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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diverticular disease of the right colon is not common, especially in western countries. It occurs in two different clinical forms, known as the "usual" and "hidden" variants. The diagnosis is not always easy, especially in the latter variant, because sometimes barium enema and CT scan are unable to distinguish this form from cancer. The final diagnosis is only intraoperative. In our experience, from 1994 to 2004, we observed 4 cases of complicated right-sided diverticulitis. Three of these patients had symptoms mimicking acute appendicitis, such as fever and abdominal pain. Only 2 of them underwent surgical treatment consisting of a right standard hemicolectomy. The 4th patient had no inflammatory symptoms, but had a history of right-sided abdominal pain and diarrhoea. Laboratory data showed only hypochromic anaemia. Barium enema and CT scan highlighted a vegetating mass in the ascending colon causing irregular severe stenosis of the lumen and hyperdensity of mesocolic fatty tissue. Surgical treatment consisted in a right hemicolectomy. Macroscopically, the mass involved the caecum and ascending colon. Enlarged lymph-nodes were present in the thickness of the mesocolon, but not in other districts. Histological examination revealed diffuse diverticular disease complicated by perforation of many diverticula into the mesocolon.
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PMID:Diverticular disease of right colon. Clinical variants and personal experience. 1673 70

Acquired (non-Meckel's) jejuno-ileal diverticular disease is uncommon, and most surgeons have limited, if any, experience with this condition. We present an interesting case with coexistence of small bowel diverticulum and small bowel volvulus with massive abdominal distension, in which the patient had a history of abdominal distension without abdominal pain over a five-year period. A brief discussion of the common clinical features is given and the principles of treatment of jejuno-ileal diverticular disease and small bowel volvulus are presented. A 29-year- old man with no history of laparotomy was admitted with abdominal distension and abdominal compartment syndrome symptoms. An emergency laparotomy revealed 180 degree clockwise volvulus of the multiple diverticula-bearing terminal ileum. There was no diverticulum in other sites of the small intestine and colon. Additionally, there was neither adhesion nor any congenital anomalies at the other sites of the gastrointestinal system. The viability of the intestine was normal but the diameter of the ileum was extremely enlarged (approximately 20 cm). In addition, the bowel wall was also hypertrophied. The rotated and enormously enlarged diverticula-bearing small intestine was removed with cecum, and ileocolostomy was performed. The patient was discharged uneventfully from hospital on the eighth postoperative day. After the operation, all symptoms of the patient disappeared. Small bowel obstruction is a common cause of emergency surgical admission. Awareness of the fact that volvulus of the diverticula-bearing segment of the jejuno- ileum is a rare cause of small bowel obstruction may lead to earlier and prompt diagnosis and treatment.
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PMID:An interesting coexistence: small bowel volvulus and small bowel diverticulosis. 1720 11

Diverticular disease-associated segmental colitis is a unique variant of chronic colitis limited to segments of the left colon that harbor diverticula. Histologically, this disease mimics chronic idiopathic inflammatory bowel disease and can be indistinguishable from ulcerative colitis or Crohn's colitis on histologic grounds alone. Patients typically present with hematochezia and cramping abdominal pain, and colonoscopic evaluation reveals inflammatory changes limited to the segment of bowel containing the diverticula, with rectal sparing. Although this disease does not appear to be an unusual form of diverticulitis but possibly an immunologically mediated process, many patients respond to treatment directed toward diverticulitis. A subset of patients requires immunosuppressive therapy and/or surgery, and a small subset progresses to develop classic ulcerative colitis. Because of the histologic overlap with ulcerative colitis and occasionally Crohn's colitis, it is essential that endoscopists provide a full description of the macroscopic appearance of the inflammatory changes at endoscopy, such as limitation to a segment of diverticular disease, so that the pathologist can provide a more informative interpretation of the biopsy.
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PMID:Diverticular disease-associated segmental colitis. 1723 53

