diverticular

• 憩室の

関

diverticula、diverticulum

WordNet

1. a herniation through the muscular wall of a tubular organ (especially the colon)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/07/23 00:27:31」(JST)

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Diverticulum
Classification and external resources
MeSH	D004240

A diverticulum (plural: diverticula) is the medical or biological term for an outpouching of a hollow (or a fluid-filled) structure in the body. Depending upon which layers of the structure are involved, they are described as being either true or false.

In medicine, the term usually implies the structure is not normally present. However, in the embryonic stage, some normal structures begin development as a diverticulum arising from another structure.

Anatomical

Guttural pouch: A large (300-500 ml), paired, air-filled ventral diverticulum of the auditory tube found in horses and other Perissodactyla.

Classification

Diverticula are described as being true or false depending upon the layers involved:

• True diverticula involve all layers of the structure, including muscularis propria and adventitia.
• False diverticula do not involve muscular layers or adventitia. False diverticula, in the GI tract for instance, involve only the submucosa and mucosa.

Pathological

Diverticulum of urinary bladder of a 59-year-old man, transverse plane

• Bladder diverticulum: Balloon-like growths on the bladder commonly associated with a chronic outflow obstruction, such as benign prostatic hyperplasia in older males. Usually found in pairs on opposite sides of the bladder, bladder diverticula are often surgically removed to prevent infection, rupture, or even cancer.
• Cardiac diverticulum: A very rare congenital malformation of the heart that is usually benign
• Colonic diverticula: These can become infected (see diverticulitis) and can perforate, requiring surgery
  Large bowel (sigmoid colon) showing multiple diverticula. Note how the diverticula appear on either side of the longitudinal muscle bundle (taenium).
• Diverticulum of Kommerell: unusual nomenclature, in that focal dilatations of a blood vessel are properly referred to as aneurysms
• Duodenal and jejunal diverticul(um|a): congenital lesions, may be a source of bacterial overgrowth, may perforate and may result in abscesses
• Epiphrenic diverticulum: due to dysfunction of the lower esophageal sphincter, as in achalasia

Diverticula may occur in one of the three areas of the esophagus - the pharyngoesophageal, the midesophageal area or the epiphrenic area of esophagus. Zenker's diverticulum is found three times more frequently in men than in women. It occurs posteriorly through the cricopharyngeal muscle in the midline of the neck. Usually seen in people older than 60 years of age.

• Gastric diverticulae - "Although usually asymptomatic, they may cause vague epigastric pain. These lesions may be confused radiologically for gastric ulcers or cancers. Endoscopically, they may be confused for paraesophageal hernias."
• Killian-Jamieson diverticulum
• Meckel's diverticulum: a persistent portion of the omphalomesenteric duct present in 2% of the population
• Rokitansky-Aschoff sinuses: in the gallbladder due to chronic cholecystitis
• Traction esophageal diverticulum: due to scarring from mediastinal or pulmonary tuberculosis
• Urethral diverticulum: congenital in males, post-infectious in females
• Zenker's diverticulum: a diverticulum of the mucosa of the pharynx affecting adults

Most of these pathological types of diverticulum are capable of harboring an enterolith. If the enterolith stays in place, it may cause no problems, but a large enterolith expelled from a diverticulum into the lumen can cause obstruction.

Embryological

• The kidneys, originally diverticula in the development of the urinary and reproductive organs
• The lungs, originally diverticula forming off of the ventral foregut.
• The thymus appears in the form of two flask-shape diverticula, which arise from the third branchial pouch (pharyngeal pouch) of the endoderm.

Footnotes

UpToDate Contents

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• 1. 結腸憩室症および結腸憩室疾患：疫学、危険因子、および病因 colonic diverticulosis and diverticular disease epidemiology risk factors and pathogenesis
• 2. 患者情報：憩室症（詳細） diverticular disease beyond the basics
• 3. 大腸憩室出血 colonic diverticular bleeding
• 4. 学会が公開する診療ガイドラインのリンク：慢性憩室性疾患 society guideline links colonic diverticular disease
• 5. 成人における急性憩室炎の臨床症状および診断 clinical manifestations and diagnosis of acute diverticulitis in adults

English Journal

• Percutaneous drainage of colonic diverticular abscess: is colon resection necessary?

