Diverticulitis Of Sigmoid Colon Research Articles

Left Side Appendicitis with Abscess Caused by Midgut Malrotation Mimicked by Complicated Diverticulitis of Sigmoid Colon: A Case Report

Midgut malrotation (MM) is a rare anatomical abnormality that complicates the diagnosis and management of acute abdominal pain. Moreover, appendicitis and diverticulitis of the sigmoid colon can be considered when there is pain in the lower left abdomen. The patient in this case report was an 86-year-old female who had continuous abdominal pain two days before the visit to the emergency room. Abdominopelvic computed tomography revealed MM, and uneven concentric wall thickening from the distal descending colon to the proximal sigmoid colon with surrounding fatty infiltration was confirmed in the left lower abdomen. Moreover, the possibility of left-sided appendicitis due to MM could not be excluded. The patient's abdominal pain increased next day. The surgery was performed laparoscopically, and the location of the appendix was reversed. The surgical findings revealed an abscess caused by perforation from inflammation of the proximal part of the appendix, and the sigmoid colon adhered mildly to the side immediately behind the abscess cavity. The base of the appendix was intact, and only an appendectomy was performed. Left-sided appendicitis due to MM was discriminated from the diverticulitis of the sigmoid colon. Diagnostic laparoscopic surgery through a physical examination based on the surgeon's experience is important.

Acute epiploic appendagitis - a rare differential diagnosis of acute abdomen.

Acute epiploic appendagitis is a rare differential diagnosis of unclear or acute abdomen. To describe - by means of a scientific case report - the extraordinary diagnosis of acute epiploic appendagitis along with contained diverticulitis and incarcerated herniation of the greater omentum into the hernial sac of a former trocar site (medical history, significant for laparoscopic ovarian cyst removal) in a 29-year-old female based on experiences obtained in the successful clinical case management, and on selective references from medical scientific literature. Medical history: A 29-year-old female was admitted with abdominal pain in the lower left quadrant. She reported a laparoscopic ovarian cyst removal 3 years prior. Physical examination of the abdomen revealed tenderness in the lower left quadrant without a palpable mass.Leading diagnoses were found using transabdominal ultrasound and confirmed by an abdominal CT scan; namely, incarcerated trocar hernia, diverticulitis of sigmoid colon, and acute epiploic appendagitis. Therapeutic approach was comprised of an explorative laparoscopy (because of the incarcerated hernia), adhesiolysis, removal of a tip of the greater omentum out of the hernial sac, closure of the hernial orifice, and removal of an unclear, inflamed, and bloody fatty tissue from the wall of the descending colon (histopathological investigation confirmed acute epiploic appendagitis). This was flanked by conservative treatment of diverticulitis of the sigmoid colon.Further clinical course was uneventful, with discharge on the 3rd postoperative day with favorable long-term outcome, characterized by no further complaints for 15 months. Acute epiploic appendagitis is an inflammatory, usually self-limiting condition of the epiploic appendages of the colon. It typically manifests with abdominal pain in the lower left quadrant. Imaging is an important diagnostic tool to determine whether the patient has, in fact, acute epiploic appendagitis, so recognizing the characteristic oval lesions with the surrounding inflammation and central fat attenuation on CT, as well as the hyperechoic oval lesions with a hypoechoic peripheral band on ultrasound images is crucial. Nevertheless, it is often overlooked in patients and confused with other differential diagnoses, such as appendicitis or diverticulitis. Although the condition appears infrequently, it is essential to be proficient in the diagnostic evaluation, as a misdiagnosis may lead to unnecessary treatment and even surgical intervention. , the patient was initially diagnosed with an incarcerated abdominal hernia, and therefore subsequently underwent surgery. The inflamed epiploic appendage was discovered in laparoscopic exploration, removed, and confirmed through the histopathology report. This is an approach to be performed with great caution so as not to 1. : misinterpret an inflamed diverticula or covered perforation of it as well as not 2. : overlooking a peritoneal tumor lesion.

