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Taha M, Fakieh AT, Alhazmi AM, Khiami AJ, Alasmari EA, Alharbi SS, Almajnoni MH. The Assessment of Knowledge, Awareness and Practice Regarding Diverticulitis and Its Risk Factors Among the Population of Saudi Arabia. Cureus 2024; 16:e60124. [PMID: 38864053 PMCID: PMC11165291 DOI: 10.7759/cureus.60124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 06/13/2024] Open
Abstract
Background The term "diverticula" refers to the existence of diverticula in the gastrointestinal tract but is mainly located in the sigmoid colon and is used to describe colonic diverticulosis. Diverticula, which are sac-like protrusions in the wall of the large bowel, are becoming more prevalent globally, in both developed and developing nations. This increase in occurrence is primarily attributed to changes in dietary and lifestyle patterns. Raising public awareness can potentially contribute to a decrease in the incidence of the disease and its associated complications. Aim This study aims to assess knowledge and awareness levels among the Saudi Arabian population regarding diverticulitis and its risk factors. Methods A descriptive cross-sectional study was conducted in Saudi Arabia between 1st January 2024 to 1st April 2024 using an online questionnaire for data collection. The target population consists of individuals who are between 18 years and 45, in Saudi Arabia without a history of diverticulitis. The study questionnaire covered participants' demographic (Western, Central, Southern, Eastern, Northern) regions, knowledge, awareness and practice of diverticulitis. Results A total of 548 eligible participants completed the study questionnaire, most of them (80.3%; 395) were from the Western region including Mecca, Medina and Jeddah. Participants' ages ranged from 18 to more than 40 years with a mean age of 30.5 ± 11.9 years old. A greater percentage (72.3%) of the participants were males compared to the percentage of females, which was 27.7%. The vast majority of the study participants had an inadequate knowledge level about diverticulitis (85.9%; 471) while only 31 (5.7%) had adequate knowledge and awareness about the disease. The most reported sources of information included study courses (6.4%), media (5.3%), and physicians (4.7%) while most respondents (83.6%) had no source. Conclusion In conclusion, aside from preventive strategies, the current study found that the public knew very little about diverticulitis, including its risk factors, clinical presentation, and diagnostic process. The two significant predictors of public awareness level were age and doctors as information sources.
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Affiliation(s)
- Medhat Taha
- Department of Anatomy, Umm Al-Qura University, Al-Qunfudhah, SAU
| | - Anas T Fakieh
- College of Medicine, Umm Al-Qura University, Al-Qunfudhah, SAU
| | | | | | - Emad A Alasmari
- College of Medicine, Umm Al-Qura University, Al-Qunfudhah, SAU
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2
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Khouchoua S, Imrani K, Cherkaoui S, Moatassim Billah N, Nassar I. Sigmoid diverticulitis mimicking a urinary bladder tumor: A rare case report. Urol Case Rep 2024; 53:102678. [PMID: 38384401 PMCID: PMC10879804 DOI: 10.1016/j.eucr.2024.102678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
Urothelial cell carcinomas represent the vast majority of urinary bladder tumors. However, many inflammatory and non-neoplastic conditions can mimic a urinary bladder malignancy. In that matter, diverticulitis can progress into colovesical fistula formation with a bladder wall abscess that can mimic a pseudo mass. Nonetheless, the presence of a bladder wall mass, usually requires pathologic examination. We report the case of a 60 year old woman with recurrent urinary infections due to a focal bladder mass revealing a colovesical fistula as a complication of sigmoid diverticulitis.
