Complication Of Diverticulosis Research Articles

S260 Racial Disparities Among Patients Hospitalized With Complications of Diverticulosis

S260 Racial Disparities Among Patients Hospitalized With Complications of Diverticulosis

The Use of Computed Tomography in the Diagnosis of Jejunal Diverticulosis Complicated by Diverticulitis and Intestinal Bleeding

The jejunal diverticulosis is rare and accounts for approximately 0.5–1 % of the general population. Diagnosis of the pathology is difficult even in the presence of symptomatic complications (perforation, abscess, peritonitis, sepsis, intestinal obstruction and bleeding), therefore, it is often overlooked or delayed, which requires high awareness and vigilance of physicians. Emergency surgical interventions are performed due to the lack of clear clinical symptoms and reliable radiological data in an average of 25 % of patients with complications of diverticulosis. In the presented case, multislice computed tomography (MSCT) with intravenous contrasting revealed multiple diverticula of the jejunum with reactively altered walls, infiltration of the adjacent cellular tissue and small gas inclusions, indicating diverticulum microperforation. Esophagogastroduodenoscopy (EGD) was performed which confirmed the jejunum bleeding, and was followed by laparotomy which confirmed multiple jejunal diverticula with microperforation and bleeding. Thus, timely MSCT in combination with EGD allowed to avoid complications of jejunal diverticulitis.

A119 ACUTE DIVERTICULITIS & CONCURRENT DIVERTICULAR BLEED: A RARE CLINICAL ENTITY

AimsColonic diverticula are mostly asymptomatic incidental findings on cross sectional imaging or colonoscopy. In the setting of known diverticulosis, complications like diverticulitis and diverticular bleeding occur in only 4% and 1% of patients respectively. It is unusual to see both complications expressed in the same patient and moreover, rare to see them expressed concurrently. We report a case of concurrent diverticulitis with diverticular bleed and expand on the clinical course.MethodsCase reportResultsA 73-year old was diagnosed with sigmoid diverticulitis based on her clinical presentation and an abdominal CT scan. She was discharged home on oral antibiotics but presented a week later with painless rectal bleeding. In view of the ongoing diverticulitis, a colonoscopy was not pursued although it is the typical procedure of choice to manage active gastrointestinal bleeding. A CT scan was recommended as the alternate initial investigation, which revealed active colonic bleeding in the region of the hepatic flexure immediately adjacent to a diverticulum. A subsequent CT angiogram identified the middle colic artery to be the responsible blood supply to the region and embolization coils were deployed within this vessel in an attempt to achieve hemostasis.Despite vascular intervention the patient continued to bleed and resuscitation with blood products was insufficient. A repeat CT scan ruled out any areas of colonic ischemia as well as any further active areas of extravasation. A decision was made to proceed with a total colectomy to provide definitive treatment of the diverticular disease and manage the bleeding. An urgent intraoperative colonoscopy was attempted but quickly abandoned due to suboptimal preparation and ongoing bleeding obscuring the view. The patient underwent a total colectomy with ileorectal anastomosis. On pathology there was extensive diverticulosis of the ascending and the sigmoid colon with diverticulitis and diverticular abscess cavities within the sigmoid colon.ConclusionsDiverticulitis and diverticular bleed are thought to be unrelated complications of diverticulosis involving distinct physiologic pathways (Figure 1). Although diverticular bleed may occur in patients with a history of prior diverticulitis, concurrent presentation of these two entities is extremely rare. In addition, diverticular bleed is mostly self-limiting. While endoscopic and vascular embolization are established treatment options, colectomy is rare for the management of diverticular bleeding.We report a rare case of concurrent diverticulitis and lower GI bleeding. The presence of the sigmoid diverticulitis made interventional radiology a relatively safer option over endoscopy, which is the typical first line diagnostic and interventional procedure. Ongoing bleeding led to total colectomy and provided the patient with a definitive cure for her diverticular disease. Funding AgenciesNone

Indications for Emergency Abdominal Surgeries in Older Patients: 7-Year Experience of a Single Centre

