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Mod Pathol 2019 Feb 14. Epub 2019 Feb 14.

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.

Appendix pathology represents uncommonly encountered specimens with unique diagnostic challenges. To delineate common knowledge gaps, extramural consults submitted to seven institutions between 2016-2017 were reviewed. All appendix consults were resections (100%, n = 43), and the majority were directed for consultation by the originating pathologist (95%, n = 41) with no additional studies performed by the consultant (65%, n = 28). Read More

Abdom Radiol (NY) 2019 Feb 13. Epub 2019 Feb 13.

Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75674, Paris, France.

Purpose: To present radiological aspects of jejunoileal diverticulosis and its complications.

Results: Jejunoileal diverticulosis is a relatively rare and underestimated condition, which mostly affects the elderly. It is frequently asymptomatic but it can lead to significant complications requiring surgical treatment. Read More

Am Surg 2018 Nov;84(11):1781-1786

The aim of this study was to identify preoperative characteristics that may determine the need for emergency surgery for diverticulitis and assess postoperative outcomes for these patients when compared with elective surgery. All patients included in the ACS-NSQIP-targeted colectomy database from 2012 to 2013 who underwent colectomy with an underlying diagnosis of diverticulitis were included. Preoperative characteristics and 30-day postoperative outcomes were evaluated for patients who underwent elective emergent/urgent surgery using univariable and multivariable analyses. Read More

J Surg Case Rep 2019 Jan 31;2019(1):rjz005. Epub 2019 Jan 31.

Saint Vincent Hospital, Erie, PA, USA.

Cases of small bowel diverticulitis, excluding Meckel's diverticulitis, are rare. Small bowel diverticular disease has been reported in approximately 0.3-1. Read More

JSLS 2019 Jan-Mar;23(1)

Department of General Surgery and Oncological Surgery-Surgery C, Sheba Medical Center, Tel Hashomer, Israel.

Background And Objective: Entero vesical fistulas (EVFs) are an uncommon complication mainly of diverticular disease (70%) and less commonly of Crohn's disease (10%). Only about 10% are caused by malignancies. At this time, it is unclear whether the laparoscopic approach can be routinely proposed as a safe procedure for patients with EVF. Read More

Eur J Cancer Care (Engl) 2019 Feb 8:e13000. Epub 2019 Feb 8.

Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.

Objectives: To identify opportunities for reducing emergency colon cancer diagnoses, we evaluated symptoms and benign diagnoses recorded before emergency presentations (EP).

Methods: Cohort of 5,745 colon cancers diagnosed in England 2005-2010, with individually linked cancer registry and primary care data for the 5-year pre-diagnostic period.

Results: Colon cancer was diagnosed following EP in 34% of women and 30% of men. Read More

Inflamm Intest Dis 2018 Dec 20;3(2):91-99. Epub 2018 Nov 20.

Norfolk and Norwich University Hospital, Norwich, United Kingdom.

Objective: Recurrent acute diverticulitis carries a major burden to any form of health care. Patients present repeatedly to medical centers with a multitude of symptoms and may require different modalities of treatment with significant morbidities and impact on quality of life.

Methods: We therefore wanted to identify factors that would imply the need and time of surgery versus conservative management. Read More

Inflamm Intest Dis 2018 Dec 16;3(2):80-90. Epub 2018 Feb 16.

Emergency and Trauma Surgery Unit, Maggiore Hospital, AUSL Bologna, Bologna, Italy.

Background: Acute complicated diverticulitis (ACD) is an important and increasing issue in Western countries that leads to a significant impact and burden for patients, but also for the society due to its effects on hospital costs. In recent years, essential progression has been made regarding the research and implementation of novel or improved treatment strategies for the various disease entities of ACD. Much debated topics in the multidisciplinary approach of patients with ACD, such as the choice for nonoperative treatment options, the role of percutaneous drainage for diverticular abscesses, the role of laparoscopic lavage for perforated diverticulitis with purulent peritonitis, and the role of sigmoidectomy with primary anastomosis for patients with perforated diverticulitis, require clinicians to attentively follow and participate in these discussions. Read More

Inflamm Intest Dis 2018 Dec 20;3(2):75-79. Epub 2018 Jul 20.

Alta Bates Summit Medical Center, East Bay Center for Digestive Health, Oakland, California, USA.

