance of computed tomography colonography (CTC) for noncolorectal cancerous conditions.
MATERIAL AND METHODS: A total of 44 patients with non-colorectal cancerous conditions underwent CTC. We researched the indications for CTC or present illness and evaluated the CTC imaging findings. We assessed whether diagnosis by CTC reduced conventional colonoscopic examinations.
RESULTS: A total of 47 examinations were performed in 44 patients. The indications for CTC or a present illness were as follows: 15 patients with impossible or incomplete colonoscopy, 7 with diverticular disease, 6 with malignancy (noncolorectal cancer), 6 with Crohn's disease, 4 suspected to have a submucosal tumor on colonoscopy, 2 with ischemic colitis, and 4 with various other diseases. Colonic findings were diagnosed on CTC in 36 examinations, and extracolonic findings were identified in 35 of 44 patients. In all, 17 patients had undergone colonoscopy previously, 9 (52.9%) of whom did not require further colonoscopy by CTC. Five patients underwent colonoscopy after CTC.
CONCLUSION: The indications for CTC were varied for patients with noncolorectal cancerous conditions. CTC examinations could be performed safely. Unlike colonoscopy or CT without preparation, CTC revealed colonic and extracolonic findings and may reduce the indication of colonoscopy in patients with noncolorectal cancerous conditions.},
}
@article {pmid21782225,
year = {2011},
author = {Mosharafa, AA and Torky, MH and El Said, WM and Meshref, A},
title = {Rising incidence of acute prostatitis following prostate biopsy: fluoroquinolone resistance and exposure is a significant risk factor.},
journal = {Urology},
volume = {78},
number = {3},
pages = {511-514},
doi = {10.1016/j.urology.2011.04.064},
pmid = {21782225},
issn = {1527-9995},
mesh = {Acute Disease ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Bacterial Infections/drug therapy/*etiology ; Biopsy, Needle/*adverse effects ; Drug Resistance, Bacterial ; Fluoroquinolones/*therapeutic use ; Humans ; Male ; Middle Aged ; Prostate/*pathology ; Prostatitis/drug therapy/*etiology/microbiology ; Risk Factors ; },
abstract = {OBJECTIVE: To evaluate the frequency and potential risk factors for infection-related complications after transrectal prostate biopsy and to propose adjustments in current antimicrobial prophylaxis recommendations.
METHODS: During 2008-2010, 107 patients underwent transrectal ultrasound-guided biopsies of the prostate at our institution. Charts were reviewed for infection-related complications within 30 days of the procedure. Potential risk factors were evaluated, including age, diabetes mellitus, chronic constipation/diverticular disease, prior use of quinolones, enema and prostatitis, on the pathology report. For patients with acute prostatitis, urine and blood samples were assessed for bacteriology and antibiotic susceptibility.
RESULTS: Of our 107 patients, acute prostatitis developed in 10 (9.3%). The most significant risk factor was prior use of a fluoroquinolone antimicrobial, with acute prostatitis developing in 7 (17.1%) of 41 patients who had used a fluoroquinolone compared with 3 (4.5%) of 66 patients who had not (P=.042). Patients who received an enema before the procedure were slightly less likely to develop prostatitis (P=.061). Of 8 positive specimens, the organisms isolated were Escherichia coli in 6, Klebsiella pneumoniae in 1, and Staphylococcus epidermidis in one. Isolated Gram-negative organisms were fluoroquinolone-resistant in 85.7% of samples.
CONCLUSION: Prior fluoroquinolone intake is a significant risk factor behind a rising incidence of acute prostatitis after transrectal prostate biopsy. Identified pathogens are mostly Gram-negative organisms with a high rate of fluoroquinolone resistance. Alternative prophylaxis regimens for the biopsy procedure should be considered in patients with recent quinolone intake.},
}
@article {pmid21779829,
year = {2011},
author = {Raue, W and Paolucci, V and Asperger, W and Albrecht, R and Büchler, MW and Schwenk, W and , },
title = {Laparoscopic sigmoid resection for diverticular disease has no advantages over open approach: midterm results of a randomized controlled trial.},
journal = {Langenbeck's archives of surgery},
volume = {396},
number = {7},
pages = {973-980},
pmid = {21779829},
issn = {1435-2451},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/diagnosis/*surgery ; Elective Surgical Procedures/adverse effects/methods ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/adverse effects/*methods ; Laparotomy/adverse effects/methods ; Male ; Middle Aged ; Pain, Postoperative/physiopathology ; Postoperative Complications/physiopathology/surgery ; Prospective Studies ; Reference Values ; Reoperation ; Severity of Illness Index ; Sigmoid Diseases/diagnosis/*surgery ; Sigmoidoscopy/adverse effects/*methods ; Single-Blind Method ; Statistics, Nonparametric ; Time Factors ; Treatment Outcome ; },
abstract = {PURPOSE: Elective laparoscopic sigmoid resection (LSR) for symptomatic diverticular disease is supposed to have significant short-term advantages compared to open surgery (open sigmoid resection (OSR)). This opinion is rather based on inferences from trials on colonic resections for malignant diseases or minor laparoscopic surgery. This randomized controlled trial was conducted to compare quality of life as well as morbidity and clinical outcome after LSR vs. OSR following a midterm follow-up period.
METHODS: Patients presenting with a symptomatic sigmoid diverticular disease stage II/III (Stock/Hansen) were randomly allocated to LSR or OSR in a prospective multicenter trial. Endpoints included the quality of life assessed with a standardized questionnaire, postoperative mortality, and complications within the follow-up of 12 months after operation.
RESULTS: A total of 143 patients randomized between 2005 and 2008 in 12 centers could be analyzed. The recruitment was aborted for nonachievement of the planned sample size. Seventy-five patients were allocated to LSR, and 68 received OSR. Nine operations were converted to OSR (9%) and analyzed as intention to treat. Groups were comparable for age, gender, body mass index, comorbidity, and indication for surgery. Operation time was longer for LSR (p < 0.001). Quality of life did not differ between LSR and OSR, either during the early postoperative course or after 12 months (p = 0.172). Also, mortality and morbidity, including subgroups of major and minor morbidity, were compared.
CONCLUSION: LSR was not superior to OSR regarding postoperative quality of life and incidence of complications in this trial.},
}
@article {pmid21774880,
year = {2011},
author = {Arya, N and Bair, D and Arya, P and Pham, J},
title = {Community experience of colonic stenting in patients with acute large bowel obstructions.},
journal = {Canadian journal of surgery. Journal canadien de chirurgie},
volume = {54},
number = {4},
pages = {282-285},
pmid = {21774880},
issn = {1488-2310},
mesh = {Aged ; Aged, 80 and over ; Cohort Studies ; Colonic Diseases/etiology/pathology/*surgery ; *Endoscopy ; Female ; *Hospitals, Community ; Humans ; Intestinal Obstruction/etiology/pathology/*surgery ; Male ; Middle Aged ; Patient Selection ; *Postoperative Complications ; *Stents ; Treatment Outcome ; },
abstract = {BACKGROUND: Self-expandable metal stents (SEMS) can provide temporary relief of acute large bowel obstructions. Placement of SEMS creates the opportunity for semi-elective 1-stage surgical resections, use of possible adjuvant therapy or palliative relief of malignant obstructions. Our aim was to assess the likelihood of success and possible complication rates of SEMS insertion in a community hospital setting in patients presenting with large bowel obstructions.
METHODS: We conducted a retrospective chart review at a single community-based hospital. This review addressed the technical success in deployment of the SEMS, clinical success defined by relief of the obstruction, procedure-related complications, surgical interventions and completion of adjuvant therapy for patients with large bowel obstructions.
RESULTS: In a 34-month period, 16 patients underwent 16 SEMS procedures. The average age of patients was 69.4 years and 7 (44%) were women. Thirteen patients had intrinsic colorectal cancers, 1 had an extracolonic lesion (ovarian cancer) and 2 had strictures due to diverticular disease. Technical success occurred in all 16 patients, but only 15 (94%) had clinical success. No procedure-related deaths (defined as death within 7 days) occurred. Palliative stenting occurred in 5 patients (31%). Eleven patients (69%) eventually had surgery. Stenting allowed a window for neoadjuvant therapy in 4 patients. Ten of 11 patients (91%) had a 1-stage procedure. One patient had a cecal perforation presenting 2 days after SEMS. This patient received a defunctioning ileostomy.
CONCLUSION: In appropriate patients with large bowel obstructions, SEMS proced ures can be safely and effectively performed in a community-based setting.},
}
@article {pmid21771850,
year = {2011},
author = {Crowe, FL and Appleby, PN and Allen, NE and Key, TJ},
title = {Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians.},
journal = {BMJ (Clinical research ed.)},
volume = {343},
number = {},
pages = {d4131},
pmid = {21771850},
issn = {1756-1833},
support = {C570/A11691//Cancer Research UK/United Kingdom ; },
mesh = {Adult ; Age Distribution ; Aged, 80 and over ; Body Mass Index ; Diet/*statistics & numerical data ; Diet, Vegetarian/statistics & numerical data ; Dietary Fiber/*statistics & numerical data ; Diverticulum/*epidemiology ; Female ; Humans ; Intestinal Diseases/*epidemiology ; Intestine, Large ; Intestine, Small ; Life Style ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Sex Distribution ; United Kingdom/epidemiology ; Young Adult ; },
abstract = {OBJECTIVE: To examine the associations of a vegetarian diet and dietary fibre intake with risk of diverticular disease.
DESIGN: Prospective cohort study.
SETTING: The EPIC-Oxford study, a cohort of mainly health conscious participants recruited from around the United Kingdom.
PARTICIPANTS: 47,033 men and women living in England or Scotland of whom 15,459 (33%) reported consuming a vegetarian diet.
MAIN OUTCOME MEASURES: Diet group was assessed at baseline; intake of dietary fibre was estimated from a 130 item validated food frequency questionnaire. Cases of diverticular disease were identified through linkage with hospital records and death certificates. Hazard ratios and 95% confidence intervals for the risk of diverticular disease by diet group and fifths of intake of dietary fibre were estimated with multivariate Cox proportional hazards regression models.
RESULTS: After a mean follow-up time of 11.6 years, there were 812 cases of diverticular disease (806 admissions to hospital and six deaths). After adjustment for confounding variables, vegetarians had a 31% lower risk (relative risk 0.69, 95% confidence interval 0.55 to 0.86) of diverticular disease compared with meat eaters. The cumulative probability of admission to hospital or death from diverticular disease between the ages of 50 and 70 for meat eaters was 4.4% compared with 3.0% for vegetarians. There was also an inverse association with dietary fibre intake; participants in the highest fifth (≥25.5 g/day for women and ≥26.1 g/day for men) had a 41% lower risk (0.59, 0.46 to 0.78; P<0.001 trend) compared with those in the lowest fifth (<14 g/day for both women and men). After mutual adjustment, both a vegetarian diet and a higher intake of fibre were significantly associated with a lower risk of diverticular disease.
CONCLUSIONS: Consuming a vegetarian diet and a high intake of dietary fibre were both associated with a lower risk of admission to hospital or death from diverticular disease.},
}
@article {pmid21771832,
year = {2011},
author = {Humes, DJ and West, J},
title = {Diet and risk of diverticular disease.},
journal = {BMJ (Clinical research ed.)},
volume = {343},
number = {},
pages = {d4115},
doi = {10.1136/bmj.d4115},
pmid = {21771832},
issn = {1756-1833},
mesh = {*Diet, Vegetarian ; Dietary Fiber/*administration & dosage ; Diverticulum, Colon/*epidemiology ; Humans ; Risk Factors ; },
}
@article {pmid21770683,
year = {2011},
author = {Villanacci, V and Manenti, S and Antonelli, E and Chiudinelli, M and Giuliano, V and Bassotti, G},
title = {Non-IBD colitides: clinically useful histopathological clues.},
journal = {Revista espanola de enfermedades digestivas},
volume = {103},
number = {7},
pages = {366-372},
doi = {10.4321/s1130-01082011000700006},
pmid = {21770683},
issn = {1130-0108},
mesh = {Colitis/*diagnosis/*pathology ; Colitis, Collagenous/diagnosis/pathology ; Colitis, Ischemic/diagnosis/pathology ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis/pathology ; Enterocolitis, Pseudomembranous/diagnosis/pathology ; Humans ; Hypersensitivity/complications ; Infections/complications ; Intestinal Mucosa/pathology ; },
abstract = {Apart from inflammatory bowel diseases (IBD), there are several other form of colitis that may resemble macroscopically IBD, entering the differential diagnosis. These forms are represented by infectious colitis, ischemic colitis, pseudomembranous colitis, colitis related to diverticular disease, colitis related to mucosal prolapse, drug colitis, allergic colitis, and microscopic colitis. However, to distinguish between these forms is not always easy, and it frequently requires a strict interrelationship between the pathologist and the gastroenterologist. Here we discuss the more frequent forms of non- inflammatory bowel diseases colitides, trying to give useful hints for helping the clinician to better understand the extent to which the pathologist is called to give a definitive response in the differential diagnosis of these entities.},
}
@article {pmid21769075,
year = {2011},
author = {Tursi, A and Elisei, W and Giorgetti, G and Aiello, F and Brandimarte, G},
title = {Role of fecal calprotectin in the diagnosis and treatment of segmental colitis associated with diverticulosis.},
journal = {Minerva gastroenterologica e dietologica},
volume = {57},
number = {3},
pages = {247-255},
pmid = {21769075},
issn = {1121-421X},
mesh = {Aged ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Biomarkers/metabolism ; Case-Control Studies ; Colitis, Ulcerative/*diagnosis/drug therapy/metabolism ; Colonoscopy ; Comorbidity ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis/*drug therapy ; Diverticulosis, Colonic/*complications/diagnosis/drug therapy ; Feces/*chemistry ; Female ; Follow-Up Studies ; Humans ; Irritable Bowel Syndrome/*diagnosis/drug therapy/metabolism ; Leukocyte L1 Antigen Complex/*metabolism ; Male ; Mesalamine/therapeutic use ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity ; Severity of Illness Index ; Treatment Outcome ; },
abstract = {AIM: Information about fecal calprotectin (FC) in segmental colitis associated with diverticulosis (SCAD) is lacking. We assessed FC in SCAD, comparing it healthy controls (HC), irritable bowel syndrome (IBS), diverticular disease (DD), ulcerative colitis (UC). Moreover, we compared FC levels in different degrees of SCAD and assessed FC SCAD before and after treatment.
METHODS: Twenty-seven consecutive patients with a new endoscopic diagnosis of SCAD, and 16 patients for each control group, underwent to FC assessment. FC was assessed by semi-quantitative method.
RESULTS: FC was not increased in HC and in IBS patients, whilst it was increased in DD, SCAD, and UC. FC concentration was higher in SCAD and UC than in DD (SCAD vs. DD, P=0.05). No difference was found in FC concentration between SCAD and UC (P=0.213), as well as between different degree of SCAD (P= 0.178). After treatment, FC values decreased to normal values in all patients obtaining remission (P<0.0005). Three patients experienced still symptoms (one SCAD type B and two SCAD type D patients), and in all of them FC was still detectable.
CONCLUSION: FC may be useful in differentiating SCAD from functional syndromes. Moreover, it may be useful in assessing response to therapy.},
}
@article {pmid21732208,
year = {2011},
author = {Masoomi, H and Buchberg, B and Nguyen, B and Tung, V and Stamos, MJ and Mills, S},
title = {Outcomes of laparoscopic versus open colectomy in elective surgery for diverticulitis.},
journal = {World journal of surgery},
volume = {35},
number = {9},
pages = {2143-2148},
pmid = {21732208},
issn = {1432-2323},
mesh = {Adult ; Aged ; Cohort Studies ; Colectomy/adverse effects/*methods ; Confidence Intervals ; Databases, Factual ; Diverticulitis, Colonic/diagnosis/*surgery ; Elective Surgical Procedures/*methods ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/adverse effects/*methods ; Laparotomy/adverse effects/*methods ; Length of Stay ; Male ; Middle Aged ; Odds Ratio ; Pain, Postoperative/physiopathology ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome ; },
abstract = {BACKGROUND: The role of laparoscopy in the management of diverticular disease is evolving. Concerns were raised in the past because laparoscopic resection for diverticulitis is often difficult and occasionally hazardous. This study was undertaken to evaluate the difference in overall outcomes between elective open and laparoscopic surgery with or without anastomosis for diverticulitis.
METHODS: Using the National Inpatient Sample (NIS) database, clinical data of patients who underwent elective open and laparoscopic surgery (lap) for diverticulitis from 2002 to 2007 were collected and analyzed. Patients who underwent emergent surgery were excluded.
RESULTS: A total of 124,734 patients underwent elective surgery for diverticulitis: open, 110,172 (88.3%); lap, 14,562 (11.7%). The overall intraoperative complication rate was significantly lower in the laparoscopy group (0.63% vs. 1.15%, P < 0.01). However, there was no significant difference observed in ureteral injury between groups (open, 0.17%; lap, 0.12%, P = 0.15). All evaluated postoperative complications (ileus, abdominal abscess, leak, wound infection, bowel obstruction, urinary tract infection, pneumonia, respiratory failure, venous thromboembolism) were significantly higher for the open procedures. The laparoscopy group had a shorter mean hospital stay (lap, 5.06 days; open, 6.68 days, P < 0.01) and lower total hospital charges (lap, $36,389; open, $39,406, P < 0.01) than the open group. Also, mortality was four times higher in the open group (open, 0.54%; lap, 0.13%, P < 0.01).
CONCLUSIONS: The laparoscopic operation was associated with lower morbidity, lower mortality, shorter hospital stay, and lower hospital charges compared to the open operation for diverticulitis. Elective laparoscopic surgery for diverticulitis is safe and can be considered the preferred operative option.},
}
@article {pmid21692963,
year = {2012},
author = {Niikura, R and Nagata, N and Yamada, A and Akiyama, J and Shimbo, T and Uemura, N},
title = {Recurrence of colonic diverticular bleeding and associated risk factors.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {3},
pages = {302-305},
doi = {10.1111/j.1463-1318.2011.02611.x},
pmid = {21692963},
issn = {1463-1318},
mesh = {Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Cohort Studies ; Colonic Diseases/diagnosis/*etiology/therapy ; Diverticulum, Colon/*pathology ; Female ; Gastrointestinal Hemorrhage/diagnosis/*etiology/therapy ; Humans ; Hypertension/complications ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/adverse effects ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Risk Factors ; },
abstract = {AIM: Colonic diverticular bleeding often recurs, but the risk factors remain unclear. Our aim was to identify risk factors for recurrence in patients with diverticular bleeding.
METHOD: Seventy-two hospitalized patients who were diagnosed with diverticular bleeding between 2004 and 2008 were analyzed. Rebleeding was considered as the main outcome measure, with the duration until recurrence identified from medical records. Potential risk factors for rebleeding, such as underlying pathologies, medication and smoking and drinking habits, were investigated from the medical records on initial admission.
RESULTS: Of the 72 patients, 19 had a diverticular disease on the right, 16 on the left side and 37 on both sides of the colon. Recurrence was identified in 27 (38%) patients at a median interval of 1535 days. The cumulative incidence of rebleeding at 6, 12 and 24 months was 15%, 20% and 33%. Multivariate analysis revealed nonsteroid anti-inflammatory drugs (NSAIDs) (hazard ratio (HR), 2.57; 95% confidence interval (CI), 0.89-7.46; P=0.08), antiplatelet drugs (HR, 2.39; 95% CI, 1.01-5.67; P=0.05) and hypertension (HR, 4.16; 95% CI, 1.22-14.2; P=0.02) to be risk factors for rebleeding.
CONCLUSION: Patients with colonic diverticular bleeding show high recurrence rates within a short period. Risk factors for recurrence have been identified as the use of NSAIDs or antiplatelet drugs and hypertension.},
}
@article {pmid21689339,
year = {2012},
author = {Cirocchi, R and Farinella, E and Trastulli, S and Sciannameo, F and Audisio, RA},
title = {Elective sigmoid colectomy for diverticular disease. Laparoscopic vs open surgery: a systematic review.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {6},
pages = {671-683},
doi = {10.1111/j.1463-1318.2011.02666.x},
pmid = {21689339},
issn = {1463-1318},
mesh = {Colectomy/adverse effects/*methods ; Colon, Sigmoid ; Diverticulitis/*surgery ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures/methods ; Humans ; *Laparoscopy/adverse effects ; },
abstract = {AIM: A meta-analysis of nonrandomized studies and one randomized trial was conducted to compare laparoscopic surgery with open surgery in the elective treatment of patients with diverticular disease.
METHOD: Published randomized and controlled clinical trials that directly compared elective open (OSR) with laparoscopic surgical resection (LSR) in patients with diverticular disease were identified using the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. End-points included 30-day mortality and morbidity and were compared by determining the relative risk ratio, odds ratio, and the absolute effects.
RESULTS: Eleven nonrandomized studies of 1430 patients were identified and included in the meta-analysis. There was only one randomized study, which included 104 patients. The meta-analysis suggested that elective LSR was a safe and appropriate option for patients with diverticular disease and was associated with lower overall morbidity (P = 0.01) and minor complication rate (P = 0.008).
CONCLUSION: The results of the nonrandomized study generally agreed with those of the randomized study, except for the incidence of minor complications, which was higher in both the LSR and OSR groups of the randomized study. In this study, the high overall morbidity of 42.3% reported in the LSR group is a cause for concern.},
}
@article {pmid21689306,
year = {2012},
author = {Steele, SR and Stein, SL and Bordeianou, LG and Johnson, E and Herzig, DO and Champagne, BJ and , },
title = {The impact of practice environment on laparoscopic colectomy utilization following colorectal residency: a survey of the ASCRS Young Surgeons.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {14},
number = {3},
pages = {374-381},
doi = {10.1111/j.1463-1318.2011.02614.x},
pmid = {21689306},
issn = {1463-1318},
mesh = {Adult ; Colectomy/*methods ; Colorectal Surgery/education ; Female ; *Hospitals, University ; Humans ; Internship and Residency ; Laparoscopy/*statistics & numerical data ; Male ; Practice Patterns, Physicians'/*statistics & numerical data ; *Private Practice ; Prospective Studies ; Self Report ; United States ; },
abstract = {AIM: It is often thought that practice patterns are different in private (PP) vs university hospital (UH) settings. We aimed to describe the impact of practice environment on the type of laparoscopic colectomy procedures performed by graduating colorectal surgeons.
METHOD: A review was carried out of prospectively gathered self-reported questionnaire data. Graduates of American Society of Colon and Rectal Surgeons' (ASCRS)-approved colorectal residencies from 2004 to 2008 underwent an on-line survey, developed by the ASCRS Young Surgeons' Committee.
RESULTS: About 177 (52%) of 342 graduates surveyed responded. Practice setting data were available for 157 (89%) surgeons. Gender, geographical location and age were similar in both cohorts. PP surgeons utilized a laparoscopic approach more often for rectal cancer (37% vs 19%; P=0.003). There was no significant difference in the rate of laparoscopic surgery in colon cancer, diverticular disease, inflammatory bowel disease, Clostridium difficile or emergency surgery. PP surgeons operated more often with a partner (43% vs 8%) or surgical assistant (13% vs 4%; both P<0.001), while UH surgeons had a colorectal resident (10% vs 21%) or general surgery resident (15% vs 55%; both P<0.001). Impediments to performing laparoscopic surgery for PP surgeons included a perceived lack of hospital equipment (33% vs 20%) and support (29% vs 17%; both P<0.05). Perception of personal experience, access to trained assistants, financial reimbursement, length of surgery and patient availability were equivalent in both groups.
CONCLUSION: While differences such as type of assistant and impediments to laparoscopic utilization exist between PP- and UH-based practices, early laparoscopic practice patterns remain similar. PP surgeons more frequently perform laparoscopic resection for rectal cancer and with hand-assistance. Despite differences, newly trained colorectal surgeons in both settings utilize and require laparoscopic skills.},
}
@article {pmid21679582,
year = {2011},
author = {de Campos-Lobato, LF and Alves-Ferreira, PC and Geisler, DP and Kiran, RP},
title = {Benefits of laparoscopy: does the disease condition that indicated colectomy matter?.},
journal = {The American surgeon},
volume = {77},
number = {5},
pages = {527-533},
pmid = {21679582},
issn = {1555-9823},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Colectomy/*methods/mortality ; Colorectal Neoplasms/mortality/pathology/*surgery ; Crohn Disease/diagnosis/mortality/*surgery ; Databases, Factual ; Diverticulum, Colon/diagnosis/mortality/*surgery ; Elective Surgical Procedures/methods/mortality ; Female ; Follow-Up Studies ; Hospital Mortality/trends ; Humans ; Laparoscopy/*methods/mortality ; Laparotomy/*methods/mortality ; Length of Stay/trends ; Middle Aged ; Postoperative Complications/epidemiology/physiopathology ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Treatment Outcome ; Young Adult ; },
abstract = {The benefits of laparoscopic (LC) over open colectomy (OC) have been well characterized for a variety of conditions. Whether the relative benefits of LC differ for different conditions has not been previously investigated. The aim of this study was to identify whether there are differences in benefits of LC for colon cancer (CC), Crohn's disease (CD), and diverticular disease (DD). Data of patients with CC, CD, and DD undergoing elective colectomy from January 2000 to December 2007 were identified from departmental databases. Patients with CC, CD, and DD undergoing LC were matched 1:1 for diagnosis, gender, body mass index, surgical procedure, American Society of Anesthesiologists scale, and date of surgery to patients undergoing OC. TNM stage was also matched for patients with CC. Two hundred eighty-nine patients undergoing LC (CC, 93; CD, 140; DD, 56) were matched 1:1 to 289 patients undergoing OC. Median age was 49 years (range, 14 to 91 years) in LC and 52 years (range, 14 to 98 years) in OC (P = 0.35). All other matched criteria were also similar in both groups. The conversion rate to OC was 13 per cent (n = 36). Patients undergoing LC had significantly shorter lengths of stay (LOS) (3 days [range, 1 to 70 days] vs 6 days [range, 1 to 37 days], P < 0.001) and lower estimated blood loss (EBL) (100 mL [range, 10 to 1750 mL] vs 200 mL [range, 10 to 1700 mL], P < 0.001). Median operative time was similar in both groups (LC: 145 minutes [range, 35 to 431 minutes] vs OC: 135 minutes [range, 23 to 485 minutes], P = 0.54). The conversion rate was lower for DD (2%) when compared with CC (18.9%) and CD (13.4%). Improvement in EBL with LC was least pronounced in patients with CD and most pronounced in patients with DD (P interaction < 0.001). In the LC group, patients with DD presented less postoperative complications (P = 0.009). LC results in reduced LOS and EBL with similar complications rates when compared with OC. The benefits of LC are more pronounced in DD when compared with CD and CC.},
}
@article {pmid21678108,
year = {2012},
author = {Lakatos, G and Sipos, F and Miheller, P and Hritz, I and Varga, MZ and Juhász, M and Molnár, B and Tulassay, Z and Herszényi, L},
title = {The behavior of matrix metalloproteinase-9 in lymphocytic colitis, collagenous colitis and ulcerative colitis.},
journal = {Pathology oncology research : POR},
volume = {18},
number = {1},
pages = {85-91},
pmid = {21678108},
issn = {1532-2807},
mesh = {Adult ; Aged ; Analysis of Variance ; Colitis, Collagenous/*enzymology/genetics ; Colitis, Lymphocytic/*enzymology/genetics ; Colitis, Ulcerative/*enzymology/genetics ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunohistochemistry ; Male ; Matrix Metalloproteinase 9/genetics/*metabolism ; Middle Aged ; Real-Time Polymerase Chain Reaction ; Up-Regulation ; },
abstract = {Matrix metalloproteinases play an important role in extracellular matrix remodelling. It has been proposed that matrix metalloproteinase-9 (MMP-9) is involved in epithelial damage in ulcerative colitis (UC). However, to our knowledge, no data are available in terms of MMP-9 expression in microscopic colitis. Determination of mucosal protein expression levels of MMP-9 in lymphocytic colitis (LC), collagenous colitis (CC) and UC. MMP-9 immunohistochemical expressions were analyzed in paraffin-embedded tissue samples by immunohistochemistry including patients with LC, CC, UC, active diverticulitis, inactive diverticular disease and healthy control subjects. UC was also subgrouped according to the severity of inflammation. Immunostaining was determined semiquantitatively. Independent colonic biopsies from healthy and severe UC cases were used for gene expression analyses. For further comparison MMP-9 serum antigen levels were also determined in patients with UC and control patients without macroscopic or microscopic changes during colonoscopy. MMP-9 mucosal expression was significantly higher in UC (26.7 ± 19.5%) compared to LC (6.6 ± 9.3%), CC (6.4 ± 7.6%), active diverticulitis (5.33 ± 2.4%), inactive diverticular disease (5.0 ± 2.2%) and controls (6.3 ± 2.6%) (P < 0.001). The immunohistochemical expression of MMP-9 in LC and CC was similar as compared to controls. MMP-9 expression was significantly higher in each inflammatory group of UC compared to controls (mild: 11.0 ± 2.8%, moderate: 23.9 ± 3.7%, severe UC: 52.6 ± 3.9% and 6.3 ± 2.6%, respectively, P < 0.005). The gene expression microarray data and RT-PCR results demonstrated a significantly higher expression of MMP-9 in severely active UC compared to healthy controls (P < 0.001). Significantly higher MMP-9 serum antigen concentrations were observed in UC patients compared with the control group (P < 0.05). MMP-9 seems to play no role in the inflammatory process of LC and CC. In contrast, the mucosal up-regulation of MMP-9 correlated with the severity of inflammation in UC. The increased MMP-9 expression could contribute to the severity of mucosal damage in active UC.},
}
@article {pmid21613363,
year = {2011},
author = {Smith, J and Humes, DJ and Spiller, RC},
title = {Should we treat uncomplicated symptomatic diverticular disease with fibre?.},
journal = {BMJ (Clinical research ed.)},
volume = {342},
number = {},
pages = {d2951},
doi = {10.1136/bmj.d2951},
pmid = {21613363},
issn = {1756-1833},
mesh = {Dietary Fiber/*administration & dosage ; Diverticulitis/*diet therapy ; Evidence-Based Medicine ; Humans ; State Medicine ; Uncertainty ; United Kingdom ; },
}
@article {pmid21605507,
year = {2010},
author = {El Zarrok Elgazwi, K and Baca, I and Grzybowski, L and Jaacks, A},
title = {Laparoscopic sigmoidectomy for diverticulitis: a prospective study.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {14},
number = {4},
pages = {469-475},
pmid = {21605507},
issn = {1086-8089},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/*surgery ; Female ; Follow-Up Studies ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Surgical treatment of complicated colonic diverticular disease is still debatable. The aim of this prospective study was to evaluate the outcome of laparoscopic sigmoid colectomy in patients with diverticulitis. Patients offered laparoscopic surgery presented with acute complicated diverticulitis (Hinchey type I, II, III), chronically recurrent diverticulitis, bleeding, or sigmoid stenosis caused by chronic diverticulitis.
METHOD: All patients who underwent laparoscopic colectomy within a 12-year period were prospectively entered into a database registry. One-stage laparoscopic resection and primary anastomosis constituted the planned procedure. A 4-trocar approach with suprapubic minilaparotomy was performed. Main data recorded were age, sex, postoperative pain, return of bowel function, operation time, duration of hospital stay, and early and late complications.
RESULTS: During the study period, 260 sigmoid colectomies were performed for diverticulitis. The cohort included 104 male and 156 female patients; M to F ratio was 4:6. Postoperative pain was controlled by NSAIDs or weak opioid analgesia. Fifteen patients (5.7%) required conversion from laparoscopic to open colectomy. The most common reasons for conversion were directly related to the inflammatory process, abscess, and peritonitis. Mean operative time was 130±54. Average postoperative hospital stay was 10±3 days. A longer hospital stay was recorded for Hinchey type IIb patients. Complications were recorded in 30 patients (11.5%). The most common complications that required reoperation were hemorrhage in 2 patients (0.76) and anastomotic leak in 5 patients (only 3 of them required reoperation). The mortality among them was 2 patients (0.76%).
CONCLUSIONS: Laparoscopic surgery for diverticular disease is safe, feasible, and effective. Therefore, laparoscopic colectomy has replaced open resection as standard surgery for recurrent and complicated diverticulitis at our institution.},
}
@article {pmid21604093,
year = {2011},
author = {Huettner, F and Pacheco, PE and Doubet, JL and Ryan, MJ and Dynda, DI and Crawford, DL},
title = {One hundred and two consecutive robotic-assisted minimally invasive colectomies--an outcome and technical update.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {15},
number = {7},
pages = {1195-1204},
pmid = {21604093},
issn = {1873-4626},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/methods/*statistics & numerical data ; Colorectal Neoplasms/*surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Robotics/*statistics & numerical data ; Treatment Outcome ; United States ; Young Adult ; },
abstract = {BACKGROUND: The objective of this study was to review 102 consecutive robotic colectomies at our institution. We evaluated the 8-year experience of one surgeon (DLC) in Peoria, IL using the da Vinci system.
METHODS: An IRB-approved retrospective review was performed. Results were compared with the literature. Changes in technique over the years were evaluated.
RESULTS: One hundred and two robotic colectomies, right (59) and sigmoid (43), were performed. Mean age is 63.5 years and mean BMI 27.4 kg/m². Preoperative indications are polyps (53), diverticular disease (27), cancer (19), and carcinoid (3). Mean total case time (TCT) for all cases is 219.6 ± 45.1 (50-380) min, and mean robot operating time (ROT) is 126.6 ± 41.6 (12-306) min. Operative times for Right: Port setup time (PST) 32.4 ± 10.5 (20-64) min, ROT 145.2 ± 39.6 (53-306) min, TCT 212.3 ± 46.4 (50-380) min; times for sigmoid: PST 31.2 ± 9.6 (10-57) min, ROT 101.2 ± 29.2 (12-165) min, TCT 229.7 ± 41.6 (147-323) min. Median length of stay for all patients is 3 (2-27) days. The overall complication rate is 18.6%, the overall conversion rate 8.8%, and the anastomotic leak rate is 0.98%. Residents PGY 1-5 participated in 61 cases (59.8%).
CONCLUSION: We report our updated procedural sequence and technical alterations. Experience has allowed residents to evolve to be primary surgeons. We add our results to the current robotic literature.},
}
@article {pmid21602969,
year = {2011},
author = {Yang, HY and Sun, WY and Lee, TG and Lee, SJ},
title = {A case of colovesical fistula induced by sigmoid diverticulitis.},
journal = {Journal of the Korean Society of Coloproctology},
volume = {27},
number = {2},
pages = {94-98},
pmid = {21602969},
issn = {2093-7830},
abstract = {Colonic diverticulosis has continuously increased, noticeably left-sided diseases, in Korea. A colovesical fistula is an uncommon complication of diverticulitis, and its most common cause is diverticular disease. Confirmation of its presence generally depends on clinical findings, such as pneumaturia and fecaluria. The primary aim of a diagnostic workup is not to observe the fistular tract itself but to find the etiology of the disease so that an appropriate therapy can be initiated. We present here the case of a 79-year-old man complaining of pneumaturia and fecaluria. On abdomen and pelvis CT, the patient was diagnosed as having a colovesical fistula due to sigmoid diverticulitis. After division of the adhesion between the sigmoid colon and the bladder, the defect of the bladder wall was repaired by simple closure. The colonic defect was treated with a segmental resection, including the rectosigmoid junction. The patient is doing well at 6 months after the operation and shows no evidence of recurrence of the fistula.},
}
@article {pmid21567193,
year = {2011},
author = {Tursi, A and Joseph, RE and Streck, P},
title = {Expanding applications: the potential usage of 5-aminosalicylic acid in diverticular disease.},
journal = {Digestive diseases and sciences},
volume = {56},
number = {11},
pages = {3112-3121},
pmid = {21567193},
issn = {1573-2568},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulitis/*drug therapy ; Gastrointestinal Agents/therapeutic use ; Humans ; Mesalamine/*therapeutic use ; Probiotics/therapeutic use ; Remission Induction ; Rifamycins/therapeutic use ; Rifaximin ; },
abstract = {Diverticular disease is a common bowel condition, the pathogenesis of which is incompletely understood. Acute exacerbations of diverticular disease usually require dietary changes, antibiotic therapy, and may necessitate urgent surgery. Approximately 25-33% of patients experience symptomatic and acute inflammatory disease recurrence, suggesting that current long-term management is inadequate. Because inflammatory complications of diverticular disease, including diverticulitis, are similarities to inflammatory bowel diseases, evidence suggests that patients may respond to anti-inflammatory therapies used in these conditions. Here, we explore the rationale and evidence for use of inflammatory bowel disease treatment, namely 5-aminosalicylic acid (5-ASA; mesalamine), in diverticular disease, and review clinical data on the efficacy of mesalamine either alone or in combination with other agents for the treatment of diverticular disease. PubMed and conference abstracts were searched for clinical studies examining the use of mesalamine in treating diverticular disease. Studies were evaluated for treatment efficacy in symptom reduction, recurrence prevention, or improving quality of life. The results of our search suggest that single-agent mesalamine can reduce diverticular disease symptoms and improve quality of life more effectively than antibiotic treatment alone. Mesalamine in combination with antibiotics can also reduce symptoms and improve quality of life with greater efficacy than either treatment alone. Combining mesalamine and probiotics treatments may reduce recurrent attacks of diverticular disease. Further randomized, well-controlled studies are required for validation; however, it seems that mesalamine is an important agent in future diverticular disease management.},
}
@article {pmid21560647,
year = {2011},
author = {Levchenko, SV},
title = {[Etiology and pathogenesis of diverticular disease of the colon].},
journal = {Eksperimental'naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology},
volume = {},
number = {2},
pages = {93-96},
pmid = {21560647},
issn = {1682-8658},
mesh = {Age Factors ; Dietary Fiber/administration & dosage ; Diverticulum, Colon/diagnostic imaging/*etiology/immunology ; Humans ; Radiography ; Risk Factors ; Surveys and Questionnaires ; },
abstract = {The article presents the literature on the etiology and pathogenesis of diverticular disease, a comparison of opposing points of view are presented results of their research.},
}
@article {pmid21551188,
year = {2012},
author = {Humes, DJ and West, J},
title = {Role of acute diverticulitis in the development of complicated colonic diverticular disease and 1-year mortality after diagnosis in the UK: population-based cohort study.},
journal = {Gut},
volume = {61},
number = {1},
pages = {95-100},
doi = {10.1136/gut.2011.238808},
pmid = {21551188},
issn = {1468-3288},
mesh = {Abscess/etiology/mortality ; Acute Disease ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cohort Studies ; Constriction, Pathologic/etiology ; Diverticulitis, Colonic/*complications/mortality ; Female ; Humans ; Intestinal Fistula/etiology/mortality ; Intestinal Obstruction/etiology/mortality ; Intestinal Perforation/etiology/mortality ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Proportional Hazards Models ; Risk ; United Kingdom/epidemiology ; },
abstract = {OBJECTIVE: To determine the risk of developing complicated colonic diverticular disease (CCDD) with prior episodes of acute diverticulitis and determine the mortality of the spectrum of CCDD.
DESIGN: Population-based cohort study.
SETTING: Computerised records from the General Practice Research Database linked to Hospital Episode Statistics data from the UK.
PARTICIPANTS: Patients and controls registered in the General Practice Research Database from 1990 to 2007.
MAIN OUTCOME MEASURES: Mortality was calculated and Cox regression modelling used to provide adjusted HRs and 95% CI. Logistic regression was used to model the effect of prior acute diverticulitis on the development of complications.
RESULTS: 2950 patients (1872 (63.5%) female) had a diagnosis of CCDD (8739 controls). A total of 1042 (35.3%) patients died compared with 2062 (23.6%) controls. Most excess deaths occurred in the first year after the complication. Patients with a perforation/abscess had a 4.5-fold increase in 1-year mortality (HR 4.55, 95% CI 3.74 to 5.52) compared with the general population, whereas those with a fistula or stricture had a 2.5-fold increase in mortality (fistula HR 2.60, 95% CI 1.47 to 4.62; stricture HR 2.41, 95% CI 1.86 to 3.11). Although most patients (2133 (72.3%)) had suffered no prior episodes of acute diverticulitis, increasing episodes of acute diverticulitis were associated with an increased risk of developing a fistula (two or more prior episodes, OR 1.54 95%, CI 1.08 to 2.19), but there was no clear relationship with stricture or perforation/abscess.
CONCLUSIONS: Although most patients have experienced no prior episodes of acute diverticulitis, fistula formation is preceded by bouts of inflammation. Excess 1-year mortality across the spectrum of CCDD compared with the general population is substantial.},
}
@article {pmid21545911,
year = {2011},
author = {Lehmann, RK and Brounts, LR and Johnson, EK and Rizzo, JA and Steele, SR},
title = {Does sacrifice of the inferior mesenteric artery or superior rectal artery affect anastomotic leak following sigmoidectomy for diverticulitis? a retrospective review.},
journal = {American journal of surgery},
volume = {201},
number = {5},
pages = {623-627},
doi = {10.1016/j.amjsurg.2011.01.011},
pmid = {21545911},
issn = {1879-1883},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects ; Anastomotic Leak/epidemiology/etiology/*prevention & control ; Colectomy/*adverse effects ; Colon, Sigmoid/blood supply/*surgery ; Diverticulitis, Colonic/*surgery ; Female ; Follow-Up Studies ; Humans ; Ischemia/etiology/*prevention & control ; Male ; Mesenteric Artery, Inferior/*surgery ; Middle Aged ; Postoperative Complications/etiology/prevention & control ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Anastomotic leak after sigmoidectomy for diverticular disease can have devastating consequences. Preservation or sacrifice of the descending colon or rectal arterial supply may affect the anastomosis. The aim of this study was to evaluate whether preservation of the inferior mesenteric artery (IMA) or superior rectal artery (SRA) was associated with a decreased anastomotic leak rate.
METHODS: A retrospective review of adult patients undergoing sigmoidectomies from 2 military tertiary care centers was performed, evaluating patient demographic and operative variables for their effects on anastomotic leak rate.
RESULTS: A total of 130 patients were identified. The overall anastomotic leak rate was 5.4%. Laparoscopy was used in 41%, and stapled anastomoses were used in 91%. The IMA was sacrificed in 29% and the SRA in 37%. There were no significant differences in leak rates when the IMA or SRA was sacrificed (0% and 3.7% with the IMA and SRA sacrificed, 9.3% and 6.5% with the vessels preserved; P = .140 and P = .610, respectively). Laparoscopic technique (P = .843), emergency surgery (P = .29), and operative time (P = .78) did not affect leak rate. Hand-sewn anastomoses were associated with a higher leak rate (33% vs 2%; odds ratio, 3.44; 95% confidence interval, 1.514-7.817; P < .001).
CONCLUSIONS: IMA or SRA preservation or sacrifice was not associated with an increased leak rate from colorectal anastomoses after sigmoidectomy for diverticular disease. Stapled anastomoses were associated with a lower leak rate than hand-sewn anastomoses.},
}
@article {pmid21533936,
year = {2011},
author = {Katsuno, G and Fukunaga, M and Nagakari, K and Yoshikawa, S},
title = {Laparoscopic one-stage resection of right and left colon complicated diverticulitis equivalent to Hinchey stage I-II.},
journal = {Surgery today},
volume = {41},
number = {5},
pages = {647-654},
pmid = {21533936},
issn = {1436-2813},
mesh = {*Colectomy/adverse effects ; Diverticulitis, Colonic/classification/pathology/*surgery ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Male ; Middle Aged ; },
abstract = {PURPOSE: The safety and effectiveness of laparoscopic surgery is well established for recurrent, uncomplicated diverticular disease, but not for complicated diverticular disease. Using the Hinchey classification, we compared laparoscopic colon resection (LAPH) with conventional open colon resection (OPH) for the treatment of complicated diverticulitis equivalent to Hinchey stage I-II.
METHODS: In this study, the Hinchey classification (I-IV) was also adopted for right-sided diverticulitis (I'-IV'). We reviewed the clinical records of 58 patients who underwent colon resection for complicated colon diverticulitis (Hinchey stage I-IV or I'-IV') between May 1994 and December 2008. Fifty-two patients underwent colon resection for Hinchey I-II or I'-II' disease; as LAPH in 36 and as OPH in 16. Only one patient required conversion to the open procedure after laparoscopy.
RESULTS: The overall complication rate was significantly higher in the OPH group (43.8%) than in the LAPH group (16.7%; P < 0.05). Wound infection was significantly more common in the OPH group (37.5%) than in the LAPH group (11.1%; P < 0.05). Hospital stay was significantly shorter in the LAPH group (P < 0.05). Hartmann procedure was performed in one patient from each group. No anastomotic leakage occurred in either group.
CONCLUSION: Our findings indicate that laparoscopic surgery can be performed safely and effectively even for patients with Hinchey I-II, I'-II' colonic diverticulitis.},
}
@article {pmid21503660,
year = {2011},
author = {Tan, KK and Liu, JZ and Yeow, Y and Gunasekaran, S and Tan, JJ},
title = {Is emergency right hemicolectomy still associated with significant morbidity and mortality rates? An institution's experience of 207 cases over 6 years.},
journal = {International journal of colorectal disease},
volume = {26},
number = {9},
pages = {1157-1161},
pmid = {21503660},
issn = {1432-1262},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*mortality ; Emergencies/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Perioperative Care ; Postoperative Complications/classification/etiology ; Singapore/epidemiology ; Treatment Outcome ; Young Adult ; },
abstract = {INTRODUCTION: Emergency right hemicolectomy has been associated with dismal outcome. But, data in Asians is lacking as pathologies that require emergency right hemicolectomy may differ from that in the Western population. The aims of our study were to review our institution's experience with emergency right hemicolectomies and to identify factors that could predict the per-operative outcome.
METHODS: A retrospective review of all patients who underwent emergency right hemicolectomy from August 2003 to April 2008 was performed. Emergency right hemicolectomy was defined as a right colectomy, comprising of an ileo-colic resection, in the emergency setting without the benefit of preoperative bowel preparation. All the complications were graded according to the classification proposed by Clavien and group.
RESULTS: A total of 207 patients, median age 62 years (range, 19-94 years), underwent emergency right hemicolectomy during the study period. Neoplasia and complicated diverticular disease were the most common pathologies in 46.4% and 21.7%, respectively. Intestinal obstruction (44.4%) and perforation (26.6%) were the two main indications for surgical intervention in our series. Twenty (9.7%) patients died, and another 39 patients (18.8%) had severe complications. Eight (3.9%) patients had anastomotic dehiscence, while burst abdomen was seen in ten (4.8%) patients. The two independent factors associated with worse outcome were high ASA score and stoma creation. Factors such as age and site of perforation were not related.
CONCLUSION: Emergency right hemicolectomy is associated with a significant morbidity and mortality rate. Patients with higher ASA score and who had stoma created fared worse.},
}
@article {pmid21487875,
year = {2011},
author = {Tarantino, I and Linke, GR and Lange, J and Siercks, I and Warschkow, R and Zerz, A},
title = {Transvaginal rigid-hybrid natural orifice transluminal endoscopic surgery technique for anterior resection treatment of diverticulitis: a feasibility study.},
journal = {Surgical endoscopy},
volume = {25},
number = {9},
pages = {3034-3042},
pmid = {21487875},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Comorbidity ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures ; Endoscopes ; Feasibility Studies ; Female ; Humans ; Middle Aged ; *Natural Orifice Endoscopic Surgery/instrumentation ; Postoperative Complications/epidemiology ; Prospective Studies ; Quality of Life ; Recurrence ; Vagina ; },
abstract = {BACKGROUND: In laparoscopic anterior resection, minilaparotomy still is required. Recently, transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy have been described. Reports on operations that require removal of larger specimens, as in anterior resection, are scarce and limited primarily to small case series and case reports. The current study aimed to evaluate the feasibility and safety of transvaginal rigid-hybrid NOTES anterior resection (tvAR) for symptomatic diverticular disease.
METHODS: All female patients presenting with symptomatic diverticulitis of the sigmoid colon were candidates for inclusion in the study. The exclusion criteria specified failure to sign informed consent, previous colorectal resection, anesthesiologic contraindication for pneumoperitoneum, liver failure and coagulopathy, severe acute diverticular bleeding, internal fistula with abscess (Hinchey 2b), perforated diverticulitis with peritonitis (Hinchey 3 or 4), gynecologic or urologic contraindications, and absence of preoperative gynecologic examination. A preoperative and 2-week postoperative gynecologic examination was performed. Quality of life and sexual function were assessed preoperatively and 6 weeks postoperatively.
RESULTS: Of 70 patients, 45 (64.3%) were scheduled for tvAR. Five patients were withdrawn at the beginning of laparoscopy with no transvaginal access performed. Of the remaining 40 patients with attempted tvAR, 4 patients underwent conversion to a minilaparotomy (Pfannenstiel incision) and 2 patients were converted to a total median laparotomy. For 34 patients (85%), the operation was completed transvaginally. A total of 2 major complications and 10 minor complications occurred. No serious postoperative gynecologic morbidity was experienced. At 6 weeks postoperatively, sexual function did not differ significantly from preoperative status.
CONCLUSIONS: For symptomatic diverticular disease, TvAR is feasible, although the presented technique requires laparoscopic expertise and further refinement.},
}
@article {pmid21462366,
year = {2011},
author = {Hjern, F and Wolk, A and Håkansson, N},
title = {Smoking and the risk of diverticular disease in women.},
journal = {The British journal of surgery},
volume = {98},
number = {7},
pages = {997-1002},
doi = {10.1002/bjs.7477},
pmid = {21462366},
issn = {1365-2168},
mesh = {Aged ; Diverticulum/epidemiology/*etiology ; Female ; Humans ; Middle Aged ; Risk Factors ; Rupture, Spontaneous/epidemiology/etiology ; Smoking/*adverse effects/epidemiology ; Sweden/epidemiology ; },
abstract = {BACKGROUND: The relationship between smoking and the risk of diverticular disease is unclear. An observational cohort study was undertaken to investigate the association between smoking and diverticular disease.
METHODS: Women in the Swedish Mammography Cohort born between 1914 and 1948 were followed from 1997 to 2008. Information on smoking and other lifestyle factors was collected through questionnaires. Patients with symptomatic diverticular disease were identified from Swedish national registers. Relative risks (RRs) of symptomatic diverticular disease (resulting in hospital admission or death) according to smoking status were estimated using Cox proportional hazards models.
RESULTS: Of 35 809 women included in the study, 561 (1·6 per cent) had symptomatic diverticular disease. In multivariable analysis, current smokers had an increased risk of symptomatic diverticular disease compared with non-smokers after adjustment for age, intake of dietary fibre, diabetes, hypertension, use of acetylsalicylic acid, non-steroidal anti-inflammatory drugs or steroid medication, alcohol consumption, body mass index, physical activity and level of education (RR 1·23, 95 per cent confidence interval 0·99 to 1·52). Past smokers also had an increased risk (RR 1·26, 1·02 to 1·56). Smokers had a higher risk of developing a diverticular perforation/abscess than non-smokers (RR 1·89, 1·15 to 3·10).
CONCLUSION: Smoking is associated with symptomatic diverticular disease.},
}
@article {pmid21448352,
year = {2011},
author = {Golder, M and Ster, IC and Babu, P and Sharma, A and Bayat, M and Farah, A},
title = {Demographic determinants of risk, colon distribution and density scores of diverticular disease.},
journal = {World journal of gastroenterology},
volume = {17},
number = {8},
pages = {1009-1017},
pmid = {21448352},
issn = {2219-2840},
mesh = {Age Factors ; Barium Compounds ; Colon/*pathology ; Diverticulum, Colon/diagnosis/*epidemiology/*pathology ; Ethnicity ; Female ; Humans ; Male ; Risk Factors ; Sex Factors ; },
abstract = {AIM: To investigate associations between ethnicity, age and sex and the risk, colon distribution and density scores of diverticular disease (DD).
METHODS: Barium enemas were examined in 1000 patients: 410 male, 590 female; 760 whites, 62 Asians, 44 black africans (BAs), and 134 other blacks (OBs). Risks and diverticula density of left-sided DD (LSDD) and right-sided-component DD (RSCDD = right-sided DD + right and left DD + Pan-DD) were compared using logistic regression.
RESULTS: Four hundred and forty-seven patients had DD (322 LSDD and 125 RSCDD). Adjusted risks: (1) LSDD: each year increase in age increased the odds by 6% (95% CI: 5-8, SE: 0.8%, P < 0.001); Asians: odds ratio (OR): 0.23 (95% CI: 0.10-0.53, SE: 0.1, P ≤ 0.001) and OBs: OR: 0.25 (95% CI: 0.14-0.43, SE: 0.07, P ≤ 0.001) appeared protected vs Whites; (2) RSCDD: each year increase in age increased the odds by 4% (95% CI: 2-6, SE: 1%, P < 0.001); females were 0.60 times (95% CI: 0.40-0.90, SE: 0.12, P = 0.01) less likely than males to have RSCDD; BAs were 3.51 times (95% CI: 1.70-7.24, SE: 1.30, P < 0.001) more likely than Whites to have RSCDD; and (3) DD density scores: each year increase in age increased the odds of high-density scores by 4% (95% CI: 1-6, SE: 1%, P < 0.001); RSCDD was 2.77 times (95% CI: 1.39-3.32, SE: 0.67, P < 0.001) more likely to be of high density than LSDD. No further significant differences were found in the adjusted models.
CONCLUSION: Right colonic DD might be more common and has higher diverticula density in the west than previously reported. BAs appear predisposed to DD, whereas other ethnic differences appear conserved following migration.},
}
@article {pmid21447765,
year = {2011},
author = {Tarleton, S and DiBaise, JK},
title = {Low-residue diet in diverticular disease: putting an end to a myth.},
journal = {Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition},
volume = {26},
number = {2},
pages = {137-142},
doi = {10.1177/0884533611399774},
pmid = {21447765},
issn = {1941-2452},
mesh = {Dietary Fiber/*administration & dosage/*metabolism ; Diverticulum/*diet therapy/*prevention & control ; Evidence-Based Medicine ; Humans ; Secondary Prevention ; Treatment Outcome ; },
abstract = {Residue refers to any indigestible food substance that remains in the intestinal tract and contributes to stool bulk. Historically, low-residue diets have been recommended for diverticulosis because of a concern that indigestible nuts, seeds, corn, and popcorn could enter, block, or irritate a diverticulum and result in diverticulitis and possibly increase the risk of perforation. To date, there is no evidence supporting such a practice. In contrast, dietary fiber supplementation has been advocated to prevent diverticula formation and recurrence of symptomatic diverticulosis, although this is based mostly on low-quality observational studies. This report focuses on the evidence that fiber intake may be beneficial in the prevention and recurrence of symptomatic and complicated diverticular disease and provides recommendations regarding fiber supplementation in individuals with diverticulosis.},
}
@article {pmid21438097,
year = {2012},
author = {Altadill, A and Eiró, N and González, LO and Junquera, S and González-Quintana, JM and Sánchez, MR and Andicoechea, A and Saro, C and Rodrigo, L and Vizoso, FJ},
title = {Comparative analysis of the expression of metalloproteases and their inhibitors in resected crohn's disease and complicated diverticular disease.},
journal = {Inflammatory bowel diseases},
volume = {18},
number = {1},
pages = {120-130},
doi = {10.1002/ibd.21682},
pmid = {21438097},
issn = {1536-4844},
mesh = {Adult ; Blotting, Western ; Colon/metabolism ; Crohn Disease/genetics/*metabolism/*surgery ; Diverticulitis/*complications/genetics/*metabolism ; Female ; Humans ; Image Processing, Computer-Assisted ; Immunoenzyme Techniques ; Intestinal Mucosa/metabolism ; Male ; Matrix Metalloproteinases/genetics/*metabolism ; Middle Aged ; Prognosis ; RNA, Messenger/genetics ; Real-Time Polymerase Chain Reaction ; Tissue Array Analysis ; Tissue Inhibitor of Metalloproteinases/genetics/*metabolism ; },
abstract = {BACKGROUND: Matrix metalloproteinases (MMPs) and their inhibitors (TIMPs), are expressed in the gastrointestinal tract by different cellular types. Nevertheless, the imbalance between MMPs and TIMPs plays an important role in the physiopathology of diverse intestinal inflammatory processes.
METHODS: An immunohistochemical study was performed using tissue arrays and specific antibodies against MMPs -1, -2, -7, -9, -11, -13, -14, and TIMPs -1, -2 and -3. Immunohistochemical staining of intestinal samples from surgical interventions from 30 patients with complicated Crohn's disease (CD) and 25 patients with diverticulitis were performed at the inflamed mucosa and in adjacent noninflamed mucosa. A reverse-transcription polymerase chain reaction (RT-PCR) analysis was performed to confirm the results obtained by immunohistochemistry. In addition, western blot experiments were carried out.
RESULTS: CD inflamed mucosa showed higher global expression of MMP-2, MMP-9, and MMP-13 than diverticulitis inflamed mucosa. However, inflamed and noninflamed diverticulitis mucosal samples showed higher global expression of MMP-1, TIMP-1, and 3 than the CD samples. Epithelial cells of inflamed mucosa showed higher expression of MMP-2, 9, and 13 in CD than diverticulitis. However, the latter showed higher expression of TIMP-1. Similar differences for fibroblast-like cells and mononuclear inflammatory cells were found. CD samples presented an increased expression of MMPs and a decreased expression of TIMPs compared to diverticulitis.
CONCLUSIONS: These results indicate a differential pattern of expression of MMPs and TIMPs in CD and diverticulitis and the necessity to study the potential role of MMP inhibitors as new protective agents in both diseases.},
}
@article {pmid21435221,
year = {2011},
author = {Heneghan, HM and Healy, NA and Martin, ST and Ryan, RS and Nolan, N and Traynor, O and Waldron, R},
title = {Modern management of pyogenic hepatic abscess: a case series and review of the literature.},
journal = {BMC research notes},
volume = {4},
number = {},
pages = {80},
pmid = {21435221},
issn = {1756-0500},
abstract = {BACKGROUND: Pyogenic hepatic abscesses are relatively rare, though untreated are uniformly fatal. A recent paradigm shift in the management of liver abscesses, facilitated by advances in diagnostic and interventional radiology, has decreased mortality rates. The aim of this study was to review our experience in managing pyogenic liver abscess, review the literature in this field, and propose guidelines to aid in the current management of this complex disease.
METHODS: Demographic and clinical details of all patients admitted to a single institution with liver abscess over a 5 year period were reviewed. Clinical presentation, aetiology, diagnostic work-up, treatment, morbidity and mortality data were collated.
RESULTS: Over a 5 year period 11 patients presented to a single institution with pyogenic hepatic abscess (55% males, mean age 60.3 years). Common clinical features at presentation were non-specific constitutional symptoms and signs. Aetiology was predominantly gallstones (45%) or diverticular disease (27%). In addition to empiric antimicrobial therapy, all patients underwent radiologically guided percutaneous drainage of the liver abscess at diagnosis and only 2 patients required surgical intervention, including one 16-year old female who underwent hemi-hepatectomy for a complex and rare Actinomycotic abscess. There were no mortalities after minimum follow-up of one year.
CONCLUSIONS: Pyogenic liver abscesses are uncommon, and mortality has decreased over the last two decades. Antimicrobial therapy and radiological intervention form the mainstay of modern treatment. Surgical intervention should be considered for patients with large, complex, septated or multiple abscesses, underlying disease or in whom percutaneous drainage has failed.},
}
@article {pmid21424908,
year = {2012},
author = {Bassotti, G and Villanacci, V},
title = {Medical treatment of colonic diverticular disease: are we sure the aim is right?.},
journal = {Internal and emergency medicine},
volume = {7},
number = {2},
pages = {97-98},
pmid = {21424908},
issn = {1970-9366},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulitis, Colonic/*drug therapy/*prevention & control ; Female ; Humans ; Male ; Mesalamine/*therapeutic use ; },
}
@article {pmid21415083,
year = {2011},
author = {Chang, CH and Lin, JW and Chen, HC and Kuo, CW and Shau, WY and Lai, MS},
title = {Non-steroidal anti-inflammatory drugs and risk of lower gastrointestinal adverse events: a nationwide study in Taiwan.},
journal = {Gut},
volume = {60},
number = {10},
pages = {1372-1378},
doi = {10.1136/gut.2010.229906},
pmid = {21415083},
issn = {1468-3288},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Female ; Gastrointestinal Diseases/chemically induced/*epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Population Surveillance/*methods ; Retrospective Studies ; Risk Factors ; Taiwan/epidemiology ; },
abstract = {OBJECTIVE: Only limited studies have evaluated the risk of non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs) and coxibs for lower gastrointestinal (GI) adverse outcomes. The objective of this study was to evaluate risks of lower GI adverse events associated with use of celecoxib, oral and parenteral nsNSAIDs.
DESIGN: Retrospective case-crossover study.
SETTING: Records of all patients aged ≥20 years hospitalised for lower GI adverse events (bleeding from small or large intestine, perforation, and complicated diverticular disease) in 2006 were retrieved using ICD-9-CM diagnosis codes from inpatient claims from the Taiwan National Health Insurance database.
INTERVENTIONS: Case periods were defined for each patient as 1-30 days prior to hospital admission date and control period as 91-120 days prior to hospital admission date. The pharmacy prescription database was searched for NSAID use during case and control periods.
MAIN OUTCOME MEASURES: We calculated adjusted self-matched ORs and 95% CIs with a conditional logistic regression model to determine the associations between NSAID use and lower GI adverse outcomes.
RESULTS: A total of 1297 patients hospitalised for lower GI adverse events were included. Celecoxib was associated with an adjusted OR of 2.33 (95% CI 0.97 to 5.59); the association became statistically significant (OR: 3.26, 95% CI 1.07 to 9.91) when a different control period (31-60 days) was applied. Both oral and parenteral nsNSAIDs significantly increased risk for lower GI adverse events (OR: 2.26, 95% CI 1.78 to 2.85 and OR: 5.64, 95% CI 3.24 to 9.82, respectively).
CONCLUSIONS: Oral and parenteral NSAIDs were associated with significantly increased risk for lower GI adverse events. Celecoxib also increased risk to a comparable extent, despite risk estimates being affected slightly by the control period chosen for comparison. The association of NSAIDs with specific lower GI adverse events and long-term complications requires further investigation.},
}
@article {pmid21404077,
year = {2011},
author = {Olakowski, M and Jabłońska, B and Lekstan, A and Szczęsny-Karczewska, W and Pilch-Kowalczyk, J and Kohut, M},
title = {Gastrointestinal image: a true giant transverse colon diverticulum.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {15},
number = {7},
pages = {1289-1291},
pmid = {21404077},
issn = {1873-4626},
mesh = {Colectomy/methods ; Colonoscopy/*methods ; Diagnosis, Differential ; Diverticulum, Colon/*diagnosis/surgery ; Female ; Humans ; Laparotomy ; Radiography, Abdominal/*methods ; Young Adult ; },
abstract = {UNLABELLED: Giant colonic diverticulum is an extremely rare condition in colonic diverticular disease. More than 90% of giant colonic diverticula are found in the sigmoid colon. Inflammatory and pseudodiverticula are the most frequent. Only one case of a true diverticulum of the transverse colon has been reported in the literature.
CASE REPORT: We report a case of a 22-year-old woman presenting with constipation and meteorism from childhood. A plain abdominal X-ray showed a round radiolucent air-filled cyst. Barium enema revealed a single, large diverticulum of the transverse colon. An extended right hemicolectomy with primary end-to-end anastomosis was performed. The postoperative course was uneventful, and she was discharged in 1 week without any complications. Histopathology showed a true diverticulum containing all layers of the colon.},
}
@article {pmid21401970,
year = {2011},
author = {Humes, D and Smith, JK and Spiller, RC},
title = {Colonic diverticular disease.},
journal = {BMJ clinical evidence},
volume = {2011},
number = {},
pages = {},
pmid = {21401970},
issn = {1752-8526},
mesh = {Abdominal Pain ; Acute Disease ; Dietary Fiber ; *Diverticulitis ; *Diverticulosis, Colonic ; Diverticulum ; Humans ; },
abstract = {INTRODUCTION: Diverticula (mucosal outpouching through the wall of the colon) are rare before the age of 40 years, after which prevalence increases steadily and reaches over 25% by 60 years. However, only 10% to 25% of affected people will develop symptoms such as lower abdominal pain. Recurrent symptoms are common, and 5% of people with diverticula eventually develop complications such as perforation, obstruction, haemorrhage, fistulae, or abscesses.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: treatments for uncomplicated diverticular disease; treatments to prevent complications; and treatments for acute diverticulitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antispasmodics, elective surgery, increasing fibre intake with bran or ispaghula husk, lactulose, medical treatment, mesalazine, methylcellulose, rifaximin, and surgery.},
}
@article {pmid21384191,
year = {2011},
author = {Antolovic, D and Reissfelder, C and Ozkan, T and Galindo, L and Büchler, MW and Koch, M and Weitz, J},
title = {Restoration of intestinal continuity after Hartmann's procedure--not a benign operation. Are there predictors for morbidity?.},
journal = {Langenbeck's archives of surgery},
volume = {396},
number = {7},
pages = {989-996},
pmid = {21384191},
issn = {1435-2451},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Anastomosis, Surgical/*methods ; Cohort Studies ; Colectomy/adverse effects/*methods ; Colorectal Neoplasms/diagnosis/surgery ; Colostomy/adverse effects/*methods ; Confidence Intervals ; Crohn Disease/diagnosis/surgery ; Digestive System Surgical Procedures/*methods/mortality ; Diverticulum, Colon/diagnosis/surgery ; Female ; Follow-Up Studies ; Gastrointestinal Transit ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/mortality/physiopathology ; Plastic Surgery Procedures/methods ; Reoperation/methods ; Retrospective Studies ; Risk Assessment ; Statistics, Nonparametric ; Surgical Wound Infection/*diagnosis/mortality/therapy ; Survival Analysis ; Time Factors ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: Restoration of intestinal continuity is usually the second step after Hartmann's procedure and an established procedure in abdominal surgery, particularly for complicated diverticular disease. This descriptive study aimed to examine the morbidity and mortality associated with the procedure and to define potential risk factors.
PATIENTS AND METHODS: Data from 161 consecutive patients (median age 62 years, median BMI 25.2) undergoing elective surgery with restoration of bowel continuity between October 2001 and November 2008 at the Department of Surgery, University of Heidelberg, were included in this study. The association of potential prognostic variables with postoperative morbidity and mortality were examined by univariate and multivariate analyses.
RESULTS: The median time between the initial operation and the restoration of bowel continuity was 7 months. The median operation time was 185 min with a blood loss of 150 ml and median postoperative hospital stay of 9 days. Fifty-one percent of the patients had an uneventful recovery, whereas 49% had a postoperative complication. Surgical infections occurred in 18% of patients, 3.8% suffered from anastomotic leakage, and surgical re-exploration was necessary in 11.2%. Medical complications occurred in 21.1% of the patients, with pneumonia in 2.5% and urinary tract infections in 1.3%. One patient died 17 days after surgery. Univariate analysis showed that patients taking immunosuppressant drugs had significantly more wound infections and, interestingly, protective ileostomy was associated with postoperative anastomotic stenosis in our cohort. The administration of PRBC and a prolonged hospital were significantly associated with increased postoperative morbidity in the multivariate analysis.
CONCLUSIONS: Restoration of bowel continuity is a surgical procedure with high overall morbidity. The high morbidity confirmed in our study and various other papers justify a randomized clinical study to investigate the one-stage concept with primary anastomosis against the Hartmann's procedure and its reversal.},
}
@article {pmid21374060,
year = {2011},
author = {Gu, HX and Zhang, YL and Zhi, FC and Jiang, B and Huang, Y},
title = {Organic colonic lesions in 3,332 patients with suspected irritable bowel syndrome and lacking warning signs, a retrospective case--control study.},
journal = {International journal of colorectal disease},
volume = {26},
number = {7},
pages = {935-940},
pmid = {21374060},
issn = {1432-1262},
mesh = {Adult ; Colon/*pathology ; Colonoscopy ; Demography ; Female ; Humans ; Irritable Bowel Syndrome/*diagnosis/*pathology ; Male ; Retrospective Studies ; },
abstract = {PURPOSE: The diagnosis of irritable bowel syndrome is symptom based, and colonoscopy is the most direct way to rule out organic colonic diseases. It is controversial on the necessity of colonoscopy for patients with suspected irritable bowel syndrome and lacking alarm features. This study was designed to verify the organic lesions and discuss the value of colonoscopy in this type of patients.
METHODS: Colonoscopy of 3,332 patients with suspected irritable bowel syndrome and lacking warning signs from 2000 to 2009 were reviewed. One thousand five hundred eighty-eight patients under 50 years of age who underwent colonoscopy screening for health care in the same period were used as controls. The prevalence of different colonic organic lesions was compared between two groups.
RESULTS: Organic colonic lesions were found in 30.3% of the patients with suspected irritable bowel syndrome (1,010/3,332) and 39.0% of the controls (619/1,588). Compared with controls, patients with suspected irritable bowel syndrome had higher prevalence of noninflammatory bowel disease and noninfectious colitis and terminal ileitis, however, had lower prevalence of diverticular disease, adenomatous polyps, and non-adenomatous polyps (all P < 0.001).
CONCLUSIONS: The diagnostic sensitivity of symptom criteria on irritable bowel syndrome without colonoscopy is not more than 69.7% in patients with suspected irritable bowel syndrome lacking warning signs. Though the method of colonoscopy is hard to screen tumor in this type of patients, it is beneficial to uncover some other relevant organic lesions such as terminal ileitis. Colonoscopy should not be refused to suspected irritable bowel syndrome patients without warning signs.},
}
@article {pmid21372765,
year = {2011},
author = {Annibale, B and Maconi, G and Lahner, E and De Giorgi, F and Cuomo, R},
title = {Efficacy of Lactobacillus paracasei sub. paracasei F19 on abdominal symptoms in patients with symptomatic uncomplicated diverticular disease: a pilot study.},
journal = {Minerva gastroenterologica e dietologica},
volume = {57},
number = {1},
pages = {13-22},
pmid = {21372765},
issn = {1121-421X},
mesh = {Abdominal Pain/drug therapy/etiology ; Aged ; Dietary Fiber/administration & dosage ; Diverticulitis/complications/*therapy ; *Diverticulum ; Female ; Flatulence/drug therapy/etiology ; Humans ; *Lacticaseibacillus casei ; Male ; Middle Aged ; Pilot Projects ; Probiotics/*therapeutic use ; Treatment Outcome ; },
abstract = {AIM: The standard therapeutic approach for symptomatic uncomplicated diverticular disease (DD) remains to be defined, and only a few studies have tested the efficacy of probiotics in these patients.
METHODS: Patients with symptomatic uncomplicated DD were randomized to a control arm, i.e., (group A, [N.=16], high-fibre diet alone), or to Group B ([n=18], twice daily 1 sachet of probiotic + high-fibre diet), or group C ([N.=16], twice daily 2 sachets of probiotic + high-fibre diet). The probiotic Genefilus F19© containing Lactobacillus paracasei sub. paracasei F19 was administered for 14 days/month for 6 months. The primary endpoint under consideration was a decrease in abdominal pain and bloating intensity after treatment.
RESULTS: Bloating decreased significantly in Groups B and C VAS score group B: 4.6 ± 2.6 vs. 2.3 ± 2.0, P<0.05, group C: 3.9 ± 2.9 vs. 1.8 ± 2.1, P<0.05). The decrease in abdominal pain within 24 hours in these groups did not reach statistical significance. During treatment, none of the group B (N.=4) or group C patients (N=3) with abdominal pain >24 hours reported the recurrence of this symptom, while the 3 group A patients reported at least one episode (P=0.016). No significant difference regarding abdominal pain <24 hours and bloating was observed between the two groups of patients treated with a low or high probiotic dose.
CONCLUSION: Lactobacillus paracasei F19, in association with a high-fibre diet, is effective in reducing abdominal bloating and prolonged abdominal pain in symptomatic uncomplicated diverticular disease, and could thus be a promising option in the treatment of these patients.},
}
@article {pmid21366632,
year = {2011},
author = {Bianchi, M and Festa, V and Moretti, A and Ciaco, A and Mangone, M and Tornatore, V and Dezi, A and Luchetti, R and De Pascalis, B and Papi, C and Koch, M},
title = {Meta-analysis: long-term therapy with rifaximin in the management of uncomplicated diverticular disease.},
journal = {Alimentary pharmacology & therapeutics},
volume = {33},
number = {8},
pages = {902-910},
doi = {10.1111/j.1365-2036.2011.04606.x},
pmid = {21366632},
issn = {1365-2036},
mesh = {Case-Control Studies ; Dietary Fiber/*administration & dosage ; Diverticulum, Colon/complications/*drug therapy ; Gastrointestinal Agents/*therapeutic use ; Humans ; Rifamycins/*administration & dosage ; Rifaximin ; Treatment Outcome ; },
abstract = {BACKGROUND: Diverticular disease of the colon is a common gastrointestinal disease. Although most patients remain asymptomatic for their whole life, about 20-25% present symptoms related to 'diverticular disease'. Several randomised trials verified efficacy of a poorly absorbed antibiotic, such as rifaximin-α (rifaximin), in soothing symptoms and preventing diverticulitis.
AIM: To evaluate the long-term efficacy administration of rifaximin plus fibre supplementation vs. fibre supplementation alone, on symptoms and complications, in patient with symptomatic uncomplicated diverticular disease.
METHODS: Pertinent studies were selected from the Medline, and the Cochrane Library Databases, references from published articles and reviews. Conventional meta-analysis according to DerSimonian and Laird method was used for the pooling of the results. The outcomes were 1- year complete symptom relief, and 1- year complication incidence. The rate difference (RD, with 95% CI) and the Number Needed to Treat (NNT) were used as measure of the therapeutic effect on each outcome.
RESULTS: Four prospective randomised trials including 1660 patients were selected. The pooled RD for symptom relief was 29.0% (rifaximin vs. control; 95% CI 24.5-33.6%; P<0.0001; NNT=3). The pooled RD for complication rate was -1.7% in favour of rifaximin (95% CI -3.2 to -0.1%; P=0.03; NNT=59). When considering only acute diverticulitis, the pooled RD in the treatment group was -2% (95% CI -3.4 to -0.6%; P=0.0057; NNT=50).
CONCLUSIONS: In symptomatic uncomplicated diverticular disease, treatment with rifaximin plus fibre supplementation is effective in obtaining symptom relief and preventing complications at 1 year.},
}
@article {pmid21359889,
year = {2011},
author = {Nicholson, BD and Hyland, R and Rembacken, BJ and Denyer, M and Hull, MA and Tolan, DJ},
title = {Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit?.},
journal = {Surgical endoscopy},
volume = {25},
number = {8},
pages = {2586-2591},
pmid = {21359889},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*pathology ; Colonic Diseases/*diagnostic imaging/*pathology ; Colonoscopy/*methods ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; *Tomography, X-Ray Computed/methods ; Young Adult ; },
abstract = {BACKGROUND: In the absence of official guidance for the management of colonic wall thickening identified by computed tomography (CT), a common clinical dilemma surrounds the volume of colonoscopies subsequently performed.
METHODS: To identify whether colonic wall thickening identified at CT consistently warrants colonoscopy, consecutive colonoscopies performed at Leeds Teaching Hospitals Trust in 2008 and recorded as "possible colonic lesion on cross-sectional abdominal CT" in an endoscopic database were retrospectively analyzed. Clinical, radiologic, colonoscopic, and histologic data were obtained from medical records.
RESULTS: Of 4,702 colonoscopies, 94 (2%) had a full data set meeting the inclusion criteria. The primary diagnoses were normal condition (n = 11, 11.7%), adenocarcinoma (n = 25, 26.6%), adenoma (n = 23, 24.5%), diverticular disease (n = 12, 12.8%), nonspecific colitis (n = 6, 6.4%), Crohn's disease (n = 4, 4.3%), and hyperplastic polyp (n = 3, 3.2%). Computed tomography and colonoscopy were concordant for specific pathology in 79.8% of the cases (n = 75). Compared with diagnosis after histology, colonoscopy alone correctly identified specific pathology in 18.1% of the cases (n = 17), and CT alone was correct in 4.3% of the cases (n = 4)), whereas both were incorrect in 3.2% of the cases (n = 3). Computed tomography had a sensitivity of 72.3% (95% confidence interval [95% CI], 61.9-80.8%), a specificity of 96.5% (95% CI, 94.9-97.6%), a positive predictive value of 72.3%, and a negative predictive value of 96.5%. In 63.8% of the cases (n = 60), CT identified pathology necessitating further intervention at the time of colonoscopy or afterward, and in 28.7% of the cases (n = 27), CT identified pathology requiring no additional intervention. In the remaining 7.4% of the cases (n = 7), CT detected no new pathology.
CONCLUSION: Computed tomography is highly predictive of colonic pathology compared with final outcome after colonoscopy and biopsy. For patients without a pre-existing diagnosis, colonic wall thickening demonstrated at CT warrants further investigation with colonoscopy.},
}
@article {pmid21354735,
year = {2012},
author = {Flor, N and Rigamonti, P and Di Leo, G and Ceretti, AP and Opocher, E and Sardanelli, F and Cornalba, GP},
title = {Technical quality of CT colonography in relation with diverticular disease.},
journal = {European journal of radiology},
volume = {81},
number = {3},
pages = {e250-4},
doi = {10.1016/j.ejrad.2011.02.006},
pmid = {21354735},
issn = {1872-7727},
mesh = {Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; *Colonography, Computed Tomographic ; Colorectal Neoplasms/diagnostic imaging ; Contrast Media ; Diverticulum, Colon/*diagnostic imaging ; Female ; Humans ; Iopamidol/analogs & derivatives ; Male ; Middle Aged ; Retrospective Studies ; Statistics, Nonparametric ; },
abstract = {OBJECTIVE: The aim of the study is to explore how the technical quality of the examination was affected by diverticular disease.
MATERIALS AND METHODS: We retrospectively evaluated a consecutive series of 78 subjects who underwent CTC for screening (n=58) or staging (n=20) colorectal cancer, 38 of them (49%) after an incomplete optical colonoscopy. Patients were administered a mild laxative and a iodinated contrast material for fecal tagging. We scored both the bowel preparation and the overall colon distension as poor, good, or optimal and measured the mean sigmoid colon diameter. We counted the number of diverticula and classified patients as having or not a severe diverticular disease (SDD). The number of the prompts of computer aided diagnosis (CAD) per patient was also considered. Mann-Whitney U and χ(2) tests were performed.
RESULTS: No CTC complications occurred. The bowel cleansing was poor in 8 (10%) patients, good in 29 (37%) and optimal in 41 (53%); colon distension was poor in 7 (9%) patients, good in 38 (49%), and optimal in 33 (42%). Fifty-four (69%) showed diverticula and 30 (38%) had an SDD. Bowel cleansing and distension were not significantly impaired by neither diverticula (p>0.590) nor the SDD (p>0.110). Mean sigmoid colon diameter was reduced in presence of diverticula (28 mm versus 23 mm, p=0.009) or SDD (26 mm versus 22 mm, p=0.016). The mean number of CAD prompts per patient was not significantly increased by the presence of SDD (p=0.829).
CONCLUSIONS: Bowel cleansing and distension at CTC were not influenced by the presence of diverticular disease.},
}
@article {pmid21342363,
year = {2011},
author = {Liu, L and Markus, I and Saghire, HE and Perera, DS and King, DW and Burcher, E},
title = {Distinct differences in tachykinin gene expression in ulcerative colitis, Crohn's disease and diverticular disease: a role for hemokinin-1?.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {23},
number = {5},
pages = {475-83, e179-80},
doi = {10.1111/j.1365-2982.2011.01685.x},
pmid = {21342363},
issn = {1365-2982},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colitis, Ulcerative/*genetics/physiopathology ; Colon/anatomy & histology/pathology/physiology/physiopathology ; Crohn Disease/*genetics/physiopathology ; Diverticulitis/*genetics/physiopathology ; Female ; *Gene Expression ; Humans ; Male ; Middle Aged ; Protein Isoforms/genetics/metabolism ; RNA, Messenger/genetics/metabolism ; Tachykinins/*genetics/metabolism ; Young Adult ; },
abstract = {BACKGROUND: In the intestine, the tachykinins substance P (SP) and neurokinin A (NKA) are found in neurons and have key roles in motility, secretion, and immune functions. A new tachykinin, hemokinin (HK-1), has been identified in non-neuronal cells in recent years and its role in intestinal inflammation is unclear. We aimed to examine the expression of genes encoding tachykinin peptides and receptors in colon from patients with ulcerative colitis (UC), Crohn's disease (CD), and acute diverticular disease (DD).
METHODS: Human colon segments were dissected into mucosa and muscle, and evaluated for tachykinin and tachykinin receptor gene expression by real-time PCR.
KEY RESULTS: In UC mucosa, the TAC4 gene (encoding HK-1) was 10-fold more abundant than in control mucosa (P < 0.01). Similarly, TAC1 (encoding SP and NKA) and TACR1 (encoding NK1 receptor) displayed 6-fold and 12-fold upregulation, respectively, in UC mucosa, but no change occurred in UC muscle. In contrast to UC, no difference was observed for any tachykinin genes in CD mucosa. In CD muscle, expression of TAC1 (P < 0.01), TAC4 and TACR1 (both P < 0.05) were moderately upregulated. In DD, there was a decrease in TACR1 (P < 0.05), and TACR2 (encoding NK2 receptor, P < 0.0001) in muscle compared with control. Histological staining showed increased collagen fibers between muscle bundles in DD smooth muscle.
CONCLUSIONS & INFERENCES: We provide evidence for the first time that HK-1, like SP, may be involved in the pathophysiology of inflammatory bowel disease. Distinctly different expression patterns of tachykinin-related genes occur in UC, CD and DD.},
}
@article {pmid21341427,
year = {2010},
author = {Inbar, R and Greenberg, R and Nir, S and Shmueli, E and Scornick, Y and Avital, S},
title = {[Three hundred laparoscopic colorectal operations--safety, levels of difficulty and survival].},
journal = {Harefuah},
volume = {149},
number = {8},
pages = {498-502, 552, 551},
pmid = {21341427},
issn = {0017-7768},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms/pathology/*surgery ; Disease-Free Survival ; Elective Surgical Procedures/adverse effects/methods ; Female ; Follow-Up Studies ; Humans ; Intestinal Diseases/pathology/*surgery ; Laparoscopy/adverse effects/*methods ; Male ; Middle Aged ; Neoplasm Staging ; Postoperative Complications/etiology ; Prospective Studies ; Reoperation ; Surgical Wound Infection/epidemiology ; Survival Rate ; Young Adult ; },
abstract = {INTRODUCTION: The accumulated data in recent years on the safety of laparoscopy in colorectal cancer patients encourage more surgeons to use this approach for different colorectal pathologies. However, laparoscopic colorectal surgery consists of different heterogeneous complex procedures that necessitate extensive experience and laparoscopic surgical skills
PURPOSE: To evaluate safety, levels of difficulty and oncological outcome in a consecutive series of patients that underwent elective laparoscopic colorectal surgery during a 5-year period.
METHODS: Evaluation of our prospective collected data of patients that underwent laparoscopic colorectal surgery during a 5-year period by our surgical team.
RESULTS: A total of 300 patients were operated on electively for different indications during this time period. Indications for surgery included cancer (58%), benign polyps (16%), Crohn's disease (6%), diverticular disease (10%) and others (10%). Operations for diverticular disease were associated with higher conversion rates and operative times. The mortality rate was 0.3% (one patient). There were 4.6% major surgical complications that necessitated a second operation and another 4.6% moderate surgical complications that were treated conservatively. Wound infection occurred in 7.2% of all patients. The conversion rate was 14.3%. A total of 171 patients underwent operations for curable colorectal cancer. In this group, the mean number of harvested nodes was 16 and 2-year disease-free survival was 87%. Stage I patients had no recurrent disease during follow-up time.
CONCLUSIONS: Laparoscopic colorectal surgery is safe. Immediate oncological results and 2-year survival in colorectal cancer patients, as demonstrated in our study, are adequate and comparable to the open approach. The authors believe that adequate results in laparoscopic colorectal operations can be achieved by a dedicated laparoscopic colorectal team.},
}
@article {pmid21336815,
year = {2011},
author = {Scarpa, M and Griggio, L and Rampado, S and Ruffolo, C and Citton, M and Pozza, A and Borsetto, L and Dall'olmo, L and Angriman, I},
title = {Long-term health-related quality of life after minimally invasive surgery for diverticular disease.},
journal = {Langenbeck's archives of surgery},
volume = {396},
number = {6},
pages = {833-843},
pmid = {21336815},
issn = {1435-2451},
mesh = {Adult ; Analysis of Variance ; Body Image ; Colectomy/*methods ; Diverticulum, Colon/*psychology/*surgery/therapy ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; *Minimally Invasive Surgical Procedures ; *Quality of Life ; Regression Analysis ; Statistics, Nonparametric ; Surveys and Questionnaires ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIMS: The aim of this multicentric study was to evaluate the disease specific and the generic quality of life in patients affected by colonic diverticular disease (DD) who had undergone minimally invasive or open colonic resection or who had been treated with medical therapy in the long-term follow-up.
PATIENTS AND METHODS: Seventy-one consecutive patients admitted to the departments of surgery of Padova and Arzignano Hospitals for DD were interviewed: 22 underwent minimally invasive colonic resection, 24 had open resection, and 25 had only medical therapy. The interview focused on disease specific and generic quality of life, body image, and disease activity.
RESULTS: Padova Inflammatory Bowel Disease Quality of Life (PIBDQL) was validated for the use in DD patients. PIBDQL scores were significantly worse in all patients with DD than those obtained by healthy subjects and it correlated with the symptoms score. The generic quality of life seemed similar in patients who had minimally invasive colonic resection compared with healthy subjects. Body Image Questionnaire scores correlated inversely with the presence of a stoma.
CONCLUSIONS: Disease activity resulted as the only independent predictor of the disease-specific quality of life. In fact, DD affected bowel function and quality of life of patients in the long-term follow-up regardless of the type of therapy adopted. The presence of a stoma affected the patients' body image.},
}
@article {pmid21306406,
year = {2011},
author = {Jeyarajah, S and Papagrigoriadis, S},
title = {Review article: the pathogenesis of diverticular disease--current perspectives on motility and neurotransmitters.},
journal = {Alimentary pharmacology & therapeutics},
volume = {33},
number = {7},
pages = {789-800},
doi = {10.1111/j.1365-2036.2011.04586.x},
pmid = {21306406},
issn = {1365-2036},
mesh = {Acetylcholine/physiology ; Age Factors ; Cell Movement/physiology ; Dietary Fiber ; Diverticulosis, Colonic/*physiopathology ; Gastrointestinal Motility/*physiology ; Humans ; Neurotransmitter Agents/*physiology ; Nitric Oxide/physiology ; Serotonin/physiology ; },
abstract = {BACKGROUND: Low-fibre diet, structural abnormalities and ageing are traditional aetiological factors implicated in the development of diverticular disease. More recently, motility disorders are implicated in its causation leading to speculation that neurotransmitters play a role in mediating these disturbances.
AIMS: To draw together studies on the role of neurotransmitters in the development of diverticular disease and its symptoms.
METHODS: Medline, GoogleScholar and Pubmed were searched for evidence on this subject using the terms neurotransmitters, motility, diverticular disease and pathogenesis. Articles relevant to the subject were cited and linked references were also reviewed.
RESULTS: Serotonin, which has been found to be an excitatory colonic neurotransmitter, has been found in early studies to be increased in colonic enterochromaffin cells. Acetylcholine, which is thought to be an excitatory neurotransmitter and cholinergic activity, has also seen to be increased in diverticular disease. These findings may suggest that an increase in excitatory neurotransmitters may result in the hypersegmentation thought to cause pulsion diverticula. Similarly, a decrease in nitric oxide which is inhibitory is found.
CONCLUSIONS: There is some evidence that neurotransmitters may play a role in the motility disturbances seen in diverticular disease; however, a clear role is yet to be ascertained.},
}
@article {pmid21301880,
year = {2011},
author = {Saad, S and Hosogi, H},
title = {Laparoscopic left colectomy combined with natural orifice access: operative technique and initial results.},
journal = {Surgical endoscopy},
volume = {25},
number = {8},
pages = {2742-2747},
pmid = {21301880},
issn = {1432-2218},
mesh = {Aged ; Colectomy/*methods ; Colonic Neoplasms/*surgery ; Combined Modality Therapy ; Diverticulosis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; *Natural Orifice Endoscopic Surgery ; },
abstract = {BACKGROUND: Minimally invasive surgery for colon resection has improved patient outcome, but a minilaparotomy still is necessary to extract the specimen and place the anvil of the circular stapler into the proximal colon. This wound can cause postoperative pain, wound infection, and hernia. This report describes a new approach that combine classical laparoscopic left colon resection and natural orifice access using an operating rectoscope, with the aim to minimize abdominal wall trauma.
METHODS: Laparoscopic left colon dissection for diverticular disease or small tumors was performed using a standard four-port technique. An operating rectoscope was transanally inserted into the rectum to remove the specimen and to pass the anvil of the circular stapler into the abdominal cavity. A straight needle was tied to the rod of the anvil to simplify its placement into the proximal colon so that a double-stapled anastomosis could be performed in the usual manner. Outcome parameters such as complications, conversions, operative time, and postoperative pain were prospectively recorded in a database.
RESULTS: Surgery was performed for 15 patients with diverticular disease or small tumors. No intraoperative complications or conversions occurred. The median operating time was 145 min. The postoperative pain level was low, and only 3 of 15 patients needed opioid analgesia on postoperative day 1. The median postoperative hospital stay was 7 days. Blood oozing from the anastomotic site in one patient was the only recorded adverse event. For malignancies, tissue margins and lymphadenectomy were oncologically adequate. The 4-week follow-up period was uneventful.
CONCLUSION: The described technique, a combination of laparoscopic and natural orifice surgery, has the potential to avoid incision-related morbidity of the minilaparotomy in laparoscopic left colon resections.},
}
@article {pmid25984109,
year = {2011},
author = {Morelle, J and Pirson, Y and Danse, E and Kanaan, N},
title = {Acute abdominal pain and chills in an ADPKD transplant recipient.},
journal = {NDT plus},
volume = {4},
number = {1},
pages = {71-72},
pmid = {25984109},
issn = {1753-0784},
}
@article {pmid21279478,
year = {2012},
author = {Gatta, L and Di Mario, F and Curlo, M and Vaira, D and Pilotto, A and Lucarini, P and Lera, M and Enkleda, K and Franzé, A and Scarpignato, C},
title = {Long-term treatment with mesalazine in patients with symptomatic uncomplicated diverticular disease.},
journal = {Internal and emergency medicine},
volume = {7},
number = {2},
pages = {133-137},
pmid = {21279478},
issn = {1970-9366},
mesh = {Administration, Oral ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects/*therapeutic use ; Biopsy, Needle ; Confidence Intervals ; Diverticulitis, Colonic/*drug therapy/mortality/*prevention & control ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Long-Term Care ; Male ; Mesalamine/adverse effects/*therapeutic use ; Middle Aged ; Prospective Studies ; Risk Assessment ; Secondary Prevention ; Severity of Illness Index ; Statistics, Nonparametric ; Survival Rate ; Treatment Outcome ; },
abstract = {The aim of this work was to compare the recurrence of diverticulitis during a 5-year follow-up in a population of patients affected by symptomatic uncomplicated diverticular disease (SUDD), taking either 800 mg of mesalamine b.i.d for 10 days every month or no 5-ASA. Sixty-seven consecutive patients affected by SUDD followed-up every 6 months for 5 years. All patients in this group (M-group) were requested to consume mesalamine 800 mg b.i.d for 10 days every month. A control group (C-group) of 82 subjects with SUDD allocated in an institution for the elderly and taking no 5-ASA medications was also followed-up for the same period. As a result in the M-group 14.9% of patients did not complete the follow-up, and diverticulitis developed in two patients (4%; 95% CI 1.1-13.5). In the C-group 6.1% patients did not complete the follow-up, and diverticulitis developed in 8 patients (10.4%; 95% CI 5.4-19.2). The difference between the two groups was not significant (difference = -6.4%; 95% CI -15.6 to 4.3; log rank test: p = 0.1256). Cyclic treatment with mesalazine seems to be clinical, although not statistically effective in reducing the incidence of diverticulitis. In future well-designed RCTs are necessary to demonstrate the therapeutic gain of the use of mesalazine, if any, in the management of patients with SUDD.},
}
@article {pmid21271653,
year = {2011},
author = {Bedeschi, MF and Bianchi, V and Colli, AM and Natacci, F and Cereda, A and Milani, D and Maitz, S and Lalatta, F and Selicorni, A},
title = {Clinical follow-up of young adults affected by Williams syndrome: experience of 45 Italian patients.},
journal = {American journal of medical genetics. Part A},
volume = {155A},
number = {2},
pages = {353-359},
doi = {10.1002/ajmg.a.33819},
pmid = {21271653},
issn = {1552-4833},
mesh = {Adult ; Diagnostic Techniques, Cardiovascular ; Diagnostic Techniques, Endocrine ; Diagnostic Techniques, Ophthalmological ; Female ; Humans ; Italy ; Male ; Neuropsychological Tests ; *Phenotype ; Williams Syndrome/*diagnosis/*metabolism/*pathology ; },
abstract = {Williams-Beuren syndrome (WBS) is a multisystem disorder that requires ongoing management by a primary care physician familiar with the natural history and specific medical problems associated with the condition. While the natural history of the disease during infancy is well known, data about the adult WBS population have been published only in the last few years, and show a wide range of medical, neurological, and psychiatric problems. We investigated 45 young adult WBS patients (mean age 23 years, range 17-39 years) using a well-coordinated team which included a cardiologist, a nephrologist, an ophthalmologist, an endocrinologist, a gastroenterologist, orthodontist, and orthopedist. Here we describe the clinical features and medical complications in this cohort of patients. Most patients demonstrated a high frequency of multiple organ systems complications, in particular, abnormal body habitus; cardiovascular disease, and hypertension; sensorineural hearing loss; gastrointestinal symptoms including diverticular disease and abnormal glucose tolerance. We offer some suggestions for clinical monitoring which we propose will be useful in the overall care of adults with WBS.},
}
@article {pmid21271350,
year = {2011},
author = {Naraynsingh, V and Maharaj, R and Hassranah, D and Hariharan, S and Dan, D and Zbar, AP},
title = {Perforated left-sided diverticulitis with faecal peritonitis: is the Hinchey classification the best guide for surgical decision making?.},
journal = {Techniques in coloproctology},
volume = {15},
number = {2},
pages = {199-203},
pmid = {21271350},
issn = {1128-045X},
mesh = {Adult ; Aged ; Anastomosis, Surgical ; Decision Making ; Digestive System Surgical Procedures/*methods ; Diverticulitis, Colonic/complications/*surgery ; Humans ; Intestinal Perforation/complications/*surgery ; Middle Aged ; Peritonitis/etiology/*surgery ; Severity of Illness Index ; Sigmoid Diseases/*surgery ; Treatment Outcome ; *Wound Closure Techniques ; },
abstract = {BACKGROUND: Although the Hinchey scoring system has guided surgical decision making for perforated diverticulitis, what constitutes optimal surgical management is controversial. We report our experience of selective primary closure of the perforation without use of a transverse colostomy and the specific circumstances in which this may be safe.
METHODS: All cases of perforated diverticular disease of the sigmoid colon with Hinchey grade IV (faecal) peritonitis seen over a 4-year period from one surgical unit were reviewed.
RESULTS: Primary closure without a diverting stoma was performed in six of the eight patients studied since the bowel was deemed healthy, and resection and primary end-to-end anastomosis were performed in the other two patients because there was associated scarring and stricture formation distally. In the primary closure patients, the site of the perforation was dissected and closed with attendant omentoplasty and a meticulous peritoneal toilet. In one of these cases, a diverting stoma was later fashioned after the patient developed a short-lived faecal fistula.
CONCLUSION: The status of the underlying bowel, not the degree of peritoneal soiling, is the most significant consideration in defining the role of minimally invasive surgical treatment options for perforated diverticulitis. A new classification system that remains to be validated, taking into account the degree of colonic scarring and stricture formation, is proposed as a guide for surgical decision making in patients with perforated left-sided diverticulitis with faecal peritonitis.},
}
@article {pmid21258132,
year = {2010},
author = {Fraser, CG and McDonald, PJ and Colford, L and Irvine, A and Kenicer, M and Morton, C and Birrell, J and Steele, RJ},
title = {Experience with a wipe guaiac-based faecal occult blood test as an alternative test in a bowel screening programme.},
journal = {Journal of medical screening},
volume = {17},
number = {4},
pages = {211-213},
doi = {10.1258/jms.2010.010048},
pmid = {21258132},
issn = {1475-5793},
support = {CZH/6/4/CSO_/Chief Scientist Office/United Kingdom ; },
mesh = {Colorectal Neoplasms/*diagnosis ; Humans ; Mass Screening/methods ; *Occult Blood ; },
abstract = {The format of the traditional guaiac faecal occult blood test (gFOBT), particularly the collection technique, might cause difficulties for some. A multistage evaluation of alternative tests was performed. Firstly, four tests with different faecal collection approaches were assessed: a focus group recommended further investigation of a wipe gFOBT. Secondly, 100 faecal samples were analysed using two wipe tests and the routine gFOBT: no differences were found. Thirdly, a wipe gFOBT was introduced. Over 21 months, 400 requests were made and 311 wipe kit sets were submitted for analysis: 153 (49.2%) were negative, 21 (6.8%) positive (all 3 kits positive), 96 (30.9%) weak positive (1 or 2 positive) and 41 (13.2%) un-testable. Forty-three participants were referred for colonoscopy. Outcome data were provided on 39 participants: nine declined colonoscopy, two were judged unsuitable, two did not attend, two were already in follow-up, 13 had normal colonoscopy and two normal barium enema, two had diverticular disease, two had a metaplastic polyp, four had a low-risk adenoma and one had a high-risk adenoma. No participant had cancer. Detection of significant neoplasia was small. The use of the wipe gFOBT was ceased: it cannot be recommended as a screening test for bowel cancer.},
}
@article {pmid21254022,
year = {2011},
author = {Pendlimari, R and Touzios, JG and Azodo, IA and Chua, HK and Dozois, EJ and Cima, RR and Larson, DW},
title = {Short-term outcomes after elective minimally invasive colectomy for diverticulitis.},
journal = {The British journal of surgery},
volume = {98},
number = {3},
pages = {431-435},
doi = {10.1002/bjs.7345},
pmid = {21254022},
issn = {1365-2168},
mesh = {Colectomy/*methods/mortality ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures/*methods ; Female ; Humans ; Laparoscopy/*methods/mortality ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/*etiology ; Prospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: The role of minimally invasive surgery in complicated diverticulitis is still being elucidated. The aim of this study was to compare short-term outcomes in patients undergoing minimally invasive surgery for complicated or uncomplicated diverticular disease.
METHODS: All patients who had elective minimally invasive surgery for diverticulitis between 2003 and 2008 were identified from a prospectively maintained database. Complicated disease was defined as diverticulitis associated with abscess, fistula, stricture or bleeding. Univariable analysis was performed to compare safety and short-term outcomes in patients with complicated and uncomplicated diverticulitis.
RESULTS: A total of 361 patients (136 with complicated and 225 with uncomplicated diverticulitis) were operated on with either a laparoscopic (36·0 per cent) or a hand-assisted laparoscopic (64·0 per cent) surgical technique. There were no significant differences between the groups with respect to age, sex, body mass index, laparoscopic approach, postoperative recovery protocol or previous open surgery. Conversion rates were similar for complicated and uncomplicated disease (14·0 versus 11·6 per cent respectively; P = 0·514). There was no difference between the groups with respect to return of bowel function (mean 3·1 versus 3·2 days respectively; P = 0·156), morbidity (27·9 versus 19·6 per cent; P = 0·070) or mean length of stay (5·4 versus 4·8 days; P = 0·186). There were no deaths within 30 days.
CONCLUSION: Elective minimally invasive colectomy is feasible for patients with uncomplicated and complicated diverticulitis, with equivalent outcomes.},
}
@article {pmid21246900,
year = {2010},
author = {Pomazkin, VI},
title = {[Necessity of the planned colon resection by complicated diverticular disease (with comments)].},
journal = {Khirurgiia},
volume = {},
number = {11},
pages = {80-83},
pmid = {21246900},
issn = {0023-1207},
mesh = {Colectomy ; Colon/*surgery ; Diverticulum, Colon/*complications/*surgery ; Humans ; Middle Aged ; },
}
@article {pmid21225568,
year = {2011},
author = {Rabenstein, T and Fromm, MF and Zolk, O},
title = {[Rifaximin--a non-resorbable antibiotic with many indications in gastroenterology].},
journal = {Zeitschrift fur Gastroenterologie},
volume = {49},
number = {2},
pages = {211-224},
doi = {10.1055/s-0029-1245705},
pmid = {21225568},
issn = {1439-7803},
mesh = {Anti-Bacterial Agents/therapeutic use ; Bacterial Infections/*drug therapy ; Gastrointestinal Agents/therapeutic use ; Gastrointestinal Diseases/*drug therapy ; Humans ; Rifamycins/*therapeutic use ; Rifaximin ; },
abstract = {Rifaximin, a non-resorbable broadband antibiotic, was approved in Germany 2 years ago for the treatment of traveller's diarrhoea caused by non-invasive enteropathogens. On account of the very good tolerance and the high efficacy against almost all enteropathogens this pharmaceutical, which has been available for 25 years, bears a high potential in many other indications which are currently under clinical investigations, including: symptomatic uncomplicated diverticular disease, Clostridium difficile-associated diarrhoea and pseudomembranous colitis, small bowel intestinal bacterial overgrowth, irritable bowel syndrome and hepathic encephalopathy. The present overview demonstrates potential indications in the field of gastroenterology and critically reviews the significance of rifiximin in the treatment of these diseases based on the latest clinica data.},
}
@article {pmid21221786,
year = {2011},
author = {Elli, L and Roncoroni, L and Bardella, MT and Terrani, C and Bonura, A and Ciulla, M and Marconi, S and Piodi, L},
title = {Absence of mucosal inflammation in uncomplicated diverticular disease.},
journal = {Digestive diseases and sciences},
volume = {56},
number = {7},
pages = {2098-2103},
pmid = {21221786},
issn = {1573-2568},
mesh = {Adult ; Aged ; Apoptosis ; Biopsy ; Caspase 9/metabolism ; Colon/metabolism/pathology ; Cytokines/metabolism ; Diverticulosis, Colonic/metabolism/*pathology ; Diverticulum, Colon/metabolism/*pathology ; Female ; GTP-Binding Proteins/metabolism ; Humans ; Intestinal Mucosa/metabolism/*pathology ; Male ; Middle Aged ; Protein Glutamine gamma Glutamyltransferase 2 ; Transglutaminases/metabolism ; },
abstract = {BACKGROUND: Uncomplicated diverticular disease is a common condition in patients older than 50 years. Symptoms are aspecific and overlapping with those of irritable bowel syndrome. Nowadays, patients are often treated with antinflammatory drugs (5-aminosalicilic acid).
AIM: Our purpose was to evaluate the presence of inflammation in the colonic mucosa of patients with symptomatic uncomplicated diverticular disease compared with subjects without diverticula.
METHODS: Endoscopic biopsies of colon from 10 patients with symptomatic uncomplicated diverticular disease and 10 from subjects without diverticula (controls) were taken. Specimens were homogenised and IL2, IL4, IL5, IL8, IL10, IL12p70, IL13, IFN gamma, TNF alfa (searchlight multiplex technique), TGF beta, transglutaminase type 2 and caspase 9 were measured. Histochemistry for transglutaminase type 2 and TUNEL were performed on the histological sections, in addition to morphologic evaluation, as markers of tissue remodelling and apoptosis. For statistical analysis Student's t test and Spearman correlation test were used.
RESULTS: No histological differences were detected between the patients with an uncomplicated diverticular disease and controls. Mean values of mucosal cytokines and of the other tested parameters did not show statistically significant differences between patients with uncomplicated diverticular disease and controls.
CONCLUSIONS: Even if based on a small number of patients, the study demonstrates the absence of inflammation in the mucosa of subjects affected by uncomplicated diverticular disease.},
}
@article {pmid21184078,
year = {2011},
author = {Kirchhoff, P and Matz, D and Dincler, S and Buchmann, P},
title = {Predictive risk factors for intra- and postoperative complications in 526 laparoscopic sigmoid resections due to recurrent diverticulitis: a multivariate analysis.},
journal = {World journal of surgery},
volume = {35},
number = {3},
pages = {677-683},
pmid = {21184078},
issn = {1432-2323},
mesh = {Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Chi-Square Distribution ; Colectomy/*adverse effects/methods ; Databases, Factual ; Diverticulitis, Colonic/diagnosis/*surgery ; Female ; Humans ; Incidence ; Intraoperative Complications/diagnosis/*epidemiology ; Laparoscopy/*adverse effects/methods ; Laparotomy/adverse effects/methods ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/diagnosis/*epidemiology ; Predictive Value of Tests ; Recurrence ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Sigmoid Diseases/diagnosis/*surgery ; Switzerland ; },
abstract = {BACKGROUND: Laparoscopic sigmoid resection is a feasible and frequent operation for patients who suffer from recurrent diverticulitis. There is still an ongoing debate about the optimal timing for surgery in patients who suffer from recurrent diverticulitis episodes. In elective situations the complication rate for this procedure is moderate, but there are patients at high risk for perioperative complications. The few identified risk factors so far refer to open surgery. Data for the elective laparoscopic approach is rare. The objective of this study was to identify potential predictive risk factors for intra- and postoperative complications in patients who underwent laparoscopic sigmoid resection due to diverticular disease.
METHODS: Uni- and multivariate analyses of a prospectively gathered database (1993-2006) were performed on a consecutive series of 526 patients who underwent laparoscopic sigmoid resection due to recurrent diverticulitis in a single institution. Patients were assessed for demographic data, operative indications, and intra- and postoperative complications. Altogether, we analyzed 17 potential risk factors to identify significant influence on the intra- and postoperative outcome, including timing of surgery.
RESULTS: Statistical analysis of specific medical and surgical complications revealed anemia, previous myocardial infarction, heart failure, experience of the surgeon, and male gender, as independent predictive risk factors for postoperative complications. Patients older than age 75 years was the only independent risk factor for intraoperative complications in a multiple logistic regression model. Early elective surgery led to increased conversion rate but did not influence the postoperative complication rate.
CONCLUSIONS: This large, single-center study provides first evidence of the significance of specific predictive risk factors for intra- and postoperative complications in laparoscopic sigmoid resection for diverticular disease.},
}
@article {pmid21178867,
year = {2010},
author = {Hwang, SS and Cannom, RR and Abbas, MA and Etzioni, D},
title = {Diverticulitis in transplant patients and patients on chronic corticosteroid therapy: a systematic review.},
journal = {Diseases of the colon and rectum},
volume = {53},
number = {12},
pages = {1699-1707},
doi = {10.1007/DCR.0b013e3181f5643c},
pmid = {21178867},
issn = {1530-0358},
mesh = {Adrenal Cortex Hormones/*administration & dosage ; Diverticulitis/*etiology/*immunology/mortality/surgery ; Humans ; *Immunocompromised Host ; Incidence ; *Organ Transplantation ; Risk Factors ; },
abstract = {BACKGROUND: The clinical course of diverticular disease in immunosuppressed patients is widely believed to be more severe than in the general population. In this study we systematically reviewed the literature regarding the epidemiology and clinical course of diverticulitis in immunosuppressed patients. Our goal was to develop recommendations regarding the care of this group of patients.
METHODS: Using PubMed and Web of Knowledge we systematically reviewed all studies published between 1970 and 2009 that analyzed the epidemiology, clinical manifestation, or outcomes of treatment of diverticulitis in immunosuppressed patients. Keywords of "transplantation," "corticosteroid," "HIV," "AIDS," and "chemotherapy" were used.
RESULTS: Twenty-five studies met our inclusion criteria. All of these studies focused on the impact of diverticulitis in patients with transplants or on chronic corticosteroid therapy. The reported incidence of acute diverticulitis in these patients was approximately 1% (variable follow-up periods). Among patients with known diverticular disease the incidence was 8%. Mortality from acute diverticulitis in these patients was 23% when treated surgically and 56% when treated medically. Overall mortality was 25%.
CONCLUSIONS: Our study summarizes evidence that patients with transplants or patients on chronic corticosteroid therapy 1) have a rate of acute diverticulitis that is higher than the baseline population and 2) a mortality rate with acute diverticulitis that is high. Further research is needed to define whether these risks constitute a mandate for screening and prophylactic sigmoid colectomy.},
}
@article {pmid21160831,
year = {2010},
author = {Chugay, P and Choi, J and Dong, XD},
title = {Jejunal diverticular disease complicated by enteroliths: Report of two different presentations.},
journal = {World journal of gastrointestinal surgery},
volume = {2},
number = {1},
pages = {26-29},
pmid = {21160831},
issn = {1948-9366},
abstract = {Jejunal diverticula are quite rare. Furthermore, small bowel diverticular disease resulting in enteroliths can lead to complications necessitating surgical intervention. In this manuscript, we report two presentations of jejunal diverticulum with complications from enteroliths followed by a review of the literature. The first case was that of a 79-year-old male who presented with abdominal pain and was found, on computed tomography (CT) scan, to have evidence of intestinal perforation. A laparotomy showed that he had perforated jejunal diverticulitis. The second case was that of an 89-year-old female who presented with recurrent episodes of bowel obstruction. A laparotomy showed that she had an enterolith impacted in her jejunum in the presence of significant diverticular disease. Although a rare entity, familiarity with jejunal diverticular disease, its complications, and its management, should be part of every surgeon's base of knowledge when considering abdominal pathology.},
}
@article {pmid21158878,
year = {2011},
author = {Kang, JY and Firwana, B and Green, AE and Matthews, H and Poullis, A and Barnabas, A and Tan, LT and Lim, AG},
title = {Uncomplicated diverticular disease is not a common cause of colonic symptoms.},
journal = {Alimentary pharmacology & therapeutics},
volume = {33},
number = {4},
pages = {487-494},
doi = {10.1111/j.1365-2036.2010.04540.x},
pmid = {21158878},
issn = {1365-2036},
mesh = {Abdominal Pain/*etiology/physiopathology ; Age Factors ; Aged ; Barium Sulfate ; Colonoscopy ; Constipation/*etiology ; Diarrhea/*etiology ; Diverticulosis, Colonic/complications/*diagnosis/physiopathology ; Enema ; Female ; Humans ; Irritable Bowel Syndrome/*etiology/physiopathology ; Male ; Middle Aged ; Severity of Illness Index ; Statistics as Topic ; Surveys and Questionnaires ; },
abstract = {BACKGROUND: Colonic diverticular disease is common among older individuals whereas colonic symptoms, such as those of irritable bowel syndrome, are frequent in the general population.
AIM: To determine among patients in secondary care, if uncomplicated diverticular disease is a common cause of colonic symptoms.
METHODS: Patients aged ≥50 years attending gastroenterology out-patient clinics or scheduled for colonoscopy or barium enema in a secondary care hospital were invited to take part. Those with structural gastrointestinal diseases were excluded. Participants completed a locally validated Rome II questionnaire on colonic symptoms. Patients with diverticular disease were compared with those without.
RESULTS: Seven hundred and eighty four patients with no structural pathology other than diverticular disease or benign colonic polyps completed the study. A total of 744 patients underwent colonoscopy, 40 barium enema. Of these, 281 patients had diverticular disease. Among patients with and without diverticular disease, the frequency of abdominal pain, diarrhoea, constipation and irritable bowel syndrome were 123 (44%) and 226 (46%), 44 (16%) and 80 (17%), 38 (14%) and 80 (17%) and 66 (25%) and 119 (25%), respectively (N.S.).
CONCLUSION: Uncomplicated colonic diverticular disease is not a common cause of colonic symptoms among patients in secondary care.},
}
@article {pmid21151635,
year = {2010},
author = {Senadhi, V and Brown, JC and Arora, D and Shaffer, R and Shetty, D and Mackrell, P},
title = {A Mysterious Cause of Gastrointestinal Bleeding Disguising Itself as Diverticulosis and Peptic Ulcer Disease: A Review of Diagnostic Modalities for Aortoenteric Fistula.},
journal = {Case reports in gastroenterology},
volume = {4},
number = {3},
pages = {510-517},
pmid = {21151635},
issn = {1662-0631},
abstract = {An 81-year-old male with a history of hypertension, hyperlipidemia, smoking, and peptic ulcer disease (PUD) presented with 2 episodes of maroon stools for 3 days and was found to be orthostatic. His PUD was thought to have accounted for a previous upper gastrointestinal (GI) bleed. A colonoscopy revealed 3 polyps and a few diverticuli throughout the colon that were considered to be the source of the bleeding. Two months later, the patient had massive lower GI bleeding and developed hypovolemic shock with a positive bleeding scan in the splenic flexure; however, angiography was negative. A repeat colonoscopy revealed transverse/descending colon diverticular disease and the patient was scheduled for a left hemicolectomy for presumed diverticular bleeding. Intraoperatively, an aortoenteric (AE) fistula secondary to an aorto-bi-iliac bypass graft placed during an abdominal aortic aneurysm (AAA) repair 14 years prior was discovered and was found to be the source of the bleeding. The patient had an AE fistula repair and did well postoperatively without further bleeding. AE fistulas can present with either upper GI or lower GI bleeding, and are universally deadly if left untreated. AE fistulas often present with a herald bleed before life-threatening bleeding. A careful history should always be elicited in patients with risk factors of AAAs such as hypertension, hyperlipidemia and a history of smoking. Strong clinical suspicion in the setting of a scrupulous patient history is the most important factor that allows for the diagnosis of an AE fistula. There are numerous diagnostic modalities for AE fistula, but there is not one specific test that universally diagnoses AE fistulas. Nuclear medicine scans and angiography should not be completely relied on for the diagnosis of AE fistulas or other lower GI bleeds for that manner. Although the conventional paradigm for evaluating lower GI bleeds incorporates nuclear medicine scans and angiography, there is evidence that early endoscopy with enteroscopy may have a better role in severe lower GI bleeding.},
}
@article {pmid21136110,
year = {2011},
author = {Wolthuis, AM and Penninckx, F and D'Hoore, A},
title = {Laparoscopic sigmoid resection with transrectal specimen extraction has a good short-term outcome.},
journal = {Surgical endoscopy},
volume = {25},
number = {6},
pages = {2034-2038},
pmid = {21136110},
issn = {1432-2218},
mesh = {Adult ; Aged ; Colon, Sigmoid/*surgery ; Diverticulosis, Colonic/*surgery ; Endometriosis/surgery ; Feasibility Studies ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Pilot Projects ; Sigmoid Diseases/*surgery ; Sigmoid Neoplasms/surgery ; Suture Techniques ; Treatment Outcome ; },
abstract = {BACKGROUND: Transrectal specimen extraction in laparoscopic sigmoid resection avoids a muscle-split incision for specimen retrieval. A technique for transrectal specimen extraction is described, and the results of a pilot study concerning feasibility are presented.
METHODS: All consecutive patients undergoing laparoscopic sigmoid resection with transrectal specimen extraction were included in this observational study. A specimen retrieval pouch was used to facilitate specimen extraction. All preoperative and operative data, postoperative morbidity, and short-term outcome were gathered in a database.
RESULTS: The described technique was used to treat 21 patients. The median age of the patients was 41 years (interquartile range [IQR], 34-66 years). The median body mass index (BMI) was 23 kg/m2 (IQR, 22-26 kg/m2), and 90% of the patients were women. Of the 21 patients, 13 (62%) underwent a resection for endometriosis, 5 (24%) had resection for diverticular disease, and 3 (14%) underwent a tumor resection. The median operating time was 105 min (IQR, 90-110 min), and the median intraoperative blood loss was 10 ml (IQR, 0-20 ml). All the procedures except one (95%) were performed within 2 h. The median length of the extracted specimen was 20 cm (IQR, 13-25 cm). There was one anastomotic leak (5%), treated by emergency laparotomy and creation of a new colorectal anastomosis. None of the patients required a temporary diverting stoma, and no postoperative mortality occurred. The median hospital stay was 6 days (IQR, 5-7 days). All the patients did well during a median follow-up period of 3.6 months, and none reported any anal dysfunction.
CONCLUSIONS: Laparoscopic sigmoid resection with transrectal specimen extraction is feasible and has a good short-term outcome.},
}
@article {pmid21133960,
year = {2011},
author = {Tursi, A and Elisei, W and Giorgetti, GM and Aiello, F and Brandimarte, G},
title = {Inflammatory manifestations at colonoscopy in patients with colonic diverticular disease.},
journal = {Alimentary pharmacology & therapeutics},
volume = {33},
number = {3},
pages = {358-365},
doi = {10.1111/j.1365-2036.2010.04530.x},
pmid = {21133960},
issn = {1365-2036},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colitis, Ulcerative/*complications/pathology/physiopathology ; Colonoscopy/*methods ; Diagnosis, Differential ; Diverticulitis, Colonic/etiology/pathology/physiopathology ; Diverticulosis, Colonic/*etiology/pathology/physiopathology ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; },
abstract = {BACKGROUND: Ulcerative colitis with diverticulosis (UCD), segmental colitis associated with diverticulosis (SCAD) and acute uncomplicated diverticulitis (AUD) may affect the same colonic regions, but the real incidence of these entities in clinical practice is unknown.
AIM: To assess the incidence and the endoscopic findings of UCD, SCAD and AUD.
METHODS: From January 2004 to June 2009, 8525 consecutive colonoscopies were performed. Diagnosis of the diseases was based on specific endoscopic and histological (UCD and SCAD), and on endoscopic and radiological (AUD) patterns.
RESULTS: Ulcerative colitis with diverticulosis was diagnosed in 25 patients (0.3%), SCAD was diagnosed in 129 patients (2%) and AUD was diagnosed in 130 patients (2%). In UCD, the inflammation in colonic area harbouring diverticula always affects the overall colonic mucosa in all cases, involving also diverticular orifices. The endoscopic characteristic of SCAD is that inflammation is mainly detected within the inter-diverticular mucosa without involvement of the diverticular orifices. In AUD, the inflammation affects primarily diverticular orifice and peri-diverticular mucosa.
CONCLUSIONS: In clinical practice, the incidence of mucosal inflammation in the presence of colonic diverticular disease is low and endoscopy is the mainstay of differential diagnosis.},
}
@article {pmid21126140,
year = {2010},
author = {Kamel, A and Eddy, J},
title = {Sigmoid-cervical fistula due to diverticular disease.},
journal = {Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology},
volume = {30},
number = {8},
pages = {875-876},
doi = {10.3109/01443615.2010.506963},
pmid = {21126140},
issn = {1364-6893},
mesh = {Diverticulosis, Colonic/*complications ; Female ; Humans ; Intestinal Fistula/*etiology ; Middle Aged ; Sigmoid Diseases/*etiology ; Uterine Cervical Diseases/*etiology ; },
}
@article {pmid21091992,
year = {2010},
author = {Narula, N and Marshall, JK},
title = {Role of probiotics in management of diverticular disease.},
journal = {Journal of gastroenterology and hepatology},
volume = {25},
number = {12},
pages = {1827-1830},
doi = {10.1111/j.1440-1746.2010.06444.x},
pmid = {21091992},
issn = {1440-1746},
mesh = {Colon/*microbiology ; Colonic Diseases/microbiology/*therapy ; Diverticulitis/microbiology/*therapy ; Diverticulum, Colon/microbiology/*therapy ; Evidence-Based Medicine ; Humans ; Probiotics/adverse effects/*therapeutic use ; Treatment Outcome ; },
abstract = {Patients with diverticular disease may experience a variety of chronic symptoms, including abdominal discomfort, bloating, and altered bowel habit. They are also at risk of complications, including hemorrhage, diverticulitis, abscess, and fistula formation. The potential role of abnormal colonic microflora in the pathogenesis of diverticular inflammation has led to investigation of novel therapies such as probiotics. Probiotics are microorganisms that may be of net benefit to humans when consumed. The rationale and safety of their use in diverticular disease is discussed and current literature is reviewed.},
}
@article {pmid21085104,
year = {2010},
author = {Morks, AN and Havenga, K and Ten Cate Hoedemaker, HO and Ploeg, RJ},
title = {The C-seal: a biofragmentable drain protecting the stapled colorectal anastomosis from leakage.},
journal = {Journal of visualized experiments : JoVE},
volume = {},
number = {45},
pages = {},
pmid = {21085104},
issn = {1940-087X},
mesh = {*Absorbable Implants ; Anastomosis, Surgical/*instrumentation/methods ; Anastomotic Leak/*prevention & control ; Colon/*surgery ; Digestive System Surgical Procedures/*instrumentation/methods ; Drainage/*instrumentation/methods ; Humans ; Polyurethanes ; Rectum/*surgery ; },
abstract = {Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates. The incidence of AL varies between 2.5 and 20%. Over the years, many strategies aimed at lowering the incidence of anastomotic leakage have been examined. The cause of AL is probably multifactorial. Etiological factors include insufficient arterial blood supply, tension on the anastomosis, hematoma and/or infection at the anastomotic site, and co-morbid factors of the patient as diabetes and atherosclerosis. Furthermore, some anastomoses may be insufficient from the start due to technical failure. Currently a new device is developed in our institute aimed at protecting the colorectal anastomosis and lowering the incidence of AL. This so called C-seal is a biofragmentable drain, which is stapled to the anastomosis with the circular stapler. It covers the luminal side of the colorectal anastomosis thereby preventing leakage. The C-seal is a thin-walled tube-like drain, with an approximate diameter of 4 cm and an approximate length of 25 cm. It is a tubular device composed of biodegradable polyurethane. Two flaps with adhesive tape are found at one end of the tube. These flaps are used to attach the C-seal to the anvil of the circular stapler, so that after the anastomosis is made the C-seal can be pulled through the anus. The C-seal remains in situ for at least 10 days. Thereafter it will lose strength and will degrade to be secreted from the body together with the gastrointestinal natural contents. The C-seal does not prevent the formation of dehiscences. However, it prevents extravasation of faeces into the peritoneal cavity. This means that a gap at the anastomotic site does not lead to leakage. Currently, a phase II study testing the C-seal in 35 patients undergoing (colo-)rectal resection with stapled anastomosis is recruiting. The C-seal can be used in both open procedures as well as laparoscopic procedures. The C-seal is only applied in stapled anastomoses within 15 cm from the anal verge. In the video, application of the C-seal is shown in an open extended sigmoid resection in a patient suffering from diverticular disease with a stenotic colon.},
}
@article {pmid21085070,
year = {2010},
author = {Bosanquet, DC and Williams, N and Lewis, MH},
title = {Acquired small bowel diverticular disease: a review.},
journal = {British journal of hospital medicine (London, England : 2005)},
volume = {71},
number = {10},
pages = {552-555},
doi = {10.12968/hmed.2010.71.10.78937},
pmid = {21085070},
issn = {1750-8460},
mesh = {Adult ; Aged ; Chronic Disease ; Diverticulum/*diagnosis/etiology ; Humans ; Intestinal Diseases/*diagnosis/etiology ; *Intestine, Small ; Middle Aged ; Tomography, X-Ray Computed ; },
}
@article {pmid21071775,
year = {2010},
author = {Vermeulen, J and van der Harst, E and Lange, JF},
title = {Pathophysiology and prevention of diverticulitis and perforation.},
journal = {The Netherlands journal of medicine},
volume = {68},
number = {10},
pages = {303-309},
pmid = {21071775},
issn = {1872-9061},
mesh = {Diet ; Diverticulitis, Colonic/etiology/*physiopathology/*prevention & control ; Diverticulum, Colon/etiology/*physiopathology/*prevention & control ; Humans ; Intestinal Perforation/etiology/*physiopathology/*prevention & control ; Life Style ; Risk Factors ; },
abstract = {OBJECTIVE: This article gives an overview of the current evidence and theories in the pathophysiology of diverticulosis, diverticulitis and perforation and discusses its prevention.
BACKGROUND: Diverticular disease is one of the most common diseases related to the gastrointestinal tract in Western countries. The pathogenesis of this disease process is probably multifactorial, but remains poorly understood and inadequately investigated.
METHODS: A literature search was performed in order to give an overview of the current evidence and theories in the pathophysiology of diverticula formation and the factors related to progression towards inflammation and even perforation. Strategies for prevention of (perforated) diverticulitis are also discussed.
RESULTS/CONCLUSION: The pathogenesis of diverticular disease and its complications seems to be a result of a complex interaction between exposure to a low-fibre diet, possible genetic influences, the coexistence of other bowel diseases and the impact of medicine use. This eventually leads to alterations in colonic pressures and motility and structural changes of the colon wall. Unfortunately the evidence is frequently conflicting in the present literature or lacking altogether.},
}
@article {pmid21037552,
year = {2010},
author = {Guslandi, M},
title = {Medical treatment of uncomplicated diverticular disease of the colon: any progress?.},
journal = {Minerva gastroenterologica e dietologica},
volume = {56},
number = {3},
pages = {367-370},
pmid = {21037552},
issn = {1121-421X},
mesh = {Diverticulosis, Colonic/*therapy ; Humans ; },
abstract = {Clinical evidence supports a therapeutic approach to uncomplicated, symptomatic diverticular disease of the colon by means of increased fiber intake and cyclic administration of the non absorbable antibiotic agent rifaximin polymorph-alpha. Alternate treatments such as mesalazine and probiotics have been recently proposed but no definitive conclusions on their efficacy can be drawn until larger, randomized placebo-controlled studies will be available.},
}
@article {pmid20976634,
year = {2011},
author = {Mete, Ö and Doğan, Ö and Kapran, Y and Tihan, D and Erbil, Y and Ozarmağan, S},
title = {Intestinal Langerhans cell histiocytosis-like lesion in an adult presented with diverticulitis: a reactive or neoplastic condition?.},
journal = {Pathology oncology research : POR},
volume = {17},
number = {2},
pages = {403-407},
pmid = {20976634},
issn = {1532-2807},
mesh = {Aged ; Diverticulitis/etiology/*pathology ; Histiocytosis, Langerhans-Cell/complications/*pathology ; Humans ; Intestinal Diseases/complications/*pathology ; Intestines/pathology ; Male ; },
abstract = {The involvement of the gut by Langerhans cell histiocytosis (LCH) is very rare in adults; however this is usually observed with a disseminated disease in children. We report a 75-year-old male patient who underwent right hemicolectomy for a complicated intestinal diverticular disease. The surgical specimen revealed LCH-like proliferative lesion associated with diverticulitis. The overall morphological and immunohistochemical findings are indistinguishable from LCH. Systemic scans and subsequently performed bone marrow biopsies were free of disease. Although the HUMARA clonality assay cannot be assessed, the lack of evidence of LCH progression or disease elsewhere in the whole body strongly supported the possibility of an atypical reactive phenomenon probably due to the underlying intestinal diverticular disease. Therefore, it is important to avoid diagnosing such a unifocal Langerhans cell proliferation as LCH in patients with underlying pathologies in the absence of systemic involvement. Therefore, without knowledge of clonal status of a unifocal Langerhans cell proliferation, we recommend using the terminology of LCH-like lesion.},
}
@article {pmid20955549,
year = {2010},
author = {Sasi, W and Hamad, I and Quinn, A and Nasr, AR},
title = {Giant sigmoid diverticulum with coexisting metastatic rectal carcinoma: a case report.},
journal = {Journal of medical case reports},
volume = {4},
number = {},
pages = {324},
pmid = {20955549},
issn = {1752-1947},
abstract = {INTRODUCTION: Giant diverticulum of the colon is a rare but clinically significant condition, usually regarded as a complication of an already existing colonic diverticular disease. This is the first report of a giant diverticulum of the colon with a co-existing rectal carcinoma.
CASE PRESENTATION: We report a case of a 66-year-old Caucasian woman who presented with lower abdominal pain, chronic constipation and abdominal swelling. Preoperative abdominal computed tomography revealed a giant diverticulum of the colon with a coexisting rectal carcinoma and pulmonary metastasis revealed on a further thoracic computed tomography. An en bloc anterior resection of the rectum along with sigmoid colectomy, partial hysterectomy and right salpingoophorectomy was subsequently performed due to extensive adhesions.
CONCLUSION: This report shows that the presence of a co-existing distal colorectal cancer can potentially lead to progressive development of a colonic diverticulum to become a giant diverticulum by increasing colonic intra-luminal pressure and through the ball-valve mechanism. This may be of interest to practising surgeons and surgical trainees.},
}
@article {pmid20953872,
year = {2011},
author = {Raue, W and Langelotz, C and Paolucci, V and Pross, M and Ludwig, K and Asperger, W and Schwenk, W},
title = {Problems of randomization to open or laparoscopic sigmoidectomy for diverticular disease.},
journal = {International journal of colorectal disease},
volume = {26},
number = {3},
pages = {369-375},
pmid = {20953872},
issn = {1432-1262},
mesh = {Aged ; Colon, Sigmoid/*pathology/*surgery ; Demography ; Digestive System Surgical Procedures/*methods ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; },
abstract = {PURPOSE: Although complicated sigmoid diverticulitis is the most common reason for laparoscopic sigmoidectomy, the level of evidence for preference of the laparoscopic approach is low.
METHODS: A multicenter, randomized clinical trial comparing laparoscopic and open sigmoidectomy for diverticulitis was conducted to evaluate the short- and mid-term outcome after both techniques. Data were assessed from randomized patients and from patients who refused randomization. Results of the here presented interim analysis describe the difficulties in randomization leading to abortion of recruitment.
RESULTS: 149 patients were enrolled in the randomized trial within 36 months until the interim analysis. A further 294 nonrandomized patients who preferred one of both surgical approaches were assessed. Several differences between these groups were apparent including simple epidemiological characteristics such as age (65 vs. 60 years, p < 0.001), gender (65% vs. 55% female, p = 0.05), BMI (27 vs. 26 kg/m(2), p = 0.01), and ASA class < III (72% vs. 87%, p < 0.001).
CONCLUSION: The majority of eligible patients refused a random allocation. A widespread presumption of the advantages of laparoscopic surgery was probably the main reason for refusal. Patients participating in randomization did not reflect the general population in recruiting hospitals. Future trials comparing minimal invasive procedures should be conducted before presumptions concerning the outcome are widespread in the general population.},
}
@article {pmid20952348,
year = {2010},
author = {Laubert, T and Hildebrand, P and Roblick, UJ and Kraus, M and Esnaashari, H and Wellhöner, P and Bruch, HP},
title = {MIS approach for diverticula of the esophagus.},
journal = {European journal of medical research},
volume = {15},
number = {9},
pages = {390-396},
pmid = {20952348},
issn = {0949-2321},
mesh = {Aged ; Barium ; Diverticulum, Esophageal/diagnostic imaging/*surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/*methods ; Postoperative Complications ; Radiography ; Retrospective Studies ; Zenker Diverticulum/diagnostic imaging/*surgery ; },
abstract = {PURPOSE: diverticula of the esophagus represent a rare pathological entity. Distinct classifications of the disease imply different surgical concepts. Surgery should be reserved for symptomatic patients only. Minimally invasive surgery (MIS) for treatment of esophageal diverticula encompasses rigid and flexible intraluminal endoscopy, thoracoscopy and laparoscopy. We here give an overview on the pathogenesis of esophageal diverticula, the minimally invasive surgical techniques for treatment and the recent literature. Additionally, we present our own experience with MIS for midthoracic diverticula.
METHODS: we analyzed the cases of patients who underwent MIS for midthoracic diverticula with regard to preoperative symptoms, perioperative and follow-up data.
RESULTS: three patients (two female, one male, age 79, 78 and 59 years) received thoracoscopic surgery for midthoracic diverticula. All patients reported of dysphagia and regurgitation. In two patients pH-investigation showed pathological reflux but manometry was normal in all patients. Operating time was 205, 135 and 141 minutes. We performed intraoperative intraluminal endoscopy in all patients. There were no intraoperative complications and although no surgical complications occured postoperatively one patient developed pneumonia which advanced to sepsis and lethal multi organ failure. Upon follow-up the two patients did not have recurrent diverticula or a recurrence of previous symptoms.
CONCLUSIONS: surgery for diverticular disease of the esophagus has been associated with high rates of morbidity and mortality. Despite the lethal non-surgical complication we encountered, with regard to recent publications minimally invasive apporaches to treat patients with symptomatic esophageal diverticula entail lower rates of complications with better long term results in comparison to open surgery.},
}
@article {pmid20942810,
year = {2010},
author = {Haboubi, N},
title = {Diverticular disease and colorectal cancer, causally associated or accidentals; the logic from Burkitt to C-CLEAR.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {12},
number = {11},
pages = {1073-1074},
doi = {10.1111/j.1463-1318.2010.02399.x},
pmid = {20942810},
issn = {1463-1318},
mesh = {Colorectal Neoplasms/*complications/etiology ; Diverticulosis, Colonic/*complications ; Humans ; },
}
@article {pmid20940283,
year = {2011},
author = {Humes, DJ and Fleming, KM and Spiller, RC and West, J},
title = {Concurrent drug use and the risk of perforated colonic diverticular disease: a population-based case-control study.},
journal = {Gut},
volume = {60},
number = {2},
pages = {219-224},
doi = {10.1136/gut.2010.217281},
pmid = {20940283},
issn = {1468-3288},
mesh = {Aged ; Aged, 80 and over ; Analgesics/adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Cardiovascular Agents/adverse effects ; Comorbidity ; Confounding Factors, Epidemiologic ; Diverticulum, Colon/*complications/epidemiology ; *Drug-Related Side Effects and Adverse Reactions ; Epidemiologic Methods ; Female ; Glucocorticoids/adverse effects ; Humans ; Intestinal Perforation/*chemically induced/epidemiology/etiology ; Male ; Middle Aged ; United Kingdom/epidemiology ; },
abstract = {OBJECTIVE: To determine the risk of diverticular perforation associated with current and ever use of corticosteroids, opiate analgesics, non-steroidal anti-inflammatory drugs, aspirin, cyclo-oxygenase-2 inhibitors, statins and calcium antagonists.
Case-control analysis using conditional logistic regression analysis of data from the UK General Practice Research Database. The study involved 899 cases of incident diverticular perforation and 8980 population controls from 1990 to 2005.
MAIN OUTCOME MEASURES: Odds ratios (ORs) are presented for perforation associated with use of corticosteroids, opiate analgesics, non-steroidal anti-inflammatory drugs, aspirin, cyclo-oxygenase-2 inhibitors, statins and calcium antagonists. Data were adjusted for smoking, comorbidity, prior abdominal pain and body mass index.
RESULTS: A total of 899 patients with an incident diagnosis of perforated diverticular disease were identified. Current use of opiate analgesics (OR=2.16; 95% CI 1.55 to 3.01) and oral corticosteroids (OR=2.74; 95% CI 1.63 to 4.61) was associated with a two- and threefold increase in the risk of diverticular perforation, respectively. Current use of a calcium antagonist and aspirin were not associated with an increased risk of diverticular perforation. Current statin use was associated with a reduction in the risk of perforation (OR=0.44; 95% CI 0.20 to 0.95).
CONCLUSION: Perforated diverticular disease is a serious surgical emergency with current opiate analgesics and oral corticosteroids being strongly associated with an increased risk of diverticular perforation.},
}
@article {pmid20937418,
year = {2011},
author = {Lee, KK and Shah, SM and Moser, MA},
title = {Risk factors predictive of severe diverticular hemorrhage.},
journal = {International journal of surgery (London, England)},
volume = {9},
number = {1},
pages = {83-85},
doi = {10.1016/j.ijsu.2010.09.011},
pmid = {20937418},
issn = {1743-9159},
mesh = {Aged ; Aged, 80 and over ; Cohort Studies ; Colonic Diseases/*complications/*diagnosis/therapy ; Colonoscopy ; Diverticulum/*complications/*diagnosis/therapy ; Female ; Gastrointestinal Hemorrhage/diagnosis/*etiology/therapy ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; },
abstract = {BACKGROUND: Diverticular disease is a common cause for lower gastrointestinal bleeding. Although the hemorrhage often resolves spontaneously, some patients will require massive transfusions and emergency surgery. In this study we report risk factors predictive of severe diverticular bleeds.
METHODS: We completed a retrospective analysis of 99 patients, admitted with lower gastrointestinal bleeding and colonoscopic evidence of diverticulosis and no other cause of the hemorrhage between January 1995 and December 2005. A database was generated and univariate and multivariate analyses were carried out.
RESULTS: Of the 99 patients, 23 patients were classified as having a severe bleed defined as having a systolic blood pressure below 90 mm Hg, requirement for more than 6 units of transfusion, or emergent surgery. Multiple logistic regression showed that the initial hemoglobin (p = 0.001), INR ≥ 1.5 (p = 0.003), initial diastolic blood pressure (p = 0.024), initial heart rate (p = 0.047), and blood pressure medications (p = 0.049) predicted severe diverticular hemorrhage.
CONCLUSIONS: The identified predictor variables are all quantifiable at the time of initial presentation, and these may help identify severe cases of diverticular bleeding requiring urgent management.},
}
@article {pmid20927068,
year = {2010},
author = {Tursi, A},
title = {Irritable bowel syndrome and diverticular disease: association or misdiagnosis?.},
journal = {The American journal of gastroenterology},
volume = {105},
number = {10},
pages = {2293; author reply 2293-4},
doi = {10.1038/ajg.2010.198},
pmid = {20927068},
issn = {1572-0241},
mesh = {*Diagnostic Errors ; Diarrhea/complications/*diagnosis ; Diverticulitis, Colonic/complications/*diagnosis ; Humans ; Irritable Bowel Syndrome/complications/*diagnosis ; },
}
@article {pmid20922195,
year = {2010},
author = {Zullo, A and Hassan, C and Maconi, G and Manes, G and Tammaro, G and De Francesco, V and Annibale, B and Ficano, L and Buri, L and Gatto, G and Lorenzetti, R and Campo, SM and Ierardi, E and Pace, F and Morini, S},
title = {Cyclic antibiotic therapy for diverticular disease: a critical reappraisal.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {19},
number = {3},
pages = {295-302},
pmid = {20922195},
issn = {1842-1121},
mesh = {Anti-Bacterial Agents/*administration & dosage ; Dietary Fiber/administration & dosage ; Diverticulitis/etiology/*prevention & control ; Diverticulum/complications/*drug therapy ; Drug Administration Schedule ; Evidence-Based Medicine ; Humans ; Patient Selection ; Rifamycins/*administration & dosage ; Rifaximin ; Treatment Outcome ; },
abstract = {Different symptoms have been attributed to uncomplicated diverticular disease (DD). Poor absorbable antibiotics are largely used for uncomplicated DD, mainly for symptom treatment and prevention of diverticulitis onset. Controlled trials on cyclic administration of rifaximin in DD patients were evaluated. Four controlled, including 1 double-blind and 3 open-label, randomized studies were available. Following a long-term cyclic therapy, a significant difference emerged in the global symptoms score (range: 0-18) between rifaximin plus fibers (from 6-6.5 to 1-2) and fibers alone (from 6.7 to 2-3.8), although the actual clinically relevance of such a very small difference remains to be ascertained. Moreover, a similar global symptom score reduction (from 6 to 2.4) can be achieved by simply recommending an inexpensive high-fiber diet. Current data suggest that cyclic rifaximin plus fibers significantly reduce the incidence of the first episode of acute diverticulitis as compared to fibers alone (1.03% vs 2.75%), but a cost-efficacy analysis is needed before this treatment can be routinely recommended. The available studies have been hampered by some limitations, and definite conclusions could not be drawn. The cost of a long-life, cyclic rifaximin therapy administered to all symptomatic DD patients would appear prohibitive.},
}
@article {pmid20877270,
year = {2010},
author = {Pagano, D and Cintorino, D and Gruttadauria, S and Spada, M and Echeverri, G and Botrugno, I and di Francesco, F and Li Petri, S and Gridelli, B},
title = {Malignant diverticulitis of the left colon complicating heart transplantation.},
journal = {Annals of transplantation},
volume = {15},
number = {3},
pages = {71-74},
pmid = {20877270},
issn = {2329-0358},
mesh = {Colon, Descending/pathology/surgery ; Colonoscopy ; Diverticulitis, Colonic/diagnosis/*etiology/surgery ; Diverticulosis, Colonic/complications/surgery ; Heart Transplantation/*adverse effects ; Humans ; Immunosuppression Therapy/adverse effects ; Male ; Middle Aged ; Treatment Outcome ; },
abstract = {BACKGROUND: Colonic diverticular disease is rare in developing nations but common in Western and industrialized societies. Many studies show that heart and lung transplantation increase the risk of having severe diverticulitis, although the exact magnitude of this risk remain unclear because many of these studies have been small with short follow up. The term malignant diverticulitis has been employed to describe an extreme form of colon diverticulitis that is characterized by an extensive phlegmon and inflammatory reaction extending below the peritoneal reflection, with a tendency toward obstruction and fistula formation.
CASE REPORT: We report a 57-year-old male, transplanted in our Institute for dilated cardiomyopathy due to previous myocardial ischemia, in whom, during the post-transplantation period, a malignant diverticulitis requiring an aggressive surgical approach was diagnosed, the diagnosis of diverticulosis was made during a colonoscopy in a pre-transplant work-up.
CONCLUSIONS: Immunosuppressed patients should be considered at high risk for developing a complicated malignant diverticular disease, and when diagnosed in a pre-transplant work-up, should be managed aggressively in terms of surgical approach when symptoms and signs suggest a diverticulitis.},
}
@article {pmid20874237,
year = {2010},
author = {Saad, S and Hosogi, H},
title = {Natural orifice specimen extraction for avoiding laparotomy in laparoscopic left colon resections: a new approach using the McCartney tube and the tilt top anvil technique.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {20},
number = {8},
pages = {689-692},
doi = {10.1089/lap.2010.0303},
pmid = {20874237},
issn = {1557-9034},
mesh = {Anastomosis, Surgical/methods ; Colon/*surgery ; Colonic Neoplasms/complications/surgery ; Diverticulitis, Colonic/complications/surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/adverse effects/*instrumentation/*methods ; Laparotomy ; Male ; Pain, Postoperative/etiology ; Sutures ; Treatment Outcome ; },
abstract = {BACKGROUND: Classical laparoscopic left colon resection requires a minilaparotomy. This wound can cause pain and morbidity. We describe our technique to avoid minilaparotomy by natural orifice specimen extraction.
METHODS: A four-port standard laparoscopic dissection for diverticular disease and small tumors of the left colon was performed. A silicon McCartney tube was transanally inserted into the rectum to remove the specimen and to pass the anvil of the circular stapler into the abdominal cavity. The head of the anvil was mechanically pretilted to facilitate introduction into the proximal colon. Double-stapled anastomosis was performed in the usual manner.
RESULTS: Eight patients with diverticular disease or small tumors were operated. There were no adverse events. Operating time ranged between 95 and 180 minutes. For malignancies, tissue margins and lymphadenectomy were oncologically adequate. Four week follow-up was uneventful.
CONCLUSION: The described natural orifice specimen extraction technique has the potential to avoid incision-related morbidity of the minilaparotomy in laparoscopic left colon resections.},
}
@article {pmid20872022,
year = {2011},
author = {Klarenbeek, BR and Bergamaschi, R and Veenhof, AA and van der Peet, DL and van den Broek, WT and de Lange, ES and Bemelman, WA and Heres, P and Lacy, AM and Cuesta, MA},
title = {Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial.},
journal = {Surgical endoscopy},
volume = {25},
number = {4},
pages = {1121-1126},
pmid = {20872022},
issn = {1432-2218},
mesh = {Comorbidity ; Diverticulitis, Colonic/*surgery ; Diverticulosis, Colonic/*surgery ; Double-Blind Method ; Elective Surgical Procedures/statistics & numerical data ; Follow-Up Studies ; Humans ; Ileostomy/methods ; Laparoscopy/*methods/statistics & numerical data ; Laparotomy/methods/statistics & numerical data ; Postoperative Complications/epidemiology/surgery ; Prospective Studies ; Quality of Life ; Recovery of Function ; Recurrence ; Sigmoid Diseases/*surgery ; Time Factors ; },
abstract = {BACKGROUND: The short-term results of the Sigma trial show that laparoscopic sigmoid resection (LSR) used electively for diverticular disease offers advantages over open sigmoid resection (OSR). This study aimed to compare the overall mortality and morbidity rates after evaluation of the clinical outcomes at the 6-month follow-up evaluation.
METHODS: In a prospective, multicenter, double-blind, parallel-arm, randomized control trial, eligible patients were randomized to either LSR or OSR. The short-term results and methodologic details have been published previously. Follow-up evaluation was performed at the outpatient clinic 6 weeks and 6 months after surgery.
RESULTS: In this trial, 104 patients were randomized for either LSR or OSR, and the conversion rate was 19.2%. The LSR approach was associated with short-term benefits such as a 15.4% reduction in the major complications rate, less pain, and a shorter hospital stay at the cost of a longer operating time. At the 6-month follow-up evaluation, no significant differences in morbidity or mortality rates were found. Two patients died of cardiac causes (overall mortality, 3%). Late complications (7 LSR vs. 12 OSR; p = 0.205) consisted of three incisional hernias, five small bowel obstructions, four enterocutaneous fistulas, one intraabdominal abscess, one retained gauze, two anastomotic strictures, and three recurrent episodes of diverticulitis. Nine of these patients underwent additional surgical interventions. Consideration of the major morbidity over the total follow-up period (0-6 months) shows that the LSR patients experienced significantly fewer complications than the OSR patients (9 LSR vs. 23 OSR; p = 0.003). The Short Form-36 (SF-36) questionnaire showed significantly better quality of life for LSR at the 6-week follow-up assessment. However, at the 6-month follow-up assessment, these differences were decreased.
CONCLUSIONS: The late clinical outcomes did not differ between LSR and OSR during the 30-day to 6-month follow-up period. Consideration of total postoperative morbidity shows a 27% reduction in major morbidity for patients undergoing laparoscopic surgery for diverticular disease.},
}
@article {pmid20869745,
year = {2010},
author = {Ye, H and Montgomery, E and Epstein, JI},
title = {Incidental anorectal pathologic findings in prostatic needle core biopsies: a 13-year experience from a genitourinary pathology consult service.},
journal = {Human pathology},
volume = {41},
number = {12},
pages = {1674-1681},
doi = {10.1016/j.humpath.2010.06.006},
pmid = {20869745},
issn = {1532-8392},
mesh = {Adenoma/pathology/surgery ; Aged ; Anus Diseases/*diagnosis ; Biopsy, Needle ; Colonic Polyps/pathology ; Humans ; *Incidental Findings ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; Prostatic Diseases/*diagnosis ; Referral and Consultation ; },
abstract = {Fragments of anorectal mucosa are frequently present in transrectal prostate core biopsy specimens. Pathologic findings within the anorectal mucosa are easily overlooked, in part because of their rarity and because anorectal mucosa is not the focus of examination. We reviewed pathologic reports of 96,656 prostate biopsies diagnosed in our consultation service from 1997 to 2010. Anorectal lesions were detected in 30 cases, which were summarized as follows: (1) Neoplasia and polyps (n = 10). A flat rectal adenoma with high-grade dysplasia was identified, for which the patient received hemicolectomy. One patient was found to have a rectal carcinoid tumor. Other neoplastic findings included 1 with low-grade B-cell lymphoma, 3 with hyperplastic polyps, 3 with tubular adenomas, and 1 with anal mucosa with high-grade dysplasia that was found to be a contaminant from another case. (2) Inflammatory changes (n = 20). Acute proctitis was found in 12 patients, including 1 with acute radiation proctitis, 2 with inflammatory bowel disease, and 9 with nonspecific proctitis probably due to bowel preparation. Pulse granulomas and nonnecrotizing granulomas were seen in 5 patients, including 3 with diverticular disease, 1 with history of perirectal fistula, and 1 with unknown etiology. Three patients had miscellaneous findings including muciphage reaction, increased eosinophils, and features of collagenous colitis. In conclusion, it is exceedingly rare to find significant pathology in the rectal fragments associated with prostate needle biopsies. Nevertheless, pathologists should evaluate the rectal mucosa for both neoplastic and inflammatory changes to avoid missing clinically significant anorectal diseases.},
}
@article {pmid20857538,
year = {2010},
author = {Golder, M},
title = {Abnormal colonic cholinergic and nitrergic activities in relation to elastosis in uncomplicated diverticular disease.},
journal = {World journal of gastroenterology},
volume = {16},
number = {36},
pages = {4625-4626},
pmid = {20857538},
issn = {2219-2840},
mesh = {Acetylcholine/*metabolism ; Choline O-Acetyltransferase/metabolism ; *Colon/pathology/physiopathology ; *Diverticulitis, Colonic/pathology/physiopathology ; Humans ; Nitric Oxide/*metabolism ; Nitric Oxide Synthase Type I/metabolism ; },
abstract = {I read with interest the review on the pathogenesis of diverticular disease by Commane et al in World J Gastroenterol 2009; 15(20): 2479-2488. However, I would like to discuss several important errors that the authors made whilst citing information from previously published work on the neuromuscular dysfunction in the disease.},
}
@article {pmid20857527,
year = {2010},
author = {Cubiella Fernández, J and Núñez Calvo, L and González Vázquez, E and García García, MJ and Alves Pérez, MT and Martínez Silva, I and Fernández Seara, J},
title = {Risk factors associated with the development of ischemic colitis.},
journal = {World journal of gastroenterology},
volume = {16},
number = {36},
pages = {4564-4569},
pmid = {20857527},
issn = {2219-2840},
mesh = {Aged ; Aged, 80 and over ; Cardiovascular Diseases/*complications ; Case-Control Studies ; *Colitis, Ischemic/etiology/pathology/physiopathology ; Diabetes Mellitus, Type 2/*complications ; Female ; Humans ; Hypertension/*complications ; ROC Curve ; Retrospective Studies ; Risk Factors ; },
abstract = {AIM: To ascertain the role of cardiovascular risk factors, cardiovascular diseases, standard treatments and other diseases in the development of ischemic colitis (IC).
METHODS: A retrospective, case-control study was designed, using matched data and covering 161 incident cases of IC who required admission to our hospital from 1998 through 2003. IC was diagnosed on the basis of endoscopic findings and diagnostic or compatible histology. Controls were randomly chosen from a cohort of patients who were admitted in the same period and required a colonoscopy, excluding those with diagnosis of colitis. Cases were matched with controls (ratio 1:2), by age and sex. A conditional logistic regression was performed.
RESULTS: A total of 483 patients (161 cases, 322 controls) were included; mean age 75.67 ± 10.03 years, 55.9% women. The principal indications for colonoscopy in the control group were lower gastrointestinal hemorrhage (35.4%), anemia (33.9%), abdominal pain (19.9%) and diarrhea (9.6%). The endoscopic findings in this group were hemorrhoids (25.5%), diverticular disease (30.4%), polyps (19.9%) and colorectal cancer (10.2%). The following variables were associated with IC in the univariate analysis: arterial hypertension (P = 0.033); dyslipidemia (P < 0.001); diabetes mellitus (P = 0.025); peripheral arterial disease (P = 0.004); heart failure (P = 0.026); treatment with hypotensive drugs (P = 0.023); angiotensin-converting enzyme inhibitors; (P = 0.018); calcium channel antagonists (P = 0.028); and acetylsalicylic acid (ASA) (P < 0.001). Finally, the following variables were independently associated with the development of IC: diabetes mellitus [odds ratio (OR) 1.76, 95% confidence interval (CI): 1.001-3.077, P = 0.046]; dyslipidemia (OR 2.12, 95% CI: 1.26-3.57, P = 0.004); heart failure (OR 3.17, 95% CI: 1.31-7.68, P = 0.01); peripheral arterial disease (OR 4.1, 95% CI: 1.32-12.72, P = 0.015); treatment with digoxin (digitalis) (OR 0.27, 95% CI: 0.084-0.857, P = 0.026); and ASA (OR 1.97, 95% CI: 1.16-3.36, P = 0.012).
CONCLUSION: The development of an episode of IC was independently associated with diabetes, dyslipidemia, presence of heart failure, peripheral arterial disease and treatment with digoxin or ASA.},
}
@article {pmid20819332,
year = {2010},
author = {McDaid, J and Reichl, C and Hamzah, I and Fitter, S and Harbach, L and Savage, AP},
title = {Diverticular fistulation is associated with nicorandil usage.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {92},
number = {6},
pages = {463-465},
pmid = {20819332},
issn = {1478-7083},
mesh = {Adult ; Aged ; Aged, 80 and over ; Angina Pectoris/drug therapy ; Case-Control Studies ; Diverticulum, Colon/*complications/pathology/therapy ; Female ; Humans ; Intestinal Fistula/*chemically induced/therapy ; Male ; Middle Aged ; Nicorandil/*adverse effects/therapeutic use ; Rectovaginal Fistula/chemically induced/therapy ; Vasodilator Agents/*adverse effects/therapeutic use ; },
abstract = {INTRODUCTION: We observed that a number of patients presenting to our clinic with diverticular fistulation were taking nicorandil for angina. Recognised side effects of nicorandil include gastrointestinal and genital ulceration. The aim of our study was to determine whether nicorandil is an aetiological agent in diverticular fistulation.
PATIENTS AND METHODS: We conducted a case-control study of patients with diverticular disease related enteric fistulae. Two patient groups were identified: a study group of patients with diverticular fistulae, and a control group with uncomplicated diverticular disease. The proportion of patients who had ever used nicorandil was compared between the two groups.
RESULTS: A total of 153 case notes were analysed, 69 patients with fistulae and 84 control patients with uncomplicated diverticular disease. Female to male ratio in both groups was 2:1. The mean age was 71 years in the fistula group and 69 years in the control diverticular disease group (P = ns). Of those with colonic fistulae, 16% were taking nicorandil compared with 2% of the control group (odds ratio 7.8; 95% confidence interval 1.5-39.1; P = 0.008). There was no significant difference in rates of ischaemic heart disease between fistula and control groups.
CONCLUSIONS: Nicorandil is associated with fistula formation in diverticular disease.},
}
@article {pmid20819228,
year = {2010},
author = {de Silva, P and Pranesh, N and Vautier, G},
title = {Presentations of perforated colonic pathology in patients with polymyalgia rheumatica: two case reports.},
journal = {Journal of medical case reports},
volume = {4},
number = {},
pages = {299},
pmid = {20819228},
issn = {1752-1947},
abstract = {INTRODUCTION: Polymyalgia rheumatica is an increasingly common disease in older people, which gives rise to arthralgia and is mainly treated with corticosteroids. Patients in this age group also have a higher incidence of other co-morbidities including colonic pathology. Corticosteroid usage may mask signs of sepsis or complications secondary to intra-abdominal pathology, thereby delaying diagnosis and treatment, with eventual adverse outcome. These two cases highlight the importance of awareness and prompt recognition of this condition in order to avoid significant morbidity and mortality.
CASE PRESENTATION: CASE 1: A 73-year-old Caucasian woman with a diagnosis of polymyalgia presented with symptoms of an exacerbation in her right hip joint. Despite standard therapy with corticosteroids she failed to improve and started to develop features of widespread sepsis. Specific questioning revealed that, at the very onset of her symptoms, she had experienced mild diarrheal symptoms. Investigations revealed perforated diverticular disease with a peri-femoral abscess. CASE 2: A 69-year-old Caucasian woman with polymyalgia presented with left thigh pain and weakness associated with weight loss. A diagnosis of exacerbation of polymyalgia rheumatica was made and she was treated with corticosteroid therapy. Shortly afterwards she was admitted with generalized peritonitis. Laparotomy revealed a retroperitoneal abscess secondary to a perforated sigmoid colonic tumor.
CONCLUSIONS: Patients with polymyalgia may have perforated colonic diverticular disease which mimics their rheumatic pathology. In such cases steroid therapy, which is the mainstay of polymyalgia therapy, can be detrimental. Primary and hospital practitioners are encouraged to be vigilant regarding non-specific gastrointestinal symptoms and consider alternative diagnoses in those patients whose symptoms do not resolve with standard therapy, as this can lead to an overall better outcome.},
}
@article {pmid20810019,
year = {2010},
author = {Owen, HA and Srikandarajah, N and Aurangabadkar, A and Downey, K and Melville, D},
title = {Laparoscopic management of foreign body perforation in diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {92},
number = {7},
pages = {W24-5},
pmid = {20810019},
issn = {1478-7083},
mesh = {Aged ; Bone and Bones ; Colon, Sigmoid/diagnostic imaging/injuries/*surgery ; Diverticulum, Colon/*complications ; Foreign Bodies/complications/diagnostic imaging/*surgery ; Humans ; Intestinal Perforation/etiology/*surgery ; Laparoscopy/methods ; Male ; Tomography, X-Ray Computed ; },
abstract = {A case is described where laparoscopic principles in the management of spontaneous sigmoid diverticular perforation are applied to foreign body perforation.},
}
@article {pmid20731014,
year = {2010},
author = {Angriman, I and Scarpa, M and Ruffolo, C},
title = {Health related quality of life after surgery for colonic diverticular disease.},
journal = {World journal of gastroenterology},
volume = {16},
number = {32},
pages = {4013-4018},
pmid = {20731014},
issn = {2219-2840},
mesh = {Clinical Trials as Topic ; Diverticulosis, Colonic/pathology/*surgery ; Humans ; Postoperative Complications/surgery ; *Quality of Life ; Surveys and Questionnaires ; },
abstract = {Diverticular disease (DD) of the colon is very common in developed countries and is ranked the fifth most important gastrointestinal disease worldwide. The management of acute diverticulitis without perforation and peritonitis is still debated. Health related quality of life (HRQL), subjectively perceived by patients, is becoming a major issue in the evaluation of any therapeutic intervention, mainly in patients with chronic disease. To date only a few published studies can be found on Medline examining HRQL in patients with DD. The aim of this study was to review the impact of surgery for DD on HRQL. All Medline articles regarding HRQL after surgery for colonic DD, particularly those comparing different surgical approaches, were reviewed. DD has a negative impact on HRQL with lower scores in bowel function and systemic symptoms. Both surgery-related complications and disease activity have a significant impact on patients' HRQL. While no significant differences in HRQL between different operations for DD in non-randomized studies were revealed, the only prospective double-blind randomized study that compared laparoscopic and open colectomy found that patients undergoing laparoscopic colectomy had significantly reduced major postoperative complication rates and subsequently had better HRQL scores. Formal assessment of HRQL could be a good instrument in the selection of appropriate patients for elective surgery as well as in the assessment of surgical outcome.},
}
@article {pmid20714895,
year = {2010},
author = {Siddiqui, MR and Sajid, MS and Khatri, K and Cheek, E and Baig, MK},
title = {Elective open versus laparoscopic sigmoid colectomy for diverticular disease: a meta-analysis with the Sigma trial.},
journal = {World journal of surgery},
volume = {34},
number = {12},
pages = {2883-2901},
pmid = {20714895},
issn = {1432-2323},
mesh = {*Colectomy/methods ; Diverticulosis, Colonic/*surgery ; Humans ; Laparoscopy ; Sigmoid Diseases/*surgery ; },
abstract = {BACKGROUND: A meta-analysis of published literature comparing open versus laparoscopic elective sigmoid resections for diverticular disease was conducted.
METHODS: Electronic databases were searched for data from January 1991 to March 2009. A systematic review was performed to obtain a summative outcome.
RESULTS: Twenty-two comparative studies involving 10,898 patients were analyzed; 1538 patients were in the laparoscopic group and 9360 were in the open group. The operative time for laparoscopic sigmoid resection (LSR) is longer than open resections (OSR) [random-effects model: SMD = 1.94, 95% CI = (1.14, 2.74), z = 4.74, p < 0.001]. However, patients who undergo LSR have earlier return to passage of feces [random-effects model: SMD = -1.01, 95% CI (-1.80, -0.22), z = -2.50, p = 0.013] and shorter hospital stay [random-effects model: SMD = -7.65, 95% CI (-10.96, -4.32), z = -4.52, p < 0.001]. Overall morbidity was higher in the OSR group [random-effects model: RR = 0.56, 95% CI (0.40, 0.80), z = -3.24, p < 0.001] and no difference in mortality rates was observed (p = 0.81).
CONCLUSIONS: Laparoscopic sigmoid resection takes longer to perform than open procedures; however, it is safe and has lower overall morbidity, earlier return of bowel function, and shorter hospital stays. This approach should be considered for elective cases but more randomized controlled trials are required to strengthen the evidence.},
}
@article {pmid20694839,
year = {2010},
author = {Hemming, J and Floch, M},
title = {Features and management of colonic diverticular disease.},
journal = {Current gastroenterology reports},
volume = {12},
number = {5},
pages = {399-407},
pmid = {20694839},
issn = {1534-312X},
mesh = {Anti-Bacterial Agents/therapeutic use ; Chronic Disease ; Diverticulitis/diagnosis/epidemiology/*physiopathology/*therapy ; Diverticulum, Colon/diagnosis/epidemiology/*physiopathology/*therapy ; Humans ; Immunocompromised Host ; Irritable Bowel Syndrome/physiopathology ; Prevalence ; },
abstract = {Diverticular disease is one of the most prevalent gastrointestinal conditions to afflict Western populations. Although the majority of patients with diverticulosis remain asymptomatic, about one third will develop symptoms at some point in their lives. Symptomatic diverticular disease can range from chronic mild gastrointestinal distress to acute bouts of diverticulitis complicated by abscess or frank colonic perforation. The mainstay of treatment of symptomatic diverticular disease has long been bowel rest, antibiotics, and pain control, reserving surgery for those with complicated disease. This review discusses the epidemiology, pathophysiology, clinical presentation, and management of the spectrum of diverticular disease, including recent advances in the treatment of chronic diverticular disease.},
}
@article {pmid20684920,
year = {2010},
author = {Hall, J and Hammerich, K and Roberts, P},
title = {New paradigms in the management of diverticular disease.},
journal = {Current problems in surgery},
volume = {47},
number = {9},
pages = {680-735},
doi = {10.1067/j.cpsurg.2010.04.005},
pmid = {20684920},
issn = {1535-6337},
mesh = {Age Factors ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Colectomy ; Diagnosis, Differential ; Dietary Fiber/administration & dosage ; Diverticulitis/*diagnosis/epidemiology/etiology/*therapy ; Geography ; Humans ; Incidence ; Intestinal Fistula/etiology/therapy ; Intestinal Mucosa/*pathology ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; Risk Factors ; Sex Factors ; },
}
@article {pmid20683744,
year = {2010},
author = {Pavlidis, TE and Pavlidis, ET and Sakantamis, AK},
title = {Current management of diverticular disease of the colon.},
journal = {Techniques in coloproctology},
volume = {14 Suppl 1},
number = {},
pages = {S79-81},
pmid = {20683744},
issn = {1128-045X},
mesh = {Diverticulitis, Colonic/surgery/*therapy ; Diverticulosis, Colonic/therapy ; Humans ; },
abstract = {The medical treatment plays the first role in the vast majority of cases. Severe acute diverticulitis requires hospitalization and supporting care with intravenous fluids and antibiotics such as ciprofloxacin and metronidazole. Emergency operative intervention is necessary if complication occurs. Laparoscopic surgery has a well-defined place and such colectomy has been gaining, nowadays, more popularity.},
}
@article {pmid20676261,
year = {2009},
author = {Lipman, JM and Reynolds, HL},
title = {Laparoscopic management of diverticular disease.},
journal = {Clinics in colon and rectal surgery},
volume = {22},
number = {3},
pages = {173-180},
pmid = {20676261},
issn = {1530-9681},
abstract = {Despite its potential advantages, laparoscopic management of diverticular disease is currently performed by a minority of surgeons on a small group of patients. However, the role for laparoscopy in diverticular disease continues to develop. At present, adequate evidence exists for the routine use of laparoscopy for uncomplicated diverticular disease. Complicated disease, including fistulizing disease and free perforation requires additional expertise and study. As the experience grows among individual surgeons and institutions, it can be expected that the complication and conversion rates will continue to decline allowing even further evolution of laparoscopy for the treatment of this challenging disease process.},
}
@article {pmid20676260,
year = {2009},
author = {Margolin, DA},
title = {Timing of elective surgery for diverticular disease.},
journal = {Clinics in colon and rectal surgery},
volume = {22},
number = {3},
pages = {169-172},
pmid = {20676260},
issn = {1530-9681},
abstract = {The timing of elective surgery for the treatment of diverticular disease is constantly evolving. Historically, the indications for elective surgery were relatively consistent. It was recommended that patients undergo elective resection after two documented attacks of uncomplicated diverticulitis or after one attack of complicated diverticulitis in which the patient did not require emergent surgery. There were some exceptions to these guidelines; people <50 years old could undergo elective resection after their first attack, and patients who had previous solid organ transplants could undergo resection after a single attack. In this article, the author updates the data regarding the timing of surgery in elective diverticular disease and challenges surgical dogma.},
}
@article {pmid20676258,
year = {2009},
author = {Beckham, H and Whitlow, CB},
title = {The medical and nonoperative treatment of diverticulitis.},
journal = {Clinics in colon and rectal surgery},
volume = {22},
number = {3},
pages = {156-160},
pmid = {20676258},
issn = {1530-9681},
abstract = {The success of medical management for diverticular disease depends on the patient's presentation and degree of response to treatment. The patient's presentation can be grouped into categories using classification systems such as the modified Hinchey system. Clinical presentation and diagnostic studies help to group patients. Mild disease can often be managed with oral antibiotics as an outpatient; more severe disease requires hospitalization, bowel rest, and intravenous antibiotics. Interventions such as percutaneous drainage of associated abscesses may allow successful medical management. Probiotics and antiinflammatories may have a supportive role. Indications for elective resections are discussed.},
}
@article {pmid20676257,
year = {2009},
author = {Destigter, KK and Keating, DP},
title = {Imaging update: acute colonic diverticulitis.},
journal = {Clinics in colon and rectal surgery},
volume = {22},
number = {3},
pages = {147-155},
pmid = {20676257},
issn = {1530-9681},
abstract = {Because the incidence of colonic diverticulosis is high in the general population, incidental asymptomatic diverticulosis is commonly seen on radiology imaging studies. However, diagnostic imaging performed specifically for diverticular disease is essentially limited to imaging of suspected acute colonic diverticulitis (ACD) and its complications. The clinical diagnosis of ACD can be challenging, and imaging has become an essential tool to aid in diagnosis, assess severity of disease, and aid in treatment planning. Computed tomography (CT) has replaced contrast enema as the imaging procedure of choice for diverticulitis. Ultrasound has also been successfully used for diagnosis, and magnetic resonance imaging (MRI) has significant potential as a radiation-free imaging test for acute colonic diverticulitis.},
}
@article {pmid20676256,
year = {2009},
author = {Matrana, MR and Margolin, DA},
title = {Epidemiology and pathophysiology of diverticular disease.},
journal = {Clinics in colon and rectal surgery},
volume = {22},
number = {3},
pages = {141-146},
pmid = {20676256},
issn = {1530-9681},
abstract = {Diverticular disease is common and thought to result from structural abnormalities of the colonic wall, disordered intestinal motility, or deficiencies of dietary fiber. Signs and symptoms of inflammation include fever, abdominal pain, and leukocytosis.},
}
@article {pmid20676255,
year = {2009},
author = {Margolin, DA},
title = {Diverticular disease.},
journal = {Clinics in colon and rectal surgery},
volume = {22},
number = {3},
pages = {139},
doi = {10.1055/s-0029-1236156},
pmid = {20676255},
issn = {1530-9681},
}
@article {pmid20672682,
year = {2010},
author = {Di Mare, L and Christoforidis, D and Demartines, N},
title = {[Current treatment strategies for sigmoid diverticulitis].},
journal = {Revue medicale suisse},
volume = {6},
number = {254},
pages = {1277-1281},
pmid = {20672682},
issn = {1660-9379},
mesh = {Acute Disease ; Digestive System Surgical Procedures/methods ; Diverticulitis/*surgery ; Humans ; Sigmoid Diseases/*surgery ; },
abstract = {Treatment of colonic diverticular disease has evolved over the past years. Most episodes are simple and can be successfully treated with antibiotics alone. For complicated diverticulitis, a strong trend is developing towards less invasive therapies including interventional radiology and laparoscopic lavage in an effort to avoid the morbidity and discomfort of a diverting colostomy. Based on a better understanding of the natural history of the disease, the indication to prophylactic colectomy after a few episodes of simple diverticulitis has been seriously challenged. For those patients who need a colectomy, single port laparoscopy, NOTES and transanal specimen extraction are being proposed. However larger studies are needed to confirm the hypothetical advantages of these evolving techniques.},
}
@article {pmid20959231,
year = {2010},
author = {Abdo Francis, JM},
title = {[Colorectal diseases. Colon diverticular disease].},
journal = {Revista de gastroenterologia de Mexico},
volume = {75 Suppl 1},
number = {},
pages = {130-132},
pmid = {20959231},
issn = {0375-0906},
mesh = {Aged ; Aged, 80 and over ; Diverticulitis, Colonic/drug therapy/epidemiology/*therapy ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid20667144,
year = {2010},
author = {Santangelo, M and Lanteri, R and D'Angelo, M and Carnazzo, SA and Ragalbuto, A and Minutolo, V and Licata, A},
title = {Appendiceal-sigmoid fistula presenting in a man with ulcerative colitis: a case report.},
journal = {Journal of medical case reports},
volume = {4},
number = {},
pages = {229},
pmid = {20667144},
issn = {1752-1947},
abstract = {INTRODUCTION: Ulcerative colitis is a chronic disease characterized by diffuse mucosal inflammation limited to the colon. It mostly affects young adults, yet a large number of middle-aged and older patients with ulcerative colitis have also been reported.
CASE PRESENTATION: A 58-year-old Caucasian man presented to our hospital in August 2006 with continuous and diffuse abdominal pain, meteorism, fever and bloody diarrhea. He had a two-year history of ulcerative colitis. Our patient was treated with intravenous medical therapy. As his condition worsened, he underwent surgery. An explorative laparotomy revealed that the entire colon was distended and pus was found around an appendiceal-sigmoid fistula.
CONCLUSIONS: Therapy for ulcerative colitis is a rapidly evolving field, with many new biological agents under investigation that are likely to change therapeutic strategies radically in the next decade. Indications for surgery are intractability (49%), stricture, dysplasia, toxic colitis, hemorrhage and perforation. To the best of our knowledge, this is the first case of an appendiceal-sigmoid fistula in a patient affected by ulcerative colitis reported in the literature. Fistulae between the appendix and the sigmoid tract are rarely reported in cases of diverticular disease and appendicitis.},
}
@article {pmid20662148,
year = {2010},
author = {Kemppainen, E},
title = {Smoking and diverticular disease of the colon.},
journal = {Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society},
volume = {99},
number = {1},
pages = {2},
doi = {10.1177/145749691009900101},
pmid = {20662148},
issn = {1457-4969},
mesh = {Diverticulosis, Colonic/*complications ; Humans ; Risk Factors ; Smoking/*adverse effects ; },
}
@article {pmid20661750,
year = {2011},
author = {Klarenbeek, BR and Coupé, VM and van der Peet, DL and Cuesta, MA},
title = {The cost effectiveness of elective laparoscopic sigmoid resection for symptomatic diverticular disease: financial outcome of the randomized control Sigma trial.},
journal = {Surgical endoscopy},
volume = {25},
number = {3},
pages = {776-783},
pmid = {20661750},
issn = {1432-2218},
mesh = {Allied Health Personnel/economics ; Blood Transfusion/economics ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Diagnostic Imaging/economics ; Direct Service Costs/statistics & numerical data ; Diverticulitis/*surgery ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures/*economics ; Emergency Medical Services/economics ; Health Care Costs ; Hospital Costs/statistics & numerical data ; Hospitalization/economics ; Humans ; Laparoscopy/*economics ; Laparotomy/economics ; Personnel, Hospital/economics ; Postoperative Complications/economics/epidemiology ; Preoperative Care/economics ; Randomized Controlled Trials as Topic/*statistics & numerical data ; Sigmoid Diseases/*surgery ; },
abstract = {BACKGROUND: Direct healthcare costs of patients with symptomatic diverticular disease randomized for either laparoscopic or open elective sigmoid resection are compared. Cost-effectiveness analysis of the laparoscopic approach compared with open sigmoid resections is presented.
METHODS: An economic evaluation of the randomized control Sigma trial was conducted, comparing elective laparoscopic sigmoid resection (LSR) to open sigmoid resection (OSR) in patients with symptomatic diverticulitis. Prospective registration of detailed intervention units per patient resulted in actual resource use per individual patient. To avoid distributional assumptions, the nonparametric bootstrap was applied. For the cost-effectiveness analysis, differences in total cost between LSR and OSR were compared with the differences in VAS pain score, SF-36 values for general health, and complication rate.
RESULTS: The difference in total healthcare costs between the group that received LSR (euro 9969) and the group that received OSR (euro 9366) was not statistically significant. The slight increase in total costs was determined mainly by the significantly higher operation costs of LSR (euro 6663 vs. euro 5306). Lower costs for hospitalization (euro 2983 vs. euro 3598), blood products (euro 87 vs. euro 240), paramedical services (euro 157 vs. euro 278), and emergency attendance (euro 72 vs. euro 115) in the LSR group partially compensated these increased operation costs. The incremental cost-effectiveness ratios (ICER) indicate that improvements in pain, quality of life, and complication rate could be achieved at limited costs.
CONCLUSION: Total healthcare costs of laparoscopic and open elective sigmoid resections for symptomatic diverticular disease are similar. As the clinical outcomes are in favor of the LSR group, candidates for an elective sigmoid resection should preferably be approached laparoscopically.},
}
@article {pmid20661017,
year = {2010},
author = {Singhi, AD and Montgomery, EA},
title = {Colorectal granular cell tumor: a clinicopathologic study of 26 cases.},
journal = {The American journal of surgical pathology},
volume = {34},
number = {8},
pages = {1186-1192},
doi = {10.1097/PAS.0b013e3181e5af9d},
pmid = {20661017},
issn = {1532-0979},
mesh = {Adenocarcinoma/*pathology/surgery ; Adult ; Biomarkers, Tumor/analysis ; Biopsy ; Colectomy ; Colon/chemistry/*pathology/surgery ; Colonoscopy ; Colorectal Neoplasms/chemistry/*pathology/surgery ; Female ; Humans ; Immunohistochemistry ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Prognosis ; S100 Proteins/analysis ; },
abstract = {Granular cell tumor (GCT) is commonly located in the subcutaneous tissue and oral cavity, and uncommon in the gastrointestinal tract, in which the majority arises in the esophagus with over-representation in African Americans (AA). However, experience with GCTs of the colorectum is quite limited. We report the clinicopathologic features of 1 of the largest series to date of colorectal GCTs. We reviewed the clinical features of 26 colorectal GCTs seen at our institution between the years 1995 to 2009, which included 24 biopsies, 1 low anterior resection, and 1 colectomy. Review of the clinical features of all 26 cases from 24 patients identified an equal gender distribution (12 males and 12 females), with patients ranging in age from 31 to 60 years (mean, 49.8 y; median, 51.5 y) with a modest White predominance (15/24, 63%; our overall patient population is 67% White). The majority of colorectal GCT involved the right colon (19/26, 73%) ranging in size from 0.2 to 1.8 cm (mean 0.6 cm). Most neoplasms were encountered on routine colonoscopy (14/24, 64%), however 3 patients presented with hematochezia, 3 with changing bowel habits, 2 with Crohn disease, 1 with diverticular disease, and 1 with appendicitis. Of the 20 cases available for histologic review, the tumors were noted to either be infiltrative (12/20, 60%) or marginated (8/20, 40%) involving either the mucosa (7/20, 35%), submucosa (10/20, 50%), or both (3/20, 15%). The microscopic features were similar to those of GCTs found elsewhere, but many of the neoplasms differed by displaying nuclear pleomorphism (8/20, 40%), lymphoid cuffs (9/20, 45%), and focal calcification (7/20, 35%). Some had reactive mucosal surface changes (7/20, 35%), including 1 initially misdiagnosed as a tubular adenoma. Neither mitoses nor necrosis were identified. On immunochemistry, 18 of the neoplasms were stained for S-100 and all cases showed positive staining. Follow-up information was available for 19 patients (19/24, 79%) with 2 documented occurrences of regrowth at the prior cecal biopsy site owing to incomplete excision, but no metastases. Although infrequently found in the colorectum, colorectal GCT typically presents incidentally on routine colonoscopy and involves the right colon; it is not over-represented in AA patients. GCTs can have both an infiltrative or marginated growth pattern with a subset displaying nuclear pleomorphism, a lymphoid cuff, focal calcification, and reactive mucosal surface changes, which in our experience, may lead to misdiagnosis on colorectal mucosal biopsies. Although GCTs were benign tumors in this series, if incompletely excised regrowth of the lesion may occur and therefore, follow-up may be warranted.},
}
@article {pmid20660440,
year = {2010},
author = {Atalla, MA and Rozen, WM and Niewiadomski, OD and Croxford, MA and Cheung, W and Ho, YH},
title = {Risk factors for colonic perforation after screening computed tomographic colonography: a multicentre analysis and review of the literature.},
journal = {Journal of medical screening},
volume = {17},
number = {2},
pages = {99-102},
doi = {10.1258/jms.2010.010042},
pmid = {20660440},
issn = {1475-5793},
mesh = {Colonoscopy/*methods ; Colorectal Neoplasms/*diagnosis ; Humans ; Risk Factors ; },
abstract = {BACKGROUND: Computed tomographic (CT) colonography (or 'virtual' colonoscopy) has become an increasingly popular tool for colorectal cancer screening. Colonic perforation, an uncommon complication, is a risk that has not been widely reported.
METHODS: A systematic review of the literature was undertaken to identify all reported risk factors for colonic perforation following CT colonography. In addition, a retrospective multicentre study was undertaken, evaluating all CT colonographies in 10 major metropolitan tertiary referral centres. All colonic perforations were assessed for risk factors.
RESULTS: A range of 'patient'-related and 'procedure'-related risk factors were identified in the literature. Among 3458 CT colonographies, there were two cases of colonic perforation contributing to an incidence of perforation of 0.06%. There was no statistical correlation between the incidence of perforation and institutional experience (P = 0.66). Risk factors common to both cases and the literature included age, recent colonoscopy and manual colonic insufflation. Diverticular disease and recent colonic biopsy were also notable factors.
CONCLUSION: There is a small but real risk of perforation following CT colonography. Patient selection and preventative procedural measures may reduce this risk. The importance of the consent process is emphasized.},
}
@article {pmid20652262,
year = {2010},
author = {Stagi, S and Lapi, E and Chiarelli, F and de Martino, M},
title = {Incidence of diverticular disease and complicated diverticular disease in young patients with Williams syndrome.},
journal = {Pediatric surgery international},
volume = {26},
number = {9},
pages = {943-944},
pmid = {20652262},
issn = {1437-9813},
mesh = {Adolescent ; Child ; Diverticulitis, Colonic/*complications/surgery ; Diverticulosis, Colonic/*complications/surgery ; Female ; Humans ; Incidence ; Male ; Retrospective Studies ; Sigmoid Diseases/*complications/surgery ; Williams Syndrome/*complications ; Young Adult ; },
}
@article {pmid20637347,
year = {2010},
author = {Siddiqui, MR and Sajid, MS and Qureshi, S and Cheek, E and Baig, MK},
title = {Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis.},
journal = {American journal of surgery},
volume = {200},
number = {1},
pages = {144-161},
doi = {10.1016/j.amjsurg.2009.08.021},
pmid = {20637347},
issn = {1879-1883},
mesh = {Colectomy/*adverse effects/methods ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures/adverse effects ; Humans ; Laparoscopy/*adverse effects ; Sigmoid Diseases/*surgery ; },
abstract = {BACKGROUND: We performed a meta-analysis of published literature comparing the complications after open and laparoscopic elective sigmoidectomy for diverticular disease.
METHODS: Electronic databases were searched from January 1991 to March 2009. A systematic review was performed to obtain a summative outcome.
RESULTS: Nineteen comparative studies involving 2,383 patients were analyzed. There were 1,014 patients in the laparoscopic group and 1,369 patients in the open group. There was no significant heterogeneity among any of the complications analyzed. Patients in the laparoscopic sigmoid resection group had fewer wound infections (fixed effects model: risk ratio [RR], .54; 95% confidence interval [CI], .36-.80; z, -3.05; P < .01; random effects model: RR, .59; 95% CI, .39-.89; z, -2.54; P < .05), blood transfusions (fixed effects model: RR, .25; 95% CI, .10-.60; z, -3.10; P < .01; random effects model: RR, .28; 95% CI, .11-.68; z, -2.81; P < .01), and ileus rates (fixed effects model: RR, .37; 95% CI, .20-.66; z, -3.34; P = .001; random effects model: RR, .37; 95% CI, .20-.68; z, -3.21; P = .001) compared with open sigmoid resections. No difference was seen for medical complications, need for rehospitalization, and reoperation.
CONCLUSIONS: Laparoscopic sigmoid resection is safe and has fewer postoperative surgical complications. This approach should be considered for elective cases, however, more randomized controlled trials are required to strengthen the evidence.},
}
@article {pmid20629976,
year = {2010},
author = {Spiller, RC and Humes, DJ and Campbell, E and Hastings, M and Neal, KR and Dukes, GE and Whorwell, PJ},
title = {The Patient Health Questionnaire 12 Somatic Symptom scale as a predictor of symptom severity and consulting behaviour in patients with irritable bowel syndrome and symptomatic diverticular disease.},
journal = {Alimentary pharmacology & therapeutics},
volume = {32},
number = {6},
pages = {811-820},
doi = {10.1111/j.1365-2036.2010.04402.x},
pmid = {20629976},
issn = {1365-2036},
mesh = {Adult ; Aged ; Anxiety/*etiology/psychology ; Depression/*etiology/psychology ; Female ; Humans ; Irritable Bowel Syndrome/complications/*physiopathology/psychology ; Male ; Middle Aged ; Quality of Life ; Referral and Consultation ; Severity of Illness Index ; Surveys and Questionnaires ; },
abstract = {BACKGROUND: Anxiety, depression and nongastrointestinal symptoms are often prominent in irritable bowel syndrome (IBS), but their relative value in patient management has not been quantitatively assessed. We modified the Patient Health Questionnaire 15 (PHQ-15) by excluding three gastrointestinal items to create the PHQ-12 Somatic Symptom (PHQ-12 SS) scale.
AIMS: To compare the value of the PHQ-12 SS scale with the Hospital Anxiety and Depression (HAD) scale in predicting symptoms and patient behaviour in IBS and diverticular disease.
METHODS: We compared 151 healthy volunteers (HV), 319 IBS patients and 296 patients with diverticular disease (DD), 113 asymptomatic [ASYMPDD] and 173 symptomatic DD (SYMPDD).
RESULTS: Patient Health Questionnaire 12 SS scores for IBS and SYMPDD were significantly higher than HV. Receiver-operator curves showed a PHQ-12 SS >6, gave a sensitivity for IBS of 66.4% with a specificity of 94.7% and a positive likelihood ratio (PLR) = 13.2, significantly better than that associated with an HAD anxiety score >7, PLR = 3.0 and depression score >7 PLR = 6.5. PHQ-12 SS correlated strongly with IBS severity scale and GP visits in both IBS and DD.
CONCLUSION: The PHQ-12 SS scale is a useful clinical tool which correlates with patient behaviour in both IBS and symptomatic DD.},
}
@article {pmid20617353,
year = {2010},
author = {Scozzari, G and Arezzo, A and Morino, M},
title = {Enterovesical fistulas: diagnosis and management.},
journal = {Techniques in coloproctology},
volume = {14},
number = {4},
pages = {293-300},
pmid = {20617353},
issn = {1128-045X},
mesh = {Endoscopy, Gastrointestinal ; Humans ; Intestinal Fistula/*diagnosis/*therapy ; Laparoscopy ; Treatment Outcome ; Urinary Bladder Fistula/*diagnosis/*therapy ; },
abstract = {Enterovesical fistula (EVF) is an abnormal communication between the intestine and the bladder. It represents a rare complication of inflammatory or neoplastic disease, and traumatic or iatrogenic injuries. The most common aetiologies are diverticular disease and colorectal carcinoma. Over 75% of affected patients describe pathognomonic features of pneumaturia, faecaluria and recurrent urinary tract infections. The diagnosis of EVF can be challenging, and frequently patients are monitored for months before the condition is recognised and treated effectively. Diagnostic tools include laboratory tests, imaging studies and endoscopic procedures. Although conservative management can be attempted in selected patients, in most cases, the treatment is mainly based on surgical interventions. Recently, the laparoscopic approach to EVF has been shown to be safe and effective. Although it is a rare condition in a general surgery setting, EVF is a challenging condition leading to high morbidity and mortality rates.},
}
@article {pmid20615784,
year = {2010},
author = {Motta-Ramírez, GA and Ortiz-León, JL and Urbina De la Vega, F and Mejía-Nogales, RE and Barinagarrenteria-Aldatz, R},
title = {[Diverticular duodenal disease as incidental finding with computer tomography].},
journal = {Revista de gastroenterologia de Mexico},
volume = {75},
number = {2},
pages = {165-170},
pmid = {20615784},
issn = {0375-0906},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Diverticulum/*diagnostic imaging ; Duodenal Diseases/*diagnostic imaging ; Female ; Humans ; Incidental Findings ; Male ; Middle Aged ; Prospective Studies ; *Tomography, X-Ray Computed ; Young Adult ; },
abstract = {BACKGROUND: Duodenal diverticular disease is a frequent condition but clinical diagnosis can be chalenging. Less than 10% of the cases are symptomatic and symptoms are vague. Only between 1% to 2% will require surgical treatment.
OBJECTIVE: To establish the prevalence of duodenal diverticulum (Dd) in patients who underwent abdominal computed tomography (CT).
METHODS: A retrospective review of all cases with Dd identified incidentally during abdominal CT scan was performed. Clinical data regarding type, location, differential diagnosis and complications were recorded.
RESULTS: During the study period 12,704 abdominal CT scans were performed and 50 patients with Dd were identified (prevalence 0.46%). Thirty patients were women (60%) and the mean patient age was 69 years (range: 23 - 93 years). In thirteen patients the Dd were located in the second portion (26%) and 24 in the third portion of the duodenum (48%). Three Dd were detected in the papillary region, one of them (2%) was complicated with hemorrhage and required surgical treatment.
CONCLUSIONS: Dd were detected in the 0.46% of the abdominal CT scans. Most of them were incidentally detected (94%). The prevalence of these lesions increases with age. Dd may mimic a cystic neoplasm in the head of the pancreas in 28% of cases and produce complications as bleeding in 2% of the cases.},
}
@article {pmid20593043,
year = {2010},
author = {Quigley, EM},
title = {Gut microbiota, inflammation and symptomatic diverticular disease. New insights into an old and neglected disorder.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {19},
number = {2},
pages = {127-129},
pmid = {20593043},
issn = {1841-8724},
mesh = {Acute Disease ; Chronic Disease ; *Colon/immunology/microbiology ; Diverticulitis, Colonic/immunology/microbiology/*therapy ; Diverticulum, Colon/immunology/microbiology/*therapy ; Humans ; Inflammation Mediators/metabolism ; Probiotics/*therapeutic use ; Treatment Outcome ; },
}
@article {pmid20583683,
year = {2009},
author = {Griffith, PS and Powlett, CL and Griffith, AD and Markogiannakis, H and Priego, P and Jonnalagadda, R and Walrond, ER},
title = {An exploratory analysis of the epidemiology and surgical management of perforated diverticular disease over a two-year period at a referral centre in the Caribbean.},
journal = {The West Indian medical journal},
volume = {58},
number = {6},
pages = {561-565},
pmid = {20583683},
issn = {0043-3144},
mesh = {Black People ; Caribbean Region/epidemiology ; Colectomy/statistics & numerical data ; Colostomy/statistics & numerical data ; Diverticulosis, Colonic/*epidemiology/ethnology/surgery ; Humans ; Ileostomy/statistics & numerical data ; Incidence ; Intestinal Perforation/*epidemiology/ethnology/surgery ; Principal Component Analysis ; Referral and Consultation/statistics & numerical data ; Retrospective Studies ; },
abstract = {OBJECTIVE: We present an exploratory analysis of data collected on perforated diverticular disease (PDD) in Barbados and suggest possible areas for further study.
SUBJECTS AND METHODS: All cases of perforated diverticular disease treated at the Queen Elizabeth Hospital (QEH) Barbados, between January 1, 2005 and December 31, 2006 were reviewed. The patient's age, gender location of disease, Hinchey stage, operative procedure, rate of colostomy reversal, length of hospitalization, incidence of peri-operative morbidity and postoperative mortality were analysed using principal components analysis (PCA).
RESULTS: Fourteen cases of PDD were treated at the QEH during this period. Six (43%) of the patients had perforated right-sided diverticulitis (PRSD). In the PCA, Dimensions 1 and 2 were the two dimensions examined, as they both had Eigenvalues over 1. Dimension 1 can be taken as an indicator of the intensity of the disease. On dimension 2, length of hospitalization had the highest component loading (0.875). The mean hospital stay was 10.6 days in PRSD, 9.5 in left-sided perforations with primary anastomosis, and 16.2 days for those with a Hartmann's procedure. The overall peri-operative morbidity was 28% and there was no mortality in the series.
CONCLUSION: This preliminary study seems to show a relatively high incidence of PRSD in a predominantly Afro-Caribbean population. More research is needed to determine the exact aetiology of this disease. In our experience, primary anastomosis in carefully selected patients with either PRSD or perforated left-sided diverticulitis (PLSD) may result in shorter hospitalization.},
}
@article {pmid20571265,
year = {2010},
author = {Mäkelä, JT and Kiviniemi, HO and Laitinen, ST},
title = {Spectrum of disease and outcome among patients with acute diverticulitis.},
journal = {Digestive surgery},
volume = {27},
number = {3},
pages = {190-196},
doi = {10.1159/000236903},
pmid = {20571265},
issn = {1421-9883},
mesh = {Acute Disease ; Age Factors ; Aged ; *Diverticulitis, Colonic/complications/epidemiology/surgery ; Female ; Humans ; Intestinal Perforation/etiology ; Male ; Middle Aged ; Recurrence ; Sex Factors ; Sigmoid Diseases/surgery ; },
abstract = {BACKGROUND: This study was designed to evaluate the natural history of patients admitted for acute diverticulitis.
METHODS: Nine hundred and seventy-seven patients admitted to Oulu University Hospital for acute symptoms of diverticular disease during the 20-year period from 1986 to 2005 were identified using a database.
RESULTS: Six hundred and ninety-five patients were admitted for uncomplicated diverticulitis and 282 for complicated diverticulitis. The patients admitted for uncomplicated diverticulitis were younger than the others and 66% of them were admitted only once. The number of admissions preceding perforation was higher in the 1980s, and the number of admissions was unrelated to the degree of perforation or the outcome of the patients. The annual prevalence of sigmoid diverticular perforation increased from 2.6/100,000 in 1986 to 4.2/100,000 in 2005. Seventy (10%) of the 695 patients admitted for the first time for acute diverticulitis underwent urgent surgery during the same admission and 66 (9%) had elective surgery during a later admission. Overall hospital mortality was 2.3%, being 1% among those admitted for acute diverticulitis and 5.5% among those admitted for diverticular perforation. Two hundred and thirty-four (42%) of the 555 nonoperated patients with acute diverticulitis developed a recurrent episode of diverticulitis. The course of recurrent disease was similar to the primary episode.
CONCLUSION: Two or more preceding admissions for acute diverticulitis do not warrant sigmoid resection after diverticulitis. Young patients do not have a greater risk of complicated diverticulitis than older ones.},
}
@article {pmid20548273,
year = {2010},
author = {Duff, SE and Sagar, PM},
title = {The current status of laparoscopic surgery for colorectal disease.},
journal = {Minerva chirurgica},
volume = {65},
number = {2},
pages = {173-179},
pmid = {20548273},
issn = {0026-4733},
mesh = {Colorectal Neoplasms/*surgery ; Digestive System Surgical Procedures/methods ; Humans ; Inflammatory Bowel Diseases/*surgery ; *Laparoscopy ; },
abstract = {Laparoscopic surgery has an expanding role in the management of colorectal disease. As technical expertise has increased, selection of patients for laparoscopic procedures has widened without any commensurate increase in operative or postoperative complications. This article aims to summarise the current status of laparoscopic surgery in colorectal disease with particular reference to colorectal cancer, inflammatory bowel disease, diverticular disease and disorders of the pelvic floor.},
}
@article {pmid20509001,
year = {2010},
author = {Beddy, D and DeBlacam, C and Mehigan, B},
title = {An unusual cause of an acute abdomen--a giant colonic diverticulum.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {14},
number = {12},
pages = {2016-2017},
pmid = {20509001},
issn = {1873-4626},
mesh = {Abdomen, Acute/*etiology ; Aged ; Diverticulum, Colon/*complications/pathology ; Humans ; Male ; },
abstract = {A giant colonic diverticulum (GCD) is a rare presentation of diverticular disease of the colon that usually necessitates surgery. The case described is of a GCD that became symptomatic due to rapid enlargement caused by an intracolonic bleed. GCD usually presents with abdominal pain and a palpable periumbilical or pelvic mass. Radiological imaging shows a large gas-filled cyst associated with the colon. Surgical resection with sigmoid colectomy is usually performed to alleviate symptoms and prevent later perforation.},
}
@article {pmid20504245,
year = {2010},
author = {Groenen, MJ and van Buuren, HR and van Berge Henegouwen, GP and Fockens, P and van der Lei, J and Stuifbergen, WN and van der Schaar, PJ and Kuipers, EJ and Ouwendijk, RJ},
title = {Validation study of automatically generated codes in colonoscopy using the endoscopic report system Endobase.},
journal = {Scandinavian journal of gastroenterology},
volume = {45},
number = {9},
pages = {1121-1126},
doi = {10.3109/00365521.2010.490597},
pmid = {20504245},
issn = {1502-7708},
mesh = {Colonoscopy ; Databases, Factual ; Humans ; *Medical Records Systems, Computerized ; },
abstract = {OBJECTIVE: Gastrointestinal endoscopy databases are important for surveillance, epidemiology, quality control and research. A good quality of automatically generated databases to enable drawing justified conclusions based on the data is of key importance. The aim of this study is to validate the correctness of coding of a national automatically generated anonymous endoscopy database.
MATERIAL AND METHODS: We evaluated a total of 500 colonoscopies performed in five larger hospitals of the TRANS.IT project focusing on endoscopy reporting. Randomly 500 examinations were selected from a total of 5,000 examinations and their generated endoscopic terminology codes as well as complete reports were analysed. Indications for the examination and described findings were scored for correctness and clinical relevance of the coding that would be exported to the anonymous database.
RESULTS: Indications were correctly coded in 92% of all examinations (range 76-100%) per hospital. Correct coding of findings ranged from 42% to 93% per hospital (mean 77%). Different correct coding proportions were seen varying with the diagnosis, with the highest correct coding rates in polyps, carcinoma and diverticular disease. Incorrect coded examinations were scored for clinical relevance. Overall 11% of the investigated examinations were incorrectly coded with clinical relevance.
CONCLUSIONS: Accuracy of clinically relevant endoscopy data recorded in the TRANS.IT anonymous central database is high. Further improvement is desirable, which may be achieved by education of individual endoscopists and enhancement of the program.},
}
@article {pmid20501352,
year = {2010},
author = {Turunen, P and Wikström, H and Carpelan-Holmström, M and Kairaluoma, P and Kruuna, O and Scheinin, T},
title = {Smoking increases the incidence of complicated diverticular disease of the sigmoid colon.},
journal = {Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society},
volume = {99},
number = {1},
pages = {14-17},
doi = {10.1177/145749691009900104},
pmid = {20501352},
issn = {1457-4969},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Colectomy ; Diverticulum, Colon/diagnosis/*epidemiology/*surgery ; Female ; Humans ; Incidence ; Male ; Middle Aged ; *Postoperative Complications ; Retrospective Studies ; Risk Factors ; Sigmoid Diseases/diagnosis/*epidemiology/*surgery ; Smoking/*adverse effects ; },
abstract = {BACKGROUND AND AIMS: The aim of this study was to establish whether smoking is associated with complicated diverticular disease and adverse outcomes of operative treatment of diverticular disease. Smoking has been associated with increased rate of perforations in acute appendicitis as well as failure of colonic anastomosis in patients resected for colonic tumours. It has also been suggested that smoking is a risk factor for complicated diverticular disease of the colon.
MATERIAL AND METHODS: Retrospective investigation of records of 261 patients electively operated for diverticular disease in Helsinki University Central Hospital during a period of five years.
RESULTS: The smokers underwent sigmoidectomy at a younger age than the non-smokers (p = 0.001) and they had an increased rate of perforations (p = 0.040) and postoperative recurrent diverticulitis episodes (p = 0.019).
CONCLUSIONS: We conclude that smoking increases the likelihood of complications in diverticulosis coli. The development of complicated disease also seems to proceed more rapidly in smokers.Key words: Sigmoid resection; laparoscopy; laparoscopic sigmoidectomy; smoking and diverticular disease; complicated diverticular disease; diverticulitis.},
}
@article {pmid20478120,
year = {2010},
author = {Rodríguez Wong, U and Santamaría Aguirre, JR and Cruz Reyes, JM and García Alvarez, J},
title = {Complicated diverticular colon disease in patients younger than 35 years: report of two cases and literature review.},
journal = {Cirugia y cirujanos},
volume = {78},
number = {2},
pages = {167-171},
pmid = {20478120},
issn = {2444-054X},
mesh = {Adult ; Diverticulosis, Colonic/*complications/surgery ; Humans ; Male ; },
abstract = {BACKGROUND: Complicated colonic diverticular disease in young patients is a rare entity, with an incidence <10% from all patients in the largest series.
CLINICAL CASES: We present two cases of complicated diverticular disease in patients <35 years old treated at the Hospital Juárez of México City. Both patients had acute abdominal pain with several days of evolution. In both patients, emergency surgery was performed and postoperative evolution was favorable.
CONCLUSIONS: Some authors have concluded that diverticulitis in younger patients demonstrates a more aggressive course than in older patients and with an increased risk of complications. Therefore, most physicians recommended elective resection after a single attack in such patients. Conversely, some recent reports highlighted that the clinical course and complications are similar in both age groups.},
}
@article {pmid20478118,
year = {2010},
author = {Valdivia Gómez, GG and Soto Guerrero, MT and Cedillo de la Cruz, MI},
title = {Extra-skeletal Ewing's sarcoma resembling acute abdomen. Case report.},
journal = {Cirugia y cirujanos},
volume = {78},
number = {2},
pages = {159-162},
pmid = {20478118},
issn = {2444-054X},
mesh = {Abdomen, Acute/*diagnosis ; Adult ; Diagnosis, Differential ; Humans ; Male ; Retroperitoneal Neoplasms/*diagnosis ; Sarcoma, Ewing/*diagnosis ; },
abstract = {BACKGROUND: Extraosseous Ewing's sarcoma is a rare tumor of neuroectodermal origin. It presents mainly in the soft tissue of the extremities and thorax. Histologically, it is similar to Ewing's sarcoma of the bone.
CLINICAL CASE: We present the case of a male who arrived at the emergency room with acute abdomen, leucocytosis and imaging techniques (abdominal ultrasound and computed tomography) suggestive of complicated diverticular disease. He was treated with emergency surgery. Intraoperative findings were an unsuspected tumor (20 x 15 x 15 cm). Treatment consisted of extirpation of the tumor, separating it from the adjacent viscera and followed by chemotherapy based on epirubicin, cyclophosphamide and vincristine for six cycles. Because the control abdominal CT demonstrated tumor activity in the retroperitoneum adjacent to the ascending colon and cecum, further resection was decided upon.
CONCLUSIONS: In a review of the literature, no previous reports of extraosseous Ewing's sarcoma were found presenting as acute abdomen. Due to the rarity of this tumor, only case reports or series have been found in the literature without randomized or comparative studies. Surgery was the cornerstone of treatment, without reports of preoperative chemotherapy. If the patient's condition permits, percutaneous needle biopsy is mandatory to obtain optimum treatment as well as to improve prognosis.},
}
@article {pmid20464419,
year = {2010},
author = {Vestweber, B and Alfes, A and Paul, C and Haaf, F and Vestweber, KH},
title = {Single-incision laparoscopic surgery: a promising approach to sigmoidectomy for diverticular disease.},
journal = {Surgical endoscopy},
volume = {24},
number = {12},
pages = {3225-3228},
pmid = {20464419},
issn = {1432-2218},
mesh = {Diverticulitis/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Sigmoid Diseases/*surgery ; },
abstract = {BACKGROUND: Laparoscopic sigmoidectomy has become the standard procedure in elective surgery for recurrent diverticular disease. To realize further benefits of this minimal invasive procedure and to offer less postoperative pain, shorter recovery time, reduced complications, and improved cosmetic results, attempts are being made to minimize the number of necessary skin incisions for trocar positioning. One method is to use only one port for laparoscopic access to perform diverticular-related elective sigmoidectomies.
METHODS: Between 7 July and 4 August 2009, 10 consecutive patients were referred for partial left colon resection due to multiple episodes of diverticulitis. In all cases, access to the abdomen was achieved through a 2- to 2.5-cm single incision via the umbilicus followed by insertion of the single-incision laparoscopic surgery (SILS™) port system. Outcomes such as change in the procedural method, operative time, postoperative complications, and length of stay were recorded.
RESULTS: Of the 10 consecutive sigmoidectomies, 9 were performed successfully with the SILS™ procedure using only one incision in the umbilicus. No mortalities or major complications were noted. The median operating time was 120 min, and the median postoperative hospital stay was 7 days.
CONCLUSION: As an alternative to the standard laparoscopic procedure, single-incision laparoscopic sigmoidectomy via the umbilicus is technically feasible and effective. This attractive procedure aims to increase the patient's comfort further after abdominal surgery.},
}
@article {pmid20449886,
year = {2010},
author = {Barranco, C},
title = {An enteric neuropathy might underlie diverticular disease.},
journal = {Nature reviews. Gastroenterology & hepatology},
volume = {7},
number = {5},
pages = {240},
pmid = {20449886},
issn = {1759-5053},
}
@article {pmid20438892,
year = {2010},
author = {Ferlitsch, A and Silberhumer, GR and Noda, W and Birsan, T and Desai, D and Kumar, A and Rao, GV and Khakar, A and Gomez, NA and Gasche, C},
title = {A novel endoscopic device for repeated right-side colonic access during colonoscopy (with video).},
journal = {Gastrointestinal endoscopy},
volume = {71},
number = {6},
pages = {1052-1055},
doi = {10.1016/j.gie.2009.12.059},
pmid = {20438892},
issn = {1097-6779},
mesh = {Colonic Polyps/*therapy ; *Colonoscopes ; Colonoscopy/*methods ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Reoperation ; Video Recording ; },
abstract = {BACKGROUND: Megachannel is a newly developed colonic access system allowing rapid and multiple passes of the colonoscope to the right side of the colon.
OBJECTIVE: The aim of this study was to evaluate the safety and clinical feasibility of placing a 100 cm Megachannel prototype in the right side of the colon.
SETTING: Six centers, international, both surgeons and gastroenterologists performing endoscopy.
DESIGN AND INTERVENTION: Patients scheduled for colonoscopy with suspected right-side colonic polypoid lesions were included. The prototype was loaded onto a 160 cm lower GI endoscope and introduced via colonoscopic guidance.
MAIN OUTCOME MEASUREMENT: The ability to place this device in the right side of the colon.
RESULTS: The Megachannel prototype was introduced in 41 patients (19 female, mean age 54 years) undergoing colonoscopy. The cecum was reached in 27 cases (66%) within 18 minutes (range, 3-35 minutes) and with 73 cm (range, 40-100 cm) of the device being inserted into the colon. Mild tissue bruises and mild pain were observed in 5 and 3 patients, respectively. In 14 patients, the device assisted the removal of multiple polyps (2-12) as tissue was repeatedly retrieved through the channel. The device also allowed delivery of an endoscopic US scope or suction caps to the right side of the colon.
LIMITATIONS: Prototype performance may differ from the actual product (80 cm in length, redesigned introducer plugs). Small number of patients, difficult in diverticular disease.
CONCLUSIONS: This newly developed colonic access system can be safely placed in the right side of the colon and is useful for a variety of advanced procedures that require repeated insertion of the colonoscope or delivery of bulky instruments. (
NCT00987896.).},
}
@article {pmid20423789,
year = {2010},
author = {Castañeda-Argáiz, R and Rodríguez-Zentner, HA and Tapia, H and González-Contreras, QH},
title = {[Synchronous diverticulitis: a case report.].},
journal = {Revista de gastroenterologia de Mexico},
volume = {75},
number = {1},
pages = {93-96},
pmid = {20423789},
issn = {0375-0906},
mesh = {*Colonic Diseases/diagnosis/surgery ; *Diverticulitis/diagnosis/surgery ; Humans ; Male ; Middle Aged ; },
abstract = {Diverticular colonic disease is not as common in developing nations as in western and industrialized societies, accounting for approximately 130 000 hospitalizations per year in the United States, being diverticulitis the most frequent complication. Synchronous presentation of this complication is very rare, with only one case reported in literature. We present a patient who presented with diffuse abdominal pain. Colonoscopy was performed identifying a mass in the sigmoid colon and a perforation in the cecum. Patient underwent total abdominal colectomy with ileorectal anastomosis and protective loop ileostomy. Histopathologic examination revealed synchronous complicated diverticular disease of the sigmoid and cecum. In this report we disclose this type of atypical presentation of diverticular disease and establish that the approach taken is safe and feasible.},
}
@article {pmid20411418,
year = {2011},
author = {Tursi, A},
title = {Segmental colitis associated with diverticulosis: complication of diverticular disease or autonomous entity?.},
journal = {Digestive diseases and sciences},
volume = {56},
number = {1},
pages = {27-34},
pmid = {20411418},
issn = {1573-2568},
mesh = {Colitis/*epidemiology/*etiology/physiopathology ; Comorbidity ; Diagnosis, Differential ; Diverticulosis, Colonic/*complications/*epidemiology/physiopathology ; Endoscopy, Digestive System ; Humans ; Prevalence ; },
abstract = {Segmental colitis associated with diverticulosis (SCAD) is a disease that affects colon harboring diverticula, mostly located in the sigmoid region. It has been considered a rare disease for many years, but new studies may contribute to easier recognition. Although its pathogenesis is not yet well defined, in the past SCAD has been considered a complication of diverticular disease, whilst new endoscopic, histological, and clinical data have encouraged the concept that SCAD includes pathogenetic and therapeutic aspects peculiar to inflammatory bowel diseases. We therefore describe herein current knowledge about this disease, and why it can be considered a truly autonomous entity instead of a complication of diverticular disease.},
}
@article {pmid20397046,
year = {2010},
author = {Yen, HH and Chen, YY and Yang, CW and Soon, MS},
title = {The clinical significance of jejunal diverticular disease diagnosed by double-balloon enteroscopy for obscure gastrointestinal bleeding.},
journal = {Digestive diseases and sciences},
volume = {55},
number = {12},
pages = {3473-3478},
pmid = {20397046},
issn = {1573-2568},
mesh = {Aged ; Aged, 80 and over ; Diverticulum/*complications/*diagnosis ; *Double-Balloon Enteroscopy ; Duodenal Ulcer/complications/surgery ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Jejunal Diseases/*complications/*diagnosis ; Laser Coagulation ; Male ; Middle Aged ; Peptic Ulcer Hemorrhage/surgery ; Retrospective Studies ; },
abstract = {BACKGROUND: Jejunal diverticular disease is a rare cause of gastrointestinal bleeding. The reported incidence of this disease is low in the studies of double-balloon enteroscopy.
AIM: The aim of this study was to evaluate the clinical features and management of jejunal diverticular disease, diagnosed by double-balloon enteroscopy, at our institution.
METHOD: This was a retrospective study of patients with jejunal diverticular disease conducted from April 2004 to September 2009 at Changhua Christian Hospital. We evaluated the clinical significance of jejunal diverticular disease and the outcome of endoscopic treatment for jejunal diverticular bleeding.
RESULTS: From April 2004 to September 2009, a total of 55 patients underwent double-balloon enteroscopy due to obscure gastrointestinal bleeding. Fifteen of these patients were diagnosed with jejunal diverticular disease (8 men and 7 women, mean age 71 years). Four patients were found to have a single diverticulum. Gastrointestinal bleeding was attributed to jejunal diverticular disease in 12 patients. Six patients received endoscopic treatment in order to achieve hemostasis. One patient received emergency surgery due to uncontrolled bleeding.
CONCLUSIONS: To our knowledge, this is the first study reporting the clinical significance of jejunal diverticular disease diagnosed by double-balloon enteroscopy. We found that obscure GI bleeding was attributed significantly to jejunal diverticular disease.},
}
@article {pmid20381203,
year = {2010},
author = {Ríos Zambudio, A and Montoya Tabares, MJ and Rodríguez González, JM and Febrero Sánchez, B and Albaladejo Meroño, A and Molina, J and Parrilla Paricio, P},
title = {[Severe lower gastrointestinal tract bleeding due to diverticulosis].},
journal = {Gastroenterologia y hepatologia},
volume = {33},
number = {5},
pages = {363-369},
doi = {10.1016/j.gastrohep.2010.02.003},
pmid = {20381203},
issn = {0210-5705},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; Colonoscopy ; Combined Modality Therapy ; Diverticulosis, Colonic/*complications/diagnosis ; Erythrocyte Transfusion ; Female ; Gastrointestinal Hemorrhage/diagnosis/*etiology/surgery/therapy ; Humans ; Laser Coagulation ; Male ; Middle Aged ; Rectum ; Recurrence ; Retrospective Studies ; },
abstract = {INTRODUCTION: Diverticulosis is the most frequent cause of lower gastrointestinal (GI) bleeding in adults in western countries. The aims of the present study were to analyze: 1) the diagnostic and therapeutic management of patients with severe lower GI bleeding due to diverticulosis; 2) associated morbidity and mortality; 3) the need for surgery, and 4) bleeding recurrence rates after hospital discharge.
MATERIAL AND METHODS: Were retrospectively reviewed 42 patients with severe lower GI bleeding due to diverticulosis. Patients with rectorrhagia requiring transfusion of at least three packed red blood cell units and those with a decrease in hematocrit of 10 points or more were included. As a control group, we used 133 patients with severe lower GI hemorrhage due to causes other than colonic diverticular disease.
RESULTS: All patients were stabilized with conservative measures except one who required emergency surgery. Colonoscopy was performed in 39 patients and the most frequent finding consisted of recent signs of bleeding independently of whether colonoscopy was performed early or was delayed. Endoscopic treatment with Argon laser electrocoagulation was performed in one patient. Bleeding recurrence after hospital discharge occurred in 13 patients (31%); of these, seven (16%) required hospital readmission.
CONCLUSION: Severe lower GI bleeding due to diverticulosis can usually be resolved with conservative treatment although the percentage of bleeding recurrence is high. Early endoscopy is not as important as in the remaining causes of severe lower GI bleeding.},
}
@article {pmid20380006,
year = {2010},
author = {Morks, AN and Klarenbeek, BR and Flikweert, ER and van der Peet, DL and Karsten, TM and Eddes, EH and Cuesta, MA and de Graaf, PW},
title = {Current surgical treatment of diverticular disease in The Netherlands.},
journal = {World journal of gastroenterology},
volume = {16},
number = {14},
pages = {1742-1746},
pmid = {20380006},
issn = {2219-2840},
mesh = {Adult ; Aged ; Aged, 80 and over ; Databases, Factual ; Digestive System Surgical Procedures/adverse effects/methods ; Diverticulitis/diagnosis/*surgery ; Diverticulum/diagnosis/*surgery ; Female ; Humans ; Male ; Middle Aged ; Netherlands ; Postoperative Complications/etiology ; },
abstract = {AIM: To evaluate the development of diagnostic tools, indications for surgery and treatment modalities concerning diverticular disease (DD) in The Netherlands.
METHODS: Data were collected from 100 patients who underwent surgery for DD in three Dutch hospitals. All hospitals used the same standardized database. The collected data included patient demographics, patient history, type of surgery and complications. Patients were divided into two groups, one undergoing elective surgery (elective group) and the other undergoing acute surgery (acute group).
RESULTS: Two hundred and ninety-nine patients were admitted between 2000 and 2007. One hundred and seventy-eight patients underwent acute surgery and 121 patients received elective operations. The median age of the 121 patients was 69 years (range: 28-94 years), significantly higher in acute patients (P = 0.010). Laparoscopic resection was performed in 31% of elective patients. In the acute setting, 61% underwent a Hartmann procedure. The overall morbidity and mortality were 51% and 10%, and 60% and 16% in the acute group, which were significantly higher than in the elective group (36% and 1%). Only 35% of the temporary ostomies were restored.
CONCLUSION: This study gives a picture of current surgical practice for DD in The Netherlands. New developments are implemented in daily practice, resulting in acceptable morbidity and mortality rates.},
}
@article {pmid20361072,
year = {2010},
author = {Lamiki, P and Tsuchiya, J and Pathak, S and Okura, R and Solimene, U and Jain, S and Kawakita, S and Marotta, F},
title = {Probiotics in diverticular disease of the colon: an open label study.},
journal = {Journal of gastrointestinal and liver diseases : JGLD},
volume = {19},
number = {1},
pages = {31-36},
pmid = {20361072},
issn = {1841-8724},
mesh = {Abdominal Pain/etiology/microbiology/*therapy ; Aged ; Bifidobacterium/genetics/*growth & development ; Colon/*microbiology ; Constipation/etiology/microbiology/*therapy ; DNA, Bacterial/isolation & purification ; Diverticulum, Colon/complications/microbiology/*therapy ; Feces/microbiology ; Female ; Humans ; Lactobacillus acidophilus/genetics/*growth & development ; Male ; Middle Aged ; Polymerase Chain Reaction ; Probiotics/*therapeutic use ; Prospective Studies ; Secondary Prevention ; Time Factors ; Treatment Outcome ; },
abstract = {AIM: To investigate the effectiveness and safety of a symbiotic mixture in preventing recurrence of constipation-related abdominal pain in patients with uncomplicated diverticular disease of the colon.
METHODS: Forty-six consecutive patients (10 men, 36 women, mean age 62.5 years, range 49 to 77 years), previously affected by symptomatic uncomplicated diverticular disease of the colon, were enrolled in a 6-month follow-up study in a prospective, randomized, open-label study. The following symptoms were assessed at entry and through follow-up by using a quantitative scale: constipation, diarrhoea and abdominal pain. After recruitment, the patients were assigned to the following treatment: SCM-III symbiotic mixture, 10 ml three times a day. The colonization of ingested Lactobacillus acidophilus 145 and Bifidobacterium spp. 420 was assessed by species-specific PCR. Forty-five patients completed the study (97%).
RESULTS: Thirty-one patients (68%) were still symptom free after the 6th month of treatment. Treatment with SCM-III was regarded as "effective" or "very effective" in more than 78% of the patients altogether (p<0.01 vs baseline values). The microbiological study showed that, as compared to baseline values, SCM-III enabled a significant increase of the lactobacilli and bifidobacteria counting and a trend decrease of clostridia. Genomic analysis confirmed the survivability of the ingested strain as long as treatment was given.
CONCLUSIONS: The present symbiotic mixture seems to be effective in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon, especially in those patients with constipation-predominant features.},
}
@article {pmid20357530,
year = {2010},
author = {Ahn, SB and Han, DS and Park, HS and Kim, TY and Eun, CS and Jeon, YC and Sohn, JH},
title = {[A case of segmental colitis associated with diverticular disease].},
journal = {The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi},
volume = {55},
number = {3},
pages = {189-193},
doi = {10.4166/kjg.2010.55.3.189},
pmid = {20357530},
issn = {1598-9992},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Colitis/complications/*diagnosis/drug therapy ; Colon, Sigmoid/pathology ; Colonoscopy ; Diverticulitis, Colonic/complications/*diagnosis/drug therapy ; Female ; Humans ; Mesalamine/therapeutic use ; Middle Aged ; },
abstract = {Segmental colitis associated with diverticular disease (SCAD) is a colonic inflammatory disorder with localized non-granulomatous inflammation at sigmoid colon, and associated with colonic diverticulosis. SCAD is an apparently uncommon disorder in Western. We experienced a rare case of SCAD in a 46-year-old woman who visited the hospital due to abdominal discomfort. Colonoscopic examination showed multiple sigmoid diverticula in association with a segment length colitis. Colonoscopic biopsies of the sigmoid colon demonstrated cryptitis and crypt abscess along with chronic inflammatory cells infiltration. The biopsies of the rectum was histologically normal. The patient was given the diagnosis of SCAD and treated with oral mesalamine. This is the first case of SCAD reported in Korea.},
}
@article {pmid20347730,
year = {2010},
author = {Faiz, O and Warusavitarne, J and Bottle, A and Tekkis, PP and Clark, SK and Darzi, AW and Aylin, P},
title = {Nonelective excisional colorectal surgery in English National Health Service Trusts: a study of outcomes from Hospital Episode Statistics Data between 1996 and 2007.},
journal = {Journal of the American College of Surgeons},
volume = {210},
number = {4},
pages = {390-401},
doi = {10.1016/j.jamcollsurg.2009.11.017},
pmid = {20347730},
issn = {1879-1190},
mesh = {Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Colectomy/mortality/*statistics & numerical data ; Colorectal Neoplasms/*surgery ; Comorbidity ; Diverticulum, Colon/*surgery ; Emergencies ; Emergency Treatment/*statistics & numerical data ; England/epidemiology ; Female ; Humans ; Inflammatory Bowel Diseases/*surgery ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; National Health Programs ; Outcome Assessment, Health Care ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: Nonelective colorectal surgery is associated with substantial patient morbidity and mortality. This study sought to describe the practice of emergency colorectal surgery in the United Kingdom during an 11-year period using the Hospital Episode Statistics (HES) database.
STUDY DESIGN: All nonelective admissions in patients undergoing 1 of 8 colorectal resectional procedures between 1996 and 2007 were included. Time trends, univariate, and multivariate mortality and length of stay outcomes were analyzed.
RESULTS: A total of 102,236 major urgent/emergency procedures were performed in English National Health Service Trusts between April 1996 and March 2007. Thirty-day in-hospital postoperative mortality rates in patients with colorectal cancer and diverticular disease were 13.3% and 15.4%, respectively. The corresponding 1-year postoperative mortality was 34.7% and 22.6%. On multivariate analysis, benign diagnosis, advanced age, high comorbidity score, social deprivation, and specific procedure types were independent predictors of early and 1-year postoperative mortality (p < 0.001). Independent risk factors for extended hospital stay were advanced age, social deprivation, distal (compared with proximal) bowel resection, and a diagnosis of ulcerative colitis (p < 0.001).
CONCLUSIONS: HES data suggest that in everyday practice, postoperative mortality among patients undergoing nonelective admission followed by colorectal resection is high. Additional investigation is required to assess the reliability of HES data for monitoring institutional variation in this context.},
}
@article {pmid20308730,
year = {2010},
author = {Joshi, V and Koulaouzidis, A and McGoldrick, S and Tighe, M and Tan, C},
title = {Actinomycotic liver abscess: a rare complication of colonic diverticular disease.},
journal = {Annals of hepatology},
volume = {9},
number = {1},
pages = {96-98},
pmid = {20308730},
issn = {1665-2681},
mesh = {Actinomycosis/diagnosis/*etiology/therapy ; Anti-Bacterial Agents/therapeutic use ; Diverticulitis, Colonic/*complications ; Drainage/methods ; Humans ; Laparoscopy ; Liver/surgery ; Liver Abscess/diagnosis/*microbiology/therapy ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {We present the first case of hepatic actinomycosis requiring both medical and surgical intervention due to liver dissemination from a primary colonic abscess. A 52-year-old white male had a computerised (CT) abdominal scan following an episode of collapse and was found to have peri-colonic and hepatic abscesses. Prior to this episode, he suffered with a two month history of fever, unexplained weight loss, and anaemia suggesting possible malignancy. He was treated with both radiological and surgical drainage of the abscesses, alongside the antibiotic cover and underwent an anterior colonic resection with primary anastomosis. There have been no previous reports of an actinomycotic liver abscess complicating colonic diverticular abscess. A multi- team approach is recommended when disseminated actinomycotic infection is encountered.},
}
@article {pmid20306062,
year = {2010},
author = {Khwaja, HA and Zakaria, R and Wilde, JM},
title = {Necrotising fasciitis of the lower limb due to diverticular disease of the sigmoid colon.},
journal = {International journal of colorectal disease},
volume = {25},
number = {9},
pages = {1145-1146},
doi = {10.1007/s00384-010-0922-9},
pmid = {20306062},
issn = {1432-1262},
mesh = {Aged ; Bacterial Infections/diagnostic imaging/*etiology ; Colon, Sigmoid/*pathology ; Diverticulum, Colon/*complications/pathology ; Fasciitis, Necrotizing/diagnostic imaging/*etiology/pathology ; Female ; Humans ; Laparotomy ; Pelvis/diagnostic imaging/pathology ; Thigh/diagnostic imaging/*pathology ; Tomography, X-Ray Computed ; },
}
@article {pmid20224508,
year = {2010},
author = {Agaba, EA and Kandel, AR and Agaba, PO and Wong, LS},
title = {Subcutaneous emphysema, muscular necrosis, and necrotizing fasciitis: an unusual presentation of perforated sigmoid diverticulitis.},
journal = {Southern medical journal},
volume = {103},
number = {4},
pages = {350-352},
doi = {10.1097/SMJ.0b013e3181c1a899},
pmid = {20224508},
issn = {1541-8243},
mesh = {Aged ; Diverticulitis, Colonic/*complications/diagnosis/surgery ; Fasciitis, Necrotizing/*etiology/surgery ; Humans ; Intestinal Perforation/*etiology/surgery ; Male ; Prognosis ; Sigmoid Diseases/*complications/diagnosis/surgery ; Subcutaneous Emphysema/*etiology/surgery ; },
abstract = {With advancing age and the affluent, low-fiber Western diet, the incidence of diverticular disease is increasing. Fortunately, most cases can be managed conservatively without resorting to surgical intervention. Life-threatening complications such as perforation, especially when it is associated with gross fecal contamination, requires urgent aggressive surgical intervention. A 75-year-old man with absolute constipation and pain in the left iliac fossa underwent urgent laparotomy following fluid and antibiotic resuscitation. A posterior perforated sigmoid diverticulitis associated with myofascial necrosis and generalized pelvic emphysema was identified. In cases where perforation occurs posteriorly and the only external manifestation is surgical emphysema, the outcome is generally favorable.},
}
@article {pmid20224374,
year = {2010},
author = {Klarenbeek, BR and Samuels, M and van der Wal, MA and van der Peet, DL and Meijerink, WJ and Cuesta, MA},
title = {Indications for elective sigmoid resection in diverticular disease.},
journal = {Annals of surgery},
volume = {251},
number = {4},
pages = {670-674},
doi = {10.1097/SLA.0b013e3181d3447d},
pmid = {20224374},
issn = {1528-1140},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/complications/*surgery ; *Elective Surgical Procedures ; Female ; Humans ; Male ; Middle Aged ; Recurrence ; Risk Factors ; },
abstract = {INTRODUCTION: To prevent an acute surgery, classic indications for elective sigmoid resections concerning diverticulitis have usually been based on the number of recurrent episodes. Since 2005 these indications have been challenged, primarily because the majority of patients first present themselves with acute complications at their first episode.
METHODS: Between 1990 and 2000, a cohort analysis was conducted involving all patients admitted to the VU University Medical Center with the diagnosis of diverticulitis, with a follow-up until January 2009. To identify those patients who might benefit from elective sigmoid resection, several risk factors were analyzed.
RESULTS: Of 291 patients examined, 111 (38%) were treated conservatively and 180 (62%) underwent surgery, of which 108 acute and 72 elective. The conservatively treated episodes of diverticulitis showed a recurrence rate of 48% (88 patients). Indications for elective surgery were recurrent attacks of diverticulitis with persistent complaints (36%), complaints of stenosis (40%), fistula (14%), persistent abscesses (3%), and recurrent diverticular bleeding (7%). Of the 74% of the patients approached laparoscopically, the overall morbidity was 22% with no mortality. The main indication for an AO was perforation with general peritonitis, holding for 57% of the acutely operated patients. Other indications were abscesses (22%), stenosis with obstruction (11%), failure of conservative therapy (6%), or diverticular bleeding (4%). Hartmann's procedure was the most frequently performed procedure (58%). This acutely operated population was associated with high morbidity (56%) and mortality (13%), perforation leads to 10% mortality and other causes to 3%. Of those patients undergoing acute surgery, 20% had a history of diverticulitis. Moreover, risk factor analysis showed that those patients having one or more of the following indications: (1) using immunosuppression therapy, (2) having chronic renal failure, or (3) collagen-vascular diseases, had a significant 5-fold greater risk (36% vs. 7%) of a perforation in recurrent episodes of diverticulitis.
CONCLUSION: In the treatment of diverticular disease, indications for an elective sigmoid resection should not be based on the number of episodes only. Clear indications for elective sigmoid resections are complaints of stenosis, fistulas, or recurrent diverticular bleeding. Furthermore, an elective sigmoid resection might be justified in high-risk patients, after a conservatively treated episode of diverticulitis, who use immunosuppression therapy and have chronic renal failure or collagen-vascular diseases.},
}
@article {pmid20214217,
year = {2009},
author = {Liu, D and Chen, L},
title = {Management of the total bowel diverticular disease.},
journal = {Hepato-gastroenterology},
volume = {56},
number = {96},
pages = {1679-1682},
pmid = {20214217},
issn = {0172-6390},
mesh = {Diverticulitis/complications/*surgery ; Diverticulum, Colon/complications/*surgery ; Duodenal Diseases/complications/*surgery ; Female ; Humans ; Ileal Diseases/complications/*surgery ; Middle Aged ; },
abstract = {The management of diverticulosis in normal conditions is well established, but in certain situations such as the large and small bowel diverticulosis coexists in the same person and throughout the intestine, which is rarely seen, the management is still controversial, varying from an expectant approach to bulk bowel resection, which can be therapeutically challenging for surgeons. It was reported here a typical case of an 50-year-old woman diagnosed with total bowel diverticulosis including ileum, duodenum and colon for 6 years, admitted in emergency because of the perforations of the diverticula. And we discussed the management of the rare cases like this. The defined perforated sections, along with the entire distal colon including the sigmoid colon were removed on surgery. In our experience, asymptomatic patients in this situation are usually treated expectantly, with surgery reserved for acute complications. On the surgery, the distal margin of resection must be located in rectum instead of sigmoid and primary anastomosis is recommended if possible.},
}
@article {pmid20205505,
year = {2010},
author = {Keränen, I and Lepistö, A and Udd, M and Halttunen, J and Kylänpää, L},
title = {Outcome of patients after endoluminal stent placement for benign colorectal obstruction.},
journal = {Scandinavian journal of gastroenterology},
volume = {45},
number = {6},
pages = {725-731},
doi = {10.3109/00365521003663696},
pmid = {20205505},
issn = {1502-7708},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/diagnosis/etiology/*surgery ; Colonoscopy ; Crohn Disease/*complications/diagnosis ; Digestive System Surgical Procedures/*methods ; Diverticulum, Colon/complications/diagnosis/surgery ; Female ; Follow-Up Studies ; Humans ; Intestinal Obstruction/diagnosis/etiology/*surgery ; Length of Stay ; Male ; Middle Aged ; Rectal Diseases/diagnosis/etiology/*surgery ; Retrospective Studies ; *Stents ; Time Factors ; },
abstract = {OBJECTIVE: Self-expanding metal stents (SEMS) have been successfully used as a "bridge to surgery" or as palliation for acute malignant colorectal obstruction. Little data on the use of stents for benign obstruction exists and the results vary. The purpose of this study was to evaluate the efficacy and safety of SEMS in benign colorectal obstruction.
MATERIAL AND METHODS: A total of 21 patients with 23 SEMS procedures between the years 1998 and 2008 were retrospectively studied. Eight patients had an obstruction in the surgical anastomosis. In addition, there were two patients with anastomotic strictures due to Crohn's disease. In 10 patients the obstruction was caused by diverticular disease and one patient had a stricture after radiation therapy.
RESULTS: Technical success was achieved for all the patients. Clinical success was achieved for 76% (16/21) of the patients. The anastomotic strictures were resolved with SEMS in 5 out of 8 cases (63%). Three patients with diverticular stricture (30%) were eventually resolved with SEMS. Nine (43%) patients in 10 out of 23 procedures (43%) had a complication, the majority being in patients with diverticular stricture.
CONCLUSIONS: SEMS is a good treatment option for patients with anastomotic stricture of the colon and for patients with benign colonic stricture who are unfit for surgery. SEMS can be used as a bridge to surgery in diverticular obstruction but there seems to be a considerable risk of complications. If a SEMS is placed into a diverticular stricture, the planned bowel resection should be performed within a month.},
}
@article {pmid20195150,
year = {2010},
author = {Cima, RR and Hassan, I and Poola, VP and Larson, DW and Dozois, EJ and Larson, DR and O'Byrne, MM and Huebner, M},
title = {Failure of institutionally derived predictive models of conversion in laparoscopic colorectal surgery to predict conversion outcomes in an independent data set of 998 laparoscopic colorectal procedures.},
journal = {Annals of surgery},
volume = {251},
number = {4},
pages = {652-658},
doi = {10.1097/SLA.0b013e3181d355f7},
pmid = {20195150},
issn = {1528-1140},
mesh = {*Colectomy ; Female ; Humans ; Intestinal Diseases/surgery ; *Laparoscopy ; Male ; Middle Aged ; *Models, Statistical ; Rectum/*surgery ; },
abstract = {OBJECTIVE: The aim of this study was to perform an external validation of 2 institutionally derived predictive models of laparoscopic conversion in colorectal surgery using the Mayo Clinic, Rochester (MCR) laparoscopic colon and rectal surgery experience.
SUMMARY OF BACKGROUND DATA: Two different predictive scoring systems of conversion in laparoscopic colorectal surgery were developed and published based upon single institution experiences. Neither model was validated on an independent data set. Thus, the utility of these models outside of their respective institutions is unknown.
METHODS: A prospectively collected data set of 998 laparoscopic colorectal procedures from MCR was analyzed. All patient-, procedure-, and surgeon-related factors used in both models were present in our data set. Logistic regression was used to evaluate their ability to predict conversion in our cohort. Model effectiveness was assessed by area under the curve from the logistic regression model, 95% confidence intervals for the observed number of conversions, and a goodness-of-fit test to compare the observed number of conversions with the predicted conversion rates for each score.
RESULTS: The cohort mean age of 552 women was 53, with a median body mass index of 25.2 kg/m. There were 382 right-sided, 251 left-sided, 46 rectal resections, and 151 proctocolectomies. Major diagnoses were inflammatory bowel disease 34%, cancer 18%, polyps 17%, and diverticular disease 13%. The overall MCR conversion rate was 15%. Several variables from the models were statistically significant predictors of conversion in our data set. However, both models performed similarly with an area under the curve of 0.62, suggesting that these models are of limited predictive value in our independent cohort with a performance closer to chance. The numbers of actual conversions were significantly different from the predicted number for both scoring systems.
CONCLUSION: Patient and clinical factors associated with laparoscopic conversion in colorectal surgery may be institution dependent. This finding cautions surgeons on the applicability of institution-based surgical predictive models. Independent data set validation is recommended before surgical predictive models are applied to general clinical practice.},
}
@article {pmid20193685,
year = {2010},
author = {Russ, AJ and Obma, KL and Rajamanickam, V and Wan, Y and Heise, CP and Foley, EF and Harms, B and Kennedy, GD},
title = {Laparoscopy improves short-term outcomes after surgery for diverticular disease.},
journal = {Gastroenterology},
volume = {138},
number = {7},
pages = {2267-74, 2274.e1},
pmid = {20193685},
issn = {1528-0012},
support = {T32 CA090217/CA/NCI NIH HHS/United States ; },
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Diverticulitis/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/etiology/prevention & control ; },
abstract = {BACKGROUND & AIMS: Observational studies and small randomized controlled trials have shown that the use of laparoscopy in colon resection for diverticular disease is feasible and results in fewer complications. We analyzed data from a large, prospectively maintained, multicenter database (National Surgical Quality Initiative Program) to determine whether the use of laparoscopy in the elective treatment of diverticular disease decreases rates of complications compared with open surgery, independent of preoperative comorbid factors.
METHODS: The analysis included data from 6970 patients who underwent elective surgeries for diverticular disease from 2005 to 2008. Patients with diverticular disease were identified by International Classification of Diseases, 9th revision codes and then categorized into open or laparoscopic groups based on Current Procedural Terminology codes. Preoperative, intraoperative, and postoperative data were analyzed to determine factors associated with increased risk for postoperative complications.
RESULTS: Data were analyzed from 3468 patients who underwent open surgery and 3502 patients who underwent laparoscopic procedures. After correcting for probability of morbidity, American Society of Anesthesiology class, and ostomy creation, overall complications (including superficial surgical site infections, deep incisional surgical site infections, sepsis, and septic shock) occurred with significantly lower incidence among patients who underwent laparoscopic procedures compared with those who received open operations.
CONCLUSIONS: The use of laparoscopy for treating diverticular disease, in the absence of absolute contraindications, results in fewer postoperative complications compared with open surgery.},
}
@article {pmid20186433,
year = {2010},
author = {Martel, G and Bouchard, A and Soto, CM and Poulin, EC and Mamazza, J and Boushey, RP},
title = {Laparoscopic colectomy for complex diverticular disease: a justifiable choice?.},
journal = {Surgical endoscopy},
volume = {24},
number = {9},
pages = {2273-2280},
pmid = {20186433},
issn = {1432-2218},
mesh = {Adult ; Aged ; Colectomy/*methods ; Comorbidity ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intraoperative Complications ; Laparoscopy/*methods ; Male ; Middle Aged ; Postoperative Complications ; Recurrence ; Statistics, Nonparametric ; Treatment Outcome ; },
abstract = {BACKGROUND: Surgery is increasingly reserved for complicated diverticulitis. The role of laparoscopy in this context is ill defined. This study aimed to evaluate the safety, feasibility, and outcomes associated with the application of laparoscopy to an unrestricted spectrum of diverticular pathologies, with an emphasis on complicated disease.
METHODS: Consecutive patients who underwent elective, urgent, or emergent laparoscopic colectomy for diverticular disease from 1991 to 2007 were analyzed from a prospectively collected database. Laparoscopy was offered to all patients presenting for surgical attention, thus minimizing selection bias. Complicated cases had abscesses, perforations, fistulas, or strictures. Uncomplicated cases had chronic or recurrent diverticulitis. Summary statistics and univariate comparisons were generated.
RESULTS: A total of 183 patients were analyzed, including 39 complicated cases. The complicated cohort included 12 abscesses or perforations (31%), 18 fistulas (46%), and 11 strictures (28%). Intraoperative complications were comparable between the two groups (7.7 vs. 9.7%), although the complicated cases resulted in more conversions (23 vs. 4.2%; p = 0.0007). More than 79% of the complicated patients and 96% of the uncomplicated patients underwent unprotected primary anastomosis. Medical (23 vs. 1.4%; p < 0.0001) and surgical (28 vs. 14%; p = 0.035) complications were more frequent in the complicated group. Leak rates were acceptably low (6.5 vs. 2.2%; p = 0.23). There were no recorded deaths. Finally, the time until discharge from hospital was significantly longer in the complicated group by a median of 1 day.
CONCLUSIONS: The laparoscopic management of complicated diverticular disease is feasible and appears to be safe in the hands of experts. Despite a high rate of conversion to open surgery, laparoscopy was the sole operative intervention for the majority of patients with complicated diverticular disease. Further studies are needed to allow rigorous comparison with an open control group.},
}
@article {pmid20186359,
year = {2010},
author = {Paoluzi, OA and Tosti, C and Andrei, F and Stroppa, I and Pallone, F},
title = {Look out before polypectomy in patients with diverticular disease--a case of a large, inverted diverticulum of the colon resembling a pedunculated polyp.},
journal = {Canadian journal of gastroenterology = Journal canadien de gastroenterologie},
volume = {24},
number = {1},
pages = {61-63},
pmid = {20186359},
issn = {0835-7900},
mesh = {Aged ; Colonic Polyps/*diagnosis/surgery ; *Colonoscopy ; Diagnostic Errors ; Diverticulum, Colon/*physiopathology ; Endoscopy/methods ; Female ; Humans ; },
abstract = {Diverticular disease of the colon may be responsible for abdominal symptoms requiring colonoscopy, which may reveal the presence of concomitant polyps. A polyp found during colonoscopy in patients with colonic diverticular disease may be removed by endoscopic polypectomy with electrosurgical snare, a procedure associated with an incidence of perforation of less than 0.05%. The risk of such a complication may be higher in the event of an inverted colonic diverticulum, which may be misinterpreted as a polypoid lesion at colonoscopy. To date, fewer than 20 cases of inverted colonic diverticula, diagnosed at colonoscopy or following air contrast barium enema, have been reported in the literature. The present report describes a 68-year-old woman who underwent a screening colonoscopy, which revealed a voluminous pedunculated polyp that was recognized to be an inverted giant colonic diverticulum before endoscopic polypectomy.},
}
@article {pmid20181157,
year = {2009},
author = {Vodovnik, A and Logishetty, K},
title = {Actinomycosis complicating sigmoid diverticular disease: a case report.},
journal = {Cases journal},
volume = {2},
number = {},
pages = {6456},
pmid = {20181157},
issn = {1757-1626},
abstract = {A 63-year-old Caucasian woman was admitted to hospital as hypotensive with abdominal tenderness and vaginal discharge. Laboratory investigations showed microcytic anaemia, low albumin and high white cell count. Computerised tomography scans revealed small bowel dilatation, sigmoid diverticula, ascites and pelvic fluid. The endometrial pipelle was positive and vaginal swab was negative for actinomyces. Post mortem examination revealed widespread sigmoid diverticular disease and bowel perforation with an intense inflammation. Actinomycotic granules were noted in the diverticular inflammatory debris, pelvic abscess and lung sections. Clinical course and histomorphological findings favour the perforating sigmoid diverticular actinomycosis as an origin of the systemic infection.},
}
@article {pmid20145937,
year = {2010},
author = {Bosker, R and Hoogenboom, F and Groen, H and Hoff, C and Ploeg, R and Pierie, JP},
title = {Elective laparoscopic recto-sigmoid resection for diverticular disease is suitable as a training operation.},
journal = {International journal of colorectal disease},
volume = {25},
number = {4},
pages = {471-476},
pmid = {20145937},
issn = {1432-1262},
mesh = {Aged ; Cohort Studies ; Colon, Sigmoid/*surgery ; Colonic Neoplasms/*surgery ; Digestive System Surgical Procedures/*education ; Diverticulitis, Colonic/*surgery ; Education, Medical ; Elective Surgical Procedures ; Female ; Humans ; Laparoscopy/*adverse effects/statistics & numerical data ; Male ; Middle Aged ; Prospective Studies ; },
abstract = {PURPOSE: Some authors state that elective laparoscopic recto-sigmoid resection is more difficult for diverticular disease as compared with malignancy. For this reason, starting laparoscopic surgeons might avoid diverticulitis, making the implementation phase unnecessary long. The aim of this study was to determine whether laparoscopic resection for diverticular disease should be included during the implementation phase.
METHODS: All consecutive patients who underwent an elective laparoscopic recto-sigmoid resection in our hospital for diverticulitis or cancer from 2003 to 2007 were analysed.
RESULTS: A total of 256 consecutive patients were included in this prospective cohort study. One hundred and fifty-one patients were operated on for diverticulitis and 105 for cancer. There was no significant difference in operation time (168 vs. 172 min), blood loss (189 vs. 208 ml), conversion rates (9.9% vs. 11.4%), hospital stay (8 vs. 8 days), total number of peroperative (2.3% vs. 1.6%) or postoperative complications (21.9% vs. 26.9%). The occurrence of anastomotic leakages was associated with higher American Society of Anesthesiologists (ASA) classification, which differed between the groups (86.8% vs. 64.8% ASA I-II, p < 0.001).
CONCLUSION: Since there are no differences in operation time, blood loss, conversion rate and total complications, there is no need to avoid laparoscopic recto-sigmoid resection for diverticular disease early in the learning curve.},
}
@article {pmid20143459,
year = {2010},
author = {Stocchi, L},
title = {Current indications and role of surgery in the management of sigmoid diverticulitis.},
journal = {World journal of gastroenterology},
volume = {16},
number = {7},
pages = {804-817},
pmid = {20143459},
issn = {2219-2840},
mesh = {Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents/therapeutic use ; Colon, Sigmoid/*surgery ; *Digestive System Surgical Procedures/adverse effects ; Diverticulitis, Colonic/diagnosis/drug therapy/etiology/*surgery ; Evidence-Based Medicine ; Humans ; *Laparoscopy/adverse effects ; Middle Aged ; *Patient Selection ; Recurrence ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Sigmoid Diseases/diagnosis/drug therapy/etiology/*surgery ; Treatment Outcome ; },
abstract = {Sigmoid diverticulitis is a common disease which carries both a significant morbidity and a societal economic burden. This review article analyzes the current data regarding management of sigmoid diverticulitis in its variable clinical presentations. Wide-spectrum antibiotics are the standard of care for uncomplicated diverticulitis. Recently published data indicate that sigmoid diverticulitis does not mandate surgical management after the second episode of uncomplicated disease as previously recommended. Rather, a more individualized approach, taking into account frequency, severity of the attacks and their impact on quality of life, should guide the indication for surgery. On the other hand, complicated diverticular disease still requires surgical treatment in patients with acceptable comorbidity risk and remains a life-threatening condition in the case of free peritoneal perforation. Laparoscopic surgery is increasingly accepted as the surgical approach of choice for most presentations of the disease and has also been proposed in the treatment of generalized peritonitis. There is not sufficient evidence supporting any changes in the approach to management in younger patients. Conversely, the available evidence suggests that surgery should be indicated after one attack of uncomplicated disease in immunocompromised individuals. Uncommon clinical presentations of sigmoid diverticulitis and their possible association with inflammatory bowel disease are also discussed.},
}
@article {pmid21577292,
year = {2010},
author = {Tursi, A},
title = {Diverticular disease: A therapeutic overview.},
journal = {World journal of gastrointestinal pharmacology and therapeutics},
volume = {1},
number = {1},
pages = {27-35},
pmid = {21577292},
issn = {2150-5349},
abstract = {Formation of colonic diverticula, via herniation of the colonic wall, is responsible for the development of diverticulosis. When diverticulosis becomes symptomatic, it becomes diverticular disease. Diverticular disease is common in Western and industrialized countries, and it is associated with numerous abdominal symptoms (including pain, bloating, nausea, diarrhea, and constipation). Standard medical therapies with antibiotics are currently recommended for patients affected by diverticular disease. However, changing concepts on the pathophysiology of the disease suggest that diverticular disease may share many of the hallmarks of inflammatory bowel diseases. On this basis, the addition of therapies using mesalazine and probiotics may enhance treatment efficacy by shortening the course of the disease and preventing recurrences.},
}
@article {pmid20134488,
year = {2010},
author = {Tursi, A},
title = {Diverticular disease: what is the best long-term treatment?.},
journal = {Nature reviews. Gastroenterology & hepatology},
volume = {7},
number = {2},
pages = {77-78},
pmid = {20134488},
issn = {1759-5053},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulitis/*drug therapy ; Gastrointestinal Agents/*therapeutic use ; Humans ; Mesalamine/*therapeutic use ; Rifamycins/*therapeutic use ; Rifaximin ; },
}
@article {pmid20130950,
year = {2010},
author = {Halevy, A and Bracha, M and Jeroukhimov, I and Schneider, D and Nesterenko, V},
title = {En bloc resection for malignant colouterine fistula.},
journal = {Techniques in coloproctology},
volume = {14},
number = {1},
pages = {37-39},
pmid = {20130950},
issn = {1128-045X},
mesh = {Adenocarcinoma/*pathology/surgery ; Aged ; Colonic Neoplasms/*pathology/surgery ; Female ; Humans ; Intestinal Fistula/*etiology/pathology/*surgery ; Middle Aged ; Uterine Diseases/*etiology/pathology/*surgery ; },
abstract = {Colouterine fistula is a rare clinical entity. A literature search revealed only a few reports dealing with this complex problem, mostly resulting as a complication of diverticular disease of the colon. During a 4-month period, we diagnosed and successfully treated 2 women with a malignant colouterine fistula originating from a primary colorectal carcinoma invading the uterus. We herein report on our experience dealing with this kind of pathology, with special emphasis on the surgical technique used to resect the tumoral mass "en bloc".},
}
@article {pmid20118600,
year = {2010},
author = {Nakamura, Y and Kayano, H and Shimada, T and Ito, Y and Bessho, M},
title = {Plasma cell granuloma of the sigmoid colon associated with diverticular disease and accompanying IgM-type monoclonal gammopathy.},
journal = {Internal medicine (Tokyo, Japan)},
volume = {49},
number = {3},
pages = {227-230},
doi = {10.2169/internalmedicine.49.2240},
pmid = {20118600},
issn = {1349-7235},
mesh = {Aged, 80 and over ; Colonoscopy ; Diverticulitis, Colonic/*complications/diagnosis ; Female ; Granuloma, Plasma Cell/*complications/diagnosis ; Humans ; Immunoglobulin M/analysis ; Immunoglobulin kappa-Chains/analysis ; Monoclonal Gammopathy of Undetermined Significance/*complications ; },
abstract = {Plasma cell granuloma is a pseudoneoplastic lesion composed of reactive plasma cells of a polyclonal nature and must be distinguished from plasmacytoma. We report a case of plasma cell granuloma in the sigmoid colon associated with diverticulosis. In this case, the lesion consisted of multiple submucosal tumors with prominent infiltration of polyclonal plasma cells. Although the patient exhibited IgM-type monoclonal gammopathy, the expression of a monoclonal immunoglobulin was not detected in the sigmoid colonic lesion, but in the bone marrow cells. Plasma cell granuloma in the lower alimentary tract has been rarely reported. Recurrent inflammatory process with diverticular disease was considered as a pathogenesis of the pseudoneoplasm and a possible cause of monoclonal proliferation of IgM-producing lymphoid cells in this case.},
}
@article {pmid20109378,
year = {2009},
author = {Cirocchi, R and La Mura, F and Farinella, E and Napolitano, V and Milani, D and Di Patrizi, MS and Trastulli, S and Covarelli, P and Sciannameo, F},
title = {Colovesical fistulae in the sigmoid diverticulitis.},
journal = {Il Giornale di chirurgia},
volume = {30},
number = {11-12},
pages = {490-492},
pmid = {20109378},
issn = {0391-9005},
mesh = {Aged ; Anastomosis, Surgical ; Appendicitis/diagnosis ; Cystitis/complications ; Diagnosis, Differential ; Diverticulitis, Colonic/*complications/diagnosis/surgery ; Douglas' Pouch/microbiology/surgery ; Elective Surgical Procedures ; Emergencies ; Escherichia coli Infections/complications ; Female ; Humans ; Intestinal Fistula/*etiology/surgery ; Klebsiella Infections/complications ; Male ; Peritonitis/complications/microbiology/surgery ; Sigmoid Diseases/*etiology/surgery ; Suture Techniques ; Urinary Bladder Fistula/*etiology/surgery ; Urinary Catheterization ; },
abstract = {In most cases Colovesical fistulae are complications of diverticular disease and representing the most common kind of colodigestive fistula; less common are colovaginal, colocutaneous, coloenteric and colouterine fistula. In this article we review the literature concerning colovesical fistulae in colorectal surgery for sigmoid diverticulitis and report on two cases that required a surgical treatment, one elective and the other in emergency. In both cases we performed a sigmoid resection with a primary anastomosis and small vesical window-ectomy placing a Foley catheter for about 10 days.},
}
@article {pmid20102635,
year = {2010},
author = {Meniconi, RL and Caronna, R and Benedetti, M and Fanello, G and Ciardi, A and Schiratti, M and Papini, F and Farelli, F and Dinatale, G and Chirletti, P},
title = {Inflammatory myoglandular polyp of the cecum: case report and review of literature.},
journal = {BMC gastroenterology},
volume = {10},
number = {},
pages = {10},
pmid = {20102635},
issn = {1471-230X},
mesh = {Cecum/*pathology/*surgery ; Colonic Polyps/*diagnosis/pathology/*surgery ; Colonoscopy ; Humans ; Inflammation/pathology ; Male ; Middle Aged ; },
abstract = {BACKGROUND: Inflammatory myoglandular polyp (IMGP) is a rare non-neoplastic polyp of the large bowel, commonly with a distal localization (rectosigmoid), obscure in its pathogenesis. Up till now, 60 cases of IMGP have been described in the literature, but none located in the cecum.
CASE PRESENTATION: We report a case of a 53-year-old man who was admitted to our hospital for further evaluation of positive fecal occult blood test associated to anemia. A colonoscopy identified a red, sessile, lobulated polyp of the cecum, 4.2 cm in diameter, partially ulcerated. The histological examination of the biopsy revealed the presence of inflammatory granulation tissue with lymphocytic and eosinophil infiltration associated to a fibrous stroma: it was diagnosed as inflammatory fibroid polyp. Considering the polyp's features (absence of a peduncle and size) that could increase the risk of a polypectomy, a surgical resection was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, hyperplastic glands with cystic dilatations, proliferation of smooth muscle and multiple erosions on the polyp surface: this polyp was finally diagnosed as IMGP. There was also another little polyp next to the ileocecal valve, not revealed at the colonoscopy, 0.8 cm in diameter, diagnosed as tubulovillous adenoma with low grade dysplasia.
CONCLUSIONS: This is the first case of IMGP of the cecum. It is a benign lesion of unknown pathogenesis and must be considered different from other non-neoplastic polyps of the large bowel such as inflammatory cap polyps (ICP), inflammatory cloacogenic polyps, juvenile polyps (JP), inflammatory fibroid polyps (IFP), polyps secondary to mucosal prolapse syndrome (MPS), polypoid prolapsing mucosal folds of diverticular disease. When symptomatic, IMGP should be removed endoscopically, whereas surgical resection is reserved only in selected patients as in our case.},
}
@article {pmid20085514,
year = {2010},
author = {Kumarasinghe, MP and Quek, TP and Chau, CY and Mustapha, NR and Luman, W and Ooi, CJ},
title = {Endoscopic biopsy features and diagnostic challenges of adult Crohn's disease at initial presentation.},
journal = {Pathology},
volume = {42},
number = {2},
pages = {131-137},
doi = {10.3109/00313020903494979},
pmid = {20085514},
issn = {1465-3931},
mesh = {Adolescent ; Adult ; Aged ; Biopsy ; Colon/pathology ; Crohn Disease/*diagnosis/etiology/*pathology/surgery ; Diagnosis, Differential ; Diverticulum, Colon/diagnosis ; Endoscopy, Gastrointestinal/*methods ; Female ; Granuloma/pathology ; Humans ; Ileum/pathology ; Intestinal Mucosa/*pathology ; Male ; Middle Aged ; Retrospective Studies ; Tuberculosis/diagnosis ; Young Adult ; },
abstract = {AIMS: Endoscopic biopsy diagnosis of Crohn's disease (CD) is problematic due to lack of specific microscopic features and patchy involvement. There is no documentation of the pattern and severity of microscopic features of CD at initial presentation in adults or children. We aimed to assess the initial mucosal biopsy features of CD in adults and to identify any specific features to confirm the diagnosis.
METHODS: Thirty sets of initial, adult endoscopic biopsies suspected to be CD with subsequent resections, repeat biopsies with long-term follow-up, and/or other confirmatory laboratory results were analysed by three gastrointestinal pathologists, blinded for the final diagnosis for mucosal architectural changes, epithelial abnormalities, chronic and active inflammation and changes of muscularis mucosae and submucosa. There were 25 cases of CD and five cases of non-CD for comparison (3 tuberculosis and 2 right-sided diverticular disease and associated colitis). Cases confirmed as ulcerative colitis were excluded, as diagnostic challenges are already well established.
RESULTS: The majority of initial biopsies (96%) of CD were abnormal with active chronic ileocolitis with a very high proportion (80%) showing the classic combination of abnormal mucosal architecture, epithelial abnormalities and active chronic inflammation. The most sensitive feature was lamina proprial chronic inflammation (sensitivity 92.7%). Sensitivity for other features was as follows: active inflammation 87.8%, basal plasmacytosis 82.1%, architectural changes 80.5% and epithelial abnormalities 70.7%. Abnormalities were found in 94% of ileal and 76% of colonic biopsies. No feature was specific as all tuberculosis and diverticular disease cases showed the classic combination. Granulomata were seen in 10 of 41 CD, in all five tuberculosis and in no diverticular disease biopsies. Small, tight, well defined granulomata characterised CD over large coalesced ganulomata of tuberculosis. Paneth cell and pseudopyloric metaplasia was seen only in CD (2/25).
CONCLUSIONS: Initial endoscopic biopsies of adult CD are significantly abnormal and a majority shows active chronic ileocolitis. The features are sufficiently important to suspect CD at initial presentation in the appropriate clinical setting. Tuberculosis and diverticular disease associated colitis are two important mimics to consider in addition to ulcerative colitis.},
}
@article {pmid20076780,
year = {2009},
author = {Daryani, NE and Keramati, MR and Habibollahi, P and Pashaei, MR and Ansarinejad, N and Ajdarkosh, H},
title = {Colonic diverticular abscess presenting as chronic diarrhea: a case report.},
journal = {Cases journal},
volume = {2},
number = {},
pages = {9389},
pmid = {20076780},
issn = {1757-1626},
abstract = {INTRODUCTION: Several complications have been reported with diverticular disease of colon. Perforation of the diverticulum of colon may lead to development of abdominal abscesses which can have diverse manifestations.
CASE PRESENTATION: This report describes a 72 year-old woman presented with a one month history of non-bloody diarrhea, abdominal pain, and low grade fever. Computed tomography scan confirmed presence of a large local air-fluid level within the culdesac area. Laparotomy revealed a large pelvic abscess which was surrounded between rectosigmoid and uterus with severe tissue necrosis of rectosigmoid colon and uterus.
CONCLUSION: Although rarely reported, abdominal abscesses due to colonic diverticulitis may present as refractory chronic diarrhea.},
}
@article {pmid20052939,
year = {2009},
author = {Zonca, P and Jacobi, CA and Meyer, GP},
title = {[The current view of surgical treatment of diverticular disease].},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {88},
number = {10},
pages = {568-576},
pmid = {20052939},
issn = {0035-9351},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Diverticulitis/surgery ; Diverticulum, Colon/classification/complications/*surgery ; Elective Surgical Procedures ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; },
abstract = {AIM: The aim of our prospective dynamic cohort trial is the evaluation of indication for surgery for diverticular disease and the evaluation of morbidity and mortality.
MATERIAL AND METHOD: All patients operated for diverticular disease and its complications were involved in the study. The conservatively treated patients were not involved. 104 patients with diverticular disease and its complication were operated from August 2007 till July 2008.46 men and 58 women at average age of 63.9 (31-85) years were in this group. 78 patients were electively operated in noninflammatory stage of diverticular disease. 3 patients of them had colovesical or enterocolical fistulas. An elective laparoscopic colon sigmoid resection was performed by 74 patients and a laparoscopic left hemicolectomy was performed by 4 patients. An end-to-end stapled colorectal suture was performed by all patients. An excision of fistula from urinary bladder and a segment resection of small bowel were performed in the case of fistula presence. In connection with previously repeated diverticulitis attacks or after previous surgeries, adhesiolysis was performed by 23 patients. 26 patients were operated for acute complication of diverticular disease. 24 patients of this group were operated for acute diverticulitis and 2 patients for diverticular bleeding. 23 colon sigmoideum resections, 2 left hemicolectomies, and once ileocecal resection were performed. The primary bowel suture was performed by 20 patients and Hartmaruts operation was performed by 4 patients.
RESULTS: The indication for surgery follows the classification according to Hansen and Stock. The abdominal postoperative complications (wound infection, anastomotic leak, prolongated bowel atonia, and others) occurred by elective operated group in 9% and by acute operated group in 26.9%. The overall abdominal postoperative complications occurred in all the involved patients in 13.4%. The extraabdominal postoperative complications (urinary infection or retention, cardiopulmonary complications, trombosis/embolia, postoperative qualitative conscious disorder, renal insufficiency, and others) occurred by elective group in 19.6% and by acute operated group in 50%. Overall extraabdominal postoperative complications occurred in all involved patients in 26.90%. The mortality was 0%. The conversion rate in elective group was 3.8% (3 pts.). An anastomosis leak occurred once (1%) by elective operated patient. An acute reoperation with resection according to Hartmann was performed. A small bowel loop perforation by coincidental adhesiolysis occurred once. A small bowel defect was identified and sutured by early laparoscopic reoperation. The conversion rate in acute group was 23.1% (6 pts.). The colonoscopy was necessary on 3rd day by 1 patient after left hemicolectomy for splenic flexure bleeding. This examination revealed bleeding from diverticulum in hepatic flexure. An endoscopic treatment was performed. An abscess in small pelvis occurred by this patient (12th postoperative day) and open drainage was performed. There was no anastomosis leak in group with acutely operated patients.
CONCLUSION: The usage of standard classification is suitable for operation's indication for diverticular disease and its complications. It helps to determine the type and operation's strategy. The acute complicated diveticulitis has high morbidity and mortality. The early indication of selected patients with diverticular disease for elective colon sigmoideum resection protects against possible complication in the case of next attack of diverticulitis. It concerns the patients with recidivated uncomplicated and complicated forms of disease as well. The primary conservative treatment with percutaneous CT navigated drainage allows a postponed elective surgery. The primary resection with suture is better than the two stage surgery. The primary laparoscopic resection is safe procedure in almost all the cases. The primary suture can be safely performed in all elective cases for uncomplicated diverticulitis, chronic fistulas, obstruction, for primarily conservatively treated stages Hinchey I and II and possibly for all the selected patients with Hinchey III and IV stages with MPI lower as 21.},
}
@article {pmid22750918,
year = {2010},
author = {Ray, K and Seymour, H and Miles, A},
title = {Organised diverticular abscess mimicking incarcerated parastomal hernia in an immunocompromised patient.},
journal = {BMJ case reports},
volume = {2010},
number = {},
pages = {},
pmid = {22750918},
issn = {1757-790X},
mesh = {Abscess/*diagnosis/*surgery ; Aged ; Atrial Fibrillation/complications ; Colostomy ; Diagnosis, Differential ; Diverticulitis, Colonic/*surgery ; Drainage ; Female ; Hernia, Ventral/diagnosis ; Humans ; *Immunocompromised Host ; Kidney Transplantation ; Radiography, Interventional ; },
abstract = {A 68-year-old immunosuppressed woman was admitted with poor-functioning colostomy, which she had following a Hartmann's procedure for diverticular disease in sigmoid colon 8 years previously. She was on cyclosporin and warfarin for transplanted kidney and atrial fibrillation, respectively. On admission, an erythematous and tender swelling was found around the stoma, which was diagnosed as an irreducible, parastomal hernia clinically. The swelling was investigated further with CT, which revealed an organised mesocolic abscess of diverticular origin. The abscess was drained percutaneously under radiological guidance. She recovered well subsequently. This case is a unique presentation of diverticular abscess and management was a challenge considering the patient's co-morbidities and the location of the abscess.},
}
@article {pmid21694857,
year = {2010},
author = {Erichsen, R and Strate, L and Sørensen, HT and Baron, JA},
title = {Positive predictive values of the International Classification of Disease, 10th edition diagnoses codes for diverticular disease in the Danish National Registry of Patients.},
journal = {Clinical and experimental gastroenterology},
volume = {3},
number = {},
pages = {139-142},
pmid = {21694857},
issn = {1178-7023},
abstract = {OBJECTIVE: To investigate the accuracy of diagnostic coding for diverticular disease in the Danish National Registry of Patients (NRP).
STUDY DESIGN AND SETTING: At Aalborg Hospital, Denmark, with a catchment area of 640,000 inhabitants, we identified 100 patients recorded in the NRP with a diagnosis of diverticular disease (International Classification of Disease codes, 10th revision [ICD-10] K572-K579) during the 1999-2008 period. We assessed the positive predictive value (PPV) as a measure of the accuracy of discharge codes for diverticular disease using information from discharge abstracts and outpatient notes as the reference standard.
RESULTS: Of the 100 patients coded with diverticular disease, 49 had complicated diverticular disease, whereas 51 had uncomplicated diverticulosis. For the overall diagnosis of diverticular disease (K57), the PPV was 0.98 (95% confidence intervals [CIs]: 0.93, 0.99). For the more detailed subgroups of diagnosis indicating the presence or absence of complications (K573-K579) the PPVs ranged from 0.67 (95% CI: 0.09, 0.99) to 0.92 (95% CI: 0.52, 1.00). The diagnosis codes did not allow accurate identification of uncomplicated disease or any specific complication. However, the combined ICD-10 codes K572, K574, and K578 had a PPV of 0.91 (95% CI: 0.71, 0.99) for any complication.
CONCLUSION: The diagnosis codes in the NRP can be used to identify patients with diverticular disease in general; however, they do not accurately discern patients with uncomplicated diverticulosis or with specific diverticular complications.},
}
@article {pmid21560617,
year = {2010},
author = {Gudkova, RB and Levchenko, SV},
title = {[Clinical value of serum cytokines in diverticular disease of the colon in elderly patients].},
journal = {Eksperimental'naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology},
volume = {},
number = {12},
pages = {27-30},
pmid = {21560617},
issn = {1682-8658},
mesh = {Age Factors ; Aged ; Cytokines/*blood/immunology ; Diverticulitis, Colonic/*blood/immunology ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {This article demonstrated changes in the level of pro-and anti-inflammatory cytokines in serum of patients of older age groups with small symptom diverticular disease of the colon. Was considered one of the links of the possible pathogenesis of this nosology, touched upon the contribution of involutive changes in the formation of the features of nonspecific immunity and the development of autoimmune reactions in elderly patients.},
}
@article {pmid20040058,
year = {2010},
author = {Wedel, T and Büsing, V and Heinrichs, G and Nohroudi, K and Bruch, HP and Roblick, UJ and Böttner, M},
title = {Diverticular disease is associated with an enteric neuropathy as revealed by morphometric analysis.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {22},
number = {4},
pages = {407-14, e93-4},
doi = {10.1111/j.1365-2982.2009.01445.x},
pmid = {20040058},
issn = {1365-2982},
mesh = {Aged ; Cell Count ; Colon, Sigmoid/metabolism/*pathology ; Diverticulum/metabolism/*pathology ; ELAV Proteins/metabolism ; Enteric Nervous System/metabolism/*pathology ; Female ; Gliosis/metabolism/pathology ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Myenteric Plexus/metabolism/*pathology ; Neuroglia/metabolism/pathology ; Neurons/metabolism/*pathology ; Statistics, Nonparametric ; },
abstract = {BACKGROUND: The pathogenesis of diverticular disease (DD) is attributed to several aetiological factors (e.g. age, diet, connective tissue disorders) but also includes distinct intestinal motor abnormalities. Although the enteric nervous system (ENS) is the key-regulator of intestinal motility, data on neuropathological alterations are limited. The study aimed to investigate the ENS by a systematic morphometric analysis.
METHODS: Full-thickness sigmoid specimens obtained from patients with symptomatic DD (n = 27) and controls (n = 27) were processed for conventional histology and immunohistochemistry using anti-HuC/D as pan-neuronal marker. Enteric ganglia, nerve and glial cells were quantified separately in the myenteric, external and internal submucosal plexus compartments.
KEY RESULTS: Compared to controls, patients with DD showed significantly (P < 0.05) (i) reduced neuronal density in all enteric nerve plexus, (ii) decrease of ganglionic nerve cell content in the myenteric plexus, (iii) decreased ganglionic density in the internal submucosal plexus, (iv) reduced glial cell density in the myenteric plexus, (v) decrease of ganglionic glial cell content in the myenteric plexus and increase in submucosal plexus compartments, (vi) increased glia index in all enteric nerve plexus. About 44.4% of patients with DD exhibited myenteric ganglia displaying enteric gliosis.
CONCLUSIONS & INFERENCES: Patients with DD show substantial structural alterations of the ENS mainly characterized by myenteric and submucosal oligo-neuronal hypoganglionosis which may account for intestinal motor abnormalities reported in DD. The morphometric data give evidence that DD is associated with structural alterations of the ENS which may complement established pathogenetic concepts.},
}
@article {pmid20036093,
year = {2012},
author = {Vermeulen, J and van Hout, N and Klaasen, R},
title = {Fistula formation to the bladder and to a corpus alienum as a rare complication of diverticulitis: a case report.},
journal = {The Journal of emergency medicine},
volume = {43},
number = {2},
pages = {e87-8},
doi = {10.1016/j.jemermed.2009.09.025},
pmid = {20036093},
issn = {0736-4679},
mesh = {Abdominal Wall ; Abscess/diagnostic imaging/*etiology/surgery ; Device Removal ; Diverticulitis/*complications/diagnostic imaging/surgery ; Drainage ; Humans ; *Implantable Neurostimulators ; Intestinal Fistula/diagnostic imaging/*etiology/surgery ; Male ; Middle Aged ; Radiography ; Sigmoid Diseases/diagnostic imaging/*etiology/surgery ; Urinary Bladder Fistula/diagnostic imaging/*etiology/surgery ; },
abstract = {BACKGROUND: Fistula formation is a known complication of diverticulitis. Treatment of a diverticular fistula depends on the comorbidity of the patient and the severity of the disease.
CASE REPORT: A 59-year-old man presented to the Emergency Department with chronic lower back pain that was being treated with a neurostimulator. He presented with severe sepsis, and an abscess formation near the neurostimulator. An abdominal and pelvic computed tomography scan revealed diverticulitis complicated by fistula formation to the neurostimulator and bladder. He was successfully treated by a two-stage procedure: first, exploration and drainage of the abscess, with removal of the foreign body, followed by a sigmoid resection 1 week later.
CONCLUSION: In rare but severe presentations of diverticular disease, it is very important to limit initial treatment to the most threatening disorder.},
}
@article {pmid20017351,
year = {2009},
author = {Kozlova, IV and Mialina, IuN},
title = {[Diagnostic criteria for different clinical variants of diverticular disease].},
journal = {Klinicheskaia meditsina},
volume = {87},
number = {10},
pages = {46-50},
pmid = {20017351},
issn = {0023-2149},
mesh = {Aged ; Biomarkers/*metabolism ; Colitis/diagnosis ; Colonoscopy/*methods ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis/metabolism ; Follow-Up Studies ; Humans ; Middle Aged ; Pancreatic Elastase/metabolism ; Vasoactive Intestinal Peptide/metabolism ; },
abstract = {New diagnostic criteria for different variants of diverticular disease (DD) are considered based on the examination of 110 patients. Patients of group 1 (n = 77) showed no signs of diverticulitis in contrast to group 2 (n = 33). Two control groups comprised 38 patients with chronic hypomotor colitis and 25 practically healthy subjects respectively. Dynamic observations included clinical and endoscopic examination supplemented by morphological and immunohistochemical Studies. It was shown that DD developed in association with undifferentiated dysplasia of connective tissue, increased number of P substance-inducing colonocytes, and lowered density of vasointestinal peptide-reactive cells. Diagnostically significant criteria in patients with diverticulitis were grade II-III intestinal dysbiosis and increased number of mast cells in rectosigmoid nucosa.},
}
@article {pmid20013934,
year = {2010},
author = {Guller, U and Rosella, L and Karanicolas, PJ and Adamina, M and Hahnloser, D},
title = {Population-based trend analysis of 2813 patients undergoing laparoscopic sigmoid resection.},
journal = {The British journal of surgery},
volume = {97},
number = {1},
pages = {79-85},
doi = {10.1002/bjs.6787},
pmid = {20013934},
issn = {1365-2168},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum/*surgery ; Humans ; Intraoperative Complications/etiology ; Laparoscopy/*methods ; Middle Aged ; Postoperative Complications/etiology ; Prospective Studies ; Risk Factors ; Sigmoid Diseases/*surgery ; Young Adult ; },
abstract = {BACKGROUND: The use of laparoscopic sigmoid resection for diverticular disease has become increasingly popular. The objective of this trend analysis was to assess whether clinical outcomes following laparoscopic sigmoid resection for diverticular disease have improved over the past 10 years.
METHODS: The analysis was based on the prospective database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery. Some 2813 patients undergoing elective laparoscopic sigmoid resection for diverticular disease from 1995 to 2006 were included. Unadjusted and risk-adjusted analyses were performed.
RESULTS: Over time, there was a significant reduction in the conversion rate (from 27.3 to 8.6 per cent; P(trend) < 0.001), local postoperative complication rate (23.6 to 6.2 per cent; P(trend) = 0.004), general postoperative complication rate (14.6 to 4.9 per cent; P(trend) = 0.024) and reoperation rate (5.5 to 0.6 per cent; P(trend) = 0.015). Postoperative median length of hospital stay significantly decreased from 11 to 7 days (P(trend) < 0.001).
CONCLUSION: This first trend analysis in the literature of clinical outcomes after laparoscopic sigmoid resection, based on almost 3000 patients, has provided compelling evidence that rates of postoperative complications, conversion and reoperation, and length of hospital stay have decreased significantly over the past 10 years.},
}
@article {pmid20003674,
year = {2009},
author = {Wu, SD and Rios, RR and Meeks, JJ and Nadler, RB},
title = {Rectal Hem-o-Lok clip migration after robot-assisted laparoscopic radical prostatectomy.},
journal = {The Canadian journal of urology},
volume = {16},
number = {6},
pages = {4939-4940},
pmid = {20003674},
issn = {1195-9479},
mesh = {Adenocarcinoma/diagnosis/surgery ; Colonoscopy/methods ; Follow-Up Studies ; Foreign-Body Migration/diagnosis/etiology/*surgery ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Neoplasm Staging ; Prostatectomy/*methods ; Prostatic Neoplasms/diagnosis/*surgery ; *Rectum ; Robotics/*methods ; Suture Techniques/*adverse effects/instrumentation ; },
abstract = {INTRODUCTION: Weck Hem-o-Lok clip migration into the bladder has been reported after robot-assisted laparoscopic radical prostatectomy (RALP). We report a case of Weck clip migration into the rectum presenting as a mass on colonoscopy.
METHODS: A 61-year-old male with a prostate specific antigen level of 4.84 ng/ml underwent transrectal ultrasound guided biopsy of the prostate revealing a Gleason's 3 + 3 adenocarcinoma of the prostate involving 20% of the sampled tissue for the left apex. He was subsequently treated with a transperitoneal robot-assisted laparoscopic radical prostatectomy and bilateral pelvic lymphadenectomy. Weck Hem-o-Lok clips were used to ligate the prostate vascular pedicles. The vesicourethral anastomosis was performed using a double armed running technique.
RESULTS: Final pathology demonstrated a Gleason 4 + 3 pT2cN0Mx adenocarcinoma of the prostate with negative margins. Four lymph nodes were negative for malignancy. No intraoperative complications occurred. Postoperatively, patient was found to have a Weck Hem-o-Lok clip that migrated into his rectum. This was found on colonoscopy performed for diverticular disease of the colon. The clip was removed without complication.
CONCLUSIONS: Judicious use of Weck clips during RALP and communication with physicians participating in patient care for those who have undergone RALP is crucial in minimizing complications and avoiding subsequent procedures.},
}
@article {pmid19966607,
year = {2009},
author = {Rink, AD and John-Enzenauer, K and Haaf, F and Straub, E and Nagelschmidt, M and Vestweber, KH},
title = {Laparoscopic-assisted or laparoscopic-facilitated sigmoidectomy for diverticular disease? A prospective randomized trial on postoperative pain and analgesic consumption.},
journal = {Diseases of the colon and rectum},
volume = {52},
number = {10},
pages = {1738-1745},
doi = {10.1007/DCR.0b013e3181b552cf},
pmid = {19966607},
issn = {1530-0358},
mesh = {Adult ; Aged ; Analgesics/*administration & dosage ; Colon, Sigmoid/diagnostic imaging/*surgery ; Diverticulitis, Colonic/diagnostic imaging/*surgery ; Fatigue/epidemiology ; Humans ; Laparoscopy/*methods ; Middle Aged ; Pain Measurement ; Pain, Postoperative/*drug therapy/epidemiology ; Prospective Studies ; Recovery of Function ; Respiratory Function Tests ; Statistics, Nonparametric ; Tomography, X-Ray Computed ; },
abstract = {PURPOSE: Laparoscopic-assisted sigmoidectomy is an attractive but sometimes challenging operative technique for the treatment of diverticulitis of the sigmoid colon. The aim of this study was to compare, with respect to early postoperative analgesic demand and postoperative pain, laparoscopic-assisted sigmoidectomy with a laparoscopic-facilitated technique. In the laparascopic-facilitated technique, the sigmoid colon is removed conventionally via a cosmetically inconspicuous incision after prior laparoscopic mobilization.
PATIENTS AND METHODS: Patients subjected to elective sigmoidectomy for diverticulitis were randomized to either laparoscopic-assisted or laparoscopic-facilitated sigmoidectomy. All patients had piritramide-based, patient-controlled analgesia. The cumulative postoperative consumption over 96 hours was defined as the primary end point. Postoperative pain, fatigue, pulmonary function, and resumption of bowel function were secondary endpoints.
RESULTS: : Forty-five patients were randomized according to the protocol to laparoscopic-assisted sigmoidectomy (n = 22) or laparoscopic-facilitated sigmoidectomy (n = 23). The analgesic consumption between the two groups was equivalent (61.3 (9-171) mg piritramide/96 hours vs. 64.3 (18-150) mg piritramide/96 hours; P = 0.827). Patients with laparoscopic-assisted sigmoidectomy had lower pain levels on Day one and Day two. Cumulative pain levels over 96 hours and over the whole 7-day observation period, however, were not significantly different, although postoperative fatigue and pulmonary function were significantly different. Duration of surgery was slightly shorter for laparoscopic-assisted sigmoidectomy (127 (47-200) vs. 135 (60-239) minutes; P = 0.28), but recovery of bowel activity was faster after laparoscopic-facilitated surgery. There was no significant difference in morbidity.
CONCLUSION: Overall, the postoperative outcome was roughly equivalent after both techniques of laparoscopic sigmoidectomy. Therefore, laparoscopic-facilitated sigmoidectomy could be considered as an alternative to laparoscopic-assisted sigmoidectomy in technically difficult cases of diverticulitis subjected to laparoscopic surgery.},
}
@article {pmid19942158,
year = {2009},
author = {Goldacre, MJ},
title = {Demography of aging and the epidemiology of gastrointestinal disorders in the elderly.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {23},
number = {6},
pages = {793-804},
doi = {10.1016/j.bpg.2009.10.008},
pmid = {19942158},
issn = {1532-1916},
mesh = {Age Distribution ; Age Factors ; Aged ; Aged, 80 and over ; *Aging ; Demography ; England/epidemiology ; Female ; Gastrointestinal Diseases/*epidemiology/physiopathology/therapy ; Global Health ; Hospitalization/statistics & numerical data ; Humans ; Incidence ; Life Expectancy ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Sex Factors ; Urbanization ; },
abstract = {Population aging is a global phenomenon. It is estimated that there were 600 million people in the world aged 60 and over in 2000 and that there will be 1.2 billion by 2025. People aged 65 and over comprise 16% of the population of Europe. About half of the world's elderly population live in the developing world. Many of the gastrointestinal disorders seen in specialist practise show age-specific incidence and prevalence rates that increase substantially with increasing age. In this review, hospitalization rates for gastroenterological disorders in England are presented by age to demonstrate gradients with age. Some of the disorders, such as colorectal cancer, appendicitis, diverticular disease and inflammatory bowel disease, became common in developed countries in association with economic development and changes in lifestyle. As the developing world becomes more urbanised and westernised, disorders that are now rare in the developing world will probably become much more common.},
}
@article {pmid19936848,
year = {2010},
author = {O'Connor, ES and Leverson, G and Kennedy, G and Heise, CP},
title = {The diagnosis of diverticulitis in outpatients: on what evidence?.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {14},
number = {2},
pages = {303-308},
pmid = {19936848},
issn = {1873-4626},
support = {UL1 RR025011/RR/NCRR NIH HHS/United States ; UL1 RR025011-01/RR/NCRR NIH HHS/United States ; T32HP10010//PHS HHS/United States ; },
mesh = {Diverticulitis, Colonic/*diagnosis/diagnostic imaging/surgery ; Female ; Humans ; Male ; Middle Aged ; Radiography ; },
abstract = {PURPOSE: Diverticular disease is common in the outpatient setting; yet, rigorous study of diagnosis and management strategies is currently limited to hospitalized patients. Here, we characterize the clinical assessment generating the diagnostic label of diverticulitis in outpatients.
METHODS: Encounters for diverticulitis were identified using ICD-9 diagnosis codes (562.11/562.13) from the electronic medical record system of a tertiary referral hospital and its regional clinics. The frequencies of various demographic and clinical variables were compared between patients presenting in the emergency room (ER) or outpatient Clinic.
RESULTS: Between 2003 and 2008, 820 inpatients and 2,576 outpatients met inclusion criteria (328 [13%] ER, 2,248 [87%] Clinic). Compared to ER patients, Clinic patients were less likely to undergo urgent abdominal/pelvic computed tomography (CT) scan (14% vs. 85%, p<.0001) or have an abnormal WBC count (35% vs. 69%, p<.0001). Twenty-four hour , including inpatient admission (30% ER vs. 3.5% Clinic, p<.0001) and colectomy (1.2% ER vs. 0.4% Clinic, p=0.08) were rare in both groups.
CONCLUSION: Diverticulitis in the outpatient setting is often characterized by infrequent use of CT scans, lack of leukocytosis, and rare need for urgent surgery or early admission. As this diagnostic label appears to be commonly applied without objective evidence, further study is needed to evaluate its validity.},
}
@article {pmid19929580,
year = {2009},
author = {Latella, G and Scarpignato, C},
title = {Rifaximin in the management of colonic diverticular disease.},
journal = {Expert review of gastroenterology & hepatology},
volume = {3},
number = {6},
pages = {585-598},
doi = {10.1586/egh.09.63},
pmid = {19929580},
issn = {1747-4132},
mesh = {Anti-Infective Agents/adverse effects/*therapeutic use ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/*drug therapy ; Diverticulosis, Colonic/*drug therapy ; Diverticulum, Colon/microbiology ; Dose-Response Relationship, Drug ; Humans ; Rifamycins/adverse effects/*therapeutic use ; Rifaximin ; Treatment Outcome ; },
abstract = {Rifaximin is a rifamycin derivative that acts by inhibiting bacterial RNA synthesis. Since it is virtually unabsorbed after oral administration, its bioavailability within the GI tract is high, with intraluminal and fecal drug concentrations largely exceeding the minimum inhibitory concentration values observed in vitro against a broad spectrum of bacteria, including Gram-positive and Gram-negative bacteria, both aerobes and anaerobes. The GI tract, therefore, represents the primary therapeutic target and the disorders in which intestinal bacteria have a pathogenic role represent the main indication. This is the case with colonic diverticular disease. As a consequence, the broad antibacterial activity of rifaximin appears to be of value in the treatment of this clinical condition. Clinical trials have provided evidence of the substantial benefit of rifaximin in diverticular disease. Indeed, available data show the efficacy of the drug in achieving symptomatic relief in patients with uncomplicated disease. A therapeutic gain of approximately 30%, compared with fiber supplementation only, can be expected after cyclic administration of rifaximin for 12 months. However, its value in the prevention of inflammatory complications of the disease needs to be further explored. Recent studies have shown some evidence of synergy between rifaximin and mesalazine and suggest that a combined treatment could be worthwhile in selected subsets of patients with diverticular disease.},
}
@article {pmid19918681,
year = {2009},
author = {Petroianu, A and Alberti, LR and de Lima, DC and Hauter, HL and Rodrigues, KC and Mendes, JC},
title = {[Colonoscopic findings in asymptomatic people].},
journal = {Arquivos de gastroenterologia},
volume = {46},
number = {3},
pages = {173-178},
doi = {10.1590/s0004-28032009000300006},
pmid = {19918681},
issn = {1678-4219},
mesh = {Adult ; Colonic Diseases/*diagnosis ; Colonic Polyps/*diagnosis ; Colonoscopy/*methods ; Colorectal Neoplasms/prevention & control ; Diverticulum, Colon/*diagnosis ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; },
abstract = {CONTEXT: Colorectal cancer is the second leading cause of cancer-related death. Prevention of colorectal cancer should be achievable by screening programs in asymptomatic patients.
OBJECTIVE: To assess the colonoscopic findings in asymptomatic people submitted to screening.
METHODS: A prospective study was undertaken on 153 consecutive asymptomatic people submitted to colonoscopy. Sex, age, previous diseases and familial cases of cancer, as well as tobacco and alcohol ingestion were assessed. Patients with rectal macro- or microscopic bleeding and colorectal diseases were excluded. Bowel preparation, polyps, angioectasias, diverticular disease, inflammation and neoplasm were also verified. Polyps were classified according to their size, number and location.
RESULTS: Mean age was 52.5 +/- 11.7 years. Family history for colorectal cancer occurred in 79.8% of individuals. Colonoscopic alterations were detected in 99 individuals: polyps in 64.3%, diverticular disease in 27.9%, inflammatory mucosal alterations in 9.7%, melanosi coli in 2.6% and angioectasias in 7.8%. There were an increasing incidence of polyps in patients older than 50 year. Multivariate logistic regression showed age and sex as predictive factors for polyps (OR = 1.43; 1.19
CONCLUSION: There is a significant incidence of colonoscopic alterations in asymptomatic people submitted to colonoscopy for colorectal cancer screening.},
}
@article {pmid19906060,
year = {2011},
author = {Fong, SS and Tan, EY and Foo, A and Sim, R and Cheong, DM},
title = {The changing trend of diverticular disease in a developing nation.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {13},
number = {3},
pages = {312-316},
doi = {10.1111/j.1463-1318.2009.02121.x},
pmid = {19906060},
issn = {1463-1318},
mesh = {Age Factors ; Analysis of Variance ; Asian People/*statistics & numerical data ; Barium Sulfate ; Cecum/*pathology ; Chi-Square Distribution ; Colon/*pathology ; Developing Countries/*statistics & numerical data ; Diverticulosis, Colonic/*epidemiology ; Diverticulum, Colon/diagnosis/*epidemiology/pathology ; Enema ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Prevalence ; Singapore/epidemiology ; },
abstract = {AIM: Left-sided diverticular disease (LDD) is associated with reduced dietary intake, whereas right-sided diverticular disease (RDD) is more common amongst Oriental populations. We aimed to determine whether the prevalence, site and distribution of diverticular disease in our Oriental population has changed over the past two decades.
METHOD: A total of 1663 barium enema studies performed between January 2001 and August 2002 were reviewed retrospectively. The site of disease was correlated with age, gender and ethnicity of the patient.
RESULTS: Forty-five per cent of patients in the study population had diverticular disease. Older patients were more likely to have LDD, whereas the Chinese ethnic group was more likely to have RDD. Right-sided diverticular disease peaks at in the sixth decade, while for LDD this occurred in the seventh and eighth decades. Right-sided diverticular disease was more common in all age groups overall. When compared with two barium enema studies carried out in Singapore two decades earlier, there was a statistically significant increase in the incidence of RDD and LDD.
CONCLUSION: There is a positive association of RDD and LDD with Chinese race and increasing age. There is an increasing incidence of both LDD and RDD compared with two decades previously.},
}
@article {pmid19906056,
year = {2010},
author = {Kalaitzis, J and Basioukas, P and Lampropoulos, P and Koilakos, K and Rizos, S},
title = {A complicated colo-ovarian cyst fistula as a result of diverticular disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {12},
number = {10 Online},
pages = {e334},
doi = {10.1111/j.1463-1318.2009.02125.x},
pmid = {19906056},
issn = {1463-1318},
mesh = {Aged, 80 and over ; Colonic Diseases/*etiology/surgery ; Diverticulitis, Colonic/*complications ; Female ; Fistula/*etiology/surgery ; Humans ; Intestinal Fistula/*etiology/surgery ; Ovarian Cysts/diagnostic imaging/*etiology/surgery ; Ultrasonography ; Urinary Tract Infections/etiology ; },
}
@article {pmid19888953,
year = {2011},
author = {Dalton, SJ and Ghosh, A and Greenslade, GL and Dixon, AR},
title = {Laparoscopic colorectal surgery - why would you not want to have it and, more importantly, not be trained in it? A consecutive series of 500 elective resections with anastomoses.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {13},
number = {2},
pages = {144-149},
doi = {10.1111/j.1463-1318.2009.02101.x},
pmid = {19888953},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colorectal Neoplasms/*surgery ; Elective Surgical Procedures ; Female ; Humans ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Treatment Outcome ; },
abstract = {AIM: We analysed the outcome of a consecutive series of 500 unselected patients who underwent elective laparoscopic colorectal resection with anastomosis (ELCRA) under the care of a single surgeon.
METHOD: A prospectively collected electronic database of all laparoscopic procedures conducted from April 2001 to September 2008 was analysed.
RESULTS: A total of 500 ELCRAs were performed [230 male and 270 female patients; mean age 65.6 years (range 19-93 years; American Society of Anesthesiologists grade I (103), II (246), III (145) and IV (6)]. Of these, 217 patients underwent high anterior resection. A total of 131 total mesorectal excisions (55 covering ileostomies), 152 right/extended right resections and 240 operations were performed by trainees under supervision. The indications for surgery included cancer (340), diverticular disease (96), Crohn's disease (40) and polyps (24). Mean operating time was 115 min (range 35-550 min). There were eight (1.6%) conversions. The mean length of hospital stay was 5.2 days (median 4 days). A total of 93 (18.6%) patients had an inpatient complication, including ileus (22), wound infection (14), anastomotic leakage (12), enterotomy (2), 'off-screen' enterotomy (2), abscess (3), ureteric injury (1), cardiac arrhythmia (12), myocardial infarction (5), pulmonary embolus (4), pneumonia (1), Clostridium difficile (3) and retention of urine (9). There were 20 (4%) readmissions for complications, including ileus (4), urinary retention (3), abscess formation (2) and leakage (2). The 30-day mortality was nine of 500 (1.8%) following anastomotic leakage (3), duodenal enterotomy (1), bleeding duodenal ulcer (1), C. difficile infection (1) and cardiac complications (3).
CONCLUSION: This unselected cohort of patients (the largest single surgeon series in the UK) demonstrates that in trained hands low conversion and complication rates can be consistently achieved.},
}
@article {pmid19886149,
year = {2009},
author = {Etzioni, DA and Cannom, RR and Ault, GT and Beart, RW and Kaiser, AM},
title = {Diverticulitis in California from 1995 to 2006: increased rates of treatment for younger patients.},
journal = {The American surgeon},
volume = {75},
number = {10},
pages = {981-985},
pmid = {19886149},
issn = {0003-1348},
mesh = {Adult ; Age Distribution ; Aged ; California/epidemiology ; Colectomy/*statistics & numerical data ; Colostomy/*statistics & numerical data ; Diverticulitis, Colonic/epidemiology/*therapy ; Elective Surgical Procedures/*statistics & numerical data ; Female ; Hospitalization/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Registries ; Retrospective Studies ; Young Adult ; },
abstract = {Colonic diverticular disease is responsible for over 300,000 admissions and expenditures exceeding $2.7 billion/year. There is recent evidence that rates of treatment for diverticulitis have increased in the United States over the last decade. We hypothesize that these national trends of increasing rates of hospitalizations for diverticulitis would be found in an analysis of a single-state discharge database. Data from the Office of Statewide Health Planning and Development were used to analyze treatment for diverticulitis in California from 1995 to 2006. For each hospitalization, surgical care was determined based on procedure codes for left colon resection and/or colostomy. Overall numbers of admissions for acute diverticulitis increased throughout the 12-year study period with an estimated annual percentage of change (EAPC) of 2.1 per cent (P < 0.001). Rates of admissions increased most rapidly in patients 20 to 34-years-old (EAPC = 8.6%, P < 0.001) and 35 to 49 years old (EAPC = 5.7%, P < 0.001). Elective colectomies had an EAPC of 2.1 per cent (P < 0.001), which was also most dramatic in younger age groups. Between 1995 and 2006 we found significant increases in both the rates of hospitalization for diverticulitis and rates of elective surgical treatment in California. These increases are entirely due to higher rates of care for younger patients.},
}
@article {pmid19881343,
year = {2010},
author = {Koo, HL and DuPont, HL},
title = {Rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases.},
journal = {Current opinion in gastroenterology},
volume = {26},
number = {1},
pages = {17-25},
pmid = {19881343},
issn = {1531-7056},
support = {K23 DK084513/DK/NIDDK NIH HHS/United States ; 1K23DK084513-01/DK/NIDDK NIH HHS/United States ; },
mesh = {Anti-Infective Agents/*administration & dosage/pharmacology ; Bacterial Infections/diagnosis/*drug therapy ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Dysentery/*drug therapy/microbiology/prevention & control ; Female ; Follow-Up Studies ; Gastroenteritis/*drug therapy/microbiology ; Humans ; Male ; Randomized Controlled Trials as Topic ; Rifamycins/pharmacology/*therapeutic use ; Rifaximin ; Risk Assessment ; *Travel ; Treatment Outcome ; },
abstract = {PURPOSE OF REVIEW: Rifaximin is gaining attention for its potential activity in a multitude of gastrointestinal diseases. We review the unique pharmaceutical properties of this antibiotic and the published evidence in the literature regarding the use of rifaximin for different gastrointestinal disorders.
RECENT FINDINGS: Rifaximin is a gastrointestinal-selective antibiotic with a broad spectrum of antimicrobial activity, an excellent safety profile, minimal drug interactions, and negligible impact on the intestinal microbiome. Rifaximin is currently approved in the United States for the treatment of travelers' diarrhea caused by noninvasive diarrheagenic Escherichia coli and is approved in more than 30 other countries for a variety of gastrointestinal disorders. Considerable research with this medication has been conducted for the treatment and prevention of travelers' diarrhea, the treatment of portal systemic encephalopathy, Clostridium difficile infection, small bowel intestinal overgrowth, irritable bowel syndrome, inflammatory bowel disease, pouchitis, and colonic diverticular disease.
SUMMARY: Rifaximin is effective for the treatment of travelers' diarrhea and can be considered as the treatment of choice for uncomplicated travelers' diarrhea. When invasive travelers' diarrhea pathogens are suspected, an alternative antibiotic should be administered. Rifaximin appears promising as a chemoprophylaxis for travelers' diarrhea and as a treatment of portal systemic encephalopathy. This antibiotic may be effective for other gastrointestinal diseases, but more well designed clinical studies are needed to confirm its efficacy for these off-label indications. Future studies will determine whether the development of significant bacterial resistance will limit rifaximin use.},
}
@article {pmid19875109,
year = {2009},
author = {Murillo Zolezzi, A and Murakami Morishige, PD and Toledo Valdovinos, SA and Maydon González, H and Belmonte Montes, C},
title = {[Hand assistance is an alternative to conversion to laparotomy during laparoscopic sigmoidectomy].},
journal = {Cirugia espanola},
volume = {86},
number = {6},
pages = {346-350},
doi = {10.1016/j.ciresp.2009.08.006},
pmid = {19875109},
issn = {0009-739X},
mesh = {Cohort Studies ; Colon, Sigmoid/*surgery ; Digestive System Surgical Procedures/methods ; Female ; Humans ; *Laparoscopy ; *Laparotomy ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {INTRODUCTION: Laparoscopic surgery in the treatment of diverticular disease offers multiple benefits compared with its open surgery counterpart. There are two distinct techniques, the laparoscopically assisted and the laparoscopic hand assisted approach. The purpose of this study is to demonstrate that the hand assisted approach can be used if, during a laparoscopically assisted approach, there is difficulty in dissection and/or exposure, and before performing a laparotomy.
MATERIAL AND METHODS: This study is a retrospective cohort series that was performed in a private tertiary hospital in Mexico City. Patients with the diagnosis of diverticular disease who underwent a laparoscopically assisted sigmoidectomy were selected. These included patients who, during their procedure required conversion to a hand assisted approach.
RESULTS: A total of 47 sigmoid colectomies began with assisted laparoscopy, of which 33 were completed, 4 required laparotomy, and 10 where completed using hand assistance (none required laparotomy). There were no statistically significant differences in return of bowel function (P=0.879) and postoperative hospital stay (P=0.679) between the group that was completed by assisted laparoscopy vs. hand assisted.
CONCLUSIONS: If there is difficulty in exposure or dissection during a laparoscopically assisted sigmoid colectomy, the hand assisted approach is an alternative before the laparotomy.},
}
@article {pmid19861955,
year = {2010},
author = {Jung, HK and Choung, RS and Locke, GR and Schleck, CD and Zinsmeister, AR and Talley, NJ},
title = {Diarrhea-predominant irritable bowel syndrome is associated with diverticular disease: a population-based study.},
journal = {The American journal of gastroenterology},
volume = {105},
number = {3},
pages = {652-661},
pmid = {19861955},
issn = {1572-0241},
support = {R01 AR030582/AR/NIAMS NIH HHS/United States ; R01 AR030582-44/AR/NIAMS NIH HHS/United States ; R01-AR30582/AR/NIAMS NIH HHS/United States ; },
mesh = {Adult ; Aged ; Aged, 80 and over ; Barium Sulfate ; Chi-Square Distribution ; Colonography, Computed Tomographic ; Colonoscopy ; Contrast Media ; Cross-Sectional Studies ; Diarrhea/diagnosis/*epidemiology ; Diverticulosis, Colonic/diagnosis/*epidemiology ; Female ; Humans ; Irritable Bowel Syndrome/diagnosis/*epidemiology ; Logistic Models ; Male ; Middle Aged ; Minnesota/epidemiology ; Risk Factors ; Surveys and Questionnaires ; },
abstract = {OBJECTIVES: A subset of patients with colonic diverticular disease have chronic gastrointestinal symptoms, and some have a clinical diagnosis of irritable bowel syndrome (IBS), but whether IBS and diverticular disease are linked is uncertain. We aimed to evaluate this association in the community.
METHODS: A population-based, cross-sectional survey was conducted by mailing a valid symptom questionnaire to the eligible residents of Olmsted County, MN, aged 30-95 years. Colonic diverticular disease (diverticulosis and diverticulitis) was ascertained through a review of the complete medical history of all responders. Subjects with at least one relevant test (colonoscopy, computed tomography (CT) scan, CT colonography, or barium enema) were included. IBS was defined using Rome II criteria.
RESULTS: Among 2,267 eligible respondents, there were 1,712 subjects who had undergone colon testing (76%): 919 women (54%); mean (+/-s.d.) age 65 (+/-11 years). Colonic diverticular disease was identified in 44.4% (95% confidence interval (CI) 42.1-46.8) of the subject. IBS was reported by 8.8% (95% CI 6.9-11.0) of men and 17.0% (95% CI 14.6-19.6) of women. After adjusting for age and gender, the presence of IBS was associated with an increased odds for diverticulosis (odds ratio (OR) =1.8, 95% CI 1.3-2.4) but not diverticulitis (OR=1.7, 95% CI 0.9-3.2). In those 65 years of age or older, the presence of IBS was associated with a ninefold higher odds for diverticulosis (OR=9.4, 95% CI 5.8-15.1). Relative to the non-IBS subgroup, diarrhea-predominant IBS and mixed IBS were significantly associated with an increased odds for diverticular disease (OR=1.9, 95% CI 1.1-3.2; OR=2.6, 95% CI 1.0-6.4, respectively).
CONCLUSIONS: There is a significantly increased odds for colonic diverticulosis in subjects with IBS (relative to those without IBS). These results suggest that IBS and colonic diverticular disease may be connected.},
}
@article {pmid19857313,
year = {2009},
author = {Draaisma, WA and van de Wall, BJ and Vermeulen, J and Unlu, C and de Korte, N and Swank, HA},
title = {[Treatment for diverticulitis not thoroughly researched].},
journal = {Nederlands tijdschrift voor geneeskunde},
volume = {153},
number = {},
pages = {A648},
pmid = {19857313},
issn = {1876-8784},
mesh = {Age Factors ; Anastomosis, Surgical ; Anti-Bacterial Agents/*therapeutic use ; Colectomy ; Digestive System Surgical Procedures/*methods ; Diverticulitis/complications/*drug therapy/*surgery ; *Evidence-Based Medicine ; Humans ; Peritonitis/surgery ; Randomized Controlled Trials as Topic ; Therapeutic Irrigation ; Treatment Outcome ; },
abstract = {In the Netherlands approximately 14,000 patients are referred to hospital for diverticular disease each year. Overall controversy persists about four aspects of treatment of the different stages of diverticulitis, i.e. the role of antibiotics in the treatment of mild diverticulitis, the question of whether elective surgical resection is justified in recurrent diverticulitis or in persisting abdominal symptoms after an episode of diverticulitis, the question of whether patients with purulent peritonitis due to perforation may be treated with laparoscopic peritoneal lavage instead of Hartmann's procedure, and finally, whether resection with a primary anastomosis is a feasible and safe alternative to Hartmann's procedure in the surgical treatment of Hinchey III or IV diverticulitis. These questions will be addressed in four upcoming Dutch randomised trials.},
}
@article {pmid19845268,
year = {2009},
author = {Lippi, CE and Beatini, L and Cervia, S and Fabbricotti, A and Miaruelli, PA and Spessa, E and Sturlese, I and Braini, A},
title = {[Laparoscopic lavage and drainage in the surgical treatment of diverticular disease complicated by peritonitis].},
journal = {Chirurgia italiana},
volume = {61},
number = {4},
pages = {467-474},
pmid = {19845268},
issn = {0009-4773},
mesh = {Aged ; Aged, 80 and over ; Diverticulosis, Colonic/*complications/*surgery ; Drainage/*methods ; Humans ; *Laparoscopy ; Peritonitis/*etiology ; Therapeutic Irrigation/*methods ; },
abstract = {The treatment of peritonitis complicating diverticular disease of the colon is yet to be universally regarded as established practice and major differences in management are to be noted in the various surgical institutions. In the emergency setting, the minimally invasive approach is used by few surgeons and the most frequent therapeutic options are sigmoid resection with primary anastomosis (with or without a diverting stoma) and Hartmann's procedure. The Authors report their preliminary experience (13 cases) with laparoscopic lavage and drainage without colonic resection in diverticulitis complicated by peritonitis and describe the technical details of the surgical procedure. They conduct a systematic review of the literature and, on the basis of their latest experience, compare the results of the traditional resective operations (resection with primary anastomosis and Hartmann's procedure) with those of laparoscopic conservative and non-resective treatment. Laparoscopic non-resective procedures reduce the frequency and severity of the surgical complications, as well as the hospital stay and costs of treatment. In conclusion, laparoscopic lavage and drainage can be used in the majority of patients, with excellent prospects of recovery, without disabling stomas, in a single operative stage.},
}
@article {pmid19830136,
year = {2009},
author = {Collin, JE and Atwal, GS and Dunn, WK and Acheson, AG},
title = {Laparoscopic-assisted resection of a giant colonic diverticulum: a case report.},
journal = {Journal of medical case reports},
volume = {3},
number = {},
pages = {7075},
pmid = {19830136},
issn = {1752-1947},
abstract = {INTRODUCTION: Diverticular disease of the colon is a common benign condition. The majority of patients with diverticular disease are asymptomatic and are managed non-operatively, however complications such as perforation, bleeding, fistulation and stricture formation can necessitate surgical intervention. A giant colonic diverticulum is defined as a diverticulum larger than 4 cm in diameter. Despite the increasing incidence of colonic diverticular disease, giant colonic diverticula remain a rare clinical entity.
CASE PRESENTATION: This is the first reported case of laparoscopic-assisted resection of a giant colonic diverticulum. We discuss the symptoms and signs of this rare complication of diverticular disease and suggest investigations and management. Reflecting on this case and those reported in the literature to date, we highlight potential diagnostic difficulties and consider the differential diagnosis of intra-abdominal gas-filled cysts.
CONCLUSION: The presence of a giant colonic diverticulum carries substantial risk of complications. Diagnosis is based on history and examination supported by abdominal X-ray and computed tomography findings. In view of the chronic course of symptoms and potential for complications, elective surgical removal is recommended. Colonic resection is the treatment of choice for this condition and, where possible, should be performed laparoscopically.},
}
@article {pmid19829828,
year = {2009},
author = {Zagler, B and Kaneppele, A and Pattis, P and Stockner, I and Sitzmann, G and Widmann, J and Pernthaler, H and Wiedermann, CJ},
title = {Patient risk factors and adverse drug interactions in the treatment of acute gouty arthritis in the elderly: a case report.},
journal = {Cases journal},
volume = {2},
number = {},
pages = {6602},
pmid = {19829828},
issn = {1757-1626},
abstract = {INTRODUCTION: Non-steroidal anti-inflammatory drugs and corticosteroids are both used in the treatment acute gouty arthritis and may adversely interact with colchicine. Gastrointestinal toxicity of colchicine is dose-dependent and can be aggravated by drug-drug and drug-patient interactions.
CASE PRESENTATION: Colonic perforation associated with second-line administration of colchicine for acute gouty arthrtitis was identified in an elderly man with several comorbidities who was also treated with non-steroidal anti-inflammatory drugs and corticostroids. Underlying diverticular disease was discovered at the time of surgical therapy.
CONCLUSIONS: Initial treatment of acute gouty arthritis with non-steroidal anti-inflammatory drugs or corticosteroids may increase colchicine toxicity by subsequent pharmacokinetic and pharmacodynamic interaction in the gut wall. The literature is reviewed suggesting that diverticular disease should be included in the list of adverse event risk factors when colchicine is being considered.},
}
@article {pmid19828387,
year = {2010},
author = {Tursi, A},
title = {Colonic microflora imbalance and diverticular disease.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {42},
number = {6},
pages = {458},
doi = {10.1016/j.dld.2009.09.003},
pmid = {19828387},
issn = {1878-3562},
mesh = {Bacteria/*growth & development/isolation & purification ; Colon/*microbiology ; Diverticulum, Colon/*etiology/microbiology ; Humans ; Risk Factors ; },
}
@article {pmid21160644,
year = {2009},
author = {Hokama, A and Kishimoto, K and Kinjo, F and Fujita, J},
title = {Endoscopic clipping in the lower gastrointestinal tract.},
journal = {World journal of gastrointestinal endoscopy},
volume = {1},
number = {1},
pages = {7-11},
pmid = {21160644},
issn = {1948-5190},
abstract = {Endoscopic clipping has been established as a safe and effective method for the treatment of nonvariceal upper gastrointestinal bleeding in numerous randomized studies. Recently, clipping has been applied to various lesions in the lower gastrointestinal tract, including diverticular bleeding, postpolypectomy bleeding, and repair of perforations with successful outcomes. We review the safety and efficacy of this maneuver for the management of diseases in the lower gastrointestinal tract.},
}
@article {pmid19783250,
year = {2009},
author = {Foppa, B and Portier, G},
title = {[Purulent peritonitis caused by diverticular disease: treatment by laparocopic peritoneal lavage and drainage (without resection of the colon)].},
journal = {Journal de chirurgie},
volume = {146},
number = {4},
pages = {403-406},
doi = {10.1016/j.jchir.2009.08.028},
pmid = {19783250},
issn = {0021-7697},
mesh = {Diverticulitis/*complications ; *Drainage ; Humans ; *Laparoscopy ; Patient Selection ; *Peritoneal Lavage ; Peritonitis/diagnostic imaging/*etiology/*surgery ; Sigmoid Diseases/*complications ; Supine Position ; Suppuration ; Tomography, X-Ray Computed ; },
}
@article {pmid19760302,
year = {2009},
author = {Csikesz, NG and Singla, A and Simons, JP and Tseng, JF and Shah, SA},
title = {The impact of socioeconomic status on presentation and treatment of diverticular disease.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {13},
number = {11},
pages = {1993-2001; discussion 2001-2},
pmid = {19760302},
issn = {1873-4626},
mesh = {Aged ; Aged, 80 and over ; Comorbidity ; Diverticulitis/diagnosis/*epidemiology ; Female ; Health Services Accessibility ; Humans ; Logistic Models ; Male ; Retrospective Studies ; *Social Class ; Socioeconomic Factors ; },
abstract = {INTRODUCTION: Diverticular disease is a common medical problem, but it is unknown if lower socioeconomic status (SES) affects patient outcomes in diverticular disease.
MATERIAL AND METHODS: The New York (NY) State Inpatient Database was used to query 8,117 cases of diverticular disease occurring in patients aged 65-85 in 2006. Race and SES were assessed by creating a composite score based on race, primary insurance payer, and median income bracket.
RESULTS: Primary outcomes were differences in disease presentation, use of elective surgery, complication rates when surgery was performed, and overall mortality and length of stay. Patients of lower SES were younger, more likely to be female, to have multiple co-morbid conditions, to present as emergent/urgent admissions, and to present with diverticulitis complicated by hemorrhage (p < 0.0001).
DISCUSSION: Overall, patients of low SES were less likely to receive surgical intervention, while rates of surgery were similar in elective cases. When surgery was performed, patients of lower SES had similar complication rates (25.4% vs. 20.2%, p = 0.06) and higher overall mortality (9.0% vs. 4.4%, p = 0.003).
CONCLUSION: Patients of low SES who are admitted with diverticular disease have an increased likelihood to present emergently, have worse disease on admission, and are less likely to receive surgery.},
}
@article {pmid19735614,
year = {2009},
author = {Di Stefano, G and Zanghì, GN and Biondi, A and Benfatto, G and Basile, F},
title = {[Surgical treatment of acute complicated diverticulitis].},
journal = {Il Giornale di chirurgia},
volume = {30},
number = {8-9},
pages = {355-358},
pmid = {19735614},
issn = {0391-9005},
mesh = {Abdominal Abscess/microbiology/surgery ; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/methods ; Diverticulitis, Colonic/*complications/epidemiology/mortality/*surgery ; Feasibility Studies ; Female ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; Incidence ; Intestinal Perforation/etiology/surgery ; Male ; Middle Aged ; Retrospective Studies ; Rupture, Spontaneous ; Sicily/epidemiology ; Survival Rate ; },
abstract = {Diverticular disease is a common condition in the western countries. Possible complications of acute diverticulitis include perforation, obstruction, fistula, bleeding: all these conditions generally require surgical treatment. Data were collected from 35 patients who underwent an emergency operation for diverticulitis associated with abscess, free perforation or obstruction. Of the 35 patients, 20 underwent primary colonic resection and anastomosis, whereas 15 underwent Hartmann's procedure. We have obtained good results, with a mortality rate of 5.7% and a morbidity rate of 17.1%. We then evaluate feasibility and safety of both surgical techniques, on the basis of our experience and by a review of the literature.},
}
@article {pmid19725287,
year = {2009},
author = {Howard, DD and White, CQ and Harden, TR and Ellis, CN},
title = {Incidence of surgical site infections postcolorectal resections without preoperative mechanical or antibiotic bowel preparation.},
journal = {The American surgeon},
volume = {75},
number = {8},
pages = {659-63; discussion 663-4},
pmid = {19725287},
issn = {0003-1348},
mesh = {Adult ; Aged ; Aged, 80 and over ; Antibiotic Prophylaxis ; Cohort Studies ; Colectomy/*adverse effects ; Female ; Humans ; Incidence ; Intestinal Diseases/complications/pathology/*surgery ; Length of Stay ; Male ; Middle Aged ; Preoperative Care ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection/*epidemiology ; Young Adult ; },
abstract = {This study was performed to determine the incidence of surgical site infections (SSIs) after colorectal resection in patients without mechanical or antibiotic bowel preparation. A retrospective review of the medical records of 136 consecutive patients undergoing an elective colorectal resection between April 2004 and April 2006 was performed. Indications for colon resection in this series were malignant neoplasia (48%), inflammatory bowel disease (18%), diverticular disease (17%), or other benign disease (17%). Overall, an SSI occurred in 31 patients (23%). An SSI occurred in 16 of 90 patients (17.8%) who received antibiotics within 1 hour before surgery and in 15 of 46 patients (33.3%) who did not receive antibiotics in a timely manner (P < 0.05). An SSI occurred in seven of 15 patients (46.7%) who received bowel preparation but in only 24 of 121 patients (19.8%) who did not receive either mechanical or antibiotic bowel preparation (P < 0.029). SSIs were not associated with age, gender, diagnosis, length of procedure, preoperative steroid use, diabetes mellitus, or previous celiotomy. This series shows administration of perioperative antibiotics within 1 hour before surgery is associated with a significant decrease in the incidence of SSI and bowel preparation can be safely omitted.},
}
@article {pmid19715018,
year = {2009},
author = {Gervaz, P and Charbonnet, P and Morel, P},
title = {[Management of sigmoid diverticulitis].},
journal = {Revue medicale suisse},
volume = {5},
number = {209},
pages = {1416-1420},
pmid = {19715018},
issn = {1660-9379},
mesh = {Anti-Bacterial Agents/therapeutic use ; Diverticulitis, Colonic/diagnosis/*therapy ; Drainage ; Humans ; Severity of Illness Index ; Sigmoid Diseases/diagnosis/*therapy ; },
abstract = {While a majority of patients with diverticular disease remain asymptomatic, a subset will develop complications such as diverticulitis or bleeding. Simple diverticulitis is successfully managed with oral or intravenous antibiotics. Complicated diverticulitis is defined by the presence of abscess, fistula, stenosis or peritonitis. The severity of infectious complications is assessed by the Hinchey classification. Hinchey I stage is a small (<4 cm) pericolic abscess and is treated with intravenous antibiotics. Hinchey II stage is a larger (<4 cm) pelvic abscess, which usually requires percutaneous CT scan-guided drainage in addition to antibiotics. Hinchey III stage refers to purulent peritonitis and Hinchey IV to fecal peritonitis. Both stages require an emergent laparotomy. Indications for an elective sigmoidectomy are: a) two or more previous episodes of simple diverticulitis; and b) one episode of complicated diverticulitis.},
}
@article {pmid19711089,
year = {2009},
author = {Santin, BJ and Prasad, V and Caniano, DA},
title = {Colonic diverticulitis in adolescents: an index case and associated syndromes.},
journal = {Pediatric surgery international},
volume = {25},
number = {10},
pages = {901-905},
pmid = {19711089},
issn = {1437-9813},
mesh = {Adolescent ; Diverticulitis, Colonic/diagnosis/*genetics ; Humans ; Male ; Sigmoid Diseases/diagnosis/*genetics ; Williams Syndrome/complications/diagnosis/*genetics ; },
abstract = {Diverticular disease of the colon, a common problem among adults, is diagnosed rarely in children. We report an adolescent patient with sigmoid diverticulitis who required operative treatment. Pediatric patients with the complications of diverticula typically have conditions that result in genetic alterations affecting the components of the colonic wall. Our patient had Williams-Beuren syndrome, although Ehlers-Danlos syndrome, Marfan syndrome, and cystic fibrosis may also be associated with colonic diverticula in adolescence. Pediatric patients with these disorders who experience abdominal pain should be evaluated for the presence of colonic diverticular complications.},
}
@article {pmid19707821,
year = {2010},
author = {Schlachta, CM and Lefebvre, KL and Sorsdahl, AK and Jayaraman, S},
title = {Mentoring and telementoring leads to effective incorporation of laparoscopic colon surgery.},
journal = {Surgical endoscopy},
volume = {24},
number = {4},
pages = {841-844},
pmid = {19707821},
issn = {1432-2218},
mesh = {Aged ; Colectomy/*education/methods ; Colonic Diseases/*surgery ; Female ; Hospitals, Community/organization & administration ; Humans ; Laparoscopy/*standards ; Male ; *Mentors ; Middle Aged ; Postoperative Complications/epidemiology ; Telemedicine/*organization & administration ; Treatment Outcome ; },
abstract = {BACKGROUND: A community surgery group was reviewed for 1 year after completion of a laparoscopic colon surgery mentoring program.
METHODS: A formal mentoring protocol had been established between a university center and two surgeons at a community hospital. Over 18 months, concluding August 2007, surgeons were mentored and telementored through 20 laparoscopic colon resections in their local setting. Surgeons tracked their cases for a further 12 months after the mentoring.
RESULTS: From September 2007 to August 2008, 30 colon resections were performed. Three of these resections (1 laparoscopic sigmoid colectomy for fistula and 2 laparoscopic subtotal colectomies) were mentored and telementored as advanced procedures. Of the remaining 27 resections, 15 (56%) were laparoscopic procedures including 9 right and 5 sigmoid colectomies as well as 1 subtotal colectomy. The 15 laparascopic colon resections were performed for cancer (n = 6), polyps (n = 5), diverticular disease (n = 2), Crohn's disease (n = 1), and colonic inertia (n = 1). Five cases were converted to open surgery (33%) due to adhesions (n = 3), unclear anatomy (n = 1), and equipment failure (n = 1). The mean number of lymph nodes in the cancer cases was 15.3 + or - 3.8. Minor postoperative complications occurred in seven cases (47%), three of which involved conversions. These complications included ileus (n = 4), wound abscess (n = 2), cardiac arrhythmia (n = 1), anastomotic bleed (n = 1), and abscess (n = 1). The patients selected for open surgery consisted of seven right and three sigmoid colectomies as well as a splenic flexure resection and a dual resection. The rationale for these open surgeries were transverse colon cancer (n = 4), medical comorbidity (n = 3), colovesicle fistulas (n = 2), rectal lesion (n = 2), and carcinoid tumor (n = 1). The laparoscopic patients were younger (58.2 + or - 13.2 vs 73.8 + or - 10.6 years; P = 0.003), had longer operating times (124 + or - 28 vs 94 + or - 38 min; P = 0.026), and a shorter median hospital stay (3 vs 7 days; P = 0.006). The laparoscopic operating time improved over the mentoring experience (124 + or - 28 vs 150 + or - 43 min; P = 0.046).
CONCLUSION: The 1-year follow-up evaluation after a longitudinal mentoring program demonstrates excellent incorporation of laparoscopic colon surgery into a community practice with appropriate case selection, quality cancer surgery, and a moderate conversion rate.},
}
@article {pmid19699411,
year = {2009},
author = {Touzios, JG and Dozois, EJ},
title = {Diverticulosis and acute diverticulitis.},
journal = {Gastroenterology clinics of North America},
volume = {38},
number = {3},
pages = {513-525},
doi = {10.1016/j.gtc.2009.06.004},
pmid = {19699411},
issn = {1558-1942},
mesh = {Acute Disease ; Aging/physiology ; Anti-Bacterial Agents/therapeutic use ; Colon, Sigmoid/surgery ; Diagnostic Imaging ; Diverticulitis/diagnosis/etiology/physiopathology/*therapy ; Diverticulosis, Colonic/diagnosis/etiology/physiopathology/*therapy ; Drainage ; Enema ; Humans ; Laparoscopy ; },
abstract = {Colonic diverticulosis is a common, usually asymptomatic, entity of Western countries, with an incidence that increases with age. When these diverticula become infected and inflamed, patients can present with a wide variety of clinical manifestations. Management of acute, uncomplicated diverticulitis can often be treated successfully with antibiotics alone and the decision to proceed with more aggressive measures such as surgical intervention is made on a case-by-case basis. The treatment algorithm for diverticular disease continues to evolve as the pathophysiology, etiology, and natural history of the disease becomes better understood.},
}
@article {pmid19690482,
year = {2009},
author = {Ricciardi, R and Baxter, NN and Read, TE and Marcello, PW and Hall, J and Roberts, PL},
title = {Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis?.},
journal = {Diseases of the colon and rectum},
volume = {52},
number = {9},
pages = {1558-1563},
doi = {10.1007/DCR.0b013e3181a90a5b},
pmid = {19690482},
issn = {1530-0358},
mesh = {Abdominal Abscess/*epidemiology/surgery ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Colectomy/*statistics & numerical data ; Databases, Factual ; Diverticulitis, Colonic/*complications/*surgery ; Female ; Hospitalization/statistics & numerical data ; Humans ; Intestinal Perforation/*epidemiology/surgery ; Male ; Middle Aged ; Practice Patterns, Physicians'/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; United States/epidemiology ; },
abstract = {PURPOSE: Indications for operative intervention in the treatment of diverticulitis have become unclear. We hypothesized that surgical treatment for diverticulitis has decreased resulting in proportionately more complicated diverticulitis cases (free perforation and/or abscess).
METHODS: We conducted a retrospective analysis of patients with diverticular disease in the Nationwide Inpatient Sample from 1991 through 2005. We used diagnostic codes to identify all patient discharges with diverticular disease and then determined the proportion of discharges with diverticulitis, perforated disease, diverticular abscess, and surgical treatment.
RESULTS: During the study period, 685,390 diverticulitis discharges were recorded. The ratio of diverticulitis discharges increased from 5.1 cases per 1,000 inpatients in 1991 to 7.6 cases per 1,000 inpatients in 2005 (P < 0.0001). The proportion of patients who underwent colectomy for uncomplicated diverticulitis declined from 17.9% in 1991 to 13.7% in 2005 (P < 0.0.0001). During the same period, the proportion of free diverticular perforations as a fraction of all diverticulitis cases remained unchanged (1.5%). The proportion of diverticular abscess discharges as a fraction of all diverticulitis cases increased from 5.9% in 1991 to 9.6% in 2005 (P < 0.0001). Last, we noted a decrease in diverticular perforations and/or abscess treated with colectomy, 71.0% in 1991 to 55.5% in 2005 (P < 0.0001).
CONCLUSIONS: Despite a significant decline in surgical treatment for diverticulitis, there has been no change in the proportion of patients discharged for free diverticular perforation. There was an increase in diverticular abscess discharges, but this finding was not associated with an increase in same stay surgical treatment.},
}
@article {pmid19681811,
year = {2009},
author = {Jeyarajah, S and Faiz, O and Bottle, A and Aylin, P and Bjarnason, I and Tekkis, PP and Papagrigoriadis, S},
title = {Diverticular disease hospital admissions are increasing, with poor outcomes in the elderly and emergency admissions.},
journal = {Alimentary pharmacology & therapeutics},
volume = {30},
number = {11-12},
pages = {1171-1182},
doi = {10.1111/j.1365-2036.2009.04098.x},
pmid = {19681811},
issn = {1365-2036},
mesh = {Aged ; Aged, 80 and over ; Diverticulitis, Colonic/epidemiology/*mortality/surgery ; Emergency Medicine/*statistics & numerical data ; England/epidemiology ; Female ; Hospitalization/*statistics & numerical data ; Humans ; Incidence ; Middle Aged ; Patient Admission/*statistics & numerical data ; Patient Readmission ; Treatment Outcome ; },
abstract = {BACKGROUND: Diverticular disease has a changing disease pattern with limited epidemiological data.
AIM: To describe diverticular disease admission rates and associated outcomes through national population study.
METHODS: Data were obtained from the English 'Hospital Episode Statistics' database between 1996 and 2006. Primary outcomes examined were 30-day overall and 1-year mortality, 28-day readmission rates and extended length of stay (LOS) beyond the 75th percentile (median inpatient LOS = 6 days). Multiple logistic regression analysis was used to determine independent predictors of these outcomes.
RESULTS: Between the study dates 560 281 admissions with a primary diagnosis of diverticular disease were recorded in England. The national admission rate increased from 0.56 to 1.20 per 1000 population/year. 232 047 (41.4%) were inpatient admissions and, of these, 55 519 (23.9%) were elective and 176 528 (76.1%) emergency. Surgery was undertaken in 37 767 (16.3%). The 30-day mortality was 5.1% (n = 6735) and 1-year mortality was 14.5% (n = 11 567). The 28-day readmission rate was 9.6% (n = 21 160). Increasing age, comorbidity and emergency admission were independent predictors of all primary outcomes.
CONCLUSIONS: Diverticular disease admissions increased over the course of the study. Patients of increasing age, admitted as emergency and significant comorbidity should be identified, allowing management modification to optimize outcomes.},
}
@article {pmid19671502,
year = {2008},
author = {Lizardi-Cervera, J and Vázquez-Elizondo, G and Becerra-Laparra, I and Chávez-Tapia, N and Noriega-Iriondo, MF and Uribe, M},
title = {[Comparative study of the clinical presentation and complications of acute colonic diverticulitis in patients older and younger than 65 years.].},
journal = {Revista de gastroenterologia de Mexico},
volume = {73},
number = {3},
pages = {153-158},
pmid = {19671502},
issn = {0375-0906},
mesh = {Age Factors ; Aged ; Diverticulitis, Colonic/*complications/*diagnosis ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {BACKGROUND AND AIM: Colonic diverticular disease has an incidence from 66 to 85% in population older than 65 years. Most of them remain asymptomatic;20% will be symptomatic and about 35%will present an episode of Acute Colonic Diverticulitis(ACD). To date, there are not studies to compare its presentation in elderly patients. The aim of this study was to compare the clinical presentation, diagnostic procedures, treatment and complications of acute colonic diverticulitis (ACD)in patients older and younger than 65 years.
MATERIAL AND METHODS: A retrospective review of patients diagnosed with ACD from January 2003 to May 2006. Exclusion criteria included patients with incomplete medical records and those who didn't complete the in hospital treatment. Demographic,clinical, laboratory, and radiological,prognostic variables as well as chosen treatment,presence of complications were evaluated. Descriptive and comparative statistic analysis was performed by the Fisher Exact Test for categorical variables and Student t-Test for continual variables considering a statistically significant difference for p <0.05. The analysis was made with SPSS/PC v12.0 software.
RESULTS: Of 126 patients, 69 were men and 57 women; 93 younger than 65 years and 33 older than 65 years. 20 patients were excluded by previously defined criteria. Significant statistical differences were found for presence of pain in the left inferior quadrant (73.2% vs. 48.5% p <0.01); mean hemoglobin level (14.6 vs. 13.2 g/dL p<0.01), presence of anemia (10.8% vs. 27.3% p <0.05) use of ultrasonography (24.7% vs. 6.1%,p < 0.05) and presence of hemorrhage (3.3% vs.21.3% p < 0.01) respectively. There was not mortality in the series.
CONCLUSION: This series demonstrates that elderly patients with ACD have a greater rate of lower gastrointestinal bleeding and greater degree of anemia than younger patients.},
}
@article {pmid19666286,
year = {2008},
author = {Charúa-Guindic, L and Mazza-Olmos, D and Orduña-Téllez, D and Orozco-Zepeda, H and Peniche-Gallareta, L and Reed-San Román, G and Roesch-Dietlen, F and Sempe-Minvielle, J and , },
title = {[Gastroenterology diagnosis and treatment guidelines of diverticular disease of the colon. Treatment.].},
journal = {Revista de gastroenterologia de Mexico},
volume = {73},
number = {4},
pages = {261-264},
pmid = {19666286},
issn = {0375-0906},
mesh = {Aged ; Aged, 80 and over ; Colon/physiopathology ; Diverticulitis, Colonic/*therapy ; Female ; Humans ; Male ; Mexico ; },
}
@article {pmid19666285,
year = {2008},
author = {Hernández-Guerrero, A and Abdo-Francis, J and Brito-Lugo, P and Dela Torre-Bravo, A and Marín-Pineda, R and Stoopen-Rometti, M and , },
title = {[Gastroenterology diagnosis and treatment guidelines of diverticular disease of the colon. Clinical and diagnostic.].},
journal = {Revista de gastroenterologia de Mexico},
volume = {73},
number = {4},
pages = {258-260},
pmid = {19666285},
issn = {0375-0906},
mesh = {Aged ; Aged, 80 and over ; Colon/physiopathology ; Diverticulitis, Colonic/*diagnosis/*therapy ; Female ; Humans ; Male ; Mexico ; },
}
@article {pmid19666284,
year = {2008},
author = {Raña-Garibay, R and Méndez-Gutiérrez, T and Sanjurjo-García, J and Huerta-Iga, F and Amaya-Echánove, T and , },
title = {[Gastroenterology diagnosis and treatment guidelines of diverticular disease of the colon. Etiology, pathophysiology, epidemiology in Mexico and the world].},
journal = {Revista de gastroenterologia de Mexico},
volume = {73},
number = {4},
pages = {255-257},
pmid = {19666284},
issn = {0375-0906},
mesh = {Aged ; Aged, 80 and over ; Colon/physiopathology ; Diverticulitis, Colonic/*epidemiology/*etiology/physiopathology ; Female ; Gastrointestinal Motility/physiology ; Humans ; Male ; Mexico/epidemiology ; Risk Factors ; },
}
@article {pmid19666269,
year = {2008},
author = {González-Contreras, QH and Tapia Cid de Léon, H and Rodríguez-Zentner, HA and Castellanos-Juárez, JC and Vega-Batista, RR and Castañeda-Argáiz, R},
title = {[Laparoscopic colorectal surgery: third level center experience.].},
journal = {Revista de gastroenterologia de Mexico},
volume = {73},
number = {4},
pages = {203-208},
pmid = {19666269},
issn = {0375-0906},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/*surgery ; Colorectal Neoplasms/surgery ; Colorectal Surgery/*methods ; Diverticulitis, Colonic/surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Rectal Diseases/*surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND: The role of laparoscopic surgery in the management of colorectal pathologies is steal unclear. Some new evidence has shown some advantages over open procedures. Because it is a technically demanding procedure, the progress is very low, and used among few colorectal surgeons.
OBJECTIVE: To describe the experience of laparoscopic colorectal surgery in a third level referral center, in a fourth year period. We analyzed short and median outcomes, for benign and malignant diseases.
MATERIAL AND METHODS: A retrospective review of all colorectal laparoscopic procedures was analyzed in a period between June 2003 and July 2007. Procedures for benign and malignant diseases were included.
RESULTS: One hundred and seventy cases were included, 52 (30%) for malignant and 118 (70%)for benign diseases. The main indication for surgery was diverticular disease followed by colorectal cancer and the most common procedure was sigmoidectomy followed by right colectomy. Conversion rate was 8.8% (15 patients) and overall morbidity and mortality were 12%, and less than 1% respectively.Oncologic results were evaluated with a median follow up of 2 years, for a loco regional recurrence rate of 6%. Mean number of nodes retrieved in the pathologic specimen were 15.69 (+/- 3.53). All malignant cases had negative margins.
CONCLUSIONS: Laparoscopic colorectal procedures are safe and feasible, in large volume centers showing equivalent results when comparing with open procedures evidenced in world literature,about results of oncologic cases, due to the short follow up period we can t conclude about oncologic outcomes.},
}
@article {pmid19652620,
year = {2009},
author = {Rocco, A and Compare, D and Caruso, F and Nardone, G},
title = {Treatment options for uncomplicated diverticular disease of the colon.},
journal = {Journal of clinical gastroenterology},
volume = {43},
number = {9},
pages = {803-808},
doi = {10.1097/MCG.0b013e3181b3ab2e},
pmid = {19652620},
issn = {1539-2031},
mesh = {Abdominal Pain/etiology/prevention & control ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents/therapeutic use ; Defecation ; Dietary Fiber/therapeutic use ; Diverticulosis, Colonic/complications/physiopathology/*therapy ; Evidence-Based Medicine ; Humans ; Practice Guidelines as Topic ; Probiotics/therapeutic use ; Recurrence ; Treatment Outcome ; },
abstract = {Patients affected by uncomplicated diverticular disease (DD) suffer from colicky, unexplained, recurrent, and short-lived but often debilitating abdominal pain and alteration in bowel habit. Although the goals of therapy, such as to improve symptoms and to prevent both recurrent attacks and complications, are clearly established, the standard approach remains still debated. We examined the current scientific evidence supporting the different treatment options for uncomplicated DD. An internet-based search strategy of the Medline and Science Citation Index was performed using the keywords: diverticulosis, DD, fiber, bran, diet, antibiotics, rifaximin, probiotics, prebiotics, bacteria, lactobacillus, bifidobacteria, 5-aminosalicylic acid, sulfasalazine, mesalazine, balsalazide in various combinations to select randomized trials published in the English language between January 1966 and March 2009. The use of fiber and nonabsorbable antibiotics is supported by the existence of randomized controlled studies. More recently, alternative treatments, such as probiotics and mesalazine have been proposed even if no definite data are available. Although the preliminary results seem to be promising, randomized, placebo-controlled studies are needed before new therapies can be recommended in the management of uncomplicated DD.},
}
@article {pmid19641950,
year = {2009},
author = {Rotholtz, NA and Montero, M and Laporte, M and Bun, M and Lencinas, S and Mezzadri, N},
title = {Patients with less than three episodes of diverticulitis may benefit from elective laparoscopic sigmoidectomy.},
journal = {World journal of surgery},
volume = {33},
number = {11},
pages = {2444-2447},
pmid = {19641950},
issn = {1432-2323},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures ; Female ; Humans ; *Laparoscopy ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications ; Prognosis ; Recurrence ; Retrospective Studies ; Sigmoid Diseases/*surgery ; Treatment Outcome ; },
abstract = {BACKGROUND: This study was designed to asses the predictive factors of postoperative complications in patients who underwent a laparoscopic elective approach for recurrent diverticulitis and to determine the relationship between the number of acute episodes and surgical morbidity.
METHODS: A retrospective analysis was performed on patients with colonic diverticular disease treated by an elective laparoscopic approach between July 2000 and November 2007. The variables studied were age, sex, BMI, ASA, number of previous acute episodes, local severity, abdominal surgery history, comorbidity, and laparoscopic training of the surgeon. Logistic regression analysis was used to establish significant results.
RESULTS: A total of 137 patients were analyzed; 87 (63.5%) were men with a mean age of 56.7 (range, 27-89) years. Intraoperative and postoperative complications occurred in 2.9% (n = 4) and 12.4% (n = 17) of the patients respectively. Conversion rate was 9.4% (n = 13). Local severity (odds ratio (OR), 16.34; 95% confidence interval (CI), 4.1-64.5, p = 0.00007), history of abdominal surgery (OR, 3.02; 95% CI, 0.8-11.5; p = 0.02), and the training of the operating surgeon (OR, 4.8; 95% CI, 1.02-22.7; p = 0.001) were significant risk factors related to surgery conversion. A history of three or more acute episodes was significantly associated with a high severity of local process and was a risk factor related to conversion (OR, 2.6; 95% CI, 0.5-12.3; p = 0.22). The severity of the local process seems to be a risk factor for perioperative complications. A significant association (chi2, 4.45; p = 0.03) between conversion and postoperative complications also was observed (OR: 3.79, 95% CI, 1.02-14.07; p = 0.04).
CONCLUSIONS: A history of three or more acute episodes of diverticulitis with conservative treatment is associated with a high severity of the local process during laparoscopic sigmoidectomy and increases the rate of conversion and perioperative complications.},
}
@article {pmid19616793,
year = {2009},
author = {Melchior, S and Cudovic, D and Jones, J and Thomas, C and Gillitzer, R and Thüroff, J},
title = {Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis.},
journal = {The Journal of urology},
volume = {182},
number = {3},
pages = {978-982},
doi = {10.1016/j.juro.2009.05.022},
pmid = {19616793},
issn = {1527-3792},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology/*surgery ; Male ; Middle Aged ; Sigmoid Diseases/complications ; },
abstract = {PURPOSE: Diverticular disease of the colon is the most frequent cause of colovesical fistulas. In this study we evaluated the accuracy of different diagnostic procedures for the detection of colovesical fistula and the clinical outcome in a series of 49 patients who underwent surgery for colovesical fistula due to sigmoid diverticulitis.
MATERIALS AND METHODS: Between 1982 and 2007, 42 men and 7 women underwent surgery for colovesical fistula due to sigmoid diverticulitis. Preoperative diagnostic procedures included the poppy seed test, abdominopelvic computerized tomography, magnetic resonance tomography of the abdomen, cystogram, retrograde colonic enema, urethrocystoscopy and colonoscopy.
RESULTS: All patients had urinary tract infections and dysuria. Pneumaturia and fecaluria, which are pathognomonic symptoms of colovesical fistula, were present in 71.4% and 51.0% of the patients (35 and 25 of 49), respectively. Colovesical fistula was correctly diagnosed by the poppy seed test in 94.6% (35 of 37 examined patients) compared to abdominopelvic computerized tomography in 61.0% (25 of 41), magnetic resonance tomography in 60.0% (3 of 5), cystogram in 16.7% (5 of 30), retrograde colonic enema in 35.7% (15 of 42), cystoscopy in 10.2% (5 of 49) and colonoscopy in 8.5% (4 of 47). Patients underwent resection of the fistulized bowel, single stage bowel anastomosis without protective colostomy and closure of the bladder defect. Postoperative morbidity was 8.2% (4 of 49) and mortality was 0%. During a median followup of 68 months there were no recurrent fistulas.
CONCLUSIONS: In our series the poppy seed test had the highest sensitivity to detect colovesical fistulas. However, abdominopelvic computerized tomography, colonoscopy and cystoscopy are essential diagnostic procedures because the presence of colon or bladder cancer as an underlying cause of colovesical fistula will determine further therapy.},
}
@article {pmid19610140,
year = {2009},
author = {Amin, AI and Shaikh, IA},
title = {Topical negative pressure in managing severe peritonitis: a positive contribution?.},
journal = {World journal of gastroenterology},
volume = {15},
number = {27},
pages = {3394-3397},
pmid = {19610140},
issn = {2219-2840},
mesh = {Bandages ; Female ; Humans ; Male ; Middle Aged ; *Negative-Pressure Wound Therapy ; Peritonitis/pathology/*surgery ; Prospective Studies ; Treatment Outcome ; },
abstract = {AIM: To assess the use of topical negative pressure (TNP) in the management of severe peritonitis.
METHODS: This is a four-year prospective analysis from January 2005 to December 2008 of 20 patients requiring TNP following laparotomy for severe peritonitis.
RESULTS: There were 11 males with an average age of (59.3 +/- 3.95) years. Nine had a perforated viscus, five had anastomotic leaks, three had iatrogenic bowel injury, and a further three had severe pelvic inflammatory disease. TNP and the VAC(R) Abdominal Dressing System were initially used. These were changed every two to three days. Abdominal closure was achieved in 15/20 patients within 4.53 +/- 1.64 d. One patient required relaparotomy due to residual sepsis. Two patients with severe faecal peritonitis due to perforated diverticular disease received primary anastomosis at second look laparotomy, as sepsis and their general condition improved. In the remaining 5/20 cases, the abdomen was left open due to bowel oedema and or abdominal wall oedema. Dressing was switched to TNP and VAC GranuFoam. Three of the five patients returned a few months later for abdominal wall reconstruction and restoration of intestinal continuity. Two patients developed intestinal fistulae. All 20 patients survived.
CONCLUSION: The use of TNP is safe. Further studies are needed to assess its value in managing these difficult cases.},
}
@article {pmid19606726,
year = {2009},
author = {Augustyn, M and Grys, I},
title = {[Diverticular disease--the rules of management].},
journal = {Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego},
volume = {26},
number = {155},
pages = {559-561},
pmid = {19606726},
issn = {1426-9686},
mesh = {Dietary Fiber ; Diverticulum/*diagnosis/epidemiology/*therapy ; Exercise ; Humans ; Life Style ; Poland/epidemiology ; Young Adult ; },
abstract = {Diverticular disease it is one from the most common disease, and the number of young people with this illness is increasing last time. It is connected with our life style: without physical activity and low-fiber diet. Main symptoms of diverticular disease can be mild (like: abdominal pain, flatulence, constipations or diarrhea) but can also be connected with serious complications (like perforation or bleeding). The aim of this article was assigning the rules of diagnostics and treatment both mild and severe causes of this illness. Methods of prevention were also presented.},
}
@article {pmid19606411,
year = {2009},
author = {Albert, JG and Lübbert, C and Surow, A and Zeuzem, S},
title = {[Small bowel diverticula - unknown disease].},
journal = {Zeitschrift fur Gastroenterologie},
volume = {47},
number = {7},
pages = {674-681},
doi = {10.1055/s-0028-1109384},
pmid = {19606411},
issn = {1439-7803},
mesh = {Diverticulum/*diagnosis/*epidemiology ; Humans ; Intestinal Diseases/*diagnosis/*epidemiology ; Intestine, Small/*abnormalities/*pathology ; },
abstract = {Diverticula of the small bowel are quite frequent (about 5 %), but being a differential diagnosis of abdominal complaints they may still be underdiagnosed. One reason for the low level of suspicion for a complication of small bowel diverticula might be that the small bowel was out of the gastroenterologists' focus until recently when small bowel endoscopy became available as a reliable and practical diagnostic tool. Diverticula of the jejunum and the ileum may lead to diverticulitis, abscess, obstruction, bleeding, and perforation. Small intestinal bacterial overgrowth syndrome due to small bowel diverticula is a common complication and involves meteorism and malassimilation syndrome. Meckel's diverticulum sometimes provokes bleeding even in the young adult and resection of the diverticulum is clearly indicated. Contrariwise, incidental detection of a Meckel's diverticulum during abdominal laparotomy does not necessarily imply resection of the diverticulum. The juxtapapillary duodenal diverticula appear to be a risk factor for gallbladder stones, bile duct stones, and their recurrence. Moreover, the complication rate of endoscopic interventions of the bile system might be increased. In this review, we highlight the historical background of small bowel diverticular disease, present the epidemiological and pathophysiological implications and provide information on the diagnostic modalities that are available. Diseases of the primary acquired and congential small bowel diverticula are described in detail.},
}
@article {pmid19604289,
year = {2010},
author = {Maslekar, S and Gardiner, AB and Monson, JR and Duthie, GS},
title = {Artificial neural networks to predict presence of significant pathology in patients presenting to routine colorectal clinics.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {12},
number = {12},
pages = {1254-1259},
doi = {10.1111/j.1463-1318.2009.02005.x},
pmid = {19604289},
issn = {1463-1318},
mesh = {Algorithms ; Colonic Diseases/*diagnosis ; Colonoscopy ; Female ; Humans ; Male ; Middle Aged ; *Neural Networks, Computer ; Prospective Studies ; Rectal Diseases/*diagnosis ; Sigmoidoscopy ; Surveys and Questionnaires ; },
abstract = {AIM: Artificial neural networks (ANNs) are computer programs used to identify complex relations within data. Routine predictions of presence of colorectal pathology based on population statistics have little meaning for individual patient. This results in large number of unnecessary lower gastrointestinal endoscopies (LGEs - colonoscopies and flexible sigmoidoscopies). We aimed to develop a neural network algorithm that can accurately predict presence of significant pathology in patients attending routine outpatient clinics for gastrointestinal symptoms.
METHOD: Ethics approval was obtained and the study was monitored according to International Committee on Harmonisation - Good Clinical Practice (ICH-GCP) standards. Three-hundred patients undergoing LGE prospectively completed a specifically developed questionnaire, which included 40 variables based on clinical symptoms, signs, past- and family history. Complete data sets of 100 patients were used to train the ANN; the remaining data was used for internal validation. The primary output used was positive finding on LGE, including polyps, cancer, diverticular disease or colitis. For external validation, the ANN was applied to data from 50 patients in primary care and also compared with the predictions of four clinicians.
RESULTS: Clear correlation between actual data value and ANN predictions were found (r = 0.931; P = 0.0001). The predictive accuracy of ANN was 95% in training group and 90% (95% CI 84-96) in the internal validation set and this was significantly higher than the clinical accuracy (75%). ANN also showed high accuracy in the external validation group (89%).
CONCLUSION: Artificial neural networks offer the possibility of personal prediction of outcome for individual patients presenting in clinics with colorectal symptoms, making it possible to make more appropriate requests for lower gastrointestinal endoscopy.},
}
@article {pmid19594602,
year = {2010},
author = {Dalton, SJ and Ghosh, AJ and Zafar, N and Riyad, K and Dixon, AR},
title = {Competency in laparoscopic colorectal surgery is achievable with appropriate training but takes time: a comparison of 300 elective resections with anastomosis.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {12},
number = {11},
pages = {1099-1104},
doi = {10.1111/j.1463-1318.2009.01998.x},
pmid = {19594602},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; *Clinical Competence ; Colitis/surgery ; Colon/surgery ; Colorectal Neoplasms/*surgery ; Colorectal Surgery/adverse effects/*education/methods ; Crohn Disease/*surgery ; Diverticulosis, Colonic/*surgery ; Education, Medical ; Elective Surgical Procedures ; Fellowships and Scholarships ; Female ; Humans ; Laparoscopy/adverse effects/*education/methods ; Male ; Middle Aged ; Rectum/surgery ; Retrospective Studies ; Statistics, Nonparametric ; Time and Motion Studies ; Treatment Outcome ; },
abstract = {AIM: The aim of this retrospective cohort study was to compare outcomes in patients who underwent elective laparoscopic colorectal resection with anastomosis performed by a single surgeon or his training fellow.
METHOD: A prospective electronic database of all laparoscopic procedures between January 2005 and September 2008 was used. Two groups were compared; those patients operated upon by the Consultant trainer (C) and those by seven supervised Fellows (F). Fellows were either post CCT or in their last year of training. Three hundred consecutive patients undergoing laparoscopic colorectal resection with anastomosis were examined, 150 in each group. Groups were matched for indication, age, American Society of Anesthesiology (ASA) grade, cancer T stage and resection performed. Preoperative work-up, operative surgery and anaesthesia were identical between groups.
RESULTS: No significant difference was demonstrated in age, mean 67 (26-91) or ASA grade. Indications for surgery were; cancer (C) 120, (F) 126, diverticular disease (C) 22, (F) 20, Crohn's disease (C) 8, (F) 7. Fellow's mean operative time was significantly longer at 123 min (95%CI 117-134) compared to the consultant trainer -105 min. (95%CI 98-111): P < 0.01). No significant differences in the complication or conversion rates were demonstrated. Length of stay and the 30-day readmission rates were similar.
CONCLUSION: In this retrospective cohort study we have demonstrate that when matched patients are compared, supervised trainee operating time is significantly longer than that of the consultant trainer but without any significant increase in length of stay, complication or readmission rates. Training to a level of competency takes time but not at the expense of patient care.},
}
@article {pmid19581849,
year = {2009},
author = {Mulhall, AM and Mahid, SS and Petras, RE and Galandiuk, S},
title = {Diverticular disease associated with inflammatory bowel disease-like colitis: a systematic review.},
journal = {Diseases of the colon and rectum},
volume = {52},
number = {6},
pages = {1072-1079},
doi = {10.1007/DCR.0b013e31819ef79a},
pmid = {19581849},
issn = {1530-0358},
mesh = {Age of Onset ; Colitis/*complications/*pathology/therapy ; Diverticulitis, Colonic/*complications/*pathology/therapy ; Humans ; Recurrence ; },
abstract = {PURPOSE: Diverticular-associated colitis significantly overlaps clinically with primary inflammatory bowel disease. However, the clinical and the pathologic features of diverticular-associated colitis suggest that it is a distinct clinical entity.
METHODS: We performed a systematic review by use of multiple health care databases and gray literature, following predefined inclusion and exclusion criteria to determine the clinical, endoscopic, and pathologic features of diverticular-associated colitis, and recurrence rates following medical and surgical treatment.
RESULTS: Two hundred twenty-seven participants were selected from 18 eligible studies, including our own patients (n = 13). The average age of disease onset was 64 years. The typical symptoms included tenesmus, hematochezia, and diarrhea. One hundred sixty-three of the 227 patients in these studies were classified as having diverticular-associated colitis, of which 142 were managed medically. Twenty-eight patients eventually required an operation. One-quarter (37 of 163) of the patients had recurrence of symptoms with an average follow-up time of three years.
CONCLUSIONS: Diverticular-associated colitis is a distinct entity that presents with segmental colitis and a variety of clinical, endoscopic, and pathologic features. Diverticular-associated colitis should be considered in the presence of recurrent symptoms after resection for diverticulitis.},
}
@article {pmid19562554,
year = {2009},
author = {Andrabi, SI and Latif, MU and Ahmad, J and Malik, AH and El-Hakeem, AA},
title = {Synchronous perforation of sigmoid diverticula: a rare presentation.},
journal = {Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES},
volume = {15},
number = {3},
pages = {293-294},
pmid = {19562554},
issn = {1306-696X},
mesh = {Aged ; Colectomy ; Colostomy ; Diverticulitis/*complications ; Diverticulitis, Colonic/*diagnosis/surgery ; *Diverticulum, Colon ; Female ; Humans ; Intestinal Perforation/*diagnosis/surgery ; Sigmoid Diseases/*diagnosis/surgery ; Treatment Outcome ; },
abstract = {Diverticular disease affects more than 50% of the population over the age of 60 years in the west and becomes even more common as the population ages. Diverticulitis is one of the complications of diverticular disease and can culminate into colonic perforation. Though perforated diverticular disease is not uncommon, synchronous colonic perforations in diverticulitis is rare. Our patient was admitted with acute abdomen and exploratory laparotomy revealed two side-by-side perforations of the sigmoid colon. A Hartmann's procedure was performed. Macro- and microscopic evaluation confirmed the presence of two perforated sigmoid diverticula due to diverticulitis. Simultaneous perforation of two abreast sigmoid diverticula is uncommon; thus, a cautious surgeon should always take into account such a probable diagnosis.},
}
@article {pmid19562444,
year = {2009},
author = {Leong, QM and Aung, MO and Ho, CK and Sim, R},
title = {Emergency colorectal resections in Asian octogenarians: factors impacting surgical outcome.},
journal = {Surgery today},
volume = {39},
number = {7},
pages = {575-579},
pmid = {19562444},
issn = {1436-2813},
mesh = {Aged, 80 and over ; Asian People ; Colectomy/mortality/*statistics & numerical data ; Colorectal Neoplasms/complications/*surgery ; Diverticulum, Colon/complications/*surgery ; Emergencies ; Female ; Health Status Indicators ; Humans ; Intestinal Obstruction/etiology/*surgery ; Male ; Morbidity ; Retrospective Studies ; Treatment Outcome ; },
abstract = {PURPOSE: The population in developing countries is aging and the number of octogenarians is expected to increase in the future at an alarmingly fast rate. This paper evaluates the surgical outcomes of emergency colorectal resections among Asian octogenarians.
METHODS: We conducted a retrospective review of all octogenarians and older, who had an emergency colorectal resection performed between February 1996 to December 2001.
RESULTS: Fifty-eight emergency colorectal resections were performed in patients with a median age of 83 years. The indications for surgery were colorectal cancer (74%) and complicated diverticular disease (12%). The most common presentation was an intestinal obstruction (72%). Fifty-one (88%) of the patients had comorbidities. Forty-five percent of patients had an American Society of Anesthesiologists (ASA) score of I and II, while 55% had a score of III and IV. Consultants performed 53% of the procedures. The mean surgical time was 156 min. Hartmann's procedure was the most common procedure performed (43%). There were 16 (28%) mortalities. The postoperative morbidity was 81%. The only factor impacting outcome was a high ASA score of III and IV. The median length of stay was 17.5 (range 3-108) days.
CONCLUSIONS: The mortality and morbidity of emergency colorectal resections among Asian octogenarians are high and can be predicted by their ASA status.},
}
@article {pmid19561530,
year = {2010},
author = {Gatta, L and Vakil, N and Vaira, D and Pilotto, A and Curlo, M and Comparato, G and Leandro, G and Ferro, U and Lera, M and Milletti, S and Di Mario, F},
title = {Efficacy of 5-ASA in the treatment of colonic diverticular disease.},
journal = {Journal of clinical gastroenterology},
volume = {44},
number = {2},
pages = {113-119},
doi = {10.1097/MCG.0b013e3181a15864},
pmid = {19561530},
issn = {1539-2031},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/*therapeutic use ; Diverticulitis, Colonic/*drug therapy/physiopathology ; Drug Administration Schedule ; Humans ; Mesalamine/administration & dosage/*therapeutic use ; Randomized Controlled Trials as Topic ; Secondary Prevention ; Treatment Outcome ; },
abstract = {OBJECTIVE: To assess the therapeutic efficacy of 5-aminosalicylic acid (5-ASA) in patients with colonic diverticular disease performing a systematic review of the literature.
DATA SOURCES: Cochrane Trial Register (until Issue 4, 2008), Medical Literature Analysis and Retrieval System Online (1966 to October 1, 2008), Excerpta Medica Database (1980 to October 1, 2008), and abstracts from the major US, European, and Asian gastroenterology conferences. Expert opinions sought and reference lists of identified studies and any relevant published reviews checked.
STUDY SELECTION: Randomized controlled trial (RCT) or a controlled clinical trial with a parallel group design using 5-ASA as 1 treatment arm.
RESULTS: Six RCTs enrolling 818 patients were found: 3 were performed in patients with uncomplicated diverticulitis, and the remaining in patients with symptomatic uncomplicated diverticular disease. The results of these studies showed that patients treated with 5-ASA had significantly better outcomes and that also mesalazine scheduled daily was superior to cyclic administration to prevent relapse of diverticular disease. However, several of these studies have not included an endoscopy at the start of the study and when patients had recurrences.
CONCLUSIONS: From this systematic review, it seems that 5-ASAs may have a role in patients with colonic diverticular disease. However, high-quality well-designed RCTs are necessary to confirm these initial observations.},
}
@article {pmid19561469,
year = {2009},
author = {Veenhof, AA and van der Peet, DL and Cuesta, MA},
title = {Laparoscopic resection for diverticular disease: follow-up of 500 consecutive patients.},
journal = {Annals of surgery},
volume = {250},
number = {1},
pages = {174-5; author reply 175},
doi = {10.1097/SLA.0b013e3181ad8aa1},
pmid = {19561469},
issn = {1528-1140},
mesh = {Diverticulum/*surgery ; Humans ; *Laparoscopy/adverse effects/methods ; },
}
@article {pmid19552027,
year = {2009},
author = {Lutkov, IV},
title = {[Evaluation of alpha-normiks (rifaximin) efficacy in the treatment of patients with diverticular disease associated with medium and severe intestinal dysbacteriosis].},
journal = {Eksperimental'naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology},
volume = {},
number = {2},
pages = {99-103},
pmid = {19552027},
issn = {1682-8658},
mesh = {Anti-Bacterial Agents/administration & dosage/*therapeutic use ; Diverticulosis, Colonic/*drug therapy/microbiology ; Drug Therapy, Combination ; Humans ; Intestines/drug effects/*microbiology ; Rifamycins/administration & dosage/*therapeutic use ; Rifaximin ; Severity of Illness Index ; Treatment Outcome ; },
abstract = {THE PURPOSE OF THE STUDY: to evaluate the efficacy of using rifaksimin drug within complex therapy of patients with the disease and diverticular intestinal dysbacteriosis.
MATERIALS AND METHODS: 57 patients participated with a moderate exacerbation of the disease, they were divided equally on the composition of the group--two control and one under study. Patients in the control groups were composed of complex treatment of oral antibacterial drugs, or bacteriophage, the investigated group of patients--rifaksimin. We evaluated the dynamics of clinical symptoms, analysis of stool for dysbacteriosis and biochemical parameters.
RESULTS: detected superior effectiveness of the Alpha-normiks drug in the treatment of patients with colon pathologies investigated in comparison with the use of oral antibacterial drugs, or bacteriophages. Proved the high safety of treatment with using of rifaksimin.
CONCLUSIONS: The preparation of Alpha-normiks may be appointed with great success at patients with diverticular disease, and with intestinal dysbacteriosis.},
}
@article {pmid19549266,
year = {2009},
author = {Tursi, A and Papagrigoriadis, S},
title = {Review article: the current and evolving treatment of colonic diverticular disease.},
journal = {Alimentary pharmacology & therapeutics},
volume = {30},
number = {6},
pages = {532-546},
doi = {10.1111/j.1365-2036.2009.04072.x},
pmid = {19549266},
issn = {1365-2036},
mesh = {Anti-Bacterial Agents/*therapeutic use ; *Dietary Supplements ; Diverticulitis, Colonic/diet therapy/drug therapy/surgery ; Gastrointestinal Agents/*therapeutic use ; Humans ; Mesalamine/*therapeutic use ; Randomized Controlled Trials as Topic ; Rifamycins/*therapeutic use ; Rifaximin ; Risk Factors ; Secondary Prevention ; },
abstract = {BACKGROUND: Formation of colonic diverticula, via herniation of the colonic wall, is responsible for the development of diverticulosis and consequently diverticular disease. Diverticular disease can be associated with numerous debilitating abdominal and gastrointestinal symptoms (including pain, bloating, nausea, constipation and diarrhoea).
AIMS: To review the state of treatment for diverticular disease and its complications, and briefly discuss potential future therapies.
METHODS: PubMed and recent conference abstracts were searched for articles describing the treatment of diverticular disease.
RESULTS: Many physicians will recommend alterations to lifestyle and increasing fibre consumption. Empirical antibiotics remain the mainstay of therapy for patients with diverticular disease and rifaximin seems to be the best choice. In severe or relapsing disease, surgical intervention is often the only remaining treatment option. Although novel treatment options are yet to become available, the addition of therapies based on mesalazine (mesalamine) and probiotics may enhance treatment efficacy.
CONCLUSIONS: Data suggest that diverticular disease may share many of the hallmarks of other, better-characterized inflammatory bowel diseases; however, treatment options for patients with diverticular disease are scarce, revolving around antibiotic treatment and surgery. There is a need for a better understanding of the fundamental mechanisms of diverticular disease to design treatment regimens accordingly.},
}
@article {pmid19542856,
year = {2009},
author = {Campos, FG and Valarini, R},
title = {Evolution of laparoscopic colorectal surgery in Brazil: results of 4744 patients from the national registry.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {19},
number = {3},
pages = {249-254},
doi = {10.1097/SLE.0b013e3181a1193b},
pmid = {19542856},
issn = {1534-4908},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brazil ; Colectomy/methods/*statistics & numerical data ; Colonic Diseases/*surgery ; Female ; Humans ; Laparoscopy/methods/*statistics & numerical data ; Laparotomy/statistics & numerical data ; Male ; Middle Aged ; Outcome Assessment, Health Care ; *Registries ; Retrospective Studies ; Young Adult ; },
abstract = {BACKGROUND: Since its introduction, laparoscopic colorectal surgery has raised intense debate and controversies regarding its safety and effectiveness.
METHODS: This multicentric registry reports the experience of 28 Brazilian surgical teams specializing in laparoscopic colorectal surgery.
RESULTS: Between 1992 and 2007, 4744 patients (1994 men--42% and 2750 women--58%) were operated upon, with ages ranging from 13 to 94 years (average 57.5 y). Benign diseases were diagnosed in 2356 patients (49.6%). Most diseases were located in 50.7% of the left and sigmoid colon, 28.2% in the rectum and anal canal, 8.0% in the right colon, and diffuse 7.0%. There were 181 (3.8%) intraoperative complications (from 0% to 14%). There were 261 (5.5%) reported conversions to laparotomy (from 0% to 16.5%), mainly during the early experience (n=119 -59.8%). Postoperative complications were registered in 683 (14.5%) patients (from 5.0% to 50%). Mortality occurred in 43 patients (0.8%). Surgeons who performed less than 50 cases reported similar rates of intraoperative (4.2% vs. 3.8%; P=0.7), postoperative complications (20.8% vs. 14.3%; P=0.07), and mortality (1.0% vs. 0.9%; P=0.5), but the conversion rate was higher (10.4% vs. 5.4%; P=0.04). Two thousand three hundred and eighty-nine (50.4%) malignant tumors were operated upon, and histologic classification showed 2347 (98%) adenocarcinomas, 30 (0.6%) spinocelular carcinomas, and 12 (0.2%) other histologic types. Tumor recurrence rate was 16.3% among patients followed more than 1 year. After an average follow-up of 52 months, 19 (0.8%) parietal recurrences were reported, 18 of which were in port sites and 1 in a patient with disseminated disease. There was no incisional recurrence in the ports used to withdraw the pathologic specimen. Compared with other registries, there was a 75% increase in the number of groups performing laparoscopic colorectal surgery and a decrease in conversions (from 10.5% to 5.5%) and mortality (from 1.5% to 0.9%) rates.
