ABSTRACT
This article reviews the evaluation and management of several gastrointestinal disorders that are commonly encountered by gastroenterologists and primary care physicians. With a focus on newer therapies, we discuss the management of chronic constipation, irritable bowel syndrome, Clostridioides difficile infection, gastroparesis, steatotic liver disease, and diverticulitis.
Subject(s)
Constipation , Gastrointestinal Diseases , Humans , Gastrointestinal Diseases/therapy , Constipation/therapy , Irritable Bowel Syndrome/therapy , Gastroparesis/therapy , Gastroparesis/diagnosis , Gastroparesis/physiopathology , Diverticulitis/therapy , Diverticulitis/diagnosisABSTRACT
Diverticulosis and diverticulitis remain common diagnoses in western countries, and the incidence continues to rise. Diverticulitis accounts for roughly one-third of admissions to acute care hospitals annually, with even more patients being treated as outpatients due to improved understanding of risk stratification and the natural history of disease progression. Thus, having a thorough understanding of the etiology of the disease in conjunction with computed tomography findings and patient presentation can help dictate the appropriate treatment.
Subject(s)
Diverticulitis , Humans , Diverticulitis/therapy , Diverticulitis/diagnosis , Tomography, X-Ray Computed , Diverticulitis, Colonic/therapy , Diverticulitis, Colonic/diagnosis , Diverticulitis, Colonic/epidemiologyABSTRACT
A previously healthy 55-year-old male patient presented repeatedly to the emergency department with severe episodic periumbilical abdominal pain. After an extensive diagnostic work-up and subsequent clinical deterioration, appendiceal diverticulitis was diagnosed. We identified a correlation of white blood cell counts and possibly faecal calprotectin with the clinical presentation. We suggest that appendiceal diverticulitis should be considered in middle-aged patients with recurrent episodes of abdominal pain that correlate with laboratory markers of inflammation.
Subject(s)
Abdominal Pain , Humans , Male , Middle Aged , Abdominal Pain/etiology , Diverticulitis/complications , Diverticulitis/diagnosis , Diagnosis, DifferentialSubject(s)
Diverticulitis , Humans , Acute Disease , Diverticulitis/diagnosis , Diverticulitis, Colonic/diagnosis , Male , Female , Middle Aged , Aged , Risk AssessmentABSTRACT
BACKGROUND: The aims of this study were to summarize the clinical presentation and histological results of 20 cases of complicated Meckel diverticulum (MD) who were presumed to have acute appendicitis before surgery, as well as to improve the diagnosis and treatment of complicated MD in children. MATERIALS AND METHODS: We retrospectively reviewed the records of 20 complicated MD admitted to our institution who were preoperatively diagnosed with acute appendicitis from January 2012 to January 2019. Patients were divided into the perforated MD group and the Meckel's diverticulitis group. Patient demographics, clinical manifestations, laboratory data, auxiliary examinations, surgical methods, and the result of heterotopic tissue were recorded. RESULTS: A total of 20 cases of complicated MD (perforated or diverticulitis) were identified. Children were aged from 3 to 13 years, with a mean age of 7.75 years (median 7.75; range, 1-13 years). Perforated Meckel's diverticulum occurred in 5 of 20 (25%) cases. For perforated MD versus diverticulitis, no significant differences were found between age, time to intervention, length of hospital stay, and distance from the ileo-cecal valve. Heterotopic tissue was confirmed on histopathology in 75% of all patients, including 10 cases of gastric mucosa, 3 cases of coexistent gastric mucosa and pancreatic tissue, and 2 cases of pancreatic tissue. All patients underwent diverticulectomy or partial ileal resection under laparoscopy or laparotomy; two cases combined with appendectomy owing to slight inflammation of the appendix. CONCLUSIONS: The most common presentation of symptomatic MD is painless rectal bleeding; however, it can present symptoms of acute abdomen mimicking acute appendicitis. The key point of diverticulectomy is to remove the ectopic mucosa completely.
