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1.
JAAPA ; 33(1): 24-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31880646

RESUMO

Segmental colitis associated with diverticulosis (SCAD) is a rare variant of chronic colitis that is limited to segments of the left colon that harbor diverticula. Histologically, SCAD is known to mimic chronic idiopathic inflammatory bowel disease. Patients usually present with hematochezia and cramping abdominal pain; SCAD often resolves spontaneously without treatment, or completely after a limited course of therapy. Due to the histologic overlap with ulcerative colitis and occasional Crohn colitis, the implications of an inaccurate diagnosis are significant.


Assuntos
Colectomia , Colite/cirurgia , Doença Diverticular do Colo/cirurgia , Ileostomia , Dor Abdominal/etiologia , Colite/complicações , Colite/patologia , Colonoscopia , Diarreia/etiologia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/patologia , Diverticulose Cólica/complicações , Diverticulose Cólica/patologia , Diverticulose Cólica/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Pessoa de Meia-Idade
2.
Korean J Gastroenterol ; 74(3): 142-148, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554029

RESUMO

Backgrounds/Aims: The etiology of colon diverticulosis is related to a range of genetic, biological, and environmental factors, but the risk factors for asymptomatic diverticulosis of the colon are unclear. This study examined the risk factors for asymptomatic colon diverticulosis. Methods: This retrospective study included examinees who underwent a colonoscopy for screening at the health check-up center of SAM Hospital between January 2016 and December 2016. The examinees with colon diverticulosis found by colonoscopy were compared with those without diverticulosis. The comparison factors were age, gender, alcohol consumption, smoking status, medical history, lipid profile, body mass index, visceral fat area, waist-hip ratio, and severity of a fatty liver. Results: This study included 937 examinees and the overall prevalence of diverticulosis was 8.1% (76/937). Fatty liver was found in 69.7% (53/76) in cases of colon diverticulosis and 50.3% (433/861) in the control group (p=0.001). The average waist-hip ratio was 0.92±0.051 in colon diverticulosis and 0.90±0.052 in the control group (p=0.052). Multivariate analysis revealed the waist-hip ratio (OR=1.035, 95% CI 1.000-1.070, p=0.043), moderate fatty liver (OR=2.238, 95% CI 1.026-4.882, p=0.043), and severe fatty liver (OR=5.519, 95% CI 1.236-21.803, p=0.025) to be associated with an increased risk of asymptomatic colon diverticulosis. Conclusions: The waist-hip ratio, moderate fatty liver, and severe fatty liver are risk factors for asymptomatic colon diverticulosis. Central obesity, which can be estimated by the waist-hip ratio, and fatty liver might affect the pathogenesis of asymptomatic colon diverticulosis.


Assuntos
Diverticulose Cólica/diagnóstico , Abdome/diagnóstico por imagem , Adulto , Colonoscopia , Diverticulose Cólica/complicações , Fígado Gorduroso/complicações , Fígado Gorduroso/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Ultrassonografia , Relação Cintura-Quadril
3.
Intern Med ; 58(16): 2277-2282, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31118377

RESUMO

Objective Colonic diverticular bleeding often recurs, and readmissions are common. The aim of this study was to identify predictors of colonic diverticular recurrent bleeding and readmission within 90 days. Methods Subjects comprised 144 patients diagnosed with colonic diverticular bleeding who received inpatient hospital care between January 2012 and June 2017. A retrospective comparative study was carried out regarding the clinical characteristics during the hospital stay by dividing the cases into 2 groups: patients with recurrent bleeding requiring readmission within 90 days (n=17) and patients without recurrent bleeding (n=127). Results A univariate analysis showed that recurrent bleeding and readmission were significantly more frequent among cases with hypovolemic shock on admission (p=0.009), blood transfusion during hospitalization (p=0.029), and hyperlipidemia (p=0.020) than among others. Shock on admission (odds ratio, 5.118; 95% confidence interval, 1.168-22.426, p=0.030) remained a significant predictor on a multivariate analysis. Conclusion Shock may predict recurrent colonic diverticular bleeding and readmission within 90 days. Careful and adequate endoscopic hemostasis is recommended for patients showing shock on admission.


