diverticulitis (quick review)

25 Oct

Caused by increased intraluminal pressures of the colon

Commonly seen in western diets of low fiber, high fat that promote decreased GI transit times.

In the US diverticulitis is primarily a left colon (sigmoid) disease 95-98% of the time and in Asia diverticulitis is primarily a right colon (ascending) disease.

What happens is the vasa recta penetrate the circular muscle layer of the colonDiverticulitis is inflammation and or infection of a diverticuli.

CT is the test of choice to diagnose with sensitivities of 97% and specificities approaching 100%.

The presence of an abscess with perforation such as in this case represents a complicated diverticulitis and requires immediate surgical referral.  Other types of complicated diverticulitis include phlegmon, stricture, obstruction, and fistula.  The Hinchey classification scheme list 4 stages of worsening complicated diverticulitis from small confined pericolic abscess to free perforation with fecal contamination of the peritoneal cavity

 

Treatment:

  • outpatient antibiotics if simple (e.g. metronidazole 500mg TID + ciprofloxacin 500mg BID x 7-10 days)
  • inpatient: IV antibiotics, surgical consult if abscess/perf/etc.

 

Submitted by C. Stokes.

 

References: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th Edition; Rosen’s Emergency Medicine. (2010); EMRA Antibiotic Guide 2011; picture

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