Right-sided diverticulitis in a Western population.

While left-sided colonic diverticular disease is common in Western Caucasian populations, right-sided colonic disease (RCD) is rare. The present study aimed to determine the rate of RCD and to identify the symptoms, clinical features, treatment, and outcomes in a single medical center in Israel. Data for this descriptive retrospective analysis were collected from the electronic medical records of all patients diagnosed with colonic diverticulitis from January 2014 to June 2019. During the study period, 1000 patients with diverticulitis were admitted to our institution, of which 99 had RCD (10%). Mean age was 50.2years. The main presenting symptom was acute onset of right-sided abdominal pain. The diagnosis was made almost exclusively by computed tomography scan and the cecum was the most frequent site. The clinical course was benign, without major complications for most patients (90.1%). Nine patients presented with abscess (n = 1), covered perforation (n = 7), or partial obstruction (n = 1). All patients were treated with intravenous antibiotics with a median length of hospital stay of 3days and a median 9days of antibiotic treatment. Only 1 patient underwent diagnostic laparoscopy due to suspected intestinal perforation. Three patients experienced disease recurrence after a median follow-up of 48months. Upon recovery, half of the patients underwent colonoscopy; no further pathology was found in any. Unlike sigmoid colon diverticulitis, the incidence of RCD in Western populations is low. The clinical course is benign, with conservative treatment without the need for surgery. The complication and recurrence rates are low.

Penetration of Sigmoid Colon Diverticulitis to the Left Uterine Adnexa Causing Ovarian Abscess Concomitantly—Report of a Case—

Penetration of Sigmoid Colon Diverticulitis to the Left Uterine Adnexa Causing Ovarian Abscess Concomitantly—Report of a Case—

S1817 Rare and Unexpected Finding on Colonoscopy for Abdominal Pain

INTRODUCTION: Incisional hernias are a common complication of abdominal surgeries with an incidence of approximately 10 to 15%. Polypropylene mesh is commonly used to repair these hernias and is effective in decreasing their recurrence. Infection, pain, and adhesions are common complications associated with hernia repair that occur early in the post-operative period. Mesh migration and erosion into adjacent organs have been rarely reported and can present with symptoms at any time after hernia repair. We present a case of migration and erosion of a hernia mesh into the colon approximately nine years after incisional hernia repair. CASE DESCRIPTION/METHODS: The patient was a 70-year-old male who underwent colonoscopy for abdominal pain. Nine years prior to this, patient had recurrent sigmoid colon diverticulitis and perforation, for which he had undergone sigmoid colon resection and Hartman's pouch with a subsequent takedown of colostomy. At the time of colostomy reversal, patient also underwent repair of an incisional hernia with placement of a polypropylene mesh. A few weeks prior to the current colonoscopy, he had developed acute left lower quadrant abdominal pain and CT scan showed thickening of the descending colon (Image 1) which was initially treated conservatively. At colonoscopy, a metal mesh was seen embedded eccentrically in the colon wall about 25 cm from the anal verge with thickening of surrounding colonic mucosa (Image 2) for which he was referred to surgery. At subsequent exploratory laparotomy, the mesh had migrated and was adherent to the pelvic side wall, extending and eroding into the adjacent colon wall. The mesh was removed, and a left hemicolectomy with an end colostomy was performed. Patient has been doing well six months following surgery with plans for abdominal wall reconstruction. DISCUSSION: Hernia repair with mesh is an effective procedure that decreases the risk of recurrence significantly and is generally tolerated well. Very rarely mesh can migrate and erode into adjacent organs. Its clinical presentation is variable and is generally related to the organ involved. Pain in the area of migration is the most common presenting symptom. Migration occurs gradually over several years. Given the frequency with which these surgical procedures are performed, this complication is extremely rare and can be missed easily. Gastroenterologists should thus be aware of this potential complication and appropriately refer these patients to our surgical colleagues.Figure 1.: Thickening of the descending colon seen on CT Scan.Figure 2.: Mesh eroding into the colon wall eccentrically seen on colonoscopy.

