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Kariyasu T, Nishikawa M, Yamaguchi H, Machida H. CT Fistulography Documented Colocutaneous Fistula Secondary to Diverticulitis. Intern Med 2024:3140-23. [PMID: 38220188 DOI: 10.2169/internalmedicine.3140-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Affiliation(s)
- Toshiya Kariyasu
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Japan
| | - Makiko Nishikawa
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Japan
| | - Hidenori Yamaguchi
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Japan
| | - Haruhiko Machida
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, Japan
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2
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Paspulati RM. Chronic Pelvic Pain: Role of Imaging in the Diagnosis and Management. Semin Ultrasound CT MR 2023; 44:501-510. [PMID: 37879545 DOI: 10.1053/j.sult.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Chronic pelvic pain (CPP) in women is not uncommon, and it may be difficult to identify the exact cause difficult to manage. It is major health problem for women that affects the quality of their daily lives. The etiology of chronic pelvic pain may be of gynecological or non-gynecological origin and associated with several predisposing and precipitating factors. Psychological and social factors also contribute to the syndrome of CPP and must be evaluated before managing these patients. Due to multifactorial etiology, CPP needs a multidisciplinary approach for diagnosis and management. A detailed history and physical examination supported by appropriate laboratory tests and imaging are the keys to diagnosis. In this paper, the role of imaging in diagnosis and management of CPP is reviewed. Imaging findings should be correlated with detailed clinical examination findings as there are imaging findings that may be unrelated and not the cause of CPP in a particular patient, imaging findings should be correlated with the clinical circumstances.
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Affiliation(s)
- Raj Mohan Paspulati
- Department of Diagnostic and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida; Department of Medical Oncology, University of South Florida, Tampa, Florida.
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3
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An elderly man with fecal materials in the Foley catheter. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918786311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 70-year-old man presented to the emergency department with a 2-week history of watery diarrhea. Fecal materials were found in the Foley catheter. A computed tomography of the abdomen and pelvis revealed chronic diverticulitis with enterovesical fistula. The patient was treated with broad-spectrum antibiotics and underwent an urgent surgery with a transverse loop colostomy. The presence of fecaluria should raise the clinical suspicion of enterovesical fistula. Computed tomography is the choice of diagnostic modality.
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Gong XH, Zhuang ZG, Zhu J, Feng Q, Xu JR, Qian LJ. Differentiation of cancerous and inflammatory colorectal perforations using multi-detector computed tomography. Abdom Radiol (NY) 2017; 42:2233-2242. [PMID: 28401282 DOI: 10.1007/s00261-017-1134-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine reliable CT features to distinguish cancerous from inflammatory colorectal perforations. MATERIALS AND METHODS A total of 43 patients with surgically and pathologically confirmed colorectal perforation caused by either colorectal cancer (n =27) or an inflammatory conditions (n = 16) were identified. Two radiologists independently assessed the contrast-enhanced CT features for locations of perforation, mural configurations, soft-tissue alterations, lymphadenopathy, and metastases. Intergroup comparisons for univariate analysis were performed using Fisher's exact test or chi-square test for categorical data and Mann-Whitney test for numeric data. Stepwise logistic regression analysis was conducted with features that were found significant under the univariate analysis. Interobserver agreement was assessed using intraclass correlation coefficient (ICC) and kappa test. RESULTS Maximal mural thickness >1.39 cm (sensitivity, 100%; specificity, 68.75%), luminal mass or shoulder formation (sensitivity, 88.89%; specificity, 68.75%), absence of diverticula (sensitivity, 96.30%; specificity, 50.00%), irregular mural thickening (sensitivity, 92.59%; specificity, 81.25%), lymphadenopathy (sensitivity, 40.74%; specificity, 93.75%), and metastases (sensitivity, 25.93%; specificity, 100%) were significantly frequent in cancerous perforations. The maximal mural thickness (P = 0.0493, odds ratio = 439.83) and irregular mural thickening (P = 0.0343, odds ratio = 4.69) were identified as the highly distinguished identifiers. CONCLUSIONS The CT manifestations of cancerous and inflammatory colorectal perforations overlap. Definitive diagnosis is not always possible with imaging alone. The maximal mural thickness >1.39 cm and irregular configuration of the thickened bowel wall were the two highly statistically significant CT features that may help order the difference between the two entities.