Bevacizumab is the first U.S. Food and Drug Association-approved vascular endothelial growth factor-targeted agent that greatly increases progression-free and overall survival in combination with standard chemotherapy regimens in patients with metastatic colorectal cancer. Although bevacizumab is generally well tolerated, some serious adverse events have occurred in some patients in clinical trials, including arterial thromboembolism and gastrointestinal (GI) perforation. GI perforation was first observed in the pivotal phase 3 trial, in which six events occurred in bevacizumab group (1.5%), compared with no events in the control group. Since then, similar rates of GI perforation have been observed in other large trials. Typical presentation was abdominal pain associated with constipation and vomiting. Such events occurred throughout treatment and were not correlated with duration of exposure. No difference in rate of GI perforations was found in patients who did and did not have a baseline history of peptic ulcer disease, diverticulosis, and history of chronic use of nonsteroidal anti-inflammatory drugs. However, the incidence of GI perforation seemed to be higher in patients with primary tumor intact, recent history of sigmoidoscopy or colonoscopy, or previous adjuvant radiotherapy, but it is necessary to confirm these preliminary findings by multivariate analyses. The mechanism responsible for causing GI perforation is not known and may be multifactorial. Bevacizumab should be permanently discontinued in patients who develop GI perforation. This article reviews the incidence, presentation, pathogenesis, risk factors, and management of GI perforation in patients with colorectal cancer who are treated with bevacizumab.
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PMID:Gastrointestinal perforation due to bevacizumab in colorectal cancer. 1735 52

Rosai-Dorfman disease (RDD) involves the gastrointestinal tract only in exceptional cases, and this very unusual site of presentation can confuse the pathologist. We present a case of RDD manifesting as an intestinal occlusion caused by colonic diverticulitis. The patient was a 79-year-old man with myelodysplasia, who presented with fever, abdominal pain, and constipation. Colonoscopy revealed sigmoiditis and diverticulosis. Microscopic study of the sigmoid colon surgical specimen showed the histological and immunological features of RDD. No human DNA of herpesvirus types 6 and 8 (HHV6/HHV8), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) was detected in tissue by polymerase chain reaction. Electron microscopic study revealed no microbes or viral particles. Widespread nodal and extranodal RDD occurred, and the patient died 2y after initial surgery. The etiology of RDD is still under debate. We discuss the association of RDD with hematological disorders.
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PMID:Intestinal occlusion caused by Rosai-Dorfman disease mimicking colonic diverticulitis. 1740 Mar 99

In uncomplicated diverticular disease, treatment is aimed at relieving symptoms. The aim of the present study was to evaluate the efficacy of mesalazine for symptomatic relief of uncomplicated diverticular disease of the colon. Two hundred sixty-eight consecutive eligible outpatients (122 male, 146 female; age, 66.1 years; range, 31-81 years) were enrolled in four treatment schedules in a randomized fashion: Group R1 (66 patients), rifaximin, 200 mg bid; Group R2 (69 patients), rifaximin, 400 mg bid; Group M1 (67 patients), mesalazine, 400 mg bid; and Group M2 (66 patients), mesalazine, 800 mg bid. Treatments were administered for 10 days every month for 12 months. Clinical evaluations were performed at admission and at 3-month intervals for 12 months considering 12 clinical variables (upper and lower abdominal pain/discomfort, tenesmus, diarrhea, abdominal tenderness, fever, bloating, general illness, nausea, emesis, dysuria, bleeding) graded as 0 = no symptoms, 1 = mild, 2 = moderate, and 3 = severe. The Global Symptomatic Score (GSS) was calculated using the sum of each symptom score. Two hundred forty-four patients completed the 12- month study; 24 were discontinued (14 treated with rifaximin and 10 treated with mesalazine) either as voluntary dropouts or because they developed side effects and/or complications. Group M2 demonstrated a lower frequency of many symptoms after 6 and 12 months of treatment; the mean GSS was significantly lower in Group M2 after 6 and 12 months of therapy by both intention-to-treat and per-protocol analyses. Patients treated with mesalazine (Groups M1+M2) had a lower GSS than subjects treated with rifaximin (Groups R1+R2) during the 12-month follow-up period. We conclude that cyclic administration of mesalazine is effective for symptomatic relief of uncomplicated diverticular disease of the colon. Some symptoms showed greater improvement with mesalazine, 800 mg bid, than with the other treatment schedules.
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PMID:Prevention of complications and symptomatic recurrences in diverticular disease with mesalazine: a 12-month follow-up. 1741 Apr 35

