Manejo y resultados de pacientes con diverticulitis aguda: experiencia de cinco años en el Hospital San Vicente Fundación / Management and results of patients with acute diverticulitis. Five year-experience at the San Vicente Fundación Hospital

Introducción. Los datos epidemiológicos de la diverticulitis en Colombia son limitados. El objetivo de este artículo fue caracterizar una población que ingresó con diverticulitis aguda al Hospital Universitario San Vicente Fundación, un centro de referencia de la ciudad de Medellín, Colombia, para analizar la presentación y comportamiento de la enfermedad en la población local, con estadísticas propias y desenlaces de la enfermedad en los últimos años. Métodos. Estudio observacional retrospectivo, descriptivo, entre enero de 2015 y diciembre de 2019. Se hizo un estudio exploratorio uni-, bi- y multivariado de factores de riesgo para fallo en el tratamiento y la mortalidad. Resultados. Se incluyeron 103 pacientes. Se presentó principalmente en mujeres y la edad promedio fue de 65 años. La diverticulitis Hinchey Ia fue la más frecuente (41,7 %) y el manejo médico fue exitoso en todos los casos, mientras que en las tipo III y IV, todos se manejaron de forma quirúrgica, con tasas de éxito entre el 50 y el 64 %. La presencia de signos de irritación peritoneal al examen físico, el recuento de leucocitos y la PCR, el ingreso a la Unidad de Cuidados Intensivos y la mortalidad aumentaron de forma directamente proporcional con el estadio de Hinchey. Conclusiones. Existe una relación directamente proporcional entre la clasificación de Hinchey y los signos de respuesta inflamatoria clínicos y paraclínicos, la necesidad de manejo quirúrgico, la estancia en la Unidad de Cuidados Intensivos y la mortalidad.

Introduction. Epidemiological data on diverticulitis in Colombia are limited. The objective of this article was to characterize a population that was admitted with acute diverticulitis to the San Vicente Fundación University Hospital, a reference center in the city of Medellín, Colombia, to analyze the presentation and behavior of the disease in the local population, with its own statistics, and outcomes of the disease in recent years. Methods. Retrospective descriptive observational study between January 2015 and December 2019. An exploratory uni-, bi- and multivariate study of risk factors for treatment failure and mortality was performed. Results. A total of 103 patients were included. The most frequent Hinchey classification was Ia (41.7%). It occurs mainly in women, mean age 65 years. Hinchey Ia diverticulitis is the most frequent and medical management is successful in 100% of cases; while in III and IV, 100% were managed surgically with success rates between 50 and 64%. The presence of peritoneal signs on physical examination, leukocyte count and CRP, ICU admission and mortality increased directly proportional with Hinchey stage. Conclusions. There is a directly proportional relationship between Hinchey staging with clinical and paraclinical signs of inflammatory response, need for surgical management, ICU stay and mortality.

Píloro doble. Presentación de un caso y revisión de la literatura / Double pylorus. Case report and literature review

RESUMEN El doble píloro es una comunicación anormal entre el antro gástrico y el bulbo duodenal y representa un raro hallazgo endoscópico. Se presentó un paciente de 80 años de edad, con antecedentes de hipertensión arterial, fumador inveterado, tomador de aspirina, que presentó melena aproximadamente 15 días antes del ingreso. La videoendoscopia reveló la existencia de dos orificios similares en el antro, que se comunicaban con el bulbo duodenal de manera independiente que fueron catalogados como píloros. La comunicación se constató con el paso del endoscopio a su través. Se impuso tratamiento médico con inhibidores de la bomba de protones y la evolución fue favorable. Es el cuarto caso reportado en la literatura en nuestro país y el primero en la provincia de Matanzas.

