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Background Perforated diverticulitis (PD) remains a serious acute abdominal condition. The aims of this study were to measure its incidence in a large UK population and to identify factors affecting outcomes. Methods Computerized searches of hospital coding databases for PD were performed in five hospitals in East Anglia, UK. Data were collected from hospital records over 5 years (1995–2000). Incidence was calculated using population data, and factors associated with mortality and morbidity were identified using univariable and multivariable testing. Results Some 202 patients with PD were identified, of whom 93·1 per cent underwent surgery and 24·3 per cent died. The age-adjusted adult incidence of perforation was 3·5 per 100 000 per annum, with a standardized female to male ratio of 1·3 (95 per cent confidence interval (c.i.) 1·1 to 1·5) to 1. Risk factors for death were increased age (odds ratio (OR) 3·5 (95 per cent c.i. 1·9 to 6·1)), pre-existing renal disease (OR 18·7 (1·6 to 211·4)) and pre-existing use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR 3·1 (1·3 to 7·3)). Conclusion PD is uncommon, with the highest incidence in women over 65 years old. Mortality rates are high, particularly in those taking NSAIDs or with pre-existing renal impairment. more...

Background Acute perforated colonic diverticular disease has a mortality rate of up to 30 per cent, but little is known about its aetiology. The aim of this study was to test the hypothesis that three classes of drugs, namely non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics and corticosteroids, are risk factors for perforated diverticular disease. Methods All patients with confirmed perforated colonic diverticular disease were identified over a 5-year period in two hospitals in Norfolk, UK. Two control groups were selected and matched for age, sex and hospital of admission. Data on medication use were obtained from hospital records. Odds ratios for each drug were calculated using conditional logistic regression. Results Opioid analgesics, NSAIDs and corticosteroids were all positively associated with perforated colonic diverticular disease. The odds ratio for opioid analgesics was 1·8 (95 per cent confidence interval (c.i.) 1·1 to 3·0) in the analysis with ophthalmology controls and 3·1 (95 per cent c.i. 1·8 to 5·5) in that with dermatology controls. Respective odds ratios for NSAIDs were 4·0 (95 per cent c.i. 2·1 to 7·6) and 3·7 (95 per cent c.i. 2·0 to 6·8), and those for corticosteroids were 5·7 (95 per cent c.i. 2·2 to 14·4) and 7·8 (95 per cent c.i. 2·6 to 23·3). Conclusion Opioid analgesics, NSAIDs and corticosteroids are all positively associated with perforated colonic diverticular disease. The consistency of these associations, together with plausible biological mechanisms, suggests that these drugs may have a causative role in this condition. more...

Sixty-five patients with suspected deep venous thrombosis (DVT) in 68 limbs were entered consecutively into a study to compare venography with duplex ultrasonography scanning. Both tests were performed on 64 limbs, venography being contraindicated in four. Overall, duplex scanning correctly identified 86 per cent of DVTs diagnosed on venography and correctly excluded 80 per cent with negative venograms. Nearly all errors arose in the diagnosis of calf DVT. In the femoral vein duplex scanning had a specificity of 100 per cent and a sensitivity of 95 per cent. In addition, duplex scanning provided data on the limb not undergoing venography. Of 55 limbs that underwent bilateral duplex scanning, five had thrombus in the femoropopliteal segment and a negative contralateral venogram. In addition, three Baker's cysts were diagnosed. Duplex scanning can be used in patients in whom venography is contraindicated and may also provide information about the contralateral limb. We regard femoropopliteal duplex scanning as sufficiently accurate that treatment can be initiated on the basis of the scan. Duplex scanning should replace venography as the standard method of diagnosing femoropopliteal DVT; radiographic studies should now be required only when the scan result is in doubt. more...