CONCLUSIONS: (1) The number of patients operated upon increased expressively during the last years; (2) operative indications for benign and malignant diseases were similar, and diverticular disease of the colon comprised 40% of the benign ones; (3) conversion and mortality rates decreased over time; (4) surgeon's experience did not influence the complication rates, but was associated with a lower conversion; and (5) oncologic outcome expressed by recurrence rates showed results similar to those reported in conventional surgery.},
}
@article {pmid19537116,
year = {2009},
author = {Tonelli, F and Di Carlo, V and Liscia, G and Serventi, A},
title = {[Diverticular disease of the colon: diagnosis and treatment. Consensus Conference, 5th National Congress of the Italian Society of Academic Surgeons].},
journal = {Annali italiani di chirurgia},
volume = {80},
number = {1},
pages = {3-8},
pmid = {19537116},
issn = {0003-469X},
mesh = {Abscess/microbiology/*surgery/therapy ; Age Distribution ; Anastomosis, Surgical/methods ; Colectomy/methods ; Digestive System Surgical Procedures/methods ; Diverticulitis, Colonic/complications/*diagnosis/*surgery/therapy ; Drainage ; Humans ; Italy ; Laparoscopy/methods ; Peritonitis/microbiology/*surgery/therapy ; Risk Factors ; Societies, Medical ; },
abstract = {Diverticular disease (DD) is one of the most common disorders of the colon with an increased prevalence in Western populations. There are still many unsolved issues about indications, timing of surgery and modality of surgical treatment. These topics were discussed during the Consensus Conference (CC). There is still common agreement indicating surgery after the second acute episode of diverticular disease; however, patients younger than 50 years should undergo surgery after the first acute episode, because of a higher risk of recurrence compared to older patients. It is not clear though how to uniformly classify an acute episode (severe, moderate or mild): an accurate clinical and instrumental valuation (based on CT scan) is recommended to establish the real severity of the acute episode before recommending a surgical procedure. In presence of septic complications (abscess or peritonitis) of DD, colonic resection is indicated, but a primary anastomosis could be at risk of failure due to sepsis. Therefore a Hartmann's procedure or protective stoma could be preferable. However, instead of a staged procedure, an appropriate strategy should be to resolve sepsis and perform resection and anastomosis in election. Abscesses smaller than 5 cm intra-meso-colic or para-colic can be successfully treated medically; vice versa larger or pelvic abscesses should undergo percutaneous or laparoscopic drainage, postponing colonic resection in elective conditions. Limited purulent peritonitis can be favourably treated by means of laparoscopic approach and simple lavage and drainage of peritoneal cavity. Diffuse purulent or faecal peritonitis is the most dramatic complication which still has a high risk of mortality and morbidity. Surgical risk is related to clinical conditions, duration of peritonitis, age of patient and comorbidities. Thus it is not possible to state a univocal approach, although Hartmann's procedure keeps being the first choice. On this matter farther randomized studies are required to compare Hartmann's procedure with other techniques (such as primary anastomosis with or without diverting colostomy). A wide left colonic resection (with splenic flexure mobilization) extended beneath sigmoid-rectal junction is recommended to avoid immediate or late complications. Laparoscopic approach is feasible, even for management of complicated diverticular disease, if strict patient selection criteria are followed, duration of the procedure is comparable to open surgery and conversion rate is under 10%.},
}
@article {pmid19535976,
year = {2009},
author = {de Oliveira, EP and Burini, RC},
title = {The impact of physical exercise on the gastrointestinal tract.},
journal = {Current opinion in clinical nutrition and metabolic care},
volume = {12},
number = {5},
pages = {533-538},
doi = {10.1097/MCO.0b013e32832e6776},
pmid = {19535976},
issn = {1473-6519},
mesh = {Digestive System Physiological Phenomena ; Exercise/*physiology ; Gastrointestinal Diseases/*etiology/*prevention & control ; Gastrointestinal Transit/physiology ; Humans ; Regional Blood Flow ; Running/physiology ; Water-Electrolyte Balance/*physiology ; },
abstract = {PURPOSE OF REVIEW: Physical exercise can be both beneficial and harmful for the gastrointestinal tract in a dose-effect relationship between its intensity and health. Mild-to-moderate intensity exercises play a protective role against colon cancer, diverticular disease, cholelithiasis and constipation, whereas acute strenuous exercise may provoke heartburn, nausea, vomiting, abdominal pain, diarrhea and even gastrointestinal bleeding. This review focuses on mechanisms involved in those symptoms and their associations with type of exercises in humans.
RECENT FINDINGS: One quarter to one half of elite athletes are hampered by the gastrointestinal symptoms that may deter them from participation in training and competitive events. Vigorous exercise-induced gastrointestinal symptoms are often attributed to altered motility, mechanical factor or altered neuroimmunoendocrine secretions. Training, lifestyle modifications, meal composition, adequate hydration and avoidance of excessive use of some medications are the recommendations.
SUMMARY: Strenuous exercise and dehydrated states would be the causes of gastrointestinal symptoms referred by 70% of the athletes. Gut ischemia would be the main cause of nausea, vomiting, abdominal pain and (bloody) diarrhea. The frequency is almost twice as high during running than during other endurance sports as cycling or swimming and 1.5-3.0 times higher in the elite athletes than the recreational exercisers.},
}
@article {pmid19502872,
year = {2009},
author = {Janes, S and Meagher, A and Faragher, IG and Shedda, S and Frizelle, FA},
title = {The place of elective surgery following acute diverticulitis in young patients: when is surgery indicated? An analysis of the literature.},
journal = {Diseases of the colon and rectum},
volume = {52},
number = {5},
pages = {1008-1016},
doi = {10.1007/DCR.0b013e3181a0a8a9},
pmid = {19502872},
issn = {1530-0358},
support = {G0700559/MRC_/Medical Research Council/United Kingdom ; },
mesh = {Acute Disease ; Adult ; Bias ; Diverticulitis/diagnosis/*surgery ; *Elective Surgical Procedures ; Emergencies ; Humans ; Incidence ; Middle Aged ; Patient Selection ; Recurrence ; Research Design ; Risk Factors ; },
abstract = {Diverticulitis in the young is often regarded as a specific entity. Resection after a single attack because of a more "virulent" course of the disease has been accepted as conventional wisdom. The evidence for such a recommendation and the place of elective surgery was reviewed by a search of Medline, PubMed, Embase, and the Cochrane library for articles published between January 1965 and March 2008 using the terms diverticular disease and diverticulitis. Publications had to give specific information on at least ten younger patients (age
PATIENTS AND METHODS: All patients who attended the RACC from 1 January 2006 to 31 December 2006 were identified and retrospectively reviewed from our prospectively collected unit database and case notes.
RESULTS: Five hundred ninety-one patients attended the RACC in 2006. One hundred sixteen (19.6%) patients were discharged after the first clinic attendance, and the remaining 475 (80.4%) had further investigations or clinic review. There were 370 barium enemas requested with 92.4% compliance. The most common pathology identified by barium enemas was diverticular disease which only required reassurance and lifestyle changes. There were nine false-positive findings from barium enemas requiring further investigations. Of the 105 patients without barium enema, 49 had a colonoscopy. In total, 42 colorectal cancers were diagnosed with 34 (81.0%) distal to the splenic flexure and eight (19.0%) proximal. Of these, 32 (76%) were diagnosed by flexible sigmoidoscopy, three (7%) by barium enemas, three (7%) by colonoscopy, and four (10%) by computed tomography.
CONCLUSIONS: A rapid access colorectal clinic using flexible sigmoidoscopy as the initial diagnostic test was safe and effective in investigating distal colonic pathologies. However, over two thirds of patients proceeded to imaging of the remaining colon, and most of them were found to have only benign pathologies. The cost effectiveness and acceptability of this were unclear.},
}
@article {pmid19474684,
year = {2009},
author = {Karanicolas, PJ and Dubois, L and Colquhoun, PH and Swallow, CJ and Walter, SD and Guyatt, GH},
title = {The more the better?: the impact of surgeon and hospital volume on in-hospital mortality following colorectal resection.},
journal = {Annals of surgery},
volume = {249},
number = {6},
pages = {954-959},
doi = {10.1097/SLA.0b013e3181a77bcd},
pmid = {19474684},
issn = {1528-1140},
mesh = {Adult ; Aged ; Canada/epidemiology ; Colectomy/*mortality/statistics & numerical data ; Colonic Diseases/mortality/pathology/*surgery ; Elective Surgical Procedures/mortality/statistics & numerical data ; Female ; Health Facility Size ; Hospital Mortality ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Risk Factors ; Workload ; },
abstract = {OBJECTIVE: To determine the in-hospital mortality rates for patients undergoing colorectal resection for malignant or benign conditions, and to identify risk factors for in-hospital death, particularly the relationships with surgeon and hospital volume.
BACKGROUND: Although there is strong evidence that complex cancer operations are best performed at specialized high-volume centers and by high-volume surgeons, the relationship between surgeon and hospital volume and perioperative outcomes is less well defined for more common procedures such as colorectal resections, particularly for benign diseases.
METHODS: We obtained data from the Canadian Institute for Health Information Discharge Abstract Database on all adult patients who underwent colorectal resection between April 1, 2005 and March 31, 2006. We performed a logistic regression to identify variables associated with a higher likelihood of in-hospital death.
RESULTS: Twenty-one thousand seventy-four patients underwent colorectal resection, with the majority being elective (59.4%). Malignancy represented the most common indication for resection (56.8%), followed by diverticular disease (16.2%) and inflammatory bowel disease (7.1%). The overall in-hospital mortality rate among patients undergoing colorectal resection was 5.3%. Increased age (adjusted Odds Ratio [OR]: 1.97 per 10 years, P < 0.001), urgent operation (OR: 2.63, P < 0.001), indication for resection (P < 0.001), nature of the surgery (P < 0.001), and several comorbidities were all independently associated with an increased risk of death. Surgeons with higher volumes of colorectal resections achieved significantly lower mortality rates (OR: 0.92 per 20 cases/y, P = 0.003), corresponding to an adjusted mortality rate of 5.6% for surgeons in the bottom decile (1 case per year) compared with 4.5% for surgeons in the top decile (greater than 43 cases per year). Hospital volume was not associated with mortality (OR: 1.00 per 10 cases, P = 0.504).
CONCLUSIONS: This large, population-based study suggests that surgeons who perform high volumes of colorectal resections achieve lower in-hospital mortality rates than surgeons with low volumes, whereas the hospital volume does not influence mortality.},
}
@article {pmid19468998,
year = {2009},
author = {Commane, DM and Arasaradnam, RP and Mills, S and Mathers, JC and Bradburn, M},
title = {Diet, ageing and genetic factors in the pathogenesis of diverticular disease.},
journal = {World journal of gastroenterology},
volume = {15},
number = {20},
pages = {2479-2488},
pmid = {19468998},
issn = {2219-2840},
mesh = {Age Factors ; Aging/*physiology ; Animals ; *Colon/anatomy & histology/pathology/physiology ; *Diet ; Dietary Fiber ; *Diverticulitis, Colonic/etiology/pathology/physiopathology ; Electrophysiology ; Gastrointestinal Motility/physiology ; Genetic Predisposition to Disease ; Humans ; Inflammation/complications/physiopathology ; Life Style ; },
abstract = {Diverticular disease (DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK. This high prevalence ranks it as one of the most common bowel disorders in western nations. The majority of patients remain asymptomatic but there are associated life-threatening co-morbidities, which, given the large numbers of people with DD, translates into a considerable number of deaths per annum. Despite this public health burden, relatively little seems to be known about either the mechanisms of development or causality. In the 1970s, a model of DD formulated the concept that diverticula occur as a consequence of pressure-induced damage to the colon wall amongst those with a low intake of dietary fiber. In this review, we have examined the evidence regarding the influence of ageing, diet, inflammation and genetics on DD development. We argue that the evidence supporting the barotrauma hypothesis is largely anecdotal. We have also identified several gaps in the knowledge base which need to be filled before we can complete a model for the etiology of diverticular disease.},
}
@article {pmid19453515,
year = {2009},
author = {Simpson, J and Sundler, F and Humes, DJ and Jenkins, D and Scholefield, JH and Spiller, RC},
title = {Post inflammatory damage to the enteric nervous system in diverticular disease and its relationship to symptoms.},
journal = {Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society},
volume = {21},
number = {8},
pages = {847-e58},
doi = {10.1111/j.1365-2982.2009.01308.x},
pmid = {19453515},
issn = {1365-2982},
support = {//Medical Research Council/United Kingdom ; },
mesh = {Aged ; Aged, 80 and over ; Animals ; Biomarkers/metabolism ; Colon/innervation/pathology ; *Diverticulitis/immunology/pathology/physiopathology ; Enteric Nervous System/metabolism/*pathology ; Female ; Humans ; *Inflammation/immunology/pathology ; Middle Aged ; Myenteric Plexus/cytology/metabolism ; Neuropeptides/metabolism ; },
abstract = {Some patients with colonic diverticula suffer recurrent abdominal pain and exhibit visceral hypersensitivity, though the mechanism is unclear. Prior diverticulitis increases the risk of being symptomatic while experimental colitis in animals increases expression of neuropeptides within the enteric nervous system (ENS) which may mediate visceral hypersensitivity. Our aim was to determine the expression of neuropeptides within the ENS in diverticulitis (study 1) and in patients with symptomatic disease (study 2). Study 1 - Nerves in colonic resection specimens with either acute diverticulitis (AD, n = 16) or chronic diverticulitis (CD, n = 16) were assessed for neuropeptide expression recording % area staining with protein gene product (PGP9.5), substance P (SP), neuropeptide K (NPK), pituitary adenylate cyclase activating polypeptide (PACAP), vasoactive intestinal polypeptide (VIP) and galanin. Study 2 - Seventeen symptomatic and 15 asymptomatic patients with colonic diverticula underwent flexible sigmoidoscopy and multiple peridiverticular mucosal biopsies. Study 1- Neural tissue, as assessed by PGP staining was increased to a similar degree in circular muscle in both AD and CD. The CD specimens showed significant increases in the immunoreactivity of SP, NPK and galanin in both mucosal and circular muscle layer compared with controls. Study 2 - Mucosal histology was normal and PGP9.5 staining was similar between groups however patients with symptomatic diverticular disease demonstrated significantly higher levels of SP, NPK, VIP, PACAP and galanin within the mucosal plexus. Patients with symptomatic diverticular disease exhibit increased neuropeptides in mucosal biopsies which may reflect resolved prior inflammation, as it parallels the changes seen in acute and chronic diverticulitis.},
}
@article {pmid19442033,
year = {2009},
author = {Ojetti, V and Lauritano, EC and Barbaro, F and Migneco, A and Ainora, ME and Fontana, L and Gabrielli, M and Gasbarrini, A},
title = {Rifaximin pharmacology and clinical implications.},
journal = {Expert opinion on drug metabolism & toxicology},
volume = {5},
number = {6},
pages = {675-682},
doi = {10.1517/17425250902973695},
pmid = {19442033},
issn = {1744-7607},
mesh = {*Anti-Bacterial Agents/pharmacokinetics/pharmacology ; Bacterial Infections/drug therapy/microbiology ; Clinical Trials as Topic ; Gastrointestinal Diseases/drug therapy ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; *Rifamycins/pharmacokinetics/pharmacology/therapeutic use ; Rifaximin ; },
abstract = {Rifaximin is a semisynthetic, rifamycin-based non-systemic antibiotic, with a low gastrointestinal absorption and a good antibacterial activity. The antibacterial action covers Gram-positive and Gram-negative organisms, both aerobes and anaerobes. Its antimicrobial action is based on its property to bind to the beta-subunit of bacterial DNA-dependent RNA polymerase inhibiting, thereby, the bacterial RNA synthesis. Rifaximin contributes to restore gut microflora imbalance, becoming an important therapeutic agent in several organic and functional gastrointestinal diseases such as hepatic encephalopathy, small intestine bacterial overgrowth, inflammatory bowel disease and colonic diverticular disease. This antibiotic has the advantage of low microbial resistance and few systemic adverse events and is safe in all patient populations, including young children.},
}
@article {pmid19388565,
year = {2009},
author = {Beuran, M and Iordache, F and Chiotoroiu, AL and Teleanu, G and Vartic, M and Turculeţ, C and Surdeanu, D and Roşu, O},
title = {Complicated diverticular disease--our recent experience.},
journal = {Chirurgia (Bucharest, Romania : 1990)},
volume = {104},
number = {1},
pages = {25-29},
pmid = {19388565},
issn = {1221-9118},
mesh = {Aged ; Aged, 80 and over ; Colectomy/*methods ; Colostomy/*methods ; Diverticulitis, Colonic/complications/diagnosis/mortality/*surgery ; Elective Surgical Procedures ; Emergency Service, Hospital ; Female ; Humans ; Intestinal Perforation/diagnosis/etiology/mortality/*surgery ; *Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Survival Analysis ; Treatment Outcome ; },
abstract = {Diverticular disease is more frequently seen in our practice. The aim of this retrospective study was to evaluate our experience with complicated diverticular disease in our surgical emergency unit. Between 2004-2007 46 cases with complicated diverticular disease were registered in Surgical Emergency Clinical Hospital of Bucharest. A male preponderance (sex ratio M: F 1:1.4) and a medium age of 62.9 +/- 15 years were recorded. Perforation was the main complication encountered and sigmoid colon was the most frequent involved segment (71.7%). Diagnostic procedures relayed especially on CT-scan. Three cases were operated laparoscopically. Failure of conservative measures was the main cause for interventions. A Hartmann procedure was performed in 7 patients (15.2%). Global mortality was 8.1% (4 cases). There were no significant differences among the surgical procedures employed. Diverticular disease is more frequently encountered in our practice. CT-scan is the most efficient diagnostic tool but there are limitations. Conservative measures are not always successful and urgent operative treatment is the only choice. Hartmann procedure is still frequently employed in our practice.},
}
@article {pmid19367267,
year = {2009},
author = {Strate, LL and Liu, YL and Aldoori, WH and Giovannucci, EL},
title = {Physical activity decreases diverticular complications.},
journal = {The American journal of gastroenterology},
volume = {104},
number = {5},
pages = {1221-1230},
pmid = {19367267},
issn = {1572-0241},
support = {P01CA055075/CA/NCI NIH HHS/United States ; P01 CA055075/CA/NCI NIH HHS/United States ; K08 HS014062/HS/AHRQ HHS/United States ; K08 HS14062/HS/AHRQ HHS/United States ; P01 CA055075-09/CA/NCI NIH HHS/United States ; R01 HL035464-13/HL/NHLBI NIH HHS/United States ; R01 HL035464/HL/NHLBI NIH HHS/United States ; },
mesh = {Adult ; Aged ; Cohort Studies ; Diverticulitis, Colonic/epidemiology/*prevention & control ; Diverticulum, Colon/*complications/diagnosis ; *Exercise ; Follow-Up Studies ; Gastrointestinal Hemorrhage/epidemiology/*prevention & control ; Humans ; Incidence ; Life Style ; Male ; Middle Aged ; Motor Activity ; Multivariate Analysis ; *Physical Fitness ; Proportional Hazards Models ; Reference Values ; Risk Assessment ; Severity of Illness Index ; },
abstract = {OBJECTIVES: Little is known about the effect of physical activity on diverticular complications. This study prospectively examined the associations between physical activity and diverticular bleeding and diverticulitis.
METHODS: We studied 47,228 US males in the Health Professionals Follow-up Study cohort who were aged 40-75 years and free of diverticular disease, gastrointestinal cancer, and inflammatory bowel disease at baseline in 1986. Men reporting newly diagnosed diverticular disease on biennial follow-up questionnaires were sent supplemental questionnaires outlining details of diagnosis and treatment. Physical activity was assessed every 2 years. Men recorded the average time per week spent in eight recreational activities, and flights of stairs climbed per day. Cox proportional hazards regression was used to calculate relative risks (RRs).
RESULTS: During 18 years of follow-up, 800 cases of diverticulitis and 383 cases of diverticular bleeding were identified. Total cumulative physical activity was associated with a decreased risk of diverticulitis and diverticular bleeding. After adjustment for potential confounders, the RR for men in the highest quintile of total activity (> or = 57.4 metabolic equivalent hours per week (MET-h/week) was 0.75 (95% confidence interval, CI, 0.58-0.95) for diverticulitis and 0.54 (95% CI, 0.38-0.77) for bleeding, as compared with men in the lowest quintile (< or = 8.2 MET-h/week). Vigorous activity was inversely related to diverticulitis in a high vs. low comparison (multivariable RR, 0.66; 95% CI, 0.51-0.86) and bleeding (multivariable RR, 0.61; 95% CI, 0.41-0.90), whereas nonvigorous activity was not. These results were similar for recent (simple updated) and baseline activity.
CONCLUSIONS: Data from this large prospective cohort suggest that physical activity lowers the risk of diverticulitis and diverticular bleeding. Vigorous activity appears to account for this association.},
}
@article {pmid19346983,
year = {2009},
author = {Williams, PT},
title = {Incident diverticular disease is inversely related to vigorous physical activity.},
journal = {Medicine and science in sports and exercise},
volume = {41},
number = {5},
pages = {1042-1047},
pmid = {19346983},
issn = {1530-0315},
support = {R01 HL072110-02/HL/NHLBI NIH HHS/United States ; R01 DK066738-01/DK/NIDDK NIH HHS/United States ; HL72110/HL/NHLBI NIH HHS/United States ; R01 DK066738-04/DK/NIDDK NIH HHS/United States ; R01 DK066738-02/DK/NIDDK NIH HHS/United States ; DK066738/DK/NIDDK NIH HHS/United States ; R01 HL072110-03/HL/NHLBI NIH HHS/United States ; R01 HL072110-04/HL/NHLBI NIH HHS/United States ; R01 DK066738-03/DK/NIDDK NIH HHS/United States ; R03 AG032004-01A1/AG/NIA NIH HHS/United States ; R03 AG032004/AG/NIA NIH HHS/United States ; R01 DK066738/DK/NIDDK NIH HHS/United States ; R01 HL072110-01A2/HL/NHLBI NIH HHS/United States ; AG032004/AG/NIA NIH HHS/United States ; R01 HL072110/HL/NHLBI NIH HHS/United States ; },
mesh = {Adult ; Aging ; Diverticulitis/*epidemiology/etiology/prevention & control ; Female ; Humans ; Male ; Middle Aged ; Risk Assessment ; Running/*physiology ; Surveys and Questionnaires ; United States/epidemiology ; },
abstract = {PURPOSE: In 1995, the Health Professionals Follow-up Study published an isolated report of lower diverticular disease risk in physically active men, particularly among those who ran. The purpose of this article was to assess whether this finding can be verified among older men and women of the National Runners' Health Study.
METHODS: Survival analyses were applied to incident disease occurring during 7.7 yr of follow-up in 9072 men and 1664 women, representing 84% follow-up of the original >or=50-yr-old cohort. In addition to the usual running distance (km x d(-1)), 80% of the baseline respondents included 10-km footrace performance times (a measure of cardiorespiratory fitness). Results were adjusted for age, sex, and reported intakes of meat, fish, fruit, and alcohol.
RESULTS: A total of 127 men and 21 women reported clinically diagnosed diverticular disease since baseline. The risk for incident diverticular disease decreased 6.2% per km x d(-1) run (P = 0.04). Relative to men and women who ran
CONCLUSION: These results demonstrate an inverse association between vigorous physical activity and incident diverticular disease among older men and women but are limited by their reliance on self-reported physician diagnosis.},
}
@article {pmid19341197,
year = {2009},
author = {Lam, HD and Tinton, N and Cambier, E and Navez, B},
title = {Laparoscopic treatment in acute complicated diverticulitis: a review of 11 cases.},
journal = {Acta chirurgica Belgica},
volume = {109},
number = {1},
pages = {56-60},
doi = {10.1080/00015458.2009.11680372},
pmid = {19341197},
issn = {0001-5458},
mesh = {Algorithms ; Digestive System Surgical Procedures/*methods ; Diverticulitis, Colonic/complications/*surgery ; Drainage ; Feasibility Studies ; Humans ; Intestinal Perforation/etiology/*surgery ; Laparoscopy ; Length of Stay ; Retrospective Studies ; Sigmoid Diseases/complications/*surgery ; Treatment Outcome ; },
abstract = {AIMS: We wanted to test the role of laparoscopy in complicated diverticulitis.
METHODS: All acute complicated sigmoid diverticulitis cases were reviewed during the last 6 years (December 1999 to 2006). Patients whose medical treatment had failed and patients admitted with peritonitis underwent emergency surgery. However, only laparoscopic procedures were included in the study. Patients were programmed 2 to 4 months later for laparoscopic elective colon resection if they underwent first lavage and drainage of the peritoneal cavity.
RESULTS: Eleven patients were treated by laparoscopic procedures out of a total of 37 who underwent emergency surgical therapy for acute perforated diverticulitis. Laparoscopic resection with primary anastomosis was performed in 2 patients (Hinchey I and IIA). Laparoscopic lavage and drainage was performed in the remaining 9 patients (one stage IIA, three stage IIB and five stage III). Three conversions into open Hartmann were needed (stage III). One patient (stage IIB) was lost during follow-up and reappeared 16 months later in general peritonitis. Two patients needed earlier resection because of persistent symptoms. Three remaining patients had a 2nd stage resection at the allocated time. No postoperative death was encountered. Long-term follow-up (mean 6 months) showed one incisional hernia in a converted patient.
DISCUSSION: In perforated diverticular disease, even though laparoscopic lavage and drainage avoids a colostomy and facilitates a 2nd stage resection, few patients have complete resolution of the inflammatory process. Resection remains mandatory after 8 to 12 weeks. In Hinchey stage III, the success rate still remains to be investigated and weighed against the Hartmann procedure or primary resection. Faecal peritonitis and instable patients should not be considered for laparoscopy.},
}
@article {pmid19339891,
year = {2009},
author = {Elphick, DA and Donnelly, MT and Smith, KS and Riley, SA},
title = {Factors associated with abdominal discomfort during colonoscopy: a prospective analysis.},
journal = {European journal of gastroenterology & hepatology},
volume = {21},
number = {9},
pages = {1076-1082},
doi = {10.1097/MEG.0b013e32832357b3},
pmid = {19339891},
issn = {1473-5687},
mesh = {Abdominal Pain/*etiology/prevention & control ; Adult ; Aged ; Aged, 80 and over ; Analgesia ; Clinical Competence ; Colonoscopy/*adverse effects/methods ; Female ; Humans ; Hypnotics and Sedatives/*administration & dosage ; Male ; Midazolam/*administration & dosage ; Middle Aged ; Pain Measurement/methods ; Prospective Studies ; Risk Factors ; Treatment Outcome ; Young Adult ; },
abstract = {OBJECTIVES: Colonoscopy can be uncomfortable. To increase safety, there is a trend, in the UK, towards reduced sedative use. We aimed to determine factors predictive of discomfort during colonoscopy.
METHODS: Prospectively recruited patients were asked to grade anticipated discomfort on a Numeric Rating Scale ranging from 0 to 10. Discomfort scores were recorded every 2 min during the procedure and during peaks of discomfort. An overall discomfort score was recorded.
RESULTS: One hundred and nine patients [44 male, 65 female; median 61.5 (21-80) years] were recruited. One hundred and three procedures were completed. Forty-five patients received midazolam [median 2 (1.5-5) mg]. Mean overall Numeric Rating Scale score was 4.7 (men 4.0; women 5.2; P<0.01) and median peak score 7. Discomfort was usually greatest at the beginning of the procedure, while in the sigmoid colon. Discomfort scores were higher in patients with irritable bowel syndrome (P = 0.03); diverticular disease (P<0.01); midazolam (P = 0.02), buscopan (P<0.001) or nitrous oxide (P<0.001) use; endoscope tracker use (P = 0.01); incomplete procedures (P<0.001) or a preceding gastroscopy (P = 0.02), but were not correlated with discomfort during venous cannulation or digital rectal examination. Multivariate analysis showed that female sex, high anxiety, anticipation of high discomfort, longer intubation time and higher endoscopist's grade of procedural difficulty were independent factors significantly related to overall discomfort scores. Recollected discomfort scores 2-3 months later were lower (P<0.01). Low-dose midazolam had no appreciable amnesic effect.
CONCLUSION: Factors indicative of difficult colonoscopy, and preceding gastroscopy, are associated with greater discomfort, as are the presence of female sex, irritable bowel, anxiety and anticipated discomfort. Low-dose midazolam neither relieves discomfort nor makes patients forget it. Selected patients may benefit from increased analgesia.},
}
@article {pmid19325923,
year = {2009},
author = {Telem, DA and Buch, KE and Nguyen, SQ and Chin, EH and Weber, KJ and Divino, CM},
title = {Current recommendations on diagnosis and management of right-sided diverticulitis.},
journal = {Gastroenterology research and practice},
volume = {2009},
number = {},
pages = {359485},
pmid = {19325923},
issn = {1687-630X},
abstract = {We present the case of a 52-year-old female with recurrent symptomatic ascending colon diverticulitis who ultimately underwent elective laparoscopic right hemicolectomy. The following is a case report and literature review pertaining to right colonic diverticular disease.},
}
@article {pmid19295012,
year = {2008},
author = {Maurer, E and Dănilă, R and Kalinowski, M and Richter, G and Kessler, K and Rothmund, M and Hassan, I},
title = {Open diverticulectomy in a patient with a giant symptomatic retro-pancreatic duodenal diverticulum. A case report.},
journal = {Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi},
volume = {112},
number = {2},
pages = {411-415},
pmid = {19295012},
issn = {0048-7848},
mesh = {Abdominal Pain/etiology ; Aged ; Catheterization ; *Choledochostomy/methods ; Diagnosis, Differential ; Digestive System Surgical Procedures ; Diverticulum/diagnosis/*surgery ; Drainage ; Duodenal Diseases/diagnosis/*surgery ; Female ; Humans ; Intestinal Obstruction/etiology/surgery ; *Pancreas ; Treatment Outcome ; },
abstract = {Although often incidentally found, diverticular disease of the small bowel and duodenum may generate complications and impose surgical treatment. Diagnosis of small bowel diverticulosis is difficult because the clinical picture is usually ambiguous. We report a case of diverticulosis of the whole intestine including a giant symptomatic retro-pancreatic duodenal diverticulum in a 74-year-old patient who presented with recurrent episodes of abdominal pain, weight loss and intestinal obstruction. The diagnosis was made by MRI enteroclysis and endoscopy. Open diverticulectomy with choledochostomy and insertion of a T-tube was performed and resulted in a rapid improvement of the symptoms.},
}
@article {pmid19292776,
year = {2010},
author = {Grant, LA and Griffin, N and Shaw, A},
title = {Two-year audit of computed tomographic colonography in a teaching hospital: are we meeting the standard?.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {12},
number = {4},
pages = {373-379},
doi = {10.1111/j.1463-1318.2009.01824.x},
pmid = {19292776},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonography, Computed Tomographic/*standards ; Female ; Guideline Adherence ; Hospitals, Teaching ; Humans ; Male ; *Medical Audit ; Middle Aged ; Patient Selection ; Practice Guidelines as Topic ; Preoperative Care/standards ; Young Adult ; },
abstract = {OBJECTIVE: We aimed to determine whether adopting the published recommendations has led to successful implementation of computed tomographic colonography (CTC) in a teaching hospital setting outside the context of a clinical trial.
METHOD: An audit of all the CTC examinations between April 2005 and June 2007 was conducted to determine the following: adequacy of bowel preparation, CTC indications and findings (compared with available colonoscopy), complications and experience of reporting radiologist.
RESULTS: The most common indications for the 111 CTC patients reviewed included exclusion of synchronous colonic tumours, incomplete colonoscopy and altered bowel habit. Only 16% of ascending colon/caecal segments was clear of faecal or fluid contamination. The rectum and sigmoid colon were free of contamination in 78% and 74% of cases respectively. Appropriately trained radiologists reported 91% of studies. Thirty-two percent of studies were normal. The most common positive findings were diverticular disease or a rectal tumour. Sensitivity, specificity and positive predictive value were 89%, 94% and 90% respectively (all polyps) with a sensitivity of 98.5% for lesions > 5 mm in size. Twenty-five percent of patients had extra colonic abnormalities. There were no recorded complications.
CONCLUSION: Our CTC practice is within accepted published guidelines. Bowel preparation is suboptimal in a significant proportion of cases and faecal tagging is being implemented.},
}
@article {pmid19279547,
year = {2009},
author = {Sorser, SA and Hazan, TB and Piper, M and Maas, LC},
title = {Obesity and complicated diverticular disease: is there an association?.},
journal = {Southern medical journal},
volume = {102},
number = {4},
pages = {350-353},
doi = {10.1097/SMJ.0b013e31819156fb},
pmid = {19279547},
issn = {1541-8243},
mesh = {Aged ; Body Mass Index ; Case-Control Studies ; Diverticulitis/diagnostic imaging/*etiology ; Female ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Obesity/*complications ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; },
abstract = {OBJECTIVE: Obesity is becoming a growing health concern in the general population. Multiple studies have linked diverticular disease to obesity. Furthermore, recent research has shown fat to be a critical element in the regulation of immunity and the inflammatory response. In this study, we sought to determine if body mass index (BMI) is associated with a higher incidence of complicated diverticulitis.
METHODS: A retrospective review of patients hospitalized with complicated diverticulitis between 1997 and 2006 was conducted. Medical, surgical and CT (Computed Tomography) guided interventions were evaluated in reference to age, gender, BMI and length of hospital stay (LOS).
RESULTS: Charts of 104 controls and 614 patients hospitalized with complicated diverticulitis were reviewed based on specified inclusion and exclusion criteria. There was no significant difference between groups by either gender (P = 0.066) or BMI (P = 0.648). There was a significant difference in age and LOS between three of the analyzed groups. No correlation was noted between BMI and LOS in any of the groups.
DISCUSSION: There has been increasing interest in obesity and its ramifications in all areas of medicine, including diverticular disease. Numerous studies have shown a strong correlation between acute diverticulitis and obesity, particularly in the young population. This study was undertaken to identify a possible link between complicated diverticulitis and obesity. Anecdotal reports and a few studies have found a parallel association. However, in this retrospective study, no correlation was found between BMI and the incidence of complicated diverticulitis.},
}
@article {pmid19274110,
year = {2008},
author = {Mensah, Y and Dakubo, J and Asiamah, S and Naaeder, S},
title = {Outcome of barium enema in patients with colorectal symptoms.},
journal = {Ghana medical journal},
volume = {42},
number = {3},
pages = {113-116},
pmid = {19274110},
issn = {0016-9560},
abstract = {BACKGROUND: For many years, double contrast barium enema has been an effective way to evaluate the large bowel. With the development of the colonoscope, the role of barium enema has been questioned. However it is still useful in investigating patients with colorectal symptoms especially in the developing world where colonoscopy is widely unavailable and fraught with challenges in completely evaluating the colon.
OBJECTIVE: This study aimed at reviewing double contrast barium enema investigations in our centre.
METHODS: This was a retrospective study on patients who underwent double contrast barium enema at the Korle Bu Teaching Hospital from May 2003 to April 2007 on account of symptoms referable to the large bowel.
RESULTS: A total of 362 investigation reports were studied, of which 205 were for males and 154 for females, the mean age of the patients was 55.3 years (S.D 15.3 years). Majority of the investigations, 228 (61.96%), were normal. Diverticular disease diagnosed in 88 (23.91%) cases was the commonest finding, followed by neoplasm 27 (7.34%) cases and Ulcerative colitis 6 (1.63%) cases, non-specific narrowing of the bowel in 4 (1.09%) and in 5 (1.36%) cases their investigations were inconclusive due to poor bowel preparation. Rectal bleeding was the most frequent symptom prompting barium enema studies.
CONCLUSION: Double contrast barium enema study of the large bowel is an important evaluation of patients with colorectal symptoms. .},
}
@article {pmid19273974,
year = {2009},
author = {Tursi, A},
title = {Is elective surgery mandatory after an attack of acute colonic diverticulitis? Some remarks about the new pathophysiology of the diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {52},
number = {1},
pages = {168-169},
doi = {10.1007/DCR.0b013e3181973f6e},
pmid = {19273974},
issn = {1530-0358},
mesh = {Acute Disease ; Colectomy ; Diverticulitis, Colonic/physiopathology/*surgery/therapy ; Humans ; Reoperation ; },
}
@article {pmid19260478,
year = {2008},
author = {Boudart, C and Simoens, Ch and Thill, V and Debergh, N and Smets, D and Mendes da Costa, P},
title = {Management of sigmoid diverticulitis: a retrospective study of 268 patients.},
journal = {Hepato-gastroenterology},
volume = {55},
number = {88},
pages = {2065-2071},
pmid = {19260478},
issn = {0172-6390},
mesh = {Aged ; Colectomy/methods ; Diverticulitis, Colonic/mortality/surgery/*therapy ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/mortality/surgery/*therapy ; },
abstract = {BACKGROUND/AIMS: The therapeutic management of acute diverticulitis has evolved over the last years in favour of an initial conservative approach with laparoscopy rather than a primary anastomosis. We studied the management of sigmoid diverticulitis in the Digestive Surgical Unit to assess it in comparison to actual practice.
METHODOLOGY: A retrospective review of patients admitted to our unit from January 1998 to June 2006 for diverticular disease. We divided the patients into 3 groups (Urgent Medical Group (UM), Urgent Surgical Group (US) and Scheduled Surgical Group (SS)), and analysed demographic data, the severity and recurrence of diverticulitis, pathology results, length of stay, morbidity and mortality.
RESULTS: The mean age was 60.5+/-14.9 years. The overall mortality was 3% (14.5% for the Acute Surgical Group and 0 % for the Elective Surgical Group); overall morbidity 38.4%; the incidence of neoplasm 4.8% in urgent colectomies and 0.9% in scheduled colectomies.
CONCLUSIONS: Based on our study and published reviews, we recommend elective colectomy after 2 recurrent episodes of acute diverticulitis, one episode of complicated acute diverticulitis managed conservatively, or if the patient is younger than 50 years-old. This approach would reduce the number of acute operations, which are associated with high morbidity and mortality.},
}
@article {pmid19258991,
year = {2009},
author = {Kapala, M and Meterissian, S and Schricker, T},
title = {Neuraxial anesthesia and intraoperative bilevel positive airway pressure in a patient with severe chronic obstructive pulmonary disease and obstructive sleep apnea undergoing elective sigmoid resection.},
journal = {Regional anesthesia and pain medicine},
volume = {34},
number = {1},
pages = {69-71},
doi = {10.1097/AAP.0b013e31819266b2},
pmid = {19258991},
issn = {1532-8651},
mesh = {Analgesia, Epidural/methods ; *Anesthesia, Epidural ; *Anesthesia, Spinal ; Anesthetics, Local/administration & dosage ; Appendectomy ; Bupivacaine/administration & dosage ; *Colectomy ; *Continuous Positive Airway Pressure ; Elective Surgical Procedures ; Humans ; Hypnotics and Sedatives/administration & dosage ; Infusions, Intravenous ; Intraoperative Care ; Ketamine/administration & dosage ; Lumbar Vertebrae ; Male ; Middle Aged ; Pain, Postoperative/prevention & control ; Pulmonary Disease, Chronic Obstructive/*complications ; Severity of Illness Index ; Sigmoid Diseases/complications/*surgery ; Sleep Apnea, Obstructive/*complications/therapy ; Thoracic Vertebrae ; Treatment Outcome ; },
abstract = {OBJECTIVE: This case report describes the anesthetic management of a patient with severe chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) who underwent elective sigmoid resection under combined spinal-epidural anesthesia and bilevel positive airway pressure (BiPAP).
CASE REPORT: A 63-year-old man with diverticular disease presented for a sigmoid resection. His medical history included coronary artery bypass grafting, diabetes mellitus, gastroesophageal reflux, chronic renal failure, COPD, a paralyzed left hemidiaphragm, and OSA treated with nighttime BiPAP and oxygen. Sigmoid resection was performed under combined lumbar spinal-thoracic epidural anesthesia without general anesthesia and/or endotracheal intubation (intrathecal 3.5 mL isobaric bupivacaine 0.5% with 100 microg epinephrine and 200 microg morphine [Epimorph], epidural 60 mg bupivacaine, and 200 mg lidocaine). Intravenous ketamine was administered at a rate between 30 and 50 mg/h. Intraoperative BiPAP was applied using a setting of 12.5/8mm Hg with a backup ventilation rate of 10 breaths/min and an oxygen flow of 4 L/min. After surgery, epidural bupivacaine (0.1%) was infused over 3 days at 10 ml/hr supplemented with oral acetaminophen, resulting in excellent pain relief. Postoperatively, the patient continued to use BiPAP when sleeping, and no adverse respiratory events were observed. The patient was discharged home 5 days after surgery.
CONCLUSION: Combined spinal-epidural anesthesia was successfully used in a patient with COPD and OSA undergoing sigmoid resection. Perioperative administration of BiPAP, excellent pain control by continuous epidural infusion of local anesthetic, and the avoidance of endotracheal intubation may have contributed to this patient's uncomplicated postoperative course.},
}
@article {pmid19253874,
year = {2009},
author = {Zinzindohoué, F and Samama, G},
title = {[Colonic diverticulosis: which patients need surgery?].},
journal = {La Revue du praticien},
volume = {59},
number = {1},
pages = {16-19},
pmid = {19253874},
issn = {0035-2640},
mesh = {Age of Onset ; Colectomy/instrumentation/*methods ; Diverticulosis, Colonic/epidemiology/*surgery ; Diverticulum, Colon/pathology/surgery ; Hemorrhage/surgery ; Humans ; Incidence ; *Patient Selection ; },
abstract = {Diverticular disease has become a very common condition in elder and more recently in younger patients in western countries that emerged at the turn of the 20th century and since then has become epidemic. An increasing incidence and an earlier onset of the disease lead us to update the current therapeutic indications, especially for surgery in elective condition. Whereas elective colectomy was performed for poorly documented suspicions of diverticulitis in the past, a positive diagnosis of diverticulitis on CT scan is needed. Therefore, indications for colectomy are restricted to patients with medical history of related endocarditis, diabetes mellitus, proven structural abnormalities of collagen, immune deficiency, after a second episode of diverticulitis requiring at least an hospitalisation or after a single complicated diverticulitis (abscess, fistula, stricture). A two-months delay between symptoms and surgery is suitable, and permits to perform preoperatively a colonoscopy in a safe condition to rule out concomitant adenoma or colonic cancer. There is no randomised trial of open versus laparoscopic colectomy in this specific indication. As the lesions of resected colon became more severe due to restricted indications, laparoscopic approach will require more surgical skill and conversion rate might increase. In selected cases, open surgery should be preferred.},
}
@article {pmid19247058,
year = {2009},
author = {Barry, M},
title = {Laparoscopic resection for diverticular disease follow-up of 500 consecutive patients.},
journal = {Annals of surgery},
volume = {249},
number = {3},
pages = {548-9; author reply 549},
doi = {10.1097/SLA.0b013e31819ac5f5},
pmid = {19247058},
issn = {1528-1140},
mesh = {Diverticulum/*surgery ; Elective Surgical Procedures ; Humans ; *Laparoscopy ; Recurrence ; },
}
@article {pmid19244147,
year = {2009},
author = {Sheth, A and Floch, M},
title = {Probiotics and diverticular disease.},
journal = {Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition},
volume = {24},
number = {1},
pages = {41-44},
doi = {10.1177/0884533608329230},
pmid = {19244147},
issn = {0884-5336},
mesh = {Diverticulosis, Colonic/*drug therapy ; Diverticulum/*drug therapy ; Humans ; Inflammatory Bowel Diseases/drug therapy ; Intestinal Mucosa/microbiology ; Irritable Bowel Syndrome/drug therapy ; Probiotics/adverse effects/*therapeutic use ; },
abstract = {Diverticular disease is one of the most common medical conditions affecting Western populations. Inflammatory complications are the most common manifestation of the disease and typically cause acute bouts of abdominal pain and fever. Chronic symptoms can also occur and can be mistakenly attributed to irritable bowel syndrome and rarely to inflammatory bowel disease. Alterations in peridiverticular bacterial flora are thought to play a role in the pathogenesis of diverticular inflammation. This article discusses the rationale and reviews the existing clinical data regarding the role of probiotics in the management of diverticular disease.},
}
@article {pmid19212172,
year = {2009},
author = {Etzioni, DA and Mack, TM and Beart, RW and Kaiser, AM},
title = {Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment.},
journal = {Annals of surgery},
volume = {249},
number = {2},
pages = {210-217},
doi = {10.1097/SLA.0b013e3181952888},
pmid = {19212172},
issn = {1528-1140},
mesh = {Acute Disease ; Adolescent ; Adult ; Aged ; Cohort Studies ; Colectomy ; Diverticulitis, Colonic/*epidemiology/surgery ; Female ; Humans ; Incidence ; Male ; Middle Aged ; United States/epidemiology ; Young Adult ; },
abstract = {OBJECTIVES: Diverticular disease imposes an impressive clinical burden to the United States population, with over 300,000 admissions and 1.5 million days of inpatient care annually. Consensus regarding the treatment of diverticulitis has evolved over time, with increasing advocacy of primary anastomosis for acute diverticulitis, and nonoperative treatment of recurrent mild/moderate diverticulitis. We analyzed whether these changes are reflected in patterns of practice in a nationally-representative patient cohort.
METHODS: We used the 1998 to 2005 nationwide inpatient sample to analyze the care received by 267,000 patients admitted with acute diverticulitis, and 33,500 patients operated electively for diverticulitis. Census data were used to calculate population-based incidence rates of disease and surgical treatment. Weighted logistic regression with cluster adjustment at the hospital level was used for hypothesis testing.
RESULTS: Overall annual age-adjusted admissions for acute diverticulitis increased from 120,500 in 1998 to 151,900 in 2005 (26% increase). Rates of admission increased more rapidly within patients aged 18 to 44 years (82%) and 45 to 74 years (36%). Elective operations for diverticulitis rose from 16,100 to 22,500 per year during the same time period (29%), also with a more rapid increase (73%) in rates of surgery for individuals aged 18 to 44 years. Multivariate analysis found no evidence that primary anastomosis is becoming more commonly used.
CONCLUSIONS: We are the first to report dramatic changes in rates of treatment for diverticulitis in the United States. The causes of this emerging disease pattern are unknown, but certainly deserve further investigation. For patients undergoing surgery for acute diverticulitis, there was little change over time in the likelihood of a primary anastomosis.},
}
@article {pmid19208318,
year = {2009},
author = {Wild, JR and Shiwani, MH and Ullah, Q},
title = {Jejunal diverticulitis.},
journal = {Journal of the College of Physicians and Surgeons--Pakistan : JCPSP},
volume = {19},
number = {2},
pages = {120-122},
pmid = {19208318},
issn = {1022-386X},
mesh = {Aged ; Anti-Infective Agents/therapeutic use ; Cefuroxime/therapeutic use ; Diagnosis, Differential ; Diverticulitis/complications/*diagnostic imaging/therapy ; Fluid Therapy ; Humans ; Jejunal Diseases/complications/*diagnostic imaging/therapy ; Male ; Metronidazole/therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {Although uncommon, jejunoileal diverticula are associated with significant morbidity and mortality. Both acute and chronic symptoms can be varied and non-specific, making jejunoileal diverticular disease a diagnostic and therapeutic challenge. We report a case of jejunal diverticular disease, complicated by acute diverticulitis, in a 75-year-old male who was successfully treated with conservative approach. The non-surgical approach was enabled by early assessment with multislice CT and active close observation.},
}
@article {pmid19190921,
year = {2009},
author = {Antolovic, D and Reissfelder, C and Koch, M and Mertens, B and Schmidt, J and Büchler, MW and Weitz, J},
title = {Surgical treatment of sigmoid diverticulitis--analysis of predictive risk factors for postoperative infections, surgical complications, and mortality.},
journal = {International journal of colorectal disease},
volume = {24},
number = {5},
pages = {577-584},
pmid = {19190921},
issn = {1432-1262},
mesh = {Aged ; Colon, Sigmoid/*surgery ; Diverticulitis/*mortality/*surgery ; Female ; Germany/epidemiology ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/*mortality ; Risk Factors ; },
abstract = {BACKGROUND AND AIMS: Sigmoid diverticular disease has great clinical importance due to its increasing incidence in the Western world and a broad spectrum of clinical features with potential fatal complications after surgery. The definition of risk factors associated with postoperative infections, surgical complications and mortality could be helpful in clinical decision-making and optimizing perioperative treatment.
MATERIALS AND METHODS: Based on a prospective database, 168 consecutive patients undergoing surgery for sigmoid diverticulitis were included in this study. The association of different potential risk factors such as age, Hinchey classification, type and duration of operation, surgeons' experience, blood loss, comorbidities, and hospital course with perioperative complications and mortality were tested by univariate and multivariate analysis.
RESULTS: Of the 168 patients enrolled in this study, there were 84 male and 84 female. A third of patients were operated as emergency cases (within 24 h after surgical evaluation); 62% underwent open surgery, 35% were treated laparoscopically with a conversion rate of 3%. A blood transfusion received 14% of patients, a surgical infection occurred in 20%, surgical complications appeared in 24% with a necessity for re-exploration in 9.5%. Leakage of the primary anastomosis was seen in 3.3%, whereas a leakage of the Hartmann's stump occurred in 4.3%. Overall in-hospital mortality was 4.1%. Multivariate analysis demonstrated Hinchey classification and intraoperative blood transfusion to be independently associated with postoperative infections, complications and mortality.
CONCLUSION: Hinchey classification and intraoperative blood transfusion are independently associated with a worse perioperative outcome in patients undergoing surgery for sigmoid diverticular disease. While Hinchey classification cannot be influenced per se by the surgeon, outcome might be influenced by reducing the need for intraoperative blood transfusion.},
}
@article {pmid19185583,
year = {2009},
author = {Humes, DJ and Solaymani-Dodaran, M and Fleming, KM and Simpson, J and Spiller, RC and West, J},
title = {A population-based study of perforated diverticular disease incidence and associated mortality.},
journal = {Gastroenterology},
volume = {136},
number = {4},
pages = {1198-1205},
doi = {10.1053/j.gastro.2008.12.054},
pmid = {19185583},
issn = {1528-0012},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Cohort Studies ; Diverticulum, Colon/*mortality ; Family Practice/statistics & numerical data ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intestinal Perforation/*mortality ; Male ; Middle Aged ; Poisson Distribution ; Population Surveillance ; Regression Analysis ; Retrospective Studies ; United Kingdom/epidemiology ; Young Adult ; },
abstract = {BACKGROUND & AIMS: Perforated diverticular disease represents the most serious complication of diverticular disease, but little is known regarding its occurrence and mortality. We aimed to determine the incidence and mortality associated with diverticular perforation and the influence of comorbidity.
METHODS: We used a population-based cohort study using patients with perforated diverticular disease and population controls identified from 1990 to 2005 in the General Practice Research Database (GPRD). Incidence and mortality rates were modelled using Poisson and Cox regression. Comorbidity was quantified using the Charlson index.
RESULTS: We identified 953 incident patients. The overall incidence was 2.66 (95% confidence interval [CI]: 2.49-2.83) per 100,000 person-years. The incidence rates increased 2.28-fold (95% CI: 1.79-2.95) when corrected for age and sex between 1990 and 2005. The risk of death was highest in the first year with a 6-fold increase (hazard ratio [HR], 5.63; 95% CI: 4.68-6.77). Adjusted for age and sex, the risk of death in the first year was highest in those with lowest comorbidity (HR, 11.11; 95% CI: 8.06-15.31), but the absolute mortality rates were greatest in those with the highest comorbidity (263.1 per 1000 person-years).
CONCLUSIONS: The incidence of perforated diverticular disease has doubled over the period of the study. Patients presenting with a perforated diverticulum are 6 times more likely to die than the general population during the first year following perforation. Those who have the greatest comorbidity are the most likely to die; however, those with least comorbidity have an 11-fold increase in mortality in the first year.},
}
@article {pmid19183536,
year = {2008},
author = {Muscari, F and Suc, B and Msika, S and Hay, JM and Flamant, Y and Fourtanier, G and Güller, U and Lorimier, G and Dziri, C and Fingerhut, A and , },
title = {Surgeon-dependent predictive factors for mortality after elective colorectal resection and immediate anastomosis for cancer or nonacute diverticular disease: multivariable analysis of 2,605 patients.},
journal = {Journal of the American College of Surgeons},
volume = {207},
number = {6},
pages = {888-895},
doi = {10.1016/j.jamcollsurg.2008.07.012},
pmid = {19183536},
issn = {1879-1190},
mesh = {Aged ; Anastomosis, Surgical/mortality ; Colectomy/*mortality ; Colorectal Neoplasms/*surgery ; Diverticulosis, Colonic/*surgery ; Elective Surgical Procedures/mortality ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Prospective Studies ; Risk Factors ; Survival Analysis ; },
abstract = {BACKGROUND: Multivariable analysis best identifies independent risk factors.
STUDY DESIGN: We conducted a prospective evaluation of 2,605 patients through univariate analysis followed by nonconditional multiple logistic regression analysis on 39 pre-, intra-, and postoperative factors, analyzed according to preoperative factors alone, preoperative and intraoperative factors together, and all 3 combined. The purpose was to identify surgeon-dependent independent risk factors for mortality after elective colorectal surgery, with immediate anastomosis for cancer and nonacute diverticular disease.
RESULTS: Overall mortality was 3.5%. Through multivariable analysis, five risk factors were found when preoperative data were analyzed alone. Four remained (age between 60 and 75 years, age greater than 75 years, male gender, and heart failure) and 4 new factors (palliative resection, total colectomy, respiratory failure, and surgeon-dependent fecal soiling [the only surgeon-dependent factor]) appeared when pre- and intraoperative factors were analyzed together. Of the latter, two remained stable when all three categories of risk factors were combined and analyzed (palliative resection and total colectomy), and the two others disappeared. Of the eight pre-, intra-, and postoperative factors combined, two new factors appeared: extrasurgical site (ESS) and surgeon-dependent, organ space surgical site (O/SSS) morbidity.
CONCLUSIONS: Every effort must be made to collect specific, surgeon-dependent (technical and clinical) data, along with administrative data, for multivariable analysis of risk factors. Classification into three periods (pre-, pre- and intraoperative together, and pre-, intra-, and postoperative combined) enables determination of relevant, surgeon-dependent risk factors (fecal soiling and postoperative morbidity) for which there are direct preventive actions.},
}
@article {pmid19179887,
year = {2009},
author = {Garcia, MA and Kling, KM and Newbury, RO and Huang, JS},
title = {Complicated diverticular disease in a child with williams syndrome.},
journal = {Journal of pediatric gastroenterology and nutrition},
volume = {48},
number = {2},
pages = {233-236},
doi = {10.1097/MPG.0b013e31815c3b1b},
pmid = {19179887},
issn = {1536-4801},
mesh = {Adolescent ; Anastomosis, Surgical/*methods ; Diverticulitis, Colonic/*diagnosis/*surgery ; Humans ; Male ; Surgical Staplers ; Tomography, X-Ray Computed ; Treatment Outcome ; Williams Syndrome/*complications ; },
}
@article {pmid19178725,
year = {2009},
author = {Kazimi, M and Ulas, M and Ibis, C and Unver, M and Ozsan, N and Yilmaz, F and Ersoz, G and Zeytunlu, M and Kilic, M and Coker, A},
title = {A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma.},
journal = {World journal of emergency surgery : WJES},
volume = {4},
number = {},
pages = {5},
pmid = {19178725},
issn = {1749-7922},
abstract = {Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare.We present a 25-year-old female who was admitted to the emergency room with recurrent lower gastrointestinal bleeding. An intraluminal bleeding mass inside the small intestinal segment was detected during explorative laparotomy as the cause of the recurrent lower gastrointestinal bleeding. After partial resection of small bowel segment, the histopathologic examination revealed a cavernous hemagioma of mesenteric origin.Although rare, gastrointestinal hemangioma should be thought in differential diagnosis as a cause of recurrent lower gastrointestinal bleeding.},
}
@article {pmid19175627,
year = {2009},
author = {Saha, AK and Tapping, CR and Foley, GT and Baker, RP and Sagar, PM and Burke, DA and Sue-Ling, HM and Finan, PJ},
title = {Morbidity and mortality after closure of loop ileostomy.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {11},
number = {8},
pages = {866-871},
doi = {10.1111/j.1463-1318.2008.01708.x},
pmid = {19175627},
issn = {1463-1318},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anemia/complications ; Female ; Humans ; Hypoalbuminemia/complications ; Ileostomy/*adverse effects/*mortality ; Male ; Middle Aged ; Reoperation/statistics & numerical data ; Retrospective Studies ; United Kingdom/epidemiology ; Young Adult ; },
abstract = {BACKGROUND: A temporary loop ileostomy is commonly used to protect low pelvic anastomoses. Closure is associated with morbidity and mortality. This study investigated patterns of complications after loop ileostomy closure and factors associated with morbidity and mortality.
METHOD: A review was performed of patients who underwent loop ileostomy closure between 1999 and 2005.
RESULTS: Three hundred and twenty-five patients underwent closure of loop ileostomy. Reasons for primary surgery were: anterior resection for cancer (n = 160, 49%), ileal pouch-anal anastomosis (n = 114, 35%), diverticular disease (n = 25, 8%), Crohn's colitis (n = 4, 1%) and other conditions (n = 22, 7%). Overall mortality was 2.5% (n = 8) and morbidity was 22.8% (n = 74). Thirty-two patients (10%) developed small bowel obstruction, of whom seven required operative intervention. Overall, the re-operation rate in this series was 28 patients (8.6%). Thirteen (4%) patients had an anastomotic leak of whom 12 patients had re-operation. Preoperative anaemia was significantly associated with leakage (Hb < 11 g/dl; n = 65, P = 0.033). The leakage rate was lower after a stapled anastomosis than a hand-sutured anastomosis (4/203 vs 9/122; P = 0.039). Hypo-albuminaemia (albumin < 34 g/l) was significantly associated with mortality (n = 46, P < 0.001).
CONCLUSIONS: Loop ileostomy closure is associated with morbidity and mortality. Anaemia and hypo-albuminaemia may be associated with poor outcome.},
}
@article {pmid19174809,
year = {2009},
author = {Festi, D and Colecchia, A},
title = {Mesalazine and rifaximin in symptomatic uncomplicated diverticular disease.},
journal = {The American journal of gastroenterology},
volume = {104},
number = {2},
pages = {532},
doi = {10.1038/ajg.2008.53},
pmid = {19174809},
issn = {1572-0241},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulitis/*drug therapy ; Diverticulum, Colon/*drug therapy ; Gastrointestinal Agents/*therapeutic use ; Humans ; Mesalamine/*therapeutic use ; Rifamycins/*therapeutic use ; Rifaximin ; },
}
@article {pmid19159054,
year = {2009},
author = {Shobeiri, SA and Quiroz, L and Nihira, M},
title = {Rectovaginal fistulography: a technique for the identification of recurrent elusive fistulas.},
journal = {International urogynecology journal and pelvic floor dysfunction},
volume = {20},
number = {5},
pages = {571-573},
pmid = {19159054},
mesh = {Adult ; Catheterization ; *Contrast Media ; Female ; Fluoroscopy ; Humans ; Radiography, Interventional/*methods ; Rectovaginal Fistula/*diagnostic imaging/surgery ; Recurrence ; Retrospective Studies ; },
abstract = {INTRODUCTION AND HYPOTHESIS: The purpose of this study is to review our experience with a technique for diagnosing small rectovaginal fistulas that occasionally permit passage of air or mucus.
METHODS: During an in-office visit suspicious areas of the vagina were probed with a cone-tip catheter and injected with a contrast dye to visualize the suspected fistula tract communicating to the rectum under fluoroscopic guidance. The fistulous tracts were further isolated using a flexi-tip glide wire.
RESULTS: Five out of nine patients were found to have fistulas not diagnosed by other means. Three patients had recurrent rectovaginal fistula after a vaginal delivery, one patient was identified with a high rectovaginal fistula due to diverticular disease, and one patient had a rectovaginal fistula due to prior hemorrhoidectomy. One patient had a negative test, and the fistula that was diagnosed intraoperatively was due to underlying Crohn's disease.
CONCLUSION: Direct fistulography is a useful technique to visualize otherwise elusive symptomatic rectovaginal fistula tracts.},
}
@article {pmid19152450,
year = {2009},
author = {Jansen, A and Harenberg, S and Grenda, U and Elsing, C},
title = {Risk factors for colonic diverticular bleeding: a Westernized community based hospital study.},
journal = {World journal of gastroenterology},
volume = {15},
number = {4},
pages = {457-461},
pmid = {19152450},
issn = {2219-2840},
support = {R24 CA095823/CA/NCI NIH HHS/United States ; },
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Antihypertensive Agents/adverse effects ; Arteriosclerosis/complications ; Diverticulum, Colon/*etiology ; Female ; Gastrointestinal Hemorrhage/*radiotherapy ; Germany ; Hospitals, Community ; Humans ; Male ; Middle Aged ; Risk Factors ; },
abstract = {AIM: To evaluate the risk factors-other than nonsteroidal anti-inflammatory drugs-for colonic diverticular bleeding in a westernized population.
METHODS: One hundred and forty patients, treated for symptomatic diverticular disease in a community based hospital, were included. Thirty (21%) had signs of diverticular bleeding. Age, gender, and the results of colonoscopy were collected and compared to a group of patients with nonbleeding symptomatic diverticulosis. Records were reviewed for comorbidities, such as obesity, alcohol consumption, smoking habits and metabolic diseases. Special emphasis was put on arterial hypertension, cardiovascular events, diabetes mellitus, hyperuricemia and hypercholesterinemia.
RESULTS: There was no difference between patients with diverticular hemorrhage and those with nonbleeding symptomatic diverticulosis regarding gender ratio (male/female 9/21 vs 47/63) and diverticular localisation. Bleeding patients differed in respect to age (73.4+/-9.9 vs 67. 8+/-13.0, P<0.013). Significant differences were found between both groups regarding the presence of hyperuricemia and use of steroids and nonsteroidal anti-inflammatory drugs. Patients with three concomitant metabolic diseases were also identified as being at risk of bleeding. A forward stepwise logistic regression analysis revealed steroids, hyperuricemia and the use of calcium-channel blockers as independent risk factors of bleeding.
CONCLUSION: Beside nonsteroidal anti-inflammatory steroid drug use, antihypertensive medication and concomitant arteriosclerotic diseases are risk factors for colonic diverticular hemorrhage. Our results support the hypothesis of an altered arteriosclerotic vessel as the source of bleeding.},
}
@article {pmid19148463,
year = {2009},
author = {Loktionov, A and Bandaletova, T and Llewelyn, AH and Dion, C and Lywood, HG and Lywood, RC and Rockall, TA and Stebbing, JF and Broughton, M and Caffarey, S and Marks, CG},
title = {Colorectal cancer detection by measuring DNA from exfoliated colonocytes obtained by direct contact with rectal mucosa.},
journal = {International journal of oncology},
volume = {34},
number = {2},
pages = {301-311},
pmid = {19148463},
issn = {1019-6439},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/pathology ; Colon, Sigmoid/pathology ; Colorectal Neoplasms/*diagnosis/*genetics/pathology ; DNA Primers ; DNA, Neoplasm/*analysis ; Female ; Humans ; Intestinal Mucosa/*pathology ; Intestinal Polyps/pathology ; Male ; Middle Aged ; Neoplasm Staging ; Polymerase Chain Reaction ; ROC Curve ; Rectum/*pathology ; Sensitivity and Specificity ; },
abstract = {The purpose of the study was to explore the potential of direct exfoliated colonocyte collection from human rectal mucosa for colorectal cancer screening. A special device was designed for standardized collection of exfoliated cells from the surface of human rectal mucosa. Material was collected from 120 outpatients selected for colonoscopy and 36 patients with confirmed diagnosis of colorectal cancer or large polyps. Determination of total DNA amounts in the collected samples (DNA scores) by PicoGreen assay and real-time PCR was employed alongside cytological assessment. Well preserved cells with cytological patterns characteristic for different colorectal conditions (cancer, inflammatory bowel disease) were detected in the collected material. In the outpatient group DNA scores were higher in patients with cancer and inflammatory bowel disease compared to those with no abnormalities detected, diverticular disease and small polyps (P<0.001 for PicoGreen assay; P=0.002 for real-time PCR). The sensitivity and specificity of the quantitative DNA test (PicoGreen assay; cut-off point 3.0 microg/ml) for detecting serious colorectal conditions were 1.00 and 0.74, respectively. In the group with confirmed tumours, the PicoGreen assay performed better for distal colorectal cancer (sensitivity 0.83; specificity 0.76) compared with proximal colon malignancies (sensitivity 0.57; specificity 0.76). It can be concluded that the proposed technique of direct collection of exfoliated cells from the surface of human rectal mucosa provides abundant cellular material suitable for diagnostic and research applications. Further refinement of the quantitative DNA test may lead to a new approach for colorectal cancer early detection and screening.},
}
@article {pmid19147627,
year = {2009},
author = {Chetty, R and Hafezi, S and Montgomery, E},
title = {An incidental enterocolic lymphocytic phlebitis pattern is seen commonly in the rectal stump of patients with diversion colitis superimposed on inflammatory bowel disease.},
journal = {Journal of clinical pathology},
volume = {62},
number = {5},
pages = {464-467},
doi = {10.1136/jcp.2008.063917},
pmid = {19147627},
issn = {1472-4146},
mesh = {Adolescent ; Adult ; Aged ; Cohort Studies ; Colectomy/adverse effects ; Colitis/etiology/*pathology ; Female ; Humans ; Ileostomy/*adverse effects ; Inflammatory Bowel Diseases/*pathology/surgery ; Male ; Middle Aged ; Phlebitis/etiology/*pathology ; Rectum/*blood supply ; Young Adult ; },
abstract = {AIMS: Enterocolic lymphocytic phlebitis (ELP) is an uncommon cause of bowel pathology and most frequently results in ischaemia. It is characterised by an artery-sparing, venulocentric lymphoid infiltrate that causes a phlebitis and vascular compromise. Rare cases of ELP have been encountered with lymphocytic colitis in the absence of ischaemic bowel change. The present study examined the occurrence of ELP in the setting of diversion colitis and inflammatory bowel disease, as well as in random colectomy specimens.
METHODS: The study cohort comprised the following: 26 completion proctectomy specimens for ulcerative colitis with superimposed diversion colitis in the rectal stump; 3 colectomy specimens for Crohn disease with diversion colitis; 6 colectomy specimens for adenocarcinoma and/or diverticular disease with diversion colitis; 34 resection specimens with ulcerative colitis only; 19 with Crohn disease only; and 100 random colon resection specimens for adenocarcinoma, adenoma, diverticular disease and ischaemia.
RESULTS: ELP was present in 18 of the 26 ulcerative colitis cases with diversion colitis, 3/3 Crohn disease cases with diversion colitis, 1/6 cases of diverticular disease with diversion colitis, 6/34 cases of ulcerative colitis without diversion, 2/19 Crohn disease cases without diversion colitis, and only 1 of 100 colectomy cases without inflammatory bowel disease or diversion colitis.
CONCLUSION: ELP occurs most frequently in cases that have been diverted for inflammatory bowel disease. Fewer cases of ELP were noted in cases of inflammatory bowel disease in the absence of diversion colitis. It is postulated that altered bowel flora and immune dysregulation may be pivotal in the causation of this association.},
}
@article {pmid19120008,
year = {2009},
author = {Ooi, K and Wong, SW},
title = {Management of symptomatic colonic diverticular disease.},
journal = {The Medical journal of Australia},
volume = {190},
number = {1},
pages = {37-40},
doi = {10.5694/j.1326-5377.2009.tb02262.x},
pmid = {19120008},
issn = {0025-729X},
mesh = {Anti-Bacterial Agents/therapeutic use ; Bed Rest ; Colectomy/*methods ; Diverticulitis, Colonic/drug therapy/physiopathology/*surgery ; Diverticulum/drug therapy/epidemiology/physiopathology ; Humans ; },
abstract = {There are controversies surrounding the indications, time and place for elective surgery, and role of multistage operations in the treatment of complicated diverticular disease. Most patients with uncomplicated diverticulitis can be managed non-operatively. Previous indications for elective surgery after two attacks of diverticulitis have been questioned. Evidence that patients are less likely to respond to medical therapy in subsequent attacks of diverticulitis is lacking. Decisions should be based on individual circumstances. The Hartmann procedure remains a safe option for patients with free perforation and generalised peritonitis. In experienced hands, a one-stage procedure can be as successful as a two-stage procedure in an emergency setting in selected patients. When possible, an operation should be converted from an emergency to a semi-elective one using techniques such as radiologically or laparoscopically guided drainage of collections.},
}
@article {pmid21977059,
year = {2009},
author = {Rees, JR and Burgess, P},
title = {Conservative management of complex diverticular disease causing a retroperitoneal perforation.},
journal = {BMJ case reports},
volume = {2009},
number = {},
pages = {},
pmid = {21977059},
issn = {1757-790X},
abstract = {Diverticular disease is very common and may cause symptoms of psoas irritation because of contiguous inflammation arising from the colon affecting the retroperitoneum. Retroperitoneal perforation is rare and is marked by free gas in the adjacent musculature. Rarely infection and associated gas may track into the lower limbs; however, if adequate drainage can be achieved, surgery in the unfit may be avoided. We present a case of a 79-year-old woman with retroperitoneal perforation of diverticular disease presenting with free gas in the leg musculature that was managed conservatively because of associated comorbidities and was associated with the formation of a cutaneous faecal fistula in the lower limb.},
}
@article {pmid21853872,
year = {2009},
author = {Pasternak, A and Kosowski, K and Walocha, JA},
title = {[Small bowel diverticula as a cause of massive gastrointestinal bleeding--case report].},
journal = {Folia medica Cracoviensia},
volume = {50},
number = {3-4},
pages = {63-69},
pmid = {21853872},
issn = {0015-5616},
mesh = {Diverticulum/*complications/diagnosis/surgery ; Female ; Gastrointestinal Hemorrhage/diagnosis/*etiology/*surgery ; Humans ; Intestinal Diseases/*complications/diagnosis/surgery ; *Intestine, Small ; Middle Aged ; Treatment Outcome ; },
abstract = {Jejunoileal diverticula are rare and often asymptomatic. However, they may lead to complications that manifest clinically with symptoms of acute abdomen. Diagnosis of complicated diverticular disease is difficult and depends on the result of surgical exploration. Resection and primary end-to-end anastomosis is the preferred method of treatment. The case of a 60-year old woman with a massive small bowel hemorrhage due to diverticular disease is described.},
}
@article {pmid21709836,
year = {2009},
author = {Hamid, UI and Khattak, S},
title = {Bleeding small bowel diverticulosis.},
journal = {BMJ case reports},
volume = {2009},
number = {},
pages = {},
pmid = {21709836},
issn = {1757-790X},
abstract = {Diverticular disease affecting the small bowel, specifically the jejunum, is rare with an incidence of 1-2% in the general population. We report a case of a 67-year-old man who presented with clinical signs and symptoms suggesting peptic ulcer disease, but complications resulting from small bowel diverticular disease should be borne in mind as they may mimic the above pathology. The diagnosis of small bowel diverticulosis can often be challenging in someone who presents or develops massive gastrointestinal bleed, and in these cases a prompt diagnosis is of the utmost importance. The best line of treatment in these cases would be a laparascopic assisted exploration or an exploratory laparotomy with resection of the lesion and primary anastomosis.},
}
@article {pmid21687014,
year = {2009},
author = {Jones, GH and Kalaher, HR},
title = {Diverticular disease presenting as subcutaneous emphysema of the thigh.},
journal = {BMJ case reports},
volume = {2009},
number = {},
pages = {},
pmid = {21687014},
issn = {1757-790X},
abstract = {A normally fit and well 79-year-old lady presented acutely confused and shocked after a few months history of atypical left-sided back and thigh pain. She was unable to tolerate movement of her left leg and soft tissue crepitus was palpable over her thigh. Emergency incision and drainage of the leg was performed with intraoperative swabs growing Streptococcusmilleri and coliforms. Postoperatively, in the Intensive Care Unit (ICU) deep faecal contamination of the wound was noted. Contrast imaging revealed severe diverticular disease and colocutaneous fistula. Abdominal examination was unremarkable throughout her admission and initial CT scan had not revealed the underlying pathology. A defunctioning colostomy was fashioned and after a prolonged period of rehabilitation the patient returned to being functionally independent.},
}
@article {pmid21686866,
year = {2009},
author = {Dowling, CM and Floyd, MS and Power, RE and Hyland, JM and Quinlan, DM},
title = {Ureterocolic fistula in the presence of a solitary kidney.},
journal = {BMJ case reports},
volume = {2009},
number = {},
pages = {},
pmid = {21686866},
issn = {1757-790X},
abstract = {Among the entero-urinary fistulae, those between the ureter and colon are rare. Most spontaneous ureterocolic fistulae are caused by urinary calculi. We report a case of a spontaneous ureterocolic fistula which occurred as a consequence of diverticular disease. This rare presentation was further complicated as it occurred in the presence of a solitary kidney. The patient underwent a laparoscopic defunctioning loop ileostomy and after 6 weeks underwent definitive surgical treatment of the ureterocolic fistula. We describe the presentation and management of this fistula and review the current literature.},
}
@article {pmid20201300,
year = {2009},
author = {Levchenko, SV and Gudkova, RB and Potapova, VB and Lazebnik, LB},
title = {[Response of immunocompetent cells and structural changes of colon mucosa in patients with diverticulum disease].},
journal = {Eksperimental'naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology},
volume = {},
number = {5},
pages = {17-20},
pmid = {20201300},
issn = {1682-8658},
mesh = {Aged ; Cell Movement/immunology ; Cell Proliferation ; Colon/*immunology/pathology ; Diverticulitis, Colonic/*immunology/pathology ; Epithelial Cells/*immunology/pathology ; Female ; Humans ; Intestinal Mucosa/*immunology/pathology ; Macrophage Activation/immunology ; Macrophages/*immunology/pathology ; Male ; Middle Aged ; },
abstract = {It was established the activisation of macrophages and plasma cells with raise their adhesion in diverticular disease. The express of immune response depends on unit or plural diverticuls. Epithelial cells proliferation is on the increase in the cript and mouth region of diverticul. The small undifferential epithelial cells migrated from depth to top of cripts. These cells formed some fields of cells connected by means of branches. Therefore the chronic inflammation and local disturbance of epithelium regeneration were established in diverticular disease.},
}
@article {pmid19093632,
year = {2008},
author = {D'Angelo, C and Zuccon, W and Tagliabue, F and Balduzzi, V and Gambarini, F and Bonandrini, L},
title = {[Surgical complications of the diverticular disease. A rare case of sigmoid-vaginal fistula].},
journal = {Annali italiani di chirurgia},
volume = {79},
number = {4},
pages = {287-291},
pmid = {19093632},
issn = {0003-469X},
mesh = {Aged ; Colonoscopy ; Diverticulosis, Colonic/*complications/diagnosis ; Female ; Humans ; Intestinal Fistula/complications/diagnostic imaging/*surgery ; Laparotomy ; Radiography ; Sigmoid Diseases/*complications/diagnosis/*surgery ; Treatment Outcome ; Vaginal Fistula/complications/diagnostic imaging/*surgery ; },
abstract = {The Authors report on a rare case of diverticular disease complicated by a sigmoid- vaginal fistula with personal considerations based on a review of literature. A 75 year old patient becomes to our observation suffering the lost of smelly vaginal secretions without fever or abdominalgia. In anamnesis hysterectomy cholecystectomy appendectomy and visceral adhesions lysis. Colonoscopy RX barium enema, gynaecological examination, vaginal buffer show diverticulis of colon sigma with sigmoid-vaginal fistula. After laparotomy, visceral adhesions lysis, it was done sigmoid- vaginal fistula resection with healing. Diverticular disease is a XX century pathology with incidence (for some authors) of 50% of population. Symptomatic forms affect 30-50% of patients (variable percentage based on age); the 1% of these need surgery. The colonic anatomical-functional disorder is the principal cause of diverticular disease that recognize the main localization in colon-sigma. Diverticulitis with pericolic inflammation are frequent complications; possible evolutions are local tamponed peritonitis, mechanical intestinal occlusion, hemorrhage from colonic wall and fistulas. Sigmoid-vaginal fistula is the most frequent in women previously treated with laparohysterectomy. The colonoscopy and RX barium enema are gold standard for instrumental diagnosis; the vaginography is diriment, urography excludes urological diseases. The surgical treatment is the fistula resection, with or without colonic resection. In consideration of the necessity of conservative surgery and on the basis of this case, the authors suggest, if it's possible, the simple fistula resection, although the literature report an high number of relapses.},
}
@article {pmid19092355,
year = {2008},
author = {Jones, OM and Stevenson, AR and Clark, D and Stitz, RW and Lumley, JW},
title = {Laparoscopic resection for diverticular disease: follow-up of 500 consecutive patients.},
journal = {Annals of surgery},
volume = {248},
number = {6},
pages = {1092-1097},
doi = {10.1097/SLA.0b013e3181884923},
pmid = {19092355},
issn = {1528-1140},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colectomy/*methods ; Diverticulitis, Colonic/complications/diagnosis/*surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Morbidity ; Recurrence ; Retrospective Studies ; },
abstract = {OBJECTIVE: To examine morbidity, mortality, conversion rates, and disease recurrence after laparoscopic resection of complicated and uncomplicated diverticular disease in a single center.
SUMMARY BACKGROUND DATA: In contrast to colorectal cancer, there are few large studies of laparoscopic or open resection for diverticular disease.
METHODS: This study represents a retrospective analysis of a prospectively collected database of all laparoscopic resections for uncomplicated and complicated diverticulitis from a single center.
RESULTS: Five hundred patients (305 female) were identified (median age 58; range, 26-89). Recurrent diverticulitis was the most common indication for surgery (77%), followed by perforation (10%) and fistulation (9%). Median operating time was 120 minutes (range, 45-285) and median length of hospital stay was 4 (2-33) days. The splenic flexure was routinely mobilized. There was 1 (0.2%) 30-day and in-hospital death and 55 (11%) patients had major morbidity after the procedure. Conversion to an open operation was performed in 14 (2.8%) cases. Dense adhesions were the most common cause for conversion (6 patients). Among patients with complicated diverticulitis, the conversion rate was 5.3%, whereas for those with uncomplicated disease, it was 2.1% (P = ns). Operating time and length of hospital stay do not differ significantly between patients with complicated and uncomplicated diverticulitis. The conversion rate has come down from 8% for the first 100 cases to 1.5% for the last 400 cases (P = 0.002). To our knowledge, there have been no cases of recurrent diverticulitis.
CONCLUSIONS: Laparoscopic resection even in complicated cases of diverticulitis is safe and effective. It can be achieved with short operating times and length of stay in conjunction with very low rates of morbidity and mortality. Adherence to surgical principles including routine mobilization of the splenic flexure and anastomosis onto the rectum may explain the absence of disease recurrence in our experience.},
}
@article {pmid19069700,
year = {2008},
author = {Pfeifer, J},
title = {Diverticulitis.},
journal = {Acta chirurgica Iugoslavica},
volume = {55},
number = {3},
pages = {97-102},
doi = {10.2298/aci0803097p},
pmid = {19069700},
issn = {0354-950X},
mesh = {*Diverticulitis, Colonic/classification/diagnosis/surgery ; Humans ; },
abstract = {Diverticular disease produces a wide range of clinical presentations varying from minimal clinical discomfort to life-threatening complications. Often there is a considerable discrepancy between clinical, radiologic, endoscopic and pathologic findings. Diverticulosis is a quite common disease affecting about 2/3 of people in the Western world over the age 80. The exact incidence of acute diverticulitis is unclear. We distinguish between uncomplicated and complicated diverticular disease forms. The latter includes abscess formation, stricture, obstruction, and free perforation causing life-threatening peritonitis. Several classifications for perforated diverticulitis have been proposed. From the practical point of view the Hansen-Stock classification seems to be the most appropriate one as it includes all forms of diverticular disease; it can also be used preoperatively. Prophylactic resection to avoid complications is not justified in minimally symptomatic individuals. Timing of the operation depends on the clinical course and the grade of peritonitis and on concomitant treatment modalities. Emergency operations should be avoided if possible, to reduce morbidity and mortality. Elective operations should be performed best 6-8 weeks after a second diverticulitis attack. Resection plus primary anastomosis is preferred to a Hartmann's procedure, if possible. Elective surgery should be done laparoscopically. In acute diverticulitis the goal is to treat uncomplicated forms conservatively, while complicated forms should undergo elective, laparoscopic colon resection.},
}
@article {pmid19069602,
year = {2008},
author = {Behrens, C and Stevenson, G and Eddy, R and Mathieson, J},
title = {Effect of intravenous Buscopan on colonic distention during computed tomography colonography.},
journal = {Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes},
volume = {59},
number = {4},
pages = {183-190},
pmid = {19069602},
issn = {0846-5371},
mesh = {Adult ; Aged ; Aged, 80 and over ; Butylscopolammonium Bromide/*administration & dosage ; Carbon Dioxide/administration & dosage ; Colon/diagnostic imaging/*drug effects ; *Colonography, Computed Tomographic ; Diverticulitis, Colonic/*diagnosis ; Female ; Humans ; Infusions, Intravenous ; Insufflation/*methods ; Male ; Middle Aged ; Observer Variation ; Odds Ratio ; Parasympatholytics/*administration & dosage ; Posture ; Retrospective Studies ; },
abstract = {OBJECTIVE: This study was designed to assess whether spasmolytic drugs are helpful in computed tomography colonography (CTC), as there is conflict in the literature.
METHOD: We assessed retrospectively in a blinded fashion colonic distention in 149 individuals, one-half of whom had intravenous (IV) Buscopan during CTC. Colonic segments (n = 1788) were analyzed by 2 observers, and allocated to one of 4 grades of distention. We also recorded the presence and severity of diverticular disease.
RESULTS: Buscopan increased the likelihood of optimal distention by an OR of 5 when considering individual colonic segments from ascending colon to sigmoid, with little effect on rectum or cecum. Considering the colon as a whole, the OR of optimal distention occurring throughout the entire colon was 7.9 times greater with Buscopan than without. In the sigmoid colon, Buscopan had a significantly greater impact on obtaining optimal distention in those with diverticulosis than in those without.
CONCLUSION: Buscopan increases the probability of obtaining optimal distention during CTC, especially in the sigmoid colon in diverticular disease. Buscopan is likely to improve polyp conspicuity and patient comfort, and to reduce both the examination time and the interpretation time. We recommend routine use of Buscopan during CTC.},
}
@article {pmid19062503,
year = {2008},
author = {Gasparrini, M and Liverani, A and Catracchia, V and Conte, S and Leonardo, G and Marino, G and Milillo, A and Mari, FS and Pezzatini, M and Favi, F},
title = {Gallstone ileus: a case report and review of the literature.},
journal = {Chirurgia italiana},
volume = {60},
number = {5},
pages = {755-759},
pmid = {19062503},
issn = {0009-4773},
mesh = {Aged, 80 and over ; Female ; Gallstones/*complications/diagnosis/surgery ; Humans ; Ileus/diagnosis/*etiology/surgery ; },
abstract = {Gallstone ileus is a rare complication of gallstone disease, accounting for 1-4% of all bowel obstructions. The phisiopathology is related to the presence of a bilio-enteric fistula. Cholecistoenteric fistulae occur in fewer than 1% of patients with gallstone. We present the case of an 83-years-old woman, complaining of acute abdominal pain, vomiting and mechanical obstruction at admission. She reported a past history of hypertension, recent miocardial ischaemia, diverticular disease and cholelithiasis. A CT scan revealed aerobilia, gastric and duodenal dilatation and a gallstone impacted just beyond the duodeno-jejunal junction. An exploratory supraumbilical laparotomy was performed: revealing a 4-cm gallstone impacted just caudal to the Treitz ligament. We then performed an enterolithotomy. According to the literature, enterolithotomy is the most commonly used surgical technique, whereas enterolithotomy combined with cholecistectomy and fistulectomy is indicated only in selected cases. The clinical presentation depends on impaction site and generally includes abdominal pain, nausea and vomiting. Some cases may present haematemesis due to mucosal erosion. The gold-standard investigation technique is CT scan.},
}
@article {pmid19062500,
year = {2008},
author = {Benini, B and Scocchera, F and Giorgiano, F and Manfroni, S and Cataldi, C and Antonellis, D},
title = {[Perforated jejunal diverticulitis: a case report].},
journal = {Chirurgia italiana},
volume = {60},
number = {5},
pages = {745-748},
pmid = {19062500},
issn = {0009-4773},
mesh = {Aged ; Diverticulitis/*complications/surgery ; Female ; Humans ; Intestinal Perforation/*complications/surgery ; Jejunal Diseases/*complications/surgery ; },
abstract = {The authors present a case of midgut perforated diverticulitis in a 78-year-old patient, associated with a colovesical fistula and sigmoid obstruction of diverticular origin. Surgical resection of the small bowel segment affected together with primary anastomosis is the preferred treatment in patients with symptomatic complicated jejunoileal diverticular disease. In complicated midgut diverticulitis the preoperative diagnosis is a challenge: the symptoms are aspecific and imaging techniques are of no use. As a result, the diagnosis of complicated jejunoileal diverticulitis can be quite difficult, and a definitive diagnosis may often be made only after surgical exploration.},
}
@article {pmid19030193,
year = {2008},
author = {Freeman, HJ},
title = {Segmental colitis associated with diverticulosis syndrome.},
journal = {World journal of gastroenterology},
volume = {14},
number = {42},
pages = {6442-6443},
pmid = {19030193},
issn = {1007-9327},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Colitis/diagnosis/drug therapy/*etiology ; Diagnosis, Differential ; Disease Progression ; Diverticulosis, Colonic/*complications/drug therapy ; Gastrointestinal Hemorrhage/etiology ; Humans ; Mesalamine/therapeutic use ; Rectum ; Remission, Spontaneous ; Selection Bias ; Syndrome ; Treatment Outcome ; },
abstract = {An inflammatory process that involves the sigmoid colonic segment associated with diverticular disease (SCAD) appears to be a distinct clinical and pathological disorder. It has been described in older adults, often presenting with rectal bleeding. Most of the patients seem to respond to treatment only with a 5-aminosalicylate, but some spontaneously resolve with no treatment. Endoscopic evaluation usually shows a non-specific inflammatory process localized in the sigmoid colon alone that may resolve completely with histologically normal colonic mucosa. Repeated symptomatic events with discrete episodes of segmental colitis may occur, but most patients have an entirely benign clinical course. Definition of the underlying molecular events that occur with SCAD may be critically important in understanding the critical elements present in a colonic inflammatory process that can completely resolve without pharmacological or biological treatment.},
}
@article {pmid19028660,
year = {2008},
author = {Antal, A and Hadijev, J},
title = {[Diagnostic and therapeutic difficulties of left lower quadrant abdominal pain].},
journal = {Magyar sebeszet},
volume = {61},
number = {5},
pages = {278-280},
doi = {10.1556/MaSeb.61.2008.5.5},
pmid = {19028660},
issn = {0025-0295},
mesh = {Abdominal Pain/*etiology ; Aged ; Biocompatible Materials ; Diagnosis, Differential ; Female ; Hernia/complications/*diagnosis ; *Herniorrhaphy ; Humans ; *Laparoscopy ; Reoperation ; *Surgical Mesh/adverse effects ; Sutures ; Tissue Adhesions/etiology/surgery ; },
abstract = {A patient presented with left lower quadrant abdominal pain and a lumbar hernia after pyeloplasty. In her history, diverticular disease, lumbar vertebral arthropathy, total abdominal hysterectomy and total left hip prosthesis were found. Due to the lack of special CT maneuvers and techniques (Valsalva, MDCT), laparoscopy provided a clear diagnosis finally. Closure of the hernia with absorbable sutures provided a temporary solution only. A Composix mesh was used therefore, but this resulted in postoperative neuropathic pain. This complication was treated with removal of the tacks and adhesiolysis.},
}
@article {pmid19026527,
year = {2008},
author = {Deduchovas, O and Saladzinskas, Z and Tamelis, A and Pavalkis, D and Pauziene, N and Pauza, DH},
title = {Morphologic pattern of myenteric neural plexus in colonic diverticular disease. A whole-mount study employing histochemical staining for acetylcholinesterase.},
journal = {Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft},
volume = {190},
number = {6},
pages = {525-530},
doi = {10.1016/j.aanat.2008.09.002},
pmid = {19026527},
issn = {1618-0402},
mesh = {Acetylcholinesterase/*metabolism ; Colon/enzymology/*innervation/pathology ; Diverticulosis, Colonic/enzymology/*pathology/surgery ; Female ; Histocytochemistry/methods ; Humans ; Middle Aged ; Myenteric Plexus/enzymology/*pathology ; },
abstract = {BACKGROUND: Diverticular disease (DD) of the colon is a frequent clinical problem because 30-50% of the population over the age of 60 years in western communities are affected by DD. Although certain clinical, physiological and biochemical studies have shown that the origin of DD may be neurogenic, the mechanism of DD pathogenesis is still not clear.
METHODS: The aim of the present study has been to assess the morphologic pattern of the myenteric nerve plexus (MNP) in diverticulous sigmoid colon (DSC) comparing the structural organization in DSC (n=10) to relatively normal sigmoid colon (rNSC) that had been resected from patients for rectal tumors (n=10). The histochemical method for acetylcholinesterase was utilized to visualize the MNP on pressure bloated, non-sectioned gut preparations.
RESULTS: The study revealed that the MNP of DSC was degenerated, as its interganglionic nerves were periodically interrupted and thinner than in rNSC. The number of myenteric ganglia in same-sized areas (125 mm(2)) as well as the average area of myenteric plexus was significantly higher in controls compared with the DD patients, (respectively, ganglion number: 163 +/- 12 and 149 +/- 12, p<0.02; MN-plexal area: 8.1 +/- 0.3 mm(2) and 7.2 +/- 0.2 mm(2), p<0.001).
CONCLUSION: The occurrence of DD in sigmoid colon is associated with morphologic alterations in MNP (i.e. the number of ganglia and plexus rarefaction, ganglion size and plexal area involution), which presumably demonstrate the failure of MNP in DD patients.},
}
@article {pmid19019604,
year = {2008},
author = {Chiche, L and Dargère, S and Le Pennec, V and Dufay, C and Alkofer, B},
title = {[Pyogenic-liver abscess: diagnosis and management].},
journal = {Gastroenterologie clinique et biologique},
volume = {32},
number = {12},
pages = {1077-1091},
doi = {10.1016/j.gcb.2008.09.019},
pmid = {19019604},
issn = {0399-8320},
mesh = {Decision Trees ; Humans ; Liver Abscess, Pyogenic/*diagnosis/*therapy ; Suppuration ; },
abstract = {Pyogenic-liver abscesses are due to bacteria mostly from the portal and biliary tracts. There is usually only one located in the right liver, but they may be found in the left liver, be multiple or multilocular. Diagnosis, based on ultrasound and/or computed tomography scan, is confirmed by percutaneous-needle aspiration to identify the bacteria causing the disease. Global management includes the treatment of sepsis and the aetiology of the liver abscess: biliary lithiasis, diverticular disease, colon cancer, appendicitis or other intra-abdominal infections. However, no cause is found in 20% of cases. Treatment is based on antibiotics and, sometimes, percutaneous drainage while the cause may be treated immediately or later if the sepsis is controlled. Interventional radiology is often used. Surgery may be performed in case of failure of initial treatment and to cure the cause of the abscess. Prognosis may be poor, especially if there are associated-risk factors, such as diabetes and immunodepression, even though the outcome has improved with a multidisciplinary approach.},
}
@article {pmid19009662,
year = {2008},
author = {Iwamoto, J and Mizokami, Y and Shimokobe, K and Matsuoka, T and Matsuzaki, Y},
title = {Therapeutic barium enema for bleeding colonic diverticula: four case series and review of the literature.},
journal = {World journal of gastroenterology},
volume = {14},
number = {41},
pages = {6413-6417},
pmid = {19009662},
issn = {1007-9327},
mesh = {Administration, Rectal ; Aged ; Angiography ; Barium Sulfate/*administration & dosage ; Colonoscopy ; Diverticulum, Colon/*complications/pathology/therapy ; *Enema ; Gastrointestinal Hemorrhage/etiology/pathology/*therapy ; *Hemostatic Techniques ; Humans ; Male ; Middle Aged ; Severity of Illness Index ; Treatment Outcome ; },
abstract = {The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period (range 17-35 mo) after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure.},
}
@article {pmid19002485,
year = {2010},
author = {Zdichavsky, M and Granderath, FA and Blumenstock, G and Kramer, M and Küper, MA and Königsrainer, A},
title = {Acute laparoscopic intervention for diverticular disease (AIDD): a feasible approach.},
journal = {Langenbeck's archives of surgery},
volume = {395},
number = {1},
pages = {41-48},
pmid = {19002485},
issn = {1435-2451},
mesh = {Acute Disease ; Aged ; Cohort Studies ; Colectomy/adverse effects/methods ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/diagnosis/*surgery ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/adverse effects/*methods ; Length of Stay ; Male ; Middle Aged ; Perioperative Care/methods ; Postoperative Complications/diagnosis/epidemiology ; Probability ; Prospective Studies ; *Quality of Life ; Severity of Illness Index ; Sigmoidoscopy/methods ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {INTRODUCTION: Early laparoscopic rectosigmoid resection for acute complicated diverticulitis may avoid secondary hospital stay and stoma-related complications. Benefits of elective surgical therapies could advance the early laparoscopic approach for acute sigmoid diverticulitis.
MATERIAL AND METHODS: From January 2006 to April 2007, a total of 26 patients underwent laparoscopic rectosigmoid resection for acute complicated diverticulitis. Laparoscopy was performed after initial antibiotic treatment and within 10 days after admission to the hospital. Characteristics and outcome were recorded prospectively.
RESULTS: Mean age for 13 females was 63.3 years (range, 45-78 years) and for 13 males was 56.2 years (range, 37-76 years). A body mass index of >or=25.0 kg/m(2) was registered in 20/26 patients. Mean operative time was 122.1 min (range, 60-192 min) and mean length of the sigmoid specimen was 179 mm (range, 120-240 mm). Mean time of recovery after surgery was 7.9 days (range, 6-12 days). Operative-related complications were two wound seromas. No anastomotic leak was observed. One month postoperatively, a condition-specific quality of life questionnaire assessed significant increase of the general score index, emotional status, and medical treatment.
CONCLUSION: This prospective study demonstrates the feasibility of an early laparoscopic rectosigmoid resection for acute complicated diverticulitis with an excellent outcome and a low morbidity rate.},
}
@article {pmid18996378,
year = {2009},
author = {Strate, LL and Liu, YL and Aldoori, WH and Syngal, S and Giovannucci, EL},
title = {Obesity increases the risks of diverticulitis and diverticular bleeding.},
journal = {Gastroenterology},
volume = {136},
number = {1},
pages = {115-122.e1},
pmid = {18996378},
issn = {1528-0012},
support = {K24 CA113433/CA/NCI NIH HHS/United States ; P01CA055075/CA/NCI NIH HHS/United States ; P01 CA055075/CA/NCI NIH HHS/United States ; K08 HS014062/HS/AHRQ HHS/United States ; K08 HS14062/HS/AHRQ HHS/United States ; P01 CA055075-070002/CA/NCI NIH HHS/United States ; R01 HL035464/HL/NHLBI NIH HHS/United States ; K24 CA113433-04/CA/NCI NIH HHS/United States ; },
mesh = {Adult ; Aged ; Body Mass Index ; Cohort Studies ; Diverticulitis/complications/*etiology ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Male ; Middle Aged ; Obesity/*complications ; Prospective Studies ; Waist Circumference ; Waist-Hip Ratio ; },
abstract = {BACKGROUND & AIMS: Studies of obesity and diverticular complications are limited. We assessed the relationship between body mass index (BMI), waist circumference, and waist-to-hip ratio and diverticulitis and diverticular bleeding.
METHODS: A prospective cohort study of 47,228 male health professionals (40-75 years old) who were free of diverticular disease in 1986 (baseline) was performed. Men reporting newly diagnosed diverticular disease on biennial follow-up questionnaires were sent supplemental questionnaires. Weight was recorded every 2 years, and data on waist and hip circumferences were collected in 1987.
RESULTS: We documented 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding during 18 years of follow-up. After adjustment for other risk factors, men with a BMI >or= 30 kg/m(2) had a relative risk (RR) of 1.78 (95% confidence interval [CI], 1.08-2.94) for diverticulitis and 3.19 (95% CI, 1.45-7.00) for diverticular bleeding compared with men with a BMI of <21 kg/m(2). Men in the highest quintile of waist circumference, compared with those in the lowest, had a multivariable RR of 1.56 (95% CI, 1.18-2.07) for diverticulitis and 1.96 (95% CI, 1.30-2.97) for diverticular bleeding. Waist-to-hip ratio was also associated with the risk of diverticular complications when the highest and lowest quintiles were compared, with a multivariable RR of 1.62 (95% CI, 1.23-2.14) for diverticulitis and 1.91 (95% CI, 1.26-2.90) for diverticular bleeding. Adjustment for BMI did not change the associations seen for waist-to-hip ratio.
CONCLUSIONS: In this large prospective cohort, BMI, waist circumference, and waist-to-hip ratio significantly increased the risks of diverticulitis and diverticular bleeding.},
}
@article {pmid18985822,
year = {2008},
author = {Staszewicz, W and Christodoulou, M and Proietti, S and Demartines, N},
title = {Acute ulcerative jejunal diverticulitis: case report of an uncommon entity.},
journal = {World journal of gastroenterology},
volume = {14},
number = {40},
pages = {6265-6267},
pmid = {18985822},
issn = {1007-9327},
mesh = {Abdomen, Acute/etiology/pathology ; Aged, 80 and over ; Anastomosis, Surgical ; Diverticulitis/complications/*pathology/surgery ; Diverticulum/*pathology/surgery ; Humans ; Jejunal Diseases/complications/*pathology/surgery ; Male ; Peritonitis/etiology/pathology ; Tomography, X-Ray Computed ; Treatment Outcome ; Ulcer/*etiology/pathology/surgery ; },
abstract = {Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Its reported incidence varies from 0.05% to 6%. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life threatening and require early surgical treatment. We report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory syndrome. Inflammation of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT). As a result of the clinical and biological signs of early peritonitis, an emergency surgical exploration was performed. The first jejunal loop showed clear signs of jejunal diverticulitis. Primary segmental jejunum resection with end-to-end anastomosis was performed. Histopathology report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local peritonitis. The patient made an excellent rapid postoperative recovery. Jejunal diverticulum is rare but may cause serious complications. It should be considered a possible etiology of acute abdomen, especially in elderly patients with unusual symptomatology. Abdominal CT is the diagnostic tool of choice. The best treatment is emergency surgical management.},
}
@article {pmid18955415,
year = {2009},
author = {Meeson, S and Alvey, CM and Golding, SJ},
title = {Justifying multidetector CT in abdominal sepsis: time for review?.},
journal = {The British journal of radiology},
volume = {82},
number = {975},
pages = {190-197},
doi = {10.1259/bjr/32680364},
pmid = {18955415},
issn = {1748-880X},
mesh = {Abdominal Pain/*diagnostic imaging/etiology ; Clinical Protocols ; Dose-Response Relationship, Radiation ; Female ; Gastrointestinal Diseases/*diagnostic imaging ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity ; Sepsis/*diagnostic imaging ; Tomography, X-Ray Computed/*methods ; },
abstract = {The further development of multidetector row CT (MDCT) has led to changes in the application and examination technique, leading to a need to justify the level and frequency of radiation exposure associated with MDCT. A literature review of how the use of modern scanners has affected diagnosis was undertaken, followed by a year-long retrospective study of MDCT scans of patients presenting with symptoms of abdominal sepsis. The diagnostic accuracy of detecting causes of abdominal sepsis using this technology was sought. Scans were performed using a LightSpeed 16 system (GE Healthcare Medical Systems, Slough, UK and Milwaukee, WI). Clinical diagnoses were based upon surgical and histopathological findings, treatment outcome and follow-up scans. System dose parameters recorded were the dose-length product (DLP) and volume CT dose index. The literature on investigating suspected abdominal sepsis has not been updated significantly since the time of conventional CT. 94 patients were included in the study; causes of abdominal sepsis could be detected with a sensitivity of 0.95 and a specificity of 0.91. Repeat examination and cumulative exposure was a key finding. Patients with abscesses and acute pancreatitis had the highest number of scanner visits; patients with diverticular disease had the lowest number of visits, lowest cumulative DLP and shortest stay in hospital. Cumulative DLP was affected by scan length, number of scans and patient size. In conclusion, diagnostic accuracy data for MDCT scans using 16 slices confirm that CT remains a suitable modality for imaging abdominal sepsis but scope for dose constraint exists.},
}
@article {pmid18954602,
year = {2008},
author = {Yoo, PS and Garg, R and Salamone, LF and Floch, MH and Rosenthal, R and Longo, WE},
title = {Medical comorbidities predict the need for colectomy for complicated and recurrent diverticulitis.},
journal = {American journal of surgery},
volume = {196},
number = {5},
pages = {710-714},
doi = {10.1016/j.amjsurg.2008.07.017},
pmid = {18954602},
issn = {1879-1883},
mesh = {Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Chi-Square Distribution ; *Colectomy ; *Comorbidity ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Risk Assessment ; Risk Factors ; },
abstract = {OBJECTIVE: The objective of this study was to identify risk factors for recurrent or complicated diverticulitis requiring colectomy.
METHODS: A total of 112 patients were admitted to the West Haven Veterans Affairs Medical Center with the diagnosis of colonic diverticular disease from January 1998 to December 2006. Patients' records were assessed for demographics, past medical history, and physical and biochemical features of presentation. Student t tests, analysis of variance, and chi-square analysis were used to compare binary and categoric data.
RESULTS: The medical records of 112 patients admitted to the West Haven Veterans Affairs hospital with the diagnosis of diverticulitis were analyzed retrospectively. A total of 97.3% were male (n = 109), with a mean age of 63.3 years, and a significant smoking history greater than 30 pack-years was present in 70.5% (n = 79) of patients. Eighty-four percent (n = 94) of patients presented with localized abdominal pain and 69.6% (n = 78) had abdominal tenderness without peritoneal signs. Computed tomography was performed in 85.7% (n = 96) of cases. A total of 23.2% (n = 26) of patients proceeded to laparotomy, with free perforation being the most common indication (38.4%, n = 12) followed by a history of 2 or more antecedent attacks of diverticulitis (23.1%, n = 6). Analysis of variance showed that serum albumin levels were significantly lower in the group undergoing colectomy compared with those who did not (3.4 vs 4.1 mg/dL; P = .016). The need for colectomy owing to complicated or recurrent attacks correlated with glucocorticoid use (P < .001) and a history of chronic obstructive pulmonary disease (P < .038), but not with diabetes mellitus, collagen vascular disease, or inflammatory bowel disease.
CONCLUSIONS: The rules regarding the treatment of diverticulitis are evolving. Comorbid conditions such as hypoalbuminemia, chronic obstructive pulmonary disease, and glucocorticoid use may predispose patients to recurrent or complicated attacks of diverticulitis requiring colectomy. Stratification and reduction of risks may reduce the overall morbidity and mortality of diverticulitis.},
}
@article {pmid18954586,
year = {2008},
author = {Marcason, W},
title = {What is the latest research regarding the avoidance of nuts, seeds, corn, and popcorn in diverticular disease?.},
journal = {Journal of the American Dietetic Association},
volume = {108},
number = {11},
pages = {1956},
doi = {10.1016/j.jada.2008.09.029},
pmid = {18954586},
issn = {0002-8223},
mesh = {Diet ; Dietary Fiber/*administration & dosage ; Diverticulum/complications/epidemiology/*prevention & control ; Humans ; Incidence ; *Nuts ; Risk Factors ; *Seeds ; *Zea mays ; },
}
@article {pmid18946642,
year = {2008},
author = {Leifeld, L and Kruis, W},
title = {[Modern therapy of diverticular disease].},
journal = {Der Internist},
volume = {49},
number = {12},
pages = {1415-6, 1418-20},
pmid = {18946642},
issn = {0020-9554},
mesh = {Abscess/etiology/therapy ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Colonoscopy ; Combined Modality Therapy ; Cross-Sectional Studies ; Diverticulitis, Colonic/complications/diagnosis/epidemiology/*therapy ; Gastrointestinal Hemorrhage/etiology/therapy ; Humans ; Intestinal Perforation/etiology/therapy ; Mesalamine/therapeutic use ; Middle Aged ; Patient Care Team ; Recurrence ; Referral and Consultation ; },
abstract = {New concepts are developed in the therapy of diverticular disease. 5-aminosalicylates can be administered in patients with slight forms of diverticulitis. In moderate diverticulitis antibiotics should be applied alternatively or additionally. In cases of severe diverticulitis patients should be kept fasting with parenteral nutrition and intravenous broad spectrum antibiotics. Small abscesses can be treated conservatively while abscesses larger than 4 cm should be drained in a first step and than treated surgically. A free perforation is still an absolute indication for emergency operation. In recurring diverticulitis indication for resection of the affected segment of the bowel should be considered depending on the extent of former attacks.},
}
@article {pmid18941760,
year = {2009},
author = {Tursi, A and Brandimarte, G and Elisei, W and Giorgetti, GM and Inchingolo, CD and Aiello, F},
title = {Faecal calprotectin in colonic diverticular disease: a case-control study.},
journal = {International journal of colorectal disease},
volume = {24},
number = {1},
pages = {49-55},
pmid = {18941760},
issn = {0179-1958},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Case-Control Studies ; Colonoscopy ; Diverticulosis, Colonic/drug therapy/*metabolism ; Feces/*chemistry ; Female ; Gastrointestinal Agents/therapeutic use ; Humans ; Irritable Bowel Syndrome/metabolism ; Leukocyte L1 Antigen Complex/*metabolism ; Lymphocytes/metabolism ; Male ; Mesalamine/therapeutic use ; Middle Aged ; Neutrophils/metabolism ; Rifamycins/therapeutic use ; Rifaximin ; Severity of Illness Index ; },
abstract = {BACKGROUND AND AIMS: Information about faecal calprotectin (FC) in colonic diverticular disease (DD) are lacking. We assessed FC in colonic DD, comparing it with irritable bowel syndrome (IBS) patients and healthy controls. Moreover, we compared FC levels in different degrees of DD and assessed FC in symptomatic DD before and after treatment.
MATERIALS AND METHODS: Forty-eight consecutive patients with a new endoscopic diagnosis of DD (16 with asymptomatic diverticulosis, 16 with symptomatic uncomplicated DD, 16 with acute uncomplicated diverticulitis), 16 healthy controls, and 16 IBS patients were studied. FC was assessed by semi-quantitative method and compared with histological inflammation. Moreover, FC was reassessed in symptomatic DD after 8 weeks of treatment.
RESULTS/FINDINGS: FC was not increased in healthy controls and IBS patients. No difference was found between asymptomatic diverticulosis, healthy controls, and IBS patients (p = n.s.). We found higher FC values in acute uncomplicated diverticulitis (p < 0.0005) and in symptomatic uncomplicated DD (p < 0.005) than in healthy controls and in IBS patients. FC values correlated with inflammatory infiltrate (p < 0.0005). FC decreased after treatment to normal values both in acute uncomplicated diverticulitis (p < 0.0005) and in symptomatic uncomplicated DD (p < 0.005) after treatment. INTERPRETATIONS/CONCLUSIONS: FC may be useful to detect colonic inflammation in DD and in distinguishing symptomatic DD from IBS, as well as in assessing response to therapy in DD.},
}
@article {pmid18936658,
year = {2008},
author = {Lewis, M and , },
title = {Bleeding colonic diverticula.},
journal = {Journal of clinical gastroenterology},
volume = {42},
number = {10},
pages = {1156-1158},
doi = {10.1097/MCG.0b013e3181862ad1},
pmid = {18936658},
issn = {1539-2031},
mesh = {Aged ; Aged, 80 and over ; Diverticulum, Colon/*complications/*epidemiology/therapy ; Gastrointestinal Hemorrhage/*epidemiology/*etiology/therapy ; Humans ; Middle Aged ; },
abstract = {Diverticula of the large intestine constitute a common source of lower gastrointestinal (GI) bleeding both occult and massive and are a particular common cause of right-sided colonic hemorrhage. Bleeding in all cases is due to rupture of the underlying vasa rectum. In all cases, rupture of the artery is not circumferential, but eccentric having occurred toward the lumen of the diverticula. It is rare to see either acute or chronic diverticulitis associated with this situation. Lower GI bleeding is frequent in the elderly secondary to diverticular disease and occurs in about 10% to 30% GI bleeds and actually is much less frequent than upper GI bleeding. Diverticular disease actually is uncommon in people under the age of 40. However, by the age of 50 almost one-third of the population has diverticulosis. Ninety percent of the diverticula are in the left colon, but bleeding is from the right colon at least 50% of the time. Diverticular hemorrhage will cease spontaneously in about 90% cases. Most often, there is no inflammatory process around the diverticular bleeding. Hypertension even may be a predisposing factor. Also anticoagulation, diabetes mellitus, and ischemic heart disease are associated with diverticular hemorrhage. As far as treatment is concerned, conservative therapy is usually the best approach. One would like to avoid angiography and surgery if at all possible. There is a significant recurrence of bleeding in those patients who are treated even with angiography and with surgery. Etiology of the bleeding is not really well understood and the diagnosis and treatment is quite difficult in some situations.},
}
@article {pmid18936655,
year = {2008},
author = {Trivedi, CD and Das, KM and , },
title = {Emerging therapies for diverticular disease of the colon.},
journal = {Journal of clinical gastroenterology},
volume = {42},
number = {10},
pages = {1145-1151},
doi = {10.1097/MCG.0b013e318188adc1},
pmid = {18936655},
issn = {1539-2031},
mesh = {Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/*drug therapy/physiopathology/*therapy ; Drug Therapy, Combination ; Humans ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; Randomized Controlled Trials as Topic ; Treatment Outcome ; },
abstract = {Diverticular disease (DD) of the colon is common. This paper reviews the evidence supporting the role of some of the conventional medical therapies such as fiber and nonabsorbable antibiotics in the treatment of DD. More importantly, it will review the emerging body of evidence supporting the use of 5-aminosalicylic acid and probiotics for symptomatic or complicated DD. Possible mechanisms supporting the role of 5-aminosalicylates will also be discussed. On the basis of strength of the evidence supporting each medical intervention, recommendations will be graded in an evidence-based fashion. Finally, an evidence-based algorithmic approach is proposed for the medical management of DD. This paper does not discuss the use of absorbable antibiotics such as ciprofloxin and metronidazole, which are discussed in all standard textbooks. The purpose of this paper is to discuss newer recommendations.},
}
@article {pmid18936654,
year = {2008},
author = {Hale, WB and , },
title = {Colonoscopy in the diagnosis and management of diverticular disease.},
journal = {Journal of clinical gastroenterology},
volume = {42},
number = {10},
pages = {1142-1144},
doi = {10.1097/MCG.0b013e3181862ab1},
pmid = {18936654},
issn = {1539-2031},
mesh = {Acute Disease ; Colitis/complications/*diagnosis/pathology/therapy ; *Colonoscopy ; Diverticulitis, Colonic/complications/*diagnosis/pathology/therapy ; Diverticulosis, Colonic/complications/*diagnosis/pathology/therapy ; Diverticulum, Colon/pathology ; Humans ; Randomized Controlled Trials as Topic ; },
abstract = {This review examines the role of colonoscopy in the evaluation of asymptomatic diverticulosis, segmental diverticular disease-associated colitis and acute diverticulitis. Asymptomatic acute diverticulitis, discovered during screening colonoscopy, is also discussed. In addition, the use of colonoscopy, both diagnostic and therapeutic, is compared to standard radiology studies for the management of acute diverticular bleeding.},
}
@article {pmid18936651,
year = {2008},
author = {Floch, MH and , },
title = {Symptom severity and disease activity indices for diverticulitis.},
journal = {Journal of clinical gastroenterology},
volume = {42},
number = {10},
pages = {1135-1136},
doi = {10.1097/MCG.0b013e318188b1bc},
pmid = {18936651},
issn = {1539-2031},
mesh = {Disease Progression ; Diverticulitis/*physiopathology ; Humans ; *Severity of Illness Index ; },
abstract = {There are no controlled studies evaluating symptoms of diverticular disease or diverticulitis. Monitoring symptoms are reported repeatedly in research studies but yet an evaluation of the significance of recording these symptoms in a controlled study does not exist. The older literature was reviewed. The literature largely classifies the disease in stages, which are reviewed in this paper. Symptomatic uncomplicated diverticular disease and its evolution and the present literature on this are discussed.},
}
@article {pmid18936649,
year = {2008},
author = {Korzenik, JR and , },
title = {Diverticulitis: new frontiers for an old country: risk factors and pathogenesis.},
journal = {Journal of clinical gastroenterology},
volume = {42},
number = {10},
pages = {1128-1129},
doi = {10.1097/MCG.0b013e318188adb1},
pmid = {18936649},
issn = {1539-2031},
mesh = {*Diverticulitis/epidemiology/etiology/physiopathology ; Female ; Humans ; Intestines/microbiology ; Male ; Risk Factors ; },
abstract = {The understanding of diverticulitis has advanced little beyond the initial postulates of Burkitt and Painter who proposed that diverticular disease results from a deficiency of dietary fiber. Diverticular disease and diverticulitis are viewed simply as a consequence of a diet, which takes in relatively little fiber. Our understanding of diverticulitis has not advanced beyond these basic concepts. As many as two-thirds of individuals in the West have diverticular disease by the age of 85 years, but only 10% to 25% will manifest any related clinical symptoms. Other than age, several risk factors have been identified for the development of diverticular disease and diverticulitis. In particular, obesity and red meat intake are risk factors. Smoking is more controversial and alcohol, coffee, and caffeine have not shown to be risk factors. Vegetable intake, a strict vegetable diet, and increased fiber intake decreases the risk of development of diverticular disease, as well as diverticulitis. Physical activity also seems protective. Despite these evidences, the risk factors and pathophysiology progression from asymptomatic diverticular disease to diverticulitis have been inadequately studied. This subject is reviewed in more detail in this manuscript.},
}
@article {pmid18936648,
year = {2008},
author = {Martel, J and Raskin, JB and , },
title = {History, incidence, and epidemiology of diverticulosis.},
journal = {Journal of clinical gastroenterology},
volume = {42},
number = {10},
pages = {1125-1127},
doi = {10.1097/MCG.0b013e3181865f18},
pmid = {18936648},
issn = {1539-2031},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Diverticulosis, Colonic/epidemiology/history/physiopathology ; Female ; History, 18th Century ; History, 19th Century ; History, 20th Century ; Humans ; Incidence ; Male ; Middle Aged ; Risk Factors ; },
abstract = {Diverticulosis of the colon is a very common condition. Described as early as the 17th century, most of the information we now have is based on much of the work during the 20th century. Age, sex, race, and geography all play a specific role in the development of diverticula. It is the merging of these factors that changes the prevalence of diverticula and their manifestations. Symptomatic diverticula can lead to serious complications requiring both medical and surgical interventions to treat these complications when they occur. This review will focus on the history and epidemiology of diverticulosis in regard to age, sex, race, geography, and the epidemiology of complicated diverticular disease.},
}
@article {pmid18935898,
year = {2008},
author = {Shapiro, SB and Lambert, PJ and Mathiason, MA},
title = {A comparison of open and laparoscopic techniques in elective resection for diverticular disease.},
journal = {WMJ : official publication of the State Medical Society of Wisconsin},
volume = {107},
number = {6},
pages = {287-291},
pmid = {18935898},
issn = {1098-1861},
mesh = {Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures ; Female ; Humans ; Laparoscopy/*methods ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Statistics, Nonparametric ; Treatment Outcome ; },
abstract = {INTRODUCTION: This study examines the outcomes of patients who underwent elective sigmoid resection for diverticular disease during the transition period from open to laparoscopic surgery.
METHODS: The medical records of patients who underwent elective sigmoid resection from July 1, 1993 to June 30, 2005 at a community-based teaching hospital were retrospectively reviewed. Data collected included age, sex, duration of surgery, estimated blood loss (EBL), postoperative day of diet, length of stay (LOS), postoperative complication rate, and readmission rate. Data were compared using Wilcoxon rank sum and chi-square tests. Recurrence rates were evaluated.
RESULTS: The medical records of 246 patients who had elective sigmoid resections were reviewed. One hundred sixty-six of the procedures were planned open operations, and 80 were initiated with laparoscopy. Of these 80 procedures, 10 were converted to open surgery. Overall, laparoscopic surgery was associated with shorter LOS (median: 4 days versus 8 days, P < 0.001; mean: 4.8 days versus 9.3 days), less EBL (median: 100 cc versus 200 cc, P < 0.001; mean: 167 cc versus 255 cc), and longer operative time (median: 185 minutes versus 153 minutes, P < 0.001; mean: 201.4 minutes versus 157.1 minutes). No mortalities occurred in either group. Readmission and recurrence rates were similar in the open and laparoscopic groups. Subset analyses to adjust for changes in practices over time did not account for improved LOS, EBL, or recurrence rate.
CONCLUSION: Compared with open surgery, laparoscopic surgery for elective sigmoid resection is associated with a significantly shorter hospitalization and similar safety and recurrence rates.},
}
@article {pmid18853981,
year = {2008},
author = {Toma, J and Paszat, LF and Gunraj, N and Rabeneck, L},
title = {Rates of new or missed colorectal cancer after barium enema and their risk factors: a population-based study.},
journal = {The American journal of gastroenterology},
volume = {103},
number = {12},
pages = {3142-3148},
doi = {10.1111/j.1572-0241.2008.02199.x},
pmid = {18853981},
issn = {1572-0241},
mesh = {Aged ; Aged, 80 and over ; *Barium Sulfate ; Colorectal Neoplasms/*diagnostic imaging ; *Contrast Media ; *Diagnostic Errors ; *Enema ; Female ; Humans ; Male ; Middle Aged ; Ontario ; Radiography ; Registries ; Risk Factors ; },
abstract = {OBJECTIVE: Double-contrast barium enema (DCBE) is widely used in clinical practice to detect colorectal cancer (CRC). Our objective was to evaluate the rate of new or missed CRC following DCBE and the associated risk factors in a population-based study.
METHODS: All patients (> or =20 yr old) with a new diagnosis of CRC between April 1, 1997, and March 31, 2004, in Ontario were identified. Data were extracted from the Ontario Health Insurance Program, the Canadian Institute for Health Information, the Registered Persons Database and the Ontario Cancer Registry. Patients who had a DCBE examination 36 months prior to the diagnosis of CRC were divided into two groups: detected cancers (DCBE within 6 months prior to diagnosis) and new or missed cancers (DCBE 6-36 months prior to diagnosis). Multivariate analysis was used to evaluate factors associated with new or missed CRC.
RESULTS: We identified 13,849 patients who had a DCBE 36 months prior to the diagnosis of CRC. The overall rate of new or missed cancers following DCBE was 22.4%. Independent risk factors for new or missed cancers were older age, female sex, previous abdominal or pelvic surgery, diverticular disease, right-sided CRC, and having the DCBE in an office setting.
CONCLUSIONS: Physicians who use DCBE to evaluate the colon must inform their patients that if a cancer is present, there is an approximately one in five chance that it will be missed. Given the recent endorsement of CT colonography by the U.S. Multi-Society Task Force on Colorectal Cancer as an option for CRC screening, it may be time to reconsider the use of DCBE to detect CRC.},
}
@article {pmid18843444,
year = {2008},
author = {Tan, KK and Wong, D and Sim, R},
title = {Superselective embolization for lower gastrointestinal hemorrhage: an institutional review over 7 years.},
journal = {World journal of surgery},
volume = {32},
number = {12},
pages = {2707-2715},
pmid = {18843444},
issn = {0364-2313},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Embolization, Therapeutic/*methods ; Female ; Gastrointestinal Hemorrhage/*diagnostic imaging/etiology/*therapy ; Humans ; Intestinal Diseases/complications/*diagnostic imaging/*therapy ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Risk Factors ; Singapore ; Treatment Outcome ; Viscera/blood supply ; },
abstract = {INTRODUCTION: Superselective embolization of visceral arterial branches has become integral in the management of acute lower gastrointestinal (GI) hemorrhage. The present study aimed to evaluate the success of superselective embolization as a primary therapeutic modality in the control of lower GI hemorrhage and to identify factors associated with rebleeding and surgical intervention after the procedure.
METHODS: We performed a retrospective review of all cases of superselective embolization for acute lower GI bleeding during a 7-year period (December 2000-October 2007) in a single 1,300-bed hospital in Singapore. Hemostasis was achieved with microcoils, polyvinyl alcohol particles, gelfoam, or by selective vasopressin infusion. Various clinical and hematologic factors were analyzed against rebleeding and surgical intervention after the procedure.
RESULTS: A total of 265 patients underwent mesenteric angiography for GI hemorrhage. Superselective embolization of visceral vessels for lower GI hemorrhage was performed in 32 patients (12%) whose median age was 66 years (range: 34-82 years). The group was of similar gender distribution, and the median follow-up was 8 months (range: 1-32 months). Location was the small bowel in 19% and the colon in 81%. The underlying etiologies included diverticular disease (59%), angiodysplasia (19%), ulcers (19%), and malignancy (3%). In 31 patients (97%) technical success was achieved, with immediate cessation of hemorrhage in every case. Clinical success was achieved in 20 patients (63%), all of whom were discharged well with no further intervention. Seven patients rebled, and 9 underwent surgery: 1 for incomplete hemostasis, 4 for rebleeding, 1 for infarcted bowel postembolization, and 3 on the basis of the surgeon's decision. There were 2 anastomotic leaks; 1 after surgery for postembolization ischemia and 1 after surgery for rebleeding. Overall mortality in this series was 9%. Rebleeding was more likely to occur if the site of bleeding was located in the small bowel compared to the colon (OR: 8.33, 95% CI 1.03-66.67). It was also more likely in patients with a hematocrit level
CONCLUSIONS: The use of superselective mesenteric embolization for the treatment of lower GI bleeding is highly successful and relatively safe-97% technical success and 3% postembolization ischemia in our series. In 63% of cases it is definitive without any further intervention. Postembolization ischemia and surgery may be associated with a higher risk of anastomotic leak. Greater vigilance must be adopted in treating patients who have active hemorrhage from the small bowel and in those with a hematocrit
OBJECTIVES: To present a case of lumbar spinal infection secondary to colonic diverticular disease, their management and outcome. To review the published literature on spinal involvement with gastrointestinal disease with a view to establishing guidelines for management.
SUMMARY OF BACKGROUND DATA: There is only 1 previous case report of spinal involvement in diverticular disease and 9 reports of spinal infection secondary to Crohn disease. Psoas abscess, osteomyelitis, cord and nerve root compression, meningitis, and hydronephrosis have all been documented. Infection is usually advanced at presentation and all but 1 patient was taking immunosuppressive drugs.
METHODS: Case notes and online databases were reviewed.
RESULTS: Management is similar for both Crohn and diverticular disease. Total parenteral nutrition and antibiotic treatment are required as is coordination between orthopedic surgeons, colorectal surgeons, and microbiologists. The spine and abdomen are best imaged with plain radiographs, magnetic resonance imaging and contrast enhanced computed tomography. Surgery involved a defunctioning stoma, debridement of abdominal and spinal infection, and instrumented stabilization of the spine if instability or vertebral collapse is likely. Operative specimens are most likely to identify the multiple enteric bacteria and fungi involved.
CONCLUSIONS: A multidisciplinary approach with aggressive supportive therapy, combined with a planned surgical procedure and appropriate antibiotics can give a good outcome in most cases.},
}
@article {pmid18818789,
year = {2008},
author = {Stermer, E and Lavy, A and Rainis, T and Goldstein, O and Keren, D and Zeina, AR},
title = {Incidental colorectal computed tomography abnormalities: would you send every patient for a colonoscopy?.},
journal = {Canadian journal of gastroenterology = Journal canadien de gastroenterologie},
volume = {22},
number = {9},
pages = {758-760},
pmid = {18818789},
issn = {0835-7900},
mesh = {Aged ; Cohort Studies ; *Colonoscopy ; Colorectal Neoplasms/*diagnostic imaging/*pathology ; Female ; Humans ; *Incidental Findings ; Intestinal Mucosa/diagnostic imaging/pathology ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; *Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: The clinical significance of colorectal wall thickening (CRWT) in patients undergoing abdominal computed tomography (CT) has not yet been definitively established.
OBJECTIVES: To compare alleged findings on abdominal CT with those of a follow-up colonoscopy.
METHODS: Ninety-four consecutive patients found to have large-bowel abnormalities on abdominal CT were referred for colonoscopy. Of these patients, 48 were referred for a suspected colorectal tumour and 46 for CRWT. Colonoscopy was performed and findings were compared.
RESULTS: Of the 48 suspected colorectal tumours, 34 were determined to be neoplastic lesions on colonoscopy. Of these, 26 were malignant and eight were benign. Colonoscopy revealed no abnormality in 30 of 46 patients with CRWT as a solitary finding, and revealed some abnormality in 16 patients (12 had diverticular disease, four had benign neoplastic lesions).
CONCLUSIONS: CRWT as an incidental and solitary finding on CT should not be regarded as a pathology prompting a colonoscopy. Approximately two-thirds of the patients had a normal colonoscopy and the remaining patients had benign lesions (12 had diverticular disease and four had benign neoplastic lesions). However, many of these patients seem to warrant colonoscopy regardless of CT findings, particularly patients who have a family history of colorectal cancer, have positive fecal occult blood test results or who are older than 50 years of age.},
}
@article {pmid18814016,
year = {2009},
author = {Turunen, P and Carpelan-Holmström, M and Kairaluoma, P and Wikström, H and Kruuna, O and Pere, P and Bachmann, M and Sarna, S and Scheinin, T},
title = {Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study.},
journal = {Surgical endoscopy},
volume = {23},
number = {1},
pages = {31-37},
pmid = {18814016},
issn = {1432-2218},
mesh = {Adult ; Aged ; *Analgesia, Epidural ; Analgesics, Opioid/therapeutic use ; Colectomy/*adverse effects ; *Colon, Sigmoid ; Diverticulum, Colon/*surgery ; Female ; Humans ; Laparoscopy/*adverse effects ; Length of Stay ; Male ; Middle Aged ; Oxycodone/therapeutic use ; Pain, Postoperative/etiology/*prevention & control ; Prospective Studies ; Recovery of Function ; },
abstract = {BACKGROUND: The primary hypothesis for this study was that epidural analgesia reduces the use of opioids and thus advances bowel function and oral intake and shortens hospital stay after laparoscopic sigmoidectomy performed according to principles of enhanced recovery after surgery.
METHODS: For this study, 60 patients with complicated diverticular disease were randomized to the epidural anesthesia group or the control group before surgery. Postoperative oxycodone consumption, pain, and recovery parameters were followed for 14 days.
RESULTS: The epidural group needed less oxycodone than the control group until 12 h postoperatively. They experienced significantly less pain related to coughing and motion until postoperative day 2. In the epidural group, fewer patients experienced significant pain, and the duration of postoperative pain was shorter. Postoperative oral intake, bowel function, hospital stay, and overall complication rate were similar in the two groups. However, the control group had more postoperative hematomas.
CONCLUSIONS: Epidural analgesia significantly alleviates pain, reducing the need for opioids during the first 48 h after laparoscopic sigmoidectomy. However, epidural analgesia does not alter postoperative oral intake, mobilization, or length of hospital stay.},
}
@article {pmid18807676,
year = {2008},
author = {Woods, K and Williams, E and Melvin, W and Sharp, K},
title = {Acquired jejunoileal diverticulosis and its complications: a review of the literature.},
journal = {The American surgeon},
volume = {74},
number = {9},
pages = {849-854},
pmid = {18807676},
issn = {0003-1348},
mesh = {Adult ; Diverticulum/complications/*diagnosis/*surgery ; Female ; Humans ; Ileal Diseases/complications/*diagnosis/*surgery ; Jejunal Diseases/complications/*diagnosis/*surgery ; Male ; Middle Aged ; },
abstract = {Jejunoileal diverticulosis is a rare entity. Jejunoileal diverticulosis is not a disease that surgeons see often in clinical practice; however, it should remain on the differential diagnosis for any patient with an acute abdomen or gastrointestinal bleeding of unknown origin. It can present with a wide range of clinical scenarios and when patients experience chronic symptoms such as bloating, abdominal pain, nausea, bacterial overgrowth, or malabsorption, medical therapy is successful in most patients. However, when patients present with acute symptoms of bleeding, inflammation, perforation, or obstruction, surgical resection and primary anastomosis is often the treatment of choice. If patients are asymptomatic, they are better left alone, even when discovered incidentally in the operating room. In closing, the possibility of a patient having jejunal diverticular disease should be suspected whenever the symptoms of obscure abdominal pain, anemia, dilated jejunal loops on abdominal radiographs, a history of colonic diverticuli, and a history of acute appendicitis.},
}
@article {pmid18799124,
year = {2008},
author = {Ballinger, A},
title = {Adverse effects of nonsteroidal anti-inflammatory drugs on the colon.},
journal = {Current gastroenterology reports},
volume = {10},
number = {5},
pages = {485-489},
pmid = {18799124},
issn = {1534-312X},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Colitis/chemically induced ; Colon/*drug effects ; Colonic Diseases/*chemically induced ; Gastrointestinal Hemorrhage/chemically induced ; Humans ; },
abstract = {Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, and a growing body of evidence suggests that they have adverse effects in the lower gastrointestinal (GI) tract in addition to the well-described toxicity in the upper GI tract. Among NSAID users who develop adverse GI effects, the proportion with lower GI events is as high as 40%. Most of the available evidence is taken from case-control studies and case reports; no large, randomized, placebo-controlled study has specifically set out to determine the magnitude of NSAID toxicity on the colon. However, the data suggest that NSAIDs cause a primary macroscopic colitis, collagenous colitis, an increased risk of complicated diverticular disease, and exacerbations of preexisting inflammatory bowel disease. Treatment depends on withdrawal of the causative drug.},
}
@article {pmid18773700,
year = {2007},
author = {Lizarzábal de Belloso, M and , },
title = {[Gastroenterology in the new century in Venezuela. A first five years situational diagnosis].},
journal = {Investigacion clinica},
volume = {48 Suppl 2},
number = {},
pages = {5-127},
pmid = {18773700},
issn = {0535-5133},
mesh = {Cause of Death ; Delivery of Health Care/statistics & numerical data ; *Gastroenterology ; *Gastrointestinal Diseases/epidemiology/therapy ; Humans ; *Societies, Medical ; Venezuela ; },
abstract = {UNLABELLED: Once the elaboration of CIE-10 Gastroenterology we used two indicators (Health and Management) as quantifiable measurements that reflect the critical success factors in the specialty. HEALTH INDICATORS:
MORBIDITY: 13,21% of main medical complains in primary care concern to Gastroenterology. Four of them rank among the first 25 ("Diarrhea", "Abdominal pain", "Helmintiasis" and "Other Esophagus, Stomach and Bowel diseases"). At the specialty care, Acid-peptic disease ranked as the first main complain according with 56-73.3% of the gastroenterologist consulted (Public and Private care) followed by Gastrointestinal reflux, Irritable bowel, Constipation, Lithiasis, Diverticular disease, Hemorrhages, Jaundice, Cirrhosis, Amibiasis, Pancreatitis, Colon cancer, Polyps, Hepatitis and Colopathy.
MORTALITY: 11,4% of the total deaths among Venezuelans are by gastrointestinal causes and five of them count among the first 25, with wide regional variability. Trujillo reports major mortality by liver disease (3%) followed by Vargas, District Federal, Tachira (2.8%). Cirrhosis and Fibrosis are more frequent in Táchira (2.3%) Trujillo, Vargas (2,1%) Some regions report mainly infections and diarrheas. Major cancer mortality is in Táchira (6,73% of deaths in the State) followed by Merida and Trujillo. MANAGEMENT INDICATORS: Services Demand. 2,86 consult/habitant/year in internal medicine and 0.77 en specialties. Services Offer. 793 Gastroenterologists (3.4/10.000 habitants). 44.5% concentrated in D.Federal, followed by Táchira (3.9%) Carabobo, Zulia y Mérida. Human Resources Formation. 16 Post-graduated Programs graduate 70 gastroenterologists annually. The Gastroenterology Education Agreement 2006 unified the Venezuelan Gastroenterologist profile and the graduation requirements. The Venezuelan Gastroenterology Society, age 60, has extraordinary national and international projection through its scientific publication (GEN Magazine). This analysis of the present of Gastroenterology in Venezuela allows us the strategically planning of its future, in order to satisfy the population needs in the specialty in a rational and effective way.},
}
@article {pmid18769806,
year = {2008},
author = {López-Köstner, F and Zárate, A and Pinedo, G and Molina, ME and Kronberg, U and Pardo, J},
title = {[Results of laparoscopic surgery for the treatment of diverticular disease of the colon].},
journal = {Revista medica de Chile},
volume = {136},
number = {5},
pages = {594-599},
pmid = {18769806},
issn = {0034-9887},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/adverse effects/*methods ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Male ; Middle Aged ; Prospective Studies ; Sigmoid Diseases/*surgery ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: The laparoscopic approach is an alternative for the elective treatment of diverticular colon disease (DCD).
AIM: To analyze the results of patients electively operated for DCD using a laparoscopic technique.
MATERIAL AND METHODS: Data of patients with DCD operated using laparoscopy at the Catholic University of Chile Clinical Hospital were prospectively recorded from January 1999 to August 2006. Indications for surgery were repetitive crises of acute diverticulitis, the persistence of the symptoms or anatomic deformity after the first crisis and complicated diverticulitis (Hinchey 1-2) that responded to the medical treatment. The laparoscopic technique used five ports and the surgical specimen was extracted through a suprapubic approach.
RESULTS: One hundred and six patients aged 32 to 82 years (49% females) were operated in the study period. Fifty five percent had a previous abdominal surgery. The mean operative time was 213 minutes (range: 135-360). Four patients were converted to open surgery (3.7%). One or more early post-operative complications were observed in five patients (4.7%). The mean time for passing gases and reinitiate liquid diet was 1.7 and 2.4 days respectively. The median post operative stay after surgery was 4 days. There was no operative mortality. Mean follow-up time was 27 months and only one patient (0.9%) had a new episode of acute diverticular disease, with a satisfactory response to medical treatment. No patient has developed bowel obstruction.
CONCLUSIONS: The laparoscopic approach is a safe alternative in the elective surgical treatment of DCD.},
}
@article {pmid18759154,
year = {2009},
author = {Cianci, R and Iacopini, F and Petruzziello, L and Cammarota, G and Pandolfi, F and Costamagna, G},
title = {Involvement of central immunity in uncomplicated diverticular disease.},
journal = {Scandinavian journal of gastroenterology},
volume = {44},
number = {1},
pages = {108-115},
doi = {10.1080/00365520802321204},
pmid = {18759154},
issn = {1502-7708},
mesh = {Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal ; Antigens, CD/drug effects/*immunology ; Biomarkers/metabolism ; CD4 Antigens/drug effects/*immunology ; CD8 Antigens/drug effects/*immunology ; Case-Control Studies ; Colon, Sigmoid/immunology ; Colon, Transverse/immunology ; Colonoscopy ; Diverticulitis, Colonic/*drug therapy/*immunology/pathology ; Female ; Flow Cytometry ; Gastrointestinal Agents/*therapeutic use ; Humans ; Integrin alpha Chains/drug effects/*immunology ; Male ; Middle Aged ; Prospective Studies ; Rifamycins/*therapeutic use ; Rifaximin ; Treatment Outcome ; },
abstract = {OBJECTIVE: The pathogenesis of symptoms of uncomplicated diverticular disease (UDD) is unclear, but changes in gut microflora and physiologic inflammation may be implicated. The objective of the study was to investigate the distribution of gut homing lymphocytes in peripheral blood and intestinal mucosa of UDD patients, and the effects of luminal antibiotic treatment.
MATERIAL AND METHODS: Ten UDD patients and 10 age- and gender-matched healthy subjects underwent peripheral blood sampling, and colonoscopy with biopsies taken from the transverse and sigmoid colon. Treatment consisted of a 2-month course of rifaximin 1.2 g/day for 15 days/month. Blood sample and mucosal biopsies were repeated in UDD patients at the end of treatment. Flow cytometry was performed using monoclonal antibodies (CD3, CD4, CD8, CD25, CD19, CD45, CD62L, CD103).
RESULTS: In peripheral blood, both CD4+ and CD8+/CD103+ were significantly higher in patients at baseline than in controls (0.95% versus 0.36%, and 0.5% versus 0.09%, respectively). After treatment, peripheral CD4+/CD103+ decreased (0.27%), while CD8+/CD103+ did not change (0.35%); on the contrary, peripheral CD25+ increased, the CD4+ subpopulation showing significantly higher levels than those in controls. No difference was found between lymphocytes in the diverticular sigmoid mucosa of patients at baseline and those in controls, but there was a significant decrease in CD8+/CD62L+ after treatment. In the normal transverse colon, CD4+/CD62L+ of patient at baseline were significantly lower than in controls. After treatment, CD4+/CD103+ levels significantly increased, while CD8+/CD62L+ levels significantly decreased.
CONCLUSIONS: Both central and mucosal immunity may be modified in UDD patients, with an increased recruitment of CD103+ lymphocytes. A 2-month course of rifaximin appears to reduce CD103+ levels, suggesting a decrease in mobilization of mucosal homing.},
}
@article {pmid18758640,
year = {2008},
author = {Becheanu, G and Manuc, M and Dumbravă, M and Herlea, V and Hortopan, M and Costache, M},
title = {The evaluation of interstitial Cajal cells distribution in non-tumoral colon disorders.},
journal = {Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie},
volume = {49},
number = {3},
pages = {351-355},
pmid = {18758640},
issn = {1220-0522},
mesh = {Antigens, CD34/metabolism ; Case-Control Studies ; Cell Count ; Colon/metabolism/*pathology ; Colonic Diseases/metabolism/*pathology ; Humans ; Intestine, Small/metabolism/pathology ; Myenteric Plexus/metabolism/*pathology ; Proto-Oncogene Proteins c-kit/metabolism ; },
abstract = {Interstitial cells of Cajal (ICC) are pacemakers that generate electric waves recorded from the gut and are important for intestinal motility. The aim of the study was to evaluate the distribution of interstitial cells of Cajal in colon specimens from patients with idiopathic chronic pseudo-obstruction and other non-tumoral colon disorders as compared with samples from normal colon. The distribution pattern of ICC in the normal and pathological human colon was evaluated by immunohistochemistry using antibodies for CD117, CD34, and S-100. In two cases with intestinal chronic idiopathic pseudo-obstruction we found a diffuse or focal reducing number of Cajal cells, the loss of immunoreactivity for CD117 being correlated with loss of immunoreactivity for CD34 marker. Our study revealed that the number of interstitial cells of Cajal also decrease in colonic diverticular disease and Crohn disease (p<0.05), whereas the number of enteric neurones appears to be normal. These findings might explain some of the large bowel motor abnormalities known to occur in these disorders. Interstitial Cajal cells may play an important role in pathogenesis and staining for CD117 on transmural intestinal surgical biopsies could allow a more extensive diagnosis in evaluation of chronic intestinal pseudo-obstruction.},
}
@article {pmid18751760,
year = {2009},
author = {Scarpa, M and Pagano, D and Ruffolo, C and Pozza, A and Polese, L and Frego, M and D'Amico, DF and Angriman, I},
title = {Health-related quality of life after colonic resection for diverticular disease: long-term results.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {13},
number = {1},
pages = {105-112},
pmid = {18751760},
issn = {1873-4626},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Disease-Free Survival ; Diverticulum, Colon/psychology/*surgery ; Female ; Follow-Up Studies ; *Health Status ; Humans ; Laparoscopy ; Male ; Middle Aged ; *Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; Time Factors ; Treatment Outcome ; Young Adult ; },
abstract = {BACKGROUND AND AIMS: While colonic resection is standard practice in complicated colonic diverticular disease (DD), treatment of uncomplicated diverticulitis is, as yet, unclear. The aim of the present study was to evaluate the long-term clinical outcome and quality of life in DD patients undergoing colonic resection compared to those receiving medical treatment only.
PATIENTS AND METHODS: Seventy-one consecutive patients who were admitted to our surgical department with left iliac pain and endoscopical or radiological diagnosis of DD were enrolled in this trial. Disease severity was assessed with Hinchey scale. Twenty-five of the patients underwent colonic resection, while 46 were treated with medical therapy alone. After a median follow-up of 47 (3-102) months from the time of their first hospital admission, the patients responded to the questions of the Cleveland Global Quality of Life (CGQL) questionnaire and to a symptoms questionnaire during a telephone interview. Admittance and surgical procedures for DD were also investigated, and surgery- and symptoms-free survival rates were calculated. Nonparametric tests and survival analysis were used.
RESULTS: The CGQL total scores and symptom frequency rate were found to be similar in the two groups (resection vs nonresection). Only current quality of health item was significantly worse in patients who had undergone colonic resection (p = 0.05). No difference was found in the rate and in the timing of surgical procedures and hospital admitting for DD in the two groups. In particular, the nine patients classified as Hinchey 1 who underwent surgery reported the same quality of life, symptoms frequency, operation, and hospital admitting rate as those who had been admitted with the same disease class but who received medical treatment only.
CONCLUSIONS: Our results indicate that there does not seem to be any long-term advantage to colonic resection which should be considered only in patients presenting complicated DD.},
}
@article {pmid18728264,
year = {2008},
author = {Strate, LL and Liu, YL and Syngal, S and Aldoori, WH and Giovannucci, EL},
title = {Nut, corn, and popcorn consumption and the incidence of diverticular disease.},
journal = {JAMA},
volume = {300},
number = {8},
pages = {907-914},
pmid = {18728264},
issn = {1538-3598},
support = {K24 CA113433/CA/NCI NIH HHS/United States ; P01 CA055075/CA/NCI NIH HHS/United States ; K24 CA113433-03/CA/NCI NIH HHS/United States ; K08 HS014062/HS/AHRQ HHS/United States ; K08 HS14062/HS/AHRQ HHS/United States ; P01 CA055075-070002/CA/NCI NIH HHS/United States ; R01 HL035464/HL/NHLBI NIH HHS/United States ; K24 CA113433-04/CA/NCI NIH HHS/United States ; },
mesh = {Adult ; Aged ; *Diet ; Diverticulitis, Colonic/complications/*epidemiology ; Gastrointestinal Hemorrhage/etiology ; Health Surveys ; Humans ; Incidence ; Male ; Middle Aged ; *Nuts ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; *Zea mays ; },
abstract = {CONTEXT: Patients with diverticular disease are frequently advised to avoid eating nuts, corn, popcorn, and seeds to reduce the risk of complications. However, there is little evidence to support this recommendation.
OBJECTIVE: To determine whether nut, corn, or popcorn consumption is associated with diverticulitis and diverticular bleeding.
DESIGN AND SETTING: The Health Professionals Follow-up Study is a cohort of US men followed up prospectively from 1986 to 2004 via self-administered questionnaires about medical (biennial) and dietary (every 4 years) information. Men reporting newly diagnosed diverticulosis or diverticulitis were mailed supplemental questionnaires.
PARTICIPANTS: The study included 47,228 men aged 40 to 75 years who at baseline were free of diverticulosis or its complications, cancer, and inflammatory bowel disease and returned a food-frequency questionnaire.
MAIN OUTCOME MEASURES: Incident diverticulitis and diverticular bleeding.
RESULTS: During 18 years of follow-up, there were 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding. We found inverse associations between nut and popcorn consumption and the risk of diverticulitis. The multivariate hazard ratios for men with the highest intake of each food (at least twice per week) compared with men with the lowest intake (less than once per month) were 0.80 (95% confidence interval, 0.63-1.01; P for trend = .04) for nuts and 0.72 (95% confidence interval, 0.56-0.92; P for trend = .007) for popcorn. No associations were seen between corn consumption and diverticulitis or between nut, corn, or popcorn consumption and diverticular bleeding or uncomplicated diverticulosis.
CONCLUSIONS: In this large, prospective study of men without known diverticular disease, nut, corn, and popcorn consumption did not increase the risk of diverticulosis or diverticular complications. The recommendation to avoid these foods to prevent diverticular complications should be reconsidered.},
}
@article {pmid18715614,
year = {2008},
author = {Dupre, MP and Jadavji, I and Matshes, E and Urbanski, SJ},
title = {Diverticular disease of the vermiform appendix: a diagnostic clue to underlying appendiceal neoplasm.},
journal = {Human pathology},
volume = {39},
number = {12},
pages = {1823-1826},
doi = {10.1016/j.humpath.2008.06.001},
pmid = {18715614},
issn = {1532-8392},
mesh = {Adenocarcinoma/complications/*pathology ; Appendectomy ; Appendiceal Neoplasms/complications/*pathology ; Appendicitis/pathology/surgery ; Appendix/*pathology ; Carcinoid Tumor/complications/*pathology ; Cystadenoma, Mucinous/complications/*pathology ; Diverticulum/complications/*pathology ; Humans ; Retrospective Studies ; },
abstract = {Acquired diverticula of the vermiform appendix are rare and arise as a result of different pathogenetic mechanisms. One of the etiologies includes proximally located, often unsuspected small neoplasms. Although the association of appendiceal diverticulosis and neoplasia is known, it remains underemphasized in the teaching and practice of surgical pathology. To investigate the frequency of appendiceal neoplasms with acquired diverticulosis, we conducted a retrospective analysis of all appendectomy specimens received in our institution for a 55-month period (January 2002-July 2006). A total of 1361 appendectomy specimens were identified. Diverticulosis was diagnosed in 23 (1.7%) of all cases. Eleven (48%) appendectomy specimens with diverticulosis also harbored an appendiceal neoplasm. The association of appendiceal neoplasms with diverticulosis was statistically significant (P < .0001, 2-sided Fisher exact test). Neoplastic processes included 5 well-differentiated neuroendocrine tumors (carcinoids), 3 mucinous adenomas, 1 tubular adenoma, and 2 adenocarcinomas. In one case, routine representative sections sampled only a small focus of carcinoma, which originally went undiagnosed. We stress the need for meticulous gross assessment with histologic examination of the entire appendectomy specimen in cases of appendiceal diverticulosis. Thorough examination is required to rule out an underlying neoplasm as a cause of diverticulosis. As acquired diverticula represent a rare finding, examination of the entire appendix in this setting does not create a significant impact on the workload within the pathologic laboratory.},
}
@article {pmid18712563,
year = {2008},
author = {Collins, D and Winter, DC},
title = {Elective resection for diverticular disease: an evidence-based review.},
journal = {World journal of surgery},
volume = {32},
number = {11},
pages = {2429-2433},
pmid = {18712563},
issn = {0364-2313},
mesh = {Cost-Benefit Analysis ; Diverticulitis, Colonic/economics/pathology/*prevention & control ; Diverticulum, Colon/economics/pathology/*surgery ; *Elective Surgical Procedures/economics ; Humans ; Secondary Prevention ; },
abstract = {Controversy exists as to the most appropriate management of patients following two episodes of diverticulitis. Despite a growing body of new evidence challenging the concept of elective sigmoid resection after a patient experiences two attacks of diverticulitis, we continue to base our practice on outdated studies carried out more than 30 years ago. The recommendation that patients undergo elective sigmoid resection after two attacks of acute diverticulitis should be re-evaluated as it is generally inappropriate and is not cost effective. Elective resection for uncomplicated diverticulitis does not alter outcome, nor does it decrease mortality or prevent complications of the disease. In fact, based on current literature, 18 patients would have to undergo elective operation to prevent one emergency surgery. This article aims to review the current evidence for elective resection following episodes of diverticular disease and addresses emerging controversies in the management of this disease.},
}
@article {pmid18705297,
year = {2008},
author = {Tursi, A and Brandimarte, G and Giorgetti, GM and Elisei, W},
title = {Mesalazine and/or Lactobacillus casei in maintaining long-term remission of symptomatic uncomplicated diverticular disease of the colon.},
journal = {Hepato-gastroenterology},
volume = {55},
number = {84},
pages = {916-920},
pmid = {18705297},
issn = {0172-6390},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage ; Cohort Studies ; Diverticulitis, Colonic/*drug therapy ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Female ; Humans ; *Lacticaseibacillus casei ; Long-Term Care ; Male ; Mesalamine/*administration & dosage ; Middle Aged ; Probiotics/*administration & dosage ; Prospective Studies ; Secondary Prevention ; },
abstract = {BACKGROUND/AIMS: Four different therapeutic schedules with mesalazine and/or probiotics were assessed in preventing recurrence of symptomatic diverticular disease (DD) of the colon.
METHODOLOGY: A prospective, dose-finding study was conducted on 75 patients, enrolled in an open fashion: mesalazine 800mg/daily (group M1) or mesalazine 1.6gr 10 days/month (group M2); mesalazine 800mg/daily + Lactobacillus casei DG 16 billion/day for 10 day/month (group LM1) or mesalazine 1.6gr + Lactobacillus casei DG 16 billion/day for 10 day/month (group LM2); Lactobacillus casei DG 16 billion/day for 10 day/month (group L).
RESULTS: Seventy one patients completed the study (94.66%). Sixty six patients (88%) were symptom-free after the 24th month of treatment: 11 of group M1 (on i-t-t: 84% [CI 95%: 55.5-98.8]), 8 of group M2 (on i-t-t: 80% [CI 95%: 44.39-97.48]), 15 of group LM1 (on i-t-t: 93.75% [CI 95%: 69.77-99.84]), 12 of group LM2 (on i-t-t: 92.30% [CI 95%: 63.97-99.81]), 20 in group L (on i-t-t: 86.95% [CI 95%: 66.41-97.22]) (p-ns). Four patients (5.33%) suspended the treatment during the follow-up: all experienced recurrence of symptoms (100%), and 2 of them developed diverticulitis (50%).
CONCLUSIONS: Mesalazine and/or Lactobacillus casei seem to be effective in maintaining remission of DD for long-time. Moreover, we found recurrence of the disease and complications in all patients suspending treatments.},
}
@article {pmid18679693,
year = {2008},
author = {Piekarek, K and Israelsson, LA},
title = {Perforated colonic diverticular disease: the importance of NSAIDs, opioids, corticosteroids, and calcium channel blockers.},
journal = {International journal of colorectal disease},
volume = {23},
number = {12},
pages = {1193-1197},
pmid = {18679693},
issn = {0179-1958},
mesh = {Adrenal Cortex Hormones/*adverse effects ; Aged ; Analgesics, Opioid/*adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Calcium Channel Blockers/*adverse effects ; Colonic Diseases/*chemically induced ; Diverticulum, Colon/*complications ; Female ; Humans ; Intestinal Perforation/*chemically induced ; Male ; Middle Aged ; },
abstract = {PURPOSE: Perforated colonic diverticular disease is associated with a high rate of late sequel and mortality. The risk of colonic perforation may relate to intracolonic pressure and mucosal barrier function in the wall of diverticula. The use of substances affecting these parameters may therefore be associated with the risk of developing a perforation. The aim was to study the effect of nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, calcium channel blockers, and antimuscarinics on perforation in diverticular disease.
MATERIALS AND METHODS: A review of 54 patients with colonic diverticular perforation-forming the case group-and 183 patients with verified colonic diverticular disease-forming the control group-was done. Patient characteristics and drug use was registered.
RESULTS: Case group and control group were comparable with respect to sex, age, and comorbidity. In multivariate analysis, the use of NSAIDs (OR 3.56; 95% CI 1.50-8.43), opioids (OR 4.51; 95% CI 1.67-12.18), and corticosteroids (OR 28.28; 95% CI 4.83-165.7) were significantly associated with perforated diverticular disease. Acetylsalicylic acid in cardiologic dose did not affect the rate of perforation (OR 0.66; 95% CI 0.27-1.61). The use of calcium channel blockers was associated with a reduced rate of diverticular complications (OR 0.14; 95% CI 0.02-0.95).
CONCLUSIONS: The administration of NSAIDs, opioids, and corticosteroids are associated with an increased risk of colonic diverticular perforation. Acetylsalicylic acid in cardiologic dose does not affect the risk of perforation. Calcium channel blockers are associated with a reduced risk of perforation.},
}
@article {pmid18677904,
year = {2008},
author = {Khder, SA and Trifan, A and Danciu, M and Stanciu, C},
title = {[Colorectal polyps: clinical, endoscopic, and histopathologic features].},
journal = {Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi},
volume = {112},
number = {1},
pages = {59-65},
pmid = {18677904},
issn = {0048-7848},
mesh = {Adenoma/diagnosis ; Adult ; Aged ; Aged, 80 and over ; Colon/*pathology ; Colonic Polyps/*diagnosis/epidemiology/pathology/surgery ; *Colonoscopy ; Colorectal Neoplasms/*diagnosis/epidemiology/pathology/surgery ; Diagnosis, Differential ; Female ; Humans ; Intestinal Polyps/*diagnosis/epidemiology/pathology/surgery ; Male ; Middle Aged ; Prevalence ; Rectum/*pathology ; Retrospective Studies ; Romania/epidemiology ; Treatment Outcome ; },
abstract = {AIM: To evaluate the prevalence of colorectal polyps in a population from North- Eastern Romania, which underwent colonoscopic examination and to identify their clinical, endoscopic and histopathologic characteristics.
METHODS: A retrospective prevalence study of subjects aged 18-95 years, with no personal or familial history of familial adenomatous polyposis and inflammatory bowel disease, who underwent a colonoscopy. The number, size, gross endoscopic appearance, histopathological examination, and the anatomic location of colorectal polyps were analyzed, as well as the associated diseases.
RESULTS: Enrolled were 1001 patients (647 men, 354 women), aged 18-95 years (mean: 62.8 +/- 11.4 years) who were diagnosed with colorectal polyps. Overall, there were 1.534 colorectal polyps, and the majority of them (83.0%) were present in patients over the age of 50 years, from urban area (73.9%) and most of the patients were men (63.8%), and had solitary polyps (61.1%). Three-quarters of polyps were distal (rectum, sigmoid, and descendent colon) in location, and most of them (75.8%) had a size less than 10 mm. Over half of all polyps (54.7%) were pedunculated. Based on the histological structural configuration, 76.5% of all polyps were adenomas, and of these 62.6% were tubular adenomas; malignant polyps have been diagnosed in 82 (5.4%) patients. Associated hemorrhoids, diverticulosis, colorectal cancer, and angiodysplasia were identified in 9.6%, 10% and 1.3%, respectively.
CONCLUSION: The prevalence of colorectal polyps in our geographical area is in the range with that observed in other regions of our country. Most of polyps were identified in patients older than 50 years, predominantly men, located in distal colon, had a tubular adenoma histological structure, and frequently associated with hemorrhoids and diverticular disease.},
}
@article {pmid18661910,
year = {2008},
author = {Christl, SU},
title = {[Diverticular disease of the colon].},
journal = {Medizinische Monatsschrift fur Pharmazeuten},
volume = {31},
number = {6},
pages = {209-213},
pmid = {18661910},
issn = {0342-9601},
mesh = {Colonic Diseases/*drug therapy/epidemiology/physiopathology ; Diverticulitis/*drug therapy/epidemiology/physiopathology ; Humans ; },
abstract = {Diverticular disease of the colon is a common civilisatory phenomenon. Its clinical relevance is defined by the typical manifestations diverticulitis (incl. its complications abscess formation and fistulation), diverticular bleeding, and chronic pain. Although clear evidence criteria are missing on many aspects of the therapy, there is broad consensus on the suitable diagnostics as well as conservative and surcigal therapy. Nevertheless, there remain open questions, and due to new data, several aspects have to be put up to discussion. As long as there are no mandatory evidence-based guidelines, in-house clinical standards should be developed in interdisciplinary working groups.},
}
@article {pmid18637926,
year = {2009},
author = {Clements, D and Tawfiq, S and Harries, B and Sheridan, W},
title = {Application of the BSG guidelines to a colonoscopy waiting list.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {11},
number = {5},
pages = {513-515},
doi = {10.1111/j.1463-1318.2008.01644.x},
pmid = {18637926},
issn = {1463-1318},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; *Colonoscopy/methods/standards ; Gastroenterology ; *Guideline Adherence ; Humans ; Middle Aged ; Practice Guidelines as Topic ; Retrospective Studies ; Societies, Medical ; Time Factors ; United Kingdom ; *Waiting Lists ; },
abstract = {Abstract Objective Currently priority for colonoscopy is given to diagnostic and therapeutic procedures. Surveillance colonoscopies place a significant demand on the service. These are held on a separate waiting list in our institution, which is currently several years behind. The purpose of this study was to apply the BSG guidelines to this waiting list in our institution in order to ascertain whether patients are appropriately listed. Method This was a retrospective review. The patients on the waiting list whose procedures were due in 2004 and 2005 formed the study group. Information on demographics, previous colonoscopies, and indication was taken from the case notes. Results were analysed using Microsoft Excel. Results A total of 172 patients were overdue their colonoscopies. If the BSG guidelines were strictly adhered to, 49% of these patients were inappropriately listed. If applied less rigidly, 42% of patients should not have been on the list. The reasons for removal from the list were as follows: Thirty-nine patients were older than the upper age limit, 23 had had clear colonoscopies after adenomatous polyp follow up, four were listed for diverticular disease follow up, four for metaplastic polyps, one for constipation and one for per rectum (PR) bleed follow up. Conclusion With strict application of the BSG guidelines to a surveillance colonoscopy waiting list, 49% of the patients on the list do not need the procedure. It is recommended that consultant led education and control of the waiting list be used to reduce unnecessary investigations.},
}
@article {pmid18633672,
year = {2009},
author = {Mazeh, H and Greenstein, AJ and Swedish, K and Nguyen, SQ and Lipskar, A and Weber, KJ and Chin, EH and Divino, CM},
title = {Laparoscopic and open reversal of Hartmann's procedure--a comparative retrospective analysis.},
journal = {Surgical endoscopy},
volume = {23},
number = {3},
pages = {496-502},
pmid = {18633672},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Chi-Square Distribution ; Colostomy/*methods ; Female ; Humans ; Intestinal Diseases/*surgery ; Laparoscopy/*methods ; Laparotomy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Restoration of intestinal continuity after Hartmann's procedure has traditionally required laparotomy. This study compares our experience with laparoscopic and open reversal of Hartmann's procedure.
STUDY DESIGN: All laparoscopic and open Hartmann's reversal procedures performed between January 1998 and June 2006 were reviewed. Patients with laparoscopic reversal were retrospectively matched by age, body mass index (BMI), and indication to controls with open reversal. Demographic data, perioperative course, and postoperative complications were documented.
RESULTS: We identified 41 patients who underwent laparoscopic reversal of Hartmann's procedure and these were matched to 41 patients with open reversal. The groups had similar average age and BMI. The predominant indication for surgery in both groups was diverticular disease. Conversion to laparotomy occurred in eight patients (19.5%), and was due to dense adhesions or difficulty in identification of the rectal stump. Adhesions were significantly greater in the conversion group (p <0.05), and the rectal stump was not marked in any of these cases. The most common short-term complications were ileus and surgical site infection. There were no anastomotic leaks and no mortalities. The mean operative times in the laparoscopic and open groups were 193 versus 209 min, respectively (p = 0.33). The laparoscopic group had a significantly lower estimated blood loss of 166 versus 326 mL (p < 0.0005), shorter time to bowel function return (4.1 versus 5.2 days, p < 0.05), and a shorter hospital stay (6.4 versus 8.0 days, p < 0.05). The major complication rate was also significantly lower in the laparoscopic group than in the open group (4.8% versus 12.1%, p < 0.05).
CONCLUSIONS: Laparoscopic reversal of Hartmann's procedure is a safe and practical alternative to open reversal. It can be performed with similar operative time, fewer complications, and a faster recovery time. Conversion during the reversal procedure was significantly impacted by severity of adhesions and marking of the rectal stump.},
}
@article {pmid18619106,
year = {2008},
author = {Kelley, MT},
title = {Diverticular disease of the colon: a conservative approach works best.},
journal = {JAAPA : official journal of the American Academy of Physician Assistants},
volume = {21},
number = {6},
pages = {48-53},
doi = {10.1097/01720610-200806000-00088},
pmid = {18619106},
issn = {1547-1896},
mesh = {Anti-Bacterial Agents/therapeutic use ; Diverticulitis, Colonic/*drug therapy/physiopathology/surgery ; Fluid Therapy ; Humans ; },
}
@article {pmid18616737,
year = {2009},
author = {Titu, LV and Zafar, N and Phillips, SM and Greenslade, GL and Dixon, AR},
title = {Emergency laparoscopic surgery for complicated diverticular disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {11},
number = {4},
pages = {401-404},
doi = {10.1111/j.1463-1318.2008.01606.x},
pmid = {18616737},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Colectomy/adverse effects/*methods ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Male ; Middle Aged ; Retrospective Studies ; Surgical Wound Infection ; Survival Analysis ; Young Adult ; },
abstract = {OBJECTIVE: The aim of this study was to analyse the outcome of emergency laparoscopic surgical management of complicated diverticular disease.
METHOD: A prospectively collected electronic database of all colorectal laparoscopic procedures between April 2001 and September 2007 has been used to identify outcomes in patients presenting with complicated diverticular disease.
RESULTS: Sixty-six patients (28 men), median age 69 years (23-95), ASA grade II (12), III (38), IV (16) have undergone emergency surgery for complicated diverticulitis--Hinchey grades I (27), II (29), III (7) and diverticular bleeding (3) over a 6(1/2)-year period: 43 high anterior resections, 17 Hartmann's resections and seven low anterior resections. Diverticular fistulas were seen in 16 patients: colovaginal (7), colovesical (2), colo-fallopian (4), entero-colic (3). The median operation time was 110 min (45-195 min). There was one conversion to open surgery. Postoperative analgesia was provided by intravenous Paracetamol in 33 patients (50%), patient-controlled analgesia in 24 (36%), oral Paracetamol and Oramorph (12%) and epidural opioid infusion (1.5%). The median time to normal diet was 24 h (4 h-6 days) and median hospital stay 5 days (2-30). There were two deaths (3.3%); anastomotic leak, ventricular fibrillation (VF) cardiac arrest. Other complications included: wound infection eight (12%), anastomotic leak four (8%), port-site hernia one and one case of Clostridium difficile colitis requiring colectomy. There were five (7.5%) returns to theatre and two readmissions (3%).
CONCLUSION: Laparoscopic resectional surgery in complicated diverticular disease is a feasible, safe and a largely predictable operation that allows for early hospital discharge and, in our opinion, improved patient care. We are encouraged to continue to offer our patients the option of an emergency laparoscopic resection.},
}
@article {pmid18608997,
year = {2008},
author = {D'Hoore, A and Hompes, D and Folkesson, J and Penninckx, F and PAhlman, L},
title = {Circular 'superelastic' compression anastomosis: from the animal lab to clinical practice.},
journal = {Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy},
volume = {17},
number = {3},
pages = {172-175},
doi = {10.1080/13645700802103142},
pmid = {18608997},
issn = {1365-2931},
mesh = {Adenocarcinoma/surgery ; Adult ; Aged ; Alloys/chemistry ; Anastomosis, Surgical/adverse effects/*methods ; Animals ; Colectomy/methods ; Colon/surgery ; Digestive System Surgical Procedures/instrumentation/*methods ; Diverticulosis, Colonic/*surgery ; Elasticity ; Humans ; Length of Stay ; Middle Aged ; Pilot Projects ; Pressure ; Prospective Studies ; Rectum/surgery ; Suture Techniques/instrumentation ; },
abstract = {The recent development of a compression device using shape memory Nitinol technology to create an end-to-end anastomosis has renewed the interest in sutureless anastomotic techniques. A phase II, prospective open label clinical trial was started in May 2007 to evaluate the feasibility and safety of this new anastomotic device. Fourty patients who need left colectomy or high anterior resection for either diverticular disease or adenocarcinoma will be recruited in two academic hospitals (Uppsala,Sweden and Leuven, Belgium). Clinical leakage is the primary endpoint. Only preliminary results are available to date as the recruitment is ongoing. The median age of the first ten patients is 57.5 years (44-72). No anastomotic leakage occurred. The median hospital stay was 4.0 days. Only three patients noticed the passage of the ring through the anal canal. By three weeks no ring was sustained in the gastrointestinal tract as was objectified by plain X-ray. First clinical use of this new anastomotic device seems promising. Final results for the total phase II trial are awaited. A prospective randomized trial to compare the efficacy of the EndoCar 28 with conventional stapling should be the next step.},
}
@article {pmid18604732,
year = {2008},
author = {Oh, HE and Chetty, R},
title = {Intramucosal ganglion cells are common in diverticular disease.},
journal = {Pathology},
volume = {40},
number = {5},
pages = {470-474},
doi = {10.1080/00313020802198028},
pmid = {18604732},
issn = {0031-3025},
mesh = {Adult ; Aged ; Aged, 80 and over ; Female ; Gastrointestinal Diseases/*pathology ; Humans ; Intestinal Mucosa/cytology/innervation/*pathology ; Male ; Middle Aged ; Neurons/*pathology ; Retrospective Studies ; },
abstract = {AIMS: Ganglion cells were thought not to occur within the mucosa of the normal colon and found only in the setting of inflammatory bowel disease and neuronal intestinal dysplasia. The aim of this study was to firmly establish the incidence of intramucosal ganglion cells in diverticular disease, normal mucosa and in a spectrum of gastrointestinal diseases.
METHODS: We retrospectively reviewed 50 resection specimens from cases of symptomatic diverticular disease and biopsies and/or resection specimens for several neoplastic and non-neoplastic gastrointestinal diseases (50 normal and 120 cases for a variety of gastrointestinal diseases). Normal cases were constituted by biopsies with no clinical history of large bowel disease and no pathology detected microscopically.
RESULTS: All 50 cases of diverticular disease contained intramucosal ganglion cells, located within the muscularis mucosae (49/50 cases) as well as within the lamina propria in nine cases. Intramucosal ganglion cells occurred throughout the colorectum within the muscularis mucosae or lamina propria in normal mucosa in 11 cases and in a further 26 colorectal specimens with Crohn's disease (11/20), ulcerative colitis (11/20), adenocarcinoma (1/20), tubular adenoma (2/20), and mucosal prolapse (1/20). None of the 20 hyperplastic polyps contained intramucosal ganglion cells.
CONCLUSIONS: We have firmly established the existence of the intramucosal ganglion cells in normal and diseased colorectum, especially in the mucosa of cases of diverticular disease (100% of cases), Crohn's disease and ulcerative colitis. These three conditions are linked by motility abnormalities which may underlie the reason for the presence of intramucosal ganglion cells.},
}
@article {pmid18594842,
year = {2008},
author = {Meurs-Szojda, MM and Terhaar sive Droste, JS and Kuik, DJ and Mulder, CJ and Felt-Bersma, RJ},
title = {Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies.},
journal = {International journal of colorectal disease},
volume = {23},
number = {10},
pages = {979-984},
pmid = {18594842},
issn = {0179-1958},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Polyps/diagnosis/*epidemiology/etiology ; Colonoscopy/*statistics & numerical data ; Colorectal Neoplasms/diagnosis/*epidemiology/etiology ; Cross-Sectional Studies ; Diverticulitis, Colonic/complications/*diagnosis/epidemiology ; Diverticulosis, Colonic/complications/*diagnosis/epidemiology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Netherlands/epidemiology ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors ; Young Adult ; },
abstract = {BACKGROUND AND AIMS: There are conflicting data concerning the association between diverticular disease and colorectal carcinoma (CRC). This study was performed to determine the prevalence and association of diverticulosis, diverticulitis, polyps, and CRC.
MATERIALS AND METHODS: In a cross-sectional, retrospective study, we analyzed the colonoscopy reports of complete colonoscopies and patho-histological results of all patients referred for colonoscopy in a period of 3 months in 18 hospitals in The Netherlands. Diverticulosis was defined as three or more diverticula present and diverticulitis as diverticulosis with inflammation. Polyps were also coded according to localization and size. Advanced neoplastic lesions were defined as polyps >or=10 mm in diameter and/or villous architecture and/or adenomas with high grade dysplasia and/or invasive cancer. Actual and previous described CRC were registered.
RESULTS: A total of 4,241 patients were included in the study [1,996 (47%) male], mean age of 59 and range 18-95. Diverticula, diverticulitis, and polyps were seen in 1,052 (25%), 75 (2%), and 1,282 (30%) patients, respectively. No association was found between patients with polyps and those with and without diverticulosis (p=0.478). Invasive adenocarcinoma and adenomas >or=10 mm were most frequently observed. CRC was present in 372 (9%) patients. Negative relation between diverticulosis and CRC and invasive adenocarcinoma was observed. No association was found between polyps and CRC and patients with diverticulitis and CRC. In conclusion, there is no relation between patients with diverticulosis and higher incidence of polyps or CRC when using age-stratified analysis. No increased risk for polyps or CRC was found in patients with diverticulitis.},
}
@article {pmid18592453,
year = {2008},
author = {Gross, V and Germer, CT},
title = {[Diverticular disease and diverticulitis].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {133},
number = {27},
pages = {1437-1446},
doi = {10.1055/s-2008-1081091},
pmid = {18592453},
issn = {1439-4413},
mesh = {Abdominal Abscess/diagnosis/mortality/therapy ; Acute Disease ; Aged ; Algorithms ; Anti-Bacterial Agents/therapeutic use ; Colectomy ; Diverticulitis, Colonic/*diagnosis/mortality/therapy ; Diverticulosis, Colonic/*diagnosis/mortality/therapy ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Recurrence ; Risk Factors ; Survival Rate ; Tomography, X-Ray Computed ; Ultrasonography ; },
}
@article {pmid18563482,
year = {2008},
author = {Mansfield, SD and Jensen, C and Phair, AS and Kelly, OT and Kelly, SB},
title = {Complications of loop ileostomy closure: a retrospective cohort analysis of 123 patients.},
journal = {World journal of surgery},
volume = {32},
number = {9},
pages = {2101-2106},
pmid = {18563482},
issn = {0364-2313},
mesh = {Aged ; Chi-Square Distribution ; England/epidemiology ; Female ; Humans ; Ileostomy/*methods ; Male ; Middle Aged ; Postoperative Complications/*epidemiology ; Retrospective Studies ; },
abstract = {BACKGROUND: Loop ileostomies are often formed in order to defunction distal anastomoses. The aim of this study was to review the complications following closure of loop ileostomies.
METHODS: This is a retrospective case note analysis of all loop ileostomy closures performed in the Northumbria Healthcare NHS Trust (population over 500,000) over a 5-year period between 2001 and 2005.
RESULTS: A total of 123 case records were reviewed. Complications occurred in 41 patients (33.3%), with 9 patients (7.3%) requiring further intervention. There were 4 (3.3%) postoperative deaths. Complications were more common in patients with increased comorbidity (p = 0.0007) and postoperative death was more frequent among the elderly (p = 0.0006). Postoperative death was more common in those patients who had their stomas created during surgery (elective or emergency) for diverticular disease (3 patients, p = 0.006). Patients with diverticular disease had significantly higher comorbidity and peritoneal contamination at the time of primary surgery. Ileostomy reversal after anterior resection for cancer was associated with a lower complication rate than the rest of the cohort (26%, p = 0.0003) but there was no significant difference in mortality. Neither the grade of the surgeon, the case volume, or the anastomotic technique affected postoperative morbidity. Reoperation was more common in patients whose closure procedure took less time (p = 0.002) and in those who had a shorter wait from creation to reversal of the stoma (p < 0.0001).
CONCLUSIONS: Reversal of loop ileostomy may be associated with significant morbidity and mortality. Increasing the delay from creation to closure may result in fewer complications.There is an increased risk in older patients with more comorbidity, particularly when the primary procedure is for diverticular disease with significant peritoneal contamination.},
}
@article {pmid18560551,
year = {2008},
author = {Dakubo, J and Kumoji, R and Naaeder, S and Clegg-Lamptey, J},
title = {Endoscopic evaluation of the colorectum in patients presenting with haematochezia at korle-bu teaching hospital accra.},
journal = {Ghana medical journal},
volume = {42},
number = {1},
pages = {33-37},
pmid = {18560551},
issn = {0016-9560},
abstract = {SUMMARY BACKGROUND: Colorectal endoscopy is the gold standard investigation of the large bowel in patients with rectal bleeding and is employed as a means of secondary prevention of colorectal cancer.
AIM: To determine the frequency of benign lesions and carcinomas in patients who underwent colorectal endoscopy because of rectal bleeding and to evaluate the role of endoscopy in secondary prevention of colorectal carcinoma in our centre.
METHOD: A retrospective study was undertaken on patients who underwent colorectal endoscopy between January 1995 and December 2000 for rectal bleeding.
RESULTS: Five hundred and ninety six (596) patients were studied. Males were 403 and females 93, mean age 50.9 (SD 7.07). Three hundred and ten patients (52%) had rigid proctosigmoidoscopy, flexible sigmoidoscopy 105 (17.6%) and colonoscopy 181 (30.4%). Of those who had colonoscopy complete examination of the colon was achieved in 55 patients (30.4%). Those in whom colonoscopy was incomplete had double contrast barium enema. Haemorrhoids were the commonest disease diagnosed, 316 patients (53%). Colorectal carcinoma 39 patients (6.7%), non-specific colitis 34 patients (5.7%), diverticular disease 27 patients (4.5%) and adenomatous polyps 17 patients (2.9%) were the next common disease. Less common conditions were ulcerative colitis, rectal schistosomiasis and angiodysplasia. In 125 patients (21.0) the cause of bleeding could not be found.
CONCLUSION: An appreciable number of the patients with rectal bleeding had serious pathology that was diagnosed early by endoscopy confirming the important role of endoscopy in secondary prevention of colorectal carcinoma. The low success rate of full colonoscopy underscores the need for training in this procedure.},
}
@article {pmid18542763,
year = {2007},
author = {Rapoport, D and Ross, A and Goshko, V and McAuley, I},
title = {Urachal-sigmoid fistula associated with diverticular disease.},
journal = {Canadian Urological Association journal = Journal de l'Association des urologues du Canada},
volume = {1},
number = {1},
pages = {52-54},
pmid = {18542763},
issn = {1911-6470},
abstract = {BACKGROUND: Urachal anomalies rarely present in adulthood. We report the second known case of urachal-sigmoid fistula associated with diverticular disease.
METHOD: We performed a case report and literature review. We searched MEDLINE and PubMed using the search words "urachus," "urachal fistula," "sigmoid colon" and "diverticulosis."
RESULTS: Our literature review revealed 1 previous report of urachal-sigmoid fistula associated with diverticular disease. We reviewed other publications with respect to pathophysiology, diagnosis and management of urachal disease.
CONCLUSION: Urachal disease that presents in an adult is usually the result of some complication of a urachal anomaly. Various modes of imaging may help confirm the diagnosis, although CT sinography has been recommended and was key in the present case. Management includes eradication of infection and, usually, surgical intervention.},
}
@article {pmid18513199,
year = {2009},
author = {David, GG and Al-Sarira, AA and Willmott, S and Cade, D and Corless, DJ and Slavin, JP},
title = {Use of Hartmann's procedure in England.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {11},
number = {3},
pages = {308-312},
doi = {10.1111/j.1463-1318.2008.01586.x},
pmid = {18513199},
issn = {1463-1318},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/methods ; Cohort Studies ; Colectomy/*methods ; Colorectal Neoplasms/mortality/pathology/*surgery ; Colostomy/*methods ; Diverticulum, Colon/diagnosis/mortality/*surgery ; Emergency Treatment ; England ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications/surgery ; Probability ; Reference Values ; Registries ; Reoperation ; Risk Assessment ; Sex Factors ; Survival Analysis ; Treatment Outcome ; },
abstract = {INTRODUCTION: Hartmann's procedure is widely used in the management of complicated diverticular disease and for colorectal cancer. Very little national data are available about the reasons for performing this procedure and the reversal rate.
METHOD: Hospital episode statistics data were obtained from The Department of Health and exported to an Access database for analysis. A cohort of patients who underwent a Hartmann's procedure between April 2001 and March 2002 were identified and followed until April 2006 to identify patients undergoing reversal of Hartmann's.
RESULTS: Approximately 3950 Hartmann's procedures were performed between April 2001 and March 2002, 2853 as an emergency and 1097 as an elective procedure. Most emergency Hartmann's were performed for benign disease (2067, 72.5%) whereas a majority of the elective Hartmann's were performed for cancer (756, 68.9%). Seven hundred and thirty six (23.3%) of these patients underwent reversal during the study period. The median time interval between a Hartmann's procedure and reversal was 284.5 days (interquartile range 181-468.25).
CONCLUSION: This study represents the single largest cohort in whom outcome after Hartmann's procedure has been studied. A majority of Hartmann's are performed as an emergency for benign diseases and most of them are not reversed.},
}
@article {pmid18506923,
year = {2008},
author = {Hadithi, M and Cazemier, M and Meijer, GA and Bloemena, E and Felt-Bersma, RJ and Mulder, CJ and Meuwissen, SG and Pena, AS and van Bodegraven, AA},
title = {Retrospective analysis of old-age colitis in the Dutch inflammatory bowel disease population.},
journal = {World journal of gastroenterology},
volume = {14},
number = {20},
pages = {3183-3187},
pmid = {18506923},
issn = {1007-9327},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Colitis/*epidemiology/pathology/therapy ; Colitis, Ulcerative/epidemiology ; Colonoscopy ; Crohn Disease/epidemiology ; Diagnostic Errors/prevention & control ; Diverticulosis, Colonic/*epidemiology/pathology/therapy ; Female ; Humans ; Inflammatory Bowel Diseases/*epidemiology/pathology/therapy ; Longitudinal Studies ; Male ; Middle Aged ; Netherlands/epidemiology ; Retrospective Studies ; },
abstract = {AIM: To describe the characteristics of Dutch patients with chronic inflammatory bowel disease (IBD) first diagnosed above 60 years of age-a disease also known as old-age colitis (OAC) and to highlight a condition that has a similar appearance to IBD, namely segmental colitis associated with diverticular disease (SCAD).
METHODS: A retrospective longitudinal survey of patient demographic and clinical characteristics, disease characteristics, diagnostic methods, management and course of disease was performed. The median follow-up period was 10 years.
RESULTS: Of a total of 1100 IBD patients attending the Department of Gastroenterology, 59 (5%) [median age 82 years (range 64-101); 25 male (42%)] were identified. These patients were diagnosed with ulcerative colitis (n = 37, 61%), Crohn's disease (n = 14, 24%), and indeterminate colitis (n = 8, 15%). Remission was induced in 40 (68%) patients within a median interval of 6 mo (range 1-21) and immunosuppressive therapy was well tolerated. Histological evaluation based on many biopsy samples and the course of the disease led to other diagnosis, namely SCAD instead of IBD in five (8%) patients.
CONCLUSION: OAC is not an infrequent problem for the gastroenterologist, and should be considered in the evaluation of older patients with clinical features suggestive of IBD. Extra awareness and extensive biopsy sampling are required in order to avoid an erroneous diagnosis purely based on histological mimicry of changes seen in SCAD, when diagnosing IBD in the presence of diverticulosis coli.},
}
@article {pmid18491196,
year = {2008},
author = {Costedio, MM and Coates, MD and Danielson, AB and Buttolph, TR and Blaszyk, HJ and Mawe, GM and Hyman, NH},
title = {Serotonin signaling in diverticular disease.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {12},
number = {8},
pages = {1439-1445},
pmid = {18491196},
issn = {1873-4626},
support = {R01 DK062267/DK/NIDDK NIH HHS/United States ; R01 DK062267-03S1/DK/NIDDK NIH HHS/United States ; P20 RR16435/RR/NCRR NIH HHS/United States ; R01 DK062267-05/DK/NIDDK NIH HHS/United States ; R01 DK062267-04A2/DK/NIDDK NIH HHS/United States ; DK62267/DK/NIDDK NIH HHS/United States ; P20 RR016435/RR/NCRR NIH HHS/United States ; },
mesh = {Adult ; Aged ; Aged, 80 and over ; Biopsy ; *Colon, Sigmoid ; Diverticulitis, Colonic/genetics/*metabolism/pathology ; Female ; Follow-Up Studies ; *Gene Expression ; Humans ; Immunohistochemistry ; Intestinal Mucosa/metabolism/pathology ; Male ; Middle Aged ; RNA, Messenger/*genetics ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; Serotonin/*metabolism ; Serotonin Plasma Membrane Transport Proteins/biosynthesis/*genetics ; Signal Transduction/*genetics ; },
abstract = {Diverticulosis is extremely common in Western societies and is associated with complications in up to 15%of cases. Altered motility is an important feature of the pathogenesis of diverticular disease, and serotonin (5-HT) release is a primary trigger of gut motility. This study aims to determine whether colonic 5-HT signaling is altered in patients with diverticulosis or diverticulitis, and whether differences in serotonin signaling may distinguish patients with asymptomatic diverticulosis from those who develop disease specific complications. Sigmoid colon biopsies were obtained from healthy control subjects, individuals with asymptomatic diverticulosis, and those with a history of CT-proven diverticulitis within the preceding 6 months. The key elements of 5-HT signaling including content, release, and 5-HT transporter (SERT) expression were analyzed. A significant decrease in SERT transcript levels was present in the mucosa of patients with a history of diverticulitis when compared with controls, but not in those with asymptomatic diverticulosis. Mucosal 5-HT content, enterochromaffin (EC) cell numbers, and TpH-1 mRNA levels were comparable amongst the groups, as were basal and stimulated 5-HT release. Alterations in 5-HT signaling do not appear to be responsible for the development of diverticula. However, patients with a recent history of acute diverticulitis have a significant attenuation in SERT expression and function, likely secondary to previous inflammation. Our findings may explain the persistent symptoms of pain and altered motility so often observed in patients with diverticulitis long after recovery from the acute inflammatory response.},
}
@article {pmid18480393,
year = {2009},
author = {Billingham, K and Radojkovic, M},
title = {Osseous metaplasia of the colon in a diversion proctocolitis.},
journal = {International journal of surgical pathology},
volume = {17},
number = {1},
pages = {81-83},
doi = {10.1177/1066896908315753},
pmid = {18480393},
issn = {1066-8969},
mesh = {Aged ; Colon/*pathology ; Humans ; Ileostomy/adverse effects ; Male ; Metaplasia/diagnosis/etiology ; Proctocolitis/*complications/etiology ; },
abstract = {Osseous metaplasia within the gastrointestinal tract is a rare phenomenon, seen most frequently in mucinproducing left-sided colonic adenocarcinomas. It has also been documented in a variety of benign conditions, occurring in polyps and lesions associated with inflammation and ulceration. This is the first case report, to the authors' knowledge, of osseous metaplasia associated with a diversion proctocolitis. The diversion was performed following stricture formation, secondary to complicated diverticular disease with diverticular phlegmon formation. In common with other cases, in which osseous metaplasia arises within a background of inflammation, the present case demonstrated stromal fibroblastic proliferation. The underlying pathogenesis of osseous metaplasia has not yet been elucidated, but secretion of various bone morphogenic proteins (belonging to the transforming growth factor-beta superfamily) and increased alkaline phosphatase activity by both epithelial and stromal cells have been documented.},
}
@article {pmid18479497,
year = {2008},
author = {Sheth, AA and Longo, W and Floch, MH},
title = {Diverticular disease and diverticulitis.},
journal = {The American journal of gastroenterology},
volume = {103},
number = {6},
pages = {1550-1556},
doi = {10.1111/j.1572-0241.2008.01879.x},
pmid = {18479497},
issn = {1572-0241},
mesh = {Diverticulitis/*diagnosis/*etiology/therapy ; Diverticulum, Colon/*diagnosis/*etiology/therapy ; Humans ; Irritable Bowel Syndrome/complications ; Risk Factors ; },
abstract = {Diverticular disease is one of the most prevalent medical conditions to affect Western populations. Symptomatic diverticular disease can range from mild, low-level symptomatology similar to that seen in irritable bowel syndrome to acute bouts of diverticulitis complicated by abscess or frank perforation. This review discusses the epidemiology, pathophysiology, clinical presentation, and management of the spectrum of diverticular disease, including mention of recent advances in the treatment of chronic diverticular disease with aminosalicyclates and probiotics.},
}
@article {pmid18467371,
year = {2008},
author = {Fraser, CG and Mathew, CM and McKay, K and Carey, FA and Steele, RJ},
title = {Automated immunochemical quantitation of haemoglobin in faeces collected on cards for screening for colorectal cancer.},
journal = {Gut},
volume = {57},
number = {9},
pages = {1256-1260},
doi = {10.1136/gut.2008.153494},
pmid = {18467371},
issn = {1468-3288},
mesh = {Adenoma/diagnosis ; Aged ; Colonic Polyps/diagnosis ; Colonoscopy ; Colorectal Neoplasms/*diagnosis ; Diagnosis, Differential ; Diverticulum, Colon/diagnosis ; Hemoglobins/*analysis ; Humans ; Mass Screening/methods ; Middle Aged ; *Occult Blood ; Sensitivity and Specificity ; Specimen Handling/methods ; },
abstract = {BACKGROUND: Simple card collection systems are becoming available for faecal immunochemical tests (FITs) as well as guaiac faecal occult blood tests (gFOBTs). FITs are now obtainable that allow quantitation of haemoglobin, so that the analytical detection limit can be set to give a positivity rate that is manageable in terms of the available colonoscopy. A combination of a card collection device and an automated FIT analytical system could be advantageous.
METHODS: The quantitation of haemoglobin in samples collected on cards with a new analytical system and the relationship between faecal haemoglobin concentration and pathology were investigated in a cohort of gFOBT-positive individuals.
RESULTS: All groups had large ranges of haemoglobin concentration and there was overlap between the groups. Median haemoglobin concentrations in participants with normal findings on colonoscopy (167), diverticular disease (43), hyperplastic polyps (41), low risk adenoma (63), higher risk adenoma (35) and cancer (27) were 13.5, 15.6, 16.8, 15.2, 65.6 and 168.9 ng/ml haemoglobin, respectively. Those with diverticular disease, hyperplastic polyps and low risk adenoma were not significantly different from the normal group (p>0.2), but those with higher risk adenoma had significantly higher concentrations (p<0.001), as did those with cancer (p<0.001). Receiver operating characteristic analysis demonstrates that the cut-off concentration can be set to give appropriate clinical characteristics; optimum sensitivity and specificity are achieved at 26.7 ng/ml.
CONCLUSIONS: The haemoglobin in faeces on simple FIT card collection devices can be immunoturbidimetrically analysed quantitatively, and the concentration relates to the presence or absence of significant neoplastic disease.},
}
@article {pmid18462249,
year = {2009},
author = {Issa, N and Dreznik, Z and Dueck, DS and Arish, A and Ram, E and Kraus, M and Gutman, M and Neufeld, D},
title = {Emergency surgery for complicated acute diverticulitis.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {11},
number = {2},
pages = {198-202},
doi = {10.1111/j.1463-1318.2008.01546.x},
pmid = {18462249},
issn = {1463-1318},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Colectomy/mortality ; Diverticulitis, Colonic/mortality/*surgery ; Emergencies ; Female ; Humans ; Incidence ; Intestinal Perforation/mortality/*surgery ; Israel/epidemiology ; Male ; Middle Aged ; Recurrence ; },
abstract = {AIM: Antecedent attacks of diverticulitis are thought to increase the risk of complicated diverticulitis, and unless elective surgery is performed, a high proportion of patients with recurrent symptoms will require emergency operations for complicated diverticulitis with its associated morbidity. In this multicentre study, we aim to assess impact of previous attacks of diverticulitis on patients requiring an emergency surgical intervention.
METHOD: All patients operated on as an emergency for complicated diverticulitis were retrospectively analysed. Patients were separated into two groups: group A included patients without previous history of diverticular disease, and group B those with previous attacks of diverticulitis.
RESULTS: A total of 96 patients were included in the study. Group A included 68 (70.8%) patients, and group B 28 (29.2%) patients. Generalized peritonitis was the reason for operation in 50 (73.5%) patients in-group A and only four (14%) patients in group B. Perforated diverticulitis occurred more often in group A, whereas pericolonic abscess and phlegmon formation occurred more commonly in group B. Resection was performed in all patients in group B; 50% had a Hartmann's procedure, and the other 50% patients had primary anastomosis. Hartmann's procedure was performed in 52 patients (76.5%) in group A, and 8 patients (11.7%) had resection and primary anastomosis. No difference in postoperative complications was identified between the groups.
CONCLUSION: Multiple attacks of diverticulitis are not associated with an increased risk of complicated diverticulitis. Recurrent episodes of diverticulitis are not associated with a less favourable outcome or an increased risk of fatality if complications ensue.},
}
@article {pmid18462241,
year = {2009},
author = {White, TJ and Avery, GR and Kennan, N and Syed, AM and Hartley, JE and Monson, JR},
title = {Virtual colonoscopy vs conventional colonoscopy in patients at high risk of colorectal cancer--a prospective trial of 150 patients.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {11},
number = {2},
pages = {138-145},
doi = {10.1111/j.1463-1318.2008.01554.x},
pmid = {18462241},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Polyps/*diagnosis ; *Colonography, Computed Tomographic ; *Colonoscopy ; Colorectal Neoplasms/*diagnosis ; Female ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Prospective Studies ; Risk Factors ; },
abstract = {OBJECTIVE: Virtual colonoscopy (VC)/CT colonography has advantages over the well-documented limitations of colonoscopy/barium enema. This prospective blinded investigative comparison trial aimed to evaluate the ability of VC to assess the large bowel, compared to conventional colonoscopy (CC), in patients at high risk of colorectal cancer (CRC).
METHOD: We studied 150 patients (73 males, mean age 60.9 years) at high risk of CRC. Following bowel preparation, VC was undertaken using colonic insufflation and 2D-spiral CT acquisition. Two radiologists reported the images and a consensual agreement reached. Direct comparison was made with CC (performed later the same day). Interobserver agreement was calculated using the Kappa method. Postal questionnaires sought patient preference.
RESULTS: Virtual colonoscopy visualized the caecum in all cases. Five (3.33%) VCs were classified as inadequate owing to poor distension/faecal residue. CC completion rate was 86%. Ultimately, 44 patients had normal findings, 44 had diverticular disease, 11 had inflammatory bowel disease, 18 had cancers, and 33 patients had 42 polyps. VC identified 19 cancers--a sensitivity and specificity of 100% and 99.2% respectively. For detecting polyps > 10 mm, VC had a sensitivity and specificity (per patient) of 91% and 99.2% respectively. VC identified four polyps proximal to stenosing carcinomas and extracolonic malignancies in nine patients (6%). No procedural complications occurred with either investigation. A Kappa score achieved for interobserver agreement was 0.777.
CONCLUSION: Virtual colonoscopy is an effective and safe method for evaluating the bowel and was the investigation of choice amongst patients surveyed. VC provided information additional to CC on both proximal and extracolonic pathology. VC may become the diagnostic procedure of choice for symptomatic patients at high risk of CRC, with CC being reserved for therapeutic intervention, or where a tissue diagnosis is required.},
}
@article {pmid18454291,
year = {2008},
author = {Ambrosetti, P and Francis, K and De Peyer, R and Frossard, JL},
title = {Colorectal anastomotic stenosis after elective laparoscopic sigmoidectomy for diverticular disease: a prospective evaluation of 68 patients.},
journal = {Diseases of the colon and rectum},
volume = {51},
number = {9},
pages = {1345-1349},
doi = {10.1007/s10350-008-9319-z},
pmid = {18454291},
issn = {1530-0358},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/*adverse effects ; Colon/pathology ; Colon, Sigmoid/*surgery ; Colonoscopy ; Constriction, Pathologic/etiology/therapy ; Dilatation ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Rectum/pathology ; },
abstract = {PURPOSE: This prospective study was designed to find the incidence of symptomatic anastomotic stenosis after elective laparoscopic sigmoidectomy for diverticular disease.
METHODS: Sixty-eight patients who underwent elective laparoscopic sigmoidectomy with double-stapling colorectal anastomosis between November 1998 and June 2007 were included. Follow-up after hospitalization was performed by using sequential rectoscopy for all patients. Symptomatic patients with anastomotic stricture were treated.
RESULTS: No patient died postoperatively and no patient had anastomotic leak or abdominal septic complication. Twenty-two patients (32 percent) had postoperative symptoms that suggested anastomotic stenosis; 12 of them (17.6 percent) eventually needed dilatation of their anastomosis (median diameter of the stenosis: 7 mm) a mean time of 176 days postoperatively. Eight patients had only one session, three patients had two sessions, and one patient had three sessions. There were no complications and all patients were symptom-free after dilatation. Age, sex, obesity, hypertension, diabetes, and vascular preservation had no influence on the risk of anastomotic stenosis.
CONCLUSIONS: Incidence of symptomatic anastomotic stenosis after elective laparoscopic sigmoidectomy is high (17.6 percent). No risk factor could be identified. Endoscopic dilatations were successful without complication in all cases. Regular rigid rectoscopy definitely should be part of the postoperative follow-up in symptomatic patients.},
}
@article {pmid18453293,
year = {2008},
author = {Paton, BL and Mostafa, G and Lincourt, AE and Kercher, KW and Heniford, BT},
title = {Profile and significance of emergency colonic resections.},
journal = {The American surgeon},
volume = {74},
number = {4},
pages = {305-309},
pmid = {18453293},
issn = {0003-1348},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Colectomy/*adverse effects/methods/mortality ; Colonic Diseases/etiology/pathology/*surgery ; *Elective Surgical Procedures ; *Emergency Treatment ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; },
abstract = {The objectives of this study are to define the distinguishing features between elective and emergency colonic surgery. The records of adult patients who underwent elective and emergent colonic resection over a 4-year period were retrospectively reviewed. Univariate analysis was performed to compare outcomes for elective and emergency procedures and multiple logistic regression analysis was performed to identify the significant predictors of outcome. Three hundred and thirty-eight elective and 147 emergency colonic resections were performed. Diverticular disease was most common in the emergency group (43.5% vs 14.2%, P = 0.001) whereas malignancy predominated in the elective group (56.2% vs 5.4%, P = 0.001). The emergency group accounted for 54.7 per cent and 79.3 per cent of the total morbidity and mortality. Emergency colonic surgery has distinctive features and significance. Emergency surgery for colonic obstruction and total/subtotal resection are associated with higher morbidity and mortality. Diverticular disease compares favorably to other pathologies in postoperative outcome.},
}
@article {pmid18449609,
year = {2008},
author = {Egger, B and Peter, MK and Candinas, D},
title = {Persistent symptoms after elective sigmoid resection for diverticulitis.},
journal = {Diseases of the colon and rectum},
volume = {51},
number = {7},
pages = {1044-1048},
doi = {10.1007/s10350-008-9234-3},
pmid = {18449609},
issn = {1530-0358},
mesh = {Abdominal Pain/epidemiology/*etiology ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/methods ; Colectomy/*adverse effects/methods ; Colon, Sigmoid/*surgery ; Diarrhea/epidemiology/*etiology ; Diverticulitis, Colonic/physiopathology/*surgery ; Elective Surgical Procedures/*adverse effects/methods ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications/epidemiology/etiology ; Prevalence ; Prognosis ; Retrospective Studies ; Sigmoid Diseases/physiopathology/*surgery ; Switzerland/epidemiology ; Time Factors ; },
abstract = {PURPOSE: Despite technically successful surgery for diverticular disease, a significant group of patients who experience persistent or recurrent symptoms remains. This study was designed to determine the incidence and pattern of persistent symptoms and their association with peroperative parameters.
METHODS: Follow-up (33 (range, 4-72) months) through structured interviews with patients who had surgery for diverticulitis in our department from December 1999 to November 2004 was conducted. Of 162 patients, 124 (76.5 percent) were available for follow-up. Nonparametric tests were used for comparison of patients who had undergone elective (n = 68) or emergency (n = 56) procedures.
RESULTS: Of patients who had elective surgery, 25 percent suffered persistent symptoms, including painful constipation, painful abdominal distension, abdominal cramps, and frequent painful diarrhea. Neither the stage of disease (complicated or uncomplicated) nor the surgical technique (laparotomy or laparoscopy) were significantly related to the occurrence of symptoms. Recurrent diverticulitis was not observed. Similar results were obtained from comparisons with emergency patients.
CONCLUSIONS: The prevalence of persistent symptoms after successful surgery for diverticular disease may be an additional reason to carefully discuss the indication for prophylactic surgery. In any case, preoperative counseling and informed consent regarding the possibility of persistent symptoms after prophylactic elective surgery is essential.},
}
@article {pmid18446265,
year = {2008},
author = {Guzmán-Valdivia, G},
title = {Incisional hernia at the site of a stoma.},
journal = {Hernia : the journal of hernias and abdominal wall surgery},
volume = {12},
number = {5},
pages = {471-474},
pmid = {18446265},
issn = {1265-4906},
mesh = {Adult ; Aged ; Aged, 80 and over ; Female ; Hernia, Ventral/epidemiology/etiology/*surgery ; Humans ; Incidence ; Male ; Middle Aged ; Ostomy/adverse effects ; Retrospective Studies ; Surgical Stomas/*adverse effects ; },
abstract = {OBJECTIVE: Incisional hernia at the site where a patient had previously had a stoma has not been clearly studied. The aim of this study is to determine the incidence and associated factors that may lead to an incisional hernia related to the reversal of an intestinal stoma.
PATIENTS AND METHODS: An analysis was made of 70 cases of intestinal reconnection. All patients received Cefotaxime or Ceftazidime during anaesthesia induction and two more doses at 1-8 h in the post-operative period. In all of the cases, closure of the stoma site was effected as a primary closure using no. 1 polyglycolic acid continuous suture. There followed wound lavage with iodopovidone, and the skin was closed with simple sutures using polypropylene 3/0. No drain was left in situ in any of the cases. The study considered the following aspects: demographic characteristics of the study group; illnesses giving rise to the need for stoma formation; the stoma site itself; clinical aspects, including body mass index (BMI); the incidence of incisional hernia; and any complications involving the surgical wound.
RESULTS: At this hospital, the cause of requiring treatment with stoma formation was diverticular disease of the colon principally, and the age of the patients varied from 36 to 87 years (median 61). The incidence of incisional hernia at the stoma site was 22 cases (31.4%), presenting equally in both sexes and with greater frequency under the following circumstances: during the first year of follow-up and in patients with concomitant illnesses, principally diabetes. Local complications involving the surgical wound occurred in six cases (8.5%).
CONCLUSION: The incidence of incisional hernia at the stoma site was found to be 31.4% in this study, which is a high incidence of hernias with simple repair.},
}
@article {pmid18435896,
year = {2008},
author = {Jaffer, U and Moin, T},
title = {Perforated sigmoid diverticular disease: a management protocol.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {12},
number = {2},
pages = {188-193},
pmid = {18435896},
issn = {1086-8089},
mesh = {Algorithms ; Clinical Protocols ; Diverticulitis, Colonic/complications/*surgery ; Humans ; Intestinal Perforation/etiology/*surgery ; Laparoscopy ; Male ; Middle Aged ; Sigmoid Diseases/complications/*surgery ; },
abstract = {BACKGROUND: To develop an evidence-based protocol for the management of perforated sigmoid diverticular disease.
METHODS: A search of the literature was undertaken. All publications pertaining to perforated sigmoid diverticular disease were analyzed and then categorized according to their level of evidence. Recommendations were then made on the basis of this.
RESULTS: Multiple case reports suggest that primary closure of perforation of sigmoid diverticula is safe in the absence of peritoneal contamination.
CONCLUSIONS: A 2-stage laparoscopic approach incorporating the principles of damage limitation surgery may be a safe strategy in the management of perforated diverticular disease.},
}
@article {pmid18427444,
year = {2008},
author = {Holt, T and Paris, B and Wietfeldt, ED and Hassan, I},
title = {Minimally invasive techniques in colon surgery.},
journal = {Minerva chirurgica},
volume = {63},
number = {2},
pages = {115-125},
pmid = {18427444},
issn = {0026-4733},
mesh = {Colitis, Ulcerative/surgery ; Colonic Diseases/*surgery ; Colonic Neoplasms/surgery ; Crohn Disease/surgery ; Diverticulitis, Colonic/surgery ; Diverticulum, Colon/surgery ; Humans ; *Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Patient Selection ; Quality of Life ; Randomized Controlled Trials as Topic ; Treatment Outcome ; },
abstract = {With the description of the first laparoscopic cholecystectomy in 1985, minimally invasive approaches have become the standard practice of surgeons in managing several disease processes. This has been mainly driven by the significant favorable impact of minimally invasive surgery on patient related outcomes. Smaller incisions lead to improved cosmesis, reduced postoperative pain and earlier return of gastrointestinal function. These factors in turn contribute to a faster recovery of the patient (compared to similar open procedures) with a reduced utilization of hospital resources, reduced costs and earlier return of the patient to normal routines of daily life and work. With experience it is clear that these favorable patient outcomes can also be seen with minimally invasive surgery for various colonic diseases and procedures. Many of the early concerns regarding minimally invasive approaches such as port site recurrence and the feasibility of adequate oncologic resections have been laid to rest by multiple randomized trials. There are now documented benefits to minimally invasive approaches for colonic diseases such as cancer, inflammatory bowel disease and diverticular disease; as long as surgeons choose the appropriate patients and spend the time and resources needed to become proficient at these advanced procedures.},
}
@article {pmid18416471,
year = {2008},
author = {Hirata, T and Kawakami, Y and Kinjo, N and Arakaki, S and Arakaki, T and Hokama, A and Kinjo, F and Fujita, J},
title = {Association between colonic polyps and diverticular disease.},
journal = {World journal of gastroenterology},
volume = {14},
number = {15},
pages = {2411-2413},
pmid = {18416471},
issn = {1007-9327},
mesh = {Adult ; Aged ; Colonic Polyps/*epidemiology/etiology/pathology ; Colonoscopy ; Diverticulosis, Colonic/*epidemiology/etiology/pathology ; Diverticulum, Colon/*pathology ; Female ; Humans ; Japan/epidemiology ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Prevalence ; Retrospective Studies ; Risk Assessment ; Risk Factors ; },
abstract = {AIM: To evaluate the association between colonic polyps and diverticular disease in Japan.
METHODS: We retrospectively reviewed the medical records of 672 consecutive patients who underwent total colonoscopy between August 2006 and April 2007 at Nishinjo Hospital, Okinawa, Japan. Patients with a history of any of the following were excluded from the study: previous polypectomy, colonic resection, and inflammatory bowel diseases. The association between colonic polyps and diverticular disease was analyzed by logistic regression analysis, adjusted for age and sex.
RESULTS: Prevalence of colonic polyps in all patients with diverticular disease was significantly higher than that in those without diverticular disease (adjusted odds ratio 1.7).
CONCLUSION: Our data showed that patients with diverticular disease have a higher risk of colonic polyps compared to those without.},
}
@article {pmid18416167,
year = {2007},
author = {Zakharash, MP and Mel'nik, VM and Poĭda, AI and Abu Shamsia, RN and Ioffe, AIu and Zavernyĭ, LG},
title = {[Quality of life in patients after restorative operations].},
journal = {Likars'ka sprava},
volume = {},
number = {5-6},
pages = {70-75},
pmid = {18416167},
issn = {1019-5297},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colonic Diseases/*psychology/*surgery ; Colonic Pouches ; Female ; Humans ; Life Style ; Male ; Middle Aged ; Proctocolectomy, Restorative/*methods ; *Quality of Life ; Surveys and Questionnaires ; Treatment Outcome ; },
abstract = {The analysis of the results of the surgical treatment of colon cancer, ulcerative colitis, Crohn's disease, polyposis of colon, diverticular disease of colon on the bases of quality of life scale indexes, questionnaire SF-36 was carried out. The authors have compared the quality of life of patients who underwent surgical treatment using restorative operations after removing functional parts of the colon. The quality of life indexes in 11-12 days after the operation were higher in the first group compared with the second one. Positive influence of laparascopic intervention on quality of life considerably differs from that in the second group in 3 and 6 months and in one and three years after the operation was done.},
}
@article {pmid18408593,
year = {2008},
author = {Agaimy, A and Wünsch, PH and Dirnhofer, S and Bihl, MP and Terracciano, LM and Tornillo, L},
title = {Microscopic gastrointestinal stromal tumors in esophageal and intestinal surgical resection specimens: a clinicopathologic, immunohistochemical, and molecular study of 19 lesions.},
journal = {The American journal of surgical pathology},
volume = {32},
number = {6},
pages = {867-873},
doi = {10.1097/PAS.0b013e31815c0417},
pmid = {18408593},
issn = {1532-0979},
mesh = {Aged ; Aged, 80 and over ; Esophageal Neoplasms/*diagnosis/genetics/pathology ; Female ; Gastrointestinal Diseases/pathology ; Gastrointestinal Stromal Tumors/*diagnosis/genetics/pathology ; Humans ; Immunohistochemistry ; Intestinal Neoplasms/*diagnosis/genetics/pathology ; Male ; Middle Aged ; },
abstract = {Microscopic gastrointestinal stromal tumors (GISTs) (synonyms: sporadic interstitial cell of Cajal hyperplasia, seedling GISTs, minimal GISTs) are common incidental findings in gastroesophageal resections (9% to 35%). To our knowledge, their frequency, clinicopathologic features, and molecular pathogenesis from nongastroesophageal sites have so far not been sufficiently analyzed. We studied 19 lesions from distal esophagus (n=8), gastroesophageal junction (n=2), sigmoid colon (n=5), and vermiform appendix, cecum, rectum, and small intestine (1 each). Microscopic GISTs were detected in 0.2%, 0.1%, and 0.01% of routinely processed resection specimens from sigmoid colon, vermiform appendix, and rectum, respectively. Patients were 11 men and 8 women with a mean age of 66 years (range, 57 to 86 y). Thirteen patients had GI cancers and 5 had diverticular disease. None has a family history of GIST or features of neurofibromatosis 1. Lesions were 0.5 to 4 mm in size (mean, 1.12 mm), were all spindled and had noncircumscribed infiltrating borders. All arose in the muscularis propria and 2 were predominantly subserosal. Immunohistochemistry revealed a CD117/CD34/smooth muscle actin-negative phenotype in 18/19 lesions. Three KIT exon 11 mutations (2 point mutations and 1 deletion, all involving W557) were detected in 3/12 lesions with successful molecular analysis. In conclusion, incidental microscopic GISTs are uncommon in intestinal resections (< or =0.1%), contrasting with their gastroesophageal counterparts (> or =9%). Somatic KIT mutations are early initiating molecular events in a subset of them. The remarkable variation in the incidence of microscopic GISTs at different GI sites suggests an origin from heterogeneous subsets of interstitial cells of Cajal with varying potentials for neoplastic transformation.},
}
@article {pmid18389782,
year = {2007},
author = {Scripcariu, V and Dajbog, E and Radu, I and Mavropol, P and Pricop, A and Dragomir, C},
title = {[The ostomy support team. A reality for ostomates].},
journal = {Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi},
volume = {111},
number = {4},
pages = {925-931},
pmid = {18389782},
issn = {0048-7848},
mesh = {Colorectal Neoplasms/*surgery ; Colostomy/*education/*methods ; Humans ; Ostomy/education/methods ; Patient Education as Topic/methods ; },
abstract = {Stoma is a Greek word meaning mouth or opening. There are many types of surgical stomas and they may be raised on many areas of the abdominal wall. A stoma may be temporary or permanent, may be needed in any age group and may be sited on any part of the abdomen. The specific digestive pathology that could have as result of the surgical management a stoma is represented by colon, rectal and anal cancer, diverticular disease of the colon and rectum, Crohn's disease, ischaemic bowel, volvulus, trauma, Hirschprung disease, imperforate anus, fecal incontinence. This paper aim is to asses the management of fecal stomas and the necessity of a trained ostomy support team.},
}
@article {pmid18389749,
year = {2008},
author = {Donati, M and Memming, M and Donati, A and Calò, PG and Nicolosi, A},
title = {[Indications and limits of laparoscopic treatment for diverticular disease of the colon: personal experience].},
journal = {Chirurgia italiana},
volume = {60},
number = {1},
pages = {63-73},
pmid = {18389749},
issn = {0009-4773},
mesh = {Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures/statistics & numerical data ; Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures/statistics & numerical data ; Emergencies ; Female ; Humans ; Intraoperative Period ; Laparoscopy/*methods ; Laparotomy/statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Postoperative Complications/epidemiology ; Reoperation ; Retrospective Studies ; },
abstract = {The aim of the study was to evaluate the role of laparoscopic surgery in diverticular disease of the colon, in the experience of a specialized centre. Sixty-seven patients were observed from November 2004 to March 2006 at the Robert Koch Krankenhaus of Gehrden (Hannover) with a diagnosis of acute diverticulitis, chronic diverticulitis and/or complications and submitted to elective or emergency surgery. The mean operating time was 171.5 minutes for the laparoscopic approach, and 142.7 minutes for open surgery. Return to normal bowel function occurred after 3.7 days for laparoscopy, as against 4.4 days for open surgery. Mean hospital stay was 9.8 days for the laparoscopic approach and 16.3 days for open surgery. Morbidity was 18.6% (8 cases) in the laparoscopic group and 25% (6 cases) in the open group. Mortality was 0%. Re-operation was necessary in 5 cases in the laparoscopic group (11.6%) and in 4 cases (16.6%) in the open group. Laparoscopy is an important innovation in the surgical treatment of diverticular disease. This approach should be assessed in relation to patient characteristics, medical history and clinical presentation. The advantages of laparoscopy are shorter postoperative hospital stay, less postoperative pain, earlier discharge, better cosmetic result, less blood loss and less peritoneal contamination. In the advanced stages of disease open surgery still remains very important.},
}
@article {pmid18387861,
year = {2008},
author = {Tursi, A and Brandimarte, G and Elisei, W and Giorgetti, GM and Inchingolo, CD and Aiello, F},
title = {Effect of mesalazine on epithelial cell proliferation in colonic diverticular disease.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {40},
number = {9},
pages = {737-742},
doi = {10.1016/j.dld.2008.02.022},
pmid = {18387861},
issn = {1878-3562},
mesh = {Aged ; Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage ; Biopsy, Needle ; Case-Control Studies ; Cell Proliferation/*drug effects ; Colonoscopy/methods ; Diverticulosis, Colonic/*drug therapy/pathology ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Epithelial Cells/drug effects/pathology ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Intestinal Mucosa/drug effects/*pathology ; Ki-67 Antigen/immunology ; Male ; Mesalamine/*administration & dosage ; Middle Aged ; Probability ; Prospective Studies ; Reference Values ; Risk Assessment ; Severity of Illness Index ; Statistics, Nonparametric ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIMS: Increased epithelial cell proliferation may be detected in diverticular disease, but antibiotics have failed in reducing it. We assess therefore the effect of mesalazine on epithelial cell proliferation in diverticular disease.
METHODS: A prospective study was conducted on 20 consecutive patients with a new endoscopic diagnosis of symptomatic uncomplicated diverticular disease. The patients were treated with mesalazine 1.6 mg/day for 1 year. The Ki-67 antigen index of the whole crypt and in the upper third was separately evaluated before and after starting the treatment.
RESULTS: Cell proliferation index was higher in diverticular disease patients than healthy controls both in the whole crypt (median 6.7%, range 2-9% vs. median 1.6%, range 1-3%, p=0.001) and in the upper third of the crypt (median 6.8%, range 2-8% vs. median 1.8%, range 1-3%, p=0.001). Cell proliferation decreased throughout the follow-up. In the whole crypt it was 6.7% at entry and 3.8% at the end of treatment (p<0.005), whereas it was 6.8% at entry and 2.9% at the end of treatment in the upper third of the crypt (p<0.005).
CONCLUSIONS: We found mesalazine effective in reducing the colonic cell proliferation in long-term treatment for colonic diverticular disease.},
}
@article {pmid18360985,
year = {2007},
author = {Erdas, E and Licheri, S and Garau, A and Pisano, G and Pomata, M and Daniele, GM},
title = {[Inflammatory complications of colon diverticular disease: current therapeutic challenges].},
journal = {Chirurgia italiana},
volume = {59},
number = {6},
pages = {801-811},
pmid = {18360985},
issn = {0009-4773},
mesh = {Acute Disease ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colostomy ; Diverticulitis, Colonic/drug therapy/etiology/surgery/*therapy ; Diverticulosis, Colonic/*complications/mortality ; Drainage ; Emergencies ; Female ; Humans ; Intestinal Perforation/*etiology/*surgery ; Male ; Middle Aged ; Peritonitis/etiology/*surgery ; Prognosis ; Quality of Life ; Risk Factors ; },
abstract = {Inflammatory complications of diverticular disease are still responsible for high mortality rates. The aim of the present study was to analyse the factors that primarily influence the type of treatment and prognosis of such pathologies. From 1996 to 2006, 88 patients were admitted to our department for inflammatory complications secondary to diverticular disease. The majority of the patients were emergency room referrals, and nearly half of them were elderly (over 65 years of age). The most frequently observed complications were acute diverticulitis (45.5%), which was almost always resolved with medical therapy, and diverticular perforations (43.2%), for which surgical therapy was always necessary. The main treatment for localised peritonitis was one-stage colorectal resection, whereas for generalized peritonitis a two-stage resection was the procedure of choice. The highest degrees of peritonitis were observed in elderly patients. Restoration of bowel continuity was performed in nearly all patients below 65 years of age, but was not possible in 44.4% of those aged above 65. Postoperative mortality occurred in two cases, both with diffuse peritonitis, advanced age, and elevated anaesthetic risk. The present series seems to confirm the findings of other Authors, namely that the prognosis of diverticular perforation is influenced more by patient-related factors (older age, sepsis, comorbidity) than by the type of surgical procedure. Thus, it is probable that a decrease in the mortality rate and improvements in the quality of life can be achieved through more aggressive diagnostic protocols and new preventive strategies.},
}
@article {pmid18347863,
year = {2008},
author = {Garrett, KA and Champagne, BJ and Valerian, BT and Peterson, D and Lee, EC},
title = {A single training center's experience with 200 consecutive cases of diverticulitis: can all patients be approached laparoscopically?.},
journal = {Surgical endoscopy},
volume = {22},
number = {11},
pages = {2503-2508},
pmid = {18347863},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Colectomy/*methods ; Diverticulitis/*surgery ; Female ; Humans ; Intraoperative Complications ; Laparoscopy/*methods ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Sigmoid Diseases/*surgery ; Statistics, Nonparametric ; Treatment Outcome ; },
abstract = {BACKGROUND: This study aimed to evaluate the outcomes for consecutive patients with diverticular disease who underwent elective laparoscopic sigmoid colectomy.
METHODS: Data for this patient population were collected by chart review and analyzed retrospectively.
RESULTS: Between December 2001 and March 2007, 200 consecutive patients (93 men and 107 women) with an average age of 55 years were identified. All cases were managed by one of two colorectal surgeons. Of the 200 patients, 158 had recurrent diverticulitis, 20 had fistulas, 12 had abscesses, 8 had strictures, 1 had a mass, and 1 had a bleed. The mean operative time was 159 min, and the conversion rate was 8%. A total of 30 early postoperative complications occurred for 26 patients including wound infection (n = 9), ileus (n = 8), Clostridium difficile colitis (n = 3), urinary retention (n = 3), pelvic abscess (n = 2), deep vein thrombosis and pulmonary embolism (n = 1), pneumonia (n = 1) urinary tract infection (n = 1), anastomotic leak (n = 1), and small bowel obstruction (n = 1). Late complications experienced by 11 patients included Clostridium difficile colitis (n = 3), incisional hernia (n = 3), wound infection (n = 3), wound hematoma (n = 1), and intraabdominal hemorrhage (n = 1).
CONCLUSIONS: The authors believe it is feasible to offer elective laparoscopic sigmoid colectomy to all patients with symptomatic diverticular disease despite preoperative risk factors.},
}
@article {pmid18347509,
year = {2008},
author = {Tursi, A and Brandimarte, G and Elisei, W and Giorgetti, GM and Inchingolo, CD and Danese, S and Aiello, F},
title = {Assessment and grading of mucosal inflammation in colonic diverticular disease.},
journal = {Journal of clinical gastroenterology},
volume = {42},
number = {6},
pages = {699-703},
doi = {10.1097/MCG.0b013e3180653ca2},
pmid = {18347509},
issn = {1539-2031},
mesh = {Aged ; Case-Control Studies ; Cell Count ; Colonoscopy ; Diverticulitis, Colonic/classification/*diagnosis/pathology ; Diverticulosis, Colonic/classification/*diagnosis/pathology ; Female ; Humans ; Inflammation/etiology/*pathology ; Intestinal Mucosa/*pathology ; Lymphocytes/metabolism ; Male ; Middle Aged ; Neutrophil Infiltration ; Severity of Illness Index ; },
abstract = {GOAL: The aim of this study was to assess and grade the mucosal inflammatory infiltrate in different degrees of diverticular disease (DD) and to compare them with healthy matched controls.
BACKGROUND: Mucosal inflammation in colonic DD has never been investigated. In particular, it is unknown whether inflammation may be found in every degree of DD.
MATERIALS AND METHODS: Thirty consecutive patients with a new endoscopic diagnosis of DD (10 with asymptomatic diverticulosis, 10 with symptomatic uncomplicated DD, and 10 with acute uncomplicated diverticulitis) and 10 healthy controls were studied.
RESULTS: A neutrophilic inflammatory infiltrate was found only in acute uncomplicated diverticulitis (overall score, 26). The mean lymphocytic cell density was significantly higher in symptomatic DD (median lymphocytic density, 7) and acute uncomplicated diverticulitis (median lymphocytic density, 11). Subdividing the patients according to different degrees of DD, we found higher lymphocytic cell density even in asymptomatic diverticulosis (median lymphocytic density, 6.5) than healthy controls (median lymphocytic density, 4; P<0.02).
CONCLUSIONS: We found an increased inflammatory infiltrate in DD according to the degree of the disease and higher than healthy controls. Moreover, also asymptomatic diverticulosis shows higher inflammatory cell density than controls.},
}
@article {pmid18346680,
year = {2008},
author = {Zuccaro, G},
title = {Epidemiology of lower gastrointestinal bleeding.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {22},
number = {2},
pages = {225-232},
doi = {10.1016/j.bpg.2007.10.009},
pmid = {18346680},
issn = {1521-6918},
mesh = {Acute Disease ; Colonoscopy ; Gastrointestinal Hemorrhage/diagnosis/*epidemiology/etiology ; Humans ; *Lower Gastrointestinal Tract ; Prognosis ; Risk Factors ; },
abstract = {Lower GI bleeding is a very broad topic, which can encompass situations from a small amount of red blood on tissue paper associated with formed brown stool, to life-threatening severe haemorrhage. Much of the literature on this topic focuses on acute bleeding necessitating hospitalisation and urgent intervention. The literature that is available focuses primarily on medical intervention and support, which will be covered in another review in this series. Causes for lower GI bleeding include diverticular disease, vascular ectasia, ischemic, inflammatory or infectious colitis, colonic neoplasia (including post polypectomy bleeding), anorectal causes (including haemorrhoids, fissures and rectal varices), and small bowel lesions (Crohn's, vascular ectasia, Meckel's diverticula, and small bowel tumours). Different clinical series identified these lesions in varying frequencies. Factors associated with the development of acute lower GI bleeding include advanced age and use of non-steroidal anti-inflammatory medication. Colonoscopy is the single most frequent intervention in evaluating all the patients with lower GI bleeding. Determining the precise impact of colonoscopy on the outcome of lower GI bleeding is difficult due to the retrospective nature of many studies, and the frequent inability to definitively establish the exact bleeding site.},
}
@article {pmid18340365,
year = {2007},
author = {Tappenden, J and Shrestha, BM},
title = {Colonic diverticular disease: current perspectives.},
journal = {JNMA; journal of the Nepal Medical Association},
volume = {46},
number = {168},
pages = {206-213},
pmid = {18340365},
issn = {0028-2715},
mesh = {Colectomy/methods ; Diagnosis, Differential ; Diagnostic Imaging/methods ; *Diverticulum, Colon/diagnosis/epidemiology/therapy ; Global Health ; Humans ; Incidence ; Prognosis ; },
abstract = {Diverticular disease is a common condition affecting large intestine in the western world, which, although remains asymptomatic in majority of people, can present with abdominal pain, acute diverticulitis, perforation, haemorrhage, intestinal obstruction and fistulation through neighbouring organs. Complicated colonic diverticular disease (CDD) is associated with significant morbidity and mortality. Increasing urbanisation globally with intake of diet deficient in fibres has led to CDD as a significant problem; hence awareness of CDD is paramount for its prevention and appropriate management. The purpose of this article is to provide a comprehensive review of the epidemiology, pathophysiology, clinical presentations, and current management of diverticular disease of the colon and its complications.},
}
@article {pmid18335181,
year = {2008},
author = {Ritz, JP and Reissfelder, C and Holmer, C and Buhr, HJ},
title = {[Results of sigma resection in acute complicated diverticulitis : method and time of surgical intervention].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {79},
number = {8},
pages = {753-758},
pmid = {18335181},
issn = {0009-4722},
mesh = {Acute Disease ; Aged ; Antibiotic Prophylaxis ; Colectomy/*methods ; Colon, Sigmoid/surgery ; Combined Modality Therapy ; Diverticulitis, Colonic/complications/diagnosis/*surgery ; Female ; Humans ; Laparoscopy/methods ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Sigmoid Diseases/complications/diagnosis/*surgery ; Surgical Wound Infection/etiology ; },
abstract = {BACKGROUND: The aim of this study was to check the results of laparoscopic sigmoid resection for sigmoid diverticular disease with respect to stage of inflammation and time of surgical intervention.
PATIENTS AND METHODS: All patients were divided into four groups: uncomplicated (Group 1) vs complicated diverticular disease (Group 2), and depending on surgical intervention in early elective (4-8 days, Group A) vs late elective sigmoid resection (4-6 weeks, Group B).
RESULTS: At total of 244 patients underwent laparoscopically-assisted resection during the examination period. Differences in favor of Group 1 were found in duration of surgery (153 min vs 167 min), postoperative wound infections (3.55% vs 15.5%), and postoperative hospitalization period (12.2 days vs 14.6 days). Group A had more conversions (7.8% vs 0.9%), more minor complications (25.9% vs 12.9%), and more wound infections (16.4% vs 4.6%) than Group B.
CONCLUSIONS: Laparoscopic sigmoid resection can be performed in cases of complicated diverticulitis without significantly increasing their overall morbidity. Because of the lower complication rate, we recommend that patients with acute sigmoid diverticulitis receive initial antibiotic treatment and then undergo late elective laparoscopic sigmoid resection.},
}
@article {pmid18330623,
year = {2008},
author = {Andeweg, C and Peters, J and Bleichrodt, R and van Goor, H},
title = {Incidence and risk factors of recurrence after surgery for pathology-proven diverticular disease.},
journal = {World journal of surgery},
volume = {32},
number = {7},
pages = {1501-1506},
pmid = {18330623},
issn = {0364-2313},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*epidemiology/pathology/surgery ; Diverticulum, Colon/*epidemiology/pathology/surgery ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Recurrence ; Risk Factors ; },
abstract = {BACKGROUND: Diverticular disease is a common problem in Western countries. Rationale for elective surgery is to prevent recurrent complicated diverticulitis and to reduce emergency procedures. Recurrent diverticulitis occurs in about 10% after resection. The pathogenesis for recurrence is not completely understood. We studied the incidence and risk factors for recurrence and the overall morbidity and mortality of surgical therapy for diverticular disease.
METHODS: Medical records of 183 consecutive patients with pathology-proven diverticulitis were eligible for evaluation. Mean duration of follow-up was 7.2 years. Number of preoperative episodes, emergency or elective surgeries, type of operation, level of anastomosis, postoperative complications, persistent postoperative pain, complications associated with colostomy reversal, and recurrent diverticulitis were noted. The Kaplan-Meier method was used to calculate the cumulative probability of recurrence. Cox regression was used to identify possible risk factors for recurrence.
RESULTS: The incidence of recurrence was 8.7%, with an estimated risk of recurrence over a 15-year period of 16%. Risk factors associated with recurrence were (younger) age (p < 0.02) and the persistence of postoperative pain (p < 0.005). Persistent abdominal pain after surgery was present in 22%. Eighty percent of patients who needed emergency surgery for acute diverticulitis had no manifestation of diverticular disease prior to surgery. In addition, recurrent diverticulitis was not associated with a higher percentage of emergency procedures.
CONCLUSION: Estimated risk of recurrence is high and abdominal complaints after surgical therapy for diverticulitis are frequent. Younger age and persistence of postoperative symptoms predict recurrent diverticulitis after resection. The clinical implication of these findings needs further investigation. The results of this study support the careful selection of patients for surgery for diverticulitis.},
}
@article {pmid18278705,
year = {2008},
author = {Kautzsch, M and Niemann, T and Mantke, R},
title = {[Surgical strategies in the treatment of acute diverticular disease--a retrospective analysis of surgical patients at the hospital "Städtisches Klinikum Brandenburg an der Havel"].},
journal = {Zentralblatt fur Chirurgie},
volume = {133},
number = {1},
pages = {61-67},
doi = {10.1055/s-2008-1004656},
pmid = {18278705},
issn = {0044-409X},
mesh = {Acute Disease ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colectomy ; Colon, Sigmoid/surgery ; Colostomy ; Cross-Sectional Studies ; Diverticulitis, Colonic/mortality/*surgery ; *Emergencies ; Female ; Germany ; Hospitals, Urban ; Humans ; Laparoscopy ; Male ; Middle Aged ; Postoperative Complications/mortality/surgery ; Reoperation ; Retrospective Studies ; Sigmoid Diseases/mortality/*surgery ; Survival Rate ; },
abstract = {BACKGROUND: Depending on the degree of severity of acute diverticular disease, operative therapy is performed as an emergency, urgent or elective resection. A challenge is posed not only by the decision on whether to opt for conservative therapy or speedy resection, but also, when resection is indicated, by choosing the most suitable procedure (primary anastomosis or discontinuity resection). The frequency of use of the various therapeutic concepts and their success rates were studied in our clinic.
METHODS: All cases of acute sigmoid diverticulitis (108) surgically treated in the Klinikum Brandenburg from 2003 to 2005 were analysed retrospectively.
RESULTS: 17 patients (15.7 %) underwent emergency resection with primary anastomosis (8) (of these, 4 were with additional protective stoma) or Hartmann procedure (9). 17 patients (15.7 %) required urgent laparotomy, 11 needed primary anastomosis (protective stoma in 8 patients) and the Hartmann procedure was performed in 3 patients. In 2 patients the laparotomy was limited to colostomy with drainage without resection because of the high cardiac risk under anaesthesia. Of 49 patients (45.4 %), 25 underwent elective resection via laparotomy, and 24 via laparoscopy, with protective stomas in 4 and 3 patients, respectively. 25 patients (23.1 %) were treated conservatively: in 8 cases a later resection was recommended. Revision was necessary in 10 cases due to anastomosis dehiscence (4), bleeding (1), stoma necrosis (2), ileus (1), wound dehiscence (1) or for programmed lavage after free perforation with faecal peritonitis (2). 3 multimorbid patients died after emergency laparotomy.
CONCLUSION: A concept of staged treatment can reduce the number of emergency laparotomies; it provides for early focus removal in cases which cannot be managed adequately with conservative treatment and aims for the largest possible number of elective resections.},
}
@article {pmid18278535,
year = {2008},
author = {Heise, CP},
title = {Epidemiology and pathogenesis of diverticular disease.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {12},
number = {8},
pages = {1309-1311},
pmid = {18278535},
issn = {1873-4626},
mesh = {*Diverticulitis/diagnosis/epidemiology/etiology ; *Diverticulum/diagnosis/epidemiology/etiology ; Gastrointestinal Motility ; Gastrointestinal Tract/*physiopathology ; Humans ; Incidence ; Pressure ; Risk Factors ; United States/epidemiology ; },
abstract = {Diverticular disease is a common entity in the USA with an apparent increasing incidence worldwide. The pathogenesis of this disease process is likely multifactorial involving dietary habits, changes in colonic pressures and motility, and colon wall structural changes associated with aging. The following review addresses our current limited knowledge regarding the epidemiology and pathogenesis of diverticulosis and diverticulitis.},
}
@article {pmid18274764,
year = {2008},
author = {Jeyarajah, S and Papagrigoriadis, S},
title = {Diverticular disease increases and effects younger ages: an epidemiological study of 10-year trends.},
journal = {International journal of colorectal disease},
volume = {23},
number = {6},
pages = {619-627},
pmid = {18274764},
issn = {0179-1958},
mesh = {Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Diverticulum/complications/*epidemiology/mortality/surgery ; Hospitalization/statistics & numerical data ; Humans ; Middle Aged ; Survival Rate ; United Kingdom/epidemiology ; },
abstract = {INTRODUCTION: Little data exists on epidemiological trends of diverticular disease (DD). This study of 2,979 admissions over 10 years aimed to examine the epidemiological trends of DD admissions and clinical outcomes.
METHODS: A retrospective analysis of all admissions with DD from 1995 to 2004 was performed. General population data for the area was obtained from the national Census and local primary care trust.
RESULTS: Annual admissions for DD increased from 71 to 263 (p = 0.000). There was a trend of decreasing mean age from 71.2 years in 1995 to 68.1 in 2004 (p = 0.06). Admissions younger than 50 years increased from eight in 1995 to 42 in 2003 (p = 0.005). The mean age and size of the catchment population remained stable in that time. More emergency admissions underwent surgery (14.4%, n = 54) than electives (6.1%, n = 66) and had longer lengths of stay (25.2 vs. 9.2 days; p = 0.000). More patients under 50 (19.6%, n = 21) had surgery compared with older ones (8.8%, n = 100; p = 0.000). Recurrent admissions increased from 18 to 72 per year (p = 0.000) but were not associated with poor clinical outcomes. There were 21 deaths overall. Deaths were more likely in emergencies (p = 0.000, OR = 56.42) and those aged over 80 (p = 0.000, OR = 2.87). Mortality was independent of co-morbidity and other demographic factors.
CONCLUSION: DD admissions increased, unexplained by an ageing population, increasingly affecting younger patients who are more likely to undergo surgery, particularly as emergencies. Emergency admissions are associated with longer stay and higher mortality. Recurrent admission cannot be used as guide to elective surgery. Efforts should be made to treat more DD electively.},
}
@article {pmid18248394,
year = {2009},
author = {Plummer, JM and Gibson, TN and Mitchell, DI and Herbert, J and Henry, T},
title = {Emergency subtotal colectomy for lower gastrointestinal haemorrhage: over-utilised or under-estimated?.},
journal = {International journal of clinical practice},
volume = {63},
number = {6},
pages = {865-868},
doi = {10.1111/j.1742-1241.2007.01632.x},
pmid = {18248394},
issn = {1742-1241},
mesh = {Aged ; Anastomosis, Surgical ; Angiodysplasia/complications ; Colectomy/*methods/statistics & numerical data ; Colonic Diseases/etiology/*surgery ; Diverticulum, Colon/complications ; Emergencies ; Female ; Gastrointestinal Hemorrhage/etiology/*surgery ; Humans ; Ileum ; Length of Stay ; Male ; Rectum/surgery ; Retrospective Studies ; },
abstract = {INTRODUCTION: A minority of patients with unlocalised massive lower gastrointestinal bleeding (LGIB) will require treatment with emergency subtotal colectomy (STC).
METHODS: To determine the outcome of STC in this high-risk group, we retrospectively reviewed the histopathology reports and case records of all subtotal colectomies performed for LGIB over a 8-year period.
RESULTS: Fifty-eight patients (mean age: 71 years; male to female ratio, 1 : 1) underwent emergency surgery for unlocalised LGIB, 45% of which were massive on admission, and unresponsive to resuscitation. The remainder had persistent or recurrent bleeding during the index hospitalisation. The hospitalisation for colectomy represented the first for LGIB for 56% of the study group, while 38% were on at least their third such admission. All but three patients underwent preoperative rigid proctosigmoidoscopy. Fifty-five of the 58 patients were treated with STC and primary ileorectal anastomosis. The major causes of bleeding were diverticular disease only (68%), angiodysplasia only (12%) and both diseases (12%). Overall mortality was 17%, with the main contributor being sepsis resulting from anastomotic leak. Non-fatal complications occurred in 20%, resulting in a mean postoperative length of stay of 13 days. All patients were doing well on their first follow-up visit with a mean number of four stools per day after 1 month.
CONCLUSION: While emergency STC is an effective and definitive method of treating unlocalised massive LGIB, its associated morbidity and mortality may limit its usefulness.},
}
@article {pmid18226143,
year = {2008},
author = {Kassab, A and El-Bialy, G and Hashesh, H and Callen, P},
title = {Magnetic resonance imaging and hysteroscopy to diagnose colo-uterine fistula: a rare complication of diverticulitis.},
journal = {The journal of obstetrics and gynaecology research},
volume = {34},
number = {1},
pages = {117-120},
doi = {10.1111/j.1447-0756.2007.00713.x},
pmid = {18226143},
issn = {1341-8076},
mesh = {Aged ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/*diagnosis/pathology/surgery ; Female ; Gynecologic Surgical Procedures ; Humans ; Hysteroscopy ; Intestinal Fistula/complications/*diagnosis/pathology/surgery ; Magnetic Resonance Imaging ; Uterine Diseases/complications/*diagnosis/pathology/surgery ; },
abstract = {Colo-uterine fistula of diverticular origin is an extremely rare disease due to the resistance of uterine tissue. Methods for diagnosis remain to be established. Non-invasive imaging like magnetic resonance imaging (MRI) may help to establish a proper diagnosis, but confirmation may be reached by diagnostic hysteroscopy or even surgical exploration. We report a 78-year-old female who presented with continuous dull aching pain associated with increasing constipation. MRI suspected a fistula between the posterior aspect of the uterine body and the sigmoid colon which contained extensive diverticulosis. Hysteroscopy confirmed the fistulous opening, but colonoscopy confirmed diverticular disease with no evidence of malignancy. The patient had en block surgical treatment of the uterus and the adjacent colon, followed by an uneventful recovery. The sensitivity and specificity of non-invasive imaging procedures to diagnose such cases remain to be established. As imaging procedures cannot rule out neoplasia, endoscopic procedures need to be added.},
}
@article {pmid18218109,
year = {2008},
author = {Hussain, A and Mahmood, H and Subhas, G and El-Hasani, S},
title = {Complicated diverticular disease of the colon, do we need to change the classical approach, a retrospective study of 110 patients in southeast England.},
journal = {World journal of emergency surgery : WJES},
volume = {3},
number = {},
pages = {5},
pmid = {18218109},
issn = {1749-7922},
abstract = {BACKGROUND: Complicated diverticular disease of the colon imposes a serious risk to patient's life, challenge to surgeons and has cost implications for health authority. The aim of this study is to evaluate the management outcome of complicated colonic diverticular disease in a district hospital and to explore the current strategies of treatment.
METHODS: This is a retrospective study of all patients who were admitted to the surgical ward between May 2002 and November 2006 with a diagnosis of complicated diverticular disease. A proforma of patients' details, admission date, ITU admission, management outcomes and the follow up were recorded from the patients case notes and analyzed. The mean follow-up was 34 months (range 6-60 months)
RESULTS: The mean age of patients was 72.7 years (range 39-87 years). Thirty-one men (28.18 %) and Seventy-nine women (71.81%) were included in this study. Male: female ratio was 1:2.5.Sixty-eight percent of patients had one or more co-morbidities. Forty-one patients (37.27%) had two or more episodes of diverticulitis while 41.8% of them had no history of diverticular disease.Eighty-six percent of patients presented with acute abdominal pain while bleeding per rectum was the main presentation in 14%. Constipation and erratic bowel habit were the commonest chronic symptoms in patients with history of diverticular disease. Generalized tenderness was reported in 64.28% while 35.71% have left iliac fossa tenderness. Leukocytosis was reported in 58 patients (52.72%).The mean time from the admission until the start of operative intervention was 20.57 hours (range 4-96 hours). Perforation was confirmed in 59.52%. Mortality was 10.90%. Another 4 (3.63%) died during follow up for other reasons.
CONCLUSION: Complicated diverticular disease carries significant morbidity and mortality. These influenced by patient-related factors. Because of high mortality and morbidities, we suggest the need to target a specific group of patients for prophylactic resection.},
}
@article {pmid18197409,
year = {2008},
author = {Beasley, WD and Beynon, J and Jenkins, GJ and Parry, JM},
title = {Reprimo 824 G>C and p53R2 4696 C>G single nucleotide polymorphisms and colorectal cancer: a case-control disease association study.},
journal = {International journal of colorectal disease},
volume = {23},
number = {4},
pages = {375-381},
pmid = {18197409},
issn = {0179-1958},
mesh = {Adult ; Aged ; Biopsy ; Cell Cycle/genetics ; Cell Cycle Proteins/*genetics ; Colonic Neoplasms/*genetics/pathology ; Comet Assay ; DNA, Neoplasm/*genetics ; Female ; Follow-Up Studies ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Glycoproteins/*genetics ; Humans ; Male ; Middle Aged ; Polymerase Chain Reaction ; *Polymorphism, Single Nucleotide ; Prognosis ; Retrospective Studies ; },
abstract = {BACKGROUND: Improved survival from colorectal cancer (CRC) may result from screening for inherited genetic risk factors. Reprimo and p53R2 are p53-inducible genes involved in cell cycle surveillance and DNA repair. Single nucleotide polymorphisms (SNPs) of these genes have been discovered, but their effects on the genes' function and association with CRC is not known.
METHODS: Ninety healthy controls, 52 diverticular disease controls and 96 CRC cases were genotyped. DNA was extracted from buccal brush biopsies. Genotyping was performed by polymerase chain reaction (PCR) or polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) methods. Tests for Hardy-Weinberg equilibrium and allelic- and genotype-disease association were performed online using the Finetti program.
RESULTS: All three populations were in Hardy-Weinberg equilibrium with respect to p53R2 4696C>G SNP, and no CRC associations were demonstrated with this SNP. The healthy and CRC populations were in Hardy-Weinberg equilibrium with respect to the Reprimo 824G>C SNP, but the diverticular disease population was not (P=0.03). No CRC were demonstrated with Reprimo 824G>C.
CONCLUSION: No association between p53R2 4696C>G and Reprimo 824G>C with CRC was shown by this study. An association between the Reprimo 824G>C heterozygote and diverticular disease may exist on the basis of deviation from Hardy-Weinberg equilibrium.},
}
@article {pmid18188028,
year = {2008},
author = {Goldacre, MJ and Duncan, M and Cook-Mozaffari, P and Griffith, M and Travis, S},
title = {Inflammatory bowel disease, peptic ulcer and diverticular disease as certified causes of death in an English population 1979-2003.},
journal = {European journal of gastroenterology & hepatology},
volume = {20},
number = {2},
pages = {96-103},
doi = {10.1097/MEG.0b013e3282f1cbc8},
pmid = {18188028},
issn = {0954-691X},
mesh = {Adolescent ; Adult ; Aged ; Cause of Death ; Colitis, Ulcerative/mortality ; Crohn Disease/mortality ; Death Certificates ; Diverticulum/mortality ; England/epidemiology ; Female ; Gastrointestinal Diseases/*mortality ; Humans ; Inflammatory Bowel Diseases/mortality ; Male ; Medical Record Linkage ; Middle Aged ; Mortality/trends ; Peptic Ulcer/mortality ; },
abstract = {BACKGROUND: When gastrointestinal diseases are certified as causes of death, they are often not selected as the underlying cause. Until recently, only one underlying cause of death has been coded and analysed in official national statistics in England and many other countries.
AIMS: To report on the total 'burden of mortality' from some common gastrointestinal diseases, and whether it has changed over time, including all certified causes of death as well as underlying causes, (i) in the Oxford region from 1979 to 2003, (ii) in England from 1996 to 2003; and to quantify the under-ascertainment of cause-specific mortality when based on underlying cause alone.
METHODS: We searched death certificate data from the Oxford Record Linkage Study database, and from English national data, for specified gastrointestinal diseases certified as underlying or contributory causes of death.
RESULTS: For all the conditions studied, underlying-cause-coded mortality missed a substantial percentage of all certified deaths. The extent of underestimation varied according to the periods in which different criteria were used for the selection of the underlying cause. For example, in Oxford, in the latest period 1993-2003, underlying-cause-coded mortality identified only 37% of all death certificates with ulcerative colitis, 47% of Crohn's disease, between 62 and 68% for the different types of peptic ulcer and 66% of diverticular disease.
CONCLUSIONS: Studies of mortality for these diseases should take account of all certified causes as well as underlying-cause mortality. This is particularly important for analyses that go across periods of change to the rules for selecting the underlying cause of death.},
}
@article {pmid18081651,
year = {2007},
author = {Szojda, MM and Cuesta, MA and Mulder, CM and Felt-Bersma, RJ},
title = {Review article: Management of diverticulitis.},
journal = {Alimentary pharmacology & therapeutics},
volume = {26 Suppl 2},
number = {},
pages = {67-76},
doi = {10.1111/j.1365-2036.2007.03491.x},
pmid = {18081651},
issn = {1365-2036},
mesh = {Diverticulitis, Colonic/etiology/*therapy ; Humans ; Prognosis ; Secondary Prevention ; Sigmoid Diseases/etiology/*therapy ; },
abstract = {BACKGROUND AND AIM: The incidence and therefore complications of (sigmoid) diverticular disease are increasing.
METHODS: Review of current literature.
RESULTS: From all patients, 15% will develop diverticulitis, 5% complications and 5% diverticular bleeding. Diagnosis is established with computerised tomography. Colonoscopy is needed to rule out malignancy. NSAIDs increase the risk of perforation; steroids, diabetes, collagen vascular disease and immune compromised are associated with complicated disease and death. In mild diverticulitis, antibiotics are recommended. In complicated disease with abscesses, <5 cm antibiotics are sufficient. Larger abscesses are drained under computerised tomography-guidance. Peritonitis forms an indication for surgery. Diverticulitis recurrence rate is around 30%, most are uncomplicated. Recurrence after surgery is around 10%. Elective surgery is reserved for fistula closure and obstruction. The need for elective surgery to prevent recurrence has diminished because of new insights. Important is to identify risk groups. New issues are the possible relationship between diverticulitis and cancer, segmental colitis associated with diverticulitis, and treatment of diverticulitis with mesalazine and probiotics.
CONCLUSIONS: Uncomplicated diverticulitis is treated medically. Complicated diverticulitis with small abscesses is treated with antibiotics while larger abscesses are drained with computerised tomography-guided puncture. Emergency surgery is reserved for peritonitis, elective surgery for fistula/stenosis. Surgery to prevent recurrence is indicated only in selected cases (e.g. immune compromised).},
}
@article {pmid21369512,
year = {2008},
author = {Sassani, P and Singh, HM and Gerety, D and Abbas, MA},
title = {Giant colonic diverticulum: endoscopic, imaging, and histopathologic findings.},
journal = {The Permanente journal},
volume = {12},
number = {1},
pages = {47-49},
pmid = {21369512},
issn = {1552-5767},
abstract = {Giant colonic diverticulum is a rare manifestation of diverticular disease. Although this entity can be discovered incidentally on imaging studies, patients can present with a variety of symptoms. This report illustrates the clinical presentation, endoscopic imaging, and histologic findings for this disorder. Surgical resection is curative and in select cases can be carried out laparoscopically.},
}
@article {pmid18157570,
year = {2008},
author = {Rosemar, A and Angerås, U and Rosengren, A},
title = {Body mass index and diverticular disease: a 28-year follow-up study in men.},
journal = {Diseases of the colon and rectum},
volume = {51},
number = {4},
pages = {450-455},
doi = {10.1007/s10350-007-9172-5},
pmid = {18157570},
issn = {0012-3706},
mesh = {*Body Mass Index ; Confidence Intervals ; Disease Progression ; Diverticulum/*epidemiology/etiology ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Obesity/*complications/epidemiology ; Prevalence ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Severity of Illness Index ; Survival Rate ; Sweden/epidemiology ; Time Factors ; },
abstract = {PURPOSE: Diverticular disease increased steadily concomitant with elevated rates of overweight and obesity during the 20th century. Therefore, the objective of this study was to investigate whether overweight and obesity in midlife predict future diverticular disease in men.
METHODS: This was a prospective cohort study of a general population of men living in Göteborg, Sweden. A community-based sample of 7,494 men, investigated when aged 47 to 55 years, were followed from baseline in 1970 to 1973 for a maximum of 28 years. Hospitalization with a discharge diagnosis of diverticular disease according to the Swedish hospital discharge register was measured.
RESULTS: Totally, 112 men (1.5 percent) were hospitalized with diverticular disease. A relationship between body mass index and diverticular disease was demonstrated; men with a body mass index between 20 and 22.5 kg/m2 had the lowest risk. After adjustment for covariates, the risk increased linearly in men who had a body mass index of 22.5 to 25 (multiple-adjusted hazard ratio, 2.3; 95 percent confidence interval, 0.9-6; 25-27.5 (hazard ratio, 3 (1.2-7.6)), 27.5-30 (hazard ratio 3.2, (1.2-8.6)), and 30 or greater (hazard ratio 4.4, (1.6-12.3)) kg/m2 (P for linear trend = 0.004). Men with a body mass index of < or =20 kg/m2 had a nonsignificantly elevated risk (hazard ratio, 3 (0.7-12.5)). Smoking (hazard ratio, 1.6 (1.1-2.3) and diastolic blood pressure (hazard ratio, 1.02 (1.01-1.04) per mmHg) also were independently related to risk of diverticular disease.
CONCLUSIONS: In a large community-based sample of middle-aged men, overweight and obesity were strongly linked to future severe diverticular disease leading to hospitalization.},
}
@article {pmid18094304,
year = {2008},
author = {Yucel, C and Lev-Toaff, AS and Moussa, N and Durrani, H},
title = {CT colonography for incomplete or contraindicated optical colonoscopy in older patients.},
journal = {AJR. American journal of roentgenology},
volume = {190},
number = {1},
pages = {145-150},
doi = {10.2214/AJR.07.2633},
pmid = {18094304},
issn = {1546-3141},
mesh = {Aged ; Aged, 80 and over ; Barium ; Colonic Polyps/*diagnostic imaging ; *Colonography, Computed Tomographic ; *Colonoscopy ; Colorectal Neoplasms/*diagnostic imaging/prevention & control ; Contraindications ; Contrast Media ; Enema ; Female ; Humans ; Male ; Middle Aged ; Pneumoradiography/methods ; },
abstract = {OBJECTIVE: Our purpose was to assess the performance of CT colonography (CTC) in patients older than 60 years who were referred because colonoscopy was contraindicated or incomplete.
MATERIALS AND METHODS: Over a 2-year period, 61 patients underwent CTC at our institution, 42 of whom (26 women, 16 men) were 60 years old or older (range, 60-87 years; mean age, 71 years). After 24-48 hours of ingesting only clear liquids and after colonic cleansing, fecal tagging, and automated CO2 insufflation, patients were scanned using a 16-MDCT scanner. Images were obtained with the patient in the supine and prone positions and as needed in the right or left decubitus position. Axial 2D and 3D endoluminal views were evaluated on a dedicated workstation.
RESULTS: Contraindications to colonoscopy in 12 (29%) of the 42 patients were as follows: anticoagulation (n = 8), increased anesthesia risk (n = 3), and poor tolerance for colonoscopy preparation (n = 1). Incomplete colonoscopy in the other 30 patients (71%) was due to diverticular disease (n = 10), colonic redundancy (n = 10), adhesions (n = 3), residual colonic content (n = 3), sigmoid stricture (n = 1), ventral hernia (n = 1), and unknown cause (n =2). No complications were observed. Optimal distention of the entire colon was achieved in 38 patients (90%). Thirty-nine (93%) of the 42 patients had abnormal findings: diverticular disease (n = 25), one or more polyps (n = 22), a mass lesion (n = 1), a lipoma (n = 1), and inflammatory stricture (n = 1). Extracolonic findings potentially requiring further evaluation or treatment were observed in 26 patients (62%).
CONCLUSION: CTC using CO2 insufflation was well tolerated and successful in imaging the entire colon in most of the 42 patients, despite the presence of sigmoid diverticular disease or colonic redundancy.},
}
@article {pmid18069157,
year = {2007},
author = {},
title = {Course is benign for uncomplicated diverticular disease.},
journal = {The Journal of family practice},
volume = {56},
number = {12},
pages = {992},
pmid = {18069157},
issn = {1533-7294},
}
@article {pmid18063263,
year = {2007},
author = {Javid, SH and Ashley, S and Breen, E},
title = {A colorectal curriculum for general surgery residents: are we ready for needs assessment?.},
journal = {Journal of surgical education},
volume = {64},
number = {6},
pages = {324-327},
doi = {10.1016/j.jsurg.2007.04.008},
pmid = {18063263},
issn = {1931-7204},
mesh = {Colorectal Surgery/*education ; *Curriculum/standards/statistics & numerical data ; General Surgery/*education ; Humans ; *Internship and Residency/standards ; *Needs Assessment ; },
abstract = {OBJECTIVE: The traditional scope of general surgery (GS) has been broadly encompassing. Although it is generally accepted that we need a more defined curriculum for GS training, the criteria for limiting its scope remain controversial. One approach is to perform a needs assessment, defined based on an analysis of current GS practice. The purpose of this study was to use such a needs assessment to model a subset of the GS curriculum in colon and rectal surgery.
DESIGN: The numbers of colon and anorectal procedures performed in the prior 24 months by 982 GS taking the 2004 ABS Recertification Examination in Surgery were examined to determine the mean number of procedures per surgeon along with the percentage of surgeons who had performed at least 1 of the identified procedures. The impact of using these numbers to define a general surgical curriculum was then examined.
RESULTS: Procedures performed frequently and by >60% GS included appendectomies, colostomies, colectomies, hemorrhoidectomies, and anorectal abscess procedures. Procedures performed infrequently, yet performed by >30% of surgeons at least once, included subtotal colectomies, abdominoperineal resections, transanal excisions, sphincterotomies, and anorectal fistulotomies. The procedures performed rarely included ileoanal pouch anastomoses and procedures for incontinence and rectal prolapse.
CONCLUSIONS: Based on this analysis, a colorectal surgical curriculum would include the treatment of diseases that led to commonly performed operations such as colon cancer, diverticular disease, lower gastrointestinal bleeding, mesenteric ischemia, inflammatory bowel disease (IBD), hemorrhoids, and anorectal diseases. The management of low rectal cancer, complex IBD, rectal prolapse, and fecal incontinence might not be essential content. A curriculum based on needs assessment would deemphasize or even eliminate some areas traditionally considered within the realm of GS. Although this might appropriately serve as a basis for defining the scope of GS, the indirect consequences will need to be defined.},
}
@article {pmid18057894,
year = {2007},
author = {Alvarez, JA and Baldonedo, RF and Bear, IG and Otero, J and Pire, G and Alvarez, P and Jorge, JI},
title = {Presentation, management and outcome of acute sigmoid diverticulitis requiring hospitalization.},
journal = {Digestive surgery},
volume = {24},
number = {6},
pages = {471-476},
doi = {10.1159/000111823},
pmid = {18057894},
issn = {1421-9883},
mesh = {Abdominal Abscess/etiology ; Abdominal Pain/etiology ; Acute Disease ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Cellulitis/etiology ; Comorbidity ; Diverticulitis, Colonic/complications/diagnosis/epidemiology/surgery/*therapy ; Duodenal Obstruction/etiology ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; Peritonitis/etiology ; Postoperative Complications/epidemiology ; Prognosis ; Retrospective Studies ; Sigmoid Diseases/complications/surgery/*therapy ; },
abstract = {AIM: This study was conducted to assess the presentation, management, and outcomes of patients with acute sigmoid diverticulitis requiring hospitalization.
METHODS: From 1986 to 2005, the medical records of 265 patients treated for acute sigmoid diverticulitis requiring hospitalization were retrospectively analyzed. Data were collected with regard to patient's demographics, clinical characteristics, presentations of acute diverticulitis, treatment, morbidity, and mortality.
RESULTS: Only 47 patients (17.7%) had a previous diverticulitis episode. Of the 265 patients, 166 (62.6%) were managed without operation, and 99 (37.4%) underwent surgery. Overall and major morbidity in the whole series were 30.2 (80/265) and 15.5% (40/265), respectively; whereas among the patients with surgical management, were 72.7 (72/99), and 35.3% (35/99), respectively. Overall and postoperative mortality rates were 2.6 (7/265) and 6.1% (6/99), respectively. Older age, steroid use, perforation, and co-morbidities were significantly associated with unfavorable outcomes.
CONCLUSIONS: It was concluded that surgery for acute sigmoid diverticulitis requiring hospitalization carries important morbidity and mortality. To achieve improvements in outcome, a selective therapeutic approach should be considered, choosing the best surgical procedure for each complication of diverticular disease.},
}
@article {pmid18035010,
year = {2007},
author = {Spaziani, E and Stagnitti, F and Iozzino, M and Notarianni, E and Cianni, R and Toccaceli, S and Casciaro, EG and Gammardella, P and Di Filippo, A and Policicchio, V and Martellucci, A and Stagnitti, A and Budak, A and Di Pucchio, E and Calì, B and De Angelis, F and Corelli, S},
title = {[Massive lower gastrointestinal bleeding due to diverticular disease during antiplatelet therapy. Case report].},
journal = {Il Giornale di chirurgia},
volume = {28},
number = {11-12},
pages = {428-431},
pmid = {18035010},
issn = {0391-9005},
mesh = {Acute Coronary Syndrome/therapy ; Aged ; Aspirin/administration & dosage/adverse effects ; Clopidogrel ; Coronary Restenosis/prevention & control ; Diverticulum/*complications/*diagnosis ; Drug-Eluting Stents ; Female ; Fluorobenzenes/administration & dosage/adverse effects ; Gastrointestinal Hemorrhage/chemically induced/*etiology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage/adverse effects ; Hypercholesterolemia/drug therapy ; Platelet Aggregation Inhibitors/*administration & dosage/*adverse effects ; Pyrimidines/administration & dosage/adverse effects ; Rosuvastatin Calcium ; Sigmoid Diseases/*complications/*diagnosis ; Sulfonamides/administration & dosage/adverse effects ; Ticlopidine/administration & dosage/adverse effects/analogs & derivatives ; },
abstract = {Diverticular disease is very frequent in Western countries; in 5% of the cases it is the cause of serious bleeding, haemodynamic instability and death. The authors report a case of 74 years old patient with severe lower gastrointestinal bleeding. She was in antiplatelet treatment with acetylsalicylic acid (100 mg/die) and clopidogrel (75 mg/die) for preventing the restenosis of medicated stents positioned to treat an acute coronary syndrome. At the same time the patient was under treatment for primary hypercholesterolemia with rosuvastatin (20 mg/die). The severe haemorrhage demanded haemodynamic stabilization, achieved by colloid infusion and blood transfusions. The bleeding continued; selective arteriography showed it's origin from the areas of the sigmoid and superior hemorrhoidal arteries. During the procedure, embolization of the inferior mesenteric artery using spiral type BALT was performed, with consequent bleeding interruption. Fifteen days after the embolization, a rectosigmoid colonoscopy showed a sigmoid diverticular disease. The treatment with acetylsalicylic acid and clopidogrel has surely contributed to the severity of the hemorrhage. Recent experimental and clinical evidence suggests a possible antiplatelet effect of the statins.},
}
@article {pmid18019645,
year = {2007},
author = {Lippi, CE and Braini, A and Cervia, S and Fabbricotti, A and Ferrari, T and Maruelli, P and Spessa, E and Sturlese, M},
title = {[Diverticular disease complicated by peritonitis: role of conservative surgical therapy].},
journal = {Chirurgia italiana},
volume = {59},
number = {5},
pages = {713-721},
pmid = {18019645},
issn = {0009-4773},
mesh = {Aged ; Anastomosis, Surgical/methods ; Colectomy/adverse effects/*methods/mortality ; Colon, Sigmoid/surgery ; Colonic Diseases/*complications/*surgery ; Diverticulum/*complications/*surgery ; Drainage ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Peritonitis/*etiology/surgery ; Treatment Outcome ; },
abstract = {Peritonitis complicating diverticular disease may be treated by sigmoid resection (with or without primary anastomosis) or by a conservative surgical approach, either laparoscopically or by open surgery. The choice depends on the severity of the peritonitis (Hinchey), the patient's conditions (ASA) and the surgeon's experience. Sigmoid resection with primary anastomosis has a lower morbidity and mortality vs Hartmann's procedure. After the introduction of laparoscopy in colorectal surgery, exploratory laparoscopy combined with drainage has been proposed to treat acute episodes, followed by laparoscopic resection. Since 1982, over 1000 patients have been operated on for colorectal disease: 119 for complicated diverticulitis, 55 of which complicated by peritonitis. In the latter, we performed conservative surgery (25 patients) and resection (30 patients) laparoscopically or by open surgery. Our results show a higher morbidity and mortality for the Hartmann procedure vs sigmoid resection with primary anastomosis and a lower specific morbidity in patients undergoing laparoscopic exploration and drainage. Moreover, there was a low percentage (52%) of re-canalisations with the Hartmann procedure, with a morbidity of 32% associated with this procedure. In conclusion, we believe that a conservative laparoscopic surgical approach may be advocated in selected cases (Hinchey II and III without clear perforation), followed by laparoscopic sigmoidectomy, resection with primary anastomosis in Hinchey I or in cases of evident perforation with purulent or faecal peritonitis (possibly combined with a stoma), reserving the Hartmann procedure for compromised patients.},
}
@article {pmid18018364,
year = {2007},
author = {Tankova, L and Berberova, M and Purvanov, P and Tsankov, Ts and Gegova, A},
title = {Complicated small bowel diverticulosis--a case report and literature review.},
journal = {Chirurgia (Bucharest, Romania : 1990)},
volume = {102},
number = {5},
pages = {603-606},
pmid = {18018364},
issn = {1221-9118},
mesh = {Aged ; Diverticulitis/*complications/surgery ; Female ; Humans ; Intestinal Perforation/*etiology/surgery ; *Intestine, Small/pathology/surgery ; Peritonitis/*etiology/surgery ; Treatment Outcome ; },
abstract = {We report herein the case of a small bowel diverticulum perforation which has caused peritonitis and consequently has led to operation. The patient, a 79-year old woman, was hospitalized due to etiological clarifying and specifying of a newly diagnosed diffuse liver pathology. During the hospital stay, she has received severe abdominal pain with features of peritonitis. Suspecting perforated appendicitis she has undergone an operation. The explorative laparotomy has identified a purulent exudation in the abdominal cavity, resulting from a perforated inflammatory jejunal diverticulum and multiple middle-size diverticula all along the small bowel and the colon. The reported case as well as the review of the literature have shown that various and sometimes potentially fatal complications could occur even for such a relatively banal insignificant entity as is diverticular disease in elderly patients.},
}
@article {pmid17977774,
year = {2008},
author = {Caudron, A and Grados, F and Boubrit, Y and Coullet, JM and Merrien, D and Domart, Y},
title = {Discitis due to Clostridium perfringens.},
journal = {Joint bone spine},
volume = {75},
number = {2},
pages = {232-234},
doi = {10.1016/j.jbspin.2007.04.026},
pmid = {17977774},
issn = {1778-7254},
mesh = {Aged ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Biopsy, Fine-Needle ; Clostridium Infections/*complications/*diagnosis/drug therapy ; Clostridium perfringens/*pathogenicity ; Discitis/*diagnosis/*microbiology ; Female ; Humans ; Lumbar Vertebrae/*microbiology/pathology ; Magnetic Resonance Imaging ; },
abstract = {INTRODUCTION: A combination of disk space narrowing and vacuum phenomenon on radiographs of the spine is usually considered a reliable indicator of degenerative disk disease. We report a case in which vacuum phenomenon was related to Clostridium perfringens discitis.
METHODS: A 79-year-old woman was admitted for inflammatory low back pain that had worsened steadily over the last 2 months. Her body temperature was normal, laboratory tests showed inflammation (erythrocyte sedimentation rate, 61 mm/h; and C-reactive protein, 13 mg/L), and blood cultures were negative. Imaging studies (radiographs, computed tomography [CT], and magnetic resonance imaging) indicated L4-L5 discitis. Vacuum phenomenon within the L4-L5 disk was seen on radiographs and CT scans. C. perfringens was recovered by fine-needle biopsy of the disk. Diverticular disease of the colon was the only identifiable portal of entry. Amoxicillin therapy ensured a full recovery.
DISCUSSION: C. perfringens discitis is rare, with only 7 published cases in humans. A gastrointestinal portal of entry was identified in 70% of cases. Radiographs or CT scans visualized vacuum phenomenon in 80% of cases. Positive blood cultures were noted in 75% of cases. The outcome was favorable with antibiotic therapy, even when a single-drug was used. The other characteristics of C. perfringens discitis were indistinguishable from those of discitis caused by the usual organisms.
CONCLUSION: Presence of gas within the disk does not rule out infectious discitis and may indicate C. perfringens discitis.},
}
@article {pmid17959748,
year = {2008},
author = {Burcher, E and Shang, F and Warner, FJ and Du, Q and Lubowski, DZ and King, DW and Liu, L},
title = {Tachykinin NK2 receptor and functional mechanisms in human colon: changes with indomethacin and in diverticular disease and ulcerative colitis.},
journal = {The Journal of pharmacology and experimental therapeutics},
volume = {324},
number = {1},
pages = {170-178},
doi = {10.1124/jpet.107.130385},
pmid = {17959748},
issn = {1521-0103},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colitis, Ulcerative/metabolism/*physiopathology ; Colon/drug effects/metabolism/physiopathology ; Diverticulum, Colon/metabolism/*physiopathology ; Female ; Humans ; In Vitro Techniques ; Indomethacin/*pharmacology ; Male ; Middle Aged ; Muscle Contraction/drug effects ; Neurokinin A/analogs & derivatives/pharmacology ; Peptide Fragments/pharmacology ; RNA, Messenger/metabolism ; Receptors, Neurokinin-2/agonists/genetics/*physiology ; },
abstract = {Neurokinin A (NKA) is an important spasmogen in human colon. We examined inflammatory disease-related changes in the tachykinin NK(2) receptor system in human sigmoid colon circular muscle, using functional, radioligand binding, and quantitative reverse transcription-polymerase chain reaction methods. In circular muscle strips, indomethacin enhanced contractile responses to NKA (p < 0.01) and to the NK(2) receptor-selective agonist [Lys(5),MeLeu(9),Nle(10)]-NKA(4-10) (p < 0.05) in both normal and acute diverticular disease (DD) specimens, indicating NK(2) receptor-mediated release of relaxant prostanoids. Contractile responses to both tachykinins were reduced in strips from DD (p < 0.001) and ulcerative colitis (UC) (p < 0.05) specimens. Responses to acetylcholine were no different in other strips from the same disease patients, demonstrating that the change in responsiveness to tachykinins in disease is specifically mediated by the NK(2) receptor. In membranes from UC specimens, receptor affinity for (125)I-NKA (median K(D) 0.91 nM, n = 16) was lower (p < 0.01) than that in age-matched control specimens (K(D) 0.55 nM, n = 40), whereas K(D) (0.65 nM, n = 28) in DD was no different from control. No disease-related changes in receptor number (B(max)) were found (mean, 2.0-2.5 fmol/mg of wet weight tissue), suggesting that the reduced contractile responses in disease are not due to a loss of receptor number. Different mechanisms may account for the reduced contractility in DD compared with UC. A gender-related difference in receptor density was seen in controls, with B(max) lower in females (1.77 fmol/mg, n = 15) than in males (2.60 fmol/mg, n = 25, p = 0.01). In contrast, no gender-related differences were seen in NK(2) receptor mRNA in control colonic muscle, indicating that the gender difference is a post-translational event.},
}
@article {pmid17944591,
year = {2007},
author = {Valero, R and Rodrigo, E and Ruiz, JC and González-Cotorruelo, J and Lastra, P and López-Rasines, G and Fernández, F and Sánchez, M and Arias, M},
title = {[Abscess colon diverticular disease produced for Actinomyces israelii in a renal transplant recipient].},
journal = {Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia},
volume = {27},
number = {4},
pages = {511-513},
pmid = {17944591},
issn = {0211-6995},
mesh = {Abscess/complications/diagnosis/*microbiology ; Actinomycosis/*complications/diagnosis ; Diverticulum, Colon/complications/diagnosis/*microbiology ; Humans ; *Kidney Transplantation ; Male ; Middle Aged ; },
abstract = {We present the case of a 53 years old man with a cadaveric kidney transplant under cyclosporin A and prednisolone therapy. Clinical transplant course was uneventful until 15 years after transplant, when he was admitted in our hospital with fever and a perirenal mass of unknown origin. Cyclosporin A was removed and a left sided colon was carried out and a abscess colon diverticular disease produced for Actinomyces israelii was diagnosed. The development was satisfactory after medical and surgical treatment.},
}
@article {pmid17938524,
year = {2007},
author = {Cheung, DY and Kim, JI and Park, YB and Park, SH and Park, KS and Jung, SE and Kim, JK},
title = {Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction.},
journal = {Internal medicine (Tokyo, Japan)},
volume = {46},
number = {20},
pages = {1701-1704},
doi = {10.2169/internalmedicine.46.0017},
pmid = {17938524},
issn = {1349-7235},
mesh = {Abdominal Pain/*etiology ; Adult ; Colonic Diseases/*etiology ; Humans ; Intestinal Mucosa/pathology ; Intestinal Obstruction/*etiology ; Male ; Prolapse ; Sigmoid Diseases/complications/*diagnosis/pathology ; },
abstract = {Colorectal polypoid lesions are classified as either neoplastic or non-neoplastic, and the differentiation between the two lesions is important for clinical practice, however, this is not easy in some rare cases. Cases of colonic prolapsing mucosal polyps are rare. They are often, but not always, associated with diverticular disease and present with abdominal pain, obstructive symptoms or bleeding. On colonoscopic examination, the lesions are characterized by multiple polyps or elevated patches with smooth and bright red colored surface. The histological features include: glandular crypt abnormalities, fibromuscular obliteration of the lamina propria, and thickened and splayed muscularis mucosa. We report herein a case of sigmoid colonic prolapsing mucosal polyps presenting with acute lower abdominal cramping pain and colonic obstruction who was diagnosed based on colonoscopy and endosonography findings and treated with conservative management.},
}
@article {pmid17937010,
year = {2007},
author = {Rumiantsev, VG and Osina, VA and Levchenko, SV},
title = {[Diverticular disease of the colon: literature review].},
journal = {Eksperimental'naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology},
volume = {},
number = {3},
pages = {76-82},
pmid = {17937010},
issn = {1682-8658},
mesh = {Aging/metabolism/pathology ; *Diverticulum, Colon/drug therapy/etiology/metabolism/pathology ; Humans ; Intestinal Perforation/etiology/metabolism/pathology/prevention & control ; },
}
@article {pmid17933278,
year = {2007},
author = {Dughera, L and Elia, C and Navino, M and Cisarò, F and , },
title = {Effects of symbiotic preparations on constipated irritable bowel syndrome symptoms.},
journal = {Acta bio-medica : Atenei Parmensis},
volume = {78},
number = {2},
pages = {111-116},
pmid = {17933278},
issn = {0392-4203},
mesh = {Adult ; *Bifidobacterium ; Colon/physiology ; Constipation/*therapy ; Female ; Gastrointestinal Transit ; Humans ; Irritable Bowel Syndrome/diagnosis/physiopathology/*therapy ; Male ; Middle Aged ; Probiotics/administration & dosage/*therapeutic use ; Prospective Studies ; Surveys and Questionnaires ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: Prebiotic and probiotic therapies are new strategies that are being used to treat different gastrointestinal diseases, such as irritable bowel syndrome, diverticular disease and inflammatory bowel diseases.
AIMS: Evaluating the effects of a symbiotic preparation on symptoms and colonic transit in patients with irritable bowel syndrome and significant bloating.
METHODS: We carried out an open-label, prospective, uncontrolled, multicenter trial on 129 patients meeting Rome II criteria for irritable bowel syndrome who did not have lactose malabsorption, abdominal surgery, overt psychiatric disorders and ongoing psychotropic drug therapy or ethanol abuse. For three months, the patients were treated with a symbiotic preparation and were investigated trough questionnaires on symptoms. Data on bloating and abdominal pain were obtained using the McNemar-Bowker's test, while data on stool frequency were evaluated using the t-test.
RESULTS: The administration of a symbiotic preparation to these patients modified the clinical picture and intestinal function, with a significant increase of stool frequency.
CONCLUSIONS: Our data, although the study had an open design, represent a further analysis of positive symbiotic effects on clinical manifestations and intestinal function in patients with irritable bowel syndrome.},
}
@article {pmid17928488,
year = {2007},
author = {Yoon, SE and Lee, YH and Yoon, KH and Kim, EA and Choi, SS and Juhng, SK and Yun, KJ and Park, WC},
title = {Complicated giant diverticulum of the transverse colon accompanied by right inguinal hernia of the greater omentum.},
journal = {The British journal of radiology},
volume = {80},
number = {957},
pages = {e201-4},
doi = {10.1259/bjr/23274345},
pmid = {17928488},
issn = {1748-880X},
mesh = {Colon, Transverse/*diagnostic imaging ; Diverticulum, Colon/complications/*diagnostic imaging ; Hernia, Inguinal/complications/*diagnostic imaging ; Humans ; Male ; Middle Aged ; Omentum/*diagnostic imaging ; Peritoneal Diseases/complications/*diagnostic imaging ; Tomography, X-Ray Computed ; },
abstract = {Giant colonic diverticulum is a very rare entity in colonic diverticular disease and is characterized by a high rate of complications such as perforation, abscess formation and even carcinoma. We report a case of a complicated giant diverticulum of the transverse colon accompanied by a right inguinal hernia of the greater omentum in a 52-year-old man, as demonstrated on CT.},
}
@article {pmid17909880,
year = {2008},
author = {Hurreiz, H and Mayes, R and Humphreys, G},
title = {A giant sigmoid diverticulum presenting as an upper abdominal mass.},
journal = {Irish journal of medical science},
volume = {177},
number = {4},
pages = {409-411},
pmid = {17909880},
issn = {1863-4362},
mesh = {Aged ; Colon, Sigmoid/*pathology/surgery ; Diverticulum, Colon/*complications/diagnosis/surgery ; Humans ; Male ; Sigmoid Diseases/*complications/diagnosis/surgery ; },
abstract = {AIM: We report a case of a giant diverticulum of the sigmoid colon presenting as a mass in the left upper quadrant of the abdomen in an elderly man.
METHODS: This report highlights a rare complication of diverticular disease. At operation, the giant cyst was situated in the supracolic compartment of the abdomen. The management options and a review of the literature are presented.
CONCLUSION: CT scan is the investigation of choice. Early surgical intervention is important in order to reduce the risk of perforation.},
}
@article {pmid17897045,
year = {2007},
author = {Hassan, C and Zullo, A and De Francesco, V and Campo, SM and Morini, S and Panella, C and Ierardi, E},
title = {Tumor necrosis factor alpha in ulcerative colitis and diverticular disease associated colitis.},
journal = {Endocrine, metabolic & immune disorders drug targets},
volume = {7},
number = {3},
pages = {187-194},
doi = {10.2174/187153007781662530},
pmid = {17897045},
issn = {1871-5303},
mesh = {Animals ; Colitis/*drug therapy/etiology ; Colitis, Ulcerative/*drug therapy ; Diverticulum/complications/*drug therapy ; Humans ; Tumor Necrosis Factor-alpha/antagonists & inhibitors/*therapeutic use ; },
abstract = {Conventional treatment of moderate-severe ulcerative colitis (UC) has resulted in only a limited therapeutic benefit. Advancing knowledge of UC pathogenesis and recent advances in biotechnology have led to the development of biological agents that selectively target individual inflammatory pathways. In particular, the role of tumor necrosis factor alpha (TNF-alpha) in UC pathogenesis has been clarified by serological and immunohistochemical studies in humans and by experimental models. Clinical efficacy of anti-TNF-alpha therapy with infliximab has been assessed in two large controlled trials, showing a good compromise between therapeutic gain and safety. The aim of this review is to provide an insight into the role of TNF-alpha and anti-TNF-alpha therapy in patients with UC and diverticular disease associated colitis.},
}
@article {pmid17888183,
year = {2007},
author = {Osbak, PS and Bindslev, N and Poulsen, SS and Kaltoft, N and Tilotta, MC and Hansen, MB},
title = {Colonic epithelial ion transport is not affected in patients with diverticulosis.},
journal = {BMC gastroenterology},
volume = {7},
number = {},
pages = {37},
pmid = {17888183},
issn = {1471-230X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Biopsy/methods ; Colon, Sigmoid/pathology/*physiopathology ; Colonoscopy ; Diverticulosis, Colonic/pathology/*physiopathology ; Electrophysiology/*methods ; Enzyme Activators/pharmacology ; Enzyme Inhibitors/pharmacology ; Epithelium/pathology/*physiopathology ; Female ; Humans ; Ion Transport/drug effects/*physiology ; Male ; Membrane Transport Modulators/*pharmacology ; Middle Aged ; Statistics, Nonparametric ; },
abstract = {BACKGROUND: Colonic diverticular disease is a bothersome condition with an unresolved pathogenesis. It is unknown whether a neuroepithelial dysfunction is present. The aim of the study was two-fold; (1) to investigate colonic epithelial ion transport in patients with diverticulosis and (2) to adapt a miniaturized Modified Ussing Air-Suction (MUAS) chamber for colonic endoscopic biopsies.
METHODS: Biopsies were obtained from the sigmoid part of the colon. 86 patients were included. All patients were referred for colonoscopy on suspicion of neoplasia and they were without pathological findings at colonoscopy (controls) except for diverticulosis in 22 (D-patients). Biopsies were mounted in MUAS chambers with an exposed area of 5 mm2. Electrical responses to various stimulators and inhibitors of ion transport were investigated together with histological examination. The MUAS chamber was easy to use and reproducible data were obtained.
RESULTS: Median basal short circuit current (SCC) was 43.8 microA x cm(-2) (0.8 - 199) for controls and 59.3 microA x cm(-2) (3.0 - 177.2) for D-patients. Slope conductance was 77.0 mS x cm(-2) (18.6 - 204.0) equal to 13 Omega x cm(2) for controls and 96.6 mS x cm(-2) (8.4 - 191.4) equal to 10.3 Omega x cm(2) for D-patients. Stimulation with serotonin, theophylline, forskolin and carbachol induced increases in SCC in a range of 4.9 - 18.6 microA x cm(-2), while inhibition with indomethacin, bumetanide, ouabain and amiloride decreased SCC in a range of 6.5 - 27.4 microA x cm(-2), and all with no significant differences between controls and D-patients. Histological examinations showed intact epithelium and lamina propria before and after mounting for both types of patients.
CONCLUSION: We conclude that epithelial ion transport is not significantly altered in patients with diverticulosis and that the MUAS chamber can be adapted for studies of human colonic endoscopic biopsies.},
}
@article {pmid17885044,
year = {2007},
author = {Hanson, ME and Pickhardt, PJ and Kim, DH and Pfau, PR},
title = {Anatomic factors predictive of incomplete colonoscopy based on findings at CT colonography.},
journal = {AJR. American journal of roentgenology},
volume = {189},
number = {4},
pages = {774-779},
doi = {10.2214/AJR.07.2048},
pmid = {17885044},
issn = {1546-3141},
mesh = {Colonography, Computed Tomographic/*methods ; Colonoscopy/*methods ; Colorectal Neoplasms/*diagnostic imaging/*pathology ; Diagnostic Errors/*prevention & control ; Female ; Humans ; Male ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; },
abstract = {OBJECTIVE: Reasons for failure to reach the cecum at optical colonoscopy are multifactorial. The purpose of this study was to compare CT colonography (CTC) findings in patients with complete versus those with incomplete optical colonoscopy.
MATERIALS AND METHODS: The clinical data and CTC examinations were reviewed in 100 patients who underwent CTC after incomplete optical colonoscopy. The findings were compared with a control group of 100 patients who underwent complete optical colonoscopy after CTC. The interactive 3D colon map and 2D multiplanar reconstruction images from CTC were reviewed independently by two experienced gastrointestinal radiologists for colorectal length (total, sigmoid colon, and transverse colon), number of acute angle flexures (reflecting tortuosity), and advanced diverticular disease. Discrepancies were resolved by secondary consensus review.
RESULTS: Significant differences existed between the complete and incomplete optical colonoscopy groups, respectively, for age (mean, 58.2 vs 63.4 years; p < 0.001), sex (60 men and 40 women vs 41 men and 59 women; p < 0.01), and prior abdominal surgery (26.0% vs 48.0%; p < 0.01). Significant differences were seen between the complete and incomplete optical colonoscopy groups, respectively, for all the CTC factors that were evaluated: total colorectal length (mean, 167.0 vs 210.8 cm; p < 0.0001), sigmoid colon length (mean, 48.7 vs 66.8 cm; p < 0.0001), transverse colon length (mean, 49.2 vs 66.3 cm; p < 0.0001), number of flexures (mean, 9.6 vs 11.9; p < 0.0001), and advanced diverticular disease (22.0% vs 34.0%; p <0.05).
CONCLUSION: Anatomic features associated with failure to reach the cecum at optical colonoscopy included colonic elongation, tortuosity, and advanced diverticular disease. These predictive factors may have implications for optical colonoscopy training and performance and for patients sent to optical colonoscopy for polyps prospectively detected at CTC.},
}
@article {pmid17869198,
year = {2008},
author = {Dionigi, G and Dionigi, R and Rovera, F and Boni, L and Padalino, P and Minoja, G and Cuffari, S and Carrafiello, G},
title = {Treatment of high output entero-cutaneous fistulae associated with large abdominal wall defects: single center experience.},
journal = {International journal of surgery (London, England)},
volume = {6},
number = {1},
pages = {51-56},
doi = {10.1016/j.ijsu.2007.07.006},
pmid = {17869198},
issn = {1743-9159},
mesh = {Adult ; Aged ; Female ; Humans ; Intestinal Fistula/complications/etiology/physiopathology/*surgery ; Length of Stay ; Male ; Middle Aged ; *Negative-Pressure Wound Therapy ; Nutritional Status ; Plastic Surgery Procedures ; Retrospective Studies ; Skin Transplantation ; Surgical Mesh ; Surgical Wound Dehiscence/complications/*surgery ; },
abstract = {BACKGROUND AND AIM: Enteric fistulas are defined by their sites of origin, communication and flow. We evaluate the treatment of complex patients with entero-cutaneous fistulae with large abdominal wall defects.
MATERIALS AND METHODS: Retrospective case note review of 19 patients (15 males, median age 46 years) treated at the Department of Surgical Sciences, University of Insubria, Varese, Italy. These were distinguished by multiple/wide gastrointestinal fistula orifices, with total discontinuity of bowel. Fistulas were not covered by abdominal wall thus presenting with a giant abdominal wall defects. Surgery was planned once adequate nutritional status was present.
RESULTS: All fistulas resulted from previous surgery for IBD in 7 cases (37%), abdominal trauma 4 (21%), acute necrotic infected pancreatitis 3 (16%), intra-abdominal malignancy 3 (16%), and diverticular disease 2 (10%). The most common site of presentation was ileum (80%). Median fistula output was 800ml/day (range 400-1600ml/day). Seltzer's prognostic index identified malnutrition in 70% of patients at the time of presentation. The elapsed mean time from onset of fistula and elective time of surgical management were 184 days (range 20-2190 days). The VAC system was used in the last 7 patients preoperatively and in 6 patients with postoperative abdominal wound dehiscences that could not be closed immediately and who were at high risk for healing complications. There were no complications from the VAC therapy. Surgery was successful in 69% of cases. Mortality rate was 21%. Factors related to mortality were persistent malignancy, malnutrition and sepsis.
CONCLUSIONS: After optimization of nutritional status surgery with en bloc resection of fistula offers best results. In this series, cancer and sepsis were unfavourable factors for outcome. These fistulas may be successfully managed with a multidisciplinary approach.},
}
@article {pmid17827951,
year = {2007},
author = {Comparato, G and Fanigliulo, L and Aragona, G and Cavestro, GM and Cavallaro, LG and Leandro, G and Pilotto, A and Nervi, G and Soliani, P and Sianesi, M and Franzé, A and Di Mario, F},
title = {Quality of life in uncomplicated symptomatic diverticular disease: is it another good reason for treatment?.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {25},
number = {3},
pages = {252-259},
doi = {10.1159/000103896},
pmid = {17827951},
issn = {1421-9875},
mesh = {Aged ; Aged, 80 and over ; Anti-Infective Agents/*administration & dosage ; Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage ; Diverticulosis, Colonic/drug therapy/*physiopathology ; Female ; Humans ; Male ; Mesalamine/*administration & dosage ; Middle Aged ; *Quality of Life ; Rifamycins/*administration & dosage ; Rifaximin ; Surveys and Questionnaires ; },
abstract = {BACKGROUND: Quality of life (QoL) is becoming a major issue in the evaluation of any therapeutic intervention.
AIMS: To assess the QoL in patients with uncomplicated symptomatic diverticular disease (DD) and to elucidate the influence of two different treatments either on symptoms or QoL.
MATERIALS AND METHODS: 58 outpatients affected by uncomplicated symptomatic DD, admitted in our Gastroenterological Unit from October 2003 to March 2004, were enrolled. Patients were randomly assigned to two different treatments consisting of rifaximin or mesalazine for 10 days every month for a period of 6 months. QoL was evaluated by means of an SF-36 questionnaire and clinical evaluation was registered by means of a global symptomatic score (GSS) at baseline and after 6 months.
RESULTS: At baseline, lower values in all SF-36 domains were confirmed in patients with DD. Both rifaximin and mesalazine groups showed a significant reduction of their mean GSS (p < 0.01 and p < 0.001, respectively) and improvement of SF-36 mean scores after therapy, even though treatment with mesalazine showed better results.
CONCLUSIONS: DD has a negative impact on QoL. Cyclic treatment with poorly absorbable antibiotics or anti-inflammatory drugs relieves symptoms and improves QoL.},
}
@article {pmid17716342,
year = {2007},
author = {Peppas, G and Bliziotis, IA and Oikonomaki, D and Falagas, ME},
title = {Outcomes after medical and surgical treatment of diverticulitis: a systematic review of the available evidence.},
journal = {Journal of gastroenterology and hepatology},
volume = {22},
number = {9},
pages = {1360-1368},
doi = {10.1111/j.1440-1746.2007.05118.x},
pmid = {17716342},
issn = {0815-9319},
mesh = {Diverticulitis/*surgery/*therapy ; Humans ; Treatment Outcome ; },
abstract = {There is still controversy regarding the appropriate management of diverticulitis of the colon in cases when both surgical and conservative treatment may be an option. We performed a systematic review of the available evidence regarding the outcomes after medical and surgical treatment of diverticulitis from studies published after 1980 and indexed in the PubMed database. We included original studies that reported comparative data for at least one outcome in medically- and surgically-treated patients with transverse or left colon diverticulitis. The main outcomes of interest were mortality, morbidity, and recurrence of diverticulitis after medical or surgical treatment. There were 21 studies fulfilling our inclusion criteria out of 1360 initially identified as possibly relevant. More patients were treated conservatively in the included studies compared to emergency surgery (24 862 vs 6504). Emergency surgery was the main option for patients with severe complications of diverticular disease, including peritonitis. In most studies, in-hospital mortality for patients treated surgically was generally higher than that of patients treated medically, whereas there were insufficient comparative data regarding mortality during follow up. However, readmission to the hospital due to diverticular disease during follow up was more common in the group of patients treated conservatively compared to those treated surgically (4358/23 446 [18.6%]vs 22/359 [6.1%]). Conservatively-treated patients, with a first or second episode of diverticulitis, required surgery for recurrent disease during follow up in a maximum of 45% of cases, with larger studies reporting percentages lower than 11%. It should be emphasized that medical and surgical treatments have not ever been compared in a randomized controlled trial in patients with diverticulitis (without generalized peritonitis that is a surgical emergency). Although medical treatment results in more readmissions due to recurrence, it may be reasonable to avoid surgical therapy in the vast majority of patients with acute diverticulitis. It is unclear what the best treatment option is for younger patients (<50 years), namely whether elective surgery should be considered with the first episode of diverticulitis.},
}
@article {pmid17681003,
year = {2007},
author = {Wallander, MA and Johansson, S and Ruigómez, A and García Rodríguez, LA},
title = {Unspecified abdominal pain in primary care: the role of gastrointestinal morbidity.},
journal = {International journal of clinical practice},
volume = {61},
number = {10},
pages = {1663-1670},
doi = {10.1111/j.1742-1241.2007.01529.x},
pmid = {17681003},
issn = {1368-5031},
mesh = {Abdominal Pain/epidemiology/*etiology ; Adolescent ; Adult ; Aged ; Alcohol Drinking/adverse effects ; Body Mass Index ; Case-Control Studies ; Child ; Child, Preschool ; Cohort Studies ; Data Collection ; Databases as Topic ; Family Practice ; Female ; Gastrointestinal Diseases/*complications/diagnosis ; Humans ; Incidence ; Male ; Middle Aged ; Smoking/adverse effects ; United Kingdom/epidemiology ; },
abstract = {BACKGROUND: Many patients with abdominal pain have no obvious cause for their symptoms and receive a diagnosis of unspecified abdominal pain.
AIM: The objective of this study was to ascertain risk factors and consequences of a diagnosis of unspecified abdominal pain in primary care.
METHODS: A population-based, case-control study was conducted using the UK General Practice Research Database. We identified 29,299 patients with a new diagnosis of abdominal pain, and 30,000 age- and sex-matched controls. Only diagnostic codes that did not specify the type or location of abdominal pain were included.
RESULTS AND DISCUSSION: The incidence of newly diagnosed unspecified abdominal pain was 22.3 per 1000 person-years. The incidence was higher in females than in males, and 29% of patients were below 20 years of age. Prior gastrointestinal morbidity was associated with abdominal pain, but high body mass index, smoking and alcohol intake were not. Patients newly diagnosed with abdominal pain were 16 to 27 times more likely than controls to receive a subsequent new diagnosis of gallbladder disease, diverticular disease, pancreatitis or appendicitis in the year after the diagnosis of abdominal pain. The likelihood of receiving other gastrointestinal diagnoses such as peptic ulcer disease, hiatus hernia, gastro-oesophageal reflux disease (GERD), irritable bowel syndrome (IBS) or dyspepsia was increased three- to 14-fold among patients consulting for abdominal pain.
CONCLUSION: When managing abdominal pain in primary care, morbidities such as GERD and IBS should be considered as diagnoses once potentially life-threatening problems have been excluded.},
}
@article {pmid17674945,
year = {2007},
author = {Crace, PP and Grisham, A and Kerlakian, G},
title = {Jejunal diverticular disease with unborn enterolith presenting as a small bowel obstruction: a case report.},
journal = {The American surgeon},
volume = {73},
number = {7},
pages = {703-705},
pmid = {17674945},
issn = {0003-1348},
mesh = {Aged ; Calculi/*diagnosis/*surgery ; Diagnosis, Differential ; Diverticulum/*diagnosis/*surgery ; Female ; Humans ; Intestinal Obstruction/*diagnosis/*surgery ; Intestine, Small ; Jejunal Diseases/*diagnosis/*surgery ; Tomography, X-Ray Computed ; },
abstract = {Jejunal diverticuli are rare and usually asymptomatic. More commonly, they are seen as incidental findings on CT images, enteroclysis, or during surgery. Complications such as bleeding, perforation, obstruction, malabsorption, diverticulitis, blind loop syndrome, volvulus, and intussusception may warrant surgical intervention. An interesting case of an unborn enterolith (enclosed calculus) from a jejunal diverticulum presenting as a small bowel obstruction is presented. The patient is a 66-year- old woman with no prior history of abdominal surgery who presented with a high-grade bowel obstruction. CT with intravenous barium contrast confirmed the presence of a transition point from dilated to decompressed small bowel in the mid jejunum. At laparotomy, a freely mobile mass was found in this area leading to the bowel obstruction. The mass was removed by making a small enterotomy in the jejunum. While running the small bowel proximally, a small segment of jejunum, approximately 8 cm, containing several diverticuli was found. This bowel obstruction was the result of an unborn enterolith from this segment of bowel. The patient's hospitalization was benign and she was discharged home on postoperative day 4.},
}
@article {pmid17674937,
year = {2007},
author = {Boland, E and Hsu, A and Brand, MI and Saclarides, TJ},
title = {Hartmann's colostomy reversal: outcome of patients undergoing surgery with the intention of eliminating fecal diversion.},
journal = {The American surgeon},
volume = {73},
number = {7},
pages = {664-7; discussion 668},
pmid = {17674937},
issn = {0003-1348},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Colon/*surgery ; *Colostomy ; Female ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Postoperative Complications/*epidemiology ; Rectum/*surgery ; Retrospective Studies ; Surgical Stapling ; Treatment Failure ; Treatment Outcome ; },
abstract = {Reversal of a Hartmann's operation can be a morbid undertaking; successful restoration of intestinal continuity cannot be guaranteed. Between June 2001 and July 2006, 35 Hartmann's reversals were undertaken. There were 19 males (54%). Mean age was 54.7 years (range, 14-82 years). Twenty-one (60%) patients had their Hartmann's for diverticular disease, 7 (20%) for anorectal cancer, 4 (11%) for volvulus, and 3 for miscellaneous reasons. Mean length of stay was 7.7 days (range, 3-16 days); 23 per cent required intensive care for a mean 2.3 days (range, 1-4 days). Blood loss was 470 mL, and mean operative time was 4.28 hours (range, 1-8.3 hours). The mean time interval between the original operation and its reversal was 8.9 months (range, 1.4-55 months). Extensive lysis of adhesions was required in 69 per cent, 40 per cent experienced minor complications (urinary tract infections, ileus, and so on), and 38 per cent had major complications (myocardial infarction, leak, hernias, respiratory failure). There was one death (3%). The operation failed because of intraoperative circumstances in three patients (8%). Ten patients (26%) had stomas at the time of discharge of which 3 were intended to be permanent and 7 were temporary. Of the latter, 3 were successfully closed, 3 are awaiting closure, and 1 had complete anastomotic failure requiring permanent diversion. Total failure rate was 10.3 per cent; contributing factors included prior radiation and ultra-low anastomoses.},
}
@article {pmid17665252,
year = {2007},
author = {Guinier, D and Mantion, GA and Alves, A and Kwiatkowski, F and Slim, K and Panis, Y and , },
title = {Risk factors of unplanned readmission after colorectal surgery: a prospective, multicenter study.},
journal = {Diseases of the colon and rectum},
volume = {50},
number = {9},
pages = {1316-1323},
doi = {10.1007/s10350-007-0310-x},
pmid = {17665252},
issn = {0012-3706},
mesh = {Aged ; *Colectomy ; Colonic Diseases/*surgery ; Female ; Follow-Up Studies ; France/epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Patient Readmission/*statistics & numerical data ; Postoperative Care/*methods ; Postoperative Complications/*epidemiology/therapy ; Prognosis ; Prospective Studies ; Rectal Diseases/*surgery ; Regression Analysis ; Survival Rate ; },
abstract = {PURPOSE: Unplanned readmission after colorectal surgery is a relatively frequent event, knowledge of which often is inaccurate. This study was designed to examine the incidence and causes of readmissions and to determine the criteria that could predict them.
METHODS: From June to September 2002, 1,421 patients were enrolled in a prospective, multicenter study performed by the Association Francaise de Chirurgie. The goal of the study was to determine mortality and morbidity after colorectal surgery for elective or emergency surgical management of diverticular disease or cancer. In the study, readmissions within three months after discharge were assessed.
RESULTS: Of 1,421 patients, 342 patients (27 percent) were readmitted once after a mean period of 53 days. Among the readmissions, 248 (19.5 percent) were planned and 94 (7.5 percent) were unplanned (mainly for septic complications). With the multivariate logistic regression analysis, five independent factors were significantly associated with a higher risk of unplanned readmission (in order of importance): surgical field contamination, long duration of operation, need for an associated surgical procedure, hemoglobin level <12 g/dl, and absence of air testing after colorectal anastomosis.
CONCLUSIONS: The study permitted to individualize several factors significantly associated with a higher risk of unplanned readmission after colorectal surgery.},
}
@article {pmid17660131,
year = {2007},
author = {Koo, V and Strange, J and Lam, CY and Epanomeritakis, M},
title = {Young patients with diverticular disease: a preliminary quality of life study.},
journal = {International journal of surgery (London, England)},
volume = {5},
number = {4},
pages = {244-249},
doi = {10.1016/j.ijsu.2006.09.010},
pmid = {17660131},
issn = {1743-9159},
mesh = {Adult ; Chi-Square Distribution ; Diverticulum, Colon/*psychology/*therapy ; Female ; Humans ; Male ; Middle Aged ; *Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; Treatment Outcome ; },
abstract = {BACKGROUND: Diverticular disease is more apparent in the younger population under 50 years however, its management remains controversial. We report a preliminary quality of life (QoL) assessment which may be useful when determining the optimal management strategy.
METHODS: A retrospective review of clinical records was carried out from April 1999 to 2004, to identify all patients diagnosed with diverticular disease and its complications, confirmed either by radiology and/or histology evidence. The younger patients were classified according to their management: surgical or conservative. Information on demographic, investigations, treatment, follow-up and recurrent episodes was recorded, and the health-related SF-36 QoL questionnaire was administered.
RESULTS: A total of 47 patients had confirmed diverticular disease. Forty-one patients were managed conservatively and six underwent surgery. Ten (24%) from the conservative group and one (17%) from the surgical group were re-admitted for recurrence of symptoms. About 80% (33 conservative and five surgical) responded to the QoL questionnaire. There was an overall negative impact on all QoL domains (conservative vs surgical): general health (54.1 vs 39.0), physical functioning (72.7 vs 56.0), social functioning (63.3 vs 67.0), physical role limitation (50.0 vs 45.0), emotional role limitation (58.6 vs 26.7), bodily pain (56.9 vs 48.5), vitality (45.0 vs 43.0), mental health (64.5 vs 57.6), PCS (44.5 vs 40.8), MCS (42.6 vs 38.8); and these domain scores did not differ significantly.
CONCLUSION: Although there was a negative impact on the quality of life, the majority of patients can be treated adequately by conservative management. We highlighted the need to consider the QoL aspect when determining the optimal management of the disease in the younger population.},
}
@article {pmid17652041,
year = {2007},
author = {Chung, YW and Han, DS and Yoo, KS and Park, CK},
title = {Patient factors predictive of pain and difficulty during sedation-free colonoscopy: a prospective study in Korea.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {39},
number = {9},
pages = {872-876},
doi = {10.1016/j.dld.2007.04.019},
pmid = {17652041},
issn = {1590-8658},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anxiety ; Body Mass Index ; Clinical Competence ; Colonoscopy/adverse effects/*methods ; Female ; Humans ; Korea ; Male ; Middle Aged ; Pain/etiology/*prevention & control/psychology ; Pain Measurement ; *Patient Satisfaction ; Prognosis ; Prospective Studies ; },
abstract = {BACKGROUND: Successful colonoscopy depends on insertion of the instrument to the cecum, precise observation, and minimal patient discomfort during the procedure. This prospective study was designed to identify factors, apart from the endoscopist's skill, that predict patient pain and technical difficulty during sedation-free colonoscopy.
METHODS: A total of 426 sedation-free colonoscopies performed by one experienced endoscopist were evaluated in a prospective manner. Factors were recorded, including patient pain level, intubation time, demographic data, history of abdominal surgery, bowel preparation status, diverticular disease, bowel habits, anxiety level, and number of previous colonoscopies. These factors were analysed to determine their association with difficulty and pain during the procedure.
RESULTS: Four hundred six colonoscopies were completed to the cecum (95.3%). Mean insertion time for complete colonoscopy was 6.5+/-3.5 min. Multivariate logistic regression analyses revealed that older age, lower body mass index, previous hysterectomy, diarrhoea, 1st time colonoscopy and anxiety were predictors of patient pain. Older age, lower body mass index and previous hysterectomy were predictors of difficulty of intubation.
CONCLUSIONS: This prospective study identified several factors that may predict patient pain and technical difficulty associated with the procedure. These findings have implications for the practice and teaching of colonoscopy.},
}
@article {pmid17651560,
year = {2007},
author = {Salimath, J and Jones, MW and Hunt, DL and Lane, MK},
title = {Comparison of return of bowel function and length of stay in patients undergoing laparoscopic versus open colectomy.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {11},
number = {1},
pages = {72-75},
pmid = {17651560},
issn = {1086-8089},
mesh = {Colectomy/*methods ; *Defecation ; Female ; *Flatulence ; Humans ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; },
abstract = {BACKGROUND: Over the last decade, many advances have been made in laparoscopic techniques in various surgical specialties. The technique of laparoscopic-assisted colectomy (LAC) has been reported since 1992 and has been slowly gaining popularity in the surgical community. Several studies have compared laparoscopic versus open colectomy, assessing its applicability to patients with colon cancer, Crohn's disease, and diverticular disease. Studies to date have assessed length of stay, operative time, and clinical outcome. This study focuses on return of bowel function and length of hospital stay in patients undergoing LAC compared with those undergoing open colectomy.
METHODS: We performed a retrospective review of patients undergoing either open colon resection or LAC between January 2000 and December 2005. All disease processes and both emergent and elective cases were included. Return of bowel function was determined by passage of flatus or first passage of stool and compared between the 2 groups. The data were statistically analyzed using the Student t test for interval data, and nominal data were analyzed using the chi-square analysis (95% confidence interval; CI).
RESULTS: The study included 247 patients; 179 (72.5%) underwent open colectomy and 68 (27.5%) underwent LAC. Passage of flatus took 3.6 days (95% CI .18 or 3.4 to 3.8) for open colectomy, and 2.9 days (95% CI .19 or 2.7 to 3.1) for LAC. First bowel movement took 4.4 days (95% CI .19 or 4.2 to 4.6) for open colectomy and 3.7 days (95% CI .22 or 3.5 to 3.9) for LAC. When compared between the groups, mean length of hospital stay was 8.01 days (95% CI .93 or 7.1 to 8.9) for open colectomy and 4.38 days (95% CI .38 or 4.0 to 4.8) for LAC.
CONCLUSION: Both return of bowel function and length of stay were statistically significantly shorter in LAC compared with those in open colectomy, which may indicate faster recovery after bowel surgery in patients undergoing the laparoscopic approach.},
}
@article {pmid17646998,
year = {2007},
author = {Zapletal, C and Woeste, G and Bechstein, WO and Wullstein, C},
title = {Laparoscopic sigmoid resections for diverticulitis complicated by abscesses or fistulas.},
journal = {International journal of colorectal disease},
volume = {22},
number = {12},
pages = {1515-1521},
pmid = {17646998},
issn = {0179-1958},
mesh = {Abscess/*etiology/surgery ; Adult ; Aged ; Anastomosis, Surgical ; Blood Loss, Surgical ; Colectomy/adverse effects/*methods ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intestinal Fistula/*etiology/surgery ; *Laparoscopy/adverse effects ; Length of Stay ; Male ; Middle Aged ; Patient Selection ; Recurrence ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIMS: Treatment of choice in recurrent and complicated diverticulitis is surgical resection of the inflamed bowel. Whereas it is accepted that recurrent diverticulitis (RD) can be handled laparoscopically, this is still not generally recommended for complicated diverticulitis (CD). Therefore, we analysed our results of laparoscopic sigmoidectomies concerning intraoperative course, conversion rate, morbidity and hospital stay in RD and CD.
MATERIALS AND METHODS: Between 09/2002 and 01/2006, laparoscopic sigmoidectomies were offered to all patients suffering from recurrent or complicated diverticulitis (Hinchey I+II). All resections were performed in a four-port technique with the use of Ultracision and intraabdominal stapler anastomosis. Data were prospectively collected and retrospectively analysed in an intention-to-treat view.
RESULTS: Out of 127 laparoscopic colectomies, 58 were performed for diverticulitis (RD 32; CD 26). Eight patients with colovesical and one patient with colovaginal fistula are included. Three patients with abscesses underwent pretreatment by percutaneous drainage. Operative time was longer in CD than in RD (205+/-41 vs 147+/-34 min; p<0.001) and associated with higher blood loss, but conversion rate was low (RD, 2/32 vs CD, 3/26; p=0.64). There was one intraoperative complication in each group; postoperative major complications occurred in 3.13% (RD) vs 11.5% (CD; p=0.316). One anastomotic leakage occurred in the RD group. Length of hospital stay was shorter for RD than for CD (7.1+/-3.4 vs 10.7+/-6.4 days; p=0.02).
CONCLUSIONS: Laparoscopic resections should not be limited to recurrent diverticular disease but can be safely applied for complicated diverticulitis.},
}
@article {pmid17641554,
year = {2007},
author = {Choi, CS and Choi, SC and Seo, GS and Cho, EY and Cho, HJ and Kim, YS and Kim, KH and Kim, TH and Nah, YH},
title = {[Association between diverticulosis and colonic Neoplasm in Koreans].},
journal = {The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi},
volume = {49},
number = {6},
pages = {364-368},
pmid = {17641554},
issn = {1598-9992},
mesh = {Adult ; Aged ; Colonic Neoplasms/*complications/diagnosis/epidemiology ; Diverticulosis, Colonic/*complications/diagnosis/epidemiology ; Diverticulum, Colon/epidemiology/etiology ; Female ; Humans ; Korea ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; },
abstract = {BACKGROUND/AIMS: Although a few published studies have reported on the relationship between diverticulosis and neoplasia in the west, it is not yet examined in Korea. The aim of this study was to determine whether there is an association between diverticulosis and colonic neoplasia.
METHODS: We retrospectely analysed the medical records of 3,007 patients (M:F=1.3:1) who underwent colonoscopic examinations from year 2002 to year 2004. Patients who had a history of previous polypectomy, colon resection, or inflammatory bowel diseases were excluded. The size, extent (none, few, or many), and location of diverticuli and polyps were analyzed.
RESULTS: Of 2,377 patients, included 57% were male and the mean age was 50.8 year-old. Nine percent of the patient had diverticulosis, 29% had more than one neoplasm, and 6% had advanced neoplasia. Patients with diverticular diseases had higher risks of any neoplasia than those without diverticulum (p=0.03, 37.7% vs. 28.2%). There was no correlation between diverticular diseases and advanced neoplasia. Patients with proximal diverticular diseases had higher risk of any proximal neoplasia than other patients (p0.01 24.6% vs. 14.3%). Moreover, they had higher risk of proximal advanced neoplasia than others (p=0.01, 4.5% vs. 2%). In addition, comparison of multiple diverticular disease with few or no diverticuli revealed no difference in the risk of any neoplasia.
CONCLUSIONS: These data show that the patients with diverticular diseases have more neoplasms than controls without diverticula.},
}
@article {pmid17608821,
year = {2007},
author = {Engledow, AH and Pakzad, F and Ward, NJ and Arulampalam, T and Motson, RW},
title = {Laparoscopic resection of diverticular fistulae: a 10-year experience.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {9},
number = {7},
pages = {632-634},
doi = {10.1111/j.1463-1318.2007.01268.x},
pmid = {17608821},
issn = {1462-8910},
mesh = {Adult ; Aged ; Diverticulitis/*surgery ; Diverticulitis, Colonic/*surgery/therapy ; Female ; General Surgery/methods ; Humans ; Intestinal Fistula/pathology/*surgery ; Laparoscopy/*methods ; Male ; Middle Aged ; Postoperative Period ; Treatment Outcome ; },
abstract = {OBJECTIVE: Until recently the laparoscopic approach was reserved for uncomplicated diverticular disease. We show that fistulating diverticular disease can be resected safely, with good clinical outcome via a laparoscopic approach.
METHOD: Between April 1994 and May 2005, 31 consecutive patients [17 male, median age of 63 years (range 40-85)], underwent attempted laparoscopic resection for diverticular fistulae. Patient data were prospectively recorded.
RESULTS: There were 22 colovesical and nine colovaginal fistulae. The median operative time was 150 min (range 60-310) and the median postoperative stay was 7 days (range 3-21). Conversion to an open procedure was required in nine of 31 patients (29%). This rate fell to 10% in cases performed after April 2000. There were two nonsurgically related postoperative deaths. Both occurred in the converted group. At 3 months follow-up, two patients complained of frequency of stools, which settled by 6 months. To date there has been no recurrence of symptomatic diverticulosis or fistulation.
CONCLUSION: Totally laparoscopic resection for diverticular fistulae is safe and feasible. Fistulae should not be considered as a contraindication to laparoscopic resection for an experienced laparoscopic surgeon.},
}
@article {pmid17593455,
year = {2007},
author = {Hassan, I and Cima, RR and Larson, DW and Dozois, EJ and O'Byrne, MM and Larson, DR and Pemberton, JH},
title = {The impact of uncomplicated and complicated diverticulitis on laparoscopic surgery conversion rates and patient outcomes.},
journal = {Surgical endoscopy},
volume = {21},
number = {10},
pages = {1690-1694},
pmid = {17593455},
issn = {1432-2218},
mesh = {Colonic Diseases/*complications/*surgery ; Diverticulitis/*complications/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Treatment Outcome ; },
abstract = {BACKGROUND: The aim of this analysis was to determine the impact of complicated and uncomplicated diverticulitis on conversion rates and complications in patients undergoing laparoscopic surgery (LS) for diverticular disease.
METHODS: Between 1993 and 2004, 125 patients underwent LS [91 laparoscopic-assisted (LA) and 34 hand-assisted (HA) colectomy for diverticular disease, 79 uncomplicated and 46 complicated]. Cases not completed laparoscopically were considered converted. Complicated diverticulitis was defined as diverticular disease associated with abscess, fistula, bleeding or stricture.
RESULTS: The mean age was 59 years with 67 (54%) men with a mean follow-up of 23 months. The conversion rate was 26% (33 patients). The only factor independently associated with conversion was a history of previous abdominal surgery (37% vs. 14%, p = 0.004). Among the subset of patients undergoing surgery for uncomplicated diverticulitis, the number of diverticulitis episodes (DE), the time between the first and last DE, and the time between the last DE and surgery, were not significantly associated with conversion. Early complications (<30 days from surgery) occurred in 30 (25%) patients. Twenty-one long-term complications (>30 days from surgery) occurred in 20 patients and the one and two-year cumulative probabilities of these complications were 14% and 22%, respectively. Early complications were significantly higher among patients requiring conversion (44% vs. 24%, p = 0.04) but were not significantly higher among patients with complicated diverticulitis (39% vs. 24%, p = 0.11). The rates of long-term complications were not significantly higher among patients that required conversion or had complicated diverticulitis (one-year rate 23% vs. 11%, p = 0.47; 18% vs. 13%, p = 0.70).
CONCLUSIONS: A previous history of abdominal surgery was associated with a higher conversion rate in patients undergoing laparoscopic surgery for diverticular disease. Long-term patient outcomes are not adversely impacted by laparoscopic surgery for complicated diverticulitis or laparoscopic surgery requiring conversion to an open procedure.},
}
@article {pmid17558908,
year = {2007},
author = {Oomen, JL and Cuesta, MA and Engel, AF},
title = {Comparison of outcome of POSSUM, p-POSSUM, and cr-POSSUM scoring after elective resection of the sigmoid colon for carcinoma or complicated diverticular disease.},
journal = {Scandinavian journal of gastroenterology},
volume = {42},
number = {7},
pages = {841-847},
doi = {10.1080/00365520601113810},
pmid = {17558908},
issn = {0036-5521},
mesh = {Adult ; Aged ; Carcinoma/*mortality/surgery ; Colon, Sigmoid/*surgery ; Colorectal Surgery/*mortality ; Diverticulosis, Colonic/classification/*mortality/surgery ; Elective Surgical Procedures/mortality ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Prognosis ; Risk Assessment/methods ; Sigmoid Neoplasms/*mortality/surgery ; Treatment Outcome ; },
abstract = {OBJECTIVE: To compare POSSUM, p-POSSUM, and cr-POSSUM-predicted mortalities with the observed postoperative mortality in patients undergoing elective sigmoid colectomy for diverticular disease (n=121) or carcinoma (n=120).
MATERIAL AND METHODS: The physiologic and operative severity score for the enumeration of mortality and morbidity (POSSUM) was used to identify patient- or disease-related risk factors and to calculate expected mortalities.
RESULTS: Patients with carcinoma had significantly higher POSSUM scores, but the observed mortality (1.7%) was lower than that in the diverticular disease group (3.3%). In the carcinoma group, mortality was over-predicted by all the POSSUM systems. In diverticular disease, POSSUM over-predicted mortality while p-POSSUM and cr-POSSUM under-predicted mortality. In the whole group, POSSUM over-predicted mortality. P-POSSUM and cr-POSSUM predicted mortality accurately: observed:expected (O:E) ratio 0.83. Replacing the score for malignancy with a minimum score of 1 gave overall O:E ratios of 0.37 (POSSUM), 1.04 (p-POSSUM), and 0.93 (cr-POSSUM).
CONCLUSIONS: In a group of patients who underwent elective resection of the sigmoid colon for carcinoma or diverticular disease, postoperative mortality was predicted accurately by p-Possum and cr-POSSUM, especially when used without a score for malignancy. None of the POSSUM scores were predictive of disease-specific mortality.},
}
@article {pmid17558013,
year = {2007},
author = {Rana, AR and Cannon, JA and Mostafa, G and Carbonell, AM and Kercher, KW and Norton, HJ and Heniford, BT},
title = {Outcomes of right- compared with left-side colectomy.},
journal = {Surgical innovation},
volume = {14},
number = {2},
pages = {91-95},
doi = {10.1177/1553350607303209},
pmid = {17558013},
issn = {1553-3506},
mesh = {Adult ; Aged ; Colectomy/adverse effects/*methods ; Colonic Neoplasms/surgery ; Comorbidity ; Diverticulum, Colon/surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; Treatment Outcome ; },
abstract = {Right colon resections are perceived as less morbid than left colon resections. The purpose of this study was to determine the differences in outcomes between right-and left-side colon resections. We reviewed 420 consecutive open colectomies over 4 years. Patient demographics, surgical indications, intraoperative variables, and outcomes were collected. Two hundred twenty-three right colectomies (RCs) were compared with 197 left colectomies (LCs). RCs were more often required for cancer (111 vs 65, P < .001) and LCs for diverticular disease (10 vs 90, P < .001). LCs were more often performed emergently (36% vs 23%, P = .004) and required longer mean operative times (149 minutes vs 130 minutes, P = .004). Complications and mortality in the two groups were equal statistically. In the emergent colectomy subset, LCs were associated with greater intraoperative blood loss (315 vs 201 mL, P = .02) but fewer complications (11% vs 17%, P = .003).},
}
@article {pmid17556033,
year = {2007},
author = {Hjern, F and Jonas, E and Holmström, B and Josephson, T and Mellgren, A and Johansson, C},
title = {CT colonography versus colonoscopy in the follow-up of patients after diverticulitis - a prospective, comparative study.},
journal = {Clinical radiology},
volume = {62},
number = {7},
pages = {645-650},
doi = {10.1016/j.crad.2007.01.019},
pmid = {17556033},
issn = {0009-9260},
mesh = {Adult ; Aged ; Colonic Diseases/*diagnosis ; Colonography, Computed Tomographic/*standards ; Colonoscopy/*standards ; Diverticulitis/*diagnosis ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Prospective Studies ; Sensitivity and Specificity ; },
abstract = {AIM: To assess whether computed tomography colonography (CTC) is a viable alternative to colonoscopy or double contrast barium enema in the follow-up of patients after diverticulitis.
MATERIAL AND METHODS: Fifty patients underwent CTC followed immediately by colonoscopy. Results were blinded to the examiners. Findings of diverticular disease and patient acceptance were evaluated.
RESULTS: Bowel preparation and distension were good in the majority of CTC and colonoscopy examinations. Diverticular disease was found in 96% of patients at CTC and in 90% at colonoscopy. The rate of agreement between CTC and colonoscopy for diverticular findings in the sigmoid colon was good (kappa=0.64). No complications were seen. Patients found colonoscopy more uncomfortable (p<0.03), more painful (p<0.001), and more difficult (p<0.01) than CTC. Of the patients favouring one examination, 74% preferred CTC.
CONCLUSION: CTC appears to have a better diagnostic potential for imaging of diverticular disease-specific findings, when compared with colonoscopy. Also, CTC was less uncomfortable and was preferred by a majority of patients. CTC seems to be a reasonable alternative in follow-up of patients with symptomatic diverticular disease.},
}
@article {pmid17547863,
year = {2007},
author = {Ibele, A and Heise, CP},
title = {Diverticular disease: update.},
journal = {Current treatment options in gastroenterology},
volume = {10},
number = {3},
pages = {248-256},
pmid = {17547863},
issn = {1092-8472},
abstract = {Diverticular disease is an extremely common disease entity in our society. The major complication of diverticular disease, diverticulitis, can have quite variable presentations. In the acute setting, treatment is divided into nonsurgical (conservative) or surgical therapy. Cases of mild or "uncomplicated" disease benefit from a conservative approach involving antibiotic therapy. With more severe or "complicated" presentations (abscess, phlegmon, obstruction, fistula, or peritonitis), a more aggressive approach may involve percutaneous abscess drainage or urgent surgical therapy. This also may be required after a failed initial attempt at medical management. The decision regarding elective surgery after successful medical management of diverticulitis is more complicated. The primary goal is to minimize disease recurrence with as little morbidity as possible while maintaining a high quality of life. Recent evidence challenges indications for elective surgery. However, data on the natural history of recurrent diverticulitis are not clear enough to support altering current surgical guidelines. In addition, the increasing use of minimally invasive techniques with favorable outcomes for sigmoid colectomy must be considered. Prior to offering elective colectomy for diverticulitis, it remains important to individualize each case, giving special consideration to age, symptomatology, and recurrence. Ultimately, the decision for elective surgery is made by both the surgeon and a well-informed patient.},
}
@article {pmid23329908,
year = {2007},
author = {Lichtenstein, GR},
title = {Rifaximin: recent advances in gastroenterology and hepatology.},
journal = {Gastroenterology & hepatology},
volume = {3},
number = {6},
pages = {474-483},
pmid = {23329908},
issn = {1554-7914},
abstract = {Rifaximin was initially developed for the treatment of bacteria-related diarrhea, but appreciation of its potentially broader use has increased as understanding of the importance of enteric bacteria in many organic and functional gastrointestinal diseases has advanced. This article reviews data that have been presented at medical meetings or published in medical journals since the publication of a 2006 rifaximin review in this journal. The data presented expand previous research, suggesting that rifaximin may be considered as monotherapy or combination therapy for a variety of enteric conditions, including Clostridium difficile-associated diarrhea, cryptosporidial diarrhea, Helicobacter pylori-associated gastritis, inflammatory bowel disease, pouchitis, diverticular disease, hepatic encephalopathy, small intestinal bacterial overgrowth, and irritable bowel syndrome. Although most of the new data come from small, uncontrolled studies, results are encouraging. Together, these studies suggest the efficacy of rifaximin and provide a foundation for further research that will help to better define the potential benefits of rifaximin in gastroenterology and hepatology.},
}
@article {pmid17526384,
year = {2007},
author = {Seriburi, V and Reynolds, J},
title = {Enteric peritonitis caused by Clostridium perfringens in peritoneal dialysis.},
journal = {Connecticut medicine},
volume = {71},
number = {5},
pages = {281-283},
pmid = {17526384},
issn = {0010-6178},
mesh = {Aged ; Aged, 80 and over ; Bacterial Translocation ; Clostridium Infections/*etiology ; *Clostridium perfringens ; Humans ; Male ; Peritoneal Dialysis/*adverse effects ; Peritonitis/*etiology ; },
abstract = {Peritonitis is a common complication in peritoneal dialysis (PD). Epidemiology of the causative organism varied over time, but anaerobes are still extremely rare. We describe a second reported case of Clostridium perfringens peritonitis in a peritoneal dialysis patient since 1998. The patient presented with PD-related peritonitis that did not respond to the antibiotic choice recommended by the International Society of Peritoneal Dialysis guidelines. We used piperacillin/tazobactam with good result, when the dialysate culture revealed a gram-positive anaerobe. We postulate that Clostridium perfringen came from an enteric source by translocation. A few studies have implicated diverticular disease and gastric acid inhibitors in PD-related enteric peritonitis, and the results are still controversial. Further study is needed to establish a correlation between bowel pathology and enteric peritonitis in peritoneal dialysis patients.},
}
@article {pmid17522918,
year = {2008},
author = {Person, B and Cera, SM and Sands, DR and Weiss, EG and Vernava, AM and Nogueras, JJ and Wexner, SD},
title = {Do elderly patients benefit from laparoscopic colorectal surgery?.},
journal = {Surgical endoscopy},
volume = {22},
number = {2},
pages = {401-405},
pmid = {17522918},
issn = {1432-2218},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Colonic Diseases/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Rectal Diseases/*surgery ; Retrospective Studies ; },
abstract = {BACKGROUND: The steadily increasing age of the population mandates that potential benefits of new techniques and technologies be considered for older patients.
AIM: To analyze the short-term outcomes of laparoscopic (LAP) colorectal surgery in elderly compared to younger patients, and to patients who underwent laparotomy (OP).
METHODS: A retrospective analysis of patients who underwent elective sigmoid colectomies for diverticular disease or ileo-colic resections for benign disorders; patients with stomas were excluded. There were two groups: age < 65 years (A) and age >or= 65 years (B). Parameters included demographics, body mass index (BMI), length of operation (LO), incision length (LI), length of hospitalization (LOS), morbidity and mortality.
RESULTS: 641 patients (M/F - 292/349) were included between July 1991 and June 2006; 407 in group A and 234 in group B. There were significantly more LAP procedures in group A (244/407 - 60%) than in group B (106/234 - 45%) - p = 0.0003. Conversion rates were similar: 61/244 (25%) in group A, and 25/106 (24%) in group B (p = 0.78). There was no difference in LO between the groups in any type of operation. LOS was shorter in patients in group A who underwent OP: 7.1 (3-17) days versus 8.7 (4-22) days in group B (p <0.0001), and LAP: 5.3 (2-19) days versus 6.4 (2-34) days in group B (p = 0.01). In both groups LOS in the LAP group was significantly shorter than in OP group. There were no significant differences in major complications or mortality between the two groups; however, the complication rates in the OP groups were significantly higher than in LAP and CON combined (p = 0.003).
CONCLUSIONS: Elderly patients who undergo LAP have a significantly shorter LOS and fewer complications compared to elderly patients who undergo OP. Laparoscopy should be considered in all patients in whom ileo-colic or sigmoid resection is planned regardless of age.},
}
@article {pmid17522465,
year = {2007},
author = {John, SK and Teo, NB and Forster, AL},
title = {A prospective study of acute admissions in a surgical unit due to diverticular disease.},
journal = {Digestive surgery},
volume = {24},
number = {3},
pages = {186-190},
doi = {10.1159/000102897},
pmid = {17522465},
issn = {0253-4886},
mesh = {Aged ; Aged, 80 and over ; Biomarkers/analysis ; Diverticulitis, Colonic/mortality/*surgery ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Middle Aged ; *Patient Admission ; Prospective Studies ; Protein C/analysis ; Secondary Prevention ; Survival Rate ; Treatment Outcome ; },
abstract = {INTRODUCTION: Considerable controversy exists in the surgical literature on the most appropriate treatment modality for patients with recurrent diverticular disease. We aim to assess the clinical outcome of acute surgical admissions with diverticular disease, and in particular patients with recurrent admissions.
METHODS: 100 consecutive emergency admissions with suspected diverticular disease were prospectively recruited from November 1, 2002 to May 31, 2004.
RESULTS: The majority of the patients were female (64%) and the median age was 74 (45-97) years. The follow-up period was up to 30 months. Four patients with tumour and polyps as definitive diagnosis were excluded from further analysis. Fifty-four patients had a known history of diverticular disease with a median duration of 4 (range 1-40) years; 44 of them had 1-7 previous emergency admissions (median 2). Acute diverticulitis (42%) and acute rectal bleeding (23%) were the commonest presentations. Patients with complicated diverticulitis requiring an emergency operation had a median C-reactive protein of 281 mg/l compared to 58 mg/l in the conservatively treated patients with acute diverticulitis (Mann-Whitney U test, Z -3.943, p<0.001). Nine of 14 patients operated had at least two previous admissions with complications of diverticular disease. Emergency operative treatment was associated with prolonged hospital stay (21 vs. 5 days; Mann-Whitney U test, Z -4.367, p<0.001), increased morbidity and postoperative mortality.
CONCLUSIONS: Symptomatic diverticular disease is associated with recurrent emergency admissions. The majority of patients who required emergency laparotomy had previous recurrent emergency admissions, which was associated with increased morbidity and prolonged hospital stay.},
}
@article {pmid17514668,
year = {2007},
author = {Jung, B and Påhlman, L and Nyström, PO and Nilsson, E and , },
title = {Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection.},
journal = {The British journal of surgery},
volume = {94},
number = {6},
pages = {689-695},
doi = {10.1002/bjs.5816},
pmid = {17514668},
issn = {0007-1323},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects ; Cathartics/*therapeutic use ; Colonic Diseases/*surgery ; Elective Surgical Procedures/adverse effects ; Enema/*statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/*prevention & control ; Sepsis/*prevention & control ; Treatment Outcome ; },
abstract = {BACKGROUND: Recent studies have suggested that MBP does not lower the risk of postoperative septic complications after elective colorectal surgery. This randomized clinical trial assessed whether preoperative MBP is beneficial in elective colonic surgery.
METHODS: A total of 1505 patients, aged 18-85 years with American Society of Anesthesiologists grades I-III, were randomized to MBP or no MBP before open elective surgery for cancer, adenoma or diverticular disease of the colon. Primary endpoints were cardiovascular, general infectious and surgical-site complications within 30 days, and secondary endpoints were death and reoperations within 30 days.
RESULTS: A total of 1343 patients were evaluated, 686 randomized to MBP and 657 to no MBP. There were no significant differences in overall complications between the two groups: cardiovascular complications occurred in 5.1 and 4.6 per cent respectively, general infectious complications in 7.9 and 6.8 per cent, and surgical-site complications in 15.1 and 16.1 per cent. At least one complication was recorded in 24.5 per cent of patients who had MBP and 23.7 per cent who did not.
CONCLUSION: MBP does not lower the complication rate and can be omitted before elective colonic resection.
REGISTRATION NUMBER: ISRCTN28535118 (http://www.controlled-trials.com).},
}
@article {pmid17509042,
year = {2008},
author = {Kelly, SB and Murphy, J and Smith, A and Watson, H and Gibb, S and Walker, C and Reddy, R},
title = {Nurse specialist led flexible sigmoidoscopy in an outpatient setting.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {10},
number = {4},
pages = {390-393},
doi = {10.1111/j.1463-1318.2007.01271.x},
pmid = {17509042},
issn = {1463-1318},
mesh = {Adult ; Aged ; Aged, 80 and over ; Ambulatory Care ; Colonic Diseases/*diagnosis ; Female ; Humans ; Male ; Middle Aged ; *Nurse Clinicians ; *Nurse Practitioners ; Retrospective Studies ; *Sigmoidoscopy ; United Kingdom ; },
abstract = {OBJECTIVE: There has been an increasing demand for diagnostic flexible sigmoidoscopy. In order to improve our diagnostic services, we established a nurse specialist led flexible sigmoidoscopy clinic in 1999. The aim of this study was to review the outcomes of this service between 1999 and 2004.
METHOD: The following information was collected prospectively: source of referral, presenting symptoms, the result of the flexible sigmoidoscopy, depth of insertion, the follow-up plan and complications.
RESULTS: A total of 3956 patients had a flexible sigmoidoscopy performed between 1999 and 2004. The presenting symptoms were as follows: rectal bleeding (RB) in 1915 patients, change of bowel habit (CBH) in 421 patients, RB+CBH in 814 patients. The depth of insertion of the sigmoidoscope was as follows: rectum in 85 patients, sigmoid colon in 595 patients, descending colon in 1969 patients, splenic flexure in 958 patients and transverse colon in 311 patients. The findings at sigmoidoscopy were as follows: normal in 1560 patients, cancer in 132 patients, inflammatory bowel disease in 276 patients, polyps in 415 patients, diverticular disease in 584 patients and haemorrhoids in 926 patients. Two patients sustained an iatrogenic rectal perforation.
CONCLUSION: The nurse specialist led flexible sigmoidoscopy clinic offers an efficient and safe diagnostic service for patients presenting with colorectal symptoms.},
}
@article {pmid17504345,
year = {2007},
author = {Moreno, AM and Wille-Jørgensen, P},
title = {Long-term outcome in 445 patients after diagnosis of diverticular disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {9},
number = {5},
pages = {464-468},
doi = {10.1111/j.1463-1318.2006.01173.x},
pmid = {17504345},
issn = {1462-8910},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Cohort Studies ; Denmark/epidemiology ; Diverticulitis, Colonic/mortality/*pathology/*surgery ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Recurrence ; Registries ; Retrospective Studies ; Risk Factors ; Sex Factors ; },
abstract = {OBJECTIVE: To describe the long-term outcome after primary diagnosis of diverticular disease (DD) with respect to demographics, lifestyle, severity of disease and primary treatment.
METHOD: Retrospective cohort study of all 445 consecutive patients admitted to the department during 1989-1995 with the diagnosis DD with prospective follow up. Follow up was performed on all patients during May 2002 by searching the Danish Patient Register and National Register. Logistic regression analyses were applied for defining risk factors for readmission or death. For defined risk factors Kaplan-Meier survival statistics was performed.
RESULTS: The male/female ratio was 30/70. Median age was 75 years (men being younger than women, P < 0.01). About 73% received conservative treatment primarily. At follow up 35.3% had suffered clinical recurrence of DD, of these 15.9% were subsequently operated. However, 3.6% of the patients died of causes related to diverticulitis. Possible high-risk groups for recurrence were males and their age above 70 years.
CONCLUSION: Age and sex are possible predictors for recurrence of DD. Elective surgery seems not to be justified after just one attack of DD.},
}
@article {pmid17504341,
year = {2007},
author = {Hjern, F and Goldberg, SM and Johansson, C and Parker, SC and Mellgren, A},
title = {Management of diverticular fistulae to the female genital tract.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {9},
number = {5},
pages = {438-442},
doi = {10.1111/j.1463-1318.2006.01171.x},
pmid = {17504341},
issn = {1462-8910},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Colectomy/*methods ; Diverticulitis, Colonic/complications/*surgery ; Female ; Follow-Up Studies ; Humans ; Hysterectomy/adverse effects ; Intestinal Fistula/complications/*surgery ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Vagina/*abnormalities/surgery ; Vaginal Fistula/etiology/*surgery ; },
abstract = {OBJECTIVE: Fistulae to the female genital tract are an infrequent but severe complication of diverticular disease. The purpose of this study was to evaluate treatment and outcome in patients with diverticular colo-genital fistulae.
METHOD: Sixty women treated for diverticular fistulae (DF) to the female genital tract during 1992-2004 were identified. Clinic and operative charts were reviewed. Mean age was 70 years and mean follow-up time after surgery was 1 year.
RESULTS: Most common presenting symptoms were vaginal discharge of faeces or gas (95% of patients) and abdominal pain (43%). About 75% of patients had undergone a hysterectomy. Forty-six patients underwent at least one radiological contrast study and the fistula was demonstrated in 35 (76%) patients. Fifty-seven patients had surgery, and findings included colo-vaginal fistulae (n = 47), colo-uterine fistulae (n = 2) and multiple fistulae involving vagina and other organs (n = 8). A sigmoid resection and primary anastomosis was performed in 51 and a Hartmann procedure with colostomy in six patients. Sixteen (28%) patients experienced morbidity after surgery, including anastomotic dehiscence (n = 4) and ureteric injury (n = 3). There was no mortality.
CONCLUSION: Diverticular fistulae to the female genital tract usually occur in elderly patients with a prior hysterectomy. Radiological contrast studies demonstrate the fistulous tract in most cases. Sigmoid resection and primary anastomosis results in a satisfactory outcome in the majority of patients.},
}
@article {pmid17500176,
year = {2007},
author = {Piccolini, M and Francia, L and Rosa, C and Biandrate, F and Campagnoni, AP and Pandolfi, U},
title = {[Complicated diverticular disease of the colon: 5 years' experience in a provincial hospital].},
journal = {Chirurgia italiana},
volume = {59},
number = {2},
pages = {197-206},
pmid = {17500176},
issn = {0009-4773},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colostomy/*methods ; Diverticulitis, Colonic/*complications/mortality/*surgery ; Elective Surgical Procedures ; Female ; Hospitals, Public ; Humans ; Italy/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; Survival Analysis ; },
abstract = {Colon diverticular disease presents in 10%-25% of cases when a complication arises. Helped by Hinchey's classification, the surgeon can choose from among the following therapeutic strategies: a) medical treatment; b) one-stage resection and anastomosis with or without a protective colostomy; and c) resection according to Hartmann. The increasingly widespread use of laparoscopic techniques, though generally improving surgical outcomes, has perhaps made the choice of treatment more difficult, because it has extended the range of indications, both in the elective and emergency setting. From January 1999 to December 2004 411 patients (174 men and 237 women) affected by symptomatic diverticular disease were admitted to our surgical department and 94 of these (22.8%) underwent surgery: 41 of them (43.6%) underwent a true emergency operation, while for 53 of them surgery was delayed (within one week). None of the patients undergoing resection-anastomosis had a protective colostomy. The total morbidity was 3.7% and total perioperative mortality 1% (one patient undergoing surgery with the Hartmann procedure). More than one year after the end of the research there was no need for operation of any of the non-surgical patients and no deaths due to diverticular disease were recorded. On the basis of our experience we may conclude that a one-stage resection, even in the emergency situation, is possible and yields excellent results, while preventive resection would not currently seem justified.},
}
@article {pmid17468955,
year = {2008},
author = {Pezzilli, R and Barassi, A and Morselli Labate, AM and Finazzi, S and Fantini, L and Gizzi, G and Lotzniker, M and Villani, V and Melzi d'Eril, G and Corinaldesi, R},
title = {Fecal calprotectin levels in patients with colonic polyposis.},
journal = {Digestive diseases and sciences},
volume = {53},
number = {1},
pages = {47-51},
pmid = {17468955},
issn = {0163-2116},
mesh = {Adult ; Aged ; Biomarkers/metabolism ; Colonic Polyps/*metabolism/pathology ; Colonoscopy ; Diagnosis, Differential ; Diverticulum, Colon/diagnosis ; Enzyme-Linked Immunosorbent Assay ; Feces/*chemistry ; Female ; Humans ; Leukocyte L1 Antigen Complex/*metabolism ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; },
abstract = {CONTEXT: The usefulness of stool calprotectin determination in diagnosis of inflammatory disease of the colon has been reported; information about its usefulness for patients with polyposis are scarce, however.
OBJECTIVE: To evaluate the significance of stool calprotectin concentrations for patients affected by colonic polyposis.
PATIENTS: Sixty-three consecutive patients (35 males, 28 females, mean age 60.3 years, range 39-78 years) were enrolled: 26 patients (41.3%) with polyps, 17 patients (27.0%) with asymptomatic diverticular disease, and 20 subjects (31.7%) with normal endoscopic appearance of the colon.
RESULTS: Stool calprotectin concentrations were 17.4 +/- 24.5 microg g(-1) for patients with colonic polyposis, significantly higher than concentrations for patients with diverticulosis (7.1 +/- 5.7 microg g(-1); P = 0.026) or for patients with normal appearance of the colon (calprotectin 6.0 +/- 5.8 microg g(-1); P = 0.003). For patients with a single polyp, stool calprotectin concentrations were similar to those for patients with multiple polyps. Calprotectin fecal concentrations for patients with sessile polyps and those with flat polyps were not significantly different. Calprotectin concentrations were not significantly related to the size of the polyps.
CONCLUSION: Our data show that colonic polyposis may cause an increase in stool calprotectin values and that these colonic lesions should be suspected when elevated stool calprotectin concentrations are found.},
}
@article {pmid17468551,
year = {2007},
author = {Comparato, G and Pilotto, A and Franzè, A and Franceschi, M and Di Mario, F},
title = {Diverticular disease in the elderly.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {25},
number = {2},
pages = {151-159},
doi = {10.1159/000099480},
pmid = {17468551},
issn = {1421-9875},
mesh = {Aged ; Aged, 80 and over ; Aging/*physiology ; Colectomy/*methods ; Colonoscopy ; Combined Modality Therapy ; Dietary Fiber/*administration & dosage ; Diverticulitis, Colonic/diagnosis/epidemiology/therapy ; Diverticulosis, Colonic/*diagnosis/epidemiology/therapy ; Female ; Humans ; Incidence ; Male ; Prognosis ; Recurrence ; Risk Assessment ; Severity of Illness Index ; Sigmoidoscopy ; Survival Rate ; },
abstract = {There are few diseases whose incidence varies as greatly worldwide as that of diverticulosis. Its prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those > or =65 years of age. Of patients with diverticula, 80-85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15-20% of patients develop symptomatic diverticular disease. Traditional concepts regarding the causes of colonic diverticula include alterations in colonic wall resistance, disordered colonic motility and dietary fiber deficiency. Currently, inflammation has been proposed to play a role in diverticular disease. Goals of therapy in diverticular disease should include improvement of symptoms and prevention of recurrent attacks in symptomatic, uncomplicated diverticular disease, and prevention of the complications of disease such as diverticulitis. Diverticulitis is the most usual clinical complication of diverticular disease, affecting 10-25% of patients with diverticula. Most patients admitted with acute diverticulitis respond to conservative treatment, but 15-30% require surgery. Predictive factors for severe diverticulitis are sex, obesity, immunodeficiency and old age. Surgery for acute complications of diverticular disease of the sigmoid colon carries significant rates of morbidity and mortality, the latter of which occurs predominantly in cases of severe comorbidity. Postoperative mortality and morbidity are to a large extent driven by patient-related factors.},
}
@article {pmid17465510,
year = {2007},
author = {Kassahun, WT and Fangmann, J and Harms, J and Bartels, M and Hauss, J},
title = {Complicated small-bowel diverticulosis: a case report and review of the literature.},
journal = {World journal of gastroenterology},
volume = {13},
number = {15},
pages = {2240-2242},
pmid = {17465510},
issn = {1007-9327},
mesh = {Aged, 80 and over ; Appendicitis/diagnosis ; Cholecystitis/diagnosis ; Diagnosis, Differential ; Diverticulitis/diagnosis ; Diverticulum/complications/*diagnosis/surgery ; Humans ; Jejunal Diseases/complications/*diagnosis/surgery ; Laparoscopy ; Male ; Sigmoid Diseases/diagnosis/etiology/surgery ; },
abstract = {While jejunoileal diverticula are rare and often asymptomatic, they may lead to chronic non-specific or acute symptoms. The large majority of complications present with an acute abdomen similar to appendicitis, cholecystitis or colonic diverticulitis but they also may appear with atypical symptoms. As a result, diagnosis of complicated jejunoileal diverticulosis can be quite difficult, and may solely depend on the result of surgical exploration. In the absence of contra-indications, diagnostic laparoscopy has the benefit of thorough examination of the abdominal contents and helps to reach an absolute diagnosis. Surgical resection of the involved small-bowel segment with primary anastomosis is the preferred treatment in patients with symptomatic complicated jejunoileal diverticular disease. An atypical presentation of complicated jejunal diverticulitis in conjunction with sigmoid diverticulitis diagnosed with laparoscopy and treated with surgical resection is presented.},
}
@article {pmid17462210,
year = {2007},
author = {Praveen, BV and Suraparaju, L and Jaunoo, SS and Tang, T and Walsh, SR and Ogunbiyi, OA},
title = {Giant colonic diverticulum: an unusual abdominal lump.},
journal = {Journal of surgical education},
volume = {64},
number = {2},
pages = {97-100},
doi = {10.1016/j.jsurg.2006.10.007},
pmid = {17462210},
issn = {1931-7204},
mesh = {Abdomen/pathology ; Abdominal Pain/diagnostic imaging ; Colon, Sigmoid/diagnostic imaging ; Diagnosis, Differential ; Diverticulum, Colon/*diagnosis ; Female ; Humans ; Mesocolon/diagnostic imaging ; Middle Aged ; Radiography, Abdominal ; Sigmoid Diseases/diagnostic imaging ; Tomography, X-Ray Computed ; },
abstract = {Giant colonic diverticulum is a rare complication of diverticular disease of the colon and is thought to result, in most cases, from a "ball-valve" effect. The presentation and clinical course can be variable and confusing. The most common symptoms are abdominal pain and a palpable abdominal lump, with many patients presenting acutely with complications such as perforation and peritonitis. Preoperative diagnosis requires a high degree of suspicion and needs to be differentiated from sigmoid volvulus, caecal volvulus, intestinal duplication cyst, pneumatosis cystoidis intestinalis, and similar conditions. A plain x-ray and computed tomography (CT) scan of the abdomen shows a huge air-filled cyst termed "balloon sign" and confirms the diagnosis. The barium enema shows a communication with the bowel in most cases. In view of the high incidence of complications, treatment is advised even in asymptomatic cases and consists of excision of the cyst with resection of the adjacent colon with primary anastomosis. This treatment would, in most cases, be a sigmoid colectomy. Percutaneous drainage and Hartmann's procedure may be appropriate in some cases who present with a well-formed abscess or gross fecal peritonitis, respectively. A case is described, and the literature is reviewed.},
}
@article {pmid17436142,
year = {2007},
author = {Bordeianou, L and Hodin, R},
title = {Controversies in the surgical management of sigmoid diverticulitis.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {11},
number = {4},
pages = {542-548},
pmid = {17436142},
issn = {1091-255X},
mesh = {Diverticulitis, Colonic/*surgery ; Humans ; Sigmoid Diseases/*surgery ; },
abstract = {The timing and appropriateness of surgical treatment of sigmoid diverticular disease remain a topic of controversy. We have reviewed the current literature on this topic, focusing on issues related to the indications and types of surgery. Current evidence would suggest that elective surgery for diverticulitis can be avoided in patients with uncomplicated disease, regardless of the number of recurrent episodes. Furthermore, the need for elective surgery should not be influenced by the age of the patient. Operation should be undertaken in patients with severe attacks, as determined by their clinical and radiological evaluation.},
}
@article {pmid17431721,
year = {2007},
author = {Salem, TA and Molloy, RG and O'Dwyer, PJ},
title = {Prospective, five-year follow-up study of patients with symptomatic uncomplicated diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {50},
number = {9},
pages = {1460-1464},
doi = {10.1007/s10350-007-0226-5},
pmid = {17431721},
issn = {0012-3706},
mesh = {Aged ; Aged, 80 and over ; Barium Sulfate/administration & dosage ; Colonoscopy ; Contrast Media/administration & dosage ; Diverticulitis, Colonic/*diagnosis/epidemiology ; Enema ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Radiography, Abdominal/methods ; Severity of Illness Index ; Time Factors ; United Kingdom/epidemiology ; },
abstract = {PURPOSE: The natural history of diverticular disease is largely unknown. Most studies are retrospective and treatment recommendations are derived from outdated literature. This study was a prospective, long-term assessment of the development of complications in patients with symptomatic diverticular disease.
METHODS: All patients with a confirmed diagnosis of symptomatic diverticular disease between August 1999 and April 2001 were followed up prospectively for an average of five years. Hospital computerized discharges were assessed for any subsequent elective or emergency admission for diverticular disease-related complications, including surgical intervention. A telephone questionnaire was conducted on all patients and/or their family physician looking specifically for symptoms, complications, and surgical intervention.
RESULTS: A total of 163 patients (106 females) were identified (median age, 74 (interquartile range, 64-80) years). The diagnosis was confirmed through colonoscopy (n = 106), flexible sigmoidoscopy (n = 57), and barium enema (n = 31). Nineteen were lost to follow-up and a further 19 died from unrelated causes. Twenty-five were excluded. After the initial diagnosis, two patients (1.7 percent) subsequently presented with an episode of diverticulitis, which was treated conservatively. A single patient (0.8 percent) required surgery for chronic symptoms. One hundred sixteen patients (97 percent) had no or mild symptoms after a median follow-up of 66 months.
CONCLUSIONS: In this prospective long-term study, symptomatic uncomplicated diverticular disease seems to run a long-term benign course with a very low incidence of subsequent complications. Symptomatic disease, acute diverticulitis, and complicated diverticular disease seem to constitute distinct clinical entities with little crossover between groups.},
}
@article {pmid17410728,
year = {2007},
author = {Miron, A and Ardelean, M and Bogdan, M and Giulea, C},
title = {[Surgical management of colonic diverticular disease].},
journal = {Chirurgia (Bucharest, Romania : 1990)},
volume = {102},
number = {1},
pages = {37-42},
pmid = {17410728},
issn = {1221-9118},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Diverticulitis, Colonic/surgery ; Diverticulosis, Colonic/complications/*surgery ; Female ; Humans ; Laparoscopy ; Male ; Medical Records ; Middle Aged ; Postoperative Complications/etiology ; Retrospective Studies ; Treatment Outcome ; },
abstract = {Diverticulosis is a common condition and affects one third of patients older than age 45. The treatment of the diverticular disease and of its complications, especially the acute inflammatory ones, is both medical and surgical. It is essential to correlate the two therapeutic means and to set an adequate time for the operation. The present study evaluates in a retrospective manner a number of 231 cases, 49% of which represent complicated forms. Fifty-eight patients underwent a surgical operation, 25 of which needed an emergency intervention. The results of the study show the increase of 1-stage procedures for the complicated forms and recommend laparoscopy as an alternative to open surgery. Recent studies have challenged the prophylactic nature of surgical operations after diverticulitis indicating a need for further evaluation.},
}
@article {pmid17410435,
year = {2007},
author = {Comparato, G and Fanigliulo, L and Cavallaro, LG and Aragona, G and Cavestro, GM and Iori, V and Maino, M and Mazzocchi, G and Muzzetto, P and Colla, G and Sianesi, M and Franzé, A and Mario, FD},
title = {Prevention of complications and symptomatic recurrences in diverticular disease with mesalazine: a 12-month follow-up.},
journal = {Digestive diseases and sciences},
volume = {52},
number = {11},
pages = {2934-2941},
pmid = {17410435},
issn = {0163-2116},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Barium Sulfate/administration & dosage ; Colonoscopy ; Contrast Media/administration & dosage ; Diverticulitis, Colonic/diagnosis/etiology/prevention & control ; Diverticulosis, Colonic/complications/diagnosis/*drug therapy ; Enema ; Female ; Follow-Up Studies ; Humans ; Male ; Mesalamine/*therapeutic use ; Middle Aged ; Prospective Studies ; Radiography, Abdominal/methods ; Secondary Prevention ; Time Factors ; Treatment Outcome ; },
abstract = {In uncomplicated diverticular disease, treatment is aimed at relieving symptoms. The aim of the present study was to evaluate the efficacy of mesalazine for symptomatic relief of uncomplicated diverticular disease of the colon. Two hundred sixty-eight consecutive eligible outpatients (122 male, 146 female; age, 66.1 years; range, 31-81 years) were enrolled in four treatment schedules in a randomized fashion: Group R1 (66 patients), rifaximin, 200 mg bid; Group R2 (69 patients), rifaximin, 400 mg bid; Group M1 (67 patients), mesalazine, 400 mg bid; and Group M2 (66 patients), mesalazine, 800 mg bid. Treatments were administered for 10 days every month for 12 months. Clinical evaluations were performed at admission and at 3-month intervals for 12 months considering 12 clinical variables (upper and lower abdominal pain/discomfort, tenesmus, diarrhea, abdominal tenderness, fever, bloating, general illness, nausea, emesis, dysuria, bleeding) graded as 0 = no symptoms, 1 = mild, 2 = moderate, and 3 = severe. The Global Symptomatic Score (GSS) was calculated using the sum of each symptom score. Two hundred forty-four patients completed the 12- month study; 24 were discontinued (14 treated with rifaximin and 10 treated with mesalazine) either as voluntary dropouts or because they developed side effects and/or complications. Group M2 demonstrated a lower frequency of many symptoms after 6 and 12 months of treatment; the mean GSS was significantly lower in Group M2 after 6 and 12 months of therapy by both intention-to-treat and per-protocol analyses. Patients treated with mesalazine (Groups M1+M2) had a lower GSS than subjects treated with rifaximin (Groups R1+R2) during the 12-month follow-up period. We conclude that cyclic administration of mesalazine is effective for symptomatic relief of uncomplicated diverticular disease of the colon. Some symptoms showed greater improvement with mesalazine, 800 mg bid, than with the other treatment schedules.},
}
@article {pmid17373915,
year = {2007},
author = {D'Incà, R and Pomerri, F and Vettorato, MG and Dal Pont, E and Di Leo, V and Ferronato, A and Medici, V and Sturniolo, GC},
title = {Interaction between rifaximin and dietary fibre in patients with diverticular disease.},
journal = {Alimentary pharmacology & therapeutics},
volume = {25},
number = {7},
pages = {771-779},
doi = {10.1111/j.1365-2036.2007.03266.x},
pmid = {17373915},
issn = {0269-2813},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Infective Agents/pharmacology/*therapeutic use ; Breath Tests ; Cross-Over Studies ; Dietary Fiber/*administration & dosage ; Diverticulum/*drug therapy/etiology ; Double-Blind Method ; Drug Interactions ; Female ; Follow-Up Studies ; Gastrointestinal Transit/drug effects ; Humans ; Hydrogen/metabolism ; Male ; Middle Aged ; Patient Compliance ; Rifamycins/pharmacology/*therapeutic use ; Rifaximin ; },
abstract = {BACKGROUND: Cyclic administration of rifaximin in association with dietary fibre achieves symptomatic relief in uncomplicated diverticular disease (DD) by means of a still undefined mechanism.
AIM: To investigate the effects of a combination of rifaximin and fibre on both hydrogen production by intestinal microflora and oro-anal transit time.
METHODS: In a controlled, double-blind crossover trial, 64 patients with uncomplicated DD were given bran (20 g/day) and randomly treated with rifaximin (1200 mg/day) or a placebo for 14 days. Evaluation was based on clinical status, breath test, oro-anal transit time and faecal weight.
RESULTS: The global symptomatic score was significantly reduced after rifaximin (7.1 +/- 4.1 to 4.1 +/- 3.3; P < 0.005) but not after placebo (6.8 +/- 3.8 to 6.1 +/- 3.5). Hydrogen production significantly increased after placebo from 198 +/- 134 to 267 +/- 161 ppm/min, while Rifaximin reduced it from 222 +/- 187 to 166 +/- 131 ppm/min (P = 0.05). The total oro-anal transit time decreased from 56.1 +/- 28.2 to 51.3 +/- 28.0 h in placebo and from 54.4 +/- 31.9 to 45.1 +/- 32.4 h (P < 0.05) in rifaximin-treated patients.
CONCLUSIONS: The administration of rifamixin improves the benefits of dietary fibre in uncomplicated DD by preventing its bacterial degradation.},
}
@article {pmid17372050,
year = {2007},
author = {Weber, WP and Guller, U and Jain, NB and Pietrobon, R and Oertli, D},
title = {Impact of surgeon and hospital caseload on the likelihood of performing laparoscopic vs open sigmoid resection for diverticular disease: a study based on 55,949 patients.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {142},
number = {3},
pages = {253-9; discussion 259},
doi = {10.1001/archsurg.142.3.253},
pmid = {17372050},
issn = {0004-0010},
mesh = {Aged ; Case Management ; Colectomy/*methods ; Diverticulum, Colon/*surgery ; Female ; Hospitals, Community/*statistics & numerical data ; Humans ; *Laparoscopy ; *Laparotomy ; Likelihood Functions ; Male ; Middle Aged ; Practice Patterns, Physicians'/statistics & numerical data ; Retrospective Studies ; Sigmoid Diseases/*surgery ; Workload/*statistics & numerical data ; },
abstract = {HYPOTHESIS: High-volume surgeons and hospitals are more likely to perform laparoscopic procedures than open procedures for diverticular disease as compared with low-volume surgeons and hospitals.
DESIGN: Real-world analysis.
SETTING: United States community hospitals.
PATIENTS: Patients with primary International Classification of Diseases, Ninth Revision diagnosis codes for diverticulosis or diverticulitis and International Classification of Diseases, Ninth Revision procedure codes for laparoscopic or open sigmoidectomy were selected from the 1992 to 2001 Nationwide Inpatient Samples commercially available US databases.
MAIN OUTCOME MEASURES: The outcome variable was the likelihood of performing laparoscopic vs open sigmoid resection. The primary predictor variable was the annual caseload of sigmoid resections per surgeon and hospital.
RESULTS: The study population included 55,949 patients who were predominantly white (70.5%) with a mean (SD) age of 60.7 (14.7) years. Unadjusted and risk-adjusted odds ratios of performing laparoscopic sigmoidectomy were significantly higher for high-volume surgeons and high-volume hospitals. In fact, high-volume surgeons were 8.80 times more likely to perform a laparoscopic sigmoid resection compared with low-volume surgeons. Similarly, in high-volume hospitals, patients were 3.02 times more likely to undergo a laparoscopic sigmoid resection compared with patients who underwent surgery in low-volume hospitals. These clinically relevant differences remained statistically significant in subset analyses stratified by age (<65 vs > or =65 years) and time of surgery (elective vs nonelective).
CONCLUSIONS: The findings of the present investigation based on data from large US nationwide databases provide compelling evidence that high-volume surgeons and hospitals are significantly more likely to perform laparoscopic surgery for diverticular disease compared with low-volume surgeons and hospitals. Based on recent studies showing clear advantages of the laparoscopic technique over the open counterpart, our results should be considered by both patients and physicians.},
}
@article {pmid17361909,
year = {2007},
author = {Bittner, R and Ulrich, M},
title = {[Surgical therapy of diverticulitis].},
journal = {Praxis},
volume = {96},
number = {7},
pages = {237-242},
doi = {10.1024/1661-8157.96.7.237},
pmid = {17361909},
issn = {1661-8157},
mesh = {Abdominal Abscess/surgery ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colectomy ; Colonoscopy ; Diverticulitis, Colonic/*surgery ; Female ; Germany ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Peritonitis/surgery ; Postoperative Complications/etiology ; Reoperation ; },
abstract = {The prevalence of sigmoid diverticular disease is increasing in western, industrialised countries. Practice parameters recommend surgical treatment for complicated disease or after the second episode of chronic recurrent disease. Surgical intervention should also be considered for younger patients after a first episode severe enough to require treatment. The preferred surgical procedure is elective sigmoid resection with primary anastomosis. Additional resection of the lower colon descendens is necessary when this region is also affected. Two-stage surgery is recommended for patients in emergency situations, i. e. severe or generalized peritonitis or extensive localized abscess formation, especially when the treating hospital is non-specialized. Segmentary resection without anastomosis and Hartmann's procedure is performed first (blind closure of the rectum with terminal colostomy). Restoration of colorectal continuity is performed at the earliest three months postoperatively. The preferred surgical technique is laparoscopy, provided the surgeon has the necessary expertise. Numerous studies have proven significant advantages of laparoscopy, although it is a completely new procedure with a long learning curve of 50-60 operations. Therefore, conversion to the conventional method should not be seen as a personal failure but rather as a responsible decision in favor of the patient's well-being.},
}
@article {pmid17361908,
year = {2007},
author = {Hoffmann, R},
title = {[Course and conservative treatment of diverticular disease].},
journal = {Praxis},
volume = {96},
number = {7},
pages = {234-236},
doi = {10.1024/1661-8157.96.7.234},
pmid = {17361908},
issn = {1661-8157},
mesh = {Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Cross-Sectional Studies ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/*diagnosis/therapy ; Echocardiography ; Humans ; Mesalamine/therapeutic use ; Parenteral Nutrition, Total ; Tomography, X-Ray Computed ; },
abstract = {Diverticular disease is one of the most gastrointestinal disorders especially in developed countries. Prevalence rises with age, about two-thirds of patients in the age of 80 years are affected. In western countries diverticulosis is predominantly located in the distal colon. Only a minority of patients with diverticulosis develops symptoms. Ultrasound studies and CT scan are most important in diagnosing diverticulitis and its complications. Patients with the first attack of uncomplicated diverticulitis are treated with broad-spectrum antibiotics and in more severe case with bowel rest. Mesalazin is another choice of treatment. Recurrence of the disease is of increased risk to develop complications such as abscess formation, fistula and obstruction. These complications should be treated by operative resection. Lower gastrointestinal bleeding from divertikular sources should be treated by interventional endoscopy.},
}
@article {pmid17357871,
year = {2007},
author = {Perez, RO and Sousa, A and Bresciani, C and Proscurshim, I and Coser, R and Kiss, D and Habr-Gama, A},
title = {Endoscopic management of postoperative stapled colorectal anastomosis hemorrhage.},
journal = {Techniques in coloproctology},
volume = {11},
number = {1},
pages = {64-66},
doi = {10.1007/s10151-007-0330-5},
pmid = {17357871},
issn = {1123-6337},
mesh = {Anastomosis, Surgical/*adverse effects/instrumentation ; Colon/*surgery ; Diverticulum/surgery ; Endoscopy, Digestive System ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage/*surgery ; Rectum/*surgery ; Surgical Stapling/*adverse effects ; },
abstract = {Rectal bleeding following colorectal anastomosis is common but usually self-limited. Continuous hemorrhage is rare, and when it occurs, often requires further treatment. The most frequently used strategies for treatment of stapled anastomotic hemorrhage are clinical observation with or without blood transfusion, rectal packing, angiographic identification of the bleeding site with vasopressin infusion or embolization, and endoscopic eletrocoagulation. We report the case of a 49-year-old man with uncomplicated diverticular disease who was treated by laparoscopic sigmoidectomy, with double-stapled colorectal anastomosis. Six hours later, the patient presented intense rectal bleeding and was taken to the operation room for urgent colonoscopic examination. After complete removal of blood clots inside the rectum, a bleed localized at the anastomotic site was identified and submucosal peri-anastomotic injection of 10 ml adrenaline (1:200 000) in saline was performed with immediate bleeding control.},
}
@article {pmid17356942,
year = {2007},
author = {Finco, C and Magnanini, P and Sarzo, G and Vecchiato, M and Luongo, B and Savastano, S and Bortoliero, M and Barison, P and Merigliano, S},
title = {Prospective randomized study on perioperative enteral immunonutrition in laparoscopic colorectal surgery.},
journal = {Surgical endoscopy},
volume = {21},
number = {7},
pages = {1175-1179},
pmid = {17356942},
issn = {1432-2218},
mesh = {Aged ; Colorectal Neoplasms/diagnosis/immunology/surgery ; Colorectal Surgery/*methods ; Diverticulum, Colon/diagnosis/immunology/surgery ; Enteral Nutrition/*methods ; Female ; Follow-Up Studies ; Humans ; Immune System/*physiology ; Male ; Middle Aged ; Nutritional Requirements ; Nutritional Status ; Perioperative Care/*methods ; Postoperative Complications/prevention & control ; Probability ; Prospective Studies ; Statistics, Nonparametric ; Treatment Outcome ; },
abstract = {BACKGROUND: Perioperative nutrition for patients undergoing colon surgery seems to be effective in reducing catabolism and improving immunologic parameters. A relatively low-fiber and highly absorbable diet may facilitate the intestinal cleansing and loop relaxation fundamental for laparoscopic surgery with a lower dose of iso-osmotic laxative.
METHODS: From 1 February 2004 to 30 July 2005, 28 patients referred to our unit with colon disease (neoplasms and diverticular disease) amenable to laparoscopic surgery were prospectively randomized into two groups of 14 patients each. For 6 days preoperatively, the patients in group 1 were given 750 ml/day of a diet enriched with arginine, omega-3 fatty acids, and ribonucleic acid (RNA) associated with low-fiber foods. They had 1 day of intestinal preparation with 3 l of iso-osmotic laxative. On postoperative day 2, they were fed orally with the same diet. The patients in group 2 preoperatively received a low-fiber diet. They had 2 days of preparation with iso-osmotic laxative (3 l/day). On postoperative day 3, oral nutrition was restored. Intraoperatively, we evaluated loop relaxation and intestinal cleanliness. Clinical trends were monitored in both groups, as well as adverse reactions to early nutrition. The nutritional (albumin, prealbumin) and immunologic (lymphocyte subpopulations, immunoglobulins) biohumoral parameters were evaluated at the first visit, on the day before surgery, on postoperative day 7, and 1 month after surgery.
RESULTS: The two groups did not differ in terms of age, gender, distribution of disease, or baseline anthropometric, biohumoral, or immunologic parameters. There was a significant increase in CD4 lymphocytes on the day before surgery as compared with baseline parameters (p < 0.05) in group 1, but not in group 2. There was no statistically significant difference between the two groups in intestinal loop relaxation or cleanliness or in postoperative infectious complications.
CONCLUSIONS: Perioperative immunonutrition proved to be safe and useful in increasing the perioperative immunologic cell response. It may contribute toward improving the preparation and relaxation of the intestinal loops despite the shorter intestinal preparation.},
}
@article {pmid17345988,
year = {2006},
author = {Baldoli, D and Musco, F and Scalambra, M and Balsamo, F and Galli, A and Rebuffat, C},
title = {[Laparoscopy in patients with colonic diverticulitis. Results of a prospectic data base].},
journal = {Annali italiani di chirurgia},
volume = {77},
number = {5},
pages = {401-405},
pmid = {17345988},
issn = {0003-469X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Prospective Studies ; },
abstract = {AIM OF STUDY: To evaluate the outcome of laparoscopic surgery in patients affected by colonic diverticulitis.
MATERIALS AND METHODS: A prospective database was established in 1998 at our department to evaluate the results of laparoscopic treatment for diverticular disease. Contraindications to laparoscopic approach were: intestinal obstruction, faecal peritonitis, previuos major abdominal operations, presence of abdominal mass. Parameters evaluated were: indications to operation, age, sex, weight, type of operation, associated operations, operation time, conversion rate, mortality, post-operative complications, postoperative hospital stay, return to normal bowel function, time of removing nasogastric tube and time of restarting oral feeding.
RESULTS: From 1998 to 2005, 109 patients operated for diverticular disease were registered. The operation was performed in 17 cases (15.5%) with open technique, in 20 cases (18.5%) throught video-assisted approach with extracorporeal anastomosis and in 72 cases (66%) with laparoscopic approach making intracorporeal anastomosis. The conversion rate was 10.8%. Mortality was 0%. In videolaparoscopic group mean operating time was 177 minutes, major complications were 4 (6.3%), minor complications were 6 (9.5%) and mean hospital stay was 7.8 days. In videoassisted group minor operation time was 158 minutes, complications were 9 (47.3%) and mean hospital stay was 10.1 days.