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Affiliation(s)
- Xu Hua Gong
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Zhi Guo Zhuang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Jiong Zhu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Qi Feng
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Jian Rong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Li Jun Qian
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China.
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Onur MR, Akpinar E, Karaosmanoglu AD, Isayev C, Karcaaltincaba M. Diverticulitis: a comprehensive review with usual and unusual complications. Insights Imaging 2016; 8:19-27. [PMID: 27878550 PMCID: PMC5265196 DOI: 10.1007/s13244-016-0532-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/06/2016] [Accepted: 11/09/2016] [Indexed: 12/30/2022] Open
Abstract
Abstract Diverticulitis is characterized by inflammation of the outpouchings of the bowel wall. Imaging findings of diverticulitis include edematous thickening of the bowel wall with inflammatory changes within the adjacent mesenteric fat. Uncomplicated diverticulitis can be treated conservatively; however, complicated diverticulitis may not be responsive to medical treatment and life-threatening conditions may occur. In this review, we aimed to illustrate the ultrasonography (US) and computed tomography (CT) features of diverticulitis and its complications including perforation, phlegmon, abscess, ascending septic thrombophlebitis (phylephlebitis), bleeding, intestinal obstruction, and fistula. Teaching Points • Complications of diverticulitis may be highly variable. • It may be difficult to diagnose diverticulitis as underlying cause of severe complications. • MDCT is essential for the primary diagnosis of the acute diverticulitis and its complications.
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Affiliation(s)
- Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey. .,Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey.
| | - Erhan Akpinar
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey.,Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey
| | - Ali Devrim Karaosmanoglu
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey.,Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey
| | - Cavid Isayev
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey.,Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey
| | - Musturay Karcaaltincaba
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey.,Hacettepe Universitesi Tıp Fakültesi Hastanesi, 06100, Sıhhiye, Ankara, Turkey
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6
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Xu HM, Wang YL, Jin HM, Xu DL, Xuan J, Chen JX, Goswami A, Tao ZS, Zhou F, Zhang XL, Wang XY. A novel micro-CT-based method to monitor the morphology of blood vessels in the rabbit endplate. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:221-227. [PMID: 27832363 DOI: 10.1007/s00586-016-4849-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 10/23/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to develop a novel method for observing the morphology of the blood vessels in the rabbit endplate. METHODS Twenty 6-month-old rabbits were used in this study. The blood vessels in the L5 endplate in Group A were injected with iohexol and Group B with barium sulfate. Group C was the control group with saline. To optimize the study, Group B was divided into two subgroups: Group B-1 was injected with 100% (w/v) barium sulfate and Group B-2 with 50% (w/v). After injection, the L4-L5 vertebral body was excised and the cranial endplate of L5 was scanned using a micro-CT scanner. Models of the vertebral endplate and vessels were reconstructed using the 3D reconstruction software (Mimics 16.0) by calculating a bone threshold value, and then merged these two models to create a superimposed model. RESULTS The 3D vessel models could not be created in Groups A and C, but they were clearly visualized in Group B. In the 3D model, the blood vessels extended from the subchondral bone to the endplate, and the density of the blood vessels in the area of the nucleus pulposus (NP) was higher than in the annulus fibrosus. CONCLUSIONS The results of this study suggest that the blood vessels in the rabbit endplate can be clearly observed by the method described using barium sulfate [the 50% (w/v) gave better results compared with the 100% (w/v)]. The information from the 3D vessel structure could provide essential data to help us understand the nutrient pathways within the vertebral endplate.
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Affiliation(s)
- Hong-Ming Xu
- Department of Orthopaedic Surgery, Affiliated Cixi Hospital of Wenzhou Medical University, Cixi, 315300, Ningbo, People's Republic of China.,Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China
| | - Yong-Li Wang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China.,Department of Orthopaedic Surgery, Huzhou Central Hospital, Huzhou, 313000, People's Republic of China
| | - Hai-Ming Jin
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China
| | - Dao-Liang Xu
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China
| | - Jun Xuan
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China
| | - Jiao-Xiang Chen
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China
| | - Amit Goswami
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China
| | - Zhou-Shan Tao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China.,Department of Orthopaedic Surgery, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu, 241001, People's Republic of China
| | - Feng Zhou
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China
| | - Xiao-Lei Zhang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China
| | - Xiang-Yang Wang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, People's Republic of China.
