Diverticulitis

The Management of Diverticular Disease

Diverticular disease is one of the most common GI disorders in Western countries and incidence is increasing with 300,000 Acute Diverticulitis hospital admissions occurring each year. The annual medical cost is $1.8 billion. Incidence increases with age – 60% of affected individuals are older than 80, only 10% are younger than 40. The disease is rare in underdeveloped countries. In the U.S. and European populations, diverticulosis occurs more frequently in the sigmoid colon. In Asian countries, more than 70% of diverticula are located in the right colon.

The most common type of diverticulum is a pseudodiverticulum, where only the mucosa protrudes through the muscularis propria of the colon at the point of penetration of the nutrient artery (vasa recti) that supplies the mucosa and submucosa. In a true diverticulum, all layers of the bowel wall are present (such as in Meckel’s Diverticulum). The pathophysiology of diverticulitis is not fully understood.

It has been though to be an infectious process caused by bacterial overgrowth, but recently this mechanism has been challenged by new reports suggesting that diverticulitis is primarily an inflammatory process of the colon. Several studies have also examined the role of genetics in the development of diverticular disease.

Symptomatic Diverticulitis

Diverticular disease is usually asymptomatic. Old reports suggested that up to 25% of patients with diverticulosis will have symptoms. New reports suggest that only 4% of patients with diverticulosis will have acute diverticulitis – characterized by inflammation and infection of the diverticula. The theory here is that the diverticulum becomes affected by fecaliths leading to focal necrosis, bacterial overgrowth, and ultimately perforation. The most common cause of lower GI bleeding is Diverticulosis (not -itis).

Presentation

 

Evaluation

 

Management

 

Management of Uncomplicated Diverticulitis

 

Management of Complicated Diverticulitis

 

Management of Diverticular Abscess (Hinchey I or II)

 

Management of Free Perforation (Hinchey III and Hinchey IV)

 

Evaluation After Recovery From Acute Diverticulitis

 

Role of Elective Surgery After Recovery From Acute Diverticulitis

 

Surgical Considerations

 

Diverticular Bleeding

 

Summary

 

Sources:

Cameron, John L., and Andrew M. Cameron. Current surgical therapy. Philadelphia, PA: Elsevier Saunders, 2017. Print.

 

 

 

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