Acute uncomplicated diverticulitis (AUD) is generally felt to be caused by obstruction and inflammation of a colonic diverticulum and occurs in about 4-5% of patients with diverticulosis. The cornerstone of AUD treatment has conventionally been antibiotic therapy, but with a paradigm shift in the underlying pathogenesis of the disease from bacterial infection to more of an inflammatory process, as well as concerns about antibiotic overuse, this dogma has recently been questioned. We will review emerging data that supports more selective antibiotic use in this population, as well as newer guidelines that advocate this position as well. Read More

Inflamm Intest Dis 2018 Dec 7;3(2):61-68. Epub 2018 Aug 7.

Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.

Background: Colonic diverticulosis is prevalent and increasing not only in Western but also in Asian countries. Diverticulosis can be complicated by diverticulitis and diverticular bleeding. Diverticular disease is a burdensome digestive disease, because it is a major cause of hospital admissions and is associated with significant health-care costs. Read More

Inflamm Intest Dis 2018 Dec 13;3(2):53-54. Epub 2018 Nov 13.

Ala I. Sharara, Beirut.

N Engl J Med 2019 01;380(5):500

Beth Israel Deaconess Medical Center, Boston, MA

N Engl J Med 2019 01;380(5):500

University Hospital 12 de Octubre, Madrid, Spain

N Engl J Med 2019 01;380(5):500-501

Mayo Clinic, Phoenix, AZ

Case Rep Gastroenterol 2018 Sep-Dec;12(3):765-772. Epub 2018 Dec 20.

Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan.

Pulse granuloma is a rare pathologic condition considered to be a benign inflammatory reaction to foreign materials originated from ingested legume matter. As for pulse granulomas of the gastrointestinal tract, association with diverticular diseases is relatively common, but only a few pulse granuloma cases associated with appendicitis have been reported. This report presents histopathologic findings of pulse granuloma lesions observed in two appendectomy cases, with some histochemical examinations of cellulose matter which is reportedly a major component to provoke pulse granuloma reaction. Read More

Surg Infect (Larchmt) 2019 Jan 24. Epub 2019 Jan 24.

1 Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio.

Background: After publication of the Study to Optimize Peritoneal Infection Therapy (STOP IT) trial, we sought to determine if we were implementing study findings into practice appropriately. We had three objectives: evaluate antibiotic usage; evaluate patient outcomes; and delineate differences in antibiotic usage between general surgeons (GS) and trauma/acute care surgery trained surgeons (TACS).

Patients And Methods: This was an analysis of patients with complicated intra-abdominal infection admitted via the emergency department from February 2014 through May 2017. Read More

JSLS 2019 Jan-Mar;23(1)

Department of Surgery, St. Joseph Mercy Hospital, Ann Arbor, Michigan USA.

Background And Objectives: The role for the robotic-assisted approach as a minimally invasive alternative to open colorectal surgery is in the evaluation phase. While the benefits of minimally invasive colorectal surgery when compared to the open approach have been clearly demonstrated, the adoption of laparoscopy has been limited. The purpose of this study was to evaluate clinical outcomes, hospital and payer characteristics of patients undergoing robotic-assisted, laparoscopic, and open elective sigmoidectomy for diverticular disease in the United States. Read More

J Gastrointest Surg 2019 Jan 22. Epub 2019 Jan 22.

Department of Surgery, Albany Medical Center, 50 New Scotland Avenue, MC-193, Albany, NY, 12208, USA.

Background: Surgical management of diverticulitis is evolving and the decision to offer elective sigmoidectomy for diverticulitis has become more individualized. However, preoperative variables that may predict recurrent diverticulitis after resection and guide surgical decision-making were not well studied.

Methods: This was a retrospective chart review with a prospective questionnaire follow-up of patients. Read More

Int J Epidemiol 2019 Jan 21. Epub 2019 Jan 21.

Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Background: In 2006, the Bowel Cancer Screening Programme (BCSP) in England began offering biennial faecal occult blood testing (FOBt) at ages 60-69 years. Although FOBt is aimed at detecting colorectal neoplasms, other conditions can affect the result. In a large UK prospective study, we examined associations, both before and after screening, between FOBt positivity and 10 conditions that are often associated with gastrointestinal bleeding. Read More

Gut 2019 Jan 19. Epub 2019 Jan 19.

Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany.

Objective: Diverticular disease is a common complex disorder characterised by mucosal outpouchings of the colonic wall that manifests through complications such as diverticulitis, perforation and bleeding. We report the to date largest genome-wide association study (GWAS) to identify genetic risk factors for diverticular disease.

Design: Discovery GWAS analysis was performed on UK Biobank imputed genotypes using 31 964 cases and 419 135 controls of European descent. Read More

J Radiol Case Rep 2018 May 31;12(5):19-26. Epub 2018 May 31.

Department of Radiology, Temple University Health System, Philadelphia, PA, USA.

The normal aortic arch branching pattern is of a three-vessel arch with the vertebral arteries arising from the subclavian arteries. There are a variety of well-known symptomatic and asymptomatic aortic branching patterns widely reported in the literature. An anomalous right vertebral artery with a diverticulum of Kommerell is an extremely rare variant, with few other cases reported in the literature. Read More

Clin Colon Rectal Surg 2019 Jan 8;32(1):8-15. Epub 2019 Jan 8.

Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.

The Rochester Epidemiology Project (REP), a longitudinal population-based database, is the largest epidemiologic database in the world. Originally established at Mayo Clinic in Rochester, Minnesota, the REP has been instrumental in defining the natural history of disease states and the impact of treatment in a well-defined population. In the United States, the REP has made important contributions to the colon and rectal literature, largely because healthcare is fragmented with no unique identifier to longitudinally follow-up with a patient throughout the system over his or her lifespan. Read More

Acta Gastroenterol Belg 2018 Oct-Dec;81(4):490-495

Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey.

Background And Study Aims: Although several factors are thought to be responsible for the development of colonic diverticulosis (CD), the underlying pathogenesis is still obscure and needs clarification. The aim of this study was to determine the prevalence, location and clinical features of CD and especially to detect whether there is an association between CD and postures during defecation.

Patients And Methods: This prospective study enrolled 757 patients. Read More

Can J Gastroenterol Hepatol 2018 6;2018:3690202. Epub 2018 Dec 6.

Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

Background: The natural history of colonic diverticulosis is unclear.

Methods: Patients with incidental diverticulosis identified in a previous prospective cross-sectional screening colonoscopy study were evaluated retrospectively for clinic or hospital visit(s) for diverticular disease (DD= acute diverticulitis or diverticular bleeding) using review of electronic health records and patient phone interview.

Results: 826 patients were included in the screening colonoscopy study. Read More

Digestion 2019 9;99 Suppl 1:1-26. Epub 2019 Jan 9.

Japanese Gastroenterological Association, Tokyo, Japan.

Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. Read More

J Laparoendosc Adv Surg Tech A 2019 Jan 8. Epub 2019 Jan 8.

1 Division of Thoracic Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia.

Background: Esophageal thoracic diverticular disease is a rare condition resulting from multiple etiologies. Surgical management is recommended when symptomatic. Traditionally, a thoracotomy was considered the standard approach; however, the use of minimally invasive approaches has been associated with improved outcomes. Read More

Colorectal Dis 2019 Jan 4. Epub 2019 Jan 4.

Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK.

Aim: In colorectal cancer, ligation of the inferior mesenteric artery (IMA) is a standard surgical approach. In contrast, ligation of the IMA is not mandatory during treatment of diverticular disease. The object of this meta-analysis was to assess if preservation of the IMA reduces the risk of anastomotic leakage. Read More

Am Surg 2018 Dec;84(12):e561-e563

Am Surg 2018 Dec;84(12):e529-e531

Am Surg 2018 Dec;84(12):e524-e526

J Investig Med 2018 Dec 27. Epub 2018 Dec 27.

Gastroenterology Service, ASL BAT, Andria, Italy.

Although rifaximin is currently advised in managing symptomatic uncomplicated diverticular disease (SUDD) of the colon, no long-term data are available. This retrospective study assessed the outcome of a large cohort of patients with SUDD, treated with rifaximin, during an 8-year follow-up. The study group (group A) included 346 patients with SUDD (median age 64 years, IQR 58-69, 62. Read More

Colorectal Dis 2018 Dec 26. Epub 2018 Dec 26.

Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.

Aim: The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies.

Method: Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30-day complications, were compared between left-sided and right-sided colectomies. Read More

J Med Case Rep 2018 Dec 25;12(1):379. Epub 2018 Dec 25.

Computed Tomography Department, Konstantpouleio General Hospital Nea Ionia, Athens, Greece.

Background: Extramedullary plasmacytoma is an uncommon tumor that most often involves the nasopharynx or upper respiratory tract. Extramedullary plasmacytoma is a type of plasma cell neoplasm that can present as a primary tumor or secondary to another plasma cell neoplasm, such as multiple myeloma. Secondary extramedullary plasmacytoma is usually noted in the advanced stages of the disease. Read More

J Urol 2019 01;201(1):24-25

Transplant Proc 2018 Dec 8;50(10):3964-3967. Epub 2018 Sep 8.

Department of Surgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai Miyagi, Japan.

A 58-year-old man who underwent cadaveric kidney transplantation twice presented to hospital with a perforated epiphrenic diverticulum. Computed tomography revealed epiphrenic diverticulitis and right pleural effusion. Upper gastrointestinal fibroscopy showed an epiphrenic diverticulum full of food residue. Read More

J Biol Regul Homeost Agents 2018 Nov-Dec;32(5):1421-1432

Gastroenterology Service, ASL BAT, Andria (BT), Italy.

Symptomatic uncomplicated diverticular disease (SUDD) affects 50% of people having diverticulosis. We performed a pilot study assessing the effect of current treatments on fecal microbiota and metabolome in SUDD. Thirteen consecutive females with SUDD were treated with a 2-week therapeutic trial of 30 g/day fiber supplementation (3 patients), 1. Read More

Surg Technol Int 2018 Dec 20;34. Epub 2018 Dec 20.

Department of General Surgery, Sant'Andrea Hospital ASL5, La Spezia, Italy.

Background: Laparoscopic colectomy represents a safe, effective and well-established procedure for both benign and malignant colic disease. Transanal anastomosis (TA) with a circular stapler is the most commonly performed anastomotic technique in laparoscopic left hemicolectomy (LLH). We report our experience with side-to-side anastomosis (STSA) and side-to-end anastomosis (STEA) in selected patients with both emergency and elective LLH. Read More

J Gastrointestin Liver Dis 2018 Dec;27(4):476-477

Division of Gastroenterology, "Cristo Re" Hospital, Rome, Italy.

J Gastrointestin Liver Dis 2018 Dec;27(4):449-457

Iuliu Hatieganu University of Medicine and Pharmacy, 2nd Medical Dept. Cluj-Napoca, Romania.

Background And Aims: Diverticular disease of the colon is a common clinical condition in developed countries, and is associated with significant (direct and indirect) economic burden. The aim of this Position Paper is to provide clinical guidance for appropriate definition, prevalence, risk factors, diagnosis, and treatment of colonic diverticular disease.

Methods: A working group of recognized experts established by the Board of the Romanian Society of Gastroenterology and Hepatology (RSGH) screened the literature and the available guidelines on colonic diverticular disease. Read More

J Gastrointestin Liver Dis 2018 Dec;27(4):351-355

Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, University of Zaragoza, IIS Aragón, Zaragoza, Spain.

United European Gastroenterol J 2018 Dec 15;6(10):1556-1562. Epub 2018 Sep 15.

Trinity Academic Gastroenterology Group, Trinity College Dublin & Tallaght University Hospital, Dublin, Ireland.

Background: Same-day colon capsule endoscopy (CCE) immediately following incomplete optical colonoscopy (OC) would have a number of advantages for patients, while also presenting unique procedural challenges including the effect of sedation on capsule propulsion and patient tolerance of protracted preparation and fasting.

Aim: The aim of this article is to prospectively assess the efficacy of same-day CCE after incomplete OC in an unselected patient cohort.

Methods: This was an observational, prospective, single-centre study of CCE post-incomplete colonoscopies. Read More

Pan Afr Med J 2018 17;30:214. Epub 2018 Jul 17.

Clinique Universitaire de Chirurgie Pédiatrique CNHU-HKM, Cotonou, Bénin.

