Multiple Diverticula Research Articles

Infected Hepatic Cyst Treated with Percutaneous Transhepatic Drainage

Simple hepatic cysts are common benign lesions that are usually asymptomatic and require no treatment. However, complications can occur. This report describes a patient with an infected hepatic cyst treated with percutaneous transhepatic drainage. A 64-year-old woman presented at a nearby hospital because of acute right-upper-quadrant pain, mild left-lower-quadrant pain, diarrhea, and fever. She was admitted and received intravenous antibiotics for 1 week, but symptoms persisted. She was, therefore, referred to our hospital. On admission, ultrasonography demonstrated multiple hepatic cysts. One 13-cm lesion was hypoechoic, unlike the other simple cysts, which were anechoic. Computed tomography showed that the density of the hypoechoic cyst was slightly higher than that of the other cysts. The wall of the cyst was thickened and showed contrast enhancement. On initial laboratory tests the serum C-reactive protein concentration was 18.49 mg/dL, and the white-cell count was 13,300/microL. An infected hepatic cyst was suspected, and percutaneous transhepatic drainage of the cyst was performed. A catheter was inserted into the cyst, and dark red fluid was obtained. The right-upper-quadrant pain gradually resolved after drainage. An infected hepatic cyst was diagnosed, and system antibiotics were administered. However, the mild left-lower-quadrant pain persisted. No pathogens were isolated from the drainage fluid. Minocycline hydrochloride (200 mg) was injected, and the catheter was clamped for 30 minutes, once daily for 3 days. The serum C-reactive protein concentration was 1.78 mg/dL, and the white-cell count was 5,700/microL. The left-lower-quadrant pain resolved, and colonoscopic examination revealed multiple diverticula of the sigmoid colon. Infection has not recurred, and the hepatic cyst has not become larger.

Häufigkeit und Bedeutung der Pseudodivertikulose des Dünndarmes

Diverticula of the small intestine were found in four among 358 consecutive major abdominal surgical procedures (1.1%). The prevalence rate was 4% among patients over the age of 70 years. All of the discovered diverticula were located in the proximal jejunum. Two patients had single, two had multiple diverticula. All patients were women (aged 73, 78, 81 and 86 years). In three the finding was by chance: in one the operation had been done for a perforating duodenal ulcer, in two because of ileus. The 86-year-old woman was operated for lower intestinal bleeding. During the operation a solitary diverticulum, the cause of the bleeding, was excised.

Tracheal and main bronchial diverticula: the role of CT

This paper describes an asymptomatic and rarely diagnosed entity without a clear correlation with respiratory disease identified in 1%-2% of cases at spiral computed tomography (CT). We retrospectively reviewed the CT features of air collections contiguous to the tracheal or main bronchial wall and communicating with the airway in 16 patients undergoing CT for other reasons. Four patients were also studied by virtual bronchoscopy and three by actual bronchoscopy. Thirteen of the 16 patients had a single diverticulum, whereas the remaining three had multiple diverticula. Only one patient had a bronchial diverticulum. The most frequent site was the right posterolateral wall of the trachea at the level of the second or third thoracic vertebral body. In 2/3 of patients, chronic obstructive pulmonary disease was not documented. CT was the most effective method for evaluating the presence and features of diverticula. A correlation between tracheobronchial diverticula and chronic respiratory disease was documented in 5/16 patients, whereas no respiratory disorder was identified in the remaining 11. Although chronic inflammatory tracheobronchial changes and increased endoluminal pressure may be important causes, we hypothesise that other, as yet unknown, aetiopathological factors could exist.

Hepatic Abscess That Formed Secondary to Fish Bone and Had a Fistula With the Ascending Colon

We present the case of a liver abscess that formed secondary to foreign bodies and formed a fistula the ascending colon and was successfully treated with percutaneous abscess drainage and colonoscopic removal of foreign bodies. A 64-year-old man presented with right upper and lower quadrant pain of 2 weeks' duration. Abdominal computed tomography was performed, demonstrating a single 3.5 x 1.9-cm abscess of the liver's right lobe and eccentric thickening of the colon wall at hepatic flexure. A percutaneous hepatic drainage catheter was placed under ultrasound guidance. Colonoscopic examination revealed multiple diverticula of the ascending colon and two 1.5-cm long fish bones at the ascending colon near the hepatic flexure. One end of each fish bone had impacted the edematous colonic mucosa and was surrounded by exudate polypoid inflammatory tissue. The fish bones were extracted with forceps. The patient was feeling well and was discharged after 12 days of treatment.

