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

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

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

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

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

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

BACKGROUND/AIMS: Recently, due to the adoption of a Western lifestyle, the incidence of colonic diverticulosis is increasing in the Korean population. The purpose of this study is to review the prevalence and clinical characteristics of colonic diverticulosis as diagnosed by a colonoscopic examination. METHODS: We retrospectely analyzed the medical records of 3,352 patients that had undergone a colonoscopy from 1 January 2002 to 31 July 31 2005. We recorded the extent (1, 2~5, 6>) and the location of a diverticulum. We also reviewed the medical records of the patients that had symptoms and other clinical features. RESULTS: A total of 2,831 patients were selected. The overall prevalence of colonic diverticulosis was 10.1%; the mean patient age was 53+/-11 years and the ratio of males to females was 2.3:1. A diverticulum occurred more frequently in the right side colon (79.0%) than the left side colon (13.9%). The most common symptom was abdominal pain (63.5%). Complications were diverticulitis (2.0%) and bleeding (0.3%). The prevalence of a colon polyp was 39.1% and the prevalence of a fatty liver was 26.4% in the diverticular patients. CONCLUSIONS: The prevalence of colonic diverticulosis is increasing in the Korean population and a diverticulum occurred more frequently in the right side colon.
Abdominal Pain ; Colon* ; Colonoscopy ; Diverticulitis ; Diverticulosis, Colonic* ; Diverticulum ; Fatty Liver ; Female ; Hemorrhage ; Humans ; Incidence ; Life Style ; Male ; Medical Records ; Polyps ; Prevalence*

PURPOSE: Diverticular disease of the colon is relatively common in western population and rare in oriental population but in recent years the incidence is steadily increasing in oriental population including Korean, so more concerns and appropriate management are required. METHODS: We reviewed 111cases who had diverticular disease in the colon from January 1988 to May 1998 in the Soonchunhyang University Chunan Hospital. Of 111 cases, 87 cases were treated conservatively and 24 cases received a surgical treatment. RESULTS: The annual incidence increased progressively for the last 10 years. The mean age of the patients at the time of diagnosis was 49.6 years and the most common age-group was forth decades (25%). The diverticula were located in the right colon 89%, left colon 7% and both side 4%. Among 24 surgically treated cases, the most common preoperative diagnosis was acute appendicitis (75%) and the correct preoperative diagnosis was made only 3 cases (13%) who had previous appendectomy history, previous diagnosed history or received barium enema due to recurrent pain attack. The surgical procedures of the colonic diverticulosis were right hemicolectomy (6 cases), ileo-ascending colectomy (6 cases), diverticulectomy (2 cases), segmental resection of transverse colon (1 case), left hemicolectomy (1 case), appendectomy (2 cases), appendectomy with drainage (3 cases), appendectomy with drainage and diverticulectomy (3 cases). The postoperative complication was wound infection in all complicated cases. There was no postoperative mortality. CONCLUSIONS: The outcome of patients in our series is satisfactory despite of diagnostic inaccuracies. Preoperative barium study is recommended in those above the 40 years of age suspected the appendicitis. We recommend surgery for patients after two or three episodes of acute diverticulitis that resolves after medical treatment with antibiotics.
Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Barium ; Chungcheongnam-do ; Colectomy ; Colon* ; Colon, Transverse ; Diagnosis ; Diverticulitis ; Diverticulosis, Colonic ; Diverticulum ; Drainage ; Enema ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Wound Infection

This study was done to evaluate prospectively the clinical significance of colonic diverticulosis. In the 1,030 consecutive outpatients undergoing colonoscopy, the information on the demographics, the patterns of bowel symptoms, and the prevalence of colon polyp were analyzed according to the presence of colonic diverticulosis. The mean age of 1,030 patients were 52.2 yr and 59.3% were male. The prevalence of diverticulosis was 19.7% (203/1,030). Of 203 diverticulosis patients 85.2% were in proximal group, 5.4% in distal group and 9.4% in both group. Six (3.0%) patients were found to have diverticulitis. Multivariate logistic regression analysis showed that an old age, diabetes and the presence of polyp were significant factors associated with proximal or both diverticulosis. A significant difference was demonstrated between the patients of distal diverticular group and the controls for the symptom frequency scores within the previous 4 weeks. The items, which showed difference, were hard stool, urgency, flatus, chest discomfort and frequent urination. In conclusion, old age, diabetes and the presence of colon polyp were associated with proximal diverticulosis. The temporal symptoms were more frequent in distal diverticulosis than in proximal diverticulosis in the study subjects.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colonic Diseases/diagnosis/epidemiology ; Colonic Polyps/complications/*diagnosis ; Colonoscopy ; Diabetes Complications/complications/diagnosis ; Diverticulitis/diagnosis/epidemiology ; Diverticulosis, Colonic/complications/*diagnosis/epidemiology ; Female ; Flatulence/complications ; Humans ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Risk Factors

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