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STICHTING BG

DIAGNOSTIEK DOOR MDL ARTS. STICHTING BG. van Waesberghen. endoscopy ? early late associated diseases bleeding diverticulum giant diverticulum. Diverticulitis endoscopy. to rule out other disease (cancer)

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STICHTING BG

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  1. DIAGNOSTIEK DOOR MDL ARTS STICHTING BG

  2. van Waesberghen endoscopy ? early late associated diseases bleeding diverticulum giant diverticulum

  3. Diverticulitis endoscopy • to rule out other disease (cancer) • postpone colonoscopy for 6 weeks (to avoid conversion of a sealed perforation into a free one)

  4. ENDOSCOPY 2004 Complete colonoscopy 81,7 % Carcinoma 2 Polyps 11 in 9 patients Chicken bone 1

  5. 7878622

  6. 4275964

  7. Association between sigmoid diverticulitis and left sided colon cancer • increased risk of left-sided cancer 10 years after the first discharge with diverticular disease • risk 4-5 fold increased • risk due to diverticulitis and not diverticulosis Kronborg, 2005 Stefanson,1993 Stefanson,2004

  8. Colitis associated with diverticulosis • diverticular colitis-crescentic fold disease • polyp-simulating mucosal prolapse syndrome • cap polyposis • segmental colitis • prolapsing mucosal polyps

  9. 7377049

  10. 7377049

  11. Diverticular colitis • not related to diverticulitis • sometimes pre-diverticular disease • in 1,4 % of all colonoscopies • in 1,3 % of sigmoid resections • caused by mucosal prolapse • inflammation is centred on the mucosal folds • can mimick ulcerative colitis • can mimick Crohn’s disease (granulomatous cryptitis)

  12. J Cli Gastroenterol 2006 aug 40;supl 3 S 132

  13. SCAD • 117 cases in literature since 1980 • complaints: painless hematochezia (lower abdominal cramps) • normal rectum and proximal colon • diverse range of histologic changes: IBD-like mucosal prolapse

  14. Prolapsing mucosal polyps • associated with diverticulosis • symptoms: 3/15 asymptomatic 7/15 bleeding 6/15 obstructive symptoms • histologic findings: 15/15 crypt abnormalities 14/15 fibromuscular obliteration of lamina propria 13/15 extension of muscle fibers in lamina propria

  15. CAP - POLYPOSIS Manoury GUT,2004

  16. 2004 Konishi GUT 2005

  17. BLEEDING DIVERTICULUM • > 40 % of lower GI-bleeding episodes • more often in proximal colon • ceases spontaneously in 70 – 80 % • rebleeding in 22 – 38 % • urgent colonoscopy (within 12 hours) • or colonoscopy within 24 hours?

  18. Dis Colon Rectum 2008,jan

  19. Kethu, NEJM 2003 Stollman Lancet 2004 Farrell Endoscopy 2003

  20. Duodenal diverticular hemostasis with hemoclip placement on the bleeding and feeder vessels: a case report Gottumukkala S. Raju, MD, DM, Samir Nath, MD, PhD, Xiaotuan Zhao, MD, PhD, Syed Jafri, MD, Guillermo Gomez, MD, Gurinder Luthra, DO Gastrointestinal Endoscopy 2003

  21. 13-01-2000

  22. Dis Colon Rectum 1998

  23. Choong 1998 103 casestype 1: pseudodiverticulum type 2: real diverticulum

  24. DIVERTICULITIS: endoscopy, yes but later • SCAD • DIVERTICULAR BLEEDING: urgent endoscopy • GIANT DIVERTICULUM

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