The majority of patients undergoing emergency laparotomy are older adults that carry the highest mortality. More research into the development of targeted interventions is required. Therefore, the aim of the study was to analyse the indications for emergency abdominal surgery in patients aged ≥ 65 admitted to the Department of General Surgery. The study included consecutive patients aged ≥ 65 who underwent emergency abdominal surgery within 48 h after admission at one institution. In 2010–2017, 986 patients were enrolled in the study (female 57%, male 43%). Patients were divided into three age groups, 65–70, 71–84 and ≥ 85, with 255 patients (25.9%), 562 patients (57.0%) and 169 patients (17.1%) in each group, respectively. In the first and second age groups, the most common indications for surgery were acute cholecystitis, non-malignant ileus, colorectal cancer complications and acute appendicitis. In the oldest patients, the most common indications were complications of colorectal cancer, acute cholecystitis, non-malignant ileus and complications of diverticulosis. In the women, the biggest differences in indications between age groups were colorectal cancer (p = 0.025) and peptic ulcer disease complications (p = 0.005); in the men, the biggest difference was seen for complicated diverticulitis (p = 0.001). The most frequent comorbidities were heart diseases (81.0%), followed by endocrine (33.6%) and vascular diseases (22.7%). The three most common indications for emergency surgery in older patients at our institution were acute cholecystitis, colorectal cancer complications and non-malignant bowel obstruction, affecting 59.5% of this group of patients. Elective surgery and endoscopic screening have the potential to prevent major part of these acute diseases. However, further prospective research is necessary on this field, particularly among frail, older patients.

Special Considerations of Diverticulitis and Diverticular Bleeding

Diverticulitis in certain subpopulations of patients may require different treatments, especially in the elective setting. Diverticular bleeding, another complication of diverticulosis, is another source of burden on United States healthcare from diverticular disease. This chapter discusses the special circumstances of right-sided diverticulitis, diverticulitis in young patients or immunocompromised patients, recurrent diverticulitis after resection, giant colonic diverticulum, and rare presentations of diverticulitis. Atypical types of diverticulitis such as segmental colitis associated with diverticulosis (SCAD), symptomatic uncomplicated diverticular disease (SUDD), and smoldering diverticulitis are also reviewed, and indications for surgical intervention are summarized. Current controversies are reviewed, including the decision to operate in young or immunocompromised patients; management of SCAD, SUDD, or smoldering diverticulitis; and best localization method to diagnose diverticular bleeding. This review contains 6 figures, 2 tables, and 55 references. Key Words: atypical diverticulitis, diverticular bleeding, diverticular disease, diverticulosis, gastrointestinal bleeding, right-sided diverticulitis, segmental colitis associated with diverticulosis, smoldering diverticulitis, symptomatic uncomplicated diverticular disease, total abdominal colectomy

Mo1707 The Effect of Pentadecapeptide BPC 157 on Colovesical Fistula Healing

Introduction. A colovesical fistulas present an important clinical problems. They usually occur as a complication of diverticulosis, IBD or malignant process. The pentadecapeptide BPC 157 , in clinical trials for IBD therapy, has already shown the effectiveness in healing colocutaneous fistulas ( J. Pharmacol Sci 2008 ) , gastrocutaneous fistulas ( Dig Dis Sci 2009 ). Therefore we suggest it as a possible therapy of colovesical fistulas. Matherials and methods. Wistar Albino rats were randomly assigned, at 5 cm from anocutanous borderline, with the diameter of 3 mm. The surgical procedure was performed according to rules brought by the Local Ethical Committee. Medication of BPC 157 (10ug/kg, 10ng/kg) was per-orally, in drinkingwater and intraperitoneally, once daily, the first dose immediately after the operation, the last dose at 24 h before sacrifice, at 7, 15, 30 post-operative day, with the biomechanical, functional, macroscopic and microscopic assessment. Results. Biomechanical analysis :we measured pressure of the fistulas rupture for all groups of animals with the system for central venous pressure assesment .In the control group pressures for fistulas rupture were similar for every experimental period : ≤1mL H2O, 1mL±0,3 mL, 2 mL±0,5 ml H2O. In the second group( BPC per-orally in drinking water 10ug/kg and 10ng/kg ) water pressures were 1mL±0,3; 2mL±0,3 and 5mL±0,5 but without fistulas rupture at the and of 30 days experimental period.In the third group( BPC intraperitoneally 10ug/kg and 10ng/kg ) water pressure was increased from 2mL±0,5mL until 5 mL±0,5 at the and of 15 days experimental period. In most animals fistulas were healed at the end of 30 days experimental period. Macroscopic analysis: We measured diameters of fistulas on the colonic and the bladder side.In the control group diameters of fistulas were similar for both sides for all experimental periods : 3mm ±0.5mm on the colon and bladder side,3mm±1mm and 2,5±0,5mm. In the second group fistulas diameter was 3±0,2 mm for both sides ( 7 days ),2mm±0,5 mm for colon and 2,5±0,5 mm for bladder ( 15 days ), 1,5mm±0,5 for colon, 2mm±0,5 mm for bladder side ( 30 days ). In the third group fistulas were reduced : 2,5mm±0,2mm colon, 3mm±0,5 bladder ( 7 days ), 1,5mm±0,5mm colon; 2mm±0,5mm bladder ( 15 days ) and at the end oft he 30 days experimental period in most animals fistulas were healed er reduced diameter at 1mm±0,3mm for both sides.. Conclusion. According to these results the pentadecapeptide BPC 157 could present a new possible pathway in therapy of colovesical fistulas.

