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Diverticular disease Presented by:farahnaz.kardan
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Definitions Colonicdiverticulum: herniation of mucosa and muscularis mucosa through colonic wall (technically, a false diverticulum) Diverticulardisease: presence of symptomatic diverticula Diverticulitis: inflammation and infection associated with diverticula )
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Epidemiology very common in Western world ~50% people > 50 y.o.
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. Barium enema with extensive sigmoid diverticulosis
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Etiology fibre diet stool volume intraluminal pressure colonic wall tension muscular hypertrophy, pulsion diverticula tensile strength elasticity age
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Uncomplicated Diverticulitis Infection, inflammation of diverticulum Presentation: LLQ pain, tenderness CT: pericolic soft-tissue stranding colonic wall thickening phlegmon
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Uncomplicated Diverticulitis: treatment Acute Bowel rest iv antibiotics Merperidine better than morphine 3 weeks later Scope to rule out cancer 4-6 weeks later Elective resection, if appropriate…
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Indications operationfor elective ≥ 2 acute attacks, successfully treated medically one attack requiring hospitalization in patient < 40 y.o. one complicated attack one attack in immunocompromised patient inability to rule out colonic carcinoma
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Complicated Diverticulitis Abscess Obstruction Diffuse peritonitis (free perforation) Fistulas, e.g., colovesical, colovaginal, coloenteric, colocutaneous
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Complicated Diverticulitis, Abscess Hinchey Stage Ipericolic abscess IIretroperitoneal or pelvic abscess IIIpurulent peritonitis IVfecal peritonitis
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Complicated Diverticulitis, Abscess Hinchey Stages I (pericolic abscess) and II (retroperitoneal or pelvic abscess) Pre-op CT-guided percutaneous drainage Elective resection, primary re-anastomosis Hinchey Stage III (purulent peritonitis) Emergent Hartmann’s procedure, or Emergent resection, primary re-anastomosis Hinchey Stage IV (feculent peritonitis) Emergent Hartmann’s procedure
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Complicated Diverticulitis, Fistula Treat acute attack Elective resection, primary re-anastomosis
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Investigations Townsend: Sabiston Textbook of Surgery, 17th ed., 2004
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Investigations - CT Air-filled diverticula Mesenteric stranding
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Investigations - CT Air in bladder Thickened wall
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THE END
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