ABSTRACT Double pylorus is an abnormal communication between the gastric antrum and the duodenal bulb and represents a rare endoscopic finding. It is presented the case of a patient aged 80 years, with a background of arterial hypertension, inveterate smoker, taking aspirin, who presented melena about 15 days before the admission. The video-endoscopy revealed the existence of two similar orifices in the antrum that were independently communicating with the duodenal bulb and they went catalogued like pylori. The communication was proved by passing the endoscope through it. He was treated with IBP (the Spanish acronym for proton bomb inhibitors) and the evolution was favorable. It is the fourth case reported in the literature in Cuba and the first one in Matanzas.

Consenso mexicano sobre el diagnóstico y tratamiento de la enfermedad diverticular del colon / The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon

Desde la publicación en 2008 de las guías de diagnóstico y tratamiento de la enfermedad diverticular del colon de la Asociación Mexicana de Gastroenterología ha habido avances significativos en el conocimiento de esta enfermedad. Se realizó una revisión sistemática de la literatura en PubMed de enero de 2008 a julio de 2018 con el fin de revisar y actualizar las guías 2008 y proporcionar nuevas recomendaciones basadas en la evidencia. Se incluyeron todas las publicaciones en español e inglés, de alta calidad. Se redactaron los enunciados, que fueron votados utilizando el método Delphi. Se estableció la calidad de la evidencia y la fuerza de las recomendaciones según el sistema GRADE para cada enunciado. Cuarenta y tres enunciados fueron finalmente votados y calificados. Se informan nuevos datos sobre definición, clasificación, epidemiología, fisiopatología y factores de riesgo. Se revisó con especial énfasis la utilidad de la tomografía computarizada y de la colonoscopia, así como los métodos endoscópicos para el control de la hemorragia. Se discutió sobre el tratamiento ambulatorio de la diverticulitis no complicada, el papel de la rifaximina y la mesalazina, en el manejo de la diverticulitis aguda complicada tanto en sus alternativas mínimamente invasivas hasta las opciones quirúrgicas con énfasis en sus indicaciones, limitaciones y contraindicaciones. Los nuevos enunciados proporcionan directrices basadas en la evidencia actualizada. Se presentan la discusión, el grado y la fuerza de la recomendación de cada uno de ellos.

Imágenes en divertículos del tubo digestivo: localizaciones infrecuentes. serie de casos / Imaging in infrequent digestive diverticula: case series

Los divertículos se pueden localizar en todo el tubo digestivo (TD): esófago, estómago, duodeno, yeyuno, íleon, apéndice, colon. Son infrecuentes, salvo en colon. Sus manifestaciones clínicas son inespecíficas, con difícil diagnóstico y mayor riesgo de complicaciones. Se presenta una serie de divertículos digestivos atípicos, mostrando las características imagenológicas multimodalidad y describir los hallazgos claves. Es una revisión retrospectiva en el archivo computacional de nuestra institución. Selección de casos de divertículos de presentación inhabitual por sus características, localización u origen. En esófago los divertículos de Zenker y Killian-Jamieson. En estómago los divertículos gástricos infrecuentes. Los divertículos en intestino delgado tienen baja prevalencia, el más frecuente en duodeno. Los divertículos colónicos pueden tener una localización o presentación atípica. Los divertículos apendiculares y Meckel presentan baja prevalencia. Los divertículos digestivos son infrecuentes, excepto los colónicos. El radiólogo debe estar familiarizado con las diferentes ubicaciones de ellos, para reconocerlos y poder diagnosticarlos.

Diverticula may occur in any segment of the digestive tract: esophagus, stomach, duodenum, jejunum, ileum, appendix, and colon. Its clinical manifestations are nonspecifi which may turn diffiult an early diagnosis, leading to a higher risk of complications. We present a cases serie of atypical digestive diverticula and to describe the fidings on the different imaging techniques. We performed a retrospective review on the imaging computer archives of our institution. The atypical diverticula were selected. Zenker and Killian-Jamieson's diverticulums in esophagus. In stomach ocasionally gastric diverticula. Diverticula in small intestine have a low prevalence, the most common location is duodenum. Colonic diverticula may present a atypical location or presentation. The appendicular and Meckel diverticuli are uncommon. The digestive diverticula are uncommon, except the colonic ones. The radiologist must be familiar with it's different locations in order to be able to recognize it and diagnose it properly.

