Racial Disparity in the Surgical Management of Diverticular Disease

Introduction Although minimally invasive surgery (MIS) has clearly been associated with improved colorectal surgery outcomes, not all populations benefit from this approach. Using a national database, we analyzed both, the trend in the utilization of MIS for diverticulitis and differences in utilization by race. Methods Colon-targeted participant user files (PUFs) from 2012 to 18 were linked to respective PUFs in National Surgical Quality Improvement Project. Patients undergoing colectomy for acute diverticulitis or chronic diverticular disease were included. Surgical approach was stratified by race and year. To adjust for confounding and estimate the association of covariates with approach, data were fit using multivariable binary logistic regression main effects model. Using a joint effects model, we evaluated whether the odds of a particular approach over time was differentially affected by race. Results Of the 46 713 patients meeting inclusion criteria, 83% were white, with 7% black and 10% other. Over the study period, there was a decrease in the rate of open colectomy of about 5% P < .001, and increase in the rate of utilization of laparoscopic and robotic approaches (RC) P < .0001. After adjusting for confounders, black race was associated with open surgery P < .0001. Conclusion There is disparity in the utilization of MIS for diverticulitis. Further research into the reasons for this disparity is critical to ensure known benefits of MIC are realized across all races.

Colonic invagination anastomosis in surgery of complicated forms of diverticular disease

AIM: to evaluate the prospects of using a colorectal invaginated anastomosis in patients with complicated diverticular disease (CDD).PATIENTS AND METHODS: during the period from 2014 to 2020, colorectal invaginated anastomosis, was used in 42 patients: 18 patients with CDD and 20 patients with colorectal cancer for stoma closure after Hartmann’s procedure. The comparison group consisted of 24 patients with CDD and 20 patients with colorectal cancer for stoma closure after Hartmann’s procedure: colorectal anastomosis was created here using traditional double-row handsewn technique. All patients underwent surgery with open access, while the primary anastomosis was performed in 20 (47.6%) patients, and in 22 (52.4%) patients of the group underwent stoma takedown.RESULTS: no anastomosis leakage developed in the main group. Moreover, the presence of single small diverticula with a diameter of 2–3 mm near the area of the anastomosis was not an indication to extend the resection borders. In the control group, in 13 (54.2%) patients, small diverticula were detected in the anastomosis are as well and required to expand the proximal border of resection. In this group, anastomosis leakage occurred in 2 (6.8%) patients with diverticular disease and required Hartmann’s procedure.CONCLUSION: the colorectal invaginated anastomosis is justified for patients with CDD during stoma takedown because it minimizes the risk of anastomosis leakage.

Computer tomography in diagnostics and treatment of inflammatory complications of diverticular disease of the colon

AIM: to evaluate the role of computed tomography (CT) in the treatment and diagnostic algorithm in patients with complicated diverticular disease (CDD).PATIENTS AND METHODS: during the period from 2014 to 2020, 165 hospitalized patients with complications of CDD included in the study. Fifteen (9.1%) patients were hospitalized for elective indications and 150 (90.9%) as emergencies. The indications for hospitalization were inflammatory complications of CDD. Computed tomography with intravenous contrast was performed in 89 (53.9%) patients. The study was performed on a 64-slice CT “Philips Brilliance 64” with intravenous bolus injection of a low-osmolar iodine-containing contrast agent. The absence of the CT in the remaining patients is due to the presence of classical symptoms of acute diverticulitis with a previously verified diagnosis of CDD, the presence of an informative transabdominal ultrasound, as well as the refusal of patients from CT.RESULTS: the CT allowed to verify the presence of diverticula in the patients, to reveal the distinctive CT signs and pathognomonic symptoms of inflammatory complications of CDD, as well as to establish the severity of the complications that occurred. The specific signs of the destruction of the diverticulum and the complications developed were abdominal mass, abscess, peritonitis, and fistula. Besides the diagnostic value, CT scan permitted to choose the treatment approach and to clarify indications for surgery. Besides that, some CDD complications revealed by CT were considered as a predictor of ineffectiveness of conservative treatment, which requires surgery.CONCLUSION: CT is a valuable diagnostic method for CDD which allows to determine timely the clinical form of inflammatory complication, to find out indications for surgery and to predict high risk of recurrence.