CONCLUSIONS: Laparoscopic approach to diverticular disease of the colon is, in selected cases, a safe, feasible and effective procedure.},
}
@article {pmid17343233,
year = {2006},
author = {Ferulano, GP and Dilillo, S and D'Ambra, M and Saviano, C and Brunaccino, R and Lionetti, R and Fico, D},
title = {[Timing and results of the surgical treatment of the diverticular disease of the colon].},
journal = {Annali italiani di chirurgia},
volume = {77},
number = {6},
pages = {497-502},
pmid = {17343233},
issn = {0003-469X},
mesh = {Aged ; Anti-Infective Agents/therapeutic use ; Colectomy/*methods ; Colon, Sigmoid/surgery ; Colonoscopy/*methods ; Combined Modality Therapy ; Diverticulitis, Colonic/drug therapy/*surgery ; Female ; Humans ; Male ; Metronidazole/therapeutic use ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; },
abstract = {AIMS: To evaluate retrospectively the outcome of the curative open and laparoscopic surgical approach to the diverticular disease according to timed steps based on the pathologic stage.
PATIENT AND MATERIAL: From 1989 83 out of 242 outpatients underwent surgery in emergency or after medical failure and at least two acute attacks requiring hospital admittance, or complicated diverticulitis. Modified Hinchey classification staged the disease. Clinic and instrumental criteria, surgical procedures, early and late complications were statistically evaluated (Students t-test and exact Fischer test, p < 0.05) in comparison with the different steps of therapeutic strategy.
RESULTS: Twenty nine patients were classified as Hinchey 0, 26 as I, 14 as II, 11 as III, 3 as IV. Clinical characteristics of the lap and open groups overlapped, with higher rate of earlier age in first and advanced stages in the second group. 16 patients (19.3%) underwent surgery at the first attack in emergency or in delayed emergency (5 TC-guided drainages). 30 open and 53 lap procedures were done: 21 two-stage: 18 primary resections + ileostomy and 3 Hartmann; 61 single stage: 49 sigmoidectomy, 12 left colectomy. 4 conversions (7.5%), 12 early (14.5%) and 10 late (12.1%) complications were observed.
DISCUSSION: Complications rate was higher in the open group including more advanced stages. Elective surgery performed following conservative therapy, 4 weeks from the first acute attack in younger people (age < 55yrs.) and after two attacks in elder (age > 55yrs.) showed a significant lower complications' incidence (p < 0.05) compared to the 8 weeks delayed operations.
CONCLUSION: Surgery of diverticulitis must follow standardized criteria. The laparoscopic approach could be performed in more severe stages, provided that conditions of delayed emergency were achieved.},
}
@article {pmid17342349,
year = {2007},
author = {Böttger, TC and Müller, M and Terzic, A and Hermeneit, S and Rodehorst, A},
title = {[Laparoscopic resection with primary anastomosis in Hinchey stages I and II without previous abscess drainage].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {78},
number = {5},
pages = {454, 456-60},
pmid = {17342349},
issn = {0009-4722},
mesh = {Abdominal Abscess/diagnostic imaging/*surgery ; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; *Anastomosis, Surgical ; Diverticulitis, Colonic/classification/diagnostic imaging/*surgery ; Early Diagnosis ; Female ; Humans ; Intestinal Perforation/classification/diagnostic imaging/surgery ; *Laparoscopy ; Male ; Middle Aged ; Postoperative Complications/etiology ; Prospective Studies ; Recurrence ; Sigmoid Diseases/classification/diagnostic imaging/*surgery ; Surgical Wound Infection/etiology ; Tomography, X-Ray Computed ; },
abstract = {INTRODUCTION: Intra-abdominal abscesses in diverticulitis so far have been drained percutaneously until the acute inflammation subsides and colon resection can be carried out for restoration of continence. However this method is successful in only about half of patients and lavage lasts for 2 to 3 weeks. Therefore it has to be decided whether an early operation without prior interventional drainage can attain results similar to those of the elective operation.
METHODS: We performed primary laparoscopic surgery without prior interventional drainage or colon lavage in 72 patients in Hinchey stages I and II within 12 h of hospital admission. The peri- and postoperative processes were analyzed prospectively using 115 parameters.
RESULTS: There was no difference in the postoperative course of patients receiving elective surgery for recurrent diverticular disease and those undergoing surgery for acute diverticulitis (Hinchey stages I and II). The rates of surgical and general complications were identical (7.7% vs 9.6% and 9% vs 3.6%, respectively). Wound infections were noted in 7.7% and 7.2%, respectively. No case of anastomotic leakage was observed.
CONSEQUENCE: Based on our prospective data (grade of evidence II), we consider laparoscopic sigmoid resection with primary anastomosis (in continuity) in Hinchey stages I and II without prior interventional drainage and colon preparation to be justified.},
}
@article {pmid17338850,
year = {2006},
author = {Green, JP and McCauley, W},
title = {Bowel perforation after single-dose activated charcoal.},
journal = {CJEM},
volume = {8},
number = {5},
pages = {358-360},
doi = {10.1017/s1481803500014081},
pmid = {17338850},
issn = {1481-8035},
mesh = {Cathartics/administration & dosage/*adverse effects ; Charcoal/administration & dosage/*adverse effects ; Colon, Sigmoid ; Drug Overdose/*therapy ; Female ; Humans ; Intestinal Perforation/*etiology ; Middle Aged ; },
abstract = {Patients presenting to the emergency department (ED) after medication overdose are often given activated charcoal initially for gastrointestinal decontamination. Complications of charcoal are rare, but do occur. The following case describes a patient with pre-existing undiagnosed diverticular disease who developed sigmoid perforation after a single dose of activated charcoal, given without cathartic for a drug overdose. A literature search revealed no other cases of bowel perforation associated with single-dose activated charcoal. This case report discusses adverse effects associated with activated charcoal and the role of cathartics in gastrointestinal decontamination.},
}
@article {pmid17338195,
year = {2006},
author = {Pignata, G},
title = {Laparoscopic treatment for acute diverticular disease.},
journal = {Acta chirurgica Iugoslavica},
volume = {53},
number = {3},
pages = {19-22},
doi = {10.2298/aci0603019p},
pmid = {17338195},
issn = {0354-950X},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures/methods ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Sigmoid Diseases/*surgery ; },
abstract = {Diverticular disease of the sigmoid colon involves more than 50% of population over 60 years, and much more in people older than 80 years. Most patients remain asymptomatic, but, about 10-20% develop complications requiring surgery. Colonic diverticulitis represents an acute bowel inflammation, in many cases, confined only to the sigmoid and descending colon. Recurrent attacks and complications of diverticulitis require surgical procedure, although most cases can be managed medically. The cause of acute diverticulitis remains obscure. It has been speculated that obstruction at the mouth of the diverticulum results in diverticulitis, similar to appendicitis, but this is no longer the accepted theory, and some feel that chronic inflammation precedes clinical diverticulitis.},
}
@article {pmid17330835,
year = {2007},
author = {Daetwiler, S and Guller, U and Schob, O and Adamina, M},
title = {Early introduction of laparoscopic sigmoid colectomy during residency.},
journal = {The British journal of surgery},
volume = {94},
number = {5},
pages = {634-641},
doi = {10.1002/bjs.5638},
pmid = {17330835},
issn = {0007-1323},
mesh = {Aged ; Clinical Competence/*standards ; Colectomy/adverse effects/education/*standards ; Colon, Sigmoid/*surgery ; Colonic Diseases/*surgery ; Feasibility Studies ; Female ; Humans ; Internship and Residency ; Laparoscopy/adverse effects/*standards ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Laparoscopic sigmoid colectomy for benign diseases is becoming the standard of care. However, few residency programmes incorporate the procedure. This study evaluated the safety and feasibility of the early introduction of laparoscopic sigmoid colectomy during residency.
METHODS: From a database of consecutive laparoscopic sigmoid colectomies collected prospectively over 6 years, those for cancer and primary open sigmoid colectomies were excluded. Surgeons were categorized into five levels of experience in colonic surgery. Patient demographics, operative data, complications and conversion rates were assessed.
RESULTS: A total of 262 sigmoid colectomies were performed by 13 surgeons. American Society of Anesthesiologists grade and diverticular disease classification were similar across the five experience levels. There were no significant differences in morbidity, mortality or readmission rates between experience levels. However, operative time (230 versus 145 min, P < 0.001) intraoperative blood loss (200 versus 100 ml, P < 0.001) and conversion rate (13.6 versus 2.1 per cent, P = 0.002) all decreased with increasing surgical experience (trainee versus trainer).
CONCLUSION: It is safe and feasible to introduce laparoscopic sigmoid colectomy to a structured residency.},
}
@article {pmid17327941,
year = {2007},
author = {Rosemar, A and Ivarsson, ML and Börjesson, L and Holmdahl, L},
title = {Increased concentration of tissue-degrading matrix metalloproteinases and their inhibitor in complicated diverticular disease.},
journal = {Scandinavian journal of gastroenterology},
volume = {42},
number = {2},
pages = {215-220},
doi = {10.1080/00365520600960104},
pmid = {17327941},
issn = {0036-5521},
mesh = {Adult ; Aged ; Aged, 80 and over ; Biomarkers/metabolism ; Biopsy ; Colon/metabolism/pathology ; Disease Progression ; Diverticulitis, Colonic/*metabolism/pathology/surgery ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibrosis ; Humans ; Immunohistochemistry ; Male ; Matrix Metalloproteinases/*metabolism ; Middle Aged ; Prognosis ; Tissue Inhibitor of Metalloproteinases/*metabolism ; },
abstract = {OBJECTIVE: Complicated diverticular disease is associated with extensive structural changes of the colonic wall. Turnover of extracellular matrix (ECM) plays a pivotal role in this process. Proteolytic enzymes, including matrix metalloproteinases (MMPs), are capable of degrading most components of ECM. Their activity is regulated by inhibitors, tissue inhibitors of metalloproteinases (TIMPs). Disturbances of the MMP-TIMP balance can cause tissue degradation or fibrosis. The aim of this study was to assess the concentration and distribution of MMPs and TIMPs in colonic biopsies.
MATERIAL AND METHODS: Twenty-seven patients who had undergone sigmoid colectomy were included in the study. Full-thickness biopsies from affected and non-affected parts of each resected specimen were collected. Expressions of the proteins MMP-1, -2, -3, -9, TIMP-1 and TIMP-2 were quantified by ELISA and localized by immunohistochemistry.
RESULTS: The concentrations of MMP-1, MMP-2 and TIMP-1 were significantly higher in affected tissue than concentrations in non-affected tissue (MMP-1 p=0.005, MMP-2 p=0.0003 and TIMP-1 p<0.0001). In affected segments in general, there was an increased expression in the entire bowel wall, predominantly for MMP-2, MMP-3 and TIMP-1.
CONCLUSIONS: Concentrations of MMP-1, MMP-2 and TIMP-1 were increased in intestinal segments affected by complicated diverticular disease and distributed throughout the entire bowel wall, which may explain the structural changes.},
}
@article {pmid17326468,
year = {2007},
author = {Maier, KP},
title = {[Diverticulosis--diverticulitis].},
journal = {Praxis},
volume = {96},
number = {5},
pages = {153-157},
doi = {10.1024/1661-8157.96.5.153},
pmid = {17326468},
issn = {1661-8157},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Colonoscopy ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis/therapy ; Diverticulosis, Colonic/*diagnosis/therapy ; Humans ; Intestinal Perforation/diagnosis/therapy ; Secondary Prevention ; Tomography, X-Ray Computed ; },
abstract = {Diverticular disease is a common disorder in the western world. The course of the illness is benign: At least 75% of all patients with diverticular disease remain asymptomatic life long. 10-20% develop clinical symptoms, usually painful diverticulitis. Diverticular disease is diagnosed clinically in most cases. Computed tomography (CT) has replaced contrast enema as the diagnostic procedure of choice for acute diverticulitis. Most patients with uncomplicated diverticulitis can be treated as outpatients Bowel rest, intravenous fluid therapy, broad spectrum antibiotics are treatment modelities if a patient has been hospitalized. Close follow-up is mandatory, especially in patients treated as outpatients. Failure to improve with conservative medical therapy warrants a diligent search for complications and surgical consultation. Surgery may be nessasary in a few of hospitalized patients. Commonly, the operation is performed in a single-stage procedure. Once the acute setting has passed, a colonoscopy should be electively performed to exclude competing diagnoses particularly colonic cancer.},
}
@article {pmid17320543,
year = {2007},
author = {Anderson, J and Luchtefeld, M and Dujovny, N and Hoedema, R and Kim, D and Butcher, J},
title = {A comparison of laparoscopic, hand-assist and open sigmoid resection in the treatment of diverticular disease.},
journal = {American journal of surgery},
volume = {193},
number = {3},
pages = {400-3; discussion 403},
doi = {10.1016/j.amjsurg.2006.12.005},
pmid = {17320543},
issn = {1879-1883},
mesh = {Anastomosis, Surgical/adverse effects ; Digestive System Surgical Procedures/adverse effects/methods/statistics & numerical data ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Ileostomy ; Ileus/etiology ; Laparoscopy/adverse effects/methods/statistics & numerical data ; Length of Stay ; Male ; Middle Aged ; Pulmonary Atelectasis/etiology ; Retrospective Studies ; Surgical Wound Infection/etiology ; Treatment Outcome ; },
abstract = {BACKGROUND: Laparoscopic colorectal surgery (LAP) has become more prevalent as evidence of its safety and benefits become apparent. However, in difficult cases, hand-assisted instrumentation has facilitated LAP. We examined the impact of hand-assisted laparoscopic surgery (HALS) on the treatment of sigmoid diverticular disease.
METHODS: This is a retrospective study using a prospectively maintained database from January 1, 2000 through November 30, 2005. Patients were divided into 3 groups: open (n = 110), LAP (n = 17), and HALS (n = 98). Data include operative time, length of stay, surgical method, conversion rate, and reasons for conversion.
RESULTS: Surgeries started as LAP were completed in that fashion 59% of the time, with 23% being converted to open and 18% converted to HALS (total 41%). HALS cases showed a 6% conversion rate to open surgery (OS). Duration of surgery and length of stay were similar between LAP and HALS.
CONCLUSIONS: HALS should be considered the optimal approach for surgery for diverticular disease.},
}
@article {pmid17299613,
year = {2007},
author = {Warner, E and Crighton, EJ and Moineddin, R and Mamdani, M and Upshur, R},
title = {Fourteen-year study of hospital admissions for diverticular disease in Ontario.},
journal = {Canadian journal of gastroenterology = Journal canadien de gastroenterologie},
volume = {21},
number = {2},
pages = {97-99},
pmid = {17299613},
issn = {0835-7900},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulosis, Colonic/*epidemiology ; Female ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Ontario/epidemiology ; },
abstract = {BACKGROUND: Diverticular disease is one of the most common gastrointestinal conditions affecting the Canadian population, yet very little is known about its epidemiology.
OBJECTIVE: The aim of the present study was to measure the rate of hospital admission for diverticular disease by age and sex over a 14-year period in the population of Ontario.
PATIENTS AND METHODS: The present study was a retrospective, population-based cohort study of all hospital admissions for diverticular disease from 1988 to 2002.
RESULTS: There were 133,875 hospital admissions during the period. Admission rates increased with age, and women were admitted at higher rates than men across all age groups.
CONCLUSION: Diverticular disease is an important cause of gastrointestinal morbidity. As the population ages, a rise in the incidence of diverticular disease can be anticipated. Future studies to explain sex difference in admissions are required.},
}
@article {pmid17298619,
year = {2007},
author = {Golder, M and Burleigh, DE and Ghali, L and Feakins, RM and Lunniss, PJ and Williams, NS and Navsaria, HA},
title = {Longitudinal muscle shows abnormal relaxation responses to nitric oxide and contains altered levels of NOS1 and elastin in uncomplicated diverticular disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {9},
number = {3},
pages = {218-228},
doi = {10.1111/j.1463-1318.2006.01160.x},
pmid = {17298619},
issn = {1462-8910},
mesh = {Aged ; Aged, 80 and over ; Diverticulitis, Colonic/enzymology/*physiopathology ; Elastin/*analysis ; Female ; Humans ; Immunohistochemistry ; Male ; Muscle Relaxation/*drug effects ; *Muscle, Smooth/chemistry/drug effects/enzymology ; Nitric Oxide/*pharmacology ; Nitric Oxide Synthase Type I/*analysis ; },
abstract = {OBJECTIVE: Recent evidence challenges the 'low-fibre/high-colonic intraluminal pressure' hypothesis of diverticular disease (DD) and raises the possibility that other mechanisms are involved. Although bowel wall smooth muscle is known to be hypercontractile in DD, the nature of its relaxation is unknown. The present study investigated colonic smooth muscle responses to nitric oxide, as well as the smooth muscle contents of neural nitric oxide and elastin associated with the disease.
METHOD: Immunohistochemical/image analysis of antibodies to nitric oxide synthase (NOS1), co-localized with protein gene product (PGP) and to elastin, was performed on three histological sections of sigmoid colons from 20 patients (10 DD, 10 controls) following resections for rectal tumours. Organ bath experiments examined smooth muscle responsiveness to nitroprusside, a nitric oxide donor.
RESULTS: Uncomplicated diverticular longitudinal muscle showed lower nitric oxide immunoreactivity compared with controls: median percentage surface area of NOS1 over PGP was 26.0% (range 0.5-58.3), controls 45.0% (35.0-70.1; P = 0.018). Median percentage surface area of elastin was elevated, 21.3% (10.6-45.6), controls 8.2% (1.7-13.5; P = 0.0002), together with a low sensitivity to nitroprusside [mean - log EC(50) 5.3 (SD 0.5), controls 6.6 (SD 0.5), difference 1.3, 95% CI 0.8-1.7; P < 0.0001] and there were lower maximum relaxation responses to nitroprusside compared with controls: median percentage (relaxation induced by nitroprussside/contraction induced by bethanecol) was 52.0%, range (20.0-92.0), controls 100.0% (71.0-125.0), P < 0.0001. No statistically significant differences were found in circular muscle, at the sample size studied.
CONCLUSION: This study established, for the first time, specific abnormalities in longitudinal muscle relaxation and contents of neural nitric oxide and elastin in uncomplicated DD. These findings may have important implications for both colon structure and function in the disease.},
}
@article {pmid17277658,
year = {2006},
author = {Franklin, ME and Ramila, GP and Treviño, JM and González, JJ and Russek, K and Glass, JL and Kim, G},
title = {The use of bioabsorbable staple line reinforcement for circular stapler (BSG "Seamguard") in colorectal surgery: initial experience.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {16},
number = {6},
pages = {411-415},
doi = {10.1097/SLE.0b013e31802b68fe},
pmid = {17277658},
issn = {1530-4515},
mesh = {Absorbable Implants ; Aged ; Digestive System Surgical Procedures/*instrumentation ; Diverticulosis, Colonic/surgery ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Rectal Neoplasms/surgery ; Sigmoid Diseases/surgery ; *Surgical Stapling ; },
abstract = {Of all the complications associated with colorectal surgery, the most devastating and constant, despite all techniques being performed properly is anastomotic leakage, especially in left colon and rectal resections with rates as high as 50% when the rectum is involved. In 2005, our center published the preliminary experience with the use of linear staple line reinforcement for colon surgery. The purpose of this paper is to present a series of cases using a new conformation of bioabsorbable reinforcement for circular staplers in 5 patients, 2 patients with rectal cancer, 2 patients with diverticular disease, and 1 patient with sigmoid cancer. These initial data are very promising and has encouraged us to continue using this device on further patients.},
}
@article {pmid17267678,
year = {2007},
author = {D'Souza, AL},
title = {Ageing and the gut.},
journal = {Postgraduate medical journal},
volume = {83},
number = {975},
pages = {44-53},
pmid = {17267678},
issn = {1469-0756},
mesh = {Aged ; Anemia/diagnosis/etiology/therapy ; *Gastrointestinal Diseases/diagnosis/etiology/therapy ; Helicobacter Infections/diagnosis/etiology/therapy ; Helicobacter pylori ; Humans ; Ischemia/diagnosis/etiology/therapy ; Mesentery/blood supply ; *Mouth Diseases/diagnosis/etiology/therapy ; },
abstract = {The current concepts on diagnosis, clinical features, and management of common gastrointestinal conditions in the elderly population, taking into account physiological aspects of ageing, are evaluated. Gastrointestinal (GI) disorders are discussed with an emphasis on oesophageal problems, Helicobacter pylori infection, malabsorption, diverticular disease, and cancer. GI problems are acquiring greater importance in hospitals and in the community and their incidence is increasing. Newer treatments have less impact on patients' wellbeing and meticulously planned investigation and treatment is needed. Careful selection of patients and application of modern techniques has improved survival and outcomes, with comparable results to those in younger age groups.},
}
@article {pmid17266465,
year = {2007},
author = {Tursi, A},
title = {New physiopathological and therapeutic approaches to diverticular disease of the colon.},
journal = {Expert opinion on pharmacotherapy},
volume = {8},
number = {3},
pages = {299-307},
doi = {10.1517/14656566.8.3.299},
pmid = {17266465},
issn = {1744-7666},
mesh = {Colon/drug effects/physiology ; Diverticulitis, Colonic/*drug therapy/*physiopathology ; Drugs, Investigational/pharmacology/*therapeutic use ; Humans ; },
abstract = {Diverticular disease of the colon is among the most common diseases of westernised and industrialised countries. Its prevalence is approximately 5-10% of people up to 50 years of age, 30% of those > 50 years of age, and 50% of those > 70 years of age, and 66% of people > 85 years of age. Standard medical therapies with antibiotics are still the recommended treatment. However, changing concepts and new therapies recently found that anti-inflammatory agents, such as mesalazine (alone or in combination with antibiotics) and probiotics, may be useful in shortening the course of the disease and perhaps in preventing recurrences.},
}
@article {pmid17255417,
year = {2007},
author = {Goh, V and Halligan, S and Taylor, SA and Burling, D and Bassett, P and Bartram, CI},
title = {Differentiation between diverticulitis and colorectal cancer: quantitative CT perfusion measurements versus morphologic criteria--initial experience.},
journal = {Radiology},
volume = {242},
number = {2},
pages = {456-462},
doi = {10.1148/radiol.2422051670},
pmid = {17255417},
issn = {0033-8419},
mesh = {Adenocarcinoma/*diagnostic imaging/pathology ; Adult ; Aged ; Aged, 80 and over ; Blood Volume/physiology ; Cineradiography ; Contrast Media/administration & dosage ; Diagnosis, Differential ; Diatrizoate Meglumine/administration & dosage ; Diverticulitis, Colonic/*diagnostic imaging/pathology ; Female ; Gastrointestinal Transit/physiology ; Humans ; Image Processing, Computer-Assisted/methods ; Intestinal Absorption/physiology ; Iopamidol/administration & dosage ; Male ; Middle Aged ; Prospective Studies ; Regional Blood Flow/physiology ; Sensitivity and Specificity ; Sigmoid Diseases/*diagnostic imaging/pathology ; Sigmoid Neoplasms/*diagnostic imaging/pathology ; Tomography, X-Ray Computed/*methods ; },
abstract = {PURPOSE: To determine whether computed tomographic (CT) perfusion measurements in prospectively recruited patients can be used to differentiate between diverticulitis and colorectal cancer and to compare this discrimination with that of standard morphologic criteria.
MATERIALS AND METHODS: After institutional review board approval and written informed consent were obtained, 60 patients (24 men, 36 women; mean age, 69 years; range, 33.5-90.4 years; 20 patients with cancer, 20 with diverticulitis, and 20 with inactive diverticular disease) underwent CT perfusion imaging at the level of the colonic abnormality, and perfusion parameters were calculated. Analysis of variance was used to investigate any differences in perfusion between the patient groups. Two independent observers also analyzed an abdominopelvic CT study obtained immediately after the CT perfusion study and noted standard morphologic criteria for differential diagnosis. The sensitivity and specificity of CT perfusion measurements for determining the diagnostic category were compared with morphologic criteria by means of multivariate analysis to identify the most discriminatory criteria.
RESULTS: Mean blood volume, blood flow, transit time, and permeability were significantly different between patients with cancer and those with diverticulitis (P < .0001); patients with cancer had the highest blood volume, blood flow, and permeability and the shortest transit time. The most discriminatory criteria for determining diagnostic category were blood volume, transit time, permeability, and presence of pericolonic nodes (P = .05, .02, .04, and .02, respectively). Blood volume and blood flow each had a sensitivity of 80% and had specificity of 70% and 75%, respectively, for cancer in comparison with standard morphologic criteria: less than 5 cm of bowel involvement (45% sensitivity, 95% specificity), presence of a mass (85% sensitivity, 90% specificity), pericolonic inflammation (75% sensitivity, 5% specificity), and pericolonic nodes (90% sensitivity, 45% specificity).
CONCLUSION: CT perfusion measurements enable differentiation and better discrimination, in comparison with morphologic criteria, between cancer and diverticulitis.},
}
@article {pmid17253134,
year = {2007},
author = {Tursi, A and Brandimarte, G and Giorgetti, GM and Elisei, W},
title = {Continuous versus cyclic mesalazine therapy for patients affected by recurrent symptomatic uncomplicated diverticular disease of the colon.},
journal = {Digestive diseases and sciences},
volume = {52},
number = {3},
pages = {671-674},
pmid = {17253134},
issn = {0163-2116},
mesh = {Aged ; Aged, 80 and over ; Diverticulum, Colon/*drug therapy ; Female ; Humans ; Male ; Mesalamine/*administration & dosage/therapeutic use ; Middle Aged ; Prospective Studies ; Recurrence ; Remission Induction ; Treatment Outcome ; },
abstract = {Forty consecutive patients affected by recurrent attacks of symptomatic uncomplicated diverticular disease of the colon were evaluated to investigate the effectiveness of 2 different mesalazine therapeutic schedules in preventing recurrence of the disease. The patients were randomly enrolled and treated with mesalazine 1.6 g/d (group A) or mesalazine 1.6 g/d 10 days per month (group B). Thirty-four patients completed the study (85%): 3 (7.5%, 1 in group A and 2 in group B) were lost to follow-up, 2 (5%, both group B) were withdrawn from the study for protocol violation, and 1 (2.5%) for hospital admission for stroke (group A). Twenty-three patients (67.65%) were symptom free after 24 months of treatment (overall symptomatic score, 0): 14 of 18 in group A (per-protocol, 77.78%; intention to treat, 70% [95% confidence interval [CI], 61.5-91.8]), 9 of 16 in group B (per protocol, 56.25%; intention to treat, 45% [95% CI, 61.5-91.8]; P < 0.05). Four patients (10%) improved, but were not completely symptom free. Six patients (15%) showed recurrence of symptoms: 1 in group A (5.56%) and 5 in group B (31.25%; P < 0.005; overall symptomatic score, 68). Daily mesalazine supplying seems to be more effective than cyclic supplying in maintaining remission in recurrent symptomatic uncomplicated diverticular disease.},
}
@article {pmid17252995,
year = {2005},
author = {Frey, J and Gil, K and Wałega, P and Herman, RM},
title = {[Current concepts of diverticular disease pathophysiology].},
journal = {Folia medica Cracoviensia},
volume = {46},
number = {3-4},
pages = {125-135},
pmid = {17252995},
issn = {0015-5616},
mesh = {Animals ; Anti-Infective Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Collagen/metabolism ; Colonoscopy ; Dietary Fiber/deficiency/therapeutic use ; Diverticulosis, Colonic/diagnosis/diet therapy/*physiopathology/*therapy ; Diverticulum, Colon/diagnosis/*physiopathology/*therapy ; Gastrointestinal Motility ; Humans ; },
abstract = {The first description of diverticular disease (DD) is dated on XVIIIth century. During last decades the DD prevalence continuously increases, especially in western countries. Nowadays, in developed countries, DD of the left colon is one of the most common diseases of gastro-intestinal tract. Because of the prevalence and costs of treatment it is still in the limelight of scientists and medical professionals. This article summarizes basic epidemiological data and discusses actual concepts of DD pathophysiology. Despite fact DD becomes more and more important, its pathophysiology remains to be unrevealed yet. Further clinical, molecular and epidemiological studies are needed to show the process and particular stages of diverticula development and progression.},
}
@article {pmid17241863,
year = {2007},
author = {Bressler, B and Paszat, LF and Chen, Z and Rothwell, DM and Vinden, C and Rabeneck, L},
title = {Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis.},
journal = {Gastroenterology},
volume = {132},
number = {1},
pages = {96-102},
doi = {10.1053/j.gastro.2006.10.027},
pmid = {17241863},
issn = {0016-5085},
mesh = {Aged ; Aged, 80 and over ; Cohort Studies ; Colonoscopy/*statistics & numerical data ; Colorectal Neoplasms/*epidemiology/*pathology ; Diagnostic Errors/*statistics & numerical data ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; National Health Programs/statistics & numerical data ; Ontario/epidemiology ; Registries/statistics & numerical data ; Risk Factors ; },
abstract = {BACKGROUND & AIMS: The rate of new or missed colorectal cancer (CRC) after colonoscopy and their risk factors in usual practice are unknown. Our objective was to evaluate the rate and risk factors in a population-based study.
METHODS: We analyzed data from the Canadian Institute for Health Information, the Ontario Health Insurance Program, and Ontario Cancer Registry for all patients (> or =20 years of age) with a new diagnosis of right-sided, transverse, splenic flexure/descending, rectal or sigmoid CRC in Ontario from April 1, 1997 to March 31, 2002, who had a colonoscopy within the 3 years before their diagnosis. Patients with new or missed cancers were those whose most recent colonoscopy was 6 to 36 months before diagnosis. We examined characteristics that might be risk factors for new or missed CRC.
RESULTS: We identified a diagnosis of CRC in 3288 (right sided), 777 (transverse), 710 (splenic flexure/descending), and 7712 (rectal or sigmoid) patients. The rates of new or missed cancers were 5.9%, 5.5%, 2.1%, and 2.3%, respectively. Independent risk factors for these cancers in men and women were older age; diverticular disease; right-sided or transverse CRC; colonoscopy by an internist or family physician; and colonoscopy in an office.
CONCLUSIONS: Because having an office colonoscopy and certain patient, procedure, and physician characteristics are independent risk factors for new or missed CRC, physicians must inform patients of the small risk (2% to 6%) of these cancers after colonoscopy. The influence of type of physician and setting on the accuracy of colonoscopy, potentially modifiable risk factors, warrants further study.},
}
@article {pmid17234553,
year = {2007},
author = {Lamps, LW and Knapple, WL},
title = {Diverticular disease-associated segmental colitis.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {5},
number = {1},
pages = {27-31},
doi = {10.1016/j.cgh.2006.10.024},
pmid = {17234553},
issn = {1542-7714},
mesh = {Abdominal Pain/etiology ; Aged ; Colitis/etiology/*pathology ; Colonoscopy ; Constipation/etiology ; Diagnosis, Differential ; Diarrhea/etiology ; Diverticulitis, Colonic/*pathology ; Humans ; Male ; },
abstract = {Diverticular disease-associated segmental colitis is a unique variant of chronic colitis limited to segments of the left colon that harbor diverticula. Histologically, this disease mimics chronic idiopathic inflammatory bowel disease and can be indistinguishable from ulcerative colitis or Crohn's colitis on histologic grounds alone. Patients typically present with hematochezia and cramping abdominal pain, and colonoscopic evaluation reveals inflammatory changes limited to the segment of bowel containing the diverticula, with rectal sparing. Although this disease does not appear to be an unusual form of diverticulitis but possibly an immunologically mediated process, many patients respond to treatment directed toward diverticulitis. A subset of patients requires immunosuppressive therapy and/or surgery, and a small subset progresses to develop classic ulcerative colitis. Because of the histologic overlap with ulcerative colitis and occasionally Crohn's colitis, it is essential that endoscopists provide a full description of the macroscopic appearance of the inflammatory changes at endoscopy, such as limitation to a segment of diverticular disease, so that the pathologist can provide a more informative interpretation of the biopsy.},
}
@article {pmid17226906,
year = {2007},
author = {Colecchia, A and Vestito, A and Pasqui, F and Mazzella, G and Roda, E and Pistoia, F and Brandimarte, G and Festi, D},
title = {Efficacy of long term cyclic administration of the poorly absorbed antibiotic Rifaximin in symptomatic, uncomplicated colonic diverticular disease.},
journal = {World journal of gastroenterology},
volume = {13},
number = {2},
pages = {264-269},
pmid = {17226906},
issn = {1007-9327},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Infective Agents/*administration & dosage ; Dietary Fiber/administration & dosage ; Diverticulosis, Colonic/*drug therapy ; Drug Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Rifamycins/*administration & dosage ; Rifaximin ; Treatment Outcome ; },
abstract = {AIM: To comparatively evaluate the long term efficacy of Rifaximin and dietary fibers in reducing symptoms and/or complication frequency in symptomatic, uncomplicated diverticular disease.
METHODS: 307 patients (118 males, 189 females, age range: 40-80 years) were enrolled in the study and randomly assigned to: Rifaximin (400 mg bid for 7 d every month) plus dietary fiber supplementation (at least 20 gr/d) or dietary fiber supplementation alone. The study duration was 24 mo; both clinical examination and symptoms' questionnaire were performed every two months.
RESULTS: Both treatments reduced symptom frequency, but Rifaximin at a greater extent, when compared to basal values. Symptomatic score declined during both treatments, but a greater reduction was evident in the Rifaximin group (6.4 +/- 2.8 and 6.2 +/- 2.6 at enrollment, P = NS, 1.0 +/- 0.7 and 2.4 +/- 1.7 after 24 mo, P < 0.001, respectively). Probability of symptom reduction was higher and complication frequency lower (Kaplan-Meyer method) in the Rifaximin group (P < 0.0001 and 0.028, respectively).
CONCLUSION: In patients with symptomatic, uncomplicated diverticular disease, cyclic administration of Rifaximin plus dietary fiber supplementation is more effective in reducing both symptom and complication frequency than simple dietary fiber supplementation. Long term administration of the poorly absorbed antibiotic Rifaximin is safe and well tolerated by the patients, confirming the usefulness of this therapeutic strategy in the overall management of diverticular disease.},
}
@article {pmid17206560,
year = {2006},
author = {Fischer, F and Bruch, HP},
title = {[Surgical principles in the treatment of diverticular disease].},
journal = {Zentralblatt fur Chirurgie},
volume = {131},
number = {6},
pages = {W72-81; quiz W82-3},
doi = {10.1055/s-2006-955448},
pmid = {17206560},
issn = {0044-409X},
mesh = {Abdomen, Acute/etiology/surgery ; Algorithms ; Anastomosis, Surgical ; Colon/pathology/surgery ; Colonoscopy ; Diagnosis, Differential ; Diverticulitis, Colonic/classification/diagnosis/etiology/*surgery ; Gastrointestinal Hemorrhage/diagnosis/etiology/surgery ; Humans ; Intestinal Obstruction/diagnosis/etiology/surgery ; Intestinal Perforation/diagnosis/etiology/surgery ; Laparoscopy ; Recurrence ; Reoperation ; Tomography, Spiral Computed ; Ultrasonography ; },
}
@article {pmid17205411,
year = {2006},
author = {Tarhan, OR and Barut, I and Cerci, C},
title = {An interesting coexistence: small bowel volvulus and small bowel diverticulosis.},
journal = {The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology},
volume = {17},
number = {4},
pages = {300-304},
pmid = {17205411},
issn = {1300-4948},
mesh = {Adult ; Diverticulum/*complications/diagnosis/surgery ; Humans ; Ileal Diseases/*complications/diagnosis/surgery ; Intestinal Volvulus/*complications/diagnosis/surgery ; Male ; },
abstract = {Acquired (non-Meckel's) jejuno-ileal diverticular disease is uncommon, and most surgeons have limited, if any, experience with this condition. We present an interesting case with coexistence of small bowel diverticulum and small bowel volvulus with massive abdominal distension, in which the patient had a history of abdominal distension without abdominal pain over a five-year period. A brief discussion of the common clinical features is given and the principles of treatment of jejuno-ileal diverticular disease and small bowel volvulus are presented. A 29-year- old man with no history of laparotomy was admitted with abdominal distension and abdominal compartment syndrome symptoms. An emergency laparotomy revealed 180 degree clockwise volvulus of the multiple diverticula-bearing terminal ileum. There was no diverticulum in other sites of the small intestine and colon. Additionally, there was neither adhesion nor any congenital anomalies at the other sites of the gastrointestinal system. The viability of the intestine was normal but the diameter of the ileum was extremely enlarged (approximately 20 cm). In addition, the bowel wall was also hypertrophied. The rotated and enormously enlarged diverticula-bearing small intestine was removed with cecum, and ileocolostomy was performed. The patient was discharged uneventfully from hospital on the eighth postoperative day. After the operation, all symptoms of the patient disappeared. Small bowel obstruction is a common cause of emergency surgical admission. Awareness of the fact that volvulus of the diverticula-bearing segment of the jejuno- ileum is a rare cause of small bowel obstruction may lead to earlier and prompt diagnosis and treatment.},
}
@article {pmid17203348,
year = {2007},
author = {Graham, J and Palmer, M},
title = {Acute, late presentation of colo-continent urinary reservoir fistula.},
journal = {International urology and nephrology},
volume = {39},
number = {3},
pages = {787-789},
pmid = {17203348},
issn = {0301-1623},
mesh = {Aged ; Carcinoma, Transitional Cell/*surgery ; Humans ; Male ; Tomography, X-Ray Computed ; Urinary Bladder Neoplasms/*surgery ; Urinary Fistula/diagnostic imaging/*etiology ; Urinary Reservoirs, Continent/*adverse effects ; },
abstract = {Complications associated with continent urinary reservoirs are well recognised. Fistulae between the pouch and colon are rare but are documented. This uncommon complication is reported in the early post-operative period in patients who have previously received pelvic radiotherapy. Colonic fistulae are normally secondary to malignancy or diverticular disease. We present the first literature report of a late, acutely presenting colo-pouch fistula secondary to neither malignancy nor diverticular disease. We highlight the need for medical staff to be aware that not all stomas are incontinent and the possible dangers to be aware of when an acutely unwell, debilitated patient is unable to convey this fact.},
}
@article {pmid21487556,
year = {2007},
author = {Fujii, T and Nakabayashi, T and Hashimoto, S and Kuwano, H},
title = {A Delayed Recrudescent Case of Sigmoidocutaneous Fistula due to Diverticulitis.},
journal = {Case reports in gastroenterology},
volume = {1},
number = {1},
pages = {116-122},
pmid = {21487556},
issn = {1662-0631},
abstract = {Colocutaneous fistula caused by diverticulitis is relatively rare, and a delayed recrudescent case of colocutaneous fistula is very uncommon. We herein report a rare case of a Japanese 56-year-old male with delayed recrudescent sigmoidocutaneous fistula due to diverticulitis. A colocutaneous fistula was formed after a drainage operation against a perforation of the sigmoid colon diverticulum. After 5 years from treatment, he was admitted to our hospital because of lower abdominal pain. We diagnosed the recrudescent sigmoidocutaneous fistula by abdominal computed tomography and gastrografin enema, and managed the patient with total parenteral nutrition and antibiotics. As the fistula formation did not improve, a low anterior resection with fistulectomy was performed. The postoperative course was uneventful and the patient was discharged. It has been reported that, in fistulas of the skin caused by diverticular disease, complete closure of the fistula by conservative therapy may not be possible. This case also implies the possibility of a recurrence of the fistula even if the conservative treatment was effective. In cases of colocutaneous fistulas due to diverticulitis, radical surgery is considered necessary because of possibility of recurrence of the fistula.},
}
@article {pmid19454119,
year = {2007},
author = {Humes, D and Simpson, J and Spiller, RC},
title = {Colonic diverticular disease.},
journal = {BMJ clinical evidence},
volume = {2007},
number = {},
pages = {},
pmid = {19454119},
issn = {1752-8526},
mesh = {Acute Disease ; Diverticulitis ; *Diverticulitis, Colonic ; *Diverticulosis, Colonic ; Diverticulum ; Humans ; Mesalamine/therapeutic use ; },
abstract = {INTRODUCTION: Diverticula (mucosal outpouching through the wall of the colon) affect over 5% of adults aged 40 years and older, but only 10-25% of affected people will develop symptoms such as lower abdominal pain. Recurrent symptoms are common, and 5% of people with diverticula eventually develop complications such as perforation, obstruction, haemorrhage, fistulae, or abscesses.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: treatments for uncomplicated diverticular disease; treatments to prevent complications; and treatments for acute diverticulitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to July 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found 13 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antispasmodics, bran, elective surgery, increasing fibre intake, ispaghula husk, lactulose, medical treatment, mesalazine, methylcellulose, rifaximin, surgery.},
}
@article {pmid17181849,
year = {2007},
author = {Platell, C and Barwood, N and Dorfmann, G and Makin, G},
title = {The incidence of anastomotic leaks in patients undergoing colorectal surgery.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {9},
number = {1},
pages = {71-79},
doi = {10.1111/j.1463-1318.2006.01002.x},
pmid = {17181849},
issn = {1462-8910},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; *Anastomosis, Surgical ; *Colorectal Surgery ; Emergencies ; Female ; Humans ; Intraoperative Complications ; Male ; Middle Aged ; Multivariate Analysis ; Prospective Studies ; Regression Analysis ; },
abstract = {BACKGROUND: There is evolving interest in auditing and credentialling the performance of surgeons. The incidence of anastomotic leakage has been proposed as a measure of performance following colorectal surgery. The aim of this study was to evaluate the incidence and risk factors associated with anastomotic leakage in patients undergoing resections of the colon and rectum.
METHODS: A prospective database was developed for all patients undergoing colorectal surgery. Anastomotic leakage was defined prior to the commencement of the study. A logistic regression analysis was performed to determine independent predictors of leakage. The variables analysed included age, sex, American Society of Anesthesiology (ASA) score, anatomical location, pathology, emergency surgery, type of anastomosis, a covering stoma and radiotherapy. Significance was defined as the probability of a type 1 error of < 5%. The results are presented as odds ratios (ORs) and 95% confidence intervals (95% CIs).
RESULTS: There were 1598 patients who underwent 1639 anastomoses. Their mean age was 63 years, 34% of patients were ASA 3 or 4, and 16% of the operations were emergencies. Anastomotic leaks occurred in 2.4% (40/1639) of anastomoses. The leak rate for intraperitoneal anastomoses was 1.5% (19/1283) vs 6.6% for extraperitoneal anastomoses (21/316). Half of these leaks (20/40) were managed with re-operation or percutaneous drainage procedures. Ultra-low anterior resections were associated with the highest leak rate (8%, 18/225). A logistic regression analysis identified a covering stoma (P = 0.0001, OR 5.078, 95% CI 2.527-10.23) and diverticular disease (P = 0.037, OR 2.304, 95% CI 1.053-5.042) as independent predictors of a leak.
CONCLUSIONS: Within this surgical unit, the incidence of leaks from intraabdominal anastomoses was relatively low. However, leaks in patients undergoing extraperitoneal anastomoses continue to be a major cause of morbidity and mortality.},
}
@article {pmid17178958,
year = {2006},
author = {Valverde, A and Msika, S and Kianmanesh, R and Hay, JM and Couchard, AC and Flamant, Y and Fingerhut, A and Fagniez, PL and , },
title = {Povidone-iodine vs sodium hypochlorite enema for mechanical preparation before elective open colonic or rectal resection with primary anastomosis: a multicenter randomized controlled trial.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {141},
number = {12},
pages = {1168-74; discussion 1175},
doi = {10.1001/archsurg.141.12.1168},
pmid = {17178958},
issn = {0004-0010},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Anti-Infective Agents, Local/*administration & dosage ; Colon/*surgery ; Colorectal Neoplasms/*surgery ; Disinfectants/*administration & dosage ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures ; *Enema ; Female ; Humans ; Male ; Middle Aged ; Povidone-Iodine/*administration & dosage ; Preoperative Care ; Prospective Studies ; Rectum/*surgery ; Sigmoid Diseases/*surgery ; Single-Blind Method ; Sodium Hypochlorite/*administration & dosage ; },
abstract = {HYPOTHESIS: The anti-infective actions of povidone-iodine (PVI) and sodium hypochlorite enemas are different.
DESIGN: Prospective, randomized, single-blind study.
SETTING: Multicenter.
PATIENTS: Five hundred seventeen consecutive patients with colorectal carcinoma or sigmoid diverticular disease undergoing elective open colorectal resection, followed by primary anastomosis.
INTERVENTION: All patients received senna (1-2 packages diluted in a glass of water) at 6 pm the evening before surgery. Patients were administered two 2-L aqueous enemas of 5% PVI (n = 277) or 0.3% sodium hypochlorite (n = 240) at 9 pm the evening before surgery and at 3 hours before operation. Intravenous ceftriaxone sodium (1 g) and metronidazole (1 g) were administered at anesthetic induction.
MAIN OUTCOME MEASURE: Rate of patients with 1 infective parietoabdominal complication or more.
RESULTS: The percentages of patients with 1 infective parietoabdominal complication or more did not differ between the 2 groups (13.7% in the PVI-treated group vs 15.0% in the sodium hypochlorite-treated group). Tolerance was better in the PVI-treated group than in the sodium hypochlorite-treated group (79.4% vs 67.9%), with fewer patients experiencing abdominal pain (13.0% vs 24.6%) or discontinuing their preparation (3.0% vs 9.0%) (P=.02 for all). There were more patients with malaise in the PVI-treated group than in the sodium hypochlorite-treated group (9.1% vs 4.9%, P<.05). Three patients in the sodium hypochlorite-treated group had necrotic ulcerative colitis.
CONCLUSION: When antiseptic enemas are chosen for mechanical preparation before colorectal surgery, PVI should be preferred over sodium hypochlorite because of better tolerance and avoidance of necrotic ulcerative colitis.},
}
@article {pmid17156149,
year = {2007},
author = {Eickhoff, A and van Dam, J and Jakobs, R and Kudis, V and Hartmann, D and Damian, U and Weickert, U and Schilling, D and Riemann, JF},
title = {Computer-assisted colonoscopy (the NeoGuide Endoscopy System): results of the first human clinical trial ("PACE study").},
journal = {The American journal of gastroenterology},
volume = {102},
number = {2},
pages = {261-266},
doi = {10.1111/j.1572-0241.2006.01002.x},
pmid = {17156149},
issn = {0002-9270},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/*diagnosis ; *Colonoscopes ; Colonoscopy/*methods ; *Computer Systems ; Diagnosis, Differential ; Equipment Design ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Reproducibility of Results ; },
abstract = {OBJECTIVES: Unsedated colonoscopy is an uncomfortable procedure for most patients. Discomfort during colonoscopy is largely related to looping of the colonoscope, which displaces the colon from its native configuration and stretches attachments to the mesentery. A novel computer-assisted colonoscope utilizes a fully articulated, computer-controlled insertion tube. On manual insertion of the colonoscope, the position and angle of the scope's tip are encoded into a computer algorithm. As the colonoscope is advanced, the computer directs each successive segment to take the same shape that the tip had at a given insertion depth. The insertion tube thus changes its shape at different insertion depths in a "follow-the-leader" manner.
METHODS: This initial clinical trial with this novel colonoscopy system was designed as a prospective, nonrandomized, unblinded, feasibility study. Three physicians of varying levels of experience participated in the study.
RESULTS: Eleven consecutive patients (seven men, four women, age range 19-80) meeting inclusion criteria for screening or diagnostic colonoscopy were enrolled in the study. The cecum was reached in 10 consecutive patients (100%). Findings included diverticular disease in two cases and multiple colonic polyps in two cases. Postprocedure assessment at discharge, 48 h, and 30 days revealed no complications or adverse effects. Physician satisfaction and patient acceptance of this new technique were high.
CONCLUSIONS: In this limited, first of its kind feasibility study, the computer-assisted colonoscope was shown to perform colonoscopy safely and effectively. The colonoscope's unique design limited loop formation during colonoscopy. Large-scale clinical trials are indicated.},
}
@article {pmid17146937,
year = {2006},
author = {Vergara-Fernández, O and Velasco, L and Zárate, X and Morales-Olivera, JM and Remes, JM and González, QH and Takahashi-Monroy, T},
title = {[Surgical treatment for colonic diverticular disease. Experience in the INCMNSZ].},
journal = {Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion},
volume = {58},
number = {4},
pages = {272-278},
pmid = {17146937},
issn = {0034-8376},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colostomy/methods ; Diverticulosis, Colonic/complications/mortality/*surgery ; Female ; Humans ; Male ; Mexico/epidemiology ; Middle Aged ; *Postoperative Complications ; Retrospective Studies ; },
abstract = {BACKGROUND: Even though most patients with colonic diverticular disease respond to conservative management, some patients persist with symptoms or develop complications that require surgery. The objective of this study was to identify main surgical indications for colonic diverticular disease, and to evaluate the outcomes of surgical treatment.
MATERIALS AND METHODS: A retrospective review of patients that underwent a surgical procedure for colonic diverticular disease from 1979 through 2000, was performed. Surgical indications were acute diverticulitis (54%) (group 1), stenosis (19%), fistula (9.54), recurrent diverticulitis (9.5%) and bleeding (8%) (group 2). Results. Seventy-four patients with a mean age of 56 years were studied. Fifty-eight percent were male. Surgical morbidity and mortality rates of acute diverticulitis were 55%, and 15%, respectively. The surgical procedures of this group were proximal stomas (45%), Hartmann's procedures (38%), and resections with primary anastomosis (17%). Second group morbidity and mortality rates were 35 and 5.8%, respectively. Thirty-six patients underwent two or more surgical procedures with statistical significance between first and second groups (61 vs. 28%; p < 0.05). The mortality of two-stage surgeries was lower than derivative procedures (13 vs. 22%; p = 0.009). A high Hinchey's score was the only factor associated with mortality (28.5 vs. 0%; p = 0.042).
CONCLUSIONS: Mortality of surgical procedures for colonic diverticular disease is associated with a high Hinchey score. Primary anastomosis is o safe, procedure in some cases.},
}
@article {pmid17125113,
year = {2006},
author = {Avital, S and Hermon, H and Greenberg, R and Karin, E and Skornick, Y},
title = {Learning curve in laparoscopic colorectal surgery: our first 100 patients.},
journal = {The Israel Medical Association journal : IMAJ},
volume = {8},
number = {10},
pages = {683-686},
pmid = {17125113},
issn = {1565-1088},
mesh = {Adult ; Aged ; Aged, 80 and over ; Clinical Competence/*statistics & numerical data ; Colonic Diseases/*surgery ; Colorectal Surgery/adverse effects/*education/methods ; Education, Medical, Continuing/*statistics & numerical data ; Female ; Humans ; Laparoscopy/adverse effects/standards/*statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Medical Audit ; Middle Aged ; Postoperative Complications/epidemiology ; Prospective Studies ; Rectal Diseases/*surgery ; Time Factors ; },
abstract = {BACKGROUND: Recent data confirming the oncologic safety of laparoscopic colectomy for cancer as well as its potential benefits will likely motivate more surgeons to perform laparoscopic colorectal surgery.
OBJECTIVES: To assess factors related to the learning curve of laparoscopic colorectal surgery, such as the number of operations performed, the type of procedures, major complications, and oncologic resections.
METHODS: We evaluated the data of our first 100 elective laparoscopic colorectal operations performed during a 2 year period and compared the first 50 cases with the following 50.
RESULTS: The mean age of the study population was 66 years and 49% were males. Indications included cancer, polyps, diverticular disease, Crohn's disease, and others, in 50%, 23%, 13%, 7% and 7% respectively. Mean operative time was 170 minutes. One patient died (massive pulmonary embolism). Significant surgical complications occurred in 10 patients (10%). Hospital stay averaged 8 days. Comparison of the first 50 procedures with the next 50 revealed a significant decrease in major surgical complications (20% vs. 0%). Mean operative time decreased from 180 to 160 minutes and hospital stay from 8.6 to 7.2 days. There was no difference in conversion rate and mean number of harvested nodes in both groups. Residents performed 8% of the operations in the first 50 cases compared with 20% in the second 50 cases. Right colectomies had shorter operative times and fewer conversions.
CONCLUSIONS: There was a significant decrease in major complications after the first 50 laparoscopic colorectal procedures. Adequate oncologic resections may be achieved early in the learning curve. Right colectomies are less difficult to perform and are recommended as initial procedures.},
}
@article {pmid17088774,
year = {2006},
author = {Trastour, C and Rahili, A and d'Angelo, L and Bafghi, A and Benizri, E and Bongain, A and Benchimol, D},
title = {[Bening enterogenital fistulas arising from the digestive tract: three cases].},
journal = {Journal de gynecologie, obstetrique et biologie de la reproduction},
volume = {35},
number = {7},
pages = {720-724},
doi = {10.1016/s0368-2315(06)76469-9},
pmid = {17088774},
issn = {0368-2315},
mesh = {Adult ; Aged ; Female ; Fistula/*diagnosis/etiology ; Genital Diseases, Female/*diagnosis/etiology ; Humans ; Intestinal Fistula/*diagnosis/etiology ; Middle Aged ; },
abstract = {Fistulas between the female genital tract and the digestive tract occur after obstetrical, oncological, or post-operative complications. We report herein 3 rare cases of enterogenital fistulas: one colouterine fistula and one colotubal fistula in a patient with diverticulitis, and one ileovaginal fistula in a patient with Crohn's disease. Vaginal discharge was frequent and incited patients to consult a gynecologist. Better knowledge of enterogenital fistulas is necessary to enable earlier diagnosis and apply specific treatment. The incidence of colovaginal fistulas is increasing in diverticular disease because of increased prevalences of hysterectomies and diverticular disease.},
}
@article {pmid17086395,
year = {2007},
author = {Banerjee, S and Akbar, N and Moorhead, J and Rennie, JA and Leather, AJ and Cooper, D and Papagrigoriadis, S},
title = {Increased presence of serotonin-producing cells in colons with diverticular disease may indicate involvement in the pathophysiology of the condition.},
journal = {International journal of colorectal disease},
volume = {22},
number = {6},
pages = {643-649},
pmid = {17086395},
issn = {0179-1958},
mesh = {Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Diverticulum, Colon/metabolism/*pathology/*physiopathology ; Enterochromaffin Cells/*metabolism/*pathology ; Female ; Humans ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; Serotonin/*analysis/biosynthesis ; Statistics, Nonparametric ; },
abstract = {INTRODUCTION: Serotonin is an important neuroendocrine transmitter participating in the control of colonic motor activity through neural and biochemical mechanisms in the Enteric Nervous System (ENS). A possible pathophysiological factor for diverticular disease (DD) is altered colonic motility. The study compared the distribution of serotonin cells (SC) in the colonic mucosa of patients with diverticular disease to controls.
METHODS: Sixteen paraffin specimens with sigmoid diverticular disease were selected and sections of bowel without diverticula from the same specimen were used as its own control. The resection margins from sixteen colonic specimens excised for sigmoid cancer were additional controls. Immunocytochemical staining for serotonin cells was performed on 4-mum tissue sections with polyclonal antibody (NCL-SEROTp). The number of serotonin-positive cells per ten microscopic fields (x200) was assessed in all groups and the staining distribution was defined as low (0-33%), moderate (>33-66%) and high (>66%) according to the percentage of the entire cell containing contrast material. The control specimens were blinded before analysis. Student's t test was used for statistical analysis and significance level was set as P < 0.05.
RESULTS: The mean number of serotonin-positive cells per ten fields in the colonic mucosa of specimens with diverticular disease was significantly higher [252.44 (SD 90.64)] than the specimen's own control [147.31 (SD 50.16)] and at normal resection margins of cancer specimens [228.38 (SD 120.10)]. The paired analysis between diverticular disease specimens and its own control (paired t test) showed significant differences for moderate (P = 0.008), high (P = 0.001) and total (P = 0.002) number of serotonin cells. There was no evidence of significance between mean DD and cancer values.
DISCUSSION: Increased presence of SCs and the higher proportion of high and moderate staining cells (indicating increased hormone content) indicate the possible role of serotonin in DD. This may be contributing to the pathogenesis of the condition by altered colonic motility in the affected segments in a similar way as in irritable bowel syndrome.},
}
@article {pmid17080262,
year = {2006},
author = {Stumpf, M and Krones, CJ and Klinge, U and Rosch, R and Junge, K and Schumpelick, V},
title = {Collagen in colon disease.},
journal = {Hernia : the journal of hernias and abdominal wall surgery},
volume = {10},
number = {6},
pages = {498-501},
pmid = {17080262},
issn = {1265-4906},
mesh = {Collagen/*metabolism ; Collagenases/metabolism ; Colonic Diseases/etiology/*metabolism/surgery ; Digestive System Surgical Procedures/methods ; Humans ; Prognosis ; Risk Factors ; Wound Healing/physiology ; },
abstract = {The pathophysiology of wound healing in the bowel wall suggests that collagen and matrix metalloproteinases (MMPs) have an important role in the changes of the bowel wall seen in several colonic diseases. Several recent studies suggest that disturbances of the collagen texture and the extracellular matrix (ECM) metabolism are major factors leading to the onset of diverticular disease. Changes of the ECM also play a role in the development of inflammatory bowel diseases. Regarding the permanent remodeling of the bowel wall, any imbalance of the ECM could support the onset of chronic inflammation and the development of fistula formation, such as that seen in patients with Crohn's disease. Disturbances of the ECM play a role in the pathogenesis of anastomotic leakage after large bowel surgery and suggest the presence of a genetically defined risk population with disturbed wound healing mechanisms. This concept could explain the well known situation where an anastomotic breakdown is observed, despite the absence of other known risk factors and after a technically correct anastomosis.},
}
@article {pmid17078894,
year = {2006},
author = {Jiwa, M and Skinner, P and Coker, AO and Shaw, L and Campbell, MJ and Thompson, J},
title = {Implementing referral guidelines: lessons from a negative outcome cluster randomised factorial trial in general practice.},
journal = {BMC family practice},
volume = {7},
number = {},
pages = {65},
pmid = {17078894},
issn = {1471-2296},
mesh = {Colonic Diseases/*diagnosis/pathology ; Colorectal Neoplasms/diagnosis ; Colorectal Surgery ; *Correspondence as Topic ; Diverticulitis, Colonic/diagnosis ; *Education, Medical, Continuing ; Family Practice/education/*standards ; Guideline Adherence ; Humans ; Inflammatory Bowel Diseases/*diagnosis ; *Interdisciplinary Communication ; Outcome Assessment, Health Care ; *Practice Guidelines as Topic ; Quality Indicators, Health Care ; Rectal Diseases/*diagnosis/pathology ; Referral and Consultation/*standards ; Software ; Time Factors ; United Kingdom ; },
abstract = {BACKGROUND: Few patients with lower bowel symptoms who consult their general practitioner need a specialist opinion. However data from referred patients suggest that those who are referred would benefit from detailed assessment before referral.
METHODS: A cluster randomised factorial trial. 44 general practices in North Trent, UK. Practices were offered either an electronic interactive referral pro forma, an educational outreach visit by a local colorectal surgeon, both or neither. The main outcome measure was the proportion of cases with severe diverticular disease, cancer or precancerous lesions and inflammatory bowel disease in those referred by each group. A secondary outcome was a referral letter quality score. Semi-structured interviews were conducted to identify key themes relating to the use of the software
RESULTS: From 150 invitations, 44 practices were recruited with a total list size of 265,707. There were 716 consecutive referrals recorded over a six-month period, for which a diagnosis was available for 514. In the combined software arms 14% (37/261) had significant pathology, compared with 19% (49/253) in the non-software arms, relative risk 0.73 (95% CI: 0.46 to 1.15). In the combined educational outreach arms 15% (38/258) had significant pathology compared with 19% (48/256) in the non-educational arms, relative risk 0.79 (95% CI: 0.50 to 1.24). Pro forma practices documented better assessment of patients at referral.
CONCLUSION: There was a lack of evidence that either intervention increased the proportion of patients with organic pathology among those referred. The interactive software did improve the amount of information relayed in referral letters although we were unable to confirm if this made a significant difference to patients or their health care providers. The potential value of either intervention may have been diminished by their limited uptake within the context of a cluster randomised clinical trial. A number of lessons were learned in this trial of novel innovations.},
}
@article {pmid17072664,
year = {2007},
author = {Hildebrand, P and Kropp, M and Stellmacher, F and Roblick, UJ and Bruch, HP and Schwandner, O},
title = {Surgery for right-sided colonic diverticulitis: results of a 10-year-observation period.},
journal = {Langenbeck's archives of surgery},
volume = {392},
number = {2},
pages = {143-147},
pmid = {17072664},
issn = {1435-2443},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/metabolism/pathology/*surgery ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Sigmoid Diseases/surgery ; Treatment Outcome ; },
abstract = {INTRODUCTION: In contrast to sigmoid diverticular disease, right colonic diverticulitis is a rare disease in Western countries. The clinical presentation is often similar to acute appendicitis.
OBJECTIVE: The aim of this study was to analyze surgical challenge in right-sided diverticulitis.
MATERIALS AND METHODS: All patients who underwent resection for both right-sided and sigmoid diverticular disease were registered prospectively in a database (observation period, 1996-2005). A retrospective analysis of all patients who underwent resection for right-sided colonic diverticulitis (ileocolic resection, right colectomy) was performed. Special focus was set on incidence, clinical symptoms, indication, procedure, clinical outcome, and histopathologic findings including immunohistochemistry.
RESULTS: From a total of 593 patients treated surgically for recurring or acute complicated diverticular disease, the majority (97.8%) suffered from sigmoid diverticulitis (n = 580), whereas 2.2% (n = 16) underwent surgery for right-sided diverticulitis (including three patients with combined sigmoid and cecal diverticulitis). Related to the total number of appendectomies (n = 1167), this represented an incidence of 1.4%. In five of 16 patients, acute appendicitis was presumed preoperatively. Most common diagnostic was ultrasonography. In the group of patients with right-sided diverticulitis, the most common procedure was right hemicolectomy (n = 10), followed by ileocolic resection (n = 3) and combined right colonic resection with sigmoid resection (n = 3). Histopathological investigation confirmed complicated diverticulitis of the cecum with local perforation or abscess in 75% of the patients (12/16). Hypoganglionosis or aganglionosis was diagnosed in seven of the 16 resected specimens.
DISCUSSION: As right-sided diverticulitis is a rare colonic disease in Western countries, the differentiation from acute appendicitis may be difficult. In general, there is no difference in the treatment of right-sided diverticulitis compared to left-sided diverticulitis. As most cases will remain clinically unimminent, surgery is only indicated in complicated right-sided cases. Resection of the inflamed colonic segment with primary anastomosis is safe and can be performed laparoscopically. It can only be speculated whether hypoganglionosis or aganglionosis is a causative factor in the etiology of right-sided diverticulitis.},
}
@article {pmid17069198,
year = {2006},
author = {, },
title = {[The role of surgery in the treatment of colonic diverticular disease. Italian Surgical Society, Consensus Conference at the SIC Congress, Cagliari, October 11, 2005 ].},
journal = {Chirurgia italiana},
volume = {58},
number = {5},
pages = {661-679},
pmid = {17069198},
issn = {0009-4773},
mesh = {Ascites/etiology ; Diagnosis, Differential ; Diverticulitis, Colonic/*complications/diagnosis/*surgery ; Humans ; Italy ; Peritonitis/etiology ; Practice Guidelines as Topic ; Societies, Medical ; },
}
@article {pmid17059147,
year = {2006},
author = {Vartic, M and Chilie, A and Beuran, M},
title = {[Gastrointestinal bleeding in intensive care].},
journal = {Chirurgia (Bucharest, Romania : 1990)},
volume = {101},
number = {4},
pages = {365-374},
pmid = {17059147},
issn = {1221-9118},
mesh = {Female ; Gastrointestinal Diseases/surgery ; Gastrointestinal Hemorrhage/etiology/mortality/*surgery ; Humans ; *Intensive Care Units ; Male ; Middle Aged ; Risk Factors ; Survival Analysis ; },
abstract = {Gastrointestinal bleeding (GIB) is a frequent finding in intensive care unit (ICU) and has considerable morbidity particularly for the elderly. The most common etiology for upper digestive bleeding is the stress ulcer and for the lower bleeding the diverticular disease of the colon. The predictive risk factors for GIB are age, organ failure, mechanical ventilation and length of stay in ICU. Even though a 4.5 times increase in mortality is seen in these patients it cannot be directly correlated to the bleeding. Routine use of H2 inhibitors is effective only in high risk patients, opposing enteral nutrition which is valuable in all patients. Prophylactic measures resulted in a 50% decrease in incidence of GIB in ICU and also of the mortality. Most of the patients are now treated non-operatively.},
}
@article {pmid17048279,
year = {2006},
author = {Constantinides, VA and Tekkis, PP and Senapati, A and , },
title = {Prospective multicentre evaluation of adverse outcomes following treatment for complicated diverticular disease.},
journal = {The British journal of surgery},
volume = {93},
number = {12},
pages = {1503-1513},
doi = {10.1002/bjs.5402},
pmid = {17048279},
issn = {0007-1323},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/mortality ; Digestive System Surgical Procedures/*adverse effects/mortality ; Diverticulum, Colon/mortality/*surgery ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/*etiology/mortality ; Prospective Studies ; Risk Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: The choice of operation for complicated diverticular disease is contentious. The aim of this study was to investigate adverse events following restorative (primary resection and anastomosis, PRA) and non-restorative (Hartmann's procedure, HP) surgery for complicated diverticular disease.
METHODS: Five hundred and thirty-nine patients who presented with complicated diverticular disease in 42 centres over a 12-month period from January 2003 were considered for the study. Data were collected prospectively from 248 patients (46.0 per cent) who underwent PRA and 167 (31.0 per cent) who had HP. A propensity score was developed for case-mix adjustment. Multifactorial logistic regression was used to evaluate differences in operative outcomes.
RESULTS: Mortality, surgical and medical complication rates were 4.0, 31.0 and 13.7 per cent respectively after PRA, and 23.4, 53.3 and 40.7 per cent for HP (all P < 0.001). After adjusting for the propensity score, the HP group had a 2.1- and 1.9-fold increase in medical and surgical complications respectively compared with those who had PRA, whereas the operative mortality rate was not significantly different. Non-colorectal surgeons performed a significantly higher proportion of HPs in the non-elective setting than colorectal surgeons (80.6 versus 60.4 per cent; chi(2) = 8.31, 1 d.f., P = 0.004).
CONCLUSION: PRA with or without a proximal diversion is more often performed non-electively by specialist colorectal surgeons. It may be a safe procedure for complicated diverticular disease in selected patients as it may be associated with fewer postoperative adverse events.},
}
@article {pmid17021746,
year = {2007},
author = {Klinge, U and Rosch, R and Junge, K and Krones, CJ and Stumpf, M and Lynen-Jansen, P and Mertens, PR and Schumpelick, V},
title = {Different matrix micro-environments in colon cancer and diverticular disease.},
journal = {International journal of colorectal disease},
volume = {22},
number = {5},
pages = {515-520},
pmid = {17021746},
issn = {0179-1958},
mesh = {Collagen Type I/metabolism ; Collagen Type III/metabolism ; Colon/metabolism/surgery ; Colon, Sigmoid/metabolism/surgery ; Colonic Neoplasms/*metabolism ; Cyclin D1/metabolism ; Cyclooxygenase 2/metabolism ; DNA-Binding Proteins/metabolism ; Diverticulosis, Colonic/*metabolism ; Extracellular Matrix/*metabolism ; Female ; Humans ; Male ; Matrix Metalloproteinase 13/metabolism ; Membrane Proteins/metabolism ; Middle Aged ; Nuclear Proteins/metabolism ; Plasminogen Activator Inhibitor 1/metabolism ; Proto-Oncogene Proteins c-kit/metabolism ; Receptor, ErbB-2/metabolism ; Retrospective Studies ; Transforming Growth Factor beta/metabolism ; Tumor Suppressor Protein p53/metabolism ; Vascular Endothelial Growth Factor A/metabolism ; Y-Box-Binding Protein 1 ; },
abstract = {BACKGROUND AND AIMS: The extracellular matrix and the interactive signalling between its components are thought to play a pivotal role for tumour development and metastasis formation. An altered matrix composition as potential underlying pathology for the development of colorectal cancer was hypothesized.
METHODS: In a retrospective study of patients with colon cancer, the extracellular matrix in tumour-free bowel specimen was investigated in comparison with non-infected bowel specimen from patients operated on for colonic diverticulosis. The following matrix parameters with known associations to tumour formation, cell proliferation, invasion and metastasis were analysed by immunohistochemistry and quantified by a scoring system: VEGF, TGF-beta, ESDN, CD117, c-erb-2, cyclin D1, p53, p27, COX-2, YB-1, collagen I/III, MMP-13, PAI and uPAR. Expression profiles and correlations were calculated.
RESULTS: The comparison of the two groups revealed a significantly decreased immunostaining for CD117 and TGF-beta in the cancer group (8.5+/-2.6 vs 10.3+/-2,1 and 4.9+/-1.5 vs 8.1+/-3, respectively), whereas PAI scores were significantly higher than in patients with diverticular disease (8.1+/-1.6 vs 6.2+/-0.9). Overall correlation patterns of matrix parameters indicated pronounced differences between tumour-free tissue in cancer patients compared with patients with diverticular disease.
CONCLUSIONS: Our results indicate distinct differences in the colonic tissue architecture between cancer patients and patients with diverticulitis that support the notion of an altered matrix composition predisposing to the development of colon cancer.},
}
@article {pmid16989714,
year = {2006},
author = {Iannelli, A and Piche, T and Novellas, S and Gugenheim, J},
title = {Small bowel diverticulitis of the Roux loop after gastric bypass.},
journal = {Obesity surgery},
volume = {16},
number = {9},
pages = {1249-1251},
doi = {10.1381/096089206778392248},
pmid = {16989714},
issn = {0960-8923},
mesh = {Diverticulitis/diagnosis/*etiology/therapy ; Female ; Gastric Bypass/*adverse effects ; Humans ; Intestinal Diseases/diagnosis/*etiology/therapy ; *Intestine, Small ; Middle Aged ; Obesity, Morbid/*surgery ; },
abstract = {The epidemic of obesity and the introduction of laparoscopic techniques have greatly increased the popularity of bariatric operations such as Roux-en-Y gastric bypass (RYGBP). Acquired diverticular disease of the small bowel is a rare condition that becomes symptomatic in about 10% of the cases. We report a 48-year-old morbidly obese woman who presented 2 months after laparoscopic RYGBP with a perforated diverticulum of the Roux loop. The diagnostic and therapeutic implications are discussed.},
}
@article {pmid16986567,
year = {2006},
author = {Mehigan, B and White, A and Winter, DC and Sheehan, KM and Hyland, JM},
title = {Laparoscopic colorectal resection: initial experience in a specialist unit.},
journal = {Irish medical journal},
volume = {99},
number = {7},
pages = {211, 213-4},
pmid = {16986567},
issn = {0332-3102},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Colectomy/mortality/statistics & numerical data ; Colorectal Neoplasms/*surgery ; Databases, Factual ; Female ; Hospital Units ; Hospitals, Teaching ; Humans ; Ireland ; Laparoscopy ; Male ; Middle Aged ; Randomized Controlled Trials as Topic ; Retrospective Studies ; Survival Rate ; },
abstract = {The adoption of the laparoscopic approach to colorectal resection has been slow amongst colorectal surgeons principally due to concerns regarding oncological safety. Recent randomized controlled trials have confirmed both the safe and some advantage of this procedure have been performing laparoscopic assisted colorectal resection since 2002 and have now performed over 100 cases on non consecutive and selected patients. We have reviewed our experience with the introduction of this technique. 61 patients were operated on for cancer and 39 for benign disease mainly Crohn's and diverticular disease. Operative time was a median of 128 minutes over the course of study. Conversion rate was 5%. Pathological analysis of the resected specimens in the cancer cases revealed adequate lymph node harvest and margins. No patient had a positive margin and no port site metastasis have been seen. Duration of ileus and length of stay were a median of 0 and 6 days. Post operative morbidity and mortality were comparable to open colorectal surgery with the exception of port site herniation which occurred in 4% of patients. This study suggests that a laparoscopic approach to colorectal resection can be successfully introduced in an Irish hospital setting. The challenge facing Irish surgery is to disseminate this technique in a controlled and safe manner for Irish patients.},
}
@article {pmid16977864,
year = {2006},
author = {Veselý, V and Cerný, V and Geiger, J and Sebor, J},
title = {[Hartmann's resection of the large intestine--a method still useful].},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {85},
number = {6},
pages = {277-279},
pmid = {16977864},
issn = {0035-9351},
mesh = {Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures/*methods ; Female ; Humans ; Intestine, Large/*surgery ; Male ; Middle Aged ; },
abstract = {UNLABELLED: Hartmann's procedure is an operation indicated especially in emergency cases for left-sided colonic pathology where primary anastomosis is considered unsafe.
METHODS: Retrospective study 95 patients who underwent Hartmann's procedure over a 5 year period in the Surgical Clinic of the University Hospital in Pilsen.
RESULTS: 81 (85%) operations were emergency procedures. 45 (47%) operations were done for the malignant disease, the remaining 50 (53%) for benign disease (33 for complications of diverticular disease). Median age of patients was 69.4 years. The 30-day mortality rate was 16.8%. 37 patients had colostomy reversed, after a mean of 5.6 months with no mortality.
CONCLUSIONS: Hartmann's procedure is a safe method. Our results are similar to results collected by foreign clinics.},
}
@article {pmid16970576,
year = {2006},
author = {Constantinides, VA and Aydin, HN and Tekkis, PP and Fazio, VW and Heriot, AG and Remzi, FH},
title = {Long-term, health-related, quality of life comparison in patients undergoing single stage vs staged resection for complicated diverticular disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {8},
number = {8},
pages = {663-671},
doi = {10.1111/j.1463-1318.2006.00961.x},
pmid = {16970576},
issn = {1462-8910},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Digestive System Surgical Procedures/methods ; Diverticulosis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Follow-Up Studies ; Humans ; Middle Aged ; Ohio ; *Postoperative Complications ; *Quality of Life ; Surveys and Questionnaires ; Treatment Outcome ; },
abstract = {OBJECTIVE: To evaluate long-term health-related quality of life, for single-staged and staged resections following reversal, for complicated diverticular disease.
PATIENTS AND METHODS: Between 1981 and 2003, 188 patients undergoing single stage (n = 158) or staged resection (n = 30) completed the SF-36 questionnaire. Health-related quality of life (HRQL) was compared between the two groups and the US normal population based on the eight domains of the SF-36. HRQL analysis was also performed at various time intervals. The effect of age and postoperative complications on HRQL was also determined. Functional and postoperative outcomes were also assessed.
RESULTS: The single and staged resection groups differed in the presence of comorbidity, degree of peritoneal contamination and operative urgency. No difference in functional outcomes or HRQL was found, even after analysing time-interval subgroups. Social functioning and general health was substantially worse in both groups when compared to US norms. Ageing was found to significantly reduce physical functioning (P < 0.001) and physical and emotional role limitations (P < 0.001 for both). Post-operative complications significantly reduced scores when compared to patients without complications, for physical functioning (63.57 vs 78.7, respectively; P < 0.001), physical role limitation (80.65 vs 86.9, respectively; P < 0.001) and bodily pain (66.67 vs 74.81, respectively; P < 0.01).
CONCLUSIONS: No significant difference in long-term HRQL was found in patients undergoing single staged or staged resection for complicated diverticular disease. There was significant impact of ageing and postoperative complications on physical health. Prospective studies that include pre-operative data on HRQL are required to compare the two operative techniques, with emphasis on quality of life of patients left with a permanent stoma.},
}
@article {pmid16956555,
year = {2006},
author = {Castellví, J and Pozuelo, O and Vallet, J and Sueiras, A and Gil, V and Espinosa, J and Pi, F},
title = {[Perforated duodenal diverticulum].},
journal = {Cirugia espanola},
volume = {80},
number = {3},
pages = {174-175},
doi = {10.1016/s0009-739x(06)70948-4},
pmid = {16956555},
issn = {0009-739X},
mesh = {*Diverticulum/complications/diagnosis/surgery ; *Duodenal Diseases/complications/diagnosis/surgery ; Humans ; *Intestinal Perforation/complications/diagnosis/surgery ; Male ; Middle Aged ; },
abstract = {Diverticular disease of the duodenum is uncommon. Perforation is the least frequent complication. Diagnosis and treatment are not well defined as the presentation and symptomatology are nonspecific. Diagnostic delay carries high rates of postoperative mortality (30%). Early diagnosis is essential to reduce morbidity and mortality. We present the case of a male patient with perforated duodenal diverticulum. This case suggests that computed tomography can be highly useful in the preoperative diagnosis of this entity. Treatment consisted of duodenal exclusion and retroperitoneal drainage.},
}
@article {pmid16948968,
year = {2006},
author = {Eglash, A and Lane, CH and Schneider, DM},
title = {Clinical inquiries. What is the most beneficial diet for patients with diverticulosis?.},
journal = {The Journal of family practice},
volume = {55},
number = {9},
pages = {813-815},
pmid = {16948968},
issn = {0094-3509},
mesh = {Clinical Trials as Topic ; Diet, Fat-Restricted ; Dietary Fiber/administration & dosage ; Diverticulosis, Colonic/*diet therapy/epidemiology/physiopathology/prevention & control ; Gastrointestinal Motility ; Humans ; },
abstract = {A diet high in fiber (particularly fruit and vegetable fiber) and low in fat and red meat may help to decrease the risk of symptomatic diverticular disease (strength of recommendation [SOR]: C, case-control studies and a large prospective cohort study). For people with diverticular disease, a diet high in fiber might decrease the risk of complications (SOR: C, case series). No studies have evaluated the effect of nut and seed avoidance.},
}
@article {pmid16945170,
year = {2006},
author = {Soran, A and Harlak, A and Wilson, JW and Nesbitt, L and Lembersky, BC and Wienad, HS and O'Connell, MJ},
title = {Diverticular disease in patients with colon cancer: subgroup analysis of national surgical adjuvant breast and bowel project protocol C-06.},
journal = {Clinical colorectal cancer},
volume = {6},
number = {2},
pages = {140-145},
doi = {10.3816/ccc.2006.n.031},
pmid = {16945170},
issn = {1533-0028},
support = {U10CA-12027/CA/NCI NIH HHS/United States ; U10CA-37377/CA/NCI NIH HHS/United States ; U10CA-69651/CA/NCI NIH HHS/United States ; U10CA-69974/CA/NCI NIH HHS/United States ; },
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Cohort Studies ; Colonic Neoplasms/*complications/*drug therapy/mortality ; Diverticulum, Colon/epidemiology/*etiology ; Female ; Fluorouracil/administration & dosage ; Humans ; Leucovorin/administration & dosage ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Tegafur/administration & dosage ; },
abstract = {BACKGROUND: Similar epidemiologic characteristics suggest a common etiology for colon cancer (CC) and diverticular disease of the colon (DD). The relationship between the 2 diseases is still unclear, and the impact of DD in patients diagnosed with CC on disease-free survival (DFS) and overall survival (OS) is unknown. National Surgical Adjuvant Breast and Bowel Project (NASBP) protocol C-06 is a clinical trial comparing oral uracil/tegafur/leucovorin with 5-fluorouracil/leucovorin in patients with resected stage II/III carcinoma of the colon.
PATIENTS AND METHODS: The NASBP enrolled 1,608 patients who had undergone potentially curative resection for stage II/III colon cancer from 256 medical sites between February 14, 1997, and March 31, 1999.
RESULTS: Pathology reports from 1561 eligible patients retrospectively reviewed for the presence of DD revealed that 160 (10.2%) had this disease. The median ages of patients with CC and DD and without DD were 67 and 61 years, respectively (P < 0.05). The majority of patients were white, and Hispanic patients were better represented in the group with DD (P < 0.05). Colon cancer was located in the rectosigmoid in 46.88% of patients with DD and in 31.92% of patients without DD (P < 0.05). A baseline diagnosis of DD made no significant contribution to DFS or OS without adjustment for confoundin factors (P = 0.2 and P = 0.32, respectively) or adjusted for Dukes classification and age (P = 0.49 and P = 0.68, respectively).
CONCLUSION: The prevalence of DD in patients diagnosed and treated for CC was 10.2%. Patients with CC with and without DD differed from each other with respect to age, tumor location, and ethnicity. There was no negative impact of having DD on DFS and OS in patients treated for stage II/III CC.},
}
@article {pmid16918893,
year = {2006},
author = {Jones, R and Latinovic, R and Charlton, J and Gulliford, M},
title = {Physical and psychological co-morbidity in irritable bowel syndrome: a matched cohort study using the General Practice Research Database.},
journal = {Alimentary pharmacology & therapeutics},
volume = {24},
number = {5},
pages = {879-886},
doi = {10.1111/j.1365-2036.2006.03044.x},
pmid = {16918893},
issn = {0269-2813},
mesh = {Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Anxiety/epidemiology ; Asthma/epidemiology ; Cohort Studies ; Comorbidity ; *Databases, Factual ; Depression/epidemiology ; Diverticulum/epidemiology ; *Family Practice ; Female ; Gallbladder Diseases/epidemiology ; Hospitalization ; Humans ; Hysterectomy ; Incidence ; Irritable Bowel Syndrome/*epidemiology/psychology ; Male ; Middle Aged ; Prevalence ; Sex Distribution ; United Kingdom/epidemiology ; Urinary Tract Infections/epidemiology ; },
abstract = {BACKGROUND: Irritable bowel syndrome is a common problem known to have a complex relationship with psychological disorders and other physical symptoms. Little information, however, is available concerning physical and psychological comorbidity in irritable bowel syndrome patients studied over an extended period.
AIM: To evaluate physical and psychological morbidity 2 years before and during 6 years after the time of diagnosis in incident cases of irritable bowel syndrome and control subjects.
METHODS: A matched cohort study was implemented in 123 general practices using the General Practice Research Database. Irritable bowel syndrome cases (n = 1827) and controls (n = 3654) were compared for 2 years before and 6 years after diagnosis.
RESULTS: The age-standardized incidence of irritable bowel syndrome in patients over 15 years of age was 1.9 per 1,000 in men and 5.8 per 1,000 in women. From 2 years before the date of diagnosis, more irritable bowel syndrome cases (13%) than controls (5%) consulted with depression or were prescribed antidepressant drugs. Consultation and prescription rates for anxiety were also higher before diagnosis, and both anxiety and depression remained prevalent up to 6 years after diagnosis. Asthma, symptoms of urinary tract infection, gall-bladder surgery, hysterectomy and diverticular disease were recorded more frequently in irritable bowel syndrome patients, who were also more likely than controls to be referred to hospital.
CONCLUSIONS: People who are diagnosed with irritable bowel syndrome experience more anxiety and depression and a range of physical problems, compared with controls; they are more likely to be referred to hospital.},
}
@article {pmid16918879,
year = {2006},
author = {Laine, L and Smith, R and Min, K and Chen, C and Dubois, RW},
title = {Systematic review: the lower gastrointestinal adverse effects of non-steroidal anti-inflammatory drugs.},
journal = {Alimentary pharmacology & therapeutics},
volume = {24},
number = {5},
pages = {751-767},
doi = {10.1111/j.1365-2036.2006.03043.x},
pmid = {16918879},
issn = {0269-2813},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Cyclooxygenase 2 Inhibitors/adverse effects ; Diverticulum/chemically induced ; Gastrointestinal Hemorrhage/chemically induced ; Humans ; Inflammation/chemically induced ; Intestinal Diseases/*chemically induced ; Intestine, Large/drug effects/physiopathology ; Intestine, Small/drug effects/physiopathology ; Lower Gastrointestinal Tract ; Permeability/drug effects ; },
abstract = {BACKGROUND: Lower gastrointestinal effects of non-steroidal anti-inflammatory drugs (NSAIDs) are much more poorly characterized than upper gastrointestinal effects.
AIM: To determine if NSAIDs increase lower gastrointestinal adverse effects and if the risk with non-selective NSAIDs is greater than with cyclooxygenase-2-selective inhibitors (coxibs).
METHODS: Computerized databases were searched to identify studies of NSAID use reporting on lower gastrointestinal integrity (e.g. permeability), visualization (e.g. erosions, ulcers) and clinical events.
RESULTS: Designs in 47 studies were randomized (18), case-control (14), cohort (eight) and before-after (seven). Non-selective-NSAIDs had significantly more adverse effects vs. no NSAIDs in 20 of 22 lower gastrointestinal integrity studies, five of seven visualization studies, seven of 11 bleeding studies (OR: 1.9-18.4 in case-control studies), two of two perforation studies (OR: 2.5-8.1) and five of seven diverticular disease studies (OR: 1.5-11.2). Coxibs had significantly less effect vs. non-selective-NSAIDs in three of four integrity studies, one endoscopic study (RR mucosal breaks: 0.3), and two randomized studies (RR lower gastrointestinal clinical events: 0.5; haematochezia: 0.4).
CONCLUSIONS: An increase in lower gastrointestinal injury and clinical events with non-selective-NSAIDs appears relatively consistent across the heterogeneous collection of trials. Coxibs are associated with lower rates of lower gastrointestinal injury than non-selective-NSAIDs. More high-quality trials are warranted to more precisely estimate the effects of non-selective-NSAIDs and coxibs on the lower gastrointestinal tract.},
}
@article {pmid16917414,
year = {2006},
author = {Frattini, JC and Abir, F and Robert, ME and Longo, WE},
title = {Colonic perforation secondary to diverticular disease in the setting of ulcerative colitis.},
journal = {Journal of clinical gastroenterology},
volume = {40},
number = {7},
pages = {652-653},
doi = {10.1097/00004836-200608000-00021},
pmid = {16917414},
issn = {0192-0790},
mesh = {Colitis, Ulcerative/*complications ; Colonic Diseases/*etiology ; Diverticulosis, Colonic/complications/*etiology ; Female ; Humans ; Intestinal Perforation/*etiology ; Middle Aged ; },
}
@article {pmid16910407,
year = {2006},
author = {Rinas, U and Adamek, HE},
title = {[Diverticulitis and diverticulosis].},
journal = {MMW Fortschritte der Medizin},
volume = {148},
number = {29-30},
pages = {37-41; quiz 42},
pmid = {16910407},
issn = {1438-3276},
mesh = {Acute Disease ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis/*therapy ; Diverticulosis, Colonic/diagnosis/*therapy ; Gastrointestinal Hemorrhage/diagnosis/etiology/therapy ; Humans ; Intestinal Perforation/diagnosis/etiology/therapy ; Prognosis ; Secondary Prevention ; },
abstract = {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.},
}
@article {pmid16905414,
year = {2006},
author = {Martel, G and Boushey, RP},
title = {Laparoscopic colon surgery: past, present and future.},
journal = {The Surgical clinics of North America},
volume = {86},
number = {4},
pages = {867-897},
doi = {10.1016/j.suc.2006.05.006},
pmid = {16905414},
issn = {0039-6109},
mesh = {Colon/*surgery ; Colonic Neoplasms/*surgery ; Humans ; Inflammatory Bowel Diseases/*surgery ; Laparoscopes ; Laparoscopy/*methods ; },
abstract = {Since its first described case in 1991, laparoscopic colon surgery has lagged behind minimally invasive surgical methods for solid intra-abdominal organs in terms of acceptability, dissemination, and ease of learning. In colon cancer, initial concerns over port site metastases and adequacy of oncologic resection have considerably dampened early enthusiasm for this procedure. Only recently, with the publication of several large, randomized controlled trials, has the incidence of port site metastases been shown to be equivalent to that of open resection. Laparoscopic surgery for colon cancer has also been demonstrated to be at least equivalent to traditional laparotomy in terms of adequacy of oncologic resection, disease recurrence, and long-term survival. In addition, numerous reports have validated short-term benefits following laparoscopic resection for cancer, including shorter hospital stay, shorter time to recovery of bowel function, and decreased analgesic requirements, as well as other postoperative variables. In benign colonic disease, much less high-quality literature exists supporting the use of laparoscopic methods. Two recent randomized controlled trials have demonstrated some short-term benefits to laparoscopic ileocolic resection for CD, in addition to evident cosmetic advantages. On the other hand, the current evidence on laparoscopic surgery for UC does not support its routine use among nonexpert surgeons outside of specialized centers. Laparoscopic colonic resection for diverticular disease appears to provide several short-term benefits, although these advantages may not translate to cases of complicated diverticulitis. Despite the increasing acceptability of minimally invasive methods for the management of benign and malignant colonic pathologies, laparoscopic colon resection remains a prohibitively difficult technique to master. Numerous technological innovations have been introduced onto the market in an effort to decrease the steep learning curve associated with laparoscopic colon surgery. Good evidence exists supporting the use of second-generation, sleeveless, hand-assist devices in this context. Similarly, new hemostatic devices such as the ultrasonic scalpel and the electrothermal bipolar vessel sealer may be particularly helpful for extensive colonic mobilizations, in which several vascular pedicles must be taken. The precise role of these hemostatic technologies has yet to be established, particularly in comparison with stapling devices and significantly cheaper laparoscopic clips. Finally, recent advances in camera systems are promising to improve the ease with which difficult colonic dissections can be performed.},
}
@article {pmid16897334,
year = {2006},
author = {Munikrishnan, V and Helmy, A and Elkhider, H and Omer, AA},
title = {Management of acute diverticulitis in the East Anglian region: results of a United Kingdom regional survey.},
journal = {Diseases of the colon and rectum},
volume = {49},
number = {9},
pages = {1332-1340},
doi = {10.1007/s10350-006-0594-2},
pmid = {16897334},
issn = {0012-3706},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Data Collection ; Diverticulitis, Colonic/diagnosis/*therapy ; Guideline Adherence ; Humans ; Middle Aged ; Practice Guidelines as Topic ; *Practice Patterns, Physicians' ; United Kingdom ; },
abstract = {PURPOSE: Acute diverticulitis is the most common presentation of diverticular disease; however, no published guidelines for management are available in the United Kingdom. This survey was designed to assess the current United Kingdom regional practice compared with the guidelines published by The American Society of Colon and Rectal Surgeons.
METHODS: A questionnaire survey focused on the management of acute diverticulitis was sent to all consultants, specialist registrars, and staff-grade surgeons in general surgery in one United Kingdom region.
RESULTS: Eighty-two questionnaires were returned (80 percent). A majority (80 percent) would request routine blood tests, abdominal, and erect chest x-rays on arrival. Pethidine (56 percent) was the preferred analgesic, followed by morphine (40 percent). Ninety-four percent used an antibiotic combination of second/third-generation cephalosporin and metronidazole. Computerized tomography was the most commonly used initial investigation (42 percent). Forty percent use barium enema and 31 percent use a combination of barium enema and sigmoidoscopy as follow-up investigations. In patients older than aged 50 years, elective resection would be considered by a majority (51 percent) only when complications arose. In those aged 50 years or younger, 35 percent would resect only if complications arose with only 6 percent after a single episode of acute diverticulitis.
CONCLUSIONS: There are major differences in the management of patients with acute diverticulitis in our current practice in one United Kingdom region compared with the guidelines published by The American Society of Colon and Rectal Surgeons, which are based on published literature. There is an urgent need to establish similar guidelines in the United Kingdom to improve the clinical outcome of patients with such a common condition.},
}
@article {pmid16892842,
year = {2006},
author = {Dormand, EL and Prabhu-Desai, A and Rice, AJ and Rosin, RD},
title = {Not all pain in the left iliac fossa is diverticular disease: A case study of a psoas myxoma and review.},
journal = {The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland},
volume = {4},
number = {4},
pages = {239-243},
doi = {10.1016/s1479-666x(06)80066-1},
pmid = {16892842},
issn = {1479-666X},
mesh = {Diagnosis, Differential ; Diverticulum/diagnosis ; Female ; Humans ; Middle Aged ; Muscle Neoplasms/complications/*diagnosis/*therapy ; Myxoma/complications/*diagnosis/*therapy ; Pelvic Pain/etiology ; *Psoas Muscles ; },
abstract = {Intramuscular myxomas are rare, benign, mesenchymal tumours that may present to a wide variety of specialties. We present a case study of an intramuscular myxoma in the psoas muscle, followed by a review of the literature regarding the diagnosis and treatment of intramuscular myxomas},
}
@article {pmid16885701,
year = {2006},
author = {White, JA},
title = {Probiotics and their use in diverticulitis.},
journal = {Journal of clinical gastroenterology},
volume = {40 Suppl 3},
number = {},
pages = {S160-2},
doi = {10.1097/01.mcg.0000225504.67547.d9},
pmid = {16885701},
issn = {0192-0790},
mesh = {Disease Progression ; Diverticulitis, Colonic/complications/*drug therapy/prevention & control ; Humans ; Probiotics/*therapeutic use ; },
abstract = {Probiotics are live microorganisms that when ingested affect the intestinal microbial flora and benefit the health of the host. Probiotics have been shown to have a positive effect on various gastrointestinal and other conditions; however, the beneficial effect of probiotics on treating diverticulitis and diverticular disease has not yet been clearly demonstrated. In this paper, the theoretical framework for using probiotics to prevent or treat diverticular disease is reviewed, and two preliminary studies on the use of probiotics for maintenance of remission of uncomplicated diverticular disease are briefly summarized.},
}
@article {pmid16885700,
year = {2006},
author = {Di Mario, F and Comparato, G and Fanigliulo, L and Aragona, G and Cavallaro, LG and Cavestro, GM and Franzé, A},
title = {Use of mesalazine in diverticular disease.},
journal = {Journal of clinical gastroenterology},
volume = {40 Suppl 3},
number = {},
pages = {S155-9},
doi = {10.1097/01.mcg.0000225509.98041.4b},
pmid = {16885700},
issn = {0192-0790},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Cytokines/metabolism ; Disease Progression ; Diverticulitis, Colonic/complications/*drug therapy/metabolism ; Diverticulosis, Colonic/complications/drug therapy/metabolism ; Humans ; Mesalamine/*therapeutic use ; Nitric Oxide/metabolism ; Secondary Prevention ; },
abstract = {Diverticular disease includes a spectrum of conditions sharing the underlying pathology of acquired diverticula of the colon: symptomatic uncomplicated diverticular disease, recurrent symptomatic uncomplicated diverticular disease, and complicated diverticular disease. Goals of therapy in diverticular disease should be to improve symptoms and to prevent recurrent attacks in symptomatic uncomplicated diverticular disease, and to prevent the complications of disease such as diverticulitis. Inflammation seems to play a key role in all forms of the disease. This is the rationale for the use of anti-inflammatory drugs such as mesalazine. Inflammation in such diseases seems to be generated by a heightened production of proinflammatory cytokines, reduced anti-inflammatory cytokines, and enhanced intramucosal synthesis of nitric oxide. The mechanisms of action of mesalazine are not yet well understood. It is an anti-inflammatory drug that inhibits factors of the inflammatory cascade (such as cyclooxygenase) and free radicals, and has an intrinsic antioxidant effect. Some recent studies confirm the efficacy of mesalazine in diverticular disease both in relief of symptoms in symptomatic uncomplicated forms and in prevention of recurrence of symptoms and main complications.},
}
@article {pmid16885698,
year = {2006},
author = {Frattini, J and Longo, WE},
title = {Diagnosis and treatment of chronic and recurrent diverticulitis.},
journal = {Journal of clinical gastroenterology},
volume = {40 Suppl 3},
number = {},
pages = {S145-9},
doi = {10.1097/01.mcg.0000225507.52300.b9},
pmid = {16885698},
issn = {0192-0790},
mesh = {Age Factors ; Chronic Disease ; Disease Progression ; Diverticulitis, Colonic/complications/*diagnosis/immunology/pathology/*therapy ; Humans ; Immunocompromised Host/immunology ; Minimally Invasive Surgical Procedures ; Quality of Life ; Recurrence ; },
abstract = {In Western countries the prevalence of diverticular disease has increased over the past century. Although, most patients remain asymptomatic, among those who experience an attack of diverticulitis, one-third will have recurrent symptoms, and a further third will have a subsequent episode. The indications for surgery after treatment of acute diverticulitis is still under debate. Uncomplicated disease less commonly as thought, progresses to a life threatening situation such as free perforation. Among those who develop complicated diverticulitis, it is often their first presentation. Fistula to the urinary tract often require surgery; however, complicated disease such as an abscess or phlegmon can be managed conservatively and subsequent surgery is selective depending on the recovery from the initial episode. Patients with chronic diverticular disease (persistent pain in the absence of inflammation) have greatly improved quality of life with surgery. The question of greater virulence of disease among young patients may no longer be true and recommendations for surgery may parallel that of older patients. Immunocompromised patients should have definitive surgical therapy early on in the course of the disease. Right-sided disease remains uncommon in the Western world and a conservative approach in the absence of free perforation is recommended. In right-sided disease and in young patients, misdiagnosis is common. In the elective setting, a laparoscopic approach is rapidly becoming preferred because of less morbidity and shorter hospital stay. The treatment of diverticular disease is rapidly undergoing reevaluation, and novel therapies and increased conservative approaches are evolving. Prospective randomized trials are needed, but remain difficult owing to the uncertain natural history of the disease.},
}
@article {pmid16885696,
year = {2006},
author = {Harpaz, N and Sachar, DB},
title = {Segmental colitis associated with diverticular disease and other IBD look-alikes.},
journal = {Journal of clinical gastroenterology},
volume = {40 Suppl 3},
number = {},
pages = {S132-5},
doi = {10.1097/01.mcg.0000225505.67547.90},
pmid = {16885696},
issn = {0192-0790},
mesh = {Colitis/diagnosis/etiology/*pathology ; Colitis, Ulcerative/diagnosis/etiology/pathology ; Colon/pathology ; Crohn Disease/diagnosis/etiology/pathology ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis/etiology/*pathology ; Humans ; Irritable Bowel Syndrome/diagnosis/etiology/*pathology ; },
abstract = {Segmental colitis associated with diverticular disease is an inflammatory disorder that bears close clinical and histopathologic similarities to idiopathic inflammatory bowel disease. Comparison with other inflammatory bowel disease-like disorders, such as blind-ended pouches in ulcerative colitis, chronic granulomatous appendicitis, and delayed-surgery appendicitis, affords intriguing analogies and potential clues to its pathogenesis.},
}
@article {pmid16885695,
year = {2006},
author = {Brian West, A},
title = {The pathology of diverticulosis: classical concepts and mucosal changes in diverticula.},
journal = {Journal of clinical gastroenterology},
volume = {40 Suppl 3},
number = {},
pages = {S126-31},
doi = {10.1097/01.mcg.0000225508.90417.07},
pmid = {16885695},
issn = {0192-0790},
mesh = {Colon/pathology ; Disease Progression ; Diverticulitis, Colonic/etiology/pathology ; Diverticulosis, Colonic/complications/*pathology ; Diverticulum, Colon/*pathology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Mucosa/*pathology ; },
abstract = {Left-sided 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 1960s to 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 muscularis propria of the left colon at points of penetration of the vasa recta that supply the submucosa and mucosa. Cardinal features of the sigmoid colon in diverticular disease are abnormalities of the muscularis propria, including thickening and elastosis of the teniae, shortening of the bowel, and thickening and folding of the circular muscle with the development of transverse semilunar ridges between the mesenteric and antimesenteric teniae. Complications of diverticular disease such as hemorrhage, diverticulitis, peridiverticular abscess, fistula, and perforation are well recognized.},
}
@article {pmid16885693,
year = {2006},
author = {Spiller, R},
title = {How inflammation changes neuromuscular function and its relevance to symptoms in diverticular disease.},
journal = {Journal of clinical gastroenterology},
volume = {40 Suppl 3},
number = {},
pages = {S117-20},
doi = {10.1097/01.mcg.0000225506.44676.03},
pmid = {16885693},
issn = {0192-0790},
mesh = {Animals ; Disease Models, Animal ; Diverticulitis, Colonic/complications/*immunology/*physiopathology ; Gastrointestinal Motility/physiology ; Humans ; *Inflammation ; Mice ; Muscle, Smooth/*innervation/pathology/*physiopathology ; Myenteric Plexus/pathology/*physiopathology ; Neuronal Plasticity/physiology ; Neurotransmitter Agents/physiology ; Pain/etiology/physiopathology ; },
abstract = {Diverticulosis is largely asymptomatic but recent evidence suggests that episodes of acute diverticulitis double the risk of subsequently suffering from recurrent noninflammatory pain. Numerous animal models demonstrate how inflammation is followed by circular muscle hypertrophy, abnormalities of innervation, and increased sensitivity to cholinergic agents. There is also an impairment of norepinephrine and acetylcholine release and damage to nitrergic neurons. These changes are also associated with visceral hypersensitivity. Many of the features, including visceral hypersensitivity are also seen in symptomatic patients with diverticulosis. The trinitrobenzene sulfonic acid colitis model demonstrates that inflammation is followed by long lasting increases in tachykinin and other neuropeptide immunoreactivity. These changes occur both in the mucosa and myenteric plexus and parallel changes seen in resections and mucosal biopsies in diverticular patients. These neural abnormalities may be responsible for the visceral hypersensitivity, which explains why symptoms correlate poorly with objective abnormalities such as intraluminal pressure or motor patterns. Treatment of visceral hypersensitivity might be more effective than current therapies that often leave pain unaltered.},
}
@article {pmid16885692,
year = {2006},
author = {Korzenik, JR},
title = {Case closed? Diverticulitis: epidemiology and fiber.},
journal = {Journal of clinical gastroenterology},
volume = {40 Suppl 3},
number = {},
pages = {S112-6},
doi = {10.1097/01.mcg.0000225503.59923.6c},
pmid = {16885692},
issn = {0192-0790},
mesh = {Age Factors ; Dietary Fiber/*deficiency/metabolism/therapeutic use ; Diverticulitis, Colonic/diet therapy/*epidemiology/*etiology/metabolism ; Diverticulosis, Colonic/diet therapy/epidemiology/etiology/metabolism ; Global Health ; Humans ; Prevalence ; Risk Factors ; },
abstract = {A major advance in understanding diverticular disease occurred decades ago with the epidemiologic association between fiber intake and the development of diverticular disease. This association has been well documented with investigations into the emergence of diverticular disease in underdeveloped countries where the disease had been virtually unknown before the adoption of a westernized diet, low in fiber. The high frequency of right-sided diverticular disease in Asian countries diverges from what is seen in the West. The physiologic effects of insoluble fiber has been well examined as well, increasing bulk and decreasing transit time, with a deficiency contributing to the high pressures implicated in the physiology which leads to diverticular disease. However, at most, 10% to 25% of individuals with diverticular disease will develop diverticulitis. Risk factors for symptomatic diverticular have been increasingly described in recent years with obesity and red meat intake being of particular importance, in addition to age. However, the known factors poorly identify those at increased risk and the predisposing pathophysiology is incompletely understood as well. Insoluble fiber, but not soluble fiber, has been viewed as the principal component which has been deficient in western diets and is the culprit which leads to the establishment of diverticular disease and in turn, diverticulitis. Soluble fiber and its effect on the intestinal flora is proposed as having significant influence on the development of diverticulitis. This understanding, if demonstrated, would have important implications for the primary and secondary prevention of diverticulitis.},
}
@article {pmid16885691,
year = {2006},
author = {Bogardus, ST},
title = {What do we know about diverticular disease? A brief overview.},
journal = {Journal of clinical gastroenterology},
volume = {40 Suppl 3},
number = {},
pages = {S108-11},
doi = {10.1097/01.mcg.0000212603.28595.5c},
pmid = {16885691},
issn = {0192-0790},
mesh = {Age Factors ; Dietary Fiber/deficiency/therapeutic use ; Disease Progression ; *Diverticulitis, Colonic/diagnosis/etiology/pathology/therapy ; *Diverticulosis, Colonic/epidemiology/etiology/pathology/therapy ; Female ; Humans ; Male ; Prevalence ; Probiotics/therapeutic use ; United States/epidemiology ; },
abstract = {Diverticulosis and its complications, particularly diverticulitis, are extremely common in western countries. The major factor in the development of diverticulosis is a lack of adequate fiber intake. Diverticulitis may be complicated by abscess formation, fistula formation, peritonitis, or obstruction. Computed tomography scans are highly useful tools to plan appropriate care. Most cases of simple, uncomplicated diverticulitis respond to conservative therapy with bowel rest and antibiotics. Many controversies remain in the care of diverticulitis patients, including the optimal timing of surgery. One particularly interesting area of recent research examines the overlap of diverticulitis and inflammatory bowel disease, including the use of probiotics and mesalamine in diverticular disease.},
}
@article {pmid16882413,
year = {2006},
author = {Nguyen, SQ and Divino, CM and Vine, A and Reiner, M and Katz, LB and Salky, B},
title = {Laparoscopic surgery for diverticular disease complicated by fistulae.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {10},
number = {2},
pages = {166-168},
pmid = {16882413},
issn = {1086-8089},
mesh = {Diverticulum/*complications/*surgery ; Female ; Humans ; Intestinal Fistula/*etiology/*surgery ; *Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/*complications/*surgery ; },
abstract = {OBJECTIVES: Elective laparoscopic surgery for recurrent, uncomplicated diverticular disease is considered safe and effective; however, little data exist on complicated cases. We investigated laparoscopic sigmoid resection for diverticulitis complicated by fistulae.
METHODS: We conducted a retrospective review of patients who underwent laparoscopic treatment of enteric fistulae complicating diverticular disease performed by 4 surgeons at the Mount Sinai Medical Center.
RESULTS: From 1994 to 2004, 14 patients underwent elective laparoscopic sigmoid resections for diverticular disease complicated by enteric fistulae. Patients' mean age was 62 and 4 were female. Multiple fistulae were present in 21%. Types of fistulae included 8 colovesical, 5 enterocolic, 2 colovaginal, 1 colosalpingal, and 1 colocutaneous. All patients successfully underwent sigmoidectomy, and 14% required additional bowel resections. No cases were proximally diverted. Conversion to open was necessary in 36% of cases, all due to dense adhesions and severe inflammation. The mean operative time was 209 minutes, and the mean blood loss was 326 mL. Two (14%) postoperative complications occurred, including one anastomotic bleed and one prolonged ileus. No anastomotic leaks or mortalities occurred. The mean postoperative stay was 6 days.
CONCLUSION: Laparoscopic management of diverticular disease complicated by fistulae can be performed effectively and safely. The conversion rate is higher than traditionally accepted rates of uncomplicated cases of diverticulitis and is associated with severe adhesions and inflammation.},
}
@article {pmid16875523,
year = {2006},
author = {Sierra-Montenegro, E and Villanueva-Sáenz, E and Fernández-Rivero, JM and Rocha-Ramírez, JL and Rojas-Illanes, M},
title = {[Rectal diverticula. Case report].},
journal = {Cirugia y cirujanos},
volume = {74},
number = {3},
pages = {209-210},
pmid = {16875523},
issn = {0009-7411},
mesh = {Aged, 80 and over ; Diverticulum/complications/*diagnosis ; Diverticulum, Colon/complications/diagnosis ; Humans ; Male ; Rectal Diseases/complications/*diagnosis ; },
abstract = {BACKGROUND: The presence of rectal diverticula is extremely rare; nevertheless, diverticular disease is considered a greater problem. We report a case of rectal diverticula in a patient with diverticular disease of the sigmoid.
CLINICAL CASE: An 88-year-old male presented to the emergency room with hematochezia of several days evolution. During colonoscopy two diverticula were seen at 5 cm from the anal verge.
DISCUSSION: Two theories exist to explain why rectal diverticula are rare, but other authors indicate its relationship to genetic alterations. Rectal diverticula are generally asymptomatic and surgical treatment only becomes necessary when these lesions progress to ulceration and abscess formation.},
}
@article {pmid16875087,
year = {2006},
author = {Lundy, JB and Edwards, KD and Parker, DM and Rivera, DE},
title = {Recurrent rectal diverticulitis.},
journal = {The American surgeon},
volume = {72},
number = {7},
pages = {633-636},
pmid = {16875087},
issn = {0003-1348},
mesh = {Colon, Descending/surgery ; Colon, Sigmoid/surgery ; Diverticulitis/*surgery ; Diverticulitis, Colonic/surgery ; Elective Surgical Procedures ; Follow-Up Studies ; Humans ; Ileostomy ; Male ; Middle Aged ; Rectal Diseases/*surgery ; Rectum/surgery ; Recurrence ; },
abstract = {Diverticular involvement of the colon is very common in the United States. Patients present with asymptomatic diverticuli and may have complications of these, spanning the spectrum of uncomplicated diverticulitis to an acute surgical abdominal as a result of feculent peritonitis. We discuss a patient requiring low anterior resection for intractable symptoms resulting from recurrent rectal diverticulitis as well as a review of the limited literature on the subject of diverticular disease of the rectum.},
}
@article {pmid16836029,
year = {2006},
author = {Adams, SM},
title = {Meperidine to manage pain related to diverticular disease.},
journal = {American family physician},
volume = {73},
number = {12},
pages = {2123; author reply 2123},
pmid = {16836029},
issn = {0002-838X},
mesh = {Analgesics, Opioid/*therapeutic use ; Diverticulosis, Colonic/*complications ; Humans ; Meperidine/*therapeutic use ; Morphine/*therapeutic use ; Pain/*drug therapy/etiology ; },
}
@article {pmid16834842,
year = {2006},
author = {Bardhan, SK and Morgan, E and Daniels, IR and Mortensen, NJ},
title = {A diverticular 'pain in the bottom'.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {88},
number = {4},
pages = {W1-2},
pmid = {16834842},
issn = {1478-7083},
mesh = {Abdominal Abscess/*complications/diagnostic imaging/therapy ; Abscess/*complications/diagnostic imaging ; Adult ; Anti-Bacterial Agents/therapeutic use ; *Buttocks ; Colon, Sigmoid ; Diverticulitis, Colonic/*complications/diagnostic imaging ; Drainage/methods ; Humans ; Low Back Pain/*etiology ; Male ; Rare Diseases ; Tomography, X-Ray Computed ; },
abstract = {This is the case of a 40-year-old man with a gluteal abscess as the first presentation of diverticular disease. As well as the unusual site, imaging revealed the lack of a connective tract between the abscess and the abdominal cavity or retroperitoneum. In addition, a lack of gastrointestinal symptoms made this case very unusual. Hence, this highlights the need for a high index of clinical suspicion when the usual clinical pointers that guide to the diagnosis of diverticulitis are absent.},
}
@article {pmid16793347,
year = {2006},
author = {Sanford, MF and Pickhardt, PJ},
title = {Diagnostic performance of primary 3-dimensional computed tomography colonography in the setting of colonic diverticular disease.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {4},
number = {8},
pages = {1039-1047},
doi = {10.1016/j.cgh.2006.04.005},
pmid = {16793347},
issn = {1542-3565},
mesh = {Adenocarcinoma/diagnosis ; Adenoma, Villous/diagnosis ; Colonic Neoplasms/diagnosis ; Colonic Polyps/diagnosis ; *Colonography, Computed Tomographic ; Colonoscopy ; Diverticulosis, Colonic/*diagnosis ; Female ; Humans ; *Imaging, Three-Dimensional ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Sensitivity and Specificity ; },
abstract = {BACKGROUND & AIMS: Colonic diverticular disease (CDD) is a leading cause of nondiagnostic segmental evaluation at computed tomography colonography (CTC). The primary goal of this study was to evaluate the impact of CDD on polyp detection at primary 3-dimensional (3D) CTC.
METHODS: The study group consisted of 280 asymptomatic average-risk adults (mean age, 58.1 y; 167 men, 113 women). All patients underwent CTC followed by same-day optical colonoscopy with segmental unblinding (reference standard). Primary 3D endoluminal evaluation with 2-dimensional correlation was used for initial polyp detection at CTC. Without knowledge of polyp findings, all colonic segments were reviewed for the presence of CDD and graded as absent, minimal, moderate, or extensive disease.
RESULTS: Moderate or extensive CDD was present in 271 (12.1%) of 2240 colonic segments and 142 (50.7%) of 280 patients. CTC performance for polyps 6 mm or larger in the presence and absence of moderate-extensive CDD was as follows: by-segment sensitivity of 90.3% (28/31) and 79.4% (123/155); by-patient sensitivity of 86.5% (64/74) and 83.1% (54/65); by-segment specificity of 97.1% (233/240) and 97.7% (1772/1814); by-patient specificity of 83.8% (57/68) and 83.6% (61/73); by-segment positive predictive value of 80.0% (28/35) and 74.5% (123/165); by-patient positive predictive value of 85.3% (64/75) and 81.8% (64/66); by-segment negative predictive value of 98.7% (233/236) and 98.2% (1172/1804); and by-patient negative predictive value of 85.1% (57/67) and 84.7% (61/72), respectively (not significant, P > or = .15).
CONCLUSIONS: CDD was common in this asymptomatic screening population, but its presence did not degrade the diagnostic performance of primary 3D CTC for polyp detection.},
}
@article {pmid16738930,
year = {2006},
author = {Lee, SY and Coughlin, B and Wolfe, JM and Polino, J and Blank, FS and Smithline, HA},
title = {Prospective comparison of helical CT of the abdomen and pelvis without and with oral contrast in assessing acute abdominal pain in adult Emergency Department patients.},
journal = {Emergency radiology},
volume = {12},
number = {4},
pages = {150-157},
pmid = {16738930},
issn = {1070-3004},
mesh = {Abdomen, Acute/*diagnostic imaging/etiology ; Administration, Oral ; Contrast Media/*administration & dosage ; Emergency Service, Hospital ; Female ; Humans ; *Iothalamate Meglumine/administration & dosage ; Male ; Middle Aged ; Observer Variation ; Pelvis/*diagnostic imaging ; *Radiography, Abdominal ; *Tomography, Spiral Computed ; },
abstract = {PURPOSE: This prospective study compares the agreement of nonenhanced helical computed tomography (NECT) with oral contrast-enhanced computed tomography (CECT) in Emergency Department (ED) patients presenting with acute abdominal pain.
MATERIALS AND METHODS: One hundred eighteen patients presenting to the ED with acute abdominal pain undergoing CT were enrolled over a 13-month period using convenience sampling. Exclusion criteria included acute trauma, pregnancy, unstable patients, and patients suspected of having urinary calculi. Patients were scanned helically using 5-mm collimation before and approximately 90 min after oral contrast administration. Both exams were prospectively interpreted by different attending radiologists in a blinded fashion using an explicit data sheet specifying the presence or absence of 28 parameters relating to various common diagnoses.
RESULTS: The 118 patients had a mean age of 49 years, a male: female ratio of 7:13, and a median height, weight, and BMI of 166 cm, 80 kg, and 29, respectively. The most common indications for the study included appendicitis (32%) and diverticular disease (12%). Pain maximally localized to the right lower quadrant in 37% and the left lower quadrant in 21%. There were 21 patients that had significant disagreement of interpretations between NECT and CECT resulting in a simple agreement of 79% (95% CI: 70-87%). For specific radiologic parameters, agreement ranged from 77 to 100%. A post hoc agreement analysis was subsequently performed by two radiologists and only five paired scans were identified as discordant between the NECT and CECT. For only one of these patients did both radiologists agree that there was a definite discordant result between the two studies. A final unblinded consensus review demonstrated that much of the disagreement between the interpretations was related to interobserver variation.
CONCLUSION: There is 79% simple agreement between NECT and CECT in diagnosing various causes of acute abdominal pain in adult ED patients. Post hoc analysis indicates that a significant portion of the discordance was attributable to interobserver variability. This data suggests that NECT should be considered in adult ED patients presenting with acute abdominal pain.},
}
@article {pmid16736310,
year = {2006},
author = {Reissfelder, C and Buhr, HJ and Ritz, JP},
title = {Can laparoscopically assisted sigmoid resection provide uncomplicated management even in cases of complicated diverticulitis?.},
journal = {Surgical endoscopy},
volume = {20},
number = {7},
pages = {1055-1059},
pmid = {16736310},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon, Sigmoid/*surgery ; Digestive System Surgical Procedures/methods ; Diverticulitis/*complications/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Sigmoid Diseases/*complications/*surgery ; },
abstract = {BACKGROUND: Laparoscopically assisted sigmoid resection has become an accepted method for treating uncomplicated diverticulitis. This prospective study aimed to compare the results of laparoscopic sigmoid resection for uncomplicated and complicated sigmoid diverticular disease used to check the indication for the complicated stages of diverticulitis.
METHODS: All patients who underwent laparoscopic resection for sigmoid diverticulitis at the authors' hospital between 1999 and 2005 were divided into two groups: group 1 (uncomplicated diverticular disease) and group 2 (complicated diverticular disease). The exclusion criteria specified generalized peritonitis, signs of sepsis, and extensive previous abdominal surgery.
RESULTS: Of the 203 patients (108 men and 95 women) who underwent laparoscopically assisted resection during the examination period, 112 were assigned to group 1 and 91 to group 2. Differences in favor of group 1 were found for the duration of surgery (154 vs 166 min), the conversion rate (1.8% vs 9.9%), the postoperative wound infections (2.7% vs 13.2%), and the postoperative hospitalization period (12.3 +/- 3.9 vs 15.0 +/- 5.6 days). No significant differences were seen in any other areas such as completion of nutritional buildup (4.6 vs 5.0 days) or time until the first postoperative bowel movement (2.8 vs 3.3 days). Total postoperative morbidity (16.1% vs 26.4%; p = 0.10) tended to be increased in group 2, but this difference was not statistically significant.
CONCLUSIONS: Laparoscopic sigmoid resection can be performed for patients who have complicated diverticulitis without significantly increasing their overall morbidity. This group of patients could benefit from the advantages of the minimally invasive procedure despite a longer operating time and a higher conversion rate.},
}
@article {pmid16734170,
year = {2006},
author = {Castronovo, G and Ciulla, A and Tomasello, G and Damiani, S and Maiorana, AM},
title = {Diverticular disease of right colon. Clinical variants and personal experience.},
journal = {Chirurgia italiana},
volume = {58},
number = {2},
pages = {213-217},
pmid = {16734170},
issn = {0009-4773},
mesh = {*Diverticulosis, Colonic/diagnostic imaging/surgery ; Female ; Humans ; Male ; Middle Aged ; Radiography ; },
abstract = {Diverticular disease of the right colon is not common, especially in western countries. It occurs in two different clinical forms, known as the "usual" and "hidden" variants. The diagnosis is not always easy, especially in the latter variant, because sometimes barium enema and CT scan are unable to distinguish this form from cancer. The final diagnosis is only intraoperative. In our experience, from 1994 to 2004, we observed 4 cases of complicated right-sided diverticulitis. Three of these patients had symptoms mimicking acute appendicitis, such as fever and abdominal pain. Only 2 of them underwent surgical treatment consisting of a right standard hemicolectomy. The 4th patient had no inflammatory symptoms, but had a history of right-sided abdominal pain and diarrhoea. Laboratory data showed only hypochromic anaemia. Barium enema and CT scan highlighted a vegetating mass in the ascending colon causing irregular severe stenosis of the lumen and hyperdensity of mesocolic fatty tissue. Surgical treatment consisted in a right hemicolectomy. Macroscopically, the mass involved the caecum and ascending colon. Enlarged lymph-nodes were present in the thickness of the mesocolon, but not in other districts. Histological examination revealed diffuse diverticular disease complicated by perforation of many diverticula into the mesocolon.},
}
@article {pmid16718843,
year = {2006},
author = {Floch, MH and White, JA},
title = {Management of diverticular disease is changing.},
journal = {World journal of gastroenterology},
volume = {12},
number = {20},
pages = {3225-3228},
pmid = {16718843},
issn = {1007-9327},
mesh = {Acute Disease ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/diagnosis/*drug therapy/*surgery ; Humans ; Inflammatory Bowel Diseases/complications ; Laparoscopy/*methods ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; },
abstract = {Diverticular disease of the colon is primarily a disease of humans living in westernized and industrialized countries. Sixty percent of humans living in industrialized countries will develop colonic diverticula. It is rare before the age of 40, but more prone to complications when it occurs in the young. By age 80, over 65% of humans have colonic diverticula. The cause remains uncertain, but epidemiologic studies attribute it to dietary fiber deficiency. The cause of diverticulitis remains uncertain, but new observations and hypotheses suggest that it is due to chronic inflammation in the bowel wall. Standard medical therapies of bowel rest and antibiotics are still the recommended treatment. However, changing concepts and new therapies indicate that anti-inflammatory agents such as mesalamine and possibly probiotics may be helpful in shortening the course and perhaps preventing recurrences. Standard surgical treatment for perforation for severe acute disease has developed so that two-stage procedures are recommended. In addition, laparoscopic surgery has proven safe and may slowly become the technique of choice.},
}
@article {pmid16708698,
year = {2006},
author = {Marrs, JA},
title = {Abdominal complaints: diverticular disease.},
journal = {Clinical journal of oncology nursing},
volume = {10},
number = {2},
pages = {155-157},
doi = {10.1188/06.CJON.155-157},
pmid = {16708698},
issn = {1092-1095},
mesh = {Abdominal Pain/etiology ; Diagnosis, Differential ; *Diverticulum/complications/diagnosis/therapy ; Humans ; Intestinal Diseases/diagnosis ; Neoplasms/diagnosis ; Patient Education as Topic ; },
abstract = {A patient with a history of follicular large cell lymphoma schedules an urgent office visit for vague complaints of intermittent abdominal pain for the past month. The pain is present in the lower quadrants and is associated with cramping and alternating periods of constipation and diarrhea. The patient denies nausea, vomiting, or fevers. A review of systems is negative for any other complaints, and the patient's weight is stable. The patient is concerned that the pain represents a recurrence of lymphoma, which originally was diagnosed eight years prior. The patient was treated for relapse more than two years ago with no evidence of disease recurrence. A computed tomography (CT) scan completed five months prior was negative for lymphadenopathy. A previously enlarged right inguinal node had resolved completely. However, mild diverticulosis was observed in the sigmoid colon. The following information represents a general review of diverticular disease.},
}
@article {pmid16706105,
year = {2006},
author = {Tucker, ON and Madhavan, P and Healy, V and Jeffers, M and Keane, FB},
title = {Unusual presentation of an appendiceal malignancy.},
journal = {International surgery},
volume = {91},
number = {1},
pages = {57-60},
pmid = {16706105},
issn = {0020-8868},
mesh = {Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Appendiceal Neoplasms/*diagnosis/pathology/surgery ; Diverticulitis/diagnosis ; Female ; Humans ; Intestinal Fistula/diagnosis ; Middle Aged ; Tomography, X-Ray Computed ; Vaginal Fistula/diagnosis ; },
abstract = {Primary malignant epithelial tumors of the appendix are uncommon. The most common presentation of appendiceal malignancy is right lower abdominal pain suggestive of acute appendicitis. Presentation caused by loco-regional spread with involvement of neighboring organs is rare. We present the case of a 48-year-old woman with an appendiceal malignancy who presented with symptoms and signs suggestive of complicated diverticular disease with an enterovaginal fistula. From a review of the literature, this is the first report of an appendiceal malignancy presenting in this manner.},
}
@article {pmid16706097,
year = {2006},
author = {Carvajal Balaguera, J and Camuñas Segovia, J and Peña Gamarra, L and Oliart Delgado de Torres, S and Martin Garcia-Almenta, M and Viso Ciudad, S and Fernández, IP and Gómez Maestro, P and Cerquella Hernández, C},
title = {Colovesical fistula complicating diverticular disease: one-stage resection.},
journal = {International surgery},
volume = {91},
number = {1},
pages = {17-23},
pmid = {16706097},
issn = {0020-8868},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Bromhexine ; Colon/surgery ; Colonic Diseases/complications/diagnostic imaging/*surgery ; Cystoscopy ; Digestive System Surgical Procedures/methods ; Diverticulitis, Colonic/complications ; Diverticulosis, Colonic/complications/*surgery ; Female ; Humans ; Intestinal Fistula/complications/diagnostic imaging/*surgery ; Middle Aged ; Radiography ; Urinary Bladder Fistula/complications/diagnostic imaging/*surgery ; },
abstract = {Colonic diverticular disease is common in developed countries, and its prevalence increases with age. Most affected individuals remain asymptomatic throughout their lives, and relatively few patients require surgical intervention for obstructive or inflammatory complications. Colovesical fistula is the most common type (65%) of fistula associated with colonic diverticular disease. Primary resection of sigmoid colon with colorectal anastomosis performed as a one-stage procedure is its definitive treatment and can be performed safely--as simple closure, using an omental flap, or through resection and closure of bladder defect--in 90% of the patients. We report our experience with four patients suffering from colovesical fistula who were treated with primary resection of sigmoid colon and colorectal anastomosis performed as a one-step procedure. In our experience, diverting colostomy or Hartmann intervention is not recommended because of the lack of fistula definitive resolution and the possibility of additional complications.},
}
@article {pmid16686882,
year = {2006},
author = {Reiss, G and Kunz, P and Koin, D and Keeffe, EB},
title = {Escherichia coli O157:H7 infection in nursing homes: review of literature and report of recent outbreak.},
journal = {Journal of the American Geriatrics Society},
volume = {54},
number = {4},
pages = {680-684},
doi = {10.1111/j.1532-5415.2006.00682.x},
pmid = {16686882},
issn = {0002-8614},
mesh = {Aged ; California/epidemiology ; Colitis/epidemiology/*microbiology ; *Disease Outbreaks ; Disease Progression ; Escherichia coli Infections/*epidemiology ; *Escherichia coli O157 ; Humans ; *Nursing Homes ; Risk Factors ; },
abstract = {Escherichia coli O157:H7 is a well-described cause of hemorrhagic colitis in isolated cases and outbreaks. The postdiarrhea complications of this infection (thrombotic thrombocytopenic purpura and hemolytic uremic syndrome) have historically been linked to illness in children aged 5 to 10, but in an elderly, institutionalized population, E. coli O157:H7 is associated with high morbidity and mortality. This geriatric population is at high risk for developing gastrointestinal infections for a number of reasons, including age- and medication-related achlorhydria, antibiotic usage, and comorbid medical conditions. The combination of age-related risk factors with those associated with group living makes nursing facilities a high-risk environment for outbreaks of infectious diseases. E. coli O157:H7 may be more likely to cause disease outbreaks in this population because of the low inoculum required for clinical infection. Moreover, the prevalence of potential competing diagnoses, such as lower gastrointestinal bleeding from neoplastic or diverticular disease, complicates the diagnosis. Clinical presentation and laboratory studies are unpredictable and pose diagnostic challenges. This report reviews the literature on nursing home outbreaks of E. coli O157:H7 and presents an outbreak that occurred in an assisted living community in San Mateo County, California, in October 2003. The purpose of this literature review and report of an outbreak is to heighten awareness of the unique susceptibility of elderly, institutionalized patients for E. coli O157:H7 infection and its sequelae.},
}
@article {pmid16684093,
year = {2006},
author = {Guy, RJ and Moin, T},
title = {Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient-related factors.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {8},
number = {5},
pages = {453},
doi = {10.1111/j.1463-1318.2006.01039.x},
pmid = {16684093},
issn = {1462-8910},
mesh = {Diverticulosis, Colonic/mortality/*surgery ; Humans ; Perioperative Care/methods/standards ; Postoperative Complications/*mortality ; Sigmoid Diseases/mortality/*surgery ; Survival Rate/trends ; },
}
@article {pmid16681868,
year = {2006},
author = {Ierfone, N and Di Fulvio, A and Pontone, S and Terzakis, P and Martino, G and Pontone, P},
title = {[Modern indications on the medical treatment of symptomatic diverticular disease].},
journal = {Il Giornale di chirurgia},
volume = {27},
number = {3},
pages = {93-96},
pmid = {16681868},
issn = {0391-9005},
mesh = {Aged ; Anti-Infective Agents/*therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulitis, Colonic/*drug therapy ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Gastrointestinal Agents/therapeutic use ; Humans ; Male ; Mesalamine/*therapeutic use ; Middle Aged ; Rifamycins/*therapeutic use ; Rifaximin ; Treatment Outcome ; },
abstract = {Authors refer about their experience on treatment of symptomatic diverticular disease both with antibiotic and anti-inflammatory drugs. They confirm the observation of other Authors on effectiveness of this new therapeutic approach versus traditional antibiotic therapy.},
}
@article {pmid16680607,
year = {2006},
author = {Constantinides, VA and Tekkis, PP and Senapati, A and , },
title = {Comparison of POSSUM scoring systems and the surgical risk scale in patients undergoing surgery for complicated diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {49},
number = {9},
pages = {1322-1331},
doi = {10.1007/s10350-006-0522-5},
pmid = {16680607},
issn = {0012-3706},
mesh = {Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures/mortality ; Diverticulum, Colon/classification/complications/mortality/*surgery ; Female ; Humans ; Male ; Middle Aged ; *Postoperative Complications ; Risk Assessment ; *Severity of Illness Index ; Survival Rate ; },
abstract = {PURPOSE: This study was designed to evaluate the accuracy of the Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity, Portsmouth-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity, colorectal-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity, and the Surgical Risk Scale for the treatment of patients with complicated diverticular disease.
METHODS: Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity variables were prospectively recorded for 324 patients undergoing colorectal resections in 42 hospitals in the United Kingdom from January to December 2003. The accuracy of each model was evaluated by measures of discrimination, calibration, and subgroup analysis.
RESULTS: The overall operative mortality was 10.8 percent (Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity-estimated mortality rate, 21.9 percent; Portsmouth-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity-estimated mortality rate, 10.5 percent; colorectal-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity-estimated mortality rate, 10 percent; Surgical Risk Scale-estimated mortality rate, 38.2 percent). Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity and the Surgical Risk Scale over-predicted mortality in young patients (P < 0.001) and Portsmouth-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity underpredicted mortality in elderly patients (P < 0.001). Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity and the Surgical Risk Scale overpredicted mortality in patients with generalized peritonitis (Hinchey III and IV). There was no significant difference between the observed and colorectal-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity predicted mortality across patient subgroups and when the overall sample was considered.
CONCLUSIONS: The study suggested a lack of calibration of Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity, Portsmouth-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity, and the Surgical Risk Scale at the extreme of age and for patients with severe peritoneal contamination. Colorectal-Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity was found to accurately evaluate mortality arising from complicated diverticular disease.},
}
@article {pmid16679352,
year = {2006},
author = {Badvie, S and Hanna-Morris, A and Andreyev, HJ and Cohen, P and Saini, S and Allen-Mersh, TG},
title = {A "field change" of inhibited apoptosis occurs in colorectal mucosa adjacent to colorectal adenocarcinoma.},
journal = {Journal of clinical pathology},
volume = {59},
number = {9},
pages = {942-946},
pmid = {16679352},
issn = {0021-9746},
mesh = {Adenocarcinoma/metabolism/*pathology/surgery ; Aged ; Aged, 80 and over ; *Apoptosis ; Cell Proliferation ; Colorectal Neoplasms/metabolism/*pathology/surgery ; Female ; Humans ; Immunoenzyme Techniques ; Intestinal Mucosa/metabolism/pathology ; Male ; Middle Aged ; Neoplasm Proteins/metabolism ; bcl-X Protein/metabolism ; },
abstract = {BACKGROUND: Colorectal cancer is associated with a "field change" of increased proliferation throughout the colonic and rectal mucosa. Both proliferation and apoptosis are disrupted during carcinogenesis. Whether altered apoptosis contributes to this field change of microscopic abnormality is, however, unclear. Bcl-xL is an anti-apoptotic protein that inhibits apoptosis by preventing release of cytochrome c, a recognised pathway to cell death.
AIM: To determine whether Bcl-xL inhibition of apoptosis is increased in colorectal mucosa adjacent to colorectal adenocarcinoma over that in normal non-neoplastic colorectal mucosa.
PATIENTS: PATIENTS undergoing surgical resection for neoplastic (adenocarcinoma) or non-neoplastic disease of the colorectum (rectal prolapse, diverticular disease or volvulus).
METHODS: Formalin-fixed, paraffin-wax-embedded surgical colorectal resection specimens were immunostained for Bcl-xL protein. Labelling indices were determined by counting the proportion of positively stained cells in mucosal crypts.
RESULTS: 85 patients were studied. Bcl-xL immunostaining was most marked in the upper third of mucosal crypts. It occurred in a minority of samples from non-neoplastic colorectal mucosa, but was seen in most mucosal samples adjacent to colorectal adenocarcinoma. Significant increases (p<0.001) were observed in Bcl-xL labelling indices in the mucosa at 1 cm (n = 46, median labelling index 31.8%, interquartile range 8.3-43.9%) and at 10 cm (n = 52, median labelling index 22.0%, interquartile range 0.0-36.3%) from colorectal carcinoma, compared with normal, non-neoplastic colorectal mucosa (n = 22, median labelling index 0.0%, interquartile range 0.0-0.0%).
CONCLUSIONS: The findings are consistent with a field change of inhibited apoptosis in mucosa adjacent to colorectal carcinoma.},
}
@article {pmid16669953,
year = {2006},
author = {Petruzziello, L and Iacopini, F and Bulajic, M and Shah, S and Costamagna, G},
title = {Review article: uncomplicated diverticular disease of the colon.},
journal = {Alimentary pharmacology & therapeutics},
volume = {23},
number = {10},
pages = {1379-1391},
doi = {10.1111/j.1365-2036.2006.02896.x},
pmid = {16669953},
issn = {0269-2813},
mesh = {Anti-Infective Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Collagen/metabolism ; Colon/pathology/physiopathology ; Colonoscopy ; Dietary Fiber/administration & dosage ; Dietary Supplements ; Diverticulum, Colon/genetics/*physiopathology/therapy ; Gastrointestinal Agents/therapeutic use ; Gastrointestinal Motility/physiology ; Humans ; Matrix Metalloproteinases/metabolism ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; Rifamycins/therapeutic use ; Rifaximin ; Viscera/physiopathology ; },
abstract = {Diverticular disease of the colon is the fifth most important gastrointestinal disease in terms of direct and indirect health care costs in western countries. Uncomplicated diverticular disease is defined as the presence of diverticula in the absence of complications such as perforation, fistula, obstruction and/or bleeding. The distribution of diverticula along the colon varies worldwide being almost always left-sided and directly related to age in western countries and right-sided where diet is rich in fibre. The pathophysiology of diverticular disease is complex and relates to abnormal colonic motility, changes in the colonic wall, chronic mucosal low-grade inflammation, imbalance in colonic microflora and visceral hypersensitivity. Moreover, there can be genetic factors involved in the development of colonic diverticula. The use of non-absorbable antibiotics is the mainstay of therapy in patients with mild to moderate symptoms, and the effect of fibre-supplementation alone does not appear to be significantly different from placebo, although no definite data are available. More recently, alternative treatments have been reported. Mesalazine acts as a local mucosal immunomodulator and has been shown to improve symptoms and prevent recurrence of diverticulitis. In addition, probiotics have also been shown to be beneficial by re-establishing a normal gut microflora. In this study, the current literature on uncomplicated diverticular disease of the colon is reviewed.},
}
@article {pmid16651879,
year = {2006},
author = {Ali, ZS and Al-Shaalan, H and Jorgensen, J},
title = {Successful treatment of massive acute lower gastrointestinal bleeding in diverticular disease of colon, with activated recombinant factor VII (NovoSeven).},
journal = {Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis},
volume = {17},
number = {4},
pages = {327-329},
doi = {10.1097/01.mbc.0000224856.95990.c2},
pmid = {16651879},
issn = {0957-5235},
mesh = {Acute Disease ; Aged, 80 and over ; Diverticulosis, Colonic/*drug therapy ; Factor VIIa/*administration & dosage ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage/*drug therapy ; Humans ; Injections, Intravenous ; Recombinant Proteins/administration & dosage ; Treatment Outcome ; },
abstract = {Recombinant coagulation factor (rFVIIa) (NovoSeven; Novo Nordisk A/S, Copenhagen, Denmark) is registered in most regions in the world for the treatment of bleeding episodes in haemophilia with inhibitors to factor VIII or factor IX. The mechanism of action suggests that its enhancing effects in haemostasis are limited to the site of injury and that systemic activation of the coagulation cascade does not occur. We report a case of lower gastrointestinal bleeding in diverticular disease of the colon in an inoperable elderly patient without pre-existing coagulopathy, which has successfully treated with a single injection of rFVIIa. This experience suggests that rFVIIa, besides its actual high costs, might be a useful and safe, noninvasive therapeutic tool in selected cases of massive lower gastrointestinal bleeding in the elderly.},
}
@article {pmid16642706,
year = {2006},
author = {Welter, HF and Wendland, S},
title = {[Laparoscopic appendectomy--a lot of effort for a minor operation?].},
journal = {MMW Fortschritte der Medizin},
volume = {148},
number = {13},
pages = {46-47},
doi = {10.1007/BF03364618},
pmid = {16642706},
issn = {1438-3276},
mesh = {Acute Disease ; Appendectomy/*methods ; Appendicitis/diagnosis/*surgery ; Chronic Disease ; Contraindications ; Diagnosis, Differential ; Endometritis/diagnosis/surgery ; Female ; Humans ; Laparoscopy/*methods ; Recurrence ; Referral and Consultation ; },
abstract = {In the hands of an experienced surgeon, laparoscopic appendectomy is by no means a time-consuming procedure that might put the patient at risk. In particular it enables an all round inspection of the abdominal cavity, thus enabling both the detection of diverticular disease and tumors or processes within the true pelvis. The complication-free operation leaves behind only tiny scars, so that, in the event of abdominal complaints at some later date, a mistaken diagnosis of appendicitis might easily be established elsewhere. To help prevent this, the patient must be given the relevant information about the procedure. In addition, provision of the patient with a medical ID card is proposed.},
}
@article {pmid16633104,
year = {2006},
author = {Sultan, K and Fields, S and Panagopoulos, G and Korelitz, BI},
title = {The nature of inflammatory bowel disease in patients with coexistent colonic diverticulosis.},
journal = {Journal of clinical gastroenterology},
volume = {40},
number = {4},
pages = {317-321},
doi = {10.1097/01.mcg.0000210095.44123.6d},
pmid = {16633104},
issn = {0192-0790},
mesh = {Adult ; Age of Onset ; Comorbidity ; Diverticulosis, Colonic/*epidemiology/pathology ; Female ; Humans ; Inflammatory Bowel Diseases/*epidemiology/pathology ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {GOALS/BACKGROUND: Reports of segmental colitis with diverticula regard this entity as a local disease. Our goal was to reexamine the association of diverticula to colitis and question the relationship of colonic diverticulosis with generalized inflammatory bowel disease (IBD).
STUDY: A retrospective database review of more than 1,600 patients matched 100 cases with IBD and colonic diverticulosis with a control group of 100 patients with IBD without diverticulosis. Patients were matched by gender, IBD diagnosis, and date of birth. Variables examined included disease distribution, strictures, fistulae, extraintestinal manifestations (EIMs), family history, and age at IBD diagnosis.
RESULTS: For all IBD diagnoses, more sigmoid inflammation occurred in cases with diverticular disease: 82% versus 65% for controls (P = 0.005), and in the rectum: 85% versus 69% for controls (P = 0.005). In the Crohn's disease with diverticulosis subset, sigmoid inflammation was more common: 70% versus 42% for controls (P = 0.007), and in the rectum: 70% versus 46% for controls (P = 0.02). Disease distribution was otherwise similar throughout the colon, ileum, and jejunum. The incidence of strictures (P = 0.99) and fistulae (P = 0.69) was similar. EIMs were more frequent in cases with diverticulosis: 28% versus 16% (P = 0.05). Family history of IBD was similar: 26% for cases and 16% for controls (P = 0.12). Age at IBD diagnosis was significantly greater in diverticulosis cases compared with controls: 51.5 years (+/-17.6) versus 42.8 years (+/- 17.5) (P < 0.001), respectively.
CONCLUSIONS: We observed an increased frequency of sigmoid and rectal inflammation, EIMs, and an older age of IBD onset in cases with diverticulosis. This suggests a role for diverticula in IBD beyond that of a mere coincidental finding.},
}
@article {pmid16633103,
year = {2006},
author = {Tursi, A and Brandimarte, G and Giorgetti, GM and Elisei, W},
title = {Mesalazine and/or Lactobacillus casei in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomized, open-label study.},
journal = {Journal of clinical gastroenterology},
volume = {40},
number = {4},
pages = {312-316},
doi = {10.1097/01.mcg.0000210092.77296.6d},
pmid = {16633103},
issn = {0192-0790},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Diverticulosis, Colonic/*prevention & control ; Female ; Humans ; *Lacticaseibacillus casei ; Male ; Mesalamine/*therapeutic use ; Middle Aged ; Probiotics/*therapeutic use ; Prospective Studies ; Secondary Prevention ; },
abstract = {GOALS: To investigate the effectiveness and safety of mesalazine, with or without Lactobacillus casei, in preventing recurrence of symptomatic diverticular disease of the colon.
BACKGROUND: Both mesalazine and probiotics showed recently their effectiveness in obtaining remission of symptomatic uncomplicated diverticular disease of the colon. Consistent data are not available on the optimal therapy to prevent recurrence of symptomatic diverticular disease of the colon.
STUDY: Multicenter, prospective, randomized, open-label study. Ninety consecutive patients (36 men, 54 women, mean age 67.5 y, range 39 to 84 y), previously affected by symptomatic uncomplicated diverticular disease of the colon (remission obtained with rifaximin 800 mg/d plus mesalazine 2.4 g/d for 10 d, followed by mesalazine 1.6 g/d for 8 wk), were enrolled in a 12-month follow-up. The following symptoms were assessed at entry and through follow-up by using a quantitative scale: (1) constipation, (2) diarrhea, (3) abdominal pain, (4) rectal bleeding, and (5) mucus with the stools. After recruitment, the patients were randomly assigned to one of the following 3 groups: mesalazine 1.6 g/d (group M), L. casei DG 16 billion/d for 15 d/mo (group L); mesalazine 1.6 g/d+L. casei DG 16 billion/d for 15 d/mo (group LM).
RESULTS: Eighty-five patients completed the study (94.5%): 2 patients (2.22%, 1 of group M and 1 of group LM) were withdrawn from the study for protocol violation and 1 (1.11%) for hospital admission due to acute pulmonary disease (group L); 2 patients (2.22%) were lost to follow-up. Seventy-five patients (88.2%) were symptom free after the 12th month of treatment (overall symptomatic score: (0): 23/27 patients of group M [on intention to treat: 76.7% confidence interval (CI 95%: 61.5 to 91.8)], 23/29 of group L [on intention to treat: 76.7% (CI 95%: 61.5 to 91.8)], 29/29 of group LM [on intention to treat: 96% (CI 95%: 94.2 to 100)] (P < 0.05). Only 10 patients (11.1%) showed recurrence of symptoms (overall symptomatic score: 68).
CONCLUSIONS: Both mesalazine and L. casei DG seem to be effective in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon, but their association seems to be more promising in this field.},
}
@article {pmid16633102,
year = {2006},
author = {Tursi, A and Brandimarte, G and Elisei, W and Inchingolo, CD and Aiello, F},
title = {Epithelial cell proliferation of the colonic mucosa in different degrees of colonic diverticular disease.},
journal = {Journal of clinical gastroenterology},
volume = {40},
number = {4},
pages = {306-311},
doi = {10.1097/01.mcg.0000210093.54425.72},
pmid = {16633102},
issn = {0192-0790},
mesh = {Cell Proliferation ; Colitis, Ulcerative/pathology ; Diverticulosis, Colonic/*pathology ; Epithelial Cells/*pathology ; Female ; Humans ; Immunohistochemistry ; Intestinal Mucosa/*pathology ; Ki-67 Antigen ; Male ; },
abstract = {GOAL: This study assesses the epithelial cell proliferation in different degrees of diverticular disease and compares this with two different control groups.
BACKGROUND: Hyperproliferation of the colonic mucosa has been recently described in diverticular disease (DD), but it is unknown whether this finding is present in every degree of DD.
PATIENTS AND METHODS: Thirty consecutive patients with a new endoscopic diagnosis of DD (10 with asymptomatic diverticulosis, 10 with symptomatic uncomplicated DD, and 10 with acute uncomplicated diverticulitis) were enrolled. Ten matched healthy people and 10 patients with ulcerative colitis (UC) (5 with UC in remission and 5 with active UC) were enrolled as control groups. The Ki-67 antigen index of the whole crypt and the upper third was separately evaluated.
RESULTS: Ki-67 index of the whole crypt and the upper third of the crypt was significantly higher in all degrees of DD compared with the healthy control group. In particular, asymptomatic diverticulosis showed a threefold higher Ki-67 index compared with that of the healthy control group (5.4% and 5.6% vs. 1.6% and 1.8%, respectively, P = 0.005), and similar to that of UC in remission (5.4% and 5.6% vs. 5.9% and 5.8%, respectively, P = not significant).
CONCLUSIONS: We found an upward shifting of cellular proliferation of the colonic mucosa in patients with different degrees of DD. In particular, asymptomatic diverticulosis seems to show the same risk for colonic carcinoma as that of UC.},
}
@article {pmid16630242,
year = {2006},
author = {Garcea, G and Majid, I and Sutton, CD and Pattenden, CJ and Thomas, WM},
title = {Diagnosis and management of colovesical fistulae; six-year experience of 90 consecutive cases.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {8},
number = {4},
pages = {347-352},
doi = {10.1111/j.1463-1318.2005.00928.x},
pmid = {16630242},
issn = {1462-8910},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/*diagnosis/etiology/*surgery ; Diagnostic Imaging ; Digestive System Surgical Procedures ; Endoscopy ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Urinary Bladder Fistula/*diagnosis/etiology/*surgery ; Urologic Surgical Procedures ; },
abstract = {INTRODUCTION: Colovesical fistulae are well-recognized but relatively uncommon presentation to colorectal surgery. As a result, few centres have sufficient experience in the investigation and surgical treatment of colovesical fistulae to develop clear protocols in its management.
METHODS: This study examines the diagnostic and treatment pathways of 90 consecutive patients with colovesical fistulae presenting to a single surgeon, over a six-year period. Using the findings from this study and previously published data, the authors suggest tentative guidelines for the diagnosis and management of such patients.
RESULTS: Pneumaturia and faecaluria were present in 90.1% of all cases. The diagnosis of colovesical fistula is predominately a clinical one, however, cystoscopy was the most accurate test to detect fistulae (46.2%) followed by barium enema (20.1%). Barium enema was the most sensitive test to detect stricture formation (70.6%). Colonic endoscopy was the most reliable means of excluding a colonic malignancy. The most common pathology was diverticular disease (72.2%), colonic carcinoma (15.3%) and Crohn's disease (9.7%). Left sided colonic resections were undertaken in 73.6% of patients, right hemicolectomy in 4.2% and defunctioning loop colostomies in 18.5%. Of the left sided resections, primary anastomosis was achieved in 92% of cases (n = 48) with one postoperative leak and no mortality.
DISCUSSION: Resection and primary anastomosis should be the treatment of choice for colovesical fistulae, with an acceptable risk of anastomotic leak and mortality. Barium enema, colonic endoscopy and CT should be routine in the investigation of colovesical fistulae.},
}
@article {pmid16630236,
year = {2006},
author = {Branagan, G and Thompson, MR and Senapati, A},
title = {Cleft closure for the treatment of unhealed perineal sinus.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {8},
number = {4},
pages = {314-317},
doi = {10.1111/j.1463-1318.2005.00925.x},
pmid = {16630236},
issn = {1462-8910},
mesh = {Adult ; Aged ; Female ; Humans ; Intestinal Diseases/*surgery ; Male ; Middle Aged ; Perineum/*surgery ; Postoperative Complications/*surgery ; Rectum/*surgery ; *Surgical Flaps ; Suture Techniques ; Treatment Outcome ; *Wound Healing ; },
abstract = {OBJECTIVE: Despite improvements in surgical practice, persistent perineal wound sinus is still a common complication after proctectomy. This study presents the success of a modified cleft closure technique in dealing with this problem.
METHODS: From May 1997 patients with a persistent perineal sinus after surgery underwent a cleft closure - similar to that performed for patients with pilonidal sinus disease.
RESULTS: Eight patients (6 male, 2 female) with an average age of 52 years underwent a cleft closure for a persistent perineal sinus after surgery. Four patients had undergone a proctocolectomy (ulcerative colitis), 2 an abdominoperineal excision of the rectum (adenocarcinoma) and 2 a proctectomy (1 Crohn's disease, 1 complication of diverticular disease). Symptoms had been present for an average of 41 months (range 5-152 months) and 3 patients had undergone other procedures attempted previously to deal with the problem. The first three patients had the procedure as an inpatient with an average stay of 4.7 days. The next 5 patients had the procedure as a day case (2 local anaesthetic, 3 general anaesthetic). Two patients developed a postoperative wound infection and all but one wound had healed completely by 8 weeks. In this patient the procedure was repeated to achieve healing. There was no other associated morbidity and no postoperative deaths. There have been no recurrences to date.
CONCLUSION: Modified cleft closure for persistent perineal sinus is a simple procedure with low morbidity that can be performed under local anaesthetic in the day surgery unit.},
}
@article {pmid16620420,
year = {2005},
author = {Simpson, J and Spiller, R},
title = {Colonic diverticular disease.},
journal = {Clinical evidence},
volume = {},
number = {14},
pages = {543-550},
pmid = {16620420},
issn = {1462-3846},
mesh = {Acute Disease ; Anti-Infective Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Dietary Fiber/therapeutic use ; Diverticulosis, Colonic/surgery/therapy ; Diverticulum, Colon/*therapy ; Humans ; Mesalamine/therapeutic use ; Rifamycins/therapeutic use ; Rifaximin ; },
}
@article {pmid16614952,
year = {2006},
author = {Tursi, A and Brandimarte, G and Giorgetti, GM and Elisei, W},
title = {Transient lactose malabsorption in patients affected by symptomatic uncomplicated diverticular disease of the colon.},
journal = {Digestive diseases and sciences},
volume = {51},
number = {3},
pages = {461-465},
pmid = {16614952},
issn = {0163-2116},
mesh = {Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Breath Tests ; Case-Control Studies ; Diverticulum, Colon/*diagnosis/*drug therapy/epidemiology ; Female ; Gastrointestinal Transit/drug effects/physiology ; Humans ; Lactose Intolerance/*diagnosis/*drug therapy/epidemiology ; Lactulose/metabolism ; Male ; Mesalamine/*therapeutic use ; Middle Aged ; Prevalence ; Prognosis ; Prospective Studies ; Reference Values ; Rifamycins/*therapeutic use ; Rifaximin ; Risk Assessment ; Severity of Illness Index ; Sex Distribution ; Treatment Outcome ; },
abstract = {Lactose malabsorption (LM) may be secondary to several small bowel diseases, and small intestinal overgrowth (SIBO) may be one of them. We looked for a correlation between symptomatic diverticular disease of the colon and LM and assessed whether this correlation may be related to SIBO. Ninety consecutive patients (pts; 39 males, 51 females; mean age, 67.2 years; range, 32-91 years) affected by symptomatic uncomplicated diverticular disease of the colon were evaluated to assess orocecal transit time (OCTT), SIBO, and LM by lactulose and lactose H2 breath test (H2-BT) at entry and after 8 weeks of treatment. OCTT was delayed in 67 of 90 pts (74.44%). Fifty-three of 90 pts (58.88%) showed SIBO, and OCTT was normal in 23 of 90 pts (25.56%). LM was diagnosed in 59 of 90 pts (65.55%): 49 of 59 (71.74%) were simultaneously affected by SIBO and delayed OCTT (and thus 49 of 53 pts [92.45%] with delayed OCTT and SIBO were affected by LM); 3 of 59 pts (5.09%) showed only delayed OCTT; 7 of 59 pts (11.86%) did not show either SIBO or delayed OCTT. The association of LM and SIBO was statistically significant (P < 0.001). Seventy-nine of 86 pts (91.86%) showed normal OCTT, while OCTT remained prolonged but shorter in the remaining 7 pts (8.14%). SIBO was eradicated in all pts completing the study, while a new lactulose H2-BT showed persistence of SIBO in one pt with recurrence of symptomatic diverticular disease. Forty-seven of 59 pts (79.66%) had a normal lactose H2-BT (P < 0.002), while 12 of 59 pts (20.34%) showed persistence of LM. LM disappeared in 46 of 49 pts (93.88%) concurrently with normalization of OCTT and eradication of SIBO (P < 0.002); it also disappeared in 1 of 3 pts (33.33%) previously affected by delayed OCTT (without SIBO) and LM concurrently with normalization of OCTT. On the contrary, it persisted in all pts with normal OCTT and absence of SIBO. Moreover, it persisted also in the pt with recurrence of symptomatic diverticular disease and persistence of SIBO. In conclusion, most pts affected by symptomatic uncomplicated diverticular disease of the colon showed LM, and in more than 70% of cases it disappeared after successful treatment of the colonic disease.},
}
@article {pmid16608627,
year = {2006},
author = {Pironi, D and Candioli, S and Manigrasso, A and La Torre, V and Palazzini, G and Romani, AM and Tarroni, D and Filippini, A},
title = {[Complicated diverticular disease. Three cases of colovesical fistulas and review of literature].},
journal = {Il Giornale di chirurgia},
volume = {27},
number = {1-2},
pages = {15-20},
pmid = {16608627},
issn = {0391-9005},
mesh = {Aged ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/*complications/diagnosis/surgery ; Humans ; Intestinal Fistula/diagnosis/*etiology/surgery ; Laparoscopy ; Male ; Middle Aged ; Treatment Outcome ; },
abstract = {Colovesical fistulas represent a possible less frequent complication of diverticular disease of colon. They represent a complex condition because of the possible and unexpected evolution into a septic shock with a high risk of death. The Authors report three cases of colovesical fistula as a complication of diverticular disease. They underline the importance of early diagnosis, specific antibiotic therapy and appropriate surgical therapy realized in one or two stages according to general and local conditions of each patient.},
}
@article {pmid16598405,
year = {2006},
author = {Aydin, HN and Tekkis, PP and Remzi, FH and Constantinides, V and Fazio, VW},
title = {Evaluation of the risk of a nonrestorative resection for the treatment of diverticular disease: the Cleveland Clinic diverticular disease propensity score.},
journal = {Diseases of the colon and rectum},
volume = {49},
number = {5},
pages = {629-639},
doi = {10.1007/s10350-006-0526-1},
pmid = {16598405},
issn = {0012-3706},
mesh = {Anastomosis, Surgical/adverse effects/methods ; Body Mass Index ; Colon, Sigmoid/surgery ; Colostomy/adverse effects/*methods ; Diverticulitis, Colonic/mortality/*surgery ; Emergencies ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; *Patient Selection ; Peritonitis/complications ; ROC Curve ; Risk Assessment/*methods ; },
abstract = {PURPOSE: The choice of operation for diverticular disease is a contentious issue, particularly in patients with acute symptoms. This study compares early outcomes between primary resection and anastomosis and Hartmann's resection and describes a propensity score for the selection of patients for nonrestorative procedures.
METHODS: Data were collected from 731 patients undergoing primary resection and anastomosis (Group 1) and 123 patients undergoing primary Hartmann's resection (Group 2) for diverticular disease in a single tertiary referral center from January 1981 to May 2003. Multifactorial logistic regression was used to develop a propensity score for estimating the likelihood of performing a nonrestorative procedure.
RESULTS: Operative 30-day mortality and surgical or medical complications were 0.7 percent, 26.0 percent, and 4.8 percent for primary resection and anastomosis and 12 percent, 43.9 percent, and 14.6 percent for Hartmann's resection, respectively (P < 0.001). There was no difference in the readmission rates between primary resection and anastomosis and Hartmann's resection (7.6 percent vs. 9.9 percent, P = 0.428). Laparoscopy was used for 32.7 percent of primary resection and anastomosis vs. 1.6 percent for Hartmann's resection (P < 0.001). Independent predictors in favor for Hartmann's resection were body mass index > or = 30 kg/m2 (odd's ratio = 2.32), Mannheim peritonitis index >10 (odd's ratio = 6.75), operative urgency (emergency, urgent vs. elective surgery, odd's ratio = 16.08 vs. 13.32), and Hinchey stage > II (odd's ratio = 27.82). The area under the receiver operating characteristic curve for the choice of operative procedure was 93.9 percent.
CONCLUSIONS: Although Hartmann's resection was associated with a higher incidence of postoperative adverse events, the choice of operation was dependent on the patient presentation and intra-abdominal contamination, which can be quantified in the preoperative setting by the Cleveland Clinic diverticulitis propensity score.},
}
@article {pmid16568016,
year = {2006},
author = {Casciola, L and Ceccarelli, G and Stefanoni, M and Spaziani, A and Conti, D and Bartoli, A and Di Zitti, L and Valeri, R and Bellochi, R and Rambotti, M},
title = {[Laparoscopic colon-sigmoid resection with mesenteric artery preservation for diverticular disease].},
journal = {Minerva chirurgica},
volume = {61},
number = {1},
pages = {1-8},
pmid = {16568016},
issn = {0026-4733},
mesh = {Aged ; Aged, 80 and over ; Colon, Sigmoid/*surgery ; Digestive System Surgical Procedures/methods ; Diverticulosis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Mesenteric Arteries ; Middle Aged ; Retrospective Studies ; },
abstract = {AIM: About 2/3 of the Western population over the age of 80 years are affected by colic diverticulosis; 25% will develop diverticular disease with or without complications: fistula, obstruction, pericolic abscess, free perforation or hemorrhage. Laparoscopic approach for benign diseases of the colon such as diverticulosis, Chrohn's disease, etc. is unanimously considered as a very effective procedure. We have performed a retrospective analysis of 9 years with laparoscopic approach of the diverticular disease. The purpose of this study was to determine the feasibility, safety and benefits of laparoscopic approach.
METHODS: From May 1994 to November 2002, 69 patients affected by non-complicated diverticular disease, were treated laparoscopically, at the Mininvasive Surgery Department of Spoleto. In the same period other 213 patients suffering from cancer of the colon-rectum were operated through laparoscopic surgery. A colosigmoid resection with mesenteric inferior artery preservation was performed in 46 cases (67%).
RESULTS: We have performed only a laparoscopic colectomy technique (no hand-assisted procedures); the convertion rate was of 7.2%, the mean operative time was 145 min, no intraoperative complications were observed and finally the mean hospital stay was of 7.4 days (6-9). The postoperative complications were 1 case of infection of the umbilical scar and 1 case of pleural effusion with bronchopneumonia.
CONCLUSIONS: Elective laparoscopic colectomy for diverticular disease is feasible, safe and gives very good results: minimum postoperative discomfort, rapid recovery, low mobility and postoperative stay, rapid return to normal activities. However, in some cases, this procedure can be extremely difficult because of previous inflammatory complications (adhesions, fistulas or stenosis), therefore, high surgical skills in laparoscopic-colic surgery are required.},
}
@article {pmid16556182,
year = {2006},
author = {Hjern, F and Johansson, C and Mellgren, A and Baxter, NN and Hjern, A},
title = {Diverticular disease and migration--the influence of acculturation to a Western lifestyle on diverticular disease.},
journal = {Alimentary pharmacology & therapeutics},
volume = {23},
number = {6},
pages = {797-805},
doi = {10.1111/j.1365-2036.2006.02805.x},
pmid = {16556182},
issn = {0269-2813},
mesh = {*Acculturation ; Acute Disease ; Adult ; Age Distribution ; Diverticulitis, Colonic/*epidemiology/ethnology ; *Emigration and Immigration ; Female ; Hospitalization ; Humans ; Life Style ; Male ; Middle Aged ; Models, Statistical ; Population Surveillance/methods ; Prospective Studies ; Risk Factors ; Sex Distribution ; Socioeconomic Factors ; Sweden/epidemiology/ethnology ; },
abstract = {BACKGROUND: Diverticular disease of the colon is more common in the Western world, compared with non-Western countries.
AIM: To investigate the risk of diverticular disease in immigrants of diverse ethnicity and in different phases of acculturation.
METHODS: Socio-demographic indicators and the risk of diverticular disease were investigated. The study population was a prospectively followed national cohort of 4 million residents born between 1925 and 1965. Risk ratios (RRs) of hospital admissions and deaths because of diverticular disease and acute diverticulitis from 1991 through 2000 were calculated.
RESULTS: The risk of hospital admission because of diverticular disease, after adjustment for age, sex and socio-economic indicators, was lower in non-Western immigrants (RRs = 0.5-0.7) compared with natives and the risk increased with time after the settlement. Women of all origins had a higher risk compared with men (RR = 1.5). This sex-difference increased with age (P < 0.001). Socio-economic status, residency or housing situation were not risk factors.
CONCLUSION: This population-based study found that immigrants from non-Westernized countries had lower relative risks for hospitalization because of diverticular disease than natives, but the risk increased during a relatively short period of time after settlement. Diverticular disease of the colon appears to be an acquired disorder and acculturation to a Western lifestyle has an impact on the risk.},
}
@article {pmid16555247,
year = {2006},
author = {Ramalingam, T and Edwards, DP},
title = {Letter 2: French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease (Br J Surg 2005; 92: 1520-1525).},
journal = {The British journal of surgery},
volume = {93},
number = {4},
pages = {504},
doi = {10.1002/bjs.5410},
pmid = {16555247},
issn = {0007-1323},
mesh = {Colectomy/*methods ; Diverticulitis, Colonic/*surgery ; Humans ; Laparoscopy/*methods ; Multicenter Studies as Topic ; Prospective Studies ; Sigmoid Diseases/*surgery ; },
}
@article {pmid16555246,
year = {2006},
author = {Salem, T},
title = {Letter 1: French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease (Br J Surg 2005; 92: 1520-1525).},
journal = {The British journal of surgery},
volume = {93},
number = {4},
pages = {504},
doi = {10.1002/bjs.5409},
pmid = {16555246},
issn = {0007-1323},
mesh = {Colectomy/*methods ; Diverticulitis, Colonic/*surgery ; Humans ; Laparoscopy/*methods ; Multicenter Studies as Topic ; Prospective Studies ; Recurrence ; Sigmoid Diseases/*surgery ; },
}
@article {pmid16534656,
year = {2006},
author = {Purkayastha, S and Constantinides, VA and Tekkis, PP and Athanasiou, T and Aziz, O and Tilney, H and Darzi, AW and Heriot, AG},
title = {Laparoscopic vs. open surgery for diverticular disease: a meta-analysis of nonrandomized studies.},
journal = {Diseases of the colon and rectum},
volume = {49},
number = {4},
pages = {446-463},
doi = {10.1007/s10350-005-0316-1},
pmid = {16534656},
issn = {0012-3706},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Digestive System Surgical Procedures ; Diverticulum, Colon/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Recovery of Function ; Treatment Outcome ; },
abstract = {PURPOSE: This study was designed to compare outcomes between laparoscopic and open surgery for patients with diverticular disease by using meta-analytic techniques.
METHODS: Comparative studies published between 1996 and 2004 of open vs. laparoscopic surgery for diverticular disease were included. The end points that were evaluated are operative and functional outcomes and adverse events. A random effects model was used during analysis of these outcomes; heterogeneity was assessed and sensitivity analysis was performed to account for bias in patient selection.
RESULTS: Twelve nonrandomized studies, incorporating 19,608 patients, were included in the analysis. One study with 18,444 patients accounted for 94.5 percent of the total sample. Laparoscopic surgery resulted in reduced infective (odds ratio, 0.61; P = 0.01), pulmonary (odds ratio, 0.4; P < 0.001), gastrointestinal tract (odds ratio, 0.75; P = 0.03), and cardiovascular complications (odds ratio, 0.28; P = 0.0008) with no significant heterogeneity. Operative time was longer with laparoscopic surgery (weighted mean difference, 67.59; P = 0.04), and length of stay was significantly shorter (weighted mean difference, -3.81; P < 0.0001); however, these outcomes demonstrated significant heterogeneity. These results remained significant throughout all the sensitivity analyses except when evaluating high-quality studies (when the study with 18,444 patients was excluded), in which only blood loss and length of stay were significantly in favor of the laparoscopic group.
CONCLUSIONS: The results for patients selected for laparoscopic surgery compared with open surgery for diverticular disease are equivalent with a potential reduction in complications and hospital stay. Laparoscopic surgery for diverticular disease performed by appropriately experienced surgeons in the elective setting may be safe and feasible; because of the potential of significant bias arising from the included studies, a randomized, controlled trial is recommended.},
}
@article {pmid16528491,
year = {2006},
author = {Riaz, AA and Jeetle, SS and Whittingham-Jones, P and Bobb, KA and Thompson, HH},
title = {A study comparing split with loop transverse colostomies for defunctioning the left colon.},
journal = {Techniques in coloproctology},
volume = {10},
number = {1},
pages = {1-4},
doi = {10.1007/s10151-006-0242-9},
pmid = {16528491},
issn = {1123-6337},
mesh = {Aged ; Aged, 80 and over ; Antibiotic Prophylaxis ; Colonic Diseases/physiopathology/*surgery ; Colostomy/*methods ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications/*epidemiology ; Retrospective Studies ; Statistics, Nonparametric ; Treatment Outcome ; },
abstract = {BACKGROUND: Loop transverse colostomy (LTC) is an established method for defunctioning the distal colon. We recently described an alternative method called split transverse colostomy (STC).
METHODS: In this study we retrospectively compared the outcomes of LTC and STC in 49 patients with colorectal malignancy, pelvic tumours and diverticular disease.
RESULTS: Patients were assigned without randomisation to undergo LTC (n=25) or STC (n=24). The two groups were similar in terms of age, gender and diagnosis. Postoperative complications were observed in 52.0% of patients in LTC group and in 16.7% of patients in STC group (p<0.05). The most common complication in both groups was stomal prolapse (n=2 and n=10, respectively). There were no intra-operative deaths.
CONCLUSIONS: STC is safe, effective and associated with a lower incidence of stomal complications compared with the established procedure for defunctioning the distal colon. We propose that STC should be used to defunction the left colon in locally advanced disease (whether benign or malignant) where closure of the stoma is not envisaged.},
}
@article {pmid16524546,
year = {2006},
author = {Novak, J and Katz, JA},
title = {Probiotics and prebiotics for gastrointestinal infections.},
journal = {Current infectious disease reports},
volume = {8},
number = {2},
pages = {103-109},
pmid = {16524546},
issn = {1523-3847},
abstract = {There is growing interest in and knowledge about the potential health-promoting benefits of both probiotics and prebiotics. Multiple mechanisms of action for the beneficial effect of probiotics and prebiotics have been postulated, including prevention of pathogenic bacteria growth, production of antimicrobial agents, stimulation of mucosal barrier function, and altering immunoregulation. Clinical trials support the efficacy of probiotics in the treatment of acute infectious diarrhea, the prevention of antibiotic associated diarrhea, and the prevention of recurrent Clostridium difficile infection. Although some data support the potential benefit of probiotic therapy in traveler's diarrhea, diverticular disease, and Helicobacter pylori, the strength of this evidence is limited. This paper will review the recent literature relevant to the mechanism of action and utility of probiotics and prebiotics in the treatment of gastrointestinal infections.},
}
@article {pmid16519636,
year = {2006},
author = {Dobbins, C and Defontgalland, D and Duthie, G and Wattchow, DA},
title = {The relationship of obesity to the complications of diverticular disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {8},
number = {1},
pages = {37-40},
doi = {10.1111/j.1463-1318.2005.00847.x},
pmid = {16519636},
issn = {1462-8910},
mesh = {Aged ; Body Mass Index ; Colonoscopy ; Diverticulosis, Colonic/diagnosis/epidemiology/*etiology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Obesity/*complications ; Recurrence ; Retrospective Studies ; Risk Factors ; },
abstract = {OBJECTIVE: Diverticular disease is common in our community. Most patients remain asymptomatic and the development of diverticular complications is rare. A common clinical observation is that patients presenting with complications of diverticular disease are obese. The aim of this study was to examine the relationship of obesity to the complications of diverticular disease.
METHODS: The study was based on a retrospective case note review conducted at the Flinders Medical Centre between 1/7/1998 and 30/6/2003. Patients were identified using ICD codes and their body mass index (BMI) calculated. Controls were taken randomly from the colonoscopy database at The Flinders Medical Centre. Patients were divided into four groups, those admitted with diverticular perforation or abscess, recurrent diverticulitis, a single episode of diverticulitis and a control group of patients with uncomplicated diverticulosis. The mean BMI for each group was calculated. Statistical analysis was performed by one way anova test with significance set at P < 0.05.
RESULTS: Sixty-one patients were studied, including 16 patients with perforated diverticular disease, 11 randomly selected with recurrent diverticulitis, 16 patients with a single episode of diverticulitis and 18 controls. The control group had a significantly lower BMI than patients presenting with perforation (P = 0.001) or recurrent diverticulitis (P = 0.002). There was no significant difference between the control group and patients with a single episode of diverticulitis (P = 1.0).
CONCLUSION: The study showed that patients with perforations and recurrent diverticulitis are significantly more obese than those who remain asymptomatic or have one episode. The aetiological relationship between obesity and diverticular complications remain unclear.},
}
@article {pmid16512469,
year = {2005},
author = {Kakodkar, R and Gupta, S and Nundy, S},
title = {Complicated colonic diverticulosis: surgical perspective from an Indian Centre.},
journal = {Tropical gastroenterology : official journal of the Digestive Diseases Foundation},
volume = {26},
number = {3},
pages = {152-155},
pmid = {16512469},
issn = {0250-636X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulosis, Colonic/*complications/diagnosis/*surgery ; Female ; Humans ; India ; Male ; Middle Aged ; Severity of Illness Index ; },
abstract = {INTRODUCTION: Colonic diverticulosis was previously uncommon in India but its incidence seems to have increased recently. Patients with the disease in developing countries are also underdiagnosed and are therefore more likely to present with complications needing operation. However there is a paucity of surgical data on the condition.
METHOD: Between August 1996 and February 2005 we operated on 32 patients (28 males, 4 females mean age 60 years) with colonic diverticulosis and analysed their characteristics from a prospective database. We here with describe our experience.
RESULTS: Operations for diverticular disease constituted 3% of all the colorectal operations we performed. The diverticula were in the sigmoid colon in 28 (88%) and also in the descending colon in 4 (12%). Twenty-four patients were symptomatic. Twenty-two patients were diagnosed before surgery, 8 at operation and the rest from resected specimens. Emergency operations were performed in 23 and elective procedures in 9 patients. Ten patients were operated on for perforation and abscess, 8 for obstruction, 8 for colovesical fistula, 3 for peritonitis and 3 for haemorrhage. Emergency procedures were performed in 2 stages (resection plus a proximal diversion) in 20; unless done for bleeding in a stable patient where a primary anastomosis was done. One patient who had had an emergency procedure died of sepsis and ketoacidosis in the post-operative period. The 8 patients with colovesical fistulae were all males, had only sigmoid involvement and had had symptoms for a longer duration than the 24 without fistulae.
CONCLUSIONS: Although operations for colonic diverticulosis still form a small proportion of the total number of colorectal operations, the diagnosis is often delayed till complications ensue and thus patients usually require emergency procedures. Males with long standing symptoms and sigmoid diverticula may develop colovesical fistulae.},
}
@article {pmid16501486,
year = {1997},
author = {Trespi, E and Panizza, P and Colla, C and Bottani, G and De Vecchi, P and Matti, C},
title = {[Efficacy of low dose mesalazine (5-ASA) in the treatment of acute inflammation and prevention of complications in patients with symptomatic diverticular disease. Preliminary results].},
journal = {Minerva gastroenterologica e dietologica},
volume = {43},
number = {3},
pages = {157-162},
pmid = {16501486},
issn = {1121-421X},
abstract = {MATERIALS AND METHODS: To assess the efficacy of mesalazine in treating acute diverticulitis and preventing diverticular disease (DD) complication. 166 patients with symptomatic DD were randomly assigned to receive mesalazine Pentacol (400 mg b.i.d., orally; M group) or no additional treatment (controls; C group).
RESULTS: After a 12 months follow-up, 26 patients experienced a symptomatic relapse (8%M vs 27% C, p=0.003), with a higher rate in C group for the patients with a history of previous diverticulitis (p=0.006) and independently of the diverticular site (sigmoid p=0.041; colon and sigmoid p=0.044). Minor diverticular haemorrhages were less frequent in M group (p=0.016), with a significant difference only for the patients with sigmoid diverticula (p=0.023); abdominal pain persisted for a shorter time in the treated group (p=0.0015).
CONCLUSIONS: No significant difference was found between the two groups for the incidence of DD major complications.},
}
@article {pmid16498335,
year = {1999},
author = {Trepsi, E and Colla, C and Panizza, P and Polino, MG and Venturini, A and Bottani, G and De Vecchi, P and Matti, C},
title = {[Therapeutic and prophylactic role of mesalazine (5-ASA) in symptomatic diverticular disease of the large intestine. 4 year follow-up results].},
journal = {Minerva gastroenterologica e dietologica},
volume = {45},
number = {4},
pages = {245-252},
pmid = {16498335},
issn = {1121-421X},
abstract = {In order to evaluate the efficacy and tolerability of mesalazine (5-ASA) in the prophylaxis of symptomatic relapses, of major complications and of microhemorrhagic phenomena in diverticular disease of the large intestine (MDC), prospective clinical study was conducted on patients with light-moderate symptomatic MDC under treatment with sulbactam-ampicillin 1.5 g/12 h i.m. and rifaximine 400 mg/12 h per os for 7 days. Follow-up period of 5 years with seriated checkups and laboratory and instrumentation controls. End points are represented by the relapse on inflammation and/or by the occurrence of major complications. On enrollment, 166 patients were randomized to receive mesalazine (Pentacol tablets--SOFAR S.p.A.) 400 mg b.i.d. per os for 8 weeks (81 patients; group M) or no supplementary treatment (85 patients; group C). After 4 years of follow-up, 44 patients dropped out of the study (9 because of major complications, 3 for massive hemorrhage, and 32 drop outs). Symptomatic relapses occurred in 51 patients (12 M; 39 C), while minor diverticular hemorrhages occurred in 43 patients (12 M; 31 C), with an estimated probability of remaining free respectively from symptomatic relapse (p=0.00005) and from microhemorrhagic phenomena (p=0.001) decisively in favor of the group treated with mesalazine. The duration of abdominal pain due to diverticolitis was also shorter in patients of group M (p=0.0002), while the incidence of major complications and side effects was comparable in the two groups. In conclusion, supplementary treatment with mesalazine in patients affected with MDC--at a follow-up limited to 48 months--proved to be well tolerated and effective in reducing the frequency of symptomatic relapses and microhemorrhagic phenomena and in reducing the duration of abdominal pain.},
}
@article {pmid16498324,
year = {1999},
author = {Pelizzari, E and Lovera, M and Pirrotta, AA},
title = {Endoscopic treatment of bezoars. A critical review of the literature and presentation of two cases.},
journal = {Minerva gastroenterologica e dietologica},
volume = {45},
number = {2},
pages = {153-161},
pmid = {16498324},
issn = {1121-421X},
abstract = {The authors report two cases of bezoars. The first was a large gastric bezoar in a patient who had undergone Billroth II gastroresection 40 years earlier. The second was a bezoar located in the distal part of the sigmoid colon accompanied by acute diverticular disease. Both bezoars were removed using endoscopic techniques. The method of exeresis is described together with the characteristics of the different anatomic sites. The authors review the literature focusing on nosology, symptomatology, diagnosis and guidelines for therapy. Considerable attention is paid to the use of endoscopy associated with prokinetic-enzymatic medical therapy. Surgery is reserved for rare cases of endoscopic failure, mostly recorded in the event of trichobezoars following the onset of intestinal occlusions caused by migration, or lastly when the cause of the bezoar is a pre-existing organic or functional stenosis.},
}
@article {pmid16498253,
year = {2006},
author = {Frieri, G and Pimpo, MT and Scarpignato, C},
title = {Management of colonic diverticular disease.},
journal = {Digestion},
volume = {73 Suppl 1},
number = {},
pages = {58-66},
doi = {10.1159/000089780},
pmid = {16498253},
issn = {0012-2823},
mesh = {Colectomy/*methods ; Dietary Fiber/*therapeutic use ; Diverticulum, Colon/*therapy ; Gastrointestinal Agents/*therapeutic use ; Humans ; Treatment Outcome ; },
abstract = {Diverticular disease of the colon is a complex syndrome that includes several clinical conditions, each needing different therapeutic strategies. In patients with asymptomatic diverticulosis, only a fiber-rich diet can be recommended in an attempt to reduce intraluminal pressure and slow down the worsening of the disease. Fiber supplementation is also indicated in symptomatic diverticulosis in order to get symptom relief and prevent acute diverticulitis. In this regard, the best results have been obtained by combination of soluble fiber, like glucomannan, and poorly absorbed antibiotics, like rifaximin, given 7-10 days every month. For uncomplicated diverticulitis the standard therapy is liquid diet and oral antimicrobials, usually ciprofloxacin and metronidazole. Hospitalization, bowel rest, and intravenous antibacterial agents are mandatory for complicated diverticulitis. Haemorrhage is usually a self-limited event but may require endoscopic or surgical treatment. Once in remission, continuous fiber intake and intermittent course of rifaximin may improve symptoms and reduce diverticulitis recurrence. These preventive strategies will likely improve patients' quality of life and reduce management costs. A surgical approach in diverticular disease is needed in 15-30% of cases and consists of removing the intestinal segment affected by diverticula. It is indicated in diffuse peritonitis, abscesses, fistulas, stenosis and after the second to fourth attack of uncomplicated diverticulitis. Young people and immunocompromised patients are more likely to be operated.},
}
@article {pmid16498252,
year = {2006},
author = {Parra-Blanco, A},
title = {Colonic diverticular disease: pathophysiology and clinical picture.},
journal = {Digestion},
volume = {73 Suppl 1},
number = {},
pages = {47-57},
doi = {10.1159/000089779},
pmid = {16498252},
issn = {0012-2823},
mesh = {Diagnosis, Differential ; Diverticulum, Colon/diagnosis/*physiopathology ; Gastrointestinal Motility/*physiology ; Humans ; Risk Factors ; },
abstract = {Colonic diverticulosis is the most frequent structural abnormality of the large bowel, although it was a rarity before the 20th century. Lifestyle changes in westernized societies with reduced fiber diet are supposed to be the main cause for its high prevalence nowadays. In African countries, where staple diet is rich in fiber, diverticulosis remains very infrequent. Prevalence increases with ageing too. A fiber-deficient diet and subsequent reduction in bowel content volume would lead to increased intraluminal pressures and colonic segmentation, thus promoting diverticula formation. Animal and human studies have shown increased intracolonic pressures in patients with diverticulosis. Alterations in colonic muscle properties, collagen metabolism and in the interactions of the extracellular matrix components may play a role in remodelling the gut wall in diverticular disease. At least one fourth of patients with diverticulosis will develop symptoms, sometimes overlapping with irritable bowel syndrome, but 10-25% will suffer diverticulitis and 3-5% diverticular bleeding. Conservative medical management is usually sufficient in the first episode of diverticulitis, but surgical treatment is generally advocated in recurrences. Diverticular bleeding is a major cause of lower digestive haemorrhage, but generally self-limited. With the application of therapeutic endoscopic and angiographic methods, emergency surgery can often be avoided.},
}
@article {pmid16498249,
year = {2006},
author = {Scarpignato, C and Pelosini, I},
title = {Experimental and clinical pharmacology of rifaximin, a gastrointestinal selective antibiotic.},
journal = {Digestion},
volume = {73 Suppl 1},
number = {},
pages = {13-27},
doi = {10.1159/000089776},
pmid = {16498249},
issn = {0012-2823},
mesh = {Animals ; Anti-Infective Agents/*pharmacology ; Bacteria/drug effects ; Bacterial Infections/*drug therapy/microbiology ; Disease Models, Animal ; Gastrointestinal Diseases/*drug therapy/microbiology ; Humans ; Rifamycins/*pharmacology ; Rifaximin ; Treatment Outcome ; },
abstract = {Rifaximin (4-deoxy-4'-methylpyrido[1',2'-1,2]imidazo [5,4-c]rifamycin SV) is a product of synthesis experiments designed to modify the parent compound, rifamycin, in order to achieve low gastrointestinal (GI) absorption while retaining good antibacterial activity. Both experimental and clinical pharmacology clearly show that this compound is a non-systemic antibiotic with a broad spectrum of antibacterial action covering Gram-positive and Gram-negative organisms, both aerobes and anaerobes. Being virtually non-absorbed, its bioavailability within the GI tract is rather high with intraluminal and fecal drug concentrations that largely exceed the minimum inhibitory concentration values observed in vitro against a wide range of pathogenic organisms. The GI tract represents therefore the primary therapeutic target and GI infections the main indication. This antibiotic has therefore little value outside the enteric area and this will minimize both antimicrobial resistance and systemic adverse events. Indeed, the drug proved to be safe in all patient populations, including young children. The appreciation of the pathogenic role of gut bacteria in several organic and functional GI diseases has increasingly broadened its clinical use, which is now extended to hepatic encephalopathy, small intestine bacterial overgrowth, inflammatory bowel disease and colonic diverticular disease.},
}
@article {pmid16493819,
year = {2006},
author = {Trasti, H},
title = {[Chronic gastrointestinal bleeding of unknown cause].},
journal = {Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke},
volume = {126},
number = {4},
pages = {459-460},
pmid = {16493819},
issn = {0807-7096},
mesh = {Aged ; Cecal Neoplasms/complications/diagnosis/surgery ; Chronic Disease ; Gastrointestinal Hemorrhage/diagnosis/*etiology/surgery ; Humans ; Male ; Peptic Ulcer Hemorrhage/diagnosis ; Rectal Diseases/complications/diagnosis/surgery ; },
abstract = {Two patients with chronic gastrointestinal bleeding are reported. One patient had chronic occult bleeding with iron deficiency. Extensive evaluations performed during a period of two years in three different medical centres did not reveal the cause of the bleeding. The patient was admitted to the local hospital with acute abdominal pain. After a review of her clinical record, she was offered exploratory laparotomy. A large malignant tumour of the caecum was found. Right hemicolectomy was performed. Metastatic disease was, however, diagnosed three years later. The other patient was admitted with melena and anaemia three times during a period of two years. On the last occasion, the rectal bleeding was severe. The patient was transferred to the university medical centre. Extensive investigations did not disclose the cause of the bleeding. The cause was, however, supposed to be diverticular disease of the sigmoid colon. Laparoscopic sigmoid resection was preformed. Four weeks later the patient was once more admitted to the local hospital with severe anaemia and rectal bleeding. A formal laparotomy was performed without any further medical examinations. Ulcerations of the mucosa were found at four places in the distal part of the small intestine. Intestinal resection was performed. Diagnostic evaluation of gastrointestinal bleeding should be swift and aggressive. Modern diagnostic technology successfully identifies the cause of bleeding in 95% of patients with gastrointestinal bleeding. In highly selected patients, however, explorative surgery may still be needed as the definitive diagnostic technique.},
}
@article {pmid16490550,
year = {2006},
author = {Senagore, AJ and Delaney, CP},
title = {A critical analysis of laparoscopic colectomy at a single institution: lessons learned after 1000 cases.},
journal = {American journal of surgery},
volume = {191},
number = {3},
pages = {377-380},
doi = {10.1016/j.amjsurg.2005.10.039},
pmid = {16490550},
issn = {0002-9610},
mesh = {Clinical Competence ; Colectomy/education/*methods ; Humans ; *Laparoscopy ; Length of Stay ; Middle Aged ; Ohio/epidemiology ; *Outcome Assessment, Health Care ; Postoperative Care ; Postoperative Complications/epidemiology ; Prospective Studies ; Reference Standards ; Utilization Review ; },
abstract = {BACKGROUND: A critical outcome analysis of a large, single-institution experience provides a better frame of reference for an assessment of the role of laparoscopic colectomy for colorectal pathology.
METHODS: Review of a prospectively gathered database was performed of a consecutive series of laparoscopic colectomy patients who were operated on by 2 surgeons at a single institution (tertiary referral center) using standardized techniques and care plans. Patients were assessed for operative indications, type of resection, operative time, conversion, complications, duration of stay, and readmission within 30 days.
RESULTS: One thousand consecutive patients undergoing laparoscopic colectomy from January 1999 thru June 2004 were analyzed. The types of resections were right colectomy = 314, left/sigmoid colectomy/anterior resection = 435, total colectomy = 61, total proctocolectomy = 14, and other = 176. The indications for surgery were diverticular disease = 285, colorectal neoplasia = 285, inflammatory bowel disease = 172, rectal prolapse = 81, and other = 177. The conversion rate was 11.4%. The mean operative time was 112 +/- 45 minutes for all resections. The mean duration of hospitalization for all patients was 3.7 +/- 3.8. The overall complication rate was 9.9%, with the most frequent complications being ileus 2.8%, pulmonary 1.6%, cardiac 1.4%, and wound infection 2.6%. The 30-day readmission rate was 9.1%, and the most frequent reasons for readmission were ileus/small-bowel obstruction, intra-abdominal infection, and anastomotic leak.
CONCLUSIONS: This largest single-institution experience with laparoscopic colectomy confirms the benefits of a standardized approach including shorter hospital rehabilitation and low rates of cardiopulmonary and wound complications. Efforts must be directed at improving access to training in laparoscopic colectomy techniques so that patients can benefit from this new technology.},
}
@article {pmid16479110,
year = {2005},
author = {Oomen, JL and Cuesta, MA and Engel, AF},
title = {Reversal of Hartmann's procedure after surgery for complications of diverticular disease of the sigmoid colon is safe and possible in most patients.},
journal = {Digestive surgery},
volume = {22},
number = {6},
pages = {419-425},
doi = {10.1159/000091444},
pmid = {16479110},
issn = {0253-4886},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*surgery ; Colon, Sigmoid/*surgery ; *Colostomy ; Diverticulitis/*surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Reoperation ; Sigmoid Diseases/*surgery ; },
abstract = {BACKGROUND: Although evidence is growing that most patients who need an operation for diverticular disease of the sigmoid colon can be treated by a single-stage procedure, a two-stage procedure will still be necessary in some patients because of significant sepsis or technical difficulties. The outcomes of 65 patients who underwent secondary restoration after a Hartmann procedure for complicated diverticulitis were studied and the factors leading to complications and mortality were identified.
PATIENTS AND METHODS: Of 91 patients, in a consecutive 12-year period, whose primary operation was a Hartmann procedure, 72 survived longer than 3 months after discharge. Sixty-five underwent an attempted reversal of the Hartmann procedure. The POSSUM scores were calculated in all patients as well as the morbidity and mortality rates.
RESULTS: In 63 (96.9%) patients the bowel continuity could be restored with a morbidity of 38.5% and a mortality of 3.1%. The POSSUM and p-POSSUM scores adequately predicted the mortality in this series.
CONCLUSION: This series shows that when surgical treatment for complicated diverticular disease of the sigmoid colon is necessary, the Hartmann procedure is still a valid indication. In a high percentage of patients the Hartmann procedure could be restored with a low mortality.},
}
@article {pmid16466555,
year = {2006},
author = {Salem, TA and Molloy, RG and O'Dwyer, PJ},
title = {Prospective study on the management of patients with complicated diverticular disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {8},
number = {3},
pages = {173-176},
doi = {10.1111/j.1463-1318.2005.00865.x},
pmid = {16466555},
issn = {1462-8910},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Diverticulitis/complications/*therapy ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome ; },
abstract = {INTRODUCTION: Diverticular disease is a common condition with high morbidity and mortality related to its complications. The aim of this study was to assess the predictive role of acute diverticulitis in the development of further complications from diverticular disease.
PATIENTS AND METHODS: Prospective assessment of all patients with complicated diverticular disease over a 1-year period in a large teaching hospital was undertaken. All patients had documented evidence of their diagnosis by radiological, endoscopic or histopathological techniques when feasible.
RESULTS: Seventy-seven patients with complicated diverticular disease were identified. There were 53 females and 24 males with a median age of 74 years (range 30-97 years). Complications included: acute diverticulitis (37), fistula (12), perforation (8), bleeding (7), abscess (7) and stricture (6). Only 8 had two or more previous documented episodes of diverticulitis. Twenty-five underwent surgery, 3 died (peritonitis 2, abscess1) and 5 had a complication (anastomotic dehiscence 1, adhesive obstruction 1, incisional hernia 2 and pneumonia 1). Three (5%) of 37 patients with acute diverticulitis had two or more admissions but none underwent surgery or developed further complications. CT was performed during acute admission in 14/37 patients with acute diverticulitis. The majority of patients with fistula (9/12), perforation 7/8, bleeding 6/7 and abscess 5/7 had no previous episode of diverticulitis while most patients with stricture (4/6) had previous documented episodes.
CONCLUSION: In our patient population acute diverticulitis is not a good predictor of the development of further complications from diverticular disease as only a minority of patients with perforation, fistula, abscess and bleeding had previous documented episodes of diverticulitis.},
}
@article {pmid16447484,
year = {2005},
author = {Abou-Nukta, F and Bakhos, C and Ikekpeazu, N and Ciardiello, K},
title = {Ruptured giant colonic diverticulum.},
journal = {The American surgeon},
volume = {71},
number = {12},
pages = {1073-1074},
pmid = {16447484},
issn = {0003-1348},
mesh = {Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colectomy/*methods ; Colon, Sigmoid/physiopathology/surgery ; Diverticulum, Colon/complications/*diagnosis/*surgery ; Female ; Follow-Up Studies ; Humans ; Laparotomy/methods ; Rare Diseases ; Risk Assessment ; Rupture, Spontaneous/etiology/surgery ; Severity of Illness Index ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {Giant colonic diverticulum (GCD) is a rare complication of diverticular disease with less than 150 cases reported in the English literature. The clinical presentation ranges from asymptomatic to that of an acute abdomen. In most cases, giant colonic diverticulum is found in the sigmoid colon. The ideal treatment is elective resection of the sigmoid colon with primary anastomosis. When the diverticulum presents with perforation or obstruction, however, the treatment is a sigmoid colectomy with diverting colostomy (Hartmann procedure).},
}
@article {pmid16432647,
year = {2006},
author = {Wilhelm, TJ and Refeidi, A and Palma, P and Neufang, T and Post, S},
title = {Hand-assisted laparoscopic sigmoid resection for diverticular disease: 100 consecutive cases.},
journal = {Surgical endoscopy},
volume = {20},
number = {3},
pages = {477-481},
pmid = {16432647},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Diverticulosis, Colonic/*surgery ; Endoscopy, Digestive System ; Feasibility Studies ; Female ; Humans ; Intraoperative Complications/epidemiology ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Reoperation ; Sigmoid Diseases/*surgery ; Spleen/injuries ; Ureter/injuries ; },
abstract = {BACKGROUND: Hand-assisted laparoscopic surgery (HALS) has been proposed as a useful alternative to conventional laparoscopic and open surgery. As compared with conventional laparoscopic surgery, it offers the advantages of tactile feedback, better exposure, and a shorter learning curve. There is increasing evidence that HALS retains the advantages of minimal-access surgery. The aim of this study was to analyze the feasibility as well as the short- and medium-term outcomes of HALS sigmoid resection for diverticular disease.
METHODS: The study included 100 consecutive patients between July 1999 and August 2004. Data were prospectively recorded. Follow-up evaluation was performed by standardized telephone interview after a mean postoperative period of 19 months (range, 2-55 months).
RESULTS: Two major intraoperative complications occurred: splenic laceration requiring splenectomy and ureteral injury requiring suture. There were only three conversions: one case of pararectal incision and two cases of extended lower Pfannestiel incision. There was no single case of conversion to midline laparotomy. One patient died postoperatively of myocardial infarction. The postoperative complications included intraabdominal hematoma (2%), anastomotic leakage (3%), wound infection (11%) and bladder dysfunction (1%). The reoperation rate was 5%. The median hospital stay was 8 days. In terms of satisfaction with the results, 97% of patients would choose HALS again.
CONCLUSIONS: When used for diverticular disease, HALS sigmoid resection has a low intra- and postoperative complication rate. The satisfaction rate among patients is high. Even in technically difficult cases, conversion to midline laparotomy can be avoided.},
}
@article {pmid20011275,
year = {2004},
author = {Larach, S},
title = {Laparoscopic management of diverticular disease.},
journal = {Clinics in colon and rectal surgery},
volume = {17},
number = {3},
pages = {187-193},
pmid = {20011275},
issn = {1530-9681},
abstract = {Laparoscopy surgery has achieved wide acceptance for the treatment of benign disease of the colon. A review of the literature regarding the indications, surgical technique, and outcomes of laparoscopic surgery for diverticular disease is presented.},
}
@article {pmid20011274,
year = {2004},
author = {Gemlo, BT},
title = {Elective surgical treatment of diverticulitis.},
journal = {Clinics in colon and rectal surgery},
volume = {17},
number = {3},
pages = {183-186},
pmid = {20011274},
issn = {1530-9681},
abstract = {Elective surgical resection in cases of diverticulitis should be offered to patients who have experienced two episodes. High-risk patients such as immunocompromised individuals or transplant patients may warrant resection after one episode. It is controversial whether young patients or patients with right-sided diverticulitis need to be treated differently. Chronic diverticulitis can be successfully treated surgically in selected cases. Adequate surgical resection margins should include the top of the true rectum and the proximal extent of thickened inflamed colon to minimize the risk of recurrence. Careful operative planning and the use of proximal diversion if unsuspected significant inflammatory changes are encountered will improve surgical outcomes.},
}
@article {pmid20011272,
year = {2004},
author = {Schaffzin, DM and Wong, WD},
title = {Nonoperative management of complicated diverticular disease.},
journal = {Clinics in colon and rectal surgery},
volume = {17},
number = {3},
pages = {169-176},
pmid = {20011272},
issn = {1530-9681},
abstract = {The complications of diverticular disease of the colon can be divided into those related to inflammatory conditions (diverticular abscess, fistula, and perforation) and those related to noninflammatory conditions (lower gastrointestinal hemorrhage and noninflammatory stricture or obstruction). Nonoperative management of uncomplicated diverticulitis includes bowel rest and antibiotics. For abscesses, percutaneous drainage by radiologic guidance often turns complicated diverticulitis to an uncomplicated condition. In very select instances, fistulas or even perforation may be managed without operation. Strictures may be dilated or stented. Diverticular hemorrhage may be controlled with colonoscopic and angiographic techniques. For colonoscopy, these include cautery, epinephrine injection, and endoclips. For angiography, these include arterial infusion of vasopressin and selective embolization of bleeding vessels. For both diverticulitis and diverticular bleeding, these nonoperative therapeutic modalities may be utilized as a bridge to surgery, or in select instances as a definitive therapy obviating the need for surgery.},
}
@article {pmid20011271,
year = {2004},
author = {Welling, DR},
title = {Medical treatment of diverticular disease.},
journal = {Clinics in colon and rectal surgery},
volume = {17},
number = {3},
pages = {163-168},
pmid = {20011271},
issn = {1530-9681},
abstract = {The medical treatment of diverticulitis is discussed, including its incidence, stages, and presentation, as are the antibiotic and dietary therapies currently recommended for this disease. Because diverticulitis can be a challenge to treat, several pitfalls are listed in this discussion, including diverticulitis in the immunocompromised, in the young, and in patients who do not have true diverticulitis but who present with some signs and symptoms of the disease.},
}
@article {pmid20011270,
year = {2004},
author = {Snyder, MJ},
title = {Imaging of colonic diverticular disease.},
journal = {Clinics in colon and rectal surgery},
volume = {17},
number = {3},
pages = {155-162},
pmid = {20011270},
issn = {1530-9681},
abstract = {Diverticular disease affects approximately two thirds of the population over the age of 70. While only a small fraction of these patients will develop diverticulitis, adequate radiological evaluation of diverticulitis and its complications is imperative in determining proper medical and surgical treatment. Clinical examination and laboratory tests alone have been found to be inaccurate in defining many aspects of the disease in up to 60% of cases. Over the past 30 years, contrast enema, computed tomography, and ultrasound have all been used extensively to diagnose the complications of diverticular disease. More recently, magnetic resonance imaging has been studied in patients with complicated diverticulitis. This article reviews the use of these different radiological modalities in diagnosing acute colonic diverticulitis and its complications.},
}
@article {pmid20011269,
year = {2004},
author = {Hobson, KG and Roberts, PL},
title = {Etiology and pathophysiology of diverticular disease.},
journal = {Clinics in colon and rectal surgery},
volume = {17},
number = {3},
pages = {147-153},
pmid = {20011269},
issn = {1530-9681},
abstract = {Diverticular disease is prevalent in Western countries and yet its pathogenesis remains poorly understood. The common theories of the cause of diverticular disease have focused on colonic motility, the structural aspects of the colonic wall, and the role of dietary factors, particularly fiber.},
}
@article {pmid20011268,
year = {2004},
author = {Karulf, RE},
title = {Diverticular disease.},
journal = {Clinics in colon and rectal surgery},
volume = {17},
number = {3},
pages = {145},
pmid = {20011268},
issn = {1530-9681},
}
@article {pmid19753719,
year = {2003},
author = {Sánchez-Medina, R and Suárez-Moreno, R and Aguilar-Soto, O and Cuéllar-Gamboa, L and Avila-Vargas, G and Di Silvio-López, M},
title = {[Manual mechanical anastomosis colorectal surgery].},
journal = {Cirugia y cirujanos},
volume = {71},
number = {1},
pages = {39-44},
pmid = {19753719},
issn = {0009-7411},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Colon/surgery ; Colonic Diseases/*surgery ; Female ; Humans ; Male ; Middle Aged ; Rectum/surgery ; Retrospective Studies ; *Suture Techniques ; Young Adult ; },
abstract = {OBJECTIVE: To determine advantages and disadvantages of manual vs mechanical sutures in colon surgery.
MATERIAL AND METHODS: A retrospective study of clinical files of 84 colon surgery patients was conducted, to establish morbidity and mortality of these patients with special emphasis in length of surgical procedure and type of suture used during procedure (either manual or mechanical).
RESULTS: Of 84 patients included in this study, manual suture was used in 70 (group 1) and mechanical suture in 14 (group 2). Most common preoperative diagnosis was diverticular disease in 22 cases (26.2%), 20 for group with manual suture, and two for group with mechanical suture. Most common surgical procedure was colectomy with ileoproctoanastomosis in group 1 and lower anterior resection with coloproctoanastomosis in group 2. Five cases presented complications (2.85%) with manual suture, while only one case presented complications in group 2 (7.14%). Main complications were dehiscence in group 1 and stenosis in group 2.
DISCUSSION: There were no significant differences between both types of suture in terms of time of surgical procedure; there were no statistical differences for both techniques in terms of morbidity and mortality. However, there is shorter time of recovery in patients in whom mechanical suture was used with less tissue edema due to manipulation and less disability period.},
}
@article {pmid19861778,
year = {2001},
author = {Isbister, WH},
title = {Diverticular disease: an experience at King Faisal specialist hospital.},
journal = {Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association},
volume = {7},
number = {3},
pages = {109-112},
pmid = {19861778},
issn = {1998-4049},
abstract = {BACKGROUND: Diverticular disease of the colon is rarely seen in Saudi Arabia and this paper describes our experience with 16 patients admitted to hospital during an 8-year period (March 1990 - February 1998).
PATIENTS AND METHODS: A computerized data base of patients having colorectal surgery was searched to identify patients admitted to the colorectal unit suffering from diverticular disease of the colon or it's complications. The records of these patients were examined and form the basis of this report.
RESULTS: Sixteen patients were admitted to the colorectal unit for the management of diverticular disease or it's complications during an 8-year period. One patient presented with a localized abscess which was drained percutaneously. Fifteen patients underwent one or more surgical interventions. There were three female patients. One patient was referred for stoma closure, four for elective surgery and ten with acute perforation of whom one underwent right hemicolectomy for a perforated caecal diverticulum and nine underwent Hartmann's procedure for sigmoid perforation. Two patients required multiple abdominal washouts. Post-operatively two patients developed severe chest infections, one developed renal failure and two urinary infections. Four wounds became infected and two intra abdominal collections were drained percutaneously. No patient died. Eight stomata (89%) were subsequently closed. The mean duration of follow up was 2.7 yr. Four patients were lost to follow up.
CONCLUSION: This small series documents the presence of diverticular disease and it's complications in the Kingdom of Saudi Arabia and suggests that the commonest method of presentation may be an acute one. Surgeons must thus be mindful of the condition and take appropriate action. Hartmann's' operation was safe and resulted in a low morbidity and no mortality. 89% of the stomata were closed at a later procedure.},
}
@article {pmid23578150,
year = {2000},
author = {Murray, D and Hellawell, G and Oakley, R and Rosenfeld, K and Al-Mufti, RA and Lewis, AA and Berger, LA},
title = {Should air contrast computed tomography become the first investigation of the colon of frail or elderly patients?.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {2},
number = {6},
pages = {330-335},
doi = {10.1046/j.1463-1318.2000.00143.x},
pmid = {23578150},
issn = {1462-8910},
abstract = {OBJECTIVE: Air contrast computed tomography (ACCT) is an alternative test to barium enema or colonoscopy. We review our experience of this test as the first investigation of frail, elderly patients with lower gastrointestinal symptoms, and record the subsequent clinical course of these patients to evaluate the efficacy of the technique.
PATIENTS AND METHODS: We performed 109 ACCT studies on frail patients aged 70 years or over with lower gastrointestinal symptoms. The findings were correlated with subsequent investigations and surgical findings. Patients with normal scans were followed up in out-patients or by their GP. Average follow up was 17 months.
RESULTS: A good quality complete examination of the colon was achieved in 97% of patients. Of 109 examinations 34 (31%) were reported as normal, 65 (60%) as diverticular disease, nine (8%) as demonstrating a colonic malignancy and one (1%) showed a benign polyp. One sigmoid tumour was missed initially but diagnosed on a repeat ACCT study.
CONCLUSION: ACCT is a reliable, well-tolerated technique in elderly frail patients.},
}
@article {pmid24398283,
year = {2000},
author = {Young, GP},
title = {Colorectal disorders: A dietary management perspective.},
journal = {Asia Pacific journal of clinical nutrition},
volume = {9 Suppl 1},
number = {},
pages = {S76-82},
doi = {10.1046/j.1440-6047.2000.00178.x},
pmid = {24398283},
issn = {0964-7058},
abstract = {Dietary lifestyle is relevant for prevention and treatment of various colorectal conditions. Colorectal disorders have significant morbidity and mortality in a western-style community, particularly irritable bowel syndrome (IBS), colorectal cancer, haemorrhoids, constipation and diverticular disease. This review addresses how bowel health can be maintained, what foods and dietary lifestyles are associated with risk for disease and what foods are of real value in management. Bowel health is that state where the individual is satisfied with defaecation, the diet does not create undue risk for disease and lumenal contents maintain an intact and functional mucosa. Bowel health depends on a healthy dietary lifestyle, but in particular on an adequate intake of non-digestable dietary polysaccharide. Diet influences biology in part by altering the lumenal environment. Effects such as high butyrate levels, lowered pH, a predominance of 'healthy'over 'unhealthy' bacteria, rapid intestinal transit, high faecal bulk, a non-leaky epithelial barrier, adsorption of dietary carcinogens by fibre, low bile salt concentrations, reduced generation of toxic bile salts or protein derivatives and provision of certain bioactive substances are seen as beneficial. Diet influences future risk for colorectal cancer (vegetables, animal fats, polysaccharides amongst others) and for diverticular disease (fibre). Adequate fibre and resistant starch can improve constipation and anorectal conditions such as fissure and haemorrhoids. The role of diet in managing patients with IBS is complex. Fibre may worsen symptoms in severe cases of IBS, diverticular disease and inflammatory bowel disease. Certain carbohydrates of limited digestibility/absorbability, such as lactose, fructose and sorbitol, can precipitate IBS symptoms. Low fat, high fibre diets may reduce recurrence of colorectal adenomas. Diet has a significant role to play in colorectal disorders.},
}
@article {pmid19864725,
year = {2000},
author = {Al Quorain, AA and Satti, MB and Al Gindan, YM and Al-Hamdan, A},
title = {The pattern of lower gastrointestinal disease in the eastern region of Saudi Arabia: a retrospective analysis of 1590 consecutive patients.},
journal = {Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association},
volume = {6},
number = {1},
pages = {27-32},
pmid = {19864725},
issn = {1998-4049},
abstract = {To determine the pattern of lower gastrointestinal disease in the Eastern region of Saudi Arabia we analysed 1907 colorectal biopsies obtained from 1590 consecutive patients (1256 males & 334 females), evaluated during a 13 year period (1983-1996) in a tertiary care teaching hospital. The age range was 6-81 years with a mean of 37 + 15. During the same period 6874 new patients were seen in the Gastroenterology Clinics. Saudi Arabs constituted 970 (61 %) of all patients. The remaining 620 (39%) were non-Saudi, mostly of Arab origin from neighbouring countries. The most common presenting symptom for referral was abdominal pain (1193 patients, 75%) followed by diarrhea (636 patients, 40%). The most frequent histologic diagnosis was a normal mucosa followed by non specific proctocolitis accounting respectively for 37.9% and 37.4% of all cases. These were followed by schistosomiasis, 113 (7.1%), adenocarcinoma, 91 (5.7%) and ulcerative colitis, 91 cases with a relative frequency of 5.7% and a calculated prevalence of 1.3%. Of significance was the encounter of 14 cases of Crohn's disease amounting to 0.9% of all cases with a calculated prevalence of 0.2%. A minority of 83 patients (5.2%) were cases of either a benign polyp, diverticular disease, tuberculosis, ischaemia, lymphoma, pseudomembranous colitis (PMC), eosinophilic gastroenteritis or malacoplakia. These data show that although a "normal mucosa" and "nonspecific proctocolitis" were the dominant diagnoses, significantly, ulcerative colitis and Crohn's disease exist and should be considered in the differential diagnosis of lower GI disease.},
}
@article {pmid23577758,
year = {1999},
author = {Hultén, and Haboubi, and Schofield, },
title = {Diverticular disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {1},
number = {3},
pages = {128-136},
doi = {10.1046/j.1463-1318.1999.00023.x},
pmid = {23577758},
issn = {1462-8910},
}
@article {pmid19311290,
year = {1990},
author = {Dawson, J},
title = {Optimal operative treatment in acute septic complications of diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {72},
number = {4},
pages = {273-274},
pmid = {19311290},
issn = {0035-8843},
}
@article {pmid19311096,
year = {1986},
author = {Adiseshiah, M},
title = {Audit on complicated diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {68},
number = {3},
pages = {176},
pmid = {19311096},
issn = {0035-8843},
}
@article {pmid21283397,
year = {1983},
author = {McDonald, J and Pirhonen, D and Rangam, MA},
title = {High fiber diets: their role in gastrointestinal disorders.},
journal = {Canadian family physician Medecin de famille canadien},
volume = {29},
number = {},
pages = {1632-1638},
pmid = {21283397},
issn = {0008-350X},
abstract = {High fiber diets may help prevent colon cancer and be used to treat constipation, diverticular disease, irritable bowel syndrome and Crohn's disease. Some research indicates that cholelithiasis, duodenal ulcers, hemorrhoids and hiatal hernias may be prevented or treated with dietary fiber. However, many claims about fiber's usefulness lack scientific validation. Physicians can help patients establish goals for the amount of fiber they eat and advise them to record their daily intake of fiber. Doctors can also help patients select high fiber foods which fit their lifestyles, warn of possible side effects such as gas, abdominal pain and malabsorption of some nutrients, and advise them to exercise and drink adequate amounts of fluid. Children can be encouraged to eat whole grain breads, high-fiber snacks and natural bran hidden in cooked cereals, cookies and ground meat recipes. The physician or dietician should follow up patients to ensure their continued compliance.},
}
@article {pmid21286521,
year = {1982},
author = {Sangster, JF and Gerace, TM},
title = {Screening for carcinoma of the colon: a family practice perspective.},
journal = {Canadian family physician Medecin de famille canadien},
volume = {28},
number = {},
pages = {1599-1603},
pmid = {21286521},
issn = {0008-350X},
abstract = {Carcinoma of the colon is the second commonest malignancy in both sexes in North America. With little hope for a suitable method of primary prevention, physicians are forced to look for an effective secondary preventive technique. Through a collaborative effort between the physician and family practice nurse, an effective protocol for screening was developed and implemented on 355 patients aged over 40. Of these, 17 were positive. Ten of those were true positive and seven false positive. One false negative was found, but no carcinoma has been found to date-the positive patients have polyps, diverticular disease or hemorrhoids. In view of increasing evidence for the polyp-cancer sequence, this finding may be significant. Widespread use of Hemoccult II in this fashion will clarify the usefulness of this test.},
}
@article {pmid20469285,
year = {1978},
author = {Rossman, R},
title = {The bulk of gastroenterology.},
journal = {Canadian family physician Medecin de famille canadien},
volume = {24},
number = {},
pages = {1295-1298},
pmid = {20469285},
issn = {0008-350X},
abstract = {Low residue or fiber deficient diets have been implicated in the etiology of numerous disorders, (1) from colonic neoplasms to dental caries, from varicose veins to atheroma and ischemic heart disease.(2, 3) Although wheat bran is the most commonly mentioned source of dietary fiber, there are many other sources available.What is fiber and what is its importance? Is it merely another fad? Previously irritable bowel syndrome and diverticular disease were treated with a low residue diet-has the change to a high fiber diet been justified? Only recently has methodology effectively separated crude fiber from dietary fiber. Few, and often conflicting, clinical trials are available for management guidance.},
}
@article {pmid21301548,
year = {1978},
author = {Smith, ER},
title = {Epidemiology of gastrointestinal disorders.},
journal = {Canadian family physician Medecin de famille canadien},
volume = {24},
number = {},
pages = {1007-1011},
pmid = {21301548},
issn = {0008-350X},
abstract = {Irritable bowel syndrome occurs most frequently in young adults in response to emotional and other factors. The 20th century western epidemic of diverticular disease may be linked to low dietary fiber intake. Peptic ulceration is determined by genetic and environmental factors including tobacco and coffee. Aspirin specifically predisposes to gastric ulcer. The incidence of peptic ulcer is declining. Crohn's disease is increasing in frequency although the incidence of ulcerative colitis is fairly steady. Gastrointestinal cancer is closely related to dietary factors including ingested procarcinogens, excessive carbohydrate, fat and animal protein. There is potential for control of some intestinal cancers.},
}
@article {pmid18668818,
year = {1969},
author = {},
title = {Motility studies in diverticular disease of the colon: Part II Effect of colonic and rectal distension.},
journal = {Gut},
volume = {10},
number = {7},
pages = {538-542},
pmid = {18668818},
issn = {0017-5749},
}
@article {pmid18859847,
year = {1948},
author = {AGUILAR SARMIENTO, S},
title = {[Diverticular disease of the prostate; diagnostic notes].},
journal = {Revista de urologia},
volume = {6},
number = {2},
pages = {388-394},
pmid = {18859847},
mesh = {*Disease ; Humans ; Male ; *Prostate ; *Prostatic Diseases ; },
}
@article {pmid18909493,
year = {1948},
author = {HEITZ-BOYER, },
title = {[Diverticular disease of the prostate].},
journal = {Bulletin de l'Academie nationale de medecine},
volume = {132},
number = {1-2},
pages = {15-21},
pmid = {18909493},
issn = {0001-4079},
mesh = {*Diverticulum ; Humans ; Male ; *Prostate ; },
}
@article {pmid16427930,
year = {2006},
author = {Iacopini, G and Frontespezi, S and Vitale, MA and Villotti, G and Bella, A and d'Alba, L and De Cesare, A and Iacopini, F},
title = {Routine ileoscopy at colonoscopy: a prospective evaluation of learning curve and skill-keeping line.},
journal = {Gastrointestinal endoscopy},
volume = {63},
number = {2},
pages = {250-256},
doi = {10.1016/j.gie.2005.09.029},
pmid = {16427930},
issn = {0016-5107},
mesh = {Aged ; *Clinical Competence ; *Colonoscopy/methods/standards ; Female ; Follow-Up Studies ; Gastroenterology/*education ; Humans ; Ileal Diseases/*diagnosis ; Male ; Outpatients ; Prospective Studies ; },
abstract = {BACKGROUND: Ileoscopy is the criterion standard for mucosal lesions of terminal ileum but is performed in 5% of colonoscopy activity, and the need for training is undefined.
OBJECTIVE: To assess the learning curve and skill-keeping line of ileoscopy.
DESIGN: Prospective randomized study.
SETTING: Single GI endoscopy unit.
PATIENTS: Adult outpatients referred for colonoscopy.
INTERVENTIONS: Patient randomization to ileocolonoscopy by trainees and seniors.
MAIN OUTCOME MEASUREMENTS: Ileoscopy skill was divided into the following: ileocecal valve (ICV) intubation (success rate, time) and ileal exploration (length, time). Consecutive blocks of 10 procedures were used to calculate the learning curve and the skill-keeping line. Variables considered to influence ICV intubation were the following: endoscopist experience, ICV morphology, patient age, gender, body mass index, diverticular disease, and preceding abdominal/pelvic surgery.
RESULTS: Learning curve showed that competency in ICV intubation (80% success rate) and ileal exploration (16 cm) was achieved after 50 procedures. The skill-keeping line showed that ileoscopy was easy (97% success rate), fast (1 minute), and well accepted up to 45 cm of the ileum. Thin-lipped and volcanic ICV are the most difficult and easiest to intubate, respectively. Crohn's disease and adenomas of the proximal edge of ICV were diagnosed in 2.2%.
CONCLUSIONS: Training in ileoscopy is recommended to achieve competency, and endoscopists should consider practicing ICV intubation to maintain and increase their skill. Ileoscopy can be difficult when the ICV is thin lipped or single bulged, and easy when it has a volcanic morphology.},
}
@article {pmid16423891,
year = {2006},
author = {Guagnini, F and Valenti, M and Mukenge, S and Matias, I and Bianchetti, A and Di Palo, S and Ferla, G and Di Marzo, V and Croci, T},
title = {Neural contractions in colonic strips from patients with diverticular disease: role of endocannabinoids and substance P.},
journal = {Gut},
volume = {55},
number = {7},
pages = {946-953},
pmid = {16423891},
issn = {0017-5749},
mesh = {Adrenergic beta-Agonists/pharmacology ; Adrenergic beta-Antagonists/pharmacology ; Aged ; Arachidonic Acids/analysis/metabolism ; Benzoxazines ; Cannabinoid Receptor Modulators/agonists/antagonists & inhibitors/*physiology ; Case-Control Studies ; Colon/*physiopathology ; Diverticulum/metabolism/*physiopathology ; *Endocannabinoids ; Female ; Glycerides/analysis/metabolism ; Humans ; Imidazoles/pharmacology ; Isoproterenol/pharmacology ; Male ; Middle Aged ; Morpholines/pharmacology ; Muscle Contraction/*drug effects ; Muscle, Smooth/*innervation/physiopathology ; Naphthalenes/pharmacology ; Neurokinin-1 Receptor Antagonists ; Piperidines/pharmacology ; Polyunsaturated Alkamides ; Propanolamines/pharmacology ; Pyrazoles/pharmacology ; Quinuclidines/pharmacology ; Rimonabant ; Substance P/*physiology ; Tetrodotoxin/pharmacology ; },
abstract = {BACKGROUND AND AIMS: Diverticulosis is a common disease of not completely defined pathogenesis. Motor abnormalities of the intestinal wall have been frequently described but very little is known about their mechanisms. We investigated in vitro the neural response of colonic longitudinal muscle strips from patients undergoing surgery for complicated diverticular disease (diverticulitis).
METHODS: The neural contractile response to electrical field stimulation of longitudinal muscle strips from the colon of patients undergoing surgery for colonic cancer or diverticulitis was challenged by different receptor agonists and antagonists.
RESULTS: Contractions of colonic strips from healthy controls and diverticulitis specimens were abolished by atropine. The beta adrenergic agonist (-) isoprenaline and the tachykinin NK1 receptor antagonist SR140333 had similar potency in reducing the electrical twitch response in controls and diseased tissues, while the cannabinoid receptor agonist (+)WIN 55,212-2 was 100 times more potent in inhibiting contractions in controls (IC50 42 nmol/l) than in diverticulitis strips. SR141716, a selective antagonist of the cannabinoid CB1 receptor, had no intrinsic activity in control preparations but potentiated the neural twitch in diseased tissues by up to 196% in a concentration dependent manner. SR141716 inhibited (+)WIN 55,212-2 induced relaxation in control strips but had no efficacy on (+)WIN 55,212-2 responses in strips from diverticular disease patients. Colonic levels of the endogenous ligand of cannabinoid and vanilloid TRPV1 receptors anandamide were more than twice those of control tissues (54 v 27 pmol/g tissue). The axonal conduction blocker tetrodotoxin had opposite effects in the two preparations, completely inhibiting the contractions of control strips but potentiating those in diverticular preparations, an effect selectively inhibited by SR140333.
CONCLUSIONS: Neural control of colon motility is profoundly altered in patients with diverticulitis. Their raised levels of anandamide, apparent desensitisation of the presynaptic neural cannabinoid CB1 receptor, and the SR141716 induced intrinsic response, suggest that endocannabinoids may be involved in the pathophysiology of complications of colonic diverticular disease.},
}
@article {pmid16420905,
year = {2005},
author = {Arteaga, I and Martín, A and Díaz, H and Alonso, M and Ramírez, J and Gómez, G and Rius, J and Moneva, E and Marchena, J and Soriano, A and Carrillo, A},
title = {[Colorectal laparoscopy in the Canary Islands. A multicenter study of 144 patients].},
journal = {Cirugia espanola},
volume = {77},
number = {3},
pages = {139-144},
doi = {10.1016/s0009-739x(05)70825-3},
pmid = {16420905},
issn = {0009-739X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colorectal Surgery/*methods/*standards ; Female ; Humans ; Laparoscopy/*methods/*standards ; Male ; Middle Aged ; Spain ; Surveys and Questionnaires ; },
abstract = {INTRODUCTION: To analyze the short-term results of laparoscopic colorectal surgery (LCRS) in the Canary Islands.
MATERIAL AND METHODS: A questionnaire was sent to hospitals performing laparoscopy and retrospective data on demographic, perioperative and pathological variables in 144 patients who underwent LCRS between May 1993 and May 2003 were obtained.
RESULTS: Sixty-five men and 79 women underwent colon (n=126) and rectal (n=18) surgery in the last 16 months of the study period. The most frequently performed procedure was sigmoidectomy in 85 patients (59%). The most frequent diagnosis was colon adenocarcinoma in 73 patients (50%), followed by diverticular disease in 36 patients (25%). The mean values of the variables studied were: body mass index, 27.3 (range, 22-35); operating time, 175 min (range, 60-255); blood loss, 183.6 ml (range, 50-500). Peristalsis reinitiated at 45 h; oral diet was introduced at 67 h and the overall mean length of hospital stay was 7.8 days (range, 3-30). The length of hospital stay was significantly longer in patients with complications (14.5 vs 6.4; p <.01). There were 7 conversions (4.86%). There were no perioperative deaths. The overall morbidity rate was 28%. The most frequent early complication was surgical wound infection in 9 patients (6.2%). Anastomotic leak was detected in 5 patients (3.4%).
CONCLUSIONS: LCRS has been shown to be a safe and effective technique that has recently increased in the centers surveyed. The factor with the greatest influence on length of hospital stay was the development of postoperative complications.},
}
@article {pmid16420895,
year = {2005},
author = {Bianchi, A and Heredia, A and Hidalgo, LA and García-Cuyàs, F and Soler, MT and del Bas, M and Suñol, X},
title = {[Diverticular disease of the cecal appendix].},
journal = {Cirugia espanola},
volume = {77},
number = {2},
pages = {96-98},
doi = {10.1016/s0009-739x(05)70815-0},
pmid = {16420895},
issn = {0009-739X},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendicitis/*complications/*surgery ; Cecal Diseases/complications/surgery ; Child ; Diverticulum/*complications/*surgery ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {INTRODUCTION: Appendiceal diverticula are uncommon, with an incidence of less than 1% in surgical specimens. We report a series of 14 patients with diverticular disease of the cecal appendix.
PATIENTS AND METHOD: A total of 547 patients with a clinical diagnosis of acute appendicitis underwent surgery over 4 years. Of these, 11 patients showed acute appendiceal diverticulitis at histological examination, and three patients showed diverticulosis associated with appendicitis. Clinical features were compared between the group of patients with diverticular disease and the group with acute appendicitis. Statistical analysis was performed using Students t-test and the chi-squared test.
RESULTS: The overall incidence of appendiceal diverticula was 2.6%, and 2% of cases had acute diverticulitis. In the group with diverticular disease, the mean age and the percentage of patients under clinical observation before the decision to perform surgery was made were significantly higher. There was a nonsignificant predominance of male over female patients and no differences were found in mean white cell count. No radiological investigations were performed in the diverticular group.
CONCLUSIONS: The incidence of appendiceal diverticula was much higher in our series than that reported in the literature. We found no clinical or perioperative data that would serve to differentiate acute diverticulitis from acute appendicitis.},
}
@article {pmid16412070,
year = {2006},
author = {Oomen, JL and Engel, AF and Cuesta, MA},
title = {Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient related factors.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {8},
number = {2},
pages = {112-119},
doi = {10.1111/j.1463-1318.2005.00848.x},
pmid = {16412070},
issn = {1462-8910},
mesh = {Aged ; Aged, 80 and over ; Comorbidity ; Diverticulosis, Colonic/mortality/*surgery ; Female ; Humans ; Male ; Middle Aged ; Morbidity ; Postoperative Complications/*mortality ; Risk Factors ; Sigmoid Diseases/mortality/*surgery ; },
abstract = {OBJECTIVE: Auditing the outcome of surgery for complicated diverticulitis of the sigmoid colon is difficult. A comparison of studies is hardly possible because risk factors both in terms of the severity of diverticulitis and patient-related risk factors are neither well described nor standardized. The purpose of this study was to define morbidity and mortality of primary surgery for acute complications of diverticular disease of the sigmoid colon and to identify the relation between risk factors and morbidity and mortality.
METHODS: In a prospective computerized morbidity and mortality registration from 1990 to 2002, 114 patients, who underwent surgery on an acute or urgent base for acute complications of diverticular disease of the sigmoid colon, were identified. In all patients the POSSUM score was calculated. To audit mortality rates a POSSUM based scoring system was introduced.
RESULTS: Mortality was 16.7%, and morbidity 71.1%. Higher morbidity rates were significantly related to a higher POSSUM physiological score (P = 0.012) and to older age (P < 0.001). Higher mortality rates also were significantly related to a higher POSSUM physiological score (P < 0.001) and older age (P = 0.003). Patients who died had significantly more sepsis (P < 0.001), multiple organ failure (P = 0.027), cardiac (P < 0.001) and pulmonary (P = 0.013) complications. Gender, operation indication and type of neither surgery nor surgeon had a significant relation with morbidity or mortality.
CONCLUSION: Surgery for acute complications of diverticular disease of the sigmoid colon carries a high morbidity rate and a substantial mortality rate. The majority of deceased patients had severe comorbidity. Post-operative mortality and morbidity are to a large extent driven by patient related factors. Elevated physiological severity scores and a lack of peri-operative management failures express this in the majority of deceased patients.},
}
@article {pmid16412069,
year = {2006},
author = {Forshaw, MJ and Sankararajah, D and Stewart, M and Parker, MC},
title = {Self-expanding metallic stents in the treatment of benign colorectal disease: indications and outcomes.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {8},
number = {2},
pages = {102-111},
doi = {10.1111/j.1463-1318.2005.00806.x},
pmid = {16412069},
issn = {1462-8910},
mesh = {Aged ; Aged, 80 and over ; Colonic Diseases/*surgery ; Humans ; Intestinal Obstruction/*surgery ; Middle Aged ; Rectal Diseases/*surgery ; *Stents ; Treatment Outcome ; },
abstract = {OBJECTIVE: The use of stents for benign colorectal obstruction is considered controversial because of a lack of data and perceived high failure and complication rates. The aim of this study was to evaluate the indications and outcomes following stent placement for benign colorectal disease in a UK district general hospital and to review the published literature.
PATIENTS AND METHODS: Between 1997 and 2004, 11 of 90 attempted stent insertions were performed for benign colorectal disease (diverticular disease, 4; anastomotic strictures, 4; idiopathic rectal stricture, 1; rectal endometriosis, 1; caecal volvulus, 1). Complications and outcomes were analysed from a prospective database.
RESULTS: Stent insertion was successful in nine patients. Early complications occurred in two patients (both with diverticular disease): one patient failed to decompress and needed a colostomy and laparotomy was performed in a second patient who developed peritonitis after five days although no stent perforation of the bowel was identified. Two patients were successfully decompressed and underwent subsequent elective surgery with full bowel preparation. Stent placement resulted in symptomatic improvement in three out of four patients with anastomotic strictures (allowing closure of defunctioning stomas) and in the one patient with an idiopathic rectal stricture. Stent migration occurred in two of these patients without recurrence of symptoms. Stent fracture occurred in one patient, who remained symptomatic.
CONCLUSIONS: Self-expanding metallic stents are an effective treatment for benign colorectal obstructions, especially anastomotic strictures with long-term patency. Stents should be avoided in acute diverticular disease because of a higher incidence of complications.},
}
@article {pmid16412067,
year = {2006},
author = {Oomen, JL and Engel, AF and Cuesta, MA},
title = {Outcome of elective primary surgery for diverticular disease of the sigmoid colon: a risk analysis based on the POSSUM scoring system.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {8},
number = {2},
pages = {91-97},
doi = {10.1111/j.1463-1318.2005.00867.x},
pmid = {16412067},
issn = {1462-8910},
mesh = {Aged ; Aged, 80 and over ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Middle Aged ; Morbidity ; Postoperative Complications/*epidemiology ; Risk Assessment ; Sigmoid Diseases/*surgery ; Treatment Outcome ; },
abstract = {BACKGROUND: The outcome of surgery for diverticular disease of the sigmoid colon remains largely unclear. A comparison of studies is hardly possible because risk factors for diverticular disease severity and patient-related risk factors are lacking. The purpose of this study was to define morbidity and mortality of primary surgery for nonacute complications of diverticular disease of the sigmoid colon and to identify the risk factors that predict a higher morbidity and mortality.
METHODS: Patients who underwent elective surgery for complications of diverticular disease of the sigmoid colon (n = 149) were identified in a prospective computerized morbidity and mortality registration. In all patients, the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) was calculated, as were the morbidity and mortality rates. Factors predicting postoperative morbidity and mortality were identified. To audit mortality figures, a POSSUM based scoring system is introduced.
RESULTS: The mortality rate was 4.7% and morbidity rate was 53.7%. Significantly higher morbidity rates were correlated with a higher physiological POSSUM score (P = 0.010). Non-survivors were older (P = 0.029) and also had a higher physiological POSSUM score (P < 0.001) and operation severity POSSUM score (P < 0.001).
CONCLUSION: The morbidity and mortality rates of surgery for nonacute complications of diverticular disease of the sigmoid colon are considerable. To a large extent, mortality and morbidity are driven by patient- and disease-related factors, as expressed by elevated physiological severity and operative severity scores and failures of peri-operative management in most deceased patients.},
}
@article {pmid16398877,
year = {2005},
author = {Deshpande, AV and Oliver, M and Yin, M and Goh, TH and Hutson, JM},
title = {Severe colonic diverticulitis in an adolescent with Williams syndrome.},
journal = {Journal of paediatrics and child health},
volume = {41},
number = {12},
pages = {687-688},
doi = {10.1111/j.1440-1754.2005.00761.x},
pmid = {16398877},
issn = {1034-4810},
mesh = {Adolescent ; Colectomy ; Diverticulitis, Colonic/diagnosis/*etiology/surgery ; Humans ; Male ; Pelvis/diagnostic imaging ; Radiography ; Williams Syndrome/*complications ; },
abstract = {Williams Syndrome (WS) is a condition with multisystemic involvement caused by a genetic deletion in chromosome 7. Colonic diverticulosis has been described in adults with WS; however, it has not previously been reported in adolescents with WS. We report an adolescent boy with WS who developed complicated colonic diverticulitis and briefly review the possible aetiology of diverticular disease.},
}
@article {pmid16394291,
year = {2006},
author = {Bansal, A and Zakhour, HD},
title = {Benign mesothelioma of the appendix: an incidental finding in a case of sigmoid diverticular disease.},
journal = {Journal of clinical pathology},
volume = {59},
number = {1},
pages = {108-110},
pmid = {16394291},
issn = {0021-9746},
mesh = {Appendiceal Neoplasms/*diagnosis ; Diverticulum/*complications ; Female ; Humans ; Incidental Findings ; Mesothelioma/*diagnosis ; Middle Aged ; Sigmoid Diseases/*complications ; },
abstract = {Benign multicystic mesothelioma is a well recognised but rare entity. The aim of this report is to describe a case of a small mesothelial proliferation of the peritoneum. A 58 year old postmenopausal woman presented with left sided abdominal pain and altered bowel habit. Radiological investigations (barium enema and computed tomography scan of the abdomen and pelvis) were undertaken. An operation was performed for symptomatic sigmoid diverticular disease. Unusually, the appendix was adherent to the sigmoid colon. Microscopy revealed a benign mesothelioma. The patient remains symptom free to date.},
}
@article {pmid16381349,
year = {2005},
author = {Blake, MF and Dwivedi, A and Tootla, A and Tootla, F and Silva, YJ},
title = {Laparoscopic sigmoid colectomy for chronic diverticular disease.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {9},
number = {4},
pages = {382-385},
pmid = {16381349},
issn = {1086-8089},
mesh = {Adult ; Aged ; Chronic Disease ; Colectomy/adverse effects/*methods ; Diverticulitis, Colonic/*surgery ; Feasibility Studies ; Female ; Humans ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/*surgery ; Surgical Stapling ; },
abstract = {BACKGROUND: The feasibility of laparoscopic sigmoid colectomy for diverticular disease has now been well established. We report herein our experience with laparoscopic sigmoid colectomy in 100 patients who underwent laparoscopic colectomy for chronic diverticular disease.
METHODS: A retrospective review was performed of a 7-year period from January 1995 to June 2002. Chronic diverticular disease was treated with laparoscopic sigmoid colectomy in 100 patients. The setting was a community hospital. All cases were performed by 1 of 2 colorectal surgeons. All laparoscopic sigmoid colectomy patients received lighted ureteral stents placed preoperatively that were removed at the end of surgery.
RESULTS: Mean age was 61.6 years. The male to female ratio was 38:62. The mean estimated blood loss was 138 mL, liquid diet was tolerated for 2.4 days, and hospital length of stay was 4.6 days. The mean operative time for laparoscopic sigmoid colectomy was 196 minutes. Relative complications for laparoscopic sigmoid colectomy are as follows: anastomotic leak in 2 (3.0%) patients, hematuria in 95 (95%) with an average duration for 3.1 days, urinary tract infection in 6 (6%), and ureteral injury in 1 (1%). The mean operating room charges in the laparoscopic sigmoid colectomy patients was dollars 9,643.
CONCLUSION: We recommend laparoscopic sigmoid colectomy as the modality of treatment for chronic diverticular disease. Laparoscopic sigmoid colectomy appears to be a reliable, safe, and efficacious treatment modality for chronic diverticular disease. The operative time for laparoscopic sigmoid colectomy is decreasing as surgeons gain more experience.},
}
@article {pmid16378180,
year = {2005},
author = {Kazama, Y and Watanabe, T and Akahane, M and Yoshioka, N and Ohtomo, K and Nagawa, H},
title = {Crohn's disease with life-threatening hemorrhage from terminal ileum: successful control by superselective arterial embolization.},
journal = {Journal of gastroenterology},
volume = {40},
number = {12},
pages = {1155-1157},
pmid = {16378180},
issn = {0944-1174},
mesh = {Crohn Disease/*complications ; Embolization, Therapeutic/*methods ; Female ; Gastrointestinal Hemorrhage/diagnostic imaging/*therapy ; Humans ; Ileal Diseases/diagnostic imaging/*therapy ; Middle Aged ; Radiography ; },
abstract = {A case of life-threatening lower gastrointestinal hemorrhage from Crohn's disease is reported. Several promising studies have recently been published that describe superselective embolization for the treatment of massive lower gastrointestinal hemorrhage in patients with bleeding colonic diverticular disease and angiodysplasia, and success rates of 74%-93% have been reported. But in patients with Crohn's disease, successful superselective embolization has rarely been reported. This is a report of successful superselective embolization in a patient with Crohn's disease; this should be the initial treatment of choice in Crohn's disease in an attempt to avoid surgical resection, because repeated resections predispose patients to the development of short-bowel syndrome.},
}
@article {pmid16376847,
year = {2006},
author = {Duval, H and Dumont, F and Vibert, E and Manaouil, D and Verhaeghe, P and Fuks, D and Bounicaud, D and Riboulot, M and Chatelain, D and Yzet, T and Mauvais, F and Lapôtre-Ledoux, B and Regimbeau, JM},
title = {[The Association Française de Chirurgie (AFC) colorectal index: a reliable preoperative prognostic index in colorectal surgery].},
journal = {Annales de chirurgie},
volume = {131},
number = {1},
pages = {34-38},
doi = {10.1016/j.anchir.2005.11.012},
pmid = {16376847},
issn = {0003-3944},
mesh = {Aged ; Anastomosis, Surgical ; Colonic Diseases/*surgery ; Digestive System Surgical Procedures/adverse effects/*mortality ; Female ; France ; Humans ; Male ; Middle Aged ; Morbidity ; *Postoperative Complications ; Predictive Value of Tests ; Prognosis ; Rectal Diseases/*surgery ; Risk Assessment ; *Severity of Illness Index ; Treatment Outcome ; Weight Loss ; },
abstract = {INTRODUCTION: Evaluation of outcome after colorectal surgery is always necessary. A new index which permits to appreciate preoperatively postoperative mortality after colorectal resection in colorectal cancer (CRC) and in diverticular disease has been published (i.e., Association Française de Chirurgie, AFC colorectal index).
PATIENTS AND METHODS: From November 2002 to July 2004, in-hospital mortality was analysed on 253 patients who underwent colic resection (N = 220, 87%) or rectal resection, with anastomosis (N = 175, 70%). Mortality was analysed according to emergency resection, neurological co morbidity, lost of weight more than 10% of weight, age older than 70 years.
RESULTS: Mean age of patients was 63 +/- 18 years (17-92) (45% older than 70 years), 26% of patients were ASA >or= III, 35% underwent surgery in emergency, and 12% underwent laparoscopic surgery. One hundred and fifteen (45%) patients underwent surgery for CRC and 50 (20%), for diverticular disease and 11 patients underwent surgery for ischemic colitis. Overall mortality rate was 10% (N = 26), it was 19% in emergency surgery versus 5% after elective surgery. Global morbidity was 38%, percentage of anastomotic leak was 8% (N = 14/175), reoperation was necessary in 14%. The mean length of stay was 13 +/- 8 days. Ten percent of patients necessitated unplanned readmission. After surgery for CCR or diverticular disease. -i) overall mortality was 9% - ii) among patients who had 0, 1, 2, or 3 predictive risk factors of mortality; mortality was 0% , 5% 15% and 33%. After surgery for other aetiology than CCR or diverticular disease, among patients who had 0, 1, 2, or 3 predictive risk factors of mortality; mortality was 0%, 12% 36% and 25%.
CONCLUSIONS: These results showed the reproducibility of the AFC colorectal index and its potential application in all aetiologies after colorectal surgery.},
}
@article {pmid16335900,
year = {2005},
author = {Gillion, JF and Julles, MC and Convard, JP and Laroudie, M and Balaton, A and Karkouche, B and Berthelot, G and Bonan, A and Bonnichon, JM and Chollet, JM and Molkhou, JM},
title = {[Giant colonic or ileo-jejunal diverticulum and infra-mesocolic abdomial pseudocysts: diagnosis, pathalogical and clinical analysis].},
journal = {Journal de chirurgie},
volume = {142},
number = {4},
pages = {248-256},
doi = {10.1016/s0021-7697(05)80913-5},
pmid = {16335900},
issn = {0021-7697},
mesh = {Aged ; Cysts/diagnosis/*pathology/surgery ; Diagnosis, Differential ; Diverticulum, Colon/diagnosis/*pathology/surgery ; Female ; Humans ; Ileal Diseases/diagnosis/*pathology/surgery ; Jejunal Diseases/diagnosis/*pathology/surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed ; },
abstract = {Giant diverticula of the small intestine and colon are rare. Four cases treated at our institution in the last year are reported and compared to published cases; specific features and those which differentiate them from abdominal pseudocysts are described. They most commonly present a clinical tableau similar to commonplace diverticular disease. Awareness of this unusual condition and a good CT study are the keys to diagnosis. Giant diverticula may be acquired or congenital. The acquired type is simply a more spectacular version of commonplace diverticulosis while the congenital type, having a muscular wall and myenteric plexus, is more akin to intestinal duplications. Treatment is surgical and, in the case of sigmoid giant diverticula, usually requires a colon resection similar to that required for sigmoid diverticulitis.},
}
@article {pmid16311695,
year = {2005},
author = {Bannura, G and Contreras, J and Melo, C and Barrera, A and Soto, D and Mansilla, J},
title = {[Indications and long term results of elective surgery for sigmoid diverticular disease].},
journal = {Revista medica de Chile},
volume = {133},
number = {9},
pages = {1037-1042},
doi = {10.4067/s0034-98872005000900006},
pmid = {16311695},
issn = {0034-9887},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; Diverticulitis, Colonic/*surgery ; *Elective Surgical Procedures ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/*surgery ; Statistics, Nonparametric ; },
abstract = {BACKGROUND: There are no clear guidelines for the indication of elective surgery in sigmoid diverticular disease.
AIM: To analyze the indications and long term results of elective surgery in sigmoid diverticular disease.
MATERIAL AND METHODS: Retrospective review of 100 patients (age range 25-86 years, 51 male) with sigmoid diverticular disease, operated in a lapse of 22 years. Sixty seven patients answered a survey about their disease at the end of follow up.
RESULTS: Among patients aged more than 70 years, there was a higher proportion of women. The main indication for surgery was recurrent diverticulitis in 54 patients, followed by diverticular fistula in 19. A sigmoidectomy was performed in 91 patients. Stapled anastomosis was performed in half of these patients. No patient died or required reoperation in the immediate postoperative period. During a follow up ranging from 8 to 280 months, 28 patients died for causes not associated with diverticular disease and five were lost. Those patients that answered the survey were free of symptoms related to diverticular disease and did not require new operations.
CONCLUSIONS: In patients with sigmoid diverticular disease and recurrent diverticulitis or with fistulae, the long term results of surgery are satisfactory.},
}
@article {pmid16237961,
year = {2005},
author = {Golder, M and Williams, NS},
title = {The patient with diverticular disease.},
journal = {The Practitioner},
volume = {249},
number = {1675},
pages = {663-4, 666, 669 passim},
pmid = {16237961},
issn = {0032-6518},
mesh = {Acute Disease ; Colonic Diseases/*diagnosis/therapy ; Diagnosis, Differential ; Diverticulum, Colon/*diagnosis ; Gastrointestinal Hemorrhage/etiology ; Humans ; Recurrence ; },
}
@article {pmid16232235,
year = {2005},
author = {Loffeld, RJ},
title = {Diverticulosis of the colon is rare amongst immigrants living in the Zaanstreek region in the Netherlands.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {7},
number = {6},
pages = {559-562},
doi = {10.1111/j.1463-1318.2005.00830.x},
pmid = {16232235},
issn = {1462-8910},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Diverticulosis, Colonic/*epidemiology ; Emigration and Immigration/*statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Netherlands/epidemiology ; },
abstract = {BACKGROUND: Data on prevalence of diverticulosis related to ethnicity or race in the Western world are very sparse. A cross-sectional study was done in patients undergoing endoscopy of the colon in order to assess the prevalence of diverticulosis and relate the presence to ethnicity.
METHODS: An analysis was undertaken of the endoscopy reports from all consecutive patients undergoing endoscopy of the colon. As a reference group all patients in whom no abnormalities were detected were used. In the Zaanstreek region a large population of immigrants, mostly of Turkish descent, is present. These immigrants were studied separately.
RESULTS: In a period of 12 years 3004 patients were diagnosed with diverticulosis. Of these 2975 were authentic Dutch. The remainder 29 patients were immigrants. Diverticulosis was diagnosed significantly more often in immigrant men (P < 0.0001). Immigrants with diverticulosis were significantly younger than the authentic Dutch, P < 0.001. There was no major difference in representation of immigrants with diverticular disease in different age cohorts. The reference group consisted of 3356 patients. In this group 2998 patients were authentic Dutch, while 358 patients were immigrants. There was no difference in numbers of men and women amongst the immigrants. Of the patients with a normal colon and rectum 11% is immigrant. In the group of patients with diverticulosis only 0.9% was immigrant.
CONCLUSION: This study clearly shows that prevalence of diverticular disease is very low in immigrants. The majority of these immigrants are of Turkish descent. In addition, the majority of immigrants with diverticulosis was male.},
}
@article {pmid16231279,
year = {2005},
author = {Alves, A and Panis, Y and Slim, K and Heyd, B and Kwiatkowski, F and Mantion, G and , },
title = {French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease.},
journal = {The British journal of surgery},
volume = {92},
number = {12},
pages = {1520-1525},
doi = {10.1002/bjs.5148},
pmid = {16231279},
issn = {0007-1323},
mesh = {Aged ; Colectomy/*methods/mortality ; Diverticulitis, Colonic/mortality/*surgery ; Humans ; Laparoscopy/*methods/mortality ; Length of Stay ; Middle Aged ; Prospective Studies ; Risk Factors ; Sigmoid Diseases/mortality/*surgery ; },
abstract = {BACKGROUND: The aim of this study was to compare in-hospital morbidity and mortality rates after elective laparoscopic and open colorectal surgery for sigmoid diverticular disease (SDD).
METHODS: This prospective national multicentre observational study included all consecutive patients undergoing open or laparoscopic elective colectomy for SDD in a 4-month period between June and September 2002. Postoperative in-hospital mortality and morbidity in the two groups were compared.
RESULTS: Three hundred and thirty-two consecutive patients undergoing either laparoscopic (163 patients) or open (169 patients) colectomy for SDD were analysed. Overall postoperative mortality and morbidity rates were 0.3 and 23.8 per cent respectively. The morbidity rate was significantly higher in the open than in the laparoscopic group (P < 0.001), leading to a significantly longer hospital stay (P < 0.001). The morbidity rate remained significantly higher in the open group when the patients were matched for age (P = 0.015) or American Society of Anesthesiologists score (P = 0.028). An open procedure (relative risk (RR) 2.13 (95 per cent confidence interval (c.i.) 1.29 to 3.45)), age over 70 years (RR 1.62 (95 per cent c.i. 1.14 to 2.30)) and intraperitoneal contamination (RR 2.54 (95 per cent c.i. 1.18 to 5.50)) were identified as independent risk factors for morbidity.
CONCLUSION: A laparoscopic approach to elective treatment of SDD may be associated with reduced postoperative morbidity and hospital stay. A randomized study is required to confirm these results.},
}
@article {pmid16230540,
year = {2005},
author = {Piscatelli, N and Hyman, N and Osler, T},
title = {Localizing colorectal cancer by colonoscopy.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {140},
number = {10},
pages = {932-935},
doi = {10.1001/archsurg.140.10.932},
pmid = {16230540},
issn = {0004-0010},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; *Colonoscopy ; Colorectal Neoplasms/*diagnosis/surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {HYPOTHESIS: Colonoscopic localization of colorectal carcinoma is frequently inaccurate and unreliable.
DESIGN: Consecutive case series.
SETTING: Tertiary care teaching hospital.
PATIENTS: Three hundred fourteen consecutive patients undergoing surgical resection for colorectal cancer from January 1, 2000, to December 31, 2003.
INTERVENTION: Surgical resection for colorectal cancer.
MAIN OUTCOME MEASURE: Incidence of erroneous site localization.
RESULTS: Two hundred thirty-six patients had complete endoscopic, pathologic, and operative records. Colonoscopy was inaccurate for tumor localization in 49 cases (21%). In 27 (11%) of these cases, a different procedure was required than initially planned; in an additional 10 cases (4%), the surgical approach required modification. Inaccurate localization was associated with previous colorectal procedures on both univariate analysis (odds ratio, 3.94; 95% confidence interval, 1.50-10.32; P<.005) and multivariate analysis (odds ratio, 4.47; 95% confidence interval, 1.64-12.08; P = .003). Having the colonoscopy performed by a surgeon trended toward protection from error on multivariate analysis (odds ratio, 0.47; 95% confidence interval, 0.20-1.08; P = .07). Age, sex, diverticular disease, endoscopist volume and years of training, and bowel preparation had no significant effect.
CONCLUSIONS: Colonoscopy has a considerable error rate for localization of colorectal cancer, especially when previous colorectal procedures have been performed. Adjunctive localizing techniques, such as endoscopic tattooing, should be strongly considered.},
}
@article {pmid16228835,
year = {2005},
author = {Aydin, HN and Remzi, FH and Tekkis, PP and Fazio, VW},
title = {Hartmann's reversal is associated with high postoperative adverse events.},
journal = {Diseases of the colon and rectum},
volume = {48},
number = {11},
pages = {2117-2126},
doi = {10.1007/s10350-005-0168-8},
pmid = {16228835},
issn = {0012-3706},
mesh = {Adult ; Aged ; Anastomosis, Surgical/adverse effects ; Colon/surgery ; Colostomy/*adverse effects ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Prevalence ; Proctocolectomy, Restorative/*adverse effects ; Rectum/surgery ; Risk Factors ; Treatment Outcome ; },
abstract = {PURPOSE: The aim of this study was to ascertain the preva lence and pattern of surgical and medical adverse events in patients undergoing Hartmann's reversal for diverticular dis ease. A comparison of postoperative outcomes is made be tween Hartmann's reversal and primary resection and anas tomosis.
METHODS: Data were collected from patients who underwent successful Hartmann's reversal (Group 1 n=121) and primary resection and anastomosis (Group 2 n=731) for diverticular disease in a single center from January 1981 to May 2003. Multivariate logistic regression was used to compare early postoperative mortality, medical and surgical complications and readmission rates between the two groups.
RESULTS: Hartmann's reversal was associ ated with a higher prevalence of surgical or medical com plications compared with primary resection and anastomo sis (43.8 percent and 9.1 percent for Hartmann's reversal vs. 26.0 percent and 4.8 percent for primary resection and anastomosis). There was no difference in the readmissior rates (7.2 percent vs. 7.6 percent, respectively, P = 0.88) or early postoperative mortality (1.7 percent vs. 0.7 percent, P = 0.25) between Hartmann's reversal and primary resection and anastomosis. The need for reoperation, prolonged ileus respiratory tract infections, and renal failure were more common adverse events in the Hartmann's reversal group (P < 0.01). Having controlled for the number of comorbid conditions, extent of diverticular disease, severity of peri toneal contamination (Mannheim Peritonitis Index), and op erative urgency, patients who underwent Hartmann's rever sal were 2.1 times more likely to have adverse surgical events during their postoperative period (95 percent confidence interval for odds ratio = 1.3-3.3).
CONCLUSIONS: Hartmann's reversal is a complex surgical procedure that is associated with a high prevalence of postoperative adverse events in comparison with primary resection and anastomosis. To minimize the prevalence of such adverse events, patients who undergo Hartmann's reversal need careful preoperative evaluation and close monitoring in their postoperative period.},
}
@article {pmid16225026,
year = {2005},
author = {, },
title = {Information from your family doctor. Diverticular disease: what you should know.},
journal = {American family physician},
volume = {72},
number = {7},
pages = {1241-1242},
pmid = {16225026},
issn = {0002-838X},
mesh = {*Diverticulosis, Colonic/diagnosis/etiology/therapy ; Humans ; },
}
@article {pmid16225025,
year = {2005},
author = {Salzman, H and Lillie, D},
title = {Diverticular disease: diagnosis and treatment.},
journal = {American family physician},
volume = {72},
number = {7},
pages = {1229-1234},
pmid = {16225025},
issn = {0002-838X},
mesh = {Anti-Bacterial Agents/therapeutic use ; Diagnosis, Differential ; Dietary Fiber/administration & dosage ; Diverticulosis, Colonic/*diagnosis/etiology/*therapy ; Humans ; },
abstract = {Diverticular disease refers to symptomatic and asymptomatic disease with an underlying pathology of colonic diverticula. Predisposing factors for the formation of diverticula include a low-fiber diet and physical inactivity. Approximately 85 percent of patients with diverticula are believed to remain asymptomatic. Symptomatic disease without inflammation is a diagnosis of exclusion requiring colonoscopy because imaging studies cannot discern the significance of diverticula. Fiber supplementation may prevent progression to symptomatic disease or improve symptoms in patients without inflammation. Computed tomography is recommended for diagnosis when inflammation is present. Antibiotic therapy aimed at anaerobes and gram-negative rods is first-line treatment for diverticulitis. Whether treatment is administered on an inpatient or outpatient basis is determined by the clinical status of the patient and his or her ability to tolerate oral intake. Surgical consultation is indicated for disease that does not respond to medical management or for repeated attacks that may be less likely to respond to medical therapy and have a higher mortality rate. Prompt surgical consultation also should be obtained when there is evidence of abscess formation, fistula formation, obstruction, or free perforation.},
}
@article {pmid16222755,
year = {2005},
author = {Liu, CY and Chang, WH and Lin, SC and Chu, CH and Wang, TE and Shih, SC},
title = {Analysis of clinical manifestations of symptomatic acquired jejunoileal diverticular disease.},
journal = {World journal of gastroenterology},
volume = {11},
number = {35},
pages = {5557-5560},
pmid = {16222755},
issn = {1007-9327},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum/*diagnosis ; Female ; Humans ; Ileal Diseases/*diagnosis ; Jejunal Diseases/*diagnosis ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening disease.
METHODS: The medical records of patients with surgically confirmed symptomatic jejunoileal diverticular disease were retrospectively reviewed. Data collected included demographic data, laboratory results, clinical course (acute or chronic), preoperative diagnosis, and operative findings. Inclusion criteria were as follows: (1) surgical confirmation of jejunoileal diverticular disease and (2) exclusion of congenital diverticula (e.g. Meckel's diverticulum).
RESULTS: From January 1982 to July 2004, 28 patients with a total of 29 operations met the study criteria. The male:female ratio was 14:14, and the mean age was 62.6+/-3.5 years. The most common manifestation was abdominal pain. In nearly half of the patients, the symptoms were chronic. Two patients died after surgery. Only four cases were correctly diagnosed prior to surgery, three by small bowel series.
CONCLUSION: Symptomatic acquired small bowel diverticular disease is difficult to diagnose. It should be considered in older patients with unexplained chronic abdominal symptoms. A small bowel series may be helpful in diagnosing this potentially life-threatening disease.},
}
@article {pmid16201088,
year = {2005},
author = {Regenet, N and Pessaux, P and Tuech, JJ and Hennekinne, S and Lermite, E and Ridereau-Zins, C and Aube, C and Bergamaschi, R and Jean-Pierre, A},
title = {Prospective evaluation of the quality of laparoscopic sigmoid resection for diverticular disease.},
journal = {Hepato-gastroenterology},
volume = {52},
number = {65},
pages = {1427-1431},
pmid = {16201088},
issn = {0172-6390},
mesh = {Aged ; Colectomy/*methods ; Diverticulitis, Colonic/surgery ; Diverticulosis, Colonic/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Prospective Studies ; Recurrence ; Sigmoid Diseases/*surgery ; Treatment Outcome ; },
abstract = {BACKGROUND/AIMS: There were no studies comparing whether the same principles as those in conventional surgery have been applied to the laparoscopic procedure. The aim of this study was to compare the quality of open sigmoid colectomy (OSC) with laparoscopic sigmoid colectomy (LSC) for diverticular disease. Specific measurements made were of the level of anastomosis from sacral promontory, distance from anal verge, specimen length and recurrence rates.
METHODOLOGY: Comparison was made between 72 consecutive patients who underwent an elective LSC to a control group of 22 patients who had previously undergone an OSC in the same institution. All patients had proctoscopy to measure the distance from the anal verge. A computed tomography without injection of contrast medium was performed in all cases to measure the distance from the sacral promontory to the top of the staple row. Length of fresh resected specimen and recurrence rates of diverticulitis were used for comparison.
RESULTS: There was no statistical difference between the two groups in terms of distance of anastomosis from anal verge (p=0.78) and distance from sacral promontory (p=0.65) in LSC and OSC patients respectively. Specimen length was more extensive in the OSC group than in the LSC group (p=0.02). After a mean follow-up of 43.5 (+/- 14.8) months in the LSC group and 62.4 (+/- 7.4) months in the OSC group, there was no difference in recurrent attack's rates of diverticulitis.
CONCLUSIONS: This study suggested that laparoscopic procedure applied the same principles as those used in conventional surgery.},
}
@article {pmid16187539,
year = {2005},
author = {Ondrejka, P and Ráth, Z and Sugár, I},
title = {[Surgical treatment of gastrointestinal bleeding].},
journal = {Orvosi hetilap},
volume = {146},
number = {35},
pages = {1807-1812},
pmid = {16187539},
issn = {0030-6002},
mesh = {Acute Disease ; Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage/*surgery ; Humans ; Peptic Ulcer Hemorrhage/surgery ; },
abstract = {INTRODUCTION: The incidence of gastrointestinal bleeding is slowly decreasing in the past decades, but they represent still a major problem in the treatment of emergency cases. Bigger part of the bleedings originates from the upper gastrointestinal tract (above Treitz ligament), The most common cause of these bleeding is peptic ulcer. The most frequent cause of lower gastrointestinal bleeding is the diverticular disease of the large bowel.
AIM: With the summary of the causes, the diagnostic procedures and the treatment possibilities of bleedings the authors should like to help the recovery of these patients.
MATERIAL AND DISCUSSION: The most important thing is the proper diagnosis as soon as it is possible. The most acceptable method for this is the endoscopy, during which some kind of treatment procedure is often possible. This method can achieve final or transient stopping of bleeding. With additional medical treatment the urgent operation is often avoidable. In case of continuous or rebleeding operative treatment is mandatory. This kind of treatment is required mainly in case of peptic ulcer bleeding in the upper, and diverticular bleeding in the lower gastrointestinal tract. If operative treatment is chosen, the best result can be expected from an aggressive resection type solution.
CONCLUSION: In case of gastrointestinal bleeding the establishment of the correct diagnosis is essential. With a careful endoscopic and medical treatment the urgent operation is often avoidable. So it would be indicated to treat patients in case of gastrointestinal bleeding in a Gastroenterology subintensive unit.},
}
@article {pmid16176220,
year = {2005},
author = {bin Mohd Zam, NA and Tan, KY and Ng, C and Chen, CM and Wong, SK and Chng, HC and Tay, KH and Eu, KW},
title = {Mortality, morbidity and functional outcome after total or subtotal abdominal colectomy in the Asian population.},
journal = {ANZ journal of surgery},
volume = {75},
number = {10},
pages = {840-843},
doi = {10.1111/j.1445-2197.2005.03552.x},
pmid = {16176220},
issn = {1445-1433},
mesh = {Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; *Colectomy/mortality ; Female ; Follow-Up Studies ; Gastrointestinal Motility ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Postoperative Complications ; Retrospective Studies ; Surveys and Questionnaires ; Time Factors ; Treatment Outcome ; },
abstract = {OBJECTIVE: This study reviews the functional outcome and satisfaction of patients after subtotal or total colectomy (STTC).
METHODS: A retrospective review of patients who underwent STTC between June 1999 and September 2003 was performed. A standardized questionnaire was formulated and phone interviews were conducted with these patients.
RESULTS: There were 50 patients who underwent STTC during this period. The most common indications were bleeding diverticular disease, patients with synchronous colorectal cancers or polyps and left-sided colonic obstruction. The presence of ischaemic heart disease and the development of perioperative acute coronary syndrome were found to be statistically significant predictors of 30 day mortality with P = 0.01 and 0.05, respectively. Phone interviews were successfully conducted in 33 patients. The patients interviewed were between 4 and 54 months postsurgery. Ninety-four percent reported that they were either happy or satisfied. Cleveland Clinic Incontinence Score (CCIS) revealed good or perfect continence in 94% of patients. Less than one-quarter of those interviewed had five or more bowel movements in a day while most had either two or three bowel movements a day. Patient satisfaction after STTC correlated strongly with the severity of CCIS and number of bowel movements a day (P < 0.01). Also, those with less than five bowel movements a day were more likely to report a better satisfaction (P < 0.01).
CONCLUSION: Subtotal or total colectomy is associated with a good functional outcome and most patients were satisfied with their bowel function on follow-up.},
}
@article {pmid16168267,
year = {2005},
author = {Lohrmann, C and Ghanem, N and Pache, G and Makowiec, F and Kotter, E and Langer, M},
title = {CT in acute perforated sigmoid diverticulitis.},
journal = {European journal of radiology},
volume = {56},
number = {1},
pages = {78-83},
doi = {10.1016/j.ejrad.2005.03.003},
pmid = {16168267},
issn = {0720-048X},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Colon, Sigmoid/*diagnostic imaging/surgery ; Contrast Media/administration & dosage ; Diatrizoate Meglumine ; Diverticulitis, Colonic/*diagnosis/surgery ; Female ; Humans ; Image Processing, Computer-Assisted/methods ; Intestinal Perforation/*diagnosis/surgery ; Iohexol/administration & dosage/analogs & derivatives ; Male ; Middle Aged ; Radiographic Image Enhancement/methods ; Retrospective Studies ; Sensitivity and Specificity ; Severity of Illness Index ; Sigmoid Diseases/*diagnosis/surgery ; Tomography, X-Ray Computed/*methods ; },
abstract = {BACKGROUND: To assess the value of computed tomography (CT) in patients with acute perforated sigmoid diverticulitis in correlation with the Hinchey classification of perforated diverticular disease.
METHODS: Thirty patients with acute perforated sigmoid diverticulitis underwent computed tomography prior to surgery. Computed tomography scans were compared with the surgical and histopathological reports, utilizing the Hinchey classification.
RESULTS: In 28 of the 30 (93%) patients examined, the Hinchey stage was correctly determined by means of computed tomography. One patient with Hinchey stage IV was falsely classified as Hinchey stage III, and one patient with Hinchey stage III as Hinchey stage II. Computed tomography revealed 12 out of 14 (86%) patients with perforation sites and 3 out of 3 (100%) patients with contained perforation. In one of 17 (6%) patients with surgically or histopathologically proven perforation or contained perforation, a bowel wall discontinuity was revealed by computed tomography. In 6 of the 17 (35%) patients with surgical or histopathological perforation or contained perforation, extraluminal contrast material was detected by computed tomography.
CONCLUSIONS: Computed tomography is a valuable imaging tool for determining the degree of acute perforated sigmoid diverticulitis, by means of which patients can be stratified according to the severity of the disease; furthermore, this tool is of assistance in surgical planning.},
}
@article {pmid16127561,
year = {2005},
author = {Nahas, SC and Marques, CF and Araújo, SA and Aisaka, AA and Nahas, CS and Pinto, RA and Kiss, DR},
title = {[Colonoscopy as a diagnostic and therapeutic method of the large bowel diseases: analysis of 2,567 exams].},
journal = {Arquivos de gastroenterologia},
volume = {42},
number = {2},
pages = {77-82},
doi = {10.1590/s0004-28032005000200003},
pmid = {16127561},
issn = {0004-2803},
mesh = {*Colonoscopy ; Humans ; Intestinal Diseases/*diagnosis/*surgery ; *Intestine, Large ; Retrospective Studies ; },
abstract = {BACKGROUND: Since the sixties, when the optic fibers were reported, colonoscopy had emerged as the first line imaging investigation of the colon.
AIM: To review the results of diagnostic and therapeutic colonoscopy at the Discipline of Coloproctology of the University of São Paulo Medical School, São Paulo, SP, Brazil, respecting the characteristics of an institution of medical education.
METHODS: Retrospective analysis of basis related to 2,567 fibro colonoscopies between 1984 and 2002. The procedure was performed in hospitalized and in outpatients. The most common indications for colonoscopy were investigation of rectal bleeding and anemia (22.4%), change of bowel habit (14.76%), inflammatory bowel disease (8.65%) and carcinoma (7.25%). Bowel preparation with manitol was used by most of the patients. Sedation, when not contra-indicated, was administered. The most common combination was meperidine and benzodiazepine. All the exams were monitored with pulse oximeter. A normal colonoscopy to the point of maximum insertion was reported in 42.42% of procedures. The most common diagnosis was polyps (15.47%), followed by diverticular disease (12.86%). Inflammatory disease was recorded in 11.88% and carcinoma in 10.21%. Polypectomy was undertaken in 397 patients (2.21 polypectomy per patient with polyps). Colonoscopy was considered incomplete (when the colonoscope did not pass to the cecum or terminal ileum) in 181 (7.05%) cases. Perforation was reported in one patient who had a subestenosing retossigmoid tumor. In 0.42%, reasons for failing to complete the procedure included complication related to sedation, with no further prejudice for the patients.
CONCLUSIONS: Colonoscopic examination of the entire colon remains the standard for visualization, biopsy and treatment of colonic affections. The incidence of complication of endoscopy of the large bowel is quite low, even in a school hospital.},
}
@article {pmid16126881,
year = {2005},
author = {Bassotti, G and Battaglia, E and Bellone, G and Dughera, L and Fisogni, S and Zambelli, C and Morelli, A and Mioli, P and Emanuelli, G and Villanacci, V},
title = {Interstitial cells of Cajal, enteric nerves, and glial cells in colonic diverticular disease.},
journal = {Journal of clinical pathology},
volume = {58},
number = {9},
pages = {973-977},
pmid = {16126881},
issn = {0021-9746},
mesh = {Aged ; *Biological Clocks ; Diverticulosis, Colonic/metabolism/*pathology/physiopathology ; Enteric Nervous System/*pathology ; Female ; Gastrointestinal Transit ; Humans ; Immunoenzyme Techniques ; Male ; Middle Aged ; Myenteric Plexus/pathology ; Neuroglia/*pathology ; S100 Proteins/metabolism ; Ubiquitin Thiolesterase/metabolism ; },
abstract = {BACKGROUND: Colonic diverticular disease (diverticulosis) is a common disorder in Western countries. Although its pathogenesis is probably multifactorial, motor abnormalities of the large bowel are thought to play an important role. However, little is known about the basic mechanism that may underlie abnormal colon motility in diverticulosis.
AIMS: To investigate the interstitial cells of Cajal (the gut pacemaker cells), together with myenteric and submucosal ganglion and glial cells, in patients with diverticulosis.
PATIENTS: Full thickness colonic samples were obtained from 39 patients undergoing surgery for diverticulosis. Specimens from tumour free areas of the colon in 10 age matched subjects undergoing surgery for colorectal cancer served as controls.
METHODS: Interstitial cells of Cajal were assessed using anti-Kit antibodies; submucosal and myenteric plexus neurones and glial cells were assessed by means of anti-PGP 9.5 and anti-S-100 monoclonal antibodies, respectively.
RESULTS: Patients with diverticulosis had normal numbers of myenteric and submucosal plexus neurones compared with controls (p = 0.103 and p = 0.516, respectively). All subtypes of interstitial cells of Cajal were significantly (p = 0.0003) reduced compared with controls, as were glial cells (p = 0.0041).
CONCLUSIONS: Interstitial cells of Cajal and glial cells are decreased in colonic diverticular disease, whereas enteric neurones appear to be normally represented. This finding might explain some of the large bowel motor abnormalities reported to occur in this condition.},
}
@article {pmid16124980,
year = {2005},
author = {Purkayastha, S and Tekkis, PP and Athanasiou, T and Aziz, O and Negus, R and Gedroyc, W and Darzi, AW},
title = {Magnetic resonance colonography versus colonoscopy as a diagnostic investigation for colorectal cancer: a meta-analysis.},
journal = {Clinical radiology},
volume = {60},
number = {9},
pages = {980-989},
doi = {10.1016/j.crad.2005.04.015},
pmid = {16124980},
issn = {0009-9260},
mesh = {Adenocarcinoma/*diagnosis ; Aged ; Colonic Polyps/diagnosis ; Colonography, Computed Tomographic ; *Colonoscopy ; Colorectal Neoplasms/*diagnosis ; Diagnosis, Differential ; Humans ; *Magnetic Resonance Imaging ; Observer Variation ; Sensitivity and Specificity ; },
abstract = {AIMS: Magnetic resonance colonography (MRC) is emerging as a potential complementary investigation for the diagnosis of colorectal cancer (CRC) and also for benign pathology such as diverticular disease. A meta-analysis reporting the use of MRC is yet to be performed. The aim of this study was to evaluate the diagnostic accuracy of MRC compared with the gold-standard investigation, conventional colonoscopy (CC).
METHODS: A literature search was carried out to identify studies containing comparative data between MRC findings and CC findings. Quantitative meta-analysis for diagnostic tests was performed, which included the calculation of independent sensitivities, specificities, diagnostic odds ratios, the construction of summary receiver operating characteristic (SROC) curves, pooled analysis and sensitivity analysis. The study heterogeneity was evaluated by the Q-test using a random-effect model to accommodate the cluster of outcomes between individual studies.
RESULTS: In all, 8 comparative studies were identified, involving 563 patients. The calculated pooled sensitivity for all lesions was 75% (95% CI: 47% to 91%), the specificity was 96% (95% CI: 86% to 98%) and the area under the ROC curve was 90% (weighted). On sensitivity analysis, MRC had a better diagnostic accuracy for CRC than for polyps, with a sensitivity of 91% (95% CI: 97% to 91%), a specificity of 98% (95% CI: 66% to 99%) and an area under the ROC curve of 92%. There was no significant heterogeneity between the studies with regard to the diagnostic accuracy of MRC for CRC.
CONCLUSION: This meta-analysis suggests that MRC is an imaging technique with high discrimination for cases presenting with colorectal cancer. The exact diagnostic role of MRC needs to be clarified (e.g. suitable for an elderly person with suspected CRC). Further evaluation is necessary to refine its applicability and diagnostic accuracy in comparison with other imaging methods such as computed tomography colonography.},
}
@article {pmid16123898,
year = {2005},
author = {Vosskamp, G and Schanz, S and Müller, G and Kruis, W},
title = {[Mysterious lower gastrointestinal bleeding in diverticular disease of the colon].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {130},
number = {34-35},
pages = {1948-1950},
doi = {10.1055/s-2005-872608},
pmid = {16123898},
issn = {0012-0472},
mesh = {Aged ; Colectomy ; *Colon ; Colonoscopy ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis/surgery ; Female ; Foreign-Body Migration/*diagnosis/surgery ; Gastrointestinal Hemorrhage/*etiology/surgery ; Humans ; Recurrence ; },
abstract = {Within a few weeks a 78-year-old woman presented three times in hospital with dramatic blood loss in need of transfusion. At her admission to hospital she complained about general weakness and painless melena. Within the last few years the patient had been treated with aspirin and phenprocoumon for chronic atrial fibrillation and coronary heart disease.
INVESTIGATIONS: Laboratory findings revealed a very low hemoglobin of 6 g/dl when the patient presented at hospital. The esophagogastroduodenoscopy was normal. The first colonoscopy detected diverticula of the left colon and fresh blood in the whole colon. The definitive bleeding site could not be identified. A technetium-colloid scan revealed an increased blood loss in the right colon. A second colonoscopy performed at the same time confirmed a right sided bleeding and an active capillary bleeding in the coecum without any mucosal lesion was identified.
As during the patient's first stay at hospital the site of lower gastrointestinal bleeding could not be determined, the patient was treated by transfusion and oral anticoagulation was stopped. The bleeding stopped spontaneously within a few days. At the third rebleeding episode examinations located the bleeding in the right colon, and a right hemicolectomy was performed. After the operation a piece of chicken bone was detected in the wall of the coecum, which had led to a chronic mucosal bleeding after penetration of the colonic wall. After surgery the patient recovered quickly and no rebleeding recurred.
CONCLUSION: Identification of the exact origin of lower gastrointestinal tract bleeding remains difficult. As the mortality rate as well as the re-bleeding rate in blind segmental colectomy is very high, compared to the resection in patients, where bleeding site could be identified, the site of bleeding must found in any case.},
}
@article {pmid16114227,
year = {2005},
author = {Self, RB and Birmingham, CL and Elliott, R and Zhang, W and Thommasen, HV},
title = {The prevalence of overweight adults living in a rural and remote community. The Bella Coola Valley.},
journal = {Eating and weight disorders : EWD},
volume = {10},
number = {2},
pages = {133-138},
pmid = {16114227},
issn = {1124-4909},
mesh = {Adult ; Age Distribution ; Aged ; Analysis of Variance ; Body Mass Index ; British Columbia/epidemiology ; Chronic Disease/epidemiology ; Comorbidity ; Female ; Humans ; Indians, North American/statistics & numerical data ; Male ; Middle Aged ; Obesity/*ethnology ; Prevalence ; Retrospective Studies ; Rural Population ; Sex Distribution ; },
abstract = {OBJECTIVE: To determine the prevalence of overweight adults living in the Bella Coola Valley.
DESIGN: A retrospective chart review of all people attending the Bella Coola Medical Clinic, and residing in the Bella Coola Valley.
MAIN OUTCOME MEASURES: Weight (killograms) and body mass index (BMI).
RESULTS: More than 92% of clinic charts had a recent measurement of weight and 65% of clinic charts had height measured; accordingly, we were able to calculate the BMI on 65% of the clinic population. Over 50% of the adults residing in the Bella Coola Valley are considered overweight (BMI > 27, the Health Canada definition) and only 25% have a BMI within an acceptable range (20.0 to 24.9). Proportionately more Aboriginal people are overweight (65%) than non-Aboriginal people (47%); men and women were similarly overweight (56% and 53%, respectively); and proportionately more people were overweight with increased age. The prevalence of being overweight in people aged 65 years and older is 66%. As weight increased so did the prevalence of diabetes mellitus, hypertension, hypercholesterolemia, diverticular disease, dyspepsia/gastroesophageal reflux disease (GERD), alcohol issues, asthma, depression, coronary artery disease, and eczematous dermatitis. There was no relationship between increasing weight and atrial fibrillation, cerebrovascular disease, inflammatory arthritis, hypothyroidism, chronic back/neck pain, peripheral vascular disease, chronic obstructive lung disease, congestive heart failure, and cancer.
CONCLUSION: Living in a remote community does not protect against obesity and the complications of obesity. Obesity is present in a greater proportion of Aboriginal people. The treatment and prevention of obesity in rural populations of differing ethnicity may need to be individualized.},
}
@article {pmid16044938,
year = {2005},
author = {Krajewski, E and Szomstein, S and Weiss, EG},
title = {Synchronous diverticular perforation: report of a case.},
journal = {The American surgeon},
volume = {71},
number = {6},
pages = {528-531},
pmid = {16044938},
issn = {0003-1348},
mesh = {Anastomosis, Surgical ; Cecal Diseases/complications/*diagnosis/surgery ; Colectomy/methods ; Diverticulitis, Colonic/complications/*diagnosis/surgery ; Follow-Up Studies ; Humans ; Intestinal Perforation/complications/*diagnosis/surgery ; Laparotomy/methods ; Male ; Middle Aged ; Risk Assessment ; Severity of Illness Index ; Sigmoid Diseases/complications/*diagnosis/surgery ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; },
abstract = {Synchronous colonic events are rare. Diverticulitis is the most common and lethal cause of colonic perforation. The first case in the literature of a synchronous diverticular perforation is presented. The patient was admitted with peritonitis. An exploratory laparotomy showed cecal and sigmoid perforations. Resection and primary anastomosis with a protective loop ileostomy was performed. Microscopic evaluation confirmed the presence of cecal and sigmoid perforated diverticuli. Diverticular disease is present in up to two-thirds of patients 80 years of age and older. Right-sided free colonic perforation is rare. Resection and primary anastomosis is feasible in the treatment of perforated diverticular disease. In this report, we emphasize the importance of a thorough abdominal exploration at the time of surgery.},
}
@article {pmid16044908,
year = {2005},
author = {Gargouri, MM and Nouira, Y and Kallel, Y and Bouraoui, K and Chebbi, F and Horchani, A},
title = {[Vesico-sigmoid fistula secondary to diverticulitis: a case report].},
journal = {La Tunisie medicale},
volume = {83},
number = {5},
pages = {308-310},
pmid = {16044908},
issn = {0041-4131},
mesh = {Aged ; Colonic Diseases/*complications ; Diverticulitis/*complications ; Hematuria/etiology ; Humans ; Male ; Sigmoid Diseases/*etiology/pathology/surgery ; Treatment Outcome ; Urinary Bladder Fistula/*etiology/pathology/surgery ; },
abstract = {Vesico-sigmoid fistula is a rare complication of colic diverticular disease. It develops when the bladder sticks to an inflammatory colon making of a communication between the bladder and the digestive segment, usually the sigmoid. Liquid usually passes from the colon to the bladder because of the existing pressure gradient. Hence, urinary symptoms are the most frequent. Surgery is the treatment of choice. The present case is about a 72-year-old man who had a total hematuria for 3 months. The diagnosis of a vesico-sigmoid fistula secondary to colic diverticulitis was established by cystoscopy, colonoscopy and cystography. Surgery was underlaken and the postoperative outcome was excellent. Through this case the clinical features, special investigations and treatment of vesico-sigmoid fistula, are reported.},
}
@article {pmid16038840,
year = {2005},
author = {Thiéfin, G and Beaugerie, L},
title = {Toxic effects of nonsteroidal antiinflammatory drugs on the small bowel, colon, and rectum.},
journal = {Joint bone spine},
volume = {72},
number = {4},
pages = {286-294},
doi = {10.1016/j.jbspin.2004.10.004},
pmid = {16038840},
issn = {1297-319X},
mesh = {Animals ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Colon/*drug effects ; Gastrointestinal Diseases/*chemically induced ; Humans ; Intestine, Small/*drug effects ; Rectum/*drug effects ; },
abstract = {The gastrointestinal toxicity of conventional nonsteroidal antiinflammatory drugs (NSAIDs) is not confined to the stomach and proximal duodenum but extends also to the rest of the small bowel, colon, and rectum. Long-term NSAID therapy usually induces clinically silent enteropathy characterized by increased intestinal permeability and inflammation. Chronic occult bleeding and protein loss may result in iron-deficiency anemia and hypoalbuminemia. NSAIDs can also induce small bowel ulcers that infrequently lead to acute bleeding, perforation, or chronic scarring responsible for diaphragm-like strictures. At the colon and rectum, NSAID use can result in de novo lesions such as nonspecific colitis and rectitis, ulcers, and diaphragm-like strictures. NSAIDs have been implicated in the development of segmental ischemic colitis. In patients with diverticular disease, NSAID use increases the risk of severe diverticular infection and perforation. NSAIDs can trigger exacerbations of ulcerative colitis or Crohn's disease. With selective COX-2 inhibitors, the risk of gastrointestinal toxicity is reduced as compared to conventional NSAIDs but is not completely eliminated. Experimental studies suggest that long-term COX-2 inhibitor therapy may cause damage to the previously healthy small bowel. Similar to conventional NSAIDs, COX-2 inhibitors may be capable of triggering exacerbations of inflammatory bowel disease.},
}
@article {pmid16035250,
year = {2005},
author = {Fornaro, R and Canaletti, M and Terrizzi, A and Davini, MD and Sticchi, C and Stabilini, C and Moraglia, E and Picori, E and Larghero, GC and Giannetta, E},
title = {[Surgery for complicated colonic diverticulitis. Our experience].},
journal = {Il Giornale di chirurgia},
volume = {26},
number = {4},
pages = {143-152},
pmid = {16035250},
issn = {0391-9005},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/complications/diagnosis/*surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Analysis ; Treatment Outcome ; },
abstract = {During the last two decades were observed 422 symptomatic patients with various degree of diverticular disease of the colon. 51 patients underwent surgery: 29 for stenosis (24) or occlusion (5), 4 for fistulas, 18 for perforation. The operations (26 emergencies, 25 elective) included: 21 cases of one-stage resection and anastomosis without protective colostomy, 16 with colostomy, 8 Hartmann's procedures, 7 Mikulicz's operations, 1 suturing of the diverticulum with colostomy. The incidence of complications was 17.6% (9 cases, 7 following emergency surgery and 2 after elective procedures). The intraoperative mortality was zero, while postoperative 5.8% (3 cases, 2 after emergency procedures and 1 following elective surgery). The best results (lowest morbidity and mortality rates) occurred with the radical procedures, especially the resection-anastomosis with or without colostomy, which allowed the removal of the septic focus from the peritoneal cavity and thus a shorter recovery in a high number of cases.},
}
@article {pmid16028706,
year = {2005},
author = {Matter, M and Saucy, F and Venetz, JP and Pascual, M},
title = {[Visceral surgery in organ transplant recipients or in patients awaiting transplantation].},
journal = {Revue medicale suisse},
volume = {1},
number = {24},
pages = {1608, 1610-2, 1614-5},
pmid = {16028706},
issn = {1660-9379},
mesh = {Gastrointestinal Diseases/*etiology/*surgery ; Humans ; Immunosuppression Therapy/*adverse effects ; *Organ Transplantation ; },
abstract = {Patients receiving immunosuppression are at higher risk for gastrointestinal complications: mortality is high if they are not diagnosed and treated rapidly. Systematic screening for cholelithiasis or diverticular disease, and prophylactic surgery, are not recommended systematically anymore. Patients awaiting a transplant with abdominal symptoms should be investigated without delay and surgery, if indicated and whenever possible based on the anaesthetic evaluation, should be performed. In the transplant population, a high degree of suspicion must be raised in case of any abdominal symptom. Radiological investigations and surgery without delay are often the only ways to preserve the function of the graft and optimize the patient's survival.},
}
@article {pmid16028704,
year = {2005},
author = {Vuilleumier, H and Nordback, P and Givel, JC},
title = {[Treatment of acute diverticulitis].},
journal = {Revue medicale suisse},
volume = {1},
number = {24},
pages = {1600-1603},
pmid = {16028704},
issn = {1660-9379},
mesh = {Acute Disease ; Diverticulitis/diagnosis/*therapy ; Humans ; },
abstract = {In Western countries, diverticular disease is a frequent condition and the prevalence of which increases with age. Acute diverticulitis is its most frequent complication. CT-scan is now the best exam for diagnosis of acute diverticulitis, classification of its severity, and for follow-up. It can also, when necessary, allow percutaneous drainage of pericolic abscesses. Treatment of acute diverticulitis is most often conservative. Surgery outside acute events is now considered as a technique with extremely low morbidity and mortality. In this situation, laparoscopy represents nowadays the technique of choice for safe sigmoid surgery.},
}
@article {pmid16027334,
year = {2005},
author = {Anaya, DA and Flum, DR},
title = {Risk of emergency colectomy and colostomy in patients with diverticular disease.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {140},
number = {7},
pages = {681-685},
doi = {10.1001/archsurg.140.7.681},
pmid = {16027334},
issn = {0004-0010},
mesh = {Adult ; Age Factors ; Aged ; Cohort Studies ; Colectomy/adverse effects/*methods ; Colostomy/adverse effects/*methods ; Confidence Intervals ; Critical Illness ; Diverticulitis, Colonic/etiology/*mortality/*surgery ; Diverticulosis, Colonic/complications/diagnosis ; Emergency Treatment/methods ; Female ; Follow-Up Studies ; Humans ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications/mortality ; Probability ; Retrospective Studies ; Risk Assessment ; Sex Factors ; Treatment Outcome ; },
abstract = {HYPOTHESIS: Patients with diverticulitis are at a lifetime risk for emergency colectomy and colostomy. Age and recurrence characteristics can serve to predict the risk for these adverse outcomes.
DESIGN: Time-to-event analysis and logistic regression were used to determine the risk of emergency colectomy/colostomy.
SETTING AND PATIENTS: A retrospective cohort study using a statewide administrative database and identifying all patients hospitalized nonelectively for diverticulitis (1987-2001).
MAIN OUTCOME MEASURE: Emergency colectomy and/or colostomy in patients treated nonsurgically after a first episode of acute diverticulitis.
RESULTS: A total of 25 058 patients (mean age [ +/- SD], 69 [16] years, 60% female) were hospitalized for an initial episode of diverticulitis. Of the 20 136 patients treated without initial operation, 19% had recurrences, with younger patients (<50 years) more likely to have a recurrence than older patients (27% vs 17%, P<.001). While only 5.5% of patients had recurrent hospitalizations during which an emergency colectomy/colostomy was performed, it occurred more commonly in younger patients (7.5% vs 5%, P<.001). The adjusted hazard ratio for emergency colectomy/colostomy in younger patients was 39% higher than in older patients (hazard ratio, 1.39; 95% confidence interval, 1.21-1.62). Among all patients, the adjusted hazard ratio for emergency colectomy/colostomy was 2.2 times higher with each subsequent admission (hazard ratio, 2.2; 95% confidence interval, 2.1-2.2). The predicted probability of emergency colectomy/colostomy was highest in younger patients with multiple rehospitalizations.
CONCLUSIONS: Age and number of recurrent events were associated with the risk of emergency colectomy/colostomy after successful nonoperative management in patients with diverticulitis. Individualization of recommendations regarding elective colectomy based on these factors may be more appropriate than the application of previously published strategies.},
}
@article {pmid16011421,
year = {2005},
author = {Aller de la Fuente, R},
title = {[Patient information. Diverticular disease of the colon].},
journal = {Revista espanola de enfermedades digestivas},
volume = {97},
number = {6},
pages = {458},
doi = {10.4321/s1130-01082005000600009},
pmid = {16011421},
issn = {1130-0108},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; *Diverticulosis, Colonic/complications/diagnosis/therapy ; Humans ; Middle Aged ; *Patient Education as Topic ; },
}
@article {pmid16003138,
year = {2005},
author = {Rajendra, S and Ho, JJ},
title = {Colonic diverticular disease in a multiracial Asian patient population has an ethnic predilection.},
journal = {European journal of gastroenterology & hepatology},
volume = {17},
number = {8},
pages = {871-875},
doi = {10.1097/00042737-200508000-00015},
pmid = {16003138},
issn = {0954-691X},
mesh = {Adenoma/epidemiology ; Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; China/ethnology ; Colonoscopy/methods ; Colorectal Neoplasms/epidemiology ; Diverticulosis, Colonic/epidemiology/*ethnology ; Epidemiologic Methods ; Female ; Humans ; India/ethnology ; Infant ; Malaysia/epidemiology ; Male ; Middle Aged ; },
abstract = {BACKGROUND: Traditionally, diverticular disease of the colon has been attributed to ageing, low dietary fibre and a high intraluminal pressure. Recently, genetic and racial factors have also been implicated.
METHODS: Four-hundred and ten consecutive multiracial Asian patients undergoing colonoscopy for a variety of bowel symptoms in a private endoscopy unit were studied for differing frequencies (if any) in colonic diverticular disease and concomitant abnormalities.
RESULTS: Forty-one patients (10%) had diverticular disease. Diverticula were present in 22/147 Chinese (15%), 14/153 Indians (9%) and 5/110 Malays (4.5%). The mean age of patients with diverticular disease was 55 years as compared with 51.3 years in those without (P = 0.12) and there was no gender difference. Thirty-six patients (88%) had diverticula in the right colon only, four patients (10%) exclusively in the left hemicolon, and one patient (2%) had bilateral involvement. Using regression analysis, Chinese ethnicity [odds ratio (OR)=2.11; 95% confidence interval (CI), 1.09-4.09; P = 0.027), constipation (OR = 2.65; 95% CI, 1.23-5.42; P = 0.007) and colorectal adenomas (OR = 2.65; 95% CI, 1.08-6.46; P = 0.033) were independently associated with diverticular disease.
CONCLUSIONS: Colonic diverticular disease in a multiracial Asian patient population has an ethnic predilection and is predominantly right-sided.},
}
@article {pmid15960348,
year = {2004},
author = {Catena, F and Agrusti, S and Gazzotti, F and Taffurelli, M},
title = {[Ruptured aortic aneurysm presenting as acute abdomen: particular case report].},
journal = {Annali italiani di chirurgia},
volume = {75},
number = {5},
pages = {579-581},
pmid = {15960348},
issn = {0003-469X},
mesh = {Abdomen, Acute/*etiology ; Aortic Aneurysm, Abdominal/*complications/diagnosis ; Aortic Rupture/*complications/diagnosis ; Diagnostic Errors ; Humans ; Male ; Middle Aged ; },
abstract = {AIM: Ruptured aortic aneurysm can be a cause of acute abdomen. Nowadays using modern diagnostic techniques diagnosis is very easy. We report a particular case of a misdiagnosed ruptured aortic aneurysm.
CASE REPORT: Man 65 y.o. admitted to hospital for abdominal pain and stipsis. After 1 week he developed acute abdomen with muscular rigidity and mild acute anemia. Few days before contrast studies showed a sigmoid diverticular disease. At laparotomy a ruptured aortic aneurysm sealed from retroperitoneal fascia and extended to abdominal walls up to rectus abdominis muscles was found.
CONCLUSIONS: In case of acute abdomen with muscular rigidity and acute anemia the diagnosis of rectus abdominis muscles hematoma caused by ruptured aortic aneurysm must be considered.},
}
@article {pmid15940180,
year = {2005},
author = {Dovlatian, AA and Riabov, MA},
title = {[Long-term results of reconstructive surgeries in iatrogenic injury of the urinary tracts].},
journal = {Khirurgiia},
volume = {},
number = {4},
pages = {45-51},
pmid = {15940180},
issn = {0023-1207},
mesh = {Acute Disease ; Adult ; Aged ; Cesarean Section/adverse effects ; Electrocoagulation/adverse effects ; Female ; Follow-Up Studies ; Gynecologic Surgical Procedures/*adverse effects ; Humans ; Hysterectomy/adverse effects ; Iatrogenic Disease ; *Intraoperative Complications ; Kidney Pelvis/surgery ; Male ; Middle Aged ; Pregnancy ; Pyelonephritis/surgery ; *Plastic Surgery Procedures ; Time Factors ; Ureter/injuries/surgery ; Urinary Bladder/injuries ; Urinary Tract/*injuries ; },
abstract = {Various reconstructive surgeries were performed in 21 patients because of intraoperative injuries of the urinary tracts. In 4 patients trauma of the ureter and urinary bladder was associated with obstetric operations (Cesarean section, hysterectomy). In 13 cases injury of the ureter was the consequence of hysterectomy due to cancer (4), hysteromyoma (4), prolapses of the uterus (1), extirpation of the stump of the uterine cervix (1), electrocoagulation of the ureter (2) and adnexectomy (1). In 4 patients ligation of the ureter complicated surgery for cancer of the sigmoid colon (1) and rectum (1), diverticular disease of the colon (1) and portal hepatic cirrhosis with severe ascites. Surgical policy was organ-saving. Only in 3 patients with severe acute pyelonephritis surgical treatment was performed in two stages with preliminary nephrostomy. In the rest cases primary reconstructive surgeries were used. Reconstructive surgeries saved the kidney as a functioning organ.},
}
@article {pmid15932369,
year = {2005},
author = {Morini, S and Hassan, C and Zullo, A and De Francesco, V and Burattini, O and Margiotta, M and Panella, C and Ierardi, E},
title = {Epithelial cell proliferation of the colonic mucosa in diverticular disease: a case-control study.},
journal = {Alimentary pharmacology & therapeutics},
volume = {21},
number = {11},
pages = {1385-1390},
doi = {10.1111/j.1365-2036.2005.02492.x},
pmid = {15932369},
issn = {0269-2813},
mesh = {Case-Control Studies ; Cell Proliferation ; Diverticulum, Colon/*drug therapy/pathology ; Epithelial Cells/pathology ; Female ; Gastrointestinal Agents/*therapeutic use ; Humans ; Immunohistochemistry ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; Prospective Studies ; Rifamycins/*therapeutic use ; Rifaximin ; },
abstract = {BACKGROUND: A higher risk of both advanced adenoma and carcinoma occurs in the sigmoid colon of patients with diverticular disease, for which bacterial carcinogens have been claimed to play a role.
AIM: To assess epithelial cell proliferation in colonic mucosa of diverticular disease patients before and after rifaximin treatment.
METHODS: Twelve consecutive patients with a new endoscopic diagnosis of left-sided diverticular disease and 12 matched controls were enrolled. Epithelial cell proliferation in the sigmoid mucosa was assessed by using proliferating cell nuclear antigen. The proliferating cell nuclear antigen index of the whole crypt and of the upper third was separately evaluated before and after 10-day rifaximin (400 mg b.d.) therapy.
RESULTS: Proliferating cell nuclear antigen index in the upper third of the crypt was significantly higher in the diverticular patients (median: 25, range: 14-32) as compared with controls (median: 15, range: 5-20) (P = 0.038), and it was not reverted by rifaximin therapy. No difference of the proliferating cell nuclear antigen index of the whole crypt was detected between cases (median: 27, range: 23-44) and controls (median: 25, range: 18-42) (P = 0.6).
CONCLUSIONS: Our data showed an upward shifting of cellular proliferation in the sigmoid mucosa of patients with diverticular disease. Because of rifaximin failure in reversing this alteration, factors other than the bacterial load should probably be investigated.},
}
@article {pmid15931311,
year = {2003},
author = {Ellingson, JL and Cheville, JC and Brees, D and Miller, JM and Cheville, NF},
title = {Absence of Mycobacterium avium subspecies paratuberculosis components from Crohn's disease intestinal biopsy tissues.},
journal = {Clinical medicine & research},
volume = {1},
number = {3},
pages = {217-226},
pmid = {15931311},
issn = {1539-4182},
mesh = {Biopsy ; Crohn Disease/*microbiology/*pathology ; DNA, Bacterial/analysis ; Humans ; Immunohistochemistry ; Intestines/microbiology/pathology ; Mycobacterium avium subsp. paratuberculosis/genetics/*isolation & purification ; Paratuberculosis/*pathology ; Retrospective Studies ; },
abstract = {BACKGROUND: Crohn's disease is a chronic human intestinal inflammatory disorder for which an etiologic agent has not been identified. Johne's disease is a similar chronic enteric granulomatous disease of ruminant species and has been used as a model of Crohn's disease. Johne's disease has been proven to be caused by Mycobacterium avium subspecies paratuberculosis (M. avium ss paratuberculosis). It has been proposed that M. avium ss paratuberculosis may also cause Crohn's disease. This is of particular concern because the organism may be spread to humans through inadequately pasteurized dairy products.
OBJECTIVE: We sought to determine whether M. avium ss paratuberculosis could be detected using identical techniques in paraffin-embedded tissue samples of bovine Johne's disease and human Crohn's, ulcerative colitis and diverticular diseases. Samples were obtained for analysis from national tissue banks.
DESIGN: Cross-species and cross-disease sample comparisons by multiple detection techniques.
METHODS: Histology, immunocytochemistry and polymerase chain reaction (PCR) were utilized to test and compare the presence of M. avium ss paratuberculosis components. Insertion sequence IS900, present in multiple copies and found only in M. avium ss paratuberculosis, was utilized in both PCR and immunocytochemical analyses.
RESULTS: The IS900 sequence was demonstrable in all samples of confirmed positive Johne's disease tissue. The sequence was not identified in the 35 Crohn's, 36 ulcerative colitis, and 21 diverticular disease samples.
CONCLUSION: M. avium ss paratuberculosis was not associated with the lesions in these Crohn's disease samples, using these methods.},
}
@article {pmid15910707,
year = {2005},
author = {Alvarez-Zepeda, C and Hermansen-Truan, C and Valencia-Lazo, O and Azolas-Marcos, R and Gatica-Jiménez, F and Castillo-Avendaño, J},
title = {[Necrotizing fasciitis of the abdominal wall secondary to a perforated sigmoid diverticulum in a Spiegel's hernia. A case report].},
journal = {Cirugia y cirujanos},
volume = {73},
number = {2},
pages = {133-136},
pmid = {15910707},
issn = {0009-7411},
mesh = {*Abdominal Wall ; Aged ; Aged, 80 and over ; Colostomy ; Debridement ; Diverticulum, Colon/*complications/surgery ; Emergencies ; Fasciitis, Necrotizing/diagnostic imaging/*etiology ; Female ; Hernia, Abdominal/*complications/surgery ; Humans ; Intestinal Perforation/*etiology/surgery ; Laparotomy ; Radiography, Abdominal ; Sigmoid Diseases/*complications/surgery ; Tomography, X-Ray Computed ; },
abstract = {It is uncommon that a complicated diverticular disease presents as an extraperitoneal manifestation, and it is also rare for diverticulitis to be the cause of a necrotizing fasciitis. Necrotizing fasciitis (NF) of the abdominal wall is not common and has a high mortality rate. We present a patient with NF of the abdominal wall secondary to a perforated colon diverticulum in a Spiegel's hernia without peritonitis or intraabdominal abscess. The absence of peritoneal manifestations delayed early diagnosis, which was evident through crepitation of the abdominal wall. Computed tomography (CT) revealed a severe inflammatory process characterized by the presence of gas in the abdominal wall. The patient underwent emergency surgery with debridement of all necrotic tissue, exploratory laparotomy, sigmoidectomy and derivative colostomy, but due to her advanced age and multiple organ failure, the outcome was fatal.},
}
@article {pmid15889263,
year = {2006},
author = {Krones, CJ and Klinge, U and Butz, N and Junge, K and Stumpf, M and Rosch, R and Hermanns, B and Heussen, N and Schumpelick, V},
title = {The rare epidemiologic coincidence of diverticular disease and advanced colonic neoplasia.},
journal = {International journal of colorectal disease},
volume = {21},
number = {1},
pages = {18-24},
pmid = {15889263},
issn = {0179-1958},
mesh = {Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Cell Transformation, Neoplastic/*pathology ; Cohort Studies ; Colonic Neoplasms/*diagnosis/*epidemiology ; Comorbidity ; Diverticulosis, Colonic/*diagnosis/*epidemiology ; Female ; Germany/epidemiology ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Odds Ratio ; Prevalence ; Probability ; Retrospective Studies ; Risk Assessment ; Sex Distribution ; Survival Rate ; },
abstract = {BACKGROUND AND AIMS: In Western industrialised countries the prevalence of neoplastic colonic lesions and diverticular disease markedly increases with age. In contrast, the coincident occurrence of both diseases seems to fall below their individual epidemiologic estimates. Because directly comparing data are rare, this retrospective study evaluates the coincidence of neoplastic lesions and diverticular disease.
PATIENT AND METHODS: A total of 1,838 patients from 1986 to 2000 were admitted to the study. For 1,326 patients-56% male (n=741), 44% female (n=585), mean age 64 (+/-11.83 SD)-with a resection due to colonic cancer, the documented findings of colonoscopy, colonic contrast enema, and/or histopathology were analysed with regard to the prevalence of colonic diverticulosis. In 512 patients--51% male (n=263), 49% female (n=249), mean age 60 (+/-12.59 SD)--with a colonic resection due to diverticulitis, the synchronous or metachronous occurrence of neoplastic colonic lesions was recorded using the database of the Tumour Centre, Aachen. To compare the observed results with published epidemiology, statistical analysis included age-referred binomial tests and an age-stratified analysis (Cochran-Mantel-Haenszel test). Odds ratios (OR) were also calculated. P<0.05 was considered to indicate locally statistical significance.
RESULTS: In the cancer group, we found a statistically significant reduced rate of diverticula in nearly all age categories and the age-stratified analyses (corresponding OR 0.30-0.51). Consistently, the diverticulitis group revealed a statistically significant decreased rate of advanced colonic neoplastic lesion in nearly all age categories and all age-stratified analyses (corresponding OR 0.13-0.43).
CONCLUSION: Our results indicate that patients with colonic neoplastic lesions or diverticular disease probably form heterogeneous groups. Because current results from molecular biology emphasize the impact of the extracellular matrix on the genesis of diverticulosis and colonic cancer, the observed heterogeneity could be an expression of a distinct composition of the local milieu.},
}
@article {pmid15875148,
year = {2005},
author = {Hoffmann, RM and Kruis, W},
title = {[Diverticulosis and diverticulitis].},
journal = {Der Internist},
volume = {46},
number = {6},
pages = {671-83; quiz 684},
pmid = {15875148},
issn = {0020-9554},
mesh = {Diverticulitis/*diagnosis/mortality/*therapy ; Diverticulum/*diagnosis/mortality/*therapy ; Humans ; Practice Guidelines as Topic ; Practice Patterns, Physicians' ; },
abstract = {Alterations in the colon wall, motility disorders, and certain nutritional habits are the essential factors in the development of colon diverticula. Thus, with advancing age this results in a high incidence in Western industrialized countries. The clinical picture is usually one of symptom-free diverticulosis. Diverticular disease can be associated with minor symptoms, but in complicated cases with diverticulitis and diverticular hemorrhage, it is potentially fatal. Further complications include abscess formation, fistula development, and obstruction. Barium double-contrast imaging exhibits the highest diagnostic sensitivity in diverticulosis but is contraindicated in cases of suspected complicated diverticular disease due to the danger of perforation. In these instances, sonography, computed tomography, or magnetic resonance imaging are performed. For diverticular hemorrhage, coloscopy not only represents a possible diagnostic tool but also a therapeutic option for various techniques of hemostasis. Treatment of diverticulitis and its complications requires careful consideration of conservative and surgical approaches and close interdisciplinary cooperation.},
}
@article {pmid15865664,
year = {2004},
author = {Simpson, J and Spiller, R},
title = {Colonic diverticular disease.},
journal = {Clinical evidence},
volume = {},
number = {12},
pages = {599-609},
pmid = {15865664},
issn = {1462-3846},
mesh = {Acute Disease ; Anti-Infective Agents/therapeutic use ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/surgery/therapy ; Diverticulum, Colon/*therapy ; Humans ; Mesalamine/therapeutic use ; Rifamycins/therapeutic use ; Rifaximin ; },
}
@article {pmid15855755,
year = {2005},
author = {Papi, C and Koch, M and Capurso, L},
title = {Management of diverticular disease: is there room for rifaximin?.},
journal = {Chemotherapy},
volume = {51 Suppl 1},
number = {},
pages = {110-114},
doi = {10.1159/000081997},
pmid = {15855755},
issn = {0009-3157},
mesh = {Anti-Bacterial Agents/*therapeutic use ; Clinical Trials as Topic ; Diverticulitis/*drug therapy ; Diverticulum, Colon/*drug therapy ; Humans ; Mannans/therapeutic use ; Rifamycins/*therapeutic use ; Rifaximin ; },
abstract = {Treatment of symptomatic diverticular disease of the colon is aimed at the relief of symptoms and the prevention of major complications. The efficacy of fiber supplementation and of anticholinergic and spasmolytic agents remains controversial. Antibiotics are commonly used in the treatment of inflammatory complications of diverticular disease. Data from open labelled and randomized controlled trials do suggest the efficacy of rifaximin in obtaining symptomatic relief in patients with diverticular disease. Approximately 30% therapeutic gain compared to fiber supplementation only can be expected after one year of intermittent treatment with rifaximin. Considering the safety and tolerability of rifaximin, this drug can be recommended for patients with symptomatic uncomplicated diverticular disease.},
}
@article {pmid15855748,
year = {2005},
author = {Scarpignato, C and Pelosini, I},
title = {Rifaximin, a poorly absorbed antibiotic: pharmacology and clinical potential.},
journal = {Chemotherapy},
volume = {51 Suppl 1},
number = {},
pages = {36-66},
doi = {10.1159/000081990},
pmid = {15855748},
issn = {0009-3157},
mesh = {Animals ; Anti-Bacterial Agents/chemistry/pharmacokinetics/*pharmacology ; Antibiotic Prophylaxis ; Bacterial Infections/drug therapy ; Clinical Trials as Topic ; Drug Interactions ; Drug Resistance, Bacterial ; Gastrointestinal Diseases/drug therapy ; Humans ; Intestinal Absorption ; Microbial Sensitivity Tests ; Rifamycins/chemistry/pharmacokinetics/*pharmacology ; Rifaximin ; },
abstract = {Rifaximin (4-deoxy-4'-methylpyrido[1',2'-1,2]imidazo- [5,4-c]-rifamycin SV) is a synthetic antibiotic designed to modify the parent compound, rifamycin, in order to achieve low gastrointestinal (GI) absorption while retaining good antibacterial activity. Both experimental and clinical pharmacology clearly show that this compound is a nonsystemic antibiotic with a broad spectrum of antibacterial action covering Gram-positive and Gram-negative organisms, both aerobes and anaerobes. Being virtually nonabsorbed, its bioavailability within the GI tract is rather high with intraluminal and fecal drug concentrations that largely exceed the minimal inhibitory concentration values observed in vitro against a wide range of pathogenic organisms. The GI tract represents, therefore, the primary therapeutic target and GI infections the main indication. The appreciation of the pathogenic role of gut bacteria in several organic and functional GI diseases has increasingly broadened its clinical use, which is now extended to hepatic encephalopathy, small intestine bacterial overgrowth, inflammatory bowel disease and colonic diverticular disease. Potential indications include the irritable bowel syndrome and chronic constipation, Clostridium difficile infection and bowel preparation before colorectal surgery. Because of its antibacterial activity against the microorganism and the lack of strains with primary resistance, some preliminary studies have explored the rifaximin potential for Helicobacter pylori eradication. Oral administration of this drug, by getting rid of enteric bacteria, could also be employed to achieve selective bowel decontamination in acute pancreatitis, liver cirrhosis (thus preventing spontaneous bacterial peritonitis) and nonsteroidal anti-inflammatory drug (NSAID) use (lessening in that way NSAID enteropathy). This antibiotic has, therefore, little value outside the enteric area and this will minimize both antimicrobial resistance and systemic adverse events. Indeed, the drug proved to be safe in all patient populations, including young children. Although rifaximin has stood the test of time, it still attracts the attention of both basic scientists and clinicians. As a matter of fact, with the advancement of the knowledge on microbial-gut interactions in health and disease novel indications and new drug regimens are being explored. Besides widening the clinical use, the research on rifaximin is also focused on the synthesis of new derivatives and on the development of original formulations designed to expand the spectrum of its clinical use.},
}
@article {pmid15855066,
year = {2005},
author = {Gollub, MJ and Jhaveri, S and Schwartz, E and Felderman, H and Cooper, C and Markowitz, AJ and Kurtz, RC and Thaler, H},
title = {CT colonography features of sigmoid diverticular disease.},
journal = {Clinical imaging},
volume = {29},
number = {3},
pages = {200-206},
doi = {10.1016/j.clinimag.2004.07.004},
pmid = {15855066},
issn = {0899-7071},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonography, Computed Tomographic/*methods ; Diverticulitis, Colonic/*diagnostic imaging ; Diverticulum, Colon/*diagnostic imaging ; Female ; Humans ; Image Interpretation, Computer-Assisted ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/*diagnostic imaging ; },
abstract = {OBJECTIVE: The objective of this study is to assess the sigmoid distensibility during CT colonography (CTC) in patients with diverticular disease.
METHODS: Consecutive patients without a history of pelvic radiation or neoplasms underwent 150 CTC. Three radiologists in consensus evaluated axial images for colonic distention, luminal diameters (mm), diverticula, and muscular thickening.
RESULTS: The minimum colon diameter in patients with muscular thickening was significantly smaller, irrespective of the presence of diverticula (P=.009).
CONCLUSION: Muscular thickening with diverticular disease was associated with significantly less sigmoid colon distension.},
}
@article {pmid15849655,
year = {2005},
author = {Hildebrand, P and Birth, M and Bruch, HP and Schwandner, O},
title = {[Surgical therapy in right-sided diverticulitis].},
journal = {Zentralblatt fur Chirurgie},
volume = {130},
number = {2},
pages = {123-127},
doi = {10.1055/s-2005-836337},
pmid = {15849655},
issn = {0044-409X},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Appendectomy ; Appendicitis/diagnosis/surgery ; Chi-Square Distribution ; Colectomy ; Colonic Diseases/diagnosis/*surgery ; Diagnosis, Differential ; Diverticulitis/diagnosis/*surgery ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Retrospective Studies ; Sigmoid Diseases/diagnosis/surgery ; Time Factors ; Treatment Outcome ; },
abstract = {INTRODUCTION: Left-sided diverticulitis is a common disease in Western countries, whereas right-sided diverticultitis is rare and symptoms are often similar to the clinical signs of an acute appendicitis. It was the aim of this study to analyse surgical experience in right-sided diverticulitis.
METHODS: All patients who underwent resectional surgery for both right-sided and sigmoid diverticular disease were entered prospectively in a registry database (8-year observation period, 1996-2003). For the current study, a retrospective analysis of all patients who underwent ileocolic resection or right colectomy for right-sided colonic diverticulitis was performed, specifically focussing on incidence, clinical symptoms, indication for surgery, type of procedure, and histopathological parameters including immunohistochemistry, and outcome in right-sided diverticulitis.
RESULTS: Within eight years, 481 patients were treated surgically for chronically recurrent or acute complicated diverticular disease: 468 patients with sigmoid diverticulitis, 12 patients with right-sided diverticulitis, and 1 patient with combined right-sided and sigmoid diverticular disease. This corresponds to an incidence of right-sided diverticulitis of 2.5 % related to the total number of resections for diverticulitis, and an incidence of 1.3 % in relation to the appendectomies in our patients. In 4 patients, acute appendicitis was presumed preoperatively. Most common diagnostic tool was ultrasonography. Right colectomy was performed in 9 patients with complicated cecal diverticulitis, whereas ileocolic resection was performed in 2 patients and simultaneous ileocolic and sigmoid resection was carried out in one patient. Postoperatively, no morbidity occurred. Histopathological assessment showed local perforation in 75 % (9/12). Hypoganglionosis or aganglionosis was detected in 5 of 12 resected specimen.
DISCUSSION: As right-sided diverticulitis is a rare colonic disease in Western countries, the differentiation from acute appendicitis can be difficult. In general, there is no difference in the treatment of right-sided diverticulitis compared to left-sided diverticulitis, and surgery is only indicated in complicated right-sided diverticulitis. Resection of the inflamed colon with primary anastomosis is safe and can be performed by laparoscopy in experienced centers. At present, it can only be speculated whether hypoganglionosis or aganglionosis are causative factors in the etiology of right-sided diverticulitis.},
}
@article {pmid15810646,
year = {2005},
author = {Di Mario, F and Aragona, G and Leandro, G and Comparato, G and Fanigliulo, L and Cavallaro, LG and Cavestro, GM and Iori, V and Maino, M and Moussa, AM and Gnocchi, A and Mazzocchi, G and Franzé, A},
title = {Efficacy of mesalazine in the treatment of symptomatic diverticular disease.},
journal = {Digestive diseases and sciences},
volume = {50},
number = {3},
pages = {581-586},
pmid = {15810646},
issn = {0163-2116},
mesh = {Administration, Oral ; Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Diverticulitis, Colonic/diagnosis/drug therapy ; Diverticulum, Colon/diagnosis/*drug therapy ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Intestinal Mucosa/drug effects/pathology ; Male ; Mesalamine/*administration & dosage ; Middle Aged ; Probability ; Prospective Studies ; Rifamycins/*administration & dosage ; Rifaximin ; Risk Assessment ; Severity of Illness Index ; Single-Blind Method ; Statistics, Nonparametric ; Treatment Outcome ; },
abstract = {We aimed to improve symptoms by means of mesalazine in symptomatic colonic diverticular disease patients. One hundred seventy outpatients (98 M, 72 F; age, 67.1 years; range, 39-84 years) were assigned to four different schedules: rifaximin, 200 mg bid (Group R1: 39 pts), rifaximin, 400 mg bid (Group R2: 43 pts), mesalazine, 400 mg bid (Group M1: 40 pts), and mesalazine, 800 mg bid (Group M2: 48 pts), for 10 days per month. At baseline and after 3 months we recorded 11 clinical variables (upper/lower abdominal pain/discomfort, bloating, tenesmus, diarrhea, abdominal tenderness, fever, general illness, nausea, emesis, dysuria), scored from 0 = no symptoms to 3 = severe. The global symptomatic score was the sum of all symptom scores. After 3 months in all schedules but Group R1, 3 of the 11 symptoms improved (P < 0.03); the global score decreased in all groups but Group R1 (P < 0.0001). Mesalazine-treated patients had the lowest global score at 3 months (P < 0.001). Mesalazine is as effective as rifaximin (higher dosage schedule) for diminishing some symptoms, but it appears to be better than rifaximin for improving the global score in those patients.},
}
@article {pmid15809788,
year = {2004},
author = {Lesurtel, M and Fritsch, S and Sellam, R and Molinier, N and Mosnier, H},
title = {Does laparoscopic colorectal resection for diverticular disease impair male urinary and sexual function?.},
journal = {Surgical endoscopy},
volume = {18},
number = {12},
pages = {1774-1777},
pmid = {15809788},
issn = {1432-2218},
mesh = {Diverticulosis, Colonic/*surgery ; Diverticulum/surgery ; Humans ; Laparoscopy/*adverse effects ; Male ; Middle Aged ; Rectal Diseases/*surgery ; Retrospective Studies ; Sexual Dysfunction, Physiological/epidemiology/*etiology ; Urination Disorders/epidemiology/*etiology ; },
abstract = {BACKGROUND: Laparoscopic colorectal resection may induce bladder and sexual dysfunction secondary to injury to the autonomic nervous system. The aim of this study was to evaluate urinary and sexual function in male patients after laparoscopic colorectal resection for diverticular disease.
METHODS: From January 1997 to March 2002, we performed a retrospective analysis of urinary and sexual function in 56 consecutive male patients who had undergone laparoscopic colorectal resection for diverticular disease. Preoperative and 6-month postoperative assessment was carried out using data collected via standardized postal questionnaires.
RESULTS: Three patients were excluded (one had a prior prostatectomy, one had Peyronie's disease, and one was treated with neuroleptics). Fifty-three patients with a mean age of 54 A+/- 2 years were included in the study. There were no conversions. The morbidity rate was 9.4%. Mean follow-up was 27 A+/- 2 months. There was no significant difference in preoperative and postoperative urinary function. Fifty-one patients (96%) were sexually active preoperatively and were still sexually active postoperatively. Compared with the preoperative period, postoperative impairment of libido, erection, ejaculation, and orgasm were not significant. Every patient was able to achieve ejaculation after the intervention, and no retrograde ejaculations were reported. One patient was unable to have an erection after the intervention.
CONCLUSION: Laparoscopic colorectal resection for diverticular disease does not significantly impair urinary and sexual function.},
}
@article {pmid15807474,
year = {2004},
author = {Misdraji, J and Graeme-Cook, FM},
title = {Miscellaneous conditions of the appendix.},
journal = {Seminars in diagnostic pathology},
volume = {21},
number = {2},
pages = {151-163},
doi = {10.1053/j.semdp.2004.11.006},
pmid = {15807474},
issn = {0740-2570},
mesh = {Appendiceal Neoplasms/pathology ; *Appendix/abnormalities ; Cecal Diseases/*pathology ; Congenital Abnormalities/pathology ; Humans ; },
abstract = {A variety of miscellaneous conditions affect the appendix, both as incidental findings and as causes of clinical signs and symptoms that often mimic appendicitis. Congenital abnormalities of the appendix are rare; the two most commonly reported are congenital absence and appendiceal duplication. Diverticular disease may be an incidental finding, but when inflamed, can be clinically confused with appendicitis. Endometriosis of the appendix, which usually occurs in the setting of generalized gastrointestinal endometriosis, often presents as acute appendicitis, but may present as intussusception, lower intestinal bleeding, and, particularly during pregnancy, perforation. Peritoneal endosalpingiosis often involves the appendiceal serosa and occasionally the wall but has no clinical manifestations in contrast to endometriosis. Vasculitis may be either isolated to the appendix or part of a systemic vasculitis, most often polyarteritis nodosa. Neural proliferations of the appendix include lesions associated with von Recklinghausen's disease, as well as mucosal and axial neuromas that are theorized to progress to fibrous obliteration of the appendix. Mesenchymal tumors of the appendix are most often of smooth muscle type, usually leiomyoma but rarely leiomyosarcoma; nonmyogenic neoplasms such as gastrointestinal stromal tumor, granular cell tumor, Kaposi's sarcoma, and miscellaneous other curiosities occur rarely. Lymphoma affects the appendix exceptionally; in children, Burkitt lymphoma is most common whereas in adults, large cell lymphomas and low grade B-cell lymphomas predominate. Secondary involvement of the appendix by leukemia has been reported. Secondary involvement of the appendix by carcinomas of the female genital tract, particularly ovary, and diverse other sites are in aggregate common but only rarely a clinical or pathological difficulty. Occasionally, however, appendiceal neoplasia that is secondary from another site may dominate the clinical picture and lead to potential pathologic misdiagnosis as primary appendiceal disease.},
}
@article {pmid15793639,
year = {2005},
author = {Takahashi, Y and Tanaka, H and Kinjo, M and Sakumoto, K},
title = {Prospective evaluation of factors predicting difficulty and pain during sedation-free colonoscopy.},
journal = {Diseases of the colon and rectum},
volume = {48},
number = {6},
pages = {1295-1300},
doi = {10.1007/s10350-004-0940-1},
pmid = {15793639},
issn = {0012-3706},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Body Mass Index ; Colonoscopy/*adverse effects ; Constipation/complications ; Female ; Humans ; Hypnotics and Sedatives ; Hysterectomy ; Male ; Middle Aged ; Pain Measurement ; Pain, Postoperative/*etiology ; Prospective Studies ; Risk Factors ; Sex Factors ; Time Factors ; },
abstract = {PURPOSE: Colonoscopy can be painful for patients and difficult for colonoscopists; however, it is hard to predict how painful or difficult the examination will be. This study was designed to identify factors that predict pain and difficulty during sedation-free colonoscopy.
METHODS: A total of 848 consecutive sedation-free colonoscopies were evaluated in a prospective manner. Factors were recorded, including patient pain, intubation time, demographic data, history of abdominal surgery, bowel preparation status, diverticular disease, bowel habits, anxiety level, and number of previous colonoscopies. These factors were analyzed to determine their association with pain and difficulty.
RESULTS: Almost all colonoscopies (845/848; 99.6 percent) were successful. Univariate analyses showed that lower body mass index, younger age, female gender, anxiety level, first time, intubation time, preparation status, previous hysterectomy, and previous gynecologic surgery were predictors of patient pain, and lower body mass index, female gender, anxiety level, preparation status, previous hysterectomy, previous gynecologic surgery, and constipation were predictors of difficulty of intubation. Multivariate logistic regression analyses revealed that lower body mass index, younger age, intubation time, preparation status, previous hysterectomy, and antispasmodic agent use were predictors of patient pain, and lower body mass index, female gender, constipation, preparation status, and previous hysterectomy were predictors of difficulty of intubation.
CONCLUSIONS: By use of intubation time and patient pain, several patient characteristics were identified that may predict technical difficulty and pain associated with the procedure. These findings have implications for the practice and teaching of colonoscopy.},
}
@article {pmid15781793,
year = {2005},
author = {Alves, A and Panis, Y and Mathieu, P and Mantion, G and Kwiatkowski, F and Slim, K and , },
title = {Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {140},
number = {3},
pages = {278-83, discussion 284},
doi = {10.1001/archsurg.140.3.278},
pmid = {15781793},
issn = {0004-0010},
mesh = {Age Factors ; Aged ; Body Weight ; Colon/surgery ; Colorectal Neoplasms/epidemiology/*surgery ; Comorbidity ; Data Collection ; Diverticulum, Colon/epidemiology/*surgery ; Emergencies ; Follow-Up Studies ; France ; Humans ; Morbidity ; Nervous System Diseases/epidemiology ; Postoperative Complications/epidemiology/*mortality ; Prospective Studies ; Rectum/surgery ; Risk Factors ; },
abstract = {HYPOTHESIS: Better knowledge of independent risk factors might decrease mortality and morbidity rates following colorectal surgery.
DESIGN: Prospective multicenter study.
INTERVENTIONS: From June to September 2002, consecutive patients undergoing open or laparoscopic surgery (electively or on an emergent basis) for colorectal cancers or diverticular disease were prospectively included. Exclusion criteria were colectomy for other causes (eg, inflammatory bowel diseases, benign polyps). The structured sheet of data collection included more than 200 items on all perioperative data concerning the patient, the disease, and the operating surgeons. Postoperative mortality and morbidity were defined as in-hospital death and complications.
RESULTS: Among 1421 patients, the in-hospital death rate was 3.4% and the overall morbidity rate was 35%. Four independent preoperative risk factors of mortality were found: emergency surgery, loss of more than 10% of weight, neurological comorbidity, and age older than 70 years. Six independent risk factors of morbidity were found: age older than 70 years, neurologic comorbidity, hypoalbuminemia, cardiorespiratory comorbidity, long duration of operation, and peritoneal contamination.
CONCLUSION: Colorectal resection in France is associated with a 3.4% mortality rate and a 35% morbidity rate. Knowledge of the risk factors could help surgeons manage cases.},
}
@article {pmid15765444,
year = {2005},
author = {Bassotti, G and Battaglia, E and De Roberto, G and Morelli, A and Tonini, M and Villanacci, V},
title = {Alterations in colonic motility and relationship to pain in colonic diverticulosis.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {3},
number = {3},
pages = {248-253},
doi = {10.1016/s1542-3565(04)00614-7},
pmid = {15765444},
issn = {1542-3565},
mesh = {Abdominal Pain/*etiology/physiopathology ; Adult ; Aged ; Colon/physiopathology ; Diverticulum, Colon/*complications/*physiopathology ; Female ; Gastrointestinal Motility/physiology ; Humans ; Male ; Manometry ; Middle Aged ; },
abstract = {BACKGROUND AND AIMS: Although the pathophysiologic basis of colonic diverticular disease is understood incompletely, there is agreement that abnormal colon motility probably plays a major role. However, several different abnormalities have been reported in such patients. The purpose of this study was to assess whether patients with diverticulosis display an abnormal duration of regular colonic contractile patterns, which has been observed in other conditions characterized by spasticity of the viscus, such as the irritable bowel syndrome.
METHODS: Twelve patients with symptomatic uncomplicated diverticular disease entered the study and underwent 24-hour colonic manometric recordings using a standard technique. The duration of regular contractile patterns was compared with that recorded in 20 healthy volunteers.
RESULTS: Patients with diverticulosis had a significant increase of the duration of regular patterns of phasic pressure activity compared with healthy controls (31% vs. 6.4%, P < .001). In both groups, the 2- or 3-cycles-per-minute activity represented more than 80% of such activity, especially in the sigmoid colon. More than 30% of patients, but none of the controls, reported episodes of abdominal pain (cramping lower abdominal pain with characteristics similar to those experienced at home) during the occurrence of a regular colonic contractile pattern. This was significant by symptom association probability criteria.
CONCLUSIONS: Patients with symptomatic uncomplicated colonic diverticulosis displayed increased duration of rhythmic, low-frequency, contractile activity, particularly in the segments bearing diverticula. These regular rhythms are associated significantly with reporting of abdominal pain.},
}
@article {pmid15750510,
year = {2005},
author = {Burch, J},
title = {Exploring the conditions leading to stoma-forming surgery.},
journal = {British journal of nursing (Mark Allen Publishing)},
volume = {14},
number = {2},
pages = {94-98},
doi = {10.12968/bjon.2005.14.2.17438},
pmid = {15750510},
issn = {0966-0461},
mesh = {*Cystostomy/nursing ; Ehlers-Danlos Syndrome/complications/surgery ; *Enterostomy/nursing ; Humans ; Intestinal Diseases/etiology/*surgery ; Spinal Dysraphism/complications/surgery ; Urinary Incontinence/etiology/*surgery ; },
abstract = {The most common disease leading to the formation of a stoma is cancer. However, there are many other diseases that affect the gastrointestinal or urinary system that may also require either a temporary or permanent stoma to be formed (a colostomy, ileostomy or urostomy). Stoma-forming surgery may be undertaken for a number of reasons, such as to eradicate a disease or improve the patient's quality of life. Cancer, inflammatory bowel disease and diverticular disease are the most common conditions that lead to stoma formation. However, faecal incontinence, familial adenomatous polyposis, Hirschsprung's disease, spina bifida and Ehlers-Danlos syndrome may also require a stoma to be formed. The nurse's role in caring for these patients at a potentially traumatic period of their life is discussed.},
}
@article {pmid15749799,
year = {2005},
author = {Yoong, KK and Heymann, T},
title = {Colonoscopy in the very old: why bother?.},
journal = {Postgraduate medical journal},
volume = {81},
number = {953},
pages = {196-197},
pmid = {15749799},
issn = {1469-0756},
mesh = {Age Factors ; Aged ; *Aged, 80 and over ; Colonic Diseases/*diagnosis ; Colonic Neoplasms/diagnosis ; Colonoscopy/adverse effects/*statistics & numerical data ; England ; *Health Care Rationing ; Humans ; Medical Audit ; *Prejudice ; Retrospective Studies ; },
abstract = {OBJECTIVES: To evaluate the use of colonoscopy in patients aged at least 85 years. Does the ideal of an ageism free service apply?
DESIGN: A retrospective audit.
SETTING: Department of gastroenterology that carries out about 1000 colonoscopies annually in a district general hospital serving a population of about 320 000.
SUBJECTS: All patients aged at least 85 years who underwent colonoscopy over five years to 2003.
MAIN OUTCOME MEASURES: The indications for colonoscopy and its findings. The outcome of patients found to have colonic cancers.
RESULTS: Colonoscopy was completed in 219 cases (69%). The main reasons for failure were poor bowel preparation and severe diverticular disease. Normal findings occurred in 65 (30%) of the 219 cases that had had a complete examination. Colonoscopy identified a problem that explained the patient's symptoms in 116 (37%) cases. Polyps were found in 45 (14.2%) cases and malignancy in 28 (8.8%).
CONCLUSIONS: The absence of significant complications and comparatively high yield of colonic malignancies and polyps reinforces the value of colonoscopy as a diagnostic tool even after 85 years of age and despite the technical challenges of the procedure in this age group that limited completion. Increasing age alone should not preclude a patient from colonoscopy.},
}
@article {pmid15749594,
year = {2005},
author = {Khanna, A and Ognibene, SJ and Koniaris, LG},
title = {Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding: evidence from a meta-analysis.},
journal = {Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract},
volume = {9},
number = {3},
pages = {343-352},
pmid = {15749594},
issn = {1091-255X},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diverticulum/*complications/diagnosis ; Embolization, Therapeutic/*methods ; Evidence-Based Medicine ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage/*etiology/mortality/physiopathology/*therapy ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Sex Factors ; Survival Rate ; Treatment Outcome ; },
abstract = {The study goal was to determine which etiologies of lower gastrointestinal bleeding (LGIB) may best be treated with superselective embolization. A meta-analysis was undertaken of 25 identified publications reporting the use of embolization and an unpublished series of 12 consecutive patients with LGIB from the authors' institution. Six published series and the authors' series met selection criteria for further analysis. Multiple regression analysis demonstrated no significant difference in pooled outcomes when varying the included study, age, or embolization method on the outcome of rebleeding. The pooled odds ratio for arteriovenous dysplastic lesions and other diseases was 3.53 compared with rebleeding after localization and embolization for diverticular disease (95% confidence interval odds ratio, 1.33, 9.41; P < 0.01). Embolization for diverticular bleeding was successful in 85% of patients. In contrast, rebleeding after embolization for nondiverticular bleeding occurred in greater than 40% of patients and over a more protracted period. Embolization for LGIB is most effective for the treatment of diverticular bleeding. Caution should be used when applying embolization therapy for nondiverticular causes due to the considerably higher associated failure rate. An inpatient observation period of 2 days is suggested following embolization for diverticular bleeding.},
}
@article {pmid15745388,
year = {2004},
author = {Pistoia, MA and Lombardi, L and Rossi, M and Vittorini, C and Cavaliere, GF and Pistoia, F},
title = {Does rifaximin prevent complications of diverticular disease? A retrospective study.},
journal = {European review for medical and pharmacological sciences},
volume = {8},
number = {6},
pages = {283-287},
pmid = {15745388},
issn = {1128-3602},
mesh = {Aged ; Aged, 80 and over ; Diverticulum, Colon/*drug therapy/epidemiology ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Gastrointestinal Agents/*therapeutic use ; Humans ; Middle Aged ; Prevalence ; Recurrence ; Retrospective Studies ; Rifamycins/*therapeutic use ; Rifaximin ; Treatment Outcome ; },
abstract = {While the treatment of complicated diverticular disease (DD) is standardized, the approach to the symptomatic DD and prevention of relapsing complicated DD is still debated. An open question is whether nonabsorbable antibiotics may reduce the incidence of major complications of DD. We wanted to retrospectively analyze the prevalence of this disease in a large population of patients undergoing colonoscopy in our center in the last 10 years. Patients with symptomatic or complicated DD were treated with rifaximin 1,200 mg/die for 10-12 days during the acute phase in addition to the appropriate systemic antibiotics, followed by a prophylactic regimen with 800 mg/die for 7 days every month. The patients were followed up to December 2003, and the incidence of new complications and the relapses of symptomatology were determined. A total of 11,344 patients were screened. Of them, 2,287 showed an anatomical diverticulosis, and 408 had a diagnosis of complicated DD. The results indicate that the prevalence of DD--either in the uncomplicated or complicated form--in our area (Abruzzo, Italy) is identical to that of European countries, whose diet is characterized by a low amount of fiber and a high content of calories and refined sugars. Along a period of 10 years, a relapsing symptomatology of DD was observed in 112 patients treated with rifaximin (4.89%), while new complications of the DD were observed in 27 patients (1.18%). The comparison of these data with those of larger published series suggests a possible role of rifaximin in the prevention of DD main complications.},
}
@article {pmid15741929,
year = {2005},
author = {Baker, DE},
title = {Rifaximin: a nonabsorbed oral antibiotic.},
journal = {Reviews in gastroenterological disorders},
volume = {5},
number = {1},
pages = {19-30},
pmid = {15741929},
issn = {1533-001X},
mesh = {Anti-Infective Agents/administration & dosage/adverse effects/*pharmacology/*therapeutic use ; Diarrhea/drug therapy ; Escherichia coli Infections/drug therapy ; Gases ; Hepatic Encephalopathy/drug therapy ; Humans ; Inflammatory Bowel Diseases/drug therapy ; Intestinal Absorption ; Intestines/physiology ; Lactulose/therapeutic use ; Microbial Sensitivity Tests ; Rifampin/analogs & derivatives/pharmacology/therapeutic use ; Rifamycins/administration & dosage/adverse effects/*pharmacology/*therapeutic use ; Rifaximin ; },
abstract = {Rifaximin is a rifamycin analogue with a broad spectrum of activity similar to that of rifampin; however, because it is poorly absorbed in the gastrointestinal tract, the focus of its development has been on intestinal infections and diseases. This agent has proven to be as effective as ciprofloxacin in treating travelers' diarrhea due to Escherichia coli, although it is ineffective in treating infections due to Campylobacter jejuni. Other potential uses for rifaximin in gastroenterologic disorders include treatment of hepatic encephalopathy, intestinal gas and gas-related symptoms, diverticular disease, intestinal bacterial overgrowth, pouchitis, ulcerative colitis, and active Crohn's disease. This article highlights several studies demonstrating the efficacy of rifaximin in treating travelers' diarrhea as well as other gastrointestinal diseases and discusses the drug's pharmacokinetics, indications, contraindications, warnings, precautions, adverse reactions, and dosing.},
}
@article {pmid15733820,
year = {2005},
author = {Loffeld, RJ and van der Putten, AB},
title = {The annual yield of diagnostic endoscopy of the lower digestive tract.},
journal = {European journal of internal medicine},
volume = {16},
number = {1},
pages = {37-40},
doi = {10.1016/j.ejim.2004.07.015},
pmid = {15733820},
issn = {1879-0828},
abstract = {BACKGROUND: Endoscopy of the colon and rectum has become a standard diagnostic procedure. No data are presented in the literature on the annual yield or on morbidity patterns. A large, cross-sectional, single-center study was done in order to detect the annual yield of endoscopy of the colon and rectum. METHODS: All consecutive endoscopies performed over an 11-year period were included. All files from a random year were taken in order to collect data on the indication for the endoscopy. A standardized endoscopy report was used. RESULTS: Over the 11-year period, 11,550 consecutive endoscopies of the lower digestive tract were performed. Seven hundred and fourteen procedures were excluded because they were done as a direct follow-up after the index procedure. The majority of endoscopies were scheduled as colonoscopy. The most common endoscopic diagnoses made each year remained constant in number. Cancer was diagnosed in 4-6% of cases, inflammation in 9-15%, polyps in 9-16%, and diverticular disease in 21-37%. The percentage of women undergoing the procedure each year ranged from 54% to 59%, that of men from 41% to 46%. CONCLUSION: From this study it can be concluded that the annual yield of endoscopy of the lower digestive tract remains rather constant. No major changes in morbidity are noted.},
}
@article {pmid15732165,
year = {2005},
author = {},
title = {Diverticular disease. The importance of getting enough fiber.},
journal = {Mayo Clinic health letter (English ed.)},
volume = {23},
number = {2},
pages = {1-3},
pmid = {15732165},
issn = {0741-6245},
mesh = {Dietary Fiber/*therapeutic use ; Diverticulitis, Colonic/etiology/therapy ; Diverticulosis, Colonic/*diet therapy/etiology ; Humans ; Life Style ; },
}
@article {pmid15731575,
year = {2005},
author = {Ye, H and Losada, M and West, AB},
title = {Diverticulosis coli: update on a "Western" disease.},
journal = {Advances in anatomic pathology},
volume = {12},
number = {2},
pages = {74-80},
doi = {10.1097/01.pap.0000155054.76119.dc},
pmid = {15731575},
issn = {1072-4109},
mesh = {Colitis, Ulcerative/diagnosis ; Colon, Sigmoid/*pathology ; Crohn Disease/diagnosis ; Diagnosis, Differential ; *Diverticulosis, Colonic/etiology/pathology/physiopathology ; Humans ; Middle Aged ; Western World ; },
abstract = {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.},
}
@article {pmid15724617,
year = {2004},
author = {Liudvov, VI and Atamaniuk, HV},
title = {[Two cases of diverticular disease of the digestive tract].},
journal = {Likars'ka sprava},
volume = {},
number = {7},
pages = {59-61},
pmid = {15724617},
issn = {1019-5297},
mesh = {Aged ; *Cholecystectomy ; Diverticulum/diagnostic imaging/*etiology/surgery ; Female ; Humans ; Intestinal Diseases/diagnostic imaging/*etiology/surgery ; Male ; *Postoperative Complications ; Radiography ; },
abstract = {The presented observations of the development of diverticula and further progression of diverticulosis of digestive system give an evidence and prove up the interconnection between neurohumaral regulation of gall-bladder functions and intestine.},
}
@article {pmid15717096,
year = {2005},
author = {Lima, MA and Barbosa, AL and Santos, VM and Misiara, FP},
title = {Intestinal spirochetosis and colon diverticulosis.},
journal = {Revista da Sociedade Brasileira de Medicina Tropical},
volume = {38},
number = {1},
pages = {56-57},
doi = {10.1590/s0037-86822005000100011},
pmid = {15717096},
issn = {0037-8682},
mesh = {Anti-Bacterial Agents/therapeutic use ; Diverticulosis, Colonic/*complications/diagnosis/drug therapy ; Gastrointestinal Hemorrhage/*etiology ; HIV Infections/complications ; Humans ; Intestinal Mucosa/microbiology/pathology ; Male ; Middle Aged ; Penicillin G/therapeutic use ; Spirochaetales/isolation & purification ; Spirochaetales Infections/*complications/diagnosis/drug therapy ; },
abstract = {A case of intestinal spirochetosis in a 62-year-old white male is reported. The condition was characterized by chronic flatulence and episodes of intestinal hemorrhage, in addition to the evidence of hypotonic diverticular disease, with a large number of slender organisms in the colon epithelium and cryptae. Spirochetes were demonstrated by Whartin-Starry stain. The serologic tests for syphilis and HIV were positive. Spirochetosis was treated with penicillin G, and the patient remains free of intestinal complaints 20 months later.},
}
@article {pmid15709884,
year = {2005},
author = {Tursi, A},
title = {Mesalazine for diverticular disease of the colon--a new role for an old drug.},
journal = {Expert opinion on pharmacotherapy},
volume = {6},
number = {1},
pages = {69-74},
doi = {10.1517/14656566.6.1.69},
pmid = {15709884},
issn = {1744-7666},
mesh = {Animals ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Diverticulitis, Colonic/*drug therapy/microbiology ; Drug Therapy, Combination ; Humans ; Mesalamine/*therapeutic use ; Rifamycins/therapeutic use ; Rifaximin ; },
abstract = {Colonic diverticulosis is among the most common diseases of developed countries. Its prevalence is approximately 5 - 10% of the population by age 50, and 30, 50 and 66% of those > 50, > 70 and > 85years of age, respectively. Antibiotics have been successfully used in the treatment of uncomplicated diverticular disease; however, the use of mesalazine (alone or in combination with antibiotics) in treating uncomplicated diverticulitis has been successfully developed in recent years. Indeed, mesalazine (with or without antibiotics) showed significant superiority in improving the severity of symptoms, bowel habits, and in preventing symptomatic recurrence of diverticulitis over antibiotics alone. More-over, in light of some preliminary results, it is probable that the association of mesalazine with probiotics may in the future be the first-choice treatment for mild-to-moderate uncomplicated attacks of acute diverticulitis.},
}
@article {pmid15702597,
year = {2005},
author = {Leitzmann, C},
title = {Vegetarian diets: what are the advantages?.},
journal = {Forum of nutrition},
volume = {},
number = {57},
pages = {147-156},
doi = {10.1159/000083787},
pmid = {15702597},
issn = {1660-0347},
mesh = {*Attitude to Health ; Chronic Disease/therapy ; *Diet, Vegetarian/adverse effects/psychology ; Humans ; Life Expectancy ; Meat/adverse effects ; Nutrition Policy ; Nutritional Requirements ; Nutritional Status ; },
abstract = {A growing body of scientific evidence indicates that wholesome vegetarian diets offer distinct advantages compared to diets containing meat and other foods of animal origin. The benefits arise from lower intakes of saturated fat, cholesterol and animal protein as well as higher intakes of complex carbohydrates, dietary fiber, magnesium, folic acid, vitamin C and E, carotenoids and other phytochemicals. Since vegetarians consume widely divergent diets, a differentiation between various types of vegetarian diets is necessary. Indeed, many contradictions and misunderstandings concerning vegetarianism are due to scientific data from studies without this differentiation. In the past, vegetarian diets have been described as being deficient in several nutrients including protein, iron, zinc, calcium, vitamin B12 and A, n-3 fatty acids and iodine. Numerous studies have demonstrated that the observed deficiencies are usually due to poor meal planning. Well-balanced vegetarian diets are appropriate for all stages of the life cycle, including children, adolescents, pregnant and lactating women, the elderly and competitive athletes. In most cases, vegetarian diets are beneficial in the prevention and treatment of certain diseases, such as cardiovascular disease, hypertension, diabetes, cancer, osteoporosis, renal disease and dementia, as well as diverticular disease, gallstones and rheumatoid arthritis. The reasons for choosing a vegetarian diet often go beyond health and well-being and include among others economical, ecological and social concerns. The influences of these aspects of vegetarian diets are the subject of the new field of nutritional ecology that is concerned with sustainable life styles and human development.},
}
@article {pmid15688797,
year = {2004},
author = {Anton, CR and Balan, G},
title = {[Colonic diverticulosis--current issues in etiopathogenesis, diagnosis and treatment].},
journal = {Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi},
volume = {108},
number = {2},
pages = {269-274},
pmid = {15688797},
issn = {0048-7848},
mesh = {Diagnosis, Differential ; Dietary Fiber/administration & dosage ; *Diverticulosis, Colonic/diagnosis/etiology/therapy ; Humans ; Risk Factors ; },
abstract = {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.},
}
@article {pmid15688763,
year = {2004},
author = {Doboşeru, R and Drug, VL and Azoicăi, D and Mitrica, D and Mihai, C and Taraşi, I and Popa, I and Cijevschi-Prelipcean, C and Stanciu, C},
title = {[The changing spectrum of lower gastrointestinal haemorrhages].},
journal = {Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi},
volume = {108},
number = {1},
pages = {90-93},
pmid = {15688763},
issn = {0048-7848},
mesh = {Adult ; Colitis, Ulcerative/complications ; Colonic Polyps/complications ; Colorectal Neoplasms/*complications ; Crohn Disease/complications ; Female ; Gastrointestinal Hemorrhage/epidemiology/*etiology ; Humans ; Linear Models ; Male ; Middle Aged ; Retrospective Studies ; Romania/epidemiology ; },
abstract = {UNLABELLED: Lower gastrointestinal haemorrhage (LGH) is a frequent reason for medical referral. It has an annual incidence ranging between 17 and 20.5 cases per 100,000 adults and represents 20-30% of all gastrointestinal haemorrhages.
OBJECTIVE: To evaluate the evolution of the etiologic spectrum of lower gastrointestinal bleeding.
METHODS: All the files of patients with lower gastrointestinal bleeding admitted in our unit between 1990 and 2001 were reviewed retrospectively. The annual admission and annual admission rates for each disease (disease/total LGH in a specific year) were analysed using linear regression.
RESULTS: We identified 2565 patients with LGH (mean age 50.8+/-8.7 years, 1338 (52%) men and 1227 (48%) women). The annual number of patients had a linear increase (p<0.05) from 103 in 1990 to 399 in 2001. The mean age of the patients increased linearly from 48.5 to 53 years (p<0.05). The annual rate for some specific diseases has changed over time. There was a trend of increase for the colorectal cancer and polyps, which reach statistical significance for diverticular disease and haemorrhoids (p<0.05). While the annual incidence for ulcerative colitis remained constant the annual rates decrease. For Crohn disease, angiodysplasia and radiation colitis no changes was found.},
}
@article {pmid15685694,
year = {2005},
author = {Janes, S and Meagher, A and Frizelle, FA},
title = {Elective surgery after acute diverticulitis.},
journal = {The British journal of surgery},
volume = {92},
number = {2},
pages = {133-142},
doi = {10.1002/bjs.4873},
pmid = {15685694},
issn = {0007-1323},
mesh = {Acute Disease ; Adult ; Diverticulitis, Colonic/complications/pathology/*surgery ; Elective Surgical Procedures/*methods ; Follow-Up Studies ; Humans ; Intestinal Perforation/etiology/pathology/surgery ; Irritable Bowel Syndrome/complications/pathology ; Middle Aged ; Postoperative Complications/etiology ; Prognosis ; Recurrence ; Reoperation/methods ; Risk Factors ; },
abstract = {BACKGROUND: Diverticulitis is a common condition. Practice guidelines from many organizations recommend bowel resection after two attacks. The evidence for such a recommendation is reviewed.
METHODS: A Medline literature search was performed to locate English language articles on surgery for diverticular disease. Further articles were obtained from the references cited in the literature initially reviewed.
RESULTS: Most people with diverticulosis are asymptomatic. Diverticular disease occurs in over 25 per cent of the population, increasing with age. After one episode of diverticulitis one-third of patients have recurrent symptoms; after a second episode a further third have a subsequent episode. Perforation is commonest during the first episode of acute diverticulitis. After recovering from an episode of diverticulitis the risk of an individual requiring an urgent Hartmann's procedure is one in 2000 patient-years of follow-up. Surgery for diverticular disease has a high complication rate and 25 per cent of patients have ongoing symptoms after bowel resection.
CONCLUSION: There is no evidence to support the idea that elective surgery should follow two attacks of diverticulitis. Further prospective trials are required.},
}
@article {pmid15678324,
year = {2006},
author = {Claassen, AT and Mourad-Baars, PE and Mearin, ML and Hilhorst-Hofstee, Y and Gerritsen van der Hoop, A},
title = {Two siblings below the age of 20 years with diverticular disease.},
journal = {International journal of colorectal disease},
volume = {21},
number = {2},
pages = {190-191},
pmid = {15678324},
issn = {0179-1958},
mesh = {Adolescent ; Biopsy ; Diagnosis, Differential ; Diverticulum, Colon/*diagnosis ; Female ; Humans ; Male ; *Siblings ; Sigmoid Diseases/*diagnosis ; Sigmoidoscopy ; Tomography, X-Ray Computed ; },
}
@article {pmid15652022,
year = {2004},
author = {Simpson, J and Spiller, R},
title = {Colonic diverticular disease.},
journal = {Clinical evidence},
volume = {},
number = {11},
pages = {552-561},
pmid = {15652022},
issn = {1462-3846},
mesh = {Acute Disease ; Anti-Infective Agents/therapeutic use ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/surgery/therapy ; Diverticulum, Colon/*therapy ; Humans ; Mesalamine/therapeutic use ; Rifamycins/therapeutic use ; Rifaximin ; },
}
@article {pmid15630918,
year = {2004},
author = {Steel, M},
title = {Colonic diverticular disease.},
journal = {Australian family physician},
volume = {33},
number = {12},
pages = {983-986},
pmid = {15630918},
issn = {0300-8495},
mesh = {Anti-Bacterial Agents/therapeutic use ; Colorectal Surgery/methods ; Diagnosis, Differential ; Diet Therapy/methods ; Diverticulitis/diagnosis ; Diverticulitis, Colonic/*diagnosis/physiopathology/*therapy ; Family Practice/*methods ; Humans ; Irritable Bowel Syndrome/diagnosis ; },
abstract = {BACKGROUND: Diverticular disease of the colon is common and the spectrum is broad, ranging from asymptomatic diverticulosis to perforation and massive haemorrhage requiring emergency colectomy.
OBJECTIVE: This article discusses the epidemiology, pathophysiology, symptomatology and management of common presentations of diverticular disease including a brief review of surgical management.
DISCUSSION: Management is based on the patient's symptoms and signs with assistance from findings at colonoscopy, computerised tomography scanning and occasionally bleeding localisation studies. For minimally symptomatic patients, a high fibre diet is the mainstay of management. Those with diverticulitis require antibiotics and bowel rest, and hospitalisation may be required. Surgery is indicated for recurrent diverticulitis, complicated diverticulitis, perforation and severe bleeding. This involves resection of the affected colon segment and can be performed laparoscopically or open.},
}
@article {pmid15624024,
year = {2004},
author = {Blachut, K and Paradowski, L and Garcarek, J},
title = {Prevalence and distribution of the colonic diverticulosis. Review of 417 cases from Lower Silesia in Poland.},
journal = {Romanian journal of gastroenterology},
volume = {13},
number = {4},
pages = {281-285},
pmid = {15624024},
issn = {1221-4167},
mesh = {Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*epidemiology/pathology ; Female ; Humans ; Male ; Middle Aged ; Poland/epidemiology ; Prevalence ; Retrospective Studies ; Sex Distribution ; },
abstract = {BACKGROUND: The prevalence of colonic diverticulosis increases with age and is the most common pathology of the large bowel in the elderly. Studies of the frequency of colon diverticulosis are performed in necroptic, radiological and endoscopic surveys.
AIM: The assessment of the prevalence and distribution of colonic diverticulosis evaluated with barium enemas.
MATERIAL AND METHODS: 1,912 consecutive barium enemas examinations, performed between 1999-2002 were reviewed. The patients were 1,228 females and 684 males (mean age 55.4 yrs).
RESULTS: Diverticula were observed in 21.7 percent (417) of the patients (279 females /mean age 64.1/ and 138 males /mean age 64.5 yrs). The prevalence of diverticulosis among females was 22.7 percent and among males 20.2 percent. The frequency of diverticulosis in patients aged 30-39 years was 5.3 percent, 40-49 years - 8.7 percent, 50-59 years - 19.4 percent, 60-69 years - 29.6 percent, 70-79 years - 40.2 per cent, and in those aged over 80 years it was 57.9 percent.
CONCLUSIONS: Diverticular disease of the colon is a significant problem in elderly patients, both females and males. The most common occurrence is in the sigmoid and descending colon.},
}
@article {pmid15622581,
year = {2004},
author = {Scheidbach, H and Schneider, C and Rose, J and Konradt, J and Gross, E and Bärlehner, E and Pross, M and Schmidt, U and Köckerling, F and Lippert, H},
title = {Laparoscopic approach to treatment of sigmoid diverticulitis: changes in the spectrum of indications and results of a prospective, multicenter study on 1,545 patients.},
journal = {Diseases of the colon and rectum},
volume = {47},
number = {11},
pages = {1883-1888},
doi = {10.1007/s10350-004-0715-8},
pmid = {15622581},
issn = {0012-3706},
mesh = {Anastomosis, Surgical ; Chi-Square Distribution ; Diverticulitis/mortality/*surgery ; Female ; Humans ; Intraoperative Complications ; Laparoscopy/*methods ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Sigmoid Diseases/mortality/*surgery ; },
abstract = {BACKGROUND: The aim of the present study was to analyze changes regarding the indications for and results of laparoscopic treatment of sigmoid diverticulitis.
METHODS: The data were collected within the framework of an ongoing prospective multicenter study carried out by the Lapa roscopic Colorectal Surgery Study Group and were submitted to a statistical subgroup analysis. The institutions participating in the study were divided into three groups by experience (Group I, >100 procedures; Group II, 30-100 procedures; Group III, < 30 procedures).
RESULTS: Among the 3,868 recruited patients, sigmoid diverticulitis (n = 1,545, 40 percent) was by far the most common indication for surgery, and sigmoid resection (n = 2,160, 55.9 percent) was by far the most common laparoscopic procedure. A total of 1,353 patients (87.6 percent) had uncomplicated diverticulitis, whereas 192 (12.4 percent) had a complicated form of diverticular disease (Hinchey I-IV, diverticular bleeding, fistula formation). Cases of complicated diverticulitis were significantly more frequently operated on at institutions with greater experience (Group I, 20.8 percent; Group II, 8.7 percent; Group III, 7.9 percent). Despite this fact, these institutions still had better intraoperative complication rates (Group I, 5.0 percent; Group II, 5.8 percent; Group III, 6.9 percent), conversion rates (Group I, 4.4 percent; Group II, 6.7 percent; Group III, 7.7 percent), and postoperative morbidity (Group I, 15.9 percent; Group II, 16.6 percent; Group III, 18.6 percent) and mortality (Group I, 0.2 percent; Group II, 0.5 percent; Group III, 0.4 percent) rates.
CONCLUSION: An increase in experience is associated with an expansion of laparoscopic indications to include complicated forms of diverticulitis, with comparable ntraoperative and postoperative complication rates, operating time, and mortality rates.},
}
@article {pmid15619525,
year = {2005},
author = {Senagore, AJ},
title = {Laparoscopic sigmoid colectomy for diverticular disease.},
journal = {The Surgical clinics of North America},
volume = {85},
number = {1},
pages = {19-24, vii},
doi = {10.1016/j.suc.2004.09.007},
pmid = {15619525},
issn = {0039-6109},
mesh = {Colectomy/*methods ; Colon, Sigmoid/*surgery ; Diverticulosis, Colonic/*surgery ; Humans ; *Laparoscopy ; },
abstract = {Laparoscopic management of sigmoid diverticular disease has emerged as an important adjunct to the armamentarium of surgical options for this disease process. Although there are no prospective randomized studies directly comparing laparoscopic and open colectomy for diverticulitis, the comparative studies provide compelling data. The magnitude of benefits achieved with laparoscopic colectomy in the hands of experienced laparoscopic colon surgeons may soon be sufficient to make laparoscopic colectomy the standard of care.},
}
@article {pmid15616751,
year = {2005},
author = {Bartus, CM and Lipof, T and Sarwar, CM and Vignati, PV and Johnson, KH and Sardella, WV and Cohen, JL},
title = {Colovesical fistula: not a contraindication to elective laparoscopic colectomy.},
journal = {Diseases of the colon and rectum},
volume = {48},
number = {2},
pages = {233-236},
doi = {10.1007/s10350-004-0849-8},
pmid = {15616751},
issn = {0012-3706},
mesh = {Aged ; Chi-Square Distribution ; Colectomy/*methods ; Contraindications ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Intestinal Fistula/*surgery ; *Laparoscopy ; Male ; Middle Aged ; Postoperative Complications ; Recurrence ; Treatment Outcome ; },
abstract = {PURPOSE: Traditionally, diverticular fistula was thought to be a contraindication for laparoscopic colectomy. The advent of hand-assisted laparoscopy has allowed repair of a diverticular fistula to be technically feasible laparoscopically. We present our experience with laparoscopic colectomy in patients with diverticular fistulas.
METHODS: Patients with colovesical or colovaginal fistulas secondary to diverticular disease were consecutively entered into a database over a five-year period. All operations were electively performed by a single group of colorectal surgeons. Patient demographics, American Society of Anesthesiologists classification, type of surgery, operating time, hospital length of stay, and early and late complications were recovered by chart review. These results were then compared to results from a group of patients who had undergone elective laparoscopic colectomy for recurrent diverticulitis during the same period by the same group of surgeons.
RESULTS: Altogether, 40 consecutive operations for diverticular fistulas were performed, 36 of which were started laparoscopically (90 percent). The average patient age was 65 years and the average American Society of Anesthesiologists class was 2. Patient demographics were similar among the group with recurrent diverticulitis (n = 149). The average hospital stay was 6.2 days for the fistula group and 4.4 days in the recurrent diverticulitis group. The average operating time was 220 minutes for the fistula group vs. 176 minutes for the uncomplicated group (P < 0.002). The conversion rate was significantly higher in the fistula group (25 percent vs. 5 percent, P < 0.001). There were no postoperative anastomotic leaks or bleeding episodes requiring reoperation in the fistula group.
CONCLUSIONS: Diverticular fistula should no longer be considered a contraindication for laparoscopic colectomy. These cases are more complex, as evidenced by the longer operating times and higher conversion rates when compared with resections for uncomplicated recurrent diverticulitis. Although the length of hospital stay was longer for patients who underwent laparoscopic colectomy for diverticular fistula, those whose operations were completed laparoscopically had the same outcome as patients with uncomplicated disease. We anticipate that minimally invasive surgery will become the standard of care for colovesical fistula, as it now is for uncomplicated diverticular disease.},
}
@article {pmid15593468,
year = {2004},
author = {Bannura, GC and Cumsille, MA and Barrera, AE and Contreras, JP and Melo, CL and Soto, DC},
title = {Predictive factors of stenosis after stapled colorectal anastomosis: prospective analysis of 179 consecutive patients.},
journal = {World journal of surgery},
volume = {28},
number = {9},
pages = {921-925},
pmid = {15593468},
issn = {0364-2313},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Colon/*surgery ; Constriction, Pathologic/epidemiology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications/*epidemiology ; Prognosis ; Prospective Studies ; Rectum/*surgery ; *Surgical Stapling ; },
abstract = {The incidence, risk factors, and clinical relevance of stenosis of stapled colorectal anastomosis (CRA) were studied prospectively. Anastomotic stricture was defined as the inability of traversing the anastomosis with the rigid proctoscope. The population studied consisted of 179 patients (94 males) with an average age of 59.3 years (range: 20 to 91 years). The main indication for surgery was colorectal cancer in 59% of the cases, followed by diverticular disease in 23%. The first endoscopic control was performed before 4 months in 25% of the patients, between 5 and 10 months in 50%, and during the following 10 months in 25%. Stenosis was verified with the rigid instrument in 21.1% of the cases and with the flexible colonoscope in 4.4%. The barium enema performed in 12 cases confirmed a punctiform stenosis in 5 patients, 4 of whom had been asymptomatic. An endoscopic dilatation was performed on 5 of the 8 symptomatic patients, with one relapse that required an additional dilatation. In the univariate analysis only the lesser 4-month interval was statistically significant (p = 0.033; odds ratio (OR) = 2.3; confidence interval (CI) 95% = 1.06 to 4.97). Male patients (p = 0.057; OR = 2.08; IC 95% = 0.97-4.44) show a tendency to CRA stricture that does not reach statistically significant levels. In the multivariate analysis, only sex (p = 0.04; OR = 4.11; IC 95% = 1.03 to 5.41) and the time interval (p = 0.012; OR = 2.87; IC 95% = 1.25 to 6.57) appear as independent variables in stenosis risk of a stapled CRA. The incidence of this complication depends on the criteria used for defining it. It is clinically relevant in no more than 5% of the patients. Five out of eight patients in category II were treated successfully with an endoscopic dilatation, while the other three improved spontaneously. Early stenosis, although frequent, is generally asymptomatic and disappears spontaneously. Considering the lack of correlation between the degree of stricture and its symptomatology, it is convenient to combine both the anatomic and the clinical criteria in the selection of candidates for an eventual therapeutic procedure.},
}
@article {pmid15578538,
year = {2004},
author = {Tursi, A},
title = {Preventive therapy for complicated diverticular disease of the colon: looking for a correct therapeutic approach.},
journal = {Gastroenterology},
volume = {127},
number = {6},
pages = {1865-1866},
doi = {10.1053/j.gastro.2004.10.030},
pmid = {15578538},
issn = {0016-5085},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Calcium Channel Blockers/adverse effects/*therapeutic use ; Diverticulitis, Colonic/drug therapy/*prevention & control ; Humans ; Inflammation ; Intestinal Perforation/etiology/*prevention & control ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; Recurrence ; },
}
@article {pmid15578077,
year = {2005},
author = {Nascimbeni, R and Di Fabio, F and Di Betta, E and Mariani, P and Fisogni, S and Villanacci, V},
title = {Morphology of colorectal lymphoid aggregates in cancer, diverticular and inflammatory bowel diseases.},
journal = {Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc},
volume = {18},
number = {5},
pages = {681-685},
doi = {10.1038/modpathol.3800343},
pmid = {15578077},
issn = {0893-3952},
mesh = {Acetic Acid ; Adult ; Aged ; Aged, 80 and over ; Antigens, CD20/analysis ; CD3 Complex/analysis ; Colitis, Ulcerative/metabolism/pathology ; Colorectal Neoplasms/metabolism/*pathology ; Crohn Disease/metabolism/pathology ; Diverticulum, Colon/metabolism/*pathology ; Female ; Histocytochemistry/methods ; Humans ; Immunohistochemistry ; Inflammatory Bowel Diseases/metabolism/*pathology ; Ki-67 Antigen/analysis ; Male ; Middle Aged ; Peyer's Patches/chemistry/*pathology ; },
abstract = {The present study compares the characteristics of colorectal lymphoid aggregates in patients with carcinoma, diverticular disease, Crohn's disease, or ulcerative colitis of the large bowel. A total of 77 patients (41 colorectal cancer, 27 diverticular disease, six ulcerative colitis, three Crohn's disease) undergoing colorectal resection were included. Acetic acid staining, hematoxylin and eosin staining, CD3, CD20, and MIB1 immunostaining were employed in order to assess density, diameter, subepithelial or basal location, cellular profile, and proliferation of lymphoid aggregates in normal-appearing and actively inflamed large bowel. In normal-appearing tissue, mean density of lymphoid aggregates was lower in patients with ulcerative colitis and Crohn's disease than in those with colorectal cancer or diverticular disease. A larger mean diameter of aggregates was observed in patients with Crohn's disease. In inflammatory bowel diseases, a marked increase of the mean density of lymphoid aggregates was observed in actively affected specimens. In Crohn's disease more than in ulcerative colitis, the aggregates had a predominant basal or transmural distribution. In diverticular disease, active inflammation determined a less significant increase of subepithelial aggregates harboring a lower proportion of germinal centers. No significant variations of CD3, CD20, and MIB1 were recorded among the four disease groups. The lymphoid aggregate derangements observed not only in the actively affected mucosa but also in the unaffected colorectal lining of patients with Crohn's disease and ulcerative colitis support a relevant involvement of lymphoid aggregate system in the pathogenesis of inflammatory bowel diseases.},
}
@article {pmid15570758,
year = {2003},
author = {Singh-Ranger, D},
title = {Re: "The role of elective colectomy for diverticular disease" by Somesakar et al J R Coll Edinb 2002; 47:2.},
journal = {The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland},
volume = {1},
number = {3},
pages = {182-3; author reply 183},
doi = {10.1016/s1479-666x(03)80108-7},
pmid = {15570758},
issn = {1479-666X},
mesh = {Age Factors ; *Colectomy ; Comorbidity ; Diverticulitis, Colonic/*surgery ; *Elective Surgical Procedures ; *Guideline Adherence ; Humans ; Immunocompromised Host ; Patient Selection ; Prognosis ; Treatment Outcome ; },
}
@article {pmid15564807,
year = {2004},
author = {Yoon, YS and Park, IJ and Lee, KH and Kim, HC and Yu, CS and Kim, JC},
title = {[Should small bowel diverticula be removed?].},
journal = {The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi},
volume = {44},
number = {5},
pages = {275-279},
pmid = {15564807},
issn = {1598-9992},
mesh = {Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Diverticulum/diagnosis/*surgery ; Female ; Humans ; Infant ; Infant, Newborn ; Intestinal Diseases/diagnosis/*surgery ; Intestine, Small/*surgery ; Male ; Middle Aged ; },
abstract = {BACKGROUND/AIMS: Small bowel diverticulum is a rare disease that can be found incidentally during a surgical operation. Since reported complication rate is low, uncomplicated small bowel diverticula are generally recommended to be untreated. The aim of this study was to elucidate clinical features of this disease and to determine whether incidental small bowel diverticula should be removed for cure.
METHODS: We reviewed the medical records of 80 patients with small bowel diverticular disease who underwent operation at Asan Medical Center between July 1989 and March 2003, retrospectively.
RESULTS: Male to female ratio was 61:19, and the mean age was 44 (0-91) years. The most common diverticulum of small bowel is Meckel's diverticulum (63.8%), followed by duodenal diverticulum (15%), jejunal diverticulum (12.5%), and ileal diverticulum (8.7%). Of the 80 cases, 43 (53.7%) were symptomatic, and 37 (46.3%) were incidental. In the symptomatic patients, the most frequent symptom was abdominal pain (58.1%), followed by bleeding (44.2%). As for the treatments, segmental resection (53.7%) was performed more commonly than diverticulectomy (43.8%) in the symptomatic patients. Postoperative complications occurred more commonly in the symptomatic patients (25.6%) than the incidental patients (8.1%). Duodenal diverticula had a high morbidity and mortality rate.
