Abdominal pain and cirrhosis at diagnosis of hemochromatosis: Analysis of 219 referred probands with HFE p.C282Y homozygosity and a literature review

Background In hemochromatosis, causes of abdominal pain and its associations with cirrhosis are poorly understood. Methods We retrospectively compared characteristics of referred hemochromatosis probands with HFE p.C282Y homozygosity with/without biopsy-proven cirrhosis: sex, age, diabetes, heavy alcohol consumption, abdominal pain/tenderness, hepatomegaly, splenomegaly, non-alcoholic fatty liver disease, chronic viral hepatitis, ascites, transferrin saturation (TS), serum ferritin (SF), and iron removed by phlebotomy (QFe). We performed logistic regression on cirrhosis using characteristics identified in univariate comparisons. We performed computerized and manual searches to identify hemochromatosis case series and compiled prevalence data on cirrhosis and abdominal pain and causes of abdominal pain. Results Of 219 probands, 57.1% were men. Mean age was 48±13 y. In 22 probands with cirrhosis, proportions of men, mean age, prevalences of heavy alcohol consumption, abdominal pain, abdominal tenderness, hepatomegaly, splenomegaly, and chronic viral hepatitis, and median TS, SF, and QFe were significantly greater than in probands without cirrhosis. Regression analysis revealed three associations with cirrhosis: abdominal pain (p = 0.0292; odds ratio 9.8 (95% CI: 1.2, 76.9)); chronic viral hepatitis (p = 0.0153; 11.5 (95% CI: 1.6, 83.3)); and QFe (p = 0.0009; 1.2 (95% CI: 1.1, 1.3)). Of eight probands with abdominal pain, five had cirrhosis and four had diabetes. One proband each with abdominal pain had heavy alcohol consumption, chronic viral hepatitis B, hepatic sarcoidosis, hepatocellular carcinoma, and chronic cholecystitis, cholelithiasis, and sigmoid diverticulitis. Abdominal pain was alleviated after phlebotomy alone in four probands. In 12 previous reports (1935–2011), there was a negative correlation of cirrhosis prevalence and publication year (p = 0.0033). In 11 previous reports (1935–1996), a positive association of abdominal pain prevalence and publication year was not significant (p = 0.0802). Conclusions Abdominal pain, chronic viral hepatitis, and QFe are significantly associated with cirrhosis in referred hemochromatosis probands with HFE p.C282Y homozygosity. Iron-related and non-iron-related factors contribute to the occurrence of abdominal pain.

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.

State-of-the-art surgery for sigmoid diverticulitis

Summary Background In the last two decades, there has been a Copernican revolution in the decision-making for the treatment of Diverticular Disease. Purpose This article provides a report on the state-of-the-art of surgery for sigmoid diverticulitis. Conclusion Acute diverticulitis is the most common reason for colonic resection after cancer; in the last decade, the indication for surgical resection has become more and more infrequent also in emergency. Currently, emergency surgery is seldom indicated, mostly for severe abdominal infective complications. Nowadays, uncomplicated diverticulitis is the most frequent presentation of diverticular disease and it is usually approached with a conservative medical treatment. Non-Operative Management may be considered also for complicated diverticulitis with abdominal abscess. At present, there is consensus among experts that the hemodynamic response to the initial fluid resuscitation should guide the emergency surgical approach to patients with severe sepsis or septic shock. In hemodynamically stable patients, a laparoscopic approach is the first choice, and surgeons with advanced laparoscopic skills report advantages in terms of lower postoperative complication rates. At the moment, the so-called Hartmann’s procedure is only indicated in severe generalized peritonitis with metabolic derangement or in severely ill patients. Some authors suggested laparoscopic peritoneal lavage as a bridge to surgery or also as a definitive treatment without colonic resection in selected patients. In case of hemodynamic instability not responding to fluid resuscitation, an initial damage control surgery seems to be more attractive than a Hartmann’s procedure, and it is associated with a high rate of primary anastomosis.