Diverticulitis of the Right Colon: Tips for Preoperative Diagnosis and Treatment Strategy

Received May 25, 2007, Accepted June 11, 2007 Correspondence to: Suk Kyun Chang, Department of Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #62, Youido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea. Tel: +82-2-3779-1175, Fax: +82-2-786-0802 E-mail: cmcgslee@catholic.ac.kr Purpo se: The planned therapy of right colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotom y. W e retrospectively analyzed the clinical characteristics of right colonic diverticulitis, the clinical distinctions between preoperatively and postoperatively diagnosed patients, the recurrence rate, and the hospital stay by treatm ent m odality. M etho ds: Among 104 patients w ho w ere treated for right colonic diverticulitis from January 1997 to M ay 2005, w e enrolled 90 patients who had been diagnosed by the operation or a barium enem a study (BE), and who had not been lost to follow -up. Patients were divided into three groups based on treatment modality: Group 1 (n= 28), conservative m anagement w ith intravenous antibiotics; Group 2 (n= 46), aggressive resection; Group 3 (n= 16), appendectomy w ith intravenous antibiotics. Results: U ltrasound and computed tomography (CT) detected 12 (22.6% ) and 21 (87.5% ) cases of right colonic diverticulitis, respectively. BE was applied to 45 patients, 28 (62.2% ) of them with multiple diverticula. Right colonic diverticulitis was the preoperative diagnosis in 39 patients (43.3% ). The length of hospital stay was significantly different between the groups (P<0.001): 4.9± 3.1 days in Group 1, 7.5± 3.7 days in Group 2, and 3.8± 0.9 days in Group 3. Two patients (7.1% ) in Group 1, 2 patients (4.3% ) in Group 2, and 5 patients (31.3% ) in Group 3 had recurrent diverticulitis during the follow-up period (P= 0.007). The Kaplan-Meier estimated recurrence rates for Groups 1, 2, and 3 were statistically significantly different (P= 0.0086). C o nclusio ns: To differentiate right colonic diverticulitis from appendicitis, focusing on the peculiar feature in contrast to appendicitis and appropriate utilization of CT are important. If diagnosed preoperatively, uncomplicated right colonic diverticulitis can be managed by conservative management with intravenous antibiotics. If diagnosed intraoperatively, aggressive resection is advocated as the most effective method for decreasing the recurrence rate. J Korean Soc C oloprocto l 2007;23:223-231

Occult Gastrointestinal Bleeding due to Acquired von Willebrand Syndrome in a Patient with Hypertrophic Obstructive Cardiomyopathy

A 69-year-old woman presented with a harsh systolic murmur and severe anemia. Echocardiography demonstrated hypertrophic obstructive cardiomyopathy with a peak pressure gradient of 154 mmHg. Endoscopic examinations disclosed an angiodysplasia and multiple diverticula in the colon, but no active bleeding was noted in these lesions. A selective defect of large multimers of von Willebrand factor was detected by electrophoresis. After collection of anemia and Ca antagonist therapy, left ventricular obstruction was relieved and cessation of the occult gastrointestinal bleeding was obtained. This is the first report whereby acquired type 2A von Willebrand syndrome was caused by hypertrophic obstructive cardiomyopathy.

Enterolith Small-Bowel Obstruction Caused by Jejunal Diverticulosis: Report of a Case

We report the successful surgical treatment of intestinal obstruction caused by enteroliths formed in jejunal diverticula. A 78-year-old man with bowel obstruction of unknown etiology was initially managed conservatively, but suffered recurrence of the obstruction. Thus, we performed a laparotomy, which revealed multiple diverticula in the jejunum, with one enterolith inside a diverticulum and one enterolith in the terminal ileum. There was no abnormal communication between the gallbladder and the intestinal tract, excluding the possibility of a gallstone ileus. The stone in the terminal ileum could not be broken manually, so we performed an enterotomy to remove the stones. Intestinal obstruction caused by enteroliths in small-bowel diverticula is a rare event, which is difficult to diagnose and manage. To our knowledge, only 35 such cases have ever been reported.