Comprehensive Ultrasound Diagnosis of Sigmoid Diverticulitis

Aim. A definition and systematisation of sigmoid diverticulitis semiotics in a comprehensive ultrasonic check-up for early illness diagnosis.Materials and methods. Ultrasound examination data on 64 patients with sigmoid diverticulum have been analysed. The primary visit reason was recurrent varying-intensity pain in left abdominal quadrant, unstable stool and flatulence. The patients were 28 (43.75%) men and 36 (56.25%) women aged 38–85 years, mean age 55.6 years; 31 (48.44%) were diagnosed with diverticulitis. We used the HD15 (Philips, the Netherlands), HS 60 (Samsung, South Korea) and Hi Vision Preirus (Hitachi, Japan) ultrasound instruments equipped with convex and intracavitary microconvex 2–12 MHz linear transducers. Patients were examined on an empty stomach and unprepared intestine. Colon and rectum were explored at different approaches, transabdominally, transperineally, transrectally and transvaginallyResults. The findings laid out a more elaborated ultrasound semiotics of diverticulitis. Ultrasound check-up enables a reliable estimation of blood supply and peristalsis, colonic wall thickness and layers, presence of asymptomatic diverticula, signs of acute diverticulitis (pain on sensor touch, mesocolic tissue infiltration, presence of faecal calculi and gas in diverticulum, peridiverticulitis) and other complications of diverticular disease (fistulae, abscess or peritonitis), as well as a consistent differential instrumental diagnosis of other organ illnesses.Conclusion. Ultrasound is an indispensable supplement in clinical diagnosis of diverticula, diverticulitis and their complications in the cases when other methods like X-ray, CT or colonoscopy are contraindicated.

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Phenome-wide association study (PheWAS) of colorectal cancer risk SNP effects on health outcomes in UK Biobank

Background Associations between colorectal cancer (CRC) and other health outcomes have been reported, but these may be subject to biases, or due to limitations of observational studies. Methods We set out to determine whether genetic predisposition to CRC is also associated with the risk of other phenotypes. Under the phenome-wide association study (PheWAS) and tree-structured phenotypic model (TreeWAS), we studied 334,385 unrelated White British individuals (excluding CRC patients) from the UK Biobank cohort. We generated a polygenic risk score (PRS) from CRC genome-wide association studies as a measure of CRC risk. We performed sensitivity analyses to test the robustness of the results and searched the Danish Disease Trajectory Browser (DTB) to replicate the observed associations. Results Eight PheWAS phenotypes and 21 TreeWAS nodes were associated with CRC genetic predisposition by PheWAS and TreeWAS, respectively. The PheWAS detected associations were from neoplasms and digestive system disease group (e.g. benign neoplasm of colon, anal and rectal polyp and diverticular disease). The results from the TreeWAS corroborated the results from the PheWAS. These results were replicated in the observational data within the DTB. Conclusions We show that benign colorectal neoplasms share genetic aetiology with CRC using PheWAS and TreeWAS methods. Additionally, CRC genetic predisposition is associated with diverticular disease.

Atypical Presentation of Colonic Diverticular Disease

Hematochezia or passage of fresh blood per rectum is a relatively common finding in medical practice which mostly indicates lower gastrointestinal bleeding. The causes for lower gastrointestinal bleeding include diverticular disease, vascular ectasia, ischemic, inflammatory or infectious colitis, colonic neoplasia, hemorrhoids, anal fissures and small bowel lesions (Crohn’s disease, Vascularectasia, Meckel’s diverticulum).If a patient comes with severe hematochezia, the first and foremost task is to stabilize the patient and then find out the source of bleeding as soon as possible. Elderly patients presenting with severe hematochezia, is most likely due to colorectal malignancy but benign causes like colonic diverticulosis can also present as life threatening bleeding in rare occasions. Here we report a case of 70-years-old male patient presenting with severe painless hematochezia leading to severe anemia due to diverticulosis. Bangladesh J Medicine July 2022; 33(1) : 94-98

Acquired Diverticulosis of the Vermiform Appendix: A Rare Case Report

Diverticulosis of the appendix, as a rare and incident disorder, mimics acute or chronic appendicitis and is characterized by herniation of the appendiceal mucosa through the muscular wall. Symptom and laboratory data of diverticular disease usually represent chronic inflammation. In this study, a 43-year-old female with a history of right lower quadrant pain and anorexia represented abdominal tenderness and rebound tenderness in the physical examination and normal laboratory tests. Abdominal sonography did not show any evidence of acute appendicitis. The removed appendix was 12 cm in length and had multiple diverticular protrusions along with it. The histologic examination showed diverticulosis without evidence of inflammation. The patient was discharged two days later in optimal clinical condition. Diverticulosis of the appendix often is confused with acute or chronic appendicitis based on similar presenting symptoms and imaging studies. Although surgery is the definitive treatment of both conditions, an appropriate diagnosis of diverticular disease before surgery is very important because of the association of appendiceal diverticular disease with neoplasm and other complications.