Chapter 47: Colon and Rectum- Diverticulitis Flashcards
What is it?
Infection or perforation of a diverticulum
What is the pathophysiology?
Obstruction of diverticulum by a fecalith leading to inflammation and microperforation
What are the signs/symptoms?
- LLQ pain (cramping or steady)
- change in bowel habits (diarrhea)
- fever
- chills
- anorexia
- LLQ mass
- nausea/vomiting
- dysuria
What are the associated lab findings?
Increased WBCs
What are the associated radiographic findings?
On x-ray:
- ileus
- partially obstructed colon
- air-fluid levels
- free air if perforated
On abdominal/pelvic CT scan:
- swollen
- edematous bowel wall
- particularly helpful in diagnosing an abscess
What are the associated barium enema findings?
Barium enema should be avoided in acute cases
Is colonoscopy safe in an acute setting?
No, there is increased risk of perforation
What are the possible complications?
- Abscess
- diffuse peritonitis
- fistula
- obstruction
- perforation
- stricture
What is the most common fistula with diverticulitis?
Colovesical fistula (to bladder)
What is the best test for diverticulitis?
CT scan
What is the initial therapy?
- IV fluids
- NPO
- broad-spectrum antibiotics with anaerobic coverage
- NG suction (as needed for emesis/ileus)
When is surgery warranted?
- Obstruction
- fistula
- free perforation
- abscess not amenable to percutaneous drainage
- sepsis
- deterioration with initial conservative treatment
What is the lifelong risk of recurrence after:
First episode?
33%
What is the lifelong risk of recurrence after:
Second episode?
50%
What are the indications for elective resection?
- Case by case decisions but usually after two episodes of diverticulitis
- should be considered after the first episode in a:
- young
- diabetic
- or immunosuppressed patient
- or to rule out cancer
What surgery is usually performed ELECTIVELY for recurrent bouts?
One-stage operation: resection of involved segment and primary anastomosis (with preoperative bowel prep)
What type of surgery is usually performed for an acute case of diverticulitis with a complication?
Hartmann’s procedure:
- resection of involved segment with an end colostomy and stapled rectal stump
Resection, primary anastomosis loop ileostomy
What is the treatment of diverticular abscess?
Percutaneous drainage; if abscess is not amenable to percutaneous drainage, then surgical approach for drainage is necessary
How common is massive lower GI bleeding with diverticulitis?
Very rare! Massive lower GI bleeding is seen with diverticulosis, not diverticulitis
What are the most common causes of massive lower GI bleeding in adults?
Diverticulosis (especially right sided), vascular ectasia
What must you rule out in any patient with diverticulitis/diverticulosis?
Colon cancer