CONCLUSIONS: We should consider the diverticular disease of small bowel in patients with unexplained abdominal pain or gastrointestinal bleeding. As most small bowel diverticula, except for duodenal diverticula, are found incidentally and easily removed without postoperative morbidity or mortality, surgical resection appears to be recommended for the purpose of accurate diagnosis and treatment.},
}
@article {pmid15555974,
year = {2004},
author = {Salem, L and Veenstra, DL and Sullivan, SD and Flum, DR},
title = {The timing of elective colectomy in diverticulitis: a decision analysis.},
journal = {Journal of the American College of Surgeons},
volume = {199},
number = {6},
pages = {904-912},
doi = {10.1016/j.jamcollsurg.2004.07.029},
pmid = {15555974},
issn = {1072-7515},
mesh = {Adult ; *Colectomy ; Colostomy ; Cost-Benefit Analysis ; Costs and Cost Analysis ; *Decision Support Techniques ; Diverticulitis/*surgery ; Elective Surgical Procedures ; Humans ; Markov Chains ; Middle Aged ; Recurrence ; Risk ; },
abstract = {BACKGROUND: Determining the optimal strategy for elective colectomy in patients with diverticular disease involves a balance of the morbidity, mortality, costs, and quality of life associated with both elective and expectant management. We used decision and cost analysis to simulate the clinical and economic outcomes after recovery from an episode of nonsurgically treated diverticulitis to determine the preferable management strategy.
STUDY DESIGN: A Markov model was constructed to evaluate lifetime risks of death and colostomy, care costs, and quality of life associated with elective colectomy after subsequent episodes of diverticulitis. The analysis was from the payer's perspective, using hypothetical cohorts of 35- and 50-year-old patients who recovered from a nonsurgically treated diverticulitis episode. Probabilities of clinical events and costs for the base-case analysis were derived from a large cohort using a statewide administrative database and published estimates.
RESULTS: Performing colectomy after the fourth rather than the second episode in patients older than 50 years resulted in 0.5% fewer deaths, 0.7% fewer colostomies, and saved US 1,035 dollars per patient. In younger patients, performing colectomy after the fourth episode compared with the first episode resulted in 0.1% fewer deaths, 2% fewer colostomies, and saved US 5,429 dollars per patient. Expectant management through three recurrent episodes with elective colectomy after the fourth episode was the dominant strategy across the full range of the variables tested in the sensitivity analysis compared with earlier intervention.
CONCLUSIONS: This study suggests that expectant management is associated with lower rates of death and colostomy and is cost-saving for both younger and older patients.},
}
@article {pmid15546583,
year = {2004},
author = {Najjar, SF and Jamal, MK and Savas, JF and Miller, TA},
title = {The spectrum of colovesical fistula and diagnostic paradigm.},
journal = {American journal of surgery},
volume = {188},
number = {5},
pages = {617-621},
doi = {10.1016/j.amjsurg.2004.08.016},
pmid = {15546583},
issn = {0002-9610},
mesh = {Aged ; Aged, 80 and over ; Colonic Diseases/*diagnosis/epidemiology/surgery ; Colonoscopy/methods ; Follow-Up Studies ; Humans ; Intestinal Fistula/*diagnosis/epidemiology/surgery ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment ; Sampling Studies ; Severity of Illness Index ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; Urinary Bladder Fistula/*diagnosis/epidemiology/surgery ; },
abstract = {BACKGROUND: Our experience with colovesical fistula (CVF) over a 12-year period was reviewed to clarify its clinical presentation and diagnostic confirmation.
METHODS: Twelve patients with CVF were identified. Presenting symptoms, etiologic factors, diagnostic investigations, and subsequent treatment were reviewed.
RESULTS: Underlying etiologies were diverticular disease (75%), colon cancer (16%), and bladder cancer (8%). Pneumaturia (77%) was the most common presentation, followed by urinary tract infections, dysuria and frequency (45%), fecaluria (36%), hematuria (22%), and orchitis (10%). The ability of various preoperative investigations to identify a CVF were: computed tomography (CT) (90%), barium enema (BE) (20%), and cystography (11%), whereas cystoscopy, intravenous pyelogram (IVP), and colonoscopy were nondiagnostic. All patients underwent single- or multiple-staged repair of the fistula.
CONCLUSIONS: In patients with a suspected CVF, we recommend CT followed by a colonoscopy as a first-line investigation to rule out malignancy as a cause of CVF. Other modalities should only be used if the diagnosis is in doubt or additional information is needed to plan operative management.},
}
@article {pmid15545570,
year = {2004},
author = {Chandra, V and Nelson, H and Larson, DR and Harrington, JR},
title = {Impact of primary resection on the outcome of patients with perforated diverticulitis.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {139},
number = {11},
pages = {1221-1224},
doi = {10.1001/archsurg.139.11.1221},
pmid = {15545570},
issn = {0004-0010},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/mortality ; Diverticulitis/complications/*mortality/*surgery ; Diverticulum, Colon/complications/*mortality/*surgery ; Female ; Humans ; Intestinal Perforation/etiology/*mortality/*surgery ; Male ; Middle Aged ; Peritonitis/etiology/mortality/surgery ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Primary resection has replaced the conventional drainage procedure in the management of patients with generalized peritonitis complicating diverticular disease of the colon. This study investigates the impact of primary resection on operative mortality, identifies predictors of mortality, and compares the results with those of our earlier experience.
HYPOTHESIS: Primary resection of the perforated diseased segment of the colon is associated with lower mortality rates than the drainage procedure in patients with Hinchey stages 3 and 4 diverticulitis.
DESIGN: Retrospective analysis.
SETTING: Tertiary care referral center.
PATIENTS: We included 138 consecutive patients who underwent emergent operation for generalized peritonitis complicating diverticular disease of the colon (Hinchey stages 3 and 4) during a period of 16 years (January 1983 to May 1999).
MAIN OUTCOME MEASURES: The 30-day mortality rate was analyzed and predictors of mortality identified.
RESULTS: Patients were classified as having spreading purulent peritonitis (n = 44, 31.9%), diffuse peritonitis (n = 64, 46.4%), or fecal peritonitis (n = 30, 21.7%). One hundred thirty-one patients (94.9%) underwent primary resection, 6 patients (4.3%) underwent resection and primary anastomosis, and 1 patient required total colectomy and end ileostomy. Thirteen of the 138 patients in the present group died (1983-1998), representing a perioperative mortality rate of 9%. There was no significant difference in mortality when compared with our earlier study (1972-1982), which had a mortality rate of 12%, considering that more than 25% of the patients in that group were managed by colostomy and drainage alone. Factors identified univariately as predictors of mortality were age of more than 70 years (P = .047), 2 or more comorbid conditions (P<.01), obstipation at initial examination (P = .02), use of steroids (P = .01), and perioperative sepsis (P<.001).
CONCLUSIONS: Primary resection has become the standard practice for patients with generalized peritonitis complicating diverticulitis. Mortality rates have not significantly declined despite more aggressive surgical management of the septic source. Because advanced age, comorbid conditions, and perioperative sepsis predict mortality, it is suggested that further reduction in mortality will require improvement in medical management of perioperative sepsis and comorbid conditions.},
}
@article {pmid15540299,
year = {2004},
author = {Casillas, S and Delaney, CP and Senagore, AJ and Brady, K and Fazio, VW},
title = {Does conversion of a laparoscopic colectomy adversely affect patient outcome?.},
journal = {Diseases of the colon and rectum},
volume = {47},
number = {10},
pages = {1680-1685},
doi = {10.1007/s10350-004-0692-4},
pmid = {15540299},
issn = {0012-3706},
mesh = {Adult ; Aged ; Case-Control Studies ; Colectomy/*adverse effects/*methods ; Colorectal Neoplasms/*surgery ; Female ; Health Care Costs ; Humans ; *Laparoscopy ; Laparotomy ; Length of Stay ; Male ; Middle Aged ; Morbidity ; Mortality ; Patient Selection ; *Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; },
abstract = {PURPOSE: Conversion during laparoscopic colectomy varies in frequency according to the surgeon's experience and case selection. However, there remains concern that conversion is associated with increased morbidity and higher hospital costs.
METHODS: From January 1999 to August 2002, 430 laparoscopic colectomies were performed by two surgeons, with 51 (12 percent) cases converted to open surgery. Converted cases were matched for operation and age to 51 open cases performed mostly by other colorectal surgeons from our department. Data collected included gender, American Society of Anesthesiology score, operative indication, resection type, operative stage at conversion, in-hospital complications, direct hospital costs, unexpected readmission within 30 days, and mortality.
RESULTS: There were no significant differences between the groups for age (converted, 55 +/- 19; open, 62 +/- 16), male:female ratio (converted, 17:34; open, 23:28), or American Society of Anesthesiology score distribution. Indications for surgery were neoplasia (converted, 16; open, 31); diverticular disease (converted, 21; open, 13); Crohn's disease (converted, 12; open, 5); and other disease (converted, 2; open, 2). Operative times were similar (converted, 150 + 56 minutes; open, 132 +/- 48 minutes). Conversions occurred before defining the major vascular pedicle/ureter (50 percent), in relation to intracorporeal vascular ligation (15 percent), or during bowel transection or presacral dissection (35 percent). Specific indications for conversion were technical (41 percent), followed by adhesions (33 percent), phlegmon or abscess (23 percent), bleeding (6 percent), and failure to identify the ureter (6 percent). Median hospital stay was five days for both groups. In-hospital complications (converted 11.6 percent; open 8 percent), 30-day readmission rate (converted 13 percent vs. open 8 percent), and direct costs were similar between groups. There were no mortalities.
CONCLUSION: Conversion of a laparoscopic colectomy does not result in inappropriately prolonged operative times, increased morbidity or length of stay, increased direct costs, or unexpected readmissions compared with similarly complex laparotomies. A policy of commencing most cases suitable for a laparoscopic approach laparoscopically offers patients the benefits of a laparoscopic colectomy without adversely affecting perioperative risks.},
}
@article {pmid15534874,
year = {2004},
author = {Cherniske, EM and Carpenter, TO and Klaiman, C and Young, E and Bregman, J and Insogna, K and Schultz, RT and Pober, BR},
title = {Multisystem study of 20 older adults with Williams syndrome.},
journal = {American journal of medical genetics. Part A},
volume = {131},
number = {3},
pages = {255-264},
doi = {10.1002/ajmg.a.30400},
pmid = {15534874},
issn = {1552-4825},
support = {M01-RR06022/RR/NCRR NIH HHS/United States ; P01 HD/DC35482/HD/NICHD NIH HHS/United States ; },
mesh = {Adult ; Bone Density ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Williams Syndrome/*physiopathology ; },
abstract = {To address the natural history of Williams syndrome (WS), we performed multisystem assessments on 20 adults with WS over 30 years of age and documented a high frequency of problems in multiple organ systems. The most striking and consistent findings were: abnormal body habitus; mild-moderate high frequency sensorineural hearing loss; cardiovascular disease and hypertension; gastrointestinal symptoms including diverticular disease; diabetes and abnormal glucose tolerance on standard oral glucose tolerance testing; subclinical hypothyroidism; decreased bone mineral density on DEXA scanning; and a high frequency of psychiatric symptoms, most notably anxiety, often requiring multimodal therapy. Review of brain MRI scans did not demonstrate consistent pathology. The adults in our cohort were not living independently and the vast majority were not competitively employed. Our preliminary findings raise concern about the occurrence of mild accelerated aging, which may additionally complicate the long-term natural history of older adults with WS. We provide monitoring guidelines to assist in the comprehensive care of adults with WS.},
}
@article {pmid15532807,
year = {2004},
author = {Agnifili, A and Schietroma, M and Carloni, A and Mattucci, S and Caterino, G and Lygidakis, NJ and Carlei, F},
title = {The value of omentoplasty in protecting colorectal anastomosis from leakage. A prospective randomized study in 126 patients.},
journal = {Hepato-gastroenterology},
volume = {51},
number = {60},
pages = {1694-1697},
pmid = {15532807},
issn = {0172-6390},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/*methods ; Colectomy/*adverse effects/methods ; Colorectal Neoplasms/diagnosis/*surgery ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Middle Aged ; Omentum/*surgery ; Postoperative Complications/prevention & control ; Probability ; Prospective Studies ; Reference Values ; Risk Assessment ; Surgical Flaps ; Surgical Wound Dehiscence/*prevention & control ; Treatment Outcome ; },
abstract = {BACKGROUND/AIMS: Anastomotic leakage is a major cause of mortality in colorectal surgery. Several methods have been evaluated in order to prevent anastomotic leakage. To decrease the rate and severity of anastomotic leakage, omentoplasty (OP) has been proposed by several authors on the basis of experimental and clinical studies. A prospective, randomized trial was designed to study the influence of omentoplasty on anastomotic leakage after colorectal resection.
METHODOLOGY: One hundred and twenty-six patients undergoing elective or emergency surgery for malignancy, benign tumor, diverticular disease and other were randomly assigned to omentoplasty (OP group) or not (NO group). The primary end point was the rate of clinical and radiological anastomotic leakage. Both groups were comparable in terms of demographic data, preoperative characteristics and intraoperative findings.
RESULTS: Eighteen patients (14.3%) had anastomotic leakage, 4 (6.4%) in the OP group and 14 (21.9%) in the NO group. Significant differences (P<0.05) between the two groups were also found in terms of repeat operation (3.2% vs. 14.1%) and deaths (3.2 vs. 7.8%). Other factors associated with anastomotic leakage were the distal site of anastomosis (<5 cm from anal verge) and the emergency.
CONCLUSIONS: Omental wrap, with its mechanical and biological properties, seems to be effective in lowering the rate and the severity of anastomotic leakage after colorectal surgery.},
}
@article {pmid15513381,
year = {2004},
author = {Koskela, RM and Niemelä, SE and Karttunen, TJ and Lehtola, JK},
title = {Clinical characteristics of collagenous and lymphocytic colitis.},
journal = {Scandinavian journal of gastroenterology},
volume = {39},
number = {9},
pages = {837-845},
doi = {10.1080/00365520410006468},
pmid = {15513381},
issn = {0036-5521},
mesh = {Age Distribution ; Biopsy, Needle ; Blood Chemical Analysis ; Case-Control Studies ; Colitis, Collagenous/*epidemiology/*pathology ; Colitis, Lymphocytic/*epidemiology/*pathology ; Colonoscopy ; Female ; Humans ; Immunohistochemistry ; Incidence ; Male ; Probability ; Prognosis ; Reference Values ; Registries ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Sex Distribution ; Statistics, Nonparametric ; },
abstract = {BACKGROUND: Microscopic colitides (MC), collagenous colitis (CC) and lymphocytic colitis (LC) share clinical features, but their mutual relationship is unclear, and clinical comparative studies are rare. We aimed to examine the clinical features in CC and LC by focusing on concomitant diseases.
METHODS: Patients with MC (30 with CC, 54 with LC) were identified in the pathology databases and by reviewing biopsies. Controls included 84 age- and sex-matched persons. The clinical data collected from patient records were prospectively completed by interviews.
RESULTS: The female:male ratio was 2:1 in CC and 5.75:1 in LC. Mean age at diagnosis was 53 in CC and 55.4 years in LC. There were no differences in the pattern of symptoms. Concomitant autoimmune diseases were more common in CC (53.3%) than in LC (25.9%; P = 0.017). Celiac disease was common in both CC (20%) and LC (14.8%). Bronchial asthma was associated with LC (25.9%), but not with CC (6.7%; P = 0.042). Colon diverticulosis was rare in MC (16%) compared with the controls (39%; P = 0.001). Hypolactasia was common in MC (45%; 76% in CC, 54% in LC) compared to its prevalence in the Finnish general population (17%).
CONCLUSIONS: CC and LC are largely similar clinically, but the differences in the occurrence of autoimmune conditions and bronchial asthma suggest that they differ in immunopathogenesis. MC is associated with reduced lactose tolerance and shows a negative association with diverticular disease, possibly related to the small intestinal pathology and abnormal stool consistency.},
}
@article {pmid15513359,
year = {2004},
author = {Stefánsson, T and Ekbom, A and Sparèn, P and Påhlman, L},
title = {Association between sigmoid diverticulitis and left-sided colon cancer: a nested, population-based, case control study.},
journal = {Scandinavian journal of gastroenterology},
volume = {39},
number = {8},
pages = {743-747},
doi = {10.1080/00365520410003272},
pmid = {15513359},
issn = {0036-5521},
mesh = {Aged ; Case-Control Studies ; Colonic Neoplasms/*etiology ; Diverticulitis/*complications/diagnosis ; Diverticulum/complications ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Sigmoid Diseases/*complications/diagnosis ; },
abstract = {BACKGROUND: An increased risk of left-sided colon cancer in patients with diverticular disease of the sigmoid colon has been reported. The aim of this study was to investigate to what extent patients with diverticulitis of the sigmoid colon differ in long-term risk of colon cancer compared to patients with diverticulosis of the colon without any clinical signs of diverticulitis.
METHODS: A total of 7159 patients (2478 M, 4681 F) discharged with a diagnosis of diverticulosis or diverticulitis in 1965-83 in the Uppsala Health Care Region were followed-up with the Swedish Cancer Registry. Sixty-four cases with colon cancer were identified and compared with 123 controls without cancer matched for sex, age and year of first discharge. Based on information from the patients' charts, an independent observer blinded to the outcome assigned a clinical diagnosis of diverticulitis or not diverticulitis to cases and controls.
RESULTS: In patients classified as having sigmoid diverticulitis there was an increased risk of left-sided colon cancer compared with patients with diverticulosis without any clinical signs of diverticulitis (odds ratio = 4.2, 95% CI 1.3-13.0) which remained after mutually adjusting for several clinical parameters in a multivariate conditional logistic regression analysis.
CONCLUSION: The results of the study indicate a causal association between sigmoid diverticulitis and a long-term increased risk of left-sided colon cancer.},
}
@article {pmid15492564,
year = {2004},
author = {Lynch, AC and Delaney, CP and Senagore, AJ and Connor, JT and Remzi, FH and Fazio, VW},
title = {Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery.},
journal = {Annals of surgery},
volume = {240},
number = {5},
pages = {825-831},
pmid = {15492564},
issn = {0003-4932},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cutaneous Fistula/etiology/*surgery ; Female ; Humans ; Intestinal Fistula/etiology/*surgery ; Male ; Middle Aged ; Recurrence ; },
abstract = {OBJECTIVE: Recent experience with surgery for enterocutaneous fistulae (ECF) at a specialist colorectal unit is reviewed to define factors relating to a successful surgical outcome.
SUMMARY BACKGROUND DATA: ECF cause significant morbidity and mortality and need experienced surgical management. Previous publications have concentrated on mortality resulting from fistulae, while factors affecting recurrence have not previously been a focus of analysis.
METHODS: Records were reviewed of patients who had ECF surgery (1994-2001). Management strategy involved early drainage of sepsis and nutritional support prior to elective ECF repair, with selective defunctioning proximal stoma formation.
RESULTS: A total of 205 patients were available (89 males, 43%; median age, 51 years; range, 16-86) years). ECF were related to Crohn's disease in 95, ulcerative colitis in 18, diverticular disease in 17, carcinoma in 25 (16 after radiotherapy), mesh ventral hernia repair in 21, and other causes in 29. Forty-one (20%) had undergone attempted fistula repair at other institutions. Initial management included CT-guided drainage of an intra-abdominal abscess in 23 patients, and total parenteral nutrition in 74 (36%). A total of 203 patients had definitive ECF repair. Forty-four had oversewing or wedge resection of the fistula, and 159 had resection and reanastomosis of the involved small bowel segment or ileocolic anastomosis. Ninety-day operative mortality was 3.5%. A total of 42 (20.5%) patients developed ECF recurrence within 3 months. Multivariate analysis demonstrated that recurrence was more likely after oversewing (36%) than resection (16%, P = 0.006).
CONCLUSIONS: A strategy of drainage of acute sepsis, maintenance of nutritional support prior to surgery, and selective use of PS allows for primary closure in 80% of complicated ECF. Resection should be performed when feasible.},
}
@article {pmid15486746,
year = {2004},
author = {Greenspon, J and Williams, SB and Young, HA and Orkin, BA},
title = {Thrombosed external hemorrhoids: outcome after conservative or surgical management.},
journal = {Diseases of the colon and rectum},
volume = {47},
number = {9},
pages = {1493-1498},
doi = {10.1007/s10350-004-0607-y},
pmid = {15486746},
issn = {0012-3706},
mesh = {Adult ; Female ; Follow-Up Studies ; Hemorrhoids/*complications/*surgery ; Humans ; Incidence ; Male ; Recurrence ; Regression Analysis ; Risk Factors ; Survival Analysis ; Thrombosis/*etiology/*surgery ; },
abstract = {PURPOSE: Few data exist on the actual recurrence rates of thrombosed external hemorrhoids. We wished to determine the incidence of recurrence, intervals to recurrence, and factors predicting recurrence of thrombosed external hemorrhoids after conservative or surgical management.
METHODS: Two hundred and thirty-one consecutive patients with thrombosed external hemorrhoids treated from 1990 to 2002 were identified. Recurrence was defined as complete resolution of the index lesion with subsequent return of a thrombosed external hemorrhoid and did not include patients with chronic symptoms. Data were gathered retrospectively. Multiple potential risk factors were reviewed.
RESULTS: The index thrombosed external hemorrhoid was managed conservatively in 51.5 percent of cases and surgically in 48.5 percent. There were no differences between groups in gender, age, or race, and 44.5 percent of all patients had a prior history of thrombosed external hemorrhoid. A prior history was less common in the conservative group than in the surgical group (38.1 percent vs. 51.3 percent; P < 0.05). The frequency of pain or bleeding as the primary complaint was higher in the surgical group (P < 0.001 and P < 0.002). In addition, the surgical group was more likely to report all three symptoms of pain, bleeding, and a lump (P < 0.005). Mean follow-up was 7.6 months, with the range extending to 7 years. Time to symptom resolution averaged 24 days in the conservative group vs. 3.9 days in the surgical group (P < 0.0001). The overall incidence to recurrence was 15.6 percent-80.6 percent in the conservative group vs. 19.4 percent in the surgical group. The rate of recurrence in the conservative group was 25.4 percent (4/29; 14 percent were excised) whereas only 6.3 percent of the surgical patients had recurrence (P < 0.0001). Mean time to recurrence was 7.1 months in the conservative group vs. 25 months in the surgical group (P < 0.0001). Survival analysis for time to recurrence of thrombosed external hemorrhoid indicated that time to recurrence was significantly longer for the surgical group (P < 0.0001). Logistic regression analysis of multiple factors (including diverticular disease, constipation, straining, benign prostatic hypertrophy, diarrhea, skin tags, history of travel, anoreceptive sex, anal fissures, internal hemorrhoids, and obesity) was performed to determine the outcome of each group. None of these variables were significant predictors of recurrence.
CONCLUSIONS: Patients whose initial presentation was pain or bleeding with or without a lump were more like to be treated surgically. Surgically treated patients had a lower frequency of recurrence and a longer time interval to recurrence than conservatively treated patients. None of the variables analyzed were significant predictors of a particular treatment, except for a prior history of thrombosed external hemorrhoids, which may represent patient choice. Although most patients treated conservatively will experience resolution of their symptoms, excision of thrombosed external hemorrhoids results in more rapid symptom resolution, lower incidence of recurrence, and longer remission intervals.},
}
@article {pmid15471269,
year = {2004},
author = {},
title = {What you need to know about...diverticular disease.},
journal = {Nursing times},
volume = {100},
number = {35},
pages = {33},
pmid = {15471269},
issn = {0954-7762},
mesh = {Anti-Bacterial Agents/therapeutic use ; Colonoscopy ; Dietary Fiber/administration & dosage ; *Diverticulitis, Colonic/diagnosis/etiology/therapy ; *Diverticulosis, Colonic/diagnosis/etiology/therapy ; Fluid Therapy ; Humans ; Parasympatholytics/therapeutic use ; Risk Factors ; },
}
@article {pmid15459774,
year = {2005},
author = {Schwandner, O and Farke, S and Bruch, HP},
title = {Laparoscopic colectomy for diverticulitis is not associated with increased morbidity when compared with non-diverticular disease.},
journal = {International journal of colorectal disease},
volume = {20},
number = {2},
pages = {165-172},
pmid = {15459774},
issn = {0179-1958},
mesh = {Adult ; Aged ; Colectomy/*methods ; Diverticulitis, Colonic/mortality/*surgery ; Female ; Follow-Up Studies ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Sigmoid Diseases/mortality/*surgery ; Survival Rate ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIMS: It was the aim of this prospective study to compare the outcome of laparoscopic sigmoid and anterior resection for diverticulitis and non-diverticular disease.
PATIENTS AND METHODS: All patients who underwent laparoscopic colectomy for benign and malignant disease within a 10-year period were entered into the prospective PC database registry. For outcome analysis, patients who underwent laparoscopic sigmoid and anterior resection for diverticular disease were compared with patients who underwent the same operation for non-inflammatory (non-diverticular) disease. The parameters analyzed included age, gender, co-morbid conditions, diagnosis, procedure, duration of surgery, transfusion requirements, conversion, morbidity including major (requiring reoperation), minor (conservative treatment) and late-onset (postdischarge) complications, stay in the ICU, hospitalization, and mortality. For objective evaluation, only laparoscopically completed procedures were analyzed. Statistics included Student's t-test and chi-square analysis (p<0.05 was considered statistically significant).
RESULTS: A total of 676 patients were evaluated including 363 with diverticular disease and 313 with non-inflammatory disease. There were no significant differences in conversion rates (6.6 vs. 7.3%, p>0.05), so that the laparoscopic completion rate was 93.4% (n=339) in the diverticulitis group and 92.7% (n=290) in the non-diverticulitis group. The two groups did not differ significantly in age or presence of co-morbid conditions (p>0.05). In the diverticulitis group, recurrent diverticulitis (58.4%), and complicated diverticulitis (27.7%) were the most common indications, whereas in the non-diverticulitis group, outlet obstruction by sigmoidoceles (30.0%) and cancer (32.4%) were the main indications. The most common procedure was laparoscopic sigmoid resection, followed by sigmoid resection with rectopexy and anterior resection. No significant differences were documented for major complications (7.4 vs. 7.9%), minor complications (11.5 vs. 14.5%), late-onset complications (3.0 vs. 3.5), reoperation (8.6 vs. 9.3%) or mortality (0.6 vs. 0.7%) between the two groups (p>0.05). In the postoperative course, no differences were noted in terms of stay in the ICU, postoperative ileus, parenteral analgesics, oral feeding, and length of hospitalization (p>0.05).
CONCLUSION: These data indicate that laparoscopic sigmoid and anterior resection can be performed with acceptable morbidity and mortality for both diverticular disease and non-diverticular disease. The results show in particular that laparoscopic resection for inflammation is not associated with increased morbidity.},
}
@article {pmid15341720,
year = {2004},
author = {Simpson, J},
title = {Recent advances in diverticular disease.},
journal = {Current gastroenterology reports},
volume = {6},
number = {5},
pages = {417-422},
pmid = {15341720},
issn = {1522-8037},
mesh = {Dietary Fiber/administration & dosage ; Diverticulosis, Colonic/*complications/*therapy ; Humans ; Manometry ; Risk Factors ; },
abstract = {Diverticulosis is the most common structural abnormality of the colon. Although most people with colonic diverticula remain asymptomatic, a significant proportion of those affected develop symptoms and may suffer from complications. Whereas early research in diverticular disease addressed the pathogenesis of the condition, recent work has focused on symptomatic or complicated disease. Recent epidemiologic studies have attempted to identify patients who are at increased risk of perforated diverticular disease, and developing knowledge in neurogastroenterology has suggested mechanisms responsible for underlying chronically symptomatic disease. Further research in these areas has the potential to provide targeted therapeutic strategies for people with colonic diverticula.},
}
@article {pmid15315578,
year = {2004},
author = {Priestley, J and Patiniotis, T},
title = {Gram-negative sepsis as a presentation of jejunal diverticular disease.},
journal = {ANZ journal of surgery},
volume = {74},
number = {8},
pages = {701},
doi = {10.1111/j.1445-1433.2004.03125.x},
pmid = {15315578},
issn = {1445-1433},
mesh = {Diverticulum/*complications ; Escherichia coli ; Escherichia coli Infections/*etiology ; Humans ; Jejunal Diseases/*complications ; Klebsiella Infections/*etiology ; Klebsiella pneumoniae ; Male ; Middle Aged ; Sepsis/*etiology ; },
}
@article {pmid15300603,
year = {2004},
author = {Mitchell, KL and Shaheen, NJ},
title = {Preventive therapy in perforated colonic diverticular disease? Calcium channel blockers may hold the key.},
journal = {Gastroenterology},
volume = {127},
number = {2},
pages = {680-682},
doi = {10.1053/j.gastro.2004.03.081},
pmid = {15300603},
issn = {0016-5085},
}
@article {pmid15296620,
year = {2004},
author = {Lawrimore, T and Rhea, JT},
title = {Computed tomography evaluation of diverticulitis.},
journal = {Journal of intensive care medicine},
volume = {19},
number = {4},
pages = {194-204},
doi = {10.1177/0885066604265260},
pmid = {15296620},
issn = {0885-0666},
mesh = {Appendicitis/diagnostic imaging ; Catheterization/methods ; Colonic Neoplasms/diagnostic imaging ; Contrast Media ; Critical Care/methods ; Diagnosis, Differential ; Diverticulitis/complications/*diagnostic imaging/therapy ; Drainage/methods ; Humans ; Intestinal Fistula/diagnostic imaging/etiology ; Intestinal Perforation/diagnostic imaging/etiology ; Predictive Value of Tests ; Radiographic Image Enhancement/methods ; Tomography, X-Ray Computed/*methods ; },
abstract = {Acute diverticulitis is a frequent and important diagnosis in gastrointestinal disease, most commonly involving the colon. It is estimated that approximately 15% to 30% of patients with diverticulosis develop symptomatic diverticulitis at some point in the natural history of the condition, often requiring medical and/or surgical therapy. The clinical diagnosis is often difficult to make, and several radiological studies have been used over the past decades to assist in the diagnosis of acute diverticulitis. These include barium enema, ultrasound, and computed tomography (CT). A number of studies over the past decade have shown CT to be the preferable initial examination because of its ability to demonstrate not only the extent of intramural inflammation but also the degree of pericolic disease, including intraperitoneal inflammation, perforation, and abscess formation. Additional benefits of CT imaging include guiding therapeutic interventions in complicated forms of diverticular disease and providing an alternative diagnosis in patients without diverticulitis. The accuracy, techniques, criteria for diagnosis, and staging and applications of CT imaging in acute diverticulitis are discussed.},
}
@article {pmid15285520,
year = {2004},
author = {Aydin, HN and Remzi, FH},
title = {Diverticulitis: when and how to operate?.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {36},
number = {7},
pages = {435-445},
doi = {10.1016/j.dld.2004.03.001},
pmid = {15285520},
issn = {1590-8658},
mesh = {Digestive System Surgical Procedures/methods ; Diverticulitis/classification/diagnosis/*surgery ; Diverticulitis, Colonic/surgery ; Humans ; },
abstract = {Diverticular disease, and particularly diverticulitis, has increasing incidence in industrialised countries. Diverticular disease can be classified as symptomatic uncomplicated disease, recurrent symptomatic disease, and complicated disease. Conservative or medical management is usually indicated for acute uncomplicated diverticulitis. Indications for surgery include recurrent attacks and complications of the disease. Surgical treatment options have changed considerably over the years along with the inventions of new diagnostic tools and new surgical therapeutic approaches. Indications and timing for surgery of diverticular disease are determined mainly by the stage of the disease. In addition to this major factor, the individual risk factors of the patient along with the course of the disease after conservative or operative therapy do play a big role in decision-making and treatment of this disease. In this context, the purpose of this article is to review the surgical treatment of diverticulitis with regard to indications, timeliness of operative intervention, operative options and techniques, and special circumstances.},
}
@article {pmid15278031,
year = {2004},
author = {Agnifili, A and Schietroma, M and Carloni, A and Mattucci, S and Caterino, G and Carlei, F},
title = {[Omentoplasty is effective in lowering the complications of ano-rectal resections].},
journal = {Minerva chirurgica},
volume = {59},
number = {4},
pages = {363-368},
pmid = {15278031},
issn = {0026-4733},
mesh = {Abdomen/*surgery ; Adult ; Aged ; Aged, 80 and over ; Anal Canal/*surgery ; Anastomosis, Surgical ; Colon/*surgery ; Colostomy ; Data Interpretation, Statistical ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; Omentum/*transplantation ; Peritoneum ; Postoperative Complications/prevention & control ; Prospective Studies ; Rectum/*surgery ; Reoperation ; Surgical Staplers ; },
abstract = {AIM: The aim of this prospective, randomized study was to investigate the influence of omentoplasty on complications following colorectal resection, Hartmann's intervention and abdominoperineal amputation.
METHODS: One hundred and seventy-one patients undergoing elective or emergency surgery for malignancy, benign tumor, diverticular disease and others were randomly assigned to omentoplasty (OP group) or not (NO group). The primary goal was to evaluate the rate of clinical and radiological anastomotic leakage. The secondary goal was to assess the morbidity (mainly septic complications) following Hartmann's and Miles' procedures.
RESULTS: In colorectal anastomosis, 18 patients (14.3%) had anastomotic leakage, 4 (6.4%) in the OP group and 14 (21.9%) in the NO group. Differences between the 2 groups were also found in terms of repeat operations (3.2% vs 14.1%) and deaths (3.2% vs 7.8%). Other factors associated with anastomotic leakage were the distal site of anastomosis (<5 cm from anal verge) and the emergency. In Hartmann's and Miles' procedures, septic complications were reduced in the OP group.
CONCLUSION: Omental wrap, with its mechanical and biological properties, seems to be effective in lowering the rate and the severity of complications after colorectal and anal surgery.},
}
@article {pmid15252398,
year = {2004},
author = {Finco, C and Sarzo, G and Parise, P and Savastano, S and De Lazzari, F and Polato, F and Merigliano, S},
title = {Laparoscopic treatment of post-hysterectomy colovaginal fistula in diverticular disease. Case report.},
journal = {Minerva chirurgica},
volume = {59},
number = {3},
pages = {301-305},
pmid = {15252398},
issn = {0026-4733},
mesh = {Colonic Diseases/complications/diagnostic imaging/*surgery ; Diverticulitis/surgery ; Diverticulum/complications/diagnostic imaging/*surgery ; Female ; Humans ; Hysterectomy, Vaginal/adverse effects ; Intestinal Fistula/diagnostic imaging/etiology/*surgery ; *Laparoscopy ; Middle Aged ; Radiography ; Sigmoid Diseases/diagnostic imaging/etiology/surgery ; Treatment Outcome ; Vaginal Fistula/diagnostic imaging/etiology/*surgery ; },
abstract = {Colonic diverticular disease is a benign condition typical of the Western world, but it is not rare for even the 1st episode of diverticulitis to carry potentially fatal complications. The evolution of a peridiverticular process generally poses problems for medical treatment and exposes patients to repeated episodes of diverticulitis, making surgical treatment necessary in approximately 30% of symptomatic patients. One of the most worrying complications of diverticulosis is internal fistula. The most common types of fistula are colovesical and colovaginal, against which the uterus can act as an important protective factor. The symptoms and the clinical and instrumental management of patients with diverticular fistulas are much the same as for patients with episodes of acute diverticulitis. Staging of the disease (according to Hinchey) should be done promptly so that the necessary action can be taken prior to surgery, implementing total parenteral nutrition (TPN), nasogastric aspiration and broad-spectrum antibiotic treatment. The best surgical approach to adopt in patients with diverticulitis complicated by fistula is still not entirely clear, though the 3-step strategy is currently tending to be abandoned due to its high morbidity and mortality rates. There is a widespread conviction, however, that the 2-step strategy (Hartmann, or resection with protective stomy) and the 1-step alternative should be reserved, respectively, for patients in Hinchey stages 3, 4 and 1, 2 with a situation of attenuated local inflammation. The 1-step approach seems to be safe and effective. This report describes a case of colovaginal fistula in a patient with colonic diverticulosis who had recently undergone hysterectomy, but who, unlike such cases in the past, was treated in a single step using a laparoscopic technique.},
}
@article {pmid15230784,
year = {2004},
author = {Killingback, M and Barron, PE and Dent, OF},
title = {Elective surgery for diverticular disease: an audit of surgical pathology and treatment.},
journal = {ANZ journal of surgery},
volume = {74},
number = {7},
pages = {530-536},
doi = {10.1111/j.1445-2197.2004.03071.x},
pmid = {15230784},
issn = {1445-1433},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis/complications/surgery ; Diverticulum, Colon/complications/pathology/*surgery ; Elective Surgical Procedures ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Audit ; Middle Aged ; Postoperative Complications/epidemiology ; Prospective Studies ; Urologic Surgical Procedures/methods ; },
abstract = {BACKGROUND: There is a need for a better classification of the surgical pathology of diverticular disease treated by elective resection.
METHODS: A prospective audit was conducted over a 25-year period, during which the surgeon studied the surgical pathology. The results of surgical treatment have been related to the pathology.
RESULTS: Two hundred and six patients were managed by elective resection with a postoperative mortality of 1.0% and a total morbidity of 51.5%. The surgical pathology was classified as: non-inflammatory 25 (12.6%), localized diverticulitis 90 (43.7%) and extracolic diverticulitis 90 (44.2%).
CONCLUSIONS: This classification is useful to relate the technical requirements of surgery and the outcome to the surgical pathology. Postoperative morbidity is associated with the presence and severity of inflammatory pathology and therefore the casemix of any series will have a significant impact on this aspect.},
}
@article {pmid15209430,
year = {2004},
author = {Beitz, JM},
title = {Diverticulosis and diverticulitis spectrum of a modern malady.},
journal = {Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society},
volume = {31},
number = {2},
pages = {75-82; quiz 83-4},
doi = {10.1097/00152192-200403000-00007},
pmid = {15209430},
issn = {1071-5754},
mesh = {*Diverticulitis, Colonic/diagnosis/epidemiology/physiopathology/therapy ; *Diverticulum, Colon/diagnosis/epidemiology/physiopathology/therapy ; Humans ; },
abstract = {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.},
}
@article {pmid15201578,
year = {2004},
author = {Heresbach, D and Alexandre, JL and Bretagne, JF and Cruchant, E and Dabadie, A and Dartois-Hoguin, M and Girardot, PM and Jouanolle, H and Kerneis, J and Le Verger, JC and Louvain, V and Pennognon, L and Richecoeur, M and Politis, J and Robaszkiewicz, M and Seyrig, JA and Tron, I and , },
title = {Crohn's disease in the over-60 age group: a population based study.},
journal = {European journal of gastroenterology & hepatology},
volume = {16},
number = {7},
pages = {657-664},
doi = {10.1097/01.meg.0000108337.41221.08},
pmid = {15201578},
issn = {0954-691X},
mesh = {Adult ; Age Factors ; Age of Onset ; Aged ; Aged, 80 and over ; Crohn Disease/complications/*epidemiology/pathology/therapy ; Diverticulum/complications ; Female ; France/epidemiology ; Gastrointestinal Agents/administration & dosage ; Granuloma/complications ; Humans ; Incidence ; Intestinal Diseases/complications ; Male ; Patient Readmission/statistics & numerical data ; Prognosis ; },
abstract = {OBJECTIVES: Late-onset Crohn's disease (CD) may show a distinctive pattern of expression. The aim of our study was to describe the incidence or presentation of CD in the elderly and compare the outcomes in patients < 60 years or > or = 60 years at diagnosis.
METHODS: The study included a population based inception cohort of all incident CD cases diagnosed in Brittany (France) between 1994 and 1997. Sixty-three patients were > or = 60 years and 201 were < 60 years at diagnosis. The physicians managing the patients used standardized questionnaires to collect the study data. The questionnaires on outcomes and treatments were completed in 2002.
RESULTS: In patients > or = 60 years, the annual incidence was 2.5 per 10 persons and clinical features were similar to those in younger patients, except for a higher rate of colon involvement. Among older patients, those with diverticula (29/63, 46%) were more likely to have granulomas (58% vs 33% of patients without diverticula, P < 0.04), but the diagnosis of CD was confirmed by lesions remote from the diverticula in most cases (23/29). Early resection rates were not higher in older patients, who were less likely to require immunosuppressants or re-admission for CD flares, as compared to younger patients. Five year mortality in older patients was 16% but was unrelated to CD.
CONCLUSIONS: In Brittany, the age specific incidence, clinical features, and prognosis of CD among the elderly are comparable to those in younger individuals. Colon involvement is more common. Concomitant diverticular disease is common and should prompt a search for CD lesions at other sites to confirm the diagnosis. Older patients are less likely to require immunosuppressants or admission for flares.},
}
@article {pmid15191491,
year = {2004},
author = {Frye, JN and Robertson, R},
title = {Complicated small bowel diverticular disease.},
journal = {ANZ journal of surgery},
volume = {74},
number = {6},
pages = {495-496},
doi = {10.1111/j.1445-2197.2004.03041.x},
pmid = {15191491},
issn = {1445-1433},
mesh = {Abdomen, Acute/diagnosis/etiology ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Diverticulitis/*complications/diagnosis ; Diverticulum/*etiology ; Humans ; Ileal Diseases/*etiology ; Jejunal Diseases/*complications/diagnosis/etiology ; Male ; },
}
@article {pmid15191205,
year = {2004},
author = {Maselli, MA and Piepoli, AL and Guerra, V and Caruso, ML and Pezzolla, F and Lorusso, D and Demma, I and De Ponti, F},
title = {Colonic smooth muscle responses in patients with diverticular disease of the colon: effect of the NK2 receptor antagonist SR48968.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {36},
number = {5},
pages = {348-354},
doi = {10.1016/j.dld.2004.01.014},
pmid = {15191205},
issn = {1590-8658},
mesh = {Aged ; Aged, 80 and over ; Anesthetics, Local/pharmacology ; Atropine/pharmacology ; Benzamides/*pharmacology ; Carbachol/pharmacology ; Case-Control Studies ; Cholinergic Agonists/pharmacology ; Colon, Sigmoid/drug effects/*physiology ; Colonic Neoplasms/surgery ; Diverticulitis, Colonic/*physiopathology/surgery ; Electric Stimulation ; Female ; Humans ; In Vitro Techniques ; Isometric Contraction/drug effects/*physiology ; Male ; Middle Aged ; Muscle, Smooth/drug effects/*physiology ; Parasympatholytics/pharmacology ; Piperidines/*pharmacology ; Receptors, Neurokinin-2/antagonists & inhibitors ; Stress, Mechanical ; Tetrodotoxin/pharmacology ; },
abstract = {BACKGROUND: Little is known about the pathophysiology of diverticular disease.
AIM: To compare passive and active stress and the response to carbachol of colonic smooth muscle specimens from patients with diverticular disease and patients with colon cancer. The effect of the NK2 receptor antagonist, SR48968, on electrically evoked contractions of circular muscle was also investigated.
PATIENTS: Sigmoid colon segments were obtained from 16 patients (51-83 years) undergoing elective sigmoid resection for diverticular disease and 39 patients (50-88 years) undergoing left hemicolectomy for non-obstructive sigmoid colon cancer.
METHODS: Isometric tension was measured on circular or longitudinal taenial muscle. Strips were stretched gradually to Lo (length allowing the development of optimal active tension with carbachol) and were also exposed to increasing carbachol concentrations. The effects of atropine, tetrodotoxin and SR48968 on electrically evoked (supramaximal strength, 0.3 ms, 0.1-10 Hz) contractions of circular strips from 8 patients with diverticular disease and 19 patients with colon cancer were also studied.
RESULTS: Both passive and active stress in circular muscle strips obtained from patients with diverticular disease was higher than in patients with colon cancer (P < 0.05). Electrically evoked contractions were significantly reduced by atropine in all preparations and were virtually suppressed by combined SR48968 and atropine. Tetrodotoxin suppressed electrically evoked contractions only in patients with colon cancer, whereas a tetrodotoxin-resistant component was identified in patients with diverticular disease.
CONCLUSIONS: The changes in both passive and active stress in specimens from patients with diverticular disease may reflect circular smooth muscle dysfunction. Acetylcholine and tachykinins are the main excitatory neurotransmitters mediating electrically evoked contractions in human sigmoid colon circular muscle.},
}
@article {pmid15167856,
year = {2004},
author = {Willis, FL and Fanning, J},
title = {Digital rectal fecal occult blood screening during gynecologic examination.},
journal = {American journal of obstetrics and gynecology},
volume = {190},
number = {5},
pages = {1422-1423},
doi = {10.1016/j.ajog.2004.01.072},
pmid = {15167856},
issn = {0002-9378},
mesh = {Aged ; Aged, 80 and over ; Cohort Studies ; Colorectal Neoplasms/*prevention & control ; Female ; Follow-Up Studies ; Gynecology/methods ; Humans ; Mass Screening/*methods ; Middle Aged ; *Occult Blood ; Physical Examination ; Predictive Value of Tests ; Rectum ; Risk Assessment ; },
abstract = {OBJECTIVE: The purpose of this study was to test the feasibility of digital rectal fecal occult blood screening during pelvic examination.
STUDY DESIGN: We reviewed the data for 232 consecutive women who underwent digital rectal fecal occult blood screening during routine pelvic examination and who had had at least 1-year of follow-up visits: 59% of the women were followed for gynecologic cancer, and 41% of the women were followed for benign gynecologic disease. The median age was 62 years. Patients with positive digital rectal fecal occult blood screening were sent for gastroenterologic examination.
RESULTS: Sixteen of 232 patients (7%) had a positive digital rectal fecal occult blood screening result. On gastroenterologic examination, 5 of the 16 patients (31%) were found to have disease (2 polyps, 1 diverticular disease, 2 radiation proctitis). At 1-year follow-up, no patient had colon cancer.
CONCLUSION: Until better compliance can be obtained with home stool sample fecal occult blood testing, we recommend a larger study of digital rectal fecal occult blood screening during gynecologic examination to verify our results.},
}
@article {pmid15134031,
year = {2004},
author = {Lukás, K},
title = {[The large intestine--literature review of recent years].},
journal = {Casopis lekaru ceskych},
volume = {143},
number = {3},
pages = {149-153},
pmid = {15134031},
issn = {0008-7335},
mesh = {Humans ; *Intestinal Diseases ; *Intestine, Large ; },
abstract = {Diagnose of the idiopathic inflammatory bowel disease depends on the set of clinical, radiological, endoscopic and histological criteria. Proctitis, proctosigmoiditis, and the left-sided colitis represent 60 to 80 percent of newly diagnosed cases of colitis. For the medical management of the inflammatory bowel diseases aminosalicylates, corticosteroids, topical corticosteroids, immunosuppressants are used. The complication of highest risk represents the toxic magacolon or periannal fistulas in patients with Crohn's disease. Pre-neoplastic epithelial changes (dysplasia) are diagnosed by pathologists according sets of cytological and architectonic markers. Indeterminate diarrhea related to the antibiotics administration is comparatively common. Roman criteria II classify functional intestinal disorders, represented by a set of isolated symptoms or various combinations of symptoms without identifiable organic, biochemical, sonographic or endoscopic abnormalities of the intestinal or biliary system, lasting minimally 12 weeks (not necessarily continuously) during the preceding year, as a persisting or recurrent distress. About 20 percent of patients with diverticular disease of the colon have some clinical manifestations.},
}
@article {pmid15115923,
year = {2004},
author = {West, AB and Losada, M},
title = {The pathology of diverticulosis coli.},
journal = {Journal of clinical gastroenterology},
volume = {38},
number = {5 Suppl 1},
pages = {S11-6},
doi = {10.1097/01.mcg.0000124005.07433.69},
pmid = {15115923},
issn = {0192-0790},
mesh = {Colon/*pathology ; Colon, Sigmoid/pathology ; Crohn Disease/complications ; Diverticulitis, Colonic/etiology ; Diverticulosis, Colonic/*complications/*pathology ; Diverticulum, Colon/etiology ; Fistula/etiology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Irritable Bowel Syndrome/etiology ; Retinal Perforations/etiology ; Rupture/etiology ; Sigmoid Diseases/pathology ; },
abstract = {Left-sided diverticulosis coli is a common condition in western communities, with 30% to 50% of adults over the age of 60 being affected. It predominantly involves the sigmoid colon. The diverticula (pseudodiverticula) are pockets of mucosa bounded by muscularis mucosae and invested with a thin layer of submucosa, that are forced out through weak points in the muscularis propria, the tips ending in the colonic subserosa. The weak points in the muscle coat are the sites of entry of the nutrient vessels of the colonic mucosa. Diverticulosis is attributed to increased colonic intraluminal pressure while straining at stool in individuals who eat low-fiber diets. Muscular hypertrophy, shortening of the bowel, and thickened mucosal folds due to mucosal redundancy are characteristic of this condition. Complications of diverticulosis include bleeding, diverticulitis, peridiverticular abscess, perforation, stricture, and fistula formation. However, most individuals with diverticulosis are asymptomatic, without evidence of complications. Mucosal changes in the diverticula in uncomplicated diverticulosis include an increased lymphoid infiltrate, development of lymphoglandular complexes, mucin depletion, mild cryptitis, architectural distortion, Paneth cell metaplasia, and ulceration. The mucosa of the remainder of the sigmoid colon (ie, the nondiverticular mucosa) is usually normal, but in about 1% of cases it has features that are indistinguishable from ulcerative colitis or from Crohn's disease (segmental colitis associated with diverticular disease, SCAD). Such cases pose a difficult diagnostic challenge as patients with SCAD respond to medical or surgical therapy for diverticular disease, whereas those with ulcerative colitis or Crohn's disease will develop other manifestations of their disease in time and require different treatment. In SCAD, the mucosal changes are confined to the area of diverticulosis; therefore, histologic evaluation of the rectum (which is unaffected by diverticulosis) and more proximal bowel can be helpful in the differential diagnosis.},
}
@article {pmid15115922,
year = {2004},
author = {Peppercorn, MA},
title = {The overlap of inflammatory bowel disease and diverticular disease.},
journal = {Journal of clinical gastroenterology},
volume = {38},
number = {5 Suppl 1},
pages = {S8-10},
doi = {10.1097/01.mcg.0000123993.13937.ec},
pmid = {15115922},
issn = {0192-0790},
mesh = {Anti-Bacterial Agents/therapeutic use ; Colitis/complications/therapy ; Colon, Sigmoid/pathology ; Crohn Disease/*complications/therapy ; Diverticulitis, Colonic/complications/therapy ; Diverticulum/*complications/therapy ; Humans ; Immunosuppressive Agents/therapeutic use ; Inflammatory Bowel Diseases/*complications/therapy ; Sigmoid Diseases/complications/therapy ; },
abstract = {An overlap of inflammatory bowel disease and diverticular disease has long been recognized. Crohn's disease and diverticulitis share clinical and radiologic features but usually differ in histopathologic findings. There is a suggestion, however, that even the characteristic pathology of Crohn's disease can be a secondary reaction to diverticulitis. It is possible, moreover, that the presence of Crohn's disease in association with diverticulosis predisposes to the development of diverticulitis. Finally, an apparently distinct form of segmental colitis associated with sigmoid diverticula has been described further contributing to the overlap of inflammatory bowel disease and diverticular disease.},
}
@article {pmid15114281,
year = {2004},
author = {Brandimarte, G and Tursi, A},
title = {Rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease.},
journal = {Medical science monitor : international medical journal of experimental and clinical research},
volume = {10},
number = {5},
pages = {PI70-3},
pmid = {15114281},
issn = {1234-1010},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage ; Diverticulitis/*drug therapy ; *Drug Therapy, Combination ; Female ; Gastrointestinal Agents/administration & dosage ; Humans ; Male ; Mesalamine/*administration & dosage ; Middle Aged ; Prospective Studies ; Remission Induction ; Rifamycins/*administration & dosage ; Rifaximin ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: Rifaximin plus mesalazine has been showed to be more effective than rifaximin alone in the treatment of recurrent and complicated diverticulitis of the colon. We investigated the effectiveness of the combination rifaximin/mesalazine followed by mesalazine alone to evaluate tolerability and effectiveness in symptomatic remission in uncomplicated diverticular disease.
MATERIAL/METHODS: We studied 90 consecutive patients (39 M, 51 F, mean age 67.2 yrs, range 32-91 yrs) with symptomatic uncomplicated diverticular disease. We assessed the following symptoms, scoring them on a quantitative scale: 1) constipation, 2) diarrhea, 3) abdominal pain, 4) rectal bleeding, and 5) mucus with stools. All were treated with 800 mg/day rifaximin plus 2.4 gr/day mesalazine for 10 days, followed by 1.6 gr/day mesalazine for 8 weeks. They were re-evaluated at the end of mesalazine-alone treatment.
RESULTS: Eighty-six patients completed the study (95.56%): the total score decreased from 1439 to 44 (p<0.001). 70 patients (per-protocol: 81.40% (C.I.: 67-94%); on intention-to-treat: 77.78% (C.I.: 60-85%)) were completely asymptomatic after the 8th week of treatment with mesalazine alone (total symptomatic score: 0), while 16 (per-protocol: 18.60%; on intention-to-treat: 17.77%) showed only slight symptoms (total score: 44). Two (2.22%) showed recurrence of diverticulitis after 4 and 6 weeks of treatment with mesalazine alone. Two patients (2.22%) were withdrawn from the study for diarrhea after starting mesalazine. Two others (2.22%) showed transitory pruritus (one) and epigastric pain (one).
CONCLUSIONS: The results show that rifaximin/mesalazine followed by mesalazine alone is extremely effective in resolving symptoms in patients with symptomatic uncomplicated diverticular disease.},
}
@article {pmid15110505,
year = {2004},
author = {Tursi, A},
title = {Diverticular disease of the colon.},
journal = {Lancet (London, England)},
volume = {363},
number = {9418},
pages = {1397-1398},
doi = {10.1016/S0140-6736(04)16061-3},
pmid = {15110505},
issn = {1474-547X},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Diverticulitis, Colonic/*drug therapy ; Diverticulosis, Colonic/*drug therapy ; Humans ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; },
}
@article {pmid15110504,
year = {2004},
author = {Makins, RJ and Irving, PM},
title = {Diverticular disease of the colon.},
journal = {Lancet (London, England)},
volume = {363},
number = {9418},
pages = {1397},
doi = {10.1016/S0140-6736(04)16060-1},
pmid = {15110504},
issn = {1474-547X},
mesh = {Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis ; Diverticulosis, Colonic/*diagnosis ; Humans ; },
}
@article {pmid15109381,
year = {2004},
author = {da Silva, GM and Kaiser, R and Börjesson, L and Colqhoun, P and Lobo, C and Khandwala, F and Thornton, J and Efron, J and Vernava, AM and Weiss, EG and Wexner, SD and Gervaz, P and Nogueras, JJ},
title = {The effect of diverticular disease on the colonic J pouch.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {6},
number = {3},
pages = {171-175},
doi = {10.1111/j.1463-1318.2004.00544.x},
pmid = {15109381},
issn = {1462-8910},
mesh = {Aged ; Anal Canal/*physiopathology/*surgery ; *Anastomosis, Surgical ; Case-Control Studies ; Colonic Pouches/*physiology ; Constriction, Pathologic/complications/radiotherapy/surgery ; Defecation ; Diverticulum, Colon/*complications ; Female ; Humans ; Male ; Middle Aged ; *Postoperative Complications ; Rectal Neoplasms/complications/radiotherapy/surgery ; Retrospective Studies ; },
abstract = {OBJECTIVE: The aim of this study was to assess the impact of the diverticular disease (DD) on function and on postoperative complications of the colonic J-pouch (CJP) with pouch-anal anastomosis.
METHODS: Patients who underwent a CJP between December 1990 and August 2001, were retrospectively reviewed. The presence of DD in the CJP was assessed on pouchogram prior to ileostomy closure. A questionnaire designed to evaluate the degree of continence (total incontinence score (IS): 0 = worst, 20 = best) and pouch evacuation (total evacuation score (ES): 0 = worst, 28 = best) was used for comparison between patients with DD and those without DD (NDD).
RESULTS: Sixty-six patients (47 males; 19 females) with a median age of 68 years (range 28-87 years) were included. The median follow-up period was 22 months (range 2-106 months). Twenty-four patients comprised the DD group and 42 were in the NDD group. The two groups were comparable for age, gender and time from ileostomy closure; all patients with postoperative chemoradiation therapy were in the NDD group. The total ES and IS total did not significantly differ between the two groups with a P-value of 0.11 and 0.09 respectively. Furthermore, there was no significant difference in the total incidence of pouch complications between the two groups (3 strictures, 1 leak, 1 fistula in the NDD group vs. 1 pelvic sepsis in the DD group; P = 0.4).
CONCLUSIONS: The presence of DD in a CJP does not seem to impact pouch function or the postoperative complication rate.},
}
@article {pmid15098095,
year = {2004},
author = {Schwenk, W and , },
title = {[The LAPDIV-CAMIC Study. Multicenter prospective randomized study of short-term and intermediate-term outcome of laparoscopic and conventional sigmoid resection in diverticular disease].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {75},
number = {7},
pages = {706-707},
doi = {10.1007/s00104-004-0887-8},
pmid = {15098095},
issn = {0009-4722},
mesh = {Colon, Sigmoid/surgery ; Diverticulitis, Colonic/*surgery ; Follow-Up Studies ; Humans ; *Laparoscopy ; Outcome and Process Assessment, Health Care ; Postoperative Complications/etiology ; Prospective Studies ; Quality of Life ; },
}
@article {pmid15085996,
year = {2004},
author = {Pisanu, A and Cois, A and Uccheddu, A},
title = {Surgical treatment of perforated diverticular disease: evaluation of factors predicting prognosis in the elderly.},
journal = {International surgery},
volume = {89},
number = {1},
pages = {35-38},
pmid = {15085996},
issn = {0020-8868},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Intestinal Perforation/etiology/*surgery ; Male ; Middle Aged ; Peritonitis/etiology/*surgery ; Prognosis ; Retrospective Studies ; },
abstract = {Diverticulitis free perforation carries a high mortality rate in the elderly, and this motivates the search for specific prognostic factors. The aim of this study was to assess prognostic factors in patients over 70 years of age that were operated on for generalized peritonitis caused by perforated colonic diverticulitis. A retrospective study in 22 patients was performed: demographic data, American Society of Anaesthesiology grading, site and diameter, degree of perforation according to Hinchey's classification, duration of symptoms, Manheim Peritonitis Index (MPI) score, and surgical treatment were evaluated. Patients over 70 years of age were grouped in deceased and not deceased. In this subgroup, postoperative mortality rate was 40%, and diameter of perforation, duration of symptoms, and MPI score seemed significantly related to postoperative death. In the elderly, prognosis is strongly related to duration of symptoms, and treatment delay is caused by late hospitalization because of a low sensibility to the disease symptoms in old people.},
}
@article {pmid15082591,
year = {2004},
author = {Clemens, CH and Samsom, M and Roelofs, J and van Berge Henegouwen, GP and Smout, AJ},
title = {Colorectal visceral perception in diverticular disease.},
journal = {Gut},
volume = {53},
number = {5},
pages = {717-722},
pmid = {15082591},
issn = {0017-5749},
mesh = {Adult ; Aged ; Colon/*physiopathology ; Compliance ; Diverticulum, Colon/physiopathology/*psychology ; Female ; Humans ; Male ; Middle Aged ; Postprandial Period ; Pressure ; Rectum/*physiopathology ; *Sensation ; },
abstract = {BACKGROUND AND AIMS: The pathogenesis of asymptomatic diverticular disease (ADD) and symptomatic uncomplicated diverticular disease (SUDD) has not been elucidated. The aim of our study was to assess whether altered visceral perception or abnormal compliance of the colorectal wall play a role in these clinical entities.
METHODS: Ten ADD patients, 11 SUDD patients, and nine healthy controls were studied. Using a dual barostat device, sensations were scored and compliance curves obtained using stepwise intermittent isobaric distensions of the rectum and sigmoid, before and after a liquid meal. In addition, the colonic response to eating was assessed by monitoring the volumes of both barostat bags at operating pressure before and after the meal.
RESULTS: In the rectum, perception was increased in the SUDD group compared with controls (p = 0.010) and the ADD group (p = 0.030). Rectal compliance curves were not different between the groups. In the sigmoid colon, perception in the pre- and postprandial periods was increased in SUDD compared with controls (p = 0.018) but not when compared with ADD. Sigmoid volume-pressure curves had comparable slopes (compliance) in all groups but were shifted downwards in SUDD compared with ADD in the preprandial period (p = 0.026). The colonic response to eating (decrease in intrabag volume) was similar in all three groups, both in the rectum and sigmoid.
CONCLUSION: Symptomatic but not asymptomatic uncomplicated diverticular disease is associated with heightened perception of distension, not only in the diverticula bearing sigmoid, but also in the unaffected rectum. This hyperperception is not due to altered wall compliance.},
}
@article {pmid15082493,
year = {2004},
author = {Mpofu, S and Mpofu, CM and Hutchinson, D and Maier, AE and Dodd, SR and Moots, RJ},
title = {Steroids, non-steroidal anti-inflammatory drugs, and sigmoid diverticular abscess perforation in rheumatic conditions.},
journal = {Annals of the rheumatic diseases},
volume = {63},
number = {5},
pages = {588-590},
doi = {10.1136/ard.2003.010355},
pmid = {15082493},
issn = {0003-4967},
mesh = {Abscess/*chemically induced ; Adrenal Cortex Hormones/*adverse effects ; Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Confidence Intervals ; Diverticulum, Colon/*chemically induced ; Female ; Humans ; Intestinal Perforation/*chemically induced ; Male ; Middle Aged ; Odds Ratio ; Rheumatic Diseases/*drug therapy ; Sigmoid Diseases/*chemically induced ; },
abstract = {BACKGROUND: Corticosteroids and non-steroidal anti-inflammatory drugs are widely used for the treatment of rheumatic conditions, but their gastrointestinal damage significantly limits their use. Sigmoid diverticular abscess perforation (SDAP) is a very serious complication of diverticular disease.
OBJECTIVE: To determine the aetiology of large bowel SDAP in rheumatic conditions.
METHODS: 64 patients with SPAD and 320 controls from a similar geographical area and of similar socioeconomic status were studied.
RESULTS: The results showed that independently of rheumatic diagnosis corticosteroid treatment is strongly associated with SDAP (OR 31.9 (95% CI 6.4 to 159.2; p<0.001), and non-steroidal anti-inflammatory drugs only weakly associated (OR 1.8 (95% CI 0.96 to 3.4); p = 0.069). A rheumatic diagnosis is also strongly associated with the development of SDAP (OR 3.5 (95% CI 1.9 to 6.7); p<0.001).
CONCLUSIONS: SDAP has serious implications for patients and consumes many healthcare resources. Patients and physicians should be warned of this potential complication.},
}
@article {pmid15043517,
year = {2004},
author = {Kang, JY and Dhar, A and Pollok, R and Leicester, RJ and Benson, MJ and Kumar, D and Melville, D and Neild, PJ and Tibbs, CJ and Maxwell, JD},
title = {Diverticular disease of the colon: ethnic differences in frequency.},
journal = {Alimentary pharmacology & therapeutics},
volume = {19},
number = {7},
pages = {765-769},
doi = {10.1111/j.1365-2036.2004.01908.x},
pmid = {15043517},
issn = {0269-2813},
mesh = {Adult ; Aged ; Aged, 80 and over ; Asia/ethnology ; Colonoscopy ; Diverticulum, Colon/*ethnology ; Female ; Humans ; Incidental Findings ; India/ethnology ; London/epidemiology ; Male ; Middle Aged ; },
abstract = {BACKGROUND: Colonic diverticular disease is more common in Western populations than in developing countries.
AIM: To determine whether the frequency of colonic diverticular disease is different in British patients of Indian-subcontinent Asian origin compared with other ethnic groups.
METHODS: All colonoscopies performed over a 3-year period in a London hospital were studied. Patients of Indian-subcontinent Asian origin were identified by name.
RESULTS: Five of 134 Indian-subcontinent Asian males (4%) had colonic diverticular disease, compared with 278 of 1268 patients of other ethnic groups (22%; P < 0.001). Five of 91 Indian-subcontinent Asian females (6%) had colonic diverticular disease, compared with 333 of 1486 patients of other ethnic groups (23%; P < 0.001). Although patients of Indian-subcontinent Asian origin (54.8 +/- 15.8 years) were younger than those of other ethnic groups (60.3 +/- 17.8 years; P < 0.0001), the ethnic difference in the frequency of diverticular disease persisted even when age was taken into account.
CONCLUSION: There is a lower frequency of colonic diverticular disease in Indian-subcontinent Asians presenting for colonoscopy, compared with other ethnic groups. This cannot be explained by sex or age differences. Our findings require confirmation, but may provide opportunities for research into the aetiology of colonic diverticular disease.},
}
@article {pmid15038662,
year = {2004},
author = {De Simone, P and Féron, P and Loi, P and Van Nuffelen, M and Nagy, N and Van Gossum, A and Gelin, M},
title = {[Acute intestinal bleeding due to Taenia solium infection].},
journal = {Chirurgia italiana},
volume = {56},
number = {1},
pages = {151-156},
pmid = {15038662},
issn = {0009-4773},
mesh = {Acute Disease ; Aged ; Female ; Gastrointestinal Hemorrhage/diagnosis/*etiology/surgery ; Humans ; Taeniasis/*complications ; },
abstract = {Parasite infections of the digestive tract are a rare cause of acute haemorrhage in Western countries. We report here on a case of acute intestinal bleeding due to Taenia solium infection diagnosed at surgery. A 79-year-old white female patient was admitted to our institution for instable angina and severe anaemia secondary to acute intestinal bleeding. The patient's medical history was positive for long-standing microcytic anaemia. A recent diagnostic work-up had revealed the presence of chronic erosive antral gastritis and colonic diverticular disease without acute bleeding. On admission to our department the patient underwent antegrade bowel endoscopy which showed a bleeding site 120 cm caudad to the Treitz ligament in the absence of ulcers and/or neoplastic lesions. The patient was eventually referred to surgery for suspected intestinal angiodysplasia. At surgery no gross lesions of the stomach, bowel or colon were observed. We then performed a custom enterotomy 120 cm caudad to the Treitz ligament and discovered a 250-cm-long tapeworm. The parasite was removed with the aid of a second enterotomy 60 cm cephalad to the previous one and the entire bowel was explored with an intraoperative fiberoptic endoscope. Histology of the parasite revealed a T. solium species. The postoperative course was uneventful and the patient was discharged on postoperative day 10 with a prescription of 2 g/day niclosamide. No recurrent digestive bleeding has so far been reported after a follow-up of 8 months. T. solium infection is a common cause of chronic microcytic anaemia in tropical and subtropical areas. In Western countries intestinal parasite infections are rarely taken into account in the diagnostic work-up of patients affected with chronic anaemia and/or acute digestive bleeding. The mechanisms responsible for acute intestinal bleeding in tapeworm infections are poorly understood and could be related to parasite-induced erosions of the bowel wall or be secondary to manipulations occurring during diagnostic manoeuvres.},
}
@article {pmid15038653,
year = {2004},
author = {Da Rold, AR and Guerriero, S and Fiamingo, P and Pariset, S and Veroux, M and Pilon, F and Tosato, S and Ruffolo, C and Tedeschi, U},
title = {Laparoscopic colorrhaphy, irrigation and drainage in the treatment of complicated acute diverticulitis: initial experience.},
journal = {Chirurgia italiana},
volume = {56},
number = {1},
pages = {95-98},
pmid = {15038653},
issn = {0009-4773},
mesh = {Acute Disease ; Aged ; Aged, 80 and over ; Diverticulitis/complications/*surgery ; Drainage ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/complications/*surgery ; Therapeutic Irrigation ; },
abstract = {The natural history of diverticulosis is worthy of note for its acute, sometimes recurrent, attacks of diverticulitis and the significant risk of serious complications, such as abscess, fistula and peritonitis. Most mild attacks of diverticulitis respond well to medical therapy while surgical treatment is indicated in the complicated forms of the disease. We evaluate the results of treatment of complicated acute diverticulitis by laparoscopic colorrhaphy, irrigation and drainage as a minimal surgical approach in 7 selected patients. We retrospectively analyzed all patients admitted to our institute for acute diverticulitis from 1996 to 2001. One hundred and thirty-five patients were admitted for acute sigmoid diverticulitis. Ninety-eight patients (72%) had their diverticular disease completely resolved after medical therapy, while 37 (28%) required a surgical approach. Seven patients underwent a laparoscopic colorrhaphy with irrigation and drainage. Laparoscopic procedures were completed in 6 patients. No perioperative morbidity or mortality was observed. All patients were discharged with no further re-operation. The technique could be considered a valid alternative for the management of complicated and perforated diverticulitis in selected patients.},
}
@article {pmid15018168,
year = {2003},
author = {Lefere, P and Gryspeerdt, S and Baekelandt, M and Dewyspelaere, J and van Holsbeeck, B},
title = {Diverticular disease in CT colonography.},
journal = {European radiology},
volume = {13 Suppl 4},
number = {},
pages = {L62-74},
pmid = {15018168},
issn = {0938-7994},
mesh = {Adult ; Aged ; Aged, 80 and over ; Biopsy, Needle ; Colonic Diseases/*diagnostic imaging/pathology ; Colonic Neoplasms/diagnostic imaging/pathology ; Colonography, Computed Tomographic/*methods ; Colonoscopy/methods ; Diagnosis, Differential ; Diverticulitis/*diagnostic imaging/pathology ; Diverticulum/*diagnostic imaging/pathology ; Female ; Humans ; Immunohistochemistry ; Intestinal Mucosa/diagnostic imaging/pathology ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Severity of Illness Index ; },
abstract = {The aim of this study was to evaluate findings on CT colonography (CTC) in patients with diverticular disease. In a retrospective analysis of 160 consecutive patients, who underwent CTC and conventional colonoscopy (CC), patients with diverticular disease were retrieved. The CTC images were compared with CC and, if possible, with pathology. Findings on both 2D and 3D images are illustrated with emphasis on diagnostic problems and the possible solutions to overcome these problems. Several aspects of diverticulosis were detected: prediverticulosis (3%); global (55.6%); and focal wall thickening (4%) caused by thickened haustral folds, fibrosis, inflammation and adenocarcinoma; diverticula (52%); pseudopolypoid lesions caused by diverticular fecaliths (39%); inverted diverticula (1.2%); and mucosal prolapse (0.6%). Solutions to overcome pitfalls are described as abdominal windowing, content of the pseudopolypoid lesion, comparison of 2D and 3D images, prone-supine imaging and the aspect of the pericolic fat. In this series there were equivocal findings in case of mucosal prolapse (0.6%) and focal wall thickening (4%). Diverticulosis is a challenge for CTC to avoid false-positive diagnosis of polypoid and tumoral disease. Knowledge of possible false causes of polypoid disease and comparison of 2D and 3D images are necessary to avoid false-positive diagnosis. In case of equivocal findings additional conventional colonoscopy should be advised whenever a clinically significant lesion (> or = 1 cm) is suspected.},
}
@article {pmid15012168,
year = {2004},
author = {Kang, JY and Melville, D and Maxwell, JD},
title = {Epidemiology and management of diverticular disease of the colon.},
journal = {Drugs & aging},
volume = {21},
number = {4},
pages = {211-228},
pmid = {15012168},
issn = {1170-229X},
mesh = {Age Factors ; Colonography, Computed Tomographic ; Diverticulosis, Colonic/*epidemiology/pathology/*surgery ; Female ; Humans ; Male ; },
abstract = {Colonic diverticula are protrusions of the mucosa through the outer muscular layers, which are usually abnormally thickened, to form narrow necked pouches. Diverticular disease of the colon covers a wide clinical spectrum: from an incidental finding to symptomatic uncomplicated disease to diverticulitis. A quarter of patients with diverticulitis will develop potentially life-threatening complications including perforation, fistulae, obstruction or stricture. In Western countries diverticular disease predominantly affects the left colon, its prevalence increases with age and its causation has been linked to a low dietary fibre intake. Right-sided diverticular disease is more commonly seen in Asian populations and affects younger patients. Its pathogenesis and relationship to left-sided diverticular disease remains unclear. Diverticular disease of the colon is a significant cause of morbidity and mortality in the Western world and its frequency has increased throughout the whole of the 20th century. Since it is a disease of the elderly, and with an aging population, it can be expected to occupy an increasing portion of the surgical and gastroenterological workload. It is uncertain what symptoms uncomplicated diverticular disease gives rise to: there is an overlap with irritable bowel syndrome. Diagnosis is primarily by barium enema and colonoscopy, but more sophisticated imaging procedures such as computed tomography (CT) are increasingly being used to assess and treat complications such as abscess or fistula, or to provide alternative diagnoses if diverticulosis is not confirmed. Initial therapy for uncomplicated diverticulitis is supportive, including monitoring, bowel rest and antibacterials. CT is used to guide percutaneous drainage of abscesses to avoid surgery or allow it to be performed as an elective procedure. Surgery is indicated for complications of acute diverticulitis, including failure of medical treatment, gross perforation, and abscess formation that cannot be resolved by percutaneous drainage. Complications of chronic diverticulitis (fistula formation, stricture and obstruction) are also usually treated surgically. However, the indications for, and the timing and staging of operations for diverticular disease are often difficult decisions requiring sound clinical judgement. Factors such as the number of episodes of inflammation, the age of the patient, and his/her overall medical condition play a role in determining whether or not a patient should undergo surgical resection. Laparoscopic surgery may be associated with less pain, less morbidity and shorter hospital stays, but its exact role is yet to be defined. Diverticular disease of the colon is the most common cause of acute lower gastrointestinal haemorrhage, which can be massive. Although the majority of patients stop bleeding spontaneously, angiographic and surgical treatment may be required, while the place of endoscopic haemostasis remains to be established.},
}
@article {pmid15008903,
year = {2004},
author = {Papagrigoriadis, S and Debrah, S and Koreli, A and Husain, A},
title = {Impact of diverticular disease on hospital costs and activity.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {6},
number = {2},
pages = {81-84},
doi = {10.1111/j.1463-1318.2004.00532.x},
pmid = {15008903},
issn = {1462-8910},
mesh = {Adult ; Aged ; Aged, 80 and over ; Costs and Cost Analysis/economics ; Digestive System Surgical Procedures/methods ; Diverticulosis, Colonic/diagnosis/*economics/*epidemiology/surgery ; Female ; Hospital Costs/*statistics & numerical data ; Hospitals, District/statistics & numerical data ; Humans ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; United Kingdom/epidemiology ; Workload/statistics & numerical data ; },
abstract = {BACKGROUND: Diverticulosis is very common in the UK and patients with clinically significant diverticular disease present regularly to departments of surgery as acute emergencies or chronic problems. There are no national data on the hospital prevalence, clinical implications or financial impact of diverticular disease hence the extent of the clinical problem is as yet not quantified.
AIM: To detect the prevalence, clinical implications and financial impact of diverticular disease over a one year period in a large district hospital.
METHODS: Retrospective review of all patients treated for diverticular disease during one financial year. Clinical and cost analysis of inpatient and outpatient investigations, treatment and hospitalization.
RESULTS: A total of 148 patients were treated of whom 83 were admitted for more than 1 day, 55 of those were emergency admissions. Five of 83 admitted patients died (in-patient mortality 6%, peri-operative mortality 26.3%). There was a total number of 982 hospitalization days of which 94 Intensive Care Unit days and 68 High Dependency Unit days. Nineteen operations were performed (16 sigmoid colectomies, 1 oversewing of perforated sigmoid, 2 reversal of colostomy). The investigations generated were 48 colonoscopies, 77 flexible sigmoidoscopies, 77 Barium enemas, 2 CT scans and 34 ultrasound scans. A total number of 410 clinic appointments were generated. One year after discharge 134/148 (90.5%) patients were alive. The total cost of this activity was pound 465263 or 5.3% of the total annual budget for General Surgery. Seventy percent of the cost was bed-days expenses with ICU hospitalization accounting for 25% of the total cost.
CONCLUSION: Diverticular disease is a major cause of morbidity in a large district hospital and a significant burden on resources. More research should be done on prevention of complications and management in the community. The current methods of management do not appear to be cost-effective and attempts should be made to produce protocols for evidence-based, cost-efficient management of the disease. A UK national audit should be undertaken.},
}
@article {pmid14994146,
year = {2004},
author = {Shafik, A and Ahmed, I and Shafik, AA and El Sibai, O},
title = {Diverticular disease: electrophysiologic study and a new concept of pathogenesis.},
journal = {World journal of surgery},
volume = {28},
number = {4},
pages = {411-415},
pmid = {14994146},
issn = {0364-2313},
mesh = {Action Potentials ; Adult ; Colon, Sigmoid/*physiopathology ; Diverticulum, Colon/*physiopathology ; Electromyography ; Female ; Gastrointestinal Motility/*physiology ; Humans ; Male ; Middle Aged ; Pressure ; },
abstract = {The cause of diverticular disease (DD) is not exactly known, although colonic motor disorder has been proposed as a factor in the pathogenesis of the condition. We investigated the hypothesis that disordered colonic electrical activity is responsible for the colonic motor dysfunction and the development of DD. The electromyographic (EMG) activity and pressure of the sigmoid colon (SC) were recorded in 36 patients [16 early cases, 20 advanced cases; age (mean +/- SD) 53.3 +/- 5.6 years; 19 women, 17 men] and 22 healthy volunteers. The percutaneous route was used for recording the SC EMG. The healthy volunteers exhibited SC slow waves with a regular rhythm and the same frequency, amplitude, and conduction velocity from the three electrodes in the same subject. The SC basal pressure (7.9 cm H(2)O) was interrupted by bouts of high pressure (26.8 cm H(2)O). The early-DD cases showed slow waves with an irregular rhythm and significantly higher variables (p < 0.05) than the volunteers. Action potentials followed randomly or were superimposed on the slow waves. The SC basal pressure was significantly higher than that of the volunteers (21.4 cm H(2)O, p < 0.01). Bouts of pressure (58.6 cm H(2)O) coupled with action potentials were recorded. No waves were recorded from 15 of 20 of the advanced-DD patients. In 5 patients, slow waves with an irregular rhythm and lower variables (p < 0.05) than those of the volunteers were recorded. The basal SC pressure was significantly above normal. Three electrical activity patterns could be identified in DD patients: "tachyrhythmic" in the early-DD patients and "bradyrhythmic" or "silent" in the late-DD patients. These dysrhythmias may result from a disordered colonic pacemaker. The similarity between early DD and the irritable bowel syndrome suggests that DD is an advanced stage of the irritable bowel syndrome; studies are required to investigate this hypothesis further.},
}
@article {pmid14991500,
year = {2004},
author = {Mimura, T and Bateman, AC and Lee, RL and Johnson, PA and McDonald, PJ and Talbot, IC and Kamm, MA and MacDonald, TT and Pender, SL},
title = {Up-regulation of collagen and tissue inhibitors of matrix metalloproteinase in colonic diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {47},
number = {3},
pages = {371-8; discussion 378-9},
doi = {10.1007/s10350-003-0050-5},
pmid = {14991500},
issn = {0012-3706},
support = {EY-05587/EY/NEI NIH HHS/United States ; },
mesh = {Aged ; Aged, 80 and over ; Case-Control Studies ; Collagen/*metabolism/ultrastructure ; Diverticulosis, Colonic/*metabolism ; Gene Expression ; Humans ; Immunohistochemistry ; Intestinal Mucosa/metabolism ; Matrix Metalloproteinases/genetics/metabolism ; Middle Aged ; RNA, Messenger/metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Staining and Labeling ; Tissue Inhibitor of Metalloproteinases/genetics/*metabolism ; *Up-Regulation ; },
abstract = {PURPOSE: Thickening of the muscularis propria is a key pathologic feature of colonic diverticulosis but its cause is unknown. This study was designed to investigate the role of collagens, matrix metalloproteinases, and tissue inhibitor of metalloproteinases in colonic diverticulosis.
METHODS: Collagen content was determined by Sircol Collagen Assay and standard van Gieson staining. Messenger-RNA expression for matrix metalloproteinases and tissue inhibitor of metalloproteinase was analyzed by quantitative competitive reverse transcription polymerase chain reaction. Immunohistochemical staining was performed to localize tissue inhibitor of metalloproteinases in sections.
RESULTS: In mucosa and submucosal layer, complicated diverticular disease samples had a higher collagen content than uncomplicated disease, which in turn had higher levels than controls. There was an 18-fold increase in tissue inhibitor of metalloproteinase-1 mRNA, and a threefold increase in tissue inhibitor of metalloproteinase-2 mRNA in complicated diverticulosis compared with controls. In the muscularis propria, the amount of total soluble collagen also was higher in both uncomplicated and complicated diverticulosis samples than in the controls. Tissue inhibitor of metalloproteinase-1 and metalloproteinase-2 mRNA was significantly increased in diverticulosis compared with controls. Macrophage-like and fibroblast-like cells stained strongly positive for tissue inhibitor of metalloproteinases in the submucosa, serosa, and muscularis propria and in areas around the blood vessels.
CONCLUSIONS: Colonic diverticulosis is associated with altered collagen content and tissue inhibitor of metalloproteinases expression. These factors may play a role in remodeling the gut wall in this condition.},
}
@article {pmid14987890,
year = {2004},
author = {Stollman, N and Raskin, JB},
title = {Diverticular disease of the colon.},
journal = {Lancet (London, England)},
volume = {363},
number = {9409},
pages = {631-639},
doi = {10.1016/S0140-6736(04)15597-9},
pmid = {14987890},
issn = {1474-547X},
mesh = {*Diverticulosis, Colonic/complications/diagnosis/epidemiology ; Humans ; },
abstract = {Colonic diverticulosis refers to small outpouchings from the colonic lumen due to mucosal herniation through the colonic wall at sites of vascular perforation. Abnormal colonic motility and inadequate intake of dietary fibre have been implicated in its pathogenesis. This acquired abnormality is typically found in developed countries, and its prevalence rises with age. Most patients affected will remain entirely asymptomatic; however, 10-20% of those affected can manifest clinical syndromes, mainly diverticulitis and diverticular haemorrhage. As our elderly population grows, we can anticipate a concomitant rise in the number of patients with diverticular disease. Here, we review the incidence, pathophysiology, clinical presentation, and management of diverticular disease of the colon and its complications.},
}
@article {pmid14986175,
year = {2004},
author = {Brunner, WC and Sierra, R and Dunne, JB and Simmang, CL and Scott, DJ},
title = {Incidental paraduodenal hernia found during laparoscopic colectomy.},
journal = {Hernia : the journal of hernias and abdominal wall surgery},
volume = {8},
number = {3},
pages = {268-270},
pmid = {14986175},
issn = {1265-4906},
mesh = {Colectomy/methods ; Diverticulitis, Colonic/complications/diagnosis ; Duodenal Diseases/*diagnosis/surgery ; Follow-Up Studies ; Hernia/*diagnosis ; Herniorrhaphy ; Humans ; Intestinal Obstruction/etiology/*surgery ; Intraoperative Complications/*diagnosis/surgery ; *Laparoscopy ; Laparotomy/methods ; Male ; Middle Aged ; Risk Assessment ; Severity of Illness Index ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {This paper describes a rare right paraduodenal hernia discovered during an elective laparoscopic colon resection. Our patient was a 60-year-old Asian man with a history of multiple bouts of diverticulitis and a lifelong history of mild constipation and postprandial abdominal pain. Prior CT scans and preoperative barium enema confirmed the diagnosis of diverticular disease, and no other abnormalities were appreciated. At laparoscopic exploration, a right paraduodenal hernia was found with complete herniation of the small intestine under the ascending colon and hepatic flexure. The unclear anatomy prompted conversion to an open laparotomy. This allowed safe reduction of the hernia and sac excision. Adhesions were lysed to relieve a partial duodenal obstruction, and a Ladd's procedure was performed to correct the incomplete rotation. Additionally, a sigmoid colectomy was performed. After prolonged ileus, the patient was discharged on postoperative day 14. At 6-month follow-up, the patient was asymptomatic and doing well.},
}
@article {pmid14985985,
year = {2004},
author = {Schwandner, O and Farke, S and Fischer, F and Eckmann, C and Schiedeck, TH and Bruch, HP},
title = {Laparoscopic colectomy for recurrent and complicated diverticulitis: a prospective study of 396 patients.},
journal = {Langenbeck's archives of surgery},
volume = {389},
number = {2},
pages = {97-103},
pmid = {14985985},
issn = {1435-2443},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; *Postoperative Complications ; Prospective Studies ; Recurrence ; Treatment Outcome ; },
abstract = {BACKGROUND: It was the aim of this prospective study to evaluate the outcome of laparoscopic surgery for diverticular disease.
METHODS: All patients who underwent elective laparoscopic colectomy for diverticular disease within a 10-year period were prospectively entered into a PC database registry. Indications for laparoscopic surgery were acute complicated diverticulitis (Hinchey stages I and IIa), chronically recurrent diverticulitis, sigmoid stenosis or outlet obstruction caused by chronic diverticulitis. Surgical procedures (sigmoid and anterior resection, left colectomy and resection rectopexy) included intracorporeal dissection and colorectal anastomosis. Parameters studied included age, gender, stage of disease, procedure, duration of surgery, intraoperative technical variables, transfusion requirements, conversion rate, total complication rate including major (requiring re-operation), minor (conservative treatment) and late-onset (post-discharge) complication rates, stay on ICU, hospitalisation, mortality, and recurrence. For objective evaluation, only laparoscopically completed procedures were analysed. Comparative outcome analysis was performed with respect to stage of disease and experience.
RESULTS: A total of 396 patients underwent laparoscopic colectomy. Conversion rate was 6.8% (n=27), so that laparoscopic completion rate was 93.2% (n=369). Most common reasons for conversion were directly related to the inflammatory process, abscess or fistulas. The most common procedure was sigmoid resection (n=279), followed by anterior resection (n=36) and left colectomy (n=29). Total complication rate was 18.4% (n=68). Major complication rate was 7.6% (n=28), whereas the most common complication requiring re-operation was haemorrhage in 3.3% (n=12). Anastomotic leakage occurred in 1.6% (n=6). Minor complications were noted in 10.7% (n=40), late-onset complications occurred in 2.7% (n=10). Mortality was 0.5% (n=2). Mean duration of surgery was 193 (range 75-400) min, return to normal diet was completed after 6.8 (range 3-19) days. Mean hospital stay was 11.8 (range 4-71) days. No recurrence of diverticulitis occurred.
CONCLUSION: Laparoscopic surgery for diverticular disease is safe, feasible and effective. Therefore, laparoscopic colectomy has replaced open resection as standard surgery for recurrent and complicated diverticulitis at our institution.},
}
@article {pmid14972273,
year = {2003},
author = {Gady, JS and Reynolds, H and Blum, A},
title = {Selective arterial embolization for control of lower gastrointestinal bleeding: recommendations for a clinical management pathway.},
journal = {Current surgery},
volume = {60},
number = {3},
pages = {344-347},
doi = {10.1016/S0149-7944(02)00749-3},
pmid = {14972273},
issn = {0149-7944},
mesh = {Aged ; Aged, 80 and over ; Angiography ; Colonoscopy ; *Critical Pathways ; Diverticulosis, Colonic/complications ; *Embolization, Therapeutic ; Female ; Gastrointestinal Hemorrhage/diagnosis/etiology/*therapy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {PURPOSE: Angiography remains as the modality of choice in the diagnosis of lower gastrointestinal bleeding. Traditionally, angiography is used for localization of a bleeding source for surgical resection. Advances in transcatheter techniques have allowed for hemorrhage control through embolization of bleeding points, without the need for emergent laparotomy.
METHODS: A series of 10 consecutive patients who underwent angiographic embolization for lower gastrointestinal hemorrhage was retrospectively reviewed. Success and complication rates, as well as post-embolization follow-up methods, were recorded.
RESULTS: Over a 3-year period, 10 angiographic embolizations were performed for lower gastrointestinal hemorrhage. Average age of the patients was 75 years. Source of hemorrhage included diverticular disease in 4 patients, cancer in 2, polyps in 2, angiodysplasia in 1, and anastomotic bleeding in 1. Six patients required no further therapy. Four patients went on to have surgery: Three secondary to recurrent hemorrhage, 1 due to sepsis from ischemic bowel necrosis. There were no deaths. Four patients had an abdominal and pelvic computed tomography (CT) scan within 48 hours of embolization. Four patients had a colonoscopy within 48 hours of the procedure.
CONCLUSIONS: Angiography remains an important diagnostic tool in the management of lower gastrointestinal bleeding. In addition, it is a safe and effective treatment option, especially in patients with high surgical risk. Hemorrhage control obtained in the angiography suite may allow for patient stabilization and resuscitation with staging and bowel preparation for surgery. Patients need to be carefully monitored for evidence of bowel ischemia through the use of colonoscopy or computed tomography.},
}
@article {pmid14725228,
year = {2003},
author = {Piccolini, M and Francia, L and Rosa, C and Battaglia, A and Biandrate, F and Pesenti Campagnoni, A and Pandolfi, U},
title = {[Complicated diverticular disease of the right colon. Diagnostic and therapeutic difficulties: our experience].},
journal = {Chirurgia italiana},
volume = {55},
number = {6},
pages = {871-877},
pmid = {14725228},
issn = {0009-4773},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulosis, Colonic/complications/*diagnosis/*surgery ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {Right colon diverticulitis is an uncommon disease in Western countries. Often the disease is congenital and the clinical manifestations presenting at onset simulate the signs and symptoms typical of other diseases, such as acute appendicitis, appendicular abscess or caecal carcinoma. Since the diagnosis is usually intraoperative, diverticulectomy is recommended only in particular cases, with no complications resulting from inflammatory reactions. In the other cases, right hemicolectomy or segmental resection are the elective surgical treatments, depending on the patient's clinical condition and on the local anatomical situation. The authors describe 8 cases of complicated right colon diverticulitis, one of which with haemorrhagic complications, observed over the period from January 1999 to March 2003. The rareness and diagnostic and therapeutic difficulties of this disease are emphasised.},
}
@article {pmid14724164,
year = {2004},
author = {Bowles, CJ and Leicester, R and Romaya, C and Swarbrick, E and Williams, CB and Epstein, O},
title = {A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?.},
journal = {Gut},
volume = {53},
number = {2},
pages = {277-283},
pmid = {14724164},
issn = {0017-5749},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anesthesia, Intravenous ; Child ; Clinical Competence ; Colonoscopy/adverse effects/mortality/*standards/statistics & numerical data ; Diagnostic Tests, Routine/adverse effects/*standards/statistics & numerical data ; Education, Medical, Continuing ; England ; Female ; Gastrointestinal Hemorrhage/etiology ; *Health Services Accessibility ; Humans ; Intestinal Perforation/etiology ; Male ; Middle Aged ; Prospective Studies ; },
abstract = {AIM: To study the availability and quality of adult and paediatric colonoscopy in three National Health Service (NHS) regions.
METHOD: A prospective four month study of colonoscopies in North East Thames, West Midlands, and East Anglia.
PATIENTS: Subjects undergoing colonoscopy in 68 endoscopy units.
RESULTS: A total of 9223 colonoscopies were studied. The mean number of colonoscopies performed over the four month period was 142 in district general hospitals and 213 in teaching hospitals. Intravenous sedation was administered in 94.6% of procedures, but 2.2% and 11.4% of "at risk" patients did not have continuous venous access or did not receive supplemental oxygen, respectively. Caecal intubation was recorded in 76.9% of procedures but the adjusted caecal intubation rate was only 56.9%. Reasons for failing to reach the caecum included patient discomfort (34.7%), looping (29.7%), and poor bowel preparation (19.6%). A normal colonoscopy was reported in 42.1%. The most common diagnosis was polyps (22.5%) followed by diverticular disease (14.9%). Inflammatory bowel disease was recorded in 13.9% and carcinoma in 3.8%. Only half of the patients remembered being told of possible adverse events prior to the procedure. Rectal bleeding requiring admission following colonoscopy was reported in six patients. The overall perforation rate was 1:769 and colonoscopy was considered a possible factor in six deaths occurring within 30 days of the procedure. Only 17.0% of colonoscopists had received supervised training for their first 100 colonoscopies and only 39.3% had attended a training course.
CONCLUSION: There is serious under provision of colonoscopy service in most NHS hospitals. Endoscopy sedation guidelines are not always adhered to and there is a wide variation in practice between units. Colonoscopy is often incomplete and does not achieve the target 90% caecal intubation rate. Serious complications of colonoscopy were comparable with previous studies. Training in colonoscopy is often inadequate and improved practice should result from better training.},
}
@article {pmid14719512,
year = {2004},
author = {Tan, BK and Tsang, CB and Nyam, DC and Ho, YH},
title = {Management of acute bleeding per rectum.},
journal = {Asian journal of surgery},
volume = {27},
number = {1},
pages = {32-38},
doi = {10.1016/S1015-9584(09)60241-4},
pmid = {14719512},
issn = {1015-9584},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Female ; Gastrointestinal Hemorrhage/epidemiology/etiology/*therapy ; Humans ; Incidence ; Male ; Middle Aged ; Rectal Diseases/epidemiology/etiology/*therapy ; Retrospective Studies ; Singapore/epidemiology ; },
abstract = {BACKGROUND: Bleeding per rectum is a common indication for acute hospital admissions to the colorectal department. The frequencies of aetiologies in Singapore are different from those in Western populations. A retrospective analysis of the demography, pathology and management of acute bleeding per rectum was performed to determine the outcome and difference in aetiology from the West.
METHODS: During the 1-year period from 1 October 1995 to 30 September 1996, 547 patients were admitted to Singapore General Hospital form the emergency department for acute bleeding per rectum. There were 377 males and 170 females; the mean age was 42 years (range, 15-97 years).
RESULTS: Of the patients admitted, 87% wer admitted due to perianal conditions diagnosed at bedside proctoscopy, where haemorrhoids mad up 94%. One percent bled from the upper gastrointestinal tract, while 12% bled from colorectal pathology. Massive bleeding form the colorectum was uncommon. Less than one third of the 47 patients required blood transfusions. Colonoscopy was the most useful diagnostic tool for bleeding from the colorectum. The more common colonic pathologies were diverticular disease (33%), adenomas (18%), and malignancy (26%), accounting for the majority of acute patient admissions. Colonic causes of bleeding were less common and were most stable. There were differences in the frequencies of aetiologies in our population compared ot Western populations. Understanding the common pathologies and outcomes guides the management fo our patients.},
}
@article {pmid14707250,
year = {2003},
author = {Rees, JR and Longstaff, A and Rigby, HL and Smith, DL and Dixon, AR},
title = {An unusual cause for a colonic stricture: a case of Mycobacterium xenopi mimicking malignancy.},
journal = {Postgraduate medical journal},
volume = {79},
number = {938},
pages = {705-706},
pmid = {14707250},
issn = {0032-5473},
mesh = {Colonic Diseases/*diagnostic imaging/microbiology ; Colonic Neoplasms/*diagnostic imaging ; Diagnosis, Differential ; Female ; Humans ; Intestinal Obstruction/*diagnostic imaging/microbiology ; Middle Aged ; Mycobacterium Infections, Nontuberculous/*diagnostic imaging ; *Mycobacterium xenopi ; Radiography ; },
abstract = {Colonic strictures are very common and are a frequent finding on double contrast barium examination; they very often reflect the presence of malignancy, diverticular disease, ischaemia, inflammatory bowel disease, and rarely mycobacterial disease. A case of mycobacterial disease mimicking malignancy is presented; this was due to a rare mycobacterial subtype and there was complete resolution of symptoms with antimycobacterial therapy.},
}
@article {pmid14691707,
year = {2004},
author = {Gonzalez, R and Smith, CD and Mattar, SG and Venkatesh, KR and Mason, E and Duncan, T and Wilson, R and Miller, J and Ramshaw, BJ},
title = {Laparoscopic vs open resection for the treatment of diverticular disease.},
journal = {Surgical endoscopy},
volume = {18},
number = {2},
pages = {276-280},
pmid = {14691707},
issn = {1432-2218},
mesh = {Aged ; Blood Loss, Surgical ; Colectomy/methods/statistics & numerical data ; Diverticulitis, Colonic/*surgery ; Diverticulosis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy/*methods/statistics & numerical data ; *Laparotomy/statistics & numerical data ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Proctocolectomy, Restorative/methods/statistics & numerical data ; Retrospective Studies ; Treatment Outcome ; },
abstract = {INTRODUCTION: The aim of this study was to evaluate whether laparoscopic colon resection (LCR) offers any advantages over open colon resection (OCR) in the treatment of diverticular disease.
METHODS: Between 1992 and 2002, 95 patients underwent LCR and 80 patients underwent OCR for the treatment of diverticular disease. Demographics, details of operative procedure, outcome, and pathology were compared.
RESULTS: Patients in both groups were matched for age, sex, body mass index, history of previous abdominal operations, comorbidities, location of the disease, and presence of complications. LCR resulted in significantly less estimated blood loss and postoperative complications, shorter time to first bowel movement, and shorter length of stay than the OCR. There was no difference in operative time, intraoperative complications, mortality rates between groups.
CONCLUSIONS: LCR is a safe and effective approach for the treatment of patients with diverticular disease. It results in less estimated blood loss, shorter time to first bowel movement, less postoperative complications, and shorter length of hospital stay.},
}
@article {pmid14691702,
year = {2004},
author = {Regan, JP and Salky, BA},
title = {Laparoscopic treatment of enteric fistulas.},
journal = {Surgical endoscopy},
volume = {18},
number = {2},
pages = {252-254},
pmid = {14691702},
issn = {1432-2218},
mesh = {Adult ; Anastomosis, Surgical ; Colectomy ; Colon/surgery ; Colon, Sigmoid/surgery ; Crohn Disease/complications/surgery ; Cutaneous Fistula/surgery ; Diverticulum/complications/surgery ; Female ; Humans ; Intestinal Fistula/etiology/*surgery ; Intestine, Small/surgery ; *Laparoscopy/methods/statistics & numerical data ; Length of Stay ; Male ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Elective laparoscopically assisted sigmoid colectomy for diverticular disease and ileocolic resection for terminal ileal Crohn's disease are safe and beneficial procedures in many patients. However, few data exist regarding the laparoscopic management of enteric fistulas from diverticular and Crohn's disease.
METHODS: We completed a retrospective chart review of patients who underwent laparoscopic treatment of enteric fistulas complicating diverticular and Crohn's disease.
RESULTS: During an 8-year period (1994-2002), 72 patients underwent 73 laparoscopically assisted bowel resections for enteric fistulas by one surgeon at the Mount Sinai Medical Center. Ninety percent of patients had Crohn's disease, the average age was 39, and the male/female ratio was 38/34. Patients had a history of prior abdominal surgery in 39.7% of cases. Multiple fistulas were present in 30% of patients and 12.3% underwent multiple resections at the time of operation. Mean operating time was 199 min, and the conversion rate was 4.1%. Average length of stay was 5.2 days. There were no mortalities in the series. Overall morbidity was 11%.
CONCLUSIONS: Laparoscopic management of enteric fistula disease is safe and effective. Low morbidity and short hospital stay demonstrate the safety and benefit of the minimally invasive approach for even complicated fistula disease in patients with history of prior abdominal surgery and multiple fistulas, or in patients requiring multiple resections for fistulas from diverticular and Crohn's disease.},
}
@article {pmid14680435,
year = {2004},
author = {Tursi, A},
title = {Acute diverticulitis of the colon--current medical therapeutic management.},
journal = {Expert opinion on pharmacotherapy},
volume = {5},
number = {1},
pages = {55-59},
doi = {10.1517/14656566.5.1.55},
pmid = {14680435},
issn = {1465-6566},
mesh = {Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Diverticulitis, Colonic/drug therapy/etiology/*therapy ; Diverticulum, Colon/pathology ; Drug Therapy, Combination ; Humans ; Mesalamine/therapeutic use ; Probiotics/therapeutic use ; },
abstract = {Diverticular disease of the colon is very common in developed countries with its prevalence increasing with age, varying from < 10% in those < 40 years of age, to an estimated 50-66% of patients > 80 years of age. Diverticulitis, defined as inflammation and/or infection associated with diverticula, is the most common clinical complication of this disorder, affecting an estimated 10-25% of patients with colonic diverticula. The therapeutic measures aim at putting the intestine 'at rest', thus resolving the infection, the consequences of the inflammation and preventing or limiting complications. For patients with severe and complicated diverticulitis, ampicillin, gentamicin, metronidazole, piperacillin and tazobactam are the antibiotics successfully used in clinical practice, whereas ciprofloxacin, metronidazole and more recently, rifaximin, have been successfully used in the treatment of uncomplicated diverticular disease. Mesalazine (alone or in association with antibiotics) and probiotics are the two latest therapies for the treatment of diverticulitis which have been developed in the last few years. In fact, the combination of mesalazine and an antibiotic showed significant superiority in improving the severity of symptoms, bowel habits and in preventing symptomatic recurrence of diverticulitis than antibiotics alone, but probiotics also seem to be effective in preventing recurrence of the disease. In light of the excellent results obtained in the treatment of inflammatory bowel disease and irritable bowel syndrome, it is probable that probiotics may be the future best treatment also for mild-to-moderate uncomplicated attacks of acute diverticulitis, especially if used with salycilates.},
}
@article {pmid14678541,
year = {2004},
author = {Brouard, MC and Chavaz, P and Borradori, L},
title = {Acute pustulosis of the legs in diverticulitis with sigmoid stenosis: an overlap between bowel-associated dermatosis-arthritis syndrome and pustular pyoderma gangrenosum.},
journal = {Journal of the European Academy of Dermatology and Venereology : JEADV},
volume = {18},
number = {1},
pages = {89-92},
doi = {10.1111/j.1468-3083.2004.00712.x},
pmid = {14678541},
issn = {0926-9959},
mesh = {Acute Disease ; Aged ; Arthritis/*pathology ; Diagnosis, Differential ; Diverticulitis/*pathology ; Fatal Outcome ; Female ; Humans ; Intestinal Obstruction/*pathology ; Leg Dermatoses/*pathology ; Pyoderma Gangrenosum/*pathology ; Sigmoid Diseases/*pathology ; Syndrome ; },
abstract = {BACKGROUND: Bowel-associated dermatosis-arthritis syndrome denotes the occurrence of diarrhoea with arthritis and skin lesions related to bowel disease with or without bowel bypass. In this condition, the histological finding of cutaneous aseptic neutrophilic cell infiltrate is non-specific and common to a wide spectrum of neutrophilic dermatoses, including pyoderma gangrenosum.
OBSERVATION: We describe a 78-year-old woman with fever, abdominal discomfort and arthralgias, who developed grouped pustular lesions on her shins with histologically spongiform pustule formation. Aetiological assessment disclosed diverticular disease with sigmoid stenosis.
CONCLUSION: Although clinical and histological features in our case fit the diagnosis of bowel-associated dermatosis-arthritis syndrome, they may also correspond to a pustular variant of pyoderma gangrenosum. Our observation raises the question of the nosological classification of bowel-associated dermatosis-arthritis syndrome within the spectrum of neutrophilic diseases.},
}
@article {pmid14672789,
year = {2003},
author = {West, SD and Robinson, EK and Delu, AN and Ligon, RE and Kao, LS and Mercer, DW},
title = {Diverticulitis in the younger patient.},
journal = {American journal of surgery},
volume = {186},
number = {6},
pages = {743-746},
doi = {10.1016/j.amjsurg.2003.08.022},
pmid = {14672789},
issn = {0002-9610},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diverticulosis, Colonic/*diagnosis/surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; },
abstract = {BACKGROUND: The purpose of this study was to examine the presentation of diverticulitis at an urban county hospital serving predominantly indigent patients and to analyze the differences, if any, in presentation and treatment in younger patients.
METHODS: A retrospective review of medical records from 1995 to 2001 was performed at a single institution to identify patients admitted to the surgical service with the diagnosis of diverticular disease. Inclusion criteria were either diverticulitis confirmed at operation or radiographic findings consistent with the disease. Patient demographics, history, pertinent physical findings, and treatment were recorded. The data were analyzed after dividing the patients into two populations: a younger population 50 years of age or less, and a second population of patients older than 50.
RESULTS: During the interval, a total of 64 patients were admitted to the surgical service with the diagnosis of diverticulitis. The mean age of this population was 45.5 years (range 21 to 86). Forty-six patients were under 50 years of age (72%). Analysis of sex differences, type and timing of surgical procedure, and complication rate with respect to age showed no significant difference between the two age groups.
CONCLUSIONS: We are clearly treating a younger patient population than previous reports on patients with diverticulitis. Although there was a trend toward increased surgical intervention in the younger population, this number did not reach statistical significance. Diverticulitis in young patients at our institution does not appear to take a more aggressive course than the same disease in older patients.},
}
@article {pmid14672782,
year = {2003},
author = {Bahadursingh, AM and Virgo, KS and Kaminski, DL and Longo, WE},
title = {Spectrum of disease and outcome of complicated diverticular disease.},
journal = {American journal of surgery},
volume = {186},
number = {6},
pages = {696-701},
doi = {10.1016/j.amjsurg.2003.08.019},
pmid = {14672782},
issn = {0002-9610},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/complications/*diagnosis/pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Diverticular disease is a common entity. The presentation, investigations performed, and management are variable. Our objectives were to assess the presentation, extent of disease, and treatment of a cohort of patients with colonic diverticulitis.
METHODS: All patients with a diagnosis of diverticulitis over a 9-year period were reviewed. Patients were assessed as to age, sex, presenting symptoms, diagnostic studies, extent of disease, treatment, and outcome.
RESULTS: Over a 9-year period (1992 to 2001), 192 patients were admitted with a diagnosis of colonic diverticulitis. The mean age was 61 years (range 28 to 90); 113 of 192 (59%) were female. The mean duration of symptoms prior to presentation was 14 days (range 1 to 270 days). One hundred eighteen of 192 (61%) had a previous documented attack of diverticulitis. Of the investigations performed 128 of 192 (66.7%) had a computed tomography (CT) scan of the abdomen and pelvis, 37 of 192 (20%) underwent a contrast enema, 61 of 192 (32%) underwent colonoscopy and 2 of 192 (1%) underwent a small bowel series. The abnormal findings on the CT scan were as follows: diverticular abscess (16%), diverticulitis (37%), diverticulosis without inflammation (15%), free air (10%) and fistula (1%). The locations of the diverticular abscesses were: pelvic (36%), pericolic sigmoid (36%), and "other," which included interloop (28%). Preoperative abscess drainage occurred in 10 of 192 (5%), which were either percutaneous, 6 of 192 (3%), or transrectal, 4 of 192 (2%). Nine of 192 (6%) presented with a fistula, colovesical fistulae (3%), colocutaneous (1%), enterocolic (1%), or colovaginal (1%). Overall, 73 of 192 (38%) underwent surgery. All patients undergoing surgery had a resection of their colon. The operative findings were localized abscess in 16 of 73 (22%), purulent/feculent peritonitis in 12 of 73 (17%), and phlegmon in 10 of 73 (14%). Sixty-seven of 73 (92%) had a primary resection with anastomosis; 38 of 67 (56%) had a protecting stoma. Five of 73 (7%) patients were found to have an unsuspected carcinoma. Overall, 29 of 192 (15%) developed a complication related to diverticulitis. Morbidity was 15.1%, of which 34% was infection related. Four of 192 patients (2%) died.
CONCLUSIONS: In our experience, most patients presented with abdominal pain predominantly in the left lower quadrant. The symptoms were present on average of 14 days, most were female (59%), and most patients had a previous attack of diverticulitis. The commonest investigation performed was a CT scan (66.7%); however, other investigations were performed, for example, barium enemas. The practice of resection and primary anastomosis for acute diverticulitis has an acceptable morbidity and mortality. For high-risk anastomoses, a covering loop ileostomy and not a Hartmann's procedure is preferred. Surgery remains safe for the majority of patients and is associated with resolution of symptoms. We believe that because of the high number of patients in our series who had a previous attack of diverticulitis, therapy should be focused on preventing recurrent and virulent attacks by earlier operative intervention.},
}
@article {pmid14639493,
year = {2004},
author = {Pessaux, P and Muscari, F and Ouellet, JF and Msika, S and Hay, JM and Millat, B and Fingerhut, A and Flamant, Y},
title = {Risk factors for mortality and morbidity after elective sigmoid resection for diverticulitis: prospective multicenter multivariate analysis of 582 patients.},
journal = {World journal of surgery},
volume = {28},
number = {1},
pages = {92-96},
pmid = {14639493},
issn = {0364-2313},
mesh = {Aged ; Colon, Sigmoid/*surgery ; Digestive System Surgical Procedures/*adverse effects/*mortality ; Diverticulitis/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Preoperative Care ; Prospective Studies ; Risk Factors ; },
abstract = {The prevalence of diverticular disease of the colon is increasing in occidental countries. It would be useful to further decrease the mortality and morbidity after elective sigmoid resection (ESR) for diverticulitis. The aim of this study was to identify modifiable preoperative and intraoperative risk factors for mortality and morbidity after ESR for diverticulitis. A database of 2615 patients who underwent a colon or rectal resection with primary anastomosis between 1985 to 1998 has been constructed from prospective randomized studies published by a French surgical group. Of those patients, 582 had undergone ESR for diverticulitis, and they constitute the population of the present study. A total of 46 potential preoperative and intraoperative risk factors for mortality and morbidity have been studied by univariate and multivariate analysis. The operative mortality for our series was 1.2%, and the overall morbidity was 24.9%. The multivariate analysis revealed two statistically significant independent risk factors of mortality: age >75 (odds-ratio=7.9; 95% confidence interval [CI 1.7-36.6]; p=0.01) and obesity (odds-ratio=5.2; 95% CI [1.1-27.9]; p=0.04). The abdominal morbidity (AM) was 6.5% (38/582). The absence of antimicrobial prophylaxis administration with ceftriaxone was the only significant risk factor for AM in multivariate analysis (p=0.003; odds-ratio=2; 95% CI [1.1-4]). The extraabdominal morbidity (EAM) was 18.4% (107/582). Both chronic pulmonary disease (p=0.008; odds-ratio=2.9; 95% CI [1.4-6]; p=0.008) and cirrhosis (odds-ratio=12; 95% CI [1.2-120]) proved to be significant risk factors for EAM. Weight control prior to surgery, routine administration of prophylactic preoperative antibiotics, and preoperative optimization of the respiratory status of patients with chronic pulmonary disease could decrease the postoperative mortality and morbidity associated with ESR for diverticulitis.},
}
@article {pmid14633952,
year = {2003},
author = {Morris, CR and Harvey, IM and Stebbings, WS and Speakman, CT and Kennedy, HJ and Hart, AR},
title = {Do calcium channel blockers and antimuscarinics protect against perforated colonic diverticular disease? A case control study.},
journal = {Gut},
volume = {52},
number = {12},
pages = {1734-1737},
pmid = {14633952},
issn = {0017-5749},
mesh = {Adult ; Aged ; Aged, 80 and over ; Calcium Channel Blockers/*therapeutic use ; Case-Control Studies ; Diverticulum, Colon/*prevention & control ; Female ; Humans ; Intestinal Perforation/*prevention & control ; Male ; Middle Aged ; Muscarinic Antagonists/*therapeutic use ; },
abstract = {BACKGROUND: The aetiology of perforated colonic diverticular disease (PCDD) remains largely unknown. Perforation may result from a combination of high intracolonic pressures, secondary to excessive colonic segmentation, and impairment of the mucosal barrier. Calcium channel blockers and antimuscarinic drugs, which reduce colonic contractility and tone, could potentially protect against perforation. The aim of this study was to test this hypothesis using a case control design.
METHODS: All cases of acute PCDD were identified over a five year period in two hospitals in Norfolk, UK. Each case was matched for age, sex, and date of admission to two controls groups: (1) patients undergoing cataract surgery and (2) patients with basal cell carcinoma. Data on drug use prior to hospital admission were obtained from medical and nursing records and compared between cases and controls.
RESULTS: A total of 120 cases of PCDD were identified and matched to 240 controls in each group. A statistically significant protective association was seen between calcium channel blocker use and PCDD using both control groups. The odds ratios were 0.41 (95% confidence interval (CI) 0.18-0.93) using the ophthalmology control group and 0.36 (95% CI 0.16-0.82) using the dermatology control group.
CONCLUSIONS: This study has shown for the first time that a protective association exists between calcium channel blockers and PCDD. The validity of this association is supported by the consistent finding in both control groups and the plausible biological mechanisms. Further studies are required to confirm this association but calcium channel blockers may represent a potential preventive therapy in PCDD.},
}
@article {pmid14628865,
year = {2003},
author = {Yamaguchi, T and Yoshikawa, K},
title = {Enhanced CT for initial localization of active lower gastrointestinal bleeding.},
journal = {Abdominal imaging},
volume = {28},
number = {5},
pages = {634-636},
doi = {10.1007/s00261-002-0099-y},
pmid = {14628865},
issn = {0942-8925},
mesh = {Adult ; Aged ; Contrast Media ; Female ; Gastrointestinal Hemorrhage/*diagnostic imaging/etiology ; Humans ; Male ; Middle Aged ; *Tomography, X-Ray Computed ; },
abstract = {BACKGROUND: Active lower gastrointestinal (GI) bleeding is a potentially dangerous situation because patients with this condition may fall into shock. Colonoscopy, angiography, and scintigraphy have been used widely to localize the source of bleeding, but time is needed to perform these examinations. The purpose of this study was to illustrate how vividly enhanced computed tomography (CT) may show active lower GI bleeding in a short time.
METHODS: Five of 10 patients with active lower GI bleeding underwent dynamic enhanced CT. Scans were obtained 0.5 and 5 min after intravenous contrast.
RESULTS: Pooling of contrast medium was found in four of five patients. Among the five patients, three had diverticular disease of the colon, one had a rectal ulcer, and one had a small intestinal ulcer. The localization procedure completed within 15 min in all patients. Extravasations of medium were confirmed by two surgeons.
CONCLUSION: Enhanced helical CT was useful for the detection of an active lower GI bleeding source. The procedure was brief, less invasive, and less demanding. Enhanced CT may be the first step for diagnosing lower GI tract bleeding.},
}
@article {pmid14625722,
year = {2004},
author = {Kercher, KW and Nguyen, TH and Harold, KL and Poplin, ME and Matthews, BD and Sing, RF and Heniford, BT},
title = {Plastic wound protectors do not affect wound infection rates following laparoscopic-assisted colectomy.},
journal = {Surgical endoscopy},
volume = {18},
number = {1},
pages = {148-151},
pmid = {14625722},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*instrumentation ; Colonic Neoplasms/surgery ; Colonic Polyps/surgery ; Crohn Disease/surgery ; Diverticulosis, Colonic/surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Neoplasm Seeding ; Retrospective Studies ; Surgical Wound Infection/*prevention & control ; Treatment Outcome ; },
abstract = {BACKGROUND: Wound protectors are plastic sheaths that can be used to line a wound during surgery. Wound protectors can facilitate retraction of an incision without the need for other mechanical retractors and have been proposed as deterrents to wound infection. The purpose of this study was to define the ability of wound protectors to reduce the rate of infection when used in laparoscopic-assisted colectomy.
METHODS: We completed a retrospective review of the medical records of patients undergoing nonemergent laparoscopic-assisted colectomy between February 1999 and November 2002. All completely laparoscopic cases were excluded. The wound protector, when used, was applied to the extraction incision during the externalized portion of the procedure (colon and mesentery transection, anastomosis). Outcomes for patients with and without the use of a wound protector were compared.
RESULTS: A total of 141 patients underwent laparoscopic-assisted colectomy (98 for benign/malignant tumors, 35 for diverticular disease, and eight for Crohn's disease). There were no differences between the wound protector group (n = 84) and the no wound protector group (n = 57) with respect to mean age (55 vs 58 years), average body mass index (27 vs 29 kg/m2), gender, indication for surgery, comorbidities, antibiotics used, or mean operative time (185 vs 173 min). Nine patients in the wound protector group and eight in the no wound protector group developed a wound infection at the colon extraction site (p = 0.42). Patients undergoing resection for Crohn's disease or diverticulitis had a higher infection rate (18.6%) than patients undergoing resection for polyps or cancer (9.2%; p < 0.05). No wound recurrence of cancer was observed in either group at a mean follow-up of 23 months (range, 3-48).
CONCLUSIONS: The wound protector, although useful for mechanical retraction of small wounds, does not significantly diminish the rate of wound infection at the bowel resection/anastomotic site. Patients undergoing elective resection for inflammatory processes have higher infection rates than patients undergoing laparoscopic-assisted colectomy for polyps or cancer.},
}
@article {pmid14617236,
year = {2003},
author = {Chung, CC and Tsang, WW and Kwok, SY and Li, MK},
title = {Laparoscopy and its current role in the management of colorectal disease.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {5},
number = {6},
pages = {528-543},
doi = {10.1046/j.1463-1318.2003.00545.x},
pmid = {14617236},
issn = {1462-8910},
mesh = {Colonic Diseases/*surgery ; Colonic Neoplasms/surgery ; Contraindications ; Diverticulitis, Colonic/surgery ; Humans ; Inflammatory Bowel Diseases/surgery ; *Laparoscopy ; Neoplasm Recurrence, Local ; Rectal Diseases/*surgery ; Rectal Neoplasms/surgery ; Treatment Outcome ; },
abstract = {OBJECTIVE: To evaluate the current place of laparoscopy in the management of colorectal disease.
METHOD: A literature search was undertaken on Medline between the period 1991 and 2002.
RESULTS: From the literature there is good evidence that the laparoscopic approach is associated with at least some short-term advantages. Improved cosmesis and better patient's satisfaction are also evident. Because of this laparoscopy has been widely employed in various benign conditions. Among others, laparoscopic stoma formation, laparoscopic resection for diverticular disease and Crohn's disease, laparoscopic rectopexy, as well as laparoscopic assisted reversal of Hartmann's procedure were commonly reported. As port site recurrence and oncological safety are of less concern, there have been increasing reports on laparoscopic resection for colorectal cancer. Although long-term follow up data is still limited, results of large prospective studies as well as various randomized trials show that recurrence and survival rates of the laparoscopic approach were at least comparable to open surgery. As experience and confidence accumulates, there are also increasing reports on technically demanding, laparoscopic sphincter-saving rectal excision. Articles on functional aspects following this type of resection also start to appear, which might be one of the future directions.
CONCLUSION: The applicability of laparoscopy to colorectal disease continues to expand. Laparoscopic approach should be considered for patients with benign conditions. For colorectal cancer, results from randomized trials so far have been favourable. Hence, the authors suggest the utility of laparoscopy in potentially curable cancer can also be judiciously relaxed.},
}
@article {pmid14609864,
year = {2003},
author = {Guller, U and Jain, N and Hervey, S and Purves, H and Pietrobon, R},
title = {Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {138},
number = {11},
pages = {1179-1186},
doi = {10.1001/archsurg.138.11.1179},
pmid = {14609864},
issn = {0004-0010},
mesh = {Age Distribution ; Colectomy/mortality/*statistics & numerical data ; Databases as Topic ; Diverticulosis, Colonic/*epidemiology ; Female ; Humans ; Laparoscopy/mortality/*statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Patient Discharge/statistics & numerical data ; Retrospective Studies ; Treatment Outcome ; United States/epidemiology ; },
abstract = {HYPOTHESIS: Laparoscopic colectomy has significant advantages over open colectomy in the treatment of diverticular disease with respect to the length of hospital stay, routine hospital discharge, and postoperative morbidity and mortality.
DESIGN: Retrospective secondary data analysis.
PATIENTS AND SETTING: Patients with primary International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for laparoscopic (709 patients [3.8%]) and open sigmoid resection (17 735 patients [96.2%]) were selected from the 1998, 1999, and 2000 Nationwide Inpatient Samples. These databases represent 20% stratified probability samples of all US community hospital discharges. Sampling weights were used to allow generalization of the study findings to the overall US population. Multiple linear and logistic regression analyses were performed to assess the risk-adjusted association between the surgery type and patient outcomes.
MAIN OUTCOME MEASURES: Length of hospital stay, in-hospital complications, in-hospital mortality, and the rate of routine discharge.
RESULTS: The patients had a mean age of 59.8 years; they were preponderantly white (89.1%) and female (54.0%). After adjusting for other covariates, laparoscopic sigmoidectomy was associated with a shorter mean hospital stay (laparoscopic sigmoidectomy vs open sigmoidectomy, 7.47 vs 9.37 days; P<.001), fewer gastrointestinal tract complications (odds ratio, 0.57; 95% confidence interval, 0.35-0.93; P =.03), a lower overall complication rate (odds ratio, 0.64; 95% confidence interval, 0.47-0.88; P =.007), and a higher routine hospital discharge rate (odds ratio, 2.21; 95% confidence interval, 1.51-3.21; P<.001).
CONCLUSION: Laparoscopic sigmoid resection in patients with diverticular disease has statistically and clinically significant advantages over open sigmoid resection with respect to the length of hospital stay, rate of routine hospital discharge, and postoperative in-hospital morbidity.},
}
@article {pmid14605562,
year = {2003},
author = {Zorcolo, L and Covotta, L and Carlomagno, N and Bartolo, DC},
title = {Toward lowering morbidity, mortality, and stoma formation in emergency colorectal surgery: the role of specialization.},
journal = {Diseases of the colon and rectum},
volume = {46},
number = {11},
pages = {1461-7; discussion 1467-8},
doi = {10.1007/s10350-004-6793-9},
pmid = {14605562},
issn = {0012-3706},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/methods ; Colectomy/*methods ; Colonic Diseases/mortality/pathology/*surgery ; Colorectal Surgery/adverse effects/methods/*mortality ; Emergency Treatment/*methods ; Female ; Humans ; Male ; Middle Aged ; Morbidity ; Patient Selection ; Postoperative Complications ; Rectal Diseases/mortality/pathology/*surgery ; Retrospective Studies ; Surgical Stomas/statistics & numerical data ; Survival Rate ; Treatment Outcome ; },
abstract = {INTRODUCTION: Surgical management of left-sided large bowel emergencies has been evolving toward single-staged procedures. Selection for single or staged resection remains the most controversial issue.
METHODS: The results from a series of 336 emergency colorectal procedures performed between January 1990 and December 2000 for cancer and diverticular disease by two different surgical units in one hospital are reported: one with a specific interest in colorectal surgery, and one specialized in upper gastrointestinal surgery.
RESULTS: A primary anastomosis was performed in 142 (64.3 percent) patients by colorectal surgeons and in 42 (36.5 percent) by noncolorectal surgeons (P < 0.0001). The overall morbidity and mortality rates were lower for colon and rectal surgeons (14.5 vs. 24.3 percent and 10.4 vs. 17.4 percent, respectively). Trainees were more likely to perform anastomoses when assisted by colorectal consultants (72.1 percent of cases) than when a noncolorectal consultant was present (47.5 percent of cases; P < 0.05). The 30-day mortality for patients with primary anastomosis was 6 percent, and anastomotic dehiscence occurred in nine (4.9 percent) patients. The mortality for patients undergoing staged resections (21.1 percent) was significantly higher than those who had primary resections performed (P < 0.001).
CONCLUSIONS: Primary anastomosis for left-sided colorectal diseases can be performed with low morbidity and mortality in selected patients. Specialization increased anastomotic rates and reduced morbidity. This study suggests that colon and rectal surgeons should manage colorectal emergencies, and trainees should not be left unsupervised.},
}
@article {pmid14603161,
year = {2003},
author = {Lezoche, E and Feliciotti, F and Guerrieri, M and Paganini, AM and De Sanctis, A and Campagnacci, R and D'Ambrosio, G},
title = {Laparoscopic versus open hemicolectomy.},
journal = {Minerva chirurgica},
volume = {58},
number = {4},
pages = {491-502, 502-7},
pmid = {14603161},
issn = {0026-4733},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Colonic Diseases/*surgery ; Colonic Neoplasms/surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Survival Analysis ; Treatment Outcome ; },
abstract = {AIM: In the last decade, laparoscopic procedures are applied to the treatment of almost all colonic diseases, including both benign and malignant lesions. Focusing our attention to the laparoscopic operative technique, we compare the perioperative results and the oncological outcomes of laparoscopic hemicolectomy with those after open conventional hemicolectomy.
METHODS: This prospective non randomized study is based on a series of 469 consecutive patients (73.6% with malignant lesions) operated on by the same surgical team following the same type of surgical technique, for laparoscopic and open approach, to perform right (RH) and left (LH) hemicolectomy, respectively, excluding segmental resections, emergency operations as well as transverse colon, splenic flexure and recurrent carcinomas. The treatment modality was selected by the patients after reading the informed consent form. Conversion rate to open surgery (for the laparoscopic group) and causes were assessed. Statistical significance (p) for operative time, resumption of gastrointestinal functions, length of stay, complications, perioperative mortality, as well as length of specimen, number of lymph-nodes harvest, incidence of local recurrences and distant metastases, and survival probability analysis in malignant cases, was assessed between the 2 groups (laparoscopic and open).
RESULTS: From March 1992 to February 2003, 166 patients underwent RH and 303 LH. In the RH group, 108 patients underwent laparoscopic approach and 58 underwent open surgery (26 vs 13 for benign lesions and 82 vs 45 for adenocarcinomas, respectively). LH was performed by laparoscopy in 202 patients and by laparotomy in 101 (55 vs 30 for benign lesions and 147 vs 71 for adenocarcinomas, respectively). There were no conversions to open surgery in laparoscopic RH, while 10 patients (4.9%) in the laparoscopic LH group required conversion: 3 of 34 performed for diverticular disease and 7 of 147 performed for malignancy. Mean operative time for laparoscopic surgery was longer than for open surgery (182 vs 140 min for RH and 222 vs 190 min for LH, respectively), but with increasing experience this decreased significantly. Mean hospital stay in patients who underwent laparoscopic procedures was significantly shorter both in RH and LH groups (9.2 vs 13.2 days and 9.9 vs 13.2 days, respectively). Similar major complication rates were observed between the 2 laparoscopic and open groups (1.8% vs 1.7% for RH and 4.1% vs 4.9% for LH, respectively). Follow-up time ranged between 12 and 109 months (mean, 57.3 months) in RH groups and between 12 and 111 months (mean, 57.5 months) in LH groups. The follow-up dropout was of only 3 patients after RH (in the laparoscopic group) and 5 after LH (3 in the laparoscopic group and 2 in the open group). The local recurrence rate was lower after laparoscopic surgery in both arms (7% vs 8.8% for RH and 3.3% vs 7% for LH, respectively), but the differences were not statistically significant. Two port site recurrences were observed in the laparoscopic groups, 1 after a Dukes D palliative RH and 1 after a Dukes C LH converted to open surgery (1.7% and 0.9%, respectively). Metachronous metastases rates were similar between the laparoscopic and open groups (20.9% vs 17.6% for RH and 4.4% vs 5.3% for LH, respectively). Cumulative survival probability (CSP) at 72 months after laparoscopic RH was 0.791 as compared to 0.765 after open surgery (p=0.326) and 0.956 after laparoscopic LH as compared to 0.877 after open surgery (p=0.115). CSP for Dukes stage A, B and C in the laparoscopic RH group was 0.875, 0.846, and 0.727 as compared to 0.9 (p=0.815), 0.889 (p=0.87), and 0.6 (p=0.183) after open surgery, respectively. CSP for Dukes stage A, B and C in the laparoscopic LH group was 0.1, 0.966, and 0.885 as compared to 0.1 (p=0.936), 0.944 (p=0.466), and 0.7 (p=0.072) after open surgery, respectively.
CONCLUSION: These results suggest that laparoscopic hemicolectomy for both benign and malignant lesions can be performed safely. Oncological outcomes were comparable with those of open surgery.},
}
@article {pmid14595301,
year = {2003},
author = {Kaffes, AJ and Mishra, A and Ding, SL and Hope, R and Williams, SJ and Gillespie, PE and Bourke, MJ},
title = {A prospective trial of variable stiffness pediatric vs. standard instrument colonoscopy.},
journal = {Gastrointestinal endoscopy},
volume = {58},
number = {5},
pages = {685-689},
doi = {10.1016/s0016-5107(03)02017-0},
pmid = {14595301},
issn = {0016-5107},
mesh = {Cecal Diseases/diagnosis ; Cecum ; *Colonoscopes ; Diverticulosis, Colonic/diagnosis ; Equipment Failure ; Female ; Humans ; Intubation, Gastrointestinal ; Male ; Middle Aged ; Prospective Studies ; Time Factors ; },
abstract = {BACKGROUND: The pediatric variable stiffness colonoscope is believed to have theoretical advantages over the standard colonoscope, however a systematic evaluation of this instrument in routine clinical practice involving adult patients is lacking.
METHODS: Consecutive patients (blinded) undergoing colonoscopy in an outpatient endoscopy center by one of 4 experienced colonoscopists had the procedure performed with a standard colonoscope (n=384) or pediatric variable stiffness colonoscope (n=413). Failure to negotiate the sigmoid colon within 10 minutes was regarded as a failure and, if suitable, the patient was crossed over to colonoscopy with the alternative instrument.
RESULTS: Median (95% CI) time to the cecum was significantly faster in the pediatric variable stiffness colonoscope group (odds ratio 5.0: 95% CI[4.7,5.3] minutes) compared with the standard colonoscope group (odds ratio 5.5: 95% CI[5.2,5.8] minutes, p=0.01). There were 22 failures overall (2.8%), 14 in the standard colonoscope group (3.6%) and 8 in the pediatric variable stiffness colonoscope group (1.9%; p=0.1). With regard to the 14 failures in the standard colonoscope group, colonoscopy was attempted with the pediatric variable stiffness colonoscope in 13 and completed successfully in 12 (92%). The pediatric variable stiffness colonoscope was superior in cases of severe stenosing diverticular disease; two of 27 examinations with the pediatric variable stiffness colonoscope were rated as failed vs. 12 of 18 with the standard colonoscope (p<0.001).
CONCLUSIONS: Intubation time was faster with the pediatric variable stiffness colonoscope, but use of this instrument was not associated with a superior cecal intubation rate compared with the standard colonoscope. However, in patients with severe stenosing diverticular disease, the intubation rate with the pediatric variable stiffness colonoscope was superior.},
}
@article {pmid14562365,
year = {2003},
author = {Bassotti, G and Chistolini, F and Morelli, A},
title = {Pathophysiological aspects of diverticular disease of colon and role of large bowel motility.},
journal = {World journal of gastroenterology},
volume = {9},
number = {10},
pages = {2140-2142},
pmid = {14562365},
issn = {1007-9327},
mesh = {Colon/*physiopathology ; Diverticulosis, Colonic/*physiopathology ; Gastrointestinal Motility/*physiology ; Humans ; },
abstract = {Colonic diverticular disease (diverticulosis) is one of the most common gastrointestinal disorders in Western countries. This disorder is strictly related to aging and fibre intake, and still bears a discrete amount of morbidity. Numerous etiological co-factors have to date been implicated in the pathogenesis of the disease, yet the supporting evidence is still far from absolute. The present review considers the pathophysiology of colonic diverticular disease, with a special emphasis on factors related to abnormal colonic motility.},
}
@article {pmid14532771,
year = {2003},
author = {Golijanin, D and Yossepowitch, O and Beck, SD and Sogani, P and Dalbagni, G},
title = {Carcinoma in a bladder diverticulum: presentation and treatment outcome.},
journal = {The Journal of urology},
volume = {170},
number = {5},
pages = {1761-1764},
doi = {10.1097/01.ju.0000091800.15071.52},
pmid = {14532771},
issn = {0022-5347},
mesh = {Adult ; Aged ; Aged, 80 and over ; BCG Vaccine/therapeutic use ; Carcinoma, Squamous Cell/*diagnosis/mortality/pathology/surgery ; Carcinoma, Transitional Cell/*diagnosis/mortality/pathology/surgery ; Cohort Studies ; Combined Modality Therapy ; Cystectomy/methods ; Cystoscopy/methods ; Diverticulum/*diagnosis/mortality/pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness/pathology ; Neoplasm Staging ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Urinary Bladder/pathology ; Urinary Bladder Diseases/*diagnosis/mortality/pathology/surgery ; Urinary Bladder Neoplasms/*diagnosis/mortality/pathology/surgery ; },
abstract = {PURPOSE: In this retrospective review we characterize the outcomes of patients treated for transitional cell carcinoma in a bladder diverticulum.
MATERIALS AND METHODS: Between 1986 and 2001, 39 patients were treated for tumors in a bladder diverticulum. All patients underwent initial transurethral resection of the tumor. Based on cystoscopic evaluation, bimanual examination and computerized tomography findings, tumors were classified as superficial (Ta, Tis), superficially invasive confined to diverticulum (T1) or extra diverticular (T3+). Patients with superficial or superficially invasive disease were treated either conservatively with repeat transurethral resection, or with partial or radical cystectomy. Patients with extra diverticular extension were treated with partial or radical cystectomy when amenable to surgical extirpation. Predictors of outcome were assessed by univariate and multivariate analyses. End point was overall and disease-specific survival.
RESULTS: Of our cohort of 39 patients 13 (33%) presented with superficial disease, 13 (33%) with superficially invasive tumors and 13 (33%) with invasive (extra diverticular) disease. Actuarial 5-year disease specific survival for the cohort was 72 +/- 5.4%. Significant differences in 5-year disease specific survival were observed among patients presenting with superficial tumors (83 +/- 9%), superficially invasive tumors (67 +/- 7%) and extra diverticular disease (45 +/- 14%). Of the patients presenting with T1 tumors the primary mode of treatment did not correlate with outcome. In a multivariate model clinical staging was the only independent predictor of outcome and concomitant carcinoma in situ reached borderline significance.
CONCLUSIONS: Our data support a conservative approach for tumors confined to the bladder diverticulum, provided complete removal is feasible and close surveillance ensues.},
}
@article {pmid14531745,
year = {2003},
author = {Delvaux, M},
title = {Diverticular disease of the colon in Europe: epidemiology, impact on citizen health and prevention.},
journal = {Alimentary pharmacology & therapeutics},
volume = {18 Suppl 3},
number = {},
pages = {71-74},
doi = {10.1046/j.0953-0673.2003.01720.x},
pmid = {14531745},
issn = {0269-2813},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulosis, Colonic/economics/*epidemiology/prevention & control ; Europe/epidemiology ; Health Care Costs ; Humans ; Middle Aged ; },
}
@article {pmid14525588,
year = {2003},
author = {Nightingale, S and Nikfarjam, M and Iles, L and Djeric, M},
title = {Small bowel diverticular disease complicated by perforation.},
journal = {ANZ journal of surgery},
volume = {73},
number = {10},
pages = {867-869},
doi = {10.1046/j.1445-2197.2003.02792.x},
pmid = {14525588},
issn = {1445-1433},
mesh = {Aged ; Aged, 80 and over ; Diverticulum/*complications/diagnosis ; Female ; Humans ; Intestinal Perforation/*complications/diagnosis ; Jejunal Diseases/*complications/diagnosis ; },
}
@article {pmid14520289,
year = {2003},
author = {Korman, LY and Overholt, BF and Box, T and Winker, CK},
title = {Perforation during colonoscopy in endoscopic ambulatory surgical centers.},
journal = {Gastrointestinal endoscopy},
volume = {58},
number = {4},
pages = {554-557},
doi = {10.1067/s0016-5107(03)01890-x},
pmid = {14520289},
issn = {0016-5107},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Ambulatory Surgical Procedures ; Colonoscopy/*adverse effects ; Female ; Humans ; Intestinal Perforation/*etiology/surgery ; Male ; Middle Aged ; Sigmoid Diseases/etiology ; },
abstract = {BACKGROUND: Perforation as a complication of colonoscopy is estimated to occur in 0.01% to 0.3% of procedures, but the frequency in ambulatory settings is unknown. This study determined the number of perforations occurring within a network of endoscopic ambulatory surgery centers.
METHODS: A total of 116,000 colonoscopies were performed within one network of 45 endoscopic ambulatory surgery centers in the United States during 1999. All identified perforations were reported to the network clinical director and reviewed by a panel of 3 gastroenterologists.
RESULTS: There were 37 (0.03%) perforations; 27 in women and 10 in men. Median patient age was 75 years (range 39-87 years); 18 patients (49%) had diverticular disease and 20 (54%) had a history of pelvic or colonic surgery. Twenty-four (65%) procedures were diagnostic, and 13 (35%) were therapeutic. The most common site of perforation was the sigmoid colon (62%); followed by the ascending colon (16%); cecum, transverse colon, and splenic flexure (11%); and rectum, anastomotic, or unknown (11%). The time to diagnosis ranged from immediate to 72 hours (29 <1 hour, 8 >1 hour). All patients were hospitalized; 35 (95%) underwent exploratory laparotomy, and 2 (5%) were treated conservatively. No patient died.
CONCLUSIONS: Reported perforations for procedures performed in endoscopic ambulatory surgery centers occurred most frequently during diagnostic colonoscopy in older woman with a history of surgery or diverticular disease. Reported perforations in endoscopic ambulatory surgery centers were uncommon.},
}
@article {pmid14515298,
year = {2003},
author = {Morris, CR and Harvey, IM and Stebbings, WS and Speakman, CT and Kennedy, HJ and Hart, AR},
title = {Anti-inflammatory drugs, analgesics and the risk of perforated colonic diverticular disease.},
journal = {The British journal of surgery},
volume = {90},
number = {10},
pages = {1267-1272},
doi = {10.1002/bjs.4221},
pmid = {14515298},
issn = {0007-1323},
mesh = {Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Analgesics, Opioid/*adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Case-Control Studies ; Diverticulum, Colon/*chemically induced ; Female ; Humans ; Intestinal Perforation/*chemically induced ; Male ; Middle Aged ; Odds Ratio ; Risk Factors ; },
abstract = {BACKGROUND: Acute perforated colonic diverticular disease has a mortality rate of up to 30 per cent, but little is known about its aetiology. The aim of this study was to test the hypothesis that three classes of drugs, namely non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics and corticosteroids, are risk factors for perforated diverticular disease.
METHODS: All patients with confirmed perforated colonic diverticular disease were identified over a 5-year period in two hospitals in Norfolk, UK. Two control groups were selected and matched for age, sex and hospital of admission. Data on medication use were obtained from hospital records. Odds ratios for each drug were calculated using conditional logistic regression.
RESULTS: Opioid analgesics, NSAIDs and corticosteroids were all positively associated with perforated colonic diverticular disease. The odds ratio for opioid analgesics was 1.8 (95 per cent confidence interval (c.i.) 1.1 to 3.0) in the analysis with ophthalmology controls and 3.1 (95 per cent c.i. 1.8 to 5.5) in that with dermatology controls. Respective odds ratios for NSAIDs were 4.0 (95 per cent c.i. 2.1 to 7.6) and 3.7 (95 per cent c.i. 2.0 to 6.8), and those for corticosteroids were 5.7 (95 per cent c.i. 2.2 to 14.4) and 7.8 (95 per cent c.i. 2.6 to 23.3).
CONCLUSION: Opioid analgesics, NSAIDs and corticosteroids are all positively associated with perforated colonic diverticular disease. The consistency of these associations, together with plausible biological mechanisms, suggests that these drugs may have a causative role in this condition.},
}
@article {pmid14513691,
year = {2003},
author = {López, F and Soto, G and Tapia, G and Schnettler, K and Zárate, A and Avendaño, R and Pinedo, G and Pérez, G and Ibáñez, L},
title = {[Elective laparoscopic surgery in diverticular disease. A comparative study with conventional operative surgery ].},
journal = {Revista medica de Chile},
volume = {131},
number = {7},
pages = {719-726},
pmid = {14513691},
issn = {0034-9887},
mesh = {Adult ; Aged ; Aged, 80 and over ; Chile/epidemiology ; Diverticulitis, Colonic/*surgery ; *Elective Surgical Procedures/adverse effects ; Feasibility Studies ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; },
abstract = {BACKGROUND: Elective surgery in diverticular disease (DD) consists classically in performing an open sigmoidectomy. Laparoscopic surgery of the colon can have results that are comparable to those of open surgery.
AIM: To compare the results of laparoscopic and conventional surgery for DD.
MATERIALS AND METHODS: Retrospective review of preoperative, operative and postoperative variables of patients operated by laparoscopic surgery between the years 2000 and 20002. These results were compared with those of patients treated with conventional surgery in the same period.
RESULTS: Thirty nine patients, mean age 59 years old, were operated via laparotomy and 18 patients, mean age 47 years old, were treated with laparoscopic surgery. Both groups were comparable in gender, amount of previous laparotomies, type of surgery performed and American Society of Anestesiologists classification. The operative time was significantly higher in the laparoscopic surgery group (230 v/s 130 min), but the opioid requirements, stay in an intensive surgical care ward, postoperative ileus and hospital stay were significantly shorter in the laparoscopic group. Eleven percent of the patients included in the laparoscopic group and 31% of the patients treated with operative surgery had complications (p = 0.07). The length of the excised colon, the degree of inflammation and treatment costs were comparable.
CONCLUSIONS: Laparoscopic surgery in DD is feasible, safe, requires less analgesia and allows a faster recovery of post-operative ileus and a lower hospital stay.},
}
@article {pmid12967373,
year = {2003},
author = {Simpson, J and Spiller, R},
title = {Colonic diverticular disease.},
journal = {Clinical evidence},
volume = {},
number = {9},
pages = {478-487},
pmid = {12967373},
issn = {1462-3846},
mesh = {Anti-Infective Agents/therapeutic use ; Dietary Fiber/administration & dosage/therapeutic use ; Diverticulitis, Colonic/surgery/therapy ; Diverticulum, Colon/*therapy ; Humans ; Mesalamine/therapeutic use ; Rifamycins/therapeutic use ; Rifaximin ; },
}
@article {pmid12953321,
year = {2003},
author = {Bahadursingh, AM and Longo, WE},
title = {Colovaginal fistulas. Etiology and management.},
journal = {The Journal of reproductive medicine},
volume = {48},
number = {7},
pages = {489-495},
pmid = {12953321},
issn = {0024-7758},
mesh = {Colonic Diseases/*etiology/*therapy ; Crohn Disease/complications ; Diverticulitis, Colonic/complications ; Diverticulum, Colon/complications ; Female ; Humans ; Hysterectomy/adverse effects ; Intestinal Fistula/*etiology/*therapy ; Quality of Life ; Rectovaginal Fistula/etiology/therapy ; Sigmoid Diseases/etiology/therapy ; Urinary Bladder Fistula/etiology/therapy ; Vaginal Fistula/*etiology/*therapy ; },
abstract = {OBJECTIVE: To review the diagnosis and treatment of colovaginal fistulas from various causes.
DATA SOURCES: Papers on colovaginal fistulas were identified using Ovid and PubMed. The search terms used were as follows: colovaginal fistulas, rectovaginal fistulas, diverticular disease and fistulas.
METHODS OF STUDY: Articles were selected based on their relevance to colovaginal fistulas and were then further subdivided into epidemiology, etiology, presentation, diagnosis and management.
RESULTS: English-language papers were selected based on their relevance to all aspects of colovaginal fistulas.
CONCLUSION: Optimizing nutrition is paramount prior to surgery. Medical management rarely corrects the problem. Diverticular colovaginal fistulas arise in patients who have previously undergone a hysterectomy. Radiation-related fistulas often involve the distal sigmoid colon and rectum, and recurrent cancer must be ruled out. Often symptoms are associated with radiation cystitis and terminal ileitis. When indicated, restoration of intestinal continuity is preferred. Malignant fistulas carry a poor prognosis, and when surgical removal is not practical, they are treated palliatively with fecal diversion or an endoluminal stent. Those arising from inflammatory bowel disease most frequently arise due to Crohn's disease, and extirpation of diseased bowel and associated abscess will successfully treat the condition. Fistulas arising from ulcerative colitis can be malignant. There remains a small role for colostomy as a nondefinitive procedure to alleviate symptoms. Colovaginal fistulas require a multidisciplinary approach and focused diagnostics, successful treatment can dramatically improve the patient's quality of life.},
}
@article {pmid12942803,
year = {2003},
author = {Urgesi, R and Cianci, R and Miele, L and Martino, A and Cesaro, P and Pirozzi, G and Vero, V and Gasbarrini, G and Cammarota, G and De Lorenzo, A},
title = {[Diverticuli of the colon].},
journal = {Recenti progressi in medicina},
volume = {94},
number = {9},
pages = {399-407},
pmid = {12942803},
issn = {0034-1193},
mesh = {Adult ; Anti-Bacterial Agents/therapeutic use ; Clinical Trials as Topic ; Colonoscopy ; Diagnosis, Differential ; Dietary Fiber ; Diverticulitis, Colonic/diagnosis/diagnostic imaging/etiology/prevention & control/surgery/therapy ; *Diverticulosis, Colonic/diagnosis/diagnostic imaging/etiology/prevention & control/surgery/therapy ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Recurrence ; },
abstract = {Colon diverticular disease is one of the most common pathologies of the western world; the aim of our review was to collect shortly but in a systematic way the main and more recent news on the etiopathogenesis, prevention, natural history, possible clinical presentations and complications of this disease without omitting, at the end, a short report on the diagnostic techniques and on the various medical and/or surgical therapy.},
}
@article {pmid12942279,
year = {2003},
author = {Bruzzi, JF and Moss, AC and Brennan, DD and MacMathuna, P and Fenlon, HM},
title = {Efficacy of IV Buscopan as a muscle relaxant in CT colonography.},
journal = {European radiology},
volume = {13},
number = {10},
pages = {2264-2270},
pmid = {12942279},
issn = {0938-7994},
mesh = {Adult ; Aged ; Aged, 80 and over ; Butylscopolammonium Bromide/*administration & dosage ; Colonic Polyps/*diagnostic imaging ; Colonography, Computed Tomographic/*methods ; Colorectal Neoplasms/*diagnostic imaging ; Female ; Humans ; Infusions, Intravenous ; Male ; Middle Aged ; Parasympatholytics/*administration & dosage ; Probability ; Reference Values ; Sensitivity and Specificity ; Statistics, Nonparametric ; },
abstract = {The aim of this study was to examine the efficacy of IV Buscopan as a muscle relaxant in CT colonography in terms of colonic distension and polyp detection, and to determine its particular efficacy in patients with diverticular disease. Seventy-three consecutive patients were randomised to receive IV Buscopan or no muscle relaxant prior to CT colonography. CT colonography was performed using a Siemens Somatom 4-detector multislice CT scanner. The following parameters were recorded: degree of colonic distension using a 4-point scale; diagnostic adequacy of colonic distension; presence or absence of diverticular disease; and presence of colonic polyps. Accuracy of polyp detection was assessed using subsequent conventional colonoscopy as a gold standard. There was no significant difference between the two groups in the number of segments that were deemed to be optimally or adequately distended (p=0.37). Although IV Buscopan did improve distension of certain segments, this effect was not sufficient to improve the number of diagnostically adequate studies in the Buscopan group (p=0.14). In patients with diverticular disease, IV Buscopan did not have any significant effect on segments affected by diverticulosis but was associated with an improvement in distension of more proximal segments. There was no significant difference between the two groups in terms of polyp detection (p=0.34). The addition of prone scanning to supine scanning was found to be the most useful technique for maximising colonic distension. Intravenous Buscopan at CT colonography does not improve the overall adequacy of colonic distension nor the accuracy of polyp detection. In patients with sigmoid diverticular disease IV Buscopan improves distension of more proximal colonic segments and may be useful in selected cases, but our results do not support its routine use for CT colonography.},
}
@article {pmid12938599,
year = {2003},
author = {Santini, P and Davini, F and Salani, A and Janni, A},
title = {Pulmonary resection for inflammatory complications due to benign oesophageal disease.},
journal = {Chirurgia italiana},
volume = {55},
number = {4},
pages = {541-544},
pmid = {12938599},
issn = {0009-4773},
mesh = {Aged ; Esophageal Diseases/*complications ; Female ; Humans ; *Pneumonectomy ; Pneumonia/*etiology/*surgery ; },
abstract = {Benign oesophageal disease is sometimes causes an irreversible damage to the pulmonary parenchyma. The earliest symptoms often occur when the respiratory tract is involved. Primary oesophageal disease can only be detected by taking an accurate and precise medical history of the patient, so that oesophageal contrast radiography can provide the correct diagnosis. In this article we present two cases in which it was necessary to carry out a diverticulectomy with pulmonary resection, left lower lobectomy and left pneumonectomy. Reports from the literature agree that diverticular disease of the oesophagus, if misdiagnosed, can have serious consequences for the pulmonary parenchyma, even if this is rare. In both cases we present the contrast radiographic study of the oesophagus together with a double endoscopic examination of the airways and upper digestive tract which played a crucial role in the diagnosis. We can therefore conclude that respiratory symptoms in an otherwise healthy patient may constitute the basis for the diagnosis of a benign oesophageal lesion.},
}
@article {pmid12931285,
year = {2003},
author = {Kaban, GK and Czerniach, DR and Litwin, DE and Litwin, DE},
title = {Hand-assisted laparoscopic surgery.},
journal = {Surgical technology international},
volume = {11},
number = {},
pages = {63-70},
pmid = {12931285},
issn = {1090-3941},
mesh = {Equipment Design ; Equipment Safety ; *Hand ; Humans ; *Laparoscopes ; Laparoscopy/*methods ; Minimally Invasive Surgical Procedures/methods ; Peritoneal Cavity ; Pneumoperitoneum, Artificial ; Sensitivity and Specificity ; },
abstract = {The introduction of hand-assisted laparoscopic surgery (HALS) has occurred in several surgical specialties. It allows the laparoscopic surgeon to insert a hand into the peritoneal cavity, through a small incision, while maintaining pneumoperitoneum. This technique has been made possible through the engineering of several unique devices. By returning the hand to the peritoneal cavity, the surgeon is allowed the return of tactile sensation, atraumatic retraction, blunt dissection, and digital vascular control. Proper device placement is mandatory. The principles include port-site triangulation, conversion to a convenient open incision if necessary, location away from bony prominences, and placement to minimize hand fatigue. Application and advantages of HALS can be shown in several procedures; specifically, laparoscopic splenectomy in cases of splenomegaly, laparoscopic live-donor nephrectomy, and laparoscopic sigmoid colectomy for diverticular disease. Its use in these procedures does not appear to be detrimental to the benefits associated with a completely laparoscopic technique, and may offer advantages. It may alter the learning curve regarding advanced laparoscopic procedures for the neophyte laparoscopic surgeon, and allow them to perform operations they otherwise would not attempt. For the experienced laparoscopic surgeon, it may allow them to complete operations laparoscopically they might otherwise have to convert. In time, HALS may have a larger role in many advanced surgical procedures.},
}
@article {pmid12923374,
year = {2003},
author = {Simpson, J and Neal, KR and Scholefield, JH and Spiller, RC},
title = {Patterns of pain in diverticular disease and the influence of acute diverticulitis.},
journal = {European journal of gastroenterology & hepatology},
volume = {15},
number = {9},
pages = {1005-1010},
doi = {10.1097/00042737-200309000-00011},
pmid = {12923374},
issn = {0954-691X},
mesh = {Abdominal Pain/*etiology/physiopathology ; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Defecation ; Diverticulitis, Colonic/*complications/drug therapy ; Diverticulum, Colon/*complications ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; Recurrence ; Surveys and Questionnaires ; Time Factors ; },
abstract = {BACKGROUND: While the association of recurrent bouts of abdominal pain with colonic diverticulosis is well recognized, the cause of this pain is obscure since in most cases it occurs without obvious diverticulitis or other potential causes.
AIMS: To define the patterns of pain in diverticular disease and the influence of acute diverticulitis.
METHODS: Two studies were undertaken to establish the relationship between bouts of prolonged abdominal pain (> 24 h) presumed to be due to inflammatory diverticulitis and recurrent short-lived pain. In Study 1, 261 patients with a barium enema showing diverticulosis completed a postal questionnaire concerning episodes of both prolonged and short-lived pain. In Study 2, 26 patients previously admitted to hospital with a firm diagnosis of diverticulitis were interviewed for details of their bowel habits since discharge.
RESULTS: Study 1: 94/261 patients experienced recurrent, short-lived pain on a median of five days a month, with a median duration of 3 h. In addition, 51/261 patients described episodes of prolonged pain with a median duration of three days. Of these, 31/51 (61%) experienced recurrent, short-lived pain compared with 63/210 (30%) who had not had an episode of prolonged pain. More specifically, 12/17 (71%) who received antibiotic treatment for presumed acute diverticulitis during their bout of prolonged pain experienced recurrent pain compared with 82/244 (34%) who did not experience such an episode. Study 2: 18/26 patients hospitalized for acute diverticulitis developed new, recurrent, short-lived abdominal pain following discharge, with a median duration of 4 h.
CONCLUSION: Episodes of prolonged, presumed inflammatory pain due to diverticulitis are frequently followed by recurrent, short-lived pain similar to that seen in irritable bowel syndrome.},
}
@article {pmid12910361,
year = {2003},
author = {Regenet, N and Pessaux, P and Hennekinne, S and Lermite, E and Tuech, JJ and Brehant, O and Arnaud, JP},
title = {Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon.},
journal = {International journal of colorectal disease},
volume = {18},
number = {6},
pages = {503-507},
pmid = {12910361},
issn = {0179-1958},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; *Colostomy ; Diverticulitis, Colonic/*complications/*surgery ; Emergency Medical Services ; Female ; Humans ; Intraoperative Care ; Length of Stay ; Male ; Middle Aged ; Peritonitis/pathology/*surgery ; Prospective Studies ; Therapeutic Irrigation/methods ; },
abstract = {BACKGROUND AND AIMS: For complicated diverticulitis Hartmann's procedure remains the favored option in patients with acute complicated sigmoid disease, but there has been increasing interest in primary resection and anastomosis with intraoperative colonic lavage. This study compared primary resection with intraoperative colonic lavage and Hartmann's procedure.
PATIENTS AND METHODS: Between January 1994 and November 2001, 60 patients underwent emergency laparotomy for diverticular peritonitis (Hinchey stages III and IV). Primary resection and anastomosis with intraoperative colonic lavage was performed in 27 patients and Hartmann's procedure in 33. All data were collected prospectively on a standardized form.
RESULTS: Mortality with intraoperative colonic lavage was 11% and with Hartmann's procedure 12%. The incidence of postoperative complication was significantly higher after Hartmann's procedure. The mean hospital stay was significantly longer after Hartmann's procedure than after primary resection with intraoperative colic lavage.
CONCLUSION: Primary resection with intraoperative colonic lavage compares favorably with Hartmann's procedure for diffuse purulent peritonitis in complicated diverticulitis. It should be an alternative to Hartmann's procedure in stercoral peritonitis.},
}
@article {pmid12910226,
year = {2003},
author = {Delaunay-Tardy, K and Barthélémy, C and Dumas, O and Balique, JG and Audigier, JC},
title = {[Endoscopic therapy of benign colonic post-operative strictures: report on 27 cases].},
journal = {Gastroenterologie clinique et biologique},
volume = {27},
number = {6-7},
pages = {610-613},
pmid = {12910226},
issn = {0399-8320},
mesh = {Aged ; Colonic Diseases/*surgery ; *Colonoscopy ; Constriction, Pathologic ; Female ; Humans ; Intestinal Obstruction/*surgery ; Male ; Middle Aged ; Postoperative Complications/*surgery ; },
abstract = {UNLABELLED: Benign postoperative anastomotic strictures are frequent.
OBJECTIVES: To evaluate the results of endoscopic dilatations and to propose an alternative treatment to surgery.
METHODS: Between 1994 and 2001, 27 patients (16 female, 11 male, median 70 years old) with colonic anastomotic strictures were treated with pneumatic or mechanical dilatation. Eleven patients (40.7%) had been operated on for colon carcinoma, 2 for colorectal adenoma and 14 (51.8%) for complicated diverticular disease. A left colectomy was performed in 12 patients and a sigmoid colectomy in 15. Anastomoses were stapled in 25 cases.
RESULTS: Twenty one patients were symptomatic (78%). The median time to diagnosis after surgery was 3 months (range: 21 days-4 years). Dilatation was possible in 26 cases (96.3%). The total number of dilatation sessions was 51 and the median number of sessions by patient was 2 (range: 1-4). Only one session was done in 11 patients (40.7%). There was one case of bowel perforation (1.9%) with the guide wire. In 21 cases (77.7%), the patients were no longer symptomatic and failure was observed in 5 cases. Surgery was necessary for 3 patients, with stenosis recurrence in 1. Three patients were treated with a self expanding metal stent.
CONCLUSION: Endoscopic dilatation is a simple and efficient method. Therefore, it might be considered as the first line approach for benign anastomotic strictures. Self expanding metal stent could be an alternative to surgery, in case of failure.},
}
@article {pmid12908570,
year = {2003},
author = {Chen, WS and Lin, JK},
title = {A potential alternative treatment of uncomplicated painful diverticular disease by trans-colonoscopic irrigation technique: a preliminary report.},
journal = {Journal of the Chinese Medical Association : JCMA},
volume = {66},
number = {5},
pages = {282-287},
pmid = {12908570},
issn = {1726-4901},
mesh = {Abdominal Pain ; Aged ; Diverticulum, Colon/*therapy ; Female ; Humans ; Male ; Middle Aged ; Therapeutic Irrigation/*methods ; },
abstract = {BACKGROUND: Colonic diverticular disease is a common disorder in elder patients. Medical treatment was usually recommended as the first line management for this disease. However, the recurrence rate of such disorder is still high. In patients with severe complications such as abscess or fulminant inflammation, non-invasive diagnostic examination, abdominal CT scan for example, is recommended. Its most common symptom is repeated abdominal pain with disturbance of bowel habit. Many patients are found to be with diverticular disease only after colonoscopic examination. The aim of this study is to introduce a new irrigation-draining method and to evaluate its efficacy in treatment of uncomplicated painful colonic diverticular disease.
METHODS: To reduce the risk of recurrence of acute diverticulitis and other severe complications, we introduce a transcolonoscopic irrigation technique for patients of uncomplicated diverticular disease by flushing out the obstructed fecalith from the diverticular sac in order to improve the drainage from the obstructed diverticular sac.
RESULTS: Thirty-two patients of uncomplicated painful diverticular disease with obstructed fecalith impacted were treated by this technique. Clinical symptom improved in all of them and no complications developed during the mean follow-up period of 46 months.
CONCLUSION: The results of this preliminary study suggest that this technique accomplished in the colonoscopic examination without additional therapeutic procedures. It provides another potential alternative to the conventional medical treatment for patients with uncomplicated diverticular disease.},
}
@article {pmid12907908,
year = {2003},
author = {McConnell, EJ and Tessier, DJ and Wolff, BG},
title = {Population-based incidence of complicated diverticular disease of the sigmoid colon based on gender and age.},
journal = {Diseases of the colon and rectum},
volume = {46},
number = {8},
pages = {1110-1114},
doi = {10.1007/s10350-004-7288-4},
pmid = {12907908},
issn = {0012-3706},
mesh = {Age Factors ; Chi-Square Distribution ; Diverticulitis, Colonic/complications/*epidemiology/surgery ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Sex Factors ; Sigmoid Diseases/complications/*epidemiology/surgery ; },
abstract = {PURPOSE: The purpose of this study was to characterize the gender and age differences in patients with clinically symptomatic sigmoid diverticular disease requiring surgery.
METHODS: All surgical patients hospitalized with proven diverticular disease requiring sigmoid resection from January 1988 to January 1998 were reviewed.
RESULTS: A total of 934 patients requiring surgical resection for diverticular disease were admitted. There were 443 men and 491 women with an average age of 64. Forty-nine patients presented with massive rectal bleeding (males, 3.6 percent; females, 1.6 percent), 329 with chronic diverticulitis (males, 15.8 percent; females, 19.3 percent), 61 with obstructive symptoms (males, 2.7 percent; females, 3.9 percent), 148 with fistulas (males, 8.0 percent; females, 7.8 percent), 170 with perforation (male, 8.7 percent; female, 9.4 percent), 79 with abscess (males, 4.0 percent; females, 4.5 percent), 59 with stricture (males, 2.2 percent; females, 4.0 percent), and 39 with acute diverticulitis (males, 2.2 percent; females, 1.9 percent). Overall, patients younger than 50 presented more often with chronic or recurrent diverticulitis.
CONCLUSIONS: Female patients present, on average, five years later than male with complications requiring surgery. Overall, men have a higher incidence of bleeding (P = 0.015), whereas women present more often with stricture and obstruction (P = 0.02). Young males present more with fistula (P = 0.03), whereas older males present with bleeding (P = 0.001). Young females present with perforation (P = 0.002), and older females present with chronic diverticulitis (P = 0.04) and stricture (P = 0.04).},
}
@article {pmid12906724,
year = {2003},
author = {Peters, JH and Bleichrodt, RP and van Goor, H},
title = {A rare manifestation of perforated diverticulitis: parastomal subcutaneous abscess.},
journal = {Surgical infections},
volume = {4},
number = {2},
pages = {227-228},
doi = {10.1089/109629603766957031},
pmid = {12906724},
issn = {1096-2964},
mesh = {Abdominal Abscess/*etiology ; Aged ; Aged, 80 and over ; Colostomy/*adverse effects ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Intestinal Perforation/*etiology ; Recurrence ; Soft Tissue Infections/*etiology ; Subcutaneous Tissue ; },
abstract = {Perforation is a serious complication of diverticular disease. The sigmoid is the main affected anatomic site of perforated diverticulitis and sigmoid resection followed either by Hartmann procedure or primary anastomosis are the standard surgical approaches. Surgery, however, does not cure diverticular disease. About 50% of patients have residual diverticula. The morbidity of residual diverticula appears to be low [1]. However, adequate follow-up studies on recurrent diverticulitis after surgery are lacking. We report a rare case of recurrent perforated diverticulitis in the subcutaneous tissue in proximity of the colostomy after a Hartmann procedure for perforated diverticulitis of the sigmoid colon.},
}
@article {pmid12905541,
year = {2003},
author = {Simpson, J and Scholefield, JH and Spiller, RC},
title = {Origin of symptoms in diverticular disease.},
journal = {The British journal of surgery},
volume = {90},
number = {8},
pages = {899-908},
doi = {10.1002/bjs.4277},
pmid = {12905541},
issn = {0007-1323},
mesh = {Abdominal Pain/etiology ; Colitis/etiology ; Colonic Diseases, Functional/etiology ; Diverticulum, Colon/*complications ; Humans ; Viscera ; },
abstract = {BACKGROUND: A significant number of patients with colonic diverticula experience unexplained, recurrent, short-lived but often debilitating abdominal pain and alteration in bowel habit. Such patients account for many medical consultations every year but, as our understanding of the cause of their symptoms remains imperfect, treatment options are limited. This article reviews the possible mechanisms that may be responsible for the symptoms of diverticular disease.
METHODS: Medline and Science Citation Index searches were performed to locate English language articles relating to colonic diverticula and symptoms published between January 1966 and July 2002. Manual cross-referencing was also performed and some historical articles were included.
RESULTS AND CONCLUSION: Several theories now exist about the mechanisms underlying the symptoms of diverticular disease. Initial studies suggested that they may be due to alterations in the intracolonic pressure, extrapolating earlier thoughts on the likely pathogenesis of diverticula. It seems more likely, however, that several inter-related processes, such as muscular dysfunction, visceral hypersensitivity and inflammation, are involved in symptom generation.},
}
@article {pmid12897885,
year = {2003},
author = {Yong, D and Grieve, P and Keating, J},
title = {Do nonsteroidal anti-inflammatory drugs affect the outcome of patients admitted to hospital with lower gastrointestinal bleeding?.},
journal = {The New Zealand medical journal},
volume = {116},
number = {1178},
pages = {U517},
pmid = {12897885},
issn = {1175-8716},
mesh = {Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Aspirin/*adverse effects ; Blood Transfusion ; Female ; Gastrointestinal Hemorrhage/chemically induced/surgery/*therapy ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/*adverse effects ; Treatment Outcome ; },
abstract = {AIM: To determine whether the outcome of patients admitted to hospital with lower gastrointestinal bleeding (LGB) is affected by their use of aspirin (ASA) or non-aspirin nonsteroidal anti-inflammatory drugs (NANSAIDs).
METHODS: A retrospective review of all patients admitted to Wellington Hospital over a four-and-a-half-year period from January 1998 with a coded discharge diagnosis that included LGB. Data were collected on requirement for blood transfusion (BT), number of units transfused, drug use, requirement for surgery, and in-hospital mortality.
RESULTS: There were 168 admissions to hospital with LGB over the study period of which, after exclusions, 146 formed the basis of this study. The mean age of patients was 69 years, with an equal gender distribution. Fifty three per cent of patients were taking medication known to interfere with platelet function (42% ASA, 18% NANSAIDs, and 7% both). Diverticular disease was the most common diagnosis. Eight patients required surgery for bleeding and there were two in-hospital deaths (1.4%). Forty three per cent of admitted patients required BT. Patients taking ASA or NANSAIDs (drug group) were more likely to receive a BT (relative risk 2.7, p <0.00001) than patients in the non-drug group. The median number of units received in transfused patients and requirement for surgery, although higher in the drug group, were not statistically different between the drug the non-drug group.
CONCLUSIONS: Patients admitted to hospital with LGB while taking ASA or NANSAIDs are significantly more likely to need BT but use of these agents does not result in a more frequent requirement for surgery.},
}
@article {pmid12889620,
year = {2003},
author = {Cobb, WS and Lokey, JS and Schwab, DP and Crockett, JA and Rex, JC and Robbins, JA},
title = {Hand-assisted laparoscopic colectomy: a single-institution experience.},
journal = {The American surgeon},
volume = {69},
number = {7},
pages = {578-580},
pmid = {12889620},
issn = {0003-1348},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Colectomy/adverse effects/methods ; Female ; Humans ; *Laparoscopy/adverse effects/methods ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; },
abstract = {The purpose of this study was to examine the results of a single institution experience with hand-assisted laparoscopic colon resection for benign disease. We conducted a retrospective study of consecutive cases performed by experienced laparoscopic surgeons at a single institution. From August 1999 to June 2001, 37 patients underwent hand-assisted laparoscopic colon resection. Seventeen patients were male, and 20 were female. Median patient age was 58 years (range 20-80). Indications for surgery were: polyp (13), uncomplicated diverticular disease (eight), complicated diverticular disease (i.e., colovesicular fistula, phlegmon, etc.) (seven), chronic constipation (four), rectal prolapse (two), ulcerative colitis (one), endometriosis (one), and fecal incontinence (one). Procedures performed were: sigmoidectomy (14), right colectomy (nine), low anterior resection (seven), subtotal colectomy (five), cecectomy (one), and transverse colectomy (one). Variables examined were: conversion to open procedure, operative time, blood loss, time to return of flatus, length of postoperative hospital stay, and complications. There were no deaths. One case was converted to celiotomy (unable to rule out malignancy). The median operative time was 122 minutes (range 32-240) with a median operative blood loss of 132 mL (range 0-300). Return of flatus was noted (median) at postoperative day 3 (range 1-5), and the median length of stay after operation was 4 days (range 2-8). One patient developed a superficial wound infection, and there was one pelvic abscess (drained percutaneously). One patient developed urinary retention. There were no reoperations. In this single-institution experience hand-assisted laparoscopic elective colectomy for benign disease was successful in both straightforward and complicated cases. A low conversion rate to celiotomy and favorable operative times compared with published "pure" laparoscopic results suggest a flatter learning curve for handoscopy while retaining the benefits of "minimally invasive" surgery such as early return of flatus and short postoperative hospital stay. For these reasons hand-assisted laparoscopy should be considered an acceptable technique in elective colon resection for benign disease.},
}
@article {pmid12887523,
year = {2003},
author = {El-Haddawi, F and Civil, ID},
title = {Acquired jejuno-ileal diverticular disease: a diagnostic and management challenge.},
journal = {ANZ journal of surgery},
volume = {73},
number = {8},
pages = {584-589},
doi = {10.1046/j.1445-2197.2003.02709.x},
pmid = {12887523},
issn = {1445-1433},
mesh = {Aged ; Aged, 80 and over ; Diverticulum/complications/*diagnosis/*therapy ; Female ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; Ileal Diseases/complications/*diagnosis/*therapy ; Intestinal Diseases/etiology/therapy ; Jejunal Diseases/complications/*diagnosis/*therapy ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {BACKGROUND: Acquired jejuno-ileal diverticular disease (JID), a result of abnormalities in the smooth muscle or myenteric plexus of the small bowel, is less rare than was once believed. Approximately 1.3% of the population has JID, of whom approximately 10% present with life-threatening complications such as inflammation, perforation, bleeding, obstruction and malabsorption. Jejuno-ileal diverticular disease can be diagnostically and therapeutically challenging, and complications are often diagnosed only at laparotomy, while the best management is not agreed on in the literature. To increase the awareness of this condition and its complications, the Auckland Hospital's experience of JID was reviewed.
METHODS: Retrospective review was carried out of the audit data and the discharge coding records of Auckland Public Hospital for the 5 year period leading to November 2001.
RESULTS: Nine cases with a variety of presentations were found. Those cases are described and a literature review of JID is provided.
CONCLUSION: Jejuno-ileal diverticular disease should be included in the differential diagnosis when dealing with surgical emergencies in the elderly presenting with features of bowel perforation, obstruction or bleeding.},
}
@article {pmid12886749,
year = {2003},
author = {Bellotti, C and D'Amata, G and Giulii Capponi, M and Gigli, R and Giordano Sciacca, P and Simone, M and Cancrini, A},
title = {[Inflammatory tumors of the cecum in emergencies: surgical considerations and case report].},
journal = {Il Giornale di chirurgia},
volume = {24},
number = {4},
pages = {119-121},
pmid = {12886749},
issn = {0391-9005},
mesh = {Acute Disease ; Appendicitis/complications ; Cecal Diseases/diagnosis/diagnostic imaging/etiology/*surgery ; Colectomy ; Diagnosis, Differential ; Emergencies ; Follow-Up Studies ; Granuloma, Plasma Cell/diagnosis/diagnostic imaging/etiology/*surgery ; Humans ; Male ; Middle Aged ; Radiography, Abdominal ; Time Factors ; Tomography, X-Ray Computed ; Ultrasonography ; },
abstract = {A cecal mass of uncertain etiology encountered during surgery for presumed appendicitis is a dilemma for the surgeon. The differential diagnosis of an unsuspected ileocecal mass must include neoplasm, diverticular disease, inflammatory bowel disease and severe appendicitis involving the ileocecal region. Right hemicolectomy is the gold standard for the treatment of the unsuspected ileocecal mass. The Authors report a case of inflammatory tumour of caecum secondary to appendicitis in a young adult.},
}
@article {pmid12872581,
year = {2003},
author = {Di Cataldo, A and Lanteri, R and Dell'Arte, M and Azzarello, G and Licata, A},
title = {Portal vein thrombosis. A multifactorial clinical entity.},
journal = {Chirurgia italiana},
volume = {55},
number = {3},
pages = {435-439},
pmid = {12872581},
issn = {0009-4773},
mesh = {Adult ; Female ; Humans ; Male ; Middle Aged ; *Portal Vein ; Venous Thrombosis/complications/*diagnosis/surgery ; },
abstract = {Portal vein thrombosis usually appears in the course of acute abdominal septic complications or after splenectomy, though in 50% of cases no aetiological factors can be identified. In our department we recently treated two patients affected by portal vein thrombosis, the first after splenectomy for haematological disease, and the second after sigmoid diverticulitis. When portal vein thrombosis occurs after splenectomy for haematological reasons, the increased viscosity of the blood due to thrombocytosis is the main factor regarded as being the cause. In the first case, acute abdominal pain appeared 15 days after splenectomy and the diagnosis was suspected and confirmed by Doppler ultrasonography. The clinical course in the second case was less typical, because, although the sigmoid diverticular disease was known, the symptomatology presented with high fever but no clear subjective or objective abdominal picture. The diagnosis was achieved by computed tomography. The clinical picture may vary greatly but usually abdominal pain, fever and intestinal ischaemia are present. Nowadays the diagnosis has improved as a result of the extensive use of Doppler ultrasonography and computed tomography. Fibrinolytic therapy and acetylsalicylic acid are the treatment of choice and in our experience the clinical picture tends to clear up rapidly. When the patient presents a number of risk factors, prophylaxis of portal vein thrombosis should be planned.},
}
@article {pmid12854126,
year = {2003},
author = {Colecchia, A and Sandri, L and Capodicasa, S and Vestito, A and Mazzella, G and Staniscia, T and Roda, E and Festi, D},
title = {Diverticular disease of the colon: new perspectives in symptom development and treatment.},
journal = {World journal of gastroenterology},
volume = {9},
number = {7},
pages = {1385-1389},
pmid = {12854126},
issn = {1007-9327},
mesh = {Diverticulitis, Colonic/classification/*physiopathology/*therapy ; Gastroenterology/*trends ; Humans ; },
abstract = {Diverticular disease of the colon is a common disease worldwide. Although the disease is asymptomatic in about 70-80 % of patients, it represents, at least in Western countries, one of the most important gastrointestinal diseases in terms of direct and indirect health costs. Pathogenesis of the disease is still unknown. However, it is the result of complex interactions between colonic structure, intestinal motility, diet and genetic factors. Whilst efficacious preventive strategies remain to be identified, fibre supplementation in the diet is recommended. Why symptoms develop is still unclear. Results of recent experimental studies on irritable bowel syndrome speculated that low grade inflammation of colonic mucosa, induced by changes in bacterial microflora, could affect the enteric nervous system, which is crucial for normal gut function, thus favouring symptom development. This hypothesis could be extrapolated also for diverticular disease, since bacterial overgrowth is present, at least in a subgroup of patients. These perspectives on symptom development are reviewed and new therapeutic approaches are hypothesized.},
}
@article {pmid12836027,
year = {2003},
author = {Menenakos, E and Hahnloser, D and Nassiopoulos, K and Chanson, C and Sinclair, V and Petropoulos, P},
title = {Laparoscopic surgery for fistulas that complicate diverticular disease.},
journal = {Langenbeck's archives of surgery},
volume = {388},
number = {3},
pages = {189-193},
pmid = {12836027},
issn = {1435-2443},
mesh = {Aged ; Colectomy ; Colon, Sigmoid/surgery ; Colonic Diseases/etiology/*surgery ; Diverticulitis, Colonic/*complications ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/etiology/*surgery ; *Laparoscopy/statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Time Factors ; Urinary Bladder Fistula/etiology/*surgery ; Vaginal Fistula/etiology/*surgery ; },
abstract = {BACKGROUND: Diverticular disease is complicated by colovesical and colovaginal fistulas in 4-20% of patients. Laparoscopic surgery is usually reserved for selected cases of uncomplicated disease. The aim of this study was to assess the efficacy and effectiveness of laparoscopic surgery in the treatment of those patients.
METHODS: Eighteen patients, 15 with colovesical fistulas and three with colovaginal fistulas, were operated on laparoscopically. Prospectively collected data, associated with technical feasibility, short-term outcome and effectiveness, were analysed.
RESULTS: Twelve sigmoidectomies, four extended left colectomies and two segmentectomies were performed. Fistulas were treated with simple dissection or mechanical division, and the bladder wall was repaired in two patients. Mean operating time was 237 min (range 165-330). There was one conversion (5.5%) and no post-operative death. Morbidity was 27.7% and included one major complication. Return of gastrointestinal function occurred 2.9 days post-operatively, and the mean hospital stay was 10 days after surgery. During the 5.1-year follow-up period there was one fistula recurrence (5.5%) and no recurrent diverticulitis.
CONCLUSIONS: Laparoscopic one-stage surgery was technically feasible and safe, with low morbidity. Effectiveness appears favourable when compared with open surgery, but prospective randomized studies are necessary to support such a conclusion.},
}
@article {pmid12820590,
year = {2002},
author = {Soliani, G and Dominici, M and Bergossi, L and Basaglia, E and Pauli, S and Carcoforo, P},
title = {Acute colon diverticulitis in multiple myeloma patient: an unusual presentation of a colonic perforation. Case report.},
journal = {Annali italiani di chirurgia},
volume = {73},
number = {6},
pages = {643-646},
pmid = {12820590},
issn = {0003-469X},
mesh = {Acute Disease ; Anti-Inflammatory Agents/*adverse effects ; Colon, Sigmoid ; Diverticulitis, Colonic/*complications ; Humans ; Intestinal Perforation/*chemically induced ; Male ; Middle Aged ; Multiple Myeloma/*drug therapy ; Retroperitoneal Space/*injuries ; Rupture, Spontaneous ; Steroids ; Subcutaneous Emphysema/drug therapy ; Thorax ; },
abstract = {This case report describes an acute colonic diverticular perforation occurred to a multiple myeloma patient, taking corticosteroid and morphine therapy, revealed by a subcutaneous emphysema of upper chest and right abdomen as initial presentation. Sigmoid diverticulitis with perforation and generalized peritonitis is a severe complication of the diverticular disease and it is due to diverticular microperforation. This condition occurs more frequently in patients with widespread diverticolosis and usually after 50 years of age, and the frequency of related complications increases with age (and with the use of corticosteroids). Extraperitoneal air from the sigmoid-rectum perforation can escape diffusing superiorly though paravertebral retroperitoneal tissues and via the diaphragmatic iatus into the mediastinum, producing pneumomediastinum and it diffuses to yield superior thoracic emphysema. This report suggests that the diagnosis of retroperitoneal perforation is usually difficult because of the lack of signs of peritoneal irritation and the paucity of symptoms, particularly in patients treated with corticosteroids.},
}
@article {pmid12814409,
year = {2003},
author = {Bolster, LT and Papagrigoriadis, S},
title = {Diverticular disease has an impact on quality of life -- results of a preliminary study.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {5},
number = {4},
pages = {320-323},
doi = {10.1046/j.1463-1318.2003.00458.x},
pmid = {12814409},
issn = {1462-8910},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Diverticulum ; Diverticulum, Colon ; Female ; Humans ; Male ; Middle Aged ; *Quality of Life ; Surveys and Questionnaires ; },
abstract = {OBJECTIVE: Diverticular disease (DD) is common in the western world, and carries a significant morbidity. Although patients can have long standing symptoms no research on quality of life (QoL) in DD exists in the literature. Assessment of QoL may be useful in decision making and selection of patients who would be appropriate candidates for elective surgical treatment. The aim of this study was to examine whether DD has an impact on QoL.
MATERIALS AND METHODS: A combination of structured interview and questionnaire survey was performed. One hundred people were divided into two groups: Group A, 50 patients with symptomatic DD as their primary diagnosis; Group B, A control group of 50 healthy volunteers. A structured QoL questionnaire, examining bowel symptoms, systemic symptoms, emotional symptoms and social function, was completed by the subjects in both the patient and the control group.
RESULTS: In the patient group scores fell well below the optimum QoL scores in each of the subscales particularly in the areas of bowel symptoms (43.8 vs 65.4 for controls) and emotional function (55.1 vs 75.9 for controls). Patients with DD had statistically significantly lower QoL scores than controls and this difference was consistent in all four examined areas (P < 0.003 for all categories).
CONCLUSION: Our preliminary study suggests that DD does affect a person's QoL. The authors recommend that further research is required in the development of a (QoL) scoring system specific for patients with diverticular disease. Having developed a tool that can accurately measure the subjective health status (QoL) of this disease group we will then be able to develop a more systematic approach to the delivery of treatment, management and care of patients with diverticular disease.},
}
@article {pmid12802642,
year = {2003},
author = {Thaler, K and Dinnewitzer, A and Mascha, E and Arrigain, S and Weiss, EG and Nogueras, JJ and Wexner, SD},
title = {Long-term outcome and health-related quality of life after laparoscopic and open colectomy for benign disease.},
journal = {Surgical endoscopy},
volume = {17},
number = {9},
pages = {1404-1408},
pmid = {12802642},
issn = {1432-2218},
mesh = {Adenomatous Polyps/psychology/*surgery ; Aged ; Colectomy/*methods/psychology ; Colonic Polyps/psychology/*surgery ; Diverticulosis, Colonic/psychology/*surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/*methods/psychology ; Male ; Middle Aged ; Patient Satisfaction ; Postoperative Complications/epidemiology ; Quality of Life ; Recurrence ; Surveys and Questionnaires ; Treatment Outcome ; },
abstract = {BACKGROUND: The benefits of laparoscopic colectomy (LC) vs open colectomy (OC) for the treatment of benign disease have not yet been clearly demonstrated with regard to long-term consequences and health-related quality of life (HRQL). The aim of this study was to compare LC and OC in terms of outcome and HRQL and to determine whether a generic nonspecific instrument for HRQL assessment is valid in postoperative follow-up.
METHODS: Forty-nine patients who underwent LC for elective right hemicolectomy (RH) or sigmoid resection (SR) for benign polyps or uncomplicated diverticular disease between 1992 and 2000 were evaluated and compared to 50 controls treated by OC in the same period. All patients were evaluated by postal questionnaire to determine recurrence rates and surgery-related complications. HRQL was assessed by the SF-36 Physical and Mental Component Summary Score (PCS, MCS) and by the SF-36 Health Survey, which measures eight different health-quality domains, including physical and social functioning (PF, SF), general health perception (GH), physical and emotional role limitations (RP, RE), body pain (BP), vitality (VT), and mental health (MH).
RESULTS: The LC and OC patients were similar in age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and diagnosis. There were significant differences between the two groups in resection type (26 RH:23 SR in LC vs 16 RH:34 SR in OC, p = 0.03) and length of follow-up (median, 39 and 53.5 months, respectively, p = 0.04), but neither parameter was predictive of the main SF-36 scores (PCS and MCS). There were no differences between the groups in recurrence rates (8% in LC vs 11% in OC) or surgery-related complications, including incisional hernias (16.3% in LC vs 17% in OC) and small bowel obstructions (2% in LC vs 10.4% in OC). None of the eight SF-36 Health Survey domains or the PCS or MCS scores showed significant differences between LC and OC patients in HRQL. However, occurrence of hernia after surgery was predictive of lower SF-36 scores, specifically in PF (p = 0.047), GH (p = 0.045), SF (p = 0.047), MH (p = 0.041), and MCS (p = 0.037). In addition, small bowel obstruction was significantly associated with lower scores in BP (p = 0.008), GH (p = 0.008), SF (p = 0.013), RE (p = 0.026), MH (p = 0.003), and MCS (p = 0.003).
CONCLUSION: LC was not different from OC for selected indications that measure long-term outcome and HRQL. SF-36 appears to be an appropriate instrument to measure postoperative HRQL, showing responsiveness to changes in objective outcome measures.},
}
@article {pmid12801738,
year = {2003},
author = {Golder, M and Burleigh, DE and Belai, A and Ghali, L and Ashby, D and Lunniss, PJ and Navsaria, HA and Williams, NS},
title = {Smooth muscle cholinergic denervation hypersensitivity in diverticular disease.},
journal = {Lancet (London, England)},
volume = {361},
number = {9373},
pages = {1945-1951},
doi = {10.1016/S0140-6736(03)13583-0},
pmid = {12801738},
issn = {0140-6736},
mesh = {Acetylcholine/pharmacology ; Aged ; Aged, 80 and over ; Antibodies ; Case-Control Studies ; Choline O-Acetyltransferase/immunology/*metabolism ; Colon, Sigmoid/drug effects/innervation/*metabolism ; Diverticulum, Colon/enzymology/*metabolism ; Female ; Humans ; Male ; Muscle, Smooth/enzymology/innervation/*metabolism ; Nerve Tissue Proteins/immunology ; Receptor, Muscarinic M3 ; Receptors, Muscarinic/*metabolism ; Up-Regulation ; },
abstract = {BACKGROUND: Evidence from clinical and laboratory investigations into the causes of diverticular disease suggests that disturbances in cholinergic activity are important, the effector mechanisms of which have yet to be established. We aimed to investigate the role of smooth muscle and neural cholinergic activity in the pathogenesis of this disease.
METHODS: Two investigators independently did a blinded immunohistochemical image analysis of localising antibodies to choline acetyltransferase, co-localised with protein gene product (PGP)--a marker of general neural tissue-and smooth muscle muscarinic M3 receptors, on three histological sections of sigmoid colons from ten patients with diverticular disease and ten controls, after resections for rectal tumours. We also did isotonic organ bath experiments to assess muscle strip sensitivities to exogenous acetylcholine.
FINDINGS: In circular muscle, activity of choline acetyltransferase was lower in patients with diverticular disease than in controls: median percentage surface area of choline acetyltransferase over PGP was 17.5% (range 10.0-37.0) in patients with diverticular disease and 47.0% (29.0-54.0) in controls (p<0.0001). M3 receptors were upregulated in patients with diverticular disease compared with controls: the median surface area was 13.2% (6.0-23.3) in patients with diverticular disease and 2.5% (1.6-3.7) in controls (p<0.0001). The sensitivity to exogenous acetylcholine was increased in patients with diverticular disease (mean -log EC(50) 5.6 [SD 0.3]) compared with controls (4.9 [0.5]; difference 0.7 [95% CI 0.3-1.1], p=0.006). In longitudinal muscle, choline acetyltransferase activity was lower in patients with diverticular disease (median 19.5%, range 12.0-30.0) than in controls (47.0%, 35.0-60.0; p<0.0001), with upregulation of M3 receptors in diverticular disease (diverticular disease 7.8% [1.9-20.4], controls 1.7% [0.8-3.0]; p<0.0001). However, sensitivity to exogenous acetylcholine did not differ between the two groups (diverticular disease mean 5.6% [SD 0.3], controls 5.2% [0.4]; difference 0.4% [95% CI -0.02-0.7], p=0.06).
INTERPRETATION: Our results suggest that cholinergic denervation hypersensitivity can affect smooth muscle. Upregulation of smooth muscle M3 receptors might account for specific clinical, physiological, and pharmacological abnormalities associated with diverticular disease.},
}
@article {pmid12801731,
year = {2003},
author = {Young-Fadok, TM and Farrugia, G},
title = {Cholinergic denervation in diverticular disease.},
journal = {Lancet (London, England)},
volume = {361},
number = {9373},
pages = {1923-1924},
doi = {10.1016/S0140-6736(03)13599-4},
pmid = {12801731},
issn = {0140-6736},
mesh = {Choline O-Acetyltransferase/*metabolism ; Colon/innervation/*metabolism ; Diverticulum, Colon/*metabolism ; Humans ; Muscle, Smooth/innervation/*metabolism ; Receptor, Muscarinic M3 ; Receptors, Muscarinic/*metabolism ; Up-Regulation ; },
}
@article {pmid12791020,
year = {2001},
author = {Biondo, S and Perea, MT and Ragué, JM and Parés, D and Jaurrieta, E},
title = {One-stage procedure in non-elective surgery for diverticular disease complications.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {3},
number = {1},
pages = {42-45},
doi = {10.1046/j.1463-1318.2001.00193.x},
pmid = {12791020},
issn = {1462-8910},
abstract = {OBJECTIVE: Admission of patients with acute complications of diverticular disease is frequent and operative management remains controversial. The aim of this study was to investigate the efficacy and safety of resection, intra-operative colonic lavage and primary anastomosis in patients who require urgent laparotomy to treat complications of diverticular disease.
PATIENTS AND METHODS: From January 1992 to December 1999, 124 surgical patients underwent emergency operation for complicated diverticular disease. Resection, intra-operative colonic lavage and primary anastomosis were carried out in 55 patients: four with obstruction, two with massive bleeding and 49 with diverticulitis. In the diverticulitis group, 33 (67.3%) patients presented with localized peritonitis and 16 (32.7%) with generalized purulent peritonitis. No patient with faecal peritonitis was treated by a one-stage procedure.
RESULTS: One or more complications were detected in 25 patients (45.4%). Four patients (7.2%) required reintervention. Mortality occurred in four patients (7.2%). Two patients (3.6%) presented with anastomotic leakage. Wound infection was detected in 16 cases (29%). The overall mean (s.d.) Hospital stay was 18.5 (12.1) days.
CONCLUSION: Resection, intra-operative colonic lavage and primary anastomosis provide an alternative procedure for achieving one-stage resection in selected patients who require emergency operation for complication of diverticular disease.},
}
@article {pmid12791016,
year = {2001},
author = {Sielezneff, I and Malouf, AJ and Pirro, N and Cesari, J and Brunet, C and Sastre, B},
title = {Short-term functional outcome following elective surgery for complicated sigmoid diverticular disease: sutured or stapled end-to-end anastomosis to the proximal rectum?.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {3},
number = {1},
pages = {23-27},
doi = {10.1046/j.1463-1318.2001.00182.x},
pmid = {12791016},
issn = {1462-8910},
abstract = {OBJECTIVE: The aim of this retrospective non-randomized study was to evaluate the short-term functional outcome following elective resectional surgery for complicated sigmoid diverticular disease, and to compare results of patients having hand-sewn or stapled end-to-end colonic anastomosis to the proximal rectum.
PATIENTS AND METHODS: Between 1983 and 1995, of 182 consecutive patients referred to our Institution for surgical treatment of complicated sigmoid diverticular disease, 137 underwent elective left hemicolectomy with primary colonic anastomosis to the proximal rectum, at a level above the peritoneal reflection. Twenty-one patients were excluded from the study because of a covering stoma (n=15), or a side-to-end (n=5) or side-to-side (n=1) anastomosis. All remaining 116 patients had an end-to-end anastomosis without covering stoma. Two groups were compared according to the type of anastomosis performed. Group I comprised the 67 patients who had a hand-sewn anastomosis, and group II the 49 patients whose anastomosis was stapled. Outcome was assessed at 6 months after surgery and compared in the two groups. Assessment included specific morbidity (anastomotic leakage, haemorrhage, fistulation and stenosis, pelvic sepsis), faecal incontinence, constipation, dyschesia, daily stool frequency, and stool consistency.
RESULTS: Preoperative patient details were comparable in both groups. There was no post-operative mortality, and the general morbidity rate was similar in both groups (P=0.85). There was no anastomotic leakage or haemorrhage, and no fistulation or pelvic sepsis in either group. One patient in group I, and two from group II, developed flatus incontinence, and a further patient from group II developed incontinence to liquid stool (P=0.17, group I vs group II). We observed better functional outcome following hand-sewn anastomosis. Three group II patients developed anastomotic stenosis compared with none in group I (P=0.04). Constipation (9% vs 28%, P=0.005) and dyschesia (18% vs 39%, P=0.03) were more frequent in group II. Excluding constipated patients (n=20), daily stool frequency was lower (mean 1.2 +/- 0.6 vs 2 +/- 1.3, P=0.0002), and more frequently of normal consistency (79% vs 43%, P=0.0001) in group I. Subgroup analysis failed to show significant differences in functional outcome in both groups in relation to the specific indications for surgery.
CONCLUSION: These retrospective data suggest for the first time in the reported literature that hand-sewn colonic anastomosis to the proximal rectum provides a better short-term functional outcome than stapled anastomosis following elective resectional surgery for complicated sigmoid diverticulosis.},
}
@article {pmid12790920,
year = {2002},
author = {Daniels, IR and Bekdash, B and Scott, HJ and Marks, CG and Donaldson, DR},
title = {Diagnostic lessons learnt from a series of enterovesical fistulae.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {4},
number = {6},
pages = {459-462},
doi = {10.1046/j.1463-1318.2002.00370.x},
pmid = {12790920},
issn = {1462-8910},
abstract = {OBJECTIVE: An enterovesical fistula (EVF) is an uncommon condition requiring careful and sometimes extensive preoperative investigation. Our experience over a 10-year period has been reviewed with emphasis on the diagnostic investigations performed.
PATIENTS AND METHOD: Forty-two patients (30 male) have been studied. Presenting symptoms, diagnostic investigations, and subsequent treatment have been reviewed.
RESULTS: The site of the fistulae were; 37 colonic, 2 rectal, and 3 ileal. The commonest presenting symptoms were; pneumaturia 75%, faecaluria 63% and urinary tract infections 57%. The positivity rate of the investigations performed were; cystoscopy 89%, urine cytology 86%, barium enema 65%, computerized tomography (CT) scanning 55%, IVP 35%, and cystography 27.5%. The causes of the fistula were; diverticular disease 71%, carcinoma 20%, Crohn's disease 7%, and radiotherapy 2%.
CONCLUSIONS: We recommend cystoscopy and urine cytology for faecal material as the first-line investigations in all patients with a suspected enterovesical fistulae. CT scanning and barium enema should not be first line investigations but may be performed subsequently to help determine the aetiology and planning of surgery.},
}
@article {pmid12789112,
year = {2002},
author = {Kiguli-Malwadde, E and Kasozi, H},
title = {Diverticular disease of the colon in Kampala, Uganda.},
journal = {African health sciences},
volume = {2},
number = {1},
pages = {29-32},
pmid = {12789112},
issn = {1680-6905},
mesh = {Adult ; Aged ; Aged, 80 and over ; Barium Sulfate ; Diverticulum, Colon/diagnostic imaging/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Radiography ; Retrospective Studies ; Uganda/epidemiology ; },
abstract = {BACKGROUND: Diverticular disease of the colon has been reported to be a disease of the western world, however of recent it has been described in the Africans.
OBJECTIVE: To study the clinical, demographic and radiological features of diverticular disease of the colon in Kampala, Uganda.
METHODS: A retrospective and prospective descriptive study was carried out between January 1995-December 1996 and January 1998-December 2000. The period January 1995-December 1996 was retrospective while January 1998-December 2000 was prospective. Thirty one consecutive patients were found to have diverticular disease of the colon at barium enema studies in two major hospitals and two private x-ray units in Kampala, Uganda.
RESULTS: Thirty-one patients were seen during the study period; all were over 40 years of age. The commonest presenting complaint was rectal bleeding in 13 patients followed by abdominal pain in 12 patients. Most patients were found to eat a mixed type of diet, that is both low and high residue food. Radiologically the diverticulae appeared as flask shaped or rounded outpouchings at barium enema. This would sometimes be accompanied by a serrated appearance of the affected area. The commonest site affected was the sigmoid colon followed by the ascending colon.
CONCLUSION: Although it was previously reported that diverticular disease was unknown in black Africans, it has been noted that cases are now being increasingly discovered. It is recommended that our index of suspicious for diverticular disease of the colon and its complications should also increase.},
}
@article {pmid12780890,
year = {2003},
author = {Zorcolo, L and Covotta, L and Carlomagno, N and Bartolo, DC},
title = {Safety of primary anastomosis in emergency colo-rectal surgery.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {5},
number = {3},
pages = {262-269},
doi = {10.1046/j.1463-1318.2003.00432.x},
pmid = {12780890},
issn = {1462-8910},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/*adverse effects ; Colorectal Neoplasms/complications/mortality/*surgery ; Diverticulitis, Colonic/complications/mortality/*surgery ; *Emergency Service, Hospital ; Emergency Treatment/*adverse effects ; Female ; Humans ; Intestinal Obstruction/etiology/mortality/*surgery ; Length of Stay ; Male ; Middle Aged ; *Outcome Assessment, Health Care ; Peritonitis/etiology/mortality/*surgery ; *Postoperative Complications ; Retrospective Studies ; Survival Rate ; },
abstract = {BACKGROUND: The surgical management of left-sided large bowel emergency patients remains controversial. There has been an increasing trend towards primary reconstructive surgery. The main dilemma remains appropriate patient selection for primary anastomosis.
METHODS: The records of 323 patients who presented as acute emergencies and underwent surgery between January 1990 and December 2000 for left-sided colorectal cancer and diverticular disease were reviewed, to compare the outcome of resection and primary anastomosis with Hartmann's procedure. Patients were stratified into 3 groups according to whether the presentation was with localized or generalized peritonitis, or with obstruction.
RESULTS: Resection and anastomosis was carried out in 176 (55.7%) patients with a 30-day mortality of 5.7%. Anastomotic dehiscence occurred in 9 (5.1%) patients, with no difference between the three groups. Wound sepsis occurred in 8 (4.5%) patients, and the median hospital stay was 13 days. Hartmann's resection was associated with a higher incidence of systemic and surgical morbidity (39.5% and 24.3%, respectively). The mortality rates in those selected for primary anastomosis (5.7%) compared favourably with those undergoing Hartmann's resections (20.4%) (P < 0.001).
CONCLUSION: Emergency primary anastomosis in left-sided disease can be performed with a low morbidity and mortality in selected patients, even in the presence of a free perforation with diffuse peritonitis. Patients selected for staged resection, were those with major comorbid disease.},
}
@article {pmid12780614,
year = {2002},
author = {Loffeld, RJ and Van Der Putten, AB},
title = {Diverticular disease of the colon and concomitant abnormalities in patients undergoing endoscopic evaluation of the large bowel.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {4},
number = {3},
pages = {189-192},
doi = {10.1046/j.1463-1318.2002.00328.x},
pmid = {12780614},
issn = {1463-1318},
abstract = {OBJECTIVE: To study the prevalence of diverticula and presence of concomitant pathology in consecutive patients undergoing endoscopic examination of the colon. METHODS: A cross-sectional analysis of the endoscopy reports of all patients sent for endoscopic evaluation of the colon in a period of 8.5 years. RESULTS: A total of 9086 endoscopies were performed. Of these 2259 (24.7%) were undertaken for follow-up. Diverticula were seen in 1849 patients (27%) (739 male, 1110 female, mean age 69 year). In 4978 patients (73%)(2162 male, 2816 female, mean age 52 year) no diverticula were seen, of these 2303 (46%) had no abnormalities in their colon. Patients with diverticula were significantly older, 69 vs 46.7 years (P < 0.001). No difference was present in gender. Colorectal cancer and inflammatory bowel disease were significantly more common in patients without diverticula, while polyps were more often seen in patient with diverticula. Patients with diverticula had a significantly lower incidence of colorectal cancer. In addition, the number of cancers located proximal to the splenic flexure was statistically higher in the group of patients presenting with diverticula (P < 0.001). CONCLUSIONS: The overall prevalence of diverticular disease in patients undergoing endoscopy is 27%, and increases with age. Patients with diverticulosis have significantly lower incidence of colorectal cancer and if cancer is detected then it is more common proximal to the splenic flexure.},
}
@article {pmid12780599,
year = {2002},
author = {Walker, KG and Anderson, JH and Iskander, N and McKee, RF and Finlay, IG},
title = {Colonic resection for colovesical fistula: 5-year follow-up.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {4},
number = {4},
pages = {270-274},
doi = {10.1046/j.1463-1318.2002.00353.x},
pmid = {12780599},
issn = {1463-1318},
abstract = {OBJECTIVES: The outcome of colovesical fistula management may be unsatisfactory; complications are reported in up to 45% of patients. Published studies are retrospective and tend to lack standardized management strategies and long-term follow-up. This cohort study assesses a policy of resection of colovesical fistulae in continuity with any distal colorectal stricture, and includes 5-year follow-up. METHOD: All patients undergoing surgery in our institution for colovesical fistula between February 1991 and April 1995 were entered into the study. The fistulae were resected in continuity with any distal bowel stricture, according to a standard single-stage operative protocol. Postoperative mortality and morbidity were recorded, and prospective review was undertaken at April 2000. RESULTS: Nineteen consecutive patients entered the study. The source of the fistula was diverticular disease (n = 14), colorectal cancer (n = 3), trauma (n = 1) or Crohn's (n = 1) disease. Thirteen patients had a colorectal stricture. One patient died due to ischaemic colitis within 30 days of surgery. Eleven other patients died of unrelated causes before April 2000, in whom there was no evidence of fistula recurrence before death at a median of 37 months after operation (range 2-95 months). At 5-year follow-up there was no evidence of fistula recurrence in the seven remaining patients. CONCLUSIONS: A policy of resection of the fistula and associated colorectal stricture with primary bowel anastomosis and bladder drainage, resulted in no recurrences and low morbidity. However comorbidity is important in this patient population, most of whom will die from unrelated causes within a few years.},
}
@article {pmid12760128,
year = {2003},
author = {Hall, NR},
title = {Managing diverticular disease.},
journal = {The Practitioner},
volume = {247},
number = {1646},
pages = {392-6, 400, 402 passim},
pmid = {12760128},
issn = {0032-6518},
mesh = {Colonography, Computed Tomographic/methods ; Diverticulitis, Colonic/complications/diagnostic imaging/surgery ; Diverticulum, Colon/complications/diagnostic imaging/*surgery ; Elective Surgical Procedures ; Gastrointestinal Hemorrhage/etiology ; Humans ; },
}
@article {pmid12752356,
year = {2003},
author = {Kang, JY and Hoare, J and Tinto, A and Subramanian, S and Ellis, C and Majeed, A and Melville, D and Maxwell, JD},
title = {Diverticular disease of the colon--on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000.},
journal = {Alimentary pharmacology & therapeutics},
volume = {17},
number = {9},
pages = {1189-1195},
doi = {10.1046/j.1365-2036.2003.01551.x},
pmid = {12752356},
issn = {0269-2813},
mesh = {Adult ; Age Distribution ; Aged ; Diverticulitis, Colonic/*epidemiology/mortality/surgery ; England/epidemiology ; Female ; Hospitalization/*trends ; Humans ; Male ; Middle Aged ; Sex Distribution ; },
abstract = {BACKGROUND: Diverticular disease emerged as a common problem in Western countries over the course of the 20th century.
AIMS: To determine the time trends in diverticular disease for hospital admissions in England between 1989/1990 and 1999/2000 and population mortality rates from 1979 to 1999.
METHODS: Hospital Episode Statistics were obtained from the Department of Health and mortality data from the Office for National Statistics.
RESULTS: Between 1989/1990 and 1999/2000, annual age-standardized hospital admission rates for diverticular disease increased by 16% for males (from 20.1 to 23.2 per 100,000) and 12% for females (from 28.6 to 31.9 per 100,000). Female rates were significantly higher than male rates throughout the study period. The proportions of admissions with an operation increased by 16% for males (from 22.9% to 24.1%) and 14% for females (from 19.7% to 22.3%). Older patients were less likely to undergo operation than younger patients. In-patient case fatality rates and population mortality rates remained unchanged.
CONCLUSIONS: Admission rates for diverticular disease increased over the study period. The proportion of patients who underwent operation increased, but in-patient and population mortality rates remained unchanged. With an ageing population, diverticular disease will become an increasingly important clinical problem in England.},
}
@article {pmid12744094,
year = {2003},
author = {Caravati, F and Ceriani, F and Moroni, M and Oalvi, A},
title = {[The learning curve in laparoscopic resections of the colon and rectum: results and considerations].},
journal = {Chirurgia italiana},
volume = {55},
number = {2},
pages = {199-206},
pmid = {12744094},
issn = {0009-4773},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/instrumentation/*methods ; Colonic Diseases/*surgery ; *Education, Medical, Continuing ; Female ; Humans ; Italy ; *Laparoscopy/methods ; Male ; Middle Aged ; Rectum/*surgery ; },
abstract = {A well-designed learning curve is essential for the success of laparoscopic colorectal surgery for cancer. The aim of this study was to evaluate the results and characteristics of the learning curve in laparoscopic colorectal surgery beginning with benign diseases and eventually going on to include colonic resections for cancer. A total of 60 laparoscopic resections were performed. In the first 33 cases only benign diseases (diverticular disease and polyps) were treated. The next 27 cases included resections for cancer, initially with the following exclusion criteria: obesity, previous abdominal surgery, emergency surgery for occlusion, voluminous tumours or infiltration of surrounding organs. Since January 2002 the only applicable exclusion criteria for laparoscopic resection have been emergency surgery for occlusion and invasion of adjacent organs. The following procedures were performed: 29 left hemicolectomies, 19 sigmoid resections, 7 segmentary resections, 3 abdomino-perineal resections and 2 right hemicolectomies. The conversion rate was 11.6%. The mean length of the segment removed was 21.5 cm. The mean number of lymph nodes harvested (for cancer) was 22.3. Major complications were observed in 3.3% and minor complications in 13.3%. The operative time decreased from a mean of 207 minutes to a mean of 170 minutes in the last group of 20 patients. Laparoscopic resections are safe and give the patient the opportunity to make a rapid recovery with less pain and a better outcome. We suggest performing laparoscopic colorectal resections initially for benign diseases (diverticular disease and polyps). This is needed in order to hone the technique. Resections for cancer can be undertaken only when the surgical team can guarantee an oncologically correct procedure in terms of lymphadenectomy, intraabdominal manipulation and extraction of the diseased segment from the abdomen.},
}
@article {pmid12731729,
year = {2003},
author = {Matthyssens, LE and Van Hee, R and Van Osselaer, GE and Lemmens, L},
title = {Giant diverticulum of the colon: report of two new cases and review of the literature.},
journal = {International surgery},
volume = {88},
number = {1},
pages = {34-40},
pmid = {12731729},
issn = {0020-8868},
mesh = {Aged ; Diagnosis, Differential ; Diverticulum, Colon/diagnostic imaging/pathology/*surgery ; Female ; Granulation Tissue/pathology ; Humans ; Male ; Radiography ; Sigmoid Diseases/diagnostic imaging/pathology/*surgery ; },
abstract = {Diverticulosis coli affects more than one in three individuals older than 65 in the Western world. Giant diverticulum of the colon is an extremely rare complication of diverticular disease; only 113 cases, mostly situated in the colon sigmoideum, have been reported in the world literature. Two new cases of giant diverticulum of the colon sigmoideum, with totally different clinical presentation, diagnosis, and management, are reported-one being the cause of chronic anemia and the other presenting as an acute abdomen. Based on a review of the literature, an update on symptomatology, diagnosis, pathogenesis, and therapeutical options of this rare disorder is provided.},
}
@article {pmid12713625,
year = {2003},
author = {Gupta, J and Shepherd, NA},
title = {Colorectal mass lesions masquerading as chronic inflammatory bowel disease on mucosal biopsy.},
journal = {Histopathology},
volume = {42},
number = {5},
pages = {476-481},
doi = {10.1046/j.1365-2559.2003.01605.x},
pmid = {12713625},
issn = {0309-0167},
mesh = {Adenocarcinoma/*secondary ; Adult ; Aged ; Aged, 80 and over ; Biopsy ; Colorectal Neoplasms/*pathology ; Diagnosis, Differential ; Diverticulum, Colon/*pathology ; Endometriosis/*pathology ; Female ; Humans ; Inflammatory Bowel Diseases/*pathology ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; Pneumatosis Cystoides Intestinalis/*pathology ; Prospective Studies ; },
abstract = {AIMS: We bring to the attention of diagnostic pathologists a further cause of mimicry of chronic inflammatory bowel disease on mucosal biopsy, namely intramural and subserosal colorectal mass lesions.
METHODS AND RESULTS: In a 10-year prospective study in one centre, we describe 26 cases in which the initial colonoscopic biopsies suggested a diagnosis of chronic inflammatory bowel disease, whereas subsequent information indicated that the mucosal changes were due to underlying mass lesions, without evidence of chronic inflammatory bowel disease. These mass lesions included underlying primary adenocarcinoma, metastatic carcinoma, pneumatosis, endometriosis and complicated diverticular disease.
CONCLUSIONS: In the colon and rectum, intramural and subserosal mass lesions are a significant cause of chronic inflammatory bowel disease mimicry. Possible pathogenic mechanisms include mechanical effects, lymphatic obstruction by underlying tumour, relative mucosal ischaemia and mucosal prolapse. Since the changes seen on mucosal biopsies are a secondary phenomenon, we tentatively suggest that 'secondary colitis' may be an appropriate appellation.},
}
@article {pmid12710240,
year = {2003},
author = {Sidebotham, J},
title = {Managing the complications of diverticular disease.},
journal = {Nursing times},
volume = {99},
number = {12},
pages = {28-29},
pmid = {12710240},
issn = {0954-7762},
mesh = {Abscess/etiology/nursing ; Bandages ; Colostomy/*adverse effects/nursing ; Cutaneous Fistula/etiology/nursing ; Diverticulitis, Colonic/*etiology/nursing/*surgery ; Diverticulum, Colon/*complications ; Humans ; Nurse's Role ; Pain/etiology/prevention & control ; Postoperative Care/methods/nursing ; Skin Care/methods/nursing ; Social Support ; },
abstract = {This article provides an update on diverticular disease and its complications, focusing on the physical and psychological considerations in the nursing management of the disease. To illuminate the topic a case study is presented describing a patient who underwent Hartmann's procedure with temporary end colostomy. The patient subsequently developed three abscesses and a complex fistula around the stoma. Nursing care and the optimum interventions to preserve skin integrity during such complications are discussed. The article concludes with a summary of key facts regarding diverticular disease, abscess and fistula.},
}
@article {pmid12692506,
year = {2003},
author = {Bianco, A and Ivaldi, L and Perino, M and Gambetta, G and Ferro, A and Colombini, M and Gennaro, M and Mura, G and Carrozza, V and Boetti, M and Revetria, P},
title = {[Jeiuno-ileal diverticula complicated by perforation. Clinical case].},
journal = {Minerva chirurgica},
volume = {58},
number = {1},
pages = {109-111},
pmid = {12692506},
issn = {0026-4733},
mesh = {Abdomen, Acute/etiology ; Aged ; Anastomosis, Surgical ; Diverticulum/*complications/surgery ; Humans ; Ileal Diseases/*complications/surgery ; Intestinal Perforation/*etiology/surgery ; Jejunal Diseases/*complications/surgery ; Male ; },
abstract = {The diverticular disease is rarely located in the small intestine (0.1-1.4%). The most important feature is due to the lack of a typical symptomatology which may appear only on the occasion of the complications it may incur (perforation, haemorrhage and so on). It isn't also infrequent that the surgeon may observe intestinal diverticula accidentally, on the occasion of laparotomies carried out in emergency or for other pathologies. The literature on intestinal diverticula is reviewed and personal experience in a clinical case presenting as acute abdomen is described.},
}
@article {pmid12691344,
year = {2003},
author = {Ghitulescu, GA and Morin, N and Jetty, P and Belliveau, P},
title = {Revisiting the biofragmentable anastomotic ring: is it safe in colonic surgery?.},
journal = {Canadian journal of surgery. Journal canadien de chirurgie},
volume = {46},
number = {2},
pages = {92-98},
pmid = {12691344},
issn = {0008-428X},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/instrumentation ; Colonic Diseases/*surgery ; Colonic Neoplasms/surgery ; Diverticulum, Colon/surgery ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Reoperation ; Surgical Stapling ; Suture Techniques ; },
abstract = {INTRODUCTION: The use of the biofragmentable anastomotic ring (BAR) has been reported in the literature with good results. Our purpose in this review was to document the clinical outcomes after gastrointestinal anastomoses performed with use of the BAR.
METHODS: Data were gathered systematically through chart review with the help of data collection forms from 159 patients who underwent 173 intestinal anastomoses performed with use of the BAR between 1992 and 1999. Of the 165 patients who had anastomoses (6 had 2 anastomoses constructed on separate occasions and were considered separately), 23 (13.9%) had surgery with anastomosis under emergency conditions, and 44 (26.7%) were steroid-dependent patients. The indications for surgery were malignant disease in 63 (38.2%) patients, inflammatory bowel disease in 54 (32.7%) patients, diverticular disease in 13 (7.9%) patients and other conditions in 35 (21.2%) patients.
RESULTS: A clinical anastomotic leak developed in the first 2 weeks after surgery in 7 (4.2%) patients, 6 of whom required reoperation. All recovered well, withno deaths related to use of the BAR. Early small-bowel obstruction developed in 13 patients (7.9%), none of whom required reoperation. The average postoperative length of hospital stay was 9.0 days, the average time to pass the first flatus was 3.2 days, and the average time to begin oral fluid intake was 3.3 days. The rate of leakage at the anastomosis in our series was comparable to that found in randomized trials with the BAR (2.0%-4.4%) and as reported with hand-sewn and stapled anastomoses (1.9%-8.2%).
CONCLUSIONS: Our data indicate that use of the BAR is safe and effective in both elective and emergent surgery. The rate of leakage is comparable to that reported in the literature when a BAR is used.},
}
@article {pmid12687960,
year = {2000},
author = {Perniceni, T and Burdy, G and Gayet, B and Dubois, F and Boudet, MJ and Levard, H},
title = {[Results of elective segmental colectomy done with laparoscopy for complicated diverticulosis].},
journal = {Gastroenterologie clinique et biologique},
volume = {24},
number = {2},
pages = {189-192},
pmid = {12687960},
issn = {0399-8320},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Diverticulum, Colon/complications/*surgery ; Elective Surgical Procedures ; Female ; Follow-Up Studies ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Sigmoid Diseases/complications/*surgery ; },
abstract = {OBJECTIVES: To analyze a unicentric series of 100 consecutive elective laparoscopic colon resections for diverticular disease and to evaluate in intention to treat the early- and middle-term postoperative results.
METHODS: From February 1993 to March 1998, 100 colon resections for complicated diverticular disease were performed through laparoscopy with systematic mobilization of the splenic flexure and resection of the rectosigmoid junction. The colorectal anastomosis was stapled or manual without proximal stoma. In 53 females and 47 males (mean age 60.4 years), indications for surgery were: one or more attacks of acute diverticulitis (n = 70), abscess (n = 17), symptomatic stenosis (n = 8), colovesical fistula (n = 4) and diverticular bleeding (n = 1).
RESULTS: Mortality was nil. The conversion rate was 9%, never for anesthetic reasons. The mean operating time was 226 +/- 68 min. There was no splenic or ureteral injury. The morbidity at 30 days was 19% with fistulae rate accounting for 2%, 2 patients were reoperated on. The median time for passage of flatus was 3 days and median length of hospital stay was 7 days. Late morbidity was 10%, one patient complained of retrograde ejaculation.
CONCLUSION: This study demonstrates that laparoscopy is a safe alternative to laparotomy for elective one-stage colectomy for complicated diverticular disease.},
}
@article {pmid12682545,
year = {2003},
author = {Senagore, AJ and Duepree, HJ and Delaney, CP and Brady, KM and Fazio, VW},
title = {Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience.},
journal = {Diseases of the colon and rectum},
volume = {46},
number = {4},
pages = {503-509},
doi = {10.1007/s10350-004-6590-5},
pmid = {12682545},
issn = {0012-3706},
mesh = {Body Mass Index ; Colectomy/*methods ; Colon, Sigmoid/surgery ; Colonic Diseases/*surgery ; Colonic Neoplasms/surgery ; Diverticulum, Colon/surgery ; Female ; Humans ; *Laparoscopy ; Male ; Postoperative Care ; Retrospective Studies ; Sigmoid Diseases/surgery ; Treatment Outcome ; },
abstract = {INTRODUCTION: Laparoscopic sigmoid colectomy has been accepted slowly despite potential advantages because of the perceptions of a steep learning curve and increased operative times and costs. The purpose of this article is to review the outcome of a standardization of all the intraoperative and postoperative processes used in our department for the performance of laparoscopic sigmoid colectomy.
METHODS: A consecutive series of patients requiring laparoscopic sigmoid colectomy from March 1999 through December 2001 at the Cleveland Clinic Foundation, Cleveland, Ohio, was analyzed. Patients requiring sigmoid or rectosigmoid resection for all colonic pathologies were included. Criteria for exclusion from an attempted laparoscopic sigmoid colectomy were body mass index >35 and prior major abdominal surgeries (exclusive of hysterectomy, cholecystectomy, or appendectomy). Data collected included age, gender, indication for surgery, American Society of Anesthesiology class, body mass index, operative duration, length of hospital stay, complications, mortality, and 30-day readmission. The operative steps for laparoscopic sigmoid colectomy were as follows: 1) open insertion of the umbilical port; 2) placement of three operating ports; 3) dissection/division of the vascular pedicle after identification of the left ureter; 4) mobilization of the sigmoid and descending colon; 5) rectal mobilization/division; 6) exteriorization of the specimen; and 7) circular stapled anastomosis. Instrumentation for the procedure was standardized. Conversion was performed when a sequential step could not be completed in a reasonable time frame. A standard perioperative care plan was used.
RESULTS: From March 1999 through December 2001, the primary surgeon performed 207 sigmoid colectomies, including 181 (87.4 percent) attempted laparoscopic sigmoid colectomies and 22 (12.1 percent) conversions. Indications for the laparoscopic sigmoid colectomies were diverticular disease (115), colonic neoplasia (32), prolapse (14), endometriosis (10), and other (10). The male/female ratio was 85:96, and the mean body mass index was 27.3 +/- 5.6. Mean operative time was 119 +/- 35 minutes. Mean length of stay was 2.9 +/- 1.2 days for completed cases and 6.4 +/- 1.4 days for converted cases. Anastomotic leaks occurred in two patients (1.1 percent), one of whom died of multisystem organ failure, yielding an operative mortality of 0.6 percent. The overall complication rate was 6.6 percent, and the 30-day readmission rate was 8 percent.
CONCLUSION: The results indicate that a structured approach to laparoscopic sigmoid colectomy provides the surgeon with objective measures of operative progress that limit unduly long operations without increasing conversion rates and that control resource utilization. This approach provides a potential guideline for teaching and mastering laparoscopic sigmoid colectomy, reducing the learning curve, and optimizing results.},
}
@article {pmid12653073,
year = {2002},
author = {Jaime-Zavala, M and Martínez-Ordaz, JL and Blanco-Benavides, R},
title = {[Solitary jejunal diverticulum with heterotopic gastric mucosa: diagnosis and management. A case report].},
journal = {Revista de gastroenterologia de Mexico},
volume = {67},
number = {4},
pages = {264-266},
pmid = {12653073},
issn = {0375-0906},
mesh = {Child ; Choristoma/*complications/diagnosis/therapy ; Diverticulum/*complications/diagnosis/therapy ; Female ; *Gastric Mucosa ; Humans ; Jejunal Diseases/*complications/diagnosis/therapy ; },
abstract = {INTRODUCTION: Diverticular disease of small bowel is an uncommon entity and may be the cause of vague abdominal symptoms generally an incidental finding that occasionally require surgical therapy for resolution.
METHOD: We report a case of a patient with complicated solitary jejunal diverticulum with perforation and non-Meckelean heterotopic gastric tissue that required resection, and include a review of the literature of this association.
CONCLUSION: Surgical treatment of diverticular disease of the small bowel is limited to symptomatic patients with non-response to medical therapy or who have some acute complications of same.},
}
@article {pmid12625749,
year = {2003},
author = {Heuschmid, M and Luz, O and Schaefer, JF and Stuecker, D and Vonthein, R and Luboldt, W and Claussen, CD and Seemann, MD},
title = {Comparison of volume-rendered and surface-rendered MR colonography.},
journal = {Technology in cancer research & treatment},
volume = {2},
number = {1},
pages = {13-18},
doi = {10.1177/153303460300200102},
pmid = {12625749},
issn = {1533-0346},
mesh = {Aged ; Colorectal Neoplasms/*diagnosis/pathology ; Female ; Humans ; Imaging, Three-Dimensional/methods ; Magnetic Resonance Imaging/*methods ; Male ; },
abstract = {In the United States and Europe, colorectal cancer is the second leading cause of cancer-related deaths. It is well known that colorectal carcinomas may originate from preexisting adenomas. For the visualization of colorectal cancer and other pathologic changes such as polyps, two 3D methods (volume-rendering (VR) and surface-rendering (SR)) in MR colonography were compared in our study. MR colonography was carried out in 17 patients on a 1.5 T MR scanner using a 10 mmolar gadolinium water solution enema. Coronal as well as rotated VR and SR views were compared in order to examine the technical quality (TQ) of the visualization model and grade of confidence (GC) in the pathological findings. Colonoscopic findings revealed 8 colorectal carcinoma, 10 patients with polyps, 4 diverticular disease, and 2 with redundant bowel loops. Based on a total of 248 colonic segments for both visualization methods, volume rendering were significantly superior to surface rendering for both, TQ (p<0.0001) and GC (p<0.0001). Volume rendering and surface rendering were not dependent on individual colon segments (p=0.13 for TQ and p=0.18 for GC) or on image rotation (p=0.06 for TQ and p=0.062 for GC). It is also independent of the type of pathology (p=0.31 for TQ and p=0.42 for GC) and the reviewers (p=0.62 for TQ and p=0.88 for GC). This indicates, that for the purpose of interpreting the technical quality and pathological findings, volume rendering is superior to surface rendering in MR colonography. Volume rendering could be used as an 3D visualization tool, enabling MR colonography examinations to be completed sooner in cases where colon distension is sufficient, and it would also provide an overview of potential mass lesions.},
}
@article {pmid12610327,
year = {2003},
author = {Fric, P and Zavoral, M},
title = {The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon.},
journal = {European journal of gastroenterology & hepatology},
volume = {15},
number = {3},
pages = {313-315},
doi = {10.1097/01.meg.0000049998.68425.e2},
pmid = {12610327},
issn = {0954-691X},
mesh = {Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Combined Modality Therapy ; Diverticulum, Colon/drug therapy/*therapy ; *Escherichia coli ; Female ; Humans ; Male ; Probiotics/*therapeutic use ; Prospective Studies ; Remission Induction ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: The effect of probiotics in symptomatic uncomplicated diverticular disease of the colon has not been followed.
DESIGN: Treatment (T1) with an intestinal antimicrobial (dichlorchinolinol) and absorbent (active coal tablets) was compared with the same set-up supplemented with non-pathogenic Escherichia coli(T2) in a prospective open trial.
SETTING: The study was performed at the outpatient department of a tertiary centre.
PARTICIPANTS: Fifteen subjects (5 males, 10 females) aged 68-91 years (average 74.8 years) presented with abdominal pain, irregular defecation, bloating and excessive flatulence. Diagnosis was established with colonoscopy, double-contrast barium enema, or both.
INTERVENTIONS: The T1 regimen was administered for 1 week. In the T2 regimen, the application of E. coli strain Nissle (Mutaflor capsules, 2.5 x 10(10) viable bacteria/capsule) followed immediately after T1 for an average of 5.2 weeks.
MAIN OUTCOME MEASURES: The lengths of two successive remissions with the T1 set-up were compared with the length of remission after T2. The intensity of symptoms before and after administration of the probiotic was also evaluated. RESULTS The lengths of two successive remissions after T1 amounted to 2.66 and 2.20 months (average 2.43 months). The average length of remission after T2 was 14.1 months (P < 0.001). All symptoms after T2 decreased significantly (P < 0.001).
CONCLUSIONS: Non-pathogenic strain Nissle significantly prolonged the remission period and improved the abdominal syndrome in symptomatic uncomplicated diverticular disease. A randomized, placebo-controlled study is recommended.},
}
@article {pmid12603892,
year = {2002},
author = {Simpson, J and Spiller, R},
title = {Colonic diverticular disease.},
journal = {Clinical evidence},
volume = {},
number = {8},
pages = {436-444},
pmid = {12603892},
issn = {1462-3846},
mesh = {Acute Disease ; Colectomy ; Colostomy ; Dietary Fiber/administration & dosage/adverse effects ; Diverticulitis, Colonic/etiology/*therapy ; Diverticulum, Colon/etiology/*therapy ; Humans ; Recurrence ; Rifamycins/adverse effects/therapeutic use ; },
}
@article {pmid12587465,
year = {2002},
author = {Ignjatovic, D and Bergamaschi, R},
title = {Preserving the superior rectal artery in laparoscopic [correction of laparoscopis] anterior resection for complete rectal prolapse.},
journal = {Acta chirurgica Iugoslavica},
volume = {49},
number = {2},
pages = {25-26},
doi = {10.2298/aci0202025i},
pmid = {12587465},
issn = {0354-950X},
mesh = {Digestive System Surgical Procedures/methods ; Humans ; *Laparoscopy ; Rectal Prolapse/*surgery ; Rectum/blood supply/*surgery ; },
abstract = {Anterior resection for the treatment of full thickness rectal prolapse has been around for over four decades. 1 However, its use has been limited due to fear of anastomotic leakage and related morbidity. It has been shown that high anterior resection is preferable to its low counterpart as the latter increases complication rates. 2 Although sparing the inferior mesenteric artery in sigmoid resection for diverticular disease has been shown to decrease leak rates in a randomized setting, 3 vascular division is current practice. We shall challenged this current practice of dividing the mesorectum in anterior resection for complete rectal prolapse developing a technique that allows the preservation of the superior rectal artery.},
}
@article {pmid12560765,
year = {2003},
author = {Mallant-Hent, RCh and van Bodegraven, AA and Meuwissen, SG and Manoliu, RA},
title = {Alternative approach to massive gastrointestinal bleeding in ulcerative colitis: highly selective transcatheter embolization.},
journal = {European journal of gastroenterology & hepatology},
volume = {15},
number = {2},
pages = {189-193},
doi = {10.1097/00042737-200302000-00014},
pmid = {12560765},
issn = {0954-691X},
mesh = {Colitis, Ulcerative/*complications/diagnostic imaging ; Colon/blood supply/diagnostic imaging ; Embolization, Therapeutic/*methods ; Female ; Gastrointestinal Hemorrhage/diagnostic imaging/etiology/*therapy ; Humans ; Middle Aged ; Radiography ; },
abstract = {Massive haemorrhage in ulcerative colitis mainly occurs as a result of exacerbated disease, usually acute or even fulminant colitis. Emergency proctocolectomy is currently advocated as the only reliable treatment of this patient group. However, this type of surgical intervention has a high rate of morbidity and mortality. Recently, several promising studies have been published that describe transcatheter embolization for the treatment of massive lower gastrointestinal bleeding in cases of bleeding colonic diverticular disease and angiodysplasia. Success rates of 48-88% have been reported. To avoid the high risk associated with emergency colectomy, this modern procedure was performed in an ulcerative colitis patient with intractable lower gastrointestinal bleeding. To our knowledge, this is the first patient with ulcerative colitis presenting with massive lower gastrointestinal blood loss to be successfully treated by highly selective transcatheter embolization. This interventional procedure is suggested as an alternative therapeutic approach to haematochezia in selected ulcerative colitis patients.},
}
@article {pmid12555996,
year = {2002},
author = {Ludeman, L and Shepherd, NA},
title = {What is diverticular colitis?.},
journal = {Pathology},
volume = {34},
number = {6},
pages = {568-572},
doi = {10.1080/0031302021000035974},
pmid = {12555996},
issn = {0031-3025},
mesh = {Chronic Disease ; Colitis, Ulcerative/pathology ; Colon/pathology ; Colonoscopy ; Crohn Disease/pathology ; Diagnosis, Differential ; Diverticulitis, Colonic/etiology/*pathology/therapy ; Humans ; Intestinal Mucosa/pathology ; },
abstract = {Diverticular colitis is the term used to describe a particular pattern of active chronic inflammation in the sigmoid colon affected by diverticular disease, namely the occurrence of luminal mucosal inflammation, whether or not there is evidence of inflammation within and/or around the diverticula themselves. The pathogenesis remains uncertain but is almost certainly multifactorial. In some cases mucosal prolapse, faecal stasis and relative mucosal ischaemia have been implicated as important pathogenetic factors, whilst other cases are clearly the result of a mass effect caused by subserosal peridiverticulitis and suppuration. Symptoms and endoscopic findings are diverse. Histologically, the disease may vary from modest inflammatory changes with vascular ectasia, through classical mucosal prolapse changes, to florid active chronic inflammation, closely mimicking chronic inflammatory bowel disease, especially ulcerative colitis. Thus, accurate clinical and endoscopic correlation is vital for the attainment of the correct diagnosis. Diverticular colitis may respond well to treatment similar to that used for chronic inflammatory bowel disease, adding to the similarities of this disease, notably localised to the sigmoid colon, and ulcerative colitis. Indeed, in a few cases described in the literature, diverticular colitis may 'progress' to otherwise classical ulcerative colitis, suggesting, in some cases at least, a similar pathogenesis.},
}
@article {pmid12555302,
year = {2003},
author = {Le Moine, MC and Fabre, JM and Vacher, C and Navarro, F and Picot, MC and Domergue, J},
title = {Factors and consequences of conversion in laparoscopic sigmoidectomy for diverticular disease.},
journal = {The British journal of surgery},
volume = {90},
number = {2},
pages = {232-236},
doi = {10.1002/bjs.4035},
pmid = {12555302},
issn = {0007-1323},
mesh = {Adult ; Aged ; Aged, 80 and over ; Clinical Competence ; Colectomy/*methods ; Colon, Sigmoid/*surgery ; Diverticulum/*surgery ; Endoscopy, Gastrointestinal/methods ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: The disadvantages of laparoscopic elective sigmoidectomy for diverticular disease include the risk of conversion to open operation and longer operative time. The aim of this study was to analyse the causes and consequences of conversion in 168 consecutive patients who underwent a laparoscopically assisted colectomy between January 1994 and June 2001.
METHODS: Data were collected prospectively to analyse the causes and consequences of conversion to open surgery in terms of postoperative morbidity and patient recovery.
RESULTS: Postoperative mortality, morbidity, conversion and reoperation rates were zero, 21.4 per cent (n = 36), 14.3 per cent (n = 24) and 3.0 per cent (n = 5) respectively. The reasons for conversion were presence of intraperitoneal adhesions and/or inflammatory pseudotumour (n = 21), an intraoperative diagnosis of sigmoid cancer (n = 1), hypercapnia (n = 1) and abdominal bleeding (n = 1). Three preoperative factors were associated with a significant higher risk of conversion: surgical expertise, the presence of sigmoid stenosis or fistula, and the severity of diverticulitis on pathological examination. Morbidity was no different between laparoscopic sigmoidectomy (30 of 144; 20.8 per cent) and converted procedures (six of 24; 25.0 per cent). Open conversion was associated with a longer operative time and significantly delayed patient recovery and hospital discharge.
CONCLUSION: Surgical experience and severe diverticular disease are predictive factors for conversion in laparoscopic elective sigmoidectomy. Even if necessary, conversion does not increase the morbidity rate.},
}
@article {pmid12541117,
year = {2003},
author = {Markose, G and Ng, CS and Freeman, AH},
title = {The impact of helical computed tomography on the diagnosis of unsuspected inflammatory bowel disease in the large bowel.},
journal = {European radiology},
volume = {13},
number = {1},
pages = {107-113},
doi = {10.1007/s00330-002-1415-1},
pmid = {12541117},
issn = {0938-7994},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colitis, Ulcerative/diagnostic imaging ; Contrast Media ; Crohn Disease/diagnostic imaging ; Enterocolitis, Pseudomembranous/diagnostic imaging ; False Negative Reactions ; False Positive Reactions ; Female ; Humans ; Inflammatory Bowel Diseases/*diagnostic imaging ; Intestines/*diagnostic imaging ; Male ; Middle Aged ; Retrospective Studies ; *Tomography, Spiral Computed ; },
abstract = {Inflammatory bowel diseases (IBD) are diagnoses that can be easily overlooked clinically. The aim of this study was to investigate if CT is able to make a contribution to the identification of previously unsuspected cases of IBD. We retrospectively identified cases in which the possibility of an IBD was raised in CT reports (over a 4-year period), by utilising a keyword search of the radiology database. Cases with a previously known or suspected IBD were rigorously excluded by review of case notes, and endoscopic, radiological, histological and microbiological findings. The CT images of the identified cases were reviewed by a blinded observer to document the extent of bowel wall thickening, the location of lesion(s), and presence of peri-colic fat abnormality, ascites and/or collections. The observer also attempted to corroborate the presence, and to identify the type, of IBD based on the CT appearances alone. Thirty-five cases (out of approximately 19,000 body CTs performed) of clinically unsuspected IBD were identified, of which 27 underwent further investigation. An IBD was confirmed in 48% (13 of 27): Crohn's disease (n=6), ulcerative colitis (n=2), pseudomembranous colitis (n=3) and other (n=2), of which 70% (9 of 13) were correctly typed by the reviewer. Inflammatory bowel disease was not substantiated in the remainder (14 of 27), although 7 of these had other bowel pathologies: diverticular disease (n=4); and carcinoma (n=3). Prospectively determining the presence, and furthermore type, of IBD on CT is challenging largely because of the considerable overlap in the appearances of the individual IBDs and indeed of normality. Nevertheless, CT is able to identify clinically unsuspected cases and radiologists should be alert to this treatable and not infrequently elusive diagnosis.},
}
@article {pmid12518261,
year = {2002},
author = {Kirchgatterer, A and Hubner, D and Aschl, G and Hinterreiter, M and Stadler, B and Knoflach, P},
title = {[Colonoscopy and sigmoidoscopy in patients aged eighty years or older].},
journal = {Zeitschrift fur Gastroenterologie},
volume = {40},
number = {12},
pages = {951-956},
doi = {10.1055/s-2002-36157},
pmid = {12518261},
issn = {0044-2771},
mesh = {Age Factors ; Aged ; *Aged, 80 and over ; Chi-Square Distribution ; Colonic Polyps/diagnosis/surgery ; *Colonoscopy/adverse effects ; Colorectal Neoplasms/diagnosis/surgery ; Diverticulum, Colon/diagnosis ; Humans ; Hypnotics and Sedatives/administration & dosage ; Palliative Care ; Postoperative Complications ; Prospective Studies ; *Sigmoidoscopy/adverse effects ; },
abstract = {BACKGROUND: The demographic development will lead to an increase in endoscopic examinations in elderly patients. Indications, feasibility and therapeutic consequences following detection of pathologic findings are important assessing the relevance of endoscopy in geriatric patients.
METHODS: We analyzed all colonoscopies and sigmoidoscopies which were performed between January 1995 and December 2000 in patients older than 80 years. The parameters indication, sedation, colonoscopy completion rate, endoscopic findings, therapeutic consequences and complications were evaluated.
RESULTS: A total of 951 endoscopies in patients older than 80 years (781 colonoscopies, 170 sigmoidoscopies; mean age 84.3 years) were performed. The most frequent indications were: abdominal pain (n = 144; 15 %), bleeding (n = 115; 12 %), constipation (n = 97; 10 %), anemia (n = 85; 9 %), and history of polyps (n = 78; 8 %). Sedation was used in 183 examinations (19 %), mostly with midazolam (n = 179). Colonoscopy was completed successfully to the coecum in 71 %. 214 examinations were unremarkable (23 %). Frequent pathologic findings were: diverticular disease (n = 396; 42 %), polyps (n = 256; 27 %), and colorectal carcinoma (n = 75; 8 %). Curative surgery was possible in 55 % and palliative surgery in 9 % of patients with colorectal carcinoma, respectively. A complication was observed in six patients (0.6 %), four bleedings following polypectomy, one perforation after dilatation of a stenotic tumor, and one transient neurologic deficit.
CONCLUSIONS: Endoscopy of the lower gastrointestinal tract is feasible in geriatric patients with a low rate of complications. The low number of normal findings and the frequent diagnosis of colorectal carcinoma were remarkable. In spite of old age more than half of the patients with carcinoma could be operated curatively emphasizing the importance of endoscopic investigations in this age group.},
}
@article {pmid12509694,
year = {2002},
author = {Debnath, D and Dielehner, N and Gunning, KA},
title = {Guidelines, compliance, and effectiveness: a 12 months' audit in an acute district general healthcare trust on the two week rule for suspected colorectal cancer.},
journal = {Postgraduate medical journal},
volume = {78},
number = {926},
pages = {748-751},
pmid = {12509694},
issn = {0032-5473},
mesh = {Colorectal Neoplasms/*diagnosis ; England ; Family Practice/standards ; *Guideline Adherence ; Hospitals, District/standards/statistics & numerical data ; Humans ; *Medical Audit ; Practice Guidelines as Topic ; Referral and Consultation/*standards/statistics & numerical data ; },
abstract = {OBJECTIVES: The Department of Health had recently introduced guidelines so that all suspected colorectal cancer patients could be seen by a specialist within two weeks of referral by their general practitioners. The usefulness and practicality of such a decision had been questioned. The aims of this study were to measure the compliance to the guidelines and evaluate the effectiveness of such referrals.
METHODS: All patients who were referred to the rapid access colorectal clinic between August 2000 and July 2001 were included.
SETTINGS: Darlington Memorial Hospital and Bishop Auckland General Hospital, both under South Durham Health Care Trust, were considered for the study.
MEASURES: Date of referral, referring practitioner, time of appointment, reasons for referral, and diagnosis.
RESULTS: A total of 239 referrals were made; 96.2% of patients were given appointments within two weeks. Rectal bleed was the commonest (32%) cause for referral. Diverticular disease was the most frequent (29%) condition diagnosed. Altogether 97.4% of referrals were incomplete and 37.6% did not comply with the guidelines. Twenty one colorectal cancers (8.9%) were diagnosed. The early cancer detection rate was 4.6%.
CONCLUSIONS: This audit showed that compliance to the guidelines was associated with a higher cancer detection rate. The majority of patients received appointments within two weeks. Contrary to some speculations, the number of referrals was not limitless. However a high number of referrals failed to adhere to the guidelines. The cancer (particularly early cancer) detection rate was disappointingly low. This does not reflect an efficient system of referral and potential benefits to patients remain questionable.},
}
@article {pmid12496319,
year = {2002},
author = {Morris, CR and Harvey, IM and Stebbings, WS and Speakman, CT and Kennedy, HJ and Hart, AR},
title = {Epidemiology of perforated colonic diverticular disease.},
journal = {Postgraduate medical journal},
volume = {78},
number = {925},
pages = {654-658},
pmid = {12496319},
issn = {0032-5473},
mesh = {Alcohol Drinking/adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Diet/adverse effects ; Diverticulitis, Colonic/epidemiology/*etiology/prevention & control ; Global Health ; Humans ; Incidence ; Risk Factors ; Smoking/adverse effects ; },
abstract = {Perforated colonic diverticular disease results in considerable mortality and morbidity. This review appraises existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition. Computerised searches were used to identify published articles relating to the epidemiology, pathophysiology, and clinical features of perforated colonic diverticular disease. Several drug and dietary exposures have potential biological mechanisms for causing perforation. Of these only non-steroidal anti-inflammatory drugs have been consistently identified as risk factors in aetiological studies. The causes of perforated colonic diverticular disease remain largely unknown. Further aetiological studies, looking specifically at perforation, are required to investigate whether cause-effect relationships exist for both drug and dietary exposures. The identification of risk factors for perforation would allow primary public health prevention, secondary risk factor modification, and early prophylactic surgery to be aimed at people at high risk.},
}
@article {pmid12477980,
year = {2002},
author = {Senagore, AJ and Erwin-Toth, P},
title = {Care of the laparoscopic colectomy patient.},
journal = {Advances in skin & wound care},
volume = {15},
number = {6},
pages = {277-83; quiz 284-5},
doi = {10.1097/00129334-200211000-00009},
pmid = {12477980},
issn = {1527-7941},
mesh = {Colectomy/adverse effects/*methods/*nursing ; Disease Management ; Humans ; Laparoscopy/adverse effects/*methods/*nursing ; Patient Care Planning ; Patient Discharge ; Patient Selection ; Perioperative Care/methods/nursing ; Skin Care/methods/nursing ; },
abstract = {Laparoscopic bowel surgery has demonstrated patient care benefits of decreased duration of hospital stay, smaller incisions, lower risk of cardiopulmonary complications, and reduced risk of small-bowel obstruction. Resection of complicated diverticular disease and inflammatory bowel disease can be technically challenging and may be associated with higher conversion rates. The applicability of these techniques to colon cancer is supported by a growing body of evidence that demonstrates similar survival and recurrence rates obtained by open resection and the exaggeration of the risk of port site recurrences. Laparoscopic colorectal surgery has also challenged much of the standard postoperative care plans used for colectomy. Optimal postoperative care of the laparoscopic colectomy patient requires an appreciation of the faster recovery enjoyed by these patients and the fact that ambulation and dietary advancement need to be accelerated. Coordination between the surgical team and the postoperative care team is essential to obtain all the benefits associated with this new approach to the management of colorectal disease.},
}
@article {pmid12469467,
year = {2002},
author = {Cavallaro, A and Loschiavo, V and Potenza, AE and Modugno, P and Fabbri, MC and Revelli, L and Colli, R},
title = {[Diverticular disease: complications and treatment].},
journal = {Chirurgia italiana},
volume = {54},
number = {5},
pages = {693-698},
pmid = {12469467},
issn = {0009-4773},
mesh = {Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Diverticulitis, Colonic/diagnosis/etiology/surgery/therapy ; *Diverticulum, Colon/complications/drug therapy/surgery ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/complications/diagnosis/drug therapy/surgery ; },
abstract = {This study reports on 10 years of experience in observing diverticular disease. The study considers 77 patients, 41 males and 36 females, aged from 50 to 88 years (mean age: 70 years), observed from January 1991 to December 2001. Sixty-two patients were admitted from the Accident and Emergency Unit and 15 were elected patients. Five patients underwent emergency surgery, while 72 received only antibiotic therapy. The overall mortality rate was 0. The morbidity rate was 22% in those patients undergoing emergency surgery. In only one of the elected patients was wound suppuration detected. Diverticular disease, in most cases, is treated by antibiotic therapy alone, but in 30% of cases surgery is necessary. Colon resection and immediate anastomosis are the first choice operation also in the emergency setting, provided local conditions (inflammation, septic contamination) make anastomosis safe. In patients with major peritoneal contamination, Hartman's operation and subsequent recanalization after 6 months are to be preferred.},
}
@article {pmid12458383,
year = {2003},
author = {Latella, G and Pimpo, MT and Sottili, S and Zippi, M and Viscido, A and Chiaramonte, M and Frieri, G},
title = {Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon.},
journal = {International journal of colorectal disease},
volume = {18},
number = {1},
pages = {55-62},
doi = {10.1007/s00384-002-0396-5},
pmid = {12458383},
issn = {0179-1958},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cathartics/adverse effects/therapeutic use ; Diverticulum, Colon/*pathology ; Drug Evaluation ; Female ; Follow-Up Studies ; Gastrointestinal Agents/adverse effects/*therapeutic use ; Humans ; Italy ; Male ; Mannans/adverse effects/therapeutic use ; Middle Aged ; Patient Compliance ; Prospective Studies ; Rifamycins/adverse effects/*therapeutic use ; Rifaximin ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND AND AIMS: We examined the efficacy of cyclic long-term administration of rifaximin, a broad spectrum, poorly absorbable antibiotic, in obtaining symptom relief in a large series of patients with uncomplicated diverticular disease, and compared the incidence of episodes of diverticulitis in the group treated with rifaximin to that in a group receiving fiber supplementation only.
PATIENTS AND METHODS: In a multicenter, prospective, open trial, 968 outpatients with uncomplicated symptomatic diverticular disease were randomized to either fiber supplementation with 4 g/day glucomannan plus 400 mg rifaximin twice daily for 7 days every month (n=558) or 4 g/day glucomannan alone (n=346). Clinical evaluation was performed on admission and at 4-month intervals for 12 months.
RESULTS: After 12 months the group treated with glucomannan + rifaximin showed fewer symptoms (abdominal pain/discomfort, bloating, tenesmus, diarrhea, abdominal tenderness) and a lower global symptomatic score. Overall 56.5% of the patients treated with glucomannan + rifaximin and 29.2% of those treated with glucomannan alone were asymptomatic at 12 months (P<0.001). The rate of complications (diverticulitis and rectal bleeding) was 1.34% in the rifaximin + glucomannan group and 3.22% in the glucomannan alone group (P<0.05).
CONCLUSION: Cyclic administration of rifaximin is effective in obtaining symptom relief in uncomplicated diverticular disease of the colon. The incidence of episodes of diverticulitis in the group treated with rifaximin was lower than that in the group treated with glucomannan alone.},
}
@article {pmid12449547,
year = {2002},
author = {Aldoori, W and Ryan-Harshman, M},
title = {Preventing diverticular disease. Review of recent evidence on high-fibre diets.},
journal = {Canadian family physician Medecin de famille canadien},
volume = {48},
number = {},
pages = {1632-1637},
pmid = {12449547},
issn = {0008-350X},
mesh = {Dietary Fats ; *Dietary Fiber ; Diverticulitis/etiology/*prevention & control ; Evidence-Based Medicine ; *Exercise ; Fruit ; Humans ; *Life Style ; Meat ; Vegetables ; },
abstract = {OBJECTIVE: To review recent evidence on dietary factors associated with diverticular disease (DD) with special emphasis on dietary fibre.
QUALITY OF EVIDENCE: MEDLINE was searched from January 1966 to December 2001 for articles on the relationship between dietary and other lifestyle factors and DD. Most articles either focused on dietary intervention in treating symptomatic DD or were case-control studies with inherent limitations for studying diet-disease associations. Only one large prospective study of male health professionals in the United States assessed diet at baseline and before initial diagnosis of DD.
MAIN MESSAGE: A diet high in fibre mainly from fruits and vegetables and low in total fat and red meat decreases risk of DD. Evidence indicates that the insoluble component of fibre is strongly associated with lower risk of DD; this association was particularly strong for cellulose. Caffeine and alcohol do not substantially increase risk of DD, nor does obesity, but higher levels of physical activity seem to reduce risk of DD.
CONCLUSION: A diet high in fibre and low in total fat and red meat and a lifestyle with more physical activity might help prevent DD.},
}
@article {pmid12439843,
year = {2002},
author = {Buemi, M and Aloisi, C and Romeo, A and Sturiale, A and Barilla', A and Cosentini, V and Aloisi, E and Corica, F and Ruello, A and Frisina, N},
title = {[Diverticular disease of the colon in peritoneal dialysis].},
journal = {Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia},
volume = {19},
number = {5},
pages = {540-544},
pmid = {12439843},
issn = {0393-5590},
mesh = {Anastomosis, Surgical ; Colonoscopy ; Combined Modality Therapy ; Contraindications ; Diagnostic Imaging ; Dietary Fiber/therapeutic use ; Diverticulum/*complications/diagnosis/diet therapy/physiopathology/surgery ; Humans ; Intestinal Perforation/etiology/prevention & control ; Kidney Failure, Chronic/complications/*therapy ; Laparoscopy ; *Peritoneal Dialysis/adverse effects ; Peritonitis/epidemiology/*etiology ; Prevalence ; Retrospective Studies ; Risk Factors ; },
abstract = {Colon diverticular disease is a very common pathology in western countries and represents a risk factor for septic-type complications, especially in peritoneal dialysis patients. We examined both diagnostic procedure and therapeutics options, either pharmacological or surgical. Ultrasonography, which is useful for the diagnosis of diverticulosis and diverticular disease, has been supported in the last few years by new imaging techniques, such as NMR and CT, that also find applications in the treatment of diverticulitis complications like peritoneal abscesses. Our emphasis is on the therapeutic perspective, either dietetic - based on the use of a fibre-rich diet and the infusion of liquids by intravenous injection - or surgical, such as the Hartmann procedure, single anastomosis with stomia conservation and laparoscopic and endoscopic treatment. These therapeutic approaches have reduced both morbidity and mortality rate and have emphasized how the reduction of surgical stress on the mesothelium promotes the recovery of the functional integrity and, consequently, faster resumption of peritoneal dialysis. In conclusion, diverticulosis alone is not a contraindication for peritoneal dialysis, but constitutes a risk factor for the continuation of this alternative treatment.},
}
@article {pmid12435311,
year = {2002},
author = {Sánchez-Tembleque, MD and González, A and de las Heras, S and Naranjo, A and Miño, G},
title = {[Endoscopic therapy with adrenalin injection for bleeding due to diverticular disease of the colon].},
journal = {Gastroenterologia y hepatologia},
volume = {25},
number = {9},
pages = {575-576},
doi = {10.1016/s0210-5705(02)70316-6},
pmid = {12435311},
issn = {0210-5705},
mesh = {Aged ; Aged, 80 and over ; Colonoscopy ; Diverticulum, Colon/*complications/diagnosis ; Epinephrine/*administration & dosage ; Female ; Gastrointestinal Hemorrhage/diagnosis/*drug therapy/*etiology ; Humans ; Injections, Intralesional ; Vasoconstrictor Agents/*administration & dosage ; },
}
@article {pmid12420025,
year = {2002},
author = {Comay, D and Marshall, JK},
title = {Resource utilization for acute lower gastrointestinal hemorrhage: the Ontario GI bleed study.},
journal = {Canadian journal of gastroenterology = Journal canadien de gastroenterologie},
volume = {16},
number = {10},
pages = {677-682},
doi = {10.1155/2002/156592},
pmid = {12420025},
issn = {0835-7900},
mesh = {Acute Disease ; Aged ; Cohort Studies ; Cost-Benefit Analysis ; Female ; Gastrointestinal Hemorrhage/diagnosis/*economics/*therapy ; Health Care Costs/*standards/trends ; Health Resources/*statistics & numerical data ; Hospital Costs/*standards/trends ; Hospitalization/*economics/statistics & numerical data ; Hospitals, Community ; Humans ; Length of Stay/economics ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Ontario ; Probability ; Sensitivity and Specificity ; },
abstract = {OBJECTIVES: Acute lower gastrointestinal hemorrhage (LGIH) is a common indication for hospitalization. However, there are few published studies of related health care resource utilization. Resource utilization, length of stay (LOS) and direct medical costs were characterized in a cohort of patients admitted for nonmalignant LGIH to centres in Ontario.
METHODS: Consecutive admissions for LGIH were identified at four Ontario hospitals. Profiles of resource utilization, LOS and estimates of direct medical costs were compiled through detailed chart review and adaptation of an administrative database. All centres were participants in the Ontario Case Cost Project. Linear regression models of log-transformed data were constructed to identify demographic variables predictive of LOS and case cost.
RESULTS: Among 124 patients enrolled (mean age 58.8 years) the average case cost was dollars 4832 (SD dollars 7187) for 7.5 days in hospital (SD 12.0). Diverticular disease was the bleeding source most often identified (34.6%), followed by hemorrhoids (13.7%) and ischemic colitis (9.7%). Older age and comorbid illness, specifically coronary artery disease (CAD), were associated with both increased LOS and higher case cost in univariate regression analyses. Age persisted as the lone independent predictor of LOS in the multivariate model (P<0.05, R2=0.076), and age and CAD were both independent predictors of cost (P<0.05, R2=0.109) in a stepwise multiple linear regression analysis. Neither sex nor nonsteroidal anti-inflammatory drug use predicted LOS or cost.
CONCLUSIONS: Admissions for acute LGIH are associated with significant resource utilization, particularly among elderly patients with CAD.},
}
@article {pmid12406456,
year = {2002},
author = {Buchanan, GN and Kenefick, NJ and Cohen, CR},
title = {Diverticulitis.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {16},
number = {4},
pages = {635-647},
doi = {10.1053/bega.2002.0322},
pmid = {12406456},
issn = {1521-6918},
mesh = {Age Factors ; Clinical Trials as Topic ; Colectomy/methods ; Colostomy/methods ; Diagnosis, Differential ; *Diverticulitis, Colonic/complications/diagnosis/surgery ; Humans ; Laparoscopy ; Peritonitis/etiology/surgery ; Prognosis ; },
abstract = {Although diverticular disease is common in the Western world, few patients who develop diverticulitis require surgery. The use of appropriate broad-spectrum antibiotics in uncomplicated diverticulitis can be an effective treatment, avoiding the need for acute surgical intervention. In the event of surgery the choice of procedure is dictated by the degree of contamination and the expertise of the operating surgeon. This chapter will outline the modern management of diverticulitis, from steps in diagnosis to different surgical options in each clinical scenario, thus aiding clinicians on a practical level.},
}
@article {pmid12406455,
year = {2002},
author = {Afzal, NA and Thomson, M},
title = {Diverticular disease in adolescence.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {16},
number = {4},
pages = {621-634},
doi = {10.1053/bega.2002.0303},
pmid = {12406455},
issn = {1521-6918},
mesh = {Adolescent ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis/therapy ; Diverticulum, Colon/complications/*diagnosis/physiopathology/therapy ; Epidemiologic Studies ; Humans ; },
abstract = {Diverticular disease is rare in the adolescent. Acute diverticulitis is almost never considered as a diagnosis for a young patient presenting with abdominal pain. Unfortunately, unrecognized it may be associated with significant morbidity and mortality. Also, when present, diverticulitis in the young adult is considered to be more aggressive compared to diverticulitis in older adults. Therefore, it is important to recognize, diagnose and manage diverticular disease appropriately in this age group. In tis chapter we will review the available literature on diverticula disease in the adolescent and young adult, discuss epidemiology, aetiology and pathogenesis and suggest guidelines for diagnosis and management.},
}
@article {pmid12406454,
year = {2002},
author = {Murray, CD and Emmanuel, AV},
title = {Medical management of diverticular disease.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {16},
number = {4},
pages = {611-620},
doi = {10.1053/bega.2002.0301},
pmid = {12406454},
issn = {1521-6918},
mesh = {Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/therapy ; Diverticulum, Colon/*therapy ; Epidemiologic Studies ; Feeding Behavior ; Humans ; },
abstract = {Diverticular disease is a common disorder affecting 30-55% of the population in the developed world. It has been described as "a deficiency disease of Western civilization", a theory that has been proposed since it was observed that diverticular disease was uncommon in African and other developing countries where dietary fibre consumption was high. At the turn of the century the medical treatment of colonic diverticulosis involved the avoidance of "roughage", which was felt to exacerbate the problem. However, the use of high fibre diets in the prevention and treatment of the symptoms of diverticular disease has now become commonplace, and the development of this practice is discussed in this chapter.},
}
@article {pmid12406453,
year = {2002},
author = {Halligan, S and Saunders, B},
title = {Imaging diverticular disease.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {16},
number = {4},
pages = {595-610},
doi = {10.1053/bega.2002.0323},
pmid = {12406453},
issn = {1521-6918},
mesh = {Barium Sulfate ; Colonoscopy ; Contrast Media ; Diagnosis, Differential ; Diverticulum, Colon/*diagnostic imaging ; Enema ; Humans ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed ; },
abstract = {Barium enema remains the gold standard for demonstrating the extent and severity of colonic diverticular disease. As such, barium studies have a role in clarifying the differential diagnosis of patients with abdominal pain and altered gut function. In acute diverticulitis or suspected diverticular perforation water soluble contrast studies are preferred to barium. An alternative in this acute scenario is cross-sectional imaging by ultrasound, or more usefully computed tomography (CT). CT is especially helpful in complicated diverticular disease. Diverticular disease is a common finding at colonoscopy and is often a complicating factor in the technical performance of the procedure. In acute diverticulitis, when the risk of perforation is high, colonoscopy should not be performed. In acute diverticular haemorrhage, colonoscopic haemostatic therapy with adrenaline can be effectively performed.},
}
@article {pmid12406452,
year = {2002},
author = {Fearnhead, NS and Mortensen, NJ},
title = {Clinical features and differential diagnosis of diverticular disease.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {16},
number = {4},
pages = {577-593},
doi = {10.1053/bega.2002.0299},
pmid = {12406452},
issn = {1521-6918},
mesh = {Diagnosis, Differential ; Diverticulum, Colon/complications/*diagnosis/physiopathology ; Humans ; Risk Factors ; },
abstract = {Colonic diverticulosis occurs in the majority of Western populations with age, but only a small proportion of people experience symptoms. Diverticular disease usually presents with either haemorrhage or diverticulitis. A quarter of patients with diverticulitis will develop complications including perforation, fistulation, obstruction or stricture. This chapter deals with the natural history, risk factors, clinical features and differential diagnoses of symptomatic diverticular disease.},
}
@article {pmid12406451,
year = {2002},
author = {Mimura, T and Emanuel, A and Kamm, MA},
title = {Pathophysiology of diverticular disease.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {16},
number = {4},
pages = {563-576},
doi = {10.1053/bega.2002.0298},
pmid = {12406451},
issn = {1521-6918},
mesh = {Aging ; Dietary Fiber/deficiency ; Diverticulum, Colon/*physiopathology ; Humans ; },
abstract = {There is substantial evidence that colonic diverticulosis is related to civilization, industrialization and a "Western" lifestyle and diet, being described as "a disease of Western civilization". Its increased incidence during the 20th century and the morbidity and mortality associated with complications, demand that this condition should receive greater attention in terms of aetiology, prevention and management. It is generally believed that low dietary fibre and ageing are the two main pathogenic factors involved in this disease. Physiological studies have also demonstrated that there is a higher intraluminal pressure in the large bowel with diverticula. This chapter provides the evidence currently available for the pathophysiology of colonic diverticulosis and discusses its aetiological factors, including low dietary fibre, ageing and intraluminal pressure as well as extracelluar matrix such as collagen and elastin. The difference between the left-sided diverticulosis commonly seen in Caucasians and the right-sided predominantly observed in Asians is also presented.},
}
@article {pmid12406450,
year = {2002},
author = {Ludeman, L and Warren, BF and Shepherd, NA},
title = {The pathology of diverticular disease.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {16},
number = {4},
pages = {543-562},
doi = {10.1053/bega.2002.0297},
pmid = {12406450},
issn = {1521-6918},
mesh = {Diverticulitis, Colonic/etiology/pathology ; Diverticulum, Colon/complications/*pathology ; Elastic Tissue/pathology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Inflammatory Bowel Diseases/pathology ; },
abstract = {Diverticular disease is common in the elderly Western population and its complications are frequent clinical presentations. Despite this, the pathogenesis of the condition remains relatively poorly understood. Several theories have been developed, the most acceptable suggesting elastosis of the taeniae coli as the primary event, causing shortening of the sigmoid colon, with relative mucosal excess and subsequent mucosal herniations. A Western-type diet is implicated in the increased uptake of proline from the gut, leading to elastosis of the sigmoid colon. For pathologists, in clinical practice, the disease is most commonly seen in sigmoid colonic resection specimens, usually performed for complications of the disease. It is now realised that mucosal biopsies of the luminal mucosa, in the sigmoid colon affected by diverticular disease, can produce perplexing pathological changes. In particular diverticular colitis can mimic both ulcerative colitis and Crohn's disease: care should be taken when diagnosing chronic inflammatory bowel disease on a background of diverticular disease. For pathologists, diverticular disease remains something of an enigma: although common, its pathogenesis remains ill-defined and its complications can provide diagnostic difficulties, which require precise clinical and radiological correlation.},
}
@article {pmid12406449,
year = {2002},
author = {Jun, S and Stollman, N},
title = {Epidemiology of diverticular disease.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {16},
number = {4},
pages = {529-542},
doi = {10.1053/bega.2002.0328},
pmid = {12406449},
issn = {1521-6918},
mesh = {Diverticulitis, Colonic/epidemiology/etiology ; Diverticulum, Colon/complications/*epidemiology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Prevalence ; Risk Factors ; },
abstract = {Diverticulosis, which is an acquired condition marked by mucosal herniation through defects in 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. Both of these epidemiological observations may provide interesting insights into the pathophysiology of diverticulosis. This chapter will review the known epidemiology of diverticulosis coli and its main complications: diverticulitis and diverticular haemorrhage. Where possible, attempts will be made to place these observational reports in the context of both the cause and clinical behaviour of this disorder.},
}
@article {pmid12405250,
year = {2002},
author = {Morini, S and Hassan, C and Zullo, A and De Francesco, V and Festa, V and Barberani, F and Faleo, D and Stroffolini, T},
title = {Diverticular disease as a risk factor for sigmoid colon adenomas.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {34},
number = {9},
pages = {635-639},
doi = {10.1016/s1590-8658(02)80206-7},
pmid = {12405250},
issn = {1590-8658},
mesh = {Adenoma/epidemiology/*etiology ; Aged ; Aged, 80 and over ; Colonoscopy ; Colorectal Neoplasms/epidemiology/*etiology ; Diverticulum, Colon/*complications ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Risk Factors ; Sigmoid Diseases/*complications ; },
abstract = {BACKGROUND: Diverticular disease and colorectal neoplasia share similar epidemiological features and risk factors.
AIM: To evaluate a possible association between diverticular disease and both adenomas and colorectal cancer in patients undergoing total colonoscopy.
METHODS: Overall, 630 consecutive patients were recruited from the 3 Units. Inclusion criteria were age over 45 years and the performance of total colonoscopy. Demographic and clinical data were recorded. Adenomas were defined as advanced when their size was >1 cm in diameter, and/or the percentage of the villous component was >30% and/or high grade dysplasia was present.
RESULTS: At endoscopy, 291 (47%) out of 630 patients presented evidence of diverticular disease. Adenomas were found in 92 (31.9%) patients with diverticular disease and in 98 (28.9%) patients without [p=ns]. The prevalence of adenomas located in the sigmoid colon was significantly higher in patients with diverticula than in controls (64.1% vs 41.8%; p<0.05). Similarly, the detection of advanced adenomas located in the sigmoid colon was more likely in patients with diverticula than in controls (59.6% vs 37.5%; p<0.05). Colorectal cancer prevalence was similar in patients with and without diverticula (8.3% vs 7.1%; p=ns), and no difference was detected regarding site, between the two groups.
CONCLUSIONS: Patients with diverticular disease have a higher risk of harbouring adenomas and advanced adenomas in the sigmoid colon. This observation should be taken into account in screening and surveillance programmes for colorectal neoplasia.},
}
@article {pmid12399858,
year = {2003},
author = {Davies, H and Slater, GH and Bailey, M},
title = {Laparascopic sigmoid colectomy for diverticular disease in a patient with situs inversus.},
journal = {Surgical endoscopy},
volume = {17},
number = {1},
pages = {160-161},
doi = {10.1007/s00464-002-4231-4},
pmid = {12399858},
issn = {1432-2218},
mesh = {Colectomy/*methods ; Diverticulitis, Colonic/*complications/*surgery ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Situs Inversus/*complications ; },
abstract = {We present the case of a 50-year-old man with situs inversus who underwent laprascopic colonic resection for diverticulitis. The patient, who had right-sided pain due to inversion of the viscera mimicking appendicitis, initially presented a diagnostic challenge. A barium meal confirmed situs inversus and the diagnosis of diverticulitis. We present an overview of the operative technique of what is the first documented laparoscopic colectemy in a patient with situs inversus. We then discuss the benefits of the laproscopic approach to colectomy, with reference to this interesting case with unusual anatomy.},
}
@article {pmid12394427,
year = {2002},
author = {Dwivedi, A and Chahin, F and Agrawal, S and Chau, WY and Tootla, A and Tootla, F and Silva, YJ},
title = {Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {45},
number = {10},
pages = {1309-14; discussion 1314-5},
doi = {10.1007/s10350-004-6415-6},
pmid = {12394427},
issn = {0012-3706},
mesh = {Colectomy/adverse effects/*methods ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/*surgery ; Treatment Outcome ; },
abstract = {PURPOSE: The feasibility of laparoscopic colectomy for colon surgery has now been well established. Most of the studies on laparoscopic colectomies include all types of colonic pathologies without discrimination. Our goal was to compare laparoscopic sigmoid colectomy open sigmoid colectomy for simple sigmoid diverticular disease, to assess whether it can be done safely and whether the proposed advantages could be realized.
METHODS: We evaluated the differences in outcomes of 66 laparoscopic sigmoid colectomy patients and 88 open sigmoid colectomy patients. We report a five-year outcomes analysis of 154 patients undergoing sigmoid colectomy for diverticular disease. We compared age, gender, history of prior abdominal surgery, estimated blood loss, operative time, total conversions with reason for conversion, time until a liquid diet was started, postoperative complications, hospital length of stay, operation costs, and total hospital charges incurred for both laparoscopic sigmoid colectomy and open sigmoid colectomy.
RESULTS: Mean age and gender were similar in the two groups. However, the mean estimated blood loss (143 ml 314 ml), time until a liquid diet was started (2.9 4.9 days), and hospital length of stay (4.8 8.8 days) were all significantly less in laparoscopic sigmoid colectomy patients. The mean operative time for laparoscopic sigmoid colectomy was 212 minutes as compared with 143 minutes for open sigmoid colectomy (< 0.05). Conversion rate of laparoscopic sigmoid colectomy to open procedure was 19.7 percent. All laparoscopic sigmoid colectomy patients received a lighted ureteral stent preoperatively, which was removed at the end of surgery. Relevant complications for laparoscopic sigmoid colectomy open sigmoid colectomy were as follows: anastomotic leak in 1 3 (1.5 3.4 percent) patients, hematuria in 64 6 (97 6.8 percent) patients, with an average duration for 2.93 3 days, urinary tract infection in 5 4 (7.6 4.5 percent) patients, and ureteral injury in 1 2 (1.5 2.2 percent) patients. Although the mean operating room charges were greater in the laparoscopic sigmoid colectomy patients ($9,566 $7,306) the mean hospital charges ($13,953 $14,863) were less.
CONCLUSIONS: We recommend laparoscopic sigmoid colectomy as the modality of treatment for diverticular disease. Laparoscopic sigmoid colectomy seems to be a reliable, safe and efficacious treatment modality with better outcomes for diverticular disease of the sigmoid colon. The operative time for laparoscopic sigmoid colectomy is decreasing as surgeons gain more experience.},
}
@article {pmid12366427,
year = {2002},
author = {Brouard, MC and Prins, C and Chavaz, P and Saurat, JH and Borradori, L},
title = {Erosive pustular dermatosis of the leg: report of three cases.},
journal = {The British journal of dermatology},
volume = {147},
number = {4},
pages = {765-769},
doi = {10.1046/j.1365-2133.2002.04878.x},
pmid = {12366427},
issn = {0007-0963},
mesh = {Administration, Topical ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents/therapeutic use ; Female ; Glucocorticoids ; Humans ; Immunosuppressive Agents/therapeutic use ; Leg Dermatoses/drug therapy/*pathology ; Male ; Skin Diseases, Vesiculobullous/drug therapy/*pathology ; Tacrolimus/therapeutic use ; },
abstract = {Erosive pustular dermatosis of the leg is a distinct form of spongiform amicrobial pustulosis. The disorder typically affects the lower limbs of elderly patients presenting with chronic venous insufficiency and stasis dermatitis, and has a chronic course. Three elderly patients with chronic venous ulcers are described, who developed pustules and moist eroded lesions on the leg. The clinical and histological features were typical for erosive pustular dermatosis. The lesions rapidly responded to topical treatment with either tacrolimus or corticosteroids. Of note, this condition was associated with a diverticular disease in two patients, while in another patient an epidermoid carcinoma of the tongue was present. Erosive pustular dermatosis of the leg is an uncommon but distinct skin disorder typically associated with trophic changes of the lower limbs. Our observations raise the question of the relation of erosive pustular dermatosis of the leg with the group of neutrophilic dermatoses. Topical immunotherapy with tacrolimus may constitute a novel therapeutic option for this frequently recalcitrant condition.},
}
@article {pmid12362093,
year = {2002},
author = {Simrén, M},
title = {Physical activity and the gastrointestinal tract.},
journal = {European journal of gastroenterology & hepatology},
volume = {14},
number = {10},
pages = {1053-1056},
doi = {10.1097/00042737-200210000-00003},
pmid = {12362093},
issn = {0954-691X},
mesh = {Exercise/*physiology ; Gastrointestinal Diseases/etiology/*prevention & control ; Humans ; },
abstract = {Physical exercise is probably both beneficial and harmful for the gastrointestinal tract, depending partly on the training intensity. On the one hand, gastrointestinal symptoms such as heartburn, chest pain, nausea, vomiting, abdominal cramps, side ache and diarrhoea are common during heavy exercise. On the other hand, physical activity seems to protect from colon cancer, cholelithiasis and diverticular disease. Constipation has been shown to be related to inactivity. Despite this, no overwhelming evidence exists for a positive effect of physical exercise as a treatment option for chronic constipation. The reasons behind these somewhat discrepant effects are not understood fully. Altered gastrointestinal blood flow, effects on gastrointestinal motor function, neuroendocrine changes and mechanical effects are probably involved. Conflicting results exist regarding the effects of physical activity on gastrointestinal motility. Modern technologies now make motility studies in various parts of the gastrointestinal tract possible. More studies are needed to understand better the effects of physical exercise on the gastrointestinal tract. In particular, the relationship between the training intensity and duration and positive and negative alterations in gastrointestinal physiology needs to be addressed further.},
}
@article {pmid12360795,
year = {2002},
author = {Bannura, G and Barrera, A and Melo, C and Contreras, J and Soto, D},
title = {[Lower gastrointestinal bleedings: results of a study and surgical treatment in 20 patients].},
journal = {Revista medica de Chile},
volume = {130},
number = {8},
pages = {869-878},
pmid = {12360795},
issn = {0034-9887},
mesh = {Adult ; Aged ; Angiodysplasia/complications ; Colonoscopy ; Diverticulitis/complications ; Diverticulum, Colon/complications ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage/*etiology/surgery ; Humans ; Intestine, Small/surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Ten to 22% of lower gastrointestinal bleedings require emergency surgery. The overall mortality of the procedure is 22%.
AIM: To report our experience in the management of patients with massive lower gastrointestinal bleeding.
PATIENTS AND METHODS: Retrospective analysis of 20 patients (10 male) aged 19 to 79 years old, with lower gastrointestinal bleeding.
RESULTS: Nine patients were operated on after the bleeding stopped and 11 were operated while still bleeding. In ten, the cause of bleeding was diverticular disease or angiodysplasia. In four, the bleeding originated in the small bowel and in 7 it was of vascular origin. Two patients with a torrential bleeding, were operated on without prior study. Colonoscopy, done in 18 patients, identified the bleeding site in 66% of cases. Scintigraphy was performed in 7 patients and it was positive in five without operative mortality. Selective angiography was done in four patients and was positive in three. A partial intestinal resection was performed in 15 patients and a total colectomy in five without operative mortality. Six patients had major postoperative complications and mean hospital stay was 18 days. Patients have been followed for 9 to 144 months and six have died. Eleven patients were reassessed and all have complete fecal continence.
CONCLUSIONS: In this series, the main causes of massive lower gastrointestinal bleeding were diverticulosis and angiodysplasia. In a high percentage of patients, the bleeding originated in the small bowel.},
}
@article {pmid12352238,
year = {2002},
author = {Asplund, S and Gramlich, T and Fazio, V and Petras, R},
title = {Histologic changes in defunctioned rectums in patients with inflammatory bowel disease: a clinicopathologic study of 82 patients with long-term follow-up.},
journal = {Diseases of the colon and rectum},
volume = {45},
number = {9},
pages = {1206-1213},
doi = {10.1007/s10350-004-6394-7},
pmid = {12352238},
issn = {0012-3706},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colectomy ; Female ; Granuloma/pathology ; Humans ; Inflammatory Bowel Diseases/*pathology/surgery ; Male ; Middle Aged ; Rectal Diseases/pathology ; Rectum/*pathology ; Retrospective Studies ; Statistics, Nonparametric ; },
abstract = {PURPOSE: Inflammation occurs in defunctioned rectums in patients without inflammatory bowel disease. Defunctioned rectums in patients with inflammatory bowel disease have additional histopathologic changes that can cause diagnostic confusion. The aim of this study was to ascertain whether histologic changes in defunctioned rectums had any association with original pathologic diagnosis in the colectomy specimen, duration of defunctionalization, or occurrence of Crohn's disease-like complications during follow-up.
METHODS: In this retrospective study, we reviewed the patient records and reexamined histologically the defunctioned rectums and original colectomy specimens of 84 consecutive patients encountered between 1983 and 1986.
RESULTS: All excised rectal specimens had ulcers and erosions, usually with prominent mucosal lymphoid aggregates, often with mucosal atrophy, diffuse mucin depletion, and marked mucosal architectural distortion. Transmural lymphoid aggregates were identified in 56 patients (67 percent) and were graded as moderate or marked in 35 (42 percent). Ten rectal specimens contained nonnecrotizing granulomas. The original pathologic diagnoses from the colectomy specimens were as follows: ulcerative colitis (n = 22), Crohn's disease (n = 19), indeterminate colitis (n = 41), adenocarcinoma (n = 1), and diverticular disease (n = 1). Only mild histologic changes were observed in rectal specimens from patients with diverticular disease and adenocarcinoma, and granulomas were identified more frequently in Crohn's disease patients. Otherwise, no feature in the defunctioned rectum was associated with the original diagnosis or duration of defunctionalization. Sixteen patients (19 percent) had late surgical complications suggestive of Crohn's disease (abscess, fistula, or subsequent biopsy specimen containing nonnecrotizing granulomas) after a median follow-up of 4.8 years. Five were patients categorized as having Crohn's disease with colectomy specimen, nine had indeterminate colitis, and two had ulcerative colitis. No histologic feature in the defunctioned rectum was associated with Crohn's disease-like complications.
CONCLUSIONS: Granulomas in a defunctioned rectum were associated with an original diagnosis of Crohn's disease. Transmural lymphoid aggregates were common in defunctioned rectums in patients with inflammatory bowel disease and did not indicate Crohn's disease. Other histologic changes developed independently of diagnosis and duration of defunctionalization.},
}
@article {pmid12242977,
year = {2002},
author = {Kasperk, R and Müller, SA and Schumpelick, V},
title = {[Sigmoid diverticulitis. Extent of resection and choice of procedure].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {73},
number = {7},
pages = {690-695},
doi = {10.1007/s00104-002-0505-6},
pmid = {12242977},
issn = {0009-4722},
mesh = {Anastomosis, Surgical ; Animals ; Diverticulitis, Colonic/mortality/*surgery ; Humans ; Intestinal Perforation/mortality/surgery ; *Laparoscopy ; Outcome and Process Assessment, Health Care ; Postoperative Complications/etiology/mortality ; Sigmoid Diseases/mortality/*surgery ; Survival Analysis ; },
abstract = {Diverticular disease of the colon ranks in prevalence equal to diabetes or coronary heart disease. Surgical treatment of colonic diverticulitis is in general very successful. Therapeutic options have broadened in recent years: while improved diagnostic modalities allow a pre-surgical containment of the disease process by percutaneous techniques, minimally-invasive surgical procedures can replace conventional surgery in many cases without a change in the risk of complications. However, there is no proof of a general superiority of the laparoscopic approach. Surgical morbidity and mortality mainly derives from perforations with diffuse peritonitis. As a rule, these cases should be treated by a Hartmann procedure. In selected cases it is also possible to perform a primary anastomosis. This decision should be guided by well-known scoring systems.},
}
@article {pmid12242976,
year = {2002},
author = {Germer, CT and Buhr, HJ},
title = {[Sigmoid diverticulitis. Surgical indications and timing].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {73},
number = {7},
pages = {681-689},
doi = {10.1007/s00104-002-0506-5},
pmid = {12242976},
issn = {0009-4722},
mesh = {Diverticulitis, Colonic/classification/diagnosis/*surgery ; Humans ; Prognosis ; Recurrence ; Risk Assessment ; Sigmoid Diseases/classification/diagnosis/*surgery ; },
abstract = {Indication and time for surgery of diverticular disease are determined by the stage of the disease. Clinically pragmatic pretreatment staging is thus a prerequisite for stage-adapted therapy. The correct indication for surgery is also based on knowledge of the spontaneous disease course, its course after conservative and operative therapy and the individual risk factors for complicated diverticular disease. Surgery is not indicated for bland diverticulosis or uncomplicated diverticulitis. It is generally indicated, however, for acute complicated diverticulitis. Decisive in establishing the indication for surgery is therefore the precise pretherapeutic differentiation of complicated and uncomplicated diverticulitis. Depending on the type of complication and the clinical appearance, the time for surgery of acute complicated diverticulitis is fixed on an emergency or early elective basis following initial conservative and/or interventional therapy. Chronically recurrent diverticulitis is likewise an indication for surgery. In terms of timing, an elective interval operation is best after the second inflammatory episode but should already be performed after the first one in risk groups, e.g. immunosuppressed patients.},
}
@article {pmid12242974,
year = {2002},
author = {Lammers, BJ and Schumpelick, V and Röher, HD},
title = {[Standards in diagnosis of diverticulitis].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {73},
number = {7},
pages = {670-674},
doi = {10.1007/s00104-002-0496-3},
pmid = {12242974},
issn = {0009-4722},
mesh = {Acute Disease ; Algorithms ; Colonic Diseases/diagnosis/surgery ; Colonoscopy ; Critical Pathways/*standards ; Diverticulitis, Colonic/*diagnosis/surgery ; Humans ; Intestinal Obstruction/diagnosis/surgery ; Intestinal Perforation/diagnosis/surgery ; Peritonitis/diagnosis/surgery ; Tomography, X-Ray Computed ; },
abstract = {The diagnostic procedure is determined by the severity of the diverticulitis. In complicated cases of diverticulitis, it is necessary to detect those patients with obstructive ileus, perforation, and peritonitis who require instant emergency surgery. In all other cases, diagnostic procedures serve as a tool to determine the best therapeutic options. The CT scan of the abdomen seems to have the highest reliability for determining therapy. Other investigations such as barium enema and coloscopy are not indicated in emergency cases or cannot exactly describe the stage of the diverticular disease. Many surgeons still prefer an enema with water-soluble contrast medium in emergency cases to visualize a perforation. CT scans have the same ability to answer this question, but they are more expensive and are not available everywhere at any given time.},
}
@article {pmid12230665,
year = {2002},
author = {Simpson, J and Spiller, R},
title = {Colonic diverticular disease.},
journal = {Clinical evidence},
volume = {},
number = {7},
pages = {398-405},
pmid = {12230665},
issn = {1462-3846},
mesh = {Acute Disease ; Colectomy ; Colostomy ; Dietary Fiber/administration & dosage/adverse effects ; Diverticulitis, Colonic/etiology/*therapy ; Diverticulum, Colon/etiology/*therapy ; Humans ; Randomized Controlled Trials as Topic ; Recurrence ; Rifamycins/adverse effects/therapeutic use ; Rifaximin ; Treatment Outcome ; },
}
@article {pmid12215033,
year = {2002},
author = {Campbell, WB and Lee, EJ and Van de Sijpe, K and Gooding, J and Cooper, MJ},
title = {A 25-year study of emergency surgical admissions.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {84},
number = {4},
pages = {273-277},
pmid = {12215033},
issn = {0035-8843},
mesh = {Age Distribution ; Emergencies/*epidemiology ; Emergency Service, Hospital/*statistics & numerical data ; England/epidemiology ; Hospital Mortality ; Hospitals, District/*statistics & numerical data ; Humans ; Length of Stay/statistics & numerical data/trends ; Longitudinal Studies ; Middle Aged ; Patient Admission/*statistics & numerical data/trends ; Surgical Procedures, Operative/*statistics & numerical data ; Utilization Review ; },
abstract = {BACKGROUND: Numbers of emergencies are increasing, but no comprehensive data are available for emergency surgical admissions. This study documents the changes over 25 years in a district general hospital.
METHODS: Details of all general surgical (including urological) emergency admissions were analysed for every fourth calendar year from 1974 to 1998.
RESULTS: A total of 19,931 patients were admitted during the 7 years studied, rising from 2137 in 1974 to 3578 in 1994 (3377 in 1998). Mean age increased from 47.9 years to 52.6 years while mean length of stay fell from 9.5 days to 5.3 days. Hospital mortality decreased from 6.6% to 3.7%. When calculated per 100,000 population, the increase in admission rate was significant (P < 0.001) but bed requirements did not increase despite the increase in workload. Several diagnoses became significantly more frequent (ruptured aortic aneurysm, gallstones, constipation, cutaneous abscess, diverticular disease, gastroenteritis, non-specific abdominal pain, pilonidal sinus and urinary diagnoses). Appendicitis and non-malignant intestinal obstruction became significantly less common.
CONCLUSIONS: This study has documented a progressive increase in surgical admissions. Despite increasing age of patients, lengths of stay and hospital mortality have decreased.},
}
@article {pmid12193817,
year = {2002},
author = {Hong, D and Lewis, M and Tabet, J and Anvari, M},
title = {Prospective comparison of laparoscopic versus open resection for benign colorectal disease.},
journal = {Surgical laparoscopy, endoscopy & percutaneous techniques},
volume = {12},
number = {4},
pages = {238-242},
doi = {10.1097/00129689-200208000-00007},
pmid = {12193817},
issn = {1530-4515},
mesh = {Adult ; Colonic Diseases/*surgery ; Colonic Polyps/surgery ; Crohn Disease/surgery ; *Digestive System Surgical Procedures ; Female ; Humans ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Prospective Studies ; Rectal Diseases/*surgery ; },
abstract = {Laparoscopic surgery is not being applied in a widespread manner in the management of benign or malignant colorectal disorders. This is a prospective comparison of 279 patients who underwent elective colorectal surgery. Colorectal diseases included inflammatory bowel, diverticular disease, colonic inertia, polyps, and rectal prolapse. Data included 136 patients who underwent laparoscopic surgery (mean age, 51.3 years) and 143 who underwent open surgery (mean age, 56.0 years). Thirteen patients' procedures were converted to open, but their results were included in the laparoscopic surgery group. There was no significant difference in operative time, postoperative complications, morbidity, or mortality between the laparoscopic and open surgery groups. More patients in the laparoscopic group had significant cardiac disease (6.0%, laparoscopic; 0.7%, open; = 0.01). More patients in the open group had undergone previous gastrointestinal surgery (3.7%, laparoscopic; 11.2%, open; = 0.02). The laparoscopic group used less postoperative analgesia and resumed oral feeding quicker (< 0.05). In addition, time to first flatus and bowel movement was faster (< 0.05), and the length of postoperative hospital stay (7.7 +/- 15.8 versus 11.0 +/- 8.3; = 0.03) was shorter in the laparoscopic surgery group. There are significant advantages in postoperative recovery with the laparoscopic technique. If proven to be cost-effective, laparoscopic colorectal surgery for benign diseases should become the standard of surgical care.},
}
@article {pmid12192936,
year = {2002},
author = {Celi, D and Biasiato, R and D'Amico, C and Danek, R and Casolino, V and Battaglino, D and Ferraro, S and Errante, D and Cadrobbi, R},
title = {[Diverticulosis of the colon: complications of surgical interest].},
journal = {Chirurgia italiana},
volume = {54},
number = {3},
pages = {385-388},
pmid = {12192936},
issn = {0009-4773},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; *Colectomy ; Constriction, Pathologic ; Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/*complications/*surgery ; Female ; Humans ; Intestinal Perforation/etiology/surgery ; Male ; Middle Aged ; Sex Factors ; },
abstract = {Diverticular disease is prevalently only of medical interest. Repeated episodes of diverticulitis, particularly in younger patients, and serious complications such as perforation, stenosis, fistula and haemorrhage demand surgical treatment. The timing and type of surgical operation are conditioned by the pathological picture and by the patient's general condition and age. The authors present a series of 586 patients admitted for diverticular disease, 84 of whom presented complicated diverticulosis. Nineteen cases (22.6%) underwent elective surgery in the form of an anterior rectal resection, while 65 of them underwent urgent surgery for complicated diverticulosis variously consisting in total colectomy, a Hartman's resection, a simple rectal resection or a left or right hemicolectomy.},
}
@article {pmid12190290,
year = {2002},
author = {Pillay, K and Chetty, R},
title = {Malakoplakia in association with colorectal carcinoma: a series of four cases.},
journal = {Pathology},
volume = {34},
number = {4},
pages = {332-335},
doi = {10.1080/003130202760120481},
pmid = {12190290},
issn = {0031-3025},
mesh = {Carcinoma, Ductal, Breast/*complications/pathology ; Colorectal Neoplasms/*complications/pathology ; Female ; Humans ; Malacoplakia/*complications/pathology ; Male ; Microscopy, Electron ; Middle Aged ; },
abstract = {AIMS: Malakoplakia is a characteristic inflammatory condition which is usually seen in the urogenital tract. Gastrointestinal malakoplakia is seen in association with a variety of conditions such as ulcerative colitis, diverticular disease, adenomatous polyps and carcinoma. The purpose of this paper is to report four additional cases of colorectal cancer associated with malakoplakia and review the literature on this association.
METHODS: All specimens were colectomies for cancer. Routine handling of the specimen with lymph node harvesting was performed. In addition to H&E stains, PAS, Perls' Prussian Blue and von Kossa stains were performed.
RESULTS: Three of the cases were encountered in males and the patients ranged in age from 55 to 64 years. One case each occurred in the caecum/ascending colon and descending colon, while the remaining two were located in the rectum. All four cases were Dukes' stage B tumours. Furthermore, all four cases had spread to pericolic fat and two had perforated. Microscopic examination showed the malakoplakia to be present at the infiltrating edge of the tumours. The draining lymph nodes were involved by malakoplakia to varying degrees in all cases.
CONCLUSIONS: From this series and the literature review, malakoplakia associated with colorectal cancer tends to occur in elderly males in the rectum. The malakoplakia is found at the infiltrating front of the tumour and is not admixed with the neoplastic glands. Although lymph node involvement by malakoplakia has been reported only once previously, all four cases in this series showed evidence of involvement. The association does not appear to have any prognostic significance.},
}
@article {pmid12172374,
year = {2002},
author = {Loffeld, RJ and van der Putten, AB},
title = {Newly developing diverticular disease of the colon in patients undergoing repeated endoscopic evaluation.},
journal = {Journal of clinical gastroenterology},
volume = {35},
number = {2},
pages = {205-206},
doi = {10.1097/00004836-200208000-00021},
pmid = {12172374},
issn = {0192-0790},
mesh = {Adult ; Aged ; Aging ; Cohort Studies ; *Colonoscopy ; Cross-Sectional Studies ; Diverticulum, Colon/*epidemiology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Prevalence ; Time Factors ; },
}
@article {pmid12163329,
year = {2002},
author = {Nascimbeni, R and Donato, F and Ghirardi, M and Mariani, P and Villanacci, V and Salerni, B},
title = {Constipation, anthranoid laxatives, melanosis coli, and colon cancer: a risk assessment using aberrant crypt foci.},
journal = {Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology},
volume = {11},
number = {8},
pages = {753-757},
pmid = {12163329},
issn = {1055-9965},
mesh = {Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cathartics/*adverse effects ; Colonic Diseases/*complications/etiology ; Colonic Neoplasms/*etiology ; Constipation/complications/*drug therapy ; Female ; Humans ; Intestinal Mucosa/pathology ; Male ; Melanosis/*complications/etiology ; Middle Aged ; Precancerous Conditions/complications/etiology ; Risk Assessment ; },
abstract = {The associations between colorectal cancer (CRC) and constipation, anthranoid laxative use, and melanosis coli are controversial. Aberrant crypt foci (ACF) are microscopic lesions of the colonic mucosa suspected of being preneoplastic, and their investigation has been advocated to evaluate the cause-effect relationship between putative risk factors and CRC. To this aim, we investigated the relationship between sigmoid cancer (SC) and constipation, anthranoid laxative use, and melanosis coli using ACF analysis as an additional tool of investigation. Fifty-five surgical patients with SC, 41 surgical patients with diverticular disease (DD), and 96 age- and sex-matched subjects without intestinal disease (controls) were interviewed on their history of constipation and anthranoid laxative use. Melanosis coli and ACF characteristics were investigated on sigmoid mucosa in patients with SC or DD. Constipation and anthranoid laxative use were similar between patients with SC (30.9% and 32.7%, respectively) and those with DD (39% and 26.8%) but higher than among controls (18.8% and 8.3%). Melanosis coli was found in 38.2% of patients with SC and in 39% of those with DD. Mean ACF frequency was higher in patients with SC (0.24/cm(2)) than in those with DD (0.10/cm(2); P < 0.0001), and it did not vary according to constipation, laxative use, or melanosis coli in either group. This study confirms the association of ACF frequency with colon cancer and does not support the hypothesis of a cause-effect relationship of CRC with constipation, anthranoid laxative, use or melanosis coli.},
}
@article {pmid12141181,
year = {2002},
author = {Rubio, MA},
title = {[Implications of fiber in different pathologies].},
journal = {Nutricion hospitalaria},
volume = {17 Suppl 2},
number = {},
pages = {17-29},
pmid = {12141181},
issn = {0212-1611},
mesh = {Cardiovascular Diseases/prevention & control ; Clinical Trials as Topic ; Diabetes Mellitus/prevention & control ; *Diet ; *Dietary Fiber ; Humans ; Intestinal Diseases/*epidemiology/prevention & control ; Obesity/prevention & control ; },
abstract = {Three decades ago, the observations of Trowell and Burkitt gave rise to the "fibre theory", in which it was contended that there was a link between the consumption of a diet rich in fibre and non-processed carbohydrates and the level of protection against many of the "first world diseases" such as constipation, diverticulosis, cancer of the colon, diabetes, obesity and cardiovascular disease. Since that time, numerous studies have been presented to analyze the relationship between fibre and disorders of the gastrointestinal tract and other processes with severe health implications. The present revision looks at the experience accumulated over this period regarding the importance of the consumption of fibre for certain phatologies. It not only deals with the epidemiological relationship existing between fibre intake and the development of diseases such as cancer of the colon or cardiovascular disorders but also reviews the interest of fibre a therapeutic agent, in view of the current information available on its different mechanism of action. Thus the possibility of using soluble fibre has taken on renewed interest for the treatment of inflammatory intestinal disease, for control of diarrhoea, in irritable bowel syndrome or no modulate the concentrations of glycaemia or cholesterol. Three is a discussion of the discrepancies found between the consumption of fibre and diverticular disease, the treatment of constipation and the association with obesity and cardiovascular disease. Despite the accumulated evidence on the consumption of fibre, there is currently no consensus as to recommendations on what type of fibre and the optimal amount that should be consumed. A high fibre intake (> 25-30 g/day) based on a variety of food sources (fruit, vegetable, legumes, cereals) is the only way to avoid many of the disorders mentioned. The consumption of a particular type of fibre (soluble or insoluble) is limited to the treatment of certain processes, because its individual relationship with many disorders is still pending determination.},
}
@article {pmid12130725,
year = {2002},
author = {Liu, L and Shang, F and Markus, I and Burcher, E},
title = {Roles of substance P receptors in human colon circular muscle: alterations in diverticular disease.},
journal = {The Journal of pharmacology and experimental therapeutics},
volume = {302},
number = {2},
pages = {627-635},
doi = {10.1124/jpet.102.034702},
pmid = {12130725},
issn = {0022-3565},
mesh = {Adult ; Aged ; Autoradiography ; Colon/drug effects/physiology/physiopathology ; Colon, Sigmoid/physiology/*physiopathology ; Diverticulitis/*physiopathology ; Female ; Humans ; Indomethacin/pharmacology ; Kinetics ; Male ; Middle Aged ; Muscle, Smooth/physiology/*physiopathology ; Neurokinin A/pharmacology ; Organ Specificity ; Receptors, Neurokinin-1/drug effects/*physiology ; Reference Values ; Substance P/analogs & derivatives/metabolism/pharmacology ; },
abstract = {The characteristics of [(125)I]Bolton-Hunter[Sar(9),Met(O(2))(11)]substance P ([(125)I]BH-SarSP) binding were investigated in membranes of human ascending, transverse, distal, and sigmoid colon circular muscle. Binding of [(125)I]BH-SarSP was of high affinity (K(D) = 68 nM) and low capacity (B(max) = 0.31 fmol/mg of wet weight tissue), and showed no regional differences. [(125)I]BH-SarSP binding was inhibited by SP approximately equal to [Pro(9)]SP > or = (2S,3S)-3-(2-methoxybenzylamino)-2-phenylpiperidine (CP99994) >> neurokinin (NK) A > or = neuropeptide gamma > [Lys(5),MeLeu(9),Nle(10)]-NKA(4-10) approximately (S)-N-methyl-N[4-acetylamino-4-phenylpiperidino)-2-(3,4-dichlorophenyl) butyl]benzamide (SR48968) >> senktide, suggesting binding to NK-1 sites. Most agonists seemed to bind to two sites. In autoradiographic studies, dense binding for [(125)I]BH-SarSP was associated with submucosal and longitudinal muscle blood vessels, and the submucosal margin of circular muscle (corresponding to interstitial cells of Cajal), with moderate binding over most of the circular muscle. In normal colon circular muscle strips, [Pro(9)]SP was almost ineffective, and SP caused contractions with pD(2) values of 5.3 to 5.7. No regional differences were observed in potency or efficacy. Responses to SP were inhibited by the NK-2 receptor antagonist SR48968, but not by NK-1 antagonist CP99994, indicating the involvement of NK-2 rather than NK-1 receptors. Atropine significantly inhibited contractions induced by SP, indicating a minor cholinergic component. Contractile responses to SP were considerably reduced in preparations from patients with diverticular disease, and marginally reduced in ulcerative colitis compared with control. This study clearly demonstrates an NK-1 binding site on human colon circular muscle, but its role in this tissue remains unclear and may not involve contractile mechanisms. The attenuated contractility in specimens with diverticular disease may reflect disease-related alterations of the tachykinin receptor system.},
}
@article {pmid12128116,
year = {2002},
author = {Ben-Josef, E and Han, S and Tobi, M and Shaw, LM and Bonner, HS and Vargas, BJ and Prokop, S and Stamos, B and Kelly, L and Biggar, S and Kaplan, I},
title = {A pilot study of topical intrarectal application of amifostine for prevention of late radiation rectal injury.},
journal = {International journal of radiation oncology, biology, physics},
volume = {53},
number = {5},
pages = {1160-1164},
doi = {10.1016/s0360-3016(02)02883-3},
pmid = {12128116},
issn = {0360-3016},
mesh = {Adenocarcinoma/drug therapy/*radiotherapy ; Administration, Topical ; Amifostine/administration & dosage/pharmacology ; Analysis of Variance ; Dose-Response Relationship, Drug ; Dose-Response Relationship, Radiation ; Humans ; Intestinal Mucosa/metabolism ; Male ; Mercaptoethylamines/pharmacology ; Multivariate Analysis ; Prostatic Neoplasms/drug therapy/metabolism/*radiotherapy ; Radiation-Protective Agents/pharmacology ; Rectum/pathology/radiation effects ; Telangiectasis/pathology ; Time Factors ; },
abstract = {PURPOSE: Clinical symptomatic late injury to the rectal wall occurs in about one-third of patients with prostate cancer treated with external beam irradiation. Reducing the physical dose to the anterior rectal wall without a similar reduction in the posterior peripheral zone is difficult because of the proximity of the prostate to the anterior rectal wall. On the basis of our previous observations in an animal model that intrarectal application of amifostine resulted in very high concentrations of amifostine and its active metabolite WR-1065 in the rectal wall, a Phase I dose-escalation clinical trial was undertaken.
METHODS AND MATERIALS: Twenty-nine patients with localized prostate cancer were accrued. Eligibility criteria included histologically confirmed adenocarcinoma, Karnofsky performance status >or=70, and no pelvic lymphadenopathy or distant metastases. The total dose to the prostate was 70.2 Gy in 20 patients and 73.8 Gy in 9 patients. Therapy was delivered using a 4-field technique with three-dimensional conformal planning. Amifostine was administered intrarectally as an aqueous solution 30 min before irradiation on the first 15 days of therapy. Amifostine was escalated in cohorts from 500 to 2500 mg. Proctoscopy was performed before therapy and at 9 months after completion. Most patients underwent repeat proctoscopy at 18 months. On Days 1 and 10 of radiotherapy, serum samples were collected for pharmacokinetic studies. The clinical symptoms (Radiation Therapy Oncology Group scale) and a proctoscopy score were assessed during follow-up.
RESULTS: All patients completed therapy with no amifostine-related toxicity at any dose level. The application was feasible and well tolerated. No substantial systemic absorption occurred. With a median follow-up of 26 months, 9 patients (33%) developed rectal bleeding (8 Grade 1, 1 Grade 2). At 9 months, 16 and 3 patients developed Grade 1 and Grade 2 telangiectasia, respectively. This was mostly confined to the anterior rectal wall. No visible mucosal edema, ulcerations, or strictures were noted. No significant differences were found between the proctoscopy findings at 9 and 18 months. Four patients (14%) developed symptoms suggestive of radiation damage that, on sigmoidoscopy, proved to be secondary to unrelated processes. These included preexisting nonspecific proctitis (n = 1), diverticular disease of the sigmoid colon (n = 1), rectal polyp (n = 1), and ulcerative colitis (n = 1). Symptoms developed significantly more often in patients receiving 500-1000 mg than in patients receiving 1500-2500 mg amifostine (7 [50%] of 14 vs. 2 [15%] of 13, p = 0.0325, one-sided chi-square test).
CONCLUSION: Intrarectal application of amifostine is feasible and well tolerated. Systemic absorption of amifostine and its metabolites is negligible, and close monitoring of patients is not required with rectal administration. Proctoscopy is superior to symptom score as a method of assessing radiation damage of the rectal wall. The preliminary efficacy data are encouraging, and further clinical studies are warranted.},
}
@article {pmid12092659,
year = {2001},
author = {Ansari, MS and Nabi, G and Singh, I and Hemal, AK and Pandey, G},
title = {Colovesical fistula an unusual complication of cytotoxic therapy in a case of non-Hodgkin's lymphoma.},
journal = {International urology and nephrology},
volume = {33},
number = {2},
pages = {373-374},
pmid = {12092659},
issn = {0301-1623},
mesh = {Aged ; Antineoplastic Combined Chemotherapy Protocols/*adverse effects/therapeutic use ; Cyclophosphamide/*adverse effects/therapeutic use ; Doxorubicin/*adverse effects/therapeutic use ; Epiglottis ; Humans ; Intestinal Fistula/*chemically induced ; Lymphoma, Non-Hodgkin/*drug therapy ; Male ; Prednisone/*adverse effects/therapeutic use ; Sigmoid Diseases/*chemically induced ; Tongue Neoplasms/*drug therapy ; Urinary Bladder Fistula/*chemically induced ; Vincristine/*adverse effects/therapeutic use ; },
abstract = {A 65-year old man, a known case of non-Hodgkin's lymphoma of base of the tongue and epiglottis presented with complaints of pneumaturia and faecaluria. He had received the first cycle of cytotoxic therapy (CHOP-regimen). At the end of the cycle he developed febrile neutropenia (circulating granulocyte count <1500/mm3). Cystogram showed air in the bladder area and a fistulous communication to a cavity behind the bladder. CT-scan showed air in the bladder, a fistulous communication between the sigmoid colon and bladder along with an intervening small abscess cavity. On exploration a fistulous communication between the sigmoid and bladder along with an intervening small abscess cavity was found. Resection of involved portion of sigmoid and end to end anastomosis along with a diverting colostomy was done. The bladder was closed in two layers with an omental interposition between it and the sigmoid along with a suprapubic cystostomy. The histopathology demonstrated only inflammatory response without any evidence of malignancy or diverticular disease.},
}
@article {pmid12073416,
year = {2002},
author = {Kouraklis, G and Glinavou, A and Mantas, D and Kouskos, E and Karatzas, G},
title = {Clinical implications of small bowel diverticula.},
journal = {The Israel Medical Association journal : IMAJ},
volume = {4},
number = {6},
pages = {431-433},
pmid = {12073416},
issn = {1565-1088},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum/*complications/diagnosis/pathology/surgery ; Female ; Humans ; Intestine, Small/*pathology/surgery ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {BACKGROUND: Small bowel diverticula are usually asymptomatic and rare. Their importance is based on the fact that they carry the risk of serious complications.
OBJECTIVE: To study the implications and the therapeutic approach regarding small bowel diverticulosis.
METHODS: The medical records of 54 patients with diverticular disease of the small bowel, including Meckel's and duodenum diverticula, were retrospectively reviewed. The mean age of the 32 male and 22 female patients was 53.2 years.
RESULTS: Diverticula were found in the duodenum in 11 cases, in the jejunum and ileum in 21 cases, and with Meckel's diverticula in 22 cases. In 24% of the patients the diverticula were multiple. The most common clinical symptom was abdominal pain, in 44.4%. Most of the duodenum diverticula were asymptomatic; 47.6% of the patients with diverticular disease located in the jejunum and ileum presented with chronic symptoms. The overall diagnostic rate for symptomatic diverticula before surgery was 52.7%; in 33.3% diverticula were found incidentally during other diagnostic or therapeutic procedures. Forty-one patients were managed surgically. 15 patients were operated on urgently because of infection or rupture, 4 patients for bleeding, 5 patients for intestinal obstruction, and one patient for jaundice.
CONCLUSIONS: The incidence of asymptomatic small bowel diverticula is difficult to ascertain. Patients with Meckel's and duodenal diverticula are usually asymptomatic, while the majority of jejunal and ileal diverticula patients present with chronic symptoms. The pre-operative diagnostic rate is higher for duodenal diverticula. Small bowel diverticula do not require surgical treatment unless refractory symptoms or complications occur.},
}
@article {pmid12063965,
year = {2002},
author = {Regenet, N and Tuech, JJ and Pessaux, P and Ziani, M and Rouge, C and Hennekinne, S and Arnaud, JP},
title = {Intraoperative colonic lavage with primary anastomosis vs. Hartmann's procedure for perforated diverticular disease of the colon: a consecutive study.},
journal = {Hepato-gastroenterology},
volume = {49},
number = {45},
pages = {664-667},
pmid = {12063965},
issn = {0172-6390},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; *Digestive System Surgical Procedures/adverse effects ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Intraoperative Period ; Male ; Middle Aged ; Peritonitis/etiology/*surgery ; Prospective Studies ; *Therapeutic Irrigation ; },
abstract = {BACKGROUND/AIMS: The ideal treatment for complicated diverticulitis is still controversial. The Hartmann's procedure remains the favored option in patients with acute complicated sigmoid disease but there has been increasing interest in primary resection and anastomosis with intraoperative colonic lavage. A prospective study was carried out on 71 patients with peritonitis, comparing primary resection with intraoperative colonic lavage, and Hartmann's procedure.
METHODOLOGY: Between January 1994 and September 1999, 71 patients underwent emergency laparotomy for diverticular peritonitis. Primary resection and anastomosis with intraoperative colonic lavage was performed in 29 patients (group I) and Hartmann's procedure in 42 patients (group II). All data were collected on standardized forms.
RESULTS: There were no differences between the two groups according to clinical features, biology, severity of disease and operative delay. The mortality rate in group I and group II was, respectively, 7 and 10% (P = 0.6). The incidence of postoperative complication was higher after Hartmann's procedure (P < 0.05). The mean hospital stay was significantly longer for the Hartmann's procedure compared to primary resection with intraoperative colonic lavage.
CONCLUSIONS: Primary resection with intraoperative colonic lavage compares favorably with Hartmann's procedure for local or diffuse purulent peritonitis in complicated diverticulitis. It should be an alternative to the Hartmann's procedure in stercoral peritonitis.},
}
@article {pmid12056468,
year = {2001},
author = {Kouraklis, G and Mantas, D and Glivanou, A and Kouskos, E and Raftopoulos, J and Karatzas, G},
title = {Diverticular disease of the small bowel: report of 27 cases.},
journal = {International surgery},
volume = {86},
number = {4},
pages = {235-239},
pmid = {12056468},
issn = {0020-8868},
mesh = {Adult ; Aged ; Aged, 80 and over ; Angiography ; Barium Sulfate ; Diagnostic Techniques, Digestive System ; Digestive System Surgical Procedures/*methods ; *Diverticulum/complications/diagnosis/surgery ; Female ; *Gastrointestinal Diseases/complications/diagnosis/surgery ; Humans ; Intestine, Small/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Technetium ; Treatment Outcome ; },
abstract = {Diverticula of the small bowel are usually asymptomatic but occasionally can present with serious complications. Because of the rarity of small bowel diverticulosis and the limited case number in most published reports, we analyzed one of the largest series with symptomatic small bowel diverticular disease. In this retrospective review, we studied 27 symptomatic patients with diverticula of the small bowel that was treated surgically. The study included 13 male and 14 female patients (age range, 30-87 years; mean age, 69.3 years). Fourteen patients underwent an elective operation for chronic refractory symptoms. Thirteen patients underwent emergency surgery because of rupture of the diverticula and associated peritonitis, diverticulitis and small bowel obstruction, or lower gastrointestinal bleeding. Surgical treatment consisted of resection of the intestinal segment containing the diverticula. All patients were symptom-free postoperatively and no "short bowel" problems developed. Abdominal pain, gastrointestinal bleeding, and bowel obstruction were the most common clinical symptoms. Small bowel diverticulosis should be treated surgically only when refractory symptoms or severe complications are present.},
}
@article {pmid12053809,
year = {2002},
author = {García-Osogobio, S and Remes-Troche, JM and Takahashi, T and Barreto Camilo, J and Uscanga, L},
title = {[Surgical treatment of lower digestive tract hemorrhage. Experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán].},
journal = {Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion},
volume = {54},
number = {2},
pages = {119-124},
pmid = {12053809},
issn = {0034-8376},
mesh = {Academies and Institutes/statistics & numerical data ; Adolescent ; Adult ; Aged ; Anastomosis, Surgical/statistics & numerical data ; Colectomy/methods/statistics & numerical data ; Colonic Diseases/diagnosis/epidemiology/etiology/*surgery ; Colonoscopy/statistics & numerical data ; Colostomy/statistics & numerical data ; Cross-Sectional Studies ; Diverticulitis/complications ; Female ; Gastrointestinal Hemorrhage/diagnosis/epidemiology/etiology/*surgery ; Humans ; Male ; Mexico/epidemiology ; Middle Aged ; Postoperative Complications/epidemiology ; Recurrence ; Retrospective Studies ; },
abstract = {BACKGROUND: Lower gastrointestinal bleeding is usually self-limiting in about 80% of cases; however, surgical treatment may be required in selected cases. Preoperative precise identification of the bleeding source is crucial for a successful outcome.
OBJECTIVE: To determine the most frequent diagnoses, as well as short and long-term results in a series of patients who underwent a surgical procedure for lower gastrointestinal bleeding.
MATERIAL AND METHODS: Retrospective analysis of 39 patients operated upon for lower gastrointestinal bleeding from 1979 through 1997 in a referral center. Demographic data, history, physical examination, laboratory tests, resuscitative measures, preoperative work-up for identification of bleeding source, definitive cause of bleeding, surgical procedure, operative morbidity and mortality, as well as long-term status and recurrence of bleeding were recorded.
RESULTS: There were 54% women and 46% men. Mean age was 56 years (range, 15-92). Most patients presented hematochezia (69%). Colonoscopy was the most used diagnostic procedure (69%). The bleeding source was located in 90% of patients. Diverticular disease was the most frequent cause of bleeding. A segmental bowel resection was the treatment in 97% of cases. Morbidity was 23% with 18% of mortality. Recurrence occurred in 9% of survivors.
CONCLUSIONS: Morbidity and mortality were high. Patients who require a surgical operation should be carefully selected and evaluated with a complete work-up to determine the site and cause of bleeding.},
}
@article {pmid12018691,
year = {2002},
author = {Somasekar, K and Foster, ME and Haray, PN},
title = {The natural history diverticular disease: is there a role for elective colectomy?.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {47},
number = {2},
pages = {481-2, 484},
pmid = {12018691},
issn = {0035-8835},
mesh = {Colectomy/*methods ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/*surgery ; *Elective Surgical Procedures ; Female ; Humans ; Male ; Retrospective Studies ; },
abstract = {BACKGROUND: The natural history of colonic diverticular disease is unclear leading to a debate on the value of elective colectomy in preventing complications of the disease.
AIM: To assess whether the complications of diverticular disease requiring emergency surgery are related to previous episodes of diverticulitis and whether elective colectomy might prevent such complications.
MATERIALS AND METHODS: A retrospective study was done on all patients admitted with complicated diverticular disease in two adjacent district general hospitals between 1995 and 2000. Information was collected on the details of management of the complications and past history of the investigations and treatment for diverticular disease in these patients.
RESULTS: A total of 108 patients were admitted with complicated diverticular disease. Ninety eight (91%) patients were admitted as an emergency for perforated diverticular disease and rectal bleeding. Ten patients were urgent admissions for fistulae and diverticular phlegmons. Ninety eight patients underwent a Hartmann's operation, two had a subtotal colectomy and 4 patients had a sigmoid colectomy. Thirty four (31.4%) patients died in hospital post-operatively. Of the 108 patients, only 28 (26%) patients were known to have diverticular disease previously. Only three (2.7%) patients had had an episode of acute diverticulitis before they presented with further complications.
CONCLUSIONS: Complications of diverticular disease occur de novo in the majority of patients who have no previous history of the disease. Further studies are needed to identify risk factors for complicated diverticular disease before adopting a policy of elective interval colectomy.},
}
@article {pmid12015620,
year = {2002},
author = {Mavrantonis, C and Wexner, SD and Nogueras, JJ and Weiss, EG and Potenti, F and Pikarsky, AJ},
title = {Current attitudes in laparoscopic colorectal surgery.},
journal = {Surgical endoscopy},
volume = {16},
number = {8},
pages = {1152-1157},
doi = {10.1007/s004640080072},
pmid = {12015620},
issn = {1432-2218},
mesh = {Adenoma/surgery ; *Attitude of Health Personnel ; Carcinoma/surgery ; Colectomy/statistics & numerical data ; Colonic Diseases/diagnosis/*surgery ; Colonic Polyps/surgery ; Colorectal Surgery/*statistics & numerical data ; Data Collection ; Humans ; Laparoscopy/*statistics & numerical data ; Neoplasm Staging ; North America/epidemiology ; Population Surveillance ; Rectal Diseases/diagnosis/*surgery ; Societies, Medical/statistics & numerical data ; Surveys and Questionnaires ; },
abstract = {BACKGROUND: In this study, we set out to examine the current attitudes among surgeons toward laparoscopic colorectal surgery (LCS).
METHODS: A total of 3628 questionnaires were sent to all North American members of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the American Society of Colon and Rectal Surgeons (ASCRS); 40% of the members of each society responded (B15 respondents).
RESULTS: Currently, 85% of the respondents perform laparoscopic surgery; LCS was performed by 48% of the respondents in 21% of their patients. Although 35% of the members of SAGES have increased the number of laparoscopic colorectal operations they perform in the last 3 years, only 26% of ASCRS members did so. Our findings showed that 74% of the surgeons who perform LCS do so for diverticular disease, 68% for colonic polyps, 61% for villous adenoma, and 36% for ileal Crohn's disease. However, only 15% operate for the cure of carcinoma of any stage (16% of SAGES members and 11% of ASCRS members), whereas 8.5% and 7% operate for the cure of all upper and lower rectal carcinomas, respectively. Thirty-six percent of the surgeons who perform LCS for cancer have done between one and 10 curative resections, 8% have done 11-20 procedures, and 14% have done >20 procedures. There were 80 cases of port site recurrence reported by 4.4% of surgeons. Although 56% of the respondents would themselves undergo laparoscopic colorectal surgery for a rectal villous adenoma, only 9% would do so for a distal-third rectal carcinoma (12% of SAGES and 5% of ASCRS respondents).
CONCLUSIONS: The overall percentage of respondents performing LCS has decreased over the last 3 years; moreover, surgeons are more hesitant to perform laparoscopic surgery for the cure of colonic cancer. Due to the overall low response rate, the fact that 4.4% of those surgeons who did respond have seen port site recurrences does not allow any conclusions to be drawn about the prevalence of this problem.},
}
@article {pmid12014937,
year = {2002},
author = {Robinson, P and Burnett, H and Nicholson, DA},
title = {The use of minimal preparation computed tomography for the primary investigation of colon cancer in frail or elderly patients.},
journal = {Clinical radiology},
volume = {57},
number = {5},
pages = {389-392},
doi = {10.1053/crad.2001.0866},
pmid = {12014937},
issn = {0009-9260},
mesh = {Aged ; Aged, 80 and over ; Chi-Square Distribution ; Colonic Neoplasms/*diagnostic imaging ; Colonography, Computed Tomographic/*methods ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnostic imaging ; Female ; Follow-Up Studies ; *Frail Elderly ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; },
abstract = {AIM: To assess the place of computed tomography (CT) of the colon in frail or elderly patients with symptoms suggestive of colon cancer.
METHOD: A total of 195 patients (median age 76 years) underwent CT of the abdomen and pelvis following the administration of positive oral contrast medium but no bowel preparation. All had symptoms suggestive of colon cancer. CT findings were classified as normal/diverticular disease (DD), possible colon cancer, definite colon cancer or extracolonic pathology. Accuracy of CT was assessed against patient outcome. Association between symptoms and colon cancer was assessed by chi-squared test.
RESULTS: There were 47 deaths and median follow up for those alive was 16 months. Overall sensitivity of CT was 100% and specificity 87% for detection of colon cancer. One hundred and ten normal/DD CT examinations had no significant bowel lesion on follow up. Of 12 cases defined as 'definite cancers' on CT, there were nine colon cancers, two extracolonic cancers, and one normal. Of 23 'possible cancers' on CT, there were two colon cancers, three DD masses and 18 normal/DD. Fifty examinations had extracolonic findings including 33 (17%) cases of significant abdominal disease. CT findings led to a halt in investigations in 115 cases (59%), colonoscopy in 18 (9%) cases and surgery in 16 (8%) cases. None of the symptoms present showed a significant association with colon cancer (all P > 0.05).
CONCLUSION: Minimal preparation CT is a non-invasive and sensitive method for investigating colon cancer in frail or elderly patients. It has a 100% negative predictive value and also detects a large number of extracolonic lesions.},
}
@article {pmid12006930,
year = {2002},
author = {Senagore, AJ and Duepree, HJ and Delaney, CP and Dissanaike, S and Brady, KM and Fazio, VW},
title = {Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences.},
journal = {Diseases of the colon and rectum},
volume = {45},
number = {4},
pages = {485-490},
doi = {10.1007/s10350-004-6225-x},
pmid = {12006930},
issn = {0012-3706},
mesh = {Colectomy/*economics ; Costs and Cost Analysis/economics ; Diverticulitis, Colonic/*economics/*surgery ; Elective Surgical Procedures/economics ; Female ; Hospital Costs ; Humans ; Laparoscopy/*economics ; Length of Stay/economics ; Male ; Middle Aged ; Sigmoid Diseases/*economics/*surgery ; },
abstract = {PURPOSE: Although laparoscopic colectomy has demonstrated a variety of advantages, it remains unclear whether the reductions in length of stay and faster return of bowel function will offset potential increases in cost caused by operating time and instrumentation. The purpose of this study was to compare the direct cost structure of elective open and laparoscopic resection for sigmoid diverticulitis.
METHODS: We compared consecutive elective open and laparoscopic sigmoid colectomies (n = 71 and n = 61, respectively) performed from March 1, 1999, through December 31, 2000. Data collected included age, gender, body mass index, American Society of Anesthesia score, indication for surgery, morbidity, mortality, conversion (laparoscopic only), operating time, and length of hospital stay. Direct cost data were provided by Stanford's integrated hospital cost management and decision software. Indirect costs and total costs were not addressed. Data were analyzed by Student's t-test and chi-squared test where appropriate. Significance was set at P < 0.05. All data are presented as mean +/- standard error of the mean.
RESULTS: There were 132 elective sigmoid colectomies for diverticular disease (61 laparoscopic and 71 open procedures). There were no significant differences between the groups with respect to age, male/female ratio, or body mass index. Operating time was similar (109 +/- 7 minutes for laparoscopic procedures vs. 101 +/- 7 minutes for open procedures). The laparoscopic group had a significantly shorter length of stay (3.1 +/- 0.2 vs. 6.8 +/- 0.4 days), fewer pulmonary complications (1 (1.6 percent) vs. 4 (5.6 percent)) and fewer wound infections (0 vs. 5 (7 percent)). Conversion to open colectomy was required in 4 (6.6 percent) of 61 patients. Readmission occurred in three laparoscopic colectomy patients (4.9 percent) and four open colectomy patients (5.6 percent). There was one operative death in the laparoscopic group (1.6 percent) and no deaths in the open group. Total direct cost per case was significantly less for laparoscopic procedures ($3,458 +/- 437) than for open colectomies ($4321 +/- 501; P < 0.05, Student's t-test), and operating costs were not significantly different between the groups.
CONCLUSION: The data demonstrate that laparoscopic colectomy is a cost-effective means of electively managing sigmoid diverticular disease. This operative approach may become very important in an era of increasing constraints on hospital occupancy rates and access to nursing services in many regions of the country.},
}
@article {pmid12002296,
year = {2002},
author = {Chahin, F and Dwivedi, AJ and Paramesh, A and Chau, W and Agrawal, S and Chahin, C and Kumar, A and Tootla, A and Tootla, F and Silva, YJ},
title = {The implications of lighted ureteral stenting in laparoscopic colectomy.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {6},
number = {1},
pages = {49-52},
pmid = {12002296},
issn = {1086-8089},
mesh = {*Colectomy/adverse effects/methods ; Female ; Humans ; Intraoperative Complications/prevention & control ; *Laparoscopy/adverse effects/methods ; Light ; Male ; Middle Aged ; *Preoperative Care ; Retrospective Studies ; *Stents ; *Ureter/injuries ; },
abstract = {OBJECTIVE: The placement of indwelling ureteral catheters during colorectal surgery has been recommended for prevention of ureteral injuries. With the advent of laparoscopic colectomy (LCo), the role of preoperative placement of lighted ureteral stents (LUS) has also become commonplace. We sought to evaluate the value of lighted ureteral stent placement in laparoscopic colectomy.
METHODS: Sixty-six patients underwent LCo with LUS inserted preoperatively. Stents were removed in the immediate postoperative period. Two surgeons performed all the colectomies; 32 patients were males and 34 were females. Fifty patients underwent sigmoid colectomy, 4 had abdominoperineal resection, 4 had right colectomy, and 1 each had transverse or subtotal colectomy. Eighteen patients had a diagnosis of cancer, 34 had diverticular disease, and 14 had neoplastic polyps. Forty patients had bilateral and 26 had unilateral stent placement. A review of the incidence of ureteral injuries, hematuria, and anuria as the cause of acute renal failure was accomplished, comparing the unilateral and bilateral stented groups.
RESULTS: One (1.5%) patient suffered a left ureteral laceration during sigmoid colectomy. This was managed successfully with stent reinsertion. Sixty-five (98.4%) patients had gross hematuria lasting 2.93 days (1 to 6 days). The cost of bilateral stent placement was $1,504.32. A statistically significant difference occurred in the duration of hematuria (days) between patients who had unilateral (2.5 +/- 0.82) and bilateral stent placement (3.37 +/- 1.05), (P < 0.001). Four patients suffered from anuria, 2 required renal support needing hemodialysis for 3 to 6 days, 3 (75%) had bilateral stents, and 1 (25%) had a unilateral stent.
CONCLUSIONS: We recommend the placement of lighted ureteral stents as a valuable adjunct to laparoscopic colectomy to safeguard ureteral integrity. Transient hematuria is common but requires no intervention. Reflux anuria occurs infrequently and is reversible.},
}
@article {pmid11995772,
year = {2002},
author = {Goh, H and Bourne, R},
title = {Non-steroidal anti-inflammatory drugs and perforated diverticular disease: a case-control study.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {84},
number = {2},
pages = {93-96},
pmid = {11995772},
issn = {0035-8843},
mesh = {Aged ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Case-Control Studies ; Diverticulum, Colon/*chemically induced/surgery ; Female ; Humans ; Intestinal Perforation/*chemically induced/surgery ; Laparotomy/methods ; Male ; Retrospective Studies ; Risk Factors ; },
abstract = {Non-steroidal anti-inflammatory drugs (NSAIDs) have a wide range of side-effects in the gastrointestinal tract and the large intestine. This study examines the hypothesis that the use of NSAIDs is associated with colonic perforation in diverticular disease. Histological evidence was used to confirm perforation. A retrospective review of case records and pathology reports identified 20 patients admitted over 3 consecutive years. A total of 125 age- and sex-matched patients diagnosed with diverticular disease not complicated by perforation formed the control group. The incidences of NSAID use in the two groups were compared. A second control group consisted of 600 age- and sex-matched randomly selected patients with no known diverticular disease admitted as emergencies in the same period. Of the 20 patients with perforation, 9 were taking NSAIDs for 4 weeks or longer, compared with 19 (15%) of the 125 patients who did not have perforation (relative risk 2.961, 95% confidence interval 1.507-5.348, P < 0.01). 19% of all patients with diverticular disease were taking NSAIDs compared with 10% of the second control group (relative risk 1.869, 95% confidence interval 1.237-2.781, P < 0.01). The findings indicate a strong association between the use of NSAIDs and the perforation of colonic diverticula. The majority of the indications for the use of NSAIDs were cardiovascular and musculoskeletal conditions. Prescribing NSAIDs to patients with diverticular disease carries an increased risk of colonic perforation.},
}
@article {pmid11984674,
year = {2002},
author = {Bouillot, JL and Berthou, JC and Champault, G and Meyer, C and Arnaud, JP and Samama, G and Collet, D and Bressler, P and Gainant, A and Delaitre, B},
title = {Elective laparoscopic colonic resection for diverticular disease: results of a multicenter study in 179 patients.},
journal = {Surgical endoscopy},
volume = {16},
number = {9},
pages = {1320-1323},
pmid = {11984674},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*surgery ; Elective Surgical Procedures/*methods/mortality ; Female ; Humans ; Intraoperative Complications/mortality/surgery ; Laparoscopy/*methods/mortality ; Laparotomy/methods/mortality ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/mortality/surgery ; Retrospective Studies ; Time Factors ; },
abstract = {BACKGROUND: We undertook a retrospective multicenter study of elective laparoscopic sigmoidectomy for diverticulitis in order to assess the safety and the results of the procedure performed by a large number of surgeons.
MATERIALS AND METHODS: Between January 1998 and April 1999, the French Society of Laparoscopic Surgery recruited retrospectively 179 patients from 10 surgical units, operated on for elective laparoscopic sigmoidectomy. There were 94 men and 85 women with a mean age of 58 years (range, 30-82). The indications for surgery were acute attacks in 123 cases, complicated diverticulitis in 47 cases, and miscellaneous in 9 cases.
RESULTS: The performed procedure was a successful laparoscopic assisted sigmoidectomy in 154 cases (with totally intracorporeal anastomosis in 136 cases and hand-sewn anastomosis via small incision in 18 cases). The mean operation time was 223 min +/- 79 (range, 100-480). There was no mortality and 23 complications occurred in 23 patients (14.9%). Postoperative ileus lasted 2.5 +/- 0.9 days (range, 1-6), and oral intake started after 3.3 +/- 1.3 days (range, 1-12). The mean postoperative stay was 9.3 days (range, 4-50). Conversion to laparotomy was necessary in 25 cases (13.9%). The essential causes of conversion were obesity, severe adhesions, and colonic inflammation. The mean postoperative stay for the 25 converted patients was 13 +/- 8.5 days (range, 7-42).
CONCLUSION: Elective laparoscopic sigmoidectomy for diverticulitis is feasible and is safe. The complication and mortality rates are similar to those observed after open procedures. For experienced surgical teams, laparoscopic colonic resection is a good approach for selected patients suffering from symptomatic diverticulitis.},
}
@article {pmid11982693,
year = {2002},
author = {Segal, I},
title = {Physiological small bowel malabsorption of carbohydrates protects against large bowel diseases in Africans.},
journal = {Journal of gastroenterology and hepatology},
volume = {17},
number = {3},
pages = {249-252},
doi = {10.1046/j.1440-1746.2002.02687.x},
pmid = {11982693},
issn = {0815-9319},
mesh = {Asian People ; *Black People ; Dietary Carbohydrates/*pharmacokinetics ; Dietary Fiber/metabolism ; Female ; Fermentation ; Humans ; *Intestinal Absorption/physiology ; Intestinal Diseases/*prevention & control ; Lactose Intolerance/metabolism ; *Malabsorption Syndromes/metabolism ; Male ; South Africa ; White People ; },
abstract = {In African black people there is a paucity of 'developed society' large bowel diseases such as diverticular disease, colorectal adenomas and carcinomas, ulcerative colitis and Crohn's disease. Appendicitis has an incidence of about 5-10% of the number likely to be observed in a white population. The conundrum is that the disparity exists despite many Africans having adopted an urbanized lifestyle with major changes in their dietary pattern. Dietary fiber intake, which was previously 30-35 g, has decreased to 12-14 g daily. Studies on small bowel function in black people have shown that physiological malabsorption of lactose, fructose, sucrose and maize (the staple food) occurs. It is hypothesized that the increased concentration of substrate available for fermentation in the colon compensates for the low dietary fiber intake, is protective to the large bowel and is a factor in the prevention of 'developed society' large bowel diseases in the African population.},
}
@article {pmid11981585,
year = {2002},
author = {Silva, JH},
title = {Pelvic lymphoscintigraphy: contribution to the preoperative staging of rectal cancer.},
journal = {Revista do Hospital das Clinicas},
volume = {57},
number = {2},
pages = {55-62},
doi = {10.1590/s0041-87812002000200002},
pmid = {11981585},
issn = {0041-8781},
mesh = {Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Female ; Humans ; Lymph Nodes/*diagnostic imaging ; Male ; Middle Aged ; Neoplasm Staging ; Pelvis ; Preoperative Care ; Prospective Studies ; Radionuclide Imaging ; Rectal Neoplasms/*diagnostic imaging/surgery ; },
abstract = {PURPOSE: Preservation of the anal sphincter in surgery for cancer of the distal rectum in an attempt to avoid colostomy has been a main concern of colorectal surgeons. Various proposed procedures contradict oncological principles, especially with respect to pelvic lymphadenectomy. Therefore, prior knowledge of pelvic lymph node involvement is an important factor in choosing the operative technique, i.e., radical or conservative resection. Introduction of ultrasound, computerized tomography, and magnetic resonance have made preoperative study of the area possible. Nevertheless, these resources offer information of an anatomical nature only. Lymphoscintigraphy enables the morphological and functional evaluation of the pelvic area and contributes toward complementing the data obtained with the other imaging techniques. The objective of this prospective study is twofold: to standardize the lymphoscintigraphy technique and to use it to differentiate patients with rectal cancer from those with other coloproctologic diseases.
CASUISTIC AND METHODS: Sixty patients with various coloproctologic diseases were studied prospectively. Ages ranged from 21 to 96 years (average, 51 and median, 55 years). Twenty-six patients were male and 34 were female. Thirty patients had carcinoma of the distal rectum as diagnosed by proctologic and anatomic-pathologic examinations, 20 patients had hemorrhoids, 5 had chagasic megacolon, 2 had diverticular disease, 2 had neoplasm of the right colon, and 1 had ulcerative colitis as diagnosed by proctologic exam and/or enema. The lymphoscintigraphy method consisted of injecting 0.25 mL of a dextran solution marked with radioactive technetium-99m into the right and left sides of the perianal region and obtaining images with a gamma camera. The results were analyzed statistically with a confidence level of 95% (P <.05) using the following statistical techniques: arithmetic and medium average, Fisher exact test, chi-square test corrected for continuity according to Yates, and distribution tables for the number of patients.
RESULTS: In rectal cancer, the tracer progresses unilaterally or is absent; in other patients, the progress of the tracer is bilateral and symmetrical, although its progress may be slow. Statistical tests showed with high significance that the agreement index between the clinical diagnosis and the result of the lymphoscintigraphic exam was 93%.
CONCLUSIONS: Lymphoscintigraphy is a standardized, painless, and harmless test that can be performed in all cases; it differentiates patients with rectal cancer from those with other coloproctological diseases.},
}
@article {pmid11977933,
year = {2002},
author = {Place, RJ and Simmang, CL},
title = {Diverticular disease.},
journal = {Best practice & research. Clinical gastroenterology},
volume = {16},
number = {1},
pages = {135-148},
doi = {10.1053/bega.2001.0270},
pmid = {11977933},
issn = {1521-6918},
mesh = {Aged ; Diagnosis, Differential ; *Diverticulitis, Colonic/diagnosis/epidemiology/therapy ; *Diverticulum, Colon/diagnosis/epidemiology/therapy ; Humans ; },
abstract = {Diverticular disease is a common finding in Western countries with an increasing prevalence with age. Many patients with the disorder remain asymptomatic. However, up to 30% of those affected may show clinical signs including pain, bleeding, obstruction, abscess, fistulae and perforation. The purpose of this chapter is to review the epidemiology, pathogenesis, clinical presentation, diagnostic regimens and treatment options for this disorder.},
}
@article {pmid11974090,
year = {2000},
author = {Hyde, C},
title = {Diverticular disease.},
journal = {Nursing standard (Royal College of Nursing (Great Britain) : 1987)},
volume = {14},
number = {51},
pages = {38-42; quiz 44-5},
doi = {10.7748/ns2000.09.14.51.38.c2914},
pmid = {11974090},
issn = {0029-6570},
mesh = {Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Colectomy ; Colostomy/nursing ; Dietary Fiber/administration & dosage ; Diverticulitis/diagnosis/epidemiology/etiology/*therapy ; Diverticulum/diagnosis/epidemiology/etiology/*therapy ; Female ; Humans ; Male ; Middle Aged ; Nurse's Role ; Patient Selection ; Sex Distribution ; Skin Care/methods/nursing ; },
abstract = {Diverticular disease is a gastrointestinal disorder. Christine Hyde discusses the physiology and care of related conditions in the large bowel, examining potential surgical outcomes.},
}
@article {pmid11961597,
year = {2002},
author = {Trebuchet, G and Lechaux, D and Lecalve, JL},
title = {Laparoscopic left colon resection for diverticular disease.},
journal = {Surgical endoscopy},
volume = {16},
number = {1},
pages = {18-21},
doi = {10.1007/s004640090122},
pmid = {11961597},
issn = {1432-2218},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*surgery ; Colon, Sigmoid/surgery ; Colonoscopy/*methods ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Prospective Studies ; },
abstract = {BACKGROUND: The aim of this study was to review our experience with laparoscopic sigmoid colectomy for diverticular disease.
METHODS: All patients presenting with acute or chronic diverticulitis, obstruction, abscess, or fistula were included. Symptomatic diverticular disease was the main surgical indication (95%).
RESULTS: Between March 1992 and August 1999 170 consecutive patients underwent surgery. Of these, 21 patients (12%) had significant obesity, with body mass index (BMI) greater than 30. The average length of surgery was 141 +/- 36 min. In 163 patients (96%), the procedure was performed solely with the laparoscope. The nasogastric tube was removed on postoperative day 2 +/- 1.9, and oral feeding was started on postoperative day 3.4 +/- 2.1. The average length of hospital stay after surgery was 8.5 +/- 3.7 days. During the first postoperative month, there were no deaths. However, 11 patients (6.5%) had surgical complications: 5 anastomotic leaks (2.9%), 1 intraabdominal abscess (0.6%), and 3 wound infections (1.7%). There were four reinterventions (2.4%), with two diverting colostomies. Secondarily, 10 anastomotic stenoses (5.9%) were observed. Eight patients required a reintervention: seven anastomotic resections by open laparotomy and one terminal colostomy. Seven patients (4.1%) reported retrograde ejaculation, and one reported impotence.
CONCLUSIONS: The feasibility of the laparoscopic approach to diverticular disease is established with a conversion rate of 4%, a low incidence of acute septic complications (5.3%), and a mortality rate of 0%. Therefore, laparoscopic sigmoid colectomy has become our procedure of choice in the treatment of diverticular disease.},
}
@article {pmid11942014,
year = {2002},
author = {Alberti, A and Dattola, P and Parisi, A and Maccarone, P and Basile, M},
title = {[Role of ultrasonographic imaging in the surgical management of acute diverticulitis of the colon].},
journal = {Chirurgia italiana},
volume = {54},
number = {1},
pages = {71-75},
pmid = {11942014},
issn = {0009-4773},
mesh = {Colon/pathology ; Colostomy ; Diverticulitis, Colonic/*diagnostic imaging/pathology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity ; Ultrasonography ; },
abstract = {Diverticulosis of the colon is a very frequent pathology in the western word and is characterised by a high percentage of dangerous complications (10-25%). The most accurate method of staging diverticular disease is by CT scan. The aim of our study was to evaluate the sensitivity of ultrasonography in the evaluation and management of diverticular disease of the colon. We studied 51 patients: the parameters used to assess complicated diverticulosis of the colon were: 1) wall thickness; 2) presence of fluid collections and pericolic abscesses; 3) free liquid collections in the peritoneal cavity; 4) subdiaphragmatic free air; 5) presence of fistula tracts. Ultrasonography showed 66% sensitivity in the assessment of wall thickness and in detecting the presence of diverticula. The sensitivity rate was 100% in the detection of abscess complications, pericolic collections, free air and fistula tracts. False-negatives (5 patients) were all recorded in Hinchey stage I. The overall sensitivity amounted to 91%. In our experience the method is a first level examination in the approach to patients suffering from diverticular disease of the colon and presents high sensitivity and diagnostic accuracy. The method, in expert hands, is suggested as a first step in the clinical-diagnostic approach to patients suffering from acute abdomen due to diverticulitis of the colon.},
}
@article {pmid11933632,
year = {2002},
author = {Vacher, C and Zaghloul, R and Borie, F and Laporte, S and Callafe, R and Skawinski, P and Leynau, G and Domergue, J},
title = {[Laparoscopic re-establishment of digestive continuity following Hartmann's procedure. Retrospective study of the French Society of Endoscopic Surgery].},
journal = {Annales de chirurgie},
volume = {127},
number = {3},
pages = {189-192},
doi = {10.1016/s0003-3944(02)00719-8},
pmid = {11933632},
issn = {0003-3944},
mesh = {Aged ; Anastomosis, Surgical ; Colostomy/*adverse effects/methods ; Diverticulitis/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Morbidity ; *Postoperative Complications ; Plastic Surgery Procedures/*methods ; Retrospective Studies ; },
abstract = {STUDY AIM: Reversal of the Hartmann's procedure is associated with a high morbidity. The aim of this study was to evaluate the feasibility and results of laparoscopic reversal of the Hartmann's procedure.
PATIENTS AND METHOD: Thirty eight consecutive patients, mean age 60 +/- 13.5 years were included in this retrospective study. The most common indication for the primary procedure was diverticular disease (70%). The mean time from the primary operation to the reconstruction was 136 +/- 124 days. The stoma was first dissected in 24 patients, allowing introduction of the first port. In the remaining 14 patients a standard umbilical port was inserted. The amount of adhesions was classified as low in 13 patients, mild in 15 patients and severe in 10 patients. All patients had a mechanical anastomosis.
RESULTS: The conversion rate was 15%, due to adhesion problems in 5 patients and for a positive leakage test in one. The morbidity rate was 23.5% including 8 surgical complications. One patient died after post operative peritonitis complicating an anastomic leakage. The average hospital stay was 10 +/- 4.4 days.
CONCLUSION: Our results indicate that laparoscopic reversal after Hartmann's procedure is feasible. The morbidity is lower than after classical open reconstruction. The presence of diffuse peritonitis at the primary operation as well as a short delay before the reconstruction, are important factors of conversion.},
}
@article {pmid11925735,
year = {2002},
author = {Landen, S and Nafteux, P},
title = {Primary anastomosis and diverting colostomy in diffuse diverticular peritonitis.},
journal = {Acta chirurgica Belgica},
volume = {102},
number = {1},
pages = {24-29},
doi = {10.1080/00015458.2002.11679258},
pmid = {11925735},
issn = {0001-5458},
mesh = {Aged ; Anastomosis, Surgical/mortality ; *Colostomy/mortality ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Length of Stay/statistics & numerical data ; Male ; Peritonitis/*surgery ; Prospective Studies ; Sigmoid Diseases/*surgery ; Time Factors ; },
abstract = {BACKGROUND: Despite the well documented morbidity associated with its reversal, Hartmann's procedure remains the favoured option in patients with complicated diverticular disease in the presence of diffuse peritonitis. A prospective study was conducted to determine whether primary anastomosis with diverting colostomy constitutes a valid alternative to the Hartmann procedure.
METHODS: Between 1994 and 1998, all patients with diffuse peritonitis due to perforated diverticulitis of sigmoid origin underwent resection and primary anastomosis with diverting colostomy. Restoration of colonic continuity was programmed six weeks later, after verification of the anastomose by gastrografin enema. The group included 5 men and 15 women with a mean age of 72 years (32-97 years). The ASA classification of the patients was as follows: ASA II (n = 2), ASA III (n = 12), ASA IV (n = 3), ASA V (n = 3). The mean delay between onset of symptoms and surgery was 74 hours (8-215 hours).
RESULTS: Operative mortality and morbidity was 15% (n = 3) and 50% respectively. No patients showed signs of suture disruption and this was confirmed by routine radiological controls of the anastomoses. Mean length of hospitalization was 20 +/- 10 days (SD; median: 18 days). Closure of the colostomy using a small peristomal incision was performed in all surviving patients after a mean delay of 45 +/- 9 days (range 28-67 days). Mean length of hospitalization for colostomy closure was 7 +/- 3 days (range 3-18 days) without mortality.
CONCLUSIONS: Applied systematically to all patients with diffuse peritonitis due to perforated diverticular disease, primary anastomosis was found to be as safe as the Hartmann procedure but appears to be superior in terms of total length of hospital stay, interval to stoma closure and rates of stoma closure. Primary anastomosis with diverting colostomy could constitute a valid alternative to the Hartmann procedure in selected patients with complicated diverticular disease, even in the presence of diffuse peritonitis.},
}
@article {pmid11917290,
year = {2002},
author = {Ben-Josef, E and Han, S and Tobi, M and Vargas, BJ and Stamos, B and Kelly, L and Biggar, S and Kaplan, I},
title = {Intrarectal application of amifostine for the prevention of radiation-induced rectal injury.},
journal = {Seminars in radiation oncology},
volume = {12},
number = {1 Suppl 1},
pages = {81-85},
doi = {10.1053/srao.2002.31379},
pmid = {11917290},
issn = {1053-4296},
mesh = {Adenocarcinoma/*radiotherapy ; Administration, Rectal ; Amifostine/*administration & dosage ; Humans ; Male ; Prostatic Neoplasms/*radiotherapy ; Radiation Dosage ; Radiation Injuries/*prevention & control ; Radiation-Protective Agents/*administration & dosage ; Radiotherapy, Conformal ; Rectum/*radiation effects ; },
abstract = {Clinically symptomatic late injury to the rectal wall occurs in about one third of patients with prostate cancer treated with external beam irradiation. Reducing the physical dose to the anterior rectal wall without a similar reduction in the posterior peripheral zone is difficult because of the proximity of these structures. Based on our previous observations that intrarectal application of amifostine resulted in very high concentrations of amifostine and its active metabolite WR-1065 in the rectal wall of Copenhagen rats, the authors initiated a phase I clinical trial in 1998. Twenty-nine patients with localized prostate cancer were accrued. Eligibility criteria included histologically confirmed adenocarcinoma, a Karnofsky performance status of > or =70, and no pelvic lymphadenopathy or distant metastases. The total dose to the prostate was 70.2 Gy (20 patients) and 73.8 Gy (9 patients). Therapy was delivered using a 4-field axial technique and 3-dimensional conformal planning. Amifostine was administered intrarectally as an aqueous solution 30 minutes before irradiation on the first 15 days of therapy. Amifostine dose was escalated, in cohorts, from 500 mg to 2,500 mg. Toxicity was evaluated using the Radiation Therapy Oncology Group late morbidity scale. All patients completed therapy with no amifostine-related toxicity at any dose level. The application was feasible and well tolerated. With a median follow-up time of 21 months, 9 patients (33%) had rectal bleeding (8 grade 1, 1 grade 2). Four patients (14%) had symptoms suggestive of radiation injury, which proved to be secondary to nonrelated processes. These included preexisting nonspecific proctitis (1 patient), diverticular disease of the sigmoid colon, rectal polyp (1 patient), and ulcerative colitis (1 patient). Symptoms developed significantly more often in patients receiving 500 to 1,000 mg than in patients receiving 1,500 to 2,500 mg amifostine (7 of 14 [50%] versus 2 of 13 [15%]; P =.0325, 1-sided chi(2) test). Intrarectal application of amifostine is feasible and well tolerated. A complete lack of systemic toxicity obviates the need for close monitoring of patients during and after administration. Rectal symptomatology after external beam radiotherapy to the pelvis cannot be assumed to reflect late radiation damage, because it often is a manifestation of an unrelated pathologic process. The preliminary efficacy data are encouraging and suggest that intrarectal administration of amifostine may reduce radiation damage. Further clinical studies are warranted.},
}
@article {pmid11869694,
year = {2002},
author = {Thörn, M and Graf, W and Stefànsson, T and Påhlman, L},
title = {Clinical and functional results after elective colonic resection in 75 consecutive patients with diverticular disease.},
journal = {American journal of surgery},
volume = {183},
number = {1},
pages = {7-11},
doi = {10.1016/s0002-9610(01)00847-9},
pmid = {11869694},
issn = {0002-9610},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/pathology/*surgery ; Colonic Diseases, Functional ; Diverticulitis/pathology/*surgery ; *Elective Surgical Procedures ; Female ; Humans ; Male ; Middle Aged ; *Patient Satisfaction ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Functional results after elective colonic resection in patients with diverticular disease have seldom been studied.
METHODS: Seventy-five consecutive patients were reviewed and sent a questionnaire about abdominal symptoms and functional results. Possible associations between patients' characteristics and postoperative complications or functional outcome were analyzed.
RESULTS: Major complications including anastomotic leakage, bleeding, and bowel obstruction occurred in 10 patients (13%). Six patients (8%) had recurrent diverticulitis. No significant associations were found between clinical characteristics and postoperative complications or recurrent disease. Fifty patients classified their final result as excellent or good. Functional symptoms or symptoms suggestive of irritable bowel syndrome before the operation predicted a less successful result (P <0.05).
CONCLUSIONS: Elective surgery in patients with diverticular disease was hampered by postoperative complications but resulted in most cases in good functional outcome and a low rate of recurrent disease. Those with functional bowel symptoms before surgery had significantly worse results.},
}
@article {pmid11866275,
year = {2002},
author = {Tendler, DA and Aboudola, S and Zacks, JF and O'Brien, MJ and Kelly, CP},
title = {Prolapsing mucosal polyps: an underrecognized form of colonic polyp--a clinicopathological study of 15 cases.},
journal = {The American journal of gastroenterology},
volume = {97},
number = {2},
pages = {370-376},
doi = {10.1111/j.1572-0241.2002.05472.x},
pmid = {11866275},
issn = {0002-9270},
mesh = {Adult ; Aged ; Biopsy, Needle ; Colonic Polyps/*pathology ; Female ; Humans ; Immunohistochemistry ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; Prolapse ; Retrospective Studies ; Sensitivity and Specificity ; Sigmoid Neoplasms/*pathology ; Sigmoidoscopy/methods ; },
abstract = {OBJECTIVE: Prolapsing intestinal mucosa occurs in many forms throughout the GI tract. We describe 15 patients with polypoid masses in the sigmoid colon and histological features of mucosal prolapse.
METHODS: Fifteen patients with colon polyps demonstrating endoscopic and histological features of mucosal prolapse were retrospectively identified from our database.
RESULTS: Twelve patients presented with signs and symptoms that were nonspecific, but consistent with mucosal prolapse, such as occult or gross intestinal bleeding and lower abdominal pain. Three patients were asymptomatic. The polyps occurred in the sigmoid colon, usually in association with diverticular disease, and appeared more often in men. Endoscopically, the polyps appeared to be well-circumscribed, hyperemic masses that contrasted sharply with normal-appearing adjacent mucosa. Histological features include glandular crypt abnormalities, fibromuscular obliteration of the lamina propria, and thickened and splayed muscularis mucosa.
CONCLUSIONS: Prolapsing mucosal polyps of the colon are histologically similar to other mucosal prolapsing conditions in the GI tract, such as the solitary rectal ulcer syndrome, inflammatory cloacogenic polyps, inflammatory "cap" polyps, and gastric antral vascular ectasia, and should therefore be designated as part of the "mucosal prolapse syndrome."},
}
@article {pmid11866269,
year = {2002},
author = {Mulcahy, HE and Patel, RS and Postic, G and Eloubeidi, MA and Vaughan, JA and Wallace, M and Barkun, A and Jowell, PS and Leung, J and Libby, E and Nickl, N and Schutz, S and Cotton, PB},
title = {Yield of colonoscopy in patients with nonacute rectal bleeding: a multicenter database study of 1766 patients.},
journal = {The American journal of gastroenterology},
volume = {97},
number = {2},
pages = {328-333},
doi = {10.1111/j.1572-0241.2002.05465.x},
pmid = {11866269},
issn = {0002-9270},
mesh = {Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Chronic Disease ; Colonoscopy/*methods/*statistics & numerical data ; Databases, Factual/statistics & numerical data ; Female ; Gastrointestinal Hemorrhage/epidemiology/*pathology ; Humans ; Incidence ; Intestinal Mucosa/pathology ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Probability ; Rectum ; Registries ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Sex Distribution ; United States/epidemiology ; },
abstract = {OBJECTIVE: There are few data to guide the choice between colonoscopy and flexible sigmoidoscopy in patients with nonacute rectal bleeding, especially in younger age groups. Our aim was to determine the yield of colonoscopy for significant proximal large bowel disease in the absence of significant distal disease, with special reference to young patients.
METHODS: This was a retrospective study of data collected prospectively in 1766 patients (median age 57 yr, 711 women). The endoscopic database (GI-Trac) contained 152 discrete fields for data input. Multiple logistic regression analysis was performed to identify variables independently associated with the presence of isolated significant proximal disease.
RESULTS: Young patients had a higher percentage of normal examinations than did older patients. The incidence of diverticular disease, small polyps, large polyps, and cancer rose with increasing age. No patient aged <40 yr had an isolated proximal cancer, but 7% had other significant isolated proximal disease. There was no overall association between age and significant proximal disease in the absence of significant distal disease (p = 0.66). The only variable associated with isolated proximal disease was anemia (odds ratio = 1.81; 95% CI = 1.11-2.93; p = 0.02).
CONCLUSION: The yield of colonoscopy (beyond the range of sigmoidoscopy) for neoplasia is low in patients aged <40 yr, but other significant disease may be missed if age is the only criterion determining colonoscopy use.},
}
@article {pmid11862955,
year = {2002},
author = {Menon, VS},
title = {Prospective study of primary anastomosis following sigmoid resection for suspected acute complicated diverticular disease (Br J Surgery 2001;88:693-7).},
journal = {The British journal of surgery},
volume = {89},
number = {2},
pages = {246-247},
doi = {10.1046/j.1365-2168.2002.t01-1-20094.x},
pmid = {11862955},
issn = {0007-1323},
mesh = {Anastomosis, Surgical/methods ; Colon, Sigmoid/*surgery ; Diverticulum, Colon/*surgery ; Humans ; Multicenter Studies as Topic ; Prospective Studies ; },
}
@article {pmid11862562,
year = {2001},
author = {Lim, JF and Ho, YH},
title = {Total colectomy with ileorectal anastomosis leads to appreciable loss in quality of life irrespective of primary diagnosis.},
journal = {Techniques in coloproctology},
volume = {5},
number = {2},
pages = {79-83},
doi = {10.1007/s101510170003},
pmid = {11862562},
issn = {1123-6337},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colectomy/*adverse effects ; Colonic Diseases/surgery ; Fecal Incontinence/etiology/*psychology ; Female ; Humans ; Ileum/*surgery ; Male ; Middle Aged ; *Quality of Life ; Rectum/*surgery ; Surveys and Questionnaires ; Time Factors ; },
abstract = {Total colectomy with ileorectal anastomosis (TC) is a well-accepted procedure for many colonic pathologies but data on faecal incontinence and related quality of life after TC are lacking. The aims of this study were to assess the long-term bowel frequency, degree of incontinence and quality of life with respect to faecal incontinence and to compare them with the outcome for TC for different diagnostic groups. We identified 54 patients who had undergone TC at Singapore General Hospital and interviewed them using two questionnaires: the faecal incontinence quality of life (FIQL) scale and the Wexner faecal incontinence score (WS). The patients were allocated in 3 groups based on the primary diagnosis leading to operation, i. e. slow-transit constipation or megacolon (STC), colonic neoplasm (CA) and complicated pan-colonic diverticular disease (DD). Median bowel frequencies for STC and DD groups were 2.5/day; for CA, it was 3.5/day (p=0.042). There was no significant difference in the FIQL score and WS between the groups. Eleven patients had some degree of faecal incontinence based on WS. Many patients (20.4%) with perfect continence had fear of faecal leakage affecting their quality of life. In conclusion, patients with frequent stools do not need to have incontinence to suffer from the fear of it. The primary pathology leading to TC made no difference to the faecal incontinence or bowel urgency problems.},
}
@article {pmid11852523,
year = {2001},
author = {Conde Santos, G and Griñó Garreta, J and Bielsa Gali, O and Arango Toro, O and Gelabert-Mas, A},
title = {[Uretero-colonic fistula in non-functioning ureter].},
journal = {Archivos espanoles de urologia},
volume = {54},
number = {10},
pages = {1126-1129},
pmid = {11852523},
issn = {0004-0614},
mesh = {Aged ; Colonic Diseases/*etiology/surgery ; Female ; Humans ; Intestinal Fistula/*etiology/surgery ; Ureteral Diseases/*etiology/surgery ; Urinary Fistula/*etiology/surgery ; },
abstract = {OBJECTIVE: To present a case of ureterocolonic fistula secondary to acute sigmoid diverticulitis in a nonfunctioning ureter due to a previous nephrectomy.
METHODS/RESULTS: A 68-year-old patient that had undergone nephrectomy due to xanthogranulomatous pyelonephritis two years earlier, consulted for long-standing non-specific abdominal pain. Radiological evaluation showed a pneumogram pattern in the ureteral stump associated to a pelvic mass. The patient underwent surgery for a suspected uretero-intestinal fistula. The intraoperative findings and anatomopathological study demonstrated a uretero-sigmoid fistula due to diverticular disease of colon.
CONCLUSIONS: Uretero-intestinal fistulas present unimportant clinical features. Radiological assessment and a clinical suspicion are important to diagnosis.},
}
@article {pmid11835936,
year = {2002},
author = {González-Zuelgaray, J and Pérez, A},
title = {Association of diverticular disease of the colon and vagal atrial fibrillation.},
journal = {The American journal of cardiology},
volume = {89},
number = {4},
pages = {475-477},
doi = {10.1016/s0002-9149(01)02276-7},
pmid = {11835936},
issn = {0002-9149},
mesh = {Adult ; Atrial Fibrillation/*complications ; Diverticulum, Colon/*complications ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid11832850,
year = {2002},
author = {Lauro, A and Alonso Poza, A and Cirocchi, R and Doria, C and Gruttadauria, S and Giustozzi, G and Wexner, SD},
title = {[Laparoscopic surgery for colon diverticulitis].},
journal = {Minerva chirurgica},
volume = {57},
number = {1},
pages = {1-5},
pmid = {11832850},
issn = {0026-4733},
mesh = {Aged ; Colonic Diseases/*surgery ; *Colonoscopy ; Diverticulitis/*surgery ; Female ; Humans ; Male ; Retrospective Studies ; },
abstract = {BACKGROUND: Laparoscopic surgery is used with increasing frequency to treat colorectal pathologies and some groups have also attempted to treat the complicated forms of diverticulitis (abscesses and/or fistulas). The results reported in the international literature are still controversial, especially in terms of the duration of surgery, the frequency of laparotomic conversions and postoperative morbidity. The aim of this study was to analyse the results of laparoscopic or laparotomic treatment of diverticular disease of the colon in patients admitted to the Department of Colorectal Surgery at the Cleveland Clinic in Florida over a three-year period.
METHODS: A retrospective analysis was made of 57 patients with diverticular disease of the colon who were admitted to CCF (Cleveland Clinic Florida) between January 1996 and December 1998 and underwent elective laparoscopic or laparotomic surgery. A comparative analysis was made of the results in the two groups.
RESULTS: Of the 57 patients treated only 15 underwent laparoscopic surgery; the majority were treated for uncomplicated diverticulitis. 22 out of 42 patients (53%) undergoing laparotomic surgery presented complicated diverticulitis (abscesses, fistulas or stenosis), whereas 12 out of 15 patients undergoing laparoscopic surgery (80%) were treated for uncomplicated diverticulitis. Statistically significant differences were found in relation to the duration of surgery: 152 min in the laparotomic group vs 209 in the laparoscopic group. No differences were found in the frequency of intraoperative complications, transfusions and the number of drainages inserted (p=0.66). The postoperative period showed significant differences in terms of the reappearance of intestinal peristalsis, use of PCA and postoperative stay.
CONCLUSIONS: This retrospective study confirms that the laparoscopic treatment of colon diverticulitis offers a number of advantages: reduced postoperative pain, more rapid recovery of intestinal peristalsis and shorter postoperative stay. Laparoscopic sigma colectomy represents the treatment of choice for diverticulitis in uncomplicated cases.},
}
@article {pmid11824027,
year = {2001},
author = {Helfritzsch, H and Seifert, S and Sölch, O and Pfister, W and Scheele, J},
title = {[Brain abscess in retroperitoneal perforated colonic diverticulitis].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {72},
number = {12},
pages = {1427-1430},
doi = {10.1007/s001040170006},
pmid = {11824027},
issn = {0009-4722},
mesh = {Abdominal Abscess/*complications/diagnosis/surgery ; Brain Abscess/diagnosis/*etiology/surgery ; Diagnosis, Differential ; Diverticulitis, Colonic/*complications/diagnosis/surgery ; *Enterobacter aerogenes ; Enterobacteriaceae Infections/diagnosis/*etiology/surgery ; Fusobacterium Infections/diagnosis/*etiology/surgery ; *Fusobacterium nucleatum ; Humans ; Intestinal Perforation/*complications/diagnosis/surgery ; Male ; Middle Aged ; Opportunistic Infections/diagnosis/*etiology/surgery ; Retroperitoneal Space/surgery ; },
abstract = {The most frequent complications in diverticular disease are local abscess, perforation with peritoneal sepsis, fistula and ileus. Extraabdominal manifestation is an actual rarity. A haematogenous bacterial spread via portal vein with formation of liver abscess has seldom been described. But a complicated diverticular disease as a cause for a brain abscess is an absolute rarity. Our case presents a patient with brain abscess caused by asymptomatic, retroperitoneal perforated colonic diverticulosis. We discuss diagnostic steps both in diverticular disease and brain abscess and different surgical options in the treatment of colonic complicated diverticular disease.},
}
@article {pmid11767489,
year = {2001},
author = {Viñas-Salas, J and Villalba-Acosta, J and Scaramucci, M and Rodas, JH and Rodríguez, G and Tiziana Ciutto, S and Torres, S and Fermiñan, A and Pelayo, A and Piñol, C},
title = {Complications of colonic diverticular disease. Comparative study of two series.},
journal = {Revista espanola de enfermedades digestivas},
volume = {93},
number = {10},
pages = {649-658},
pmid = {11767489},
issn = {1130-0108},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum, Colon/*complications ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {OBJECTIVE: To compare the form of presentation and management of the disease in two surgical units covering geographically different populations.
DESIGN: Observational retrospective study.
PATIENTS AND METHOD: 203 cases from the 2nd Chair of Surgery of the Hospital Universitario de Clínicas de Asunción, Paraguay and 150 cases from the Hospital Universitario de Lleida, Spain. We analyzed the cause of admission, medical history, treatment and post-operative morbidity and mortality.
RESULTS: Paraguay series: average age: 53 years (range 34-84) for men and 62 years (range 36-92) for women. Fifty-five per cent were hospitalized because of hemorrhagic complications and 45% because of acute diverticulitis. Medical treatment was provided in 109 cases and surgery in 110, 72 of which were emergencies and 38 elective procedures (p < 0.05). Morbidity was 31.8% (40.2% in emergencies and 16% in elective procedures, p < 0.05) and mortality was 15.5% (20.2% in emergencies and 2.6% in elective procedures, p < 0.003). LLEIDA SERIES: Average age: 65.5 years (range 38-85, p < 0.01) for men and 71.4 years (range 30-93, p < 0.01) for women. Eighty-six per cent were hospitalized because of acute diverticulitis and 10.7% because of acute hemorrhage (p < 0.001). Sixteen per cent have had previous attacks (p < 0.001). Medical treatment was provided to 111 patients and surgery to 39 (p < 0.001), 33 of which were emergencies and 6 elective procedures (p < 0.04). Morbidity was 41% and mortality 12.8% (5 cases), all of which were emergencies. The surgical technique was similar in both groups: resection with primary anastomosis in elective procedures and Hartmann's procedure in most emergencies, with a rate of immediate anastomosis of 33 and 21%, respectively.
CONCLUSIONS: Factors related to nutrition and quality of life may influence the development of diverticular disease. Emergency surgery should be prevented. Surgeons must adapt their surgical approach to the socioeconomic and cultural medium of the population.},
}
@article {pmid11765349,
year = {2001},
author = {Mastrandrea, G and Petrone, R and Sciumè, C and Diliberti, S and Lo Biundo, N and Bajardi, G},
title = {[Bacterial endocarditis. Unusual complications of acute diverticulitis].},
journal = {Annali italiani di chirurgia},
volume = {72},
number = {3},
pages = {317-321},
pmid = {11765349},
issn = {0003-469X},
mesh = {Acute Disease ; Aged ; Aged, 80 and over ; Colonic Diseases/*complications ; Diverticulitis/*complications ; Endocarditis, Bacterial/*microbiology ; Female ; Humans ; },
abstract = {BACKGROUND: Colon diverticular disease represents an affection with high prevalence in the western countries. It appears particularly insidious in the elderly population for the presence of concomitant illnesses.
CLINICAL CASE: A patient (> 80 years old) is submitted to surgical intervention in emergency sec. Hartman for acute diverticulitis and pelvic abscess. The post-operating time has been complicated for the arising of a fever resistant to the common antibiotic therapy, in absence of abdominal and respiratory objectivity. An accurate clinical examination has set the suspect of bacterial endocarditis, confirmed to the echocardiographic examination.
DISCUSSION: The acute complicated diverticulitis therapy variates in according to the clinical presentation, the complications and the experience of the different Authors. A first conservative approach foresees the Total Parenteral Nutrition (TPN) and the wide spectrum antibiotic therapy and the eventual percutaneous drainage. The surgical treatment, realized with "open" or laparoscopic method, foresees the resection of the sick intestinal tract and the packing of a temporary preternatural anus. However, some Authors prefer an intestinal anastomosis performed in single time with the resection. Among all the complications, the most frequent are those affecting the respiratory and cardiovascular apparatus, as well as the sepsis. The bacterial endocarditis is not signalled in most recent international Literature.
