Diverticulitis

Question 1

What is diverticulitis?

Answer 1

• Obstruction of diverticulum
  
  • Commonly impacted faeces
• Elderly patients with previous history of constipation

Question 2

Describe the presentation of diverticulitis?

Answer 2

• Abdominal pain and tenderness
  
  • Typically Left iliac fossa (sometimes mass present)
  • Localied peritonitis
• Fever
• N/V
• Altered bowel habit

Question 3

What are the investigations into a suspected diverticulitis?

Answer 3

• Clinical diagnosis
• Confirmed with CT colonography
• Flex sig/colonscopy can be used after the acute attack

Question 4

Describe a grading system for diverticulitis?

Answer 4

• Hinchey Grading

1. Small, confined pericolic abscesses
2. Large abscess extending into pelvis
3. Generalised purulent peritonitis
4. Generalised faecal peritonitis

Question 5

What do the different stages of Hinchley grading correspond to in terms of management?

Answer 5

1. Surgery rarely needed
2. May resolve without surgery
3. Surgery needed
4. Surgery needed

Question 6

Describe the management of mild attacks of Acute diverticulitis?

Answer 6

• Treated at home with bowel rest (fluids only)
• Antibiotics if signs of sepsis are present

Question 7

When should patients with Acute dicerticulitis be admitted ?

Answer 7

• Unwell
• Fluids not tolerated
• Pain cannot be controlled

Question 8

Describe the medical management of Acute diverticulitis (during admission)?

Answer 8

• Nil by mouth
• IV fluids
• Analgesia
• If signs of sepsis:
  
  • Antibiotics: Cefotaxime + metronidazole

Question 9

Describe the surgical management of Acute diverticulitis?

Answer 9

• Indications:
  
  • Perforation
  • Large haemorrhage
  • Stricture -> obstruction
• Hartmann’s to resect diseased bowel

Question 10

Name some complications of diverticulitis?

Answer 10

• Perforation
• Haemorrhage
• Abscess
• Fistula
• Strictures

Question 11

Describe perforation as a complication of diverticulitis?

Answer 11

• Sudden onset pain
• Generalised peritonitis and shock
• CXR: free air under diaphragm
• Treated with Hartmanns procedure

Question 12

Describe fistulae as a complication of diverticulitis?

Answer 12

• Enterocolic
• Colovaginal
• Colovesicular
• Treatment with resection

Question 13

Describe haemorrhage as a complication of diverticulitis?

Answer 13

• Sudden, painless, bright red PR bleed
• Investigate with mesenteric angiography or colonoscopy
• Treatment:
  
  • Usually resolves spontaneously
  • Colonscopy +/- adrenaline injection
  • Embolisation
  • Resection

Question 14

Describe strictures as a complication of diverticulitis?

Answer 14

• After diverticulitis, colon may heal with fibrous strictures
• Treatment with:
  
  • Resection (usually with primary anastomosis)
  • Stenting

Question 15

What is Hartmann’s operation?

Answer 15

• Resection of rectosigmoid colon
  
  • With closure of anorectal stump
• Formation of an end colostomy

Question 16

Describe a pericolic abscess as a complication of diverticulitis?

Answer 16

• Surgical resection with peritoneal toilet
• Combined with surgical drainage of abscess

Question 17

Describe the features of Meckel’s diverticulum?

Answer 17

• Remnant of the vitello-intestinal duct
• Rule of 2s:
  
  • 2% of the population
  • 2 inches long
  • 2 feet from the ileocaecal junction

Question 18

Describe Meckel’s diverticulitis?

Answer 18

• Abdominal pain
• Pyrexia
• Leucocytosis
• Can mimic Acute appendicitis
• Surgical excision

Question 19

During a laparotomy, if a surgeon notices a Meckels diverticulum what should they do?

Answer 19

Leave it alone if asymptomatic