Coexisting carcinoma with peridiverticulitis of the colon

Microscopic intraepithelial neoplasia in large bowel mucosa

Early neoplastic changes within the nonpolypoid mucosa of the large bowel have been incidentally discovered in two individuals. One of these patients is a 31-year-old man without any known large bowel disease; the other is a 61-year-old woman with diverticulosis. Only small microscopic foci of several neoplastic crypts were observed in otherwise normal-appearing mucosa. This finding lends support to the concept that cells in the crypts, irrespective of their location either in the flat mucosa, polyps, diverticula, or elsewhere, are susceptible to neoplastic transformation.

Surgical treatment of acute diverticulitis by staged procedures

A retrospective 10-year experience with the traditional three-stage plan (diverting colostomy, resection, colostomy closure) for perforated diverticulitis of the colon in four urban hospitals was reviewed to accurately assess the mortality rate. Only patients who were admitted in a non-elective manner with signs of an acute abdomen or who were already hospitalized with another illness and developed an acute abdomen were considered. Fecal or generalized purulent peritonitis, or pelvic peritonitis with abscess were observed at laparotomy in all instances. Two hundred and eight patients representing 211 episodes met the above stated criteria for inclusion in the study. A transverse colostomy was performed in 203 instances associated with 16 deaths, and 8 sigmoid colostomies were associated with two deaths. The overall mortality after the first stage was 8.5%. A loop colostomy was constructed most frequently and a completely divided colostomy performed in only 31 of 211 (15%) instances. Of 147 instances in which the diseased sigmoid colon was resected, 44 (30%) had the colostomy ablated at the same operation, resulting in only one death (0.7% mortality). Colostomy closure as a separate procedure in 103 instances resulted in 4 deaths (3.9% mortality). The highest mortality rate occurred in patients in the in the eighth decade. Staged procedures for perforated colonic diverticula can be carried out with a mortality rate of 11%.

Adenocarcinoma arising in a sigmoid diverticulum: report of a case

A case of adenocarcinoma arising in a sigmoid diverticulum is presented. A patient who had colonic diverticulosis was found to have one diverticular lumen distended by tumor mass. Microscopically, this was seen to be adenocarcinoma arising from the diverticular mucosa. Apparently, this is the first reported case of adenocarcinoma arising in an intact diverticulum of the colon.