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

Diverticulosis is one of the most common diseases of the colon. Its importance arises from complications. In countries of the Western hemisphere the incidence is 10-20% beyond the age of 50. Among the natives of Africa and South-Eastern Asia it is practically unknown. It is suggested that the disease is caused by low residue diet, modern living conditions. and constitutional disorders. 500 barium enemas revealed 13,4% patients with diverticula including a 5-year-old child and a 32-year-old woman. The incidence of diverticulosis among patients over 40 years of age is 19,6%. The sex distribution is 1 : 1,9 male to female. The complications are demonstrated by case histories: Diverticulitis with ileus, foreign body trap, sub-acute perforation, sigmoid-vaginal fistula, sigmoid-bladder fistula, sigmoid-uterus fistula in a 5-year-old girl.
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PMID:[Diverticulosis of the sigmoid colon from the radiological point of view (author's transl)]. 100 10

A clustering of radiologic signs is associated with the presence of ovarian and/or peritoneal endometriosis: some indicate fibrosis of utero-sacral ligaments (isthmic dissection of the uterus, fixed retroversion); others are linked to pathology of the tube (ampullar retention of dye after evacuation, sometimes inducing false aspects of hydrosalpinx); the last ones suggesting peritoneal adhesions (incomplete peritoneal diffusion). All these signs have been systematically studied, independently of the diagnosis, on 154 hysterosalpingograms of infertile patients known to have patent tubes at laparoscopy: in 107 out of these cases endometriosis was diagnosed at laparoscopy; the 47 last cases constituted the control group. The results confirm that all the signs described are significantly more frequent in cases of endometriosis, although non-specific for this condition. On the contrary, neither adenomyosis, tubal diverticulosis, nor intramural polyps are significantly linked to external endometriosis. In conclusion, some radiologic signs suggest the presence of peritoneo-ovarian endometriosis. Their detection is possible only on high quality pictures, including a last one taken after 10 to 20 minutes walking, to feature the anomalies of tubal evacuation and peritoneal diffusion. The clustering of these signs allows the clinician to propose an early laparoscopy in the work-up of an infertility case. Furthermore, some of these salpingograms provide evidence of a functional disorder of tubal motility in endometriosis, possibly responsible for the low fertility associated with the disease.
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PMID:[Hysterosalpingographic aspects of ovarian and peritoneal endometriosis. Case-control study]. 273 21

In the past Actinomycosis has been associated with diverticular disease of the colon, abdominal surgery, cholecystitis, and penetrating trauma. Recent reports have demonstrated an increased incidence in women using IUDs. Such a case is presented. a 40-year-old woman experienced lower abdominal pain and a 20 pound weight loss over a 2 month period. The patient had had an IUD (a Dalkon shield) placed 7 years previously and had not sought medical attention since then. Pelvic examination revealed an IUD in place and an 8 cm mass fixed to the left side wall and displacing the rectum. The IUD was removed after the pelvic examination. Laboratory studies were all within normal limits except for mild anemia. A computed tomographic scan of the pelvis showed a left hydroureter, an 8 cm pelvic mass with left side wall extension, and displacement of the rectum to the right. A barium enema examination showed fixed narrowing of the rectum and mucosal irregularity. A fine needle aspiration biopsy showed endometritis and frank pus with the presence of Actinomyces. Surgery confirmed these findings. The patient responded to antibiotic therapy after surgery and did well. The colonization of the vagina, cervix, and uterus by Actinomyces and complications such as tubo-ovarian and pelvic abscesses have been reported in IUD users. 1 study reported Actinomyces in as many as 25% of IUD users, although all patients in that study were asymptomatic. In addition, this group had an increased incidence of abnormal pap smears, which may add a confusing note in the event of a pelvic mass. The association if IUD use and abscess appears increased in those patients who have had the same iud in place for more that 2 years, although the complication has been reported only 2 1/2 months following IUD insertion. Actinomycosis is a diagnosis seldom made before biopsy or surgery. Culture of the organism is essential and the diagnosis is best made using immunofluorescent staining of formaldehyde-fixed, paraffin-embedded tissue. This needle biopsy can provide a quick diagnosis. Therapy includes high dose penicillin, to which the disease responds quickly, and incision and drainage if necessary. Prompt diagnosis and adequate treatment reduce the morbidity of dissemination and of chronic infection.
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PMID:Pelvic actinomycosis. 686 30

