1/16. Transverse colon diverticulitis: successful nonoperative management in four patients. Report of four cases.PURPOSE: diverticulitis of the transverse colon is a rare disorder and is often confused with other conditions. Previously reported cases of transverse colon diverticulitis were diagnosed and treated by surgical exploration. Four cases are presented that were successfully managed with a nonsurgical approach. methods AND RESULTS: review of the literature in English disclosed 31 cases of transverse colon diverticulitis. The clinical characteristics and management of these patients are reviewed and compared with the current series of patients. The utility of computerized tomography in the diagnosis of diverticulitis is discussed. CONCLUSIONS: Medical therapy with bowel rest and antibiotics is appropriate for transverse colon diverticulitis when free perforation and peritoneal signs are absent and the inflammation is contained, as shown by computerized tomography. Operative exploration should be reserved for patients with diffuse peritonitis or those where perforated colon cancer cannot be excluded.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
2/16. Aortocolic fistula, a lethal cause of lower gastrointestinal bleeding: report of a case.Aortocolic fistula occurs with spontaneous rupture of aortic and iliac aneurysms into the sigmoid colon, or due to involvement of the aneurysmal wall by acute diverticulitis. In the eight cases reviewed, this complication proved uniformly lethal, although sufficient clinical findings were present for diagnosis, and adequate time was available for a planned therapeutic approach. Lower gastrointestinal bleeding in the patient who has an aortic aneurysm and left-lower-quadrant inflammation suggests the presence of an aortocolic fistual. angiography should be performed during a bleeding episode to confirm the diagnosis. Surgical correction consists of an axillofemoral by pass graft, excision of the aortic aneurysm, and a Hartmann procedure.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
3/16. diverticulitis causing a high serum level of carbohydrate antigen 19-9: report of a case.We report herein a rare case of diverticulitis causing a high serum level of carbohydrate antigen (CA) 19-9. A 52-year-old man was admitted to our hospital with lower abdominal pain. Laboratory data showed evidence of inflammation and a high serum level of CA 19-9 (370 U/ml). Computed tomography demonstrated thickening of the wall of the sigmoid colon. He was diagnosed as having diverticulitis of the sigmoid colon and was treated with antibiotics. Although his symptoms improved, the presence of a malignancy such as colorectal cancer could not be completely ruled out because of the persistently high serum level of CA 19-9. A laparotomy was performed and the sigmoid colon was found to be adherent to the bladder. Under a diagnosis of diverticulitis, a sigmoidectomy was performed. Pathological examination revealed diverticulitis of the sigmoid colon, but there was no evidence of malignancy in the resected specimen. The serum CA 19-9 level decreased to normal postoperatively and immunohistochemical staining revealed CA 19-9 antigen in the cytoplasm of the diverticular epithelium. Therefore, a possible explanation for the high level of this tumor marker was diverticulitis of the sigmoid colon.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
4/16. Early lap-band erosion associated with colonic inflammation: a case report and literature review.INTRODUCTION: Laparoscopic adjustable gastric banding is an effective and safe surgical modality for the treatment of morbid obesity. Erosion of the band into the stomach has been reported. No reports are available on erosion of the Lap-Band following diverticulitis of the colon. CASE REPORT: A 31-year-old female with a body mass index (BMI) of 52 underwent an uneventful laparoscopic Lap-Band placement. Postoperative contrast study revealed good positioning of the band and no evidence of leakage. The patient's recovery was uneventful except for an elevated temperature of 101.5 degrees F that was attributed to her atelectasis. She had lost 52 lbs. and remained asymptomatic for 3 months. Following this period of successful weight loss, she presented with complaints of abdominal pain for 3 days associated with diarrhea of 7 days' duration. A Gastrografin contrast study showed no evidence of a leak or band slippage but erosion was suspected. Upper endoscopy confirmed erosion of the band into the stomach. Computed tomography (CT) of the abdomen revealed thickening of the sigmoid and descending colon with mesenteric fat stranding consistent with diverticulitis. Laparoscopic removal of the Lap-Band system was performed. CONCLUSION: We postulate that colonic diverticulitis could have been a precipitating factor in the development of band erosion. Intraabdominal sepsis resulting in subacute infection of the Lab-Band system may be the underlying factor.- - - - - - - - - - ranking = 4keywords = inflammation (Clic here for more details about this article) |
