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The incidence of colonic diverticular disease is increasing significantly and is showing a trend of youthfulness. The treatment of colonic diverticulum disease mainly involves drugs, including antibiotics, rifaximin, and mesalazine. In addition, probiotics and dietary fiber are believed to have a positive impact on the treatment of diverticular diseases. When it progresses to acute complicated diverticulitis, surgical treatment becomes a necessary means. Up to now, our country has not formulated standards and guidelines of the diagnosis and treatment for colonic diverticulitis.

Rectal diverticula are extremely rare with an incidence of less than 0.1% of colonic diverticular disease cases, and the factors that contribute to their evolution are poorly understood. Majority of the cases are diagnosed incidentally, and they are usually clinically asymptomatic and carry a low risk of developing complications; therefore, treatment is not required in most cases. Surgery is generally performed only in the event of complications or when they become symptomatic, such as with the development of obstructive defecation with an impacted fecalith within the diverticulum. As it is a rare entity, there is currently no consensus on the surgical management of rectal diverticulum. Here, we describe a novel and effective method of surgical management of rectal diverticulum utilizing transanal minimally invasive surgery. [ABSTRACT FROM AUTHOR]

Background: Colonic diverticulum is one of the rare findings in dogs characterized by an out-pouching of mucosal and submucosal layers through the defect in muscularis layer of the colon. Case description: A five years old intact female Labrador was presented with an anamnesis of dyschezia and tenesmus. Findings/treatment and outcome: Rectal examination was normal, and the survey radiograph showed an almost crescent shaped abnormal dilatation (10.52 cm × 6.21 cm) with gas and increased radiopaque material, dorsal to the urinary bladder and ventral to the descending colon suggesting fecal stasis. Ultrasonographic examination revealed gas-filled out-pouching with hyperechoic colon wall and acoustic shadowing. Exploratory celiotomy confirmed the diagnosis of colonic diverticulum, and diverticulectomy was performed. All four layers of the colonic wall were detected histopathologically in the biopsy sample and excluded neoplasia. The dog recovered uneventfully with no post-operative complications. Conclusion: This surgery produced an excellent resolution of clinical signs. To our knowledge, this is one of the few cases of colonic diverticulum reported in dogs. [ABSTRACT FROM AUTHOR]

Background/Aims Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicated because of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. The aim of this study was to evaluate the feasibility and safety of D-ESD. Methods D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients who underwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategy were analyzed. Results The en bloc resection rate was 96.2%. The R0 and curative resection rates were 76.4% and 70.6% in strategy A and 88.9% and 77.8% in strategy B, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforation case required emergency surgery, but the other cases were managed conservatively. Conclusions D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert hands because it requires highly skilled endoscopic techniques.

Background/aims: Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicated because of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. The aim of this study was to evaluate the feasibility and safety of D-ESD., Methods: D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients who underwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategy were analyzed., Results: The en bloc resection rate was 96.2%. The rates of R0 and curative resection in strategies A and B were 80.8%, 73.1%, 84.6%, and 70.6%, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforation case required emergency surgery, but the other cases were managed conservatively., Conclusion: D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert hands because it requires highly skilled endoscopic techniques.