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 h as received little attention, with most being generically referred to as diverticular perforations. PURPOSE: This study was designed to iden tify the pathogenetic factors responsible for free perforations that m ay occur in the antimesenteric intertenial area during the course of d iverticular 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 subsero sal vascular network developed in the antimesenteric intertenial area in instances of multiple bilateral diverticula. Free perforations occu rred in the antimesenteric haustral area only with multiple bilateral diverticula. CONCLUSIONS: Alterations of the intramural vascular patte rn secondary to the presence of multiple and bilateral diverticula may predispose the colonic wall to acute vascular injury. These changes m ay be enhanced by an episodic increase of intraluminal pressure and co nsequent distention of the colonic wall occurring in the course of div erticular disease.