1.Diverticulitis: Focused on Clinical Course and Relapse.
Kwi Sook CHOI ; Jeong Sik BYEON ; Soon Man YOON ; Kyung Jo KIM ; Byong Duk YE ; Seung Jae MYUNG ; Suk Kyun YANG ; Jin Ho KIM
Intestinal Research 2008;6(1):37-44
BACKGROUND/AIMS: There are a limited number of studies concerning the outcomes of diverticulitis in the Oriental population. We sought to evaluate the clinical features and the long-term outcomes of diverticulitis in Korean patients. METHODS: We retrospectively reviewed the clinical courses of 104 patients (59 men, 45 women; median age 48.5 years [range: 24-83 years]) hospitalized for their first episode of diverticulitis between 1989 and 2005. RESULTS: Right-sided diverticulitis was more common (71/104, 68%). However, the proportion of left-sided diverticulitis increased as age increased. Thirty-two patients underwent operations: 30 because of complications and 2 because of presumed appendicitis. Left-sided diverticulitis was an independent risk factor for complications (OR=7.6, p<0.001), and it required surgical treatment more often than right-sided diverticulitis did (61% vs. 17%, p<0.001). Eighty-five patients were followed for a median of 36 months. Four of the 62 medically treated patients developed recurrence of diverticulitis, with a 3-year cumulative recurrence rate of 4.8%. None of the 4 recurrences showed complications, and all were successfully managed using conservative treatment. No predictive factors for the recurrence of diverticulitis could be determined. CONCLUSIONS: The recurrence rate and risk of complications associated with recurrence are low in patients treated conservatively for the first episode of diverticulitis. Therefore, elective surgery to prevent recurrence and complications should be utilized sparingly in patients with diverticulitis.
Appendicitis
;
Diverticulitis
;
Diverticulitis, Colonic
;
Diverticulosis, Colonic
;
Humans
;
Male
;
Recurrence
;
Retrospective Studies
;
Risk Factors
2.A Case of Colon Cancer with Ovarian Metastasis Mimicking Acute Diverticulitis.
Ji Hyun YOON ; Jung Soo PARK ; Da Hyun JUNG ; Jie Hyun KIM ; Young Hoon YOON ; Hyojin PARK ; Sang In LEE
Korean Journal of Medicine 2012;82(4):459-464
Colonic diverticulitis develops in 10-25% of patients with colonic diverticulosis. Most patients complain of lower abdominal pain and fever. The complications of diverticulitis are abscess, fistula, bowel obstruction, free perforation, and panperitonitis. The relationship between diverticulitis and colon cancer is complicated and conflicted. We report a 35-year-old woman diagnosed with metastatic colon cancer, who initially presented with acute colonic diverticulitis in the same location 3 months earlier. To the best of our knowledge, this is the first case of colon cancer with ovarian metastasis presenting as acute diverticulitis.
Abdominal Pain
;
Abscess
;
Adult
;
Colon
;
Colonic Neoplasms
;
Colonoscopy
;
Diverticulitis
;
Diverticulitis, Colonic
;
Diverticulosis, Colonic
;
Female
;
Fever
;
Fistula
;
Humans
;
Neoplasm Metastasis
3.Relationship Between Intestinal Gas and the Development of Right Colonic Diverticula.
Sung Ill JANG ; Jie Hyun KIM ; Young Hoon YOUN ; Hyojin PARK ; Sang In LEE ; Jeffrey L CONKLIN
Journal of Neurogastroenterology and Motility 2010;16(4):418-423
BACKGROUNDS/AIMS: High intraluminal pressure has been reported to cause left colonic diverticula. However, the pathophysiology of right colonic diverticula is still unclear. Methane gas has been reported to delay small intestinal transit and to increase intraluminal pressure. The aim of this study was to evaluate the relationship between right colonic diverticula and intestinal gas produced by enteric bacteria. METHODS: Lactulose breath tests were performed in 30 patients who were diagnosed with right colonic diverticula via colonoscopy. The control group consisted of 30 healthy adults with no specific symptoms or medical histories. A hydrogen or methane producer was defined in 2 ways: either one that exhibited a breath hydrogen level > or = 20 ppm (methane > or = 10 ppm) baseline or one that exhibited an increase in breath hydrogen > or = 20 ppm (methane > or = 10 ppm) above baseline within the first 90 minutes of the test. RESULTS: The lactulose breath test (LBT) positivity in the diverticular group and the control group were 40.0% and 33.3%, respectively, without a statistically significant difference. The concentrations of methane and hydrogen gas measured by LBT increased over time, but there was no significant difference between the control and the diverticular groups. CONCLUSIONS: There was no significant relationship between right colonic diverticula and intestinal gases produced by enteric bacteria. However, time-dependent formation of diverticula should be taken into consideration, therefore long-term, large-scale follow-up studies may reveal further pathogenesis of right colonic diverticulosis.
