Fariba Jafari

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

Associated Risk FactorsDecreased physical activityIntake of non-steroidal anti-inflammatory

drugs (NSAID)SmokingConstipation from any cause• Incidence increases with age.• Diet has been associated with the emergence

of this disease.

• 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

Saint’s triadCholelithiasis, diverticulitis, and hiatal hernia

frequently occur together.

Characteristic FindingsAbdominal painLLQ tendernessIrregular bowel habitsFever

Physical ExaminationUncomplicated: 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

2 coursesMild: outpatient basis. Liquid diet, oral

antibioticsIf not: hospitalize patient. NPO. IV

antibiotics. CT with contrast.

What now?Symptoms resolve: colonoscopy or contrast

studyRecur: surgical treatment

• 20% of patients with diverticulitis require surgical treatment.

Surgical

ObstructionPerform

diagnostic imaging

Small bowel: high-grade, low-grade

Large bowel: cecal distention

AbscessPerform

diagnostic imaging

Small abscessLarge abscess

FistulaSignaled by fecaluria and pneumaturiaDiagnostic imagingbladder airTreat medicallyResect colon and fistula in one-stage

procedure

Free PerforationSURGICAL

TREATMENT!!

Hinchey Stage III & IV

To the WEB

Bleeding (lower GI)Massive

TransfusionsAngiographyIf + superselective embolizationIf - observe patient, RBC scanning.

ModerateObserve patientColonoscopy