Diverticular Disease Dr. Charles H. Knowles (PhD FRCS)
|
|
- Christopher Robert Webster
- 5 years ago
- Views:
Transcription
1 Diverticular Disease Academic Surgical Unit Barts and the London School of Medicine and Dentistry Queen Mary University of London 1 Overview - diverticular disease Definitions Spectrum of disease Epidemiology Aetiology Management Societal impact 2 Diverticular disease A common condition of uncertain aetiology in which serosa-covered out-pouchings (diverticula) of mucosa occur through gaps in the muscularis propria Pseudo (false) diverticula Mucosa and serosa only Rarely true diverticula Solitary caecal All 3 layers Definitions (1) 3 1
2 Definitions (2) Taxonomy Noun singular: diverticulum Noun plural: diverticula (not ae) Adjective: diverticular The presence (symptomatic or asymptomatic) of diverticula is termed: diverticulosis: syn. diverticular disease 4 Spectrum of disease (1) Uncomplicated Classification of diverticulitis 1 Asymptomatic (incidental) I. Symptomatic uncomplicated disease Symptomatic II. Recurrent symptomatic disease Complicated III. Complicated disease Septic complications Diverticulitis Perforation Abscess Mass Fistula Peritonitis (purulent or faecal) Bleeding Obstruction 1. Kohler et al., EAES Consensus statement; Surg Endosc 1999; 13: Spectrum of disease (2) Diverticulosis Diverticulitis 6 2
3 Spectrum of disease (3) Hinchey classification of perforated disease 1 Pericolic abscess or phlegmon Pelvic, intra-abdominal or retroperitoneal abscess Diverticulitis with purulent peritonitis Diverticulitis with faecal peritonitis Stage I II III IV Modified Hinchey classification 2 Distant abscess amenable to drainage Complex abscess +/- fistula IIa IIb 1. Hinchey EJ et al., Adv Surg 1978; 12: Sher et al., Surg Endosc 1997; 1: Spectrum of disease (4) Hinchey IIb 8 Spectrum of disease (5) Hinchey IIb + fistulae Hinchey III 9 3
4 History First pathological description ascribed to Cruveilhier First clinical description First textbook description First population studies Epidemiology (1) Projecting from sides of the colon, in intervals of the septa, were small coecal pouches, in each was situated one of the concretions referred to; The number of pouches and concretions amounted to nearly thirty (Sir Erasmus Wilson, Lancet 1840) 1925: 10% adults barium enema (UK) : 6% adults barium enema (USA) 5 NB: Alexis Littre 1719 = ileal (Meckels) 1. Cruveilhier J. Traite d Antomie Pathologique; Balliere et Cie 1849; 1: Telling & Gunner; Br J Surg 1917; 4: Telling WHM; Proc R Soc Med 1920; 13: Sprigs & Marxer; Q J Med 1925; 19: Mayo WJ 1930; Ann Surg Med 1930; 92: Epidemiology (2) DD: increasing incidence Radiological Trend towards increasing prevalence Over-estimateestimate High risk populations (age, symptomatic) Autopsy studies Mostly unselected (asymptomatic?) Hospital admissions for complications 11 Epidemiology (3) Changing incidence of diverticular disease on barium enema Author Year Population N % Sprigs & Marxer 1925 UK (adults) Rankin & Brown 1930 USA Edwards 1934 UK (over 40 years) Landing 1935 Sweden Oschner & Burgen 1935 USA Willard & Bockus 1936 USA Median 11 Eggers 1941 USA Allen 1953 USA Edwards 1953 UK (over 35 years) Smith & Christensen 1959 USA Manousos et al UK (over 60 years) Median
5 Epidemiology (4) Autopsy incidence Left sided: 1917: Drummond: 4.4% (n = 500) 1930: Rankin & Brown: 5.6% (n =1925) 1968: Parks: 37% (n = 300) 1969: Hughes: 45% (n = 200) Right sided: 1986: Lee (Singapore): 19% (n = 1014) 1993: Munakata et al., (Japan): 23% 13 Epidemiology (5) Age incidence Slack (1962) unselected autopsies 60 e % incidence Slack WW. Br J Surg 1962; 50: Epidemiology (6) Changing sex ratio of diverticular disease Author Year Male: female Telling & Gunner : 1.0 Sprigs & Marxer : 1.0 Mayo : 1.0 Oschner & Burgen : 1.0 Boles & Jordan : 1.2 Brown & Toomey : 1.5 Brown & Toomey : 1.3 Manousos et al : 1.8 Manousos et al : 1.4 Parks : 1.5 Botsford et al : 1.3 Male predominant Female predominant 15 5
6 Epidemiology (7) Geography Pre-1960s Post-1960s 16 Epidemiology (8) Right-sided diverticular disease 1-2% Western cases Majority of Japan, South East Asian Caecum 79%, 1/3 rd = solitary Some true (full thickness)? developmental Present younger (30-40 years) Increasing incidence (Lee 1986; Munakata et al., 1993; Miura et al., 2000) Presentations: acute appendicitis or bleeding 17 Epidemiology (9) Complicated diverticular disease Increase burden well-documented by admission and death rates Age M F M F Admission rates in Scotland per 100,000 population Kyle & Davidson. Br J Surg 1975; 62:
7 Epidemiology (10) Admission rate / 100,000 pop n % of admissions with surgery 1989/ /2000 % change M F M F M F Case fatality rate Kang et al., APT 2003; 17: Epidemiology (11) Humes et al., Gastroenterology 2009; 136: Increasing incidence even with age adjustment Epidemiology (12) Etzioni et al., Ann Surg 2009; 249:
8 Aetiology (1) Ageing Lower dietary fibre Congenital pre-disposition Colonic thickening & segmentation Weakening of the colonic wall High intraluminal pressures Diverticular disease 22 Aetiology (2) 23 Aetiology (3) Dietary fibre: epidemiological evidence DD incidence parallels inc refined sugar & decreased fibre (roller milling from 1880s) 1 Changing incidence in mobile populations e.g. Japan to Hawaii 2 and Negro Americans 3 reflect dietary reductions in fibre Decreased incidence in vegetarians 4 Increased in low SES populations with poor diet 5 Case control 6 and cohort 7 studies of fibre intake 1. Burkitt DP. Lancet 1970; 2: Stemmerman GN. Arch Envirn Health 1969; 20: Cleave TL et al., Gear et al., Lancet 1979; 1: Eastwood et al., Gut 1978; 19: Brodribb & Humphries. Br Med J 1976; 1: Aldoori et al., J Nutr 1998; 128:
