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Cureus Nov 2023Small-bowel diverticulosis is rare. We report the case of a male with an acute abdomen secondary to an ileal diverticulum. A 46-year-old male complained of progressive...
Small-bowel diverticulosis is rare. We report the case of a male with an acute abdomen secondary to an ileal diverticulum. A 46-year-old male complained of progressive abdominal pain over 24 hours of evolution in the left flank. On physical examination, we found abdominal pain in the left flank and mesogastrium, tenderness, and signs of peritonitis. The simple abdominal CT showed a heterogeneous tubular image in the small bowel. We performed a diagnostic laparoscopy and found a normal cecal appendix. There was no free abdominal fluid or adhesions, and the colon was without diverticula. We found a single diverticulum of 4 cm in length and 2 cm in diameter in the small intestine and therefore converted the procedure to a laparotomy. We performed a bowel resection including the diverticulum and intestinal anastomosis. The patient reported remission of symptoms after surgery.
PubMed: 38024071
DOI: 10.7759/cureus.48693 -
Radiology Case Reports Jul 2024Small bowel jejunoileal diverticulosis is an uncommon and usually asymptomatic condition. Complications may occur such as acute diverticulitis including infection or...
Small bowel jejunoileal diverticulosis is an uncommon and usually asymptomatic condition. Complications may occur such as acute diverticulitis including infection or perforation, bleeding, small bowel obstruction and volvulus. Herein we report a case of a 76 years-old woman with acute left side abdominal pain and tenderness. A clinical suspected diagnosis of colonic diverticulitis was formulated. She underwent Ultrasound that revealed a collapsed small bowel loop with a large sac-like out-pouching lesion with mixed content (fluid and pockets of air) associated to hyperechogenicity of perilesional fat. Because of the atypical US findings, the patient underwent abdominopelvic CT that confirmed that the large sac-like out-pouching was a jejunal inflamed diverticulum. The patient underwent emergency surgery. Radiologist should be aware of imaging findings of jejunoileal diverticulitis in order to achieve a prompt diagnosis.
PubMed: 38680749
DOI: 10.1016/j.radcr.2024.04.003 -
PloS One 2023[This corrects the article DOI: 10.1371/journal.pone.0281498.].
Correction: Comparison between single and serial computed tomography images in classification of acute appendicitis, acute right-sided diverticulitis, and normal appendix using EfficientNet.
[This corrects the article DOI: 10.1371/journal.pone.0281498.].
PubMed: 37976277
DOI: 10.1371/journal.pone.0294794 -
Langenbeck's Archives of Surgery Aug 2023Weighing the perioperative risk of elective sigmoidectomy is done regardless of the specific diverticulitis classification. The aim of this study is to evaluate surgical...
OBJECTIVE
Weighing the perioperative risk of elective sigmoidectomy is done regardless of the specific diverticulitis classification. The aim of this study is to evaluate surgical outcomes according to the classification grade and the indication.
METHODS
All patients who underwent elective colonic resection for diverticulitis during the ten-year study period were included. They were divided into two groups: relative surgery indication (RSI) and absolute surgery indication (ASI). RSI included microabscess and recurrent uncomplicated disease. ASI included macroabscess and recurrent complicated disease. Propensity score-matching (PSM, 1:1) was performed.
RESULTS
585 patients fulfilled criteria for RSI and 318 patients fulfilled criteria for ASI. In the univariate analysis, RSI patients were younger (62 vs. 67.7 years, p < 0.001), had a higher physical status (ASA score 1 or 2 in 80.7% vs. 60.8%, p < 0.001), were less immunosuppressed (3.4% vs. 6.9%, p = 0.021) and suffered less often from coronary heart disease (3.8% vs. 7.2%, p = 0.025). After PSM, 318 RSI vs. 318 ASI patients were selected; baseline characteristics results were comparable. The proportion of planned laparoscopic resection was 93% in RSI versus 75% in ASI (p < 0.001), and the conversion rate to open surgery for laparoscopic resection was 5.0% and 13.8% in RSI versus ASI, respectively (p < 0.001). Major morbidity (Clavien/Dindo ≥ IIIb) occurred less frequently in RSI (3.77% vs. 10%, p = 0.003). A defunctioning stoma was formed in 0.9% and 11.0% in RSI vs ASI, respectively (p < 0.001).
CONCLUSION
The lower risk for postoperative morbidity, the higher chance for a laparoscopic resection and the decreased rate of stoma formation are attributed to patients with recurrent uncomplicated diverticulitis or diverticulitis including a microabscess as compared to patients with complicated diverticulitis or diverticulitis and a macroabscess, and this applies even after PSM.
