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Keiichiro Kume Masahiro Yamasaki Ichiro Yoshikaw 《World journal of gastroenterology : WJG》2009,15(30):3817-3818
We herein report the rare complication of sepsis caused by endoscopic clipping for colonic diverticular bleeding. A 78-year-old man with a 12-h history of near syncope and painless hematochezia was admitted to our hospital. Following the transfusion of 4 U of blood and continued hematochezia, a colonoscopy was performed. Active bleeding was seen as continuous arterial spurting from a single diverticulum located in the middle ascending colon. This diverticulum was seamed by four endoclips. The next day, the patient became febrile with a temperature of 39.2℃. Laboratory data included a white blood cell count of 18100/mm^3 and a C-reactive protein level of 3.4 mg/dL. He was diagnosed with sepsis since Escherichia coli was detected in the blood culture. Antibiotics were started. Four days later his fever had improved and laboratory data improved 9 d later. 相似文献
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Antje Jansen Sabine Harenberg Uwe Grenda Christoph Elsing 《World journal of gastroenterology : WJG》2009,15(4):457-461
AIM: To evaluate the risk factors-other than nonsteroidal anti-inflammatory drugs-for colonic diverticular bleeding in a westernized population. METHODS: One hundred and forty patients, treated for symptomatic diverticular disease in a community based hospital, were included. Thirty (21%) had signs of diverticular bleeding. Age, gender, and the results of colonoscopy were collected and compared to a group of patients with nonbleeding symptomatic diverticulosis. Records were reviewed for comorbidities, such as obesity, alcohol consumption, smoking habits and metabolic diseases. Special emphasis was put on arterial hypertension, cardiovascular events, diabetes mellitus, hyperuricemia and hypercholesterinemia. RESULTS: There was no difference between patients with diverticular hemorrhage and those with nonbleeding symptomatic diverticulosis regarding gender ratio (male/female 9/21 vs 47/63) and diverticular Iocalisation. Bleeding patients differed in respect to age (73.4± 9.9 vs 67. 8± 13.0, P 〈 0.013). Significant differences were found between both groups regarding the presence of hyperuricemia and use of steroids and nonsteroidal anti-inflammatory drugs. Patients with three concomitant metabolic diseases were also identified as being at risk of bleeding. A forward stepwise logistic regression analysis revealed steroids, hyperuricemia and the use of calcium-channel blockers as independent risk factors of bleeding.CONCLUSION: Beside nonsteroidal anti-inflammatory steroid drug use, antihypertensive medication and concomitant arteriosclerotic diseases are risk factors for colonic diverticular hemorrhage. Our results support the hypothesis of an altered arteriosclerotic vessel as the source of bleeding. 相似文献
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Niikura R Nagata N Akiyama J Shimbo T Uemura N 《International journal of colorectal disease》2012,27(9):1137-1143
Purpose
Colonic diverticular bleeding is a major cause of lower gastrointestinal bleeding. However, a limited number of studies have been reported on the risk factors for diverticular bleeding. Our aim was to identify risk factors for diverticular bleeding.Methods
Our study design is a case (diverticular bleeding)–control (diverticulosis) study. We prospectively collected information of habits, comorbidities, history of medications and symptoms by a questionnaire, and diagnosed diverticular bleeding and diverticulosis by colonoscopy. Logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (CI).Results
A total of 254 patients (diverticular bleeding, 45; diverculosis, 209) were selected for analysis. Cluster (≥10 diverticula) type (OR, 4.0; 95% CI, 1.8–8.9), hypertension (OR, 2.2; 95% CI, 1.0–4.6), ischemic heart disease (OR, 2.4; 95% CI, 1.1–5.4), and chronic renal failure (OR, 6.4; 95% CI, 1.3–32) were independent risk factors for diverticular bleeding.Conclusions
Large number of diverticula, hypertension, and concomitant arteriosclerotic diseases including ischemic heart disease and chronic renal failure are risk factors for diverticular bleeding. This study identifies new information on the risk factors for diverticular bleeding. 相似文献6.