Spontaneous Acute Mediastinitis Secondary to Rupture Esophageal Diverticula in Patient with Esophageal Diverticulosis

We are presenting a patient who had spontaneous perforation of esophageal diverticulosis with limited mediastinitis. The patient is a 45-year-old white male who presented with fever, hypoxemia, and chest pain. He was in a good state of health until one month before presentation, when he developed solid food dysphagia. with emesis (On one occasion). Three days prior to presentation he developed right sided chest pain, with radiation to back. The pain worsened, and became associated with SOB. CT was negative for PE. The patient's pain intensified further, requiring him to be transferred to our hospital. Upon arrival he exhibited the following signs and symptoms: fever, chest discomfort, red throat, and decreased breath sounds to auscultation on the right. Remainder of PE was negative. Repeat CT of the chest with contrast showed air in the mediastinum but no contrast leak. Patient was started on broad spectrum antibiotics, esophagram with gastrografin and barium showed no extra-luminal leak but multiple diverticula in the esophgeal wall (Figure 1). Patient underwent thoracentesis with removal of inflammatory fluid.Patient was placed on liquid diet and he continues to improve with conservative therapy and he was discharged home. Endoscopy 6 weeks later confirmed the presence of the diverticulosis (Figure 2). The patient remained symptoms free 4 month after inital presenattion. Diffuse intramural esophageal diverticulosis is a rare entity that was first described in 1960. Multiple cases have been reported, most of them presenting with Dysphagia, this case is unique because the initial presentation was with mediastinitis and the patient was treated conservatively with good result. [figure 1][figure 2]Figure 1Figure 2

Jumbo biopsy is useful for the diagnosis of colonic prolapsing mucosal polyps with diverticulosis

We report here a case of multiple prolapsing mucosal polyps with diverticulosis in the sigmoid colon. A 52-year-old man was admitted to our hospital because of bloody diarrhea. Colonoscopy and barium enema showed multiple diverticula, markedly thickened mucosal folds and polypoid lesions with mucus on the top of them in the sigmoid colon. Endoscopic ultrasonography showed thickening of the mucosal and submucosal layers. Several endoscopic biopsy specimens were taken from the polypoid lesions. Histological examination revealed only chronic inflammatory cell infiltration. In order to obtain a definite diagnosis, we performed endoscopic jumbo biopsy for the polypoid lesions after obtaining informed consent. Histological examination revealed marked lymphocyte infiltration, hemosiderin deposits and fibromuscular obliteration in the lamina propria, features similar to those of mucosal prolapsing syndrome. After anti-diarrhetic treatment, clinical findings were improved. Thus, jumbo biopsy is useful for diagnosis and treatment of prolapsing mucosal polyps.

Radiologic Findings of Perforated Jejunal Diverticulitis: A Case Report

We report a case of perforated jejunal diverticulitis in a 68-year-old man with iatrogenic Cushing’s syndrome. The patient presented with right upper abdominal pain. Ultrasonography showed a hypoechoic structure connected to a small bowel loop, and subsequent CT examination showed multiple diverticula in proximal jejunal loops with free air trapped within the mesenteric leaf. Segmental resection of the jejunal loop confirmed jejunal diverticulitis with perforation.

A 'corrugated' extrahepatic bile-duct: a new cholangiographic picture.

Abstract A patient with an operative cholangiogram showing appearances suggestive of multiple diverticula is recorded; these appearances are apparently unique.