Divertículo colónico gigante: Dos nuevos casos en la literatura / Giant Colonic Diverticulum: Two New Cases in Literature / Divertículo gigante de colom: Dois novos casos na literatura

Introducción: El divertículo colónico gigante es una presentación rara de la enfermedad diverticular del colon descrita por primera vez en la literatura francesa en 1946; se define cuando su diámetro es mayor a 4cm. Objetivo: Adicionar a la literatura dos casos diagnosticados en la Fundación Oftalmológica de Santander, Colombia debido al bajo número de casos reportados en la actualidad; además, mencionar los principales datos encontrados en la literatura en cuanto a la epidemiología, la presentación clínica, los diagnósticos diferenciales, las herramientas diagnósticas más importantes a tener en cuenta y la diferencia de los esquemas de tratamiento. Presentación de los casos: Se presentan dos casos de pacientes con clínica de dolor abdominal para los cuales se solicitaron estudios imagenológicos que permitieron realizar un adecuado diagnóstico de divertículo colónico gigante; el primero fue manejado de manera conservadora con antibiótico-terapia y el segundo de forma quirúrgica con resección de colon transverso con anastomosis primaria. Conclusiones: El divertículo colónico gigante es una entidad poco frecuente y por tanto escasamente descrita en la literatura asociada en su mayoría con la diverticulosis. Se presenta con una clínica muy diversa, sugestiva de múltiples patologías abdominales que deben ser descartadas para poder realizar un adecuado diagnóstico por medio de técnicas de imagen como la radiografía, el colon por enema y la tomografía axial computarizada que representan las principales herramientas diagnósticas de esta entidad. El tratamiento de elección es la intervención quirúrgica, sin embargo, en contextos determinados como pacientes ancianos, asintomáticos y con alto riesgo quirúrgico puede manejarse de manera conservadora. Su importancia a pesar de la baja prevalencia radica en la necesidad del diagnóstico oportuno para evitar una alta tasa de complicaciones. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Divertículo colónico gigante: Dos nuevos casos en la literatura MedUNAB 2017; 20(2): 235-243].

Introduction: The giant colonic diverticulum is a rare presentation of the diverticular disease of the colon described for the first time in French literature in 1946 and it is defined when its diameter is greater than 4cm. Objective: To add to the literature two more cases diagnosed in the Ophthalmological Foundation of Santander, Colombia due to the low number of cases reported today; in addition, to mention the main data found in the literature in terms of epidemiology, clinical presentation, differential diagnoses, the most important diagnostic tools to consider and the difference of treatment schemes for it. Presentation of the cases: Two cases of patients with abdominal pain clinic for whom imaging studies were requested that allowed an adequate diagnosis of giant colonic diverticulum are presented. The first one was managed conservatively with antibiotic therapy and the second one was surgically treated with a transverse colon resection with primary anastomosis. Conclusions: The giant colonic diverticulum is a rare entity and therefore poorly described in the literature associated mostly with diverticulosis. It is presented with a very diverse clinic, suggestive of multiple abdominal pathologies that must be discarded in order to perform an adequate diagnosis by means of imaging techniques such as x-rays, colon by enema and computerized axial tomography scan which represent the main diagnostic tools for this entity. The treatment of choice is surgery; however, in determined contexts such as with elderly patients who are asymptomatic and with a high surgical risk can be managed conservatively. Its importance despite its low prevalence lies in the need for timely diagnosis to avoid a high rate of complications. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Giant Colonic Diverticulum: Two New Cases in Literature. MedUNAB 2017; 20(2): 235-243].

