Operative Treatment of the Colonic Diverticular Disease

PURPOSE: In recent years, colonic diverticular disease has increased rapidly because of high intraluminal pressure in the colon due to the low fiber westernized diet and the increasing number of elderly people. Furthermore, emergency operation is required in many cases. Therefore, the aim of this study is proposed to review the optimal treatment guide. METHODS: This study is a retrospective review of the hospital records of 34 patients who underwent surgical treatment for colonic diverticular diseases at the National Medical Center from March 1992 to July 2003. RESULTS: The patients consisted of 23 males and 11 females, with mean age of 49 years. The lesion sites were cecum (62%), sigmoid colon (20%), ascending colon (9%), transverse colon (6%) and descending colon (3%), in descending orders of frequency. The patients were staged by Thorsen classification at the right colon and by Hinchey classification at the other sites. At the right colon, there were no cases of stage IV and 2 of bleeding. At the transverse colon and left colon, there were 3 cases of stage II, 5 of III, and 2 of IV. For the right colon, all patients underwent one- stage operation. For the other sites, 3 one- stage operations and 7 two- stage operations were performed. Major or minor postoperative complications occurred in 12 patients, including 2 mortality cases. Among them, 2 cases with colocutaneous fistulas might have been prevented if the operation had been made on the basis of stage. CONCLUSION: Because diverticular disease occurs at the various sites of the colon and has potential risk, it is important that patient treatment is based on stage.

CT of Blunt Renal Injury; Correation of Renal Injury and Retroperitoneal Hematoma

PURPOSE: The this study was performed to evaluate whether the extent and location of retroperitoneal hematoma correlate with the severity of renal injury. MATERIALS AND METHODS: We evaluated the CT findings of 27 patients with renal trauma. The retroperitoneal hematoma were subdivided into perirenal hematoma(PRH), anterior pararenal hematoma(APH), posterior pararenal hematoma(PPH) and interfascial hematoma(IFH) The perirenal hematoma (PRH) was classified as grade I, II and III according to the amount of hematoma. RESULTS: PRH was present in all 27, PPH in 8, IFH in 3 patients and APH was not observed. Grade I PRH was present in 7 (70%) of 10 minor injury (contusion, intrarenal hematoma), grade Ill PRH in 2(20%) of 10 minor injury and in 7 (41.2%) of 17 major and catastrophic injury (laceration, fracture, shattered kidney and renal pedicle injury). Eight PPH were present only in the major and catastrophic injury and 3 IFH in each of intrarenal hematoma, laceraton and pedicle injury. CONCLUSION: The location and extent of PRH and PPH correlated somewhat with the severity of renal injury, while the presence of IFH and APH did not correlate with severity of the renal inury.