Meckel's diverticulum is the most common congenital anomaly of the small bowel. Although it is a common anomaly in the general population, its occurrence in a hernial sac, in particular at the umbilicus, is uncommon and it is known as Littré's hernia. We here report the case of a 6-month female infant, admitted with painful irreducible umbilical swelling. Read More

Acta Biomed 2018 Dec 17;89(9-S):113-118. Epub 2018 Dec 17.

Department of Medicine and Surgery, University of Parma, Parma, Italy.

Colonic Diverticulosis is one of the most common anatomical findings during colonoscopy. This condition has 60% incidence in the population over 60 years old. About 20% of patients will develop Diverticular Disease, and 5% of them will evolve into Diverticulitis. Read More

Acta Biomed 2018 Dec 17;89(9-S):107-112. Epub 2018 Dec 17.

Department of Medicine and Surgery, University of Parma, Parma, Italy.

Diverticulosis of the colon is the most frequent anatomical alteration diagnosed at colonoscopy. The prevalence of the disease is higher in elderly patients over 65 years old, recent studies show an increment also in youngers over 40 years old. Even its large prevalence in the population, its pathophysiology still remain poorly understood. Read More

Eur J Intern Med 2018 Dec 4. Epub 2018 Dec 4.

First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.

Background: Gastrointestinal bleeding (GIB) is burdened by high mortality rate that increases with aging. Elderly patients may be exposed to multiple risk factors for GIB. We aimed at defining the impact of GIB in elderly patients. Read More

Rom J Morphol Embryol 2018 ;59(3):833-837

Institute of Gastroenterology and Hepatology, Iaşi, Romania;

Aim: The aim of our study was to compare baseline characteristics and clinical data as well as endoscopic retrograde cholangiopancreatography (ERCP) results in patients with and without periampullary diverticulum (PAD).

Patients, Materials And Methods: A single center retrospective analysis was conducted from June 2016 to June 2017 and the patients that had undergone ERCP were divided into two groups, according to the presence (Group A, 43 patients) or absence (Group B, 55 patients) of PAD.

Results: Mean age of patients with PAD was significantly higher than the ones in the control group (69. Read More

Dig Dis Sci 2018 Dec 3. Epub 2018 Dec 3.

Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA.

Background: The management of diverticulitis is compromised by difficulty in identifying patients who require surgery for recurrent or persistent disease. Here, we introduce the concept of multifocal diverticulitis (MFD), characterized by multiple episodes of diverticulitis occurring at different locations within the colon.

Aims: To compare clinical characteristics, success of surgical management, and colonic transcriptomes of MFD patients to patients with conventional unifocal diverticulitis (UFD). Read More

Ann Med Surg (Lond) 2018 Dec 20;36:239-241. Epub 2018 Nov 20.

Caboolture Hospital, 120 McKean Street, 4510, Queensland, Australia.

Introduction: Acute appendicitis in older adults is relatively uncommon and could be the first presentation of an underlying colorectal carcinoma. Colonoscopy in these individuals affords the opportunity for earlier diagnosis and treatment. The finding of increased rates of colorectal cancer (CRC) with older patients who have had appendicitis was supported by a number of small studies and case reports in the early 1980s. Read More

World J Gastrointest Oncol 2018 Nov;10(11):449-464

Department of General and Laparoscopic Colorectal Surgery, Brighton and Sussex University Hospitals NHS Trust, the Royal Sussex County Hospital, Brighton, West Sussex BN2 5BE, United Kingdom.

Aim: To compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision (RTME) laparoscopic total meso-rectal excision (LTME).

Methods: Standard medical electronic databases such as PubMed, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in patients undergoing RTME LTME was analysed using the principles of meta-analysis. Read More

Nutrients 2018 Nov 28;10(12). Epub 2018 Nov 28.

Nutrition Science Solutions, LLC, Wimberley, 78676 TX, USA.

Less than 10% of most Western populations consume adequate levels of whole fruits and dietary fiber with typical intake being about half of the recommended levels. Evidence of the beneficial health effects of consuming adequate levels of whole fruits has been steadily growing, especially regarding their bioactive fiber prebiotic effects and role in improved weight control, wellness and healthy aging. The primary aim of this narrative review article is to examine the increasing number of health benefits which are associated with the adequate intake of whole fruits, especially fruit fiber, throughout the human lifecycle. Read More