CONCLUSION: The bacterial endocarditis must be suspected in case of common antibiotic therapy resistant fever, with negative abdominal and pulmonary objectivity, arising after a septic surgical intervention.},
}
@article {pmid11742167,
year = {2001},
author = {Bassotti, G and Battaglia, E and Spinozzi, F and Pelli, MA and Tonini, M},
title = {Twenty-four hour recordings of colonic motility in patients with diverticular disease: evidence for abnormal motility and propulsive activity.},
journal = {Diseases of the colon and rectum},
volume = {44},
number = {12},
pages = {1814-1820},
doi = {10.1007/BF02234460},
pmid = {11742167},
issn = {0012-3706},
mesh = {Adult ; Aged ; Case-Control Studies ; Circadian Rhythm/physiology ; Diverticulum, Colon/*physiopathology ; Female ; *Gastrointestinal Motility ; Humans ; Male ; Manometry/instrumentation ; Middle Aged ; Statistics, Nonparametric ; },
abstract = {INTRODUCTION: Diverticular disease of the colon is one of the most common pathologic entities in western countries. Although altered motility of the large bowel is commonly believed to be one of the major pathophysiologic mechanisms, no convincing evidence has been reported yet. In fact, only a few conflicting studies concerning distal colonic motility (with no information on forceful propulsive activity) are available in the literature.
PURPOSE: The purpose of the present study was to investigate basal and stimulated (postprandial) colonic motility from the transverse (not affected), descending, and sigmoid colon in patients with diverticular disease, together with detection of high-amplitude propagated contractions (mass movements). Motility data from patients were compared with those obtained in healthy control subjects.
METHODS: Ten patients and 16 control subjects of both sexes were recruited for the study. In all subjects, colonic motility was recorded for a 24-hour period by a colonoscopically positioned manometric catheter. Two 1000-kcal mixed meals were served during the study.
RESULTS: Compared with control subjects, patients with diverticular disease displayed significantly increased amounts of motility in the affected segments; the response to a physiologic stimulus (meal) was also abnormal in the patients' group. Diverticular disease patients also had a significant increase of forceful propulsive activity compared with control subjects (average = 10.3 +/- 2.7/subject/day high-amplitude propagated contractions for patients and 5.5 +/- 0.8/subject/day for control subjects; P = 0.051); interestingly, about 20 percent of such activity was abnormal, being propagated in a retrograde fashion.
CONCLUSIONS: We concluded that patients with diverticular disease of the colon have abnormal motor and propulsive activities of the large bowel, which are confined to the affected segments.},
}
@article {pmid11736970,
year = {2001},
author = {Baako, BN},
title = {Diverticular disease of the colon in Accra, Ghana.},
journal = {The British journal of surgery},
volume = {88},
number = {12},
pages = {1595},
doi = {10.1046/j.0007-1323.2001.01917.x},
pmid = {11736970},
issn = {0007-1323},
mesh = {Diverticulum, Colon/*epidemiology ; Gastrointestinal Hemorrhage/epidemiology ; Ghana/epidemiology ; Humans ; Incidence ; Middle Aged ; Prospective Studies ; Rectal Diseases/epidemiology ; Sepsis/epidemiology ; },
}
@article {pmid11721120,
year = {2001},
author = {Sahan, C and Akpolat, T and Uçer, T and Güner, E and Dilek, M and Danaci, M},
title = {Behçet's disease and diverticulosis.},
journal = {Digestive surgery},
volume = {18},
number = {5},
pages = {421-422},
doi = {10.1159/000050185},
pmid = {11721120},
issn = {0253-4886},
mesh = {Adult ; Behcet Syndrome/*complications/diagnosis ; Diagnosis, Differential ; Diverticulum, Colon/diagnosis/*etiology ; Female ; Humans ; },
abstract = {Behçet's disease (BD) is a multisystem disorder characterized by vasculitis. The aim of this report is to present a patient with BD and diverticular disease of the colon and discuss the possible association between BD and diverticulosis. To our knowledge, diverticular disease of the colon has not been previously reported in a patient with BD. We conclude that the significance of this association between BD and diverticulosis needs to be clarified.},
}
@article {pmid11695304,
year = {2001},
author = {Rosati, E and Aracri, N and Bottone, A and Cau, C and Scotti, E},
title = {[Sweet syndrome in a female patient with intestinal multiple lipomas and diverticular disease of the colon].},
journal = {Recenti progressi in medicina},
volume = {92},
number = {10},
pages = {599-601},
pmid = {11695304},
issn = {0034-1193},
mesh = {Aged ; Colonic Diseases/complications ; Diverticulum, Colon/*complications ; Female ; Humans ; Lipomatosis/*complications ; Sweet Syndrome/*complications ; },
abstract = {Sweet's syndrome (SS), or acute febrile neutrophilic dermatosis, is a condition characterized by the sudden onset of fever, leukocytosis, and painful, erythematous, well-demarcated papules and plaques which show dense, neutrophilic infiltrates on histologic examination. Myalgias and arthralgias are common. Although it may occur in the absence of other known disease, SS is often associated with hematologic disease (including leukemia), and immunologic disease (rheumatoid arthritis, inflammatory bowel disease). A case of SS is reported. Furthermore the patient presented multiple intestinal lipomas and diverticular colon disease. The authors, on the ground of recent studies which correlate SS with several digestive system disorders, hypothesize an association between acute febrile neutrophilic dermatosis and patient's intestinal diseases. Treatment with systemic corticosteroids is usually successful.},
}
@article {pmid11686523,
year = {2001},
author = {Illert, B and Engemann, R and Thiede, A},
title = {Success in treatment of complicated diverticular disease is stage related.},
journal = {International journal of colorectal disease},
volume = {16},
number = {5},
pages = {276-279},
doi = {10.1007/s003840100320},
pmid = {11686523},
issn = {0179-1958},
mesh = {Anti-Bacterial Agents/therapeutic use ; Diverticulitis, Colonic/*surgery ; Humans ; Postoperative Complications/drug therapy/*surgery ; Postoperative Hemorrhage/etiology ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Surgical Wound Dehiscence/etiology ; Treatment Outcome ; },
abstract = {The clinical stage of disease is one of the many factors affecting outcome after treatment for complicated diverticular disease. We retrospectively assessed surgical results during the period 1994-1999 in 406 patients with complicated diverticular disease, according to the stage of disease, surgical technique, postoperative complications, and mortality. Single-stage resection and primary anastomosis were performed safely in most patients with stage I or II disease. Severe complications were rare in stage I but increased in incidence with higher stages. Patients with stage III are a high-risk group. This stage often requires a two-stage procedure (primary anastomosis and protective ileostoma or the Hartmann procedure). Despite these measures, many severe complications occurred in stage III.},
}
@article {pmid11686522,
year = {2001},
author = {Stumpf, M and Cao, W and Klinge, U and Klosterhalfen, B and Kasperk, R and Schumpelick, V},
title = {Increased distribution of collagen type III and reduced expression of matrix metalloproteinase 1 in patients with diverticular disease.},
journal = {International journal of colorectal disease},
volume = {16},
number = {5},
pages = {271-275},
doi = {10.1007/s003840100310},
pmid = {11686522},
issn = {0179-1958},
mesh = {Adult ; Aged ; Case-Control Studies ; Collagen Type I/metabolism ; Collagen Type III/*metabolism ; Diverticulitis, Colonic/*enzymology/genetics/pathology ; Down-Regulation ; Humans ; Immunohistochemistry ; Matrix Metalloproteinase 1/genetics/*metabolism ; Middle Aged ; Procollagen/metabolism ; },
abstract = {Diverticular disease is an increasingly common clinical problem especially in Western industrialized countries, but the mechanism by which the disease develops remains unclear. Based on studies showing a structural change in the colonic wall in these patients, we examined whether there are any disorders concerning the collagen metabolism in patients with diverticular disease. Samples of colonic tissue from 13 patients with diverticulitis were compared to 14 controls. We performed a Sirius red test for the overall collagen content and immunohistochemical studies facing differentiation between collagen type I and type III and the expression of matrix metalloproteinases 1 and 13. In the bowel sections of patients with diverticulitis there were decreased levels of mature collagen type I (1.37+/- 0.32 vs. 1.59 +/- 0.31) and increased levels of collagen type III (1.61+/- 0.32 vs. 1.42 +/- 0.42), with a resulting lower collagen ratio I/III. The expression of MMP-I was reduced significantly in the diverticulitis group (4.83 +/- 0.92 vs. 6.02 +/- 1.98) while expression of MMP-13 did not differ significantly between the two groups (1.03 +/- 0.11 vs. 1.04 +/- 0.12). Our findings support the theory of structural changes in the colonic wall as one of the major pathogenic factors in the development of diverticular disease. Further studies must focus on the complex interactions of several extracellular matrix components.},
}
@article {pmid11677470,
year = {2001},
author = {Anderson, JC and Messina, CR and Cohn, W and Gottfried, E and Ingber, S and Bernstein, G and Coman, E and Polito, J},
title = {Factors predictive of difficult colonoscopy.},
journal = {Gastrointestinal endoscopy},
volume = {54},
number = {5},
pages = {558-562},
doi = {10.1067/mge.2001.118950},
pmid = {11677470},
issn = {0016-5107},
mesh = {Age Factors ; Body Mass Index ; Clinical Competence ; *Colonoscopy ; Feasibility Studies ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Sex Factors ; Time Factors ; },
abstract = {BACKGROUND: Prediction of a technically difficult colonoscopy may influence patient selection and procedure scheduling. Identification of predictive factors may be difficult because a common endpoint used to evaluate the success of colonoscopy is intubation of the cecum, which is usually achieved. The goal of this study was to examine the feasibility of using an alternative measure, time required for cecal intubation, to identify factors that can impact performance of colonoscopy.
METHODS: The time required for cecal intubation was prospectively recorded for 802 consecutive outpatient colonoscopies performed by 7 experienced gastroenterologists. Patient data collected included height, weight, age, bowel habits, surgical history, and findings at colonoscopy. Forty-seven examinations that were stopped because of disease or unacceptable bowel preparation were excluded. The impact of the patient characteristics of the remaining sample of 755 patients on the median time required for cecal intubation for men and women was examined.
RESULTS: Older age and female gender, body mass index < or =25.0 (regardless of gender), diverticular disease in women, and a history of constipation or reported laxative use in men were predictors of difficult colonoscopy.
CONCLUSIONS: By using median time required for cecal intubation, several patient characteristics were identified that may predict technical difficulty at colonoscopy. These findings have implications for practice and teaching.},
}
@article {pmid11677425,
year = {2001},
author = {Petrakis, I and Sakellaris, G and Kogerakis, N and Zacharioudakis, G and Kourtis, D and Xynos, E and Chalkiadakis, G},
title = {New perspectives in the management of sigmoid diverticulitis.},
journal = {Panminerva medica},
volume = {43},
number = {4},
pages = {289-293},
pmid = {11677425},
issn = {0031-0808},
mesh = {Colon, Sigmoid ; Colonoscopy ; Diverticulitis, Colonic/diagnosis/surgery/*therapy ; Humans ; Laparoscopy ; },
abstract = {The sigmoid colon is the part of the large intestine, which most commonly involved in diverticular disease due to its anatomical properties. Diverticular disease of the colon is being seen with increasing frequency mostly in western countries. Diverticulitis results from inflammation and subsequent perforation of a colonic diverticulum. Mild forms of diverticulitis usually present with gradually increasing symptoms from the lower left quadrant of the abdomen, whereas acute complicated disease is characterised by dramatic onset of abdominal pain, followed by fever within a few hours. The standard treatment for uncomplicated diverticulitis is bowel rest, with liquid diet or intravenous fluids in combination with antibiotics. Prophylactic resection is not to be recommended for patients with diverticular disease, but a high-fibre diet may afford protection by preventing further complications. Patients not responding to conservative treatment within the first 24 hours require further evaluation by computed tomography or ultrasonography. Fistula formation and intestinal obstruction are indications for surgical intervention, although the frequent recurrent attacks, which commonly afflict these patients, are seldom associated with severe complications. Laparoscopic approach has been introduced in the diagnosis and definitive treatment of uncomplicated diverticulitis, with less morbidity and mortality rates, and hospitalisation of the patients and in these terms could be promising in the future.},
}
@article {pmid11598475,
year = {2001},
author = {Schlegel, RD and Dehni, N and Parc, R and Caplin, S and Tiret, E},
title = {Results of reoperations in colorectal anastomotic strictures.},
journal = {Diseases of the colon and rectum},
volume = {44},
number = {10},
pages = {1464-1468},
doi = {10.1007/BF02234598},
pmid = {11598475},
issn = {0012-3706},
mesh = {Adult ; Aged ; *Anastomosis, Surgical ; Constriction, Pathologic ; Female ; Humans ; Intestinal Diseases/*surgery ; Male ; Middle Aged ; Postoperative Complications/*surgery ; Reoperation ; Retrospective Studies ; },
abstract = {PURPOSE: The incidence of colorectal anastomotic strictures varies from 3 to 30 percent. Most of these anastomotic strictures are simple narrowings shorter than 1 cm that can be successfully treated by dilation or endoscopic alternatives. However, up to 28 percent of patients will require surgical correction. This can be technically difficult, with the possibility of a permanent colostomy. This study reports the outcomes after operative treatment of severe strictures of colorectal anastomoses.
METHODS: From August 1992 to October 1996, 27 patients were referred for surgical treatment of severe rectal anastomotic strictures. The reasons for the initial surgery were as follows: rectal cancer (13), diverticular disease (7), Hirschsprung's disease (2), rectal endometriosis (2), uterine carcinoma with rectal invasion (1), ruptured abdominal aortic aneurysm with rectosigmoid necrosis (1), and rectovaginal fistula (1). There were 15 (56 percent) stapled anastomoses, and 21 (78 percent) patients had developed a postoperative leak.
RESULTS: The median time between initial surgery and diagnosis of the stenosis was 7.2 (range, 1-24) months and between the last operation and referral was 15.1 (range, 1-44) months. Stenosis was located at a mean distance of 9.5 (range, 4-15) cm from the anal verge. Eleven patients (41 percent) had been unsuccessfully dilated before referral. Surgical correction of the stenosis required 7 colorectal anastomoses for upper rectal anastomotic strictures and 20 coloanal anastomoses for middle and lower rectal strictures (19 Soave's procedures and 1 colon J-pouch-anal anastomosis). Intestinal continuity was restored in all cases. After a mean follow-up of 28.7 +/- 14 months, no recurrences were detected and functional results were satisfactory.
CONCLUSIONS: Resection of the stenosis and construction of a new colorectal anastomosis can be performed successfully for upper rectal anastomotic stricture. For a stenosis located in the middle and lower rectum, Soave's procedure offers a good alternative, with satisfactory long-term functional results. Whichever technique is used, a permanent colostomy should rarely be required.},
}
@article {pmid11588768,
year = {2001},
author = {Senagore, AJ},
title = {Laparoscopic techniques in intestinal surgery.},
journal = {Seminars in laparoscopic surgery},
volume = {8},
number = {3},
pages = {183-188},
pmid = {11588768},
issn = {1071-5517},
mesh = {Colorectal Neoplasms/surgery ; Diverticulitis/surgery ; Endoscopy, Gastrointestinal ; Gastrointestinal Diseases/*surgery ; Humans ; Inflammatory Bowel Diseases/surgery ; Laparoscopy/*methods ; Rectal Prolapse/surgery ; },
abstract = {Laparoscopic bowel surgery has developed slowly over the last decade, with virtually all procedures having been attempted with these laparoscopic techniques. The benefits of this approach to colorectal surgery have resulted in decreased lengths of stay, smaller incisions, and a potentially lower risk of small bowel obstruction. Resection of benign inflammatory disease presents particular challenges and may be expected to result in higher conversion rates. However, with increasing experience, even complicated diverticular disease and Crohn's disease can be managed laparoscopically. There is a growing body of data that suggests the early concerns regarding colon cancer resection, specifically port site recurrences, may have been exaggerated. Even more importantly, the early results of a number of prospective randomized trials are suggesting that survival and cure rates are not jeopardized by laparoscopic colectomy. The surgical techniques are demanding and require a level of standardization to achieve success. Laparoscopic colorectal surgery will have a definite role in the future.},
}
@article {pmid11587398,
year = {2001},
author = {del Peso, G and Bajo, MA and Gadola, L and Millán, I and Codoceo, R and Celadilla, O and Castro, MJ and Aguilera, A and Gil, F and Selgas, R},
title = {Diverticular disease and treatment with gastric acid inhibitors do not predispose to peritonitis of enteric origin in peritoneal dialysis patients.},
journal = {Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis},
volume = {21},
number = {4},
pages = {360-364},
pmid = {11587398},
issn = {0896-8608},
mesh = {Adolescent ; Adult ; Aged ; Antacids/*adverse effects ; Anti-Ulcer Agents/adverse effects ; Cross-Sectional Studies ; Diverticulum, Colon/*complications ; Female ; Humans ; Intestines/microbiology ; Logistic Models ; Male ; Middle Aged ; Peritoneal Dialysis/*adverse effects ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects ; Peritonitis/*etiology/microbiology ; Retrospective Studies ; Risk Factors ; },
abstract = {OBJECTIVE: Enteric peritonitis (EP) is an infrequent complication of peritoneal dialysis (PD), with severe consequences for peritoneal membrane viability and patient outcome. Factors such as diverticular disease and gastric acid inhibitors have been implicated in its appearance. We investigated several risk factors, including those mentioned below, that can influence the development of EP.
DESIGN: Retrospective cross-sectional study.
SETTING: Tertiary-care public university hospital.
PATIENTS: Fifty-seven PD patients treated in our PD unit during August 1998.
MAIN OUTCOME MEASURES: A barium enema was performed on 50 of the 57 patients (the remaining 7 patients refused it) in order to exclude the presence of diverticulosis. All episodes of peritonitis occurring in those patients, including EP, were registered. Enteric peritonitis was defined as that caused by gram-positive, gram-negative, or fungus micro-organisms that colonized the intestinal tract, excluding episodes secondary to genitourinary tract or peritoneal catheter exit-site infections.
RESULTS: Twenty-four patients showed diverticular disease in the barium enema, but only 5 of them (21%) had any EP episode. Five of the 26 patients with no diverticula (19%) had EP. Fifty-five episodes of peritonitis were reported in 21 patients; 15 episodes of EP (27.3% of all) developed in 11 patients. Seven of the 11 patients (64%) required peritoneal catheter removal and 3 of them (27%) finally were transferred to hemodialysis due to consequences of the EP episode. Logistic regression analysis did not find any of the independent variables analyzed (age, sex, time on PD, type of PD, peritoneal transport parameters, presence of polycystic kidney disease, constipation or diverticulosis, or treatment with gastric acid inhibitors, or phosphate-binding agents) to be risk factors for developing EP.
CONCLUSIONS: Neither diverticulosis nor treatment with gastric acid inhibitors seem to be risk factors for developing peritonitis of enteric origin in PD patients. This type of peritonitis has to be promptly identified and treated in order to diminish the high frequency of peritoneal catheter removal and PD dropout due to such episodes.},
}
@article {pmid11584207,
year = {2001},
author = {Horgan, AF and McConnell, EJ and Wolff, BG and The, S and Paterson, C},
title = {Atypical diverticular disease: surgical results.},
journal = {Diseases of the colon and rectum},
volume = {44},
number = {9},
pages = {1315-1318},
doi = {10.1007/BF02234790},
pmid = {11584207},
issn = {0012-3706},
mesh = {Aged ; Aged, 80 and over ; *Colectomy ; Diagnosis, Differential ; Diverticulitis/diagnosis/pathology/*surgery ; Female ; Humans ; Inflammation ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/diagnosis/pathology/*surgery ; Treatment Outcome ; },
abstract = {PURPOSE: Patients with diverticular disease may present with chronic symptoms but never develop diverticulitis. The purpose of this research was to review the outcome of surgical intervention in this subgroup of patients with atypical "smoldering" diverticular disease.
METHODS: Records of 930 patients who underwent sigmoid resection for diverticular disease during a ten-year period at the Mayo Clinic in Rochester, Minnesota, were reviewed. Forty-seven patients (5 percent) fit our inclusion criteria for smoldering diverticular disease and underwent sigmoid colectomy with primary anastomosis. A minimum of 12 months of follow-up was completed in 68 percent of these patients.
RESULTS: Evidence of acute or chronic inflammatory changes was present in 76 percent of resected specimens. Complete resolution of symptoms occurred in 76.5 percent, with 88 percent being pain free.
CONCLUSIONS: We conclude that the diagnosis and presentation of atypical smoldering diverticular disease is an uncommon and poorly defined entity. However, sigmoid resection in this subgroup of patients is safe and is associated with resolution of symptoms in the majority of cases.},
}
@article {pmid11574089,
year = {2001},
author = {Tocchi, A and Mazzoni, G and Fornasari, V and Miccini, M and Daddi, G and Tagliacozzo, S},
title = {Preservation of the inferior mesenteric artery in colorectal resection for complicated diverticular disease.},
journal = {American journal of surgery},
volume = {182},
number = {2},
pages = {162-167},
doi = {10.1016/s0002-9610(01)00681-x},
pmid = {11574089},
issn = {0002-9610},
mesh = {Aged ; Aged, 80 and over ; Colectomy/*methods ; Colon/surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; *Mesenteric Artery, Inferior ; Middle Aged ; Rectum/surgery ; Time Factors ; },
abstract = {BACKGROUND: Preservation of the inferior mesenteric artery (IMA) and consequential blood flow to the rectum would reduce the risk of leakage of a colorectal anastomosis.
METHODS: One hundred and sixty-three patients undergoing left colectomy for complicated diverticular disease of the colon were randomly placed into two groups: A, n = 86; and B, n = 77. In group A, the integrity of the IMA was preserved by artery skeletization (IMAS); in group B, the IMA was divided at its origin. Variables recorded included duration of the surgical procedure, need for blood transfusion, length of hospital stay, operative mortality and morbidity, staple-ring disruption, and radiologic and clinical leakage. Anastomotic stenosis and recurrence of diverticular disease were noted.
RESULTS: Surgical time was superior in the IMAS group. Radiologic and clinical leakages were significantly higher in group B (P = 0.02, P = 0.03, respectively). In group A a significant lower number of staple-ring disruptions was observed, evolving into clinical dehiscence.
CONCLUSION: Preserving the natural blood supply to the rectum and the ensuing use of a healthy well-nourished rectal stump are suggested as the main aspects of IMAS in preventing and healing leakage of colorectal anastomosis.},
}
@article {pmid11566683,
year = {2001},
author = {Funaki, B and Kostelic, JK and Lorenz, J and Ha, TV and Yip, DL and Rosenblum, JD and Leef, JA and Straus, C and Zaleski, GX},
title = {Superselective microcoil embolization of colonic hemorrhage.},
journal = {AJR. American journal of roentgenology},
volume = {177},
number = {4},
pages = {829-836},
doi = {10.2214/ajr.177.4.1770829},
pmid = {11566683},
issn = {0361-803X},
mesh = {Aged ; Aged, 80 and over ; Colonic Diseases/*therapy ; Embolization, Therapeutic/*instrumentation ; Female ; Gastrointestinal Hemorrhage/*therapy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; },
abstract = {OBJECTIVE: We evaluated therapeutic microcoil embolization in a group of patients with severe colonic hemorrhage.
MATERIALS AND METHODS: Twenty-seven patients with severe colonic bleeding due to diverticular disease (n = 19), angiodysplasia (n = 6), cecal ulcer (n = 1), or unknown cause (n = 1) underwent attempted microcoil embolization (n = 25). Microcatheters were used in all procedures, and embolization was performed at the level of the vasa recta or the marginal artery of Drummond. Branches of the superior mesenteric artery were embolized in 12 patients, branches of the inferior mesenteric artery were embolized in 12 patients, and branches of both the superior and inferior mesenteric arteries were embolized in one patient.
RESULTS: Technical success was achieved in 93% (25/27) of the procedures. However, immediate hemostasis occurred in 96% (26/27) of patients because in one failed procedure, an occlusive dissection of the inferior mesenteric artery arrested bleeding. Three patients rebled within 24 hr. One patient was treated with endoscopic cauterization, and two patients underwent right hemicolectomy. One patient who underwent right hemicolectomy for rebleeding had ischemic changes found on pathologic analysis of the resected specimen, and a second patient who underwent embolization of branches of the superior and inferior mesenteric arteries developed bowel infarction requiring left hemicolectomy. Prolonged clinical success occurred in 81% (22/27) of patients.
CONCLUSION: Therapeutic microcoil embolization for severe colonic hemorrhage is an effective and well-tolerated procedure.},
}
@article {pmid11560801,
year = {2001},
author = {Cima, RR and Young-Fadok, TM},
title = {New developments in diverticular disease.},
journal = {Current gastroenterology reports},
volume = {3},
number = {5},
pages = {420-424},
pmid = {11560801},
issn = {1522-8037},
mesh = {Colectomy/*methods ; Colonoscopy/methods ; Colostomy/methods ; Diverticulitis, Colonic/*diagnosis/epidemiology/*therapy ; Diverticulum, Colon/complications/*diagnosis/epidemiology/*therapy ; Gastrointestinal Hemorrhage/*diagnosis/etiology/*therapy ; Humans ; Laparoscopy/*methods ; },
abstract = {Colonic diverticular disease is common but surprisingly poorly understood. Recent advances in the field continue to focus on the introduction of new technology. Diagnosis and assessment of the severity of acute diverticulitis is improved with CT scanning. A specialized bleeding team employing advanced endoscopic techniques can control diverticular bleeding so that emergency surgical resection may be avoided. Selected patients undergoing laparoscopic sigmoid resection may benefit from this approach. The vast majority of reports are from retrospective studies and include few randomized, controlled trials.},
}
@article {pmid11507364,
year = {2001},
author = {Ala, A and Safar-Aly, H and Millar, A},
title = {Metallic cough and pyogenic liver abscess.},
journal = {European journal of gastroenterology & hepatology},
volume = {13},
number = {8},
pages = {967-969},
doi = {10.1097/00042737-200108000-00016},
pmid = {11507364},
issn = {0954-691X},
mesh = {Aged ; Bronchial Fistula/diagnosis/*etiology/therapy ; Cough/*etiology ; Digestive System Fistula/diagnosis/*etiology/therapy ; Female ; Fusobacterium Infections/*diagnosis/therapy ; *Fusobacterium nucleatum ; Humans ; Liver Abscess/*complications/diagnosis/therapy ; Liver Diseases/diagnosis/*etiology/therapy ; },
abstract = {The curious symptom of a metallic cough in association with a pyogenic hepatic abscess should heighten awareness of a fistula. We describe a 78-year-old female with severe diverticular disease, on long-term steroid treatment for polymyalgia rheumatica. She developed a pyogenic liver abscess, treated initially by antimicrobial therapy, and subsequently drained by ultrasound and computed tomography-guided percutaneous transhepatic pigtail catheterization. This was complicated by a fistulous communication between the abscess cavity and the bronchus, confirmed by radiology. After repeated attempts at drainage and antimicrobial therapy the abscess cavity, including the hepatobronchial fistula, resolved.},
}
@article {pmid11475135,
year = {2001},
author = {Geboes, K},
title = {Crohn's disease, ulcerative colitis or indeterminate colitis--how important is it to differentiate?.},
journal = {Acta gastro-enterologica Belgica},
volume = {64},
number = {2},
pages = {197-200},
pmid = {11475135},
issn = {1784-3227},
mesh = {Colitis/*diagnosis ; Colitis, Ulcerative/*diagnosis ; Crohn Disease/*diagnosis ; Diagnosis, Differential ; Humans ; },
abstract = {In most patients coming to the general practitioner or specialist with a history of bloody diarrhoea, bacteria or drugs are the most likely causative agents and it will be possible to make a diagnosis fairly easily. Because of differences in treatment, ulcerative colitis (UC) and Crohn's disease (CD) must however seriously be considered especially in younger patients, with severe symptoms and whenever the history is prolonged. A variety of colitides may indeed be clinically confused with UC and CD. Pathological mimics that should not be missed include infectious diseases such as Campylobacter colitis, yersiniosis, amoebiasis and others; drug-induced diseases (due to nonsteroidal antiinflammatory drugs...); diverticular disease-associated colitis; intestinal endometriosis; intestinal vasculitis and Behçet's disease and iatrogenic conditions such as graft-versus-host-disease and radiation colitis. In most situations a precise diagnosis of these conditions should be possible when all data are available. The term "indeterminate colitis" is used, when a diagnosis of chronic idiopathic inflammatory bowel disease (IBD) is suggested, but the differential diagnosis between UC and CD can not be solved. This occurs in approximately 5% of all patients with IBD. Diagnostic problems can occur in acute fulminant colitis, acute prolonged colitis, chronic relapsing disease and pouchitis. Indeterminate colitis is essentially a temporary diagnosis. Surgical and medical treatment of these patients can be difficult. When surgical treatment is indicated, the type of surgery must be seriously considered. The clinical course of patients with indeterminate colitis is usually more severe when compared with classical UC and these patients require often more severe medical treatment. Diagnostic problems can also arise in longstanding IBD, either UC and CD. Relapse of symptoms can be due to intercurrent infection (CMV is one of the candidates). Medical treatment can influence the microscopic features and induce a discontinuous inflammation in UC, reminiscent of CD. In cases of doubt, the original biopsies should be reviewed to ascertain the diagnosis, and orient treatment.},
}
@article {pmid11468853,
year = {2000},
author = {Carbajo Caballero, MA and Martín del Olmo, JC and Blanco Alvarez, JI and Martín Acebes, F and De la Cuesta de la Llave, C and Atienza Sánchez, R and Toledano Trincado, M and Vaquero Puerta, C},
title = {Acute diverticulitis and diverticular disease of the colon: a safe indication for laparoscopic surgery.},
journal = {Revista espanola de enfermedades digestivas},
volume = {92},
number = {11},
pages = {718-725},
pmid = {11468853},
issn = {1130-0108},
mesh = {Adult ; Age Factors ; Aged ; Colon, Sigmoid/surgery ; *Digestive System Surgical Procedures/adverse effects ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy/adverse effects ; Male ; Middle Aged ; },
abstract = {AIM: We analyzed our experience with a laparoscopic method for the treatment of acute diverticular disease.
METHODS: Between January 1994 and October 1999 a group of 52 patients who fulfilled the criteria for symptomatic diverticular disease in the descending and sigmoid colon underwent laparoscopy with resection of an average of 40 cm of the bowel. Intraabdominal mechanical anastomosis completed the procedure.
RESULTS: The use of ultrasonic scissors made the laparoscopic technique easier and shortened operative time. Operative morbidity was 15%. Two patients with acute diverticulitis and associated sepsis were reconverted to open surgery, and 4 patients presented postoperative rectal bleeding which ceased spontaneously. No long-term complications were found except in 1 patient who developed an incisional hernia through an entry port. Oral intake began between the second and third day. Postoperative hospitalization was 3-8 days (mean: 5.5 days) and mean operative time was 130 min (range: 70-240 min).
CONCLUSIONS: Despite the steep learning curve for this type of surgery, the good morbidity and mortality rates with the laparoscopic method, especially with high-risk groups of patients (age > 65 years, high blood pressure, etc.) suggest that this surgical option can be used efficiently and safely, and that it achieves better results than with open surgery. However, we feel that the treatment of patients with acute complications of diverticular colon disease requires extensive experience with laparoscopic colorectal surgery.},
}
@article {pmid11468852,
year = {2000},
author = {Torres García, AJ},
title = {Diverticular disease of the colon and laparoscopic surgery.},
journal = {Revista espanola de enfermedades digestivas},
volume = {92},
number = {11},
pages = {711-717},
pmid = {11468852},
issn = {1130-0108},
mesh = {Colon, Sigmoid/surgery ; *Digestive System Surgical Procedures ; Diverticulitis, Colonic/*surgery ; Humans ; *Laparoscopy ; },
}
@article {pmid11464601,
year = {2000},
author = {Unzueta-Hebert, A and Villanueva-Sáenz, E and Rocha-Ramírez, JL and Peña-Ruiz Esparza, JP and Barrientos-Castro, FJ},
title = {[Colonoscopy. Analysis of 2,000 procedures].},
journal = {Revista de gastroenterologia de Mexico},
volume = {65},
number = {3},
pages = {104-108},
pmid = {11464601},
issn = {0375-0906},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Colonic Diseases/*diagnosis/epidemiology ; *Colonoscopy ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {BACKGROUND: During the last 3 decades, colonoscopy has become the diagnostic study with greatest sensitivity and acuity in colonic pathology.
AIMS: To know the most frequent diagnostic and colonoscopic disorders, and the pathology found, to establish certainty of the colonoscopic procedure.
METHOD: Between 1987 and 1997, a descriptive, transversal, retrospective and observational study of the 2,000 colonoscopies that were carried out at on service was done, making a registry of the endoscopic search in colorectal pathology and their characteristics in on patients.
RESULTS: Colonoscopies were done in 967 men (47.3%) and 1,053 women (52.6%) with a median age of 55.8 years (10 range (-) 93 years). In 1,780 of them (89.%), it was possible to arrive to cecum; 1,150 (57.5%) were pathologic. The most frequent finding was hemorrhage of the lower digestive tube in 525 (26.2%) patients; in addition cancer in 402 (20.1%), suspicion of intestinal inflammatory disease 292 (14.6%) and colorectal polyps 199 (10%) were found. The most frequent endoscopic diagnosis was colorectal polyps in 405 (35.7%) patients; in additions diverticular disease was found in 404 (35.1%) patients intestinal inflammatory disease in 185 (16%), colorectal cancer in 85 (7.4%), and vascular ectasias in 52 (4.5%) patients. There were four complicated cases (0.25%), three by resolved therapeutic colonoscopy and one diagnostically.
CONCLUSION: The most frequent colonoscopic were findings hemorrhage of the lower digestive tube and the finding of cancer. The most frequent diagnoses were colorectal polyps and diverticular disease. Colonoscopy is a safe diagnostic and therapeutic procedure.},
}
@article {pmid11464598,
year = {2000},
author = {Niño, J and Girón, GE and Sánchez, P and Blanco, R and María Gómez, L and Muñoz, JR},
title = {[Digestive tract hemorrhage secondary to jejunal angiodysplasia associated with jejunal diverticulosis].},
journal = {Revista de gastroenterologia de Mexico},
volume = {65},
number = {2},
pages = {81-84},
pmid = {11464598},
issn = {0375-0906},
mesh = {Aged ; Aged, 80 and over ; Angiodysplasia/*complications/diagnosis ; Diverticulum/*complications/diagnosis ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Jejunal Diseases/*complications/diagnosis ; Male ; },
abstract = {The most important factor in the management of alimentary tract bleeding is the adequate localization of the lesion. Small bowel bleeding is a rare entity and determination of the specific anatomic site is difficult. Once stomach, duodenum, or colon origin has been discharged through endoscopy, methods such as angiography and Tc99m RBC scans are appropriate. We present a patient with lower gastrointestinal bleeding secondary to jejunal angiodysplasia associated with jejunal diverticular disease. In the present case, Tc99m RBC scans were used to identify the bleeding site. In cases of lower gastrointestinal bleeding of undetermined origin, we suggest the consideration of both diagnoses (angiodysplasia or diverticular disease) with exploratory celiotomy to resolve these pathologies, particularly in the elderly patient.},
}
@article {pmid11457749,
year = {2001},
author = {Goodall, S and Crowther, M and Hemingway, DM and Bell, PR and Thompson, MM},
title = {Ubiquitous elevation of matrix metalloproteinase-2 expression in the vasculature of patients with abdominal aneurysms.},
journal = {Circulation},
volume = {104},
number = {3},
pages = {304-309},
doi = {10.1161/01.cir.104.3.304},
pmid = {11457749},
issn = {1524-4539},
mesh = {Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/*enzymology/pathology/surgery ; Blotting, Northern ; Cells, Cultured ; Elastin/metabolism ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunohistochemistry ; Male ; Matrix Metalloproteinase 2/genetics/*metabolism ; Matrix Metalloproteinases, Membrane-Associated ; Mesenteric Veins/cytology/*enzymology ; Metalloendopeptidases/genetics/metabolism ; Middle Aged ; Muscle, Smooth, Vascular/cytology/*enzymology ; RNA, Messenger/analysis ; Tissue Inhibitor of Metalloproteinase-2/genetics/metabolism ; },
abstract = {BACKGROUND: Patients with abdominal aortic aneurysms (AAAs) exhibit arterial dilation and altered matrix composition throughout the vasculature. Matrix metalloproteinase-2 (MMP-2) is the dominant elastase in small AAAs, and overexpression of MMP-2 in vascular smooth muscle cells (SMCs) may be a primary etiological event in aneurysm genesis. The aim of this study was to investigate MMP-2 production in vascular tissue remote from the abdominal aorta.
METHODS AND RESULTS: Inferior mesenteric vein (IMV) was harvested from patients undergoing aneurysm repair (n=21) or colectomy for diverticular disease (n=13, control). Matrix composition of the vessels was determined by stereological techniques. MMPs were extracted from tissue homogenates and quantified by gelatin zymography and ELISA. MMP-2, membrane type-1 MMP (MT1-MMP), and tissue inhibitor of metalloproteinases type 2 (TIMP-2) expression were determined by Northern analysis. SMCs were isolated from IMV, and the production and expression of MMP-2 and TIMP-2 in the SMC lines were quantified. Tissue homogenates and isolated inferior mesenteric SMCs from patients with aneurysms demonstrated significantly elevated MMP-2 levels, with no difference in TIMP-2 or MT1-MMP. These differences were a result of increased MMP-2 expression. Histological examination revealed fragmentation of elastin fibers within venous tissue obtained from patients with AAA and a significant depletion of the elastin within the media. In situ zymography localized elastolysis to medial SMCs.
CONCLUSIONS: Patients with AAA have elevated MMP-2 levels in the vasculature remote from the aorta. This finding is due to increased MMP-2 expression from SMCs, a characteristic maintained in tissue culture. These data support both the systemic nature of aneurysmal disease and a primary role of MMP-2 in aneurysm formation.},
}
@article {pmid11436693,
year = {2001},
author = {Bielecki, K and Kamiński, P},
title = {[Surgical treatment of colonic diverticulitis--personal observations].},
journal = {Wiadomosci lekarskie (Warsaw, Poland : 1960)},
volume = {54},
number = {3-4},
pages = {233-240},
pmid = {11436693},
issn = {0043-5147},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects ; Colectomy ; Digestive System Surgical Procedures/adverse effects ; Diverticulitis, Colonic/complications/diagnosis/*surgery ; Female ; Humans ; Male ; Middle Aged ; Peritonitis/etiology/therapy ; Recurrence ; Retrospective Studies ; },
abstract = {The aim of paper is presentation of our experience in surgical treatment of diverticular disease. In the period of 11 years we operated on 22 patients aged from 38 to 85 years because of complicated diverticulitis. We admitted to hospital 11 patients as emergency cases; operation was performed urgently in 9 of them due to symptoms and signs of acute peritonitis. The other patients were admitted to hospital because of stenosing inflammatory pericolic mass, pericolic abscess or at least two episodes of acute diverticulitis in the past. Resection of affected part of colon was performed in all patients. Primary anastomosis was performed in 13 patients, Hartmann's operation was performed in 8 patients and suture of caecum in site of resected diverticulum was performed in one patient. There was no mortality. Perioperative complications occurred in 31.8% of patients; anastomotic leak occurred in 1 (7.7%) of 13 patients with primary bowel anastomosis. Results were discussed on the base of recent literature.},
}
@article {pmid11432301,
year = {2001},
author = {Farrell, RJ and Farrell, JJ and Morrin, MM},
title = {Diverticular disease in the elderly.},
journal = {Gastroenterology clinics of North America},
volume = {30},
number = {2},
pages = {475-496},
doi = {10.1016/s0889-8553(05)70191-6},
pmid = {11432301},
issn = {0889-8553},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/diagnosis/etiology/therapy ; *Diverticulum/diagnosis/etiology/therapy ; Hemorrhage/diagnosis/etiology/therapy ; Humans ; },
abstract = {Diverticular disease is common among the elderly. Because of the advanced age and muted symptoms and signs of many of those affected, diagnosis can be difficult. Consequently, great demands are placed on the physician to diagnose and treat clinically evident diverticular disease. Endoscopic, radiologic, and surgical advances have increased the availability of more definitive therapies for patients with complicated diverticular disease and diverticular hemorrhage.},
}
@article {pmid11405093,
year = {2001},
author = {Buttenschoen, K and Buttenschoen, DC and Odermath, R and Beger, HG},
title = {Diverticular disease-associated hemorrhage in the elderly.},
journal = {Langenbeck's archives of surgery},
volume = {386},
number = {1},
pages = {8-16},
doi = {10.1007/s004230000198},
pmid = {11405093},
issn = {1435-2443},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Algorithms ; Diverticulum/*complications/diagnosis/therapy ; Female ; Gastrointestinal Hemorrhage/complications/*etiology/therapy ; Humans ; Male ; Middle Aged ; },
abstract = {Lower gastrointestinal bleeding is frequent in the elderly secondary to diverticular disease and occurs in about 10-30%. It is the most frequent cause of lower gastrointestinal hemorrhage (about 40% of cases) followed by angiodysplasia (up to 20% of cases). The incidence of both diseases increase with age, but the patient's general condition and state of health decrease. Often cardiovascular morbidity coexists, resulting in an eventual risk of ischemic consequences. The intensity of bleeding varies from massive to occult. In diverticular disease, hemorrhage is caused by rupture or erosion of the vasa recti stretched by diverticula. Classically inflammation is absent. Although most diverticula (> 90%) are located in the sigmoid colon, bleeding originates more frequently from the right (> 50%) than the left colon. The preferred diagnostic tool following resuscitation is colonoscopy with an ability to locate the site of bleeding in up to 90% of cases. Additionally, injections and thermocoagulation are available to control bleeding endoscopically with a success rate of about 27%. Angiography is considerably variable concerning positive results (13.6-86%), has a complication rate of about 10% and is expensive. Hence, it is a second-line diagnostic method. Diverticular hemorrhage will cease spontaneously in about 90% of cases. Therefore, conservative treatment is preferred. Patients with persistent, massive or recurrent bleeding despite active conservative measures require surgical treatment. If surgical intervention is necessary, the site of hemorrhage must be sought to allow segmental resection. However, if the source of blood loss cannot be located, a subtotal colectomy is justified.},
}
@article {pmid11396243,
year = {2001},
author = {Wahl, W and Wern, T and Kirsch, D and Junginger, T},
title = {[Status of discontinuity resection in septic diverticular complications. History or a still current procedure?].},
journal = {Zentralblatt fur Chirurgie},
volume = {126},
number = {5},
pages = {357-363},
doi = {10.1055/s-2001-14750},
pmid = {11396243},
issn = {0044-409X},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Anastomosis, Surgical ; Cause of Death ; *Colostomy ; Diverticulitis, Colonic/mortality/*surgery ; Female ; Follow-Up Studies ; Germany ; Humans ; Male ; Middle Aged ; Peritonitis/mortality/*surgery ; Postoperative Complications/*mortality ; Reoperation ; Surgical Wound Dehiscence/mortality/surgery ; Survival Rate ; },
abstract = {Primary anastomosis is becoming increasingly favoured because of the shorter hospital stay even in emergency operations on the colon and rectum. This appears entirely justified when an objective of cost-effective medicine has been set. At our hospital between September 1985 and February 1999, 365 patients were operated on because of diverticular disease. The data from 346 of these patients were evaluated. 202 of these cases were elective; 144 were carried out on an emergency or urgent basis. In 223 cases, a primary anastomosis (Stage I and II according to Hinchey) and in 56 patients a double-barreled colostomy with a distal mucus fistula were performed. 57 patients had a too short rectum-sigma stump and were operated in two stages, according to Hartmann. Of 223 patients with a primary anastomosis, 6 (2.7%) developed an insufficiency of the anastomosis, whereby 3 (1.3%) of these patients subsequently died. Of the patients with Hartmann operation, 11 (19.3%) died due to the sequelae of peritonitis and only 2 patients died following insufficiency of the Hartmann's stump. Of the patients with a mucus fistula, 10 patients (17.9%) died as a result of complications of peritonitis. Of the 113 patients (21 died) with a discontinuity resection, 66 (71%) had their colostomy closed. There were no cases of anastomosis insufficiency and no patient died as a result of the colostomy closure. In the interest of the patients in septic diverticulitis the safest surgical procedure, the discontinuity resection, should be chosen.},
}
@article {pmid11392213,
year = {2001},
author = {Angott, BE and Bross, RJ and Still, CD},
title = {Overview and treatment of diverticular disease.},
journal = {The Journal of the American Osteopathic Association},
volume = {101},
number = {4 Suppl Pt 1},
pages = {S19-21},
pmid = {11392213},
issn = {0098-6151},
mesh = {*Diverticulitis, Colonic/diagnosis/therapy ; *Diverticulum, Colon/diagnosis/therapy ; Humans ; },
abstract = {Diverticular disease is a common medical problem seen in Western society. Outpatient management with close observation is appropriate for the majority of patients. Established criteria for hospitalization and treatment of diverticulitis can help to reduce medical costs and length of stay. Minimally invasive techniques such as computed tomography-guided drainage of diverticular abscess can expedite medical and surgical treatment.},
}
@article {pmid11392048,
year = {2001},
author = {Krska, Z and Klofanda, J and Pesková, M and Schmidt, D and Sváb, J and Melechovský, D and Kormanová, K},
title = {[Massive intestinal hemorrhage as the first sign of diverticular disease of the colon].},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {80},
number = {5},
pages = {250-252},
pmid = {11392048},
issn = {0035-9351},
mesh = {Acute Disease ; Aged ; Diverticulum, Colon/*complications/diagnosis ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Prospective Studies ; Retrospective Studies ; },
abstract = {Retrospective and prospective analysis of massive enterorrhagia (m.e.). The aim of the study is the analysis of frequent causes of m.e--diverticular disease of the colon (DDC). The total number of patients with m.e. was 154 and the proportion of DDC in this total group was 17%, i.m. 24 patients. The total number of patients with the acute symptomatic DDC was 198 and the proportion of haemorrhagic DDC in this total group was 13.3%. The dominant form is conservative therapy (88.4%), surgical therapy was performed in 11.6% of cases. Discontinuous types of operations predominated. The analysis of the group and comparison with problems of m.e. in the literature.},
}
@article {pmid11344425,
year = {2001},
author = {Lagares-Garcia, JA and Kurek, S and Collier, B and Diaz, F and Schilli, R and Richey, J and Moore, RA},
title = {Colonoscopy in octogenarians and older patients.},
journal = {Surgical endoscopy},
volume = {15},
number = {3},
pages = {262-265},
pmid = {11344425},
issn = {1432-2218},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colonoscopy/adverse effects/*methods ; Female ; Gastrointestinal Diseases/diagnosis/epidemiology ; Gastrointestinal Neoplasms/diagnosis/epidemiology ; Humans ; Male ; Middle Aged ; Risk Factors ; },
abstract = {INTRODUCTION: Colonoscopy in the elderly has been considered by many to be risky because of mechanical bowel preparation and dehydration, electrolyte disturbances, conscious sedation, and hypoxic complications. We hypothesized that colonoscopy in octogenarians and older patients is a safe procedure.
MATERIALS AND METHODS: A retrospective review of 803 patients who underwent colonoscopy from January 1997 to October 1997 was performed. The patients were grouped by age: group A (17-49 years) had 166 patients (20%); group B (50-79 years) had 534 patients (67%); and group C (80 years and older) had 103 patients (13%). Results were considered significant at p value less than 0.05 unless otherwise noted.
RESULTS: Blood in the stool (84%) and history of colonic vascular disease (5.8%) were the most common indication in group C (84%). Colonoscopy was used in group A (18%) more often than in the other groups to rule out inflammatory bowel disease. History of colon polyps was a more common indication in group B (20%) than in the other groups. Group A had a significantly higher incidence of normal examinations (84%) and diagnosis of inflammatory bowel disease (14%). Group B had a higher incidence of polyps than the other groups. Group C had the highest incidence of vascular disease (15%). Diverticular disease and carcinoma were more common in groups B (37%) and C (52%). The amount of sedation in the groups did not significantly differ. Completion of the colonoscopy to the cecum or anastomotic sites did not differ among the groups (p > 0.05), nor did complication rates among groups (p > 0.05).
CONCLUSIONS: Colonoscopy is safe in octogenarians and older patients. Age does not, by itself, confer an increased risk to the procedure.},
}
@article {pmid11350443,
year = {2001},
author = {Gooszen, AW and Tollenaar, RA and Geelkerken, RH and Smeets, HJ and Bemelman, WA and Van Schaardenburgh, P and Gooszen, HG},
title = {Prospective study of primary anastomosis following sigmoid resection for suspected acute complicated diverticular disease.},
journal = {The British journal of surgery},
volume = {88},
number = {5},
pages = {693-697},
doi = {10.1046/j.1365-2168.2001.01748.x},
pmid = {11350443},
issn = {0007-1323},
mesh = {APACHE ; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/*etiology/mortality ; Prospective Studies ; Risk Factors ; Sigmoid Diseases/*surgery ; Surgical Wound Dehiscence/etiology ; Survival Analysis ; Treatment Outcome ; },
abstract = {BACKGROUND: A primary anastomosis after resection of the sigmoid colon for suspected acute complicated diverticular disease has the advantage of saving the patient a secondary operation for restoring bowel continuity. Fear of anastomotic leakage often deters surgeons from making a primary anastomosis.
METHODS: A series of 45 patients who underwent primary anastomosis was studied prospectively to evaluate the feasibility of a primary anastomosis following acute sigmoid resection. Acute Physiology and Chronic Health Evaluation (APACHE) II score, Mannheim Peritonitis Index (MPI) and Hughes' peritonitis classification were used to classify patients and to detect factors predictive of postoperative outcome. Death, anastomotic leakage and septic complications were main outcome measures.
RESULTS: Neither anastomotic leakage (four of 45 patients) nor death (three of 45) was related to a higher MPI, APACHE II or Hughes' score. More postoperative septic complications were seen in patients with a MPI over 16. Death, anastomotic leakage, reintervention and wound infection were observed more frequently in patients who presented with colonic obstruction than in those with abscess or perforation.
CONCLUSION: Primary anastomosis is safe and effective in non-obstructed cases of complicated diverticular disease. Colonic obstruction seems to be a risk factor for the development of postoperative complications.},
}
@article {pmid11341617,
year = {1999},
author = {Szinicz, G},
title = {Laparoscopic therapy of colonic diverticular disease.},
journal = {International journal of surgical investigation},
volume = {1},
number = {3},
pages = {251-252},
pmid = {11341617},
issn = {1028-5229},
mesh = {Colon/surgery ; Diverticulum, Colon/*surgery ; Humans ; *Laparoscopy ; Middle Aged ; },
}
@article {pmid11301944,
year = {2001},
author = {De Mulder, W and Gillardin, JP and Hofman, P and Van Molhem, Y},
title = {Laparoscopic colorectal surgery. Analysis of the first 237 cases.},
journal = {Acta chirurgica Belgica},
volume = {101},
number = {1},
pages = {25-30},
pmid = {11301944},
issn = {0001-5458},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Colonic Diseases/mortality/*surgery ; Colorectal Neoplasms/mortality/*surgery ; Female ; Humans ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/etiology/mortality/surgery ; Rectal Diseases/mortality/*surgery ; Reoperation ; Survival Analysis ; },
abstract = {This study was made to prospectively assess the results of our first 237 consecutive patients who underwent laparoscopic or laparoscopic-assisted colorectal procedures. Between May 1995 and July 1999, two hundred thirty seven laparoscopic (assisted) colorectal procedures were performed: 97 sigmoidectomies, 31 right hemicolectomies, 26 rectosigmoidectomies, 23 abdominoperineal rectum amputations and 60 other procedures. The following parameters were recorded and analysed: patients gender, age, diagnosis, procedure, conversion to open surgery, peroperative and postoperative complications, duration of procedure, mortality and length of hospitalization. There were 104 men (44%) and 133 women (56%) with a mean age of 62 years. Hundred and fifty-one operations were performed for benign indications (diverticular disease (51.6%), benign colonic polyps (17.5%) and others (30.9%)) and 86 for cancer (palliative and curative). The conversion rate was 4%. Postoperative complications occurred in 65 patients (27%). In 20% of these cases re-operation was necessary. The most common cause was bowel obstruction. Surgery lasted an average of 110 minutes. Mean overall hospital stay was 11 days. Sixty per cent left the hospital within eight days after operation. The 60-day mortality rate was 2.9%. The feasibility and safety of laparoscopic colorectal surgery has been established in a variety of procedures for different indications. Care must be taken in the case of acute diverticulitis which in our series is associated with higher minor and major complication rate and conversion rate. Although our results for malign cases are good, the definitive incidence of neither port-site metastasis nor local recurrence is known and no long-term results after laparoscopic surgery for carcinoma are available, we believe that curative procedures for cancer should continue to be carried out only within the framework of prospective studies unless the patient is more than 75-year old, is in bad general condition or when a palliative procedure has to be performed.},
}
@article {pmid11268943,
year = {2001},
author = {Akritidis, N and Mantzios, G and Pappas, G},
title = {Gallbladder adenomyomatosis presenting as fever of unknown origin: a case report.},
journal = {Hepato-gastroenterology},
volume = {48},
number = {37},
pages = {112-113},
pmid = {11268943},
issn = {0172-6390},
mesh = {Adenomyoma/*diagnosis/pathology/surgery ; Adolescent ; Cholecystectomy ; Female ; Fever of Unknown Origin/*etiology ; Gallbladder Neoplasms/*diagnosis/pathology/surgery ; Humans ; },
abstract = {Gallbladder adenomyomatosis is a rare disorder, characterized by benign hyperplasia of the gallbladder mucosa creating invaginations through the muscular layer, known as Rokitansky-Aschoff sinuses. It is considered an acquired disease, with pathophysiology similar to that of the diverticular disease of the colon. Diagnosis is often achieved by ultrasound, but a significant percentage is misdiagnosed as chronic cholecystitis, whereas the diagnosis is finally achieved histologically. We describe a case of gallbladder adenomyomatosis presenting as fever of unknown origin. The patient was a 17-year-old girl with a history of sustained fever of 38.5 degrees C of two months' duration. There were no accompanying symptoms and the whole diagnostic workup, including abdominal ultrasound, was negative. Gallbladder inflammation was evident during an eventual investigatory laparoscopy, and cholecystectomy was performed. The histologic results were consistent with diffuse adenomyomatosis. The patient became afebrile immediately after cholecystectomy. To our knowledge, fever has never been associated with gallbladder adenomyomatosis before in bibliography, nor has adenomyomatosis been mentioned as a cause of fever of unknown origin. We therefore believe that gallbladder adenomyomatosis should be considered in the differential diagnosis of sustained fever with negative workup.},
}
@article {pmid11258561,
year = {2000},
author = {Mullin, JM and Laughlin, KV and Tongue, JN and Russell, WR and Reindl, DV and Thornton, JJ and Schulzke, JD},
title = {Electrophysiological differences in normal colon mucosa from diverticular disease vs cancer.},
journal = {Digestive diseases and sciences},
volume = {45},
number = {12},
pages = {2374-2375},
pmid = {11258561},
issn = {0163-2116},
mesh = {Colon/*physiopathology ; Colonic Neoplasms/*physiopathology ; Diverticulum, Colon/*physiopathology ; Electrophysiology ; Humans ; In Vitro Techniques ; Intestinal Mucosa/*physiopathology ; },
}
@article {pmid11240684,
year = {2000},
author = {Scolyer, RA and Carter, J and Russell, P},
title = {Aggressive endometriosis: report of a case.},
journal = {International journal of gynecological cancer : official journal of the International Gynecological Cancer Society},
volume = {10},
number = {3},
pages = {257-262},
doi = {10.1046/j.1525-1438.2000.010003257.x},
pmid = {11240684},
issn = {1525-1438},
abstract = {A 54-year-old premenopausal woman presented with abdominal pain, constipation, and raised serum CA-125 levels during routine follow-up of a low-grade endometrial stromal sarcoma with prominent sex cord-like features, which had been treated by vaginal hysterectomy 4 years previously. The findings at laparotomy included: a 100-mm unilocular thick-walled right ovarian cyst, a solid 25-mm nodule in the left meso-ovarium, and a phlegmonous mass in the wall of the sigmoid colon, which proved to be a pericolic abscess due to diverticular disease. The ovarian cyst was a histologically benign endometrioid cystadenoma with stromal luteinization in the wall. Small islands of morphologically benign endometrial tissue were present in vessels of the meso-ovarium. The left adnexal nodule exhibited florid morphologically benign endometriosis, much of which was within and occluding large vascular spaces, and of apparently recent onset. No lesions resembled, in any way, the original stromal sarcoma. There was no evidence of endometriosis elsewhere in the pelvis or abdomen. The patient has made an uneventful recovery and is being monitored, as before, by tumor markers only. The discordance in morphology between the uterine sarcoma and the subsequent pelvic lesions was so complete as to raise doubts about any pathogenetic relationship between them. We propose the use of the term aggressive endometriosis to describe the changes observed.},
}
@article {pmid11213818,
year = {2001},
author = {Gooszen, AW and Gooszen, HG and Veerman, W and Van Dongen, VM and Hermans, J and Klien Kranenbarg, E and Tollenaar, RA},
title = {Operative treatment of acute complications of diverticular disease: primary or secondary anastomosis after sigmoid resection.},
journal = {The European journal of surgery = Acta chirurgica},
volume = {167},
number = {1},
pages = {35-39},
doi = {10.1080/110241501750069792},
pmid = {11213818},
issn = {1102-4151},
mesh = {Aged ; Anastomosis, Surgical ; Colon, Sigmoid/*surgery ; Digestive System Surgical Procedures/methods ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Male ; Middle Aged ; Peritonitis/etiology/prevention & control ; Postoperative Complications/prevention & control ; Reoperation ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; },
abstract = {OBJECTIVE: To assess the comparative effects of two surgical regimens on the outcome of acute complicated diverticular disease.
DESIGN: Retrospective study.
SETTING: Teaching hospital, The Netherlands.
SUBJECTS: 60 patients who presented with acute complicated diverticular disease.
INTERVENTIONS: 28 patient were treated by sigmoid resection and a Hartmann operation, and 32 by resection with primary anastomosis and defunctioning stoma.
MAIN OUTCOME MEASURES: Morbidity and mortality.
RESULTS: The severity of peritonitis and the amount of faecal contamination were similar in the 2 groups. 12 patients died (7 in the Hartmann group and 5 in the primary anastomosis group). There were 3 radiological leaks with no clinical implications in the primary anastomosis group. 6 patients in the Hartmann group and 5 in the primary anastomosis group required reoperations for intra-abdominal abscess or infection. 7 and 3 patients, respectively, developed dysfunction of their stomas, and 9/21 and 3/27, respectively, required a permanent stoma (p = 0.02, 95% confidence interval of difference 0.07 to 0.56). 3 patients in the Hartmann group developed anastomotic leaks after closure of their stomas, 1 of whom required reoperation but died. No patient developed an anastomotic leak after closure of the stoma in the primary anastomosis group.
CONCLUSION: Both regimens are accepted treatments for patients with acute complicated diverticular disease, but because of the higher morbidity after the Hartmann procedure we prefer primary anastomosis with covering stoma.},
}
@article {pmid11199997,
year = {2000},
author = {Citone, G and Perri, S and Nardi, M and Leardi, S and Gola, P and Lotti, R and Gabbrielli, F and Simi, M},
title = {[Therapeutic strategy in symptomatic diverticular disease of the colon].},
journal = {Chirurgia italiana},
volume = {52},
number = {6},
pages = {631-641},
pmid = {11199997},
issn = {0009-4773},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum, Colon/complications/surgery/*therapy ; Elective Surgical Procedures ; Emergency Treatment ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {Diverticular disease of the colon has been recorded with increasing frequency and approximately 25-30% of symptomatic patients require surgery for complications. Controversy still surrounds the best operative approach for the management of diverticular disease, particularly when it presents with complications. The three-stage operation has, for the most part, been abandoned because of its unacceptably high morbidity and mortality rates. Today it is generally believed that performing two-stage surgery is a wise decision, namely segmentary resection either without (Hartmann's procedure) or with anastomosis, protected by a covering colostomy. However, the ideal intervention is a one-stage surgical procedure (segmentary resection and primary anastomosis without a covering colostomy), but this can only be performed in selected patients. The aim of this study was to analyse the clinical course and the medical and surgical therapy retrospectively in 79 patients with symptomatic diverticular disease in order to identify the best therapeutic procedure; specifically, the severity of septic complications was evaluated using Hinchey's classification. The authors conclude that most patients with symptomatic diverticular disease require specific medical therapy. If surgical treatment is necessary (complicated diverticular disease), Hartmann's procedure is still a valid surgical option, particularly in the presence of diffuse faecal peritonitis. Colonic resection and primary anastomosis are certainly a satisfactory treatment, because of their low morbidity and mortality rates, but this surgical approach is only feasible in selected patients. Finally, it is a matter for the individual surgeon's experience to select the best surgical procedure in any particular situation, depending on age and general state, local findings and the extent of peritonitis.},
}
@article {pmid11109667,
year = {2000},
author = {Testini, M and Margari, A and Amoruso, M and Lissidini, G and Bonomo, GM},
title = {[The dehiscence of colorectal anastomoses: the risk factors].},
journal = {Annali italiani di chirurgia},
volume = {71},
number = {4},
pages = {433-440},
pmid = {11109667},
issn = {0003-469X},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/statistics & numerical data ; Colon/*surgery ; Elective Surgical Procedures ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; Rectum/*surgery ; Reoperation/methods/statistics & numerical data ; Risk Factors ; Surgical Wound Dehiscence/*etiology/surgery ; },
abstract = {OBJECTIVE: To evaluate the results of emergency and elective colorectal resective surgery; to identify general and local factors that influence the anastomotic leak rate.
MATERIAL AND METHOD: 200 selected consecutive patients (115 males and 85 females, medium age 50.6 years, range 16-87) underwent resective colorectal surgery between 1990 to 1997. 154 (77.0%) were operated in elective surgery and 46 (23.0%) in urgency, for carcinoma, diverticular disease, mesenteric infarction, chronic intestinal disease, dolicosigma, anastomotic leakage, familiar polyposis or lesions by firearm. The operations consisted in 58 right colectomy, 28 left colectomy, 6 resection of the transverse and 29 of the sigmoid colon, 40 anterior resection, 12 total colectomy, 19 closing of colostomy, 6 by-passes. Anastomoses were performed in 88 cases by manual and in 110 by mechanical sutures.
RESULTS: We observed 12 (6%) anastomotic leakages. Mortality rate was 1.0%. 13%.0 of these patients were underwent before to emergency and 3.9% to elective surgery; 5.7% by manual and 6.4% by mechanical suture. Diagnosis of leakage was made by clinical features, blood vessel examinations and abdominal TC scan.
DISCUSSION: The risk factors of anastomotic leakage are general or local. Chronic obstructive pulmonary disease, perioperative transfusion, level of serum albumin, use of corticosteroid in the first group and sepsis, bowel obstruction, anastomotic level and tension and poor blood supply in the second, appear the most important causative factors in the development of anastomotic leaks.
CONCLUSION: The incidence of dehiscence in colo-rectal surgery was seen significatively lower when anastomoses were performed in ideal circumstances than in the presence of one or more unfavorable factors. Healing remains a process depending more on the patient than on any aspect of the surgical technique.},
}
@article {pmid11097734,
year = {1999},
author = {Eggenberger, JC},
title = {Diverticular Disease.},
journal = {Current treatment options in gastroenterology},
volume = {2},
number = {6},
pages = {507-516},
pmid = {11097734},
issn = {1092-8472},
abstract = {The spectrum of colonic diverticular disease includes asymptomatic diverticulosis, acute and chronic diverticulitis, and diverticular hemorrhage. Most often discovered incidentally on endoscopy or contrast radiography, asymptomatic diverticulosis is best treated by patient education, which focuses on increasing dietary fiber intake. Acute diverticulitis can be managed on either an inpatient or outpatient basis, depending on the severity of the symptoms, with bowel rest and broad spectrum-antibiotics. Surgery is indicated for complications of the acute inflammatory process, including failure of medical treatment, gross perforation, and abscess formation that cannot be resolved by percutaneous drainage. Manifestations of chronic diverticulitis (fistula formation, stricture, and obstruction) are most often treated surgically. Diverticular hemorrhage is most often massive and self-limited. It requires aggressive resuscitation and a thorough evaluation aimed at localizing the bleeding site. Patients whose bleeding stops spontaneously are treated expectantly. Actively bleeding patients whose bleeding site is successfully localized can be initially treated by selective infusion of vasoconstrictive agents. Recurrent or persistent bleeding requires surgical resection.},
}
@article {pmid11071990,
year = {2000},
author = {Peña, JM and Pernaute, R and Vicente de Vera, C},
title = {Is ADPKD associated with small-bowel diverticular disease?.},
journal = {Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association},
volume = {15},
number = {11},
pages = {1890-1891},
doi = {10.1093/ndt/15.11.1890},
pmid = {11071990},
issn = {0931-0509},
mesh = {Aged ; Barium Sulfate ; Diverticulitis/*complications/diagnostic imaging ; Female ; Gastrointestinal Transit ; Humans ; Ileal Diseases/*complications/diagnostic imaging ; Jejunal Diseases/*complications/diagnostic imaging ; Polycystic Kidney, Autosomal Dominant/*complications ; Radiography ; },
}
@article {pmid11052515,
year = {2000},
author = {Miura, S and Kodaira, S and Shatari, T and Nishioka, M and Hosoda, Y and Hisa, TK},
title = {Recent trends in diverticulosis of the right colon in Japan: retrospective review in a regional hospital.},
journal = {Diseases of the colon and rectum},
volume = {43},
number = {10},
pages = {1383-1389},
doi = {10.1007/BF02236634},
pmid = {11052515},
issn = {0012-3706},
mesh = {Aged ; Aged, 80 and over ; Aging/*physiology ; Diverticulum, Colon/*epidemiology/pathology ; Female ; Humans ; Incidence ; Japan/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {PURPOSE: Diverticulosis of the right colon has been increasing in the Far East; however, a considerable proportion of these patients includes cases of solitary right-sided diverticular disease. This study aimed to determine whether the incidence of such solitary diverticula (defined as 1 or 2 diverticula in this study) and multiple (3 or more) diverticula of the right colon is increasing in Japan.
METHODS: A total of 13,947 consecutive barium enema examinations, performed in the period from 1982 to 1997, were reviewed. Changes in the frequency (detection rate) and number of diverticula across time and with aging of three types of diverticula, right-sided, left-sided, and bilateral, were investigated, with special interest in those patients with one or two diverticula of the right colon.
RESULTS: Right-sided and bilateral diverticula have increased in frequency across time; however, left-sided diverticula have not. Patients with one or two diverticula in the right colon of right-sided disease, unexpectedly, have increased across time in both genders, and patients with three or more diverticula in the right colon of right-sided disease have shown an increase in males. The number of diverticula of the right colon showed no increase across time or with aging.
CONCLUSIONS: Diverticulosis of the right colon, both solitary and multiple, has been increasing steadily in Japan; therefore, diverticulitis and bleeding diverticula of the right colon may continue to increase. Diverticula of the right colon might be an acquired disease and self-limiting in development, because the frequency did not increase substantially in the elderly and because the number changed little across time and with aging.},
}
@article {pmid11051348,
year = {2000},
author = {Anderson, JC and Gonzalez, JD and Messina, CR and Pollack, BJ},
title = {Factors that predict incomplete colonoscopy: thinner is not always better.},
journal = {The American journal of gastroenterology},
volume = {95},
number = {10},
pages = {2784-2787},
doi = {10.1111/j.1572-0241.2000.03186.x},
pmid = {11051348},
issn = {0002-9270},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; *Colonoscopy ; Diverticulitis, Colonic/diagnosis/physiopathology ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Sex Factors ; Thinness/*physiopathology ; },
abstract = {OBJECTIVE: The aim of this study was to determine whether anatomic factors such as body mass index (BMI) impacts the success rate of cecal intubation during colonoscopy.
METHODS: We retrospectively reviewed the cecal intubation rate of 2000 colonoscopies performed at our institution from March 1997 to March 1999. The analysis sample was composed of charts for all incomplete procedures and a sample (23%) of complete examinations that were randomly selected. Data collected included age, gender, height, weight, bowel habits, abdominal surgery, psychiatric medication use, the presence of diverticular disease, amount of sedation administered, and location and reason for halting the examination. Patients were divided by BMI: thin (BMI < or = 22.1), average weight (BMI > 22.1-25.0), overweight (BMI = 25.1-29.9), and obese (BMI > 30).
RESULTS: Colonoscopies in women had a lower adjusted completion rate (94.8%) than in men (98.2%) (p < 0.005). A low BMI in women was predictive of an incomplete examination (p < 0.001). Factors that did not predict incomplete examinations in women included age and previous hysterectomy. The small number of male patients with an incomplete examination (n = 16) precluded accurate identification of any factors.
CONCLUSIONS: Women with a low BMI (especially < 22) were more likely to have an incomplete procedure. This finding may have implications for colorectal cancer screening in female patients.},
}
@article {pmid11045068,
year = {1999},
author = {Muthu, A and Qureshi, A and Ismail, MA},
title = {Massive bleeding from colonic diverticular disease with NSAID use.},
journal = {The Medical journal of Malaysia},
volume = {54},
number = {3},
pages = {374-376},
pmid = {11045068},
issn = {0300-5283},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Colectomy ; Diclofenac/*adverse effects ; Diverticulum, Colon/*complications/surgery ; Gastrointestinal Hemorrhage/*chemically induced/*complications/surgery ; Humans ; Male ; Middle Aged ; },
abstract = {Non-steriodal anti-inflammatory drugs (NSAID) are not only associated with bleeding in the stomach and duodenum, but can also complicate pre-existing diverticular disease of the colon. Here, a 58 year-old male with severe per rectal bleeding is presented and the role of NSAID as a causative factor of his problem is discussed.},
}
@article {pmid11026203,
year = {2000},
author = {Timerbulatov, VM and Mekhdiev, DI and Men'shikov, AM and Verzakova, IV and Mikheeva, EA and Koval'skaia, SF and Galliamov, AKh},
title = {[Treatment strategy in diverticulosis of the colon].},
journal = {Khirurgiia},
volume = {},
number = {9},
pages = {48-51},
pmid = {11026203},
issn = {0023-1207},
mesh = {Aged ; Diverticulum, Colon/diagnosis/*surgery ; Emergencies ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Postoperative Complications ; },
abstract = {The results of treatment of 645 patients with diverticular disease of the colon have been analysed. There were 65.4% of women and 34.6%--of men, 54.4% of patients were hospitalized urgently and 45.6% electively. 82.5% of patients underwent conservative treatment, 24.8% of them were operated. In hyperkinetic type of bowel motor activity preference was given to mini-invasive organ-saving operations. In 28 cases Laparoscopic serosa myotomy by Reilly and Hodson were carried out (in 17 cases through miniapproach). In hypokinetic type various types of resection of the colon (20 patients) were performed. In necessity for urgent operation various methods of operations may be made depending on general condition of the patient and extension of the pathologic process. In 29 cases initial resection with anastomosis has been performed. Postoperative complications developed in 20.5% patients. There were no lethal outcomes. In 66 cases 2-stage operations were carried out, lethality being 10.6%, and complications--23.7%.},
}
@article {pmid10993612,
year = {2000},
author = {Faynsod, M and Stamos, MJ and Arnell, T and Borden, C and Udani, S and Vargas, H},
title = {A case-control study of laparoscopic versus open sigmoid colectomy for diverticulitis.},
journal = {The American surgeon},
volume = {66},
number = {9},
pages = {841-843},
pmid = {10993612},
issn = {0003-1348},
mesh = {Adult ; Case-Control Studies ; Colectomy/adverse effects/*methods ; Colon, Sigmoid/physiopathology/*surgery ; Diverticulitis, Colonic/*surgery ; Eating/physiology ; Elective Surgical Procedures ; Feasibility Studies ; Female ; Hospitalization ; Hospitals, University ; Hospitals, Urban ; Humans ; *Laparoscopy/adverse effects/methods ; Length of Stay ; Male ; Middle Aged ; Recovery of Function/physiology ; Retrospective Studies ; Sigmoid Diseases/*surgery ; Time Factors ; },
abstract = {Laparoscopic sigmoid colectomy (LSC) for diverticular disease accounts for a limited number of laparoscopic colon cases performed nationally because of the technical challenge it presents. Our objective was to determine the feasibility and impact of the laparoscopic approach in elective sigmoid colectomy for diverticular disease and to compare these results with those of the open approach. Twenty elective laparoscopic sigmoid colectomies (LSCs) were performed for diverticulitis between April 1992 and July 1999 at a university-affiliated urban hospital. A case-control study was performed comparing LCS with a matched control group of conventional open sigmoidectomies. Fourteen of 20 sigmoidectomies were successfully completed laparoscopically. The mean operative time for LSC was similar to that for open sigmoid colectomy (251 vs 243 minutes). There was earlier return to oral intake in the LSC group (1 vs 5 days; P < 0.001). The mean length of stay was significantly shorter (P = 0.029) in LSC (4.8 days) versus open sigmoid colectomy (7.8 days). Conversion to open sigmoidectomy extended hospital stay to 8.16 days. The overall complication rate was 10 per cent in both groups. We conclude that LSC can be performed effectively and with a low complication rate for diverticular disease. LSC provides the benefit of quicker return of bowel function and shorter hospitalization.},
}
@article {pmid10976284,
year = {2000},
author = {Timofeev, IuM and Perevoshchikov, AG},
title = {[A pseudotumorous form of diverticular disease of the sigmoid].},
journal = {Voprosy onkologii},
volume = {46},
number = {3},
pages = {344-346},
pmid = {10976284},
issn = {0507-3758},
mesh = {Aged ; Colon, Sigmoid/pathology/surgery ; Colostomy ; Diagnosis, Differential ; Diverticulum, Colon/*diagnosis/pathology/surgery ; Female ; Granuloma, Plasma Cell/*diagnosis/pathology/surgery ; Humans ; Sigmoid Diseases/*diagnosis/pathology/surgery ; Sigmoid Neoplasms/diagnosis ; },
}
@article {pmid10954818,
year = {2000},
author = {Eijsbouts, QA and de Haan, J and Berends, F and Sietses, C and Cuesta, MA},
title = {Laparoscopic elective treatment of diverticular disease. A comparison between laparoscopic-assisted and resection-facilitated techniques.},
journal = {Surgical endoscopy},
volume = {14},
number = {8},
pages = {726-730},
pmid = {10954818},
issn = {0930-2794},
mesh = {Aged ; Diverticulum, Colon/*surgery ; Elective Surgical Procedures ; Female ; Hospitalization ; Humans ; Laparoscopy/economics/*methods ; Male ; Middle Aged ; Postoperative Care ; Postoperative Complications ; Time Factors ; },
abstract = {BACKGROUND: Because of the presence of significant inflammatory reaction, elective surgical laparoscopic-assisted treatment of complicated diverticular disease can be difficult, leading to a high conversion and complication rate. Laparoscopic alternatives to this assisted approach consist of the hand-assisted method and the more conventional facilitated laparoscopic sigmoid resection. Facilitated laparoscopic sigmoid resection implies laparoscopic mobilization of the sigmoid as much as possible and splenic flexure when called for. Through a Pfannenstiel incision, the difficult steps of the operation-such as the dissection of the inflammatory process and taking down the fistula, but also resection and manual anastomosis-can be performed. In this study, we compare the operating time, conversion rate, complications, and costs of both assisted and resection-facilitated techniques.
METHODS: We compared two consecutive series of 35 patients with diverticular disease who underwent a sigmoid resection by laparoscopy. Both groups were comparable in terms of age, gender, and kind of complicated diverticular disease.
RESULTS: The operating time, conversion rate, and costs were all less in the laparoscopic-facilitated group. The fact that there were no conversions in this group is the most important finding of this study. Not only was it possible to convert from the assisted laparoscopic approach to laparotomy (five patients of 35), it was also possible to convert from the assisted to the facilitated form (seven of 35 patients).
CONCLUSIONS: Laparoscopic-facilitated sigmoid resection is a feasible intervention for all forms of complicated diverticular disease and yields marked reductions in operating time, conversion rate, and operative and general costs.},
}
@article {pmid10932672,
year = {2000},
author = {Young-Fadok, TM and Roberts, PL and Spencer, MP and Wolff, BG},
title = {Colonic diverticular disease.},
journal = {Current problems in surgery},
volume = {37},
number = {7},
pages = {457-514},
doi = {10.1016/s0011-3840(00)80011-8},
pmid = {10932672},
issn = {0011-3840},
mesh = {Diverticulitis, Colonic/classification/diagnosis/physiopathology/surgery ; *Diverticulum, Colon/diagnosis/etiology/physiopathology/surgery ; Gastrointestinal Hemorrhage/surgery ; Humans ; Immunocompromised Host ; Intestinal Fistula/surgery ; Intestinal Obstruction/surgery ; Intestinal Perforation/surgery ; Recurrence ; },
}
@article {pmid10919013,
year = {2000},
author = {Tomita, R and Fujisaki, S and Tanjoh, K and Fukuzawa, M},
title = {Role of nitric oxide in the left-sided colon of patients with diverticular disease.},
journal = {Hepato-gastroenterology},
volume = {47},
number = {33},
pages = {692-696},
pmid = {10919013},
issn = {0172-6390},
mesh = {Adult ; Aged ; Colon, Sigmoid/*innervation ; Diverticulitis, Colonic/*physiopathology ; Female ; Humans ; In Vitro Techniques ; Male ; Middle Aged ; Nitric Oxide/*physiology ; Tetrodotoxin/pharmacology ; },
abstract = {BACKGROUND/AIMS: Non-adrenergic non-cholinergic inhibitory nerves are the most important nerves in the enteric nervous system of the human gut. Recently, it has been established that nitric oxide is released by stimulation of non-adrenergic non-cholinergic inhibitory nerves. Therefore, in order to evaluate the function of nitric oxide in the left-sided colon of patients with diverticular disease, we examined the enteric nerve responses in colonic tissues from patients with this disease, and also used the left-sided normal colon as a control.
METHODOLOGY: Colonic tissue specimens (the diverticular bearing segments) were obtained from 9 patients with diverticular disease of the left-sided colon, and normal segments of the left-sided colon were obtained from 16 patients with ascending colon cancer. A mechanograph was used to evaluate in vitro colonic responses to electrical field stimulation of adrenergic and cholinergic nerve before and after treatments with various autonomic nerve blockers, NG-nitro-L-arginine, and L-arginine.
RESULTS: 1) The diverticular colon was more strongly innervated by cholinergic nerves than the normal colon (P < 0.01); 2) Non-adrenergic non-cholinergic inhibitory nerves were found to act on the normal colon and to a lesser extent in the diverticular colon (P < 0.05). 3) Nitric oxide mediates the relaxation reaction of non-adrenergic non-cholinergic inhibitory nerves in the normal colon and to a lesser extent in the diverticular colon.
CONCLUSIONS: These findings suggest that the intrinsic intestinal innervation contains excitatory and inhibitory nerves and that the former, especially cholinergic nerves, are dominant in the left-sided colon with diverticula. In addition, diminution of action of non-adrenergic non-cholinergic inhibitory nerves by substances such as nitric oxide may be largely related to the high intraluminal pressure by colonic segmentation observed in the left-sided colon with diverticula.},
}
@article {pmid10917478,
year = {2000},
author = {Jenkins, JT and Taylor, AJ and Behrns, KE},
title = {Secondary causes of intestinal obstruction: rigorous preoperative evaluation is required.},
journal = {The American surgeon},
volume = {66},
number = {7},
pages = {662-666},
pmid = {10917478},
issn = {0003-1348},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Contrast Media ; Diagnosis, Differential ; Female ; Humans ; Intestinal Diseases/*complications/*diagnosis/diagnostic imaging/surgery ; Intestinal Obstruction/diagnostic imaging/*etiology/*surgery ; Male ; Middle Aged ; Postoperative Complications/etiology/prevention & control ; Preoperative Care/*methods ; Reoperation ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {The clinical presentation, management and outcome of patients with small intestinal and large bowel obstruction unrelated to adhesive or primary colonic neoplastic disease is not well described. The aim of this study was to determine the clinical presentation, evaluation, operative management, and outcome in patients with secondary causes of intestinal obstruction. The medical records of 200 patients who underwent an operation for intestinal obstruction from January 1995 through December 1997 were reviewed. Seventy-three patients (37%) had secondary causes of intestinal obstruction, and these records were reviewed in detail. The cohort included 37 men and 36 women with a mean age of 52 +/- 2 years. The etiology of intestinal obstruction was metastatic neoplastic obstruction (19%), colonic volvulus (18%), Crohn's disease (14%), herniae (11%), diverticular disease (7%), and miscellaneous causes (31%). Six patients (8%) had intestinal motor disorders and a misdiagnosis of intestinal obstruction. The clinical presentation of patients with secondary causes of obstruction was similar to typical patients with adhesive small bowel obstruction. Preoperative evaluation included frequent use of CT (42%), but intestinal contrast studies were used in 13 (18%) patients only. Two-thirds of the patients required an intestinal resection, and 50 per cent of the patients with a misdiagnosis had a nontherapeutic celiotomy. Operative mortality and morbidity were 3 per cent and 48 per cent, respectively, and 15 per cent of patients required reoperation. Suspected intestinal obstruction from secondary causes requires rigorous preoperative evaluation with liberal use of intestinal contrast examinations to avoid misdiagnosis, operative complications, and reoperations.},
}
@article {pmid10912487,
year = {2000},
author = {Hart, AR and Kennedy, HJ and Stebbings, WS and Day, NE},
title = {How frequently do large bowel diverticula perforate? An incidence and cross-sectional study.},
journal = {European journal of gastroenterology & hepatology},
volume = {12},
number = {6},
pages = {661-665},
doi = {10.1097/00042737-200012060-00016},
pmid = {10912487},
issn = {0954-691X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Analgesics, Opioid/adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Cecal Diseases/*complications/epidemiology ; Cross-Sectional Studies ; Diverticulum/*complications/epidemiology ; Diverticulum, Colon/*complications/epidemiology ; England/epidemiology ; Female ; Humans ; Incidence ; Intestinal Perforation/epidemiology/*etiology ; Male ; Middle Aged ; Risk Factors ; },
abstract = {The aetiology of perforation of large bowel diverticula is poorly understood and a case-control study is required to identify the causes. Before such a study can be attempted, the incidence must be determined and groups at particular risk identified. Cases of perforated large bowel diverticula living in the Norwich postal code region treated between 1995 and 1997 were identified. Fifty-eight cases presented in a population of 531 241. The incidence was 4.0 cases per 100,000 per year, increased with age and was higher in men than women (5.8 vs 3.1). The most frequently used drugs were non-steroidal anti-inflammatory drugs (NSAIDs) (29%) and opiate analgesics (26% of cases). This is the first report of the incidence of perforated diverticular disease and allows a calculation of the population size needed to recruit sufficient cases for an aetiological investigation. The differences in incidence between genders should prompt a search for factors which differ between the sexes such as diet. NSAIDs are a known risk factor, although the data show that opiate analgesics should be investigated.},
}
@article {pmid10900734,
year = {2000},
author = {Le Néel, JC and Denimal, F and Letessier, E and Bernard, P and Jurczak, F and Armstrong, O},
title = {[Complicated colonic diverticulosis. Results of surgical treatment between 1981 and 1998 in 370 patients].},
journal = {Annales de chirurgie},
volume = {125},
number = {4},
pages = {334-339},
doi = {10.1016/s0003-3944(00)00203-0},
pmid = {10900734},
issn = {0003-3944},
mesh = {Abdominal Abscess/etiology ; Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/etiology ; Diverticulum, Colon/complications/drug therapy/*surgery ; Elective Surgical Procedures ; Emergencies ; Female ; Gastrointestinal Hemorrhage/etiology ; Hernia, Ventral/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Male ; Middle Aged ; Peritonitis/etiology ; Prognosis ; Retrospective Studies ; Suppuration ; Survival Rate ; Treatment Outcome ; },
abstract = {AIM OF THE STUDY: The aim of this retrospective study was to analyze case reports of all the patients with complicated diverticular disease of the colon admitted in the same surgical center during an 18-year period and to report the postoperative results in patients operated on in emergency and in patients operated on electively.
PATIENTS AND METHOD: From 1981 to 1998, 501 patients were admitted for complicated diverticular disease. There were 233 men and 268 women. Mean age was 66 years (range: 27-96). One hundred and thirty-one patients were only treated medically and 370 patients were operated on, either as an emergency (n = 211) or electively (n = 159). The complicated diverticular disease was located on the left colon in 362 cases and in the right colon in 8 cases.
RESULTS: In the emergency group, 103 patients were operated on for pelvic (n = 24) and generalized purulent (n = 67) or stercoral (n = 12) peritonitis, mainly with Hartmann procedure (n = 80) with 14 postoperative deaths; 67 were operated on for pericolic abscess with 6 deaths, 19 for colonic obstruction with two deaths and 22 for profuse hemorrhage with 4 deaths. The overall postoperative mortality rate was 12.3%, and morbidity rate 38.7%. Intestinal continuity was restored in 74% and eventrations were present in 10%. In the elective group, there were two postoperative deaths in patients with a colic fistula (n = 30), no mortality and a 10.8% morbidity rate in the other patients (n = 129).
CONCLUSION: This series of an 18-year duration emphasizes the severity of surgery for acute complications in diverticular disease of the colon and the advantages of elective surgery. Large progress in the management of peritonitis and pericolic abscesses has made possible the improvement of their prognosis.},
}
@article {pmid10884665,
year = {2000},
author = {Schneider, DB and Clary-Macy, C and Challa, S and Sasse, KC and Merrick, SH and Hawkins, R and Caputo, G and Jablons, D},
title = {Positron emission tomography with f18-fluorodeoxyglucose in the staging and preoperative evaluation of malignant pleural mesothelioma.},
journal = {The Journal of thoracic and cardiovascular surgery},
volume = {120},
number = {1},
pages = {128-133},
doi = {10.1067/mtc.2000.106529},
pmid = {10884665},
issn = {0022-5223},
mesh = {Adult ; Aged ; Aged, 80 and over ; Female ; *Fluorodeoxyglucose F18 ; Humans ; Male ; Mesothelioma/*diagnostic imaging/*pathology ; Middle Aged ; Neoplasm Staging ; Pleural Neoplasms/*diagnostic imaging/*pathology ; Preoperative Care ; *Radiopharmaceuticals ; Reproducibility of Results ; *Tomography, Emission-Computed ; },
abstract = {OBJECTIVES: The purpose of this study was to evaluate the utility of positron emission tomography with F18-fluorodeoxyglucose in the preoperative evaluation and staging of malignant mesothelioma in patients who were candidates for aggressive combined modality therapy.
METHODS: Eighteen consecutive patients with biopsy-proven malignant mesothelioma underwent positron emission tomographic scanning. The results of positron emission tomographic imaging were compared with results obtained by computed tomography, mediastinoscopy, thoracoscopy, and pathologic examination of surgical specimens. All patients fasted and received an average of 14.5 +/- 2.7 mCi of F18-fluorodeoxyglucose for positron emission tomographic scanning. Attenuation-corrected whole-body and regional emission images of the chest and upper abdomen were acquired and formatted into transaxial, coronal, and sagittal images.
RESULTS: All primary malignant mesotheliomas accumulated F18-fluorodeoxyglucose, and the mean standardized uptake value was 7. 6 (range, 3.33-14.85; n = 9). There were no false-negative results of positron emission tomography. Identification of occult extrathoracic metastases by positron emission tomography was the basis for excluding two patients from surgical therapy. There were two false-positive results of positron emission tomography: increased F18-fluorodeoxyglucose uptake in the contralateral chest that was negative by thoracoscopic biopsy (n = 1) and increased abdominal F18-fluorodeoxyglucose uptake after partial colectomy for diverticular disease (n = 1).
CONCLUSIONS: Positron emission tomography can identify malignant pleural mesothelioma and appears to be a useful noninvasive staging modality for patients being considered for aggressive combined modality therapy.},
}
@article {pmid10832297,
year = {2000},
author = {De Fina, S and Franciosi, C and Codecasa, G and Real, G and Colombo, G and Visintini, G and Romano, F and Uggeri, F},
title = {[The use of the biofragmentable ring (BAR-Valtrac) in colon surgery].},
journal = {Minerva chirurgica},
volume = {55},
number = {3},
pages = {133-137},
pmid = {10832297},
issn = {0026-4733},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/*instrumentation ; Biocompatible Materials ; Colon/*surgery ; Digestive System Surgical Procedures/*instrumentation ; Equipment Design ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {BACKGROUND: Clinical results of colic anastomosis using biofragmentable anastomosis ring (BAR-Valtrac) are presented. Such a method showed to be a real alternative technique to the usual ones.
METHODS: Eighty-six colic anastomosis using BAR are collected, 76 of which performed as elective surgery and 10 in emergency. The patients were 47 males and 39 females, with a mean age of 64 years. In 63 cases the patients were affected by colic neoplastic disease, in 16 by complicated diverticular disease (stenosis or perforation) and 7 patients had neoplastic disease of other organs involving the colon BAR device was used in 48 colic reconstructions after segmentary resection and in 38 colic reconstructions after left hemicolectomy. In each case 31-34 mm BAR were used.
RESULTS: No perioperative death occurred in our series. Only one case (2%) of anastomotic leak was observed, while in 3 cases (4%) intestinal canalization disorders occurred. No problems for ring expulsion occurred in any patient. Three late complications were observed, as three cases of asymptomatic substenosis discovered during instrumental follow-up and spontaneously cleared up.
CONCLUSIONS: On the basis of clinical results, and according to those reported in literature BAR anastomosis is considered a safe, feasible and easy technique to perform colic anastomosis, even in emergency, limited to the intraperitoneal tract of the colon.},
}
@article {pmid10829501,
year = {2000},
author = {Burgel, JS and Navarro, F and Lemoine, MC and Michel, J and Carabalona, JP and Fabre, JM and Domergue, J},
title = {[Elective laparoscopic colectomy for sigmoid diverticulitis. Prospective study of 56 cases].},
journal = {Annales de chirurgie},
volume = {125},
number = {3},
pages = {231-237},
doi = {10.1016/s0001-4001(00)00129-x},
pmid = {10829501},
issn = {0003-3944},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Diverticulum, Colon/pathology/*surgery ; Elective Surgical Procedures ; Feasibility Studies ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Sigmoid Diseases/pathology/*surgery ; Treatment Outcome ; },
abstract = {OBJECTIVE: The aim of this prospective study was to assess the feasibility and postoperative advantages of the laparoscopic-assisted elective colectomy for diverticular disease.
PATIENTS AND METHODS: From january 1989 to december 1997, among the 114 patients electively operated on for diverticulitis, 56 patients were treated by laparoscopic approach. Evaluated parameters included: gender, age, weight, size, ASA score, operating time, duration of hospital stay, of analgesic treatment, and of postoperative ileus, morbidity and mortality rate.
RESULTS: The study group consisted of 35 women and 21 men. Mean age was 59 years (34-81 years); 29 patients were ASA 1 and 27 ASA 2. Overall postoperative mortality rate was 0% and morbidity rate 16% (n = 9). There were no complications directly related to laparoscopic technique. The conversion rate was 14% (n = 8). Mean operating time was 300 min (200-600 min). Mean duration of postoperative ileus was 2.4 days. Mean duration of hospital stay was 9.4 days.
CONCLUSION: This study demonstrates the feasibility of elective laparoscopic-assisted colonic resection for diverticular disease in more than 80% of cases with a postoperative morbidity and mortality rate comparable to those of conventional surgery.},
}
@article {pmid10807280,
year = {2000},
author = {Schwesinger, WH and Page, CP and Gaskill, HV and Steward, RM and Chopra, S and Strodel, WE and Sirinek, KR},
title = {Operative management of diverticular emergencies: strategies and outcomes.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {135},
number = {5},
pages = {558-62; discussion 562-3},
doi = {10.1001/archsurg.135.5.558},
pmid = {10807280},
issn = {0004-0010},
mesh = {Adult ; Anastomosis, Surgical ; Colectomy ; Diverticulum, Colon/mortality/*surgery ; *Emergencies ; Female ; Gastrointestinal Hemorrhage/mortality/*surgery ; Humans ; Intestinal Obstruction/mortality/*surgery ; Intestinal Perforation/mortality/*surgery ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/mortality ; Survival Rate ; },
abstract = {HYPOTHESIS: A selective surgical approach using either a 1- or a 2-stage resection is relatively safe and effective in the management of acute complicated colonic diverticulosis.
DESIGN: A consecutive cohort study.
SETTING: A university hospital.
PATIENTS: Eighty-nine consecutive patients who underwent emergency operations for diverticular disease between July 1, 1984, and June 30, 1999. There were 53 male and 36 female patients (mean age, 47 years). The ethnic background was predominantly Mexican American (58 patients [65.2%]).
INTERVENTIONS: Resections of the affected colon (n = 83) plus construction of a Hartmann pouch or mucous fistula (n = 72) or primary anastomosis (n = 11).
MAIN OUTCOME MEASURES: Morbidity, mortality, and length of hospital stay.
RESULTS: Sixty-eight operations were performed for perforation at an annual rate that has increased greater than 75% in the past 15 years. Another 14 patients underwent operations for obstruction, and 7 underwent operations to control unremitting hemorrhage. Surgical therapy included resection of the affected segment of the bowel in 83 (93%) of the 89 patients, and a Hartmann pouch or mucous fistula was added in 72 (81%). A primary anastomosis was performed in 4 (80%) of 5 right-sided lesions but in only 7 (8%) of 84 left-sided lesions. Morbidity occurred in 38 (43%) of the 89 patients, and the mortality was 4%, with 4 deaths occurring secondary to sepsis in high-risk patients with perforations (n = 3) or obstructions (n = 1). The average length of hospital stay was 19.7 days (range, 5-80 days).
CONCLUSIONS: Emergency operations for diverticular disease are uncommon but may be associated with substantial morbidity and occasional mortality. Complicated diverticulosis may present at a relatively young age, and perforated forms appear to be increasing rapidly in prevalence. Most diverticular lesions can be satisfactorily managed using a selective approach based on resection with either a primary anastomosis or a temporary colostomy.},
}
@article {pmid10793765,
year = {1999},
author = {Porzio, S and Rossi, S and Lombardi, V and Milito, G},
title = {[Surgical treatment of complicated diverticular disease of the colon].},
journal = {Chirurgia italiana},
volume = {51},
number = {3},
pages = {199-205},
pmid = {10793765},
issn = {0009-4773},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/surgery ; Diverticulum, Colon/complications/mortality/*surgery ; Emergencies ; Female ; Humans ; Intestinal Perforation/etiology/mortality/surgery ; Male ; Middle Aged ; Peritonitis/etiology/mortality/surgery ; Retrospective Studies ; },
abstract = {The present study analyzes the results obtained by the AA with the different types of surgery adopted in the treatment of the complicated diverticulosis of the colon, highlighting, on the basis of data available in literature, the possible treatments in the different clinical settings. A retrospective study analyzing type of complication, the surgical technique adopted, Hinchey stage, mortality and morbidity rates and average hospital stay correlated with the kind of intervention has been carried out on 83 surgical interventions performed between 1984 and 1988. The results show that 43 R.A.P. (R.A.P. = primitive anastomosis resection) (32 cases at the I-II stage and 11 cases at the III-IV stage), 27 Hartmann (11 at the I-II and 16 at the III-IV), 9 colostomies (2 at the I-II and 7 at the III-IV), 2 esteriorizations and 2 simple drains have been carried out on a total of 44 intestinal perforations, 16 recurrent diverticulitis, 13 intestinal occlusions, 2 fistulae, 5 abscesses and 3 hemorrhages. The total mortality rate amounts to 10.6%; the morbidity rate of the R.A.P. interventions to 14.4 (I-II stage-related morbidity = 15.6%, III-IV stage = 63.6%), Hartmann's to 9.6% and that of the colostomies to 3.6%. Furthermore, in this work, we have considered the cases of riconversation after Hartmann interventions (9 cases): in the second operations the mortality and morbility rate amounts to 0 and the hospital stay to 9 days. The AA analyze on the surgical technique adopted in the different cases and the of choice criteria. According to the data obtained and to current literature, it results that the primitive anastomosis resection represents the first choice intervention at the I-II stage, although, in selected cases, it can be carried out also at the III-IV stage. Hartmann surgery confirms its effectiveness while simple colostomy is no longer accepted in literature.},
}
@article {pmid10779060,
year = {2000},
author = {Isbister, WH},
title = {Study populations and casemix: influence on analysis of postoperative outcomes.},
journal = {The Australian and New Zealand journal of surgery},
volume = {70},
number = {4},
pages = {279-284},
doi = {10.1046/j.1440-1622.2000.01807.x},
pmid = {10779060},
issn = {0004-8682},
mesh = {Adult ; Colonic Diseases/*surgery ; *Diagnosis-Related Groups ; Digestive System Surgical Procedures ; Female ; Humans ; Male ; Middle Aged ; New Zealand ; Postoperative Complications ; Rectal Diseases/*surgery ; Rectal Neoplasms/surgery ; Saudi Arabia ; Treatment Outcome ; },
abstract = {BACKGROUND: The importance of patient casemix as a determinant of surgical outcome is now being recognized. The present study was undertaken in order to compare the presentation and outcomes in colorectal patients managed surgically by the same surgeon, in the same way, in different settings.
METHODS: Colorectal outcome data from the University Department of Surgery in Wellington and the King Faisal Specialist Hospital in Riyadh were analysed in order to determine casemix differences between the two hospitals. Data relating to the type of surgery, the surgeon, the patient's disease, the operation performed and the postoperative complications were compared. Specific colorectal clinical indicators were compared for two commonly performed operations for rectal cancer: anterior resection and abdomino-perineal resection of the rectum.
RESULTS: Wellington patients were slightly older and there were more females. Emergency surgery was more frequent in Wellington. Left hemicolectomy, sigmoid colectomy, abscess drainage and pilonidal surgery were more common in Wellington whereas abdomino-perineal resection and anterior resection of the rectum, stoma closure, fistula surgery, seton insertion, restorative proctocolectomy and ileostomy were undertaken more frequently in Riyadh. More complex anal fistulas were managed in Riyadh. Condylomata accuminata, pilonidal abscess, anorectal abscess, rectal prolapse and diverticular disease were rarely seen in Riyadh. There were more postoperative pulmonary and cardiac complications in Wellington. Patients having anterior resection of the rectum were younger in Riyadh and there were proportionally more females. There were some obvious numerical outcome differences in postoperative atelectasis, wound infection, anastomotic leak and deep vein thrombosis rates but none of these reached statistical significance except atelectasis. In Riyadh the usual male-to-female ratio of patients undergoing abdomino-perineal resection was reversed but, again, none of the numerical outcome differences observed reached statistical significance except postoperative atelectasis and intraabdominal abscess.
CONCLUSION: Although not statistically significant, the results of the present study suggest that when the same surgeon operates using the same technique in different communities, the outcomes may be different. Care should thus be taken when comparing different populations with different casemixes before definitive conclusions are made in comparative studies.},
}
@article {pmid10775276,
year = {2000},
author = {Hart, AR and Kennedy, HJ and Day, NE},
title = {Beyond Burkitt--is diverticular disease more than just cereal fibre deficiency?.},
journal = {Postgraduate medical journal},
volume = {76},
number = {895},
pages = {257-258},
doi = {10.1136/pmj.76.895.257},
pmid = {10775276},
issn = {0032-5473},
mesh = {Aged ; Dietary Fiber/*deficiency ; Diverticulum/epidemiology/*etiology ; *Edible Grain ; Feeding Behavior ; Fruit ; Humans ; Meat Products/*adverse effects ; Middle Aged ; Vegetables ; },
}
@article {pmid10768708,
year = {2000},
author = {Tamim, WZ and Ghellai, A and Counihan, TC and Swanson, RS and Colby, JM and Sweeney, WB},
title = {Experience with endoluminal colonic wall stents for the management of large bowel obstruction for benign and malignant disease.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {135},
number = {4},
pages = {434-438},
doi = {10.1001/archsurg.135.4.434},
pmid = {10768708},
issn = {0004-0010},
mesh = {Adult ; Aged ; Aged, 80 and over ; Endoscopy ; Female ; Humans ; Intestinal Neoplasms/*complications ; Intestinal Obstruction/etiology/*therapy ; Male ; Middle Aged ; *Stents ; Treatment Outcome ; },
abstract = {HYPOTHESIS: To assess the applicability and efficacy of endoluminal colonic wall stents (ECWSs) in the management of large bowel obstruction (LBO).
DESIGN: Inception cohort study.
SETTING: University-based tertiary medical center.
PATIENTS: Eleven consecutive patients with LBO in the absence of peritonitis.
INTERVENTION: Placement of ECWS under endoscopic and fluoroscopic guidance.
MAIN OUTCOME MEASURES: The success rate in ECWS placement, the efficacy in decompressing the obstruction, and the patency rate of the ECWS.
RESULTS: Successful placement of ECWSs was obtainable in 10 of 11 patients. Once placed, all 10 patients achieved immediate decompression of their LBO. Eight patients had malignant obstructions associated with distant spread of disease; 3 patients had diverticular disease. Among those with malignant obstruction, 6 patients had successful and lasting palliation without colostomy, 1 patient underwent 1-stage resection 1 month later with no evidence of obstruction, and 1 patient could not be stented so diversion was done. None of the patients with diverticular disease required diversion: 2 had complete bowel preparation followed by resection with primary anastomosis, whereas the third declined surgery. Four of the 10 patients required overlapping ECWSs to bridge the stricture. One patient required a second ECWS secondary to recurrence of obstruction after stent migration and has continued palliation of his stage 4 rectal cancer for the last 11 months. No other complications were encountered.
CONCLUSIONS: Urgent surgery with colostomy for LBO was avoided in 10 of 11 patients because of successful placement of ECWSs. We believe that endoscopic colonic stenting is safe, effective, and lasting, and should be considered as initial nonoperative management in all patients seen with LBO in the absence of peritonitis.},
}
@article {pmid10738610,
year = {1999},
author = {Pugliese, R and Di Lernia, S and Scandroglio, I and Maggioni, D},
title = {[Laparoscopic treatment of complicated colonic diverticulosis].},
journal = {Chirurgia italiana},
volume = {51},
number = {5},
pages = {367-375},
pmid = {10738610},
issn = {0009-4773},
mesh = {Aged ; Colonic Diseases/*complications/*surgery ; Diverticulum/*complications/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Severity of Illness Index ; },
abstract = {Despite certain controversies over applying a laparoscopic approach to neoplastic pathologies of the colorectum, it seems to be an ideal form of treatment for benign lesions. The Authors have analysed the results of videolaparoscopic treatment in 23 cases of complicated diverticular disease of the colon using their experience of 205 mininvasive colonic operations. Age, sex, diagnosis, time morbidity and type of intervention such as intra and postoperative, length of hospital stay and the parameters that characterise it (length of nasogastric probe, canalisation and restoration of feeding) were the variables considered in both absolute and comparative methods among the various stages of the disease. The aim was to find the best possible treatment. Out of the 23 patients in the study group, immediate recanalisation was impossible in only one case and all interventions were performed according to the predicted video-assisted technique. A partial ureteral lesion was the only single intraoperatory complication found and was intraoperatively repaired by means of transureteral endoscopy. In three cases non specific complication were encountered. The average length of the intervention was 180 minutes, nasogastric tube was taken 3 days, patients passed and start to feed at the 3rd and 4th postoperative day. These data overlap in the various stages of the disease. An adequate preoperatory study and good experience in major laparoscopic interventions resulted in the common difficulties that surgeons might encounter in this pathology to be overcome. We can therefore conclude that based on our results as well as those found in the literature, diverticular disease can ideally be treated with mininvasive surgery.},
}
@article {pmid10730574,
year = {1999},
author = {Meuwissen, SG and Vandenbroucke-Grauls, CM and Geboes, K},
title = {Spectrum of acute self-limiting colitis: role of the clinician and pathologist.},
journal = {Italian journal of gastroenterology and hepatology},
volume = {31},
number = {8},
pages = {807-816},
pmid = {10730574},
issn = {1125-8055},
mesh = {Acute Disease ; Colitis/*diagnosis/etiology/microbiology/pathology ; Diagnosis, Differential ; Humans ; },
abstract = {Acute self-limited colitis encompasses several diagnostic possibilities such as infectious colitis, post-antibiotic colitis, drug-induced colitis and should be differentiated from acute forms of inflammatory bowel disease. Diverticular disease in the elderly patient with colonic ischaemia may also give symptoms of acute bloody mucoid rectal discharge and should be recognised, although the clinical picture is usually completely different. Recognition of the causative agent--if possible--is particularly important in the patient with a foudroyant colitis (e.g. toxic megacolon), when the clinician has to decide, whether antibiotics or corticosteroids should be given or even a resection should be performed. A short history usually indicates towards infection, but a long-standing history of inflammatory bowel disease may be complicated by a superinfection. Faecal cultures, endoscopy with colonic biopsy should be performed and results be discussed. New techniques for the assessment and follow up of difficult cases are: white cell scintigraphy, computerized tomography scanning and magnetic resonance imaging scanning. Acute self-limited colitis can usually be classified properly and treated accordingly. This review discusses the role to be played by the clinician, microbiologist and pathologist and is illustrated by several clinical examples, in which patients presented with unusual forms of acute self-limited colitis.},
}
@article {pmid10719724,
year = {2000},
author = {Hardingham, JE and Hewett, PJ and Sage, RE and Finch, JL and Nuttall, JD and Kotasek, D and Dobrovic, A},
title = {Molecular detection of blood-borne epithelial cells in colorectal cancer patients and in patients with benign bowel disease.},
journal = {International journal of cancer},
volume = {89},
number = {1},
pages = {8-13},
pmid = {10719724},
issn = {0020-7136},
mesh = {Adenoma/blood ; Adult ; Aged ; Aged, 80 and over ; Biomarkers/analysis ; Colorectal Neoplasms/*blood/metabolism/surgery ; *Epithelial Cells/cytology ; Humans ; Immunomagnetic Separation ; Inflammatory Bowel Diseases/blood ; Intestinal Diseases/*blood/surgery ; Intestinal Mucosa/*cytology ; Middle Aged ; *Neoplastic Cells, Circulating ; Reverse Transcriptase Polymerase Chain Reaction ; Survival Analysis ; Tumor Cells, Cultured ; },
abstract = {In colorectal cancer (CRC), a proportion of patients with early stage disease still die of metastatic or recurrent disease within 5 years of "curative" resection. Detection of carcinoma cells in the peripheral circulation at presentation may identify a subgroup of patients with micro-metastatic disease who may benefit from adjuvant chemotherapy or radiotherapy. Our aim was to determine the presence and clinical significance of colon carcinoma cells in peripheral blood at the time of surgery. Preoperative peripheral blood samples were collected from 94 patients with CRC and 64 patients undergoing bowel resection for benign conditions (adenoma, diverticular disease or Crohn's colitis). Blood was also obtained from 20 normal donors not undergoing bowel surgery. Immunomagnetic beads were used to isolate epithelial cells followed by reverse transcription-polymerase chain reaction (RT-PCR) analysis of expression of cytokeratin (CK) 19, CK 20, mucin (MUC) 1 and MUC 2. Nineteen of 94 (20%) CRC patients were positive for epithelial cells in preoperative blood, including 6 with early stage disease. Kaplan-Meier survival analysis showed that detection of epithelial cells in preoperative blood was associated with reduced disease-free and overall survival (log-rank test, p = 0.0001). Surprisingly, circulating epithelial cells were detected in 3/30 (10%) patients resected for adenoma, and in 4/34 (12%) patients resected for benign inflammatory conditions, suggesting that cells from nonmalignant colonic epithelium may also gain entry into the bloodstream in the presence of bowel pathology. All 20 normal control bloods were negative for epithelial cells.},
}
@article {pmid10695753,
year = {2000},
author = {Lederman, ED and McCoy, G and Conti, DJ and Lee, EC},
title = {Diverticulitis and polycystic kidney disease.},
journal = {The American surgeon},
volume = {66},
number = {2},
pages = {200-203},
pmid = {10695753},
issn = {0003-1348},
mesh = {Case-Control Studies ; Diverticulitis, Colonic/*epidemiology/etiology ; Female ; Humans ; Incidence ; Kidney Failure, Chronic/epidemiology/etiology/surgery ; *Kidney Transplantation ; Male ; Middle Aged ; Polycystic Kidney Diseases/complications/epidemiology/*surgery ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; },
abstract = {Patients with adult polycystic kidney disease (PKD) have previously been shown to have an increased incidence of complicated diverticulitis after renal transplantation. The purpose of this study was to assess the risk of diverticulitis in the PKD population. We retrospectively reviewed patients with advanced PKD, defined as end-stage renal failure requiring dialysis. Patients were obtained from a single nephrology group practice between January 1985 and January 1997, or from all patients being evaluated or actively considered for renal transplantation at our institution as of May 1997. The incidence and severity of diverticulitis in these patients was compared with that observed in a similar cohort of patients with end-stage renal disease due to other etiologies. The study population consisted of 184 renal failure patients, 59 with PKD and 125 with other causes of end-stage renal disease. Twelve (20%) patients with PKD had a history of active diverticulitis, whereas only 4 (3%) of the non-PKD controls had diverticulitis (P = 0.0003, Fisher's exact test). Six of the 12 PKD patients required surgical intervention. Patients with renal failure due to PKD experience a significantly higher rate of diverticulitis than do other patients with end-stage renal disease. Furthermore, diverticulitis is frequently severe in PKD patients, with 50 per cent requiring surgical intervention. These data suggest that diverticular disease may be an extrarenal manifestation of polycystic kidney disease.},
}
@article {pmid10695745,
year = {2000},
author = {Wolff, BG and Devine, RM},
title = {Surgical management of diverticulitis.},
journal = {The American surgeon},
volume = {66},
number = {2},
pages = {153-156},
pmid = {10695745},
issn = {0003-1348},
mesh = {Colon, Sigmoid/surgery ; Diverticulitis, Colonic/complications/*surgery ; Humans ; Sigmoid Diseases/complications/*surgery ; },
abstract = {Diverticular disease, and particularly diverticulitis, has an increasing incidence in Westernized countries because of low-fiber diet. Diverticular disease may be classified as asymptomatic, atypical, acute or uncomplicated, and complicated. Conservative or medical management is usually indicated for acute or uncomplicated diverticulitis, with elective surgical resection generally being recommended after two documented episodes. Complicated diverticulitis, because of the high rate of recurrent problems, is generally managed promptly with sigmoid resection. Sigmoid resection for diverticulitis, under appropriate circumstances, has one of the highest success rates of any of the common gastrointestinal procedures.},
}
@article {pmid10690606,
year = {2000},
author = {Chiu, EJ and Shyr, YM and Su, CH and Wu, CW and Lui, WY},
title = {Diverticular disease of the small bowel.},
journal = {Hepato-gastroenterology},
volume = {47},
number = {31},
pages = {181-184},
pmid = {10690606},
issn = {0172-6390},
mesh = {Abdominal Pain/etiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Child ; Child, Preschool ; Diverticulum/diagnosis/*pathology/surgery ; Duodenal Diseases/diagnosis/pathology/surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Infant ; Intestine, Small/*pathology/surgery ; Jejunal Diseases/diagnosis/pathology/surgery ; Male ; Meckel Diverticulum/diagnosis/*pathology/surgery ; Middle Aged ; Postoperative Complications ; },
abstract = {BACKGROUND/AIMS: The clinical picture of small bowel diverticula has not been well-clarified because of its infrequent incidence and limited case number in most published reports. We evaluated a large series of small bowel diverticula and further compared the clinical picture of the diverticula at different parts of small bowel.
METHODOLOGY: The medical records of 88 patients with diverticular disease of the small bowel were reviewed from 1979-1997. This study included all diverticula from duodenum to ileum.
RESULTS: The most common small bowel diverticulum was duodenal diverticulum (45%), followed by Meckel's diverticulum (23%). The most common clinical presentation was abdominal pain (48.9%), followed by gastrointestinal bleeding (29.5%). However, among the Meckel's diverticula, gastrointestinal bleeding (60%) was the most common presentation. The accurate diagnostic rate for diverticula, overall, was 25.0%. Thirty-nine (44.3%) of the diverticula were found incidentally. Twenty-three cases (26.1%) were diagnosed by gastrointestinal barium study. Thirty-eight (42.1%) diverticula were left alone without any sequela, and the remaining 55 (56.8%) diverticula needed either bowel resection (30.7%) or diverticulectomy (26.1%). All of the Meckel's diverticula were treated by surgery. Postoperative complication occurred in 9 (10.3%) patients. Hospital mortality rate was 3.4%.
CONCLUSIONS: Duodenal diverticulum was the most common small bowel diverticulum. Abdominal pain and gastrointestinal bleeding were the most common clinical presentations. The small bowel diverticula, except for Meckel's diverticulum, did not need to be treated if there were no significant symptoms.},
}
@article {pmid10672772,
year = {1999},
author = {Closset, J},
title = {[Digestive emergencies of elderly patients].},
journal = {Revue medicale de Bruxelles},
volume = {20},
number = {6},
pages = {491-493},
pmid = {10672772},
issn = {0035-3639},
mesh = {Abdomen, Acute/*diagnosis/surgery ; Aged ; Appendicitis/diagnosis/surgery ; Cholecystitis/diagnosis/surgery ; Cholelithiasis/diagnosis/surgery ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis/surgery ; Hernia, Inguinal/diagnosis/surgery ; Humans ; Intestinal Obstruction/diagnosis/surgery ; Intestine, Small/blood supply ; Ischemia/diagnosis/surgery ; Mesenteric Vascular Occlusion/diagnosis/surgery ; Peptic Ulcer/diagnosis/surgery ; },
abstract = {Evaluation of an elderly patient with acute abdominal conditions presents a challenge to the physician on account of the general poverty of history and clinical signs and the poor reliability of diagnostic procedures. The management of these pathologies are analyzed: cholecystitis, appendicitis, incarcerated hernia, small bowel obstruction, côlonic diverticular disease, intestinal ischemia and gastroduodenal ulcer. An early elective treatment of chronic pathologies like gallstones, hernias and intestinal ischemia trends to avoid complications.},
}
@article {pmid10671931,
year = {2000},
author = {Watts, AM and Thompson, MR},
title = {Evaluation of Delorme's procedure as a treatment for full-thickness rectal prolapse.},
journal = {The British journal of surgery},
volume = {87},
number = {2},
pages = {218-222},
doi = {10.1046/j.1365-2168.2000.01342.x},
pmid = {10671931},
issn = {0007-1323},
mesh = {Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures/*methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Care ; Prognosis ; Rectal Prolapse/physiopathology/*surgery ; Recurrence ; Risk Factors ; },
abstract = {BACKGROUND: Delorme's procedure is a well tolerated perineal operation for full-thickness rectal prolapse. However, prolapse recurrence is common and reported recurrence rates vary widely. This study attempted to standardize outcome assessment for recurrence following primary and subsequent Delorme's operations. Patient and operative factors were analysed to identify any that might improve patient selection.
METHODS: Some 101 primary and 17 secondary Delorme's procedures were carried out on 113 consecutive patients presenting with rectal prolapse, who were followed for a minimum of 12 months, unless death or recurrent prolapse intervened. The rate of prolapse recurrence was calculated using the Kaplan-Meier method of analysis. Patient age, sex, grade of incontinence, presence of diverticular disease, length of mucosal resection and position in the operative series were analysed to identify factors affecting recurrence.
RESULTS: The predicted recurrence-free period for 50 per cent of patients undergoing primary and secondary Delorme's procedures was 91 (95 per cent confidence interval 77-105) and 27 (15-39) months respectively. None of the patient or operative factors analysed was related to recurrent prolapse.
CONCLUSION: Delorme's procedure is a simple operation with satisfactory functional results which can be considered in all patients of all ages. However, high recurrence rates for primary and repeat operations should be explained to patients when planning their surgical management.},
}
@article {pmid10670154,
year = {1999},
author = {Boulez, J and Blanchet, MC and Espalieu, P},
title = {[Colonic diverticulosis and laparoscopy. Analysis of a series of 60 cases].},
journal = {Annales de chirurgie},
volume = {53},
number = {10},
pages = {1033-1038},
pmid = {10670154},
issn = {0003-3944},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colectomy ; Colon/surgery ; Colon, Sigmoid/surgery ; Diverticulum, Colon/complications/diagnosis/*surgery ; Female ; Follow-Up Studies ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Postoperative Complications ; Rectum/surgery ; Retrospective Studies ; Time Factors ; },
abstract = {AIM: This is a retrospective analysis of a series of 60 cases diverticular disease.
MATERIAL AND METHOD: From May 1991 to April 1999, 60 laparoscopic colorectal resections were performed for diverticulitis.
RESULTS: Conversion to a classical procedure was necessary in 3 patients (5%). There was no mortality and 9 postoperative complications (3 reoperations). The mean length of hospital stay was 9 days, and 6.3 days for patients in whom surgery was performed after January 1998.
CONCLUSION: Laparoscopic surgery for diverticular disease is associated with acceptable morbidity and mortality rates and a short median postoperative stay.},
}
@article {pmid10670104,
year = {1999},
author = {Nyström, PO and Kald, A},
title = {[Laparoscopic sigmoid resection in diverticulitis].},
journal = {Zentralblatt fur Chirurgie},
volume = {124},
number = {12},
pages = {1147-1151},
pmid = {10670104},
issn = {0044-409X},
mesh = {Colectomy/methods ; Colon, Sigmoid/surgery ; Diverticulitis/*complications/pathology/surgery ; Humans ; *Laparoscopy ; Peritonitis/*etiology/pathology/surgery ; Sigmoid Diseases/*etiology/pathology/surgery ; },
abstract = {It is still difficult to determine the exact indication for a laparoscopic sigmoid resection for diverticular disease. Frequently, the severity of diverticulitis is not sufficiently defined. For this reason a modification of the Hinchey classification is proposed to which a stage II b for fistula formation and a differentiation between acute and chronic disease have been added. Another problem is the lack of criteria which define a "laparoscopic" resection. A sigmoid resection should be called "laparoscopic" if the mobilization of the sigmoid colon, the transsection of the mesenteric vein and artery and the mesentery itself and the distal transsection of the bowel are done laparoscopically. The resection of the bowel and the introduction of the anvil of the stapler device can be done extraabdominally, however, the anastomosis again should be performed laparoscopi-cally. A so defined sigmoid resection can be done in the chronic stage I. In the chronic stage II a there will be significant problems due to adhesion formation, and in the acute stages II a and II b as well as in the chronic stage II b a laparoscopic resection should not be attempted.},
}
@article {pmid10653074,
year = {2000},
author = {Place, RJ and Simmang, CL and Huber, PJ},
title = {Appendiceal diverticulitis.},
journal = {Southern medical journal},
volume = {93},
number = {1},
pages = {76-79},
pmid = {10653074},
issn = {0038-4348},
mesh = {Appendectomy ; *Appendix ; Cecal Diseases/*diagnosis/pathology/surgery ; Diverticulitis/*diagnosis/pathology/surgery ; Humans ; Male ; Middle Aged ; },
abstract = {We report the case of a 56-year-old man with episodic right lower quadrant abdominal pain. Preoperative evaluation included computed tomography (CT) showing a right lower quadrant phlegmon consistent with cecal diverticulitis or appendicitis. The patient was treated with a short course of bowel rest and antibiotics. Four weeks later, he had an appendectomy. The patient was found to have chronic appendiceal diverticulitis and recovered uneventfully. Histopathologic studies revealed herniated mucosa through the muscular layer associated with chronic inflammation and marked fibrosis. These findings represent appendiceal diverticulitis. Diverticulosis of the appendix is believed to be uncommon and roentgenologic diagnosis of appendiceal diverticular disease is rarely made. We discuss the diagnosis and CT findings of appendiceal diverticulitis and present a thorough review of the literature.},
}
@article {pmid10647635,
year = {1999},
author = {Reisman, Y and Ziv, Y and Kravrovitc, D and Negri, M and Wolloch, Y and Halevy, A},
title = {Diverticulitis: the effect of age and location on the course of disease.},
journal = {International journal of colorectal disease},
volume = {14},
number = {4-5},
pages = {250-254},
doi = {10.1007/s003840050219},
pmid = {10647635},
issn = {0179-1958},
mesh = {Adult ; Age Factors ; Aged ; Disease Progression ; Diverticulitis, Colonic/classification/*pathology/surgery/therapy ; Female ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Time Factors ; },
abstract = {To examine the effect of patient's age and the location of diverticular disease on the course of the acute disease we retrospectively collected demographic data, symptoms, laboratory findings, imaging techniques, type of treatment (conservative vs. surgical), early and late complications, and follow-up data on 119 patients with acute diverticulitis (74 women, 45 men; mean age 64+/-14 years; follow-up 7-102 months, median 40). Patients were divided by their age into two groups (42 aged 60 years or younger, 77 aged over 60) and on the location of their disease (108 to the left of the middle transverse, 11 to the right). Lower abdominal pain, abdominal tenderness, and fever were the most common complaints (70-97%). In the younger patients we found a significantly greater preponderance in the right colon (P = 0.02) than in older patients. Abdominal abscesses and fistulas were more common in right-sided diverticulitis (P = 0.01). Patients with right-sided colon diverticulitis were treated surgically (82%) and on an emergency basis more often than patients with left-side colon diverticulitis (25%; P = 0.001). Older patients treated conservatively suffered more than younger patients (61% and 33% respectively; P = 0.04) from recurrent abdominal pain but not from recurrent, confirmed diverticulitis. Patients with right-sided diverticulitis treated conservatively suffered more from recurrent diverticulitis episodes than patients with left-sided diverticulitis (P = 0.05). Younger patients thus do not have a more aggressive form of diverticulitis than older patients. Patients with acute diverticulitis in the right colon are likely to be operated earlier and for mistaken diagnoses than patients with left-sided diverticulitis.},
}
@article {pmid10633835,
year = {1999},
author = {D'Abbicco, D and Amoruso, M and Notarnicola, A and Margari, A and Bonomo, GM},
title = {[The indications and surgical treatment in the complications of colonic diverticular disease].},
journal = {Chirurgia italiana},
volume = {51},
number = {4},
pages = {277-282},
pmid = {10633835},
issn = {0009-4773},
mesh = {Aged ; Anastomosis, Surgical ; Colectomy ; Colostomy ; Diverticulum, Colon/*complications/*surgery ; Emergencies ; Female ; Humans ; Male ; Postoperative Complications/epidemiology ; },
abstract = {In this work the authors describe the different stages of diverticulosis and analyze the pathogenetic principal factors. During the period from 1979 to 1998 they observed 420 patients affected by diverticular disease (224 M; 196 F), 42 (10%) of them were operated on for complications. Fifteen patients operated on in elective time underwent a one stage procedure of resection and anastomosis with derivative colostomy; 27 patients were operated on in emergency: 6 patients had one stage procedure of resection and anastomosis with derivative colostomy, 16 patients Hartmann's procedure, 3 patients Mikulicz's procedure and 2 patients colostomy and peritoneal drainage. Two patients died from septic shock. There was absence of postoperative complications for the patients operated on in elective time, while 8 cases (29.6%) showed peritoneal sepsis and 4 cases (14.8%) infection of wound in the patients operated on in emergency. The Authors describe the different surgical options in the treatment of colonic complicated diverticular disease and conclude that the surgical treatment is not definite. A tendency is to make a one-stage procedure of resection and anastomosis and to reduce the Hartmann's procedure or the simple colostomy with drainage of abdominal cavity.},
}
@article {pmid10597057,
year = {1999},
author = {Lahr, SJ and Lahr, CJ and Srinivasan, A and Clerico, ET and Limehouse, VM and Serbezov, IK},
title = {Operative management of severe constipation.},
journal = {The American surgeon},
volume = {65},
number = {12},
pages = {1117-21; discussion 1122-3},
pmid = {10597057},
issn = {0003-1348},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects ; Child ; Cineradiography ; Colectomy ; Colon, Sigmoid/surgery ; Colonic Diseases, Functional/classification/complications/surgery ; Constipation/diagnosis/etiology/physiopathology/*surgery ; Female ; Fluoroscopy ; Follow-Up Studies ; Hernia, Hiatal/classification/complications/surgery ; Humans ; Ileostomy ; Ileum/surgery ; Male ; Middle Aged ; Patient Satisfaction ; Polytetrafluoroethylene ; Postoperative Complications ; Rectum/surgery ; Risk Factors ; Surgical Mesh ; Treatment Outcome ; Vagina/surgery ; },
abstract = {This report investigates the concept that severe constipation requiring major abdominal surgery may result from one of three common causes: 1) colonic inertia, 2) pelvic hiatal hernia, or 3) both colonic inertia and pelvic hernia. This study evaluates the symptoms, anatomy and outcome in 201 patients with severe surgical constipation treated by a single surgeon. In 2042 patients with constipation referred to one colon and rectal surgeon, 211 major abdominal surgical procedures were performed on 201 patients for severe constipation between 1989 and 1999. There were 187 women and 14 men. Mean age was 49 years (range, 9-84). Five high-risk patients had ileostomy; 196 had major colonic surgery for anatomic or physiologic causes of constipation, excluding malignancy, diverticular disease, and inflammatory bowel disease. Pelvic hiatal hernia was defined as the herniation of bowel through the hiatus of the pelvic diaphragm seen on pelvic videofluoroscopy or physical examination. Of these 196 patients, 44 per cent had pelvic hiatal hernia repair (PHHR), 27 per cent had total abdominal colectomy and ileorectal anastomosis for colonic inertia, and 29 per cent had surgery for both colonic inertia and pelvic hiatal hernia. Of the 144 patients undergoing PHHR, 95 had Gore-Tex patch (W. L. Gore and Associates, Inc., Phoenix, AZ) sacral colpopexy. PHHR for pelvic hiatal hernia without colonic inertia included sigmoid resection, rectopexy, and Gore-Tex patch sacral colpopexy. Mean duration of follow-up was 20 months. Symptoms noted preoperatively included abdominal pain (84%), straining at stool (90%), incomplete rectal emptying (85%), painful bowel movements (74%), pelvic pain (69%), vaginal bulge (55%), digital assistance with evacuation (35%), and incontinence of stool (38%). Outcome assessed by symptom relief was successful in 89.1 per cent of patients. 8.6 per cent of patient conditions were unchanged, and 2.3 per cent were unsatisfied with the outcome. There were no postoperative deaths. The complication rate was 6.1 per cent (small bowel obstruction, 7; anastomotic leak, 2; ureteral stenosis, 2; and patch erosion, 1). In our experience, severe surgical constipation can be due to colonic inertia, pelvic hiatal hernia, or both. Careful preoperative evaluation identifies these disorders, and surgical therapy aimed at correction of anatomic and physiologic defects results in high patient satisfaction and improvement in bowel function.},
}
@article {pmid10540589,
year = {1999},
author = {Arendt, J and Sieroń, A and Skrzydło, M and Martula, W},
title = {[Sigmoid-vesical fistula in the course of long-term conservative treatment for recurrent sigmoid diverticulitis].},
journal = {Wiadomosci lekarskie (Warsaw, Poland : 1960)},
volume = {52},
number = {7-8},
pages = {409-412},
pmid = {10540589},
issn = {0043-5147},
mesh = {Diverticulitis/*surgery ; Humans ; Long-Term Care ; Male ; Middle Aged ; Recurrence ; Sigmoid Diseases/*surgery ; Urinary Bladder Fistula/*surgery ; },
abstract = {The authors describe a case of sigmoidovesical fistula developed in a man with sigmoid diverticular disease. Appropriate surgical procedure has been done thanks to proper diagnosis. In authors' opinion early operation performing is the best therapy of colon diverticulitis even if a patient suffer from other serious disorders.},
}
@article {pmid10576357,
year = {1999},
author = {Tomita, R and Tanjoh, K and Fujisaki, S and Fukuzawa, M},
title = {Physiological studies on nitric oxide in the right sided colon of patients with diverticular disease.},
journal = {Hepato-gastroenterology},
volume = {46},
number = {29},
pages = {2839-2844},
pmid = {10576357},
issn = {0172-6390},
mesh = {Adrenergic Fibers/physiology ; Adult ; Aged ; Cholinergic Fibers/physiology ; Colon/innervation ; Diverticulum, Colon/*physiopathology/surgery ; Enteric Nervous System/physiopathology ; Female ; Humans ; Male ; Middle Aged ; Neural Inhibition/physiology ; Nitric Oxide/*physiology ; Reference Values ; },
abstract = {BACKGROUND/AIMS: Previously, we reported that non-adrenergic non-cholinergic (NANC) inhibitory nerves are decreased in the left-sided colon of patients with diverticular disease, contributing to their intraluminal high pressure by segmentation (1). It is established that nitric oxide (NO) is released by stimulation of NANC inhibitory nerves. Among Oriental people, including the Japanese, right-sided diverticular disease has predominated more frequently than among Western people. In order to evaluate the function of NO in the right-sided colon of patients with diverticular disease, we examined the enteric nerve responses in colonic materials from patients with this disease, using the right-sided normal colon as a control.
METHODOLOGY: Colonic tissue specimens were obtained from 8 patients with diverticular disease of the right-sided colon, and normal segments of the right-sided colon were obtained from 11 patients with localized diseases. A mechanograph was used to evaluate in vitro colonic responses to electrical field stimulation (EFS) of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, N(G)-nitro-L-arginine (L-NNA), and L-arginine.
RESULTS: 1) Cholinergic nerves were more dominant in the diverticular colon than in the normal colon (p<0.01). 2) NANC inhibitory nerves were found to act on the normal colon and to a lesser extent in the diverticular colon (p<0.05). 3) NO mediates the relaxation reaction of NANC inhibitory nerves in the normal colon and to a lesser extent in the diverticular colon.
CONCLUSIONS: The intrinsic intestinal innervation contains excitatory and inhibitory nerves and the former, especially cholinergic nerves, are dominant in the right-sided colon with diverticula. In addition, reduction of the action of NANC inhibitory nerves by substances such as NO may be largely related to the tight intraluminal pressure by colonic segmentation observed in the right-sided colon with diverticula.},
}
@article {pmid10566700,
year = {1999},
author = {Stollman, NH and Raskin, JB},
title = {Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology.},
journal = {The American journal of gastroenterology},
volume = {94},
number = {11},
pages = {3110-3121},
doi = {10.1111/j.1572-0241.1999.01501.x},
pmid = {10566700},
issn = {0002-9270},
mesh = {Abscess/diagnosis/therapy ; Adult ; Anti-Bacterial Agents/therapeutic use ; Diagnostic Imaging ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/classification/diagnosis/therapy ; Diverticulum, Colon/*diagnosis/etiology/prevention & control/therapy ; Gastrointestinal Hemorrhage/diagnosis/therapy ; Humans ; Intestinal Fistula/diagnosis/therapy ; Intestinal Obstruction/diagnosis/therapy ; Treatment Outcome ; },
}
@article {pmid10561142,
year = {1999},
author = {Sharp, CK and Zeligman, BE and Johnson, AM and Duley, I and Gabow, PA},
title = {Evaluation of colonic diverticular disease in autosomal dominant polycystic kidney disease without end-stage renal disease.},
journal = {American journal of kidney diseases : the official journal of the National Kidney Foundation},
volume = {34},
number = {5},
pages = {863-868},
doi = {10.1016/S0272-6386(99)70043-0},
pmid = {10561142},
issn = {0272-6386},
support = {DK34309/DK/NIDDK NIH HHS/United States ; MORR-00051/OR/ORS NIH HHS/United States ; },
mesh = {Diverticulum, Colon/diagnosis/*genetics ; Female ; Genetic Predisposition to Disease/genetics ; Humans ; Intestinal Perforation/genetics ; Kidney Failure, Chronic/diagnosis/*genetics ; Kidney Function Tests ; Male ; Middle Aged ; Polycystic Kidney, Autosomal Dominant/diagnosis/*genetics ; Risk Factors ; },
abstract = {A previous study had shown an increased prevalence (83%) of diverticula among patients with autosomal dominant polycystic kidney disease (ADPKD) with end-stage renal disease (ESRD) compared with other ESRD patients without ADPKD (32%). Others have also suggested an increased risk for diverticular complications in renal transplant recipients with ADPKD. To determine whether there was an increased occurrence of diverticula among non-ESRD patients with ADPKD, we studied 55 patients with ADPKD who were not receiving renal replacement therapy compared with 12 unaffected family members (non-ADPKD) and 59 random patients who had undergone barium enemas (control [C]). No study patient had a history of diverticular disease. All patients underwent a double-contrast barium enema after administration of glucagon. The occurrence, number, location, and size of diverticula were noted. There was no significant difference among the three groups in regard to sex (men: ADPKD, 42% versus non-ADPKD, 42% versus C, 37%) or age (ADPKD, 49.3 +/- 0.7 versus non-ADPKD, 51.2 +/- 2.1 versus C, 49 +/- 1 years). There was no significant difference in the percentage of patients with diverticula (ADPKD, 47% versus non-ADPKD, 58% versus C, 59%), the percentage with only right-colon diverticula (ADPKD, 5% versus non-ADPKD, 17% versus C, 5%), the mean number of diverticula in patients with diverticulosis (ADPKD, 13.8 versus non-ADPKD, 7.9 versus C, 9.9 diverticula), or the size of the largest diverticula (ADPKD, 9.5 versus non-ADPKD, 10.4 versus C, 10.5 mm). There was no significant difference in these variables between the patients with ADPKD with a creatinine clearance greater than 70 mL/min/1.73 m(2) (n = 25) or less than 70 mL/min/1.73 m(2). This study does not show the greater prevalence of diverticular disease in non-ESRD patients with ADPKD compared with the general population. Thus, patients with ADPKD need not be considered at greater risk for diverticular disease than the general population.},
}
@article {pmid10533783,
year = {1999},
author = {Bromberg, SH and Waisberg, J and Franco, MI and Oliveira, CV and Lopes, RG and Godoy, AC},
title = {Surgical treatment for colorectal endometriosis.},
journal = {International surgery},
volume = {84},
number = {3},
pages = {234-238},
pmid = {10533783},
issn = {0020-8868},
mesh = {Adult ; Colonic Diseases/*surgery ; Endometriosis/*surgery ; Female ; Humans ; Rectal Diseases/*surgery ; Retrospective Studies ; Sigmoid Diseases/surgery ; },
abstract = {The authors studied the surgical treatment of patients with intestinal endometriosis. A total of 10 patients, with a median age range of 43 years, underwent an operation. Cramp abdominal pain (100%), diarrhea (30%), constipation and enterorrhagia (20%) dominated the clinical picture. At the time of surgery, four patients presented intestinal obstructive symptoms. Five (50%) patients reported gynecological complaints. Four patients were infertile and five had prior surgical gynaecological events. Seven cases presented sigmoid involvement, and three had involvement of the cecal appendix. Pre-operative diagnosis was carried out in two patients only. Surgical indications were due to suspicion of cancer (4 patients), appendicitis (3 patients), diverticular disease (1 patient) and unmanageable pain (2 patients). The following procedures were performed: left colectomy (2 cases), rectosigmoidectomy (3 cases), sigmoidectomy (3 cases), colostomy (2 cases) and three appendicectomy cases associated with concomitant gynecological interventions. No postoperative complications or deaths were observed. The authors emphasize that intestinal stenotic lesions should be treated by means of extirpation while the parietal nodule should be treated by exeresis. Intestinal endometriosis should be suspected in cases of lower abdomen recurrent pain in premenopausal infertile women or with previous surgical, gynecological events associated with intestinal symptoms or distal colon stenosis.},
}
@article {pmid10524527,
year = {1999},
author = {Nascimbeni, R and Villanacci, V and Mariani, PP and Di Betta, E and Ghirardi, M and Donato, F and Salerni, B},
title = {Aberrant crypt foci in the human colon: frequency and histologic patterns in patients with colorectal cancer or diverticular disease.},
journal = {The American journal of surgical pathology},
volume = {23},
number = {10},
pages = {1256-1263},
doi = {10.1097/00000478-199910000-00011},
pmid = {10524527},
issn = {0147-5185},
mesh = {Adenoma/complications/*pathology ; Colon/*pathology ; Colorectal Neoplasms/complications/*pathology ; Diverticulum, Colon/complications/*pathology ; Female ; Humans ; Hyperplasia/pathology ; Intestinal Mucosa/*pathology ; Male ; Precancerous Conditions/complications/*pathology ; },
abstract = {Aberrant crypt foci are considered potential markers of colorectal cancer risk. The aim of this study was to analyze a large series of human aberrant crypt foci according to frequency, distribution, and histology. Aberrant crypt foci were identified in methylene blue-stained colonic mucosa from 103 patients undergoing surgery for colorectal cancer or diverticular disease. Foci were histologically classified into surface hyperplastic type, surface and glandular hyperplastic type, mixed hyperplastic and adenomatous type, and adenomatous type. The mean frequency of aberrant crypt foci (n = 720) was higher in the colorectal cancer group (0.20/cm2) than in the diverticular disease group (0.07/cm2), and in distal colonic segments than in proximal segments. Most of the histologically examined foci (n = 366) were hyperplastic (88.8%). Surface hyperplasia accounted for 30.6% and prevailed in small lesions. Surface and glandular hyperplasia accounted for 58.2% and prevailed in medium-sized to large foci. Partially or totally dysplastic foci accounted for 10.1% of examined lesions (10.8% and 2.8% in the colorectal cancer and diverticular disease groups, respectively). Most of them (94.6%) were composed of mixed hyperplastic and adenomatous crypts and prevailed in large lesions. The higher frequency of aberrant crypt foci in patients with colorectal cancer sustains their putative role as preneoplastic markers. The high rate of mixed hyperplastic and adenomatous lesions supports the possible adenomatous transformation of hyperplastic lesions.},
}
@article {pmid10514914,
year = {1999},
author = {Setti Carraro, PG and Magenta, A and Segala, M and Ravizzini, C and Nespoli, A and Tiberio, G},
title = {Predictive value of a pathophysiological score in the surgical treatment of perforated diverticular disease.},
journal = {Chirurgia italiana},
volume = {51},
number = {1},
pages = {31-36},
pmid = {10514914},
issn = {0009-4773},
mesh = {APACHE ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/complications/mortality/*surgery ; Diverticulum, Colon/complications/mortality/*surgery ; Humans ; Intestinal Perforation/etiology/mortality/*surgery ; Middle Aged ; Odds Ratio ; Postoperative Complications ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; },
abstract = {Resection is the preferred method of perforated diverticular disease treatment compared to conservative treatment. However, the immediate or deferred timing of bowel continuity restoration for advanced degrees of peritoneal contamination is debatable. This is a retrospective study designed to identify operative mortality predictors and guidelines for safe primary anastomosis. A pathophysiological score (acute physiology and chronic health evaluation, APACHE II) was applied to 135 consecutive patients who had undergone surgery for acute inflammatory complication of diverticular disease. A multivariate analysis was used to identify prognostic factors such as age, chronic diseases, neoplastic cancer, Acute Physiology Score (APS), Hinchey's classification and APACHE II scores. Seventy patients underwent primary resection and anastomosis, 35 underwent Hartmann's procedure and 15 conservative treatment. There was a significant correlation between operative mortality and increasing disease severity based on Hinchey's classification, APS and APACHE II scores. The multivariate analysis proved APACHE II scores to be the only prognostic factor of operative mortality. Both single and multivariate analysis of variance failed to identify a factor significantly associated with surgical and/or medical postoperative complications. APACHE II scores were the best predictor for operative mortality in patients with diverticular disease complications, but none of the classification criteria used was effective in predicting postoperative complication. Patients with phlegmonous sigmoiditis can be safely treated with primary resection and anastomosis. Conservative treatment should not be considered an effective method for diverticular disease. A prospective trial comparing resection with and without colostomy should be done for local and diffuse purulent peritonitis treatment. Hartmann's procedure is seen to be the only indicator for faecal peritonitis.},
}
@article {pmid10509950,
year = {1999},
author = {Stollman, NH and Raskin, JB},
title = {Diverticular disease of the colon.},
journal = {Journal of clinical gastroenterology},
volume = {29},
number = {3},
pages = {241-252},
doi = {10.1097/00004836-199910000-00004},
pmid = {10509950},
issn = {0192-0790},
mesh = {Diverticulitis/diagnosis/etiology/*prevention & control ; Diverticulum, Colon/complications/*diagnosis/*therapy ; Female ; Gastrointestinal Hemorrhage/etiology/therapy ; Humans ; Male ; Prognosis ; },
abstract = {Diverticular disease of the colon is quite common in developed countries, and its prevalence increases with age. Although present in perhaps two thirds of the elderly population, the large majority of patients will remain entirely asymptomatic. Nonetheless, an estimated 20% of those affected may manifest clinical illness, mainly diverticulitis, with its potential complications of abscesses, fistulas, and obstruction, as well as lower intestinal hemorrhage. The purpose of this report is to review our understanding of the epidemiology, pathophysiology, clinical presentation, and treatment options for this disorder.},
}
@article {pmid10484027,
year = {1999},
author = {Goenka, P and Iqbal, M and Manalo, G and Youngberg, GA and Thomas, E},
title = {Colo-cholecystic fistula: an unusual complication of colonic diverticular disease.},
journal = {The American journal of gastroenterology},
volume = {94},
number = {9},
pages = {2558-2560},
doi = {10.1111/j.1572-0241.1999.01396.x},
pmid = {10484027},
issn = {0002-9270},
mesh = {Aged ; Aged, 80 and over ; Colonic Diseases/*etiology ; Diverticulum, Colon/*complications ; Gallbladder Diseases/*etiology ; Humans ; Intestinal Fistula/*etiology ; Male ; },
abstract = {Colonic diverticular disease can lead to various complications. We describe a case of an 81-yr-old man who was found to have intrabiliary air on computed tomography of the abdomen. Endoscopic retrograde cholangiopancreatography and subsequent surgical exploration of the abdomen revealed an ascending colonic diverticulum penetrating into the gall bladder. Colocholecystic fistula is an unusual cause of intrabiliary air and, to our knowledge, this has not been reported in the literature.},
}
@article {pmid10466879,
year = {1999},
author = {Huizinga, JD and Waterfall, WE and Stern, HS},
title = {Abnormal response to cholinergic stimulation in the circular muscle layer of the human colon in diverticular disease.},
journal = {Scandinavian journal of gastroenterology},
volume = {34},
number = {7},
pages = {683-688},
doi = {10.1080/003655299750025886},
pmid = {10466879},
issn = {0036-5521},
mesh = {Action Potentials/drug effects/physiology ; Carbachol/pharmacology ; Cholinergic Agonists/pharmacology ; Colon/*physiopathology ; Diverticulitis, Colonic/*physiopathology ; Electric Stimulation ; Humans ; In Vitro Techniques ; Muscle Contraction ; Muscle, Smooth/drug effects/physiology/*physiopathology ; Stimulation, Chemical ; },
abstract = {BACKGROUND: Diverticular disease is characterized by the occurrence of small herniations of the colonic mucosa, through the external muscle coats of the colon. The muscle wall is thickened, high intraluminal pressures can be recorded, and often constipation develops. The aim of the present study was to investigate whether an abnormality in the electric myogenic control activity could be found to help explain the etiology and symptoms of the disease.
METHODS: Electric activity was studied by extracellular electrodes on tissues from both the circular and the longitudinal muscle of the colon from 12 patients.
RESULTS: In tissues from 10 patients a distinctly abnormal response to cholinergic stimulation was observed. A characteristic development of bursts of action potentials did not develop; instead, slow-wave activity of relatively low frequency was maintained throughout the period of stimulation. This slow-wave activity showed a lack of synchronization.
CONCLUSIONS: The results indicate that, in diverticular disease, local changes in electric activity occur that change the response to cholinergic stimulation. When this happens, development of periodic bursts of action potentials normally associated with propulsive activity do not develop, favoring segmental contractile activity associated with low-frequency slow-wave activity.},
}
@article {pmid10466166,
year = {1999},
author = {Key, TJ and Davey, GK and Appleby, PN},
title = {Health benefits of a vegetarian diet.},
journal = {The Proceedings of the Nutrition Society},
volume = {58},
number = {2},
pages = {271-275},
doi = {10.1017/s0029665199000373},
pmid = {10466166},
issn = {0029-6651},
mesh = {Body Mass Index ; Cholesterol/blood ; *Diet, Vegetarian ; Female ; *Health Promotion ; Heart Diseases/mortality ; Humans ; Male ; Obesity/epidemiology ; },
abstract = {Compared with non-vegetarians, Western vegetarians have a lower mean BMI (by about 1 kg/m2), a lower mean plasma total cholesterol concentration (by about 0.5 mmol/l), and a lower mortality from IHD (by about 25%). They may also have a lower risk for some other diseases such as constipation, diverticular disease, gallstones and appendicitis. No differences in mortality from common cancers have been established. There is no evidence of adverse effects on mortality. Much more information is needed, particularly on other causes of death, other morbidity including osteoporosis, and long-term health in vegans. The evidence available suggests that widespread adoption of a vegetarian diet could prevent approximately 40,000 deaths from IHD in Britain each year.},
}
@article {pmid10460390,
year = {1999},
author = {Williams, SM and Nolan, DJ},
title = {Colosalpingeal fistula: a rare complication of colonic diverticular disease.},
journal = {European radiology},
volume = {9},
number = {7},
pages = {1432-1433},
doi = {10.1007/s003300050864},
pmid = {10460390},
issn = {0938-7994},
mesh = {Aged ; Aged, 80 and over ; Barium Sulfate ; Colonic Diseases/diagnostic imaging/*etiology ; Contrast Media ; Diverticulitis, Colonic/*complications/diagnostic imaging ; Enema ; Fallopian Tube Diseases/diagnostic imaging/*etiology ; Female ; Fistula/diagnostic imaging/*etiology ; Humans ; Intestinal Fistula/diagnostic imaging/*etiology ; Radiography ; },
abstract = {Diverticular disease is a common condition in Western countries. The formation of inflammatory fistulae, usually from sigmoid colon to bladder or vagina, can be a feature of complicated cases of the disorder and is normally an indication for surgical intervention. We present a case of colosalpingeal fistulation occurring secondary to diverticulitis, a complication which, to our knowledge, has not been previously reported in the radiological literature. As in this instance, the initial clinical presentation of this problem can often be non-specific, with localising symptoms occurring later. In our case, barium enema examination allowed good demonstration of the fistulous communication before the more specific symptoms were clinically apparent.},
}
@article {pmid10430692,
year = {1999},
author = {Siriser, F},
title = {Laparoscopic-assisted colectomy for diverticular sigmoiditis. A single-surgeon prospective study of 65 patients.},
journal = {Surgical endoscopy},
volume = {13},
number = {8},
pages = {811-813},
doi = {10.1007/s004649901106},
pmid = {10430692},
issn = {0930-2794},
mesh = {Aged ; Colectomy/*methods ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Sigmoid Diseases/*surgery ; },
abstract = {BACKGROUND: The feasibility of laparoscopic colectomy has now been established, but little attention has been paid to its indications. Therefore, we undertook a prospective study of the laparoscopic treatment of diverticular disease of the colon.
METHODS: A total of 65 patients were operated on by a single surgeon between July 1993 and March 1998. Indications for operation included a previous acute attack of diverticulitis, abscess, or colovesical fistula. All procedures were laparoscopic-assisted.
RESULTS: Three conversions (4. 6%) were necessary. There were no postoperative mortalities. Nine postoperative complications occurred (17%); one of them (1.5%) was directly related to the operation and required reoperation. Patients passed flatus after 2.2 +/- 1.2 days (range, 1-9), and oral feeding was started after 2.6 +/- 1.3 days (range, 1-9). The hospital stay was 7.6 +/- 3 days (range, 5-19). No patient with >6 months of follow-up (40 patients) had any complaints related to diverticular disease.
CONCLUSIONS: These results suggest that this procedure is as safe as the traditional approach and provides superior comfort and cosmesis with the same long-term outcome.},
}
@article {pmid10421016,
year = {1999},
author = {Ruiz-Healy, F and Manzanilla-Sevilla, M and Orozco-Vazquez, J},
title = {Acute abdomen caused by inflammatory colonic non-parasitic pathology: staging by CT.},
journal = {International surgery},
volume = {84},
number = {1},
pages = {39-42},
pmid = {10421016},
issn = {0020-8868},
mesh = {Abdomen, Acute/*diagnostic imaging/pathology ; Aged ; Female ; Humans ; Inflammatory Bowel Diseases/*diagnostic imaging/pathology ; Male ; Middle Aged ; Retrospective Studies ; *Tomography, X-Ray Computed ; },
abstract = {A staging classification is proposed by CT findings in 27 patients with acute abdomen, caused by inflammatory colonic non-parasitic pathology. Of the 17 patients with diverticular disease, 4 were stage A (edema/ischemia on thickness of the abdominal wall), 2 were stage B (partial intramural infarction on the abdominal wall) and 3 were stage C (abscess/peritonitis and obstruction/vascular strangulation). None of the patients in the series were stage D (ischemia/infarction of the colonic wall with dilatation). Of the 4 patients with ulcerative colitis, 3 were stage A and 1 in stage C. Of the 3 patients with Crohn's disease, 2 were stage A and 1 was in stage C. Classified as stage D were 1 pseudomembranous colitis, 1 volvulus and 1 idiopathic megacolon. Clinical severity was in parallel with CT stages that gave better information on the progression of the pathology. Staging by CT in acute abdomen caused by inflammatory colonic non-parasitic pathology could be useful in therapeutics.},
}
@article {pmid10417566,
year = {1999},
author = {Papagrigoriadis, S and Macey, L and Bourantas, N and Rennie, JA},
title = {Smoking may be associated with complications in diverticular disease.},
journal = {The British journal of surgery},
volume = {86},
number = {7},
pages = {923-926},
doi = {10.1046/j.1365-2168.1999.01177.x},
pmid = {10417566},
issn = {0007-1323},
mesh = {Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking/adverse effects ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Smoking/*adverse effects ; },
abstract = {BACKGROUND: The vast majority of people with diverticula remain asymptomatic or develop minor symptoms while a small group develop serious complications that are associated with significant morbidity and mortality rates. The aim was to identify any risk factors predisposing to complications.
METHODS: Eighty patients with diverticular disease were studied. Patients in group 1 (n = 45) with complications requiring hospitalization or surgery were compared with those in group 2 (n = 35) with asymptomatic diverticula or minor symptoms. Logistic regression analysis was performed.
RESULTS: No differences in epidemiological factors, concurrent and past medical and surgical conditions or chronic medication were detected between the two groups. Generalized disease was not associated with more complications than sigmoid disease. However, smoking seemed to be an independent factor predisposing to complications; the proportion of smokers in group 1 was significantly greater (24 of 45) than that in group 2 (ten of 35) (odds ratio 2.9, P = 0.028).
CONCLUSION: In patients with diverticular disease, smoking is associated with an increased risk of complications.},
}
@article {pmid10378592,
year = {1999},
author = {Schoetz, DJ},
title = {Diverticular disease of the colon: a century-old problem.},
journal = {Diseases of the colon and rectum},
volume = {42},
number = {6},
pages = {703-709},
doi = {10.1007/BF02236921},
pmid = {10378592},
issn = {0012-3706},
mesh = {Diverticulitis, Colonic/diagnosis/*history/therapy ; Diverticulum, Colon/*history/therapy ; History, 19th Century ; History, 20th Century ; Humans ; },
}
@article {pmid10347292,
year = {1999},
author = {Köckerling, F and Schneider, C and Reymond, MA and Scheidbach, H and Scheuerlein, H and Konradt, J and Bruch, HP and Zornig, C and Köhler, L and Bärlehner, E and Kuthe, A and Szinicz, G and Richter, HA and Hohenberger, W},
title = {Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group.},
journal = {Surgical endoscopy},
volume = {13},
number = {6},
pages = {567-571},
doi = {10.1007/s004649901042},
pmid = {10347292},
issn = {0930-2794},
mesh = {Diverticulitis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Prospective Studies ; Sigmoid Diseases/*surgery ; },
abstract = {BACKGROUND: In the large bowel, resection of the sigmoid colon is the most commonly performed laparoscopic intervention because large bowel lesions often are located in this part of the bowel and the procedure technically is the most favorable one. A number of publications involving case series or the results of highly experienced individual surgeons already have confirmed the feasibility of laparoscopic resection in cases of diverticulitis. The aim of the present prospective multicentric investigation was to check the results obtained by a large number of surgeons performing laparoscopic resection of the sigmoid colon for diverticulitis in various stages of severity.
RESULTS: Between January 8, 1995 and January 1, 1998, the Laparoscopic Colorectal Surgery Study Group recruited 1,118 patients to the prospective multicenter study. Diverticulitis of the sigmoid colon, which accounted for 304 cases, was the most common indication for laparoscopic intervention. In most of these patients undergoing laparoscopic surgery (81.9%), the diverticulitis manifested as acute phlegmonous peridiverticulitis, recurrent attacks of inflammation, or stenosis. Complicated forms of diverticulitis in Hinchey stages I to IV and late complications of chronic diverticular disease with fistula formation and bleeding accounted for only 18.1% of the cases. For the overall group, the conversion rate was 7.2%. Patients with less severe diverticulitis (i.e., those presenting with peridiverticulitis, stenosis, or recurrent attacks of inflammation) had a conversion rate of 4.8% and the rate for complicated cases was 18.2%. Regarding laparoscopically completed interventions, 3 of 282 patients died (1.1%). In the group of patients with peridiverticulitis, stenosis, or recurrent attacks of inflammation the overall complication rate was 14.8%. The group with perforated diverticulitis in Hinchey stages I to IV or those with fistula and bleeding, the corresponding rate was 28.9%, and after conversion it was 31.8%.
CONCLUSIONS: Laparoscopic colorectal interventions in sigmoid diverticulitis are, for the most part, carried out as elective procedures for peridiverticulitis, stenosis, or recurrent attacks of inflammation. The conversion, complication, and mortality rates associated with these interventions are acceptable. Laparoscopic procedures in Hinchey stages I to IV sigmoid diverticulitis and in the presence of fistula and bleeding are more likely to be associated with complications, and should be carried out only by highly experienced laparoscopic surgeons.},
}
@article {pmid10330942,
year = {1999},
author = {Merad, F and Hay, JM and Fingerhut, A and Yahchouchi, E and Laborde, Y and Pélissier, E and Msika, S and Flamant, Y},
title = {Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. French Association for Surgical Research.},
journal = {Surgery},
volume = {125},
number = {5},
pages = {529-535},
pmid = {10330942},
issn = {0039-6060},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anal Canal/*surgery ; *Anastomosis, Surgical ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Pelvis ; Postoperative Complications/*prevention & control ; Rectum/*surgery ; Reoperation ; },
abstract = {OBJECTIVE: We investigated the role of drainage in the prevention of complications after elective rectal or anal anastomosis in the pelvis. Anastomotic leakage after colorectal resection is more prevalent when the anastomosis is in the distal or infraperitoneal pelvis than in the abdomen. The benefit of pelvic drains versus their potential harm has been questioned. Drain-related complications include (1) those possibly benefiting from drainage (leakage, intra-abdominal infection, bleeding) and (2) those possibly caused by drainage (wound infection or hernia, intestinal obstruction, fistula).
METHODS: Between September 1990 and June 1995, 494 patients (249 men and 245 women), mean age 66 +/- 15 (range 15 to 101) years, with either carcinoma, benign tumor, colonic Crohn's disease, diverticular disease of the sigmoid colon, or another disorder located anywhere from the right colon to the midrectum undergoing resection followed by rectal or anal anastomosis were randomized to undergo either drainage (n = 248) with 2 multiperforated 14F suction drains or no drainage (n = 246). The primary end point was the number of patients with one or more postoperative drain-related complications. Secondary end points included severity of these complications as assessed by the rate of related repeat operations and associated deaths as well as extra-abdominally related morbidity and mortality.
RESULTS: After withdrawal of 2 patients (1 in each group) both groups were comparable with regard to preoperative characteristics and intraoperative findings. The overall leakage rate was 6.3% with no significant difference between those with or without drainage. There were 18 deaths (3.6%), 8 (3.2%) in those with drainage and 10 (4%) in those without drainage. Five patients with anastomotic leakage died (1%), 3 of whom had drainage. There were 32 repeat operations (6.5%) for anastomotic leakage 11 in the group with drainage and 4 in the group with no drainage. The rate of these and the other intra-abdominal and extra-abdominal complications did not differ significantly between the 2 groups.
CONCLUSION: Prophylactic drainage of the pelvic space does not improve outcome or influence the severity of complications.},
}
@article {pmid10323423,
year = {1999},
author = {Valverde, A and Hay, JM and Fingerhut, A and Boudet, MJ and Petroni, R and Pouliquen, X and Msika, S and Flamant, Y},
title = {Senna vs polyethylene glycol for mechanical preparation the evening before elective colonic or rectal resection: a multicenter controlled trial. French Association for Surgical Research.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {134},
number = {5},
pages = {514-519},
doi = {10.1001/archsurg.134.5.514},
pmid = {10323423},
issn = {0004-0010},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cathartics/*therapeutic use ; Colonic Neoplasms/*surgery ; Elective Surgical Procedures ; Female ; Humans ; Male ; Middle Aged ; Polyethylene Glycols/*therapeutic use ; *Preoperative Care ; Prospective Studies ; Rectal Neoplasms/*surgery ; Senna Extract/*therapeutic use ; Single-Blind Method ; },
abstract = {HYPOTHESIS: Senna is more efficient than polyethylene glycol as mechanical preparation before elective colorectal surgery.
DESIGN: Prospective, randomized, single-blind study.
SETTING: Multicenter study (18 centers).
PATIENTS: Five hundred twenty-three consecutive patients with colonic or rectal carcinoma or sigmoid diverticular disease, undergoing elective colonic or rectal resection followed by immediate anastomosis.
INTERVENTION: Two hundred sixty-two patients were randomly allotted to receive senna (1 package diluted in a glass of water) and 261 to receive polyethylene glycol (2 packages diluted in 2-3 L of water), administered the evening before surgery. All patients received 5% povidone iodine antiseptic enemas (2 L) the evening and the morning before surgery. Ceftriaxone sodium and metronidazole were given intravenously at anesthetic induction.
MAIN OUTCOME MEASURES: Degree of colonic and rectal cleanliness.
RESULTS: Colonic cleanliness was better (P=.006), fecal matter in the colonic lumen was less fluid (P=.001), and the risk for moderate or large intraoperative fecal soiling was lower (P=.11) with senna. Overall, clinical tolerance did not differ significantly between groups, but 20 patients receiving polyethylene glycol (vs 16 with senna) had to interrupt their preparation, and 15 patients (vs 8 with senna) complained of abdominal distension. Senna, however, was better tolerated (P = .03) in the presence of stenosis. There was no statistically significant difference found in the number of patients with postoperative infective complications (14.7% vs 17.7%) or anastomotic leakage (5.3% vs 5.7%) with senna and polyethylene glycol, respectively.
CONCLUSION: Mechanical preparation before colonic or rectal resection with senna is better and easier than with polyethylene glycol and should be proposed in patients undergoing colonic or rectal resection, especially patients with stenosis.},
}
@article {pmid10222517,
year = {1999},
author = {Rao, PM},
title = {CT of diverticulitis and alternative conditions.},
journal = {Seminars in ultrasound, CT, and MR},
volume = {20},
number = {2},
pages = {86-93},
doi = {10.1016/s0887-2171(99)90040-9},
pmid = {10222517},
issn = {0887-2171},
mesh = {Appendicitis/complications/diagnostic imaging ; Cholecystitis/complications/diagnostic imaging ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/*diagnostic imaging ; Female ; Humans ; Ileitis/complications/diagnostic imaging ; Intestinal Obstruction/complications/diagnostic imaging ; Ovarian Cysts/complications/diagnostic imaging ; Reproducibility of Results ; *Tomography, X-Ray Computed ; Ureteral Calculi/complications/diagnostic imaging ; },
abstract = {The clinical diagnosis of diverticulitis is often uncertain and frequently incorrect. Diagnostic imaging such as with helical CT offers a rapid and accurate diagnosis of diverticulitis and its complications as well as alternative conditions. In particular, helical CT combined with contrast material administered through the colon is highly accurate and can be obtained quickly. CT signs of diverticulitis include focal inflammatory wall thickening and paracolic inflammation superimposed on diverticular disease (diverticula, muscular wall hypertrophy). Common alternative conditions that can clinically mimic diverticulitis include small bowel obstruction, primary epiploic appendagitis, acute cholecystitis, appendicitis, ileitis, ovarian cystic disease, and ureteral stone disease. Early and frequent use of diverticular CT promises to improve diagnosis and treatment of patients with clinically suspected diverticulitis.},
}
@article {pmid10220819,
year = {1999},
author = {Durieux, S and Rozenberg, S and Bourgeois, P},
title = {[Complications of colonic diverticular disease during rheumatoid polyarthritis: 7 cases].},
journal = {La Revue de medecine interne},
volume = {20},
number = {1},
pages = {50-53},
doi = {10.1016/s0248-8663(99)83008-2},
pmid = {10220819},
issn = {0248-8663},
mesh = {Abscess/chemically induced ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Antirheumatic Agents/*adverse effects ; Arthritis, Rheumatoid/complications/*drug therapy ; Colonic Diseases/chemically induced ; Diverticulitis, Colonic/*chemically induced ; Gastrointestinal Hemorrhage/chemically induced ; Glucocorticoids/adverse effects ; Humans ; Hydroxychloroquine/adverse effects ; Immunosuppressive Agents/adverse effects ; Intestinal Fistula/chemically induced ; Intestinal Perforation/chemically induced ; Middle Aged ; Organogold Compounds ; Pelvis ; Peritonitis/chemically induced ; Polyarteritis Nodosa/complications ; Urinary Bladder Fistula/chemically induced ; },
abstract = {INTRODUCTION: Among the gastrointestinal adverse effects of nonsteroidal anti-inflammatory drugs (NSAID) and corticoids are mentioned complications of colonic diverticular disease. However, very few studies have described their consequences in rheumatoid arthritis.
EXEGESIS: We report on seven patients who were admitted in our department between 1984 and 1997. All patients received corticoids and another antirheumatic drug (gold salts, hydroxychloroquine, immunosuppressive drugs); treatment also included NSAID in four cases. Two patients had a necrotizing vasculitis accompanying rheumatoid arthritis. Intestinal accompanying diseases were the following: one diverticulitis, three colonic perforations with pelviperitonitis, one colovesical fistula, one pelvic abscess, and one diverticular hemorrhage. All patients underwent surgery with positive results.
CONCLUSION: Combination of the four following symptoms: fever, abdominal pain, diarrhea, and hemorrhage, can uncover a complication of colónic diverticular disease occurring in the course of rheumatoid arthritis. It should be investigated, even if no history of diverculosis may be evidenced.},
}
@article {pmid10210940,
year = {1998},
author = {Gullino, D and Giordano, O and Lijoi, C and Masella, M and De Carlo, A},
title = {[Perforated diverticular disease of the left colon. Proposed single-stage left colectomy protected by a three-way lavage and active aspiration tube (di Gullino) positioned inside or below the anastomosis. Experience in 65 cases].},
journal = {Minerva chirurgica},
volume = {53},
number = {12},
pages = {1059-1067},
pmid = {10210940},
issn = {0026-4733},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colectomy/*methods ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Intestinal Perforation/complications/*surgery ; Male ; Middle Aged ; Peritonitis/etiology ; Therapeutic Irrigation/*instrumentation/methods ; },
abstract = {BACKGROUND: The incidence of perforative diverticulitis of the left colon is steadily increasing. Today the decision is generally taken to perform two-stage surgery: segmentary resection without (Hartmann's operation) or with anastomosis, but protected by a colostomy ("limited intervention"). This study aimed to examine standard colectomy performed in a single operation ("ideal intervention").
METHODS: Left colectomy with primary ligature of the lower mesenteric artery and vein at the source and outlet, en bloc removal of the colon-mesocolon and immediate transverse colorectal anastomosis. Anastomosis protected by the omentum which is also used to peritonise the retroperitoneum and to wrap around the anastomosis, and anastomosis also protected by the author's three-way lavage and active aspiration tube in either a trans- or subanastomosis and transanal position. Urgency is essential for this single-stage operation, together with massive dose antibiotic treatment limited to the pre- and postoperative stages, but above all peritoneal cleansing using accurate, methodical, repeated and abundant lavage with 8-10-20 or more litres, but only used 500 ml at a time. Of these 65 cases, 40 (62%) were purulent localised peritonitis and 25 (38%) were generalised (14 purulent, 4 fecaloid and 7 fecal). 8 cases (12.3%) underwent surgery in three stages and 16 (24.6%) underwent sigmoidectomy in one or two stages ("limited intervention"), 41 cases (63%) (1985-95, when Gullino's three-way tube became available) underwent standard colectomy in a single stage.
RESULTS: Morbidity in 10 cases/65 (15%) and septic mortality in 5 cases/65 (7.7%) (limited to generalised peritonitis alone) only affected patients undergoing "limited interventions", but none of the 41 patients undergoing "ideal intervention". Mortality was significantly influenced by age: 50% of over 80 year-olds, none below 60. Postoperative hospitalisation was 17.1 days (in the first stage) of "limited interventions" and 9.7 days for "ideal interventions".
CONCLUSIONS: The results argue clearly in favour of the "courageous" ideal colectomy with peritoneal lavage and protection of the colorectal anastomosis using Gullino's three-way tube.},
}
@article {pmid10209709,
year = {1999},
author = {Oddo, F and Chevallier, P and Souci, J and Baque, J and Buckley, MJ and Fabiani, P and Diaine, B and Coussement, A},
title = {[Radiologic aspects of the complications of duodenal diverticula].},
journal = {Journal de radiologie},
volume = {80},
number = {2},
pages = {134-140},
pmid = {10209709},
issn = {0221-0363},
mesh = {Acute Disease ; Aged ; Aged, 80 and over ; Bezoars/complications/diagnosis ; Cholestasis/diagnosis/etiology ; Common Bile Duct Diseases/diagnosis/etiology ; Dilatation, Pathologic/diagnosis/etiology ; Diverticulitis/complications/diagnosis ; Diverticulum/*complications/diagnosis ; Duodenal Diseases/*complications/diagnosis ; Female ; Gallstones/diagnosis/etiology ; Humans ; Intestinal Perforation/diagnosis/etiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreatic Ducts/pathology ; Pancreatitis/diagnosis/etiology ; Retrospective Studies ; Tomography, X-Ray Computed ; },
abstract = {The duodenum is the second most common site, after the colon, for intestinal diverticulae. This condition is most often asymptomatic and is usually an accidental finding. Complications, with variable clinical presentations, may occur in up to 5% of such individuals. We report a retrospective analysis of 5 patients who presented with complicated duodenal diverticular disease. The complications, either isolated or multiple, consisted of bezoar formation (n = 2), diverticulitis (n = 2), extrinsic compression of the common bile duct (n = 3), perforation (n = 1), choledocholithiasis (n = 1), and an abnormality of the bilio-pancreatic ductal convergence (n = 1). The radiological aspects, in particular, the magnetic resonance imaging (MRI) features are reviewed. These are, to our knowledge, the first descriptions of MRI and magnetic resonance cholangiopancreatographic (MRCP) findings in complicated duodenal diverticular disease. MRI facilitates precise delineation of the complicated duodenal diverticulum while MRCP allows assessment of the effects on the biliary and pancreatic ducts.},
}
@article {pmid10207735,
year = {1999},
author = {Isbister, WH},
title = {Colorectal operative experience in general surgical training.},
journal = {International journal of colorectal disease},
volume = {14},
number = {1},
pages = {69-72},
doi = {10.1007/s003840050187},
pmid = {10207735},
issn = {0179-1958},
mesh = {Adult ; Colon/surgery ; Colorectal Neoplasms/surgery ; Digestive System Surgical Procedures/*standards ; Diverticulitis/surgery ; Female ; General Surgery/*education ; Humans ; *Internship and Residency ; Male ; Medical Audit ; Quality Assurance, Health Care ; Rectum/surgery ; Treatment Outcome ; Workload ; },
abstract = {BACKGROUND: Surgical trainees often feel that their operative training is inadequate--trainers usually do not share this view.
METHODS: The distribution of colorectal operative surgical workloads between consultants and trainees was examined over a 15-year period in the Colorectal Service at the Wellington School of Medicine.
RESULTS: Consultants performed 947 operations and trainees performed 1012 operations. The average age of patients operated on by trainees was lower than that of those operated on by consultants. Trainees performed more emergency surgery. Anorectal surgery, except fistula surgery, was more commonly performed by trainees, whereas abdominal colorectal surgery was more commonly performed by consultants. Trainees had lower postoperative morbidity and mortality rates. The diseases predominantly treated by consultants and trainees differed. Twenty-four percent of patients with colorectal cancers and 25% of patients with diverticular disease were managed operatively by trainees. Yearly trainee workloads for minor anorectal conditions were similar to those of trainees in the USA.
CONCLUSION: Although this small colorectal audit provides some information about trainees' operative experience, until all surgical procedures performed by all surgical trainees are accurately audited and criteria for adequacy of operative training are clearly stated, it will not be possible to say whether our training programs provide adequate operative training or not.},
}
@article {pmid10202750,
year = {1999},
author = {Forsnes, EV and Eggleston, MK and Heaton, JO},
title = {Enterovesical fistula complicating pregnancy. A case report.},
journal = {The Journal of reproductive medicine},
volume = {44},
number = {3},
pages = {297-298},
pmid = {10202750},
issn = {0024-7758},
mesh = {Adult ; Crohn Disease/complications/*diagnosis ; Cystoscopy ; Diagnosis, Differential ; Female ; Humans ; Ileal Diseases/*diagnosis/etiology/surgery ; Intestinal Fistula/*diagnosis/etiology/surgery ; Pregnancy ; Pregnancy Complications/*diagnosis ; Recurrence ; Urinary Bladder Fistula/*diagnosis/etiology/surgery ; Urinary Tract Infections/etiology ; },
abstract = {BACKGROUND: Enterovesical fistula is a rare cause of recurrent urinary tract infections. This condition is unusual in young people as common etiologies include diverticular disease and cancer. When an enterovesical fistula occurs in women of childbearing age, Crohn's disease is a likely cause. To our knowledge, enterovesical fistula complicating pregnancy has not been reported before.
CASE: A pregnant woman with recurrent urinary tract infections was evaluated. Cystoscopy was suggestive of an enterovesical fistula, which was confirmed by charcoaluria following oral charcoal administration. The prenatal course was complicated by two episodes of hemorrhagic cystitis despite antibiotic prophylaxis. The patient had an uncomplicated term spontaneous vaginal delivery. An upper gastrointestinal series performed postpartum was suggestive of Crohn's disease and confirmed an enterovesical fistula. Surgical repair was successfully performed three months following delivery, revealing Crohn's disease.
CONCLUSION: Enterovesical fistula may be an unusual cause of recurrent urinary tract infections in pregnancy. In this case, enterovesical fistula was the presenting symptom of Crohn's disease.},
}
@article {pmid10190349,
year = {1999},
author = {So, JB and Kok, K and Ngoi, SS},
title = {Right-sided colonic diverticular disease as a source of lower gastrointestinal bleeding.},
journal = {The American surgeon},
volume = {65},
number = {4},
pages = {299-302},
pmid = {10190349},
issn = {0003-1348},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Diverticulum, Colon/*complications/diagnosis/therapy ; Female ; Gastrointestinal Hemorrhage/diagnosis/*etiology/therapy ; Humans ; Male ; Middle Aged ; },
abstract = {Right-sided colonic diverticular disease is a distinct disease entity uncommon in the West. Occasionally, the condition may be complicated by hemorrhage and present as lower gastrointestinal bleeding. We report a series of 25 cases of bleeding right colon diverticulosis and discuss its presentation and management. Patients were selected from the colonoscopic reports of all 190 patients presented with suspected acute lower gastrointestinal bleeding in National University Hospital, Singapore, from 1988 to 1994. Fifty-seven patients (30%) had bleeding diverticulosis in which 25 patients (44%) suffered from right-sided disease. Sixty-four per cent of patients had a history of hypertension. Patients presented with either fresh blood in stools or melena. Fifteen patients (60%) required blood transfusion (median, 2 units). Colonoscopy showed blood clots in the right colon in 15 cases (60%) and active bleeding from the right colon diverticula in 3 patients (12%). The bleeding stopped spontaneously in 16 patients (64%). The other 9 patients required surgery because of continuous or recurrent bleeding. All had a right hemicolectomy performed. The hospital stay was 13 days in this group, compared with 5 days for those undergoing conservative treatment (P = 0.0004). There were no deaths. No patients had further bleeding episodes during a median 7-month follow-up.},
}
@article {pmid10095846,
year = {1998},
author = {Hemadeh, G and Chebli, A and Uthman, S},
title = {Spectrum of diverticular disease of the colon in Lebanon AUBMC experience.},
journal = {Le Journal medical libanais. The Lebanese medical journal},
volume = {46},
number = {3},
pages = {146-148},
pmid = {10095846},
issn = {0023-9852},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Colectomy ; Colostomy ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis/*epidemiology/surgery ; Diverticulum, Colon/diagnosis/*epidemiology ; Drainage ; Female ; Humans ; Lebanon/epidemiology ; Male ; Middle Aged ; },
abstract = {There is an increasing number of cases of colonic diverticular disease among hospital admissions to AUBMC being more prevalent in patients > 50 years old (76.5%). Colonic diverticular disease were more prevalent in urban population admitted to AUBMC (95.6%). Diverticulitis is the most common complication of colonic diverticular disease among admitted cases with colonic diverticular disease (51%). All patients with diverticulitis who presented without abdominal pain had fever. This finding made diverticulitis part of the differential diagnosis in cases of FUO in patients over 50 years old.},
}
@article {pmid10094765,
year = {1999},
author = {Köhler, L and Sauerland, S and Neugebauer, E},
title = {Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery.},
journal = {Surgical endoscopy},
volume = {13},
number = {4},
pages = {430-436},
doi = {10.1007/s004649901007},
pmid = {10094765},
issn = {0930-2794},
mesh = {Diverticulitis/*diagnosis/etiology/surgery/*therapy ; Humans ; *Laparoscopy ; },
abstract = {BACKGROUND: With the aim of resolving the current controversy over the diagnosis and treatment of diverticular disease, this consensus development conference set out to summarize the actual state of the art.
METHODS: A multidisciplinary panel of international experts (n = 16) was selected to take part in the consensus process. Prior to the conference, all experts were asked to answer a series of questions on diverticular disease. The consensus statement compiled out of these evaluations was modified during a joint meeting of the panel members, then presented for discussion in a public session, and finally revised by the expert panel. The finalized statement was mailed to all panel members for approval (Delphi method).
RESULTS: Asymptomatic diverticulosis, diverticular disease (with actual or recurrent symptoms), and complicated diverticular disease were defined separately. No agreement was reached on whether barium enema or colonoscopy is the better choice as an initial diagnostic tool in uncomplicated cases. In complicated cases, computed tomography is recommended for diagnosis. After two attacks of diverticular disease, elective resection should be considered. For patients in whom a concomitant carcinoma cannot be excluded and those with chronic complications (fistula, stenosis, or bleeding) surgery is also indicated. Laparoscopic sigmoid colectomy is recommended only for uncomplicated and, after percutaneous drainage of abscesses, Hinchey stage I and II cases.
CONCLUSIONS: Laparoscopic surgery has already begun to influence the management of diverticular disease, but the randomized controlled trials needed to support therapy decisions are largely missing.},
}
@article {pmid10090390,
year = {1999},
author = {Matthews, MR and Caruso, DM and Al-Kasspooles, MF and Phillips, BJ and Schiller, WR},
title = {Development of a colocutaneous fistula in a patient with a large surface area burn.},
journal = {Burns : journal of the International Society for Burn Injuries},
volume = {25},
number = {1},
pages = {81-85},
doi = {10.1016/s0305-4179(98)00117-x},
pmid = {10090390},
issn = {0305-4179},
mesh = {Anastomosis, Surgical ; Burns/*complications ; Colon/surgery ; Colonic Diseases/*etiology ; Cutaneous Fistula/*etiology ; Female ; Humans ; Intestinal Fistula/*etiology ; Middle Aged ; Postoperative Complications ; Rectum/surgery ; },
abstract = {A 61 year old female sustained a large surface area burn, complicated by inhalation injury. One month before the incident, she had undergone a left hemicolectomy with colorectal anastomosis for diverticular disease. Due to the severity of her burns, multiple surgical debridement and skin grafting procedures were required, including a large fascial debridement of her flank and back. Her hospital course was complicated by recurrent episodes of pulmonary and systemic infection, as well as pre-existing malnutrition. Prior to her discharge to a rehabilitation center, stool began to drain from her left posterior flank. This complication represented a colonic fistula arising from the recent colon anastomosis. The fistula was managed nonoperatively and gradually closed. To our knowledge, this is the first report of a colocutaneous fistula spontaneously draining from the abdomen via the retroperitoneum in a burn victim, not related to direct thermal injury to the peritoneal cavity.},
}
@article {pmid10079644,
year = {1999},
author = {Schock, J and Mainster, H},
title = {Perforation of acquired small bowel diverticulum.},
journal = {The Journal of the American Osteopathic Association},
volume = {99},
number = {2},
pages = {113-115},
doi = {10.7556/jaoa.1999.99.2.113},
pmid = {10079644},
issn = {0098-6151},
mesh = {Aged ; Diverticulitis/*complications/epidemiology ; Diverticulum, Colon/complications ; Female ; Humans ; Intestine, Small/*injuries ; Rupture, Spontaneous ; },
abstract = {A 77-year old woman was seen with an unusual pathologic entity after emergent abdominal exploration--a ruptured small bowel diverticulum. This patient had a known previous history of colonic diverticulosis when she had acute onset of severe abdominal pain. The patient underwent an exploratory laparotomy with resection of representative segments of small and large bowel. The large bowel had evidence of diverticulosis, while the small bowel resected segment had evidence of diverticulitis with rupture. An extensive review of the literature revealed a very small number of reported cases in the world literature (less than 150 cases). We reviewed the history of reported cases of ruptured and nonruptured small bowel diverticular disease, as well as this case.},
}
@article {pmid10063548,
year = {1998},
author = {Printz, H and Göke, B},
title = {[Conservative and interventional therapy of acute diverticulitis with reference to pathophysiology].},
journal = {Zentralblatt fur Chirurgie},
volume = {123},
number = {12},
pages = {1375-1381},
pmid = {10063548},
issn = {0044-409X},
mesh = {Abdominal Abscess/etiology/surgery ; Acute Disease ; Anastomosis, Surgical ; Colostomy ; Diverticulitis, Colonic/etiology/*surgery ; Humans ; Recurrence ; },
abstract = {Diverticular disease is most common in the sigmoid colon. Its etiology is multifactorial and probably related to low-fiber diets, age dependent changes of the colonic wall, hypermotility and myochosis with subsequent increase in intraluminal pressure. Acute diverticulitis results from inflammation of a pseudo-diverticulum. It can progress to pericolitis and perforation with abscess formation. Therapy of uncomplicated diverticulitis is a conservative regimen with bowel rest and intravenous broad spectrum antibiotics. In subjects with complicated diverticulitis, preoperative percutaneous image-guided catheter drainage of diverticular macroabscesses is indicated. This aims at resolving intra-abdominal sepsis thereby avoiding the need for temporary colostomy and multiple-stage surgery. Interval single stage sigmoid resection with primary anastomosis should then be performed. Generalized peritonitis, with or without evidence of free perforation, should be treated surgically. Long-term cereal fiber supplementation and physical activity may prevent complications and inflammatory recurrences in diverticular disease.},
}
@article {pmid9921096,
year = {1998},
author = {al-Damegh, S},
title = {Radiological diagnosis and management of diverticulitis.},
journal = {West African journal of medicine},
volume = {17},
number = {4},
pages = {273-277},
pmid = {9921096},
issn = {0189-160X},
mesh = {Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Barium Sulfate ; Combined Modality Therapy ; Diverticulum/*diagnostic imaging/*therapy ; Drainage ; Enema ; Female ; Humans ; Male ; Middle Aged ; Radiology, Interventional ; Tomography, X-Ray Computed ; Ultrasonography ; },
abstract = {Thirteen (13) patients with proven diverticulitis are presented with the aim of demonstrating the current evaluation and management. Radiological evaluation were obtained with plain abdominal x-rays and computed tomography (CT) in all cases, abdominal ultrasonography (US) in 8 cases and contrast enema in 5 patients. Radiological percutaneous abscess drainage (PAD) were performed in 5 cases, two of which preceded surgery. A clinical suspicion of diverticulitis was made in only 3 of the 13 cases. CT provided the diagnosis in all cases and helped in directing the appropriate management. Ultrasound was also useful but to a lesser extent. CT or US guided PAD reduced the surgical operation to a single stage procedure instead of the former 2- to 3-stage surgical management. Plain abdominal x-ray were only useful for the diagnosis in intestinal obstruction and vesical fistula. Contrast enema provided supporting information when necessary. CT clearly diagnosed both suspected and totally unsuspected cases of diverticulitis and provides guidance for the appropriate management. When CT is unavailable US with accurate colonic imaging and abscesses identification can also be useful in diagnosing and guiding drainage. Plain abdominal x-rays are less helpful but mandatory since the presentation is usually that of acute abdomen. Water soluble contrast enema also provides supportive features when necessary. In areas where diverticular disease is uncommon, diverticulitis should be suspected in cases with left iliac fossa or pelvic pain with mass and tenderness.},
}
@article {pmid9918619,
year = {1999},
author = {Schwandner, O and Schiedeck, TH and Bruch, H},
title = {The role of conversion in laparoscopic colorectal surgery: Do predictive factors exist?.},
journal = {Surgical endoscopy},
volume = {13},
number = {2},
pages = {151-156},
doi = {10.1007/s004649900927},
pmid = {9918619},
issn = {0930-2794},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Colonic Diseases/complications/*surgery ; Female ; Humans ; Intraoperative Complications ; *Laparoscopy ; Logistic Models ; Male ; Middle Aged ; Obesity/complications ; Prospective Studies ; Rectal Diseases/complications/*surgery ; Reoperation ; Risk Factors ; },
abstract = {BACKGROUND: This study was performed to analyze the reasons for conversion of laparoscopic colorectal procedures to open surgery and to identify risk factors.
METHODS: All patients who underwent laparoscopic colorectal surgery at our institution were enrolled in a prospective trial. The causes of conversion were analyzed. Statistical analysis, including a logistic regression model, was performed to identify factors that would predict an increased risk of conversion.
RESULTS: A total of 300 laparoscopic or laparoscopic-assisted procedures for both benign and malignant diseases were performed within 5 years. Mean patient age was 61.4 years (range, 17-93). There were 218 women and 82 men. Major complications occurred in 8.6%, and 30-day-mortality rate was 1.1%. Postoperative hospitalization was 13.9 days (range, 6-47). Conversion occurred in 22 cases (7.3%). The mean age of the converted group was 64.7 years (range, 31-93). Postoperative hospital stay was 15.0 days (range, 10-25). The main reasons for conversion to open surgery were inflammation, obesity, anesthetic problems, technical difficulties, intraoperative complications, and intraoperative decisions concerning oncological resection. The conversion rate was 14.6% in patients who underwent sigmoid resection for diverticular disease. By univariate analysis, statistically significant factors defining a higher risk of conversion were male gender (p = 0.0029), age from 55 to 64 years (p = 0.0015), extreme body status (p = 0.0001), and diagnosis of diverticular disease (p = 0.0011). According to the logistic regression model, all four factors combined would give a probability of conversion of 70.3%.
CONCLUSIONS: The risk factors contributing to the possibility of conversion included male gender, age between 55 and 64 years, extreme body status, and diverticular disease. Using these data, patients with an increased likelihood of conversion can be identified. However, if conversion is necessary, laparoscopic colorectal surgery can be safely applied to the patients with no additional morbidity.},
}
@article {pmid9882974,
year = {1998},
author = {Nistri, R and Basili, G and Vitali, A and Carrieri, P and Nardi, S},
title = {[Colo-uterine fistula, a complication of sigma diverticulitis].},
journal = {Minerva chirurgica},
volume = {53},
number = {10},
pages = {827-830},
pmid = {9882974},
issn = {0026-4733},
mesh = {Aged ; Colon, Sigmoid ; Colonic Diseases/diagnosis/*etiology ; Diverticulitis, Colonic/*complications/diagnosis ; Female ; Fistula/diagnosis/*etiology ; Humans ; Intestinal Fistula/diagnosis/*etiology ; Uterine Diseases/diagnosis/*etiology ; },
abstract = {The colo-uterine fistula is a rare complication of diverticular disease of the colon; the literature review has shown only few well studied cases. The fistula, among the complications of the sigma diverticulitis, is 20% of the observed cases; generally, the bladder is the most involved organ, but also the skin or gut can be interested. If we consider the aetiology of the colo=uterine fistula of the observed case, the presence of the sigma locked stenosis with an endocolic pressure increase, associated with a peridiverticulitis condition, seems to have a relevant rule. The clinical symptomatology is represented by vague abdominal pain localized in particular in the left iliac cavity and by emission of blood, purulent material and stools from the vagina. The diagnosis of colo-uterine fistula is not easily reached: barium enema, Fallopian tube endoscopy and colon endoscopy not always allow to visualize in a right manner the fistula and only the oral administration of non-absorbable substances to be searched in the vaginal tampon, clear each doubt. Regarding the therapy to be carried out, we think that, colic resection en bloc with the uterus is the treatment of choice, while, in emergency, the Hartman operation is the most suitable to avoid the beginning of septic complications.},
}
@article {pmid9876730,
year = {1998},
author = {Carbajo Caballero, MA and Martín del Olmo, JC and Blanco, JI and de la Cuesta, C and Atienza, R},
title = {The laparoscopic approach in the treatment of diverticular colon disease.},
journal = {JSLS : Journal of the Society of Laparoendoscopic Surgeons},
volume = {2},
number = {2},
pages = {159-161},
pmid = {9876730},
issn = {1086-8089},
mesh = {Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colectomy/methods ; Colon, Sigmoid/pathology/surgery ; Diverticulum, Colon/diagnosis/physiopathology/*surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/adverse effects/*methods ; Male ; Middle Aged ; Treatment Outcome ; },
abstract = {BACKGROUND AND OBJECTIVES: The experience with treatment of diverticular colon disease (DCD) by the laparoscopic method is analyzed.
METHODS: Between January 1994 and July 1997, a group of 22 patients with criteria for symptomatic diverticular disease in the descending and sigmoid colon underwent laparoscopy with average resections of 40 cm. Intra-abdominal mechanical anastomosis completed the procedure.
RESULTS: The operative morbidity was 28%. Two cases, in acute diverticulitis phase, were reconverted to open surgery, and three cases presented postoperative rectorrhagia which ceased spontaneously. No long-term complications have been found. Postoperative hospitalization was 4-8 days (mean 5.5) and mean operative time was 165 minutes (range 120-240).
CONCLUSIONS: Nevertheless, the learning curve precise to practice this type of surgery, the acceptable morbity-mortality rates which the laparoscopic method presents, especially with these high-risk groups of patients (age > 65, high blood pressure, etc), encouraged us to modified the criteria indicating surgery for the disease, offering first choice operative treatment with efficiency and safety. However, we feel that those patients with acute complications of diverticular colon disease must be excluded initially for laparoscopic approach.},
}
@article {pmid9865555,
year = {1998},
author = {Kok, KY and Kum, CK and Goh, PM},
title = {Colonoscopic evaluation of severe hematochezia in an Oriental population.},
journal = {Endoscopy},
volume = {30},
number = {8},
pages = {675-680},
doi = {10.1055/s-2007-1001387},
pmid = {9865555},
issn = {0013-726X},
mesh = {Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Angiography ; Child ; Colonic Diseases/*diagnosis/epidemiology ; *Colonoscopy ; Female ; Gastrointestinal Hemorrhage/*diagnosis/epidemiology ; Humans ; Incidence ; Japan/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Sex Distribution ; },
abstract = {BACKGROUND AND STUDY AIMS: Hematochezia is a common clinical problem. When the bleeding is brisk and continuous it requires prompt hospital admission and careful diagnostic evaluation and management. Colonoscopy has become the first-line investigative modality in patients presenting with severe hematochezia in many centers, including ours. A retrospective review was carried out to evaluate the effectiveness of colonoscopy in determining the cause of severe hematochezia in our Oriental population.
PATIENTS AND METHODS: One hundred and ninety patients with severe hematochezia underwent colonoscopy at the National University Hospital, Singapore, from 1 January 1988 to 31 December 1994. Their records were retrieved and the data analyzed for sex, age, presentation, concomitant medical conditions, prevalence of recent non-steroidal anti-inflammatory drugs ingestion, past history of hematochezia, investigations, subsequent interventions and outcome.
RESULTS: Colonoscopy as the fist-line investigative modality identified the site and cause of hematochezia in 78% (148/190) of cases. The site of bleeding remained "obscure" even after additional investigations in 15% (29/190) of cases. The commonest cause of severe hematochezia in our Oriental population was diverticular disease (30%, 57/190) with right-sided diverticular bleeding constituting 44% (25/57) of these cases. Overall, bleeding stopped spontaneously in 81% (154/190) of cases. Surgery was performed in 16% (30/190) of cases. The mortality related to severe hematochezia in this series was 5% (9/190).
CONCLUSIONS: The diagnostic efficiency of colonoscopy in defining the site and cause of severe hematochezia in the Oriental population is comparable to most Western series. The commonest cause of severe hematochezia in our population was diverticular disease.},
}
@article {pmid9860333,
year = {1998},
author = {Mäkelä, J and Vuolio, S and Kiviniemi, H and Laitinen, S},
title = {Natural history of diverticular disease: when to operate?.},
journal = {Diseases of the colon and rectum},
volume = {41},
number = {12},
pages = {1523-1528},
doi = {10.1007/BF02237300},
pmid = {9860333},
issn = {0012-3706},
mesh = {Adult ; Age Factors ; Aged ; Anti-Bacterial Agents/therapeutic use ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Male ; Middle Aged ; Patient Selection ; Prognosis ; Retrospective Studies ; Sex Factors ; Surgical Procedures, Operative ; Treatment Outcome ; },
abstract = {PURPOSE: The natural history of patients admitted because of acute diverticulitis is largely unknown, and the selection of patients for surgical treatment varies notably. This study presents our experience concerning the outcome for 366 patients admitted during a 10-year period.
METHODS: Three hundred sixty-six patients admitted to our hospital with acute diverticulitis from 1981 to 1990 were identified from a computer database, and their clinical data up to the end of 1996 were reviewed from the database and patient records.
RESULTS: There were significantly more males than females in the age group less than 50 years old, and young males underwent surgical treatment during the first treatment period more frequently than the others. Young patients were operated on without mortality, and all their temporary colostomies were closed. Older patients died more often of diseases unrelated to the diverticular disease during the years after the first episode of acute diverticulitis. Recurrences of diverticular disease developed in 22 percent of patients, and they were significantly more common in patients less than 50 years old than in the older age groups. Males less than 50 years old more often developed complications of diverticular disease after two hospital admissions.
CONCLUSIONS: Males first admitted when less than 50 years of age undergo more primary operations and develop more recurrences of diverticular disease than do older people. Based on our data, however, we recommend surgery for all patients after two episodes of acute diverticulitis that resolves after conservative treatment with antibiotics.},
}
@article {pmid9845136,
year = {1998},
author = {Jolobe, OM},
title = {Misdiagnosis of ruptured aortic aneurysm in diverticular disease.},
journal = {The European journal of surgery = Acta chirurgica},
volume = {164},
number = {11},
pages = {875},
doi = {10.1080/110241598750005327},
pmid = {9845136},
issn = {1102-4151},
mesh = {Acute Disease ; Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/*complications ; Aortic Rupture/*diagnosis ; *Diagnostic Errors ; Diverticulitis/*diagnosis ; Fatal Outcome ; Humans ; Male ; },
}
@article {pmid9835184,
year = {1998},
author = {Vitalone, AM and Caracino, V and Barone, C and Migliorato, L},
title = {[Colovesical fistulae as a complication of diverticula: a report of 2 cases].},
journal = {Il Giornale di chirurgia},
volume = {19},
number = {10},
pages = {395-398},
pmid = {9835184},
issn = {0391-9005},
mesh = {Aged ; Aged, 80 and over ; Colectomy ; Colon, Sigmoid/surgery ; Colonic Diseases/*etiology/surgery ; Diverticulum, Colon/*complications/surgery ; Emergencies ; Female ; Humans ; Intestinal Fistula/*etiology/surgery ; Urinary Bladder/surgery ; Urinary Bladder Fistula/*etiology/surgery ; },
abstract = {The authors report two cases of colovesical fistula as a complication of diverticular disease. They underline the increasing frequency of this complication, although the less frequent one. They also stress the importance of clinical and instrumental examinations that are several and among which TC scan can be crucial for surgical treatment. The therapy, exclusively surgical, can be made in one or two steps, according to patient status.},
}
@article {pmid9835123,
year = {1998},
author = {Messinetti, S and Giacomelli, L and Manno, A and Finizio, R and Fabrizio, G and Granai, AV and Busicchio, P and Lauria, V},
title = {Preservation and peeling of the inferior mesenteric artery in the anterior resection for complicated diverticular disease.},
journal = {Annali italiani di chirurgia},
volume = {69},
number = {4},
pages = {479-82; discussion 482-3},
pmid = {9835123},
issn = {0003-469X},
mesh = {Adult ; Aged ; Anastomosis, Surgical/methods ; Colon, Sigmoid/surgery ; Diverticulum, Colon/classification/*complications/*surgery ; Humans ; Male ; Mesenteric Artery, Inferior/*surgery ; Middle Aged ; Rectum/surgery ; Sigmoid Diseases/classification/*complications/*surgery ; },
abstract = {The authors, on the basis of 3 cases of complicated diverticular disease, discuss the indications to surgery, considering the advantages and disadvantages of the various surgical techniques and examining in particular the rules for a correct operation with resection and primary or secondary anastomosis. As they performed a rectosigmoidectomy with primary high colorectal anastomosis, they report the reasons why they adopted the preservation and peeling of the inferior mesenteric artery (IMA).},
}
@article {pmid9835119,
year = {1998},
author = {Gabrielli, F and Chiarelli, M and Guttadauro, A and Poggi, L and Pauna, I and Lovaria, A},
title = {[Bleeding in diverticular disease of the colon].},
journal = {Annali italiani di chirurgia},
volume = {69},
number = {4},
pages = {451-457},
pmid = {9835119},
issn = {0003-469X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/methods ; Diverticulum, Colon/*complications/pathology/surgery ; Female ; Gastrointestinal Hemorrhage/*etiology/pathology/surgery ; Humans ; Male ; Middle Aged ; },
abstract = {The incidence of bleeding from diverticular disease ranges from 3 to 30%. Haemorrhage is more common when the whole colon is affected; the source is more frequently in the right colon. Typically, the bleeding is massive, with 15% of the patients admitted in shock. It nearly always stops spontaneously, but recurrence rate is high. Chronic blood loss suggests alternative sources. Emergency angiography detects aetiology and site of the haemorrhage in most of the patients. Vasopressin infusion can frequently stop the bleeding. Colonoscopy is profitable only when bleeding stops, after a rapid clearing of the colon. On the other hand, intraoperative colonoscopy could be useful in emergency cases when urgent surgery is clearly indicated. Surgical treatment is requested only in few patients: segmental resections (generally right hemicolectomy) are indicated when there is evidence of the source of the blood loss. In the other cases sub-total or total colectomy are justified and provide better and safer results.},
}
@article {pmid9835118,
year = {1998},
author = {Gaetini, A and Camandona, M and Giaccone, M and Bertero, D and Iuliani, R},
title = {[Fistulae in diverticular disease of the colon].},
journal = {Annali italiani di chirurgia},
volume = {69},
number = {4},
pages = {445-450},
pmid = {9835118},
issn = {0003-469X},
mesh = {Aged ; Colectomy ; Colonic Diseases/diagnosis/*etiology/surgery ; Colostomy ; Diverticulum, Colon/*complications/diagnosis/surgery ; Female ; Humans ; Intestinal Fistula/diagnosis/*etiology/surgery ; Male ; Reoperation ; Surgical Wound Dehiscence/surgery ; },
abstract = {Fistulas in colon diverticular disease are a not uncommon complication, that arise spontaneously in the evolution of a diverticulitis, and also as a complicated dehiscence of surgical anastomosis. The intermediate step of a fistula is a deep abscess that finds through the parietal layers of abdomen or towards other adjacent organs. So the surgeon can be confronted with external and internal and complex fistulas. As for diagnostic manoeuvres, the surgical choices are outside a rigid schedule, and is on the personal sensibility of the surgeon.},
}
@article {pmid9835117,
year = {1998},
author = {Rosso, R and Parc, R},
title = {[The perforation complication in diverticulitis: the evolution of the surgical procedure].},
journal = {Annali italiani di chirurgia},
volume = {69},
number = {4},
pages = {439-443},
pmid = {9835117},
issn = {0003-469X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Diverticulitis, Colonic/complications/mortality/*surgery ; Female ; Humans ; Intestinal Perforation/etiology/mortality/*surgery ; Italy/epidemiology ; Male ; Middle Aged ; Peritonitis/etiology/mortality/surgery ; },
abstract = {The ideal treatment for perforative complication in diverticular disease of the colon is still now rather controversial. Fundamental remains the simple and practical classification of Hinchey for perforated diverticulitis, especially for a meaningful evaluation of different experience. Without a common reference classification the percentage differences in mortality are completely devoid of scientific value. From a "three-stage" procedure the preferences are shifted towards a "two-stage procedure", thanks to the improvement of anesthetic and surgical modern facilities. The Hartmann procedure, performed not earlier than 4-6 months is the experience of the authors, but the ultimate choice is conditioned by the degree of peritoneal contamination.},
}
@article {pmid9835116,
year = {1998},
author = {Carcoforo, P and Navarra, G and Sartori, A and Rocca, T and Pozza, E and Donini, I},
title = {[The indications for prophylactic colectomy in diverticular disease].},
journal = {Annali italiani di chirurgia},
volume = {69},
number = {4},
pages = {433-438},
pmid = {9835116},
issn = {0003-469X},
mesh = {*Colectomy/methods ; Diverticulitis, Colonic/*prevention & control ; Diverticulum, Colon/complications/*surgery ; Elective Surgical Procedures ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {Still controversial is the role of surgery in symptomatic colon diverticular disease, outside the major complications. In such circumstances the surgeon has to comfort himself with diagnostic and then with operative choices, and also the preventive colectomy has to be considered. To make a correct decision very important is the global evaluation of the patient, for age, sex life habits, other existing pathologies, general condition. Also unsolved doubt for a neoplastic evolution has its worth.},
}
@article {pmid9835115,
year = {1998},
author = {Zanghì, M and Cappellani, A and Di Vita, M and Zanghì, G},
title = {[Does there exist a current indication for myotomy in diverticular disease of the colon?].},
journal = {Annali italiani di chirurgia},
volume = {69},
number = {4},
pages = {427-432},
pmid = {9835115},
issn = {0003-469X},
mesh = {Adult ; Aged ; Colon/surgery ; Diverticulum, Colon/physiopathology/*surgery ; Humans ; Middle Aged ; Muscle, Smooth/*surgery ; Surgical Procedures, Operative/methods ; },
abstract = {Thanks to advances of gastroenterological and dietary regimen of patient with more complicated diverticular disease of the colon, the surgical indications to myotomy are nowadays very low, if not more at all. The insurgence of complications is naturally a precise indication to demolitive surgery actually with low postoperative morbidity and mortality.},
}
@article {pmid9835114,
year = {1998},
author = {Cola, B and Farella, S and Berardi, M and Lecce, F},
title = {[Diverticular disease of the colon: its epidemiology and etiology].},
journal = {Annali italiani di chirurgia},
volume = {69},
number = {4},
pages = {421-425},
pmid = {9835114},
issn = {0003-469X},
mesh = {Diverticulum, Colon/*epidemiology/*etiology/pathology/physiopathology ; Global Health ; Humans ; Incidence ; },
abstract = {Epidemiology for diverticular disease of the colon is rather difficult to assess because of the almost regularly selection of the patients submitted to analysis and described in literature. Therefore data extracted from different experiences are useful only for orientative epidemiologic implications. In the meanwhile these studies have been very useful to understand the possible reasons of its insurgence and evolution. Actually for etiopathogenesis the more diffuse opinion is to give importance to low fibre diet and to intrinsic motor derangement of the colon.},
}
@article {pmid9834314,
year = {1999},
author = {Lewis, BS},
title = {Radiology versus endoscopy of the small bowel.},
journal = {Gastrointestinal endoscopy clinics of North America},
volume = {9},
number = {1},
pages = {13-27},
pmid = {9834314},
issn = {1052-5157},
mesh = {Angiography ; Barium Sulfate/administration & dosage ; Biopsy ; Contrast Media/administration & dosage ; *Endoscopy, Gastrointestinal ; Enema ; Female ; Humans ; Intestinal Diseases/*diagnosis ; Intestine, Small/*diagnostic imaging/*pathology ; Male ; *Radiography, Abdominal ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; },
abstract = {Since the development of endoscopy, physicians have been comparing radiographic studies with endoscopic examinations. Colonoscopy and upper endoscopy have largely replaced barium enema and upper gastrointestinal series. Unfortunately, many study protocols comparing colonoscopy with barium enema have been retrospective and the radiologic examination is compared with colonoscopy in a cohort group. The greatest difficulty with interpreting results of these studies is the inclusion of clinically insignificant findings in the calculation of the diagnostic yield. For example, in most studies barium enema is more successful than colonoscopy in diagnosing diverticular disease, and inclusion of this clinically insignificant entity increases the overall yield.},
}
@article {pmid9831844,
year = {1998},
author = {Pereira, MC},
title = {Diverticular disease-associated colitis: progression to severe chronic ulcerative colitis after sigmoid surgery.},
journal = {Gastrointestinal endoscopy},
volume = {48},
number = {5},
pages = {520-523},
doi = {10.1016/s0016-5107(98)70097-5},
pmid = {9831844},
issn = {0016-5107},
mesh = {Aged ; Colitis, Ulcerative/*etiology/*pathology ; Disease Progression ; Diverticulitis, Colonic/*complications/*surgery ; *Endoscopy ; Female ; Humans ; Middle Aged ; Severity of Illness Index ; *Sigmoidoscopy ; },
}
@article {pmid9822925,
year = {1998},
author = {Burroughs, SH and Bowrey, DJ and Morris-Stiff, GJ and Williams, GT},
title = {Granulomatous inflammation in sigmoid diverticulitis: two diseases or one?.},
journal = {Histopathology},
volume = {33},
number = {4},
pages = {349-353},
doi = {10.1046/j.1365-2559.1998.00521.x},
pmid = {9822925},
issn = {0309-0167},
mesh = {Aged ; Aged, 80 and over ; Disease-Free Survival ; Diverticulitis, Colonic/immunology/*pathology/surgery ; Female ; Granuloma/immunology/*pathology/surgery ; Humans ; Male ; Middle Aged ; Sigmoid Diseases/immunology/*pathology/surgery ; },
abstract = {AIMS: Histological appearances indistinguishable from Crohn's disease have been described in patients undergoing sigmoid colectomy for complicated diverticular disease. To investigate whether this finding represents coincidental dual pathology or merely a granulomatous colitis confined to the diverticular segment, we undertook clinical follow-up of affected patients.
METHODS AND RESULTS: Eight patients (median age 64 years, four males) whose sigmoid colectomy specimens showed acute diverticulitis and granulomatous inflammation were identified. All had a pre-operative diagnosis of diverticular disease and no previous evidence of Crohn's disease. Non-caseating epithelioid granulomas, unrelated to foreign material and usually unrelated to inflamed diverticular were present in the bowel wall of seven cases and in the regional lymph nodes of five. Three had granulomatous vasculitis and two had granulomas in 'background' mucosa. Mural lymphoid aggregates were identified in all cases. However, fissuring ulcers distinct from inflamed diverticula were not identified. On median follow-up of 51 months (range 18-112 months) none of the patients developed evidence of chronic inflammatory bowel disease. Three had died from unrelated causes.
CONCLUSIONS: Granulomatous inflammation appears to be part of a spectrum of sigmoid diverticulitis. In this setting, caution should be exercised to avoid an inappropriate diagnosis of Crohn's disease.},
}
@article {pmid9822464,
year = {1998},
author = {Bouillot, JL and Aouad, K and Badawy, A and Alamowitch, B and Alexandre, JH},
title = {Elective laparoscopic-assisted colectomy for diverticular disease. A prospective study in 50 patients.},
journal = {Surgical endoscopy},
volume = {12},
number = {12},
pages = {1393-1396},
doi = {10.1007/s004649900866},
pmid = {9822464},
issn = {0930-2794},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/*methods ; Diverticulitis/diagnosis/*surgery ; Elective Surgical Procedures ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Prospective Studies ; Retrospective Studies ; Sigmoid Diseases/diagnosis/*surgery ; Sigmoidoscopy ; Treatment Outcome ; },
abstract = {BACKGROUND: Although several recent reports described the different methods utilized for laparoscopic colon resection, only a few of them questioned whether the procedure is appropriate for the surgical treatment of diverticular disease. To assess this question, we performed a retrospective study of 50 consecutive patients operated using laparoscopic assistance to remove the sigmoid colon for diverticular disease.
METHOD: The surgical technique was a laparoscopically assisted procedure that included mobilization of the left colon and vascular ligation laparoscopically and then, via a small abdominal incision, division of the colon, removal of the specimen, and hand-sewn anastomosis.
RESULTS: The surgical goal was achieved in 46 cases, with a conversion rate of 8%. The mean operative time was 195 min (range 150-280 min). There was no mortality, and the morbidity rate was 14%. There were no complications directly related to the laparoscopic technique. The mean return of regular bowel habits was 3.2 days, and the median postoperative stay was 10 days.
CONCLUSIONS: These preliminary results suggest that laparoscopic-assisted sigmoidectomy can be used safely for the surgical treatment of diverticular disease.},
}
@article {pmid9786292,
year = {1998},
author = {Kuganeswaran, E and Fisher, JK},
title = {Giant sigmoid diverticulum: a rare manifestation of diverticular disease.},
journal = {Southern medical journal},
volume = {91},
number = {10},
pages = {952-955},
pmid = {9786292},
issn = {0038-4348},
mesh = {Aged ; Diverticulum, Colon/diagnostic imaging/*pathology ; Humans ; Male ; Middle Aged ; Sigmoid Diseases/diagnostic imaging/*pathology ; Tomography, X-Ray Computed ; },
abstract = {We report two unusual cases of giant sigmoid diverticulum, which is a rare manifestation of diverticular disease. Giant diverticula are 3 to 4 cm or greater in size and are produced by gradual enlargement of an acquired pseudodiverticulum that has had superimposed infection, abscess formation, and healing. For more than 3 years, we have observed and managed the first case conservatively, without surgery. The second case represents the largest recorded giant sigmoid diverticulum (33 cm) in the literature. We review the pathogenesis, clinical features, differential diagnosis, and management of this condition.},
}
@article {pmid9785111,
year = {1998},
author = {Mendez, LE and Bhoola, SM and Horowitz, IR},
title = {Bilateral tubo-ovarian abscesses four years after total abdominal hysterectomy.},
journal = {Infectious diseases in obstetrics and gynecology},
volume = {6},
number = {3},
pages = {138-140},
pmid = {9785111},
issn = {1064-7449},
mesh = {Abscess/*diagnosis/microbiology ; Adult ; Diagnosis, Differential ; Female ; Humans ; *Hysterectomy ; Pelvic Inflammatory Disease/*diagnosis/microbiology ; Streptococcal Infections/*diagnosis ; },
abstract = {BACKGROUND: Pelvic inflammatory disease (PID) is a common gynecologic disorder. One known complication of PID is tubo-ovarian abscess (TOA) formation. The predominant theory on TOA formation postulates that an ascending infection from the cervix through the uterus to the fallopian tubes and ovaries results in abscess formation. Other theories include seeding via a hematogenous infection, diverticular disease, and appendicitis.
CASE: A 39-year-old female patient with abdominal pain was referred to our institution and was found to have a pelvic mass. After a thorough evaluation, surgical exploration revealed the presence of TOA. No evidence of gastrointestinal disease was present. The patient's history was significant for an uncomplicated total abdominal hysterectomy for benign disease of the uterus four years prior. Abscess cultures grew Streptococcus intermedius.
CONCLUSION: This case reports the rare occurrence of TOA in a patient who had undergone an abdominal hysterectomy four years prior to presentation. If the patient reports a surgical history of prior hysterectomy, TOA is often stricken from consideration. Although unlikely, adnexal abscess formation should be considered in the differential diagnosis of a patient with abdominal pain and a pelvic mass, even with a remote history of hysterectomy.},
}
@article {pmid9749503,
year = {1998},
author = {Choong, CK and Frizelle, FA},
title = {Giant colonic diverticulum: report of four cases and review of the literature.},
journal = {Diseases of the colon and rectum},
volume = {41},
number = {9},
pages = {1178-85; discussion 1185-6},
doi = {10.1007/BF02239441},
pmid = {9749503},
issn = {0012-3706},
mesh = {Aged ; Aged, 80 and over ; Colon/abnormalities/diagnostic imaging/pathology/surgery ; Colostomy ; Diagnosis, Differential ; Diverticulum, Colon/diagnostic imaging/pathology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; },
abstract = {PURPOSE: Giant colonic diverticulum are rare, with 103 reported cases in 95 patients. The experience of any one surgeon is limited. We aimed to retrospectively review our experience and to review the literature on origin, pathology, and management of this rare and unusual problem.
METHOD: Cases were identified by review of pathologic database and by computerized audit from three hospitals.
RESULTS: Five giant colonic diverticulum were identified in four patients, and the pathology and management were reviewed.
CONCLUSION: A definition and classification system of giant colonic diverticulum is suggested. Giant colonic diverticulum should be the universal term to cover all colonic diverticulum larger than 4 cm, and we suggest that there are two types based on histology. Literature review reveals 103 reported cases in 95 patients. Type I (87 percent) is a pseudodiverticulum, perhaps related to conventional diverticular disease, whereas Type II (13 percent) is a true diverticulum, which is probably a type of communicating cystic congenital duplication. These lesions tend to occur in the sigmoid colon (93 percent) and present with complications similar to conventional diverticular disease. In the presence of conventional diverticular disease, consideration should be given to anterior resection, and in the absence, diverticulectomy should be considered.},
}
@article {pmid9740981,
year = {1998},
author = {Kennedy, MV and Zarling, EJ},
title = {Answers to 10 key questions on diverticular disease of the colon.},
journal = {Comprehensive therapy},
volume = {24},
number = {8},
pages = {364-369},
pmid = {9740981},
issn = {0098-8243},
mesh = {Diverticulum, Colon/diagnosis/diet therapy/physiopathology/*therapy ; Humans ; *Patient Education as Topic ; },
abstract = {Diverticular disease is common in industrialized countries, and will become more prevalent in the future. Although it is usually a benign condition, treatment with high-fiber diet may prevent complications such as infection, stricture, or bleeding.},
}
@article {pmid9731807,
year = {1998},
author = {Trillo, C and Paris, MF and Brennan, JT},
title = {Primary anastomosis in the treatment of acute disease of the unprepared left colon.},
journal = {The American surgeon},
volume = {64},
number = {9},
pages = {821-4; discussion 824-5},
pmid = {9731807},
issn = {0003-1348},
mesh = {Abdominal Abscess/complications ; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; *Anastomosis, Surgical/adverse effects/methods ; Colitis, Ischemic/complications ; Colon/*surgery ; Colonic Diseases/*surgery ; Colonic Neoplasms/surgery ; Contraindications ; Diverticulitis, Colonic/surgery ; Enterocolitis, Pseudomembranous/surgery ; Feces ; Female ; Glucocorticoids/administration & dosage/therapeutic use ; Humans ; Intestinal Obstruction/surgery ; Intestinal Perforation/surgery ; Intraoperative Complications ; Length of Stay ; Male ; Middle Aged ; Pelvis ; Peritoneum/pathology ; Prednisolone/administration & dosage/therapeutic use ; Pulmonary Atelectasis/etiology ; Rectal Neoplasms/surgery ; Shock/complications ; Sigmoid Diseases/surgery ; Surgical Stapling/adverse effects/methods ; Surgical Wound Dehiscence/etiology ; Surgical Wound Infection/etiology ; Time Factors ; },
abstract = {Between June 1, 1990 and December 31, 1996, 58 consecutive patients with unprepared colons were urgently explored for nontraumatic disease with intent to proceed with primary left-sided colonic anastomosis. Unprotected anastomoses were not attempted in 15 patients. The causes of exclusion included preoperative and intraoperative shock in three patients, and three patients were on long-term high-dose steroids, four had gross fecal contamination of the peritoneal cavity, four had large pelvic abscesses, and one had ischemic colitis. All 43 patients undergoing anastomosis without protective colostomy had stapled anastomoses. Indications included complicated diverticular disease in 32 cases. There were nine cases of obstruction from colorectal carcinoma and one obstruction due to sigmoid volvulus. There was one case of perforation from pseudomembranous enterocolitis. The most common complications were: atelectasis in nine cases, wound infection in two cases, and prolonged ileus in two cases. Pelvic abscess occurred in one case. There was one wound dehiscence. There was one anastomotic dehiscence, and there was no mortality. Operative time averaged 85 minutes and hospital length of stay 9.7 days. Primary anastomosis of the unprepared left colon is safe in most urgent and emergent situations, thus avoiding the significant morbidity and cost of colostomy closure.},
}
@article {pmid9708006,
year = {1998},
author = {Rodríguez Romano, D and Jiménez Romero, C and Moreno González, E and Hidalgo Pascual, M and Rey Pérez, P and Manzanera Díaz, M and Castellón Pavón, C},
title = {Management of lower gastrointestinal bleeding in colonic diverticular disease.},
journal = {Revista espanola de enfermedades digestivas},
volume = {90},
number = {6},
pages = {411-418},
pmid = {9708006},
issn = {1130-0108},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*complications ; Female ; Gastrointestinal Hemorrhage/*etiology/*therapy ; Humans ; Male ; Middle Aged ; },
abstract = {AIM: To evaluate the clinical course, diagnostic approach, therapeutic measures and results, in a series of 13 patients with colonic bleeding diverticula.
MATERIAL AND METHODS: From 1973 to 1995, 72 patients were admitted with the diagnosis of lower gastroin testinal bleeding. Thirteen presented a colonic diverticula bleeding. Mean age was 65.2 years. Medical history, symptoms, diagnosis, treatment (conservative or surgical) and pathology were recorded.
RESULTS: Main bleeding time was 3 days. Eight patients needed blood transfusion. All patients underwent colonoscopic examination and it was diagnostic in every patient. Four patients underwent surgery: one case, because of massive hemorrhage and the other three cases due to bleeding recurrence. Pancolectomy was performed in one patient, ileal resection in another and the other two were treated with a sigmoidectomy and a left hemicolectomy. Pathology analysis corroborated colonic diverticula diagnosis. There was no postoperative mortality. Bleeding recurrence did not occur either in postoperative period or in the follow-up.
CONCLUSIONS: Colonic diverticular bleeding usually stops spontaneously, obtaining high rates of preoperative diagnosis with colonoscopy. Less than a third of the cases requires surgical resection.},
}
@article {pmid9677809,
year = {1998},
author = {Vitale, MV and Cervo, F and Barbieri, F},
title = {[Vaginal-sigmoid fistula caused by diverticular disease].},
journal = {Minerva ginecologica},
volume = {50},
number = {5},
pages = {195-197},
pmid = {9677809},
issn = {0026-4784},
mesh = {Aged ; Diverticulum/*complications/surgery ; Female ; Fistula/*etiology/surgery ; Humans ; Laparoscopy ; Sigmoid Diseases/*etiology/surgery ; Vaginal Diseases/*etiology/surgery ; },
abstract = {A case of a 66 years old patient suffering from a sigmoido-vaginal fistula and diverticulosis, previously treated with a total laparohysterectomy, is reported. Retrograde studies demonstrated the presence of fistula, whereas colonoscopy and barium enema failed. After laparotomy and an appropriate bowel preparation, surgery was restricted to the bowel resection and anastomosis, whereas the vaginal defect was not closed.},
}
@article {pmid9666292,
year = {1998},
author = {Fernández Ruiz, M and Fernández Fernández, A},
title = {[Pneumomediastinum and diverticular disease].},
journal = {Archivos de bronconeumologia},
volume = {34},
number = {6},
pages = {312},
doi = {10.1016/s0300-2896(15)30420-8},
pmid = {9666292},
issn = {0300-2896},
mesh = {Aged ; Diverticulum/*complications/surgery ; Humans ; Male ; Mediastinal Emphysema/*etiology ; Sigmoid Diseases/*complications/surgery ; },
}
@article {pmid9596461,
year = {1998},
author = {Mold, JW},
title = {Analgesics and symptomatic diverticular disease.},
journal = {Archives of family medicine},
volume = {7},
number = {3},
pages = {262-263},
doi = {10.1001/archfami.7.3.262},
pmid = {9596461},
issn = {1063-3987},
mesh = {Acetaminophen/*adverse effects ; Analgesics, Non-Narcotic/*adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Causality ; Confounding Factors, Epidemiologic ; Cross-Sectional Studies ; Diverticulitis/*chemically induced/diagnosis/epidemiology ; Humans ; Reproducibility of Results ; Research Design ; United States/epidemiology ; },
}
@article {pmid9596460,
year = {1998},
author = {Aldoori, WH and Giovannucci, EL and Rimm, EB and Wing, AL and Willett, WC},
title = {Use of acetaminophen and nonsteroidal anti-inflammatory drugs: a prospective study and the risk of symptomatic diverticular disease in men.},
journal = {Archives of family medicine},
volume = {7},
number = {3},
pages = {255-260},
doi = {10.1001/archfami.7.3.255},
pmid = {9596460},
issn = {1063-3987},
support = {CA55075/CA/NCI NIH HHS/United States ; HL35464/HL/NHLBI NIH HHS/United States ; },
mesh = {Acetaminophen/*adverse effects ; Adult ; Aged ; Analgesics, Non-Narcotic/*adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Diverticulitis/*chemically induced/diagnosis/epidemiology ; Health Personnel/statistics & numerical data ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk ; Risk Factors ; Surveys and Questionnaires ; United States/epidemiology ; },
abstract = {OBJECTIVE: To examine prospectively the relationship between self-reported regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen and the risk of symptomatic diverticular disease.
DESIGN: Prospective cohort study using a mailed baseline questionnaire in 1986, and follow-up every 2 years through 1992.
SETTING: Male health professionals residing in 50 US states.
PATIENTS: A total of 35 615 male health professionals (dentists, optometrists, veterinarians, physicians, pharmacists, osteopathic physicians, podiatrists) 40 to 75 years of age at baseline and free of diagnosed diverticular disease, colon or rectal polyp, ulcerative colitis, and cancer prior to 1988.
MAIN OUTCOME MEASURES: Follow-up questionnaires in 1988, 1990, and 1992 about use of NSAIDs, acetaminophen, and other variables including the diagnosis of symptomatic diverticular disease.
RESULTS: During 4 years of follow-up, we documented 310 newly diagnosed cases of symptomatic diverticular disease. After adjustment for age, physical activity, and energy-adjusted dietary fiber and total fat intake, regular and consistent use of NSAIDs and acetaminophen was positively associated with the overall risk of symptomatic diverticular disease (for users vs nonusers, relative risk [RR] for NSAIDs = 2.24, 95% confidence interval [CI], 1.28-3.91; RR for acetaminophen = 1.81, 95% CI, 0.79-4.11). Most of this positive association was attributable to cases associated with bleeding, particularly for acetaminophen (for users vs nonusers, RR for NSAIDs = 4.64, 95% CI, 0.99-21.74; RR for acetaminophen = 13.63, 95% CI, 3.53-52.60).
CONCLUSIONS: These results suggest that regular and consistent use of NSAIDs in general and acetaminophen is associated with symptoms of severe diverticular disease, particularly bleeding. Further research is needed to investigate the potentially deleterious effect of NSAIDs and other medications on the lower gastrointestinal tract.},
}
@article {pmid9593248,
year = {1998},
author = {Mooney, MJ and Elliott, PL and Galapon, DB and James, LK and Lilac, LJ and O'Reilly, MJ},
title = {Hand-assisted laparoscopic sigmoidectomy for diverticulitis.},
journal = {Diseases of the colon and rectum},
volume = {41},
number = {5},
pages = {630-635},
doi = {10.1007/BF02235273},
pmid = {9593248},
issn = {0012-3706},
mesh = {Adult ; Aged ; Diverticulitis/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Treatment Outcome ; },
abstract = {BACKGROUND: Sigmoid colectomy for diverticular disease, a routine procedure when performed using standard open methods, can prove much more challenging using minimum access techniques. Hand-assisted laparoscopic colectomy is a new technique that reportedly has a minimum learning curve, yet retains the benefits of a laparoscopic procedure. The purpose of this study was to perform and then prospectively to evaluate the outcome of this procedure on patients needing elective sigmoidectomy for diverticular disease.
METHODS: Hand-assisted laparoscopic sigmoidectomy was performed on all patients undergoing elective sigmoidectomy for diverticular disease between January 18, 1996, and November 21, 1996.
RESULTS: The study group consisted of six men and three women. Age averaged 50.8 (range, 39-66) years, weight averaged 183 (range, 150-224) pounds, and operation time averaged 3 hours and 42 minutes (range, 3-5 hours). No cases were converted to open methods. There were two minor postoperative complications (bleeding from the staple line, 1 patient; urinary retention, 1 patient; 22 percent). Resumption of flatus (which was the indication to start the patient on an oral diet) occurred between one and three (average, 1.44) days postoperatively. Patients were discharged from the hospital between one and three (average, 2.1) days postoperatively. Primary surgeon responsibility was distributed among four different surgeons, of which only the lead author previously had performed laparoscopic colectomy at this institution.
CONCLUSIONS: Hand-assisted laparoscopic sigmoidectomy is a procedure that has a minimum learning curve, yet retains the benefits of a laparoscopic procedure.},
}
@article {pmid9586163,
year = {1998},
author = {Illert, B and Thiede, A},
title = {[Therapeutic aspects of diverticular disease from the surgical viewpoint over time].},
journal = {Zentralblatt fur Chirurgie},
volume = {123 Suppl},
number = {},
pages = {4-9},
pmid = {9586163},
issn = {0044-409X},
mesh = {Acute Disease ; Adult ; Aged ; Anastomosis, Surgical/trends ; Colectomy/*trends ; Diverticulitis, Colonic/complications/mortality/*surgery ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/mortality/surgery ; Reoperation ; Risk Factors ; Survival Rate ; },
}
@article {pmid9521633,
year = {1998},
author = {Aldoori, WH and Giovannucci, EL and Rockett, HR and Sampson, L and Rimm, EB and Willett, WC},
title = {A prospective study of dietary fiber types and symptomatic diverticular disease in men.},
journal = {The Journal of nutrition},
volume = {128},
number = {4},
pages = {714-719},
doi = {10.1093/jn/128.4.714},
pmid = {9521633},
issn = {0022-3166},
support = {CA55075/CA/NCI NIH HHS/United States ; HL35464/HL/NHLBI NIH HHS/United States ; },
mesh = {Adult ; Aged ; Cohort Studies ; Dietary Fiber/*administration & dosage/pharmacology ; Diverticulum/*prevention & control ; Health Personnel ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Prospective Studies ; },
abstract = {To examine prospectively dietary fiber calculated from food composition values based on analytic techniques and specific dietary fiber types in relation to risk of diverticular disease, we analyzed data from a prospective cohort of 43,881 U.S. male health professionals 40-75 y of age at base line; subjects were free of diagnosed diverticular disease, colon or rectal polyps, ulcerative colitis and cancer. The insoluble component of fiber was inversely associated with risk of diverticular disease relative risk (RR) = 0. 63, 95% confidence interval (CI), 0.44-0.91, P for trend = 0.02, and this association was particularly strong for cellulose (RR = 0.52, 95% CI, 0.36-0.75, P for trend = 0.002). The association between diverticular disease and total dietary fiber intake calculated from the AOACstandards method was not appreciably different from results using the Southgate or Englyst method [for AOAC method, RR = 0.60, 95% CI, 0.41-0.87; for Southgate method, RR = 0.61, 95% CI, 0.42-0. 88; for Englyst method, RR = 0.60, 95% CI, 0.42-0.87, for the highest quintiles]. Our findings provide evidence for the hypothesis that a diet high in dietary fiber decreases the risk of diverticular disease, and this result was not sensitive to the use of different analytic techniques to define dietary fiber. Our findings suggest that the insoluble component of fiber was significantly associated with a decreased risk of diverticular disease, and this inverse association was particularly strong for cellulose.},
}
@article {pmid9577347,
year = {1998},
author = {Gledhill, A and Dixon, MF},
title = {Crohn's-like reaction in diverticular disease.},
journal = {Gut},
volume = {42},
number = {3},
pages = {392-395},
pmid = {9577347},
issn = {0017-5749},
mesh = {Aged ; Aged, 80 and over ; Crohn Disease/*complications/pathology ; Diagnosis, Differential ; Diverticulitis, Colonic/*complications/pathology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {BACKGROUND: Diverticulitis and Crohn's disease affecting the colon occur at similar sites in older individuals, and in combination are said to carry a worse prognosis than either disease in isolation. It is possible that diverticulitis may initiate inflammatory changes which resemble Crohn's disease histologically, but do not carry the clinical implications of chronic inflammatory bowel disease.
AIMS: To evaluate histological features and clinical outcome in individuals initially diagnosed histologically as having both Crohn's colitis and diverticulitis.
PATIENTS: Eleven consecutive individuals having a colonic resection showing histological features of both Crohn's disease and diverticulitis.
METHODS: Retrospective review of histological specimens, case notes, and discharge letters.
RESULTS: In nine patients, the Crohn's-like reaction was confined to the segment bearing diverticula. They had no clinical evidence of Crohn's disease.
CONCLUSION: A Crohn's-like inflammatory response can be a localised reaction to diverticulitis and does not necessarily indicate chronic inflammatory bowel disease.},
}
@article {pmid9577071,
year = {1998},
author = {Lux, G and Langer, M and Stabenow-Lohbauer, U and Orth, KH and Bozkurt, T and Meyer, MJ},
title = {[Diverticulosis and diverticulitis in the elderly].},
journal = {Fortschritte der Medizin},
volume = {116},
number = {9},
pages = {26-8, 30, 32-4},
pmid = {9577071},
issn = {0015-8178},
mesh = {Aged ; Colonoscopy ; Combined Modality Therapy ; Diagnosis, Differential ; Diagnostic Imaging ; Diverticulitis, Colonic/complications/*diagnosis/therapy ; Diverticulum, Colon/complications/*diagnosis/therapy ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {Diverticulosis of the colon is a disease that mainly affects the elderly, presenting in 10 to 20% of this age group. The most common complication--painful diverticular disease, is usually treated conservatively with a high-fiber diet, intermittent use of antispasmodics and possibly regulation of the stools. Diagnostic differentiation is best performed using ultrasonography of the bowel wall, supplemented where necessary by computer tomography and colonoscopy (sigmoidoscopy) or, where this latter is not possible, barium enema using Gastrografin. Conservative treatment of diverticulitis with antibiotics, bowel rest, possibly including parenteral alimentation, is usually applied for three to ten days. In the absence of a response to this treatment, frequent recurrence, immunosuppression or complications (perforation, peritonitis, enterovesicular fistula), surgery is indicated.},
}
@article {pmid9572644,
year = {1998},
author = {Candelas, G and Jover, JA and Fernandez, B and Rodriguez-Olaverri, JC and Calatayud, J},
title = {Perforation of the sigmoid colon in a rheumatoid arthritis patient treated with methylprednisolone pulses.},
journal = {Scandinavian journal of rheumatology},
volume = {27},
number = {2},
pages = {152-153},
doi = {10.1080/030097498441056},
pmid = {9572644},
issn = {0300-9742},
mesh = {Arthritis, Rheumatoid/*drug therapy ; Colon, Sigmoid/diagnostic imaging/*drug effects ; Drug Therapy, Combination ; Humans ; Infusions, Intravenous ; Intestinal Perforation/*chemically induced/diagnostic imaging ; Male ; Methylprednisolone/administration & dosage/*adverse effects ; Middle Aged ; Radiography ; },
abstract = {We describe a 61 year-old caucasian male diagnosed with rheumatoid arthritis. He was started on methylprednisolone pulses because of a severe flare of symmetric polyarthritis while he was on weekly intramuscular methotrexate and low-dose oral prednisone. After the second pulse of methylprednisolone the patient suddenly developed severe abdominal pain with free air under the right hemidiaphragm in the chest roentgenogram. The emergency surgery revealed the perforation of a colonic diverticulum. We suggest that methylprednisolone pulses should be carefully used in those patients over 50 years of age and/or people with demonstrated or suspected diverticular disease.},
}
@article {pmid9563217,
year = {1998},
author = {Balsara, KP and Dubash, C},
title = {Complicated sigmoid diverticulosis.},
journal = {Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology},
volume = {17},
number = {2},
pages = {46-47},
pmid = {9563217},
issn = {0254-8860},
mesh = {Aged ; Aged, 80 and over ; Cellulitis/etiology/surgery ; Diverticulum, Colon/*complications/surgery ; Female ; Humans ; Intestinal Fistula/etiology/*surgery ; Male ; Middle Aged ; Peritonitis/etiology/*surgery ; Postoperative Complications ; Sigmoid Diseases/*complications/surgery ; Treatment Outcome ; },
abstract = {BACKGROUND: To evaluate the outcome of patients treated for complications of sigmoid diverticular disease.
METHODS: Fifteen patients (11 women; aged 54-80 years) were treated over a 6-year period in a community hospital. Five patients presented with perforation and peritonitis, 3 with colovesical fistula, 2 with colovaginal fistula, 2 with recurrent phlegmon and 3 with bleeding. Six patients (5 with perforation, 1 colovesical fistula with hematuria) underwent emergency surgery. Six patients (2 with colovesical fistula, 2 colovaginal fistula and 2 recurrent phlegmon) underwent planned sigmoid resection. All 3 patients with bleeding were treated conservatively.
RESULTS: One patient with a colovesical fistula and severe hematuria died 72 hours later with septicemia. All 5 patients with peritonitis survived; two had an eventful post-operative period and were in hospital for nearly 3 months. All 5 developed wound sepsis. Six patients who had a planned procedure had uneventful recovery. The 3 patients who presented with bleeding recovered.
CONCLUSION: Complicated diverticular disease carries a high morbidity and mortality especially when operated on as an emergency. Interval sigmoid resection should be offered to patients who have recovered from an acute complication.},
}
@article {pmid9556247,
year = {1998},
author = {Eu, KW and Lim, SL and Seow-Choen, F and Leong, AF and Ho, YH},
title = {Clinical outcome and bowel function following total abdominal colectomy and ileorectal anastomosis in the Oriental population.},
journal = {Diseases of the colon and rectum},
volume = {41},
number = {2},
pages = {215-218},
doi = {10.1007/BF02238251},
pmid = {9556247},
issn = {0012-3706},
mesh = {Adenomatous Polyposis Coli/surgery ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Antidiarrheals/therapeutic use ; *Colectomy/mortality ; Colon/*surgery ; Colonic Neoplasms/surgery ; Defecation/physiology ; Diverticulum, Colon/surgery ; Female ; Follow-Up Studies ; Humans ; Ileum/*surgery ; Intestinal Obstruction/etiology ; Length of Stay ; Male ; Middle Aged ; Peristalsis/physiology ; Postoperative Complications ; Rectum/*surgery ; Reoperation ; Treatment Outcome ; },
abstract = {UNLABELLED: Total abdominal colectomy with ileorectal anastomosis is a commonly performed surgical procedure. The postoperative outcome of these patients, however, has not been studied in detail in the Asian population.
AIM: The purpose of this study was to analyze the functional outcome of patients following total abdominal colectomy and ileorectal anastomosis.
METHOD: All patients subjected to a total abdominal colectomy with ileorectal anastomosis during a six-year period from February 1989 to October 1995 were reviewed.
RESULTS: Sixty-six patients (male:female, 40:26) with a mean age of 55.2 (range, 20-88) years underwent total abdominal colectomy with ileorectal anastomosis. Median follow-up after surgery was 26 (range, 4-78) months. Indications for surgery were synchronous or metachronous tumors (18), complicated pancolonic diverticular disease (15), obstructed tumors with impending perforation (13), familial adenomatous polyposis (7), slow-transit constipation (6), and others (7). Mean operative time was 137 +/- 48 minutes. Mean postoperative hospitalization was 13.3 +/- 11.9 days. Time to first bowel movement and commencement of solid diet were 4.7 +/- 1.8 and 7.2 +/- 2.4 days, respectively. Four patients had prolonged postoperative ileus. Average stool frequencies per day were 5.5 at one week, 4.3 at one month, 3.9 at six months, 3.2 at one year, and 2.9 at two years postoperatively. Thirty-three patients (50 percent) required antidiarrheal treatment for a transient period, but none required long-term therapy. Ninety-seven percent of all patients rated the functional outcome as good to excellent, and 3 percent said it was fair. There was two perioperative mortalities. Five cases required re-laparotomy, three for anastomotic complications and two for hemoperitoneum. Five patients had recurrent admissions for adhesion colic, which resolved with nonsurgical therapy. Ten patients succumbed on follow-up, six to tumor recurrence, two to unrelated cancers (stomach and bladder), and three to medical conditions.
CONCLUSION: The functional outcome of ileorectal anastomosis is generally rated as good to excellent by patients. Acceptable bowel function and control is regained within six months of the operation and levels off at one year after surgery, and no patient requires long-term antidiarrheal medication.},
}
@article {pmid9551261,
year = {1998},
author = {Flückiger, R and Styger, S and Huber, A},
title = {[Diverticulitis of the cecum and ascending colon].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {69},
number = {2},
pages = {174-179},
doi = {10.1007/s001040050392},
pmid = {9551261},
issn = {0009-4722},
mesh = {Abdomen, Acute/etiology ; Adult ; Aged ; Cecal Diseases/diagnosis/*surgery ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis/*surgery ; Female ; Humans ; Intestinal Perforation/diagnosis/surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed ; },
abstract = {Right colon diverticulitis, representing 1-3.6% of cases of diverticular disease is an uncommon cause of right lower quadrant pain. Its presentation is difficult to distinguish from acute appendicitis. Patients are between 35 and 50 years old, have a history of 2-3 days of abdominal pain and few gastrointestinal symptoms. The diagnosis is best confirmed by computed tomography and colonoscopy. Conservative treatment is justified in uncomplicated disease, whereas perforations, abcesses and inflammatory tumors require resection. We describe the cases of six patients treated at our institution from 1991 to 1996. Presentation, geographic variations, diagnostic procedures and management are discussed.},
}
@article {pmid9548100,
year = {1998},
author = {Köhler, L and Rixen, D and Troidl, H},
title = {Laparoscopic colorectal resection for diverticulitis.},
journal = {International journal of colorectal disease},
volume = {13},
number = {1},
pages = {43-47},
doi = {10.1007/s003840050130},
pmid = {9548100},
issn = {0179-1958},
mesh = {Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Colon, Sigmoid/surgery ; Convalescence ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy/methods ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Time Factors ; },
abstract = {This study evaluated outcome in patients undergoing laparoscopically assisted sigmoid resection for diverticular disease. A total of 29 consecutive patients were treated surgically for colonic diverticulitis; in 27 of these laparoscopy was performed. The review of medical records from a control group of 34 patients undergoing open resection were used for comparison. The conversion rate was 7.5%. Using the laparoscopic technique the duration of surgery was longer (165 vs. 121 min, P < 0.05), blood loss less (182 vs. 352 ml, P < 0.05), and subsequent blood transfusion less (0 vs. 61%). The incidence of complications following laparoscopic resection was lower (two anastomotic leakages, two wound infections) than in the conventional group. Convalescence in the laparoscopic group was more rapid and hospital stay shorter (7.9 vs. 14.3 days, P < 0.05). In the laparoscopic group patients expressed less pain at rest and in motion. The cost of the laparoscopically assisted procedure was less than that of conventional resection (7185 vs. 8975 DM). In this series laparoscopically assisted sigmoid resection for diverticulitis proved safe. Recovery was faster, hospital stay was shorter, and patients expressed less pain than in conventional open surgery.},
}
@article {pmid9543529,
year = {1998},
author = {Davidson, R and Sweeney, WB},
title = {Endoluminal stenting for benign colonic obstruction.},
journal = {Surgical endoscopy},
volume = {12},
number = {4},
pages = {353-354},
doi = {10.1007/s004649900670},
pmid = {9543529},
issn = {0930-2794},
mesh = {Colonic Diseases/etiology/*therapy ; Diverticulitis, Colonic/complications ; *Endoscopy, Gastrointestinal ; Female ; Humans ; Intestinal Obstruction/etiology/*therapy ; Middle Aged ; *Stents ; },
abstract = {We report a case of complete descending colon obstruction due to diverticular disease that was initially managed by endoscopic stent placement followed by single-stage left colectomy with primary anastomosis. Traditional management of complete large bowel obstruction, whether due to benign or malignant disease, most often requires a temporary colostomy because of unprepared colon. In this case, preparation of the colon was accomplished by successful stenting of the benign colonic obstruction. We believe that endoscopic colonic stenting is an effective way of avoiding a temporary colostomy in patients with complete large bowel obstruction.},
}
@article {pmid9527055,
year = {1998},
author = {Stevenson, AR and Stitz, RW and Lumley, JW and Fielding, GA},
title = {Laparoscopically assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients.},
journal = {Annals of surgery},
volume = {227},
number = {3},
pages = {335-342},
pmid = {9527055},
issn = {0003-4932},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum/*surgery ; Follow-Up Studies ; Humans ; *Laparoscopy ; Middle Aged ; Prospective Studies ; },
abstract = {PURPOSE: The objectives of this study were to refine the technique of laparoscopically assisted anterior resection (LAR) for diverticular disease and to analyze the morbidity and mortality rates, and longer term follow-up of the first 100 consecutive patients.
METHODS: Data were collected prospectively, and follow-up was performed by an independent assessor using a standardized questionnaire.
RESULTS: The median duration of surgery was 180 minutes, the median time for passage of flatus was 2 days after surgery, and the median length of hospital stay was 4 days. Overall, the morbidity rate was 21%, and the wound infection rate was 5%. There were no deaths. Eight patients underwent open laparotomy. The rate of complications was significantly greater in the latter group of patients (75%) than in those who underwent laparoscopy (16%, p = 0.002). The comparison between the first 20 cases and the last 20 patients revealed a significantly shorter duration of surgery (median 225 min. vs. 150 min.; p < 0.0001) and decreased length of stay (6 days vs. 4 days, p < 0.0001). Apart from a nonsignificant increase in the length of surgery, there were no differences in other study parameters when comparisons were made between those patients who underwent LAR for complicated diverticular disease and those patients who underwent uncomplicated diverticular disease.
FOLLOW-UP: Ninety patients were available for follow-up at a median time of 37 months. Ninety-three percent of the patients reported that the surgery had improved their symptoms. No patient required hospitalization, and no one was treated with antibiotics for recurrent symptoms.
CONCLUSION: Laparoscopically assisted anterior resection for diverticular disease has acceptable morbidity and mortality rates and a median postoperative hospital stay of only 4 days. Follow-up investigations revealed no recurrence of diverticulitis, and patients reported satisfaction regarding cosmetic and functional results.},
}
@article {pmid9519193,
year = {1997},
author = {Gaya, AM and Chisholm, EM and Scott, HJ and Donaldson, DR},
title = {Perforated diverticulitis following extra-abdominal surgery.},
journal = {Postgraduate medical journal},
volume = {73},
number = {865},
pages = {739-740},
pmid = {9519193},
issn = {0032-5473},
mesh = {Aged ; Diverticulitis/*complications ; Female ; Humans ; Intestinal Perforation/*complications ; Male ; Middle Aged ; Peritonitis/*etiology ; *Postoperative Complications ; },
abstract = {The peritonitis of perforated diverticular disease is a life-threatening condition. We report three cases where it occurred following unrelated extra-abdominal surgery and where surgical intervention proved to be the correct course of management. All cases were treated with a Hartmann's procedure; this is probably the safest option for purulent peritonitis in patients who are a high operative risk and have recently undergone major surgery.},
}
@article {pmid9514439,
year = {1998},
author = {Armstrong, N and Pozniak, M and Helgerson, R and Harms, B},
title = {Computed tomographic angiography with three-dimensional reconstruction in patients with complex diverticular disease and portal hypertension: report of a case.},
journal = {Diseases of the colon and rectum},
volume = {41},
number = {3},
pages = {391-394},
doi = {10.1007/BF02237498},
pmid = {9514439},
issn = {0012-3706},
mesh = {Abdomen/*blood supply ; Acute Disease ; *Angiography ; Diverticulitis, Colonic/complications/*diagnostic imaging/surgery ; Female ; Humans ; Hypertension, Portal/complications/*diagnostic imaging/surgery ; *Image Processing, Computer-Assisted ; Liver Cirrhosis, Alcoholic/complications ; Middle Aged ; Portasystemic Shunt, Transjugular Intrahepatic ; Radiography, Abdominal ; *Tomography, X-Ray Computed ; Varicose Veins/complications/diagnostic imaging ; },
abstract = {We report a case of a patient with portal hypertension secondary to alcoholic cirrhosis (Child's Class C) who initially presented with a colovaginal fistula secondary to acute sigmoid diverticulitis. The patient had a prior history of hepatic cirrhosis with ascites, coagulopathy, and portal hypertension. Computed tomography of the abdomen and pelvis demonstrated a large diverticular phlegmon and ascites. Computed tomographic angiography demonstrated a large left anterior abdominal wall varix in the region of the anticipated sigmoid resection. Three-dimensional reconstruction of the computed tomographic angiography further delineated the path of this large varix, confirming the increased risk from surgical intervention. Following initial conservative treatment with intravenous antibiotics, parenteral nutrition, and percutaneous abscess drainage, a transjugular intrahepatic portosystemic shunt procedure was performed to decompress the portal system varices. A repeat computed tomographic scan with three-dimensional reconstruction confirmed decompression of the varix. A successful sigmoid resection was subsequently performed. Preoperative computed tomographic angiography with three-dimensional reconstruction is a useful adjunct in planning the operative strategy in patients with complex intraabdominal pathology and collateral portovenous flow secondary to portal hypertension.},
}
@article {pmid9488514,
year = {1998},
author = {Merad, F and Hay, JM and Fingerhut, A and Flamant, Y and Molkhou, JM and Laborde, Y},
title = {Omentoplasty in the prevention of anastomotic leakage after colonic or rectal resection: a prospective randomized study in 712 patients. French Associations for Surgical Research.},
journal = {Annals of surgery},
volume = {227},
number = {2},
pages = {179-186},
pmid = {9488514},
issn = {0003-4932},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; *Colectomy ; Colonic Diseases/*surgery ; Female ; Humans ; Male ; Middle Aged ; Omentum/*surgery ; Postoperative Complications/*prevention & control ; Reoperation ; Risk Factors ; *Surgical Flaps ; Treatment Outcome ; },
abstract = {OBJECTIVE: To investigate the role of omentoplasty (OP) in the prevention of anastomotic leakage after colonic or rectal resection.
SUMMARY BACKGROUND DATA: It has been proposed that OP--wrapping the omentum around the colonic or rectal anastomosis--reinforces intestinal sutures with the expectation of lowering the rate of anastomotic leakage. However, there are no prospective, randomized trials to date to prove this.
METHODS: Between September 1989 and March 1994, a total of 705 patients (347 males and 358 females) with a mean age of 66 +/- 15 years (range, 15-101) originating from 20 centers were randomized to undergo either OP (n = 341) or not (NO, n = 364) to reinforce the colonic anastomosis after colectomy. Patients had carcinoma, benign tumor, colonic Crohn's disease, diverticular disease of the sigmoid colon, or another affliction located anywhere from the right colon to and including the midrectum. Patients undergoing emergency surgery were not included. Random allotment took place once the resection and anastomosis had been performed, the surgeon had tested the anastomosis for airtightness, and the omental flap was deemed feasible. Patients were divided into four strata: ileo- or colocolonic anastomosis, supraperitoneal ileo- or colorectal anastomosis, infraperitoneal ileo- or colorectal anastomosis, and ileo- or coloanal anastomosis. The primary end point was anastomotic leakage. Secondary end points included intra- and extraabdominal related morbidity and mortality. Severity of anastomotic leakage was based on the rate of repeat operations and related deaths.
RESULTS: Both groups were comparable in terms of preoperative characteristics. Intraoperative findings were similar, except that there were significantly more septic operations and abdominal drainage performed in the NO group (p < 0.05 and p < 0.01, respectively). Thirty-five patients (4.9%) had postoperative anastomotic leakage, 16 in the OP group (4.7%) and 19 in the NO group (5.2%). There were 32 deaths (4.5%), 17 (4.9%) in the OP group and 15 (4.2%) in the NO group. Five patients with anastomotic leakage died (0.8%), 2 of whom had OP. There were 37 repeat operations (30%), 12 (6 in each group) for anastomotic leakage. Repeat operation was associated with fatal outcome in 14% of cases. The rate of these and the other intra- and extraabdominal complications did not differ significantly between the two groups.
CONCLUSION: OP to reinforce colorectal anastomosis decreases neither the rate nor the severity of anastomotic failure.},
}
@article {pmid9471028,
year = {1997},
author = {Collins, CE and Rampton, DS and Rogers, J and Williams, NS},
title = {Platelet aggregation and neutrophil sequestration in the mesenteric circulation in inflammatory bowel disease.},
journal = {European journal of gastroenterology & hepatology},
volume = {9},
number = {12},
pages = {1213-1217},
pmid = {9471028},
issn = {0954-691X},
mesh = {Adult ; Aged ; Colitis, Ulcerative/physiopathology ; Crohn Disease/physiopathology ; Female ; Humans ; Inflammatory Bowel Diseases/*physiopathology ; Leukocyte Count ; Male ; Mesenteric Arteries/*cytology ; Mesenteric Veins/*cytology ; Middle Aged ; Neutrophils/*cytology ; *Platelet Aggregation ; Platelet Count ; },
abstract = {BACKGROUND AND OBJECTIVES: Mesenteric microvascular thrombosis may be an early pathogenic event in Crohn's disease (CD), and intravascular platelet aggregates have been identified in mucosal biopsies in ulcerative colitis (UC). Activated platelets are involved in thrombogenesis and exhibit inflammatory properties. In active inflammatory bowel disease (IBD) increased numbers of platelet aggregates are detectable in the peripheral circulation. The aim of this study was to test the hypothesis that in IBD, platelet aggregation is triggered in the mesenteric vasculature.
PATIENTS AND METHODS: Platelet numbers, platelet aggregate ratios and differential leucocyte counts were compared in mesenteric arterial and venous blood obtained from paired vessels at the time of intestinal resection from 13 patients with inflammatory bowel disease and, as controls, 6 patients with colonic carcinoma or diverticular disease.
RESULTS: In UC and CD, but not in controls, fewer neutrophils were found in blood draining the intestine compared with that supplying it (arteriovenous gradient median 1.0 x 10(9)/l (interquartile range 0.2-1.3) for UC, P < 0.05; 0.8 (0.2-1.5) for CD, P < 0.02; 0.4 (-0.3-1.1) for controls, P = NS). In CD, increased numbers of circulating platelet aggregates were identified in venous samples (platelet aggregate ratio 0.83 (0.71-0.93)) than in paired arterial samples (0.99 (0.95-1.01), P < 0.02) and control venous samples (0.99 (0.93-0.97), P < 0.05). The mesenteric arteriovenous gradient for neutrophils in IBD reflects their migration into the extravascular tissue and lumen of the inflamed intestine. Increased circulating platelet aggregates in the mesenteric venous circulation support the hypothesis that platelet activity is stimulated in the mesenteric microcirculation in CD.},
}
@article {pmid9376553,
year = {1997},
author = {Luboldt, W and Bauerfeind, P and Pelkonen, P and Steiner, P and Krestin, GP and Debatin, JF},
title = {[3D MRI of the colon: methods and initial results].},
journal = {RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin},
volume = {167},
number = {3},
pages = {252-256},
doi = {10.1055/s-2007-1015528},
pmid = {9376553},
issn = {1438-9029},
mesh = {Aged ; Aged, 80 and over ; Colonic Diseases/*diagnosis ; Colonic Neoplasms/diagnosis ; Colonic Polyps/diagnosis ; Colonoscopy ; Contrast Media ; Diagnosis, Differential ; Diverticulum, Colon/diagnosis ; Gadolinium DTPA ; Humans ; *Image Processing, Computer-Assisted ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; },
abstract = {PURPOSE: "Exoscopic" and endoscopic identification of colorectal pathologies via MRI.
METHODS: 5 patients (36-88 years), two normal and three with different colorectal pathologies (diverticular disease, polyps and carcinoma of the colon), were examined by MRI after colonoscopy. Subsequent to filling of the colon with a gadolinium-water mixture under MRI-monitoring, 3D-data sets of the colon were acquired in prone and supine positions over a 28 sec breath hold interval. Subsequently multiplanar T1-weighted 2D-sequences were acquired before and following i. v. administration of Gd-DTPA (0.1 mmol/kg BW). All imaging was performed in the coronal orientation. The 3D-data were interactively analysed based on various displays: maximum intensity projection (MIP), surface shadowed display (SSD), multiplanar reconstruction (MPR), virtual colonoscopy (VC).
RESULTS: All of the colorectal pathologies could be interactively diagnosed by MPR. On MIP images some pathologies were missed. VC presented the morphology of colon haustra as well as of all endoluminally growing lesions in a manner similar to endoscopy. The colon masses showed uptake of contrast media and could thus be differentiated from air or faeces.
CONCLUSION: The potential of CMRI in colorectal diagnosis warrants further investigation in a larger series of patients.},
}
@article {pmid9448391,
year = {1997},
author = {Bowrey, DJ and Wheeler, JM and Evans, RO and Fligelstone, LJ and Vellacott, KD},
title = {Can emergency general surgical referrals be reduced? A prospective study.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {42},
number = {6},
pages = {381-382},
pmid = {9448391},
issn = {0035-8835},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Diagnosis-Related Groups ; Emergency Service, Hospital/statistics & numerical data ; Emergency Treatment/*statistics & numerical data ; Female ; Humans ; Infant ; Length of Stay ; Male ; Middle Aged ; Prospective Studies ; Referral and Consultation/*statistics & numerical data ; Surgical Procedures, Operative/*statistics & numerical data ; Triage/statistics & numerical data ; United Kingdom ; *Unnecessary Procedures ; },
abstract = {It has been proposed that early assessment by a senior surgeon would result in a significant reduction in the number of general surgical admissions. A prospective study of 290 surgical patients admitted to a busy district general hospital over a period of 1 calendar month has been performed to test this hypothesis. After admission, all patients were assessed by a senior surgeon who carried out triage for each patient. The commonest diagnoses in descending order of frequency were non-specific abdominal pain, appendicitis, diverticular disease, cholecystitis, head injury and pancreatitis. Twenty-two per cent of emergency admissions underwent emergency surgery. A total of 90.7% of admissions were deemed appropriate, 5.5% were deemed inappropriate and in 3.8% of cases the senior surgeon was uncertain as to whether the patient should be admitted or not. Our data fail to substantiate the claim that a significant reduction in intake size would be achieved by early assessment by a senior surgeon. Assessment by surgeons may mean sacrificing other clinical commitments, and is likely to result in a diminution in the standard of both basic and higher surgical training.},
}
@article {pmid9416254,
year = {1997},
author = {Lorimer, JW},
title = {Is prophylactic resection valid as an indication for elective surgery in diverticular disease?.},
journal = {Canadian journal of surgery. Journal canadien de chirurgie},
volume = {40},
number = {6},
pages = {445-448},
pmid = {9416254},
issn = {0008-428X},
mesh = {Aged ; Colon/*surgery ; Diverticulitis, Colonic/complications/epidemiology/*surgery ; Diverticulum, Colon/*complications/epidemiology ; Elective Surgical Procedures ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Morbidity ; Recurrence ; Retrospective Studies ; },
abstract = {OBJECTIVE: To determine whether interval resection in asymptomatic patients after 1 or 2 episodes of acute diverticulitis (prophylactic resection) is justified as a means of preventing late inflammatory complications of diverticular disease.
DESIGN: A retrospective analysis.
SETTING: A university-affiliated tertiary care hospital.
PATIENTS: Those requiring hospitalization from 1987 to 1995 for treatment of acquired diverticular disease of the colon. Twenty-eight patients underwent elective resection and 154 were treated for inflammatory complications (perforation, fistula, complete large-bowel obstruction).
INTERVENTIONS: Standard surgical management for diverticular disease, but only 3 prophylactic resections were undertaken during this period.
OUTCOME MEASURES: Type of operation, stoma creation and closure, hospital death. In those treated for complicated disease, the effects on outcome of all previous outpatient treatment and hospitalizations.
RESULTS: Only 10% of those presenting with complications had been treated conservatively for acute diverticulitis and only 5% had been hospitalized for this reason.
CONCLUSIONS: Prophylactic resection is unlikely to prevent late major complications of diverticular disease; therefore, as an elective indication for surgery in this disease its use is questionable.},
}
@article {pmid9411143,
year = {1997},
author = {Larsson, PA},
title = {[Diverticulitis is increasing among the elderly. Significant cause of morbidity and mortality].},
journal = {Lakartidningen},
volume = {94},
number = {43},
pages = {3837-40, 3842},
pmid = {9411143},
issn = {0023-7205},
mesh = {Aged ; *Diverticulitis, Colonic/complications/diagnosis/mortality/therapy ; Humans ; },
abstract = {The prevalence of diverticulosis in western countries has increased and two-thirds of the population over the age of 85 are now affected. Diverticulitis results from inflammation and subsequent perforation of a colonic diverticulum. Mild forms of diverticulitis usually present with gradually increasing symptoms from the lower left quadrant of the abdomen, whereas acute complicated disease is characterised by dramatic onset of abdominal pain, followed by fever within a few hours. The standard treatment for uncomplicated diverticulitis is bowel rest, with liquid diet or intravenous fluids in combination with antibiotics. Patients not responding to conservative treatment within the first 24 hours require further evaluation by computed tomography or ultrasonography. If an abscess is present, it can often be drained percutaneously. In cases of perforation and peritonitis, surgical intervention is mandatory, though no consensus exists as to the choice of procedure. Fistula formation and intestinal obstruction are also indications for surgical intervention, although the frequent recurrent attacks which commonly afflict these patients are seldom associated with severe complications. Prophylactic resection is not to be recommended for patients with diverticular disease, but a high-fibre diet may afford protection by preventing further complications.},
}
@article {pmid9397001,
year = {1997},
author = {Isbister, WH},
title = {The management of colorectal perforation and peritonitis.},
journal = {The Australian and New Zealand journal of surgery},
volume = {67},
number = {11},
pages = {804-808},
doi = {10.1111/j.1445-2197.1997.tb04586.x},
pmid = {9397001},
issn = {0004-8682},
mesh = {Colonic Diseases/etiology/pathology/*surgery ; Colorectal Surgery ; Female ; Humans ; Intestinal Perforation/etiology/pathology/*surgery ; Laparotomy ; Male ; Middle Aged ; Peritonitis/etiology/pathology/*surgery ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; },
abstract = {BACKGROUND: Surgical outcomes in patients presenting with colonic perforation or peritonitis tend to be poor. This study was undertaken to determine outcomes in such patients at a time before multiple re-laparotomies were performed.
METHODS: Retrospective analysis of computer records of all patients presenting acutely to the University Surgical Unit (Wellington School of Medicine) with colonic perforation or peritonitis over a 15-year period.
RESULTS: Seventy-three patients, 33 males and 40 females were admitted with either perforation or localized peritonitis of colorectal origin. Of these, 78% were managed as emergencies, but six were admitted electively and found incidentally. Consultant surgeons performed surgery slightly more frequently than registrars. Two patients were managed non-operatively. Forty-one per cent received peri-operative blood transfusion and 22% peri-operative total parenteral nutrition. The majority of patients presented with either peritonitis or free perforation in association with diverticular disease. The site of perforation was either ileocolic or sigmoid colonic in the majority of patients. Hartmann's operation was the most commonly performed resection. Respiratory, urinary and wound infections were the most commonly observed postoperative complications. Two patients developed anastomotic leaks (6.3%). The overall persistent intra-abdominal infection rate was 5.5%. Seven patients died following surgery.
CONCLUSIONS: Resection of the perforated bowel is mandatory and this should be followed by anastomoses in the case of right-sided lesions and a Hartmann's operation or resection, colostomy and mucous fistula in distally situated lesions.},
}
@article {pmid9394962,
year = {1997},
author = {Sommeling, CA and Haeck, L},
title = {Caecostomy in the management of acute left colonic obstruction.},
journal = {Acta chirurgica Belgica},
volume = {97},
number = {5},
pages = {217-219},
pmid = {9394962},
issn = {0001-5458},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Cecostomy ; Colonic Neoplasms/*surgery ; Emergencies ; Female ; Humans ; Intestinal Obstruction/*surgery ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; },
abstract = {In the management of acute left colonic obstruction there is a tendency to perform immediate resection with anastomosis. We evaluated 27 consecutive patients (mean age 73.8 years) with acute left colonic obstruction and gross dilatation of the proximal colon treated by the "traditional" staged procedure. After caecostomy, no further resection was performed in two patients. In 25 patients, the obstructing tumour was resected after a median period of 14 days. In 17 (68%) patients the caecostomy was closed simultaneously. In 8 patients this was done at a third stage. Histologic examination revealed diverticular disease in 6 and adenocarcinoma in 19 patients. No deaths occurred after caecostomy nor was there major morbidity. After colonic resection, one in-hospital, nonprocedure related, death occurred (mortality rate 4%). In 21 patients with an anastomosis no dehiscence occurred. Other postoperative complications occurred in 5 patients (morbidity rate 20%). The median hospital stay for patients with a two-stage procedure was 32 days and with a three-stage procedure 39.5 days. The staged procedure in the management of acute colonic obstruction is still a safe and acceptable procedure in elderly patients with acute large bowel obstruction. To shorten the hospital stay the period between caecostomy and colonic resection should be reduced and it is best to close the caecostomy simultaneously.},
}
@article {pmid9369113,
year = {1997},
author = {Tagliacozzo, S and Tocchi, A},
title = {Antimesenteric perforations of the colon during diverticular disease: possible pathogenetic role of ischemia.},
journal = {Diseases of the colon and rectum},
volume = {40},
number = {11},
pages = {1358-1361},
doi = {10.1007/BF02050823},
pmid = {9369113},
issn = {0012-3706},
mesh = {Colon, Sigmoid/*blood supply/*pathology/surgery ; Diverticulum, Colon/*complications/etiology/*pathology ; Humans ; Intestinal Perforation/*etiology/pathology ; Ischemia/*complications ; Mesentery ; },
abstract = {UNLABELLED: The pathogenesis of free perforations occurring on the antimesenteric border of the pelvic colon during the course of diverticular disease has received little attention, with most being generically referred to as diverticular perforations.
PURPOSE: This study was designed to identify the pathogenetic factors responsible for free perforations that may occur in the antimesenteric intertenial area during the course of diverticular disease.
METHODS: Vascular alterations of the colonic wall associated with diverticula and open antimesenteric perforations were analyzed.
RESULTS: Previous data on the site of diverticula formation and related intramural vascular alterations were confirmed. A subserosal vascular network developed in the antimesenteric intertenial area in instances of multiple bilateral diverticula. Free perforations occurred in the antimesenteric haustral area only with multiple bilateral diverticula.
CONCLUSIONS: Alterations of the intramural vascular pattern secondary to the presence of multiple and bilateral diverticula may predispose the colonic wall to acute vascular injury. These changes may be enhanced by an episodic increase of intraluminal pressure and consequent distention of the colonic wall occurring in the course of diverticular disease.},
}
@article {pmid9347846,
year = {1997},
author = {Arenas, RB and Fichera, A and Mhoon, D and Michelassi, F},
title = {Incidence and therapeutic implications of synchronous colonic pathology in colorectal adenocarcinoma.},
journal = {Surgery},
volume = {122},
number = {4},
pages = {706-9; discussion 709-10},
doi = {10.1016/s0039-6060(97)90077-5},
pmid = {9347846},
issn = {0039-6060},
mesh = {Adenocarcinoma/*pathology/surgery ; Adult ; Aged ; Aged, 80 and over ; Colon/*pathology ; Colonic Diseases/complications/*epidemiology/pathology ; Colonic Neoplasms/*epidemiology/pathology/surgery ; Colorectal Neoplasms/*pathology/surgery ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasms, Second Primary/*epidemiology/pathology/surgery ; },
abstract = {BACKGROUND: The presence of synchronous benign and malignant colonic pathology may influence the magnitude of surgery for colorectal adenocarcinoma. The aim of this prospective study was to quantitate the need for a more extensive surgical procedure because of synchronous pathology in colorectal cancer patients.
METHODS: Between 1984 and 1996, 235 consecutive patients were treated for colorectal adenocarcinoma. Preoperative survey of the colon in 228 patients included colonoscopy (91%) and double contrast barium enema (35.7%). Seven patients were excluded for incomplete preoperative survey because of perforating or obstructing colon carcinoma or acute ulcerative colitis.
RESULTS: One hundred four patients (45.6%) had the following synchronous colonic lesions: benign polyps (68 patients, 29.8%), diverticular disease (30, 13.1%), ulcerative colitis (10, 4.4%), synchronous adenocarcinoma (8, 3.5%), and Crohn's colitis (3, 1.3%). Pathologic examination demonstrated three additional synchronous adenocarcinomas for a total of 11 patients (4.9%). Twenty-five (11%) required more extensive surgery than dictated by the primary cancer. Of these 25 patients, 17 had a benign or premalignant condition associated with their carcinoma and 8 had a synchronous carcinoma. Seventeen patients underwent a sphincter-saving procedure. Of the remaining eight patients requiring sphincter ablation, seven were needed because of a synchronous nonmalignant lesion, rather than because of the primary tumor.
CONCLUSIONS: In our patient population, the incidence of synchronous colorectal lesions was 45.6%. Synchronous colorectal cancer occurred in 4.9%. In 11%, the presence of synchronous colorectal lesions made the surgical procedure more extensive than that dictated by the primary cancer, and in 3%, the need for a sphincter ablating procedure was dictated by a synchronous nonmalignant lesion.},
}
@article {pmid9382070,
year = {1997},
author = {Novak, JS and Tobias, J and Barkin, JS},
title = {Nonsurgical management of acute jejunal diverticulitis: a review.},
journal = {The American journal of gastroenterology},
volume = {92},
number = {10},
pages = {1929-1931},
pmid = {9382070},
issn = {0002-9270},
mesh = {Acute Disease ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Combined Modality Therapy ; Diagnosis, Differential ; Diverticulitis/diagnosis/*therapy ; Female ; Humans ; Jejunal Diseases/diagnosis/*therapy ; Male ; Radiography, Interventional ; Suction ; },
abstract = {BACKGROUND: Diverticular disease of the colon and its complications are well known and readily considered when patients present with the proper clinical scenario. Conversely, complications of small bowel diverticula are very uncommon entities and are not often thought of as a cause of bleeding, obstruction, or an acute abdomen.
OBJECTIVE: To report two patients presenting with an acute abdomen caused by acute jejunal diverticulitis who were treated nonsurgically as opposed to surgically as the literature dictates.
METHODS: Two patients presented with sudden onset of acute periumbilical pain that had increased progressively over 1-2 days before admission. An emergent CT scan performed in each patient with localized peritonitis revealed "collections" consistent with abscess cavities. One patient was treated with antibiotics alone and the other with a combination of antibiotics and percutaneous CT-guided aspiration. CT-guided needle aspiration was performed and the injection of contrast clearly revealed communication with a jejunal diverticulum. Both patients did well and were subsequently discharged without incident or surgical intervention.
CONCLUSIONS: Acute jejunal diverticulitis must be considered in the differential diagnosis of an acute abdominal process and may be successfully treated nonsurgically despite the recommendations of previous reports.},
}
@article {pmid9381341,
year = {1997},
author = {Franklin, ME and Dorman, JP and Jacobs, M and Plasencia, G},
title = {Is laparoscopic surgery applicable to complicated colonic diverticular disease?.},
journal = {Surgical endoscopy},
volume = {11},
number = {10},
pages = {1021-1025},
doi = {10.1007/s004649900516},
pmid = {9381341},
issn = {0930-2794},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/complications/epidemiology/*surgery ; Diverticulum, Colon/complications/epidemiology/*surgery ; Female ; Gastrointestinal Hemorrhage/epidemiology/etiology/*surgery ; Humans ; Intestinal Perforation/epidemiology/etiology/*surgery ; *Laparoscopy/adverse effects/methods ; Length of Stay ; Male ; Middle Aged ; Morbidity ; Postoperative Complications ; Retrospective Studies ; Rupture, Spontaneous ; Treatment Outcome ; },
abstract = {BACKGROUND: Expanding upon our experience with laparoscopic surgery for colonic benign and malignant processes and for bowel obstruction, we have reviewed our experience with minimal access laparoscopic surgery for complicated diverticular disease. We propose an approach of surgical care incorporating diagnostic laparoscopy in those not responding to medical therapy alone.
METHODS: Our study includes data from two different surgical teams working in separate hospital-and-patient environments. Our theory that laparoscopy could be widely applicable to this complex disease process is borne out by experience in both locations. One hundred forty-eight patients were managed by laparoscopic or laparoscopically assisted methods with 18 patients requiring drainage only without resection.
RESULTS: Our management of 148 of 164 patients (90%) by laparoscopic approach was successful, with a very acceptable morbidity of 5% in the elective cases and decreased ileus (20% of open vs 7% laparoscopic) in acute complicated cases. Elective resections required hospitalization of 4-5 days, demonstrating the benefits of incorporating laparoscopy in the care of these cases, particularly when compared to standard open procedures requiring 8 days' hospitalization.
CONCLUSIONS: We believe complications of diverticular disease including abscess, perforation, fistula, and bleeding can potentially be managed in this way by minimal access procedures, decreasing postoperative wound problems, decreasing length of hospitalization and overall morbidity, and improving patient care.},
}
@article {pmid9317081,
year = {1997},
author = {Harris, LM and Volpe, CM and Doerr, RJ},
title = {Small bowel obstruction secondary to enterolith impaction complicating jejunal diverticulitis.},
journal = {The American journal of gastroenterology},
volume = {92},
number = {9},
pages = {1538-1540},
pmid = {9317081},
issn = {0002-9270},
mesh = {Age Factors ; Anastomosis, Surgical ; Calculi/*complications/diagnosis/surgery ; Diagnosis, Differential ; Diverticulitis/*complications/diagnosis/surgery ; Diverticulum/complications ; Humans ; Incidence ; Intestinal Obstruction/diagnosis/*etiology/surgery ; *Jejunal Diseases/complications/diagnosis/etiology/surgery ; Jejunum/surgery ; Laparoscopy ; Male ; Middle Aged ; },
abstract = {A case of small bowel obstruction secondary to enterolith impaction in the presence of jejunal diverticular disease is described. Only 27 cases of small bowel obstruction by enterolith expelled from small bowel diverticula have been reported in the literature. The reported incidence of jejunal diverticulosis in the general population ranges from 0.02 to 7.1%. Most patients are asymptomatic, but 10% develop complications requiring surgical intervention. Surgical treatment is an enterotomy and stone extraction or manually crushing and milking the stone distally into the colon. Small bowel resection and anastomosis or laparoscopic-assisted small bowel resection are indicated for the treatment of diverticulitis, bowel perforation, or multiple diverticuli. Jejunal diverticular disease should be considered in the differential diagnosis of mechanical small bowel obstruction without an obvious cause, especially in the elderly population.},
}
@article {pmid9313717,
year = {1997},
author = {Påhlman, L and Ejerblad, S and Graf, W and Kader, F and Kressner, U and Lindmark, G and Raab, Y},
title = {Randomized trial of a biofragmentable bowel anastomosis ring in high-risk colonic resection.},
journal = {The British journal of surgery},
volume = {84},
number = {9},
pages = {1291-1294},
doi = {10.1046/j.1365-2168.1997.02771.x},
pmid = {9313717},
issn = {0007-1323},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/*instrumentation ; Barium Sulfate/*therapeutic use ; Biocompatible Materials/*therapeutic use ; Colonic Diseases/*surgery ; Female ; Hospital Mortality ; Humans ; Length of Stay ; Male ; Middle Aged ; Polyglycolic Acid/*therapeutic use ; Reoperation ; Treatment Outcome ; },
abstract = {BACKGROUND: Biofragmentable anastomosis ring (BAR) has been proven to be a safe anastomotic device in elective surgery. The use of this anastomotic ring in high-risk patients has not been established.
METHODS: During a 5-year period (1990-1995), 100 high-risk patients undergoing colonic resection and suitable for a primary anastomosis were allocated randomly to a standard suture technique or to anastomosis performed with a BAR. High risk was defined as large bowel obstruction, complicated diverticular disease, Crohn's disease, local cancer recurrence, previously irradiated colon, and trauma to the colon or rectum. The patients were equally distributed to the two groups regarding sex, age, emergency surgery and concomitant diseases.
RESULTS: In three patients allotted to the BAR group, the device could not be used. There were three (6 per cent) postoperative deaths in each group; none was related to anastomotic problems. Three anastomotic dehiscences were diagnosed, two (4 per cent) in the BAR group and one (2 per cent) in the suture group. Postoperative complications and postoperative recovery were similar.
CONCLUSION: This study shows that the BAR anastomosis probably is as safe as the standard band-sewn anastomosis in high-risk colorectal surgery. As the cost of a BAR anastomosis is substantially higher than that for a hand-sewn anastomosis, the latter technique is still the preferred method in the authors' unit.},
}
@article {pmid9293926,
year = {1997},
author = {Bernini, A and Spencer, MP and Wong, WD and Rothenberger, DA and Madoff, RD},
title = {Computed tomography-guided percutaneous abscess drainage in intestinal disease: factors associated with outcome.},
journal = {Diseases of the colon and rectum},
volume = {40},
number = {9},
pages = {1009-1013},
doi = {10.1007/BF02050920},
pmid = {9293926},
issn = {0012-3706},
mesh = {Abscess/etiology/*therapy ; Adult ; Aged ; Aged, 80 and over ; Drainage/*methods ; Female ; Humans ; Intestinal Diseases/etiology/*therapy ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; },
abstract = {PURPOSE: This study was designed to assess the efficacy of computed tomography-guided percutaneous abscess drainage in intestinal disease.
METHODS: Retrospective chart review of patients who underwent percutaneous abscess drainage for complications of intestinal disease with or without surgery between 1990 and 1994.
RESULTS: Eighty-two patients with 111 abscesses were identified. Causes of abscess included anastomotic leaks (35 percent), postoperative complications without leak (30 percent), and diverticular disease (23 percent). Complete success (no surgery necessary) was achieved in 53 of 82 patients (65 percent). Nine patients (11 percent) who underwent interval surgery were classified as having partial successes. Twenty-six of 26 (100 percent) well-defined unilocular collections containing pus were successfully drained. Complex abscesses (loculated, poorly defined, multiple, associated with fistula, draining feces) were successfully drained in 35 of 55 patients (63 percent). Success rates varied inversely with the number of complicating factors present. Apache II scores of 15 or higher were associated with decreased success rates.
CONCLUSION: Percutaneous abscess drainage is a highly successful technique for treatment of patients with intra-abdominal infection related to intestinal disease. Although several factors are associated with decreased success rates and multiple complicating factors combine to reduce success rates, no identifiable factor or combination of factors preclude the possibility of a successful outcome.},
}
@article {pmid10182250,
year = {1997},
author = {Taroni, F and Repetto, F and Louis, DZ and Moro, ML and Yuen, EJ and Gonnella, JS},
title = {Variation in hospital use and avoidable patient morbidity.},
journal = {Journal of health services research & policy},
volume = {2},
number = {4},
pages = {217-222},
doi = {10.1177/135581969700200406},
pmid = {10182250},
issn = {1355-8196},
mesh = {Acute Disease/classification ; Catchment Area, Health ; Chronic Disease/classification ; Data Collection ; Geography ; Hospitals, Private/statistics & numerical data ; Hospitals, Public/statistics & numerical data ; Humans ; Italy/epidemiology ; *Morbidity ; Patient Admission/*statistics & numerical data ; *Severity of Illness Index ; },
abstract = {OBJECTIVES: To determine whether geographical areas with relatively low overall hospitalization rates have higher population-based rates of admission of patients with advanced stages of disease.
METHODS: Age- and sex-standardized hospital admission rate were calculated for the residents of the 80 Local Health Units in Lombardia, Italy. Using the Disease Staging classification, advanced stage admissions were identified for six common medical and surgical conditions, which it was presumed would reflect untimely hospital admission. Standardized rates of advanced stage admissions were compared in areas with overall high hospitalization rates (high-use areas).
RESULTS: Hospitalization at advanced stages of disease in the low-use areas were significantly higher for the six conditions combined (55.9 vs 43.0 per 100,000; P = 0.005), and for external hernia, appendicitis and uterine fibroma, but not for bacterial pneumonia, diverticular disease and peptic ulcer. For the six study conditions combined, residents of overall low-use area were 30% more likely to be admitted with advanced stages of disease.
CONCLUSION: Low overall hospitalization rates were found to be associated with greater severity of illness at hospitalization and potentially avoidable morbidity for some conditions. Policies aimed at curbing unnecessary hospital admission should consider preserving access for appropriate treatment.},
}
@article {pmid9287925,
year = {1997},
author = {Isbister, WH},
title = {Colorectal surgery in the elderly: an audit of surgery in octogenarians.},
journal = {The Australian and New Zealand journal of surgery},
volume = {67},
number = {8},
pages = {557-561},
doi = {10.1111/j.1445-2197.1997.tb02038.x},
pmid = {9287925},
issn = {0004-8682},
mesh = {Aged ; Aged, 80 and over ; Colectomy/*methods ; Colorectal Neoplasms/*surgery ; Colostomy ; Female ; Heart Failure/epidemiology ; Humans ; Ileostomy ; Length of Stay ; Lung Diseases/epidemiology ; Male ; *Medical Audit ; Postoperative Complications ; Rectal Prolapse/surgery ; Rectum/*surgery ; Treatment Outcome ; Urinary Tract Infections/epidemiology ; Wound Infection/epidemiology ; },
abstract = {BACKGROUND: Morbidity and mortality rates are higher in elderly compared to younger patients undergoing colorectal cancer surgery. This study was undertaken to see whether this finding applied to all colorectal surgery in the elderly and if so to try to identify the determining factors.
METHODS: All patients undergoing colorectal surgery between 1975 and 1990 were entered into a computerized database. Patients were divided into two groups, those less than 80 years (< 80) and those 80 years and more (80+), and compared with regard to the type of surgery performed, the patient's race, the seniority of the surgeon, the patient's disease, the operation performed and the postoperative morbidity and mortality. In addition, patients undergoing major resectional surgery and patients undergoing colorectal cancer surgery were compared separately.
RESULTS: Of 2011 admissions, 88 were for patients of 80+. The male to female admission rate was 1:0.79 in the < 80 group and 1:1.25 in the 80+ group. More surgical procedures were performed by consultants in older patients. More emergency admissions were for 80+ patients. Rectal, sigmoid and right colonic pathology was more common in the elderly. Very few elderly patients were admitted with minor anorectal problems. Rectal prolapse and colorectal cancer were the commonest causes for admission in octogenarians. There were more pulmonary and cardiovascular postoperative complications in 80+ patients. Urinary tract infections were also more common. The postoperative mortality rate was higher in older patients (7.9 vs 1.4%). Four hundred and sixty-two patients underwent major resectional surgery and 45 were 80+. Surgery for diverticular disease was more frequent in younger patients (13.4 vs 2.2%) and cancer surgery in older patients (93.3 vs 70.5%). The postoperative mortality rate was higher in the elderly (11.1 vs 3.6%). Three hundred and thirty-six major resections were for cancer and 42 were 80+. Emergency surgery was performed more commonly in the older group (38.1 vs 14.9%). The rate of advanced disease seemed to be similar in both groups. The postoperative death rate was higher in the elderly (11.9 vs 3.4%).
CONCLUSIONS: Elderly patients were more likely to die from cardiopulmonary problems after surgical interventions than either from their primary disease or from the surgery undertaken for it. Good postoperative cardiopulmonary support should thus be provided for all such patients.},
}
@article {pmid9276575,
year = {1997},
author = {Roy, MK and Delicata, RJ and Carey, PD},
title = {Distal mucus fistula following resection for perforated sigmoid diverticular disease.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {42},
number = {4},
pages = {286},
pmid = {9276575},
issn = {0035-8835},
mesh = {Diverticulitis, Colonic/complications/*surgery ; Humans ; Intestinal Perforation/etiology/*surgery ; Sigmoid Diseases/*surgery ; },
}
@article {pmid9240142,
year = {1997},
author = {Gianetta, E and de Cian, F and Cuneo, S and Friedman, D and Vitale, B and Marinari, G and Baschieri, G and Camerini, G},
title = {Hernia repair in elderly patients.},
journal = {The British journal of surgery},
volume = {84},
number = {7},
pages = {983-985},
doi = {10.1002/bjs.1800840721},
pmid = {9240142},
issn = {0007-1323},
mesh = {Aged ; Aged, 80 and over ; Anesthesia, General ; Anesthesia, Local ; Female ; Hernia, Femoral/complications/*surgery ; Hernia, Inguinal/complications/*surgery ; Hernia, Umbilical/complications/*surgery ; Humans ; Length of Stay ; Male ; Surgical Mesh ; },
abstract = {BACKGROUND: This study evaluates a 5-year experience of the management of the most frequent abdominal wall hernias in an elderly population.
METHODS: From April 1990 to December 1995, 231 inguinal, 12 femoral and seven umbilical hernias were repaired in 221 patients (mean age 74 (range 66-93) years). Concomitant diseases were present in 157 patients. A mesh repair was performed with 'tension-free' or 'plug' techniques in all but 23 inguinal and two femoral hernia repairs, in which the Bassini or Shouldice procedures were adopted. Ten emergency hernia repairs were performed for strangulation. A total of 232 operations, including four emergency hernia repairs, were carried out under local anaesthesia.
RESULTS: There was no perioperative mortality. Acute intestinal bleeding occurred 2 days after surgery in a patient with colonic diverticular disease. Urinary retention occurred once following emergency hernia repair under general anaesthesia and twice after elective hernia repair under local anaesthesia. Local complications included four scrotal haematomas (2 per cent), three wound infections (1 per cent) and one case of orchitis with atrophy after repair of a recurrent hernia. There was one recurrence after a Bassini repair and one after Shouldice inguinal herniorrhaphy. No recurrence was observed after mesh repair.
CONCLUSION: Local anaesthetic mesh hernia repair is safe and effective in elderly patients. Age should be no bar to elective hernia repair. This policy should avoid the complications of emergency operation.},
}
@article {pmid9219776,
year = {1997},
author = {de Oliveira, NC and Welch, JP},
title = {Giant diverticula of the colon: a clinical assessment.},
journal = {The American journal of gastroenterology},
volume = {92},
number = {7},
pages = {1092-1096},
pmid = {9219776},
issn = {0002-9270},
mesh = {Colonoscopy ; Diagnosis, Differential ; *Diverticulum, Colon/complications/diagnosis/pathology/physiopathology/therapy ; Humans ; },
abstract = {Giant colonic diverticulum is a rare complication of diverticular disease. In the English literature, only 81 cases have been described. Twelve patients had complications caused by the giant diverticulum. Seventy patients were treated operatively, and three died. Elective resection of the diverticulum and the adjacent colon with primary anastomosis is the ideal treatment. The significant number of complications caused by the giant diverticulum and the low morbidity and mortality rate associated with surgical treatment reinforce the importance of accurate diagnosis and elective treatment of this disorder.},
}
@article {pmid9214325,
year = {1997},
author = {Eijsbouts, QA and Cuesta, MA and de Brauw, LM and Sietses, C},
title = {Elective laparoscopic-assisted sigmoid resection for diverticular disease.},
journal = {Surgical endoscopy},
volume = {11},
number = {7},
pages = {750-753},
doi = {10.1007/s004649900442},
pmid = {9214325},
issn = {0930-2794},
mesh = {Colon, Sigmoid/*surgery ; Dissection ; Diverticulitis, Colonic/*surgery ; Feasibility Studies ; Female ; Humans ; *Laparoscopy ; Male ; Prospective Studies ; Sigmoid Diseases/*surgery ; Treatment Outcome ; },
abstract = {BACKGROUND: Although the laparoscopic-assisted approach to colorectal cancer remains controversial, its use for benign diseases can have important advantages. The purpose of this study is to determine the feasibility of this approach for the treatment of elective diverticular disease and to identify preoperative and perioperative factors which can help to select the best procedure for each patient: either assisted laparoscopic resection (ALR) or dissection-facilitated laparoscopic resection (DLR).
METHODS: From November 1991 to the present, we conducted a prospective study of 41 patients approached electively for diverticular disease.
RESULTS: Twenty-nine patients underwent an ALR, seven were approached by DLR, and another five patients were converted to laparotomy (15%). Morbidity was 17.5% and there was no mortality in this series. The mean hospital stay after operation was 6.5 days.
CONCLUSIONS: Because of the complexity of this inflammatory process, choice of either an assisted or a more invasive laparoscopic facilitated approach is necessary. The decision is based on the technical difficulty as determined by data collected both preoperatively and during laparoscopy.},
}
@article {pmid9195813,
year = {1997},
author = {Frizelle, FA and Dominguez, JM and Santoro, GA},
title = {Management of post-operative recurrent diverticulitis: a review of the literature.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {42},
number = {3},
pages = {186-188},
pmid = {9195813},
issn = {0035-8835},
mesh = {Carcinoma/diagnosis ; Colitis, Ischemic/diagnosis ; Colonic Diseases, Functional/diagnosis ; Colonic Neoplasms/diagnosis ; Colonoscopy ; Colostomy ; Contrast Media ; Diagnosis, Differential ; Disease Progression ; Diverticulitis, Colonic/diagnosis/*surgery ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Postoperative Complications ; Recurrence ; Reoperation ; Tomography, X-Ray Computed ; },
abstract = {Recurrent abdominal symptoms following resection for diverticular disease occur in 1-10% of patients. Not all of these patients have recurrent diverticulitis. Other conditions such as carcinoma, irritable bowel syndrome, inflammatory bowel disease and ischaemic colitis should be considered in the differential diagnosis. A thorough investigation including computerized tomography (CT) scanning, contrast studies and colonoscopy must be undertaken. The cause of recurrent diverticulitis may be the result of inadequate previous resection or progression of disease. Re-resection has been required in 0-3.1% of patients in a collected series. Re-resection may be technically demanding although permanent colostomy is usually not necessary. The best method of prevention is adequate initial resection.},
}
@article {pmid9195812,
year = {1997},
author = {Driver, CP and Anderson, DN and Findlay, K and Keenan, RA and Davidson, AI},
title = {Vesico-colic fistulae in the Grampian region: presentation, assessment, management and outcome.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {42},
number = {3},
pages = {182-185},
pmid = {9195812},
issn = {0035-8835},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Barium Sulfate ; Carcinoma/epidemiology ; Colectomy/statistics & numerical data ; Colon, Sigmoid/surgery ; Colonic Diseases/diagnosis/*epidemiology/surgery ; Colonic Neoplasms/epidemiology ; Colostomy/statistics & numerical data ; Contrast Media ; Cystectomy/statistics & numerical data ; Cystoscopy ; Diverticulum, Colon/epidemiology ; Enema ; Female ; Humans ; Inflammatory Bowel Diseases/epidemiology ; Intestinal Fistula/diagnosis/*epidemiology/surgery ; Male ; Middle Aged ; Palliative Care ; Rectum/surgery ; Recurrence ; Scotland/epidemiology ; Survival Rate ; Tomography, X-Ray Computed ; Treatment Outcome ; Urinary Bladder Fistula/diagnosis/*epidemiology/surgery ; Urinary Diversion/statistics & numerical data ; },
abstract = {Over a 12-year period, 67 patients presented with a vesico-colic fistula. The mean age was 69 years (range 19-96 years), with symptoms predominantly referred to the urinary tract. Cystoscopy and barium enema confirmed the presence of a fistula in 60 and 44% of patients respectively. A computerized tomography (CT) scan, used in only seven patients, revealed the fistula in each case. The underlying pathology included diverticular disease (62%), carcinoma (27%) and inflammatory bowel disease (6%). Fifty-one patients proceeded to surgery, of whom 32 (63%) had a sigmoid/recto sigmoid resection with primary anastomosis, and 13 (25%) a Hartmann's procedure. A diverting colostomy alone was employed to palliate cases of widespread carcinoma. No patient subsequently had the Hartmann's reversed. In addition to colonic resection, 48 (92%) patients had a simultaneous bladder procedure, varying from simple oversew in 32 (70%) patients to cystectomy and ileal conduit in three (6%). Wedge excision with primary bladder closure was practised in 12 (24%). Fistula recurrence occurred in seven (14%) patients, and the 30-day mortality was 10%. Surgery for vesico-colic fistula has an appreciable morbidity and mortality, yet if offers the only hope of achieving permanent symptomatic control.},
}
@article {pmid9194460,
year = {1997},
author = {Lee, EC and Murray, JJ and Coller, JA and Roberts, PL and Schoetz, DJ},
title = {Intraoperative colonic lavage in nonelective surgery for diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {40},
number = {6},
pages = {669-674},
doi = {10.1007/BF02140895},
pmid = {9194460},
issn = {0012-3706},
mesh = {Abdominal Abscess/etiology ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects ; Colectomy/adverse effects ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intraoperative Period ; Laparotomy ; Male ; Middle Aged ; Peritonitis/complications ; Recurrence ; Surgical Wound Infection/etiology ; Therapeutic Irrigation/*methods ; Treatment Outcome ; },
abstract = {BACKGROUND: Staged resection of the sigmoid colon has been the traditional strategy for treating patients who require nonelective surgery to manage complications of diverticular disease. Resection and primary anastomosis has not generally been recommended when the clinical setting is compromised by contiguous inflammation or inadequate mechanical cleansing of the colon because of concerns regarding the potential risk of anastomotic dehiscence. Although many reports have confirmed that intraoperative colonic lavage (ICL) is a safe method for relieving fecal loading of the colon to facilitate primary intestinal anastomosis in patients with mechanical obstruction of the distal colon, there is very limited experience with the use of this technique in treating acute inflammatory disorders of the colon. In this report, we present our results with ICL in the nonelective treatment of patients with complications of diverticulitis.
METHODS: Records of all patients undergoing urgent operations at the Lahey Clinic to treat complications of diverticular disease from July 1987 to January 1996 were reviewed.
RESULTS: Of 62 patients who required nonelective operations, 33 underwent ICL in an attempt to perform primary anastomosis. In five patients, the operation included creation of a colostomy. The indication for surgery was obstruction in 13 patients (39 percent), persistent abscess or phlegmon in 13 (39 percent), perforation in 6 patients (18 percent), and hemorrhage in 1 patient (3 percent). According to Hinchey's classification system, 18 patients had Stage I disease, 10 had Stage II, and 5 patients had Stage III disease. There were no patients with Stage IV disease. The single anastomotic complication in the series was responsible for the sole operative mortality. The morbidity rate of 42 percent, included three intraoperative complications (2 splenic injuries and 1 ureteral laceration), two intra-abdominal abscesses (6 percent), and six wound infections (18 percent).
CONCLUSION: In our experience, ICL has proven to be a safe method for accomplishing single-stage resection of the colon in selected patients with diverticulitis who require an urgent operation. When there is no evidence of diffuse purulent or feculent peritonitis, we believe this is the preferred method for treating patients who are hemodynamically stable.},
}
@article {pmid9167612,
year = {1997},
author = {Thomas, DB and Huston, BM and Lamm, KR and Maia, DM},
title = {Primary Hodgkin's disease of the sigmoid colon: a case report and review of the literature.},
journal = {Archives of pathology & laboratory medicine},
volume = {121},
number = {5},
pages = {528-532},
pmid = {9167612},
issn = {0003-9985},
mesh = {Aged ; Aged, 80 and over ; Diverticulum/pathology ; Hodgkin Disease/diagnosis/metabolism/*pathology ; Humans ; Immunohistochemistry ; Male ; Reed-Sternberg Cells/pathology ; Sigmoid Neoplasms/chemistry/diagnosis/*pathology ; Staining and Labeling ; },
abstract = {We report the case of an 81-year-old man who underwent a segmental resection of the sigmoid colon for severe diverticular disease. Histopathologic diagnosis revealed extranodal Hodgkin's disease, and the diagnosis was confirmed by immunohistochemistry. The incidence of extranodal Hodgkin's disease is rare and represents an infrequent occurrence as a gastrointestinal neoplasm and primary gastrointestinal lymphoma. A review of the literature for gastrointestinal lymphomas with emphasis on the occurrence of Hodgkin's disease, the diagnostic features, and the site of gastrointestinal tract involvement is reported.},
}
@article {pmid9179743,
year = {1997},
author = {Parikh, VA},
title = {Colosalpingeal fistula: a rare complication of diverticular disease of the colon.},
journal = {Journal of clinical gastroenterology},
volume = {24},
number = {3},
pages = {187-188},
doi = {10.1097/00004836-199704000-00016},
pmid = {9179743},
issn = {0192-0790},
mesh = {Barium Sulfate ; Colonic Diseases/*diagnostic imaging ; Contrast Media ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/*diagnostic imaging ; Enema ; Fallopian Tube Diseases/*diagnostic imaging ; Female ; Fistula/*diagnostic imaging ; Humans ; Intestinal Fistula/*diagnostic imaging ; Middle Aged ; Radiography ; },
}
@article {pmid9156125,
year = {1997},
author = {Walmsley, RS and Gillen, CD and Allan, RN},
title = {Prognosis and management of Crohn's disease in the over-55 age group.},
journal = {Postgraduate medical journal},
volume = {73},
number = {858},
pages = {225-229},
pmid = {9156125},
issn = {0032-5473},
mesh = {Aged ; Aged, 80 and over ; Cause of Death ; Colonic Diseases/diagnosis/physiopathology/therapy ; Crohn Disease/complications/mortality/physiopathology/*therapy ; Female ; Humans ; Ileal Diseases/diagnosis/physiopathology/therapy ; Male ; Middle Aged ; Prognosis ; Recurrence ; Treatment Outcome ; },
abstract = {The course, prognosis and management of 62 patients with Crohn's disease aged 55 years or over at diagnosis has been reviewed. The distal ileus was the commonest site of disease in the older patient, where the characteristic presentation was acute after initially mild symptoms. Early local resection was often required, particularly where there was diagnostic doubt or suspicion of caecal malignancy. Recurrence rates were much lower in the older patient than after resection in younger patients. Medical treatment played a minor role in the management of patients with distal ileal disease, in part because stricture formation was present at diagnosis and the acute nature of symptoms at presentation led to early surgical treatment. Colonic Crohn's disease was usually confined to the distal or left side of the colon and initially could be difficult to distinguish from diverticular disease. Extensive colonic Crohn's disease was rare. The apparently limited disease was not necessarily associated with a good prognosis, since disease at this site sometimes progressed rapidly, necessitating urgent surgical resection. Medical treatment (corticosteriod therapy, with or without azathioprine) was usually effective initially for treatment of symptomatic colonic Crohn's disease, but sustained remission was rare. Those patients with persistent symptoms were restored to good health with surgical treatment but at a price, in that nearly half eventually required a permanent stoma.},
}
@article {pmid9124212,
year = {1997},
author = {Goldstein, NS and Ahmad, E},
title = {Histology of the mucosa in sigmoid colon specimens with diverticular disease: observations for the interpretation of sigmoid colonoscopic biopsy specimens.},
journal = {American journal of clinical pathology},
volume = {107},
number = {4},
pages = {438-444},
doi = {10.1093/ajcp/107.4.438},
pmid = {9124212},
issn = {0002-9173},
mesh = {Adenocarcinoma/*pathology/ultrastructure ; Colon, Sigmoid/*pathology ; Diverticulitis, Colonic/*pathology ; Humans ; Intestinal Mucosa/*pathology ; Microvilli/ultrastructure ; Retrospective Studies ; Sigmoid Neoplasms/*pathology/ultrastructure ; Sigmoidoscopy/methods ; },
abstract = {We examined retrospectively 100 sigmoid colon resection specimens removed for diverticulitis (DD [diverticular disease]-diverticulitis), 53 adenocarcinoma specimens that also had diverticulosis (DD-adenocarcinoma), and 50 adenocarcinoma specimens that did not have DD (adenocarcinoma only) to study the mucosal changes that occur in DD. Documenting these histologic features could be helpful in deciphering changes seen in colonoscopic biopsy specimens from the sigmoid colon in older patients. Prominent mucosal folds were present in approximately 90% of all DD specimens. Increased mucosal lymphoplasmacytic inflammation at the bases of the prominent folds was present in 15% and 9% of DD-diverticulitis and DD-adenocarcinoma specimens, respectively. Eleven percent of the DD-diverticulitis and 4% of the DD-adenocarcinoma specimens had prolapselike mucosal abnormalities of the mucosa on the surface of the prominent mucosal folds. Mildly increased lymphoplasmacytic inflammation surrounded the diverticulosis ostia in approximately 25% of all DD specimens. All the diverticulitis ostia had neutrophilic and lymphoplasmacytic inflammation in the surrounding mucosa. No specimens had crypt distortion. Diverticular disease-related inflammation may be one cause of mild patchy inflammation that is occasionally observed in sigmoid colon biopsy specimens. Diverticular disease also should be considered as a cause of mucosal prolapse changes in sigmoid colon biopsy specimens. Other diseases should be considered when markedly increased mucosal inflammation, crypt distortion, or granulomas are present. Distinction between a DD-related incidental finding and a significant pathologic abnormality frequently can be made with the procurement of multiple biopsy specimens.},
}
@article {pmid9114680,
year = {1997},
author = {Anderson, DN and Driver, CP and Davidson, AI and Keenan, RA},
title = {Diverticular disease in patients under 50 years of age.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {42},
number = {2},
pages = {102-104},
pmid = {9114680},
issn = {0035-8835},
mesh = {Adult ; Age Factors ; Colectomy ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/diagnosis/*surgery ; Female ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Scotland ; },
abstract = {Sigmoid diverticular disease, when it occurs in a young age group, may follow a more aggressive course with a higher incidence of complications than in elderly. The mode of presentation and management in 77 patients under 50 years of age presenting with sigmoid diverticular disease over a 6-year period is described. Surgery for complications (peritonitis, abscess, bowel obstruction, fistula and haemorrhage) was performed in 18 (23%) individuals. Colonic resection was carried out in 14 (78%) of the operated group with primary anastomosis in six patients and Hartmann's procedure in eight patients. The mortality (30 day) was zero. Nineteen (25%) of the entire group, and 12 (67%) of those undergoing surgery had been previously hospitalized with a complication of diverticular disease. The recurrent nature and frequency of serious complications in this group, suggests that elective surgery should be considered if an acute infective episode is successfully managed conservatively.},
}
@article {pmid9112911,
year = {1997},
author = {Elliott, TB and Yego, S and Irvin, TT},
title = {Five-year audit of the acute complications of diverticular disease.},
journal = {The British journal of surgery},
volume = {84},
number = {4},
pages = {535-539},
pmid = {9112911},
issn = {0007-1323},
mesh = {Abscess/etiology ; Acute Disease ; Aged ; Diverticulitis, Colonic/*complications/surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Male ; Medical Audit ; Middle Aged ; Recurrence ; Reoperation ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Treatment Outcome ; },
abstract = {BACKGROUND: The objective of this study was to audit the presentation and outcome for patients admitted with an acute complication of diverticular disease.
METHODS: This study was a retrospective review of 418 admissions with an acute complication of diverticular disease over a 5-year interval.
RESULTS: Of the 418 admissions, 15 patients were eventually found to have an alternative diagnosis. Some 403 patients were studied further. The overall mortality rate in this group was 5.7 per cent. A total of 113 patients (28.0 per cent) required an operation and in this group the mortality rate was 17.7 per cent. All deaths occurred in patients who had surgery for septic complications or bowel obstruction. Of the patients who had surgery, 90.2 per cent had a resection of the involved colon. One-third of these had a primary anastomosis; the remainder underwent Hartmann's procedure. Some 83 patients had a stoma fashioned and of these 72 went on to have the stoma closed. The median age of those who died after operation was 80 years. An American Society of Anesthesiologists (ASA) score of 3 or more, concurrent medical disease and shock on admission were all associated with a high mortality rate (P < 0.001). Some 30 per cent of patients were readmitted during this study with a further complication of diverticular disease.
CONCLUSION: The mortality rate after surgery for acute diverticular disease remains excessive and a high-risk group can be identified before operation. A policy of resection and anastomosis appears justified for selected patients. Adopting a practice of interval elective sigmoid colectomy after admission with acute diverticulitis might prevent readmission with further complications.},
}
@article {pmid9148215,
year = {1997},
author = {Formento, E and Guglielminotti, P and Reggio, D and Saracco, M and Patelli, E},
title = {[Diverticular disease and its treatment].},
journal = {Minerva chirurgica},
volume = {52},
number = {3},
pages = {261-270},
pmid = {9148215},
issn = {0026-4733},
mesh = {Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/diagnosis/surgery ; Diverticulum, Colon/diagnosis/*surgery ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {Diverticular disease of the colon is being seen with increasing frequency. Not infrequently, the first attack of diverticulitis may result in serious and potentially fatal complications. A period of observation and conservative management is necessary to determine the outcome of a particular attack. Approximately 30% of symptomatic patients require surgical intervention. Controversy still surrounds the appropriate operative approach to be employed in the management of diverticular disease, moreover when it presents with a complication. In general, resection is the procedure of choice for perforating diverticulitis. There is an emerging role for down-staging interventions in the recent literature; with few exception, there is no role for three-stages procedure for diverticular disease. In the setting of stage I or stage II disease (Hinchey classification) primary resection with anastomosis is safe and should be performed. Proximal colostomy formation may be carried out at the discretion of the surgeon if warranted by such local circumstances as contiguous inflammation or macroscopic contamination. For patients with stage III and stage IV disease endcolostomy with Hartmann closure of the rectum is the procedure of choice, although anastomosis with proximal stoma may prove to be an acceptable alternative. We reviewed the changing patterns in the operative treatment in 46 patients admitted to our Division for perforated diverticulitis. We performed the resection with anastomosis in 39 patients with perforation at the II stage; in 7 patients with generalized peritonitis (stage III-IV by Hinchey) we preferred Hartmann intervention in 4 cases and the three-stages procedure in 3 cases. We had no death at all. From 1979 to 1994 we noticed an increasing use of down-staging procedures.},
}
@article {pmid9118752,
year = {1997},
author = {Wong, SK and Ho, YH and Leong, AP and Seow-Choen, F},
title = {Clinical behavior of complicated right-sided and left-sided diverticulosis.},
journal = {Diseases of the colon and rectum},
volume = {40},
number = {3},
pages = {344-348},
doi = {10.1007/BF02050427},
pmid = {9118752},
issn = {0012-3706},
mesh = {Aged ; Asia/ethnology ; *Asian People ; Diverticulitis/etiology ; Diverticulum/*etiology/*pathology/physiopathology/surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Incidence ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Male ; Middle Aged ; Prospective Studies ; Singapore ; },
abstract = {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.},
}
@article {pmid9079606,
year = {1997},
author = {Sher, ME and Agachan, F and Bortul, M and Nogueras, JJ and Weiss, EG and Wexner, SD},
title = {Laparoscopic surgery for diverticulitis.},
journal = {Surgical endoscopy},
volume = {11},
number = {3},
pages = {264-267},
doi = {10.1007/s004649900340},
pmid = {9079606},
issn = {0930-2794},
mesh = {Adult ; Aged ; Colectomy/*methods ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; *Laparoscopy ; Laparotomy ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Treatment Outcome ; },
abstract = {BACKGROUND: Resection of diverticular disease may be quite challenging; the acute inflammatory process, thick sigmoid mesentery, and any associated fistula or abscess can make this procedure technically demanding. The aim of this study was to compare the results between laparoscopic and laparotomy-type resections stratified by disease severity and thereby predict outcome and possibly a subset of patients who may benefit from a laparoscopic approach.
METHODS: From August 1991 to December 1995, all patients with diverticular disease were classified according to a modified Hinchey classification system. The laparoscopic group included 18 patients who underwent a laparoscopic assisted colectomy, one with a loop ileostomy. The identical procedures were performed in 18 patients by laparotomy. The mean age of the two groups were 62.8 and 67.1 years, respectively (p = NS).
RESULTS: Seven of 18 patients in whom laparoscopy was attempted (38.9%) had conversion to laparotomy. Six of seven (85.7%) conversions were directly related to the intense inflammatory process. Laparoscopic treated patients with Hinchey IIa or IIb disease had a morbidity rate of 33.3% and a conversion rate of 50% while all patients with Hinchey I disease were successfully completed without morbidity or conversions to laparotomy. However, after the first four cases, the intraoperative morbidity and postoperative morbidity rates were zero and 14.3% and after ten cases they were zero and zero, respectively. Furthermore, the median length of hospitalization for Hinchey I patients after laparoscopy was 5.0 days vs 7 days after laparotomy (p < 0.05). In Hinchey IIa and IIb patients, the median length of hospitalization was almost 50% shorter with a laparoscopic approach (6 days vs 10 days, p < 0.05).
CONCLUSION: In conclusion, laparoscopic resection of diverticulitis can be performed without additional morbidity particularly in Hinchey I patients and with a reduced length of hospitalization in patients with class I or II disease. Patients with class I disease, and after initial experience even those with class II disease, can benefit from the reduced morbidity and length of hospitalization associated with laparoscopic treatment.},
}
@article {pmid9154723,
year = {1997},
author = {Greenberg, R and Avital, S and Kashtan, H and Skornik, Y},
title = {[Diverticular disease of the appendix].},
journal = {Harefuah},
volume = {132},
number = {3},
pages = {180-2, 239},
pmid = {9154723},
issn = {0017-7768},
mesh = {Appendectomy ; *Appendix ; Cecal Diseases/therapy ; *Diverticulum/therapy ; Humans ; },
abstract = {The incidence of appendiceal diverticulosis in pathologic specimens is 0.004-2.1%. Diverticular disease of the appendix is classified as congenital (true) or acquired (false). The clinical presentation differs from that of acute appendicitis. The average age is older, the pain is often intermittent, and while localized in the right lower abdominal quadrant, is of longer duration. No further treatment besides appendectomy is needed. Since a high rate of perforations, peritonitis and lower gastrointestinal bleeding have been reported as complications, it is recommended that in those with an incidental finding of diverticula of the appendix during surgery, that appendectomy be performed. It is not recommended to perform prophylactic appendectomy when diverticula of the appendix are found on barium enema.},
}
@article {pmid9065589,
year = {1997},
author = {Oehler, U and Bulatko, A and Jenss, H and Helpap, B},
title = {Lethal complications in a case of sigmoid diverticulitis. A case report.},
journal = {General & diagnostic pathology},
volume = {142},
number = {3-4},
pages = {231-234},
pmid = {9065589},
issn = {0947-823X},
mesh = {Aneurysm, Ruptured/pathology ; Basilar Artery/pathology ; Diagnosis, Differential ; Diverticulitis, Colonic/*pathology ; Fatal Outcome ; Female ; Humans ; Lung Abscess/pathology ; Meningitis/pathology ; Middle Aged ; Osteoporosis/pathology ; Sigmoid Diseases/*pathology ; },
abstract = {A 61-year-old female complaining of arthralgia was repeatedly treated with antibiotics and also with prednisolone. A chronic polyarthritis was assumed. In hospital, leukocytosis of 21.000 was found one day before death as well as moderate anemia. Colonoscopy was rejected by the patient. A computer tomography revealed destructive arthritis of the symphysis, vertebral osteochondrosis L5/S1, and sigmoid diverticulosis. The patient died with clinical signs of central dysregulation. At autopsy, a covered perforation of a sigmoid diverticulum with purulent peridiverticulitis was found. The 5th lumbal vertebra and the symphysis showed hematogenic abscesses. Microabscedating pneumonia, purulent meningitis and hypophysitis, and mycotic aneurysm of the basilar artery with lethal rupture were further results of hematogenic spread. Death was caused by massive subarachnoidal hemorrhage. This history is not untypical for elder patients with complicated diverticular disease. The intestinal perforation is often clinically occult due to only few and unspecific symptoms which cannot be exactly attributed to the colon. In the last ten years, we have found lethal complications of sigmoid diverticulitis at a frequency of 0.32% (5 cases in 1.557 subsequent autopsies). The clinical differential diagnosis included diverticulitis in none of the cases. This underlines the importance of autopsies for quality control in medicine, because modern diagnostic methods such as computer tomography were not able to give the correct diagnosis in these cases.},
}
@article {pmid9058636,
year = {1997},
author = {Walker, AR and Segal, I},
title = {Effects of transition on bowel diseases in sub-Saharan Africans.},
journal = {European journal of gastroenterology & hepatology},
volume = {9},
number = {2},
pages = {207-210},
doi = {10.1097/00042737-199702000-00019},
pmid = {9058636},
issn = {0954-691X},
mesh = {Africa South of the Sahara/epidemiology ; Appendicitis/epidemiology ; Colonic Neoplasms/epidemiology ; Developing Countries ; Diet ; Diverticulitis/epidemiology ; Environmental Exposure ; Humans ; Intestinal Diseases/*epidemiology ; Rural Population ; },
abstract = {In populations in sub-Saharan Africa, transitional changes in patterns of morbidity and mortality are taking place, with decreases in the diseases of poverty and infection, but rises in chronic diseases of prosperity, associated, however, with greater longevity. Remarkably, bowel diseases - appendicitis, diverticular disease, colon cancer - while nearly absent in rural areas, have very low incidences in urban dwellers, despite rises in risk factors, including a decreasing intake of fibre-containing foods. Currently, there is no explanation for the phenomenon, which stands in marked contrast to the considerable rises which have occurred in dental caries, obesity in women and diabetes.},
}
@article {pmid16160968,
year = {1997},
author = {Qureshi, AM and Mitchenere, P and Savalgi, R},
title = {Fistula complications of diverticular disease.},
journal = {Surgical technology international},
volume = {6},
number = {},
pages = {151-154},
pmid = {16160968},
issn = {1090-3941},
abstract = {Right-sided sliding inguinal hernias usually involve the cecum and occasionally the ascending colon. Colocutaneous fistulas secondary to diverticular disease are rare and usually present with a short tract to the anterior abdominal wall. The authors describe a case of colocutaneous fistula secondary to diverticular disease in an inguinal hernia and review fistula formation after diverticular disease.},
}
@article {pmid9587545,
year = {1997},
author = {Benziane, K and Boudier, P and Kalfon, M},
title = {[Right sigmoid-popliteal fistula in diverticular disease].},
journal = {Gastroenterologie clinique et biologique},
volume = {21},
number = {11},
pages = {895-897},
pmid = {9587545},
issn = {0399-8320},
mesh = {Aged ; Cutaneous Fistula/*etiology ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Intestinal Fistula/*etiology ; Sigmoid Diseases/*complications ; },
}
@article {pmid9412141,
year = {1997},
author = {Gonzalez Cueto, DM and Arozamena, C and Tezanos Pinto, R and Willis, R},
title = {[Granulomatous colitis associated with diverticular disease. Report of a case].},
journal = {Acta gastroenterologica Latinoamericana},
volume = {27},
number = {3},
pages = {127-129},
pmid = {9412141},
issn = {0300-9033},
mesh = {Aged ; Colonic Diseases/etiology ; Crohn Disease/*complications/pathology ; Diverticulum, Colon/*complications ; Female ; Humans ; Intestinal Obstruction/*etiology ; },
abstract = {We report the case of a 71 years old lady with clinical and radiological evidence of colonic obstruction due to diverticulosis. A segmentary resection of the sigmoid colon was performed and the diagnosis of diverticulosis and Crohn's disease was made in the surgical specimen. The patient is doing well and no further extension of the colonic granulomatosis has been found 8 months after surgery. In spite of the great frequency of diverticulosis in the elderly its association with Crohn's disease is quite uncommon. This is probably due to the infrequency of colonic Crohn's disease in this population, particularly of the segmentary type. A few cases of segmentary colonic Crohn's disease that were cured after resection have been published. Even though the postoperative period of our patient is too short for making a good prognosis. Crohn's disease is a chronic relapsing disease and frequency of recurrences is closely related with long term evolution.},
}
@article {pmid9408407,
year = {1997},
author = {Varga, J},
title = {Surgical treatment of diverticulitis of the sigmoid.},
journal = {Acta chirurgica Hungarica},
volume = {36},
number = {1-4},
pages = {373-374},
pmid = {9408407},
issn = {0231-4614},
mesh = {Abscess/etiology/surgery ; Aged ; Anastomosis, Surgical ; *Colectomy/adverse effects ; Colonic Diseases/etiology/surgery ; Colostomy ; Diverticulitis, Colonic/complications/*surgery ; Elective Surgical Procedures ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; Intestinal Diseases/etiology/surgery ; Intestinal Obstruction/etiology/surgery ; Middle Aged ; Peritonitis/etiology/surgery ; Sigmoid Diseases/complications/*surgery ; Survival Rate ; },
abstract = {This study demonstrates that elective colon surgery for diverticular disease is benign, with a low mortality and morbidity. The acute severe complications of the colonic diverticular disease are characterized by a large mortality and morbidity. The results reported here, as all those published recently on the same subject, are in favor of broadening the indications of colectomy in diverticular disease, before the occurrence of a severe acute complication.},
}
@article {pmid9401843,
year = {1997},
author = {Isbister, WH and Prasad, J},
title = {Emergency large bowel surgery: a 15-year audit.},
journal = {International journal of colorectal disease},
volume = {12},
number = {5},
pages = {285-290},
doi = {10.1007/s003840050107},
pmid = {9401843},
issn = {0179-1958},
mesh = {Adult ; Aged ; Colonic Diseases/surgery ; Colorectal Neoplasms/surgery ; Colorectal Surgery/adverse effects/*statistics & numerical data ; Diverticulum/surgery ; Female ; Humans ; Intestine, Large/*surgery ; Male ; *Medical Audit ; Middle Aged ; Postoperative Complications ; Rectal Diseases/surgery ; Treatment Outcome ; },
abstract = {OBJECT: To evaluate the management of patients presenting with colorectal emergencies.
METHOD: Computerized audit of patients undergoing urgent/semi-urgent surgery in the Colorectal Service, University Department of Surgery, Wellington School of Medicine, NZ.
RESULTS: 246 patients underwent major emergency or semi-emergency operations. Consultants performed 144 operations. The complications of cancer and diverticular disease were the commonest indications for surgery. Patients with inflammatory processes required significant perioperative nutrition. The disease site varied with the pathology. Overall the sigmoid colon was the commonest. Resection and anastomosis was generally performed for right-sided lesions whereas Hartmann's operation was the commonest procedure for more distally situated non neoplastic lesions. A loop diverting stoma was used most commonly in patients with obstructing cancer. The most frequent post-operative complication was urinary tract infection. Four patients developed pulmonary embolism, 2 ARDS, 4 myocardial infarction and 1 CVA. Persistent intra-abdominal sepsis requiring drainage occurred in five patients. There were 6 anastomotic leaks. 3 patients were re-operated upon to relieve post-operative small bowel obstruction. The overall post-operative mortality rate was 6.9%.
CONCLUSION: A cautious policy of resecting right sided lesions and either diversion or resection without anastomosis for patients presenting acutely with left-sided colonic lesions resulted in a low overall mortality rate.},
}
@article {pmid9361853,
year = {1997},
author = {Aldoori, WH},
title = {The protective role of dietary fiber in diverticular disease.},
journal = {Advances in experimental medicine and biology},
volume = {427},
number = {},
pages = {291-308},
doi = {10.1007/978-1-4615-5967-2_29},
pmid = {9361853},
issn = {0065-2598},
mesh = {Adult ; Aged ; Colonic Diseases/*prevention & control ; Dietary Fats/administration & dosage ; Dietary Fiber/*administration & dosage/therapeutic use ; *Diverticulum ; Edible Grain ; Energy Intake ; Exercise ; Fruit ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Vegetables ; },
}
@article {pmid9289836,
year = {1997},
author = {Hunkeler, R and Gerstl, P and Seifert, M and Wehrli, H},
title = {[Laparoscopic colon surgery in the regional hospital: initial experiences after 65 interventions].},
journal = {Schweizerische medizinische Wochenschrift. Supplementum},
volume = {89},
number = {},
pages = {25S-30S},
pmid = {9289836},
issn = {0250-5525},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; Colonic Diseases/*surgery ; Colonic Neoplasms/*surgery ; Colostomy ; Female ; Hospitals, Community ; Humans ; Intraoperative Complications/etiology ; *Laparoscopy ; Male ; Middle Aged ; Palliative Care ; Postoperative Complications/etiology ; Switzerland ; },
abstract = {321 colorectal operations have been performed in our institution in a 4-year period from 1992 to 1996. They included 65 laparoscopic interventions for benign disease or for palliative treatment of malignancy. 40 patients underwent low anterior resections, mostly for diverticular disease. 11 right hemicolectomies, 3 left hemicolectomies, 1 total colectomy and 7 rectopexies (6 with sigmoid resection) were performed. 3 patients with advanced malignant disease underwent colostomy. There was a conversion rate of 26%, largely due to adhesions or unclear anatomy, decreasing with increasing experience. One trokar-injury of a major vessel required immediate conversion to laparotomy. 2 reoperations were performed, for an anastomotic leakage after low anterior resection and an incarcerated port-site-hernia respectively. A rather high rate of wound infections (27%) was reduced to 15% by modifying the technique for retrieval of the specimen. The median postoperative hospital stay was 11.6 days. The trend towards shorter hospital stay and recovery should not result in uncritical use of laparoscopy in colon surgery, in an attempt to meet the rising demand for less postoperative pain and shorter hospital stay. This criticism mainly applies to tumor surgery, where laparoscopic procedures are indicated in our institution only for palliative treatment.},
}
@article {pmid9264855,
year = {1997},
author = {Greco, B and Wettstein, M and Hack, I and Meyer, A and Rosso, R},
title = {[Gastrointestinal hemorrhage and diverticula of the jejunum--presentation of a case report and review of the literature].},
journal = {Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera},
volume = {3},
number = {3},
pages = {104-106},
pmid = {9264855},
issn = {1023-9332},
mesh = {Aged ; Arteries/pathology ; Diverticulum/*complications/pathology/surgery ; *Emergencies ; Gastrointestinal Hemorrhage/*etiology/pathology/surgery ; Humans ; Jejunal Diseases/*complications/pathology/surgery ; Jejunum/blood supply/pathology/surgery ; Male ; },
abstract = {Gastrointestinal bleeding due to jejunal diverticulosis is an uncommon emergency condition that has been encountered recently in one patient. The case of this patient treated with an emergency laparotomy and a segmentary small bowel resection is here presented. The clinical significance, proper diagnostic evaluation, and treatment of the hemorrhagic complication of jejunal diverticular disease are reviewed.},
}
@article {pmid8955249,
year = {1996},
author = {Reissman, P and Agachan, F and Wexner, SD},
title = {Outcome of laparoscopic colorectal surgery in older patients.},
journal = {The American surgeon},
volume = {62},
number = {12},
pages = {1060-1063},
pmid = {8955249},
issn = {0003-1348},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colectomy/methods ; Colonic Diseases/*surgery ; Colostomy/methods ; Female ; Humans ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Rectal Diseases/*surgery ; Treatment Outcome ; },
abstract = {The object of this study was to assess the outcome of laparoscopic colorectal surgery in patients >60 years of age and compare it to a younger group of patients who underwent similar procedures. All consecutive patients who underwent a laparoscopic or laparoscopic-assisted procedure were evaluated. The parameters analyzed included gender, indication for surgery, procedure, complications, conversions, length of ileus, length of hospitalization, and comorbidity. The results of patients 60 years of age or older were compared to a procedure-matched group of younger patients. Between August 1991 and August 1995, 165 patients underwent a laparoscopic or laparoscopic-assisted colorectal procedure. Thirty-six patients were 60 years of age or older [mean age, 73 (60-88) years; 17 males and 19 females] and were compared with 36 younger patients [mean age, 44 (20-58) years; 13 males and 23 females]. The indications for surgery included Crohn's disease in 14 patients, polyps in 23, diverticular disease in 15, carcinoma in 11, fecal incontinence in 4, rectal prolapse in 2, radiation proctitis in 2, and sigmoidocele in 1. Identical procedures were performed in each group including right colectomy or ileocolic resection in 17 patients, sigmoidectomy in 14, loop ileostomy in 3, loop colostomy in 1, and abdominoperineal resection in 1 patient. Fourteen patients (38%) in the elderly group had comorbid conditions including ischemic heart disease (3), chronic obstructive pulmonary disease (3), hypertension (2), chronic renal failure (2), atherosclerotic vascular disease (2), congestive heart failure (1), and diabetes (1). All patients were cleared for surgery by their respective specialists. There were no statistically significant differences between the younger and older groups relative to the incidence of complications (11 vs 14%, respectively) and conversion (8 vs 11%, respectively) or the length of ileus (2.8 vs 4.2 days, respectively) or hospitalization (5.2 vs 6.5 days, respectively) (P = NS for all). There was no mortality in either group. The outcome of laparoscopic colorectal surgery in older patients is similar to that noted in younger patients. Advanced age should not be a contraindication to laparoscopic colorectal surgery.},
}
@article {pmid8955231,
year = {1996},
author = {Hain, JM and Sherick, DG and Cleary, RK},
title = {Salpingocolonic fistula secondary to diverticulitis.},
journal = {The American surgeon},
volume = {62},
number = {12},
pages = {984-986},
pmid = {8955231},
issn = {0003-1348},
mesh = {Adult ; Colectomy ; Colonic Diseases/*etiology/surgery ; Diverticulitis/*complications/surgery ; Fallopian Tube Diseases/*etiology ; Female ; Fistula/*etiology ; Humans ; Intestinal Fistula/*etiology/surgery ; },
abstract = {A rare diverticular fistula is reported in a 37-year-old woman. The case history and literature were reviewed for clinical presentation, radiologic investigations, and treatment options. Internal fistulas may complicate diverticular disease. The least common fistula is between the colon and the fallopian tube. Successful management of this complication is directed at removing the diseased colon. The woman had a salpingocolonic fistula secondary to diverticulitis. To our knowledge, she represents the youngest patient with this complication of diverticular disease in the literature. Diagnosis of a salpingocolonic fistula complicating diverticular disease requires clinical suspicion when genitourinary symptoms complicate the clinical presentation. Hysterosalpingography or contrast injection of percutaneous drainage tubes may contribute to the diagnosis.},
}
@article {pmid8982175,
year = {1996},
author = {Isbister, WH},
title = {A comparison between colorectal surgical admissions in Maori and nonMaori.},
journal = {The New Zealand medical journal},
volume = {109},
number = {1034},
pages = {442-444},
pmid = {8982175},
issn = {0028-8446},
mesh = {Adult ; Colonic Diseases/*surgery ; Databases, Factual ; Female ; Humans ; Male ; Middle Aged ; New Zealand ; Polynesia/ethnology ; Rectal Diseases/*surgery ; },
abstract = {AIMS: To compare Maori with nonMaori colorectal surgical admissions to a specialised colorectal unit in a teaching hospital.
METHODS: All patients admitted to the colorectal service of the university department of surgery, Wellington, New Zealand between April 1975 and March 1990 have been entered into a computerised data base. Patients claiming to be Maori or of Maori descent were compared, in relation to colorectal diagnosis, type of admission and surgery and surgical complications, with those designated European or other.
RESULTS: There were 90 Maori admissions (47 male, 43 female) and 1842 nonMaori admissions (1007 male, 835 female). The urgency of admission was similar in both groups. There were no significant differences in admission rates for obstruction, perforation, bleeding, diverticular disease, or anorectal abscess but more Maori seemed to have problems with haemorrhoids and perineal condylomata acuminata. More nonMaori were admitted with colorectal cancer. The frequencies of most major operations were similar in the two groups studied, although haemorrhoidectomy was more common in the Maori. A higher proportion of nonMaori patients had a consultant surgeon as the primary operator. The overall complication rates, with the exception of urinary tract infections were similar in both groups. One Maori patient died and there were 31 nonMaori deaths.
CONCLUSION: There was no evidence that Maori had either less access to the public hospital system or that surgical colorectal diseases were more neglected. In general hospital admission rates for colorectal diseases in Maori and nonMaori were remarkably similar.},
}
@article {pmid9014784,
year = {1996},
author = {Michell, NP and Chung-Faye, G and Trash, DB},
title = {Diverticular disease.},
journal = {Gut},
volume = {39},
number = {5},
pages = {773},
pmid = {9014784},
issn = {0017-5749},
mesh = {Adult ; Colitis, Ulcerative/diagnosis ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis ; Female ; Humans ; Male ; Proctocolitis/*diagnosis ; },
}
@article {pmid9004782,
year = {1996},
author = {Proposito, D and Hidalgo, M and Rubio de Molina, J and Ibáñez Cabeza, E and Negro, P and Carboni, M},
title = {[Diverticular disease. Our experience].},
journal = {Revista espanola de enfermedades digestivas},
volume = {88},
number = {11},
pages = {763-769},
pmid = {9004782},
issn = {1130-0108},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Diverticulum, Colon/drug therapy/mortality/surgery ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Surgical Wound Dehiscence/epidemiology ; },
abstract = {The authors herein present their personal experience on the surgical treatment of complicated diverticular disease. The series consists of 243 patients seen between January 1974 and May 1994. One hundred and fifty nine (65.4%) were admitted in an elective and 84 (34.6%) in an emergency setting. Medical therapy was efficacious in resolving the clinical symptoms in 133. One hundred and ten pts. were treated surgically: 91 (82.7%) underwent a left hemicolectomy (one-step surgery), 13 (11.8%) the Hartmann's procedure and 6 (5.4%) a sigmoid resection. Between 1974 and 1980, when anastomoses were performed manually and an excluding colostomy was the procedure of choice, the reported rate of anastomotic dehiscence was 21%. With the technological break-through of mechanical staplers, that enabled the performance of colostomies "on demand" such rate decreased to 8% and finally to 2%, as reported during 1987-94. The operative mortality, between 1974-84, of those patients who underwent emergency surgery was 14% and decreased to 3% between 1985-94. The operative mortality of patients who underwent elective surgery between 1974-84 was 1.3% and decreased to 0% between 1985-1994. The authors underline the importance of respecting the surgical indications and the proper evaluation of pre-operative parameters aiming at a one-step surgery, that reduces both post-operative complications and recovery time.},
}
@article {pmid8918429,
year = {1996},
author = {Mealy, K and O'Broin, E and Donohue, J and Tanner, A and Keane, FB},
title = {Reversible colostomy--what is the outcome?.},
journal = {Diseases of the colon and rectum},
volume = {39},
number = {11},
pages = {1227-1231},
doi = {10.1007/BF02055113},
pmid = {8918429},
issn = {0012-3706},
mesh = {Colonic Diseases/*surgery ; Colostomy/adverse effects/*methods ; Elective Surgical Procedures ; Emergencies ; Humans ; Morbidity ; Retrospective Studies ; },
abstract = {PURPOSE: The trend toward avoidance of a colostomy at both elective and emergency large-bowel surgery is partly driven by the perceived morbidity and low closure rates of temporary stomas. The aim of this study was to examine whether significant colostomy-related morbidity remains persistently high.
METHODS: To examine this, we reviewed 120 patients with a potentially reversible colostomy performed during either elective or emergency large-bowel surgery during a seven-year period.
RESULTS: Forty-seven patients underwent elective and 73 patients underwent emergency colonic or colorectal resection. Fifty-eight patients had colorectal carcinoma (48.3 percent), diverticular disease accounted for 39 patients (32.5 percent), and a miscellaneous group of 23 patients (19.2 percent) made-up the remainder. Seven patients died, all in the emergency group (9.6 percent). Colostomy-related morbidity, which included stenosis, retraction, prolapse, and hernia formation, occurred in 19.2 percent of patients, with no difference between the elective (14.9 percent) and emergency (21.9 percent) groups or underlying pathologic condition. Colostomy closure was performed initially in 71 patients (59.2 percent). Highest closure rates occurred in the diverticular group (84.6 percent), followed by the colorectal carcinoma group (48.3 percent), and then the miscellaneous group (43.5 percent). One patient died undergoing colostomy closure, and complications occurred in 25 patients (35.2 percent), requiring fashioning of a second colostomy in eight patients, two of whom were closed. Final colostomy closure rate was 54.2 percent.
CONCLUSIONS: This study confirms the contention that both formation and closure of defunctioning colostomies are associated with significant complications; furthermore, approximately one-half of patients will not have their colostomy closed.},
}
@article {pmid9193770,
year = {1996},
author = {Van Rosendaal, GM and Andersen, MA},
title = {Segmental colitis complicating diverticular disease.},
journal = {Canadian journal of gastroenterology = Journal canadien de gastroenterologie},
volume = {10},
number = {6},
pages = {361-364},
doi = {10.1155/1996/519418},
pmid = {9193770},
issn = {0835-7900},
mesh = {Aged ; Colectomy ; Colitis, Ulcerative/*etiology/pathology/surgery ; Colon, Sigmoid/*pathology/surgery ; Diverticulum, Colon/*complications/pathology/surgery ; Follow-Up Studies ; Humans ; Male ; Sigmoid Diseases/*etiology/pathology/surgery ; Sigmoidoscopy ; },
abstract = {Two cases of idiopathic colitis affecting the sigmoid colon in elderly patients with underlying diverticulosis are presented. Segmental resection has permitted close review of the histopathology in this syndrome which demonstrates considerable similarity to changes seen in idiopathic ulcerative colitis. The reported experience with this syndrome and its clinical features are reviewed.},
}
@article {pmid8908955,
year = {1996},
author = {Kumar, P and Sangwan, YP and Horton, A and Ross, AH},
title = {Distal mucus fistula following resection for perforated sigmoid diverticular disease.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {41},
number = {5},
pages = {316-318},
pmid = {8908955},
issn = {0035-8835},
mesh = {Aged ; Anastomosis, Surgical ; Case-Control Studies ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intestinal Perforation/etiology/*surgery ; Length of Stay ; Male ; Peritonitis/etiology/surgery ; Rectum/*surgery ; Retrospective Studies ; Sigmoid Diseases/complications/*surgery ; Time Factors ; },
abstract = {A retrospective study of 62 consecutive patients undergoing resection of perforated diverticular disease was undertaken to assess influence of distal stump closure (DSC) or creating a distal mucus fistula (DMF) on subsequent restoration of bowel continuity. Forty-one patients underwent DSC and 21 DMF. Mean operating time and hospital stay were 164 min and 30 days for patients undergoing DSC compared with 142 min and 18 days for those undergoing DMF. Of the 54 survivors, 44 underwent reversal (25/35; DSC, 19/19; DMF). Mean operative time and hospital stay was 208 min and 17 days for DSC compared to 143 min and 10 days for DMF (P = 0.0003). Overall mortality and morbidity of either groups were comparable. Distal mucus fistula can often be safely created following resection of perforated sigmoid diverticulitis. This may result in higher reversal rates and significantly reduces the operating time and hospital stay without compromising the outcome.},
}
@article {pmid8905378,
year = {1996},
author = {Yoshida, M and Kawabata, K and Kutsumi, H and Fujita, T and Soga, T and Nishimura, K and Kawanami, C and Kinoshita, Y and Chiba, T and Fujimoto, S},
title = {Polypoid prolapsing mucosal folds associated with diverticular disease in the sigmoid colon: usefulness of colonoscopy and endoscopic ultrasonography for the diagnosis.},
journal = {Gastrointestinal endoscopy},
volume = {44},
number = {4},
pages = {489-491},
doi = {10.1016/s0016-5107(96)70109-8},
pmid = {8905378},
issn = {0016-5107},
mesh = {Colectomy ; Colonic Polyps/complications/*diagnosis/diagnostic imaging/surgery ; Colonoscopy/methods ; Diagnosis, Differential ; Diverticulum/complications/*diagnosis/diagnostic imaging/surgery ; *Endosonography ; Follow-Up Studies ; Humans ; Intestinal Mucosa/diagnostic imaging/pathology ; Male ; Middle Aged ; Sigmoid Diseases/complications/*diagnosis/diagnostic imaging/surgery ; },
}
@article {pmid8897240,
year = {1996},
author = {Macpherson, SC and Hansell, DT and Porteous, C},
title = {Laparoscopic-assisted reversal of Hartmann's procedure: a simplified technique and audit of twelve cases.},
journal = {Journal of laparoendoscopic surgery},
volume = {6},
number = {5},
pages = {305-310},
doi = {10.1089/lps.1996.6.305},
pmid = {8897240},
issn = {1052-3901},
mesh = {Adult ; Aged ; Anastomosis, Surgical/methods ; Colostomy ; Diverticulitis, Colonic/surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Laparoscopy/*methods ; Length of Stay ; Male ; *Medical Audit ; Middle Aged ; Postoperative Complications/etiology ; Retrospective Studies ; Sigmoid Neoplasms/*surgery ; Wound Infection/etiology ; },
abstract = {Laparoscopic-assisted reversal of Hartmann's procedure was performed in 12 patients over a 2-year period. The group comprised three patients with colonic carcinoma and nine with diverticular disease, their mean age being 62 years (range 40-73). In all twelve cases, intestinal continuity was successfully restored, without conversion to open surgery, in a median anesthetic time of 165 min (range 110-240). One patient required a temporary defunctioning colostomy and two other patients had three complications. The median postoperative hospital stay was 8 days (range 5-12). We report a retrospective audit of this consecutive series of 12 patients, showing that laparoscopic-assisted reversal of Hartmann's is technically feasible. We also give details of the morbidity associated with the technique.},
}
@article {pmid8831539,
year = {1996},
author = {Bruce, CJ and Coller, JA and Murray, JJ and Schoetz, DJ and Roberts, PL and Rusin, LC},
title = {Laparoscopic resection for diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {39},
number = {10 Suppl},
pages = {S1-6},
doi = {10.1007/BF02053798},
pmid = {8831539},
issn = {0012-3706},
mesh = {Chronic Disease ; Colectomy/*methods ; Diet ; Diverticulitis, Colonic/*surgery ; Female ; Hospital Costs ; Humans ; *Laparoscopy/adverse effects/economics/methods ; Laparotomy ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Surgical Wound Infection/etiology ; },
abstract = {PURPOSE: The role of laparoscopic surgery in treatment of patients with diverticulitis is unclear. A retrospective comparison of laparoscopic with conventional surgery for patients with chronic diverticulitis was performed to assess morbidity, recovery from surgery, and cost.
METHODS: Records of patients undergoing elective resection for uncomplicated diverticulitis from 1992 to 1994 at a single institution were reviewed. Laparoscopic resection involved complete intracorporeal dissection, bowel division, and anastomosis with extracorporeal placement of an anvil.
RESULTS: Sigmoid and left colon resections were performed laparoscopically in 25 patients and by open technique in 17 patients by two independent operating teams. No significant differences existed in age, gender, weight, comorbidities, or operations performed. In the laparoscopic group, three operations were converted to open laparotomy (12 percent) because of unclear anatomy. Major complications occurred in two patients who underwent laparoscopic resection, both requiring laparotomy, and in one patient in the conventional surgery group who underwent computed tomographic-guided drainage of an abscess. Patients who underwent laparoscopic resection tolerated a regular diet sooner than patients who underwent conventional surgery (3.2 +/- 0.9 vs. 5.7 +/- 1.1 days; P < 0.001) and were discharged from the hospital earlier (4.2 +/- 1.1 vs. 6.8 +/- 1.1 days; P < 0.001). Overall costs were higher in the laparoscopic group than the open surgery group ($10,230 +/- 49.1 vs. $7,068 +/- 37.1; P < 0.001) because of a significantly longer total operating room time (397 +/- 9.1 vs. 115 +/- 5.1 min; P < 0.001). Follow-up studies with a mean of one year revealed two port site infections in the laparoscopic group and one wound infection in the open group. Of patients undergoing conventional resection, one patient experienced a postoperative bowel obstruction that was managed nonoperatively, and, in one patient, an incarcerated incisional hernia developed that required urgent laparotomy.
CONCLUSIONS: Laparoscopic resection in patients with chronic diverticulitis is safe, with faster recovery and shorter hospital stay compared with conventional open surgery. Higher cost of operating room usage time makes the laparoscopic technique difficult to justify economically. Simplification of operating room use and better case selection may improve cost-effectiveness of the laparoscopic approach.},
}
@article {pmid8949660,
year = {1996},
author = {Cummings, JH},
title = {Diverticular disease and your mother's diet.},
journal = {Gut},
volume = {39},
number = {3},
pages = {489-490},
pmid = {8949660},
issn = {0017-5749},
mesh = {Animals ; Dietary Fiber/*administration & dosage ; Diverticulum, Colon/*embryology ; Female ; Humans ; *Maternal-Fetal Exchange ; Pregnancy ; Rats ; },
}
@article {pmid8936846,
year = {1996},
author = {Awad, Z and Ryan, T},
title = {An unusual presentation of complicated diverticular disease.},
journal = {Irish medical journal},
volume = {89},
number = {5},
pages = {190},
pmid = {8936846},
issn = {0332-3102},
mesh = {Aged ; Colectomy ; Colon, Sigmoid/*injuries ; Diverticulitis/complications/*diagnosis ; Diverticulum, Colon/complications/diagnosis/surgery ; Female ; Humans ; Laparotomy ; Rupture, Spontaneous ; Sigmoid Diseases/complications/*diagnosis ; },
}
@article {pmid8889456,
year = {1996},
author = {Lipscomb, G and Loughrey, G and Thakker, M and Rees, W and Nicholson, D},
title = {A prospective study of abdominal computerized tomography and colonoscopy in the diagnosis of colonic disease in an elderly population.},
journal = {European journal of gastroenterology & hepatology},
volume = {8},
number = {9},
pages = {887-891},
pmid = {8889456},
issn = {0954-691X},
mesh = {Aged ; Aged, 80 and over ; Colonic Diseases/*diagnosis ; *Colonoscopy ; Female ; Humans ; Male ; Prospective Studies ; *Tomography, X-Ray Computed ; },
abstract = {OBJECTIVE: The aim of this prospective study was to compare the accuracy of abdominal computed tomography (CT) and colonoscopy in diagnosing colonic pathology in an elderly population.
METHODS: Patients over the age of 70 for whom an outpatient diagnostic colonoscopy had been requested, were invited to attend for a CT scan of the abdomen following oral colonic preparation. CT was carried out within 1 month of the colonoscopy and all images were evaluated by a single consultant radiologist with no prior knowledge of the colonoscopy result.
RESULTS: Of 72 patients who fulfilled entry criteria and attended for colonoscopy, 55 (29 female) had abdominal CT of the abdomen (mean age 76.6 years, range 70-92). Colonoscopy was successful in 67% of cases and the following colonoscopic diagnoses were made: diverticular disease (26), normal (14), colonic carcinoma (6), polyps (9) colitis (2) and angiodysplasia (1). There was agreement between colonoscopic and CT diagnoses in 38 patients (69%) including all those with carcinoma of the colon. There was disagreement in 12 patients with diverticular disease, CT missed three polyps in three patients and angiodysplasia in one patient. CT provided additional important information in 9 patients: gastric leiomyosarcoma (1), aortic aneurysm (1), absence of metastases (3), liver metastases (2), cirrhosis and portal hypertension (1) and a large pleural effusion (1). One patient thought to have a carcinoma of the colon by both techniques was subsequently found to have a diverticular mass at laparotomy. Two patients undergoing colonoscopy had colonic perforations and one of these died.
CONCLUSION: CT may provide an alternative to colonoscopy in diagnosis of colonic disease in the elderly population.},
}
@article {pmid8858744,
year = {1996},
author = {Bramley, PN and Masson, JW and McKnight, G and Herd, K and Fraser, A and Park, K and Brunt, PW and McKinlay, A and Sinclair, TS and Mowat, NA},
title = {The role of an open-access bleeding unit in the management of colonic haemorrhage. A 2-year prospective study.},
journal = {Scandinavian journal of gastroenterology},
volume = {31},
number = {8},
pages = {764-769},
doi = {10.3109/00365529609010349},
pmid = {8858744},
issn = {0036-5521},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/etiology/mortality/physiopathology/*therapy ; Disease Progression ; Female ; Gastrointestinal Hemorrhage/etiology/mortality/physiopathology/*therapy ; Hospitalization ; Humans ; Male ; Middle Aged ; Prospective Studies ; Severity of Illness Index ; Survival Rate ; Triage ; },
abstract = {BACKGROUND: Major colonic haemorrhage poses difficult diagnostic and therapeutic problems and, in contrast to upper gastrointestinal bleeding, has no generally accepted plan of management.
METHODS: We report community-based prospective data accumulated over 2 years (1991-93) on 1602 patients referred to an open-access bleeding unit with suspected gastrointestinal haemorrhage.
RESULTS: Of 278 (17%) admissions with suspected lower GI haemorrhage, 252 were confirmed. Forty-eight per cent were defined as "significant' bleeds, with a decrease in haemoglobin and cardiovascular compromise. Of 102 significant bleeds in subjects more than 60 years old, 29% rebled, and 12.6% required emergency surgery. Diverticular disease (24%) was the commonest diagnosis, with tumours, infective colitis, and inflammatory colitis each at 10%. The overall 30-day mortality for colonic bleeding was 5.1% (13 of 252), with only 1 death occurring in the group less than 60 years old.
CONCLUSIONS: This study provides a unique database for the natural history of colonic bleeding and its management within the setting of a specialized bleeding unit.},
}
@article {pmid8884300,
year = {1996},
author = {Tucci, G and Torquati, A and Grande, M and Stroppa, I and Sianesi, M and Farinon, AM},
title = {Major acute inflammatory complications of diverticular disease of the colon: planning of surgical management.},
journal = {Hepato-gastroenterology},
volume = {43},
number = {10},
pages = {839-845},
pmid = {8884300},
issn = {0172-6390},
mesh = {Abdominal Abscess/*etiology/mortality/*surgery ; Anastomosis, Surgical ; Case-Control Studies ; Colostomy ; Diverticulitis, Colonic/*complications/mortality/surgery ; Drainage ; Female ; Humans ; Intestinal Perforation/*etiology/mortality/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/*complications/mortality/surgery ; },
abstract = {BACKGROUND/AIMS: The aim of this study was to determine the most appropriate surgical strategy in the management of patients with major inflammatory complications of colonic diverticular disease.
MATERIALS AND METHODS: Out of 259 patients affected by complicated diverticular disease of the colon, 43 consecutive patients (16.6%) who underwent urgent or emergency surgical intervention for diverticular perforation during a 20-year period (1975-1994) were retrospectively analyzed. According to the changes in the surgical approach over the time, the series was divided into two groups: 1975-1985 group A (n = 23), 1986-1994 group B (n = 20). The clinical diagnosis was confirmed by operative and pathologic findings.
RESULTS: Out of 43 patients, 11 underwent derivative procedure and 32 resection. There were no significant differences among the two groups of patients according to sex ratio and mean age. The overall percentage of patients in group B who underwent resective procedure (100%) was significantly greater in comparison with that in group A (52%) (p < 0.001). Colostomy and drainage was employed only during the first period (30%)(vs group B, p < 0.05) and the proportion of patients who underwent primary resection and anastomosis was significantly higher during the second period (45%) (vs group A, p < 0.05).
CONCLUSIONS: It must be stressed that resection of the diseased segment at initial operation appears mandatory; one-stage procedure is indicated when infection is confined to the mesentery, while resection and anastomosis with covering colostomy (two-stage procedure) is preferable whenever peritoneal contamination has occurred. Hartmann's operation remains the procedure of choice in the patients presenting known impaired immunity or fecal contamination.},
}
@article {pmid8818690,
year = {1996},
author = {Bak, M},
title = {Nodular intra-abdominal panniculitis: an accompaniment of colorectal carcinoma and diverticular disease.},
journal = {Histopathology},
volume = {29},
number = {1},
pages = {21-27},
doi = {10.1046/j.1365-2559.1996.d01-486.x},
pmid = {8818690},
issn = {0309-0167},
mesh = {Abdomen/*pathology ; Aged ; Aged, 80 and over ; Carcinoma/*complications ; Colorectal Neoplasms/*complications ; Diverticulum/*complications ; Female ; Humans ; Male ; Middle Aged ; Panniculitis, Nodular Nonsuppurative/*etiology ; },
abstract = {Intra-abdominal panniculitis is a tumour-like inflammatory condition of adipose tissue. The aetiology and pathogenesis of the disease is unknown, but a number of associated diseases have been recorded. It has been customary to deal with only primary cases in the literature. This study was undertaken in order to describe the entire spectrum of the disease including primary as well as secondary cases. Eleven patients are reported, nine of which had an associated colorectal disease in direct continuity with areas of intra-abdominal panniculitis. It is concluded that intra-abdominal panniculitis should not be regarded as a specific nosological entity but merely a result of injury to the fat cells. Intra-abdominal panniculitis is seen more often as a secondary local phenomenon than as a primary condition, and in both cases it is associated with considerable differential diagnostic problems. Primary diseases involved are, among others, colorectal carcinoma and diverticulosis. The aetiologic agent(s) are still unknown, but substances liberated from a damaged bowel might play a pathogenetic role.},
}
@article {pmid8984028,
year = {1996},
author = {Allan, ES and Winter, S and Light, AM and Allan, A},
title = {Mucosal enzyme activity for butyrate oxidation; no defect in patients with ulcerative colitis.},
journal = {Gut},
volume = {38},
number = {6},
pages = {886-893},
pmid = {8984028},
issn = {0017-5749},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Butyrates/*metabolism ; Case-Control Studies ; Colitis, Ulcerative/*enzymology ; Crohn Disease/*enzymology ; Female ; Fluorometry ; Humans ; Intestinal Mucosa/enzymology ; Male ; Middle Aged ; Spectrophotometry ; },
abstract = {BACKGROUND: Butyrate is an important energy source for the colon and its metabolism has been reported to be defective in ulcerative colitis. One mechanism for defective butyrate metabolism in patients with ulcerative colitis could be an enzyme deficiency in the beta-oxidation pathway of butyrate.
AIMS: This study was undertaken to measure the activity of each enzyme involved in the beta-oxidation pathway of butyrate in colonic epithelium.
PATIENTS: Patients with ulcerative colitis (n = 33), Crohn's colitis (n = 10), and control subjects with colorectal cancer or diverticular disease (n = 73) were studied.
METHODS: Analysis was carried out using fluorometric and spectrophotometric techniques on homogenised epithelial biopsy specimens.
RESULTS: Significantly increased butyryl CoA dehydrogenase activity was found in mucosa from patients with ulcerative colitis (33.2 (28.3, 38.1) mumol/g wet weight/min:mean (95% CI)) compared with activity in mucosa from control patients (24.3 (20.9, 27.7) mumol/g wet weight/min:mean (95% CI)) p < 0.02. No significant increase in activity of the enzymes butyryl-CoA synthetase, crotonase or hydroxybutyryl-CoA dehydrogenase was found in patients with ulcerative colitis. In contrast the mucosal thiolase activity was significantly lower in those patients with quiescent colitis (3.21 (2.61, 3.81) mumol/g wet weight/min:mean (95% CI)) when compared with control mucosa (5.69 (5.09, 6.29) mumol/g wet weight/min:mean (95% CI)) p < 0.001. However, mucosal thiolase activity increases with the age of the donor patient and differences in the age range of the patient groups probably account for this finding.
CONCLUSIONS: This study shows no substantial deficiency of enzyme activity in the beta-oxidation pathway of butyrate in the mucosa of patients with ulcerative colitis in histological remission.},
}
@article {pmid8984012,
year = {1996},
author = {Shepherd, NA},
title = {Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades.},
journal = {Gut},
volume = {38},
number = {6},
pages = {801-802},
pmid = {8984012},
issn = {0017-5749},
mesh = {Colitis, Ulcerative/diagnosis ; Crohn Disease/diagnosis ; Diagnosis, Differential ; Diverticulum, Colon/complications/*diagnosis ; Humans ; Inflammatory Bowel Diseases/complications/*diagnosis ; },
}
@article {pmid8691502,
year = {1996},
author = {McCarthy, DW and Bumpers, HL and Hoover, EL},
title = {Etiology of diverticular disease with classic illustrations.},
journal = {Journal of the National Medical Association},
volume = {88},
number = {6},
pages = {389-390},
pmid = {8691502},
issn = {0027-9684},
mesh = {Colon/blood supply ; Colonoscopy ; Diverticulitis/etiology ; Diverticulum, Colon/complications/*etiology/pathology ; Gastrointestinal Hemorrhage/etiology ; Humans ; },
abstract = {Diverticulosis is a common colonic disorder and often is found incidentally on colonic endoscopy and contrast enema radiographs. Theories relating to the etiology of the pathologic processes are commonly quoted, although the actual anatomic features are rarely seen during colonoscopic examinations. Here we show classic illustrations that support the widely held theories regarding the etiologies of diverticular diseases.},
}
@article {pmid8646956,
year = {1996},
author = {Kewenter, J and Brevinge, H},
title = {Endoscopic and surgical complications of work-up in screening for colorectal cancer.},
journal = {Diseases of the colon and rectum},
volume = {39},
number = {6},
pages = {676-680},
doi = {10.1007/BF02056949},
pmid = {8646956},
issn = {0012-3706},
mesh = {Barium Sulfate ; Colorectal Neoplasms/*prevention & control ; Enema ; Humans ; Intestinal Perforation/etiology ; Laparoscopy/*adverse effects ; Laparotomy/*adverse effects ; Length of Stay ; Mass Screening/*adverse effects/methods ; Middle Aged ; *Occult Blood ; Reoperation ; Sigmoidoscopy/*adverse effects ; },
abstract = {BACKGROUND AND PURPOSE: In an ongoing randomized screening study of 68,306 patients for early detection of colorectal neoplasm, those with positive Hemoccult II tests (Smith Kline Diagnostic, Sunnyvale, CA) were examined with a flexible sigmoidoscope (FS; 60 cm) and double-contrast barium enema (DCE). The aim of this study was to determine the rate of complications to the work-up.
METHODS: A total of 2,108 FS, 1,987 DCE, 190 colonoscopies, and 104 laparotomies were performed because of a positive Hemoccult.
RESULTS: One patient's large bowel was perforated during diagnostic endoscopy. Four perforations of the large bowel occurred during endoscopic polypectomy (0.8 percent of 513 adenomas removed), and one case of bleeding occurred 12 days after polypectomy. No complications occurred in connection with the 1,987 DCE. Five of 104 laparotomized patients underwent relaparotomy, 3 after removal of a colorectal carcinoma, and 2 of 4 patients with diverticular disease. All five patients healed but required a longer stay at the hospital.
CONCLUSIONS: Complications occurred in 0.3 percent of the endoscopies, and 5 percent of patients had to undergo laparotomy again. No mortality occurred. If mortality attributable to colorectal cancer will decrease because of screening, we find the complication rate is acceptable.},
}
@article {pmid8645067,
year = {1996},
author = {Belmonte, C and Klas, JV and Perez, JJ and Wong, WD and Rothenberger, DA and Goldberg, SM and Madoff, RD},
title = {The Hartmann procedure. First choice or last resort in diverticular disease?.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {131},
number = {6},
pages = {612-5; discussion 616-7},
doi = {10.1001/archsurg.1996.01430180038006},
pmid = {8645067},
issn = {0004-0010},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colostomy/*methods ; Diverticulum, Colon/mortality/*surgery ; Evaluation Studies as Topic ; Female ; Humans ; Ileostomy ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; },
abstract = {OBJECTIVE: To critique changing trends in the surgical management of diverticular disease.
DESIGN: Case series. Two hundred twenty-seven consecutive patients required surgery for diverticular disease from 1988 to 1993. Patient records were reviewed retrospectively. Operative procedures included primary resection in all patients with either anastomosis, anastomosis with proximal ileostomy, or the Hartmann procedure. Morbidity, mortality, and length of stay were then compared with each operative procedure and stage of disease. Patients were categorized according to the following pathologic stages: stage 0, no inflammation; stage I, chronic inflammation; stage II, acute inflammation with or without microabscesses; stage III, pericolonic or mesenteric abscess; stage IV, pelvic abscess; and stage V, purulent or feculent peritonitis.
SETTING: A university hospital and private affiliated hospitals in a large metropolitan area.
MAIN OUTCOME MEASURES: Study outcome parameters included mortality, morbidity, length of hospital stay, and leak rates. These outcomes were then compared with different disease stages and treatments.
RESULTS: Mean patient age was 66 years (range, 25-98 years). Male-female ratio was 84:143. Mean follow-up was 23 months (range, 1-132 months). There were 50 fistulas: 24 colovesical, 21 colovaginal, 3 colocolonic, 1 coloenteric, and 1 colouterine. Surgery was categorized as elective for 196 patients (86%), urgent for 12 (5%), and emergent for 19 (8%). Primary resection was performed in all cases. Primary anastomosis was performed in 200 patients (88%), 183 without and 17 with proximal diversion. Twenty-seven patients (12%) underwent a Hartmann procedure with colostomy; 19 patients (70%) have since undergone colostomy closure. Morbidity occurred in 52 patients (23%), including 4 anastomotic leaks (2%). There were 3 perioperative deaths (1%). Mean length of initial hospital stay was 11 days (range, 4-59 days). Length of stay was 5 days (range, 4-7 days) for ileostomy closure (7% morbidity) and 13 days (range, 7-35 days) for the colostomy closure after the Hartmann procedure (33% morbidity).
CONCLUSIONS: Primary resection is virtually always possible in complicated diverticular disease. Primary anastomosis, with or without proximal diversion, is safe for patients with no abscesses or localized abscesses and should be considered on an individual basis for patients with pelvic abscesses and peritonitis. Colostomy closure after the Hartmann procedure is associated with significant length of hospitalization and morbidity and leaves one third of patients with permanent stomas.},
}
@article {pmid9072734,
year = {1996},
author = {Fantini, C and Gauthier, P and Pastore, S and Leone, C and Conte, R},
title = {[Use of compression anastomosis devices in digestive surgery].},
journal = {Minerva chirurgica},
volume = {51},
number = {5},
pages = {265-272},
pmid = {9072734},
issn = {0026-4733},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/*instrumentation ; Colon/*surgery ; Colorectal Neoplasms/surgery ; Crohn Disease/surgery ; Diverticulum, Colon/surgery ; Evaluation Studies as Topic ; Female ; Follow-Up Studies ; Humans ; Ileum/surgery ; Male ; Middle Aged ; Rectum/surgery ; Time Factors ; },
abstract = {In this summary the authors report their experience of the clinical utilization in digestive surgery of a new compression anastomosis device consisting of a biofragmentable ring (BAR-Valtrac). From January 1993 through August 1994 26 patients underwent operations with Valtrac application: 22 for malignant colo-rectal neoplasms, 3 for diverticular disease and 1 for Crohn disease. The authors have performed 8 ileo-colic, 16 colo-colic and 2 colo-rectal anastomoses. There was no perioperatively mortality. Valtrac was discharged post-operatively between XVI and XXVIII days. There were no anastomotic leakage, bleeding or obstruction. Six months postoperatively an endoscopic control carried out in the 50% of the patients showed no anastomotic stenoses. These results, in association with those ones reported by the literature, confirm that anastomoses performed with Valtrac are safe, reliable and allow the same of better results than stapled anastomoses.},
}
@article {pmid9065127,
year = {1996},
author = {Tancer, ML and Veridiano, NP},
title = {Genital fistulas caused by diverticular disease of the sigmoid colon.},
journal = {American journal of obstetrics and gynecology},
volume = {174},
number = {5},
pages = {1547-1550},
doi = {10.1016/s0002-9378(96)70604-x},
pmid = {9065127},
issn = {0002-9378},
mesh = {Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*complications ; Female ; Fistula/diagnostic imaging/*etiology/surgery ; Genital Diseases, Female/diagnostic imaging/*etiology/surgery ; Humans ; Middle Aged ; Radiography ; Sigmoid Diseases/*complications ; },
abstract = {OBJECTIVE: Our purpose was to bring to the attention of gynecologists a subject not mentioned in a single textbook of gynecology, namely, genital fistulas resulting from diverticular disease of the sigmoid colon.
STUDY DESIGN: We report our experience with 13 genital fistulas caused by sigmoid diverticulitis.
RESULTS: Ten fistulas involved the vagina, one the vagina and bladder, one the tube, and one the uterus. Average age of the patients was 68.6 years (range 54 to 89 years). Presenting symptom in 12 patients was a malodorous vaginal discharge. All with vaginal lesions had previously undergone total hysterectomy. A barium enema failed to demonstrate a fistula in 8 of 11 patients. Colonoscopy failed in 8 of 8 patients. All fistulas were demonstrated by retrograde dye studies. Ten patients operated on were cured. Three patients refused surgery; of these, 1 had intestinal obstruction, 1 may have had spontaneous closure of the fistula, and 1 is being observed. Surgery involved staged procedures in 2 patients, fistulectomy in 4, and bowel resection and anastomosis in 4.
CONCLUSIONS: Sigmoidovaginal fistulas are the most prevalent variety of cologenital fistula caused by sigmoid diverticulitis. The diagnosis should be considered in a patient > 50 years old who complains of a foul vaginal discharge and has a history of total hysterectomy. Its presence is best demonstrated by vaginogram. Surgical therapy is advised, the extent of which will rest on the surgeon's judgment of the severity of the inflammatory process found at exploration.},
}
@article {pmid8668976,
year = {1996},
author = {Gut, A and Halter, F and Ruchti, C},
title = {[Nonsteroidal antirheumatic drugs and acetylsalicylic acid: adverse effects distal to the duodenum].},
journal = {Schweizerische medizinische Wochenschrift},
volume = {126},
number = {15},
pages = {616-625},
pmid = {8668976},
issn = {0036-7672},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Aspirin/*adverse effects ; Colitis/chemically induced ; Colitis, Ulcerative/chemically induced ; Colonic Diseases/*chemically induced ; Constriction, Pathologic/chemically induced ; Diclofenac/adverse effects ; Diverticulitis, Colonic/chemically induced ; Humans ; *Iatrogenic Disease ; },
abstract = {An increasing number of case reports and controlled trials have drawn attention to NSAID-induced side effects in the lower gastrointestinal tract. In this review we also report 9 cases of colonic ulcers and 7 cases of diaphragm disease of the ascending colon, most of them associated with the long-term intake of slow release diclofenac. NSAIDs not only can exacerbate preexisting conditions such as inflammatory bowel disease or diverticular disease, but may also induce de novo enteropathy, colitis, collagenous colitis ulcers and strictures. Complications such as bleeding, perforation or bowel obstruction may require surgery. From the literature and our own experience we conclude that the use of slow release formulations has shifted the toxicity of NSAIDs from the upper to the lower gastrointestinal tract. This must be considered in differential diagnosis and checked by endoscopy if appropriate.},
}
@article {pmid8728088,
year = {1996},
author = {Livengood, CH},
title = {Colovaginal fistula. Report of a case with failure of transvaginal repair.},
journal = {The Journal of reproductive medicine},
volume = {41},
number = {4},
pages = {291-293},
pmid = {8728088},
issn = {0024-7758},
mesh = {Aged ; Colonic Diseases/etiology/*pathology/surgery ; Diverticulum, Colon/complications ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology/*pathology ; Laparotomy/methods/standards ; Recurrence ; Vagina/surgery ; Vaginal Fistula/etiology/*pathology/surgery ; },
abstract = {BACKGROUND: Spontaneous development of colovaginal fistula is a rare cause of abnormal vaginal discharge in older women and most commonly arises from diverticular disease. Laparotomy for segmental colonic resection is the accepted treatment. The author found no previous reports of attempted transvaginal closure of these fistulae, although such closure of similar fistulae can sometimes be accomplished in patients with Crohn's disease when quiescence is achieved.
CASE: An otherwise healthy 69-year-old female developed a colovaginal fistula as a result of diverticular disease. Resolution of all associated inflammatory changes was achieved over four months. A three-layer transvaginal closure of the fistula using the Futh technique was then performed; it was technically successful but broke down one week later.