計画的なReduced port surgeryによりドレナージおよび二期的手術を施行したS状結腸憩室穿通の1例

計画的なReduced port surgeryによりドレナージおよび二期的手術を施行したS状結腸憩室穿通の1例

3076 Post Colonoscopy Diverticulitis in a 50-Year-Old Woman Undergoing Surveillance Colonoscopy

INTRODUCTION: Colonoscopy is used as a diagnostic and therapeutic tool to treat a wide range of gastrointestinal disorders. Acute diverticulitis after colonoscopy is a rare but potentially serious complication. The incidence of acute diverticulitis after colonoscopy is reported to be 0.084%. Since this is a rare entity, there is limited data regarding the risk, prevention and management of acute diverticulitis after colonoscopy. CASE DESCRIPTION/METHODS: A 50 year old woman with a history of adenomatous polyp with villous component detected 4 years prior presented for surveillance colonoscopy. She did not have any abdominal pain. Her labs from a year prior showed WBC 6.86 k/uL. Colonoscopy was notable for pan-colonic diverticulitis (Figure 1), most prominent in sigmoid colon. There was a 2 mm sessile polyp in recto-sigmoid colon that was removed with cold biopsy forceps. The procedure was otherwise uncomplicated. She presented to the emergency department (ED) 3 days later with left lower quadrant pain (LLQ) and fever up to 101 Fahrenheit. The pain started 2 days after she underwent colonoscopy. She did not have nausea, vomiting or rectal bleeding. In the ED, she was afebrile with moderate LLQ tenderness without rebound or guarding. Labs showed WBC 15.41 k/uL (72.5% segmented neutrophils), BUN 11 mg/dL, Cr 1.0 mg/dL. CT of the abdomen and pelvis had findings concerning for acute sigmoid colon diverticulitis without abscess (Figure 2). The patient was discharged from the ED on moxifloxacin and metronidazole. DISCUSSION: The American Society for Gastrointestinal Endoscopy (ASGE) lists diverticulitis as a miscellaneous complication, however, there is limited data regarding the risk of developing diverticulitis after colonoscopy. In a retrospective cohort of 236, 377 patients who underwent colonoscopy, 68 patients (0.029%) developed post-colonoscopy diverticulitis. The mean time to develop diverticulitis after colonoscopy was 12 ± 8 days. 34 patients (50%) had a history of diverticulitis prior to colonoscopy and 30 patients (44%) required hospitalization. Prospective studies are now needed to evaluate the risk, mechanism and prevention of colonoscopy induced diverticulitis. If significant diverticula are noted on colonoscopy, post-colonoscopy diverticulitis should be discussed as a potential complication, and it should be considered in a patient who presents with fever and abdominal pain after undergoing colonoscopy.

\u201cSigmoid diverticulitis mimicking cholecystitis\u201d a clinical challenge

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.

Clinical presentation and outcomes of acute diverticulitis in a Middle Eastern population

Background and study aimsThere is lack of literature describing the presentation of diverticulitis in the Middle East population. The aim of this study is to provide an analysis of the epidemiological indicators, patterns of presentation and outcomes of acute diverticulitis in a Middle Eastern population. Patients and methodsA retrospective review of all adult patients over the age of 17 who were admitted to the surgical service with a diagnosis of acute diverticulitis between January 2010 and May 2018 at a major university affiliated government hospital in the state of Kuwait. Data collected included patients’ demographics, clinical presentation, management and outcome. ResultsBetween January 2010 and May 2018 there were 132 patients admitted with a diagnosis of acute diverticulitis. The mean age was 49.2 [±14.3] years. There were 89 (67.4%) men and 43 (32.6%) women. One-hundred and fifteen patients (87.1%) were Arabs, of which Kuwaiti citizens represented 58.3%. Most patients (76.5%) presented with uncomplicated diverticulitis. One hundred and twelve patients (84.8%) had sigmoid colon diverticulitis. There were nine patients that were readmitted within thirty days. The mean length of hospital stay was 5.3 days [±4.5]. The median follow-up period was 15.6 weeks (IQR 1.8, 118.4), during which time recurrent attacks occurred in 25 patients (18.9%). ConclusionsIt appears that there is a low prevalence of acute diverticulitis in Arabs living in Kuwait, and that when they do present with acute diverticulitis the majority present at a relatively younger age with uncomplicated disease.