Subject(s)
Appendicitis , Choristoma , Diverticulitis , Intestinal Perforation , Meckel Diverticulum , Child , Humans , Meckel Diverticulum/diagnosis , Meckel Diverticulum/surgery , Meckel Diverticulum/complications , Retrospective Studies , Appendicitis/diagnosis , Appendicitis/surgery , Diverticulitis/diagnosis , Diverticulitis/surgery , Diverticulitis/complications , Intestinal Perforation/etiology , Acute DiseaseABSTRACT
BACKGROUND: Despite its prevalence and associated morbidity, we remain limited in our ability to predict the course of a patient with diverticular disease. Although several clinical and genetic risk factors have been identified, we do not know how these factors relate to one another. OBJECTIVE: Our aim was to determine whether a polygenic risk score could improve risk prediction for diverticulitis and recurrent diverticulitis compared with a model using only clinical factors. DESIGN: This is an observational study. SETTING: The study examines the predictive ability of a polygenic risk score for diverticulitis developed using prior genome-wide association studies and validated using the MyCode biobank. PATIENTS: This study included patients of European ancestry in the Geisinger Health System who were enrolled in the MyCode Community Health biobanking program. MAIN OUTCOME MEASURES: The ability of a polygenic risk score to predict diverticulosis, diverticulitis, and recurrent diverticulitis was the main outcome measure of this study. RESULTS: A total of 60,861 patients were included, of whom 9912 (16.3%) had diverticulosis or diverticulitis (5015 with diverticulosis and 4897 with diverticulitis). When divided into deciles, our polygenic risk score stratified patients by risk of both diverticulosis and diverticulitis with a 2-fold difference in disease risk between the highest and lowest deciles for diverticulitis and a 4.8-fold difference for recurrent complicated diverticulitis. When compared with clinical factors alone, our polygenic risk score was able to improve risk prediction of recurrent diverticulitis. LIMITATIONS: Our population is largely located in a single geographic region and were classified by disease status, using international classification of diseases codes. CONCLUSIONS: This predictive model stratifies patients based on genetic risk for diverticular disease. The increased frequency of recurrent disease in our high-risk patients suggests that a polygenic risk score, in addition to other factors, may help guide the discussion regarding surgical intervention. See Video Abstract . DESARROLLO DE UNA PUNTUACIN DE RIESGO POLIGNICO PARA PREDECIR LA DIVERTICULITIS: ANTECEDENTES:A pesar de su prevalencia y morbilidad asociada, nuestra capacidad para predecir el curso en un paciente con enfermedad diverticular sigue siendo limitada. Si bien se han identificado varios factores de riesgo clínicos y genéticos, no sabemos cómo se relacionan estos factores entre sí.OBJETIVO:Determinar si una puntuación de riesgo poligénico podría mejorar la predicción del riesgo de diverticulitis y diverticulitis recurrente en comparación con un modelo que utiliza solo factores clínicos.DISEÑO:Un estudio observacional que examina la capacidad predictiva de una puntuación de riesgo poligénico para la diverticulitis desarrollada usando estudios previos de asociación amplia del genoma y validada usando el biobanco MyCode.ÁMBITOS Y PACIENTES:Pacientes de ascendencia europea en el Sistema de Salud Geisinger que estaban inscritos en el programa de biobancos MyCode Community Health.PRINCIPALES MEDIDAS DE VALORACIÓN:La capacidad de una puntuación de riesgo poligénico para predecir diverticulosis, diverticulitis y diverticulitis recurrente.RESULTADOS:Se incluyeron un total de 60.861 pacientes, de los cuales 9.912 (16,3%) presentaban diverticulosis o diverticulitis (5.015 con diverticulosis y 4.897 con diverticulitis). Cuando se dividió en deciles, nuestra puntuación de riesgo poligénico estratificó a los pacientes según el riesgo de diverticulosis y diverticulitis con una diferencia de 2 veces en el riesgo de enfermedad entre los deciles más alto y más bajo para diverticulitis y una diferencia de 4,8 veces para diverticulitis complicada recurrente. En comparación con los factores clínicos solos, nuestra puntuación de riesgo poligénico pudo mejorar la predicción del riesgo de diverticulitis recurrente.LIMITACIONES:Nuestra población se encuentra en gran parte en una sola región geográfica y se clasificó por estado de enfermedad utilizando códigos de clasificación internacional de enfermedades.CONCLUSIONES:Este modelo predictivo estratifica a los pacientes en función del riesgo genético de enfermedad diverticular. La mayor frecuencia de enfermedad recurrente en nuestros pacientes de alto riesgo sugiere que un puntaje de riesgo poligénico, además de otros factores, puede ayudar a guiar la discusión sobre la intervención quirúrgica. (Traducción- Dr. Ingrid Melo ).
