Pericolic Abscesses Research Articles

Effectiveness of Treatment with Antibiotics Alone in Patients with Acute Diverticulitis and Pelvic Abscesses.

Introduction: The available evidence regarding the treatment of acute diverticulitis (AD) with pelvic abscess using antibiotics alone is very limited. The objective of this study was to determine whether the short- and long-term outcomes of AD with pelvic abscesses treated exclusively with antibiotics are comparable to those of pericolic abscesses. Methods: A retrospective study was conducted on patients diagnosed with AD and either pelvic or pericolic abscesses, as confirmed by computed tomography, who were treated solely with antibiotic therapy between 2011 and 2021. Cases involving percutaneous drainage as part of conservative treatment were excluded. Results: Fifty-eight patients met the inclusion criteria, comprising 12 with pelvic abscesses and 46 with pericolic abscesses. Both groups exhibited similar baseline characteristics and radiological findings, except for a more frequent presence of free fluid in pelvic abscesses. The success rate of antibiotic therapy was 91.7% for pelvic abscess cases and 96.7% for pericolic cases (p = 0.508). No significant differences were observed in recurrence or elective surgery. In the subgroup of abscesses with a diameter ≥4 cm, the evolution was similar in both locations (treatment success rate of 87.5% in pelvic and 94.4% in pericolic; p = 0.529), although recurrence was slightly higher for pericolic abscesses (38.4% vs. 14.3%; p = 0.362). Conclusions: Antibiotic therapy alone proves to be effective and safe for pelvic abscesses, demonstrating a course similar to pericolic abscesses, even in the case of large abscesses. Although the analyzed patient cohort is small, this study provides additional evidence that percutaneous drainage is not always essential for treating this complication.

Recurrent Lower Abdominal Pain, Altered Bowel Habits, and Malaise: Conservative or Surgical Approach to a Common Disorder

Recurrent Lower Abdominal Pain, Altered Bowel Habits, and Malaise: Conservative or Surgical Approach to a Common Disorder

EP.TU.809Challenges in management of acute diverticulitis within a district general hospital

Abstract Aim Incidence of perforated sigmoid diverticular disease is estimated at 3.4 to 4.5 per 100,000. Perforation may be the first manifestation of complicated diverticulitis with a range of 50% to 70%. We aim to review management of systemically unwell patients with acute diverticulitis in a district general hospital against the 2019 NICE guidelines. Methods 29 patients presenting septic with acute diverticulitis, M:F ratio 12:17, median age 55 (range 24-82), median ASA 2 (range 0-3) were retrospectively reviewed over a 6-month period. Results Mean time to antibiotics was 3.96 hours (range 0-23.11). Of the 7 with perforated diverticulitis severity classification included: Hinchey I – n = 1, 3.4%; Hinchey IIa – 5 (17.2%), and; Hinchey IIb – 1 (3.4%). Time to CT abdomen pelvis was 3.38 hours (range 0-16.4 hours). Two pericolic abscesses met NICE drainage criteria at 3.7 cm and 3.9 cm respectively. The 3.7 cm abscess was drained radiologically at 7 days post-admission and was re-admitted 6 days later requiring further radiological drainage. The patient with a 3.9 cm abscess received a Hartmann’s procedure and had multiple re-admissions requiring a hospital stay of 34 days. There was 0% mortality at 30 days. Conclusion Management of acute diverticulitis continues to present a unique challenge. For systemically unwell patients, timely administration of antibiotics within an hour of sepsis recognition is encouraged to optimise outcomes. Timely cross-sectional imaging is pivotal in disease classification and decision-making regarding acute management. Interventional drainage and surgical resection remain important therapeutic strategies for unwell patients with Hinchey grade II diverticulitis.

Acute diverticulitis: Key features for guiding clinical management

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.

Systematic review of failure of nonoperative management in complicated sigmoid diverticulitis with abscess.

