Diverticulitis disease of the large intestine: done by Dr. layth Q

Found around 75% of over seventy year olds in western world Found around 75% of over seventy year olds in western world.Mostly affect sigmoid colon, but can occur in the caecum or the whole colon ( but not the rectum). Diverticula are most often asymptomatic( diverticulosis) and found incidentally,but can present clinically with sepsis or haemorrhage.

Aetiology: western diet deficient in dietary fibre

Complications of diverticulitis disease: 2. Perforations , leading to peri colic abscess,occasionally generalised peritonitis. 3. Intestinal obstruction lead to fibrosis can cause stenosis or loops of small bowel adhere to inflamed sigmoid. 4.Haemorrhage ,diverticulitis may cause haemorrhage. 5. Fistula,colovesical,colocutanous,colovajnal,enterocutaneous.

Classification of contamination: The major of sepsis impact on the outcome in acute diverticulitis. The most commonly used system of classification is: Hinchey

classification of complicated diverticulitis. Grade I .Mesenteric or pelvic abscess. I l.pelvic abscess. I l l.purulent peritonitis I v.faecal peritonitis.

Radiology: Plain chests and abdominal radiograph can demonstrate pneumoperitonium. Spiral CT,identifying the bowel wall. On identifying of abscess in stable patient ,drainage maybe carried out per cutaneously. Barium enemas and colonoscopy,avoided in acute cases.How can be used after the attack has settled to exclude a co existing carcinoma. Colovesical fistula evaluated with cystoscopy and biopsy in addition .

The differential diagnosis for colovesical fistula includes: Cancer Radiation injury Crohn's disease Tuberculosis Actinomycosis .

Management Conservative Nothing by mouth ,rest to the bowel. I.v.fluid and antibiotics for gram negative bacilli and anaerobes. CT.scan can confirm the diagnosis and assess the complications.

Principles of surgical management: *Hartman's procedure ,safest option in emergency surgery ** primary anastamosis in selected patients *** elective resection **** colovesical fistula requires resection.