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Rentiya ZS, Palle LRA, Emmanuel S, Shah H, Adegbite A, Chu Carredo CK, Blanco Montecino RM, Asfeen UZ, Hussain A, Akuma O, Khan AM, Kelechi AE. Management of an undetectable Diverticular Bleed: A Case Report and Literature review. Clin Case Rep 2024; 12:e8588. [PMID: 38523824 PMCID: PMC10957488 DOI: 10.1002/ccr3.8588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Diverticular bleeding is the most common cause of lower gastrointestinal bleeding and accounts for 20.8%-41.6% of cases in the Western world. Management involves initial resuscitation followed by diagnostic assessment. Colonoscopy is the investigation of choice as it localizes the bleed and has the potential to effectively deliver therapeutic interventions. Other diagnostic modalities include flexible sigmoidoscopy, a tagged red blood cell scan, or angiography. In cases where the bleeding source cannot be identified, intraoperative enteroscopy has emerged as a valuable tool for investigating obscure gastroenterology bleeds in specific patients. In this case report, we describe the management of a 77-year-old male with recently diagnosed pan-colonic diverticulosis who presented with multiple episodes of rectal bleeding and syncope. Due to his declining hemodynamic status and failed endoscopy and embolization, he was taken to surgery for a colectomy. Intraoperative colonoscopy was utilized to facilitate accurate identification of the pathology, assessment of anastomotic patency, and detection of surgical complications. This case report attempts to portray how the incorporation of endo-videoscopy into surgical planning has the potential to enhance patient outcomes and represent a significant advancement in the field of minimally invasive surgery.
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Affiliation(s)
- Zubir S. Rentiya
- Department of Radiation Oncology & RadiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
- Department of SurgeryMedStar Georgetown UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Sanni Emmanuel
- Department of SurgeryNational Hospital AbujaAbujaNigeria
| | - Heeya Shah
- Medical University of South CarolinaLancasterPennsylvaniaUSA
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Sinha MK, Sahu S, Hansda U, Kumar A. End-to-Side Ileo-Sigmoid Anastomosis and Late Onset Gangrenous Diverticulitis: A Case Report. Cureus 2023; 15:e43441. [PMID: 37719581 PMCID: PMC10503664 DOI: 10.7759/cureus.43441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
End-to-side ileo-sigmoid anastomosis converts the proximal colon into a blind intestinal segment which is excised during the surgery. If we do not resect the proximal colon, it is expected to behave like a colonic diverticulum, but direct evidence of this assumption is lacking. During an exploratory laparotomy, we detected an end-to-side ileo-sigmoid anastomosis and found that the proximal colon was gangrenous. The patient passed away during the postoperative period, yet their remarkably long period of symptom-free survival remained intriguing.
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Affiliation(s)
- Mithilesh K Sinha
- General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Shantanu Sahu
- General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Upendra Hansda
- Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Amarendra Kumar
- General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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Higashimori A, Nakatani M, Jinnai K, Kin D, Maeda N, Nakamura Y, Hashimoto A, Morimoto K, Sasaki E, Fukuda T, Watanabe T, Fujiwara Y. Chronic constipation is negatively associated with colonic diverticula. Scand J Gastroenterol 2021; 56:1264-1270. [PMID: 34411502 DOI: 10.1080/00365521.2021.1961307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Constipation has been considered the key risk factor for diverticulosis occurrence, but the underlying mechanism is unclear. We investigated the factors associated with diverticulosis, focusing on the association of constipation severity with the localization and number of diverticula. MATERIALS AND METHODS We analyzed consecutive patients who underwent colonoscopy between March and December 2019. Chronic constipation was diagnosed as constipation meeting Rome IV criteria or as that requiring laxative therapy for more than 6 months. The degree of constipation was scored using the Constipation Scoring System (CSS). RESULTS We assessed 1014 patients. Multivariate analysis revealed that age, alcohol consumption, and hypertension were positively associated with diverticulosis, whereas chronic constipation was negatively associated with diverticulosis (odds ratio [OR] = 0.74; 95% confidence interval [CI], 0.55-0.99). When assessed according to the location of diverticula, right-sided diverticula were significantly associated with a lower incidence of constipation (OR = 0.94; 95% CI, 0.89-0.98), whereas neither left-sided nor bilateral diverticula was associated with constipation. This negative association of diverticula with constipation was stronger in patients with a high CSS score. In stratified analysis, the number of diverticula decreased with increasing degree of constipation (p for trend <.01), and a high CSS score was associated with a decreased prevalence of ≥3 diverticula (OR = 0.64; 95% CI, 0.44-0.99). CONCLUSIONS Chronic constipation was negatively associated with colonic diverticulosis. The association increased with the degree of constipation and was strong only in cases with right-sided diverticula and those with ≥3 diverticula.