CONCLUSION: Transvaginal closure of a colovaginal fistula, even with intensive preparatory efforts, cannot be recommended on the basis of this attempt.},
}
@article {pmid8713697,
year = {1996},
author = {Yang, JL and Crowe, PJ and Ow, KT and Ham, JM and Crouch, RL and Russell, PJ},
title = {DNA flow-cytometric analysis in colorectal cancer: a comparison of metastasizing and non-metastasizing tumours.},
journal = {Journal of gastroenterology and hepatology},
volume = {11},
number = {4},
pages = {319-324},
doi = {10.1111/j.1440-1746.1996.tb01378.x},
pmid = {8713697},
issn = {0815-9319},
mesh = {Cell Cycle ; Colorectal Neoplasms/*genetics/pathology ; DNA, Neoplasm/*analysis/genetics ; Flow Cytometry ; Humans ; Liver Neoplasms/pathology/*secondary ; Ploidies ; },
abstract = {The most common cause of death in patients with colorectal cancer is metastatic liver disease. In order to identify patients at a high risk of developing hepatic secondaries from colorectal cancers, DNA content was measured in metastasizing colorectal primaries (Group I, n = 32) as well as in their subsequently resected liver secondaries and in sections of non-metastasizing colorectal cancers (Group II, n = 25). A modified interpretation system involving both a DNA index and percentage of cycling cells (those in S and G2 + M phases) was developed. DNA content was measured in paraffin-embedded sections by flow cytometry using internal controls (human peripheral blood mononuclear cells) and non-malignant tissue controls (19 patients with diverticular disease). In Group I there were significantly more tumours with both abnormal ploidy (aneuploid or abnormal tetraploid peak) and > 15% cycling cells compared with Group II (Chi-squared; P = 0.034). The combination of abnormal ploidy and > 15% cycling cells was superior to Dukes' classification for identifying metastasizing tumours (Logistic Regression; P = 0.047). However, it was not possible to discriminate between the two groups using either DNA ploidy or the percentage of cycling cells alone. The metastasizing colorectal cancers exhibited similar DNA ploidy characteristics and had a similar percentage of cycling cells compared with their liver metastases. These results suggest that tumour DNA ploidy plus the percentage of cycling cells may predict the development of liver metastases and thus survival in patients with colorectal cancer.},
}
@article {pmid8604837,
year = {1996},
author = {O'Sullivan, GC and Murphy, D and O'Brien, MG and Ireland, A},
title = {Laparoscopic management of generalized peritonitis due to perforated colonic diverticula.},
journal = {American journal of surgery},
volume = {171},
number = {4},
pages = {432-434},
doi = {10.1016/S0002-9610(97)89625-0},
pmid = {8604837},
issn = {0002-9610},
mesh = {Adult ; Aged ; Anti-Bacterial Agents/administration & dosage ; Cephalosporins/administration & dosage ; Diverticulum, Colon/*complications ; Female ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Intestinal Perforation/*complications ; *Laparoscopy ; Male ; Metronidazole/administration & dosage ; Middle Aged ; Peritoneal Lavage ; Peritonitis/*etiology/*therapy ; Suppuration ; Time Factors ; },
abstract = {PURPOSE: The use of laparoscopic peritoneal lavage in conjunction with parenteral fluids and antibiotic therapy in the management of generalized peritonitis secondary to perforated diverticular disease of the colon was assessed.
PATIENTS AND METHODS: This cohort comprised 8 patients with generalized peritonitis secondary to perforated diverticular disease of the left colon that was diagnosed laparoscopically. All the patients had purulent peritonitis, but no fecal contamination. They were treated with laparoscopic peritoneal lavage and intravenous fluids and antibiotics.
RESULTS: All patients made a complete recovery, with resumption of normal diet within 5 to 8 days. No patient has required surgical intervention during a 12- to 48-month follow-up. This approach merits further assessment as an alternative to the traditional open surgical management.},
}
@article {pmid8681735,
year = {1996},
author = {Vogt, W and Schölmerich, J},
title = {[Diverticular disease].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {121},
number = {13},
pages = {411-415},
doi = {10.1055/s-2008-1043020},
pmid = {8681735},
issn = {0012-0472},
mesh = {Decision Trees ; *Diverticulum, Colon/complications/diagnosis/etiology/therapy ; Humans ; },
}
@article {pmid8929033,
year = {1996},
author = {Tenze, L and Scevola, LC and Maghetti, F},
title = {[Surgical treatment of complications in diverticular disease].},
journal = {Annali italiani di chirurgia},
volume = {67},
number = {2},
pages = {187-192},
pmid = {8929033},
issn = {0003-469X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; Diverticulitis, Colonic/etiology/surgery ; Diverticulum, Colon/complications/diagnosis/*surgery ; Emergencies ; Female ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; Male ; Middle Aged ; Peritonitis/etiology/surgery ; },
abstract = {The modern approach to large bowel diverticulae is nowadays directed to localize group of patients, at risk for complications, who can be admitted to prophylactic surgery in order to avoid large number of emergency treatments. Despite this clinical attention 10% to 25% of the patients develop a minor or major complication either septic or bleeding. Surgery still remain the most common approach, and above all resection anastomosis treatment are to be preferred. Radiological and endoscopic diagnosis and care are getting more and more better in dealing with acute localised peritonitis and bleeding and can avoid invasive treatments when possible for a number of selected patients.},
}
@article {pmid8929028,
year = {1996},
author = {Tendella, E},
title = {[Emergencies in colorectal diseases. Introduction].},
journal = {Annali italiani di chirurgia},
volume = {67},
number = {2},
pages = {151-152},
pmid = {8929028},
issn = {0003-469X},
mesh = {Colectomy ; Colonic Diseases/diagnosis/*surgery ; Colorectal Neoplasms/diagnosis/surgery ; Emergencies ; Endoscopy ; Humans ; Rectal Diseases/diagnosis/*surgery ; },
abstract = {The colo-rectal emergencies are caused by perforation, penetration, large bowel obstruction, haemorrhage. Various acute colonic diseases have been clearly described as basic disease (traumatic events, malformations, inflammatory stenosis or functional obstruction, diverticular disease, cancer). Due to technological progress new diagnostic and surgical procedures have been introduced. This editorial symposium's aim is to study the radiological and endoscopic diagnosis and treatment and the surgical procedures in colo-rectal emergency.},
}
@article {pmid8731622,
year = {1996},
author = {Metcalf, JV and Smith, J and Jones, R and Record, CO},
title = {Incidence and causes of rectal bleeding in general practice as detected by colonoscopy.},
journal = {The British journal of general practice : the journal of the Royal College of General Practitioners},
volume = {46},
number = {404},
pages = {161-164},
pmid = {8731622},
issn = {0960-1643},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/complications ; Colonoscopy ; Family Practice ; Female ; Gastrointestinal Hemorrhage/*epidemiology/etiology ; Humans ; Incidence ; Male ; Middle Aged ; Prospective Studies ; Rectum ; United Kingdom/epidemiology ; },
abstract = {BACKGROUND: Rectal bleeding is common, but it is still unclear which patients require investigation to exclude serious pathology, although it is known that colectoral cancer is very rare under the age of 40 years. Few studies have examined all patients presenting to their primary health physician rather than screening whole populations.
AIM: The aim of this study was to investigate the view that all patients over the age of 40 who present to their general practitioner with rectal bleeding should undergo investigation by colonoscopy to rule out serious pathology, regardless of symptomatology.
METHOD: A prospective study was carried out of 99 consecutive patients over 40 years presenting with rectal bleeding to 17 general practices in Newcastle upon Tyne.
RESULTS: Serious pathology was detected by colonoscopy in 44.4% of patients. The diagnoses were: colorectal carcinoma, eight cases (two Dukes' grade A, two Dukes' grade B, four Dukes' grade C); one or more polyps, 25 cases (in 17 cases at least one polyp was 5 mm or greater in diameter); inflammatory bowel disease, 11 cases. In the remaining 55 patients, bleeding was associated with diverticular disease (16 cases) and haemorrhoids (28 cases). No cause was found in 11 patients. This high rate of pathology may be partly caused by selection of cases for referral by the general practitioner, despite efforts to minimize this. Three symptoms as elicited by the colonoscopist were found to be significantly associated with serious disease: blood mixed with stool (P < 0.001); change in bowel habit (P < 0.005); and the presence of abdominal pain (P < 0.025). However, symptoms elicited on primary presentation were less helpful and symptoms changed significantly between consultation with the general practitioner and colonoscopy.
CONCLUSION: All patients over the age of 40 years presenting with rectal bleeding should be referred for flexible sigmoidoscopy or colonoscopy. Symptoms are unhelpful in deciding who requires investigation.},
}
@article {pmid8607582,
year = {1996},
author = {Shuler, FW and Newman, CN and Angood, PB and Tucker, JG and Lucas, GW},
title = {Nonoperative management for intra-abdominal abscesses.},
journal = {The American surgeon},
volume = {62},
number = {3},
pages = {218-222},
pmid = {8607582},
issn = {0003-1348},
mesh = {APACHE ; Abdominal Abscess/etiology/*therapy ; Adolescent ; Adult ; Aged ; Child ; Drainage/adverse effects/methods ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Radiography, Interventional ; Retrospective Studies ; },
abstract = {Percutaneous drainage of an intra-abdominal abscess is utilized frequently. To evaluate its effectiveness at our institution over 16 months, 18 patients (mean age 49 years) who underwent radiologically directed percutaneous drainage of intra-abdominal abscesses were retrospectively reviewed. The abscesses were postoperative in 14 patients (laparotomy, 5; appendectomy, 4; colectomy, 3; hysterectomy, 2). Primary abscesses were due to diverticular disease (3), perforated appendicitis (3), perforated colon carcinoma (1), and perforated peptic ulcer (1). Percutaneous drainage was ultimately established in all patients with complete resolution of the abscesses occurring in 12 patients (67%). The average duration for drainage was 5.5 days (range 1-23). Average length of hospital stay after the establishment of drainage was 14.6 days (range 1-48). Six patients required surgical procedures because of inadequate abscess drainage (4) or continued clinical deterioration (2). There were no deaths. A major complication (colon perforation, enteric fistula) occurred in two patients (11%). Catheter-related problems were common (7/18 patients), and included drain migration (3), inadequate drainage, and catheter obstruction(2). Four patients required multiple percutaneous drainage procedures. Despite technical feasibility and clinical success in the majority of patients, percutaneous drainage of these intra-abdominal abscesses had frequent catheter-related complications. One-third of patients (31.8%) required surgical intervention despite a prolonged period (average 15 days) of percutaneous drainage. Patients demonstrated to have nonresolving abscesses by computer tomography (CT), abscesses associated with colonic diverticular disease of colon cancer, and abscesses localized to the left lower quadrant were noted to have less successful percutaneous abscess drainage. Patients with a persistent of rising leukocyte count and/or an elevated APACHE II score prior to drainage should be routinely reevaluated at 4 days. Earlier surgical intervention is felt to be warranted because these two factors in this study were indicative of a low nonoperative success rate. Post-appendectomy abscesses uniformly demonstrated prompt response to percutaneous drainage. CT-directed percutaneous drainage of intra-abdominal abscesses provides an alternative to immediate surgical intervention. The preliminary findings from this study suggest a limited application of this intervention in one-third of patients. Further detailed analysis of this patient group is required to delineate guidelines for identifying those patients where percutaneous drainage is unlikely to be successful.},
}
@article {pmid8932614,
year = {1996},
author = {Wexner, SD and Reissman, P and Pfeifer, J and Bernstein, M and Geron, N},
title = {Laparoscopic colorectal surgery: analysis of 140 cases.},
journal = {Surgical endoscopy},
volume = {10},
number = {2},
pages = {133-136},
pmid = {8932614},
issn = {0930-2794},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Colonic Diseases/pathology/*surgery ; Colorectal Neoplasms/pathology/*surgery ; Evaluation Studies as Topic ; Female ; Humans ; Laparoscopy/adverse effects/*methods ; Male ; Middle Aged ; Postoperative Complications/*physiopathology ; Prognosis ; Prospective Studies ; Rectal Diseases/pathology/*surgery ; Survival Rate ; },
abstract = {BACKGROUND: This study was performed to prospectively assess the results of our first 140 consecutive patients who underwent laparoscopic or laparoscopic-assisted colorectal operations.
METHODS: The parameters studied included the type and length of procedure, intra- and postoperative complications, conversion to open surgery, and length of ileus and hospitalization.
RESULTS: 140 laparoscopic and laparoscopic-assisted procedures were performed between May 1991 and January 1995. The mean patient age was 48 (range 12-88) years; there were 78 males and 62 females. Indications for surgery included inflammatory bowel disease in 47, colorectal carcinoma in 19, diverticular disease in 17, polyps in 16, familial polyposis in 7, colonic inertia in 7, fecal incontinence in 11, sigmoidocele in 3, irradiation proctitis in 3, rectal prolapse in 2, intestinal lymphoma in 2, and miscellaneous conditions in 6. The procedures included 38 total abdominal colectomies (TAC) (ileoanal reservoir 28, ileorectal anastomosis 8 and end ileostomy 2); 70 segmental resections of the colon, small bowel, and rectum; 18 diverting stoma creations; 10 reversal of Hartmann's procedures; and 4 other procedures. In 15 cases, the laparoscopic procedure was converted to a laparotomy (11%); 31 patients (22%) sustained 37 complications, which included: enterotomies(7), hemorrhage(10), intraabdominal abscess(4), prolonged ileus(6), wound infection(4), intestinal obstruction(2), anastomotic leak(1), aspiration(1), cardiac arrhythmia(1), and upper intestinal bleeding(1); there was no mortality. The overall complication rate in TAC cases was significantly higher (42%) when compared to that of all other procedures (segmental resection 17%, others 9%), P < 0.05. The mean length of operating time was 4 (range 2.5-6.5) h for TAC, 2.6 (range 1.5-5.5) h for segmental colonic resections, and 1.7 (range 0.7-4) for all other procedures. The length of ileus was 3.5 (range 2-7) days after TAC, 3 (range 2-7) after the segmental resections and 2 (range 1-4) after the other procedures. The mean length of hospital stay was 6.8 (2-40) days (8.4, 6.5, and 6.3 days for the TAC, segmental resections, and other procedures, respectively).
CONCLUSION: The feasibility of laparoscopic colorectal surgery has been well established. TAC is associated with a higher complication rate compared to other laparoscopic colorectal procedures.},
}
@article {pmid9101902,
year = {1996},
author = {Hansen, O and Zarras, K and Graupe, F and Stock, W},
title = {[Surgical therapy of sigmoid diverticulitis in elderly patients.--What decides against early elective resection].},
journal = {Langenbecks Archiv fur Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress},
volume = {113},
number = {},
pages = {470-473},
pmid = {9101902},
issn = {0942-2854},
mesh = {Aged ; Aged, 80 and over ; Cause of Death ; Diverticulitis, Colonic/mortality/*surgery ; Elective Surgical Procedures ; Geriatric Assessment ; Humans ; Male ; Postoperative Complications/mortality ; Retrospective Studies ; Risk Factors ; Sigmoid Diseases/mortality/*surgery ; Survival Rate ; },
abstract = {The results of an offensive surgical approach to diverticulitis, aimed at early elective resection, have been analysed retrospectively for 377 patients. 36.9% of older patients (> 74 years, n = 65) showed significantly higher general complications than younger patients (< 75 years, n = 312) with 26.9% (p = 0.03); local complications (18.3% vs. 12.3%; old vs. young) and mortality (1.5% vs. 1%) were similar. Age over 74 years was not a risk factor for a high morbidity and mortality in multivariate analysis. In order patients a definitive treatment for diverticular disease is also possible with high and safe standards due to early elective resection without high morbidity and mortality.},
}
@article {pmid9035424,
year = {1996},
author = {Bouillot, JL and Badawy, A and Milhade, JF and Aouad, K and Marczuck, C and Alexandre, JH},
title = {[Laparoscopy-assisted colonic surgery. Initial experience. Apropos of 49 cases].},
journal = {Annales de chirurgie},
volume = {50},
number = {7},
pages = {542-547},
pmid = {9035424},
issn = {0003-3944},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/methods ; Colon/*surgery ; Colonic Diseases/*surgery ; Female ; Humans ; *Laparoscopy/adverse effects/methods ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {From November 1993 to December 1995, 49 colonic operations were performed by a videolaparoscopic assisted approach. Indications were malignant conditions in 10 cases, benign diseases in 39 cases (diverticular disease: 28, benign tumour: 9, reversal of Hartmann's procedure: 1, volvulus: 1). Conversion to a classical procedure was necessary in 6 patients. There was no mortality and 6 postoperative complications (3 reoperations). Colonic surgery this type of (laparoscopic-assisted operations) is technically feasible. It reduces the rate of post-operative wound complications and decreases the post-operative stay. It can be recommended for the surgical treatment of benign colonic diseases.},
}
@article {pmid8867345,
year = {1996},
author = {Hansen, O and Zarras, K and Graupe, F and Dellana, M and Stock, W},
title = {[Surgical treatment of diverticulitis of the large intestine--a plea for early elective resection].},
journal = {Zentralblatt fur Chirurgie},
volume = {121},
number = {3},
pages = {190-200},
pmid = {8867345},
issn = {0044-409X},
mesh = {Aged ; Aged, 80 and over ; *Colectomy ; Colon/pathology ; *Colostomy ; Diverticulitis, Colonic/pathology/*surgery ; Female ; Humans ; Intestinal Obstruction/pathology/surgery ; Intestinal Perforation/pathology/surgery ; Male ; Middle Aged ; Postoperative Complications/*etiology/pathology/surgery ; Reoperation ; Retrospective Studies ; Surgical Wound Dehiscence/pathology/surgery ; Treatment Outcome ; },
abstract = {PURPOSE: Diverticulitis of the colon is observed more and more frequently in highly developed countries. The spontaneous course of the disease is not predictably; an exact definition of risk factors for perforated diverticulitis is missing. Therefore the decision for the conservative therapy or for an early elective resection is subject of a controversial discussion. The results of an offensive surgical concept, aiming at an early elective resection for definite therapy of diverticulitis have been analysed in a retrospective study.
RESULTS: From 1980-1995 337 patients were operated due to diverticular disease (rate of resection: 98.8%). In spite of the increase of cases with severe complicated diverticulitis from 36.2% (1980-1985) to 45.8% (1991-1995; p = 0.05) the incidence of protective colostomies decreased from 18.8% in the first six years to 0.6% (n = 1) in the last 4 1/2 years (p < 0.001). After elective resection general complications occurred in 30.1% (n = 101), local complications in 17.0% (n = 57). The clinical anastomotic leakage rate was 2.1% (n = 7). During the study the morbidity rate decreased significantly (p < 0.005). Especially the incidence of nosocomial infections was reduced from 37.7% (1980-1985) to 14.8% (1991-1995); severe local complications (anastomotic leakage, bowel obstruction, peritonitis, hemorrhage, abscess) were reduced from 10.1% (1980-1985) to 3.2% (1991-1995). The mortality rate was 1.2% (n = 4).
CONCLUSION: By consistent early elective resection of diverticulitis together with a standardized surgical management a definitive treatment of diverticulitis with a high and safe standard is possible. Already after the first severe attack of the disease, which leads to hospitalization, the early elective resection allows the definite cure for diverticular disease analogous to cholecystectomy or appendectomy, avoiding the life threatening complications.},
}
@article {pmid8739830,
year = {1996},
author = {Miura, S and Kodaira, S and Aoki, H and Hosoda, Y},
title = {Bilateral type diverticular disease of the colon.},
journal = {International journal of colorectal disease},
volume = {11},
number = {2},
pages = {71-75},
pmid = {8739830},
issn = {0179-1958},
mesh = {Adult ; Age Distribution ; Aged ; Chi-Square Distribution ; Diverticulum, Colon/diagnosis/*epidemiology/physiopathology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Japan/epidemiology ; Male ; Middle Aged ; Risk Factors ; Sex Distribution ; },
abstract = {7,543 double-contrast barium enema studied for the presence of diverticula which were classified into right-sided, left-sided and bilateral types, and the relationship of the frequency (detection rate) and numbers of diverticula to age were examined for the earlier (1982-87) and later (1988-92) periods. Diverticular disease was found in 22.2% of male and 15.5% of female examinees. The right-sided type predominated among the subjects. Frequency distribution by age of the bilateral type was similar to that of the left-sided type. Bilateral diverticular disease increased in frequency with advancing years in the sixth and seventh decade, the right-sided type increased in middle-aged subjects, and the left-sided type did not. The bilateral type was composed of diverticula in the right colon, where numbers were greater than in the pure right-sided type, but remained unchanged with increasing age, and diverticula in the left colon, where numbers were similar to the pure left-sided type, but did not increase with age. Increase in the prevalence of bilateral and not pure left-sided form has contributed to the recent increase in diverticula in the left colon among the Japanese, and might have been preceded by an increase in the right-sided type.},
}
@article {pmid8659968,
year = {1996},
author = {Vipond, MN and Moshakis, V},
title = {Four-year evaluation of a direct-access fibreoptic sigmoidoscopy service.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {78},
number = {1},
pages = {23-26},
pmid = {8659968},
issn = {0035-8843},
mesh = {Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Colonic Diseases/*diagnosis ; Colonic Neoplasms/diagnosis ; England ; Evaluation Studies as Topic ; Fiber Optic Technology/*organization & administration ; Health Services Accessibility/*organization & administration ; Humans ; Middle Aged ; Prospective Studies ; Rectal Diseases/*diagnosis ; Rectal Neoplasms/diagnosis ; *Sigmoidoscopy ; },
abstract = {Over a 4-year period, a direct-access fibreoptic sigmoidoscopy service was evaluated prospectively. In all, 756 patients were referred (median age 58 years, range 18-91 years). The principal indications were rectal bleeding (45%) or change of bowel habit (28%); both features were present in 13%. Abnormalities were present in 68% of examinations. Major disease was identified in 22% (carcinoma 7.0%, adenoma 6.3%, inflammatory bowel disease 8.3%) and minor disease in 53% (haemorrhoids 36.8%, severe diverticular disease 10.9%, non-adenomatous polyp 3.4%, perianal disease 1.4%). In patients under 40 years of age, major disease was rare (one carcinoma, three adenomas). Of the patients, 21% underwent barium enema for incomplete examination or suspected additional disease. No additional major disease was identified, but one carcinoma found in a patient with stricture. These data show that a direct-access fibreoptic sigmoidoscopy service produces a high diagnostic yield and may be of value to both patients and general practitioners in expediting a clinical colorectal service.},
}
@article {pmid8657399,
year = {1996},
author = {Tancer, ML and Veridiano, NP},
title = {Genital fistulas secondary to diverticular disease of the colon: a review.},
journal = {Obstetrical & gynecological survey},
volume = {51},
number = {1},
pages = {67-73},
doi = {10.1097/00006254-199601000-00023},
pmid = {8657399},
issn = {0029-7828},
mesh = {Diverticulitis, Colonic/*complications/history ; Female ; History, 19th Century ; History, 20th Century ; Humans ; Intestinal Fistula/diagnosis/epidemiology/*etiology/therapy ; Vaginal Fistula/diagnosis/epidemiology/*etiology/therapy ; },
abstract = {Genital fistulas that complicate diverticular disease of the sigmoid colon may no longer be considered esoteric, or even rare phenomena. The vast majority of such lesions present with a foul, often fecal, sometimes purulent and occasionally blood-tinged, vaginal discharge for which patients customarily first seek relief from their gynecologists. Despite this fact, the topic is not mentioned in a single American textbook of gynecology. It is the purpose of this report to review the pertinent literature and to include the authors' experience with 13 additional cases in order to bring this topic to the attention of our gynecologic colleagues.},
}
@article {pmid8615995,
year = {1996},
author = {Fernández, E and Linares, A and Alonso, JL and Sotorrio, NG and de la Vega, J and Artimez, ML and Giganto, F and Rodríguez, M and Rodrigo, L},
title = {Colonoscopic findings in patients with lower gastrointestinal bleeding send to a hospital for their study. Value of clinical data in predicting normal or pathological findings.},
journal = {Revista espanola de enfermedades digestivas},
volume = {88},
number = {1},
pages = {16-25},
pmid = {8615995},
issn = {1130-0108},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Angiodysplasia/diagnosis ; Colitis, Ischemic/diagnosis ; Colonic Neoplasms/diagnosis ; *Colonoscopy ; Diagnosis, Differential ; Diverticulum, Colon/diagnosis ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Intestinal Polyps/diagnosis ; Male ; Middle Aged ; Proctitis/diagnosis ; },
abstract = {BACKGROUND: Lower gastrointestinal bleeding is a highly frequent clinical problem that may reflect serious pathology in the colon. Colonoscopy is generally accepted as the diagnostic procedure of choice. Decisions as to whether to carry out colonoscopy or not, are not well defined.
METHODS: 536 colonoscopies, made to discover the cause of lower gastrointestinal bleeding were analyzed and a final 457 included in the study. All of these patients came to the hospital because they had presented at least in one occasion, one episode of rectal bleeding, and were send by the specialist of the zone, in order to achieve a correct diagnosis of its process. In all cases the following associated symptoms were analyzed: the presence of diarrhea, constipation, abdominal pain and rectal mass on examination. The characteristics of lower gastrointestinal bleeding were analyzed in a subset of 150 consecutive patients.
RESULTS: Mean age was 59 +/- 16.9 years. 54.5% were male and 45.5% female. The exploration was normal until the cecum in 146 patients (32%). In the remaining 311, the findings were: polyps (25.1%), diverticular disease (24%), neoplasia (12.6%), inflammatory bowel disease (9.4%), unspecific proctitis (2.4%), ischemic colitis (2.4%), angiodysplasia (1.9%), infectious colitis (1.1%), and miscellaneous (0.7%). An age of less than 40 years and the existence of anal pathology were significantly more frequent among patients with a normal examination (p < 0.001), but with a sensitivity of only 66%. No differences were found among patients with disordered bowel frequency or abdominal pain in relation to the colonoscopic findings. Previous presence of a rectal mass when the examination proved abnormal (p=0.06). Intermittent bleeding and the presence of blood in the stools were more frequent in patients with normal examination (p= 0.07 and p< 0.05, respectively). No significant differences in relation to colour, duration of bleeding, or to whether toilet paper was stained with blood were found.
CONCLUSIONS: 1) The more frequent endoscopic findings were polyps and diverticular disease. 2) Clinical data are of little value in predicting a normal examination. 3) Total colonoscopy appears to be the first procedure of choice in all patients with lower gastrointestinal bleeding, irrespective of the clinical data and the presence of anal pathology.},
}
@article {pmid8540614,
year = {1996},
author = {Makapugay, LM and Dean, PJ},
title = {Diverticular disease-associated chronic colitis.},
journal = {The American journal of surgical pathology},
volume = {20},
number = {1},
pages = {94-102},
doi = {10.1097/00000478-199601000-00011},
pmid = {8540614},
issn = {0147-5185},
mesh = {Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Colitis/*etiology/pathology/therapy ; Colonoscopy ; Diagnosis, Differential ; Diverticulum, Colon/*complications/therapy ; Female ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases/pathology ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; },
abstract = {A clinical syndrome of chronic colitis unique to the sigmoid colon harboring diverticular was recently reported; its histopathological appearance has not been fully elucidated. In this study, the authors analyzed the clinical and pathological features of 23 patients (age range, 38-87 years; median age, 72 years) with diverticular disease-associated chronic colitis. Nineteen presented with hematochezia; four had abdominal pain. Colonoscopic visualization of the mucosa showed patchy or confluent granularity and friability affecting the sigmoid colon encompassing diverticular ostia. Colonic mucosae proximal and distal to the sigmoid were endoscopically normal. Mucosal biopsy specimens showed features of idiopathic inflammatory bowel disease that included plasmacellular and eosinophilic expansion of the lamina propria (100%), neutrophilic cryptitis (100%) with crypt abscesses (61%), basal lymphoid aggregates (100%), distorted crypt architecture (87%), basal plasmacytosis (61%), surface epithelial sloughing (61%), focal Paneth cell metaplasia (48%), and granulomatous cryptitis (26%). Concomitant rectal biopsies obtained in five patients demonstrated histologically normal mucosa. Fourteen patients treated with high-fiber diet or antibiotics or both improved clinically, as did nine patients administered sulfasalazine or 5-aminosalicylic acid. Five patients underwent sigmoid colonic resection, three for stricture with obstruction and two for chronic blood loss anemia. Among a control population of 23 age- and gender-matched patients with diverticular disease without luminal surface mucosal abnormality, none required resection during the same follow-up period. By Fisher's exact test, a statistically significant difference in outcome for patients with and without colitis was detected (p = 0.049). In addition, three patients developed ulcerative proctosigmoiditis 6, 9, and 17 months after the onset of diverticular disease-associted colitis. The data indicate that diverticular disease-associated chronic sigmoid colitis expresses morphological features traditionally reserved for idiopathic inflammatory bowel disease. Its clinical and endoscopic profiles permit distinction from Crohn's disease and ulcerative colitis. Patients with chronic colitis in conjunction with diverticula are at increased risk for sigmoid colonic resection. Diverticular disease-associated chronic colitis may also precede the onset of conventional ulcerative proctosigmoiditis in some cases.},
}
@article {pmid8582159,
year = {1995},
author = {Morton, DG and Keighley, MR},
title = {[Prospective national study of complicated diverticulitis in Great Britain].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {66},
number = {12},
pages = {1173-1176},
pmid = {8582159},
issn = {0009-4722},
mesh = {Abdominal Abscess/etiology/mortality/surgery ; Anastomosis, Surgical ; Cause of Death ; Colonic Diseases/etiology/mortality/surgery ; Colostomy ; Cross-Sectional Studies ; Diverticulitis, Colonic/complications/mortality/*surgery ; Gastrointestinal Hemorrhage/etiology/mortality/surgery ; Humans ; Incidence ; Intestinal Fistula/etiology/mortality/surgery ; Intestinal Perforation/etiology/mortality/surgery ; Medical Audit ; Peritonitis/etiology/mortality/surgery ; Postoperative Complications/mortality ; Prospective Studies ; Survival Rate ; Treatment Outcome ; United Kingdom/epidemiology ; },
abstract = {Three hundred cases of complicated diverticular disease were entered into a national audit organised by the Surgical Research Society from 30 hospitals between 1985 and 1988. Admission complications included acute phlegmon (n = 104), pericolic abscess (n = 34), purulent peritonitis (n = 40), large bowel obstruction (n = 31), faecal peritonitis (n = 23), pericolic abscess complicated by fistula (n = 28) and lower GI bleeding (n = 40). The overall mortality was only 11% (4% acute phlegmon, 27% purulent peritonitis, 12% pericolic abscess, 48% faecal peritonitis, 6% large bowel obstruction, 2.5% bleeding, 3.5% fistula). Acute phlegmon was managed non-operatively in 75% and by resection in 23%. Purulent peritonitis was generally managed by Hartmann resection (62%) or by resection and primary anastomosis (15%). Similarly pericolic abscess was usually managed by Hartmann resection (38%) or resection and primary anastomosis (35%). The principal operation for faecal peritonitis was Hartmann resection (83%). Large bowel obstruction was either managed conservatively (13%), by Hartmann resection (29%) or by resection and primary anastomosis with and without a proximal stoma (42%). Most fistulas associated with an abscess were managed by resection and primary anastomosis (82%) and acute GI bleeding was usually managed non-operatively (90%).},
}
@article {pmid8582158,
year = {1995},
author = {Hoffmann, P and Layer, P},
title = {[Pathogenesis and pathophysiology of sigmoid diverticulitis].},
journal = {Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen},
volume = {66},
number = {12},
pages = {1169-1172},
pmid = {8582158},
issn = {0009-4722},
mesh = {Colonic Diseases/etiology/pathology/physiopathology ; Diverticulitis, Colonic/*etiology/pathology/physiopathology ; Humans ; Intestinal Mucosa/pathology/physiopathology ; Intestinal Perforation/etiology/pathology/physiopathology ; Muscle, Smooth/pathology/physiopathology ; Sigmoid Diseases/*etiology/physiopathology ; },
abstract = {The sigmoid colon is the part of the large intestine which is most commonly involved in diverticular disease due to its anatomical properties. True diverticula containing all layers of the colonic wall are rare. The majority of diverticula found are pseudodiverticula. They are herniations of mucosa and submucosa through clefts in the colonic muscle layers as a result of morphologic changes of the colonic wall and an imbalance between the intraluminal pressure and the pressure in the abdominal cavity. Microperforations of the tip of the diverticula are an important factor leading to inflammation and symptomatic disease.},
}
@article {pmid8577218,
year = {1995},
author = {Graupe, F and Rassek, D and Schwenk, W and Stock, W},
title = {[Diverticulitis of the jejunum as a rare cause of acute gastrointestinal hemorrhage--diagnosis and therapy].},
journal = {Leber, Magen, Darm},
volume = {25},
number = {6},
pages = {279-281},
pmid = {8577218},
issn = {0300-8622},
mesh = {Aged ; Aged, 80 and over ; Diagnosis, Differential ; Diagnostic Imaging ; Diverticulitis/*complications/diagnosis/pathology/surgery ; Gastrointestinal Hemorrhage/*etiology/pathology/surgery ; Humans ; Jejunal Diseases/*complications/diagnosis/pathology/surgery ; Jejunum/pathology/surgery ; Male ; },
abstract = {Small bowel diverticulosis is in contrast to large intestine diverticulosis an uncommon, acquired entity. In most cases it was found in duodenum and as a Meckel's diverticulum. Jejunal or ileal diverticulosis is a relatively rare disease. Although the majority of the patients do not require surgical treatment because of the absence of clinical signs, in 10% complications may necessitate small bowel resection. The clinical significance, diagnostic evaluation, and treatment of jejunal diverticular disease are reviewed.},
}
@article {pmid8578135,
year = {1995},
author = {Boudet, MJ and Lacaine, F},
title = {[Diagnosis and treatment of colonic and anorectal hemorrhages].},
journal = {La Revue du praticien},
volume = {45},
number = {18},
pages = {2307-2312},
pmid = {8578135},
issn = {0035-2640},
mesh = {Aged ; Anus Diseases/*diagnosis/etiology/therapy ; Colonic Diseases/*diagnosis/etiology/therapy ; Gastrointestinal Hemorrhage/*diagnosis/etiology/therapy ; Humans ; Rectal Diseases/*diagnosis/etiology/therapy ; },
abstract = {In lower gastrointestinal bleeding, the first step is the exclusion of an upper gastrointestinal cause, responsible in 15 to 20% of cases, and the assessment of the severity of blood loss, so that an adequate resuscitation can be rapidly performed. Eighty percent of these bleeding episodes stop spontaneously; among these, 25% recurs, sometimes severely. When bleeding episode stops, it is essential to repeat the examinations to find out the cause of bleeding. The therapy may be endoscopic, radiologic, surgical or medical. For patients who require an emergent surgical procedure, intraoperative endoscopic techniques can be helpful. In 95% of cases, the source of bleeding is the colon or the rectum: the most common causes are diverticular disease, in particular from the right colon, colorectal tumours, angiodysplasia and colitis, but there are some simple causes easy to diagnose such as hemorrhoids, anal fissures and thermometric ulcerations.},
}
@article {pmid8731248,
year = {1995},
author = {Habr-Gama, A and Sousa, AH and Araújo, SE and Jureidini, R and Simões, FA and Gama-Rodrigues, J},
title = {[Colectomy and anterior resection with a video-laparoscopic approach. Initial experience-results].},
journal = {Revista do Hospital das Clinicas},
volume = {50},
number = {6},
pages = {299-304},
pmid = {8731248},
issn = {0041-8781},
mesh = {Adult ; Colectomy/*methods ; Humans ; Intraoperative Complications ; Laparoscopy/*methods ; Postoperative Complications ; Surgical Stapling ; *Video Recording ; },
abstract = {Laparoscopic procedures are rapidly advancing. Laparoendoscopic colectomy appears to be an option the treatment of colonic disease and is increasingly being performed in selected patients. The purpose of this study is to review our initial experience with the method which initiated in 1992. Thirty-three patients underwent laparoscopic resection of colorectal segment. All the patient, charts were assessed and data were obtained about the diagnosis, operation performed, complications, conversion and postoperative course. Diverticular disease was the most frequent (54.5%) indication of laparoscopic colorectal procedure in our series followed by adenocarcinoma (27.3%). Left colectomy was performed in 19 (57.6%) patients. Anastomosis followed double-stapling technique in most of them. Conversion to open procedure occurred in six (18.2%) cases. There were 4 complications associated to the method resulting in an specifíc morbidity of 12.1% in this series. There were no complications related to the anastomosis and no death occurred. Postoperative course was favorable for the patients and all could take oral liquids in the day after the procedure. Colorectal surgery performed by video-laparoscopic access is feasible, safe and benefits all patients. Conversion and morbidity in our series are similar to those shown in literature. It must, however, be indicated in a selected basis and in centers of reference for treatment of colorectal disease.},
}
@article {pmid8712601,
year = {1995},
author = {Gabrielli, F and Di Gioia, F and Di Sibio, T and Chiarelli, M and Campanelli, G and Pietri, P},
title = {[Crohn's disease in the elderly].},
journal = {Annali italiani di chirurgia},
volume = {66},
number = {6},
pages = {851-6; discussion 856-7},
pmid = {8712601},
issn = {0003-469X},
mesh = {Aged ; *Crohn Disease/diagnosis/therapy ; Diagnosis, Differential ; Humans ; Middle Aged ; },
abstract = {Primary Crohn's disease in the elderly is a not frequent pathology, which however have distinguished from the reheightening or relapse of an inflammatory illness risen up in juvenile age. The Authors compare the personal experience (6 cases on 120 patients operated for Crohn's disease) with the data of the literature. The more frequent localization stays the ileo-colic one, also if in the elderly present better impact the cases of Crohn's colitis (pancolitis or left colitis), with frequent and- perianal implications. The symptomatology is not pathognomonic and above all in the cases of colitis sets problems of differential diagnosis with other pathologies, among which the diverticular disease, that on the other hand, can also coexist with the inflammatory illness. A pharmacological treatment is desiderable, but frequently doesn't result effective. The surgical conservative therapy is not always possible and could be necessary resort to maiming interventions, like massive ileal resections or a total proctocolectomy. From the prognostic point of view, the course appears from the beginning or very favorable (with low index of relapse) or tumultuous (with acute manifestations, which require an emergency surgery, wighted by a more elevated rates of mortality and morbidity.},
}
@article {pmid8580138,
year = {1995},
author = {Meindl, S and Knoflach, P and Neuwirth, G and Spöttl, A},
title = {[Radiologic image of massive diverticulosis of the small intestine].},
journal = {Aktuelle Radiologie},
volume = {5},
number = {6},
pages = {374-375},
pmid = {8580138},
issn = {0939-267X},
mesh = {Aged ; Diagnosis, Differential ; Diverticulum/*diagnostic imaging ; Gastrointestinal Hemorrhage/diagnostic imaging ; Gastrointestinal Motility/physiology ; Humans ; Intestinal Mucosa/diagnostic imaging ; Intestine, Small/*diagnostic imaging ; Male ; Radiography ; },
abstract = {Diverticulosis of the small bowel is rare compared with diverticular disease of the colon. Diverticulosis of the duodenum is more common than the involvement of the whole small bowel including the ileum which is a very rare condition. In a patient presenting with gastrointestinal bleeding extensive diverticulosis of the whole small bowel was identified; the etiology is discussed.},
}
@article {pmid8553229,
year = {1995},
author = {Wishner, JD and Baker, JW and Hoffman, GC and Hubbard, GW and Gould, RJ and Wohlgemuth, SD and Ruffin, WK and Melick, CF},
title = {Laparoscopic-assisted colectomy. The learning curve.},
journal = {Surgical endoscopy},
volume = {9},
number = {11},
pages = {1179-1183},
pmid = {8553229},
issn = {0930-2794},
mesh = {Aged ; Case-Control Studies ; Colectomy/*methods/statistics & numerical data ; Colonic Neoplasms/surgery ; Colonic Polyps/surgery ; Diverticulum, Colon/surgery ; Female ; Humans ; Intraoperative Complications/epidemiology ; *Laparoscopy ; Learning ; Length of Stay/statistics & numerical data ; Male ; Postoperative Complications/epidemiology ; Time Factors ; },
abstract = {One hundred fifty consecutive laparoscopic-assisted colectomies performed by a surgical team were analyzed in an attempt to define a learning curve. These colectomies performed by the Norfolk Surgical Group over a 24-month period, were divided chronologically into six groups of 25 patients each. The groups were then compared to determine if any improvement in length of procedure, complication rate, conversion rate, or length of stay developed as experience increased. Colon cancer and diverticular disease were the most common indications for surgery in all groups. Right hemicolectomy, left colectomy, and low anterior resection accounted for the majority of procedures in all groups. A significant decrease in mean operative time, from 250 min to 156 min over the first 35-50 cases was observed before leveling off at approximately 140 min for the remaining group. Intraoperative complications were low in all groups (range zero to two) and did not show any trend. There was no statistically significant difference in the conversion rate (23.3% overall) among the six groups. Length of stay decreased from 6 days in the first two groups to 5 days in the last four groups, although the difference was not statistically significant. The learning curve for laparoscopic-assisted colectomies is longer than appreciated by many surgeons, requiring as many as 35-50 procedures to decrease operative time to baseline. Complications can be kept at an acceptably low level while on the curve if a cautious approach is taken and the surgeon realizes that a prolonged operative time is not only acceptable, but appropriate during this long learning process. A conversion rate of 20-25% at any phase of the learning process may in fact represent a limitation of current technology. When combined with a low complication rate it may be the sign of a careful surgeon.},
}
@article {pmid8550704,
year = {1995},
author = {Guivarc'h, M and Hakim, M and Roullet-Audy, JC and Mosnier, H and Kone, LD},
title = {[Evolution of Hartmann's procedure. 249 interventions].},
journal = {Journal de chirurgie},
volume = {132},
number = {11},
pages = {417-422},
pmid = {8550704},
issn = {0021-7697},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colitis, Ischemic/epidemiology/mortality/*surgery ; Colorectal Neoplasms/epidemiology/mortality/*surgery ; Female ; France/epidemiology ; Humans ; Male ; Middle Aged ; Morbidity ; Postoperative Complications ; Retrospective Studies ; Sigmoid Diseases/epidemiology/mortality/*surgery ; },
abstract = {A retrospective study of 249 patients undergoing Hartmann's procedure over twenty-five years was undertaken to analyse the evolution of indications and results. Patients were divided into three time period groups: from 1969 to 1978, 1979 to 1990 and 1991 to 1994. Mean age was 68 years old. Major indications were complicated diverticular disease (42.9%), colo-rectal malignancies (35.7%) and ischemic colitis (14%). Operative mortality is 10.8%, higher in ischemic colitis (20%) than in complicated diverticulitis (6.5%) and cancer (13.4%). Overall morbidity has significantly reduced, from 65.51% to 17.24%. General complications have changed a little, while local and/or inherent operative complications have reduced from 22.4% to 1.72. Restoration of colorectal continuity was done in 59.54% of patients, increasing from 36% to 71% during the three periods. This is variable depending on initial disease: 92% in diverticular disease, 69% in ischemic colitis but remains stable for carcinoma at 33%. Overall mortality since 1981 is 2.5% and morbidity is 19.13%. Mean Hospital stay was 20 days for the initial operation and 15 days for secondary restoration of colorectal continuity. Hartmann's procedure is well indicated as emergency surgery in colonic perforations, abscessus and ischemia. Progressive improvement of its results is essentially due to persistent attention to indications and technical details.},
}
@article {pmid8544155,
year = {1995},
author = {Dwarakanath, AD and Chua, E and Rhodes, JM and Hershman, MJ},
title = {Inspecting the colon from inside and out to solve pyrexia of unknown origin.},
journal = {Journal of the Royal Society of Medicine},
volume = {88},
number = {11},
pages = {661P-662P},
pmid = {8544155},
issn = {0141-0768},
mesh = {Colonoscopy ; Diverticulitis, Colonic/*complications ; Fever of Unknown Origin/*etiology ; Humans ; Laparoscopy ; Male ; Middle Aged ; Sigmoid Diseases/*complications ; },
abstract = {A man with longstanding intermittent symptoms of abdominal pain, diarrhoea and pyrexia of unknown origin was diagnosed with the novel technique of laparoscopic-assisted colonoscopy. At subsequent laparotomy, a longstanding perforation of sigmoid diverticular disease was resected, with resolution of his symptoms.},
}
@article {pmid8771149,
year = {1995},
author = {Gratama, S and Smedts, F and Whitehead, R},
title = {Obstructive colitis: an analysis of 50 cases and a review of the literature.},
journal = {Pathology},
volume = {27},
number = {4},
pages = {324-329},
doi = {10.1080/00313029500169233},
pmid = {8771149},
issn = {0031-3025},
mesh = {Aged ; Aged, 80 and over ; Colitis, Ulcerative/etiology/*pathology ; Female ; Humans ; Intestinal Obstruction/complications/*pathology ; Male ; Middle Aged ; Necrosis ; },
abstract = {Obstructive colitis is an ulcero-inflammatory and necrotizing condition that occurs in the colon proximal to benign or malignant stenosing lesions. it is the result of ischemia due to impairment of blood supply secondary to elevation of the endoluminal pressure, distension of the colonic wall and other factors which impair adequate perfusion. The incidence among patients with colonic obstruction is reported at between 1 and 7%. Of 50 patients with this condition in this series, 30 female and 20 male, 2/3rds were well over 70 yrs of age. Obstruction was most common in the rectosigmoid. In half the patients this was due to adenocarcinoma, 24 were due to benign obstruction and 15 were caused by diverticular disease. Type, extent and depth of ischemic lesions were highly variable and comprised early mucosal hemorrhage and edema, ulcero-hemorrhagic lesions and transmural necrosis. There was always an abrupt transition between affected and normal bowel. A segment of preserved mucosa was usually present on the proximal side of the stenosis. In 16 patients massive dilatation with stretching and thinning of the bowel wall, associated with a blow-out type of perforation or with transmural necrosis, was observed and was considered to have resulted from a rapid rise of endoluminal pressure to high levels. The microscopic and macroscopic features are described in detail and histological factors discussed in relation to the pathological lesions encountered. Emphasis is placed upon the range of appearances and similarities are shared with other inflammatory colonic diseases, particularly idiopathic inflammatory bowel disease. The importance of recognition of this disease entity, not only by pathologists but by surgeons dealing with the disease at operation, is stressed.},
}
@article {pmid8555344,
year = {1995},
author = {Stefánsson, T and Ekbom, A and Sparén, P and Påhlman, L},
title = {Cancers among patients diagnosed as having diverticular disease of the colon.},
journal = {The European journal of surgery = Acta chirurgica},
volume = {161},
number = {10},
pages = {755-760},
pmid = {8555344},
issn = {1102-4151},
mesh = {Aged ; Cohort Studies ; Colonic Neoplasms/complications/epidemiology ; Diverticulitis, Colonic/complications/diagnosis ; Diverticulum, Colon/complications/*diagnosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasms/*complications/epidemiology ; Retrospective Studies ; },
abstract = {OBJECTIVE: To assess the incidence of underlying malignancy in patients with a diagnosis of diverticular disease of the colon.
DESIGN: Retrospective cohort study.
SETTING: University hospital, Sweden.
SUBJECTS: 7159 patients discharged from hospital with a first diagnosis of diverticulosis or diverticulitis in central Sweden 1965-1983.
INTERVENTION: The cohort was followed up for two years for the occurrence of cancer.
MAIN OUTCOME MEASURE: Cancer incidence.
RESULTS: A total of 372 cancer cases were identified standard incidence ratio = 2.4; 95% confidence interval 2.2 to 2.7). Sites at excess risk during the first year were: colon and rectum, pancreas, prostate, stomach, lymphatic and haemopoietic tissue, liver and bile ducts, ovary and lung, with the highest excess risk in the left colon (standard incidence ratio = 17.8; 95% CI 12.7 to 24.1).
CONCLUSION: Malignant diseases, especially colorectal cancer, are relatively common among patients with a clinical diagnosis of diverticulosis or diverticulitis of the colon. This may indicate a need for a change in current clinical practice.},
}
@article {pmid7656745,
year = {1995},
author = {Cirocco, WC and Rusin, LC},
title = {Factors that predict incomplete colonoscopy.},
journal = {Diseases of the colon and rectum},
volume = {38},
number = {9},
pages = {964-968},
doi = {10.1007/BF02049733},
pmid = {7656745},
issn = {0012-3706},
mesh = {Abdomen/surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Colectomy ; *Colonoscopy ; Diverticulitis ; Female ; Humans ; Hysterectomy ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; },
abstract = {PURPOSE AND METHODS: Certain factors in a patient's history, such as prior abdominal surgery or complicated diverticular disease, have been reported to hinder cecal intubation during colonoscopy. Over a 16-month period, 1,047 consecutive colonoscopies were prospectively evaluated to determine whether these factors were indeed clinically relevant.
RESULTS: Of the 90 patients (9 percent) who had incomplete intubation of the colon, there were significantly more women (66 percent) than men (34 percent) (P < 0.001). Women with a history of abdominal hysterectomy had a significantly lower cecal intubation rate (P < 0.01). A history of diverticulitis did not alter the cecal intubation rate. In patients with incomplete colonic intubation, the most proximal extent of intubation was the sigmoid colon in women (31 percent) and the right colon in men (68 percent). Sixty-seven percent of patients with incomplete intubation of the colon had a prior colonoscopy completed to the cecum (67 percent women, 67 percent men), whereas 50 percent had a follow-up colonoscopy completed to the cecum (56 percent women, 40 percent men).
CONCLUSIONS: Women, especially those with a history of abdominal hysterectomy, had a significantly lower cecal intubation rate usually because of an impassable sigmoid colon. Prior inability to complete colonoscopy to the cecum does not necessarily forecast future failure.},
}
@article {pmid7607039,
year = {1995},
author = {Nakada, I and Ubukata, H and Goto, Y and Watanabe, Y and Sato, S and Tabuchi, T and Soma, T and Umeda, K},
title = {Diverticular disease of the colon at a regional general hospital in Japan.},
journal = {Diseases of the colon and rectum},
volume = {38},
number = {7},
pages = {755-759},
doi = {10.1007/BF02048036},
pmid = {7607039},
issn = {0012-3706},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Diverticulum, Colon/*epidemiology/surgery ; Female ; Hospitals, General ; Humans ; Japan/epidemiology ; Male ; Middle Aged ; },
abstract = {PURPOSE: X-ray film registry records were reviewed to better understand the changing nature of diverticular disease (DD) of the colon in Japan.
RESULTS: Among 6,849 patients undergoing barium enema examination during a eight-year period from 1985 to 1992, this condition was found in 1,074 patients (15.7 percent), including 702 males (65.4 percent) and 372 females (34.6 percent). During this eight-year period there was an increase in frequency from 10.7 percent in 1985 to 17.8 percent in 1992. The proportion of patients with right-sided, bilateral, and left-sided DD was 69.2 percent, 17.5 percent, and 13.3 percent, respectively. The right-sided DD was more common in the younger age group and was predominant in male patients, whereas the left-sided DD increased with age, especially in female patients. Of the 1,074 patients, 11 (1.0 percent) underwent surgery in the same period. Regarding the right-sided DD, only 2 of 743 patients received surgery (0.3 percent). On the other hand, of the 143 patients with left-sided DD, 9 patients (6.3 percent) received some form of surgery.
CONCLUSION: Right-sided diverticular disease of the colon is still common in Japan. It does not appear that this tendency will change in the future. Nearly all patients diagnosed as having diverticula had either no symptoms or only mild symptoms, and only about 1 percent required surgery. Right-sided diverticular disease of the colon seems to have had no serious clinical problems compared with left-sided DD.},
}
@article {pmid7665712,
year = {1995},
author = {Deans, GT and Hale, RJ and McMahon, RF and Brough, WA},
title = {Amyloid tumour of the colon.},
journal = {Journal of clinical pathology},
volume = {48},
number = {6},
pages = {592-593},
pmid = {7665712},
issn = {0021-9746},
mesh = {Adenoma, Villous/complications/*pathology ; Aged ; Amyloidosis/complications/*pathology ; Colonic Diseases/complications/*pathology ; Colonic Neoplasms/complications/*pathology ; Humans ; Male ; Rectal Diseases/complications ; },
abstract = {A case of amyloid tumour of the colon and the first in association with a carcinoma is reported. A previously healthy 65 year old man presented with non-specific symptoms of lower abdominal pain and flatulence without rectal bleeding. A clinical diagnosis of diverticular disease was made and colonoscopy performed. Two lesions (one at 15 cm and the other at 30 cm from the anal margin) were found on endoscopy and removed. On histology, the lesion at 15 cm was a moderately differentiated adenocarcinoma and that at 30 cm contained amyloid. Further tests (standard tinctorial methods and immunohistochemistry) revealed the 30 cm lesion to be an amyloid tumour of the colon of AL (lambda) type. When biopsy of an atypical, large, solitary colorectal lesion reveals amyloid deposition, the possibility of an amyloid tumour should be considered and the lesion resected.},
}
@article {pmid7773067,
year = {1995},
author = {Heaton, KW and Thompson, WG},
title = {Exercise and diverticular disease.},
journal = {BMJ (Clinical research ed.)},
volume = {310},
number = {6990},
pages = {1332},
pmid = {7773067},
issn = {0959-8138},
mesh = {Diverticulum, Colon/*prevention & control ; *Exercise ; Humans ; },
}
@article {pmid7743720,
year = {1995},
author = {Saunders, BP and Halligan, S and Jobling, C and Fukumoto, M and Moussa, ME and Williams, CB and Bartram, CI},
title = {Can barium enema indicate when colonoscopy will be difficult?.},
journal = {Clinical radiology},
volume = {50},
number = {5},
pages = {318-321},
doi = {10.1016/s0009-9260(05)83424-5},
pmid = {7743720},
issn = {0009-9260},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anthropometry ; *Barium Sulfate ; Colon/pathology/physiopathology ; *Colonoscopy ; Diverticulum, Colon/*diagnostic imaging ; *Enema ; Female ; Humans ; Intestine, Large/*diagnostic imaging ; Male ; Middle Aged ; Movement ; Radiography ; Rectum/pathology ; Retrospective Studies ; Risk Factors ; },
abstract = {The barium enemas of 48 consecutive patients, who were technically difficult to intubate at colonoscopy, were compared to those of 46 patients who were not. Measurements were taken of colonic length and mobility, and an assessment made of diverticular disease. Rectosigmoid length (mean difficult group = 61 cm, mean control = 54 cm, P = 0.01) and total colonic length (mean difficult group = 157 cm, mean control = 140 cm, P < 0.0001) were greater in the difficult colonoscopy group as were transverse colon mobility (mean difficult group = 10 cm, mean control = 7 cm, P = 0.003) or redundancy (transverse colon reaching the true pelvis on the erect film); 65% difficult group vs 17% control group, P < 0.0001. The presence of moderate or severe diverticular disease was also greater in the difficult (23%) compared to the control (4%) group, P = 0.02. When available, assessment of a previous barium enema is a useful guide to probable technical difficulty of colonscopy. It may allow appropriate allocation of potentially difficult cases to specialist endoscopy lists.},
}
@article {pmid7676377,
year = {1995},
author = {Rosing, MA and Amory, S},
title = {Perforated ileal diverticulitis. An atypical presentation with definitive diagnosis by laparoscopy.},
journal = {Surgical endoscopy},
volume = {9},
number = {5},
pages = {522-524},
pmid = {7676377},
issn = {0930-2794},
mesh = {Diagnosis, Differential ; Diverticulitis/*diagnosis/surgery ; Humans ; Ileal Diseases/*diagnosis/surgery ; Intestinal Perforation/*diagnosis/surgery ; *Laparoscopy ; Male ; Middle Aged ; },
abstract = {An atypical presentation of ileal diverticulosis definitively diagnosed and treated with laparoscopy is presented. While jejunoileal diverticula are often asymptomatic, they may lead to chronic or acute symptoms. The large majority of complications secondary to small-bowel diverticulitis present with an acute abdomen similar to appendicitis but they also may appear with atypical symptoms. As a result, identification of jejunoileal diverticulosis can be quite difficult and surgery is often required in order to reach an absolute diagnosis. Surgical exploration, resection of the involved segment, and primary reanastomosis may be indicated in instances of symptomatic diverticular disease of the small bowel. Current laparoscopic techniques make this procedure well suited for both diagnosis and treatment of jejunoileal diverticula. In this report, the surgical incision was directed and limited under laparoscopic guidance while still allowing the benefit of thorough examination of the abdominal contents.},
}
@article {pmid7620415,
year = {1995},
author = {Mendelson, RM and Kelsey, PJ and Chakera, T},
title = {A combined flexible sigmoidoscopy and double-contrast barium enema service: initial experience.},
journal = {Abdominal imaging},
volume = {20},
number = {3},
pages = {238-241},
pmid = {7620415},
issn = {0942-8925},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anemia, Iron-Deficiency/diagnostic imaging ; Barium Sulfate ; Colonic Diseases, Functional/diagnostic imaging ; Colonic Polyps/diagnostic imaging ; Colorectal Neoplasms/*diagnostic imaging ; Diverticulitis, Colonic/diagnostic imaging ; Enema ; Female ; Gastrointestinal Hemorrhage/*diagnostic imaging ; Humans ; Male ; Middle Aged ; *Patient Care Team ; Radiography ; *Sigmoidoscopes ; },
abstract = {BACKGROUND: A service has been instituted offering a combined single-stage procedure of flexible sigmoidoscopy and double-contrast barium enema (FS/DCBE). The results have been reviewed in the first 80 patients to undergo this examination (45 male: 35 female; mean age 61.4 years).
METHODS: Indications for investigation were abdominal pain or suspected diverticular disease (22 patients), altered bowel habit (19), rectal bleeding (17), iron deficiency anemia (6), and miscellaneous (16). FS was followed immediately by DCBE. Radiographs were reviewed by two radiologists unaware of the FS findings.
RESULTS: The extent of FS was to the proximal sigmoid or sigmoid descending colon or splenic flexure in 12.5%, and mid or distal sigmoid in 37.5%. Biopsies were performed at FS in 26 patients (33%). In 67 (84%) of DCBEs the barium coating was assessed as satisfactory or better. FS yielded pathological findings not seen at DCBE in 21 patients (26%). DCBE demonstrated additional abnormalities within the range of the FS examination in 15 patients (19%), almost entirely due to its increased sensitivity for diverticular disease.
CONCLUSION: FS/DCBE is feasible as a one-stage combined procedure. The quality of DCBE following FS is satisfactory, and the extra yield of FS and its potential for biopsy make the combined FS/DCBE a useful technique in the investigation of large bowel disease.},
}
@article {pmid7606311,
year = {1995},
author = {Aldoori, WH and Giovannucci, EL and Rimm, EB and Wing, AL and Trichopoulos, DV and Willett, WC},
title = {A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men.},
journal = {Annals of epidemiology},
volume = {5},
number = {3},
pages = {221-228},
doi = {10.1016/1047-2797(94)00109-7},
pmid = {7606311},
issn = {1047-2797},
support = {CA55075/CA/NCI NIH HHS/United States ; HL35464/HL/NHLBI NIH HHS/United States ; },
mesh = {Adult ; Age Factors ; Aged ; Alcohol Drinking/*epidemiology ; Beverages/statistics & numerical data ; *Caffeine ; Coffee ; Cohort Studies ; Dietary Fats/administration & dosage ; Dietary Fiber/administration & dosage ; Diverticulum, Colon/*epidemiology ; Energy Intake ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Motor Activity ; Prospective Studies ; Risk Factors ; Smoking/*epidemiology ; United States/epidemiology ; },
abstract = {The relationship between smoking, caffeine, and alcohol intake and the risk of symptomatic diverticular disease has not been investigated directly. We examined these associations in a prospective cohort of 47,678 US men, 40 to 75 years old. During 4 years of follow-up (1988 to 1992), we documented 382 newly diagnosed cases of symptomatic diverticular disease. After adjustments for age, physical activity, and energy-adjusted intake of dietary fiber and total fat, alcohol intake (comparing those who drink > 30 g of alcohol/d to nondrinkers) was only weakly and nonsignificantly associated with risk of symptomatic diverticular disease (relative risk (RR) = 1.36; 95 percent confidence interval (CI), 0.94 to 1.97; P for trend = 0.37). We observed no association between caffeine, specific caffeinated beverages, and decaffeinated coffee and the risk of symptomatic diverticular disease. Current smoking was not appreciably associated with risk of symptomatic diverticular disease compared to nonsmokers (RR = 1.25; 95 percent CI, 0.75 to 2.09) after adjustment for age, physical activity, and energy-adjusted intake of dietary fiber and total fat. In a subset analysis restricted to men who had undergone sigmoidoscopy or colonoscopy, a modest positive association was seen between smoking and risk of symptomatic diverticular disease. These results suggest that smoking, caffeine, and alcohol intake are not associated with any substantially increased risk of symptomatic diverticular disease.},
}
@article {pmid7598428,
year = {1995},
author = {Hocken, DB},
title = {Surgical management of the septic complications of diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {77},
number = {3},
pages = {233-234},
pmid = {7598428},
issn = {0035-8843},
mesh = {*Colostomy ; Diverticulum, Colon/*complications ; Humans ; Postoperative Complications ; Sepsis/*surgery ; },
}
@article {pmid7598410,
year = {1995},
author = {Senapati, A and Marks, CG},
title = {Management of perforated diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {77},
number = {3},
pages = {161-162},
pmid = {7598410},
issn = {0035-8843},
mesh = {Anastomosis, Surgical/methods ; Clinical Trials as Topic ; Colon/*surgery ; Colostomy ; Diverticulum, Colon/*surgery ; Humans ; Intestinal Perforation/*surgery ; Multicenter Studies as Topic ; },
}
@article {pmid7754489,
year = {1995},
author = {Brenna, E and Sandvik, AK and Kleveland, PM and Waldum, HL},
title = {[Damages to the large intestine induced by non-steroidal anti-inflammatory agents].},
journal = {Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke},
volume = {115},
number = {10},
pages = {1225-1227},
pmid = {7754489},
issn = {0029-2001},
mesh = {Adult ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Aspirin/adverse effects ; Colitis/*chemically induced ; Colon/*drug effects ; Female ; Humans ; Male ; Naproxen/adverse effects ; },
abstract = {Non-steroidal anti-inflammatory drugs can cause side effects in the large bowel. We describe two cases which illustrate some of the aspects associated with this problem, and briefly outline the different types of side effects encountered, and possible pathogenetic mechanisms. It is emphasized that non-steroidal anti-inflammatory drugs can cause exacerbation of quiescent colitis in patients with inflammatory bowel disease. The use of these drugs in such patients should be very restrictive. Non-steroidal anti-inflammatory drugs can also precipitate de novo colitis. They are also associated with collagenous colitis, non-gangrenous ischemic colitis, complications to diverticular disease, and ulceration of the colon.},
}
@article {pmid7761783,
year = {1995},
author = {Keller, P and Marescaux, J},
title = {[Colonic diverticular haemorrhage].},
journal = {La Revue du praticien},
volume = {45},
number = {8},
pages = {983-989},
pmid = {7761783},
issn = {0035-2640},
mesh = {Diverticulum, Colon/*complications/epidemiology ; Female ; France/epidemiology ; Gastrointestinal Hemorrhage/epidemiology/*etiology ; Humans ; Male ; },
abstract = {Bleeding related to diverticular disease occurs in 10 to 30% of patients suffering from diverticular disease. Haemorrhage varies from occult to massive bleeding. Bleeding is related to mechanical aggression of the artery in the wall of a diverticulum. Bleeding prevalence is not exactly known. In 1 to 7% of cases, massive bleeding is observed; diverticular disease is thus the most common cause of major lower gastrointestinal tract haemorrhage, followed by angiodysplasias. Although 95% of diverticular involve the sigmoid colon, more than 50% of bleeding diverticular occur in the right colon. Classically, presentation of bleeding is sudden without any inflammatory diverticulitis. Bleeding from diverticula stops spontaneously in 80% of cases. For definite diagnosis, selective abdominal angiography during bleeding phase is the procedure of choice. Other explorations are not contributive. Most haemorrhages have a benign outcome. Massive, persistent or recurrent haemorrhage should benefit from surgical procedure. In case of active bleeding in which diverticular origin has been validated by angiography, intra-arterial perfusion of vasopressor agents may be attempted, as a temporary treatment before delayed colonic resection. Segmental colectomy usually prevents recurrent haemorrhage when site of diverticular bleeding has not been identified with precision by angiography. Subtotal colectomy should only be used in the last resort. Extent of surgery will be based on likely origin of bleeding.},
}
@article {pmid7761782,
year = {1995},
author = {Gouzi, JL and Bloom, E},
title = {[Radiological and endoscopic diagnosis of sigmoid diverticulitis].},
journal = {La Revue du praticien},
volume = {45},
number = {8},
pages = {978-981},
pmid = {7761782},
issn = {0035-2640},
mesh = {Colonoscopy ; Diverticulitis, Colonic/*diagnosis/diagnostic imaging ; Enema ; Female ; Humans ; Male ; Sigmoid Diseases/*diagnosis/diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography ; },
abstract = {In emergency, the most commonly used examination, other than plain radiographs of the abdomen, is the water-soluble contrast enema (Gastrografin). It demonstrates three different pictures, which may be more or less associated one to the other: "peridiverticulitis", featuring serrate lesions, abnormal stiffness and fixity and, in some cases, a long narrowing or stricture of the colon; diverticula, mainly in the sigmoid colon, becoming sharp-pointed or spark-liked; spillage of contrast material out of the colic lumen or into a neighbouring organ (fistula). Ultrasonography may be a useful emergency procedure to secure a hesitating diagnosis in a patient with a febrile abdominal pain or with a abdominal-pelvic mass, especially in women. Colonoscopy and barium enema are both usually contra-indicated in the acute setting of diverticulitis because of their potential hazards. On the other hand, after resolution of the acute event, these tests may allow to rule out carcinoma or associated adenomas (which coexist in more than 15% of the patients). Endoscopic control appears more especially important as initial accurate diagnosis in sometimes impossible to assess between adenocarcinoma and diverticulitis. CT scan has found an increasing place in both diagnosis and evaluation of infectious complications of diverticular disease. It is most recommended to assess the diagnosis of severe episodes, failing to clearly improve after medical treatment, and most particularly when an abscess in suspected. CT scan may demonstrate a thickening of the colic wall, high densities of pericolic fat and a tissular mass which may enclose gas bubbles.},
}
@article {pmid7761781,
year = {1995},
author = {Bouillot, JL},
title = {[Abscess, fistula and occlusion of colonic diverticulosis].},
journal = {La Revue du praticien},
volume = {45},
number = {8},
pages = {973-977},
pmid = {7761781},
issn = {0035-2640},
mesh = {Abscess/*complications/diagnosis/therapy ; Colonic Diseases/*complications/diagnosis/therapy ; Diverticulum, Colon/*complications/surgery ; Female ; Fistula/*complications ; Humans ; Intestinal Obstruction/*complications/diagnosis/therapy ; Male ; Sigmoid Diseases/*complications/diagnosis/therapy ; },
abstract = {Diverticular disease is generally benign but may be serious in case of septic complications. The most common complication of acute diverticulitis is development of an abscess which can be located around the colon or in the pelvis. The diagnosis can be clinically suspected in case of non-response to medical management of severe acute diverticulitis. Confirmation is obtained by conventional radiographic examinations and computerized tomography. This condition can be safely treated by percutaneous catheter drainage associated to antibiotics followed by an elective delayed single-stage operation without colostomy. Fistula occurs in 20% of the patients who undergo surgery for diverticular disease. Colovesical fistula is the most common type of spontaneous internal fistula. Routine evaluation may raise the suspicion of complication. Surgical management requires colonic resection and primary anastomosis. Complete obstruction secondary to diverticular disease is uncommon and generally resolves with conservative management. However, some degree of ileus is frequent secondary to inflammatory changes of diverticulitis but should imperatively be differentiated from ileus observed in case of generalized peritonitis.},
}
@article {pmid7761780,
year = {1995},
author = {Flamant, Y and Parmentier, G},
title = {[Generalised peritonitis complicating colonic diverticulosis. Associations de Recherche en Chirurgie].},
journal = {La Revue du praticien},
volume = {45},
number = {8},
pages = {968-972},
pmid = {7761780},
issn = {0035-2640},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum, Colon/*complications/diagnosis/therapy ; Female ; Humans ; Male ; Middle Aged ; Peritonitis/diagnosis/*etiology/therapy ; },
abstract = {Perforated diverticulitis is an uncommon but severe complication of diverticular disease. Whatever the type of the contamination, whether bacterial or fecal, the peritonitis is responsible for septic shock, which necessitates emergent and aggressive medical and surgical treatment. Intensive intravenous perfusion under monitoring, adapted antibiotherapy should come before surgical decision. The aim of surgery is twofold: to suppress the infectious source and to clean the peritoneum. After all, the peritonitis has a tendency to recur and therefore postoperative abscesses have to be searched systematically and if the case arises, these abscesses have to be reoperated or drained. Best results were obtained with immediate sigmoidectomy and colo-rectal anastomosis associated with loop colostomy; that procedure should be preferred to Hartmann technique. If the morbidity remains high, the mortality should decrease under 10% with intensive therapy.},
}
@article {pmid7716088,
year = {1995},
author = {Manten, HD and Green, JA},
title = {Acute lower gastrointestinal bleeding. A guide to initial management.},
journal = {Postgraduate medicine},
volume = {97},
number = {4},
pages = {154-157},
pmid = {7716088},
issn = {0032-5481},
mesh = {Acute Disease ; Colonic Diseases/*diagnosis/etiology/surgery ; Gastrointestinal Hemorrhage/*diagnosis/etiology/surgery ; Humans ; },
abstract = {Initial assessment of any patient with acute gastrointestinal bleeding includes thorough history taking and physical examination, with special attention to orthostatic changes in vital signs as a guide to severity of blood loss. The next crucial step is exclusion of massive upper gastrointestinal hemorrhage. Once that is accomplished, a lower gastrointestinal source should be sought. Diagnostic options include bleeding scans, colonoscopy, and angiography. The latter two measures confer therapeutic advantages, especially for diverticular disease and angiodysplastic lesions, which are the most common causes of acute lower gastrointestinal bleeding.},
}
@article {pmid7660265,
year = {1995},
author = {Hewett, PJ and Stitz, R},
title = {The treatment of internal fistulae that complicate diverticular disease of the sigmoid colon by laparoscopically assisted colectomy.},
journal = {Surgical endoscopy},
volume = {9},
number = {4},
pages = {411-413},
pmid = {7660265},
issn = {0930-2794},
mesh = {Aged ; Aged, 80 and over ; Colectomy/instrumentation/methods ; Diverticulum, Colon/complications/physiopathology/*surgery ; Female ; Humans ; Intestinal Fistula/etiology/physiopathology/*surgery ; Laparoscopes ; Laparoscopy/methods ; Male ; Middle Aged ; Prospective Studies ; Sigmoid Diseases/complications/physiopathology/*surgery ; Treatment Outcome ; Vaginal Fistula/etiology/physiopathology/*surgery ; },
abstract = {Seven patients with internal fistulae complicating colonic diverticular disease were treated by laparoscopic assisted colectomy over a 24-month period. Prospective review of these patients was carried out to ascertain efficacy of the treatment. No intraoperative complications were encountered and return of gastrointestinal function was apparent within two days in all cases. Postoperative hospital stay was limited to an average of 4.7 days. No long-term complication or fistula recurrence has been noted in the mean 11-month follow-up period. This study indicates laparoscopic assisted colectomy is an effective means of treatment for diverticular fistulae.},
}
@article {pmid7774516,
year = {1995},
author = {Gillis, JC and Brogden, RN},
title = {Rifaximin. A review of its antibacterial activity, pharmacokinetic properties and therapeutic potential in conditions mediated by gastrointestinal bacteria.},
journal = {Drugs},
volume = {49},
number = {3},
pages = {467-484},
pmid = {7774516},
issn = {0012-6667},
mesh = {Diarrhea/drug therapy ; Diverticulum, Colon/drug therapy ; Drug Resistance, Microbial ; Gram-Negative Bacteria/*drug effects ; Gram-Positive Bacteria/*drug effects ; Hepatic Encephalopathy/drug therapy ; Humans ; Intestinal Absorption ; Lactulose/administration & dosage/pharmacology/therapeutic use ; Neomycin/administration & dosage/pharmacology/therapeutic use ; Paromomycin/administration & dosage/pharmacology/therapeutic use ; Rifamycins/pharmacokinetics/*pharmacology/therapeutic use ; Rifaximin ; },
abstract = {Rifaximin is a derivative of rifamycin which acts by inhibiting bacterial ribonucleic acid (RNA) synthesis. It is virtually unabsorbed after oral administration; thus it is used primarily to treat local conditions within the gastrointestinal tract. In vitro data indicate rifaximin possesses good activity against species of Staphylococcus, Streptococcus and Enterococcus but lesser activity against species of Enterobacteriaceae. Bacterial resistance during exposure to rifaximin has been reported but its clinical importance remains to be fully defined. Results of comparative trials demonstrate that rifaximin is similar in efficacy to neomycin and lactulose in patients with hepatic encephalopathy and appears to be better tolerated. In 1 study, cyclical administration of rifaximin for 15 days per month was associated with progressive improvement over a 3-month period. In patients with infectious diarrhoea, rifaximin induces more rapid improvement in stool consistency and decreased frequency of faecal evacuations when compared with placebo, and is similar in efficacy to neomycin. Available data suggest rifaximin may be of some use in acute diverticulitis, but its use for the prevention of inflammatory complications or for control of common symptoms of diverticulosis requires further study. Preoperative treatment with rifaximin as antibacterial prophylaxis in colorectal surgery shows some potential but should be further investigated. Overall, rifaximin may be useful as an alternative therapy in hepatic encephalopathy but more data are needed to better define its clinical potential in infectious diarrhoea, diverticular disease and as antibacterial prophylaxis prior to colorectal surgery.},
}
@article {pmid7730493,
year = {1995},
author = {Trendell-Smith, NJ and Warren, BF and Sheffield, EA and Durdey, P},
title = {An unusual case of colonic angiodysplasia.},
journal = {Journal of clinical pathology},
volume = {48},
number = {3},
pages = {272-275},
pmid = {7730493},
issn = {0021-9746},
mesh = {Aged ; Angiodysplasia/*complications/diagnostic imaging/pathology ; Colonic Diseases/*complications/diagnostic imaging/pathology ; Diverticulum/*complications/congenital ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Male ; Radiography ; },
abstract = {An unusual case of a colonic vascular anomaly resembling angiodysplasia associated with right sided diverticular disease is presented. The patient, a 74 year old man, presented with a four day history of rectal bleeding and subsequently underwent hemicolectomy. The resected specimen was flushed out with heparin-saline solution and injected with a barium-gelatine mixture. Preoperative barium enema revealed right sided diverticula, whereas post-resection angioradiography revealed the "coral reef" vascular anomaly consistent with angiodysplasia. Histology confirmed the presence of both diverticular disease and angiodysplasia. This case report highlights the importance of considering a vascular anomaly in patients presenting with rectal bleeding despite the presence of another radiologically demonstrable anatomical lesion.},
}
@article {pmid7877547,
year = {1995},
author = {Balson, R and Gibson, PR},
title = {Lower gastrointestinal tract. 2. Diarrhoea and diverticular disease.},
journal = {The Medical journal of Australia},
volume = {162},
number = {4},
pages = {217-219},
pmid = {7877547},
issn = {0025-729X},
mesh = {Age Factors ; Aged ; *Diarrhea/diagnosis/etiology/therapy ; *Diverticulum, Colon/diagnosis/etiology/therapy ; Humans ; },
abstract = {For more than 70% of patients with diarrhoea, investigation can reveal a cause, which should be treated specifically whenever possible. Symptomatic treatment can be a useful adjunct or a mainstay if no cause can be found. Drug selection and doses are similar to those for younger age groups, but drug interactions and side effects, and dose adjustment because of renal failure, are more likely in the elderly.},
}
@article {pmid7883230,
year = {1995},
author = {Aldoori, WH and Giovannucci, EL and Rimm, EB and Ascherio, A and Stampfer, MJ and Colditz, GA and Wing, AL and Trichopoulos, DV and Willett, WC},
title = {Prospective study of physical activity and the risk of symptomatic diverticular disease in men.},
journal = {Gut},
volume = {36},
number = {2},
pages = {276-282},
pmid = {7883230},
issn = {0017-5749},
support = {CA55075/CA/NCI NIH HHS/United States ; HL35464/HL/NHLBI NIH HHS/United States ; },
mesh = {Adult ; Aged ; Body Mass Index ; Dietary Fiber/administration & dosage ; Diverticulum, Colon/etiology/*prevention & control ; Energy Intake ; *Exercise ; Humans ; Male ; Middle Aged ; Physical Fitness ; Prospective Studies ; Risk Factors ; },
abstract = {The relationship between physical activity and risk of symptomatic diverticular disease has not been investigated directly. This association was examined in a prospective cohort of 47,678 American men, 40 to 75 years of age, and free of diagnosed diverticular disease, colon or rectal polyp, ulcerative colitis, and cancer before 1988. During four years of follow up, 382 newly diagnosed cases of symptomatic diverticular disease were documented. After adjustment for age, energy adjusted dietary fibre, and energy adjusted total fat, overall physical activity was inversely associated with the risk of symptomatic diverticular disease (for highest versus lowest extremes, relative risk (RR) = 0.63 (95% confidence interval (CI) 0.45, 0.88). Most of the inverse association was attributable to vigorous activity, for extreme categories RR = 0.60 (95% CI 0.41, 0.87). For activity that was not vigorous the RR was 0.93 (95% CI 0.67, 1.69). Several specific activities were inversely associated with the risk of diverticular disease, but jogging and running combined was the only individual activity that was statistically significant (p for trend = 0.03). For men in the lowest quintile for dietary fibre intake and total physical activity (compared with those in the opposite extreme), the RR was 2.56 (95% CI 1.36, 4.82). Physical activity, along with a high fibre diet, may be an important factor in the prevention of symptomatic diverticular disease.},
}
@article {pmid7857238,
year = {1995},
author = {Isbister, WH and Prasad, J},
title = {Hartmann's operation: a personal experience.},
journal = {The Australian and New Zealand journal of surgery},
volume = {65},
number = {2},
pages = {98-100},
doi = {10.1111/j.1445-2197.1995.tb07269.x},
pmid = {7857238},
issn = {0004-8682},
mesh = {Aged ; Aged, 80 and over ; Colostomy/*methods/mortality ; Diverticulum, Colon/*surgery ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Rectal Neoplasms/pathology/*surgery ; Recurrence ; Sigmoid Neoplasms/pathology/*surgery ; },
abstract = {This paper documents a 15 year experience with Hartmann's operation in the Colorectal Service at the Wellington School of Medicine, New Zealand. There were 31 male and 30 female patients. The majority had either complicated diverticular disease (27) or rectal cancer (27). Fifty-six patients were discharged home and five patients died within 30 days of surgery (8.2%). Of the 27 patients with complicated diverticular disease 19 proceeded to stoma closure with no mortality. Of the 27 patients who had complicated colorectal cancer only 2 had their stoma closed. There were 41 patients in whom bowel continuity was restored following construction of a Hartmann's stoma. Thirty-nine anastomoses were hand-sewn and two anastomoses were stapled. One patient developed a major anastomotic leak and one patient died postoperatively. Hartmann's operation has a definite place in the management of patients with complicated diverticular disease and recto-sigmoid cancer. The operation can be performed and the stoma closed safely in the former group but is less likely to be followed by restoration of continuity in the latter group.},
}
@article {pmid7856969,
year = {1995},
author = {Denning, DA and Lipshy, KA},
title = {Missed pathology following laparoscopic cholecystectomy: a cause for concern?.},
journal = {The American surgeon},
volume = {61},
number = {2},
pages = {117-120},
pmid = {7856969},
issn = {0003-1348},
mesh = {Abdominal Neoplasms/complications/*diagnosis/surgery ; Adult ; Aged ; *Cholecystectomy, Laparoscopic ; Cholelithiasis/*complications/surgery ; Colonic Neoplasms/complications/diagnosis/surgery ; Crohn Disease/complications/diagnosis/surgery ; Female ; Humans ; Intestinal Diseases/complications/*diagnosis/therapy ; *Patient Readmission ; },
abstract = {Although many have recorded the incidence of complications after laparoscopic cholecystectomy, few have discussed the possibility of missing intra-abdominal pathology after this procedure. We have evaluated the first two years, September 1990-September 1992, of laparoscopic cholecystectomy in our community. Readmissions within 10 months of the original surgery with another diagnosis similar to gallbladder disease were considered "missed pathology" at the original surgical procedure. For the first 12-month period, 465 laparoscopic cholecystectomies were performed. Seventy-seven patients were readmitted, with 13 of these patients having other intra-abdominal pathology. These readmissions were for carcinoma (6), inflammatory bowel disease (2), diverticular disease, esophageal varices, and appendicitis. In the second year 429 laparoscopic cholecystectomies were performed; 59 patients were readmitted, with 10 of these patients having other intra-abdominal pathology. These readmissions were for carcinoma (3), inflammatory bowel disease (2), strongyloides, peptic ulcer disease, and abdominal pain of unknown etiology (3). Although intra-abdominal pathology was found in only 2%-5% of all patients having surgery for gallbladder disease, of the patients who were readmitted for "missed pathology," 46% the first year and 30% the second year were readmitted for carcinomas. Several other diseases were found in patients whose symptoms mimicked gallbladder disease. It is therefore possible that in the zeal to perform a new procedure, other diagnoses may be overlooked.},
}
@article {pmid7766741,
year = {1995},
author = {Papi, C and Ciaco, A and Koch, M and Capurso, L},
title = {Efficacy of rifaximin in the treatment of symptomatic diverticular disease of the colon. A multicentre double-blind placebo-controlled trial.},
journal = {Alimentary pharmacology & therapeutics},
volume = {9},
number = {1},
pages = {33-39},
doi = {10.1111/j.1365-2036.1995.tb00348.x},
pmid = {7766741},
issn = {0269-2813},
mesh = {Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Dietary Fiber/administration & dosage/therapeutic use ; Diverticulitis, Colonic/*drug therapy ; Double-Blind Method ; Drug Synergism ; Drug Therapy, Combination ; Female ; Humans ; Male ; Mannans/administration & dosage/therapeutic use ; Middle Aged ; Rifamycins/administration & dosage/*therapeutic use ; Rifaximin ; },
abstract = {BACKGROUND AND AIMS: In a recent open trial we have shown the efficacy of long term intermittent administration of a poorly absorbable antibiotic (rifaximin) in obtaining symptomatic relief in uncomplicated diverticular disease of the colon. The aim of this double-blind placebo-controlled trial was to test our previous observations.
METHODS: One hundred and sixty-eight outpatients with symptomatic uncomplicated diverticular disease were treated with fibre supplementation (glucomannan 2 g/day) plus rifaximin 400 mg b.d. for 7 days every month (84 patients), or with glucomannan 2 g/day plus placebo two tablets b.d. for 7 days every month (84 patients). Clinical evaluation was performed at admission and at three-month intervals for 12 months.
RESULTS: After 12 months, 68.9% of the patients treated with rifaximin were symptom-free or mildly symptomatic, compared to 39.5% in the placebo group (P = 0.001). Symptoms such as bloating and abdominal pain or discomfort were primarily affected by antibiotic treatment when compared with placebo (P < 0.001).
CONCLUSION: Rifaximin appears to be of some advantage in obtaining symptomatic relief in diverticular disease of the colon when compared with fibre supplementation alone.},
}
@article {pmid8520022,
year = {1995},
author = {Celestino, A},
title = {[Massive lower digestive bleeding].},
journal = {Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru},
volume = {15 Suppl 1},
number = {},
pages = {S71-6},
pmid = {8520022},
issn = {1022-5129},
mesh = {Adult ; Child ; Colonoscopy ; Emergencies ; *Gastrointestinal Hemorrhage/diagnosis/etiology/therapy ; Humans ; Middle Aged ; Risk Factors ; Sigmoidoscopy ; },
abstract = {Lower digestive bleeding is the bleeding distal to the ligament of Treitz and ranges from occult loss to massive hemorrhage. Acute and massive form represents about 20% of all gastrointestinal acute bleeding. In children and young patients the most frequent causes are juvenile, polyps Meckel diverticula, and intussusception; in adult ages are the diverticular disease of colon, angiodysplasia and neoplasia; we must include also the intestinal TBC, typhoid fever, and intestinal amebiasis. The first aim in the management of this acute syndrome is the treatment of the hypovolemic shock; when the patient is well resuscitated, the diagnosis of the cause of hemorrhage will start using the clinical history and physical examination, proctosigmoidoscopy, emergency colonoscopy and/or angiography, or scintigraphy with 99mTc-labeled red blood cells. Definitive therapy include endoscopic an angiographic methods, or the emergency surgery. Mortality is 11% to 21%.},
}
@article {pmid7966788,
year = {1995},
author = {Jarrett, TW and Vaughan, ED},
title = {Accuracy of computerized tomography in the diagnosis of colovesical fistula secondary to diverticular disease.},
journal = {The Journal of urology},
volume = {153},
number = {1},
pages = {44-46},
doi = {10.1097/00005392-199501000-00018},
pmid = {7966788},
issn = {0022-5347},
mesh = {Aged ; Colonic Diseases/*diagnostic imaging/etiology ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Intestinal Fistula/*diagnostic imaging/etiology ; Male ; Middle Aged ; *Tomography, X-Ray Computed ; Urinary Bladder Fistula/*diagnostic imaging/etiology ; },
abstract = {We reviewed 9 consecutive patients with colovesical fistula secondary to diverticulitis during a 2-year period. Preoperative evaluation included computerized tomography (CT) and a barium enema or colonoscopy in all patients (8 underwent cystoscopy). All patients subsequently underwent laparotomy with a single or multiple staged repair. Using CT criteria for diagnosis of colovesical fistulas, the study accurately predicted the presence and location of fistula in 8 patients, and was suspicious in 1. Findings at cystoscopy only diagnosed 3 fistulas and were suspicious in 4. The remaining diagnostic tests, including excretory urography, barium enema, abdominal plain films, colonoscopy and cystogram, were unremarkable except for a single cystogram and barium enema. In addition to documenting the fistula, CT provided important intraluminal and extraluminal pathological findings helpful in planning subsequent surgery. Thus, CT should be included in the initial evaluation of patients with suspected colovesical fistula.},
}
@article {pmid7884183,
year = {1995},
author = {Read, NW and Celik, AF and Katsinelos, P},
title = {Constipation and incontinence in the elderly.},
journal = {Journal of clinical gastroenterology},
volume = {20},
number = {1},
pages = {61-70},
doi = {10.1097/00004836-199501000-00016},
pmid = {7884183},
issn = {0192-0790},
mesh = {Aged ; Aged, 80 and over ; Constipation/epidemiology/*etiology ; Defecation ; Diverticulum, Colon/complications/pathology ; Fecal Incontinence/epidemiology/*etiology ; Female ; Humans ; Male ; Nervous System Diseases/complications/physiopathology ; },
abstract = {We summarize the prevalence and causes of constipation and incontinence in an elderly, drawing particular attention to the roles of immobility, dietary fiber, and dehydration. The physiology of fecal impaction is described in detail, and neurological and mechanical causes (rectal prolapse, rectocele, and hemorrhoids) of constipation are discussed. Consideration is also given to constipation associated with diverticular disease and ulcerative colitis. We also discuss the pathogenesis of fecal incontinence in the elderly, paying particular attention to fecal impaction and neurological causes that result in both constipation and incontinence. The importance of previous obstetric trauma and pudendal enuropathy is emphasized. We conclude with detailed guidelines of the clinical assessment and management of an elderly patient with a disorder of defecation.},
}
@article {pmid7787502,
year = {1995},
author = {Yuen, EJ and Gonnella, JS and Louis, DZ and Epstein, KR and Howell, SL and Markson, LE},
title = {Severity-adjusted differences in hospital utilization by gender.},
journal = {American journal of medical quality : the official journal of the American College of Medical Quality},
volume = {10},
number = {2},
pages = {76-80},
doi = {10.1177/0885713X9501000203},
pmid = {7787502},
issn = {1062-8606},
mesh = {Diagnostic Tests, Routine ; Female ; Hospital Charges/statistics & numerical data ; Hospital Costs/statistics & numerical data ; Hospitals/*statistics & numerical data ; Humans ; Length of Stay/statistics & numerical data ; Male ; Patient Discharge/statistics & numerical data ; *Severity of Illness Index ; Sex Factors ; United States ; Utilization Review/*statistics & numerical data ; },
abstract = {Gender-based differences in hospital use may result from biological differences or may suggest problems of access to health services and quality of care. We hypothesized that there should be no difference in hospital care between men and women, given the same diagnosis. Hospitalizations were characterized by severity of illness, as this may indicate the timeliness of hospital care. Hospitalizations may be too late (with higher severity of illness) resulting in long stays and high costs, or too early (with lower severity of illness) resulting in care that could be given in alternative treatment settings. Three abdominal conditions were examined which could be misdiagnosed or confused with other diseases involving the female reproductive system: appendicitis, diverticulitis, and cholecystitis. The National Hospital Discharge Survey (NHDS) was used for analysis. Disease staging was used to assign a severity of illness indicator, ranging from stage 1 (conditions with no complications) to stage 3 (multiple site involvement, poor prognosis). For each disease, the percentage of discharges and the age-adjusted discharge rate per 1000 population was examined by stage of illness and gender. For appendectomy, there was a significantly greater percentage of men at stage 1 (lower severity) compared to women (73% versus 67%). For diverticular disease, women had higher proportions of stage 2/3 discharges than men for both medical and surgical hospitalizations. For cholecystitis, women had a greater percentage of hospitalizations at stage 1 than men, notably for surgical treatment (63% compared with 38%), although more men were admitted at stage 2 for both medical and surgical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)},
}
@article {pmid7774108,
year = {1995},
author = {Myllykangas-Luosujärvi, R},
title = {Diverticulosis--a primary cause of life-threatening complications in rheumatoid arthritis.},
journal = {Clinical and experimental rheumatology},
volume = {13},
number = {1},
pages = {79-82},
pmid = {7774108},
issn = {0392-856X},
mesh = {Aged ; Aged, 80 and over ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/*complications/drug therapy/*mortality ; Cause of Death ; Diverticulum/*complications/*mortality ; Female ; Humans ; Male ; Retrospective Studies ; Survival Analysis ; },
abstract = {OBJECTIVE: To assess the role of complicated diverticular disease as a cause of death in rheumatoid arthritis (RA).
METHODS: In 1989 there were in Finland 1,666 deaths in subjects entitled to specially reimbursed medication for RA under the nationwide sickness insurance scheme. A retrospective clinical study was performed on these cases.
RESULTS: In 12 subjects, four males and eight females, the underlying cause of death was diverticular disease; the expected number was two. The mean age at death was 74 years in males and 80 years in females. The duration of RA ranged from 4 to 22 years (mean 13 years). In none of these cases was the death connected in the death certificate to RA or its treatment, yet all the subjects had been taking antirheumatic medication, usually two or three different drugs, at the time of death.
CONCLUSION: Complicated diverticular disease, probably related to antirheumatic medication, is a more important cause of death in patients with RA than is generally recognized.},
}
@article {pmid7745325,
year = {1995},
author = {Bielecki, K and Kamiński, P},
title = {Hartmann procedure: place in surgery and what after?.},
journal = {International journal of colorectal disease},
volume = {10},
number = {1},
pages = {49-52},
pmid = {7745325},
issn = {0179-1958},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; *Colostomy ; Female ; Humans ; Length of Stay ; Male ; Methods ; Middle Aged ; Postoperative Complications ; Rectum/*surgery ; Reoperation ; Retrospective Studies ; },
abstract = {The results of 65 consecutive cases of Hartmann's procedure carried out between 1982/1993 inclusive, were reviewed. There were 41 emergency procedures including 27 cases with complicated carcinoma and 24 elective procedures including 20 with carcinoma, 3 with diverticular disease and one with perirectal haemangioma. Postoperative complications occurred in 25 (38.5%) patients, including 13 (19%) with wound infection. Seven patients had to be reoperated because of intraperitoneal abscess (3 cases) or wound dehiscence (4 cases). There were five (7.7%) postoperative deaths. The mean hospital stay of operation survivors was 16 days (range 8-54). Intestinal continuity has been reestablished in 13 (81.2%) of 16 survivors in the benign disease group and in 4.5% of patients of the malignant group. The mean time to of restoration of continuity was 240 days (range 40-630) after the primary procedure. No one died after these procedures. In five (31.2%) patients postoperative complications were observed: anastomotic leak (2 cases) and wound infection (3 cases). All complications were treated conservatively.},
}
@article {pmid7717637,
year = {1995},
author = {Khan, AL and Ah-See, AK and Crofts, TJ and Heys, SD and Eremin, O},
title = {Surgical management of the septic complications of diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {77},
number = {1},
pages = {16-20},
pmid = {7717637},
issn = {0035-8843},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colostomy ; Critical Care ; Diverticulitis, Colonic/complications/*surgery ; Humans ; Medical Staff, Hospital ; Middle Aged ; Peritonitis/etiology/*surgery ; Postoperative Complications/mortality ; Retrospective Studies ; Risk Factors ; },
abstract = {This retrospective study has reviewed the surgical management of the septic complications of diverticular disease involving the left colon in 77 patients who presented between 1980 and 1992. Over this period, Hartmann's resection continued to be the predominant surgical procedure. The overall mortality and morbidity rates in the study period were 10% and 31%, respectively. However, a marked improvement in survival was recorded in the latter half of the study (17% vs 6%). The mortality from Hartmann's resection was also reduced substantially in the second half of the study (24% vs 7.5%). These improvements occurred despite having a higher number of poor-risk patients (APACHE II score) with more severe pathology (generalised peritonitis, 35% vs 50%; faecal peritonitis, 9% vs 25%) in the latter half. There was a significantly worse survival in patients who were over 70 years of age (P < 0.03), those who had a severe concomitant medical illness (P < 0.02), those who had a generalised peritonitis (P < 0.02), and in those patients who had an APACHE II score of over 11 (P < 0.05) (Fisher's exact test). There was no difference in outcome (morbidity, mortality) between the various grades of surgeon involved in performing the emergency surgical procedures.},
}
@article {pmid7696779,
year = {1995},
author = {Cheskin, LJ and Lamport, RD},
title = {Diverticular disease. Epidemiology and pharmacological treatment.},
journal = {Drugs & aging},
volume = {6},
number = {1},
pages = {55-63},
pmid = {7696779},
issn = {1170-229X},
mesh = {Aged ; Analgesics/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Diagnosis, Differential ; Diet Therapy ; Diverticulitis, Colonic/diagnosis/drug therapy/epidemiology ; Diverticulum/diagnosis/drug therapy/*epidemiology ; Diverticulum, Colon/diagnosis/drug therapy/epidemiology ; Glucagon/therapeutic use ; Humans ; Parasympatholytics/therapeutic use ; },
abstract = {Diverticular disease is worldwide in distribution, but the incidence is highest in industrialised countries. It is associated with aging and low intake of dietary fibre. There is a broad range of clinical manifestations--from asymptomatic diverticula to life-threatening complications. Elderly patients often present with complicated diverticular disease, and may lack typical symptoms and signs. Treatment includes fibre supplementation, drugs or antibiotics for complications, and surgery for refractory disease. Proper diagnosis and treatment requires knowledge of the full range of presentations and careful selection and timing of medical versus surgical intervention.},
}
@article {pmid7668485,
year = {1995},
author = {Vuolo, G and Di Cosmo, L and Brandi, C and Maglio, C and Masellis, D and Verre, L and Piccolomini, A and Carli, A},
title = {[Diverticulosis and neoplasms of the colon].},
journal = {Annali italiani di chirurgia},
volume = {66},
number = {1},
pages = {63-67},
pmid = {7668485},
issn = {0003-469X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; Colonic Neoplasms/*complications/diagnosis/surgery ; Colonoscopy ; Colorectal Neoplasms/complications/diagnosis/surgery ; Diagnosis, Differential ; Diverticulum, Colon/*complications/diagnosis/surgery ; Female ; Humans ; Male ; Middle Aged ; Rectal Neoplasms/complications/diagnosis/surgery ; Sigmoid Neoplasms/complications/diagnosis/surgery ; },
abstract = {About half of the carcinomas and polyps of the large intestine is placed in the descendent colon and in the sigma, where most frequently the diverticula are found. Literature refers to them as varying percentage of association diverticulosis-carcinoma between 2 to 8 percent. The increase of the frequency of neoplasms and diverticula in the same population classes may indicate common factors in their development. The study includes 1149 cases of colo-rectal neoplasms examined in the Department of Scienze Chirurgiche--University of Siena, from january 1981 to december 1993. The association of carcinomas and diverticula has been found in 8.96% of the cases (103 pts) and the tumours with stenosis in 59,2% of the cases. The colonoscopy is very important for a more precise differential diagnosis especially in occlusive forms, in which a multiple biopsy is indispensable. Referring to the data of literature, the authors consider that patients with symptomatic diverticular disease have a major general risk for cancer of the large intestine; the existence of certain common symptoms in either disease (especially the bleeding) may not exclude the presence of a tumor in patients with diverticular disease.},
}
@article {pmid7636374,
year = {1995},
author = {Skipper, D and Moran, B and Dormandy, JA and Heald, RJ},
title = {Two cases of colo-ovarian cyst fistula.},
journal = {International journal of colorectal disease},
volume = {10},
number = {2},
pages = {70-72},
pmid = {7636374},
issn = {0179-1958},
mesh = {Aged ; *Colonic Diseases/diagnosis ; Cystadenocarcinoma/complications ; Diagnosis, Differential ; Female ; *Fistula/diagnosis ; Humans ; *Intestinal Fistula/diagnosis ; Middle Aged ; *Ovarian Cysts/complications ; *Ovarian Diseases/diagnosis ; Ovarian Neoplasms/complications ; },
abstract = {Fistula between the large bowel and an ovarian cyst is a recognised but rare pathological entity. We present two cases of colo-ovarian cyst fistula, the first occurring as a result of diverticular disease of the sigmoid colon and the second complicating a cystadenocarcinoma of the ovary. The aetiology of colo-ovarian cyst fistula is reviewed and the differential diagnosis is discussed.},
}
@article {pmid7610729,
year = {1995},
author = {Baca, I and Götzen, V and Schultz, C},
title = {[Laparoscopic interventions in acute and chronic diverticulitis].},
journal = {Zentralblatt fur Chirurgie},
volume = {120},
number = {5},
pages = {396-399},
pmid = {7610729},
issn = {0044-409X},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/instrumentation ; Chronic Disease ; Colostomy ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Intestinal Perforation/surgery ; Intraoperative Complications/etiology/surgery ; *Laparoscopes ; Male ; Middle Aged ; Postoperative Complications/etiology/surgery ; Reoperation ; Surgical Instruments ; Surgical Staplers ; },
abstract = {UNLABELLED: Since the beginning of 1993 until May 1994 in our hospital 25 patients were operated upon for diverticular disease. 16 patients required a laparoscopic assisted elective one-stage resection. One laparoscopic Hartmann's procedure was performed on account of a free perforation. 4 patients underwent laparoscopic reconstruction of the intestinal continuity after an Hartmann's resection. In 4 cases it was necessary to change to the conventional procedure.
TECHNIQUE: the patient is placed in dorso-sacral position (modified lithotomy position) in order to allow transanal colonic access. 4 trocars are necessary. The linear stapler is used to transsect the sigmoid colon and to dissect the entire mesentery. The left lateral trocar incision is enlarged to remove the specimen. The intracorporeal double staple anastomosis is created by a circular stapler.
RESULTS: there were two wound infections, one postoperative bleeding and one small anastomotic leak. After the operation we observed all advantages of the laparoscopic procedure in form of less pain, earlier beginning of bowel movements, faster return to full diet and earlier hospital discharge. These positive results combined with the possibility of a standardized procedure encourage us to continue laparoscopic sigmoidectomy.},
}
@article {pmid7561437,
year = {1995},
author = {Naber, A and Sliutz, AM and Freitas, H},
title = {Giant diverticulum of the sigmoid colon.},
journal = {International journal of colorectal disease},
volume = {10},
number = {3},
pages = {169-172},
pmid = {7561437},
issn = {0179-1958},
mesh = {Diagnosis, Differential ; *Diverticulum, Colon/diagnosis/pathology/therapy ; Humans ; *Sigmoid Diseases/diagnosis/pathology/therapy ; },
abstract = {While diverticulosis of the colon is a relatively common disease, a solitary giant diverticulum (GD) of the sigmoid is rare. Although there exist some theories about the formation of a GD, none is really conclusive. Symptoms are similar to diverticular disease, and diagnosis is easy with the aid of radiology. Early surgical treatment is necessary since the complication rate is high (19%).},
}
@article {pmid7881143,
year = {1994},
author = {Senagore, AJ and Luchtefeld, M},
title = {An initial experience with lighted ureteral catheters during laparoscopic colectomy.},
journal = {Journal of laparoendoscopic surgery},
volume = {4},
number = {6},
pages = {399-403},
doi = {10.1089/lps.1994.4.399},
pmid = {7881143},
issn = {1052-3901},
mesh = {Colectomy/economics/*instrumentation ; Costs and Cost Analysis ; Female ; Humans ; Intraoperative Complications/prevention & control ; *Laparoscopes ; Laparoscopy/economics ; Lighting ; Male ; Middle Aged ; Operating Rooms/economics ; Time Factors ; Ureter/injuries ; Urinary Catheterization/economics/*instrumentation ; },
abstract = {Ureteral catheters are recommended when a difficult pelvic dissection is anticipated to minimize the risk of ureteral injuries. With the introduction of laparoscopic-assisted colectomy, it has become necessary to replace tactile with visual feedback. Lighted ureteral catheters (LUC) have been advocated for major laparoscopic pelvic surgery as a means of enhancing ureteral identification. However, the use of LUC has been anecdotal to this point. We present the first series of selectively used LUC during laparoscopic-assisted colectomy. Forty-nine consecutive laparoscopic-assisted colectomies were reviewed in which patients had LUC placed or not (NC) [LUC,24(49%); NC, 25(51%)]. Indications for catheter insertion included complicated diverticular disease, previous pelvic surgery, and obesity. The need for LUC was at the discretion of the surgeon. Data collected included catheter visualization, type of procedure, operative time, operating room cost, and catheter or ureteral complications. Catheters were visualized in 5 of 6 (83%) right colectomies and 15 of 18 (83%) left colectomies. Nonvisualization was because of migration to the bladder (2 cases) and dense inflammatory reaction (2 cases). No catheter complications or ureteral injuries occurred in either group. Operative time (LUC, 192 +/- 11.3 min, NC, 161.4 +/- 9.5 min) was significantly longer in the LUC group as a result of the time for catheter insertion and the greater complexity of the case. The operating room cost was similar in the two groups (LUC, $3488.63 +/- 259.01; NC, $3537.56 +/- 313.43). The results indicate that selected use of LUC does significantly increase operating time without significantly increasing operating room cost or operative morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)},
}
@article {pmid7866737,
year = {1994},
author = {Ozick, LA and Salazar, CO and Donelson, SS},
title = {Pathogenesis, diagnosis, and treatment of diverticular disease of the colon.},
journal = {The Gastroenterologist},
volume = {2},
number = {4},
pages = {299-310},
pmid = {7866737},
issn = {1065-2477},
mesh = {*Diverticulitis, Colonic ; *Diverticulum, Colon ; Female ; Humans ; Male ; },
abstract = {Diverticular disease of the colon is a disease of twentieth century Western society. A diverticulum is an outpouching of mucosa through the colonic wall. Etiology and pathogenesis are related to altered colonic structure and physiology in an aging population. Epidemiological evidence suggests that a decrease in dietary fiber, as well as increasing age, lead to formation of diverticula. Diverticular disease includes pain without inflammation, diverticulitis, and bleeding. Severe diverticulitis is often complicated by abscess or fistula formation or peritonitis. Young obese men and immunocompromised patients have a more virulent course. Diverticular bleeding occurs as a result of a diverticulum eroding through a nutrient artery. Treatment of diverticular disease depends on severity and clinical presentation. A higher-fiber diet is recommended if there is no acute inflammation. Broad-spectrum antibiotics, diagnostic and therapeutic computed tomography scans, and early surgical intervention have improved the treatment of hospitalized patients with diverticular disease. The one-stage operation has increased in popularity for patients with localized disease because it reduces reoperative rates and hospitalization costs. Mortality remains high in patients with purulent and fecal peritonitis, and early recognition and treatment may benefit this subset of patients.},
}
@article {pmid7837477,
year = {1994},
author = {Takami, M and Fujimoto, T and Kimura, M},
title = {[Diverticular disease and diverticulitis of the colon].},
journal = {Nihon rinsho. Japanese journal of clinical medicine},
volume = {Suppl 6},
number = {},
pages = {296-299},
pmid = {7837477},
issn = {0047-1852},
mesh = {*Diverticulum, Colon ; Humans ; },
}
@article {pmid7829459,
year = {1994},
author = {Ide, C and Van Beers, B and Pauls, C and Pringot, J},
title = {[Diagnosis of acute colonic diverticulitis: comparison with echography and tomodensitometry].},
journal = {Journal belge de radiologie},
volume = {77},
number = {6},
pages = {262-267},
pmid = {7829459},
issn = {0302-7430},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; *Tomography, X-Ray Computed ; Ultrasonography ; },
abstract = {The sensitivity of ultrasonography (US) as the initial imaging procedure in acute diverticulitis of the left colon was retrospectively compared with that of computed tomography (CT) in 34 patients. Final diagnosis was based on clinical findings and follow-up in a first group of 20 patients with mild diverticulitis, and was proved by surgery in a second group of 14 patients with severe diverticulitis. In the first group, US showed findings consistent with diverticulitis in 19 patients, as did CT. The image of an inflamed diverticulum was shown by US in 10 patients. In the surgical group, findings consistent with diverticulitis were shown by US in 11 cases, and by CT in 13 cases. An inflamed diverticulum was not detected at US in this group of patients, presumably because the diverticulum was incorporated in the inflammatory process. These results suggest that US is a valuable technique in the initial evaluation of patients suspected of having acute diverticulitis, especially when the disease is not severe. The image of an inflamed diverticulum shown at US strongly suggests the diagnosis of mild diverticular disease. When diverticulitis is severe, CT should be performed in addition to US.},
}
@article {pmid7993247,
year = {1994},
author = {Beswick, JS and Desai, S},
title = {Diverticular disease of the vermiform appendix and its clinical relevance.},
journal = {Australasian radiology},
volume = {38},
number = {4},
pages = {260-261},
doi = {10.1111/j.1440-1673.1994.tb00194.x},
pmid = {7993247},
issn = {0004-8461},
mesh = {Appendix/*diagnostic imaging ; Cecal Diseases/diagnostic imaging ; Diverticulum/*diagnostic imaging ; Diverticulum, Colon/complications/diagnostic imaging ; Humans ; Male ; Middle Aged ; Radiography ; },
abstract = {The case of a solitary diverticulum of the appendix found on routine barium enema is presented. The types of diverticula, their presentations and their potential outcomes and significance are discussed.},
}
@article {pmid7978692,
year = {1994},
author = {Acosta, JA and Fournier, TK and Knutson, CO and Ragland, JJ},
title = {Colonoscopic evaluation of rectal bleeding in young adults.},
journal = {The American surgeon},
volume = {60},
number = {11},
pages = {903-906},
pmid = {7978692},
issn = {0003-1348},
mesh = {Adenocarcinoma/diagnosis ; Adolescent ; Adult ; Angiodysplasia/diagnosis ; Colitis/diagnosis ; Colonic Diseases/diagnosis ; Colonic Neoplasms/diagnosis ; Colonic Polyps/diagnosis ; *Colonoscopy ; Diverticulum, Colon/diagnosis ; Gastrointestinal Hemorrhage/*diagnosis ; Humans ; *Occult Blood ; Rectum ; Retrospective Studies ; },
abstract = {The role of colonoscopy in the evaluation of blood loss per rectum has been studied extensively in older patients but not in the younger adult population. The objective of this study was to review the diagnostic yield of colonoscopy in patients 40 years of age or younger with passage of minimal amounts of bright red blood per rectum or occult blood positive stools. Retrospectively, 5924 colonoscopic examinations were reviewed. All patients, 40 years of age or younger, with rectal bleeding as the only indication for colonoscopy were selected. A total of 280 patients met these criteria and 59 (21%) had significant findings. Polyps were present in 25 (8.9%) of patients. Other findings included colitis, diverticular disease, and angiodysplastic lesions present in 8.6 per cent, 2.1 per cent, and 1.1 per cent, respectively. Adenocarcinoma was present in one patient (0.03%). These results suggest that colonoscopy in patients 40 years of age or younger with rectal bleeding may be justified because significant findings may be present in up to 21 per cent of patients.},
}
@article {pmid7978675,
year = {1994},
author = {Cirocco, WC and Priolo, SR and Golub, RW},
title = {Spontaneous ureterocolic fistula: a rare complication of colonic diverticular disease.},
journal = {The American surgeon},
volume = {60},
number = {11},
pages = {832-835},
pmid = {7978675},
issn = {0003-1348},
mesh = {Aged ; Colonic Diseases/*etiology ; Diagnosis, Differential ; Diverticulitis, Colonic/*complications ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/*etiology ; Ureteral Diseases/*etiology ; Urinary Fistula/*etiology ; },
abstract = {Spontaneous ureterocolic fistula is rare and usually caused by urinary calculi. We present the fifth reported case of spontaneous ureterocolic fistula caused by diverticular disease of the colon. Review of these cases revealed a preponderance of women (3:1 ratio), with mean age of 77 years. These patients may have a protracted course before an accurate diagnosis is made (up to 10 years) because of the typical vague presentation. Urologic symptoms predominate, especially urinary tract infection (100%), fecaluria (75%), and abdominal (75%) or flank pain (50%). Barium enema is the most reliable diagnostic test in demonstrating the fistula (75%) compared with intravenous pyelogram (33%) or retrograde pyelogram (25%). The left ureter is usually involved (75%). Surgical intervention is generally directed towards resection of the diseased bowel with primary anastomosis when feasible. Surgical manipulation of the urinary system is unnecessary except for removing a non-functioning, infected kidney. Results of surgery were excellent, with 100 per cent cure and one unrelated mortality on long term follow-up. We recognize the potential for increase in this type of internal fistula, given the increasing lifespan and the established increase in incidence of colonic diverticular disease with advancing age. The correct diagnosis can often be determined preoperatively (75%), and surgical intervention is routinely successful.},
}
@article {pmid7974940,
year = {1994},
author = {McBeath, RB and Schiff, M and Allen, V and Bottaccini, MR and Miller, JI and Ehreth, JT},
title = {A 12-year experience with enterovesical fistulas.},
journal = {Urology},
volume = {44},
number = {5},
pages = {661-665},
doi = {10.1016/s0090-4295(94)80200-9},
pmid = {7974940},
issn = {0090-4295},
mesh = {Adult ; Aged ; Aged, 80 and over ; Cystoscopy ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/*diagnosis/etiology/*surgery ; Intestine, Large ; Intestine, Small ; Male ; Middle Aged ; Postoperative Complications/epidemiology/surgery ; Predictive Value of Tests ; Reoperation ; Retrospective Studies ; Surgical Procedures, Operative/methods ; Time Factors ; Urinary Bladder Fistula/*diagnosis/etiology/*surgery ; },
abstract = {OBJECTIVES: To review our experience with enterovesical fistulas in order to determine the most accurate diagnostic studies and most effective method of treatment.
METHODS: A retrospective record review of 76 patients who were diagnosed and treated for enterovesical fistulas over a 12-year period was performed. Data collection focused on presenting symptoms, urinary disease process, diagnostic studies, and methods of management.
RESULTS: Diverticular disease was the primary etiologic factor in the majority of patients (59%), with colonic malignancy, granulomatous bowel disease, and radiation therapy accounting for the majority of the remainder. Cystoscopy (60%) and cystography (44%) were the most sensitive diagnostic studies. There was no statistical difference in the complication rate between groups treated with single or multistage repair.
CONCLUSIONS: One-stage repair of enterovesical fistulas can be safely performed when the cause is diverticular or granulomatous bowel disease. Staged repairs may be more judicious in patients with large intervening pelvic abscesses or those in whom advanced malignancy or radiation changes are present.},
}
@article {pmid7967911,
year = {1994},
author = {Fleischer, DE and Grimm, IS and Friedman, LS},
title = {Inflammatory bowel disease in older patients.},
journal = {The Medical clinics of North America},
volume = {78},
number = {6},
pages = {1303-1319},
doi = {10.1016/s0025-7125(16)30102-x},
pmid = {7967911},
issn = {0025-7125},
mesh = {Aged ; Diagnosis, Differential ; Humans ; *Inflammatory Bowel Diseases/diagnosis/therapy ; Prognosis ; },
abstract = {The onset of UC and CD may occur later in life. Although making the diagnosis of IBD in the elderly can be challenging, the clinical course, natural history, and response to treatment are similar for older and younger patients. In fact, both UC and CD tend to be less extensive in older patients, a feature that may contribute to the overall favorable prognosis for elderly patients with IBD. Overall mortality rates for both UC and CD appear to be similar to that of the general population except for those few patients that present with severe initial disease. Typical features of IBD in the elderly are summarized in Table 3. The differential diagnosis of IBD in the elderly includes infectious causes of enterocolitis, ischemic colitis, and diverticular disease as well as several other mimics of IBD. Awareness of the possibility of late-onset disease and the unique manifestations of disease in the elderly contributes to accurate diagnosis and timely treatment.},
}
@article {pmid7942584,
year = {1994},
author = {Aldoori, WH and Giovannucci, EL and Rimm, EB and Wing, AL and Trichopoulos, DV and Willett, WC},
title = {A prospective study of diet and the risk of symptomatic diverticular disease in men.},
journal = {The American journal of clinical nutrition},
volume = {60},
number = {5},
pages = {757-764},
doi = {10.1093/ajcn/60.5.757},
pmid = {7942584},
issn = {0002-9165},
support = {CA55075/CA/NCI NIH HHS/United States ; HL35464/HL/NHLBI NIH HHS/United States ; },
mesh = {Adult ; Aged ; Dietary Fats/*administration & dosage/adverse effects ; Dietary Fiber/*administration & dosage ; Diverticulum/*etiology/prevention & control ; Humans ; Intestinal Diseases/*etiology/prevention & control ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Surveys and Questionnaires ; United States ; },
abstract = {To examine the association between dietary fiber, sources of fiber, other nutrients, and the diagnosis of symptomatic diverticular disease, we analyzed data from a prospective cohort of 47,888 US men. During 4 y of follow-up we documented 385 new cases of symptomatic diverticular disease. Total dietary fiber intake was inversely associated with the risk of diverticular disease after adjustment for age, energy-adjusted total fat intake, and physical activity [relative risk (RR) 0.58; 95% CI 0.41, 0.83; P for trend = 0.01 for men in the highest as compared with the lowest quintile of dietary fiber]. This inverse association was primarily due to fruit and vegetable fiber. For men on a high-total-fat, low-fiber diet, the RR was 2.35 (95% CI 1.38, 3.98) compared with those on a low-total-fat, high-fiber diet, and for men on a high-red-meat, low-fiber diet the RR was 3.32 (95% CI 1.46, 7.53) compared with those on a low-red-meat, high-fiber diet. These prospective data support the hypothesis that a diet low in total dietary fiber increases the incidence of symptomatic diverticular disease. They also provide evidence that the combination of high intake of total fat or red meat and a diet low in total dietary fiber particularly augments the risk.},
}
@article {pmid7884196,
year = {1994},
author = {Mader, TJ},
title = {Acute diverticulitis in young adults.},
journal = {The Journal of emergency medicine},
volume = {12},
number = {6},
pages = {779-782},
doi = {10.1016/0736-4679(94)90483-9},
pmid = {7884196},
issn = {0736-4679},
mesh = {Acute Disease ; Adult ; Age Factors ; Colon, Sigmoid ; Diverticulitis, Colonic/*diagnosis ; Female ; Humans ; },
abstract = {Diverticular disease of the colon is generally considered a disease of older patients, rarely causing symptoms before age 40. Two recent cases of ruptured sigmoid diverticulitis in young female patients presenting to our Emergency Department prompted a review of the literature on this topic. Diverticulitis is more common in patients under 40 than previously suspected. Presented are the two cases and a brief summary of the literature review.},
}
@article {pmid7827899,
year = {1994},
author = {Drabble, EH and Greatorex, RA},
title = {Colocutaneous fistula between the sigmoid colon and popliteal fossa in diverticular disease.},
journal = {The British journal of surgery},
volume = {81},
number = {11},
pages = {1659},
doi = {10.1002/bjs.1800811133},
pmid = {7827899},
issn = {0007-1323},
mesh = {Aged ; Cutaneous Fistula/*etiology ; Diverticulum, Colon/*complications ; Fatal Outcome ; Female ; Humans ; Intestinal Fistula/*etiology ; *Knee ; Sigmoid Diseases/*etiology ; },
}
@article {pmid7659904,
year = {1994},
author = {Bannura, G},
title = {[Abdominal actinomycosis].},
journal = {Revista medica de Chile},
volume = {122},
number = {11},
pages = {1307-1315},
pmid = {7659904},
issn = {0034-9887},
mesh = {*Abdomen ; *Actinomycosis/diagnosis/microbiology/pathology/surgery ; Adult ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {Actinomycosis is a non opportunistic chronic infection caused by a superior bacteria that forms grains in the pus or affected organs. Fifty four cases have been reported in the last 50 years in the chilean literature, 51% were abdominal actinomycoses, 25.5% pelvic and 18.5% pulmonary. Fourteen cases have been treated in the last 9 years at San Borja Arriaran. Of these 7 were abdominal (1 parietal and 6 visceral forms) and four involved the rectosigmoid; two were ileocecal and occurred after an appendicectomy. The presenting picture was of a giant abdominal mass in two cases (one with a colocutaneous fistula), rectal stricture in one case, tubo-ovarian abscess with colonic involvement in one case, parietal mass in one case and a fistula after an appendicectomy in two cases. Actinomyces Israelli was found in the histopathological study in three cases and in the bacteriological study in two. All visceral forms were treated with penicillin plus tetracycline or amoxicillin during 6 to 12 months with complete and permanent recovery. Two patients required a colonic resection due to a iatrogenic damage and an associated diverticular disease. Three patients required a colostomy to overcome the obstruction, all of them are asymptomatic and without colostomy 18 months to 8 years later. Due to its different presentation forms, actinomycosis has been called "the great pretender" and in several occasions the histological or bacteriological diagnosis is not achieved.},
}
@article {pmid7935958,
year = {1994},
author = {Gooszen, AW and Geelkerken, RH and Tollenaar, RA and Timmermans, DR and Kievit, J and Gooszen, HG},
title = {[Surgical strategy in acute or elective sigmoid resection in The Netherlands; survey based on a marketing model].},
journal = {Nederlands tijdschrift voor geneeskunde},
volume = {138},
number = {40},
pages = {2005-2010},
pmid = {7935958},
issn = {0028-2162},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Clinical Competence ; Enterostomy/methods ; Humans ; Marketing of Health Services ; Middle Aged ; Netherlands ; Patient Care Planning ; Sigmoid Diseases/*surgery ; Specialties, Surgical ; Surgical Procedures, Operative/*methods ; Surveys and Questionnaires ; },
abstract = {OBJECTIVE: To gain insight into the operative strategies used by Dutch surgeons for complicated diverticulitis and sigmoid carcinoma, and into the influence of patient risk factors and surgeon's experience on the preferred operative strategy.
DESIGN: Descriptive.
METHOD: A questionnaire was sent to all 148 members of the Dutch Society of Gastrointestinal Surgery, concerning 32 fictitious patients with sigmoid pathology. It was based on conjoint-analysis, a model used in marketing research. This model analyses qualities that make a product preferable to another product of the same product group. The operative choices were: resection with Hartmann's procedure, resection with primary anastomosis after on-table lavage, or with primary anastomosis only, or no primary resection but diverting stoma only, or some personal technique. The survey focused on experience of the surgeons with the operative procedures, and on treatment choices in four fictitious cases frequently encountered in general surgery.
RESULTS: There was little agreement concerning the preferred surgical option for treatment of complicated diverticular disease or sigmoid carcinoma. With the exception of one fictitious young, electively operated 'ideal' patient (resection with primary anastomosis) there is hardly any consensus among the surgeons with respect to preferred treatment.
CONCLUSIONS: Reasons to depart from the conceptually optimal treatment (resection and anastomosis) in complicated cases (from the point of view of the surgeon or the patient), and absence of agreement on responsible other treatment could be differences in appraisal of the importance of several risk factors, or differences in acquired decision making strategies. The literature offers no answer to the question which techniques should be preferred under various circumstances.},
}
@article {pmid7821243,
year = {1994},
author = {Madiba, TE and Mokoena, T},
title = {Pattern of diverticular disease among Africans.},
journal = {East African medical journal},
volume = {71},
number = {10},
pages = {644-646},
pmid = {7821243},
issn = {0012-835X},
mesh = {Adult ; Black or African American/statistics & numerical data ; Aged ; Aged, 80 and over ; Black People ; Diet/adverse effects ; Diverticulitis, Colonic/epidemiology ; Diverticulum, Colon/*epidemiology/pathology ; Female ; Gastrointestinal Hemorrhage/epidemiology ; Humans ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; South Africa/epidemiology ; United States/epidemiology ; Urban Health/statistics & numerical data ; },
abstract = {Diverticular disease of the colon was found to be a rare but emerging clinical problem among Urban Africans where 26 patients were recorded in this 5 year retrospective study, giving a hospital prevalence of 5 per 100,000 admissions. The pattern was different from that reported in Western communities in that, while diverticula were left sided in 77% of cases, 62% were right sided and 73% presented with haemorrhage. This confirms a reported experience among African Americans. We would like to postulate that it might be the pattern during a transition from traditional to Western diet.},
}
@article {pmid7575173,
year = {1994},
author = {Viebig, RG and Pontes, JF and Michelsohn, NH},
title = {Electromanometry of the rectosigmoid in colonic diverticulosis.},
journal = {Arquivos de gastroenterologia},
volume = {31},
number = {4},
pages = {135-144},
pmid = {7575173},
issn = {0004-2803},
mesh = {Adult ; Colon, Sigmoid/*physiopathology ; Colonic Diseases, Functional/complications/physiopathology ; Constipation/complications/physiopathology ; Diarrhea/complications/physiopathology ; Diverticulitis, Colonic/complications/physiopathology ; Diverticulum, Colon/complications/*physiopathology ; Female ; Gastrointestinal Motility ; Humans ; Male ; Manometry ; Middle Aged ; Rectum/*physiopathology ; },
abstract = {In order to better understand the rectosigmoid motor activity in diverticular disease of the colon, we studied 186 patients, grouped according to their intestinal habit, the presence of diverticular disease and previous crisis of sigmoid diverticulitis. The intestinal habit was classified as: normal habit, irritable colon syndrome, diarrhea and constipation. The group of diverticulosis was classified by their intestinal habit and by diverticula localization (localized or generalized). The presence of systemic diseases or drug ingestion that could modify intestinal motility, were considered criteria for exclusion. The manometric study was preceded by food stimulus, with 650 kcal meal, by mechanic intestinal cleansing, with 500 ml of saline solution enema and by one hour resting period. A manometric catheter, was introduced by rectosigmoidoscopy, with open ended orifices situated at the sigmoid and upper rectum, respectively. The catheter was perfused by a capillary infusion system and the bowel pressures were registered for 30 minutes, in a thermal paper physiograph. We analyzed the % of activity, mean amplitude and motility index, by non parametric tests. No significant difference was observed between sexes. Difference or close to it were found for the groups with constipation, with or without diverticulosis, and for the latter in its subdivisions (localized, generalized and sigmoid diverticulitis). The rectal motor activity was similar in all groups. There was no difference for diverticulosis and its subdivision, when we take into account the several kinds of intestinal habits and the diverticula localization. The motility index averages showed low values for the sigmoid diverticulitis fact that suggests some dysfunction of this segment (hypocontractility). The key factor differentiating the groups was the presence of constipation and no influence was noted regarding the localization of diverticula or previous inflammatory process on intraluminal pressures. The fact that no difference was found in the mean amplitude or % of activity among patients with or without diverticulosis, suggests that the high pressures in a colonic segment, may not be responsible for the diverticular disease, and there must be other factors, besides motility, accounting for the development of the different forms of this disease.},
}
@article {pmid8065183,
year = {1994},
author = {Elftmann, TD and Nelson, H and Ota, DM and Pemberton, JH and Beart, RW},
title = {Laparoscopic-assisted segmental colectomy: surgical techniques.},
journal = {Mayo Clinic proceedings},
volume = {69},
number = {9},
pages = {825-833},
doi = {10.1016/s0025-6196(12)61783-2},
pmid = {8065183},
issn = {0025-6196},
mesh = {Colectomy/*instrumentation/methods ; Humans ; Laparoscopy/*methods ; },
abstract = {OBJECTIVE: To describe our surgical techniques for successful completion of laparoscopic-assisted segmental colectomy.
DESIGN: We reviewed the important preoperative, operative, and postoperative factors that should be considered for laparoscopic resection of the right, left, and sigmoid colon.
RESULTS: The current indications for laparoscopic-assisted colectomy include most benign colonic conditions (such as colorectal polyps, rectal prolapse, diverticular disease, and colonic lipomas). Laparoscopic procedures for malignant disease, however, are currently reserved for prospective trials and palliation of patients with stage IV colonic cancer because the adequacy of staging and lymphatic resection remains questionable. Patients who are appropriate candidates for laparoscopic-assisted colectomy should be counseled about the potential benefits, risks, and possible need for conversion to an open surgical procedure--a decision that should be considered application of sound surgical judgment rather than a failure. For laparoscopic-assisted colectomy, we prefer to use the closed technique for establishing a pneumoperitoneum. We use a two-surgeon, four-cannula approach for resections of the right and left colon and a three-surgeon, five-cannula technique for resections of the sigmoid colon. Laparoscopic techniques are used to mobilize the bowel and divide the principal blood supply; the resection and anastomosis are performed extracorporeally, with use of a small incision.
CONCLUSION: The associated morbidity and mortality rates are comparable to those for conventional open procedures. Despite a shortened period of ileus and fewer hospital days, the total costs for laparoscopic colectomy have been equivalent to those for standard colectomy. This result has generally been due to longer operative times, which should decrease with additional experience.},
}
@article {pmid7991209,
year = {1994},
author = {Freschi, G and Pichi Graziani, M and Pacifico, G and Panconesi, R and Masi, C},
title = {[Diverticular disease of the vermiform appendix. Anatomo-clinical observations].},
journal = {Minerva chirurgica},
volume = {49},
number = {9},
pages = {869-870},
pmid = {7991209},
issn = {0026-4733},
mesh = {Adult ; *Appendix ; Cecal Diseases/diagnosis/surgery ; Diagnosis, Differential ; *Diverticulum/diagnosis/surgery ; Humans ; Male ; },
abstract = {The authors describe a case of diverticular disease of the appendix. The diagnosis is intraoperative and histological while therapy is based on surgical treatment. The authors seem to be favorable to surgical treatment in case of diverticulosis of the appendix in order to avoid dangerous complications.},
}
@article {pmid7991188,
year = {1994},
author = {Gullà, N and Serafini, S and Patriti, A and Giannini, P and Pucciarini, LC and Tristaino, B},
title = {[Surgical treatment of diverticular disease of the colon. Our experience in the last decade].},
journal = {Minerva chirurgica},
volume = {49},
number = {9},
pages = {759-765},
pmid = {7991188},
issn = {0026-4733},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/etiology ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Intestinal Perforation/etiology ; Male ; Middle Aged ; Peritonitis/etiology ; Postoperative Complications ; Recurrence ; },
abstract = {The authors analyse their personal experience of diverticular disease of the colon and, comparing it with that of other authors, draw attention to some fundamental data relating to the type of management chosen. Having underlined the high incidence of disease in relation changed living conditions, the authors point out that this pathology is becoming more frequent as a result of the increased average age and that subacute and acute clinical manifestations of the disease are also more common-place. Attention has often been drawn to the presence of non-evolved phlogistic symptoms which it is possible to treat medically thus enabling the operation to be postponed in some cases to a time which is more convenient for the patient, whereas in other cases it has resulted in the remission of symptoms. Surgical therapy need not be used in "silent" cases, but is obligatory in recurring or complicated forms. The authors also affirm that surgery is not burdened by particular postoperative complications which, if present, are linked essentially to peritonitis due to perforation or to other associated pathologies. The use of mechanical staplers has also restricted the number of derivative operations and those performed in several stages.},
}
@article {pmid7949389,
year = {1994},
author = {Rubio, PA},
title = {Laparoscopic resection of a solitary cecal diverticulum.},
journal = {Journal of laparoendoscopic surgery},
volume = {4},
number = {4},
pages = {281-285},
doi = {10.1089/lps.1994.4.281},
pmid = {7949389},
issn = {1052-3901},
mesh = {Appendectomy/methods ; Cecal Diseases/*surgery ; Diverticulitis/*surgery ; Diverticulum/*surgery ; Female ; Humans ; *Laparoscopy ; Middle Aged ; },
abstract = {Cecal diverticulitis is an uncommon disorder that, unlike sigmoid diverticular disease, usually involves a solitary true diverticulum. The resulting pain is hard to distinguish from that of appendicitis or perforating carcinoma. The typical patient is male, Asian, and in the fourth decade of life. The following case is unusual in that the patient was a 50-year-old Caucasian woman, and the diverticulum was excised laparoscopically. To the author's knowledge, this is the first case in which laparoscopy has been used for this purpose.},
}
@article {pmid7949381,
year = {1994},
author = {Slim, K and Pezet, D and Stencl, J and Lagha, K and Le Roux, S and Lechner, C and Chipponi, J},
title = {Prospective analysis of 40 initial laparoscopic colorectal resections: a plea for a randomized trial.},
journal = {Journal of laparoendoscopic surgery},
volume = {4},
number = {4},
pages = {241-245},
doi = {10.1089/lps.1994.4.241},
pmid = {7949381},
issn = {1052-3901},
mesh = {Colectomy/*methods ; Colorectal Neoplasms/surgery ; Diverticulitis, Colonic/surgery ; Diverticulum, Colon/surgery ; Female ; Humans ; *Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Prospective Studies ; Randomized Controlled Trials as Topic ; Rectum/*surgery ; },
abstract = {The experience reported herein is on our initial 40 cases of laparoscopic-assisted (LA) colorectal resection that were prospectively evaluated. The operations were performed for colonic tumors of the right segment (n = 4), sigmoid (n = 11), or rectum (n = 7), diverticular disease (n = 17), and chronic constipation (n = 1). Among 22 tumors, 11 were malignant. The operative procedures were 4 right hemicolectomies, 28 segmental left colectomies, 5 anterior resections, 2 abdominoperineal resections, and 1 total colectomy. Thirty-one patients (77.5%) had a successfully completed LA resection. The reasons for conversion in the majority of the cases (66.6%) were difficulties in dissection. In the entirely LA procedures, the mean flatus postoperative day was 3, the mean postoperative hospitalization was 10.7 days, and there were 8 complications (25%) in 7 patients. Two patients were reoperated 2 and 3 months later for adhesion and ischemic stenosis of the colon above the anastomosis. There was 1 death in the LA group (3.2%). The length of operative specimen was 19.6 cm, and the mean number of resected lymph node was six. In contrast to laparoscopic biliary surgery, the benefits of LA colorectal surgery are not obvious. A randomized trial comparing LA and open colorectal resection must be carried out.},
}
@article {pmid7807457,
year = {1994},
author = {Khan, AL and Ah-See, AK and Crofts, TJ and Heys, SD and Eremin, O},
title = {Reversal of Hartmann's colostomy.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {39},
number = {4},
pages = {239-242},
pmid = {7807457},
issn = {0035-8835},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colostomy/*methods ; Diverticulum, Colon/complications ; Female ; Humans ; Male ; Middle Aged ; Peritonitis/etiology/surgery ; Postoperative Complications ; Reoperation ; },
abstract = {From January 1980 to December 1992, sixty-two Hartmann's procedures were performed for septic complications of sigmoid diverticular disease, in the Professorial Unit at Aberdeen Royal Infirmary. Colorectal continuity was subsequently restored in 53% of the fifty-three surviving patients. The overall morbidity and mortality was 34% and 0% respectively. There were two anastomotic leaks (7%) while two patients (7%) developed anastomotic stenoses requiring multiple dilations. Closure of Hartmann's colostomy was carried out by consultants (48%), senior registrars (38%) and registrars with consultant supervision (14%). Fifteen anastomoses were hand sewn and fourteen were stapled. Twenty-one per cent of patients had closure of colostomy in less than 3 months, 48% between 3 and 6 months and 31% of reversals were carried out more than 6 months following their formation. The grade of surgeon had no influence on the outcome of reversal. Although the numbers were small, the morbidity was found to be highest in those patients in whom colostomy closure was carried out within 3 months of colostomy formation. Also, there was an increased incidence (7%) of anastomotic stenoses in the stapled anastomosis group.},
}
@article {pmid8066255,
year = {1994},
author = {Di Nardo, R and Capanna, G and Iannicelli, E and Drudi, FM and Chianta, GL and Passariello, R},
title = {[Diagnostic imaging in the evaluation of pelvic complications in intestinal diseases].},
journal = {La Radiologia medica},
volume = {88},
number = {1-2},
pages = {49-55},
pmid = {8066255},
issn = {0033-8362},
mesh = {Abscess/diagnostic imaging ; Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Humans ; Intestinal Diseases/complications/*diagnostic imaging ; Intestinal Fistula/diagnostic imaging ; Male ; Middle Aged ; Pelvis/*diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography ; Urinary Bladder Fistula/diagnostic imaging ; Vaginal Fistula/diagnostic imaging ; },
abstract = {During 12 consecutive months, 680 patients with recent pelvic symptoms were examined with ultrasonography (US). In 44 patients we found evidence of intestinal disease; 19 of them exhibited pelvic complications--11 pelvic abscesses, 3 enterovesical fistulas, 2 enterovaginal fistulas and 1 enterovesicle fistula; in 11 cases the inflammation spread to the surrounding organs. Of these 19 patients, 8 had an intestinal disease in their case history, whereas symptom onset was recent in the other 11 patients. In the latter group US yielded the first diagnostic information showing a bowel disease and other diagnostic examinations with different techniques were therefore performed. In 15 patients US indicated which type of bowel disease had caused the pelvic complications, while in 4 patients US showed a bowel disease without differentiating diverticular disease from neoplasms. In all patients US results were compared with X-ray and CT findings. In 17 patients the diagnoses were confirmed at surgery. The results we obtained from this study indicate US as an accurate method to detect not only the various pelvic conditions but also to differentiate pelvic complications of intestinal conditions from diseases originating in the pelvic organs.},
}
@article {pmid7991169,
year = {1994},
author = {Foglia Manzillo, A and Imperato, L and Paolillo, C and Fabbrocini, R and Romano, M and Ranieri, AJ and Aiello, D and Ciccone, M},
title = {[The colorectal restoration. When should it be done?].},
journal = {Minerva chirurgica},
volume = {49},
number = {7-8},
pages = {643-645},
pmid = {7991169},
issn = {0026-4733},
mesh = {Aged ; Anastomosis, Surgical ; Colon/*surgery ; Colorectal Neoplasms/surgery ; Diverticulum, Colon/surgery ; Humans ; Middle Aged ; Rectum/*surgery ; Reoperation ; Time Factors ; Treatment Outcome ; },
abstract = {The authors report a series of 10 reconnections, 4 after Hartmann operations for cancer, 3 after Mikulicz for diverticular disease, 1 after Hartmann for diverticular disease, 2 after Hartmann for traumatic perforation of sigma. Neither surgical complications nor death are reported. To reduce the risk of complication it is necessary to execute colorectal restoration with careful fiming. After the Hartmann operation you must operate in the shortest time. After operations for diverticular disease, you must operate after the lowest period of 6 months.},
}
@article {pmid7960894,
year = {1994},
author = {Zengaffinen, R and Clerici, T and Lange, J},
title = {[Therapy of choice in complicated diverticulitis?].},
journal = {Helvetica chirurgica acta},
volume = {60},
number = {5},
pages = {713-716},
pmid = {7960894},
issn = {0018-0181},
mesh = {Aged ; Anastomosis, Surgical ; Colonic Diseases/mortality/*surgery ; Colostomy ; Diverticulitis, Colonic/complications/mortality/*surgery ; Female ; Gastrointestinal Hemorrhage/mortality/*surgery ; Humans ; Intestinal Obstruction/mortality/*surgery ; Intestinal Perforation/mortality/*surgery ; Male ; Postoperative Complications/etiology/mortality ; Prospective Studies ; Retrospective Studies ; },
abstract = {Between 1988 and 1992 we treated in our hospital 79 patients with a complicated diverticular disease. We analysed and compared two groups (group A 42 cases January 1988 to February 1991/retrospectively, group B 37 cases March 1991 to December 1992/prospectively). We studied our operative procedure in respect to the postoperative morbidity and lethality, the number of performed and persistent stomata and the mean length of stay. The complications of diverticular disease in both groups were similar. Since March 1991 we performed primary resection with primary anastomosis in 89% of the patients, three-stage resection or primary resection with an anastomosis and a proximal colostomy was no more done. The Hartmann procedure was rarely chosen (only in 4 of 37 patients). In spite of forcing the primary resection with a primary anastomosis in group B, the complication rate (local and general) decreased from 35.7% to 29.7%, the lethality rate from 9.5% to 2.7%. The number of performed stomata showed a great difference with 22 in group A against 4 in group B. The mean length of stay was 31 versus 22 days. Therefore we consider primary resection with an anastomosis for the best therapy in complicated diverticular disease.},
}
@article {pmid7922061,
year = {1994},
author = {Stephenson, BM and Wheeler, MH},
title = {Unpredictable course of 'minimal' diverticular disease.},
journal = {The British journal of surgery},
volume = {81},
number = {7},
pages = {1050},
doi = {10.1002/bjs.1800810741},
pmid = {7922061},
issn = {0007-1323},
mesh = {Aged ; Colon, Sigmoid/*pathology/surgery ; Diverticulum, Colon/*pathology/surgery ; Humans ; Male ; },
}
@article {pmid7709317,
year = {1994},
author = {Pantanowitz, D},
title = {Colonic diverticular disease--blood or pain?.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {84},
number = {7},
pages = {453-454},
pmid = {7709317},
issn = {0256-9574},
mesh = {Abdominal Pain/*etiology ; Black or African American ; Black People ; Diverticulum, Colon/*complications/ethnology ; Gastrointestinal Hemorrhage/*etiology ; Humans ; South Africa ; },
}
@article {pmid8087711,
year = {1994},
author = {Chen, WS and Tzeng, KH and Leu, SY and Hsu, H},
title = {The application of laparoscopy in colorectal surgery: a preliminary report of twelve cases.},
journal = {Zhonghua yi xue za zhi = Chinese medical journal; Free China ed},
volume = {53},
number = {6},
pages = {357-362},
pmid = {8087711},
issn = {0578-1337},
mesh = {Adult ; Aged ; Colectomy/*methods ; Female ; Humans ; *Laparoscopy ; Male ; Middle Aged ; },
abstract = {BACKGROUND: With the development of video camera imaging system and the improvement of laparoscopic manipulation instruments, laparoscopic surgery has become applicable to many abdominal surgeries. Having completed the feasibility studies of animal model over 10 dogs, we began to apply this new technique in the field of colorectal surgery.
METHODS: From March to July 1993, 12 cases of large bowel resection were performed with laparoscopy. Operations performed included seven cases of laparoscopy-assisted right colectomy (LARC), three cases of laparoscopic abdominal-perineal resection (LAPR), one case of laparoscopic low anterior resection (LLAR) and one case of laparoscopy-assisted subtotal colectomy. Five cases received operation due to diverticular disease, three due to rectal carcinoma, three due to broad villous adenoma and one due to lipoma over ileocecal region.
RESULTS: The average operation time for LARC was 4 hours and 50 minutes, and for LAPR was 6 hours and 35 minutes. Operation time required decreased substantially as the number of laparoscopic surgery performed increased. The average post-operative length of stay was 5.5 days for LARC and 11.5 days for LAPR. Most of the patient started diet intake on the third day after surgery. There was no major complication. Only two cases developed minor complications of subcutaneous hematoma over trocar insertion site and minor wound infection.
CONCLUSIONS: Laparoscopic technique can feasibly be employed in certain cases of colorectal surgery, although it is rather complicated and requires longer learning curve than other laparoscopic procedures. Therefore, surgeons should take it most caution while carrying out this procedure. Experimental trials over animal model is also highly recommended before clinical practice.},
}
@article {pmid8044619,
year = {1994},
author = {Burke, P and Mealy, K and Gillen, P and Joyce, W and Traynor, O and Hyland, J},
title = {Requirement for bowel preparation in colorectal surgery.},
journal = {The British journal of surgery},
volume = {81},
number = {6},
pages = {907-910},
doi = {10.1002/bjs.1800810639},
pmid = {8044619},
issn = {0007-1323},
mesh = {Aged ; Aged, 80 and over ; Anastomosis, Surgical ; *Cathartics ; Citrates ; Colon/*surgery ; Colonic Diseases/surgery ; Female ; Humans ; Male ; Middle Aged ; Organometallic Compounds ; *Picolines ; Postoperative Complications ; *Preoperative Care ; Prospective Studies ; Rectal Diseases/surgery ; Rectum/*surgery ; Single-Blind Method ; Surgical Wound Dehiscence/etiology ; },
abstract = {To determine whether mechanical bowel preparation influences the incidence of anastomotic dehiscence following colorectal surgery, 186 patients undergoing elective left colonic or rectal resection were randomized before surgery to bowel preparation (n = 89) or no bowel preparation (n = 97). Surgical technique was standardized and no patient had a defunctioning colostomy. Seventeen patients were excluded (seven with preparation, ten without). Indications for surgery in the remaining 169 patients were carcinoma (133 patients), diverticular disease (26), inflammatory bowel disease (six) and miscellaneous conditions (four). Operations performed were left colonic resection or reversal of Hartmann's procedure (26 with preparation, 28 without) and anterior resection (56 versus 59). The overall morbidity rate (18 per cent) was similar in the two groups. All seven clinical anastomotic leaks occurred after low anterior resection, in three of the 39 patients who had undergone bowel preparation and four of the 36 who had not (P > 0.9). Two deaths occurred, both of patients who had received bowel preparation, one being secondary to anastomotic leakage. Bowel preparation does not influence outcome after elective colorectal surgery.},
}
@article {pmid7970067,
year = {1994},
author = {Mandarano, R and Ciccone, A and Sereni, P and Venturini, N},
title = {[Acute diverticulitis of the cecum].},
journal = {Minerva chirurgica},
volume = {49},
number = {6},
pages = {597-601},
pmid = {7970067},
issn = {0026-4733},
mesh = {Acute Disease ; Adult ; *Cecal Diseases/diagnosis/surgery ; *Diverticulitis/diagnosis/surgery ; Humans ; Male ; },
abstract = {Following a brief introduction regarding the epidemiology of diverticular disease, the authors report a rare case of diverticulitis of the cecum which had developed into an abscess. The patient was a 37-year-old man who was referred to the authors' attention with classic symptoms of acute appendicitis and it was therefore decided to operate. During laparotomy a small paracecal abscess involving a diverticulum with suppurating infection was found on the anterior wall of the cecum, whereas the appendix appeared to be completely unaffected. The diverticulum was removed together with a small area of the surrounding healthy tissue using a double-layer suture of the cecal wall. In the discussion the authors analyse the similarities and rarities of the case and compare it with national and international findings. Special attention is drawn to the problems of differential diagnosis raised by this rare pathology. In conclusion, the authors state that it is difficult to make a preoperative diagnosis and that therefore the decision to operate must be extemporary.},
}
@article {pmid7937603,
year = {1994},
author = {Rohr, S and Thiry, CL and Sadok, H and de Manzini, N and Hollender, LF and Meyer, C},
title = {[Complicated colonic diverticulosis. Changes in treatment and results over 22 years].},
journal = {Presse medicale (Paris, France : 1983)},
volume = {23},
number = {18},
pages = {834-838},
pmid = {7937603},
issn = {0755-4982},
mesh = {Abscess/*etiology/mortality/surgery ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colostomy ; Diverticulitis, Colonic/*etiology/mortality/surgery ; Diverticulum, Colon/*complications/mortality/surgery ; Female ; Gastrointestinal Hemorrhage/etiology/mortality/surgery ; Humans ; Intestinal Perforation/*etiology/mortality/surgery ; Male ; Middle Aged ; Peritonitis/etiology/mortality/surgery ; Retrospective Studies ; Sigmoid Diseases/*etiology/mortality/surgery ; },
abstract = {OBJECTIVES: The aim of this study was to analyse the clinical course, surgical strategy and results in patients with complicated colonic diverticular disease.
METHODS: We retrospectively compared two groups of patients who underwent surgery for complicated colonic diverticulosis from 1970 to 1984 (Group A, n = 94, mean age 60 years, 49 males, 45 females) and from 1985 to 1992 (Group B, n = 76, mean age 63.5, 32 males, 44 females).
RESULTS: Patients in the two groups were comparable; only the rate of peritonitis (20 vs 8%) was different (p < 0.05). The most frequent operations in Group A were colostomy-drainage (43%) and Hartman's procedure (26%) in emergency situations and resection with immediate anastomosis (63%) or resection-anastomosis with diverting stomy (19%) in elective cases. In Group B, surgical strategy led to a different pattern of operations, 4 and 56% in emergency, and 94 and 2% in elective surgery, respectively. Overall mortality was 11%, with 17% and 4% in Groups A and B respectively (p < 0.01). This major drop in mortality was particularly important in emergency cases (31 vs 4%; p < 0.02). Morbidity in emergency surgery fell from 21 to 4% (P < 0.0006). Interrupting the use of colostomy-drainage was a major factor in reducing mortality followed by a sharp fall in mortality after Hartmann's procedure (28.5 vs 0%).
CONCLUSION: The marked improvement in results between the two groups was mainly due to preferring resections of pathological colonic segments over colostomy-drainage.},
}
@article {pmid8181408,
year = {1994},
author = {Oliver, GC and Vachon, D and Eisenstat, TE and Rubin, RJ and Salvati, EP},
title = {Delorme's procedure for complete rectal prolapse in severely debilitated patients. An analysis of 41 cases.},
journal = {Diseases of the colon and rectum},
volume = {37},
number = {5},
pages = {461-467},
doi = {10.1007/BF02076192},
pmid = {8181408},
issn = {0012-3706},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Care ; Postoperative Complications/epidemiology ; Preoperative Care ; Rectal Prolapse/*surgery ; Recurrence ; Reoperation ; Risk Factors ; Severity of Illness Index ; Surgical Procedures, Operative/methods ; Treatment Outcome ; },
abstract = {PURPOSE: This study was designed to assess the results of a minimally invasive surgical procedure for the correction of complete rectal prolapse in a poor surgical risk group.
METHODS: Over a ten-year period, 40 patients underwent 41 Delorme operations when advanced age and/or poor overall health mitigated against an abdominal approach. Mean age was 82 (range, 30-100) years. Eighty-eight percent were females. Surgery was performed in the prone jackknife position utilizing intravenous sedation and local anesthesia.
RESULTS: Follow-up ranges from 1 year to 2 years (mean, 47 months). There have been 9 recurrences in 8 patients (22 percent). Mean time to recurrence was 13 months (range, 1 month to 6 years). One death occurred in an 81-year-old patient within 24 hours of surgery from cardiopulmonary arrest. Minor complications occurred in 25 percent of patients.
CONCLUSION: Satisfactory prolapse repair was safely performed in 78 percent of this high-risk group. Pitfalls in performing this procedure relate primarily to associated perineal and colonic conditions. Most prominent among these conditions are weak or absent and sphincter tone, perineal descent, and previous sphincter injury. Extensive diverticular disease may prohibit effective and complete proximal mucosectomy. An inadequate mucosectomy sets the stage for early recurrence of prolapse.},
}
@article {pmid8176156,
year = {1994},
author = {Oreopoulos, DG},
title = {Diverticular disease in the elderly on continuous ambulatory peritoneal dialysis.},
journal = {Journal of the American Geriatrics Society},
volume = {42},
number = {5},
pages = {569-570},
doi = {10.1111/j.1532-5415.1994.tb04984.x},
pmid = {8176156},
issn = {0002-8614},
mesh = {Aged ; Diverticulitis/*complications ; Humans ; *Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis/*etiology ; },
}
@article {pmid8044566,
year = {1994},
author = {Farmakis, N and Tudor, RG and Keighley, MR},
title = {The 5-year natural history of complicated diverticular disease.},
journal = {The British journal of surgery},
volume = {81},
number = {5},
pages = {733-735},
doi = {10.1002/bjs.1800810538},
pmid = {8044566},
issn = {0007-1323},
mesh = {Acute Disease ; Cause of Death ; Colon, Sigmoid/*surgery ; Diverticulum, Colon/complications/mortality/*surgery ; Follow-Up Studies ; Humans ; Medical Audit ; Recurrence ; },
abstract = {The natural history of complicated diverticular disease based on details of 300 patients entered into a national audit between 1985 and 1988 is reported. Questionnaires were sent to the general practitioners of 176 patients with this condition 5 years after hospital admission; 120 responded. Of these 120 patients, ten died from recurrent complicated diverticular disease, 29 died from other disorders and 81 remain alive. Forty of 110 patients (excluding those who died from recurrence) are still symptomatic or were so at the time of unrelated death. Thirty-nine patients developed a severe complication after the index admission, 14 of whom had the same complication initially. Of the 77 patients who had initially been managed by sigmoid resection, only two developed recurrent complications compared with 37 of 43 managed conservatively. Of the ten patients who died from recurrent diverticular disease, nine had not undergone sigmoid colectomy at or after the original admission. These data argue for interval sigmoid colectomy in most patients who initially present to hospital with complicated diverticular disease to prevent later development of potentially lethal complications.},
}
@article {pmid8044565,
year = {1994},
author = {Tudor, RG and Farmakis, N and Keighley, MR},
title = {National audit of complicated diverticular disease: analysis of index cases.},
journal = {The British journal of surgery},
volume = {81},
number = {5},
pages = {730-732},
doi = {10.1002/bjs.1800810537},
pmid = {8044565},
issn = {0007-1323},
mesh = {Abscess/etiology ; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Cellulitis/etiology ; Diverticulum/*complications/mortality ; Female ; Gastrointestinal Hemorrhage/etiology ; *Hospital Mortality ; Humans ; Intestinal Diseases/*complications/mortality ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Male ; *Medical Audit ; Middle Aged ; Peritonitis/etiology ; Prospective Studies ; United Kingdom ; },
abstract = {Details of 300 patients with complicated diverticular disease from 30 hospitals between 1985 and 1988 were entered into a national audit organized by the Surgical Research Society. Complications present on admission included acute phlegmon (n = 104), pericolic abscess (n = 34), purulent peritonitis (n = 40), large bowel obstruction (n = 31), faecal peritonitis (n = 23), pericolic abscess complicated by fistula (n = 28) and lower gastrointestinal bleeding (n = 40). The overall mortality rate was 11.3 per cent (acute phlegmon, 4 per cent; purulent peritonitis, 27 per cent; pericolic abscess, 12 per cent; faecal peritonitis, 48 per cent; large bowel obstruction, 6 per cent; bleeding, 2 per cent; fistula, 4 per cent). Acute phlegmon was treated without operation in 78 patients (75.0 per cent) and by resection in 24 (23.1 per cent). Management of purulent peritonitis generally involved Hartmann's procedure (62 per cent) or resection and primary anastomosis (15 per cent). Similarly, patients with pericolic abscess usually underwent Hartmann's procedure (38 per cent) or resection and primary anastomosis (35 per cent). The principal operation for faecal peritonitis was Hartmann's resection (83 per cent). Large bowel obstruction was managed conservatively in four patients (13 per cent), by Hartmann's procedure in nine (29 per cent), and by resection and primary anastomosis with or without a proximal stoma in 13 (42 per cent). Most patients (82 per cent) with fistula associated with an abscess were managed by resection and primary anastomosis; 90 per cent with acute gastrointestinal bleeding were treated without operation.},
}
@article {pmid7988064,
year = {1994},
author = {Nair, P and Mayberry, JF},
title = {Vegetarianism, dietary fibre and gastro-intestinal disease.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {12},
number = {3},
pages = {177-185},
doi = {10.1159/000171451},
pmid = {7988064},
issn = {0257-2753},
mesh = {Cholelithiasis/epidemiology ; Constipation/epidemiology ; *Diet, Vegetarian/statistics & numerical data ; Dietary Fiber/*administration & dosage ; Diverticulum, Colon/epidemiology ; Gastrointestinal Diseases/*epidemiology ; Gastrointestinal Neoplasms/diet therapy/epidemiology ; Humans ; Inflammatory Bowel Diseases/diet therapy ; Male ; Mortality ; Peptic Ulcer/diet therapy ; United Kingdom/epidemiology ; },
abstract = {PURPOSE: To review the association between vegetarianism, dietary fibre and gastro-intestinal disease.
DATA: There is an increasing trend towards vegetarianism in the United Kingdom. Studies have shown a lower than expected death rate in vegetarians with a significant association between meat eating and mortality from all causes in men. Vegetarians were found to have a lower incidence of gastro-intestinal cancer, gallstones, diverticular disease and constipation. Patients treated with vegetarian/high-fibre diets have not experienced significant benefits when diets are used in gastro-intestinal cancer, peptic ulcer disease or inflammatory bowel disease.
CONCLUSION: The benefits of a vegetarian life-style may be conferred to non-vegetarians by eating a carefully planned non-vegetarian diet consisting of increased fruit, vegetables and fibre.},
}
@article {pmid7948939,
year = {1994},
author = {Celestino, A and Castillo, T and Contardo, C and Frisancho, O and Osorio, M and Huaroto, M and Vidal, P and Ruiz, E and Gómez, A and Mantilla, L},
title = {[Colonoscopic diagnosis].},
journal = {Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru},
volume = {14},
number = {2},
pages = {115-122},
pmid = {7948939},
issn = {1022-5129},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Colonic Diseases/*diagnosis/diagnostic imaging ; *Colonoscopy/methods ; Diagnosis, Differential ; Female ; Humans ; Infant ; Male ; Middle Aged ; Radiography ; },
abstract = {Between 1974 and 1992, we perform 3,054 colonoscopies for diagnosis in 2,770 patients, both of sexes, between the ages of 1 and 101 yr, most of them over the fifth decade of life. In 300 procedures the bowel cleansing was made with the standard method of liquid diet and enemas, and in the other 2,754 with the oral administration of saline solution 9% with optimal results. We get the sedation of patients with the intravenous administration of diazepam 10mg, or pethidine 50 mg, or midazolam 2.5 to 5 mg, and in children with ketamine and the anesthesiologist assistance. In 95% of the procedures we can see the cecum and the ileum; the diagnosis was abnormal in 52.78% of cases, normal in 45.20%, and insufficient in 02.02% specially for a bad cleansing of the bowel. In the abnormal group, the most frequent diseases we diagnose were: polyps, cancer, diverticular disease, and specific inflammatory disease of the bowel like TBC, radiation proctosigmoiditis, amebiasis, and non-specific bowel disease: "colitis", ulcerative proctocolitis, erosive colitis, and Crohn's disease. Colonoscopy is a very important method for diagnosis of colon diseases, alone or complementary of double contrast X-ray of the colon.},
}
@article {pmid8180772,
year = {1994},
author = {Puente, I and Sosa, JL and Desai, U and Sleeman, D and Hartmann, R},
title = {Laparoscopic treatment of colovesical fistulas: technique and report of two cases.},
journal = {Surgical laparoscopy & endoscopy},
volume = {4},
number = {2},
pages = {157-160},
pmid = {8180772},
issn = {1051-7200},
mesh = {Adult ; Diverticulum, Colon/complications ; Humans ; Intestinal Fistula/*surgery ; Laparoscopy/*methods ; Male ; Middle Aged ; Sigmoid Diseases/*surgery ; Urinary Bladder Fistula/*surgery ; },
abstract = {Colovesical fistulas are a serious complication of diverticular disease. Management by one-stage resection and anastomosis has resulted in lower morbidity and shorter hospital stay. Nevertheless, hospital time remains long, approaching an average of 2-3 weeks. Here we describe our technique of laparoscopic approach to colovesical fistulas. Our initial experience suggests that this is a safe operation with minimal pain, absent ileus, and a short postoperative stay.},
}
@article {pmid8192484,
year = {1994},
author = {Spiro, CM and Grant, EG and Gilley, MT},
title = {Diverticular disease. Surgical options, patient management.},
journal = {AORN journal},
volume = {59},
number = {3},
pages = {625-9, 632-4; quiz 635-7, 639-40},
doi = {10.1016/s0001-2092(07)69979-7},
pmid = {8192484},
issn = {0001-2092},
mesh = {Diverticulitis, Colonic/diagnosis/*nursing/*surgery ; Diverticulum, Colon/diagnosis/*nursing/*surgery ; Humans ; Operating Room Nursing ; Patient Education as Topic ; },
abstract = {Diverticular disease is a common and occasionally complicated disease in our western society. Although the exact etiology is unknown, diet is thought to be a contributing factor to the formation of diverticula. Diverticular disease most often is managed medically. When surgery is indicated, perioperative nursing care is based on knowledge of the disease process and attention to the physical and emotional needs of the patient.},
}
@article {pmid8173926,
year = {1994},
author = {Brewster, NT and Grieve, DC and Saunders, JH},
title = {Double-contrast barium enema and flexible sigmoidoscopy for routine colonic investigation.},
journal = {The British journal of surgery},
volume = {81},
number = {3},
pages = {445-447},
doi = {10.1002/bjs.1800810341},
pmid = {8173926},
issn = {0007-1323},
mesh = {*Barium Sulfate ; Colonic Diseases/*diagnosis/diagnostic imaging ; Colonic Polyps/diagnosis ; Diverticulum, Colon/diagnosis ; Enema ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Radiography ; Sensitivity and Specificity ; *Sigmoidoscopy ; },
abstract = {Over a 3-year period, all patients referred for barium enema examination had a double-contrast barium enema and flexible sigmoidoscopy performed on the same day. A total of 462 joint examinations were performed. Abnormalities were found in 193 patients by the use of barium enema, 164 patients by using sigmoidoscopy and 294 by the use of both methods of investigation. Sigmoidoscopy was superior to barium enema in the detection of polyps and inflammatory bowel disease but barium enema was more sensitive for diverticular disease. The presenting symptoms had no predictive value in distinguishing carcinoma, polyps and diverticular disease. Diverticular disease did not reduce the sensitivity of barium enema examination to polyps in the sigmoid colon. Fibreoptic sigmoidoscopy immediately before barium enema was well tolerated by patients. The investigations were complementary in the diagnosis of colonic polyps, inflammatory bowel disease and diverticular disease.},
}
@article {pmid8154804,
year = {1994},
author = {Sarin, S and Boulos, PB},
title = {Long-term outcome of patients presenting with acute complications of diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {76},
number = {2},
pages = {117-120},
pmid = {8154804},
issn = {0035-8843},
mesh = {Acute Disease ; Aged ; Aged, 80 and over ; Diverticulitis/mortality/surgery ; Diverticulitis, Colonic/therapy ; Diverticulum, Colon/*complications ; Female ; Gastrointestinal Hemorrhage/mortality/therapy ; Humans ; Intestinal Obstruction/therapy ; Male ; Middle Aged ; Peritonitis/therapy ; Prospective Studies ; Recurrence ; Time Factors ; Treatment Outcome ; },
abstract = {The immediate management of acute diverticular disease is well defined but the risk of further complications and the long-term course of the disease, after conservative or surgical treatment, is not clearly documented. Over an 8-year period, a total of 164 patients (male/female = 69/95, median age 68 years) presented with acute complications of diverticular disease and were prospectively followed up for a median of 48 months. Medical treatment of acute diverticulitis was effective in 85% of 86 patients, with a mortality of 1.3% and a recurrence rate of 2% per patient year follow-up. All 37 patients presenting with bleeding responded to conservative management without mortality and a readmission rate, with further bleeding, of 5% per patient year. Patients who required colonic resection (n = 52), either as a single or staged procedure, had a mortality of 12% but with no further admissions with complications of diverticular disease. The low risk of readmission with recurrent disease after successful conservative treatment of the acute complications of diverticular disease does not justify elective operation in this group of patients.},
}
@article {pmid8137671,
year = {1994},
author = {Keck, JO and Collopy, BT and Ryan, PJ and Fink, R and Mackay, JR and Woods, RJ},
title = {Reversal of Hartmann's procedure: effect of timing and technique on ease and safety.},
journal = {Diseases of the colon and rectum},
volume = {37},
number = {3},
pages = {243-248},
doi = {10.1007/BF02048162},
pmid = {8137671},
issn = {0012-3706},
mesh = {Anastomosis, Surgical ; Colon, Sigmoid/surgery ; Colonic Diseases/mortality/*surgery ; Colostomy/*methods ; Diverticulum/mortality/*surgery ; Humans ; Postoperative Complications/epidemiology/mortality ; Rectal Neoplasms/mortality/*surgery ; Rectum/surgery ; Reoperation ; Survival Rate ; Time Factors ; Treatment Outcome ; },
abstract = {PURPOSE: The optimal time for reversal of Hartmann's procedure is controversial. Significant operative difficulty and morbidity have been reported for Hartmann's reversal. The purpose of this study was to examine 11 years' experience with Hartmann's reversal, with particular attention to rate of reversibility, operative difficulty, and timing of reversal.
METHODS: Case records of all patients undergoing either Hartmann's procedure or Hartmann's reversal at St. Vincent's Hospital between 1981 and 1991 were examined. Patients having Hartmann's reversal were divided into an early group (before 15 weeks) and a late group (after 15 weeks). These groups were compared in terms of morbidity and mortality, bed stay, and operative difficulty.
RESULTS: Hartmann's procedure was performed on 111 patients, mostly for advanced cancer and complicated diverticular disease. Of 96 patients who survived, 50 (52 percent) underwent reversal. Of those with diverticular disease, 40 of 48 (83 percent) underwent reversal. Mortality for Hartmann reversal was 2 percent; anastomotic leak rate 4 percent; and overall complication rate 26 percent. Early reversal was performed in 13 patients and late reversal in 37 patients. There was no difference between these groups in mortality, morbidity, or anastomotic leakage. However, bed stay was longer in the early group and graded operative difficulty greater. In particular, cases in which adhesion density was most severe and in which accidental enterotomy occurred were more common in the early group (P = 0.02, Miettinen's modification of Fisher's exact test).
CONCLUSIONS: Hartmann's reversal can be performed with an acceptable morbidity and mortality in most survivors of complicated diverticular disease. Operative difficulty appears to be less after a delay of 15 weeks.},
}
@article {pmid8128134,
year = {1994},
author = {Marchiondo, K},
title = {When the Dx is diverticular disease.},
journal = {RN},
volume = {57},
number = {2},
pages = {42-6; quiz 47},
pmid = {8128134},
issn = {0033-7021},
mesh = {Diverticulum/complications/diagnosis/diet therapy/*nursing ; Humans ; Patient Education as Topic ; },
}
@article {pmid8042103,
year = {1994},
author = {Mokoena, T and Madiba, TE},
title = {Haemorrhage--the main presenting feature of diverticular disease of the colon in blacks.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {84},
number = {2},
pages = {83-85},
pmid = {8042103},
issn = {0256-9574},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Black People ; Diverticulum, Colon/*complications/diagnosis/ethnology/therapy ; Female ; Gastrointestinal Hemorrhage/*etiology/therapy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; South Africa ; },
abstract = {Haemorrhage is one of the less common presentations of diverticular disease. This retrospective 5-year study of 23 patients has identified it as the main presentation (74%) among South African blacks in whom the disease is uncommon, but emerging as a clinical problem. Women constituted a statistically significant majority of patients with bleeding (76%); this was in excess of their overall proportion among patients with diverticular disease (61%) (P = 0.018).},
}
@article {pmid7978752,
year = {1994},
author = {Colombo, PL and Todde, A and Belisomo, M and Bianchi, C and Sciutto, AM and Tinozzi, S},
title = {[Massive hemorrhage caused by colonic diverticulosis].},
journal = {Annali italiani di chirurgia},
volume = {65},
number = {1},
pages = {89-97; discussion 97-8},
pmid = {7978752},
issn = {0003-469X},
mesh = {Aged ; Angiography ; Colectomy ; Colonoscopy ; Diverticulum, Colon/*complications/diagnosis/surgery ; Gastrointestinal Hemorrhage/diagnosis/*etiology/surgery ; Humans ; Mesenteric Arteries/diagnostic imaging ; },
abstract = {Massive hemorrhage from diverticular disease of the colon is a very difficult problem in abdominal emergency surgery. The pathogenesis of bleeding colonic diverticulosis is strictly correlated to the angioarchitecture of the colonic diverticular wall. Here the vasa recta penetrate the colonic wall from the serosa to the submucosa through connective tissue septa. Injurious factors arising from the colonic or diverticular lumen can produce an eccentric damage to the luminal side with intimal thickening, segmental weakening of the artery and its rupture with massive bleeding. Conventional barium enema is not able to show the source of the hemorrhage in the majority of the bleeding patients; colonoscopy, as primary emergency procedure, has significant positive findings in 41.5%-83.7% of patients. Radionuclide bleeding scans have a sensitivity rate of 86%-94%. Emergency arteriography localizes the bleeding source in higher rates ranging from 58% to 86% and is successful after intraarterial infusion of vasopressin or embolization in 47%-92% of patients. Surgical treatment for continued bleeding from diverticular disease is controversy. Segmental resection should be performed on patients with localized bleeding sources (positive arteriogram). Laparotomy, anterograde irrigation and intraoperative colonoscopy are indicated in patients with multiple bleeding sites and negative arteriography. Because the right colon is the most common site of bleeding in same cases is necessary to perform a subtotal colectomy with ileorectal anastomosis. Blind resections particularly in the elderly patients present high rebleeding rate (> 60%) and high mortality (30%) with sepsis accounting for the majority of deaths.},
}
@article {pmid7973439,
year = {1994},
author = {Spencer, J},
title = {What is needed from imaging? The surgeon's point of view.},
journal = {Scandinavian journal of gastroenterology. Supplement},
volume = {203},
number = {},
pages = {1-4},
doi = {10.3109/00365529409091387},
pmid = {7973439},
issn = {0085-5928},
mesh = {Abdominal Abscess/*diagnosis/diagnostic imaging/surgery ; Humans ; Laparoscopy ; Laparotomy ; Tomography, X-Ray Computed ; Ultrasonography ; },
abstract = {Abdominal sepsis after surgery is decreasing in incidence but has a high mortality, especially in those with other complicating factors. The most difficult abscesses to localize are those in intermesenteric folds. Pyrexia of unknown origin is much less of a clinical problem since the advent of ultrasound and computerized tomography (CT) scanning. Laparotomy still has an occasional role but laparoscopy should precede it and may be therapeutic using minimally invasive surgical techniques; for example, in appendicitis and cholecystitis. Pancreatitis remains a serious clinical problem in which imaging plays an important role. Percutaneous drainage has a similar morbidity and success rate to open drainage. In certain cases of diverticular disease it may obviate altogether the need for surgical resection. The differentiation between abscess and necrotic tumour is important, and CT is most helpful in this area.},
}
@article {pmid7882699,
year = {1994},
author = {Ventrucci, M and Ferrieri, A and Bergami, R and Roda, E},
title = {Evaluation of the effect of rifaximin in colon diverticular disease by means of lactulose hydrogen breath test.},
journal = {Current medical research and opinion},
volume = {13},
number = {4},
pages = {202-206},
doi = {10.1185/03007999409110484},
pmid = {7882699},
issn = {0300-7995},
mesh = {Adult ; Aged ; Breath Tests ; Diverticulum, Colon/*drug therapy ; Female ; Humans ; Hydrogen/analysis ; Lactulose/metabolism ; Lung/metabolism ; Male ; Middle Aged ; Rifamycins/pharmacokinetics/*therapeutic use ; },
abstract = {To understand better the mechanism by which rifaximin produces symptomatic relief in diverticular disease of the colon, the effect of this antibiotic on orocaecal transit time and on the production of hydrogen by intestinal microflora after ingestion of lactulose was studied in 33 patients with this disease and in 11 healthy subjects. An hydrogen breath test was carried out to measure pulmonary hydrogen excreted during the 3 hours after ingestion of 10 g lactulose. In patients, the hydrogen breath test with lactulose was repeated after treatment with 400 mg rifaximin twice daily for 10 days. In patients under basal conditions and controls, orocaecal transit time did not differ significantly, but hydrogen production was significantly higher in the former (p < 0.02). In patients, transit time and hydrogen excretion in response to lactulose administration did not differ significantly before and after treatment with rifaximin, and these two parameters were inversely correlated both before (r = 0.49, p < 0.01) and after rifaximin (r = 0.58, p < 0.001). Fifteen of the 33 patients showed accelerated transit time after treatment with the antibiotic, 10 showed no variation, and 8 showed prolonged transit. In 19 patients a reduction in hydrogen production was noted after rifaximin, while in 14 an increase was demonstrated. Twenty-one of the 33 patients reported an improvement in their symptoms with rifaximin; of these, only 10 showed accelerated transit time and 9 a reduction in hydrogen production after rifaximin.(ABSTRACT TRUNCATED AT 250 WORDS)},
}
@article {pmid7876719,
year = {1994},
author = {Masaki, T and Sheffield, JP and Talbot, IC and Williams, CB},
title = {Non-polypoid adenoma of the large intestine.},
journal = {International journal of colorectal disease},
volume = {9},
number = {4},
pages = {180-183},
pmid = {7876719},
issn = {0179-1958},
mesh = {Adenoma/epidemiology/*pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms/epidemiology/*pathology ; Diploidy ; Europe ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {In order to find non-polypoid (flat) adenomas in the large intestine, one hundred and twenty-six consecutively resected large bowels were stained with methylene blue or haematoxylin and examined using a stereoscopic microscope with special attention to pit pattern abnormalities. The primary diseases were classified into familial adenomatous polyposis (FAP) in 9 cases, multiple adenomas in 2 cases, colorectal cancers in 90 cases, Crohn's disease in 5 cases, ulcerative colitis in 2 cases, constipation in 9 cases, diverticular disease in 3 cases and others in 6 cases, respectively. Thirty-five flat adenomas were detected in 14 colons (14/126 = 11%). Twenty-one flat adenomas were found in 9 non-FAP cases (7 colons removed for cancer and 2 for multiple adenomas) and the remaining 14 flat adenomas were found in 5 FAP colons. No flat adenomas were found in any of the 25 colons removed for non-neoplastic disease. Nine flat adenomas (26%) had a depressed shape. The mean age of the non-FAP cases was 57 years and that of the FAP cases was 29 years (P < 0.005). The mean size of non-FAP flat adenomas was 6.1 mm and that of FAP flat adenomas was 3.1 mm (P < 0.005). Non-FAP flat adenomas were more frequently right-sided than those in FAP. Epithelial dysplasia was graded as mild in 31 (89%) and moderate in 4 (11%), respectively. Moderate dysplasia was found in non-FAP cases exclusively. These results suggest that flat adenomas may be heterogeneous. The significance of these lesions is discussed.},
}
@article {pmid7761680,
year = {1994},
author = {Porta, E and Germano, A and Ferrieri, A and Koch, M},
title = {The natural history of diverticular disease of the colon: a role for antibiotics in preventing complications? A retrospective study.},
journal = {Rivista europea per le scienze mediche e farmacologiche = European review for medical and pharmacological sciences = Revue europeenne pour les sciences medicales et pharmacologiques},
volume = {16},
number = {1-2},
pages = {33-39},
pmid = {7761680},
issn = {0392-291X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/adverse effects/*therapeutic use ; Diverticulitis, Colonic/*complications/drug therapy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {Medical and surgical treatment of diverticular disease has to be set against a background of incomplete knowledge of the natural history and geographical differences of the disease, and difficulties in its definition and classification. This clinical retrospective study was performed to answer the following questions: 1) what was the clinical course after an episode of acute diverticulitis, obliging to an hospital admission? 2) what was the role of cyclic course of antibiotics, if any, in reducing the risk of complications? We examined all admissions to the surgical ward from 1967 to 1991 for a complication of diverticular disease: we looked for occlusion, perforation, fistula, or bleeding. Patients not operated with diverticular disease have been divided in 2 groups, that is patients with a medical prescription at the end of hospital period, and patients admitted without a drug prescription. All patients have been prescribed bulk agents. The medical prescription included monthly cycles of 1 week of oral antibiotics (Neomycin associated with Bacitracin, Paromomycin, or 1989 Rifaximin). We looked for the natural history of the disease in the 2 groups (the "drug" group and the "no drug" group) after the first admission, that is the development of new complications of the diverticular disease and the reason for readmissions, calculating the Absolute Risk Reduction (the difference in event rates between the treatment and control groups) and the Relative Risk Reduction (the difference in event rates between the treated and control groups, divided by the event rate in the control groups). The total number of admitted patients in the period 1967-1991 was 505. A statistically significant trend in favour of a risk reduction of new admissions in the group given antibiotics seems evident.(ABSTRACT TRUNCATED AT 250 WORDS)},
}
@article {pmid7736049,
year = {1994},
author = {Takami, M and Fujimoto, T and Kimura, M},
title = {[Diverticular disease and diverticulitis of the colon].},
journal = {Ryoikibetsu shokogun shirizu},
volume = {},
number = {6},
pages = {296-299},
pmid = {7736049},
mesh = {Aged ; Aged, 80 and over ; *Diverticulitis, Colonic ; *Diverticulum, Colon ; Female ; Humans ; Male ; },
}
@article {pmid8303208,
year = {1993},
author = {Mäkelä, JT and Kiviniemi, H and Laitinen, S and Kairaluoma, MI},
title = {Diagnosis and treatment of acute lower gastrointestinal bleeding.},
journal = {Scandinavian journal of gastroenterology},
volume = {28},
number = {12},
pages = {1062-1066},
doi = {10.3109/00365529309098310},
pmid = {8303208},
issn = {0036-5521},
mesh = {Acute Disease ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Colonic Diseases/*diagnosis/etiology/*therapy ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology/*therapy ; Humans ; Male ; Middle Aged ; Sex Distribution ; },
abstract = {Diagnostic sigmoidoscopy and barium enema examinations (n = 214) or colonoscopy (n = 52) were performed for acute lower gastrointestinal (GI) bleeding. The cause of bleeding was detected in 76% (203 of 266) of the primary examinations, and the cause remained unclear after subsequent examinations in 17% of the cases. Hemorrhoids were the cause of bleeding in 28% (56 of 203) of the cases, colonic diverticular disease in 19% (39 of 203), adenomatous polyps in 11% (23 of 203), and colorectal cancer in 10% (20 of 203). The sources of bleeding did not differ significantly by sex. An anorectal site of bleeding was most often detected in patients less than 50 years of age (p < 0.0001) and a left colonic site in those more than 70 years (p < 0.0001). Hemorrhoids significantly more often caused rectal bleeding among the youngest patients (p < 0.0001) and colonic diverticular disease among the oldest patients (p < 0.0001) and colonic diverticular disease among the oldest patients (p < 0.0001) than among the others. Of the 266 patients, 19% have been operated on for the bleeding lesion. The mortality related to lower GI bleeding was 4% (11 of 266). The mean age of the patients who died was higher than that of those who survived (p < 0.05).},
}
@article {pmid8248836,
year = {1993},
author = {McIntyre, PB and Pemberton, JH},
title = {Pathophysiology of colonic motility disorders.},
journal = {The Surgical clinics of North America},
volume = {73},
number = {6},
pages = {1225-1243},
doi = {10.1016/s0039-6109(16)46189-x},
pmid = {8248836},
issn = {0039-6109},
mesh = {Animals ; Colon/physiopathology ; Colonic Diseases, Functional/*physiopathology ; Diverticulum, Colon/physiopathology ; Gastrointestinal Motility/*physiology ; Humans ; Rectum/physiopathology ; },
abstract = {When no identifiable organic cause for colonic symptoms can be found, it is easy for the busy clinician to label the patient neurotic. It is evident that many of these "functional" disorders do reflect an underlying motility disorder, although our understanding is far from clear. However, currently, patients with severe constipation are evaluated in a much more rational manner and, as a consequence, are offered a reasonable therapeutic approach that can be predicted to have a good chance for success. We can hope that as our understanding of irritable bowel syndrome is strengthened, treatment will become more efficacious than the unproved and costly medications that are in use currently. Until dietary modification becomes commonplace, it is unlikely that the incidence of diverticular disease or its complications will change. Already, our understanding of ileus has allowed us to realize the benefits of laparoscopic surgery, and as our knowledge of the various gut hormones and the inhibitory role that some play in intestinal motility grows, ileus, and its resulting prolongation of hospital stay, may become less problematic.},
}
@article {pmid8277491,
year = {1993},
author = {Cross, SB and Copas, PR},
title = {Colovaginal fistula secondary to diverticular disease. A report of two cases.},
journal = {The Journal of reproductive medicine},
volume = {38},
number = {11},
pages = {905-906},
pmid = {8277491},
issn = {0024-7758},
mesh = {Aged ; Diverticulum, Colon/*complications ; Female ; Humans ; Hysterectomy/adverse effects ; Intestinal Fistula/*etiology ; Sigmoid Diseases/*etiology ; Vaginal Fistula/*etiology ; },
abstract = {Two cases of diverticular abscess presented with abdominal pain, pelvic mass and vaginal discharge. Both patients had previously undergone hysterectomy. Although relatively rare, colovaginal fistula secondary to diverticular disease should be considered in the differential diagnosis in an elderly woman with similar symptoms.},
}
@article {pmid8140834,
year = {1993},
author = {Binda, GA and Saccomani, G and Gramegna, A},
title = {Emergency surgery of complicated colonic diverticulitis.},
journal = {Acta chirurgica Belgica},
volume = {93},
number = {6},
pages = {253-257},
pmid = {8140834},
issn = {0001-5458},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/complications/mortality/*surgery ; Emergencies ; Female ; Humans ; Intestinal Obstruction/etiology/surgery ; Intestinal Perforation/etiology/surgery ; Male ; Middle Aged ; Peritonitis/etiology/surgery ; Postoperative Complications/mortality ; },
abstract = {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.},
}
@article {pmid8092923,
year = {1993},
author = {Hirano, T and Yoshioka, H},
title = {[Operative cases of diverticular disease of the colon: in comparison with colo-rectal cancers].},
journal = {Nihon geka hokan. Archiv fur japanische Chirurgie},
volume = {62},
number = {6},
pages = {294-296},
pmid = {8092923},
issn = {0003-9152},
mesh = {Aged ; Aged, 80 and over ; Chi-Square Distribution ; Colectomy ; Colorectal Neoplasms/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {From January 1986 through December 1992, 9 cases of diverticular disease of the colon have been surgically operated in our department. In 56% of the cases, diverticula were located in the left side, in 33% in the right side, and in 11% in the both sides. 67% cases had a complication of hypertension, 33% cases had hypoproteinemia, and 78% cases had anemia. Moreover, 67% cases had hyperlipidemia. Only one case had a minor leakage in the anastomosis after colectomy, which was cured by intravenous hyperalimentation. These results suggest that such a complication should be taken into consideration in the surgical treatment of diverticular disease of the colon, although the disease is in itself a benign disease.},
}
@article {pmid8404385,
year = {1993},
author = {Longo, WE and Milsom, JW and Lavery, IC and Church, JC and Oakley, JR and Fazio, VW},
title = {Pelvic abscess after colon and rectal surgery--what is optimal management?.},
journal = {Diseases of the colon and rectum},
volume = {36},
number = {10},
pages = {936-941},
doi = {10.1007/BF02050629},
pmid = {8404385},
issn = {0012-3706},
mesh = {Abscess/*etiology/physiopathology/*therapy ; Adult ; Colonic Diseases/*surgery ; Female ; Humans ; Male ; *Pelvis ; Postoperative Complications/*therapy ; Prognosis ; Rectal Diseases/*surgery ; Recurrence ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; },
abstract = {PURPOSE: The aim of this study was to compare treatment outcomes in the management of pelvic abscess (PA) after rectal surgery.
METHODS: Over a 12-year period all PAs occurring in the patients undergoing colorectal resection were retrospectively reviewed. The APACHE II Score was used to stratify illness.
RESULTS: Postoperative PA developed in 56 patients after cancer (32 percent), ulcerative colitis (26 percent), diverticular disease (24 percent), and Crohn's colitis (18 percent)/surgery. Overall, 24 (43 percent) of PAs were after operations for inflammatory bowel disease and 43 (77 percent) of PAs were after intrapelvic intestinal anastomoses. PAs were treated by 1) antibiotics alone (11/56), 2) percutaneous computerized tomography-guided catheter drainage (13/56), 3) transperineal drainage (15/56), or 4) laparotomy (17/56). Recurrent PAs developed in 11/56 (19 percent) after initial treatment, of which 7 required additional surgery. These recurrences were evenly distributed between treatment groups. There were three deaths as a result of PA, two after laparotomy and one after percutaneous drainage. Long-term sequela in patients with intestinal anastomosis included loss of intestinal continuity (10/43) and anastomotic stenosis (7/43). There was no difference in APACHE II Score among the four treatment groups. The mortality rate was 75 percent among patients whose APACHE II Scores were greater than 15. The development of a PA after colon and rectal surgery was associated with a 5 percent mortality and 41 percent functional morbidity (23 percent permanent stoma and 18 percent symptomatic stricture rate).
CONCLUSION: Using clinical judgment, if PA is amenable to computerized tomography-guided percutaneous or transperineal drainage, one of these techniques should be attempted initially in the hemodynamically stable nonseptic patient. Long-term functional disability is common after PA in rectosigmoid surgery in patients who undergo pelvic/intestinal anastomosis.},
}
@article {pmid8378835,
year = {1993},
author = {Rothenberger, DA and Wiltz, O},
title = {Surgery for complicated diverticulitis.},
journal = {The Surgical clinics of North America},
volume = {73},
number = {5},
pages = {975-992},
doi = {10.1016/s0039-6109(16)46136-0},
pmid = {8378835},
issn = {0039-6109},
mesh = {Acute Disease ; Algorithms ; Diverticulitis, Colonic/complications/diagnosis/*surgery ; Humans ; Methods ; },
abstract = {The surgical treatment of acute, complicated diverticulitis remains controversial. No randomized studies have been performed to clarify which operative procedure best fits each situation. As a result, the surgeon must use accumulated knowledge and judgment to make the correct decisions for an individual patient. The morbidity and mortality of patients with complicated diverticular disease in 1993 depend, not so much on the operative procedure, but on the severity of the disease and the associated comorbid conditions, namely the presence of fecal or purulent peritonitis, past medical problems, immune status, and nutritional status. However, adherence to the several principles detailed in this report will minimize morbidity and mortality. The surgeon should always attempt to convert the patient from an emergency to an urgent or elective operative status. In the absence of free perforation, this goal usually can be achieved. Rushing into surgery in patients with a normal immune system is generally ill advised. It is far preferable to stabilize the patient, percutaneously drain abscesses if possible, prepare the bowel before exploration, and thus keep the option of primary anastomosis open. A primary anastomosis done first thing in the morning is far preferable to an end-stoma created in the middle of the night in an emergency situation. The algorithm displayed in Figure 1 provides a useful guideline for treating patients with complicated diverticulitis.},
}
@article {pmid8214970,
year = {1993},
author = {Parkes, BM and Obeid, FN and Sorensen, VJ and Horst, HM and Fath, JJ},
title = {The management of massive lower gastrointestinal bleeding.},
journal = {The American surgeon},
volume = {59},
number = {10},
pages = {676-678},
pmid = {8214970},
issn = {0003-1348},
mesh = {Aged ; Angiodysplasia/complications ; Colectomy ; Colonic Polyps/complications ; Diverticulum, Colon/complications ; Gastrointestinal Hemorrhage/etiology/*surgery ; Humans ; Middle Aged ; Recurrence ; },
abstract = {To evaluate what has been the most effective surgical treatment for massive lower gastrointestinal bleeding, we reviewed the records of 31 patients who underwent colon resection for hemodynamic instability and/or the need for continued transfusions. These 31 patients underwent either segmental colectomy (21 patients) or subtotal colectomy (10 patients). Resections were performed for diverticular disease (19 patients), angiodysplasia (eight patients), acute ulceration (three patients), and polyps (one patient). The re-bleeding rate (mean follow-up 1 year) for subtotal colectomy was 0 per cent, segmental resection with positive angiography was 14 per cent, and segmental resection with negative angiography was 42 per cent. The complication rate including myocardial infarction, ARDS, pneumonia, and renal failure was highest (83 per cent) in those patients receiving segmental resection with a negative angiogram. The mortality rate was also highest for segmental resection patients with negative angiography (57 per cent). The results of this review suggest that segmental resection should be performed when the bleeding site is identified angiographically. Subtotal colectomy should be reserved for massive bleeding with negative angiography.},
}
@article {pmid8409186,
year = {1993},
author = {Deckmann, RC and Cheskin, LJ},
title = {Diverticular disease in the elderly.},
journal = {Journal of the American Geriatrics Society},
volume = {41},
number = {9},
pages = {986-993},
doi = {10.1111/j.1532-5415.1993.tb06766.x},
pmid = {8409186},
issn = {0002-8614},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Barium Sulfate ; *Dietary Fiber/therapeutic use ; *Diverticulitis/complications/diagnosis/epidemiology/etiology/therapy ; *Diverticulum/complications/diagnosis/epidemiology/etiology/therapy ; Enema ; Female ; Glucagon/therapeutic use ; Humans ; Incidence ; Male ; Middle Aged ; Nutritive Value ; Prevalence ; Sex Factors ; Terminology as Topic ; Tomography, X-Ray Computed ; },
}
@article {pmid8338287,
year = {1993},
author = {Senagore, AJ and Luchtefeld, MA and Mackeigan, JM and Mazier, WP},
title = {Open colectomy versus laparoscopic colectomy: are there differences?.},
journal = {The American surgeon},
volume = {59},
number = {8},
pages = {549-53; discussion 553-4},
pmid = {8338287},
issn = {0003-1348},
mesh = {Activities of Daily Living ; Aged ; Blood Loss, Surgical/prevention & control ; Colectomy/adverse effects/instrumentation/*methods ; Colon/physiopathology/surgery ; Colonic Neoplasms/surgery ; Humans ; Intraoperative Complications ; *Laparoscopy ; Length of Stay ; Lung Diseases/etiology ; Mesentery/surgery ; Middle Aged ; Surgical Staplers ; Suture Techniques ; },
abstract = {Laparoscopic colectomy has been increasingly reported as an option for the treatment of colonic pathology. However, there is very little information regarding perioperative morbidity and the cost effectiveness of this technique. The purpose of this study is to review our first year of experience with laparoscopic colon resection. Data collected includes: age, technique (open laparotomy, laparoscopic, laparoscopic/converted open), Karnofsky score, complications, specimen size/nodes, OR time, hospital stay, and cost. This is a consecutive series of 140 elective colonic resections including 102 open laparotomies (O) and 38 laparoscopic (L) cases. The indications for surgery have included adenocarcinoma col/rect (O = 59, L = 9), diverticular disease (O = 10, L = 10), adenomatous polyp (O = 3, L = 7), IBD (Crohn's, CUC) (O = 15, L = 4), rectal prolapse (O = 3, L = 4), and other (O = 12, L = 4). There were no significant differences with respect to age (O = 60.7 +/- 1.5; L = 54.8 +/- 3.8; C = 66.1 +/- 3.1), perioperative morbidity (O = 11%; L = 15%; C = 17%). The laparoscopic and laparoscopic converted cases required significantly more time compared to the open laparotomy group (O = 2.1 +/- 0.2 hours; L = 2.9 +/- 0.2; C = 3.4 +/- 0.2). There were significantly less intraoperative blood loss associated with laparoscopic procedures compared with either open or converted groups of patients (O = 687 +/- 54 cc; L = 157 +/- 19; C = 491 +/- 50).(ABSTRACT TRUNCATED AT 250 WORDS)},
}
@article {pmid7692505,
year = {1993},
author = {Tomita, R and Munakata, K and Aoki, N and Tanjoh, K and Kurosu, Y},
title = {A study on the peptidergic nerves (VIP, substance P) in the colon of patients with diverticular disease.},
journal = {Regulatory peptides},
volume = {46},
number = {1-2},
pages = {244-246},
doi = {10.1016/0167-0115(93)90048-d},
pmid = {7692505},
issn = {0167-0115},
mesh = {Atropine/pharmacology ; Colon/*drug effects/physiology/physiopathology ; Diverticulitis, Colonic/*physiopathology ; Electric Stimulation ; Humans ; In Vitro Techniques ; Muscle Contraction/*drug effects ; Muscle Relaxation/drug effects ; Muscle, Smooth/*drug effects/physiology/physiopathology ; Phenoxybenzamine/pharmacology ; Propranolol/pharmacology ; Substance P/*pharmacology ; Tetrodotoxin/pharmacology ; Vasoactive Intestinal Peptide/*pharmacology ; },
}
@article {pmid8398622,
year = {1993},
author = {Troiani, F and Attardo, S and Del Papa, M and Paolucci, G and Mobili, M and Braccioni, U},
title = {[Complications of colonic diverticular disease: a rare case of sigmoid-vaginal fistula].},
journal = {Il Giornale di chirurgia},
volume = {14},
number = {6},
pages = {305-308},
pmid = {8398622},
issn = {0391-9005},
mesh = {Aged ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Intestinal Fistula/*etiology ; Sigmoid Diseases/*etiology ; Vaginal Fistula/*etiology ; },
}
@article {pmid8398620,
year = {1993},
author = {Tommasi, GV and Barabino, M and Casolino, V and Morelli, N and Vassallo, S and Mondello, R and Guasone, F and Valente, U},
title = {[Diverticulitis of the appendix: a rare cause of acute abdomen].},
journal = {Il Giornale di chirurgia},
volume = {14},
number = {6},
pages = {299-300},
pmid = {8398620},
issn = {0391-9005},
mesh = {Abdomen, Acute/*etiology ; Adult ; *Appendix ; Cecal Diseases/complications ; Diverticulitis/*complications ; Humans ; Male ; },
abstract = {Diverticulosis of the vermiform appendix, either single or multiple, congenital or acquired, is rather infrequent and usually asymptomatic. However, it may be complicated by flogosis configuring an acute abdomen hardly recognizable from an acute appendicitis not related to the diverticular disease. The Authors report a case of acute appendicular diverticulitis surgically treated. A brief review of the literature is also reported.},
}
@article {pmid8365715,
year = {1993},
author = {Chetty, R and Bhathal, PS and Slavin, JL},
title = {Prolapse-induced inflammatory polyps of the colorectum and anal transitional zone.},
journal = {Histopathology},
volume = {23},
number = {1},
pages = {63-67},
doi = {10.1111/j.1365-2559.1993.tb01184.x},
pmid = {8365715},
issn = {0309-0167},
mesh = {Adult ; Aged ; Anus Neoplasms/etiology/*pathology ; Colonic Neoplasms/etiology/*pathology ; Female ; Humans ; Inflammation/etiology/pathology ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; Polyps/etiology/*pathology ; Rectal Neoplasms/etiology/*pathology ; Rectal Prolapse/complications/*pathology ; },
abstract = {A clinicopathological study of polypoid lesions of the lower gastrointestinal tract from 12 patients was undertaken. Clinically, the majority had signs and symptoms of rectal prolapse despite having a variety of other primary diagnoses (e.g. carcinoma of the bowel or diverticular disease). Three patients were asymptomatic. The polyps were more common in females and were usually solitary. Histologically, fibrin 'caps', fibromuscular hypertrophy and obliteration of the lamina propria, goblet cell hypertrophy and serrated tubules were consistently noted. The fibromuscular tissue often extended into the lamina propria in a radial fashion. This study shows that mucosal prolapse underpins a variety of lesions that are part of a histological spectrum of changes. Inflammatory cloacogenic polyps, inflammatory 'cap' polyps, polypoid prolapsing mucosal folds of diverticular disease and inflammatory myoglandular polyps are all due to mucosal prolapse.},
}
@article {pmid8355846,
year = {1993},
author = {Weiner, HL and Rezai, AR and Cooper, PR},
title = {Sigmoid diverticular perforation in neurosurgical patients receiving high-dose corticosteroids.},
journal = {Neurosurgery},
volume = {33},
number = {1},
pages = {40-43},
doi = {10.1227/00006123-199307000-00006},
pmid = {8355846},
issn = {0148-396X},
mesh = {Abdomen, Acute/diagnosis/etiology ; Adrenal Cortex Hormones/*adverse effects/therapeutic use ; Aged ; Central Nervous System Neoplasms/complications/*drug therapy/surgery ; Combined Modality Therapy ; Diverticulum/*complications ; Duodenal Diseases/chemically induced/complications/epidemiology ; Humans ; Incidence ; Intestinal Perforation/*chemically induced/complications/diagnosis/epidemiology ; Male ; Methylprednisolone/adverse effects/therapeutic use ; Middle Aged ; Peritonitis/diagnosis/etiology ; Postoperative Complications/*chemically induced/diagnosis ; Retrospective Studies ; Risk Factors ; Sigmoid Diseases/*chemically induced/complications/diagnosis/epidemiology ; },
abstract = {Perforation of colonic diverticula is a complication of corticosteroid use that has not been described in the neurosurgical literature. Between 1987 and 1992, 719 patients who underwent surgery for primary and metastatic brain and spinal tumors of the central nervous system received 2246 to 4936 mg of methylprednisolone given over at least 7 days. Five patients in this group (all men, ages 50-69 yr) experienced a sigmoid diverticular perforation at a mean dose of 3947 mg of methylprednisolone (range, 2240-6160 mg). Of these five, two had a known history of diverticular disease. In contrast, during this same period, 3749 patients who underwent neurosurgical procedures for non-neoplastic conditions did not receive corticosteroids and experienced no colonic perforations. All five patients with colonic perforations presented with abdominal pain and had free intraperitoneal air that was revealed on radiographs of the abdomen. Perforation of a sigmoid diverticulum was confirmed in all five at exploratory laparotomy. Four patients had good outcomes, and one died. We conclude the following: 1) patients over age 50 who receive high-dose corticosteroids are at risk for sigmoid colonic perforation, and these medications should be used with caution in such patients; 2) if possible, lower total doses of perioperative corticosteroids should be used in patients with known diverticular disease; and 3) because corticosteroids mask many of the inflammatory signs of perforation, this diagnosis should be considered in any patient with abdominal discomfort, fever of unknown origin, or unexplained leukocytosis.},
}
@article {pmid8237229,
year = {1993},
author = {Totté, E and Creve, U and Hubens, A},
title = {The Hartmann procedure revisited.},
journal = {Acta chirurgica Belgica},
volume = {93},
number = {4},
pages = {159-163},
pmid = {8237229},
issn = {0001-5458},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Colorectal Neoplasms/complications/*surgery ; Emergencies ; Female ; Humans ; Intestinal Obstruction/etiology/*surgery ; Intestinal Perforation/etiology/*surgery ; Male ; Middle Aged ; Postoperative Complications/etiology ; Surgical Procedures, Operative/methods ; },
abstract = {The results of 37 consecutive cases of Hartmann's procedure over a 5-year period (1985-1990) were reviewed. The series consisted of 27 emergency procedures (11 diverticular disease, 13 carcinoma, two trauma and one sigmoid volvulus) and ten elective procedures (nine carcinoma and one peridiverticular abscess). The indications for emergency procedures were obstruction and perforation. All patients presented with faecal peritonitis owing to colonic perforation. The mean (range) age was 79.4 (34-90) years. The postoperative mortality rate was 30 per cent overall (11 of 37), 33 per cent (four of 12) in the diverticulitis group, 23 per cent (five of 22) in the carcinoma group, and 100 per cent in the iatrogenic trauma group. Death was mainly due to sepsis (82 per cent). Postoperative complications were mainly wound infections, which occurred in 43 per cent (16 of 37) cases. In 25 per cent of the surviving patients, re-establishment of continuity was performed in three of 17 (18 per cent) of the carcinoma group and three of seven (43 per cent) of the diverticulitis group. No attempt at restoration of intestinal continuity was made in six cases due to medical risk in two, extensive carcinoma in two and local recurrence with metastatic disease in two. Three patients refused all further intervention. There were no postoperative deaths after the restoration of continuity. This series reflects the severity of the pathology in this high risk group of patients. However, the operation can be life-saving for a selected group of patients and offers good palliation for advanced colorectal tumours.},
}
@article {pmid7904505,
year = {1993},
author = {Chen, SC and Wei, TC and Wang, SM and Hsu, CY},
title = {Distributional pattern of diverticular disease of the colon in Taiwan.},
journal = {Journal of the Formosan Medical Association = Taiwan yi zhi},
volume = {92},
number = {7},
pages = {662-664},
pmid = {7904505},
issn = {0929-6646},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*pathology ; Diverticulum, Colon/epidemiology/*pathology ; Female ; Humans ; Male ; Middle Aged ; Sex Distribution ; Taiwan/epidemiology ; },
abstract = {From May 1981 to October 1991, 66 patients with diverticular disease of the colon were analyzed retrospectively. Data were obtained from medical records. There were 29 men and 37 women, ranging in age from 32 to 85 years, with a mean age of 58.7 years. Forty-nine patients had a singular site of distribution in the diverticulum, and 17 patients had more than two sites of distribution in the diverticula. The locations of the diverticular disease were sigmoid colon (45.4%), ascending colon (36.4%), cecum (33.3%), descending colon (18.2%), transverse colon (12.1%) and rectum (1.5%). The left-sided lesions (46.9%) were approximately equal to the right-sided lesions (43.9%).},
}
@article {pmid8500743,
year = {1993},
author = {Bjarnason, I and Hayllar, J and MacPherson, AJ and Russell, AS},
title = {Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans.},
journal = {Gastroenterology},
volume = {104},
number = {6},
pages = {1832-1847},
doi = {10.1016/0016-5085(93)90667-2},
pmid = {8500743},
issn = {0016-5085},
mesh = {Animals ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Colon/drug effects ; Enteritis/chemically induced ; Humans ; Intestinal Diseases/*chemically induced/complications/therapy ; Intestinal Perforation/chemically induced ; Intestine, Large/*drug effects ; Intestine, Small/*drug effects ; Permeability ; },
abstract = {BACKGROUND: It is not widely appreciated that nonsteroidal anti-inflammatory drugs (NSAIDs) may cause damage distal to the duodenum. We reviewed the adverse effects of NSAIDs on the large and small intestine, the clinical implications and pathogenesis.
METHODS: A systematic search was made through Medline and Embase to identify possible adverse effects of NSAIDs on the large and small intestine.
RESULTS: Ingested NSAIDs may cause a nonspecific colitis (in particular, fenemates), and many patients with collagenous colitis are taking NSAIDs. Large intestinal ulcers, bleeding, and perforation are occasionally due to NSAIDs. NSAIDs may cause relapse of classic inflammatory bowel disease and contribute to serious complications of diverticular disease (fistula and perforation). NSAIDs may occasionally cause small intestinal perforation, ulcers, and strictures requiring surgery. NSAIDs, however, frequently cause small intestinal inflammation, and the associated complications of blood loss and protein loss may lead to difficult management problems. The pathogenesis of NSAID enteropathy is a multistage process involving specific biochemical and subcellular organelle damage followed by a relatively nonspecific tissue reaction. The various possible treatments of NSAID-induced enteropathy (sulphasalazine, misoprostol, metronidazole) have yet to undergo rigorous trials.
CONCLUSIONS: The adverse effects of NSAIDs distal to the duodenum represent a range of pathologies that may be asymptomatic, but some are life threatening.},
}
@article {pmid8488412,
year = {1993},
author = {Kurgansky, D and Foxwell, MM},
title = {Pyoderma gangrenosum as a cutaneous manifestation of diverticular disease.},
journal = {Southern medical journal},
volume = {86},
number = {5},
pages = {581-584},
doi = {10.1097/00007611-199305000-00021},
pmid = {8488412},
issn = {0038-4348},
mesh = {Aged ; Diverticulitis, Colonic/*complications/diagnosis ; Female ; Humans ; Intestinal Perforation/etiology ; Leg Dermatoses/complications/pathology ; Pyoderma Gangrenosum/*complications/pathology ; Skin/pathology ; },
abstract = {We have described a case of pyoderma gangrenosum due to diverticular disease. The patient was an elderly woman with a 3-month history of cutaneous disease without associated gastrointestinal complaints. There was no history of inflammatory bowel disease, malignancy, or seropositive arthritis. Evaluation revealed a retroperitoneal abscess due to a ruptured diverticulum. Surgical resection of the affected colon led to rapid and complete resolution of all symptoms. Pathologic examination of resected tissue showed diverticulitis without evidence of chronic inflammatory bowel disease.},
}
@article {pmid8316423,
year = {1993},
author = {Messieh, M and Turner, R and Bunch, F and Camer, S},
title = {Hip sepsis from retroperitoneal rupture of diverticular disease.},
journal = {Orthopaedic review},
volume = {22},
number = {5},
pages = {597-599},
pmid = {8316423},
issn = {0094-6591},
mesh = {Aged ; Aged, 80 and over ; Arthritis, Infectious/diagnostic imaging/*etiology ; Diverticulum, Colon/*complications ; Female ; Femoral Neck Fractures/surgery ; Hip Joint ; *Hip Prosthesis ; Humans ; Intestinal Fistula/*complications ; Intestinal Perforation/*complications ; Radiography ; Sigmoid Diseases/*complications ; },
abstract = {Retroperitoneal perforation of diverticular disease is very uncommon and can be difficult to diagnose because of possible pathways of communication between the retroperitoneal space and the thigh. An iliopsoas abscess from a ruptured diverticulum may drain into the hip joint if the capsule has been violated. Cases of abscesses or gas in the thigh have been reported in which thigh pain was the predominant symptom, overshadowing any abdominal signs. We report a case in which hip sepsis due to a ruptured diverticulum was the presenting feature.},
}
@article {pmid8488353,
year = {1993},
author = {Bertschinger, P},
title = {[Diverticulosis].},
journal = {Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis},
volume = {82},
number = {16},
pages = {487-489},
pmid = {8488353},
issn = {1013-2058},
mesh = {Abscess/etiology ; Aged ; Combined Modality Therapy ; Diverticulitis/complications ; Diverticulum, Colon/*complications/diagnosis/therapy ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Middle Aged ; Urinary Fistula/etiology ; },
abstract = {Diverticula of the colon are very common in developed countries. In most of those affected diverticulosis is an asymptomatic condition. Only 20% complain of recurrent symptoms. Symptomatic diverticulosis is common only after the age of 50. Dietary treatment combined with antispasmodics is generally sufficient. Diverticular disease is complicated by bleeding or by diverticulitis in 20% of symptomatic patients. Diverticulitis itself can be complicated by intra-abdominal abscess, fistulas, perforation with generalized peritonitis or bowel obstruction. Each clinical appearance is described and treatment is discussed.},
}
@article {pmid8491397,
year = {1993},
author = {Stefánsson, T and Ekbom, A and Sparèn, P and Påhlman, L},
title = {Increased risk of left sided colon cancer in patients with diverticular disease.},
journal = {Gut},
volume = {34},
number = {4},
pages = {499-502},
pmid = {8491397},
issn = {0017-5749},
mesh = {Adult ; Aged ; Cohort Studies ; Colon/pathology ; Colonic Neoplasms/epidemiology/*etiology/pathology ; Diverticulum, Colon/*complications ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Rectal Neoplasms/complications ; Retrospective Studies ; Risk Factors ; },
abstract = {Certain similar epidemiological characteristics suggest a common aetiology for colon cancer and diverticulosis of the colon. The hypothesis that patients with diverticulosis are at increased risk of developing colon cancer was tested in a retrospective, population based, cohort study in Sweden. A total of 7159 patients (2478 men and 4681 women) who had been given a hospital discharge diagnosis of diverticulosis or diverticulitis of the colon between 1965 and 1983 were followed up during 1985 by means of record linkage procedures. After excluding the first 2 years of follow up, there was not a significant increase in risk (SIR) overall for colon cancer (SIR = 1.2; 95% confidence intervals (CI) 0.9, 1.6) or for rectal cancer (SIR = 1.1; 95% CI 0.7, 1.7). The observed number of right sided colon cancers was as expected (SIR = 0.9; 95% CI 0.5, 1.5). In contrast, an increased risk of left sided colon cancer was found both overall (SIR = 1.8; 95% CI 1.1, 2.7) and consistently in men and women as well as in different age groups. This risk increased the longer the follow up (p value for trend < 0.001). These results do not support the hypothesis of a common aetiology in diverticular disease and colonic cancer but suggest a causal relationship between diverticular disease and cancer of the left colon.},
}
@article {pmid8477071,
year = {1993},
author = {Papadaki, PJ and Vassiliou, PM and Zavras, GM and Kounis, NG and Hadjioannou, N and Fezoulidis, IB and Manolakis, P and Kelekis, D},
title = {A modified per os double contrast examination of the colon in the elderly.},
journal = {RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin},
volume = {158},
number = {4},
pages = {320-324},
doi = {10.1055/s-2008-1032657},
pmid = {8477071},
issn = {1438-9029},
mesh = {Administration, Oral ; Aged ; Aged, 80 and over ; Barium Sulfate/*administration & dosage ; Colonic Diseases/*diagnostic imaging ; Colonic Neoplasms/*diagnostic imaging ; Contrast Media/*administration & dosage ; Diatrizoate Meglumine/*administration & dosage ; Female ; Humans ; Lactulose/*administration & dosage ; Male ; Radiography ; },
abstract = {A modified per os double contrast examination of the colon was used in 62 elderly patients in whom conventional barium enema had been unsuccessful. We created endogenous gas generation instead of air insufflation by per os administration of a special mixture containing barium sulfate, lactulose and gastrografin. Good quality double contrast images of the colon were obtained after 12 hours in 59 of the 62 patients. The sensitivity of the method was 100% in 6 patients suffering from carcinoma and in 15 patients suffering from diverticular disease. However, the method failed to demonstrate small solitary polyps in 5 patients and it was also negative in another 27 patients. 7 of these had negative endoscopy and in the remaining a definite diagnosis was not established by any other method. It seems that this method may become an alternative for investigation of suspected colonic pathology in the elderly patients with difficulty in retaining the barium enema.},
}
@article {pmid8472228,
year = {1993},
author = {Bard, V and Cohen, Z and Ross, T},
title = {An unusual intraoperative complication of stapled colorectal anastomosis: report of a case and review of the literature.},
journal = {Canadian journal of surgery. Journal canadien de chirurgie},
volume = {36},
number = {2},
pages = {165-168},
pmid = {8472228},
issn = {0008-428X},
mesh = {Acute Disease ; Anastomosis, Surgical/adverse effects ; Colon/*surgery ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Intraoperative Complications/prevention & control/*surgery ; Middle Aged ; Rectum/*surgery ; Reoperation ; Surgical Staplers/*adverse effects ; Vagina/*injuries ; },
abstract = {The unusual intraoperative complication of inadvertent formation of a stapled colovaginal anastomosis is described in a 61-year-old woman with diverticular disease. Intraoperative complications of linear staplers, linear cutters and circular end-to-end anastomotic staplers are reviewed, as are methods of prevention and management of such complications. The discussion focuses mainly on the complications that may arise in low anterior resection. They are more likely due to operator error than to instrument failure.},
}
@article {pmid8472988,
year = {1993},
author = {Roe, AM and Warren, BF and Brodribb, AJ and Brown, C},
title = {Diversion colitis and involution of the defunctioned anorectum.},
journal = {Gut},
volume = {34},
number = {3},
pages = {382-385},
pmid = {8472988},
issn = {0017-5749},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colitis/*etiology/pathology/physiopathology ; Colostomy ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/*etiology ; Pressure ; Rectum/pathology/*physiopathology ; Time Factors ; },
abstract = {To measure the effects of defunction in the anorectum, 12 patients (seven men and five women aged 59 (44-81) years) were studied after the Hartmann operation. The operation was for septic complications of diverticular disease in nine and sigmoid carcinoma in three patients. Physiology studies were undertaken 1 and 3 months after surgery, and diversion colitis was assessed endoscopically and by mucosal biopsy at 3 months. There was no change in anal sphincter function by three months. Proctometrogram studies, however, showed an appreciable decrease in rectal volume in all cases, by a mean of 35% of the 1 month volume. The maximum tolerable volume at 1 month was 157 (111-210) ml and at 3 months 87 (71-145) ml; p < 0.01. There was no change in rectal sensation or compliance. Erythema and granularity without gross erosions or ulceration were found at endoscopy. Histology showed abnormalities in all cases by 3 months. The characteristic features were of a chronic inflammatory cell infiltrate with surface exudate, microscopic erosions, and lymphoid follicular hyperplasia. Crypt abscesses were not a feature at this stage and there was no distortion of crypt architecture. After defunction the previously normal rectum is affected by diversion colitis which, at 3 months, is mild but has characteristics that distinguish the changes from those of inflammatory bowel disease. It is associated with progressive rectal stump involution.},
}
@article {pmid8462606,
year = {1993},
author = {Allan, RA and Sladen, GE and Bassingham, S and Lazarus, C and Clarke, SE and Fogelman, I},
title = {Comparison of simultaneous 99mTc-HMPAO and 111In oxine labelled white cell scans in the assessment of inflammatory bowel disease.},
journal = {European journal of nuclear medicine},
volume = {20},
number = {3},
pages = {195-200},
pmid = {8462606},
issn = {0340-6997},
mesh = {Adult ; Colonic Diseases, Functional/diagnostic imaging ; Female ; Humans ; *Indium Radioisotopes ; Inflammatory Bowel Diseases/*diagnostic imaging ; Intestines/diagnostic imaging ; *Leukocytes ; Male ; *Organometallic Compounds ; *Organotechnetium Compounds ; *Oximes ; Oxyquinoline/*analogs & derivatives ; Radionuclide Imaging ; Technetium Tc 99m Exametazime ; Time Factors ; },
abstract = {Forty-seven patients, 29 with chronic inflammatory bowel disease (IBD) and 18 with presumed irritable bowel syndrome, including one with uncomplicated diverticular disease, were studied with simultaneous technetium-99m hexamethylpropylene amine oxime and indium-111 oxine labelled leucocyte scans performed at 1, 3 and 24 h. Twenty-seven patients with IBD had active disease as judged by clinical and laboratory criteria and all of these had positive scans with both agents. No false positive studies were obtained. The 1-h 99mTc-HMPAO WBC scans showed the same distribution to disease as the 3-h 111-In WBC scans, with no difference in intensity (P < 0.92); they showed more extensive disease (P < 0.02) and more intense uptake (P < 0.001) than did the 1-h 111-In scans. The 3-h 99mTc-HMPAO WBC scans showed more extensive disease (P < 0.002), with greater intensity (P < 0.0005), than did the 3-h 111In WBC scans. Physiological bowel activity on 3-h 99mTc-HMPAO WBC scans was present in 12 patients but was faint and did not interfere with assessment of disease extent and activity. It is concluded that in terms of isotope availability, radiation dosimetry and image quality, 99mTc-HMPAO is the agent of choice in detecting active IBD, with localization of disease possible at 1-h after re-injection and optimal resolution and definition of disease extent at 3 h. A negative scan reliably excludes active disease.},
}
@article {pmid8431124,
year = {1993},
author = {Fingerhut, A and Hay, JM},
title = {Single-dose ceftriaxone, ornidazole, and povidone-iodine enema in elective left colectomy. A randomized multicenter controlled trial. The French Association for Surgical Research.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {128},
number = {2},
pages = {228-232},
doi = {10.1001/archsurg.1993.01420140105017},
pmid = {8431124},
issn = {0004-0010},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects ; Cefotaxime/administration & dosage/*therapeutic use ; Ceftriaxone/administration & dosage/*therapeutic use ; *Colectomy/adverse effects/methods ; Colonic Neoplasms/surgery ; Diverticulum, Colon/surgery ; Drug Tolerance ; *Enema ; Female ; Humans ; Male ; Metronidazole/administration & dosage/*therapeutic use ; Middle Aged ; Ornidazole/administration & dosage/*therapeutic use ; Povidone-Iodine/*therapeutic use ; Prognosis ; Risk Factors ; Senna Extract/therapeutic use ; Surgical Wound Infection/*prevention & control ; Survival Rate ; },
abstract = {Patients undergoing elective left colectomy for colonic carcinoma or diverticulosis (n = 341) were randomly assigned to three groups. Patients in groups 1 (102 patients) and 2 (122 patients) had two 5% povidone-iodine enemas whereas those in group 3 (117 patients) had saline enemas. Groups 1 and 3 received 24-hour intravenous cefotaxime sodium and metronidazole hydrochloride. Group 2 received single injections of ceftriaxone sodium (1 g) and ornidazole (1 g). Senna concentrate was administered the evening before surgery. There was no statistically significant difference found between groups 1 and 2 concerning the number of infected patients (eight vs 11), anastomotic leakages (four vs four), extra-abdominal complications (32 vs 29), or infection-related deaths (one vs zero). Despite poorer tolerance, povidone-iodine enema was more effective than saline enemas, as there were less infected patients in group 1 (8%) or groups 1 + 2 (8.5%) than in group 3 (13%). Single-dose ceftriaxone-ornidazole combined with povidone-iodine enemas is effective against infective complications in elective left colonic surgery for carcinoma or diverticular disease. Single-dose antibiotic prophylaxis reduces costs and work for the nursing staff.},
}
@article {pmid8465616,
year = {1993},
author = {Karavias, T and Hager, K and Ernst, M and Dollinger, U},
title = {[Changes in surgery of diverticulitis].},
journal = {Zentralblatt fur Chirurgie},
volume = {118},
number = {2},
pages = {76-80},
pmid = {8465616},
issn = {0044-409X},
mesh = {Aged ; Anastomosis, Surgical ; Colectomy ; Diverticulitis, Colonic/mortality/*surgery ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications/mortality ; Retrospective Studies ; Survival Rate ; },
abstract = {This retrospective study investigates the surgical progress in the treatment of diverticular disease during the last two decades. We reviewed 304 patients (149 women and 155 men) operated for diverticular disease from 1970-1992 at the Surgical Clinic of Steglitz Medical Center, Free University of Berlin. Comparing the results between the first and the second decade, we observed a significant increase in the total number of patients who have been treated surgically (from 118 to 186) and in the proportion of elective surgery (from 45% to 57%). In the second decade, early elective resection in selected patients with a severe diverticulitis and primary resection for perforated diverticulitis were the procedures of choice. Through this concept the over-all operative mortality rate could be reduced from 24% in the first to 7% in the last decade of this report.},
}
@article {pmid8430251,
year = {1993},
author = {Iosca, N and Ferrieri, A},
title = {[The rifaximin therapy and prophylaxis of episodes of acute diverticulitis].},
journal = {Recenti progressi in medicina},
volume = {84},
number = {1},
pages = {49-53},
pmid = {8430251},
issn = {0034-1193},
mesh = {Aged ; Colonoscopy ; Combined Modality Therapy ; Diverticulitis, Colonic/complications/*drug therapy/prevention & control ; Female ; Humans ; Male ; Middle Aged ; Recurrence ; Rifamycins/*therapeutic use ; Rifaximin ; },
abstract = {The authors consider some nosographic aspects of diverticular disease, and refer the personal experience on the treatment of 36 patients with diverticulitis. Beside surgery, that is indicated when complications occur (perforation, abscess, fistulae, occlusion), medical therapy (diet + drugs) could reduce the symptomatology and the risk or progression of complications. The authors present data on the clinical use of rifaximin in the treatment of acute diverticulitis.},
}
@article {pmid8420256,
year = {1993},
author = {Levi, DM and Levi, JU and Rogers, AI and Bergau, DK and Wenger, J},
title = {Giant colonic diverticulum: an unusual manifestation of a common disease.},
journal = {The American journal of gastroenterology},
volume = {88},
number = {1},
pages = {139-142},
pmid = {8420256},
issn = {0002-9270},
mesh = {Aged ; Colonic Diseases/*diagnostic imaging ; Diverticulum/*diagnostic imaging ; Humans ; Male ; Tomography, X-Ray Computed ; },
abstract = {Giant colonic diverticula are an uncommon manifestation of colonic diverticular disease. This report documents another case of this rare entity. The clinical presentation is variable, but abdominal pain and the presence of an abdominal mass are common. Their etiology is uncertain, but they are thought to originate from pulsion diverticula. Abdominal plain films and barium enema are helpful in making the diagnosis. Computerized tomography is useful when the diagnosis is unclear. Surgical resection is recommended to alleviate symptoms and avoid complications.},
}
@article {pmid8159832,
year = {1993},
author = {Giaccari, S and Tronci, S and Falconieri, M and Ferrieri, A},
title = {Long-term treatment with rifaximin and lactobacilli in post-diverticulitic stenoses of the colon.},
journal = {Rivista europea per le scienze mediche e farmacologiche = European review for medical and pharmacological sciences = Revue europeenne pour les sciences medicales et pharmacologiques},
volume = {15},
number = {1},
pages = {29-34},
pmid = {8159832},
issn = {0392-291X},
mesh = {Aged ; Diverticulitis, Colonic/complications/drug therapy/*therapy ; Female ; Humans ; Intestinal Obstruction/drug therapy/etiology/*therapy ; *Lactobacillus ; Male ; Middle Aged ; Rifamycins/*therapeutic use ; Rifaximin ; },
abstract = {The authors report their endoscopic experience in the treatment of intestinal inflammatory complications and their prevention with cyclic antibiotic treatment (rifaximin 400 mg b.i.d. for 7 days/month), followed by recolonizing treatment with lactobacilli (2 capsules in the morning for 7 days/month), for an overall period of 12 months. In all 79 cases (45 males and 34 females, mean age 63 years, range 55-75 years), the treatment proved capable of controlling the symptoms and averting the onset of the complications which follow attacks of acute diverticulitis. These complications include uncontrollable sepsis, free perforation of a hollow viscus, evolutive fistulation, intestinal occlusion, abscesses not drained percutaneously, all factors which necessitate urgent elective surgery. Rifaximin, together with lactobacillus treatment, proved to be effective, well-tolerated and safe, and can thus be considered an indispensable aid in the treatment of diverticular disease and in the prevention of its complications.},
}
@article {pmid8147145,
year = {1993},
author = {Eypasch, E and Menningen, R and Paul, A and Troidl, H},
title = {[Value of laparoscopy in diagnosis and therapy of the acute abdomen].},
journal = {Zentralblatt fur Chirurgie},
volume = {118},
number = {12},
pages = {726-732},
pmid = {8147145},
issn = {0044-409X},
mesh = {Abdomen, Acute/*etiology/surgery ; Appendectomy/instrumentation ; Cholecystectomy, Laparoscopic/instrumentation ; Diagnosis, Differential ; Humans ; *Laparoscopes ; Treatment Outcome ; },
abstract = {While diagnostic laparoscopy is a well established tool, therapeutic laparoscopy for acute abdominal disorders has recently been made possible by video-endoscopic techniques. From July 1989 to April 1992, 243 laparoscopic interventions were carried out in patients with an acute abdomen. After a pilot phase, patients with acute appendicitis were entered into a randomized trial, those with acute cholecystitis were operated within the next day list. Among the 243 operations were 202 appendectomies, 12 closures of perforated peptic ulcers, 4 successful interventions for intestinal obstruction, 4 irrigations for intraabdominal abscesses and 35 further operations, some of which had to be finished as laparotomies. Laparoscopic appendectomy was less painful but technically more difficult. In cases which needed bowel resection for ischemic necrosis or diverticular disease, conversion to open surgery had to be performed. Laparoscopic treatment of acute abdominal disorders including peritonitis can be effective and beneficial in one out of two patients. Adequate surgical training, expertise and respect to the safety of the patient are mandatory. The application of endoscopic suture devices will further enlarge the spectrum of laparoscopic treatment options for the acute abdomen.},
}
@article {pmid7976684,
year = {1993},
author = {Vyslouzil, K and Unger, R and Zmrzlík, P},
title = {Colon diverticular disease as cause of acute abdominal cases.},
journal = {Acta Universitatis Palackianae Olomucensis Facultatis Medicae},
volume = {135},
number = {},
pages = {75-76},
pmid = {7976684},
issn = {0301-2514},
mesh = {Acute Disease ; Aged ; Colostomy ; Diverticulum, Colon/complications/mortality/*surgery ; Humans ; Inflammation ; Peritonitis/etiology ; Retrospective Studies ; },
abstract = {The present therapeutic approach to acute complications of diverticula is disease is discussed by the authors. The poor results together with high lethality are pointed out provided that inflammatory states are surgically treated by means of simple derivation and drainage. The Hartmann's or Paul-Mikulicz's resection followed by passage reconstruction is considered to be the best approach and method.},
}
@article {pmid7812349,
year = {1993},
author = {Sakamoto, K and Muratani, M and Ogawa, T and Nagamachi, Y},
title = {Evaluation of a new test for colorectal neoplasms: a prospective study of asymptomatic population.},
journal = {Cancer biotherapy},
volume = {8},
number = {1},
pages = {49-55},
doi = {10.1089/cbr.1993.8.49},
pmid = {7812349},
issn = {1062-8401},
mesh = {Adult ; Aged ; Antigens, Tumor-Associated, Carbohydrate/analysis ; Biomarkers, Tumor/analysis ; Carbohydrate Sequence ; Colorectal Neoplasms/diagnosis/*prevention & control ; Evaluation Studies as Topic ; Female ; Galactose ; Humans ; Male ; Mass Screening ; Middle Aged ; Molecular Sequence Data ; Mucins/analysis ; Occult Blood ; Prospective Studies ; Schiff Bases ; Sensitivity and Specificity ; },
abstract = {In a recent pilot study, we have suggested of potential usefulness of a new test (Shams' test) for screening colorectal (CR) cancer in Japan. Although the sensitivity of this test was remarkably high, its accurate specificity was unclear. The purpose of our present study is to evaluate the incidence of non-specific reaction of Shams' test in the normal Japanese populations. We analyzed 330 asymptomatic individuals, who were seen for annual health checkup, for the presence of the tumor marker D-Gal-B (1- > 3)-D-GalNAc in their rectal mucin. The rectal mucin was smeared on nitrocellulose membrane filter and developed by a sequential reaction of B-D-galactose oxidase and Schiff's reagent. Immunological fecal occult blood test (FOBT) was done in parallel. Extensive study by barium enema/total colonoscopy was indicated only for those who showed positive results with Shams' test or FOBT. A total of 271 individuals were negative, while 50 and 9 had positive and equivocal (+/-) results, respectively. Subsequent barium enema and fiberoptic proctocolonoscopic examinations, which were available on 32 of 59 cases, revealed 6 adenomatous polyps, one villous adenoma with focal severe atypia, and 4 cases of diverticular disease. Except for one patient with polyp, 6 other patients harboring polyps were negative with immunological FOBT. The overall specificity of Shams' test was 92.2% (271/294). Based on these results and preceding reports, we concluded that Shams' test could be a useful tool in our strategy for early detection of CR neoplasms and precancerous lesions.},
}
@article {pmid10150089,
year = {1992},
author = {McCune, TR and Nylander, WA and Van Buren, DH and Richie, RE and MacDonell, RC and Johnson, HK and Shull, H and Cate, CK and Helderman, JH},
title = {Colonic screening prior to renal transplantation and its impact on post-transplant colonic complications.},
journal = {Clinical transplantation},
volume = {6},
number = {2},
pages = {91-96},
pmid = {10150089},
issn = {0902-0063},
mesh = {Colitis/prevention & control ; Colorectal Neoplasms/prevention & control ; Cytomegalovirus Infections/prevention & control ; Diverticulitis, Colonic/prevention & control ; Humans ; Immunosuppression Therapy ; Kidney Transplantation/*mortality ; Mass Screening ; Postoperative Complications/*prevention & control ; Predictive Value of Tests ; },
abstract = {Colonic complications after renal transplantation are uncommon but have a high mortality rate. Some have recommended colonic screening in patients over 50 years of age prior to transplantation to lessen the impact of colonic diverticular disease. We report our 9-year experience of colonic screening for diverticular disease in potential recipients over the age of 50 and compare these results to the overall colonic complication rate in the same time period. From 1981-1990, 1186 renal transplants in 1019 patients were performed, during which time all potential recipients over the age of 50 yr were required to undergo colon evaluation prior to transplantation. Twenty cases of diverticular disease were found with more than a quarter of the cases in patients with adult polycystic disease. All underwent renal transplantation without a pre-transplant colectomy, and none had post transplant symptomatic colon disease. During that same time period a total of 14 colonic complications requiring surgical intervention were encountered with a mortality rate of 40%. Acute diverticulitis occurred in 5 patients, all of whom were over 50 yr of age, on low-dose immunosuppression, and in most cases it occurred remotely after transplantation. Colonic dysplasia/neoplasia also occurred remotely after transplantation in 2 patients over the age of 50. Cytomegalovirus (CMV) colitis was the next most common complication, accounting for 3 cases. This complication, which occurred in younger patients, was associated with high-dose steroid immunosuppression and had a high mortality rate, in spite of surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)},
}
@article {pmid6388723,
year = {1984},
author = {Krukowski, ZH and Matheson, NA},
title = {Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: a review.},
journal = {The British journal of surgery},
volume = {71},
number = {12},
pages = {921-927},
doi = {10.1002/bjs.1800711202},
pmid = {6388723},
issn = {0007-1323},
mesh = {Abscess/etiology ; Diverticulitis, Colonic/complications/mortality/pathology/*surgery ; Emergencies ; Feces ; Humans ; Intestinal Perforation/surgery ; Peritoneal Diseases/etiology ; Peritonitis/*etiology ; Postoperative Complications ; },
abstract = {There is little uniformity in either the indications for operation, the classification of the pathology or the operative management of generalized or faecal peritonitis secondary to perforated diverticular disease. Nevertheless, this review has shown a clear advantage both in terms of immediate mortality and morbidity for primary resection over conservative operations in which the colon is retained in the abdomen. We propose that, when a clinical diagnosis of localized sepsis secondary to diverticular disease is made, the management should be nonoperative with systemic antibiotics and supportive therapy. Operation should be reserved for those patients with obvious generalized peritonitis or failure of conservative treatment. When operation is necessary the affected sigmoid loop should be resected and the operation completed as a Hartmann's procedure in all but the most favourable circumstances when a primary anastomosis may be considered after on-table irrigation of the colon.},
}
@article {pmid6489070,
year = {1984},
author = {Wolff, BG and Ready, RL and MacCarty, RL and Dozois, RR and Beart, RW},
title = {Influence of sigmoid resection on progression of diverticular disease of the colon.},
journal = {Diseases of the colon and rectum},
volume = {27},
number = {10},
pages = {645-647},
doi = {10.1007/BF02553353},
pmid = {6489070},
issn = {0012-3706},
mesh = {Adult ; Aged ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Sigmoid Diseases/*surgery ; },
abstract = {The surgeon is frequently confronted with the problem of how much colon to resect when operating on patients with colonic diverticulosis or diverticulitis. Two questions arise: will diverticulosis progress in the proximal colon if only the sigmoid is removed, and will diverticulitis recur in the more proximal diverticula? To evaluate these potential problems, the histories were reviewed of 61 patients who had elective sigmoid resection for diverticular disease and who had barium enema examinations before operation, early during the postoperative period, and at least five years later. Progression of diverticulosis was noted in only nine (14.7 per cent) patients on repeat barium-enema examination five to nine years after resection; the progression was noted to be minimal in all nine. Seven patients (11.4 per cent) had signs and symptoms of recurrent diverticulitis. Only three patients demonstrated progression of diverticulosis and recurrent diverticulitis. We see no benefit in resecting all of the diverticula-bearing colon after adequate sigmoid resection, as there is minimal progression in the diverticular process and the risk of recurrence is low.},
}
@article {pmid6487981,
year = {1984},
author = {Kingsnorth, AN and Lumsden, AB and Wallace, HM},
title = {Polyamines in colorectal cancer.},
journal = {The British journal of surgery},
volume = {71},
number = {10},
pages = {791-794},
doi = {10.1002/bjs.1800711019},
pmid = {6487981},
issn = {0007-1323},
mesh = {Aged ; Colonic Neoplasms/*analysis/pathology ; Female ; Humans ; Liver Neoplasms/secondary ; Male ; Middle Aged ; Neoplasm Staging ; Polyamines/*analysis ; Putrescine/analysis ; Rectal Neoplasms/*analysis/pathology ; Spermidine/analysis ; Spermine/analysis ; },
abstract = {Polyamine levels (putrescine, spermidine and spermine) in colorectal cancers (n = 25) were measured in order to assess their importance as markers of cellular proliferation. Colonic mucosa from healthy resection margins of patients with diverticular disease (n = 5) was used as control material. Polyamine levels (expressed as nanomoles per 100 mg tumour) in cancers ranged from 0.8 to 7.9 for putrescine (mean: 2.3 +/- 0.7), from 6.5 to 22.8 for spermidine (mean: 13.9 +/- 0.9) and from 13.0 to 37.5 for spermine (mean: 22.1 +/- 1.3). Mean spermidine and spermine content of cancers was more than three times mean spermidine (3.92 +/- 0.8), and more than four times mean spermine (5.0 +/- 1.2), content of normal colonic mucosa (P less than 0.01). Polyamine content of colorectal cancers was independent of tumour site, Dukes' stage, histological grade and the presence of palpable liver metastases at laparotomy. Because colorectal cancers contain such high levels of spermidine and spermine, polyamines may play an essential role in the regulation of their growth.},
}
@article {pmid6333217,
year = {1984},
author = {Rodkey, GV and Welch, CE},
title = {Changing patterns in the surgical treatment of diverticular disease.},
journal = {Annals of surgery},
volume = {200},
number = {4},
pages = {466-478},
pmid = {6333217},
issn = {0003-4932},
mesh = {Abscess/etiology ; Aged ; Colonic Diseases/etiology ; Diverticulitis, Colonic/complications/*surgery ; Diverticulum, Colon/complications/*surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Longitudinal Studies ; Male ; Massachusetts ; Middle Aged ; Pain ; Peritonitis/etiology ; Sigmoid Diseases/complications/*surgery ; },
abstract = {This paper includes a brief historic summary of the surgical aspects of diverticular disease and of corresponding developments in the Massachusetts General Hospital from 1911 to the present. The 350 cases observed in 1974-1983 are compared with 338 seen in the previous decade. Major trends include a decrease in hospital admissions for diverticular disease but a sustained number of operations; increased severity of the disease in hospitalized patients manifested by an increased percentage of patients with immunosuppression or serious other diseases (p less than 0.001), an increased number with sepsis and general peritonitis (p less than 0.001); an increased percentage of cases with one-stage resection and anastomosis (p less than 0.02); in patients with general peritonitis, resection of the perforated segment at the time of the original operation was accompanied by the lowest mortality (p less than 0.02); incidental splenectomy appears to be dangerous, with three deaths in eight cases; and overall mortality in the last decade is 6.4%; for emergency cases 10.2%, for urgent 9.7%, and for elective cases 2.4%.},
}
@article {pmid6521050,
year = {1984},
author = {Inoue, M and Yoshida, I and Munekiyo, M},
title = {[Diverticular disease of the colon in the aged].},
journal = {Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics},
volume = {21},
number = {5},
pages = {453-458},
pmid = {6521050},
issn = {0300-9173},
mesh = {Adult ; Age Factors ; Aged ; Diverticulum, Colon/complications/*epidemiology ; Female ; Humans ; Japan ; Male ; Middle Aged ; Sex Factors ; },
}
@article {pmid6146851,
year = {1984},
author = {Berry, CS and Fearn, T and Fisher, N and Gregory, JA and Hardy, J},
title = {Dietary fibre and prevention of diverticular disease of colon: evidence from rats.},
journal = {Lancet (London, England)},
volume = {2},
number = {8397},
pages = {294},
doi = {10.1016/s0140-6736(84)90344-1},
pmid = {6146851},
issn = {0140-6736},
mesh = {Animals ; Dietary Fiber/*administration & dosage ; Diverticulum, Colon/*prevention & control ; Female ; Male ; Rats ; },
}
@article {pmid6468191,
year = {1984},
author = {Aktan, H and Ozden, A and Kesim, E and Smith, AN},
title = {Colonic function in rural and urban populations of Turkey.},
journal = {Diseases of the colon and rectum},
volume = {27},
number = {8},
pages = {538-541},
doi = {10.1007/BF02555519},
pmid = {6468191},
issn = {0012-3706},
mesh = {Adult ; Calcium/analysis ; Colon/*physiology ; Diet ; Feces/analysis ; Female ; *Gastrointestinal Motility ; Humans ; Magnesium/analysis ; Male ; Middle Aged ; Pressure ; Rural Population ; Turkey ; Urban Population ; },
abstract = {Two Turkish populations, one with an urban background and the other rural, were compared in regard to their colonic function. Rural subjects consume a diet with higher fiber than urban people in Turkey. The rural group had a greater daily fecal output, faster intestinal transit, and lower intraluminal pressure, with a greater output of calcium in the feces than those living in an urban area in Turkey. The effects are similar to those described when fiber is added to the diet. Urban dwellers in Turkey who lack these effects are said to have a rising incidence of fiber-related diseases of the colon, such as diverticular disease.},
}
@article {pmid6468190,
year = {1984},
author = {Sugihara, K and Muto, T and Morioka, Y and Asano, A and Yamamoto, T},
title = {Diverticular disease of the colon in Japan. A review of 615 cases.},
journal = {Diseases of the colon and rectum},
volume = {27},
number = {8},
pages = {531-537},
doi = {10.1007/BF02555517},
pmid = {6468190},
issn = {0012-3706},
mesh = {Adult ; Aged ; Barium Sulfate ; Colectomy ; Diverticulitis, Colonic/diagnostic imaging/surgery ; Diverticulum, Colon/diagnostic imaging/*surgery ; Emergencies ; Enema ; Female ; Humans ; Japan ; Male ; Middle Aged ; Radiography ; },
abstract = {Of 615 patients with diverticular disease of the colon, 429 had diverticula in the cecum and ascending colon, 98 in the sigmoid and descending colon and 88 in both the right- and left-side colon. The right-sided type was more common in younger people and more predominant in men, whereas the left-sided type was more common in the elderly and showed no difference in numbers between men and women. More than 50 per cent of patients were asymptomatic and 25 per cent complained of disturbed bowel function. The frequency of diverticulitis was not related to location, but to the number of diverticula. Seventy-seven were complicated by acute inflammation (right-sided diverticulitis, 61, and left-sided diverticulitis, 16). Many patients with right-sided diverticulitis improved with medical treatment and the operative procedure of choice was drainage of the inflamed area with supplemental appendectomy.},
}
@article {pmid6431861,
year = {1984},
author = {Watne, AL and Boyd, JB and Bradford, B},
title = {The elderly patient and colon surgery for cancer or diverticular disease.},
journal = {The American surgeon},
volume = {50},
number = {8},
pages = {460-464},
pmid = {6431861},
issn = {0003-1348},
mesh = {Age Factors ; Aged ; Colonic Neoplasms/mortality/*surgery ; Diverticulum, Stomach/mortality/*surgery ; Female ; Humans ; Male ; Middle Aged ; Preoperative Care ; Rectal Neoplasms/mortality/*surgery ; Surgical Wound Infection/prevention & control ; },
abstract = {The mortality and morbidity for 246 patients over the age of 50 who underwent colon resection for cancer or diverticular disease during a 5-year period were reviewed. The increased risk for patients over 70 years of age was based on the presence of two or more preoperative diseases, the occurrence of emergency surgery and the occurrence of postoperative complications, especially surgical infection.},
}
@article {pmid6147239,
year = {1984},
author = {Sladen, GE and Filipe, MI},
title = {Is segmental colitis a complication of diverticular disease?.},
journal = {Diseases of the colon and rectum},
volume = {27},
number = {8},
pages = {513-514},
doi = {10.1007/BF02555508},
pmid = {6147239},
issn = {0012-3706},
mesh = {Aged ; Colectomy ; Colitis/*etiology/therapy ; Diverticulum, Colon/*complications ; Female ; Humans ; Male ; Middle Aged ; Sigmoid Diseases/*complications ; Sulfasalazine/therapeutic use ; },
abstract = {In five patients, rectal bleeding was ascribed to a patchy or diffuse mucosal colitis affecting the sigmoid colon only. The patients all had well marked localized sigmoid diverticular disease. The histologic features were nonspecific, without any changes suggestive of Crohn's disease. One patient had a short, self-limited illness, whereas the others had continuing illnesses lasting at least six months. In one patient who underwent sigmoid colectomy, the inflammatory features had disappeared, probably in response to sulphasalazine therapy. It is suggested that this syndrome may be a complication of the muscular disorder that underlies the formation of colonic diverticula.},
}
@article {pmid6610300,
year = {1984},
author = {Hunter, TB and Merkley, R and Pitt, MJ},
title = {Relation between pelvic phleboliths and diverticular disease of the colon.},
journal = {AJR. American journal of roentgenology},
volume = {143},
number = {1},
pages = {105-107},
doi = {10.2214/ajr.143.1.105},
pmid = {6610300},
issn = {0361-803X},
mesh = {Aged ; Barium Sulfate ; Calculi/*complications/diagnostic imaging ; Diverticulum, Colon/*complications/diagnostic imaging ; Enema ; Female ; Humans ; Male ; Middle Aged ; Pelvis/*blood supply ; Radiography ; },
abstract = {The frequent occurrence of colon diverticula and pelvic phleboliths in older persons in Western society has been attributed to the long-term effects of a low-fiber diet. If diet is a common factor for both processes, their incidence should be related. A statistical study was performed to correlate the number and size of pelvic phleboliths with the amount of colon diverticular disease present at barium enema. Examination of barium enemas of 203 patients (98 male, 105 female) aged 60-69 years showed no statistical difference between the genders in regard to the location and amount of either diverticular disease or number and size of pelvic phleboliths . There was no statistical correlation between the amount of diverticular disease and the mere presence or absence of pelvic phleboliths . However, when phleboliths were present, there was a definite statistical correlation between the number and size of the phleboliths and the degree of diverticular disease present. On the basis of this study, the relation between phleboliths and colon diverticula seems complex and needs further examination.},
}
@article {pmid6534335,
year = {1984},
author = {Gonçalves, ES and Tacla, M},
title = {[Correlation between colonoscopy and histopathology of the colon in diverticular disease and the irritable colon syndrome].},
journal = {Arquivos de gastroenterologia},
volume = {21},
number = {3},
pages = {104-112},
pmid = {6534335},
issn = {0004-2803},
mesh = {Adult ; Aged ; Colonic Diseases, Functional/*diagnosis/pathology/psychology ; *Colonoscopy ; Diverticulitis, Colonic/*diagnosis/pathology/psychology ; Enema ; Female ; Humans ; Male ; Middle Aged ; Stress, Psychological/complications ; },
abstract = {In this study 29 patients were carriers of diverticular disease of the colons (DDC) and 29 patients with irritable bowel syndrome (IBS). The patients were diagnosed by means of a directed anamnesis standardized by the radiologic study of the colons. The methodology included, radiologic study of the colons, endoscopic examination of the colon (colonoscopy with biopsy) and anatomic pathologic examination of the fragments obtained in the endoscopy. It was tried, by means of colonoscopy with biopsy and anatomic pathological examination, to demonstrate, classify and relate, in agreement with pre-established criterion, the degree of intensity of the inflammatory process in the colic mucosa. According to the results we may conclude that: 1) colonoscopy in the studied inflammatory diseases is important for diagnosis, evaluation of the inflammatory process, identification of associated illness and material obtention for the anatomic pathological examination; 2) there is always a chronic inflammatory process, in variable degrees, of the colic mucosa in DDC and in IBS; 3) colonoscopy with biopsy and the anatomic pathological examination are adequate to diagnose with precision the degree of intensity of the chronic inflammatory process of the colic mucosa and the presence of associated disease in DDC and in IBS.},
}
@article {pmid6437755,
year = {1984},
author = {Pan, GZ and Liu, TH and Chen, MZ and Chang, HC},
title = {Diverticular disease of colon in China. A 60-year retrospective study.},
journal = {Chinese medical journal},
volume = {97},
number = {6},
pages = {391-394},
pmid = {6437755},
issn = {0366-6999},
mesh = {Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; China ; *Diverticulitis, Colonic/epidemiology ; *Diverticulum, Colon/epidemiology ; Female ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies ; },
}
@article {pmid6721047,
year = {1984},
author = {Karamchandani, MC and West, CF},
title = {Vesicoenteric fistulas.},
journal = {American journal of surgery},
volume = {147},
number = {5},
pages = {681-683},
doi = {10.1016/0002-9610(84)90141-7},
pmid = {6721047},
issn = {0002-9610},
mesh = {Adult ; Crohn Disease/complications ; Diverticulitis, Colonic/complications ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology/surgery ; Male ; Methods ; Retrospective Studies ; Sex Factors ; Urinary Bladder Fistula/*diagnosis/etiology/surgery ; },
abstract = {Vesicoenteric fistulas are a challenge to both the urologist and the general surgeon. Awareness of the possibility of an enteric origin of recurrent urinary symptoms should help us prevent the long delays in diagnosis. Thorough and accurate preoperative evaluation will help us make the proper selection as to a one stage or multistage repair. There is room for both in the surgeon's armamentarium, and a wise decision can produce excellent results as seen in this series. When the fistula is of malignant origin, the long-term prognosis remains poor, as it is for any colonic carcinoma extending beyond the serosa and involving a contiguous organ. Fistulas secondary to radiation necrosis and recurrent tumor have an extremely poor outlook with some palliation afforded by a diverting colostomy or a Hartman procedure. Patients with fistulas due to diverticular disease and, to a lesser extent, Crohn's disease can look forward to complete correction with low mortality and morbidity.},
}
@article {pmid6462497,
year = {1984},
author = {Nociti, V and Redaelli, MR and Brivio, F and Erba, L and Perego, P},
title = {[Surgical emergency in complicated diverticular disease].},
journal = {Minerva chirurgica},
volume = {39},
number = {6},
pages = {395-399},
pmid = {6462497},
issn = {0026-4733},
mesh = {Adult ; Aged ; Colonic Diseases/etiology ; Colostomy ; Diverticulum, Colon/complications/*surgery ; Drainage ; *Emergencies ; Female ; Humans ; Intestinal Perforation/etiology ; Male ; Middle Aged ; Peritonitis/etiology ; },
}
@article {pmid6730837,
year = {1984},
author = {Potvliege, M and Azagra, JS and Clerckx, L},
title = {[Diverticular and instrumental perforations of the colon].},
journal = {Acta chirurgica Belgica},
volume = {84},
number = {2},
pages = {109-112},
pmid = {6730837},
issn = {0001-5458},
mesh = {Adult ; Aged ; Barium Sulfate ; Colon/*injuries ; Colonoscopy/*adverse effects ; Diverticulitis/*complications ; Enema/*adverse effects ; Female ; Humans ; Intestinal Perforation/*etiology ; Male ; Middle Aged ; Peritonitis/*etiology ; },
abstract = {From july 1976 to july 1982, two groups of patients consisting of eleven peritonitis due to acute perforated diverticulitis, and five instrumental colonic perforations were treated in our department. None of the patients died in both groups. The relative infrequency, the important morbidity and the inaugural aspect of the perforation in the diverticular disease are in agreement with the literature. The ideal surgical attitude is still controversial. With the majority of the authors, we prefer the Hartmann's operation. The frequency of iatrogenic perforations is not negligible, and could increase in the future, with the development of endoscopic investigations. The morbidity is lower than in the first group, provided that the surgical treatment is applied early.},
}
@article {pmid6730836,
year = {1984},
author = {Odimba, BF and Stoppa, R and Henry, X and Verhaeghe, P and Plachot, JP},
title = {[Generalized peritonitis as a result of perforation of diverticular sigmoiditis. Retrospective analysis of 32 cases].},
journal = {Acta chirurgica Belgica},
volume = {84},
number = {2},
pages = {105-108},
pmid = {6730836},
issn = {0001-5458},
mesh = {Aged ; Colitis/complications ; Diverticulitis/*complications ; Female ; Humans ; Intestinal Perforation/complications ; Male ; Middle Aged ; Peritonitis/*etiology ; Retrospective Studies ; Sigmoid Diseases/*complications ; },
abstract = {A retrospective study of 32 cases. The authors relate about a series of thirty-two cases of diffuse peritonitis, complicating diverticular sigmo iditis in which the etiological features, means of diagnosis and surgical procedures are analysed. According to obtained results, the preference is given to Hartmann's intervention. They are convinced that the better results after that surgical technique are due to the better management of the stercoral peritonitis it offers, taking away the infectious segment. It is neither long to perform nor dangerous and prevents anastomotic fistula in these no-prepared colons. The global mortality of peritonitis in diverticular disease of the colon appears them still very high and they prefer the one stage prophylactic segmentary colectomy after one or two medically treated acute sigmo iditis , particularly in the young patient of who the liability to complications is high.},
}
@article {pmid6703636,
year = {1984},
author = {Drumm, J and Clain, A},
title = {The management of acute colonic diverticulitis with suppurative peritonitis.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {66},
number = {2},
pages = {90-91},
pmid = {6703636},
issn = {0035-8843},
mesh = {Acute Disease ; Aged ; Colostomy ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Male ; Middle Aged ; Peritonitis/etiology/*surgery ; },
abstract = {With improvement in the medical management of diverticular disease, perforation has become the most common indication for surgical intervention. It is a source of considerable morbidity and mortality and consequently has provoked a considerable and controversial challenge for surgeons. We are proposing that all patients found to have purulent peritonitis secondary to perforating diverticulitis at laparatomy, should be managed initially by a defunctioning transverse colostomy, drainage and the administration of appropriate antibiotics. Subsequent management should consist of simple closure of the colostomy following a check barium enema and the commencement of a high fibre diet. We substantiate this by reporting 20 cases from Dudley Road Hospital and 20 others mentioned in the current literature.},
}
@article {pmid6698804,
year = {1984},
author = {Reid, PE and Culling, CF and Dunn, WL and Ramey, CW and Clay, MG},
title = {Chemical and histochemical studies of normal and diseased human gastrointestinal tract. I. A comparison between histologically normal colon, colonic tumours, ulcerative colitis and diverticular disease of the colon.},
journal = {The Histochemical journal},
volume = {16},
number = {3},
pages = {235-251},
pmid = {6698804},
issn = {0018-2214},
mesh = {Colitis, Ulcerative/*metabolism ; Colon/*analysis ; Colonic Diseases/*metabolism ; Colonic Neoplasms/*analysis ; Diverticulitis, Colonic/metabolism ; Diverticulum, Colon/metabolism ; Epithelium/analysis ; Glycoproteins/*analysis ; Histocytochemistry ; Humans ; Neoplasm Proteins/analysis ; Neuraminidase ; Sialic Acids/analysis ; },
abstract = {Chemical and histochemical methods were used to compare the epithelial glycoproteins from formalin-fixed surgical specimens of normal human large intestine, colonic tumours, ulcerative colitis and diverticular disease. All the epithelial glycoproteins contained fucose, galactose, glucosamine, galactosamine and, in addition, sialic acids both with and without O-acyl substituents in the side chain and/or at position C4. The glycoproteins of the normal ascending and descending colons differed significantly with respect to the percentage of the sialic acids released following digestion of the de-O-acylated glycoprotein with Vibrio cholera neuraminidase and to the molar fucose-sialic acid ratio. Statistical analysis of the chemical data showed that (a) compared to normal, the sialic acids of the tumour and ulcerative colitis glycoproteins from the descending colon were significantly less substituted in the side chain and at position C4; (b) the O-acetyl substitution pattern of the sialic acids of the ulcerative colitis glycoproteins from the ascending colon and the quantitative composition of the carbohydrate prosthetic groups of the ulcerative colitis glycoproteins from both ascending and descending colons differed from normal; (c) it was not always possible to distinguish between the ulcerative colitis and tumour glycoproteins on the basis of the O-acetyl substitution pattern of their sialic acids; and (d), there were minor differences between normal glycoproteins and those from cases of diverticular disease.},
}
@article {pmid6697123,
year = {1984},
author = {Underwood, JW and Marks, CG},
title = {The septic complications of sigmoid diverticular disease.},
journal = {The British journal of surgery},
volume = {71},
number = {3},
pages = {209-211},
doi = {10.1002/bjs.1800710314},
pmid = {6697123},
issn = {0007-1323},
mesh = {Abscess/etiology ; Aged ; Colonic Diseases/surgery ; Colostomy ; Diverticulum, Colon/*complications ; Female ; Humans ; Intestinal Fistula/surgery ; Male ; Middle Aged ; Pelvis ; Peritonitis/etiology ; Postoperative Complications ; Sigmoid Diseases/*complications ; Urinary Bladder Fistula/surgery ; Vaginal Fistula/surgery ; },
abstract = {In 2 years 41 patients were treated surgically for septic complications of diverticular disease of the sigmoid colon. Nine patients had fistulae arising from sigmoid diverticular disease. Resection of the sigmoid was undertaken as the primary procedure in 8 patients with anastomosis in 5. Thirty-two patients had pericolic abscesses or peritonitis. The outcome (morbidity, length of stay) of the 21 patients who underwent primary resection was compared with that of the 11 patients treated by defunctioning colostomy alone. The better results in the larger group of 21 patients indicate that primary resection should be the treatment of choice for the septic complications of diverticular disease.},
}
@article {pmid6694718,
year = {1984},
author = {Falchuk, ZM and Griffin, PH},
title = {A technique to facilitate colonoscopy in areas of severe diverticular disease.},
journal = {The New England journal of medicine},
volume = {310},
number = {9},
pages = {598},
doi = {10.1056/NEJM198403013100919},
pmid = {6694718},
issn = {0028-4793},
mesh = {Aged ; Colonoscopy/*methods ; Diverticulum, Colon/*pathology ; Female ; Humans ; Sigmoid Diseases/*pathology ; Water ; },
}
@article {pmid6737389,
year = {1984},
author = {Lewis, SL and Abercrombie, GF},
title = {Conservative surgery for vesicocolic fistula.},
journal = {Journal of the Royal Society of Medicine},
volume = {77},
number = {2},
pages = {102-104},
pmid = {6737389},
issn = {0141-0768},
mesh = {Aged ; Colonic Diseases/etiology/*surgery ; Diverticulum, Colon/complications ; Female ; Humans ; Intestinal Fistula/etiology/*surgery ; Male ; Middle Aged ; Urinary Bladder Fistula/etiology/*surgery ; },
abstract = {Vesicocolic fistula due to diverticular disease of the colon is conventionally treated by resection of the diseased bowel and closure of the vesical defect. Three cases are described in which separation of the viscera and simple suture of the vesical and colonic defects was carried out. A greater omental graft was interposed between the rectum and bladder. Two of the patients are well 12 and 26 months postoperatively. The third patient died a year postoperatively from a complication of her diverticular disease.},
}
@article {pmid6360334,
year = {1984},
author = {Weigensberg, IJ},
title = {Preoperative radiation therapy in Stage I endometrial adenocarcinoma. II. Final report of a clinical trial.},
journal = {Cancer},
volume = {53},
number = {2},
pages = {242-247},
doi = {10.1002/1097-0142(19840115)53:2<242::aid-cncr2820530210>3.0.co;2-0},
pmid = {6360334},
issn = {0008-543X},
mesh = {Adenocarcinoma/*radiotherapy/surgery ; Aged ; Clinical Trials as Topic ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Probability ; Random Allocation ; Uterine Neoplasms/*radiotherapy/surgery ; },
abstract = {From 1968 to 1975 105 patients with adenocarcinoma of the endometrium, FIGO clinical Stage I, were randomly allocated to receive, prior to hysterectomy, either a single implant with Heyman capsules and/ or tandem and ovoids, or external megavoltage irradiation. There were no significant differences between the two study arms with respect to distribution of age, uterine size, obesity, frequency of diverticular disease, or histologic grade. Complications were graded rigorously to assure recording all possible treatment related complications and to minimize under-reporting of complications not obviously or directly attributable to the radiation. Fifty-five patients received intracavity irradiation and experienced 5 - and 10-year actuarial disease-free survivals of 80% and 67%, respectively, as compared to 70% and 59% for 50 patients who received external beam. There were only 4 recurrences in the intracavitary group versus 14 in the external beam group. One half of the recurrences in each group were in the pelvis. Major complications occurred with equal frequency in both groups, but minor complications were much more frequent in the external beam group. The differences in survival, recurrences and minor complications were statistically significant, with P values of 0.023, 0.03, and less than 0.02, respectively. With the techniques utilized here, intracavitary radiation is thus seen to be superior to external beam irradiation in terms of higher disease-free survival, lower frequency of recurrence and fewer complications.},
}
@article {pmid6140435,
year = {1984},
author = {Boulos, PB and Karamanolis, DG and Salmon, PR and Clark, CG},
title = {Is colonoscopy necessary in diverticular disease?.},
journal = {Lancet (London, England)},
volume = {1},
number = {8368},
pages = {95-96},
doi = {10.1016/s0140-6736(84)90016-3},
pmid = {6140435},
issn = {0140-6736},
mesh = {Aged ; Barium Sulfate ; Biopsy ; Colon/pathology ; *Colonoscopy ; Diverticulum, Colon/complications/*diagnosis ; Enema ; False Negative Reactions ; False Positive Reactions ; Female ; Humans ; Intestinal Polyps/complications/diagnosis ; Male ; Middle Aged ; Sigmoid Neoplasms/complications/diagnosis ; },
abstract = {Colonoscopy was carried out in 65 patients in whom double-contrast barium enemas for bowel symptoms had shown sigmoid diverticular disease. In 19 of these, barium enemas had shown neoplastic lesions--polyps in 17 and carcinoma in 2; but colonoscopy showed no polyps in 9 of the 17. In 1 a carcinoma not a polyp was found, and of the 2 carcinomas only 1 was confirmed. In 46 patients the barium enemas showed diverticular disease only, but colonoscopy revealed polyps in 8 and carcinoma in 3. Thus in 23 patients (35%) the barium enema was inaccurate. 13 of 20 patients with neoplasia but only 11 of 45 without had rectal bleeding, but the numbers in the two groups who had abdominal pain or change in bowel habit were similar in the two groups. Colonoscopy revealed neoplastic lesions in 20 of the 65 patients (31%), an incidence great enough to recommend routine colonoscopy in patients with symptomatic diverticular disease, especially those with rectal bleeding.},
}
@article {pmid6748295,
year = {1984},
author = {Sugihara, K},
title = {[Manometric study in right-sided diverticular disease of the colon].},
journal = {Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology},
volume = {81},
number = {1},
pages = {28-36},
pmid = {6748295},
issn = {0446-6586},
mesh = {Adolescent ; Adult ; Aged ; Colon/*physiopathology ; Diverticulum, Colon/etiology/*physiopathology ; Female ; Gastrointestinal Motility ; Humans ; Male ; Manometry ; Middle Aged ; Transducers, Pressure ; },
}
@article {pmid6737765,
year = {1984},
author = {Seki, T and Furuya, Y and Miyasaka, Y and Sudo, N and Aoyama, D},
title = {[Diverticular disease of the colon].},
journal = {Rinsho hoshasen. Clinical radiography},
volume = {29},
number = {1},
pages = {61-65},
pmid = {6737765},
issn = {0009-9252},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Diverticulum, Colon/diagnostic imaging/*epidemiology ; Female ; Humans ; Infant ; Male ; Middle Aged ; Radiography ; Sex Factors ; },
}
@article {pmid6704291,
year = {1984},
author = {Cullen, KW and Ferguson, JC},
title = {Diverticular disease as a surgical emergency.},
journal = {The British journal of clinical practice},
volume = {38},
number = {1},
pages = {20, 24},
pmid = {6704291},
issn = {0007-0947},
mesh = {Acute Disease ; Adult ; Aged ; Diverticulitis, Colonic/mortality/*surgery ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid6591381,
year = {1984},
author = {Snape, WJ},
title = {Myoelectric and motor activity of the colon in normal and abnormal states.},
journal = {Scandinavian journal of gastroenterology. Supplement},
volume = {96},
number = {},
pages = {55-60},
pmid = {6591381},
issn = {0085-5928},
mesh = {Colon/physiology/*physiopathology ; Colonic Diseases/*physiopathology ; Colonic Diseases, Functional/physiopathology ; Diabetes Mellitus/physiopathology ; Diverticulum, Colon/physiopathology ; Electrophysiology ; Food ; Gastrointestinal Motility ; Humans ; Intestinal Pseudo-Obstruction/physiopathology ; Scleroderma, Systemic/physiopathology ; },
abstract = {The nature of colonic motility in normal subjects is discussed. Colonic myoelectrical control is disturbed in certain diseases: slow-wave activity may be affected, or the postprandial gastrocolonic spike response may be altered. Due to these changes in contractile activity, abnormal movement of materials through the colon takes place. These phenomena are reviewed with reference to the irritable colon syndrome, idiopathic constipation, diverticular disease, diabetes mellitus, peripheral systemic sclerosis, and chronic idiopathic intestinal pseudo-obstruction. The treatment of hypermotile states requires the use of agents that diminish colonic motility. If the colon is inert, however, stimulating drugs, e.g. metoclopramide or prostigmine, are indicated.},
}
@article {pmid6567494,
year = {1984},
author = {Libson, E and Bloom, RA and Verstandig, A and Lax, E and Lutwak, E},
title = {Sigmoid-appendiceal fistula in diverticular disease.},
journal = {Diagnostic imaging in clinical medicine},
volume = {53},
number = {5},
pages = {262-264},
pmid = {6567494},
issn = {0254-881X},
mesh = {Appendix/*diagnostic imaging ; Cecal Diseases/diagnostic imaging/etiology ; Diverticulitis, Colonic/*complications/diagnostic imaging ; Humans ; Intestinal Fistula/*diagnostic imaging/etiology ; Male ; Middle Aged ; Radiography ; Sigmoid Diseases/*diagnostic imaging/etiology ; },
abstract = {Sigmoid-appendiceal fistulae are unusual. A case in which such a fistula occurred secondary to diverticulitis is reported.},
}
@article {pmid6545364,
year = {1984},
author = {Thomas, C and Madden, F and Jehu, D},
title = {Psychosocial morbidity in the first three months following stoma surgery.},
journal = {Journal of psychosomatic research},
volume = {28},
number = {3},
pages = {251-257},
doi = {10.1016/0022-3999(84)90027-8},
pmid = {6545364},
issn = {0022-3999},
mesh = {Activities of Daily Living ; *Adaptation, Psychological ; Colonic Diseases/*surgery ; Colostomy/*psychology ; Female ; Humans ; Male ; Middle Aged ; Mood Disorders/psychology ; Rehabilitation, Vocational/psychology ; Sick Role ; Social Adjustment ; },
abstract = {One hundred and six consecutive subjects were seen in hospital a few days after undergoing surgery for bowel disease that necessitated the formation of a stoma. They consisted of patients with cancer (74), colitis (17) and diverticular disease (15). At this initial assessment details of psychological and social functioning were obtained for the preceding three months before operation. At 3 months post-operatively the subjects were interviewed in their own homes, 87 subjects were available (12 died, 7 refused) and again psychological and social assessments were made. Seventeen per cent of males and 19% of females had moderate or severe psychiatric disturbance and there was also a significant number of patients with various social disturbances. Physical diagnosis did not significantly affect psychiatric outcome. There was, however, high pre-operative psychiatric disturbance and the relevance of this in assessing post-operative symptoms is discussed.},
}
@article {pmid6537727,
year = {1984},
author = {Zelli, GP and Rispoli, GG},
title = {[Diverticular disease and colo-rectal carcinoma. Pathogenetic and clinical considerations based on personal cases].},
journal = {Annali italiani di chirurgia},
volume = {56},
number = {4},
pages = {361-369},
pmid = {6537727},
issn = {0003-469X},
mesh = {Aged ; Colonic Neoplasms/*complications/diagnosis ; Diverticulitis, Colonic/*complications/diagnosis ; Female ; Humans ; Male ; Middle Aged ; Rectal Neoplasms/*complications/diagnosis ; },
}
@article {pmid6500906,
year = {1984},
author = {De Masi, E and Bertolotti, A and Fegiz, GF},
title = {The importance of endoscopy in the diagnosis of neoplasms associated with diverticular disease of the colon, and its effect on surgical treatment.},
journal = {The Italian journal of surgical sciences},
volume = {14},
number = {3},
pages = {195-199},
pmid = {6500906},
issn = {0392-3525},
mesh = {Colon/surgery ; Colonic Neoplasms/*diagnosis ; Colonoscopy/*methods ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis ; Fiber Optic Technology ; Humans ; },
abstract = {The results of fibercolonoscopy performed in 149 patients with clinical and or X-ray appearances of diverticular disease are reported. Examination could not be completed in 16 per cent of patients because of impassable strictures in the left colon. Concurrent lesions were diagnosed in 69 per cent, and carcinoma was found in 6 per cent. The respective role of endoscopy and radiology are compared in the diagnosis of polyps, strictures, and cancer, coexisting with diverticulosis. It is concluded that colonoscopy is always indicated in diverticulosis with symptoms because it often provides a precise differential diagnosis thus obviating useless operations. Surgery is essential when impassable strictures prevent colonoscopy because the underlying conditions always require surgical treatment.},
}
@article {pmid6468864,
year = {1984},
author = {Pillari, G and Greenspan, B and Vernace, FM and Rosenblum, G},
title = {Computed tomography of diverticulitis.},
journal = {Gastrointestinal radiology},
volume = {9},
number = {3},
pages = {263-268},
pmid = {6468864},
issn = {0364-2356},
mesh = {Aged ; Barium Sulfate ; Diverticulitis, Colonic/*diagnostic imaging ; *Enema ; Female ; Humans ; Intestinal Fistula/diagnostic imaging ; Male ; Middle Aged ; Sigmoid Diseases/diagnostic imaging ; *Tomography, X-Ray Computed ; Urinary Bladder Fistula/diagnostic imaging ; },
abstract = {Six cases of diverticulitis were studied by means of pelvic computed tomography (CT) and contrast enema. CT is effective in defining the intramural and extracolonic component of diverticulitis; abscess formation in the extracolonic space resulted in consistent changes in the contour of the opacified urinary bladder. Inflammatory extracolonic masses were imaged on CT as low or mixed-attenuation lesions frequently containing pockets of gas. Bladder wall thickening and edema, as well as contour asymmetry of the opacified and distended bladder, were reliable indicators of pericolonic or extracolonic extension of diverticular disease. Contrast enema and sigmoidoscopy are inherently limited in the evaluation of diverticulitis; CT of the pelvis reveals secondary changes outside the mucosa and bowel wall, CT directly images the inflammatory mass and associated changes in pelvic anatomic relationships. CT findings of pelvic inflammatory mass are not specific for abscess of diverticular origin; however, CT interpretation is reliable and confident since it is directed by the supporting findings on contrast enema. Integrated study by CT and contrast enema effectively defines the extent of disease in patients with diverticulitis. Summary evaluation of these studies has a serious impact on the choice of medical or surgical management.},
}
@article {pmid6382575,
year = {1984},
author = {Wienbeck, M and Erckenbrecht, J},
title = {Therapeutic possibilities in colonic motility disorders.},
journal = {Scandinavian journal of gastroenterology. Supplement},
volume = {96},
number = {},
pages = {137-144},
pmid = {6382575},
issn = {0085-5928},
mesh = {Colonic Diseases, Functional/physiopathology/*therapy ; Constipation/physiopathology/therapy ; Diverticulum, Colon/drug therapy/physiopathology ; Fecal Incontinence/physiopathology/therapy ; Humans ; },
abstract = {Colonic motility disorders can be treated by changing the diet, modifying the patient's daily behaviour, giving drugs to enhance or inhibit colonic contraction, or by performing surgery. Therapy in constipation mainly relies on the use of bulk-forming agents, in addition to a change in behaviour. Dietary fibre, particularly bran, appears to be effective in diverticular disease. Bowel atony is largely caused by increased sympathetic activity, and thus frequently responds to sympatholysis. In the irritable bowel syndrome, amelioration is achieved by taking bran and omitting badly tolerated food; antispasmodics and psychotherapy are also probably beneficial. Diarrhoea and incontinence may be treated by opioids, such as loperamide. Recent progress has been mainly in the understanding of the pathophysiology of these disorders, but rapid therapeutic advances are now taking place.},
}
@article {pmid6331700,
year = {1984},
author = {Knutsen, OH and Wählby, L},
title = {Colonic haemorrhage in diverticular disease--diagnosis and treatment.},
journal = {Acta chirurgica Scandinavica},
volume = {150},
number = {3},
pages = {259-264},
pmid = {6331700},
issn = {0001-5482},
mesh = {Aged ; Blood Transfusion ; Colonic Diseases/*diagnosis/therapy ; Diverticulum, Colon/*diagnosis/surgery ; Female ; Gastrointestinal Hemorrhage/*diagnosis/therapy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {A retrospective review of acute diverticular disease in 230 patients revealed that 46 had presented with haemorrhage. The symptoms, investigations and outcome in these 46 cases are reported and the optimum management of profuse colonic haemorrhage is discussed.},
}
@article {pmid6231476,
year = {1984},
author = {Hălălău, F and Ardeleanu, C and Moianu, R and Alexa-Dogaru, M},
title = {Histopathological study on inflammation in cholecystoses.},
journal = {Morphologie et embryologie},
volume = {30},
number = {1},
pages = {33-37},
pmid = {6231476},
issn = {0377-5038},
mesh = {Cholecystitis/*complications/pathology ; Cholelithiasis/complications ; Chronic Disease ; Gallbladder Diseases/*complications/pathology ; Humans ; },
abstract = {At present, according to the unanimously accepted data, cholecystoses are noninflammatory, nonlithiasic, gallbladder diseases. However the authors' experience has proved that the inflammatory process is much more frequent than it is believed and often associated also with lithiasis, a fact which, in the authors' opinion, would justify a reconsideration of this group of diseases. This study, based on histopathologic examination, was carried out in 1,630 gallbladder specimens, surgically removed. Out of these, 278 (17.05 per cent) were identified as cholecystoses; 156 out of them were cholesteroloses and 122 diverticular diseases of the gallbladder. Inflammation as a well defined morphologic process was found in 104 cases (66.67 per cent) of cholesterolosis and in 119 cases (97.54 per cent) of diverticular disease, therefore 80.21 per cent of the cases of cholecystosis examined were associated with inflammation. As regards lithiasis, it was present in 131 of the cases (46.76 per cent). The inflammatory process presented a chronic aspect with no other particular morphologic characteristics. By correlating the histopathologic data with the clinical evolutive ones, it was observed that the presence of inflammation corresponded with a clinical evolution of the disease of about three years. The authors believed that the group of cholecystoses should be reconsidered bearing in mind that inflammation is present in most of the cases and in almost half of them it is associated with lithiases. Under these conditions the sphere of chronic nonlithiasic, noninflammatory gallbladder diseases becomes considerably reduced today.},
}
@article {pmid6642277,
year = {1983},
author = {Sugihara, K and Muto, T and Morioka, Y},
title = {Motility study in right sided diverticular disease of the colon.},
journal = {Gut},
volume = {24},
number = {12},
pages = {1130-1134},
pmid = {6642277},
issn = {0017-5749},
mesh = {Adolescent ; Adult ; Aged ; Colon/drug effects/physiopathology ; Colonoscopy ; Diverticulum, Colon/*physiopathology ; Female ; *Gastrointestinal Motility/drug effects ; Humans ; Male ; Middle Aged ; Neostigmine/pharmacology ; Pressure ; Transducers, Pressure ; },
abstract = {Intraluminal pressure in the ascending colon of 13 patients with right sided diverticular disease and 10 of normal subjects was studied with catheter-tip transducer inserted through colonoscopes. In the resting state the colonic motility index of patients with diverticular disease was greater than that of the controls. After intravenous injection of neostigmine methylsulphate higher pressure waves were more frequently observed in patients with diverticular disease than the controls, and the colonic motility index of patients was much greater than that of the controls with statistical significance. From these observations it is suggested that high intraluminal pressure and the abnormal motility in the ascending colon plays an important role in the pathogenesis of right sided diverticular disease.},
}
@article {pmid6422502,
year = {1983},
author = {Fuchs, HF},
title = {[Diverticular disease of the colon].},
journal = {Der Radiologe},
volume = {23},
number = {12},
pages = {545-550},
pmid = {6422502},
issn = {0033-832X},
mesh = {Abscess/etiology ; Barium Sulfate ; Colonic Diseases/*diagnostic imaging ; Constipation/etiology ; Diarrhea/etiology ; Diverticulum/complications/*diagnostic imaging ; Endoscopy ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Pain/etiology ; Radiography ; },
abstract = {The great significance of diverticular disease, clinical symptoms, and pathologic-anatomical changes are demonstrated. In our opinion the diagnostic possibilities of a carefully performed hypotonic enema with double contrast are not yet fully used; mostly the patients have to suffer from an endoscopic investigation of the colon. Radiologic double-contrast examination is the method of choice, resulting in reliable and clear pictures of the extent of diverticulosis and in most cases also of its complications. Some typical examples are given to point out radiological criteria of the diverticular disease.},
}
@article {pmid6322221,
year = {1983},
author = {Waldmann, D and Farthmann, EH},
title = {[Diverticulosis of the colon and its complications. Surgical and clinical aspects].},
journal = {Der Radiologe},
volume = {23},
number = {12},
pages = {540-544},
pmid = {6322221},
issn = {0033-832X},
mesh = {Barium Sulfate ; Colon, Sigmoid/pathology ; Colonic Diseases/*pathology ; Dietary Fiber/therapeutic use ; Diverticulum/diagnostic imaging/*pathology/surgery ; Gastrointestinal Hemorrhage/surgery ; Humans ; Methods ; Nutritional Requirements ; Radiography ; },
abstract = {Colonic diverticula in reality are herniations of the mucosa through a thickened musculature of the bowel wall where it is penetrated by the vasa recta. Their prevalence increases with western food and with age. Low-residue diet and increased intraluminal pressure are considered to be etiologic factors. Diverticular disease is characterised by inflammatory and bleeding complications. Diverticulitis may lead to peridiverticulitis and pericolitis with frank peritonitis. Uncomplicated diverticulosis warrants observation only under dietary guidance. Repeated complications indicate elective operation by one-stage-resection. Perforation, abscess and massive bleeding necessitate immediate operative treatment aimed at elimination of the involved segment.},
}
@article {pmid6669280,
year = {1983},
author = {Ferraris, V and Bonelli, R and Della Barba, A and De Simone, M and Moor, E and Mortara, G and Visin, G and Vitali, T},
title = {[Diverticular disease of the colon. Surgical therapy].},
journal = {Minerva chirurgica},
volume = {38},
number = {21},
pages = {1763-1766},
pmid = {6669280},
issn = {0026-4733},
mesh = {Adult ; Aged ; Diverticulum, Colon/complications/diagnosis/pathology/*surgery ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid6628146,
year = {1983},
author = {Farrands, PA and Vellacott, KD and Amar, SS and Balfour, TW and Hardcastle, JD},
title = {Flexible fiberoptic sigmoidoscopy and double-contrast barium-enema examination in the identification of adenomas and carcinoma of the colon.},
journal = {Diseases of the colon and rectum},
volume = {26},
number = {11},
pages = {725-727},
doi = {10.1007/BF02554983},
pmid = {6628146},
issn = {0012-3706},
mesh = {Adenoma/*diagnostic imaging ; Aged ; Barium Sulfate ; Carcinoma/*diagnostic imaging ; Colonic Neoplasms/*diagnostic imaging ; Colonoscopy ; Evaluation Studies as Topic ; Female ; *Fiber Optic Technology ; Humans ; Male ; Middle Aged ; Radiography ; *Sigmoidoscopy ; },
abstract = {To assess the accuracy of the flexible fiberoptic sigmoidoscope, 227 consecutive patients (mean age 61.8 +/- 13 years) requiring investigation of colonic symptoms were evaluated using rigid and flexible sigmoidoscopy (PAF and KDV) and double-contrast barium enema (SSA). Patients with equivocal findings or adenomatous polyps underwent colonoscopy (TWB). Thirty-four patients had carcinoma and 50 patients had one or more adenomatous polyps (greater than 5mm). The neoplastic yield from rigid sigmoidoscopy was 12 per cent, flexible fiberoptic sigmoidoscopy 90 per cent, and double-contrast barium enema only 76 per cent. Barium enema failed to identify eight carcinomas and 13 adenomatous polyps; seven of the eight carcinomas were polypoid Dukes' Stage A lesions, and associated diverticular disease was present in 62.5 per cent of cases. Flexible fiberoptic sigmoidoscopy failed to identify seven carcinomas and one adenomatous polyp. Five of the carcinomas were beyond range of the instrument; in one patient, a stricture was seen that was caused by the carcinoma; and in the seventh patient, the examination was terminated because of angulation spasm. Double-contrast barium enema is inaccurate in detecting lesions in the sigmoid colon, with flexible sigmoidoscopy being superior.},
}
@article {pmid6627148,
year = {1983},
author = {Wassef, R and Morgan, S and Tassé, D and Bernard, D},
title = {[Fistulas in diverticular disease of the colon: study of 29 cases].},
journal = {Canadian journal of surgery. Journal canadien de chirurgie},
volume = {26},
number = {6},
pages = {546-549},
pmid = {6627148},
issn = {0008-428X},
mesh = {Adult ; Aged ; Colonic Diseases/*etiology ; Diverticulum, Colon/*complications ; Female ; Fistula/*etiology ; Humans ; Ileal Diseases/etiology ; Intestinal Fistula/*etiology ; Intestinal Perforation/complications ; Male ; Middle Aged ; Skin Diseases/etiology ; Urinary Bladder Fistula/etiology ; Vaginal Fistula/etiology ; },
abstract = {In analysing 29 patients with diverticular disease of the colon complicated by fistula, the authors encountered four types of fistula: colovesical, colovaginal, coloileal and colocutaneous. The commonest was the colovesical fistula (50%), which was diagnosed by the history and the suggestive cystoscopic findings. Colovaginal fistula was also suspected by the history and the presence of a pelvic mass in hysterectomized patients. Colocutaneous fistulas are demonstrated by fistulography whereas coloileal fistulas, which do not have clinical signs, are discovered only at operation. Surgical treatment, consisting of resection and anastomosis of the involved segment of the colon, is necessary. A one-stage procedure is usually feasible with little morbidity if the delay between the acute phase and the operation is longer than 3 months. When the operation is attempted sooner, the surgeon may have to use more than one stage with a longer period of disability and the possibility of more complications. Because the development of a fistula with diverticular disease seldom needs urgent surgical exploration, the authors recommend 3 months of conservative therapy after the acute phase to allow the local inflammatory reaction to subside so a one-stage operation can be performed.},
}
@article {pmid6664583,
year = {1983},
author = {Griffa, B and Basilico, V and Pescio, R and Cortese, F},
title = {[Our experience in the treatment of the complications of diverticular disease of colon].},
journal = {Minerva chirurgica},
volume = {38},
number = {20},
pages = {1747-1749},
pmid = {6664583},
issn = {0026-4733},
mesh = {Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Male ; },
}
@article {pmid6623368,
year = {1983},
author = {Alexander, J and Karl, RC and Skinner, DB},
title = {Results of changing trends in the surgical management of complications of diverticular disease.},
journal = {Surgery},
volume = {94},
number = {4},
pages = {683-690},
pmid = {6623368},
issn = {0039-6060},
mesh = {Adult ; Aged ; Colostomy ; Diverticulum, Colon/*surgery ; Evaluation Studies as Topic ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/*surgery ; Retrospective Studies ; },
abstract = {During the past decade, primary resection with anastomosis has gained acceptance in the surgical treatment of complications arising from diverticular disease of the colon. We have reviewed our experience during the past 10 years to determine whether this approach has clinical validity. Of 673 patients followed over a 10-year period, 93 (14%) required operation. Operative indications were generally limited to urgent complications of the disease: abscess (36), bleeding (18), perforation (10), obstruction (10), and fistula (5). A small group of patients underwent operation for recurrent symptoms (7) and for the suspicion of coexistent carcinoma (8). Initial operative management included resection with anastomosis (44), resection and colostomy (26), and diverting colostomy (23). The overall incidence of complications was significant; the most common complication was infectious in nature: abscess (7), fistula (9), wound infection (11), dehiscence (2), and sepsis (5). Complications were more numerous in patients who did not receive primary resection of the diseased segment 2.1 versus 1.1 complications per patient, respectively), and the duration of hospitalization was significantly greater in this group as well. The perioperative mortality rate of our surgical patients was 6.4%; none of these deaths were associated with resection and anastomosis. These data indicate that resection with primary anastomosis is a sound approach in properly selected patients with urgent complications of diverticular disease, and that aggressive surgical management can yield results that are better than those obtained from the use of colostomy alone.},
}
@article {pmid6867330,
year = {1983},
author = {Maloney, JJ and Cho, SR},
title = {Pelvic actinomycosis.},
journal = {Radiology},
volume = {148},
number = {2},
pages = {388},
doi = {10.1148/radiology.148.2.6867330},
pmid = {6867330},
issn = {0033-8419},
mesh = {Actinomycosis/*diagnostic imaging ; Adult ; Female ; Humans ; Pelvis/*diagnostic imaging ; Radiography ; },
abstract = {A case of actinomycosis involving the pelvic cavity is reported. The patient had a pelvic mass clinically and radiographically. Barium enema examination showed a mass with extrinsic compression and fixed narrowing of the rectum with mucosal irregularity. A computed tomographic scan showed a pelvic mass displacing the rectum.},
}
@article {pmid6620706,
year = {1983},
author = {Kubo, A and Ishiwata, J and Maeda, Y and Kida, T and Yamabe, K and Shimosegawa, T},
title = {Clinical studies on diverticular disease of the colon.},
journal = {Japanese journal of medicine},
volume = {22},
number = {3},
pages = {185-189},
doi = {10.2169/internalmedicine1962.22.185},
pmid = {6620706},
issn = {0021-5120},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; *Barium Sulfate ; Diverticulum, Colon/complications/*diagnosis/epidemiology ; *Enema ; Female ; Humans ; Japan ; Male ; Middle Aged ; },
abstract = {In 12,505 patients who received barium enemas during the past 14 days, 979 cases (7.8%) of diverticular disease of the colon (DDC) were found. The incidence of DDC increased with age; 2.2% of the patients were below age 29 and 14.3% were over 70 years old. The sex distribution was 584 males and 395 females. 76.1% had diverticula in the right-side colon, 12.9% in the left-side colon, and 11.0% in both sides. All patients below age 29 had the right-side colon type, while 44% of those aged 70 or more did. On the other hand, the left-side colon type and both-sides colon type were found only in patients over 30 years old, and constituted a majority in those of 70 years old or more. The main symptoms and signs were: disturbances in bowel habits 50.7%, abdominal pain 48.1%, abdominal distension and/or discomfort 41.5%, occult blood 25.2% and melena 5.8%. Therefore, DDC is clinically becoming an important disease in recent years in Japan as well as in Western countries.},
}
@article {pmid6633898,
year = {1983},
author = {Guglielmini, G and Pich, A and Solazzo, L and Resani, M},
title = {[Diverticular disease of the large intestine. Anatomo-pathologic considerations and clinical results of the surgical treatment].},
journal = {Minerva chirurgica},
volume = {38},
number = {13-14},
pages = {1103-1112},
pmid = {6633898},
issn = {0026-4733},
mesh = {Adult ; Aged ; Diverticulitis, Colonic/complications/pathology/*surgery ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid6612277,
year = {1983},
author = {Gonvers, JJ},
title = {[Diverticular disease of the colon. Physiopathology and medical treatment].},
journal = {Schweizerische medizinische Wochenschrift},
volume = {113},
number = {26},
pages = {956-960},
pmid = {6612277},
issn = {0036-7672},
mesh = {Animals ; Diverticulitis, Colonic/etiology ; *Diverticulum, Colon/complications/physiopathology/therapy ; Gastrointestinal Motility ; Hemorrhage/etiology ; Humans ; },
abstract = {Almost unknown in 1900, diverticular disease has become the commonest disease of the colon and appears to be a deficiency disease caused by the removal of vegetable fibre from the diet. It occurs most commonly in the sigmoid colon and is frequently asymptomatic, but it may be symptomatic without evidence of inflammation. It may be complicated by inflammation or bleeding. A high residue diet forms the rational basis for successful therapy.},
}
@article {pmid6305184,
year = {1983},
author = {Ohi, G and Minowa, K and Oyama, T and Nagahashi, M and Yamazaki, N and Yamamoto, S and Nagasako, K and Hayakawa, K and Kimura, K and Mori, B},
title = {Changes in dietary fiber intake among Japanese in the 20th century: a relationship to the prevalence of diverticular disease.},
journal = {The American journal of clinical nutrition},
volume = {38},
number = {1},
pages = {115-121},
doi = {10.1093/ajcn/38.1.115},
pmid = {6305184},
issn = {0002-9165},
mesh = {Dietary Fiber/*administration & dosage ; Diverticulitis, Colonic/*epidemiology ; *Feeding Behavior ; Humans ; Japan ; United States ; },
abstract = {In view of the fact that Japanese dietary patterns have been undergoing rapid "Westernization," in part characterized by decrease in fiber, we assessed dietary and crude fiber content in the Japanese diet using food consumption tables for the period from 1911 to 1980, and studied the trend in the reported prevalence of diverticular disease of the colon. Fiber content declined in diphasic pattern: the first decline, which probably had started in the late 19th century, progressed until the Second World War. Although records during the war period were unavailable, the high fiber content of the Japanese diet in the period immediately after the war reflects the tendency to supplement rice with more fiber-rich cereals, and to increase the amount of rice through reduced polishing during the war time. The second decline in fiber content in the Japanese diet, which started in the 1950s and progressed throughout the period of "high economic growth," was mainly due to the decrease in cereal consumption. The changes in crude fiber content in the Japanese diet after the Second World War resemble the pattern of rapid decline noted in the United States during the 1930s to the 1950s. The prevalence of diverticular disease in both countries also shows sudden steep upward turns during the period between 1930 and 1950 in the United States and the late 1970s in Japan, suggesting the presence of threshold level(s) of fiber intake for the effective prevention of diverticular disease. The prevalence of diverticular disease is still relatively low in Japan. However, if the current dietary trend continues, it may rise to a level currently found in the "Western" countries in the coming few decades.},
}
@article {pmid6864719,
year = {1983},
author = {Schofield, PF and Holden, D and Carr, ND},
title = {Bowel disease after radiotherapy.},
journal = {Journal of the Royal Society of Medicine},
volume = {76},
number = {6},
pages = {463-466},
pmid = {6864719},
issn = {0141-0768},
mesh = {Female ; Humans ; Intestinal Diseases/*etiology/surgery ; Male ; Radiotherapy/*adverse effects ; Time Factors ; Urinary Bladder Neoplasms/radiotherapy ; Uterine Cervical Neoplasms/radiotherapy ; },
abstract = {The clinical presentation, operative findings and outcome in 40 patients who required surgery for bowel disease after radiotherapy are presented. The type of presentation varied according to the time after radiotherapy. In the first month, many patients had a proctitis but none required surgery. Five patients were operated on within one month, 2 for radiation-induced acute ileitis and 3 for exacerbations of pre-existing disease (diverticular disease 2, ulcerative colitis 1). The commonest time of presentation was between 3 and 18 months after radiotherapy, when 20 patients needed surgery for bowel disease caused by radiation-induced local ischaemia. Twelve of these patients had chronic perforation, 6 had severe rectal bleeding and 2 had painful anorectal ulceration. Fifteen patients presented between 2 and 24 years after radiotherapy, usually with incomplete intestinal obstruction due to a fibrous stricture, but 2 patients had rectal carcinoma. Wide resection of the involved bowel was the principal method of treatment but any anastomosis was protected by a proximal defunctioning stoma. There was no operative mortality but 10 patients have died subsequently. The danger of dismissing these patients as having incurable malignancy is stressed because, although the condition is infrequent, it is usually amenable to adequate surgery.},
}
@article {pmid6408538,
year = {1983},
author = {Gramse, CA},
title = {Diverticular disease.},
journal = {Nursing},
volume = {13},
number = {6},
pages = {56-57},
doi = {10.1097/00152193-198306000-00023},
pmid = {6408538},
issn = {0360-4039},
mesh = {Diverticulitis/*nursing ; Diverticulum/*nursing ; Humans ; },
}
@article {pmid6132173,
year = {1983},
author = {Gledhill, T and Hunt, RH},
title = {Bleeding and diverticular disease.},
journal = {Lancet (London, England)},
volume = {1},
number = {8328},
pages = {830},
doi = {10.1016/s0140-6736(83)91898-6},
pmid = {6132173},
issn = {0140-6736},
mesh = {Diverticulum/complications/*diagnosis ; Gastrointestinal Hemorrhage/*diagnosis/etiology ; Humans ; Occult Blood ; },
}
@article {pmid6877645,
year = {1983},
author = {Virgilio, C and Magnano, A and Sanfilippo, G and Pecorella, S and Russo, A and Ingegneros, L},
title = {[Diagnostic validity of the traditional enema and of colonoscopy in the study of diverticular disease of the colon. Apropos of 121 cases].},
journal = {Minerva dietologica e gastroenterologica},
volume = {29},
number = {2},
pages = {113-116},
pmid = {6877645},
issn = {0391-1993},
mesh = {Adult ; Aged ; Barium Sulfate ; *Colonoscopy ; Diverticulum, Colon/*diagnosis ; *Enema ; Evaluation Studies as Topic ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
}
@article {pmid6839895,
year = {1983},
author = {Fatayer, WT and A-Khalaf, MM and Shalan, KA and Toukan, AU and Daker, MR and Arnaout, MA},
title = {Diverticular disease of the colon in Jordan.},
journal = {Diseases of the colon and rectum},
volume = {26},
number = {4},
pages = {247-249},
doi = {10.1007/BF02562489},
pmid = {6839895},
issn = {0012-3706},
mesh = {Adult ; Aged ; Diverticulum, Colon/diagnostic imaging/*epidemiology ; Female ; Humans ; Jordan ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; },
abstract = {In a case review over a nine-year period, 35 patients were referred to the University Hospital with a variety of abdominal symptoms related to the gastrointestinal tract, were found to have diverticular disease of the colon. In a retrospective evaluation of 274 consecutive barium enemas performed at the same institute in patients aged 20 to 85 years, in a three-year period (1979 to 1981), colonic diverticula were found in 11 patients, giving incidence of 4 per cent; all positive enemas for diverticulosis in this group occurred in patients over the age of 40 years.},
}
@article {pmid6406994,
year = {1983},
author = {Bruce-Chwatt, RM},
title = {Diverticular disease of the appendix.},
journal = {The Practitioner},
volume = {227},
number = {1378},
pages = {671},
pmid = {6406994},
issn = {0032-6518},
mesh = {Aged ; Appendix/*diagnostic imaging ; Cecal Diseases/diagnostic imaging ; Diverticulum/*diagnostic imaging ; Humans ; Male ; Middle Aged ; Radiography ; },
}
@article {pmid6858538,
year = {1983},
author = {Mendes da Costa, P and Ansay, J and Beernaerts, A and Blondiau, R and Carlier, P and Cornil, C and Delvaux, C and Demol, J and Deschreyer, M and Detry, R and Dingens, C and Govaerts, JP and Hendrickx, L and Huyghe, J and Janne, P and Khaddaj, S and Lebec, JC and Limbosch, JM and Richir, C and Steuve, J and Vereecken, L and Vossaert, R},
title = {[Diverticular disease of the left colon. Belgian surgical experience. Multicenter study of 962 cases].},
journal = {Acta chirurgica Belgica},
volume = {83},
number = {2},
pages = {69-76},
pmid = {6858538},
issn = {0001-5458},
mesh = {Adolescent ; Adult ; Aged ; Belgium ; Diverticulitis, Colonic/complications/mortality/*surgery ; Diverticulum, Colon/complications/mortality/*surgery ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid6857061,
year = {1983},
author = {Akovbiantz, A},
title = {[Diverticular disease of the colon. Surgical treatment].},
journal = {Revue medicale de la Suisse romande},
volume = {103},
number = {2},
pages = {123-128},
pmid = {6857061},
issn = {0035-3655},
mesh = {Colonic Diseases/surgery ; Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Hemorrhage/surgery ; Humans ; Intestinal Fistula/surgery ; Intestinal Obstruction/surgery ; Sigmoid Diseases/surgery ; },
}
@article {pmid6857060,
year = {1983},
author = {Gonvers, JJ},
title = {[Diverticular disease of the colon. Medical treatment].},
journal = {Revue medicale de la Suisse romande},
volume = {103},
number = {2},
pages = {117-121},
pmid = {6857060},
issn = {0035-3655},
mesh = {Anti-Bacterial Agents/therapeutic use ; Diverticulitis, Colonic/*therapy ; Diverticulum, Colon/diet therapy/*therapy ; Humans ; Parasympatholytics/therapeutic use ; },
}
@article {pmid6826002,
year = {1983},
author = {Aste, H and Pugliese, V and Munizzi, F and Giacchero, A},
title = {Left-sided stenosing lesions in colonoscopy.},
journal = {Gastrointestinal endoscopy},
volume = {29},
number = {1},
pages = {18-20},
doi = {10.1016/s0016-5107(83)72491-0},
pmid = {6826002},
issn = {0016-5107},
mesh = {Adenocarcinoma/diagnosis ; Adult ; Aged ; Colonic Diseases/diagnosis ; Colonic Neoplasms/*diagnosis/pathology ; *Colonoscopy ; Constriction, Pathologic/diagnosis ; Diverticulum, Colon/diagnosis ; Female ; Humans ; Male ; Middle Aged ; Rectal Diseases/diagnosis ; Sigmoid Neoplasms/*diagnosis ; },
abstract = {Of 2625 consecutive colonoscopic examinations, 122 stenotic lesions interfered with endoscopy. The sigmoid was the most frequent site of stenosis (64%). Of the two types of endoscopic patterns, type A, in which there is an intraluminal protruding mass, is the most frequent, and type B, in which a segment of colon gradually narrows, has intact mucosa. Adenocarcinoma was the most frequent cause of type A (83%), and complications related to diverticular disease (32%) and adenocarcinoma (27%) were most often associated with type B. Colonoscopy, guided multiple biopsies, and brushing cytology gave high diagnostic accuracy for type A lesions. In type B cases, brushings were usually negative.},
}
@article {pmid6824243,
year = {1983},
author = {Brief, DK and Brener, BJ and Goldenkranz, R and Alpert, J and Yalof, I and Parsonnet, V},
title = {An argument for increased use of subtotal colectomy in the management of carcinoma of the colon.},
journal = {The American surgeon},
volume = {49},
number = {2},
pages = {66-72},
pmid = {6824243},
issn = {0003-1348},
mesh = {Adult ; Aged ; *Colectomy/methods ; Colon, Sigmoid/surgery ; Colonic Neoplasms/complications/mortality/*surgery ; Colostomy ; Evaluation Studies as Topic ; Female ; Humans ; Ileum/surgery ; Intestinal Polyps/complications ; Male ; Middle Aged ; Neoplasms, Multiple Primary/surgery ; Postoperative Complications/prevention & control ; Rectum/surgery ; },
abstract = {Subtotal colectomy (STC) is a safe operation because operative mortality rates are as good as, if not better than, conventional segmental colon resections. It is no more difficult to perform than conventional segmental resections. Suture line complications, such as fecal fistulas and suture line recurrences, are not as common before as they are after colocolic anastomoses. In addition to being used in cases with known synchronous carcinomas, and carcinoma associated with polyps, STC should be considered in selected patients with obstructing or partially obstructing lesions of the sigmoid or left colon when complete evaluation of the proximal colon has not been possible. STC can be combined with a preliminary transverse colostomy for obstructing left colon lesions when appropriate evaluation demonstrates suitable indications for the resection of the colostomy as a one-stage procedure with ileocolic anastomosis. It also should be considered if there is significant distal sigmoidal diverticular disease associated with proximal carcinomas. Statistically, STC does not appear to be indicated as a prophylactic operation to avoid the development of metachronous colon cancer when the entire colon can be surveyed colonoscopically to assure that there is no associated neoplasm.},
}
@article {pmid6296805,
year = {1983},
author = {Handler, S},
title = {Dietary fiber. Can it prevent certain colonic diseases?.},
journal = {Postgraduate medicine},
volume = {73},
number = {2},
pages = {301-307},
doi = {10.1080/00325481.1983.11697775},
pmid = {6296805},
issn = {0032-5481},
mesh = {Appendicitis/etiology ; Carcinogens/biosynthesis ; Colonic Diseases/*prevention & control ; Colonic Neoplasms/etiology ; Diet, Vegetarian ; Dietary Fats/adverse effects ; *Dietary Fiber ; Diverticulitis/etiology ; Humans ; },
abstract = {Most of the serious organic diseases of the colon are etiologically linked to the high-saturated-fat and low-fiber Western diet. Benign but common conditions, such as appendicitis and diverticular disease of the colon, appear to be due to deficiency of fiber and attendant low-bulk stools. Colon cancer appears to be due to carcinogens created in the colon itself. Contributing to carcinogen production are cocarcinogens in bile and an increase in anaerobic bacteria, both directly related to high levels of saturated fat in the diet. If these common disorders of the colon are to be controlled, our diet will require major modification. Changes will have to include reduction of saturated fats of animal origin and increase in cereal grains.},
}
@article {pmid6840403,
year = {1983},
author = {Morris, IR and Hammond, P and Darby, C and Taylor, I},
title = {Simultaneous recording of myoelectrical activity and resistance from the human colon.},
journal = {Digestion},
volume = {26},
number = {1},
pages = {33-42},
doi = {10.1159/000198866},
pmid = {6840403},
issn = {0012-2823},
mesh = {Colon/*physiology ; Colonic Diseases, Functional/physiopathology ; Diverticulum, Colon/physiopathology ; Electric Conductivity ; *Gastrointestinal Motility/drug effects ; Glucagon/pharmacology ; Humans ; },
abstract = {A system used to record myoelectrical activity from the rectosigmoid colon has been modified so that a continuous recording of electrical resistance is obtained simultaneously. Normal subjects, patients with diverticular disease and patients with the irritable colon syndrome have been studied by this method. There were variations in resistance in the form of waves for 74.7, 88.5 and 89.0% of the time in the three groups. These changes were abolished by intravenous glucagon. The predominant frequency of the waves was 2-4 c/min and often coincided with myoelectrical waves of the same frequency. It is concluded that the resistance changes are produced by local movement in the colonic wall at the electrode site and that this technique may be valuable in studying colonic motility.},
}
@article {pmid6826357,
year = {1983},
author = {Chalmers, K and Wilson, JM and Smith, AN and Eastwood, MA},
title = {Diverticular disease of the colon in Scottish hospitals over a decade.},
journal = {Health bulletin},
volume = {41},
number = {1},
pages = {32-41},
pmid = {6826357},
issn = {0374-8014},
mesh = {Aged ; Colectomy ; Colonic Diseases/surgery ; Diet ; Diverticulum, Colon/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Scotland ; },
}
@article {pmid6680266,
year = {1983},
author = {Rojman, JA and Korsten, MA},
title = {[Clinical spectrum of amebic colitis].},
journal = {Acta gastroenterologica Latinoamericana},
volume = {13},
number = {4},
pages = {733-739},
pmid = {6680266},
issn = {0300-9033},
mesh = {Adult ; Aged ; Colitis, Ulcerative/diagnosis ; Colon/diagnostic imaging ; Diagnosis, Differential ; Dysentery, Amebic/*diagnosis ; Humans ; Male ; Middle Aged ; Radiography ; Sigmoidoscopy ; },
abstract = {We present six cases to illustrate the protean clinical and sigmoidoscopic features of the amebic colitis. Three cases presented with a clinical picture resembling ulcerative colitis. In one fatal case, diverticular disease, ischemic colitis and toxic megacolon of uncertain origin were considered before arriving at the proper diagnosis. Two cases were believed to have pseudomembranous colitis on sigmoidoscopic examination. Given the multiple expressions of this entity, amebic colitis should be considered a diagnostic possibility in any protracted inflammatory condition of the colon. From the cases summarized here, it is evident that the clinical and endoscopic features of amebic colitis are variable and may often mimic other illnesses.},
}
@article {pmid6650075,
year = {1983},
author = {Fasth, S and Hedlund, H and Svaninger, G and Oresland, T and Hultén, L},
title = {Functional results after subtotal colectomy and caecorectal anastomosis.},
journal = {Acta chirurgica Scandinavica},
volume = {149},
number = {6},
pages = {623-627},
pmid = {6650075},
issn = {0001-5482},
mesh = {Adult ; Aged ; Bile Acids and Salts/metabolism ; *Colectomy ; Colon/physiopathology/*surgery ; Colonic Neoplasms/surgery ; Constipation/surgery ; *Defecation ; Diverticulum, Colon/surgery ; Feces/analysis ; Female ; Humans ; Lipids/analysis ; Male ; Middle Aged ; Rectum/physiopathology/*surgery ; },
abstract = {Subtotal colectomy, preserving the ileocaecal valve and caecum, and caecoproctostomy has been recommended by some authors in the past and hypothetically it is a good a priori argument on the grounds of function for its use. The procedure has been employed in nine patients on different indications and the functional results assessed. When employed for treatment of chronic constipation or diverticular disease of the colon the functional results were poor. If the operation should be used at all it should probably be restricted to patients with an otherwise normal colorectal function. Even when employed on these indications, bowel habits differ little from those experienced by patients with a conventional ileorectal anastomosis.},
}
@article {pmid6642152,
year = {1983},
author = {Greenall, MJ and Levine, AW and Nolan, DJ},
title = {Complications of diverticular disease: a review of the barium enema findings.},
journal = {Gastrointestinal radiology},
volume = {8},
number = {4},
pages = {353-358},
pmid = {6642152},
issn = {0364-2356},
mesh = {Abscess/etiology ; *Barium Sulfate ; Diverticulitis, Colonic/*complications/diagnostic imaging ; *Enema ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Radiography ; Sigmoid Diseases/etiology ; Urinary Bladder Fistula/etiology ; },
abstract = {Complications of diverticular disease are among the most common causes of all acute hospital admissions. The barium enema is the most important investigation in these patients, both for establishing the diagnosis and planning their management. However, few comprehensive reviews have described the radiological appearances of the complications of diverticular disease. We describe the radiological features and emphasize the diagnostic difficulties that may occur.},
}
@article {pmid6600422,
year = {1983},
author = {Ryan, P},
title = {Changing concepts in diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {26},
number = {1},
pages = {12-18},
doi = {10.1007/BF02554670},
pmid = {6600422},
issn = {0012-3706},
mesh = {Abscess/etiology ; Acute Disease ; Chronic Disease ; Colonic Diseases/etiology/therapy ; Diverticulitis, Colonic/*complications ; Diverticulum, Colon/*complications ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology/therapy ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Peritonitis/therapy ; Urinary Bladder Fistula/etiology/therapy ; },
abstract = {Conventionally, acquired diverticular disease of the colon has been regarded as a single entity, so far as complications go. Experience at St. Vincent's Hospital, Melbourne, suggests that there are two kinds of diverticular disease, one with the classic muscle abnormality, chiefly confined to the left colon and characterized by inflammatory and perforative complications and the other without muscle abnormality, but with diverticula throughout the colon, in which bleeding is common, perhaps due to a connective-tissue abnormality which, on the one hand, allows development of diverticula in the absence of abnormal intraluminal pressure and, on the other, provides inadequate support for vessels in the diverticular wall or for vascular malformations, which are therefore likely to bleed. Clinical evidence from admissions to St. Vincent's Hospital suggests that both acute and chronic pain may be either inflammatory or associated with muscle spasm and hypertrophy. Finally, there is some evidence to suggest that perforation may be due often, or usually, to abnormal intraluminal pressures rather than to diverticular inflammation.},
}
@article {pmid6600202,
year = {1983},
author = {Ouriel, K and Schwartz, SI},
title = {Diverticular disease in the young patient.},
journal = {Surgery, gynecology & obstetrics},
volume = {156},
number = {1},
pages = {1-5},
pmid = {6600202},
issn = {0039-6087},
mesh = {Acute Disease ; Adolescent ; Adult ; Anti-Bacterial Agents/therapeutic use ; Appendicitis/diagnosis ; Colon/surgery ; Diagnosis, Differential ; *Diverticulitis, Colonic/diagnosis ; *Diverticulum, Colon/diagnosis/drug therapy/surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Male ; Pelvic Inflammatory Disease/diagnosis ; Retrospective Studies ; },
abstract = {The records of 115 patients less than 40 years of age with roentgenographic or operative documentation of diverticular disease were reviewed. Ninety-two patients presented with acute diverticulitis; five, with bleeding diverticulosis, and 18 were asymptomatic. An urgent operation for fistula, abscess or free perforation was necessary upon initial presentation in 16 patients. Nine patients underwent resection during the initial hospitalization after a cooling-off period. The remaining 67 patients were managed medically and discharged. Fifty-five per cent of the medically managed patients required readmission during the follow-up period, 23 per cent having a serious complication. Forty-five per cent of the medically managed patients underwent a subsequent operation. Elective resection after a cooling-off period appears to be the safest alternative for young patients.},
}
@article {pmid6551260,
year = {1983},
author = {German, SV},
title = {[Diverticular disease of the large intestine].},
journal = {Fel'dsher i akusherka},
volume = {48},
number = {2},
pages = {32-36},
pmid = {6551260},
issn = {0014-9772},
mesh = {Adult ; Aged ; Diet ; Diverticulitis, Colonic/*diagnosis/therapy ; Diverticulum, Colon/*diagnosis/therapy ; Humans ; Middle Aged ; Prognosis ; },
}
@article {pmid6400859,
year = {1983},
author = {Balbulović-Telalbasić, S},
title = {[Clinical characteristics of diverticular disease of the colon].},
journal = {Medicinski arhiv},
volume = {37},
number = {4},
pages = {195-197},
pmid = {6400859},
mesh = {Adult ; Aged ; *Diverticulum, Colon/complications/diagnosis/therapy ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid6314784,
year = {1983},
author = {Antos, F},
title = {The present-day aspect of treating diverticular disease of the colon.},
journal = {Acta Universitatis Carolinae. Medica},
volume = {29},
number = {1-2},
pages = {63-75},
pmid = {6314784},
issn = {0001-7116},
mesh = {Adult ; Aged ; Dietary Fiber/administration & dosage ; Diverticulitis, Colonic/etiology ; Diverticulum, Colon/complications/diagnosis/*therapy ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Peritonitis/etiology ; Postoperative Complications ; },
}
@article {pmid6816561,
year = {1982},
author = {Ajao, OG},
title = {Differences between surgical colorectal conditions seen in the temperate and tropical regions.},
journal = {Diseases of the colon and rectum},
volume = {25},
number = {8},
pages = {795-797},
doi = {10.1007/BF02553315},
pmid = {6816561},
issn = {0012-3706},
mesh = {*Climate ; Colonic Diseases/*diagnosis/surgery ; Colonic Neoplasms/diagnosis ; Diagnosis, Differential ; Diverticulum/diagnosis ; Dysentery, Amebic/diagnosis ; Humans ; Intestinal Obstruction/diagnosis ; Intussusception/diagnosis ; Nigeria ; Rectal Prolapse/diagnosis ; Sigmoid Diseases/diagnosis ; *Tropical Climate ; Typhoid Fever/diagnosis ; United States ; },
abstract = {Geographic location of a population plays a significant role in the interpretation of symptoms of some diseases of the colon. Because diverticular disease of the colon is very rare in the tropics, frank rectal bleeding, which may be suggestive of bleeding diverticulosis when it occurs in a temperate region, is suggestive of a bleeding ileal typhoid ulcer eroding terminal branches of the superior mesenteric artery. Similarly, symptoms suggestive of ulcerative colitis in a temperate region are suggestive of amebic colitis in the tropics. Anatomic variation also plays a part in the nature of some disease processes. The high incidence of freely mobile cecum and ascending colon and the freely mobile redundant sigmoid colon, seen in a tropical population, play a part in the frequent occurrence of nontumid intussusception, relatively high incidence of sigmoid volvulus, and relatively high incidence of rectal prolapse seen in the area.},
