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Matsunaga T, Fukuhara S, Sasaki M, Kato M. Successful resection of a sessile serrated lesion completely involving a colonic diverticulum by endoscopic submucosal dissection with water pressure method. Endoscopy 2024; 56:E10-E12. [PMID: 38194980 PMCID: PMC10776271 DOI: 10.1055/a-2218-3103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Takahiro Matsunaga
- Department of Gastroenterology and Hepatology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Seiichiro Fukuhara
- Department of Gastroenterology and Hepatology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Motoki Sasaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motohiko Kato
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
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Miyaguchi K, Tsuzuki Y, Imaeda H. Direct clipping using a half-opened reopenable clip and long hood for colonic diverticular bleeding. Dig Endosc 2024; 36:638-639. [PMID: 38469739 DOI: 10.1111/den.14783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024]
Abstract
Watch a video of this article.
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Affiliation(s)
- Kazuya Miyaguchi
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - Yoshikazu Tsuzuki
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - Hiroyuki Imaeda
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
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Yamaguchi D, Tanaka Y, Nomura T. Over-the-scope clip rescue method of endoscopic hemostasis for severe acute colonic diverticular bleeding. Dig Endosc 2024; 36:506-507. [PMID: 38353173 DOI: 10.1111/den.14764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/16/2024] [Indexed: 04/13/2024]
Abstract
Watch a video of this article.
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Affiliation(s)
- Daisuke Yamaguchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Saga, Japan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuichiro Tanaka
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Tadahiro Nomura
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Saga, Japan
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McKechnie T, Yang S, Wu K, Sharma S, Lee Y, Park LJ, Passos EM, Doumouras AG, Hong D, Parpia S, Bhandari M, Eskicioglu C. Fragility of Statistically Significant Outcomes in Colonic Diverticular Disease Randomized Trials: A Systematic Review. Dis Colon Rectum 2024; 67:414-426. [PMID: 37889999 DOI: 10.1097/dcr.0000000000003014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND The p value has been criticized as an oversimplified determination of whether a treatment effect exists. One alternative is the fragility index. It is a representation of the minimum number of nonevents that would need to be converted to events to increase the p value above 0.05. OBJECTIVE To determine the fragility index of randomized controlled trials assessing the efficacy of interventions for patients with diverticular disease since 2010 to assess the robustness of current evidence. DESIGN MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to August 2022. SETTINGS Articles were eligible for inclusion if they were randomized trials conducted between 2010 and 2022 with parallel, superiority designs evaluating interventions in patients with diverticular disease. Only randomized trials with dichotomous primary outcomes with an associated p value of <0.05 were considered for inclusion. PARTICIPANTS Any surgical or medical intervention for patients with diverticular disease. MAIN OUTCOME MEASURES The fragility index was determined by adding events and subtracting nonevents from the groups with the smaller number of events. Events were added until the p value exceeded 0.05. The smallest number of events required was considered the fragility index. RESULTS After screening 1271 citations, 15 randomized trials met the inclusion criteria. Nine of the studies evaluated surgical interventions and 6 evaluated medical interventions. The mean number of patients randomly assigned and lost to follow-up per randomized controlled trial was 92 (SD 35.3) and 9 (SD 11.4), respectively. The median fragility index was 1 (range, 0-5). The fragility indices for the included studies did not correlate significantly with any study characteristics. LIMITATIONS Small sample, heterogeneity, and lack of inclusion of studies with continuous outcomes. CONCLUSIONS The randomized trials evaluating surgical and medical interventions for diverticular disease are not robust. Changing a single-outcome event in most studies was sufficient to make a statistically significant study finding not significant. See Video Abstract . FRAGILIDAD DE LOS RESULTADOS ESTADSTICAMENTE SIGNIFICATIVOS EN ENSAYOS ALEATORIOS DE ENFERMEDAD DIVERTICULAR DEL COLON UNA REVISIN SISTEMTICA ANTECEDENTES:El valor p ha sido criticado por una determinación demasiado simplificada de si existe un efecto del tratamiento. Una alternativa es el Índice de Fragilidad. Es una representación del número mínimo de no eventos que deberían convertirse en eventos para aumentar el valor p por encima de 0,05.OBJETIVO:Determinar el IF de ensayos controlados aleatorios que evalúan la eficacia de las intervenciones para pacientes con enfermedad diverticular desde 2010 para evaluar la solidez de la evidencia actual.FUENTES DE DATOS:Se realizaron búsquedas en MEDLINE, Embase y CENTRAL desde el inicio hasta agosto de 2022.SELECCIÓN DE ESTUDIOS:Los artículos eran elegibles para su inclusión si eran ensayos aleatorizados realizados entre 2010 y 2022 con diseños paralelos de superioridad que evaluaran intervenciones en pacientes con enfermedad diverticular. Sólo se consideraron para su inclusión los ensayos aleatorizados con resultados primarios dicotómicos con un valor de p asociado menor que 0,05.INTERVENCIÓNES:Cualquier intervención quirúrgica o médica para pacientes con enfermedad diverticular.PRINCIPALES MEDIDAS DE VALORACIÓN:El índice de fragilidad se determinó sumando eventos y restando no eventos de los grupos con el menor número de eventos. Se agregaron eventos hasta que el valor p superó 0,05. El menor número de eventos requeridos se consideró índice de fragilidad.RESULTADOS:Después de examinar 1271 citas, 15 ensayos aleatorios cumplieron los criterios de inclusión. Nueve de los estudios evaluaron intervenciones quirúrgicas y seis evaluaron intervenciones médicas. El número medio de pacientes aleatorizados y perdidos durante el seguimiento por ECA fue 92 (DE 35,3) y 9 (DE 11,4), respectivamente. La mediana del índice de fragilidad fue 1 (rango: 0-5). Los índices de fragilidad de los estudios incluidos no se correlacionaron significativamente con ninguna característica del estudio.LIMITACIONES:Muestra pequeña, heterogeneidad y falta de inclusión de estudios con resultados continuos.CONCLUSIONES:Los ensayos aleatorios que evalúan las intervenciones quirúrgicas y médicas para la enfermedad diverticular no son sólidos. Cambiar un solo evento de resultado en la mayoría de los estudios fue suficiente para que un hallazgo estadísticamente significativo del estudio no fuera significativo. (Traducción- Dr. Ingrid Melo ).
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Shuling Yang
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kathy Wu
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sahil Sharma
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lily J Park
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Edward M Passos
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
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Rodríguez Jiménez J, Iglesias Sobrino C, García Solo de Zaldívar FJ, Pérez Hernández FA. Complicated giant colonic diverticulum: imaging-based diagnosis. Rev Esp Enferm Dig 2024; 116:161-162. [PMID: 36562530 DOI: 10.17235/reed.2022.9312/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 66-year-old male from Venezuela with history of high blood pressure and diverticulosis is being studied on an outpatient basis for abdominal pain and weight loss of several months of evolution. He presented to the emergency department due to worsening abdominal pain in the last 48 hours and fever. His abdomen was mildly tender to palpation in the left hypochondrium but did not exhibit signs of peritonitis. An abdominal x-ray was performed, revealing an oval, smooth-walled mass located in the left upper quadrant that contained a gas-fluid level. An outpatient abdominal CT scan performed two months earlier showed an intraabdominal, 14.8x10x16cm air cystic lesion, proposing giant colonic diverticulum as first diagnostic possibility. Given the findings of the abdominal x-ray, urgent abdominal CT was requested (image 3) with results suggestive of sigmoid-dependent giant diverticulum, complicated by probable superinfection and torsion of the sigma at its base. Considering the suspected diagnosis, the patient underwent diverticulectomy, demonstrating purulent content inside. Histopathology confirmed the diagnosis. Evolution after surgery was favourable and the patient was discharged on the sixth postoperative day.
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Ozawa N, Yamazaki K, Koizumi H, Otani K, Hasegawa K, Shimizu S, Shimizu M. Novel method combining endoscopic band ligation and clipping for hemostasis of colonic diverticular bleeding. Endoscopy 2023; 55:E887-E888. [PMID: 37442176 PMCID: PMC10344617 DOI: 10.1055/a-2109-1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Noritaka Ozawa
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kenji Yamazaki
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Haruka Koizumi
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kiichi Otani
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kosuke Hasegawa
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Shogo Shimizu
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Masahito Shimizu
- Department of Gastroenterology, Gifu University School of Medicine, Gifu, Japan
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Zeng S, Zhang Q, Li Q, Luo Q, Jiang M, Cheng CS. Surgical suture-assisted endoscopic band ligation for the management of recurrent hemostasis after unsuccessful use of hemoclips for diverticular bleeding. Endoscopy 2023; 55:E1164-E1165. [PMID: 37984392 PMCID: PMC10659840 DOI: 10.1055/a-2183-6154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Shaoxiong Zeng
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Qu Zhang
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Qin Li
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Qingtian Luo
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Minwen Jiang
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Chun-sheng Cheng
- Department of Gastroenterology and Endoscopy Center, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital) and the 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
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Nagahashi T, Hamada K, Horikawa Y, Shiwa Y, Techigawara K, Fukushima D, Nishino N, Todate Y, Irisawa A. Delayed Perforation after Endoscopic Detachable Snare Ligation for Colonic Diverticular Hemorrhage. Intern Med 2023; 62:3137-3142. [PMID: 36948616 PMCID: PMC10686718 DOI: 10.2169/internalmedicine.1180-22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/09/2023] [Indexed: 03/24/2023] Open
Abstract
A 74-year-old man was admitted to our hospital with severe hematochezia. Abdominal enhanced computed tomography (CT) demonstrated extravasation of contrast material from the descending colon. Colonoscopy revealed recent bleeding in the descending colon diverticulum. Bleeding was stopped using detachable snare ligation. Eight days later, the patient developed abdominalgia, and CT revealed free air caused by delayed perforation. The patient underwent emergency surgery. Perforation at the ligation site was detected using intraoperative colonoscopy. This report is the first to describe a case of delayed perforation after endoscopic detachable snare ligation for colonic diverticular hemorrhage.