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7
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Galia M, Agnello F, La Grutta L, Lo Re G, Cabibbo G, Grassedonio E, Gioia BG, Sparacia G, Lo Casto A, Lagalla R, Midiri M. Computed tomography of bowel obstruction: tricks of the trade. Expert Rev Gastroenterol Hepatol 2016; 9:1115-25. [PMID: 26092117 DOI: 10.1586/17474124.2015.1051030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Bowel obstruction (BO) is a frequent cause of hospitalization and surgical consultation for acute abdominal pain. It is usually suspected at physical examination, but clinical and laboratory data are often nonspecific. Thus, computed tomography plays a crucial role in a correct diagnosis of BO. Indeed, computed tomography can confirm a diagnosis of BO, and identify the location and cause of the obstruction. In this review, the computed tomography appearances of common and uncommon causes of BO and pseudo-obstruction are reviewed.
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Affiliation(s)
- Massimo Galia
- Section of Radiological Sciences, DIBIMED, University of Palermo, 90127 Palermo, Italy
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Short Occult Retractile Fibrous Scar Causing Exclusive Retrograde Stenosis of the Sigmoid Colon: An Incidental Diagnosis Nineteen Years After a Single Episode of Colonic Diverticulitis. J Belg Soc Radiol 2016; 100:31. [PMID: 30151448 PMCID: PMC6100695 DOI: 10.5334/jbr-btr.933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a rare case of purely retrograde stenosing stricture of the sigmoid descending colonic junction fortuitously diagnosed during the waning of a failed virtual colonoscopy in a 69-year-old patient. The rather asymptomatic patient was addressed to investigate a positive fecal occult blood test. He had suffered a single acute colonic diverticulitis episode 19 years before. A contrast-enhanced abdominal CT and complementary focused abdominal ultrasound fully diagnosed a short curvilinear contrast-enhancing “scar-like” tissue infiltrating the posterior colonic wall and developing retractile adherences with the retroperitoneum of the left iliac fossa. The imaging features are presented with pathologic correlation.
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9
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Wan D, Bruni SG, Dufton JA, O'Brien P. Differential Diagnosis of Colonic Strictures: Pictorial Review with Illustrations from Computed Tomography Colonography. Can Assoc Radiol J 2015; 66:259-71. [DOI: 10.1016/j.carj.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 01/06/2015] [Accepted: 01/29/2015] [Indexed: 01/18/2023] Open
Abstract
Strictures of the colon can lead to significant morbidity requiring surgical management. The etiology of strictures is broad and generally categorized as benign, malignant, or pseudostrictures. Computed tomography (CT) is a crucial imaging modality in the assessment and characterization of colonic pathologies but colonoscopy remains the diagnostic gold standard. However, in the setting of incomplete colonoscopy due to strictures, the imaging features of CT will be relied on. This review will focus on the CT features of different colon pathologies leading to strictures and will be illustrated with images from 10 years of experience with CT colonography at our institutions from 2002-2012 (Hotel Dieu Hospital, Queen's University and Mount Sinai Hospital, University of Toronto).
