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Highlights • Diverticular disease may result in complications like inflammation, abscess, bleeding and formation of fistula to adjacent organs. • Colouterine fistula secondary to diverticular disease are extremely rare. • Accurate diagnosis of a colouterine fistula requires correlation of clinical presentation, properly selected radiologic examination and endoscopic evaluation. • Colouterine fistulas from other causes must be considered to properly select appropriate management. • The surgical treatment of choice will be dictated by patient factors, local tissue conditions and available expertise., Introduction and importance Colouterine fistulas related to diverticulitis are very rare due to the thickness of the uterine myometrium. Other causes related to colouterine fistula formation particularly malignancy, have to be considered. Diagnosis by imaging or endoscopy may be inconclusive. Case presentation We are presenting a case of a 70-year-old female who presented with malodorous vaginal discharge and painful labial lesions. No previous history of surgery, gynecologic malignancy or other possible causes of the fistula was elicited. CT scan imaging suggested a colouterine fistula. The patient was admitted and underwent Exploratory laparotomy, Hartmann’s procedure and total hysterectomy with bilateral salpingo oophorectomy. The patient was discharged without perioperative complications. Clinical discussion Colouterine fistulas are extremely rare complications of diverticular disease. Diagnosis entails clinical astuteness and judicious use of imaging and endoscopic modalities. Accurate diagnosis is essential to select the appropriate surgical approach, along with intraoperative findings patient status and prevailing conditions. Conclusion This case is being presented not only for the rarity of the case but also for the complexity of the management and decision making during the period of the pandemic.

Introduction Inguinal hernia repair has evolved from open suture methods to mesh repair which is preformed either open or laparoscopically. Mesh hernia repair has improved the outcome in regards to patient care and recurrence rate but it is also associated with a number of complications. The complications of mesh hernia repair such as deep seated infections, mesh erosion and mesh perforation into nearby viscera has been scarcely reported in literature. Case presentation We report a 43 years old male case of diverticulosis adherent to a migrated mesh plug from previous laparoscopic inguinal hernia repair procedure. Discussion The choice of mesh material, appropriate suture placement and closure of the peritoneum after mesh repair is very crucial to avoid long term mesh complications. Conclusion The aim of this case report is to present a rare complication of mesh erosion with colovesical fistula and abscess formation.

Author: Inga Daugirdaite Title: Risk Factors for Colon Diverticulosis Aim: To analyse the risk factors for colon diverticulosis. Tasks: To assess the association between age, gender, BMI, education, night shifts, smoking, NSAID use and colonic diverticulosis. To evaluate the connection between meat, fish, fluid intake, number of meals per day and diverticulosis. To evaluate the relationship between defecation-related factors, such as frequency, duration, sensations during defecation and diverticulosis. Methods: 844 individuals aged 20-95 who underwent colonoscopy from 2015 to 2017 were included in the study. Data of colonoscopies and questionnaires were obtained from Digestive System Research Institute, LSMU. Patients were categorized according to colonoscopy: those with diverticula were included in the group of diverticulosis (524) and those without in the control group (320). Statistical data analysis was performed by SPSS 26 program. The non-parametric χ2 criteria was used for qualitative features, Stjudent t-test for independent samples – for quantitative features. Using multivariate logistic regression the independent association of factors with the disease were assessed, OR and CI of 95% were calculated. Results were considered significant when p0.05). Eating habits – consumption of meat, fish, fluids, total amount of meals per day – did not increase the risk (p>0.05). The feeling of incomplete defecation was associated with diverticulosis (p0.05). Conclusions: Age, male gender, obesity increased the possibility of diverticulosis. Education, working at night, smoking, NSAID use did not increse the chances of the disease. The studied eating habits were not associated with diverticulosis. Feeling of incomplete defecation was related to diverticulosis. Other defecation factors were not significantly associated.