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Affiliation(s)
- Takayuki Nagahashi
- Department of Gastroenterology, Southern-Tohoku General Hospital, Japan
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Koichi Hamada
- Department of Gastroenterology, Southern-Tohoku General Hospital, Japan
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Japan
| | | | - Yoshiki Shiwa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Japan
| | - Kae Techigawara
- Department of Gastroenterology, Southern-Tohoku General Hospital, Japan
| | - Daizo Fukushima
- Department of Gastroenterology, Southern-Tohoku General Hospital, Japan
| | - Noriyuki Nishino
- Department of Gastroenterology, Southern-Tohoku General Hospital, Japan
| | - Yukitoshi Todate
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
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de Armas-Conde M, Hernández-Alonso R, Concepción-Martín V, Abellán-Fernández J, Padilla-Quintana J, Menéndez-Moreno A, Martínez-Blanco LI, Barrera-Gómez MÁ. Giant sigmoid diverticulum. Rev Esp Enferm Dig 2023; 115:536-537. [PMID: 37539515 DOI: 10.17235/reed.2023.9804/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Unlike acute diverticulitis, giant diverticulum larger than 4 cm is a rare entity with few cases described in the literature. We present a case of a 66-year-old male patient diagnosed with colonic diverticulosis. He presented to the emergency department with symptoms of acute abdomen and was diagnosed by CT scan with a 13x14 cm giant diverticulum showing signs of complication. Given the findings, an urgent surgical intervention was decided, and diverticulectomy at the diverticular neck was performed using an endostapler. The etiology of giant diverticula is related to a mechanism of one-way valve at the diverticular neck. Diagnosis poses a challenge as the clinical presentation is nonspecific. The imaging modality of choice is CT scan, which reveals a large cystic image dependent on the sigmoid colon. Definitive treatment is surgical, either by resecting the affected segment including the lesion or by performing a simple diverticulectomy in uncomplicated cases.
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Affiliation(s)
- María de Armas-Conde
- Cirugía General y del Aparato Digestivo, Hospital Universitario Nuestra Señora de la Candelaria, España
| | | | | | - Jorge Abellán-Fernández
- Cirugía General y del Aparato Digestivo, Hospital Universitario Nuestra Señora de la Candelaria
| | - Javier Padilla-Quintana
- Cirugía General y del Aparato Digestivo, Hospital Universitario Nuestra Señora de la Candelaria
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Cameron R, Walker MM, Jones M, Eslick GD, Keely S, Pockney P, Cosentino CC, Talley NJ. Increased mucosal eosinophils in colonic diverticulosis and diverticular disease. J Gastroenterol Hepatol 2023; 38:1355-1364. [PMID: 37415341 PMCID: PMC10946982 DOI: 10.1111/jgh.16278] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/06/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
AIMS Eosinophils contribute to tissue homeostasis, damage, and repair. The mucosa of colonic diverticula has not been evaluated for eosinophils by quantitative histology. We aimed to investigate whether mucosal eosinophils and other immune cells are increased in colonic diverticula. METHODS Hematoxylin and eosin stained sections from colonic surgical resections (n = 82) containing diverticula were examined. Eosinophils, neutrophils, and lymphocytes, in five high power fields in the lamina propria were counted at the base, neck, and ostia of the diverticulum and counts compared to non-diverticula mucosa. The cohort was further subgrouped by elective and emergency surgical indications. RESULTS Following an initial review of 10 surgical resections from patients with diverticulosis, a total of 82 patients with colonic resections containing diverticula from the descending colon were evaluated (median age 71.5, 42 M/40F). Eosinophil counts for the entire cohort were increased in the base and neck (median 99 and 42, both P = <0.001) compared with the control location (median 16). Eosinophil counts remained significantly increased in the diverticula base (both P = <0.001) and neck (P = 0.01 and <0.001, respectively) in both elective and emergency cases. Lymphocytes were also significantly increased at the diverticula base compared to controls in both elective and emergency subgroups. CONCLUSION Eosinophils are significantly and most strikingly increased within the diverticulum in resected colonic diverticula. While these observations are novel, the role of eosinophil and chronic inflammation is as yet unclear in the pathophysiology of colonic diverticulosis and diverticular disease.
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Affiliation(s)
- Raquel Cameron
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Marjorie M. Walker
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
| | - Michael Jones
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Department of PsychologyMacquarie UniversityNorth RydeAustralia
| | - Guy D. Eslick
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Simon Keely
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | - Peter Pockney
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
| | | | - Nicholas J. Talley
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- NHMRC Centre for Research Excellence in Digestive HealthNew Lambton HeightsAustralia
- Hunter Medical Research InstituteNewcastleAustralia
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Yamauchi A, Ishii N, Yamada A, Kobayashi K, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Mori Y, Osawa K, Nakagami S, Kawai Y, Yoshikawa T, Kaise M, Nagata N. Outcomes and recurrent bleeding risks of detachable snare and band ligation for colonic diverticular bleeding: a multicenter retrospective cohort study. Gastrointest Endosc 2023; 98:59-72.e7. [PMID: 36801460 DOI: 10.1016/j.gie.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND AND AIMS Ligation therapy, including endoscopic detachable snare ligation (EDSL) and endoscopic band ligation (EBL), has emerged as an endoscopic treatment for colonic diverticular bleeding (CDB); its comparative effectiveness and risk of recurrent bleeding remain unclear, however. Our goal was to compare the outcomes of EDSL and EBL in treating CDB and identify risk factors for recurrent bleeding after ligation therapy. METHODS We reviewed data of 518 patients with CDB who underwent EDSL (n = 77) or EBL (n = 441) in a multicenter cohort study named the Colonic Diverticular Bleeding Leaders Update Evidence From Multicenter Japanese Study (CODE BLUE-J Study). Outcomes were compared by using propensity score matching. Logistic and Cox regression analyses were performed for recurrent bleeding risk, and a competing risk analysis was used to treat death without recurrent bleeding as a competing risk. RESULTS No significant differences were found between the 2 groups in terms of initial hemostasis, 30-day recurrent bleeding, interventional radiology or surgery requirements, 30-day mortality, blood transfusion volume, length of hospital stay, and adverse events. Sigmoid colon involvement was an independent risk factor for 30-day recurrent bleeding (odds ratio, 1.87; 95% confidence interval, 1.02-3.40; P = .042). History of acute lower GI bleeding (ALGIB) was a significant long-term recurrent bleeding risk factor on Cox regression analysis. A performance status score of 3/4 and history of ALGIB were long-term recurrent bleeding factors on competing risk regression analysis. CONCLUSIONS There were no significant differences in outcomes between EDSL and EBL for CDB. After ligation therapy, careful follow-up is required, especially in the treatment of sigmoid diverticular bleeding during admission. History of ALGIB and performance status at admission are important risk factors for long-term recurrent bleeding after discharge.
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Affiliation(s)
- Atsushi Yamauchi
- Department of Gastroenterology and Hepatology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Naoki Ishii
- Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan.
