Saturday, November 19, 2016

General Health: Diverticulitis Treatments In conventional medicine perspective

Kyle J. Norton(Scholar, Master of Nutrients), all right reserved.
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                 
                       Diverticulitis

 Diverticulitis is defined as a condition of inflammation of the small, bulging sacs or pouches of the inner lining of the intestine that bulge outward through weak spots as a result of small pieces of stool (feces) trapped in these pouches. In most cases, the disease is found in the large intestine (colon). According to the statistic, approximately, About 10 percent of Americans older than 40 have diverticulitis.

  Treatments In conventional medicine perspective

 In the examination of the data fom January 2004 to June 2005 of 796 consecutive patients referred for total colonoscopy to 17 physicians included age, gender, presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding, showed that the prevalence of colonic diverticula increased from less than 10% in adults under 40 to about 75% in those over 75 years. Of these patients, nearly one third presented with right-sided involvement(1).

A.1. In conventional medicine perspective
According to the study by American Family Pgysician, hospitalization is recommended if patients show signs of significant inflammation, are unable to take oral fluids, are older than 85 years, or have significant comorbid conditions(52).

A.1.1. Non surgical treatment
1. Antibiotics
Also according to tthe study byUnit, Department of Surgery, Hospital Universitario del Mar, All patients diagnosed with uncomplicated diverticulitis based on abdominal computed tomography findings from June 2003 to December 2008 were considered for outpatient treatment. Treatment consisted of oral antibiotics for 7 days (amoxicillin-clavulanic or ciprofloxacin plus metronidazole in patients with penicillin allergy). Patients were seen again at between 4 and 7 days after starting treatment to confirm symptom improvement(53). Side effects are not limit to rash, diarrhea, abdominal pain, nausea/vomiting, drug fever, hypersensitivity (allergic) reactions, etc.

2. Anti-inflammatory medicine
Mesalazine is an anti-inflammatory drug used to treat inflammatory bowel disease. According to ths study by the University of Parma, Inflammation in such diseases seems to be generated by a heightened production of proinflammatory cytokines, reduced anti-inflammatory cytokines, and enhanced intramucosal synthesis of nitric oxide. The mechanisms of action of mesalazine are not yet well understood. It is an anti-inflammatory drug that inhibits factors of the inflammatory cascade (such as cyclooxygenase) and free radicals, and has an intrinsic antioxidant effect. Some recent studies confirm the efficacy of mesalazine in diverticular disease both in relief of symptoms in symptomatic uncomplicated forms and in prevention of recurrence of symptoms and main complications(54). Side effects are not limit to Diarrhea, Nausea, Cramping, Flatulence, etc.

A.1.2. Surgical treatments
According to the WGO 2007 guidelines, 15-30% of patients admitted for management of diverticulitis will need surgery during their admission, with an 18% surgical mortality rate(55).

1. Laparoscopic lavage
Traditionally the management of acute diverticulitis complicated by perforation has been the Hartmann’s procedure, which may be associated with significant morbidity and mortality and the unpleasantness of a colostomy(56). According to the study by John Flynn Gold Coast Hospital, Gold Coast, Queensland, Australia, In the data of Treatment with laparoscopic lavage was performed in only 38 patients in ten hospitals, found that lavage was successful in controlling sepsis in 31 of the 38 included patients, with 32 per cent morbidity (10 of 31 patients) and fast recovery. Overall, 17 of 38 patients developed complications, of whom two had a missed overt sigmoid perforation(57). Other study suggested that the Hartman modification consists of the creation of a distal mucus fistula rather than suturing the rectum closed. To facilitate the creation of a distal mucus fistula, it is suggested that less sigmoid colon be resected at the time of the initial operation. The colon can be assessed for residual diverticular disease later and more resected at the later closure operation if required(58).