Introdução: O divertículo colônico gigante é uma apresentação rara da doença diverticular do cólon descrita pela primeira vez na literatura francesa em 1946; é definido quando seu diâmetro é maior que 4cm. Objetivo: Adicionar à literatura dois casos diagnosticados na Fundação Oftalmológica de Santander, Colômbia devido ao baixo número de casos relatados no presente; Além disso, mencionar os principais dados encontrados na literatura em termos de epidemiologia, apresentação clínica, diagnósticos diferenciais, as ferramentas de diagnóstico mais importantes a serem consideradas e a diferença de esquemas de tratamento. Apresentação dos casos: Foram apresentados dois casos de pacientes com clínica de dor abdominal para os quais foram solicitados estudos de imagem que permitiram um diagnóstico adequado de divertículo colônico gigante; O primeiro foi administrado de forma conservadora com terapia antibiótica e o segundo foi tratado cirurgicamente com ressecção do colo cruzado com anastomose primária. Conclusões: Divertículo colônico gigante é uma entidade rara e, portanto, pouco descrita na literatura associada principalmente à diverticulose. É apresentado um quadro clínico muito diverso, sugestivo de múltiplas patologias abdominais que devem ser descartadas para poder fazer um diagnóstico adequado por meio de técnicas da imagem como a radiografia, o cólon por enema e tomografia axial computorizada que representam as principais ferramentas Diagnóstico desta entidade. O tratamento a escolher é a cirurgia, no entanto, em determinados casos como é a dos pacientes idosos, assintomáticos e com alto risco cirúrgico podem ser tratados de forma tradicional. Sua importância, apesar da baixa prevalência, reside na necessidade de um diagnóstico oportuno para evitar uma alta taxa de complicações. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Divertículo gigante de colom: Dois novos casos na literatura. MedUNAB 2017; 20(2): 235-243].

Diverticulitis y neumoperitoneo: una condición no siempre quirúrgica / Diverticulitis and pneumoperitoneum: A condition that not always is surgical

Introducción. La enfermedad diverticular es una condición degenerativa usual del colon y motivo de consulta frecuente por dolor abdominal en los servicios de urgencias. Una de las complicaciones frecuentes de esta enfermedad es la perforación del divertículo, lo cual puede resultar en neumoperitoneo, una colección abdominal o una peritonitis localizada o generalizada que, en algunos casos, requiere drenaje de la colección o tratamiento quirúrgico. Se presentan tres casos de pacientes con diverticulitis y neumoperitoneo, que fueron tratados en forma conservadora y tuvieron una evolución satisfactoria. Objetivos. Los objetivos del estudio fueron determinar las características de los pacientes con diverticulitis y neumoperitoneo y evaluar su evolución con tratamiento médico. Material y métodos. Se hizo una revisión retrospectiva de una base de datos. Se evaluó la incidencia de neumoperitoneo, las características demográficas y la evolución con el tratamiento médico instaurado, en pacientes con diverticulitis atendidos en la Fundación Clínica Shaio, durante el periodo comprendido entre octubre de 2014 y octubre de 2015. Resultados. De 60 pacientes con diagnóstico de diverticulitis, en 3 se presentó neumoperitoneo, sin evidencia de colecciones o líquido libre abdominales. Estos tres pacientes fueron manejados conservadoramente con antibióticos, obteniéndose una mortalidad nula a corto plazo, sin necesidad de manejo quirúrgico en esta hospitalización. Conclusión. La incidencia de diverticulitis asociada a neumoperitoneo sin colecciones abdominales o líquido libre, es poco frecuente en el servicio de urgencias. En pacientes seleccionados, se recomienda un tratamiento inicial conservador, con antibiótico y control sintomático, con lo cual se obtienen buenos resultados.

