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Diverticular Disease
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Diverticular Disease
Last updated 30th November 2021
- Diverticulum is outpouching of the mucosal bowel wall and commonly seen in sigmoid colon and descending colon
- Risk factors – low fibre diet, constipation, age, obesity, smoking and NSAID use
- Largely asymptomatic – found incidentally during colonoscopy/ CT scan
Presentation (Acute Diverticulitis)
- Abdominal pain, sharp or colicky in nature, usually in LIF
- Altered bowel habit +/- PR bleeding
- Systemic upset – nausea, anorexia, pyrexia
- Perforated diverticulitis – localised peritonism or generalised peritonitis
Investigations
- IV access + Bloods
Routine – FBC, U&E, LFT, CRP
Venous blood gas
Blood cultures – if septic/ has temperature
If surgical intervention required – Group and save, Cross match 2 units - Urine dip
- Erect CXR + AXR
- CT Abdo/pelvis
Hinchey Classifications
- Classifies colonic perforation due to diverticulitis
-
Stage I Small, confined pericolonic or mesenteric abscess Stage II Larger, walled off pelvic abscess Stage III Generalized purulent peritonitis Stage IV Generalized faecal peritonitis - Stage I and II can be managed with antibiotics +/- percutaneous drainage
Stage III and IV are surgical emergencies that require immediate surgical exploration
Management
- IV Antibiotics – based on local guidelines
- Regular analgesia – antispasmodics (Eg mebeverine, hyoscine) may help
- IV fluids if not tolerating oral fluids
- Low residue diet if plan is conservative management
Complications
- Perforation
Will present with septic shock, peritonitis
Initial resuscitation with IV Fluids, IV antibiotics
Will require laparotomy and colonic resection (Hartmann procedure) if generalized purulent or faecal peritonitis - Lower GI bleed
Common cause of rectal bleed, usually painless
May require blood transfusion - Fistula
Enterocolic, colovaginal, colovesical - Abscess
Treatment depends on location, size of abscess and patient’s clinical condition
Treatment options include conservative management with IV antibiotics, percutaneous drainage or laparoscopy and washout.