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Diverticulitis


Inflammation of one or more diverticula is termed as diverticulitis. Small mucosal herniations or sacs form and protrude through the intestinal layers. Inflamed diverticula can be very painful. Bacteria from faecal material and undigested food particles accumulate in the diverticulum leading to obstruction. This results in diverticular distension due to bacterial overgrowth infection leading to infection and inflammation. The colonic lumen is at a risk of narrowing and obstruction with recurrent diverticulitis.

 diverticulitis treatment

Signs And Symptoms

  • Pain in the lower left quadrant of the abdomen
  • Nausea
  • Vomiting
  • Diarrhoea
  • Constipation
  • Change in bowel habits
  • Bloating and flatulence
  • Loss of appetite
  • Fevers
  • Chills

Diagnosis

  • Physical examination:
  • Localized abdominal tenderness
  • Tenderness in the lower left quadrant and right lower quadrant much like appendicitis
  • Abscess formations
  • Tender and palpable mass
  • Rebound and guarding
  • Distended abdomen

Laboratory Tests:

  • Haemogram: to check for infection
  • Blood chemistries
  • Urinalysis for suspected colovesical fistula
  • Blood cultures

Imaging Studies:

  • CT scan of the abdomen is the best modality to diagnose diverticulitis.
  • Colonoscopy can diagnose diverticular disease of the colon

Indications For Surgery

Diverticulosis is a common condition in the old age. If it is asymptomatic, no treatment except for a high fibre diet is needed.

Some indications for surgery are:

  • Uncontrolled sepsis
  • Formation of fistula
  • Perforation of diverticuli
  • Pelvic or abdominal abscess (discovered on CT scan) with significant sepsis
  • Intestinal obstruction
  • Recurrent episodes of diverticulitis
  • Recurrent episodes of bleeding from the diverticuli: this is more common in right-sided diverticuli.

Treatment

Conservative management is advised for patients with Hinchey Stage I disease, which is mild diverticulitis. Broad-spectrum antimicrobial therapy with clear liquid diet is prescribed. Acute and severe diverticulitis require surgical intervention. The surgical approach is in two stages. At first, a Hartmann procedure is performed where the diseased bowel is removed, and the rectal stump is closed after an end colostomy. A few months later, another procedure is conducted to reverse the colostomy to reestablish the rectal stump and intestinal continuity.

We treat emergency and elective complications of diverticulosis. Elective laparoscopic surgery is conducted for recurrent diverticulitis with good functional results.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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