Introduction: Diverticular disease is an usual degenerative condition of the colon and frequent cause of consultation in the emergency departments because of abdominal pain. Perforation is a common complication and may result in pneumoperitoneum, an abdominal collection or peritonitis requiring drainage or surgical management. We report three patients with diverticulitis and pneumoperitoneum who received conservative treatment with adequate evolution. Objective: The aims of this study were to determine the characteristics of the patients with diverticulitis and pneumoperitoneum, and to evaluate their clinical course under medical nonoperative treatmet. Material and methods: Retrospective review of a prospectively set database. We evaluated the incidence of diverticulitis and pneumoperitoneum at the Shaio Clinic Foundation, Bogotá, Colombia, in the period October 2014 and October 2015, and additionaly described the outcomes with the medical management. Results: Among 60 patients with the diagnosis of diverticulitis, three had pneumoperitoneum (incidence of 5%) with no evidence of abdominal collections or free fluid in the peritoneal cavity. The three patients were managed with conservative antibiotic treatment, ending without short term mortality and no need of surgical intervention during their hospital stay. Conclusion: The incidence of diverticulitis and pneumoperitoneum without collections or free liquid is considerable. We believe that in select patients the conservative management should be the first line of treatment with a low rate of morbidity and mortality.

Analysis of Risk Factors for Colonic Diverticular Bleeding: A Matched Case-Control Study

BACKGROUND/AIMS: Diverticular bleeding can occasionally cause massive bleeding that requires urgent colonoscopy (CS) and treatment. The aim of this study was to identify significant risk factors for colonic diverticular hemorrhage. METHODS: Between January 2009 and December 2012, 26,602 patients underwent CS at our institution. One hundred twenty-three patients underwent an urgent CS due to acute lower gastrointestinal hemorrhage. Seventy-two patients were diagnosed with colonic diverticular hemorrhage. One hundred forty-nine age- and sex-matched controls were selected from the patients with nonbleeding diverticula who underwent CS during the same period. The relationship of risk factors to diverticular bleeding was compared between the cases and controls. RESULTS: Uni- and multivariate conditional logistic regression analyses demonstrated that the use of nonsteroidal anti-inflammatory drugs (odds ratio [OR], 14.70; 95% confidence interval [CI], 3.89 to 55.80; p<0.0001), as well as the presence of cerebrovascular disease (OR, 8.66; 95% CI, 2.33 to 32.10; p=0.00126), and hyperuricemia (OR, 15.5; 95% CI, 1.74 to 138.00; p=0.014) remained statistically significant predictors of diverticular bleeding. CONCLUSIONS: Nonsteroidal anti-inflammatory drugs, cerebrovascular disease and hyperuricemia were significant risks for colonic diverticular hemorrhage. The knowledge obtained from this study may provide some insight into the diagnostic process for patients with lower gastrointestinal bleeding.

Yellow nail syndrome, Phrygian cap gallbladder and Saint's triad? Case report / ¿Síndrome de uñas amarillas, vesícula biliar en gorro frigio y tríada de Saint? Reporte de caso

The yellow nail syndrome is scarcely described and is characterized by dystrophic nails, pulmonary disturbances and lymphedema of extremities. A case of this syndrome is reported in an 89-year-old Brazilian woman with well-controlled diabetes mellitus and arterial hypertension. Additionally to the typical syndrome, the patient also presented pincer nails and yellow-brownish chromonychia. She was admitted because of acute abdominal symptoms associated with sigmoid diverticulitis and an adjacent abscess. The imaging studies revealed pulmonary and pleural changes, in addition to pericardial effusion. Incidentally, the features of Phrygian cap gallbladder anomaly were found. Neither diverticular disease nor gallbladder disorders have been related to yellow nail syndrome. In the present case study, the synchronism between some of these conditions could be casual; but diverticular disease, cholelithiasis, and diaphragmatic hernia are associated in the Saint's triad. MÉD UIS. 2015;28(3):387-91.

