STICHTING BG DIAGNOSTIEK DOOR MDL ARTS. endoscopy ? early late associated diseases bleeding...
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Transcript of STICHTING BG DIAGNOSTIEK DOOR MDL ARTS. endoscopy ? early late associated diseases bleeding...
STICHTING BG
DIAGNOSTIEK DOOR MDL ARTS
endoscopy ? early lateassociated diseases
bleeding diverticulum
giant diverticulum
vanWaesberghen
Diverticulitis endoscopy
• to rule out other disease (cancer)
• postpone colonoscopy for 6 weeks
(to avoid conversion of a sealed perforation into a free one)
ENDOSCOPY2004
Complete colonoscopy 81,7 %
Carcinoma 2
Polyps 11 in 9 patients
Chicken bone 1
7878622
4275964
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, 2005Stefanson,1993Stefanson,2004
Colitis associated with diverticulosis
• diverticular colitis-crescentic fold disease• polyp-simulating mucosal prolapse syndrome• cap polyposis • segmental colitis• prolapsing mucosal polyps
7377049
7377049
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)
J Cli Gastroenterol 2006 aug40;supl 3 S 132
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
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
CAP - POLYPOSIS
ManouryGUT,2004
KonishiGUT 2005
2004
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?
Dis Colon Rectum2008,jan
Kethu,NEJM2003
StollmanLancet 2004
FarrellEndoscopy2003
Duodenal diverticular hemostasis withhemoclip placement on the bleeding andfeeder vessels: a case report
Gottumukkala S. Raju, MD, DM, Samir Nath, MD, PhD,Xiaotuan Zhao, MD, PhD, Syed Jafri, MD, GuillermoGomez, MD, Gurinder Luthra, DO
Gastrointestinal Endoscopy2003
13-01-2000
Dis Colon Rectum1998
103 cases type 1: pseudodiverticulum type 2: real diverticulum
Choong1998
•DIVERTICULITIS: endoscopy, yes but later
•SCAD
•DIVERTICULAR BLEEDING: urgent endoscopy
•GIANT DIVERTICULUM