9 Aetiology (4) Dietary fibre: experimental evidence - Pulsion theory of diverticular disease (Buie 1939; Painter et al., 1965) Sigmoid has highest regional pressures in colon Wall thickening in DD (Morson et al., 1963) Pressures inc. in DD (Parks & Connell, 1969; Christopher et al., 2000) Longitudinal animal studies e.g. rodents (Fischer et al., 1985) Surgery of the Anus, Rectum & Colon; WB Saunders Co. Ltd, London 1993, Vol 2, p Aetiology (5) Effect of obesity: cohort studies: BMI > 30 Study Population N F.up RR/hazard ratio Humes et al., UK general y 1.39 (perforated) 2009 Rosemar et al., Sweden, male y 4.4 (hospitalised) 2008 Strate et al., USA, Health y 1.78 (diverticulitis) 2009 Professionals 3.19 (D. bleeding) Etzioni et al., Ann Surg 2009; 249: Aetiology (6) Abnormal neuromuscular function Changes in neurochemical coding of enteric neurones Motor: unlikely to contribute to aetiology Sensory: post-inflammatory visceral hypersensitivity Changes in ICC Probably secondary PGP 9.5 (Simpson et al., 2009) Milner et al., 1990; Golder et al., 2003; Bassotti et al., 2005; Guagnini et al., 2006; Simpson et al., 2009 CD 117 (Bassotti et al., 2005) 27 9
10 Aetiology (7) Abnormal extracellular matrix Rare connective tissue (collagen) disorders are associated with early-onset diverticular disease Ehlers Danlos inc. tenascin mutations Several studies demonstrate ECM (collagen & elastin) changes in thickened colonic wall (Whiteway & Morson, 1985; Wess ) Abnormal cross linking of collagen III 28 Management (1) Symptomatic complicated Outline Diverticulitis Asymptomatic Symptomatic uncomplicated Hinchey I/II Hinchey III/IV Special cases Preventative strategy Dietary advice Weight loss Exercise Pharmacological based on symptoms Dietary advice Anti-spasmodics Laxatives Anti-diarrhoeals IV antibiotics Resuscitation Bowel rest (level II/III) Hydration IV antibiotics Analgesia Bowel rest + Analgesia CT scan + +/- Laparotomy Percutaneous or laparoscopic drainage washout of abscess +/- Elective resection As specific complication e.g. GI bleeding Obstruction 29 Management (2) Diagnosis Elective DCBE preferable to colonoscopy Emergency revolutionised by widespread availability of helical CT (and interventional radiology) Septic patient with abdominal signs and known diverticulosis 30 10
11 Management (3) Principles of surgery Sigmoid colectomy Sigmoid colectomy & defunct. loop ileostomy Hartmann s Procedure +/- mucous fistula Defunctioning loop colostomy Elective Hinchey I Emergency Hinchey IV 31 Management (4) Medical therapy for symptomatic uncomplicated disease Case series: fibre (bran): excellent results ( ) Early controlled studies mixed results Devroede et al., no advantage Taylor & Duthie, all improved Brodribb most improved Hodgson no advantage Ornstein et al., reduced straining only Leahy et al., reduction in complications and symptoms No recent RCTs 32 Management (5) Surgical therapy for symptomatic uncomplicated disease Sigmoid myotomy (and variations): no longer practiced Elective resection: rarely recommended Morbidity higher than cancer surgery Patients often unfit and elderly High complication rates (esp. anastomotic leaks) High permanent stoma rates Poor symptomatic control Failure to consistently prevent complicated disease Surgery of the Anus, Rectum & Colon; WB Saunders Co. Ltd, London 1993, Vol 2, p
12 Management (6) Management of diverticulitis: Hinchey I/II Clinical assessment IV fluid resuscitation Analgesia Broad spectrum antibiotics Low residue diet or bowel rest CT +/- abscess drainage Confirmation of the diagnosis after resolution (DCBE or colonoscopy) Laparotomy if failure (low threshold in immunocompromised) 34 Management (7) Management of diverticulitis - Hinchey I/II: indications for elective surgery Controversial Evidence limited to audit data (Farmakis et al., 1994) and eminence-based opinion General indications: 2 episodes diverticulitis (single episode in immuno-compromised) Fistula (colovaginal or colovesical) Mass in which cancer cannot be excluded endoscopically Problems of high complication rates persist even in specialist centres 35 Sigmoid diverticulitis : the Dutch experience Elective n = 149 Acute n = 114 Age 64 (M 61; F 66) 67 (M 62; F 70) Female/male 98/51 67/47 Possum score completeness >95% >95% Predicted possum mortality 4.9% 23.4% Mortality 4.7% (M 7.8%; F 3.1%) 17% (M 15%; F18%) Complication 53.7% 71.1% Reoperation at first admission 12.1% 15.8 Operations after discharge 15.4% 61.4% Surgery Resection and anastomosis 88% 8% Hartmann 5% 71% Other 8% 21% AF Engel, JLT Oomen, Zaans Medical Centre,