El síndrome de las uñas amarillas está poco descrito y se caracteriza por uñas distróficas, trastornos pulmonares y linfedema de las extremidades. Se presenta un caso de este síndrome en una mujer brasileña de 89 años de edad con diabetes mellitus bien controlada e hipertensión arterial. Adicionalmente al síndrome típico, la paciente presentó uñas en pinza y cromoniquia amarillo-marrón. La paciente fue admitida debido a síntomas abdominales agudos asociados con diverticulitis del sigmoide y un absceso adyacente. Los estudios de imágenes revelaron cambios pulmonares y pleurales, además de un derrame pericárdico. Incidentalmente, se encontraron anomalías características de vesícula biliar en gorro frigio. Ni la enfermedad diverticular ni los trastornos de la vesícula biliar se han relacionado con el síndrome de las uñas amarillas. En el presente estudio de caso, el sincronismo entre algunas de estas condiciones podría ser casual, pero la enfermedad diverticular, colelitiasis, y hernia hiatal se asocian a esta tríada. MÉD UIS. 2015;28(3):387-91.

Are There Any Association Between Colonic Diverticula and Bowel Symptoms?

No abstract available.

Colonic Diverticulitis Complicating Colo-ovarian Fistula and Tuboovarian Abscess Formation in on Old Woman

The inflammation of colonic diverticulum, diverticulitis, is occasionally accompanied by several complications, such as bleeding, bowel obstruction, fistula and abscess formation. Both colo-ovarian fistula and tuboovarian abscess formation, as complications of diverticulitis, are rare. Here, we report a case of colonic diverticulitis which ultimately resulted in colo-ovarian fistula and tuboovarian abscess formation. A 76-year-old female was presented with lower abdominal pain, diarrhea and intermittent hematochezia for about 1 month. According to the abdominal computed tomography, tuboovarian abscess was shown to adhere to the inflamed sigmoid diverticulum. Sigmoidoscopy revealed pus flowing from the opening of the diverticulum at the sigmoid colon. Hence, the patient underwent oophorosalpingectomy and low anterior resection. Thereafter, she was treated with bowel rest and broad spectrum antibiotics, and finally recovered. Although rare, colonic diverticulitis may result in colo-ovarian fistula causing tuboovarian abscess formation in postmenopausal patients. Early recognition of the condition and appropriate treatment, including surgery and antibiotics, are necessary in order to achieve full recovery from complicated diverticulitis.

Divertículo sigmoideo gigante complicado en un paciente diabético / Complicated sigmoid giant diverticulum seen in a diabetic patient

La divertículosis colónica es una entidad frecuente en los países occidentales y representa una de las primeras enfermedades gastrointestinales con mayor repercusión en cuanto a costos de salud. La prevalencia de esta dolencia aumenta con la edad, aproximadamente hasta un 50 porciento de los adultos mayores de 60 años la padecen. Se señala que una de las razones de este incremento es el bajo consumo de fibras en la dieta y una interacción compleja entre la fibra dietética, la estructura de la pared colónica y la motilidad intestinal. El divertículo gigante de colon (mayor de 4 cm) es una entidad rara, hemos encontrado 156 publicados en la literatura. El presente caso es un paciente masculino de 47 años de edad con múltiples comorbilidades que hicieron su forma de presentación inusual y difícil su diagnóstico(AU)

Colonic diverticulosis is a frequent pathology in Western countries and represents one of the major gastrointestinal diseases with higher impact on health costs. Its prevalence increases with the age and is present in almost 50 percent of adults over 60 years old living in these countries. It has been said that among the reasons for this rise is the low dietary fiber consumption, and the complex interaction among the dietary fiber, the colon wall structure and the intestinal motility. Giant colonic diverticulum (over 4 cm long) is a rare entity; we have found just 156 cases reported in literature. This is the case of a 47 years-old male patient, who presented with multiple comorbidities that cause the unusual presentation of the diverticulum and create difficulties in diagnosing it(AU)

Giant Ascending Colonic Diverticulum Presenting With Intussusception

Diverticular disease of the colon is a common disease, and its incidence is increasing gradually. A giant colonic diverticulum (GCD) is a rare entity and is defined as a diverticulum greater than 4 cm in size. It mainly arises from the sigmoid colon, and possible etiology is a ball-valve mechanism permitting progressive enlargement. A plain abdominal X-ray can be helpful to make a diagnosis initially, and a barium enema and abdominal computed tomography may confirm the diagnosis. Surgical intervention is a definite treatment for a GCD. We report a case of an ascending GCD presenting with intussusception in a young adult.

