Su1444 EUS COLONOSCOPY DETECTION OF THE RUPTURED DIVERTICULUM IN PATIENTS WITH RECURRENT DIVERTICULAR DISEASE OF THE COLON

Abstract

Rupture of the diverticulum is a predictor of failure of conservative treatment and evidence in favor of surgical intervention. The role of colonoscopy in diverticular disease of the colon is controversial and not defined in case of recurrent diverticular disease with ruptured diverticulum. The role of EUS in diagnosis of this complication not defined. The study was due to these reasons and the aim of the study was to clarify indicators for EUS colonoscopy to identification of the ruptured diverticulum in patients with recurrent diverticular disease of the colon. Pre-operative EUS colonoscopy data of patients with symptomatic recurrent diverticular disease of the colon with repeated attacks and courses of antibiotic therapy during a period of at least 6 months, operated on and diagnosis confirmed by the histological examination of the surgical specimens collected prospectively in our Center from 2000 to 2016. We excluded EUS colonoscopies that were incomplete due to the difficulties of positioning the ultrasonic probe, so prognostic significance of EUS colonoscopy not evaluated. Comparative analysis of histological and EUS colonoscopy data was performed. 23 patients (53.3 ± 9.6 years; male - 43.5%) were included. Histological specimens revealed the ruptured diverticulum in 21 (91.3%) cases, so the patients were divided into three groups according to the histological results: group1 (not ruptured diverticulum with inflammation) - 2 (8.7%) cases, group2 (ruptured diverticulum with inflammation of adjacent pericolic tissue) - 9 (39.1%) cases, group3 (destroyed diverticulum with infiltrate) - 12 (52.2%) cases. EUS colonoscopy identified thickening, hyperechogenic muscular layer in group1, local interruption of the hyperechogenic muscular layer with the presence of a small hypoechogenic cavity (1.0-2.0 cm) adjacent to the rupture zone in group2 and destruction of the muscular layer with the presence of pericolic infiltrates of different sizes and ultrasound characteristics in group3. EUS colonoscopy reveals the first step of the destruction of the diverticulum. The presence of local interruption of the hyperechogenic muscular layer with small hypoechogenic cavity (1.0-2.0 cm) adjacent to the rupture zone is the EUS colonoscopy indicator of the ruptured diverticulum in case of recurrent diverticular disease of the colon. The information obtained in this study within limitations of the small group and may be used for the generation of hypotheses in future studies.