The formation of an atrial bout of diverticulitis secondary to hydrocephalus due to colloid cyst of the third ventricle has not been described. In these 3 patients, CT and MRI examinations showed findings characteristic of colloid cysts of the third ventricle with hydrocephalus of lateral ventricles and formation of unilateral atrial diverticula.

The diverticula subsided when cerebrospinal fluid pressure fell after ventricular drainage. The formation of atrial diverticula in these cases was probably facilitated by the fact that hydrocephalus of lateral ventricles was not accompanied by an increase in pressure in the third ventricle or the posterior fossa. This may lead to herniation of the atrial wall, especially in patients with a tentorial defect. The absence of dilatation of the third ventricle in these cases is a further aid to the differential diagnosis, distinguishing these cysts from cysts in the area of the quadrigeminal and cerebellar cistern, which can lead to triventricular hydrocephalus.

In our view, the progressive or maintained increase in cerebrospinal fluid pressure in the lateral ventricles due to obstruction of the foramina of Monro in cases of colloid cyst of the third ventricle favors the, formation of atrial diverticula, especially in patients with shortening of the tentorial band.

Diverticulosis is a collection of hernias (pockets) along the wall of the colon. In its acute form, when the hernias are inflamed and infected, it is called diverticulitis. Symptoms include severe abdominal pain and chronic diarrhea. Diverticulosis is not an uncommon occurrence, affecting 50 percent to 75 percent of people older than age 80, but it is rarely seen in individuals younger than 40. People at greatest risk are those who have had a low-fiber intake for many years, a risk that increases when not enough fluids are consumed.

Fortunately, only about 15 percent of people with diverticulosis ever experience the more painful form, diverticulitis. When it occurs, however, nutrition therapy plays a strong role in treating the current infection as well as preventing recurrent episodes.

Before the 1970s, diverticular disease was treated with low-fiber diets, based on the premise that coarse, high-fiber dietary residue would lodge in the diverticular pockets and result in inflammation and infection. Doctors discovered, however, that eating a consistently high-fiber diet helps alleviate pressure on the colon walls and makes food’s transit time through the gastrointestinal tract more consistent, yielding bulkier stools. Bulkier stools pass more smoothly and are less likely to get caught in the hernia pockets, causing an infection.

Once the benefit of a high-fiber diet was established, people with diverticulosis who had been eating low-fiber foods daily had to make different food choices. While eating a high-fiber diet can be accomplished fairly easily, changing the opinions of patients who had been told to do the exact opposite was more difficult. Overall, a high-fiber diet is recommended daily, leaving the low-fiber choices as a short-term eating prescription if an acute flare-up of diverticulitis occurs. Make sure you understand the difference between the two conditions.

Many people are concerned that, because of the small but hard-to-digest nature of nuts and seeds, these foods could get caught in the hernia pockets and cause an infection. The National Institutes of Health acknowledge, however, that some people with diverticulosis can comfortably and safely consume these foods. If you are bold enough, try adding one type of nut or seed at a time to your diet to see whether you have any trouble. But unless any one of them is part of a favorite food you gave up for a long time (such as fresh berries with seeds), you may want to continue to avoid them all together.

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.