Assuntos
Doença Crônica/terapia , Diverticulose Cólica/complicações , Diverticulose Cólica/terapia , Divertículo do Colo/complicações , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Readmissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/métodos , Diverticulose Cólica/diagnóstico , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemostase Endoscópica/métodos , Hospitalização/estatística & dados numéricos , Humanos , Japão , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Recidiva , Estudos Retrospectivos , Fatores de Risco
6.
J Gastroenterol Hepatol ; 34(8): 1351-1356, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30636058

RESUMO

BACKGROUND AND AIM: A significant percentage of patients with colonic diverticular bleeding (CDB) experience bleeding that is severe enough to necessitate prolonged hospitalization. Prolonged hospitalization causes deterioration in patients' quality of life, as well as difficulties with cost-effective utilization of medical resources, and is a financial burden to the society. Therefore, we investigated the factors associated with the length of hospitalization for the optimal management of patients hospitalized with CDB. METHODS: This study included patients who were hospitalized for the treatment of CDB and underwent colonoscopy between July 2008 and February 2016. Logistic regression analysis was performed to investigate the association between the length of hospitalization and the patients' baseline characteristics, in-hospital procedures performed, and the clinical outcomes. RESULTS: The study included 223 patients. Diabetes mellitus (odds ratio [OR] 3.4, P = 0.014) and blood transfusion (OR 3.1, P = 0.0006) were identified as risk factors for prolonged hospitalization (≥ 8 days). Urgent colonoscopy (OR 0.41, P = 0.0072) predicted a shorter length of hospitalization (≤ 7 days). The study also indicated that endoscopic treatment showed a stronger association with urgent colonoscopy (OR 7.8, P < 0.0001) than with elective colonoscopy and that urgent colonoscopy was not associated with an increased rate of adverse events or re-bleeding. CONCLUSIONS: Compared with elective colonoscopy, urgent colonoscopy shortens the length of hospitalization in patients with CDB. Moreover, it is not associated with an increased rate of adverse events. Urgent colonoscopy may be impracticable in a few cases; however, if possible, aggressive urgent colonoscopy should be considered for the efficient management of the patient's hospital stay.


Assuntos
Colonoscopia , Diverticulose Cólica/terapia , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica , Tempo de Internação , Idoso , Idoso de 80 Anos ou mais , Colonoscopia/efeitos adversos , Diverticulose Cólica/complicações , Diverticulose Cólica/diagnóstico , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemostase Endoscópica/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Alta do Paciente , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
J Gastrointestin Liver Dis ; 28(suppl. 4): 49-52, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31930222

RESUMO

BACKGROUND AND AIM: Symptomatic uncomplicated diverticular disease (SUDD) is characterized by abdominal pain, bloating and altered bowel habits (constipation or diarrhea) attributed to diverticula in the absence of macroscopic mucosal alterations. There is no consensus about management of these patients. DIVER-100®, an association of natural active ingredients may be effective in the treatment of patients with SUDD. The aim was to evaluate the efficacy and safety of DIVER-100® in patients with SUDD. METHODS: We conducted a prospective observational study to evaluate the efficacy of DIVER-100® in consecutive patients with SUDD, confirmed by radiology or endoscopy. All patients were treated with DIVER-100® 2 capsules/day 10 days per month, for 3 months. The primary endpoint was the clinical remission rate, defined as the reduction of abdominal pain and bloating, improvement of bowel habits and prevention of acute diverticulitis (AD). The secondary endpoint was the rate of adverse events. RESULTS: One hundred and one patients were consecutively enrolled at the Internal Medicine and Gastroenterology Unit, Sant'Orsola Hospital, Bologna, Italy. DIVER-100® was effective in inducing remission of symptoms in 12 patients (11.9%) at 3 months and in 10 patients (9.9%) at 6 months. DIVER-100® significantly reduced abdominal pain and bloating in 45.5% and 57.4% of patients respectively (p <0.001) after 3 months. No episodes of AD and no adverse events related to DIVER--100® were recorded at month 6 in the study population. CONCLUSIONS: DIVER-100® is a safe and effective nutraceutical compound in obtaining remission and symptom relief in SUDD patients. Further randomized, placebo-controlled clinical trials are needed to confirm these preliminary data.