2. Colostomy
Colostomy is a surgical procedure to bring one end of the large intestine out through the abdominal wall. There is a report by the University of Pittsburgh Medical Centre of a 62-year-old Caucasian woman with a history of sigmoid diverticulitis presented to our facility with a three-week history of abdominal pain, fevers, chills, loss of appetite and fatigue. Her laboratory test results showed leukocytosis and elevated alkaline phosphatase. A computed tomography scan revealed portal vein thrombosis and a sigmoid diverticulitis with an abscess. Our patient was given pipercillin-tozabactam followed by sigmoid colectomy and loop transverse colostomy(59).

3. Ileostomy
Ileostomy is surgical procedure to bring the end or loop of small intestine (the ileum) out onto the surface of the skin. According to the study by the Surgical Specialists of Spokane, the use of diverting loop ileostomy in patients undergoing colon and rectal surgery with high-risk anastomoses is beneficial. Their selected use has resulted in a 1% anastomotic loss rate with an acceptably low rate of complications related to the ileostomy(60).

4. Other surgical procedure such as the classic 3-stage surgical approach is no longer mention, as a result of high associated morbidity and mortality.

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Friday, November 18, 2016

General Health: Diverticulitis Prevention – The Phytochemicals and Antioxidants

Kyle J. Norton(Scholar, Master of Nutrients), all right reserved.
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                 
                       Diverticulitis

 Diverticulitis is defined as a condition of inflammation of the small, bulging sacs or pouches of the inner lining of the intestine that bulge outward through weak spots as a result of small pieces of stool (feces) trapped in these pouches. In most cases, the disease is found in the large intestine (colon). According to the statistic, approximately, About 10 percent of Americans older than 40 have diverticulitis.

          Prevention – The Phytochemicals and Antioxidants
In the examination of the data fom January 2004 to June 2005 of 796 consecutive patients referred for total colonoscopy to 17 physicians included age, gender, presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding, showed that the prevalence of colonic diverticula increased from less than 10% in adults under 40 to about 75% in those over 75 years. Of these patients, nearly one third presented with right-sided involvement(1).

1. Decaffeinated green tea extract
According to the study of the immunomodulatory effects of decaffeinated green tea extract on rainbow trout, with a 30-day feeding trial, showed that decaffeinated green tea in lower doses of administration could be optimum to enhance the immunity of rainbow trout(48).

2. Quercetin and epigallocatechin gallate
Found abundantly in green tea, the Quercetin and epigallocatechin gallate capacity of the tested polyphenols is due to their stabilizing effect on the cell membranes, thus contributing to cell protection in various pathologies and as adjuvant therapy in highly toxic treatment regimens(49).
Other study indicated that all dietary flavonoids studied (epicatechin, epigallocatechin gallate, gallic acid and quercetin-3-glucoside) show a significant antioxidant effect in a chemical model system, but only epigallocatechin gallate or gallic acid are able to interfere with the cell cycle in Caco2 cell lines(50).

3. Polyphenols
Polyphenols possess beneficial features such as antioxidant, immunomodulatory, anti-cancer and antibacterial activity. According to the study by Uniwersytet Łódzki, ul. Banacha, the ability of phytochemicals to induce apoptosis of cancer cells and bacterial cell damage may be, at least partly, due to their prooxidant properties. Phytocompounds enter the body through the digestive system where they undergo metabolic processes that often change their chemical features. The gastrointestinal microbiome interacts with phytochemicals and influences their bioavailability and absorption in the gut. Except for biochemical changes of plant polyphenols in the host, the achievement of therapeutic concentration in vivo may be the main problem in the determination of their real efficacy(51).

4. Etc.

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Thursday, November 17, 2016

General Health: Diverticulitis Prevention – The Diet

Kyle J. Norton(Scholar, Master of Nutrients), all right reserved.
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                 
                       Diverticulitis

 Diverticulitis is defined as a condition of inflammation of the small, bulging sacs or pouches of the inner lining of the intestine that bulge outward through weak spots as a result of small pieces of stool (feces) trapped in these pouches. In most cases, the disease is found in the large intestine (colon). According to the statistic, approximately, About 10 percent of Americans older than 40 have diverticulitis.

