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Diverticular disease (diverticulosis and diverticulitis): Difference between revisions

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Diverticular disease (diverticulosis and diverticulitis) (view source)

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== Complications ==
== Complications ==
The inflamed diverticulum may perforate due to erosion of the diverticular wall by increased pressure and food particles. The perforation is usually contained by pericolic fat and mesentery, causing only a simple localised inflammation, in which case this is known as ''diverticulitis with contained (''or ''confined) perforation''. However, in rare cases, the [[Gastrointestinal perforation|perforation]] is not contained, which may cause abscess, bowel obstruction, large perforation or fistula may occur (complicated diverticulitis), which may lead to peritonitis.
The inflamed diverticulum may perforate due to erosion of the diverticular wall by increased pressure and food particles. The perforation is usually contained by pericolic fat and mesentery, causing only a simple localised inflammation, in which case this is known as ''diverticulitis with contained (''or ''confined) perforation''. However, in rare cases, the [[Gastrointestinal perforation|perforation]] is not contained, which may cause [[abscess]], [[Ileus|bowel obstruction]], large perforation or fistula may occur (complicated diverticulitis), which may lead to [[peritonitis]].
 
=== Hinchey classification of complicated diverticulitis ===
 
* Stage I – Pericolic abscess
* Stage II – Walled-off pelvic abscess
* Stage III – Generalised purulent peritonitis
* Stage IV – Generalised faeculent peritonitis


== Clinical features ==
== Clinical features ==
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Asymptomatic diverticulosis requires no treatment.
Asymptomatic diverticulosis requires no treatment.


Uncomplicated diverticulitis usually requires no specific treatment as it resolves on its own. Oral analgesics, a liquid diet, and laxatives to keep the stool soft alleviates symptoms while waiting for resolution.
Diverticular bleeding can be treated endoscopically during colonoscopy.
 
The treatment of uncomplicated diverticulitis is conservative. Oral analgesics, a liquid diet, and laxatives to keep the stool soft alleviates symptoms while waiting for resolution. Mild cases may be managed outpatient. These are usually self-limiting.
 
Complicated diverticulitis is treated according to the Hinchey stage. Hinchey I and II diverticulitis are treated with percutaneous drainage of the abscess, while Hinchey III and IV are treated surgically (usually with the Hartmann operation).
 
In the Hartmann operation, the diseased colon (usually sigmoid) is removed. The rectal stump is then oversewn, while a colostomy is formed for the proximal colonic stump. This colostomy may be reversed in the future (after months/year), when the proximal colonic stump and rectal stump may be re-joined.
 
All patients with diverticulitis should undergo colonoscopy after the acute illness, often 6 weeks later, to assess the extent of diverticulosis and to rule out malignancy.


Complicated diverticulitis should be treated as uncomplicated but with the addition of antibiotics. In Norway [[ampicillin]] + [[gentamicin]] + [[metronidazole]] are used. Larger abscesses should be drained.  
No treatment can cure diverticulosis, but it’s important to prevent progression and recurrence with a high-fibre diet, weight reduction, etc.


Perforated diverticulitis or diverticulitis leading to colon obstruction must be treated with surgery.
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<noinclude>‎[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Gastrointestinal surgery]]</noinclude>
[[Category:Gastrointestinal surgery]]
</noinclude>