A Case of Sigmoid Colon Diverticulitis in which a Transanal Ileus Tube Inserted into the Ileum

A Case of Sigmoid Colon Diverticulitis in which a Transanal Ileus Tube Inserted into the Ileum

S状結腸憩室炎に対する手術適応，術式および治療成績に関する検討

S状結腸憩室炎に対する手術適応，術式および治療成績に関する検討

Complete Genome Sequence of bla IMP-6-Positive Metakosakonia sp. MRY16-398 Isolate From the Ascites of a Diverticulitis Patient.

A novel species of carbapenemase-producing Enterobacteriaceae (CPE) was isolated from a patient diagnosed with sigmoid colon diverticulitis. At first, laboratory testing suggested it was Klebsiella oxytoca or Pantoea sp.; however, a complete genome sequence of the isolate, MRY16-398, revealed that it could be novel species, most similar to [Kluyvera] intestini, of which taxonomic nomenclature is still under discussion. Orthologous conserved gene analysis among 42 related bacterial strains indicated that MRY16-398 was classified as the newly proposed genus Metakosakonia. Further, MRY16-398 was found to harbor the blaIMP-6 gene-positive class 1 integron (In722) in plasmid pMRY16-398_2 (IncN replicon, 47.4 kb in size). This finding implies that rare and opportunistic bacteria could be potential infectious agents. In conclusion, our results highlight the need for continuous monitoring for CPE even in nonpathogenic bacteria in the nosocomial environment.

A Case of Perianorectal Abscess due to Sigmoid Colon Diverticulitis with Coffin-Lowry Syndrome

A Case of Perianorectal Abscess due to Sigmoid Colon Diverticulitis with Coffin-Lowry Syndrome

A Case of Colonic Bladder Fistula Due to Sigmoid Colon Diverticulitis Treated Laparoscopically

A Case of Colonic Bladder Fistula Due to Sigmoid Colon Diverticulitis Treated Laparoscopically

A Case of Colovaginal Fistula Secondary to Sigmoid Colon Diverticulitis after Total Hysterectomy

A Case of Colovaginal Fistula Secondary to Sigmoid Colon Diverticulitis after Total Hysterectomy

Sigmoid Diverticulitis Mimicking Acute Appendicitis in Right-Sided Descending and Sigmoid Colon: A Case Report

Introduction: Acute abdominal pain in the lower-right quadrant can be misdiagnosed as acute appendicitis and may be caused by anatomic variations of the intra-abdominal organs in rare cases. Anatomical variations in the position and morphology of the sigmoid colon should be considered by clinicians and radiologists to avoid misdiagnosis and unnecessary surgical procedures.Case Report: A 54-year-old man was admitted to our emergency department complaining of abdominal pain in the lowerright quadrant, nausea, vomiting, and fever for 2 days. Physical examination revealed local rebound tenderness on the lowerright quadrant and a temperature of 38°C. Abdominal ultrasound showed that the intestinal loops were thickened and the surrounding mesenteric tissue was edematous in the right abdominal quadrant. Abdominal computed tomography was performed after a bolus administration of intravenous contrast material, and sigmoid colon position anomalies and diverticulitis were observed. The patient was treated medically, and diverticulosis was confirmed by colonoscopy. Conclusion: Clinical evaluation and ordered appropriate imaging methods by the emergency specialist is important in patients with abdominal pain on the lower-right quadrant who are admitted to the emergency department. Thus, rare anatomical variations mimicking acute appendicitis can be diagnosed accurately, and patients can be protected from undergoing unnecessary surgeries