                               Prevention – The Diet

 In the examination of the data fom January 2004 to June 2005 of 796 consecutive patients referred for total colonoscopy to 17 physicians included age, gender, presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding, showed that the prevalence of colonic diverticula increased from less than 10% in adults under 40 to about 75% in those over 75 years. Of these patients, nearly one third presented with right-sided involvement(1).


1. High-fibre dietary
Although many professionals suggested that high-fibre diet is associated to decreased risk of diverticulitis(44a), in the study to assess the treatment of diverticular disease or the prevention of recurrent diverticulitis with a high-fibre diet, showed that high-quality evidence for a high-fibre diet in the treatment of diverticular disease is lacking, and most recommendations are based on inconsistent level 2 and mostly level 3 evidence. Nevertheless, high-fibre diet is still recommended in several guidelines(44).

2. Low-residue diet
Low-residue diets have been recommended for diverticulosis because of a concern that indigestible nuts, seeds, corn, and popcorn could enter, block, or irritate a diverticulum and result in diverticulitis and possibly increase the risk of perforation. According to the study by the Division of Gastroenterology, Mayo Clinic, indicated that there is no evidence supporting such a practice. In contrast, dietary fiber supplementation has been advocated to prevent diverticula formation and recurrence of symptomatic diverticulosis, although this is based mostly on low-quality observational studies(45).

3. Probotics and fruit and vegetables
According to the study by University Hospital Lozano Blesa, changes in intestinal microflora could be one of the putative mechanisms responsible for low-grade inflammation. In patients with uncomplicated diverticulosis, a diet abundant in fruit and vegetables is recommended. The current therapeutic approaches in preventing recurrence of symptoms are based on nonabsorbable antibiotics, mesalazine, and/or probiotics(46).

4. Low fat diet
In the study to examine the association between dietary fiber, sources of fiber, other nutrients, and the diagnosis of symptomatic diverticular disease, showed that for men on a high-total-fat, low-fiber diet, the RR was 2.35 (95% CI 1.38, 3.98) compared with those on a low-total-fat, high-fiber diet, and for men on a high-red-meat, low-fiber diet the RR was 3.32 (95% CI 1.46, 7.53) compared with those on a low-red-meat, high-fiber diet. These prospective data support the hypothesis that a diet low in total dietary fiber increases the incidence of symptomatic diverticular disease. They also provide evidence that the combination of high intake of total fat or red meat and a diet low in total dietary fiber particularly augments the risk(47).

5. Peas
Pulses, including peas, have long been important components of the human diet due to their content of starch, protein and other nutrients. According to the University of Florida, peas contain a variety of phytochemicals once thought of only as antinutritive factors. These include polyphenolics, in coloured seed coat types in particular, which may have antioxidant and anticarcinogenic activity, saponins which may exhibit hypocholesterolaemic and anticarcinogenic activity, and galactose oligosaccharides which may exert beneficial prebiotic effects in the large intestine(47a).

6. Chickpea
Chickpea (Cicer arietinum L.) is an important pulse crop grown and consumed all over the world, especially in the Afro-Asian countries. According to the study by International Crops Research Institute for the Semi-Arid Tropics, chickpea is rich in nutritionally important unsaturated fatty acids such as linoleic and oleic acids. β-Sitosterol, campesterol and stigmasterol are important sterols present in chickpea oil. Ca, Mg, P and, especially, K are also present in chickpea seeds. Chickpea is a good source of important vitamins such as riboflavin, niacin, thiamin, folate and the vitamin A precursor β-carotene. As with other pulses, chickpea seeds also contain anti-nutritional factors which can be reduced or eliminated by different cooking techniques. Chickpea has several potential health benefits, and, in combination with other pulses and cereals, it could have beneficial effects on some of the important human diseases such as CVD, type 2 diabetes, digestive diseases and some cancers(47b).