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Affiliation(s)
- Selma Khouchoua
- Central Radiology Department, Ibn Sina University Hospital Center, Mohamed V University, Avenue Abderrahim Bouabid, 10000, Rabat, Morocco
| | - Kaoutar Imrani
- Central Radiology Department, Ibn Sina University Hospital Center, Mohamed V University, Avenue Abderrahim Bouabid, 10000, Rabat, Morocco
| | - Sara Cherkaoui
- Central Radiology Department, Ibn Sina University Hospital Center, Mohamed V University, Avenue Abderrahim Bouabid, 10000, Rabat, Morocco
| | - Nabil Moatassim Billah
- Central Radiology Department, Ibn Sina University Hospital Center, Mohamed V University, Avenue Abderrahim Bouabid, 10000, Rabat, Morocco
| | - Ittimade Nassar
- Central Radiology Department, Ibn Sina University Hospital Center, Mohamed V University, Avenue Abderrahim Bouabid, 10000, Rabat, Morocco
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3
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Tiralongo F, Di Pietro S, Milazzo D, Galioto S, Castiglione DG, Ini’ C, Foti PV, Mosconi C, Giurazza F, Venturini M, Zanghi’ GN, Palmucci S, Basile A. Acute Colonic Diverticulitis: CT Findings, Classifications, and a Proposal of a Structured Reporting Template. Diagnostics (Basel) 2023; 13:3628. [PMID: 38132212 PMCID: PMC10742435 DOI: 10.3390/diagnostics13243628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Acute colonic diverticulitis (ACD) is the most common complication of diverticular disease and represents an abdominal emergency. It includes a variety of conditions, extending from localized diverticular inflammation to fecal peritonitis, hence the importance of an accurate diagnosis. Contrast-enhanced computed tomography (CE-CT) plays a pivotal role in the diagnosis due to its high sensitivity, specificity, accuracy, and interobserver agreement. In fact, CE-CT allows alternative diagnoses to be excluded, the inflamed diverticulum to be localized, and complications to be identified. Imaging findings have been reviewed, dividing them into bowel and extra-intestinal wall findings. Moreover, CE-CT allows staging of the disease; the most used classifications of ACD severity are Hinchey's modified and WSES classifications. Differential diagnoses include colon carcinoma, epiploic appendagitis, ischemic colitis, appendicitis, infectious enterocolitis, and inflammatory bowel disease. We propose a structured reporting template to standardize the terminology and improve communication between specialists involved in patient care.
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Affiliation(s)
- Francesco Tiralongo
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Stefano Di Pietro
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Dario Milazzo
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Sebastiano Galioto
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Davide Giuseppe Castiglione
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Corrado Ini’
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, 80131 Naples, Italy;
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, 21100 Varese, Italy;
| | | | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
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Serpa E, Pacheco F, Pindicura S, Marar O. Colo-cutaneous fistula to the thigh secondary to acute sigmoid diverticulitis: a case report. J Surg Case Rep 2023; 2023:rjad267. [PMID: 37215627 PMCID: PMC10198643 DOI: 10.1093/jscr/rjad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Acute diverticulitis is one of the most common gastrointestinal illnesses that requires hospital admission. It has a broad range of presentations from uncomplicated disease to perforation and peritonitis that require emergent surgical exploration. Abscesses are one of the most common complications. We present a case of retroperitoneal abscess with extension to the antero-lateral upper thigh that was successfully treated with open Hartman's procedure with drainage of psoas abscess and open drainage of thigh abscess.
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Affiliation(s)
- Eduardo Serpa
- Correspondence address. Department of Surgery, Central Michigan University College of Medicine, Saginaw MI 48601, United States. E-mail:
| | - Felipe Pacheco
- Department of Surgery, Central Michigan University College of Medicine, Saginaw MI 48601, United States
| | - Sundarachalam Pindicura
- Department of Surgery, Central Michigan University College of Medicine, Saginaw MI 48601, United States
| | - Omar Marar
- Department of Surgery, Central Michigan University College of Medicine, Saginaw MI 48601, United States
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Chang CY, Hsu TY, He GY, Shih HM, Wu SH, Huang FW, Chen PC, Tsai WC. Utility of monocyte distribution width in the differential diagnosis between simple and complicated diverticulitis: a retrospective cohort study. BMC Gastroenterol 2023; 23:96. [PMID: 36977993 PMCID: PMC10047462 DOI: 10.1186/s12876-023-02736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Colonic diverticulitis is a leading cause of abdominal pain. The monocyte distribution width (MDW) is a novel inflammatory biomarker with prognostic significance for coronavirus disease and pancreatitis; however, no study has assessed its correlation with the severity of colonic diverticulitis. METHODS This single-center retrospective cohort study included patients older than 18 years who presented to the emergency department between November 1, 2020, and May 31, 2021, and received a diagnosis of acute colonic diverticulitis after abdominal computed tomography. The characteristics and laboratory parameters of patients with simple versus complicated diverticulitis were compared. The significance of categorical data was assessed using the chi-square or Fisher's exact test. The Mann-Whitney U test was used for continuous variables. Multivariable regression analysis was performed to identify predictors of complicated colonic diverticulitis. Receiver operator characteristic (ROC) curves were used to test the efficacy of inflammatory biomarkers in distinguishing simple from complicated cases. RESULTS Of the 160 patients enrolled, 21 (13.125%) had complicated diverticulitis. Although right-sided was more prevalent than left-sided colonic diverticulitis (70% versus 30%), complicated diverticulitis was more common in those with left-sided colonic diverticulitis (61.905%, p = 0.001). Age, white blood cell (WBC) count, neutrophil count, C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and MDW were significantly higher in the complicated diverticulitis group (p < 0.05). Logistic regression analysis indicated that the left-sided location and the MDW were significant and independent predictors of complicated diverticulitis. The area under the ROC curve (AUC) was as follows: MDW, 0.870 (95% confidence interval [CI], 0.784-0.956); CRP, 0.800 (95% CI, 0.707-0.892); NLR, 0.724 (95% CI, 0.616-0.832); PLR, 0.662 (95% CI, 0.525-0.798); and WBC, 0.679 (95% CI, 0.563-0.795). When the MDW cutoff was 20.38, the sensitivity and specificity were maximized to 90.5% and 80.6%, respectively. CONCLUSIONS A large MDW was a significant and independent predictor of complicated diverticulitis. The optimal cutoff value for MDW is 20.38 as it exhibits maximum sensitivity and specificity for distinguishing between simple and complicated diverticulitis The MDW may aid in planning antibiotic therapy for patients with colonic diverticulitis in the emergency department.
