This document discusses diverticulums (diverticula), which are pouches that form in the lining of the gastrointestinal tract. It describes different types of diverticula including Meckel's diverticulum, colonic diverticula, and jejunal/ileal diverticula. It discusses potential complications like hemorrhage, diverticulitis, obstruction, and perforation. The document also provides information on diagnosis and treatment of diverticula including enteroclysis, endoscopy, and surgery.

1. Diverticulums-Bowel cancer
Clínicas quirúrgicas
Dr. Héctor Manuel Virgen Ayala
Dr. Benjamin Robles Mariscal
Ponente: Héctor Eduardo Velázquez Domínguez

2. Diverticulums
http://www.medicinapratica.com.br/tag/diverticulo/

3. Type
Congenital Meckel (2%)
Jejunum/Ileum 15%
Acquired
Colon (50%)

4. Pathologies
• Diverticular disease (symphtomatic
diverticulum)
• Diverticulosis (diverticulum without
inflamation)
• Diverticulitis (inflamation and infection)

5. Meckel diverticulum
• 2%
• M 3:2 F
• Congenital real
diverticulum
• Faulty onfalomesenteric
duct obliteration
• Ileum-1m ileocecal valve
http://www.pedsurg.com.pe/El_diverticulo_de_meckel.php

6. Faulty onfalomesenteric duct obliteration
http://scielo.sld.cu/img/revistas/rpr/v9n1/f0111105.jpg

7. Cells
• Gastric (60%)
• Pancreas
60% heterotopic mucosa
• Brunner glands
• Colon
• Endometrial
• Hepatobiliary

8. Clinical presentation
• Usually asymptomatic
• 4% complications (50%
<10 â)
• Appendicitis like!
http://www.aurorahealthcare.org/yourhealth/healthgate/
getcontent.asp?URLhealthgate=%22127569.html%22

9. Complications
SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F.
MCGRAW‐HILL / INTERAMERICANA DE MEXICO
• Hemorrhage (50% <18â)
• Diverticulitis (more
common in adults)
• Obstruction
• Perforation
• Volvulus
• Intussusception
http://www.revistahnrg.com.ar/pdf_contenidos/con194‐89.pdf

10. http://www.elsevier.es/sites/default/ciles/elsevier/images/288/288v73n04/grande/288v73n04‐13149799cig1.jpg

11. Acquired diverticulum
• False diverticulum
• Duodenum near the ampulla
• Jejunum-big and multiple
• Ileum-small and solitary
• Colon (sigmoid)-between tenias/vessels

12. Jejunum/ileum
diverticulum
• 56-76 â
• Traction, muscular weakness and bacteria
• 6-10% symphtomatic
• Intermittent pain, flatulence, diarrhea
(10-30%)
• Same complications as Meckel
• Duodenal: compression choledocus or
Wirsung

13. Colon diverticulum
• >50 â (50%)
• Pulsion, low fiber
• most are asymphtomatic
• Left side pain
• Fieber, leukocytosis
• Same complications as Meckel

14. Dx/Tx
• Enteroclysis • Diverticulectomy
• Endoscopy • Segmental resection
• Barium enema
• Qx
SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F.
MCGRAW‐HILL / INTERAMERICANA DE MEXICO

15. http://www.youtube.com/watch?v=9S1Xn0Kk4kY

16. Polyposis

17. http://mingaonline.uach.cl/scielo.php?pid=s0718‐28642007000100009&script=sci_arttext

18. Classification
• Neoplasic
• Hamartomatous (youth) Sessile
• Inflammatory Pedunculated
• Hyperplastic
• ¡Most of carcinomas evolve from polyps!

19. Neoplasic
http://www.boloncol.com/images/stories/boletin15/colon3.jpg
• Villous adenoma (40%)
• Tubulovillous adenoma
(22%)
• Tubular adenoma (5%)
http://escuela.med.puc.cl/publ/patologiageneral/patol_097.html

20. Hamartomatous
• Rarely premalignant
• Familiar juvenile
polyposis (colon and
rectum)
• Peutz-Jeghers syndrome
(small intestine, less
colon and rectum)
http://www.ngoaikhoathuchanh.info/vn/chitiettintuc.aspx?IDTT=1042011113514&IDLOAI=266201002348

21. Inherited cancer
• Familiar adenomatous
polyposis (100%)
• Lynch syndrome (no
polyps)
http://www.elsevier.es/sites/default/ciles/elsevier/images/
288/288v74n04/grande/288v74n04‐13147781cig1.jpg

22. Jejunum and ileum
cancer

23. Statistics
• 1.5% • 80% metastasis
gastrointestinal at diagnosis
tract tumor
• 25% 5 year
• 10% survival
symptomatic
(75% malign) • 5th-6th decade

24. http://www.mdsaude.com/
http://www.gastrointestinalatlas.com/ http://emedicine.medscape.com/article/179284‐overview
2010/07/polipos‐intestinais.html
• Adenocarcinoma 35-50%
• Carcinoid tumor 20-40%
• Lymphoma 10-15%
• GIST 10-15%

25. Risk factors
• Red meat
• Smoked food
• Crohn disease
• Celiac sprue
• Polyps
• FAP
• Lynch syndrome http://www.cocinerosonline.com/blog/?page_id=499
• Peutz-Jeghers syndrome

26. Clinical
presentation
Asymptomatic
Parcial or total obstruction
(25%)
Palpable mass (25%)
Colicky abdominal pain
Distension
Nausea and vomiting
Hemorrhage
http://milennium.net/aikiblog/wp‐content/uploads/2010/09/dolor‐abdomen.jpg

27. Diagnosis
• Enteroclysis
• Endoscopy
• Endoscopy capsule
• 5-HIAA (carcinoid
tumor)
SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F.
MCGRAW‐HILL / INTERAMERICANA DE MEXICO

28. http://www.portalesmedicos.com/publicaciones/articles/889/2/
Treatment resection

29. Colon cancer

30. Statistics
• Most • 5th-6th decade
common GI of life
• 95% • PAF and CCHSP
Adenocarcinoma (20%)

31. Location

32. Risk factors
• Same as jejunum and ileum cancer
• Smoking and alcohol AINE
• Poor fiber intake Vitamin D
• High saturated fat intake Excersise

33. Symptoms
• Right colon:
• Left colon: Weakness
Changes in Anemia
bowel habits Hidden blood in
Blood in stool stool
Obstructive Dispeptic
symptoms symptoms
Right disconfort
Palpable mass

34. Laboratory
tests
Urinalysis
CBC (biometría hemática)
Carcinoembryonic antigen
(ACE)
70% colon Cancer
detect recurrences after resection

35. Radiology
Rx
Barium enema
Colonoscopy
TAC
Sigmoidoscopy
Endorectal ultrasound
http://hnsebimagenes.blogspot.com/2009/01/cncer‐de‐colon‐derecho.html

36. Treatment
Resection
Paliative
Electrocoagulation
Fotocoagulation with laser
Splints-endoferulas
Adjuvant and neoadjuvant therapy
Radio and quimio

37. Staging: TNM

38. http://www.youtube.com/watch?v=hycQvTO0C24

39. Thanks