• True- Involves All Layers of Bowel
• False- Involves a Portion of Bowel
Wall
• Pseudo- Herniation of Mucosa
Through Wall- No Muscularis
• Colonic Diverticula are False or
Pseudo- Diverticula

• Presence of Diverticula With No
Implication of Number or Location
• Rare <30 Years, 70% >80 Years
• Diets Low in Fiber, High in
Carbohydrates, Meats

• Occur at Sites of Penetration of Wall by Vessels
• Mesenteric Side of the Colon
• Between Mesenteric and Two Lateral
Taeniae
• Colonic Musculature Becomes
Hypertrophic

• 50% Sigmoid
• 40% Ascending
• Rare in Transverse
• 10% Throughout Colon
• Do Not Occur in Rectum
• Occur Due to Colonic Pressures as
High as 90mm Hg

• Misnomer- Should Be Peri-Diverticulitis
• Occlusion of Neck of Diverticulum
• ↓
• Distention With Secreted Mucus
• ↓
• Venous Gangrene
• ↓
• Perforation Into Mesocolon

• Left Lower Quadrant Pain
• Radiation to Suprapubic, Groin,
Back
• Alteration in Bowel Habits
• Constipation or Diarrhea
• Fever, Chills, Urinary Urgency
• No Rectal Bleeding

• Depends on Site of Perforation
• Amount of Contamination
• Involvement of Adjacent
Organs
• Left Lower Quadrant Tenderness, Guarding
• Tender Left Lower Quadrant Mass
• Distention, Ileus
• Fluctuant Mass on Rectal, Vaginal Exam

•
• Preferred Imaging Study
• Reveals Location of Infection
Extent of Process
• Presence/Absence of Abcess
• Secondary Complications
• Allows Percutaneous Drainage

•
•
•
• Estimates Severity of Disease
• Stage I. Pericolic or Mesenteric Abcess
II. Walled Off Pelvic Abcess
III. Generalized Purulent Peritonitis
IV. Generalized Feculent
Peritonitis
Based on Clinical and CT Information

• Treat With Antibiotics (Cipro and Flagyl)
• Avoid Morphine (Increases Intracolonic
Pressure)
• Avoid Colonoscopy, Barium enema
• Symptoms Should Resolve <48 Hours
• <25% Have Recurrent Attacks
• 6% Recovered Patients Need Operation
• Long-Term- High Fiber Diet

• Complicated Diverticulitis
• After Two or More Episodes
• Electively After Abcess Drainage
• Resection With Anastamosis
• Resection With Hartmann’s
Procedure and Colostomy
• Resect Only Involved Bowel, Not All
Diverticula

• Pneumaturia, Fecaluria
• Frequent Urinary Tract Infections
• CT Scan- Air in Bladder
• Cysto- Bullous Edema, Cystitis
• Antibiotics, One Stage Colon Resection,
Possible Need for Repair of Bladder

• Two Causes-
• 1. “Free Perforation”- Colon to
Mesocolon to Free Peritoneum-
Hinchey IV
• 2. Rupture of Abcess- Hinchey III
• Develop Acute Abdomen
• Often Free Air on Abdominal Film, CT
• Requires Emergency Operation

• Rarely Occurs
• Two Causes
• 1. Chronic Stricture Due to Progressive
Disease
• 2. Small Bowel Obstruction Due to
Adhesion of Intestine to
Inflammatory Process
• Both Need Operation