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Br J Surg 2019 Apr 23. Epub 2019 Apr 23.

Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.

Background: Studies on incidence rates of first-time colonic diverticular disease are few, and population-based estimates of lifetime risk are lacking. In this observational study, the incidence, admission rates and lifetime risks of hospitalization and surgery for diverticular disease were investigated.

Methods: Considering the entire Swedish population as an open cohort, incidence and admission rates, and lifetime risk estimates (considering death as a competing risk) of hospitalization and surgery for diverticular disease were calculated using data from cross-linked national registers and population statistics from 1987 to 2010. Read More

Biomed Res Int 2019 13;2019:9721781. Epub 2019 Mar 13.

Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2S2.

Previous studies have linked systemic glucocorticoid use with intestinal perforation. However, the association between intestinal perforation and endogenous hypercortisolism has not been well described, with only 14 previously published case reports. In this study, we investigated if intestinal perforation occurred more frequently in patients with ectopic ACTH syndrome and in those with a greater than 10-fold elevation of 24-hour urinary free cortisol level. Read More

Mediators Inflamm 2019 14;2019:8328490. Epub 2019 Mar 14.

Gastroenterology Unit, ASL Roma 6, Albano Laziale, Roma, Italy.

Diverticulosis of the colon is the most common condition in Western societies and it is the most common anatomic alteration of the human colon. Recurrent abdominal pain is experienced by about 20% of patients with diverticulosis, but the pathophysiologic mechanisms of its occurrence are not completely understood. In the last years, several fine papers have showed clearly the role of low-grade inflammation both in the occurrence of symptoms in people having diverticulosis, both in symptom persistence following acute diverticulitis, even if the evidence available is not so strong. Read More

Colorectal Dis 2019 Apr 16. Epub 2019 Apr 16.

Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands.

Introduction: Patients undergoing resectional surgery for enterovesical fistulas generally have an in-dwelling urinary catheter postoperatively to prevent a recurrent fistula. The aim of this study was to assess the place of a postoperative cystogram after such surgery, when it should be performed and for how long the bladder should be drained after surgery.

Methods: A retrospective single centre study of all patients undergoing ileocaecal or sigmoid resection for surgery for enterovesical fistula with the primary endpoint of recurrent urinary fistula. Read More

J Laparoendosc Adv Surg Tech A 2019 Apr 16. Epub 2019 Apr 16.

1 Duke Surgery, Division of Metabolic and Weight Loss Surgery, Durham, North Carolina.

Background: Appropriate tissue retraction is essential in laparoscopic surgery, and colorectal operations often require an additional incision and trocar that can disturb visualization and maneuverability. Each incision carries an increased risk for complications as well as increased pain and cosmetic issues. Magnetic devices have been developed for a less invasive retraction. Read More

Chirurg 2019 Apr 11. Epub 2019 Apr 11.

Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Städtisches Klinikum Solingen gGmbH, Gotenstraße 1, 42653, Solingen, Deutschland.

Diverticular bleeding is a complication of diverticular disease but in contrast to diverticulitis, publications concerning diverticular bleeding are less common. Diverticular bleeding is the cause of approximately 20-50% of cases of lower gastrointestinal bleeding and in rare cases can be life-threatening. The main symptom of diverticular hemorrhage is painless hematochezia and the German guidelines recommend that further diagnostics of suspected diverticular bleeding should be performed in hospital. Read More

Gastrointest Tumors 2019 Feb 5;5(3-4):77-81. Epub 2018 Nov 5.

Colorectal Unit, Department of Surgery, SUS Malmö, Malmö, Sweden.

Purpose: Hartmann's procedure is a well-established alternative in colorectal surgery when a primary anastomosis is contraindicated. However, the rectal remnant may cause complications. This study was designed to investigate the occurrence of pelvic sepsis after Hartmann's procedure and identify possible risk factors. Read More

Gastroenterol Rep (Oxf) 2019 Apr 16;7(2):115-120. Epub 2018 Aug 16.

Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.

