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The occurrence of rectal diverticula are rare. They are invariably accompanied by colonic diverticulosis, especially the sigmoid segment. To our knowledge, this condition has not been previously detected during childhood, and the youngest patient reported was 18 years old. In this report we present a solitary rectal diverticulum in a 25-day-old infant without accompanying colonic diverticula. The existence of rectal diverticulum in this infant convincingly suggests a congenital etiology.

Inverted Colonic Diverticulum: An Infrequent and Dangerous Endoscopic Finding R. Merino, T. Kinney, R. Santander, R. Yazigi, C. Navarrete, M. Saenz, R. Saenz Background: Inverted Colonic Diverticula (ICD) can be misinterpreted as elevated polypoid lesions, and biopsy or endoscopic resection of these lesions can lead to severe complications. These important lesions are rarely reported in the medical literature and marginally mentioned in classic texts. The aim of this study is to describe the endoscopic characteristics of ICD to avoid misdiagnosis and to report the frequency of these lesions in a large endoscopic series. Materials and Methods: A retrospective analysis was performed of all patients undergoing colonoscopy at our institution between July 2001 and July 2004 using Medicaps 2.0 InfoCYS endoscopic database and selecting patients diagnosed with ICD. Patient characteristics as well as lesion characteristics were recorded, including location, endoscopic characteristics, and the presence of synchronous polypoid lesions.The following endoscopic characteristics were considered in diagnosing ICD: 1) elevated sessile appearance with fine concentric folds surrounding the lesion, 2) mucosal pattern on lesion is similar to surrounding mucosa, 3) umbilicated appearance, 4) found in an area of diverticula, 5) surrounding fine concentric folds enhance with Methylene Blue, and 6) lesion reverts to typical diverticular appearance with direct water infusion, air insufflation, or gentle pressure with biopsy forceps. Results: Among 4508 colonoscopies performed in the selected period, 33 (0.7%) were diagnosed with ICD according to the endoscopic criteria above. Mean patient age was 62.3 years, with 7/9 male/female ratio. 89% of ICD were in an area of multiple colonic diverticula, and 75% were located in the sigmoid colon. One had active bleeding from the inverted diverticulum and was treated with injection therapy. 2 cases required gentle pressure with the biopsy forceps for diagnosis and the remaining were diagnosed according to the other referred endoscopic criteria. No biopsies or resections were performed. There were no complications in this series. Conclusion: ICD is a rare endoscopic finding (0.7%) that is occasionally complicated by local bleeding. Misdiagnosis could be dangerous as these lesions appear similar to sessile polyps, and biopsy or endoscopic resection could lead to serious complications. The endoscopic criteria described should be considered to avoid complications.

During the colonoscopy, this man reported abdominal discomfort, and profound abdominal distention developed.

A 73-year-old man presented with acute lower gastrointestinal bleeding. He was hemodynamically stable, and nasogastric-tube lavage revealed bile with no blood, suggesting a lower gastrointestinal source for the bleeding. Urgent colonoscopy, performed after a rapid colonic purge, revealed a profusely bleeding diverticulum in the sigmoid colon; at the neck of the diverticulum, a bleeding vessel was identified (arrow in Panel A). Hemostasis was achieved by injecting epinephrine (dilution, 1:10,000) around the diverticulum (Panel B). The patient was discharged two days later, without any further bleeding or complications. Diverticula develop where vasa recta (intramural branches of the marginal artery supplying the . . .

Figure 1. A 70-year-old woman had a six-month history suggestive of recurrent, self-limited episodes of acute diverticulitis. A scout film for a barium enema showed a rounded, smooth-walled structure measuring 10 cm in diameter and containing air (Panel A). The barium enema showed entry of contrast medium into the structure (Panel B). Puddling and the even distribution of barium within the structure in all positions suggested that this was most likely a large sigmoid diverticulum. Surgery was scheduled, but before the scheduled date the patient presented with an acute abdomen. A plain film showed that the diverticulum had enlarged to . . .

• The use of corticosteroids is associated with numerous and, at times, grave complications involving the gastrointestinal tract. Perforation of peptic ulcer is one of the most frequent gastrointestinal catastrophies attributed to the use of corticosteroids. An underappreciated relationship is that of perforation of colonic diverticula and corticosteroid therapy. This report describes the course of three patients who developed perforations of colonic diverticula that were temporally related to corticosteroid use. An overview of the problem is given, and potential difficulties in managing these patients are highlighted. ( Arch Intern Med . 1990;150:1337-1338)

Benign, nonpolypoid mucosal hyperplasia has been consistently observed adjacent to colonic carcinomas. In order to determine the specificity of this association we looked for this type of mucosa in diverticulosis with or without diverticulitis, a disease thought not to be causally related to carcinoma. Nonpolypoid mucosal hyperplasis was frequently found within diverticula suggesting that this mucosal abnormality is, in some instances, unrelated specifically to malignancy.