Assuntos
Suplementos Nutricionais , Diverticulose Cólica/terapia , Dor Abdominal/etiologia , Dor Abdominal/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Suplementos Nutricionais/efeitos adversos , Doença Diverticular do Colo/prevenção & controle , Diverticulose Cólica/complicações , Diverticulose Cólica/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Indução de Remissão , Resultado do Tratamento
8.
Expert Rev Gastroenterol Hepatol ; 12(8): 791-796, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29888630

RESUMO

INTRODUCTION: Diverticulosis of the colon is a common condition, and about one-fourth of those people develop symptoms, which is called 'diverticular disease' (DD). Since there are still some concerns about the diagnosis of DD, the aim of this review was to analyze current and evolving advances in its diagnosis. Area covered: Analysis of clinical, radiology, laboratory, and endoscopic tools to pose a correct diagnosis of DD was performed according to current PubMed literature. Expert commentary: A combination of clinical characteristic of the abdominal pain and fecal calprotectin expression may help to differentiate between symptomatic uncomplicated diverticular disease and irritable bowel syndrome. Abdominal computerized tomography (CT) scan is still the gold standard in diagnosing acute diverticulitis and its complications. CT-colonography may be useful as a predicting tool on the outcome of the disease. Diverticular Inflammation and Complications Assessment (DICA) endoscopic classification shows a significant relationship between severity of DICA score inflammatory indexes, as well as with severity of abdominal pain. Moreover, it seems to be predictive of the outcome of the disease in terms of acute diverticulitis occurrence/recurrence and surgery occurrence. Finally, preliminary data found intestinal microbiota analysis is a promising tool in diagnosing and monitoring this disease.


Assuntos
Diverticulose Cólica/diagnóstico , Dor Abdominal/etiologia , Colonoscopia , Diagnóstico Diferencial , Doenças Diverticulares/complicações , Doenças Diverticulares/diagnóstico , Doenças Diverticulares/diagnóstico por imagem , Diverticulose Cólica/sangue , Diverticulose Cólica/complicações , Diverticulose Cólica/diagnóstico por imagem , Fezes/química , Humanos , Síndrome do Intestino Irritável/diagnóstico , Complexo Antígeno L1 Leucocitário/análise
9.
Int J Colorectal Dis ; 33(9): 1277-1283, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29602977

RESUMO

PURPOSE: Aim of this observational case-control study was to assess the prevalence, features, and risk factors of colonic diverticula in patients with ulcerative colitis (UC). METHODS: The data of 896 UC patients aged ≥ 30 years from Brescia IBD database were retrospectively analyzed. Individuals with colonic diverticula were identified and prevalence was compared with that of control patients undergoing screening colonoscopy after gender/age matching. A nested cohort study was then conducted among UC patients in order to define eventual association of diverticula with specific clinico-pathologic parameters. RESULTS: Prevalence of subjects with diverticula was 11.4% among 465 UC patients aged 49 years and older, significantly lower than 35.1% prevalence in control patients of same age and gender (p < 0.001). Advancing age was a significant risk factor for diverticula development in both groups. Among UC patients, a short duration and a late onset of UC were both significantly associated to the presence of diverticula. Moreover, UC patients with diverticula had a significantly lower frequency of flares per year, even if maximal flare severity and frequency of hospital admission were similar to those of subjects without diverticula. UC patients with diverticula had a trend toward more frequent extension of UC to the left colon, possibly because of their older age. The majority of those patients had few sigmoid diverticula without symptoms. CONCLUSIONS: Development of colonic diverticula is substantially reduced in patients with UC, markedly among those with an early onset, a long history of inflammatory disease, and a high flare frequency. This study reinforces the hypothesis sustaining a protective role of UC against colonic diverticula.