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Jun Omori
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International University, Tokyo, Japan
| | - Taiki Aoyama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Naoyuki Tominaga
- Department of Gastroenterology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Takaaki Kishino
- Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Aichi, Japan
| | - Masaki Murata
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akinari Takao
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Ken Kinjo
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Shunji Fujimori
- Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Takahiro Uotani
- Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hiroki Sato
- Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Sho Suzuki
- Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan
| | - Toshiaki Narasaka
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan; Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan
| | | | - Tomohiro Funabiki
- Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan; Emergency and Critical Care Center, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan
| | - Yuzuru Kinjo
- Department of Gastroenterology, Naha City Hospital, Okinawa, Japan
| | - Akira Mizuki
- Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Shu Kiyotoki
- Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan
| | - Ryosuke Gushima
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Yuta Fuyuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naohiko Gunji
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Koji Nagaike
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan
| | - Tetsu Kinjo
- Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan
| | - Yorinobu Sumida
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Sadahiro Funakoshi
- Department of Gastroenterological Endoscopy, Fukuoka University Hospital, Fukuoka, Japan
| | - Kiyonori Kobayashi
- Department of Gastroenterology, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuga Komaki
- Digestive and Lifestyle Diseases, and Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kuniko Miki
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiro Watanabe
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuki Mori
- Department of Gastroenterology and Hepatology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Kazuki Osawa
- Department of Gastroenterology and Hepatology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Sota Nakagami
- Department of Gastroenterology and Hepatology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Yuya Kawai
- Department of Gastroenterology and Hepatology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Takaaki Yoshikawa
- Department of Gastroenterology and Hepatology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Mitsuru Kaise
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan; Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
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12
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Takasu A, Ikeya T, Shiratori Y, Dai Z, Yoshimoto T, Yamamoto K, Okamoto T, Okuyama S, Takagi K, Fukuda K. Use of the NOBLADS Score to Predict Endoscopic Treatment in Patients with Colonic Diverticular Bleeding by Age Stratification. Intern Med 2022; 61:3009-3016. [PMID: 35314553 PMCID: PMC9646343 DOI: 10.2169/internalmedicine.9202-21] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective A high NOBLADS score reflecting the severity of lower gastrointestinal bleeding contributes to the identification of stigmata of recent hemorrhage (SRH) in colonic diverticular bleeding (CDB). The burden of colonoscopy is particularly high in elderly patients; therefore, we investigated the utility of the NOBLADS score for managing CDB by age stratification. The NOBLADS score performance in SRH prediction was estimated by the area under the receiver operating characteristic calculation and a multiple logistic regression model. Methods This was a single-center, retrospective cohort study. Patients who underwent initial colonoscopy with CDB between April 2008 and December 2019 were divided into a young group (<65 years old) and an elderly group (≥65 years old). We further categorized patients according to colonoscopy findings as SRH-positive, with successful endoscopic hemostasis performance, and SRH-negative, with suspected CDB. The main outcome measure was successful SRH identification. Results Four-hundred and seventeen CDB patients were included, of whom 250 (60.0%) were elderly. There were 72 (43.1%) SRH-positive patients in the young group and 94 (37.6%) in the elderly group. The areas under the receiver operating characteristic curves of the NOBLADS score predicting SRH identification were 0.76, 0.71, and 0.81 for all ages, young patients, and elderly patients, respectively. A multiple logistic regression analysis showed that SRH identification was significantly associated with NOBLADS scores in both groups. Eighty-one patients (32.4%) scored ≥4 in the elderly group, and 60 of those were SRH-positive (74.1%). All 27 patients (10.8%) who scored ≥4 with extravasation on computed tomography were found to have SRH. Conclusion The NOBLADS score is useful for predicting SRH identification, especially in elderly patients.
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Affiliation(s)
- Ayaka Takasu
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | | | - Zhehao Dai
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Japan
| | - Takaaki Yoshimoto
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Kazuki Yamamoto
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Shuhei Okuyama
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Koichi Takagi
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Japan
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Okada T, Mikamo T, Nakashima A, Yanagitani A, Tanaka K, Isomoto H. Construction of a Model for Predicting the Severity of Diverticular Bleeding in an Elderly Population. Intern Med 2022; 61:2247-2253. [PMID: 35022353 PMCID: PMC9424098 DOI: 10.2169/internalmedicine.8761-21] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective To identify the risk factors for severe diverticular bleeding in an elderly population. Methods Using a comprehensive computerized hospital database, severe and non-severe diverticular bleeding cases were compared for 19 factors: the age, sex, body mass index, comorbid conditions (hypertension, cardiovascular disease, cerebrovascular disease, and chronic renal failure, including those undergoing dialysis), history of diverticular bleeding, use of low-dose aspirin, use of antiplatelet agent besides aspirin, use of anticoagulant agent, use of prednisolone, use of non-steroidal anti-inflammatory drugs, use of cyclooxygenase-2 selective inhibitors, changes in vital signs, hypoalbuminemia, bilateral diverticula, identification of bleeding lesion, and rebleeding. Severe bleeding was defined as the need for blood transfusion, emergency surgery, or vascular embolization. Patients A total of 258 patients were admitted for lower gastrointestinal bleeding between August 2010 and July 2020, among whom 120 patients over 65 years old diagnosed with diverticular bleeding were included in this study. Results Fifty-one patients (43%) had severe diverticular bleeding. Independent risk factors for severe diverticular bleeding were as follows: change in vital signs [odds ratio (OR), 5.23; 95% confidence interval (CI), 1.9-14.4; p=0.0014], hypoalbuminemia (OR, 12.3; 95% CI, 1.97-77.3; p=0.0073), bilateral diverticula (OR, 3.47; 95% CI, 1.33-9.02; p=0.011), and rebleeding (OR, 5.92; 95% CI, 2.21-15.8; p<0.001). The area under the receiver operating characteristic curve was 0.79 after cross validation. Conclusion Severe diverticular bleeding in elderly population may be predicted by changes in their vital signs, hypoalbuminemia, bilateral diverticula, and rebleeding.
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Affiliation(s)
| | | | | | | | | | - Hajime Isomoto
- Division of Medicine and Clinical Science, Faculty of Medicine, Tottori University, Japan
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14
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Hamada K, Kawano K, Nishida S, Shiwa Y, Horikawa Y, Techigawara K, Fukushima D, Noriyuki N, Honda M. Endoscopic Detachable Snare Ligation Therapy for Colonic Diverticular Hemorrhage Improves Procedure Time Compared to Endoscopic Band Ligation. Turk J Gastroenterol 2022; 33:443-448. [PMID: 35678803 DOI: 10.5152/tjg.2022.21494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The clipping method is widely used in endoscopic hemostasis for colonic diverticular hemorrhage. Recently, rebleeding was shown to be less common in ligation therapy than in clipping. Ligation methods include endoscopic band ligation (EBL) and endoscopic detachable snare ligation (EDSL). No studies have compared procedure times for EBL and EDSL. The present study aimed to compare EDSL and EBL in terms of procedure time. METHODS In this single-center retrospective observational cohort study, we evaluated the data of 39 patients who underwent EBL or EDSL for colonic diverticular hemorrhage. The primary and secondary outcomes measured were the total procedure time and early rebleeding rate, respectively. RESULTS Among the 39 patients included in the study, 18 underwent EBL, and 21 underwent EDSL for hemostasis. The median total pro- cedure times for the EBL and EDSL groups were 50 (range, 30-80) minutes and 35 (range, 18-55) minutes, respectively, demonstrating that the total colonoscopy time was significantly shorter in the EDSL group (P < .001). The early rebleeding rate was 11.1% (2/18) in the EBL group and 4.8% (1/21) in the EDSL group (P = .246). CONCLUSION Important improvements in procedure time were achieved in the EDSL group. Based on our results, we believe that EDSL may reduce patient and endoscopist burden.
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Affiliation(s)
- Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan; Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Koichiro Kawano
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Shinya Nishida
- Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Yoshiki Shiwa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Yoshinori Horikawa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Kae Techigawara
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Daizo Fukushima
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Nishino Noriyuki
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan; Department of Surgery, Southern-Tohoku General Hospital, Koriyama, Japan
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15
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Hayasaka J, Kikuchi D, Odagiri H, Nomura K, Ochiai Y, Okamura T, Suzuki Y, Mitsunaga Y, Dan N, Tanaka M, Yamashita S, Matsui A, Hoteya S. Effectiveness of Clipping for Definitive Colonic Diverticular Bleeding in Preventing Early Recurrent Bleeding. Intern Med 2022; 61:451-460. [PMID: 35173136 PMCID: PMC8907776 DOI: 10.2169/internalmedicine.7702-21] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Clipping is a common technique for managing colonic diverticular bleeding (CDB), despite the lack of published evidence regarding its effectiveness. We aimed to evaluate the effectiveness of clipping for CDB in preventing early recurrent bleeding. Methods This dual-center retrospective study included 93 patients who underwent emergency hospitalization for bloody stool, diagnosed with definitive CDB, and treated with clipping or conservative treatment. The primary outcome was early recurrent bleeding. A logistic regression analysis was performed to assess the association between the occurrence of early recurrent bleeding and clipping with adjustment for propensity scores. Secondary outcomes included death, transfusion, length of hospitalization, need for transcatheter arterial embolization or surgery, and adverse events. Results The patient characteristics were similar between the clipping (n=85) and conservative treatment (n=8) groups. The rate of early recurrent bleeding was significantly lower in the clipping group than in the conservative treatment group [23.5% (20 cases) vs. 75% (6 cases), p=0.005]. In the propensity score-adjusted logistic regression analysis, the odds ratio for early recurrent bleeding in the clipping group was 0.094 (95% confidence interval, 0.008-0.633, p=0.026). Secondary outcomes were not significantly different between the two groups. Stigmata of recent hemorrhage (SRH) at the time of recurrent bleeding was identified in 79.2% of patients (19/24). In the clipping group, recurrent bleeding was observed in 62.5% of cases (10/16) from the same diverticulum. However, early recurrent bleeding tended to be less likely with direct clipping (p=0.072). Conclusion Clipping for definite CDB was more effective in preventing early recurrent bleeding than conservative treatment.
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Affiliation(s)
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Japan
- Department of Gastroenterology, Toranomon Hospital Kajigaya, Japan
| | | | - Kosuke Nomura
- Department of Gastroenterology, Toranomon Hospital, Japan
| | | | | | - Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, Japan
| | | | - Nobuhiro Dan
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Masami Tanaka
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Satoshi Yamashita
- Department of Gastroenterology, Toranomon Hospital, Japan
- Department of Gastroenterology, Toranomon Hospital Kajigaya, Japan
| | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Japan
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16
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González-Valverde FM, Madrid-Baños B, Ruiz-Marín M. Giant Diverticulum of the Sigmoid Colon. J Gastrointest Surg 2021; 25:1347-1349. [PMID: 33123874 DOI: 10.1007/s11605-020-04841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/17/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Francisco Miguel González-Valverde
- Department of Surgery, Pediatrics and Obstetrics and Gynecology, University of Murcia, Murcia, Spain.
