Diverticulitis disease of the large intestine:
Found around 75% of over seventy
year olds in western world.Mostly
affect sigmoid colon, but can occur in
the caecum or the whole colon ( but
not the rectum). Diverticula are most
often asymptomatic( diverticulosis)
and found incidentally,but can present
clinically with sepsis or haemorrhage.
• Aetiology: western diet
deficient in dietary fibre
Complications of diverticulitis disease:
1. Diverticulitis
2. Perforations , leading to peri colic abscess,occasionally generalised
peritonitis.
3. Intestinal obstruction lead to fibrosis can cause stenosis or loops of
small bowel
adhere to inflamed sigmoid.
4.Haemorrhage ,diverticulitis may cause haemorrhage
.5.
Fistula,colovesical,colocutanous,colovajnal,enterocutaneous
• Classification of contamination:
• The major of sepsis impact on the outcome in acute diverticulitis.
The most commonly used system of classification is: Hinchey
classification of complicated diverticulitis.
Grade
I .Mesenteric or pelvic abscess.
I l.pelvic abscess.
I l l.purulent peritonitis
I v.faecal peritonitis
.
• Radiology:
• Plain chests and abdominal radiograph can demonstrate
pneumoperitonium.
• Spiral CT,identifying the bowel wall.
• On identifying of abscess in stable patient ,drainage maybe carried
out per cutaneously.
• Barium enemas and colonoscopy,avoided in acute cases.How can
be used after the attack has settled to exclude a co existing
carcinoma.
• Colovesical fistula evaluated with cystoscopy and biopsy in
addition .
• The differential diagnosis for colovesical fistula includes:
• Cancer
• Radiation injury
• Crohn's disease
• Tuberculosis
• Actinomycosis .
Management:
• Conservative
• Nothing by mouth ,rest to the bowel.
• I.v.fluid and antibiotics for gram negative bacilli and anaerobes.
• CT.scan can confirm the diagnosis and assess the complications.
Principles of surgical management:
*Hartman's procedure ,safest option in emergency surgery
** primary anastamosis in selected patients
*** elective resection
**** colovesical fistula requires resection.