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Mamoru Takenaka, Kosuke Minaga, Masatoshi Kudo
Intra-diverticular papilla is considered as a difficult anatomical orientation for biliary cannulation. 1 2 3 To our knowledge, this is the first report to show the usefulness of biopsy forceps for cannulation not only to expose the ampulla in the case of an intra-diverticular papilla but also for axis alignment.An 85-year-old woman underwent endoscopic retrograde cholangiopancreatography for a common bile duct (CBD) stone. A duodenoscope (TJF TYPE 260V; Olympus Medical Systems, Tokyo, Japan) was inserted into Vater's papilla...
June 22, 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Anne F Peery
The assumption that acute uncomplicated diverticulitis requires antibiotics has been challenged. In this issue, the Dutch Diverticular Disease Collaborative Study Group report the 2-year follow-up to their trial of observation vs. treatment with amoxicillin-clavulanic acid for acute uncomplicated diverticulitis. The new study provides useful insights on the natural history of acute uncomplicated diverticulitis. The most intriguing data compared rates of elective sigmoid resection between the groups. There was a trend toward more elective surgery in the observation group compared to those in the antibiotic group...
June 21, 2018: American Journal of Gastroenterology
Yuji Sakai, Toshio Tsuyuguchi, Harutoshi Sugiyama, Rintaro Mikata, Hiroshi Ohyama, Shin Yasui, Masato Nakamura, Koji Takahashi, Junichjiro Kumagai, Mutsumi Yamato, Yuko Kusakabe, Ayako Shingyoji, Yotaro Iino, Naoya Kato
PURPOSE: To investigate whether the 2-devices-in-1-channel method is useful for selective biliary cannulation in patients with parapapillary diverticulum or intradiverticular papilla, where the papilla cannot be seen from the front. MATERIALS AND METHODS: Biliary cannulation using the 2-devices-in-1-channel method was performed in 28 patients who presented difficulty due to parapapillary diverticulum or intradiverticular papilla. There were 15 men and 13 women whose mean age was 68...
June 16, 2018: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Hirokazu Saito, Kana Noda, Koji Ogasawara, Shutaro Atsuji, Hiroko Takaoka, Hiroo Kajihara, Jiro Nasu, Mitsuhiko Kitaoka, Shoji Morishita, Ikuo Matsushita, Kazuhiro Katahira
Contrast-enhanced computed tomography using iodinated contrast media is useful for diagnosis of gastrointestinal diseases. However, contrast-induced nephropathy remains problematic for kidney diseases patients. Although current guidelines recommended the use of a minimal dose of contrast media necessary to obtain adequate images for diagnosis, obtaining adequate images with sufficient contrast enhancement is difficult with conventional computed tomography using reduced contrast media. Dual-layer spectral detector computed tomography enables the simultaneous acquisition of low- and high-energy data and the reconstruction of virtual monochromatic images ranging from 40 to 200 keV, retrospectively...
April 2018: Radiology Case Reports
Hany M El-Haddad, Mohamed I Kassem, Ahmed A Sabry, Ahmed Abouelfotouh
BACKGROUND: Diverticular disease of sigmoid colon can rarely be complicated by a connective track to urinary bladder. Pneumaturia and fecaluria are the pathognomonic symptoms. Resection surgery is the preferred treatment to overcome the renal sequellae of the disease. The purpose of this study is to propose a guiding classification to help general surgeons during surgical management of diverticular disease complicated by sigmoidovesical fistula (SVF). PATIENTS AND METHODS: The data of 40 cases with colovesical fistula due to diverticular disease of sigmoid colon were retrospectively analyzed...
June 11, 2018: International Journal of Surgery
Robin Germán Prieto, Manuel Alejandro Mahler, Gustavo Vidales
Lower gastrointestinal bleeding is a common pathology with diverse causes depending on the patients´ age. The most common causes in adults are polyps, neoplasias, diverticular disease and angiodysplasia. In neonates, necrotizing enterocolitis and volvulus, and anal fissures and bowel intussusception in infants. Polyps are reported as a cause of bleeding only in children of preschool age.
June 14, 2018: Revista Española de Enfermedades Digestivas
Shotaro Umezawa, Naoyoshi Nagata, Jun Arimoto, Shiori Uchiyama, Takuma Higurashi, Kaoru Nakano, Naoki Ishii, Toshiyuki Sakurai, Shiori Moriyasu, Yuichi Takeda, Hajime Nagase, Hirokazu Komatsu, Atsushi Nakajima, Akira Mizuki
Purpose To demonstrate the usefulness of precolonoscopy intravenous contrast material-enhanced CT for colonic diverticular bleeding (CDB). Materials and Methods A prospective, multicenter, observational study was performed. Patients with acute-onset hematochezia who were admitted to hospital were included, and those without CDB were excluded. CT was performed before colonoscopy. A Mann-Whitney U test, χ2 test, and multivariable logistic regression analysis were performed to determine the accuracy of CT before colonoscopy...