Background: Diverticular bleeding (DB) is the most common cause of severe acute lower gastrointestinal bleeding (GIB) in developed countries. The role of early colonoscopy (<24 hours) continues to remain controversial and data on early colonoscopy in acute DB are scant. We aimed to evaluate the effect of timing of colonoscopy on outcomes in patients with acute DB using a nationwide inpatient sample. Read More

Radiologia 2019 Apr 8. Epub 2019 Apr 8.

Departamento de Radiología, Hospital Universitari Vall d'Hebron, Barcelona, España.

Objective: To review the embryology, the clinical findings and the appearance in multidetector computed tomography (MDCT) of complicated Meckel's diverticulum (DM) in adults.

Conclusion: The presence of an MD in a MDCT should be suspected when a blind tubular structure connected to the terminal ileum by a neck of variable size is observed. Multiplanar 2D reconstructions images and CT enterography can help in the diagnosis. Read More

J Surg Case Rep 2019 Apr 6;2019(4):rjz102. Epub 2019 Apr 6.

Department of General Surgery, Joondalup Health Campus, Joondalup, Western Australia, Australia.

Chronic abdominal pain is often a diagnostic dilemma. We present a 59-year-old female with chronic generalized colicky abdominal and altered bowel habits. She was investigated with colonoscopy and CT abdomen. Read More

Am Surg 2019 Mar;85(3):284-287

Two of the accepted treatments for symptomatic Zenker's diverticula are open resection of the diverticulum with cricopharyngotomy and transoral, endoscopic diverticuloesophagostomy with cricopharyngotomy. We report our experience with open surgical resection of the diverticulum with repeat cricopharyngotomy in patients with persistent symptoms after endoscopic diverticuloesophagostomy. This is a retrospective review of patients who underwent open surgical resection of the diverticulum, with repeat cricopharyngotomy in patients with persistent symptoms after endoscopic diverticuloesophagostomy. Read More

Prz Gastroenterol 2019 12;14(1):69-78. Epub 2019 Mar 12.

Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland.

Introduction: Symptomatic uncomplicated diverticular disease (SUDD) is the most common manifestation of diverticulosis. Data concerning the optimal treatment after SUDD exacerbation are inconsistent.

Aim: To assess the effectiveness and necessity of cyclic rifaximin treatment for recurrent SUDD symptoms and for preventing exacerbations in patients who responded to the initial treatment. Read More

Surg Infect (Larchmt) 2019 Mar 30. Epub 2019 Mar 30.

3 Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands.

Background: Although uncomplicated acute diverticulitis has a benign disease course, some patients are at increased risk for complications. Identification of these patients may aid the selection of treatment strategies such as outpatient treatment. This study aimed to assess the rate and timing of a complicated disease course in initially computed tomography (CT)-proven uncomplicated diverticulitis, and to identify risk factors for the development of these diverticular complications. Read More

Dig Surg 2019 Mar 28:1-9. Epub 2019 Mar 28.

Department of Thoracic Surgery, University Witten/Herdecke, City Hospital Cologne, Cologne, Germany,

Background: Single-incision laparoscopic surgery (SILS) is a variant of laparoscopic surgery, especially for diverticular disease (DD), but there are very little data comparing SILS to standard surgical procedures for DD, and most studies on DD surgery do not declare the disease stage. We compared SILS to open sigmoidectomy for DD in a stage-stratified matched-pair analysis to validate the significance of SILS.

Methods: All patients with SILS or conventional sigmoidectomy for diverticulitis of a single visceral surgery department were subject to a matched-pair analysis stratified by age, sex, body mass index, previous abdominal surgery, and the stage of DD. Read More

Gastrointest Endosc 2019 04;89(4):887-888

Gastroenterology Department, São Paulo University Medical School, São Paulo, Brazil.

Colorectal Dis 2019 Mar 21. Epub 2019 Mar 21.

Department of Surgery, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Stockton-on-Tees, UK.

Aim: Restoration of bowel continuity after Hartmann's procedure (RoH) can be challenging and associated with considerable morbidity. A technique using single-incision laparoscopic surgery through the stoma site (SIL RoH) has been shown to be feasible and safe. In this study, we compared clinical outcomes of SIL RoH with conventional laparoscopic surgery (CL) and open surgery (OS). Read More

J Surg Case Rep 2019 Mar 14;2019(3):rjz071. Epub 2019 Mar 14.

