Acute Diverticulitis

Pathophysiology

Investigations

Differential Diagnoses

When to refer/seek help

Common pitfalls

Initial management

Likely presentation

Garden,J, Parks, R. 2018. Principles and practice of Surgery, 7th edition. pp. 232 - 269 Elsevier


Cook et al 2017, Diverticulitis Case study available from https://www.onhealth.com/content/1/diverticulitis_diverticulosis

nausea + vomiting

Altered Bowel Habit

Pyrexia -

Pain and tenderness LIF

CXR / AXR to look for signs of perforation

CT vs CT contrast preferably with renal contrast - in the first instance also shows if any suggestion of malignancy, abscess or fistula

Colonoscopy / Flexible Sigmoidoscopy performed although if findings suggest inflammation this would be done at a later date to prevent the risk of perforation

IVF

Analgesia

Fasting or Clear fluids to rest the bowel

Antibiotics if found to be showing signs of Sepsis, broad spectrum such as cephalosporins or gentamicin including metronidazole should be considered

10-% of these patients go on to requiring bowel resection as a result.

A third of patients require further invention, eg. Surgery

Perforation - septic shock, dehydration, marked abdominal pain and distention

Obstruction - Strictures formed in the intestinal tract

PR Bleeding

Diverticula usually develop in the left colon although can be found in the small intestine although rare

Small pouches of mucosa are called diverticula

muscular lining of the digestive system, particularly in the colon, herniations can develop. These small pouches of mucosa are called diverticula

When these herniated areas or diverticula become inflamed it is named Diverticulitis

Patient referal to appropriate speciality for colonsopy

Refer to Colorectal Surgeon for ongoing treatment

Inpatient stay in hospital until symptoms have eased

IBD

IBS

Colitis

Crohns

Obstruction