A case report and review of the literature support a new theory that giant colonic diverticula are three distinct pathologic entities. The three types can be separated by histologic type.

Fifteen cases in which the same part of the colon has been affected by both diverticular disease and Crohn's disease have been studied. When Crohn's disease affects an area of colon where diverticula are present, radiological examination may show a diminution in number or disappearance of the diverticula with progress of the Crohn's disease. With improvement in the Crohn's disease diverticula may appear.

A mucus-secreting carcinoid tumor arising in a colonic (rectosigmoid) diverticulum is presented. Carcinoid tumors in colonic diverticula have not been previously reported. The presence of mucin and argentaffin granules in the same tumor cell is illustrated. The recognition of mucus-secreting carcinoid tumors is emphasized in order to avoid overtreatment of small colonic carcinoid tumors by extensive surgical procedures.

当科外来の最近5年間の注腸検査例1212例について大腸憩室を検討した.その結果,1)大腸憩室頻度は11.1%,男性13.4%,女性9.0%,男女比は1.49:1であった.2)大腸憩室は30歳台8.1%,40歳台8.2%,50歳台15.5%,60歳台14.7%,70歳以上11.5%で,加齢に伴い増加した.3)大腸憩室は右側結腸型74.1%,両側結腸型12,6%,左側結腸型13.3%で右側結腸型が多かったが,加齢に伴い左側結腸型の頻度が増加した.4)大腸憩室のうち散発例が62.2%と最も多く,次いで単発例28.1%,群発例9.6%の順であった,なお,右側結腸型では単発例33.0%,散発例63.0%,群発例4.0%,左側結腸型では単発例27.8%,散発例55.6%,群発例16.7%であり,前者では単発例,後者では群発例が多い傾向がみられた,5)東北,関東地区の食物繊維摂取量を算出した結果,両地区とも最近繊維摂取量は減少していたが,とくに東北地区で顕著であった.

Forty patients underwent operative therapy for acute perforation of colonic diverticula. The group I patients had some localization of infection, group II had generalized feculent-purulent contamination with free perforation, and group III had free perforation and were treated with chronic steroids for various medical disorders. The retrospective evaluation was directed at evaluating the effect on survival of methods to treat the hole in the colon and methods to treat peritoneal contamination. It is concluded that control of the perforation in the bowel and aggressive peritoneal irrigation may decrease the high morbidity and mortality rates.

1. 1. A review of the documented cases of massive bleeding from diverticular disease of the colon reported in the literature reveals a disproportionately high incidence of bleeding from diverticula of the ascending colon. 2. 2. In those patients with continued or recurrent bleeding, we believe that angiography is very important in the diagnosis and treatment of the condition. 3. 3. Bleeding can be arrested by adrenalin perfusion through an arterial catheter. 4. 4. In case bleeding does not stop, localization of the bleeding site by angiography greatly simplifies the operative procedure in those patients who come to surgery. 5. 5. Barium enema studies should be performed in all patients with massive colonic bleeding, but should be delayed until after angiographic studies have been completed. 6. 6. Emergency subtotal colectomy is indicated in only those patients who continue to have bleeding or have recurrent bleeding and in whom the bleeding site has not been accurately localized by angiography. 7. 7. Rarely, elective colectomy may be indicated in those patients with repeated massive hemorrhage when bleeding has been controlled by nonoperative means. In this situation, if the bleeding site has been localized angiographically, limited resection of the involved area should be adequate. In the absence of localization of the bleeding site, subtotal colectomy with ileoproctostomy should be seriously considered.

Analysis was made on the 34 cases of colonic diverticula.Microangiography war performed to the resected specimen in order to study the relationship between vascular architecture and herniated mucosa. The subgross pathology was also observed stereoscopically by using transillumination technique.One case of Marfan's syndrom associated with multiple jejunal and colonic diverticula was repored. Experimental study was made using rat fed by BAPN, and tensile strength of the colon was measured.Complications of colonic diverticulosis and operative results was reported with a review of literatures.

The intramural distribution of the vasa recta of the colon and particularly their relationship to diverticula were investigated in a group of operative and postmortem specimens using intra-arterial barium-gelatin injections, followed by high resolution radiography, microdissections, and histologic sections. Detailed study demonstrated a large arterial branch arching immediately over the dome of the diverticulum. Multiple short branches are displaced intimately around the body and neck of the sac. A pathogenetic relationship between bleeding colonic diverticulosis and the distinctive angioarchitecture is strongly indicated.