Subject(s)
Diverticular Diseases , Diverticulitis, Colonic , Diverticulitis , Diverticulum , Humans , Diverticulitis, Colonic/diagnosis , Diverticulitis, Colonic/epidemiology , Diverticulitis, Colonic/genetics , Genetic Risk Score , Genome-Wide Association Study , Biological Specimen Banks , Diverticulitis/diagnosis , Diverticulitis/epidemiology , Diverticulitis/genetics , Diverticulum/complications , Diverticular Diseases/complicationsABSTRACT
Epiploic appendagitis is a rare cause of acute lower abdominal pain. Epiploic appendices are fat-filled serosal outpouchings of the cecum and sigmoid colon. Primary epiploic appendagitis (PEA) is characterized by epiploic inflammation caused by torsion of the appendage leading to ischemia or thrombosis of the appendage draining vein. Secondary epiploic appendagitis occurs in association with other inflammatory conditions of the abdomen or pelvis, most commonly diverticulitis. PEA is an important clinical mimicker of more severe causes of acute abdominal pain, such as diverticulitis, appendicitis, or gynaecological causes. The ease of access to computed tomography (CT), the diagnostic test of choice, has resulted in increased recognition of PEA. The classic CT findings of PEA are an ovoid mass measuring between 1.5 and 3.5 cm surrounded by a hyperattenuating/hyperdense ring with a centrally located hyperdense area. It is important to diagnose PEA as it is self-limiting and the correct diagnosis can prevent unnecessary hospital admission, antibiotic use, or even surgical intervention. We present a case of a 65-year-old male with a history of diverticulitis, presenting with left lower quadrant abdominal pain who was diagnosed with PEA based on CT and successfully managed with conservative treatment.
Subject(s)
Abdomen, Acute , Colitis, Ischemic , Connective Tissue Diseases , Diverticulitis , Male , Humans , Aged , Diagnosis, Differential , Abdominal Pain/diagnostic imaging , Abdominal Pain/etiology , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Diverticulitis/diagnosis , Diverticulitis/diagnostic imaging , Colitis, Ischemic/complications , Colitis, Ischemic/diagnosis , Connective Tissue Diseases/complications , Connective Tissue Diseases/diagnosisABSTRACT
A 40-year-old female with a 24-hour course of abdominal pain suggestive of acute appendicitis. An emergency laparotomy was performed, finding plastron in the cecum and ascending colon, color changes, with purulent liquid and 5 cm in diameter, fixed to Toldt's. It was decided to perform a right hemicolectomy with an ileotransverse end-to-side anastomosis with adequate postsurgical evolution. The histopathological report showed acute purulent diverticulitis of the cecum, which is very low incidence in the Mexican population, that's why this case report is carried out.
Mujer de 40 de años con cuadro de dolor abdominal de 24 h de evolución clínicamente sugestiva de apendicitis aguda. Se realiza laparotomía de urgencia, encontrando plastrón en ciego y colon ascendente, irregular, pétreo, con cambios de coloración, de 5 cm de diámetro, fijo a la fascia de Toldt, con líquido purulento. Se decide realizar hemicolectomía derecha con ileotransverso anastomosis terminolateral, con adecuada evolución posquirúrgica. El reporte histopatológico mostró diverticulitis aguda purulenta de ciego, lo cual es de baja incidencia en la población mexicana, motivo por el que se realiza este reporte de caso.
Subject(s)
Appendicitis , Cecal Diseases , Diverticulitis , Female , Humans , Adult , Cecal Diseases/diagnosis , Cecal Diseases/surgery , Diverticulitis/complications , Diverticulitis/diagnosis , Diverticulitis/surgery , Cecum/surgery , Appendicitis/diagnosis , Appendicitis/surgery , Colectomy , Diagnosis, DifferentialABSTRACT
Duodenal diverticula are the second most common type of digestive diverticula after those in the colon. They are present in approximately 27% of patients who undergo upper digestive endoscopy. Most of these diverticula, especially those located near the papilla, are asymptomatic. However, in rare cases, they can be associated with obstructive jaundice (Lemmel Syndrome), bacterial infection, pancreatitis, or bleeding. In this report, we present two cases of acute obstructive pancreatitis caused by duodenal diverticulitis. Both patients were managed conservatively, resulting in a positive outcome.