Przesuwanie granicy wieku i zmniejszanie liczby przeciwwskazań do resekcji wątroby u obciążonych onkologicznych chorych — opis przypadku

Liver resections are performed in increasing numbers due to oncological indications. Thus, the indications for surgical treatment of liver tumors are constantly expanding. Advanced age and other comorbidities often exclude this group of patients from treatment by liver resection. Patient C.S. (80 y.a., height 166 cm, weight 97 kg, ASA = 4) with risk factors was admitted for resection of metastatic lesions (adenocarcinoma) of the cecum to the liver. The patient was diagnosed with hypertension, atherosclerosis, stable coronary heart disease, type 2 diabetes, chronic renal failure (eGFR = 37), obesity, degenerative spinal lesions, sigmoid colon diverticulitis, dystonic tremor of the head. Previously operated upon and had amputation of the uterus with appendages (2005), cholecystectomy, right hemicolectomy (2012) complicated by respiratory failure with the need for ventilation seven days post-surgery. Prior to surgery, the patient had imaging tests such as ultrasound, CT and MRI scans of the abdomen, which confirmed a 55mm metastatic tumor in the seventh segment of the liver. The results were analyzed during a radiological and surgical consultation in order to prepare the safest available surgical access and the scope of the planned resection. A cardiac echocardiography was performed and the patient had a cardio-, neuro- and anesthetic consultation. The patient was fully informed about the high risk of complications and possible operational failure. During surgery a right hemihepatectomy was performed. The resected lobe weighed 712 g. Blood loss was < 500 ml, 2 units RBC and 2 units FFP were transfused. The surgery and the postoperative period proceeded without serious complications. The only problem was a short-lived biliary fistula, which healed spontaneously. Age and comorbid conditions are often a contraindication for surgery, but with proper medical support, the opportunity to interact with other professionals and thorough preparation of the patient and the team of surgeons, the risk of failure can be significantly minimized. A modern, personalized, multidisciplinary approach towards each patient can expand indications and reduce contraindications for hepatic resection.

子宮留膿腫を合併したS状結腸憩室炎の1例

症例は77歳，女性．主訴は下腹部痛．抗菌薬治療で改善なく当院に紹介入院となった．下腹部に圧痛あるも筋性防御は認めず．WBC 21,900/μl，CRP 20.58mg/dlと炎症反応高値であった．腹部造影CT検査でS状結腸の多発憩室と周囲に低吸収域を複数認め，S状結腸憩室炎による腹腔内膿瘍と診断した．症状の改善がないため手術を行った．S状結腸は子宮・左付属器と強固に癒着し，子宮は腫大していた．子宮を圧排するとS状結腸と子宮の間に膿の流出を認めたため子宮留膿腫の合併と判断し，S状結腸切除，子宮全摘，左付属器切除を行った．病理組織学的検査でS状結腸と子宮との間には，膿瘍腔と強い炎症を伴った左付属器を認めたが，結腸子宮瘻は認めなかった．以上のことから，S状結腸憩室炎から先ず腹腔内膿瘍が形成され，その後，卵管を介して子宮留膿腫が形成されたと考えられた．子宮留膿腫を合併したS状結腸憩室炎の1例を報告する．

直腸周囲膿瘍を形成し経肛門的に排膿されたS状結腸憩室炎の1例

直腸周囲膿瘍を形成し経肛門的に排膿されたS状結腸憩室炎の1例

人工肛門造設後に多発瘻孔を形成したS状結腸憩室炎の1例

人工肛門造設後に多発瘻孔を形成したS状結腸憩室炎の1例