Esophageal Pseudodiverticulosis

A 39-year-old woman with human immunodeficiency virus infection and intermittent compliance with antiretroviral medication and CD4 count <100 presented with odynophagia, dysphagia, and weight loss. An esophagoscopy (Figure A) revealed multiple outpouchings throughout the esophagus with a somewhat narrowed lumen and poor contractility. Biopsies showed chronic inflammation with candidal forms present. There was no evidence of either herpes simplex virus or cytomegalovirus infection. Barium esophogram (Figure B) revealed multiple tracks of barium paralleling the esophageal lumen. The patient was treated with antifungal medication with no resolution of her symptoms. Persistent inability to maintain her weight resulted in placement of a percutaneous endoscopic gastrostomy.Esophageal pseudodiverticulosis is a rare cause of dysphagia and has been described in the setting of chronic inflammation due to infection or reflux.1Hahne M. Schilling D. Arnold J.C. et al.Esophageal intramural pseudodiverticulosis.J Clin Gastroenterol. 2001; 33: 378-382Crossref PubMed Scopus (46) Google Scholar The diagnosis might not always be as apparent as in this case because the diverticula can be quite small. Confirmation can be obtained radiologically. Findings include multiple diverticula, esophageal narrowing or stricture, and/or tracking of barium. These tracks, visible on the barium study, are often misinterpreted as linear ulcerations and have been reported as a feature of esophageal pseudodiverticulosis.2Canon C.L. Levine M.S. Cherukuri R. et al.Intramural tracking a feature of esophageal intramural pseudodiverticulosis.AJR. 2000; 175: 371-374Crossref PubMed Scopus (21) Google Scholar They represent a separation, which develops between a thickened mucosa and submucosa resulting from chronic inflammation, and the underlying muscular layer. Treatment has included bougienage, when there is an accompanying stricture, and treatment of the underlying condition. A 39-year-old woman with human immunodeficiency virus infection and intermittent compliance with antiretroviral medication and CD4 count <100 presented with odynophagia, dysphagia, and weight loss. An esophagoscopy (Figure A) revealed multiple outpouchings throughout the esophagus with a somewhat narrowed lumen and poor contractility. Biopsies showed chronic inflammation with candidal forms present. There was no evidence of either herpes simplex virus or cytomegalovirus infection. Barium esophogram (Figure B) revealed multiple tracks of barium paralleling the esophageal lumen. The patient was treated with antifungal medication with no resolution of her symptoms. Persistent inability to maintain her weight resulted in placement of a percutaneous endoscopic gastrostomy. Esophageal pseudodiverticulosis is a rare cause of dysphagia and has been described in the setting of chronic inflammation due to infection or reflux.1Hahne M. Schilling D. Arnold J.C. et al.Esophageal intramural pseudodiverticulosis.J Clin Gastroenterol. 2001; 33: 378-382Crossref PubMed Scopus (46) Google Scholar The diagnosis might not always be as apparent as in this case because the diverticula can be quite small. Confirmation can be obtained radiologically. Findings include multiple diverticula, esophageal narrowing or stricture, and/or tracking of barium. These tracks, visible on the barium study, are often misinterpreted as linear ulcerations and have been reported as a feature of esophageal pseudodiverticulosis.2Canon C.L. Levine M.S. Cherukuri R. et al.Intramural tracking a feature of esophageal intramural pseudodiverticulosis.AJR. 2000; 175: 371-374Crossref PubMed Scopus (21) Google Scholar They represent a separation, which develops between a thickened mucosa and submucosa resulting from chronic inflammation, and the underlying muscular layer. Treatment has included bougienage, when there is an accompanying stricture, and treatment of the underlying condition.

A case of endoscopic hemostasis for the bleeding of the multiple duodenal diverticula

An 84-year-old female was admitted to our hospital because of hematemesis and melena. At emergency gastrointestinal endoscopy, multiple diverticula with clot were visualized in the second portion of the duodenum. Since active bleeding from the diverticulum persisted, although a vessel was not visible, endoscopic hemostasis was performed using clipping. However, she developed massive melena 6 days after. Endoscopic examination revealed active bleeding from the diverticulum in the oral side of the papilla of Vater, and hemostasis using clipping was performed successfully. No hemorrhage occurred thereafter. The case in this study suggests that endoscopic clipping is a safe and effective method of hemostasis for the hemorrhage from the diverticulum.

Sodium polystyrene induced colonic perforation unmasked after flexible sigmoidoscopy

77 years old female with CAD, CVA, and polycystic kidney disease was admitted for 2 weeks of abdominal pain and 20 lb weight loss with anorexia over 6 months. Three weeks prior to this admission, she was given stool softeners for constipation. Subsequently, she had diarrhea and developed sharp left lower quadrant abdominal pain radiating to her back; associated with nausea and bilious vomiting. She also had 1 week of fevers up to 100°F which dissipated upon admission. Physical exam revealed normoactive bowel sounds and left lower quadrant tenderness without rebound or guarding. Lab data: hemoglobin 9.0 gm/dl, white count 9.2 k/cu mm, BUN 52 mg/dl and creatinine 2.6 mg/dl, bicarbonate 14 mmol/liter and lactate 0.5 mmol/liter. A CT scan of the abdomen revealed large tumor involving the sigmoid colon, sigmoid diverticula, polycystic kidneys, and small pericardial effusion. Empiric antibiotics (levofloxacin and metronidazole) were given. During hospitalization, she developed K+ 5.1 mg/dl for which she received a dose of oral sodium polystyrene (SPS). Flexible-sigmoidoscopy up to 35 cm from the anal verge revealed multiple diverticula and edematous and erythematous folds from 15 cm to 20 cm (biopsy showed acute colitis with focal non-necrotizing granulomas). Immediately post-sigmoidoscopy, she developed distended, tympanic abdomen and became tachycardic. An abdominal x-ray revealed free air and she underwent emergency exploratory laparotomy. The left colon was rock hard and the right colon was dusky with gross fecal soilage from cecal perforation. A right hemicolectomy was performed along with an abdominal wash out. Pathological examination revealed acute ischemic perforation of cecum with SPS crystals noted within the feces and in the perforation tract. She continued to deteriorate and expired one week later.