Adult
;
Breath Tests
;
Colon
;
Colonoscopy
;
Diverticulosis, Colonic
;
Diverticulum
;
Diverticulum, Colon
;
Enterobacteriaceae
;
Gases
;
Humans
;
Hydrogen
;
Lactulose
;
Methane
4.Sigmoid Diverticular Bleeding Detected by Capsule Endoscopy.
Youn Ju NA ; Ki Nam SHIM ; Min Jung KANG ; Ji Min JUNG ; Hae Sun JUNG ; Su Jung BAIK ; Su Jin YOUN ; Hyun Joo SONG ; Kum Hei RYU ; Hye Jung YEOM ; Tae Hun KIM ; Sung Ae JUNG ; Kwon YOO ; Il Hwan MOON ; Kyu Won CHUNG
Korean Journal of Gastrointestinal Endoscopy 2007;35(1):56-59
Colonic diverticulosis is small outpouching from the lumen of the colon, and this caused by mucosal herniation. Most patients are asymptomatic, but 5~15% of those affected manifest diverticular bleeding. Because most of them stop bleeding spontaneously, the source of the bleeding can not be found by colonoscopy in 15% of these cases. We report here on a case of sigmoid diverticular bleeding that detected by capsule endoscopy in a 68-year old woman who presented with acute obscure gastrointestinal bleeding.
Aged
;
Capsule Endoscopy*
;
Colon
;
Colon, Sigmoid*
;
Colonoscopy
;
Diverticulosis, Colonic
;
Female
;
Hemorrhage*
;
Humans
5.Clinical Characteristics of Colonic Diverticular Disease Diagnosed with Colonoscopy.
Jung Hoon SONG ; Jin Gook HUH ; You Sun KIM ; Jin Ho LEE ; Won Cheol JANG ; Kyung Sun OK ; Soo Hyung RYU ; Jung Hwan LEE ; Jeong Seop MOON
Intestinal Research 2008;6(2):110-115
BACKGROUND/AIMS: Although colonic diverticular disease is less common in Koreans than in Western people, its incidence has been on the increase in Korea. We investigated the clinical characteristics and related complications of colonic diverticular disease in Koreans. METHODS: We retrospectively reviewed the medical records of 9,006 patients who underwent colonoscopy at the Seoul Paik hospital between July 2002 and January 2008. RESULTS: Of the 9,006 patients, there were 654 cases (7.3%) of colonic diverticulosis (472 men, 182 women). The mean age of the patients was 54.6+/-12.0 years. The right colon was involved in 535 cases, the left colon was involved in 86 cases and both the left and right colon was involved in 33 cases. Among the patients, a single diverticulum was seen in 253 cases and two or more diverticuli were seen in 401 cases. Related complications were diverticulitis (11 cases, 1.7%) and diverticular bleeding (3 cases, 0.5%). CONCLUSIONS: The incidence of colonic diverticular disease in Korea shows an increasing trend. Colonic diverticular lesions are frequently found in the right colon.
Colon
;
Colonoscopy
;
Diverticulitis
;
Diverticulitis, Colonic
;
Diverticulosis, Colonic
;
Diverticulum
;
Diverticulum, Colon
;
Hemorrhage
;
Humans
;
Incidence
;
Korea
;
Male
;
Medical Records
;
Retrospective Studies
6.A Case of Colovesical Fistula Induced by Sigmoid Diverticulitis.