Subject(s)
Diverticulitis , Diverticulum , Duodenal Diseases , Jaundice, Obstructive , Pancreatitis , Humans , Pancreatitis/etiology , Pancreatitis/complications , Diverticulitis/complications , Diverticulitis/diagnosis , Duodenum , Diverticulum/complications , Diverticulum/diagnosis , Duodenal Diseases/diagnostic imaging , Duodenal Diseases/etiologyABSTRACT
Acute diverticulitis, which refers to inflammation or infection, or both, of a colonic diverticulum, is a common medical condition that may occur repeatedly in some persons. It most often manifests with left-sided abdominal pain, which may be associated with low-grade fever and other gastrointestinal symptoms. Complications may include abscess, fistula formation, perforation, and bowel obstruction. The American College of Physicians recently published practice guidelines on the diagnosis and management of acute diverticulitis, the role of colonoscopy after resolution, and interventions to prevent recurrence of this condition. Among the recommendations were the use of abdominal computed tomography (CT) scanning in cases where there was diagnostic uncertainty, initial management of uncomplicated cases in the outpatient setting without antibiotics, referral for colonoscopy after an initial episode if not performed recently, and discussion of elective surgery to prevent recurrent disease in patients with complicated diverticulitis or frequent episodes of uncomplicated disease. Here, 2 gastroenterologists with expertise in acute diverticulitis debate CT scanning for diagnosis, antibiotics for treatment, colonoscopy to screen for underlying malignancy, and elective surgery to prevent recurrent disease.
Subject(s)
Diverticulitis , Teaching Rounds , Humans , Diverticulitis/complications , Diverticulitis/diagnosis , Diverticulitis/therapy , Tomography, X-Ray Computed , Colonoscopy , Chronic Disease , Anti-Bacterial Agents/therapeutic useABSTRACT
Acute abdominal pain, defined as nontraumatic abdominal pain lasting fewer than seven days, is a common presenting concern with a broad differential diagnosis. The most common causes are gastroenteritis and nonspecific abdominal pain, followed by cholelithiasis, urolithiasis, diverticulitis, and appendicitis. Extra-abdominal causes such as respiratory infections and abdominal wall pain should be considered. Pain location, history, and examination findings help guide the workup after ensuring hemodynamic stability. Recommended tests may include a complete blood count, C-reactive protein, hepatobiliary markers, electrolytes, creatinine, glucose, urinalysis, lipase, and pregnancy testing. Several diagnoses, such as cholecystitis, appendicitis, and mesenteric ischemia, cannot be confirmed clinically and typically require imaging. Conditions such as urolithiasis and diverticulitis may be diagnosed clinically in certain cases. Imaging studies are chosen based on the location of pain and index of suspicion for specific etiologies. Computed tomography with intravenous contrast media is often chosen for generalized abdominal pain, left upper quadrant pain, and lower abdominal pain. Ultrasonography is the study of choice for right upper quadrant pain. Point-of-care ultrasonography can aid in the prompt diagnosis of several etiologies of acute abdominal pain, including cholelithiasis, urolithiasis, and appendicitis. In patients who have female reproductive organs, diagnoses such as ectopic pregnancy, pelvic inflammatory disease, and adnexal torsion should be considered. If ultrasonography results are inconclusive in pregnant patients, magnetic resonance imaging is preferred over computed tomography when available.
