colonic diverticular disease Flashcards
colonic diverticular disease is ____ sided in western countries
left
outward herniation of the mucosa and submucosa which occurs in areas where nutrient/penetrating arteries (vasa recta) are located
diverticula
pseudodiverticula only involves what layers
mucosa through the musculairs propria
diverticula are clogged by feces that erodes into the diverticulum that causes inflammatory changes because the colonic glands are not drained
diverticulitis
Left or RIght:
Diverticulitis -
Diverticular bleeding
diverticulitis - left
diverticular bleeding - right
Diverticula ruptures/perforates because of
blockage by a fecalith or hardened stool
why does the rectum not develop diverticula
it has no points of weakness
no taenia coli
LLQ pain is a presenting symptom if this disease
SUDD
simple uncomplicated diverticular disease
dual purpose of detecting pneumoperitoneum and assessing cardiopulmonary status in a generally elderly population with common comorbid illness
erect chest film
plain ab x-ray does not confirm diverticulitis, but it’s useful in
ruiling out other conditions
why barium enema is not used
it can leak to the peritoneum and cause peritonitis
why air contrast is not used
it can increase intraluminal pressure of the colon. It can induce rupture.
Procedure of choice for confirmation
CT
what can be seen in UTS
active inflammation
diverticula findings in UTS
Bowel wall thickening
─ Presence of diverticula abscess
─ Hyperechogenicity of the bowel wall
MRI is not good with
intestines and diverticula diagnosis
SUDD with confirmation of inflammation and infection within the colon should be treated initially with
antibiotics and bowel rest
For long-term medical management of uncomplicated diverticular disease
rifaximin
why rifaximin is used for IBS
it eradicates concimitant small bowel bacterial overgrowth
goals of surgery in in diverticular diseases
controlling sepsis
Eliminating complications such as fistula or obstruction
─ Removing the diseased colonic segment
restoring intestinal continuity
when is elective resection recommended
after 2 attacks of uncomplicated diverticulitis
procedure of choice for diverticulitis in the elective setting
sigmoid colectomy with primary anastomosis
clinical signs of abscess
tender mass of abdomen
persistent fever
leukocytosis
management if < 5cm
antibiotics
─ small pericolic abscesses (stage I) can be treated conservatively with broad-spectrum antibiotics and bowel rest only
management if .5cm
percutaneous drainage with definitive surgery after 1.5 months
─ 1 stage resection in 3-6 weeks
indications for urgent surgery
inaccessible (can not be punctured)
• multiloculated
• no improvement after 7-10 days of antibiotics
presence of small pericolic or mesenteric abscesses
• Stage I (Confined Pericolic Abscess)
presence of larger abscesses, often at the pelvis
abscesses may be retroperitoneal or pelvic
Stage II (Distant Abscess)
due to the rupture of a peridiverticular abscess
Stage III (Generalized Purulent Peritonitis)
peritonitis due to the rupture of an uninflamed and unobstructed diverticulum into the free peritoneal cavity with fecal contamination (a “free rupture”)
Stage IV (Fecal Peritonitis)
considered surgical emergencies that require urgent operative intervention
Free Perforation (Stages III & IV)
EVIDENCES SUGGESTIVE OF DIVERTICULAR HEMORRHAGE
bright red or marron blood per rectum
• diverticulosis on colonoscopy or contrast studies
• exclusion of UGIB
