Diverticulitis: a follow-up of 100 cases.

From available evidence lymphography must be considered to be a potentially dangerous method of investigation. However, if certain precautions are taken no serious complications should develop. Particular care should be taken over the amount of Lipiodol Ultra Fluid injected, especially after lymphadenectomy or in the presence of lymphatic obstruction, and the procedure should not be undertaken when there is pre-existing pulmonary disease. To prevent the occurrence of thrombo-embolism it is suggested that the limbs should rest on a soft mattress, and should periodically be passively exercised while the investigation is proceeding. Summary Lymphography with Lipiodol Ultra Fluid was successfully performed in 110 out of a consecutive series of 115 female patients with a carcinoma arising from the genital tract. The complications associated with the procedure were recorded. In 98 the study was bilateral and in 12 unilateral. The investigation was repeated in 20 patients ; in eight this was bilateral and in 12 unilateral. The total amount of contrast medium injected in any patient did not exceed 16 ml. Minor complications, which have been described by most other workers, developed in 30% of cases, but there has been little previous reference to two complications which occurred thrombo-embolism and haemoptysis. The occurrence of thrombo-embolism in three patients may have been precipitated by venous stasis resulting from complete immobility of the limbs over a period of three to four hours. Haemoptysis which occurred in six patients probably resulted from breakdown of oil and release of fatty acids in the lungs. The repeat studies indicated that no permanent interference with the internodal or intranodal lymph circulation develops after lymphography. In a review of acute diverticulitis McLaren (1957) observed: "This review has revealed two surprising features in the British and American literature on perforated diverticulitis. The first is the lack of adequate statistical information regarding the incidence and mortality of this condition; the second, that there has not been any investigation of the factors determining death or survival." Surgical literature does not lack expressions of opinion on the treatment of the condition, but statistical support for opinions expressed is much less in evidence. In the search for more reliable information on the late results of treatment in diverticulitis of the colon 100 consecutive cases operated on at the West Middlesex Hospital during 1948-57 were followed up and their subsequent progress was studied. The follow-up was conducted by questionaries to general practitioners and patients, and, …