The authors report a case in which an 87-year-old woman underwent diagnostic laparoscopy for abdominal pain of unknown etiology. Jejunal diverticulosis was discovered with diverticulitis and perforation into the mesentery. Visualization of the appendix, ovaries, uterus, colon, and liver ruled out additional pathology. The disease was serious enough that resection of the involved jejunum was necessary. With the aid of the laparoscope, the incision was directed nearer to the area of the disease. A 5 cm left upper quadrant transverse incision was made, allowing removal of perforation and the diseased bowel. Primary resection and anastomosis were performed. This case sets a precedence for use of exploratory diagnostic laparoscopy and particularly small bowel resection for symptomatic diverticulitis. The authors believe that this technique results in less postoperative pain, allowing for a prompt recovery with minimal morbidity and mortality, particularly in the elderly population.
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PMID:Laparoscopic-directed small bowel resection for jejunal diverticulitis with perforation. 845 28

A 74-year-old woman was referred to our hospital with the chief complaints of pneumaturia, fecaluria and discharge of feces and urine from vagina. Fistulography on the vaginal side showed the presence of contrast medium both in the sigmoid colon and bladder. Colonoscopy revealed multiple diverticulosis of the sigmoid colon. Under diagnosis of colo-vesico-vaginal fistula due to sigmoid colon diverticulitis, a one-stage operation removing sigmoid colon, uterus-vaginal wall and urinary bladder wall including the fistula and careful reconstruction was performed. Postoperatively, urinary leakage from vagina in large amounts continued due to the recurrence of vesico-vaginal fistula. An attempt to use human fibrin glue in the recurrent fistula was successful, and the patient was asymptomatic at 21 months of follow-up. Colovesical fistula has been reported in about 10-20% of patients undergoing surgery for complicated diverticulitis, but a combined fistula is a rare condition. Furthermore, we recommend the use of human fibrin glue for a recurrent fistula.
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PMID:[A case of colo-vesico-vaginal fistula caused by sigmoid colon diverticulitis]. 975 10

The colo-uterine fistula is a rare complication of diverticular disease of the colon; the literature review has shown only few well studied cases. The fistula, among the complications of the sigma diverticulitis, is 20% of the observed cases; generally, the bladder is the most involved organ, but also the skin or gut can be interested. If we consider the aetiology of the colo=uterine fistula of the observed case, the presence of the sigma locked stenosis with an endocolic pressure increase, associated with a peridiverticulitis condition, seems to have a relevant rule. The clinical symptomatology is represented by vague abdominal pain localized in particular in the left iliac cavity and by emission of blood, purulent material and stools from the vagina. The diagnosis of colo-uterine fistula is not easily reached: barium enema, Fallopian tube endoscopy and colon endoscopy not always allow to visualize in a right manner the fistula and only the oral administration of non-absorbable substances to be searched in the vaginal tampon, clear each doubt. Regarding the therapy to be carried out, we think that, colic resection en bloc with the uterus is the treatment of choice, while, in emergency, the Hartman operation is the most suitable to avoid the beginning of septic complications.
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PMID:[Colo-uterine fistula, a complication of sigma diverticulitis]. 988 74

Different reconstructive operations were performed in 20 patients for intraoperative traumas of the urinary tract. 4 patients had injured ureter and urinary bladder. The damage was done in the course of obstetric operations (cesarean section, uterine extirpation). In 12 cases the ureter was injured in uterine extirpation for cancer (n = 4), myoma (n = 4), prolapse of the uterus, (n = 1), extirpation of uterine cervix stump (n = 1), ureteral electrocoagulation (n = 1) and adnexectomy (n = 1). In 4 cases ligation of the ureter complicated surgical interventions for cancer of the sigmoid colon (n = 1) and rectum (n = 1), diverticulosis of the colon (n = 1) and portal cirrhosis of the liver with evident cirrhosis (n = 1). Surgical policy in the treatment of intraoperative urinary tract injuries was organ-saving. Only in 3 patients with severe acute pyelonephritis surgery was two-staged with prior nephrostomy. In the rest cases primary reconstructive operations were made. Two patients with bilateral injury of the ureters after uterine extirpation have undergone transabdominal bilateral reimplantation of the ureters by Boari in Gregoir's modification. Reconstruction of pelvic ureter was often made by using a urinary bladder graft (Boari's technique). In 1 female patient with extensive vesicovaginal fistula resultant in detruzor corrugation sigmocystoplasty was made with a good result. Serious complications after the reconstruction were absent. Urinary fistulas formed in 4 cases. In 3 of them they closed without surgical intervention. In 1 patient, to close urinary fistula complicating ureterocystoanastomosis Boari's operation was conducted with a favourable outcome. Reconstructive operations saved the kidney function.
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PMID:[Reconstructive-reparative operations in injuries of the urinary tract in obstetrical, gynecologic and abdominal surgery]. 1257 73

