Rectosigmoidal mucosal puckering and diverticulosis

Ultrasonographic and Functional Features of Symptomatic Uncomplicated Diverticular Disease

INTRODUCTION

To evaluate the ability of intestinal ultrasound (IUS) in discriminating symptomatic uncomplicated diverticular disease (SUDD) among patients with abdominal symptoms including irritable bowel syndrome (IBS).

METHODS

This observational, prospective study included consecutive patients classified into the following categories: (i) SUDD; (ii) IBS; (iii) unclassifiable abdominal symptoms; and (iv) controls, including asymptomatic healthy subjects and diverticulosis. The IUS evaluation of the sigmoid: assessed the presence of diverticula, thickness of the muscularis propria, and IUS-evoked pain, namely the intensity of pain evoked by compression with the ultrasound probe on sigmoid colon compared with an area of the left lower abdominal quadrant without underlying sigmoid colon.

RESULTS

We enrolled 40 patients with SUDD, 20 patients with IBS, 28 patients with unclassifiable abdominal symptoms, 10 healthy controls, and 20 patients with diverticulosis. Patients with SUDD displayed significantly ( P < 0.001) greater muscle thickness (2.25 ± 0.73 mm) compared with patients with IBS (1.66 ± 0.32 mm), patients with unclassifiable abdominal pain, and healthy subjects, but comparable with that of patients with diverticulosis (2.35 ± 0.71 mm). Patients with SUDD showed a greater (not significant) differential pain score than other patients. There was a significant correlation between the thickness of the muscularis propria and the differential pain score only for patients with SUDD ( r = 0.460; P : 0.01). Sigmoid diverticula were detected by colonoscopy in 40 patients (42.4%) and by IUS with a sensitivity of 96.0% and a specificity of 98.5%.

DISCUSSION

IUS could represent a useful diagnostic tool for SUDD, potentially useful in characterizing the disease and appropriately address the therapeutic approach.

[On the role of myotomy in the treatment of diverticular disease (author's transl)]

Spontaneous motor action of fresly prepared circular and longitudinal muscle strips were examined in two separated trials. Bowel musculature of diverticular patients were compared with those of normal subjects. Finally all explantations were examined histologically.

RESULTS

1. There was no difference in electrical activity and tension development regarding circular muscle strips of patients suffering from D.D. and those of normal subjects. 2. The longitudinal muscles show however significant differences in contrast to normal subjects; to sum up D.D. presents us a spastic and contracted taenia. 3. The histological investigations did not explain the different electromechanical results. There were however remarcable ribbons only in the longitudinal muscle of D.D.--known from myoma uteri. The results of the electrophysiological analysis have importance for our surgical concept in the treatment of peridiverticulitis. They justify the horizontal myotomy in the left, functionally disturbed colon descendens additional to the resection as an preventive procedure.

Combined horizontal and longitudinal colomyotomy for diverticular disease: preliminary report

The operation of horizontal and longitudinal colomyotomy for diverticular disease is described and satisfactory short-term results in six patients are presented. The indications and reasons for the use of this procedure are discussed. It is suggested that the operation is a satisfactory treatment, without the risks associated with division of all the circular muscle fibers, or with resection and anastomosis. The necessity for long-term high dietary fiber intake is stressed.

Colonic haustral pattern in relation to pressure activity and presence of diverticula

The correlation between the haustral pattern in the sigmoid colon, on the one hand, and the pressure activity and presence of diverticula, on the other, was examined in 184 patients, subjected to both X-ray examination and sigmoid pressure measurement. No correlation was found between an increased haustral pattern and a high pressure activity. Only a special S-shaped haustral pattern showed a slight correlation to an increased pressure activity. An interpretation of colonic haustral pattern in terms of muscular activity, therefore, seems unwarranted. A significant correlation was found between an increased haustral pattern and the presence of sigmoid diverticula.