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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of a cutaneous renocolic fistula in a patient with staghorn calculus and diverticulitis. The most common origins of renocolic fistula are primary renal diseases including xanthogranulomatous pyelonephritis, trauma, malignancy or tuberculosis. While diverticulitis has rarely been associated with renocolic fistula, previous instances of fistulae have been noted in patients with simultaneous kidney disease. Inflammation resulting from kidney disease may place patients with colonic diverticulitis at higher risk for developing renocolic or cutaneous renocolic fistulas.
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PMID:Cutaneous renocolic fistula associated with diverticulitis. 1870 51

Overall, the diagnosis of diverticulitis is more reliably made by computed tomography (CT) than by ultrasound (US). However, since US is often used as a first modality in acute abdomen, it is important to be aware of the US signs of diverticulitis. Besides, in not too obese patients, US may be superior to CT. US is most useful in early, uncomplicated diverticulitis. Daily, repeated US examinations in patients with diverticulitis have taught that diverticulitis, in the majority of cases, runs a predictable and benign course. Initially, there is local wall thickening of the colon with preservation of the US layer structure. Within the inflamed diverticulum, a fecolith is present, and the diverticulum is surrounded by hyperechoic, noncompressible tissue, which represents the inflamed mesentery and omentum 'sealing off' the imminent perforation. US follow-up shows evacuation of the fecolith to the colonic lumen, with or without the transient development of a small paracolic abscess, sometimes with disintegration of the fecolith. This process of spontaneous evacuation of pus and fecolith via local weakening of the colonic wall at the level of the original diverticular neck towards the colonic lumen takes place within 1 or 2 days, rarely longer. The residual inflammatory changes remain present for several days after the evacuation, and it is not uncommon to find an empty diverticulum at first presentation. If, in such cases, patients are specifically asked for their symptoms, they invariably declare that 'the worst pain is over'. Whenever diverticulitis takes a complicated course, CT is superior to US, especially in the detection of free air, fecal peritonitis and deeply located abscesses, and in general in obese patients. Finally, US, if necessary followed by CT, has an important role in the diagnosis of alternative conditions: ureterolithiasis, pyelonephritis, perforated peptic ulcer, appendicitis, Crohn's disease, epiploic appendagitis, gynecological conditions, colonic malignancy, pancreatitis, etc. Right-sided colonic diverticulitis in many respects differs from its left-sided cousin. Diverticula of the right colon are usually congenital, solitary, true diverticula containing all bowel wall layers. The fecoliths within these diverticula are larger and the diverticular neck is wider. There is no hypertrophy of the muscularis of the right colonic wall. My observations with US and CT in 110 patients with right colonic diverticulitis clearly show that it invariably has a favorable course and never leads to free perforation or large abscesses. Although relatively rare (left:right = 15:1), it is crucial to make a correct diagnosis since the clinical symptoms of acute right lower quadrant pain may lead to an unnecessary appendectomy or even right hemicolectomy.
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PMID:Ultrasound of colon diverticulitis. 2257 86

OBJECTIVE. The purpose of this study was to determine the prevalence and demographic distribution of colonic diverticulitis (CD) and alternative diagnoses (AD), as well as the diagnostic accuracy of MDCT in patients with suspected CD. MATERIALS AND METHODS. This study retrospectively included 1069 patients (560 women) undergoing MDCT for the evaluation of suspected CD. The prevalence of CD and AD was determined and the diagnostic accuracy of MDCT calculated. The final clinical diagnosis derived from the discharge report served as the standard of reference. Prevalence of diagnoses by age, sex, and admission status were compared using Cochran-Armitage, chi-square, and Fisher exact tests. RESULTS. Prevalence of CD was 52.5% (561/1069) and of AD was 39.9% (427/1069). In the remaining 7.6% (81/1069) no final clinical diagnosis was established. The most frequent AD were appendicitis (12.6%, 54/427), infectious colitis (10.5%, 45/427), infectious gastroenteritis (8.2%, 35/427), urolithiasis (6.1%, 26/427), and pyelonephritis (4.9%, 21/427). The prevalence of diverticulitis and AD varied statistically significantly according to both age (p < 0.001) and admission status (p < 0.001). Also, the prevalence of the 10 most frequent specific AD varied statistically significantly according to sex (p = 0.022). CT had a sensitivity and specificity of 99.1% and 99.8% for diagnosing CD and 92.7% and 98.8% for AD, respectively. CONCLUSION. In about 40% of patients with suspected diverticulitis a broad spectrum of AD is causative for symptoms. MDCT provides high diagnostic accuracy in the diagnosis of diverticulitis and AD. The prevalence of diagnoses is related to admission status and demographic data; in particular age-related AD have to be considered in patients with clinically suspected diverticulitis.
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PMID:MDCT in the Setting of Suspected Colonic Diverticulitis: Prevalence and Diagnostic Yield for Diverticulitis and Alternative Diagnoses. 3231 96