Right-sided diverticulitis in a Western population.

BACKGROUND: While left-sided colonic diverticular disease is common in Western Caucasian populations, right-sided colonic disease (RCD) is rare. The present study aimed to determine the rate of RCD and to identify the symptoms, clinical features, treatment, and outcomes in a single medical center in Israel. METHODS: Data for this descriptive retrospective analysis were collected from the electronic medical records of all patients diagnosed with colonic diverticulitis from January 2014 to June 2019. RESULTS: During the study period, 1000 patients with diverticulitis were admitted to our institution, of which 99 had RCD (10%). Mean age was 50.2 years. The main presenting symptom was acute onset of right-sided abdominal pain. The diagnosis was made almost exclusively by computed tomography scan and the cecum was the most frequent site. The clinical course was benign, without major complications for most patients (90.1%). Nine patients presented with abscess (n = 1), covered perforation (n = 7), or partial obstruction (n = 1). All patients were treated with intravenous antibiotics with a median length of hospital stay of 3 days and a median 9 days of antibiotic treatment. Only 1 patient underwent diagnostic laparoscopy due to suspected intestinal perforation. Three patients experienced disease recurrence after a median follow-up of 48 months. Upon recovery, half of the patients underwent colonoscopy; no further pathology was found in any. CONCLUSION: Unlike sigmoid colon diverticulitis, the incidence of RCD in Western populations is low. The clinical course is benign, with conservative treatment without the need for surgery. The complication and recurrence rates are low.

The effect of the somatostatin analogue octreotide on experimental intestinal obstruction in rats

Background: Somatostatin has an inhibitory effect on the endocrine and exocrine secretions of the gut. It may have a beneficial effect in the conservative treatment of intestinal obstruction. The aim of the present study is to investigate the effect of octreotide in mechanical intestinal obstruction in rats. Method: Intestinal obstruction was induced in rats by ligation of a segment of the distal ileum. Animals were treated with the somatostatin analogue octreotide (n=16), or saline (n=16). Eight rats were operated but their intestine was not ligated (n=8) serving as sham controls. Forty eight hours after the operation, the animals were operated upon again and blood samples from the femoral vein were tested for electrolytes, urea, glucose, lactic acid, amylase, ph and bicarbonate. Portal vein blood samples were also obtained and tested for lactic acid and amylase. Results: Intestinal obstruction resulted, after 48 hours, in severe dilatation of bowel loops. A significant increase in plasma levels of urea, amylase and lactic acid was observed. Plasma pH decreased. In blood samples from the portal vein, a significant increase in lactic acid was observed, indicating metabolic acidosis, probably secondary to bowel ischemia. Octreotide treatment, resulted in less acidosis, with concomitant lower urea and lactic acid levels in the plasma and especially in the portal vein. Conclusion: Octreotide treatment may have a beneficial effect in the conservative treatment of selected cases of intestinal obstruction.

Objetivo: A somatostatina tem efeito inibidor nas secrees endcrina e excrina do intestino. Poderß ter efeito benfico no tratamento conservador da obstruo intestinal. O objetivo do presente estudo investigar o efeito do octreotide na obstruo mecnica do intestino delgado de ratos. Mtodo: A obstruo intestinal foi induzida em ratos pela ligadura do segmento distal do ileum. Os animais foram tratados com somatostatina anßloga octreotide (n=16) ou com soluo salina (n=16). Oito ratos foram operados mas o intestino delgado no foi ligado (n=8) servindo como o grupo sham. Quarenta oito horas aps a operao os animais foram re-operados e submetidos a colheita de sangue da veia femoral a fim de verificar os eletrlitos, uria, glicose, ßcido lßtico, amilase, pH e bicarbonato. Obteve-se tambm amostra de sangue da veia porta para verificar os nveis de ßcido lßtico e amilase. Resultados: Aps 48 horas de obstruo houve intensa dilatao das alas intestinais. Observou-se aumento significante dos nveis plasmßticos de uria, amilase e ßcido lßtico. Diminuiu o pH plasmßtico. Observou-se aumento do ßcido lßtico no sangue portal, indicando acidose metablica, provavelmente secundßria a isquemia intestinal. O tratamento com octreotide resultou em menos acidose, com nveis baixos de uria e ßcido lßtico no plasma, e especialmente na veia porta. Concluso: O emprego de octreotide pode ter efeito benfico no tratamento conservador de casos selecionados de obstruo intestinal.