Hwa Yeon YANG ; Woo Young SUN ; Taek Gu LEE ; Sang Jeon LEE
Journal of the Korean Society of Coloproctology 2011;27(2):94-98
Colonic diverticulosis has continuously increased, noticeably left-sided diseases, in Korea. A colovesical fistula is an uncommon complication of diverticulitis, and its most common cause is diverticular disease. Confirmation of its presence generally depends on clinical findings, such as pneumaturia and fecaluria. The primary aim of a diagnostic workup is not to observe the fistular tract itself but to find the etiology of the disease so that an appropriate therapy can be initiated. We present here the case of a 79-year-old man complaining of pneumaturia and fecaluria. On abdomen and pelvis CT, the patient was diagnosed as having a colovesical fistula due to sigmoid diverticulitis. After division of the adhesion between the sigmoid colon and the bladder, the defect of the bladder wall was repaired by simple closure. The colonic defect was treated with a segmental resection, including the rectosigmoid junction. The patient is doing well at 6 months after the operation and shows no evidence of recurrence of the fistula.
Abdomen
;
Aged
;
Colon
;
Colon, Sigmoid
;
Diverticulitis
;
Diverticulitis, Colonic
;
Diverticulosis, Colonic
;
Fistula
;
Humans
;
Intestinal Fistula
;
Korea
;
Pelvis
;
Recurrence
;
Urinary Bladder
7.Colo-uterine Fistula Caused by Sigmoid Diverticulitis.
Soojung HONG ; Jaekwan HWANG ; Sungheum PARK ; Jongheung KIM
Journal of the Korean Surgical Society 2004;66(5):435-437
A colo-uterine fistula is a rare complication of diverticular disease, due to the resistance of the uterine tissue. Only 18 cases have been reported in the world literature. Here, a case of an 82-year-old woman, with a colo-uterine fistula secondary to diverticulitis, is described. She presented with a malodorous vaginal discharge. A barium enema revealed colonic diverticulosis with a fistula tract to the body of uterus. The clinical symptoms were not specific, with the exception of the purulent material and stools from the vagina. A Sigmoidectomy, with fistula tract removal, and simple closure of the uterus was performed curatively.
Aged, 80 and over
;
Barium
;
Colon, Sigmoid*
;
Diverticulitis*
;
Diverticulosis, Colonic
;
Enema
;
Female
;
Fistula*
;
Humans
;
Uterus
;
Vagina
;
Vaginal Discharge
8.Colonic Diverticulosis: Evaluation wth Double Contrast Barium Enema.
Jae Kook KO ; Jong Koo LEE ; Eun Joo YUN ; Hee Jung MOON ; Hyun Ja SHIN
Journal of the Korean Radiological Society 1997;36(2):285-289
PURPOSE: To evaluate the pattern of colonic diverticulosis according to age and sex, and recent trend. MATERIALS AND METHODS: The authors retrospectively reviewed 120 cases of colonic diverticulosis in 1,020 patients who had undergone a double contrast barium enema examination between January 1st, 1993, and December 31st, 1995, and analyzed the frequency, size, multiplicity and anatomical site, according to age and sex. Diverticulum size was classified into one of three groups : less than 5mm, 5-10mm, over 10mm in diameter. RESULTS: The overall incidence of colonic diverticulosis was 120 cases among 1,020 patients(11.8%) with an incidence 5.3 times higher in males than in females. Peak incidence was in the fifth decade, with 19 cases (15.8%) among males, and after the sixth decade, with four cases(3.3%) among females. Mean age was 57.7 years. Diverticulum size of 5-10mm in diameter was predominant 2% of cases) ; average diameter was 5-6mm. The incidence of colonic diverticulosis was 5.1 times more frequent in the right colon(101 cases) than in the left (20 cases). CONCLUSION: The overal overall incidence of colonic diverticulosis has continually increased; in addition it has also recently increased slightly in left-sided colon. This is thought to be due to various factors, both congenital and acquired, including longer life with good health care, constipation, irritable bowel syndrome, stress and the tendency of eating patterns to more closely resemble those of the west.
Barium*
;
Colon*
;
Constipation
;
Delivery of Health Care
;
Diverticulosis, Colonic*
;
Diverticulum
;
Eating
;
Enema*
;
Female
;
Humans
;
Incidence
;
Irritable Bowel Syndrome
;
Male
;
Retrospective Studies
9.Association between Diverticulosis and Colonic Neoplasm in Koreans.