Assuntos
Colite Ulcerativa/complicações , Diverticulose Cólica/complicações , Adulto , Idoso , Estudos de Casos e Controles , Colite Ulcerativa/epidemiologia , Diverticulose Cólica/epidemiologia , Divertículo do Colo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
J Coll Physicians Surg Pak ; 28(4): 317-319, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29615177

RESUMO

We present a case of 14-year girl with left-sided acute appendicitis who presented with lower abdominal pain. Midgut malrotation occurs at a rate of 1 in 500 live births. The condition is incidentally diagnosed during various radiological investigations done for other purposes. However, such patients may present with conditions like acute appendicitis, which poses a diagnostic dilemma if a high index of suspicion is not kept. The purpose of this case report is to increase awareness in the emergency physicians and young surgeons of this rare presentation; and the importance of radiological investigations in the diagnosis of left-sided appendicitis, to decrease morbidity and mortality.


Assuntos
Dor Abdominal/etiologia , Apendicite/complicações , Anormalidades do Sistema Digestório/diagnóstico por imagem , Volvo Intestinal/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Dor Abdominal/diagnóstico por imagem , Doença Aguda , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Anormalidades do Sistema Digestório/complicações , Diverticulose Cólica/complicações , Serviço Hospitalar de Emergência , Feminino , Humanos , Volvo Intestinal/complicações , Volvo Intestinal/congênito , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Rev Chilena Infectol ; 34(4): 397-403, 2017 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-29165522

RESUMO

Reports of Lactococcus garvieae infections in humans are scarce, and only one of them in a patient under-going hemodialysis. We report the first case of Lactococcus garvieae infection in Chile, presenting as an infective endocarditis, ultimately fatal, in a patient with uncomplicated colonic diverticulosis and end stage renal failure undergoing chronic hemodialysis. We review the published cases and discuss the diagnostic and therapeutic challenges associated with this new, increasingly diagnosed pathogen, capable of producing serious infections in susceptible patients.


Assuntos
Endocardite Bacteriana/microbiologia , Lactococcus/isolamento & purificação , Diálise Renal/efeitos adversos , Idoso , Chile , Diverticulose Cólica/complicações , Evolução Fatal , Feminino , Humanos , Lactococcus/classificação , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia
12.
Rev. esp. enferm. dig ; 109(11): 768-771, nov. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-167787

RESUMO

Background and objectives: Colonic diverticulosis (CD) is related to advanced age and a lack of dietary fiber. Recently, several studies have shown that metabolic syndrome (MS) is also implicated in the etiopathogenesis of CD. This study aimed to assess the association between MS, obesity and CD. Methods: This was a prospective study of a one-year duration. The MS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). Demographic data, risk factors for MS and endoscopic findings of patients who underwent a total colonoscopy in the department were collected. Obesity was defined as a body mass index ≥ 30 kg/m2. Informed consent was obtained. The local Ethics Committee and National Data Protection Committee approved the study. Statistical analysis was performed with SPSS 21 and statistical significance was defined as p < 0.05. Results: The study included 203 patients, 95 males with a mean age of 65.5 years. CD was diagnosed in 30.5% of patients. Univariate analysis showed that age, hypertension, increased waist circumference and hyperlipidemia were associated with colonic diverticulosis. There was no association with gender, obesity or type 2 diabetes mellitus. Multivariate analysis showed that age and a greater waist circumference increased the risk of diverticulosis. Ageadjusted analysis showed that MS was associated with diverticulosis. The prevalence of adenoma in patients with CD was similar to that in patients without CD. Conclusion: In this series, MS was significantly associated with CD. The identification of risk groups is important since diverticulosis can have serious and potentially fatal complications. To our knowledge, this is the first Southern European prospective study evaluating the association between MS and CD (AU)


No disponible


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Diverticulose Cólica/complicações , Diverticulose Cólica/etiologia , Síndrome Metabólica/complicações , Obesidade/complicações , Fatores de Risco , Colonoscopia/métodos , Estudos Prospectivos , Análise Estatística , Análise Multivariada , Circunferência Abdominal , Inquéritos e Questionários
13.
Metas enferm ; 20(9): 25-31, nov. 2017. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-168762

