临床胃肠病学杂志

Aim: Diverticular bleeding is a common cause of lower gastrointestinal bleeding. Aggressive treatment because of spontaneous hemostasis is typically required only in severe cases. To determine the clinical characteristics of Japanese patients with diverticular bleeding and evaluate the treatment methods used with the aim of developing an effective management approach. Method: We conducted a retrospective cohort study of 626 Japanese patients (769 endoscopic procedures) who underwent diagnostic lower gastrointestinal endoscopy at Fujita Health University Hospital between November 2011 and April 2014. Results: Diverticular bleeding was the most frequent cause of lower gastrointestinal bleeding, occurring in 155 patients. Concurrent illness, such as hypertension, was common and 92 patients were receiving anticoagulant or antiplatelet therapy on admission. However, no significant clinical differences were observed between patients with severe and mild diverticular bleeding. Computed tomography (CT) was useful for a treatment policy decision of the one from diverticular bleeding as well as other lower gastrointestinal bleeding. Clipping via colonoscopy could stop bleeding effectively for patients with an identified bleeding point. Barium impaction had utility in patients with persistent bleeding. Angiographic hemostasis or colectomy (intestinal resection) was only performed in uncontrolled patients in whom clipping and barium impaction was not possible. Conclusion: No significant clinical differences were observed between patients with severe and mild diverticular bleeding. CT angiography was useful for a treatment policy decision of the one from diverticular bleeding. Endoscopic clipping and barium impaction had efficacy in severe cases of diverticular bleeding, at first.

Agenesis of celiac axis (AGCA) is one of the rare anomalies of abdominal aorta. Very few cases have been reported in the medical literature in the past mainly on angiographic studies performed for various indications. With the advent of multidetector computed tomography (MDCT), it is now possible to detect anomalies of abdominal aorta on routine abdominal MDCT scans performed for indications other than angiography. Detection of these anomalies has assumed significant importance due to increasing number of interventional procedures; minimally-invasive and transplantation surgeries and also in understanding the morbidity and mortality related to diseases involving the anomalous arteries. Hence, we are presenting a rare case of agenetic celiac axis that was diagnosed incidentally on routine MDCT abdominal examination.

  

Jejunoileal diverticulosis (JID) is an acquired condition affecting up to 0.06-1.3% of the population of the United States, with a peak incidence of 60-80 years old. While often asymptomatic, JID can present in numerous ways ranging from chronic mal absorption to acute hemorrhage to perforation and sepsis. Treatment of JID is best catered to the presenting symptoms. The following review details the epidemiology, pathophysiology, diagnostic testing, presenting signs and symptoms, and treatment options for this uncommon disease.

Jejunoileal diverticulosis (JID) is an acquired condition affecting up to 0.06-1.3% of the population of the United States, with a peak incidence of 60-80 years old. While often asymptomatic, JID can present in numerous ways ranging from chronic mal absorption to acute hemorrhage to perforation and sepsis. Treatment of JID is best catered to the presenting symptoms. The following review details the epidemiology, pathophysiology, diagnostic testing, presenting signs and symptoms, and treatment options for this uncommon disease.

Agenesis of celiac axis (AGCA) is one of the rare anomalies of abdominal aorta. Very few cases have been reported in the medical literature in the past mainly on angiographic studies performed for various indications. With the advent of multidetector computed tomography (MDCT), it is now possible to detect anomalies of abdominal aorta on routine abdominal MDCT scans performed for indications other than angiography. Detection of these anomalies has assumed significant importance due to increasing number of interventional procedures; minimally-invasive and transplantation surgeries and also in understanding the morbidity and mortality related to diseases involving the anomalous arteries. Hence, we are presenting a rare case of agenetic celiac axis that was diagnosed incidentally on routine MDCT abdominal examination.