DOCSLIB.ORG

Postmortem Survey of Diverticular Disease of the Colon

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Postmortem Survey of Diverticular Disease of the Colon Gut, 1969, 10, 336-351 Gut: first published as 10.1136/gut.10.5.336 on 1 May 1969. Downloaded from Postmortem survey of diverticular disease of the colon L. E. HUGHES From the Department ofSurgery, University of Queensland, and the Princess Alexandra Hospital, Brisbane Part I Diverticulosis and diverticulitis Diverticular disease of the colon is a common each of 100 consecutive colons, the first taken during cause of morbidity among many western races, winter and the second during summer. The colons in and, being especially a disease of the elderly, is this series were fixed in the undistended state, and all personally examined 24 to 48 hours after fixation. The becoming a problem ofincreasing magnitude. mesentery and associated fat was dissected from the Abdominal symptoms are common in this age left colon, and the bowel carefully examined from group, and in the absence of evidence of other internal and external aspects for the presence of diver- disease, the finding of diverticula on x-ray examin- ticula. In this way small diverticula 2 to 3 mm in diameter ation is prone to lead to a diagnosis of 'diverticulitis'. were readily found. The colon and pericolic tissues were The frequency with which such an association is a carefully examined for signs of recent or old infection, chance one, without causal relationship, would and sections were taken from such areas for histological depend on the incidence of diverticulosis in the study. normal population. Among details routinely recorded during necropsies at this hospital are the presence or absence of gallstones, It is probable that the present safety of colonic an assessment of the degree of atheroma of the aorta, surgery is the major reason for a tendency to treat and the thickness of the subcutaneous fat at the diverticular disease by resection at an early stage, umbilicus. These details were taken from the postmortem for there has been little work reported on the records for correlation with the presence of diverti- http://gut.bmj.com/ natural history of the disease when treated con- cula. The clinical records of all patients were studied to servatively to prove that routine surgical excision determine the cause of death and the presence of coexist- is justified. The work which has been reported ent disease, including hypertension, and the presence of suggests that the disease is not as inexorable in its bowel symptoms at the time of admission or as recorded progress to serious complications as much surgical in the past history. literature implies (Bolt and Hughes, 1966; Horner, 1958). INCIDENCE AND RESULTS Detailed studies of the pathology of diverticular on October 1, 2021 by guest. Protected copyright. disease are also surprisingly few, considering its INCIDENCE OF DIVERTICULA IN THE COLON Diver- importance as a cause of morbidity, while very little ticula were found in 90 of the 200 colons (Table I). indeed is known of its aetiology. Deficiences in knowledge of aetiology and basic pathology make TABLE I rational treatment difficult. This, together with the INCIDENCE OF DIVERTICULA OF COLON RELATED TO AGE tendency to frequent diagnosis and radical therapy, AND SEX1 may readily lead to overtreatment. Age No. Diverticula (%) This work has been carried out to determine the Group in Group incidence of diverticula and associated pathology Males Females Total in Queensland, to attempt to assess the relationship 10-30 4 0 0 0 of diverticula to symptoms, and to seek any evidence 31-50 23 12 6 9 51-70 72 33 41 36 which may throw light on the aetiology of this 71 + 101 60 54 56 condition. Over 50 173 48 47 48 All ages 200 45 40 43 MATERIALS AND METHODS 'Solitary caecal diverticula excluded. Colons were studied from 200 unselected necropsies at In five of these the caecum alone was involved. As the Princess Alexandra Hospital, Brisbane, in two series this may be a distinct condition, these have been 336 Gut: first published as 10.1136/gut.10.5.336 on 1 May 1969. Downloaded from Postmortem survey of diverticular disease of the colon 337 The distribution of diverticula around the circumference of the bowel, in particular in the sigmoid colon, did not differ from that reported by other workers (Slack, 1962; Watt and Marcus, 1964). A I 1 CAECAL DIVERTICULA Diverticula involved the 13 (150/o) 23 (26 °/o) 2.7 (30 °/o) caecum in 24 cases. In 14 the caecum was involved in continuity with extensive diverticulosis of the rest of the colon. In the other 10 cases, the caecum was involved more or less discontinuously, and the details of this group are set out in Table II. Five of the 10 cases were primary caecal diverticula in that they were not associated with other diverticula, and a further two cases were accompanied by early 5(5 sigmoid diverticular disease only. It is probable that 