Diverticulitis

Question 1

Define complicated diverticulitis

Answer 1

bowel obstruction, abscess, fistula, or perforation

Question 2

Risk of crack after acute diverticulitis vs normal population?

Answer 2

2.1% vs 0.4-1%

Question 3

where is the most common site of fistulas D/T diverticulitis?

Answer 3

Most common - dome of the bladder.
Vagina and small bowel are also notable sites.

The sigmoid colon causes local attachments and ultimately communication with the bowel.

Question 4

History sujesting a colovesical fistula?

Answer 4

Recurrent urinary tract infections

Pneumaturia or fecaluria.

Question 5

pathognemonic CT findings for colovesical fistula?

Answer 5

Evidence of air in the bladder that has not been instrumented

Question 6

which gender has more colovesical fistulas d/t diverticulitis and why?

Answer 6

MEN

Because the uterus prevents the sigmoid from adhering to the bladder.

Question 7

What is the sensitivity of barium enema to diagnose colovesical fistula?

Answer 7

Up to 50% of the time.

other chapter - 34%

Question 8

findings in cystoscopy d/t colovesical fistula

Answer 8

Cystoscopy identifies the fistula opening in 40% of enterovesical fistulas.
Cystitis and bullous edema at the site of the fistula are suggestive.

Question 9

What is the initial treatment for colovesical fistula?

Answer 9

1. broad-spectrum antibiotics
2. colonoscopy to examine the affected colon and to exclude colon cancer or Crohn’s disease as
   the cause of the fistula is important for preoperative planning.
3. Elective resection of the involved colon and fistula should then be performed with subsequent primary anastomosis tract

Question 10

In the case of resection a colovesical fistula, what type of bladder closure should be performed?

Answer 10

Small defect - foley catheter for 7 days
Large defects - primary closure + catheter
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If a small defect is encountered in the bladder, it may not be necessary to close this primarily, as healing will occur spontaneously if the bladder is drained with a Foley catheter for 7 days after the operation.
Larger defects will require primary closure with absorbable sutures combined with Foley drainage.

Fistulas to the small bowel will typically require resection and primary anastomosis.