}
@article {pmid7145153,
year = {1982},
author = {Calcagno, A and Marino, G and Rimassa, PL},
title = {[Differential diagnostic problems in stenosis caused by colonic diverticular disease. Case studies].},
journal = {Minerva chirurgica},
volume = {37},
number = {19},
pages = {1513-1518},
pmid = {7145153},
issn = {0026-4733},
mesh = {Adult ; Aged ; Colonic Diseases/*diagnosis ; Colonic Neoplasms/diagnosis ; Diagnosis, Differential ; Diverticulum, Colon/*diagnosis ; Female ; Humans ; Intestinal Obstruction/*diagnosis/etiology ; Male ; Middle Aged ; },
}
@article {pmid7127036,
year = {1982},
author = {Bakker, FC and Hoitsma, HF and Den Otter, G},
title = {The Hartmann procedure.},
journal = {The British journal of surgery},
volume = {69},
number = {10},
pages = {580-582},
doi = {10.1002/bjs.1800691007},
pmid = {7127036},
issn = {0007-1323},
mesh = {Adult ; Aged ; Colon/injuries ; Colonic Diseases/surgery ; Colonic Neoplasms/surgery ; *Colostomy ; Diverticulitis, Colonic/surgery ; Female ; Humans ; Male ; Methods ; Middle Aged ; Postoperative Complications ; Rectum/*surgery ; Retrospective Studies ; },
abstract = {During a 10-year period, 59 patients had a Hartmann operation for diverticular disease (n = 19), carcinoma (n = 21), anastomotic disruption (n = 5), injury (n = 3) and various other conditions (n = 11). Twenty-two patients (37.3 per cent) died postoperatively. Wound infection or wound dehiscence occurred in 26 patients. Other complications inherent in this operation were colostomy necrosis or retraction (n = 12) and leakage of the rectal stump (n = 3). The mean hospital stay of the surviving patients was 28.4 days. Colorectal continuity was subsequently restored in 12 patients (32.4 per cent) and no difficulties were encountered with this procedure.},
}
@article {pmid6981860,
year = {1982},
author = {Shinya, H and Cwern, M and Wolf, G},
title = {Colonoscopic diagnosis and management of rectal bleeding.},
journal = {The Surgical clinics of North America},
volume = {62},
number = {5},
pages = {897-903},
doi = {10.1016/s0039-6109(16)42840-9},
pmid = {6981860},
issn = {0039-6109},
mesh = {Colitis/complications ; *Colonoscopy ; Diverticulitis/complications ; Evaluation Studies as Topic ; Gastrointestinal Hemorrhage/*etiology ; Hemorrhoids/complications ; Humans ; Intestinal Neoplasms/complications ; Intestinal Polyps/complications ; Proctitis/complications ; Rectum ; },
abstract = {The use of the colonoscope to evaluate the cause of rectal bleeding in a series of 2200 patients has been reviewed. The most common cause of bleeding in this series was found to be neoplastic polyps, which were present in 723 patients (32 per cent). Colonic carcinoma was detected as the source of the bleeding in 425 cases (19 per cent). Although a large number of barium enema films were false negatives, the patients reviewed are a highly select group. It is still believed that barium enema studies and colonoscopy are complementary rather than competitive procedures. Their continued combined use greatly enhances diagnostic accuracy. Various other causes of colonic bleeding, including inflammatory bowel disease, arteriovenous malformations, endometriosis, ovarian carcinoma, ischemic colitis, and radiation colitis, have been discussed and their endoscopic appearance described. Of particular significance is the coexistence of internal hemorrhoids or diverticular disease and neoplastic colonic lesions. Barium enema films and sigmoidoscopy have been frequently described as the twin pillars of diagnosis in the detection of colonic pathology. Colonoscopy, as the third pillar of diagnosis, should be an integral part of the evaluation of patients with rectal bleeding.},
}
@article {pmid6957779,
year = {1982},
author = {Sim, GP and Scobie, BA},
title = {Large bowel diseases in New Zealand based on 1118 air contrast enemas.},
journal = {The New Zealand medical journal},
volume = {95},
number = {715},
pages = {611-613},
pmid = {6957779},
issn = {0028-8446},
mesh = {Adolescent ; Adult ; Aged ; Air ; Barium Sulfate ; Child ; Colitis, Ulcerative/epidemiology ; Colonic Diseases/diagnostic imaging/*epidemiology ; Colonic Neoplasms/epidemiology ; Crohn Disease/epidemiology ; Diverticulum, Colon/epidemiology ; Enema ; Female ; Humans ; Intestinal Polyps/epidemiology ; Male ; Middle Aged ; New Zealand ; Radiography ; Rectal Diseases/diagnostic imaging/*epidemiology ; Rectal Neoplasms/epidemiology ; },
abstract = {Colorectal disorders were analysed from a radiology practice, where specific data were indexed at the time of each examination. Among 1118 consecutive adults examined by air contrast barium enema, 49 were found to have colorectal cancer, 49 polyps, 35 inflammatory bowel disease and 395 diverticular disease. The 267 patients under the age of 40 showed no carcinoma, two with polyps, 18 with inflammatory bowel disease and 16 with one or more diverticula. Carcinoma, polyp, and inflammatory bowel disease were detected no more frequently in patients with diverticular disease than without. Complicated diverticular disease was rare. An analysis of specific symptoms with uncomplicated diverticular disease showed patterns of bowel habit, pain or bleeding, no different from patients with negative barium enemas. Of the 44 colon carcinomas, 28 were located in the sigmoid; bleeding was the major presenting symptom in 11, while two others were anaemic. The importance of sigmoidoscopy in assessing abdominal symptoms and rectal bleeding is stressed, along with the need for radiology in patients over, rather than under, 40 years of age.},
}
@article {pmid6127581,
year = {1982},
author = {Bünte, H},
title = {[Prognosis of diverticular disease].},
journal = {Lebensversicherungs Medizin},
volume = {34},
number = {7},
pages = {161-162},
pmid = {6127581},
issn = {0024-0044},
mesh = {Adult ; Aged ; Diverticulum, Colon/complications/*therapy ; Humans ; Middle Aged ; Prognosis ; },
}
@article {pmid7114767,
year = {1982},
author = {Adiseshiah, M and Gault, D},
title = {Exteriorisation resection of the colon.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {64},
number = {5},
pages = {321-323},
pmid = {7114767},
issn = {0035-8843},
mesh = {Aged ; Colon/*surgery ; Colostomy ; Emergencies ; Female ; Humans ; Male ; Methods ; Middle Aged ; Postoperative Complications ; },
abstract = {The early results of 34 exteriorisation resections of the colon are presented, 25 being emergency procedures and 9 elective. The operative mortality in the emergency group was 20% and there were no deaths in the elective group. All patients who survived the postoperative period have had their colostomies closed. The operation was technically simple and quick to perform. It is one of the safest methods of resecting colon. The technique proved to be a useful alternative to standard techniques in colonic perforation, colonic obstruction with proximal faecal retention, nonviable sigmoid volvulus, diverticular disease requiring resection, and colovesical and colouterine fistula.},
}
@article {pmid6752421,
year = {1982},
author = {Barnett, WO},
title = {Surgical management of diverticular disease of the colon.},
journal = {Journal of the Mississippi State Medical Association},
volume = {23},
number = {9},
pages = {249-253},
pmid = {6752421},
issn = {0026-6396},
mesh = {Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Humans ; },
}
@article {pmid6291823,
year = {1982},
author = {Eastwood, MA and Watters, DA and Smith, AN},
title = {Diverticular disease--is it a motility disorder?.},
journal = {Clinics in gastroenterology},
volume = {11},
number = {3},
pages = {545-561},
pmid = {6291823},
issn = {0300-5089},
mesh = {Adolescent ; Adult ; Aged ; Aging ; Bile Acids and Salts/pharmacology ; Biomechanical Phenomena ; Calcium/pharmacology ; Child ; Child, Preschool ; Colon/physiopathology ; Dietary Fiber/administration & dosage ; Diverticulitis, Colonic/diagnosis/diet therapy/*physiopathology ; Diverticulum, Colon/diagnosis/diet therapy/*physiopathology ; Elasticity ; Feces ; Female ; Gastrointestinal Hormones/physiology ; *Gastrointestinal Motility/drug effects ; Humans ; Male ; Middle Aged ; Pain/diagnosis ; },
}
@article {pmid7131365,
year = {1982},
author = {Ferrie, BG and Smith, IS},
title = {Subcutaneous emphysema of thigh secondary to diverticular disease.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {27},
number = {4},
pages = {239-240},
pmid = {7131365},
issn = {0035-8835},
mesh = {Aged ; Diverticulum, Colon/*complications ; Emphysema/*etiology ; Humans ; Intestinal Fistula/*complications ; Male ; Radiography ; Sigmoid Diseases/*complications ; Subcutaneous Emphysema/*etiology ; Thigh/diagnostic imaging ; },
}
@article {pmid7104610,
year = {1982},
author = {Vellacott, KD and Amar, SS and Hardcastle, JD},
title = {Comparison of rigid and flexible fibreoptic sigmoidoscopy with double contrast barium enemas.},
journal = {The British journal of surgery},
volume = {69},
number = {7},
pages = {399-400},
doi = {10.1002/bjs.1800690714},
pmid = {7104610},
issn = {0007-1323},
mesh = {Adult ; *Barium Sulfate ; Colonic Diseases/*diagnosis/diagnostic imaging ; Enema ; Female ; Fiber Optic Technology ; Humans ; Male ; Middle Aged ; Radiography ; Sigmoid Diseases/diagnosis ; *Sigmoidoscopy ; },
abstract = {One hundred consecutive new patients attending a general surgical and gastrointestinal outpatient clinic had a flexible fibreoptic sigmoidoscopic examination before a double contrast barium enema. Colonic lesions were found in 45 patients and flexible sigmoidoscopy was superior to barium enemas in diagnosing lesions in the sigmoid colon. Two cancers, 1 histologically a Dukes' A lesion and 6 adenomatous polyps greater than 0.5 cm in diameter, in the sigmoid colon, were not detected by barium enemas. In 6 of these patients extensive diverticular disease was present. In patients with rectal bleeding found to have diverticular disease demonstrated radiographically, an endoscopic examination must be performed to exclude polyps or cancer. Flexible fibreoptic sigmoidoscopy may reduce the numbers needing barium enemas.},
}
@article {pmid7094785,
year = {1982},
author = {Garber, HI and Morris, DM and Eisenstat, TE and Coker, DD and Annous, MO},
title = {Factors influencing the morbidity of colostomy closure.},
journal = {Diseases of the colon and rectum},
volume = {25},
number = {5},
pages = {464-470},
doi = {10.1007/BF02553657},
pmid = {7094785},
issn = {0012-3706},
mesh = {Adolescent ; Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Child ; Child, Preschool ; Colon/injuries/*surgery ; Colonic Neoplasms/surgery ; *Colostomy ; Diverticulum, Colon/surgery ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Postoperative Complications ; Premedication ; Preoperative Care ; Surgical Wound Infection/epidemiology ; },
abstract = {In a series of 80 colostomy closures, a total complication rate of 26 per cent was found, with a wound infection rate of 14 per cent and an anastomotic leak rate of four per cent. Patients having preoperative systemic antibiotics had fewer wound infections than those who did not (eight per cent versus 19 per cent). Delayed primary skin closure or closure by secondary intention was associated with less wound morbidity than was primary closure (ten per cent versus 17 per cent). However, the use of preoperative systemic antibiotics decreased the incidence of wound infection in those having primary skin closure (five per cent versus 27 per cent). Patients having diverticular disease had more wound infections (40 per cent) and greater overall morbidity (70 per cent). Older patients had a higher incidence of complications (24 per cent if less than 40 years and 45 per cent if greater than 50 years). Closure of left-sided colostomies was associated with a higher infectious complication rate (26 per cent versus 13 per cent). The time interval to colostomy closure was found to alter subsequent morbidity with a waiting period of one to two months associated with zero complications.},
}
@article {pmid6806053,
year = {1982},
author = {Thompson, WG and Patel, DG and Tao, H and Nair, RC},
title = {Does uncomplicated diverticular disease produce symptoms?.},
journal = {Digestive diseases and sciences},
volume = {27},
number = {7},
pages = {605-608},
pmid = {6806053},
issn = {0163-2116},
mesh = {Abdomen ; Adolescent ; Adult ; Aged ; Body Weight ; Child ; Colon/physiopathology ; Constipation/etiology ; Diarrhea/etiology ; Diverticulum/*physiopathology ; Female ; Gastrointestinal Hemorrhage ; Humans ; Male ; Middle Aged ; Pain/etiology ; Rectum ; },
abstract = {A questionnaire dealing with bowel symptoms was administered to 97 outpatients referred for air-contrast barium enema. Subsequently, the barium enema was interpreted by a radiologist who did not know the results of the questionnaire. Forty-nine had normal x-rays, and 27 had uncomplicated diverticular disease. Weight loss, rectal bleeding, abdominal pain, and pain at night were as common in those with a normal examination as in those with diverticula. Symptoms of colon dysfunction included abdominal pain relieved by defecation, altered stool frequency and consistency with pain onset, abdominal distension, feeling of incomplete evacuation after defecation, and mucus in the stool. These were equally prevalent in both groups. Therefore, no symptoms could be ascribed to the presence of diverticula.},
}
@article {pmid6283684,
year = {1982},
author = {Painter, NS},
title = {Diverticular disease of the colon. The first of the Western diseases shown to be due to a deficiency of dietary fibre.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {61},
number = {26},
pages = {1016-1020},
pmid = {6283684},
issn = {0256-9574},
mesh = {Black or African American ; Black People ; Colon/ultrastructure ; Defecation ; Diet ; Dietary Fiber/*therapeutic use ; Diverticulum, Colon/diet therapy/epidemiology/*etiology ; Humans ; South Africa ; Terminology as Topic ; Time Factors ; Uganda ; White People ; },
abstract = {Diverticular disease of the colon is a new disease that appeared at the beginning of this century. It is now the commonest disease of the colon in the Western world, being found in 1 in 3 people of over 60 years of age. The pathogenesis of the disease involves excessive segmentation, but this does not explain its aetiology. The historical appearance of the disease on the clinical scene and its geographical distribution suggest that it is due to the removal of fibre from carbohydrates. The author treated 70 patients with symptomatic diverticular disease with a high-fibre diet. The results of this and the effects of bran are discussed.},
}
@article {pmid6280802,
year = {1982},
author = {Math, MV},
title = {Is bran useful in diverticular disease?.},
journal = {British medical journal (Clinical research ed.)},
volume = {284},
number = {6326},
pages = {1408-1409},
pmid = {6280802},
issn = {0267-0623},
mesh = {Constipation/prevention & control ; Dietary Fiber/*therapeutic use ; *Drinking ; Humans ; },
}
@article {pmid7081565,
year = {1982},
author = {Letwin, ER},
title = {Diverticulitis of the colon. Clinical review of acute presentations and management.},
journal = {American journal of surgery},
volume = {143},
number = {5},
pages = {579-581},
doi = {10.1016/0002-9610(82)90167-2},
pmid = {7081565},
issn = {0002-9610},
mesh = {Adult ; Aged ; Colonic Diseases/etiology ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intestinal Obstruction/etiology/surgery ; Intestinal Perforation/etiology/surgery ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; },
abstract = {A series of 46 patients treated surgically for acute sequelae of diverticular disease of the colon was reviewed. Perforation of sigmoid diverticulitis and colon obstruction were the most common indications for surgical treatment. Resection of the involved colon was carried out in 44 of 46 patients. Primary resection was performed in 27 patients and primary anastomosis was achieved in 19 of these. Staged resections were employed in 17 patients. The mortality rate was 4.4 percent and the complication rate 28.3 percent. Some suggestions are made in an effort to decrease morbidity in the future.},
}
@article {pmid6814467,
year = {1982},
author = {Palmieri, B and Fiore, N},
title = {[Clinically conclusive considerations on diverticular disease in the elderly].},
journal = {Bollettino chimico farmaceutico},
volume = {121},
number = {5},
pages = {47S-60S},
pmid = {6814467},
issn = {0006-6648},
mesh = {Aged ; Diagnosis, Differential ; Diverticulum/diagnosis/diet therapy/etiology/*physiopathology/therapy ; Humans ; },
}
@article {pmid6807798,
year = {1982},
author = {Zakhour, HD and Clark, RG},
title = {Intramural gas cysts in a case of diverticular disease of the jejunum.},
journal = {Histopathology},
volume = {6},
number = {3},
pages = {363-369},
doi = {10.1111/j.1365-2559.1982.tb02730.x},
pmid = {6807798},
issn = {0309-0167},
mesh = {Adult ; Diverticulum/*complications/pathology ; Female ; *Gases ; Humans ; Jejunal Diseases/*complications/pathology ; Lymph Nodes/pathology ; Pneumatosis Cystoides Intestinalis/*complications/etiology/pathology ; },
}
@article {pmid7088856,
year = {1982},
author = {Parks, TG},
title = {The clinical significance of diverticular disease of the colon.},
journal = {The Practitioner},
volume = {226},
number = {1366},
pages = {643-8, 650-4},
pmid = {7088856},
issn = {0032-6518},
mesh = {Adult ; Age Factors ; Aged ; Bed Rest ; Colonic Neoplasms/diagnosis ; Diagnosis, Differential ; Diverticulum, Colon/*diagnosis/pathology/therapy ; Female ; Humans ; Male ; Middle Aged ; Sigmoidoscopy ; },
}
@article {pmid6279226,
year = {1982},
author = {Allen-Mersh, T and De Jode, LR},
title = {Is bran useful in diverticular disease?.},
journal = {British medical journal (Clinical research ed.)},
volume = {284},
number = {6317},
pages = {740},
pmid = {6279226},
issn = {0267-0623},
mesh = {Aged ; Dietary Fiber/*adverse effects ; Diverticulum, Colon/*diet therapy ; Humans ; Intestinal Obstruction/etiology ; Intestine, Small ; Male ; },
}
@article {pmid7078781,
year = {1982},
author = {Stockmann, CH and Jakimowicz, JJ and Mak, B},
title = {Colovesical fistulas in diverticular disease of the colon.},
journal = {The Netherlands journal of surgery},
volume = {34},
number = {1},
pages = {18-20},
pmid = {7078781},
issn = {0167-2487},
mesh = {Adult ; Aged ; Colonic Diseases/*etiology/surgery ; Diverticulum, Colon/*complications ; Female ; Humans ; Intestinal Fistula/*etiology/surgery ; Male ; Methods ; Middle Aged ; Urinary Bladder Fistula/*etiology/surgery ; },
}
@article {pmid6951553,
year = {1982},
author = {Pheils, MT and Chapuis, PH and Bokey, EL and Hayward, P},
title = {Diverticular disease: a retrospective study of surgical management 1970-1980.},
journal = {The Australian and New Zealand journal of surgery},
volume = {52},
number = {1},
pages = {53-56},
pmid = {6951553},
issn = {0004-8682},
mesh = {Diverticulum, Colon/etiology/mortality/*surgery ; Drainage ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/complications ; Peritonitis/complications/mortality/surgery ; Postoperative Complications/etiology ; Retrospective Studies ; Sepsis/etiology ; },
abstract = {At Concord Hospital during the period 1970-1980, there were 2,530 admissions for diverticular disease. One hundred and twenty nine patients required operative treatment, 80 patients had a 'planned' resection and of the 56 patients admitted with peritonitis, 49 came to operation. The hospital mortality following resection was 7.5% and following operation for peritonitis was 14%. The morbidity after planned resection was 36% and after operation for peritonitis was 51%. Measures adopted to improve these results are discussed.},
}
@article {pmid6281350,
year = {1982},
author = {Kay, RM},
title = {Dietary fiber.},
journal = {Journal of lipid research},
volume = {23},
number = {2},
pages = {221-242},
pmid = {6281350},
issn = {0022-2275},
mesh = {Adsorption ; Animals ; Arteriosclerosis/prevention & control ; Bile Acids and Salts/metabolism ; Body Water/metabolism ; Cecum/microbiology ; Chemical Phenomena ; Chemistry ; Cholelithiasis/diet therapy ; Colon/microbiology ; Constipation/diet therapy ; Dietary Fiber/analysis/*pharmacology/therapeutic use ; Diverticulitis/diet therapy ; Gastrointestinal Motility/drug effects ; Glucose/metabolism ; Humans ; Intestinal Absorption ; Lignin/analysis ; Lipid Metabolism ; Polysaccharides/analysis ; },
abstract = {Dietary fiber is plant-derived material that is resistant to digestion by human alimentary enzymes. Fiber may be divided into two broad chemical classes: 1) non-alpha-glucan polysaccharides (cellulose, hemicelluloses, and pectins) and 2) lignins. Dietary fiber behaves within the gastrointestinal tract as a polymer matrix with variable physicochemical properties including susceptibility to bacterial fermentation, water-holding capacity, cation-exchange, and adsorptive functions. These properties determine physiological actions of fiber and are dependent on the physical and chemical composition of the fiber. Fiber undergoes compositional changes as a consequence of bacterial enzymatic action in the colon. Dietary fiber is of clinical significance in certain disorders of colonic function and in glucose and lipid metabolism. Dietary fiber increases stool bulk by acting as a vehicle for fecal water and by increasing fecal bacterial volume. Use of fiber in the treatment of constipation and uncomplicated diverticular disease is well established. By increasing stool bulk, fiber also reduces the fecal concentration of bile acids and other substances. Certain types of fiber decrease the rate of glucose absorption and attenuate postprandial rises in blood glucose and insulin. Plasma cholesterol levels are reduced by mucilaginous forms of fiber. This effect appears to be mediated in part by an increase in fecal acidic sterol excretion.},
}
@article {pmid7063830,
year = {1982},
author = {Lawson, AH},
title = {The incidence of occult bleeding per rectum in a general practice in Scotland: a study using haemoccult.},
journal = {Scottish medical journal},
volume = {27},
number = {1},
pages = {49-51},
doi = {10.1177/003693308202700111},
pmid = {7063830},
issn = {0036-9330},
mesh = {Aged ; Colonic Diseases/diagnosis/epidemiology ; Diverticulum, Colon/diagnosis ; Family Practice ; Female ; Hemorrhoids/diagnosis ; Humans ; Male ; Middle Aged ; *Occult Blood ; Rectal Diseases/diagnosis/epidemiology ; Scotland ; },
abstract = {Haemoccult (Eaton Laboratories) was offered to all 405 subjects aged 45 to 65 years in a Scottish, rural general practice as a screening test for occult bleeding per rectum. Subjects contacted verbally had a compliance rate of 85.2 per cent and those by post 59.5 per cent--2.6 per cent (7) returned positive tests. Of these seven, one refused follow-up. Two had diverticular disease, one had haemorrhoids, one had a possible polyp, one had ingested aspirin and also had a few diverticula. In one patient, no cause of bleeding was found. The last two and one with diverticular disease were negative on re-testing. In general, the test was aesthetically acceptable to undertake for both patient and doctor and provided a suitable screening technique for occult bleeding.},
}
@article {pmid7054629,
year = {1982},
author = {Wedell, J and Meier zu Eissen, J and Störmer, J and Meier zu Eissen, P},
title = {[Morbidity and mortality following intraperitoneal closure of transverse loop colostomy (author's transl)].},
journal = {Langenbecks Archiv fur Chirurgie},
volume = {356},
number = {1},
pages = {17-24},
pmid = {7054629},
issn = {0023-8236},
mesh = {Adult ; Aged ; Colonic Neoplasms/surgery ; Colostomy/*methods ; Diverticulitis, Colonic/surgery ; Female ; Humans ; Intestinal Fistula/surgery ; Male ; Middle Aged ; Postoperative Complications/*mortality ; Rectal Neoplasms/surgery ; Retrospective Studies ; Wound Healing ; },
abstract = {The postoperative course of 104 patients, who underwent closure of a transverse loop colostomy at the Surgical Department of the Teaching Hospital Herford between 1974 and 1980 after distal resection and anastomosis of the large bowel for neoplastic or diverticular disease has been reviewed in detail. The mortality was 0.9% and the morbidity rate was 25%, including 25% wound infections and 4.8% fecal fistulas. The highest complication rate was noted, when colostomies were closed during the first 6 weeks. Wound infections and fecal fistulae did not occur more frequently than in patients with diverticulitis. The intraperitoneal procedure of transverse loop colostomy closure can be recommended as to be straightforward and safe.},
}
@article {pmid6813167,
year = {1982},
author = {Segal, I and Walker, AR},
title = {Diverticular disease in urban Africans in South Africa.},
journal = {Digestion},
volume = {24},
number = {1},
pages = {42-46},
doi = {10.1159/000198773},
pmid = {6813167},
issn = {0012-2823},
mesh = {Adult ; Black or African American ; Age Factors ; Aged ; Black People ; Colon/diagnostic imaging ; Diet ; Diverticulum, Stomach/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Sex Factors ; South Africa ; Urban Population ; },
abstract = {At Baragwanath Hospital, Johannesburg, South Africa, during a 3-year period diverticular disease was diagnosed in 42 Black patients (16 men, 26 women), from an urban population approaching 1,5 million. Patients presented mainly with rectal bleeding, abdominal mass or pain. Of average age 62 years, all were among the more privileged. The persisting very low frequency of the disease, which is in consonance with low frequencies of other bowel diseases (appendicitis, ulcerative colitis, colon cancer), is deemed valid. The mean daily dietary fibre intake, 26.5 +/- 8.5 g, was higher than that of local Whites, 22.4 +/- 6.0 g, but significantly less than that of a sex-age matched urban Black control group, 32.5 +/- 11.4 g. Although a measure of westernization of diet has obviously occurred, its extent, also the period of exposure, would seem to have been insufficient to have evoked significant rises in the occurrence of diverticular disease.},
}
@article {pmid6298928,
year = {1982},
author = {Weinreich, J},
title = {Treatment of diverticular disease.},
journal = {Scandinavian journal of gastroenterology. Supplement},
volume = {79},
number = {},
pages = {128-129},
pmid = {6298928},
issn = {0085-5928},
mesh = {Atropine/therapeutic use ; Colon, Sigmoid/physiopathology ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/drug therapy/physiopathology/*therapy ; Humans ; },
}
@article {pmid6275936,
year = {1981},
author = {Littlewood, ER and Ornstein, MH and Baird, IM and Cox, AG},
title = {Doubts about diverticular disease.},
journal = {British medical journal (Clinical research ed.)},
volume = {283},
number = {6305},
pages = {1524-1526},
pmid = {6275936},
issn = {0267-0623},
mesh = {Clinical Trials as Topic ; Colon/physiopathology ; Dietary Fiber/administration & dosage/*therapeutic use ; Diverticulum, Colon/*diet therapy/physiopathology ; Humans ; },
}
@article {pmid6275935,
year = {1981},
author = {Heaton, KW},
title = {Is bran useful in diverticular disease?.},
journal = {British medical journal (Clinical research ed.)},
volume = {283},
number = {6305},
pages = {1523-1524},
pmid = {6275935},
issn = {0267-0623},
mesh = {Clinical Trials as Topic ; Dietary Fiber/administration & dosage/*therapeutic use ; Diverticulum, Colon/*diet therapy ; Humans ; Random Allocation ; },
}
@article {pmid7336302,
year = {1981},
author = {Antos, F and Nahodil, V and Leffler, J},
title = {[Indications for the surgical treatment of diverticular disease of the large intestine].},
journal = {Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti},
volume = {60},
number = {12},
pages = {827-833},
pmid = {7336302},
issn = {0035-9351},
mesh = {Adult ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Male ; Methods ; Middle Aged ; },
}
@article {pmid6279729,
year = {1981},
author = {Stephen, AM},
title = {Should we eat more fibre?.},
journal = {Journal of human nutrition},
volume = {35},
number = {6},
pages = {403-414},
pmid = {6279729},
issn = {0308-4329},
mesh = {Colonic Neoplasms/prevention & control ; Constipation/diet therapy ; Coronary Disease/prevention & control ; *Dietary Fiber/analysis/therapeutic use ; Diverticulum/diet therapy ; Feces ; Feeding Behavior ; Humans ; United Kingdom ; },
abstract = {Controversy continues over the role of dietary fibre in health, and whether or not a standard fibre intake should be recommended for the UK. In this review an attempt is made to consider the evidence for and against making such a recommendation. In doing so, it is clear that many problems exist in studies examining the role of fibre in disease, such as the inherent inadequacies of epidemiological studies and distrust of such studies by some circles, or the lack of uniformity in definition of dietary fibre and in its chemical analysis. The effect of fibre on faecal bulking is given as an example of experimental verification of epidemiological findings which has led to the widespread use of fibre in treating diverticular disease and constipation. Evidence of beneficial effects for cancer of the colon and ischaemic heart disease are far less convincing. Few harmful effects of fibre have been documented, apart from continuing disagreement regarding fibre and mineral balance, a question which remains to be solved. On weighing the evidence, it is suggested that recommending higher-fibre intakes in the UK is a favourable guideline. The type of fibre to be recommended is discussed, based on new evidence of the mode of action of different types of fibre in the gastrointestinal tract, and the amount of fibre considered, in relation to intakes in other countries and in the past in the UK.},
}
@article {pmid7301230,
year = {1981},
author = {Raventos, JM and Symmonds, RE},
title = {Surgical management of acute diverticulitis in women.},
journal = {Obstetrics and gynecology},
volume = {58},
number = {5},
pages = {557-565},
pmid = {7301230},
issn = {0029-7844},
mesh = {Acute Disease ; Adult ; Aged ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis/mortality/*surgery ; Female ; Genital Diseases, Female/diagnosis ; Humans ; Methods ; Middle Aged ; Postoperative Complications/mortality ; Retrospective Studies ; },
abstract = {The incidence of diverticular disease of the colon has increased during the course of this century. The management of diverticulitis has changed in many centers from a conservative medical approach to a more aggressive surgical one. The surgical technique has also evolved; primary resection and anastomosis is currently preferred after a standard bowel preparation. The authors reviewed the medical histories of 387 women who had undergone abdominal operation for acute diverticulitis at the Mayo Clinic during a recent 8-year period. Of the 387 patients, 71 (18.3%) had presented with a pelvic mass and 84 (21.7%) had the operation performed by a gynecologic surgeon. The preoperative evaluation, type of operation, morbidity, and mortality in the entire group and in the group managed by a gynecologic surgeon were studied and compared.},
}
@article {pmid6272566,
year = {1981},
author = {Smith, AN and Drummond, E and Eastwood, MA},
title = {The effect of coarse and fine Canadian Red Spring Wheat and French Soft Wheat bran on colonic motility in patients with diverticular disease.},
journal = {The American journal of clinical nutrition},
volume = {34},
number = {11},
pages = {2460-2463},
doi = {10.1093/ajcn/34.11.2460},
pmid = {6272566},
issn = {0002-9165},
mesh = {Colon/*physiology ; Dietary Fiber/*pharmacology ; Diverticulitis, Colonic/*physiopathology ; Feces ; Gastrointestinal Motility/*drug effects ; Humans ; *Triticum ; },
abstract = {Bran from a Canadian Red Spring Wheat, of both a coarse and fine type, was compared with that from a French Soft Wheat, also with coarse and fine characteristics. The coarse type whether Canadian or French had the more significant effect on the stool weight, speeded the intestinal transit as measured by Hinton markers, and reduced intraluminal pressure in the colon more than did the fine types from the same sources in patients with diverticular disease. The texture of a bran may be important in relationship to its clinical efficacy.},
}
@article {pmid6796727,
year = {1981},
author = {Shimura, A and Momiyama, T and Takashima, Y and Ito, H},
title = {[A case of diverticular disease of the rectum (author's transl)].},
journal = {Rinsho hoshasen. Clinical radiography},
volume = {26},
number = {10},
pages = {1071-1074},
pmid = {6796727},
issn = {0009-9252},
mesh = {Adult ; Diagnosis, Differential ; Diverticulum/*diagnosis ; Humans ; Male ; Proctoscopy ; Rectal Diseases/*diagnosis ; },
}
@article {pmid6271651,
year = {1981},
author = {Smith, AN and Shepherd, J and Eastwood, MA},
title = {Pressure changes after balloon distension of the colon wall in diverticular disease.},
journal = {Gut},
volume = {22},
number = {10},
pages = {841-844},
pmid = {6271651},
issn = {0017-5749},
mesh = {Colon/*physiopathology/surgery ; Dietary Fiber/therapeutic use ; Dilatation ; Diverticulum, Colon/diet therapy/*physiopathology/surgery ; Humans ; Pressure ; },
abstract = {Balloon distension of the distal colon in diverticular disease does not produce the pressure change in response to increasing volumes that occurs in normal subjects. This phenomenon, though modified at first by resection, is not abolished by resection nor by myotomy or bran. This adaptive quality of the wall of the colon to balloon distension possibly reflects a structural change in its wall, as the phenomenon was present in the colon in diverticular disease in vitro as well as in vivo.},
}
@article {pmid6269023,
year = {1981},
author = {Bonardi, O},
title = {[Diverticular disease of the colon].},
journal = {Minerva medica},
volume = {72},
number = {35},
pages = {2378-2382},
pmid = {6269023},
issn = {0026-4806},
mesh = {Adult ; Aged ; Anorexia/etiology ; Diagnosis, Differential ; Dietary Fiber ; Diverticulum, Colon/complications/diagnosis/diet therapy/*epidemiology ; Female ; Humans ; Intestinal Mucosa/pathology ; Intestinal Neoplasms/diagnosis ; Male ; Middle Aged ; Nausea/etiology ; Pain/etiology ; Sigmoid Diseases/complications/diagnosis/diet therapy/epidemiology ; },
}
@article {pmid6912318,
year = {1981},
author = {},
title = {Back to basics: diverticular disease.},
journal = {The Journal of practical nursing},
volume = {31},
number = {8},
pages = {27-8, 39},
pmid = {6912318},
issn = {0022-3867},
mesh = {Aged ; Diverticulitis, Colonic/*nursing ; Diverticulum, Colon/*nursing ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid7286782,
year = {1981},
author = {Segal, I and Cooke, SA and Hamilton, DG and Ou Tim, L},
title = {Polyps and colorectal cancer in South African Blacks.},
journal = {Gut},
volume = {22},
number = {8},
pages = {653-657},
pmid = {7286782},
issn = {0017-5749},
mesh = {Adolescent ; Adult ; Aged ; Black People ; Colonic Neoplasms/*epidemiology/etiology ; Diet/adverse effects ; Female ; Humans ; Intestinal Polyps/*epidemiology/etiology ; Male ; Middle Aged ; Rectal Neoplasms/*epidemiology/etiology ; South Africa ; },
abstract = {This study reflects the fact that cancer of the large bowel is uncommon in South African Blacks, and that colorectal polyps do not appear to constitute a precursor to most colorectal cancers. Furthermore, it is shown that dietary factors associated with this cancer in Western populations are not evident in the Black population. In the South African White population, however, the disease behaves in a similar way to that observed in Western countries. Other definitive differences found were the absence of multiple synchronous cancers and diverticular disease in the Blacks with colorectal cancer. It is thus postulated that dietary factors are absent, or have not been present for a sufficient length of time to influence the development of polyps or polyp--cancer sequence in this population. It is also possible that the adenoma--carcinoma progression observed in Western countries may not be relevant to the development of all colorectal carcinomas in communities such as those reported here.},
}
@article {pmid7029176,
year = {1981},
author = {Raguse, T and Kühnel, W},
title = {[Pathogenesis of colon diverticular disease (author's transl)].},
journal = {Leber, Magen, Darm},
volume = {11},
number = {4},
pages = {147-158},
pmid = {7029176},
issn = {0300-8622},
mesh = {Colitis, Ulcerative/pathology/physiopathology ; Diverticulitis, Colonic/etiology/pathology/*physiopathology ; Electrophysiology ; Gastrointestinal Motility ; Humans ; Intestine, Large/*ultrastructure ; Muscle Contraction ; Muscle, Smooth/metabolism/*physiopathology ; },
abstract = {The longitudinal musculature of the taenia of the colon does play an important role in diverticular disease (DD), as can be found by comparing light and electron microscopic pictures of the colon from healthy persons and patients with diverticulitis and ulcerative colitis. Already in the early stages histological changes can be found, which have to be interpreted as being due to maximal contraction of the longitudinal musculature and to increased metabolism. These morphological changes are accompanied by increased electrical and mechanical activity. Disturbed function seems to be myogenic, as could be shown by studies with different drugs. These results seem to indicate that it might be preferable to incise the longitudinal musculature of the colon transversally during surgery because of diverticulosis.},
}
@article {pmid6266574,
year = {1981},
author = {Painter, NS},
title = {Are fibre supplements really necessary in diverticular disease.},
journal = {British medical journal (Clinical research ed.)},
volume = {283},
number = {6284},
pages = {140},
doi = {10.1136/bmj.283.6284.140-a},
pmid = {6266574},
issn = {0267-0623},
mesh = {Cellulose/*therapeutic use ; Dietary Fiber/*therapeutic use ; Diverticulum, Colon/*diet therapy ; Humans ; },
}
@article {pmid7237380,
year = {1981},
author = {Riddell, RH and Goodman, MJ and Moossa, AR},
title = {Peritoneal malignant mesothelioma in a patient with recurrent peritonitis.},
journal = {Cancer},
volume = {48},
number = {1},
pages = {134-139},
doi = {10.1002/1097-0142(19810701)48:1<134::aid-cncr2820480124>3.0.co;2-4},
pmid = {7237380},
issn = {0008-543X},
mesh = {Adult ; Diverticulitis, Colonic/*complications/pathology ; Humans ; Male ; Mesothelioma/*complications/pathology ; Peritoneal Neoplasms/*complications/pathology ; },
abstract = {A patient is presented who developed a peritoneal malignant mesothelioma in association with severe persistent and recurrent diverticulitis. The case is unusual in that a spectrum of mesothelial proliferation was documented beginning initially as benign foci of mesothelial proliferation and passing through a stage of atypical proliferation before terminating as a malignant process. The possible role of the diverticular disease in the pathogenesis of the tumor is discussed.},
}
@article {pmid6266788,
year = {1981},
author = {Dabestani, A and Aliabadi, P and Shah-Rookh, FD and Borhanmanesh, FA},
title = {Prevalence of colonic diverticular disease in southern Iran.},
journal = {Diseases of the colon and rectum},
volume = {24},
number = {5},
pages = {385-387},
doi = {10.1007/BF02603424},
pmid = {6266788},
issn = {0012-3706},
mesh = {Adult ; Aged ; Dietary Fiber ; Diverticulum, Colon/*epidemiology ; Female ; Humans ; Iran ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {Five hundred fifty-six barium enema examinations performed in male and female patients (aged 20--70+ years) were studied retrospectively to estimate the prevalence of colonic diverticulosis in southern Iran. The frequency of diverticulosis in all subjects above the age of 20 years was 1.6 per cent, in persons above the age of 50 years, 2.4 per cent, and in persons below the age of 50 years, 1.2 per cent. This is in marked contrast to the high prevalence of the disease in Western countries, e.g., the 20 per cent overall prevalence in the United States. The high dietary fiber intake of the Iranian people may explain the rarity of the disease in Iran.},
}
@article {pmid6265284,
year = {1981},
author = {Talbot, JM},
title = {Role of dietary fiber in diverticular disease and colon cancer.},
journal = {Federation proceedings},
volume = {40},
number = {9},
pages = {2337-2342},
pmid = {6265284},
issn = {0014-9446},
mesh = {*Cellulose ; Clinical Trials as Topic ; Colonic Neoplasms/*etiology ; *Dietary Fiber/administration & dosage ; Digestion ; Diverticulum, Colon/*etiology ; Gastrointestinal Motility ; Humans ; Risk ; },
abstract = {This paper reviews recent research on the characterization, properties, and definition of dietary fiber as well as its possible role in colonic carcinogenesis and diverticulosis. Despite progress in analytic methods and characterization, an accepted definition and terminology for fiber are lacking as is an accurate, rapid method for measurement of total dietary fiber or fiber in foods. Mechanisms of effects of fiber in the gut and the significant of interactions between fiber, nutrients gut flora and associated metabolites, and enteric secretions are unclear. Epidemiologic and experimental data indicate an increased risk of diverticular disease and colonic cancer with low-fiber intakes; however, genetic, environmental, cultural, dietary, and other variables were often uncontrolled in the epidemiologic studies. Thus, conclusive evidence for a causal relationship between low intake of fiber and diverticulosis or colonic cancer is not available, and the question whether first protects against human colonic cancer and/or diverticulosis is not completely resolved. Clinical trials in which symptomatic diverticular disease was treated with supplementary dietary fiber have generally had favorable results. Numerous specific questions require additional study before a role for dietary fiber in the prevention of human colonic diverticulosis and cancer of the colon can be established. Suggestions for possible future investigation are provided.},
}
@article {pmid7257366,
year = {1981},
author = {},
title = {Diverticular disease of the colon.},
journal = {The Western journal of medicine},
volume = {134},
number = {6},
pages = {515-523},
pmid = {7257366},
issn = {0093-0415},
mesh = {Animals ; Diagnosis, Differential ; *Diverticulitis, Colonic/pathology/physiopathology ; *Diverticulum, Colon/pathology/physiopathology ; Humans ; Macaca mulatta ; Rabbits ; },
}
@article {pmid7238272,
year = {1981},
author = {Capron, JP and Piperaud, R and Dupas, JL and Delamarre, J and Lorriaux, A},
title = {Evidence for an association between cholelithiasis and diverticular disease of the colon: a case-controlled study.},
journal = {Digestive diseases and sciences},
volume = {26},
number = {6},
pages = {523-527},
pmid = {7238272},
issn = {0163-2116},
mesh = {Adult ; Age Factors ; Aged ; Body Weight ; Cholelithiasis/*complications ; Diverticulum, Colon/*complications/diagnosis ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; },
abstract = {A prospective case-control study was carried out to determine if there was a true association between diverticular disease of the colon and cholelithiasis. The prevalence of gallstones was higher in 102 patients with diverticular disease of the colon (45%) than in 102 control subjects, matched for age, sex, body weight, and number of pregnancies (22%) (P less than 0.001). The difference was only significant in women. Although these results obtained in hospitalized patients cannot be generalized to the population at large, this study suggests an association between diverticular disease of the colon and gallstone disease. The possibilities of referral bias, detection bias, and chance are considered, and the mechanism of this association is discussed, with particular reference to the role of a fiber-depleted diet.},
}
@article {pmid6263077,
year = {1981},
author = {Spiller, GA and Freeman, HJ},
title = {Recent advances in dietary fiber and colorectal diseases.},
journal = {The American journal of clinical nutrition},
volume = {34},
number = {6},
pages = {1145-1152},
doi = {10.1093/ajcn/34.6.1145},
pmid = {6263077},
issn = {0002-9165},
mesh = {1,2-Dimethylhydrazine ; Animals ; Cellulose/*therapeutic use ; Colitis/prevention & control ; Colitis, Ulcerative/etiology ; Colonic Diseases/*prevention & control ; Colonic Neoplasms/chemically induced/prevention & control ; Crohn Disease/etiology ; Dietary Fats/administration & dosage ; Dietary Fiber/administration & dosage/*therapeutic use ; Dimethylhydrazines ; Disease Models, Animal ; Diverticulum, Colon/drug therapy/epidemiology/etiology/prevention & control ; Humans ; Rectal Diseases/*prevention & control ; },
abstract = {Dietary fiber has emerged in the past decade as a factor in nutrition that appears to have complex physiological and clinical implications. A great deal of research has focused on its effect on colorectal diseases. Some human epidemiological studies on colon cancer point to a possible preventive role of dietary fiber, but the results are confounded by the difference in the intake of many other food substances such as fat and the overall differences in the dietary pattern of the populations investigated. Animal studies using chemical carcinogens, such as 1,2-dimethylhydrazine, have lent support to a protective role of certain components of fiber, such as purified cellulose. Other fiber polymers, such as pectin, have not shown any protective effect. Perhaps the strongest evidence for a protective role of fiber in the colon comes from studies relating low dietary fiber intake to the higher incidence of diverticular disease of the colon; addition of dietary fiber to the diet of patients with symptomatic diverticular disease seems to relieve pain effectively. Recently, some preliminary studies have shown the possible correlation of low dietary fiber intake with a greater incidence of ulcerative colitis and Crohn's disease, but these studies are too limited in number and scope to allow any conclusion to be reached at this time.},
}
@article {pmid7244594,
year = {1981},
author = {Marti, MC and Premet, C},
title = {[Follow-up of patients operated on for diverticular diseases].},
journal = {Schweizerische medizinische Wochenschrift},
volume = {111},
number = {22},
pages = {792-793},
pmid = {7244594},
issn = {0036-7672},
mesh = {Diverticulum, Colon/*surgery ; Emergencies ; Follow-Up Studies ; Humans ; Surveys and Questionnaires ; },
abstract = {Clinical follow-up of 118 patients who had undergone emergency of elective large bowel resection for diverticular disease proves that surgery prevents recurrences of acute diverticular disease and is curative of the complications of the disease. No reoperation was necessary for complications of diverticulitis. Healing was achieved subjectively and objectively in 44.9% of patients. Wound healing defects are, however, too frequent. Large bowel motility disorders were present in 55.1% of our cases; they can be corrected by dietetic and pharmacologic measures.},
}
@article {pmid6263399,
year = {1981},
author = {Ornstein, MH and Littlewood, ER and Baird, IM and Fowler, J and Cox, AG},
title = {Are fibre supplements really necessary in diverticular disease of the colon?.},
journal = {British medical journal (Clinical research ed.)},
volume = {282},
number = {6276},
pages = {1629-1630},
pmid = {6263399},
issn = {0267-0623},
mesh = {Cellulose/*therapeutic use ; Dietary Fiber/*therapeutic use ; Diverticulum, Colon/*diet therapy ; Food, Fortified ; Humans ; },
}
@article {pmid6263398,
year = {1981},
author = {},
title = {Are fibre supplements really necessary in diverticular disease of the colon?.},
journal = {British medical journal (Clinical research ed.)},
volume = {282},
number = {6275},
pages = {1546-1547},
pmid = {6263398},
issn = {0267-0623},
mesh = {Cellulose/*administration & dosage ; Dietary Fiber/*administration & dosage ; Diverticulum, Colon/*diet therapy ; Humans ; },
}
@article {pmid6972688,
year = {1981},
author = {Ogle, SJ},
title = {Changing views on diverticular disease as a cause of gastro-intestinal bleeding.},
journal = {Age and ageing},
volume = {10},
number = {2},
pages = {110-114},
doi = {10.1093/ageing/10.2.110},
pmid = {6972688},
issn = {0002-0729},
mesh = {Aged ; Colonoscopy ; Diverticulitis, Colonic/*complications ; Diverticulum, Colon/*complications ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; },
abstract = {Over the past 60 years there has been continuing controversy and changing views about the relative importance of diverticular disease as a cause of gastro-intestinal haemorrhage. In the 1920s neoplasms were thought to be the commonest cause of colonic bleeding, then in the 1950s diverticulitis and subsequently diverticulosis. However, at that time the diagnosis of diverticular haemorrhage was mostly one of exclusion. In the 1960s an attempt was made to identify the site of bleeding and it was found that even though diverticula are mostly in the left colon, bleeding occurred from the right colon. A partial explanation for this came with the advent of arteriography and the discovery of caecal angiodysplasias. The relative importance of the two conditions remains uncertain but it is clear that, in patients with gastro-intestinal haemorrhage, the presence of diverticula should not stop a thorough search for other causes of bleeding.},
}
@article {pmid6972290,
year = {1981},
author = {Ulin, AW and Pearce, AE and Weinstein, SF},
title = {Diverticular disease of the colon: surgical perspectives in the past decade.},
journal = {Diseases of the colon and rectum},
volume = {24},
number = {4},
pages = {276-281},
doi = {10.1007/BF02641877},
pmid = {6972290},
issn = {0012-3706},
mesh = {Colectomy ; Diverticulum, Colon/classification/diagnosis/*surgery ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; },
abstract = {Review of 475 cases of diverticular disease of the colon emphasized needs to stratify patients into clinical categories. Of 223 cases of diverticulosis coli, had significant colonic complaints which received no attention. Of 198 emergency admissions for acute diverticulitis, only 16 required emergency surgery. Resection in the face of serious peritonitis is not advisable. Twenty-seven elective resections gave excellent results. Three subtotal colectomies were successfully done for major bleeding. Final focus was on determination of therapy groups: medical, surgery advisable, and surgery inevitable.},
}
@article {pmid6263396,
year = {1981},
author = {Ornstein, MH and Littlewood, ER and Baird, IM and Fowler, J and North, WR and Cox, AG},
title = {Are fibre supplements really necessary in diverticular disease of the colon? A controlled clinical trial.},
journal = {British medical journal (Clinical research ed.)},
volume = {282},
number = {6273},
pages = {1353-1356},
pmid = {6263396},
issn = {0267-0623},
mesh = {Adult ; Aged ; Cellulose/*therapeutic use ; Clinical Trials as Topic ; Defecation ; Dietary Fiber/*therapeutic use ; Diverticulum, Colon/*diet therapy/physiopathology ; Double-Blind Method ; Feces ; Female ; Humans ; Male ; Middle Aged ; Random Allocation ; },
abstract = {Fifty-eight patients with uncomplicated diverticular disease of the colon took bran crispbread, ispaghula drink, and placebo for four months each in a randomised, cross-over, double-blind controlled trial. Assessments were made subjectively, using a monthly self-administered questionnaire, and objectively, by examining a seven-day stool collection at the end of each treatment period. In terms of a pain score, lower bowel symptom score (the pain score and sensation of incomplete emptying, straining, stool consistency, flatus, and aperients taken), and total symptom score (belching, nausea, vomiting, dyspepsia, and abdominal distension) fibre supplementation conferred no benefit. Symptoms of constipation, however, when assessed alone, were significantly relieved. Both fibre regimens produced the expected changes in stool weight, consistency, and frequency. It is concluded that dietary fibre supplements in the commonly used doses do no more than relieve constipation. Perhaps the impression that fibre helps diverticular disease is simply a manifestation of Western civilisation's obsession with the need for regular frequent defecation.},
}
@article {pmid7227131,
year = {1981},
author = {Bokey, EL and Chapuis, PH and Pheils, MT},
title = {Elective resection for diverticular disease and carcinoma. Comparison of postoperative morbidity and mortality.},
journal = {Diseases of the colon and rectum},
volume = {24},
number = {3},
pages = {181-182},
doi = {10.1007/BF02962329},
pmid = {7227131},
issn = {0012-3706},
mesh = {Aged ; Colectomy ; Colonic Neoplasms/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Retrospective Studies ; Risk ; Surgical Wound Dehiscence/epidemiology/mortality ; },
abstract = {A retrospective comparison was made of 47 patients who underwent elective surgical resection for diverticular disease and 106 patients who had sigmoid colectomy or left hemicolectomy for carcinoma over an eight and one-half-year period. There was higher morbidity and mortality in those patients with diverticular disease.},
}
@article {pmid7463618,
year = {1981},
author = {Bohrer, SP and Prado, J and Orozco, L and Piedrasanta, E},
title = {Diverticular disease and pelvic phleboliths in Mayan Indians.},
journal = {JAMA},
volume = {245},
number = {10},
pages = {1026-1027},
doi = {10.1001/jama.1981.03310350016011},
pmid = {7463618},
issn = {0098-7484},
mesh = {Adult ; Aged ; Calculi/*epidemiology ; Diverticulum, Colon/*epidemiology ; Female ; Humans ; *Indians, Central American ; Male ; Middle Aged ; Pelvis/blood supply ; *Veins ; },
}
@article {pmid7215806,
year = {1981},
author = {Burakoff, R},
title = {An updated look at diverticular disease.},
journal = {Geriatrics},
volume = {36},
number = {3},
pages = {83-91},
pmid = {7215806},
issn = {0016-867X},
mesh = {Abdomen ; Aged ; Barium Sulfate ; Colon/diagnostic imaging ; Colonic Diseases, Functional/diagnosis ; Colonic Neoplasms/diagnosis ; Constipation/diagnosis ; Diagnosis, Differential ; Diarrhea/diagnosis ; Diverticulitis, Colonic/*diagnosis/therapy ; Enema ; Humans ; Melena/diagnosis ; Middle Aged ; Pain/diagnosis ; Radiography ; Rectum ; },
}
@article {pmid6259926,
year = {1981},
author = {Burkitt, DP},
title = {Hiatus hernia: is it preventable?.},
journal = {The American journal of clinical nutrition},
volume = {34},
number = {3},
pages = {428-431},
doi = {10.1093/ajcn/34.3.428},
pmid = {6259926},
issn = {0002-9165},
mesh = {Africa ; Black or African American ; Black People ; Cellulose/*pharmacology ; Cholelithiasis/epidemiology/etiology ; Defecation ; Developing Countries ; Diet ; Dietary Fiber/*pharmacology ; Diverticulum, Colon/epidemiology/etiology ; Europe ; Hernia, Diaphragmatic/*etiology ; Hernia, Hiatal/epidemiology/*etiology/prevention & control ; Humans ; Middle Aged ; North America ; White People ; },
abstract = {Hiatus hernia, diverticular disease of the colon, and gallstones have their maximum prevalence in economically most developed Western countries, and their minimum in Africa. These three diseases are associated not only epidemiologically but also in individual patients. Their prevalence is closely comparable in black and white Americans today. Evidence is presented to support the hypothesis that each of these diseases is in fact a result of consuming fiber-depleted diets, and it is argued that this accounts for interrelationships.},
}
@article {pmid7460720,
year = {1981},
author = {Desechalliers, JP and Galmiche, JP and Denis, P and Teniere, P and Testart, J and Colin, R},
title = {Diverticulitis in a patient with a 47-year defunctionalized colon.},
journal = {Digestive diseases and sciences},
volume = {26},
number = {2},
pages = {187-190},
pmid = {7460720},
issn = {0163-2116},
mesh = {Colectomy ; Colonic Diseases/*surgery ; Diverticulitis/*surgery ; Humans ; Male ; Manometry ; Middle Aged ; },
abstract = {A patient who had a cecostomy because of a complicated appendicitis at the age of 17 functioned with an excluded colon for 47 years. He was then hospitalized for diverticulitis and left pericolic abscess. After treatment of the abscess by left segmental colectomy and reanastomosis, the cecostomy was closed. Two years later, he presented a normal bowel habit and improvement of his diverticulosis. Rectal manometric study showed that the rectal was normal both before and two years after surgery. Occurrence of diverticular disease in a normally innervated and vascularized, but almost empty, colon presenting with normal mechanical properties is consistent with Burkitt's hypothesis concerning long-term effects of a low residue diet on the gastrointestinal tract.},
}
@article {pmid7472099,
year = {1981},
author = {Restrepo, C and Correa, P and Duque, E and Cuello, C},
title = {Polyps in a low-risk colonic cancer population in Colombia, South America.},
journal = {Diseases of the colon and rectum},
volume = {24},
number = {1},
pages = {29-36},
doi = {10.1007/BF02603446},
pmid = {7472099},
issn = {0012-3706},
support = {N01-CP-33286/CP/NCI NIH HHS/United States ; N01-CP-53521/CP/NCI NIH HHS/United States ; },
mesh = {Adolescent ; Adult ; Child ; Colombia ; Colonic Neoplasms/*epidemiology/pathology ; Female ; Humans ; Intestinal Polyps/*epidemiology/pathology ; Male ; Middle Aged ; Risk ; Sex Factors ; },
abstract = {Colonic polyps were systematically searched for in 508 specimens collected from unselected autopsies in individuals more than 10 years of age from Medellín, Colombia, a low-incidence geographic region for colorectal cancer. Adenomatous polyps have a low prevalence rate in both sexes, comparable to that found in Cali, Colombia and other populations with low risk for cancer. They were found more frequently in the right side of the colon and are rare in the sigmoid colon. They begin to appear in the third decade of life in both sexes. Prevalence rates for single and multiple polyps increase with age in both sexes, males showing higher rates than females at every age group. Adenomatous polyps in this population are usually less than 3 mm in diameter and do not show villous changes or epithelial atypia. Hyperplastic polyps were more frequently observed than adenomatous polyps and rates show a progressive increase with age in both sexes. Multiplicity also increases with age. Most polyps are located in the low rectum and sigmoid followed by the cecum and ascending colon. Usually hyperplastic polyps are smaller than 3 mm in diameter and do not show epithelial atypia. Juvenile polyps were infrequently found in this series because children less than 10 years old were excluded. Diverticular disease was also rare and, when found, was not associated with adenomatous polyps. The association between adenomatous polyps and colonic cancer is discussed based on findings in this report.},
}
@article {pmid7331660,
year = {1981},
author = {Wara, P and Sørensen, K and Berg, V and Amdrup, E},
title = {The outcome of staged management of complicated diverticular disease of the sigmoid colon.},
journal = {Acta chirurgica Scandinavica},
volume = {147},
number = {3},
pages = {209-214},
pmid = {7331660},
issn = {0001-5482},
mesh = {Adult ; Age Factors ; Aged ; Colectomy ; Colostomy/methods ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intestinal Obstruction/etiology ; Male ; Middle Aged ; Peritonitis/etiology ; Postoperative Complications ; Retrospective Studies ; Risk ; Sigmoid Diseases/complications/*surgery ; Time Factors ; },
abstract = {In a retrospective study, 83 consecutive patients with indication for a staged treatment of complicated diverticular disease were reviewed. There was a considerable overall morbidity rate following construction of the colostomy, colonic resection, and colostomy closure. However, only 58% underwent a resection of the diseased segment, and even fewer (46%) obtained an eventual restoration of the colon continuity. This was primarily due to an unacceptable high mortality rate when patients with general peritonitis were managed by a proximal colostomy and drainage only. Subsequently, advanced age and associated major illness in patients with a planned three-stage management were the most important factors, determining the deficient completion of the staged treatment. Due to the permanence of many transverse colostomies but also to the fact that serious anastomotic complications, including fatal consequences, occurred despite a defunctioning colostomy, one should re-evaluate the need for a proximal colostomy in patients at high risk, considering resection and an end sigmoid colostomy which is the superior permanent stoma if reconstruction fails to come.},
}
@article {pmid7324604,
year = {1981},
author = {Raguse, T},
title = {[Diverticular disease; investigation on therapeutical tactics (author's transl)].},
journal = {Zentralblatt fur Chirurgie},
volume = {106},
number = {21},
pages = {1393-1408},
pmid = {7324604},
issn = {0044-409X},
mesh = {Colectomy ; Colon/pathology ; Diverticulitis, Colonic/pathology/*surgery ; Electromyography ; Gastrointestinal Motility ; Humans ; Muscle Contraction ; Muscle, Smooth/pathology ; Prospective Studies ; Recurrence ; },
abstract = {In the state of beginning complications if diverticular disease a resection of the inflammed section is indicated. This procedure prevents progression to life threatening complications. However, 5 to 30% of these patients treated in this way will have residual complaints. Our own morphological and functional in vitro investigations reveal an explanation for these findings. Furthermore, they show that the longitudinal musculature (taenias) plays a central role in the pathogenesis of the diverticular disease. The results obtained lead to the following conclusion: to make resection more complete, i.e. to prevent residual complaints and avoid relapses the longitudinal musculature should be incised transversely. Indications for taenia-myotomy are pointed out and its value is underlined by a prospective study including clinical data and functional in vivo investigations.},
}
@article {pmid7251278,
year = {1981},
author = {Castrini, G and Pappalardo, G},
title = {A new technique of combined colomyotomy for diverticular disease.},
journal = {International surgery},
volume = {66},
number = {1},
pages = {71-72},
pmid = {7251278},
issn = {0020-8868},
mesh = {Diverticulitis, Colonic/*surgery ; Humans ; Muscles/surgery ; },
}
@article {pmid6267275,
year = {1981},
author = {Clark, CG and Godfrey, J},
title = {Constipation--a simple approach to treatment.},
journal = {The Journal of the Royal College of General Practitioners},
volume = {31},
number = {222},
pages = {38-40},
pmid = {6267275},
issn = {0035-8797},
mesh = {Adult ; Aged ; Constipation/*therapy ; Dietary Fiber/therapeutic use ; Energy Intake ; Female ; Humans ; Magnesium Hydroxide/therapeutic use ; Male ; Middle Aged ; },
abstract = {A simple method of treating patients with constipation is outlined and has been used successfully in 40 patients with severe primary constipation or constipation associated with diverticular disease.},
}
@article {pmid6258626,
year = {1981},
author = {Gear, JS and Brodribb, AJ and Ware, A and Mann, JI},
title = {Fibre and bowel transit times.},
journal = {The British journal of nutrition},
volume = {45},
number = {1},
pages = {77-82},
doi = {10.1079/bjn19810078},
pmid = {6258626},
issn = {0007-1145},
mesh = {Cellulose/*administration & dosage ; Diet, Vegetarian ; Dietary Fiber/*administration & dosage ; Diverticulum/*physiopathology ; Female ; *Gastrointestinal Motility ; Humans ; Male ; Sex Factors ; Time Factors ; },
abstract = {1. Bowel transit time has been investigated in vegetarians and non-vegetarians and related to dietary fibre intake and the presence of diverticular disease. 2. Vegetarians who have less diverticular disease than non-vegetarians have more rapid transit times. 3. Subjects with total dietary fibre intake of more than 30 g/d all had transit times of less than 75 h whereas 38% of those eating less had transit times exceeding 75 h and varying up to 124 h. 4. Individuals with diverticular disease were found to have faster transit times than those without the disease. 5. The colon may respond to a fibre-depleted diet either by becoming hyperactive and prone to diverticular disease or by becoming hypoactive leading to constipation.},
}
@article {pmid6116641,
year = {1981},
author = {Sasaki, D and Munakata, A and Saitoh, Y and Yoshida, Y},
title = {Anti-spasmodic effect of prifinium bromide on the proximal and distal colon in patients with diverticular disease.},
journal = {Gastroenterologia Japonica},
volume = {16},
number = {4},
pages = {344-349},
pmid = {6116641},
issn = {0435-1339},
mesh = {Colon/drug effects/innervation/*physiology ; Diverticulum, Colon/drug therapy/*physiopathology ; Female ; Gastrointestinal Motility/*drug effects ; Humans ; Male ; Middle Aged ; Pyrrolidines/*pharmacology ; },
abstract = {In 5 patients with diverticular disease, colonic motilities of the proximal and distal colon were recorded using the ERBI method. The motilities were studied during resting, after prostigmin 0.5 mg i.m. injection and after prifinium bromide 7.5 mg i.m. injection, with the following results: After prostigmin colonic motility of the proximal colon became significantly greater than that of the distal colon. Prifinium bromide inhibited the prostigmin-induced hypermotility markedly. It was demonstrated that this drug has an antispasmodic action not only on the distal colon but also on the proximal colon. Prifinium bromide was an antispasmodic drug which brought about a rapid effect which appears within 3 minutes after injection. The effect persisted for about 1 hour.},
}
@article {pmid7442843,
year = {1980},
author = {de Graaff, P and Holwerda, PJ},
title = {[Hypertrophic and atrophic type of diverticular disease of the colon].},
journal = {Nederlands tijdschrift voor geneeskunde},
volume = {124},
number = {46},
pages = {1959-1965},
pmid = {7442843},
issn = {0028-2162},
mesh = {Atrophy ; Colon/*pathology ; Diverticulum, Colon/complications/*pathology/therapy ; Humans ; Hypertrophy ; },
}
@article {pmid6968437,
year = {1980},
author = {Davis, WD},
title = {Lower bowel disorders. 2. Diverticular disease.},
journal = {Postgraduate medicine},
volume = {68},
number = {4},
pages = {69-72},
doi = {10.1080/00325481.1980.11715559},
pmid = {6968437},
issn = {0032-5481},
mesh = {Aged ; Constipation/complications ; Diarrhea/complications ; Diverticulitis, Colonic/*etiology/surgery ; Diverticulum, Colon/*complications/etiology/therapy ; Female ; Gastrointestinal Hemorrhage/diagnosis/etiology ; Humans ; Male ; Middle Aged ; },
abstract = {Diverticula are thought to result from high intraluminal pressures in closed segments of the sigmoid colon, causing herniation of mucosa and submucosa through muscle along the paths of the nutrient vessels. Mild diverticular disease usually can be managed with bed rest and a controlled diet, plus administration of antibiotics. Acute diverticulitis, especially recurrent bouts, may call for colonic resection.},
}
@article {pmid7231727,
year = {1980},
author = {Griffa, B and Campagnoli, P and Di Giusto, F},
title = {[Fistulas complicating diverticular disease of the colon].},
journal = {Minerva chirurgica},
volume = {35},
number = {18},
pages = {1393-1400},
pmid = {7231727},
issn = {0026-4733},
mesh = {Aged ; Colonic Diseases/*etiology ; Diverticulitis, Colonic/complications ; Diverticulum, Colon/*complications ; Female ; Humans ; Intestinal Fistula/*etiology/surgery ; Male ; Middle Aged ; Urinary Bladder Fistula/*etiology/surgery ; },
abstract = {Five patients were admitted to the 1st and 2nd Division of General Surgery of Soronno Hospital between July '75 and September '78 suffering from fistulas complicating colon diverticulosis. A sixth patient, operated on for diverticulitis, developed a stercoraceous cutaneous fistula in the postoperative period. This was closed by conservative therapy. A woman patient suffering from colo-enteric fistula, was not operated because she refused. In all operated patients, broad resection of the sigmoid was carried out with end-to-end anastomosis. In three cases a caecostomy was formed to protect the anastomosis. All operated patients were treated preoperatively with laxatives, clysters and intestinal antibiotics, prevalently paromomycin and in one case neomycin plus base erythromycin. Surgery led to the cure of all patients treated.},
}
@article {pmid7430280,
year = {1980},
author = {Marti, MC and Simmen, U},
title = {[Recto-vesical fistula (author's transl)].},
journal = {Journal de chirurgie},
volume = {117},
number = {8-9},
pages = {469-474},
pmid = {7430280},
issn = {0021-7697},
mesh = {Adult ; Aged ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology/therapy ; Male ; Middle Aged ; Urinary Bladder Fistula/*diagnosis/etiology/surgery ; },
abstract = {23 cases of recto-vesical fistula are described; their diagnostic and therapeutic approach are discussed. The entero-vesical fistula result mainly from diverticular disease but may be secondary to tumor or Crohn's disease of the large bowel too. The treatment needs allways surgery: bowel resection and bladder extraperitonisation. Results and literature are compared.},
}
@article {pmid7427061,
year = {1980},
author = {Flynn, M and Hyland, J and Hammond, P and Darby, C and Taylor, I},
title = {Faecal bile acid excretion in diverticular disease.},
journal = {The British journal of surgery},
volume = {67},
number = {9},
pages = {629-632},
doi = {10.1002/bjs.1800670907},
pmid = {7427061},
issn = {0007-1323},
mesh = {Bile Acids and Salts/*metabolism ; Colon, Sigmoid/physiopathology ; Deoxycholic Acid/metabolism ; Diverticulum, Colon/*metabolism/physiopathology ; Electromyography ; Feces/*analysis ; Female ; Gastrointestinal Motility ; Humans ; Lithocholic Acid/metabolism ; Male ; },
abstract = {Faecal bile acid excretion and sigmoid myoelectrical activity were measured on three separate occasions over a 12-month period in 21 patients with diverticular disease and the result were compared with those of 17 age-matched normal subjects. Statistically significantly lower faecal concentrations of both deoxycholic and lithocholic acid were found in patients with diverticular disease (96.7 +/- 11.3 mg/100 g, 59.6 +/- 6.0 mg/100 g respectively) when compared with normal subjects (219 +/- 32.0 mg/100 g and 117.6 +/- 14.6 mg/100 g respectively, P < 0.001). These values persisted throughout the period of study. Patients with diverticular disease were found to have an abnormally rapid myoelectrical rhythm (frequency 0.2-0.3 Hz [12-18 c/min] which returned towards normal after 1 year's bran treatment. Significant correlations were found between lithocholic acid concentrations and activity of 0.2-0.3 Hz (r = 0.67) and deoxycholic acid concentrations and activity of 0.1-015 Hz (6-9 c/min) (r = 0.62). It is suggested that increased colonic absorption of bile acids may occur in diverticular disease which may influence the myoelectrical activity.},
}
@article {pmid7419541,
year = {1980},
author = {Slomic, A and Saunders, GM and Khor, CY},
title = {[Giant diverticulum of the sigmoid].},
journal = {Journal of the Canadian Association of Radiologists},
volume = {31},
number = {3},
pages = {168-170},
pmid = {7419541},
issn = {0008-2902},
mesh = {Aged ; Diagnosis, Differential ; Diverticulum, Colon/*complications/diagnostic imaging ; Humans ; Male ; Pneumatosis Cystoides Intestinalis/diagnostic imaging/*etiology ; Radiography ; Sigmoid Diseases/*complications/diagnostic imaging ; },
abstract = {We have located only 40 cases of giant diverticulum of the colon in the medical literature. We wish to inform radiologists of this rare complication of diverticular disease of the colon.},
}
@article {pmid7419444,
year = {1980},
author = {Stone, D},
title = {Diverticular disease of the colon: surgical approaches.},
journal = {The Journal of the American Osteopathic Association},
volume = {79},
number = {11},
pages = {696-709},
pmid = {7419444},
issn = {0098-6151},
mesh = {Adult ; Aged ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Methods ; Middle Aged ; },
}
@article {pmid6973104,
year = {1980},
author = {Masi, C and Bechi, P and Pratesi, C},
title = {[Surgical treatment of diverticular disease of the colon. Operative methods in 106 cases].},
journal = {Minerva dietologica e gastroenterologica},
volume = {26},
number = {3},
pages = {195-198},
pmid = {6973104},
issn = {0391-1993},
mesh = {Adult ; Aged ; Diverticulum, Colon/diet therapy/etiology/*surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Male ; Middle Aged ; Postoperative Complications ; },
}
@article {pmid6771840,
year = {1980},
author = {Gallego, MJ and Miguel, V and Peñarroja, J and Miro, F and Pinazo, MD and Peñarroja, C and Camps, C and García Tell, G},
title = {[Diverticular disease].},
journal = {Revista espanola de las enfermedades del aparato digestivo},
volume = {57},
number = {5},
pages = {577-594},
pmid = {6771840},
issn = {0034-9437},
mesh = {Digestive System Diseases/*diagnostic imaging ; Diverticulum/*diagnostic imaging ; Humans ; Radiography ; },
}
@article {pmid6246593,
year = {1980},
author = {Maillet, P and Baulieux, J and Boulez, J and Peix, JL and Mignotte, H},
title = {[Surgical complications of the diverticular disease of the colon. Series of 110 cases (author's transl)].},
journal = {La semaine des hopitaux : organe fonde par l'Association d'enseignement medical des hopitaux de Paris},
volume = {56},
number = {13-14},
pages = {654-658},
pmid = {6246593},
mesh = {Adult ; Aged ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Male ; Middle Aged ; Peritonitis/etiology ; Postoperative Complications/*etiology/mortality ; },
abstract = {The authors are reviewing a series of 110 cases of operated diverticulitis. Emergency operations mainly concerned cases of fecal peritonitis. Mortality is still fairly high (27 percent). In these cases, immediate resection (two-stages operation) brings better results than the classical three-stages operation. The latter, however, remains in some cases a safe solution. Concerning chronic patients, surgical procedures always require immediate resection, whatever the anatomic lesions can be. Hartmann operation has been given up by the authors. Presently, in every cases, continuity is carried out by ideal colectomy or by anastomosis protected by a transverse colostomy. In such cases, mortality has been, 2,6 percent and functional results are most satisfactory.},
}
@article {pmid6769655,
year = {1980},
author = {Vajrabukka, T and Saksornchai, K and Jimakorn, P},
title = {Diverticular disease of the colon in a far-eastern community.},
journal = {Diseases of the colon and rectum},
volume = {23},
number = {3},
pages = {151-154},
doi = {10.1007/BF02587617},
pmid = {6769655},
issn = {0012-3706},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Cecal Diseases/epidemiology/etiology ; Child ; Diverticulum/epidemiology/etiology ; Diverticulum, Colon/*epidemiology/etiology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sex Factors ; Thailand ; },
abstract = {A 5-year retrospective case review and 6-month clinical observation, in a teaching and general hospital in Bangkok, Thailand, show that colonic diverticular disease is not so common as in the West and has many distinctive features. Solitary cecal diverticula are at least five times more common, accounting for about one-fourth of all diverticula of the large bowel, and show definite male preponderance and occur in younger patients. Their congenital origin is supported by the lack of association with social classes, by the finding of structural relationship with the appendix in one of the patients, and by the presence of the muscular coat. On the other hand, multiple colonic diverticulosis is essentially a disease of those above the age of 40 years and shows slight female preponderance. The diverticula appear segmental and need not originate in the sigmoid colon first. Almost all multiple diverticula show radiologic features of simple massed diverticulosis and seem to be associated with higher social classes. The differences in the pattern of diverticular disease in this series and in the West cannot be readily explained on the basis of the difference in dietary habit or psychologic stress.},
}
@article {pmid7362732,
year = {1980},
author = {Rees, BI and Bond, J and Spriggs, TL and Hughes, LE},
title = {Observations on the muscle abnormality of the human sigmoid colon in diverticular disease.},
journal = {British journal of clinical pharmacology},
volume = {9},
number = {3},
pages = {229-232},
pmid = {7362732},
issn = {0306-5251},
mesh = {Acetylcholine/pharmacology ; Colon/*physiopathology/surgery ; Diverticulitis, Colonic/*physiopathology ; Diverticulum, Colon/*physiopathology ; Histamine/pharmacology ; Humans ; In Vitro Techniques ; Muscle Contraction/drug effects ; Muscle, Smooth/*physiopathology ; Norepinephrine/pharmacology ; },
abstract = {1 Pharmacological experiments were performed on circular and longitudinal muscle strips of sigmoid colon from diverticular disease specimens, and their responses compared with those of similar muscle strips from sigmoid colon resected from carcinoma (control). 2 The longitudinal muscle strips from diverticular disease specimens were significantly less responsive to acetylcholine, histamine or noradrenaline than control longitudinal muscle strips. 3 The responses of the diverticular circular muscle strips showed a small decrease to acetylcholine, a small increase to noradrenaline and no change to histamine when compared to control strips.},
}
@article {pmid6985709,
year = {1980},
author = {Almy, TP and Howell, DA},
title = {Medical progress. Diverticular disease of the colon.},
journal = {The New England journal of medicine},
volume = {302},
number = {6},
pages = {324-331},
doi = {10.1056/NEJM198002073020605},
pmid = {6985709},
issn = {0028-4793},
mesh = {Analgesics/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Blood Transfusion ; Diet ; Dietary Fiber/administration & dosage ; Diverticulitis, Colonic/diagnosis/therapy ; *Diverticulum, Colon/complications/diagnosis/epidemiology/etiology/therapy ; Gastrointestinal Hemorrhage/diagnosis/etiology/therapy ; Gastrointestinal Motility ; Humans ; Parasympatholytics/therapeutic use ; United States ; },
}
@article {pmid7370721,
year = {1980},
author = {Carey, PB and Johnson, JN},
title = {Diverticular disease presenting at a special clinic.},
journal = {The British journal of venereal diseases},
volume = {56},
number = {1},
pages = {57},
pmid = {7370721},
issn = {0007-134X},
mesh = {Aged ; Colonic Diseases/*etiology ; Diverticulum, Colon/*complications ; Humans ; Intestinal Fistula/*etiology ; Male ; Urethritis/*etiology ; Urinary Bladder Fistula/*etiology ; },
}
@article {pmid6928760,
year = {1980},
author = {Theile, D},
title = {The management of perforated diverticulitis with diffuse peritonitis.},
journal = {The Australian and New Zealand journal of surgery},
volume = {50},
number = {1},
pages = {47-49},
doi = {10.1111/j.1445-2197.1980.tb04490.x},
pmid = {6928760},
issn = {0004-8682},
mesh = {Colonic Diseases/*complications/surgery ; Diverticulitis/*complications/surgery ; Female ; Humans ; Intestinal Perforation/*complications/surgery ; Length of Stay ; Male ; Methods ; Middle Aged ; Mortality ; Peritonitis/*complications ; Postoperative Complications ; },
abstract = {In a ten-year period 53 patients presented with perforated colonic diverticular disease with diffuse peritonitis. Eight patients died--all with uncontrolled intraabdominal sepsis. Various surgical techniques were employed. None of the 12 patients having immediate resection of the affected bowel segment died. There was no mortality from subsequent operations in any form of staged treatment. Primary resection without anastomosis is supported as the treatment of choice for this condition.},
}
@article {pmid6766288,
year = {1980},
author = {Scheff, RT and Zuckerman, G and Harter, H and Delmez, J and Koehler, R},
title = {Diverticular disease in patients with chronic renal failure due to polycystic kidney disease.},
journal = {Annals of internal medicine},
volume = {92},
number = {2 Pt 1},
pages = {202-204},
doi = {10.7326/0003-4819-92-2-202},
pmid = {6766288},
issn = {0003-4819},
mesh = {Adult ; Aged ; Diverticulitis/complications/epidemiology ; Diverticulum/*complications/epidemiology ; Female ; Humans ; Intestinal Perforation/complications ; Kidney Failure, Chronic/*complications ; Male ; Middle Aged ; Missouri ; Polycystic Kidney Diseases/*complications ; },
abstract = {Twelve patients with chronic renal failure and polycystic kidney disease represent 8% of the 151 hemodialysis patients followed up at the Chromalloy American Kidney Center, Washington University School of Medicine. Ten (83%) of these patients have diverticulosis, and four of these patients developed gross colonic perforation secondary to diverticulitis. Barium enemas on 31 chronic renal failure patients without polycystic kidney disease revealed diverticulosis in 10 (32%). None had diverticulitis. Barium enemas in 120 age-matched non-renal failure control patients revealed diverticulosis in 45 (38%). None had diverticulitis. These findings suggest that patients with chronic renal failure due to polycystic kidney disease have a high incidence of diverticulosis and diverticulitis, that diverticulosis occurs in patients with chronic renal failure without polycystic kidney disease at a rate similar to that in the general population, and that diverticulitis should be an initial consideration in the differential diagnosis of abdominal pain in patients with polycystic kidney disease.},
}
@article {pmid6244871,
year = {1980},
author = {Hyland, JM and Taylor, I},
title = {Does a high fibre diet prevent the complications of diverticular disease?.},
journal = {The British journal of surgery},
volume = {67},
number = {2},
pages = {77-79},
doi = {10.1002/bjs.1800670202},
pmid = {6244871},
issn = {0007-1323},
mesh = {Acute Disease ; Adult ; Aged ; Cellulose/*therapeutic use ; Dietary Fiber/*therapeutic use ; Diverticulum, Colon/complications/*diet therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; },
abstract = {The management of diverticular disease has altered radically with the widespread use of high fibre diet (HFD) over the past decade. However, whether this regimen has improved the prognosis in patients admitted with acute complications is still debatable. In this study the outcome of 100 such patients admitted to hospital with acute episodes of diverticular disease has been reviewed. Seventy-five per cent were treated conservatively with HFD and review after 5--7 years showed that over 90 per cent remained symptom-free, suggesting that HFD may afford protection by preventing further complications.},
}
@article {pmid7409350,
year = {1980},
author = {Eastwood, MA and Smith, AN and Mitchell, WD and Pritchard, JL},
title = {Faecal characteristics and colonic intraluminal pressure in diverticular disease.},
journal = {Digestion},
volume = {20},
number = {6},
pages = {399-402},
doi = {10.1159/000198481},
pmid = {7409350},
issn = {0012-2823},
mesh = {Aged ; Bile Acids and Salts/analysis ; Calcium/analysis ; Defecation ; Diverticulum, Colon/*metabolism/physiopathology ; Feces/*analysis ; Female ; Gastrointestinal Motility ; Humans ; Magnesium/analysis ; Male ; Middle Aged ; Potassium/analysis ; Pressure ; Sodium/analysis ; },
abstract = {Daily faecal calcium and magnesium outputs were inversely related to food-stimulated colonic intraluminal pressure in diverticular disease subjects. There was no relationship to sodium potassium and bile acid concentrations, nor to intestinal transit.},
}
@article {pmid7390053,
year = {1980},
author = {Hyland, JM and Darby, CF and Hammond, P and Taylor, I},
title = {Myoelectrical activity of the sigmoid colon in patients with diverticular disease and the irritable colon syndrome suffering from diarrhoea.},
journal = {Digestion},
volume = {20},
number = {5},
pages = {293-299},
doi = {10.1159/000198450},
pmid = {7390053},
issn = {0012-2823},
mesh = {Adult ; Aged ; Colon, Sigmoid/*physiopathology ; Colonic Diseases, Functional/complications/*physiopathology ; Diarrhea/etiology/*physiopathology ; Diverticulitis, Colonic/complications/*physiopathology ; Electric Conductivity ; Humans ; Middle Aged ; },
abstract = {It is often suggested that the irritable colon syndrome is a pre-diverticular condition and that patients with diverticular disease and predominant diarrhoea are in fact suffering from the irritable colon syndrome. In this study colonic motor function in diverticular disease (7 patients with predominant diarrhoea), in the irritable colon syndrome (7 patients with predominant diarrhoea) and in 8 normal subjects were compared. Patients with diarrhoea were matched for symptom score, stool weight and transit time. Slow wave electrical activity was measured by an intraluminal suction electrode and patients with the irritable colon syndrome displayed a predominant frequency at 3 cpm. This was not found in patients with diverticular disease. No myoelectrical evidence to link the two conditions was found.},
}
@article {pmid7363837,
year = {1980},
author = {Barbezat, GO},
title = {Rational treatment of diverticular disease.},
journal = {Drugs},
volume = {19},
number = {1},
pages = {63-69},
doi = {10.2165/00003495-198019010-00006},
pmid = {7363837},
issn = {0012-6667},
mesh = {Anti-Bacterial Agents/therapeutic use ; Diverticulitis, Colonic/diagnosis/*drug therapy/surgery ; Diverticulum, Colon/diagnosis/*drug therapy/surgery ; Humans ; Pain/drug therapy ; },
}
@article {pmid7358015,
year = {1980},
author = {Calder, JF and Wachira, MW and Van Sant, T and Malik, MS and Bowry, RN},
title = {Diverticular disease, carcinoma of the colon and diet in urban and rural Kenya Africans.},
journal = {Diagnostic imaging},
volume = {49},
number = {1},
pages = {23-28},
pmid = {7358015},
issn = {0378-9837},
mesh = {Adolescent ; Adult ; Aged ; Barium Sulfate ; Colonic Neoplasms/diagnostic imaging/*etiology ; *Diet ; Diverticulum, Colon/diagnostic imaging/*etiology ; Female ; *Health ; Humans ; Kenya/ethnology ; Male ; Middle Aged ; Occupations ; Prospective Studies ; Radiography ; Residence Characteristics ; *Rural Health ; *Urban Health ; },
abstract = {20 cases of diverticular disease and 12 cases of carcinoma of the colon have been demonstrated in 183 barium enemas in 1 year. These results, along with a dietary survey, show that diverticular disease can no longer be considered rare in Kenyan Africans and that a low-fibre diet is a contributory but perhaps not the only factor in its aetiology. There is probably an increasing incidence of diverticular disease as well as an increasing recognition of it. The incidence of carcinoma does not appear to be increasing to the same extent.},
}
@article {pmid7357242,
year = {1980},
author = {Peel, AL and Benyon, L and Grace, RH},
title = {The value of routine preoperative urological assessment in patients undergoing elective surgery for diverticular disease or carcinoma of the large bowel.},
journal = {The British journal of surgery},
volume = {67},
number = {1},
pages = {42-45},
doi = {10.1002/bjs.1800670113},
pmid = {7357242},
issn = {0007-1323},
mesh = {Bacteriuria/diagnosis ; Colonic Neoplasms/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Postoperative Complications ; Preoperative Care/*methods ; Prospective Studies ; Rectal Neoplasms/*surgery ; Urea/blood ; Urography ; Urologic Diseases/*diagnosis ; },
abstract = {A consecutive series of 176 patients was studied prospectively in order to assess the value of full urological assessment prior to elective colorectal surgery for carcinoma or diverticular disease. Fifty-one patients had urological symptoms and 29 of these had an abnormal intravenous urogram (IVU); when compared with the 125 asymptomatic patients, they were twice as likely to develop acute retention of urine and four times more likely to require prostatectomy. Twenty of the 31 patients with an abdominal mass had an abnormal intravenous urogram, and the presence of this physical sign may be regarded as an absolute indication for IVU. Forty-five patients had a urological abnormality on the preoperative IVU; of these, 1 in 6 required treatment prior to elective large bowel surgery and 1 in 3 developed acute retention of urine postoperatively (half required prostatectomy). Twenty-two patients had a disease-related abnormality on preoperative IVU and in 12 planned urological surgery was undertaken at the time of the colorectal resection. In the 91 patients with no urological symptoms, no abnormal mass and normal blood urea and mid-stream urine sample, the incidence of IVU abnormalities and of postoperative complications was low and surgical management was not altered in these patients.},
}
@article {pmid7350709,
year = {1980},
author = {Bell, GA},
title = {Closure of colostomy following sigmoid colon resection for perforated diverticulitis.},
journal = {Surgery, gynecology & obstetrics},
volume = {150},
number = {1},
pages = {85-90},
pmid = {7350709},
issn = {0039-6087},
mesh = {Adult ; Aged ; Colon/surgery ; *Colostomy ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intestinal Perforation/etiology/*surgery ; Male ; Methods ; Middle Aged ; Rectum/surgery ; Sigmoid Diseases/complications/*surgery ; },
abstract = {Hartmann resection has been the treatment of choice for perforated diverticulitis of the sigmoid colon at the Vancouver General Hospital for nearly 20 years. A retrospective analysis of 70 patients who had the colonic stomas closed following the Hartmann resection was done. A modified Hartmann resection for the initial procedure has been recommended on the basis of fewer complication and shorter hospital stay when the closure operation is performed. The modification consists of the creation of a distal mucus fistula rather than suturing the rectum closed. To facilitate the creation of a distal mucus fistula, it is suggested that less sigmoid colon be resected at the time of the initial operation. The colon can be assessed for residual diverticular disease later and more resected at the later closure operation if required.},
}
@article {pmid7013392,
year = {1980},
author = {Ewerth, S and Ahlberg, J and Holmström, B and Persson, U and Udén, R},
title = {Influence on symptoms and transit-time of Vi-SiblinR in diverticular disease.},
journal = {Acta chirurgica Scandinavica. Supplementum},
volume = {500},
number = {},
pages = {49-50},
pmid = {7013392},
issn = {0301-1860},
mesh = {Aged ; Clinical Trials as Topic ; Constipation/diet therapy/physiopathology ; Diverticulum, Colon/diagnosis/*diet therapy/physiopathology ; Double-Blind Method ; Female ; Gastrointestinal Motility ; Humans ; Male ; Middle Aged ; Psyllium/*therapeutic use ; Time Factors ; },
abstract = {Nine patients complaining of constipation and with diverticuli of the colon on barium-enema were examined with regard to transit-time, bowel movements and subjective symptoms. They were treated with placebo and Vi-SiblinR, using a doubleblind cross-over technique. The transit-time remained normal during the Vi-SiblinR treatment. The feces became softer and increased in weight and the subjective symptoms were significantly reduced (p less than 0,05).},
}
@article {pmid4547577,
year = {1974},
author = {Tagart, RE},
title = {General peritonitis and haemorrhage complicating colonic diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {55},
number = {4},
pages = {175-183},
pmid = {4547577},
issn = {0035-8843},
mesh = {Acute Disease ; Age Factors ; Aged ; Anti-Bacterial Agents/therapeutic use ; Appendectomy ; Colostomy/methods/mortality ; Diverticulitis, Colonic/*complications/drug therapy/mortality ; Drainage ; Female ; Gastrointestinal Hemorrhage/*complications ; Humans ; Male ; Melena/diagnosis ; Middle Aged ; Peritonitis/*complications/diagnosis/mortality/surgery ; Sex Factors ; },
abstract = {The very varied pathology which underlies peritonitis caused by colonic diverticular disease makes the comparison of various methods of treatment very difficult. The best results are probably achieved by removal of the affected part of the colon from the abdomen as soon as possible. Really aggressive medical treatment is an essential accompaniment to any form of surgery. A two-stoma or Hartmann procedure is generally the safest form of resection. Immediate anastomosis has no particular advantage since it should always be accompanied by a proximal diverting colostomy, making a second operation necessary in any case. In desperate cases proximal colostomy may be the only possible procedure and can be life-saving. The advantage of a skin-bridge colostomy is stressed.In cases of haemorrhage the source of bleeding is usually impossible to locate. Conservative treatment is successful in most cases, but if there is no alternative to surgery subtotal colectomy with ileorectal anastomosis is the treatment of choice.},
}
@article {pmid4547184,
year = {1974},
author = {Veidenheimer, MC and Corman, ML and Coller, JA},
title = {Diverticular disease of the colon.},
journal = {Geriatrics},
volume = {29},
number = {10},
pages = {77-83},
pmid = {4547184},
issn = {0016-867X},
mesh = {Abscess/etiology/surgery ; Acute Disease ; Aged ; Angiography ; Colectomy ; Colostomy/methods ; Diverticulitis, Colonic/etiology/surgery/therapy ; *Diverticulum, Colon/complications/diagnosis/diagnostic imaging/physiopathology/surgery ; Gastrointestinal Hemorrhage/etiology ; Hospitalization ; Humans ; Intestinal Fistula/surgery ; Intestinal Perforation/etiology ; Middle Aged ; },
}
@article {pmid4850652,
year = {1974},
author = {Trowell, H and Painter, N and Burkitt, D},
title = {Aspects of the epidemiology of diverticular disease and ischemic heart disease.},
journal = {The American journal of digestive diseases},
volume = {19},
number = {9},
pages = {864-873},
pmid = {4850652},
issn = {0002-9211},
mesh = {Age Factors ; Aged ; Animals ; Asia ; Black People ; Coronary Disease/complications/*epidemiology/etiology/prevention & control ; Developing Countries ; Diet/*adverse effects ; Dietary Carbohydrates ; Diverticulum, Colon/complications/*epidemiology/etiology ; Europe ; Female ; Humans ; Male ; Middle Aged ; Rabbits ; Racial Groups ; Rats ; Sex Factors ; South Africa ; Time Factors ; United Kingdom ; United States ; },
}
@article {pmid4844663,
year = {1974},
author = {Hodgson, J},
title = {Transverse taeniamyotomy. A new surgical approach for diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {55},
number = {2},
pages = {80-89},
pmid = {4844663},
issn = {0035-8843},
mesh = {Age Factors ; Aged ; Barium Sulfate ; Colon/*surgery ; Diverticulitis, Colonic/surgery ; Diverticulum, Colon/diagnostic imaging/*surgery ; Female ; Humans ; Male ; Methods ; Middle Aged ; Muscle, Smooth/surgery ; Postoperative Care ; Radiography ; },
abstract = {The rationale of transverse taeniamyotomy in the treatment of diverticular disease of the colon, with or without inflammatory or other complications, is discussed. The technique of the operation is described, multiple transverse incisions being made at 2-cm intervals through the two thickened antimesenteric taeniae coli throughout the affected length of bowel. The indications and results in 18 patients are tabulated and discussed. Transverse taeniamyotomy is a simple procedure, rapidly performed, with minimal morbidity, and is well tolerated even by elderly, poor-risk patients. The results so far have been promising.},
}
@article {pmid4597916,
year = {1974},
author = {Shapiro, JL},
title = {Diverticular disease of the colon.},
journal = {Southern medical journal},
volume = {67},
number = {6},
pages = {710-722},
doi = {10.1097/00007611-197406000-00020},
pmid = {4597916},
issn = {0038-4348},
mesh = {Abscess/etiology ; Age Factors ; Aged ; Angiography ; Cecal Diseases/complications ; Colon/pathology ; Diagnosis, Differential ; Diet Therapy ; Diverticulitis, Colonic/etiology ; *Diverticulum, Colon/complications/epidemiology/etiology/pathology/surgery ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; Intestinal Diseases/etiology ; Intestinal Fistula/etiology ; Intestinal Neoplasms/diagnosis ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Middle Aged ; Recurrence ; Sex Factors ; },
}
@article {pmid4545264,
year = {1974},
author = {Rodkey, GV and Welch, CE},
title = {Colonic diverticular disease with surgical treatment. A study of 338 cases.},
journal = {The Surgical clinics of North America},
volume = {54},
number = {3},
pages = {655-674},
doi = {10.1016/s0039-6109(16)40340-3},
pmid = {4545264},
issn = {0039-6109},
mesh = {Abscess/etiology ; Adult ; Age Factors ; Aged ; Colon/anatomy & histology/pathology ; Colonic Diseases/etiology ; Diet ; Diverticulum, Colon/complications/epidemiology/etiology/mortality/pathology/*surgery ; Emergencies ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Perforation/etiology ; Male ; Middle Aged ; Neuromuscular Diseases/etiology ; Peritonitis/etiology ; Postoperative Complications ; Sex Factors ; Time Factors ; },
}
@article {pmid4832656,
year = {1974},
author = {Findlay, J and Smith, AN and Shariff, S and Mitchell, WD and Eastwood, MA},
title = {Proceedings: The effect of bran on transit time, bile acid concentration and motility in colonic diverticular disease.},
journal = {The British journal of surgery},
volume = {61},
number = {4},
pages = {323},
pmid = {4832656},
issn = {0007-1323},
mesh = {Bile Acids and Salts/*metabolism ; Diverticulitis, Colonic/*metabolism ; *Edible Grain ; *Gastrointestinal Motility ; Humans ; Pressure ; Time Factors ; },
}
@article {pmid4821705,
year = {1974},
author = {Shulman, AG},
title = {High bulk diet for diverticular disease of the colon.},
journal = {The Western journal of medicine},
volume = {120},
number = {4},
pages = {278-281},
pmid = {4821705},
issn = {0093-0415},
mesh = {Animals ; *Diet Therapy ; Diverticulitis, Colonic/*therapy ; Diverticulum, Colon/physiopathology/*therapy ; Female ; Humans ; Male ; },
abstract = {In the past century diverticular disease of the colon has changed from being almost unknown to becoming the most common disease of the colon. Studies in Britain indicated that the pathological basis of the disease is a thickening of the colonic musculature, with diverticulosis and diverticulitis developing because of increased intracolonic pressures generated by the thickened colon wall. This pressure can be sharply reduced by increased colonic bulk. Geographical and anthropological data reveal that diverticular disease results from Western civilization's food habits, specifically the reduced fiber content in food. There is evidence that increasing the dietary intake of fiber by the addition of bran can prevent formation of diverticula and relieve the symptoms of established disease. Large scale studies are recommended both as treatment and to further test the validity of this concept.},
}
@article {pmid4841277,
year = {1974},
author = {Findlay, JM and Mitchell, WD and Eastwood, MA and Anderson, AJ and Smith, AN},
title = {Intestinal streaming patterns in cholerrhoeic enteropathy and diverticular disease.},
journal = {Gut},
volume = {15},
number = {3},
pages = {207-212},
pmid = {4841277},
issn = {0017-5749},
mesh = {Adult ; Aged ; Bile/*metabolism ; Chromium ; Diarrhea/metabolism/*physiopathology ; Diverticulum, Colon/metabolism/*physiopathology ; Female ; *Gastrointestinal Motility ; Glycols ; Humans ; Indicators and Reagents ; Intestinal Absorption ; Male ; Middle Aged ; Water/metabolism ; },
abstract = {Streaming of gastrointestinal contents depends on the demonstration of differential rates of recovery of equal doses of two synchronously fed markers. There was no significant difference in the rate of throughput of polyethylene glycol (a liquid phase marker) and chromium sesquioxide (a solid phase marker) in healthy volunteers (n = 7) and hospital inpatients (n = 5) with normal bowel habit, so that streaming does not usually occur. In cholerrhoeic enteropathy (n = 5), however, the rate of throughput of polyethylene glycol was increased. In colonic diverticular disease (n = 7) the rate of throughput of polyethylene glycol was significantly lower. In cholerrhoeic enteropathy the liquid phase marker was excreted 1.5 times faster than the solid phase, but in the diverticular disease group the liquid phase was excreted 0.75 times more slowly than the solid phase marker. This may reflect the effects of colonic hypersegmentation on the relative distribution of the liquid and solid phases.},
}
@article {pmid4819154,
year = {1974},
author = {Stanciu, C and Bennett, JR},
title = {Preliminary communications.},
journal = {British medical journal},
volume = {1},
number = {5903},
pages = {312-313},
pmid = {4819154},
issn = {0007-1447},
mesh = {Adult ; Colon/drug effects ; Colonic Diseases, Functional/physiopathology ; Diverticulitis/physiopathology ; Female ; Gastrointestinal Motility/*drug effects ; Humans ; Male ; Pain/drug therapy ; Pentazocine/*pharmacology ; Pressure ; Sigmoidoscopy ; Spirometry ; },
abstract = {The effects of pentazocine on colonic motor activity were studied in five normal subjects, five patients with irritable bowel syndrome, and five patients with diverticular disease. The drug decreased intraluminal colonic pressures in all patients but one. Since morphine, which increases intraluminal colonic pressures, is contraindicated in patients with abdominal pain of colonic origin (diverticular disease, irritable bowel syndrome), we suggest that pentazocine may be a useful drug in such cases.},
}
@article {pmid4607445,
year = {1974},
author = {Schumpelick, V and Koch, G},
title = {[The role of incomplete diverticle for diverticular disease (author's transl)].},
journal = {Langenbecks Archiv fur Chirurgie},
volume = {336},
number = {1},
pages = {1-14},
pmid = {4607445},
issn = {0023-8236},
mesh = {Cellulitis/etiology ; Chronic Disease ; Colon, Sigmoid/pathology ; Diverticulitis, Colonic/*etiology ; Diverticulum, Colon/*complications/diagnostic imaging/pathology/surgery ; Humans ; Intestinal Perforation/etiology ; Postoperative Complications ; Prognosis ; Radiography ; },
}
@article {pmid4781589,
year = {1973},
author = {Salter, RH},
title = {Some aspects of diverticular disease of the colon.},
journal = {Age and ageing},
volume = {2},
number = {4},
pages = {225-229},
doi = {10.1093/ageing/2.4.225},
pmid = {4781589},
issn = {0002-0729},
mesh = {Aged ; Benzoates/therapeutic use ; Colon, Sigmoid/surgery ; Colonic Diseases, Functional ; Diagnosis, Differential ; Diet Therapy ; *Diverticulitis, Colonic/diagnosis/etiology/surgery/therapy ; Gastrointestinal Motility/drug effects ; Humans ; Parasympatholytics/therapeutic use ; Phenethylamines/therapeutic use ; Propantheline/therapeutic use ; },
}
@article {pmid4752790,
year = {1973},
author = {Parks, TG},
title = {Proceedings: the role of a high-residue diet in the treatment of diverticular disease of the colon.},
journal = {The British journal of surgery},
volume = {60},
number = {11},
pages = {915},
pmid = {4752790},
issn = {0007-1323},
mesh = {Chromium Radioisotopes ; *Diet Therapy ; Diverticulum, Colon/*therapy ; Feces ; Humans ; },
}
@article {pmid4758664,
year = {1973},
author = {Findlay, JM and Mitchell, WD and Anderson, AJ and Eastwood, MA and Smith, AN},
title = {Proceedings: The effect of bran on steaming patterns in normal volunteers and patients with colonic diverticular disease.},
journal = {Gut},
volume = {14},
number = {10},
pages = {817},
pmid = {4758664},
issn = {0017-5749},
mesh = {Diverticulitis, Colonic/*physiopathology ; *Edible Grain ; *Gastrointestinal Motility ; Humans ; },
}
@article {pmid4583420,
year = {1973},
author = {Bolt, DE},
title = {Diverticular disease of the large intestine.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {53},
number = {4},
pages = {237-245},
pmid = {4583420},
issn = {0035-8843},
mesh = {Colon/surgery ; Colon, Sigmoid/surgery ; *Diverticulitis, Colonic/complications/etiology/pathology/surgery ; *Diverticulum, Colon/etiology/pathology/surgery ; Humans ; Intestinal Fistula/etiology/surgery ; Peritonitis/complications ; },
}
@article {pmid4741987,
year = {1973},
author = {Labow, SB and Salvati, EP and Rubin, RJ},
title = {The Hartman procedure in the treatment of diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {16},
number = {5},
pages = {392-394},
doi = {10.1007/BF02587584},
pmid = {4741987},
issn = {0012-3706},
mesh = {*Colon, Sigmoid ; Diverticulitis, Colonic/complications/mortality/*surgery ; Humans ; Intestinal Obstruction/complications ; Intestinal Perforation/complications ; Methods ; Postoperative Complications ; },
}
@article {pmid4741181,
year = {1973},
author = {Penfold, JC},
title = {Management of uncomplicated diverticular disease by colonic resection in patients at St. Mark's Hospital, 1964-9.},
journal = {The British journal of surgery},
volume = {60},
number = {9},
pages = {695-698},
doi = {10.1002/bjs.1800600909},
pmid = {4741181},
issn = {0007-1323},
mesh = {Adult ; Aged ; *Colectomy ; Colostomy ; Diverticulitis, Colonic/diagnostic imaging/pathology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Pain ; Postoperative Complications ; Radiography ; },
}
@article {pmid4720002,
year = {1973},
author = {Hodgson, J},
title = {Transverse taeniomyotomy for diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {16},
number = {4},
pages = {283-289},
doi = {10.1007/BF02587702},
pmid = {4720002},
issn = {0012-3706},
mesh = {Aged ; Barium Sulfate ; Colon/diagnostic imaging/surgery ; Contrast Media ; Diverticulum, Colon/diagnostic imaging/*surgery ; Female ; Humans ; Male ; Middle Aged ; Muscle Contraction ; Postoperative Complications ; Radiography ; },
}
@article {pmid4541502,
year = {1973},
author = {Penfold, JC},
title = {Significance of rectal bleeding in diverticular disease in patients at St. Mark's Hospital.},
journal = {The British journal of surgery},
volume = {60},
number = {7},
pages = {557-558},
doi = {10.1002/bjs.1800600716},
pmid = {4541502},
issn = {0007-1323},
mesh = {Colitis, Ulcerative/complications ; Colon, Sigmoid ; Diverticulum, Colon/*complications/surgery ; Endometriosis/complications/diagnosis ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Polyps/complications/diagnosis/diagnostic imaging ; Radiography ; Rectal Diseases/*etiology ; Rectal Neoplasms/complications/diagnosis ; },
}
@article {pmid4705099,
year = {1973},
author = {Berman, PM and Kirsner, JB},
title = {Diverticular disease of the colon--the possible role of "roughage" in both food and life.},
journal = {The American journal of digestive diseases},
volume = {18},
number = {6},
pages = {506-507},
pmid = {4705099},
issn = {0002-9211},
mesh = {*Diet ; Diverticulum, Colon/*etiology/pathology/therapy ; Food ; Humans ; *Life Style ; Stress, Psychological ; },
}
@article {pmid4574225,
year = {1973},
author = {Drapanas, T and Pennington, DG and Kappelman, M and Lindsey, ES},
title = {Emergency subtotal colectomy: preferred approach to management of massively bleeding diverticular disease.},
journal = {Annals of surgery},
volume = {177},
number = {5},
pages = {519-526},
pmid = {4574225},
issn = {0003-4932},
mesh = {Aged ; Arteriosclerosis/complications ; *Colectomy ; Diabetes Complications ; Diverticulum, Colon/complications/diagnostic imaging/*surgery ; *Emergencies ; Female ; Gastrointestinal Hemorrhage/diagnostic imaging/etiology/*surgery ; Humans ; Hypertension/complications ; Male ; Middle Aged ; Postoperative Complications ; Radiography ; Suture Techniques ; },
}
@article {pmid4540344,
year = {1973},
author = {Veidenheimer, MC},
title = {Technical considerations in the surgical management of diverticular disease of the colon.},
journal = {The Surgical clinics of North America},
volume = {53},
number = {2},
pages = {381-394},
doi = {10.1016/s0039-6109(16)39992-3},
pmid = {4540344},
issn = {0039-6109},
mesh = {Abscess/etiology ; Colectomy ; Colon, Sigmoid/surgery ; Colostomy ; Diverticulitis, Colonic/complications/*surgery ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Methods ; },
}
@article {pmid4540320,
year = {1973},
author = {Behringer, GE and Albright, NL},
title = {Diverticular disease of the colon. A frequent cause of massive rectal bleeding.},
journal = {American journal of surgery},
volume = {125},
number = {4},
pages = {419-423},
doi = {10.1016/0002-9610(73)90075-5},
pmid = {4540320},
issn = {0002-9610},
mesh = {Aged ; Diagnostic Errors ; Diverticulum, Colon/*complications/diagnostic imaging ; Female ; Gastrointestinal Hemorrhage/diagnosis/*etiology/mortality/therapy ; Humans ; Male ; Radiography ; Rectal Diseases/diagnosis/*etiology/mortality/therapy ; Time Factors ; },
}
@article {pmid4690116,
year = {1973},
author = {Eusebio, EB and Eisenberg, MM},
title = {Natural history of diverticular disease of the colon in young patients.},
journal = {American journal of surgery},
volume = {125},
number = {3},
pages = {308-311},
doi = {10.1016/0002-9610(73)90047-0},
pmid = {4690116},
issn = {0002-9610},
mesh = {Adult ; Age Factors ; Diet Therapy ; Diverticulitis, Colonic/*diagnosis/surgery ; Diverticulum, Colon/complications/*diagnosis/diagnostic imaging/surgery ; Follow-Up Studies ; Humans ; Leukocyte Count ; Radiography ; },
}
@article {pmid4735245,
year = {1973},
author = {Zeitlin, IJ and Smith, AN},
title = {Mobilization of tissue kallikrein in inflammatory disease of the colon.},
journal = {Gut},
volume = {14},
number = {2},
pages = {133-138},
pmid = {4735245},
issn = {0017-5749},
mesh = {Biological Assay ; Colitis, Ulcerative/enzymology/*metabolism ; Colon/analysis/enzymology ; Diverticulum, Colon/*metabolism ; Female ; Humans ; Intestinal Mucosa/analysis ; Kallikreins/analysis/*metabolism ; Kininogens/analysis ; Muscle, Smooth/analysis/enzymology ; Uterus/drug effects ; },
abstract = {Colonic tissue was taken at operation from 10 patients with active ulcerative colitis and three patients with uncomplicated diverticular disease but with severe symptoms. Levels of kininogen, kallikrein, and kallikrein precursor were measured in blood-free tissue samples. In normal colon tissue a kininogen occurred in the muscle and none was detected in the mucosa. Kallikrein and its precursor were found in mucosa but not in muscle. In acutely inflamed tissue from ulcerative colitis patients relatively high levels of active kallikrein were detected in the underlying colonic muscle. There was little change in the level of kallikrein in inflamed mucosa or of kininogen in the muscle of these patients. No kallikrein was found in colonic muscle from patients with diverticular disease and the mucosal kallikrein level in these patients was unchanged. The findings suggest a mechanism for the formation of kinins in the wall of the colon which is present in ulcerative colitis but not in diverticular disease.},
}
@article {pmid4805633,
year = {1973},
author = {Burkitt, D},
title = {Diverticular disease of the colon epidemiological evidence relating it to fibre-depleted diets.},
journal = {Transactions of the Medical Society of London},
volume = {89},
number = {},
pages = {81-84},
pmid = {4805633},
issn = {0076-6011},
mesh = {Africa, Southern ; Age Factors ; Diverticulitis, Colonic/epidemiology/*etiology ; Edible Grain ; *Feeding Behavior ; Humans ; Socioeconomic Factors ; United Kingdom ; United States ; Vegetables ; },
}
@article {pmid4699125,
year = {1973},
author = {Raia, A and Gama, AH and Rodrigues, JJ and Pinotti, HW},
title = {[Diverticular disease in transposed colon after esophagoplasty. Report of 2 cases].},
journal = {Revista do Hospital das Clinicas},
volume = {28},
number = {1},
pages = {15-20},
pmid = {4699125},
issn = {0041-8781},
mesh = {Colon/*surgery ; Diverticulitis, Colonic/*etiology ; Esophagoplasty/*adverse effects ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid4682505,
year = {1973},
author = {Raia, A and Gama, AH and Pinotti, HW and Rodrigues, JJ},
title = {Diverticular disease in the transposed colon used for esophagoplasty: report of two cases.},
journal = {Annals of surgery},
volume = {177},
number = {1},
pages = {70-74},
pmid = {4682505},
issn = {0003-4932},
mesh = {Caustics/poisoning ; Colon/*transplantation ; Deglutition Disorders/complications ; Diverticulum, Colon/*diagnosis/diagnostic imaging ; Esophageal Neoplasms/surgery ; *Esophagoplasty ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Transplantation, Autologous ; },
}
@article {pmid4646524,
year = {1972},
author = {Almeda, AZ},
title = {Methylcellulose in diverticular disease.},
journal = {British medical journal},
volume = {4},
number = {5843},
pages = {792},
pmid = {4646524},
issn = {0007-1447},
mesh = {Diverticulum, Colon/*drug therapy ; Edible Grain ; Humans ; Intestinal Obstruction/chemically induced ; Methylcellulose/*adverse effects ; Resins, Plant/therapeutic use ; },
}
@article {pmid4539294,
year = {1972},
author = {Crowson, WN and McCaughan, JJ},
title = {Total abdominal colectomy in the surgical management of diverticular disease of the colon: twenty years' experience.},
journal = {Southern medical journal},
volume = {65},
number = {12},
pages = {1443-1447},
doi = {10.1097/00007611-197212000-00004},
pmid = {4539294},
issn = {0038-4348},
mesh = {Adult ; Age Factors ; Aged ; *Colectomy ; Diverticulum, Colon/complications/mortality/*surgery ; Gastrointestinal Hemorrhage/surgery ; Humans ; Intestinal Fistula/surgery ; Methods ; Middle Aged ; Postoperative Complications ; Urinary Bladder Fistula/surgery ; },
}
@article {pmid4637129,
year = {1972},
author = {Hodgson, WJ},
title = {Diverticular disease treated by methyl cellulose tablets.},
journal = {The British journal of surgery},
volume = {59},
number = {11},
pages = {909-910},
pmid = {4637129},
issn = {0007-1323},
mesh = {Colon, Sigmoid/physiopathology ; Diverticulum, Colon/*drug therapy/physiopathology ; Humans ; Methylcellulose/administration & dosage/*therapeutic use ; Pressure ; Rectum/physiopathology ; Sigmoidoscopy ; },
}
@article {pmid4484812,
year = {1972},
author = {Hawkins, C},
title = {Diverticular disease of the colon: a disease of civilisation.},
journal = {Nursing mirror and midwives journal},
volume = {135},
number = {14},
pages = {35-37},
pmid = {4484812},
issn = {0143-2524},
mesh = {Diverticulum, Colon ; },
}
@article {pmid5087077,
year = {1972},
author = {Hodgson, J},
title = {An animal model for diverticular disease.},
journal = {Gut},
volume = {13},
number = {10},
pages = {838},
pmid = {5087077},
issn = {0017-5749},
mesh = {Animals ; Diet ; *Disease Models, Animal ; Diverticulum, Colon/*etiology ; Gastrointestinal Motility ; Manometry ; Neostigmine ; *Rabbits ; },
}
@article {pmid5077910,
year = {1972},
author = {Hodgson, J},
title = {Effect of methylcellulose on rectal and colonic pressures in treatment of diverticular disease.},
journal = {British medical journal},
volume = {3},
number = {5829},
pages = {729-731},
pmid = {5077910},
issn = {0007-1447},
mesh = {Aged ; Colon/*physiopathology ; Diverticulum, Colon/*drug therapy/physiopathology ; Female ; Gastrointestinal Motility ; Humans ; Male ; Manometry ; Methylcellulose/*therapeutic use ; Pressure ; Rectum/*physiopathology ; },
abstract = {Six patients with diverticular disorder confirmed by barium-enema examination were given a six-month course of methylcellulose (Celevac) tablets; their rectal and rectosigmoid colonic pressures were measured before and afterwards. Open-tipped, fluid-filled, narrow-bore polyethylene tubes were used for pressure measurements and care was taken to site the tubes similarly in all patients before and after treatment. After methylcellulose treatment the mean rectosigmoid pressures had fallen to the same range as the mean rectal pressures, a highly significant reduction. Methylcellulose significantly reduces rectosigmoid pressures in diverticular disease.},
}
@article {pmid4538937,
year = {1972},
author = {Heald, RJ and Ray, JE},
title = {Bleeding in diverticular disease of the colon.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {65},
number = {9},
pages = {779-780},
pmid = {4538937},
issn = {0035-9157},
mesh = {Colectomy ; Colon/pathology ; Colostomy ; Diverticulitis, Colonic/*complications/pathology ; Diverticulum, Colon/*complications ; Gastrointestinal Hemorrhage/*complications/surgery ; Granulation Tissue ; Humans ; Hypertension/complications ; Ulcer/complications ; },
}
@article {pmid4538249,
year = {1972},
author = {Berman, PM and Kirsner, JB},
title = {Diverticular disease of the colon in the elderly.},
journal = {Geriatrics},
volume = {27},
number = {9},
pages = {70-75},
pmid = {4538249},
issn = {0016-867X},
mesh = {Aged ; Colonic Diseases/etiology ; Colonic Neoplasms/complications ; Diet Therapy ; *Diverticulitis, Colonic/complications/etiology/surgery ; *Diverticulum, Colon/complications/diagnosis/epidemiology/therapy ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; },
}
@article {pmid5069224,
year = {1972},
author = {Thomson, JP and Hawley, PR},
title = {Results of closure of loop transverse colostomies.},
journal = {British medical journal},
volume = {3},
number = {5824},
pages = {459-462},
pmid = {5069224},
issn = {0007-1447},
mesh = {Adult ; Age Factors ; Aged ; Colon/surgery ; *Colostomy ; Diverticulitis/surgery ; Drainage ; Female ; Hernia/etiology ; Humans ; Intestinal Neoplasms/surgery ; Intestine, Large/surgery ; Male ; Methods ; Middle Aged ; Peritoneum ; Postoperative Complications ; Rectum/surgery ; Surgical Wound Infection ; },
abstract = {The postoperative course of 139 patients who underwent closure of a loop transverse colostomy at St. Mark's Hospital between 1961 and 1970 after distal resection and anastomosis of the large intestine for neoplastic or diverticular disease has been reviewed in detail. There were no deaths and the incidence of breakdown at the site of the colostomy closure was 2.9%. The procedure can be straightforward and safe.},
}
@article {pmid4558374,
year = {1972},
author = {Berman, PM and Kirsner, JB},
title = {Current knowledge of diverticular disease of the colon.},
journal = {The American journal of digestive diseases},
volume = {17},
number = {8},
pages = {741-759},
pmid = {4558374},
issn = {0002-9211},
mesh = {Abscess/complications ; Adult ; Aged ; Barium Sulfate ; Colon/anatomy & histology/physiology ; Colonic Diseases/diagnostic imaging ; Colonic Neoplasms/complications ; Diet Therapy ; *Diverticulitis, Colonic/complications/etiology/therapy ; *Diverticulum, Colon/etiology/therapy ; Enema ; Gastrointestinal Hemorrhage/complications ; Humans ; Intestinal Fistula/complications ; Intestinal Obstruction/complications ; Middle Aged ; Radiography ; },
}
@article {pmid4537707,
year = {1972},
author = {Becker, WF},
title = {Elective surgical treatment of persistent diverticular disease of the colon.},
journal = {The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society},
volume = {124},
number = {7},
pages = {233-235},
pmid = {4537707},
issn = {0024-6921},
mesh = {Barium Sulfate ; Diverticulitis, Colonic/complications/diagnostic imaging/*surgery ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Radiography ; },
}
@article {pmid4555653,
year = {1972},
author = {Jones, FA and Godding, EW},
title = {Unprocessed bran and diverticular disease.},
journal = {British medical journal},
volume = {2},
number = {5814},
pages = {651},
doi = {10.1136/bmj.2.5814.651},
pmid = {4555653},
issn = {0007-1447},
mesh = {Cathartics/*therapeutic use ; *Constipation ; Humans ; Plants, Medicinal ; Plants, Toxic ; Resins, Plant/therapeutic use ; Rhamnus ; },
}
@article {pmid5037798,
year = {1972},
author = {Beachley, MC},
title = {Intramural masses secondary to diverticular disease of the colon.},
journal = {The American journal of roentgenology, radium therapy, and nuclear medicine},
volume = {115},
number = {2},
pages = {368-373},
doi = {10.2214/ajr.115.2.368},
pmid = {5037798},
issn = {0002-9580},
mesh = {Acute Disease ; Adult ; Barium Sulfate ; Colon/diagnostic imaging/pathology ; Colonic Diseases/*diagnostic imaging ; Diverticulitis, Colonic/*diagnostic imaging/pathology/surgery ; Enema ; Female ; Humans ; Middle Aged ; Radiography ; },
}
@article {pmid5037795,
year = {1972},
author = {Beranbaum, SL and Zausner, J and Lane, B},
title = {Diverticular disease of the right colon.},
journal = {The American journal of roentgenology, radium therapy, and nuclear medicine},
volume = {115},
number = {2},
pages = {334-348},
doi = {10.2214/ajr.115.2.334},
pmid = {5037795},
issn = {0002-9580},
mesh = {Angiography ; Appendicitis/diagnostic imaging ; Barium Sulfate ; Colonic Neoplasms/diagnostic imaging ; Crohn Disease/diagnostic imaging ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnostic imaging ; Enema ; Fluoroscopy ; Humans ; Intestinal Diseases/diagnostic imaging ; Ulcer/diagnostic imaging ; },
}
@article {pmid5029841,
year = {1972},
author = {Colcock, BP and Stahmann, FD},
title = {Fistulas complicating diverticular disease of the sigmoid colon.},
journal = {Annals of surgery},
volume = {175},
number = {6},
pages = {838-846},
pmid = {5029841},
issn = {0003-4932},
mesh = {Adult ; Aged ; Colonic Diseases/*etiology ; Diverticulitis, Colonic/*complications/surgery ; Female ; Fistula/etiology ; Humans ; Ileum ; Intestinal Fistula/*etiology/surgery ; Jejunum ; Male ; Middle Aged ; Postoperative Complications ; Skin Diseases/etiology ; Urinary Bladder Fistula/etiology ; Uterine Diseases/etiology ; Vaginal Fistula/etiology ; },
}
@article {pmid5027869,
year = {1972},
author = {Painter, NS},
title = {Diverticular disease of the colon and constipation. 3. High fibre diet with added bran.},
journal = {Nursing times},
volume = {68},
number = {20},
pages = {620-621},
pmid = {5027869},
issn = {0954-7762},
mesh = {Constipation/*therapy ; *Diet Therapy ; Diverticulum, Colon/*therapy ; *Edible Grain ; Humans ; },
}
@article {pmid5023931,
year = {1972},
author = {Cleave, TL},
title = {Bran and diverticular disease.},
journal = {British medical journal},
volume = {2},
number = {5810},
pages = {408-409},
pmid = {5023931},
issn = {0007-1447},
mesh = {Bread ; Constipation/*therapy ; Diverticulum, Colon/therapy ; *Edible Grain ; Enema ; Humans ; Male ; },
}
@article {pmid5026118,
year = {1972},
author = {Painter, NS},
title = {Diverticular disease of the colon and constipation and their relationship to our diet. 2.},
journal = {Nursing times},
volume = {68},
number = {19},
pages = {564-565},
pmid = {5026118},
issn = {0954-7762},
mesh = {Constipation/*therapy ; *Diet Therapy ; Diverticulum, Colon/*therapy ; Edible Grain ; Humans ; },
}
@article {pmid5024123,
year = {1972},
author = {Painter, NS},
title = {Diverticular disease of the colon and constipation and their relationship to our diet. 1.},
journal = {Nursing times},
volume = {68},
number = {18},
pages = {536-537},
pmid = {5024123},
issn = {0954-7762},
mesh = {Constipation/*etiology ; *Diet ; Diverticulum, Colon/*etiology ; Humans ; },
}
@article {pmid4622783,
year = {1972},
author = {Painter, NS and Almeida, AZ and Colebourne, KW},
title = {Unprocessed bran in treatment of diverticular disease of the colon.},
journal = {British medical journal},
volume = {2},
number = {5806},
pages = {137-140},
pmid = {4622783},
issn = {0007-1447},
mesh = {Adult ; Aged ; Cathartics/therapeutic use ; Defecation ; *Diet Therapy ; Dietary Carbohydrates ; Diverticulum/complications ; Diverticulum, Colon/*therapy ; *Edible Grain ; Female ; Humans ; Male ; Middle Aged ; Time Factors ; },
abstract = {Seventy patients with diverticular disease of the colon were treated with a high-residue, low-sugar diet including unprocessed bran. Follow-up for an average of 22 months showed marked relief of symptoms in 62 patients. Bowel habit was restored towards normal and abdominal discomfort relieved. Only seven patients were unable to give up the use of laxatives. Eight patients did not tolerate the bran diet, and one of these needed surgical treatment. None of the 62 patients who took the diet needed surgery.},
}
@article {pmid5020783,
year = {1972},
author = {Hodgson, I},
title = {An animal model to study diverticular disease.},
journal = {The British journal of surgery},
volume = {59},
number = {4},
pages = {315},
pmid = {5020783},
issn = {0007-1323},
mesh = {Animals ; Diet ; *Disease Models, Animal ; *Diverticulum, Colon/etiology ; Gastrointestinal Motility ; Manometry ; Neostigmine/pharmacology ; Rabbits ; },
}
@article {pmid5020782,
year = {1972},
author = {Hughes, LE},
title = {The relationship of colonic symptoms to the muscular abnormality of diverticular disease.},
journal = {The British journal of surgery},
volume = {59},
number = {4},
pages = {315},
pmid = {5020782},
issn = {0007-1323},
mesh = {Constipation ; Diarrhea ; Diverticulum, Colon/*diagnostic imaging ; Humans ; Muscle, Smooth/diagnostic imaging ; Pain ; Prospective Studies ; Radiography ; },
}
@article {pmid4622770,
year = {1972},
author = {Miyar González, A},
title = {[Diverticular disease of the digestive tract in the aged].},
journal = {Revista espanola de las enfermedades del aparato digestivo},
volume = {36},
number = {6},
pages = {707-734},
pmid = {4622770},
issn = {0034-9437},
mesh = {Age Factors ; Aged ; *Diverticulum ; *Diverticulum, Esophageal ; *Gastrointestinal Diseases ; Humans ; },
}
@article {pmid5042584,
year = {1972},
author = {Hilton, HD and Griffin, WT},
title = {Which operation for diverticular disease?.},
journal = {Medical times},
volume = {100},
number = {3},
pages = {214 passim},
pmid = {5042584},
issn = {0025-7583},
mesh = {Aged ; Colectomy ; Colostomy ; Diverticulum, Colon/*surgery ; Humans ; Middle Aged ; },
}
@article {pmid4537737,
year = {1972},
author = {Raynham, WH and Helman, P},
title = {Massive haemorrhage from diverticular disease of the colon.},
journal = {South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie},
volume = {10},
number = {1},
pages = {45-52},
pmid = {4537737},
issn = {0038-2361},
mesh = {Aged ; Diverticulitis, Colonic/*complications/surgery ; Diverticulum, Colon/*complications/surgery ; Gastrointestinal Hemorrhage/*etiology/surgery ; Humans ; Male ; Middle Aged ; },
}
@article {pmid5034236,
year = {1972},
author = {Levin, L and Wapnick, S},
title = {Cholelithiasis, diverticular disease and hiatus hernia in a Rhodesian African.},
journal = {The Central African journal of medicine},
volume = {18},
number = {2},
pages = {25-27},
pmid = {5034236},
issn = {0008-9176},
mesh = {Cholelithiasis/*complications ; Diverticulum, Colon/*complications ; Female ; Hernia, Diaphragmatic/*complications ; Humans ; Middle Aged ; Zimbabwe ; },
}
@article {pmid5011922,
year = {1972},
author = {Ranson, JH and Lawrence, LR and Localio, SA},
title = {Colomyotomy. A new approach to surgery for colonic diverticular disease.},
journal = {American journal of surgery},
volume = {123},
number = {2},
pages = {185-191},
doi = {10.1016/0002-9610(72)90331-5},
pmid = {5011922},
issn = {0002-9610},
mesh = {Adult ; Aged ; Barium Sulfate ; Diverticulitis, Colonic/diagnostic imaging/*surgery ; Female ; Humans ; Intestinal Fistula/etiology ; Male ; Methods ; Middle Aged ; Postoperative Complications ; Radiography ; Surgical Wound Infection/etiology ; },
}
@article {pmid4537588,
year = {1972},
author = {Kosaka, T and Yazawa, C},
title = {[Colonic diverticular disease].},
journal = {Nihon Daicho Komonbyo Gakkai zasshi},
volume = {25},
number = {1},
pages = {5-6},
pmid = {4537588},
issn = {0047-1801},
mesh = {Adult ; Aged ; Cecal Diseases ; *Diverticulum, Colon/diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Radiography ; },
}
@article {pmid4537587,
year = {1972},
author = {Kasukawa, G and Yoshio, T and Gonohe, T and Suzuki, Y and Ogai, T},
title = {[Colonic diverticular disease].},
journal = {Nihon Daicho Komonbyo Gakkai zasshi},
volume = {25},
number = {1},
pages = {4-5},
pmid = {4537587},
issn = {0047-1801},
mesh = {Adolescent ; Adult ; Aged ; *Diverticulum, Colon ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid4537554,
year = {1972},
author = {Ikenaga, T},
title = {[Colonic diverticular disease--with particular reference to diverticulosis and diverticulitis of the right colon].},
journal = {Nihon Daicho Komonbyo Gakkai zasshi},
volume = {25},
number = {1},
pages = {10-11},
pmid = {4537554},
issn = {0047-1801},
mesh = {*Diverticulitis, Colonic/diagnosis ; *Diverticulum, Colon/diagnosis ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid5142931,
year = {1971},
author = {Levy, N},
title = {[The etiology of diverticular disease of the colon].},
journal = {Harefuah},
volume = {81},
number = {11},
pages = {559-560},
pmid = {5142931},
issn = {0017-7768},
mesh = {Diet ; Diverticulum, Colon/*etiology ; Humans ; },
}
@article {pmid5097410,
year = {1971},
author = {Wapnick, S and Levin, L},
title = {Diverticular disease of the colon.},
journal = {British medical journal},
volume = {4},
number = {5779},
pages = {115},
doi = {10.1136/bmj.4.5779.115-c},
pmid = {5097410},
issn = {0007-1447},
mesh = {Adult ; Diverticulum, Colon/*epidemiology ; Female ; Humans ; Zimbabwe ; },
}
@article {pmid5096009,
year = {1971},
author = {Dick, ET},
title = {Sigmoidmyotomy in diverticular disease of the colon.},
journal = {Diseases of the colon and rectum},
volume = {14},
number = {5},
pages = {341-346},
doi = {10.1007/BF02553418},
pmid = {5096009},
issn = {0012-3706},
mesh = {Barium Sulfate ; Colon, Sigmoid/diagnostic imaging/pathology/*surgery ; Diverticulitis, Colonic/pathology/*surgery ; Diverticulum, Colon/pathology/*surgery ; Enema ; Female ; Humans ; Intestine, Large/physiopathology ; Male ; Methods ; Middle Aged ; Pressure ; Radiography ; Sigmoidoscopy ; },
}
@article {pmid5314849,
year = {1971},
author = {May, KJ},
title = {Surgical management of diverticular disease of the colon.},
journal = {The American surgeon},
volume = {37},
number = {8},
pages = {490-494},
pmid = {5314849},
issn = {0003-1348},
mesh = {Aged ; Barium Sulfate ; Diverticulitis, Colonic/complications/diagnostic imaging/*surgery ; Diverticulum, Colon/diagnostic imaging/*surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Radiography ; },
}
@article {pmid5160999,
year = {1971},
author = {Conole, FD},
title = {Surgical critique of diverticular disease of the large bowel; as encountered at the Binghamton General Hospital during a five-year period--1964 through 1968.},
journal = {American journal of proctology},
volume = {22},
number = {4},
pages = {251-254},
pmid = {5160999},
issn = {0002-9521},
mesh = {Colon/surgery ; Colostomy ; Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Methods ; },
}
@article {pmid5096788,
year = {1971},
author = {Smith, AN and Attisha, RP and Clarke, S},
title = {Motility after colomyotomy and resection of the colon for diverticular disease.},
journal = {The American journal of digestive diseases},
volume = {16},
number = {8},
pages = {728-733},
pmid = {5096788},
issn = {0002-9211},
mesh = {Colon/*physiopathology/surgery ; Colon, Sigmoid/physiopathology ; Diverticulum, Colon/diagnostic imaging/*physiopathology/surgery ; *Gastrointestinal Motility/drug effects ; Humans ; Neostigmine/pharmacology ; Pressure ; Radiography ; },
}
@article {pmid5563120,
year = {1971},
author = {De Arzua Zulaica, E},
title = {[Diverticular disease of the colon].},
journal = {Revista espanola de las enfermedades del aparato digestivo},
volume = {35},
number = {1},
pages = {37-68},
pmid = {5563120},
issn = {0034-9437},
mesh = {*Diverticulitis, Colonic ; *Diverticulum, Colon ; Humans ; },
}
@article {pmid5316376,
year = {1971},
author = {Paulino, F},
title = {[Hemorrhage in diverticular disease of the colon].},
journal = {Revista brasileira de medicina},
volume = {28},
number = {7},
pages = {327-328},
pmid = {5316376},
issn = {0034-7264},
mesh = {Diverticulitis, Colonic/*complications ; Gastrointestinal Hemorrhage/*etiology ; Humans ; },
}
@article {pmid5580738,
year = {1971},
author = {Calder, JF},
title = {Diverticular disease of the colon.},
journal = {British medical journal},
volume = {2},
number = {5762},
pages = {654},
pmid = {5580738},
issn = {0007-1447},
mesh = {Adult ; Black or African American ; Black People ; *Diverticulitis, Colonic/complications/epidemiology/surgery ; Female ; Humans ; Malawi ; Peritonitis/complications ; },
}
@article {pmid5578807,
year = {1971},
author = {Floyd, RD and Griffen, WO},
title = {Colonic diverticular disease: changing operative management.},
journal = {Annals of surgery},
volume = {173},
number = {6},
pages = {979-982},
pmid = {5578807},
issn = {0003-4932},
mesh = {Aged ; Colectomy ; Colon, Sigmoid/surgery ; Colostomy ; Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Drainage ; Female ; Humans ; Ileum/surgery ; Male ; Middle Aged ; Retrospective Studies ; },
}
@article {pmid4930390,
year = {1971},
author = {Painter, NS and Burkitt, DP},
title = {Diverticular disease of the colon: a deficiency disease of Western civilization.},
journal = {British medical journal},
volume = {2},
number = {5759},
pages = {450-454},
pmid = {4930390},
issn = {0007-1447},
mesh = {Africa ; Colitis, Ulcerative/epidemiology ; Colon/physiopathology ; Colonic Neoplasms/epidemiology ; Developing Countries ; *Diet ; Diverticulum, Colon/complications/epidemiology/*etiology/mortality/physiopathology ; Edible Grain ; Humans ; Intestinal Polyps/epidemiology ; United Kingdom ; United States ; },
}
@article {pmid5551474,
year = {1971},
author = {Barabas, AP},
title = {Peritonitis due to diverticular disease of the colon: review of 44 cases.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {64},
number = {3},
pages = {253-254},
pmid = {5551474},
issn = {0035-9157},
mesh = {Appendicitis/diagnosis ; Diagnosis, Differential ; Diverticulitis, Colonic/*complications/diagnosis/surgery ; Drainage ; Duodenal Ulcer/diagnosis ; Humans ; Peritonitis/*etiology ; Suppuration/surgery ; },
}
@article {pmid5549273,
year = {1971},
author = {Fleischner, FG},
title = {Diverticular disease of the colon. New observations and revised concepts.},
journal = {Gastroenterology},
volume = {60},
number = {2},
pages = {316-324},
pmid = {5549273},
issn = {0016-5085},
mesh = {Colon/pathology ; Diverticulitis, Colonic/*classification ; Diverticulum, Colon/etiology/pathology ; Female ; Humans ; Male ; },
}
@article {pmid5549377,
year = {1971},
author = {Jacobs, E},
title = {Changing ocepts of diverticular disease of the colon.},
journal = {Diseases of the colon and rectum},
volume = {14},
number = {1},
pages = {29-31},
doi = {10.1007/BF02553171},
pmid = {5549377},
issn = {0012-3706},
mesh = {*Colon, Sigmoid ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis/*etiology/surgery ; Diverticulum, Colon/diagnosis ; Humans ; Pressure ; },
}
@article {pmid5312733,
year = {1971},
author = {Paulino, F and Roselli, A and Martins, U},
title = {Pathology of diverticular disease of the colon.},
journal = {Surgery},
volume = {69},
number = {1},
pages = {63-69},
pmid = {5312733},
issn = {0039-6060},
mesh = {Colon/*pathology ; Colon, Sigmoid/*pathology ; Diverticulitis, Colonic/*pathology ; Diverticulum, Colon/*pathology ; Gastrointestinal Hemorrhage/*pathology ; Humans ; },
}
@article {pmid5120457,
year = {1971},
author = {Reilly, M},
title = {Sigmoid myotomy for diverticular disease of the colon.},
journal = {Modern trends in surgery},
volume = {3},
number = {},
pages = {109-135},
pmid = {5120457},
issn = {0544-6953},
mesh = {Aged ; Colon, Sigmoid/surgery ; Colonic Neoplasms/*surgery ; Diverticulum, Colon/pathology/*surgery ; Female ; Humans ; },
}
@article {pmid4949985,
year = {1971},
author = {Colcock, BP},
title = {Diverticular disease of the colon.},
journal = {Major problems in clinical surgery},
volume = {11},
number = {},
pages = {1-135},
pmid = {4949985},
issn = {0025-1062},
mesh = {Aged ; Colitis/diagnosis ; Colonic Diseases/etiology ; Colonic Diseases, Functional/diagnosis ; Colonic Neoplasms/diagnosis ; Diagnosis, Differential ; *Diverticulitis, Colonic/complications/diagnosis/etiology/pathology/surgery ; *Diverticulum, Colon/complications/diagnosis/surgery ; Gastrointestinal Hemorrhage/diagnosis ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Middle Aged ; Postoperative Complications ; },
}
@article {pmid4941821,
year = {1971},
author = {Zollinger, RW and Zollinger, RM},
title = {Diverticular disease of the colon.},
journal = {Advances in surgery},
volume = {5},
number = {},
pages = {255-280},
pmid = {4941821},
issn = {0065-3411},
mesh = {Acute Disease ; Adult ; Aged ; Appendicitis/diagnosis ; Autopsy ; Cecum/surgery ; Chronic Disease ; Colon/pathology ; Colonic Diseases ; Colonic Neoplasms/diagnosis/surgery ; Diagnosis, Differential ; *Diverticulitis, Colonic/diagnosis/epidemiology/etiology/pathology/therapy ; Female ; Fistula ; Fluoroscopy ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; Intestinal Fistula ; Intestinal Obstruction/diagnostic imaging/surgery ; Intestinal Perforation/etiology/surgery ; Male ; Middle Aged ; Peritonitis/etiology ; Recurrence ; Urinary Fistula ; Uterine Diseases ; Vaginal Fistula ; },
}
@article {pmid5490779,
year = {1970},
author = {Parks, TG},
title = {Prognosis in diverticular disease of the colon.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {63},
number = {12},
pages = {1262-1263},
pmid = {5490779},
issn = {0035-9157},
mesh = {Age Factors ; Aged ; Chronic Disease ; Colectomy ; Diverticulum, Colon/complications/*diagnosis/mortality ; Follow-Up Studies ; Humans ; Peritonitis/etiology ; Prognosis ; },
}
@article {pmid5506904,
year = {1970},
author = {Jackson, PP},
title = {Sigmoid myotomy in treatment of diverticular disease of the colon.},
journal = {The American surgeon},
volume = {36},
number = {10},
pages = {607-609},
pmid = {5506904},
issn = {0003-1348},
mesh = {Aged ; Colectomy ; Colon, Sigmoid/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Methods ; Middle Aged ; },
}
@article {pmid5504874,
year = {1970},
author = {Jarpa, S},
title = {[Diverticular disease of the colon].},
journal = {Revista medica de Chile},
volume = {98},
number = {10},
pages = {699-702},
pmid = {5504874},
issn = {0034-9887},
mesh = {Aged ; Diverticulitis, Colonic ; *Diverticulum, Colon ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid5476757,
year = {1970},
author = {Parks, TG and Connell, AM},
title = {The outcome in 455 patients admitted for treatment of diverticular disease of the colon.},
journal = {The British journal of surgery},
volume = {57},
number = {10},
pages = {775-778},
doi = {10.1002/bjs.1800571021},
pmid = {5476757},
issn = {0007-1323},
mesh = {Aged ; Colonic Neoplasms/complications ; Colostomy ; Diverticulum, Colon/complications/surgery/*therapy ; Drainage ; Female ; Follow-Up Studies ; Humans ; Intestinal Fistula/etiology ; Male ; Middle Aged ; Postoperative Complications ; Rectovaginal Fistula/etiology ; },
}
@article {pmid4918894,
year = {1970},
author = {Fenger, C and Nyholm, K and Amdrup, E},
title = {[Diverticular disease of the colon].},
journal = {Ugeskrift for laeger},
volume = {132},
number = {38},
pages = {1766-1771},
pmid = {4918894},
issn = {0041-5782},
mesh = {Age Factors ; Anti-Bacterial Agents/therapeutic use ; Biphenyl Compounds ; Chronic Disease ; Colonic Neoplasms/diagnosis ; Colostomy ; Diagnosis, Differential ; Diet Therapy ; *Diverticulum, Colon/complications/diagnosis/surgery/therapy ; Female ; Humans ; Intestinal Perforation/etiology ; Male ; Middle Aged ; Peritonitis/etiology ; Time Factors ; },
}
@article {pmid5313004,
year = {1970},
author = {Theodor, E},
title = {[The diverticular disease of the colon].},
journal = {Harefuah},
volume = {79},
number = {4},
pages = {186-187},
pmid = {5313004},
issn = {0017-7768},
mesh = {*Diverticulitis, Colonic/complications/diagnosis ; Gastrointestinal Hemorrhage/complications ; Humans ; Intestinal Fistula/complications ; Peritonitis/complications ; },
}
@article {pmid5471035,
year = {1970},
author = {Jalan, KN and Walker, RJ and Prescott, RJ and Butterworth, ST and Smith, AN and Sircus, W},
title = {Faecal stasis and diverticular disease in ulcerative colitis.},
journal = {Gut},
volume = {11},
number = {8},
pages = {688-696},
pmid = {5471035},
issn = {0017-5749},
mesh = {Barium Sulfate ; Cathartics/therapeutic use ; Colitis, Ulcerative/*complications ; Colon/pathology/physiopathology ; Constipation/drug therapy/*etiology ; Diverticulum, Colon/*etiology ; Female ; Gastrointestinal Motility ; Humans ; Male ; Paraffin/therapeutic use ; Succinates/therapeutic use ; },
abstract = {The incidence of faecal stasis and of diverticular disease has been studied in a group of 399 patients with ulcerative colitis. Sixty-one patients had faecal stasis and 23 patients had diverticular disease. Pathological studies demonstrated an increase in the thickness of the inner spiral muscle in colitis patients with faecal stasis. The thickening was not as great as that seen in diverticular disease. Preliminary studies on the motility patterns in patients with faecal stasis show a higher mean activity in the pelvic colon than in normals but not as great as that seen in diverticular disease. Pressure studies in patients with faecal stasis have shown hypotonia in the proximal colon associated with dilatation.The possible significance of these results is discussed. It is suggested that ulcerative colitis may initiate a motility disturbance which leads to muscle thickening similar to that in diverticular disease. Diverticula associated with ulcerative colitis are usually not involved in the mucosal inflammatory process.},
}
@article {pmid4913873,
year = {1970},
author = {Painter, NS},
title = {Diverticular disease of the colon--a disease of western civilisation.},
journal = {Disease-a-month : DM},
volume = {},
number = {},
pages = {3-57},
pmid = {4913873},
issn = {0011-5029},
mesh = {Adult ; Age Factors ; Aged ; Colectomy ; Colon/blood supply/drug effects/*pathology/physiopathology ; Colon, Sigmoid/physiopathology ; Diet/adverse effects ; *Diverticulitis, Colonic ; *Diverticulum, Colon/complications/diagnosis/etiology/pathology/physiopathology/surgery/therapy ; Female ; Humans ; Intestinal Fistula/etiology ; Male ; Meperidine/pharmacology ; Middle Aged ; Morphine/pharmacology ; Neostigmine/pharmacology ; Parasympatholytics/therapeutic use ; Peritonitis/etiology ; Pressure ; Propantheline/therapeutic use ; Quaternary Ammonium Compounds/therapeutic use ; Sex Factors ; Xanthenes/therapeutic use ; },
}
@article {pmid5423677,
year = {1970},
author = {MacGregor, AB and Hamilton, T},
title = {Diverticular disease of the jejunum.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {15},
number = {3},
pages = {145-150},
pmid = {5423677},
issn = {0035-8835},
mesh = {Aged ; *Diverticulitis ; Female ; Humans ; *Jejunum ; Male ; },
}
@article {pmid5423676,
year = {1970},
author = {MacGregor, AB and Abernethy, BC and Thomson, JW},
title = {The role of surgery in diverticular disease of the colon.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {15},
number = {3},
pages = {137-144},
pmid = {5423676},
issn = {0035-8835},
mesh = {Adult ; Aged ; Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid5440594,
year = {1970},
author = {Parks, TG and Connell, AM and Gough, AD and Cole, JO},
title = {Limitations of radiology in the differentiation of diverticulitis and diverticulosis of the colon.},
journal = {British medical journal},
volume = {2},
number = {5702},
pages = {136-138},
pmid = {5440594},
issn = {0007-1447},
mesh = {Acute Disease ; Barium Sulfate ; Colonic Neoplasms/complications ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/*diagnostic imaging ; Diverticulum, Colon/complications/*diagnostic imaging ; Enema ; Humans ; Inflammation ; Radiography ; Retrospective Studies ; Terminology as Topic ; },
abstract = {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.},
}
@article {pmid5440589,
year = {1970},
author = {},
title = {Diverticular disease.},
journal = {British medical journal},
volume = {2},
number = {5702},
pages = {126-127},
pmid = {5440589},
issn = {0007-1447},
mesh = {Acute Disease ; Chronic Disease ; *Diverticulitis, Colonic ; *Diverticulum, Colon ; Humans ; },
}
@article {pmid5435160,
year = {1970},
author = {Hughes, LE},
title = {Diverticular disease of the colon.},
journal = {British medical journal},
volume = {1},
number = {5694},
pages = {496},
pmid = {5435160},
issn = {0007-1447},
mesh = {*Diverticulitis, Colonic/complications/diagnostic imaging/surgery ; Humans ; Middle Aged ; Radiography ; },
}
@article {pmid5441880,
year = {1970},
author = {Parks, TG},
title = {Rectal and colonic studies after resection of the sigmoid for diverticular disease.},
journal = {Gut},
volume = {11},
number = {2},
pages = {121-125},
pmid = {5441880},
issn = {0017-5749},
mesh = {Colon/drug effects/*physiopathology ; Diverticulum, Colon/etiology/*surgery ; Food ; Gastrointestinal Motility/drug effects ; Humans ; Neostigmine/pharmacology ; Pressure ; Rectum/drug effects/*physiopathology ; Stimulation, Chemical ; },
abstract = {Spontaneous basal rectal activity, recorded after resection of the sigmoid colon for diverticular disease, was more than twice the normal. The rectum of post-resection cases yielded a markedly exaggerated overall response to prostigmine, in addition to producing abundant fast wave patterns. The response to stretch of the apparently normal colonic muscle remaining after resection of the sigmoid for diverticular disease resembled unresected diverticular segments, though less in degree, suggesting that a fundamental disorder of colonic muscle may be involved in the aetiology of colonic diverticula.},
}
@article {pmid5441878,
year = {1970},
author = {Hughes, LE},
title = {A study of abnormal muscular patterns in diverticular disease of the colon using the polysiloxane foam enema.},
journal = {Gut},
volume = {11},
number = {2},
pages = {111-117},
pmid = {5441878},
issn = {0017-5749},
mesh = {Colon/pathology ; Diverticulitis, Colonic/pathology/*physiopathology/surgery ; Enema ; *Gastrointestinal Motility ; Humans ; Muscle Contraction ; Muscle, Smooth/pathology/physiopathology ; Silicones ; },
abstract = {Three-dimensional, functional studies of the left colon using a polysiloxane foam enema have shown that three types of impressions due to muscular contractions are commonly found in the region of the rectum and sigmoid, and that at least two of these are closely associated with the presence of diverticular disease. Each type of abnormality has been defined and its extent and frequency assessed. A tentative mechanism for the development of the main muscular abnormality through muscle thickening and simple sigmoid curves is put forward, and it is suggested that the third type of abnormality may be associated with sphincteric action at the recto-sigmoid junction. The reproducibility of findings on repeated examinations must mean that there is a local anatomical basis for the muscular impressions seen and that such contractions do not represent evanescent peristaltic type activity. Sigmoid resection and myotomy as practised for diverticular disease should eliminate the first type of abnormality in the majority of cases, but it is necessary to carry the operation well distally to ensure this. Neither operation is likely to correct the type III abnormality, and further work is necessary to determine whether this is responsible for some of the symptoms persisting after surgery.},
}
@article {pmid5436532,
year = {1970},
author = {Wilson, E},
title = {Bowel resection for diverticular disease of the colon.},
journal = {The Medical journal of Australia},
volume = {1},
number = {5},
pages = {204-207},
doi = {10.5694/j.1326-5377.1970.tb77811.x},
pmid = {5436532},
issn = {0025-729X},
mesh = {Abscess/etiology ; Adult ; Aged ; Chronic Disease ; Colectomy ; Colonic Diseases/etiology ; Colostomy ; Diverticulitis, Colonic/complications/mortality/*surgery ; Female ; Fistula/etiology ; Humans ; Intestinal Obstruction/etiology ; Male ; Middle Aged ; Postoperative Complications ; },
}
@article {pmid5525506,
year = {1970},
author = {Morgan, B},
title = {Results of elective surgery in diverticular disease of the colon.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {63 Suppl},
number = {Suppl 1},
pages = {61-62},
pmid = {5525506},
issn = {0035-9157},
mesh = {Colostomy ; Diverticulitis, Colonic/mortality/*surgery ; Diverticulum, Colon/mortality/*surgery ; Drainage ; Humans ; Laparotomy ; Peritonitis/etiology ; Postoperative Complications ; Surgical Wound Dehiscence ; Surgical Wound Infection ; },
}
@article {pmid5525502,
year = {1970},
author = {Chapman, M},
title = {Radiology of diverticular disease.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {63 Suppl},
number = {Suppl 1},
pages = {50-51},
pmid = {5525502},
issn = {0035-9157},
mesh = {Colitis, Ulcerative/diagnostic imaging ; Crohn Disease/diagnostic imaging ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnostic imaging ; Diverticulum, Colon/*diagnostic imaging ; Enema ; Humans ; Radiography ; },
}
@article {pmid5525501,
year = {1970},
author = {Slack, WW},
title = {Pathology of diverticular disease.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {63 Suppl},
number = {Suppl 1},
pages = {49-50},
pmid = {5525501},
issn = {0035-9157},
mesh = {Colon/blood supply/physiopathology ; Diverticulitis, Colonic/*pathology ; Diverticulum, Colon/*pathology ; Humans ; Hyperplasia ; Hypertrophy ; Intestinal Mucosa/pathology ; Muscle Contraction ; Muscle, Smooth/pathology ; },
}
@article {pmid5525499,
year = {1970},
author = {Parks, TG},
title = {Motor responses in unresected and resected diverticular disease of the colon.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {63 Suppl},
number = {Suppl 1},
pages = {3-6},
pmid = {5525499},
issn = {0035-9157},
mesh = {Colon/physiopathology ; Defecation ; Diverticulitis, Colonic/*physiopathology/surgery ; Diverticulum, Colon/*physiopathology/surgery ; Electrophysiology ; Gastrointestinal Motility ; Humans ; Muscle Contraction ; Pressure ; Rectum/physiopathology ; },
}
@article {pmid5525488,
year = {1970},
author = {Painter, NS},
title = {Pressures in the colon related to diverticular disease.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {63 Suppl},
number = {Suppl 1},
pages = {144-145},
pmid = {5525488},
issn = {0035-9157},
mesh = {Colon/*physiopathology ; Diet ; Diverticulitis, Colonic/mortality/*physiopathology ; Diverticulum, Colon/mortality/*physiopathology ; Humans ; Muscle Contraction ; Pressure ; },
}
@article {pmid5484974,
year = {1970},
author = {Schulenburg, CA},
title = {Diverticular disease of the colon.},
journal = {South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie},
volume = {8},
number = {2},
pages = {18-19},
pmid = {5484974},
issn = {0038-2361},
mesh = {Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Humans ; },
}
@article {pmid5317023,
year = {1970},
author = {Hoare, EM},
title = {Massive haemorrhage and diverticular disease of the colon.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {63 Suppl},
number = {Suppl 1},
pages = {55-57},
pmid = {5317023},
issn = {0035-9157},
mesh = {Age Factors ; Aged ; Colectomy ; Diverticulum, Colon/*complications/surgery/therapy ; Female ; Gastrointestinal Hemorrhage/*complications/epidemiology/therapy ; Humans ; Hypertension/complications ; Male ; Sex Factors ; },
}
@article {pmid5359918,
year = {1969},
author = {Parks, TG},
title = {Reappraisal of clinical features of diverticular disease of the colon.},
journal = {British medical journal},
volume = {4},
number = {5684},
pages = {642-645},
pmid = {5359918},
issn = {0007-1447},
mesh = {Abdomen ; Adult ; Aged ; Defecation ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/*diagnosis/diagnostic imaging ; Diverticulum, Colon/complications/*diagnosis/diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Nausea/complications ; Pain/complications ; Prognosis ; Radiography ; Vomiting/complications ; },
abstract = {In patients with diverticular disease of the colon factors which indicate a worse prognosis include widespread abdominal pain, nausea and vomiting, disturbed bowel habit, a palpable abdominal mass, abdominal distension, and any of the inflammatory complications. While radiology is of prime importance in the initial diagnosis, it is often impossible to differentiate between diverticulosis and diverticulitis. A more accurate distinction can be made by assessing all the available clinical, radiological, and pathological data, but again there are limitations and inaccuracies. The use of the term "diverticular disease" is preferable.},
}
@article {pmid5359917,
year = {1969},
author = {Parks, TG},
title = {Natural history of diverticular disease of the colon. A review of 521 cases.},
journal = {British medical journal},
volume = {4},
number = {5684},
pages = {639-642},
pmid = {5359917},
issn = {0007-1447},
mesh = {Adult ; Age Factors ; Aged ; *Diverticulitis, Colonic/diagnosis/diagnostic imaging/epidemiology/mortality ; *Diverticulum, Colon/diagnosis/diagnostic imaging/epidemiology/mortality ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prognosis ; Radiography ; Sex Factors ; },
abstract = {In a survey of the natural history of 521 patients with diverticular disease of the colon half of the patients had had symptoms for less than one month on presentation at hospital, and these carried the highest morbidity and mortality. Progression of the disease was usually within segments initially involved, and extension to other regions of the colon rarely occurred. The overall prognosis of patients with total colonic involvement was similar to those with localized disease, while the morbidity and mortality associated with a recurrent attack were higher than in the initial acute episode.},
}
@article {pmid5358959,
year = {1969},
author = {Smith, AN and Attisha, RP and Balfour, T},
title = {Clinical and manometric results one year after sigmoid myotomy for diverticular disease.},
journal = {The British journal of surgery},
volume = {56},
number = {12},
pages = {895-899},
doi = {10.1002/bjs.1800561206},
pmid = {5358959},
issn = {0007-1323},
mesh = {Aged ; Colon, Sigmoid/pathology/*surgery ; Diarrhea/etiology ; Diverticulum, Colon/*physiopathology/*surgery ; Female ; Follow-Up Studies ; Gastrointestinal Motility ; Humans ; Intestinal Perforation/etiology ; Male ; Manometry ; Middle Aged ; Muscle, Smooth/surgery ; Postoperative Complications ; },
}
@article {pmid5358958,
year = {1969},
author = {Attisha, RP and Smith, AN},
title = {Pressure activity of the colon and rectum in diverticular disease before and after sigmoid myotomy.},
journal = {The British journal of surgery},
volume = {56},
number = {12},
pages = {891-894},
doi = {10.1002/bjs.1800561205},
pmid = {5358958},
issn = {0007-1323},
mesh = {Atropine/pharmacology ; Colon, Sigmoid/drug effects/*surgery ; Diverticulum, Colon/*physiopathology/*surgery ; Gastrointestinal Motility ; Humans ; Manometry ; Muscle, Smooth/surgery ; Neostigmine/pharmacology ; Pressure ; Propantheline/pharmacology ; },
}
@article {pmid5367081,
year = {1969},
author = {Hunt, T},
title = {Diverticular disease of the colon.},
journal = {The Practitioner},
volume = {203},
number = {217},
pages = {599-605},
pmid = {5367081},
issn = {0032-6518},
mesh = {Aged ; *Diverticulitis, Colonic/surgery/therapy ; *Diverticulum, Colon/therapy ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid5405010,
year = {1969},
author = {Gutierrez Blanco, H},
title = {[Diverticular disease of the colon or diverticular colopathy].},
journal = {Prensa medica argentina},
volume = {56},
number = {32},
pages = {1532-1542},
pmid = {5405010},
issn = {0032-745X},
mesh = {Adolescent ; Adult ; Aged ; Child ; *Diverticulitis, Colonic ; *Diverticulum, Colon ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid5307148,
year = {1969},
author = {Klein, RR and Gallagher, DM},
title = {Massive colonic bleeding from diverticular disease.},
journal = {American journal of surgery},
volume = {118},
number = {4},
pages = {553-557},
doi = {10.1016/0002-9610(69)90182-2},
pmid = {5307148},
issn = {0002-9610},
mesh = {Aged ; Colectomy ; Colonic Diseases/diagnosis/*etiology/surgery ; Diverticulum, Colon/*complications/diagnosis/surgery ; Female ; Gastrointestinal Hemorrhage/*etiology/surgery ; Humans ; Male ; Methods ; Middle Aged ; },
}
@article {pmid5800334,
year = {1969},
author = {},
title = {Diverticular disease of the colon.},
journal = {British medical journal},
volume = {3},
number = {5666},
pages = {311-312},
pmid = {5800334},
issn = {0007-1447},
mesh = {Adult ; Aged ; Diverticulitis, Colonic/*etiology ; Diverticulum, Colon/*etiology ; Humans ; Middle Aged ; Muscle, Smooth/pathology ; Muscular Diseases/etiology ; },
}
@article {pmid5798341,
year = {1969},
author = {Castro, AF},
title = {Diverticular disease of the colon.},
journal = {Southern medical journal},
volume = {62},
number = {8},
pages = {991-994},
doi = {10.1097/00007611-196908000-00021},
pmid = {5798341},
issn = {0038-4348},
mesh = {Colectomy ; Diverticulitis, Colonic/epidemiology/*surgery ; Diverticulum, Colon/diagnosis/*surgery ; Follow-Up Studies ; Humans ; },
}
@article {pmid5806933,
year = {1969},
author = {Parks, TG and Connell, AM},
title = {Motility studies in diverticular disease of the colon.},
journal = {Gut},
volume = {10},
number = {7},
pages = {534-542},
pmid = {5806933},
issn = {0017-5749},
mesh = {Colon, Sigmoid/physiopathology ; Diverticulitis, Colonic/*physiopathology ; Diverticulum, Colon/*physiopathology ; Food ; *Gastrointestinal Motility ; Humans ; Manometry ; Pain ; Pressure ; Rectum/physiopathology ; },
}
@article {pmid5784600,
year = {1969},
author = {Henderson, MA and Small, WP},
title = {Vesico-colic fistula complicating diverticular disease.},
journal = {British journal of urology},
volume = {41},
number = {3},
pages = {314-319},
doi = {10.1111/j.1464-410x.1969.tb11889.x},
pmid = {5784600},
issn = {0007-1331},
mesh = {Adult ; Aged ; Colonic Diseases/*complications ; Cystoscopy ; Diverticulitis, Colonic/*complications/diagnosis/pathology/surgery ; Female ; Gases/urine ; Humans ; Intestinal Fistula/*complications/diagnosis/surgery ; Male ; Middle Aged ; Urinary Bladder Fistula/*complications/diagnosis ; },
}
@article {pmid5305843,
year = {1969},
author = {Tagart, RE},
title = {Diverticular disease of the colon. Clinical aspects.},
journal = {The British journal of surgery},
volume = {56},
number = {6},
pages = {417-423},
doi = {10.1002/bjs.1800560605},
pmid = {5305843},
issn = {0007-1323},
mesh = {Adult ; Aged ; Diverticulitis, Colonic/therapy ; Diverticulum, Colon/mortality/surgery/*therapy ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Inflammation/surgery ; Male ; Middle Aged ; Peritonitis/etiology/surgery ; Sex Factors ; Sigmoidoscopy ; },
}
@article {pmid5771677,
year = {1969},
author = {Parks, TG and Connell, AM},
title = {A comparative study of the radiological and clinical findings in diverticular disease of the colon.},
journal = {Gut},
volume = {10},
number = {5},
pages = {414-415},
pmid = {5771677},
issn = {0017-5749},
mesh = {Diagnosis, Differential ; Diverticulitis, Colonic/*diagnostic imaging ; Diverticulum, Colon/complications/*diagnostic imaging ; Humans ; Prognosis ; Radiography ; },
}
@article {pmid5771666,
year = {1969},
author = {Hughes, LE},
title = {Postmortem survey of diverticular disease of the colon. II. The muscular abnormality of the sigmoid colon.},
journal = {Gut},
volume = {10},
number = {5},
pages = {344-351},
pmid = {5771666},
issn = {0017-5749},
mesh = {Colon, Sigmoid/*pathology ; Diverticulitis, Colonic/pathology ; Diverticulum, Colon/*pathology ; Humans ; Muscle, Smooth/*pathology ; Spasm/pathology ; },
}
@article {pmid5771665,
year = {1969},
author = {Hughes, LE},
title = {Postmortem survey of diverticular disease of the colon. I. Diverticulosis and diverticulitis.},
journal = {Gut},
volume = {10},
number = {5},
pages = {336-344},
pmid = {5771665},
issn = {0017-5749},
mesh = {Adolescent ; Adult ; Aged ; Aorta, Abdominal ; Arteriosclerosis/complications ; Australia ; Cecum/pathology ; Child ; Cholelithiasis/complications ; Colon/pathology ; Colon, Sigmoid/pathology ; Diverticulitis, Colonic/complications/*epidemiology ; Diverticulum, Colon/*epidemiology/etiology/*pathology ; Female ; Humans ; Hypertension/complications ; Intestinal Diseases/complications ; Male ; Middle Aged ; },
}
@article {pmid5781338,
year = {1969},
author = {Emanuele, B and Bignamini, A and Ferraro, U},
title = {[Intestinal diverticular disease in patients with tuberculosis].},
journal = {Minerva medica},
volume = {60},
number = {24},
pages = {1095-1105},
pmid = {5781338},
issn = {0026-4806},
mesh = {Adult ; Aged ; *Diverticulitis, Colonic ; *Diverticulum, Colon ; Female ; Humans ; Male ; Middle Aged ; *Tuberculosis, Gastrointestinal ; Tuberculosis, Pulmonary/*complications ; },
}
@article {pmid5718006,
year = {1968},
author = {Chapman, M and Misiewicz, JJ},
title = {Changes in the haustral pattern in diverticular disease and the irritable colon syndrome.},
journal = {Gut},
volume = {9},
number = {6},
pages = {735},
pmid = {5718006},
issn = {0017-5749},
mesh = {Age Factors ; Barium Sulfate ; Colon/*pathology ; Colonic Diseases, Functional/*pathology ; Diverticulitis, Colonic/*pathology ; Humans ; },
}
@article {pmid5687014,
year = {1968},
author = {Parks, TG and Connell, AM},
title = {Motility studies after resection of the sigmoid colon for diverticular disease.},
journal = {The British journal of surgery},
volume = {55},
number = {11},
pages = {867},
pmid = {5687014},
issn = {0007-1323},
mesh = {Diverticulum, Colon/*surgery ; Electromyography ; *Gastrointestinal Motility ; Humans ; Muscle, Smooth/physiopathology ; Neostigmine/pharmacology ; },
}
@article {pmid4887300,
year = {1968},
author = {Williams, I},
title = {Diverticular disease of the colon: a 1968 view.},
journal = {Gut},
volume = {9},
number = {5},
pages = {498-501},
pmid = {4887300},
issn = {0017-5749},
mesh = {Barium Sulfate ; Colon/diagnostic imaging/pathology ; *Diverticulitis, Colonic/diagnosis/drug therapy/surgery ; Humans ; Muscle, Smooth/physiopathology ; Muscles/therapeutic use ; Pressure ; Radiography ; },
}
@article {pmid5673972,
year = {1968},
author = {Campbell, GD and Cleave, TL},
title = {Diverticular disease of the colon.},
journal = {British medical journal},
volume = {3},
number = {5620},
pages = {741},
doi = {10.1136/bmj.3.5620.741},
pmid = {5673972},
issn = {0007-1447},
mesh = {Diet ; Diverticulum, Colon/*etiology ; Humans ; Intestines/*physiology ; },
}
@article {pmid5705371,
year = {1968},
author = {Parks, TG},
title = {Diverticular disease of the colon.},
journal = {Postgraduate medical journal},
volume = {44},
number = {515},
pages = {680-683},
pmid = {5705371},
issn = {0032-5473},
mesh = {*Diverticulitis, Colonic/therapy ; *Diverticulum, Colon/therapy ; Gastrointestinal Motility ; Humans ; },
}
@article {pmid5679019,
year = {1968},
author = {Parks, TG},
title = {Post-mortem studies on the colon with special reference to diverticular disease.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {61},
number = {9},
pages = {932-934},
pmid = {5679019},
issn = {0035-9157},
mesh = {Adipose Tissue/analysis ; Adolescent ; Adult ; Age Factors ; Aged ; Angiography ; Anthropometry ; Autopsy ; Colon/blood supply ; Diverticulitis, Colonic/*pathology ; Diverticulum, Colon/*pathology ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid5666807,
year = {1968},
author = {Painter, NS},
title = {Diverticular disease of the colon.},
journal = {British medical journal},
volume = {3},
number = {5616},
pages = {475-479},
pmid = {5666807},
issn = {0007-1447},
mesh = {Abscess/etiology ; Adult ; Aged ; Cecal Diseases ; Colonic Diseases/classification ; *Diverticulitis, Colonic/complications/therapy ; *Diverticulum, Colon/diagnosis/epidemiology/etiology ; Female ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Male ; Peritonitis/etiology ; Urinary Bladder Fistula/etiology ; Vaginal Fistula/etiology ; },
}
@article {pmid5666803,
year = {1968},
author = {Roxburgh, RA and Dawson, JL and Yeo, R},
title = {Emergency resection in treatment of diverticular disease of colon complicated by peritonitis.},
journal = {British medical journal},
volume = {3},
number = {5616},
pages = {465-466},
pmid = {5666803},
issn = {0007-1447},
mesh = {Adult ; Aged ; *Colectomy ; Diverticulitis, Colonic/*complications/mortality/*surgery ; Female ; Humans ; Male ; Methods ; Middle Aged ; Peritonitis/*etiology/mortality ; },
abstract = {Of a consecutive series of 25 patients with peritonitis secondary to colonic diverticular disease all, except one with faecal peritonitis, underwent some form of emergency resection.All the three patients with faecal peritonitis died, but the 22 with purulent peritonitis survived. The average duration of the emergency admission of the 22 survivors was 25.4 days, and in nine (41%) of them intestinal continuity had been restored by the end of that admission.Thus some form of emergency resection is the operation of choice in patients with spreading peritonitis due to diverticular disease of the sigmoid colon.},
}
@article {pmid5299876,
year = {1968},
author = {Olsen, WR},
title = {Hemorrhage from diverticular disease of the colon. The role of emergency subtotal colectomy.},
journal = {American journal of surgery},
volume = {115},
number = {2},
pages = {247-263},
doi = {10.1016/0002-9610(68)90036-6},
pmid = {5299876},
issn = {0002-9610},
mesh = {Adult ; Aged ; Colectomy ; Colostomy ; Diverticulitis, Colonic/pathology ; Diverticulum, Colon/complications/diagnostic imaging ; Emergencies/therapy ; Female ; Gastrointestinal Hemorrhage/diagnostic imaging/etiology/pathology/*therapy ; Granulation Tissue/pathology ; Humans ; Ileostomy ; Male ; Middle Aged ; Peptic Ulcer/pathology ; Radiography ; },
}
@article {pmid5300252,
year = {1968},
author = {Peck, DA and Labat, R and Waite, VC},
title = {Diverticular disease of the right colon.},
journal = {Diseases of the colon and rectum},
volume = {11},
number = {1},
pages = {49-54},
doi = {10.1007/BF02616745},
pmid = {5300252},
issn = {0012-3706},
mesh = {Adult ; Aged ; Colectomy ; Diverticulitis, Colonic/complications/mortality/pathology/*surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Obstruction/etiology ; Male ; Middle Aged ; Postoperative Complications ; Racial Groups ; },
}
@article {pmid6060077,
year = {1967},
author = {Levy, SB and Fitts, WT and Lench, JB},
title = {Surgical treatment of diverticular disease of the colon: evaluation of an eleven-year period.},
journal = {Annals of surgery},
volume = {166},
number = {6},
pages = {947-954},
pmid = {6060077},
issn = {0003-4932},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Child ; Diverticulitis, Colonic/diagnosis/epidemiology/mortality/*surgery ; Diverticulum, Colon/diagnosis/epidemiology/mortality/*surgery ; Female ; Humans ; Male ; Medical Records ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Sex Factors ; },
}
@article {pmid4866461,
year = {1967},
author = {Localio, SA and Stahl, WM},
title = {Diverticular disease of the alimentary tract. I. The colon.},
journal = {Current problems in surgery},
volume = {},
number = {},
pages = {1-78},
doi = {10.1016/s0011-3840(67)80010-8},
pmid = {4866461},
issn = {0011-3840},
mesh = {Colonic Neoplasms/complications ; *Diverticulitis, Colonic/complications/diagnosis/pathology/surgery ; Gastric Fistula ; },
}
@article {pmid4863219,
year = {1967},
author = {Devroede, GJ and Reitemeier, RJ},
title = {Diverticular disease of the colon.},
journal = {Minnesota medicine},
volume = {50},
number = {11},
pages = {1617-1621},
pmid = {4863219},
issn = {0026-556X},
mesh = {*Diverticulitis, Colonic ; Diverticulum, Colon ; Humans ; },
}
@article {pmid5594400,
year = {1967},
author = {Connell, AM},
title = {[Diverticular disease].},
journal = {Acta gastro-enterologica Belgica},
volume = {30},
number = {10},
pages = {695-703},
pmid = {5594400},
issn = {1784-3227},
mesh = {Colon/*physiopathology ; Diverticulitis, Colonic/*physiopathology ; *Gastrointestinal Motility ; Humans ; },
}
@article {pmid6039641,
year = {1967},
author = {},
title = {Diverticular disease of the colon.},
journal = {British medical journal},
volume = {3},
number = {5568},
pages = {751-752},
pmid = {6039641},
issn = {0007-1447},
mesh = {Diverticulum, Colon/*etiology ; Humans ; },
}
@article {pmid6034907,
year = {1967},
author = {Williams, I},
title = {Diverticular disease of the colon without diverticula.},
journal = {Radiology},
volume = {89},
number = {3},
pages = {401-412},
doi = {10.1148/89.3.401},
pmid = {6034907},
issn = {0033-8419},
mesh = {Colon, Sigmoid/diagnostic imaging ; Colonic Diseases/*diagnostic imaging ; Diverticulitis, Colonic/pathology ; Diverticulum, Colon/diagnostic imaging/pathology ; Humans ; Radiography ; Rectal Neoplasms/diagnostic imaging ; },
}
@article {pmid4960564,
year = {1967},
author = {Borow, M and Smith, M and Soto, D},
title = {Diverticular disease of the duodenum.},
journal = {The American surgeon},
volume = {33},
number = {5},
pages = {373-377},
pmid = {4960564},
issn = {0003-1348},
mesh = {Aged ; Biliary Tract Diseases/*etiology ; Common Bile Duct/diagnostic imaging ; Diverticulum/*complications/*diagnosis/diagnostic imaging/surgery ; Duodenal Diseases/*complications/*diagnosis/surgery ; Female ; Humans ; Male ; Middle Aged ; Radiography ; },
}
@article {pmid6039940,
year = {1967},
author = {Quinn, WF},
title = {Diverticular disease in the distal colon.},
journal = {Rocky Mountain medical journal},
volume = {64},
number = {3},
pages = {81-83},
pmid = {6039940},
issn = {0035-760X},
mesh = {Aged ; *Diverticulitis, Colonic ; *Diverticulum, Colon ; Humans ; Middle Aged ; },
}
@article {pmid5297487,
year = {1967},
author = {Lane, D},
title = {Current views on diverticular disease of the colon.},
journal = {The Medical journal of Australia},
volume = {1},
number = {5},
pages = {217-220},
doi = {10.5694/j.1326-5377.1967.tb21157.x},
pmid = {5297487},
issn = {0025-729X},
mesh = {Constipation/etiology ; Diarrhea/etiology ; Diverticulitis, Colonic/*complications/diagnostic imaging/*surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Male ; Middle Aged ; Peritonitis/etiology ; Radiography ; },
}
@article {pmid6015656,
year = {1967},
author = {Williams, I},
title = {Mass movements (mass peristalsis) and diverticular disease OF THE COLON.},
journal = {The British journal of radiology},
volume = {40},
number = {469},
pages = {2-14},
doi = {10.1259/0007-1285-40-469-2},
pmid = {6015656},
issn = {0007-1285},
mesh = {Barium Sulfate ; Defecation/physiology ; Diverticulitis, Colonic/*diagnostic imaging ; Diverticulum, Colon/*diagnostic imaging ; Fluoroscopy ; Gastrointestinal Motility/*physiology ; Humans ; },
}
@article {pmid5297358,
year = {1967},
author = {Paradny, R and Kark, AE},
title = {Massive hemorrhage in diverticular disease of the colon.},
journal = {The American journal of gastroenterology},
volume = {47},
number = {1},
pages = {41-47},
pmid = {5297358},
issn = {0002-9270},
mesh = {Aged ; Diverticulitis, Colonic/*complications ; Diverticulum, Colon/*complications ; Female ; Gastrointestinal Hemorrhage/*etiology/surgery ; Humans ; Male ; Middle Aged ; },
}
@article {pmid4959615,
year = {1966},
author = {Slack, WW},
title = {Bowel muscle in diverticular disease.},
journal = {Gut},
volume = {7},
number = {6},
pages = {668-670},
pmid = {4959615},
issn = {0017-5749},
mesh = {Colonic Diseases/*pathology ; DNA/analysis ; Diverticulum/*pathology ; Humans ; In Vitro Techniques ; Muscle, Smooth/analysis/*pathology ; Nitrogen/analysis ; },
}
@article {pmid5921885,
year = {1966},
author = {Nigro, ND},
title = {The trend prophylactic resection in diverticular disease of the colon.},
journal = {Southern medical journal},
volume = {59},
number = {9},
pages = {1019-1022},
doi = {10.1097/00007611-196609000-00006},
pmid = {5921885},
issn = {0038-4348},
mesh = {Diverticulitis, Colonic/*etiology/*surgery/therapy ; Humans ; Middle Aged ; },
}
@article {pmid5296836,
year = {1966},
author = {Paradny, R and Kark, AE},
title = {Massive hemorrhage in diverticular disease of the colon.},
journal = {Journal of the Mount Sinai Hospital, New York},
volume = {33},
number = {5},
pages = {371-381},
pmid = {5296836},
issn = {0099-9695},
mesh = {Aged ; Diverticulum, Colon/*complications ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Male ; Middle Aged ; },
}
@article {pmid5999678,
year = {1966},
author = {Heidenreich, A and Paladino, AM and Acosta Pimentel, MA},
title = {[Complications of diverticular disease of the colon].},
journal = {Prensa medica argentina},
volume = {53},
number = {26},
pages = {1437-1440},
pmid = {5999678},
issn = {0032-745X},
mesh = {Diverticulum, Colon/*complications/surgery ; Female ; Humans ; Intestinal Fistula/*etiology ; Intestinal Perforation/*etiology ; Male ; Middle Aged ; Urinary Bladder Fistula/*etiology ; },
}
@article {pmid5933823,
year = {1966},
author = {},
title = {Diverticular disease of the colon.},
journal = {British medical journal},
volume = {1},
number = {5497},
pages = {1186},
pmid = {5933823},
issn = {0007-1447},
mesh = {Aged ; *Diverticulum, Colon ; Humans ; },
}
@article {pmid5844526,
year = {1965},
author = {Beranbaum, SL and Yaghmai, M and Beranbaum, ER},
title = {Ulcerative colitis in association with diverticular disease of the colon.},
journal = {Radiology},
volume = {85},
number = {5},
pages = {880-886},
doi = {10.1148/85.5.880},
pmid = {5844526},
issn = {0033-8419},
mesh = {Colitis, Ulcerative/*complications ; Diverticulitis, Colonic/*complications ; Humans ; Radiography ; },
}
@article {pmid5879658,
year = {1965},
author = {Oñate, TJ and Petrozzi, CA},
title = {[Colonic diverticular disease of tumoral form].},
journal = {Prensa medica argentina},
volume = {52},
number = {36},
pages = {2256-2259},
pmid = {5879658},
issn = {0032-745X},
mesh = {Aged ; Colonic Neoplasms/*diagnosis ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid5295673,
year = {1965},
author = {Diaz Walker, NG and Espeche, AN and Mera, J},
title = {[Massive hemorrhages caused by diverticular disease of the colon].},
journal = {Prensa medica argentina},
volume = {52},
number = {36},
pages = {2259-2260},
pmid = {5295673},
issn = {0032-745X},
mesh = {Diverticulum, Colon/*complications ; Gastrointestinal Hemorrhage/*etiology ; Humans ; },
}
@article {pmid14340523,
year = {1965},
author = {REMINGTON, JH},
title = {DIVERTICULAR DISEASE OF THE COLON.},
journal = {Postgraduate medicine},
volume = {38},
number = {},
pages = {294-300},
doi = {10.1080/00325481.1965.11695655},
pmid = {14340523},
issn = {0032-5481},
mesh = {*Colon ; *Diverticulitis ; *Diverticulitis, Colonic ; *Diverticulosis, Colonic ; *Diverticulum ; Humans ; *Surgical Procedures, Operative ; },
}
@article {pmid5833178,
year = {1965},
author = {Marcus, R and Watt, J},
title = {Diverticular disease of the pelvic colon.},
journal = {Journal of the Indian medical profession},
volume = {12},
number = {6},
pages = {5468-5471},
pmid = {5833178},
issn = {0019-588X},
mesh = {Colon, Sigmoid/*pathology ; *Diverticulum, Colon ; Humans ; },
}
@article {pmid5832006,
year = {1965},
author = {Todd, IP},
title = {Diverticular disease.},
journal = {Journal of the Indian medical profession},
volume = {12},
number = {6},
pages = {5466-7 passim},
pmid = {5832006},
issn = {0019-588X},
mesh = {Diverticulum, Colon/*diagnosis/*surgery ; Humans ; },
}
@article {pmid14272097,
year = {1965},
author = {FLEISCHNER, FG and MING, SC},
title = {REVISED CONCEPTS ON DIVERTICULAR DISEASE OF THE COLON. II. SO-CALLED DIVERTICULITIS: DIVERTICULAR SIGMOIDITIS AND PERISIGMOIDITIS; DIVERTICULAR ABSCESS, FISTULA, AND FRANK PERITONITIS.},
journal = {Radiology},
volume = {84},
number = {},
pages = {599-609},
doi = {10.1148/84.4.599},
pmid = {14272097},
issn = {0033-8419},
mesh = {*Abscess ; *Barium Sulfate ; *Colitis ; *Colon, Sigmoid ; *Colonic Diseases ; *Colonic Diseases, Functional ; *Diverticulitis ; *Diverticulitis, Colonic ; *Diverticulosis, Colonic ; *Diverticulum ; *Geriatrics ; Humans ; *Intestinal Fistula ; *Intestinal Obstruction ; *Intestinal Perforation ; *Peritonitis ; *Radiography ; },
}
@article {pmid14247702,
year = {1965},
author = {MACBETH, WA and HAWTHORNE, JH},
title = {INTRAMURAL GANGLIA IN DIVERTICULAR DISEASE OF THE COLON.},
journal = {Journal of clinical pathology},
volume = {18},
number = {1},
pages = {40-42},
pmid = {14247702},
issn = {0021-9746},
mesh = {*Diverticulitis ; *Diverticulitis, Colonic ; *Diverticulum ; *Diverticulum, Colon ; *Ganglia ; Humans ; *Hypertrophy ; *Pathology ; },
abstract = {Intramural plexuses were studied in 30 colons, and a plethora of ganglionic tissue was observed in specimens with diverticula when compared with a control series. This alteration in the ganglionic pattern is considered real rather than apparent; the changes are confined to the region of the colon where muscular hypertrophy is present.},
}
@article {pmid14229129,
year = {1964},
author = {FLEISCHNER, FG and HENKEN, EM and MING, SC},
title = {REVISED CONCEPTS ON DIVERTICULAR DISEASE OF THE COLON. I. DIVERTICULOSIS: EMPHASIS ON TISSUE DERANGEMENT AND ITS RELATION TO THE IRRITABLE COLON SYNDROME.},
journal = {Radiology},
volume = {83},
number = {},
pages = {859-872},
doi = {10.1148/83.5.859},
pmid = {14229129},
issn = {0033-8419},
mesh = {*Colonic Diseases ; *Colonic Diseases, Functional ; *Diverticulosis, Colonic ; *Diverticulum ; *Geriatrics ; Humans ; *Irritable Bowel Syndrome ; *Pathology ; *Radiography ; },
}
@article {pmid14201233,
year = {1964},
author = {SMITH, WR and BERNE, CJ},
title = {SEVERE COLONIC BLEEDING.},
journal = {California medicine},
volume = {101},
number = {4},
pages = {235-239},
pmid = {14201233},
issn = {0008-1264},
mesh = {*Colonic Diseases ; *Diagnosis, Differential ; *Diverticulum ; *Emergencies ; *Enema ; *Exsanguination ; *Feces ; *Gastrointestinal Hemorrhage ; Humans ; *Melena ; *Proctoscopy ; *Surgical Procedures, Operative ; },
abstract = {Patients requiring emergency operation for severe acute colonic hemorrhage usually arrive in the operating room inadequately studied and the point of bleeding not known. A well planned procedure for making an operative diagnosis is lacking. The fact that diverticular disease is the most common cause of massive colonic bleeding, dominates the surgical management of this problem. A critical interpretation of the color and the consistency of the stools must be made by the surgeon. Since the bleeding lesion is usually otherwise clinically silent, the character of the stools may be the only indication of the level of bleeding and the rate and the amount of the blood loss. A proctoscopic examination, followed by an emergency barium enema study if possible, is always done before subjecting a patient to laparotomy. The indications for emergency operation include acute exsanguinating hemorrhage, less severe but persistent colonic bleeding and recurrent colonic bleeding. The steps for the operative diagnosis and the surgical procedure utilized for a specific situation are discussed.},
}
@article {pmid14128303,
year = {1964},
author = {BROCK, DT and KING, JV},
title = {PROFUSE BLEEDING FROM DIVERTICULAR DISEASE OF THE COLON.},
journal = {Diseases of the colon and rectum},
volume = {7},
number = {},
pages = {99-101},
doi = {10.1007/BF02616903},
pmid = {14128303},
issn = {0012-3706},
mesh = {*Adenocarcinoma ; *Cecal Neoplasms ; *Colon ; *Diverticulosis, Colonic ; *Diverticulum ; *Gastrointestinal Hemorrhage ; *Geriatrics ; Humans ; *Surgical Procedures, Operative ; },
}
@article {pmid14266754,
year = {1964},
author = {DEGRAAFF, P and VANDERPLOEG, E},
title = {[COLONIC DIVERTICULAR DISEASE].},
journal = {Tijdschrift voor gastro-enterologie},
volume = {7},
number = {},
pages = {270-289},
pmid = {14266754},
issn = {0049-3899},
mesh = {*Colonic Neoplasms ; *Diverticulitis ; *Diverticulitis, Colonic ; *Diverticulosis, Colonic ; *Diverticulum ; *Pathology ; *Surgical Procedures, Operative ; },
}
@article {pmid14227870,
year = {1964},
author = {ARFWIDSSON, S and KNOCK, NG and LEHMANN, L and WINBERG, T},
title = {PATHOGENESIS OF MULTIPLE DIVERTICULA OF THE SOGMOID COLON IN DIVERTICULAR DISEASE.},
journal = {Acta chirurgica Scandinavica. Supplementum},
volume = {63},
number = {},
pages = {SUPPL 342:1-68},
pmid = {14227870},
issn = {0301-1860},
mesh = {*Classification ; *Colon, Sigmoid ; *Diagnosis ; *Diverticulosis, Colonic ; *Diverticulum ; Humans ; *Manometry ; *Microscopy ; *Pathology ; *Radiography ; *Statistics as Topic ; *Surgical Procedures, Operative ; },
}
@article {pmid14106200,
year = {1964},
author = {REICHMAN, HR and WILBUR, D and CARBONE, J and ANDERSON, W and DUNPHY, JE and GALLAGHER, DM},
title = {SYMPOSIUM. DIVERTICULAR DISEASE OF THE COLON.},
journal = {Diseases of the colon and rectum},
volume = {7},
number = {},
pages = {14-21},
doi = {10.1007/BF02617998},
pmid = {14106200},
issn = {0012-3706},
mesh = {*Diagnosis ; *Diverticulitis ; *Diverticulitis, Colonic ; *Diverticulosis, Colonic ; *Diverticulum ; Humans ; *Surgical Procedures, Operative ; },
}
@article {pmid14103418,
year = {1964},
author = {ANDERSON, WS},
title = {MASSIVE HEMORRHAGE FROM DIVERTICULAR DISEASE OF THE COLON.},
journal = {Canadian journal of surgery. Journal canadien de chirurgie},
volume = {7},
number = {},
pages = {21-24},
pmid = {14103418},
issn = {0008-428X},
mesh = {*Colon ; *Diverticulitis ; *Diverticulitis, Colonic ; *Diverticulosis, Colonic ; *Diverticulum ; *Gastrointestinal Hemorrhage ; *Hemorrhage ; Humans ; },
}
@article {pmid14080071,
year = {1963},
author = {MORSON, BC},
title = {THE MUSCLE ABNORMALITY IN DIVERTICULAR DISEASE OF THE COLON.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {56},
number = {9},
pages = {798-800},
pmid = {14080071},
issn = {0035-9157},
mesh = {*Diverticulitis ; *Diverticulitis, Colonic ; *Diverticulosis, Colonic ; *Diverticulum ; Humans ; *Muscle, Smooth ; *Pathology ; },
}
@article {pmid14029510,
year = {1963},
author = {JONES, L and HOFFLER, OW},
title = {Diverticular disease of the colon: an underestimated cause of massive gastro-intestinal hemorrhage.},
journal = {Journal of the National Medical Association},
volume = {55},
number = {4},
pages = {315-316},
pmid = {14029510},
issn = {0027-9684},
mesh = {*Colon ; *Diverticulosis, Colonic ; *Diverticulum ; *Gastrointestinal Hemorrhage ; Humans ; },
}
@article {pmid14000876,
year = {1963},
author = {WILLIAMS, I},
title = {Changing emphasis in diverticular disease of the colon.},
journal = {The British journal of radiology},
volume = {36},
number = {},
pages = {393-406},
doi = {10.1259/0007-1285-36-426-393},
pmid = {14000876},
issn = {0007-1285},
mesh = {*Colon ; *Diverticulitis ; *Diverticulitis, Colonic ; *Diverticulum ; Humans ; },
}
@article {pmid13953462,
year = {1963},
author = {HEINS, W},
title = {Diverticular disease of the colon.},
journal = {The Journal of the American Osteopathic Association},
volume = {62},
number = {},
pages = {808-817},
pmid = {13953462},
issn = {0098-6151},
mesh = {*Colon ; *Diverticulosis, Colonic ; *Diverticulum ; Humans ; },
}
@article {pmid13973738,
year = {1962},
author = {REICHMAN, HR and WATKINS, JB},
title = {Diverticular disease of the colon.},
journal = {JAMA},
volume = {182},
number = {},
pages = {1023-1028},
pmid = {13973738},
issn = {0098-7484},
mesh = {*Colon ; *Diverticulitis ; *Diverticulitis, Colonic ; *Diverticulosis, Colonic ; *Diverticulum ; Humans ; },
}
@article {pmid14468468,
year = {1962},
author = {MAHORNER, H and HOVNATANIAN, L and BECKER, WF},
title = {Diverticular disease of the colon and small intestine requiring surgery.},
journal = {Texas state journal of medicine},
volume = {58},
number = {},
pages = {696-700},
pmid = {14468468},
issn = {0096-7165},
mesh = {*Colon ; *Digestive System Surgical Procedures ; Diverticulum/*surgery ; Humans ; *Intestine, Small ; *Intestines ; },
}
@article {pmid13876891,
year = {1962},
author = {CARROLL, PT and ANDARSIO, CO},
title = {Surgical management of diverticular disease in the aged.},
journal = {Geriatrics},
volume = {17},
number = {},
pages = {205-216},
pmid = {13876891},
issn = {0016-867X},
mesh = {Aged ; Aged, 80 and over ; *Diverticulitis ; *Diverticulum ; Humans ; },
}
@article {pmid13873563,
year = {1962},
author = {BROWER, AB and STRAUSS, L},
title = {Diverticular disease of the colon: viewpoints concerning its surgical management.},
journal = {The American surgeon},
volume = {28},
number = {},
pages = {67-73},
pmid = {13873563},
issn = {0003-1348},
mesh = {*Colon ; Diverticulitis/*surgery ; *Diverticulum ; *Health Services ; Humans ; },
}
@article {pmid13904386,
year = {1961},
author = {HANNAN, CE and KNIGHTLY, JJ and COFFEY, RJ},
title = {Diverticular disease of the colon in the younger age group.},
journal = {Diseases of the colon and rectum},
volume = {4},
number = {},
pages = {419-423},
doi = {10.1007/BF02616575},
pmid = {13904386},
issn = {0012-3706},
mesh = {Diverticulum/*statistics & numerical data ; Humans ; },
}
@article {pmid14490811,
year = {1961},
author = {REALES, JA},
title = {[Hemorrhage caused by diverticular disease of the colon].},
journal = {Prensa medica argentina},
volume = {48},
number = {},
pages = {2695-2696},
pmid = {14490811},
issn = {0032-745X},
mesh = {*Colon ; Diverticulum/*complications ; Gastrointestinal Hemorrhage/*etiology ; Humans ; },
}
@article {pmid14477654,
year = {1961},
author = {MYBURGH, JA},
title = {Diverticular disease of the colon.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {35},
number = {},
pages = {706-711},
pmid = {14477654},
issn = {0256-9574},
mesh = {*Colon ; Diverticulitis/*diagnostic imaging ; Humans ; Radiography ; },
}
@article {pmid14477653,
year = {1961},
author = {MYBURGH, JA},
title = {Diverticular disease of the colon.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {35},
number = {},
pages = {685-9 contd},
pmid = {14477653},
issn = {0256-9574},
mesh = {*Colon ; Diverticulitis/*complications ; Humans ; },
}
@article {pmid13727192,
year = {1961},
author = {MYBURGH, JA},
title = {Diverticular disease of the colon. I.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {35},
number = {},
pages = {668-72 contd},
pmid = {13727192},
issn = {0256-9574},
mesh = {*Colon ; *Diverticulitis ; *Diverticulum ; Humans ; },
}
@article {pmid13685704,
year = {1961},
author = {BACON, HE and McGREGOR, RA},
title = {Diverticular disease with particular reference to the management of concomitant fistula and sinus formation.},
journal = {The American journal of gastroenterology},
volume = {36},
number = {},
pages = {127-132},
pmid = {13685704},
issn = {0002-9270},
mesh = {*Digestive System Surgical Procedures ; Diverticulitis/*surgery ; *Diverticulum ; Humans ; Intestinal Fistula/*surgery ; },
}
@article {pmid13745626,
year = {1961},
author = {SALGADO, I and WLODEK, GK and MATHEWS, WH and ROBERTSON, HR},
title = {Massive hemorrhage due to diverticular disease of the colon: a case illustrating the bleeding point.},
journal = {Canadian journal of surgery. Journal canadien de chirurgie},
volume = {4},
number = {},
pages = {473-476},
pmid = {13745626},
issn = {0008-428X},
mesh = {*Colon ; Diverticulum/*complications ; *Hemorrhage ; Humans ; },
}
@article {pmid13738734,
year = {1961},
author = {QUINN, WC},
title = {Gross hemorrhage from presumed diverticular disease of the colon: results of treatment in 103 patients.},
journal = {Annals of surgery},
volume = {153},
number = {6},
pages = {851-860},
pmid = {13738734},
issn = {0003-4932},
mesh = {*Colon ; Diverticulitis/*complications ; Gastrointestinal Hemorrhage/*etiology ; *Hemorrhage ; Humans ; },
}
@article {pmid13696078,
year = {1961},
author = {COVEY, MC and MOELLER, HC},
title = {Massive rectal hemorrhage and diverticular disease of the colon.},
journal = {The American journal of gastroenterology},
volume = {35},
number = {},
pages = {42-45},
pmid = {13696078},
issn = {0002-9270},
mesh = {Cardiovascular Diseases/*complications ; *Colon ; *Colonic Diseases ; *Disease ; Diverticulum/*complications ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Hypertension/*complications ; },
}
@article {pmid14407243,
year = {1960},
author = {JEW, EW and HARBISON, SP},
title = {Resection for diverticular disease of the sigmoid colon.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {81},
number = {},
pages = {435-443},
doi = {10.1001/archsurg.1960.01300030095012},
pmid = {14407243},
issn = {0004-0010},
mesh = {*Colon, Sigmoid ; Diverticulum/*surgery ; Humans ; *Sigmoid Diseases ; },
}
@article {pmid13804560,
year = {1960},
author = {BROCK, DT and KING, JV},
title = {Diverticular disease of the colon.},
journal = {Journal of the Mississippi State Medical Association},
volume = {1},
number = {},
pages = {477-482},
pmid = {13804560},
issn = {0026-6396},
mesh = {*Colon ; Diverticulitis/*complications ; Diverticulum/*complications ; Humans ; },
}
@article {pmid13724558,
year = {1960},
author = {DUBARRY, JJ and DUBOURG, G and TOURNERIE, J and DUBARRY, E and CAYZAC, },
title = {[Apropos of a duodenojejuno-ileal diverticular disease].},
journal = {Archives des maladies de l'appareil digestif et des maladies de la nutrition},
volume = {49},
number = {},
pages = {1179-1182},
pmid = {13724558},
issn = {0365-4117},
mesh = {*Disease ; *Diverticulum ; Humans ; *Intestinal Diseases ; *Intestine, Small ; *Intestines ; },
}
@article {pmid13819308,
year = {1960},
author = {DUNNING, EJ},
title = {The diagnosis and treatment of acute diverticular disease of the colon.},
journal = {North Carolina medical journal},
volume = {21},
number = {},
pages = {322-325},
pmid = {13819308},
issn = {0029-2559},
mesh = {*Colon ; Diverticulum/*complications ; Humans ; North Carolina ; },
}
@article {pmid13810650,
year = {1960},
author = {CLEMENTS, NC},
title = {Diverticular disease of the colon as a cause of severe hemorrhage in the aged.},
journal = {The Surgical clinics of North America},
volume = {40},
number = {},
pages = {933-940},
doi = {10.1016/s0039-6109(16)36137-0},
pmid = {13810650},
issn = {0039-6109},
mesh = {Aged ; Aged, 80 and over ; *Colon ; *Colonic Diseases ; *Disease ; *Diverticulum ; *Gastrointestinal Hemorrhage ; Humans ; },
}
@article {pmid14435576,
year = {1960},
author = {QUINN, WC},
title = {Surgical treatment of twenty patients with gross hemorrhage from presumed diverticular disease of the colon.},
journal = {The American surgeon},
volume = {26},
number = {},
pages = {355-360},
pmid = {14435576},
issn = {0003-1348},
mesh = {*Colon ; Diverticulum/*complications ; Gastrointestinal Hemorrhage/*etiology ; Humans ; },
}
@article {pmid14435575,
year = {1960},
author = {QUINN, WC},
title = {Diverticular disease of the colon with hemorrhage: a study of 78 cases.},
journal = {The American surgeon},
volume = {26},
number = {},
pages = {171-174},
pmid = {14435575},
issn = {0003-1348},
mesh = {*Colon ; Diverticulitis/*complications ; *Diverticulum ; Gastrointestinal Hemorrhage/*etiology ; *Hemorrhage ; Humans ; },
}
@article {pmid13806249,
year = {1960},
author = {BURNS, FJ},
title = {Bleeding diverticular disease of the colon.},
journal = {Southern medical journal},
volume = {53},
number = {},
pages = {312-314},
doi = {10.1097/00007611-196003000-00010},
pmid = {13806249},
issn = {1541-8243},
mesh = {*Colon ; Diverticulum/*complications ; Gastrointestinal Hemorrhage/*etiology ; *Hemorrhage ; Humans ; },
}
@article {pmid13804903,
year = {1960},
author = {BROWN, DB and TOOMEY, WF},
title = {Diverticular disease of the colon. A review of 258 cases.},
journal = {The British journal of surgery},
volume = {47},
number = {},
pages = {485-493},
doi = {10.1002/bjs.18004720506},
pmid = {13804903},
issn = {0007-1323},
mesh = {*Colon ; Diverticulum/*statistics & numerical data ; Humans ; },
}
@article {pmid13826669,
year = {1959},
author = {GARRIZ, RA and MAS, LM},
title = {[Diverticular disease of the colon].},
journal = {Prensa medica argentina},
volume = {46},
number = {},
pages = {2201-2207},
pmid = {13826669},
issn = {0032-745X},
mesh = {*Colon ; *Diverticulum ; Humans ; },
}
@article {pmid13643964,
year = {1959},
author = {ADKINS, CD},
title = {Massive bleeding in diverticular disease of the colon; report of two cases.},
journal = {Minnesota medicine},
volume = {42},
number = {4},
pages = {411-3 passim},
pmid = {13643964},
issn = {0026-556X},
mesh = {*Colon ; Diverticulum/*complications ; *Hemorrhage ; Humans ; Minnesota ; },
}
@article {pmid13631363,
year = {1959},
author = {REYNOLDS, JF},
title = {Diverticular disease of the colon; a review.},
journal = {The Journal of the Maine Medical Association},
volume = {50},
number = {2},
pages = {45-48},
pmid = {13631363},
issn = {0025-0694},
mesh = {*Colon ; *Diverticulum ; Humans ; },
}
@article {pmid13625045,
year = {1959},
author = {EARLEY, CM},
title = {The management of massive hemorrhage from diverticular disease of the colon.},
journal = {Surgery, gynecology & obstetrics},
volume = {108},
number = {1},
pages = {49-60},
pmid = {13625045},
issn = {0039-6087},
mesh = {*Colon ; *Disease Management ; Diverticulum/*complications ; *Hemorrhage ; Humans ; },
}
@article {pmid13609907,
year = {1958},
author = {REIDER, RA and SULLIVAN, JF and MACK, RE},
title = {Incidence and type of bleeding in diverticular disease of colon; analysis of 131 cases.},
journal = {Geriatrics},
volume = {13},
number = {12},
pages = {790-794},
pmid = {13609907},
issn = {0016-867X},
mesh = {Aged ; *Colon ; *Diverticulum ; Humans ; Incidence ; },
}
@article {pmid13537823,
year = {1958},
author = {McGREGOR, RA and BACON, HE},
title = {Diverticular disease of the colon.},
journal = {Diseases of the colon and rectum},
volume = {1},
number = {3},
pages = {197-204},
doi = {10.1007/BF02616832},
pmid = {13537823},
issn = {0012-3706},
mesh = {*Colon ; *Diverticulitis ; *Diverticulum ; Humans ; },
}
@article {pmid13514396,
year = {1958},
author = {SIMPSON, WC},
title = {Diverticular disease of the colon; a clinical report.},
journal = {Journal of the Medical Association of the State of Alabama},
volume = {27},
number = {9},
pages = {226-227},
pmid = {13514396},
issn = {0025-7044},
mesh = {*Colon ; Diverticulitis/*surgery ; Diverticulum/*surgery ; Humans ; },
}
@article {pmid13495693,
year = {1957},
author = {CASTRO, AF},
title = {The coexistence of diverticular disease and adenomatous polyps of the colon.},
journal = {Southern medical journal},
volume = {50},
number = {12},
pages = {1437-1440},
doi = {10.1097/00007611-195750120-00001},
pmid = {13495693},
issn = {0038-4348},
mesh = {*Adenomatous Polyps ; *Colonic Neoplasms ; Diverticulitis/*complications ; Diverticulum/*complications ; Humans ; Polyps/*complications ; },
}
@article {pmid13486395,
year = {1957},
author = {KNIGHT, CD},
title = {Massive hemorrhage from diverticular disease of the colon.},
journal = {Surgery},
volume = {42},
number = {5},
pages = {853-861},
pmid = {13486395},
issn = {0039-6060},
mesh = {*Colon ; Diverticulitis/*complications ; Diverticulum/*complications ; *Hemorrhage ; Humans ; },
}
@article {pmid13352137,
year = {1956},
author = {TEICHER, I and ABRAHAMS, JI},
title = {The treatment of selected cases of multiple polyps, familial polyposis, and diverticular disease of the colon by subtotal colectomy and ileoproctostomy.},
journal = {Surgery, gynecology & obstetrics},
volume = {103},
number = {2},
pages = {136-146},
pmid = {13352137},
issn = {0039-6087},
mesh = {*Adenomatous Polyposis Coli ; *Colectomy ; *Colonic Neoplasms ; Diverticulum/*surgery ; Humans ; Polyps/*surgery ; },
}
@article {pmid14366245,
year = {1955},
author = {NOER, RJ},
title = {Diverticular disease of the colon.},
journal = {Geriatrics},
volume = {10},
number = {5},
pages = {221-224},
pmid = {14366245},
issn = {0016-867X},
mesh = {Aged ; *Diverticulitis ; *Diverticulum ; Humans ; },
}
@article {pmid13168856,
year = {1954},
author = {HOAR, CS and BERNHARD, WF},
title = {Colonic bleeding and diverticular disease of the colon.},
journal = {Surgery, gynecology & obstetrics},
volume = {99},
number = {1},
pages = {101-107},
pmid = {13168856},
issn = {0039-6087},
mesh = {*Colon ; Diverticulitis/*complications ; *Diverticulum ; *Gastrointestinal Hemorrhage ; *Hemorrhage ; Humans ; },
}
@article {pmid1360092,
year = {1992},
author = {Brydon, WG and Ferguson, A},
title = {Haemoglobin in gut lavage fluid as a measure of gastrointestinal blood loss.},
journal = {Lancet (London, England)},
volume = {340},
number = {8832},
pages = {1381-1382},
doi = {10.1016/0140-6736(92)92562-t},
pmid = {1360092},
issn = {0140-6736},
mesh = {Barium Sulfate ; Colonoscopy ; Enema ; Gastric Lavage ; Gastrointestinal Hemorrhage/*diagnosis ; Hemoglobins/*analysis ; Humans ; Occult Blood ; },
abstract = {To detect and measure occult gastrointestinal bleeding, we have measured haemoglobin concentrations (by HemoQuant) in the clear fluid obtained after whole-gut lavage. In subjects with healthy gastrointestinal tracts, lavage-fluid haemoglobin concentrations were 0.5-5.1 mg/L, equivalent to daily blood loss of 0.1-1.1 mL. High concentrations were found for patients with colorectal cancer, severe diverticular disease, and rectal varices, in seven of sixteen patients with active inflammatory bowel disease, and in four patients with iron-deficiency anaemia thought to be due to gastrointestinal bleeding. In these four patients, estimated blood loss ranged from 2.6-24.5 mL per day. This method could have various research and clinical applications.},
}
@article {pmid1486193,
year = {1992},
author = {Di Febo, G and Calabrese, C and Matassoni, F},
title = {New trends in non-absorbable antibiotics in gastrointestinal disease.},
journal = {The Italian journal of gastroenterology},
volume = {24},
number = {9 Suppl 2},
pages = {10-13},
pmid = {1486193},
issn = {0392-0623},
mesh = {Bacterial Infections/*drug therapy ; Gastrointestinal Diseases/*drug therapy/microbiology ; Humans ; Intestinal Absorption/physiology ; Rifamycins/pharmacokinetics/*therapeutic use ; Rifaximin ; },
abstract = {Numerous antibiotics have been used for several years in the treatment of intestinal diseases, the majority belonging to the class of aminoglycosides. These are effective against gram-positive and some gram-negative bacteria, above all aerobes, and do not therefore cover the entire range of microorganisms responsible for intestinal infections. With these antibiotics, moreover, it is not possible to exclude intestinal absorption which can lead to serious side effects. Other intestinal antibiotics, however, such as Vancomycin, have a restricted spectrum of action which limits their use. This study analyzes the pharmacological characteristics of a new non-absorbable antibiotics with particularly interesting properties from a clinical pharmacokinetic and pharmacodynamic point of view: Rifaximin. This drug has an extremely broad spectrum of action covering all intestinal germs, and its absorption is practically zero. The results of some controlled clinical studies in gastrointestinal diseases are examined, such as the treatment of infectious diarrhoea, of acute or chronic portal-caval encephalopathy and of diverticular disease of the colon. The possible role of Rifaximin in some intestinal diseases, such as small bowel bacterial overgrowth and Crohn's disease and ulcerative colitis, is also analyzed.},
}
@article {pmid1472403,
year = {1992},
author = {Allan, AN},
title = {Diverticular disease.},
journal = {The British journal of general practice : the journal of the Royal College of General Practitioners},
volume = {42},
number = {364},
pages = {491},
pmid = {1472403},
issn = {0960-1643},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Diverticulum, Colon/*epidemiology ; England/epidemiology ; Family Practice ; Humans ; Middle Aged ; },
}
@article {pmid1443367,
year = {1992},
author = {Schauer, PR and Ramos, R and Ghiatas, AA and Sirinek, KR},
title = {Virulent diverticular disease in young obese men.},
journal = {American journal of surgery},
volume = {164},
number = {5},
pages = {443-6; discussion 446-8},
doi = {10.1016/s0002-9610(05)81177-8},
pmid = {1443367},
issn = {0002-9610},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/complications/diagnosis/*epidemiology/physiopathology/surgery ; Feeding Behavior ; Female ; Hospitalization/statistics & numerical data ; Humans ; Incidence ; Male ; Middle Aged ; Obesity/*epidemiology ; Retrospective Studies ; Sex Factors ; Texas/epidemiology ; },
abstract = {Recent treatment of young patients (aged 40 years or less) with complicated diverticulitis prompted us to review our experience. During a 9-year period ending in December 1990, 61 of 238 patients treated for acute diverticulitis were 40 years of age or younger. The younger patients were primarily obese Hispanic males in whom the correct diagnosis was frequently missed. Younger patients more frequently required an operation on an urgent basis for complications of diverticulitis during the initial hospitalization. The most common indication for operation in young patients was perforation compared with recurrent disease for the older age group. The younger group had a sevenfold incidence of enteric fistulas complicating their acute episode of diverticulitis. Our data suggest that diverticular disease in young patients is more common and more likely to require early surgical intervention than previously noted. In addition, obesity may represent an important etiologic factor in the development of diverticular disease.},
}
@article {pmid1336684,
year = {1992},
author = {Papi, C and Camarri, E},
title = {Non-absorbable antibiotics in the treatment of diverticular disease of the colon.},
journal = {The Italian journal of gastroenterology},
volume = {24},
number = {9 Suppl 2},
pages = {19-22},
pmid = {1336684},
issn = {0392-0623},
mesh = {Bacterial Infections/*drug therapy ; Dietary Fiber/administration & dosage ; Diverticulitis, Colonic/*drug therapy/microbiology ; Diverticulum, Colon/microbiology/therapy ; Humans ; Intestinal Absorption/physiology ; Mannans/therapeutic use ; Rifamycins/pharmacokinetics/*therapeutic use ; Rifaximin ; },
abstract = {Diverticular disease of the colon is a common health problem in western societies. Most patients with colonic diverticula are asymptomatic; it has been estimated that only 20% of individuals harboring diverticula will develop symptoms and signs of illness and a minority will develop major complications. Medical treatment of diverticular disease is aimed to the relief of symptoms and to prevent inflammatory complications. High fiber diets and antispasmodics are widely used in the treatment of uncomplicated diverticular disease although their real efficacy has not been fully elucidated. Antibiotics are used to treat major inflammatory complications of diverticular disease but apparently there is no rationale for their use in uncomplicated disease where an inflammatory component is, by definition, excluded. However two recent papers suggest a possible role of rifaximin, a broad-spectrum poorly absorbable antibiotic, in the management of mild acute diverticulitis and in obtaining symptomatic relief in patients with uncomplicated disease. Prospective studies with an adequate sample size per group of treatment are needed to assess the efficacy of cyclic long term administration of poorly absorbable antibiotics in preventing major complications of diverticular disease.},
}
@article {pmid1395980,
year = {1992},
author = {Fleshner, PR and Schoetz, DJ and Roberts, PL and Murray, JJ and Coller, JA and Veidenheimer, MC},
title = {Anastomotic-vaginal fistula after colorectal surgery.},
journal = {Diseases of the colon and rectum},
volume = {35},
number = {10},
pages = {938-943},
doi = {10.1007/BF02253495},
pmid = {1395980},
issn = {0012-3706},
mesh = {Aged ; Anastomosis, Surgical/adverse effects/methods ; Colonic Diseases/*etiology/surgery ; *Colorectal Surgery ; Female ; Humans ; Intestinal Fistula/*etiology/surgery ; Middle Aged ; *Postoperative Complications ; Rectal Fistula/*etiology/surgery ; Treatment Outcome ; Vaginal Fistula/*etiology/surgery ; },
abstract = {The most feared complication of anterior and low anterior resection is anastomotic dehiscence. Although most leakages remain clinically silent, some may lead to formation of a colovaginal fistula. At the Lahey Clinic Medical Center, the records of nine patients with colovaginal fistula as a complication of colorectal surgery were reviewed to determine clinical characteristics and optimal management. The mean age was 63.7 years (range, 47-72 years). The initial indications for surgery were carcinoma of the rectum (n = 4), diverticular disease (n = 3), and closure of the colostomy after Hartmann's procedure (n = 2). Hysterectomy had been performed earlier in seven patients (78 percent). The end-to-end anastomosis (EEA) stapling device was used in five patients, and four patients had a handsewn anastomosis. The fistula developed within 23 days after surgery and usually originated within 8 cm of the anal verge. Two patients underwent immediate diverting transverse colostomy. None of the seven patients who were initially managed medically had spontaneous closure of the fistula. High fistulas were successfully treated by colorectal resection in two patients, whereas low fistulas healed after transanal repair without colostomy in two patients. These results suggest that previous hysterectomy predisposes to development of a colovaginal fistula after colorectal surgery. Not all patients require fecal diversion. Colorectal resection for high fistulas and transanal repair for low fistulas appear to be viable options for treatment.},
}
@article {pmid1422660,
year = {1992},
author = {de Vries, EH and Ginai, AZ and Robben, SG and Hop, WC},
title = {Pelvic phleboliths: is there an association with diverticulitis?.},
journal = {The British journal of radiology},
volume = {65},
number = {778},
pages = {868-870},
doi = {10.1259/0007-1285-65-778-868},
pmid = {1422660},
issn = {0007-1285},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Calcinosis/etiology ; Diverticulitis, Colonic/*complications ; Diverticulum, Colon/*complications ; Female ; Humans ; Male ; Middle Aged ; Pelvis/blood supply ; Thrombosis/*etiology ; },
abstract = {Pelvic phleboliths are familiar structures to radiologists although their pathogenesis is not fully understood. The literature suggests a relationship between the prevalence of phleboliths and diverticular disease, and with a low-fibre diet. Phleboliths are said to be seen more frequently in women and on the left side in the pelvis. Their number seems to increase with advancing age. We have attempted to establish relations of phleboliths with diverticulitis, diverticulosis, sex, age and pelvic location. In this study the only statistically significant relation was an increase of the number of phleboliths with advancing age.},
}
@article {pmid1416433,
year = {1992},
author = {Acosta, JA and Grebenc, ML and Doberneck, RC and McCarthy, JD and Fry, DE},
title = {Colonic diverticular disease in patients 40 years old or younger.},
journal = {The American surgeon},
volume = {58},
number = {10},
pages = {605-607},
pmid = {1416433},
issn = {0003-1348},
mesh = {Acute Disease ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*epidemiology/ethnology/surgery ; Diverticulum, Colon/*epidemiology/ethnology/surgery ; Female ; Hispanic or Latino ; Humans ; Incidence ; Male ; Middle Aged ; New Mexico/epidemiology ; Postoperative Complications ; },
abstract = {Diverticular disease in patients 40 years of age or younger has been described as rare but virulent. Previous studies, based on age, on diverticular disease are often confusing because of inexact definitions of the disease status. With these criticisms in mind, the authors studied 322 clinical records on patients admitted with a diagnosis of colonic diverticulosis or diverticulitis to the University of New Mexico Hospital and the Lovelace Medical Center. Of these patients, 285 had documented evidence of colonic diverticula with only 6 per cent of these being 40 years of age or younger. The criteria for acute diverticulitis were met by 86 patients, 17 of whom were 40 years of age or younger. The younger group had disproportionately more men, particularly Hispanics. The authors conclude that acute diverticulitis is more common in the young than suggested by previous reports, but the behavior of the disease is not distinctive.},
}
@article {pmid1411931,
year = {1992},
author = {Rosati, C and Smith, L and Deitel, M and Burul, CJ and Baida, M and Borowy, ZJ and Bryden, P},
title = {Primary colorectal anastomosis with the intracolonic bypass tube.},
journal = {Surgery},
volume = {112},
number = {4},
pages = {618-22; discussion 622-3},
pmid = {1411931},
issn = {0039-6060},
mesh = {Aged ; Anastomosis, Surgical/*methods ; Colon/*surgery ; Colonic Diseases/surgery ; Colonic Neoplasms/complications/*surgery ; Female ; Humans ; Intestinal Diseases/*surgery ; Intestinal Obstruction/surgery ; Male ; Postoperative Complications ; Rectum/*surgery ; },
abstract = {BACKGROUND: Intracolonic bypass with primary colocolonic or colorectal anastomosis may be an effective option in the operative management of complicated colonic disease when adequate bowel preparation is not possible. A pliable latex tube is anchored to mucosa and submucosa 3 centimeters proximal to a site of colocolonic anastomosis and later spontaneously evacuated by way of the rectum.
METHODS: Twenty-nine consecutive patents who required urgent colorectal operations in the presence of unprepared bowel underwent left colon resection with intracolonic bypass and primary anastomosis. These patients would have otherwise undergone multistage procedures for the management of the colorectal disorders. Demographic data, APACHE II scores, and type and frequency of complications were recorded.
RESULTS: Between July 1, 1990, and June 30, 1991, 31 patients were eligible for entry in the study. Two patients ultimately had contraindications for the use of intracolonic bypass. The causes encountered included complicated diverticular disease, colonic carcinoma, sigmoid volvulus, and iatrogenic colorectal injury. Complications included wound infection (7), myocardial infarction (2), prolonged ileus (1), deep vein thrombosis (2), and anastomotic leak (2). Postoperative myocardial infarction and subsequent multiorgan system failure were responsible for the only death in this study.
CONCLUSIONS: Intracolonic bypass permits a safe primary anastomosis where multistage procedures would otherwise be required. Avoidance of colostomy and the attendant socioeconomic benefits warrants further study of this method.},
}
@article {pmid1330083,
year = {1992},
author = {Papi, C and Ciaco, A and Koch, M and Capurso, L},
title = {Efficacy of rifaximin on symptoms of uncomplicated diverticular disease of the colon. A pilot multicentre open trial. Diverticular Disease Study Group.},
journal = {The Italian journal of gastroenterology},
volume = {24},
number = {8},
pages = {452-456},
pmid = {1330083},
issn = {0392-0623},
mesh = {Abdominal Pain/drug therapy ; Adult ; Aged ; Aged, 80 and over ; Cathartics/administration & dosage/therapeutic use ; Defecation ; Dietary Fiber/administration & dosage/therapeutic use ; Diverticulum, Colon/*drug therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Mannans/administration & dosage/therapeutic use ; Middle Aged ; Pilot Projects ; Rifamycins/administration & dosage/*therapeutic use ; Rifaximin ; Time Factors ; },
abstract = {Diverticular disease of the colon is a common health problem in western societies. Most patients with colonic diverticula are asymptomatic; it has been estimated that only 20% of individuals harboring diverticula will develop symptoms and signs of illness and a minority will develop major complications. Although the efficacy of a high fiber diet in the management of symptomatic uncomplicated diverticular disease is still controversial, bran and bulking agents are commonly used. Antibiotics are used to treat major inflammatory complications of diverticular disease but apparently there is no rationale for the use of antibiotics in uncomplicated disease where an inflammatory component is by definition excluded. In a multicenter open trial, 217 patients with symptomatic uncomplicated diverticular disease were treated with glucomannan (110 pts) or with glucomannan plus a poorly absorbable antibiotic (rifaximin 400 mg bid for 7 days each month) (107 pts). Clinical evaluation was performed bimonthly for 12 months using a global score system for 8 clinical variables. After 12 months, patients treated with glucomannan plus rifaximin showed a 63.9% reduction of the score as compared to 47.6% in patients treated with glucomannan only (p < 0.001). Cyclic administration of rifaximin appears to be of some advantage in obtaining symptomatic relief in uncomplicated diverticular disease.},
}
@article {pmid1294764,
year = {1992},
author = {Kuo, SW and Chai, CY and Chou, CK and Chan, HM},
title = {Pneumatosis cystoides intestinalis arising in jejunal diverticular disease: report of a case and a suggestion to its pathogenesis.},
journal = {Gaoxiong yi xue ke xue za zhi = The Kaohsiung journal of medical sciences},
volume = {8},
number = {9},
pages = {486-494},
pmid = {1294764},
issn = {0257-5655},
mesh = {Diverticulum/*etiology ; Female ; Humans ; Jejunal Diseases/*etiology ; Middle Aged ; Pneumatosis Cystoides Intestinalis/*etiology ; },
abstract = {The occurrence of pneumatosis cystoides intestinalis (PCI) in the gastrointestinal tract is rare. Among the cases already documented in the English language literature, the association of PCI with jejunal diverticulosis has only been mentioned once or twice. We herein report a case of a 63-year-old woman who had both entities concurrently in a segment of the jejunum. What is important to note is the relationship of PCI to the diverticulosis and its possible pathogenesis. Through histological examination and review of related articles, we are convinced that a mechanical theory plays a pivotal role when both diseases occur in the same segment of intestine and are compounded by obstruction or impaired peristalsis. This finding, when properly applied to PCI in other settings, helps to resolve the pathogenesis of PCI and other related gas-filled cysts.},
}
@article {pmid1507886,
year = {1992},
author = {Hiremagalur, SR and Wilhoite, SL and Gibson, JW and Thomas, E},
title = {Radiology case of the month. Diverticular disease of the colon (with abscess formation).},
journal = {Journal of the Tennessee Medical Association},
volume = {85},
number = {8},
pages = {378-379},
pmid = {1507886},
issn = {0040-3318},
mesh = {Abscess/*diagnostic imaging/surgery ; Bacteroides Infections/*diagnostic imaging/surgery ; *Bacteroides fragilis ; Colectomy ; Diverticulitis, Colonic/*diagnostic imaging/surgery ; Humans ; Male ; Middle Aged ; *Tomography, X-Ray Computed ; },
}
@article {pmid1484069,
year = {1992},
author = {Letoquart, JP and Bansard, JY and Kunin, N and La Gamma, A and Podeur, L and Aussel, D and Lavenac, G and Mambrini, A},
title = {[Surgical treatment of colonic diverticulosis: results of a series of 70 cases].},
journal = {Journal de chirurgie},
volume = {129},
number = {8-9},
pages = {345-351},
pmid = {1484069},
issn = {0021-7697},
mesh = {Abscess/etiology ; Adult ; Aged ; Aged, 80 and over ; Colectomy ; Colonic Diseases/etiology ; Colostomy ; Diverticulum, Colon/complications/mortality/*surgery ; Female ; Humans ; Intestinal Obstruction/etiology ; Male ; Middle Aged ; Peritonitis/etiology ; Prognosis ; },
abstract = {Results are reported on a series of 70 patients operated upon for colon diverticulosis, surgery being elective in only 23 (32.9%) cases. Global mortality (12.9%), was higher in patients over 70 years of age (P < 0.01) and for emergency cases (17% against 4.3% (NS) after cold surgery). Global morbidity was 20%, the onset of septic complications being influenced (p < 0.01) only by treatment with antiinflammatory drugs. Despite the absence of precise factors predictive of the course of diverticular disease, it should be possible to further improve the very poor prognosis in patients with serious septic complications (Hinchley's stages I to IV) by: prophylactic colectomy in symptomatic diverticulosis, improved evaluation by complementary examinations, notably the scanner, of localized septic complications (stages I and II), with the possible association of guided puncture to avoid the septic areas and to allow performance of a cold colectomy without the need for colostomy. Certain severe septic complications may still develop and these cannot be totally prevented by any therapy. In these cases preference is given to resection of the septic focus using mainly Hartmann's operative techniques. Further studies are needed to evaluate those cases where protected anastomotic resection provides the best results, since in the long term the incidence of re-establishment is higher.},
}
@article {pmid1439545,
year = {1992},
author = {Nordgaard, I and Rumessen, JJ and Nielsen, SA and Gudmand-Høyer, E},
title = {Absorption of wheat starch in patients resected for left-sided colonic cancer.},
journal = {Scandinavian journal of gastroenterology},
volume = {27},
number = {8},
pages = {632-634},
doi = {10.3109/00365529209000131},
pmid = {1439545},
issn = {0036-5521},
mesh = {Adult ; Aged ; Colonic Neoplasms/*metabolism/*surgery ; Disaccharides/administration & dosage/pharmacokinetics ; Female ; Gastrointestinal Transit/physiology ; Humans ; Intestinal Absorption/*physiology ; Male ; Middle Aged ; Starch/administration & dosage/*pharmacokinetics ; Triticum/*metabolism ; },
abstract = {Bacterial fermentation of carbohydrate in the colon, producing short-chain fatty acids (SCFA)--and especially butyrate--has been shown possibly to impede cell proliferation and regulate cell differentiation of colonocytes. In patients with diverticular disease or benign polyps in the colon a hyperabsorption of potato starch in the small intestine has been found. We have investigated the absorption of wheat starch in 15 patients radically resected for cancer in the descending or sigmoid colon, and the results were compared with those of 15 healthy controls. The starch malabsorption was quantified by the hydrogen breath test. The patients malabsorbed 2-14 g (median, 8 g) of 100 g wheat starch ingested, and the control group malabsorbed 3-11 g (median, 6 g) (P greater than 0.1). Mouth-to-cecum transit time for wheat starch and lactulose and the hydrogen production capacity after the lactulose standards were also similar in patients and controls. The results do not support the theory that hyperabsorption of starch is characteristic of patients with malignant disease in the large intestine.},
}
@article {pmid1428451,
year = {1992},
author = {Ko, CB and Walton, S and Wyatt, EH},
title = {Pyoderma gangrenosum: associations revisited.},
journal = {International journal of dermatology},
volume = {31},
number = {8},
pages = {574-577},
doi = {10.1111/j.1365-4362.1992.tb02723.x},
pmid = {1428451},
issn = {0011-9059},
mesh = {Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; *Pyoderma Gangrenosum/complications/diagnosis ; },
abstract = {Fourteen cases of pyoderma gangrenosum were seen over a period of 24 years at the Hull Royal Infirmary Dermatology Department. Several associated conditions were found. Seven cases were associated with rheumatoid arthritis of which five were sero-positive, including one with Felty's syndrome. One case was associated with both ulcerative colitis and psoriasis; one with polycythemia rubra vera; two patients had diverticular disease including one who also had rheumatoid arthritis; one had positive syphilis serology. In three cases there was no significant associated disease identified. Ten out of the fourteen cases were women, indicating a female preponderance by a ratio of about 2F:1M; a figure similar to that stated by Seitzinger. The age of presentation ranged from 30 to 80 years.},
}
@article {pmid1611960,
year = {1992},
author = {Kyzer, S and Gordon, PH},
title = {Experience with the use of the circular stapler in rectal surgery.},
journal = {Diseases of the colon and rectum},
volume = {35},
number = {7},
pages = {696-706},
doi = {10.1007/BF02053764},
pmid = {1611960},
issn = {0012-3706},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Blood Loss, Surgical ; Colon/surgery ; Equipment Failure ; Female ; Humans ; Intraoperative Complications ; Male ; Middle Aged ; Postoperative Complications ; Rectum/*surgery ; *Surgical Staplers/adverse effects ; },
abstract = {This report provides our personal experience along with a general overview of the use of the circular stapler in rectal surgery. To determine the results of our experience with the use of the circular stapler for construction of anastomoses following resection, a series of 215 anastomoses performed in 214 patients was reviewed. The patients ranged in age from 33 to 88 years. There were 116 men and 98 women. Indications for operation included malignancy, diverticular disease, villous adenoma, Crohn's disease, and rectal procidentia. The types of operation performed included removal of varying portions of the large bowel. The anastomosis was performed in a uniform manner with the EEA (United States Surgical Corp., Norwalk, CT) and more recently the CEEA (United States Surgical Corp., Norwalk, CT). The operative mortality was 0.47 percent, with the death being unrelated to the anastomosis. Intraoperative complications encountered included bleeding, difficult extraction, instrument failure, incomplete doughnuts, deficient anastomoses, and miscellaneous problems. Early postoperative complications included one leak and a number of complications unrelated to the anastomoses. Anastomotic stenosis developed in 27 patients, but only 8 were permanent and only 3 of these were symptomatic. Two of these patients were treated with balloon dilatation. Anastomotic recurrences developed in 13.1 percent of patients. Our experience gained with the circular stapling device and that reported in the literature have shown it to be a reliable method of performing anastomoses to the rectum in a safe and expeditious manner.},
}
@article {pmid1320772,
year = {1992},
author = {Dölle, W and Daiss, W},
title = {[Internistic therapy of acute diverticulitis].},
journal = {Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis},
volume = {81},
number = {26},
pages = {861-862},
pmid = {1320772},
issn = {1013-2058},
mesh = {Acute Disease ; Analgesics/therapeutic use ; Dietary Fiber/administration & dosage ; Diverticulitis, Colonic/diet therapy/drug therapy/*therapy ; Humans ; Parasympatholytics/therapeutic use ; Sulfonamides/therapeutic use ; },
abstract = {Diverticular disease of the large bowel is very common in Western societies. The clinical pattern reaches from uncomplicated diverticular disease to acute peridiverticulitis, that ultimately afflicts about one in four patients having colonic diverticulosis. The illness may be indolent or fulminant, depending on the degree of colonic spillage and its containment. Therapy is usually medical and consists of "resting" the bowel, administering antibiotics and analgetics. Surgery is reserved for recurrent acute attacks, diffuse peritonitis, abscesses, fistulas, severe diverticular hemorrhage or obstruction. A diet rich in fibers reduces infectious complications.},
}
@article {pmid1436567,
year = {1992},
author = {Nahum, M and Ruffo, A},
title = {[Paradigmatic endoscopic features of diverticular disease of the colon].},
journal = {Minerva chirurgica},
volume = {47},
number = {11},
pages = {1005-1007},
pmid = {1436567},
issn = {0026-4733},
mesh = {*Colonoscopy ; Diverticulum, Colon/complications/*diagnosis ; Humans ; },
}
@article {pmid1615303,
year = {1992},
author = {Egger, B and Gertsch, P and Wagner, HE},
title = {[Anemia-inducing colonic diverticular hemorrhages].},
journal = {Schweizerische medizinische Wochenschrift},
volume = {122},
number = {24},
pages = {936-939},
pmid = {1615303},
issn = {0036-7672},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anemia/*etiology/prevention & control ; Blood Transfusion ; Colectomy/methods ; Diverticulum, Colon/*complications/surgery ; Female ; Gastrointestinal Hemorrhage/complications/*etiology/therapy ; Humans ; Male ; Middle Aged ; },
abstract = {20 patients with massive lower gastrointestinal bleeding caused by segmental or total colonic diverticular disease are presented. The bleeding source was localized by colonoscopy, angiography and intraoperatively in 5, 5 and 2 patients respectively. The hemorrhage occurred in the right colon in 9 patients and in the left colon in 3 patients. Due to ongoing bleeding 9 patients needed immediate surgery (7 right hemicolectomies, 1 left hemicolectomy, 1 sigmoidectomy). The median transfusion requirement of operated individuals was 14 units of blood. 2 (22%) patients died from postoperative complications. The remaining 7 patients had no recurrent bleeding during a median follow-up of 3.5 years (0.5-9 years). 11 patients with arrested bleeding (median transfusion requirement 3 units of blood) were treated conservatively. During a mean follow-up of 4.5 years (1.5-10 years) only one (9%) of the conservatively treated patients complained of recurrent bleeding requiring sigmoidectomy. We conclude that massive and ongoing hemorrhage (greater than 6 units of blood) occurs predominantly in right-sided colonic diverticula and requires immediate surgery. Arrested bleeding (transfusion requirements less than 6 units of blood) from colonic diverticula can be treated conservatively since operative mortality is high and recurrent bleeding is rare.},
}
@article {pmid1613298,
year = {1992},
author = {Gore, S and Shepherd, NA and Wilkinson, SP},
title = {Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance.},
journal = {International journal of colorectal disease},
volume = {7},
number = {2},
pages = {76-81},
pmid = {1613298},
issn = {0179-1958},
mesh = {Adult ; Aged ; Biopsy ; Colitis, Ulcerative/pathology ; Colon, Sigmoid/pathology ; Diverticulitis, Colonic/pathology ; Diverticulum, Colon/pathology ; Female ; Humans ; Male ; Middle Aged ; Rectum/pathology ; Sigmoid Diseases/*pathology/therapy ; *Sigmoidoscopy ; },
abstract = {In this paper we describe an endoscopic appearance of the sigmoid colon characterised by mucosal swelling, erythema and haemorrhage strictly localised to the crescentic mucosal folds. In a 5-year period these changes were seen in 34 (1.42%) of 2380 colonoscopies and fibreoptic sigmoidoscopies. The majority of patients were middle-aged or elderly. Diverticular disease was present in most (82%) but the abnormalities were confined to the crescentic mucosal folds with sparing of the diverticular orifices. The majority of patients presented with a history of bleeding per anum. Histologically there was a spectrum of changes varying from minor vascular congestion to florid active inflammatory disease with crypt architectural abnormalities mimicking ulcerative colitis, but rectal biopsies were invariably normal. Three patients later progressed to typical distal ulcerative colitis and two other patients presenting to us with endoscopic crescentic fold disease had a previous histologically documented history of distal ulcerative colitis. In three patients the histological features were of mucosal prolapse. About half the patients required some form of therapy to control their symptoms. Steroids and/or sulphasalazine were of value although two patients subsequently underwent sigmoid resection, one to control bleeding and the second for a diverticulosis-associated stricture. Whilst endoscopic crescentic fold disease represents a specific endoscopic appearance the clinical and histological features indicate a wide spectrum of disease.},
}
@article {pmid1628026,
year = {1992},
author = {Jones, DJ},
title = {ABC of colorectal diseases. Diverticular disease.},
journal = {BMJ (Clinical research ed.)},
volume = {304},
number = {6839},
pages = {1435-1437},
doi = {10.1136/bmj.304.6839.1435},
pmid = {1628026},
issn = {0959-8138},
mesh = {*Diverticulitis, Colonic/etiology/therapy ; *Diverticulum, Colon/etiology/therapy ; Humans ; },
}
@article {pmid1612488,
year = {1992},
author = {Riddell, RH and Tanaka, M and Mazzoleni, G},
title = {Non-steroidal anti-inflammatory drugs as a possible cause of collagenous colitis: a case-control study.},
journal = {Gut},
volume = {33},
number = {5},
pages = {683-686},
pmid = {1612488},
issn = {0017-5749},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Case-Control Studies ; Colitis/*chemically induced ; Collagen Diseases/*chemically induced ; Diarrhea/chemically induced ; Female ; Humans ; Male ; Middle Aged ; Time Factors ; },
abstract = {The use of oral non-steroidal anti-inflammatory drugs (NSAIDs) in 31 patients with collagenous colitis and in 31 matched control patients with irritable bowel syndrome or colonic diverticular disease who had also undergone colonoscopy and biopsy was investigated. The long term use (greater than 6 months) of NSAIDs was significantly commoner in the study group (19/31) than in the control group (4/31) (p less than 0.02), even assuming the most adverse drug history in six patients in whom this could not be established. In all patients with collagenous colitis taking NSAIDs, diarrhoea followed the use of these drugs, and by a mean (SD) of 5.5 (4.4) years (range 0.5 to 15 years). In three patients with collagenous colitis, diarrhoea improved after withdrawing NSAIDs; rechallenge in one was followed by a recurrence of diarrhoea, which improved after withdrawing the drug again. It is suggested that NSAIDs may play an aetiological role in the diarrhoea and thickened collagen band in some patients with collagenous colitis.},
}
@article {pmid1514769,
year = {1992},
author = {Moreaux, J},
title = {[Sigmoid diverticular diseases: surgical treatment].},
journal = {Annales de gastroenterologie et d'hepatologie},
volume = {28},
number = {3},
pages = {141-144},
pmid = {1514769},
issn = {0066-2070},
mesh = {Adult ; Aged ; Aged, 80 and over ; Barium Sulfate ; Colectomy/methods/standards ; Colostomy/standards ; Diverticulum, Colon/diagnostic imaging/epidemiology/*surgery ; Enema ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiography ; Recurrence ; Sigmoid Diseases/diagnostic imaging/epidemiology/*surgery ; },
abstract = {From 1966 to 1990, 226 consecutive patients were operated on electively for diverticular disease of the sigmoid colon. The indications for surgery were colovesical fistula or suspicion of residual abscess, existence of two or more previous attacks of acute inflammation, existence of chronic symptoms and suspicion of colonic carcinoma. Colonic resection with primary anastomosis was performed in 217 patients with a covering colostomy in 1 case only. The Hartmann procedure was performed in 9 patients with extension of the lesions to the rectum and/or high operative risk. One or more abscesses were found by the surgeon or the pathologist in 50 p. cent of the patients. There were no postoperative deaths, no clinical anastomotic leakages. Long-term results were evaluated for the patients operated on before 1987, with a follow-up from 2 to 22 years. 85 p. cent of the patients had no more symptoms, 11 p. cent complained of persistent symptoms and 3% had recurrent attacks of pain and fever. Colonic barium enema is the best examination for diverticulitis and chronic abscesses. Surgical treatment is easier for abscesses located within the colonic wall and mesentery, than for extracolic abscesses with local peritonitis. Correlations between preoperative symptoms and operative findings are often not good. The good results obtained in 82 p. cent of the patients operated on for chronic symptoms suggest that chronic symptoms should be part of the indications for elective surgery. The low incidence (3 p. cent) of recurrent attacks of pain and fever is in favour of a resection limited to the sigmoid colon even when diffuse colonic diverticula are present.(ABSTRACT TRUNCATED AT 250 WORDS)},
}
@article {pmid1586088,
year = {1992},
author = {Baran, JJ and Goldstein, SD and Resnik, AM},
title = {The double-staple technique in colorectal anastomoses: a critical review.},
journal = {The American surgeon},
volume = {58},
number = {4},
pages = {270-272},
pmid = {1586088},
issn = {0003-1348},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/instrumentation/*methods ; Colon/pathology/radiation effects/*surgery ; Colostomy ; Female ; Humans ; Ileostomy ; Male ; Middle Aged ; Postoperative Complications ; Rectal Neoplasms/radiotherapy/surgery ; Rectum/pathology/radiation effects/*surgery ; Sigmoid Neoplasms/radiotherapy/surgery ; *Surgical Staplers ; },
abstract = {The widespread availability and use of stapling devices have changed colorectal surgery. In 1980, Knight and Griffen developed the "double-staple" technique, using a circular stapler to transect a linear rectal staple line. This eliminated the need for a hand-sewn, distal purse string, which was sometimes difficult or even impossible to accurately place low in the pelvis. To evaluate this procedure, the authors have reviewed their results with the double-staple technique over the past 5 years. One hundred four patients underwent this procedure between 1985 and 1990 at Thomas Jefferson University Hospital (Philadelphia, PA). There were 60 men and 44 women, with a mean age of 62.4 years. Seventy-two patients underwent operation for carcinoma of the rectum or sigmoid. Thirty-five of these had preoperative radiation therapy. Other diagnoses included 1) diverticular disease, 2) rectal prolapse, 3) villous adenoma, 4) endometrial carcinoma, 5) fistula, 6) stricture, 7) Crohn's disease, 8) colonic endometriosis, 9) lymphoma, 10) ovarian carcinoma, and 11) ulcerative colitis. Incomplete "donuts" were observed in 5 patients. Diverting colostomies were performed in 23 patients, ileostomies in 3. Postoperative complications relating to the double-staple technique itself included a rectovaginal fistula in 1 patient. There were 3 clinical leaks (2.8%), all treated nonoperatively. No strictures were observed. As previously observed, the authors believe the double-staple technique offers certain advantages over traditional, hand-sewn and stapled anastomoses, for instance: 1) there is significantly less contamination, 2) the anastomosis is technically easier, and 3) bowel segments of different diameters can be easily anastomosed.},
}
@article {pmid1582362,
year = {1992},
author = {Longo, WE and Vernava, AM},
title = {Clinical implications of jejunoileal diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {35},
number = {4},
pages = {381-388},
doi = {10.1007/BF02048119},
pmid = {1582362},
issn = {0012-3706},
mesh = {Algorithms ; *Diverticulum/complications/diagnosis/etiology ; Humans ; *Ileal Diseases/complications/diagnosis/etiology ; *Jejunal Diseases/complications/diagnosis ; },
abstract = {Congenital and acquired diverticula of the jejunum and ileum in the adult are unusual and occur in approximately 1 percent to 2 percent of the population. They are pulsion diverticula thought to be the result of intestinal dyskinesia. These lesions can produce a significant diagnostic and therapeutic dilemma. They are multiple in the jejunum and solitary distally and are characteristically found in 60- or 70-year-old males. The diagnosis may be confirmed with contrast studies of the small intestine, arteriography, or nuclear scan. Consider these disorders in patients with 1) unexplained gastrointestinal bleeding, 2) unexplained intestinal obstruction, 3) an unexpected cause of acute abdomen, 4) chronic abdominal pain, 5) anemia, or 6) malabsorption. Medical therapy is helpful in controlling diarrhea and anemia, while surgical therapy is reserved for hemorrhage, obstruction, perforation, or failure of medical management. Asymptomatic diverticula discovered on routine contrast studies need not be resected. At surgery, incidental diverticula should be removed when evidence of dilated, hypertrophied loops of small bowel with large diverticula is found. Intraoperative air distention will aid in diagnosis. Resection and primary anastomosis is the preferred treatment for non-Meckelian diverticula. Diverticulectomy is reserved for a Meckel's diverticulum without evidence of ulceration. An incidental Meckel's diverticulum should be removed in the presence of mesodiverticular bands or ectopic tissue. Removal of a Meckel's diverticulum is not advised in the patient with Crohn's disease but may be performed in the patient undergoing restorative proctocolectomy for ulcerative colitis.},
}
@article {pmid1556344,
year = {1992},
author = {Wunderlich, SM and Tobias, A},
title = {Relationship between nutritional status indicators and length of hospital stay for patients with diverticular disease.},
journal = {Journal of the American Dietetic Association},
volume = {92},
number = {4},
pages = {429-433},
pmid = {1556344},
issn = {0002-8223},
mesh = {Diverticulitis, Colonic/complications/*metabolism ; Diverticulum, Colon/complications/*metabolism ; Female ; Gastrointestinal Hemorrhage/etiology/*metabolism ; Hematocrit ; Hemoglobins/analysis ; Humans ; *Length of Stay ; Male ; *Nutritional Status ; Regression Analysis ; Retrospective Studies ; Serum Albumin/analysis ; Sex Factors ; },
abstract = {The length of a patient's stay in a hospital is an indication of the patient's recovery rate. Length of hospital stay has also become an important economic factor for hospitals. This is especially true since 1983 as a result of implementation of the Prospective Payment System based on diagnosis-related groups. In this study, the results of routine laboratory tests of nutritional status were examined for relationships between nutritional status and the length of hospital stay. We conducted a retrospective analysis of 163 patients with diverticulosis and diverticulitis of the colon to determine which nutrition assessment parameters are sensitive in predicting recovery rate (length of hospital stay). We found that serum albumin level was negatively correlated with length of hospital stay. Women without gastrointestinal bleeding stayed an average of 20.1 +/- 8.5 days when serum albumin level was 30 g/L or less vs 11.2 +/- 10.5 days when it was greater than 30 g/L. Hemoglobin and/or hematocrit levels were also negatively correlated with length of hospital stay for this group. Women without bleeding stayed an average of 16.4 +/- 13.4 days when the hemoglobin level was 120 g/L or less vs 10.4 +/- 9.1 days when it was greater than 120 g/L. These results suggest that a patient's nutritional status upon admission has an effect on the length of hospital stay for patients with diverticular disease.},
}
@article {pmid1377244,
year = {1992},
author = {Ihekwaba, FN},
title = {Diverticular disease of the colon in black Africa.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {37},
number = {2},
pages = {107-109},
pmid = {1377244},
issn = {0035-8835},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diet ; *Diverticulitis, Colonic/diagnosis/etiology/therapy ; *Diverticulum, Colon/diagnosis/etiology/therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Nigeria ; },
abstract = {Diverticular disease of the colon, previously believed to be rare among Africans, is now an emerging disease entity in many areas of the African tropics. Fifteen patients, the majority of whom were overweight (73%), under 50 years of age (73%) and who have remained on the bulky diet traditional to much of Africa, are reported. The findings suggest that factors previously uncommon in the area may now be operating to cause the disease in the population, and the highly processed food products of the supermarkets may be an important contributor to the development of this new disease entity.},
}
@article {pmid1594125,
year = {1992},
author = {Tinozzi, S and Bianchi, C and Todde, A and Belisomo, M and Volpato, G and Massera, F and Silvestri, M},
title = {[Epidemiology and physiopathology of diverticular disease of the colon].},
journal = {Minerva chirurgica},
volume = {47},
number = {5},
pages = {269-271},
pmid = {1594125},
issn = {0026-4733},
mesh = {Age Factors ; Aged ; Colon/physiopathology ; *Diverticulum, Colon/epidemiology/physiopathology ; Humans ; Manometry ; Risk Factors ; },
}
@article {pmid1594124,
year = {1992},
author = {Bazzocchi, R and Grazia, M and Bini, A},
title = {[Diagnostic timing in complicated and uncomplicated diverticular disease].},
journal = {Minerva chirurgica},
volume = {47},
number = {5},
pages = {261-267},
pmid = {1594124},
issn = {0026-4733},
mesh = {Angiography ; Colonic Diseases/diagnosis/diagnostic imaging/etiology ; Cytodiagnosis ; Diagnosis, Differential ; Diverticulum, Colon/complications/*diagnosis/diagnostic imaging ; Endoscopy ; Humans ; Intestinal Fistula/diagnosis/diagnostic imaging/etiology ; Intestinal Obstruction/diagnosis/diagnostic imaging/etiology ; Intestinal Perforation/diagnosis/diagnostic imaging/etiology ; Tomography, X-Ray Computed ; },
}
@article {pmid1594123,
year = {1992},
author = {Basile, G},
title = {[Colovesical fistulas caused by diverticular disease].},
journal = {Minerva chirurgica},
volume = {47},
number = {5},
pages = {257-260},
pmid = {1594123},
issn = {0026-4733},
mesh = {Colonic Diseases/diagnosis/*etiology/surgery ; Diagnosis, Differential ; Diverticulum, Colon/*complications/diagnosis/surgery ; Female ; Humans ; Intestinal Fistula/diagnosis/*etiology/surgery ; Male ; Urinary Bladder Fistula/diagnosis/*etiology/surgery ; },
}
@article {pmid1592647,
year = {1992},
author = {Wehrli, H and Akovbiantz, A},
title = {[Surgical therapy of diverticular disease at the Waid City Hospital, Zurich, 1980-1990].},
journal = {Helvetica chirurgica acta},
volume = {58},
number = {5},
pages = {735-739},
pmid = {1592647},
issn = {0018-0181},
mesh = {Aged ; *Anastomosis, Surgical ; *Colostomy ; Diverticulitis, Colonic/mortality/*surgery ; *Emergencies ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/*mortality ; Risk Factors ; Survival Rate ; },
abstract = {Our experience with 431 patients suffering from diverticular disease is presented. Indications for emergency (severe bleeding, bowel obstruction, sigmoid perforation with peritonitis) and elective surgery (recurrent attacks of diverticulitis or bleeding, painful or obstructing diverticular disease, fistula, impossibility to exclude a cancer) are given. Resection of the perforated sigmoid by the Hartmann procedure helps to reduce mortality markedly for diffuse purulent and fecal peritonitis. A resection with primary anastomosis can be performed with equal safety for a more localised peritonitis. Aggressive indication for elective surgery helps to lower mortality and morbidity in symptomatic diverticular disease.},
}
@article {pmid1568654,
year = {1992},
author = {Thorburn, HA and Carter, KB and Goldberg, JA and Finlay, IG},
title = {Does ispaghula husk stimulate the entire colon in diverticular disease?.},
journal = {Gut},
volume = {33},
number = {3},
pages = {352-356},
pmid = {1568654},
issn = {0017-5749},
mesh = {Aged ; Bicarbonates/*therapeutic use ; Citrates/*therapeutic use ; *Citric Acid ; Colon/*drug effects/physiopathology ; Diverticulum, Colon/diet therapy/*drug therapy/physiopathology ; Drug Combinations ; Female ; Gastrointestinal Motility/drug effects ; Gastrointestinal Transit/drug effects ; Humans ; Male ; Middle Aged ; Plant Extracts/*therapeutic use ; *Sodium Bicarbonate ; },
abstract = {The effect of ispaghula husk on colonic motility of the right and left side was examined in 10 patients with left sided diverticular disease using an untethered pressure sensitive radiotelemetry capsule. After treatment, ispaghula husk reduced mouth to rectum transit by a median of 8.8 hours and the time to midtransverse colon by five hours. In the right colon there was an increase in the median percentage activity of 7% and the median number of pressure waves greater than 5 mm Hg/hour rose by 35.3. Motility changes in the left colon were less pronounced. Five of the seven patients with abdominal pain and six of the nine patients with altered bowel habit responded to treatment. These results suggest that it is ispaghula husk's action on the right unaffected colon which alleviates the symptoms of left sided diverticular disease.},
}
@article {pmid1374000,
year = {1992},
author = {Szewczuk, MR and Depew, WT},
title = {Analysis of direct tissue isoelectric focused protein profiles of resected intestinal mucosa and endoscopic biopsies from patients with inflammatory bowel disease.},
journal = {Clinical and investigative medicine. Medecine clinique et experimentale},
volume = {15},
number = {1},
pages = {49-59},
pmid = {1374000},
issn = {0147-958X},
mesh = {Biopsy ; Colitis, Ulcerative/metabolism/pathology ; Colon/chemistry ; Colonic Neoplasms/chemistry/metabolism/pathology ; Crohn Disease/metabolism/pathology ; Epitopes ; Humans ; Inflammatory Bowel Diseases/*metabolism/pathology ; Intestinal Mucosa/*chemistry/metabolism/pathology ; Isoelectric Focusing/*methods ; Neoplasm Proteins/analysis ; Proteins/*analysis ; Sepharose ; },
abstract = {Direct tissue isoelectric focusing was used as a procedure to analyze differences in soluble tissue protein profiles of resected intestinal segments and endoscopic biopsies from patients with ulcerative colitis, Crohn's disease, and colonic cancer. Extraction of tissue proteins was accomplished by electrophoresis of mucosal cryostat sections on agarose gels across a broad pH gradient. The inflamed colonic mucosa from Crohn's disease patients showed similar isoelectric focusing protein patterns. Small bowel mucosa from a patient with both colonic diverticular disease and Crohn's disease showed protein patterns identical with that of the mucosa from a patient with only Crohn's disease. The inflamed mucosae from ulcerative colitis patients revealed identical protein patterns but were distinct from those of non-inflamed ulcerative colitis mucosa and from the inflamed mucosae from Crohn's disease patients. Non-inflamed small bowel mucosae from cancer, ulcerative colitis, and Crohn's disease patients showed distinct protein patterns which were absent in the non-inflamed large bowel mucosae. The inflamed resected ileum of a Crohn's disease patient exhibited protein patterns similar to those of the biopsy of an inflamed mid-transverse large bowel. Mucosal biopsies from inflamed sigmoid colon of a Crohn's disease patient showed different protein patterns than those in biopsies from the inflamed mid-transverse colon. Thus, distinctive isoelectric focusing protein patterns may be useful in differentiating Crohn's colitis and ulcerative colitis when granulomata are absent, and in resolving indeterminant colitis to one of these classic inflammatory bowel diseases.},
}
@article {pmid1739231,
year = {1992},
author = {Wheeler, WE and Hanks, J and Raman, VK},
title = {Primary aortoenteric fistulas.},
journal = {The American surgeon},
volume = {58},
number = {1},
pages = {53-54},
pmid = {1739231},
issn = {0003-1348},
mesh = {Aged ; Aorta, Abdominal/surgery ; Aortic Aneurysm/complications/surgery ; Aortic Diseases/*etiology/surgery ; Duodenal Diseases/*etiology/surgery ; Duodenum/surgery ; Fistula/*etiology/surgery ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; Intestinal Fistula/*etiology/surgery ; Male ; Middle Aged ; },
abstract = {Aortoenteric fistulas were first reported in 1822. Primary aortoenteric fistulas are uncommon (less than 200 cases reported). Secondary aortoenteric fistulas are a well-recognized complication of prosthetic grafts (incidence from 0.4 to 2.4%). Atherosclerosis, gallstones, foreign bodies, carcinomas, and diverticular disease are the most common etiologies. Diagnosis is difficult with most studies being nondiagnostic. A high incidence of suspicion is required to successfully diagnosis preoperatively. Surgical repair is required for survival of the patients and should consist of the following: 1) primary closure of the intestinal defect, 2) either primary anatomical repair with a prosthetic graft or extra-anatomical vascular reconstruction, depending upon the presence or absence of infection, and 3) treatment with appropriate antibiotics. One of the largest series of primary aortoenteric fistulas from a single institution consisting of three cases secondary to aneurysmal and granulomatous disease is discussed.},
}
@article {pmid1444149,
year = {1992},
author = {Gallot, D and Jauffret, B and Goujard, F and Deslandes, M and Sezeur, A and Malafosse, M},
title = {[Hartmann's procedure. A retrospective study of 86 cases].},
journal = {Annales de chirurgie},
volume = {46},
number = {6},
pages = {491-496},
pmid = {1444149},
issn = {0003-3944},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/*surgery ; Colorectal Neoplasms/surgery ; Colostomy/adverse effects/*methods/mortality ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; Rectal Neoplasms/*surgery ; Reoperation ; Retrospective Studies ; Suture Techniques ; },
abstract = {The purpose of this retrospective study is to define current indications and results of Hartmann's procedure (H). From 1978 to 1989, 86 H were performed, 52 (60%) as emergency surgery. Indications were: colo-rectal cancer (37): 15 complicated and 22 as an elective procedure, diverticular disease acute or complicated (24), ischemic colitis (10), volvulus of the pelvic colon (5), inflammatory bowel disease (4), colonic perforation (3), traumatic hematoma of the sigmoid mesocolon (1). Fourteen patients died after operation (mean age: 79). There was no death after elective H for cancer. Post-operative complications were numerous: pulmonary (25%), abdominal would sepsis or disruption (21%), rectal strump leakage (14%), the later being harmless due to the associated Mickulicz drainage. Seven patients were reoperated on for necrosis of the colonic stoma. Mean initial hospital stay was 31 days. Restoration of the gastrointestinal continuity was done in 27 cases (37% of the surviving patients, 76% of the diverticular diseases). The authors conclude that for complicated diverticular disease H procedure improves survival without preferable continuity. For cancer, H procedure is permanently compromising gastrointestinal in the elderly to hazardous low anastomosis, and to palliative abdomino-perineal resection.},
}
@article {pmid1344789,
year = {1992},
author = {Khalife, ME},
title = {[Right and left laparoscopic colectomy. Apropos of 10 cases].},
journal = {Chirurgie; memoires de l'Academie de chirurgie},
volume = {118},
number = {9},
pages = {538-540},
pmid = {1344789},
issn = {0001-4001},
mesh = {Aged ; Aged, 80 and over ; Colectomy/*methods ; Colonic Neoplasms/surgery ; Diverticulitis, Colonic/surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/adverse effects/*methods ; Male ; Middle Aged ; },
abstract = {Ten successive cases of celioscopic colectomy are reported (5 right and 5 left colons). Colectomies were made for diverticular disease in 6 case and for cancer in the remaining cases. The patients ages range from 52 to 80 years, with an average of 72 years. The average duration of surgery is 92 minutes. The stay in hospital lasted from 5 to 7 days with an average of 6 days. All patients resumed fluid feeding on the 3rd postoperative day and solid feeding on the 4th to 6th day. None of them received analgesics later than 48 hours postoperatively. There was no mortality. Only one complication was noted in the form of urinary retention. In our opinion, colectomy with celioscopic video surgery currently has a definite role to play and, owing to technical and instrumental progress, colectomy can be performed without complementary laparotomy, at least for the left colon.},
}
@article {pmid1685073,
year = {1991},
author = {Snape, WJ and Williams, R and Hyman, PE},
title = {Defect in colonic smooth muscle contraction in patients with ulcerative colitis.},
journal = {The American journal of physiology},
volume = {261},
number = {6 Pt 1},
pages = {G987-91},
doi = {10.1152/ajpgi.1991.261.6.G987},
pmid = {1685073},
issn = {0002-9513},
support = {5P30-DK-36200/DK/NIDDK NIH HHS/United States ; R01-DK-3114/DK/NIDDK NIH HHS/United States ; R32-HD-22912/HD/NICHD NIH HHS/United States ; },
mesh = {Adenocarcinoma/physiopathology ; Adult ; Bethanechol ; Bethanechol Compounds/pharmacology ; Colitis, Ulcerative/*physiopathology ; Colon/drug effects/*physiopathology ; Colonic Neoplasms/physiopathology ; Diverticulitis, Colonic/physiopathology ; Electric Stimulation ; Humans ; In Vitro Techniques ; Middle Aged ; *Muscle Contraction ; Muscle, Smooth/drug effects/*physiopathology ; Potassium/physiology ; },
abstract = {Patients with ulcerative colitis have decreased postprandial colonic contractions. The purpose of this study was to determine whether the smooth muscle from patients with ulcerative colitis responds abnormally in vitro to different stimuli. Circular colonic smooth muscle strips from patients with ulcerative colitis, acute diverticular disease, or adenocarcinoma were stretched to the optimal length and stimulated with electrical field stimulation (EFS), bethanechol, or increased concentrations of extracellular K+. The EFS-stimulated on-contraction was similar in each group, but the off-contraction was decreased in patients with colitis compared with patients with cancer (P less than 0.02) or diverticular disease (P less than 0.01). Bethanechol stimulated a dose-dependent colonic contraction, which was less in the strips from patients with colitis compared with cancer (P less than 0.02) or diverticular disease (P less than 0.05). The response to increased extracellular K+ was less in muscle from patients with colitis (P less than 0.01) than in the other tissues. Muscle from diverticular disease developed greater stress to K+ stimulation than did muscle from cancer (P less than 0.05). These studies suggest that there is a decrease in the force of muscle contraction in colonic muscle obtained from patients with colitis compared with normal muscle resected from patients with cancer or with muscle associated with diverticular disease of the colon. The similar relatively low amplitude of the on-contraction in each group suggests the physiological release of an inhibitory neurotransmitter.},
}
@article {pmid1773958,
year = {1991},
author = {Seldenrijk, CA and Morson, BC and Meuwissen, SG and Schipper, NW and Lindeman, J and Meijer, CJ},
title = {Histopathological evaluation of colonic mucosal biopsy specimens in chronic inflammatory bowel disease: diagnostic implications.},
journal = {Gut},
volume = {32},
number = {12},
pages = {1514-1520},
pmid = {1773958},
issn = {0017-5749},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colitis, Ulcerative/pathology ; Colon/*pathology ; Crohn Disease/pathology ; Diagnosis, Differential ; Evaluation Studies as Topic ; Female ; Humans ; Inflammatory Bowel Diseases/*pathology ; Intestinal Mucosa/*pathology ; Lymphocytes/pathology ; Male ; Middle Aged ; Neutrophils/pathology ; Plasma Cells/pathology ; Predictive Value of Tests ; Prospective Studies ; },
abstract = {In a prospective blind evaluation of multiple colonic mucosal biopsy specimens, 45 clinically well defined patients with chronic inflammatory bowel disease (21 Crohn's disease and 24 ulcerative colitis) and 16 control subjects (seven normal subjects and nine patients with diverticular disease) were studied to identify reproducible histopathological features which could distinguish chronic inflammatory bowel disease (CIBD) from non-CIBD and Crohn's disease from ulcerative colitis. Using kappa statistics 16 of 41 histological features were sufficiently reproducible for further stepwise discriminant analysis to differentiate between CIBD and non-CIBD, and between Crohn's disease and ulcerative colitis. Using the combination of three features (an increase of lymphocytes and plasma cells in the lamina propria, the presence of branching of crypts, and neutrophils in the crypt epithelium) we were able to distinguish CIBD from non-CIBD in 89% of the cases with high probability (p greater than 0.85). To separate Crohn's disease from ulcerative colitis three features (an excess of histiocytes in combination with a villous or irregular aspect of the mucosal surface and granulomas) had a high predictive value. Using these features 70% of Crohn's disease patients and 75% of ulcerative colitis patients were correctly classified with a high probability (p greater than 0.85). These findings indicate that the pathologist is dependent on the presence of only a few histological features for a reliable classification of Crohn's disease and ulcerative colitis.},
}
@article {pmid1935471,
year = {1991},
author = {Grissom, R and Snyder, TE},
title = {Colovaginal fistula secondary to diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {34},
number = {11},
pages = {1043-1049},
doi = {10.1007/BF02049975},
pmid = {1935471},
issn = {0012-3706},
mesh = {Colonic Diseases/*etiology ; Diverticulitis, Colonic/*complications/diagnosis/surgery ; Diverticulum, Colon/*complications/diagnosis/surgery ; Female ; Humans ; Intestinal Fistula/*etiology ; Vaginal Fistula/*etiology ; },
abstract = {Colovaginal fistula is infrequently encountered in gynecologic practice, but, when it does occur, diverticular disease is the most common cause. This paper discusses current concepts in etiology, diagnosis, and treatment of patients with colovaginal fistula secondary to diverticular disease. Review of the literature reveals that a majority of patients have a history of hysterectomy and are primarily diagnosed by barium enema. The current trend in treatment is surgical correction with primary resection and anastomosis.},
}
@article {pmid1809498,
year = {1991},
author = {Moreaux, J},
title = {[Diverticular sigmoiditis: surgical treatment].},
journal = {Bulletin de l'Academie nationale de medecine},
volume = {175},
number = {8},
pages = {1285-91; discussion 1291-3},
pmid = {1809498},
issn = {0001-4079},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Middle Aged ; Sigmoid Diseases/*surgery ; },
abstract = {From 1966 to 1990, 226 consecutive patients were operated on electively for diverticular disease of the sigmoid colon. The indications for surgery were colovesical fistula or suspicion of residual abscess, existence of two or more previous attacks of acute inflammation, existence of chronic symptoms and suspicion of colonic carcinoma. Colonic resection with primary anastomosis was performed in 217 patients with a covering colostomy in 1 case only. The Hartmann procedure was performed in 9 patients with extension of the lesions to the rectum and/or high operative risk. One or more abscesses were found by the surgeon or the pathologist in 50% of the patients. There were no postoperative deaths, no clinical anastomotic leakages. Long-term results were evaluated for the patients operated on before 1987, with a follow-up from 2 to 22 years. 85% of the patients had no more symptoms, 11% complained of persistent symptoms and 3% had recurrent attacks of pain and fever. Colonic barium enema is the best examination for diverticulitis and chronic abscesses. Surgical treatment is easier for abscesses located within the colonic wall and mesentery, than for extracolic abscesses with local peritonitis. Correlations between preoperative symptoms and operative findings are often not good. The good results obtained in 82% of the patients operated on for chronic symptoms suggest that chronic symptoms should be part of the indications for elective surgery. The low incidence (3%) of recurrent attacks of pain and fever is in favour of a resection limited to the sigmoid colon even when diffuse colonic diverticula are present.(ABSTRACT TRUNCATED AT 250 WORDS)},
}
@article {pmid1761598,
year = {1991},
author = {Proye, C and Martinot, JC and Triboulet, JP and Carnaille, B and Sautier, M and Dromer, D and Camp, D},
title = {[Mortality in the surgical unit of a general hospital. Study of 27 postoperative deaths among patients operated on during 1990-1492].},
journal = {Journal de chirurgie},
volume = {128},
number = {11},
pages = {453-458},
pmid = {1761598},
issn = {0021-7697},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms/complications/*mortality/surgery ; Diverticulitis, Colonic/complications/mortality/surgery ; Duodenal Ulcer/complications/*mortality/surgery ; Esophageal Neoplasms/complications/*mortality/surgery ; France ; Heart Diseases/etiology/mortality ; Hospital Units ; Humans ; Middle Aged ; Postoperative Complications/mortality ; Respiratory Insufficiency/etiology/mortality ; Sigmoid Diseases/complications/mortality/surgery ; Stomach Ulcer/complications/*mortality/surgery ; },
abstract = {This study takes in account all post operative deaths during the year 1990 in one surgical Professorial unit of Lille academic hospital (France). During this year, 1492 consecutive patients underwent surgery. The mean age of deceased patients was 63.7 years. 15 died after emergency procedure and 12 after elective surgery. Lastly 2 patients died without any operation. The most common condition encountered in those cases was oesophageal carcinoma, thereafter gastric or duodenal complicated peptic ulcer, and finally colonic carcinoma and diverticular disease. 13 patients had neoplasia (45%). From a critical point of view, 14 patients died after surgical indication or procedure of questionable legitimacy. The comparison with a similar study conducted five years ago and the analysis of these charts allow us to reaffirm some basic principles of surgery.},
}
@article {pmid1759778,
year = {1991},
author = {Ornstein, MH},
title = {Two kinds of diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {73},
number = {6},
pages = {400},
pmid = {1759778},
issn = {0035-8843},
mesh = {Diverticulum, Colon/*history ; History, 18th Century ; History, 19th Century ; Humans ; },
}
@article {pmid1759772,
year = {1991},
author = {Pain, J and Cahill, J},
title = {Surgical options for left-sided large bowel emergencies.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {73},
number = {6},
pages = {394-6; discussion 397},
pmid = {1759772},
issn = {0035-8843},
mesh = {Attitude of Health Personnel ; Colectomy ; Colostomy ; Diverticulitis, Colonic/*surgery ; Emergencies ; Humans ; Intestinal Obstruction/surgery ; Medical Staff, Hospital ; Peritoneal Lavage ; Peritonitis/surgery ; Sigmoid Diseases/*surgery ; Sigmoid Neoplasms/*surgery ; },
abstract = {Current choices of operation for left-sided large bowel emergencies have been established by a questionnaire sent to 218 consultant surgeons asking which operation they would perform under varying circumstances for obstructing sigmoid carcinoma and diverticular disease. A 92% response rate was obtained. Hartmann's procedure (with or without a mucus fistula) is the most popular operation for all conditions. Sigmoid colectomy with primary anastomosis is performed by 40% of surgeons for obstructing carcinomas, but less commonly in other situations. On-table lavage is rarely used, and the majority of anastomoses are not protected by a proximal stoma. Subtotal colectomy is very seldom employed, except when caecal perforation results from an obstructing carcinoma. Some surgeons perform a defunctioning colostomy alone even in the presence of a perforation.},
}
@article {pmid1744873,
year = {1991},
author = {Scholefield, JH and Wyman, A and Rogers, K},
title = {Management of generalized faecal peritonitis--can we do better?.},
journal = {Journal of the Royal Society of Medicine},
volume = {84},
number = {11},
pages = {664-666},
pmid = {1744873},
issn = {0141-0768},
mesh = {Adult ; Aged ; Crohn Disease/complications ; Diverticulum, Colon/complications ; *Feces ; Humans ; Middle Aged ; Peritoneal Lavage/methods ; Peritonitis/etiology/*surgery ; Therapeutic Irrigation/*methods ; },
abstract = {Generalized faecal peritonitis is associated with a mortality of over 50% in most series of cases. Despite great improvements in the standards of intensive care the morbidity and mortality associated with this condition have not improved, in part due to recurrent intra-abdominal sepsis. This preliminary study investigated the role of laparotomy, repeated abdominal lavage and debridement to determine whether such a policy might lead to an improvement in outcome. Of six cases studied three had perforated diverticular disease, two had Crohn's disease. Twenty lavages were performed on these six patients who had a mean ICU stay of 8 days. Five out of the six patients left hospital and remain well, one patient died of septicaemia and pre-existing renal failure. This study found that laparotomy, repeated abdominal lavage and debridement may be effective in reducing the morbidity and mortality of generalized faecal peritonitis and further study of this technique is appropriate.},
}
@article {pmid1958975,
year = {1991},
author = {Roe, AM and Prabhu, S and Ali, A and Brown, C and Brodribb, AJ},
title = {Reversal of Hartmann's procedure: timing and operative technique.},
journal = {The British journal of surgery},
volume = {78},
number = {10},
pages = {1167-1170},
doi = {10.1002/bjs.1800781006},
pmid = {1958975},
issn = {0007-1323},
mesh = {Anastomosis, Surgical/methods/mortality ; Colon/*surgery ; Colonic Neoplasms/surgery ; *Colostomy ; Diverticulum, Colon/surgery ; Humans ; Postoperative Period ; Rectum/*surgery ; Time Factors ; },
abstract = {A review of closure of Hartmann's colostomy was undertaken to establish guidelines for the timing and technique of reversal. Between 1984 and 1990 there were 69 reversals; 48 patients originally had diverticular disease and 21 had carcinoma. One-third underwent reversal before 4 months and two-thirds after this time. The operative mortality rate was 3 per cent and the anastomotic leak rate 4 per cent. Significant morbidity occurred in 30 per cent. There was no advantage in delayed closure. Complications occurred in 24 per cent of patients undergoing reversal before and 35 per cent undergoing reversal after 4 months. Thirty-five anastomoses were hand-sewn and 34 stapled. There were no differences in operating time for the two techniques, but a greater number were stapled after 4 months than before (P less than 0.05), which may reflect increased rectal stump shrinkage with time. There were no differences in complication rates whether the anastomosis was hand-sewn (34 per cent) or stapled (26 per cent). Closure of Hartmann's colostomy is a safe procedure but has a significant morbidity in nearly one-third of cases. On the basis of these results, there is no indication to delay closure after 4 months have elapsed, and earlier reversal, when the rectal stump is most accessible, is recommended.},
}
@article {pmid1761590,
year = {1991},
author = {Moquet, PY and Letoquart, JP and Pompilio, M and Kunin, N and La Gamma, A and Mambrini, A},
title = {[Sigmoido-uterine fistula of diverticular origin. Review of the literature apropos of a case].},
journal = {Journal de chirurgie},
volume = {128},
number = {10},
pages = {419-423},
pmid = {1761590},
issn = {0021-7697},
mesh = {Colectomy ; Diverticulum, Colon/*complications ; Female ; Fistula/*etiology/surgery ; Humans ; Hysterectomy ; Intestinal Fistula/etiology/surgery ; Middle Aged ; Sigmoid Diseases/*etiology/surgery ; Uterine Diseases/*etiology/surgery ; },
abstract = {The authors report one case of sigmoid-uterine fistula of diverticular origin with a favorable outcome after an ideal colectomy associated with subtotal hysterectomy. They emphasize the rarity of this complication, due to the resistance of the uterine tissue. Its diagnosis is primarily clinical, and other examinations are required only to establish the etiological diagnosis. Surgery must be curative, ideally in one stage including the treatment of the diverticular disease and that of its gynecological consequences, which may vary according to the local conditions.},
}
@article {pmid1951844,
year = {1991},
author = {Kelly, JK},
title = {Polypoid prolapsing mucosal folds in diverticular disease.},
journal = {The American journal of surgical pathology},
volume = {15},
number = {9},
pages = {871-878},
doi = {10.1097/00000478-199109000-00007},
pmid = {1951844},
issn = {0147-5185},
mesh = {Colonic Diseases/complications/*pathology ; Colonic Polyps/*pathology ; Diverticulum/complications/*pathology ; Hemorrhage/etiology ; Humans ; Intestinal Mucosa/*pathology ; Male ; Middle Aged ; Prolapse ; },
abstract = {Redundant or polypoid mucosal folds were found in eight surgically resected sigmoid colons with diverticular disease. Grossly, they were either swellings of mucosal folds or larger, leaflike, smooth-surfaced polyps with broad bases arising from mucosal folds. The number of lesions ranged from one to 11, and when multiple they formed two rows between diverticula. Swollen mucosal folds showed submucosal and mucosal vascular congestion, scanty thrombi, edema, hemorrhage, and hemosiderin deposition. Some were markedly inflamed. Polypoid lesions also showed crypt elongation and fission, upgrowth of muscle from the muscularis mucosae, and hyperplastic-metaplastic change typical of mucosal prolapse. One polyp showed evidence of an inverted diverticulum. Two cases displayed diffuse mucosal inflammation resembling inflammatory bowel disease in the region of the polyps. We speculate that these lesions result from a combination of venous congestion and mucosal redundancy secondary to spastic contraction of the muscle coat.},
}
@article {pmid1933208,
year = {1991},
author = {Wilson, RG and Smith, AN and Macintyre, IM},
title = {Non-steroidal anti-inflammatory drugs and complicated diverticular disease: a case-control study.},
journal = {The British journal of surgery},
volume = {78},
number = {9},
pages = {1148},
doi = {10.1002/bjs.1800780936},
pmid = {1933208},
issn = {0007-1323},
mesh = {Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Diverticulum/*chemically induced ; Gastrointestinal Hemorrhage/*chemically induced ; Humans ; },
}
@article {pmid1929127,
year = {1991},
author = {Sarin, S and Boulos, PB},
title = {Evaluation of current surgical management of acute inflammatory diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {73},
number = {5},
pages = {278-282},
pmid = {1929127},
issn = {0035-8843},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/etiology ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intestinal Obstruction/etiology/surgery ; Length of Stay ; Male ; Middle Aged ; Peritonitis/etiology/surgery ; Postoperative Complications ; Retrospective Studies ; },
abstract = {During the period 1980 to 1987, 127 patients were admitted with acute complications of diverticular disease; clinically diagnosed as acute diverticulitis in 86, peritonitis in 33 and colonic obstruction in eight. In those patients diagnosed as acute diverticulitis, conservative treatment was effective in 73 (85%), the other 13 requiring surgery. Of 31 patients, with a clinical diagnosis of peritonitis who underwent operation, 19 (61%) had free purulent or faecal fluid at laparotomy and the remainder had a localised phlegmonous mass. Sigmoid resection was performed in 34 patients and nonexcisional surgery in 18. In the earlier period of the study, there was a preference for the former procedure in patients with peritonitis rather than those with phlegmonous diverticulitis (63% vs 28%), and in the later period of the study, resection was the preferred treatment in both groups (91% vs 93%). The increase in resectional surgery significantly reduced mortality, at completion of treatment, in patients with peritonitis (P less than 0.05) but not in those with phlegmonous diverticulitis. There was an additional benefit of resection in the lower number of procedures per patient (1.5 vs 2.1), a lower median total hospital stay (32 days vs 50.5, P less than 0.01) and a lower wound infection rate (16% vs 32%, P less than 0.01) at the end of treatment. The optimum surgical approach at laparotomy for acutely complicated diverticular disease would therefore appear to be a resectional procedure. Of the patients operated on for 'peritonitis', 39% were found to have a localised diverticular mass/phlegmon. This group of patients, if identified earlier, may respond to conservative management in the first instance, and highlight an area where further improvements in management may be possible.},
}
@article {pmid1928585,
year = {1991},
author = {Franko, E and Cohen, JR},
title = {General surgical problems requiring operation in postoperative vascular surgery patients.},
journal = {American journal of surgery},
volume = {162},
number = {3},
pages = {247-250},
doi = {10.1016/0002-9610(91)90079-s},
pmid = {1928585},
issn = {0002-9610},
mesh = {Aged ; Female ; Humans ; Male ; Postoperative Complications/mortality/*surgery ; Retrospective Studies ; *Vascular Surgical Procedures ; },
abstract = {Surgical intervention after vascular surgery usually occurs as a result of bleeding or thrombosis, whereas general surgical problems requiring operation after vascular surgery are unusual. The purpose of this study was to review the results of operations for general surgical problems done soon after major vascular surgery. From January 1985 to December 1989, 1,236 major vascular procedures were performed, and 15 patients developed significant postoperative general surgical problems including perforated duodenal ulcer (2), perforated diverticular disease (2), evisceration and dehiscence (2), liver infarct (1), gangrenous cholecystitis (2), clostridial myonecrosis (1), pseudomembranous colitis (1), and small bowel obstruction (4). The overall mortality was very high (47%), and the chance of dying was significantly higher (p less than 0.05) if the initial vascular procedure was an emergency (100% mortality). All the patients who died (n = 7) succumbed to sepsis. There was a long delay in diagnosis in all groups; however, the delay did not correlate with mortality. Although this is a study of a small group of patients with a very heterogenous group of complications, several observations can be made: (1) a general surgical problem after vascular surgery carries a very high mortality; (2) general surgical complications in postoperative vascular patients in whom the initial procedure was an emergency are very poorly tolerated and almost uniformly lethal; and (3) these elderly patients have multiple medical problems and seem unlikely to tolerate any septic insult.},
}
@article {pmid1688289,
year = {1991},
author = {Jacobs, M and Verdeja, JC and Goldstein, HS},
title = {Minimally invasive colon resection (laparoscopic colectomy).},
journal = {Surgical laparoscopy & endoscopy},
volume = {1},
number = {3},
pages = {144-150},
pmid = {1688289},
issn = {1051-7200},
mesh = {Adult ; Aged ; Aged, 80 and over ; Analgesics, Opioid/therapeutic use ; Anastomosis, Surgical/adverse effects ; Colectomy/adverse effects/*methods ; Colon/physiopathology ; Colonic Diseases/surgery ; Colonic Neoplasms/surgery ; Defecation ; Dissection ; Electrocoagulation ; Female ; Humans ; Intestinal Obstruction/etiology ; Intestine, Small/pathology ; *Laparoscopy/adverse effects/methods ; Length of Stay ; Male ; Middle Aged ; Pain, Postoperative/prevention & control ; Pilot Projects ; Sigmoid Diseases/surgery ; Time Factors ; },
abstract = {The successful application of laparoscopic surgery to gallbladder disease and acute appendicitis has encouraged clinical investigators to develop this technology further in an attempt to manage other pathologic disorders of the gastrointestinal (GI) tract. After gaining experience with various laparoscopic skills while performing clinical biliary tract surgery, appendectomy and then in a controlled animal laboratory, a pilot program for laparoscopic colonic surgery was initiated. Twenty patients with ages ranging from 43 to 88 years (mean age of 57 years) underwent laparoscope-assisted colon resection. In nine patients, a right hemicolectomy was performed and a sigmoid colectomy in eight. A low anterior resection, Hartman's procedure, and abdominal perineal resection were each performed in one patient. Indications for surgery were large villous adenomas or adenocarcinoma in 12, diverticular disease in 5, sigmoid endometrioma in 1, cecal volvulus in 1, and inflammatory bowel disease in 1. Eighty percent of patients were able to tolerate a liquid diet on the first postoperative day and 70% were discharged within 96 h eating a regular diet and having normal bowel movements. There were three operative complications: a 3 unit postoperative bleed managed without surgery, one patient developed marked edema of the rectosigmoid anastomosis requiring decompression with a rectal tube, and one individual with metastatic colon cancer was operated on for a mechanical small bowel obstruction 7 days after the initial laparoscopic surgery. Although laparoscope-assisted colonic surgery may still be considered a procedure in evolution, we feel that in time it has the potential to be as popular as laparoscopic cholecystectomy.},
}
@article {pmid1790075,
year = {1991},
author = {Hidalgo, F and De Castro, J and Servent, R and Alastrué, A and Rull, M and Casas, D and Albero, J and Llamazares, JF and Vilagrasa, M and Salvá, JA},
title = {[Gigantic diverticulum of the colon. A complication of diverticulosis?].},
journal = {Revista espanola de enfermedades digestivas},
volume = {80},
number = {2},
pages = {115-118},
pmid = {1790075},
issn = {1130-0108},
mesh = {Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*complications/pathology ; Diverticulum, Colon/*complications/pathology ; Humans ; Male ; Sigmoid Diseases/*complications/pathology ; },
abstract = {We present a patient affected of diverticular disease of the colon, with diverticulosis and two giant diverticula of the sigma, both located at the mesenteric edge. We would like to stress the low incidence of reports about this entity in the medical literature, its uncommon location and the fact of a double lesion coinciding in a single patient. We discuss the most important nosocomial aspects and the different diagnoses. Finally, we support the idea of distinguishing three different entities that in the medical literature are usually unified as a single "giant diverticulum of the colon". We reaffirm ourselves on the importance of an early diagnosis and a correct indication for surgery.},
}
@article {pmid1926008,
year = {1991},
author = {Wehrli, H},
title = {[Diverticular disease: When to operate?].},
journal = {Therapeutische Umschau. Revue therapeutique},
volume = {48},
number = {7},
pages = {480-487},
pmid = {1926008},
issn = {0040-5930},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/*surgery ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Intestinal Perforation/*surgery ; Male ; Middle Aged ; Peritonitis/*surgery ; Postoperative Complications/mortality ; Retrospective Studies ; },
abstract = {We present our experience with 431 patients suffering from diverticular disease. Indications for emergency and elective surgery are given. Immediate laparatomy is mandatory for severe diverticular bleeding, bowel obstruction and sigmoid perforation. Aggressive surgical management is appropriated for purulent and fecal peritonitis. Resection of the perforated sigmoid colon by the Hartmann procedure is the method of choice and helps to reduce mortality markedly. A resection with primary anastomosis can be performed in equal safety if there is only a localised peritonitis. One stage resection is most frequently performed for elective cases with recurrent attacks and bleeding, painful or obstructing diverticular disease, fistula and if a cancer cannot be excluded. Aggressive surgical treatment helps to lower mortality and morbidity and is the best tool in prevention of severe complications for diverticular disease.},
}
@article {pmid1863055,
year = {1991},
author = {Nathan, B},
title = {Two kinds of diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {73},
number = {4},
pages = {267},
pmid = {1863055},
issn = {0035-8843},
mesh = {Diverticulum, Colon/*history ; England ; History, 18th Century ; History, 19th Century ; Humans ; },
}
@article {pmid2070233,
year = {1991},
author = {Ritchie, AJ and Carson, JG and Humphreys, WG},
title = {Encysted pneumatocele: a complication of diverticular disease.},
journal = {The British journal of surgery},
volume = {78},
number = {6},
pages = {683},
doi = {10.1002/bjs.1800780615},
pmid = {2070233},
issn = {0007-1323},
mesh = {Aged ; Colon, Sigmoid/diagnostic imaging ; Diverticulum, Colon/*complications ; Humans ; Male ; Middle Aged ; Pneumatosis Cystoides Intestinalis/diagnostic imaging/*etiology ; Radiography ; Sigmoid Diseases/*complications ; },
}
@article {pmid2059175,
year = {1991},
author = {Serpell, JW and Johnson, CD},
title = {Complicated Crohn's disease in the over 70 age group.},
journal = {The Australian and New Zealand journal of surgery},
volume = {61},
number = {6},
pages = {427-431},
doi = {10.1111/j.1445-2197.1991.tb00256.x},
pmid = {2059175},
issn = {0004-8682},
mesh = {Aged ; Crohn Disease/*diagnosis/surgery ; Female ; Humans ; Male ; },
abstract = {Crohn's disease is rare and is infrequently reported in the over 70 age group. Such patients often present urgently with acute complications of Crohn's disease. Seven patients with Crohn's disease all presented with complications. The diagnosis was initially unsuspected in these patients, and in 3 cases coexisting diverticular disease led to a delay in diagnosis. Three patients with ileocolic disease presented with peritonitis or bowel obstruction. In a further 2 patients a diagnosis of Crohn's disease was not made until after histological examination of resected tissue. It is likely that, as the population ages, more elderly patients will present with complicated Crohn's disease. Surgeons should be aware of this possibility to allow appropriate management of this condition, which generally has a favourable prognosis in this age group.},
}
@article {pmid1645247,
year = {1991},
author = {Chia, JG and Wilde, CC and Ngoi, SS and Goh, PM and Ong, CL},
title = {Trends of diverticular disease of the large bowel in a newly developed country.},
journal = {Diseases of the colon and rectum},
volume = {34},
number = {6},
pages = {498-501},
doi = {10.1007/BF02049937},
pmid = {1645247},
issn = {0012-3706},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Child ; *Developing Countries ; Dietary Fiber/administration & dosage ; Diverticulum, Colon/*epidemiology/etiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Prevalence ; Singapore ; },
abstract = {Five hundred twenty four consecutive barium enemas done over an 18-month period were reviewed in Singapore to ascertain the prevalence and distribution of diverticular disease in the large bowel. In this study, the prevalence rate was 20 percent, which is comparable to European and American studies but higher than similar studies in Asian countries. However, the distribution of the disease showed a predominance of right-sided disease (70 percent). This is a pattern that is markedly different from that seen in Europe and North America, where the disease involves largely the left side of the large bowel. The high prevalence rate in this series is at variance with the widely held belief that diverticulosis occurs less frequently in oriental communities.},
}
@article {pmid1931527,
year = {1991},
author = {Scavelli, V and Vestita, G and Manghisi, D and Veneziani, P and Sorino, F and Gabrieli, G},
title = {[A rare cause of acute abdomen: perforation of cecal diverticulum].},
journal = {Il Giornale di chirurgia},
volume = {12},
number = {5},
pages = {332-333},
pmid = {1931527},
issn = {0391-9005},
mesh = {Abdomen, Acute/*etiology ; Acute Disease ; Adult ; Appendicitis/diagnosis ; Cecal Diseases/*complications/diagnosis/surgery ; Diagnosis, Differential ; Diverticulitis/*complications/diagnosis/surgery ; Female ; Humans ; Intestinal Perforation/*complications/diagnosis/surgery ; },
abstract = {The Authors, after a brief review of the literature on the frequency and localization of large bowel diverticular disease report a case of perforation of a cecal diverticulum operated on emergency. They also add some brief comments on the interesting aspects of the case, its diagnostic difficulties and operating technique.},
}
@article {pmid1860312,
year = {1991},
author = {Medina, VA and Papanicolaou, GK and Tadros, RR and Fielding, LP},
title = {Acute perforated diverticulitis: primary resection and anastomosis?.},
journal = {Connecticut medicine},
volume = {55},
number = {5},
pages = {258-261},
pmid = {1860312},
issn = {0010-6178},
mesh = {Acute Disease ; Aged ; Anastomosis, Surgical ; Colostomy ; Diverticulitis, Colonic/*surgery ; Feces ; Female ; Follow-Up Studies ; Humans ; Intestinal Perforation/*surgery ; Male ; Middle Aged ; Peritonitis/etiology/surgery ; Therapeutic Irrigation ; Time Factors ; },
abstract = {Surgical management of patients with acute colonic diverticulitis is evolving from multiple towards single operations. The patterns of presentation and treatment of 146 patients with acute perforated diverticulitis have been reviewed (1983-1988) using the Hinchey classification system (Stages I-IV). This paper focuses on the six patients who presented with fecal peritonitis (Stage IV disease), half of whom were treated by primary resection and anastomosis and the remainder by a Hartmann procedure. The mean length of stay was 18.7 +/- 7.9 days and 12.7 +/- 4.8 days with a mortality of zero and one, respectively. These data suggest that in selected patients who present with perforated diverticular disease, primary resection with anastomosis offers a possible alternative to other operative management. The presence of fecal peritonitis should no longer be considered an absolute contraindication to immediate bowel reconstruction. Furthermore, we suggest that this decision be based on the relative absence of concomitant disease, a satisfactory response to preoperative resuscitation, the availability of a surgeon experienced in colonic surgery, and attention to postoperative management.},
}
@article {pmid2063109,
year = {1991},
author = {Debry, G},
title = {[Diet peculiarities. Vegetarianism, veganism, crudivorism, macrobiotism].},
journal = {La Revue du praticien},
volume = {41},
number = {11},
pages = {967-972},
pmid = {2063109},
issn = {0035-2640},
mesh = {Deficiency Diseases/etiology ; *Diet ; Diet, Macrobiotic/adverse effects ; Diet, Vegetarian ; *Feeding Behavior/physiology ; Humans ; Nutritional Requirements ; Nutritive Value ; },
abstract = {People who refuse to eat meat animal products mostly adhere to vegetarianism, veganism, crudivorism or macrobiotism, But these food habits are only one part of life-style chosen for spiritual, ethic or hygienic and healthy motivations. Except vitamin B12 deficiencies these regimens do not produce other deficiencies if they are correctly followed and if the energy intake is in agreement with the RDA'S. They reduce the risks of metabolic diseases, coronaropathies, arterial hypertension, colon cancer, diverticular disease of the colon, kidney and gallstones. Nevertheless crudivorism and macrobiotism are associated with high risks of deficiencies especially in children and pregnant women.},
}
@article {pmid2012956,
year = {1991},
author = {Bowman, S and Paice, E and Binder, A},
title = {Death from unsuspected diverticular disease in patients taking corticosteroids for polymyalgia rheumatica or giant cell arteritis.},
journal = {British journal of rheumatology},
volume = {30},
number = {2},
pages = {159-160},
doi = {10.1093/rheumatology/30.2.159-a},
pmid = {2012956},
issn = {0263-7103},
mesh = {Aged ; Diverticulum, Colon/*mortality ; Female ; Giant Cell Arteritis/*drug therapy ; Humans ; Polymyalgia Rheumatica/*drug therapy ; Prednisolone/*adverse effects/therapeutic use ; Rupture, Spontaneous ; },
}
@article {pmid2007352,
year = {1991},
author = {Cortesini, C and Pantalone, D},
title = {Usefulness of colonic motility study in identifying patients at risk for complicated diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {34},
number = {4},
pages = {339-342},
doi = {10.1007/BF02050595},
pmid = {2007352},
issn = {0012-3706},
mesh = {Diverticulum, Colon/*physiopathology/surgery ; *Gastrointestinal Motility ; Humans ; Middle Aged ; Risk Factors ; },
abstract = {Colonic motility study was performed on a total of 145 patients. Of these, 55 were patients with symptomatic complicated diverticular disease, 30 had symptomatic uncomplicated diverticular disease, 30 had asymptomatic diverticular disease, and 30 were controls. The pressure sensors were positioned in the descending and the true sigmoid colon. Colonic motility index was significantly higher in symptomatic rather than in asymptomatic diverticular disease in the resting (P less than 0.001) and postprandial (P less than 0.001) states. This confirmed the association between symptomatic diverticular disease and high intraluminal pressure. The patients of the subgroup--complicated diverticular disease--were relatively young (mean age: 51.1 +/- 2.02 years) and had a short history of abdominal pain (18-36 months) and a short segment of colon with diverticula (cm 7.25 +/- 1.31). Our observations suggest that patients showing these indicators are at risk for major complication.},
}
@article {pmid1949209,
year = {1991},
author = {Ibrarullah, M and Sikora, SS and Saxena, R and Kapoor, VK and Kackcer, L and Awasthi, S},
title = {Diverticular disease of colon; Indian variant.},
journal = {Tropical gastroenterology : official journal of the Digestive Diseases Foundation},
volume = {12},
number = {2},
pages = {87-90},
pmid = {1949209},
issn = {0250-636X},
mesh = {Aged ; Diverticulum, Colon/complications/*epidemiology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Incidence ; India/epidemiology ; Intestinal Perforation/etiology ; Male ; Middle Aged ; Peritonitis/etiology ; Sigmoid Diseases/etiology ; },
abstract = {Diverticular disease of colon is a rare entity in our country; true incidence of which is not known. We present three cases of diverticular disease, two with lower gastro-intestinal (GI) hemorrhage and one with sigmoid colon perforation and peritonitis. All three patients underwent emergency surgical treatment. Two patients survived and one died. No further complications were noted on follow up.},
}
@article {pmid1843093,
year = {1991},
author = {Averbach, M and D'Assunção, MA and de Barros, Mdos S and Ribeiro, PC and Hashiba, K},
title = {[Colonoscopy: experience in a general hospital].},
journal = {Arquivos de gastroenterologia},
volume = {28},
number = {2},
pages = {52-54},
pmid = {1843093},
issn = {0004-2803},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Colonic Diseases/diagnosis/therapy ; Colonoscopy/*statistics & numerical data ; Female ; Hospitals, General ; Humans ; Male ; Middle Aged ; Rectal Diseases/diagnosis/therapy ; Retrospective Studies ; },
abstract = {The authors emphasize the colonoscopy's importance and report their experience with the procedure in a general hospital. In a nearly 4 year period, 300 patients were submitted to the procedure, and the main indication was digestive bleeding, followed by alterations of bowels movements. The bowel preparation was done with mannitol ingestion except when contraindicated. The most frequent pathology were polyps and diverticular disease. Fifty three polypectomies were done in 22 patients.},
}
@article {pmid1998405,
year = {1991},
author = {Brief, DK and Brener, BJ and Goldenkranz, R and Alpert, J and Parsonnet, V and Ferrante, R and Huston, J and Eisenbud, D},
title = {Defining the role of subtotal colectomy in the treatment of carcinoma of the colon.},
journal = {Annals of surgery},
volume = {213},
number = {3},
pages = {248-252},
pmid = {1998405},
issn = {0003-4932},
mesh = {Adult ; Aged ; Aged, 80 and over ; *Colectomy/methods ; Colonic Neoplasms/complications/pathology/*surgery ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Neoplasms, Multiple Primary ; Postoperative Complications ; },
abstract = {Seventy-two patients with colon cancer were treated by primary subtotal colectomy, including 23 patients with acute and subacute left colon obstruction. There were two operative deaths and no cases of disabling diarrhea. One death occurred in the group with colon obstruction. Other indications for subtotal colectomy included multiple polyps associated with the primary tumor (32), synchronous carcinomas (15), a previous transverse colostomy for obstruction (8), associated severe sigmoid diverticular disease (2), age less than 50 years with a positive family history (3), adherence of the sigmoid loop to a cecal tumor (2), and metachronous carcinoma (2). There were multiple indications in several patients. Subtotal colectomy has a defined role in a wide variety of clinical settings associated with colon cancer, including management of obstruction of the left and sigmoid colon, particularly if the proximal colon cannot be evaluated before operation by colonoscopy or barium enema. Segmental or regional colonic resections are appropriate if the entire colon can be evaluated before operation and no associated neoplasms are revealed.},
}
@article {pmid1859173,
year = {1991},
author = {Sezeur, A and Quinaux, D and Gravie, JF and Gallot, D and Malafosse, M},
title = {[Surgical treatment of acute complications of diverticular disease].},
journal = {Annales de gastroenterologie et d'hepatologie},
volume = {27},
number = {2},
pages = {73-77},
pmid = {1859173},
issn = {0066-2070},
mesh = {Abscess/etiology/*surgery ; Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/etiology/*surgery ; Diverticulitis, Colonic/*complications ; Diverticulum, Colon/*complications ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; Intestinal Obstruction/etiology/surgery ; Middle Aged ; Peritonitis/etiology/*surgery ; },
}
@article {pmid1859172,
year = {1991},
author = {Sebag, A},
title = {[The scanner in diverticular disease].},
journal = {Annales de gastroenterologie et d'hepatologie},
volume = {27},
number = {2},
pages = {69-72},
pmid = {1859172},
issn = {0066-2070},
mesh = {Colonic Diseases/diagnostic imaging ; Diverticulitis, Colonic/*diagnostic imaging ; Diverticulum, Colon/*diagnostic imaging ; Humans ; Intestinal Fistula/diagnostic imaging ; Sigmoid Diseases/diagnostic imaging ; *Tomography Scanners, X-Ray Computed ; Tomography, X-Ray Computed ; },
}
@article {pmid1859171,
year = {1991},
author = {Gravie, JF and Quinaux, D and Sezeur, A and Gallot, D and Malafosse, M},
title = {[Elective surgical treatment of colonic diverticulosis].},
journal = {Annales de gastroenterologie et d'hepatologie},
volume = {27},
number = {2},
pages = {65-68},
pmid = {1859171},
issn = {0066-2070},
mesh = {Abscess/surgery ; Anastomosis, Surgical ; Colonic Diseases/surgery ; Diverticulitis, Colonic/surgery ; Diverticulum, Colon/*surgery ; Humans ; Intestinal Fistula/surgery ; Postoperative Complications ; Retrospective Studies ; },
abstract = {In a retrospective study from 1978 to 1990, 143 patients had elective surgery for colonic diverticular disease. Surgical indications were: uncomplicated diverticulitis (128), functional discomfort (6), suspicion of associated neoplasia (6), bleeding (3). The overall mortality is 1/143 (0.6 p. cent). 3 patients (2.2 p. cent) had to be reoperated for anastomotic fistula with peritonitis. Definitive re-establishment of digestive continuity was done in 139 patients (98.6 p. cent). Our results suggest that surgery is to be widely indicated for diverticular disease. Resection must be performed in every patients presenting with an history of two or more acute recurrences, with a fistula, and when clinical and/or radiological abnormalities continue after a first acute crisis.},
}
@article {pmid1755272,
year = {1991},
author = {De Koster, E and Mante, M and Denis, P and Nyst, JF and Otero, J and Van Geel, J and Buset, M and Bellemans, M and Deltenre, M},
title = {Juxtapapillary duodenal diverticula and diverticula of the colon: is there a general "gastrointestinal diverticular disease"?.},
journal = {Acta gastro-enterologica Belgica},
volume = {54},
number = {2},
pages = {191-194},
pmid = {1755272},
issn = {1784-3227},
mesh = {Barium Sulfate ; Diverticulum/*complications/diagnostic imaging ; Diverticulum, Colon/*complications/diagnostic imaging ; Duodenal Diseases/*complications/diagnostic imaging ; Enema ; Female ; Humans ; Male ; Radiography ; },
abstract = {Both juxtapapillary duodenal diverticula and colon diverticula are acquired lesions, the pathogenesis of which is believed to involve the influence of high intraluminal pressure on loci minoris resistentiae in the gastrointestinal wall. We wanted to investigate whether juxtapapillary duodenal diverticula and colon diverticula occur independently, or whether they are part of a hypothetical general "gastrointestinal diverticular disease". 239 patients with juxtapapillary duodenal diverticula were identified in 2231 patients undergoing ERCP. Complete radiology data were available in 119/239 patients. Double contrast barium enema had been performed in 28/119 patients. In these patients, colon diverticula were present in 9/20 women and 1/8 men. The frequency of colon diverticula in these patients was compared with randomly chosen age- and sex-matched controls, for whom barium enema results were available. In these controls, 9/20 women and 1/8 men also had colon diverticula (n.s.). We conclude that after stratification for age and sex, the occurrence of colon diverticula is not higher in patients with juxtapapillary duodenal diverticula than in the general population. Juxtapapillary duodenal diverticula and colon diverticula thus occur independently. These data are not in favor of the existence of a general gastrointestinal diverticular disease.},
}
@article {pmid1741807,
year = {1991},
author = {Ryan, P},
title = {Two kinds of diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {73},
number = {2},
pages = {73-79},
pmid = {1741807},
issn = {0035-8843},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Barium Sulfate ; Chronic Disease ; Diverticulum, Colon/diagnostic imaging/*pathology/surgery ; Female ; Gastrointestinal Hemorrhage/pathology ; Humans ; Intestinal Perforation/pathology ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; },
abstract = {Two kinds of acquired diverticular disease were identified. The more common variety presented with pain, bowel symptoms or fistulae, and the less common with bleeding. The former patients rarely had a history of bleeding and among the latter pain and bowel symptoms were uncommon. In contrast to the few, chiefly sigmoid, diverticular often found in the former group, barium enemas of those presenting with bleeding usually showed densely packed and extensive diverticula. Even where there was no history suggesting perforation or evidence of it at operation, specimens resected for the more common form of diverticular disease invariably showed histological evidence of previous perforation. There was no histological evidence of previous perforation in those specimens resected for bleeding. This retrospective clinical, radiological and histological study supported the idea that there are two kinds of diverticular disease, one associated with perforation and its sequelae, the other associated with bleeding.},
}
@article {pmid2015469,
year = {1991},
author = {Campbell, K and Steele, RJ},
title = {Non-steroidal anti-inflammatory drugs and complicated diverticular disease: a case-control study.},
journal = {The British journal of surgery},
volume = {78},
number = {2},
pages = {190-191},
doi = {10.1002/bjs.1800780218},
pmid = {2015469},
issn = {0007-1323},
mesh = {Abscess/chemically induced ; Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Case-Control Studies ; Colonic Diseases/chemically induced ; Contraindications ; Diverticulum, Colon/*complications ; Female ; Gastrointestinal Hemorrhage/chemically induced ; Humans ; Intestinal Fistula/chemically induced ; Male ; Middle Aged ; Peritonitis/chemically induced ; },
abstract = {Fifty patients with severe complications of diverticular disease were compared with two groups of 50 controls, matched for age and sex. The first control group (A) was randomly selected from all emergency hospital admissions, and the second group (B) from patients with uncomplicated diverticular disease. Of the 50 study patients, 24 (48 per cent) were taking non-steroidal anti-inflammatory drugs (NSAIDs) at the time of admission compared with nine (18 per cent) of control group A and ten (20 per cent) of control group B. Both of these differences were statistically significant, indicating a strong association between the ingestion of NSAIDs and the development of severe complications of diverticular disease.},
}
@article {pmid1992645,
year = {1991},
author = {Petros, JG and Happ, RA},
title = {Crohn's colitis in patients with diverticular disease.},
journal = {The American journal of gastroenterology},
volume = {86},
number = {2},
pages = {247-248},
pmid = {1992645},
issn = {0002-9270},
mesh = {Aged ; Crohn Disease/complications/*diagnosis ; Diagnosis, Differential ; Diverticulum, Colon/complications/*diagnosis ; Humans ; },
}
@article {pmid1936780,
year = {1991},
author = {Morosi, C and Ballardini, G and Pisani, P and Bellomi, M and Cozzi, G and Vidale, M and Spinelli, P and Severini, A},
title = {Diagnostic accuracy of the double-contrast enema for colonic polyps in patients with or without diverticular disease.},
journal = {Gastrointestinal radiology},
volume = {16},
number = {4},
pages = {345-347},
pmid = {1936780},
issn = {0364-2356},
mesh = {*Barium Sulfate ; Colonic Polyps/complications/*diagnostic imaging/epidemiology ; Diverticulum, Colon/*complications ; Enema ; Humans ; Middle Aged ; *Pneumoradiography ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; },
abstract = {The accuracy of the double-contrast enema for the diagnosis of polypoid lesions in the presence or absence of diverticula was evaluated by retrospectively reviewing the medical records of 202 patients subjected to examination and endoscopy. Analysis of the data on 215 polypoid lesions showed that (a) the diagnostic accuracy of the examination is not affected significantly by the presence of diverticula; (b) the sensitivity of the examination is highly dependent on the size of the polyps (smaller or larger than 0.5 cm) but not on the form (sessile or pedunculated); and (c) the positive predictive value is higher in patients without diverticula. The double-contrast enema was confirmed to be a valid method for the diagnosis of polypoid lesions.},
}
@article {pmid1891261,
year = {1991},
author = {Abramson, SJ and Berdon, WE and Laffey, K and Ruzal-Shapiro, C and Nash, M and Baer, J},
title = {Colonic diverticulitis in young patients with chronic renal failure and transplantation.},
journal = {Pediatric radiology},
volume = {21},
number = {5},
pages = {352-354},
pmid = {1891261},
issn = {0301-0449},
mesh = {Abscess/*complications ; Adult ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Kidney Failure, Chronic/*complications/surgery ; *Kidney Transplantation ; Male ; Sigmoid Diseases/*complications ; },
abstract = {The association of colonic diverticulitis with chronic renal failure is well known. In those patients with "adult" autosomal dominant polycystic kidney disease, colonic diverticulitis is an especially common complication. We present two young patients (one teenager and one mid-twenties) who developed intra-abdominal abscess several years after renal transplantation. Neither patient had autosomal dominant polycystic disease nor a known history of gastrointestinal problems but both proved to have underlying, previously unsuspected colonic diverticular disease with abscess formation.},
}
@article {pmid1746180,
year = {1991},
author = {Huber, MA and Woisetschläger, R and Sulzbacher, H and Wayand, W},
title = {[Surgical therapy of complicated diverticular disease].},
journal = {Zentralblatt fur Chirurgie},
volume = {116},
number = {17},
pages = {999-1007},
pmid = {1746180},
issn = {0044-409X},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; Colonic Diseases/mortality/*surgery ; Diverticulitis, Colonic/mortality/*surgery ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage/mortality/surgery ; Humans ; Intestinal Obstruction/mortality/*surgery ; Intestinal Perforation/mortality/*surgery ; Male ; Middle Aged ; Postoperative Complications/*mortality ; },
abstract = {From 1975-1989 55 patients were operated on for complicated diverticular disease at our unit. Intraoperative we found the following complications: 21 walled of perforations, 22 stenosis of the sigmoid colon combined with obstruction of the small and/or large bowel, 8 free perforations with generalized, faecal peritonitis, 7 diverticular fistulae (5 colovesical, 1 colojejunal and 1 colocutaneous fistula) and diverticular bleedings. In 33 cases we performed a resection with primary anastomosis (8 times with protecting stoma). 17 times the Hartmann's procedure was carried out and 5 times a transverse colostomy and drainage was elected. Lethality was 20% and morbidity came to 25%. We consider the primary resection with primary anastomosis to be the procedure of choice for complicated diverticulitis except for free perforation with generalized and faecal peritonitis where we prefer the Hartmann's procedure.},
}
@article {pmid1746179,
year = {1991},
author = {Richter, S and vd Linde, J and Dominok, GW},
title = {[Diverticular disease. Pathology and clinical aspects based on 368 autopsy cases].},
journal = {Zentralblatt fur Chirurgie},
volume = {116},
number = {17},
pages = {991-998},
pmid = {1746179},
issn = {0044-409X},
mesh = {Adult ; Aged ; Cause of Death ; Diagnosis, Differential ; Diverticulitis/mortality/*pathology/surgery ; Diverticulitis, Colonic/mortality/*pathology/surgery ; Duodenitis/mortality/*pathology/surgery ; Duodenum/pathology ; Female ; Humans ; Intestine, Small/*pathology ; Male ; Middle Aged ; },
abstract = {There were found 368 cases (4.5 percent) of diverticulosis of the intestine based on 8124 autopsies in the years of 1979 till 1988 with regard to their localisation, complications and accompanied diseases. In 174 of 368 cases clinical files could be examined and integrated in the evaluation. Sigmoid diverticula were most frequently followed from duodenal diverticula chiefly in the immediate vicinity of the "Papilla of Vateri". Constipation, stomachache, haemorrhoids and spasm of the anal sphincter were typical complaints. One during lifetime known diverticulosis was noted only approximately half on the autopsy application as a second disease. The autopsy results a complication of diverticula (mostly with a peritonitis) in 39 percent as the primary cause of death. Most frequently complication was a diverticulitis (in 16.8 percent refer to the total number). Arteriosclerosis, hypertension and/or diabetes (so called "civilization diseases") were in the main accompanied diseases, which were found too. Surgical intervention took place principal under suspicion of malignoma or as an "acute abdomen". Non-characteristic complaints (protraction by the physician) and the ignorance of the illness among the population (protraction by the patients) are disadvantageous to the identification of the diverticulosis. Because the diverticulosis as a disease of the economic developed countries represents a growing problem ought to direct more attention to prevention, which consists in application of food rich in ballast-substances and the treatment of the constipation.},
}
@article {pmid2286801,
year = {1990},
author = {Hold, M and Denck, H and Bull, P},
title = {Surgical management of perforating diverticular disease in Austria.},
journal = {International journal of colorectal disease},
volume = {5},
number = {4},
pages = {195-199},
pmid = {2286801},
issn = {0179-1958},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Austria ; Chi-Square Distribution ; Colon/surgery ; Colostomy ; Diverticulitis, Colonic/complications/*surgery ; Drainage ; Female ; Humans ; Intestinal Perforation/complications/*surgery ; Male ; Middle Aged ; Peritonitis/complications ; Postoperative Complications/mortality ; },
abstract = {Perforated diverticulitis is a much feared complication of diverticular disease and requires immediate surgical therapy to limit the incipient peritonitis and its sequelae. The ensuing surgical approach which could best irradiate the septic focus as well as restore normal intestinal continuity with less morbidity and mortality has been a matter of controversy. In the last ten years primary resection and colostomy has replaced the three-stage procedure in most cases of peritonitis. Primary anastomosis, when peritoneal involvement is well confined, has been shown to give excellent results. To assess the surgical management of perforating diverticulitis in Austria, a questionnaire was sent to leading hospitals throughout the country and information of 241 patients with perforating diverticulitis was compiled. The overall peroperative mortality was 9%, and the highest rate of complication (37.9%) was observed after primary resection and anastomosis with temporary defunctioning proximal colostomy. The mortality, as expected, is directly proportional to the extent of peritonitis; it was significantly greater among patients with generalised peritonitis and lowest among cases of covered perforation.},
}
@article {pmid2244809,
year = {1990},
author = {Walsh, RM and Aranha, GV and Freeark, RJ},
title = {Mortality and quality of life after total abdominal colectomy.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {125},
number = {12},
pages = {1564-1566},
doi = {10.1001/archsurg.1990.01410240042009},
pmid = {2244809},
issn = {0004-0010},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy/adverse effects/*mortality ; Consumer Behavior ; Female ; Humans ; Male ; Middle Aged ; *Quality of Life ; Survival Rate ; },
abstract = {We have reviewed the results of 107 consecutive total abdominal colectomies performed at our institutions during the past 10 years. Indications for surgery were carcinoma of the colon (60), multiple polyps (nine), diverticular disease (31), and other conditions (seven). Seven (6.5%) were emergency operations. All patients had anastomosis of the terminal ileum into the lower rectum or distal sigmoid colon no more than 25 cm above the anus. Thirty days after surgery, two patients (1.8%) had died of complications of anastomotic leaks. Both were poor candidates for primary reanastomosis. Morbidity was low, occurring in 11 patients (10.3%). Follow-up evaluation of bowel function revealed satisfactory results in 102 patients (95%). Five patients (5%) had experienced chronic debilitating diarrhea. Unfavorable results were more common with diverticular disease than with neoplasia.},
}
@article {pmid2269692,
year = {1990},
author = {Vayre, P},
title = {[Surgical treatment of sigmoid diverticulitis].},
journal = {Journal de chirurgie},
volume = {127},
number = {11},
pages = {547-551},
pmid = {2269692},
issn = {0021-7697},
mesh = {Aged ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/diagnosis/*surgery ; Humans ; Intestinal Obstruction/etiology/surgery ; Intestinal Perforation/etiology/surgery ; Middle Aged ; Peritonitis/etiology/surgery ; Prognosis ; Sigmoid Diseases/complications/diagnosis/*surgery ; Sigmoid Neoplasms/diagnosis ; },
abstract = {Diverticular disease is generally benign but may be life threatening should progressive complications occur. Under these circumstances cure may only be obtained if properly performed surgery is undertaken at the right moment. The end result of a low fibre diet, diverticular disease may affect the entire colon, but always tends to particularly affect the sigmoid region. This is the usual site of complications where the etiology is related to diverticular infection associated with fecal impaction proximal to the high pressure zone at the recto-sigmoid junction. The radical treatment of sigmoid diverticulitis is rectosigmoid resection, however, this concept may be altered according to the circumstances as follows: 1 - sigmoid diverticulitis without pericolic complications 2 - peri-sigmoid complications: peri-sigmoid abscess, intestinal and vesical fistulae. 3 - generalised peritonitis due to perforation into the peritoneal cavity. The advanced age of the patient should be stressed (mean age 65 years and 25% over 75 years) associated with a high incidence of multiple organ failure and hence the high mortality in more than 50% of cases in the event of peritonitis.},
}
@article {pmid2152644,
year = {1990},
author = {Bottinelli, A and López, F and Rahmer, A and Zúñiga, A},
title = {[Diverticular disease of the colon, the indications for and results of elective surgical treatment].},
journal = {Revista medica de Chile},
volume = {118},
number = {11},
pages = {1206-1210},
pmid = {2152644},
issn = {0034-9887},
mesh = {Adult ; Aged ; Aged, 80 and over ; Chile/epidemiology ; Colectomy ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/diagnosis/epidemiology/surgery ; Diverticulum, Colon/diagnosis/epidemiology/*surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; },
abstract = {Precise criteria were prospectively used to indicate surgery in patients with diverticular disease of the colon: a) anatomical deformity of the sigmoid (ADS), including stenosis and fistulae with presence of contrast media extraluminally; b) recurrent acute diverticulitis (RAD); c) prior diverticulitis with perforation (DP) and d) recurrent GI bleeding (GIB). 42 patients were operated on according to these criteria, from 1978 to 1988, 26 males and 16 females, with a mean age of 61 years (range 31 to 93). ADS was the indication in 22 patients (52%), with fistulae present in 9. RAD was the indication in 16 patients (37%), DP in 9 patients (21%) and GIB in 5%. All patients were submitted to either ample sigmoid resection or left hemicolectomy. All patients were followed, with a mean of 43 months for the series. Only 1 patient died after surgery from pulmonary embolism. Late clinical evaluation revealed absence of preoperative symptoms and signs. We feel that surgical treatment of diverticular disease of the colon is warranted with the criteria described, with good immediate and longterm results.},
}
@article {pmid2121310,
year = {1990},
author = {Wilson, RG and Smith, AN and Macintyre, IM},
title = {Complications of diverticular disease and non-steroidal anti-inflammatory drugs: a prospective study.},
journal = {The British journal of surgery},
volume = {77},
number = {10},
pages = {1103-1104},
doi = {10.1002/bjs.1800771008},
pmid = {2121310},
issn = {0007-1323},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Diverticulum/chemically induced/*complications ; Female ; Gastrointestinal Hemorrhage/chemically induced ; Humans ; Intestinal Perforation/chemically induced ; Male ; Middle Aged ; Peritonitis/chemically induced ; Prospective Studies ; },
abstract = {Previous retrospective studies have suggested an association between consumption of non-steroidal anti-inflammatory drugs (NSAIDs) and the complications of diverticular disease. Ninety-two patients were entered into a prospective study of the complications of diverticular disease over a 3 year period; 31 were taking NSAIDs, compared with only four age- and sex-matched controls from a representative general practice (P less than 0.001). A second control group comprised 306 patients with cancer of the colon in whom NSAID consumption was again significantly lower than in patients with diverticular disease (22 of 306 versus 31 of 92, P less than 0.001). Of the 31 patients taking NSAIDs, 19 presented with a perforation or peritonitis. By contrast, only eight of the 61 patients not taking NSAIDs had such complications (P less than 0.001). Eleven patients presented with bleeding of whom five were taking NSAIDs and six were not. Patients admitted with complications of diverticular disease have a high incidence of NSAID intake, and it appears that NSAID consumption is associated with a more severe form of the disease.},
}
@article {pmid2221775,
year = {1990},
author = {Yeo, R},
title = {Optimal operative treatment in acute septic complications of diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {72},
number = {5},
pages = {345},
pmid = {2221775},
issn = {0035-8843},
mesh = {Acute Disease ; Diverticulum, Colon/*surgery ; Emergencies ; Humans ; Peritonitis/*complications ; },
}
@article {pmid2207569,
year = {1990},
author = {Moreaux, J and Vons, C},
title = {Elective resection for diverticular disease of the sigmoid colon.},
journal = {The British journal of surgery},
volume = {77},
number = {9},
pages = {1036-1038},
doi = {10.1002/bjs.1800770927},
pmid = {2207569},
issn = {0007-1323},
mesh = {Abscess/complications/surgery ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colon, Sigmoid/surgery ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Intestinal Fistula/complications/surgery ; Male ; Middle Aged ; Postoperative Complications/etiology ; Sigmoid Diseases/*surgery ; Urinary Bladder Fistula/complications/surgery ; },
abstract = {From 1966 to 1987, 177 consecutive patients were operated on electively for diverticular disease of the sigmoid colon. The indications for surgery were: colovesical fistula (n = 12), suspicion of residual abscess (n = 39), two or more previous attacks of acute inflammation (n = 52), chronic symptoms (n = 72) and suspicion of carcinoma (n = 2). An abscess was found at operation in 76 patients (43 per cent) and this was extracolic with local peritonitis in 52 patients (29 per cent). An unsuspected abscess was found in 25 of the 72 patients operated on for chronic symptoms. Colonic resection with primary anastomosis was performed in 95 per cent of the 177 patients and in 94 per cent of those 52 patients with an extracolic abscess. There were no postoperative deaths and no clinical anastomotic leakages. Long-term results were very good in 85 per cent of the 177 patients and in 82 per cent of the 72 patients operated on for chronic symptoms. The results of this series suggest that a one-stage procedure can be safely performed with some technical precautions in most patients operated on electively for diverticular disease, even if an extracolic abscess is found. The good long-term results in patients operated on for chronic symptoms suggest that such symptoms should be taken into account with respect to surgical indications.},
}
@article {pmid1696228,
year = {1990},
author = {Milner, P and Crowe, R and Kamm, MA and Lennard-Jones, JE and Burnstock, G},
title = {Vasoactive intestinal polypeptide levels in sigmoid colon in idiopathic constipation and diverticular disease.},
journal = {Gastroenterology},
volume = {99},
number = {3},
pages = {666-675},
doi = {10.1016/0016-5085(90)90953-x},
pmid = {1696228},
issn = {0016-5085},
support = {//Wellcome Trust/United Kingdom ; },
mesh = {Colon, Sigmoid/innervation/*metabolism ; Constipation/*metabolism ; Diverticulum/*metabolism ; Female ; Humans ; Immunoassay ; Immunohistochemistry ; Male ; Middle Aged ; Neuropeptide Y/metabolism ; Substance P/metabolism ; Vasoactive Intestinal Peptide/*metabolism ; },
abstract = {The distribution in the bowel wall of vasoactive intestinal polypeptide-, neuropeptide Y-, and substance P-containing nerve cell bodies and nerve fibers has been described in human sigmoid colon by immunohistochemical examination. In patients with chronic idiopathic constipation, diverticular disease, and in controls (of tissue taken from patients with carcinoma, from a site distant from the tumor that appeared macroscopically normal), the concentrations of vasoactive intestinal polypeptide, neuropeptide Y, and substance P have been measured by immunoassay in the following preparations of sigmoid colon: mucosa, whole colonic wall with mucosa dissected away, circular muscle, and taenia coli. In idiopathic constipation, the vasoactive intestinal polypeptide content of the whole wall minus mucosa was reduced when compared with controls (P less than 0.05) but was unaltered in the mucosa, circular muscle, and taenia coli. In diverticular disease, the vasoactive intestinal polypeptide content of the mucosa and whole wall minus the mucosal layer was increased when compared with control tissue (P less than 0.05 and P less than 0.02, respectively) but was unaltered in the circular muscle and taenia coli. Substance P and neuropeptide Y levels in all layers of colonic wall were unaltered in these two diseases. The disturbances in the normal neural content of vasoactive intestinal polypeptide in the bowel wall in idiopathic constipation and diverticular disease may initiate or contribute to the functional changes seen in these disorders.},
}
@article {pmid2120763,
year = {1990},
author = {Gonvers, JJ},
title = {[Gastroenterological problems in the elderly].},
journal = {Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis},
volume = {79},
number = {35},
pages = {1008-1010},
pmid = {2120763},
issn = {1013-2058},
mesh = {Aged ; Constipation/therapy ; Diverticulum/diagnosis/therapy ; Esophageal Diseases/diagnosis/therapy ; Gastrointestinal Diseases/*diagnosis/therapy ; Humans ; Stomach Ulcer/complications/therapy ; },
abstract = {An increasing number of elderly patients presenting with gastroenterological problems is seen in hospital and private practice. It is therefore very important to be able to recognize the different clinical aspects of these diseases in this category of patients. Esophageal reflux and problems of motility can give rise to vague, atypical symptomatology, which does not orient the clinician to the esophagus. Unrecognized gastric ulcer is frequently complicated by hemorrhage or perforation leading to high mortality rates. Mesenteric infarction, even when diagnosed early still remains a serious complication. The prognosis of ischaemic colitis is more favorable than that of mesenteric infarction, thanks to the existence of a collateral circulation. Its evolution to gangrene is rare. 30% of patients 60-years or older suffer from diverticular disease which can remain asymptomatic or progress to diverticulitis, hemorrhage or fistulization. The prevalence of constipation, often aggravated by sedentary life style or drugs, increases in patients over 65 years. Fecal impaction is often unrecognized due to the poor specificity of its symptoms.},
}
@article {pmid2378393,
year = {1990},
author = {Toner, M and Condell, D and O'Briain, DS},
title = {Obstructive colitis. Ulceroinflammatory lesions occurring proximal to colonic obstruction.},
journal = {The American journal of surgical pathology},
volume = {14},
number = {8},
pages = {719-728},
pmid = {2378393},
issn = {0147-5185},
mesh = {Aged ; Aged, 80 and over ; Colitis/diagnosis/*pathology ; Colon/pathology/surgery ; Female ; Humans ; Intestinal Obstruction/diagnosis/*pathology ; Male ; Middle Aged ; },
abstract = {The term "obstructive colitis" refers to ulceroinflammatory lesions occurring in the colon proximal to an obstructing or potentially obstructing lesion. We studied nine cases identified over a 9-month period. The patients were predominantly female (only one was male), elderly (mean age, 73), and usually had hypertension, diabetes, or other prior chronic illness. The colonic obstruction was due to adenocarcinoma in seven cases and to diverticular disease in two cases. Areas of colitis occurred either as circumscribed ulcers 0.5-2 cm in diameter (three cases) or as confluent circumferential lesions 8-25 cm in length; they were always separated from the more distal obstructing lesions by a segment of normal colon measuring 2.5-35 cm (mean, 14.6 cm). The involved area of colon was usually only mildly dilated; it exhibited moderate thickening of the wall and had a granular luminal surface accentuated in areas by deeper longitudinal or transverse ulcers. Often there were scattered pseudopolyps, and the margin separating the lesion from normal mucosa was well demarcated and irregular. In one case, two distinct separate areas of colitis were present; in another, the appendix was acutely inflamed. Microscopically, the lesions were composed of granulation tissue with a mixed acute and chronic inflammatory infiltrate that replaced the mucosa and often the submucosa; sometimes it extended into the muscularis propria, with associated peritonitis and perforation. Many of the features of obstructive colitis suggest an ischemic origin, probably mainly due to hypoperfusion following raised intramural pressure, but altered fecal flora may have a synergistic effect. The features of the disease are usually sufficiently characteristic to distinguish it from Crohn's disease and other forms of colitis. Complications include peritonitis, perforation and breakdown of anastomoses made through involved segments of colon that may appear externally normal at surgery.},
}
@article {pmid2216003,
year = {1990},
author = {Konsten, J and Gouma, DJ and Obertop, H and Soeters, PB},
title = {Effect of preoperative risk factors on the outcome after surgery for complicated diverticular disease.},
journal = {The Netherlands journal of surgery},
volume = {42},
number = {4},
pages = {101-104},
pmid = {2216003},
issn = {0167-2487},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Colostomy ; Diverticulitis/complications/mortality/*surgery ; Female ; Humans ; Intestinal Perforation/complications/mortality/*surgery ; Length of Stay ; Male ; Middle Aged ; Peritonitis/etiology/*surgery ; Prognosis ; Recurrence ; Reoperation ; Risk Factors ; Severity of Illness Index ; },
abstract = {The influence of age and severity of peritonitis was studied in 111 (16%) out of a total of 694 patients treated for diverticular disease. These 111 patients had complications of the disease and were operated upon by four different approaches. The outcome after surgery was expressed as 30 days mortality, number of operations and postoperative complications per patient, overall hospital stay and number of permanent colostomies in surviving patients. The overall hospital stay lasted significantly longer for patients older than 70 years compared to the younger patients (64 versus 41 days). The complications per patient increased significantly from 1.0 to 1.9 and from 1.1 to 2.7 respectively for an age above 70 years and for peritonitis. Preoperative risk factors as age and peritonitis adequately predict the outcome after surgery for complicated diverticular disease. The type of surgery employed seems more dependent on the perioperative findings than on the superiority of one of the procedures.},
}
@article {pmid2212846,
year = {1990},
author = {King, DW and Lubowski, DZ and Armstrong, AS},
title = {Sigmoid stricture at colonoscopy--an indication for surgery.},
journal = {International journal of colorectal disease},
volume = {5},
number = {3},
pages = {161-163},
pmid = {2212846},
issn = {0179-1958},
mesh = {Adenocarcinoma/*diagnosis/surgery ; Colon, Sigmoid/*pathology ; Constriction, Pathologic/diagnosis/surgery ; Diverticulum, Colon/*diagnosis/surgery ; Humans ; Laparotomy ; Sigmoid Diseases/*diagnosis/surgery ; Sigmoid Neoplasms/*diagnosis/surgery ; Sigmoidoscopy ; },
abstract = {Strictures of the sigmoid colon continue to pose a diagnostic dilemma. They commonly appear to be due to diverticular disease but carcinoma must always be excluded. In some cases diverticula may be present but in others there is no obvious cause for the stricture. In a series of 1039 consecutive colonoscopies performed between 1984 and 1986, 19 cases of sigmoid stricture that could not be negotiated with the colonoscope were encountered. In each case the cause of the stricture could not be demonstrated. Fifteen patients (79%) underwent laparotomy primarily on clinical grounds or with barium enema findings suggestive of carcinoma. A final diagnosis of diverticular disease was made in nine cases and adenocarcinoma is six cases. Barium enema was a poor predictor of malignancy in a stricture. Four patients were treated conservatively and two of these patients continued to have significant symptoms due to diverticular disease. This experience suggests that sigmoid strictures that prevent the passage of a colonoscope should be resected when the cause of the stricture is not apparent.},
}
@article {pmid2169839,
year = {1990},
author = {Smits, BJ and Whitehead, AM and Prescott, P},
title = {Lactulose in the treatment of symptomatic diverticular disease: a comparative study with high-fibre diet.},
journal = {The British journal of clinical practice},
volume = {44},
number = {8},
pages = {314-318},
pmid = {2169839},
issn = {0007-0947},
mesh = {Adult ; Aged ; Dietary Fiber/*administration & dosage ; Diverticulum/*therapy ; Female ; Humans ; Intestinal Diseases/*therapy ; Lactulose/*therapeutic use ; Male ; Middle Aged ; Prospective Studies ; },
abstract = {OBJECTIVE: To compare the efficacy and tolerance of lactulose (Duphalac) and high-fibre diet in the treatment of symptomatic diverticular disease.
DESIGN: Prospectively randomised, parallel groups study over 12 weeks. Patients were seen by their clinician for an initial assessment and then at weeks 4, 8 and 12.
SETTING: Hospital out-patients in the United Kingdom.
PATIENTS: Forty-three patients with a confirmed diagnosis of diverticular disease were entered into the study.
INTERVENTION: Patients were prospectively randomised to receive lactulose (15 ml bd) or high-fibre diet (30-40 g daily) for 12 weeks.
MEASUREMENTS AND RESULTS: Data were collected using diary cards and physicians' assessments. Bowel frequency and stool consistency improved similarly with both treatments. Pain on bowel movement improved with both treatments in respect of frequency (lactulose: P = 0.017, fibre: P = 0.084) and severity (lactulose: P = 0.028, fibre: P = 0.043). Abdominal pain also improved with both treatments in respect of frequency (lactulose: P = 0.0015, fibre: P = 0.022) and severity (lactulose: P = 0.009, fibre: P = 0.028). Nine patients on lactulose and 12 on fibre reported treatment-emergent symptoms, of which none was serious.