The aim of this systematic review was to determine the rates of failure following nonoperative management for acute sigmoid diverticulitis complicated by abscess. Pubmed and Medline were systematically searched by two independent researchers. Studies reporting outcomes of nonoperative management of diverticulitis with abscess revealed on CT scan were included. The endpoint of the study was failure of nonoperative management which included relapse and recurrence. Relapse was defined as development of additional complications such as peritonitis or obstruction that required urgent surgery during index admission or readmission within 30days. Recurrence was defined as development of symptoms after an asymptomatic period of 30-90days following nonoperative management. Nonoperative management included nil per os, intravenous fluids and antibiotics, CT-guided percutaneous drainage, and/or total parenteral nutrition. Twenty-four of 844 studies yielded by literature search totaling 12,601 patients were eligible for inclusion. Pooled relapse rate was 18.9%. The pooled rate of recurrence of acute diverticulitis was found to be 25.5%. 60.9% of recurrences were complicated diverticulitis. Failure rate appeared to be significantly increased in patients undergoing percutaneous drainage for distant abscess as compared with pericolic abscess (51% vs. 18%; p = 0.0001). The rate of failure of nonoperative management was 44.4%. The rate of relapse at 30days following nonoperative management was at 18.9%. Distant abscesses were associated with significantly increased rates of relapse compared with pericolic abscesses. The rate of recurrence following nonoperative management was 25.5% at themean follow-up of 38months.

Elective surgery should be considered after successful conservative treatment of recurrent diverticular abscesses

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.

Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis

The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis has evolved towards more conservative and minimally invasive strategies. The aim of this review is to highlight recent concepts and advances in management. A literature review was performed on the electronic databases MEDLINE from PubMed, Embase and the Cochrane Library for publications in English. The keywords 'diverticulitis', 'diverticular' were searched for the past decade (to September 2013). Diverticulitis occurs frequently in the Western world, but only one in five patients develops complications (such as abscess and perforation) during the first acute presentation. The reported perforation rate is 3.5 per 100,000 population. Based on recent data, including the AVOD and DIVER trials, antibiotic therapy for mild episodes may be unnecessary and outpatient management reasonable in most patients. Antibiotics and admission to hospital is required for complicated diverticulitis confirmed on imaging and for patients with sepsis. Diverticular abscesses (about 5 per cent of patients) may require percutaneous drainage if antibiotics alone fail. Laparoscopic management of non-faecal perforated diverticulitis is feasible in selected patients, and peritoneal lavage in combination with antibiotic therapy may avoid colonic resection and a stoma. However, the collective, published worldwide experience is limited to fewer than 800 patients, and results from ongoing randomized trials (LapLAND, SCANDIV, DILALA and LADIES trials) are needed to inform better decision-making. The treatment of diverticulitis continues to evolve with a trend towards a more conservative and minimally invasive management approach. Judicious use of antibiotics in uncomplicated cases, greater application of laparoscopic techniques, and primary resection and anastomosis are of benefit in selected patients.

Divertículos intestinales. Enfermedad diverticular del colon. Diverticulitis

The mayority of patients with diverticula (about 70–80%) have no symptoms or complications. Diverticulitis is the most common complication of appearing in 10–25% of patients. Most are limited to an inflammation of the wall, (simple or uncomplicated diverticulitis). Approximately 25% presented complications including pericolic or distant abscesses, fistulas in surrounding organs, stenosis, obstruction or peritonitis The diagnosis of diverticulitis can be performed in 66% of patients exclusively on the basis of clinical history and physical examination. Computed tomography (CT) is currently the imaging method of election for the diagnosis and to provide prognostic information useful in the differential diagnosis. Medical treatment based on antibiotics, aimed to cover gram negative and anaerobic, resolve 70–100% of cases of uncomplicated diverticulitis, but in the absence of response we should exclude the presence

Nonoperative management of right colonic diverticulitis using radiologic evaluation