Department of Surgery, Regional Hospital Mullingar, Longford Road, Robinstown (Levinge), Mullingar, County Westmeath, Republic of Ireland.

Denture ingestion is a rare clinical entity among foreign body ingestions. The caveat is that there is often no recollection of the event and that dentures are radiolucent and as such hard to identify on conventional imaging. To date not all dentures contain radiopaque marker. Read More

Int J Surg Case Rep 2019 Mar 5;57:39-41. Epub 2019 Mar 5.

Department of General Surgery, Alnoor Specialized Hospital, Makkah, Saudi Arabia.

Introduction: Small bowel diverticular disease is uncommon, representing 1-2% of general population. The ileum diverticulum is very rare, especially if it is complicated by enterocutaneous fistula with abdominal wall abscess.

Presentation Of The Case: Here, we report a case of small bowel diverticulum, ileum diverticulum with enterocutaneous fistula in a 65-year man presented with lower abdominal pain and an irreducible swelling for 5 days. Read More

Surg Endosc 2019 Mar 13. Epub 2019 Mar 13.

Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.

This study aimed to assess intra- and postoperative outcomes of robotic resection of left-sided complicated diverticular disease. Retrospective analysis of a prospectively maintained institutional database on consecutive patients undergoing elective robotic resection for diverticular disease (2014-2018). All procedures were performed within an enhanced recovery pathway (ERP). Read More

ANZ J Surg 2019 Apr 11;89(4):E109-E112. Epub 2019 Mar 11.

Department of General Surgery, Central Coast Local Health District, Gosford, New South Wales, Australia.

Background: Radiological angioembolization is an important strategy in management of acute colonic bleeding. Due to requirement for specialized interventional radiology, many hospitals rely on transfer for this service. This study aimed to identify patient and clinical factors associated with positive (blush) computed tomography mesenteric angiogram (CTMA) or need for invasive angiography. Read More

J Gastrointestin Liver Dis 2019 Mar;28(1):23-27

Division of Gastroenterology, ASL Roma 6, Albano Laziale, Rome,Italy.

Background And Aim: An endoscopic classification of Diverticular Disease (DD), called DICA (Diverticular Inflammation and Complication Assessment) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement levels for this classification among an endoscopist community setting. Read More

Am Surg 2018 Aug;84(8):e275-e276

Am J Gastroenterol 2019 Mar;114(3):500-510

Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

Introduction: Low-grade chronic inflammation has been suggested to play a role in uncomplicated asymptomatic and symptomatic diverticular disease. However, population-based studies are lacking. We investigated whether community participants with diverticulosis, with or without symptoms, would have colonic inflammation on histology and serology. Read More

Neurogastroenterol Motil 2019 Mar 5:e13575. Epub 2019 Mar 5.

Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy.

Background: Colonic diverticulosis is a common condition in industrialized countries. Up to 25% of patients with diverticula develop symptoms, a condition termed symptomatic uncomplicated diverticular disease (SUDD). The aim of the present study was to characterize neuroimmune interactions and nerve fiber plasticity in the colonic mucosa of patients with diverticula. Read More

Gut 2019 05 2;68(5):769-770. Epub 2019 Mar 2.

Gastroenterology Unit, Addenbrookes Hospital, Cambridge, UK.

J Gastrointest Surg 2019 Mar 1. Epub 2019 Mar 1.

Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.

Background: A defunctioning stoma can become necessary in a relevant number of patients undergoing gastrointestinal surgery. As a matter of course, patients seek an early closure of the stoma. However, preoperative management of these patients varies and the prediction of continence after stoma removal can become challenging. Read More

World J Gastrointest Pathophysiol 2018 Nov;9(4):73-78

Department of Gastroenterology, Acibadem City Clinic Oncology Center, Sofia 1784, Bulgaria.

