Difference between revisions of "Diverticular disease"
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*Corrugated - like cardboard. | *Corrugated - like cardboard. | ||
*Wall thickening (reactive).<ref name=pmid21359889>{{Cite journal | last1 = Nicholson | first1 = BD. | last2 = Hyland | first2 = R. | last3 = Rembacken | first3 = BJ. | last4 = Denyer | first4 = M. | last5 = Hull | first5 = MA. | last6 = Tolan | first6 = DJ. | title = Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit? | journal = Surg Endosc | volume = 25 | issue = 8 | pages = 2586-91 | month = Aug | year = 2011 | doi = 10.1007/s00464-011-1591-7 | PMID = 21359889 }}</ref> | *Wall thickening (reactive).<ref name=pmid21359889>{{Cite journal | last1 = Nicholson | first1 = BD. | last2 = Hyland | first2 = R. | last3 = Rembacken | first3 = BJ. | last4 = Denyer | first4 = M. | last5 = Hull | first5 = MA. | last6 = Tolan | first6 = DJ. | title = Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit? | journal = Surg Endosc | volume = 25 | issue = 8 | pages = 2586-91 | month = Aug | year = 2011 | doi = 10.1007/s00464-011-1591-7 | PMID = 21359889 }}</ref> | ||
*Usually sigmoid colon. | |||
**May be elsewhere, e.g. appendix.<ref name=pmid23323233>{{Cite journal | last1 = Sohn | first1 = TJ. | last2 = Chang | first2 = YS. | last3 = Kang | first3 = JH. | last4 = Kim | first4 = DH. | last5 = Lee | first5 = TS. | last6 = Han | first6 = JK. | last7 = Kim | first7 = SH. | last8 = Hong | first8 = YO. | title = Clinical characteristics of acute appendiceal diverticulitis. | journal = J Korean Surg Soc | volume = 84 | issue = 1 | pages = 33-7 | month = Jan | year = 2013 | doi = 10.4174/jkss.2013.84.1.33 | PMID = 23323233 }}</ref> | |||
===Endoscopic image=== | ===Endoscopic image=== | ||
<gallery>Image:Diverticulosis_2.jpg | Diverticular disease. (WC/Samir)</gallery> | <gallery>Image:Diverticulosis_2.jpg | Diverticular disease. (WC/Samir)</gallery> | ||
Revision as of 17:09, 14 January 2014
| Diverticular disease | |
|---|---|
| Diagnosis in short | |
 Diverticulum. H&E stain. | |
|
| |
| LM | mucosa/submucosa invaginate into the musuclaris propria |
| Gross | outpouching - best seen after sectioning |
| Site | colon - classically sigmoid, other sites |
|
| |
| Associated Dx | diverticulitis, peritonitis, diverticular disease-associated colitis |
| Symptoms | usu. asymptomatic, diverticulitis presents with abdominal pain |
| Prevalence | common - especially elderly |
| Clin. DDx | colorectal carcinoma |
| Treatment | usually conservative, surgical resection (recurrent or perforating diverticulitis) |
Diverticular disease, also diverticulosis, is a common disease of the colon. Inflammation of diverticula is known as diverticulitis.
General
- Very common.
- Typically seen in elderly patients - 50s and 60s.
Complications:
- Diverticulitis.
- Peformation - peritonitis.
- Diverticular-associated colitis - see below.
Diverticular disease-associated colitis
Features:[1]
- Rare.
- Definitions vary somewhat - one is: IBD-like inflammation restricted to areas with diverticular disease.
- Considerable overlap with IBD histologically - no definite histologic findings.
- Rectal biopsy may be used to differentiate from ulcerative colitis.
Gross
- Corrugated - like cardboard.
- Wall thickening (reactive).[2]
- Usually sigmoid colon.
- May be elsewhere, e.g. appendix.[3]
Endoscopic image
Diverticular disease. (WC/Samir)
Grossing notes
Microscopic
Features:
- Mucosa/submucosa invagination into the musuclaris propria (MP).
- At the site the blood vessels supplying the mucosa and submucosa penetrate the MP.[4]
DDx:
- Colorectal carcinoma - may cause a stricture, usually obvious on microscopy.
- Inflammatory bowel disease.
Images
Diverticular disease. (WC)
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SIGMOID COLON, SIGMOIDECTOMY: - DIVERTICULAR DISEASE WITHOUT DIVERTICULITIS. - NEGATIVE FOR MALIGNANCY.
Perforated
RECTO-SIGMOID, LARGE BOWEL RESECTION: - PERFORATED DIVERTICULITIS WITH SEROSITIS AND ABSCESS FORMATION. - SUBMUCOSAL FIBROSIS. - ONE LYMPH NODE NEGATIVE FOR MALIGNANCY ( 0 POSITIVE / 1 ). - NEGATIVE FOR MALIGNANCY.
SIGMOID COLON, RESECTION: - COLONIC PERFORATION ASSOCIATED WITH FAT NECROSIS, SEROSITIS AND MICROABSCESS FORMATION, IN THE SETTING OF DIVERTICULAR DISEASE. - ONE LYMPH NODE NEGATIVE FOR MALIGNANCY ( 0 POSITIVE / 1 ). - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
See also
References
- ↑ Mulhall, AM.; Mahid, SS.; Petras, RE.; Galandiuk, S. (Jun 2009). "Diverticular disease associated with inflammatory bowel disease-like colitis: a systematic review.". Dis Colon Rectum 52 (6): 1072-9. doi:10.1007/DCR.0b013e31819ef79a. PMID 19581849.
- ↑ Nicholson, BD.; Hyland, R.; Rembacken, BJ.; Denyer, M.; Hull, MA.; Tolan, DJ. (Aug 2011). "Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit?". Surg Endosc 25 (8): 2586-91. doi:10.1007/s00464-011-1591-7. PMID 21359889.
- ↑ Sohn, TJ.; Chang, YS.; Kang, JH.; Kim, DH.; Lee, TS.; Han, JK.; Kim, SH.; Hong, YO. (Jan 2013). "Clinical characteristics of acute appendiceal diverticulitis.". J Korean Surg Soc 84 (1): 33-7. doi:10.4174/jkss.2013.84.1.33. PMID 23323233.
- ↑ West, AB.. "The pathology of diverticulitis.". J Clin Gastroenterol 42 (10): 1137-8. doi:10.1097/MCG.0b013e3181862a9f. PMID 18936652.
- ↑ URL: http://histology-group28.wikispaces.com/DigestiveSystemProject. Accessed on: 23 August 2011.