• Humans
• Diverticulitis
• Diverticulitis, Colonic/drug therapy
• Anti-Infective Agents/therapeutic use
• Anti-Bacterial Agents/adverse effects

• Colonic diverticulitis
• Conservative treatment
• Hepatic flexure
• Neutrophil to lymphocyte ratio
• South America

• ASCVD
• Diverticulosis
• Exercise performance
• METs
• Screening colonoscopy

• Humans
• Male
• Cardiovascular Diseases/complications
• Retrospective Studies
• Risk Factors
• Cross-Sectional Studies
• Diverticulosis, Colonic/diagnosis
• Diverticulosis, Colonic/epidemiology
• Diverticulum/complications
• Diverticular Diseases/complications
• Heart Disease Risk Factors
• Atherosclerosis/complications
• Physical Fitness

• Humans
• Diverticular Diseases
• Risk
• Neoplasms/epidemiology
• Neoplasms/etiology
• Risk Factors

• P30 CA016672 NCI NIH HHS
• 2P30CA016672-43 NIH HHS
• The University of Texas MD Anderson Cancer Center Support
• National Cancer Institute, the Cancer Prevention and Research Institute of Texas Rising Stars Award
• American Cancer Society

• colonic diverticular bleeding
• right-sided colon
• surgery

Diverticulosis of the colon is a common condition in Western countries and most patients will remain asymptomatic, but some will present with symptoms of acute diverticulitis or bleeding. Our understanding of diverticulosis is evolving but is mostly derived from diverticulosis affecting the left-sided colon. In contrast, right-sided colonic diverticulosis (RCD) is more commonly seen in Asian countries but is much less common overall. Based on the marked differences in epidemiology, it is commonly thought that these are 2 distinct disease processes. A review of the literature describing the epidemiology and etiology of RCD was performed, with a comparison to the current understanding of left-sided diverticulosis. RCD is becoming increasingly common. The epidemiology of RCD shows it to be a mostly acquired condition, and not congenital as previously thought. Many factors in the etiology of RCD are similar to that seen in left-sided diverticulosis, with a few variations. It is therefore likely that most cases of RCD represent the same disease process that is seen in the left colon.

• Ascending colon
• Cecum
• Colon
• Diverticulitis
• Diverticulum

• Antibiotics
• Classification
• Diverticulitis
• Epidemiology
• Laparoscopic lavage
• Surgical resection

• Aged
• Colectomy
• Colon, Sigmoid/surgery
• Diverticulitis/surgery
• Diverticulitis, Colonic/diagnostic imaging
• Diverticulitis, Colonic/epidemiology
• Elective Surgical Procedures
• Humans
• Laparoscopy

•

Diverticular disease may result in complications like inflammation, abscess, bleeding and formation of fistula to adjacent organs.

Colouterine fistulas related to diverticulitis are very rare due to the thickness of the uterine myometrium. Other causes related to colouterine fistula formation particularly malignancy, have to be considered. Diagnosis by imaging or endoscopy may be inconclusive.

We are presenting a case of a 70-year-old female who presented with malodorous vaginal discharge and painful labial lesions. No previous history of surgery, gynecologic malignancy or other possible causes of the fistula was elicited. CT scan imaging suggested a colouterine fistula. The patient was admitted and underwent Exploratory laparotomy, Hartmann’s procedure and total hysterectomy with bilateral salpingo oophorectomy. The patient was discharged without perioperative complications.

Colouterine fistulas are extremely rare complications of diverticular disease. Diagnosis entails clinical astuteness and judicious use of imaging and endoscopic modalities. Accurate diagnosis is essential to select the appropriate surgical approach, along with intraoperative findings patient status and prevailing conditions.

This case is being presented not only for the rarity of the case but also for the complexity of the management and decision making during the period of the pandemic.

• Case report
• Colon diverticulosis
• Colouterine fistula
• Diverticular fistula
• Diverticulitis

• chest pain
• differential diagnosis
• diverticulitis
• referred pain

• Colonic diverticulitis
• complications
• prognosis

For a disease process that affects so many, we continue to struggle to define optimal care for patients with diverticular disease. Part of this stems from the fact that diverticular disease requires different treatment strategies across the natural history- acute, chronic and recurrent.

