P. F. Wrafter1, T. M. Connelly3, B. C. Lucey4, A. Berg5, W. Koltun6, W. P. Joyce1 1Galway Clinic,Department Of Surgery,Galway, GALWAY, Ireland 3University College Hospital Galway,Department of Surgery,Galway, GALWAY, Ireland 4Galway Clinic,Department Of Radiology,Galway, GALWAY, Ireland 5Penn State University College Of Medicine,Division Of Biostatistics & Bioinformatics,Hershey, PA, USA 6Penn State Hershey Medical Center,Division Of Colon And Rectal Surgery,York, PA, USA
Introduction: Colonic diverticula have been linked with dysregulated collagen, dysfunctional matrix metalloproteinases, incisional hernia formation and genetic disorders with a collagen vascular component. Similarly, hepatic and renal cysts have been associated with defects in collagen deposition and matrix metalloproteinase overexpression. We aimed to determine a correlation between diverticular disease (DD) and cystic disease of the kidneys and liver.
Methods: Consecutive abdominal computed topography (CT) scans performed between January and July 2015 at our institution were prospectively studied. Patient demographics, the presence or absence of DD and the number of renal and hepatic cysts were recorded. Patients who had a sigmoid colectomy for pathology other than DD and scans in which DD and/or solid organs were not fully visualized due to patient or disease factors were excluded. R software was used for statistics. A subgroup analysis was performed on youthful DD patients (<55 years of age, n=32) vs older Controls (>55, n=213).
Results: After exclusion, 607 (369 non DD controls, 40.5% male and 238 DD patients, 50.8% male) were studied. Incidence of cystic disease in Controls vs DD patients was 22.5% vs 71.4% (p<0.00001). The mean number of cysts was 3.8 +/-3.9 (SD) vs 5.6+/-4.3 (SD, p=.0009).
Renal cysts were more common than hepatic cysts in both groups (88% of all Control cysts and 86% of all DD patient cysts) and were present in 18.7% of the Controls vs 53.4% of the DD cohort (p<.00001). Hepatic cyst prevalence was 2.4% vs 8.8% (p=.0008).
In the subgroup analysis, a similar result was found with cystic disease present in 29.1% of Controls >55 years old vs 56.2% of DD patients <55 years old (p=.004).
Conclusion: A significant association between benign intra-abdominal cystic disease and DD was demonstrated. This association was present overall and in the subgroup analysis of youthful DD patients who are more likely to have a genetic versus environmental disease aetiology compared with Controls >55. These findings suggest a global defect in connective tissue integrity in the majority of DD patients.
