Diverticulitis

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Diverticulitis

• Fariba Jafari

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Definition

• Outpouchings of the colon
• Located at sites where blood vessels enter the
  colonic wall
• Inflamed as a result of obstruction by feces or
  hardened mucus or of mucosal erosion? localized
  perforation diverticulitis

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Associated Risk Factors

• Decreased physical activity
• Intake of non-steroidal anti-inflammatory drugs
  (NSAID)
• Smoking
• Constipation from any cause
• Incidence increases with age.
• Diet has been associated with the emergence of
  this disease.

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• Low-residue diet? constipation ? lead to
  increased intraluminal pressure in the large
  bowel
• High pressure zones or areas of segmentation may
  develop (sigmoid colon), and diverticula begin to
  protrude at these locations
• Microperforation of thin walled diverticulum?
  widespread contamination with fecal organisms may
  ensue

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Saints triad

• Cholelithiasis, diverticulitis, and hiatal hernia
  frequently occur together.

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Characteristic Findings

• Abdominal pain
• LLQ tenderness
• Irregular bowel habits
• Fever

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Physical Examination

• Uncomplicated LLQ tenderness, possible mass,
  bleeding (uncommon), localized inflammation,
• Complicated mass, evidence of fistula,
  ambdominal distention, abdominal tenderness,
  marked in cases of free perforation, hypotension
  bleeding

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2 courses

• Mild outpatient basis. Liquid diet, oral
  antibiotics
• If not hospitalize patient. NPO. IV antibiotics.
  CT with contrast.

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What now?

• Symptoms resolve colonoscopy or contrast study
• Recur surgical treatment

Surgical

• 20 of patients with diverticulitis require
  surgical treatment.

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Obstruction

• Perform diagnostic imaging
• Small bowel high-grade, low-grade
• Large bowel cecal distention

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Abscess

• Perform diagnostic imaging
• Small abscess
• Large abscess

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Fistula

• Signaled by fecaluria and pneumaturia
• Diagnostic imaging?bladder air
• Treat medically
• Resect colon and fistula in one-stage procedure

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Free Perforation

• SURGICAL TREATMENT!!
• Hinchey Stage III IV
• To the WEB

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Bleeding (lower GI)

• Massive
• Transfusions
• Angiography
• If ?superselective embolization
• If - ?observe patient, RBC scanning.
• Moderate
• Observe patient
• Colonoscopy