To understand where we are currently, it is worth understanding how treatment of diverticular disease has evolved. Diverticular disease was rarely described in the literature prior to the 1900’s. In the late 1960’s and early 1970’s, Painter and Burkitt popularized the theory that diverticulosis is a disease of Western civilization based on the observation that diverticulosis was rare in rural Africa but common in economically developed countries. Previous surgical guidelines focused on early operative intervention to avoid potential complicated episodes of recurrent complicated diverticulitis (e.g., with free perforation) that might necessitate emergent surgery and stoma formation. More recent data has challenged prior concerns about decreasing effectiveness of medical management with repeat episodes and the notion that the natural history of diverticulitis is progressive. It has also permitted more accurate grading of the severity of disease and permitted less invasive management options to attempt conversion of urgent operations into the elective setting, or even avoid an operation altogether.

The role of diet in preventing diverticular disease has long been debated. A high fiber diet appears to decrease the likelihood of symptomatic diverticulitis. The myth of avoid eating nuts, corn, popcorn, and seeds to prevent episodes of diverticulitis has been debunked with modern data. Overall, the recommendations for “diverticulitis diets” mirror those made for overall healthy lifestyle – high fiber, with a focus on whole grains, fruits and vegetables.

Diverticulosis is one of the most common incidental findings on colonoscopy and the eighth most common outpatient diagnosis in the United States. Over 50% of people over the age of 60 and over 60% of people over age 80 have colonic diverticula. Of those with diverticulosis, the lifetime risk of developing diverticulitis is estimated at 10–25%, although more recent studies estimate a 5% rate of progression to diverticulitis. Diverticulitis accounts for an estimated 371,000 emergency department visits and 200,000 inpatient admissions per year with annual cost of 2.1–2.6 billion dollars per year in the United States. The estimated total medical expenditure (inpatient and outpatient) for diverticulosis and diverticulitis in 2015 was over 5.4 billion dollars. The incidence of diverticulitis is increasing.

Besides increasing age, other risk factors for diverticular disease include use of NSAIDS, aspirin, steroids, opioids, smoking and sedentary lifestyle. Diverticula most commonly occur along the mesenteric side of the antimesenteric taeniae resulting in parallel rows. These spots are thought to be relatively weak as this is the location where vasa recta penetrate the muscle to supply the mucosa. The exact mechanism that leads to diverticulitis from diverticulosis is not definitively known.

The most common presenting complaint is of left lower quadrant abdominal pain with symptoms of systemic unwellness including fever and malaise, however the presentation may vary widely. The gold standard cross-sectional imaging is multi-detector CT. It is minimally invasive and has sensitivity between 98% and specificity up to 99% for diagnosing acute diverticulitis. Uncomplicated acute diverticulitis may be safely managed as an out-patient in carefully selected patients. Hospitalization is usually necessary for patients with immunosuppression, intolerance to oral intake, signs of severe sepsis, lack of social support and increased comorbidities. The role of antibiotics has been questioned in a number of randomized controlled trials and it is likely that we will see more patients with uncomplicated disease treated with observation in the future

Acute diverticulitis can be further sub classified into complicated and uncomplicated presentations. Uncomplicated diverticulitis is characterized by inflammation limited to colonic wall and surrounding tissue. The management of uncomplicated diverticulitis is changing. Use of antibiotics has been questioned as it appears that antibiotic use can be avoided in select groups of patients. Surgical intervention appears to improve patient’s quality of life. The decision to proceed with surgery is recommended in an individualized manner.

Complicated diverticulitis is defined as diverticulitis associated with localized or generalized perforation, localized or distant abscess, fistula, stricture or obstruction. Abscesses can be treated with percutaneous drainage if the abscess is large enough. The optimal long-term strategy for patients who undergo successful non-operative management of their diverticular abscess remains controversial. There are clearly patients who would do well with an elective colectomy and a subset who could avoid an operation all together however, the challenge is appropriate risk-stratification and patient selection. Management of patients with perforation depends greatly on the presence of feculent or purulent peritonitis, the extent of contamination and hemodynamic status and associated comorbidities. Fistulas and strictures are almost always treated with segmental colectomy.