13 Management (8) Elective surgery: notes The surgery is nearly always more difficult than for cancer Consent must realistically explain: Potential outcomes (anastomosis, loop ileostomy, Hartmann s) Complications (anastomotic leak) Low threshold for ureteric stenting Anatomical above and below approach inc. splenic flexure Low threshold for defunctioning stoma (mark both sides) 37 Management (9) Management of diverticulitis: Hinchey III/IV Resuscitation Level II/III care Fluids, pressors & invasive monitoring +/- other organ support IV antibiotics, analgesia Laparotomy almost always indicated Frank discussion with patient & carers Mortality > 20% High likelihood of stoma (mark both sides) 38 Mortality after acute surgery for complications of diverticular disease of the sigmoid colon First author Year No. of patients Overall (%) Mortality Hinchey I/II (%) Hinchey III/IV (%) Rodkey (183) 35.3 (17) Rodkey (218) 21.6 (51) Krukowski Krukowski (11) 30.0 (10) Greg Kronborg (62) Tudor (117) 32.8 (58) Wedell (31) 28.0 (25) Oomen JLT et al. Colorectal Disease 2006; 8: Hoemke (103) 10.0 (10) Zeitoun (99) Gooszen (35) (10) Schilling (55) Blair (24) 22.2 (9) Biondo (28) (55) Present study (67) 21.3 (47) Number in parentheses is number of patients per Hinchey group Median 22% 39 13
14 Management (10) Surgery for diverticulitis: Hinchey III/IV Contentious (no good quality evidence) Hinchey III Fit patients without profound contamination or sepsis Resection and anastomosis possible +/- defunct. loop ileostomy +/- OT bowel wash out Avoids morbidity of reversal of Hartmann s Hinchey IV Always Hartmann s procedure +/- mucous fistula Defunct loop colostomies are suboptimal (use limited to genuine cases of damage limitation) Anastomosis is madness! 40 Management (11) Avoiding laparotomy and resection in Hinchey III Hinchey II, n = 25 Hinchey III, n = 67 Myers E et al., Br J Surg 2008; 95: /- elective surgery 41 Management (12) Role of laparoscopy in elective resection No RCTS Meta-analysis of non-randomised studies Decrease LOS Decrease complications Laparoscopic vs. Open resection for diverticular disease Length of stay Purkayastha S et al., DCR 2006; 49: Favors laparoscopic Favors open 42 14
15 Societal impact (1) DD is common US 2004 national audit data 312,000 admissions 1.5 million inpatient days $2.6 billion UK 2005 NHS data 217,000 bed days (more than UC and CD combined!) Epidemiological data show clearly increasing incidence (age independent) Increasingly aged and obese population 43 Societal impact (2) DD is highly morbid Patients are frequently unfit Elective and emergency surgery are hazardous Complication rates are high Mortality rates are high Stoma rates are high 60-70% never reversed (Navara et al., 1995; Belmonte et al., 1996) Frequently suboptimal quality 44 Societal impact (3) DD is an orphan disease Governments obsessed with cancer initiatives Of all system specific areas, oral/gi has the poorest ratio of investment in research to burden of disease with the exception of respiratory (3 years) MeSH core clinical journals 208 vs for colon cancer Only 1 study of pathophysiology/aetiology Only 1 RCT (c.f. 13 in IBS) No non-human studies (c.f. 38 in IBS) 1. UK Clinical Research Collaboration 2006 data 45 15
16 Summary Diverticular disease Increasing incidence of asymptomatic and complicated forms Aetiology: low fibre, aging and obesity (complications) Medical management limited, surgical management complex and hazardous High societal cost but little research investment 46 Thank you The old (1742) and the new (2010)
DIVERTICULOSIS MEDICAL AND SURGICAL MANAGEMENT. Simon Radley Consultant Surgeon March 2013
DIVERTICULOSIS MEDICAL AND SURGICAL MANAGEMENT Simon Radley Consultant Surgeon March 2013 Definitions Diverticulosis: presence of diverticulae Diverticular disease: diverticulae associated with symptoms
More informationDiverticular Disease Emerging evidence in a common condition Determinants of treatment
FALK SYMPOSIUM 148, Munich 17-18 th June 2005 Diverticular Disease Emerging evidence in a common condition Determinants of treatment NATURAL COURSE OF THE DISEASE Marios Z Panos Euroclinic of Athens WHY
More informationProf. Dr. Ahmed ElGeidie Professor of General surgery GEC Dr. Ahmed Abdelrafee
Prof. Dr. Ahmed ElGeidie Professor of General surgery GEC Dr. Ahmed Abdelrafee Diverticulosis of the colon is the presence of pockets in the wall of the colon called diverticula which may, or may not,
More informationWhen should we operate for recurrent diverticulitis. Savvas Papagrigoriadis MD MSc FRCS Consultant Colorectal Surgeon King's College Hospital
When should we operate for recurrent diverticulitis Savvas Papagrigoriadis MD MSc FRCS Consultant Colorectal Surgeon King's College Hospital ASCRS Practice parameters for the Treatment of Acute Diverticulitis
More informationAcute Diverticulitis. Andrew B. Peitzman, MD Mark M. Ravitch Professor of Surgery University of Pittsburgh
Acute Diverticulitis Andrew B. Peitzman, MD Mark M. Ravitch Professor of Surgery University of Pittsburgh Focus today: when to operate n Recurrent, uncomplicated diverticulitis; after how many episodes?
More informationDeterminants of treatment: Outcome measures or how to read studies on diverticular disease
Determinants of treatment: Outcome measures or how to read studies on diverticular disease Jörg C. Hoffmann, Medizinische Klinik I, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin Outcome:
More informationAcute Care Surgery: Diverticulitis
Acute Care Surgery: Diverticulitis Madhulika G. Varma, MD Associate Professor and Chief Section of Colorectal Surgery University of California, San Francisco Modern Treatment of Diverticular Disease Increasing
More informationGuideline scope Diverticular disease: diagnosis and management
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Diverticular disease: diagnosis and management The Department of Health in England has asked NICE to develop a clinical guideline on diverticular
More informationDIVERTICULAR DISEASE HANDS OFF OR HANDS ON?
