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Journal of Clinical Gastroenterology Oct 2016Diverticula of the colon and their symptomatic manifestations, including acute diverticulitis (AD), are frequent complaints and the cause of an increasing burden of... (Review)
Review
Diverticula of the colon and their symptomatic manifestations, including acute diverticulitis (AD), are frequent complaints and the cause of an increasing burden of ambulatory visits, diagnostic procedures, and hospital admissions. Endoscopic and radiologic diagnostic procedures have a well-known role in the diagnosis and management of the disease, but recently intestinal ultrasonography has been proposed as a complementary tool in the diagnosis and follow-up of diverticular disease. This review shows the main sonographic features of diverticula and discusses the potential role of ultrasound in suggesting the presence of symptomatic uncomplicated diverticular disease of the colon. Moreover, the sonographic features of AD, diagnostic accuracy, advantages, and limitations of the technique will be discussed. We place special emphasis on the present role of intestinal ultrasonography in patients with suspected AD. Owing to its high sensitivity and high positive predictive value in assessing AD, intestinal ultrasound is currently suggested by some European national consensus guidelines as the first-line examination in this setting. In fact, to minimize false-negative findings and avoid unnecessary radiation exposure in patients with suspected AD, intestinal ultrasound might be used as the first-line examination in a sequential diagnostic strategy, followed by computed tomography only in the case of negative or inconclusive findings.
Topics: Diverticulosis, Colonic; Diverticulum; Humans; Intestines; Predictive Value of Tests; Sensitivity and Specificity; Ultrasonography
PubMed: 27622354
DOI: 10.1097/MCG.0000000000000657 -
Medicine Mar 2018Small intestinal diverticulum with bleeding is an important reason for obscure gastrointestinal bleeding (OGB) , in addition to tumor and vascular diseases. Small... (Review)
Review
RATIONALE
Small intestinal diverticulum with bleeding is an important reason for obscure gastrointestinal bleeding (OGB) , in addition to tumor and vascular diseases. Small intestinal diverticulum with bleeding is difficult to detect by barium meal and angiographic methods and has been regarded as an important cause of obscure gastrointestinal tract bleeding in adolescents. Because of its complicated etiology and non-specific clinical manifestations, it is relatively difficult to detect small intestinal diverticulum with bleeding, especially in patients with a large amount of bleeding and hemodynamic instability.
PATIENT CONCERNS
This retrospective study collects clinical statistics of 19 patients admitted to our hospital from January 2010 to December 2016. Patients who had small intestinal diverticulum patients with bleeding were included in this study. Patients who were taking anticoagulants were excluded DIAGNOSES:: Small intestinal diverticulum patients with bleeding.
INTERVENTIONS
This retrospective study describes the clinical features of patients with small intestinal diverticulum whose main symptom was gastrointestinal bleeding and analyze the literature on this topic, with particular reference to the clinical characteristics, pathological features, and choice of examination methods.
LESSONS
Small intestinal diverticulum with bleeding is a common cause of obscure gastrointestinal bleeding, but it is difficult to detect using normal examination methods. For patients with repeated gastrointestinal bleeding and no positive results found on gastroscopy and colonoscopy, endoscopy of the small intestine and CTE with contrast can be considered as a diagnostic modality.
Topics: Adolescent; Adult; Diverticulum; Female; Gastrointestinal Hemorrhage; Humans; Intestine, Small; Male; Middle Aged; Retrospective Studies; Young Adult
PubMed: 29489685
DOI: 10.1097/MD.0000000000009871 -
Modern Pathology : An Official Journal... May 2020Post-inflammatory mucosal hyperplasia and appendiceal diverticulosis simulate mucinous neoplasms, causing diagnostic confusion. Distinction between neoplasia and its...