4 (4 °/o) 14 (16 `/o) 5 (5 O/°) these two patients also are cases of true 'solitary' IRREGULAR 4 (4 olo) diverticula and have subsequently developed sig- FIG. 1. Incidence of diverticula at necropsy. In 200 moid diverticular disease; both were aged less cases diverticula were present in 90. than 65 years. The three cases associated with more extensive left-sided diverticular disease might be excluded to give an overall incidence of 43 % of merely an extension of the general process, or colonic diverticula. Little difference w'as found in might also be primary caecal disease with coincident incidence between the two sexes. but unrelated left-sided diverticular disease. The The distribution of diverticula thr4oughout the incidence of solitary caecal diverticula in this series, length of the colon is shown in Figiure 1. Early therefore, lies between 2.5 and 5% and is probably diverticular disease, a group arbitrarilIy formed of about 3.5%. Histologically all the diverticula were thin-walled, 'false' diverticula (Fig. 2). No those in whom less than five diverticula were present http://gut.bmj.com/ in the sigmoid colon, was found in 6.5 % of the example of the 'congenital' diverticulum containing series or in 14% of those with divertticula. As in all muscle coats in its wall was seen. In two cases most reported series the sigmoid colon 'was involved more than one diverticulum was present in the in almost all cases (99 %), there being anly one case caecum (Fig. 3). The diverticula varied from a with diverticula elsewhere where the silgmoid colon few millimetres to 15 mm in diameter, and were was not affected, diverticula localized tc the caecum randomly distributed around the caecum, occurring being excluded. In this case there were two isolated on both mesenteric and peritoneal aspects. diverticula, one each at the splenic and hepatic on October 1, 2021 by guest. Protected copyright. flexures. The remaining three cases, classified as AGE The relationship between age and the extent 'irregular', showed diverticula of the right colon of the disease is shown in Table III, where the associated with sigmoid diverticula, thec intervening median age of patients in each group is given. bowel being unaffected. Cases of total colonic involvement occur at a later TABLE II CAECAL DIVERTICULA1 Case Age Caecal Distance from Other Muscle Change (yr) Diverticula Ileo-caecal Valve (cm) Diverticula in Sigmoid Colon 76 10 Left colon Present 2 68 5 Nil 3 99 16 Nil 4 49 3 2-5 Sigmoid Present 5 49 2 3,8 Nil 6 79 8 Left colon Present 7 62 8 Sigmoid 8 70 8 Left colon 9 57 7.5 Nil Present 10 64 15 Nil Present 'Excluding caecal involvement in continuity with diffuse colonic diverticula. 338 L. E. Hughes Gut: first published as 10.1136/gut.10.5.336 on 1 May 1969. Downloaded from or thickening, whereas diverticula proximal to the sigmoid colon usually had wide necks. The combi- nation of a wide neck and soft or liquid faeces probably accounts for the rarity of inflammatory disease proximal to the sigmoid. However, the converse is not always true. Some colons had large diverticula containing faecoliths which had ob- viously been in situ for a very long time yet showed no microscopic evidence of inflammation. Jejunal diverticula of the typical multiple, mes- FIG. 2. Section of a large solitary diverticulum of the enteric type are occasionally associated-perhaps caecuim ofthe 'false' type. (Scale: 1 division = 1 mm.) by chance-with colonic diverticula. Ileal diverticula have been reported much less commonly. In two cases in this series, small (5 mm) false diverticula were situated just proximal to the ileo-caecal valve (no jejunal diverticula were present). The first case was noted towards the end of the series and until this time the small bowel had not been examined, so the incidence of terminal ileal diverticula asso- ciated with colonic diverticula could not be assessed. Spriggs and Marxer (1925), from their radiological FIG. 3. A section of caecum showing two 'solitary' studies, described these diverticula of the terminal caecal diverticula. (Scale: 1 division = 1 mm.) ileum in association with colonic diverticula. Chronic periileal inflammatory disease is occasion- age than lesser degrees of affection. In fact no case ally seen in this region and these diverticula may be a of total colonic involvement was seen in this series causative factor in this lesion. under the age of 70 years, although caecal involve- ment in association with diverticula of the distal EARLY DIVERTICULA A particular study was made left colon was seen three in of the histological findings in cases of very small times patients under and early diverticula. At this stage, when the diverti- this age. Involvement of the caecum alone occurred http://gut.bmj.com/ in an earlier age group, as is typically found in cula are less than 2 mm in diameter, the diverti- cula move very easily in and out of the bowel through clinical diverticulitis of this region.
