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Query: UMLS:C1510475 (diverticular disease)
 2,138 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Jejunal diverticulosis, a marker of disordered small intestinal motility, presents varied clinical manifestations. It is important to consider this disorder in elderly patients with unexplained abdominal discomfort accompanied by signs of intermittent small bowel obstruction and malabsorption. Diagnosis can be made by a small bowel follow-through x-ray film obtained as part of the evaluation of diarrhea and obstructive symptoms. Medical therapy is helpful in controlling diarrhea and anemia, while surgical therapy can give excellent results in treating complications or refractory symptoms.
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PMID:Jejunal diverticulosis: medical and surgical management. 392 56

Two cases of segmental, small-intestinal lipomatosis are described. In both, the patients had crampy abdominal pain secondary to partial intestinal obstruction. A review of the literature uncovered reports of 16 similar cases, in some of which virtually the entire small intestine was involved. Diverticulosis and intussusception are associated lesions. Diagnosis may be made by an abnormal roentgenographic pattern. Provided the bowel is not so extensively involved that complete resection is impractical, surgical removal of the affected segment results in cure.
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PMID:Small-intestinal lipomatosis. 677 78

The clinical presentation, operative findings and outcome in 40 patients who required surgery for bowel disease after radiotherapy are presented. The type of presentation varied according to the time after radiotherapy. In the first month, many patients had a proctitis but none required surgery. Five patients were operated on within one month, 2 for radiation-induced acute ileitis and 3 for exacerbations of pre-existing disease (diverticular disease 2, ulcerative colitis 1). The commonest time of presentation was between 3 and 18 months after radiotherapy, when 20 patients needed surgery for bowel disease caused by radiation-induced local ischaemia. Twelve of these patients had chronic perforation, 6 had severe rectal bleeding and 2 had painful anorectal ulceration. Fifteen patients presented between 2 and 24 years after radiotherapy, usually with incomplete intestinal obstruction due to a fibrous stricture, but 2 patients had rectal carcinoma. Wide resection of the involved bowel was the principal method of treatment but any anastomosis was protected by a proximal defunctioning stoma. There was no operative mortality but 10 patients have died subsequently. The danger of dismissing these patients as having incurable malignancy is stressed because, although the condition is infrequent, it is usually amenable to adequate surgery.
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PMID:Bowel disease after radiotherapy. 686 19

Surgeons operating on patients with an obscure peritonitis should be aware of the diverse etiologies of small intestinal perforation and the general principles of management of each. A series of 16 adult patients with free perforation of the small intestine and spreading peritonitis in the absence of bowel obstruction, incarcerated hernia, or trauma is reviewed. Etiologies were as follows: Crohn's disease, four patients; foreign body ingestion, two patients; jejunal diverticulosis, one patient; lymphoma, two patients; cancer chemotherapy, one patient, amyloidosis, one patient; idiopathic, five patients. Although all patient presented with diffuse peritonitis, the findings of fever and leukocytosis were inconstant. Free air was demonstrated on radiographs in only eight of 16 patients, and the correct preoperative diagnosis was not made except in the four patients with Crohn's disease. Resection and primary anastomosis were utilized successfully in ten patients, the remainder of the patients undergoing oversewing the the perforation. Four patients (25%) died.
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PMID:Free perforation of the small intestine. 712 43

Details of 300 patients with complicated diverticular disease from 30 hospitals between 1985 and 1988 were entered into a national audit organized by the Surgical Research Society. Complications present on admission included acute phlegmon (n = 104), pericolic abscess (n = 34), purulent peritonitis (n = 40), large bowel obstruction (n = 31), faecal peritonitis (n = 23), pericolic abscess complicated by fistula (n = 28) and lower gastrointestinal bleeding (n = 40). The overall mortality rate was 11.3 per cent (acute phlegmon, 4 per cent; purulent peritonitis, 27 per cent; pericolic abscess, 12 per cent; faecal peritonitis, 48 per cent; large bowel obstruction, 6 per cent; bleeding, 2 per cent; fistula, 4 per cent). Acute phlegmon was treated without operation in 78 patients (75.0 per cent) and by resection in 24 (23.1 per cent). Management of purulent peritonitis generally involved Hartmann's procedure (62 per cent) or resection and primary anastomosis (15 per cent). Similarly, patients with pericolic abscess usually underwent Hartmann's procedure (38 per cent) or resection and primary anastomosis (35 per cent). The principal operation for faecal peritonitis was Hartmann's resection (83 per cent). Large bowel obstruction was managed conservatively in four patients (13 per cent), by Hartmann's procedure in nine (29 per cent), and by resection and primary anastomosis with or without a proximal stoma in 13 (42 per cent). Most patients (82 per cent) with fistula associated with an abscess were managed by resection and primary anastomosis; 90 per cent with acute gastrointestinal bleeding were treated without operation.
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PMID:National audit of complicated diverticular disease: analysis of index cases. 804 65