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General Health: Diverticulitis Prevention – The do and do not’s list

Kyle J. Norton(Scholar, Master of Nutrients), all right reserved.
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                 
                       Diverticulitis

 Diverticulitis is defined as a condition of inflammation of the small, bulging sacs or pouches of the inner lining of the intestine that bulge outward through weak spots as a result of small pieces of stool (feces) trapped in these pouches. In most cases, the disease is found in the large intestine (colon). According to the statistic, approximately, About 10 percent of Americans older than 40 have diverticulitis.

                                Prevention – The do and do not’s list

 In the examination of the data fom January 2004 to June 2005 of 796 consecutive patients referred for total colonoscopy to 17 physicians included age, gender, presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding, showed that the prevalence of colonic diverticula increased from less than 10% in adults under 40 to about 75% in those over 75 years. Of these patients, nearly one third presented with right-sided involvement(1).


1. Increase intake of vegetable
Vegetable intake, a strict vegetable diet, and increased fiber intake are associated with the decreased risk of diverticolosis(37).

2. Increased intake of nuts and corn
According to the study by the University of Washington School of Medicine, Harborview Medical Center, Seattle, cotrary to a long-standing belief, a large prospective study found that nuts and corn did not increase the risk of diverticulitis or diverticular bleeding(38).

3. Physical activity but not Vigorous activity
In the study of 47,228 US males in the Health Professionals Follow-up Study cohort who were aged 40-75 years and free of diverticular disease, gastrointestinal cancer, and inflammatory bowel disease at baseline in 1986, found that physical activity lowers the risk of diverticulitis and diverticular bleeding. Vigorous activity appears to account for this association(39).

4. Lose weight
There is an associated of Diverticulitis with obese patients(40).

5. Stop smoking
Although there are conflict result in study, smoking is associated to Diverticulitis in some studies(41).

6. Avoid excessive drinking
Alcohol may increase the risk of asymptomatic diverticulosis and diverticulitis(42).

7. Reduced intake of carbohydrates
Epidemiologic studies have demonstrated an association between diverticulosis and diets that are low in fiber and high in refined carbohydrates(42a).

8. Avoid Low level of folate and vitamin B12
There is a report of an elderly man in whom hereditary spherocytosis (HS) had been diagnosed many years previously. He also had diverticulitis and was referred because of increasing anaemia (Hb 7.7 g/dl). He was suffering from diarrhoea and anorexia, and was taking a very poor diet. Serum investigations showed low folate and vitamin B12 levels, according to the Haematology Department, University Hospital(42b). Other study found that bacterial production of cobamides, both de novo and from ingested CN-Cbl bound to intrinsic factor, occurs in humans with bacterial overgrowth states and results in a significant loss of vitamin B12 to the host(42c).

9. Drink plenty of water to ease passage through the colon to prevent constipation of that may cause severity of the disease.

10. Others
According to the study by Groote Schuur Hospital, South Africa, indicated that a weight loss of greater than 30% accompanying a variety of diseases was associated with a reduction in pancreatic enzyme secretion of over 80%, villus atrophy and impaired carbohydrate and fat absorption. Finally, specific nutrients can induce disease, for example, gluten-sensitive enteropathy, whilst dietary factors such as fibre, resistant starch, short-chain fatty acids, glutamine and fish-oils may prevent gastrointestinal diseases such as diverticulitis, diversion colitis, ulcerative colitis(43).
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Tuesday, November 15, 2016

General Health: Diverticulitis - The Misdiagnosis

Kyle J. Norton(Scholar, Master of Nutrients), all right reserved.
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                 
                       Diverticulitis

 Diverticulitis is defined as a condition of inflammation of the small, bulging sacs or pouches of the inner lining of the intestine that bulge outward through weak spots as a result of small pieces of stool (feces) trapped in these pouches. In most cases, the disease is found in the large intestine (colon). According to the statistic, approximately, About 10 percent of Americans older than 40 have diverticulitis.

