DIVERTICULOSIS OF THE COLON

DIMITRA POULI

Who gets diverticulosis and why?

RIGHT SIDED DIVERTICULOSIS • entirely different condition from

left-sided diverticulosis • True diverticula of the colon • It is relatively common in Asians

but rare in whites. • it is thought to reflect a genetic

predisposition • Muscle abnormalities and

inflammatory complications are uncommon

• Presents more commonly with bleeding

LEFT-SIDED DIVERTICULOSIS

• Prevalence of colonic diverticulosis is difficult to measure because most patients are asymptomatic.

• Prevalence of diverticular disease increases with age, from less than 10%in people younger than age 40 years to 50–66% in patients older than age 80 years

• No sex differences seem to exist.

• In western countries, over 90% of patients withdiverticulosis have left-sided disease.

Why worry?

• 15% to 20% go on to develop diverticulitis (two-thirds mild to moderate, one-third serious)

• and 5% to 10% develop bleeding (two-thirds mild to moderate, one-third life-threatening).

• In all it accounts for 3,400 deaths in the United States each year while draining

the economy of over $2.4 billion a year

Diverticulitis: Symptoms

• Pain is the major symptom usually most

pronounced in the lower left part of the abdomen, but other areas may be involved

• Fever is also very common, sometimes

accompanied by chills.

• Urinary urgency, frequency, and discomfort to mimic prostatitis or a bladder

infection

• Other symptoms may include nausea, loss of appetite, and fatigue. Some patients have constipation, others diarrhea.

Diverticulitis: Diagnosis

• tenderness over the inflamed tissues, typically in the lower left abdomen

• less often swelling

• white blood cell counts are usually elevated

• best test is a CT scan of the abdomen, ideally performed after the patient

receives contrast material both by mouth and intravenously.

• a month or two later, after treatment has quieted things

down, the patient should have a colonoscopy

Diverticulitis: Therapy

• mild-to-moderate diverticulitis-> antibiotics in pill form at home

• severe inflammation or complications (see below->intravenous (IV) antibiotics in the hospital, and then finish up with pills at home. In most cases, seven to 10 days of antibiotics will

do the trick.

• Bowel rest is also important for acute diverticulitis. For home treatment,

that means sticking to a diet of clear liquids for a few days, then gradually adding soft solids and moving to a more normal diet over a week or two.

• Intravenous fluids can sustain hospitalized patients until they are

well enough to switch to clear liquids en route to a full diet.

• Because diverticulitis tends to recur, prevention is always part of the treatment plan. And for men with any form of colonic diverticular

disease, that means a high-fiber diet and exercise and quitting smoking.

Diverticulitis: Complications • Abscess formation. Patients with

abscesses tend to be sicker - have higher temperatures- more pain- and higher white blood cell counts. Treatment involves antibiotics and bowel rest, but it also requires drainage of the abscess

• Peritonitis. Patients are critically ill with high fever- severe abdominal pain- and often low blood pressure. Prompt surgery and powerful antibiotics are required.

• Fistula formation. This complication is less common than abscess formation and less urgent than peritonitis, but it does require both surgery and antibiotics.

• Stricture formation. It's another uncommon complication that can develop from recurrent bouts of diverticulitis.

Diverticulitis: Surgery

typical indications : • Severe diverticulitis that does not respond to medical treatment • Diverticulitis in patients with impaired immune systems • Diverticulitis that recurs>4 times despite a high-fiber diet • Abscesses that cannot be drained with a catheter • Peritonitis, fistula formation, or obstruction • Strong suspicion of cancer.

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