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Affiliation(s)
- Daniel Wan
- Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada
| | - Silvio G. Bruni
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - John A. Dufton
- Department of Imaging, University Hospital of Northern British Columbia, Prince George, British Columbia, Canada
| | - Paul O'Brien
- Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada
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10
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Ripollés T, Martínez-Pérez MJ, Gómez Valencia DP, Vizuete J, Martín G. Sigmoid stenosis caused by diverticulitis vs. carcinoma: usefulness of sonographic features for their differentiation in the emergency setting. ACTA ACUST UNITED AC 2015; 40:2219-31. [DOI: 10.1007/s00261-015-0448-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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11
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The relation between quality of life and histopathology in diverticulitis; can we predict specimen-related outcome? Int J Colorectal Dis 2015; 30:665-71. [PMID: 25739887 DOI: 10.1007/s00384-015-2176-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE An important factor in the decision to perform laparoscopic sigmoid resection for patient suffering from recurrent and ongoing diverticulitis is quality of life (QoL). It is unknown whether quality of life relates to the severity of diverticulitis as seen in the resected colonic segment. The aim of this study is to analyze histopathological findings of patients suffering from recurrent or ongoing diverticulitis and their QoL before and after surgery in order to improve patient outcome prediction. METHODS A cohort of consecutive patients with diverticulitis between January 2010 and April 2014 was analyzed. All patients were scheduled for surgery and had at least three episodes of diverticulitis or more within the last 2 years or experienced ongoing complaints for at least 3 months or more and confirmation by a radiologist. We compared QoL questionnaires, to known histopathological entities. RESULTS For this study, 54 consecutive patients were included, 15 (27.8%) men and 39 (72.2%) women. A marked difference in quality of life before and after surgery for patients having a more severe histopathological entity was not found (p = 0.83). However, a clinically relevant higher VAS score 6 months after surgery was shown in patients with peritonitis. Furthermore, these patients had more fibrosis in the histopathological samples. CONCLUSION In conclusion, even though a relation between the different pathological entities and QoL could not be determined, patients with diverticulitis and concomitant microscopic peritonitis had significantly more fibrosis and suffered from a higher VAS scores 6 months after surgery.
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12
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Lips LMJ, Cremers PTJ, Pickhardt PJ, Cremers SEH, Janssen-Heijnen MLG, de Witte MT, Simons PCG. Sigmoid Cancer versus Chronic Diverticular Disease: Differentiating Features at CT Colonography. Radiology 2015; 275:127-35. [DOI: 10.1148/radiol.14132829] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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13
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Solak A, Solak I, Genç B, Sahin N, Yalaz S. Transverse colon diverticulitis with calcified fecalith. Eurasian J Med 2015; 45:68-70. [PMID: 25610254 DOI: 10.5152/eajm.2013.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/29/2012] [Indexed: 12/14/2022] Open
Abstract
Left colonic diverticula are common in Western populations, whereas right colonic diverticulosis primarily occurs in Oriental populations. Diverticulitis of the transverse colon is very rare, with very few cases reported in the literature. Herein, we report a case of transverse colon diverticulitis caused by a calcified stone in a 69-year-old female. This was a solitary diverticulum. The signs and symptoms of the disease are similar to acute pancreatitis. To the best of our knowledge, this is the first report describing the MRI findings of a patient with trans-verse colon diverticulitis caused by a calcified stone.
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Affiliation(s)
- Aynur Solak
- Department of Radiology, Sifa Hospital, Izmir, Turkey
| | - Ilhami Solak
- Department of General Surgery, Scool of Medicine Ege University, Izmir, Turkey
| | - Berhan Genç
- Department of Radiology, Sifa Hospital, Izmir, Turkey
| | - Neslin Sahin
- Department of Radiology, Sifa Hospital, Izmir, Turkey
| | - Seyhan Yalaz
- Department of General Surgery, Sifa Hospital, Izmir, Turkey
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14
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Cuomo R, Barbara G, Pace F, Annese V, Bassotti G, Binda GA, Casetti T, Colecchia A, Festi D, Fiocca R, Laghi A, Maconi G, Nascimbeni R, Scarpignato C, Villanacci V, Annibale B. Italian consensus conference for colonic diverticulosis and diverticular disease. United European Gastroenterol J 2014; 2:413-42. [PMID: 25360320 PMCID: PMC4212498 DOI: 10.1177/2050640614547068] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/18/2014] [Indexed: 02/05/2023] Open
Abstract
The statements produced by the Consensus Conference on Diverticular Disease promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) are reported. Topics such as epidemiology, risk factors, diagnosis, medical and surgical treatment of diverticular disease (DD) in patients with uncomplicated and complicated DD were reviewed by a scientific board of experts who proposed 55 statements graded according to level of evidence and strength of recommendation, and approved by an independent jury. Each topic was explored focusing on the more relevant clinical questions. Comparison and discussion of expert opinions, pertinent statements and replies to specific questions, were presented and approved based on a systematic literature search of the available evidence. Comments were added explaining the basis for grading the evidence, particularly for controversial areas.