                               The Misdiagnosis

 In the examination of the data fom January 2004 to June 2005 of 796 consecutive patients referred for total colonoscopy to 17 physicians included age, gender, presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding, showed that the prevalence of colonic diverticula increased from less than 10% in adults under 40 to about 75% in those over 75 years. Of these patients, nearly one third presented with right-sided involvement(1).

1. Glioma
There is a report of a case of a 64 year old woman with diverticulitis complicated by a metastatic cerebral abscess is reported. Presentation was atypical and investigations were misleading; the computed tomographic scan was interpreted as showing a glioma(31).

2. Crohn’s disease
Meckel’s diverticulum is the most common congenital abnormality of the gastrointestinal system. there is a report of a 19-year-old case with Meckel’s diverticulum operated with ileus while under followup, who was assumed to have Crohn’s disease(32).

3. Acute prostatitis
According of the study by, abdominal abscess resulting from a perforated diverticulitis has never been reported as a cause of acute urinary retention. There is a report of an atypical presentation, the patient was initially misdiagnosed and treated as having acute prostatitis(33).

4. Appendicitis
The clinical diagnosis of appendicitis and diverticulitis remains challenging. There is a report of a case of a patient with right-sided diverticulitis misdiagnosed as appendicitis both clinically and on plain film radiography(34).

5. Prostate abscess
There is a report of a case report of sigmoid diverticular abscess presenting as prostate abscess. Helical computed tomography (CT) scan revealed the prostate abscess but failed to demonstrate the underlying diverticular abscess(35).

6. Ruptured aortic aneurysm
The rupture of an abdominal aortic aneurysm is one of the most dramatic event in the daily clinical practice. It is often easily suspected when the classical signs of hemorrhagic shock are associated with an anterior (mesogastric) abdominal pain and an expanding mass, especially in the non-obese patients(36). 
There is a report of a misdiagnosis of ruptured aortic aneurysm in diverticular disease(36).

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Monday, November 14, 2016

General Health: Diverticulitis - The Diseases associated with Diverticulitis

Kyle J. Norton(Scholar, Master of Nutrients), all right reserved.
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                 
                       Diverticulitis

 Diverticulitis is defined as a condition of inflammation of the small, bulging sacs or pouches of the inner lining of the intestine that bulge outward through weak spots as a result of small pieces of stool (feces) trapped in these pouches. In most cases, the disease is found in the large intestine (colon). According to the statistic, approximately, About 10 percent of Americans older than 40 have diverticulitis.

                              The Diseases associated with Diverticulitis

 In the examination of the data fom January 2004 to June 2005 of 796 consecutive patients referred for total colonoscopy to 17 physicians included age, gender, presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding, showed that the prevalence of colonic diverticula increased from less than 10% in adults under 40 to about 75% in those over 75 years. Of these patients, nearly one third presented with right-sided involvement(1).

1. Stenosis
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(26).

2. Advanced colonic neoplasia
According to the study of 1,326 patients-56% male (n=741), 44% female (n=585), mean age 64 (+/-11.83 SD)-with a resection due to colonic cancer, the documented findings of colonoscopy, colonic contrast enema, and/or histopathology were analysed with regard to the prevalence of colonic diverticulosisby, showed that the diverticulitis group revealed a statistically significant decreased rate of advanced colonic neoplastic lesion in nearly all age categories and all age-stratified analyses (corresponding OR 0.13-0.43)(27).

3. Obesity
There is an association between diverticular disease and obesity exists, there is no evidence suggesting that obese patients should be managed any differently from the non-obese(28).

4. Bacteremia
There is a report of two cases of bacteraemia with the anaerobic bacterium Ruminococcus gnavus. In both cases the bacteraemia was associated with diverticular disease. Preliminary conventional identification suggested peptostreptococci and MALDI-TOF analysis did not produce scores high enough for species identification. Finally the bacteria were identified with 16S rRNA gene sequencing(29).