DIVERTICULAR DISEASE HANDS OFF OR HANDS ON? TE MADIBA AND M NAIDOO TE MADIBA MMed, LLM, PhD, FCS (SA), FASCRS Emeritus Professor of Surgery & Director of the Gastrointestinal Cancer Research Centre, University
More informationHits and Myths of Diverticulosis. JR Gray Gastoenterology UBC
Hits and Myths of Diverticulosis JR Gray Gastoenterology UBC Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form
More informationManagement of Diverticulitis. Sanjay Adusumilli MBBS MS FRACS
Management of Diverticulitis Sanjay Adusumilli MBBS MS FRACS 0411 051 281 Trained by CSSANZ in Oxford (UK) and Perth Appointments at BMDH, HSS, Norwest Private and SAN Hospital Surgery performed: Laparoscopic
More informationSTOMAS AND DIVERTICULITIS
STOMAS AND DIVERTICULITIS Jean-Jacques Jacques HOUBEN U.L.B. CENTRE HOSPITALIER INTERREGIONAL EDITH CAVELL First Post-Graduate course of the BSCRS colorectal section BRUSSELS 2002 jjhouben@ulb.ac.be gastrospace.com
More informationSpectrum of Diverticular Disease. Outline
Spectrum of Disease ACG Postgraduate Course January 24, 2015 Lisa Strate, MD, MPH Associate Professor of Medicine University of Washington, Seattle, WA Outline Traditional theories and updated perspectives
More informationA Population-Based Analysis of the Clinical Course of Colonic Diverticulitis and its Evolving Management
A Population-Based Analysis of the Clinical Course of Colonic Diverticulitis and its Evolving Management by Debbie Li A thesis submitted in conformity with the requirements for the degree of Masters of
More informationChapter I 7. Laparoscopic versus open elective sigmoid resection in diverticular disease: six months follow-up of the randomized control Sigma-trial
Chapter I 7 Laparoscopic versus open elective sigmoid resection in diverticular disease: six months follow-up of the randomized control Sigma-trial Bastiaan R. Klarenbeek Roberto Bergamaschi Alexander
More informationA clinical and radiological comparison of sigmoid diverticulitis episodes 1 and 2
Original article doi:10.1111/j.1463-1318.2011.02642.x A clinical and radiological comparison of sigmoid diverticulitis episodes 1 and 2 P. Gervaz*, A. Platon, L. Widmer, P. Ambrosetti* and P.-A. Poletti
More informationSurgery ~ Current Problems in. Colonic Diverticular Disease
Current Problems in Surgery ~ Volume 37 Number 7 July 2000 Colonic Diverticular Disease II Foreword In Brief Biographic InFormation Introduction Epidemiologic and Pathophysiologic Features and Natural
More informationDiverticulosis Diverticulitis
Diverticulosis Diverticulitis 28.02.2018 Ioannis Kapoglou/Riad Sarraj Universitätsklinik für Viszerale Medizin Gastroenterologie Epidemiology Diverticulosis / Diverticulitis 2 Epidemiology
More information8/29/2016 DIVERTICULAR DISEASE: WHAT EVERY NURSE PRACTITIONER SHOULD KNOW. LENORE LAMANNA Ed.D, ANP-C LEARNING OBJECTIVES
DIVERTICULAR DISEASE: WHAT EVERY NURSE PRACTITIONER SHOULD KNOW LENORE LAMANNA Ed.D, ANP-C LEARNING OBJECTIVES Define Diverticular Disease Discuss Epidemiology and Pathophysiology of Diverticular disease
More informationDIVERTICULAR DISEASE. Dr. Irina Murray Casanova PGY IV
DIVERTICULAR DISEASE Dr. Irina Murray Casanova PGY IV Diverticular Disease Colonoscopy Abdpelvic CT Scan Surgical Indications Overall, approximately 20% of patients with diverticulitis require surgical
More informationCurrent indications and role of surgery in the management of sigmoid diverticulitis
Online Submissions: http://www.wjgnet.com/1007-9327office wjg@wjgnet.com doi:10.3748/wjg.v16.i7.804 World J Gastroenterol 2010 February 21; 16(7): 804-817 ISSN 1007-9327 (print) 2010 Baishideng. All rights
More informationComplicated Diverticulitis. Evidence Based Recommendations
Complicated Diverticulitis Evidence Based Recommendations Frederick A Moore MD September 10, 2014 Complicated Diverticulitis Evidence Based Recommendations I have no financial disclosures A Management
More informationLONG TERM OUTCOME OF ELECTIVE SURGERY
LONG TERM OUTCOME OF ELECTIVE SURGERY Roberto Persiani Associate Professor Mini-invasive Oncological Surgery Unit Institute of Surgical Pathology (Dir. prof. D. D Ugo) Dis Colon Rectum, March 2000 Dis
More informationColostomy & Ileostomy
Colostomy & Ileostomy Indications, problems and preference By Waleed Omar Professor of Colorectal surgery, Mansoura University. Disclosure I have no disclosures. Presentation outline Stoma: Definition
More informationSmall Bowel and Colon Surgery
Small Bowel and Colon Surgery Why Do I Need a Small Bowel Resection? A variety of conditions can damage your small bowel. In severe cases, your doctor may recommend removing part of your small bowel. Conditions
More informationPerforated diverticulitis: Washout it s happening
Perforated diverticulitis: Washout it s happening or maybe not! Ori D. Rotstein, M.D. Department of Surgery St. Michael s Hospital University of Toronto 62 year old male 24 hour history of LLQ pain Now-
More informationCOLONIC DIVERTICULAR DISEASE: ABNORMALITIES OF NEUROMUSCULAR FUNCTION
UNIVERSITA' DEGLI STUDI DI PERUGIA (1308-2016) COLONIC DIVERTICULAR DISEASE: ABNORMALITIES OF NEUROMUSCULAR FUNCTION Gabrio Bassotti, MD, PhD Associate Professor of Gastroenterology CDD: ETIOLOGY Interaction