Right-Sided Diverticulitis—Surgical and Nonsurgical Treatment: Two Case Reports and Review of the Literature

Right-sided diverticulitis is difficult to distinguish from other sources of right-sided abdominal pain. Diverticula localized to the right colon occur at a rate of 6.6 to 14 per cent. Two types of diverticula have been described in the right colon on the basis of etiologic and pathologic features: multiple diverticula and solitary diverticulum of the cecum. The most common clinical presentation of right-sided colonic diverticula is an acute inflammatory complication, which is difficult to distinguish from other causes of right iliac fossa pain. We present two case reports on right-sided diverticulitis with one treated surgically and the other treated nonsurgically. The clinical manifestations, differential diagnosis and management options are discussed including a review of the literature.

Physiologic basis for the treatment of epiphrenic diverticulum.

To quantitate and characterize the motility abnormalities present in patients with epiphrenic diverticula and to assess the outcome of surgical treatment undertaken according to these abnormalities. The concept that epiphrenic diverticula are complications of esophageal motility disorders rather than primary anatomic abnormalities is gradually becoming accepted. The inconsistency in identifying motility abnormalities in patients with epiphrenic diverticula is a major obstacle to the general acceptance of this concept. The study population consisted of 21 consecutive patients with epiphrenic diverticula. All patients underwent videoesophagography, upper gastrointestinal endoscopy, and esophageal motility studies. The diverticula ranged in size from 3 to 10 cm and were predominantly right-sided. Seventeen patients underwent transthoracic diverticulectomy or diverticulopexy with esophageal myotomy and an antireflux procedure. The length of the myotomy was determined by the extent of the motility abnormality. Transhiatal esophagectomy was performed in one patient with multiple diverticula. Two patients declined surgical treatment and another patient died of aspiration before surgery. Symptomatic outcome was assessed via a questionnaire at a median of 24 months after surgery. The primary symptoms were dysphagia in 5 (24%) patients, dysphagia and regurgitation in 11 (52%) patients, and pulmonary symptoms in 5 (24%) patients. The median duration of the primary symptoms was 10 years. Esophageal motility abnormalities were identified in all patients. An esophageal motor disorder was diagnosed only by 24-hour ambulatory motility testing in one patient, and 24-hour ambulatory motility testing clarified the motility diagnosis in five other patients. The most common underlying disorder was achalasia, which was detected in nine (43%) patients. A hypertensive lower esophageal sphincter was diagnosed in three patients, diffuse esophageal spasm in five, "nutcracker" esophagus in two, and a nonspecific motor disorder in two patients. One patient had an intraoperative myocardial infarction and died. Two patients had persistent mild dysphagia after surgery. The remaining patients had complete relief of their primary symptoms. There is a high prevalence of named motility disorders in patients with epiphrenic diverticula, and this condition is associated with the potential for lethal aspiration. Twenty-four-hour ambulatory motility testing can be helpful if the results of the stationary examination are normal or indefinite. Resection of the diverticula and a surgical myotomy of the manometrically defined abnormal segment results in relief of symptoms and protection from aspiration.