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Affiliation(s)
- Rosario Cuomo
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
- Rosario Cuomo, Department of Clinical Medicine and Surgery, Federico II University Hospital School of Medicine via S. Pansini 5, 80131 Napoli, Italy.
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pace
- Department of Biochemical and Clinical Sciences, University of Milan, Milan, Italy
| | - Vito Annese
- Department of Gastroenterology, AOU Careggi, Florence, Italy
| | - Gabrio Bassotti
- Gastroenterology and Hepatology Section, University of Perugia School of Medicine, Perugia, Italy
| | | | | | - Antonio Colecchia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Roberto Fiocca
- Pathology Unit, IRCCS San Martino-IST University Hospital, Genoa, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, La ‘Sapienza' University, Rome, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, L. Sacco University Hospital, Milan, Italy
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Carmelo Scarpignato
- Clinical Pharmacology & Digestive Pathophysiology Unit, University of Parma, Parma, Italy
| | | | - Bruno Annibale
- Medical-Surgical and Translational Medicine Department, La Sapienza University, Rome, Italy
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15
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Mellnick VM, Menias CO. Computed tomography of colonic and appendiceal emergencies. Semin Roentgenol 2014; 49:202-9. [PMID: 24836494 DOI: 10.1053/j.ro.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.
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16
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Antonopoulos P, Almyroudi M, Kolonia V, Kouris S, Troumpoukis N, Economou N. Toxic Megacolon and Acute Ischemia of the Colon due to Sigmoid Stenosis Related to Diverticulitis. Case Rep Gastroenterol 2013; 7:409-13. [PMID: 24163654 PMCID: PMC3806696 DOI: 10.1159/000355345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We present a rare case of toxic megacolon accompanied by necrosis of the colon due to chronic dilation caused by stenosis of the sigmoid colon as a complication of diverticulitis. The patient presented at the emergency department with diffuse abdominal pain, fever (38.8°C) and tachycardia (120 beats/min). Physical examination revealed distension and tenderness on deep palpation on the left lower quadrant without peritoneal signs. Abdominal computed tomography showed located stenosis in the sigmoid colon and marked dilation of the descending (12 cm diameter) and transverse (7.5 cm diameter) colon. A few hours later, the patient developed severe septic shock with electrolyte abnormalities. He had a history of two prior admissions to our hospital due to crises of acute diverticulitis. Based on Jalan's criteria the diagnosis was compatible with toxic megacolon. The patient's condition deteriorated suddenly and an emergency colectomy was performed. The operative findings revealed a necrotic colon. Histology examination confirmed the diagnosis of ischemia of the colon. To our knowledge this is the first published report in the literature which refers to a rare complication of diverticulitis, namely chronic stenosis which complicated to colonic ischemia and toxic megacolon.
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Affiliation(s)
- P Antonopoulos
- Computed Tomography and Magnetic Resonance Imaging Department, Sismanogleio General Hospital, Athens, Greece
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17
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Gryspeerdt S, Lefere P. Chronic diverticulitis vs. colorectal cancer: findings on CT colonography. ACTA ACUST UNITED AC 2013; 37:1101-9. [PMID: 22366853 DOI: 10.1007/s00261-012-9858-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this update article is to evaluate findings on CT colonography in patients with chronic diverticulitis and to compare the findings in patients with colorectal carcinoma. MATERIALS AND METHODS Different morphological criteria retrieved from a literature review were retrospectively analyzed in a series of 13 patients with proven chronic diverticulitis. The findings were compared with a series of 10 patients with colorectal carcinoma. RESULTS Overall, the findings in chronic diverticulitis resemble the findings in acute diverticulitis. The advantage of virtual CT colonography in differentiating both entities relies in the combination of morphological features previously described on axial computed tomography and double contrast barium enema. The single strongest morphological feature pointing towards the diagnosis of chronic diverticulitis is the presence of diverticula in the affected segment. In the presence of diverticula in the affected segment, a long segment (≥10 cm), thick fascia sign without adenopathies, mild bowel wall thickening, tapered margins, and distorted but preserved mucosal folds are likely to further improve accuracy of diagnosing chronic diverticulitis. CONCLUSION The single strongest morphological sign to differentiate chronic diverticulitis from colorectal cancer is the presence of diverticula in the affected segment.
