Diverticulitis

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Introduction

The Case of

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Causes and Risk Factors

In Western society, diverticula are found in 5-10% of adults over 45 and the majority of people over 80.

Diverticulitis develops in 20% of people with diverticula, the majority occurring in the descending or sigmoid colon.

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Pathophysiology

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Signs and Symptoms

history
physical exam

History

The most common presenting problem is pain and tenderness in the lower left quadrant. If the affected bowel is near the bladder, dysuria and increased urinary frequency may occur. Right lower quadrant pain can also be present.

Diarrhea or constipation can occur, though gross blood is rare (Ferzoco, Raptopoulos, and Silen, 1998). Gross blood can follow diverticulosis

Medications

Physical Exam

Febrile

Assess for perforation by looking for peritoneal signs

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Investigations

lab investigations
diagnostic imaging

Lab Investigations

CBC (increased WBC count)

Diagnostic Imaging

CT scanning is the imaging of choice, showing thickened bowel wall.

Endoscopy can help rule out other conditions but is not useful for making the diagnosis, as the inflammatory process leaves the mucosa intact.

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Differential Diagnosis

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Treatments

Treatments should be tailored according to clinical picture.

Treatment of a first attack is a 7-10 day course of liquid diet, coupled with broad-spectrum antibiotics (ie ciprofloxacin and metronidazole), covering both aerobic and anaerobic microbes.

Sicker patients require admission, NPO, and IV antibiotics.

In many cases, abcesses can be treated with CT-guided percutaneous drainage.

Once the acute attack has resolved, a high fibre diet should be instituted.

Surgery should pursued with with worsening clinical picture recurrent disease, sepsis, fistulization, obstruction, or with peritoneal signs. Sigmoid resection is most commonly performed, followed by temporary stoma formation (Hartman procedure).

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