The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of...The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period (range 17-35 mo) after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure.展开更多
AIM:To evaluate the safety and effectiveness of endoscopic papillary large balloon dilation(EPLBD)for bile duct stone extraction in patients with periampullary diverticula.METHODS:The records of 223 patients with larg...AIM:To evaluate the safety and effectiveness of endoscopic papillary large balloon dilation(EPLBD)for bile duct stone extraction in patients with periampullary diverticula.METHODS:The records of 223 patients with large common bile duct stones(≥10 mm)who underwent EPLBD(12-20 mm balloon diameter)with or without limited endoscopic sphincterotomy(ES)from July 2006to April 2011 were retrospectively reviewed.Of these patients,93(41.7%)had periampullary diverticula(PAD),which was categorized into three types.The clinical variables of EPLBD with limited ES(EPLBD+ES)and EPLBD alone were analyzed according to the presence of PAD.RESULTS:Patients with PAD were significantly older than those without(75.2±8.8 years vs 69.7±10.9years,P=0.000).The rates of overall stone removal and complete stone removal in the first session were not significantly different between the PAD and nonPAD groups,however,there was significantly less need for mechanical lithotripsy in the PAD group(3.2%vs 11.5%,P=0.026).Overall stone removal rates,complete stone removal rates in the first session and the use of mechanical lithotripsy were not significantly different between EPLBD+ES and EPLBD alone in patients with PAD(96.6%vs 97.1%;72.9%vs 88.2%;and 5.1%vs 0%,respectively).No significant differences with respect to the rates of pancreatitis,perforation,and bleeding were observed between EPLBD+ES and EPLBD alone in the PAD group(3.4%vs 14.7%,P=0.095;0%vs 0%;and 3.4%vs 8.8%,P=0.351,respectively).CONCLUSION:EPLBD with limited ES and EPLBD alone are safe and effective modalities for common bile duct stone removal in patients with PAD,regardless of PAD subtypes.展开更多
AIM: To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD). METHODS:...AIM: To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD). METHODS: A total of 139 patients with common bile duct (CBD) stones were treated with LBD (10-20 mm balloon diameter) after limited EST. Of this total, 73 patients had PAD and 66 patients did not have PAD (controls). The results of stone removal and complications were retrospectively evaluated. RESULTS: There were no significant differences between the PAD and the control groups in overall successful stone removal (94.5% vs 93.9%), stone removal in first session (69.9% vs 81.8%), mechanical lithotripsy (12.3% vs 13.6%), and complications (11.0% vs 7.6%). Clinical outcomes were also similar between the types of PAD, but the rate of stone removal in first session and the number of sessions were significantly lower and more frequent, respectively, in type B PAD (papilla located near the diverticulum) than controls [23/38 (60.5%) vs 54/66 (81.8%), P = 0.021; and 1 (1-2) vs 1 (1-3), P = 0.037, respectively] and the frequency of pancreatitis was significantly higher in type A PAD (papilla located inside or in the margin of the diverticulum) than in controls (16.1% vs 3.0%, P = 0.047). CONCLUSION: Limited EST plus LBD was an effective and safe procedure for removing choledocholithiasis in patients with PAD. However, some types of PAD should be managed with caution.展开更多
AIM： To evaluate the risk factors-other than nonsteroidal anti-inflammatory drugs-for colonic diverticular bleeding in a westernized population. METHODS： One hundred and forty patients, treated for symptomatic diver...AIM： To evaluate the risk factors-other than nonsteroidal anti-inflammatory drugs-for colonic diverticular bleeding in a westernized population. METHODS： One hundred and forty patients, treated for symptomatic diverticular disease in a community based hospital, were included. Thirty （21%） had signs of diverticular bleeding. Age, gender, and the results of colonoscopy were collected and compared to a group of patients with nonbleeding symptomatic diverticulosis. Records were reviewed for comorbidities, such as obesity, alcohol consumption, smoking habits and metabolic diseases. Special emphasis was put on arterial hypertension, cardiovascular events, diabetes mellitus, hyperuricemia and hypercholesterinemia. RESULTS： There was no difference between patients with diverticular hemorrhage and those with nonbleeding symptomatic diverticulosis regarding gender ratio （male/female 9/21 vs 47/63） and diverticular Iocalisation. Bleeding patients differed in respect to age （73.4± 9.9 vs 67. 