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EN
Diverticulosis, its associated symptoms and complications are one of the most common pathologies of the gastrointestinal tract in more economically developed countries. Presence of diverticuli and their clinical consequences can be divided into four categories: 1) diverticulosis, i.e. an asymptomatic presence of diverticuli that are usually found by accident 2) symptomatic uncomplicated diverticulosis 3) diverticulitis (acute uncomplicated diverticulitis) 4) complications of diverticulitis (conditions requiring hospital stay). The aim of this study was to retrospectively analyze the efficacy of rifaximin in preventing diverticulitis in patients visiting proctology clinics. The diagnostic criterium for diverticulosis was confirmation by colonoscopy, barium enema or CT colography (virtual colonoscopy) as well as history of at least one documented episode of diverticulosis. History of diverticulosis was evaluated based on medical records, clinical symptoms, elevated level of CRP (>5.0) and/or diagnostic imaging (ultrasound, CT). After setting strict exclusion criteria, 248 patients were qualified for the study out of 686, and they were later divided into two groups: control group (group I – 145 patients) and studied group (group II – 103 patients receiving rifaximin prophylaxis). Diverticulitis rate was comparable in both groups over a period of 6 months before study (p = 0.1306) and 6 months of treatment (p=0.3044). Between the 6th and 12th month of treatment, a significantly lower rate of diverticulitis was noted in the group receiving rifaximin compared to control group (p<0.0001). Patients receiving rifaximin reported higher quality of life (which was assessed using the VAS scale) compared to control group after 12 months. The results confirmed the efficacy of riaximin in prevention of diverticulitis, even in the scheme of repeated courses every 3 months. Not only did application of rifaximin lower the rate of diverticulitis and its complications in patients after an episode of diverticulitis, but also it improved the patients’ quality of life. It seems that diverticulitis prophylaxis based on rifaximin can be economically efficient, however, it requires further research.
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Diverticulitis of the Small Bowel

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EN
In contrast to diverticulosis of the large bowel, diverticular disease of the small bowel is rare. This small bowel disease is predominantly localized to the duodenum. Jejunal and ileal diverticula are rare and occur in the majority of patients without clinical impact. Less than 10% of patients develop serious complications, including obstruction, hemorrhage, perforation and penetration. Here, we present 4 patients with jejunal diverticulitis. Three of these patients experienced perforation.
EN
Objective: Cecal diverticulitis may be encountered as a real etiological factor in 1/300 appendectomies. Differential diagnosis of acute appendicitis and cecal diverticulitis is crucial because of the different treatment methods. Our aim is to reveal the importance of distinguishing acute appendicitis from cecal diverticulitis. Methods: The data of patients who were admitted to the hospital between 2015 and 2019 with the complaint of abdominal pain and then finally diagnosed with colon diverticular disease, colon diverticulitis, or acute appendicitis, analyzed retrospectively. Results: A total of 19 cecum diverticulitis patients were detected during surgery for acute appendicitis or during clinical and radiological evaluation. 1247 appendectomies were evaluated; the final diagnosis was observed as cecal diverticulitis in 5 patients (0,4%). One hundred nineteen patients diagnosed with colonic diverticulitis at admission were evaluated, while 105 (88,2%) of them had left-sided diverticulitis, 14 (11,7%) of them had solitary cecal diverticulitis. All of the solitary cecal diverticulitis patients were treated conservatively, except one patient who has Hinchey 3 diverticulitis. Conclusion: Differential diagnosis of cecum diverticulitis with acute appendicitis is important because cecum diverticulitis can be managed as conservatively in most cases. In order to prevent unnecessary surgical interventions, this importance has increased, especially during the COVID-19 pandemic period.
EN
Background: Diverticulosis is the most common finding in the GI tract. Nearly half of the people with diverticula experience symptomatic uncomplicated diverticular disease (SUDD). Aims: The primary endpoints of our study were to assess the effectiveness of combined therapy with rifaximin-α and arabinogalactan-lactoferrin in symptom reduction and normalization of bowel movements. The secondary endpoints were an assessment of efficacy in SUDD recurrence prevention and patients’ compliance to the combined therapy. Material and methods: A retrospective observational survey study was performed in 2019 among physicians experienced in diverticular disease (DD) treatment in Poland. Patients with previous episodes of recurrences treated with combined therapy (cyclic rifaximin-α at least 400 mg b.i.d/7 days/every month and continuous arabinogalactan-lactoferrin supplementation 1 sachet daily) were assessed after 3 and 6 months regarding symptoms’ resolution in the three-point scale. The patients’ SUDD history, diagnostic methods, treatment, and results, as well as patients’ compliance were evaluated. Results: 281 patients met inclusion criteria, and were further evaluated (67.6% women, median age 65 years). After 6 months of combined treatment, there was statistically significant reduction in the total severity score (sum from 8.5 [max 15 points] to 1.28; p < 0.0001); and improvement in each symptom score (median from 1.7 [max 3 points] to 0.26; p < 0,001). Stool frequency statistically normalized in every group. As many as 31.7% had complete symptom resolution. Patients’ compliance with the therapy was very good and good in 92.9% of cases. Conclusions and discussion: Combined therapy with cyclic rifaximin-α and continuous arabinogalactan combination with lactoferrin is effective in SUDD treatment in terms of symptom resolution, bowel movement normalization, prevention of recurrences with very good patient’s compliance.