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Affiliation(s)
- Akira Higashimori
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan.,Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masami Nakatani
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Kagami Jinnai
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Daiyu Kin
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Natsumi Maeda
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan.,Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | - Kenichi Morimoto
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Eiji Sasaki
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Takashi Fukuda
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Toshio Watanabe
- Department of Premier Preventive Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Nakaji K. Colon Capsule Endoscopy in Detecting Colonic Diverticula in a Japanese Population. Cureus 2020; 12:e12393. [PMID: 33409107 PMCID: PMC7779143 DOI: 10.7759/cureus.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective The assessment of colonic diverticula with colon capsule endoscopy (CCE) in a Japanese population provided unclear results. In this study, we retrospectively reviewed a cohort of Japanese patients who had undergone CCE to assess its safety and usefulness in the diagnosis of colonic diverticula. Methods In this study, 175 consecutive Japanese patients who had their entire colon observed via CCE from November 2013 to July 2018 were included. Patients were retrospectively stratified according to age, gender, colonic segment, and symptoms involvement. A multivariable regression analysis was performed to investigate the presence of any correlation among variables. The safety of CCE was assessed in terms of the incidence of adverse events (AEs). Results Colonic diverticula were observed in 42.3% of all cases; of those; 36.5% were right-sided, 31.1% were left-sided, and 32.4% were bilateral. Moreover, one to two colonic diverticula were observed in 35.1%, while three or more diverticula were seen in 64.9%. Multivariable analysis showed that age (≥70 years) was positively associated with colonic diverticula, while male gender and the presence of colonic polyps were negatively associated with colonic diverticula. No correlation was found between colonic diverticula and symptoms. There was no significant difference between groups with and without colonic diverticula in the incidence of AEs. AEs were mild in severity, with no severe AE-related bowel preparation and capsule ingestion reported. Conclusion CCE was well-tolerated by the participants, and the incidence of colonic diverticula was 42.3%, with one to two and three or more diverticula being found in 35.1% and 64.9%, respectively. There was little difference in the frequency of colonic diverticula formation on the right side, left side, and on both sides. Age was a positive association factor, while male gender and the presence of colorectal polyps were negative association factors. No correlation was found between diverticula and symptoms.
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Affiliation(s)
- Konosuke Nakaji
- Internal Medicine: Gastroenterology, Endoscopy Center, Aishinkai Nakae Hospital, Wakayama-Shi, JPN
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Kaise M, Nagata N, Ishii N, Omori J, Goto O, Iwakiri K. Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding. Dig Endosc 2020; 32:240-250. [PMID: 31578767 DOI: 10.1111/den.13547] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/29/2019] [Indexed: 12/13/2022]
Abstract
There is the East-West paradox in prevalence and phenotype of colonic diverticula, but colonic diverticular bleeding (CDB) is the most common cause of acute lower gastrointestinal bleeding worldwide. Death from CDB can occur in elderly patients with multiple comorbidities, thus the management of CDB is clinically pivotal amid the aging populations in the East and West. Colonoscopy is the key modality for managing the condition appropriately; however, conventional endoscopic hemostasis by thermal coagulation and clipping cannot achieve the expected results of preventing early rebleeding and conversion to intensive intervention by surgery or transcatheter arterial embolization. Ligation therapy by endoscopic band ligation or endoscopic detachable snare ligation has emerged recently to enable more effective hemostasis for CDB, with an early rebleeding rate of approximately 10% and very rare conversion to intensive intervention. Ligation therapy might in turn reduce long-term rebleeding rates by eliminating the target diverticulum itself. Adverse events have been reported with ligation therapy including diverticulitis of the ascending colon in less than 1% of cases and perforation of the sigmoid colon in a few cases, thus more data are necessary to verify the safety of ligation therapy. Endoscopic hemostasis is indicated only for diverticulum with stigmata of recent hemorrhage (SRH), but the detection rates of SRH are relatively low. Therefore, efforts to increase detection are also key for improving CDB management. Urgent colonoscopy and triage by early contrast-enhanced computed tomography may be candidates to increase detection but further data are necessary in order to make a conclusion.
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Affiliation(s)
- Mitsuru Kaise
- Department of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastrointestinal Endoscopy, Tokyo Medical School, Tokyo, Japan
| | - Naoki Ishii
- Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan
| | - Jun Omori
- Department of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Osamu Goto
- Department of Gastroenterology, Nippon Medical School, Tokyo, Japan
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Abstract
Colonic diverticular disease is a common health care issue which has historically been attributed to western countries and older age population. Recent studies have shown a rise in incidence among developing countries that have adopted western diets as well as rise in prevalence among younger patients. In this article, the authors discuss the incidence, epidemiology, and pathophysiology of colonic diverticular disease.
