Lege Artis Medicinae

[Diverticulitis of the appendix]

KRUTSAY Miklós

DECEMBER 18, 2013

Lege Artis Medicinae - 2013;23(12)

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[DIVERTICULOSIS, DIVERTICULITIS - SYMPTOMS, DIAGNOSTICS AND TREATMENT]

NÉMETH Anna Mária, ENDER Ferenc, BANAI János

[Diverticulosis of the colon is frequent in developed countries. Decreased intake of dietary fibre have been implicated as an important pathogenetic factor. Most of the affected patients are asymptomatic but 10-20% of them have abdominal problems. Clinical manifestations range from simple, non-complicated form (abdominal pain, distension, constipation, urgency etc.) to severe complications (diverticulitis, abscess, peritonitis, perforation, haemorrhage etc.) The diagnosis and therapy of different forms of diverticular disease can be very simple but in several cases differential diagnostical problems and therapeutical difficulties may arise. The gold standard for establishment of uncomplicated diverticulosis is the barium enema or colonoscopy. In case of complicated forms non-invasive methods (US, CT scan, CT-colonography, MRI) have to be preferred. These examinations have no risk for perforation and extraintestinal pathology (air, fluid, abscess) can be detected. Colonoscopy or angiography are the methods of choice in case of haematochesia. The choice of therapy is based on clinical presentation, symptoms and pathology. Fibre supplementation is recommended for patients with diverticulosis without symptoms. In case of noncomplicated symptomatic diverticular disease fiber supplementation or cyclic administration of broad spectrum, poorly absorbable antibiotic can be effective in the prevention of inflammatory episodes and complications. If some of the severe or recurrent complications can not be treated conservatively, surgery is necessary. Prevention of diverticulosis and diverticular disease has to be emphasized. While fibre supplementation in the diet is recommended, other efficacious preventive strategies remain to be identified.]

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Hungarian Radiology

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VÁRKONYI Ildikó, VÖRÖS Péter, SZÉKELY Eszter

[INTRODUCTION - Omental infarction is a rare entity, mimicking symptoms of acute appendicitis. Although omental infarction has typical morphology, both on sonography and CT, it is rarely diagnosed preoperatively. CASE REPORT - A 4-years-old girl presenting with right lower quadrant abdominal pain underwent abdominal sonography, which revealed normal appendix and a superficial hyperechoic solid mass at the site of the pain. The patient underwent laparotomy which confirmed the presumed diagnosis of partial omental necrosis. The necrotic tissue was resected, the appendix was normal. After uneventful postoperative course the child became symptom -free and was discharged. CONCLUSION - The sonomorphology of omental infarction is typical. The suspicion of this entity should be considered as a differential diagnosis of appendicitis, especially if normal appendix can be visualized.]

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NYITRAI Anna, KISS Imre, KIS Éva

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KRUTSAY Miklós, HAJDU Mária