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Antimesenteric perforations of the colon during diverticular disease: possible pathogenetic role of ischemia

S Tagliacozzo1, A Tocchi

  • 1Rome La Sapienza University Medical School, First Department of Surgery, Italy.

Diseases of the Colon and Rectum
|November 22, 1997
PubMed
Abstract

Insights

Free perforations in diverticular disease often occur on the antimesenteric border. Multiple bilateral diverticula alter vascular patterns, predisposing the colon to injury and perforation.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Pathology

Background:

  • Diverticular disease commonly causes colonic perforations, but the specific pathogenesis of free perforations on the antimesenteric border remains under-investigated.
  • These perforations are often generically classified as diverticular perforations, lacking detailed etiological analysis.

Purpose of the Study:

  • To elucidate the pathogenetic factors contributing to free perforations in the antimesenteric intertenial area of the colon during diverticular disease.
  • To differentiate these specific perforations from general diverticular perforations.

Main Methods:

  • Analysis of vascular alterations within the colonic wall in patients with diverticula and open antimesenteric perforations.
  • Correlation of diverticula formation sites with intramural vascular changes.

Main Results:

  • Confirmation of previous findings regarding diverticula location and associated intramural vascular alterations.
  • Identification of a specific subserosal vascular network in the antimesenteric intertenial area associated with multiple bilateral diverticula.
  • Demonstration that free perforations exclusively occur in the antimesenteric haustral area when multiple bilateral diverticula are present.

Conclusions:

  • Alterations in the intramural vascular pattern, particularly with multiple bilateral diverticula, increase susceptibility to acute vascular injury in the colonic wall.
  • Episodic increases in intraluminal pressure and subsequent colonic wall distention can exacerbate these vascular changes, promoting perforation.

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