More informationEpidemiology of diverticulosis and diverticular disease. Alfredo Papa U.O.C. Medicina Interna e Gastroenterologia, C.I. Columbus
Epidemiology of diverticulosis and diverticular disease Alfredo Papa U.O.C. Medicina Interna e Gastroenterologia, C.I. Columbus Summary Burden of disease on health care resources (outpatients visits, admissions,
More informationONE of the most severe complications of diverticulitis of the sigmoid
CLEVELAND CLINIC QUARTERLY Copyright 1970 by The Cleveland Clinic Foundation Volume 37, July 1970 Printed in U.S.A. Colonic diverticulitis with perforation to region of left hip: a rare complication Report
More informationsigmoid for diverticular disease
Gut, 1970, 11, 121-125 Rectal and colonic studies after resection of the sigmoid for diverticular disease T. G. PARKS From the Department of Surgery, Queen's University of Belfast, and St. Mark's Hospital,
More informationAcute Diverticulitis: 5 Years Experience in a Teaching Hospital in Kuwait
Original Paper Med Principles Pract 1999;8:6 11 Received: July 14, 1997 Revised: February 7, 1998 Acute Diverticulitis: 5 Years Experience in a Teaching Hospital in Kuwait M. Afifi El-Sayed T.H. Juma Hilal
More informationOriginal article Surgical outcomes and their relation to the number of prior episodes of diverticulitis
Gastroenterology Report 1 (2013) 64 69, doi:10.1093/gastro/got017 Original article Surgical outcomes and their relation to the number of prior episodes of diverticulitis Shota Takano, Cesar Reategui, Giovanna
More informationInflammatory Bowel Disease and Surgery: What You Should Know
Inflammatory Bowel Disease and Surgery: What You Should Know Ask the Experts March 9, 2019 Kristen Blaker, MD Colon and Rectal Surgery MetroHealth Medical Center Disclosures None Outline Who undergoes
More informationDoes the Presence of Abscesses in Diverticular Disease Prelude Surgery?
J Gastrointest Surg (2013) 17:540 547 DOI 10.1007/s11605-012-2097-x ORIGINAL ARTICLE Does the Presence of Abscesses in Diverticular Disease Prelude Surgery? B. J. M. van de Wall & W. A. Draaisma & E. C.
More informationCitation Acta medica Nagasakiensia. 1988, 33
NAOSITE: Nagasaki University's Ac Title Author(s) Surgery for complications by divert Harada, Yoshihide; Sato, Tetsuya; O Oh, Shimei; Obatake, Masayuki; Kawa Takatoshi; Tomita, Masao Citation Acta medica
More informationGastrointestinal Diverticulosis A Retrospective Analysis
Abstract Gastrointestinal Diverticulosis A Retrospective Analysis Pages with reference to book, From 14 To 19 Huma Qureshi, Sarwar J. Zuberi ( PMRC Research Centre, Jinnah Postgraduate Medical Centre,
More informationThe role of Surgery and Stomas in IBD
The role of Surgery and Stomas in IBD When do I need it? Can I avoid it? How do I live with it? Kyle G. Cologne, MD Assistant Professor of Surgery USC Division of Colorectal Surgery Topics Surgical Differences
More informationDiverticular disease of the large intestine in Northern Norway
Epidemiology Diverticular disease of the large intestine in Northern Norway T. J. EDE' AND HELGE STALSBERG From the nstitute of Medical Biology, University of Troms0, Troms0, Norway Gut, 1979, 20, 609-615
More information3/22/2011. Inflammatory Bowel Disease. Inflammatory Bowel Disease Objectives: Appendicitis. Lemone and Burke Chapter 26
Inflammatory Bowel Disease Lemone and Burke Chapter 26 Inflammatory Bowel Disease Objectives: Discuss etiology, patho and clinical manifestations of Appendicitis Peritonitis Ulcerative Colitis Crohn s
More informationCase discussion. Anastomotic leakage. intern superviser
Case discussion Anastomotic leakage intern superviser Basic data Name : XX ID: M101881671 Age:51 Y Gender: male Past history: Hospitalized for acute diverticulitis on 2004/7/17, 2005/5/28 controlled by
More informationNational Emergency Laparotomy Audit. Help Box Text
National Emergency Laparotomy Audit Help Box Text Version Control Version 1.1 06/12/13 1.2 13/12/13 1.3 20/12/13 1.4 20/01/14 1.5 30/01/14 1.6 13/03/14 1.7 07/04/14 1.8 01/12/14 1.9 05/05/15 1.10 02/07/15
More informationPercutaneous CT Scan-Guided Drainage vs. Antibiotherapy Alone for Hinchey II Diverticulitis: A Case-Control Study
Percutaneous CT Scan-Guided Drainage vs. Antibiotherapy Alone for Hinchey II Diverticulitis: A Case-Control Study D. Brandt, M.D., 1 P. Gervaz, M.D., 1 Y. Durmishi, M.D., 1 A. Platon, M.D., 2 Ph. Morel,
More informationThis is the portion of the intestine which lies between the small intestine and the outlet (Anus).
THE COLON This is the portion of the intestine which lies between the small intestine and the outlet (Anus). 3 4 5 This part is responsible for formation of stool. The large intestine (colon- coloured
More informationSurgery and Stomas in IBD When do I need it? Can I avoid it? How do I live with it?
Surgery and Stomas in IBD When do I need it? Can I avoid it? How do I live with it? Kyle G. Cologne, MD Assistant Professor of Surgery USC Division of Colorectal Surgery Topics Surgical Differences between
More informationUncomplicated diverticular disease is not a common cause of colonic symptoms
Alimentary Pharmacology and Therapeutics Uncomplicated diverticular disease is not a common cause of colonic symptoms J. Y. Kang*, B. Firwana*, A. E. Green*, H. Matthews*, A. Poullis*, A. Barnabas*, L.
