Fariba Jafari
Definition
• Outpouchings of the
colon
• Located at sites where
blood vessels enter the
colonic wall
• Inflamed as a result of
obstruction by feces or
hardened mucus or of
mucosal erosion
localized perforation=
diverticulitis
Associated Risk Factors
 Decreased physical activity
 Intake of non-steroidal anti-inflammatory drugs
(NSAID)
 Smoking
 Constipation from any cause
• Incidence increases with age.
• Diet has been associated with the emergence of this
disease.
• Low-residue diet constipation  lead to increased
intraluminal pressure in the large bowel
• High pressure zones or areas of segmentation may
develop (sigmoid colon), and diverticula begin to
protrude at these locations
• Microperforation of thin walled diverticulum
widespread contamination with fecal organisms may
ensue
Saint’s triad
 Cholelithiasis, diverticulitis, and hiatal hernia
frequently occur together.
Characteristic Findings
 Abdominal pain
 LLQ tenderness
 Irregular bowel habits
 Fever
Physical Examination
 Uncomplicated: LLQ tenderness, possible mass,
bleeding (uncommon), localized inflammation,
 Complicated: mass, evidence of fistula, ambdominal
distention, abdominal tenderness, marked in cases of
free perforation, hypotension; bleeding
2 courses
 Mild: outpatient basis. Liquid diet, oral antibiotics
 If not: hospitalize patient. NPO. IV antibiotics. CT
with contrast.
What now?
 Symptoms resolve: colonoscopy or contrast study
 Recur: surgical treatment
Surgical
• 20% of patients with diverticulitis require
surgical treatment.
Obstruction
 Perform diagnostic
imaging
 Small bowel: highgrade, low-grade
 Large bowel: cecal
distention
Abscess
 Perform diagnostic
imaging
 Small abscess
 Large abscess
Fistula
 Signaled by fecaluria and pneumaturia
 Diagnostic imagingbladder air
 Treat medically
 Resect colon and fistula in one-stage procedure
Free
Perforation
 SURGICAL
TREATMENT!!
 Hinchey Stage III
& IV

To the WEB
Bleeding (lower GI)
 Massive
 Transfusions
 Angiography
 If + superselective embolization
 If - observe patient, RBC scanning.
 Moderate
 Observe patient
 Colonoscopy