1. DIAGNOSTIEK DOOR MDL ARTS
STICHTING BG

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

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

12. 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)

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

14. 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

17. 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

18. CAP - POLYPOSIS
Manoury
GUT,2004

19. 2004
Konishi
GUT 2005

20. 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?

21. Dis Colon Rectum
2008,jan

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

23. 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

26. Dis Colon Rectum
1998

28. 103 cases type 1: pseudodiverticulum type 2: real diverticulum
Choong
1998
103 cases type 1: pseudodiverticulum type 2: real diverticulum

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