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Affiliation(s)
- Chang-Yuan Chang
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tai-Yi Hsu
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Guan-Yi He
- Department of Dermatology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hong-Mo Shih
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Shih-Hao Wu
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Fen-Wei Huang
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City, 406040, Taiwan.
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Flor N, Scolari S, Liedenbaum M, Maconi G, Colombo F, Maffioli A, Bondurri A, Crespi M. Colonic Acquired Fistulae: The Potential of CT Colonography. Acad Radiol 2022; 30:959-965. [PMID: 35933280 DOI: 10.1016/j.acra.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/01/2022]
Abstract
The diagnosis of colonic fistulae is crucial in defining the best therapeutic approach. Fistulae can be suspected from clinical history or specific symptoms, but imaging plays a key role in confirming the diagnosis. Previous studies described conventional studies with barium as methods of choice for the diagnosis; more recently intestinal ultrasound, CT and MR have been considered promising tests. CT Colonography is the best radiologic test to evaluate the colon, but only few case reports described its role in this setting. Aim of this paper is to highlight the potentials of CT colonography in evaluating patients with suspected colonic fistulae.
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Affiliation(s)
- Nicola Flor
- Department of Radiology (N.F.), Ospedale L. Sacco ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy.
| | - Sofia Scolari
- Postgraduation School in Radiodiagnostics (S.S.), Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | | | - Giovanni Maconi
- Division of Gastroenterology (G.M.), ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Francesco Colombo
- Division of General Surgery (F.C., A.M., A.B., M.C.), ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Anna Maffioli
- Division of General Surgery (F.C., A.M., A.B., M.C.), ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Andrea Bondurri
- Division of General Surgery (F.C., A.M., A.B., M.C.), ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Michele Crespi
- Division of General Surgery (F.C., A.M., A.B., M.C.), ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
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7
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Chabok A, Thorisson A, Nikberg M, Schultz JK, Sallinen V. Changing Paradigms in the Management of Acute Uncomplicated Diverticulitis. Scand J Surg 2021; 110:180-186. [PMID: 33934672 PMCID: PMC8258726 DOI: 10.1177/14574969211011032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/30/2021] [Indexed: 12/13/2022]
Abstract
Left-sided colonic diverticulitis is a common condition with significant morbidity and health care costs in Western countries. Acute uncomplicated diverticulitis which is characterized by the absence of organ dysfunction, abscesses, fistula, or perforations accounts for around 80% of the cases. In the last decades, several traditional paradigms in the management of acute uncomplicated diverticulitis have been replaced by evidence-based routines. This review provides a comprehensive evidence-based and clinical-oriented overview of up-to-date diagnostics with computer tomography, non-antibiotic treatment, outpatient treatment, and surgical strategies as well as follow-up of patients with acute uncomplicated diverticulitis.
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Affiliation(s)
- A. Chabok
- Department of Surgery, Region Västmanland Hospital, Västerås, Sweden
- Centre for Clinical Research Uppsala University, Region Västmanland Hospital, Västerås, Sweden
| | - A Thorisson
- Centre for Clinical Research Uppsala University, Region Västmanland Hospital, Västerås, Sweden
- Department of Radiology, Region Västmanland Hospital, Västerås, Sweden
| | - M. Nikberg
- Department of Surgery, Region Västmanland Hospital, Västerås, Sweden
- Centre for Clinical Research Uppsala University, Region Västmanland Hospital, Västerås, Sweden
| | - J. K. Schultz
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway
| | - V Sallinen
- Department of Abdominal Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Carboni F, Corona F, Esposito L, Valle M. Diffuse subcutaneous emphysema: a clinical challenge. ANZ J Surg 2020; 91:1622-1623. [PMID: 33320414 DOI: 10.1111/ans.16495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Fabio Carboni
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Corona
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Esposito
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mario Valle
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Affiliation(s)
- Nicole M Kapral
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Arthur J Pesch
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA..
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