Mo1708 Serum-Derived Bovine Immunoglobulin/Protein Isolate Attenuated DSSInduced Colitis in a Defined Floral Model

Introduction. A colovesical fistulas present an important clinical problems. They usually occur as a complication of diverticulosis, IBD or malignant process. The pentadecapeptide BPC 157 , in clinical trials for IBD therapy, has already shown the effectiveness in healing colocutaneous fistulas ( J. Pharmacol Sci 2008 ) , gastrocutaneous fistulas ( Dig Dis Sci 2009 ). Therefore we suggest it as a possible therapy of colovesical fistulas. Matherials and methods. Wistar Albino rats were randomly assigned, at 5 cm from anocutanous borderline, with the diameter of 3 mm. The surgical procedure was performed according to rules brought by the Local Ethical Committee. Medication of BPC 157 (10ug/kg, 10ng/kg) was per-orally, in drinkingwater and intraperitoneally, once daily, the first dose immediately after the operation, the last dose at 24 h before sacrifice, at 7, 15, 30 post-operative day, with the biomechanical, functional, macroscopic and microscopic assessment. Results. Biomechanical analysis :we measured pressure of the fistulas rupture for all groups of animals with the system for central venous pressure assesment .In the control group pressures for fistulas rupture were similar for every experimental period : ≤1mL H2O, 1mL±0,3 mL, 2 mL±0,5 ml H2O. In the second group( BPC per-orally in drinking water 10ug/kg and 10ng/kg ) water pressures were 1mL±0,3; 2mL±0,3 and 5mL±0,5 but without fistulas rupture at the and of 30 days experimental period.In the third group( BPC intraperitoneally 10ug/kg and 10ng/kg ) water pressure was increased from 2mL±0,5mL until 5 mL±0,5 at the and of 15 days experimental period. In most animals fistulas were healed at the end of 30 days experimental period. Macroscopic analysis: We measured diameters of fistulas on the colonic and the bladder side.In the control group diameters of fistulas were similar for both sides for all experimental periods : 3mm ±0.5mm on the colon and bladder side,3mm±1mm and 2,5±0,5mm. In the second group fistulas diameter was 3±0,2 mm for both sides ( 7 days ),2mm±0,5 mm for colon and 2,5±0,5 mm for bladder ( 15 days ), 1,5mm±0,5 for colon, 2mm±0,5 mm for bladder side ( 30 days ). In the third group fistulas were reduced : 2,5mm±0,2mm colon, 3mm±0,5 bladder ( 7 days ), 1,5mm±0,5mm colon; 2mm±0,5mm bladder ( 15 days ) and at the end oft he 30 days experimental period in most animals fistulas were healed er reduced diameter at 1mm±0,3mm for both sides.. Conclusion. According to these results the pentadecapeptide BPC 157 could present a new possible pathway in therapy of colovesical fistulas.