8± 13.0, P 〈 0.013）. Significant differences were found between both groups regarding the presence of hyperuricemia and use of steroids and nonsteroidal anti-inflammatory drugs. Patients with three concomitant metabolic diseases were also identified as being at risk of bleeding. A forward stepwise logistic regression analysis revealed steroids, hyperuricemia and the use of calcium-channel blockers as independent risk factors of bleeding.CONCLUSION： Beside nonsteroidal anti-inflammatory steroid drug use, antihypertensive medication and concomitant arteriosclerotic diseases are risk factors for colonic diverticular hemorrhage. Our results support the hypothesis of an altered arteriosclerotic vessel as the source of bleeding.展开更多
Jejunal diverticula are quite rare.Furthermore,small bowel diverticular disease resulting in enteroliths can lead to complications necessitating surgical intervention.In this manuscript,we report two presentations of ...Jejunal diverticula are quite rare.Furthermore,small bowel diverticular disease resulting in enteroliths can lead to complications necessitating surgical intervention.In this manuscript,we report two presentations of jejunal diverticulum with complications from enteroliths followed by a review of the literature.The first case was that of a 79-year-old male who presented with abdominal pain and was found,on computed tomography scan,to have evidence of intestinal perforation.A laparotomy showed that he had perforated jejunal diverticulitis.The second case was that of an 89-year-old female who presented with recurrent episodes of bowel obstruction.A laparotomy showed that she had an enterolith impacted in her jejunum in the presence of significant diverticular disease.Although a rare entity,familiarity with jejunal diverticular disease,its complications,and its management,should be part of every surgeon's base of knowledge when considering abdominal pathology.展开更多
Small bowel diverticulosis represents an uncommon disorder (except for Meckel diverticulum) often misdiagnosed since it causes non-specific gastroin- testinal symptoms. Most of times the diagnosis is carried out in ca...Small bowel diverticulosis represents an uncommon disorder (except for Meckel diverticulum) often misdiagnosed since it causes non-specific gastroin- testinal symptoms. Most of times the diagnosis is carried out in case of related complications, such as diverticulitis, hemorrhage, perforation or obstruction. Intestinal obstruction can be caused by inflammatory stenosis due to repeated episodes of diverticulitis, volvulus, intussusception or jejunal stones. Herein we report a case of multiple jejunal diverticula causing chronic gastrointestinal obstruction.展开更多
Background: Calyceal diverticulae and megacalycosis are rare congenital anomalies. The majorities are asymptomatic but they can present with complications. Objective: The objective of this study is to describe the cli...Background: Calyceal diverticulae and megacalycosis are rare congenital anomalies. The majorities are asymptomatic but they can present with complications. Objective: The objective of this study is to describe the clinical presentations, complications, urographic diagnosis of calyceal diverticulae, megacalycosis, and their treatment. Methods: A descriptive study carried out over 8 years period from March 2012 to December 2019. In three big hospital of Aden province, we collect 15 patients aged from seven to 41 years (mean 13.5 years), our patients were 9 female (60%) and 6 male (40%). They diagnosed incidentally with calyceal