Diverticular disease of the colon is frequent bowel disease. Wide spread of this pathol- ogy, especially among elderly patients, is caused by characteristics of the diet in developed countries. In modern conditions the clinician is faced with the complicated forms of diverticular disease, in some cases requiring urgent surgical intervention. However, the frequency of diagnostic errors on the back- ground of complicated diverticular disease can reach significant values. A clinical case, indicating the significant difficulties, appearing while diagnosis and surgical treatment of diverticular disease late complications is exampled.

The gamma-glutamyltransferase (GGT) is recognized in medical practice as a useful indicator for the detection of liver lesions, especially those induced by the excessive consumption of alcoholic or cholesterol-associated drinks. The present study, although it includes a very small number of cases diagnosed with colon diverticulosis-diverticulitis associated with polyposis at the same intestinal level, identifies the presence of increased circulating concentrations of this enzyme in the serum. Its serum levels are tracked “dynamically” throughout a year after the diagnosis and start of the therapy. The study calls into question the release of the enzyme from the edge of the enterocytes’ brush-like edge, leading to the pathogenic disturbance of regional redox homeostasis. The hypothesis gives the circulating values of GGT predictive value for cellular oxidative stress, as well as for indirectly expressing the glutathione level in cytosol.

OBJECTIVE Right-sided type colonic diverticulosis has been predominant in Japan, in contrast to European counties where the left-sided type is predominant. Considering the recent change in the dietary habits of Japanese people to a more Western diet in urban areas of Japan, the features of colonic diverticulosis may also change to reflect a more Western type. Therefore, we attempted to clarify the current situation. METHODS A total of 435 consecutive outpatients who agreed to a barium enema and complete examination were enrolled in this study. RESULTS 113 patients (26.0%) revealed colon diverticulosis; 50.4% of the patients had more than ten diverticula. The percentage of man with ten or more diverticula (67.4%) was significantly higher than that of women patients (40.0%, p

Background: Insufficient intake of dietary fiber (DF) is currently a major problem in the overall promotion of health in the general population in Japan. Aim of the study: To analyze the time trends in DF intake, including DF density (total DF intake/1,000 kcal), and the ratio of water-insoluble fiber to water-soluble fiber (IS ratio) in Japan. Methods: The time trend in DF intake in Japan was calculated from data compiled in the Japanese National Nutrition Survey. Results: The mean daily DF intake (total DF intake) in 1952 was 20.5 g/day, which rapidly declined to about 70 % of the 1952 level in 1970, after which there was little change to 1998. DF density in 1952 was 9.7 g/1000 kcal, which declined by about 30 % in 1970, and remained at about the same level to 1998. The IS ratio has remained stable over this period. Whereas total DF intake and DF density in Japan are similar to those in Western countries, the IS ratios are higher in Japan. Therefore, the higher incidence of, and mortality from, colon diverticulosis, coronary heart disease, hyperlipidemia, etc., which are all thought to be related to fiber deficiency, in Western countries compared to Japan might be due to the differences in the IS ratio. Conclusions: A decline in total DF intake and DF density is predicted for Japan in the future, because these parameters were lower among the younger generation. This may be due to the marked changes in the dietary habits of the younger generation, and is a problematic trend for Japanese health.

In this report, we attempt to propose a recommended level of dietary fiber (DF) for the Japanese from several epidemiological reports. The authors previously investigated the daily DF intake in 50 patients with colon polyp, 33 patients with colon diverticulosis, 45 patients with colorectal cancer, and two groups 84 and 45 control subjects; the values obtained were 18.2, 17.4, 14.9, and 21.1 and 19.9 g, respectively. In another study, of the 5 regions in Japan, in only one, Aomori, where the rate of the colon diverticulosis detection was the lowest, did the DF intake exceed 20 g. Furthermore, in Japan the incidence of colorectal cancer showed a marked increase after 1955. It was assumed that the period between the diagnosis of colorectal cancer and death was 15 years, and that the DF intakes at this time (before 1940) to had contributed to the development of the disease. However unfortunately daily DF intake before 1940 in Japan were unknown, and we have only data 25.0 g in 1946. Thus, it is proposed that the recommended level for daily DF intake in Japanese be set at about 20–25 g, i.e. 10 g per 1,000 kcal.