Post-inflammatory mucosal hyperplasia and appendiceal diverticulosis simulate mucinous neoplasms, causing diagnostic confusion. Distinction between neoplasia and its mimics is particularly important since many authorities now consider all appendiceal mucinous neoplasms to be potentially malignant. The purpose of this study was to identify clinicopathologic and molecular features that may distinguish appendiceal mucinous neoplasms from non-neoplastic mimics. We retrospectively identified 92 mucinous lesions confined to the right lower quadrant, including 55 non-neoplastic examples of mucosal hyperplasia and/or diverticulosis and 37 low-grade neoplasms. Presenting symptoms, radiographic findings, appendiceal diameter, appearances of the lamina propria, non-neoplastic crypts, and epithelium, as well as mural changes were recorded. Twenty non-neoplastic lesions were subjected to KRAS mutational testing. Non-neoplastic appendices were smaller (p < 0.05) and more likely to present with symptoms of appendicitis (p < 0.05) than neoplasms. While post-inflammatory mucosal hyperplasia and diverticula often showed goblet cell-rich epithelium, extruded mucin pools, and patchy mural alterations with fibrosis, they always contained non-neoplastic crypts lined by mixed epithelial cell types and separated by lamina propria with predominantly preserved wall architecture. On the other hand, mucinous neoplasms lacked normal crypts (p < 0.05) and showed decreased lamina propria (p < 0.05) with diffusely thickened muscularis mucosae and lymphoid atrophy. Six (30%) non-neoplastic lesions contained KRAS mutations, particularly those containing goblet cell-rich hyperplastic epithelium. We conclude that distinction between neoplastic and non-neoplastic mucinous appendiceal lesions requires recognition of key morphologic features; KRAS mutational testing is an unreliable biomarker that cannot be used to assess biologic risk or confirm a diagnosis of neoplasia.
Topics: Adenocarcinoma, Mucinous; Adult; Aged; Appendiceal Neoplasms; Appendicitis; Appendix; Cecal Diseases; Diagnosis, Differential; Diverticulum; Female; Humans; Hyperplasia; Male; Middle Aged; Retrospective Studies
PubMed: 31857681
DOI: 10.1038/s41379-019-0435-1 -
Gaceta Medica de Mexico 2016Right aortic arch with aberrant left subclavian artery from a Kommerell's diverticulum is a very rare variant of the incomplete vascular ring. Associated symptoms are...
Right aortic arch with aberrant left subclavian artery from a Kommerell's diverticulum is a very rare variant of the incomplete vascular ring. Associated symptoms are caused due to tracheal or esophagus compression. Magnetic resonance is the gold standard for diagnosis. Surgical treatment is recommended for symptomatic patients or asymptomatic patients with a large diverticulum. We report three consecutive cases of patients with Kommerell's diverticulum, aberrant left subclavian artery, and right-sided aortic arch.
Topics: Aneurysm; Aorta, Thoracic; Cardiovascular Abnormalities; Child, Preschool; Deglutition Disorders; Diverticulum; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Subclavian Artery
PubMed: 27335200
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Jan 2024Small bowel non-Meckelian diverticulosis is a rare condition with only a few published cases despite being described over 200 years ago. In the midst of the COVID-19... (Review)
Review
Small bowel non-Meckelian diverticulosis is a rare condition with only a few published cases despite being described over 200 years ago. In the midst of the COVID-19 pandemic, studies suggested that many patients may experience gastrointestinal manifestations. Intestinal symptoms could worsen the inflammation and infection associated with small bowel diverticulitis. Here we present three cases: one with inflammation and rupture in a COVID-19 patient and another as an asymptomatic detection. The third case involved recurrence after the first laparoscopic lavage approach. Furthermore, we provide a mini-review of the literature to emphasize the importance of considering this entity in the differential diagnosis of an acute abdomen. In the majority of cases involving small bowel diverticula, conservative management is the preferred approach. However, when complications arise, surgical intervention, including enteroctomy and primary anastomosis, may be necessary to achieve optimal outcomes.
Topics: Humans; Pandemics; COVID-19; Diverticulum; Diverticulitis; Inflammation
PubMed: 38399517
DOI: 10.3390/medicina60020229 -
Journal of Bronchology & Interventional... Oct 2014Multiple tracheal diverticulosis is a rare clinical entity. Tracheal diverticula are usually recognized radiologically as solitary right paratracheal air collections on...