RESUMO

Se presenta el caso de un varón de 48 años, con diagnóstico de enfermedad diverticular complicada, que presenta sangrado recurrente posterior a la cirugía. La valoración enfermera se realiza teniendo como marco la Teoría del Autocuidado de Dorothea Orem. Se identificaron los factores condicionantes básicos y los requisitos de autocuidado universales del desarrollo y de desviación a la salud. Se utilizó el modelo de Análisis de Resultados del Estado Actual (AREA) y la taxonomía de la North American Nursing Diagnosis Association (NANDA), elaborándose un plan de cuidados considerando los resultados esperados y las intervenciones de Enfermería propuestas también en la Nursing Interventions Classification (NIC) y la Nursing Outcomes Classification (NOC). La aplicación del modelo AREA para el razonamiento clínico de Enfermería ayuda a priorizar los requisitos de autocuidado alterados del paciente, lo que permite identificar el diagnóstico enfermero principal, los diagnósticos secundarios y los diagnósticos de riesgo y, de esta forma, planificar los cuidados específicos para brindar una atención de salud integral (AU)


We hereby present the case of a 48-year-old male patient, with diagnosis of complicated diverticular disease, presenting recurrent postsurgical bleeding. Nursing evaluation was conducted within the setting of the Dorothea Orem's Self-Care Theory. Basic determining factors were identified, as well as universal self-care requirements for development and health deviation. The study used the model from the Analysis of Current Status Outcomes (ACSO), and the taxonomy by the North American Nursing Diagnosis Association (NANDA); the care plan was prepared considering the expected outcomes and the nursing interventions also put forward by the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC). The application of the ACSO model for the clinical rationale of Nursing allows to prioritize the altered self-care requirements of the patient, which facilitates the identification of the primary Nursing diagnosis, secondary diagnoses and risk diagnoses, and therefore, to plan the specific care in order to offer comprehensive patient care (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/normas , Diverticulose Cólica/complicações , Avaliação em Enfermagem/métodos , Autocuidado/métodos , Fatores de Risco , Hemorragia/complicações , Recidiva , Avaliação de Processos e Resultados em Cuidados de Saúde , Diverticulose Cólica/cirurgia
14.
Rev. clín. med. fam ; 10(3): 194-196, oct. 2017.
Artigo em Espanhol | IBECS | ID: ibc-169433

RESUMO

Presentamos el caso de una mujer de 75 años que presenta hepatitis aguda tras recibir tratamiento prolongado con nitrofurantoína, como profilaxis de infecciones urinarias recurrentes. Los fármacos son una importante causa de hepatotoxicidad; más de 900 fármacos, toxinas y plantas han sido implicados como causa del daño hepático. Los clínicos deben vigilar y detectar precozmente para evitar cuadros severos de toxicidad hepática (AU)


We report the case of a 75-year-old female with acute hepatitis after a long-term treatment with nitrofurantoin as prophylaxis for recurrent urinary tract infections. Drugs are an important cause of hepatotoxicity; over 900 drugs, toxins, and herbs have been reported to cause liver damage. Physicians must be vigilant and identify drug-related liver damage early to avoid severe liver toxicity (AU)


Assuntos
Humanos , Feminino , Idoso , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Nitrofurantoína/efeitos adversos , Infecções Urinárias/prevenção & controle , Antibioticoprofilaxia/métodos , Diverticulose Cólica/complicações , Fatores de Risco
15.
Medicine (Baltimore) ; 96(38): e8090, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28930849