- General and Digestive Surgery service. Reina Sofia General University Hospital, Avda. Intendente Jorge Palacios 1, 30.003, Murcia, Región de Murcia, Spain.
| | - Beatriz Madrid-Baños
- General and Digestive Surgery service. Reina Sofia General University Hospital, Avda. Intendente Jorge Palacios 1, 30.003, Murcia, Región de Murcia, Spain
| | - Miguel Ruiz-Marín
- General and Digestive Surgery service. Reina Sofia General University Hospital, Avda. Intendente Jorge Palacios 1, 30.003, Murcia, Región de Murcia, Spain
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17
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Kriegler T, Majernik J, Ninger V. Perforation of descending colon diverticulum by swallowed rabbit bone - a case report. Rozhl Chir 2021; 100:94-96. [PMID: 33910343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Authors present a case of a 58-year old pacient that underwent acute surgery for perforation of descending colon diverticulum by swallowed rabbit bone. The thesis focuses only on foreign bodies swallowed by adult patients. Comprehensive spectrum of foreign bodies that have entered the digestive tract in another way is omitted.
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18
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Darwich I, Stephan D, Klöckner-Lang M, Scheidt M, Friedberg R, Willeke F. A roadmap for robotic-assisted sigmoid resection in diverticular disease using a Senhance™ Surgical Robotic System: results and technical aspects. J Robot Surg 2020; 14:297-304. [PMID: 31161448 PMCID: PMC7125057 DOI: 10.1007/s11701-019-00980-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022]
Abstract
Since the turn of the century, robotic-assisted colorectal surgery has been synonymous with the da Vinci® robotic surgical system. We report in this study our first results in robotic-assisted sigmoid resection for diverticular disease using the Senhance™ Surgical Robotic System, while introducing a standardized roadmap for engaging the robotic arms. 12 patients underwent a sigmoid resection using the Senhance™ Surgical Robotic System. All four arms of the robotic system were engaged during all procedures according to a previously devised roadmap. A 4-trocar technique was used in all patients. Perioperative data, including those regarding technical difficulties, were collected and analyzed. Two procedures were converted into standard laparoscopy. There were no conversions to open surgery. The mean age of the patients was 62.5 years (47-79). One third of the patients were males. The mean BMI was 27 kg/m2 (19-38). The mean operative time, the mean console time and the mean docking time were 219 min (204-305), 149 min (124-205) and 10 min (6-15), respectively. The mean length of stay was 9 days (6-15). There was one major complication (8.3%, Clavien-Dindo IIIb). There were no mortalities. No other complications were observed. No patients were readmitted after discharge. The Senhance™ Surgical Robotic System can be used safely in sigmoid resection for diverticular disease after adequate training and systematic planning of the different steps of the procedure. Further experience is needed to judge the benefit for patient and surgeon, as well as the cost and time effectiveness.
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Affiliation(s)
- Ibrahim Darwich
- Department of Surgery, St. Marien Hospital Siegen, Kampenstr. 51, 57074, Siegen, Germany.
| | - D Stephan
- Department of Surgery, St. Marien Hospital Siegen, Kampenstr. 51, 57074, Siegen, Germany
| | - M Klöckner-Lang
- Department of Surgery, St. Marien Hospital Siegen, Kampenstr. 51, 57074, Siegen, Germany
| | - M Scheidt
- Department of Surgery, St. Marien Hospital Siegen, Kampenstr. 51, 57074, Siegen, Germany
| | - R Friedberg
- Department of Surgery, St. Marien Hospital Siegen, Kampenstr. 51, 57074, Siegen, Germany
| | - F Willeke
- Department of Surgery, St. Marien Hospital Siegen, Kampenstr. 51, 57074, Siegen, Germany
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19
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Pricolo VE. Giant Colonic Diverticulum after Side-to-Side Colonic Anastomosis. Am Surg 2020; 86:e183-e184. [PMID: 32391772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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20
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Vanetta C, González Salazar E, Rossi G. [Giant colonic diverticulum. A strange entity]. Medicina (B Aires) 2020; 80:705. [PMID: 33254118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Affiliation(s)
- Carolina Vanetta
- Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Argentina
| | - Esteban González Salazar
- Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Argentina
- Sector de Coloproctología, Hospital Italiano de Buenos Aires, Argentina
| | - Gustavo Rossi
- Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Argentina
- Sector de Coloproctología, Hospital Italiano de Buenos Aires, Argentina
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21
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Williams LC, Steinhagen RM. Presentation and Management of Giant Colonic Diverticula. Am Surg 2019; 85:e585-e587. [PMID: 31908236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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22
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Cassini D, Depalma N, Grieco M, Cirocchi R, Manoochehri F, Baldazzi G. Robotic pelvic dissection as surgical treatment of complicated diverticulitis in elective settings: a comparative study with fully laparoscopic procedure. Surg Endosc 2019; 33:2583-2590. [PMID: 30406387 DOI: 10.1007/s00464-018-6553-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recently, minimally invasive treatment of complicated sigmoid diverticulitis is becoming a valid alternative to standard procedures. Robotic approach may be useful to allow more precise dissection in arduous pelvic dissection as in complicated diverticulitis. The aim of this study is to investigate effectiveness, potential benefits and short-term outcomes of robotic-assisted laparoscopic surgical resection, compared with fully laparoscopic resection in complicated diverticulitis. METHODS Between January 2009 and December 2017, 156 consecutive patients with history of complicated diverticular disease were referred to our Department of General, Mininvasive and Robotic Surgery. All patients underwent elective colonic resections performed by the same colorectal surgeon and followed a perioperative ERAS program. Demographic and clinical features, surgical data, postoperative data, 30-day morbidity and mortality, VAS for surgeon's compliance were evaluated. RESULTS One hundred and fifty-six consecutive patients underwent elective colonic resection: 92 fully laparoscopic (FL) colorectal resections and 64 procedures with robotic hybrid approach (RHA). Conversion rate was none in the RHA group versus 6.5% in the FL group, because of poor vision due to bowel distension, inflammatory pseudotumor and peritoneal adhesions. No 30-day mortality was observed. Mean operative time was 167.5 ± 54.4 min (80-420) in the FL group and 172.5 ± 55.64 min (110-325) in the RHA group (p 0.079), mean intraoperative blood loss was 144.6 ± 40.6 ml (40-200) with the FL technique and 138.4 ± 28.3 ml (20-185) with the RHA (p 0.295). Mean hospital stay for FL was 5 ± 4.1 days (range 3-45) and 5 ± 2.7 days (range 3-20) for RHA (p 0.974). Overall postoperative morbidity rate was 21.6% in the FL group and 12.3% in the RHA (p 0.067). Major postoperative morbidity (Clavien-Dindo 3 and 4) represented 13% and 4.6%, respectively (p 0.091). VAS for surgeon's compliance revealed a better performance in the robotic arm (p 0.059). CONCLUSIONS This preliminary study highlights the potential benefits of robotic-assisted laparoscopy in colorectal resections for complicated diverticular disease in terms of surgical efficacy, postoperative morbidity and better surgeon's compliance.
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Affiliation(s)
- Diletta Cassini
- Department of General and Mini-Invasive Surgery, Policlinico Abano Terme, Padova, Italy.
| | - Norma Depalma
- Department of Emergency Surgery, "Sapienza" Medical School, Rome, Italy
| | - Michele Grieco
- General Surgery Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Cirocchi
- Department of Surgery and Biochemical Sciences, University of Perugia, AOSP Terni, Perugia, Italy
| | - Farshad Manoochehri
- Department of General and Mini-Invasive Surgery, Policlinico Abano Terme, Padova, Italy
| | - Gianandrea Baldazzi
- Department of General e Surgery, Ospedale Citta Sesto San Giovanni, ASST Milano Nord, Sesto San Giovanni, Italy
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Mari G, Costanzi A, Crippa J, Berardi V, Santurro L, Gerosa M, Maggioni D. Endoscopic Treatment of Anastomotic Bleeding in Laparoscopic Colorectal Surgery. Chirurgia (Bucur) 2019; 114:295-299. [PMID: 31060664 DOI: 10.21614/chirurgia.114.2.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 11/23/2022]
Abstract
Bleeding from the stapled line is a rare but potentially lethal complication that requires a proper and immediate management. Treatment for stapled anastomotic hemorrhage may be operative or conservative. We report three cases of anastomotic stapled line bleeding after colorectal surgery successfully treated endos-copically. Laparoscopic High Anterior Resection with a trans anal anastomosis according to Knight-Griffen with circular a stapler was performed for adenocarcinoma, rectal endometriosis and diverticular disease. All three patients had major rectal bleeding within 24 hours from surgery. 1 patients had endoscopy before the end of the surgical procedure. Endoscopic wash out with removal of the clots and infiltration of the bleeding sites along the stapled line with Adrenaline 1 : 10000 (2 ml) was performed achieving a good hemostasis. Early endoscopy is a safe and efficient treatment in colorectal anastomotic bleeding.
