Surgery - Diverticulosis And Diverticulitis

Front 1

Pathology of Diverticulosis

Back 1

weakness in bowel wall at points where blood vessesl enter between antimesenteric and mesenteric tineae

Front 2

Incidence of diverticulosis

Back 2

60% by age 60
~10% become symptomatic

Front 3

most common site of diverticulosis

Back 3

sigmoid colon (involved in 95% of cases)

Front 4

Diagnostic Approach to potential diverticulitis

Back 4

Bleeding: Colonoscopy
Pain/Inflam: CT
NB: wait to perform colonoscopy 6 weeks after inflammation resovles to be sure that you are not missing colon CA

Front 5

Surgical Indications for Diverticulosis

Back 5

--Hemorrhage
--Recurrance
--Suspected CA
--Non-drainable Abscess
--Complixns: Fistula, Obstrx, Strix

Front 6

Diagnostic Modalities of Diverticulitis

Back 6

CT scan
NO Barium Enema/Colonoscopy --> Perforation

Front 7

Complixns of Diverticulitis:

Back 7

Abscess, Fistula, Obstrx, Perf, Strix, Peritonitis
NB: unlike diverticulosis, frank hemorrhage is extremely rare

Front 8

Tx: Diverticulitis

Back 8

NPO + NG suxn, IV fluids, broad spectrum abx with anaerobic coverage

Front 9

Surgical Indications for Diverticulitis:

Back 9

Acute: Obstrx, Fistula, Perf, Abscess, Sepsis/Deterioration
--> Hartmann's procedure & colostomy, reanastomosis 2 mo post-op.
Elective: Two episodes (33--> 50% recurrence rate after 2nd episode)
Or young, diabetic or immunosuppressed pt.
--> One stage resection with primary anastomosis

Front 10

Staging Diverticulitis

Back 10

Hinchy Staging
1: local abscess --immediately paracolonic
2: pelvic abscess
3. purulent peritonitis (pus outside abscess)
4: fecal purulent peritonitis (spillage)

Front 11

Tx: diverticular abscess

Back 11

percutaneous drainage if possible
otherwise surgical intervention