[Treatment of acute diverticulitis]. / Traitement actuel de la diverticulite colique.

In Western countries, diverticular disease is a frequent condition and the prevalence of which increases with age. Acute diverticulitis is its most frequent complication. CT-scan is now the best exam for diagnosis of acute diverticulitis, classification of its severity, and for follow-up. It can also, when necessary, allow percutaneous drainage of pericolic abscesses. Treatment of acute diverticulitis is most often conservative. Surgery outside acute events is now considered as a technique with extremely low morbidity and mortality. In this situation, laparoscopy represents nowadays the technique of choice for safe sigmoid surgery.

Hepatic portal gas in adults: review of the literature and presentation of a consecutive series of 11 cases.

BACKGROUND: Hepatic portal venous gas (HPVG) in adults is a rare entity. The underlying pathologic condition is usually an intestinal ischemia, but it has been reported in association with a variety of conditions. HYPOTHESIS: Miscomprehension of the underlying pathologic conditions has led to some confusion in the literature concerning its etiology, diagnostic methods, and clinical consequences. SETTING: Centre Hospitalier et Universitaire Vaudois, Lausanne, Switzerland, and District Hospital of Morges, Morges, Switzerland. METHOD: Between February 1, 1995, and May 30, 2000, eleven cases of HPVG were treated. These cases were retrospectively reviewed, together with a review of the literature to define the clinical significance of HPVG, the role of the computed tomographic scan, and the necessity of performing systematic emergency exploratory surgery. RESULTS: Two groups have to be distinguished-those who have HPVG with associated pneumatosis intestinalis and those who have HPVG without associated pneumatosis intestinalis. When associated with pneumatosis intestinalis, the cause is usually an intestinal ischemia and in a symptomatic patient it justifies systematic exploratory surgery. An abdominal computed tomographic scan including lung window settings to better identify air in the bowel wall will distinguish between these 2 groups. Pneumatosis intestinalis and HPVG due to bowel ischemia do not allow prediction of the severity of bowel wall damage. CONCLUSIONS: The cause of HPVG without pneumatosis intestinalis is variable. Good knowledge of the possible causes combined with the clinical picture and the abdominal computed tomographic scan is required to correctly identify the underlying cause of HPVG and to avoid unnecessary surgery.