Load more

Recommended publications
  • Umbilical Hernia with Cholelithiasis and Hiatal Hernia
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Springer - Publisher Connector Yamanaka et al. Surgical Case Reports (2015) 1:65 DOI 10.1186/s40792-015-0067-8 CASE REPORT Open Access Umbilical hernia with cholelithiasis and hiatal hernia: a clinical entity similar to Saint’striad Takahiro Yamanaka*, Tatsuya Miyazaki, Yuji Kumakura, Hiroaki Honjo, Keigo Hara, Takehiko Yokobori, Makoto Sakai, Makoto Sohda and Hiroyuki Kuwano Abstract We experienced two cases involving the simultaneous presence of cholelithiasis, hiatal hernia, and umbilical hernia. Both patients were female and overweight (body mass index of 25.0–29.9 kg/m2) and had a history of pregnancy and surgical treatment of cholelithiasis. Additionally, both patients had two of the three conditions of Saint’s triad. Based on analysis of the pathogenesis of these two cases, we consider that these four diseases (Saint’s triad and umbilical hernia) are associated with one another. Obesity is a common risk factor for both umbilical hernia and Saint’s triad. Female sex, older age, and a history of pregnancy are common risk factors for umbilical hernia and two of the three conditions of Saint’s triad. Thus, umbilical hernia may readily develop with Saint’s triad. Knowledge of this coincidence is important in the clinical setting. The concomitant occurrence of Saint’s triad and umbilical hernia may be another clinical “tetralogy.” Keywords: Saint’s triad; Cholelithiasis; Hiatal hernia; Umbilical hernia Background of our knowledge, no previous reports have described the Saint’s triad is characterized by the concomitant occur- coexistence of umbilical hernia with any of the three con- rence of cholelithiasis, hiatal hernia, and colonic diverticu- ditions of Saint’s triad.
    [Show full text]
  • Diverticulosis Beyond the Basics.Xps
    Patient education: Diverticular disease (Beyond the Basics) - UpToDate Page 1 of 10 Official reprint from UpToDate® www.uptodate.com ©2017 UpToDate® The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of UpToDate content is governed by the UpToDate Terms of Use. ©2017 UpToDate, Inc. All rights reserved. Patient education: Diverticular disease (Beyond the Basics) Author: John H Pemberton, MD Section Editor: J Thomas Lamont, MD Deputy Editor: Shilpa Grover, MD, MPH All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Dec 2016. | This topic last updated: Sep 16, 2015. DIVERTICULAR DISEASE OVERVIEW — A diverticulum is a pouch-like structure that can form through points of weakness in the muscular wall of the colon (ie, at points where blood vessels pass through the wall) (figure 1). Diverticulosis affects men and women equally. The risk of diverticular disease increases with age. It occurs throughout the world but is seen more commonly in developed countries. WHAT IS DIVERTICULAR DISEASE? Diverticulosis — Diverticulosis merely describes the presence of diverticula. Diverticulosis is often found during a test done for other reasons, such as flexible sigmoidoscopy, colonoscopy, or barium enema. Most people with diverticulosis have no symptoms and will remain symptom free for the rest of their lives. (See 'Diverticular disease prognosis' below.) A person with diverticulosis may have diverticulitis, or diverticular bleeding.
    [Show full text]
  • Diverticular Disease of the Colon
    ® ® GasTroenTerology DepArTmenT Diverticular Disease of the Colon WHAT is DiverTiculosis? Diverticulosis refers to the presence of small out-pouchings (called diverticula) or sacs that can develop in the lining of the gastrointestinal tract. While diverticula can be present anywhere in the entire digestive tract, they are most common on the left side of the large intestine, the area known as the descending and sigmoid colon (Figure 1). HoW common is DiverTiculosis? Diverticulosis is a common disorder especially in older people. The condition is rarely seen in people under the age of 30 and is most common in those over 60. Both men and women are equally affected. What cAuses DiverTiculosis? Figure 1 No one knows for certain why diverticulosis develops; however, a few theories have been suggested. Some experts believe that abnormal contraction and spasm (resulting in intermittent high pressure in the colon) may cause diverticula to form in a weak spot of the intestinal wall. Low fiber diets may play a role in the development of diverticulosis. In rural Africa where diet is high in roughage, diverticulosis is rare. There also appears to be a genetic predisposition to diverticulosis, that is, if your parent or grandparent had diverticulosis you may develop it as well. What Are the sympToms of DiverTiculosis Most patients with diverticulosis have no symptoms. Many will never know they have the condition until it is discovered during an endoscopic or radiographic (X-ray) examination. While most people have no symptoms, some individuals may experience pain or discomfort in the left lower abdomen, bloating, and/or change in bowel habits.
