Acute Diverticulitis

Question 1

What is diverticulum

Answer 1

outpouching of the gut wall, usually at sites of entry or perforating arteries; can be acquired or congenital and may occur elsewhere but most important are colonic diverticula

Question 2

What is diverticulosis

Answer 2

• diverticuli are present

Question 3

What is diverticular disease

Answer 3

implies diverticula are symptomatic

Question 4

what is diverticulitis

Answer 4

Inflammation of a diverticulum

Question 5

Where does diverticulitis tend to occur

Answer 5

• Mostly within the sigmoid colon

- right sided and massive single diverticula can occur

Question 6

What is the pathology of diverticulitis

Answer 6

• high intraluminal pressures (e.g. due to lack of dietary fibre) force the mucosa to herniate through the muscle layers of the gut at weak points adjacent to penetrating vessels

Question 7

How do you diagnose acute diverticulitis

Answer 7

• CT abdomen - to confirm acute diverticulitis and can identify extent of disease and any complications
• colonoscopy - risks perforation in an acute setting
• AXR - may identify obstruction or perforation

Question 8

What are the symptoms of diverticular disease

Answer 8

• Altered bowel habit +/- left sided colic relieved by defecation
• nausea
• flatulence

Question 9

How do you treat diverticular disease

Answer 9

• Antispasmodics

- Surgical resection

Question 10

What are the symptoms of diverticulitis

Answer 10

• alterated bowel habit
• nausea
• flatulence
• fever
• WCC increase
• increase in CRP/ESR
• tender colon +/- localised or generalised peritoneum

Question 11

At what stage do you need surgery for diverticulitis

Answer 11

• Stage 1 = pericolic or mesenteric abscess = surgery rarely needed
• Stage 2 = walled off pelvic abscess = may resolve without surgery
• Stage 3 = generalised purulent peritonitis = surgery required
• Stage 4 = generalised faecal peritonitis = surgery required

Question 12

What are the complications of diverticulitis

Answer 12

• perforation
• haemorrhage
• fistulae
• abscesses
• post-infective strictures

Question 13

What does perforation of diverticulitis look like

Answer 13

• ileus + peritonitis + shock

- manage like you would an acute abdomen

Question 14

What is the treatment of a perforation of diverticulitis

Answer 14

• Hartmann’s procedure may be performed; primary anastomosis possible in some patients
• emergency laparoscopic management emerging alternative

Question 15

What is the treatment of haemorrhage of diverticulitis

Answer 15

• embolisation or colonic resection only necessary if ongoing massive bleeding and colonoscopies haemostats has been unsuccessful

Question 16

What fistulae can you get in diverticulitis

Answer 16

• entercoloic
• colovaginal
• colovescial

Question 17

What is the treatment of fistulae in diverticulitis

Answer 17

• Surgical e.g. colonic resection

Question 18

How does an abscess present

Answer 18

• Swinging fever
• leucocytosis
• localising signs

Question 19

What is the treatment of an abscess

Answer 19

• antibiotics +/- US/CT guided drainage

Question 20

What are the causes of diverticular disease

Answer 20

• age
• lack of fibre in the diet

risk

• obesity
• smoking
• lack of exercise