Topics: Humans; Cohort Studies; Diverticulitis, Colonic; Propensity Score; Diverticulitis; Colon, Sigmoid; Laparoscopy; Elective Surgical Procedures; Abscess; Treatment Outcome
PubMed: 37535118
DOI: 10.1007/s00423-023-03034-9 -
Cureus Mar 2024Diverticulitis is a prevalent gastrointestinal disease that may require surgical intervention. The aim of the study was to investigate the involvement of...
INTRODUCTION
Diverticulitis is a prevalent gastrointestinal disease that may require surgical intervention. The aim of the study was to investigate the involvement of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as biomarkers of severity in complicated diverticular disease (CDD) in Mexican patients and their correlation with the need for surgical intervention, the length of hospital stay, and mortality.
MATERIAL AND METHODS
An observational, longitudinal, and retrospective study performed from 2017 to 2021 was considered in patients over 18 years of age, with a diagnosis of CDD by using computed tomography and with a hemogram taken in the first 24 hours upon admission to the emergency department to describe the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) of NLR and PLR in the CDD. Results: A total of 102 Mexican patients suffering from CDD, 54% women and 46% men with a mean of 59 years, were analyzed. According to Hinchey's classification, 79 (77.5%) patients showed type I, 12 (12.8%) type II, 5 (4.9%) type III, and 6 (5.9%) type IV. The mean hospital stay was 8.8 days, with a mortality rate of 3.9%. The cut-off value was established at 5.1 for NLR according to the results of the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.633, a sensitivity of 90%, a specificity of 43%, PPV of 21.8%, and NPV of 96% for the prediction of CDD. A cut-off value for PLR at 72 was established according to the results of the ROC curve with an AUC of 0.482, a sensitivity of 78%, a specificity of 40%, PPV of 96%, and NPV of 9% for the prediction of CDD.
CONCLUSION
The NLR and PLR are easily calculable and accessible biomarkers that can be part of the decision-making for the diagnosis and treatment of CDD in Mexican people as has been observed in other populations. However, more prospective, multicenter comparative studies are needed to assess the efficacy and safety of these biomarkers in relation to those already described.
PubMed: 38646313
DOI: 10.7759/cureus.56656 -
Cureus Feb 2024Colovesical fistulas present a diagnostic and therapeutic challenge, commonly arising from complications of diverticular disease. In our case, a 71-year-old male with...
Colovesical fistulas present a diagnostic and therapeutic challenge, commonly arising from complications of diverticular disease. In our case, a 71-year-old male with colovesical fistula symptoms underwent robotic-assisted surgery for complicated sigmoid diverticulitis. Intraoperatively, meticulous adhesiolysis and fistula repair were performed. Histopathology confirmed diverticular disease. Postoperatively, the patient recovered well. Colovesical fistulas may indicate underlying malignancy in diverticulitis. With a lack of standardized protocols, our case suggests that robotic-assisted surgery offers improved outcomes, better vision, and ergonomics. To conclude, robotic-assisted colovesical fistula repair and sigmoidectomy demonstrated excellent outcomes, suggesting a promising approach for enhanced postoperative recovery.
PubMed: 38505449
DOI: 10.7759/cureus.54404 -
Journal of the Korean Society of... Sep 2023Multi-detector CT (MDCT) is a highly accurate diagnostic tool that is commonly used to evaluate appendicitis and its complications. The diagnosis of appendicitis based...
Multi-detector CT (MDCT) is a highly accurate diagnostic tool that is commonly used to evaluate appendicitis and its complications. The diagnosis of appendicitis based on MDCT findings can be difficult and challenging when the observed findings are inconsistent with the typical features. Atypical appendicitis includes a wide spectrum of features, such as variable positions of the appendix and cecum, complications, and unusual pathological findings of secondary appendicitis that mimic or induce appendicitis. Our pictorial essay describes the diverse spectrum of atypical appendicitis and appendicitis-like conditions in terms of location abnormalities, complications, and uncommon pathologies, including related tumors, reactive appendicitis, appendiceal diverticulitis, and IgG4-related disease. Through this essay, the readers can become more familiar with MDCT findings of atypical appendicitis.
PubMed: 37869118
DOI: 10.3348/jksr.2023.0027 -
International Journal of Surgery Case... Nov 2023Amyand's hernia with an inflamed or perforated appendix is rare with incidence of 0.1 % and 0.01 % of cases respectively. It has been described in conjunction with...
INTRODUCTION
Amyand's hernia with an inflamed or perforated appendix is rare with incidence of 0.1 % and 0.01 % of cases respectively. It has been described in conjunction with cecal perforation, cholecystitis and ureterolithiasis. Yet, its association with acute sigmoid diverticulitis has never been reported before.