RESUMO

The increase in incidence of colonic diverticular bleeding is relative to an age-related rise in the incidence of colonic diverticulosis and use of antithrombotic medication. However, risk factors related to the onset, recurrence, and prophylaxis have not been established. Therefore, we aimed to determine risk factors for the onset and recurrence of colonic diverticular bleeding.An age- and sex-matched case-control study was performed to assess the risk factors for the onset of colonic diverticular bleeding. The distribution of diverticulosis, comorbidity, and medication were evaluated from medical records. We also assigned patients with a first-time bleeding into groups with and without rebleeding during follow-up to determine risk factors for recurrence.Bilateral colonic diverticulosis, nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin (LDA), and anticoagulants were significant risk factors for the onset of colonic diverticular bleeding on multivariate analysis. In contrast, the use of selective cyclooxygenase-2 (COX-2) inhibitor was not a risk factor for the onset. The incidence of bleeding in direct oral anticoagulant and warfarin users was not different between the 2 groups. The cumulative recurrence rate at 1 year was 15%. Recurrence rate was significantly higher in patients with a prior history of colonic diverticular bleeding than those without. Steroid use was associated with recurrence.Extensive distribution of diverticulosis and use of nonselective NSAIDs, LDA, and anticoagulants are regarded as risk factors for the onset of colonic diverticular bleeding. In addition, a prior history of colonic diverticular bleeding is related to the recurrence.


Assuntos
Diverticulose Cólica/complicações , Hemorragia Gastrointestinal/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/efeitos adversos , Anticoagulantes/efeitos adversos , Aspirina/efeitos adversos , Estudos de Casos e Controles , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco
16.
Cir. Esp. (Ed. impr.) ; 95(7): 369-377, ago.-sept. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-167127

RESUMO

Desde la Asociación Española de Coloproctología (AECP) y la Sección de Coloproctología de la Asociación Española de Cirujanos (AEC), se propone un documento de consenso sobre la enfermedad diverticular complicada que pueda ser de utilidad en la toma de decisiones. En él se expone, principalmente, la actualidad en el tratamiento ambulatorio, la intervención de Hartmann, el lavado laparoscópico peritoneal, así como el papel del abordaje laparoscópico en la resección colónica (AU)


The Spanish Association of Coloproctology (AECP) and the Coloproctology Section of the Spanish Association of Surgeons (AEC), propose this consensus document about complicated diverticular disease that could be used for decision-making. Outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage, and the role of a laparoscopic approach in colonic resection are exposed (AU)


Assuntos
Humanos , Diverticulose Cólica/terapia , Lavagem Peritoneal , Laparoscopia , Infecção da Ferida Cirúrgica/epidemiologia , Diverticulose Cólica/complicações , Padrões de Prática Médica , Assistência Ambulatorial/métodos , Comorbidade
17.
Rev Esp Enferm Dig ; 109(11): 768-771, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28776378

RESUMO

BACKGROUND AND OBJECTIVES: Colonic diverticulosis (CD) is related to advanced age and a lack of dietary fiber. Recently, several studies have shown that metabolic syndrome (MS) is also implicated in the etiopathogenesis of CD. This study aimed to assess the association between MS, obesity and CD. METHODS: This was a prospective study of a one-year duration. The MS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). Demographic data, risk factors for MS and endoscopic findings of patients who underwent a total colonoscopy in the department were collected. Obesity was defined as a body mass index ≥ 30 kg/m2. Informed consent was obtained. The local Ethics Committee and National Data Protection Committee approved the study. Statistical analysis was performed with SPSS 21 and statistical significance was defined as p < 0.05. RESULTS: The study included 203 patients, 95 males with a mean age of 65.5 years. CD was diagnosed in 30.5% of patients. Univariate analysis showed that age, hypertension, increased waist circumference and hyperlipidemia were associated with colonic diverticulosis. There was no association with gender, obesity or type 2 diabetes mellitus. Multivariate analysis showed that age and a greater waist circumference increased the risk of diverticulosis. Age-adjusted analysis showed that MS was associated with diverticulosis. The prevalence of adenoma in patients with CD was similar to that in patients without CD. CONCLUSION: In this series, MS was significantly associated with CD. The identification of risk groups is important since diverticulosis can have serious and potentially fatal complications. To our knowledge, this is the first Southern European prospective study evaluating the association between MS and CD.


Assuntos
Diverticulose Cólica/complicações , Diverticulose Cólica/epidemiologia , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Portugal/epidemiologia , Prevalência , Estudos Prospectivos , Circunferência da Cintura
18.
Mayo Clin Proc ; 92(5): 797-804, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28473039

RESUMO

The evaluation of the patient with hematochezia can be complex because of the broad differential diagnosis and the number of management strategies available. In this article, a simplified approach to the history and physical examination is presented, with management illustrated in a case-oriented manner.