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Okamoto N, Tominaga N, Sakata Y, Hara M, Yukimoto T, Tsuruta S, Yamanouchi K, Takeshita E, Matsunaga K, Ito Y, Miyahara K, Noda T, Yamaguchi D, Tsunada S, Tanaka Y, Kawakubo H, Tsuruoka N, Shimoda R, Ogata S, Fujimoto K. Lower Rebleeding Rate after Endoscopic Band Ligation than Endoscopic Clipping of the Same Colonic Diverticular Hemorrhagic Lesion: A Historical Multicenter Trial in Saga, Japan. Intern Med 2019; 58:633-638. [PMID: 30333407 PMCID: PMC6443565 DOI: 10.2169/internalmedicine.1473-18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective This historical control study was performed to evaluate i) the rebleeding rate of bleeding colon diverticula treated with endoscopic band ligation (EBL) versus endoscopic clipping (EC) and ii) risk factors for rebleeding of diverticula initially treated by endoscopic hemostasis. Methods From January 2010 to December 2012, 68 patients were treated with EC, and from January 2013 to August 2016, 67 patients were treated with EBL. All patients in each group were followed up for one year to check for rebleeding. Results The rebleeding rate was lower in the EBL group (7 of 67, 10%) than in the EC group (21 of 68, 31%; p<0.01). This difference was mainly due to the lower rebleeding rate from the same hemorrhagic diverticulum initially treated by hemostasis (EBL: 4 of 67, 6%; EC: 15 of 68, 22%; p<0.01). The time span until rebleeding in the EBL group was ≤1 week. A multivariate analysis indicated that bleeding from the diverticula on the right side of the colon was a high-risk factor for rebleeding from the diverticula (odds ratio, 4.48; 95% confidence interval, 1.22-16.46; p=0.02). Conclusion The low rebleeding rate in the EBL group was attributed to the low degree of rebleeding from the same diverticulum, indicating that EBL was superior to EC in preventing rebleeding of an initially treated diverticulum.
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Affiliation(s)
- Norihiro Okamoto
- Department of Gastroenterology, Saga Medical Centre Koseikan, Japan
- Department of Internal Medicine, Saga Medical School, Japan
- Department of Internal Medicine, Yuaikai Oda Hospital, Japan
| | - Naoyuki Tominaga
- Department of Gastroenterology, Saga Medical Centre Koseikan, Japan
| | | | - Megumi Hara
- Department of Preventive Medicine, Saga Medical School, Japan
| | - Takahiro Yukimoto
- Department of Gastroenterology, Saga Medical Centre Koseikan, Japan
- Department of Internal Medicine, Saga Medical School, Japan
| | - Sanae Tsuruta
- Department of Gastroenterology, Saga Medical Centre Koseikan, Japan
| | - Kohei Yamanouchi
- Department of Internal Medicine and Gastrointestinal Endoscopy, Takagi Hospital, Japan
| | - Eri Takeshita
- Department of Internal Medicine, Yuaikai Oda Hospital, Japan
| | - Keiji Matsunaga
- Department of Internal Medicine, Yuaikai Oda Hospital, Japan
| | - Yoichiro Ito
- Department of Internal Medicine, Karatsu Red Cross Hospital, Japan
| | - Koichi Miyahara
- Department of Internal Medicine, Karatsu Red Cross Hospital, Japan
| | - Takahiro Noda
- Department of Internal Medicine, Karatsu Red Cross Hospital, Japan
| | - Daisuke Yamaguchi
- Department of Internal Medicine, National Hospital Organization Ureshino Medical Center, Japan
| | - Seiji Tsunada
- Department of Internal Medicine, National Hospital Organization Ureshino Medical Center, Japan
| | - Yuichiro Tanaka
- Department of Internal Medicine, Imari Arita Kyoritsu Hospital, Japan
| | - Hiroharu Kawakubo
- Department of Internal Medicine, Imari Arita Kyoritsu Hospital, Japan
| | - Nanae Tsuruoka
- Department of Internal Medicine, Saga Medical School, Japan
| | - Ryo Shimoda
- Department of Internal Medicine, Saga Medical School, Japan
| | - Shinichi Ogata
- Department of Gastroenterology, Saga Medical Centre Koseikan, Japan
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Affiliation(s)
- F M Braeunling
- Departments of General Surgery, Medicine, and Radiology, Glan Clwyd Hospital, Rhyl, North Wales LL18 5UJ, UK
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Affiliation(s)
- Ryan Francis Bendl
- Department of Surgery, Norwalk Hospital, 30 Stevens Street, Suite D, Norwalk, CT 06856, USA.
| | - Roberto Bergamaschi
- Division of Colorectal Surgery, Department of Surgery, Stony Brook School of Medicine, Stony Brook, NY 11794, USA
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Mari G, Crippa J, Costanzi A, Mazzola M, Magistro C, Ferrari G, Maggioni D. Genito-Urinary Function and Quality of Life after Elective Totally Laparoscopic Sigmoidectomy after at Least One Episode of Complicated Diverticular Disease According to Two Different Vascular Approaches: the IMA Low Ligation or the IMA Preservation. Chirurgia (Bucur) 2017; 112:136-142. [PMID: 28463672 DOI: 10.21614/chirurgia.112.2.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 11/23/2022]
Abstract
The arterial ligation during elective laparoscopic sigmoidectomy for diverticular disease can affect genito-urinary function injuring the superior hypogastric plexus, and can weaken the distal colonic stump arterial perfusion. Ligation of the inferior mesenteric artery distal to the left colic artery or the complete preservation of the inferior mesenteric artery can therefore be compared in terms of preservation of the descending sympathetic fibres running along the aorta to the rectum resulting in a different post operative genito urinary function. From January 2015 to March 2016, 66 patients underwent elective laparoscopic sigmoidectomy for diverticular disease among two enrolling hospitals. In one centre 35 patients underwent laparoscopic sigmoidectomy with the ligation of the inferior mesenteric artery distal to the left colic artery (low ligation). In the other centre 31 patient were operated on the same procedure with complete inferior mesenteric artery preservation (IMA preservation). There was no difference in terms of major complication occurred, first passage of stool and length of hospital stay between the two groups. Time of surgery was significantly shorter in LL group compared to IMA preserving group and intra operative blood loss was significantly lower in the LL group. There were no differences in the genito urinary function between the two group pre operatively, at 1 and 9 months post operatively. Genito urinary function did not significantly change across surgery in each groups. The low ligation and the IMA preserving vascular approach are safe end feasible techniques in elective laparoscopic sigmoidectomy for diverticular disease. They both prevent from genito-urinary post-operative disfunction and allow good post operative quality of life. The low ligation approach is related to shorter operative time and slower intra operative blood loss.
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Molière S, Romain B, Triki E. Big gas bubble in the belly: Beware of giant sigmoid diverticulum. Surgery 2017; 162:1334-1335. [PMID: 28666684 DOI: 10.1016/j.surg.2017.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/21/2017] [Accepted: 05/23/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Sébastien Molière
- Departments of Radiology and Abdominal Surgery, University Hospital of Strasbourg, Strasbourg, France.
| | - Benoit Romain
- Departments of Radiology and Abdominal Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Elhocine Triki
- Departments of Radiology and Abdominal Surgery, University Hospital of Strasbourg, Strasbourg, France
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Marcucci T, Giannessi S, Giudici F, Riccadonna S, Gori A, Tonelli F. Management of colovesical and colovaginal diverticular fistulas Our experience and literature reviewed. Ann Ital Chir 2017; 88:55-61. [PMID: 28447967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM This study aims evaluate the effectiveness of various surgical techniques in treating diverticular fistulas, and the safety and efficacy of the laparoscopic procedure comparing our results with those of the literature. MATERIAL OF STUDY This was a prospective and uncontrolled study performed at a general surgery units. Between 2005 and 2011, 16 patients (11 men, 5 women) underwent surgery for diverticular fistulas. The mean age was 70.2 (range, 35-87) years. The medical evaluation of these patients was based on symptoms and diagnostic procedures confirming the diagnosis of diverticular fistulas. Our surgical options included one-stage, two-stage, and defunctioning procedures. RESULTS Out of 16 cases of diverticular fistula 14 were colovesical and 2 colovaginal. One-stage procedure was performed in 12 patients, two-stage procedure in 3 and defunctioning colostomy in 1. The overall complication rate was 31.2%. We recorded 1 colovesical recurrent fistula. The laparoscopic surgery was performed in 4 patients, nobody was converted to open and there were no post-operative complications and recurrence. DISCUSSION AND CONCLUSIONS The data show that one-stage procedure is effective in the majority of cases of diverticular fistulas. However, the surgery of colovesical and colovaginal fistulas is often associated to high complication rates. This is often due to the shoddy clinical conditions and long-term diverticular illness of this group of patients. At present, the laparoscopy in an elective setting is not considered any more a contraindication in the treatment of diverticular fistulas. KEY WORDS Diverticular fistulas, Laparoscopic surgery.