Subject(s)
Abdomen, Acute , Appendicitis , Cholelithiasis , Diverticulitis , Pregnancy , Humans , Adult , Female , Appendicitis/complications , Appendicitis/diagnosis , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Abdomen, Acute/etiology , Ultrasonography , Diagnosis, Differential , Diverticulitis/diagnosis , Acute Disease , Cholelithiasis/complications , Cholelithiasis/diagnosisABSTRACT
BACKGROUND: Colonic diverticulitis is a leading cause of abdominal pain. The monocyte distribution width (MDW) is a novel inflammatory biomarker with prognostic significance for coronavirus disease and pancreatitis; however, no study has assessed its correlation with the severity of colonic diverticulitis. METHODS: This single-center retrospective cohort study included patients older than 18 years who presented to the emergency department between November 1, 2020, and May 31, 2021, and received a diagnosis of acute colonic diverticulitis after abdominal computed tomography. The characteristics and laboratory parameters of patients with simple versus complicated diverticulitis were compared. The significance of categorical data was assessed using the chi-square or Fisher's exact test. The Mann-Whitney U test was used for continuous variables. Multivariable regression analysis was performed to identify predictors of complicated colonic diverticulitis. Receiver operator characteristic (ROC) curves were used to test the efficacy of inflammatory biomarkers in distinguishing simple from complicated cases. RESULTS: Of the 160 patients enrolled, 21 (13.125%) had complicated diverticulitis. Although right-sided was more prevalent than left-sided colonic diverticulitis (70% versus 30%), complicated diverticulitis was more common in those with left-sided colonic diverticulitis (61.905%, p = 0.001). Age, white blood cell (WBC) count, neutrophil count, C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and MDW were significantly higher in the complicated diverticulitis group (p < 0.05). Logistic regression analysis indicated that the left-sided location and the MDW were significant and independent predictors of complicated diverticulitis. The area under the ROC curve (AUC) was as follows: MDW, 0.870 (95% confidence interval [CI], 0.784-0.956); CRP, 0.800 (95% CI, 0.707-0.892); NLR, 0.724 (95% CI, 0.616-0.832); PLR, 0.662 (95% CI, 0.525-0.798); and WBC, 0.679 (95% CI, 0.563-0.795). When the MDW cutoff was 20.38, the sensitivity and specificity were maximized to 90.5% and 80.6%, respectively. CONCLUSIONS: A large MDW was a significant and independent predictor of complicated diverticulitis. The optimal cutoff value for MDW is 20.38 as it exhibits maximum sensitivity and specificity for distinguishing between simple and complicated diverticulitis The MDW may aid in planning antibiotic therapy for patients with colonic diverticulitis in the emergency department.
Subject(s)
Diverticulitis, Colonic , Diverticulitis , Humans , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/diagnosis , Retrospective Studies , Monocytes , Diagnosis, Differential , Diverticulitis/complications , Diverticulitis/diagnosis , Neutrophils , Biomarkers , ROC CurveABSTRACT
Diverticulosis and the subsequent progression to diverticular disease and diverticulitis is becoming more prevalent in western countries. The cause for this progression is not known. Diverticulitis is a significant health burden - both financially to healthcare systems, and to the patients it affects in terms of morbidity. There is a dearth of research pertaining to diverticulitis and its impact on continence. This article examines the parallels between irritable bowel syndrome and diverticular disease, which have many symptom similarities, the overlap between the conditions, and the impact on continence. Current studies regarding the role of fibre in managing diverticular disease are also discussed.
Subject(s)
Diverticular Diseases , Diverticulitis , Irritable Bowel Syndrome , Humans , Diverticulitis/diagnosis , Diverticulitis/etiology , Diverticular Diseases/complications , Irritable Bowel Syndrome/complications , Irritable Bowel Syndrome/diagnosisABSTRACT
Diverticulitis of the ileum is an inflammatory complication of diverticulosis. It is an uncommon cause of acute abdomen that can have a very serious course, leading, for example, to intestinal perforation or bleeding. Imaging findings are very often negative and the true cause of the condition is only revealed peroperatively. In this case report, we present a case of perforated ileal diverticulitis in a patient with bilateral pulmonary embolism. This was the main reason for conservative management in the first period of time. After resolution of the pulmonary embolism, resection of the affected bowel segment was performed at the time of the next attack.
Subject(s)
Abdomen, Acute , Diverticulitis , Intestinal Perforation , Humans , Diverticulitis/diagnosis , Ileum/surgery , Abdomen, Acute/complications , Intestinal Perforation/etiology , Diagnosis, DifferentialABSTRACT
CASE SUMMARY: A 58-year-old man with a previous history of hypertension presented to the emergency department because of acute left lower quadrant pain. Neither nausea nor vomiting was described. At physical examination, he had tenderness to palpation in the left lower quadrant with no signs of peritonitis. The patient's body temperature and heart rate were unremarkable (37.2°C/86 beats per minute). Laboratory blood tests showed minimal leukocytosis (13,000 cells/mm 3 ) with no other relevant findings. An abdominal CT was performed, which confirmed the clinical suspicion of acute uncomplicated diverticulitis (AUD). It was described as the presence of a sigmoid thickening and phlegmon in an area with several diverticula, but no free air, fluid, or abscesses were identified ( Fig. 1 ). After the administration of painkillers, the patient remained completely asymptomatic, with good pain control and no fever, so he was recommended conservative outpatient treatment without antibiotics. One week after the AUD episode, the patient was checked, and he confirmed that the resolution had been uneventful and he had been asymptomatic, confirming that the outpatient treatment was successful. The patient asked for any measures that he could follow to prevent further episodes and showed interest in surgical treatment options.