June 12, 2018: Radiology
Francesco Pugliese, Lorenzo Dioscoridi, Antonello Forgione, Edoardo Forti, Marcello Cintolo, Massimiliano Mutignani
Cricopharyngeal myotomy with flexible endoscope is a well-known and safe treatment for Zenker's diverticulum. We describe hereafter how we perform this flexible endotherapy. From January 2011 to January 2017, we treated 28 patients with this endotherapy. Our technique is described step-by-step in the paper: the main principle is to perform an endoscopic cut of the diverticular septum and cricopharyngeal muscle's fibers (see the video). We describe an objective measurement of the cutting length and depth of the myotomy...
April 2018: Esophagus: Official Journal of the Japan Esophageal Society
Antonio Tursi
Diverticulosis of the colon is a common condition, and about one fourth of those people develop symptoms, which is called "diverticular disease" (DD). Since there are still some concerns about the diagnosis of diverticular disease, the aim of this review was to analyse current and evolving advances in its diagnosis. Area covered: Analysis of clinical, radiology, laboratory and endoscopic tools to pose a correct diagnosis of DD was performed according to current PubMed literature. Expert commentary: A combination of clinical characteristic of the abdominal pain and fecal calprotectin expression may help to differentiate between Symptomatic Uncomplicated Diverticular Disease (SUDD) and Irritable Bowel Syndrome (IBS)...
June 9, 2018: Expert Review of Gastroenterology & Hepatology
Yuki Nakamura, Takahiro Nomi, Keiko Morio, Takuki Sakaguchi, Yuichirou Sasaki, Yoshikazu Murawaki, Hajime Isomoto
A 66-year-old man was hospitalized for diverticular bleeding of the colon. Anticoagulant drugs (Dabigatran and Beraprost sodium), which had been taken for chronic underlying atrial fibrillation, were interrupted for three days. After two months, he presented with acute pancreatitis and a pancreatic pseudocyst. The contrast-enhanced CT scan revealed an atrial thrombus and localized splenic infarction. Consequently, we suspected ischemic acute pancreatitis secondary to thrombus. Anticoagulant drug interruption and the resultant local ischemia were potential factors contributing to ischemic pancreatitis...
2018: Nihon Shokakibyo Gakkai Zasshi, the Japanese Journal of Gastro-enterology
Nassir Alhaboob Arabi, Abdulmagid Mohammed Musaad, Fatima Abbas Habiballah Mohammed, Elsaggad Eltayeb Ahmed, Muataz Salah Eldin Abdelaziz
BACKGROUND AND STUDY AIMS: Lower gastrointestinal bleeding originates from a site distal to the ligament of Treitz. It can present as an acute life-threatening or chronicbleeding. It is common among older patients and those with comorbidity. The common causes are diverticular disease, angiodysplasias, neoplasms, colitis, ischaemia and anorectal disorders. The aim of this study is to determine the prevalence and causes of acute lower gastrointestinal bleeding among Sudanese patients. PATIENTS AND METHODS: In a period of 2 years we studied 301 patients with fresh rectal bleeding out of 5625 patients with gastrointestinal bleeding in Ibn Sina Specialized Hospital, Khartoum, Sudan, This is a cross sectional observational hospital based study...
June 6, 2018: Arab Journal of Gastroenterology: the Official Publication of the Pan-Arab Association of Gastroenterology
Bernardo Cálamo-Guzmán, Luis De Vinatea-Serrano, Alejandro Piscoya
No abstract text is available yet for this article.
June 5, 2018: Gastroenterología y Hepatología
Marco Ceresoli, Giulia Lo Bianco, Luca Gianotti, Luca Nespoli
The pathogenesis of diverticular disease and acute diverticulitis is still unclear and many different hypotheses have been formulated. Seemingly, there are several related factors such as chronic inflammation, gut microbiome, obesity and the immunogenic properties of fat tissue and diet. Inflammation plays a pivotal role in diverticular disease and acute diverticulitis. The aim of the present review is to investigate the role of inflammation in diverticular disease as well as in mild and complicated acute diverticulitis with a focus on current research and treatment perspectives...
