1/151. Perforation of acquired small bowel diverticulum. A 77-year old woman was seen with an unusual pathologic entity after emergent abdominal exploration--a ruptured small bowel diverticulum. This patient had a known previous history of colonic diverticulosis when she had acute onset of severe abdominal pain. The patient underwent an exploratory laparotomy with resection of representative segments of small and large bowel. The large bowel had evidence of diverticulosis, while the small bowel resected segment had evidence of diverticulitis with rupture. An extensive review of the literature revealed a very small number of reported cases in the world literature (less than 150 cases). We reviewed the history of reported cases of ruptured and nonruptured small bowel diverticular disease, as well as this case. ( info) |
2/151. Effect of Crohn's disease on colonic diverticula. Fifteen cases in which the same part of the colon has been affected by both diverticular disease and Crohn's disease have been studied. When Crohn's disease affects an area of colon where diverticula are present, radiological examination may show a diminution in number or disappearance of the diverticula with progress of the Crohn's disease. With improvement in the Crohn's disease diverticula may appear. ( info) |
3/151. Giant sigmoid diverticulum: a report of three cases. The imaging appearances of three patients with a giant sigmoid diverticulum are described. The prominent feature was a large gaseous lucency noted in the lower abdomen on plain radiographs. Computed tomography (CT) was undertaken in two cases and in these a large gas filled collection was identified containing a small quantity of fluid. In the third case the collection was aspirated, contrast medium injected and a communication with the large bowel demonstrated. The condition is uncommon and needs to be distinguished from sigmoid and caecal volvulus. ( info) |
4/151. amyloidosis presenting as a perforated giant colonic diverticulum. Colonic amyloidosis is frequent, although rarely radiographically evident. The radiological findings are varied and unspecific. We report a case of perforated giant colonic diverticulum (GCD) diagnosed by helical CT in which amyloid deposition was pathologically demonstrated. The patient was a renal transplant recipient who previously had undergone hemodialysis for 10 years. A possible role of amyloidosis in the pathogenesis of this case is discussed. Giant colonic diverticulum must be included in the spectrum of gastrointestinal manifestations of amyloidosis. ( info) |
5/151. Giant colonic diverticulum: report of a case. Giant colonic diverticulum is a rare complication of colonic diverticulosis. It typically occurs as a single diverticulum located on the antimesenteric border of the sigmoid colon. The most widely accepted theory for its development attributes the progressive dilation to a "ball-valve" mechanism, allowing air to enter but not to exit. patients usually present complaining of abdominal pain and/or an abdominal mass, although they may remain asymptomatic. physical examination reveals a tympanic abdominal mass that appears as a round radiolucency on plain radiographs and CT. barium enema demonstrates the relationship of the diverticulum to bowel and may document communication with the colonic lumen. To alleviate symptoms and prevent complications, the recommended treatment is excision of the diverticulum in continuity with the involved colonic segment. We report a case and discuss the presentation, diagnosis, and management of giant colonic diverticulum. ( info) |
6/151. Seldom found acute abdomen: perforated diverticulum in the transverse colon. The authors report a recently examined rare case of isolated perforated diverticulum of the transverse colon. At surgery, a perforated omentum-sealed diverticulum was found in the third distal wall of the transverse colon. A diverticulectomy was performed. The postoperative course was excellent. ( info) |
7/151. hemostasis of colonic diverticular bleeding with hemoclips under endoscopic control: report of a case. This paper reports a case in which endoscopic hemostasis of a bleeding colonic diverticula was successful with endoscopic hemoclip. The patient, a 53 year-old man with painless hematochezia, was urgently admitted to our institute. After colonic cleaning preparation, colonoscopic examination was performed. At the bottom of the diverticulum of the ascending colon, a vessel with oozing blood was endoscopically noted. Hemoclips were placed on and around the visible vessel and immediate hemostasis was completed. Endoscopic clipping method for management of bleeding diverticular vessel is an effective, simple, and safe procedure. ( info) |
8/151. Inflammatory pseudotumor of the urinary bladder and sigmoid colon. We report an unusual case of an inflammatory pseudotumor of the bladder. A biopsy specimen prior to surgical treatment suggested leiomyosarcoma, and computerized tomography and magnetic resonance imaging strongly suggested bladder tumor with sigmoid colon invasion. Accordingly, radical surgical treatment consisting of total cystectomy, anterior resection of the sigmoid colon, and ileal conduit was performed. After operation, however, histological examination revealed an inflammatory pseudotumor of bladder and sigmoid colon. These findings were confirmed by immunohistochemical staining for smooth muscle specific actin, desmin, S-100, and vimentin. Histological examination revealed a diverticulum of the sigmoid colon in the middle of the pseudotumor, and this diverticulum may have ruptured to cause the inflammatory pseudotumor of bladder and sigmoid colon. ( info) |
9/151. Giant colonic diverticulum: a rare manifestation of a common disease. Giant colonic diverticulum is a rare manifestation of a common disease primarily affecting patients over the age of 50 years. We reviewed all 81 cases of giant colonic diverticulum reported in the medical literature and present herein an additional case in a younger patient. Published reports were summarized with regard to current epidemiology, clinical aspects, diagnosis, pathogenesis, treatment, and complications. Giant colonic diverticulum can present as an acute, chronic, or incidental condition, or with complications. There are several suggested theories for the pathogenesis of giant colonic diverticulum, but none is universally satisfactory. A diagnosis can be made with plain films, barium enema, and CT scans. A combination of sigmoid resection and primary anastomosis was successful in 75% of the cases reported after the mid-1970s. More than 90% of giant colonic diverticula are found in the sigmoid colon. Sigmoid resection with primary anastomosis is the preferred treatment, although patients presenting with complications typically should be treated with Hartmann's procedure for free perforation or percutaneous drainage for a localized abscess. Because of the high risk of complications, we recommend segmental resection of the involved colon for those found incidentally. ( info) |
10/151. Colo-cholecystic fistula: an unusual complication of colonic diverticular disease. Colonic diverticular disease can lead to various complications. We describe a case of an 81-yr-old man who was found to have intrabiliary air on computed tomography of the abdomen. Endoscopic retrograde cholangiopancreatography and subsequent surgical exploration of the abdomen revealed an ascending colonic diverticulum penetrating into the gall bladder. Colocholecystic fistula is an unusual cause of intrabiliary air and, to our knowledge, this has not been reported in the literature. ( info) |