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Affiliation(s)
- Semeret T Munie
- Department of General Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Surya P M Nalamati
- Department of Colon and Rectal Surgery, Henry Ford Hospital, Detroit, Michigan
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Yamada E, Kuriyama H, Uchida E, Murata Y, Hata Y, Tagri M, Isozaki Y, Oyamada H, Ozawa Y, Ito T, Mizuki A, Inamori M, Manabe N, Haruma K, Nakajima A. Association between endoscopic findings related to colonic diverticula and bowel habits: A multicenter study in Japan. J Gastroenterol Hepatol 2017; 32:1938-1942. [PMID: 28425144 DOI: 10.1111/jgh.13805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/08/2017] [Accepted: 04/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Few studies have shown the associations between colonic diverticula and endoscopic findings such as location, inflammation, number of diverticula, sigmoid colon rigidity, and bowel habits. METHODS Japanese subjects who underwent total colonoscopies at six centers in Japan from November 2015 to October 2016 were analyzed. Bowel habits were evaluated using the Gastrointestinal Symptom Rating Scale. Location and number of diverticula, inflammation, and sigmoid colon rigidity were evaluated from endoscopy results. RESULTS A total of 762 subjects (486 men and 276 women [ratio, 1.76:1]) whose mean age was 65.5 ± 11.4 years were evaluated. In multivariate analysis, presence of constipation was associated with a significantly lower likelihood of left-sided colonic diverticula (odds ratio = 0.40, 95% confidence interval 0.20-0.82, P = 0.012), whereas right-sided and bilateral-sided colonic diverticula, multiple colonic diverticula, inflammation findings, and sigmoid colon rigidity were not related to bowel habits. CONCLUSIONS Among endoscopic findings related to colonic diverticula and bowel habits, only left-sided colonic diverticula were inversely associated with constipation, whereas inflammation findings, multiple diverticula, and sigmoid colon rigidity were not related to bowel habits. However, the association of inflammation findings with colonic diverticula and bowel habits should be further studied. Investigation of changes in left-sided colonic diverticula may lead to new treatments for constipation.
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Affiliation(s)
- Eiji Yamada
- Gastroenterology Division, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan
| | - Hitoshi Kuriyama
- Gastroenterology Division, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Eri Uchida
- Gastroenterology Division, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Yoriko Murata
- Gastroenterology Division, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Yasuo Hata
- Gastroenterology Division, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Masataka Tagri
- Department of Biostatistics and Epidemiology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yutaka Isozaki
- Department of Gastroenterology, Matsushita Memorial Hospital, Osaka, Japan
| | - Hirokazu Oyamada
- Department of Gastroenterology, Matsushita Memorial Hospital, Osaka, Japan
| | - Yukihiro Ozawa
- Department of Surgery, Miura City Hospital, Miura, Japan
| | - Takafumi Ito
- Department of Internal Medicine, Keiyu Hospital, Yokohama, Japan
| | - Akira Mizuki
- Department of Internal Medicine, Keiyu Hospital, Yokohama, Japan
| | - Masahiko Inamori
- Department of Medical Education, Yokohama City University School of Medicine, Yokohama, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Kawasaki Medical School, Kurashiki, Japan
| | - Ken Haruma
- Department of Gastroenterology, Kawasaki Medical School, Kurashiki, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
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Yamada E, Inamori M, Watanabe S, Sato T, Tagri M, Uchida E, Tanida E, Izumi M, Takeshita K, Fujisawa N, Komatsu K, Hamanaka J, Kanesaki A, Matsuhashi N, Nakajima A. Constipation is not associated with colonic diverticula: a multicenter study in Japan. Neurogastroenterol Motil 2015; 27:333-8. [PMID: 25469640 DOI: 10.1111/nmo.12478] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/01/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND The association of diverticula with bowel habits is unclear. We therefore analyzed the association between diverticula and bowel habits in over 1000 Japanese individuals. METHODS Japanese subjects who underwent total colonoscopies at seven centers in Japan from June to September 2013 were analyzed. Bowel habits were evaluated using the Gastrointestinal Symptom Rating Scale, and stool form was assessed using a part of the Bristol Scale and Rome ΙΙΙ criteria. Diverticula were diagnosed by colonoscopy with a transparent soft-short hood. KEY RESULTS The study evaluated 1066 subjects, 648 males and 418 females (ratio, 1.55 : 1), of mean age 63.9 ± 13.0 years. After adjusting for age and sex, the presence of constipation was associated with a significantly reduced likelihood of diverticula (odds ratio [OR] = 0.70, 95% confidence interval [CI] 0.52-0.93). When assessed according to the location of diverticula, the presence of constipation was associated with a significantly decreased likelihood of left-sided (OR = 0.39, 95% CI 0.16-0.93), but not right-sided (OR = 1.10, 95% CI 0.48-2.53), diverticula. Furthermore, stool form was unrelated with the presence or absence of diverticula. CONCLUSIONS & INFERENCES The wide-spread hypothesis that constipation was associated with colonic diverticula was not supported. Rather, we found that the absence of diverticula was associated with constipation, suggesting the need to reassess the etiology of colonic diverticula.
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Affiliation(s)
- E Yamada
- Gastroenterology Division, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan
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