Issue Highlights

Issue Highlights

SMALL BOWEL DIVERTICULAR DISEASE;

Objectives: 1). To see the prevalence of small bowel diverticulosis in patients presenting with acute abdomen. 2). To knowpresentation and complications of diverticulosis in teaching hospital in Sialkot region of Pakistan. Introduction: Small bowel diverticulardisease may be complicated by small bowel obstruction. Multiple diverticulosis represents an uncommon pathology of the small bowel.Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction, and acute pancreatitis appear in 10-30% ofthe patients, increasing the morbidity and mortality rates. This pathology which is uncommon is much higher in our study in patientsundergoing exploratory laparotomy in district level hospitals in Sialkot region of Pakistan. Study Design: Prospective and observational.Setting and duration: Combined Military Hospital, Sialkot (June 2005 to August 2010). Islam teaching hospital, Sialkot (September 2010to September 2012). Methods: 260 consecutive patients undergoing exploratory laparotomy for obstruction, peritonitis, pain and massabdomen were included in the study. Patient with established cause of obstruction were excluded. The data including demographicinformation, presentation, operative findings, complications and follow up were entered in structured proforma. Patients with less thanthree months of followup were also excluded from study. Results: Small bowel diverticuli were encountered in 24 (9%) out of 260 patientsincluding; 8 (3%) Meckel's, 9 (3.5%) jejunal, 3 (1.2%) duodenal and 4 (1.5%) Ileal diverticuli. These patients with diverticuli presented asintestinal obstruction, peritonitis, mass abdomen, vague abdominal pain and one patient with fresh bleeding per rectum. The indicationsof surgery were peritonitis 6 (25%), intestinal obstruction 13 (54.2%), abdominal mass 3(12.5%), nonspecific abdominal pain 1 (4.2%)and fresh bleeding per rectum of obscure origin 1 (4.2%). Complications encountered as Intestinal obstruction due to adhesion formationin 8; obstruction due to congenital bands attached to diverticuli in 3; diverticular perforation in 2; peritonitis due to diverticulitis in2,bleeding from arteriovenous malformation within the jejuna diverticuli in 1 and mass formation due to volvulus in 1. Three duodenaldiverticuli and 4 jejunal diverticuli were found as silent pathologies synchronous with other active pathologies.

A High-Fiber Diet Does Not Protect Against Asymptomatic Diverticulosis

The complications of diverticulosis cause considerable morbidity in the United States; health care expenditures for this disorder are estimated to be $2.5 billion per year. Many physicians and patients believe that a high-fiber diet and frequent bowel movements prevent the development of diverticulosis. Evidence for these associations is poor. We sought to determine whether low-fiber or high-fat diets, diets that include large quantities of red meat, constipation, or physical inactivity increase risk for asymptomatic diverticulosis. We performed a cross-sectional study of 2104 participants, 30-80 years old, who underwent outpatient colonoscopy from 1998 to 2010. Diet and physical activity were assessed in interviews using validated instruments. The prevalence of diverticulosis increased with age, as expected. High intake of fiber did not reduce the prevalence of diverticulosis. Instead, the quartile with the highest fiber intake had a greater prevalence of diverticulosis than the lowest (prevalence ratio = 1.30; 95% confidence interval, 1.13-1.50). Risk increased when calculated based on intake of total fiber, fiber from grains, soluble fiber, and insoluble fiber. Constipation was not a risk factor. Compared to individuals with <7 bowel movements per week, individuals with >15 bowel movements per week had a 70% greater risk for diverticulosis (prevalence ratio = 1.70; 95% confidence interval, 1.24-2.34). Neither physical inactivity nor intake of fat or red meat was associated with diverticulosis. A high-fiber diet and increased frequency of bowel movements are associated with greater, rather than lower, prevalence of diverticulosis. Hypotheses regarding risk factors for asymptomatic diverticulosis should be reconsidered.

