Antimesenteric perforations of the colon during diverticular disease: possible pathogenetic role of ischemia.
The pathogenesis of free perforations occurring on the antimesenteric border of the pelvic colon during the course of diverticular disease has received little attention, with most being generically referred to as diverticular perforations.


OBJECTIVE
This study was designed to identify the pathogenetic factors responsible for free perforations that may occur in the antimesenteric intertenial area during the course of diverticular disease.


METHODS
Vascular alterations of the colonic wall associated with diverticula and open antimesenteric perforations were analyzed.


RESULTS
Previous data on the site of diverticula formation and related intramural vascular alterations were confirmed. A subserosal vascular network developed in the antimesenteric intertenial area in instances of multiple bilateral diverticula. Free perforations occurred in the antimesenteric haustral area only with multiple bilateral diverticula.


CONCLUSIONS
Alterations of the intramural vascular pattern secondary to the presence of multiple and bilateral diverticula may predispose the colonic wall to acute vascular injury. These changes may be enhanced by an episodic increase of intraluminal pressure and consequent distention of the colonic wall occurring in the course of diverticular disease.
Tagliacozzo
S
S
Rome La Sapienza University Medical School, First Department of Surgery, Italy.
Tocchi
A
A
D012809:Colon, Sigmoid / Q000098:blood supply* / Q000473:pathology* / Q000601:surgery; D004241:Diverticulum, Colon / Q000150:complications* / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology* / Q000473:pathology; D007511:Ischemia / Q000150:complications*; D008643:Mesentery