diverticulae and megacalycosis by contrasted urography, describing the clinical manifestations, localization, complications, and type of treatment. Results: Sixty percent of patients with calyceal diverticulae and megacalycosis were women and (40%) were men. Clinical manifestations including, dull aching flank and abdominal pain in (40%), acute renal colic (20%), recurrent urinary tract infection (33%), and abdominal pain with a fever of unknown origin in (7%). Calyceal diverticula and megacalycosis were bilateral in (53%) and unilateral in (47%). In the right kidney were (57%), and in the left kidney (43%). In the upper pole of the kidney were (53.3%), middle pole (33.3%), and lower pole (13.3%). Complications occurred in (47%) of patients. They including, urinary stones in (71.4%), hypertension (14.3%), and delayed renal excretion (14.3%). Conservative treatment carried out in (73%) and surgically intervened in (27%). Conclusions: Calyceal diverticula and megacalycosis are rare anomalies. Dull aching flank pain and recurrent urinary tract infections are the most frequent clinical presentations. The most common complications are urinary stones. Conservative treatment is a common type of treatment.展开更多
目的评价320排螺旋CT用于诊断十二指肠憩室的临床意义。方法分析2021年5月至2022年5月北京市平谷区医院经上消化道造影或内镜检查证实的并已行320排螺旋CT检查的71例十二指肠憩室患者的临床资料,分析十二指肠憩室的直接征象、典型表现...目的评价320排螺旋CT用于诊断十二指肠憩室的临床意义。方法分析2021年5月至2022年5月北京市平谷区医院经上消化道造影或内镜检查证实的并已行320排螺旋CT检查的71例十二指肠憩室患者的临床资料,分析十二指肠憩室的直接征象、典型表现及伴发征象。结果71例患者共检出十二指肠憩室82个,单发61例,双发9例,多发1例。发生在十二指肠降段56例,水平段5例,降段与水平段均有10例。憩室直径<1.0 cm 3例,1.0~2.0 cm 29例,>2.0 cm 39例。憩室内成分为纯气体19个(23.17%);气液混合、气-液平面20个(24.39%);气体、食物残留混杂成分43个(52.44%)。71例患者中有31例合并胆道胰腺相关疾病。合并胆胰相关疾病组憩室位于降段的比例高于未合并胆胰相关疾病组,差异有统计学意义(P<0.05);两组的憩室大小占比比较,差异无统计学意义(P>0.05)。结论320排螺旋CT可很好地诊断十二指肠憩室,能及时发现相关的胆胰类并发症,具有重要的临床意义。展开更多
Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and femal...Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and female urethral strictures are rare pathologies.They can cause symptoms,which can mimic commoner conditions,leading to delay in diagnosis and unnecessary delay in treatment.In this article,we discuss in detail the definition,symptoms,epidemiology,pathogenesis,diagnosis,and treatment option for these two conditions.Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.展开更多
文摘The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period (range 17-35 mo) after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure.
基金Supported by A Yeungnam University Research Grant in 2012
文摘AIM:To evaluate the safety and effectiveness of endoscopic papillary large balloon dilation(EPLBD)for bile duct stone extraction in patients with periampullary diverticula.METHODS:The records of 223 patients with large common bile duct stones(≥10 mm)who underwent EPLBD(12-20 mm balloon diameter)with or without limited endoscopic sphincterotomy(ES)from July 2006to April 2011 were retrospectively reviewed.Of these patients,93(41.7%)had periampullary diverticula(PAD),which was categorized into three types.The clinical variables of EPLBD with limited ES(EPLBD+ES)and EPLBD alone were analyzed according to the presence of PAD.RESULTS:Patients with PAD were significantly older than those without(75.2±8.8 years vs 69.7±10.9years,P=0.000).The rates of overall stone removal and complete stone removal in the first session were not significantly different between the PAD and nonPAD groups,however,there was significantly less need for mechanical lithotripsy in the PAD group(3.2%vs 11.5%,P=0.026).Overall stone removal rates,complete stone removal rates in the first session and the use of mechanical lithotripsy were not significantly different between EPLBD+ES and EPLBD alone in patients with PAD(96.6%vs 97.1%;72.9%vs 88.2%;and 5.1%vs 0%,respectively).No significant differences with respect to the rates of pancreatitis,perforation,and bleeding were observed between EPLBD+ES and EPLBD alone in the PAD group(3.4%vs 14.7%,P=0.095;0%vs 0%;and 3.4%vs 8.8%,P=0.351,respectively).CONCLUSION:EPLBD with limited ES and EPLBD alone are safe and effective modalities for common bile duct stone removal in patients with PAD,regardless of PAD subtypes.
