During colonoscopies, clinicians often find feces accumulated in the colonic diverticula. We hypothesized that these feces and potential changes in fecal microbial communities contribute to colon diverticulitis. The aim of this study was to investigate potential changes in the fecal microbiota in symptomatic uncomplicated diverticular disease by terminal restriction fragment length polymorphism (T-RFLP) analyses of fecal microbiota from patients with colonic diverticula, and stool samples. Materials: Fifteen patients with colon diverticulum and 28 healthy volunteers were enrolled. The fecal samples were classified as follows: Group I, feces from a healthy individual; Group II, feces in colonic diverticula obtained during colonoscopy; Group III, feces from the natural defecation of Group II patients. Methods: Fecal microbiota profiles were evaluated by T-RFLP analysis. Results: T-RF patterns of fecal microbiota were divided into three clusters. Most Group I samples were included in clusters A and B, whereas most Group II samples were included in cluster C. Operational taxonomic units of 657 bp (p < 0.05) and 955 bp (p < 0.01) differed in abundance between patients with colon diverticulum and healthy individuals. Conclusions: T-RFLP analyses revealed that the fecal microbial communities in patients with diverticular disease differed from those of healthy individuals, particularly for the operational taxonomic units of 657 and 955 bp. Changes in the fecal microbiota, including Lactobacillales and Clostridium subcluster XIVa, may play a role in diverticular disease.

Incarcerated inguinal hernia is often encountered by surgeons in daily practice. Although rare, hernial reduction en masse is a potential complication of manual reduction of an incarcerated hernia. Manual reduction was performed in a case of Zollinger classification type VII (combined type) hernia in which the indirect hernia portion included an incarcerated small intestine. This procedure caused hernial reduction en masse, but this went unnoticed, and the remaining portion of the direct hernia in the inguinal region was treated surgically by the anterior approach. Because the incarcerated small bowel that had been reduced en masse was not completely obstructed, the patient's general condition was not greatly affected, and he was able to resume eating. Twenty days after surgery, he developed sudden abdominal pain as a result of gastrointestinal perforation. When performing manual reduction of an incarcerated hernia in cases after self-reduction over a long period, the clinician should always be aware of the possibility of reduction en masse.

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