More informationManagement of complicated diverticulitis of the colon
Received: 3 March 2017 Accepted: 13 July 2017 DOI: 10.1002/ags3.12035 REVIEW ARTICLE Management of complicated diverticulitis of the colon Toru Tochigi Chihiro Kosugi Kiyohiko Shuto Mikito Mori Atsushi
More informationRecurrent Left Colonic Diverticulitis Episodes: More Severe Than the Initial Diverticulitis?
World J Surg (2009) 33:547 552 DOI 10.1007/s00268-008-9898-9 Recurrent Left Colonic Diverticulitis Episodes: More Severe Than the Initial Diverticulitis? Olivier Pittet Æ Nikos Kotzampassakis Æ Sabine
More informationMohamed EL-hemaly Gastro- intestinal surgical center, Mansoura University.
Mohamed EL-hemaly Gastro- intestinal surgical center, Mansoura University. Chronic transmural inflammatory process of the bowel & affects any part of the gastro -intestinal tract from the mouth to the
More informationIndications and Surgical Techniques In the Treatment of Complicated Acute Diverticulitis. Retrospective Study of a 13 Year Old case History
Article ID: WMC004324 ISSN 2046-1690 Indications and Surgical Techniques In the Treatment of Complicated Acute Diverticulitis. Retrospective Study of a 13 Year Old case History Corresponding Author: Dr.
More informationPatient Information Leaflet
Patient Information Leaflet Explaining Diverticular disease What is diverticular disease? A diverticulum is the name given to a small pouch which bulges out from any hollow structure in the body. The plural
More informationDiverticular Disease Information Leaflet THE DIGESTIVE SYSTEM. gutscharity.org.
THE DIGESTIVE SYSTEM http://healthfavo.com/digestive-system-for-kids.html This factsheet is about Diverticular Disease Diverticulum refers to a side-branch or pouch which sticks outwards from the wall
More informationListed below are some of the words that you might come across concerning diseases and conditions of the bowels.
Listed below are some of the words that you might come across concerning diseases and conditions of the bowels. Abscess A localised collection of pus in a cavity that is formed by the decay of diseased
More informationUNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN
UNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN Radiology Enterprises radiologyenterprises@gmail.com www.radiologyenterprises.com STOMACH AND SMALL BOWEL STOMACH AND SMALL BOWEL Swallowed air is a
More informationDIGESTIVE SYSTEM SURGICAL PROCEDURES December 22, 2015 (effective March 1, 2016) INTESTINES (EXCEPT RECTUM) Asst Surg Anae
December 22, 2015 (effective March 1, 201) INTESTINES (EXCEPT RECTUM) Z513 Hydrostatic - Pneumatic dilatation of colon stricture(s) through colonoscope... 10.50 Z50 Fulguration of first polyp through colonoscope...
More informationRight Colon, Sigmoid Colon, and Transverse Colon Diverticulitis in the Same Patient: Report of a Case
Right Colon, Sigmoid Colon, and Transverse Colon Diverticulitis in the Same Patient: Report of a Case Marc Greenwald, M.D., Tzvi Nussbaum, M.D. Department of Surgery, Division of Colon and Rectal Surgery,
More informationThe Role of Surgery in Inflammatory Bowel Disease. Cory D Barrat, MD Colon and Rectal Surgeon Mercy Health
The Role of Surgery in Inflammatory Bowel Disease Cory D Barrat, MD Colon and Rectal Surgeon Mercy Health THANKS FOR INVITING ME! I have no financial disclosures Outline - Who am I and what do I do? -
More informationGeneral Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons
General Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons MODULE TITLE: SMALL BOWEL 7-Nov-2016 DEVELOPED BY: Graham Cullingford,
More informationLEGS: Laparoscopy in Emergency General Surgery
LEGS: Laparoscopy in Emergency General Surgery A UK Survey - Version 5 North West Research Collaborative INSTRUCTIONS FOR COMPLETION Please print out this questionnaire and complete ALL questions Once
More informationGENERAL SURGERY FOR SMART PEOPLE JOE NOLD MD, FACS WICHITA SURGICAL SPECIALISTS
GENERAL SURGERY FOR SMART PEOPLE JOE NOLD MD, FACS WICHITA SURGICAL SPECIALISTS CONFLICTS/DECLARATIONS I have no financial conflicts or declarations I AM always willing to see a consult for you TEXT TOPICS
More informationLARGE BOWEL OBSTRUCTION MARCUS BURNSTEIN
LARGE BOWEL OBSTRUCTION MARCUS BURNSTEIN MCQ A 78 yr. old man (HT, DM, 2 coronary stents) has 3 mos. of irregular bowel habits and 72 hrs. of LBO. Distended, non-tender. Normal blood work. Plain xray,
More informationBowel Preparation for Elective Colorectal Surgery: Helpful or Harmful? Michael J Stamos, MD University of California, Irvine
Bowel Preparation for Elective Colorectal Surgery: Helpful or Harmful? Michael J Stamos, MD University of California, Irvine History of Colon Surgery Early 20 th Century mortality rates for colorectal
More informationANZ Emergency Laparotomy Audit Quality Improvement (ANZELA-QI) Pilot Collaboration between RACS, ANZCA, GSA, NZAGS, ASA, NZSA, ACEM, CICM
ANZ Emergency Laparotomy Audit Quality Improvement (ANZELA-QI) Pilot Collaboration between RACS, ANZCA, GSA, NZAGS, ASA, NZSA, ACEM, CICM DATA COLLECTION FORM Most Australian hospitals contribute data
More informationDiverticulitis laparoscopic lavage vs resection (Hartman procedure) for acute diverticulitis with peritonitis
Protocol Diverticulitis laparoscopic lavage vs resection (Hartman procedure) for acute diverticulitis with peritonitis DILALA trial A trial within the Scandinavian Surgical Network for Clinical Trials
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 4 2013 Article 6 Case report: Intussusception of the colon through a colostomy: A rare presentation of colonic intussusception. Dr. Nora Trabulsi Dr.
