BACKGROUND/AIMS: The prevalence of colonic diverticulosis in Korea is increasing in conjunction with the adoption of western dietary pattern, extension of lifespan, and advances in diagnostic modalities. The clinical characteristics of colonic diverticulosis seem to be gradually becoming similar to those of Western societies. Therefore, factors associated with the clinical characteristics of colonic diverticulosis in Korea were investigated. METHODS: The data of 200 patients diagnosed with colonic diverticulosis using colonoscopy between May 2010 and April 2012 at Inje University Seoul Paik Hospital (Seoul, Korea) were prospectively collected. Clinical parameters acquired through a questionnaire include age, body mass index, waist circumference, exercise, diet, smoking, drinking habits, etc. Correlation between these factors and the clinical features of diverticulosis were analyzed. RESULTS: Mean age of the patients was 54.9+/-11.9 (range 17-79) years and male to female ratio was 2.2:1. Most diverticula were located on the right side of the colon (83%) and the mean number of diverticulum was 4.07+/-3.9. Factor associated with the location of diverticulum on the left side was age (p=0.001). There was a positive correlation between the waist circumference and the number of diverticulum (partial correlation coefficient r'=0.143, p=0.047). Diverticulitis occurred more frequently in younger patients than in older patients (p=0.002). CONCLUSIONS: Colonic diverticulosis in older patients is found more frequently on the left colon, and the number of diverticulosis is associated with central obesity.
Adolescent ; Adult ; Age Factors ; Aged ; Alcohol Drinking ; Body Mass Index ; Colonoscopy ; Diverticulosis, Colonic/complications/*diagnosis/epidemiology ; Exercise ; Female ; Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Factors ; Smoking ; Waist Circumference ; Young Adult

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

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

BACKGROUND/AIMS: The prevalence of colonic diverticulosis has been reported to be lower in Korea than in Western countries. This disease also shows markedly different characteristics in the Korean population. We describe herein a prospective investigation, based on colonoscopic examination, of the prevalence, clinical characteristics, and factors associated with colonic diverticulosis in Korea. METHODS: The prevalence of colonic diverticulosis has been reported to be lower in Korea than in Western countries. This disease also shows markedly different characteristics in the Korean population. We describe herein a prospective investigation, based on colonoscopic examination, of the prevalence, clinical characteristics, and factors associated with colonic diverticulosis in Korea. RESULTS: The overall prevalence of colonic diverticulosis was 12.1% (103 / 848). The right side of the colon was involved in 84.5% of patients (87 / 103); patients with right side diverticula were, on average, younger than those with left side diverticulosis (p = 0.014). Multiple diverticula were observed in 60.2% (62 / 103) of patients. Age greater than 60 years, a high-fat diet, and alcohol consumption were significantly associated with the presence of colonic diverticulosis (p < 0.05). CONCLUSIONS: The prevalence of colonic diverticulosis in Korea is increasing and is most commonly located in the right side of the colon. Further, old age and diet may affect the risk of development of this disease.
Adult ; Age Distribution ; Alcohol Drinking/epidemiology ; *Colonoscopy ; Diabetes Mellitus/epidemiology ; Dietary Fats/administration & dosage ; Diverticulosis, Colonic/*epidemiology/*pathology ; Female ; Humans ; Hypertension/epidemiology ; Life Style ; Male ; Middle Aged ; Multivariate Analysis ; Prevalence ; Prospective Studies ; Questionnaires ; Republic of Korea/epidemiology ; Risk Factors ; Smoking/epidemiology

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

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

Most common cause of brisk hematochezia is diverticular bleeding in Western countries. It occurs in 15% of patients with diverticulosis and one-third of them appear to be massive. Most of diverticulosis in Western countries occur in the left colon but the right colon is more common in Korea. Especially, the reports of diverticular bleeding on left colon are rare in Korea. We report a case presenting with multiple diverticuli complicated by recurrent massive bleeding restricted to the left colon. 75-year-old female was admitted due to hematochezia and dizziness. On past history, two years and two weeks ago respectively, she was treated of diverticular bleeding with and without diverticulitis. Hemoglobin level was 9.8 g/dL. On Colonoscopy, numerous diverticuli were seen at sigmoid colon upto splenic flexure which showed fresh blood clots in the lumen. We diagnosed her as recurrent massive diverticular bleeding on the sigmoid colon. She received elective laparoscopic left hemicolectomy.
Aged ; Colonoscopy ; Diagnosis, Differential ; Diverticulosis, Colonic/complications/*diagnosis/surgery ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology/therapy ; Humans ; Recurrence ; Sigmoid Diseases/*diagnosis/etiology/therapy ; Tomography, X-Ray Computed

BACKGROUND/AIMS: The prevalence of colonic diverticulosis in Korea is lower than in Western contries and the involved site is different. But, the recently increasing prevalence in Korea may be due to changing life style and advances in diagnostic approachs. We analyzed the annual incidence and clinical manifestations of colonic diverticulosis of the patients who underwent colonofibroscopy. METHODS: Medical records of 25,808 patients who underwent colonofibroscopy at Yeungnam University Medical Center from January 2000 to December 2007 were retrospectively reviewed. RESULTS: Overall prevalence was 5.5%. The mean age of the patients was 57.02+/-12.41 years (range 19-97 years) and the most frequent occurrence (28.8%) occurred in the 7th decade of life. Male to female ratio was 977:159. The annual incidence rate increased from 4.6% to 7.2% since 2000. Diverticulum occurred more frequently in the right side colon (997 cases) than the left side colon (159 cases), with involvement of both sides in 62 cases. The rate of left sided colon increased with age. In 516 patients, only one diverticulum was detected and the other 682 patients had multiple diverticuli. Complications were evident in 51 cases, consisting of diverticulititis in 35 cases and bleeding in 16 cases. CONCLUSIONS: According to this single center analysis, the annual incidence rate of colonic diverticulosis is increasing with right sided colon as the predominant site. But, the frequency in left-sided colon is increasing with age.
Academic Medical Centers ; Colon ; Diverticulosis, Colonic ; Diverticulum ; Diverticulum, Colon ; Female ; Hemorrhage ; Humans ; Incidence ; Korea ; Life Style ; Male ; Medical Records ; Population Characteristics ; Prevalence ; Retrospective Studies

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

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