After an episode of acute diverticulitis, routine colonoscopy has been recommended by a number of societies to exclude the presence of colorectal cancer or presence of alternative diagnosis like ischemic colitis or inflammatory bowel disease for the clinical presentation. Endoscopic evaluation of the colon is normally delayed by about 6 weeks from the acute episode to reduce the risk associated with colonoscopy. Further study has questioned the need for endoscopic evaluation for every patient with acute diverticulitis. Colonoscopy should be routinely performed after complicated diverticulitis cases, when the clinical presentation is atypical or if there are any diagnostic ambiguity, or patient has other indications for colonoscopy like rectal bleeding or is above 50 years of age without recent colonoscopy.

For patients in whom elective colectomy is indicated, it is imperative to identify a wide range of modifiable patient co-morbidities. Every attempt should be made to improve a patient’s chance of successful surgery. This includes optimization of patient risk factors as well as tailoring the surgical approach and perioperative management. A positive outcome depends greatly on thoughtful attention to what makes a complicated patient “complicated”.

Operative management remains complex and depends on multiple factors including patient age, comorbidities, nutritional state, severity of disease, and surgeon preference and experience. Importantly, the status of surgery, elective versus urgent or emergent operation, is pivotal in decision-making, and treatment algorithms are divergent based on the acuteness of surgery. Resection of diseased bowel to healthy proximal colon and rectal margins remains a fundamental principle of treatment although the operative approach may vary.

For acute diverticulitis, a number of surgical approaches exist, including loop colostomy, sigmoidectomy with colostomy (Hartmann’s procedure) and sigmoidectomy with primary colorectal anastomosis. Overall, data suggest that primary anastomosis is preferable to a Hartman’s procedure in select patients with acute diverticulitis. Patients with hemodynamic instability, immunocompromised state, feculent peritonitis, severely edematous or ischemic bowel, or significant malnutrition are poor candidates. The decision to divert after colorectal anastomosis is at the discretion of the operating surgeon. Patient factors including severity of disease, tissue quality, and comorbidities should be considered. Technical considerations for elective cases include appropriate bowel preparation, the use of a laparoscopic approach, the decision to perform a primary anastomosis, and the selected use of ureteral stents.

Management of the patient with an end colostomy after a Hartmann’s procedure for acute diverticulitis can be a challenging clinical scenario. Between 20 – 50% of patients treated with sigmoid resection and an end colostomy after an initial severe bout of diverticulitis will never be reversed to their normal anatomy. The reasons for high rates of permanent colostomies are multifactorial. The debate on the best timing for a colostomy takedown continues. Six months is generally chosen as the safest time to proceed when adhesions may be at their softest allowing for a more favorable dissection. The surgical approach will be a personal decision by the operating surgeon based on his or her experience. Colostomy takedown operations are challenging surgeries. The surgeon should anticipate and appropriately plan for a long and difficult operation. The patient should undergo a full antibiotic bowel preparation. Preoperative planning is critical; review the initial operative note and defining the anatomy prior to reversal. When a complex abdominal wall closure is necessary, consider consultation with a hernia specialist. Open surgery is the preferred surgical approach for the majority of colostomy takedown operations. Finally, consider ureteral catheters, diverting loop ileostomy, and be prepared for all anastomotic options in advance.

Since its inception in the late 90’s, laparoscopic lavage has been recognized as a novel treatment modality in the management of complicated diverticulitis; specifically, Hinchey III (purulent) diverticulitis. Over the last decade, it has been the subject of several randomized controlled trials, retrospective studies, systematic reviews as well as cost-efficiency analyses. Despite being the subject of much debate and controversy, there is a clear role for laparoscopic lavage in the management of acute diverticulitis with the caveat that patient selection is key.

Segmental colitis associated with diverticulitis (SCAD) is an inflammatory condition affecting the colon in segments that are also affected by diverticulosis, namely, the sigmoid colon. While SCAD is considered a separate clinical entity, it is frequently confused with diverticulitis or inflammatory bowel disease (IBD). SCAD affects approximately 1.4% of the general population and 1.15 to 11.4% of those with diverticulosis and most commonly affects those in their 6th decade of life. The exact pathogenesis of SCAD is unknown, but proposed mechanisms include mucosal redundancy and prolapse occurring in diverticular segments, fecal stasis, and localized ischemia. Most case of SCAD resolve with a high-fiber diet and antibiotics, with salicylates reserved for more severe cases. Relapse is uncommon and immunosuppression with steroids is rarely needed. A relapsing clinical course may suggest a diagnosis of IBD and treatment as such should be initiated. Surgery is extremely uncommon and reserved for severe refractory disease.