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Affiliation(s)
- Stefaan Gryspeerdt
- Virtual Colonoscopy Teaching Centre, Akkerstraat 32 c, 8830 Hooglede, Belgium.
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Kahveci S, Tokmak TT, Yıldırım A, Mavili E. Acute right-sided colonic diverticulitis mimicking appendicitis: a report of two cases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:238-241. [PMID: 22855407 DOI: 10.1002/jcu.21967] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 05/30/2012] [Indexed: 06/01/2023]
Abstract
We describe two right-sided diverticulitis cases that presented with marked right iliac fossa tenderness with guarding and rebound and laboratory parameters resembling acute appendicitis. The imaging findings suggested diverticulitis in both cases. One of the patients underwent surgery and the other one was followed up with medical treatment. Awareness of these imaging findings may aid in the diagnosis of right-sided diverticulitis, which is frequently misdiagnosed and mistreated.
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Affiliation(s)
- Servet Kahveci
- Erciyes University Medical Faculty, Department of Radiology, 38039, Kayseri, Turkey
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Ochoa SR. Dolor pélvico en mujeres y el papel de la imágenes diagnósticas. MEDUNAB 2012. [DOI: 10.29375/01237047.1860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
El dolor pélvico es un motivo de consulta frecuente tanto en los servicios de consulta externa como de urgencias, e implica un reto diagnóstico para los médicos, especialmente en el caso de las mujeres, en quienes hay un amplio espectro de diagnósticos diferenciales debido a las estructuras contenidas que implican varios sistemas. Con este preámbulo vemos la necesidad de realizar una revisión de la literatura basada en la evidencia acerca del uso adecuado de las imágenes diagnósticas en estas patologías para obtener los mayores beneficios.
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Chronic diverticulitis of the large intestine characterized by stenosis symptoms in Japan: report of 6 cases. Clin J Gastroenterol 2012; 5:47-52. [PMID: 26181875 DOI: 10.1007/s12328-011-0273-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 10/24/2011] [Indexed: 10/14/2022]
Abstract
The concept of chronic diverticulitis, which is characterized by stenosis symptoms, has recently been proposed. However, it is not widely known in Japan. To stress the prevalence of this disease in Japan, we herein report 6 patients with chronic diverticulitis who required surgery. The present study involved both clinicopathological analyses of 6 patients and a review of case reports in Japan. The site involved in all 6 patients was the left-sided colon. Stenosis symptoms (i.e., ileus) were observed in all 6 patients. Preoperative clinical diagnoses were diverticulitis (n = 4) and suspected type 4 colon cancer (n = 2). Histopathological examination confirmed the presence of diverticulitis and fibrous thickening of the bowel wall due to chronic diverticulitis in all patients. Our review of the case reports of 32 patients with chronic diverticulitis in Japan revealed that the site most frequently involved was the left-sided colon, despite the fact that diverticulitis occurs most frequently in the right-sided colon in Japan. The present report confirmed that chronic diverticulitis is not an uncommon disease, with the same preponderance in the left-sided colon also in Japan. Therefore, we need to bear in mind the concept of chronic diverticulitis for patients with colonic obstruction.
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Abstract
Because the incidence of colonic diverticulosis is high in the general population, incidental asymptomatic diverticulosis is commonly seen on radiology imaging studies. However, diagnostic imaging performed specifically for diverticular disease is essentially limited to imaging of suspected acute colonic diverticulitis (ACD) and its complications. The clinical diagnosis of ACD can be challenging, and imaging has become an essential tool to aid in diagnosis, assess severity of disease, and aid in treatment planning. Computed tomography (CT) has replaced contrast enema as the imaging procedure of choice for diverticulitis. Ultrasound has also been successfully used for diagnosis, and magnetic resonance imaging (MRI) has significant potential as a radiation-free imaging test for acute colonic diverticulitis.
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Affiliation(s)
- Kristen K Destigter
- Department of Radiology, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, Vermont
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Vijayaraghavan G, Kurup D, Singh A. Imaging of acute abdomen and pelvis: common acute pathologies. Semin Roentgenol 2009; 44:221-7. [PMID: 19715787 DOI: 10.1053/j.ro.2009.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Gopal Vijayaraghavan
- Department of Radiology, University of Massachusetts Memorial Health Center, Worcester, MA, USA
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