Multiple tracheal diverticulosis is a rare clinical entity. Tracheal diverticula are usually recognized radiologically as solitary right paratracheal air collections on thoracic computed tomography examination. They are usually asymptomatic but can occasionally present with persistent symptoms. We herein report the case of a 50-year-old male patient who underwent extensive evaluation for persistent cough. Multiple posterior right paratracheal air collections were recognized on thoracic multidetector computed tomography examination, which was confirmed as multiple-acquired posterior upper tracheal diverticula on flexible bronchoscopy. The patient improved with conservative medical management.
Topics: Bronchoscopy; Diverticulum; Humans; Male; Middle Aged; Radiography; Tomography Scanners, X-Ray Computed; Tracheal Diseases
PubMed: 25321454
DOI: 10.1097/LBR.0000000000000091 -
Connective Tissue Research Jul 2019: An underlying connective tissue disorder (CTD) may predispose to formation of intestinal diverticula. We assess the association of diverticulosis with nine selected...
: An underlying connective tissue disorder (CTD) may predispose to formation of intestinal diverticula. We assess the association of diverticulosis with nine selected CTDs, to inform the pathophysiology of diverticula. : A population-based period-prevalence study. Individuals (3.5 million New Zealand residents born 1901-1986) with a health system record 1999-2016 were grouped into those with a hospital diagnosis of diverticulosis or diverticulitis (ICD-10-AM K57), and those without. Also recorded were any hospital diagnoses of nine selected CTDs. The association of exposure to diverticulosis and each CTD was assessed using logistic regressions adjusted for age, gender, ethnicity and region. : In all, 85,958 (2.4%) people had a hospital diagnosis of diverticulosis. Hospitalisation with diverticulosis was highly significantly associated with rectal prolapse (adjusted odds ratio [OR] = 3.9), polycystic kidney disease (OR = 3.8), heritable syndromes (Marfan or Ehlers-Danlos) (OR = 2.4), female genital prolapse (OR = 2.3), non-aortic aneurysm (OR = 2.3), aortic aneurysm (OR = 2.2), inguinal hernia (OR = 1.9) and dislocations of shoulder and other joints (OR = 1.7), but not subarachnoid haemorrhage (OR = 1.0). : People with diverticulosis are more likely to have colonic extracellular matrix (ECM)/connective tissue alterations in anatomical areas other than the bowel, suggesting linked ECM/connective tissue pathology. Although biases may exist, the results indicate large-scale integrated studies are needed to investigate underlying genetic pathophysiology of colonic diverticula, together with fundamental biological studies to investigate cellular phenotypes and ECM changes.
Topics: Adult; Aged; Aged, 80 and over; Connective Tissue Diseases; Diverticulum; Female; Humans; Male; Middle Aged; Odds Ratio
PubMed: 30719942
DOI: 10.1080/03008207.2019.1570169 -
Internal Medicine (Tokyo, Japan) Jan 2023
Topics: Humans; Mediastinitis; Bronchoscopy; Tomography, X-Ray Computed; Diverticulum; Bronchi
PubMed: 35705276
DOI: 10.2169/internalmedicine.9769-22 -
Endoscopy Dec 2023
Topics: Humans; Diverticulum; Endoscopy
PubMed: 37714211
DOI: 10.1055/a-2155-4535 -
Journal of Clinical Gastroenterology Oct 2016The statements produced by the Chairmen of the 2nd International Symposium on Diverticular Disease, held in Rome on April 8th to 9th, 2016, are reported. Topics such as...
The statements produced by the Chairmen of the 2nd International Symposium on Diverticular Disease, held in Rome on April 8th to 9th, 2016, are reported. Topics such as epidemiology, risk factors, diagnosis, medical and surgical treatment of diverticular disease in patients with uncomplicated and complicated diverticular disease were reviewed by the Chairmen who proposed 41 statements graded according to level of evidence and strength of recommendation. Each topic was explored focusing on the more relevant clinical questions. The vote was conducted on a 6-point scale and consensus was defined a priori as 67% agreement of the participants. The voting group consisted of 80 physicians from 6 countries, and agreement with all statements was provided. Comments were added explaining some controversial areas.
Topics: Consensus; Disease Management; Diverticular Diseases; Diverticulum; Humans; Practice Guidelines as Topic
PubMed: 27622350
DOI: 10.1097/MCG.0000000000000654