But : recenser les etiologies des rectorragies au CHU Campus de Lome. Methodologie : Il s’agit d’une etude retrospectivr sur 12 ans (1er janvier 1990 - 31 decembre 2001), realisee a partir des comptes-rendus de coloscopie. Elle a inclus les dossiers des malades des deux sexes, âges de plus de 15 ans, ayant presente une rectorragie exploree par une ano-rectoscopie et une coloscopie totale. Resultats : les rectorragies representent 38,72 % des indications de la coloscopie. Les malades âges de 24 a 45 ans ont ete les plus atteints (52,94 %). Une predominance masculine a ete retrouvee (sex-ratio : 2,4). Parmi les etiologies retrouvees, les hemorroides ont ete plus frequentes (23,53 %) suivies par les colites non specifiques (16,47 %), la recto-colite ulcero-hemorragique (15,29 %), la diverticulose colique (10,58 %), les colites amibiennes (9,4 %) et le cancer colorectal (5,88%). Les hemorroides etaient associees a une colite non specifique (1 cas), a une recto-colite ulcero-hemorragique (1 cas), a une colite amibienne (1 cas) et a une diverticulose colique (1 cas). Dans 12 cas (14,12 %), aucune etiologie n’a ete retrouvee. Conclusion : Les hemorroides representent l’etiologie la plus frequente des rectorragies a Lome; cependant leur decouverte a l’ano-rectoscopie ne doit pas dispenser de la realisation d’une coloscopie complete a la recherche de lesions associees. Mots cles : Rectorragie, etiologie, ano-rectoscopie, coloscopie. Purpose: To count the aetiology of proctorrhagia in Lome. Methods: It is a retrospective study, over 12 years (1st January 1990-31 December 2001), realised from the reports of the coloscopy. It included the patients of the two sexes, old of more than 15 years, having presented a proctorrhagia explored by ano-rectoscopy and coloscopy. Results: The proctorrhagia represent 38.72 % of the indications of the coloscopy. The patients from 24 to 45 years were reached (52.94 %). A male prevalence was found (sex-ratio: 2.4). Among the aetiology found, the haemorrhoids more frequent (23.53 %) were followed by the non specific colitis (16.47 %), the ulcero-haemorrhage rectocolitis (15.29 %), the colon diverticulosis (10.58 %), the amoebic colitis (9.4%) and colorectal cancer (5.88 %). The haemorrhoids were associated with a non specific colitis (1 case), an ulcero-hemorrhagic rectocolitis (1 case), an amoebic colitis (1 case) and diverticulose colic (1 case). In 12 cases (14.12 %), no aetiology was found. Conclusion: The haemorrhoids represent the most frequent aetiology of the proctorrhagia in Lome; however their discovery in ano-rectoscopy should not exempt realisation of a complete coloscopy in the search of other causes. Key words: Proctorrhagia, aetiology, ano-rectoscopy, coloscopy.

A 64-year-old woman was admitted to our hospital with lower abdominal pain. Routine laboratory values were unremarkable except for the white blood cell count (15,000/micro litter) and the C-reactive protein (CRP) value (22.5 mg/dl). A Computed tomography (CT) scan revealed air collection in the middle of the anterior pararenal space. One day later, CT revealed air collection in the anterior pararenal space spread to the right side and abscess in the sigmoid mesentery. Because an intramesocolic perforation of the sigmoid colon was suspected, an emergency operation was performed. Abscess formation was recognized in the sigmoid mesentery, and sigmoidectomy including the contaminated mesentery and Hartmann.s procedure were performed. The perforation was 3 cm in diameter, and some diverticula were present in the vicinity of the perforated site. The specimen microscopically revealed perforation at the edge of the diverticulum in association with sudden disruption of the proper muscle layer. Based on pathological findings, intramesocolic diverticular perforation of the sigmoid colon was diagnosed. The present case is a very rare condition. However, it was possible to make a diagnosis preoperatively by detecting air collection in the anterior pararenal space on CT scan. If a sigmoid perforation occurs between the leaves of the mesocolon, air extends into the root of the sigmoid mesocolon and within the anterior pararenal space.