More informationIndex. Note: Page numbers of article title are in boldface type.
Index Note: Page numbers of article title are in boldface type. A Abscess(es) in Crohn s disease, 168 169 IPAA and, 110 114 as unexpected finding in colorectal surgery, 46 Adhesion(s) trocars-related laparoscopy
More informationSurgical Management of IBD in the Age of Biologics
Surgical Management of IBD in the Age of Biologics Lisa S. Poritz, M.D Associate Professor of Surgery Division of Colon and Rectal Surgery Objectives Discuss surgical management of IBD When to operate
More informationThe Binational Colorectal Cancer Audit. A/Prof Paul McMurrick Head, Cabrini Monash University Dept of Surgery 2017
The Binational Colorectal Cancer Audit A/Prof Paul McMurrick Head, Cabrini Monash University Dept of Surgery 2017 Binational Colorectal Cancer Database 2010 First Patient 2011 Contract between CMUDS and
More informationTreatment of Right Colonic Diverticulitis: The Role of Nonoperative Treatment
Original Article Journal of the Korean Society of DOI: 10.3393/jksc.2010.26.6.402 pissn 2093-7822 eissn 2093-7830 Treatment of Right Colonic Diverticulitis: The Role of Nonoperative Treatment Ma Ru Kim,
More informationDIGESTIVE SYSTEM SURGICAL PROCEDURES May 1, 2015 INTESTINES (EXCEPT RECTUM) Asst Surg Anae
ENDOSCOPY Z50 Duodenoscopy (not to be claimed if Z399 and/or Z00 performed on same patient within 3 months)... 92.10 Z9 Subsequent procedure (within three months following previous endoscopic procedure)...
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdominal surgery prior as factor in laparoscopic colorectal surgery, 554 555 Abscess(es) CRC presenting as, 539 540 Adenocarcinoma of
More informationEndoscopic evaluation of the colon after an episode of diverticulitis: a call for a more selective approach
Int J Colorectal Dis (2012) 27:1145 1150 DOI 10.1007/s00384-012-1448-0 ORIGINAL ARTICLE Endoscopic evaluation of the colon after an episode of diverticulitis: a call for a more selective approach Bryan
More informationCurrent outcomes of emergency large bowel surgery
COLORECTAL SURGERY Ann R Coll Surg Engl 2015; 97: 151 156 doi 10.1308/003588414X14055925059679 Current outcomes of emergency large bowel surgery HJ Ng 1, M Yule 2,MTwoon 2, NR Binnie 1,EHAly 1 1 NHS Grampian,
More informationLaparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial
Surg Endosc (2011) 25:1121 1126 DOI 10.1007/s00464-010-1327-0 Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial Bastiaan R.
More informationThe management and outcome of anastomotic leaks in colorectal surgery
Original article doi:10.1111/j.1463-1318.2007.01417.x The management and outcome of anastomotic leaks in colorectal surgery A. A. Khan*, J. M. D. Wheeler, C. Cunningham, B. George, M. Kettlewell and N.
More informationIncidence and risk factors of anastomotic leaks. By: khaled Said Assistant professor of colorectal surgery Alexandria
Incidence and risk factors of anastomotic leaks By: khaled Said Assistant professor of colorectal surgery Alexandria Anastomotic leakage after colorectal surgery is a major and potentially life-threatening
More informationMotility Disorders. Pelvic Floor. Colorectal Center for Functional Bowel Disorders (N = 701) January 2010 November 2011
Motility Disorders Pelvic Floor Colorectal Center for Functional Bowel Disorders (N = 71) January 21 November 211 New Patients 35 3 25 2 15 1 5 Constipation Fecal Incontinence Rectal Prolapse Digestive-Genital
More informationSurgery and Crohn s. Crohn s Disease 70 % Why Operate? Complications of Disease. The Gastrointestinal Tract. Surgery for Inflammatory Bowel Disease
The Gastrointestinal Tract Surgery for Inflammatory Bowel Disease Jonathan Chun, MD The regon Clinic Gastrointestinal and Minimally Invasive Surgery Crohn s Disease Can affect anywhere in the GI tract,
More informationUniversity College Hospital. Laparoscopic colorectal surgery. Gastrointestinal Services Division
University College Hospital Laparoscopic colorectal surgery Gastrointestinal Services Division 2 Colon 3 If you would like a large print, audio or translated version of this document contact us on 0845
More informationUniversity of Groningen. Colorectal Anastomoses Bakker, Ilsalien
University of Groningen Colorectal Anastomoses Bakker, Ilsalien IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document
More informationMotility Disorders In Diverticular Disease. M. Kreis. Ludwig-Maximilians Universität München Klinikum Großhadern, Chirurgische Klinik
Motility Disorders In Diverticular Disease. M. Kreis Ludwig-Maximilians Universität München Klinikum Großhadern, Chirurgische Klinik Pathophysiology Diet? Age? Diverticula Disposition? Constipation? Toxines?