Colonic diverticular disease is a benign condition typical of the Western world, but it is not rare for even the 1st episode of diverticulitis to carry potentially fatal complications. The evolution of a peridiverticular process generally poses problems for medical treatment and exposes patients to repeated episodes of diverticulitis, making surgical treatment necessary in approximately 30% of symptomatic patients. One of the most worrying complications of diverticulosis is internal fistula. The most common types of fistula are colovesical and colovaginal, against which the uterus can act as an important protective factor. The symptoms and the clinical and instrumental management of patients with diverticular fistulas are much the same as for patients with episodes of acute diverticulitis. Staging of the disease (according to Hinchey) should be done promptly so that the necessary action can be taken prior to surgery, implementing total parenteral nutrition (TPN), nasogastric aspiration and broad-spectrum antibiotic treatment. The best surgical approach to adopt in patients with diverticulitis complicated by fistula is still not entirely clear, though the 3-step strategy is currently tending to be abandoned due to its high morbidity and mortality rates. There is a widespread conviction, however, that the 2-step strategy (Hartmann, or resection with protective stomy) and the 1-step alternative should be reserved, respectively, for patients in Hinchey stages 3, 4 and 1, 2 with a situation of attenuated local inflammation. The 1-step approach seems to be safe and effective. This report describes a case of colovaginal fistula in a patient with colonic diverticulosis who had recently undergone hysterectomy, but who, unlike such cases in the past, was treated in a single step using a laparoscopic technique.
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PMID:Laparoscopic treatment of post-hysterectomy colovaginal fistula in diverticular disease. Case report. 1525 98

Various reconstructive surgeries were performed in 21 patients because of intraoperative injuries of the urinary tracts. In 4 patients trauma of the ureter and urinary bladder was associated with obstetric operations (Cesarean section, hysterectomy). In 13 cases injury of the ureter was the consequence of hysterectomy due to cancer (4), hysteromyoma (4), prolapses of the uterus (1), extirpation of the stump of the uterine cervix (1), electrocoagulation of the ureter (2) and adnexectomy (1). In 4 patients ligation of the ureter complicated surgery for cancer of the sigmoid colon (1) and rectum (1), diverticular disease of the colon (1) and portal hepatic cirrhosis with severe ascites. Surgical policy was organ-saving. Only in 3 patients with severe acute pyelonephritis surgical treatment was performed in two stages with preliminary nephrostomy. In the rest cases primary reconstructive surgeries were used. Reconstructive surgeries saved the kidney as a functioning organ.
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PMID:[Long-term results of reconstructive surgeries in iatrogenic injury of the urinary tracts]. 1594 Jan 80

The effects of subcutaneous dosing of neonatal CD-1 mice with tamoxifen on days 1-5 after birth at doses of 0, 5, 10, 25 or 50 microg/pup or with 4-hydroxyoestradiol at 2 microg/pup have been investigated. Animals were culled at 1.5, 3, 6, 12 and 18 months after dosing and changes in uterine and ovarian pathology examined. Results showed both compounds to result in uterine hypoplasia relative to controls. At 18 months after dosing in the uterus, there was a fairly marked atrophy of the muscle layer, mild to moderate glandular hyperplasia of the endometrium even though these irregularly shaped glands did not penetrate through the myometrium and no adenocarcinomas were detected. At 18 months after dosing, oviducts showed mild focal adenomatous changes characterized by penetration epithelial hyperplasia, changes similar to those previously reported as 'diverticulosis and salpingitis isthmica nodosa' following diethylstilbestrol treatment of mice. At this time, both tamoxifen and 4-hydroxyoestradiol also affected the ovaries which showed a paucity of follicles and no corpora lutea, suggesting that there had been disruption to the oestrus cycle, particularly with tamoxifen at the highest dose where the ovaries of mice contained no developing follicles. At 18 months, control mice were cycling normally. Results failed to substantiate that tamoxifen and 4-hydroxyoestradiol are uterine carcinogens in this neonatal mouse model.
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PMID:Absence of uterine tumours in CD-1 mice treated neonatally with subcutaneous tamoxifen or 4-hydroxyoestradiol. 1782 43


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