CONCLUSIONS: Lactulose and high-fibre diet were both shown to be effective in the treatment of diverticular disease, with some differences in favour of lactulose.},
}
@article {pmid2152239,
year = {1990},
author = {Calderón Moncayo, C},
title = {[Frequency of diverticular disease of the colon in Chile].},
journal = {Revista medica de Chile},
volume = {118},
number = {8},
pages = {942-943},
pmid = {2152239},
issn = {0034-9887},
mesh = {Age Factors ; Chile/epidemiology ; Diverticulum, Colon/*epidemiology ; Humans ; },
}
@article {pmid2204105,
year = {1990},
author = {Katschinski, M and Lederer, P and Ellermann, A and Ganzleben, R and Lux, G and Arnold, R},
title = {Myoelectric and manometric patterns of human rectosigmoid colon in irritable bowel syndrome and diverticulosis.},
journal = {Scandinavian journal of gastroenterology},
volume = {25},
number = {7},
pages = {761-768},
doi = {10.3109/00365529008997605},
pmid = {2204105},
issn = {0036-5521},
mesh = {Adult ; Colon/*physiopathology ; Colonic Diseases, Functional/*diagnosis/physiopathology ; Diagnosis, Computer-Assisted/*methods ; Diverticulum, Colon/*diagnosis/physiopathology ; Electromyography ; Female ; Gastrointestinal Motility ; Humans ; Male ; Manometry ; Middle Aged ; },
abstract = {Rectosigmoid electric control activity and intraluminal pressure were measured in the fasting state and after a standard 3040-kJ meal in irritable bowel syndrome (IBS) patients (n = 41), diverticulosis patients (n = 15), and healthy controls (n = 13). Analysis of myoelectric and motor patterns was performed computer-based with home-made software. Spectral analysis (fast Fourier transform) and computer recognition of slow waves emulating visual scoring showed very similar slow-wave frequency patterns in all three groups. Calculation of contractile indices displayed a widely scattered variable of motility in all three groups without significant differences. IBS subgroups with different bowel patterns showed very similar frequencies of basic myoelectric rhythm and a considerable overlap of contractile activity without significant differences among the subgroups and compared with controls. Slow-wave rhythm seems unlikely to be the basis of disturbed motility in IBS and diverticular disease. A specific pattern of contractile activity was not detectable in either condition.},
}
@article {pmid2101516,
year = {1990},
author = {Canedo Acosta, J and Salazar Mendoza, R},
title = {[Colonoscopy in hemorrhagic lesions of the colon].},
journal = {Revista de gastroenterologia de Mexico},
volume = {55},
number = {3},
pages = {185-190},
pmid = {2101516},
issn = {0375-0906},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Colonic Diseases/*diagnosis ; *Colonoscopy ; Female ; Gastrointestinal Hemorrhage/*diagnosis ; Humans ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {Patients with this pathology represents a difficult problem in differential diagnosis. Clinical findings and radiologic studies could help but endoscopy is now the most precise method in order to determine the site and nature of hemorrhage. We performed 504 colonoscopies in colon hemorrhage finding that our most frequent cause were polyps in both, children and adults in 199 cases (39%); diverticular disease was the second with 131 patients (26%) and third carcinoma with 52 (10%). Other causes were amebic colitis in 47 (8%); inflammatory bowel disease in 28 (6%) and infectious colitis in 13 (3%). Risks, complications and limitations of colonoscopy, as well as its great utility in diagnosis and treatment of colonic hemorrhagic lesions are commented.},
}
@article {pmid2389971,
year = {1990},
author = {Puyol, M and Alcaraz, A and Romero, JA and Vargas, C and González, S and Barrera, M and Llovera, JM and Piulachs, J and Talbot-Wright, R and Carretero, P},
title = {[Entero-urinary fistula. A study of 22 cases].},
journal = {Archivos espanoles de urologia},
volume = {43},
number = {5},
pages = {457-460},
pmid = {2389971},
issn = {0004-0614},
mesh = {Adolescent ; Adult ; Aged ; Animals ; Child ; Child, Preschool ; Female ; Humans ; Intestinal Fistula/*surgery ; Male ; Middle Aged ; Urinary Fistula/*surgery ; Vaginal Fistula/*surgery ; },
abstract = {We performed a retrospective study on 22 patients with entero-urinary fistulas that had been diagnosed and treated at the Hospital Clinico i Provincial in Barcelona during the period spanning 1981-1988. Fistulas were classified according to the organs or parts with which they communicated. Among the important etiogenic conditions were diverticular disease of colon. Crohn's disease, actinic lesions, trauma and xanthogranulomatous pyelonephritis. The clinical manifestations were principally urological in the form of recurrent urinary infection and terminal pneumaturia. The most useful diagnostic techniques were cystoscopy; serial voiding cystourethrography (SVCU), retrograde urethrography and pyelography. Treatment was by surgery in all cases. Diversion procedures or surgical excision of the fistulous tract were performed as warranted by each case. The etiopathogenic, morphological and therapeutical aspects of vesico-enteric fistulas are discussed.},
}
@article {pmid2194951,
year = {1990},
author = {Cheskin, LJ and Bohlman, M and Schuster, MM},
title = {Diverticular disease in the elderly.},
journal = {Gastroenterology clinics of North America},
volume = {19},
number = {2},
pages = {391-403},
pmid = {2194951},
issn = {0889-8553},
mesh = {Abdominal Pain/diagnosis/etiology ; Adult ; Age Factors ; Aged ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis/etiology/therapy ; Diverticulum, Colon/*diagnosis/etiology/therapy ; Female ; Gastrointestinal Hemorrhage/diagnosis/etiology ; Humans ; Middle Aged ; Pain Measurement ; },
abstract = {The prevalence of diverticular disease shows a striking correlation with advancing age. The spectrum of disease ranges from the entirely asymptomatic to a life-threatening surgical emergency. The diagnosis of acute diverticulitis is often particularly difficult to make in the elderly because of muted symptoms and signs. Current concepts of diagnosis and therapy are discussed.},
}
@article {pmid2110429,
year = {1990},
author = {Ross, CB and Richards, WO and Sharp, KW and Bertram, PD and Schaper, PW},
title = {Diverticular disease of the jejunum and its complications.},
journal = {The American surgeon},
volume = {56},
number = {5},
pages = {319-324},
pmid = {2110429},
issn = {0003-1348},
mesh = {Abdominal Pain/etiology ; Aged ; Aged, 80 and over ; Chronic Disease ; Diverticulum/*complications/diagnostic imaging/surgery ; Female ; Humans ; Jejunal Diseases/*complications/diagnostic imaging/surgery ; Male ; Radiography ; },
abstract = {Jejunal diverticulosis is an uncommon, acquired condition that has been encountered recently in four patients. These cases (two patients with diverticulitis, one patient with chronic abdominal pain, and one patient incidentally discovered at laparotomy for colonic diverticulitis) are reported. Acute complications of jejunal diverticulosis include diverticulitis, bleeding, and intestinal obstruction. Chronic complications include intractable abdominal pain, malabsorption, and intestinal pseudo-obstruction. Up to 15 per cent of patients with jejunal diverticulosis may require small-bowel resection for treatment of these acute or chronic complications. The clinical significance, proper diagnostic evaluation, and treatment of jejunal diverticular disease are reviewed.},
}
@article {pmid2077798,
year = {1990},
author = {De Reuck, M and Nyst, JF and Jonas, C and De Koster, E and Deltenre, M},
title = {[Endoscopic findings compared with clinical findings in diverticular disease of the colon].},
journal = {Acta gastro-enterologica Belgica},
volume = {53},
number = {3},
pages = {354-358},
pmid = {2077798},
issn = {1784-3227},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Colonic Neoplasms/complications ; Colonic Polyps/complications ; *Colonoscopy ; Diverticulum, Colon/complications/*diagnosis/physiopathology ; Female ; Gastrointestinal Transit ; Humans ; Male ; Middle Aged ; Occult Blood ; Retrospective Studies ; },
abstract = {In a retrospective study of 702 consecutive colonoscopies, the authors observed 185 cases of diverticulosis or moderate diverticulitis. They studied the colonic diseases associated with the presence of diverticula (78 cases) and discussed the role of endoscope in the approach of colonic diverticulosis.},
}
@article {pmid1963994,
year = {1990},
author = {Melange, M and Vanheuverzwyn, R},
title = {[Etiopathogenesis of colonic diverticular disease; role of dietary fiber and therapeutic perspectives].},
journal = {Acta gastro-enterologica Belgica},
volume = {53},
number = {3},
pages = {346-350},
pmid = {1963994},
issn = {1784-3227},
mesh = {Aging/physiology ; Dietary Fiber/therapeutic use ; Diverticulum, Colon/*etiology/physiopathology/prevention & control ; Gastrointestinal Motility ; Humans ; },
abstract = {The authors review the literature about the aetiopathogenesis, the epidemiology and the treatment of uncomplicated diverticular disease of the colon. The influence of dietary fibre deficiency explaining the increasing prevalence in industrialized countries and the variable geographical distribution are explained, as well as the effects of dietary fibres on colonic functions. Progressive elastosis of the taeniae may explain the influence of age on the incidence of diverticulosis. The rationale for the introduction of dietary fibre into the treatment is based on the observation that a high fibre diet such as coarse bran is lowering the colonic pressure and therefore may prevent the development of new diverticula and complications, although an effect on symptoms is not always obtained.},
}
@article {pmid2379997,
year = {1990},
author = {Gheissari, A and Rajyaguru, V and Kumashiro, R and Matsumoto, T},
title = {Gastrointestinal hemorrhage in end stage renal disease patients.},
journal = {International surgery},
volume = {75},
number = {2},
pages = {93-95},
pmid = {2379997},
issn = {0020-8868},
mesh = {Adult ; Aged ; Aged, 80 and over ; Female ; Gastrointestinal Diseases/complications/diagnosis/epidemiology ; Gastrointestinal Hemorrhage/complications/*diagnosis/epidemiology ; Gastroscopy ; Humans ; Kidney Failure, Chronic/*complications/epidemiology/physiopathology ; Male ; Medical Records ; Middle Aged ; Retrospective Studies ; },
abstract = {Over a six year span, 41 patients with end stage renal disease (ESRD) were treated for 53 episodes of upper and lower gastrointestinal (UGI & LGI) hemorrhage. Thirty-two patients (78%) were diagnosed as having UGI bleeding and nine patients as having LGI bleeding. Mucosal inflammation of the esophagus, stomach and duodenum were the predominant etiologies of UGI bleeding (64%). The predominant cause of LGI hemorrhage was diverticular disease (33%). Angiodysplasias were found in six patients (15%), four with UGI bleeding and two with LGI bleeding. In the UGI hemorrhage group 20% of the bleeding episodes were recurrent and 13% were from multiple sites. There were no recurrent bleeding episodes in the LGI hemorrhage group. We therefore conclude that UGI bleeding is much more common than LGI bleeding in ESRD patients, and that there is a significantly higher tendency for recurrent bleeding episodes and for multiple bleeding sites in the UGI hemorrhage patients. We also note a higher prevalence of angiodysplasias of the upper and lower gastrointestinal tract in ESRD patients.},
}
@article {pmid2223511,
year = {1990},
author = {Occhigrossi, G and De Angelis, G and Caggiati, A and Serrao, E and Mangialardi, N and Cosenza, UM and Genovese, V},
title = {[Diverticula of the cecum. Our experience].},
journal = {Il Giornale di chirurgia},
volume = {11},
number = {4},
pages = {219-221},
pmid = {2223511},
issn = {0391-9005},
mesh = {Aged ; Cecal Diseases/pathology/*surgery ; Diverticulitis/pathology/*surgery ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {On the basis of their experience in right colonic emergencies, the Authors report two cases of diverticular disease presenting with acute abdomen. Pointing out the difficulty of a correct pre- and intraoperative diagnosis, different surgical procedures are analysed.},
}
@article {pmid2180657,
year = {1990},
author = {Naschitz, JE and Yeshurun, D and Horovitz, IL and Misselevitch, I and Boss, JH},
title = {Colonic diverticulitis-related exuberant granulomatous reaction in a patient with sarcoidosis.},
journal = {Digestive diseases and sciences},
volume = {35},
number = {4},
pages = {533-538},
pmid = {2180657},
issn = {0163-2116},
mesh = {Chronic Disease ; Colon/pathology ; Colonic Diseases/complications/diagnosis/*pathology ; Diverticulitis, Colonic/complications/diagnosis/*pathology ; Granuloma/complications/diagnosis/*pathology ; Humans ; Intestinal Mucosa/pathology ; Intestinal Obstruction/diagnosis/etiology/pathology ; Male ; Middle Aged ; Sarcoidosis/complications/diagnosis/*pathology ; },
abstract = {A patient with long-standing sarcoidosis underwent partial colectomy for diverticular disease. Whereas sarcoid granulomas were rare in the otherwise normal colonic mucosa, an unusually large number of granulomas were scattered within the chronically inflamed peridiverticular tissues. It is suggested that in the framework of the sarcoidotic background, activated macrophages, being nonspecifically attracted to areas of inflammation, elicit an exuberant sarcoid granulomatous response. Our observation represents a previously undescribed variant of the "homing" phenomenon in sarcoidosis, unrelated insults inducing formation of granulomas in overabundance.},
}
@article {pmid2114067,
year = {1990},
author = {Wilcox, RD and Shatney, CH},
title = {Surgical significance of acquired ileal diverticulosis.},
journal = {The American surgeon},
volume = {56},
number = {4},
pages = {222-225},
pmid = {2114067},
issn = {0003-1348},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum/complications/diagnosis/pathology/*surgery ; Evaluation Studies as Topic ; Female ; Humans ; Ileal Diseases/complications/diagnosis/pathology/*surgery ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {Acquired (non-Meckel's) ileal diverticular disease is uncommon, and most surgeons have limited, if any, experience with this condition. To gain insight into the frequency of surgical complications of ileal diverticula, we reviewed our experience during the past ten years with 21 patients, 12 women, and nine men. The mean patient age was 62 years; 16 patients (76%) were more than 50 years of age. Thirteen patients had associated diverticula in another segment of the small intestine. In 15 patients ileal diverticulosis was diagnosed during gastrointestinal (GI) radiologic evaluation of abdominal symptomatology. Ileal diverticula were identified intraoperatively in the remaining six patients. In three patients ileal diverticulosis was an incidental finding. Documented surgical complications of acquired ileal diverticula occurred in four patients (19%). Three patients had acute diverticular perforation, and one patient had diverticulitis without perforation. These patients underwent successful operative intervention. Three other patients, all managed nonoperatively, had abdominal symptoms that may have been related to ileal diverticula and were of potential surgical significance. Two patients experienced recurrent rectal bleeding, and the third patient had severe chronic abdominal pain. Although the majority of patients with acquired ileal diverticula do not require surgical treatment, complications such as perforation, bleeding, or incapacitating abdominal pain may necessitate ileal resection.},
}
@article {pmid2334102,
year = {1990},
author = {Corder, AP and Williams, JD},
title = {Optimal operative treatment in acute septic complications of diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {72},
number = {2},
pages = {82-86},
pmid = {2334102},
issn = {0035-8843},
mesh = {Abscess/etiology/*surgery ; Acute Disease ; Adult ; Aged ; Bacterial Infections/etiology/*surgery ; Colostomy ; Diverticulum, Colon/*complications/surgery ; Drainage ; Humans ; Intestinal Perforation/etiology/surgery ; Methods ; Middle Aged ; Peritonitis/etiology/*surgery ; },
abstract = {There is still no unanimity regarding optimal operative treatment in acute septic complications of diverticular disease. Logistic regression analysis was used to investigate factors influencing inpatient mortality in 100 patients who underwent urgent laparotomy for such complications. Thirteen preoperative and operative factors including operation type were investigated and odds ratios (OR) were calculated to indicate the approximate risk associated with each factor. A significant advantage for excision/exteriorisation operations compared with defunctioning operations was found (OR 0.17, 95% confidence interval (CI) 0.04-0.79). Although more conservative procedures (mainly laparotomy with drainage) were associated with an increased mortality relative to defunctioning procedures, this difference just failed to reach statistical significance (OR 3.83, 95% CI 0.89-16.5). Age (OR 1.14, 95% CI 1.05-1.24), co-existing illness (OR 2.38, 95% CI 1.08-5.25) and preoperative shock (OR 4.63, 95% CI 1.00-21.5) were significant as adverse prognostic factors. A higher proportion of survivors treated by defunction than by excision/exteriorisation underwent colostomy closure, but this was in part due to the higher proportion of excision/exteriorisation operations in the latter part of the series. We conclude that in patients requiring urgent laparotomy for septic complications of diverticular disease, the septic focus should be removed from the abdominal cavity. This is most often achieved using a Hartmann's procedure and we recommend this form of treatment.},
}
@article {pmid2315787,
year = {1990},
author = {Lock, JH and Wheeler, WE},
title = {Diverticular disease of the appendix.},
journal = {Southern medical journal},
volume = {83},
number = {3},
pages = {350},
doi = {10.1097/00007611-199003000-00026},
pmid = {2315787},
issn = {0038-4348},
mesh = {Adult ; Appendectomy ; *Appendix/pathology ; Cecal Diseases/pathology/surgery ; *Diverticulitis/pathology/surgery ; Humans ; Male ; },
abstract = {We have discussed a case of appendiceal diverticulitis diagnosed at laparotomy, and reviewed the histologic and clinical findings. Although infrequently encountered, appendiceal diverticulitis must be entertained in the differential diagnosis of pain in the right lower quadrant, especially in the adult patient.},
}
@article {pmid2305935,
year = {1990},
author = {Peoples, JB and Vilk, DR and Maguire, JP and Elliott, DW},
title = {Reassessment of primary resection of the perforated segment for severe colonic diverticulitis.},
journal = {American journal of surgery},
volume = {159},
number = {3},
pages = {291-3; discussion 294},
doi = {10.1016/s0002-9610(05)81220-6},
pmid = {2305935},
issn = {0002-9610},
mesh = {Abscess/etiology/mortality/surgery ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colostomy ; Diverticulitis, Colonic/complications/mortality/*surgery ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Peritonitis/etiology/mortality/surgery ; },
abstract = {Primary resection with colostomy has been widely adopted during the past decade for the treatment of patients with severe complications of diverticulitis. Because of this, a retrospective review was performed of all patients undergoing surgery for colonic diverticular disease during the two time periods 1974 to 1978 (n = 196) and 1982 to 1986 (n = 230). Forty-three patients had abscess or peritonitis from 1974 to 1978, whereas 52 had these complications from 1982 to 1986. Colostomy and drainage alone were used for 31 of 43 patients (72%) from 1974 to 1978, while primary resection with colostomy was used for 39 of 52 patients (75%) from 1982 to 1986 (p less than or equal to 0.5). Despite this shift in treatment method, mortality increased from 14% in 1974 to 1978 to 19% in 1982 to 1986 (p = NS). Patients with peritonitis had identical mortalities (22%) during both intervals. Patients with abscess experienced an increase in mortality from 8% in 1974 to 1978 to 15% in 1982 to 1986 (p = NS). The widespread use of primary resection for patients with severe complications of diverticulitis appears not to have altered mortality for those with diffuse peritonitis and may have worsened the outcome for those with abscess.},
}
@article {pmid2157518,
year = {1990},
author = {Watters, DA and Smith, AN},
title = {Strength of the colon wall in diverticular disease.},
journal = {The British journal of surgery},
volume = {77},
number = {3},
pages = {257-259},
doi = {10.1002/bjs.1800770308},
pmid = {2157518},
issn = {0007-1323},
mesh = {Aging/physiology ; Biomechanical Phenomena ; Colon/*physiopathology ; Dietary Fiber ; Diverticulum, Colon/*physiopathology ; Elasticity ; Humans ; Middle Aged ; },
abstract = {Studies of the aetiology of diverticular disease of the colon have been focused on intraluminal pressure for almost three decades. It is only relatively recently that the mechanical properties of the wall of the colon have been examined. The tensile strength and elasticity of the colon decline with age and this is the most marked in the left colon which is the narrowest and thickest part. This review discusses the case that the mechanical properties of the bowel wall are key factors in the development of diverticular disease. The potential role of high fibre diets in reducing the pressure changes which may stress the colon wall in this disease is also considered.},
}
@article {pmid2111043,
year = {1990},
author = {Madiba, TE and Haffejee, AA and Essa, AS},
title = {Ileal diverticulosis in a black patient. A case report.},
journal = {South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie},
volume = {28},
number = {1},
pages = {30-32},
pmid = {2111043},
issn = {0038-2361},
mesh = {Black People ; Diverticulum/*pathology ; Humans ; Ileal Diseases/*pathology ; Male ; Middle Aged ; },
abstract = {A 54-year-old black man presented to hospital with diarrhoea containing blood and mucus and marked loss of weight over a 1-year period. Barium enema examination revealed cobblestoning and rose-thorn ulceration with possible stricture formation of the terminal ileum. A right hemicolectomy was performed to remove inflamed sections of small and large bowel. Histological examination of the resected specimen demonstrated features of ileal diverticular disease. This is the first documented case of this disease occurring in a black patient.},
}
@article {pmid2342001,
year = {1990},
author = {Milewski, PJ},
title = {Towards selecting the vagotomy and avoiding diarrhoea.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {35},
number = {1},
pages = {11-15},
pmid = {2342001},
issn = {0035-8835},
mesh = {Adult ; Aged ; Diarrhea/*etiology/prevention & control ; Duodenal Ulcer/*surgery ; Female ; Humans ; Male ; Middle Aged ; Pylorus/*surgery ; Recurrence ; Retrospective Studies ; Risk Factors ; Vagotomy, Truncal/*adverse effects/methods ; },
abstract = {A retrospective review was carried out of 148 consecutive personal truncal vagotomies and anterior pylorectomies (TV + P), median follow-up 5.0 years. The recurrent ulcer rate was 6/148 (4.1%) for suspected (SRU) and 5/148 (3.4%) for proven ones (RU). This led to one death from RU. Thirty-six patients (24.3%) developed postvagotomy diarrhoea (PVD). Two of these were graded Visick IV because their occupations made PVD particularly inconvenient. These results are similar to those for TV and pyloroplasty, despite the slightly more destructive nature of pylorectomy. There were nine patients in whom evidence of associated bowel disease had been documented before or during operation. The occurrence of such evidence was significantly more frequent in the PVD group (6/36 vs. 3/112 patients, P = 0.014), suggesting either a summation of effects due to the bowel disease and the operation or that the diagnosis of PVD was sometimes incorrect. Of the six in the PVD group, two were in Visick Grade II because of their PVD, and four in Visick grade III or IV, but in one of these SRU was the main cause of the poor result, and in two the PVD was subsidiary to vomiting or dumping. One further patient in Visick III due to PVD had diverticular disease diagnosed after operation. Thus there were identifiable factors (occupation, associated bowel disorder) which could have been used to predict seven of the unsatisfactory results due partly or completely to PVD. TV + P is an effective operation for duodenal ulcer but, as with TV + pyloroplasty (though to no greater an extent), severe diarrhoea may occasionally mar the result.(ABSTRACT TRUNCATED AT 250 WORDS)},
}
@article {pmid2340009,
year = {1990},
author = {Massoud, TF},
title = {Distribution of diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {33},
number = {2},
pages = {166},
doi = {10.1007/BF02055553},
pmid = {2340009},
issn = {0012-3706},
mesh = {*Black People ; Colon, Sigmoid/anatomy & histology ; Diverticulum, Colon/*ethnology ; Humans ; },
}
@article {pmid2139380,
year = {1990},
author = {Cortesini, C and Pantalone, D},
title = {[Diverticular disease of the colon. Concepts to be reviewed for a rational therapeutic approach].},
journal = {La Clinica terapeutica},
volume = {132},
number = {2},
pages = {79-83},
pmid = {2139380},
issn = {0009-9074},
mesh = {Diverticulum, Colon/complications/*surgery ; Humans ; Middle Aged ; Risk Factors ; },
abstract = {Indicators of a risk group for complicated diverticular disease have been suggested. They are: a) Age 50 years, 2) short history of left lower quadrant abdominal pain, 3) short segment of colon with diverticula, 4) elevated motility index.},
}
@article {pmid2405945,
year = {1990},
author = {Smith, RG},
title = {Large bowel problems.},
journal = {British medical bulletin},
volume = {46},
number = {1},
pages = {246-261},
doi = {10.1093/oxfordjournals.bmb.a072389},
pmid = {2405945},
issn = {0007-1420},
mesh = {Aged ; Colonic Diseases/etiology/*therapy ; Colonic Diseases, Functional/therapy ; Combined Modality Therapy ; Humans ; Rectal Diseases/etiology/*therapy ; },
abstract = {Some large bowel disorders are common to all age groups, others are commoner in the elderly. Colonic function is complex and not fully understood. Diarrhoeal states tend to cause faecal incontinence in the elderly and constipation is commoner in immobile institutionalised elderly patients. Two types of constipation have been identified requiring different approaches in treatment. The management of constipation includes the treatment of the underlying cause and the clearing of the bowel using enemas and suppositories given rectally and laxatives given orally. The neurological causes of faecal incontinence may be local or more commonly cortical. Deliberate constipation and planned evacuation of the rectum may help to reduce the frequency of faecal incontinence. The management of diverticular disease centres around fibre and bulking agents. The treatment of ulcerative colitis and Crohn's disease is similar to that in younger patients.},
}
@article {pmid2310144,
year = {1990},
author = {Clot, JP and Pascual, S and Murata, I},
title = {[Sigmoid diverticular pathology. Apropos of a homogeneous series of 82 cases].},
journal = {Annales de chirurgie},
volume = {44},
number = {1},
pages = {39-43},
pmid = {2310144},
issn = {0003-3944},
mesh = {Adult ; Age Factors ; Aged ; Diverticulitis/etiology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Sigmoid Diseases/etiology/*surgery ; },
abstract = {The authors report a retrospective series of 82 cases of sigmoid diverticulosis which revealed the following points: surgery is rarely performed on "cold" disease but for acute or chronic complications, diverticular disease is very often present for a very long time and the doctor or the patient has refused operation for various reasons, whenever possible, infection must be eradicated as first line treatment and continuity must be restored under protection of a right transverse colostomy which is closed 4 to 6 weeks later. The authors prefer this approach to Hartmann's operation, in which the restoration of colonic continuity appears to be more delicate and which tends to prevent the surgeon from performing a sufficiently low inferior section, the source of poor long-term results. There was no postoperative mortality in this series, which may be due to the special environment in which surgery was performed. It is preferable to operate patients with "cold" diverticulosis before the development of complications, which allows simpler one-stage surgery requiring a shorter and therefore less expansive hospital stay.},
}
@article {pmid2292348,
year = {1990},
author = {Probert, CS and Mayberry, JF and Mann, R},
title = {Inflammatory bowel disease in the rural Indian subcontinent: a survey of patients attending mission hospitals.},
journal = {Digestion},
volume = {47},
number = {1},
pages = {42-46},
doi = {10.1159/000200475},
pmid = {2292348},
issn = {0012-2823},
mesh = {Bangladesh/epidemiology ; Bhutan/epidemiology ; Humans ; Incidence ; India/epidemiology ; Inflammatory Bowel Diseases/*epidemiology ; Missionaries ; Nepal/epidemiology ; Pakistan/epidemiology ; *Religious Missions ; Risk Factors ; Rural Population ; },
abstract = {39 missionaries working at 38 separate mission hospitals or clinics in Bangladesh. India, Nepal and Pakistan completed questionnaires about their clinical practice during the previous year, 1980. Data were collected about gastrointestinal disorders, including coeliac disease, tropical sprue, bloody diarrhoea, amoebiasis, typhoid, cholera, inflammatory bowel disease and diverticular disease. More than 386,000 out-patients and over 56,000 in-patients were treated with an estimated 12,272 cases of bloody diarrhoea, 7,310 of amoebiasis, 2,113 of typhoid and 872 cases of intestinal tuberculosis, 74 cases of inflammatory bowel disease were diagnosed, of which 56 were ulcerative colitis and the remainder were said to have Crohn's disease. Surgery was performed in 28 hospitals, but only 10 (26%) had a histology service. Inflammatory bowel disease appears to be a relatively more common cause of diarrhoea in the Indian subcontinent than in sub-Saharan Africa (z = 5.47, p less than 0.001). The proportion of patients with bloody diarrhoea who have ulcerative colitis Crohn's disease was similar throughout the region. The rate of cases having ulcerative colitis rather than Crohn's disease was greater in India (z = 3.1, p less than 0.005), and in Bangladesh (z = 3.2, p less than 0.005), than in Pakistan (z = 1.28, NS) or Nepal and Bhutan (z = 0, NS). The relative risk of Indians developing ulcerative colitis rather than Crohn's disease is 2.6 (95% confidence limits 1.4-4.8, NS). This may reflect diagnostic difficulties in distinguishing Crohn's disease from intestinal tuberculosis, but it may also shed light on similar differences now being reported in migrant groups in Western Europe.},
}
@article {pmid2226041,
year = {1990},
author = {d'Almeida, JB and Bessa, JS and Costa e Silva, R and Neves, JM},
title = {[Emergency surgery of complicated diverticular disease of the colon].},
journal = {Chirurgie; memoires de l'Academie de chirurgie},
volume = {116},
number = {1},
pages = {65-70; discussion 70-1},
pmid = {2226041},
issn = {0001-4001},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/etiology/surgery ; Diverticulum, Colon/complications/*surgery ; Emergencies ; Female ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; Intestinal Obstruction/etiology/surgery ; Male ; Middle Aged ; Peritonitis/etiology/surgery ; },
abstract = {Emergency surgery is aimed at achieving the same results as elective surgery, but still has specific limitations in the case of CDDC, in spite of significant progress. We describe the physiopathological bases of the emergent treatment of the septic, occlusive and hemorrhagic complications of the CDDC, as well as the experience acquired in the Emergency Unit and Department 3 Hospital San José with 54 cases operated since 1981. The modern means of intensive care and preparation, including powerful antibiotics, make primary resection (1) as a principle possible, but do not allow yielding to the temptation of immediately creating an anastomosis as long as the local conditions have not improved. On the other hand, we emphasize the advantages of performing primary resection-anastomosis surgery in elective operations for non-emergent cases.},
}
@article {pmid2137357,
year = {1990},
author = {Paterson-Brown, S and Vipond, MN},
title = {Modern aids to clinical decision-making in the acute abdomen.},
journal = {The British journal of surgery},
volume = {77},
number = {1},
pages = {13-18},
doi = {10.1002/bjs.1800770105},
pmid = {2137357},
issn = {0007-1323},
mesh = {Abdomen, Acute/*diagnosis ; Ascitic Fluid/pathology ; Diagnosis, Computer-Assisted ; Diagnosis, Differential ; Humans ; Laparoscopy ; Ultrasonography ; },
abstract = {Acute abdominal pain continues to provide not only a large workload for the general surgeon but also many diagnostic and management problems. Many different techniques have been introduced over the past two decades to help in the management of the acute abdomen and this review considers their relative claims to become incorporated into the process of clinical decision-making. The evidence in support of formally structured patient interview pathways with or without computer-aided diagnostic programs is now overwhelming and should become routine. Both laparoscopy and peritoneal cytology have an important role to play in the management of patients in whom the decision to operate is in doubt, and a combination of the two would be complementary. Ultrasonography has become increasingly popular for investigating the acute abdomen, and results from specialist centres are impressive. However, the problems of operator variation and the difficulties in providing a 24-h service will probably prevent it from becoming a first-line investigation in most hospitals. Although plain radiography has been available for many years, its routine use in the management of the acute abdomen remains controversial. Recent studies have confirmed that contrast radiography is an important adjunct to decision-making, particularly in the management of large bowel obstruction, and there is increasing evidence to support its use in suspected small bowel obstruction, perforated peptic ulcer and acute diverticular disease.},
}
@article {pmid2113212,
year = {1990},
author = {Tranaeus, A and Heimbürger, O and Granqvist, S},
title = {Diverticular disease of the colon: a risk factor for peritonitis in continuous peritoneal dialysis.},
journal = {Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association},
volume = {5},
number = {2},
pages = {141-147},
doi = {10.1093/ndt/5.2.141},
pmid = {2113212},
issn = {0931-0509},
mesh = {Adult ; Aged ; Aged, 80 and over ; Barium Sulfate ; Diverticulum, Colon/*complications/diagnostic imaging/pathology ; Enema ; Female ; Humans ; Intestinal Perforation/complications ; *Lung Diseases, Obstructive ; Male ; Middle Aged ; Peritonitis/*etiology ; Prospective Studies ; Radiography ; Risk Factors ; },
abstract = {To study the possible influence of colonic diverticula on the risk of peritonitis of enteral (intestinal) origin in patients undergoing continuous peritoneal dialysis, a barium enema was carried out as a pretreatment investigation in 129 consecutive patients starting CAPD over a 9-year period. In this prospective study comprising 3103 patient months, a total of 44 (15% of all) episodes of peritonitis with micro-organisms of enteral origin occurred in 30 of the 129 patients. The estimated probability of developing such an episode was 16% and 24%, respectively, within 1 or 2 years of treatment. Diverticula (greater than or equal to 1) were found in 54 (42%) of all patients. In all cases the following factors: greater than or equal to 10 diverticula, diverticular size of greater than or equal to 10 mm and diverticula in the ascending, transverse, or descending colon, significantly increased the risk of developing peritonitis of enteral origin (P less than 0.05). Neither diverticula in the sigmoid colon nor diverticulitis, as assessed by radiological findings, were identified as risk factors. Enteral episodes (as defined in this study) appear to represent mainly microperformations of existing diverticula; such episodes should probably be regarded as and handled differently from episodes due to major perforations of the colon secondary to diverticulitis. We conclude that diverticular disease of the non-sigmoid colon is a risk factor for peritonitis in CAPD.},
}
@article {pmid2558553,
year = {1989},
author = {Ogunbiyi, OA},
title = {Diverticular disease of the colon in Ibadan, Nigeria.},
journal = {African journal of medicine and medical sciences},
volume = {18},
number = {4},
pages = {241-244},
pmid = {2558553},
issn = {0309-3913},
mesh = {Adult ; Aged ; Barium Sulfate ; Diagnosis, Differential ; Diverticulum/diagnostic imaging/*epidemiology/physiopathology ; Female ; Hospitals, University ; Humans ; Male ; Middle Aged ; Nigeria/epidemiology ; Prevalence ; Prospective Studies ; Radiography ; },
abstract = {Eleven cases of diverticular disease of the colon were seen in a review of 603 adult barium enema examinations carried out over a 2-year period (January 1984-December 1985) at the University College Hospital, Ibadan, Nigeria--a prevalence of 1.85%. All the cases were clinically unsuspected and the diagnosis was established only at barium examination. Five of the 11 patients presented with rectal bleeding, six with alteration in bowel habit, six with abdominal pain and associated fever and one with right iliac fossa pain and tenderness mimicking appendicitis. Although an uncommon disease in Nigerians, clinicians are urged to suspect diverticular disease in their differential diagnoses of disorder of the colon in Africans in order not to miss a potentially lethal but treatable condition.},
}
@article {pmid2680774,
year = {1989},
author = {Levitan, R},
title = {GI problems in the elderly, Part II: Prevalent diseases and disorders.},
journal = {Geriatrics},
volume = {44},
number = {11},
pages = {80-86},
pmid = {2680774},
issn = {0016-867X},
mesh = {Age Factors ; Aged ; Aged, 80 and over ; Cholelithiasis/diagnosis ; Colitis, Ulcerative/diagnosis ; Colonic Diseases, Functional/diagnosis ; Deglutition Disorders/diagnosis ; Diverticulitis, Colonic/diagnosis ; Gastrointestinal Diseases/*diagnosis/therapy ; Gastrointestinal Neoplasms/*diagnosis ; Humans ; Intestines/blood supply ; Ischemia/diagnosis ; Peptic Ulcer/diagnosis ; },
abstract = {When ambulatory geriatric patients present with gastrointestinal (GI) complaints, a complete workup is necessary to determine whether the cause is a functional problem or organic disease. Some of the more common organic diseases found in the elderly GI patient include peptic ulcer disease, neoplasms, inflammatory bowel diseases, and diverticular disease. Special considerations that must be given the geriatric patient during workup, diagnosis, and treatment are discussed.},
}
@article {pmid2791771,
year = {1989},
author = {Berry, AR and Turner, WH and Mortensen, NJ and Kettlewell, MG},
title = {Emergency surgery for complicated diverticular disease. A five-year experience.},
journal = {Diseases of the colon and rectum},
volume = {32},
number = {10},
pages = {849-854},
doi = {10.1007/BF02554554},
pmid = {2791771},
issn = {0012-3706},
mesh = {Aged ; Aged, 80 and over ; Diverticulum, Colon/complications/mortality/*surgery ; Emergencies ; Humans ; Intestinal Perforation/etiology ; Methods ; Middle Aged ; Peritonitis/etiology ; Postoperative Complications ; },
abstract = {Ninety-three patients who underwent surgery were studied retrospectively over a five-year period for complications of diverticular disease, including free perforation in 32 patients (with fecal peritonitis in 8), inflammation or peritonitis in 22 patients, an abscess in 11 patients, and intestinal obstruction in 14 patients. Sixty-eight patients (73 percent) had systemic symptoms and signs consistent with serious sepsis. There has been a growing popularity of the Hartmann procedure throughout the study period. The overall 30-day mortality rate was 10.8 percent. Because of a high proportion of poor-risk patients, the Hartmann group fared particularly badly compared with those who had other operations, with a 28 percent mortality rate, 69 percent incidence of major complications, and one third of the survivors having a permanent colostomy. Other operative procedures are discussed, but until prospective data become available, it is unlikely that the widespread popularity of the Hartmann procedure will decline. Therefore, the importance of meticulous attention to technical detail is stressed if results are to improve.},
}
@article {pmid2805023,
year = {1989},
author = {Snape, WJ},
title = {The effect of methylcellulose on symptoms of constipation.},
journal = {Clinical therapeutics},
volume = {11},
number = {5},
pages = {572-579},
pmid = {2805023},
issn = {0149-2918},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Constipation/*drug therapy ; Female ; Humans ; Male ; Methylcellulose/*therapeutic use ; Middle Aged ; },
abstract = {The efficacy of methylcellulose was evaluated in 538 patients with a history of constipation. The patients were seen both by primary care physicians and by consultants. Patients were selected on the basis of passage of fewer than three stools per week. Frequency, consistency, and ease of passage of the stools were measured before and after one to three tablespoonsful per day of methylcellulose. The frequency of bowel movements as well as the consistency and ease of passage of the stools returned to normal with methylcellulose treatment; 61% of the patients were judged to have less constipation. The response to methylcellulose was not altered by the sex or age of the patients nor by the presence of colonic diverticular disease. This study suggests that methylcellulose is beneficial for the treatment of chronic and acute constipation.},
}
@article {pmid2774905,
year = {1989},
author = {Riseman, JA and Wichterman, K},
title = {Evaluation of right hemicolectomy for unexpected cecal mass.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {124},
number = {9},
pages = {1043-1044},
doi = {10.1001/archsurg.1989.01410090049011},
pmid = {2774905},
issn = {0004-0010},
mesh = {Appendectomy ; Appendicitis/*diagnosis/surgery ; Cecal Neoplasms/diagnosis/*surgery ; *Colectomy ; Diagnosis, Differential ; Female ; Humans ; Intraoperative Period ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {Ileocecal mass is occasionally encountered unexpectedly by surgeons operating for presumed appendicitis. A five-year retrospective study was performed to review the management of this problem. Thirteen patients were identified who had had right hemicolectomy performed for unexpected mass in which neoplasm, diverticular disease, or inflammatory bowel disease could not be differentiated from severe appendicitis at laparotomy. Seven patients (group 1) had a final pathologic diagnosis of appendiceal phlegmon. The other patients (group 2) had Crohn's disease, typhlitis, or neoplasm. Right hemicolectomy was performed with a morbidity of 7% and mortality of 7% in all patients. This procedure is acceptable for unexpected cecal mass.},
}
@article {pmid2608592,
year = {1989},
author = {McCue, J and Coppen, MJ and Rasbridge, SA and Lock, MR},
title = {Coexistent Crohn's disease and sigmoid diverticulosis.},
journal = {Postgraduate medical journal},
volume = {65},
number = {767},
pages = {636-639},
pmid = {2608592},
issn = {0032-5473},
mesh = {Aged ; Colon/pathology/surgery ; Crohn Disease/*complications/pathology/surgery ; Diverticulum, Colon/*complications/pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/*complications/pathology/surgery ; },
abstract = {This study reports six patients with a diagnosis of diverticular disease with associated localized Crohn's colitis who were all treated by segmental resection. Two patients died in the post-operative period from disease unrelated to their colonic pathology. The remaining four patients remain well, show no signs of recurrent disease and have required no further surgery. The behaviour and significance of the two conditions occurring in the same patient is discussed.},
}
@article {pmid2596257,
year = {1989},
author = {Lindahl, J and Ristkari, SK and Vorne, M and Mokka, RE},
title = {99m-technetium-HmPAO-labelled leucocytes in the diagnosis of acute colonic diverticulitis.},
journal = {Acta chirurgica Scandinavica},
volume = {155},
number = {9},
pages = {479-482},
pmid = {2596257},
issn = {0001-5482},
mesh = {Acute Disease ; Diverticulitis, Colonic/blood/*diagnostic imaging ; Humans ; Leukocytes/*diagnostic imaging ; *Organotechnetium Compounds ; *Oximes ; Radionuclide Imaging ; Technetium Tc 99m Exametazime ; },
abstract = {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.},
}
@article {pmid2767386,
year = {1989},
author = {Bat, L and Williams, CB},
title = {Usefulness of pediatric colonoscopes in adult colonoscopy.},
journal = {Gastrointestinal endoscopy},
volume = {35},
number = {4},
pages = {329-332},
doi = {10.1016/s0016-5107(89)72803-0},
pmid = {2767386},
issn = {0016-5107},
mesh = {Biopsy ; Cecal Diseases/therapy ; Colon/pathology ; Colonic Diseases/pathology ; Colonic Neoplasms/pathology ; *Colonoscopes ; Electrocoagulation/instrumentation/methods ; Female ; Humans ; Male ; Middle Aged ; Pediatrics/*instrumentation ; },
abstract = {Use of small diameter, extraflexible pediatric colonoscopes has proved to be valuable in adult endoscopy practice, not only for passing strictures and stomas but also where either fixation due to diverticular disease or postoperative adhesions, or unavoidably painful looping made passage of adult colonoscopes impossible. In 70 of 78 (92%) of the cases where the adult colonoscope could not be passed through the sigmoid colon by an expert endoscopist, the pediatric colonoscope passed through, often very easily. Fifteen of these patients were considered to have been saved surgery by successful passage. The "failure" rate for all colonoscopy examinations was only 2%; this low failure rate was attributable to the use of pediatric instruments whenever passage through the sigmoid colon proved to be impossible with standard colonoscopes. In our opinion every unit performing frequent colonoscopies should have a pediatric colonoscope available for selected adult patients as well as for use in children.},
}
@article {pmid2737058,
year = {1989},
author = {Gramegna, A and Saccomani, G},
title = {On-table colonic irrigation in the treatment of left-sided large-bowel emergencies.},
journal = {Diseases of the colon and rectum},
volume = {32},
number = {7},
pages = {585-587},
doi = {10.1007/BF02554178},
pmid = {2737058},
issn = {0012-3706},
mesh = {Aged ; Colon/*surgery ; Colonic Diseases/surgery ; Emergencies ; Female ; Humans ; Intraoperative Care/*methods ; Male ; Rectum/surgery ; Therapeutic Irrigation ; },
abstract = {In a series of 27 patients who required surgery for distal colonic lesions, primary bowel resection with immediate anastomosis after intraoperative antegrade colonic irrigation was performed. The technique of on-table lavage was similar to that described by Dudley and Radcliffe in 1980; however, some new technical details are introduced to minimize fecal contamination. There were 17 men and 10 women (mean age, 68.5 years). Twenty patients were admitted for obstructing carcinoma of the left colon; 11 underwent immediate surgery, while the remaining 9 underwent delayed surgery after 12 hours of intravenous fluids and nasogastric suction. Of the remaining seven patients, five had perforated sigmoid diverticula and diffuse peritonitis and two had obstructing diverticular disease of the left colon with remarkable bowel distention. One hospital mortality occurred secondary to a ruptured aortic aneurysm. The radiologic anastomotic leakage rate was 14.8 percent. Clinical anastomotic dehiscence was not observed.},
}
@article {pmid2668368,
year = {1989},
author = {Coellen, D},
title = {Understanding diverticular disease.},
journal = {Journal of enterostomal therapy},
volume = {16},
number = {4},
pages = {176-180},
doi = {10.1097/00152192-198907000-00017},
pmid = {2668368},
issn = {0270-1170},
mesh = {Diverticulitis, Colonic/diagnosis/physiopathology/*surgery ; Enterostomy/*nursing/psychology ; Humans ; },
}
@article {pmid2771115,
year = {1989},
author = {Viti, M and Invernizzi, C and Paganelli, E and Campana, M and Tinghi, A and Bonsanti, A and Lenzi, M},
title = {[Treatment of septic complications in diverticular disease of the colon].},
journal = {Minerva chirurgica},
volume = {44},
number = {12},
pages = {1633-1636},
pmid = {2771115},
issn = {0026-4733},
mesh = {Aged ; Aged, 80 and over ; Colectomy/methods ; Colostomy ; Diverticulitis, Colonic/*complications/surgery ; Drainage ; Emergencies ; Female ; Humans ; Intestinal Obstruction/etiology/*surgery ; Male ; Middle Aged ; Peritonitis/etiology/*surgery ; },
abstract = {Eight years' experience in the treatment of the septic complications of diverticular disease of the colon is examined and 44 cases treated in the period 1980-1988 are considered. The Hartman procedure gave good results in the majority of cases; other procedures such as drainage with colostomy, or anastomosis resection during a single intervention are reserved for particular cases. In addition, on examining the case histories and the current literature it seems that it is correct to treat DD (diverticular disease) surgically whenever the typical manifestations of the overt disease appear; waiting often represents nothing more than a postponement of the surgical treatment until an emergency arises.},
}
@article {pmid2810165,
year = {1989},
author = {Ratcliffe, R and Kiff, RS and Kingston, RD and Walsh, SH and Jeacock, J},
title = {Early diagnosis in colorectal cancer. Still no benefit?.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {34},
number = {3},
pages = {152-155},
pmid = {2810165},
issn = {0035-8835},
mesh = {Adult ; Aged ; Carcinoma/*diagnosis ; Colorectal Neoplasms/*diagnosis ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; },
abstract = {Time to diagnosis from first symptoms has been assessed in 332 patients with colorectal cancer treated by the three general surgeons in Trafford Health Authority. When compared with other series, delay to diagnosis has been shortened, particular general practitioner and hospital delay. Fewer patients presented as emergencies and a greater proportion of patients had early-stage disease. There was no significant difference in delay times between Dukes' stage B and C patients but there was a significant difference in survival at 2 years between these two stages. Delay times for patients with risk factors, family histories or diverticular disease were not significantly different from times in patients without these factors.},
}
@article {pmid2753752,
year = {1989},
author = {Wehmann, TW and Rongaus, VA},
title = {Diverticular disease in young adults.},
journal = {The Journal of the American Osteopathic Association},
volume = {89},
number = {6},
pages = {791-793},
pmid = {2753752},
issn = {0098-6151},
mesh = {Abdomen, Acute/diagnosis ; Adult ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis ; Humans ; Male ; },
abstract = {Acute diverticulitis of the colon should be considered in the differential diagnosis in young adult (younger than 40 years) patients with pain and tenderness in the lower abdomen. Among young adults, men are afflicted more commonly than women and the disease runs a more virulent course. Complications are commonly encountered, and the key to diagnosis is a high index of suspicion. Barium enema examination without bowel preparation is useful and safe in this age group. In patients with acute diverticulitis with perforation and abscess, the most appropriate therapy is surgical, as demonstrated in the three cases reported here.},
}
@article {pmid2747989,
year = {1989},
author = {De Masi, E},
title = {[Tiropramide hydrochloride in the premedication of diagnostic and therapeutic proctosigmoidocolonoscopy (endoscopic polypectomy) and the treatment of colonic diverticulosis].},
journal = {Minerva medica},
volume = {80},
number = {6},
pages = {587-590},
pmid = {2747989},
issn = {0026-4806},
mesh = {Adult ; *Colonoscopy ; Diverticulum, Colon/*drug therapy ; Drug Evaluation ; Humans ; Intestinal Polyps/*surgery ; Parasympatholytics/*therapeutic use ; *Premedication ; *Sigmoidoscopy ; Tyrosine/*analogs & derivatives/therapeutic use ; },
abstract = {This study was undertaken with a view to assessing the effectiveness and tolerance of tiropramide hydrochloride in the premedication of endoscopic rectosigmoidoscopy. The following were considered for this purpose: 1) speed of execution of the procedure; 2) its tolerance; 3) possible complications. The effectiveness of tiropramide was also examined in uncomplicated diverticular disease: 1) comparison of execution times for rectosigmoidoscopy before and after therapy; 2) the evaluation of the reduction in symptomatology. The patients were subdivided into three groups: 1st group submitted to diagnostic rectosigmoidoscopy; 2nd group submitted to therapeutic rectosigmoidoscopy; 3rd group with diverticular disease. In the first group, execution times were less than 20 minutes in all cases bar 1 and tolerance was good in 27 cases, average in 3. In the second group, times were less than 15 minutes in 6 cases and higher in 4, and tolerance was good in 7 cases and average in 3. In the third group (10 patients), examination execution time was reduced after therapy in 9 cases and in the same number pain symptomatology regressed. Tiropramide proved to be the antispastic of choice in premedication for rectosigmoidoscopy and an effective drug in the treatment of uncomplicated diverticular disease.},
}
@article {pmid2924670,
year = {1989},
author = {Porter, JA and Salvati, EP and Rubin, RJ and Eisenstat, TE},
title = {Complications of colostomies.},
journal = {Diseases of the colon and rectum},
volume = {32},
number = {4},
pages = {299-303},
doi = {10.1007/BF02553484},
pmid = {2924670},
issn = {0012-3706},
mesh = {Colonic Diseases/etiology ; Colostomy/*adverse effects ; Emergencies ; Female ; Follow-Up Studies ; Hernia/etiology ; Humans ; Intestinal Obstruction/etiology ; Male ; Middle Aged ; Postoperative Complications/mortality ; Reoperation ; Surgical Wound Infection/etiology ; },
abstract = {One hundred twenty-six patients underwent 130 end colostomies, 44 for benign and 86 for malignant disease, and were followed for an average of 35 months. The left or sigmoid colon was used in 99 and the transverse colon in 31. Stomas were made electively in 98 patients and urgently in 32. Seventy-six stomas were brought out through the incision and 54 from separate sites. There were 69 complications in 55 patients (44 percent) including 11 strictures, 9 wound infections, 14 hernias, 9 small-bowel obstructions, 4 prolapses, 2 abscesses, 1 peristomal fistula, 17 skin erosions, and 2 poor stoma locations. Fifteen complications required reoperation. Five of these procedures included stoma revision. Total numbers of complications were not related to the stoma site, the disease process, the urgency of the procedure, or the segment of colon used. Wound infections, however, were increased in urgently made stomas. The incidence of hernia was equivalent in stomas brought out through the incision or at a separate site. Forty-one patients (30 percent) had 43 colostomies closed an average of 3.5 months after creation. Thirteen patients had 14 complications--5 wound infections, 6 hernias, 2 small-bowel obstructions, and 1 rectovaginal fistula. One patient died. Four patients required reoperation. There were no anastomotic leaks. Complications were equivalent in Hartmann closures and transverse colostomy closures. Complications were similar in stomas created for cancer and those created for diverticular disease.},
}
@article {pmid2920084,
year = {1989},
author = {Raymond, PL and Gibler, WB},
title = {Detection of colovesical fistula in the emergency department: report of a case.},
journal = {The American journal of emergency medicine},
volume = {7},
number = {2},
pages = {191-195},
doi = {10.1016/0735-6757(89)90137-x},
pmid = {2920084},
issn = {0735-6757},
mesh = {Adult ; Colonic Diseases/*diagnosis ; Emergency Service, Hospital ; Humans ; Intestinal Fistula/*diagnosis ; Male ; Urinary Bladder Fistula/*diagnosis ; Urinary Tract Infections/etiology ; },
abstract = {A case of colovesical fistula is described, revealing the pathognomonic findings of terminal pneumaturia and fecaluria. The sensitivity and specificity of various procedures that can be performed in the emergency department for confirmation of the diagnosis are evaluated. Dye studies including methylene blue, the Bourne test, the modified diatrizoate (gastrograffin) test, barium enema and cystography, cystoscopy and colocystoscopic examination, and computed tomography and nuclear medicine scans are discussed as diagnostic modalities. Surgical treatment of colovesical fistula is briefly reviewed. As colovesical fistula are thought to occur in 2% to 22% of patients with known diverticular disease, it is reasonable to question all patients with recurrent urinary tract infection, especially those with known disease of the colon, regarding symptoms of terminal pneumaturia and fecaluria.},
}
@article {pmid2785230,
year = {1989},
author = {Herzog, P and König, U and Holtermüller, KH},
title = {[A new latex agglutination test for the immunologic detection of occult blood in stool].},
journal = {Klinische Wochenschrift},
volume = {67},
number = {5},
pages = {291-296},
pmid = {2785230},
issn = {0023-2173},
mesh = {Aged ; Colorectal Neoplasms/*diagnosis ; Diagnosis, Differential ; Female ; Gastrointestinal Hemorrhage/diagnosis ; Humans ; *Latex Fixation Tests ; Male ; *Occult Blood ; Prospective Studies ; },
abstract = {An new latex agglutination system was developed for the detection of occult blood in the feces. Antibodies against human hemoglobin were raised in a goat. Blood in concentrations of 0.1 ml-8.0 ml/100 g feces were detected in vitro. The antibodies were separated and adsorbed to latex particles (0.3 microns). After in vitro standardisation of the new test system we compared the efficacy of the commonly used guaiac slide test for detection of occult blood in the stool (hemoccult-test) with the latex test system. A significant higher sensitivity could be reached with the latex test system. In a clinical study 61 patients were tested. In 31 of them occult blood was found with the latex test system while with the guaiac slide-test system no blood was detected using the same stool specimen. 13 of the 31 patients had a neoplastic lesion of the colon - 4 a colon carcinoma and 9 had adenomatous polyps of the large bowel larger than 5 mm in diameter. In the remaining patients the sources of intestinal bleeding were: upper gastro-intestinal bleeding sources in 8 patients and other colonic bleeding sources like diverticular disease, inflammatory bowel disease, hemorrhoids and a rectal ulcer in 8 patients. In 2 of the 61 patients the latex test was positive without endoscopic significance for the bleeding source.},
}
@article {pmid2651018,
year = {1989},
author = {Rege, RV and Nahrwold, DL},
title = {Diverticular disease.},
journal = {Current problems in surgery},
volume = {26},
number = {3},
pages = {133-189},
doi = {10.1016/0011-3840(89)90031-2},
pmid = {2651018},
issn = {0011-3840},
mesh = {Colonic Diseases/etiology/therapy ; Diverticulitis, Colonic/etiology/therapy ; *Diverticulum, Colon/complications/diagnosis/epidemiology/etiology/therapy ; Humans ; Intestinal Fistula/etiology/therapy ; },
abstract = {Although most often clinically silent, colonic diverticula are responsible for a large number of gastrointestinal illnesses in our society. Complications of diverticular disease, including perforation and hemorrhage, may occur in 15% to 20% of patients with diverticula during their lifetime, and although often mild and self-limiting diseases, they too frequently cause life-threatening problems that require prompt surgical intervention. Despite a cadre of sophisticated laboratory and radiologic tests that have been developed to aid in the diagnosis of complicated diverticular disease, the diagnosis and treatment of diverticulitis still relies heavily on patient history, physical examination, physician judgment, and the patient's clinical response to treatment. Thus it is important for the managing physician to fully understand the pathogenesis of diverticula, the clinical consequences and modes of presentation of complicated diverticular disease, and the array of interventions available for treatment of these problems. This monograph summarizes our knowledge of diverticular disease to date and tries to give specific guidelines for the treatment of patients with complicated diverticulitis. However, it must be understood that the presentation and severity of these complications vary widely from patient to patient. Thus one cannot take a single approach toward a patient who has diverticulitis or diverticular bleeding. Rather, successful outcomes depend on an individual approach to each patient while maintaining certain generally accepted principles of treatment.},
}
@article {pmid2493362,
year = {1989},
author = {Segal, I and Leibowitz, B},
title = {The distributional pattern of diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {32},
number = {3},
pages = {227-229},
doi = {10.1007/BF02554534},
pmid = {2493362},
issn = {0012-3706},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum/*ethnology/pathology ; Female ; Humans ; Male ; Middle Aged ; South Africa ; },
abstract = {In Western communities diverticular disease occurs mainly in the sigmoid colon. This contrasts with Oriental populations, in which diverticula occur mainly in the right colon. Diverticular disease has recently emerged in black South Africans. This study shows that diverticula in this population occurs predominantly in the descending colon. The variable anatomic distribution of diverticula in different ethnic groups implies that fiber deficiency is not the only factor responsible for this condition. It is suggested that diverticular disease may comprise several entities with different causes.},
}
@article {pmid2717034,
year = {1989},
author = {Pappalardo, G},
title = {[Our current approach to the surgical therapy of diverticular disease of the colon].},
journal = {Minerva chirurgica},
volume = {44},
number = {4},
pages = {609-612},
pmid = {2717034},
issn = {0026-4733},
mesh = {Colectomy/*methods ; Diverticulum, Colon/*surgery ; Humans ; Muscle, Smooth/surgery ; },
}
@article {pmid2654732,
year = {1989},
author = {Cagliani, P and Rossi, R},
title = {[Our experience in diverticular disease of the colon. Resection and myotomy intervention].},
journal = {Minerva chirurgica},
volume = {44},
number = {4},
pages = {613-618},
pmid = {2654732},
issn = {0026-4733},
mesh = {Aged ; Aged, 80 and over ; Colectomy/*methods ; Colonic Diseases/etiology/surgery ; Diverticulum, Colon/complications/*surgery ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; Intestinal Perforation/etiology/surgery ; Muscle, Smooth/*surgery ; Prognosis ; },
}
@article {pmid2709351,
year = {1989},
author = {Haiart, DC and Stevenson, P and Hartley, RC},
title = {Leg pain: an uncommon presentation of perforated diverticular disease.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {34},
number = {1},
pages = {17-20},
pmid = {2709351},
issn = {0035-8835},
mesh = {Aged ; Diverticulum, Colon/diagnostic imaging/*physiopathology ; Female ; Humans ; Intestinal Perforation/diagnostic imaging/*physiopathology ; *Leg ; Middle Aged ; Pain/*etiology ; Radiography ; },
abstract = {Five cases of perforated diverticular disease are described in which pain in the thigh or leg was the predominant symptom. In four patients pyrexia or leucocytosis were present and three patients ultimately developed surgical emphysema in the left thigh. In retroperitoneal perforation of the colon, the symptoms in the leg may overshadow those in the abdomen and lead to delay in diagnosis.},
}
@article {pmid2910658,
year = {1989},
author = {Levien, DH and Mazier, WP and Surrell, JA and Raiman, PJ},
title = {Safe resection for diverticular disease of the colon.},
journal = {Diseases of the colon and rectum},
volume = {32},
number = {1},
pages = {30-32},
doi = {10.1007/BF02554721},
pmid = {2910658},
issn = {0012-3706},
mesh = {Abscess/etiology ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Colonic Diseases/etiology ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intestinal Fistula/etiology ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; },
abstract = {A retrospective study of 83 patients undergoing surgery for diverticular disease over two years at a colorectal specialty hospital was undertaken to assess the safety of resection. No patient had free perforation. Eighty-nine percent of 46 patients with neither abscess nor fistula underwent resection and primary anastomosis, the remainder undergoing other resectional therapy; there was no mortality in this group. Of the 37 patients with abscesses, fistulas, or both, all had resections with or without primary anastomoses and one of these 37 patients died (2.7 percent mortality). In the entire series of 83 patients, the operative mortality was 1.2 percent, although 69 percent had morbidity. Resection can be performed safely for diverticulitis, and primary anastomosis can be safely added in uncomplicated and selected complicated cases.},
}
@article {pmid2909128,
year = {1989},
author = {Lipton, S and Estrin, J and Glasser, I},
title = {Diverticular disease of the appendix.},
journal = {Surgery, gynecology & obstetrics},
volume = {168},
number = {1},
pages = {13-16},
pmid = {2909128},
issn = {0039-6087},
mesh = {Acute Disease ; Age Factors ; Appendicitis/complications/*diagnosis/pathology ; *Appendix ; Diagnosis, Differential ; Diverticulitis/*diagnosis/etiology/pathology ; Humans ; Intestinal Perforation/complications/diagnosis ; Retrospective Studies ; Rupture, Spontaneous ; },
abstract = {A retrospective study of diverticular disease of the appendix was made in 3,343 consecutive instances of appendectomies. A 2 per cent incidence of diverticular disease was found. These instances were classified into four morphologic types: 1, acute diverticulitis; 2, acute appendicitis with acute diverticulitis; 3, acute appendicitis with diverticulum, and 4, appendix with diverticulum. Types 1, 2 and 3 were divided into subgroups with or without perforation. The elements of clinical behavior in each group were examined in detail. Diverticulitis of the appendix is presented as a clinically variant form of the inflamed appendix. Some followed the pattern of typical acute appendicitis. However, most were distinctive at a later age of onset, longer interval of disease, fewer or absent symptoms of the gastrointestinal tract, failure of typical abdominal pain progression, delay in surgical treatment and a remarkably high incidence of perforation. In a chi-square analysis of 56 patients with acute diverticulitis of the appendix compared with 2,503 patients with acute appendicitis, more than a fourfold incidence of perforation in acute diverticulitis was significant beyond the 0.001 level. These findings of variant behavior and high incidence of perforation are cautionary features of this frequently overlooked disease.},
}
@article {pmid2748210,
year = {1989},
author = {Gangemi, P and Manusia, M and Puzzo, L},
title = {[Pneumatosis cystoides intestinalis].},
journal = {Pathologica},
volume = {81},
number = {1071},
pages = {71-75},
pmid = {2748210},
issn = {0031-2983},
mesh = {Colonic Diseases/*pathology ; Female ; Humans ; Ileal Diseases/*pathology ; Male ; Middle Aged ; Pneumatosis Cystoides Intestinalis/*pathology ; },
abstract = {Pneumatosis Cystoides Intestinalis. Pneumatosis Cystoides Intestinalis is usually associated with intrinsic disease of the bowel. A case of the ileum associated with duodenal ulcer and a case of the large bowel associated with diverticular disease are reported. It was an unexpected finding in both patients. The histiocytic origin of the cells which line the gas cysts and the pathogenesis are discussed.},
}
@article {pmid2656010,
year = {1989},
author = {Manousos, ON},
title = {Diverticular disease of the colon.},
journal = {Digestive diseases (Basel, Switzerland)},
volume = {7},
number = {2},
pages = {86-103},
doi = {10.1159/000171209},
pmid = {2656010},
issn = {0257-2753},
mesh = {*Diverticulitis, Colonic ; Humans ; },
}
@article {pmid2628390,
year = {1989},
author = {Cortesini, C and Bruno, L and Pantalone, D},
title = {Motility effects of anterior resection of the rectum performed for diverticular disease.},
journal = {The Italian journal of surgical sciences},
volume = {19},
number = {4},
pages = {369-373},
pmid = {2628390},
issn = {0392-3525},
mesh = {Colon/*physiopathology/surgery ; Diverticulum, Colon/complications/physiopathology/*surgery ; *Gastrointestinal Motility ; Humans ; Manometry ; Middle Aged ; Rectum/*surgery ; },
abstract = {Colonic motility study was performed in fiftyfive patients with symptomatic complicated diverticular disease, who underwent semielective surgery, and in twenty healthy volunteers. The pressure sensors were positioned in the descending and the true sigmoid colon. The colonic motility index was significantly higher in patients with symptomatic complicated diverticular disease than in controls in the basal (p less than 0.001) and post-prandial periods (p less than 0.001). Three months after anterior resection of the rectum with wide resection of descending colon the motility index was significantly reduced (p less than 0.001) in comparison to that before treatment; all patients were asymptomatic. Three years and five years later, the manometric findings continued to be stable and the patients continued to be asymptomatic. These data suggest that anterior resection of the rectum (with wide resection of the descending colon) lowers intraluminal pressure significantly and this effect appears long lasting.},
}
@article {pmid2619225,
year = {1989},
author = {Ratcliffe, R and Kiff, RS and Hoare, EM and Kingston, RD and Walsh, SH and Jeacock, J},
title = {Early diagnosis in colorectal cancer still no benefit?.},
journal = {Annales de chirurgie},
volume = {43},
number = {7},
pages = {570-574},
pmid = {2619225},
issn = {0003-3944},
mesh = {Colorectal Neoplasms/*diagnosis/pathology/surgery ; Humans ; Neoplasm Staging ; Time Factors ; },
abstract = {Delay to diagnosis from first symptom has been assessed in 332 patients with colorectal cancer treated by the three general surgeons in Trafford Health Authority. Delay was divided into three parts; that due to (a) the patient, (b) the general practitioner and (c) the hospital. There was no significant difference in delay between Dukes stage B and C patients but there was a significant difference in survival at two years between these two stages. Delay for patients with risk factors as family histories or diverticular disease was not significantly different to patients without these factors. When compared to other series delay has been shortened, particularly general practitioner and hospital delay. Fewer patients presented as emergencies and a greater proportion of patients had disease at an earlier stage. However, these favourable aspects are not reflected in an improved survival at 2 years.},
}
@article {pmid3231329,
year = {1988},
author = {Feltri, R and Tava, P and Boveri, E and Franzosi, W and Pacquola, MG and Prete, R and Allegrina, S},
title = {[Complicated diverticular disease].},
journal = {Minerva chirurgica},
volume = {43},
number = {21},
pages = {1811-1817},
pmid = {3231329},
issn = {0026-4733},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colectomy ; Colostomy ; Diverticulum, Colon/*complications/surgery ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; },
}
@article {pmid3149062,
year = {1988},
author = {Hessdörfer, E and Kühn, R and Sigel, A},
title = {[Pathogenetic synopsis of diverticular disease of the female urethra].},
journal = {Der Urologe. Ausg. A},
volume = {27},
number = {6},
pages = {343-347},
pmid = {3149062},
issn = {0340-2592},
mesh = {Diverticulum/*etiology ; Female ; Humans ; Urethral Diseases/*etiology ; Urinary Incontinence/etiology ; Urography ; },
abstract = {Diverticular disease of the female urethra is rare, but not so rare as assumed hitherto. The predominant theory is that diverticula urethrae is secondary to infection of the glandulae paraurethrales, but they can be easily pared out, and this together with their three-dimensional appearance with subdivision in side, undermines this theory. On the other hand, the known fact that urethral diverticula can be observed in female babies and girls of school age and also in urethral moulds of healthy young women, in which widened urethral glands can be found, supports the idea of a congenital origin. The irritability of the female urethra results from the fact that it is made up of two germ layers. Inflammation of paraurethral ducts causes secondary widening of small congenital diverticula of the female urethra. Proximally located diverticula can irritate sphincter function, as does invasive treatment. In some cases endoscopic therapy might be justified rather than plastic surgical removal via the vagina. The history, symptoms, diagnostis, histology and secondary pathology are indicated only very briefly.},
}
@article {pmid3250415,
year = {1988},
author = {Kourtesis, GJ and Williams, RA and Wilson, SE},
title = {Acute diverticulitis: safety and value of contrast studies in predicting need for operation.},
journal = {The Australian and New Zealand journal of surgery},
volume = {58},
number = {10},
pages = {801-804},
doi = {10.1111/j.1445-2197.1988.tb00983.x},
pmid = {3250415},
issn = {0004-8682},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Contrast Media ; Diverticulitis, Colonic/*diagnostic imaging/surgery ; Emergencies ; Enema ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Safety ; },
abstract = {Results of treatment of 70 patients hospitalized with acute diverticulitis were analysed to determine the value of early contrast enema in management. A water-soluble enema done during the first week of hospitalization in 48 patients showed diverticulosis with spasm (30), a leak or peridiverticulitis (16) and a normal study (two). No complications were caused by the study. Forty patients improved on medical therapy, but four relapsed after discharge. Thirty-four (49%) patients had urgent operation during hospitalization for the acute episode of diverticulitis. Findings on contrast enema correlated with the need for surgery during the acute phase: 13 of 16 with peridiverticulitis or a leak compared with three of 30 with diverticulosis/spasm (P less than 0.001). Operations performed were: sigmoid resection and primary anastomosis (17) with covering colostomy (five). Hartmann's operation (eight), colostomy and/or drainage (seven), right hemicolectomy (two). Findings at surgery were: abscess (15), phlegmon (12), peritonitis (five) and colovesical fistula (two). It is concluded that early contrast enemas of the distal colon done with appropriate precautions are useful in confirming the diagnosis of diverticular disease: only two of 48 studies were falsely negative. A pericolic extravasation (as opposed to a small sinus tract) or abscess usually indicates need for operation, whereas the finding of diverticulosis/spasm suggests a favourable outcome of conservative management.},
}
@article {pmid3220465,
year = {1988},
author = {Allen, DC and Connolly, NS and Biggart, JD},
title = {High iron diamine-alcian blue mucin profiles in benign, premalignant and malignant colorectal disease.},
journal = {Histopathology},
volume = {13},
number = {4},
pages = {399-411},
doi = {10.1111/j.1365-2559.1988.tb02056.x},
pmid = {3220465},
issn = {0309-0167},
mesh = {Colonic Diseases/*metabolism/pathology ; Colonic Neoplasms/metabolism/pathology ; Histocytochemistry ; Humans ; Indoles ; Intestinal Mucosa/metabolism/pathology ; Mucins/*metabolism ; Precancerous Conditions/metabolism/pathology ; Rectal Diseases/*metabolism/pathology ; Rectal Neoplasms/metabolism/pathology ; Sialomucins ; },
abstract = {The presence of mucosal hyperplasia and sialomucin goblet cell secretion (transitional mucosa) was assessed in various benign, premalignant and malignant colorectal tissues. Transitional mucosa was seen in diverticular disease, solitary ulcer syndrome of the rectum, ischaemic and irradiation colitis and other diseases including pneumatosis coli, endometriosis, haemorrhoids and a colostomy margin. Adenocarcinomas had a sulphomucin or mixed secretion pattern with transitional features in the adjacent mucosa mucosa (18/27). Premalignant adenomatous polyps showed mixed secretion with transitional glands incorporated in the stalk and sometimes in the adjacent mucosa. Epithelium showing dysplasia secreted sulphomucins and in amounts related to its degree of differentiation. Transitional mucosa may not be a primary premalignant phenomemon. The conclusion and unifying concept is that it is a secondary event related to goblet cell immaturity. This can occur, secondary to proliferation in mucosal inflammation, ischaemia and prolapse or as a phenotypic expression of growth derived from underlying dysplastic epithelium.},
}
@article {pmid3168666,
year = {1988},
author = {Morini, S and de Angelis, P and Manurita, L and Colavolpe, V},
title = {Association of colonic diverticula with adenomas and carcinomas. A colonoscopic experience.},
journal = {Diseases of the colon and rectum},
volume = {31},
number = {10},
pages = {793-796},
doi = {10.1007/BF02560109},
pmid = {3168666},
issn = {0012-3706},
mesh = {Adenoma/*complications ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Carcinoma/*complications ; Colonic Polyps/complications ; Colonoscopy ; Colorectal Neoplasms/*complications ; Diverticulum, Colon/*complications ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary/diagnosis ; Risk Factors ; Sex Factors ; },
abstract = {A case control study of 150 individuals with colonic symptoms and diverticular disease diagnosed by total colonoscopy was performed to ascertain whether adenomas and carcinomas are detected with a higher frequency in these patients than in matched controls with symptoms but not diverticular disease. Adenomas and carcinomas were seen in 36 percent of the patients and in 17 percent of the controls (P less than .001); the overall odds ratio was calculated to be 3.0 (95 percent confidence interval +/- 1.8). When examined separately, adenomas maintained their significantly higher frequency (27 vs. 10 percent, P less than .001), while no difference was observed as regards carcinomas (9 vs. 7 percent). The odds ratios for adenomas and carcinomas were calculated to be 3.5 +/- 2.5 and 1.4 +/- 1.4, respectively. From the fifth to eighth decades there was a fourfold increase in premalignant and malignant lesions in the patient group and a twofold increase in controls. With relation to sex, a statistically significant difference was reached in men but not in women in the sample examined. These data show that symptomatic patients with colonic diverticula have more frequent adenomas, but not carcinomas, than symptomatic control matched by sex and age.},
}
@article {pmid3150660,
year = {1988},
author = {Christie, PM and Shaw, JH},
title = {Diverticular disease in Auckland.},
journal = {The Australian and New Zealand journal of surgery},
volume = {58},
number = {10},
pages = {795-799},
doi = {10.1111/j.1445-2197.1988.tb00982.x},
pmid = {3150660},
issn = {0004-8682},
mesh = {Acute Disease ; Adult ; Aged ; Colonic Diseases/etiology ; *Diverticulum/epidemiology/etiology/mortality/pathology/surgery ; Emergencies ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology/surgery ; Male ; Middle Aged ; New Zealand ; Retrospective Studies ; Urinary Bladder Fistula/epidemiology/surgery ; },
abstract = {A retrospective study is presented of 200 cases of diverticular disease admitted to Auckland Hospital over the 6-year period 1979-84. The epidemiology of the total group, the mode or type of presentation, pathology and investigative practice have been examined. Seventy-six patients required surgical intervention either electively or as an emergency and these cases have been considered in detail. The surgical group included 44 men and 32 women; 21 patients presented for elective resection, and 55 patients underwent surgery during their emergency admission. In the emergency group, 20 laparotomies were performed for pericolic/pelvic abscesses, five for small/large bowel obstruction, 30 for peritonitis and only one laparotomy was performed for haemorrhage. The mortality for the entire group was 4% with all deaths occurring in the acute diverticulitis group. Three deaths followed emergency surgery and a further five patients died without coming to surgery, the diagnosis of acute diverticulitis being made only at post-mortem. Overall, 44% of cases of acute diverticulitis underwent emergency surgery and a further 6% required surgery over the next 1-5 years. Resectional surgery was practised widely in the emergency group (the most common being Hartmann's operation). Less radical surgery is also preferred for localized sepsis in selected cases. The mortality was confined to patients who did not undergo resection of the septic focus. The elective group (24 patients) usually presented as a result of stricture, or chronic symptoms, and these patients generally did well with elective resection. The group of patients presenting with colonic bleeding behaved in a very benign manner. There was no mortality and only one patient required emergency surgery for bleeding.},
}
@article {pmid3273756,
year = {1988},
author = {Irvine, EJ and O'Connor, J and Frost, RA and Shorvon, P and Somers, S and Stevenson, GW and Hunt, RH},
title = {Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding.},
journal = {Gut},
volume = {29},
number = {9},
pages = {1188-1193},
pmid = {3273756},
issn = {0017-5749},
mesh = {*Barium Sulfate ; Colonic Neoplasms/diagnosis ; *Colonoscopy ; Diverticulum, Colon/diagnosis ; *Enema ; Gastrointestinal Hemorrhage/*diagnosis ; Humans ; Predictive Value of Tests ; Prospective Studies ; Rectum ; *Sigmoidoscopy ; },
abstract = {Rectal bleeding often heralds serious colonic disease. The literature suggests that colonoscopy is superior to barium enema plus sigmoidoscopy, although no good comparative studies exist. Seventy one patients with overt rectal bleeding had prospectively flexible sigmoidoscopy, double contrast barium enema and colonoscopy completed independently. Against the gold standard, the sensitivity and specificity of colonoscopy were 0.69 and 0.78 respectively for a spectrum of colonic lesions, while for combined flexible sigmoidoscopy and double contrast barium enema these values were 0.80 and 0.56, respectively. When assessing adenoma or carcinoma, colonoscopy was more sensitive at 0.82 v 0.73, while flexible sigmoidoscopy plus double contrast barium enema was superior for detecting diverticular disease. The positive predictive value for colonoscopy was 0.87 against 0.81 for flexible sigmoidoscopy and double contrast barium enema. This study confirms that colonoscopy should be a first line investigation in subjects likely to require biopsy or therapeutic intervention.},
}
@article {pmid3263990,
year = {1988},
author = {Gubbay, N},
title = {Diverticular disease of the right colon.},
journal = {Journal of clinical pathology},
volume = {41},
number = {9},
pages = {1025-1026},
pmid = {3263990},
issn = {0021-9746},
mesh = {Aged ; Colon/pathology ; Diverticulum, Colon/*pathology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Rectum ; },
}
@article {pmid3046302,
year = {1988},
author = {Dwyer, JT},
title = {Health aspects of vegetarian diets.},
journal = {The American journal of clinical nutrition},
volume = {48},
number = {3 Suppl},
pages = {712-738},
doi = {10.1093/ajcn/48.3.712},
pmid = {3046302},
issn = {0002-9165},
mesh = {Diet ; *Diet, Vegetarian ; *Health ; *Health Status ; Humans ; Mortality ; },
abstract = {Recent studies of vegetarian diets and their effects on morbidity and mortality are reviewed. Vegetarian diets are heterogeneous as are their effects on nutritional status, health, and longevity. Mortality rates are similar or lower for vegetarians than for nonvegetarians. Risks of dietary deficiency disease are increased on vegan but not on all vegetarian diets. Evidence for decreased risks for certain chronic degenerative diseases varies. Both vegetarian dietary and lifestyle practices are involved. Data are strong that vegetarians are at lesser risk for obesity, atonic constipation, lung cancer, and alcoholism. Evidence is good that risks for hypertension, coronary artery disease, type II diabetes, and gallstones are lower. Data are only fair to poor that risks of breast cancer, diverticular disease of the colon, colonic cancer, calcium kidney stones, osteoporosis, dental erosion, and dental caries are lower among vegetarians. Reduced risks for chronic degenerative diseases can also be achieved by manipulations of omnivorous diets and lifestyles.},
}
@article {pmid2848938,
year = {1988},
author = {Gangahar, DM and Liggett, SP and Casey, J and Carveth, SW and Reese, HE and Buchman, RJ and Breiner, MA},
title = {Two episodes of cytomegalovirus-associated colon perforation after heart transplantation with successful result.},
journal = {The Journal of heart transplantation},
volume = {7},
number = {5},
pages = {377-379},
pmid = {2848938},
issn = {0887-2570},
mesh = {Cecal Diseases/*etiology ; Cytomegalovirus Infections/*complications ; Diverticulitis, Colonic/complications ; *Heart Transplantation ; Humans ; Immunosuppression Therapy/adverse effects ; Intestinal Perforation/*etiology ; Male ; Middle Aged ; Recurrence ; Sigmoid Diseases/*etiology ; },
abstract = {A patient with end-stage heart disease was discharged from the hospital on postoperative day 7 after orthotopic heart transplantation. Three weeks from the day of operation, he developed sigmoid colon perforation, which required Hartmann's procedure, and 2 weeks later he had cecal disruption. A pathologic specimen showed underlying diverticular disease with associated cytomegalovirus colitis. Subsequently, the patient had multiple complications. Three months after colon perforation, the patient left the hospital, and now 1 year after transplantation he continues to do well. To the best of our knowledge, this is the first reported case of a patient who survived multiple colon perforations soon after heart transplantation.},
}
@article {pmid3402284,
year = {1988},
author = {Woods, RJ and Lavery, IC and Fazio, VW and Jagelman, DG and Weakley, FL},
title = {Internal fistulas in diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {31},
number = {8},
pages = {591-596},
doi = {10.1007/BF02556792},
pmid = {3402284},
issn = {0012-3706},
mesh = {Colonic Diseases/*etiology/surgery ; Diverticulitis, Colonic/*complications ; Female ; Fistula/*etiology/surgery ; Humans ; Intestinal Fistula/*etiology/surgery ; Male ; Middle Aged ; Urinary Bladder Fistula/*etiology/surgery ; Uterine Diseases/*etiology/surgery ; Vaginal Fistula/*etiology/surgery ; },
abstract = {Internal fistulas in diverticular disease are uncommon and have a reputation of being difficult to treat. Eighty four patients treated from 1960 to April 1986, representing 20.4 percent (84 of 412) of the surgically treated diverticular disease patients, were reviewed. Eight patients had multiple fistulas. Sixty-five percent (60 to 92) of fistulas were colovesical, 25 percent (23 of 92) colovaginal, 6.5 percent (6 of 92) coloenteric, and 3 percent (3 of 92) colouterine fistulas. There were 66 percent (35 of 53) males and 34 percent (18 of 53) females with colovesical fistulas only. Hysterectomies had been performed in 50 percent (12 of 24) and 83 percent (19 of 23) of females with colovesical and colovaginal fistulas, respectively. Operative management included: resection anastomosis, resection with anastomosis and diversion, Hartmann procedure, and three-stage procedure. In the latter half of the series there was a significant decrease in staging procedures with no significant statistical difference in complications. There were three deaths (3.5 percent) in the series. Other complications included: wound infection, 21 percent (18 of 84), enterocutaneous fistula, 1 percent (4 of 84), and anastomotic dehiscence, 5 percent (4 of 84). Primary anastomosis can be performed with acceptable morbidity and mortality and today is the procedure of choice, leaving staging procedures to selected patients.},
}
@article {pmid3172076,
year = {1988},
author = {Wisniewski, PM and Coonrod, T and Thonet, MA and Horn, AS},
title = {Early diagnosis of a diverticular colovaginal fistula with colposcopy. A case report.},
journal = {The Journal of reproductive medicine},
volume = {33},
number = {8},
pages = {705-708},
pmid = {3172076},
issn = {0024-7758},
mesh = {Aged ; Biopsy ; Colonic Diseases/*pathology/surgery ; *Colposcopy ; Diverticulitis, Colonic/*pathology ; Female ; Humans ; Hysterectomy, Vaginal ; Intestinal Fistula/*pathology/surgery ; Postoperative Complications/pathology ; Vagina/pathology ; Vaginal Fistula/*pathology/surgery ; },
abstract = {Seventy cases of colovaginal fistula complicating diverticular disease are documented in the literature. Predisposing factors are advanced age and previous hysterectomy. We diagnosed a case early on with careful colposcopic observation of the volcanic ejection of pus from multiple sites in the vaginal apex; we propose naming that phenomenon the "Io" sign after the most eruptive celestial body known. We also documented the association of a coloovarian fistula, ureteral obstruction and endometriosis with this disease process. Considering the expected growth in the geriatric population and the frequency of hysterectomy, clinicians should familiarize themselves with this life-threatening illness.},
}
@article {pmid3380980,
year = {1988},
author = {Lappas, JC and Maglinte, DD and Kopecky, KK and Cockerill, EM and Lehman, GA},
title = {Diverticular disease: imaging with post-double-contrast sigmoid flush.},
journal = {Radiology},
volume = {168},
number = {1},
pages = {35-37},
doi = {10.1148/radiology.168.1.3380980},
pmid = {3380980},
issn = {0033-8419},
mesh = {Barium Sulfate ; Colon, Sigmoid/*diagnostic imaging ; Diverticulum, Colon/*diagnostic imaging ; Enema ; Humans ; Methods ; Prospective Studies ; Radiography ; Sigmoid Diseases/*diagnostic imaging ; Water ; },
abstract = {In a prospective study, the effect of infusion of a low-density contrast material was evaluated as an adjunct to high-density, double-contrast imaging of the sigmoid colon. After double-contrast barium enema (DCBE) study, 52 consecutive patients with sigmoid diverticulosis received an additional 500-750-mL enema either with water or a 1.5% barium suspension for computed tomography. Rectosigmoid radiographs were evaluated for luminal distention, visualization of the interhaustral space, definition of diverticula, and interpretation of polypoid defects. While double-contrast views were excellent in 21% of patients, improvement in multiple factors by water or 1.5% barium flush resulted in improved sigmoid images in 65% and 75% of patients, respectively. Polyps were confirmed and artifactual defects confidently excluded. Sigmoid flush, particularly with low-density barium, is a simple adjunct to DCBE study that improves visualization of the diverticular sigmoid and increases interpretive confidence.},
}
@article {pmid3131886,
year = {1988},
author = {Segal, I},
title = {The geography of chronic digestive disease in southern Africa.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {73},
number = {11},
pages = {649-652},
pmid = {3131886},
issn = {0256-9574},
mesh = {Black or African American ; Appendicitis/epidemiology ; Black People ; Colonic Neoplasms/epidemiology ; Diet ; Digestive System Diseases/*epidemiology/etiology ; Diverticulum/epidemiology ; Duodenal Ulcer/etiology ; Esophageal Neoplasms/etiology ; Humans ; Pancreatitis/chemically induced ; South Africa ; Urbanization ; },
abstract = {Lifestyle and dietary patterns are in the process of rapid transformation in Soweto. Comparisons with whites indicate differences in bowel behaviour, lactase deficiency and breath methanes. The association between smoking pipe tobacco and cancer of the oesophagus is confirmed, but home-brew consumption has been found to be the major risk factor in this cancer. A recent swing to Western-type alcohol has led to the emergence of alcohol-induced pancreatitis in blacks. Urbanisation and westernisation have also affected the influence of the traditional healer and the incidence of duodenal ulcer disease. The fundamental environmental influence which determines non-infective large-bowel disease is diet. A dietary survey of Sowetans indicates that their present diet is low in fat and fibre. Despite the latter, appendicitis is still relatively uncommon. Other significant differences are observed in colorectal cancer and diverticular disease.},
}
@article {pmid3395751,
year = {1988},
author = {Schofield, PF},
title = {Colovesical fistulas.},
journal = {British journal of hospital medicine},
volume = {39},
number = {6},
pages = {483-487},
pmid = {3395751},
issn = {0007-1064},
mesh = {Aged ; Colonic Diseases/*etiology/surgery ; Colonic Neoplasms/complications ; Crohn Disease/complications ; Diverticulitis/complications ; Female ; Humans ; Intestinal Fistula/*etiology/surgery ; Male ; Middle Aged ; Radiation Injuries/complications ; Urinary Bladder Fistula/*etiology/surgery ; },
abstract = {Colovesical fistula often presents with recurrent or persistent urinary tract infection, especially in men. The commonest cause is diverticular disease. Other causes include carcinoma of the colon, Crohn's disease, radiotherapy and trauma. Barium enema may suggest the pathology but cystoscopy is the best investigation to confirm the presence of a fistula. One-stage resection and anastomosis is suitable for most patients with diverticular disease.},
}
@article {pmid3049349,
year = {1988},
author = {Potter, GD and Sellin, JH},
title = {Lower gastrointestinal bleeding.},
journal = {Gastroenterology clinics of North America},
volume = {17},
number = {2},
pages = {341-356},
pmid = {3049349},
issn = {0889-8553},
mesh = {Arteriovenous Malformations/complications ; Colon/blood supply ; *Colonic Diseases ; Diverticulum, Colon/complications ; Emergencies ; *Gastrointestinal Hemorrhage/etiology ; Humans ; },
abstract = {Lower gastrointestinal bleeding remains an important medical emergency. Most lower gastrointestinal bleeding is now known to come from angiodysplasia or diverticular disease. Accurate angiographic and colonoscopic diagnosis may lead to a better focus for treatment and improved survival.},
}
@article {pmid2840168,
year = {1988},
author = {Cranston, D and McWhinnie, D and Collin, J},
title = {Dietary fibre and gastrointestinal disease.},
journal = {The British journal of surgery},
volume = {75},
number = {6},
pages = {508-512},
doi = {10.1002/bjs.1800750604},
pmid = {2840168},
issn = {0007-1323},
mesh = {Dietary Fiber/*therapeutic use ; Gastrointestinal Diseases/*diet therapy/prevention & control ; Humans ; },
abstract = {This review examines the evidence linking dietary fibre to gastrointestinal disease. Fibre increases stool weight, decreases whole gut transit time and lowers colonic intraluminal pressure. While it may be of benefit in the treatment of constipation, the irritable bowel syndrome and diverticular disease, its role in the prevention or treatment of other gastrointestinal disease has yet to be established.},
}
@article {pmid3358570,
year = {1988},
author = {Klein, S and Mayer, L and Present, DH and Youner, KD and Cerulli, MA and Sachar, DB},
title = {Extraintestinal manifestations in patients with diverticulitis.},
journal = {Annals of internal medicine},
volume = {108},
number = {5},
pages = {700-702},
doi = {10.7326/0003-4819-108-5-700},
pmid = {3358570},
issn = {0003-4819},
mesh = {Aged ; Arthritis/*etiology/therapy ; Colectomy ; Colitis/diagnosis ; Crohn Disease/diagnosis ; Diagnosis, Differential ; Diverticulitis, Colonic/*complications/diagnosis/surgery ; Female ; Humans ; Male ; Middle Aged ; Pyoderma/*etiology/therapy ; Recurrence ; },
abstract = {Three patients had diverticulitis and extraintestinal manifestations of arthritis and pyoderma gangrenosum. In each, a mistaken diagnosis of idiopathic inflammatory bowel disease was first made because of extraintestinal complaints associated with the gastrointestinal symptoms of diverticular disease. The joint and skin manifestations were refractory to various treatments, including oral and intradermal steroids, immunosuppressive agents, and hyperbaric oxygen. Segmental resection of the involved colon promptly and completely resolved all symptoms, without recurrence 26 to 38 months after surgery. Microscopic examination of the resected specimens showed only diverticulitis without any evidence of chronic idiopathic inflammatory bowel disease. Patients with diverticulitis may have extraintestinal manifestations as do patients with other inflammatory diseases of the colon. The failure to recognize this relationship may result in misdiagnosis and prolonged medical therapy, whereas segmental colonic resection may be curative.},
}
@article {pmid3132221,
year = {1988},
author = {Kalra, L and Price, WR and Jones, BJ and Hamlyn, AN},
title = {Open access fibresigmoidoscopy: a comparative audit of efficacy.},
journal = {British medical journal (Clinical research ed.)},
volume = {296},
number = {6629},
pages = {1095-1096},
pmid = {3132221},
issn = {0267-0623},
mesh = {*Ambulatory Care ; Family Practice ; Female ; Fiber Optic Technology ; Gastrointestinal Hemorrhage/diagnosis ; Humans ; Inpatients ; Intestinal Diseases/diagnosis ; Male ; Medical Audit ; Rectum ; Referral and Consultation ; *Sigmoidoscopy ; },
abstract = {A total of 541 open access referrals for fibresigmoidoscopy over five years were compared with 495 hospital initiated procedures during the same period. The number of open access fibresigmoidoscopies doubled during the five years but diagnostic yield remained unchanged at about 40% and was similar to that of the hospital initiated procedures. Colorectal carcinoma was seen in 64 open access patients compared with 47 hospital referred patients, the proportion of Dukes's type A lesions being similar (34%) in both groups. Polyps, colitis, and diverticular disease were equally common in open access and hospital referred patients. Fibresigmoidoscopy failed to detect disease in only 12 patients (1.2%) and the procedure was unsatisfactory in only 54. Referral was considered justified in 475 (88%) open access patients, and only 54 (17%) patients with normal appearances at endoscopy required further investigations. Diagnostic yields were low (19%; 30/156 cases) in open access patients under 40 and in patients with abdominal pain, constipation, or abdominal pain with constipation (0-17%). Most of these young patients presumably suffer from the irritable bowel syndrome and do not justify fibresigmoidoscopy. In contrast, there was a high diagnostic yield (90-100%) in patients of all ages referred for diarrhoea and rectal bleeding, altered blood from the rectum, and rectal bleeding associated with abdominal pain. Open access fibresigmoidoscopy is an effective service that should be freely available to general practitioners.},
}
@article {pmid3387892,
year = {1988},
author = {McCallum, A and Eastwood, MA and Smith, AN and Fulton, PM},
title = {Colonic diverticulosis in patients with colorectal cancer and in controls.},
journal = {Scandinavian journal of gastroenterology},
volume = {23},
number = {3},
pages = {284-286},
doi = {10.3109/00365528809093866},
pmid = {3387892},
issn = {0036-5521},
mesh = {Barium Sulfate ; Colonic Neoplasms/*complications/diagnosis ; Diverticulum, Colon/*complications/diagnosis ; Enema ; Female ; Humans ; Male ; Middle Aged ; Rectal Neoplasms/*complications/diagnosis ; Retrospective Studies ; },
abstract = {The barium enemas of 119 patients with colorectal cancer and 119 age-matched controls were examined for evidence of diverticula. Amongst men, 39.6% of patients with colorectal cancer had diverticulosis, compared with 50% in the control group. In the women, 39.3% of patients with colorectal cancer had diverticular disease, compared with 36% of the controls. There appears to be no significant aetiologic association between the two conditions, since they do not occur together more frequently than in controls, although each is reputedly the result of fibre lack.},
}
@article {pmid3279548,
year = {1988},
author = {Chappuis, CW and Cohn, I},
title = {Acute colonic diverticulitis.},
journal = {The Surgical clinics of North America},
volume = {68},
number = {2},
pages = {301-313},
doi = {10.1016/s0039-6109(16)44479-8},
pmid = {3279548},
issn = {0039-6109},
mesh = {Abdomen, Acute/*etiology ; Acute Disease ; Anastomosis, Surgical ; Colon/surgery ; Diverticulitis, Colonic/*complications/diagnosis/therapy ; Humans ; },
abstract = {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.},
}
@article {pmid3361523,
year = {1988},
author = {Reeves, KO and Young, RL and Gordon, AN and Thomas, SJ and Redwine, WA and Edwards, GR},
title = {Sigmoidovaginal fistula secondary to diverticular disease. A report of three cases.},
journal = {The Journal of reproductive medicine},
volume = {33},
number = {3},
pages = {313-316},
pmid = {3361523},
issn = {0024-7758},
mesh = {Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Intestinal Fistula/diagnostic imaging/*etiology ; Middle Aged ; Radiography ; Sigmoid Diseases/diagnostic imaging/*etiology ; Vaginal Fistula/diagnostic imaging/*etiology ; },
abstract = {Colovaginal fistula from any cause is rare. Diverticular disease is the most common cause. We treated three women for sigmoidovaginal fistulae secondary to diverticular disease. These 3 cases bring the total number reported to 49. Diagnosis of these fistulae may be difficult, and controversy exists over which form of surgical management should be employed. Since more women are living to an age at which diverticular disease is common, colovaginal fistulae probably will be encountered by the gynecologist with increasing frequency. Colovaginal fistula secondary to diverticular disease should be considered in the differential diagnosis when an elderly women complains of flatus vaginalis.},
}
@article {pmid3043491,
year = {1988},
author = {Wilson, JL},
title = {Diverticular disease of the colon.},
journal = {Primary care},
volume = {15},
number = {1},
pages = {111-124},
pmid = {3043491},
issn = {0095-4543},
mesh = {Diagnosis, Differential ; Diverticulum, Colon/diagnosis/epidemiology/surgery/*therapy ; Humans ; },
abstract = {Diverticular disease of the colon has been called a "deficiency disease of the Western Civilization" and has become increasingly more common in industrialized countries during this century. Diets low in fiber predispose the patient to the development of this condition, and adding fiber to the diet is effective in prevention and treatment. Most patients with the condition are asymptomatic, but many patients experience pain and bowel disturbance along with other symptoms. Complications include infection, bowel obstruction and bleeding, and they may be life threatening. Medical and/or surgical management are indicated.},
}
@article {pmid3379776,
year = {1988},
author = {Kubo, A and Kagaya, T and Nakagawa, H and Kuma, E},
title = {[Diverticular disease of the colon].},
journal = {Nihon rinsho. Japanese journal of clinical medicine},
volume = {46},
number = {2},
pages = {417-422},
pmid = {3379776},
issn = {0047-1852},
mesh = {Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diet ; Diverticulitis, Colonic/complications ; Diverticulum, Colon/complications/*epidemiology/therapy ; Female ; Humans ; Male ; Middle Aged ; Sex Factors ; },
}
@article {pmid3375529,
year = {1988},
author = {Suárez Muñoz, MA and Navarro Piñero, A and López Rueda, B and Sánchez Gallego, P and Lage Galle, JM and Mate Hurtado, A and De la Fuente Perucho, A},
title = {[Treatment of complicated diverticular disease. Our experience].},
journal = {Revista espanola de las enfermedades del aparato digestivo},
volume = {73},
number = {2},
pages = {191-196},
pmid = {3375529},
issn = {0034-9437},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis/complications/*surgery ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid3345933,
year = {1988},
author = {Trotman, IF and Misiewicz, JJ},
title = {Sigmoid motility in diverticular disease and the irritable bowel syndrome.},
journal = {Gut},
volume = {29},
number = {2},
pages = {218-222},
pmid = {3345933},
issn = {0017-5749},
mesh = {Adult ; Aged ; Colon, Sigmoid/*physiopathology ; Colonic Diseases, Functional/*physiopathology ; Diverticulum, Colon/*physiopathology ; Female ; Food ; *Gastrointestinal Motility ; Humans ; Male ; Middle Aged ; Pressure ; Sigmoid Diseases/*physiopathology ; },
abstract = {Intraluminal pressures were measured with four open ended, water perfused tubes in the fasting state and after a standard liquid meal (400 KCal, 375 ml, protein 15 g, carbohydrate 55 g, lipid 13.4 g) in six patients with sigmoid diverticular disease, 20 with the irritable bowel syndrome and in 13 controls. The pressure sensors were positioned in the true sigmoid colon at colonoscopy at 25, 35, 45, and 55 cm from the anus. Colonic pressures were significantly higher in diverticular disease than in controls before (p less than 0.02) and after the meal (p less than 0.002), some pressure amplitudes exceeding 300 cm H2O. Patients with the irritable bowel syndrome had lower (p less than 0.05) pressures than controls before the meal. Postprandial sigmoid pressures were within the mean +/- 2 SD of controls in 10, above in two and below in eight patients with the irritable bowel. Hypercontractility of the sigmoid colon in the irritable bowel syndrome was not confirmed under the conditions of this study. The association between sigmoid diverticulosis and high intraluminal pressures is confirmed.},
}
@article {pmid3338344,
year = {1988},
author = {Schein, M and Decker, G},
title = {The Hartmann procedure. Extended indications in severe intra-abdominal infection.},
journal = {Diseases of the colon and rectum},
volume = {31},
number = {2},
pages = {126-129},
doi = {10.1007/BF02562644},
pmid = {3338344},
issn = {0012-3706},
mesh = {Abdomen, Acute/*surgery ; Adult ; Aged ; Aged, 80 and over ; Colon/*injuries ; Colonic Neoplasms/*surgery ; Colostomy/adverse effects/*methods/mortality ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Laparotomy ; Male ; Middle Aged ; Reoperation ; Surgical Wound Infection/epidemiology ; },
abstract = {During a three-year period, 30 patients had emergency Hartmann procedures for diverticular disease (N = 12), carcinoma (N = 6), trauma (N = 3), and miscellaneous causes (N = 9). Two patients died postoperatively (6.7 percent) and wound infection developed in 60 percent of the patients. Planned relaparotomies for severe intra-abdominal infection were performed in ten patients (an average of 2.5 procedures per patient) with no mortality. In five cases a mucous fistula was converted into a Hartmann pouch; a preference for the Hartmann pouch in patients undergoing repeated explorations is discussed. Colorectal continuity was subsequently restored in 23 patients (76.6 percent).},
}
@article {pmid3277310,
year = {1988},
author = {Pruett, TL and Simmons, RL},
title = {Status of percutaneous catheter drainage of abscesses.},
journal = {The Surgical clinics of North America},
volume = {68},
number = {1},
pages = {89-105},
doi = {10.1016/s0039-6109(16)44434-8},
pmid = {3277310},
issn = {0039-6109},
mesh = {Abdomen/surgery ; Abscess/diagnostic imaging/mortality/*therapy ; Catheterization/instrumentation/methods ; Drainage/instrumentation/*methods ; Evaluation Studies as Topic ; Humans ; Needles ; Radiography, Abdominal ; },
abstract = {The definitive role of catheter drainage in the therapy of abscesses has not yet been totally elucidated. The resolution rate of intra-abdominal infection with catheter drainage is highly variable, depending on the inclusion criteria employed. Certain infections are very effectively treated (i.e., abscesses that are single, not communicating with abdominal viscera, noncancerous, and bacterial) with simple catheter drainage, whereas others (i.e., infected pancreatic tumor phlegmon) prove to be much more resistant to simple catheter drainage. When all intra-abdominal "abscesses" are collected, the success of catheter drainage ranges from 47 per cent to 73 per cent. The wide variation should be seen not so much as a reflection of differences in technical ability of the radiologist to introduce a catheter, but rather as emblematic of the highly variable nature of the cause of intra-abdominal infection and the definition of an abscess. Hospitals with a large number of complex problems such as malignancy, transplant and other immunosuppressed patients, and referrals of patients with complex long-standing intra-abdominal infections are likely to have a much lower rate of success with percutaneously placed catheters than are those institutions that derive their series from post-traumatic or primary diseases such as appendiceal or diverticular disease. In the former series, a higher morbidity and mortality rate would be expected from any form of treatment when compared to a series from a practice based on more primary care problems. Intra-abdominal infections are a heterogeneous set of processes, and the role of interventional radiology in the diagnostic and therapeutic approach cannot be underestimated. In planning for the care of a patient with a presumed intra-abdominal infectious process, percutaneous aspiration of a fluid mass is an effective tool for establishing the diagnosis of an abscess. The brief introduction of a catheter has rarely led to contamination of an otherwise sterile collection. However, it often effects dramatic symptomatic relief if the fluid collection is infected. It has therefore been an evolving recommendation to employ the techniques of interventional radiology aggressively in a diagnostic capacity. Subsequently, therapeutic interventions can be undertaken in joint agreement among the physician, surgeon, and radiologist. The diagnosis and treatment of intra-abdominal infections can often times be carried out in a relatively easy and non-morbid manner that effects cure in a significant percentage of patients.(ABSTRACT TRUNCATED AT 400 WORDS)},
}
@article {pmid3122983,
year = {1988},
author = {Lindsay, DC and Freeman, JG and Cobden, I and Record, CO},
title = {Should colonoscopy be the first investigation for colonic disease?.},
journal = {British medical journal (Clinical research ed.)},
volume = {296},
number = {6616},
pages = {167-169},
pmid = {3122983},
issn = {0267-0623},
mesh = {Adult ; Aged ; Aged, 80 and over ; Barium Sulfate ; Colonic Diseases/*diagnosis/diagnostic imaging ; *Colonoscopy ; Enema ; Humans ; Middle Aged ; Radiography ; Sigmoidoscopy ; },
abstract = {Many patients with suspected colonic disease undergo rigid sigmoidoscopy, barium enema examination, and ultimately total colonoscopy, but the need for preliminary radiology has not been formally assessed. A total of 168 patients requiring large bowel investigation were therefore randomised to undergo either rigid sigmoidoscopy plus double contrast barium enema examination or total colonoscopy. Disease was found in 56 patients, including 14 with a carcinoma, 11 with polyps, and 16 with inflammatory bowel disease, the remainder having diverticular disease alone. Of the 89 patients allocated to double contrast barium enema examination, nine required a subsequent colonoscopy for suspected tumour or polyps, three because of incomplete radiological examination, and 12 for rectal bleeding for which no cause was found at the radiological examination. In 16 patients this yielded further information or altered treatment. Of the 79 patients undergoing total colonoscopy, only six required subsequent radiology. As both procedures were well tolerated with no major complications total colonoscopy may be the preferred initial investigation where facilities allow.},
}
@article {pmid3381318,
year = {1988},
author = {Omojola, MF and Mangete, E},
title = {Diverticula of the colon in three Nigerian siblings.},
journal = {Tropical and geographical medicine},
volume = {40},
number = {1},
pages = {54-57},
pmid = {3381318},
issn = {0041-3232},
mesh = {Diverticulum, Colon/epidemiology/*genetics/pathology ; Female ; Humans ; Male ; Middle Aged ; Nigeria ; },
abstract = {This is a report of diverticular disease of the colon in three Nigerian adult siblings. Diverticular disease of the colon is known to be rare in Nigerians. Presence of this disease in a large number of a particular family raises the possibility of a familial tendency or some other undefined underlying abnormality. The three siblings have spent some years in the industrialized world. Our anecdotal experience however shows that the prevalence of diverticular disease of the colon may be on the increase in Nigeria.},
}
@article {pmid3350273,
year = {1988},
author = {Chen, YM and Ott, DJ and Gelfand, DW and Munitz, HA},
title = {Impact of the barium enema on patient management.},
journal = {Gastrointestinal radiology},
volume = {13},
number = {1},
pages = {81-84},
pmid = {3350273},
issn = {0364-2356},
mesh = {*Barium Sulfate ; Colonic Diseases/*diagnosis ; *Enema ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {The medical records of 214 consecutive inpatients who had a barium enema examination were reviewed, and the clinical indications, efficacy of the barium enema, and patient outcome were correlated to determine the impact of the barium enema on patient management. The most frequent indications were rectal bleeding (33%), abdominal pain (31%), anemia (17%), weight loss (12%), and previous lesions needing reevaluation (12%). Diverticular disease (30%), colonic polyps (10%), and primary or secondary malignancies (12%) were the most common abnormalities detected radiographically. The sensitivity of the barium enema for colonic neoplasms was 89%, with only 1 small cecal polyp being undetected. The effects of barium enema on patient management were serious pathology excluded (64%), diagnosis made that changed therapy (24%), existing therapy continued (10%), and a further study ordered (2%). No serious or life-threatening lesion was missed by barium enema.},
}
@article {pmid3243753,
year = {1988},
author = {Francot, C and Blomme, G},
title = {A complicated case of sigmoid diverticular disease.},
journal = {Journal belge de radiologie},
volume = {71},
number = {6},
pages = {724-725},
pmid = {3243753},
issn = {0302-7430},
mesh = {Abscess/etiology ; Diverticulitis/*complications ; Humans ; Intestinal Perforation/diagnostic imaging/*etiology ; Male ; Mesentery ; Middle Aged ; Peritonitis/etiology ; Sigmoid Diseases/*complications/diagnostic imaging/surgery ; Tomography, X-Ray Computed ; },
}
@article {pmid3242146,
year = {1988},
author = {Schrock, TR},
title = {Conceptual developments through colonoscopy.},
journal = {Surgical endoscopy},
volume = {2},
number = {4},
pages = {240-244},
pmid = {3242146},
issn = {0930-2794},
mesh = {Colonic Diseases/diagnosis/surgery ; *Colonoscopy/trends ; Diagnosis, Differential ; Forecasting ; Humans ; },
abstract = {Fiberoptic colonoscopy is 25 years old this year. Improvement in instruments led rapidly to wide acceptance of colonoscopy in diagnosis and therapy of colorectal diseases. The diagnosis of benign and malignant neoplasms was revolutionized by colonoscopy. The differential diagnosis of inflammatory bowel disease, assessment of its extent and severity, response to treatment, and potential for development of cancer are all made easier by colonoscopy. Colonoscopy has improved the diagnosis of diverticular disease, rectal bleeding, identification of ischemia, and other problems. Therapeutic colonoscopy has radically changed the management of colonic polyps, and colonoscopic polypectomy is now the standard form of treatment for most of these lesions. Treatment of bleeding lesions, decompression of obstruction, and removal of foreign bodies are other examples of therapeutic colonoscopic procedures.},
}
@article {pmid3691263,
year = {1987},
author = {Finlay, IG and Carter, DC},
title = {A comparison of emergency resection and staged management in perforated diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {30},
number = {12},
pages = {929-933},
doi = {10.1007/BF02554278},
pmid = {3691263},
issn = {0012-3706},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/mortality/*surgery ; Colostomy ; Diverticulum, Colon/complications/mortality/*surgery ; Emergencies ; Female ; Humans ; Intestinal Perforation/complications/mortality/*surgery ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; },
abstract = {This retrospective view examines the outcome of surgical treatment of perforated diverticular disease in one hospital in the period 1976 to 1983. Of the 78 patients, 38 underwent emergency colonic resection (group A) whereas 40 (group b) were treated by proximal colostomy and drainage (37 patients) or suture of the perforation with drainage (three patients). There was no significant difference between groups A and B in terms of operative mortality (21 percent vs. 24 percent, respectively). Mortality rates were highest in patients with generalized peritonitis treated by colostomy and drainage (36 percent), whereas those with localized disease undergoing resection had a mortality rate of 17 percent (P less than .05). Eight of the 40 patients in group B developed fistulas whereas none of the group A patients had this complication. Only four (16 percent) of the surviving group A patients were left with a permanent colostomy as opposed to 15 (56 percent) of their counterparts in group B. In the presence of perforated diverticular disease, emergency resection carries a lower morbidity than colostomy and drainage, although the present review shows no statistically significant differences in terms of mortality.},
}
@article {pmid3120962,
year = {1987},
author = {Corder, A},
title = {Steroids, non-steroidal anti-inflammatory drugs, and serious septic complications of diverticular disease.},
journal = {British medical journal (Clinical research ed.)},
volume = {295},
number = {6608},
pages = {1238},
pmid = {3120962},
issn = {0267-0623},
mesh = {Abscess/etiology ; Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents/*adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Diverticulum, Colon/*complications ; Female ; Humans ; Male ; Middle Aged ; Peritonitis/etiology ; Sepsis/etiology ; Steroids ; },
}
@article {pmid3694019,
year = {1987},
author = {Thomson, HJ and Busuttil, A and Eastwood, MA and Smith, AN and Elton, RA},
title = {Submucosal collagen changes in the normal colon and in diverticular disease.},
journal = {International journal of colorectal disease},
volume = {2},
number = {4},
pages = {208-213},
pmid = {3694019},
issn = {0179-1958},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aging/metabolism ; Child ; Collagen/*analysis ; Colon/*ultrastructure ; Diverticulum, Colon/metabolism/*pathology ; Female ; Humans ; Intestinal Mucosa/analysis/pathology/*ultrastructure ; Male ; Middle Aged ; Sex Factors ; },
abstract = {Full thickness specimens of normal colon (n = 15), and colon from patients with diverticular disease (n = 5) were obtained at operation or autopsy. In the isolated submucosa the ultrastructure of the constituent collagen fibres was examined by transmission electron microscopy. Collagen fibrils in the left colon become smaller (p less than 0.001) and more tightly packed (p less than 0.001) than those in the right colon with increasing age. This difference is accentuated in diverticular disease (p less than 0.01). Factors which contribute to the development of colonic diverticulosis, such as raised intraluminal pressure, may be responsible for premature change in submucosal structure.},
}
@article {pmid3439923,
year = {1987},
author = {Sweeney, JL and Hoffmann, DC},
title = {Restoration of continuity after Hartmann's procedure for the complications of diverticular disease.},
journal = {The Australian and New Zealand journal of surgery},
volume = {57},
number = {11},
pages = {823-825},
doi = {10.1111/j.1445-2197.1987.tb01273.x},
pmid = {3439923},
issn = {0004-8682},
mesh = {Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects/methods ; Colon/*surgery ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Male ; Middle Aged ; Peritonitis/etiology/*surgery ; Reoperation ; Retrospective Studies ; Surgical Staplers/adverse effects ; },
abstract = {Although Hartmann's procedure has been accepted by most as the treatment of choice for diverticular disease complicated by generalized peritonitis, restoration of continuity may be difficult. A retrospective review of 30 patients, having had Hartmann's procedure for complicated diverticular disease, was made to assess restoration of continuity and factors which may influence its performance. This revealed zero mortality with a morbidity rate of 31.5% and a reversibility rate of 85% (with two cases still awaiting restoration of continuity).},
}
@article {pmid3690780,
year = {1987},
author = {Dagradi, V and Lolli, P and Piccinelli, D and Delaini, GG and Carolo, F and Merico, G},
title = {[Our experience in the surgical treatment of diverticular disease (I: Election)].},
journal = {Chirurgia italiana},
volume = {39},
number = {5},
pages = {439-443},
pmid = {3690780},
issn = {0009-4773},
mesh = {Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Middle Aged ; Recurrence ; },
abstract = {The authors review their patient population with regard to the surgical treatment of diverticular disease. This population consists of 76 cases, 30 of which were subjected to elective surgery. They conclude by stating that, in the light of their experience, the most effective elective operation is resection of the tract affected by diverticuli followed by and end-to-end anastomosis with the protection of a decompressive transversostomy.},
}
@article {pmid3040840,
year = {1987},
author = {Klurfeld, DM},
title = {The role of dietary fiber in gastrointestinal disease.},
journal = {Journal of the American Dietetic Association},
volume = {87},
number = {9},
pages = {1172-1177},
pmid = {3040840},
issn = {0002-8223},
mesh = {Animals ; Cholelithiasis/prevention & control ; Colonic Diseases, Functional/prevention & control ; Colonic Neoplasms/prevention & control ; Constipation/prevention & control ; Dietary Fiber/adverse effects/*therapeutic use ; Diverticulum, Colon/prevention & control ; Gastrointestinal Diseases/*prevention & control ; Humans ; Intestinal Obstruction/etiology ; Peptic Ulcer/therapy ; Rats ; },
abstract = {The most consistent benefit of consumption of adequate dietary fiber is regular laxation; this effect alone justifies inclusion of fiber in the diet, in view of the enormous expenditure on drugs for digestive diseases. Dietary fiber has proved effective in decreasing symptoms of diverticular disease, Crohn's disease, and hemorrhoids in a limited number of small clinical studies. Fiber may also reduce the incidence of gallstone formation. Fiber is currently being touted as protection against colon cancer. However, the epidemiological and experimental data do not provide convincing evidence that fiber alone is a major determinant of risk for colon cancer. Furthermore, the data from international comparisons indicating that fiber is protective against colon cancer can be used in a similar simplistic manner to suggest that fiber may be a risk factor for stomach cancer. This should not dissuade individuals from obtaining adequate fiber from a wide variety of foods but should caution them against consumption of excessive amounts of fiber from a single source or from dietary supplements.},
}
@article {pmid3681805,
year = {1987},
author = {Grainger, R and Edwards, MH},
title = {Complicated colonic diverticular disease in two young adult brothers.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {32},
number = {4},
pages = {255-256},
pmid = {3681805},
issn = {0035-8835},
mesh = {Adult ; Diverticulum, Colon/*genetics ; Humans ; Male ; },
}
@article {pmid3608731,
year = {1987},
author = {Suchowiecky, M and Clarke, DD and Bhasker, M and Perry, RJ and Snape, WJ},
title = {Effect of secoverine on colonic myoelectric activity in diverticular disease of the colon.},
journal = {Digestive diseases and sciences},
volume = {32},
number = {8},
pages = {833-840},
pmid = {3608731},
issn = {0163-2116},
support = {R0I-AM-31147/AM/NIADDK NIH HHS/United States ; },
mesh = {Aged ; Diverticulum, Colon/*physiopathology ; Double-Blind Method ; Electromyography ; Electrophysiology ; Female ; Gastrointestinal Motility/*drug effects ; Humans ; Male ; Middle Aged ; Muscle, Smooth/*physiopathology ; Phenethylamines/*pharmacology ; Prospective Studies ; Random Allocation ; },
abstract = {The effect of secoverine on colonic smooth muscle was measured in patients with diverticular disease and in healthy subjects. The frequency of slow wave activity was determined using the fast Fourier transform (FFT) and peak identification analysis (SWSA). The mean slow wave frequency was similar (6 cycles/minute) in healthy subjects using both analytic methods. The slow wave frequency in patients with diverticular disease was similar to that in healthy subjects. The peak frequency measured with SWSA was uniformly higher than that measured with FFT. Secoverine, a muscarinic antagonist, did not affect the slow wave frequency. Eating a 1000-kcal meal initiates an increase in colonic spike activity (22 +/- 2 spike potential/30 min) (P less than 0.001) in healthy subjects during the immediate postprandial period. The gastrocolonic response in patients with diverticular disease was prolonged for 60 min. Secoverine inhibited the gastrocolonic response in patients with diverticular disease. These studies suggest patients with diverticular disease have a similar slow wave frequency as healthy subjects, the gastrocolonic response is prolonged in patients with diverticular disease, and secoverine inhibits the colonic response.},
}
@article {pmid3631873,
year = {1987},
author = {Pollard, SG and Macfarlane, R and Greatorex, R and Everett, WG and Hartfall, WG},
title = {Colovesical fistula.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {69},
number = {4},
pages = {163-165},
pmid = {3631873},
issn = {0035-8843},
mesh = {Colon/surgery ; Colonic Diseases/diagnosis/etiology/*surgery ; Female ; Humans ; Intestinal Fistula/diagnosis/etiology/*surgery ; Male ; Urinary Bladder/surgery ; Urinary Bladder Fistula/diagnosis/etiology/*surgery ; },
abstract = {The experience of 66 cases of colovesical fistula is reported. The most common cause was diverticular disease (71%), the remainder being due to malignancy, Crohn's disease, radiotherapy, appendicitis and trauma. The most sensitive investigation was barium enema, which was abnormal in 98% and actually showed the fistula in 57%. In 32 patients a single stage resection was performed, without mortality or significant morbidity and we would advocate this form of treatment for fistulae which are not complicated by gross sepsis or obstruction.},
}
@article {pmid3628920,
year = {1987},
author = {Prytz Pérez, MA and Pérez Albelo, T and Hernández Armas, J and Toledo Trujillo, F and Otón Sánchez, C},
title = {[Epidemiology of diverticular disease of the colon in the province of Santa Cruz de Tenerife].},
journal = {Revista espanola de las enfermedades del aparato digestivo},
volume = {72},
number = {1},
pages = {13-17},
pmid = {3628920},
issn = {0034-9437},
mesh = {Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Diverticulum, Colon/complications/*epidemiology/pathology ; Female ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies ; Socioeconomic Factors ; Spain ; },
}
@article {pmid3474129,
year = {1987},
author = {Frykholm, G and Enblad, P and Påhlman, L and Busch, C},
title = {Expression of the carcinoma-associated antigens CA 19-9 and CA-50 in inflammatory bowel disease.},
journal = {Diseases of the colon and rectum},
volume = {30},
number = {7},
pages = {545-548},
doi = {10.1007/BF02554787},
pmid = {3474129},
issn = {0012-3706},
mesh = {Antigens, Neoplasm/*analysis ; Antigens, Surface/*analysis ; Antigens, Tumor-Associated, Carbohydrate ; Colitis, Ulcerative/*diagnosis/immunology ; Crohn Disease/*diagnosis/immunology ; Diagnosis, Differential ; Humans ; Precancerous Conditions/diagnosis/immunology ; Time Factors ; },
abstract = {The expression of gastrointestinal cancer antigen, CA 19-9, and of carcinoma-associated antigen, CA-50, was studied in formalin-fixed and paraffin-embedded tissue from 18 patients with ulcerative colitis, 29 with Crohn's disease in the colon, four with diverticular disease, and eight with sigmoid volvulus. None of the patients with inflammatory bowel disease showed strong dysplasia or had manifest carcinoma. Both antigens were expressed frequently in patients with inflammatory bowel disease. Of the 18 patients with ulcerative colitis, 17 were positive for both CA 19-9 and CA-50, and of the 29 with Crohn's colitis, 21 were positive for CA 19-9 and 22 for CA-50. No distinct differences in antigenic expression were found between Crohn's disease and ulcerative colitis. CA-50 was expressed in normal colonic mucosa from 10 of 12 patients with sigmoid volvulus or diverticular disease, and such mucosa was positive for CA 19-9 in three of the four patients with diverticular disease and in two of the eight patients with sigmoid volvulus. It is concluded that immunodetection of CA-50 or CA 19-9 is of limited value in the differential diagnosis of inflammatory bowel disease. The usefulness of these antigens as markers for precancerous changes in inflammatory bowel disease is also doubtful, since the expression is also frequent in cases of inflammatory lesions, with no obviously increased risk of malignancy.},
}
@article {pmid3324923,
year = {1987},
author = {Sugihara, K},
title = {Diverticular disease of the colon in Japan.},
journal = {Annals of the Academy of Medicine, Singapore},
volume = {16},
number = {3},
pages = {504-508},
pmid = {3324923},
issn = {0304-4602},
mesh = {Adult ; Aged ; Colon/physiopathology ; Diverticulitis/epidemiology ; *Diverticulum, Colon/epidemiology/pathology/physiopathology ; Female ; Gastrointestinal Motility ; Humans ; Japan ; Male ; Middle Aged ; Pressure ; },
abstract = {In order to clarify characteristics of diverticular disease in Japan, 625 patients with diverticular disease were studied. The frequency was 13.3% and increasing with years. The right-sided type was seen in 68.8% and was common in the younger patients. 77 patients were complicated with diverticulitis; 61 presented right sided diverticulitis and 16 left-sided diverticulitis. Most of those with right-sided diverticulitis recovered with medical treatment successfully. Drainage and supplemental appendectomy were recommended procedure for emergency operation. Patients with recurring inflammation should receive elective right hemicolectomy. Intraluminal pressure studies disclosed abnormal motility with high intraluminal pressure of the ascending colon in the patients with right-sided diverticular disease. This abnormal motility might play an important role in the pathogenesis of right-sided diverticular disease.},
}
@article {pmid3656233,
year = {1987},
author = {Naraynsingh, V and Sieunarine, K and Rao, K and Raju, GC},
title = {Diverticular disease in the West Indies: a Trinidad study.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {32},
number = {3},
pages = {137-138},
pmid = {3656233},
issn = {0035-8835},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulum, Colon/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Trinidad and Tobago ; },
}
@article {pmid3646660,
year = {1987},
author = {Alterescu, KB},
title = {Colostomy.},
journal = {The Nursing clinics of North America},
volume = {22},
number = {2},
pages = {281-289},
pmid = {3646660},
issn = {0029-6465},
mesh = {*Colostomy/methods/nursing ; Humans ; Postoperative Care ; Postoperative Complications/nursing ; Preoperative Care ; },
abstract = {The colostomy is the most commonly performed diversion of the fecal stream in the surgical management of colorectal carcinoma, diverticular disease, congenital birth defects, and trauma. The evolution of the colostomy has resulted in improved surgical techniques and a better quality of life for the patient. The clinician should be familiar with the indications for colostomy surgery, the different types of colostomies, preoperative and postoperative care, complications related to colostomy, and special diagnostic procedures required for follow-up care.},
}
@article {pmid3611227,
year = {1987},
author = {Dubertret, M and Bouillot, JL and Alexandre, JH},
title = {[Diverticular peritonitis. Clinical, prognosis and therapeutic aspects].},
journal = {Journal de chirurgie},
volume = {124},
number = {5},
pages = {299-303},
pmid = {3611227},
issn = {0021-7697},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*complications/surgery ; Female ; Humans ; Intestinal Perforation/*complications ; Male ; Middle Aged ; Peritonitis/*complications/diagnosis/mortality ; Prognosis ; },
abstract = {The results of diagnosis and management of perforated sigmoid diverticulitis were studied retrospectively over a 10 years period. 23 patients underwent operation, 17 for generalized peritonitis and 6 for local peritonitis. The mean age of patients was 65.7 years. Diverticular disease were known previously in 5 patients (21%) and complicated (diverticulitis) in 2 patients (8.6%). Depending on the symptoms and the spreading of the peritonitis 4 types of the disease can be described: primary generalized peritonitis, secondary generalized peritonitis, progressive generalized peritonitis and local peritonitis. Hartman procedure was performed in 16 patients, and proximal colostomy with drainage in 6 patients, ideal resection in one. The over all mortality was 34.7%, 43% after resection, 16% after conservatrice procedure, depending on the clinical status, duration of symptoms, type of peritonitis, surgical procedure. Improved results will require early diagnosis, adapted surgical procedure, appropriate antibiotics therapy and extension of prophylactic segmentation colectomie after one acute diverticulitis.},
}
@article {pmid3593110,
year = {1987},
author = {Barker, B},
title = {Diverticular disease.},
journal = {Australian family physician},
volume = {16},
number = {4},
pages = {420},
pmid = {3593110},
issn = {0300-8495},
mesh = {Diverticulum, Colon/*physiopathology ; Humans ; *Patient Education as Topic ; Peristalsis ; },
}
@article {pmid3562383,
year = {1987},
author = {Bingley, LJ and Iung, E},
title = {Colonic diverticular disease. Its spectrum in a community hospital.},
journal = {Postgraduate medicine},
volume = {81},
number = {5},
pages = {79-81, 84},
doi = {10.1080/00325481.1987.11699782},
pmid = {3562383},
issn = {0032-5481},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/complications/*epidemiology ; Diverticulum, Colon/complications/*epidemiology ; Female ; *Hospitals, Community ; Humans ; Male ; Michigan ; Middle Aged ; Retrospective Studies ; },
abstract = {A retrospective study of 239 patients who were hospitalized for diverticular disease is reported. Two thirds of patients had simple diverticulosis, and the remainder had gastrointestinal bleeding, evidence of microabscess, or more serious complications. The prevalence of bleeding on the left side in this series differs from the prevalence of right-sided bleeding noted in the literature, and this difference is unexplained. Only three patients in this series died (overall mortality, 1.2%); all had other associated life-threatening diseases.},
}
@article {pmid3496039,
year = {1987},
author = {Poilleux, J and Delhomme, P and Gignoux, M and Joubert, M and Lalaude, J and Laurent, B and Lemarchand, F and Marchand, P and Piel-Desruisseaux, JL and Samama, G},
title = {[Complications of diverticular disease of the colon. Apropos of 247 cases].},
journal = {Annales de gastroenterologie et d'hepatologie},
volume = {23},
number = {2},
pages = {55-61},
pmid = {3496039},
issn = {0066-2070},
mesh = {Abscess/complications ; Colitis/etiology ; Diverticulitis, Colonic/*complications ; Diverticulum, Colon/*complications ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/complications ; Intestinal Perforation/etiology ; Pelvis ; Peritonitis/etiology ; Sigmoid Diseases/etiology ; },
abstract = {In the last five years, 7 teams, members of a surgical club of lower Normandy, have performed 1,136 colon procedures, including 247 for severe diverticular disease. The patients were grouped in two categories according to the severity of the complications presented: 159 sub-acute complications including 137 acute cases of sigmoiditis (diverticulitis, peri-colic micro abscesses, pseudo-tumoral forms) and 22 fistulae, 88 severe acute complications including 60 generalized peritonites, 12 huge abscesses, 9 occlusions and 7 hemorrhages. The total post-operative mortality is 6 p. cent. It is quite different in the surgery of sub-acute complications (0.6%) and the surgery of acute severe complications (16%). The total morbidity reaches 14.8 p. cent. Complications are more frequent and more severe in acute forms (18.5%) than in subacute forms (10.5%). At long term, 10.8 p. cent of the patients operated upon, kept a permanent colostomy (25 p. cent in acute forms vs 2.3 p. cent in subacute forms). 89.2 p. cent have a normal digestive tract following treatment (97.7 p. cent in subacute forms and 53 p. cent in acute forms).},
}
@article {pmid3103994,
year = {1987},
author = {Finkelstein, JA and Jamieson, CG},
title = {An association between anti-inflammatory medication and internal pelvic fistulas.},
journal = {Diseases of the colon and rectum},
volume = {30},
number = {3},
pages = {168-170},
doi = {10.1007/BF02554329},
pmid = {3103994},
issn = {0012-3706},
mesh = {Adult ; Aged ; Anti-Inflammatory Agents/*adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects ; Diverticulum/complications ; Female ; Fistula/*chemically induced ; Humans ; Male ; Middle Aged ; *Pelvis ; Steroids ; },
abstract = {Spontaneous internal fistulas involving intestine, rectum, bladder, or vagina in patients without predisposing illnesses were studied. Twelve of 20 (60 percent) were receiving steroids or other anti-inflammatory medication at the time the fistulas developed. Fifteen of the 20 patients subsequently had diverticular disease identified. It is proposed that there is an association between anti-inflammatory medication and fistulas that develop from intestine to other pelvic viscera, spontaneously or in association with colonic diverticula.},
}
@article {pmid3667206,
year = {1987},
author = {Fiora, U and Calvo, F and Carpani, G and De Giuli, M and Freddi, M},
title = {One-stage operation for diverticular disease.},
journal = {The Italian journal of surgical sciences},
volume = {17},
number = {3},
pages = {233-237},
pmid = {3667206},
issn = {0392-3525},
mesh = {Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Diverticulitis/*surgery ; Female ; Humans ; Intestinal Diseases/surgery ; *Intestine, Large/surgery ; Male ; Methods ; Middle Aged ; Postoperative Complications ; },
abstract = {The experience with 59 patients affected by diverticular disease who underwent surgery after failure of medical treatment, is reported. 40 patients showed one or more postoperative complications, 19 none. The operations performed were: in 46 cases one-stage resection with anastomosis, Hartmann's operation in 8 and other procedures in 5. Six patients died: 3 after Harmann's operation, 2 after colostomy and one after anastomosis. The mean stay in bed for complicated cases was 24 days after anastomosis and 36 after Hartmann's operation. Therefore anastomosis is preferred in all cases including those with stenosis, fistula or abscess provided that peritonitis is not present. The anastomosis is performed away from the site of abdominal sepsis. In cases with peritonitis the selected surgical procedure is usually Hartmann's operation.},
}
@article {pmid3625583,
year = {1987},
author = {Thomas, C and Madden, F and Jehu, D},
title = {Psychological effects of stomas--I. Psychosocial morbidity one year after surgery.},
journal = {Journal of psychosomatic research},
volume = {31},
number = {3},
pages = {311-316},
doi = {10.1016/0022-3999(87)90050-x},
pmid = {3625583},
issn = {0022-3999},
mesh = {Adaptation, Psychological ; Anxiety/*etiology ; Colostomy/*psychology ; Depression/*etiology ; Female ; Humans ; Ileostomy/*psychology ; Male ; Postoperative Complications/*psychology ; Prospective Studies ; Social Adjustment ; Time Factors ; },
abstract = {Sixty eight subjects who had undergone stoma surgery 12 months previously were assessed as to their psychiatric and social outcome. They had been previously also assessed at the 3rd month postoperatively. The majority had a diagnosis of bowel cancer (38) and smaller numbers had inflammatory bowel disease (15) or diverticular disease (15). 22% of the subjects had moderate or severe psychiatric symptoms and most of these had also shown similar disturbance at the 3 month assessment, indicating that the condition was longstanding. There was no significant difference in outcome between the diagnostic groups. The results also showed that ability to perform housework, leisure and sexual activities was affected in a number of subjects.},
}
@article {pmid3596145,
year = {1987},
author = {Tobin, KD and Young, JW},
title = {The bowler hat: a valid sign of colonic polyps?.},
journal = {Gastrointestinal radiology},
volume = {12},
number = {3},
pages = {250-252},
pmid = {3596145},
issn = {0364-2356},
mesh = {Barium Sulfate ; Colonic Polyps/*diagnostic imaging ; Diagnosis, Differential ; Diverticulum, Colon/*diagnostic imaging ; Humans ; Radiography ; Retrospective Studies ; },
abstract = {This report briefly describes several cases of diverticula simulating colonic mucosal lesions. We have found that the bowler hat configuration, in particular, frequently occurs in the presence of diverticular disease. In our series, no polyp was found to exhibit the bowler hat sign, while 12 cases of diverticular disease displayed 1 or more "bowler hats." Differentiation between polyps and diverticula displaying the bowler hat sign may be possible, but we conclude that the bowler hat sign per se is a nonspecific finding and that additional views may be necessary to confirm the presence of polyps.},
}
@article {pmid3547705,
year = {1987},
author = {Tudor, RG and Keighley, MR},
title = {The options in surgical treatment of diverticular disease.},
journal = {Surgery annual},
volume = {19},
number = {},
pages = {135-149},
pmid = {3547705},
issn = {0081-9638},
mesh = {Diverticulum, Colon/complications/*surgery ; Humans ; Methods ; },
}
@article {pmid3545337,
year = {1987},
author = {Morris, DL and Tudor, RG},
title = {The management of inflammatory complications of colonic diverticular disease.},
journal = {British journal of hospital medicine},
volume = {37},
number = {1},
pages = {36, 40-1},
pmid = {3545337},
issn = {0007-1064},
mesh = {Diverticulitis, Colonic/surgery ; Diverticulum, Colon/*complications/pathology ; Humans ; Intestinal Perforation/*etiology/surgery ; Peritonitis/*etiology/surgery ; },
abstract = {Inflammatory complications of colonic diverticular disease remain a common and dangerous cause for hospital admission in our ageing society. The presentation, pathology, general and surgical management of acute diverticulitis, peritonitis and perforation of colonic diverticular disease are reviewed.},
}
@article {pmid3498610,
year = {1987},
author = {Poilleux, J and Delhomme, P and Gignoux, M and Joubert, M and Lalaude, J and Laurent, B and Lemarchand, F and Marchand, P and Pheline, Y and Piel-Desruisseaux, JL},
title = {[Therapeutic choice in complications of colonic diverticular disease. Apropos of 247 cases].},
journal = {Chirurgie; memoires de l'Academie de chirurgie},
volume = {113},
number = {4},
pages = {356-359},
pmid = {3498610},
issn = {0001-4001},
mesh = {Abscess/surgery ; *Colectomy ; *Colostomy ; Diverticulum, Colon/*complications ; Gastrointestinal Hemorrhage/surgery ; Humans ; Peritonitis/surgery ; Retrospective Studies ; },
}
@article {pmid3493190,
year = {1987},
author = {Thompson, JN and Salem, RR and Hemingway, AP and Rees, HC and Hodgson, HJ and Wood, CB and Allison, DJ and Spencer, J},
title = {Specialist investigation of obscure gastrointestinal bleeding.},
journal = {Gut},
volume = {28},
number = {1},
pages = {47-51},
pmid = {3493190},
issn = {0017-5749},
mesh = {Adolescent ; Adult ; Aged ; Child ; Chronic Disease ; Colonic Diseases/complications ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Intestine, Small/blood supply ; Male ; Meckel Diverticulum/complications ; Middle Aged ; Pancreatitis/complications ; },
abstract = {The investigation and treatment of 131 patients with 'obscure' gastrointestinal bleeding has been reviewed. One hundred and six patients were assessed electively for recurrent haemorrhage, 25 presented as emergencies. The major presenting feature was melaena (55 patients), anaemia (35), rectal bleeding (34), haematemesis (six) and ileostomy bleeding (one). The lesions responsible for haemorrhage were colonic angiodysplasia (52 patients), small bowel vascular anomalies (16), Meckel's diverticula (nine), small bowel smooth muscle tumours (seven), gastric vascular anomalies (four), chronic pancreatitis (three), colonic diverticular disease (three) and 16 other miscellaneous lesions. No lesion was found in 21 cases. Lesions were first shown by visceral angiography (69 patients), at laparotomy (23), on endoscopy (11), on gastrointestinal contrast radiological studies (four), and at ERCP (three). Lesions which were undetectable at operation increased markedly with age (p less than 0.0001). Expert visceral angiography is strongly recommended before surgery in patients over 45 years of age and after laparotomy when no cause has been found. Exploratory laparotomy is recommended at an early stage for younger patients, and for older patients after non-diagnostic angiography.},
}
@article {pmid3154819,
year = {1987},
author = {Kim, BH and Lee, SH and Lee, SS and Oh, DJ and Chung, ES and Lee, SJ},
title = {Diverticular disease of the colon in Korea.},
journal = {The Korean journal of internal medicine},
volume = {2},
number = {1},
pages = {79-83},
pmid = {3154819},
issn = {1226-3303},
mesh = {Adult ; Aged ; Diverticulum, Colon/complications/*epidemiology/pathology ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; },
abstract = {This study is designed to determine the relative prevalence and characteristics of diverticular disease of the colon in Korea. We did a retrospective evaluation of 16,964 consecutive barium enemas performed at Koryo General Hospital between January 1971 and October 1986, and found 100 patients with diverticular disease of the colon. The results are as follows: 1) Colonic diverticula were found in 100 patients, and incidence of 0.59% in 16,964 consecutive barium enemas. The male to female ratio was 2.1:1. 2) Incidence rose with advancing age from 0.45% in the second decade to 2.5% in the seventh decade. 3) Patient age ranged from 19 to 77 years with more than 70% of the patients in the 5th, 6th and 7th decades. 4) The greater majority (81%) of the diverticular disease the right colon. 5) Fifty percent of the cases were classified as multiple diverticula. 6) The mean age of patients with right sided diverticula was 47.5 years and that of patients with left sided diverticula was 57.7 years. The mean age of single diverticular patients was 50.4 years and that of multiple diverticular patients was 48.4 year. 7) Associated diseases were hemorrhoids (18%), gall stones (12%) and previous appendectomy (11%). Among the 29 patients who had hemorrhoids and or a previous appendectomy, 28 of those had right sided diverticula.},
}
@article {pmid3130866,
year = {1987},
author = {Machin, GA and Walther, GL and Fraser, VM},
title = {Autopsy findings in two adult siblings with Coffin-Lowry syndrome.},
journal = {American journal of medical genetics. Supplement},
volume = {3},
number = {},
pages = {303-309},
doi = {10.1002/ajmg.1320280536},
pmid = {3130866},
issn = {1040-3787},
mesh = {Abnormalities, Multiple/*genetics/pathology ; Adult ; Connective Tissue Diseases/*genetics/pathology ; Diverticulum/genetics ; Female ; Genetic Linkage ; Humans ; Intellectual Disability/genetics ; Jejunal Diseases/genetics ; Male ; Syndrome ; X Chromosome ; },
abstract = {We describe the major autopsy findings in two adult sibs of the original pedigree of Lowry et al [Am J Dis Child 121:496-500, 1971]. These results support the idea that Coffin-Lowry syndrome is a systemic connective tissue disorder. Visceral neuropathy was also noted as the basis of extensive intestinal diverticular disease.},
}
@article {pmid3099619,
year = {1987},
author = {Sardi, A and Gokli, A and Singer, JA},
title = {Diverticular disease of the cecum and ascending colon. A review of 881 cases.},
journal = {The American surgeon},
volume = {53},
number = {1},
pages = {41-45},
pmid = {3099619},
issn = {0003-1348},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; *Cecal Diseases/diagnosis/etiology/surgery ; Child ; *Diverticulum/diagnosis/etiology/surgery ; *Diverticulum, Colon/diagnosis/etiology/surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Sex Factors ; },
abstract = {A total of 881 cases of diverticula of cecum and the ascending colon were reviewed, including 30 new cases at the authors' institution. The average patient age was 43.6 years. The preoperative diagnosis was correct in only 7 per cent of the cases. Appendicitis accounted for 68 per cent of the preoperative diagnoses. Even at the time of surgery, the diagnosis was correct in only 58.7 per cent. Carcinoma was incorrectly diagnosed in 37.2 per cent. Operative procedures varied markedly. Diverticulectomy was performed in 28.2 per cent of the cases, 3.6 per cent had invagination of the diverticula, and 37.6 per cent had right hemicolectomy. The overall mortality rate was 2.5 per cent. The authors advocate local resection of the diverticulum, when possible, and a right hemicolectomy or segmental resection when the diagnosis is in doubt or when local resection or invagination will jeopardize the ileocecal valve or the blood supply to the intestine.},
}
@article {pmid3094466,
year = {1986},
author = {Browder, W and Cerise, EJ and Litwin, MS},
title = {Impact of emergency angiography in massive lower gastrointestinal bleeding.},
journal = {Annals of surgery},
volume = {204},
number = {5},
pages = {530-536},
pmid = {3094466},
issn = {0003-4932},
mesh = {Adult ; Aged ; Angiography ; Arteriovenous Malformations/complications ; Barium Sulfate ; Colectomy ; Colon/*blood supply/diagnostic imaging ; Diverticulum/complications ; Diverticulum, Colon/complications ; Emergencies ; Female ; Gastrointestinal Hemorrhage/*diagnostic imaging/etiology/therapy ; Humans ; Male ; Mesenteric Arteries/diagnostic imaging ; Middle Aged ; Vasopressins/therapeutic use ; },
abstract = {Fifty patients with massive lower gastrointestinal bleeding were initially managed with emergency angiography. The average age was 67.2; mean hematocrit, 23.7; and average transfusion, 7.6 units. Thirty-six patients (72%) had bleeding site located; bleeding sites were distributed throughout the colon. Etiologies of bleeding included diverticular disease (19 patients) and arteriovenous malformations (15 patients). Twenty of 22 (91%) patients receiving selective intra-arterial vasopressin stopped bleeding; however, 50% rebled on cessation of vasopressin. Thirty-five of 50 (70%) patients underwent surgery, with 57% operated on electively after vasopressin therapy. Seventeen patients had segmental colectomy, with no rebleeding. Nine of the 17 patients had diverticular disease in the remaining colon. Operative morbidity in these 35 patients was significantly improved when compared to previously reported patients undergoing emergency subtotal colectomy without angiography (8.6% vs. 37%) (p less than 0.02). Emergency angiography successfully locates the bleeding site, allowing for segmental colectomy. Vasopressin infusion transiently halts bleeding, permitting elective surgery in many instances.},
}
@article {pmid3025279,
year = {1986},
author = {Trowell, H and Burkitt, D},
title = {Physiological role of dietary fiber: a ten-year review.},
journal = {ASDC journal of dentistry for children},
volume = {53},
number = {6},
pages = {444-447},
pmid = {3025279},
issn = {1945-1954},
mesh = {Dietary Fiber/*metabolism ; Humans ; Intestine, Large/metabolism ; },
abstract = {It is accepted nowadays that dietary fiber is an important constituent of the diet. There is growing evidence that the low fiber Western diets and the low consumption of whole grain products are important factors in several common diseases of the large bowel. Cereal fiber differs from that present in vegetables and fruit. A low intake of cereal fiber has been implicated in cancer of the large bowel, diverticular disease of the colon and coronary heart disease. High fiber diets are often prescribed for diabetes. Although fiber consumption by British and American consumers has decreased over the past century, consumption of whole wheat breads and fiber-rich breakfast cereals has received new attention during the past ten years.},
}
@article {pmid2876280,
year = {1986},
author = {Aldridge, MC and Sim, AJ},
title = {Colonoscopy findings in symptomatic patients without X-ray evidence of colonic neoplasms.},
journal = {Lancet (London, England)},
volume = {2},
number = {8511},
pages = {833-834},
doi = {10.1016/s0140-6736(86)92869-2},
pmid = {2876280},
issn = {0140-6736},
mesh = {Adult ; Aged ; Colonic Neoplasms/*diagnosis ; Colonic Polyps/diagnosis ; *Colonoscopy ; Diverticulitis, Colonic/diagnosis ; Evaluation Studies as Topic ; Female ; Humans ; Male ; Middle Aged ; Sigmoidoscopy ; },
abstract = {Colonoscopy was carried out in 97 patients with persistent large-bowel symptoms in whom double-contrast barium enemas were either normal or showed diverticular disease alone. In 37 the X-ray was normal, but colonoscopy showed 9 polyps and 3 carcinomas. In 60 patients with barium enemas showing diverticular disease alone colonoscopy revealed 13 polyps and 1 carcinoma. Of the 4 carcinomas 1 was Dukes' A, 2 Dukes' B, and 1 Dukes' C. 23 of the 26 patients with a neoplastic lesion at colonoscopy had rectal bleeding, compared with only 40 of the 71 without a lesion. The frequency of neoplasia in those with a normal barium enema was 32%, compared with 23% in those whose X-ray showed diverticular disease. Colonoscopy, rather than double-contrast barium enema, should be the first line of investigation in patients with persistent large-bowel symptoms, especially rectal bleeding.},
}
@article {pmid3782484,
year = {1986},
author = {Sugihara, K and Jass, JR},
title = {Colorectal goblet cell sialomucin heterogeneity: its relation to malignant disease.},
journal = {Journal of clinical pathology},
volume = {39},
number = {10},
pages = {1088-1095},
pmid = {3782484},
issn = {0021-9746},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms/*metabolism ; Female ; Humans ; Intestinal Mucosa/metabolism ; Male ; Middle Aged ; Mucins/*metabolism ; Periodic Acid-Schiff Reaction ; Rectal Neoplasms/*metabolism ; Sialomucins ; },
abstract = {Mucus secreted by colorectal cancer differs in three respects from that produced normally: an overall reduction, a loss of O-acetyl substituents in sialic acid, and an increase in neutral mucin. Similar changes have been reported in apparently normal mucosa bordering colorectal cancer. "Normal" left sided colorectal mucosa from 32 patients with rectal cancer was studied. Each case was matched by age and sex to a patient with diverticular disease and a patient with irritable bowel syndrome. Twenty five patients with right sided cancer were matched to patients with Crohn's disease. Sections were stained with mild periodic acid Schiff (mPAS) (selectively stains N-acetyl sialic acid lacking in O-acetyl group) and other closely related techniques. Reactions were graded negative, weak, and intense. An intense reaction was found in 9% of cases; there was no difference between the various matched groups. Phenylhydrazine interposition failed to block the mPAS effect, indicating that a positive result was due to a deficiency of sialic acid with O-acetyl substituents rather than neutral mucin. Different staining patterns in left and right colon were probably due to differing ratios of total sialic acid:fucose. These findings indicate a hitherto unsuspected colorectal goblet cell sialomucin heterogeneity within the general population, but no association with neoplastic disease is apparent.},
}
@article {pmid3757703,
year = {1986},
author = {Freischlag, J and Bennion, RS and Thompson, JE},
title = {Complications of diverticular disease of the colon in young people.},
journal = {Diseases of the colon and rectum},
volume = {29},
number = {10},
pages = {639-643},
doi = {10.1007/BF02560326},
pmid = {3757703},
issn = {0012-3706},
mesh = {Adult ; Age Factors ; Diverticulitis, Colonic/*complications/diagnostic imaging/surgery ; Emergencies ; Female ; Humans ; Intestinal Perforation/etiology ; Male ; Peritonitis/etiology ; Postoperative Complications ; Radiography ; },
abstract = {Diverticular disease of the colon in patients under the age of 40 years is uncommon. Between 1975 and 1985, 58 patients (31 men and 27 women) were admitted for pathologically or radiographically proven acute diverticulitis. Seventeen (29.3 percent) were younger than 40 years. Fifteen of the 17 (88.2 percent) required urgent or emergent surgery for complications of diverticular disease. This represents a significantly (P less than 0.02) larger proportion of that age group than those patients older than the age of 40 (17/41 or 41.5 percent). Twelve of the patients younger than age 40 (70.6 percent) had had their symptoms for 72 hours or less, and in 13, surgery was required during the first attack. Indications for surgery included abscess, perforation, and persistence of symptoms. Six patients required surgery in less than 24 hours. In young people, the initial attack of colonic diverticulitis is frequently severe, often requiring an urgent operation for complications. Excellent results with few complications can be obtained when the index of suspicion is high, an early diagnosis is made, and timely surgical intervention is employed.},
}
@article {pmid3536214,
year = {1986},
author = {Smith, AN},
title = {Colonic muscle in diverticular disease.},
journal = {Clinics in gastroenterology},
volume = {15},
number = {4},
pages = {917-935},
pmid = {3536214},
issn = {0300-5089},
mesh = {Adult ; Aged ; Child ; Colon/pathology/physiopathology ; Diverticulum, Colon/*etiology/pathology/physiopathology ; Gastrointestinal Motility ; Humans ; Infant ; Middle Aged ; Muscle, Smooth/metabolism/pathology/*physiopathology ; },
abstract = {The muscle abnormality in diverticular disease is seen most often in surgically excised specimens in the sigmoid colon, though a pancolonic form of the disease without muscle thickening also exists in the elderly. In terms of physiopathology, the condition has a raised intraluminal pressure operating on the wall locally, this being most readily demonstrated in symptomatic patients. In Western societies the colon loses its tensile properties throughout life. The anatomical and functional evidence is that the colon is outstandingly strong in infancy in both Africans and Europeans, but later the mechanical properties of the African colon become superior and they remain so throughout ensuing decades. The diminished tensile strength and elasticity of the wall is no different in the diverticular and non-diverticular subjects and this suggests that an additional factor, such as pressure, may be necessary in Europeans to cause the mucosal extrusion which constitutes each diverticulum. Fiber fills the colon with bulkier, moister feces, which necessitates less work, especially as it operates for most of the time as a low-pressure system, only occasionally evacuating by mass peristalsis into the rectum. Cereal fiber binds salt and water and there is evidence that this is mostly a physicochemical process, dependent on particle size. Certain types of fibers undergo chemical degradation in the cecum and increase the bacterial population of the stool. Population studies show that diverticular disease subjects consume less fiber and in countries where the fiber intake is reduced, fecal output is lessened, transit is slower, and intraluminal pressure may be rising. As a result of the adoption of high-fiber diets and the use of bulking agents elective operations for diverticular disease are less commonly performed. The number of operations in most Western countries may be increasing because of increasing longevity. Complications often arise after a relatively short history; most are explicable on the basis of sudden pressure increments. The recent important finding in this disease is the change in colonic wall compliance, which probably occurs because of a collagen failure. Contraction of the taeniae may follow elastosis, which may relate to under-filling; this produces the contracted structure seen in the excised colonic specimen. The strength of the colonic wall diminishes throughout life, due to changes in its composition; some of these changes are hastened by self-imposed stresses, which currently seem to be mainly of dietary origin.},
}
@article {pmid3536213,
year = {1986},
author = {Thompson, WG and Patel, DG},
title = {Clinical picture of diverticular disease of the colon.},
journal = {Clinics in gastroenterology},
volume = {15},
number = {4},
pages = {903-916},
pmid = {3536213},
issn = {0300-5089},
mesh = {Colonic Diseases, Functional/complications ; Diverticulitis, Colonic/etiology/therapy ; *Diverticulum, Colon/complications/physiopathology/therapy ; Gastrointestinal Hemorrhage/etiology/therapy ; Humans ; },
abstract = {Uncomplicated diverticular disease is usually asymptomatic. When abdominal pain or discomfort related to defecation, altered bowel habit, and flatulence occur, they are likely a result of a coexistent irritable bowel. Nonetheless, diverticula are subject to serious complications. Diverticular hemorrhage may be massive and require emergency angiography and segmental resection. Peridiverticulitis occurs when a diverticulum ruptures, perhaps because of inspissated fecal material. This occurs usually in the sigmoid, resulting in a peridiverticular abscess localized by the adjacent fat and mesentery. If the infection extends beyond this, abscess, fistula, or free perforation may occur. These complications require antibiotics, intravenous therapy, and, in the case of uncontrollable abscess or perforation, urgent surgery. Obstruction of the colon, sometimes associated with ileus, may occur and in this case one may find a carcinoma among extensive diverticular disease. Although there is insufficient evidence to justify a high-fiber diet for the general population, the notion of a low-residue diet in the management of uncomplicated diverticular disease should be laid to rest.},
}
@article {pmid3536212,
year = {1986},
author = {Huizinga, JD},
title = {Electrophysiology of human colon motility in health and disease.},
journal = {Clinics in gastroenterology},
volume = {15},
number = {4},
pages = {879-901},
pmid = {3536212},
issn = {0300-5089},
mesh = {Colon/*physiology ; Colonic Diseases/physiopathology ; Electrophysiology ; *Gastrointestinal Motility ; Humans ; },
abstract = {Recent years have seen a number of studies measuring electrical activities of the human colon muscle layers. In vitro studies have enhanced our understanding of myogenic control of colon motility. In vivo studies have suggested a relationship between patterns of electrical activities and the transport of colon contents. This chapter describes the patterns of electrical and motor activity that the human colon can perform depending on the nature and intensity of the stimulus, using recent in vitro and in vivo data. In vitro studies with human tissue have shown differences between the electrical activity of the longitudinal and circular muscles. They have also revealed the unique nature of the electrical control activity of the circular muscle of human colon. The electrical oscillatory activity of this layer is variable in frequency from 1 to 60 cpm, variable in amplitude, and not omnipresent. Furthermore, the activity is sensitive to stretch and markedly altered by excitatory and inhibitory substances. In vivo data, especially spike action potential recordings for 24 h, have revealed patterns of electrical activity related to intake of meals, sleep, and also constipation. The limitations of some intraluminal techniques to record electrical activity are discussed. Further studies are needed to accurately relate in vivo activities to cellular events recorded in vitro, and to relate these to altered patterns of activity in disease. The suggestion is made that a relevant in vivo assessment of the colonic motility of a patient can only be achieved by long-lasting (24-h) studies, because of the large variability in the hour-to-hour colonic activity. Timing of experimental drug intervention is important since colonic motility undergoes diurnal changes. Recent studies into profiles of electrical and motor activity in irritable bowel syndrome (IBS) suggest that there is not a typical IBS myogenic activity. Rather, patterns of electrical activity can be related to the symptoms of IBS: diarrhea and constipation. Recent electrophysiologic data on Hirschsprung's disease reveal absence of intrinsic inhibitory innervation in the aganglionic segment. In vitro studies on tissue from diverticular disease patients show abnormal myogenic activity.},
}
@article {pmid3096618,
year = {1986},
author = {Mendeloff, AI},
title = {Thoughts on the epidemiology of diverticular disease.},
journal = {Clinics in gastroenterology},
volume = {15},
number = {4},
pages = {855-877},
pmid = {3096618},
issn = {0300-5089},
mesh = {Adult ; Aged ; Aged, 80 and over ; Diet ; Diverticulitis, Colonic/complications/*epidemiology/etiology/mortality ; Diverticulum/complications/*epidemiology/etiology/mortality ; Diverticulum, Colon/complications/*epidemiology/etiology/mortality ; Female ; Humans ; Life Style ; Male ; Middle Aged ; },
}
@article {pmid3020970,
year = {1986},
author = {Jenkins, DJ and Jenkins, AL and Wolever, TM and Rao, AV and Thompson, LU},
title = {Fiber and starchy foods: gut function and implications in disease.},
journal = {The American journal of gastroenterology},
volume = {81},
number = {10},
pages = {920-930},
pmid = {3020970},
issn = {0002-9270},
mesh = {Colon/physiology ; Dietary Carbohydrates/administration & dosage/*therapeutic use ; Dietary Fiber/administration & dosage/*therapeutic use ; Esophageal Neoplasms/diet therapy ; Gastrointestinal Diseases/*diet therapy ; Gastrointestinal Motility ; Humans ; Intestinal Absorption ; Starch/*metabolism ; },
abstract = {Increased intake of fiber and starchy foods has been recommended in the treatment or prevention of a range of diseases including dumping syndrome, hyperlipidemia, gallstones, diabetes, Crohn's disease, constipation, irritable bowel, diverticular disease, and colonic cancer. The nature and physiological effects of fiber are diverse. However in general, insoluble fibers increase fecal bulk and decrease transit time. On the other hand, soluble fibers have metabolic effects secondary to reducing the rate of small intestinal absorption. In the colon, along with undigested starch, they are largely fermented yielding short-chain fatty acids which may have further metabolic effects. At present although much further work is required, the clinical management of hyperlipidemia, diabetes, constipation, and diverticular disease have already been significantly influenced as a result of the ideas and experimental evidence generated by the fiber hypothesis.},
}
@article {pmid3020710,
year = {1986},
author = {Vanderpool, DM},
title = {Dietary fiber: its role in preventing gastrointestinal disease.},
journal = {Southern medical journal},
volume = {79},
number = {10},
pages = {1201-1204},
doi = {10.1097/00007611-198610000-00003},
pmid = {3020710},
issn = {0038-4348},
mesh = {Appendicitis/etiology ; Colon/physiopathology ; Colonic Neoplasms/etiology ; Dietary Fiber/*administration & dosage ; Diverticulum, Colon/etiology ; Duodenal Ulcer/etiology ; Gastrointestinal Diseases/etiology/physiopathology/*prevention & control ; Gastrointestinal Motility ; Humans ; },
abstract = {Only in relatively recent years has the role of dietary fiber, once thought to be an unnecessary and even undesirable by-product, begun to be appreciated in the maintenance of health. Research now indicates that a deficiency of fiber in the modern western diet may contribute to a host of diseases. Inadequate dietary fiber produces low fecal bulk, which in turn causes a high intraluminal pressure in the colon and may contribute to diverticular disease, appendicitis, and even carcinoma. This paper examines the evidence for these conclusions and the mechanisms for production of chronic gastrointestinal disease.},
}
@article {pmid3747911,
year = {1986},
author = {Askew, A and Ward, M and Cowen, A},
title = {The influence of colonoscopy on the operative management of colorectal cancer.},
journal = {The Medical journal of Australia},
volume = {145},
number = {6},
pages = {254-255},
doi = {10.5694/j.1326-5377.1986.tb101118.x},
pmid = {3747911},
issn = {0025-729X},
mesh = {Aged ; Carcinoma/diagnosis/*surgery ; Colonic Neoplasms/diagnosis/*surgery ; *Colonoscopy ; Female ; Humans ; Male ; Middle Aged ; Postoperative Care ; Preoperative Care ; Rectal Neoplasms/diagnosis/*surgery ; },
abstract = {Total colonoscopy was used in the evaluation of 85 patients with colorectal cancer, either preoperatively or within six months of surgery. Synchronous lesions (six carcinomas, 22 adenomatous polyps, one villous adenoma and nine cases of severe diverticular disease) were detected in 38 (44.7%) patients. The planned surgical procedure was altered in 10 patients (11.8%)--a more extensive resection being performed in each case. In particular, five of the six cases of synchronous cancers were located in different surgical segments. Colonoscopy is a necessary prerequisite in the evaluation of patients with colorectal cancer.},
}
@article {pmid3492735,
year = {1986},
author = {Wong, JC},
title = {[Complications of diverticular disease of the colon observed in the Hospital Santo Tomás 1967-1982].},
journal = {Revista medica de Panama},
volume = {11},
number = {3},
pages = {210-213},
pmid = {3492735},
issn = {0379-1629},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/epidemiology/etiology ; Diverticulum, Colon/*complications/surgery ; Female ; Gastrointestinal Hemorrhage/epidemiology/etiology ; Humans ; Intestinal Fistula/epidemiology/etiology ; Intestinal Obstruction/epidemiology/etiology ; Intestinal Perforation/epidemiology/etiology ; Male ; Middle Aged ; Panama ; Postoperative Complications/*epidemiology ; },
}
@article {pmid3488885,
year = {1986},
author = {Udén, P and Jiborn, H and Jonsson, K},
title = {Influence of selective mesenteric arteriography on the outcome of emergency surgery for massive, lower gastrointestinal hemorrhage. A 15-year experience.},
journal = {Diseases of the colon and rectum},
volume = {29},
number = {9},
pages = {561-566},
doi = {10.1007/BF02554254},
pmid = {3488885},
issn = {0012-3706},
mesh = {Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Colectomy ; Emergencies ; Female ; Gastrointestinal Hemorrhage/diagnostic imaging/etiology/mortality/*surgery ; Humans ; Male ; Mesenteric Arteries/*diagnostic imaging ; Middle Aged ; Postoperative Complications ; Radiography ; },
abstract = {From 1970 to 1984, 64 patients with massive hemorrhage of lower gastrointestinal origin were treated at the intensive care unit, Surgical Department, Malmö General Hospital. The records of these patients have been studied retrospectively. Emergency exploration for hemostasis was performed on 31 patients, while in 33 patients hemorrhage stopped with conservative therapy. Acute selective mesenteric arteriography revealed the bleeding site in 16 of 28 patients (57 percent). The commonest bleeding sources detected by selective mesenteric arteriography were diverticular disease and angiodysplastic lesions of the colon. Fourteen patients with positive arteriography finding were operated on as emergencies, resulting in two postoperative deaths. Ten patients were operated on as emergencies without preoperative arteriography. Despite intraoperative efforts, no bleeding source was found in three of those patients. In the remaining seven patients, the diagnoses were similar to the 14 patients with positive arteriography. Five of 10 patients in this group died postoperatively. Emergency laparotomy eventually was necessary in seven of 12 patients with negative arteriography. This group had a variety of diagnoses and no postoperative mortality. Positive preoperative mesenteric arteriography findings allowed the surgeon to perform a limited resection of the bleeding bowel segment with a reduced postoperative mortality.},
}
@article {pmid3774178,
year = {1986},
author = {Ceraudo, E and Monaco, M},
title = {[Complicated diverticular disease as inflammatory tumor of the sigmoid. Problems of differential diagnosis with cancer].},
journal = {Minerva chirurgica},
volume = {41},
number = {15-16},
pages = {1321-1327},
pmid = {3774178},
issn = {0026-4733},
mesh = {Adult ; Aged ; Aged, 80 and over ; Constriction, Pathologic/etiology ; Diagnosis, Differential ; Diverticulum, Colon/complications/*diagnosis ; Female ; Humans ; Male ; Middle Aged ; Sigmoid Neoplasms/*diagnosis ; },
}
@article {pmid3788398,
year = {1986},
author = {Hulkko, OA and Laitinen, ST and Haukipuro, KA and Ståhlberg, MJ and Juvonen, TS and Kairaluoma, MI},
title = {The Hartmann procedure for the treatment of colorectal emergencies.},
journal = {Acta chirurgica Scandinavica},
volume = {152},
number = {},
pages = {531-535},
pmid = {3788398},
issn = {0001-5482},
mesh = {Adolescent ; Adult ; Aged ; Colonic Diseases/mortality/physiopathology/*surgery ; Colostomy ; Emergencies ; Evaluation Studies as Topic ; Female ; Humans ; Male ; Methods ; Middle Aged ; Postoperative Complications/mortality ; Rectal Diseases/mortality/physiopathology/*surgery ; Retrospective Studies ; },
abstract = {A total of 80 patients with colorectal emergencies were treated by the Hartmann procedure at the Oulu University Central Hospital during the years 1973-1984. The median age of the patients was 65 (18-81) years. The operative indications were: diverticular disease (n = 26), cancer (n = 21), stercoraceous perforation (n = 9), vascular accident (n = 5), radiation damage (n = 4) and miscellaneous (n = 11). 13 patients (16.3%) died after a median of 8 (1-33) days, mostly due to organ failure. 44 of the surviving 67 patients (65.7%) had postoperative complications. Intestinal continuity was restored in 34 patients (42.5%) after a median of 139 (65-794) days. Two patients (5.6%) died after the reconstruction. The permanency of the stoma in half of the surviving patients and the technical difficulties encountered in stoma closure are disadvantages attached to the Hartmann procedure which are sufficiently serious that alternative operative methods should always be considered.},
}
@article {pmid3760526,
year = {1986},
author = {Parker, S and Cobb, CF and Spero, JA and Van Thiel, DH},
title = {Sigmoidovesicular fistula in a hemophiliac with diverticular disease.},
journal = {Journal of clinical gastroenterology},
volume = {8},
number = {4},
pages = {461-465},
doi = {10.1097/00004836-198608000-00017},
pmid = {3760526},
issn = {0192-0790},
mesh = {Adult ; Diverticulum, Colon/*complications ; Hemophilia A/*complications ; Humans ; Intestinal Fistula/*complications ; Male ; Sigmoid Diseases/*complications ; Urinary Bladder Fistula/*complications ; },
abstract = {A sigmoidovesicular fistula developed in a hemophiliac from a spontaneous sigmoid intramural hematoma. As the hemophiliac population lives longer as a result of improved factor therapy, they will develop more of the diseases and complications of age.},
}
@article {pmid3741003,
year = {1986},
author = {Morris, J and Stellato, TA and Lieberman, J and Haaga, JR},
title = {The utility of computed tomography in colonic diverticulitis.},
journal = {Annals of surgery},
volume = {204},
number = {2},
pages = {128-132},
pmid = {3741003},
issn = {0003-4932},
mesh = {Adult ; Aged ; Barium Sulfate ; Diverticulitis, Colonic/diagnosis/*diagnostic imaging/surgery ; Enema ; Female ; Humans ; Intestines/diagnostic imaging ; Male ; Middle Aged ; Retrospective Studies ; Sigmoidoscopy ; Tomography, X-Ray Computed ; },
abstract = {Forty-one patients admitted to our hospital during an 18-month period with the clinical diagnosis of colonic diverticulitis were analyzed to evaluate the utility of computed tomography (CT). Abdominal pain and leukocytosis were the most common presenting manifestations, 75 and 66%, respectively. Just over one-half of the patients also demonstrated hematuria. Twenty patients required surgical intervention, most commonly for failure to improve despite medical management. Preoperative studies included 10 sigmoidoscopies, 30 plain abdominal roentgenograms, 20 barium enemas (BE), and 24 CT scans. Two CT scans were also obtained after operation for successful percutaneous drainage of intra-abdominal abscesses. Abdominal roentgenograms were most commonly obtained but least helpful, with only one third demonstrating any abnormality whatsoever. Sigmoidoscopy was least commonly performed but almost universally abnormal. Specificity was low, however, in that spasm with inability to advance the endoscope was the most common finding. Of the 20 barium enemas obtained, 60% had findings consistent with diverticulitis, most commonly localized perforation or fixed narrow segment. Sixty-three per cent of CT scans were abnormal. The most frequent findings were localized thickening of the colonic wall and increased density in the pericolic fat. Diverticular abscess, which may be inferred by other studies, was definitely diagnosed in one third of the patients with abnormal CT scans. CT also provided the ability to identify extracolonic intra-abdominal pathology. The study demonstrates that both barium enema and CT are effective in diagnosing diverticulitis, although CT can be performed without risk. CT played no therapeutic role before operation, although two patients benefited after operation by CT-guided drainage of intra-abdominal abscesses. The decision for surgery was most frequently dependent on clinical examination and never solely on the basis of either the barium enema or CT in this study. The major benefit of CT appears to be its ability to identify both gross and subtle changes indicative of diverticular disease and extracolonic pathology in a relatively noninvasive manner.},
}
@article {pmid3461382,
year = {1986},
author = {Graham, AN and Neale, TJ and Hatfield, PJ and Morrison, RB and Meech, PR and Jacobson, A and Faircloth, C},
title = {Endstage renal failure due to polycystic kidney disease managed by continuous ambulatory peritoneal dialysis.},
journal = {The New Zealand medical journal},
volume = {99},
number = {805},
pages = {491-493},
pmid = {3461382},
issn = {0028-8446},
mesh = {Female ; Humans ; Intestinal Perforation/etiology ; Kidney Failure, Chronic/*etiology/therapy ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Peritonitis/etiology ; Polycystic Kidney Diseases/*therapy ; Renal Dialysis ; },
abstract = {Over a five and one half year period, four of nine patients with endstage renal failure due to polycystic kidney disease managed by continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis following intestinal perforation. Two patients had colonic perforation associated with diverticular disease, one necrosis of the terminal ileum, and one acute appendicitis. Two of the patients died subsequent to these complications. The survivors had early transfer to haemodialysis. In contrast, over the same period, only two of 125 patients with renal failure due to other causes and managed by CAPD had acute intestinal perforation. In both cases this was associated with acute appendicitis. Both patients survived. All episodes of peritonitis in CAPD patients with polycystic kidneys demand very close monitoring, cessation of CAPD, and early surgical intervention. CAPD is relatively contraindicated in such patients.},
}
@article {pmid3752908,
year = {1986},
author = {Castiglioni, GC and Pescatori, M and Lucibello, L},
title = {[Prevention of complications of surgery of diverticular disease].},
journal = {Annales de gastroenterologie et d'hepatologie},
volume = {22},
number = {4},
pages = {213-215},
pmid = {3752908},
issn = {0066-2070},
mesh = {Aged ; Colectomy ; Colon, Sigmoid/surgery ; Colostomy ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/prevention & control ; Rectum/surgery ; Recurrence ; },
abstract = {Results are reported for 335 patients hospitalized for diverticular disease of the symptomatic colon: bowel movement disorders, abdominal pains and/or rectorrhagia. Of 81 patients that received operative surgery, 62 presented inflammatory stenosis or perforation. Recurrence is prevented by surgical treatment combining sigmoidectomy and exeresis of the rectosigmoid junction.},
}
@article {pmid3752907,
year = {1986},
author = {Bernades, P},
title = {[Natural history of diverticular disease of the colon].},
journal = {Annales de gastroenterologie et d'hepatologie},
volume = {22},
number = {4},
pages = {209-211},
pmid = {3752907},
issn = {0066-2070},
mesh = {Adult ; Aged ; Diverticulitis, Colonic/*diagnosis/epidemiology/surgery ; Diverticulum, Colon/*diagnosis/epidemiology/surgery ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {Diverticular disease of the colon is frequent in developed countries, probably due to diets poor in fiber. Prevalence increases with age, reaching 65 percent at 70 years. The preferred seat of the disease is the sigmoid colon. The disease is usually asymptomatic, but inflammatory signs are seen in 10 to 25 percent of cases. Diagnosis of diverticulitis is difficult since correlation between clinical signs and histological data is often mediocre. Surgery is carried out in 15 to 30 percent of patients presenting severe disorders, i.e. in 1 to 2 percent of the overall population presenting diverticulosis of the colon. The most efficacious method of preventing complications may be the implementation of a fiber-rich diet.},
}
@article {pmid3738144,
year = {1986},
author = {Godayol Rovira, J and Valencia Parparcén, J},
title = {[Diverticular disease of the colon. Personal experience].},
journal = {Revista espanola de las enfermedades del aparato digestivo},
volume = {70},
number = {1},
pages = {49-55},
pmid = {3738144},
issn = {0034-9437},
mesh = {Adult ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis ; *Diverticulum, Colon/complications/diagnosis/surgery ; Female ; Humans ; Male ; Postoperative Complications/etiology ; },
}
@article {pmid3730793,
year = {1986},
author = {Lambert, ME and Knox, RA and Schofield, PF and Hancock, BD},
title = {Management of the septic complications of diverticular disease.},
journal = {The British journal of surgery},
volume = {73},
number = {7},
pages = {576-579},
doi = {10.1002/bjs.1800730721},
pmid = {3730793},
issn = {0007-1323},
mesh = {Abscess/surgery ; Adult ; Aged ; Colostomy ; Diverticulum, Colon/*complications ; Drainage ; Emergencies ; Female ; Humans ; Intestinal Obstruction/*surgery ; Intestinal Perforation/surgery ; Male ; Middle Aged ; Peritonitis/*surgery ; Retrospective Studies ; Suppuration/surgery ; },
abstract = {One hundred and five patients underwent surgical treatment of septic complications of diverticular disease. In nine cases, operation was carried out for acute large bowel obstruction and in the remainder for peritonitis. An inflammatory mass and/or localized abscess was found in 23 cases. Free pus without evidence of 'communicating' perforation was found in a further 33 and 'communicating' perforation in 40. Treatment by primary resection or by transverse colostomy and drainage were both associated with significantly lower mortality from sepsis than treatment by drainage alone. In cases without 'communicating' perforation, there was no difference in mortality between primary resection and transverse colostomy with drainage. Although the advantage of primary resection was most apparent in cases with 'communicating' perforation, it did not reach statistical significance. In three cases treated primarily without resection the pathology was subsequently found to be that of carcinoma. In 'favourable' circumstances, i.e. without 'communicating' perforation, defunctioning colostomy with drainage has an acceptably low mortality rate and may be undertaken by a less experienced surgeon to avoid a difficult resection. Ideally these problems should be dealt with by an experienced surgeon; we prefer to treat the septic complications of diverticular disease by primary resection.},
}
@article {pmid3717113,
year = {1986},
author = {Otte, JJ and Larsen, L and Andersen, JR},
title = {Irritable bowel syndrome and symptomatic diverticular disease--different diseases?.},
journal = {The American journal of gastroenterology},
volume = {81},
number = {7},
pages = {529-531},
pmid = {3717113},
issn = {0002-9270},
mesh = {Adult ; Aged ; Colonic Diseases, Functional/*classification/complications/diagnosis ; Diverticulum, Colon/*classification/complications/diagnosis ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; },
abstract = {The influence of colonic diverticula on symptomatology and prognosis was investigated in 69 patients with irritable bowel syndrome. Roentgenograms at the time of diagnosis were blindly correlated to patient complaints and to result of follow-up 5 to 7 yr after the irritable bowel syndrome had been diagnosed. Patient complaints were not related to the presence or extent of diverticulosis. Half the patients had unchanged or aggravated symptoms at follow-up irrespective of diverticulosis. Accordingly, the presence of colonic diverticula did not change the natural history of the irritable bowel syndrome.},
}
@article {pmid3532653,
year = {1986},
author = {Limbosch, JM and Druart, ML and Blondiau, J and Blairon, J},
title = {[Analysis of 66 cases of colorectal side-to-end anastomosis by the Baker method].},
journal = {Acta chirurgica Belgica},
volume = {86},
number = {4},
pages = {216-221},
pmid = {3532653},
issn = {0001-5458},
mesh = {Adult ; Aged ; Aged, 80 and over ; Colon/*surgery ; Colostomy ; Female ; Humans ; Male ; Methods ; Middle Aged ; Postoperative Care ; Postoperative Complications ; Preoperative Care ; Rectum/*surgery ; *Suture Techniques ; },
abstract = {From 1976 to 1985, 66 elective side to end colorectal anastomosis according to Baker's technique were performed. 36 of those 66 anastomoses (54.5%) were performed lower than 10 cm from the anal verge. Our series includes 17 cases of diverticular disease, 1 case of post radiotherapy stenosis of the rectosigmoïd junction and 49 carcinomas. 50% of all carcinomas were Dukes' C or D lesions and more than 34.8% of all lesions were subobstructive. The method of preoperative colonic preparation is described. The results are the following:--clinical fistulas: 2 (3.0%)--wound infections: 3 (4.5%)--deaths: 4 (6.1%). None of the colorectal sutures were protected by a colostomy whereas 4 colostomies previously instaured were suppressed at the time colorectal continuity was restored. This study clearly demonstrates that manual colorectal anastomosis following Baker's technique are as secure as stapled anastomosis although very less expensive.},
}
@article {pmid3089363,
year = {1986},
author = {Thornton, JR and Dryden, A and Kelleher, J and Losowsky, MS},
title = {Does super efficient starch absorption promote diverticular disease?.},
journal = {British medical journal (Clinical research ed.)},
volume = {292},
number = {6537},
pages = {1708-1710},
pmid = {3089363},
issn = {0267-0623},
mesh = {Aged ; Diverticulum, Colon/*etiology/metabolism ; Female ; Humans ; *Intestinal Absorption ; Intestine, Small/*metabolism ; Lactulose/administration & dosage ; Male ; Random Allocation ; Starch/administration & dosage/*metabolism ; },
abstract = {The amount of starch escaping absorption in the small intestine was measured in eight patients with symptomatic diverticular disease and eight controls. Unabsorbed starch was calculated from breath hydrogen measurements after a potato meal compared with the hydrogen response to lactulose. The proportion of unabsorbed starch was low in all the patients (mean 3.3%) and was only about a quarter of that in the controls (12.4%; p less than 0.01). These findings confirm that unabsorbed starch provides an important quantity of carbohydrate reaching the colon and suggest that super efficient starch absorption, by reducing this provision, may promote the development of diverticular disease.},
}
@article {pmid3721137,
year = {1986},
author = {Sasaki, D and Kido, A and Yoshida, Y},
title = {An endoscopic method to study the relationship between bowel habit and motility of the ascending and sigmoid colon.},
journal = {Gastrointestinal endoscopy},
volume = {32},
number = {3},
pages = {185-189},
doi = {10.1016/s0016-5107(86)71801-4},
pmid = {3721137},
issn = {0016-5107},
mesh = {Adolescent ; Adult ; Aged ; Colon/*physiopathology ; Colon, Sigmoid/*physiopathology ; Colonic Diseases, Functional/physiopathology ; Colonoscopy/*methods ; Constipation/physiopathology ; *Defecation/drug effects ; Diarrhea/physiopathology ; Diverticulum, Colon/physiopathology ; Female ; *Gastrointestinal Motility/drug effects ; Humans ; Male ; Middle Aged ; Neostigmine/pharmacology ; Transducers, Pressure ; },
abstract = {Endoscopic retrograde bowel insertion (ERBI), a new method, offers rapid access to the entire colon for pressure sensors. The authors measured the pressure of both the ascending colon and the sigmoid colon and related them to the bowel habits of the subjects. The following groups were studied: control subjects, patients with diarrhea-dominant irritable bowel syndrome, patients with constipation-dominant irritable bowel syndrome, and patients with right-sided diverticular disease of the colon. In patients with irritable bowel syndrome with diarrhea or constipation, colonic motility indices (CMIs) showed a so-called "paradoxical motility" pattern. In patients with right-sided diverticular disease, the CMI was higher in the ascending colon than in the sigmoid colon. The pattern of CMIs for diverticular disease and irritable bowel syndrome varied inversely in the ascending colon and in the sigmoid colon with diarrhea and constipation. These results suggest that the mechanisms of altered bowel habits in patients with these diseases are quite different.},
}
@article {pmid3488056,
year = {1986},
author = {Pieterse, AS and Rowland, R and Miliauskas, JR and Hoffmann, DC},
title = {Right-sided diverticular disease of the colon: a morphological analysis of 16 cases.},
journal = {The Australian and New Zealand journal of surgery},
volume = {56},
number = {6},
pages = {471-475},
doi = {10.1111/j.1445-2197.1986.tb02357.x},
pmid = {3488056},
issn = {0004-8682},
mesh = {Acute Disease ; Adult ; Aged ; Appendicitis/diagnosis ; Cecal Diseases/diagnosis ; Diagnosis, Differential ; Diverticulum, Colon/classification/diagnosis/*pathology/surgery ; Gastrointestinal Hemorrhage/etiology ; Humans ; Inflammation/diagnosis ; Middle Aged ; Rectum ; },
abstract = {Right-sided diverticular disease is uncommon and represents a heterogeneous group of cases with varying clinical presentation often confused with other disorders. Based on number, size, distribution and histological appearance of the diverticula, four distinct groups were identified, each with a distinct clinical presentation. Six patients had solitary false diverticula mimicking acute appendicitis and at operation were found to have inflamed caecal masses. Five patients had diverticula formed on the basis of defects in the muscularis propria. The mean age of these patients was 30 years older than the previous group and all of them presented with rectal haemorrhage, often confused with angiodysplasia clinically. At laparotomy the external appearance of the bowel was unremarkable. Three patients had diverticular disease similar to that seen in the left side of colon. Two patients had true congenital caecal diverticula confirming that the minority of caecal diverticula conforms to this group.},
}
@article {pmid3736917,
year = {1986},
author = {Ingegneros, L and Pepe, G and Pepe, F and Bellitti, G and Cutuli, N and Calì, V},
title = {[Perforative complications in diverticular disease of the colon. Clinical contribution: 14 cases].},
journal = {Minerva chirurgica},
volume = {41},
number = {10},
pages = {845-849},
pmid = {3736917},
issn = {0026-4733},
mesh = {Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Intestinal Perforation/etiology/*surgery ; Male ; Middle Aged ; },
}
@article {pmid3720687,
year = {1986},
author = {Mathus-Vliegen, EM and Tytgat, GN},
title = {Polyp-simulating mucosal prolapse syndrome in (pre-) diverticular disease.},
journal = {Endoscopy},
volume = {18},
number = {3},
pages = {84-86},
doi = {10.1055/s-2007-1018337},
pmid = {3720687},
issn = {0013-726X},
mesh = {Adult ; Aged ; Colonic Diseases/*diagnosis/pathology ; Colonic Polyps/*diagnosis/pathology/surgery ; *Colonoscopy ; Diagnosis, Differential ; Diverticulum, Colon/*diagnosis/pathology ; Female ; Humans ; *Intestinal Mucosa/pathology ; Male ; Middle Aged ; Prolapse ; Sigmoidoscopy ; },
abstract = {Eight patients with anal blood loss were referred for endoscopic polyp removal (4) or because of problems with the differential diagnosis (4). These patients were referred because of an apparent discrepancy between the initial diagnosis (malignancy, ulcerative colitis and hemangioma) and the clinical and/or radiographic and endoscopic findings. At endoscopy a polyp-simulating lesion was found in all patients; this was not adenomatous in nature, but was made up of bright red, hyperemic prolapsing redundant mucosa. Also, polypoid excrescences were present with a clearly distinguishable transition between the intensely red congested mucosa and the normal pink adjacent epithelium at the base of the stalk. The distribution of the lesions was confined to the sigmoid area. After institution of a fibre-enriched diet, regression of the lesions was documented. However, the conspicuous hypercontractility and thickening of the mucosal layer persisted. The clinical significance of the recognition of this polyp-simulating mucosal prolapse syndrome lies in the fact that endoscopic polyp removal is not indicated and that such abnormalities may be responsible for low-grade, chronic and recurrent bleeding.},
}
@article {pmid3086412,
year = {1986},
author = {Bryant, R},
title = {Diverticular disease.},
journal = {Journal of enterostomal therapy},
volume = {13},
number = {3},
pages = {114-117},
doi = {10.1097/00152192-198605000-00035},
pmid = {3086412},
issn = {0270-1170},
mesh = {Diverticulitis/*etiology/therapy ; Diverticulum/*etiology/therapy ; Humans ; Societies, Nursing ; United States ; },
}
@article {pmid3084185,
year = {1986},
author = {Lee, YS},
title = {Diverticular disease of the large bowel in Singapore. An autopsy survey.},
journal = {Diseases of the colon and rectum},
volume = {29},
number = {5},
pages = {330-335},
doi = {10.1007/BF02554125},
pmid = {3084185},
issn = {0012-3706},
mesh = {Adolescent ; Adult ; Aged ; Appendix/pathology ; Autopsy ; Cecal Diseases/epidemiology/pathology ; Cecum/pathology ; China/ethnology ; Diverticulum/epidemiology/*pathology ; Diverticulum, Colon/epidemiology/pathology ; Ethnicity ; Female ; Humans ; India/ethnology ; Intestinal Diseases/epidemiology/*pathology ; Intestine, Large/*pathology ; Malaysia/ethnology ; Male ; Middle Aged ; Singapore ; },
abstract = {One thousand fourteen consecutive large intestines were removed at autopsy from persons over the age of 14 years and examined for diverticular disease. Diverticulosis was encountered in 194 patients (19 percent). The lesion appeared early in life, after the second decade. Men were affected more frequently than women before the age of 60 years. Chinese men had significantly more diverticular disease than Malayan men (P less than 0.01) and Indian men (P less than 0.02). Chinese men also had significantly more diverticular disease than Chinese women. There was a predominance of right colon involvement, with the disease affecting especially the ascending colon and cecum. This pattern was observed in all three major ethnic groups, and in both the Singapore-born and foreign-born Singaporeans. The cause of right-sided diverticulosis is unknown. It appears that, while adoption of the western diet may influence the prevalence of diverticular disease, the site of predilection is determined more by racial or genetic predisposition. All diverticula examined histologically were false, including 39 (20 percent) solitary diverticula. The distribution of solitary diverticula was similar to that of multiple diverticulosis. It is suggested that solitary and multiple diverticulosis are part of the spectrum of the same disease.},
}
@article {pmid3954274,
year = {1986},
author = {Cohen, H and Willis, I and Wallack, M},
title = {Surgical experience of colon resection in the extreme elderly.},
journal = {The American surgeon},
volume = {52},
number = {4},
pages = {214-217},
pmid = {3954274},
issn = {0003-1348},
mesh = {Age Factors ; Aged ; *Colectomy/adverse effects/mortality ; Colon/surgery ; Colonic Neoplasms/surgery ; Diverticulitis, Colonic/surgery ; Female ; Humans ; Male ; },
abstract = {A retrospective review was undertaken at Mount Sinai Medical Center of Miami Beach for patients aged 70 and greater undergoing colon resection between January 1, 1983 and December 31, 1983. These resections were performed for carcinoma 67.3 per cent, diverticular disease 10.9 per cent, and other indications 21.8 per cent. The operations were performed by different surgeons with a wide spectrum of procedures and associated simultaneous procedures. The morbidity and mortality were reviewed. Complications occurred in 27.7 per cent (38 complications in 28 patients). The complication rate was highest in those with diverticular disease. The overall mortality rate was 4.95 per cent with a zero mortality in patients undergoing elective colon resections. It would appear that with careful monitoring and avoidance of emergency surgery, colon resection can be safely undertaken in this elderly portion of the population.},
}
@article {pmid3953963,
year = {1986},
author = {Rotstein, OD and Pruett, TL and Simmons, RL},
title = {Thigh abscess. An uncommon presentation of intraabdominal sepsis.},
journal = {American journal of surgery},
volume = {151},
number = {3},
pages = {414-418},
doi = {10.1016/0002-9610(86)90481-2},
pmid = {3953963},
issn = {0002-9610},
mesh = {Abscess/diagnosis/*etiology/therapy ; Adenocarcinoma/surgery ; Aged ; Anti-Bacterial Agents/therapeutic use ; Bacterial Infections/diagnosis/*etiology/therapy ; Carcinoma, Squamous Cell/surgery ; Diagnosis, Differential ; Humans ; Lymph Nodes/surgery ; Male ; Prognosis ; Prostatic Neoplasms/surgery ; Rectal Neoplasms/surgery ; Surgical Wound Infection/*complications ; *Thigh ; Thrombophlebitis/diagnosis ; Urinary Bladder Neoplasms/surgery ; },
abstract = {Abscesses of the thigh are rare and, although easily diagnosed, their cause is often obscure. We present two cases of thigh abscesses which resulted from the extension of intraabdominal sepsis. A review of the literature reveals only 46 previously reported cases. The underlying pathologic abnormality is usually a retroperitoneal perforation of a colorectal neoplasm or diverticular disease, whereas origin from the small bowel or appendix is distinctly less common. Routes of extension of infection into the thigh can be either direct, through the subcutaneous tissues, or through naturally occurring defects in the abdominal wall. These include: (1) along the psoas muscle deep to the inguinal ligament; (2) through the femoral canal; (3) by way of the obturator foramen; and (4) through the sacrosciatic notch. The two cases presented are unusual in that they both followed radical cystectomy with lymph node dissection, which opens up these natural avenues to the spread of intraabdominal infection. The overall mortality in the literature is high (53 percent), but recognition of an abdominal source and appropriate treatment combined with local drainage of the thigh abscess appears to improve survival.},
}
@article {pmid3080802,
year = {1986},
author = {Maglinte, DD and Chernish, SM and DeWeese, R and Kelvin, FM and Brunelle, RL},
title = {Acquired jejunoileal diverticular disease: subject review.},
journal = {Radiology},
volume = {158},
number = {3},
pages = {577-580},
doi = {10.1148/radiology.158.3.3080802},
pmid = {3080802},
issn = {0033-8419},
mesh = {Diverticulum/*diagnostic imaging/epidemiology ; Female ; Humans ; Ileum ; Intestinal Diseases/*diagnostic imaging ; Jejunum ; Male ; Middle Aged ; Radiography ; },
abstract = {Of 519 consecutive patients examined by enteroclysis, 12 (2.3%) were found to have acquired diverticula of the jejunum and ileum. All except one patient had multiple diverticula, most occurring in the jejunum. In only one patient could symptoms be ascribed to the abnormality. The combination of intraluminal distention and extrinsic abdominal compression provided by the enteroclysis technique appears to be the most reliable method for the demonstration of small-bowel diverticula. A discussion of the complications that may result from acquired jejunoileal diverticulosis and a review of the literature are presented.},
}
@article {pmid3946763,
year = {1986},
author = {Benn, PL and Wolff, BG and Ilstrup, DM},
title = {Level of anastomosis and recurrent colonic diverticulitis.},
journal = {American journal of surgery},
volume = {151},
number = {2},
pages = {269-271},
doi = {10.1016/0002-9610(86)90085-1},
pmid = {3946763},
issn = {0002-9610},
mesh = {Adult ; Aged ; Colon, Sigmoid/*surgery ; Diverticulitis, Colonic/mortality/*surgery ; Female ; Humans ; Male ; Middle Aged ; Rectal Diseases/surgery ; Rectum/*surgery ; Recurrence ; Reoperation ; Sigmoid Diseases/mortality/*surgery ; },
abstract = {About 7 percent of patients who have resections for diverticular disease later suffer from recurrent disease. In resections for sigmoid disease, the surgeon often has the choice of using either the distal sigmoid colon or the upper rectum for the distal portion of the anastomosis. We examined the courses of 501 consecutive patients who had resection and anastomosis for diverticular disease at the Mayo Clinic between 1970 and 1975. Recurrent diverticulitis developed in 12.5 percent of the patients in whom the sigmoid colon had been used for the distal margin of anastomosis and in 6.7 percent of those in whom the rectum had been used (p = 0.03). Reoperation was required in 3.4 percent of the patients in whom the sigmoid colon was used as the distal anastomotic site and in 2.2 percent of those in whom the rectum had been used (p greater than 0.05). We found no increase in anastomotic leaks or other perioperative complications in patients in whom the rectum had been mobilized. We conclude that the entire distal sigmoid colon should be removed during resection for diverticular disease and anastomosed to the upper rectum to avoid recurrent diverticulitis.},
}
@article {pmid3943428,
year = {1986},
author = {Stebbings, WS and Farthing, MJ and Vinson, GP and Northover, JM and Wood, RF},
title = {Androgen receptors in rectal and colonic cancer.},
journal = {Diseases of the colon and rectum},
volume = {29},
number = {2},
pages = {95-98},
doi = {10.1007/BF02555385},
pmid = {3943428},
issn = {0012-3706},
mesh = {Adenocarcinoma/*analysis/pathology ; Aged ; Cecal Neoplasms/analysis/pathology ; Colonic Neoplasms/*analysis/pathology ; Cytosol/analysis ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Radioligand Assay ; Receptors, Androgen/*analysis ; Rectal Neoplasms/*analysis/pathology ; },
abstract = {To evaluate the potential effect of androgens on human colorectal cancer, the prevalence and concentration of cytosolic androgen receptors were analyzed in 23 rectal and 13 cecal adenocarcinomas by a hybrid radioligand assay. Androgen receptors were detected in nine of the rectal (39 percent) and five of the cecal tumors (38 percent). Androgen receptor levels demonstrated were low, ranging from three to 17 fmol/mg cytosol protein. Dissociation constants were 1 nM or less. The presence of androgen receptors was independent of age or sex of the patient, and of the state of histologic differentiation and Dukes' staging of the tumor. Androgen receptor prevalence was similar in mucosa adjacent to rectal and cecal adenocarcinomas and in mucosa from five of ten patients (50 percent) with diverticular disease. Our findings suggest that androgen dependency does not play a major role in endocrine control of the development of rectal cancer.},
}
@article {pmid3753594,
year = {1986},
author = {Adrian, TE and Savage, AP and Bacarese-Hamilton, AJ and Wolfe, K and Besterman, HS and Bloom, SR},
title = {Peptide YY abnormalities in gastrointestinal diseases.},
journal = {Gastroenterology},
volume = {90},
number = {2},
pages = {379-384},
doi = {10.1016/0016-5085(86)90936-4},
pmid = {3753594},
issn = {0016-5085},
mesh = {Adult ; Aged ; Celiac Disease/blood ; Chromatography, Gel ; Colitis, Ulcerative/blood ; Colonic Diseases, Functional/blood ; Crohn Disease/blood ; Diarrhea/blood ; Diverticulitis/blood ; Duodenal Ulcer/blood ; Female ; Food ; Gastrointestinal Diseases/*blood ; Gastrointestinal Hormones/*blood/physiology ; Humans ; Intestinal Absorption ; Male ; Middle Aged ; Pancreatitis/blood ; Peptide YY ; Peptides/*blood/physiology ; Radioimmunoassay ; },
abstract = {Plasma concentrations of peptide YY (PYY), a newly isolated peptide produced by ileal and colonic endocrine cells, were measured in several groups of patients with digestive disorders after a standardized normal breakfast. Peptide YY levels were found to be grossly elevated in patients with steatorrhea due to small intestinal mucosal atrophy (tropical sprue). Basal levels in these patients were 79 +/- 18 pM, which was nearly 10-fold higher than those seen in healthy controls (8.5 +/- 0.8 pM). Patients with steatorrhea due to chronic destructive pancreatitis also had substantially increased basal PYY levels (47.5 +/- 6.3 pM), and their postprandial response was also greater than that of normal subjects. Moderately elevated plasma PYY concentrations were seen in patients with inflammatory bowel disease and patients recovering from acute infective diarrhea. In contrast, patients with diverticular disease, duodenal ulcer, and functional bowel disease had normal PYY responses. These changes in the secretion of PYY responses. These changes in the secretion, may shed light on the physiologic role of this newly discovered peptide and on intestinal adaptation to common digestive disorders.},
}
@article {pmid3947025,
year = {1986},
author = {Shephard, AA and Keighley, MR},
title = {Audit on complicated diverticular disease.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {68},
number = {1},
pages = {8-10},
pmid = {3947025},
issn = {0035-8843},
mesh = {Adult ; Aged ; Colostomy ; Diverticulitis/complications/mortality/*surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Audit ; Methods ; Middle Aged ; Peritonitis/complications ; Postoperative Complications ; Retrospective Studies ; },
abstract = {Seventy-three patients were seen between 1970 and 1983 with complicated diverticular disease. There were only six hospital deaths (8%). Two out of 7 patients with faecal peritonitis died, 2 of 27 patients with purulent peritonitis died and there was one death each associated with an inflammatory mass and a peridiverticular abscess. Five of the six hospital deaths were from cardiorespiratory disease and only one was from sepsis. Three of the early deaths were in patients who were receiving steroid therapy. There were three late deaths: one from uncontrolled sepsis, one an anaesthetic death from coronary occlusion during revision of a Hartmann operation and the third was an incidental myocardial infarction. A very conservative surgical policy was adopted, primary resection only being used for an inflammatory mass and selectively for fistula and local purulent disease. Despite our apparent low hospital mortality there was a high incidence of complication; wound sepsis 29%, fistula after colostomy closure 12% and anastomotic dehiscence after primary or secondary reconstruction 12%. These findings indicate the need for a prospective audit which is now in progress.},
}
@article {pmid3940799,
year = {1986},
author = {Habib, NA and Dawson, PM and Krausz, T and Blount, MA and Kersten, D and Wood, CB},
title = {A study of histochemical changes in mucus from patients with ulcerative colitis, Crohn's disease, and diverticular disease of the colon.},
journal = {Diseases of the colon and rectum},
volume = {29},
number = {1},
pages = {15-17},
doi = {10.1007/BF02555277},
pmid = {3940799},
issn = {0012-3706},
mesh = {Colitis, Ulcerative/*metabolism ; Crohn Disease/*metabolism ; Diverticulum, Colon/*metabolism ; Histocytochemistry ; Humans ; Intestinal Mucosa/*metabolism ; },
abstract = {The colonic mucosa produces a protective and lubricating layer of mucus. In certain conditions, the quantity and quality of this mucus is impaired. This study assessed the histochemical changes in mucus in inflammatory bowel disease compared with the severity and extent of the condition. Biopsy specimens were taken from 62 patients (32 with ulcerative colitis; ten with colonic Crohn's disease; ten with diverticular disease; ten with normal controls) and sections stained with high iron diamine-alcian blue to distinguish sulphated mucins from sialomucins. Normal subjects showed a predominance of sulphated mucins. The patients with Crohn's and diverticular disease also demonstrated this normal pattern. Of the 20 patients with ulcerative colitis, and without demonstrable dysplastic changes, only one showed a moderate increase in sialomucins. However, of the 12 patients with extensive colitis and dysplastic changes, ten had an increase in sialomucins. Thus, the predominant sialomucin pattern was seen mainly in patients with dysplasia. It may, therefore, indicate patients at high risk of malignancy.},
}
@article {pmid3743945,
year = {1986},
author = {Rabast, U},
title = {Simultaneous endoscopic and radiologic examination of the colon.},
journal = {Gastrointestinal radiology},
volume = {11},
number = {3},
pages = {247-250},
pmid = {3743945},
issn = {0364-2356},
mesh = {Aged ; Colonic Diseases/*diagnosis/diagnostic imaging ; Colonic Neoplasms/diagnosis ; Colonoscopy ; Constriction, Pathologic/diagnosis ; Contrast Media ; Female ; Humans ; Male ; Middle Aged ; Radiography ; },
abstract = {The selective radiologic visualization of pathologic ileocolonoscopic findings using contrast medium offers various advantages over endoscopy or radiologic evaluation performed alone. It allows one to combine a macroscopic biopsy with the radiologic examination and documentation procedure. The technique proves useful to document benign and malignant stenoses and tumors of the colon, diverticular disease, and mucosal abnormalities in long-standing ulcerative colitis and Crohn's disease, and to visualize fistulae, the appendix, or terminal ileum. Up to now, 146 patients have been examined without complication.},
}
@article {pmid3508644,
year = {1986},
author = {Adedeji, A and Akande, B and Olumide, F},
title = {The changing pattern of cholelithiasis in Lagos.},
journal = {Scandinavian journal of gastroenterology. Supplement},
volume = {124},
number = {},
pages = {63-66},
pmid = {3508644},
issn = {0085-5928},
mesh = {Adult ; Cholelithiasis/*epidemiology/etiology ; Contraceptives, Oral/adverse effects ; Diet/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Nigeria ; },
abstract = {Colo-rectal carcinoma, diverticular disease and cholecystitis which are prevalent in the industrialised world are very rare in the African population. The last two decades have, however witnessed a big socio-economic change with incorporation of western dietary items, especially in the Nigerian urban areas. Collection of 69 cases of cholecystitis over a five year period contrasts sharply with the earlier reports in Nigeria. The female to male ratio is 5.3 to 1. The age range is 10-66 years, median female 36.9 +/- 11.3 S.D., and male 49 +/- 7.1 S.D. Probable factors contributing to the increased occurrence may include increased admittance to hospitals, incorporation of the western dietary items in the diet of the urbanised Nigerians and oral contraceptive pills.},
}
@article {pmid3098210,
year = {1986},
author = {Meneghelli, UG and Martinelli, AL and Martucci, NC and Romanello, LM and Dantas, RO},
title = {[Incidence of diverticular disease of the large bowel in non-chagasic and chagasic individuals with and without megacolon].},
journal = {Arquivos de gastroenterologia},
volume = {23},
number = {1},
pages = {3-8},
pmid = {3098210},
issn = {0004-2803},
mesh = {Adult ; Aged ; Aged, 80 and over ; Barium Sulfate ; Chagas Disease/*complications ; Diverticulum, Colon/*complications/diagnosis ; Enema ; Female ; Humans ; Male ; Megacolon/*complications ; Middle Aged ; },
abstract = {To study the frequency of association between two common colonic disease in our midst, chagasic megacolon and diverticular disease, we reviewed the barium enemas of 243 patients aged more than 35 years. Diverticula were detected in 22 (21.6%) of the 102 non-chagasic individuals, in 10 (35.7%) of 20 chagasics without megacolon, and in 14 (12.4%) of the 113 chagasics with megacolon. There was a statistically significant difference between the two chagasic groups, but not between each one of them and the non-chagasic group. The incidence of diverticula in the sigmoid colon of the non-chagasic group was significantly higher than in the sigmoid colon of the other two groups studied. Among the patients with association of megacolon and diverticular disease, the diverticula were always located in the nondilated portions of the large bowel. It is suggested that totally unfavorable conditions for the genesis and/or maintenance of diverticula exist in the dilated colon of chagasic patients.},
}
@article {pmid3081071,
year = {1986},
author = {Williams, I and Slavin, G and Cox, A and Simpson, P and de Lacey, G},
title = {Diverticular disease (adenomyomatosis) of the gallbladder: a radiological-pathological survey.},
journal = {The British journal of radiology},
volume = {59},
number = {697},
pages = {29-34},
doi = {10.1259/0007-1285-59-697-29},
pmid = {3081071},
issn = {0007-1285},
mesh = {Adult ; Aged ; Cholecystectomy ; Cholecystography ; Cholelithiasis/diagnostic imaging/pathology ; Diverticulum/*diagnostic imaging/pathology/surgery ; Endometriosis/*diagnostic imaging/pathology/surgery ; Female ; Gallbladder/pathology ; Gallbladder Diseases/*diagnostic imaging/pathology/surgery ; Gallbladder Neoplasms/*diagnostic imaging/parasitology/surgery ; Humans ; Male ; Middle Aged ; Postoperative Period ; },
abstract = {Seventy consecutive gallbladders removed at surgery were examined radiologically and pathologically. Fifteen (21%) of the operative specimens showed naked-eye changes of adenomyomatosis. The main conclusions drawn from this study are that this abnormality is present in a much higher proportion of gallbladders removed at surgery than is generally realised, and that the pathogenesis is primarily an abnormality of muscle contractions, with a strong similarity to diverticular disease of the colon. Diverticular disease of the gallbladder might well be the most appropriate name for this condition. The results of a post-operative clinical assessment of patients with diverticular disease are also presented. But this represents a small number of patients and larger, perhaps multicentre, surveys would be required in order to assess the clinical significance of this interesting abnormality.},
}
@article {pmid3079996,
year = {1986},
author = {Church, JM and Fazio, VW and Braun, WE and Novick, AC and Steinmuller, DR},
title = {Perforation of the colon in renal homograft recipients. A report of 11 cases and a review of the literature.},
journal = {Annals of surgery},
volume = {203},
number = {1},
pages = {69-76},
pmid = {3079996},
issn = {0003-4932},
mesh = {Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Diverticulum/complications ; Fecal Impaction/complications ; Female ; Humans ; Immunosuppression Therapy/adverse effects ; Intestinal Perforation/diagnosis/*etiology/mortality/prevention & control/surgery ; Kidney Failure, Chronic/complications ; *Kidney Transplantation ; Male ; Middle Aged ; Mortality ; Transplantation, Homologous/adverse effects ; },
abstract = {Colon perforation in renal transplant recipients is a potentially lethal condition that is amenable to appropriate medical and surgical treatment. The 11 cases seen at the Cleveland Clinic (incidence 1.1% of all renal transplant patients) and previous reports in the literature have been reviewed. The pathogenesis is related to a high incidence of diverticular disease in patients with polycystic kidneys and/or chronic renal failure, the effects of long-term immunosuppression, and the transplant procedure itself. The high mortality of this condition (61% overall) is related to the effects of immunosuppression on the response to sepsis and the surgical procedure used. Mortality has fallen from 88% (1970-1974) to 53% (1975-1979), and there are indications that it is continuing to fall. All four cases operated on here since 1980 have survived, giving a total operative mortality of 2/6, and all have maintained excellent allograft function. A high clinical index of suspicion, prompt exteriorization of the perforated colon, reduction of immunosuppression to minimal levels, and effective antibiotic coverage have all contributed to the declining mortality.},
}
@article {pmid4088522,
year = {1985},
author = {van Vugt, AB and Sleeboom, C and Dekker, LA and Mallens, WM and ten Velde, J},
title = {Giant cysts in diverticular disease of the sigmoid colon.},
journal = {The Netherlands journal of surgery},
volume = {37},
number = {6},
pages = {183-186},
pmid = {4088522},
issn = {0167-2487},
mesh = {Aged ; Colon, Sigmoid/pathology ; Diverticulitis, Colonic/pathology/surgery ; Diverticulum, Colon/pathology/*surgery ; Female ; Humans ; Middle Aged ; Pneumatosis Cystoides Intestinalis/pathology/*surgery ; Sigmoid Diseases/pathology/*surgery ; },
abstract = {Two patients with a giant cyst of the sigmoid colon are presented. The literature is reviewed and the clinical features, differential diagnosis and treatment are discussed.},
}
@article {pmid4071166,
year = {1985},
author = {Wheeler, WE and Scott-Conner, CE and Stone, RA},
title = {Flexible sigmoidoscopy as a screening procedure for asymptomatic colorectal carcinoma in patients with inguinal hernia.},
journal = {Southern medical journal},
volume = {78},
number = {12},
pages = {1417-1420},
doi = {10.1097/00007611-198512000-00005},
pmid = {4071166},
issn = {0038-4348},
mesh = {Adenoma/*diagnosis ; Aged ; Colonic Neoplasms/*diagnosis ; Colonic Polyps/*diagnosis ; Hernia, Inguinal/*complications ; Humans ; Male ; Middle Aged ; Rectal Neoplasms/*diagnosis ; Retrospective Studies ; Sigmoidoscopy/*methods ; },
abstract = {In patients about to have hernia repair, preoperative screening studies for early colorectal cancer using the rigid proctosigmoidoscope and barium enema have previously shown minimal cost effectiveness and poor patient acceptance. Flexible sigmoidoscopy may be more acceptable to patients and of greater diagnostic value. Between October 1980 and December 1983, 100 consecutive asymptomatic male surgical patients were examined using the Olympus 60 flexible proctosigmoidoscope. All patients were admitted for elective hernia repair. Age ranged from 21 to 88 years (mean 59.7). All patients with stool positive for occult blood on admission were excluded from this study. In addition, patients with any gastrointestinal symptoms, history of colorectal disease, or family history of colorectal polyps or carcinoma were excluded. Examinations were done under direct supervision of an attending surgeon (W.W. or C.S.C.). Of the 22 patients who had one or more benign polyps, three had villous adenomas. Two additional patients had carcinoma. Results of examination were completely normal in 63, while 13 patients were found to have hemorrhoids or diverticular disease. There were no complications and the procedure was well tolerated by all patients.},
}
@article {pmid3833411,
year = {1985},
author = {Vigoni, A and Marcato, M and Lo Monaco, GP and Mandelli, L and Omodei-Zorini, D},
title = {[Diverticulosis and diverticular disease (reference to a case of diverticular disease observed in 3 sisters)].},
journal = {Chirurgia italiana},
volume = {37},
number = {6},
pages = {656-659},
pmid = {3833411},
issn = {0009-4773},
mesh = {Aged ; Diverticulum, Colon/classification/genetics/*surgery ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {We started from this frequent and important intestinal pathology to emphasize the above mentioned observation of three cases where it was possible to apply three different medico-surgical techniques with excellent results.},
}
@article {pmid4051609,
year = {1985},
author = {Boulos, PB and Cowin, AP and Karamanolis, DG and Clark, CG},
title = {Diverticula, neoplasia, or both? Early detection of carcinoma in sigmoid diverticular disease.},
journal = {Annals of surgery},
volume = {202},
number = {5},
pages = {607-609},
pmid = {4051609},
issn = {0003-4932},
mesh = {Aged ; Carcinoma/*diagnosis ; Colon, Sigmoid ; Colonic Neoplasms/*diagnosis ; Diverticulum, Colon/*diagnosis ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {In 105 patients with symptomatic sigmoid diverticular disease, colonoscopy revealed an associated frequency of carcinoma of seven (6.6%) (Dukes A in 4, B in 2, and C in 1) and adenomas in 29 (27.6%), with a peak incidence of 60 to 79 years and an equal sex distribution. In 45 (43%) examinations, the barium enema was inaccurate. The presenting complaints of abdominal pain and/or alteration in bowel habit in 36 patients with neoplasms and 69 without were similar, but significantly more patients with neoplasms complained of rectal bleeding (p less than 0.05). Endoscopic examination is therefore recommended in patients with sigmoid diverticular disease, particularly in those aged over 60 years and with rectal bleeding.},
}
@article {pmid3001302,
year = {1985},
author = {Steer, C},
title = {Diverticular disease treated with corticotrophin.},
journal = {The Journal of the Royal College of General Practitioners},
volume = {35},
number = {280},
pages = {532-533},
pmid = {3001302},
issn = {0035-8797},
mesh = {Adrenocorticotropic Hormone/*analogs & derivatives ; Adult ; Aged ; Cosyntropin/*therapeutic use ; Diverticulitis/*drug therapy ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {Since 1968 the inflammatory stage of diverticular disease (acute and chronic diverticulitis) has been treated with tetracosactrin in one practice. This paper reviews 100 episodes treated in this way and compares these with 50 episodes treated with rest in bed and dietary measures. Abatement of pyrexia, swelling and tenderness, as well as relief of the symptoms of pain and malaise, were usually found to occur within 24 hours of the administration of tetracosactrin zinc (1 mg) intramuscularly. No complications directly attributable to this therapy have been observed, while the duration of the clinical illness has been reduced by more than half. In neither group were antibiotics found to influence the outcome.},
}
@article {pmid2998175,
year = {1985},
author = {Fisher, N and Berry, CS and Fearn, T and Gregory, JA and Hardy, J},
title = {Cereal dietary fiber consumption and diverticular disease: a lifespan study in rats.},
journal = {The American journal of clinical nutrition},
volume = {42},
number = {5},
pages = {788-804},
doi = {10.1093/ajcn/42.5.788},
pmid = {2998175},
issn = {0002-9165},
mesh = {Animals ; Body Weight ; Breast Neoplasms/prevention & control ; Dietary Fiber/metabolism/*therapeutic use ; Diverticulum, Colon/pathology/*prevention & control ; Feces/analysis ; Female ; Male ; Organ Size ; Rats ; Rats, Inbred Strains ; Sex Factors ; },
abstract = {The relationship between consumption of dietary fiber (DF) from white bread, wholemeal bread, or bran and the development of diverticular disease of the colon has been investigated in a lifespan study using 1800 Wistar rats in nine diet groups. Use of the rat as a model for the human condition was validated by demonstration of significant relationships between fiber intake and fecal output and transit time, and the observation of true acquired diverticula, both single and multiple. Significant inverse relationships (mostly with p less than 0.001) were observed between the incidence of diverticula (and prediverticula) and the concentrations of fiber in the diets, measured by the neutral detergent fiber and Southgate methods. The study offers strong support to the Painter-Burkitt view of human diverticular disease as being due to fiber deficiency, if the extrapolation from rat to man is valid. On the same assumption, the amount of additional fiber required to be consumed in order to achieve a substantial reduction in incidence of the disease is very large. Effects of fiber on body weight, food intake, mineral levels, blood composition and properties, mortality, organ weights, and incidence of tumors and lesions are reported. Significantly fewer mammary tumors were found in rats fed the very high fiber stock diet than in those fed the purified diets.},
}
@article {pmid2864589,
year = {1985},
author = {Burkitt, DP and Clements, JL and Eaton, SB},
title = {Prevalence of diverticular disease, hiatus hernia, and pelvic phleboliths in black and white Americans.},
journal = {Lancet (London, England)},
volume = {2},
number = {8460},
pages = {880-881},
doi = {10.1016/s0140-6736(85)90139-4},
pmid = {2864589},
issn = {0140-6736},
mesh = {*Black People ; Calculi/*epidemiology ; Diverticulum/*epidemiology ; Female ; Gastrointestinal Diseases/epidemiology ; Hernia, Diaphragmatic/*epidemiology ; Hernia, Hiatal/*epidemiology ; Humans ; Male ; Pelvis/*blood supply ; Prospective Studies ; United States ; Vascular Diseases/epidemiology ; *Veins ; White People ; },
abstract = {Phleboliths, and especially diverticular disease and hiatus hernia, are rarer in developing countries than in economically more developed communities, but all three conditions were as common in Black as in White Americans. This finding suggests that they are due to environmental rather than to genetic causes. A deficient intake of dietary fibre may be the common factor predisposing to these three conditions.},
}
@article {pmid4049624,
year = {1985},
author = {Kapp, A and Kendall, AR and Shea, F},
title = {Diverticular abscess of colon: irritative bladder symptoms.},
journal = {Urology},
volume = {26},
number = {4},
pages = {420-422},
doi = {10.1016/0090-4295(85)90200-6},
pmid = {4049624},
issn = {0090-4295},
mesh = {Abscess/diagnosis/*etiology/surgery ; Aged ; Colon, Sigmoid/diagnostic imaging ; Diverticulum, Colon/*complications/diagnosis/surgery ; Humans ; Male ; Sigmoid Diseases/*complications/diagnosis/etiology/surgery ; Tomography, X-Ray Computed ; Urinary Bladder/diagnostic imaging/physiopathology ; Urinary Bladder Diseases/diagnosis/*etiology/surgery ; },
abstract = {Diverticular disease can affect the bladder in subtle ways. Presented herein is a case of a chronic abscess secondary to diverticulitis presenting as irritable vesical symptoms overlooked for several years. The value of pelvic computerized tomography in the diagnosis is stressed.},
}
@article {pmid3910310,
year = {1985},
author = {Whiteway, J and Morson, BC},
title = {Pathology of the ageing--diverticular disease.},
journal = {Clinics in gastroenterology},
volume = {14},
number = {4},
pages = {829-846},
pmid = {3910310},
issn = {0300-5089},
mesh = {Age Factors ; Aged ; Colon, Sigmoid/pathology/ultrastructure ; Diverticulitis, Colonic/epidemiology ; *Diverticulum, Colon/complications/diagnostic imaging/epidemiology/etiology/pathology ; Elastin ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Male ; Middle Aged ; Radiography ; Sex Factors ; *Sigmoid Diseases/complications/diagnostic imaging/epidemiology/etiology/pathology ; },
abstract = {The correlation of increased incidence of diverticular disease with age is well documented. Such a correlation results from the development of a structural change in the taeniae coli, a progressive elastosis. The consequences of this elastosis are a shortening of the taeniae coli and a subsequent change in the circular muscle layer secondary to this. This type of structural alteration takes time to develop and thus explains the time lag experienced between a change in diet and an altered incidence of the disease. Eastwood et al (1982) have suggested that diverticular disease is merely a normal concomitant of ageing which is degenerative in nature. However, the changes in structure in this condition appear to be dynamic, being associated with an altered intraluminal environment. Such a concept is crucial to our understanding of the pathology of ageing in general. Atherogenesis is associated with muscle cell hypertrophy, another dynamic change, which also leads to elastin formation. This suggests that treatment of such conditions should not just be limited to the control of an inevitable deterioration but should be directed to the investigation of the stimuli that may trigger such conditions. For example, it is interesting to speculate exactly when the changes that lead to diverticular disease begin: not only is a high fibre diet eaten in Africa, but breast-feeding may continue until the age of two years. The greatest increase in thickness in the normal colon occurs in this period and it may be that early weaning distorts this proliferation. The initiating factor in the aetiology of elastogenesis could be the small stools produced on a 'Western' diet which only intermittently distend the colon. Arterial smooth muscle cells increase their uptake of elastin precursors (particularly proline) when subjected to intermittent distension (Leung et al, 1976) and this may form a common link in the changes generated in vascular and colonic muscle tissue with time. This type of change is independent of alterations in motility and thus explains why asymptomatic patients have a normal motility index (Weinreich and Anderson, 1976). The muscular thickening in uncomplicated diverticular disease can therefore be explained in terms of elastosis and contracture of the taeniae coli in the presence of normal muscle cells. This does not exclude the possibility that hypertrophy and hyperplasia of these cells can develop in response to subsequent pericolic inflammation and fibrosis.},
}
@article {pmid3878575,
year = {1985},
author = {Kewenter, J and Hellzen-Ingemarsson, A and Kewenter, G and Olsson, U},
title = {Diverticular disease and minor rectal bleeding.},
journal = {Scandinavian journal of gastroenterology},
volume = {20},
number = {8},
pages = {922-924},
doi = {10.3109/00365528509088847},
pmid = {3878575},
issn = {0036-5521},
mesh = {Aged ; Diverticulitis, Colonic/*complications/diagnosis ; Female ; Gastrointestinal Hemorrhage/*complications/diagnosis ; Humans ; Male ; *Occult Blood ; Rectum ; },
abstract = {The purpose of the study was to compare the history of rectal bleeding during the year before the study and the presence of faecal occult bleeding in patients with advanced diverticular disease of the large bowel and two sex- and age-matched reference groups, one consisting of patients with normal large-bowel barium enemas and the other of persons without any history of gastrointestinal disease. The number of persons with faecal occult bleeding or macroscopic anal bleeding during the year before the study was not increased in the group with diverticular disease as compared with the other two groups. The bleeding frequency and characteristics of the bleeding did not differ among the three groups. It is concluded that minor rectal bleeding is rather uncommon in persons with uncomplicated diverticular disease. Patients with a history of rectal bleeding in whom a barium study has only shown diverticular disease should be further investigated as though the diverticula were not present.},
}
@article {pmid3005724,
year = {1985},
author = {Nagahashi, M and Yamazaki, N and Ohi, G and Kai, I and Suzuki, H and Hayakawa, K and Nagasako, K and Kimura, K},
title = {[Dietary fiber intake and diverticular disease of the colon--a case control study].},
journal = {Nihon eiseigaku zasshi. Japanese journal of hygiene},
volume = {40},
number = {4},
pages = {781-788},
doi = {10.1265/jjh.40.781},
pmid = {3005724},
issn = {0021-5082},
mesh = {Aged ; Dietary Fiber/*administration & dosage ; Diverticulum, Colon/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Nutritional Physiological Phenomena ; Rural Health ; Urban Health ; },
}
@article {pmid3876020,
year = {1985},
author = {Johnson, RE and Vellozzi, CJ},
title = {Colonic angiodysplasia and blood loss.},
journal = {American family physician},
volume = {32},
number = {3},
pages = {93-102},
pmid = {3876020},
issn = {0002-838X},
mesh = {Angiography ; Arteriovenous Malformations/*complications/diagnosis/etiology/therapy ; Colectomy/methods ; Colon/*blood supply ; Colonoscopy ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis ; Gastrointestinal Hemorrhage/*etiology/therapy ; Humans ; Middle Aged ; Technetium Tc 99m Sulfur Colloid ; },
abstract = {Colonic angiodysplasia is now recognized as a frequent cause of gastrointestinal bleeding in patients over age 55. These microvascular arteriovenous malformations may be as common a cause of colonic bleeding as diverticular disease. The lesions are not evident on barium studies. Even colonoscopy and selective colonic angiography can give false-negative results. Therefore, repeated studies for recurrent episodes of bleeding are often necessary before the diagnosis is made. Methods of treatment include coagulation biopsy, segmental colon resection and right hemicolectomy.},
}
@article {pmid2994031,
year = {1985},
author = {Johnson, HC and Block, MA},
title = {Diverticular disease. Current trends in therapy.},
journal = {Postgraduate medicine},
volume = {78},
number = {3},
pages = {75-9, 82},
doi = {10.1080/00325481.1985.11699113},
pmid = {2994031},
issn = {0032-5481},
mesh = {Adult ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/diagnosis/surgery/therapy ; Diverticulum, Colon/prevention & control/surgery/*therapy ; Female ; Gastrointestinal Hemorrhage/etiology/surgery/therapy ; Humans ; Middle Aged ; Prognosis ; },
abstract = {Colonic diverticulosis is a common problem in the United States, apparently related to low dietary intake of fiber. Diverticula may bleed or cause local infection or perforation. When antibiotic treatment of infection fails, surgical intervention is necessary. Currently, the most common procedures are primary resection and anastomosis for limited disease and a two-stage Hartmann procedure for severe disease or abscess. If the fiber hypothesis of diverticular formation is correct, then addition of fiber to the diet should prevent diverticular disease.},
}
@article {pmid2992104,
year = {1985},
author = {Walker, AR},
title = {Diet and bowel diseases--past history and future prospects.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {68},
number = {3},
pages = {148-152},
pmid = {2992104},
issn = {0256-9574},
mesh = {Black or African American ; Appendicitis/epidemiology/etiology ; Colitis, Ulcerative/epidemiology/etiology ; Colonic Diseases, Functional/epidemiology ; Colonic Neoplasms/epidemiology/etiology ; Colonic Polyps/epidemiology/etiology ; Constipation/epidemiology/etiology ; Crohn Disease/epidemiology/etiology ; *Diet/trends ; Diet Therapy ; Dietary Fiber ; Diverticulum/epidemiology/etiology ; Hemorrhoids/epidemiology/etiology ; History, 18th Century ; History, 19th Century ; History, 20th Century ; History, Ancient ; History, Medieval ; Humans ; Intestinal Diseases/epidemiology/*etiology ; White People ; },
abstract = {Changes in diet from ancient times until the present are described. Previously relatively low in energy and animal products yet high in fibre-containing foods, diets are now high in energy and animal products (particularly fat), yet contain less fibre. The changing incidences of bowel disorders and diseases are described, with assessments of the role of diet. Clearly, diet is implicated as regards predisposition to constipation, appendicitis, colorectal cancer and diverticular disease; however, a meaningful dietary role in irritable bowel syndrome, ulcerative colitis and Crohn's disease is doubtful. In South Africa the rarity of bowel diseases in rural blacks compared with whites affords valuable aetiological information about some bowel diseases. The low occurrence thereof (except inflammatory bowel disease) in Indian and coloured populations is not readily explicable. While dietary changes in whites are being widely urged in order to combat degenerative diseases, the magnitude of changes made is unlikely to reduce the occurrence of bowel diseases. The progressive westernization of the diets and lifestyles of less-privileged populations is likely to be associated with increases in the incidences of these diseases.},
}
@article {pmid3927497,
year = {1985},
author = {Brian, JE and Stair, JM},
title = {Noncolonic diverticular disease.},
journal = {Surgery, gynecology & obstetrics},
volume = {161},
number = {2},
pages = {189-195},
pmid = {3927497},
issn = {0039-6087},
mesh = {Cecal Diseases/diagnosis/surgery ; *Digestive System Diseases/diagnosis/surgery ; *Diverticulum/diagnosis/surgery ; Diverticulum, Esophageal/diagnosis/surgery ; Diverticulum, Stomach/diagnosis/surgery ; Duodenal Diseases/diagnosis/surgery ; Humans ; Ileal Diseases/diagnosis/surgery ; Jejunal Diseases/diagnosis/surgery ; Meckel Diverticulum/diagnosis/surgery ; },
abstract = {Diverticula occur throughout the gastrointestinal tract. A high index of suspicion is necessary to diagnose and treat complications arising from diverticula. Presented is a review of gastrointestinal diverticular disease exclusive from the more common diverticular disease of the colon.},
}
@article {pmid4007438,
year = {1985},
author = {Franzin, G and Fratton, A and Manfrini, C},
title = {Polypoid lesions associated with diverticular disease of the sigmoid colon.},
journal = {Gastrointestinal endoscopy},
volume = {31},
number = {3},
pages = {196-199},
doi = {10.1016/s0016-5107(85)72043-3},
pmid = {4007438},
issn = {0016-5107},
mesh = {Adenoma/complications/pathology ; Adult ; Biopsy ; Colonoscopy ; Diverticulitis, Colonic/*complications/pathology ; Female ; Humans ; Intestinal Mucosa/pathology ; Intestinal Polyps/*complications/pathology ; Male ; Middle Aged ; Sigmoid Diseases/*complications ; Sigmoid Neoplasms/*complications/pathology ; },
abstract = {Colonscopy performed in five patients because of narrowing of the sigmoid colon with intramural diverticula revealed several bright red, slightly elevated patches. In three patients, some bright red polypoid structures 1 cm in size and hemispherical in shape were also present. On light microscopy the polyps showed the features of transitional mucosa but revealed a different pattern of mucus secretion.},
}
@article {pmid4006637,
year = {1985},
author = {Levy, N and Stermer, E and Simon, J},
title = {The changing epidemiology of diverticular disease in Israel.},
journal = {Diseases of the colon and rectum},
volume = {28},
number = {6},
pages = {416-418},
doi = {10.1007/BF02560228},
pmid = {4006637},
issn = {0012-3706},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Barium Sulfate ; Diverticulum, Colon/diagnostic imaging/*epidemiology ; Enema ; *Ethnicity ; Female ; Humans ; Israel ; Male ; Middle Aged ; Radiography ; },
abstract = {In a retrospective evaluation of 1244 consecutive barium enemas performed at two hospitals over a five-year period (1979 to 1984), colonic diverticula were found in 177 (14.2 percent). The prevalence among the Ashkenazi Jews was 19.7 percent, among the Sephardi and Oriental Jews, 16 percent, and among the Arabs, 9.5 percent. Comparing these figures with the results of a similar study performed ten years ago, it becomes obvious that the prevalence of diverticular disease in the Ashkenazi group remained the same, while there was a three-fold increase among Sephardi and Oriental Jews, and a seven-fold increase among Arabs. It is postulated that, in less than one generation, diverticular disease will be equally frequent among all ethnic groups in Israel.},
}
@article {pmid3894495,
year = {1985},
author = {Maguire, TM and Wensel, RH and Malcolm, N and Jewell, L and Thomson, AB},
title = {Massive gastrointestinal hemorrhage cecal ulcers and salmonella colitis.},
journal = {Journal of clinical gastroenterology},
volume = {7},
number = {3},
pages = {249-250},
doi = {10.1097/00004836-198506000-00012},
pmid = {3894495},
issn = {0192-0790},
mesh = {Aged ; Cecal Diseases/*etiology/microbiology ; Colitis/*complications/microbiology ; Colonoscopy ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Male ; Salmonella Infections/*complications ; Salmonella typhimurium ; Ulcer/*etiology/microbiology ; },
abstract = {A 65-year-old man presented with massive lower gastrointestinal tract hemorrhage. Minimal changes were noted on sigmoidoscopy, no bleeding lesions were identified on arteriography or red blood cell scan, and barium enema examination demonstrated only diverticular disease and minimal cecal deformity, interpreted as secondary to a recent appendectomy. Colonoscopy demonstrated multiple deep cecal ulcers. These were presumed to be due to an infectious etiology, since the stools were culture-positive for Salmonella typhimurium. The hemorrhage stopped within 24 hours of treatment with Ampicillin, Flagyl, and Gentamicin. The patient has remained well over a 12-month follow-up period. Repeat colonoscopy demonstrated healing of the cecal ulcers and there was also clearing of the Salmonella from the stools. This case report serves to remind us of the different methods used to diagnose lower gastrointestinal tract hemorrhage, and the importance of considering infectious causes of colitis.},
}
@article {pmid3996147,
year = {1985},
author = {Hackford, AW and Schoetz, DJ and Coller, JA and Veidenheimer, MC},
title = {Surgical management of complicated diverticulitis. The Lahey Clinic experience, 1967 to 1982.},
journal = {Diseases of the colon and rectum},
volume = {28},
number = {5},
pages = {317-321},
doi = {10.1007/BF02560431},
pmid = {3996147},
issn = {0012-3706},
mesh = {Anti-Bacterial Agents/therapeutic use ; Colectomy/methods/mortality ; Colonic Diseases/etiology/surgery ; *Colostomy/mortality ; Diverticulitis, Colonic/mortality/pathology/*surgery ; Drainage ; Female ; Hospitalization ; Humans ; Intestinal Fistula/etiology/surgery ; Length of Stay ; Male ; Middle Aged ; Premedication ; Retrospective Studies ; Surgical Wound Infection/etiology ; },
abstract = {One hundred forty patients who had complicated diverticular disease were identified in a retrospective review at the Lahey Clinic between 1967 and 1982. Of these patients, 86 underwent resection with primary anastomosis with a 1 percent mortality rate and an 18 percent morbidity rate; 13 had resection with anastomosis and creation of a proximal colostomy with no death and a 22 percent morbidity rate; 19 had the Hartmann operation or colostomy with mucous fistula with a 16 percent mortality rate and a 23 percent morbidity rate; and 22 underwent a traditional three-stage operation with 14 percent mortality and 24 percent morbidity rates. The average duration of hospitalization was 21 days for patients who underwent the one-stage procedure, 31 and 39 days for those who had a two-stage operation, and 52 days for patients who underwent the three-stage procedure. Primary resection for complicated disease is associated with acceptable morbidity and mortality rates under appropriate circumstances.},
}
@article {pmid3158193,
year = {1985},
author = {Ravo, B and Khan, SA and Ger, R and Mishrick, A and Soroff, HS},
title = {Unusual extraperitoneal presentations of diverticulitis.},
journal = {The American journal of gastroenterology},
volume = {80},
number = {5},
pages = {346-351},
pmid = {3158193},
issn = {0002-9270},
mesh = {Abscess/diagnostic imaging/etiology/surgery ; Aged ; Back Pain/diagnostic imaging/*etiology ; Buttocks ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Intestinal Obstruction/diagnostic imaging ; Intestinal Perforation/*complications ; Rectal Diseases/diagnostic imaging ; Sigmoid Diseases/diagnostic imaging ; Tomography, X-Ray Computed ; },
abstract = {Extraperitoneal presentations of complicated diverticular disease are unusual. The initial clinical presentations of these extraperitoneal manifestations have been described in the perineum, scrotum, buttock, hip, joints, thigh, lower extremities, mediastinum, and neck. These presentations render the diagnosis difficult and may lead to the delay of the proper therapy. The purpose of this report is to call attention to these unusual extraperitoneal presentations of complicated diverticular disease to describe the routes of spread and to present a case in point. Reviewing the literature, we have concluded that these unusual presentations occur more commonly in women and the elderly, that a delayed diagnosis significantly increases the mortality rate, and that the most common site of an extraperitoneal presentation is in the area of the hip.},
}
@article {pmid2988400,
year = {1985},
author = {Leahy, AL and Ellis, RM and Quill, DS and Peel, AL},
title = {High fibre diet in symptomatic diverticular disease of the colon.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {67},
number = {3},
pages = {173-174},
pmid = {2988400},
issn = {0035-8843},
mesh = {Dietary Fiber/*administration & dosage ; Diverticulum, Colon/complications/*diet therapy ; Humans ; Retrospective Studies ; },
abstract = {Over the past decade fibre supplementation has achieved widespread acceptance in the management of symptomatic diverticular disease, although the efficacy of this treatment has been debated. We have conducted a retrospective review of 72 patients admitted to hospital with symptomatic diverticular disease over a ten year period in order to determine whether or not high fibre diet afforded protection against the development of complications, necessity for surgery or persistence of symptoms. Fifty-six patients were treated non-operatively, of these 43 received advice concerning a high fibre diet but only 31 patients complied. The 12 patients who failed to take additional fibre and the 13 patients who never received dietary advice (25 patients) formed the non high fibre group. Those treated with fibre supplementation fared significantly better in developing fewer complications and required less surgery (P less than 0.05). At the time of follow-up review patients on a high fibre diet reported significantly fewer symptoms (P less than 0.05).},
}
@article {pmid2858428,
year = {1985},
author = {James, SP and Fiocchi, C and Graeff, AS and Strober, W},
title = {Immunoregulatory function of lamina propria T cells in Crohn's disease.},
journal = {Gastroenterology},
volume = {88},
number = {5 Pt 1},
pages = {1143-1150},
doi = {10.1016/s0016-5085(85)80073-1},
pmid = {2858428},
issn = {0016-5085},
support = {AM-30399/AM/NIADDK NIH HHS/United States ; },
mesh = {Adolescent ; Adult ; Aged ; Antibodies, Monoclonal ; Colon/*immunology ; Crohn Disease/blood/*immunology/pathology ; Female ; Humans ; Immunoglobulins/biosynthesis ; Lymphocyte Activation ; Male ; Middle Aged ; T-Lymphocytes/classification/*immunology ; T-Lymphocytes, Helper-Inducer/immunology ; T-Lymphocytes, Regulatory/immunology ; },
abstract = {The pathogenesis of Crohn's disease may involve altered function of immunoregulatory T cells in the intestine. To investigate this hypothesis, lamina propria lymphocytes were isolated from intestinal specimens resected from patients with active Crohn's disease and control subjects (colon carcinoma and diverticular disease) using an enzymatic technique. The T-cell phenotypes and function of these lymphocytes were compared with that of peripheral blood lymphocytes. The proportion of Leu-2-positive (suppressor/cytotoxic) cells was similar in peripheral blood and isolated lamina propria lymphocytes, both in Crohn's disease and control patients. Although the proportion of Leu-3-positive (helper/inducer) lymphocytes was lower in lamina propria lymphocytes than peripheral blood lymphocytes, there was no difference comparing Crohn's disease and control patients. Helper T-cell function, as determined by measuring the ability of T cells to increase immunoglobulin synthesis by pokeweed mitogen-stimulated normal peripheral blood B cells, was similar in peripheral blood lymphocytes and lamina propria lymphocytes, and comparing Crohn's disease with control patients. Suppressor T-cell function, as determined by measuring the ability of T cells to inhibit immunoglobulin production by cultures containing pokeweed mitogen-stimulated normal peripheral blood T and B cells, was also similar comparing peripheral blood lymphocytes and lamina propria lymphocytes, and comparing Crohn's disease with control patients: neither peripheral blood lymphocytes nor lamina propria lymphocytes significantly suppressed immunoglobulin synthesis. OKT8 (suppressor/cytotoxic)-enriched lamina propria lymphocytes mediated only marginal suppression, whereas concanavalin A-activated intestinal T cells did mediate significant suppression, in both Crohn's disease and control patients. Thus, patients with active Crohn's disease have no alteration of immunoregulatory T-cell function for polyclonal mitogen-induced immunoglobulin synthesis at the gut mucosal level, despite the presence of an inflammatory process in the intestine.},
}
@article {pmid4012531,
year = {1985},
author = {Hackford, AW and Veidenheimer, MC},
title = {Diverticular disease of the colon. Current concepts and management.},
journal = {The Surgical clinics of North America},
volume = {65},
number = {2},
pages = {347-363},
doi = {10.1016/s0039-6109(16)43588-7},
pmid = {4012531},
issn = {0039-6109},
mesh = {Colectomy ; Colon/pathology ; Colon, Sigmoid/surgery ; Colostomy/methods ; Diverticulitis, Colonic/diagnosis/etiology/surgery/*therapy ; Hospitalization ; Humans ; Intestinal Mucosa/pathology ; Length of Stay ; Sigmoid Diseases/surgery/therapy ; },
abstract = {Diverticular disease of the colon is being seen with increasing frequency. An acute complicated presentation of the disease occurs in a minority of patients. In contrast to a previous study in which we found that 70 per cent of patients had had prior episodes, our most recent study revealed that for nearly 50 per cent of the patients with acute diverticular disease a complicated attack was the initial manifestation of the disease. Because these patients are more likely to have concomitant medical problems, aggressive elective surgical management is appropriate. This approach is now associated with a mortality rate of less than 1 per cent in patients with uncomplicated disease. Even in patients with complicated active disease, a mortality rate of less than 4 per cent can be anticipated when bowel preparation can be achieved. In patients below the age of 55 resection is advocated after a single attack because the rate of recurrence in this group may be as high as 50 per cent. In the setting of stage I or stage II disease primary resection with anastomosis is safe and should be performed. Proximal colostomy formation may be carried out at the discretion of the surgeon if warranted by such local circumstances as contiguous inflammation or macroscopic contamination. For patients with stage III and stage IV disease end-colostomy with Hartmann closure of the rectum is the procedure of choice, although anastomosis with proximal stoma may prove to be an acceptable alternative. The morbidity and mortality rates associated with the classic three-stage approach are similar to those with two-stage management, but the latter is associated with a substantially shorter duration of hospitalization and disability. The best form of management of diverticular disease is prevention. It is appealing to embrace high-bulk dietary management as a prophylaxis based on current knowledge of pathophysiologic principles, but good prospective randomized data are not yet forthcoming.},
}
@article {pmid3981102,
year = {1985},
author = {Zatlin, GS and Krieger, AP},
title = {Diverticular disease in younger adults.},
journal = {The Journal of family practice},
volume = {20},
number = {4},
pages = {401-402},
pmid = {3981102},
issn = {0094-3509},
mesh = {Adult ; Colostomy ; Diverticulitis, Colonic/complications/*diagnosis/pathology ; Humans ; Intestinal Perforation/etiology ; Male ; Sigmoid Diseases/etiology ; },
}
@article {pmid3920126,
year = {1985},
author = {Watters, DA and Smith, AN and Eastwood, MA and Anderson, KC and Elton, RA and Mugerwa, JW},
title = {Mechanical properties of the colon: comparison of the features of the African and European colon in vitro.},
journal = {Gut},
volume = {26},
number = {4},
pages = {384-392},
pmid = {3920126},
issn = {0017-5749},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Colon/*physiology/physiopathology ; Colon, Sigmoid/physiology ; Diverticulum/physiopathology ; Elasticity ; Humans ; In Vitro Techniques ; Infant ; Infant, Newborn ; Middle Aged ; Preservation, Biological ; Scotland ; Tensile Strength ; Uganda ; },
abstract = {The tensile properties of the colon have been examined using methods which gave repeatable results. They showed little change after storage in salt for up to five weeks. The burst strength remained unchanged along the length of the colon. The tensile strength fell distally, as the thickness of the colonic wall increased. The width at burst decreased distally as did the internal diameter. The visco-elastic property of stress relaxation was constant in all regions. The tensile property of the colon was well developed at birth, but fell with age as did the width at burst and the internal diameter. Stress relaxation was unaffected. Because there may be a mechanical abnormality of the colonic wall in diverticular disease and as Europeans are prone to this condition while Africans are not commonly affected, European and African colons were compared. The tensile strength in a Kampala group was greater than in an Edinburgh one, but fell significantly in both groups with age. The width at burst was greater in the Kampala group, but also declined with age. Stress-relaxation was similar in both groups. In view of the similar properties in childhood of colons from Edinburgh and Kampala, the strength of the adult African compared with European colons may derive later from environmental factors such as diet. There were, however, no differences between the colons with and without diverticular disease in European subjects over the age of 50 years.},
}
@article {pmid2991507,
year = {1985},
author = {Painter, NS},
title = {The cause of diverticular disease of the colon, its symptoms and its complications. Review and hypothesis.},
journal = {Journal of the Royal College of Surgeons of Edinburgh},
volume = {30},
number = {2},
pages = {118-122},
pmid = {2991507},
issn = {0035-8835},
mesh = {Colonic Diseases/etiology ; Dietary Fiber/administration & dosage ; Diverticulitis, Colonic/complications/*etiology ; Diverticulum, Colon/complications/*etiology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Urinary Bladder Fistula/etiology ; },
}
@article {pmid3972272,
year = {1985},
author = {Whiteway, J and Morson, BC},
title = {Elastosis in diverticular disease of the sigmoid colon.},
journal = {Gut},
volume = {26},
number = {3},
pages = {258-266},
pmid = {3972272},
issn = {0017-5749},
mesh = {Collagen/analysis ; Diverticulum, Colon/etiology/metabolism/*pathology ; Elastic Tissue/*pathology/ultrastructure ; Elastin/analysis ; Humans ; Microscopy, Electron ; Muscle, Smooth/analysis/ultrastructure ; Sigmoid Diseases/etiology/metabolism/*pathology ; },
abstract = {Diverticular disease of the sigmoid colon is an increasingly common clinical problem in the ageing population of western industrialised countries but the mechanism by which the disease develops remains unknown. The muscular abnormality is the most striking and consistent feature and this has been studied by light and electron microscopy in 25 surgical specimens of uncomplicated diverticular disease and in 25 controls. This is the first ultrastructural study of human colonic muscle to be published and shows that the muscle cells in diverticular disease are normal; neither hypertrophy nor hyperplasia is present. There is, however, an increase in the elastin content of the taeniae coli by greater than 200% compared with controls: elastin is laid down between the muscle cells and the normal fascicular pattern of the taeniae coli is distorted. There is no alteration in the elastin content of the circular muscle. As elastin is laid down in a contracted form, this elastosis may be responsible for the shortening or 'contracture' of the taeniae which in turn leads to the characteristic concertina-like corrugation of the circular muscle. Such a structural change could explain the altered behaviour of the colon wall in diverticular disease and its failure to change on treatment with bran.},
}
@article {pmid3973376,
year = {1985},
author = {Glover, JL and Egan, W},
title = {Chronic diverticular disease of the colon.},
journal = {Indiana medicine : the journal of the Indiana State Medical Association},
volume = {78},
number = {2},
pages = {97-100},
pmid = {3973376},
issn = {0746-8288},
mesh = {Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis/surgery ; Humans ; },
}
@article {pmid3971809,
year = {1985},
author = {Nagorney, DM and Adson, MA and Pemberton, JH},
title = {Sigmoid diverticulitis with perforation and generalized peritonitis.},
journal = {Diseases of the colon and rectum},
volume = {28},
number = {2},
pages = {71-75},
doi = {10.1007/BF02552645},
pmid = {3971809},
issn = {0012-3706},
mesh = {Adult ; Aged ; Colostomy ; Diverticulitis, Colonic/complications/mortality/*surgery ; Drainage ; Female ; Humans ; Intestinal Perforation/complications/etiology/*surgery ; Male ; Methods ; Middle Aged ; Peritonitis/*etiology/surgery ; Sigmoid Diseases/complications/mortality/*surgery ; },
abstract = {Sigmoid diverticulitis with perforation and generalized peritonitis is a grave complication of diverticular disease. To compare accurately the results of two operative approaches--proximal colostomy with drainage and proximal colostomy with resection or exteriorization--the authors assessed the clinical and pathologic features of 121 consecutive patients with perforating sigmoid diverticulitis. There were no differences between treatment groups in age, sex, mean duration of symptoms, clinical presentation, number of coexistent diseases, type of peritonitis or chronic corticosteroid use. Overall mortality for emergency operation was 12 percent. Mortality was significantly greater (P less than 0.05) among the 31 patients treated by colostomy and drainage (26 percent) than among the 90 patients treated by colostomy and resection or exteriorization (7 percent). Seven of the nine patients who died from persistent sepsis had undergone colostomy and drainage. Four clinical factors were found to be predictive of mortality (P less than 0.05): persistent postoperative sepsis, fecal peritonitis, preoperative hypotension, and prolonged duration of symptoms. These factors identified a subgroup of patients who, because of an increased risk of death, would be likely to benefit from the more complete eradication of the septic focus that is achieved by colostomy and resection.},
}
@article {pmid3873561,
year = {1985},
author = {Kubo, A and Kagaya, T and Nakagawa, H},
title = {Studies on complications of diverticular disease of the colon.},
journal = {Japanese journal of medicine},
volume = {24},
number = {1},
pages = {39-43},
doi = {10.2169/internalmedicine1962.24.39},
pmid = {3873561},
issn = {0021-5120},
mesh = {Adult ; Aged ; Anemia/etiology ; Diverticulitis, Colonic/*complications/epidemiology ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Japan ; Male ; Middle Aged ; },
abstract = {Out of 1,124 cases of diverticular disease of the colon seen during the past 15 years, 27 cases (2.4%) of diverticulitis and 44 cases (3.9%) of diverticular hemorrhage were found. The incidence of diverticulitis was more frequent in the both-sides colon type, and also in the multiple form having 10 or more diverticula. The average age was higher in diverticulitis of the sigmoid colon (57.8 years) than in diverticulitis of the right-side colon (47.9 years). Twenty-two cases (81%) of these patients were recovered by medical treatment, and in 5 cases (19%) of these, elective colectomy was carried out. On the other hand, the incidence of diverticular hemorrhage was more frequent in patients over 70 years old, and also in the multiple form having 10 or more diverticula. Though anemia was seen in 11 (25%) of 44 cases, all patients were recovered by medical management. Namely, diverticulitis of the right-side colon is more frequent in middle age, and both diverticulitis of the sigmoid colon and diverticular hemorrhage are more frequent in old age.},
}
@article {pmid4054506,
year = {1985},
author = {Feldberg, MA and Hendriks, MJ and van Waes, PF},
title = {Role of CT in diagnosis and management of complications of diverticular disease.},
journal = {Gastrointestinal radiology},
volume = {10},
number = {4},
pages = {370-377},
pmid = {4054506},
issn = {0364-2356},
mesh = {Abscess/diagnostic imaging/etiology ; Adult ; Aged ; Contrast Media ; Diverticulitis, Colonic/*complications/diagnostic imaging ; Female ; Humans ; Intestinal Fistula/diagnostic imaging/etiology ; Iothalamic Acid/analogs & derivatives ; Male ; Middle Aged ; Sigmoid Diseases/*complications/diagnostic imaging ; *Tomography, X-Ray Computed ; },
abstract = {The clinical complications of diverticular disease may be unclear. Seven patients with complicated diverticulitis of the transverse, descending, and sigmoid colon were examined with computed tomography. Exact knowledge of the anatomical relationships of the transverse, descending, and sigmoid colon and neighboring structures are a prerequisite for understanding and interpreting the extensions of peridiverticular disease. Computed tomography proved to be useful in evaluating the presence and extent of sequelae of perforations, and, as a consequence, influenced the planning and timing of treatment.},
}
@article {pmid4011872,
year = {1985},
author = {Müller, H},
title = {[X-ray diagnosis of diverticular disease].},
journal = {Radiologia diagnostica},
volume = {26},
number = {2},
pages = {245-253},
pmid = {4011872},
issn = {0033-8354},
mesh = {Aged ; Diverticulitis, Colonic/*diagnostic imaging ; Diverticulum, Colon/*diagnostic imaging ; Humans ; Middle Aged ; Radiography ; },
}
@article {pmid233442,
year = {1979},
author = {Hillemand, B and Joly, JP and Todoskoff, J and Allard, S and Martin, C and Reumont, G and Gray, H and Maitrot, B and Matray, F},
title = {[Alcoholism, colic diverticular disease and metabolic disorders (author's transl)].},
journal = {La semaine des hopitaux : organe fonde par l'Association d'enseignement medical des hopitaux de Paris},
volume = {55},
number = {43-44},
pages = {2001-2007},
pmid = {233442},
mesh = {Adult ; Aged ; Alcoholism/*complications ; Diverticulum, Colon/*complications ; Female ; Humans ; Male ; Metabolic Diseases/*complications ; Middle Aged ; },
abstract = {70 patients with colic diverticular disease and 50 control subjects were compared. Sexes and ages were matched in the two groups. Significant higher frequencies of alcoholism (P < 0,00001), hyperlipidemia (P < 0,0001), impaired oral glucose tolerance test (P < 0,001), hyperuricemia (P < 0,01) and atherosclerosis (P < 0,000001) were noted in the diverticular group. Hypothesis about pathogenesis of diverticular disease are suggested.},
}
@article {pmid539584,
year = {1979},
author = {Nelson, AM and Grayer, DI},
title = {Development of diverticular disease in the transplanted colon.},
journal = {The American journal of gastroenterology},
volume = {72},
number = {6},
pages = {660-661},
pmid = {539584},
issn = {0002-9270},
mesh = {Aged ; Colon/*transplantation ; Diverticulum, Colon/*etiology ; Esophageal Neoplasms/*surgery ; Gastrectomy ; Humans ; Male ; Stomach Neoplasms/*surgery ; Transplantation, Autologous ; },
abstract = {A patient who had undergone an esophagogastrectomy and colon interposition for carcinoma subsequently developed diverticulosis in the graft years after. The pathogenesis is discussed.},
}
@article {pmid393230,
year = {1979},
author = {Meech, PR and Hardie, IR and Hartley, LC and Strong, RW and Clunie, GJ},
title = {Gastrointestinal complications following renal transplantation.},
journal = {The Australian and New Zealand journal of surgery},
volume = {49},
number = {6},
pages = {621-625},
doi = {10.1111/j.1445-2197.1979.tb06474.x},
pmid = {393230},
issn = {0004-8682},
mesh = {Cholestasis, Extrahepatic/etiology ; Colonic Diseases/etiology ; Duodenal Ulcer/etiology ; Gastrointestinal Diseases/*etiology ; Gastrointestinal Hemorrhage/etiology ; Graft Rejection ; *Kidney Transplantation ; Mesenteric Vascular Occlusion/etiology ; },
abstract = {Gastrointestinal complications occurred in 19 of 290 recipients (6.6%) of the 325 cadaveric renal allografts undertaken between September 1969 and December 1978. The mortality was 42.1%. Upper gastrointestinal complications, principally haemorrhage, occurred in 12 patients (4.1%), 11 of whom were males, usually within four months of transplantation, and often associated with acute rejection and its treatment. Surgery was required in five patients. The overall mortality was 16.7%. Colonic complications occurred in five patients (1.7%), four of whom died, the absence of specific signs having led to a significant delay in diagnosis. One patient died from abdominal vascular disease, and one from carcinoma of the gallbladder. To decrease the high morbidity and mortality, both medical and appropriate surgical prophylaxis for peptic ulceration and diverticular disease are necessary, as is an awareness of the transplant recipient's propensity to develop a gastrointestinal complication at any time, up to years after transplantation. Early recognition and treatment of such complications are essential.},
}
@article {pmid525173,
year = {1979},
author = {Reilly, MC},
title = {The place of sigmoid myotomy in diverticular disease.},
journal = {Acta chirurgica Belgica},
volume = {78},
number = {6},
pages = {387-390},
pmid = {525173},
issn = {0001-5458},
mesh = {Abscess/etiology ; Adult ; Aged ; Colon, Sigmoid/*surgery ; Colonic Diseases/etiology ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Male ; Methods ; Middle Aged ; Muscle, Smooth/surgery ; Urinary Bladder Fistula/etiology ; },
abstract = {The place of longitudinal myotomy in the treatment of diverticular disease of the sigmoid colon is discussed, with passing reference to the drawbacks of transverse myotomy. The prime indication for longitudinal myotomy is in the longstanding uncomplicated case of troublesome diverticular disease that has not responded to correct medical treatment, which should include high-residue diet and bran. Such cases are usually over 50 years of age, when a functional and reversible obstruction has become organic and irreversible. They comprise 75% of a series of 104 cases described. A secondary indication is in cases of diverticular disease which have been complicated by perforation, abscess formation, acute intestinal obstruction or fistulae. Such cases comprise 25% of the present series. They may settle after drainage and/or defunctioning colostomy. Myotomy can be carried out later, with or without limited resection, provided that all signs of pus or peritonitis have disappeared. The technique of the operation is described and the results are analysed.},
}
@article {pmid525171,
year = {1979},
author = {Morson, BC},
title = {Diverticular disease of the colon.},
journal = {Acta chirurgica Belgica},
volume = {78},
number = {6},
pages = {369-376},
pmid = {525171},
issn = {0001-5458},
mesh = {Adult ; Colitis, Ulcerative/complications ; Colonic Diseases/complications ; Colonic Neoplasms/complications ; Crohn Disease/complications ; Diverticulitis, Colonic/etiology ; Diverticulum, Colon/complications/*etiology ; Humans ; Intestinal Polyps/complications ; Middle Aged ; Muscle Hypotonia/*complications ; *Muscle, Smooth ; },
abstract = {Diverticular disease is basically a disorder of muscle function, particularly of the sigmoid colon. Increase in tone of the muscle layers of the bowel with consequent muscular thickening of a characteristic pattern. The thickening is not a true cellular hypertrophy and there is no evidence of muscle cell hyperplasia. The formation of diverticula are distributed along the points of greatest weakness in the bowel wall, namely where the blood supply penetrates, suggests that pulsion plays a major role in their development. The inflammation in diverticular disease is purely a complication of the diverticulosis.},
}
@article {pmid525170,
year = {1979},
author = {Painter, NS},
title = {The treatment of uncomplicated diverticular disease of the colon with a high fibre diet.},
journal = {Acta chirurgica Belgica},
volume = {78},
number = {6},
pages = {359-368},
pmid = {525170},
issn = {0001-5458},
mesh = {Aged ; Cellulose/*therapeutic use ; Constipation/complications ; Defecation ; Dietary Fiber/*therapeutic use ; Diverticulum, Colon/*diet therapy/etiology ; Feces ; Food Preferences ; Humans ; Middle Aged ; },
abstract = {This paper describes the pathogenesis, aetiology, epidemiology and the historical emergence of diverticular disease as a clinical problem. The symptoms of the uncomplicated disease can be treated successfully and cheapli with a high fibre diet including miller's bran. The method of giving bran and its results are described. The adoption of a high fibre diet lessens the need for surgery in diverticulitis and the author believes that it could prevent the appearance of the condition in future generations.},
}
@article {pmid525169,
year = {1979},
author = {Wesdorp, IC and Glerum, J and Agenant, A and Schrijver, M and Tytgat, GN},
title = {Value of colonoscopy in the detection of sigmoid malignancy in patients with diverticular disease.},
journal = {Acta chirurgica Belgica},
volume = {78},
number = {6},
pages = {355-358},
pmid = {525169},
issn = {0001-5458},
mesh = {Colon ; Diverticulum, Colon/*complications/diagnosis/diagnostic imaging ; *Endoscopy ; Evaluation Studies as Topic ; Female ; Fiber Optic Technology ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Sigmoid Neoplasms/complications/*diagnosis ; },
abstract = {Sixty patients with diverticular disease, referred because a barium enema examination could not exclude a co-existing malignanty, were studied in a retrospective manner, to find out the contribution of colonoscopy in the diagnosis of sigmoid carcinoma in such patients. All X-ray studies were blindly reviewed and divided in two categories: a) diverticular disease with malignancy or strong suspicion for malignancy and b) diverticular disease without suspicion for malignancy. The accuracy of the endoscopical examination was evaluated by a follow-up study with a range of 3 months-3 years. Colonoscopy appeared to be accurate in more than 3/4 of the referred patients but was not helpful when there was a severe stenoisis and/or the diseases segment could not be reached for biopsy. The incidence diminished when a small calibre fiberendoscope was used, practically always allowing to reach or to pass the stenotic segment. There were no false positive nor false negative endoscopical results in our study. In a substantial number of patients major surgical exploration could be prevented. We consider colonoscopy therefore a valuable adjunct in detecting or eliminating cancer in colonic diverticular disease. The availability of various fiberendoscopic instruments is a prerequisite for reaching an acceptable success rate and diagnostic accuracy.},
}
@article {pmid525168,
year = {1979},
author = {Hunt, RH},
title = {The role of colonoscopy in complicated diverticular disease. A review.},
journal = {Acta chirurgica Belgica},
volume = {78},
number = {6},
pages = {349-353},
pmid = {525168},
issn = {0001-5458},
mesh = {Aged ; Colon ; Colonic Diseases/diagnosis ; Colonic Neoplasms/*diagnosis ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis ; Diverticulum, Colon/*diagnosis ; *Endoscopy ; Humans ; Intestinal Polyps/diagnosis ; Middle Aged ; },
abstract = {Colonoscopy in complicated diverticular disease may assist the clinician in establishing the diagnosis of associated strictures. A review of the literature shows that carcinoma was identified in 21 (17%) of 125 patients and that an additional diagnosis was made in 40 (32%) patients. Although colonoscopy may be a difficult procedure in patients with diverticular disease the caecum was reached in 27 (61%) of 44 patients and took no longer than routine colonoscopic orpcedures. Further analysis of these results confirms that the barium enema frequently produces both false positive and false negative diagnoses of carcinoma and polyps. The presence of bleeding strongly suggests the presence of a concomitant lesion. Fifteen (11%) carcinomas were identified in a group of 135 patients with persistent rectal bleeding whose barium enema showed only diverticular disease and an additional diagnosis was made in 50 (37%) of these patients. Colonoscopy is an important investigation in patients with complicated diverticular disease.},
}
@article {pmid525167,
year = {1979},
author = {Mahieu, P and Pringot, J and Detry, R and Haot, J},
title = {[Radiological aspects of peri-diverticular disease of the colon. An anatomo-pathological correlation (author's transl].},
journal = {Acta chirurgica Belgica},
volume = {78},
number = {6},
pages = {339-347},
pmid = {525167},
issn = {0001-5458},
mesh = {Barium Sulfate ; Diverticulitis, Colonic/*diagnostic imaging/pathology ; Diverticulum, Colon/*diagnostic imaging/pathology ; Enema ; Humans ; Urography ; },
abstract = {Sixty consecutive cases operated for diverticular disease of the colon within the last 10 years are reviewed. A comparative study is made of the anatomopathological examination of the specimens and their radiological aspect trying to establish the precise radiological picture of acute, chronic and fibrotic peri-diverticular disease. Plain films of the abdomen, intravenous uro- and cystography are very useful in acute cases. A baryum enema just prior to surgery (33 cases) heralds by the rigid aspect of the involved bowelsegment the acute case; spasms, thick disorderly folds and localized extravasation characterize the acute peridiverticulitis. Fibrotic peri-diverticular disease shows disorderly, fine but "ragged" folds associated with extrinsic fistulae. In many cases the inflammation is not purely acute nor chronic or fibrotic. The distinguishing histological types are simultaneously present and render the radiological picture complex.},
}
@article {pmid523375,
year = {1979},
author = {Reasbeck, PG},
title = {Caecal and sigmoid volvulus in the same patient.},
journal = {Postgraduate medical journal},
volume = {55},
number = {649},
pages = {824-825},
pmid = {523375},
issn = {0032-5473},
mesh = {Adult ; Cecal Diseases/*diagnosis ; Colectomy ; Humans ; Intestinal Obstruction/*diagnosis ; Male ; Recurrence ; Sigmoid Diseases/*diagnosis/surgery ; },
abstract = {A patient is described who developed caecal volvulus several years after sigmoid colectomy for recurrent sigmoid volvulus. The pathophysiology of colonic volvulus is briefly reviewed, and it is suggested that an innate tendency to poor muscular tone in the colon may predispose to volvulus, while conversely excessive tone may lead to diverticular disease.},
}
@article {pmid121630,
year = {1979},
author = {Safatle, NF and De Paula, P and Dib, JA and De Almeida, MC},
title = {[Association of Chagas' megacolon with diverticular disease of the colon].},
journal = {Revista paulista de medicina},
volume = {94},
number = {5-6},
pages = {142-144},
pmid = {121630},
issn = {0035-0362},
mesh = {Aged ; Chagas Disease/*complications ; Colectomy ; Diverticulum, Colon/*complications/diagnostic imaging/pathology ; Humans ; Male ; Megacolon/*complications ; Radiography ; },
}
@article {pmid93359,
year = {1979},
author = {Ansay, J and Andrianne, Y},
title = {[Does one have to be aggressive in the surgical management of diverticular disease of the colon (author's transl)].},
journal = {Acta chirurgica Belgica},
volume = {78},
number = {6},
pages = {395-400},
pmid = {93359},
issn = {0001-5458},
mesh = {Adult ; Aged ; Colonic Diseases/etiology ; Diverticulitis, Colonic/complications/*surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Male ; Methods ; Middle Aged ; Palliative Care ; Patient Care Planning ; Peritonitis/etiology ; },
abstract = {A series of 61 consecutive cases with diverticular disease and its complications is presented. Fourteen cases with uncomplicated diverticular disease and 3 with massive GI tract hemorrhage underwent an uneventful (segmental) resection. Of 6 cases operated for fistula formation 1 died. Surgical therapy for abscessformation, peritonitis and "pseudo-tumoral" obstruction (38 cases) carried a high mortality (26.3%). The application of a one-staged aggressive and curative surgical approach lowers the mortality considerably, especially in the complicated forms of the disease. In a group of 30 cases so treated only 1 death occurred (3.3%). This in contrast with a group of 31 patients treated with a two-staged and initially palliative procedure with a mortality of 10 (32.2%). The Hartmann procedure with total excision of the lesion and avoidance of an enteroenteric anastomosis gives excellent results in the treatment of the complicated forms of the disease.},
}
@article {pmid485819,
year = {1979},
author = {Morgenstern, L and Weiner, R and Michel, SL},
title = {'Malignant' diverticulitis: a clinical entity.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {114},
number = {10},
pages = {1112-1116},
doi = {10.1001/archsurg.1979.01370340018002},
pmid = {485819},
issn = {0004-0010},
mesh = {Aged ; Colon, Sigmoid/diagnostic imaging/pathology ; Colostomy ; Diverticulitis, Colonic/diagnostic imaging/pathology/*surgery ; Humans ; Middle Aged ; Radiography ; Retrospective Studies ; Sigmoid Diseases/diagnostic imaging/pathology/*surgery ; },
abstract = {A form of severe diverticulitis exists that is characterized by (1) phlegmonous inflammation of the sigmoid and rectosigmoid colon, often extending below the peritoneal reflection, (2) frequent fistulization to skin, urinary bladder, and small intestine, (3) frequent colonic obstruction, and (4) high postoperative morbidity and mortality. The clinical similarity to granulomatous colitis is very apparent, but pathologic findings are consistent with severe diverticulitis rather than granulomatous colitis. The term "malignant" diverticulitis is suggested because of the progressive nature of the disease process and the frequency of severe morbidity associated with it. Seventeen patients have been studied since 1965, comprising approximately 7% of patients operated on for diverticular disease at Cedars-Sinai Medical Center.},
}
@article {pmid384945,
year = {1979},
author = {Meyers, WC and Harris, N and Stein, S and Brooks, M and Jones, RS and Thompson, WM and Stickel, DL and Seigler, HF},
title = {Alimentary tract complications after renal transplantation.},
journal = {Annals of surgery},
volume = {190},
number = {4},
pages = {535-542},
pmid = {384945},
issn = {0003-4932},
mesh = {Adolescent ; Adult ; Biliary Tract Diseases/etiology ; Child ; Esophagitis/etiology ; Gastrointestinal Diseases/*etiology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Immunosuppression Therapy ; Intestinal Perforation/etiology ; *Kidney Transplantation ; Middle Aged ; Pancreatitis/etiology ; *Postoperative Complications ; Tissue Donors ; Transplantation, Homologous ; },
abstract = {A computer analysis of post renal transplantation gastrointestinal problems was performed to identify important associated clinical factors. Thirty-seven per cent of all transplant recipients developed one or more significant problems. Hemorrhage, nondiverticular intestinal perforation, and esophagitis occurred most frequently in hospitalized patients. Pancreatitis, diverticulitis, and gastroduodenal perforation occurred characteristically in long-term survivors with well functioning allografts. Eleven of 32 HLA identical recipients treated with maintenance corticosteroids during stable kidney function developed gastrointestinal disease while only one of 13 HLA identical recipients not given maintenance steroids developed a problem, which strongly suggests a causal role for steroids in the development of late complications. The association of preexisting peptic ulcer and diverticular disease with hemorrhage and perforation supports previous recommendations that documented peptic ulcer disease or diverticulitis should be corrected surgically prior to transplantation.},
}
@article {pmid398455,
year = {1979},
author = {Löhr, B and Thiede, A and Poser, H and Kampe, A},
title = {[Diverticulosis and diverticular disease. Current aspects of pathogenesis, physiopathology, radiology and surgical treatment].},
journal = {Minerva chirurgica},
volume = {34},
number = {18},
pages = {1217-1225},
pmid = {398455},
issn = {0026-4733},
mesh = {*Diverticulitis, Colonic ; *Diverticulum, Colon ; Humans ; },
}
@article {pmid115541,
year = {1979},
author = {Archampong, EQ},
title = {Diverticular disease in urban Kenyans.},
journal = {British medical journal},
volume = {2},
number = {6191},
pages = {672-673},
doi = {10.1136/bmj.2.6191.672-c},
pmid = {115541},
issn = {0007-1447},
mesh = {Diet/adverse effects ; Diverticulum/*etiology ; Humans ; Kenya ; Urban Population ; },
}
@article {pmid507713,
year = {1979},
author = {Maillet, P and Baulieux, J and Boulez, J and Peix, JL and Mignotte, H},
title = {[Surgical complications of the diverticular disease of the colon. Series of 110 cases (author's transl)].},
journal = {Annales de chirurgie},
volume = {33},
number = {7},
pages = {449-453},
pmid = {507713},
issn = {0003-3944},
mesh = {Adult ; Aged ; Diverticulitis, Colonic/*surgery ; Emergencies/surgery ; Female ; Humans ; Male ; Middle Aged ; Peritonitis/etiology/surgery ; *Postoperative Complications ; },
}
@article {pmid114266,
year = {1979},
author = {Harverson, G},
title = {Diverticular disease in Kenyan Africans.},
journal = {British medical journal},
volume = {2},
number = {6188},
pages = {498-499},
doi = {10.1136/bmj.2.6188.498-d},
pmid = {114266},
issn = {0007-1447},
mesh = {Adult ; Diverticulum/*epidemiology ; Humans ; Kenya ; Male ; Urban Population ; },
}
@article {pmid114265,
year = {1979},
author = {Calder, JF},
title = {Diverticular disease in Kenyan Africans.},
journal = {British medical journal},
volume = {2},
number = {6188},
pages = {498},
doi = {10.1136/bmj.2.6188.498-c},
pmid = {114265},
issn = {0007-1447},
mesh = {Diverticulum/*epidemiology ; Humans ; Kenya ; Social Class ; },
}
@article {pmid315041,
year = {1979},
author = {Austad, WI},
title = {Diverticular disease of the colon.},
journal = {The New Zealand medical journal},
volume = {90},
number = {642},
pages = {160-162},
pmid = {315041},
issn = {0028-8446},
mesh = {Colonic Diseases, Functional/etiology ; Dietary Fiber ; Diverticulitis, Colonic/etiology ; *Diverticulum, Colon ; Endoscopy ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; },
}
@article {pmid462353,
year = {1979},
author = {Heymann, AD},
title = {Clinical aspects of grave pyogenic abscesses of the liver.},
journal = {Surgery, gynecology & obstetrics},
volume = {149},
number = {2},
pages = {209-213},
pmid = {462353},
issn = {0039-6087},
mesh = {Adult ; Aged ; Humans ; *Liver Abscess/diagnosis/surgery ; Middle Aged ; },
abstract = {Solitary hepatic abscess has a favorable prognosis in contrast with multiple abscesses which generally are fatal. As compared with the classical cause of appendicitis, at present, abscesses are frequently related to biliary tract and diverticular disease. Occult or temporally remote processes are responsibile for many solitary abscesses. Lethality of multiple abscesses is related to fulminant hepatic and source sepsis, atypical syndromes, late diagnosis and difficult, complex treatment. Causative organisms are predominantly gram-negative and increasingly anaerobic, requiring special bacteriology for isolation. Various laboratory data are useful in diagnosis and prognosis, but liver scans and celiac angiography are critical procedures. Treatment aimed at lowering the mortality of multiple liver abscesses includes early diagnosis, surgical exploration and abscess drainage, direct bacterial identification emphasizing anaerobic techniques, intense specific antibiotic therapy and identification and definitive therapy of the seeding focus with special attention being given to the biliary tract.},
}
@article {pmid115452,
year = {1979},
author = {Ti, TK},
title = {Inflammatory diseases of the bowel: a Malaysian experience.},
journal = {The Australian and New Zealand journal of surgery},
volume = {49},
number = {4},
pages = {428-431},
doi = {10.1111/j.1445-2197.1979.tb05832.x},
pmid = {115452},
issn = {0004-8682},
mesh = {Colitis, Ulcerative/pathology/therapy ; Crohn Disease/diagnosis/pathology ; Diverticulum/surgery ; Dysentery, Amebic/diagnosis/therapy ; Female ; Humans ; *Intestinal Diseases/therapy ; Malaysia ; Male ; Tuberculosis, Gastrointestinal/diagnosis/pathology/therapy ; },
abstract = {A 10-year experience in the diagnosis and treatment of 92 patients with inflammatory bowel diseases in Kuala Lumpur is described. Tuberculosis (34 cases) was the most common inflammatory bowel disease of surgical importance. The clinical presentation of tuberculous enteritis and Crohn's disease is similar, though tuberculosis is strongly suggested by associated pulmonary disease and radiological evidence of caecal involvement. The finding of 10 cases each of Crohn's disease and ulcerative colitis is in keeping with an increased awareness of these conditions in a developing urban society where facilities exist for thorough investigation of diarrhoeal diseases. Amoebiasis sometimes causes a granulomatous lesion simulating carcinoma. Diverticular disease of the colon as known in the West is of very rare occurrence.},
}
@article {pmid114456,
year = {1979},
author = {Eide, TJ and Stalsberg, H},
title = {Diverticular disease of the large intestine in Northern Norway.},
journal = {Gut},
volume = {20},
number = {7},
pages = {609-615},
pmid = {114456},
issn = {0017-5749},
mesh = {Adult ; Age Factors ; Aged ; Diverticulum/complications/*epidemiology ; Diverticulum, Colon/epidemiology ; Female ; Humans ; Intestinal Diseases/complications/epidemiology ; *Intestine, Large ; Male ; Middle Aged ; Norway ; Sex Factors ; Sigmoid Diseases/epidemiology ; },
abstract = {In 280 unselected necropsies on patients over 20 years of age in Northern Norway, diverticular disease was present in 25% of the males and 43% of the females. The frequency of diverticular disease increased in both sexes by age. Both the frequency of diverticular disease and the average number of diverticula per case with diverticular disease were higher in females than in males in all age groups. The sigmoid was the most frequent site of diverticula in both sexes and for all ages, and the average number of diverticula per diverticulum-bearing segment was also highest in the sigmoid for all ages and in both sexes. The average number of diverticula in the sigmoid of affected individuals increased with age and with the number of segments involved. Diverticular disease was not associated with adenomas of the large intestine or with malignant or benign neoplasms elsewhere in the body or with any of the common diseases thought to be related to a Western type of diet, except with cerebrovascular disease.},
}
@article {pmid466231,
year = {1979},
author = {Trowell, HC and Burkitt, DP},
title = {Diverticular disease in urban Kenyans.},
journal = {British medical journal},
volume = {1},
number = {6180},
pages = {1795},
pmid = {466231},
issn = {0007-1447},
mesh = {Adult ; *Cellulose ; *Dietary Fiber ; Diverticulum, Colon/*epidemiology/etiology ; Feeding Behavior ; Humans ; Kenya ; Urban Health/trends ; },
}
@article {pmid466065,
year = {1979},
author = {Calder, JF},
title = {Diverticular disease of the colon in Africans.},
journal = {British medical journal},
volume = {1},
number = {6176},
pages = {1465-1466},
pmid = {466065},
issn = {0007-1447},
mesh = {Adolescent ; Adult ; Aged ; Diverticulum, Colon/*epidemiology ; Humans ; Kenya ; Middle Aged ; Retrospective Studies ; },
}
@article {pmid484170,
year = {1979},
author = {Castleden, WM and Jennings, KP and Doous, TW and Leighton, M},
title = {Diverticular disease of the colon and gallstones in New Zealand and England.},
journal = {Acta hepato-gastroenterologica},
volume = {26},
number = {3},
pages = {211-216},
pmid = {484170},
issn = {0300-970X},
mesh = {Adult ; Aged ; Cholecystectomy ; Cholelithiasis/*complications ; Diverticulum, Colon/*complications ; England ; Female ; Humans ; Male ; Middle Aged ; New Zealand ; },
abstract = {The clinical presentation and subsequent treatment of 160 consecutive patients with proven diverticular disease of the colon from the Auckland Hospital, New Zealand were compared with 182 consecutive patients admitted to St. Bartholomew's Hospital, London. There were significant differences in sex incidence, in the ages of the male patients at presentation, patient symptoms, extent of disease and methods of surgical treatment. These probably reflect differences in the types of National Health Services of the two countries, rather than differences in the natural history of diverticular disease of the colon. Overall, the 342 patients studied show a very good correlation with other large series published over the last 10 years. This study confirms the previously reported association between diverticular disease of the colon and gallstones. It confirms that gallstones are more common in female patients with or without diverticular disease. It suggests that Auckland patients with gallstones are more likely to have had a cholecystectomy than London patients. The possible role of dietary fiber in the aetiology of both gallstones and diverticular disease of the colon is discussed.},
}
@article {pmid455240,
year = {1979},
author = {Adelstein, P and Baldwin, JA and Fedrich, J},
title = {Cancers of the large bowel: associated disorders in individuals.},
journal = {Cancer},
volume = {43},
number = {6},
pages = {2553-2557},
doi = {10.1002/1097-0142(197906)43:6<2553::aid-cncr2820430657>3.0.co;2-y},
pmid = {455240},
issn = {0008-543X},
mesh = {Abscess/complications ; Aged ; Appendicitis/complications ; Colitis, Ulcerative/complications ; Constipation/complications ; Diverticulitis/complications ; Female ; Humans ; Intestinal Neoplasms/*complications/diagnosis/etiology ; Intestinal Obstruction/complications ; *Intestine, Large ; Male ; Middle Aged ; Neoplasms, Multiple Primary/*complications/etiology ; Pelvis ; Risk ; Time Factors ; },
abstract = {The individual medical histories in the files of the Oxford Record Linkage Study for the years 1963 to 1967 were analyzed to ascertain any previously unsuspected associations between cancers of the large bowel and other diseases in individuals, and to quantify the relative risks of disorders already known to be associated. In males significant associations were shown between cancers of the large bowel and cancer of the prostate. In females, cancer of the colon was associated with breast cancer, and cancer of the rectum with a mixed group of genital cancers. The relative risk of colorectal cancer associated with previous benign neoplasms of the large bowel was 20, and with ulcerative colitis, 25. There was no significant association with appendicitis or long-standing diverticular disease.},
}
@article {pmid386910,
year = {1979},
author = {Montariol, T and Hay, JM and Lauru, Y and Dazza, F and Maillard, JN},
title = {[Effect of pre-operative oral antibiotics on septic complications following resection for cancer and diverticular disease of the colon. Controlled clinical trial (author's transl)].},
journal = {Annales de chirurgie},
volume = {33},
number = {6},
pages = {413-416},
pmid = {386910},
issn = {0003-3944},
mesh = {Administration, Oral ; Aged ; Clinical Trials as Topic ; Colonic Neoplasms/*surgery ; Diverticulitis, Colonic/*surgery ; Female ; Humans ; Male ; Middle Aged ; Neomycin/administration & dosage/*therapeutic use ; Preoperative Care ; Random Allocation ; Sigmoid Diseases/*surgery ; Surgical Wound Dehiscence/complications ; Surgical Wound Infection/mortality/*prevention & control ; Tetracycline/administration & dosage/*therapeutic use ; },
}
@article {pmid447496,
year = {1979},
author = {Walker, AR and Segal, I},
title = {Epidemiology of noninfective intestinal diseases in various ethnic groups in South Africa.},
journal = {Israel journal of medical sciences},
volume = {15},
number = {4},
pages = {309-313},
pmid = {447496},
issn = {0021-2180},
mesh = {Adolescent ; Adult ; Appendicitis/epidemiology ; Black People ; Colitis, Ulcerative/epidemiology ; Colonic Diseases, Functional/epidemiology ; Colonic Neoplasms/epidemiology ; Constipation/epidemiology ; Crohn Disease/epidemiology ; Diet ; Diverticulitis/epidemiology ; Environment ; *Ethnicity ; Female ; Hemorrhoids/epidemiology ; Humans ; India/ethnology ; Intestinal Diseases/*epidemiology ; Intestinal Polyps/epidemiology ; Intestine, Large ; Male ; Middle Aged ; *Racial Groups ; South Africa ; White People ; },
abstract = {The prevalences of bowel diseases (hemorrhoids, appendicitis, polyps, ulcerative colitis, irritable bowel syndrome, diverticular disease, and colon cancer) are similar in South African whites and in populations of prosperous western countries. Among rural South African blacks with a traditional life style, these diseases are very uncommon or almost unknown. Among the urban South African blacks with a partially westernized life style, the diseases remain uncommon. Frequencies of appendectomies and colon cancer in urban blacks have increased little during the last three decades, although an increase undoubtedly has occurred in the frequency of diverticular disease. Frequencies of bowel diseases in South African Indian and colored (Eurafrican, Malay) populations are intermediate. Because the diseases are almost entirely of environmental causation (due to principally to changes in diet), prevalences almost certainly will increase in blacks, Indians and coloreds, as their way of life becomes further westernized.},
}
@article {pmid444816,
year = {1979},
author = {Htoo, AM and Bartram, CI},
title = {The radiological diagnosis of polyps in the presence of diverticular disease.},
journal = {The British journal of radiology},
volume = {52},
number = {616},
pages = {263-267},
doi = {10.1259/0007-1285-52-616-263},
pmid = {444816},
issn = {0007-1285},
mesh = {Adult ; Aged ; Barium Sulfate ; Colonic Neoplasms/complications/*diagnostic imaging ; Diverticulum, Colon/*complications/diagnostic imaging ; Enema ; Female ; Humans ; Intestinal Polyps/complications/*diagnostic imaging ; Male ; Middle Aged ; Radiography ; },
abstract = {The double contrast barium enemas in 20 patients with endoscopically proven polyps within a segment of diverticular disease have been reviewed. Ninety per cent of the polyps were detected. The increased density sign and negative shadow filling defect proved valuable in their detection. Antispasmodics are advised to distend the sigmoid and allow double contrast views to be obtained. With severe diverticular changes it may be impossible to exclude a polyp, and if the patient complains of rectal bleeding, endoscopy is indicated.},
}
@article {pmid85104,
year = {1979},
author = {Gear, JS and Ware, A and Fursdon, P and Mann, JI and Nolan, DJ and Brodribb, AJ and Vessey, MP},
title = {Symptomless diverticular disease and intake of dietary fibre.},
journal = {Lancet (London, England)},
volume = {1},
number = {8115},
pages = {511-514},
doi = {10.1016/s0140-6736(79)90942-5},
pmid = {85104},
issn = {0140-6736},
mesh = {Aged ; Barium Sulfate ; *Cellulose ; *Diet, Vegetarian ; *Dietary Fiber ; Diverticulum, Colon/diagnostic imaging/*epidemiology/etiology ; England ; *Feeding Behavior ; Female ; Humans ; Male ; Middle Aged ; Nutrition Surveys ; Radiography ; Surveys and Questionnaires ; },
abstract = {A study is reported in which the prevalence of symptomless diverticular disease of the colon is related to the consumption of dietary fibre in vegetarians and non-vegetarians. Vegetarians had a significantly higher mean fibre intake (41.5 g/day) than non-vegetarians (21.4 g/day). Diverticular disease was commoner in non-vegetarians (33%) than in vegetarians (12%). Comparison of subjects with and without diverticular disease in the vegetarian and non-vegetarian groups provided some further evidence that a low intake of cereal fibre is associated with the presence of diverticular disease.},
}
@article {pmid263132,
year = {1979},
author = {Schnyder, P and Moss, AA and Thoeni, RF and Margulis, AR},
title = {A double-blind study of radiologic accuracy in diverticulitis, diverticulosis, and carcinoma of the sigmoid colon.},
journal = {Journal of clinical gastroenterology},
volume = {1},
number = {1},
pages = {55-66},
doi = {10.1097/00004836-197903000-00008},
pmid = {263132},
issn = {0192-0790},
mesh = {Adenocarcinoma/diagnostic imaging ; Carcinoma/diagnostic imaging ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/*diagnostic imaging ; Diverticulum, Colon/complications/*diagnostic imaging ; Double-Blind Method ; False Negative Reactions ; False Positive Reactions ; Humans ; Radiography ; Sigmoid Diseases/*diagnostic imaging ; Sigmoid Neoplasms/complications/*diagnostic imaging ; },
abstract = {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.},
}
@article {pmid422845,
year = {1979},
author = {Mann, JI},
title = {A prudent diet for the nation.},
journal = {Journal of human nutrition},
volume = {33},
number = {1},
pages = {57-63},
doi = {10.3109/09637487909143350},
pmid = {422845},
issn = {0308-4329},
mesh = {Adult ; Coronary Disease/etiology ; Dental Caries/etiology ; Diabetes Mellitus/etiology ; Dietary Carbohydrates/adverse effects ; Dietary Fats/adverse effects ; Dietary Fiber/metabolism ; Diverticulum, Colon/etiology ; *Feeding Behavior ; Female ; Humans ; Male ; Middle Aged ; Nutrition Disorders/complications ; Obesity/etiology ; },
abstract = {Nutritional factors in the aetiology of coronary heart disease, maturity-onset diabetes, diverticular disease and dental caries are discussed. Four principles for a prudent diet are suggested, namely: avoid excess intake of energy, increase dietary fibre intake, reduce total fat intake to approximately 30 per cent of energy intake, take a high proportion of fat as the polyunsaturated form.},
}
@article {pmid419425,
year = {1979},
author = {Landi, E and Fianchini, A and Landa, L and Maniscalco, L},
title = {Multiple transverse taeniamyotomy for diverticular disease.},
journal = {Surgery, gynecology & obstetrics},
volume = {148},
number = {2},
pages = {221-226},
pmid = {419425},
issn = {0039-6087},
mesh = {Colon/physiopathology/*surgery ; Diverticulum, Colon/physiopathology/*surgery ; Follow-Up Studies ; Gastrointestinal Motility ; Humans ; Middle Aged ; Pressure ; },
abstract = {The indications for transverse taeniamyotomy, and the results obtained on a group of 11 patients, were analyzed. Intraluminal pressure recordings carried out before and one year after operation showed a significant decrease of the mean motility index after both natural and pharmacologic stimuli. The use of such a procedure, even in an early stage of the disease, should be considered.},
}
@article {pmid311770,
year = {1979},
author = {Huber, A and Zingher, E},
title = {[The importance of selective angiography in colonic diverticulosis surgery].},
journal = {Helvetica chirurgica acta},
volume = {45},
number = {6},
pages = {723-727},
pmid = {311770},
issn = {0018-0181},
mesh = {Aged ; Angiography ; Diverticulum, Colon/*diagnostic imaging/surgery ; Female ; Gastrointestinal Hemorrhage/*diagnostic imaging/surgery ; Humans ; Risk ; },
abstract = {The diverticular disease of the colon is one of the most frequent causes of massive bleeding of the large bowel. The results of emergency operations without localisation of the bleeding are disappointing. The bleeding point can be localised by selective angiography, and this renders possible the most favourable surgical procedure as shown by the case report of a high risk patient.},
}
@article {pmid288432,
year = {1979},
author = {Failes, D and Killingback, M and Stuart, M and De Luca, C},
title = {Elective resection for diverticular disease.},
journal = {The Australian and New Zealand journal of surgery},
volume = {49},
number = {1},
pages = {66-72},
doi = {10.1111/j.1445-2197.1979.tb06439.x},
pmid = {288432},
issn = {0004-8682},
mesh = {Acute Disease ; Chronic Disease ; Colectomy ; Colonic Diseases/complications ; Colostomy ; Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/complications ; Female ; Humans ; Ileum/surgery ; Intestinal Fistula/complications ; Peritonitis/complications ; Postoperative Complications ; Urinary Bladder Fistula/complications ; Vaginal Fistula/complications ; },
abstract = {A series of 119 patients undergoing elective resection for diverticular disease has been reviewed. The indications for resection were classified into two major groups--those with severe infections ("complicated" diverticulitis), comprising 58 patients, and those with minimal infections, comprising 61 patients. The majority of the resections were limited to the sigmoid colon (101 patients). Fifteen patients underwent left hemicolectomy, whilst three had total colectomy. Thirty-six patients (30%) had a proximal defunctioning stoma--18 prior to resection and 19 at the time of resection. Anastomotic defects were noted in 15 patients (12.6%), but these were of clinical significance only in eight (6.7%). There were two deaths (1.7%) and 17 wound infections (14.3%). The group classified as "complicated" diverticulitis included the great majority of the patients requiring colostomy (32 out of 37), almost all those with anastomotic defects (14 out of 15), and most of the patients who had postoperative complications.},
}
@article {pmid758352,
year = {1979},
author = {Jesseph, JE},
title = {Observations on diverticular disease of the colon.},
journal = {The Journal of the Indiana State Medical Association},
volume = {72},
number = {1},
pages = {39-41},
pmid = {758352},
issn = {0019-6770},
mesh = {Adult ; Age Factors ; Anti-Bacterial Agents/therapeutic use ; Diverticulum, Colon/drug therapy/surgery/*therapy ; Humans ; Middle Aged ; },
}
@article {pmid547774,
year = {1979},
author = {Martinelli, V and Picardi, N and Manurita, L},
title = {[Trends in surgical treatment of diverticular disease of the colon in the aged].},
journal = {Annali italiani di chirurgia},
volume = {51},
number = {6},
pages = {651-660},
pmid = {547774},
issn = {0003-469X},
mesh = {Age Factors ; Aged ; Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid507737,
year = {1979},
author = {Haglund, U and Hellberg, R and Johnsén, C and Hultén, L},
title = {Complicated diverticular disease of the sigmoid colon. An analysis of short and long term outcome in 392 patients.},
journal = {Annales chirurgiae et gynaecologiae},
volume = {68},
number = {2},
pages = {41-46},
pmid = {507737},
issn = {0355-9521},
mesh = {Acute Disease ; Adult ; Age Factors ; Aged ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/complications/drug therapy/*surgery ; Follow-Up Studies ; Humans ; Intestinal Obstruction/complications ; Intestinal Perforation/complications ; Middle Aged ; Peritonitis/complications ; Prognosis ; Recurrence ; Time Factors ; },
}
@article {pmid456121,
year = {1979},
author = {Raguse, T and Bubenzer, J},
title = {[Functional and morphological studies on diverticulosis of the large bowel].},
journal = {Chirurgisches Forum fur experimentelle und klinische Forschung},
volume = {},
number = {},
pages = {138-143},
pmid = {456121},
issn = {0303-6227},
mesh = {Colon/*pathology ; Diverticulum, Colon/pathology/*physiopathology ; *Gastrointestinal Motility ; Humans ; Intestinal Mucosa/*pathology ; Muscle Contraction ; Muscle, Smooth/pathology/physiopathology ; },
abstract = {In comparison to the normal colon, longitudinal and circular musculature in diverticular disease (DD) was investigated--regarding motility and morphology--and a comparative measurement between musculature and mucosa was also performed with following results: 1. Only the tenia in DD revealed a spastically contracted muscle. 2. There was a ribbon formation due to contraction only in tenias of DD, although there was hypertrophy in both muscle groups. 3. The longitudinal muscle in DD was found to be shortened.},
}
@article {pmid433890,
year = {1979},
author = {Hodgson, WJ and Schanzer, H and Bakare, S and McElhinney, AJ},
title = {Transverse taeniamyotomy in localized acute diverticulitis.},
journal = {The American journal of gastroenterology},
volume = {71},
number = {1},
pages = {61-67},
pmid = {433890},
issn = {0002-9270},
mesh = {Acute Disease ; Aged ; Colon/surgery ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/*surgery ; Humans ; Male ; Methods ; Middle Aged ; Muscle, Smooth/*surgery ; },
abstract = {Transverse taeniamyotomy has been in use for over four years in the surgical correction of the muscle abnormality of diverticular disease. Essentially, the technic is to carefully transversely incise the two antimesenteric taeniae coli at 2 cm. intervals, in a stepwise manner, from the rectosigmoid junction proximally up to normal colon. This causes the cut ends of the taeniae coli to pull apart into separate 2 cm. blocks of longitudinal muscle. Thus elongation and widening of the colon occurs, resulting in dilatation of the necks and free drainage of the diverticula obstructed by inflammation. Four patients are presented with localized diverticulitis who had simple transverse taeniamyotomy from which they quickly recovered. This operation justifies continuing study as it may increase the surgeon's range of response over one end of the spectrum of acute diverticulitis.},
}
@article {pmid431228,
year = {1979},
author = {Raguse, T},
title = {[On the role of myotomy in the treatment of diverticular disease (author's transl)].},
journal = {Langenbecks Archiv fur Chirurgie},
volume = {348},
number = {1},
pages = {51-60},
pmid = {431228},
issn = {0023-8236},
mesh = {Diverticulitis, Colonic/physiopathology/*surgery ; Electromyography ; Humans ; Methods ; Muscle, Smooth/physiopathology/*surgery ; },
abstract = {UNLABELLED: Spontaneous motor action of fresly prepared circular and longitudinal muscle strips were examined in two separated trials. Bowel musculature of diverticular patients were compared with those of normal subjects. Finally all explantations were examined histologically.
RESULTS: 1. There was no difference in electrical activity and tension development regarding circular muscle strips of patients suffering from D.D. and those of normal subjects. 2. The longitudinal muscles show however significant differences in contrast to normal subjects; to sum up D.D. presents us a spastic and contracted taenia. 3. The histological investigations did not explain the different electromechanical results. There were however remarcable ribbons only in the longitudinal muscle of D.D.--known from myoma uteri. The results of the electrophysiological analysis have importance for our surgical concept in the treatment of peridiverticulitis. They justify the horizontal myotomy in the left, functionally disturbed colon descendens additional to the resection as an preventive procedure.},
}
@article {pmid295519,
year = {1979},
author = {Clamp, SE and Hebert, M and Matharu, SS and Blackband, D},
title = {Sampling gastro-enterologists' opinions--an OMGE study.},
journal = {Scandinavian journal of gastroenterology. Supplement},
volume = {56},
number = {},
pages = {45-53},
pmid = {295519},
issn = {0085-5928},
mesh = {*Attitude of Health Personnel ; *Gastroenterology ; Gastrointestinal Diseases ; Humans ; Pilot Projects ; Surveys and Questionnaires ; },
abstract = {This study describes a pilot project to sample gastroenterologists' opinions on a variety of interesting and controversial topics. At the Madrid World Congress, a sample of delegates were asked to respond to a questionnaire distributed at the meeting itself. A total of 224, representative of those attending by discipline and by geographical area, did so. The results were analysed in two days and presented to the Congress within 72 hours. Amongst the findings were several of interest. Vagotomy is now the most common operation for (elective) duodenal ulcer surgery. Three-quarters of those responding prescribe high-fibre diet for chronic diverticular disease. Over 80% routinely prescribe sulphazalazine for patients with ulcerative colitis--even in remission. The most useful mode of detection of gastro-intestinal cancer is now felt to be endoscopy, even ahead of double contrast radiology. The results should be interpreted with caution, although the survey represents findings in over 200 hospitals. The principle of an on-the-spot rapid attitude survey has been established as feasible. It is proposed to repeat the exercise on a wider scale at the next World Congress in Stockholm in 1982.},
}
@article {pmid310702,
year = {1978},
author = {Swarbrick, ET and Fevre, DI and Hunt, RH and Thomas, BM and Williams, CB},
title = {Colonoscopy for unexplained rectal bleeding.},
journal = {British medical journal},
volume = {2},
number = {6153},
pages = {1685-1687},
pmid = {310702},
issn = {0007-1447},
mesh = {Colitis/diagnosis ; Colonic Diseases/complications/*diagnosis ; Colonic Neoplasms/diagnosis ; Diverticulum, Colon/diagnosis ; *Endoscopy ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Intestinal Polyps/diagnosis ; Vascular Diseases/diagnosis ; },
abstract = {Two hundred and thirty-nine patients underwent colonoscopy for unexplained rectal bleeding. Local anorectal conditions were excluded by digital and proctosigmoidoscopic examinations and results of barium studies were negative for all patients. A cause for bleeding was found in 95 patients. Thirty-nine had adenomatous polyps, 24 had unrecognised inflammatory bowel disease, and most importantly 23 (10% of series) had carcinomas. Forty patients had diverticular disease, but nine of them were found to have an adenomatous polyp and four a carcinoma. Colonoscopy can contribute positively to the investigation and treatment of unexplained rectal bleeding and may prevent unnecessary laparotomy.},
}
@article {pmid747992,
year = {1978},
author = {Calder, JF and Wasunna, AE},
title = {Diverticular disease of the colon in Kenyan Africans.},
journal = {East African medical journal},
volume = {55},
number = {12},
pages = {579-581},
pmid = {747992},
issn = {0012-835X},
mesh = {Adult ; Diverticulum, Colon/*epidemiology ; Humans ; Kenya ; Male ; Middle Aged ; },
}
@article {pmid744500,
year = {1978},
author = {Eastwood, MA and Smith, AN and Brydon, WG and Pritchard, J},
title = {Comparison of bran, ispaghula, and lactulose on colon function in diverticular disease.},
journal = {Gut},
volume = {19},
number = {12},
pages = {1144-1147},
pmid = {744500},
issn = {0017-5749},
mesh = {Adult ; Aged ; *Cellulose/therapeutic use ; Colloids ; Colon/*physiopathology ; *Dietary Fiber/therapeutic use ; *Disaccharides/therapeutic use ; Diverticulum, Colon/*physiopathology/therapy ; Feces/analysis ; Gastrointestinal Motility ; Humans ; *Lactulose/therapeutic use ; Middle Aged ; Pressure ; },
abstract = {Bran, ispaghula (Fybogel), and lactulose were given to three groups of patients with diverticular disease for four weeks. Faecal weights, bile acids, fat and electrolytes, transit time, and colonic motility were estimated before and after treatment. Stool weight increased, notably with Fybogel. Cereal bran had the greatest effect on the transit time, reducing it significantly. There were no changes in faecal bile acids, fat or electrolytes. Coarse bran reduced colonic motility and the number of high pressure waves after food; Fybogel increased the basal pressure and was without effect on the food-stimulated pressures; whereas lactulose influenced neither. All agents paradoxically equally alleviated symptoms.},
}
@article {pmid736370,
year = {1978},
author = {Orebaugh, JE and MaCris, JA and Lee, JF},
title = {Surgical treatment of diverticular disease of the colon.},
journal = {The American surgeon},
volume = {44},
number = {11},
pages = {712-715},
pmid = {736370},
issn = {0003-1348},
mesh = {Adult ; Aged ; Diverticulitis, Colonic/diagnosis/mortality/*surgery ; Female ; Florida ; Humans ; Male ; Methods ; Middle Aged ; },
}
@article {pmid730073,
year = {1978},
author = {Foster, KJ and Holdstock, G and Whorwell, PJ and Guyer, P and Wright, R},
title = {Prevalence of diverticular disease of the colon in patients with ischaemic heart disease.},
journal = {Gut},
volume = {19},
number = {11},
pages = {1054-1056},
pmid = {730073},
issn = {0017-5749},
mesh = {Adult ; Aged ; Blood Glucose ; Body Weight ; Coronary Disease/*complications ; Diverticulum, Colon/*complications ; Humans ; Male ; Middle Aged ; Prospective Studies ; Social Class ; },
abstract = {In view of the similar patterns of incidence of diverticular disease of the colon (DD) and ischaemic heart disease (IHD) in different communities, the prevalence of diverticular disease was investigated in male patients after recovery from acute myocardial infarction. A significantly higher prevalence of DD was found among infarct patients (57%) than among male control subjects (25%) matched for age and social class.},
}
@article {pmid720802,
year = {1978},
author = {Flores-Espinosa, J and Flores de Masvidal, G and Zanolini, L},
title = {[Diverticular disease of the colon. Saccharine disease of Cleave and Saint's triad].},
journal = {Gaceta medica de Mexico},
volume = {114},
number = {11},
pages = {515-523},
pmid = {720802},
issn = {0016-3813},
mesh = {Adult ; Age Factors ; Cholelithiasis/diagnostic imaging ; Colon/pathology ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnostic imaging/pathology ; Diverticulum, Colon/*diagnostic imaging/pathology ; Female ; Hernia, Diaphragmatic/diagnostic imaging ; Humans ; Intestinal Mucosa/pathology ; Male ; Middle Aged ; Radiography ; Syndrome ; },
}
@article {pmid718074,
year = {1978},
author = {Archampong, EQ and Christian, F and Badoe, EA},
title = {Diverticular disease in an indigenous African community.},
journal = {Annals of the Royal College of Surgeons of England},
volume = {60},
number = {6},
pages = {464-470},
pmid = {718074},
issn = {0035-8843},
mesh = {Aged ; Diet ; Diverticulum, Colon/*epidemiology/pathology ; Female ; Ghana ; Humans ; Male ; Middle Aged ; Social Class ; },
abstract = {Sixteen cases of diverticular disease of the colon occurring in an urban hospital in Ghana are described. Ten of the patients had diffuse diverticulosis affecting the greater part of the colon. Apart from a high incidence of presentation with rectal bleeding the disease shows no particular differences in manifestation from what is encountered in the advanced countries. Sixty per cent of the patients belonged to the higher social classes, but all had lived on traditional African high-residue food. Other factors as yet unknown may contribute to the pathogenesis of this disorder.},
}
@article {pmid309720,
year = {1978},
author = {Twiford, TW and Goldstein, HM and Zornoza, J},
title = {Transcatheter therapy of gastrointestinal arterial bleeding.},
journal = {The American journal of digestive diseases},
volume = {23},
number = {11},
pages = {1046-1053},
pmid = {309720},
issn = {0002-9211},
mesh = {Aged ; Catheterization ; *Embolization, Therapeutic/adverse effects ; Female ; Gastrointestinal Hemorrhage/diagnostic imaging/drug therapy/*therapy ; Gastrointestinal Neoplasms/complications ; Humans ; Infusions, Intra-Arterial ; Male ; Methods ; Middle Aged ; Peptic Ulcer Hemorrhage/drug therapy/therapy ; Radiography ; Vasoconstriction ; Vasopressins/administration & dosage/adverse effects/*therapeutic use ; },
abstract = {Transcatheter therapy for arteriocapillary gastrointestinal bleeding is often an effective form of treatment. The choice of transcatheter therapy (ie, vasoconstrictor or occlusive) often is dependent on the etiology and location of bleeding. Vasopressin is a generally safe form of treatment which is often successful in treating bleeding secondary to gastritis, Mallory-Weiss mucosal tears, and diverticular disease. It is less effective in treating bleeding peptic ulcers, neoplastic bleeding, or bleeding when clotting abnormalities exist. Occlusive therapy is an effective alternate form of therapy in selected circumstances. Ischemic complications from vasoconstrictor and embolic therapy may occur and require appropriate caution and discretion with their use.},
}
@article {pmid309657,
year = {1978},
author = {Smith, KR and Kovalcik, PJ and Cross, GH},
title = {Diverticular disease of the colon: surgical management at a military hospital.},
journal = {Southern medical journal},
volume = {71},
number = {11},
pages = {1404-1405},
doi = {10.1097/00007611-197811000-00025},
pmid = {309657},
issn = {0038-4348},
mesh = {Adult ; Aged ; Cecal Diseases/surgery ; Colonic Diseases/etiology/surgery ; Diverticulitis/surgery ; Diverticulitis, Colonic/complications/*surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology/surgery ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Male ; Middle Aged ; Recurrence ; },
abstract = {A recent review of the surgical management of diverticular disease of the colon included 73 patients. One-stage resections were accomplished in 67%, primarily in patients operated on electively for recurrent diverticulitis or fistula, and in the group of patients with cecal diverticulitis operated on for presumed appendicitis. Single-stage resection with ileorectal anastomosis is also preferred in patients with massive diverticular bleeding. For patients with large abscesses or diffuse peritonitis a two-stage procedure which removes the site of disease in the initial operation is recommended. There were no deaths and a lower incidence of complications in the group of patients who had elective operations for recurrent diverticulitis and fistula.},
}
@article {pmid707391,
year = {1978},
author = {Eastwood, MA},
title = {Fiber in the gastrointestinal tract.},
journal = {The American journal of clinical nutrition},
volume = {31},
number = {10 Suppl},
pages = {S30-S32},
doi = {10.1093/ajcn/55.2.436},
pmid = {707391},
issn = {0002-9165},
mesh = {*Cellulose/metabolism/therapeutic use ; Colon/*metabolism ; Colonic Diseases/diet therapy ; *Dietary Fiber/metabolism/therapeutic use ; Gastrointestinal Motility ; Humans ; },
abstract = {It has long been recognized that fruit, vegetables, and cereal fiber alter bowel function. The right colon can be regarded as a fermenter and an absorbing organ, and the left colon is for continence. A rationale for the use of fiber based on physical chemical properties is discussed. On this basis, the use of coarse wheat bran, apples, oranges, and carrots is recommended to treat diverticular disease, spastic colon, and constipation.},
}
@article {pmid101074,
year = {1978},
author = {Connell, AM},
title = {The effects of dietary fiber on gastrointestinal motor function.},
journal = {The American journal of clinical nutrition},
volume = {31},
number = {10 Suppl},
pages = {S152-S156},
doi = {10.1093/ajcn/31.10.S152},
pmid = {101074},
issn = {0002-9165},
mesh = {*Cellulose ; Colonic Diseases, Functional/physiopathology ; *Dietary Fiber ; Diverticulum/physiopathology ; *Gastrointestinal Motility ; Humans ; },
abstract = {For normal individuals and probably for persons with diverticular disease, dietary fiber affects stool bulk and decreases transit time. The unproven rationale for the use of fiber in irritable colon and diverticular disease assumes that these diseases are the result of increased intraluminal pressure caused by excessive segmentation over a period of years. In short-term experiments, certain fibrous materials do decrease intraluminal pressures, usually in response to a stimulus such as food but sometimes under resting conditions as well. It seems likely that the physical and probably chemical characteristics of fiber influence the motor responses of the alimentary tract. Anecdotal testimonials to the merits of fiber abound, but firm evidence that even wheat bran, the most commonly studied fiber, is effective is difficult to obtain. Controlled clinical trials have been attempted and to date have given conflicting results. Careful studies using a number of well-defined fibrous materials are urgently required to determine the physiological mechanisms of action of different fibers on gastrointestinal motor activity.},
}
@article {pmid79911,
year = {1978},
author = {Pescatori, M and Castiglioni, GC},
title = {Operations for diverticular disease.},
journal = {Lancet (London, England)},
volume = {2},
number = {8088},
pages = {534},
doi = {10.1016/s0140-6736(78)92269-9},
pmid = {79911},
issn = {0140-6736},
mesh = {Colon, Sigmoid/surgery ; Diverticulum, Colon/*surgery ; Evaluation Studies as Topic ; Humans ; Methods ; Muscle, Smooth/surgery ; },
}
@article {pmid698544,
year = {1978},
author = {Pescatori, M and Castiglioni, GC},
title = {Sigmoid motility and clinical results after transverse taeniamyotomy for diverticular disease.},
journal = {The British journal of surgery},
volume = {65},
number = {9},
pages = {666-668},
doi = {10.1002/bjs.1800650923},
pmid = {698544},
issn = {0007-1323},
mesh = {Colon/*surgery ; Colon, Sigmoid/*physiopathology ; Diverticulum, Colon/*surgery ; Female ; *Gastrointestinal Motility ; Humans ; Male ; Methods ; Middle Aged ; Time Factors ; },
}
@article {pmid687079,
year = {1978},
author = {Rombeau, JL and Collins, JP and Turnbull, RB},
title = {Left-sided colectomy with retroileal colorectal anastomosis.},
journal = {Archives of surgery (Chicago, Ill. : 1960)},
volume = {113},
number = {8},
pages = {1004-1005},
doi = {10.1001/archsurg.1978.01370200098020},
pmid = {687079},
issn = {0004-0010},
mesh = {Adult ; Aged ; *Colectomy ; Colon/*surgery ; Colonic Neoplasms/surgery ; Female ; Functional Laterality ; Humans ; Male ; Methods ; Middle Aged ; Rectum/*surgery ; },
abstract = {Following resection of the sigmoid and descending colon for cancer or extensive diverticular disease, it may be impossible to make a colorectal anastomosis due to inadequate length of the residual transverse colon. To correct this problem, the remaining transverse colon may be pulled into the pelvis by making a "window" in the terminal part of the ileal mesentery. From January 1966 to January 1975, 302 resections of the descending colon with colorectal anastomoses were performed by one of the authors (R.B.T.) for upper sigmoid cancer and extensive diverticulitis at the Cleveland Clinic. Eleven patients (4%) had retroileal colorectal anastomoses. The retroileal apprach is a technical aid when performing an extensive left-sided colectomy and/or when there is insufficient length of residual transverse colon to make a tension-free colorectal anastomosis.},
}
@article {pmid699721,
year = {1978},
author = {Axelsson, CK and Francis, D},
title = {Peroperative fine-needle aspiration biopsy: an aid to differential diagnosis between diverticular disease and colonic cancer? A preliminary report.},
journal = {Diseases of the colon and rectum},
volume = {21},
number = {5},
pages = {319-321},
doi = {10.1007/BF02586659},
pmid = {699721},
issn = {0012-3706},
mesh = {Adult ; Aged ; *Biopsy, Needle/methods ; Colonic Neoplasms/*diagnosis/microbiology/pathology ; Diagnosis, Differential ; Diverticulum, Colon/*diagnosis/microbiology/pathology ; Female ; Humans ; Male ; Middle Aged ; },
abstract = {Fine-needle aspiration biopsy was performed at laparotomy on 15 patients in whose cases differential diagnosis between colonic diverticulitis and colonic cancer on the basis of preoperative and peroperative examinations was impossible. Histologic examination confirmed the cytologic diagnosis to be correct in 14 cases, in four of them correctly positive for tumor cells. There was one false-negative result. Culture of swabs taken from 11 patients after puncture showed growth of intestinal bacteria in five cases, but no complication developed in association with or after the punctures. Peroperative fine-needle aspiration biopsy is a cheap, simple, rapid and safe method that seems to offer a reliable aid to differential diagnosis between diverticulitis and carcinoma. With the use of a rapid staining technique, the result can be available as early as that of frozen-section microscopic examination.},
}
@article {pmid78218,
year = {1978},
author = {},
title = {Operations for diverticular disease.},
journal = {Lancet (London, England)},
volume = {2},
number = {8079},
pages = {25},
pmid = {78218},
issn = {0140-6736},
mesh = {Aged ; Colectomy/*methods ; Congresses as Topic ; Diverticulum, Colon/complications/*surgery ; Humans ; International Cooperation ; Spain ; },
}
@article {pmid78109,
year = {1978},
author = {Teague, RH and Thornton, JR and Manning, AP and Salmon, PR and Read, AE},
title = {Colonscopy for investigation of unexplained rectal bleeding.},
journal = {Lancet (London, England)},
volume = {1},
number = {8078},
pages = {1350-1352},
doi = {10.1016/s0140-6736(78)92417-0},
pmid = {78109},
issn = {0140-6736},
mesh = {Colitis/diagnosis ; *Colon ; Colonic Neoplasms/diagnosis ; Diagnosis, Differential ; Diverticulum, Colon/diagnosis ; *Endoscopy ; Evaluation Studies as Topic ; Gastrointestinal Hemorrhage/*diagnosis/etiology ; Humans ; Intestinal Polyps/diagnosis ; Rectum ; Sigmoidoscopy ; },
abstract = {215 colonsocopic examinations were performed on patients with rectal bleeding whose cause had not been determined by barium enema. The probable or definite source of the bleeding was diagnosed in 41% of cases. 13% had a carcinoma, 14% had one or more colonic polyps, 7% had previously unrecognised inflammatory bowel disease. The remainder had various other colonic conditions. The source of bleeding was twice as likely to be found by colonoscopy in patients presenting with frank rectal blood-loss as in those with occult blood. A carcinoma was found twice as often in those patients with diverticular disease as in those without this condition. A lesion was discovered in the majority of patients who had had two or more negative barium enemas. These results emphasise the importance of rectal bleeding as a symptom of colonic abnormality and the value of colonscopy in its investigation in patients where the results of radiology are negative.},
}
@article {pmid694648,
year = {1978},
author = {Segal, I and Tim, LO and Solomon, A and Giraud, A},
title = {Diverticular disease in urban blacks.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {53},
number = {23},
pages = {922},
pmid = {694648},
issn = {0256-9574},
mesh = {Black or African American ; Black People ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis/epidemiology ; Humans ; Male ; Middle Aged ; South Africa ; Urban Population ; },
}
@article {pmid77946,
year = {1978},
author = {Eastwood, MA and Smith, AN and Brydon, WG and Pritchard, J},
title = {Colonic function in patients with diverticular disease.},
journal = {Lancet (London, England)},
volume = {1},
number = {8075},
pages = {1181-1182},
doi = {10.1016/s0140-6736(78)90969-8},
pmid = {77946},
issn = {0140-6736},
mesh = {Adult ; Aged ; Colon/*physiopathology ; Constipation/etiology ; Diverticulum, Colon/*physiopathology ; Feces/analysis ; Gastrointestinal Motility ; Humans ; Middle Aged ; Pressure ; Rectum/physiopathology ; Time Factors ; },
abstract = {Diverticular disease is thought to be associated with prolonged intestinal transit-time, a reduced stool weight, and increased intracolonic pressure. Sixty patients with diverticular disease did not regularly show these features. Variation in colonic function was considerable in these patients and was similar to that in the general population from which the patients were recruited. Constipation may be a complication of diverticular disease and not necessarily part of its aetiology.},
}
@article {pmid675467,
year = {1978},
author = {Gallagher, DM and Russell, TR},
title = {Surgical management of diverticular disease.},
journal = {The Surgical clinics of North America},
volume = {58},
number = {3},
pages = {563-572},
doi = {10.1016/s0039-6109(16)41538-0},
pmid = {675467},
issn = {0039-6109},
mesh = {Colon/surgery ; Colonic Diseases/etiology/therapy ; Colostomy/methods ; Diverticulitis, Colonic/complications/pathology/*surgery ; Drainage ; Humans ; Intestinal Fistula/etiology/therapy ; Intestinal Perforation/etiology ; Peritonitis/etiology ; Urinary Bladder Fistula/etiology/therapy ; },
}
@article {pmid668244,
year = {1978},
author = {Castleden, WM and Doouss, TW and Jennings, KP and Leighton, M},
title = {Gallstones, carcinoma of the colon and diverticular disease.},
journal = {Clinical oncology},
volume = {4},
number = {2},
pages = {139-144},
pmid = {668244},
issn = {0305-7399},
mesh = {Adenocarcinoma/*complications/etiology ; Cholecystectomy/adverse effects ; Cholelithiasis/*complications/surgery ; Colonic Neoplasms/*complications/etiology ; Diverticulum, Colon/*complications ; Female ; Humans ; Male ; Retrospective Studies ; },
}
@article {pmid656750,
year = {1978},
author = {Ardran, GM and Nolan, DJ and Gear, JS and Fursdon, PS and Brodribb, AJ},
title = {X-ray dose received by patients in a population survey for colonic diverticular disease.},
journal = {The British journal of radiology},
volume = {51},
number = {606},
pages = {472},
doi = {10.1259/0007-1285-51-606-472},
pmid = {656750},
issn = {0007-1285},
mesh = {Colon/diagnostic imaging ; Diverticulum, Colon/*diagnostic imaging ; Humans ; *Radiation Dosage ; Radiography ; X-Rays ; },
}
@article {pmid694622,
year = {1978},
author = {Barbezat, GO},
title = {The diagnosis and management of diverticular disease.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {53},
number = {20},
pages = {793-796},
pmid = {694622},
issn = {0256-9574},
mesh = {Colonic Diseases/complications/diagnosis ; Diagnosis, Differential ; *Diverticulitis, Colonic/diagnosis/etiology ; *Diverticulum, Colon/etiology ; Humans ; },
abstract = {Diverticular disease is very common among elderly members of "Western, civilized" communities. The aetiopathogenesis is unknown, but may be related to diet and raised intracolonic pressure. Patients with diverticulosis are usually asymptomatic, but those with diverticulitis (which implies inflammation) often present with pain, pyrexia and changes in bowel habit. Careful differential diagnosis is necessary to permit appropriate treatment (medical or surgical), and to detect and treat potentially dangerous complications (abscess, peritonitis, haemorrhage, stenosis, fistula).},
}
@article {pmid662838,
year = {1978},
author = {Gear, JS and Ware, AC and Nolan, DJ and Fursdon, PS and Brodribb, AJ and Mann, JI},
title = {Dietary fibre and asymptomatic diverticular disease of the colon.},
journal = {The Proceedings of the Nutrition Society},
volume = {37},
number = {1},
pages = {13A},
pmid = {662838},
issn = {0029-6651},
mesh = {Aged ; Cellulose/*therapeutic use ; Colon/diagnostic imaging ; *Diet, Vegetarian ; Dietary Fiber/*therapeutic use ; Diverticulum, Colon/etiology/*prevention & control ; Female ; Humans ; Male ; Middle Aged ; Radiography ; },
}
@article {pmid658769,
year = {1978},
author = {Taylor, I and Darby, C and Hammond, P and Basu, P},
title = {Is there a myoelectrical abnormality in the irritable colon syndrome?.},
journal = {Gut},
volume = {19},
number = {5},
pages = {391-395},
pmid = {658769},
issn = {0017-5749},
mesh = {Adult ; Colon/*physiopathology ; Colonic Diseases, Functional/*physiopathology ; Electromyography ; Female ; Gastrointestinal Motility ; Humans ; Male ; Muscle, Smooth/physiopathology ; },
abstract = {Although recent work has suggested that an abnormality of the 0.05 Hz (3 c/m) slow wave electrical activity exists in the distal colon of patients with the irritable colon syndrome, it is not established whether this is related to altered bowel habit alone, or whether it is specific to the irritable colon syndrome. We have therefore studied 10 patients referred with this disorder and compared their colonic myoelectrical pattern with 10 patients suffering from assorted disorders with similar symptoms--for example, chronic pancreatitis, diverticular disease, ulcerative colitis, etc. Transit time, stool weights, percentage motility, and slow wave electrical activity were measured in each patient. The two groups were well matched for age and patients with similar symptoms in the two groups had similar values for transit time and percentage motility. There was a statistically significant increase in the 3 c/m electrical activity in patients with the irritable colon syndrome unrelated to the degree of diarrhoea or constipation. It would appear, therefore, that the abnormally high incidence of 3 c/m electrical activity in the colon is specific to the irritable colon syndrome and not merely a feature of altered bowel habit.},
}
@article {pmid662644,
year = {1978},
author = {Frexinos, J},
title = {[Why, when and how dietary fiber will be used in gastrointestinal disorders (author's transl)].},
journal = {La Nouvelle presse medicale},
volume = {7},
number = {14},
pages = {1195-1198},
pmid = {662644},
issn = {0301-1518},
mesh = {Cellulose/*therapeutic use ; Colonic Diseases, Functional/*therapy ; Constipation/diet therapy ; Dietary Fiber/metabolism/*therapeutic use ; Diverticulum, Colon/diet therapy ; Humans ; },
abstract = {This paper reviews the current status of knowledge with relation to the effects of dietary fiber on intestinal physiology and pathology. Vegetable dietary fiber is a physical complex acting principally in the colon. Fibers have water-holding, cation exchange and absorptive properties and important effects on bacterial activity. Data on transit times, colonic intraluminal pressure and colonic motor activity, favour the view that fibers are interesting in the therapy of constipation, irrtable colon and diverticular disease. High residue diet must be recommended in this colonic disease. Indications are given for the choice, dosage and administration of dietary fibers.},
}
@article {pmid715585,
year = {1978},
author = {Pantanowitz, D and Rabin, MS},
title = {Diverticular disease of the colon--blood or pain.},
journal = {South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie},
volume = {16},
number = {1},
pages = {75-79},
pmid = {715585},
issn = {0038-2361},
mesh = {Aged ; Diverticulitis, Colonic/*classification ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid649707,
year = {1978},
author = {Landi, E},
title = {[Clinical and manometric results one year after transverse multiple myotomy for diverticular disease of the sigmoid colon (author's transl)].},
journal = {Journal de chirurgie},
volume = {115},
number = {3},
pages = {167-170},
pmid = {649707},
issn = {0021-7697},
mesh = {Adult ; Aged ; *Colon, Sigmoid ; Diverticulum, Colon/diagnostic imaging/*surgery ; Follow-Up Studies ; Humans ; Intestinal Fistula/etiology/surgery ; Middle Aged ; Radiography ; },
}
@article {pmid638438,
year = {1978},
author = {Ingram, NP and Holford, CP and Ellis, WR},
title = {Two cases of giant intestinal gas cyst.},
journal = {The British journal of surgery},
volume = {65},
number = {3},
pages = {214},
doi = {10.1002/bjs.1800650321},
pmid = {638438},
issn = {0007-1323},
mesh = {Aged ; Colonic Diseases/diagnostic imaging ; Diverticulum, Colon/complications ; Female ; Humans ; Male ; *Pneumatosis Cystoides Intestinalis/diagnostic imaging ; Radiography ; },
abstract = {Large gas cysts of the colon are uncommon and only some 30 cases have been reported (Moss, 1975). They usually arise from the sigmoid colon and are always associated with diverticular disease (Schenken and Cochran, 1972). In view of their rarity, 2 further cases with different presenting factors are discussed.},
}
@article {pmid343584,
year = {1978},
author = {Dwyer, JT and Goldin, B and Gorbach, S and Patterson, J},
title = {Drug therapy reviews: dietary fiber and fiber supplements in the therapy of gastrointestinal disorders.},
journal = {American journal of hospital pharmacy},
volume = {35},
number = {3},
pages = {278-287},
pmid = {343584},
issn = {0002-9289},
mesh = {Cellulose/*therapeutic use ; Chemical Phenomena ; Chemistry ; Dietary Fiber/adverse effects/pharmacology/*therapeutic use ; Feces/drug effects ; Gastrointestinal Diseases/*diet therapy/physiopathology ; Gastrointestinal Motility/drug effects ; Humans ; },
abstract = {Dietary fiber and fiber supplements are reviewed, with particular emphasis on their sources, composition and properties; physiological actions on gastrointestinal functions; and uses in gastrointestinal disease states (functional bowel disease, diverticular disease and other conditions). Adverse effects and contraindications, and the hypothesis of diet's effect on colon cancer also are discussed. Dietary fiber supplements may relieve symptoms of constipation, spastic colon, and diverticular disease; in the two latter disorders, colonic pressure relationships are altered. It is concluded that current evidence does not support other therapeutic uses for dietary fiber sonstituents, except possibly in patients with anal fissures and hemorrhoids, which can be helped by the passage of a softer stool.},
}
@article {pmid343568,
year = {1978},
author = {Huang, CT and Gopalakrishna, GS and Nichols, BL},
title = {Fiber, intestinal sterols, and colon cancer.},
journal = {The American journal of clinical nutrition},
volume = {31},
number = {3},
pages = {516-526},
doi = {10.1093/ajcn/31.3.516},
pmid = {343568},
issn = {0002-9165},
mesh = {Adult ; Bile Acids and Salts/metabolism ; *Cellulose/pharmacology ; Colonic Neoplasms/*prevention & control ; Diet, Vegetarian ; *Dietary Fiber ; Digestion ; Feces/microbiology ; Humans ; Intestines/*physiology ; Lignin/pharmacology ; Male ; Pectins/pharmacology ; Polysaccharides/pharmacology ; },
abstract = {It has been postulated that dietary fiber's protective effect against the development of colon cancer, diverticular disease, and atherosclerosis may be due to the adsorption and/or dilution of intestinal sterols such as bile acids and neural sterols and their bacterial metabolites by component(s) of fiber. Dietary fiber is made up of four major components-cellulose, hemicellulose, lignin, and pectin. There is evidence that hemicellulose and pectin may induce an increase in fecal bile acid excretion in man which may be accompanied by a decrease in serum cholesterol. Natural fibers, such as rolled oats, alfalfa, guar gum, and Bengal gram have been shown to have hypocholesterolemic properties of alfalfa, wheat straw, and some other fibers found considerable amounts of bile acids in vitro. On the other hand, wheat bran, oat hulls, and all the synthetic fibers tested bound only negligible amounts of bile acids under the same conditions. Vegetarians in the United States have lower plasma lipids and different plasma lipoprotein patterns than those of comparable control populations on regular mixed diet. They also have smaller daily fractional turnover rates of cholic acid and deoxycholic acid pool size. In addition, populations on a mixed Western diet, where the rate of large bowel cancer is high (North American, English, Scottish, etc.) degraded and excreted cholesterol and bile acid metabolites to a greater degree than populations where the rate of colon cancer is comparatively low (Ugandan, Japanese, etc). It cannot be denied that the fiber theory linking fiber deficiency with the development of colon cancer and other diseases, is simple, attractive and appears to be firmly based in common sense. When subjected to research studies, however, the situation appears much more complex than expected. Although some progress is being made, the data are often contradictory and confusing, probably due to lack of adequate documentation of fiber intake (e.g., use of dietary fiber instead of crude fiber) and/or the absence of detailed information on the chemistry of the fiber itself.},
}
@article {pmid305277,
year = {1978},
author = {Grace, DM and Gold, RE},
title = {Angiography in determining the cause and treatment of gastrointestinal bleeding.},
journal = {Canadian journal of surgery. Journal canadien de chirurgie},
volume = {21},
number = {2},
pages = {171-174},
pmid = {305277},
issn = {0008-428X},
mesh = {Adult ; Aged ; *Angiography ; Embolization, Therapeutic ; Endoscopy ; Esophageal and Gastric Varices/diagnosis ; Gastrointestinal Hemorrhage/*diagnostic imaging/drug therapy/surgery ; Humans ; Middle Aged ; Peptic Ulcer Hemorrhage/diagnosis ; Vasopressins/therapeutic use ; },
abstract = {Angiography is useful in the diagnosis of active gastrointestinal bleeding if the rate is greater than 0.5 mL/min. For upper gastrointestinal bleeding, endoscopy is the preferred initial investigation and angiography is used for diagnosis only if the site of bleeding is still obscure. Angiography is the preferred method for investigation of massive lower gastrointestinal bleeding if results of sigmoidoscopy are negative. Vasopressin infusion is most useful for control of bleeding from esophageal varices, erosive gastritis and diverticular disease of the colon. Embolization with Gelfoam or clot is possible for massive hemorrhage from a single source in poor-risk patients. This is most successful for gastric or duodenal bleeding since the collateral blood supply prevents infarction. Some of the methods and complications of embolization are discussed and examples are given. Standard surgical principles should still apply in most cases.},
}
@article {pmid344156,
year = {1978},
author = {Tarpila, S and Miettinen, TA and Metsäranta, L},
title = {Effects of bran on serum cholesterol, faecal mass, fat, bile acids and neutral sterols, and biliary lipids in patients with diverticular disease of the colon.},
journal = {Gut},
volume = {19},
number = {2},
pages = {137-145},
pmid = {344156},
issn = {0017-5749},
mesh = {Adult ; Bile/*analysis ; Bile Acids and Salts/analysis ; Cellulose/*therapeutic use ; Cholesterol/biosynthesis/*blood ; Clinical Trials as Topic ; Deoxycholic Acid/analysis ; Dietary Fiber/*therapeutic use ; Diverticulum, Colon/*therapy ; Feces/*analysis ; Female ; Humans ; Lipids/analysis ; Male ; Middle Aged ; Sterols/analysis ; *Triticum ; },
abstract = {Twenty-two patients with symptomatic diverticular disease of the colon were randomly allocated to control and high-fibre groups so that the long-term effect (up to 12 months) of bran on serum, faecal and biliary lipids could be studied. Even in cases of high initial values, faecal mass was increased by bran and the change was positively correlated with the change in dietary fibre. Faecal fat and dry weight were also increased. Faecal bile acids were initially slightly raised and were positively correlated with wet weight both off and on bran. The latter significantly decreased the excretion and concentration of bile acids, in particular the high initial values. The change in bile acids was not correlated with the change in dietary fibre or faecal wet weight. Sterol balance values indicated that the bran-induced decrease in faecal bile acids was associated with a lower cholesterol synthesis. Serum cholesterol decreased significantly in two hypercholesterolaemic individuals only. Correlations between different parameters revealed that the higher the initial level or the greater the drop in cholesterol synthesis, the greater the decrease in serum cholesterol. Bran had no effect on the biliary saturation of cholesterol. The percentage of biliary deoxycholate was negatively correlated with faecal mass (less so with faecal bile acid output) both before and during bran and was significantly decreased by bran. The percentage of cholic acid increased correspondingly and that of chenodeoxycholate remained unchanged. Faecal bile acids also indicated that the synthesis of the two primary bile acids was lowered by bran to the same degree.},
}
@article {pmid740274,
year = {1978},
author = {Bonardi, O},
title = {[Diverticular disease of the colon].},
journal = {Minerva dietologica e gastroenterologica},
volume = {24},
number = {1},
pages = {78-79},
pmid = {740274},
issn = {0391-1993},
mesh = {*Diverticulum, Colon/diagnosis/therapy ; Humans ; },
}
@article {pmid735943,
year = {1978},
author = {Hinchey, EJ and Schaal, PG and Richards, GK},
title = {Treatment of perforated diverticular disease of the colon.},
journal = {Advances in surgery},
volume = {12},
number = {},
pages = {85-109},
pmid = {735943},
issn = {0065-3411},
mesh = {Aged ; Colectomy/methods ; Colostomy ; Diverticulitis, Colonic/complications/microbiology/*surgery ; Humans ; Intestinal Perforation/etiology/*surgery ; Middle Aged ; Peritonitis/etiology/surgery ; },
abstract = {Diverticular disease of the colon now is recognized to be functional disease resulting from altered neuromuscular activity in the colon. Inflammatory complications, when they occur, usually result from inflammation around a single diverticulum. This may lead to the formation of a pericolic or pelvic abscess. Free perforation of these leads to purulent peritonitis. The original communication with the lumen of the bowel usually is obliterated. More rarely, with either rapid evolution or failure of the diverticular neck to obliterate, a free communication develops between the bowel lumen and the peritoneal cavity, leading to fecal peritonitis. Fecal peritonitis results in an extremely high mortality rate. The operative approach for a patient with perforated diverticular disease should be individualized and depends on the stage of the disease present, the general condition of the patient, the experience of the surgeon in colon surgery and the availability of facilities and personnel to provide intensive care. In larger institutions when these conditions are optimal, primary resection of the diseased bowel with or without anastomosis is becoming the procedure of choice. In smaller institutions or if conditions are not optimal, right transverse colostomy with drainage of the perforated segment can be relied on to control the disease with a mortality rate compared to that of primary resection. If free perforation and fecal peritonitis are present, exteriorization or primary resection of the perforated segment must be carried out. We would not recommend primary anastomosis under these circumstances.},
}
@article {pmid705252,
year = {1978},
author = {Miettinen, TA and Tarpila, S},
title = {Fecal beta-sitosterol in patients with diverticular disease of the colon and in vegetarians.},
journal = {Scandinavian journal of gastroenterology},
volume = {13},
number = {5},
pages = {573-576},
doi = {10.3109/00365527809181766},
pmid = {705252},
issn = {0036-5521},
mesh = {Adult ; Aged ; Diet, Vegetarian ; Dietary Fiber/analysis ; Diverticulum, Colon/*metabolism ; Feces/*analysis ; Humans ; Middle Aged ; Sitosterols/*analysis ; },
abstract = {Fecal sterol analysis showed that excretion of beta-sitosterol, a major component of poorly absorbable dietary vegetable sterols, is subnormal in patients with diverticular disease of the colon. Thus, the patients had evidently consumed a diet low in plant materials. The finding agrees with the current opinion that diverticular disease of the colon is associated with dietary fibre deficiency and suggests that fecal beta-sitosterol provides a rough measure of the vegetable intake. In vegetarians the beta-sitosterol excretion was actually high.},
}
@article {pmid618479,
year = {1978},
author = {Walton, L and Schwartz, M and Photopulos, G and Fowler, W},
title = {Sigmoidovaginal fistulae due to diverticular disease. Two case reports and an update.},
journal = {Obstetrics and gynecology},
volume = {51},
number = {1 Suppl},
pages = {59s-61s},
pmid = {618479},
issn = {0029-7844},
mesh = {Aged ; *Colon, Sigmoid ; Diverticulum, Colon/*complications ; Female ; Humans ; Intestinal Fistula/diagnosis/*etiology ; Middle Aged ; Vaginal Fistula/diagnosis/*etiology ; },
abstract = {Sigmoidovaginal fistulae are rare. They occur as a result of malignancy, irradiation, pelvic surgery, or diverticular disease, the latter being the principal cause. Numerous diagnostic techniques are available. Therapeutic modalities for these fistulae are discussed.},
}
@article {pmid307312,
year = {1978},
author = {Welch, CE and Athanasoulis, CA and Galdabini, JJ},
title = {Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease.},
journal = {World journal of surgery},
volume = {2},
number = {1},
pages = {73-83},
pmid = {307312},
issn = {0364-2313},
mesh = {Colon/*blood supply ; Colonic Diseases/*complications ; Diverticulum, Colon/*complications ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Varicose Veins/*complications ; },
}
@article {pmid278431,
year = {1978},
author = {Holmström, B and Uldén, R and Wallensten, R},
title = {Angiography with vasoactive drugs in diagnosis of diverticular disease and carcinoma of the sigmoid colon.},
journal = {Acta chirurgica Scandinavica. Supplementum},
volume = {482},
number = {},
pages = {57-58},
pmid = {278431},
issn = {0301-1860},
mesh = {Diagnosis, Differential ; Diverticulitis, Colonic/diagnostic imaging ; Diverticulum, Colon/*diagnostic imaging ; Epinephrine ; Humans ; Mesenteric Arteries/*diagnostic imaging ; Propranolol ; Radiography ; Sigmoid Neoplasms/*diagnostic imaging ; },
abstract = {39 patients with sigmoid lesions have been examined with angiografphy, using epinephrine and propranolol. 11 had carcinoma, all were diagnosed angiographically. Fibrosis may appear similar on phamacoangiography whereas the inflammatory reaction is different.},
}
@article {pmid606632,
year = {1977},
author = {Foster, DR and Ross, B},
title = {Giant sigmoid diverticulum: clinical and radiological features.},
journal = {Gut},
volume = {18},
number = {12},
pages = {1051-1053},
pmid = {606632},
issn = {0017-5749},
mesh = {Aged ; Colon, Sigmoid/*diagnostic imaging/pathology ; Diverticulum, Colon/*diagnostic imaging/pathology ; Female ; Humans ; Male ; Middle Aged ; Radiography ; },
abstract = {Two case reports of giant sigmoid diverticulum associated with diverticular disease of the sigmoid colon are presented. The clinical and radiological features of 30 similar cases found in the literature are reviewed. Our two cases represent the largest recorded diverticulum and the oldest recorded patient with this condition.},
}
@article {pmid310229,
year = {1977},
author = {Jorge, AD and Sánchez, D and Díaz, M and Lorenzo, J and Milutin, C},
title = {[Early detection of colonic and rectal cancer; extensive study of occult blood].},
journal = {Acta gastroenterologica Latinoamericana},
volume = {7},
number = {4},
pages = {261-268},
pmid = {310229},
issn = {0300-9033},
mesh = {Adenocarcinoma/diagnosis ; Adult ; Colonic Neoplasms/complications/*diagnosis ; Feces/*analysis ; Female ; Gastrointestinal Hemorrhage/diagnosis/etiology ; Hodgkin Disease/diagnosis ; Humans ; Male ; Melena/diagnosis/*etiology ; Middle Aged ; Occult Blood ; Rectal Neoplasms/complications/*diagnosis ; },
abstract = {Due to the high frequency and usually late diagnosis of cancer of colon and rectum the "haemoccult test" has been recommended as an easy, quick, and unexpensive method for stool determination of occult blood that will allow us to suspect the existence of these tumors in their early asymptomatic stages. The test was performed in 1437 patients attending the gastroenterology clinic which had no clinical evidence of bleeding, of these, 1150 returned the samples. In 52 (4,6%) the test was positive for occult blood. The studies performed revelated that 4 were upper gastrointestinal ilions, one ileal diverticulum and 40 (3,47%) patients had colonic disease of the latter 19 were diverticular disease, 1 crohnis disease of rectum, 2 adenomatous and 2 villous polips, 1 Hodkgin disease and 7 carcinomas. There were 6 false positive results. The high frequency of positive "haemoccult test" in colonic disease, specially benign and malignant tumors, make this test and appropiate method of this time in the detection for colo-rectal carcinoma.},
}
@article {pmid593590,
year = {1977},
author = {Monti, GF and Lucchetti, P},
title = {[Surgical treatment of diverticular disease of the colon].},
journal = {Minerva medica},
volume = {68},
number = {55},
pages = {3727-3728},
pmid = {593590},
issn = {0026-4806},
mesh = {Diverticulitis, Colonic/*surgery ; Diverticulum, Colon/*surgery ; Humans ; },
}
@article {pmid916114,
year = {1977},
author = {Underwood, JW},
title = {An unusual renocolic fistula.},
journal = {The Journal of urology},
volume = {118},
number = {5},
pages = {847-848},
doi = {10.1016/s0022-5347(17)58218-x},
pmid = {916114},
issn = {0022-5347},
mesh = {Aged ; Colonic Diseases/diagnostic imaging/*etiology ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Intestinal Fistula/diagnostic imaging/*etiology ; Kidney Calculi/*complications ; Kidney Diseases/diagnostic imaging/*etiology ; Radiography ; Urinary Fistula/diagnostic imaging/*etiology ; },
abstract = {A case of a left renocolic fistula that was caused by a combination of diverticular disease and renal calculi is presented. It is suggested that bowel disease will only produce such a fistula if there is pre-existing chronic renal disease.},
}
@article {pmid590214,
year = {1977},
author = {Glerum, J and Agenant, D and Tytgat, GN},
title = {Value of coloscopy in the detection of sigmoid malignancy in patients with diverticular disease.},
journal = {Endoscopy},
volume = {9},
number = {4},
pages = {228-230},
doi = {10.1055/s-0028-1098522},
pmid = {590214},
issn = {0013-726X},
mesh = {Biopsy ; Diverticulum, Colon/*complications/pathology ; Female ; Humans ; Male ; Middle Aged ; Sigmoid Neoplasms/*diagnosis/etiology/pathology ; Sigmoidoscopy/methods ; },
abstract = {Coloscopy was accurate in 83% of patients referred because of a radiological suspicion of malignancy in a diverticula-bearing sigmoid colon. In 17% the sigmoid could not be reached or inspected because of deformity or stenosis. All 13 coexisting carcinomas were correctly diagnosed endoscopically except for one which could not be reached. Coloscopy is therefore a valuable adjunct in detecting or eliminating cancer in colonic diverticular disease.},
}
@article {pmid243179,
year = {1977},
author = {Goldner, FH},
title = {Diverticular disease of the colon.},
journal = {Nursing care},
volume = {10},
number = {11},
pages = {20-1, 28},
pmid = {243179},
issn = {0091-2379},
mesh = {*Diverticulum, Colon/prevention & control ; Humans ; },
}
@article {pmid147496,
year = {1977},
author = {Simici, P and Popa, F and Baican, S and Olărescu, A},
title = {[Spontaneous sigmoido-vesical fistula].},
journal = {Revista de chirurgie, oncologie, radiologie, o.r.l., oftalmologie, stomatologie. Chirurgie},
volume = {26},
number = {6},
pages = {449-454},
pmid = {147496},
issn = {0377-5003},
mesh = {Aged ; *Colon, Sigmoid ; Female ; Humans ; *Intestinal Fistula/diagnosis/surgery ; Male ; Middle Aged ; *Urinary Bladder Fistula/diagnosis/surgery ; },
abstract = {The colo-vesical fistula, most frequently of diverticular origin, usually occurs at a later age, when the diverticular disease is complicated by local and peri-sigmoidal processes. A characteristic of this disturbance is the fact that, although the causal affection is colical, the manifestation, at least initially, is mostly at the level of the urinary bladder, under the form of repeated bouts of cystitis of an apparently undetermined origin. Such manifestations should prompt, besides exploration of the urinary apparatus, also an exploration of the colon. The exclusively surgical treatment should be applied as early as possible after the identification of the fistular lesion, in view of preventing more severe local complications and ascendent urinary infections.},
}
@article {pmid95774,
year = {1977},
author = {Watts, GT},
title = {Bowel transit, stool weight, and diverticular disease.},
journal = {Lancet (London, England)},
volume = {2},
number = {8037},
pages = {564},
doi = {10.1016/s0140-6736(77)90707-3},
pmid = {95774},
issn = {0140-6736},
mesh = {Dietary Fiber/administration & dosage ; Diverticulitis, Colonic/*physiopathology ; *Feces ; Gastrointestinal Transit/*physiology ; Humans ; },
}
@article {pmid414968,
year = {1977},
author = {Scarpello, JH and Sladen, GE},
title = {Appraisal of the 14C-glycocholate acid test with special reference to the measurement of faecal 14C excretion.},
journal = {Gut},
volume = {18},
number = {9},
pages = {742-748},
pmid = {414968},
issn = {0017-5749},
mesh = {Adult ; Aged ; Breath Tests ; Carbon Dioxide ; Carbon Radioisotopes ; Diarrhea/diagnosis ; Diverticulum/diagnosis ; Evaluation Studies as Topic ; Feces/*analysis ; Female ; *Glycocholic Acid ; Humans ; Ileostomy ; Ileum/surgery ; Intestinal Diseases/*diagnosis ; Male ; Middle Aged ; },
abstract = {The (14)C-glycocholate test, including the measurement of marker corrected faecal (14)C, has been assessed in the following groups of subjects: normal controls (18), patients with diarrhoea not attributable to altered bile acid metabolism (21), patients with diverticula of the small intestine (12), patients with previous resection of ileum and often proximal colon (34), and established ileostomists (10). Patients with diverticular disease had increased breath (14)CO(2) excretion, but normal faecal excretion of (14)C, and this test was more frequently abnormal than the Schilling test. Ileostomists excreted increased amounts of faecal (14)C, even when the ileum was intact and apparently normal. The pattern after resection was complex. Breath (14)C output was normal if the ileal resection was less than 25 cm in length, although some of these patients had increased faecal (14)C excretion if, in addition, at least 15 cm of proximal colon had been resected or by-passed. Longer ileal resections were associated with increased breath and/or faecal (14)C excretion, depending in part on the length of colon resected or by-passed and the 24 hour faecal volume. Fewer than half these patients had both increased breath and faecal excretion of isotope and faecal (14)C alone was occasionally normal with an ileal resection of 50 cm of more. The (14)C-glycocholate test was more frequently abnormal than the Schilling test in this group. The use of faecal marker correction had only a minor impact on the results. These data suggest that, in patients with ileal resection, faecal (14)C, like faecal weight, is determined by the extent of colonic resection as well as by the amount of ileum resected.},
}
@article {pmid409591,
year = {1977},
author = {Payan, HM},
title = {Diverticular disease of the appendix.},
journal = {Diseases of the colon and rectum},
volume = {20},
number = {6},
pages = {473-476},
doi = {10.1007/BF02586583},
pmid = {409591},
issn = {0012-3706},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Appendicitis/pathology ; *Appendix/pathology ; *Diverticulum/pathology ; Female ; Humans ; Male ; Middle Aged ; Pain ; },
abstract = {Diverticular disease of the appendix involves about 1 per cent of all appendices removed. Considering the large number, the subject appears to have been neglected in medical literature. Since the symptomatology is similar to that of appendicits and diverticula are frequently very small, they could go unnoticed. A comparison of 30 cases of diverticular disease and 30 cases of acute appendicitis reveals a few fine differences. The patients with diverticular disease are at least a decade older, the duration of pain in these patients is longer, and the diverticula and appendix may or may not be inflamed.},
}
@article {pmid328553,
year = {1977},
author = {Connell, AM},
title = {Wheat bran as an etiologic factor in certain diseases. Some second thoughts.},
journal = {Journal of the American Dietetic Association},
volume = {71},
number = {3},
pages = {235-239},
pmid = {328553},
issn = {0002-8223},
mesh = {*Cellulose/therapeutic use ; Colon/physiology ; Colonic Diseases/diet therapy/*etiology ; Colonic Neoplasms/etiology ; *Dietary Fiber/deficiency/therapeutic use ; Diverticulum, Colon/epidemiology/etiology ; Feces ; Female ; Humans ; Lipids/blood ; Male ; Sex Factors ; *Triticum ; },
abstract = {The author questions "the bran hypothesis" that a deficiency of natural fiber--wheat bran in particular--is responsible for a number of prevalent diseases in Western societies, namely diverticular disease, cancer of the colon, gallstones, and myocardial disease. In re-examining the hypothesis, he cites reports which fail to support the theory. For instance, the incidence of diverticular disease in women has increased since 1925, yet there is no evidence that their diets have changed or are different from those of men. Also, it is a mistake to equate wheat bran with fiber in general, and it cannot be shown that dietary fiber in general has declined. In addition, clinical studies have failed to show beneficial results in treating diverticular disease and irritable colon by adding bran to the diet. Similar problems arise in testing the hypothesis that natural fiber can prevent cancer of the colon and lower serum cholesterol and triglycerides. Recent interest in dietary fiber is welcome, for it has been grossly neglected, but much research is still needed to place it in proper perspective.},
}
@article {pmid906546,
year = {1977},
author = {Jarrett, F},
title = {Diverticular disease of the colon.},
journal = {Wisconsin medical journal},
volume = {76},
number = {8},
pages = {106-108},
pmid = {906546},
issn = {0043-6542},
mesh = {Aged ; Diverticulitis, Colonic/surgery/therapy ; Diverticulum, Colon/complications/*therapy ; Humans ; Middle Aged ; },
}
@article {pmid873339,
year = {1977},
author = {Eastwood, MA and Sanderson, J and Pocock, SJ and Mitchell, WD},
title = {Variation in the incidence of diverticular disease within the city of Edinburgh.},
journal = {Gut},
volume = {18},
number = {7},
pages = {571-574},
pmid = {873339},
issn = {0017-5749},
mesh = {Adolescent ; Adult ; Age Factors ; Aged ; Colon/diagnostic imaging ; Diverticulum, Colon/*epidemiology/etiology ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Scotland ; },
abstract = {An estimate of the incidence of diverticular disease of the colon was based on all the barium enema examinations in Edinburgh over four years (12 335 cases); using the census data for 1971, incidence rates for the city by age, sex, and electoral ward were calculated. The overall annual incidence rate was 1-55/1000, the rate rising sharply with increasing age. The incidence of diverticular disease varies from ward to ward (range 0-92-2-04/1000), adjacent wards have similar incidence rates and the six wards with the lowest rates are clustered together in the South East of the city. Ward incidence rates have a significant negative association with the percentage of owner occupiers living in that area.},
}
@article {pmid67885,
year = {1977},
author = {Halliday, WJ and Maluish, AE and Stephenson, PM and Davis, NC},
title = {An evaluation of leukocyte adherence inhibition in the immunodiagnosis of colorectal cancer.},
journal = {Cancer research},
volume = {37},
number = {7 Pt 1},
pages = {1962-1971},
pmid = {67885},
issn = {0008-5472},
mesh = {Adenocarcinoma/*diagnosis/immunology ; Adult ; Aged ; Antibodies, Neoplasm ; Antigens, Neoplasm ; Binding, Competitive ; Colonic Neoplasms/*diagnosis/immunology ; Diverticulum/immunology ; Epitopes ; Evaluation Studies as Topic ; False Positive Reactions ; Female ; Gastrointestinal Diseases/immunology ; Humans ; Immunity ; Immunity, Cellular ; *Immunologic Techniques ; *Leukocyte Adherence Inhibition Test ; Leukocytes/immunology ; Male ; Middle Aged ; Rectal Neoplasms/*diagnosis/immunology ; Recurrence ; Remission, Spontaneous ; },
abstract = {The leukocyte adherence inhibition technique was used to assess cell-mediated immunoreactivity and serum-blocking factors related to adenocarcinoma of the colon or rectum. In the group of 48 patients with confirmed tumors of this type, 36 of 38 had reactive leukocytes and 46 of 47 had serum-blocking factors. Patients whose tumors had been removed surgically, with no sign of recurrence, retained their leukocyte activity for up to 3.5 years in 6 of 6 cases, but only a small proportion (7 of 30) retained blocking factors. In 67 controls (who were patients with nonmalignant gastrointestinal disorders, patients with gastrointestinal tumors other than colorectal adenocarcinoma, patients with other cancers, or healthy volunteers), negative reactions were obtained, with diverticular disease the only prominent exception. The leukocyte adherence inhibition test appeared to be highly sensitive and specific. Application to the immunodiagnosis of colorectal cancer thus seems to be warranted.},
}
@article {pmid917304,
year = {1977},
author = {Castiglioni, GC and Pescatori, M},
title = {[Transversal multiple taeniamyotomy in diverticular disease of the colon. Clinical and manometric study].},
journal = {Minerva chirurgica},
volume = {32},
number = {12},
pages = {783-790},
pmid = {917304},
issn = {0026-4733},
mesh = {Cholelithiasis/complications ; Diverticulum, Colon/etiology/*surgery ; Duodenal Ulcer/complications ; Female ; Gastrointestinal Motility ; Humans ; Male ; Manometry ; Methods ; Middle Aged ; Postoperative Complications/physiopathology ; },
}
@article {pmid890761,
year = {1977},
author = {Mezerová, M},
title = {[Myenteric plexuses in diverticular disease of the large intestine (author's transl)].},
journal = {Ceskoslovenska gastroenterologie a vyziva},
volume = {31},
number = {4},
pages = {229-233},
pmid = {890761},
issn = {0009-0565},
mesh = {Aged ; Diverticulum, Colon/*physiopathology ; Humans ; Middle Aged ; Myenteric Plexus/*physiopathology ; },
}
@article {pmid873823,
year = {1977},
author = {Mancuso, LG},
title = {Diverticular disease of the colon.},
journal = {The Journal of the American Osteopathic Association},
volume = {76},
number = {10},
pages = {771-773},
pmid = {873823},
issn = {0098-6151},
mesh = {Adult ; Age Factors ; Aged ; Diet/adverse effects ; *Diverticulum, Colon/etiology/therapy ; Humans ; Middle Aged ; },
}
@article {pmid871616,
year = {1977},
author = {Charnock, FM and Rennie, JR and Wellwood, JM and Todd, IP},
title = {Results of colectomy for diverticular disease of the colon.},
journal = {The British journal of surgery},
volume = {64},
number = {6},
pages = {417-419},
doi = {10.1002/bjs.1800640612},
pmid = {871616},
issn = {0007-1323},
mesh = {Adolescent ; Adult ; Aged ; *Colectomy/adverse effects ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; },
abstract = {A retrospective study of 71 patients who had a colonic resection for diverticular disease at one hospital during a 7-year period was undertaken. Patients were divided into those undergoing surgery for complications of diverticular disease (49) and those in whom abdominal pain and an altered bowel habit were attributed to the presence of diverticular disease in the absence of any detectable complication (22). In both groups major complications occurred after operation. The incidence of complications was greater when surgery was undertaken in stages to effect colonic resection and restoration of intestinal continuity. Symptoms were more often cured or relieved in those patients undergoing surgery for complicated diverticular disease than in those with 'uncomplicated' disease. These poor results may be due to incorrectly attributing symptoms to diverticula which happened to be present.},
}
@article {pmid301085,
year = {1977},
author = {Glauser, R and Filippini, L},
title = {[Diverticular disease of the colon (author's transl)].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {102},
number = {20},
pages = {755-759},
doi = {10.1055/s-0028-1104966},
pmid = {301085},
issn = {0012-0472},
mesh = {Adult ; Aged ; Dietary Fiber ; Diverticulitis, Colonic/diet therapy/*pathology ; Diverticulum, Colon/diet therapy/*pathology ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Obstruction/etiology ; Male ; Middle Aged ; },
abstract = {Admission diagnosis of 100 patients with diverticular disease of the colon indicated that the clinical features of the disease is still relatively unknown. The most important cardinal symptoms are abdominal complaints, irregular stools and/or bleeding from the large intestine. These symptoms occur with about equql frequency in patients with diverticular disease, whether or not there was evidence of inflammatory complications. If there is clinically manifest diverticulum formation of the colon, the term "diverticular disease" seems appropriate, since transition between diverticulosis and diverticulitis is fluid. In addition to bleeding and attacks of diverticulitis, fistulae and gut narrowing with or without ileus are other complications. Mechanical small-intestinal ileus with involvement of the small intestine in the inflammatory diverticulitis mass was a feature of several of the authors' cases. Low-residue diet is contra-indicated because such food probably plays an important part in the aetiology and pathogenesis of diverticular disease.},
}
@article {pmid301108,
year = {1977},
author = {Forde, KA},
title = {Colonoscopy in complicated diverticular disease.},
journal = {Gastrointestinal endoscopy},
volume = {23},
number = {4},
pages = {192-193},
doi = {10.1016/s0016-5107(77)73648-x},
pmid = {301108},
issn = {0016-5107},
mesh = {Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis ; Endoscopy ; Gastrointestinal Hemorrhage/diagnosis ; Humans ; },
}
@article {pmid404702,
year = {1977},
author = {Stalder, GA},
title = {[Clinical findings and conservative therapy in diverticular disease of the colon].},
journal = {Schweizerische medizinische Wochenschrift},
volume = {107},
number = {15},
pages = {493-498},
pmid = {404702},
issn = {0036-7672},
mesh = {Acute Disease ; Chronic Disease ; Diagnosis, Differential ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/diagnosis/therapy ; Diverticulum/*diagnosis/therapy ; Humans ; },
abstract = {Diverticular disease of the colon can be divided into 1) a prediverticular state similar to spastic colon syndrome, 2) colon diverticulosis without symptoms, 3) chronic symptomatic diverticular disease with pain and stool irregularities and possible attacks with acute colicky pain and 4) acute diverticular disease with possible obstruction, fistula, and perforation and also bleeding. A diet rich in plant fibers is indicated in spastic colon syndrome, chronic diverticular disease and in patients after attacks of acute diverticular disease. A conservative and waiting policy is also indicated in acute diverticulitis and in bleeding.},
}
@article {pmid300897,
year = {1977},
author = {Kümmerle, F and Brückner, R},
title = {[Surgical therapy in diverticular disease of the large bowel].},
journal = {Schweizerische medizinische Wochenschrift},
volume = {107},
number = {15},
pages = {498-505},
pmid = {300897},
issn = {0036-7672},
mesh = {Chronic Disease ; Colectomy ; Colon/*surgery ; Colonic Neoplasms/diagnosis ; Colostomy ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/diagnosis/*surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Male ; Postoperative Complications ; },
abstract = {Operative proceeding, postoperative complications and postoperative mortality in 97 selective and 44 emergency operations for different states in diverticular disease are reported. In states of uncomplicated, chronically recurrent inflammation, one-stage resection is indicated. General condition of the patient and severe complicated diverticulitis may require two- or three-stage therapy. Our experience of 141 operations prompts us to propose early resection in states of chronically recurrent inflammation.},
}
@article {pmid843136,
year = {1977},
author = {Walker, JD and Gray, LA and Polk, HC},
title = {Diverticulitis in women: an unappreciated clinical presentation.},
journal = {Annals of surgery},
volume = {185},
number = {4},
pages = {402-405},
pmid = {843136},
issn = {0003-4932},
mesh = {Adult ; Aged ; Diagnosis, Differential ; Diverticulitis, Colonic/*diagnosis/epidemiology/surgery ; Diverticulum, Colon/diagnosis/surgery ; Female ; Genital Diseases, Female/diagnosis ; Humans ; Kentucky ; Middle Aged ; },
abstract = {A final diagnosis of diverticulosis or diverticulitis was made in 1,031 women over a 10 year period. The 69 patients who underwent abdominal operation for what proved to be diverticulitis are discussed in detail. Thirty-eight per cent of these women were believed to have gynecologic disease because of the presence of a pelvic mass. Diverticulitis is an important differential diagnosis of a pelvic mass with or without clinical and laboratory indications of infection and with or without history of diverticulosis or diverticulitis. The increasing awareness of ovarian carcinoma and its ominous prognosis make this differential diagnosis especially important. Diverticular disease should always be considered among such patients and preparations made to allow optimal treatment at that operation, whatever the ultimate cause of the mass.},
}
@article {pmid66471,
year = {1977},
author = {Brodribb, AJ},
title = {Treatment of symptomatic diverticular disease with a high-fibre diet.},
journal = {Lancet (London, England)},
volume = {1},
number = {8013},
pages = {664-666},
doi = {10.1016/s0140-6736(77)92112-2},
pmid = {66471},
issn = {0140-6736},
mesh = {Aged ; Cellulose/*administration & dosage ; Clinical Trials as Topic ; Dietary Fiber/*administration & dosage/therapeutic use ; Diverticulitis, Colonic/*diet therapy ; Evaluation Studies as Topic ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Time Factors ; Triticum ; },
abstract = {The therapeutic value of increasing the daily dietary fibre intake was assessed over 3 months in a double-blind controlled trial of 18 patients. Significantly greater symptomatic relief was obtained by those on a high fibre regimen than by those in the control group, despite a marked initial placebo effect. The effectiveness of a high-fibre diet increased over the 3-month period.},
}
@article {pmid846950,
year = {1977},
author = {Filippine, L},
title = {[Diverticular disease of the sigmoid colon (author transl)].},
journal = {Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis},
volume = {66},
number = {10},
pages = {295-302},
pmid = {846950},
issn = {1013-2058},
mesh = {*Colon, Sigmoid/diagnostic imaging ; *Diverticulum, Colon/diagnostic imaging ; Humans ; Radiography ; },
}
@article {pmid849845,
year = {1977},
author = {Zer, M and Dintsman, M},
title = {[Diverticular disease of the colon--a new therapeutic approach].},
journal = {Harefuah},
volume = {92},
number = {4},
pages = {185-186},
pmid = {849845},
issn = {0017-7768},
mesh = {Diverticulum, Colon/*therapy ; Humans ; },
}
@article {pmid834146,
year = {1977},
author = {Baird, IM and Walters, RL and Davies, PS and Hill, MJ and Drasar, BS and Southgate, DA},
title = {The effects of two dietary fiber supplements on gastrointestinal transit, stool weight and frequency, and bacterial flora, and fecal bile acids in normal subjects.},
journal = {Metabolism: clinical and experimental},
volume = {26},
number = {2},
pages = {117-128},
doi = {10.1016/0026-0495(77)90047-6},
pmid = {834146},
issn = {0026-0495},
mesh = {Adult ; Aged ; Bile Acids and Salts/metabolism ; Cellulose/*metabolism ; Cholesterol/blood ; Dietary Fiber/*metabolism ; Feces/*analysis/microbiology ; Female ; Humans ; Lipids/blood ; Male ; Middle Aged ; Steroids/metabolism ; },
abstract = {The effect of dietary supplements of sugar-cane fiber (bagasse), on stool weight, solids, and water content were studied in normal ambulant volunteers over a 9-mo period; a second inpatient study was done with bran supplements. The addition on 10.5 g of bagasse containing 5.1 g of crude fiber to a normal diet containing 3.7 g of crude dietary fiber daily raised the mean fecal weight from 88.3 +/- 6.4 g to 139.7 +/- 10.2 g/day (p less than 0.005). There was also a significant rise in fecal solids and fecal water, although the percentage of water in the stools remained unchanged. Bagasse supplements accelerated gastrointestinal transit when measured by the carmine marker technique. Radiopaque "shapes" showed a trend toward more rapid transit with bagasse supplements. Daily supplements of 39 g of wheat bran or 10.5 g of bagasse increased the total daily excretion of fecal bacteria, but there were no changes in bacteria excreted per gram of feces. The composition of the bacterial flora showed no change. There was increased excretion of fecal acid sterols on the bagasse supplement, but this failed to occur with bran. No changes attributable to fiber supplements occurred in the plasma triglycerides or cholesterol. Future work may define specific dietary fiber supplements for different therapeutic purposes. One fiber may be used as a bulk expander in diverticular disease and another as a hypocholesteremic fiber.},
}
@article {pmid830571,
year = {1977},
author = {Segal, I and Solomon, A and Hunt, JA},
title = {Emergence of diverticular disease in the urban South African black.},
journal = {Gastroenterology},
volume = {72},
number = {2},
pages = {215-219},
pmid = {830571},
issn = {0016-5085},
mesh = {Adult ; *Black or African American ; Aged ; Black People ; Dietary Fiber ; Diverticulum, Colon/diagnosis/*epidemiology/etiology ; Female ; Humans ; Male ; Middle Aged ; South Africa ; Urban Population ; },
abstract = {A low residue, fiber-deficient diet has been postulated as the cause of diverticular disease--the commonest affliction of the colon in the Western nations. This condition is virtually unknown in Africans (blacks) who live south of the Sahara, and who have not changed their traditional high residue diet. This paper presents 16 Africans with diverticular disease. A disturbing feature is that 5 of the patients are young, being in their fourth decade, and only 4 are over the age of 60. Their dietary history confirms the hypothesis as to the etiology, and also shows that the urbanization of the South African black has been accompanied by the emergence of diverticular disease, a condition higherto virtually nonexistent in this population.},
}
@article {pmid324270,
year = {1977},
author = {Hodgson, WJ},
title = {The placebo effect. Is it important in diverticular disease?.},
journal = {The American journal of gastroenterology},
volume = {67},
number = {2},
pages = {157-162},
pmid = {324270},
issn = {0002-9270},
mesh = {Aged ; Clinical Trials as Topic ; Diverticulum, Colon/*drug therapy ; Drug Evaluation ; Female ; Humans ; Male ; Methylcellulose/administration & dosage/*therapeutic use ; Middle Aged ; *Placebos ; Tablets ; },
abstract = {Thirty patients with diverticular disease confirmed by barium enema examination were entered into a three-month double-blind trial of two tablets of methylcellulose (Celevac) daily or two placebo tablets daily. As these tablets were indistinguishable it was possible to cross over nine of the patients and follow them for a further three-month period. The placebo effect was sufficient for 11 patients who completed the trial on placebo to show a small mean improvement. A greater mean clinical improvement was shown, however, by the 16 patients who completed the trial on methylcellulose and in those who were crossed over, most of the improvement occurred during the time the patients were on methylcellulose.},
}
@article {pmid866996,
year = {1977},
author = {Kirwan, WO and Smith, AN},
title = {Colonic propulsion in diverticular disease, idiopathic constipation, and the irritable colon syndrome.},
journal = {Scandinavian journal of gastroenterology},
volume = {12},
number = {3},
pages = {331-335},
doi = {10.3109/00365527709180936},
pmid = {866996},
issn = {0036-5521},
mesh = {Colon/*physiopathology ; Colonic Diseases, Functional/*physiopathology ; Constipation/*physiopathology ; Diverticulum, Colon/*physiopathology ; *Gastrointestinal Motility ; Humans ; Pressure ; },
abstract = {Colonic intraluminal pressure and intestinal transit were examined in diverticular disease, idiopathic constipation, and the irritable colon syndrome. Small bowel transit was normal. Total gastrointestinal transit was prolonged. Colonic transit showed an equal delay in all segments, expedited by bran. In constipation, transit was the more prolonged, but in the irritable colon syndrome, pressure was more affected. Diverticular disease patients showed features resembling each of these two groups. Pressure and transit showed an inverse relationship maintained after bran.},
}
@article {pmid851108,
year = {1977},
author = {Simonowitz, D and Paloyan, D},
title = {Diverticular disease of the colon in patients under 40 years of age.},
journal = {The American journal of gastroenterology},
volume = {67},
number = {1},
pages = {69-72},
pmid = {851108},
issn = {0002-9270},
mesh = {Adolescent ; Adult ; Colon/*surgery ; Diverticulum, Colon/diagnosis/epidemiology/*surgery ; Female ; Humans ; Illinois ; Male ; },
}
@article {pmid842390,
year = {1977},
author = {Connell, AM},
title = {Pathogenesis of diverticular disease of the colon.},
journal = {Advances in internal medicine},
volume = {22},
number = {},
pages = {377-395},
pmid = {842390},
issn = {0065-2822},
mesh = {Colitis/etiology ; Colonic Diseases/complications ; Diet ; Diet Therapy ; Diverticulum, Colon/congenital/*etiology/prevention & control ; Gastrointestinal Motility ; Humans ; Muscle Contraction ; Muscular Diseases/complications ; Pressure ; },
}
@article {pmid835782,
year = {1977},
author = {Eng, K and Ranson, JH and Localio, SA},
title = {Resection of the perforated segment. A significant advance in treatment of diverticulitis with free perforation or abscess.},
journal = {American journal of surgery},
volume = {133},
number = {1},
pages = {67-72},
doi = {10.1016/0002-9610(77)90195-7},
pmid = {835782},
issn = {0002-9610},
mesh = {Abscess/etiology/*surgery ; Adult ; Aged ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intestinal Perforation/etiology/*surgery ; Male ; Methods ; Middle Aged ; },
abstract = {As a result of improved medical management of chronic diverticular disease, perforation has become the most common indication for surgical intervention. During the past five years sixty-three patients underwent operation for colonic diverticular disease, of which forty-six were for perforation (generalized peritonitis in 8, abscess in 30, and fistula in 8). The eight patients with generalized peritonitis underwent emergency exploration for spreading peritoneal signs and were managed by resection of the perforated segment, end colostomy, and mucous fistula or Hartmann's pouch. Treatment of thirty-eight patients with abscess or fistula has also stressed primary resection of the perforated segment of colon. Resection and end colostomy without anastomosis was performed in three. Primary anastomosis with proximal diverting colostomy was performed in four. Primary anastomosis alone was done in thirty-one patients. There were no deaths. These results support primary resection of the involved colon with immediate or delayed anastomosis in the operative management of perforated diverticular disease.},
}
@article {pmid832999,
year = {1977},
author = {Smith, AN},
title = {Fibre, intra-colonic pressure and diverticular disease.},
journal = {Health bulletin},
volume = {35},
number = {1},
pages = {49-54},
pmid = {832999},
issn = {0374-8014},
mesh = {Adult ; Aged ; *Cellulose ; Colon/*physiopathology ; *Dietary Fiber ; *Diverticulum, Colon/physiopathology/surgery ; Humans ; Middle Aged ; Pressure ; },
}
@article {pmid832556,
year = {1977},
author = {Kettlewell, MG and Moloney, GE},
title = {Combined horizontal and longitudinal colomyotomy for diverticular disease: preliminary report.},
journal = {Diseases of the colon and rectum},
volume = {20},
number = {1},
pages = {24-28},
doi = {10.1007/BF02587447},
pmid = {832556},
issn = {0012-3706},
mesh = {Adult ; Aged ; Colon/*surgery ; Diverticulum, Colon/*surgery ; Female ; Humans ; Male ; Methods ; Middle Aged ; },
abstract = {The operation of horizontal and longitudinal colomyotomy for diverticular disease is described and satisfactory short-term results in six patients are presented. The indications and reasons for the use of this procedure are discussed. It is suggested that the operation is a satisfactory treatment, without the risks associated with division of all the circular muscle fibers, or with resection and anastomosis. The necessity for long-term high dietary fiber intake is stressed.},
}
@article {pmid831294,
year = {1977},
author = {Sweatman, CA and Aldrete, JS},
title = {The surgical management of diverticular disease of the colon complicated by perforation.},
journal = {Surgery, gynecology & obstetrics},
volume = {144},
number = {1},
pages = {47-50},
pmid = {831294},
issn = {0039-6087},
mesh = {Adult ; Aged ; Colonic Diseases/complications/pathology ; Diverticulitis, Colonic/complications/*surgery ; Female ; Humans ; Intestinal Perforation/*complications/pathology ; Male ; Middle Aged ; },
abstract = {Thirty instances of perforating diverticulitis seen at the University of Alabama Hospital were retrospectively reviewed. The correct diagnosis was assumed prior to operation in only 12. A palpable mass located in the lower part of the abdomen was found in 15 patients. All of the patients had a pericolic type of perforation. Seven patients, five with symptoms highly suggestive of a diverticular disease of the colon, were operated upon for suspected gynecologic problems. It appears that the patients in this group could have been treated more appropriately if the diagnosis of a perforating diverticulitis had been considered preoperatively. It is important to determine whether or not the perforation is pericolic, intramesenteric or free, with spreading peritonitis, since the advocated treatment is different for each type of perforation observed.},
}
@article {pmid1006494,
year = {1976},
author = {Burkitt, DP and Walker, AR},
title = {Saint's triad: confirmation and explanation.},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
volume = {50},
number = {54},
pages = {2136-2138},
pmid = {1006494},
issn = {0256-9574},
mesh = {Adult ; Africa ; Black or African American ; Aged ; Black People ; Cholelithiasis/*epidemiology/etiology ; Dietary Fiber ; Diverticulum, Colon/*epidemiology/etiology ; Ethnicity ; Female ; Hernia, Diaphragmatic/*epidemiology ; Hernia, Hiatal/*epidemiology/etiology ; Humans ; Middle Aged ; Syndrome ; United Kingdom ; United States ; },
abstract = {A quarter of a century ago Professor C. F. M. Saint of the University of Cape Town noted the occasional association of diverticular disease, hiatus hernia, and gallstones in a patient. The occurrences of these diseases, and the significance of their associations, are discussed. The suggestion is made that the diseases are casually related to the consumption of fibre-depleted diets.},
}
@article {pmid1018650,
year = {1976},
author = {Goulston, E},
title = {Diverticular disease of the colon and megacolon. Incidence in a psychiatric centre compared with a teaching hospital.},
journal = {The Medical journal of Australia},
volume = {2},
number = {23},
pages = {863-864},
pmid = {1018650},
issn = {0025-729X},
mesh = {Aged ; Australia ; Diverticulum, Colon/*epidemiology/surgery ; Hospitalization ; *Hospitals, Psychiatric ; *Hospitals, Teaching ; Humans ; Megacolon/*epidemiology ; Middle Aged ; },
abstract = {A five-year survey of hospital admissions at a modern mental hospital reveals a rarity in the incidence of diverticular disease of the colon and its complications and a greatly increased frequency of idiopathic megacolon and its complications compared with patients admitted to a general hospital.},
}
@article {pmid1087015,
year = {1976},
author = {Stein, GN},
title = {Radiology of colonic diverticular disease.},
journal = {Postgraduate medicine},
volume = {60},
number = {6},
pages = {95-102},
doi = {10.1080/00325481.1976.11708408},
pmid = {1087015},
issn = {0032-5481},
mesh = {Abscess/diagnostic imaging ; Barium Sulfate ; Colitis, Ulcerative/diagnostic imaging ; Colonic Diseases/diagnostic imaging ; Colonic Neoplasms/diagnostic imaging ; Diagnosis, Differential ; Diverticulum, Colon/complications/*diagnostic imaging ; Gastrointestinal Hemorrhage/diagnostic imaging/etiology ; Humans ; Intestinal Obstruction/diagnostic imaging ; Intestinal Perforation/diagnostic imaging ; Radiography ; },
abstract = {Nonsurgical diagnosis of colonic diverticulosis and most complications of diverticular disease is best established by barium enema study. Multiple diverticula can produce narrowing and shortening of the colon that is unrelated to any complication occurring in the diverticula. The diagnosis of diverticulitis is made radiologically be demonstrating the effects on the lumen of the bowel of the pathologic changes visible on gross inspection, eg, local abscess, intramural dissection, fistula, obstruction. Frequently the radiologic findings are subtle.},
}
@article {pmid1029529,
year = {1976},
author = {Donati, A and Fusto, A and Morici, V and Ubrano, V and Biondi, M},
title = {[Emergency surgical treatment of diverticular disease of the colon (personal cases and review)].},
journal = {Chirurgia italiana},
volume = {28},
number = {6},
pages = {769-789},
pmid = {1029529},
issn = {0009-4773},
mesh = {Diverticulitis, Colonic/etiology ; Diverticulum, Colon/complications/*surgery ; Intestinal Obstruction/etiology ; Melena/etiology ; Methods ; Peritonitis/etiology ; Postoperative Complications ; },
abstract = {After a critical review of the indications, techniques and results recorded in literature, there is a description of experiences in emergency surgical treatment of 24 cases of diverticulum disease of the colon. In the light of personal results and in agreement with the majority of cases reported in literature, the conviction is expressed that in this surgery the processes graduated in stages (Mickulicz, Hartman, colostomy on transverse - resection) may frequently be indicated, especially in serious and weak patients.},
}
@article {pmid995781,
year = {1976},
author = {Roth, JL},
title = {Colonic diverticular disease. Introduction.},
journal = {Postgraduate medicine},
volume = {60},
number = {6},
pages = {75},
doi = {10.1080/00325481.1976.11708405},
pmid = {995781},
issn = {0032-5481},
mesh = {Aged ; *Diverticulum, Colon ; Humans ; Middle Aged ; },
}
@article {pmid826153,
year = {1976},
author = {Goy, JA and Eastwood, MA and Mitchell, WD and Pritchard, JL and Smith, AN},
title = {Fecal characteristics contrasted in the irritable bowel syndrome and diverticular disease.},
journal = {The American journal of clinical nutrition},
volume = {29},
number = {12},
pages = {1480-1484},
doi = {10.1093/ajcn/29.12.1480},
pmid = {826153},
issn = {0002-9165},
mesh = {Adult ; Age Factors ; Aged ; Bile Acids and Salts ; Calcium/analysis ; *Colonic Diseases, Functional/metabolism ; *Diarrhea/metabolism ; *Diverticulum/metabolism ; *Feces/analysis ; Female ; Humans ; Magnesium/analysis ; Male ; Middle Aged ; Potassium/analysis ; Sodium/analysis ; },
abstract = {A comparison has been made of the fecal characteristics in controls and patients with the irritable bowel syndrome and diverticular disease. No detectable difference was found in the fecal wet weight, dry weight, or total bile acid excretion in the four groups. A significant increase in the percentage of the water content of the stool was seen in the idiopathic diarrhea group with irritable bowel syndrome. Significantly less magnesium, potassium, and calcium was found in the stools of patients with diverticular disease and a similar trend was noted in patients with the spastic colon. These changes did not relate to the age of the patients. This suggests a common etiology for these disorders. The presence of increased water and primary bile acids in the feces of patients with idiopathic diarrhea suggests that this is a separate entity.},
}
@article {pmid826152,
year = {1976},
author = {Bone, E and Tamm, A and Hill, M},
title = {The production of urinary phenols by gut bacteria and their possible role in the causation of large bowel cancer.},
journal = {The American journal of clinical nutrition},
volume = {29},
number = {12},
pages = {1448-1454},
doi = {10.1093/ajcn/29.12.1448},
pmid = {826152},
issn = {0002-9165},
mesh = {Adult ; Bacteria/*metabolism ; Colostomy ; Cresols/biosynthesis/urine ; Diverticulum/metabolism/microbiology ; Female ; Humans ; Ileostomy ; Intestinal Neoplasms/*etiology ; Intestinal Polyps/genetics/metabolism ; *Intestine, Large ; Intestines/*microbiology ; Male ; Megacolon/metabolism ; Phenols/*biosynthesis/urine ; Species Specificity ; },
abstract = {Epidemiological evidence is presented to relate the amount of dietary meat to the risk of large bowel cancer; it has been suggested that this may be due to the production of cocarcinogenic volatile phenols by intestinal bacteria from tyrosine. This paper describes preliminary experiments to test this suggestion. In vitro, aerobic bacteria tended to produce phenol from tyrosine while anaerobic bacteria produced p-cresol. Urine from 10 normal healthy persons contained a mean of 9.8 mg phenol/day and 51.8 mg p-cresol/day. Results from studies on patients with ileostomy, colostomy, and diverticular disease indicated that p-cresol is largely produced by the anaerobic flora of the left colon while phenol was produced in the ileum (when colonized) and cecum. In patients with familial polyposis the activity of the aerobic flora was apparently normal but there was greatly reduced amounts of p-cresol produced. The amounts of urinary volatile phenols in six patients with newly diagnosed large bowel cancer were not different from the normal values, indicating that cocarcinogenic phenols were unlikely to be a major cause of the disease.},
}
@article {pmid826151,
year = {1976},
author = {Connell, AM},
title = {Natural fiber and bowel dysfunction.},
journal = {The American journal of clinical nutrition},
volume = {29},
number = {12},
pages = {1427-1431},
doi = {10.1093/ajcn/29.12.1427},
pmid = {826151},
issn = {0002-9165},
mesh = {*Cellulose/pharmacology/therapeutic use ; Colon/physiology ; Colonic Diseases, Functional/therapy ; *Dietary Fiber/therapeutic use ; Diverticulum/therapy ; *Feces ; Gastrointestinal Motility ; Intestines/drug effects/*physiology/physiopathology ; Pressure ; },
abstract = {This paper reviews the current status of knowledge with relation to the effects of natural fiber on intestinal physiology. The one clear feature that emerges from literature is that most types of natural fiber increase the bulk of the stool. It is probable also that transit time is affected. Transit time appears to be decreased in persons with initially a slow time when they use certain forms of natural fiber and it may be that persons with rapid transit have a decrease in the rate of passage as fiber is added to the diet. Data on colonic intraluminal pressures are scanty, but those that exist seem to indicate that the addition of bran to the diet results in a decrease in overall colonic pressures. Much has been written and speculated about the role of natural fiber in the prevention or therapy of irritable colon and diverticular disease. Clinical studies, while enthusiastic, are preliminary and there are no hard data to indicate that the use of these materials are, in fact, helpful. Such clinical trials that have been published are, in general, small, poorly controlled and overall equivocal in their conclusions. A great deal of further work requires to be done to justify the claims that have been made on the role of fiber in altering normal or abnormal bowel habit.},
}
@article {pmid792842,
year = {1976},
author = {Sethbhakdi, S},
title = {Pathogenesis of colonic diverticulitis and diverticulosis.},
journal = {Postgraduate medicine},
volume = {60},
number = {6},
pages = {76-81},
doi = {10.1080/00325481.1976.11708406},
pmid = {792842},
issn = {0032-5481},
mesh = {Civilization ; Colon, Sigmoid/pathology/physiopathology ; Colonic Diseases, Functional/etiology ; Diet/adverse effects ; Diverticulitis, Colonic/*etiology/pathology/physiopathology ; Diverticulum, Colon/*etiology/pathology/physiopathology ; Emotions ; Humans ; Muscle, Smooth/physiopathology ; Pressure ; },
abstract = {Colonic diverticula result from herniation of the mucosa through weak spots in the muscular wall. Clinically manifested diverticulitis has been thought to have its pathologic basis in an abscessed diverticulum obstructed by a fecalith, but studies of resected sigmoids have failed to produce evidence to support this view. Instead, the outstanding lesion was found to be a perforation in the fundus of a diverticulum, with surrounding peridiverticular or pericolic inflammation. Another surprising finding in pathologic studies was that one out of three sigmoids resected for "diverticulitis" showed no inflammation in or around the diverticula, but the wall of the sigmoid was impressively thickened. This type of diverticulosis, which is frequently symptomatic, has been referred to as painful diverticular disease or spastic colon diverticulosis. Diverticula without muscle thickening are usually asymptomatic, and the condition is referred to as diverticulosis or simple massed diverticulosis. It is uncertain whether the two types have a similar pathogenesis. High intrasigmoid pressures, abnormalities of sigmoid musculature, low-fiber diet, and psychologic stress are thought to be important factors in the formation of diverticula.},
}
@article {pmid792840,
year = {1976},
author = {Herrera, AF},
title = {Medical therapy of colonic diverticular disease.},
journal = {Postgraduate medicine},
volume = {60},
number = {6},
pages = {107-109},
doi = {10.1080/00325481.1976.11708409},
pmid = {792840},
issn = {0032-5481},
mesh = {Acute Disease ; Clinical Trials as Topic ; Constipation/etiology/prevention & control ; Dietary Fiber/therapeutic use ; Diverticulitis, Colonic/complications/drug therapy/therapy ; Diverticulum, Colon/*diet therapy/drug therapy ; Humans ; Parasympatholytics/therapeutic use ; Sepsis/etiology ; },
abstract = {Treatment of asymptomatic diverticulosis is geared to the prevention of constipation, with vigilance for possible signs of complications. A bulky stool decreases colonic intraluminal pressures, probably lessening pain and the chance of development of new diverticula. Increased stool weight may be achieved by the addition of vegetables, fruits, and cereals (bran) to the diet. Foods with undigestible residues should be avoided. When dietary manipulations are not well tolerated, hydrophilic bulk laxatives are a useful alternative. Treatment of acute attacks consists of bowel rest and administration of intravenous fluids and antibiotics. Side effects of anticholinergics may outweigh their questionable usefulness. Nonabsorable oral sulfonamides have little or no place in the treatment of the acute attack (peridiverticulitis).},
}
@article {pmid1086943,
year = {1976},
author = {Heuck, F},
title = {[X-ray findings in diverticulitis (author's transl)].},
journal = {Langenbecks Archiv fur Chirurgie},
volume = {342},
number = {},
pages = {421-430},
pmid = {1086943},
issn = {0023-8236},
mesh = {Adult ; Diagnosis, Differential ; Diverticulitis/complications/*diagnostic imaging ; Duodenal Diseases/etiology ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Motility ; Humans ; Male ; Radiography ; },
abstract = {The frequency of congenital and acquired diverticula is discussed with reference to geographical aspects, their location and the function of the colon in diverticular disease. The X-ray findings in the presence of complications are demonstrated. Radiological differential diagnosis is discussed with special reference to cinematographic analysis of function. The possiblity of the simultaneous appearance of polyposis and carcinoma in diverticular diseases is indicated. A sensitive radiologic diagnostic procedure is important for planning of the optimal treatment.},
}
@article {pmid994660,
year = {1976},
author = {Strohmeyer, G},
title = {[Internal aspects of diverticulosis (author's transl)].},
journal = {Langenbecks Archiv fur Chirurgie},
volume = {342},
number = {},
pages = {413-420},
pmid = {994660},
issn = {0023-8236},
mesh = {Colitis, Ulcerative/physiopathology ; Diverticulitis, Colonic/diet therapy/*physiopathology ; Diverticulum, Colon/diet therapy/*physiopathology ; Environment ; Feeding Behavior ; Humans ; Nutritional Requirements ; },
abstract = {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.},
}
@article {pmid825692,
year = {1976},
author = {Schellerer, W},
title = {[The outcome of conservative treatment of diverticular disease (author's transl)].},
journal = {Langenbecks Archiv fur Chirurgie},
volume = {342},
number = {},
pages = {449-452},
doi = {10.1007/BF01267408},
pmid = {825692},
issn = {0023-8236},
mesh = {Acute Disease ; Diverticulitis/diagnosis/*therapy ; Diverticulum/therapy ; Follow-Up Studies ; Humans ; Pain ; Postoperative Complications/diagnosis ; },
abstract = {Patients with diverticular disease should be categorized for therapeutic purposes into 3 groups: (1) asymptomatic diverticulosis (accidental finding; (2) painful diverticular disease (no inflammation); and (3) acute diverticulitis (pericolitis present). In asymptomatic diverticulosis a high-fiber diet should be given, and an operation is not indicated. In painful diverticular disease resection of the sigmoid colon should be considered after recurrent attacks. In acute diverticulitis resection should be performed after the second inflammatory attack. The younger the patient, the earlier an operation should be considered.},
}
@article {pmid1009306,
year = {1976},
author = {Berridge, FR and Dick, AP},
title = {Effect of Crohn's disease on colonic diverticula.},
journal = {The British journal of radiology},
volume = {49},
number = {587},
pages = {926-929},
doi = {10.1259/0007-1285-49-587-926},
pmid = {1009306},
issn = {0007-1285},
mesh = {Aged ; Crohn Disease/*complications/diagnostic imaging ; Diverticulum, Colon/*complications/diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Radiography ; },
abstract = {Fifteen cases in which the same part of the colon has been affected by both diverticular disease and Crohn's disease have been studied. When Crohn's disease affects an area of colon where diverticula are present, radiological examination may show a diminution in number or disappearance of the diverticula with progress of the Crohn's disease. With improvement in the Crohn's disease diverticula may appear.},
}
@article {pmid1008052,
year = {1976},
author = {Harris, AI and Marshak, RH},
title = {The radiology corner: Longitudinal fistulous tract of the colon and a perianal fistula in diverticulitis.},
journal = {The American journal of gastroenterology},
volume = {66},
number = {5},
pages = {487-491},
pmid = {1008052},
issn = {0002-9270},
mesh = {Aged ; Colon, Sigmoid ; Colonic Diseases/*diagnostic imaging/etiology ; Crohn Disease/diagnosis ; Diagnosis, Differential ; Diverticulitis, Colonic/complications/diagnosis/*diagnostic imaging ; Female ; Humans ; Intestinal Fistula/*diagnostic imaging/etiology ; Radiography ; Rectal Fistula/*diagnostic imaging/etiology ; },
abstract = {Diverticular disease may mimic many of the symptoms and signs of Crohn's disease. The presence, however, of perirectal involvement and a longitudinal fistula greater than 10 cm. in the wall of the colon are two unusual features of diverticular disease. Discussed herein is a patient who presented with both of these complications.},
}
@article {pmid973657,
year = {1976},
author = {Schuffler, MD and Rohrmann, CA and Templeton, FE},
title = {The radiologic manifestations of idiopathic intestinal pseudoobstruction.},
journal = {AJR. American journal of roentgenology},
volume = {127},
number = {5},
pages = {729-736},
doi = {10.2214/ajr.127.5.729},
pmid = {973657},
issn = {0361-803X},
mesh = {Adolescent ; Adult ; Colon/diagnostic imaging ; Esophagus/diagnostic imaging ; Female ; Gastrointestinal Motility ; Humans ; Intestinal Obstruction/*diagnostic imaging/physiopathology ; Intestine, Small/diagnostic imaging ; Male ; Middle Aged ; Radiography, Abdominal ; Stomach/diagnostic imaging ; },
abstract = {Six patients with idopathic intestinal pseudoobstruction underwent extensive radiographic evaluation of the gastrointestinal tract. Propulsive motor activity was consistently absent. All had smooth muscle dysfunction of the esophagus, small bowel, and colon, and two had abnormal gastric emptying. Two forms of the syndrome were observed, characterized by either hyper- or hypoactive smooth muscle. In the hyperactive form chaotic, spontaneous contractions of the esophagus and small intestine occurred and extensive diverticular disease of the colon was present. In the hypoactive form the esophagus was atonic and there was marked widening and hypomotility of the small intestine and colon. The presence of two forms of smooth muscle dysfunction suggests that the syndrome has a heterogeneous pathology and pathophysiology.},
}
@article {pmid964566,
year = {1976},
author = {Larson, DM and Masters, SS and Spiro, HM},
title = {Medical and surgical therapy in diverticular disease: a comparative study.},
journal = {Gastroenterology},
volume = {71},
number = {5},
pages = {734-737},
pmid = {964566},
issn = {0016-5085},
mesh = {Adult ; Aged ; Colectomy ; Colostomy ; Diverticulitis, Colonic/diet therapy/surgery/*therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Recurrence ; },
abstract = {The course of 132 patients with documented acute diverticulitis was analyzed: 99 patients treated medically and 33 patients treated surgically were followed for an average of 9.2 years. Seventy-three per cent of the medical group and 79% of the surgical group had no further symptoms or hospital admissions as a result of their diverticular disease once they were recovered from the acute episode. For three-quarters of the patients, therefore, acute diverticulitis occurred as a single episode that responded to either medical or surgical management. Considering the morbidity and cost to the patient, the treatment of the patient recovered from acute diverticulitis should be medical, with operation reserved for complications.},
}
@article {pmid824970,
year = {1976},
author = {Roses, DF and Gouge, TH and Scher, KS and Ranson, JH},
title = {Perforated diverticula of the jejunum and lleum.},
journal = {American journal of surgery},
volume = {132},
number = {5},
pages = {649-652},
doi = {10.1016/0002-9610(76)90364-0},
pmid = {824970},
issn = {0002-9610},
mesh = {Adult ; Aged ; Diverticulum/*complications/diagnosis/etiology ; Female ; Humans ; *Ileum ; Intestinal Perforation/diagnosis/*etiology ; *Jejunum ; Male ; Middle Aged ; },
abstract = {Over a ten year period, four patients with inflammation or perforation of non-Meckelian, small intestinal diverticula were treated on the surgical services of Bellevue Hospital. This entity remains uncommon but may be increasing in incidence. The patients presented with a short history of severe abdominal pain, usually accompanied by nausea and vomiting. Each patient also gave a longer preceding history of less well defined abdominal symptoms. The pathogenesis of the small intestinal diverticula is uncertain but may be related to disturbed muscular peristalsis in the small bowel analogous to the changes implicated in esophageal and colonic diverticular disease. The diverticulum may be difficult to demonstrate at operation, and careful exploration for this possibility should be carried out at the time of operation for peritonitis of obscure origin. Segmental resection and end-to-end anastomosis is the treatment of choice.},
}
@article {pmid790986,
year = {1976},
author = {Juler, GL and Dietrick, WR and Eisenman, JI},
title = {Intramesenteric perforation of sigmoid diverticulitis with nonfatal venous intravasation.},
journal = {American journal of surgery},
volume = {132},
number = {5},
pages = {653-656},
doi = {10.1016/0002-9610(76)90365-2},
pmid = {790986},
issn = {0002-9610},
mesh = {Adult ; Barium Sulfate/*adverse effects ; Diverticulitis, Colonic/*complications ; Enema/*adverse effects ; Escherichia coli Infections ; Humans ; Intestinal Perforation/*etiology ; Male ; Mesenteric Veins/injuries ; Portal Vein/injuries ; },
abstract = {Complications from barium enema are rare (0.035 per cent). A patient with venous intravasation during barium enema complicated by pylephlebitis and portal vein obstruction is the tenth to be reported on, the fourth to survive. This accident was associated with colon disease in eight of the patients studied, five of whom had diverticular disease.},
}
@article {pmid183528,
year = {1976},
author = {Clark, K and Rowan, D},
title = {Electrical stimulation for anal sphincter control in barium enema examinations: an extended trial.},
journal = {AJR. American journal of roentgenology},
volume = {127},
number = {3},
pages = {429-431},
doi = {10.2214/ajr.127.3.429},
pmid = {183528},
issn = {0361-803X},
mesh = {Adolescent ; Adult ; Aged ; Anal Canal/*physiology ; *Barium Sulfate ; Catheterization/instrumentation ; Electric Stimulation ; Humans ; Middle Aged ; Muscle Contraction ; Muscles/*physiology ; },
abstract = {The routine use in 500 consecutive patients of a barium enema cannula incorporating stimulating electrodes is described. Barium retention was improved by the electrically maintained contraction of the anal sphincter. The cannula was connected to a battery-powered control unit which provided the stimulus; pulse width was 1 msec and frequency was 20 pulses/sec. The pulse amplitude, adjusted for each patient, was in the range of 5--17V. A standard procedure was adopted throughout the trial without the use of colonic relaxants (such as anticholinergic drugs). The barium suspension and water were in stilled at body temperature. A comparison with a control series of 200 patients showed a significant reduction in the failure rate from 20% to 4%. No unpleasant side effects were encountered apart from a tingling sensation in the anal region which was expected. The principal factors contributing to failure were fecal impaction and diverticular disease.},
}
@article {pmid953512,
year = {1976},
author = {Smith, AN and Shepherd, J},
title = {Proceedings: The stength of the colon wall in diverticular disease.},
journal = {The British journal of surgery},
volume = {63},
number = {8},
pages = {666},
pmid = {953512},
issn = {0007-1323},
mesh = {Colon/*physiopathology ; Diverticulitis, Colonic/*physiopathology ; Humans ; Muscle, Smooth/physiopathology ; Pressure ; },
}
@article {pmid781315,
year = {1976},
author = {Aguilo, JJ and Zincke, H and Woods, JE and Buckingham, JM},
title = {Intestinal perforation due to fecal impaction after renal transplantation.},
journal = {The Journal of urology},
volume = {116},
number = {2},
pages = {153-155},
doi = {10.1016/s0022-5347(17)58726-1},
pmid = {781315},
issn = {0022-5347},
mesh = {Adult ; Cathartics/therapeutic use ; Colonic Diseases/etiology ; Diverticulum, Colon/diagnosis ; Early Ambulation ; Fecal Impaction/*complications/prevention & control ; Humans ; Immunosuppressive Agents/therapeutic use ; Intestinal Perforation/*etiology ; Jejunum ; *Kidney Transplantation ; Male ; Postoperative Complications/etiology ; Preoperative Care ; Transplantation, Homologous ; },
abstract = {Three renal allograft recipients suffered major intestinal complications shortly after the operation. Identification of diverticular disease, adequate preoperative bowel preparation, avoidance of excessive amounts of non-absorbable antacids, early ambulation, and periodic laxatives and stool softeners can prevent these complications. Surgical management includes careful inspection for additional perforations, resection and colostomy, and continuous peritoneal lavage.},
}
@article {pmid952322,
year = {1976},
author = {Parsa, F and Passaro, E},
title = {Sigmoidovesicocutaneous fistula complicating diverticular disease of the colon.},
journal = {American journal of surgery},
volume = {132},
number = {1},
pages = {105-107},
doi = {10.1016/0002-9610(76)90301-9},
pmid = {952322},
issn = {0002-9610},
mesh = {Aged ; *Colon, Sigmoid ; Colonic Diseases/*complications ; Diabetes Complications ; Diverticulitis, Colonic/*complications ; *Fistula/diagnostic imaging/surgery ; Hernia, Inguinal/surgery ; Humans ; Intestinal Fistula/*complications ; Male ; Radiography ; Skin Diseases/*complications ; Urinary Bladder Fistula/*complications ; },
abstract = {A sixty-six year old diabetic male had a draining sinus tract from the lateral portion of a fourteen year old left herniorrhaphy scar. The diagnosis of sigmoidovesicocutaneous fistula was confirmed by a sinogram and the patient was treated in one stage with left hemicolectomy and resection of the fistula site from the dome of the bladder. To our knowledge this is the first report of a sigmoidovesicocutaneous fistula.},
}
@article {pmid940199,
year = {1976},
author = {Krompier, A and Howard, R and Macewen, A and Natoli, C and Wear, JB},
title = {Vesicocolonic fistulas in diverticulitis.},
journal = {The Journal of urology},
volume = {115},
number = {6},
pages = {664-666},
doi = {10.1016/s0022-5347(17)59328-3},
pmid = {940199},
issn = {0022-5347},
mesh = {Aged ; Barium Sulfate ; Colonic Diseases/diagnosis/*etiology/surgery ; Cystoscopy ; Diverticulitis/*complications ; Female ; Humans ; Intestinal Fistula/diagnosis/*etiology/surgery ; Male ; Middle Aged ; Physical Examination ; Retrospective Studies ; Sex Ratio ; Urinary Bladder Fistula/diagnosis/*etiology/surgery ; },
abstract = {Diverticulitis is a disease affecting patients in the fifth to sixth decades. The charts of 12 patients with cesicocolonic fistulas secondary to diverticulitis were reviewed. Their presentation was primarily urological with pneumaturia present in 10 of 12 patients and fecaluria present in 5 of 12. The process of fistulization occurs in stages. If the incipient stage can be identified early fistulization can be prevented and the morbidity and mortality rates will be reduced significantly. In older patients with bladder irritation (with or without positive urine cultures) a high degree of suspicion for diverticular disease will ensure an accurate diagnosis earlier. Patients with penumaturia or fecaluria present less of a diagnostic challenge. Cystoscopy is a reliable procedure and we recommend its use in discovering a vesicocolonic fistula. Surgical therapy should be individualized for each patient and good results were obtained with primary resection as well as staged repair.},
}
@article {pmid791568,
year = {1976},
author = {Painter, NS},
title = {Wheat bran for diverticular disease of the colon.},
journal = {Comprehensive therapy},
volume = {2},
number = {6},
pages = {51-55},
pmid = {791568},
issn = {0098-8243},
mesh = {Diverticulum, Colon/*diet therapy/epidemiology/history ; History of Medicine ; Humans ; *Triticum ; },
}
@article {pmid817775,
year = {1976},
author = {},
title = {Bran tablets and diverticular disease.},
journal = {British medical journal},
volume = {1},
number = {6021},
pages = {1341},
pmid = {817775},
issn = {0007-1447},
mesh = {Diverticulum/*diet therapy ; Humans ; Parasympatholytics/therapeutic use ; Triticum ; },
}
@article {pmid1277971,
year = {1976},
author = {Griffen, WO},
title = {Management of the acute complications of diverticular disease: acute perforation of colonic diverticula.},
journal = {Diseases of the colon and rectum},
volume = {19},
number = {4},
pages = {293-295},
doi = {10.1007/BF02590923},
pmid = {1277971},
issn = {0012-3706},
mesh = {Acute Disease ; Colectomy ; Colon/*surgery ; Colostomy ; Diverticulitis, Colonic/*complications/surgery ; Drainage ; Female ; Humans ; Intestinal Perforation/diagnosis/etiology/*surgery ; Male ; Peritonitis/complications ; },
}
@article {pmid1277973,
year = {1976},
author = {Veidenheimer, MC and Lawrence, DC},
title = {Anastomotic myotomy: an adjunct to resection for diverticular disease.},
journal = {Diseases of the colon and rectum},
volume = {19},
number = {4},
pages = {310-313},
doi = {10.1007/BF02590926},
pmid = {1277973},
issn = {0012-3706},
mesh = {Adult ; Aged ; Colon/physiopathology/*surgery ; Colonic Diseases/surgery ; Diverticulitis, Colonic/physiopathology/*surgery ; Female ; Gastrointestinal Motility ; Humans ; Male ; Middle Aged ; Muscle, Smooth/physiopathology/*surgery ; Postoperative Complications ; Pressure ; },
}
@article {pmid1277972,
year = {1976},
author = {Condon, RE},
title = {Management of the acute complications of diverticular disease: peritonitis and septicemia.},
journal = {Diseases of the colon and rectum},
volume = {19},
number = {4},
pages = {296-300},
doi = {10.1007/BF02590924},
pmid = {1277972},
issn = {0012-3706},
mesh = {Abdomen/surgery ; Abscess/etiology ; Acute Disease ; Colostomy ; Diverticulitis, Colonic/*complications ; Humans ; Intestinal Perforation/*surgery ; Peritonitis/complications/etiology/*surgery ; Sepsis/etiology ; Therapeutic Irrigation ; },
}
@article {pmid1277970,
year = {1976},
author = {Alexander-Williams, J},
title = {Management of the acute complications of diverticular disease: the dangers of colostomy.},
journal = {Diseases of the colon and rectum},
volume = {19},
number = {4},
pages = {289-292},
doi = {10.1007/BF02590922},
pmid = {1277970},
issn = {0012-3706},
mesh = {Adult ; Aged ; Colon/surgery ; Colostomy/*methods/mortality ; Diverticulitis, Colonic/complications/epidemiology/*surgery ; England ; Female ; Humans ; Intestinal Perforation/complications/*surgery ; Male ; Middle Aged ; Peritonitis/complications/diagnosis ; },
}
@article {pmid1084260,
year = {1976},
author = {},
title = {Management of the acute complications of diverticular disease: discussion.},
journal = {Diseases of the colon and rectum},
volume = {19},
number = {4},
pages = {301-309},
doi = {10.1007/BF02590925},
pmid = {1084260},
issn = {0012-3706},
mesh = {Acute Disease ; Angiography ; Barium Sulfate/adverse effects ; Colon/diagnostic imaging/*surgery ; Diet Therapy ; Diverticulitis, Colonic/*complications/surgery ; Gastrointestinal Hemorrhage/*surgery ; Humans ; Therapeutic Irrigation ; },
}
@article {pmid1084259,
year = {1976},
author = {Blaisdell, FW},
title = {Management of the acute complications of diverticular disease: hemorrhage.},
journal = {Diseases of the colon and rectum},
volume = {19},
number = {4},
pages = {287-288},
doi = {10.1007/BF02590921},
pmid = {1084259},
issn = {0012-3706},
mesh = {Aged ; Angiography ; Barium Sulfate ; Colectomy ; Diverticulum, Colon/*complications/surgery ; Gastrointestinal Hemorrhage/*diagnosis/etiology/surgery ; Humans ; Sigmoidoscopy ; },
}
@article {pmid1067069,
year = {1976},
author = {Barnett, JE and Endrey-Walder, P and Pheils, MT},
title = {Closure of colostomy.},
journal = {The Australian and New Zealand journal of surgery},
volume = {46},
number = {2},
pages = {131-133},
doi = {10.1111/j.1445-2197.1976.tb03215.x},
pmid = {1067069},
issn = {0004-8682},
mesh = {Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Colon/*surgery ; Colonic Neoplasms/surgery ; *Colostomy ; Diverticulum, Colon/surgery ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Preoperative Care ; Surgical Wound Infection/prevention & control ; },
abstract = {A retrospective review of 110 patients who had their colostomies closed during the period from 1963 to 1973 has been undertaken. Their average age was 64 years. Diverticular disease and colorectal cancer had been the most frequent indications for the colostomy. Wound infection occurred in 36.4% and faecal fistula in 7.3%. These complications occurred less frequently in patients who had antibiotic bowel preparation. The overall mortality rate was 4.5%. Measures to reduce the morbidity and mortality are discussed.},
}
@article {pmid773493,
year = {1976},
author = {Taylor, I and Duthie, HL},
title = {Bran tablets and diverticular disease.},
journal = {British medical journal},
volume = {1},
number = {6016},
pages = {988-990},
pmid = {773493},
issn = {0007-1447},
mesh = {Clinical Trials as Topic ; Colon ; Diverticulitis, Colonic/*diet therapy/physiopathology ; *Edible Grain ; Feces ; Gastrointestinal Motility ; Humans ; Muscle, Smooth/physiopathology ; Parasympatholytics/therapeutic use ; Pressure ; Tablets ; Time Factors ; },
abstract = {Three treatments for patients with symptomatic diverticular disease were compared in a crossover trial. Neither a high-roughage diet (HRD) nor Normacol plus an antispasmodic were as effective as bran tablets, which produced a significant increase in daily stool weight and a decrease in the intestinal transit time. An abnormal rapid electrical rhythm in colonic smooth muscle was found initially in 80% of the patients, but the incidence was reduced by each treatment after one month; it was present in only 40% of patients after treatment with bran tablets. Only bran significantly reduced a high percentage motility to within normal limits. Bran proved to be the most effective treatment, not only in improving the symptoms in patients with diverticular disease but also in returning to normal the abnormal pathophysiological changes. Bran tablets were both convenient and acceptable as well as effective.},
}
@article {pmid1276664,
year = {1976},
author = {McGinn, FP},
title = {Distal colomyotomy: follow-up of 37 cases.},
journal = {The British journal of surgery},
volume = {63},
number = {4},
pages = {309-312},
doi = {10.1002/bjs.1800630414},
pmid = {1276664},
issn = {0007-1323},
mesh = {Adult ; Aged ; Colon/*surgery ; Colon, Sigmoid/surgery ; Diverticulum, Colon/*surgery ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Middle Aged ; Muscle, Smooth/surgery ; Postoperative Complications ; Recurrence ; },
abstract = {The 3-7-year follow-up results of 37 patients undergoing the operation of distal colomyotomy are reported. Twenty-five underwent surgery for uncomplicated diverticular disease; there was no mortality but 40 per cent of patients had recurrent symptoms. Twelve patients underwent surgery for complicated diverticular disease, with an operative mortality of 16-6 per cent and a recurrent symptom rate of 37-5 per cent.},
}
@article {pmid773166,
year = {1976},
author = {Trowell, H},
title = {Definition of dietary fiber and hypotheses that it is a protective factor in certain diseases.},
journal = {The American journal of clinical nutrition},
volume = {29},
number = {4},
pages = {417-427},
doi = {10.1093/ajcn/29.4.417},
pmid = {773166},
issn = {0002-9165},
mesh = {Adult ; Cellulose/analysis ; Cholelithiasis/prevention & control ; Colonic Diseases/epidemiology/*prevention & control ; Coronary Disease/epidemiology/prevention & control ; Diabetes Mellitus/epidemiology/prevention & control ; Diet ; Dietary Carbohydrates/analysis/therapeutic use ; Female ; Humans ; Lignin/analysis ; Male ; Metabolic Diseases/*prevention & control ; Obesity/epidemiology/prevention & control ; *Polysaccharides/analysis/therapeutic use ; Rural Population ; Urban Population ; },
abstract = {Crude fiber (CF) is the residue of plant food left after extraction by dilute acid followed by dilute alkali. Dietary fiber (DF), a new term, is the residue of plant food resistant to hydrolysis by human alimentary enzymes. DF is composed of cellulose, hemicellulose, and lignin; these constituents are not reported in food tables. For instance, whole wheatmeal has DF about 11%, CF about 2%. It is suggested that a new term, dietary fiber complex (DFC), should include all substances of DF plus all chemical compounds naturally associated with, and concentrated around, these structural polymers. CF supplies from starchy staples, wheat and potato, in England and Wales were probably stationary from 1770 to 1860, fell greatly from 1860 to 1910, rose during food controls in 1942 to 1953, and declined slightly from 1954 to 1970. It is postulated that fiber is a protective factor against certain colonic disorders, such as diverticular disease, and certain metabolic diseases, such as ischemic heart disease, diabetes mellitus, and obesity. These three diseases had changing trends of mortality rates in England during the food control years. Westernization of African diets is accompanied by a large fall in CF from starchy foods and vegetables and an increased prevalence of the same three diseases.},
}
@article {pmid1085003,
year = {1976},
author = {Waye, JD},
title = {Diverticular disease.},
journal = {Primary care},
volume = {3},
number = {1},
pages = {91-105},
pmid = {1085003},
issn = {0095-4543},
mesh = {Adult ; Barium Sulfate ; Colonic Diseases/etiology ; Diverticulitis, Colonic/etiology ; *Diverticulum, Colon/diagnosis/diet therapy/surgery ; Endoscopy ; Enema ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Obstruction/etiology ; Middle Aged ; Sigmoidoscopy ; },
abstract = {Diverticular disease comprises a spectrum of illness beginning with the irritable bowel syndrome and progressing to the life-threatening complications of diverticulitis and hemorrhage. Step-wise progression of this disease may be seen but is not invariably present; many patients with diverticulosis do not have preceding symptoms of the irritable bowel syndrome. The typical complaints of irregularity of bowel habits and abdominal pain will usually respond to the relatively new treatment modality of a high fiber diet with added wheat bran. Barium enema x-ray examination remains the primary diagnostic modality in the investigation of diverticular disease, and colonoscopy should be used only in the presence of certain specific circumstances. Surgery, aimed at the treatment of complications of this disease, has progressed to the point where one-stage extirpation of the diseased bowel is recommended.},
}
@article {pmid1017830,
year = {1976},
author = {Connell, AM},
title = {Dietary fiber and diverticular disease.},
journal = {Hospital practice},
volume = {11},
number = {3},
pages = {119-124},
doi = {10.1080/21548331.1976.11706919},
pmid = {1017830},
issn = {0018-5809},
mesh = {Cellulose/*therapeutic use ; Colon/physiology ; Colonic Neoplasms/etiology ; Developing Countries ; Diet/adverse effects ; Dietary Fiber/*therapeutic use ; Diverticulitis, Colonic/diet therapy/etiology/*prevention & control ; Diverticulum, Colon/diet therapy/etiology/*prevention & control ; Europe ; Gastrointestinal Motility ; Humans ; North America ; },
abstract = {Can the regular consumption of bran and other fibrous foods help in preventing diseases of the colon? Indirect evidence supports the idea, although much remains to be learned. It seems probable that bulkier feces could increase the diameter of the colon and prevent sudden sharp rises in pressure that are believed to be responsible for the formation of diverticula. For most people, fiber is probably harmless and it may do some good.},
}
@article {pmid818130,
year = {1976},
author = {Kealy, WF},
title = {Lymphoid tissue and lymphoid-glandular complexes of the colon: relation to diverticulosis.},
journal = {Journal of clinical pathology},
volume = {29},
number = {3},
pages = {245-249},
pmid = {818130},
issn = {0021-9746},
mesh = {Adult ; Aged ; Autopsy ; Colectomy ; Colon/anatomy & histology/*pathology ; Diverticulum/*pathology ; Female ; Humans ; Lymphoid Tissue/anatomy & histology/pathology ; Male ; Middle Aged ; Peyer's Patches/anatomy & histology/pathology ; },
abstract = {The lymphoid tissue of the normal colon is compared with that of colons with diverticular disease. Colons with diverticular disease show a significant increase in the number of lymphoid nodules in areas not containing diverticula. Lymphoid-glandular complexes of the colon were studied in relation to diverticular disease. It is suggested that the lymphoid nodules and the lymphoid-glandular complexes of the colon constitute weak points in the bowel wall and may play a part in the pathogenesis of diverticula.},
}
@article {pmid815794,
year = {1976},
author = {Bloch, C and Bryk, D},
title = {Diverticular disease of the terminal ileum.},
journal = {The Mount Sinai journal of medicine, New York},
volume = {43},
number = {2},
pages = {122-128},
pmid = {815794},
issn = {0027-2507},
mesh = {Barium Sulfate ; Diverticulitis/diagnostic imaging ; Diverticulum/*diagnostic imaging ; Female ; Humans ; Ileum/*diagnostic imaging ; Methods ; Middle Aged ; Radiography ; },
}
@article {pmid1252775,
year = {1976},
author = {Brodribb, AJ and Humphreys, DM},
title = {Diverticular disease: three studies. Part III - Metabolic effect of bran in patients with diverticular disease.},
journal = {British medical journal},
volume = {1},
number = {6007},
pages = {428-430},
pmid = {1252775},
issn = {0007-1447},
mesh = {Adult ; Aged ; Body Weight ; Diverticulum, Colon/diet therapy/*metabolism ; Feces/analysis ; Female ; Folic Acid/blood ; Glucose Tolerance Test ; Humans ; Indican/urine ; Lipid Metabolism ; Liver Function Tests ; Male ; Middle Aged ; Nitrogen/metabolism ; Time Factors ; *Triticum ; },
abstract = {Patients with diverticular disease were given about 24 g bran daily for at least six months. After treatment the oral glucose tolerance curve fell, faecal fat excretion increased, the serum lipoprotein pattern was altered, urinary calcium excretion was reduced, and the serum folate level fell. These changes were not considered to contraindicate the use of bran in the treatment of diverticular disease.},
}
@article {pmid1252774,
year = {1976},
author = {Brodribb, AJ and Humphreys, DM},
title = {Diverticular disease: three studies. Part I--Relation to other disorders and fibre intake.},
journal = {British medical journal},
volume = {1},
number = {6007},
pages = {424-425},
pmid = {1252774},
issn = {0007-1447},
mesh = {Adult ; Aged ; Cholelithiasis/complications ; Diverticulum, Colon/complications/*etiology ; *Feeding Behavior ; Female ; Food ; Hemorrhoids/complications ; Hernia/complications ; Hernia, Hiatal/complications ; Humans ; Male ; Middle Aged ; Varicose Veins/complications ; },
abstract = {The fibre intake of 40 patients with diverticular disease was compared with that of 80 age- and sex-matched controls. The daily crude-fibre intake of the patients was significantly lower than that of the controls, and the incidence of haemorrhoids, varicose veins, hiatus hernia, gall stones, and abdominal hernias was significantly higher than in the control group. These findings suggest that a fibre-depleted diet may be a causative factor in diverticular disease and several other conditions.},
}
@article {pmid766894,
year = {1976},
author = {Brodribb, AJ and Humphreys, DM},
title = {Diverticular disease: threee studies. Part II - Treatment with bran.},
journal = {British medical journal},
volume = {1},
number = {6007},
pages = {425-428},
pmid = {766894},
issn = {0007-1447},
mesh = {Clinical Trials as Topic ; Defecation ; Diverticulum, Colon/*diet therapy ; Gastrointestinal Motility ; Humans ; Pressure ; Time Factors ; *Triticum ; },
abstract = {Forty patients with diverticular disease were treated with wheat bran 24g/day for at least six months. Thirty-three patients showed a very satisfactory clinical response. Sixty per cent of all symptoms were abolished, and a further 28% were relieved. After treatment the transit times accelerated in patients whose initial times were slower than 60 hours and slowed down in those whose initial transit times were faster than 36 hours. Stool weight increased significantly. The number of intracolonic high pressure waves decreased, especially during and after eating. Barium enema studies showed less spasm in eight patients and no diverticula in three patients after taking bran. As well as relieving the symptoms of diverticular disease a high-fibre diet may also prevent the condition from developing.},
}
@article {pmid55653,
year = {1976},
author = {Grimes, DS},
title = {Refined carbohydrate, smooth-muscle spasm and disease of the colon.},
journal = {Lancet (London, England)},
volume = {1},
number = {7956},
pages = {395-397},
doi = {10.1016/s0140-6736(76)90219-1},
pmid = {55653},
issn = {0140-6736},
mesh = {Colitis/etiology ; Colitis, Ulcerative/etiology ; Colon/blood supply ; Colonic Diseases/*etiology ; Colonic Diseases, Functional/etiology ; Dietary Carbohydrates/*adverse effects ; Diverticulum, Colon/etiology ; Humans ; Ischemia/etiology ; *Muscle, Smooth ; Spasm/*complications/etiology ; },
abstract = {A diet high in refined carbohydrate is implicated in the aetiology of some diseases of the colon-i.e., diverticular disease, irritable bowel syndrome, ulcerative colitis, non-occlusive ischaemic colitis, and pseudomembranous colitis. It is suggested that spasm of the smooth muscle is the common pathogenetic mechanism in these colonic diseases. The strength of the spasm producing increased pressure in the colonic lumen or wall and the length of time for which the colon has been affected are believed to determine the type of disease resulting. A diet high in refined carbohydrate allows the intense muscle spasm to occur because the physical buffering effect of faecal bulk is considerably reduced.},
}
@article {pmid764934,
year = {1976},
author = {Srivastava, GS and Smith, AN and Painter, NS},
title = {Sterculia bulk-forming agent with smooth-muscle relaxant versus bran in diverticular disease.},
journal = {British medical journal},
volume = {1},
number = {6005},
pages = {315-318},
pmid = {764934},
issn = {0007-1447},
mesh = {Clinical Trials as Topic ; Colon/drug effects ; Constipation/drug therapy ; Diverticulitis, Colonic/diet therapy/*drug therapy ; Edible Grain ; Gastrointestinal Motility/drug effects ; Humans ; Muscle, Smooth/drug effects ; Parasympatholytics/*therapeutic use ; Plant Extracts/*therapeutic use ; Pressure ; Propylamines/*therapeutic use ; Resins, Plant/*therapeutic use ; },
abstract = {Sterculia with and without a smooth-muscle relaxant (alverine citrate) had similar beneficial effects on constipation and reduced the transit times in diverticular disease. Intracolonic pressure, however, varied with the preparation used. Though both preparations relieved the symptoms of diverticular disease, the one containing alverine citrate was more effective. Part of the mode of action of bran may be to relax the smooth muscle of the gut, since its actions were more comparable to those of sterculia plus alverine citrate than to those of sterculia alone.},
}
@article {pmid1082429,
year = {1976},
author = {Painter, NS},
title = {Diverticular disease of the colon: a bane of the elderly.},
journal = {Geriatrics},
volume = {31},
number = {2},
pages = {89-94},
pmid = {1082429},
issn = {0016-867X},
mesh = {Aged ; Diverticulitis, Colonic/therapy ; *Diverticulum, Colon/complications/etiology/surgery ; Gastrointestinal Hemorrhage/complications ; Humans ; },
}
@article {pmid814951,
year = {1976},
author = {Mitchell, WD and Eastwood, MA and Smith, AN},
title = {Proceedings: Faecal electrolytes and motility in diverticular disease.},
journal = {The British journal of surgery},
volume = {63},
number = {2},
pages = {159-160},
pmid = {814951},
issn = {0007-1323},
mesh = {Adult ; Aged ; Diverticulum/*physiopathology ; Electrolytes/*analysis ; Feces/*analysis ; *Gastrointestinal Motility ; Humans ; Middle Aged ; },
}
@article {pmid814949,
year = {1976},
author = {Taylor, I and Duthie, HL},
title = {Proceedings: Bran tablets in the treatment of diverticular disease.},
journal = {The British journal of surgery},
volume = {63},
number = {2},
pages = {158},
pmid = {814949},
issn = {0007-1323},
mesh = {Diverticulum/*therapy ; *Edible Grain ; Humans ; },
}
@article {pmid1245282,
year = {1976},
author = {Staniland, JR and Ditchburn, J and de Dombal, FT},
title = {Clinical presentation of diseases of the large bowel. A detailed study of 642 patients.},
journal = {Gastroenterology},
volume = {70},
number = {1},
pages = {22-28},
pmid = {1245282},
issn = {0016-5085},
mesh = {Adult ; Aged ; Colitis, Ulcerative/diagnosis ; Colonic Neoplasms/diagnosis ; Crohn Disease/diagnosis ; Diverticulitis/diagnosis ; Female ; Humans ; Intestinal Diseases/complications/*diagnosis ; Intestinal Neoplasms/complications/*diagnosis ; *Intestine, Large ; Male ; Middle Aged ; Rectal Neoplasms/diagnosis ; Sigmoid Neoplasms/diagnosis ; Sigmoidoscopy ; },
abstract = {This paper presents in detail the symptomatology and findings on examination of 642 patients suffering from a variety of lower gastrointestinal disorders, such as colonic and rectal cancer, diverticular disease, Crohn's disease, and ulcerative colitis. Location of precise sites of abdominal pain and tenderness was shown to carry a high level of diagnostic discrimination between the various disorders. Some surprising features emerged: almost half of patients with lower gastrointestinal tract disease complained of symptoms referable to the upper gastrointestinal tract, such as nausea/vomiting or anorexia. It is suggested that the provision on demand of such data to junior staff may benefit both diagnostic ability and decision making. As an incidental finding, just under 40% of patients with large bowel cancer had undergone previous (unrelated) abdominal surgery. The significance of this is unclear.},
}
@article {pmid981962,
year = {1976},
author = {Weinreich, J and Andersen, D},
title = {Intraluminal pressure in the sigmoid colon. II. Patients with sigmoid diverticula and related conditions.},
journal = {Scandinavian journal of gastroenterology},
volume = {11},
number = {6},
pages = {581-586},
pmid = {981962},
issn = {0036-5521},
mesh = {Adult ; Aged ; Chronic Disease ; Colic ; Colon, Sigmoid/*physiopathology ; Colonic Diseases/*physiopathology ; Diverticulitis, Colonic/*physiopathology ; Female ; Humans ; Male ; Middle Aged ; Pressure ; Syndrome ; },
abstract = {Patients with lower abdominal symptoms, indicating colonic disorder, were classified into predefined clinical syndromes. Two important syndromes were colicky sigmoid syndrome and chronic diverticular disease. The first one, characterized by presence of colicky lower abdominal pains but absence of colonic diverticula, probably covers what is generally referred to as 'irritable bowel syndrome'. The second one was characterized by presence of lower abdominal colics and of colonic diverticula. The results showed a significant correlation between the presence of lower abdominal colics and a high pressure activity in the sigmoid colon after intravenous neostigmine. There was, however, no correlation between the presence of diverticula and a high pressure activity. The generally accepted theory of a high pressure activity as the dominant factor in the pathogenesis of colonic diverticula, therefore, was questioned, as was the equally accepted theory of a gradual development of chronic diverticular disease from the adiverticular colicky sigmoid syndrome.},
}
@article {pmid1214569,
year = {1975},
author = {Goldner, FH},
title = {Treatments of choice in diverticular disease of the colon.},
journal = {Medical times},
volume = {103},
number = {12},
pages = {81-86},
pmid = {1214569},
issn = {0025-7583},
mesh = {Diagnosis, Differential ; Diet Therapy ; *Diverticulum, Colon/diagnosis/surgery/therapy ; Humans ; },
}
@article {pmid1181160,
year = {1975},
author = {Castro, AF},
title = {Colonic diverticular disease: one-stage resection for colovesical fistula.},
journal = {Diseases of the colon and rectum},
volume = {18},
number = {7},
pages = {563-564},
doi = {10.1007/BF02587133},
pmid = {1181160},
issn = {0012-3706},
mesh = {Colon/surgery ; Colon, Sigmoid/surgery ; Colonic Diseases/etiology/*surgery ; Diverticulitis, Colonic/*complications ; Humans ; Intestinal Fistula/etiology/*surgery ; Postoperative Complications/etiology ; Prognosis ; Rectum/surgery ; Urinary Bladder/surgery ; Urinary Bladder Fistula/etiology/*surgery ; },
}
@article {pmid1181159,
year = {1975},
author = {Pheils, MT},
title = {Colonic diverticular disease: colovesical fistula.},
journal = {Diseases of the colon and rectum},
volume = {18},
number = {7},
pages = {560-562},
doi = {10.1007/BF02587132},
pmid = {1181159},
issn = {0012-3706},
mesh = {Acute Disease ; Aged ; Cellulitis/etiology/surgery ; Chronic Disease ; Colonic Diseases/*etiology/surgery ; Colostomy ; Diverticulitis, Colonic/*complications ; Female ; Humans ; Intestinal Fistula/complications/*etiology/surgery ; Male ; Urinary Bladder Fistula/complications/*etiology/surgery ; Urinary Tract Infections/etiology ; },
}
@article {pmid1181158,
year = {1975},
author = {Hodgson, J},
title = {Colonic diverticular disease: transverse taeniamyotomy.},
journal = {Diseases of the colon and rectum},
volume = {18},
number = {7},
pages = {555-559},
doi = {10.1007/BF02587131},
pmid = {1181158},
issn = {0012-3706},
mesh = {Aged ; Colon/physiopathology ; Colonic Neoplasms/etiology/surgery ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Intestinal Obstruction/etiology ; Male ; Muscle Contraction ; Muscles/surgery ; },
}
@article {pmid1181157,
year = {1975},
author = {Gallagher, DM and Painter, NS and Hodgson, J and Pheils, M and Castro, AF},
title = {Colonic diverticular disease. Miller's bran in management.},
journal = {Diseases of the colon and rectum},
volume = {18},
number = {7},
pages = {549-554},
doi = {10.1007/BF02587130},
pmid = {1181157},
issn = {0012-3706},
mesh = {Africa ; Aged ; Asia ; Colon/physiopathology ; Defecation ; Dietary Carbohydrates/analysis ; Diverticulum, Colon/*diet therapy/physiopathology ; *Edible Grain ; Europe ; Feeding Behavior ; Female ; Humans ; Male ; Middle Aged ; },
}
@article {pmid1081037,
year = {1975},
author = {},
title = {Colonic diverticular disease: discussion.},
journal = {Diseases of the colon and rectum},
volume = {18},
number = {7},
pages = {570-575},
doi = {10.1007/BF02587137},
pmid = {1081037},
issn = {0012-3706},
mesh = {Aged ; Diverticulum, Colon/*diagnosis/surgery ; Gastrointestinal Hemorrhage/therapy ; Humans ; Middle Aged ; Muscle Contraction ; Muscles/surgery ; Prognosis ; },
}
@article {pmid1081036,
year = {1975},
author = {Veidenheimer, MC},
title = {Colonic diverticular disease: management of massive bleeding.},
journal = {Diseases of the colon and rectum},
volume = {18},
number = {7},
pages = {568-569},
doi = {10.1007/BF02587136},
pmid = {1081036},
issn = {0012-3706},
mesh = {Angiography ; Barium Sulfate/therapeutic use ; Diverticulum, Colon/*complications/surgery ; Gastrointestinal Hemorrhage/diagnosis/surgery/*therapy ; Hemostatics ; Humans ; Vasoconstrictor Agents/therapeutic use ; },
}
@article {pmid1081035,
year = {1975},
author = {Mock, J},
title = {Colonic diverticular disease: angiography for the diagnosis of bleeding.},
journal = {Diseases of the colon and rectum},
volume = {18},
number = {7},
pages = {565-567},
doi = {10.1007/BF02587135},
pmid = {1081035},
issn = {0012-3706},
mesh = {Adult ; Aged ; *Angiography ; Colonic Diseases/*diagnostic imaging/etiology ; Diverticulum, Colon/*complications ; Gastrointestinal Hemorrhage/*diagnostic imaging/drug therapy/etiology ; Humans ; Male ; Mesenteric Arteries/diagnostic imaging ; Mesenteric Veins/diagnostic imaging ; Middle Aged ; Perfusion ; Vasopressins/administration & dosage/therapeutic use ; },
}
@article {pmid1197344,
year = {1975},
author = {Rennie, JA and Charnock, MC and Wellwood, JM and Todd, IP},
title = {Results of resection for diverticular disease and its complications.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {68},
number = {9},
pages = {575},
pmid = {1197344},
issn = {0035-9157},
mesh = {Diverticulum, Colon/*surgery ; Humans ; Postoperative Complications ; },
}
@article {pmid51965,
year = {1975},
author = {Wynne-Jones, G},
title = {Flatus retention is the major factor in diverticular disease.},
journal = {Lancet (London, England)},
volume = {2},
number = {7927},
pages = {211-212},
doi = {10.1016/s0140-6736(75)90677-7},
pmid = {51965},
issn = {0140-6736},
mesh = {*Colon, Sigmoid/physiology ; Diverticulum, Colon/*etiology/pathology/therapy ; Feeding Behavior ; Flatulence/*complications/prevention & control ; Humans ; Muscle Contraction ; Urban Population ; },
abstract = {Retention of flatus is the main factor in the origin and progression of sigmoid diverticular disease. This hypothesis explains why the disease is confined to modern urban communities, and why the patient must avoid "windy" foods.},
}
@article {pmid1155331,
year = {1975},
author = {Latto, C},
title = {Diverticular disease and varicose veins.},
journal = {American heart journal},
volume = {90},
number = {2},
pages = {274},
doi = {10.1016/0002-8703(75)90132-5},
pmid = {1155331},
issn = {0002-8703},
mesh = {Developing Countries ; Diverticulum, Colon/*complications ; Humans ; United Kingdom ; United States ; Varicose Veins/*complications ; },
}
@article {pmid1154265,
year = {1975},
author = {Ram, MD and Midha, D},
title = {Adenomyomatosis of the gallbladder.},
journal = {Surgery},
volume = {78},
number = {2},
pages = {224-229},
pmid = {1154265},
issn = {0039-6060},
mesh = {Adult ; Aged ; Cholecystectomy ; Cholecystitis/complications/diagnosis ; Cholecystography ; Cholelithiasis/complications/diagnosis ; Diagnosis, Differential ; Endometriosis/*diagnosis ; Epithelium ; Female ; Gallbladder/*pathology ; Gallbladder Neoplasms/*diagnosis/diagnostic imaging ; Humans ; *Hyperplasia ; Male ; Middle Aged ; },
abstract = {Adenomyomatosis of the gallbladder is an entity that is being recognized increasingly, chiefly by radiologists. The pathogenesis, pathology, and indications for surgery are not well understood. This report is a study of 27 patients seen in the last 6 years, all of whom had proved histologic features. Patients ranged from 21 to 72 years of age, with a preponderance of women. Thirteen patients had no gallstones. The disease was confined to the fundus in 15 patients, to the neck in one patient, and was generalized in 11 patients. Bile cultures were obtained in the last six consecutive patients and all were negative. Histologically there was evidence of thickening of the gallbladder wall, glandular elements in the mucosa, and invagination of glands into the muscularis. The clinical, radiological, and pathologic features supported a hyperplastic and degenerative disorder which should be distinguished from cholecystitis. Associated with these morphologic changes is a dyskinesia similar to that seen in diverticular disease of the colon. Follow-up studies after cholecystectomy have shown that over 90 percent of all patients were completely relieved of symptoms. Adenomyomatosis should be identified as a distinct entity, probably of a degenerative nature. Cholecystectomy is indicated and beneficial when the symptoms suggest biliary tract diseases.},
}
@article {pmid1174784,
year = {1975},
author = {Kyle, J and Davidson, AI},
title = {The changing pattern of hospital admissions for divertical disease of the colon.},
journal = {The British journal of surgery},
volume = {62},
number = {7},
pages = {537-541},
doi = {10.1002/bjs.1800620709},
pmid = {1174784},
issn = {0007-1323},
mesh = {Adult ; Age Factors ; Aged ; Diverticulum, Colon/complications/*epidemiology/mortality ; Female ; Hospital Records ; *Hospitalization ; Humans ; Male ; Marriage ; Middle Aged ; Scotland ; Sex Factors ; },
abstract = {Hospital admissions for symptomatic diverticular disease of the colon were studied during two periods, 1958-61 and 1968-71, in a relatively closed community in north-east Scotland. There was a significant increase in the numbers admitted, from 206 to 366. In the earlier 4-year period among patients aged 70 years and over there was a preponderance of females, but in the later study period the risk of developing symptomatic disease was almost as great among elderly males. Most of the elderly female patients were widowed city dwellers. The proportion of patients requiring operation for or dying from diverticular disease declined, but perforation remained as a frequent complication carrying a high mortality.},
}
@article {pmid1080234,
year = {1975},
author = {Pheils, MT},
title = {The complications of diverticular disease.},
journal = {The Medical journal of Australia},
volume = {1},
number = {23},
pages = {707-711},
doi = {10.5694/j.1326-5377.1975.tb111653.x},
pmid = {1080234},
issn = {0025-729X},
mesh = {Aged ; Colon, Sigmoid ; Colonic Diseases/etiology/surgery ; Colostomy ; Diverticulitis, Colonic/*complications ; Female ; Gastrointestinal Hemorrhage/etiology/surgery ; Humans ; Intestinal Fistula/etiology/surgery ; Intestinal Obstruction/etiology/surgery ; Intestinal Perforation/etiology/surgery ; Male ; Urinary Bladder Fistula/etiology/surgery ; },
}
@article {pmid1130611,
year = {1975},
author = {Rios-Dalenz, J and Smith, LB and Thompson, TF},
title = {Diseases of the colon and rectum in Bolivia.},
journal = {American journal of surgery},
volume = {129},
number = {6},
pages = {661-664},
doi = {10.1016/0002-9610(75)90341-4},
pmid = {1130611},
issn = {0002-9610},
mesh = {Altitude ; Bolivia ; Colitis, Ulcerative/epidemiology ; Colonic Diseases/*epidemiology/etiology ; Crohn Disease/epidemiology ; Developing Countries ; Diet ; Diverticulum, Colon/epidemiology ; Female ; Humans ; Indians, South American ; Intestinal Neoplasms/epidemiology ; Intestinal Obstruction/epidemiology ; Intestinal Polyps/epidemiology ; Male ; Megacolon/epidemiology ; Rectal Diseases/*epidemiology/etiology ; Sex Factors ; },
abstract = {A review of the surgical and autopsy records from two general hospitals in La Paz, Bolivia, discloses an incidence of colon and rectal disease, excluding hemorrhoids, of 0.6 per cent (138 of 22,361 surgical cases) and 2.5 per cent (16 of 640 consecutive autopsies). Acquired megacolon complicated by volvulus represented more than half of all cases in the surgical series. Ulcerative colitis, diverticular disease, and neoplastic polyps represented less than 10 per cent of the cases of colonic disease. Only ten cases of carcinoma of the colon were seen, whereas five cases of granulomatous colitis or ileocolitis were detected in the same surgical material. Among sixty-four lesions of the rectum, so-called retention polyps accounted for 54.5 per cent of the cases, with carcinoma next in frequency (25 per cent), and the remainder being different varieties of inflammatory conditions. In the autopsy material almost half of the cases were infectious conditions, followed by congenital malformations and complicated acquired megacolon. No case of diverticular disease of the colon or neoplastic polyps was seen, and there was only one case of cancer of the large bowel. Because of the high incidence of acquired megacolon and the low incidence of cancer, ulcerative colitis, adenomatous polyps, and diverticular disease of the colon, possible etiopathogenic factors of these conditions are discussed in comparison with their incidence in other developed and developing countries of the world.},
}
@article {pmid1148667,
year = {1975},
author = {Wray, D and Ferguson, MM and Mason, DK and Hutcheon, AW and Dagg, JH},
title = {Recurrent aphthae: treatment with vitamin B12, folic acid, and iron.},
journal = {British medical journal},
volume = {2},
number = {5969},
pages = {490-493},
pmid = {1148667},
issn = {0007-1447},
mesh = {Adenocarcinoma/complications ; Adolescent ; Adult ; Aged ; Anemia, Pernicious/complications ; Cecal Neoplasms/complications ; Child ; Colitis/complications ; Crohn Disease/complications ; Diverticulum, Colon/complications ; Female ; Folic Acid/*therapeutic use ; Folic Acid Deficiency/drug therapy ; Humans ; Iron/*therapeutic use ; Iron Deficiencies ; Malabsorption Syndromes/complications ; Male ; Middle Aged ; Proctitis/complications ; Recurrence ; Stomatitis, Aphthous/*drug therapy/etiology ; Vitamin B 12/*therapeutic use ; Vitamin B 12 Deficiency/drug therapy ; },
abstract = {A series of 130 consecutive outpatients with recurrent aphthous stomatitis were screened at the oral medicine department, Glasgow Dental Hospital, for deficienciesin vitamin b12, folic acid, and iron. In 23 patients (17.7%) such deficiencies werefound; five were deficient in vitamin B12, seven in folic acid, and 15 in iron. Four had more than one deficiency. Out of 130 controls matched for age and sex 11 (8.5%) were found to have deficiencies. The 23 deficient patients with recurrent aphthaewere treated with specific replacement therapy, and all 130 patients were followed up for at least one year. Of the 23 patients on replacement therapy 15 showed complete remission of ulceration and eight definite improvement. Of the 107 patientswith no deficiency receiving local symptomatic treatment only 33 had a remission or wereimproved. This difference was significant (P less than 0.001). Most patients withproved vitamin B12 or folic acid deficiency improved rapidly on replacement therapy;those with iron deficiency showed a less dramatic response. The 23 deficient patientswere further investigated to determine the cause of their deficiencies and detect the presence of any associated conditions. Four were found to have Addisonian perniciousanaemia. Seven had a malabsorption syndrome, which in five proved to be a gluten-induced enteropathy. In addition, there were single patients with idiopathic proctocolitis, diverticular disease of the colon, regional enterocolitis, and adenocarcinoma of thecaecum. We suggest that the high incidence of deficiencies found in this series andthe good response to replacement therapy shows the need for haematological screening of such patients.},
}
@article {pmid1173186,
year = {1975},
author = {Tolins, SH},
title = {Surgical treatment of diverticulitis. Experience at a large Municipal Hospital.},
journal = {JAMA},
volume = {232},
number = {8},
pages = {830-832},
pmid = {1173186},
issn = {0098-7484},
mesh = {Adult ; Age Factors ; Aged ; Arteriosclerosis/complications ; Colectomy ; Colostomy ; Diverticulitis/complications/diagnosis/*surgery ; Diverticulitis, Colonic/surgery ; Female ; Humans ; Hypertension/complications ; Male ; Methods ; Middle Aged ; New York City ; Obesity/complications ; Postoperative Complications ; Time Factors ; },
abstract = {In the past 5 1/2 years, 71 patients with diverticulitis were operated on--20.8% of all cases of diverticulitis admitted to the Bronx Municipal Hospital Center. Operative mortality was 22%, primarily because of delayed diagnosis, inadequate surgery, and a high incidence of associated disease. Only 20% of patients operated on had a previous history of diverticular disease. Hemorrhage was the indication for surgery in 16 cases; in this situation, a subtotal colectomy in one stage is the operation of choice. Perforation was the indication in 47 cases, eight of these being acute and with free air under the diaphragm. In cases with peritoneal contamination, a two-stage procedure (removing the diseased portion of colon at stage one) is advocated. Colostomy without drainage, or closure of a free perforation, is condemned.},
}
@article {pmid1128730,
year = {1975},
author = {Saporta, JA and Bleicher, JE and Cegielski, M},
title = {Colonic diverticular disease--report of six cases managed by total colectomy.},
journal = {The Nebraska medical journal},
volume = {60},
number = {4},
pages = {106-110},
pmid = {1128730},
issn = {0091-6730},
mesh = {Age Factors ; Aged ; *Colectomy/methods ; Diverticulum, Colon/complications/*surgery ; Female ; Humans ; Middle Aged ; },
}
@article {pmid1147863,
year = {1975},
author = {Mow, TK and Kwi, NK},
title = {Diverticular disease of the colon among West Malaysians.},
journal = {Australasian radiology},
volume = {19},
number = {1},
pages = {47-51},
doi = {10.1111/j.1440-1673.1975.tb01919.x},
pmid = {1147863},
issn = {0004-8461},
mesh = {Aged ; Diverticulum, Colon/complications/*diagnostic imaging ; Humans ; Malaysia ; Male ; Middle Aged ; Radiography ; },
}
@article {pmid1078946,
year = {1975},
author = {Athanasoulis, CA and Baum, S and Rösch, J and Waltman, AC and Ring, EJ and Smith, JC and Sugarbaker, E and Wood, W},
title = {Mesenteric arterial infusions of vasopressin for hemorrhage from colonic diverticulosis.},
journal = {American journal of surgery},
volume = {129},
number = {2},
pages = {212-216},
doi = {10.1016/0002-9610(75)90300-1},
pmid = {1078946},
issn = {0002-9610},
mesh = {Aged ; Diverticulum, Colon/*complications ; Evaluation Studies as Topic ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage/*drug therapy ; Humans ; Infusions, Parenteral ; Male ; *Mesenteric Arteries/diagnostic imaging ; Radiography ; Recurrence ; Vasopressins/*administration & dosage/therapeutic use ; },
abstract = {Twenty-four patients with massive rectal hemorrhage and known or subsequently proved colonic diverticular disease had the bleeding site localized by mesenteric angiography and received intra-arterial infusion of vasopressin to arrest the bleeding. In twenty-two patients the bleeding was controlled with the vasopressin infusion whereas in the remaining two, hemorrhage did not stop and surgery was performed. Of the twenty-two patients in whom bleeding was arrested by vasopressin infusion, twelve received no further surgical therapy, five had elective prophylactic surgical resection after a period of hemostasis, and the remaining five underwent segmental resection for bleeding that recurred after cessation of the infusion. Of the twelve patients who were not operated on, three had rebleeding two, four, and twelve months after vasopressin infusion and two of these three patients required surgery. The remaining nine have had no recurrent bleeding for periods ranging from seven to thirty-four months. Of ten patients who had segmental resection after precise localization of the bleeding site and initial control with vasopressin, no one has had recurrent hemorrhage for periods ranging from two to eighteen months.},
}
@article {pmid1110887,
year = {1975},
author = {Eastwood, M and Mitchell, WD},
title = {Diverticular disease.},
journal = {Nursing times},
volume = {71},
number = {2},
pages = {68},
pmid = {1110887},
issn = {0954-7762},
mesh = {*Diverticulum, Colon ; Female ; Humans ; Male ; },
}
@article {pmid1209471,
year = {1975},
author = {Magness, LJ and Sanfelippo, PM and van Heerden, JA and Judd, ES},
title = {Diverticular disease of the right colon.},
journal = {Surgery, gynecology & obstetrics},
volume = {140},
number = {1},
pages = {30-32},
pmid = {1209471},
issn = {0039-6087},
mesh = {Adult ; Aged ; Appendicitis/diagnosis ; Diagnosis, Differential ; Diverticulitis, Colonic/diagnosis/*epidemiology/surgery ; Diverticulum, Colon/*epidemiology/surgery ; Female ; Humans ; Male ; Middle Aged ; Minnesota ; },
abstract = {Diverticular disease of the right colon is uncommon. Most frequently, rightsided diverticula occur in the cecum, and usually, they are solitary. Generally, the diverticular are true diverticular containing all coats of the intestine, and usually the younger age group is affected. Right-sided diverticulitis mimics appendicitis. The diverticulum and adjacent reaction may be mistaken for carcinoma. Surgical excision is indicated to prevent recurrent symptoms as well as confusion at later barium studies.},
}
@article {pmid1167350,
year = {1975},
author = {Small, WP and Smith, AN},
title = {Fistula and conditions associated with diverticular disease of the colon.},
journal = {Clinics in gastroenterology},
volume = {4},
number = {1},
pages = {171-199},
pmid = {1167350},
issn = {0300-5089},
mesh = {Abscess ; Cecum ; Colitis, Ulcerative/complications ; Colonic Diseases/*etiology ; Colonic Neoplasms/complications ; Crohn Disease/complications ; Diverticulitis, Colonic/complications ; Diverticulum, Colon/*complications/pathology ; Female ; Gallbladder Diseases/complications ; Hernia, Hiatal/complications ; Humans ; Intestinal Fistula/*etiology ; Ischemia/complications ; Skin ; Urinary Bladder Fistula/*etiology ; Vaginal Fistula/*etiology ; },
}
@article {pmid1109820,
year = {1975},
author = {Parks, TG},
title = {Natural history of diverticular disease of the colon.},
journal = {Clinics in gastroenterology},
volume = {4},
number = {1},
pages = {53-69},
pmid = {1109820},
issn = {0300-5089},
mesh = {Adult ; Age Factors ; Aged ; Colonic Diseases, Functional ; Colonic Neoplasms ; Colostomy ; Diverticulum, Colon/*diagnosis/physiopathology/surgery ; Feeding Behavior ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Sex Factors ; },
}
@article {pmid1109819,
year = {1975},
author = {Morson, BC},
title = {Pathology of diverticular disease of the colon.},
journal = {Clinics in gastroenterology},
volume = {4},
number = {1},
pages = {37-52},
pmid = {1109819},
issn = {0300-5089},
mesh = {Colitis, Ulcerative/pathology ; Crohn Disease/pathology ; Diverticulitis, Colonic/pathology ; Diverticulum, Colon/*pathology/physiopathology ; Humans ; Intestinal Neoplasms/pathology ; Intestinal Polyps/pathology ; Muscles/pathology ; },
}
@article {pmid1109818,
year = {1975},
author = {Painter, NS and Burkitt, DP},
title = {Diverticular disease of the colon, a 20th century problem.},
journal = {Clinics in gastroenterology},
volume = {4},
number = {1},
pages = {3-21},
pmid = {1109818},
issn = {0300-5089},
mesh = {Africa ; Colon, Sigmoid ; Diverticulitis, Colonic/diagnosis/surgery ; Diverticulum, Colon/*epidemiology/etiology/physiopathology ; Edible Grain ; Europe ; *Feeding Behavior ; Humans ; India ; Iran ; Iraq ; Obesity ; Pressure ; },
}
@article {pmid1109817,
year = {1975},
author = {Connell, AM},
title = {Applied physiology of the colon: factors relevant to diverticular disease.},
journal = {Clinics in gastroenterology},
volume = {4},
number = {1},
pages = {23-36},
pmid = {1109817},
issn = {0300-5089},
mesh = {Colon/*physiology ; Colonic Diseases, Functional/physiology ; Diverticulum, Colon/*physiopathology ; Electrolytes/metabolism ; Humans ; Intestinal Absorption ; Peristalsis ; Pressure ; Water/metabolism ; },
}
@article {pmid1109816,
year = {1975},
author = {Hodgson, J},
title = {Animal models in the study of diverticular disease. Part I: aetiology and treatment.},
journal = {Clinics in gastroenterology},
volume = {4},
number = {1},
pages = {201-219},
pmid = {1109816},
issn = {0300-5089},
mesh = {Animals ; Diet ; *Disease Models, Animal ; Diverticulum, Colon/etiology/pathology/*surgery ; Rabbits ; Surgical Procedures, Operative/methods ; Wound Healing ; },
}
@article {pmid1078561,
year = {1975},
author = {Colcock, BP},
title = {Diverticular disease: proven surgical management.},
journal = {Clinics in gastroenterology},
volume = {4},
number = {1},
pages = {99-119},
pmid = {1078561},
issn = {0300-5089},
mesh = {Abscess/etiology ; Colostomy ; Diverticulum, Colon/complications/*surgery ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Male ; Morbidity ; Postoperative Complications/prevention & control ; Surgical Procedures, Operative/methods/mortality ; Urinary Bladder Fistula ; Vaginal Fistula ; },
}
@article {pmid1078559,
year = {1975},
author = {Samuel, E and Dean, AC},
title = {Investigative measures in diverticular disease: radiology, colonoscopy.},
journal = {Clinics in gastroenterology},
volume = {4},
number = {1},
pages = {71-84},
pmid = {1078559},
issn = {0300-5089},
mesh = {Abscess/etiology ; Barium Sulfate ; Colonic Neoplasms/diagnostic imaging ; Crohn Disease/diagnostic imaging ; Diagnosis, Differential ; Diverticulum, Colon/complications/*diagnostic imaging/etiology ; Enema ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/etiology ; Intestinal Perforation/etiology ; Intestine, Small ; Radiography ; *Sigmoidoscopy ; Vaginal Fistula/etiology ; },
}
@article {pmid1078558,
year = {1975},
author = {Hughes, LE},
title = {Complications of diverticular disease: inflammation, obstruction and bleeding.},
journal = {Clinics in gastroenterology},
volume = {4},
number = {1},
pages = {147-170},
pmid = {1078558},
issn = {0300-5089},
mesh = {Abscess/complications ; Colon, Sigmoid ; Colostomy ; Diverticulitis, Colonic/*etiology/surgery ; Diverticulum, Colon/*complications ; Gangrene/complications ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Intestinal Obstruction/*etiology ; Intestinal Perforation/surgery ; Intestine, Large ; Intestine, Small ; Peritonitis/etiology ; Recurrence ; },
}
@article {pmid4422902,
year = {1974},
author = {Kirwan, WO and Smith, AN and McConnell, AA and Mitchell, WD and Eastwood, MA},
title = {Action of different bran preparations on colonic function.},
journal = {British medical journal},
volume = {4},
number = {5938},
pages = {187-189},
pmid = {4422902},
issn = {0007-1447},
mesh = {Constipation/*diet therapy ; Diverticulum, Colon/*diet therapy ; *Edible Grain ; Gastrointestinal Motility/drug effects ; Humans ; Neostigmine/pharmacology ; Particle Size ; Pressure ; Water ; },
abstract = {Two different types of commercially available bran were studied. One of these was composed of flake-like particles (coarse bran) whereas the other had smaller, finer particles with a floury component (fine bran). The effectiveness of the two preparations in lowering intraluminal pressure and decreasing transit time in patients with constipation and diverticular disease was assessed. Only coarse bran promoted changes at the dose used. The physical properties of the brans were examined in an effort to explain their differing effects. It is concluded that water-holding capacity, upon which the beneficial effect of bran may depend, is a function of particle size. The greater water-holding capacity of coarse bran makes it preferable for the treatment of colonic disorders.},
}
@article {pmid4138711,
year = {1974},
author = {},
title = {Editorial: Conservative operations for diverticular disease.},
journal = {Lancet (London, England)},
volume = {2},
number = {7887},
pages = {994-995},
pmid = {4138711},
issn = {0140-6736},
mesh = {Colon/surgery ; Colon, Sigmoid/surgery ; Diverticulum/*surgery ; Female ; Humans ; Methods ; Muscle, Smooth/surgery ; },
}
@article {pmid4467859,
year = {1974},
author = {Painter, NS},
title = {The high fibre diet in the treatment of diverticular disease of the colon.},
journal = {Postgraduate medical journal},
volume = {50},
number = {588},
pages = {629-635},
pmid = {4467859},
issn = {0032-5473},
mesh = {Adult ; Child ; Dietary Carbohydrates/*therapeutic use ; Diverticulum, Colon/*diet therapy/etiology ; Edible Grain ; Feeding Behavior ; Female ; Humans ; Male ; },
abstract = {Diverticular disease of the colon causes symptoms even in the absence of inflammatory diverticulitis. These symptoms vary from vague dyspepsia to severe colic which may lead to resection of the sigmoid for ‘diverticulitis’. This paper discusses the use of a high fibre diet, including miller's bran, in the treatment of uncomplicated diverticulosis. In the majority of cases this diet relieves symptoms and lessens the need for surgery in diverticular disease.},
}
@article {pmid4427897,
year = {1974},
author = {Pace, JL and Podestà, MT},
title = {Diverticular disease of right colon: report of 7 post-mortem cases.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {67},
number = {10},
pages = {1044},
pmid = {4427897},
issn = {0035-9157},
mesh = {Aged ; Autopsy ; Diverticulum, Colon/diagnostic imaging/*pathology ; Female ; Functional Laterality ; Humans ; Male ; Middle Aged ; Radiography ; },
}
@article {pmid4427896,
year = {1974},
author = {Smith, AN and Kirwan, WO and Shariff, S},
title = {Motility effects of operations performed for diverticular disease.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {67},
number = {10},
pages = {1041-1043},
pmid = {4427896},
issn = {0035-9157},
mesh = {Civilization ; Colon/innervation/physiopathology ; Diet ; Diverticulum, Colon/*surgery ; Feces ; Follow-Up Studies ; *Gastrointestinal Motility ; Humans ; Pressure ; Time Factors ; Triticum ; },
}
@article {pmid4427895,
year = {1974},
author = {Parks, TG},
title = {Diet and diverticular disease.},
journal = {Proceedings of the Royal Society of Medicine},
volume = {67},
number = {10},
pages = {1037-1040},
pmid = {4427895},
issn = {0035-9157},
mesh = {Animals ; Bread ; Civilization ; Colon/physiopathology ; Diet ; Diverticulum, Colon/*diet therapy/etiology/physiopathology ; Dogs ; Edible Grain ; Feces ; Gastrointestinal Motility ; Humans ; Pressure ; Rabbits ; Racial Groups ; Rats ; Triticum ; },
}
@article {pmid4412856,
year = {1974},
author = {Hodgson, J},
title = {Diverticular disease. Possible correlation between low residue diet and raised intracolonic pressures in the rabbit model.},
journal = {The American journal of gastroenterology},
volume = {62},
number = {2},
pages = {116-123},
pmid = {4412856},
issn = {0002-9270},
mesh = {Animals ; Cecum/pathology ; Colon/pathology ; Diet/*adverse effects ; *Disease Models, Animal ; Diverticulum, Colon/*etiology/pathology ; Gastrointestinal Motility ; Pressure ; Rabbits ; },
}
@article {pmid4208704,
year = {1974},
author = {Alvarez, WC},
title = {Editorial: Diet and diverticular disease.},
journal = {Geriatrics},
volume = {29},
number = {6},
pages = {136},
pmid = {4208704},
issn = {0016-867X},
mesh = {Aged ; Diet/*adverse effects ; Diet Therapy ; Diverticulum/*etiology/therapy ; Humans ; },
}
@article {pmid4129718,
year = {1974},
author = {Findlay, JM and Smith, AN and Mitchell, WD and Anderson, AJ and Eastwood, MA},
title = {Effects of unprocessed bran on colon function in normal subjects and in diverticular disease.},
journal = {Lancet (London, England)},
volume = {1},
number = {7849},
pages = {146-149},
doi = {10.1016/s0140-6736(74)92439-8},
pmid = {4129718},
issn = {0140-6736},
mesh = {Adult ; Aged ; Bile Acids and Salts/analysis ; Colon/*physiology/physiopathology ; Diet ; Diverticulum, Colon/*physiopathology ; *Edible Grain ; Feces/analysis ; *Gastrointestinal Motility ; Humans ; Middle Aged ; Neostigmine ; Polyethylene Glycols ; Pressure ; },
}
@article {pmid4200581,
year = {1973},
author = {Plumley, PF and Francis, B},
title = {Dietary management of diverticular disease.},
journal = {Journal of the American Dietetic Association},
volume = {63},
number = {5},
pages = {527-530},
pmid = {4200581},
issn = {0002-8223},
mesh = {Aged ; Bread ; Colon, Sigmoid ; Defecation ; *Diet Therapy ; Diverticulum/diagnostic imaging/*therapy ; Diverticulum, Colon/therapy ; Evaluation Studies as Topic ; Humans ; Intestines/physiopathology ; Mucus ; Pain ; Polysaccharides/*therapeutic use ; Radiography ; *Triticum ; },
}
@article {pmid4199198,
year = {1973},
author = {Crowley, JG},
title = {Perforation in acquired diverticular disease of the terminal ileum.},
journal = {The American surgeon},
volume = {39},
number = {9},
pages = {514-517},
pmid = {4199198},
issn = {0003-1348},
mesh = {Adult ; Diverticulum/complications/pathology/*surgery ; Humans ; Ileocecal Valve/pathology ; *Ileum ; Intestinal Perforation/etiology/pathology/*surgery ; Male ; },
}
@article {pmid4122010,
year = {1973},
author = {Latto, C and Wilkinson, RW and Gilmore, OJ},
title = {Diverticular disease and varicose veins.},
journal = {Lancet (London, England)},
volume = {1},
number = {7812},
pages = {1089-1090},
doi = {10.1016/s0140-6736(73)90397-8},
pmid = {4122010},
issn = {0140-6736},
mesh = {Adult ; Africa ; Black or African American ; Age Factors ; Aged ; Appendectomy ; Barium Sulfate ; Black People ; Cholecystectomy ; Diverticulum, Colon/diagnosis/*epidemiology ; Female ; Humans ; Leg/blood supply ; Male ; Middle Aged ; United States ; Varicose Veins/*epidemiology ; White People ; },
}
@article {pmid4193898,
year = {1970},
author = {Subbuswamy, SG},
title = {Paneth cells in diverticular disease of the colon.},
journal = {Journal of clinical pathology},
volume = {23},
number = {4},
pages = {351-353},
pmid = {4193898},
issn = {0021-9746},
mesh = {Colon, Sigmoid/pathology ; Diverticulitis, Colonic/*pathology ; Diverticulum, Colon/*pathology ; Humans ; Intestinal Mucosa/pathology ; Staining and Labeling ; },
abstract = {Paneth cells were found in the mucosa of the sigmoid colon in 13 out of 27 cases of diverticulosis and diverticulitis. It is concluded that their appearance at this site is a non-specific reaction to injury.},
}
@article {pmid4186305,
year = {1969},
author = {Manousos, ON},
title = {Diverticular disease of the colon.},
journal = {Lancet (London, England)},
volume = {2},
number = {7625},
pages = {848-849},
doi = {10.1016/s0140-6736(69)92302-2},
pmid = {4186305},
issn = {0140-6736},
mesh = {*Diet ; Diverticulum, Colon/epidemiology/*etiology ; Humans ; },
}
@article {pmid4186011,
year = {1969},
author = {Painter, NS},
title = {Diverticular disease of the colon--a disease of the century.},
journal = {Lancet (London, England)},
volume = {2},
number = {7620},
pages = {586-588},
doi = {10.1016/s0140-6736(69)90278-5},
pmid = {4186011},
issn = {0140-6736},
mesh = {Africa ; Asia ; Colon, Sigmoid/physiopathology ; *Diverticulitis, Colonic/epidemiology/etiology/mortality ; *Diverticulum, Colon/etiology ; Food ; Humans ; United Kingdom ; },
}