基金Supported by A Grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfare and Family Affairs,Republic of Korea (A091047)
文摘AIM: To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD). METHODS: A total of 139 patients with common bile duct (CBD) stones were treated with LBD (10-20 mm balloon diameter) after limited EST. Of this total, 73 patients had PAD and 66 patients did not have PAD (controls). The results of stone removal and complications were retrospectively evaluated. RESULTS: There were no significant differences between the PAD and the control groups in overall successful stone removal (94.5% vs 93.9%), stone removal in first session (69.9% vs 81.8%), mechanical lithotripsy (12.3% vs 13.6%), and complications (11.0% vs 7.6%). Clinical outcomes were also similar between the types of PAD, but the rate of stone removal in first session and the number of sessions were significantly lower and more frequent, respectively, in type B PAD (papilla located near the diverticulum) than controls [23/38 (60.5%) vs 54/66 (81.8%), P = 0.021; and 1 (1-2) vs 1 (1-3), P = 0.037, respectively] and the frequency of pancreatitis was significantly higher in type A PAD (papilla located inside or in the margin of the diverticulum) than in controls (16.1% vs 3.0%, P = 0.047). CONCLUSION: Limited EST plus LBD was an effective and safe procedure for removing choledocholithiasis in patients with PAD. However, some types of PAD should be managed with caution.
文摘AIM： To evaluate the risk factors-other than nonsteroidal anti-inflammatory drugs-for colonic diverticular bleeding in a westernized population. METHODS： One hundred and forty patients, treated for symptomatic diverticular disease in a community based hospital, were included. Thirty （21%） had signs of diverticular bleeding. Age, gender, and the results of colonoscopy were collected and compared to a group of patients with nonbleeding symptomatic diverticulosis. Records were reviewed for comorbidities, such as obesity, alcohol consumption, smoking habits and metabolic diseases. Special emphasis was put on arterial hypertension, cardiovascular events, diabetes mellitus, hyperuricemia and hypercholesterinemia. RESULTS： There was no difference between patients with diverticular hemorrhage and those with nonbleeding symptomatic diverticulosis regarding gender ratio （male/female 9/21 vs 47/63） and diverticular Iocalisation. Bleeding patients differed in respect to age （73.4± 9.9 vs 67. 8± 13.0, P 〈 0.013）. Significant differences were found between both groups regarding the presence of hyperuricemia and use of steroids and nonsteroidal anti-inflammatory drugs. Patients with three concomitant metabolic diseases were also identified as being at risk of bleeding. A forward stepwise logistic regression analysis revealed steroids, hyperuricemia and the use of calcium-channel blockers as independent risk factors of bleeding.CONCLUSION： Beside nonsteroidal anti-inflammatory steroid drug use, antihypertensive medication and concomitant arteriosclerotic diseases are risk factors for colonic diverticular hemorrhage. Our results support the hypothesis of an altered arteriosclerotic vessel as the source of bleeding.
文摘Jejunal diverticula are quite rare.Furthermore,small bowel diverticular disease resulting in enteroliths can lead to complications necessitating surgical intervention.In this manuscript,we report two presentations of jejunal diverticulum with complications from enteroliths followed by a review of the literature.The first case was that of a 79-year-old male who presented with abdominal pain and was found,on computed tomography scan,to have evidence of intestinal perforation.A laparotomy showed that he had perforated jejunal diverticulitis.The second case was that of an 89-year-old female who presented with recurrent episodes of bowel obstruction.A laparotomy showed that she had an enterolith impacted in her jejunum in the presence of significant diverticular disease.Although a rare entity,familiarity with jejunal diverticular disease,its complications,and its management,should be part of every surgeon's base of knowledge when considering abdominal pathology.
