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Diverticulitis
Published in Charles Theisler, Adjuvant Medical Care, 2023
Approximately 15% of diverticulitis patients will experience complications, which can include an abscess (collection of pus) in the pelvis if and where the diverticulum has ruptured, colonic obstruction due to extensive inflammation, fistula, generalized infection of the abdominal cavity (bacterial peritonitis), or bleeding into the colon.2 Complicated diverticulitis needs immediate medical care. The goal of treating diverticulosis is to prevent the pouches from causing symptoms or problems.
Do I Have IBS?
Published in Melissa G. Hunt, Aaron T. Beck, Reclaim Your Life From IBS, 2022
Melissa G. Hunt, Aaron T. Beck
Diverticulosis is a condition in which the walls of the colon weaken in some spots and bulge out into little balloon-shaped sacks or pouches. It is uncommon in people under the age of 40, but about half of people over the age of 60 have at least some diverticula. When the pouches become inflamed or infected, the condition is called diverticulitis. The symptoms of diverticulitis are – wait for it – cramping pain or discomfort in the abdomen and a change in bowel habits – either diarrhea or constipation. Complications of diverticulitis may also include low-grade fever and bloody stools.
Peri-operative medicine
Published in Henry J. Woodford, Essential Geriatrics, 2022
Diverticular disease affects around 80% of people aged over 85 in developed countries and around 10–20% of these people will develop diverticulitis at some time.58 Possible signs of diverticulitis include fever, nausea, change in bowel habit (diarrhoea or constipation), left lower quadrant pain and raised serum WCC, but atypical presentations are common. Intravenous antibiotics and fluids are the usual initial management for severe cases. Diverticulitis can lead to fistulae, abscesses or bowel obstruction, which can sometimes be managed by interventional radiology. In addition, 15% of people with diverticulosis develop rectal bleeding. This is the commonest cause of large lower gastrointestinal bleeds in older people. Most will settle spontaneously.
Colorectal resection in end-stage renal disease (ESRD) patients: experience from a single tertiary center
Published in Acta Chirurgica Belgica, 2022
Julie Frezin, Julie Navez, Paryse Johnson, Philippe Bouchard, Sébastien Drolet
Concerning diverticular disease, our study included a few patients operated for diverticulitis (n = 12). There was no difference in morbidity and mortality between elective and emergency surgery. However, the rate of ostomy was higher in the emergency surgery group. Moran-Atkin et al. [18] compared 834 ESRD patient operated in emergency for diverticulitis with 161 ESRD patients who beneficiated from elective surgery. The two groups were matched for age categories, race, sex and period of admission. In-hospital mortality was not significantly different but overall morbidity, ostomy placement and LOS was higher in the emergency group. Compared to the general population, ESRD operated electively still had a 17.3 increased odd of mortality. Thus, indication for elective surgery after diverticulitis in ESRD patients should be individualized as it is still associated with high morbidity and mortality.
Colon stenting in benign diverticular stricture – a case report and review of literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Hany Eskarous, Mahesh Krishnamurthy, Endeshaw Habtesilassie
Some of the reported complications after acute diverticulitis include abscess, fistula, stricture, perforation, and peritonitis. The recurrence rate of diverticulitis is 10% to 35% after the first episode [1], and the risk of complications is higher with each recurrence [2]. Most reported cases of colonic strictures are malignancy-related, but almost 50% of cases are associated with benign diseases [2]. Complicated diverticulitis with stricture formation requires elective surgical resection and 30% end up with permanent colostomy [1]. The case report’s objective is to elucidate the use of colonic stenting in strictures acting as a bridge to surgery in patients with acute mechanical obstruction by providing preoperative decompression. We also highlight stenting complications, including bowel perforation, stent migration, and re-obstruction [3].
Acute diverticulitis masquerading as unilateral sciatica-like symptoms
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Victoria Novoselova, Alexandre Lacasse
Classically, suspicion of acute diverticulitis is based on history, physical examination, and laboratory data [11]. Based on our patient experience and literature review, the presence of air in lower extremity musculature seen on X-ray and/or CT scan should prompt further imaging of the abdominal cavity. CT imaging with both IV and oral contrast has shown a sensitivity of 98% and specificity of 99%, respectively, for the diagnosis of acute diverticulitis [12,13]. As was evident in our patient, the non-contrast CT scan of the abdomen and pelvis may not confirm the presence of diverticulitis. Oral and/or rectal contrast could be used with IV contrast to improve accuracy of the study. If there are significant contraindications for IV contrast at least oral and/or rectal contrast should be used [14]. According to the American Society of Colon and Rectal Surgeons, MR imaging or ultrasound (US) should be performed if CT with contrast is contraindicated [11]. US has shown sensitivity of 77–98% and specificity of 80–99% whereas MR imaging demonstrated 86–94% and 88–92% respectively for diagnosis of acute diverticulitis [11,12,14].