While sigmoid colon involvement is considered the most common site of colonic diverticulitis in Western countries, diverticular disease can be problematic in other areas of the colon. In Asian countries, right-sided diverticulitis outnumbers the left. This difference seems to be secondary to dietary and genetic factors. Differential diagnosis might be difficult because of similarity with appendicitis. However accurate imaging studies allow a precise preoperative diagnosis and management planning. Transverse colonic diverticulitis is very rare accounting for less than 1% of colonic diverticulitis with a perforation rate that has been estimated to be even more rare. Rectal diverticula are mostly asymptomatic and diagnosed incidentally in the majority of patients and rarely require treatment. Giant colonic diverticula (GCD) is a rare presentation of diverticular disease of the colon and it is defined as an air-filled cystic diverticulum larger than 4 cm in diameter. The pathogenesis of GCD is not well defined.

Overall, the management of diverticular disease depends greatly on patient, disease and surgeon factors. Only by tailoring treatment to the patient in front of us can we achieve optimal outcomes.

• Age Factors
• Colonoscopy
• Diagnostic Imaging
• Digestive System Surgical Procedures
• Disease Management
• Diverticulitis, Colonic/diagnosis
• Diverticulitis, Colonic/therapy
• Humans
• Risk Factors

• K23 DK118192 NIDDK NIH HHS

In Asia, right-sided diverticular bleeding is more common than that of the left side. It often causes massive bleeding and difficulties in identifying the stigmata of recent hemorrhage (SRH) of colonic diverticular bleeding (CDB). This case series demonstrates the efficacy of the gel immersion method using OS-1 Jelly (Otsuka Pharmaceuticals Factory, Tokushima, Japan) in patients with CDB.

This retrospective case series analyzed data of patients with CDB who underwent the gel immersion method from April 2016 to February 2020 at St. Luke’s International Hospital, Japan. All patients diagnosed with CDB who underwent the gel immersion method were included. We collected data on the site of bleeding, identification of SRH, and efficacy of the method from the electronic medical records.

A total of 9 patients (including 7 with right-sided CDB) underwent gel immersion method and were included in this study. SRH were successfully found in 66.7% (6/9) of patients. Moreover, effective hemostasis was achieved in 85.7% (6/7) of patients with right-sided CDB. There were no adverse events.

The gel immersion method was found to be effective, especially for massive right-sided CDB.

• Diverticular diseases
• Diverticulum
• Gastrointestinal hemorrhage

• Diverticular Hemorrhage
• Diverticulitis
• Diverticulum

• Colon/physiopathology
• Diverticulitis, Colonic/epidemiology
• Diverticulitis, Colonic/genetics
• Diverticulitis, Colonic/physiopathology
• Genetic Predisposition to Disease
• Genome-Wide Association Study
• Humans
• Molecular Epidemiology
• Polymorphism, Single Nucleotide

• K23 DK113225 NIDDK NIH HHS
• P30 DK034987 NIDDK NIH HHS
• R01 DK115950 NIDDK NIH HHS

Diverticulosis results from complex interactions related to aging, environmental factors and genetic predisposition. Despite epidemiologic evidence of genetic risk factors, there has been no attempt to identify genes that confer susceptibility to colonic diverticulosis. We performed the first genome-wide association study (GWAS) on susceptibility to diverticulosis in a Korean population. A GWAS was carried out in 7,948 healthy individuals: 893 patients and 1,075 controls comprised the test set, and 346 patients and 305 controls comprised the replication set. Diverticulosis was diagnosed by colonoscopy during comprehensive medical check-ups, and single-nucleotide polymorphisms (SNPs) related to diverticulosis were detected with the Affymetrix Axiom KORV1.1-96 Array. In all, 9 SNPs were identified in three SNP aggregates in the test set (P < 10⁻³, within 200 kb) after adjusting for sex. All the SNPs were replicated in the replication set (P < 0.05). Three SNPs were near the WNT4 gene, four near the RHOU gene, and two in the OAS1/3 genes. The top SNP associated with right-sided colonic diverticulosis was rs22538787, located near the WNT4 gene [combined set, P-value = 3.128 × 10⁻⁶, odds ratio = 1.415 (95% confidence interval: 1.223–1.637)]. These 9 novel SNP alleles associated with the WNT4, RHOU, and OAS1/3 genes are possibly involved in the underlying genetic susceptibility to right-sided diverticulosis. Our results provide basic knowledge about the development of diverticulosis in an Asian population.