Although a few reviews have been conducted, nonoperative management may be the mainstay of therapy for uncomplicated right colonic diverticulitis. With increasing use of radiological evaluation for diverticulitis, the status of the disease is becoming more accessible. In this study, clinical outcomes of nonoperative management for right colonic diverticulitis were assessed according to disease status using radiological evaluation. From April 2000 to March 2007, 296 patients were admitted for acute right colonic diverticulitis upon first attack and were treated with nonoperative management. The status of diverticulitis was classified using ultrasonography and/or computed tomography as inflamed diverticulum or phlegmon in 276 patients or pericolic abscess in 20 patients. Uncomplicated diverticulitis was defined as inflamed diverticulum or phlegmon. Length of hospital stay, antibiotic use, failure of initial therapy and the incidence of recurrence after nonoperative management were assessed. The mean length of hospital stay and antibiotic use were 6 and 4.7 days respectively. All patients were successfully treated with the initial medical therapy and their hospital stays were uneventful. Of the 276 patients with an uncomplicated diverticulitis, two patients (1%) had a recurrence during follow-up that could be managed nonoperatively. Of the 20 patients with pericolic abscesses, four patients (20%) had a recurrence. One patient underwent laparoscopic ileocolic resection and the other patients were treated nonoperatively. Nonoperative management may be the treatment of choice for right colonic diverticulitis with inflamed diverticulum or phlegmon. Diverticulitis with pericolic abscess should be treated with additional care.

Conservative Treatment for Patients with Acute Right Colonic Diverticulitis

Little is known about the natural history of right colonic diverticulitis treated with conservative management. The purpose of this study was to analyze the short-term outcome of a conservative approach to the treatment of patients with acute right colonic diverticulitis. A retrospective review of the clinical and radiological findings of 62 patients with acute right colonic diverticulitis was carried out. Conservative treatment was provided to 47 patients and surgical treatment to 15 patients with the diagnosis of acute right colonic diverticulitis. An initial ultrasound was performed in 45 of 62 patients (73%) and a CT was performed in 16 of 62 patients (26%). Diverticulitis was confirmed pretreatment diagnosis in 56 of 61 (91.8%) patients who had radiological evaluation. There were seven (11.3%) pericolic abscesses identified as a complication of the diverticulitis. All 47 patients who received conservative management were successfully treated and had improvement of symptoms with no sign of clinical deterioration. For the fifteen patients who had surgery: 5 had right hemicolectomies, 8 had appendectomies without diverticulectomy, 1 had an appendectomy with diverticulectomy, and 1 had diverticulectomy alone. During a median followup of 23.9 months, two of 55 (3.6%) patients who did not have surgical resection for inflamed diverticulum had recurrences one and ten months after the initial treatment; they were successfully treated again with bowel rest and antibiotics without complication. Conservative treatment should be considered as a safe and effective option for acute right colonic diverticulitis. In addition, a less aggressive approach may be more suitable for recurrent diverticulitis than extended surgical resection.

High-Resolution Sonographic Spectrum of Diverticulosis, Diverticulitis, and Their Complications

The purpose of this study was to evaluate the high-resolution sonographic features of diverticulosis, diverticulitis, and their complications. During a period of about 4 years 8 months, there were 25 patients with sonographic features of diverticulosis, uncomplicated diverticulitis, and complicated diverticulitis. The clinical symptoms, sonographic features, follow-up investigations, and management details were recorded. The common symptoms were pain in the left lower quadrant and fever. Sonographic features of uncomplicated diverticulitis were a varying appearance of the diverticulum with pericolic inflammation. Colonic wall thickening was not a consistent sign. Complications seen were pericolic, mesocolic, and intraperitoneal abscesses, colovesical fistulas, colouterine fistulas, perforation, and small-bowel obstruction. Uninflamed diverticula were seen in all patients with left-sided disease. They had 7 types of sonographic appearances. Uncomplicated diverticulitis is seen as a diverticulum of variable echogenicity with pericolic inflammation. An inflamed diverticulum is not visualized in complicated diverticulitis. Visualization of uninflamed diverticula helps reinforce the diagnosis of uncomplicated diverticulitis and predict the cause in complicated diverticulitis.

The septic complications of sigmoid diverticular disease.

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.