2018: Journal of Inflammation Research
Filip Sköldberg, Ola Olén, Anders Ekbom, Peter T Schmidt
BACKGROUND: Appendicitis and acute diverticulitis share clinical features and are both influenced by genetic and environmental factors. Appendectomy has been positively associated with diverticular disease in hospital-based case-control studies. OBJECTIVE: The aim of the present study was to investigate, in a population-based setting, whether appendectomy, with or without appendicitis, is associated with an altered risk of hospitalization with diverticular disease...
July 2018: Diseases of the Colon and Rectum
Violet Kayamba, Kate Nicholls, Catrin Morgan, Paul Kelly
Introduction: Colorectal disease is common throughout the world, but the spectrum of diagnoses across Africa remains largely unexplored. There is anecdotal evidence of changing colorectal disease but this has not been systematically investigated. The aim of this study was to enhance our insight into the spectrum of colonoscopic diagnoses in Zambia. Methods: We retrieved written colonoscopy reports from January 2008 to December 2015. Collected data were coded by experienced endoscopists and analysed by age, sex, referral source, indication and diagnosis...
March 2018: Malawi Medical Journal: the Journal of Medical Association of Malawi
Toru Tochigi, Chihiro Kosugi, Kiyohiko Shuto, Mikito Mori, Atsushi Hirano, Keiji Koda
Diverticular disease of the colon occurs quite frequently in developed countries, and its prevalence has recently increased in Japan. The appearance of diverticulosis increases with age, although mostly remaining asymptomatic. Approximately 20% of cases require treatment. As the Western lifestyle and number of elderly people increase, the need for medical treatment also increases. Computed tomography (CT) is the gold standard for diagnosing diverticulitis. Complicated diverticulitis is classified by the size and range of abscess formation and the severity of the peritonitis...
January 2018: Annals of gastroenterological surgery
Zahraa Abdul Sater, Smita Jha, Raven McGlotten, Iris Hartley, Mustapha El Lakis, Katherine Araque Triana, Lynnette K Nieman
Context: Patients taking exogenous glucocorticoids are at risk of gastrointestinal (GI) complications including peptic ulcer disease with perforation, and gastric bleeding. However, little is known about the GI co-morbidity in patients with endogenous hypercortisolemia. Case descriptions: We describe six patients with endogenous Cushing's Syndrome (CS) who developed sudden perforation of colonic diverticula requiring urgent exploratory laparotomy. Most of these patients shared the following features of Cushing's syndrome: significant skin thinning, severe hypercortisolemia (24-hour urine free cortisol ≥10X the upper limit of normal), ectopic secretion of ACTH, and severe hypokalemia...
May 28, 2018: Journal of Clinical Endocrinology and Metabolism
Kathleen M Schieffer, Bryan P Kline, Gregory S Yochum, Walter A Koltun
Inflammation of diverticula, or outpouchings of the colonic mucosa and submucosa through the muscularis layer, leads to diverticulitis. The development of diverticular disease, encompassing both diverticulosis and diverticulitis, is a result of genetic predisposition, lifestyle, and environmental factors, including the microbiome. Areas covered: Previous reports implicated genetic predisposition, environmental factors, and colonic dysmotility in diverticular disease. Recent studies have associated specific host immune responses and the microbiome as contributors to diverticulitis...
May 30, 2018: Expert Review of Gastroenterology & Hepatology
Carmelo Scarpignato, Giovanni Barbara, Angel Lanas, Lisa L Strate
Diverticulosis is a common anatomical condition, which appears to be age-dependent. Individuals who develop chronic gastrointestinal symptoms or complications are referred to as having diverticular disease. Although the diagnosis of this condition can be relatively straightforward, randomized controlled trials are scarce and management often follows tradition rather than principles of evidence-based medicine. This report deals with the topics discussed during a symposium held during the United European Gastroenterology Week (Barcelona, October 2017)...
2018: Therapeutic Advances in Gastroenterology
Javier Serrano-González, Mariano Artés-Caselles, Laura Román-García de León, Pau Plá-Sánchez, Víctor Sánchez-Turrión
Jejunal diverticular disease is a very uncommon pathology often asymptomatic. Associated complications appear in less than 30% of patients and they can present as diverticulitis, refractary inflammation, obstruction, hemorrhage, perforation or intraabdominal abscess formation. Clinical manifestations are usually unspecific and high suspicion index is required to reach the diagnosis. Treatment of complications includes volume replacement, transfusions, antibiotic therapy, percutaneous drainage or surgical intervention...
2018: Cirugia y Cirujanos
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