SINCE the advent of the barium meal the various pathologic conditions of the colon have become of increasing interest, as by this means the character, severity, and location of the lesions can more accurately be determined. Among the various pathologic conditions studied by the opaque meal, diverticula have assumed an important place. Abbe, in 1914, discussed a case of diverticula diagnosed by Le Wald with the aid of the X-ray, and since that time a mass of comprehensive literature has been contributed on the same subject, until now nearly every phase of the predisposing conditions, the progress of development, and the roentgen signs in their various stages have been more or less fully discussed (1). The object of this paper is to review the development and the various phases of diverticula as demonstrated roentgenologically, with a brief description of the more practical roentgen-ray signs and a demonstration by means of a case report of the X-ray appearance of a ruptured diverticulum, resulting in an ex...

Two cases of massive hemorrhage from colonic diverticula are reported in which an eroded artery has been demonstrated as the source of bleeding. Eight previously reported cases have been reviewed.

Giant colonic diverticulum is an uncommon complication of diverticulosis, with only 52 previously reported cases. Complications secondary to the giant air cysts occurred in only six instances, and all but one occurred in the sigmoid colon. Two additional cases are described, presenting atypical location, age, and complication by pneumoperitoneum.

A case of progressive systemic sclerosis, with blood and pleural fluid eosinophilia and a fulminating course, is presented. Wide-mouth colonic diverticula developed within 10 weeks. Death from renal failure occured five and a half months after the onset of symptoms. The possibility of eosinophilia as a marker of severe disease in progressive systemic sclerosis is raised.

Six New Zealand white rabbits were given gas induction anaesthetics and maintained on glucochloralose (Merck) 60 mg/kg given intravenously. Intracolonic pressures were measured after a standard dose of prostigmine, 0·05 mg/kg, using fluid-filled, open-tipped, narrow-bore polythene tubes. Then the rabbits were put on a diet of white bread, butter, milk, and sugar supplemented by vitamins for four months. All six rabbits had put on weight but their general condition deteriorated; they had become constipated and the colon contracted. After stimulation with prostigmine 0·05 mg/kg scattered intertaenial wide-necked diverticula appeared which were thinner than the normal haustra and looked like a blackcurrant in colour, size, and shape. Repeat pressure measurements showed that the colonic motility index was increased up to 10 times from predietary levels with a highly significant mean increase from 5299 to 33151 (p < 0·0005).

A gastrocolic fistula was demonstrated on barium-enema examination of a patient with recurrent left upper abdominal pain. The underlying cause proved to be perforated diverticulitis of the splenic flexure. This unusual etiology may be considered when the radiologic evidence for gastrocolic fistula and colonic diverticula occur together.

Diverticular disease of the colon has become a clinical problem only in the last 70 years, the traditional life-span of man. Any clinical student of today would recognize a barium enema showing colonic diverticula but, in 1900, Telling of Leeds in England could not find anyone who knew anything about diverticulitis. Colonic diverticula had been described in 1845 but were regarded only as a pathological curiosity until 1900.

This chapter discusses the factors that are considered responsible for diverticulosis. Colonic diverticula are false diverticula and consist of herniations of the colonic mucosa membrane through the colonic wall. The segmental vessels that serve the colon penetrate the muscularis propria in an orderly arrangement. The arteries give off large lateral branches that pass through the circular muscle between the taenia and, consequently, become smaller by the time they reach the antimesocolic periphery of the colon. The blood vessels bear the same relationship to diverticula as does the spermatic cord to an inguinal hernia. The anatomical arrangement of these vessels is common to the normal colons as well as to those which are diseased, regardless of race or ethnic origin, and therefore, while it may be admitted freely that diverticula usually follow the course of the blood vessels, it must never be claimed that the structure of the colon is in itself responsible for the mucosal herniation. The circular muscle of the colon forms a complete tube but the longitudinal muscle is gathered into three bands, the taenia coli, one of which is usually situated at the mesocolic border. Thus, the colonic wall is congenitally thinner between the taenia, and it is here that it is further weakened by the tunnel that contains the segmental blood vessels. Diverticula usually appear first between the taenia on each side of the colon.

The clinical, radiographic, and pathologic findings of 3 patients with giant colonic diverticula are presented. Although several theories have been proposed for the formation of these diverticula, they have not been fully documented. One of our cases illustrates the evolution of this disorder following typical colonic diverticulitis. The pathogenesis and differential diagnosis of this unusual entity are discussed.

Of all patients referred to a gastroenterology clinic, nearly half will have no organic cause found on investigation to explain their symptoms. If they complain of disturbances of bowel habit or abdominal pain, or both, then a diagnosis of irritable bowel syndrome (IBS) may be made. Others with similar symptoms will be found to have colonic diverticula. This chapter deals with these two groups of patients.