• Gaertner WB, Willis DJ, Madoff RD, Rothenberger DA, Kwaan MR, Belzer GE, Melton GB.Source1Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 2Division of Colon and Rectal Surgery, Department of Surgery, Park Nicollet Methodist Hospital, St. Louis Park, Minnesota.
• Diseases of the colon and rectum.Dis Colon Rectum.2013 May;56(5):622-6. doi: 10.1097/DCR.0b013e31828545e3.
• BACKGROUND: : Recurrent diverticulitis has been reported in up to 30% to 40% of patients who recover from an episode of colonic diverticular abscess, so elective interval resection is traditionally recommended.OBJECTIVE: : The aim of this study was to review the outcomes of patients who underwent pe
• PMID 23575402

• Should elective colectomy be routine following percutaneous drainage of a diverticular abscess?

• Hall J.SourceBurlington, MA.
• Diseases of the colon and rectum.Dis Colon Rectum.2013 May;56(5):533-4. doi: 10.1097/DCR.0b013e3182854601.
• PMID 23575391

• Diverticular Disease of the Colon Does Not Increase Risk of Repeat C. difficile Infection.

• Feuerstadt P, Das R, Brandt LJ.Source*Gastroenterology Center of Connecticut, Hamden, CT ‡Division of Gastroenterology †Montefiore Medical Center, Bronx, NY.
• Journal of clinical gastroenterology.J Clin Gastroenterol.2013 May-Jun;47(5):426-31. doi: 10.1097/MCG.0b013e318276beea.
• BACKGROUND: : Studies have suggested that colonic diverticulosis might increase the likelihood of repeat Clostridium difficile infection (CDI). Our study was designed to compare rates of repeat infection in patients with and without colon diverticula.METHODS: : Patients who had a positive C. diffici
• PMID 23442832

Japanese Journal

• 大腸憩室出血への対応

• 杉山 宏,吉田 健作,足達 広和,中川 貴之,安田 陽一
• 日本消化器内視鏡学会雑誌 57(5), 1296-1311, 2015
• 前処置不良下で行う通常内視鏡では大腸憩室出血の診断は困難である．高率に診断するためには洗腸と透明フードが不可欠である．病歴，薬剤歴，直腸診所見から憩室出血を疑ったらまず造影CTを行い，そして速やかに洗腸し，フードを装着した内視鏡を行う．フードを憩室周囲に軽く押し当て憩室を吸引，反転することで内部の観察ができる．また，フードを憩室周囲に軽く押し当てたまま鉗子孔より水を注入すると，非責任憩室では内部に …
• NAID 130005072133

• 腸石嵌頓を伴う十二指腸憩室穿孔に対してENBDチューブ留置が奏効した1例

• 川口 浩太郎
• 日本消化器内視鏡学会雑誌 57(5), 1271-1277, 2015
• 症例は80歳女性．主訴は高熱，全身倦怠感．腹部CT検査で十二指腸憩室穿孔と診断され，上部消化管内視鏡検査で腸石の嵌頓した傍十二指腸乳頭憩室が確認された．腸石嵌頓を解除し排膿を促すため，膿瘍腔内に7.5Fr ENBDチューブを留置して保存的治療を施行した．患者は入院26日目に重篤な合併症なく退院した．腸石嵌頓を伴う十二指腸憩室穿孔に対し，内視鏡的治療を用いて保存的に治療し得た希少な症例と考えられた．
• NAID 130005072130

• Perforated Meckel's Diverticulitis and an Ileal Ulcer in Rheumatoid Arthritis::The Pathogenic Role of Arterial Thrombosis in these Lesions

• , , [他], , , , ,
• 北関東医学 65(1), 61-68, 2015
• … The pathology showed an artery with organized thrombi in the diverticular wall associated with recanalization and a fresh thrombotic arteriole beneath the ileal ulcer, although there was no evidence of arteriosclerosis, angiitis, amyloidosis or infection. …
• NAID 130005060951

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