    [Show full text]
  • Jejunal Diverticulosis: Presenting As Peritonitis
    Section: Surgery Original Article ISSN (0): 2347-3398; ISSN (P): 2277-7253 Jejunal Diverticulosis: Presenting As Peritonitis 1 2 2 2 3 4 Vikas Chalotra , Puneet Bansal , Natasha Nuna , Shifali Joshi , Sarbjeet Singh , Aman Bharti 1Assistant Professor, General Surgery, GGSMC&H, Faridkot, 2PG Resident, General Surgery , GGSMC&H , Faridkot, 3Associate Professor, General Surgery, 4GGSMC&H , Faridkot, Assistant Professor, General Medicine , GGSMC&H, Faridkot. Abstract Jejunal diverticular perforation is a rare complication of jejunal diverticular disease and few cases have been reported in the literature. Jejunal diverticula have a prevalence of approximately 1% in the general population. Pathophysiology of chronic symptoms is related to either intestinal dyskinesia or bacterial overgrowth from blind loop syndrome due to stasis in diverticular lumen. Patients may develop malabsorption, steatorrhea, and megaloblastic anaemia from vitamin B12 deficiency. Conventional enteroclysis and CT enteroclysis is beneficial for diagnosis of jejunal diverticular disease. Jejunal diverticular perforation is very rare. Clinically, the diagnosis is challenging and mimics with other causes of acute abdomen. Presentation varies widely from asymptomatic to non specific symptoms to acute abdomen with catastrophic consequences. Here, we present a rare case of jejunal diverticular perforation. Keywords: Jejunal diverticulosis, Small bowel diverticulosis, Acute abdomen, Diverticular perforation. Corresponding Author: Dr. Vikas Chalotra, Assistant Professor, General Surgery, GGSMC&H, Faridkot. Received: September 2019 Accepted: September 2019 Introduction elevated white cell count (WBC 16000\mc L), Hb 6gm% normal RFTs and LFTs. Jejunal diverticular perforation is a rare entity with a X ray abdomen erect showed multiple air fluid levels. X ray prevalence of approximately 1% in the general population. chest showed air under diaphragm[Figure 1].
    [Show full text]
  • Are We Missing Any Other Components of Saint Triad?
    International Journal of Medical and Pharmaceutical Case Reports 6(1): 1-5, 2016; Article no.IJMPCR.22364 ISSN: 2394-109X, NLM ID: 101648033 SCIENCEDOMAIN international www.sciencedomain.org Are We Missing Any Other Components of Saint Triad? Jayabal Pandiaraja 1* and Arumuguam Sathyaseelan 1 1SRM Medical College, Potheri, Kancheepuram, 603203, India. Authors’ contributions This work was carried out in collaboration between both authors. Author JP wrote the draft of the manuscript. Author JP managed the literature searches. Author AS designed the figures, managed literature searches and contributed to the correction of the draft. Author JP provided the case, the figures and supervised the work. Both authors read and approved the final manuscript. Article Information DOI: 10.9734/IJMPCR/2016/22364 Editor(s): (1) Erich Cosmi, Director of Maternal and Fetal Medicine Unit, Department of Woman and Child Health, University of Padua School of Medicine, Padua, Italy. (2) Jignesh G. Patel, Department of Pathology, University of Texas Medical Branch at Galveston, Texas, USA. Reviewers: (1) Aşkın Ender Topal, Dicle University, Turkey. (2) Eyo E. Ekpe, University of Uyo, Nigeria. (3) Ketan Vagholkar, D. Y. Patil University, School of Medicine, India. Complete Peer review History: http://sciencedomain.org/review-history/12062 Received 29 th September 2015 Accepted 17 th October 2015 Case Study nd Published 2 November 2015 ABSTRACT Saint triad consists of colonic diverticulosis, gall stone and hiatus hernia. But there are reports of colonic diverticulosis with cardiomyopathy. This is a case report of Saint Triad with dilated cardiomyopathy and duodenal diverticulosis. So all patients who fall under Saint Triad have to undergo upper gastro intestinal endoscopy to identify duodenal diverticulum apart from hiatus hernia and echo cardiography to identify cardiomyopathy as a part of screening.