5/16. Colonic diverticulitis-related exuberant granulomatous reaction in a patient with sarcoidosis.A patient with long-standing sarcoidosis underwent partial colectomy for diverticular disease. Whereas sarcoid granulomas were rare in the otherwise normal colonic mucosa, an unusually large number of granulomas were scattered within the chronically inflamed peridiverticular tissues. It is suggested that in the framework of the sarcoidotic background, activated macrophages, being nonspecifically attracted to areas of inflammation, elicit an exuberant sarcoid granulomatous response. Our observation represents a previously undescribed variant of the "homing" phenomenon in sarcoidosis, unrelated insults inducing formation of granulomas in overabundance.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
6/16. Unusual presentation of sigmoid diverticulitis as an acute scrotum.We report a case of inflammation of the spermatic cord and testicle resulting from a perforated diverticulum of the sigmoid colon. Management included sigmoid resection with diversion, right orchiectomy and debridement of the right groin. To our knowledge this is the first reported case of retroperitoneal necrotizing fasciitis presenting initially as an acute scrotum.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
7/16. A pseudotumor of the urinary bladder secondary to diverticulitis of the sigmoid colon with colo-vesical fistula: a case report.A case of pseudotumor of the urinary bladder secondary to diverticulitis of the sigmoid colon with colo-vesical fistula is reported. Computed tomography and cystoscopy of the granulomatous mass caused by the inflammation suggested a colon or bladder cancer. A transurethral biopsy from the tumor was therefore performed at first, but showed only inflammation. Because primary bladder cancer was ruled out, partial cystectomy and partial colectomy were subsequently performed. Through histological examination the mass proved to be an inflammatory granuloma.- - - - - - - - - - ranking = 2keywords = inflammation (Clic here for more details about this article) |
8/16. Colouterine fistula secondary to diverticulitis.Colouterine fistula complicating diverticulitis is rare. Our experience with two patients, one with chronic vaginal discharge and the other with acute overwhelming sepsis, emphasizes the wide spectrum of clinical presentations that may accompany this entity. In patients with chronic symptoms, surgery is indicated to forestall further local infectious complications, and a single-stage sigmoid resection without hysterectomy may be adequate. If malignancy cannot be excluded, a single-stage en bloc resection of the uterus and colon is the procedure of choice. hysterectomy may also be mandatory to extirpate a nidus of acute infection. When severe local inflammation or obstruction mandate urgent operation, a two-stage procedure involving resection and end colostomy, followed by reanastomosis at a later time, is safest and most effective.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
9/16. Transverse taeniamyotomy in localized acute diverticulitis.Transverse taeniamyotomy has been in use for over four years in the surgical correction of the muscle abnormality of diverticular disease. Essentially, the technic is to carefully transversely incise the two antimesenteric taeniae coli at 2 cm. intervals, in a stepwise manner, from the rectosigmoid junction proximally up to normal colon. This causes the cut ends of the taeniae coli to pull apart into separate 2 cm. blocks of longitudinal muscle. Thus elongation and widening of the colon occurs, resulting in dilatation of the necks and free drainage of the diverticula obstructed by inflammation. Four patients are presented with localized diverticulitis who had simple transverse taeniamyotomy from which they quickly recovered. This operation justifies continuing study as it may increase the surgeon's range of response over one end of the spectrum of acute diverticulitis.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
10/16. Submuscular emphysema as a result of diverticulitis of the sigmoid colon without clinical implication.diverticulitis of the colon may be the cause of the formation of subcutaneous or submuscular air in the hip or leg region. This phenomenon results mostly in an inflammation or abscess. A case is presented in which sigmoid diverticulitis caused submuscular air without any clinical discomfort.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
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