In a retrospective evaluation of 1244 consecutive barium enemas performed at two hospitals over a five-year period (1979 to 1984), colonic diverticula were found in 177 (14.2 percent). The prevalence among the Ashkenazi Jews was 19.7 percent, among the Sephardi and Oriental Jews, 16 percent, and among the Arabs, 9.5 percent. Comparing these figures with the results of a similar study performed ten years ago, it becomes obvious that the prevalence of diverticular disease in the Ashkenazi group remained the same, while there was a three-fold increase among Sephardi and Oriental Jews, and a seven-fold increase among Arabs. It is postulated that, in less than one generation, diverticular disease will be equally frequent among all ethnic groups in Israel.

Single or multiple heavy-metal densities seen on abdominal radiographs give rise to several diagnostic possibilities. These include pills or foreign bodies in the gastrointestinal tract, barium in colonic diverticula, and bullets or shrapnel. This communication describes two patients in whom heavy-metal densities observed on abdominal radiographs were caused by residual Pantopaque® from prior renal cyst puncture.

Perhaps Professor Arthur Keith, who described the pathology of diverticula of the alimentary tract in an article in the British Medical Journal in 1910, should be the person to deliver this paper (Keith, 1910). If alive today he would be 110 years old and hence a little elderly for flying the Atlantic! In that paper he described colonic diverticula as true invaginations of the epithelium through the bowel wall, caused probably by increased luminal pressure. He noted that the taeniae were contracted and the circular muscle was thrown into folds, like a concertina. He also observed that diverticula occurred at points of weakness in the colonic wall where it was penetrated by blood vessels. Since that publication, surgical pathologists have been able to improve but little on the description of the pathological changes in diverticular disease.

Publisher Summary This chapter explains that a colonic diverticulum is a herniation of the colonic mucosa through the muscular wall of the colon, and hence, diverticular disease is an acquired condition. Diverticulosis implies that diverticula are present but they are not inflamed. Patients with diverticula may complain of symptoms even in the absence of true inflammatory diverticulitis and the symptoms may be cured by changing the diet or by Reilly's operation.. Diverticulitis means that diverticula are both present and inflamed. It usually means that pericolitis is also present as the inflammatory process is not confined to one or more of the mucosal pouches once the patients complain of symptoms of sufficient severity to merit this diagnosis. The term “low residue diet” means a diet that is absorbed by the bowel and consequently leading to a small quantity of feces being passed. The term “high residue diet” implies that the diet contains all those constituents that are not absorbed by the gut so that the stools are large and usually soft.

Inverted diverticula of the gastrointestinal tract are rare. This paper briefly presents the roentgen findings of an inverted Meckel's diverticulum and is the first reported case of the roentgen appearance of an inverted colonic diverticulum.

The distinctive haustral contour of the large intestine is provided by three bands of longitudinal muscle—the taeniae coli. Since the taeniae are shorter than the length of the colon itself, their tethering action in relation to the circular muscle results in the characteristic haustral sacculations. The colonic haustra are thus organized into three distinct rows, each of which has characteristic anatomic relationships (6).

The actual demonstration of a bleeding point in or adjacent to a colonic diverticulum is rare despite the fact that diverticulosis is considered responsible for approximately 70 per cent of all cas...

Approximately 17 per cent of 500 patients with diverticular disease had colonic hemorrhage. In most cases the bleeding was mild, but it is potentially a lethal complication. In this series the associated mortality was 3.6 per cent. If the bleeding site is readily identifiable it is reasonable to resect the involved area; if not, total abdominal colectomy with ileorectal anastomosis is the preferred procedure. Selective arteriography is now performed more often, and has been helpful in localizing the site of hemorrhage in several patients.

1. 1. Eleven patients who experienced perforated colonie diverticula while receiving adrenocorticosteroid therapy presented clinical features which differed from those who had diverticular perforation but were not receiving steroids. 2. 2. A high index of suspicion for this potentially lethal catastrophe is necessary to establish the diagnosis in patients who usually present without prior gastrointestinal symptoms. 3. 3. Early operation is mandatory in these patients, and consideration should be given to exteriorization or resection of the perforation at the first procedure. 4. 4. In addition to adversely affecting the course of diverticular perforation, long-term adrenocorticosteroid therapy may actually predispose to such perforation.

The consensus of thought regarding the formation of colonic diverticula and the mechanism by which bleeding occurs has been reviewed. The problems involved in the surgical treatment of those cases in which hemorrhage has not been controlled by conservative measures has been discussed. A case showing some unusual features has been presented.