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Kato M, Uraoka T, Wada M, Banno S, Kinoshita S, Takabayashi K, Kikuchi M. Laterally spreading tumor involving a colon diverticulum successfully resected by endoscopic submucosal dissection. Gastrointest Endosc 2016; 84:191-2. [PMID: 26772893 DOI: 10.1016/j.gie.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/03/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Motohiko Kato
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Toshio Uraoka
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Michiko Wada
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Shigeo Banno
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Satoshi Kinoshita
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kaoru Takabayashi
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masahiro Kikuchi
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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Casso CD, Lalam M, Ghosh S, Timms M. Endoscopic Stapling Diverticulotomy: An Audit of Difficulties, Outcome, and Patient Satisfaction. Otolaryngol Head Neck Surg 2016; 134:288-93. [PMID: 16455379 DOI: 10.1016/j.otohns.2005.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE: To evaluate the procedure in terms of technical difficulties, patient satisfaction, symptom relief, recurrence, and further management. STUDY DESIGN: Retrospective study including 41 patients who underwent endoscopic stapling diverticulotomy. Clinical notes were reviewed, and patients were sent a patient satisfaction questionnaire. Statistical analysis was done using the χ2 square test. SETTING: Teaching hospital. RESULTS: Larger pouches had the best results; 81.578% were satisfied with the surgery, and 86.84% had improved swallowing. Complications presented in 6 patients (15%), including a perforated pouch and an esophageal perforation. Complications were more frequent in small pouches. CONCLUSIONS AND SIGNIFICANCE: Endoscopic stapling diverticulotomy offers rapid recovery in most patients, with early oral intake and short hospital stay. There is a high degree of symptoms relief, and the patient's satisfaction rate is high. The assessment of the pharyngeal pouch size is an important factor when deciding the best management for a patient with a pharyngeal pouch. EBM rating: C-4
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Affiliation(s)
- Carmen de Casso
- Ear, Nose, and Throat Department, Blackburn Royal Infirmary, Blackburn, UK
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Merino Peñacoba LM, Ruiz Rebollo ML, López de Cenarruzabeitia Í, González Obeso E, Beltrán de Heredia Y Rentería J. Endoscopic diagnosis of asymptomatic perforation of colonic diverticulum. Rev Esp Enferm Dig 2016; 108:281-282. [PMID: 27188592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Colonic perforation as complication of acute diverticulitis is a relatively frequent pathology and generally very symptomatic. Nevertheless, when it occurs in the mesenteric border the course can be indolent.
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Dederichs F, Iesalnieks I. Combined endoscopic-laparoscopic treatment of a rectal pocket syndrome after sigmoid resection. Tech Coloproctol 2016; 20:415-417. [PMID: 27118466 DOI: 10.1007/s10151-016-1470-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/14/2015] [Indexed: 11/26/2022]
Affiliation(s)
- F Dederichs
- Department of Internal Medicine and Gastroenterology, Marienhospital Gelsenkirchen, Virchowstr. 135, 45886, Gelsenkirchen, Germany.
| | - I Iesalnieks
- Department of Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
- Department of Surgery, Städtisches Klinikum München Bogenhausen, Munich, Germany
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Okpala AM, Joshi M, Andrews B. Leukocytoclastic vasculitis associated with perforated diverticular disease. BMJ Case Rep 2016; 2016:bcr2015212310. [PMID: 26791117 PMCID: PMC4735271 DOI: 10.1136/bcr-2015-212310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 11/03/2022] Open
Abstract
Leukocytoclastic vasculitis (LV) is a small vessel vasculitis associated with infections, connective tissue disease, malignancies and, rarely, gastrointestinal conditions. An association between LV and acute diverticulitis has not previously been reported. LV may be localised to the skin as a purpuric rash or might manifest with systemic involvement, such as of the joints, gastrointestinal tract or kidneys. Management of LV can be medical or surgical, based on the degree of systemic involvement. We present the case of a 56-year-old man with a 2-year history of a purpuric rash associated with diarrhoea, who presented acutely with abdominal pain. Imaging studies revealed sigmoid diverticulitis with a pericolic collection. Operative findings were purulent peritonitis secondary to perforated diverticular abscess, which was treated with a Hartmann's procedure. Postoperatively, the purpuric rash resolved rapidly on treatment with antibiotics and steroids. Histopathology of the resected bowel and skin punch biopsy confirmed sigmoid diverticulitis and LV, respectively.
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MESH Headings
- Abdominal Pain/diagnosis
- Abdominal Pain/etiology
- Abscess/complications
- Abscess/surgery
- Colon, Sigmoid/pathology
- Colon, Sigmoid/surgery
- Diarrhea/diagnosis
- Diarrhea/etiology
- Diverticulitis, Colonic/complications
- Diverticulitis, Colonic/surgery
- Diverticulum, Colon/complications
- Diverticulum, Colon/surgery
- Exanthema/diagnosis
- Exanthema/etiology
- Exanthema/therapy
- Humans
- Intestinal Perforation/complications
- Intestinal Perforation/surgery
- Male
- Middle Aged
- Peritonitis/etiology
- Skin/pathology
- Vasculitis, Leukocytoclastic, Cutaneous/diagnosis
- Vasculitis, Leukocytoclastic, Cutaneous/etiology
- Vasculitis, Leukocytoclastic, Cutaneous/pathology
- Vasculitis, Leukocytoclastic, Cutaneous/surgery
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Affiliation(s)
| | - Meera Joshi
- Department of Surgery, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Brian Andrews
- Department of Surgery, Medway Maritime Hospital, Gillingham, Kent, UK
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Turoldo A, Bortul M, Ceglar S, Dobrinja C, de Manzini N. Does sigmoidectomy for diverticular disease have a negative impact on patients' quality of life and bowel function? Ann Ital Chir 2016; 87:564-571. [PMID: 28070032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM Aim of this study was to evaluate bowel function after colonic resection for diverticular disease and assess its impact on patients' quality of life. MATERIAL OF STUDY 47 patients who underwent urgent or elective surgery for diverticular disease were either personally contacted or interviewed by telephone and given a questionnaire. The Memorial Bowel functional index, the short form (36) health survey questionnaire, and the fecal incontinence severity index were used. RESULTS Fecal Urgency was found in 4,25% of cases, Incomplete Evacuation in 17,03%, and the Lifestyle/Diet Modification Score in 23,4% of patients. Incontinence cases were not found. After surgery we found reduction of abdominal pain (p=0.017) and improved bowel function (p=0.001). The quality of life correlated to bowel function was defined good or very good in 87.2% of cases whereas 4.3% of patients reported poor bowel function. This condition was related to female patients (p=0.02), urgent surgery (p=0.05), and to post-operative complication (p=0.05). DISCUSSION AND CONCLUSIONS In our experience, both bowel function and abdominal pain improved after surgery and 91.4% of patients were satisfied with the choice of surgery and would agree to do it again. The presence of not recognized inflammatory bowel syndromes can occasionally be responsible for persistent disorders after surgery. KEY WORDS Bowel function, Diverticular disease, Sigmoidectomy.
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36
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Lamm SH, Zerz A, Efeoglou A, Steinemann DC. Transrectal Rigid-Hybrid Natural Orifice Translumenal Endoscopic Sigmoidectomy for Diverticular Disease: A Prospective Cohort Study. J Am Coll Surg 2015; 221:789-97. [PMID: 26282488 DOI: 10.1016/j.jamcollsurg.2015.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/13/2015] [Accepted: 07/13/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Our goal was to evaluate the feasibility of transrectal rigid hybrid natural orifice translumenal endoscopic surgery (NOTES) sigmoidectomy (trNS) in a series of consecutive prospective patients with diverticular disease. The NOTES for left colectomy offers patients reduced pain and easier recovery. Limited data are available for trNS, which is considered safe for various indications. However, the technique is not standardized, and patients in the reported series are highly selected. STUDY DESIGN Patients scheduled for trNS were entered into a prospective registry on an intention-to-treat basis. The primary endpoint was trNS feasibility, and secondary endpoints were morbidity, pain, length of stay, and inflammatory response. A medial-to-lateral dissection with full mobilization of the splenic flexure and total intracorporeal anastomosis was performed. The rectum was covered with a wound protector for transrectal extraction. RESULTS Of 95 elective sigmoidectomies, 81% (n = 77) were enrolled for either transvaginal NOTES resection (n = 37) or trNS (n = 40). There was no difference in body mass index or indication between patients undergoing laparoscopic-assisted sigmoidectomy (LAS), transvaginal resection, or trNS, although trNS patients were younger. Mainly because of a mismatch of bulky specimen and narrow pelvis, 17.5% of trNS were converted to LAS. Major morbidity was 10%, including 2 septic complications. During the study, the anastomosis technique was changed from double stapled end-to-end to side-to-end anastomosis. CONCLUSIONS Transrectal rigid hybrid natural orifice translumenal endoscopic sigmoidectomy is feasible and safe in a high proportion of unselected consecutive patients with diverticular disease undergoing elective treatment. Intracorporeal side-to-end anastomosis is the preferred technique, and trNS should be offered for elective sigmoidectomy presupposing advanced laparoscopic experience.
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Affiliation(s)
- Sebastian H Lamm
- Department of Surgery, Cantonal Hospital Baselland, Bruderholz, Switzerland
| | - Andreas Zerz
- Department of Surgery, Cantonal Hospital Baselland, Bruderholz, Switzerland
| | | | - Daniel C Steinemann
- Department of Surgery, Cantonal Hospital Baselland, Bruderholz, Switzerland.
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Abstract
Giant colonic diverticulum is defined by a diverticulum whose diameter is greater than 4 cm. This is a rare entity, arising mainly in the sigmoid colon. The diagnosis is based on abdominal computed tomography that shows a gas-filled structure communicating with the adjacent colon, with a smooth, thin diverticular wall that does not enhance after injection of contrast. Surgical treatment is recommended even in asymptomatic diverticula, due to the high prevalence and severity of complications. The gold standard treatment is segmental colectomy. Some authors propose a diverticulectomy when the giant diverticulum is unique.