Increased Prevalence and Complications of Diverticulosis Among Hospitalized Inflammatory Bowel Disease Patients

Increased Prevalence and Complications of Diverticulosis Among Hospitalized Inflammatory Bowel Disease Patients

The Pathology of Diverticular Disease

Left-sided diverticular disease of the colon is a common affliction of the elderly that is widely believed to be a consequence, at least in part, of consumption of low fiber diets. Complications of diverticulosis (diverticulitis, hemorrhage, perforation, peridiverticular abscess, fistula, stricture) account for > 300,000 hospital admissions annually in the United States at a cost of $2.6 billion. Morphologic changes in the sigmoid colon include shortening of this segment of large intestine with thickening of the circular muscle of the bowel wall, enlargement of the crescentic folds of circular muscle and the mucosal folds, and bunching up of the mesocolon. Mucosal diverticula emerge through the thickened circular muscle into the subserosa at points of entry of blood vessels as a result of locally increased intracolonic pressure. The development of the muscular changes predates formation of diverticula. It is claimed by some investigators that the muscle changes are not due to hypertrophy or hyperplasia but this has been disputed. A substantial increase in the elastin content of the taeniae with increasing age and in diverticular disease has been reported, without alterations in the content of elastin or collagen in the circular muscle. Increased cross-linking of collagen increases the rigidity of the bowel wall. Myoelectrical and mannometric studies show hypermotility of the sigmoid colon in diverticular disease and increased intraluminal pressure, and morphologic studies have documented loss of neurons with age, and also loss of the interstitial cells of Cajal, believed to be the pacemakers of the colon.

The Outcome of Diverticulosis in Kidney Recipients With Polycystic Kidney Disease

Introduction Diverticulosis is a common finding in autosomal-dominant polycystic kidney disease (ADPKD). To avoid the serious complications of diverticulosis after kidney transplantation, some policies have recommended aggressive actions, such as elective colectomy. These policies are not widely agreed upon. This controversy led us to investigate the serious complications and the outcome of diverticulosis in ADPKD kidney recipients to see whether such therapies are justified. Materials and methods From 2002 to 2006, we followed 18 ADPKD kidney recipient patients with barium enema-documented diverticulosis. All subjects were asymptomatic for diverticulosis at the time of transplantation. The mean value ± SD of follow-up duration was 25.4 ± 28.5 months. We documented demographic data, familial history of ADPKD, barium enema findings, and complications as well as graft and patient survivals. Results Hepatic flexure was the most prevalent site for diverticula. The mean (SD) of diverticular count was 6 ± 5.1. Patients with a familial history of ADPKD showed a higher number of diverticular ( P = .01). Diverticulitis occurred in three patients, all of whom died. Conclusion Diverticulitis is a fatal and not rare complication in ADPKD patients. The rate of complications in our study was similar to previous findings, but we observed serious complications even among patients asymptomatic at the time of transplantation. The decision to take aggressive action such as elective colectomy is still a matter of debate that needs further evaluation.

Meta-analysis on minimally invasive surgical therapy of sigmoid diverticulitis

The bowel diverticulitis is a complication of diverticulosis, occuring in 35% patients in 20 years after diagnosis. The study purpose was analysis of the results published in world literature. Double blind electronic search of several databases using key words: diverticulitis, laparoscopy. 11 studies with 415 patients that satisfy the criteria were selected. AGE: 62.7 + 14.2. Hinchey stadiums: I, IIa i IIb of these 44% I and 28% IIa i Iib each. Operative time: 197.4 +/- 49.6 min. Conversions: 11.7 +/- 10.1 (0 - 38.9%). Protective stoma: 5.5%. Bowel sounds: 2.3 - 3.2 postoperative day. Oral feeding: 2.6-5 postoperative day. Hospitalization: 6.1 2.1 dana. Anastomotic dehiscence: 2.8%, wound infection: 7.3%, iatrogen rectum perforation with stapler: 3.3%, bleeding: 3.5%, ileus: 4.4%, reoperation rate: 4.7%. Sigmoid resection with or without a protective "loop" ileostomy is technically feasable by minimally invasive surgical technique, with an acceptable ratio of benefits and complications.

Giant sigmoid diverticula: a review.

Two patients with giant sigmoid diverticula are added to 13 cases reported in the literature and the clinical features of this rare complication of diverticulosis are reviewed. These lesions probably arise as pseudodiverticula of the sigmoid colon with herniation of the mucosa through the muscle wall. They become progressively inflated by colonic gas via a ball-valve type mechanism. They are best treated by resection of the diverticulum, in continuity with the involved sigmoid, and primary anastomosis.