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Therapeutic barium enema for bleeding colonic diverticula: Four case series and review of the literature 总被引:1,自引:0,他引:1
Jun-ichi Iwamoto Yuji Mizokami Koichi Shimokobe Takeshi Matsuoka Yasushi Matsuzaki 《World journal of gastroenterology : WJG》2008,14(41):6413-6417
The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period (range 17-35 mo) after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure. 相似文献
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Smoot RL Gostout CJ Rajan E Pardi DS Schleck CD Harmsen WS Zinsmeister AR Nolte T Melton LJ 《The American journal of gastroenterology》2003,98(9):1996-1999
OBJECTIVES: Urgent colonoscopy has been proposed for the diagnosis and management of acute colonic diverticular bleeding. Identification of active bleeding and nonbleeding stigmata facilitates diagnosis and endoscopic therapy, but it is unclear whether urgent colonoscopy after presentation increases the diagnostic yield. This study evaluated the association between timing of colonoscopy and diagnostic yield in patients admitted with acute colonic diverticular bleeding. METHODS: Patients admitted for hematochezia and receiving a diagnosis of diverticular hemorrhage were identified using the Mayo Clinic GI Bleeding Team and Emergency Room Admissions Databases for the years 1998-2000. Timing of colonoscopy was determined from the time of admission. Logistic regression analysis was used to assess whether the timing of colonoscopy was associated with an endoscopic finding of active bleeding or nonbleeding stigmata (or both). RESULTS: A diagnosis of definitive or presumptive diverticular bleeding was made in 78 patients (39 men and 39 women, mean age 78 yr, range 49-96 yr). Twelve patients (15%) had active bleeding or stigmata. Colonoscopies were performed a mean of 18 +/- 11 h after admission. The association between a definitive diagnosis of acute diverticular bleeding and the timing of colonoscopy was not significant (p > 0.46). CONCLUSIONS: No significant association is apparent between the timing of colonoscopy after admission and encountering active bleeding or nonbleeding stigmata. Based on these observations, urgent colonoscopy for these patients does not seem advantageous. 相似文献
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Tursi A Brandimarte G Elisei W Giorgetti GM Inchingolo CD Aiello F 《International journal of colorectal disease》2009,24(1):49-55
Background and aims Information about faecal calprotectin (FC) in colonic diverticular disease (DD) are lacking. We assessed FC in colonic DD,
comparing it with irritable bowel syndrome (IBS) patients and healthy controls. Moreover, we compared FC levels in different
degrees of DD and assessed FC in symptomatic DD before and after treatment.
Materials and methods Forty-eight consecutive patients with a new endoscopic diagnosis of DD (16 with asymptomatic diverticulosis, 16 with symptomatic
uncomplicated DD, 16 with acute uncomplicated diverticulitis), 16 healthy controls, and 16 IBS patients were studied. FC was
assessed by semi-quantitative method and compared with histological inflammation. Moreover, FC was reassessed in symptomatic
DD after 8 weeks of treatment.
Results/findings FC was not increased in healthy controls and IBS patients. No difference was found between asymptomatic diverticulosis, healthy
controls, and IBS patients (p = n.s.). We found higher FC values in acute uncomplicated diverticulitis (p < 0.0005) and in symptomatic uncomplicated DD (p < 0.005) than in healthy controls and in IBS patients. FC values correlated with inflammatory infiltrate (p < 0.0005). FC decreased after treatment to normal values both in acute uncomplicated diverticulitis (p < 0.0005) and in symptomatic uncomplicated DD (p < 0.005) after treatment.
Interpretations/conclusions FC may be useful to detect colonic inflammation in DD and in distinguishing symptomatic DD from IBS, as well as in assessing
response to therapy in DD. 相似文献
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Yu Jin Kwon Ji Hun Kim Seung Hyoung Kim Bong Soo Kim Heung Up Kim Eun Kwang Choi In Ho Jeong 《World journal of gastroenterology : WJG》2009,15(30):3819-3822
We present a 69-year-old woman with a duodenal obstruction after successful selective transcatheter arterial embolization (TAE) for a duodenal diverticular hemorrhage. Two weeks after TAE, the patient showed abrupt symptoms of duodenal obstruction. Resolving hematomas after successful selective transcatheter arterial embolization should be thoroughly observed because they might result in duodenal fibrotic encasement featuring inflammatory duodenal wall thickening, duodenal deformity, dysmotility, and finally obstruction. 相似文献
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A total of 26 cases of nonspecific erosions and ulcers of the colonic mucosa are reported. The most common causes were previous abdominal irradiation or ischemic disease due to arteriosclerosis. The lesions were localized to all segments of the colon. Of the 26 cases, five (19.2%) had erosions (ie, not penetrating beyond the muscularis mucosae) and the remaining 21, ulcers (ie, penetrating beyond the muscularis mucosae). In seven of the 26 cases (26.9%) more than one ulcer was found in the same specimen. Erosions may heal completely by epithelial regeneration (ie,restitutio ad integrum) while ulcers usually heal by replacing scarring tissue. Thus, the two lesions may not be clinically synonymous. The relatively high proportion of erosions among nonspecific ulcerations of the colonic mucosa has not been previously pointed out in the literature.This study was supported by grants from the Karolinska Institute. 相似文献
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Zucker SD 《Gastroenterology》2002,123(1):384-6; discussion 386-7
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Andrea Rossetti Nicolas C. Buchs Romain Breguet Pascal Bucher Sylvain Terraz Philippe Morel 《International journal of colorectal disease》2013,28(6):777-782