• Diverticular bleeding
• Diverticulitis
• Diverticulosis
• East
• West

• diverticular disease
• diverticulosis
• diverticulitis
• genomics
• genome-wide association study

• Adult
• Aged
• Case-Control Studies
• Diverticular Diseases/epidemiology
• Diverticular Diseases/genetics
• Female
• Genetic Loci
• Genetic Predisposition to Disease
• Genome-Wide Association Study/methods
• Genome-Wide Association Study/statistics & numerical data
• Humans
• Male
• Middle Aged
• Polymorphism, Single Nucleotide
• Quantitative Trait Loci
• United Kingdom/epidemiology

• R01 DK106621 NIDDK NIH HHS
• MC_QA137853 Medical Research Council
• P30 DK034933 NIDDK NIH HHS
• R01 DK107904 NIDDK NIH HHS
• MC_PC_17228 Medical Research Council

• cecal diverticulosis
• giant diverticula
• small bowel diverticula

• Animal models
• Colon
• Diet
• Diverticulosis
• Microstructure

• Animal Feed
• Animal Nutritional Physiological Phenomena
• Animals
• Chlorocebus aethiops
• Colon/pathology
• Dietary Fiber
• Disease Models, Animal
• Disease Progression
• Diverticulosis, Colonic/etiology
• Diverticulosis, Colonic/pathology
• Dogs
• Female
• Humans
• Male
• Rabbits
• Rats
• Risk Factors
• Species Specificity
• Time Factors
• Translational Research, Biomedical/methods

• Acute diverticulitis
• Hinchey
• LPD
• Perforated diverticulitis
• RPD

• acute colonic diverticulitis
• clinical features
• conservative treatment
• recurrence
• surgical treatment

• Adult
• Aged
• Diverticulitis, Colonic/diagnosis
• Diverticulitis, Colonic/diagnostic imaging
• Diverticulitis, Colonic/pathology
• Female
• Humans
• Incidence
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Recurrence
• Retrospective Studies
• Tokyo

• Abscess
• Colonoscopy
• Colovesical
• Complicated
• Diverticulitis
• Fistula
• Obstruction
• Perforation

• Clinical Decision-Making
• Colectomy/methods
• Conservative Treatment/methods
• Disease Progression
• Diverticulitis/diagnostic imaging
• Diverticulitis/physiopathology
• Diverticulitis/therapy
• Diverticulum, Colon/diagnostic imaging
• Diverticulum, Colon/physiopathology
• Diverticulum, Colon/surgery
• Elective Surgical Procedures/methods
• Female
• Humans
• Male
• Prognosis
• Recurrence
• Reoperation/methods
• Reoperation/statistics & numerical data
• Risk Assessment
• Severity of Illness Index
• Treatment Outcome

• Clinical presentation
• Diverticulitis cólica derecha
• Enfermedad diverticular del colon derecho
• Management
• Presentación clínica
• Right colon diverticulitis
• Right colonic diverticular disease
• Tratamiento

• Diverticulitis
• Laparoscopy
• Outcome assessment

• Adult
• Age Distribution
• Aged
• Aged, 80 and over
• Diagnosis, Differential
• Dietary Fiber/standards
• Diverticulitis, Colonic/diagnosis
• Diverticulitis, Colonic/epidemiology
• Diverticulitis, Colonic/etiology
• Diverticulitis, Colonic/therapy
• Diverticulosis, Colonic/diagnosis
• Diverticulosis, Colonic/epidemiology
• Diverticulosis, Colonic/etiology
• Diverticulosis, Colonic/therapy
• Female
• Geography
• Humans
• Male
• Middle Aged
• Prevalence
• Protective Factors
• Risk Factors
• Sex Distribution

• Acute diverticulitis
• Colon cancer
• Colonoscopy
• Colorectal surgery

• acute diverticulitis
• diverticulosis
• epidemiology
• pathogenesis
• symptomatic uncomplicated diverticular disease
• treatment

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Cross-Sectional Studies
• Diverticulitis, Colonic/complications
• Diverticulitis, Colonic/diagnosis
• Diverticulitis, Colonic/epidemiology
• Female
• Humans
• Japan/epidemiology
• Logistic Models
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Risk Factors

• Diverticulitis
• Management
• Non-malignant stricture
• Quality of life
• Sigmoid colon

Previous studies have suggested a weak correlation between self-reported rectal effluent status and bowel preparation quality. We aim to evaluate whether photographic examples of rectal effluents could improve the correlation between patient descriptions of rectal effluents and bowel preparation quality.