Subject(s)
Diverticulitis , Peritonitis , Male , Humans , Middle Aged , Diverticulitis/complications , Diverticulitis/diagnosis , Diverticulitis/therapy , Abscess/complications , Abdominal Pain/diagnosis , Abdominal Pain/etiology , FeverABSTRACT
BACKGROUND: Acute epiploic appendagitis is a rare differential diagnosis of unclear or acute abdomen. AIM: To describe - by means of a scientific case report - the extraordinary diagnosis of acute epiploic appendagitis along with contained diverticulitis and incarcerated herniation of the greater omentum into the hernial sac of a former trocar site (medical history, significant for laparoscopic ovarian cyst removal) in a 29-year-old female based on experiences obtained in the successful clinical case management, and on selective references from medical scientific literature. CASE SUMMARY: Medical history: A 29-year-old female was admitted with abdominal pain in the lower left quadrant. She reported a laparoscopic ovarian cyst removal 3 years prior. Physical examination of the abdomen revealed tenderness in the lower left quadrant without a palpable mass.Leading diagnoses were found using transabdominal ultrasound and confirmed by an abdominal CT scan; namely, incarcerated trocar hernia, diverticulitis of sigmoid colon, and acute epiploic appendagitis. Therapeutic approach was comprised of an explorative laparoscopy (because of the incarcerated hernia), adhesiolysis, removal of a tip of the greater omentum out of the hernial sac, closure of the hernial orifice, and removal of an unclear, inflamed, and bloody fatty tissue from the wall of the descending colon (histopathological investigation confirmed acute epiploic appendagitis). This was flanked by conservative treatment of diverticulitis of the sigmoid colon.Further clinical course was uneventful, with discharge on the 3rd postoperative day with favorable long-term outcome, characterized by no further complaints for 15 months. DISCUSSION: Acute epiploic appendagitis is an inflammatory, usually self-limiting condition of the epiploic appendages of the colon. It typically manifests with abdominal pain in the lower left quadrant. Imaging is an important diagnostic tool to determine whether the patient has, in fact, acute epiploic appendagitis, so recognizing the characteristic oval lesions with the surrounding inflammation and central fat attenuation on CT, as well as the hyperechoic oval lesions with a hypoechoic peripheral band on ultrasound images is crucial. Nevertheless, it is often overlooked in patients and confused with other differential diagnoses, such as appendicitis or diverticulitis. Although the condition appears infrequently, it is essential to be proficient in the diagnostic evaluation, as a misdiagnosis may lead to unnecessary treatment and even surgical intervention. IN CONCLUSION: , the patient was initially diagnosed with an incarcerated abdominal hernia, and therefore subsequently underwent surgery. The inflamed epiploic appendage was discovered in laparoscopic exploration, removed, and confirmed through the histopathology report. This is an approach to be performed with great caution so as not to 1. : misinterpret an inflamed diverticula or covered perforation of it as well as not 2. : overlooking a peritoneal tumor lesion.
Subject(s)
Abdomen, Acute , Diverticulitis , Ovarian Cysts , Female , Humans , Adult , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Abdomen, Acute/surgery , Diagnosis, Differential , Abdominal Pain/etiology , Diverticulitis/diagnosis , Hernia/complications , Hernia/diagnosis , Ovarian Cysts/complications , Ovarian Cysts/diagnosisABSTRACT
Pyometra is a rare disease in which pus accumulates in the uterus and is typically caused by stenosis of the cervix. Only a few case reports have indicated that diverticular disease causes pyometra. We herein report an 83-year-old woman presented to our hospital with a fever, loss of appetite, general fatigue and back pain. After some inspections, she was diagnosed with pyometra and lumbar pyogenic spondylitis secondary to diverticulitis of the sigmoid colon. We performed transvaginal drainage and continued antibiotic administration for about three months. The pyometra and pyogenic spondylitis successfully resolved, and she did not experience any recurrence.