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No Shinkei Geka. Neurological Surgery May 2024A right aortic arch and aberrant subclavian artery result from an interruption in the remodeling of the pharyngeal arch arteries. We occasionally encounter this... (Review)
Review
A right aortic arch and aberrant subclavian artery result from an interruption in the remodeling of the pharyngeal arch arteries. We occasionally encounter this anatomical variation during angiography. Patients with disorders such as Down syndrome and congenital heart disease show a high incidence of an aberrant right subclavian artery, and this anomaly can cause symptomatic esophageal or tracheal compression. The root of the aberrant artery may show dilatation(referred to as a Kommerell diverticulum), dissection, intramural hematoma, or rupture necessitating cardiac intervention using a surgical or endovascular approach. Neurointerventionalists should have working knowledge of the anatomy to rapidly understand the anatomy and ensure a safe procedure. A left transradial approach should be considered if prior knowledge of the aberrant subclavian anatomy is available.
Topics: Humans; Aorta, Thoracic; Subclavian Artery; Vascular Remodeling; Cardiovascular Abnormalities
PubMed: 38783489
DOI: 10.11477/mf.1436204939 -
The American Journal of Gastroenterology Nov 2023We assessed the prevalence and clinical outcomes of segmental colitis associated with diverticulosis (SCAD) in patients with newly diagnosed diverticulosis.
INTRODUCTION
We assessed the prevalence and clinical outcomes of segmental colitis associated with diverticulosis (SCAD) in patients with newly diagnosed diverticulosis.
METHODS
A 3-year international, multicenter, prospective cohort study was conducted involving 2,215 patients.
RESULTS
SCAD diagnosis was posed in 44 patients (30 male patients; median age: 64.5 years; prevalence of 1.99%, 95% confidence interval, 1.45%-2.66%). Patients with SCAD types D and B showed worse symptoms, higher fecal calprotectin values, needed more steroids, and reached less likely complete remission.
DISCUSSION
Although SCAD generally had a benign outcome, types B and D were associated with more severe symptoms and worse clinical course.
Topics: Humans; Male; Middle Aged; Prevalence; Prospective Studies; Treatment Outcome; Colitis; Diverticulum
PubMed: 37314163
DOI: 10.14309/ajg.0000000000002362 -
Aktuelle Urologie Sep 2023We report the case of a 39-year-old woman with a gastric diverticulum misdiagnosed as a left adrenal lesion on computed tomography imaging.
We report the case of a 39-year-old woman with a gastric diverticulum misdiagnosed as a left adrenal lesion on computed tomography imaging.
Topics: Female; Humans; Adult; Diverticulum, Stomach; Tomography, X-Ray Computed
PubMed: 36702133
DOI: 10.1055/a-1971-6854 -
Internal and Emergency Medicine Jun 2024The management of patients with diverticular disease remains challenging. The aim of this national survey was to assess how gastroenterologists and general practitioners...
The management of patients with diverticular disease remains challenging. The aim of this national survey was to assess how gastroenterologists and general practitioners use rifaximin to manage diverticulosis and diverticular disease. Members of the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) and the Italian Federation of General Practitioners (FIMMG) were invited to complete a 39-item online survey concerning the use of rifaximin in five clinical settings: (1) diverticulosis; (2) reducing symptoms in symptomatic uncomplicated diverticular disease; (3) reducing the occurrence of diverticulitis in patients with symptomatic uncomplicated diverticular disease (primary prevention); (4) reducing the recurrence of diverticulitis in patients with previous attacks of diverticulitis (secondary prevention); (5) treatment of uncomplicated acute diverticulitis. A total of 1094 physicians completed the survey. Overall, 25.1%, 83.5%, 68%, 74.2%, and 63% of physicians prescribed rifaximin for the clinical settings 1, 2, 3, 4, and 5, respectively. In each clinical setting, the dosage of rifaximin most frequently used was 800 mg/day, the most common duration of therapy was 7 days, and the cyclic administration of treatment (expressed in months) most frequently used was > 24 months. These results highlight that a reappraisal of the use of rifaximin in patients with diverticulosis and diverticular disease is required to reduce the gap between the evidence available and the daily clinical practice, optimizing also the use of healthcare resources.