The prevalence of colorectal cancer (CRC) and diverticular disease has increased in recent years. Both have common risk factors such as age and a lack of dietary fiber. A causal relationship between diverticulosis and CRC has been suggested in di.erent studies. Despite common epidemiological trends and risk factors, there are conflicting data concerning the association between diverticular disease and CRC. Such discrepancy could be referred to the highly heterogeneous study design and setting in the di. erent epidemiologic series. Unravelling the dilemma seems to be clinically relevant, because a di.erent screening and/or surveillance protocol for CRC could be scheduled in patients with diverticula. The present review aimed to perform a comprehensive evaluation of the available data. (Korean J Med 2013;85:559-562)

Mutant p53 protein was investigated by ELISA using the stool of 132 patients with various colorectal diseases. Mutant p53 protein was detected in 41 cases (31.1%). The positive rates of fecal mutant p53 protein were 68.2% of colorectal cancer, 29.4% of colon polyps, 21.2% of colon diverticulosis, 0% of inflammatory bowel diseases and 27.7% of the patients with normal findings. The frequency of fecal mutant p53 protein in patients with colorectal cancers was significantly high compared with those without cancers (P

Four cases of jejunal diverticulosis have been presented with autopsy findings. One of these, we believe, is the fifth recorded case of jejunal diverticulosis associated with colon diverticulosis. The inconstant organic findings suggest that some abnormal muscular action may be the outstanding etiological factor in the production of diverticulosis.

Diverticula can appear and disappear while under fluoroscopic observation at barium enema examination. These changing diverticula may exhibit all the various shapes that are seen with the ordinary, nondisappearing type of diverticulum. Within the past two years, roentgenograms obtained during examination of three patients, besides the case reported here, showed spontaneously appearing and disappearing diverticula (Fig. 14). Only a few references are made in the literature to spontaneously appearing or disappearing diverticula (3, 10), and no reference has been made to fluoroscopic observation of this phenomenon. Since 1925, colon diverticula coated by muscle have been described as intramural diverticula, early or “pre-” diverticula (2, 5–8), or spastic colon diverticulosis (1, 3). Recently, diverticular disease without diverticula has been documented (1, 9). It has been suggested that “early” stages of diverticula may develop into large, saccular diverticula in months or years (3, 6). That this developmen...

Diverticulosis of the ascending colon is rare. Perforation of a diverticulum is very uncommon and at times it is difficult to differentiate from carcinoma. Two unusual cases of perforated solitary diverticula of the ascending colon are reported, and liter-ature is briefly reviewed.

Colonic diverticula result from herniation of the mucosa through weak spots in the muscular wall. Clinically manifested diverticulitis has been thought to have its pathologic basis in an abscessed diverticulum obstructed by a fecalith, but studies of resected sigmoids have failed to produce evidence to support this view. Instead, the outstanding lesion was found to be a perforation in the fundus of a diverticulum, with surrounding peridiverticular or pericolic inflammation. Another surprising finding in pathologic studies was that one out of three sigmoids resected for "diverticulitis" showed no inflammation in or around the diverticula, but the wall of the sigmoid was impressively thickened. This type of diverticulosis, which is frequently symptomatic, has been referred to as painful diverticular disease or spastic colon diverticulosis. Diverticula without muscle thickening are usually asymptomatic, and the condition is referred to as diverticulosis or simple massed diverticulosis. It is uncertain whether the two types have a similar pathogenesis. High intrasigmoid pressures, abnormalities of sigmoid musculature, low-fiber diet, and psychologic stress are thought to be important factors in the formation of diverticula.

This report briefly describes several cases of diverticula simulating colonic mucosal lesions. We have found that the bowler hat configuration, in particular, frequently occurs in the presence of diverticular disease. In our series, no polyp was found to exhibit the bowler hat sign, while 12 cases of diverticular disease displayed 1 or more “bowler hats.” Differentiation between polyps and diverticula displaying the bowler hat sign may be possible, but we conclude that the bowler hat sign per se is a nonspecific finding and that additional views may be necessary to confirm the presence of polyps.