Assuntos
Dor Abdominal , Colonoscopia , Exame Retal Digital , Hemorragia Gastrointestinal , Dor Pélvica , Exame Físico/métodos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/complicações , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/terapia , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico , Tumor Carcinoide/complicações , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgia , Colo/irrigação sanguínea , Colonoscopia/métodos , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Exame Retal Digital/métodos , Diverticulose Cólica/complicações , Diverticulose Cólica/diagnóstico , Diverticulose Cólica/terapia , Feminino , Fissura Anal/complicações , Fissura Anal/diagnóstico , Fissura Anal/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Isquemia/complicações , Isquemia/diagnóstico , Isquemia/terapia , Masculino , Divertículo Ileal/complicações , Divertículo Ileal/diagnóstico , Anamnese/métodos , Pessoa de Meia-Idade , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia
19.
Am J Ther ; 24(2): e213-e221, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28267692

RESUMO

Colonic diverticular disease (CDD) and colonic diverticular hemorrhage (CDH) are the most common disorders in hospital admissions and outpatient health clinic visits. However, risk factors of CDD and CDH are complicated and need to be discussed. Diabetes mellitus (DM) has been related with CDD and CDH, but the associations remain ambiguous. Therefore, we performed a literature search for studies involving the associations among DM, morbidity of CDD, and incidence of CDH. Relative risks or odds ratios with their corresponding 95% confidence intervals (CIs) were combined and weighted to produce summary effect size. Sensitivity analysis and subgroup analysis were further performed. We selected 17 studies that involved a total of 8212 patients with diabetes, 381,579 controls without diabetes. We found that patients with DM had approximately 1.201 times higher CDD morbidity in prospective studies (95% CI, 1.135-1.270) with no significant heterogeneity (Q = 0.42, P = 0.519, I = 0%). DM was associated with a 52.8% increase in risk of CDH (95% CI, 14%-104%); we did not find significant heterogeneity among these studies (Q = 12.94, P = 0.114, I = 38.2%). This meta-analysis confirms that DM is an important risk factor for morbidities of CDD and CDH.


Assuntos
Diabetes Mellitus/epidemiologia , Diverticulose Cólica/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Doenças do Colo/epidemiologia , Doenças do Colo/etiologia , Comorbidade , Diverticulose Cólica/complicações , Hemorragia Gastrointestinal/etiologia , Humanos , Incidência , Fatores de Risco
20.
Hernia ; 21(4): 525-529, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28349226

RESUMO

PURPOSE: Colonic diverticulosis and abdominal wall hernia are common pathologies. Studies have suggested that connective tissue alterations play a role in the formation of both diverticulosis and abdominal wall hernia. The aim of this cohort study was to evaluate the association between diverticulosis and abdominal wall hernia in a large cohort of patients undergoing colonoscopy. METHODS: All consecutive patients who underwent colonoscopy between 2001 and 2013 at Bispebjerg Hospital were eligible for inclusion. The endoscopists prospectively registered the findings of diverticulosis in a database. Data were merged with the Danish Hernia Database identifying patients who underwent groin and ventral hernia repair. Calculated odds ratios (ORs) were used to describe the extent of association and multivariable logistic regression models were utilized to adjust for age and gender. RESULTS: A total of 13,855 patients were included, 3685 (26.6%) of whom were diagnosed with diverticulosis. Diverticulosis was independently associated with direct inguinal, OR 1.33, 95% CI 1.00-1.76, P = 0.049, and umbilical/epigastric hernia repair, OR 1.74, 95% CI 1.16-2.63, P = 0.008. CONCLUSIONS: Colonic diverticulosis was associated with direct inguinal and umbilical/epigastric hernia repair suggesting that connective tissue alterations, herniosis, could be a common etiologic factor of colonic diverticulosis and these abdominal wall hernias.


Assuntos
Diverticulose Cólica/complicações , Diverticulose Cólica/diagnóstico , Hérnia Ventral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colonoscopia , Feminino , Hérnia Ventral/cirurgia , Herniorrafia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances
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