Diverticular Disease Medical and Health News Headlines

Is There a Role for Magnetic Resonance Imaging in Diagnosing Colovesical Fistulas?

Urology. 2008 Aug 19;

Authors: Ravichandran S, Ahmed HU, Matanhelia SS, Dobson M

OBJECTIVES: Colovesical fistula is a devastating complication, usually secondary to diverticulitis or colon cancer. Imaging plays a crucial role in delineating the underlying anatomy and identifying an etiologic factor. Barium enema, computed tomography, and cystoscopy have been the mainstays of investigation, but they have less than ideal sensitivity and specificity. This study assessed the role of magnetic resonance imaging (MRI) in the investigation of patients with probable colovesical fistulas. METHODS: A total of 22 patients with presentations suspicious for enterovesical fistulas who underwent evaluation with axial T(1)-weighted and axial, coronal, and sagittal T(2)-weighted 1.5T MRI (body-phased array) were identified. Of the 22 patients, 19 underwent laparotomy and repair. RESULTS: MRI correctly identified the presence of a fistula and defined the underlying etiology in 18 of 19 patients. Colovesical fistula was correctly excluded in 1 of 19 patients. The remaining 3 patients were either unfit for surgery or refused. CONCLUSIONS: The results of our study have shown that MRI is an accurate method of evaluating patients with suspicion of colovesical fistulas, identifying the anatomy of the tract, as well as the etiology. This is not only useful for diagnosis, but also for surgical planning.

PMID: 18718640 [PubMed - as supplied by publisher]

Caecal epiploic appendagitis: an unlikely occurrence.

Clin Radiol. 2008 Aug;63(8):895-900

Authors: Macari M, Laks S, Hajdu C, Babb J

AIM: To determine whether epiploic appendagitis occurs in the caecum. METHODS: From 2000-2006, 58 cases with classic computed tomography (CT) features of acute epiploic appendagitis (focal round or oval fat density immediately adjacent to the colon with surrounding oedema and stranding, with or without a central area of high attenuation) were identified from a radiology information system and available for review on the picture archiving and communication system (PACS). Cases were assigned to one of six colonic segments: rectum, sigmoid, descending colon, transverse colon, ascending colon, and caecum. The Blyth-Still-Casella procedure was used to derive an exact upper bound on the likelihood of epiploic appendagitis occurring within the caecum. RESULTS: Twenty-eight cases occurred in the sigmoid colon, 16 in the descending colon, four in the transverse colon, and 10 in the ascending colon. No cases of acute epiploic appendagitis were identified in the caecum. Four cases of prospectively dictated caecal epiploic appendagitis were identified from the database. Retrospective review of these cases showed two cases to be epiploic appendagitis of the ascending colon. The third case demonstrated peritoneal thickening without evidence of an inflamed epiploic appendage. The fourth case was caecal diverticulitis. Based on these findings there is 95% confidence that no more than 4.6% of patients with epiploic appendagitis will show this condition within the caecum. CONCLUSION: In the authors' experience, epiploic appendagitis does not occur in the caecum. Therefore, it is an unlikely cause for an inflammatory process in this region and other conditions should be considered.

PMID: 18625354 [PubMed - in process]

Related Articles

Incidence of perforated diverticulitis and risk factors for death in a UK population.

Br J Surg. 2008 Jul;95(7):876-81

Authors: Morris CR, Harvey IM, Stebbings WS, Hart AR

BACKGROUND: Perforated diverticulitis (PD) remains a serious acute abdominal condition. The aims of this study were to measure its incidence in a large UK population and to identify factors affecting outcomes. METHODS: Computerized searches of hospital coding databases for PD were performed in five hospitals in East Anglia, UK. Data were collected from hospital records over 5 years (1995-2000). Incidence was calculated using population data, and factors associated with mortality and morbidity were identified using univariable and multivariable testing. RESULTS: Some 202 patients with PD were identified, of whom 93.1 per cent underwent surgery and 24.3 per cent died. The age-adjusted adult incidence of perforation was 3.5 per 100 000 per annum, with a standardized female to male ratio of 1.3 (95 per cent confidence interval (c.i.) 1.1 to 1.5) to 1. Risk factors for death were increased age (odds ratio (OR) 3.5 (95 per cent c.i. 1.9 to 6.1)), pre-existing renal disease (OR 18.7 (1.6 to 211.4)) and pre-existing use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR 3.1 (1.3 to 7.3)). CONCLUSION: PD is uncommon, with the highest incidence in women over 65 years old. Mortality rates are high, particularly in those taking NSAIDs or with pre-existing renal impairment.

PMID: 18509877 [PubMed - in process]

Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation.

World J Gastroenterol. 2008 Jun 14;14(22):3583-6

Authors: Markogiannakis H, Konstadoulakis M, Tzertzemelis D, Antonakis P, Gomatos I, Bramis C, Manouras A

Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigation of even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.

PMID: 18567091 [PubMed - in process]