    [Show full text]
  • Jejunal Diverticula Causing a Life-Threatening Lower
    Available online at www.ijmrhs.com cal R edi ese M ar of c l h a & n r H u e o a J l l t h International Journal of Medical Research & a S n ISSN No: 2319-5886 o c i t i Health Sciences, 2019, 8(4): 196-200 e a n n c r e e t s n I • • IJ M R H S Jejunal Diverticula Causing a Life-Threatening Lower Gastrointestinal Bleeding: A Case Report Abdelmoniem MM Makkawi* and Mohammed Eltoum Hamid Azoz Department of Surgery, University of Elimam Elmahadi, Kosti, Sudan *Corresponding e-mail: [email protected] ABSTRACT A jejunal diverticulum is a rare and usually asymptomatic disease. More commonly it is usually seen as incidental findings on radiological studies or during surgery. Complications such as bleeding, perforation, abscess formation, obstruction, malabsorption, blind loop syndrome, volvulus, and intussusception may warrant surgical intervention. Herein, we report a case of a 62-year old woman presenting with massive lower gastrointestinal bleeding, she was pale, clammy and hemodynamically unstable, she was initially resuscitated with IV fluids and whole blood, urgent upper endoscopy was normal, colonoscopy revealed sigmoid colon ulcerative lesion with histopathological evidence of adenocarcinoma, there was bleeding coming from upwards. After staging of the tumor, the decision was then made to proceed to exploratory laparotomy with a pre-operative plan of segmental colectomy. Intra-operatively segmental sigmoid colectomy was performed with end to end anastomosis, during formal laparotomy we found 2 giant diverticula in the proximal jejunum, small bowel resection and end to end anastomosis was done with the good postoperative outcome.
    [Show full text]
  • Diverticulosis, Diverticulitis, Ischaemic Colitis, Irritable Bowel Syndrome
    Diverticulosis, diverticulitis, Ischemic colitis. Irritable bowel syndrome Dr. Fuszek Péter Phd. Semmelweis Egyetem Kútvölgyi Klinikai Tömb 2016-10-12 Case Riport • The 55-year-old female patient (referred by a family doctor) • History: serious illness is not known. Constipation since childhood. • Complaints: left upper quadrant abdominal pain, bloody stool, nausea, dysuria • temperature: 38,3 UH: thickened sigmoid colon • LAB: Dg: Diverticulitis • WBC: 14 Colon cancer • CRP: 15 Haemorrhoids, ? • Urine: normal Colitis Diverticulosis, diverticulitis Diverticula are small, bulging Sometimes, however, pouches that can form in large one or more of the bowel. They are found most often pouches become in the lower part of the large inflamed or infected. intestine (colon). Diverticula are That condition is common, especially after age 40, known as diverticulitis and seldom cause problems. Epidemiology The incidence of diverticular disease has increased over the past century. Autopsy studies from the early part of the 20th century reported colonic diverticula rates of 2% to 10%. This has increased dramatically over the years. More recent data suggest that up to 50% of individuals older than 60 years of age have colonic diverticula, with 10% to 25% developing complications such as diverticulitis. Hospitalizations for diverticular disease have also been on the rise. According to an American study evaluating hospitalization rates between 1998 and 2005, rates of admission for diverticular disease increased by 26% during the eight-year study period. Similar trends have been observed in Canadian and European data over the same time period . Can J Gastroenterol. 2011 Jul; 25(7): 385–389. Patogenesis Diverticula are small mucosal herniations protruding through the intestinal layers and the smooth muscle along the natural openings created by the vasa recta or nutrient vessels in the wall of the colon.