Virtual coloscopy with multi-slice computerized tomography. Preliminary results

Using multi-slice computed tomography (MSCT) large body areas can scanned with high spatial resolution. In this study, MSCT was employed for virtual colonoscopy in various pathologies of the colon. For MSCT a Somatom Plus 4, Volume Zoom scanner, (Siemens, Forchheim) was employed, equipped with four parallel detector rows. Twenty-five patients were included in this trial, prior to colonoscopy or partial colon resection. After cleaning the colon, distension was achieved by insufflation of room air using a rectal tube. The parameters of acquisition and reconstruction were as follows: collimation 4 x 1 mm and 4 x 2.5 mm respectively; tube charge per slice: 140-160 mAs; pitch 5-6; i.v. contrast medium: 120 ml Ultravist 300 (Schering) with a flow rate of 3 ml/s; delay: 35 s. For 3D reconstruction we used edge-enhanced volume rendering, virtual colonoscopy and extraluminal views of volume-rendered images. Nine polyps and four of five colon carcinomas were detected using MSCT virtual colonoscopy. In three patients with ulcerative colitis virtual coloscopy revealed morphological alterations compatible with this disease. In two of four patients with multiple diverticula of the colon the true extent of the disorder could be assessed in virtual colonoscopy. Utilizing virtual MSCT colonoscopy polyps and cancer of the colon can be reliably detected, if proper cleaning and distension is provided. On axial images alone smaller polyps may be assessed. The high z-axis resolution of MSCT offers superior conditions for CT-based virtual colonoscopy.

DIFFUSE DIVERTICULOSIS OF COLON WITH SPONTANEOUS PERFORATION IN A CHILD

128 Colonic diverticulosis is commonly seen in adults, frequently involving the sigmoid colon. Diffuse colonic diverticulosis has not been reported in pediatric population. We report a 10 year-old, white female, referred for a two week history of vomiting and severe abdominal pain. There was no history of chronic constipation, fever, diarrhea or weight loss. The patient's prior history was significant for spontaneous colonic perforation that required colostomy and resection of sigmoid colon (6cm) two years prior. An additional short segment of colon was resected due to "muscular weakness" during reanastomosis three months later. Further evaluation included a suction rectal biopsy which revealed presence of ganglion cells. No underlying etiology was determined for the colonic perforation. She had been asymptomatic until this hospitalization. An upper gastrointestinal series with small bowel follow through was normal, however a colonoscopy revealed multiple diverticula (40 or more) throughout the colon. An elective abdominal colectomy was performed due to potential risk of perforation. Gross and histological examination of the resected colon showed multiple diverticula with loss of muscularis propria and fibrous replacement. Diffuse colonic diverticulosis (congenital or acquired) should be considered in children with spontaneous colonic perforations. The awareness and prompt recognition of diverticulosis could prevent potential life threatening gastrointestinal complications.

Identification of seminiferous tubule aberrations and a low incidence of testicular microliths associated with the development of azoospermia

Objective: To evaluate the use of percutaneous testicular sperm aspiration in the assessment of azoospermia and its association with seminiferous tubule microliths. Design: Case report. Setting: Tertiary care fertility center in a university hospital. Patient(s): Male undergoing infertility evaluation. Intervention(s): Testicular biopsy and percutaneous testicular aspiration. Main Outcome Measure(s): Serum hormone analysis, sperm concentration in semen, spermatogenesis in samples from testicular biopsies and aspirations, and microlith composition. Result(s): A patient presented for infertility evaluation with a history of severe oligospermia that progressed to azoospermia. The serum testosterone concentration (357 ng/dL) and LH concentration (9.2 mIU/mL) were normal and the serum FSH concentration (18.3 mIU/mL) was elevated. Testicular biopsy results indicated spermatogenic hypoplasia with limited spermatozoa. Seminiferous tubules obtained by percutaneous testicular aspiration were structurally aberrant, with multiple diverticula. Microliths averaging 120 μm in diameter were observed within and blocking the seminiferous tubules. The microliths were composed of calcium phosphate (hydroxyapatite) in both the core and peripheral regions. Electron microscopy revealed a high degree of collagen-like material within the peripheral zone. Conclusion(s): The presence of seminiferous tubule microliths is associated with the development of azoospermia. In patients with a low incidence of seminiferous tubule microliths and aberrant seminiferous tubule architecture, percutaneous testicular aspiration may provide a diagnostic advantage over testicular biopsy.

A JUVENILE CASE OF PERFORATION OF A DIVERTICULUM ARISED IN THE ASCENDING COLON

Perforation of a diverticulum of the colon is extremely rare in juvenile people, and it commonly appears in the sigmoid colon and in patients who have multiple diverticula if it occurs. This time we have experienced a case of perforation of solitary diverticulum in the ascending colon in a juvenile patient. In this patient a barium enema study and abdominal computed tomography scan presented difficulty in differential diagnosis from acute appendicitis. This case which is thought to be rare as well as to be suggestive in terms of the differential diagnosis is reported here, together with a review of the literature.