Giant Ascending Colonic Diverticulum Presenting With Intussusception

Diverticular disease of the colon is a common disease, and its incidence is increasing gradually. A giant colonic diverticulum (GCD) is a rare entity and is defined as a diverticulum greater than 4 cm in size. It mainly arises from the sigmoid colon, and possible etiology is a ball-valve mechanism permitting progressive enlargement. A plain abdominal X-ray can be helpful to make a diagnosis initially, and a barium enema and abdominal computed tomography may confirm the diagnosis. Surgical intervention is a definite treatment for a GCD. We report a case of an ascending GCD presenting with intussusception in a young adult.

Pathophysiology of Colon Diverticulum / 대한내과학회지

Although the pathogenesis of diverticulum remains unclear, traditionally it has been thought to result from structural abnormalities of the colonic wall, deficiencies of dietary fiber, or disordered intestinal motility. More recently, new pathophysiologic factors including inflammation, gut flora, neurotransmitters, visceral hypersensitivity, and chemical mediators are proposed, and their mechanism of interactions in developing diverticulum is quite complex and currently poorly understood. Future studies are needed to find out the multifaceted pathogenesis of diverticulum, ultimately for the treatment and prevention of disease.

Diagnosis and Treatment of Colon Diverticulitis / 대한내과학회지

Colonic diverticular disease is the common conditions in industrialized and westernized countries, but it is relatively rare in areas such as Asia. Colonic diverticula are asymptomatic in most cases, only 10-25% develop diverticulitis and 1% finally gets surgery. The location of colonic diverticulitis are significantly different in Western countries and Asia. Left-sided diverticulitis is common in Western countries, while in Asians, right-sided diverticulitis is more prevalent. A CT scans is commonly used to diagnose diverticulitis and its complication such as abscess, obstruction, fistula and perforation. It also has been used in percutaneous drainage of diverticular abscess and predicting the success of medical therapy. After resolution of clinical attack of diverticulitis, colonoscopy can be performed to exclude colon cancer. The current therapeutic approaches for colonic diverticulitis are relieving symptoms and preventing complications. Uncomplicated diverticulitis is successfully treated with antibiotics, bowel rest and pain control, while complicated diverticulitis require surgical consultation. Treatment strategy of recurrent diverticulitis depends on age and comorbid diseases as well as the frequency and severity of subsequent attacks.

A Case of Acute Colonic Diverticulitis as a Complication of Colonoscopy

Colonoscopy is a good diagnostic tool and facilitates treatment of various colonic diseases. Nevertheless, it can induce many serious complications such as perforation and hemorrhage. Diverticulitis has also been reported as a serious complication of colonoscopy, with an incidence ranging from 0.04% to 0.08%. A 44-year-old male with chronic hepatitis B was presented with general weakness, myalgia, and febrile sensation. After admission for evaluation, pneumonia detected in the left upper and lower lobe and treated. We performed colonoscopy for screening and found multiple colonic diverticula in the right side of the colon. After 48 hours, the patient complained of abdominal pain and febrile sensation. Physical examination revealed tenderness in the right side of the abdomen. Abdomen-pelvis computed tomography showed bowel wall thickening of the cecum and ascending colon and multiple inflamed diverticula at the cecum with pericolic fat infiltration and fluid collection. We diagnosed the patient with acute diverticulitis after colonoscopy. Thereafter, he was treated with bowel rest and broad-spectrum intravenous antibiotics, and recovered. With a review of the relevant literature, we report a case of acute colonic diverticulitis as a complication of colonoscopy.