    [Show full text]
  • Diverticular Disease Medical Appendix (Diverticulosis
    DIVERTICULAR DISEASE MEDICAL APPENDIX (DIVERTICULOSIS) DEFINITION 1. Diverticulosis is a disorder characterised by the presence of outpouchings of mucosa and submucosa through the muscular wall of the intestine. These diverticula (or more strictly, pseudodiverticula) may occur anywhere along the course of the gastrointestinal tract but are commonest by far in the distal and sigmoid colon. 2. ‘Diverticular disease’ encompasses all aspects and effects of the condition but conventionally applies to diverticulosis of the large intestine and its complications. CLINICAL MANIFESTATIONS OF DIVERTICULOSIS Small intestinal diverticula 3. With the exception of Meckel’s diverticulum the most common locations in the small intestine are the duodenum and jejunum. Usually they are asymptomatic and are discovered incidentally during investigation for other disorders, but occasionally they may cause symptoms either because of their proximity to other structures or due to bleeding or inflammation. Meckel’s diverticulum 4. This congenital anomaly consists of a persistent omphalomesenteric duct. It occurs typically as a 5cm wide-mouthed diverticulum arising from the antimesenteric border of the ileum, usually within 100cm of the ileocaecal valve. The sac may be lined with ileal, gastric, duodenal, pancreatic or colonic mucosa. It is rarely symptomatic after the age of five years, but may give rise to haemorrhage, inflammation or obstruction in children and adolescents. In older children and young adults inflammation of the diverticulum may mimic appendicitis. Other complications, such as intussusception, enterolith formation and tumour may occur. Colonic diverticula 5. The prevalence of colonic diverticula increases with age. They are rare under the age of 30 years, but almost universal in people over 80.
    [Show full text]
  • Best Practices in the Diagnosis and Treatment of Diverticulitis And
    AHRQ Safety Program for Improving Antibiotic Use 1 Best Practices in the Diagnosis and Treatment of Diverticulitis and Biliary Tract Infections Acute Care Slide Title and Commentary Slide Number and Slide Best Practices in the Diagnosis and Acute CareSlide 1 Treatment of Diverticulitis and Biliary Tract Infections Acute Care SAY: This presentation will address two common intra- abdominal infections: diverticulitis and biliary tract infections. Objectives Slide 2 SAY: The objectives for this presentation are to: Describe the approach to the diagnosis of diverticulitis and biliary tract infections Identify options for empiric antibiotic therapy for diverticulitis and biliary tract infections Discuss the importance of source control in the management of intra-abdominal infections Identify options for antibiotic therapy for diverticulitis and biliary tract infections after additional clinical data are known Describe the optimal duration of therapy for diverticulitis and biliary tract infections AHRQ Pub. No. 17(20)-0028-EF November 2019 Slide Title and Commentary Slide Number and Slide Diverticulitis Slide 3 SAY: We will start by discussing diverticulitis. The Four Moments of Antibiotic Decision Slide 4 Making SAY: We will review diverticulitis using the Four Moments of Antibiotic Decision Making. 1. Does my patient have an infection that requires antibiotics? 2. Have I ordered appropriate cultures before starting antibiotics? What empiric therapy should I initiate? 3. A day or more has passed. Can I stop antibiotics? Can I narrow therapy
    [Show full text]
  • Diverticular Disease-Related Colitis
    Diverticular Disease-Related Colitis KEY FACTS Colon TERMINOLOGY ○ Abscess, fistula, perforation • Segmental colitis-associated diverticulosis (SCAD) ○ Exception is Crohn disease-like variant of SCAD that may show mural lymphoid aggregates ETIOLOGY/PATHOGENESIS MICROSCOPIC • Unknown, TNF-α may play role • Chronic colitis-like changes mimicking inflammatory bowel CLINICAL ISSUES disease • Presents with hematochezia, abdominal pain, diarrhea • Ulcerative colitis-like variant shows changes confined to • Median age: 64 years mucosa ○ Range: 40-86 years ○ Diverticulitis may or may not be present in these cases • Predominately involves descending and sigmoid colon (with • Crohn disease-like variant shows mural lymphoid rectal sparing) aggregates • Treatment directed toward diverticular disease suppresses • Changes in both variants confined to segment involved symptoms with diverticulosis coli MACROSCOPIC TOP DIFFERENTIAL DIAGNOSES • Mucosal changes are mild and nonspecific • Ulcerative colitis, Crohn disease, infectious colitis, diversion • Mural changes are related more to underlying diverticulosis colitis, NSAID-associated colitis coli rather than SCAD Diverticular Disease-Associated Colitis Diverticular Disease-Associated Colitis (Left) The mucosa surrounding the openings of diverticula ſt into the colonic lumen is erythematous and granular, consistent with diverticular disease-associated colitis (DDAC) ﬊. (Right) It is not uncommon to find some inflammation or erosions ﬊ around the luminal opening of a colonic diverticulum ſt. To be diagnostic of DDAC, inflammation must involve the mucosa in the interdiverticular region ﬉. Chronic Active Colitis Basal Lymphoplasmacytosis (Left) A chronic colitis pattern of inflammatory infiltrate is seen in both the ulcerative colitis-like and Crohn disease- like variant of DDAC. The mucosal changes are indistinguishable from true inflammatory bowel disease (IBD). (Right) A band of lymphoplasmacytic infiltrate ﬊ is present beneath the base of the crypts ﬇ in the mucosa.
