Diverticular disease Flashcards
What is diverticular disease?
Diverticular disease is a common surgical problem characterized by the herniation of colonic mucosa through the muscular wall of the colon.
Where is diverticular disease usually located?
The usual site is between the taenia coli where vessels pierce the muscle to supply the mucosa.
Why is the rectum often spared in diverticular disease?
The rectum lacks taenia, which is why it is often spared.
What are the symptoms of diverticular disease?
Symptoms include altered bowel habit, rectal bleeding, and abdominal pain.
What are the complications of diverticular disease?
Complications include diverticulitis, haemorrhage, development of fistula, perforation and faecal peritonitis, perforation and development of abscess, and development of diverticular phlegmon.
How is diverticular disease diagnosed?
Diagnosis typically involves colonoscopy, CT cologram, or barium enema, all of which can identify diverticular disease.
What is the challenge in diagnosing diverticular strictures?
It can be difficult to confidently exclude cancer, particularly in diverticular strictures.
What investigations are done for acutely unwell surgical patients?
Plain abdominal films and an erect chest x-ray will identify perforation, while an abdominal CT scan with oral and intravenous contrast helps identify acute inflammation and local complications.
What is the Hinchey classification for diverticular disease severity?
Hinchey classification includes: I - Para-colonic abscess, II - Pelvic abscess, III - Purulent peritonitis, IV - Faecal peritonitis.
What is the initial treatment for diverticular disease?
Initial treatment includes increasing dietary fibre intake.
How are mild attacks of diverticulitis managed?
Mild attacks may be managed conservatively with antibiotics.
What should be done for peri colonic abscesses?
Peri colonic abscesses should be drained either surgically or radiologically.
What is indicated for recurrent episodes of acute diverticulitis?
Recurrent episodes requiring hospitalisation are a relative indication for a segmental resection.
What is the treatment for Hinchey IV perforations?
Hinchey IV perforations require a resection and usually a stoma, with a very high risk of post operative complications.
How are less severe perforations managed?
Less severe perforations may be managed by laparoscopic washout and drain insertion.
Hinchey severity classification I - IV