PRESENTATION OF CASE
A 57-year-old male presented to the emergency department with acute abdomen and an indurated right inguinal mass. A preoperative computed tomography (CT) scan reported a giant inflamed sigmoid diverticulum and an Amyand's hernia with a complicated appendicitis. The patient was taken to the operating room and a midline laparotomy incision was made. A giant sigmoid diverticulum with ischemic patches was encountered. The cecal appendix was found inside the right inguinal canal, with a perforation in its distal third. A Hartmann's procedure, appendicectomy and non-mesh inguinal hernia repair was accomplished.
DISCUSSION
Case reports of Amyand's hernia in patients with simultaneous abdominal conditions are scarce. Symptoms in these patients could be various and may lead to preoperative imaging and diagnosis. In this case acute abdomen in physical examination demanded imaging analysis and a preoperative diagnosis of acute diverticulitis and Amyand's hernia with a perforated appendicitis was made.
CONCLUSIONS
Amyand's hernia with acute perforated appendicitis is a rare entity. CT scan is useful for diagnosis of Amyand's hernia and associated conditions. Preoperative diagnosis of Amyand's hernia and concomitant abdominal disease aids in the therapeutic approach and management. To our knowledge this is the first case report of an Amyand's hernia in a patient with acute diverticulitis.
PubMed: 37883877
DOI: 10.1016/j.ijscr.2023.108972 -
Clinical Medicine & Research Sep 2023Epiploic appendagitis is a rare cause of acute lower abdominal pain. Epiploic appendices are fat-filled serosal outpouchings of the cecum and sigmoid colon. Primary...
Epiploic appendagitis is a rare cause of acute lower abdominal pain. Epiploic appendices are fat-filled serosal outpouchings of the cecum and sigmoid colon. Primary epiploic appendagitis (PEA) is characterized by epiploic inflammation caused by torsion of the appendage leading to ischemia or thrombosis of the appendage draining vein. Secondary epiploic appendagitis occurs in association with other inflammatory conditions of the abdomen or pelvis, most commonly diverticulitis. PEA is an important clinical mimicker of more severe causes of acute abdominal pain, such as diverticulitis, appendicitis, or gynaecological causes. The ease of access to computed tomography (CT), the diagnostic test of choice, has resulted in increased recognition of PEA. The classic CT findings of PEA are an ovoid mass measuring between 1.5 and 3.5 cm surrounded by a hyperattenuating/hyperdense ring with a centrally located hyperdense area. It is important to diagnose PEA as it is self-limiting and the correct diagnosis can prevent unnecessary hospital admission, antibiotic use, or even surgical intervention. We present a case of a 65-year-old male with a history of diverticulitis, presenting with left lower quadrant abdominal pain who was diagnosed with PEA based on CT and successfully managed with conservative treatment.
Topics: Male; Humans; Aged; Diagnosis, Differential; Abdominal Pain; Abdomen, Acute; Diverticulitis; Colitis, Ischemic; Connective Tissue Diseases
PubMed: 37985168
DOI: 10.3121/cmr.2023.1837 -
Cureus Dec 2023The co-occurrence of diverticulitis with pregnancy is incredibly rare and the management of recurrent complicated diverticulitis may not be feasible in a pregnant...
The co-occurrence of diverticulitis with pregnancy is incredibly rare and the management of recurrent complicated diverticulitis may not be feasible in a pregnant patient. Adding cases to the incredibly sparse literature may highlight similarities and create potential recommendations for at-risk populations. We present a case of a female at 18 weeks' gestation who presented with left lower quadrant pain. The initial physical exam and clinical findings revealed severe abdominal tenderness without signs of generalized peritonitis, leukocytosis with predominant neutrophils, and fundal height with confirmatory ultrasonography of intrauterine pregnancy. The main diagnosis was diverticulitis complicated by an abscess and pregnancy, confirmed with CT imaging. The initial intervention was IV antibiotics and bowel rest; however, with each subsequent discharge, she returned to the emergency department with worsening symptoms. Eventually, at 28 weeks, she was escalated to IV meropenem, CT-guided drainage of the abscess, and preterm vaginal delivery at 28 weeks, with a lower anterior resection and diverting ileostomy at six weeks postpartum. She is currently being followed outpatient with improvement in pain, meaningful healthy weight gain, and a healthy newborn child. While management of diverticulitis is generally straightforward, severe presentations like this, even when compared to existing literature, suggest traditional notions of contraindications and risks may not fully apply. Timing and management of recurrent diverticulitis in pregnancy necessitate further research to establish comprehensive guidelines tailored to these at-risk populations.
PubMed: 38222159
DOI: 10.7759/cureus.50590