The dietary treatment for diverticulitis flare ups has taken an about-face in recent years. In the past, people were advised to adhere to bland and low-residue diets. These are exactly the diets which, it seems, were responsible for causing the diverticulosis in the first place. Nowadays, people are encouraged to consume diets that are higher in fiber and roughage. The fiber increases the quantity of stool and softens its consistency. Commercial preparations, such as Metamucil, also have a similar effect.

Although fiber may not be of benefit to all people, it does seem that a high fiber diet lessens the frequency of the problems that may result from diverticulosis. It is hoped that high fiber diets, when eaten at younger ages, may even help to prevent diverticulosis from occurring at all.

The key to the use of fiber is to use it in moderation. As many people already have discovered, fiber, found in cereals, fibers, and vegetables, can itself cause a sense of bloating and cramps. People should eat a quantity of fiber that does not cause these problems, yet is sufficient for softening the stools. This can only happen with trial and error, and anywhere from three to eight weeks must be allowed to see if fiber has an effect.

It is hoped that as people become much more aware of the importance of dietary fiber, then diverticulosis, a disease of modern society, may become a thing of the past.

Diverticulitis is often incorrectly diagnosed on presentation and computed tomography (CT) scanning is probably the best tool for correcting this situation. That’s the conclusion of a retrospective analysis of 125 acute diverticulitis cases undertaken by researchers at the University of Alberta, Edmonton. The cases were seen between mid - 2005 and early 2007.

The study was undertaken in part to assess compliance with treatment guidelines for complicated and uncomplicated diverticulitis endorsed by the Canadian Society of Colon and Rectal Surgeons. Results were presented here at the annual meeting of the Royal College of Physicians and Surgeons by Dr. David Williams, a general surgery resident at the university.

Guidelines recommend complicated potential diverticulitis surgery cases with free perforation or fistula be treated surgically. Percutaneous drainage is recommended if an abscess is found. Conservative management is advocated for uncomplicated cases with antibiotics and bowel rest recommended.

In their analysis, the researchers assessed how valuable clinical markers such as fever, pain and white blood cell count were in making a correct diagnosis. A similar assessment of ultrasound, CT and contrast enema studies was undertaken.

We wanted to see how we were treating our patients and if it was treatment according to the guidelines,” Dr. Williams said in an interview. Ten patients were excluded from the outcome analysis, he said, because although they were diagnosed with diverticulitis on admission they were later found to have a different problem.

The researchers found only 60% of patients had the correct diagnosis made at presentation. The sensitivity and specificity of CT was better than any of the other tests. Patient - reported pain was a reliable marker of a diverticulitis diet candidate but had no specificity.

Magnetic resonance imagings (MRI) showed the nodular lesion of the third ventricle to be hyper intense, without enhancement, in weighted spin-echo sequences, and mainly hypo intense in-weighted spin-echo sequences.

External ventricular drainage resulted in clinical and radio logic improvement. The cyst was evacuated by endoscopy, and pathologic examination revealed colloid cyst material.

A 58-year-old woman presented with cognitive deterioration, memory loss and apathy of approximately 3 months’ duration. Her history was unremarkable. Neurologic examination revealed temporal — spatial disorientation, mental slowness, memory alteration, right crural paresis and hyperreflexia in the left leg.

A cranial CT examination showed a homogeneous nodular lesion localized in the third ventricle, with minimal peripheral contrast uptake, as well as biventricular hydrocephalus and left atrial diverticula. MRI scanning revealed a nodular lesion in the anterior third of the third ventricle, which was hyper intense on weighted spinecho sequences and had areas of hypo intense signal on weighted spin-echo sequences, as well as active biventricular hydrocephalus and left atrial diverticula. The patient underwent surgery for excision of the lesion. Pathologic examination revealed a colloid cyst.

Massive ventricular dilatation causes stretching and dehiscence of the fornix with formation of unilateral or bilateral pial pulsion diverticula of the inferomedial wall of the atrium. Such dilatation may result from a partial defect in the ipsilateral tentorial band, which leads to herniation of the wall. Enlargement of the pial pouch creates a dramatic subarachnoid cyst, which may herniate downward through the incisura into the supracerebellar and quadrigeminal cistern.

These atrial diverticula can compress the mesencephalic tectum and can be mistaken for an arachnoid cyst or an ependymal cyst(f.1,3) of the quadrigeminal cistern. It is important to recognize these cysts and distinguish them from atrial diverticula, since these cysts can cause hydrocephalus, which should be treated with a direct intracystic shunt or excised. In contrast, atrial diverticula generally improve or disappear with suitable drainage of the hydrocephalus. This indicates that, although atrial diverticula are favoured by the defect in the tentorial band, they are secondary to severe, chronic hydrocephalus.

The CT and MRI images showed clearly the herniation of the atrial wall, tentorial hypoplasia and, on occasion, lateral displacement of the internal cerebral veins. They also demonstrated the possible mass effect on the area of the quadrigeminal platform and vermian cistern.

Bilateral diverticula can be seen in cases with shortening of both tentorial bands. The formation of atrial diverticula has been described in severe hydrocephalus secondary to brain stem gliomas, hypothalamic gliomas, third ventricular epidermoidomas and other tumours. Other nontumoral causes include granular ependymitis, aqueductal gliosis, external hydrocephalus and atresia of the foramen of Monro.

Colloid cysts of the third ventricle are rare, benign, congenital cystic neoplasms. They account for 0.25% to 0.5% of all intracranial cysts. Although the most widely accepted theory is that they originate in the primitive neuroepithelium of the tela choroidea they present non-neuronal traces of olfactory mucosa, and for this reason the term ”neuroepithelial cyst” is not exact.

Their location in the anterior part of the third ventricle can obstruct the foramina of Monro and create acute or chronic hydrocephalus, which can become severe. Colloid cysts are usually biventricular and symmetrical, but can be unilateral.

See also:  Zenker’s Diverticulitis and Diverticulitis Causes