Before colonoscopy, patients were asked to describe the nature of their last three rectal effluents. Photographic examples of rectal effluents were provided as a reference for scoring. Bowel preparation was subsequently assessed by a single endoscopist using a global preparation assessment scale. Preparation outcomes were grouped into two levels (excellent to good vs. fair to inadequate). Both univariate and multivariate logistic regression models were used to find any association between bowel preparation quality and patient characteristics.

A total of 138 patients completed the questionnaires. The mean age was 56.5±10.4 years. The mean sum of the last three rectal effluent scores was 5.9±2.0. Higher rectal effluent scores (odds ratio [OR], 0.82; P=0.043) and the presence of diverticula (OR, 0.16; P<0.001) were risk factors for suboptimal preparation.

Photographic example-guided patient descriptions of rectal effluents showed a statistically significant association with bowel preparation quality. However, clinical significance seemed to be low. The presence of diverticula was an independent predictive factor for suboptimal bowel preparation quality.

• Bowel preparation
• Colonoscopy
• Rectal effluent

Diverticula of the colon are pseudodiverticula defined by multiple outpouchings of the mucosal and submucosal layers penetrating through weak spots of the muscle coat along intramural blood vessels. A complete prolapse consists of a diverticular opening, a narrowed neck, and a thinned diverticular dome underneath the serosal covering. The susceptibility of diverticula to inflammation is explained by local ischemia, translocation of pathogens due to retained stool, stercoral trauma by fecaliths, and microperforations. Local inflammation may lead to phlegmonous diverticulitis, paracolic/mesocolic abscess, bowel perforation, peritonitis, fistula formation, and stenotic strictures. Diverticular bleeding is due to an asymmetric rupture of distended vasa recta at the diverticular dome and not primarily linked to inflammation. Structural and functional changes of the bowel wall in diverticular disease comprise: i) Altered amount, composition, and metabolism of connective tissue; ii) Enteric myopathy with muscular thickening, deranged architecture, and altered myofilament composition; iii) Enteric neuropathy with hypoganglionosis, neurotransmitter imbalance, deficiency of neurotrophic factors and nerve fiber remodeling; and iv) Disturbed intestinal motility both in vivo (increased intraluminal pressure, motility index, high-amplitude propagated contractions) and in vitro (altered spontaneous and pharmacologically triggered contractility). Besides established etiologic factors, recent studies suggest that novel pathophysiologic concepts should be considered in the pathogenesis of diverticular disease.

• Connective tissue
• Diverticular disease
• Enteric musculature
• Enteric nervous system
• Intestinal motility

While left sided colonic diverticular disease is common in Western countries, right sided colonic diverticular disease is rare. With increasing migration from Asia, many western countries including Australia, are now seeing more right sided diverticular disease, of which caecal diverticulitis is the commonest. This study aims to determine the incidence of caecal diverticulitis in patients presenting with colonic diverticulitis, as well as identify the symptoms and clinical features that may aid in making a pre-operative diagnosis.

Data was collected using the Queen Elizabeth II Hospital medical records database identifying patients diagnosed with colonic diverticulitis and, more specifically, those with caecal diverticulitis from January 2007 to December 2013. Only those patients who had confirmed caecal diverticulitis on imaging studies or at laparoscopy on their first admission were included in this study.

A total of 632 patients with colonic diverticulitis were admitted to our institution over a seven-year period, of which 13 patients had caecal diverticulitis (2.06%). Of the 13 patients, twelve were of Asian background and ten were considered young (≤50 years of age). The main complaints were right sided abdominal pain (n = 11, 84.6%) and diarrhoea (n = 5, 38.5%). Nine were diagnosed using computed tomography (n = 9/10, 90%), three on laparoscopy and one using ultrasound (n = 1/2, 50%). Ten patients were treated successfully by conservative means.

A high index of suspicion in Asian patients with atypical symptoms of appendicitis, especially diarrhoea, may provide the diagnosis of caecal diverticulitis.

•

CD occurs mostly in young Asians, presenting with atypical symptoms of appendicitis.