    [Show full text]
  • Case Report: Challenges in Diagnosis and Treatment of Small Bowel Diverticulitis Presenting with Acute Abdomen
    Vol. 8(2), pp. 4-8, August 2018 DOI: 10.5897/MCS2018.0121 Article Number: E3F987858483 ISSN: 2141-6532 Copyright ©2018 Author(s) retain the copyright of this article Medical Case Studies http://www.academicjournals.org/MCS Case report Case report: Challenges in diagnosis and treatment of Small bowel diverticulitis presenting with acute abdomen Jeong-moh John Yahng Department of General Surgery, Western Health, Victoria, Australia. Received 24 April, 2018; Accepted 31 July, 2018 Small bowel diverticulitis is a rare condition that is often excluded in the differential diagnosis of acute abdomen. We herein present two cases of patients with small bowel diverticulitis who presented with acute abdomen. First case was a 72-year-old lady who presented to emergency with 2 days of sudden- onset worsening generalized abdominal pain. The computed tomography (CT) revealed a segment of abnormally thickened jejunum with marked adjacent inflammatory mesenteric fat stranding and adjacent extraluminal gas locules, in keeping with complicating perforation. The patient was subsequently taken to the operating theater for an emergency laparotomy which revealed a contained perforation of the proximal jejunum secondary to a ruptured diverticulum. 20 cm of proximal jejunum containing the perforation was resected. The patient recovered uneventfully and was discharged day 7 following the operation. Second case was a 78-year-old lady who presented with 12 h of sudden-onset right-sided abdominal pain. The CT revealed the presence of multiple diverticula in the jejunum associated with diffuse wall thickening and marked peridiverticular inflammatory changes. This was most in keeping with small bowel diverticulitis, however, there was no definite extraluminal gas to suggest any evidence of perforation.
    [Show full text]
  • Distinction from Diverticulitis
    Gut, 1968, 9, 7-16 Gut: first published as 10.1136/gut.9.1.7 on 1 February 1968. Downloaded from Crohn's disease of the colon and its distinction from diverticulitis G. T. SCHMIDT, J. E. LENNARD-JONES, B. C. MORSON, AND A. C. YOUNG From St. Mark's Hospital, London Crohn's disease may affect segments of the colon GROUP I: DIAGNOSIS MADE ON A RESECTED SPECIMEN (Brooke, 1959; Lindner, Marshak, Wolf, and Fourteen patients have been seen with Crohn's Janowitz, 1963; Lockhart-Mummery and Morson, disease and diverticula of the sigmoid colon in whom 1960, 1964) where diverticula are a common finding the diagnosis was established by pathological in the middle-aged and elderly (Dearlove, 1954; examination of a resected specimen. Nine of these Pemberton, Black, and Maino, 1947). It would 14 patients were diagnosed clinically as diverti- thus be surprising if Crohn's disease did not some- culitis, four as Crohn's disease, and one as ulcera- times occur in the region of colonic diverticula and tive colitis. Crohn's disease was diagnosed in the the object of this paper is to describe 26 such presence of colonic diverticula in 10 of the 14 patients. specimens when first examined but in the other Some of these patients presented little diagnostic four only after review of the pathology following difficulty. Others, with colonic diverticula, presented the development of characteristic postoperative as 'diverticulitis' but the inflammation of the colon complications such as anal or entero cutaneous was subsequently shown to be due to Crohn's disease. fistulae.
    [Show full text]