PubMed: 38850356
DOI: 10.1007/s11739-024-03669-6 -
Journal of Gastroenterology and... Jul 2023The role of the microbiota in diverticulosis and diverticular disease is underexplored. This systematic review aimed to assess all literature pertaining to the... (Review)
Review
BACKGROUND AND AIMS
The role of the microbiota in diverticulosis and diverticular disease is underexplored. This systematic review aimed to assess all literature pertaining to the microbiota and metabolome associations in asymptomatic diverticulosis, symptomatic uncomplicated diverticular disease (SUDD), and diverticulitis pathophysiology.
METHODS
Seven databases were searched for relevant studies published up to September 28, 2022. Data were screened in Covidence and extracted to Excel. Critical appraisal was undertaken using the Newcastle Ottawa Scale for case/control studies.
RESULTS
Of the 413 papers screened by title and abstract, 48 full-text papers were reviewed in detail with 12 studies meeting the inclusion criteria. Overall, alpha and beta diversity were unchanged in diverticulosis; however, significant changes in alpha diversity were evident in diverticulitis. A similar Bacteroidetes to Firmicutes ratio compared with controls was reported across studies. The genus-level comparisons showed no relationship with diverticular disease. Butyrate-producing microbial species were decreased in abundance, suggesting a possible contribution to the pathogenesis of diverticular disease. Comamonas species was significantly increased in asymptomatic diverticulosis patients who later developed diverticulitis. Metabolome analysis reported significant differences in diverticulosis and SUDD, with upregulated uracil being the most consistent outcome in both. No significant differences were reported in the mycobiome.
CONCLUSION
Overall, there is no convincing evidence of microbial dysbiosis in colonic diverticula to suggest that the microbiota contributes to the pathogenesis of asymptomatic diverticulosis, SUDD, or diverticular disease. Future research investigating microbiota involvement in colonic diverticula should consider an investigation of mucosa-associated microbial changes within the colonic diverticulum itself.
Topics: Humans; Diverticulum, Colon; Diverticulosis, Colonic; Microbiota; Diverticulitis; Diverticular Diseases
PubMed: 36775316
DOI: 10.1111/jgh.16142 -
Seminars in Nuclear Medicine Nov 2023Imaging of gastrointestinal bleeding crucial in the diagnosis of occult gastrointestinal bleeding. Gastrointestinal bleeding scintigraphy is a well-established study to... (Review)
Review
Imaging of gastrointestinal bleeding crucial in the diagnosis of occult gastrointestinal bleeding. Gastrointestinal bleeding scintigraphy is a well-established study to aid localisation of gastrointestinal bleeding site. This article discusses about the use of gastrointestinal bleeding scintigraphy in its current practice with emphasis on radiopharmaceutical, imaging techniques, interpretation and pitfalls. There is also discussion on the use of Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) within this method of scintigraphy. Meckel's diverticulum is known to be a frequent source of bleeding, mainly in children. It is also know that nuclear medicine imaging can help with Meckel's diverticulum identification. This article also discusses about the technique, imaging, interpretation and SPECT-CT usage for Meckel's diverticulum imaging.
Topics: Child; Humans; Meckel Diverticulum; Diagnostic Imaging; Radionuclide Imaging; Gastrointestinal Hemorrhage; Nuclear Medicine
PubMed: 37451934
DOI: 10.1053/j.semnuclmed.2023.06.002 -
Frontline Gastroenterology Jan 2024Colonic diverticulosis is prevalent, affecting approximately 70% of the western population by 80 years of age. Incidence is rapidly increasing in younger age groups.... (Review)
Review
Colonic diverticulosis is prevalent, affecting approximately 70% of the western population by 80 years of age. Incidence is rapidly increasing in younger age groups. Between 10% and 25% of those with diverticular disease (DD) will experience acute diverticulitis. A further 15% will develop complications including abscess, bleeding and perforation. Such complications are associated with significant morbidity and mortality and constitute a worldwide health burden. Furthermore, chronic symptoms associated with DD are difficult to manage and present a further significant healthcare burden. The pathophysiology of DD is complex due to multifactorial contributing factors. These include diet, colonic wall structure, intestinal motility and genetic predispositions. Thus, targeted preventative measures have proved difficult to establish. Recently, commonly held conceptions on DD have been challenged. This review explores the latest understanding on pathophysiology, risk factors, classification and treatment options.