Colonic diverticulosis

Colonic diverticulosis is small outpouchings from the colonic lumen. Prevalence of diverticulosis increases with age and there is considerable geographic variation. Diverticulosis is seen mainly in the distal colon in western populations, whereas right-sided involvement is more prominent in Asia. Most patients with diverticulosis coli will remain asymptomatic and the diagnosis is frequently an incidental finding. Symptoms of uncomplicated diverticular disease are non-specific and similar to those of irritable bowel syndrome. Acute diverticulitis is the commonest complication of diverticular disease, affecting up to 25% of patients. Patients should be treated with bowel rest, analgesia and appropriate antibiotics (i.v.). Diverticular perforations may be contained locally as peridiverticular, mesenteric or pericolic abscesses. Small pericolic abscesses can often be treated conservatively. Larger abscesses may be drained percutaneously under ultrasound or CT guidance. Some abscesses are not amenable to, or fail to settle with, percutaneous drainage and surgery is indicated. Perforation into the peritoneal cavity causes purulent or faecal peritonitis with the attendant signs of shock. Patients require active resuscitation before emergency laparotomy. A fistula can result if a phlegmon or diverticular abscess extends or ruptures into an adjacent organ. Other complications include obstruction of the small or large bowel, and rectal bleeding.

Les diverticuloses coliques compliquées. Résultats du traitement chirurgical entre 1981 et 1998 chez 370 patients

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.

Acute Diverticulitis: 5 Years Experience in a Teaching Hospital in Kuwait

Objective: To evaluate the diagnostic and therapeutic modalities of all patients admitted to a hospital over a period of time. Methods: Review of the medical files of 60 cases of colonic diverticulitis seen over a period of 5 years at the Amiri Hospital, Kuwait, which serves a population of about 150,000. Results: Two thirds of our patients were females. The age at presentation was lower (56.6 year) than in the West. The commonest presenting manifestation was left iliac fossa pain and tenderness. Plain abdominal X-ray and an erect chest X-ray were the most valuable diagnostic tools. Ultrasound scan was helpful in percutaneous drainage of pericolic abscesses. Combined CT scan with water-soluble enemas is recommended once the patient’s condition is stable. Conclusion: The majority of conservatively managed patients responded well to treatment. Surgery should be reserved for those presenting with generalized peritonitis (6/60), for the very few who do not respond to the conservative modality (4/54), or those who come back with recurrent diverticulitis.

Diagnosis of acute left-sided colonic diverticulitis by three radiological modalities

To compare the findings at US, CT and contrast enema (CE) with the clinical, biochemical, and surgical findings in patients with suspected acute left-sided colonic diverticulitis (ALCD). The study comprised 32 consecutive patients hospitalized with clinically diagnosed ALCD. During the first 3 days of hospitalization, they were examined by US and CT of the pelvis and abdomen, and CE. Of the 32 patients, 21 had ALCD according to the combined radiological, clinical, biochemical and surgical findings. Findings compatible with ALCD were verified by radiological examination alone in 12 patients (4 patients at US, 10 at CT, and 6 at CE). In 9 patients, only diverticula or tethering was found at either CE or CT, and the diagnoses were then supported by clinical and biochemical findings and clinical follow-up. The most common clinical symptoms and signs associated with ALCD were left lower quadrant pain, left-sided tenderness, and fever. Most patients showed elevations of the white blood-cell count, erythrocyte sedimentation rate, and C-reactive protein, but there was no statistical difference in the stages of severity of ALCD, or between ALCD and other abdominal disorders. Radiological examination is valuable in confirming the diagnosis of ALCD. CT was the radiological modality that best demonstrated ALCD and revealed complications (e.g. pericolic abscesses) during the course of the illness.

Lung Cancer: Detection, Prevention, and Therapeutics

Lung cancer remains the leading cause of cancer death in the U.S. adult population, and the American Cancer Society estimates that cigarette smoking is responsible for about 83% of all lung cancer cases. It is unlikely that significant reductions in the incidence and mortality associated with lung cancer will be realized without effective antismoking campaigns. Surgery, radiation therapy, and chemotherapy all play a role in the management of lung cancer. At the current time, NSCLC is generally curable only if it is diagnosed while the tumor is small and localized and can be surgically removed. Radiation therapy may also be effective in localized cases. Combination chemotherapy regimens have not consistently produced quality responses in patients with advanced tumors; however, newer regimens utilizing high doses of cisplatin, mitomycin and vinca alkaloids, or cisplatin and etoposide have produced encouraging results. In contrast to NSCLC, SCLC is responsive to combination chemotherapy regimens. Although many different agents are effective in this disease, most small-cell tumors eventually become refractory to chemotherapy and most patients do not survive longer than two years. Although progress has been made in the understanding and management of lung cancer, effective therapies that consistently produce major and durable responses are still lacking. Clinical trials must continue to evaluate therapeutic modalities for all types of lung cancer.