文摘Small bowel diverticulosis represents an uncommon disorder (except for Meckel diverticulum) often misdiagnosed since it causes non-specific gastroin- testinal symptoms. Most of times the diagnosis is carried out in case of related complications, such as diverticulitis, hemorrhage, perforation or obstruction. Intestinal obstruction can be caused by inflammatory stenosis due to repeated episodes of diverticulitis, volvulus, intussusception or jejunal stones. Herein we report a case of multiple jejunal diverticula causing chronic gastrointestinal obstruction.
文摘Background: Calyceal diverticulae and megacalycosis are rare congenital anomalies. The majorities are asymptomatic but they can present with complications. Objective: The objective of this study is to describe the clinical presentations, complications, urographic diagnosis of calyceal diverticulae, megacalycosis, and their treatment. Methods: A descriptive study carried out over 8 years period from March 2012 to December 2019. In three big hospital of Aden province, we collect 15 patients aged from seven to 41 years (mean 13.5 years), our patients were 9 female (60%) and 6 male (40%). They diagnosed incidentally with calyceal diverticulae and megacalycosis by contrasted urography, describing the clinical manifestations, localization, complications, and type of treatment. Results: Sixty percent of patients with calyceal diverticulae and megacalycosis were women and (40%) were men. Clinical manifestations including, dull aching flank and abdominal pain in (40%), acute renal colic (20%), recurrent urinary tract infection (33%), and abdominal pain with a fever of unknown origin in (7%). Calyceal diverticula and megacalycosis were bilateral in (53%) and unilateral in (47%). In the right kidney were (57%), and in the left kidney (43%). In the upper pole of the kidney were (53.3%), middle pole (33.3%), and lower pole (13.3%). Complications occurred in (47%) of patients. They including, urinary stones in (71.4%), hypertension (14.3%), and delayed renal excretion (14.3%). Conservative treatment carried out in (73%) and surgically intervened in (27%). Conclusions: Calyceal diverticula and megacalycosis are rare anomalies. Dull aching flank pain and recurrent urinary tract infections are the most frequent clinical presentations. The most common complications are urinary stones. Conservative treatment is a common type of treatment.
文摘目的评价320排螺旋CT用于诊断十二指肠憩室的临床意义。方法分析2021年5月至2022年5月北京市平谷区医院经上消化道造影或内镜检查证实的并已行320排螺旋CT检查的71例十二指肠憩室患者的临床资料,分析十二指肠憩室的直接征象、典型表现及伴发征象。结果71例患者共检出十二指肠憩室82个,单发61例,双发9例,多发1例。发生在十二指肠降段56例,水平段5例,降段与水平段均有10例。憩室直径<1.0 cm 3例,1.0~2.0 cm 29例,>2.0 cm 39例。憩室内成分为纯气体19个(23.17%);气液混合、气-液平面20个(24.39%);气体、食物残留混杂成分43个(52.44%)。71例患者中有31例合并胆道胰腺相关疾病。合并胆胰相关疾病组憩室位于降段的比例高于未合并胆胰相关疾病组,差异有统计学意义(P<0.05);两组的憩室大小占比比较,差异无统计学意义(P>0.05)。结论320排螺旋CT可很好地诊断十二指肠憩室,能及时发现相关的胆胰类并发症,具有重要的临床意义。
文摘Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and female urethral strictures are rare pathologies.They can cause symptoms,which can mimic commoner conditions,leading to delay in diagnosis and unnecessary delay in treatment.In this article,we discuss in detail the definition,symptoms,epidemiology,pathogenesis,diagnosis,and treatment option for these two conditions.Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.
