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Diverticulitis Updated 12/2010

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BASICS

  • Description
  • Etiology

DIAGNOSIS

  • Signs and Symptoms
  • Essential Workup
  • Tests
  • Differential Diagnosis

TREATMENT

  • Pre-hospital
  • Initial Stabilization
  • ED Treatment
  • Medication (Drugs)
  • In-patient Considerations

Ongoing Care

  • Follow-Up Recommendations
The following is an excerpt....
BASICS
Description
  • Inflammation and/or perforation of diverticulum:
    • Microscopic or macroscopic
    • Uncomplicated vs. complicated
  • Incidence increasing
Etiology
  • Fecal material in diverticulum hardens, forming fecalith.
  • Fecalith abrades mucosa or compromises blood supply, causing inflammation.
  • Inflammation causes microperforation of bowel wall:
    • Peridiverticulitis: Inflammation of wall not extending beyond serosa (uncomplicated diverticulitis)
    • Pericolic abscess: Serosal perforation, yet inflammation remains localized (complicated diverticulitis)
    • Peritonitis: Serosal perforation with generalized spread of inflammation (complicated diverticulitis)
  • Uncomplicated diverticulitis:
    • Colonic wall thickening
    • Inflammatory changes (fat stranding on CT)
  • Complicated diverticulitis:
    • Abscess
    • Bowel obstruction
    • Fistulas after recurrent attacks
    • Colovesical fistula (most common) presents with dysuria, frequency, urgency, pneumaturia, and fecaluria.

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See Also
Images >
Figure 15-27 Acute and chronic diverticulitis. In this cross-section of the colon, the opened bowel lumen appears at top center. The incision extends from the lumen into an abscess that has obliterated the diverticulum.Credit: Thomas H. McConnell, The Nature Of Disease Pathology for the Health Professions, Philadelphia: Lippincott Williams & Wilkins, 2007
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