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Affiliation(s)
- C Chater
- Service de chirurgie digestive et transplantation, université Lille Nord de France, CHU Lille, 59000 Lille, France.
| | - A Saudemont
- Service de chirurgie digestive et transplantation, université Lille Nord de France, CHU Lille, 59000 Lille, France
| | - P Zerbib
- Service de chirurgie digestive et transplantation, université Lille Nord de France, CHU Lille, 59000 Lille, France
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38
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Borota AV, Kukhto AP, Baziyan-Kukhto NK. [DIVERTICULAR DISEASE OF LARGE BOWEL: DIAGNOSIS, SURGICAL TACTICS]. Klin Khir 2015:69-72. [PMID: 26263651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Wise KB, Merchea A, Cima RR, Colibaseanu DT, Thomsen KM, Habermann EB. Proximal intestinal diversion is associated with increased morbidity in patients undergoing elective colectomy for diverticular disease: an ACS-NSQIP study. J Gastrointest Surg 2015; 19:535-42. [PMID: 25416544 DOI: 10.1007/s11605-014-2700-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/07/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Elective colectomy for diverticular disease is common. Some patients undergo primary resection with proximal diversion in an effort to limit morbidity associated with potential anastomotic leak. METHODS The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried. All patients undergoing a single, elective resection for diverticular disease from 2005 to 2011 were analyzed. Thirty-day outcomes were reviewed. Factors predictive of undergoing diversion and the risk-adjusted odds of postoperative morbidity with and without proximal diversion were determined by multivariable logistic regression models. RESULTS Fifteen thousand six hundred two patients undergoing non-emergent, elective resection were identified, of whom 348 (2.2 %) underwent proximal diversion. Variables predictive for undergoing proximal diversion included age ≥65 years, BMI ≥30, current smoking status, corticosteroid use, and serum albumin <3.0 g/dL. Multivariable analysis demonstrated that diversion was associated with significantly increased risk of surgical site infection (OR = 1.68), deep venous thrombosis (OR = 5.27), acute renal failure (OR = 5.83), sepsis or septic shock (OR = 1.75), readmission (OR = 2.57), and prolonged length of stay (OR = 3.35). CONCLUSIONS Proximal diversion in the setting of elective segmental colectomy for diverticular disease is uncommon. A combination of preoperative factors and intraoperative factors drives the decision for diversion. Patients who undergo diversion experience increased postoperative morbidity. Surgeons should have a low index of suspicion for postoperative complications and be prepared to mitigate their effect on the patient's outcome.
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Affiliation(s)
- Kevin B Wise
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
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40
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Nigri G, Petrucciani N, Giannini G, Aurello P, Magistri P, Gasparrini M, Ramacciato G. Giant colonic diverticulum, clinical presentation, diagnosis and treatment: Systematic review of 166 cases. World J Gastroenterol 2015; 21:360-368. [PMID: 25574112 PMCID: PMC4284356 DOI: 10.3748/wjg.v21.i1.360] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 08/19/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical presentation, diagnosis, and treatment of giant colonic diverticulum (GCD, by means of a complete and updated literature review). GCD is a rare manifestation of diverticular disease of the colon. Less than 200 studies on GCD were published in the literature, predominantly case reports or small patient series.
METHODS: A systematic review of the literature was performed using the Embase and PubMed databases to identify all the GCD studies. The following MESH search headings were used: “giant colonic diverticulum”; “giant sigmoid diverticulum”. The “related articles” function was used to broaden the search, and all of the abstracts, studies, and citations were reviewed by two authors. The following outcomes were of interest: the disease and patient characteristics, study design, indications for surgery, type of operation, and post-operative outcomes. Additionally, a subgroup analysis of cases treated in the last 5 years was performed to show the current trends in the treatment of GCD. A GCD case in an elderly patient treated in our department by a sigmoidectomy with primary anastomosis and a diverting ileostomy is presented as a typical example of the disease.
RESULTS: In total, 166 GCD cases in 138 studies were identified in the literature. The most common clinical presentation was abdominal pain, which occurred in 69% of the cases. Among the physical signs, an abdominal mass was detected in 48% of the cases, whereas 20% of the patients presented with fever and 14% with abdominal tenderness. Diagnosis is based predominantly on abdominal computed tomography. The most frequent treatment was colic resection with en-bloc resection of the diverticulum, performed in 57.2% of cases, whereas Hartmann’s procedure was followed in 11.4% of the cases and a diverticulectomy in 10.2%. An analysis of sixteen cases reported in the last 5 years showed that the majority of patients were treated with sigmoidectomy and en-bloc resection of the diverticulum; the postoperative mortality was null, morbidity was very low (1 patient was hospitalized in the intensive care unit for postoperative hypotension), and the patients were discharged 4-14 d after surgery.
CONCLUSION: Giant colonic diverticulum is a rare manifestation of diverticular diseases. Surgical treatment, consisting predominantly of colonic resection with en bloc resection of the diverticulum, is the preferred option for GCD and guarantees excellent results.
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Borota AV, Sovpel' OV, Kukhto AP, Baziian-Kukhto NK. [Combined operative interventions for locally-spread diseases of large bowel]. Klin Khir 2014:14-16. [PMID: 25675735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In the clinic of general surgery, based on The Rural coloproctological centre, in 2012-2013 yrs 469 patients were operated for various diseases of large bowel. There were analyzed the results of treatment in 51 (10.8%) patients, to whom the combined operative interventions (COI) were conducted. For the large bowel tumors 48 (94.1%) patients were operated, for nontumoral diseases--3 (5.9%). COI, as a palliative procedures for the large bowel tumors of various localization, were performed in 22 (13.1%) patients, in 34 (67%)--with resection and excision of one organ, and in 17 (33%)--of two organs and more. In 49 (96%) patients the operation was completed by formation of interintestinal anastomosis or using colonic descendence. In adequate conduction of diagnostic measures and preoperative preparations of patients the COI performance is expedient, because it do not compromise the indices of the patients quality of life. For estimation of the COI risk grade it is necessary to take into account the volume and severity of each stage, expressiveness of the disorders in the organs and systems function as well as the tumors resectability.
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Nomi M, Umemoto S, Kikutake T, Hosaka S, Mase T, Kawamoto S, Yoshida T. [A case of carcinoma arising in a diverticulum of the transverse colon]. Gan To Kagaku Ryoho 2014; 41:1680-1682. [PMID: 25731294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 64 year-old woman presented with advanced, transverse colon cancer arising in the diverticulum. Tumor invasion extended beyond the serosa to the anal side of the colon. Anemia and fatigue progressed after 6 months of iron administration. The hemoglobin value was 5.3 g/dL and carcinoembryonic antigen (CEA) level was elevated to 44.2 ng/mL. A palpable and tender fist-sized mass was found in the right upper abdomen. Computed tomography (CT) revealed a low-density mass in the transverse colon invading beyond the serosa to the anal side of the colon. Right hemi-colectomy with lymph node dissection was performed. The resected specimen contained multiple diverticula including the one from which the tumor arose. Histological examination revealed a well-differentiated, tubular adenocarcinoma (UICC TNM T4bN0M0) arising in a transverse colon diverticulum. There has been no recurrence for 2 years. Colon cancer arising in a diverticulum may expand to the extra-serosa and easily invade to the adjacent organ. In such cases, malignancy should be considered.
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Affiliation(s)
- Masako Nomi
- Dept. of Surgery, of Pathology, Fukuoka Tokushukai Hospital
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Xu XQ, Hong T, Li BL, Liu W. Active gastrointestinal diverticulum bleeding diagnosed by computed tomography angiography. World J Gastroenterol 2014; 20:13620-13624. [PMID: 25309094 PMCID: PMC4188915 DOI: 10.3748/wjg.v20.i37.13620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/29/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
A diverticulum is a bulging sack in any portion of the gastrointestinal tract. Small intestine diverticular disease is much less common than colonic diverticular disease. The most common symptoms include non-specific epigastric pain and a bloating sensation. Major complications include diverticulitis, gastrointestinal bleeding, acute perforation, intestinal obstruction, intestinal perforation, localized abscess, malabsorption, anemia, volvulus and bacterial overgrowth. We report one case of massive jejunal diverticula bleeding and one case of massive colonic diverticula bleeding, both diagnosed by acute abdominal computed tomography angiography and treated successfully by surgery.
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Oh HK, Han EC, Ha HK, Choe EK, Moon SH, Ryoo SB, Jeong SY, Park KJ. Surgical management of colonic diverticular disease: Discrepancy between right- and left-sided diseases. World J Gastroenterol 2014; 20:10115-10120. [PMID: 25110438 PMCID: PMC4123340 DOI: 10.3748/wjg.v20.i29.10115] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 05/04/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.
METHODS: The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed. The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology. Right-sided diverticula were classified as those arising from the cecum, ascending colon, and transverse colon, and those from the descending colon, sigmoid colon, and rectum were classified as left-sided diverticulosis. To assess the changing trend of occurrence of diverticulosis, data were compared with two previous studies of 51 patients.
RESULTS: The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001, (27.5% vs 48.1%, P < 0.05). Moreover, no differences in gender, body mass index, multiplicity of the diverticula, fever, or leukocytosis were noted between patients with right-sided and left-sided disease. However, patients with right-sided disease were significantly younger (50.9 year vs 64.0 year, P < 0.01). Furthermore, left-sided disease was significantly associated with a higher incidence of complicated diverticulitis (89.2% vs 57.5%, P < 0.01), combined resection due to extensive inflammation (21.6% vs 5.0%, P < 0.05), operative complications (51.4% vs 27.5%, P < 0.05), and in-hospital mortality (10.8% vs 0%, P < 0.05), along with longer post-operative hospitalization duration (21.3 ± 10.2 d vs 10.6 ± 8.1 d, P < 0.05).
