Diverticular disease Presented by:farahnaz.kardan.
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Transcript of Diverticular disease Presented by:farahnaz.kardan.
Diverticular disease
Presented by:farahnaz.kardan
Definitions
Colonicdiverticulum: herniation of mucosa and muscularis mucosa through colonic wall (technically, a false diverticulum)
Diverticulardisease: presence of symptomatic diverticula
Diverticulitis: inflammation and infection associated with diverticula
)
Epidemiology
very common in Western world~50% people > 50 y.o.
.
Barium enema with extensive sigmoid diverticulosis
Etiology fibre diet
stool volume
intraluminal pressure
colonic wall tension
muscular hypertrophy,
pulsion diverticula
tensile strength elasticity
age
Uncomplicated Diverticulitis
Infection, inflammation of diverticulum
Presentation:LLQ pain, tendernessCT:
pericolic soft-tissue strandingcolonic wall thickeningphlegmon
Uncomplicated Diverticulitis:treatmentAcuteBowel restiv antibioticsMerperidine better than morphine3 weeks laterScope to rule out cancer4-6 weeks laterElective resection, if appropriate…
Indications operationfor elective≥ 2 acute attacks, successfully treated
medicallyone attack requiring hospitalization in
patient < 40 y.o.one complicated attackone attack in immunocompromised patientinability to rule out colonic carcinoma
Complicated Diverticulitis
AbscessObstructionDiffuse peritonitis (free perforation)Fistulas, e.g., colovesical, colovaginal,
coloenteric, colocutaneous
Complicated Diverticulitis, Abscess
Hinchey Stage
I pericolic abscess
II retroperitoneal or pelvic abscess
III purulent peritonitis
IV fecal peritonitis
Complicated Diverticulitis, Abscess
Hinchey Stages I (pericolic abscess) and II (retroperitoneal or pelvic abscess)
Pre-op CT-guided percutaneous drainageElective resection, primary re-anastomosisHinchey Stage III (purulent peritonitis)Emergent Hartmann’s procedure, orEmergent resection, primary re-anastomosisHinchey Stage IV (feculent peritonitis)Emergent Hartmann’s procedure
Complicated Diverticulitis, Fistula
Treat acute attackElective resection, primary re-
anastomosis
Investigations
Townsend: Sabiston Textbook of Surgery,17th ed., 2004
Investigations - CT
Air-filled diverticula
Mesenteric stranding
Investigations - CT
Air in bladder
Thickened wall
THE END