Gastrointestinal diseases, specifically Crohn's disease, ulcerative colitis, diverticular disease, and primary biliary cirrhosis are all characterized by complicated inflammation of the digestive tract. Their pathology is multifactorial, and risk factors encompass both genetic and environmental factors. Recent advances in the genetic component of inflammatory bowel diseases (IBDs) have revealed that the tumor necrosis factor superfamily member 15 () contains a number of risk alleles associated not only with IBD but also with other diseases such as diverticular disease and primary biliary cirrhosis. Read More

Dis Colon Rectum 2019 May;62(5):608-614

Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.

Background: Although acute diverticulitis and its recurrence are well studied, little is known about the period after these attacks have passed. Many patients appear to be affected by persistent symptoms that impair quality of life. The few published studies on this topic are mostly limited by the lack of CT confirmation of the acute diverticulitis diagnosis, low numbers of patients, or cross-sectional design. Read More

Transpl Int 2019 Feb 21. Epub 2019 Feb 21.

Department of Internal Medicine, Division of Pulmonary and Critical Care, Loyola University Chicago Health Science Division, Maywood, IL, USA.

Lung Transplant recipients are at increased risk of complicated diverticular disease. We aim to assess the rate of diverticular surgery in a postlung transplantation population and identify risk factors for surgery. We performed a retrospective cohort study of lung transplant recipients from 2007 to 2011. Read More

Expert Rev Gastroenterol Hepatol 2019 Mar 23;13(3):257-262. Epub 2019 Jan 23.

c Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery , University of Pisa , Pisa , Italy.

Introduction: Prucalopride is a prokinetic drug, that has been commercially available in recent years for the treatment of chronically constipated patients. In this update of a previous 2016 article, we reviewed the more recent data supporting its role in the treatment of constipation and constipation-associated conditions. Areas covered: We carried out an extensive literature review on the effects of prucalopride for the years 2012-2018 by means of scientific databases and manual research. Read More

ANZ J Surg 2019 Feb 21. Epub 2019 Feb 21.

Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.

Am J Case Rep 2019 Feb 21;20:228-232. Epub 2019 Feb 21.

Departmet of Catdiology, Universidade Nove de Julho, São Paulo, SP, Brazil.

BACKGROUND Kommerell diverticulum with a right-sided aortic arch is a rare congenital anatomical condition most often observed in adults. A possible etiology of the subclavian artery's anomalous origin would be an abnormality in regression of the fourth primitive aortic arch during embryonic development. CASE REPORT We report on the case of a 16-year-old female patient presenting with complaints of occasional tachycardia and mild non-specific dyspnea after anxiety crises. Read More

Rozhl Chir Winter 2019;98(1):27-30

Introduction: Diverticula of the small bowel are quite rare findings, frequently confirme only by necropsy. The authors describe the signs and symptoms resulting from complications of small bowel diverticula as well as the diagnostic options and treatment modalities. The paper also presents the results of treatment in the Department of Surgery at University Hospital in Pilsen. Read More

Ann R Coll Surg Engl 2019 Apr 18;101(4):256-260. Epub 2019 Feb 18.

Zen Hospital , Mumbai , India.

Introduction: Epiphrenic diverticulum (ED) is an uncommon disease that is invariably associated with an underlying oesophageal motility disorder such as achalasia. Management of ED should always be accompanied by treatment of the underlying motility disorder to prevent recurrence of symptoms. Traditionally, ED were approached via a left thoracotomy but as laparoscopy offers better access to the distal oesophagus, its use is becoming more widespread. Read More

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

Am Surg 2019 Jan;85(1):e12-e13

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 Oct;84(10):1608-1612

Department of General Surgery, Arrowhead Regional Medical Center, Colton, California, USA.

Right-side diverticulitis (RSD) is an uncommon disease in Western countries. We conducted a case-matched comparison of surgically managed right-side and left-side diverticulitis (LSD) from the Southern California Kaiser Permanente database (2007-2014). Of 995 patients undergoing emergent surgery for diverticulitis, 33 RSD (3. 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

Pediatr Int 2019 Feb 11;61(2):200-201. Epub 2019 Feb 11.

Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam, Korea.

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 Mar 8;28(2):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