Chang Soo CHOI ; Suck Chei CHOI ; Geom Seog SEO ; Eun Young CHO ; Hyang Jung CHO ; Yong Sung KIM ; Ki Hoon KIM ; Tae Hyeon KIM ; Yong Ho NAH
The Korean Journal of Gastroenterology 2007;49(6):364-368
BACKGROUND/AIMS: Although a few published studies have reported on the relationship between diverticulosis and neoplasia in the west, it is not yet examined in Korea. The aim of this study was to determine whether there is an association between diverticulosis and colonic neoplasia. METHODS: We retrospectely analysed the medical records of 3,007 patients (M:F=1.3:1) who underwent colonoscopic examinations from year 2002 to year 2004. Patients who had a history of previous polypectomy, colon resection, or inflammatory bowel diseases were excluded. The size, extent (none, few, or many), and location of diverticuli and polyps were analyzed. RESULTS: Of 2,377 patients, included 57% were male and the mean age was 50.8 year-old. Nine percent of the patient had diverticulosis, 29% had more than one neoplasm, and 6% had advanced neoplasia. Patients with diverticular diseases had higher risks of any neoplasia than those without diverticulum (p=0.03, 37.7% vs. 28.2%). There was no correlation between diverticular diseases and advanced neoplasia. Patients with proximal diverticular diseases had higher risk of any proximal neoplasia than other patients (p<0.01 24.6% vs. 14.3%). Moreover, they had higher risk of proximal advanced neoplasia than others (p=0.01, 4.5% vs. 2%). In addition, comparison of multiple diverticular disease with few or no diverticuli revealed no difference in the risk of any neoplasia. CONCLUSIONS: These data show that the patients with diverticular diseases have more neoplasms than controls without diverticula.
Adult
;
Aged
;
Colonic Neoplasms/*complications/diagnosis/epidemiology
;
Diverticulosis, Colonic/*complications/diagnosis/epidemiology
;
Diverticulum, Colon/epidemiology/etiology
;
Female
;
Humans
;
Korea
;
Male
;
Middle Aged
;
Prevalence
;
Retrospective Studies
10.Endoscopic Diagnosis of Right-Sided Colonic Diverticulitis.
Soon Uk KWON ; Sun Taek CHOI ; Jin Su CHOI ; Hak Jun LEE ; Chan Won PARK ; Byeong Ik JANG ; Tae Nyeun KIM ; Moon Kwan CHUNG
Korean Journal of Gastrointestinal Endoscopy 2000;21(3):704-709
BACKGROUND/AIMS: Recently, it has been well known that the incidence of colonic diverticulosis is increasing in Korea. However, cases of right-sided colonic diverticulitis are rare although diverticula are located in right-sided colon more than left-side. The major clinical symptom of right-sided colonic diverticulitis is acute right lower quadrant pain which may mimic acute appendicitis. Therefore, we evaluated the clinical characteristics of the patients with right-sided colonic diverticulitis and safety of the colonoscopic examinations in these patients. METHODS: The evidence of diverticulitis was confirmed by the presence of pus at the diverticular lesions on colonoscopy. We retrospectively analyzed clinical menifestations, laboratory findings, colonoscopic findings and the presence of complications after colonoscopy, and radiologic findings of the patients with right-sided colonic diverticulitis. RESULTS: All the patients with right-sided colonic diverticulitis had abdominal pain. Physical examinations showed abdominal tenderness in all patients and leukocytosis was noticed in 8 out of 12 patients (66%). There was no complication during and after colonoscopy. All the patients were managed with conservative treatment including broad-spectrum antibiotics and improved without clinical aggravation. CONCLUSIONS: The colonoscopic examination may be helpful to diagnose right-sided colonic diverticulitis.
Abdominal Pain
;
Anti-Bacterial Agents
;
Appendicitis
;
Colon*
;
Colonoscopy
;
Diagnosis*
;
Diverticulitis
;
Diverticulitis, Colonic*
;
Diverticulosis, Colonic
;
Diverticulum
;
Humans
;
Incidence
;
Korea
;
Leukocytosis
;
Physical Examination
;
Retrospective Studies
;
Suppuration