PubMed: 38487561
DOI: 10.1136/flgastro-2022-102361 -
Journal of Clinical Medicine Sep 2023Segmental colitis associated with diverticulosis (SCAD) is characterized by inflammation involving the sigmoid inter-diverticular mucosa, sparing the proximal colon and... (Review)
Review
Segmental colitis associated with diverticulosis (SCAD) is characterized by inflammation involving the sigmoid inter-diverticular mucosa, sparing the proximal colon and rectum. Due to the heterogeneity of clinical manifestations and endoscopic and histological findings, SCAD diagnosis might be challenging in clinical practice. This narrative review aimed to report the SCAD diagnostic criteria adopted in different studies, highlighting the current challenges and main pitfalls in its diagnosis. We analysed fourteen studies, mainly prospective observational studies. Haematochezia and rectal bleeding were the main complaints leading to diagnosis, followed by diarrhoea. An accurate endoscopic description was performed in 86% of studies, while a standardised biopsy sampling protocol (sigma, proximal colon and rectum) was scarcely adopted, being complete only in 28.5% of studies. The evaluation of concomitant drugs potentially inducing colitis was carried out in only 57% of studies. Great heterogeneity in sigmoid endoscopic (edema, erythema, erosions, ulcers, mucosal friability) and histological findings (chronic and/or acute inflammatory infiltrate) was observed. We showed that SCAD diagnosis is often based on not fully adequate macroscopic colonic description and scant biopsy protocol sampling. An accurate clinical and endoscopic evaluation, with an adequate sampling biopsy protocol, with attention to differential diagnosis, seemed to be crucial for a prompt SCAD diagnosis.
PubMed: 37763023
DOI: 10.3390/jcm12186084 -
Disease-a-month : DM Nov 2023Colonic diverticular bleeding is the most common cause of lower gastrointestinal (GI) bleeding, which can be life-threatening and frequently recurrent. In recent years,... (Review)
Review
Colonic diverticular bleeding is the most common cause of lower gastrointestinal (GI) bleeding, which can be life-threatening and frequently recurrent. In recent years, the prevalence of diverticulosis has increased in developed countries, with a documented incidence of 50% in patients older than 60 years. Based on the evidence, the use of anticoagulants and/or antiplatelets in the elderly population has resulted in an increased incidence of acute diverticular bleeding. According to the literature, about 50% of patients with diverticular bleeding require a blood transfusion, and 18% - 53% need emergency surgery. Although endoscopic identification of the culprit diverticula and appropriate intervention is a challenge, the newer treatment modality, over-the-scope clip method (OTSC) has been demonstrated to be an effective endoscopic hemostatic method in severe diverticular bleeding, especially in cases of rebleeding after first-line conventional endoscopic procedures. In this review, we summarize the pathophysiology of colonic diverticulosis and diverticular bleeding, recent evidence in its management, and existing theories on various preventive strategies to control diverticular bleeding. We also discuss the efficacy and treatment outcome of the OTSC technique in controlling diverticular bleeding.
Topics: Humans; Aged; Colon; Diverticular Diseases; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Diverticulum
PubMed: 36918300
DOI: 10.1016/j.disamonth.2023.101543 -
Journal of Visceral Surgery Jun 2024A pathology well known by pediatric surgeons, ileal duplication is in rare instances a cause of acute surgical abdomen in adults; that said, its atypical presentation...
A pathology well known by pediatric surgeons, ileal duplication is in rare instances a cause of acute surgical abdomen in adults; that said, its atypical presentation often leads it to be mistaken for other etiologies. Even though it is benign in children, the risk of malignant transformation in adults should be taken into account in surgical procedures.
Topics: Humans; Ileum; Abdomen, Acute; Ileal Diseases; Female; Male; Adult
PubMed: 38418365
DOI: 10.1016/j.jviscsurg.2024.02.004