Diverticular Disease

Question 1

What are diverticuli?

Answer 1

Outpouchings of the mucosa in weakened points along the digestive tract, esp where blood vessels enter the colon

Question 2

True vs False diverticuli

Answer 2

True diverticuli are typically congenital and include all 3 layers (mucosa, muscularis and serosa). False diverticuli typically just include the mucosa and are typically what are seen in the colon. Meckel’s diverticulum is an example of a true diverticulum

Question 3

Diverticulosis vs diverticulitis

Answer 3

Diverticulosis is the condition of having diverticula. Diverticulitis is inflammation of the diverticula and can lead to them bursting and leaking bacteria rich faeces into the abdominal cavity causing peritonitis

Question 4

Hinchey Classification for acute diverticulitis

Answer 4

Stage 1a: Phlegmon (diffuse inflammation of soft or connective tissue due to infection with microaerophilic streptococci)
Stage 1b: Diverticulitis with pericolic or mesenteric abscess
Stage 2: Diverticulitis with walled off pelvic abscess
Stage 3: Diverticulitis with generalised purulent peritonitis
Stage 4: Diverticulitis with generalised faecal peritonitis

Question 5

Surgical options for acute diveritculits (Stage 3 or 4)

Answer 5

Hartmann procedure: resection of diseased segment, proximal section undergoes an end-colostomy and distal end is closed and left in abdominal cavity (Hartmann’s pouch). Second surgery can reverse end-colostomy and re-establish continuity with rectal stump.
Alternative: resection of diseased colon, primary anastomosis and proximal diverting stoma - either colostomy or ileostomy. The second procedure closes the stoma. (protective proximal stoma!)
Name of alternative procedure - McColicks???