• Caecal
• Colorectal
• Conservative
• Diverticulitis
• General surgery

Rectal diverticulum is defined as the sac-like pathological hernia that protrudes outside the intestinal wall. In recent years, the incidence of rectal diverticulum as revealed by autopsy has gradually increased. The development of colon diverticulum is related to anatomical factors, disorders of intestinal motor nerves, intestinal bacterial overgrowth and hormonal factors. In addition, the development of colon diverticulum is also affected by race, gender, environment, food styles and exercise. Colon diverticulum is different between Westerns and Easterns in terms of epidemiology and etiology. Previous studies have demonstrated that high fat diet and low fiber diet might be important in the onset of colon diverticulum. In this review, we will discuss the differences in etiology and risk factors for colon diverticulum between Westerns and Easterns.

• Rectal diverticulum
• Risk factors
• Cellulose
• High fat diet
• Differences between Westerns and Easterns

• Adult
• Aged
• Aged, 80 and over
• Asian People/statistics & numerical data
• Barium Sulfate/administration & dosage
• Contrast Media/administration & dosage
• Diet, High-Fat/adverse effects
• Disease Progression
• Diverticulosis, Colonic/diagnostic imaging
• Diverticulosis, Colonic/ethnology
• Diverticulosis, Colonic/pathology
• Female
• Humans
• Incidence
• Japan/epidemiology
• Male
• Middle Aged
• Radiography
• Sex Distribution

• Appendicitis
• Tomography, X-ray Computed
• Ultrasonography

• Acute Disease
• Adolescent
• Adult
• Appendicitis/diagnosis
• Appendicitis/diagnostic imaging
• Cross-Sectional Studies
• Diagnostic Imaging/instrumentation
• Diagnostic Imaging/statistics & numerical data
• Female
• Humans
• Male
• Middle Aged
• Sensitivity and Specificity
• Tomography, X-Ray Computed
• Ultrasonography
• Young Adult

• Asians
• diverticulitis
• management
• young

• Adolescent
• Adult
• Asian People
• Diverticulitis, Colonic/pathology
• Diverticulitis, Colonic/surgery
• Humans
• Middle Aged
• Retrospective Studies
• Severity of Illness Index
• Young Adult

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Colectomy
• Diverticulitis, Colonic/surgery
• Diverticulitis, Colonic/therapy
• Emergency Medical Services
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Treatment Outcome
• Young Adult

• cardiovascular risk factor
• colonic diverticulum
• diabetes

The incidence of colonic diverticulosis with or without diverticulitis has increased in the Japanese population due to the modernization of food and aging. The rate of diverticulitis in colon diverticulosis ranges from 8.1% to 9.6%. However, few cases of stenosis due to diverticulitis have been reported. These reports suggest that the differentiation between sigmoid diverticulitis and colon cancer is difficult. This report describes two cases of colon stenosis due to diverticulitis that were difficult to differentiate from colon cancer. Case 1 was a 70-year-old woman with narrowed stools for 1 month who underwent colonofiberscopy (CFS). CFS revealed a diverticulum and circumferential stenosis in the sigmoid colon. Barium enema revealed a marked, hourglass-shaped, 2-cm circumferential stenosis in the sigmoid colon. Fluorodeoxyglucose (FDG)-positron emission tomography computed tomography (CT) revealed an increased FDG uptake at the affected portion of the sigmoid colon. Sigmoid colon cancer was suspected, and laparoscopic sigmoidectomy was performed. Pathological examination demonstrated active inflammation with no evidence of malignancy. Case 2 was a 50-year-old man who presented to a nearby clinic with reduced stool output despite the urge to defecate. CFS detected severe stenosis in the sigmoid colon approximately 25 cm from the dentate line. Contrast-enhanced abdominal CT revealed multiple diverticula, wall thickening, and swelling of the lymph nodes around the peritoneal aorta and the inferior mesenteric artery. A partial sigmoidectomy was performed. Pathological examination of the resected specimen revealed no changes in the mucosal epithelial surface, but a marked infiltration of inflammatory cells was observed.

• Diverticulosis
• Colon cancer
• Colon stenosis
• Positron emission tomography-computed tomography
• Magnetic resonance imaging

• Diverticulitis
• Diverticulosis
• Location
• Obesity

• arteriosclerotic diseases
• colonic diverticular bleeding
• colonic diverticulosis
• risk factors