The treatment of perforated diverticulitis by one-stage intracolonic bypass procedure.

The one-stage intracolonic bypass procedure prevents gastrointestinal secretions and fecal content from coming in contact with an anastomotic site without interrupting the intraluminal continuity of the fecal flow from proximal to distal colon. This can be achieved by the intraluminal implantation of a soft, pliable tube above the anastomotic site. Previous clinical and experimental data have indicated that the intracolonic bypass procedure can protect an anastomosis in the presence of maximal colonic loading, gross dehiscences, or fecal peritonitis. This report presents 28 patients with perforated diverticulitis, all of whom were treated by one-stage intracolonic bypass procedures. Ten of the 28 patients had peritonitis, and 18 had pericolic abscesses. Results indicate no deaths and no anastomotic leakages. Three patients (10.7%) had a complicated postoperative course. One patient with fecal peritonitis had prolonged ileus and a pulmonary effusion, and one had a myocardial infarction. Both of these patients responded to medical therapy. Another patient had a wound infection. The hospital stay ranged from 10 to 18 postoperative days. All patients passed the tubes spontaneously 2 to 3 weeks after operation. The one-stage intracolonic bypass procedure can be recommended as a viable alternative to the two- or three-stage procedures commonly used for perforated diverticulitis.

The Influence of Corticotrophin and Adrenal Steroids on the Course of Ulcerative Colitis: A Comparison with the Presteroid Era

Summary The course of 238 patients with moderate to severe ulcerative colitis treated with corticotrophin or adrenal steroids, or both, during 1952 to 1958, is analyzed and compared with the course of 245 patients treated during the presteroid era. The total number of serious complications has been reduced. The reduction in the number of perforations, pericolic abscesses, perirectal infections, arthritic complications, and cases of pyoderma gangrenosum and pneumonia can be correlated with hormonal therapy. An increase in the number of cases of toxic dilation, osteoporosis, thrombophlebitis, nephrolithiasis, psychic complications, and massive upper gastrointestinal bleeding can also be correlated with the use of these agents. The evidence that ACTH and adrenal steroids have influenced the proportion of patients requiring definitive surgery for ulcerative colitis during the period of follow up is inconclusive. The indications for surgical intervention have been altered in the steroid era so that many more .eleotivc or relatively elective procedures and less emergency operations are performed. Coincidentally more extensive colonic surgery is done as a primary procedure. The over-all mortality rate has decreased from 21 to 12 per cent. Of the 29 deaths concerned, 5 were directly attributable to ulcerative colitis, 8 had complications caused or accentuated by hormonal therapy, 6 seriously ill patients died in the postoperative period, including 1 whose death was attributable to adrenal insufficiency, 4 died of complications after secondary operations, 1 died of carcinoma of the colon, and 5 died of unrelated diseases. At the time of follow up, 37 per cent of the patients from each group were completely well, but less of the steroid treated patients had been symptomatic in the interim. Only 6 per cent of the steroid treated patients required maintenance medication.

Indirect roentgen changes in the colon produced by regional enteritis.

Regional enteritis, although primarily a disease of the small intestine, can produce both direct and indirect changes in the colon, visible on routine barium-enema examination. The barium-enema examination is often the initial roentgen study for the presenting symptoms of regional enteritis. It is important, therefore, to recognize which colonic changes are produced by this entity. The colitis frequently associated with it, and considered by some to be a direct extension of the disease process to the large bowel, will not be considered here in detail. Primary emphasis will be placed on the various indirect colonic changes. These indirect findings are: 1. Spasm (mainly of the cecum) 2. Extrinsic colonic deformity due to (a)enlarged nodes (b)adhesions (c)masses of diseased small bowel (d)intra-abdominal abscesses (e)pericolic abscesses with or without fistula 3. Intrinsic colonic deformity due to (a)extension of inflammation from immediately adjacent diseased small bowel, or (b)abscesses with or without fis...