EN
Bowel obstruction is the interference with movement of bowel content. Large and small in testing from duodenum to anal region can be obstructed mechanical or non-mechanical and complete or partial. Mechanical obstruction can presented because of obstructive causes in intestinal lumen, intestinal wall or pressure from other tissue on intestine.The aim of the study was to evaluate etiology, laboratory findings of intestinal obstruction and ileus among children and adults who discharged with good condition.Material and methods. This retrospective study was carried out from 2001 to 2006 in Imam Khomeini Hospital (Ahvaz-Iran). Cases of bowel obstruction were included in this study. For each case, a questionnaire was filled. There are 752 cases with suspected bowel obstruction. From 752 cases, 403 patients that agreed and treated and discharged with good condition were studied. Cases were divided into two groups: children (age < 15 yrs) and adults (age> 15 yrs). Data were analyzed by SPSS Ver 16.0 (Chicago, IL, USA) and Epi-info Ver 6.00.Results. In our study, 221 adults and 192 children were included. Mortality rate was 12.2%. Forty-eight percent of 403 cases were children (m - 61%, f - 38%, ambigus genitalia - 1%) and 52% were adults (m - 67%, f - 33%). Etiology of bowel obstruction in children were as follows: ileus (26%); adhesion band (17.7%), partial obstruction (16.1%), and Hirschsprung's disease (12%). Causes of bowel obstruction in adults are: partial obstruction (29.9%); ileus (19%); adhesion band (18.5%); colonic pseudo obstruction(8.5%); GI cancer (5.2%); hernia (4.7%); Crohn (2.8%); fecal impaction (3.3%); bezoar (2.4%), and 4.7% for other causes. Fifty-one percent of children and 36% of adults were operated. Of all children, 91.7% had upright abdominal X-ray, 51.6% had supine X-ray, and 80.7% had sonography. Hundred percents of adults had upright & supine plain abdominal X-ray and 75.4% had sonography. Most change in children's CBC was 10000
EN
Diverticulosis of colon is the state of having diverticula in the colon, which are sac-like, outpocketings (protrusion) of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall. These are more common in the sigmoid colon which is a common place for increased intracolon pressure. Diverticular disease – symptomatic form of diverticulosis – is one of the most prevalent medical conditions to affect Western populations and its prevalence increases with age up to 65% in 85 years old population. As our elderly population grows, we can anticipate a concomitant rise in the number of patients with diverticular disease. But the number of young people with this illness increased last time. The etiopathogenesis of colonic diverticulosis remains unclear. It is hypothesized that the main factor responsible for diverticulum development is a diet poor in fibre. Probably it is connected with “Western” life style. Although diverticula are often asymptomatic, their presence is associated with possible complications, such as diverticulitis, diverticular bleeding, and diverticular colitis. Symptomatic diverticular disease can range from mild, low-level symptomatology similar to that seen in irritable bowel syndrome to acute bouts of diverticulitis complicated by abscess or frank perforation. The purpose of this paper is to briefly review the epidemiology, etiopathogenesis and clinical presentations of diverticular disease, and then propose recommendations regarding appropriate diagnostic and therapeutic strategies supported by the best available current evidence.
PL
Uchyłkowatość jelita grubego to obecność uchyłków w jelicie, które są przypominającymi kieszonki uwypukleniami (przepuklinami) błony śluzowej i podśluzowej przez błonę mięśniową jelita, w miejscach zmniejszonej oporności mięśniówki. Najczęściej występują w esicy, gdzie ciśnienie w świetle jelita jest największe. Choroba uchyłkowa jelita grubego, czyli objawowa postać uchyłkowatości, jest jedną z najczęstszych chorób występujących w populacjach krajów Europy Zachodniej i USA. Zachorowalność rośnie wraz z wiekiem – w populacji 85-latków choroba występuje u 65% osób. Ponieważ liczba osób w wieku podeszłym zwiększa się, należy spodziewać się wzrostu liczby pacjentów z tą patologią. W ostatnim czasie zwiększa się również liczba osób w młodym wieku dotkniętych tą chorobą. Etiopatogeneza uchyłkowatości jelita grubego nie jest do końca jasna. Przypuszcza się, że podstawowym czynnikiem odpowiedzialnym za powstanie uchyłku jest dieta uboga we włókna roślinne. Prawdopodobnie jest to związane z zachodnim stylem życia. Chociaż uchyłki często nie dają objawów, ich obecność wiąże się z ryzykiem powikłań, takich jak zapalenie, krwawienie z uchyłka czy zapalenie okrężnicy związane z obecnością uchyłków. Objawowa choroba uchyłkowa może mieć różny obraz kliniczny: może przebiegać łagodnie, skąpoobjawowo, podobnie jak zespół jelita nadwrażliwego, lub mogą towarzyszyć jej ciężkie ataki zapalenia uchyłków powikłanych ropniem lub perforacją. Celem pracy jest omówienie epidemiologii, etiopatogenezy, przebiegu klinicznego choroby uchyłkowej oraz zaleceń dotyczących rozpoznania i leczenia w oparciu o bieżącą literaturę medyczną.
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