5. Segmental colitis
Diverticular disease-associated segmental colitis is a unique variant of chronic colitis limited to segments of the left colon that harbor diverticula, according to the study by the University of Arkansas for Medical Sciences(30).

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General Health: Diverticulitis - The Complications

Kyle J. Norton(Scholar, Master of Nutrients), all right reserved.
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                 
                       Diverticulitis

 Diverticulitis is defined as a condition of inflammation of the small, bulging sacs or pouches of the inner lining of the intestine that bulge outward through weak spots as a result of small pieces of stool (feces) trapped in these pouches. In most cases, the disease is found in the large intestine (colon). According to the statistic, approximately, About 10 percent of Americans older than 40 have diverticulitis.

                               The Complications

 In the examination of the data fom January 2004 to June 2005 of 796 consecutive patients referred for total colonoscopy to 17 physicians included age, gender, presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding, showed that the prevalence of colonic diverticula increased from less than 10% in adults under 40 to about 75% in those over 75 years. Of these patients, nearly one third presented with right-sided involvement(1).

Diverticulosis and its complications, particularly diverticulitis, are extremely common in western countries. The major factor in the development of diverticulosis is a lack of adequate fiber intake. Diverticulitis may be complicated by abscess formation, fistula formation, peritonitis, or obstruction(19).
Other study indicated that diverticular disease is a common problem in the western population and sometimes leads to serious complications such as hemorrhage, bowel stenosis, obstruction, abscesses, fistulae, bowel perforation, and peritonitis. The severity of these complications can differ, and it is not always clear which procedure is indicated in each case and what measures should be followed before bringing the patient into the operating room(19a).

1. Bowel obstruction
there is a report of a neonate who presented with acute intestinal obstruction secondary to a large, mobile Meckel’s diverticulum which due to a direct compression effect on the adjacent small bowel caused mechanical intestinal obstruction(20). Other study reported the clinical case of a 65-year-old female patient with a diagnosis on hospital admittance of acute appendicitis and a intraoperative finding of diverticular disease of the small intestine, accompanied by complications such as intestinal perforation, bleeding and abdominal sepsis(21).

2. Peritonitis
Peritonitis is defined as an inflammation of the peritoneum, the thin tissue that lines the inner
wall of the abdomen covering most of the abdominal organs. According to the study of Thirty-eight patients (3.7%) were pathologically diagnosed with acute appendiceal diverticulitis among 1,029 cases of appendectomy. The mean age of patients in the diverticulitis group was significantly older than that of the appendicitis group (49.0 ± 15.2 years vs. 25.4 ± 14.2 years, P < 0.05). Mean duration of preoperative symptoms was longer in the diverticulitis group (3.6 ± 3.8 days vs. 1.8 ± 3.2 days, P < 0.05). The site of abdominal pain, fever, signs of localized peritonitis, accompanying gastrointestinal symptoms, and white blood cell count showed no differences between the two groupsby(22).

3. Abscess
According to the study by Westfälischen Wilhelms Universität, Münster, Normally colonic diverticulitis presents itself clinically with symptoms. Pyogenic liver abscess was the primary finding of a concealed perforation of sigma colon diverticulitis(23).

4. Fistula
Colouterine fistula is an extremely rare condition because the uterus is a thick, muscular organ. There is a report of an 81-year-old woman was referred to the emergency department with abdominal pain and vaginal discharge. Computed tomography showed a myometrial abscess cavity in the uterus adherent to the thick sigmoid wall. Upon contrast injection via the cervical os for fistulography, we observed spillage of the contrast into the sigmoid colon via the uterine fundus(24).

5. Bleeding
Colonic diverticular bleeding cases account for 30-40% of the lower gastrointestinal bleeding, among which, 3-5% appear to be massive bleeding, according to the study by Seoul National University Bundang Hospital(25).

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