l Diverticular disease l Presented by farahnaz kardan

l. Diverticular disease l Presented by: farahnaz. kardan

Definitions l Colonicdiverticulum: herniation of mucosa and muscularis mucosa through colonic wall (technically, a false diverticulum) l Diverticulardisease: presence of symptomatic diverticula l Diverticulitis: inflammation and infection associated with diverticula )

Epidemiology l very common in Western world l ~50% people > 50 y. o.

. Barium enema with extensive sigmoid diverticulosis

Etiology fibre diet stool volume intraluminal pressure colonic wall tension age tensile strength elasticity muscular hypertrophy, pulsion diverticula

Uncomplicated Diverticulitis l Infection, inflammation of diverticulum Presentation: l LLQ pain, tenderness l CT: ¡pericolic soft-tissue stranding ¡colonic wall thickening ¡phlegmon

Uncomplicated Diverticulitis: treatment Acute l Bowel rest l iv antibiotics l Merperidine better than morphine 3 weeks later l Scope to rule out cancer 4 -6 weeks later l Elective resection, if appropriate…

Indications operationfor elective l ≥ 2 acute attacks, successfully treated medically l one attack requiring hospitalization in patient < 40 y. o. l one complicated attack l one attack in immunocompromised patient l inability to rule out colonic carcinoma

Complicated Diverticulitis l Abscess l Obstruction l Diffuse peritonitis (free perforation) l 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) l Pre-op CT-guided percutaneous drainage l Elective resection, primary re-anastomosis Hinchey Stage III (purulent peritonitis) l Emergent Hartmann’s procedure, or l Emergent resection, primary re-anastomosis Hinchey Stage IV (feculent peritonitis) l Emergent Hartmann’s procedure

Complicated Diverticulitis, Fistula l Treat acute attack l Elective resection, primary re-anastomosis

Investigations Townsend: Sabiston Textbook of Surgery, 17 th ed. , 2004

Investigations - CT Air-filled diverticula Mesenteric stranding

Investigations - CT Air in bladder Thickened wall

THE END