CONCLUSION: Compared with right-sided diverticular disease, the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Colectomy/adverse effects
- Colectomy/mortality
- Colon/pathology
- Colon/surgery
- Diverticulitis, Colonic/diagnosis
- Diverticulitis, Colonic/mortality
- Diverticulitis, Colonic/surgery
- Diverticulosis, Colonic/diagnosis
- Diverticulosis, Colonic/mortality
- Diverticulosis, Colonic/surgery
- Diverticulum, Colon/diagnosis
- Diverticulum, Colon/mortality
- Diverticulum, Colon/surgery
- Female
- Hospital Mortality
- Humans
- Incidence
- Length of Stay
- Male
- Middle Aged
- Postoperative Complications/mortality
- Postoperative Complications/therapy
- Republic of Korea/epidemiology
- Retrospective Studies
- Risk Factors
- Tertiary Care Centers
- Time Factors
- Treatment Outcome
- Young Adult
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Oh HK, Han EC, Ha HK, Choe EK, Moon SH, Ryoo SB, Jeong SY, Park KJ. Surgical management of colonic diverticular disease: discrepancy between right- and left-sided diseases. World J Gastroenterol 2014. [PMID: 25110438 DOI: 10.37 48/wjg.v20.i29.10115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM To compare the outcome of the surgical management of left-sided and right-sided diverticular disease. METHODS The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed. The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology. Right-sided diverticula were classified as those arising from the cecum, ascending colon, and transverse colon, and those from the descending colon, sigmoid colon, and rectum were classified as left-sided diverticulosis. To assess the changing trend of occurrence of diverticulosis, data were compared with two previous studies of 51 patients. RESULTS The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001, (27.5% vs 48.1%, P < 0.05). Moreover, no differences in gender, body mass index, multiplicity of the diverticula, fever, or leukocytosis were noted between patients with right-sided and left-sided disease. However, patients with right-sided disease were significantly younger (50.9 year vs 64.0 year, P < 0.01). Furthermore, left-sided disease was significantly associated with a higher incidence of complicated diverticulitis (89.2% vs 57.5%, P < 0.01), combined resection due to extensive inflammation (21.6% vs 5.0%, P < 0.05), operative complications (51.4% vs 27.5%, P < 0.05), and in-hospital mortality (10.8% vs 0%, P < 0.05), along with longer post-operative hospitalization duration (21.3 ± 10.2 d vs 10.6 ± 8.1 d, P < 0.05). CONCLUSION Compared with right-sided diverticular disease, the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Colectomy/adverse effects
- Colectomy/mortality
- Colon/pathology
- Colon/surgery
- Diverticulitis, Colonic/diagnosis
- Diverticulitis, Colonic/mortality
- Diverticulitis, Colonic/surgery
- Diverticulosis, Colonic/diagnosis
- Diverticulosis, Colonic/mortality
- Diverticulosis, Colonic/surgery
- Diverticulum, Colon/diagnosis
- Diverticulum, Colon/mortality
- Diverticulum, Colon/surgery
- Female
- Hospital Mortality
- Humans
- Incidence
- Length of Stay
- Male
- Middle Aged
- Postoperative Complications/mortality
- Postoperative Complications/therapy
- Republic of Korea/epidemiology
- Retrospective Studies
- Risk Factors
- Tertiary Care Centers
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Heung-Kwon Oh
- Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
| | - Eon Chul Han
- Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
| | - Heon-Kyun Ha
- Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
| | - Eun Kyung Choe
- Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
| | - Sang Hui Moon
- Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
| | - Seung-Bum Ryoo
- Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
| | - Seung-Yong Jeong
- Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
| | - Kyu Joo Park
- Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
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Mahieu J, Mansvelt B, Veys E. Sigmoid Resection with Primary Anastomosis for Uncomplicated Giant Colonic Diverticulum : a Report of two Cases. Acta Chir Belg 2014; 114:280-283. [PMID: 26021425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Giant colonic diverticulum (GCD) is a rare complication of colonic diverticulosis. A small number of cases has been reported in the literature. Patients with GCD have often few non-specific symptoms. Unfortunately, severe complications exist and may lead to surgical acute abdomen. Therefore, this complication of the diverticular disease must be known and properly treated. There is no gold standard diagnostic test, but an air-fluid or air-filled, rounded, pseudocystic image in relation with the colonic wall in a patient with colonic diverticula should suggest this diagnosis to the clinician. We report two cases of a 70-year-old male patient and a 44-year-old female patient having a giant sigmoid diverticulum. The treatment of choice of an uncomplicated GCD is an elective colonic resection, including the giant -diverticulum, with primary anastomosis ; while in case of complicated GCD (peritonitis, abscess or complex fistula), a two-stage resection should be considered.
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Affiliation(s)
- J Mahieu
- Department of General and Visceral Surgery, CH Jolimont-Lobbes, La Louvière, Belgium
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Borota AV, Sovpel' OV, Kukhto AP, Baziian-Kukhto NK. [Simultant operative interventions for diseases of the colon and other abdominal organs]. Klin Khir 2014:20-22. [PMID: 25252406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the clinic of general surgery, basing on surgical department No 2, for the 2012 - 2013 yrs period 469 patients were operated for the large bowel diseases (LBD). In 60 (12.8%) patients in LBD and concomitant diseases of abdominal cavity simultant operative interventions (SOI) were performed. Rate of postoperative complications have constituted 15%. All the patients are alive. Performance of SOI, not depending from duration and significant volume of the operative intervention, we consider optimal and feasible, because the complications rate in the patients did not differ trustworthy from such after a standard operative interventions.
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Lee JT, Dunn TB, Sirany AM, Melton GB, Madoff RD, Kwaan MR. Colorectal surgery after kidney transplantation: characteristics of early vs. late posttransplant interventions. J Gastrointest Surg 2014; 18:1299-305. [PMID: 24838995 DOI: 10.1007/s11605-014-2534-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 05/02/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The majority of colorectal complications after kidney transplantation reportedly occur <1 year of transplant. We aimed to identify differences in complications in the early and late posttransplant period. METHODS We retrospectively reviewed kidney transplant recipients undergoing colorectal resection from 1 June 2000 to 1 June 2012 at a single institution, comparing patients by posttransplant year (<1 vs. >1 year). Measured outcomes included major complications, postoperative length of stay, perioperative mortality, reoperations, and readmissions. RESULTS We identified 45 patients aged 31-77 (median 55). Gastrointestinal malignancy (31 %), diverticular disease (24 %), and ischemic colitis (16 %) were the most common indications for surgery. The early group (n = 9) had more cases of ischemic colitis (44 vs. 6 %, p = 0.01), emergent operations (100 vs. 33 %, p = 0.0003), blood transfusion (78 vs. 31 %, p = 0.02), longer length of stay (23.2 ± 12 vs. 11.7 ± 10 days, p = 0.02), and higher mortality rate (33 vs. 6 %, p = 0.05 compared to the late group (n = 36)). There were no significant differences in major complications, reoperations, or readmissions. CONCLUSIONS Kidney transplant recipients undergoing colorectal resection <1 year of transplant have a higher incidence of emergency surgery and ischemic colitis compared with those with >1 year posttransplant. Despite these findings, patients with grafts <1 year had a similar postoperative complication rate to patients with grafts >1 year.
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Affiliation(s)
- Janet T Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC#195, Minneapolis, MN, 55455, USA,
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Levchenko SV. [Anti-recurrent treatment of colon diverticulitis]. Eksp Klin Gastroenterol 2014:45-54. [PMID: 25842405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The article presents the recent data of individual studies and meta-analyses of the frequency of relapses after one, two or more episodes of acute colon diverticulitis, lits different opinions about the predictors of the recurrent course of the disease. The bigger part of the article is devoted to the analysis of the results of different variants of anti-recurrent treatment of diverticulitis with the assessment of the effectiveness of therapy, with the conclusion that today the problem of the most effective method of treatment exists.
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50
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Mori H, Tsushimi T, Kobara H, Nishiyama N, Fujihara S, Matsunaga T, Ayagi M, Yachida T, Masaki T. Endoscopic management of a rare granulation polyp in a colonic diverticulum. World J Gastroenterol 2013; 19:9481-9484. [PMID: 24409079 PMCID: PMC3882425 DOI: 10.3748/wjg.v19.i48.9481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/01/2013] [Accepted: 10/14/2013] [Indexed: 02/06/2023] Open
Abstract
There are many case reports on colon diverticula that cause irritable bowel syndrome, constipation, bleeding, diverticulitis, stricture due to multiple recurrences of diverticulitis, and perforation. However, few articles have examined neoplasms that arise from a diverticulum, such as adenoma and adenocarcinoma, and there have been no reports of granulation polyps that arise from a colon diverticulum after recurrent diverticulitis. We observed a rare granulation polyp that arose from a diverticulum as a result of repeated episodes of local diverticulitis. Narrow band imaging magnified colonoscopy was very useful to diagnose the polyp as a granulation polyp because of the absence of a pit pattern on the surface of the polyp. We successfully resected the polyp using endoscopic mucosal resection. We inverted the diverticulum, and the resected stalk of the polyp was used to close the diverticulum with an over-the-scope clip. If a granulomatous polyp could arise from a diverticulum, differential diagnosis between a colon neoplasm and a granulomatous polyp would not only be difficult but also necessary for suitable endoscopic treatment.
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