While diagnostic laparoscopy is a well established tool, therapeutic laparoscopy for acute abdominal disorders has recently been made possible by video-endoscopic techniques. From July 1989 to April 1992, 243 laparoscopic interventions were carried out in patients with an acute abdomen. After a pilot phase, patients with acute appendicitis were entered into a randomized trial, those with acute cholecystitis were operated within the next day list. Among the 243 operations were 202 appendectomies, 12 closures of perforated peptic ulcers, 4 successful interventions for intestinal obstruction, 4 irrigations for intraabdominal abscesses and 35 further operations, some of which had to be finished as laparotomies. Laparoscopic appendectomy was less painful but technically more difficult. In cases which needed bowel resection for ischemic necrosis or diverticular disease, conversion to open surgery had to be performed. Laparoscopic treatment of acute abdominal disorders including peritonitis can be effective and beneficial in one out of two patients. Adequate surgical training, expertise and respect to the safety of the patient are mandatory. The application of endoscopic suture devices will further enlarge the spectrum of laparoscopic treatment options for the acute abdomen.
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PMID:[Value of laparoscopy in diagnosis and therapy of the acute abdomen]. 814 45

Duodenal diverticulosis is not a rare condition. Usually of little clinical significance, it can produce a variety of disorders such as malabsorption, hemorrhage, diverticulitis, and obstruction. The rarest complication appears to be enterolith formation and obstruction. The case presented is a 70-year-old woman with the chief complaints of intermittent abdominal pain and vomiting. At laparotomy, duodenal diverticulitis and one enterolith obstructing the distal ileum were found. The literature review presents the other 26 cases with small bowel obstruction due to an enterolith formed within a small bowel diverticulum. The diagnosis can be established only by documenting the normalcy of the gallbladder and the presence of duodenal or jejunal diverticula.
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PMID:Enterolith ileus as a complication of duodenal diverticulosis--one case report and review of the literature. 823 Mar 70

Use of the biofragmentable anastomosis ring (BAR) was attempted in 33 patients at two New York City institutions and employed in 31 instances. Anastomoses performed were end-to-end enterocolic (n = 15), colocolic (n = 15), and side-to-side colocolic (n = 1). Patients ranged in age from 27 to 86 years, with the following diagnoses: primary colon cancer, 15; sessile adenoma, four; colostomy, five; diverticulosis, two; metastatic cancer with obstruction, multiple polyposis, perforated appendiceal mass, malignant carcinoid of appendix, intussuscepting right colon mass, one each. In two instances use of the device was aborted because of concern with the blood supply to the bowel wall in one and tissue edema in another. The average duration of postoperative ileus was 4.7 days. Two patients were subsequently treated for small bowel obstruction thought unrelated to use of the anastomotic device. There were no deaths and no evidence of stricture.
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PMID:Murphy's Button revisited. Clinical experience with the biofragmentable anastomotic ring. 842 5

Diverticula of the colon are very common in developed countries. In most of those affected diverticulosis is an asymptomatic condition. Only 20% complain of recurrent symptoms. Symptomatic diverticulosis is common only after the age of 50. Dietary treatment combined with antispasmodics is generally sufficient. Diverticular disease is complicated by bleeding or by diverticulitis in 20% of symptomatic patients. Diverticulitis itself can be complicated by intra-abdominal abscess, fistulas, perforation with generalized peritonitis or bowel obstruction. Each clinical appearance is described and treatment is discussed.
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PMID:[Diverticulosis]. 848 53

Small bowel diverticulosis is a rare disease of gastrointestinal tract that occurs most frequently in older patients. Since this disease can be asymptomatic, for a long time, the diagnosis rarely is made in the preoperative period. In 40% of cases there are acute or chronic complications, most frequently diverticulitis either with or without perforation, bowel obstruction and massive haemorrhage clinically manifested as bleeding from the lower part of the gastrointestinal tract. Abdominal pain, pseudoobstructive and malabsorption syndrome, expressive weight loss, steatorrhea and anemia are common chronic complications. In these cases a surgical treatment is necessary. Resection of the affected part of the small bowel is usually performed with end-to-end anastomosis. The authors present 4 cases with diverticulosis of the small bowel, two cases of which were manifested by diverticulitis and one of them was perforated. Pseudoobstructive syndrome, malabsorption and expressive weight loss were presented in other two cases. All four cases were dominated by severe abdominal pain. The surgical treatment was based upon radical resection of the small bowel with end-to-end anastomosis. (Fig. 4, Ref. 28.)
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PMID:[Diverticulosis of the small intestine]. 855 55


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