Diverticulitis

Arnelis
7 February 2018
Div Gastroenterohepatology IPD FKUA
Diverticular Disease

 Diverticulosis
 Diverticulitis
Diverticulosis

 Common disease
with age
 Cause unknown
 Potential causes:
 Constipation

 Pressure caused
by moving dry,
hard bowel
movements
 Diverticula
http://digestive.niddk.nih.gov
 pouch-like
projections
Diverticulitis

 Inflammation of the diverticula

 Material caught in pocket causes
inflammation, infection
and bleeding.
Signs and Symptoms

 Diverticulosis
 Most people have no pain or symptoms
 Diarrhea
 Constipation
 Flatulence
 Heartburn
What causes Diverticular
Disease?
 Lack of fiber in diet
 weak areas form pouches
 Lack of exercise
 Diverticulitis
Pathophysiology

 Diverticula
 Acquired or congenital
 Can affect small or large intestine
 May be related to an increase in
intramural pressure
 Occurs in the weakest areas of the
colonic wall
 Adjacent to the vasa recta
 Mesenteric side of the colon

Joffe, S, Kachulis, A., Emedicine, Online Version, 2005, Colon, diverticulitis, www.emedicine.com
  Diverticula
Diverticulitis
Definition
 Etiology
 Outpouchings

 Occur in areas weak and under

stress
 Prolapse of mucosa and
submucosa may occur.
 Location

 Arteries penetrate the

muscularis to reach the
submucosa and mucosa.
 Diverticula form through entire
colon
http://health-pictures.com/diverticulitis-picture.htm
 Left colon

 Sigmoid (most common)

 Right sided (uncommon)

Saunders, W., B., Wilcox, M., 2004, Elsevier imprint, Cecil’s Textbook of Medicine, Chapter 143, Online version, Diverticulitis
  Diverticula
Diverticulitis
ca and Asia •
States, Definition
with

EPIDEMIOLOGY

• Overall prevalence - 12% to 49% •

Increases with age
< 10% in those younger than 40 years >
50% to 66% of patients 80 years

• As common in men and women

• Men - higher incidence of diverticular
http://health-pictures.com/diverticulitis-picture.htm
bleeding
• Women - more episodes of obstruction
or stricture
Saunders, W., B., Wilcox, M., 2004, Elsevier imprint, Cecil’s Textbook of Medicine, Chapter 143, Online version, Diverticulitis
Location
Location
• Arteries penetrate the muscularis to reach the
submucosa and mucosa.

Diverticula form through entire colon

Left colon
Sigmoid (most common)
Right sided (uncommon)
 Diagnosis
o
• Plain Films -abnormal in 30% to 50%
• Contrast Enema Examinations - only watersoluble
contrast enemas, such as Gastrografin, should be
used
• A gentle, single-contrast study should be
performed and terminated once findings of
diverticulitis are discovered,
• Findings -- extravasated contrast material with or
without the outlining of an abscess cavity, an
intramural sinus tract, or a fistula
 CT Scan
o
Computed Tomography
• Diagnostic procedure of choice for acute
diverticulitis
• Because diverticulitis is mainly an
extraluminal disease
• CT criteria for diverticulitis- presence of
diverticula - with pericolic infiltration of
fatty tissue (often appearing as fat
stranding), - thickening of the colon wall -
and formation of abscesses
 Endoscopy
o
• Suspected acute diverticulitis - endoscopy
generally is avoided (risk of perforation,
either from the instrument itself or from air
insufflation)
• Once the acute phase has passed (one to
three months later), a colonoscopy should
be electively performed to exclude
competing diagnoses, particularly neoplasia
o

Treatment -Uncomplicated
diverticulitis
 Out patient
o

• Mild symptoms
• No peritoneal signs
• The ability to take oral fluids • Supportive
home network
• These patients should be treated with a
clear liquid diet and antibiotics.
• Mixed aerobic and anaerobic organisms
( Escherichia coli, Streptococcus species,
and Bacteroides fragilis )
 Hospitalization
o
• Elderly
• Immunosuppressed
• Severe comorbidities
• High fever / significant leukocytosis
• Bowel rest /Intravenous fluid
• Broad-spectrum intravenous antibiotics
should be started
 Hospitalization
o
•If improvement continues, patients may be
discharged, but they should complete a
seven- to 10-day course of oral antibiotics.
• Failure to improve with conservative
medical therapy warrants a diligent search
for complications, consideration of
alternative diagnoses, and surgical
consultation
 Complicated
o
• Abscess • Small pericolic abscesses
(Hinchey stage I)
• Noninterventional management- with
broadspectrum antibiotics and bowel rest •
Continued of abscesses should be
considered only in stable patients who
demonstrate unequivocal improvements in
pain, fever, tenderness, and leukocytosis
over the first few days of therapy.
• Percutaneous catheter drainage
 Complicated
o
• Single operation (resection with primary
anastomosis) have become the preferred
surgical approaches • Two-stage
management - Hartmann procedure