Giant colonic diverticulum is a rare complication of diverticular disease of the colon and is thought to result, in most cases, from a "ball-valve" effect. The presentation and clinical course can be variable and confusing. The most common symptoms are abdominal pain and a palpable abdominal lump, with many patients presenting acutely with complications such as perforation and peritonitis. Preoperative diagnosis requires a high degree of suspicion and needs to be differentiated from sigmoid volvulus, caecal volvulus, intestinal duplication cyst, pneumatosis cystoidis intestinalis, and similar conditions. A plain x-ray and computed tomography (CT) scan of the abdomen shows a huge air-filled cyst termed "balloon sign" and confirms the diagnosis. The barium enema shows a communication with the bowel in most cases. In view of the high incidence of complications, treatment is advised even in asymptomatic cases and consists of excision of the cyst with resection of the adjacent colon with primary anastomosis. This treatment would, in most cases, be a sigmoid colectomy. Percutaneous drainage and Hartmann's procedure may be appropriate in some cases who present with a well-formed abscess or gross fecal peritonitis, respectively. A case is described, and the literature is reviewed.
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PMID:Giant colonic diverticulum: an unusual abdominal lump. 1746 10

Williams-Beuren syndrome (WBS) is a multi-system disorder that requires ongoing management by a primary care physician familiar with the natural history and common medical problems associated with the condition. Some abnormalities are unique to WBS, such as the elastin arteriopathy that often manifests as supravalvar aortic stenosis and hypertension. Still other features, such as diverticulosis, are seen in the general population but tend to present earlier in WBS. Life long monitoring of the cardiovascular and endocrine systems is essential to the clinical management of individuals with Williams-Beuren syndrome. Constipation should be aggressively managed, and symptoms of abdominal pain should prompt an evaluation for diverticulosis/diverticulitis. While the mean IQ of WBS is in the mild mental retardation range, difficulties with attention and anxiety are more likely to negatively impact independent functioning in the adult with WBS. There is no evidence for decline in cognitive ability over time, but adaptive functioning may be improved with treatment of anxiety by both behavior and medical modalities.
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PMID:Diagnosis and management of medical problems in adults with Williams-Beuren syndrome. 1763 96

Acquired (non-Meckel's) jejunoileal diverticulosis is an uncommon disease, generally characterised by vague and unspecific symptoms. This rare condition is mainly expressed as acute complications: gastrointestinal haemorrhage, mechanic obstruction of the small intestine or perforated diverticulum, requiring urgent surgical intervention. The authors report a case of this unusual clinical occurrence characterized by a picture of abdominal pain due to perforation of jejuneal diverticulum. The final etiological diagnosis was possible only during surgery.
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PMID:Perforated jejuneal diverticulosis. Case report and review of literature. 1772 2

Colorectal polypoid lesions are classified as either neoplastic or non-neoplastic, and the differentiation between the two lesions is important for clinical practice, however, this is not easy in some rare cases. Cases of colonic prolapsing mucosal polyps are rare. They are often, but not always, associated with diverticular disease and present with abdominal pain, obstructive symptoms or bleeding. On colonoscopic examination, the lesions are characterized by multiple polyps or elevated patches with smooth and bright red colored surface. The histological features include: glandular crypt abnormalities, fibromuscular obliteration of the lamina propria, and thickened and splayed muscularis mucosa. We report herein a case of sigmoid colonic prolapsing mucosal polyps presenting with acute lower abdominal cramping pain and colonic obstruction who was diagnosed based on colonoscopy and endosonography findings and treated with conservative management.
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PMID:Prolapsing mucosal polyps in the sigmoid colon: presenting with chronic abdominal cramping pain and colonic obstruction. 1793 24


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