More informationOutcomes of Colostomy Reversal Procedures in Two Teaching Hospitals in Addis Ababa, Ethiopia A. Bekele, B. Kotisso, H. Biluts Correspondence to
East and Central African Journal of Surgery http://www.bioline.org.br/js 9 Outcomes of Colostomy Reversal Procedures in Two Teaching Hospitals in Addis Ababa, Ethiopia A. Bekele, B. Kotisso, H. Biluts
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 1 2013 Article 9 ISSUE 1 Perforation Of The Caecum Owing To Benign Rectal Obstruction: A Paradigm Of Damage Control In Emergency Colorectal Surgery DIMITRIOS
More informationGRANULOMATOUS COLITIS: SIGNIFICANCE OF INVOLVEMENT OF THE TERMINAL ILEUM
GASTROENTEROLOGY 64: 1071-1076, 1973 Copyright 1973 by The Williams & Wilkins Co. Vol. 64, No.6 Printed in U.S.A. GRANULOMATOUS COLITIS: SIGNIFICANCE OF INVOLVEMENT OF THE TERMINAL ILEUM JAMES A. NELSON,
More informationCOLORECTAL CANCER FAISALGHANISIDDIQUI MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE
COLORECTAL CANCER FAISALGHANISIDDIQUI MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE PROFESSOR OF SURGERY & DIRECTOR, PROFESSIONAL DEVELOPMENT CENTRE J I N N A H S I N D H M E D I C A L U N I V E R S I T Y faisal.siddiqui@jsmu.edu.pk
More informationFrequency of Diagnosis of Colorectal Cancer with Double Contrast Barium Enema
Bahrain Medical Bulletin, Vol.24, No.3, September 2002 Frequency of Diagnosis of Colorectal Cancer with Double Contrast Barium Enema Najeeb S Jamsheer, MD, FRCR* Neelam. Malik, MD, MNAMS** Objective: To
More informationCitation for published version (APA): Bartels, S. A. L. (2013). Laparoscopic colorectal surgery: beyond the short-term effects
UvA-DARE (Digital Academic Repository) Laparoscopic colorectal surgery: beyond the short-term effects Bartels, S.A.L. Link to publication Citation for published version (APA): Bartels, S. A. L. (2013).
More information11/13/11. Biologics for CD and CUC: The Impact on Surgical Outcomes. Principles of Successful Intestinal Surgery
Biologics for CD and CUC: The Impact on Surgical Outcomes Robert R. Cima, M.D., M.A. Associate Professor of Surgery Division of Colon and Rectal Surgery Overview Antibody based medications (biologics)
More informationLaparoscopic Resection Of Colon & Rectal Cancers. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Laparoscopic Resection Of Colon & Rectal Cancers R Sim Centre for Advanced Laparoscopic Surgery, TTSH Feasibility and safety Adequacy - same radical surgery as open op. Efficacy short term benefits and
More informationSurgery for Inflammatory Bowel Disease
Surgery for Inflammatory Bowel Disease Emily Steinhagen, MD Assistant Professor Department of Surgery, Division of Colorectal Surgery University Hospitals Cleveland Medical Center Common Questions Why
More informationFuture Trends in Diverticular Disease: What is Role of Surgery. President, ISUCRS
Future Trends in Diverticular Disease: What is Role of Surgery Philip F. Caushaj, MD, PhD, PhD(hon), FACS, FACG, FASCRS, FISUCRS,AGAF, FASGE, FSSO Professor of Surgery, University of Connecticut Vice Chair,
More informationSeptic Phlebitis and Gas in the Inferior Mesenteric Vein: CT findings in Two Cases and Review of Literature
ISPUB.COM The Internet Journal of Surgery Volume 16 Number 2 Septic Phlebitis and Gas in the Inferior Mesenteric Vein: CT findings in Two Cases and Review of J McClenathan Citation J McClenathan. Septic
More informationSocietà Medico Chirurgica di Ferrara 12 maggio Malattia diverticolare del colon. La TC in faseacuta
Società Medico Chirurgica di Ferrara 12 maggio 2012 La TC in faseacuta Pier Marco Cervi U.O. Radiodiagnostica Ospedaliera Direttore Dott. Stefano Bighi Azienda Ospedaliera Universitaria S. Anna di Ferrara
More informationSurgical Management of IBD. Val Jefford Grand Rounds October 14, 2003
Surgical Management of IBD Val Jefford Grand Rounds October 14, 2003 Introduction Important Features Clinical Presentation Evaluation Medical Treatment Surgical Treatment Cases Overview Introduction Two
More informationRisk factors for future repeat abdominal surgery
Langenbecks Arch Surg (2016) 401:829 837 DOI 10.1007/s00423-016-1414-3 ORIGINAL ARTICLE Risk factors for future repeat abdominal surgery Chema Strik 1 & Martijn W. J. Stommel 1 & Laura J. Schipper 1 &
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Oakland K, Jairath V, Uberoi R, et al. Derivation
More information12 Blueprints Q&A Step 2 Surgery
12 Blueprints Q&A Step 2 Surgery 34. A 40-year-old female has been referred to you for a recent ER and hospital admission, from which she was given a diagnosis of acute diverticulitis. Treatment at that
More informationAccepted Manuscript. Caecal diverticulitis: presentation and management
Accepted Manuscript Caecal diverticulitis: presentation and management Dr. Adam Cristaudo, MBBS, MS, Praga Pillay, FRCS, FRACS, FACS, Associate Professor, Dr. Sanjeev Naidu, MBBS, FRACS PII: S2049-0801(15)00008-4
More informationAminosalicylates. Giovanni Barbara. Department of Medical and Surgical Sciences Alma Mater Studiorum, University of Bologna, Italy ( )
Aminosalicylates Giovanni Barbara Department of Medical and Surgical Sciences Alma Mater Studiorum, University of Bologna, Italy (1088 2016) Colonic Diverticula, a Painless Ageing Change? 20% develop symptoms
More informationPsoas abscesses complicating colonic disease: imaging and therapy
Ann R Coll Surg Engl 1998; 80: 405-409 Psoas abscesses complicating colonic disease: imaging and therapy D N Lobo MS FRCSEd(Gen Surg)' Specialist Surgical Registrar W K Dunn MB BS FRCR1 Consultant Radiologist
More informationThe CREST Trial. Funded by Cancer Research UK and developed by the National Cancer Research Institute
The CREST Trial A randomised phase III study of stenting as a bridge to surgery in obstructing colorectal cancer. Results of the UK ColoRectal Endoscopic Stenting Trial (CREST). Funded by Cancer Research
More information