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Diverticular Abscess

Diverticulitis with Abscess


Presentation

  • Acute diverticulitis may present with an abscess that is usually pericolonic or pelvic and can be treated with urgent surgery or percutaneous drainage. We present a case of a diverticular abscess presenting as a left inguinal hernia.[ncbi.nlm.nih.gov]
  • Presented herein is a case of a chronic abscess secondary to diverticulitis presenting as irritable vesical symptoms overlooked for several years. The value of pelvic computerized tomography in the diagnosis is stressed.[ncbi.nlm.nih.gov]
  • OBJECTIVES: To present a case of lumbar spinal infection secondary to colonic diverticular disease, their management and outcome.[ncbi.nlm.nih.gov]
  • Colonic diverticular abscess can have many unusual presentations, and multiple imaging modalities may be required to reveal the underlying pathology.[ncbi.nlm.nih.gov]
  • The authors report a case of a 70-year-old lady who was on steroids for over 40 years for asthma and presented with a subcutaneous abscess related to diverticular disease of the colon.[ncbi.nlm.nih.gov]
Fever
  • A 59-year-old woman with left lower abdominal pain and fever was admitted to our hospital. Abdominal computed tomography revealed diverticulitis with abscess formation. Colonoscopy revealed colonic inflammation with abscess caused by diverticulitis.[jstage.jst.go.jp]
  • Fever is a typical feature (distinguishing from diverticular disease) Nausea, vomiting and anorexia may also be present Urinary symptoms may also be present due to subsequent inflammation of urinary structures.[dundeemedstudentnotes.wordpress.com]
  • At times she had a fever of 102 F. during the episodes of pain. Menstruation had begun at the age of thirteen; the periods were always regular and lasted four days. The patient did not recall ever having had any unusual discharge.[pubs.rsna.org]
  • Patient History A 73 year-old female presented to the emergency room with a 5-day history of left lower quadrant pain, fever and leukocytosis.[veranmedical.com]
  • The clinical symptoms are nonspecific from fever and weight loss to abdominal pain.[karger.com]
Weight Loss
  • The clinical symptoms are nonspecific from fever and weight loss to abdominal pain.[karger.com]
  • loss heavy meat consumption [27] [28] [29] History [ edit ] The modern emphasis on the value of fiber in the diet began with Thomas L.[en.wikipedia.org]
Malaise
  • Diverticular Disease Condition where diverticula cause intermittent pain, but without any signs of acute infection or inflammation Diverticulitis Infection and inflammation of the diverticula, usually causing marked pain, fever and malaise.[dundeemedstudentnotes.wordpress.com]
  • Presentation is of LIF tenderness, possibly with fever and malaise. A tender mass may be palpated, indicating the presence of an inflammatory mass. There may be leukocytosis on FBC and an elevated CRP.[gponline.com]
Perineal Pain
  • A 49-year-old woman presented with perineal pain, pyuria and inflammatory reaction. Conventional MRI revealed urethral diverticulum with the content of slightly lower-signal-intensity than urine on T2-weighted contrast.[ncbi.nlm.nih.gov]
Inguinal Mass
  • Leaking abdominal aortic aneurysm presenting as an inguinal mass. Eur J Vas Surg. 1991; 5 (6):695–6. [ PubMed ] [ Google Scholar ] 10. Sellu DP. Pus in groin hernial sacs: a complication of non-generalised peritonitis.[ncbi.nlm.nih.gov]
Pleuritic Pain
Abdominal Pain
  • Abdominal CT scan is not always a definitive and absolute imaging modality for abdominal pain evaluation and cannot supplant clinical judgment in the evaluation of confusing cases.[ncbi.nlm.nih.gov]
  • A 59-year-old woman with left lower abdominal pain and fever was admitted to our hospital. Abdominal computed tomography revealed diverticulitis with abscess formation. Colonoscopy revealed colonic inflammation with abscess caused by diverticulitis.[jstage.jst.go.jp]
  • The clinical symptoms are nonspecific from fever and weight loss to abdominal pain.[karger.com]
  • pain that may localise to the left iliac fossa.[dundeemedstudentnotes.wordpress.com]
  • If you have significant abdominal pain, seek the advice of Dr. Fall.[fallgeneralsurgery.com]
Constipation
  • Pain may be brought on with eating and may be relieved by bowel movements Altered bowel habit- commonly constipation but diarrhoea can be a symptom Bloated feeling mucus discharge PR bleeding- usually fresh or mixed with the stool (haematochezia); can[dundeemedstudentnotes.wordpress.com]
  • These pains were relieved by a bowel movement and were more severe when the patient was constipated. They were not, however, of sufficient severity to warrant her consulting a physician.[pubs.rsna.org]
  • Fiber prevents constipation by making the stool soft and easier to pass. Constipation makes the muscles in the colon work strenuously to move the hard stool, which increases pressure.[charlottegastro.com]
  • Diets low in fiber cause stool to be harder, and can lead to constipation. Constipation can cause repeated straining during bowel movements, and can increase the pressure in the colon, which can lead to the formation of diverticula.[onhealth.com]
  • A high-fibre diet helps to prevent constipation and formation of diverticula. Exercising regularly and drinking enough water (up to 8 cups a day) are also recommended.[healthdirect.gov.au]
Left Lower Quadrant Pain
  • In addition, the left lower quadrant pain was more severe. The patient was well developed and well nourished and did not appear acutely ill. Temperature was 100 F.; pulse 90; blood pressure 140/80.[pubs.rsna.org]
  • Patient History A 73 year-old female presented to the emergency room with a 5-day history of left lower quadrant pain, fever and leukocytosis.[veranmedical.com]
  • Diverticulitis will present as a 67-year-old man with a long history of constipation presents with steady left lower quadrant pain. Physical exam reveals low-grade fever, mid-abdominal distention, and lower left quadrant tenderness .[smartypance.com]
  • Signs and symptoms usually found The most common symptom of acute diverticulitis is left lower quadrant pain. Other common symptoms include low-grade fever, nausea, vomiting, constipation, and diarrhea.[clinicaladvisor.com]
  • lower quadrant pain Possibly tender, palpable mass (pericolonic inflammation ) Change in bowel habits ( 50% constipation, 25–35% diarrhea ) Nausea and vomiting ; caused by bowel obstruction or ileus Urinary urgency and frequency ( 15% ) Acute abdomen[amboss.com]
Acute Abdomen
  • Diverticulosis involving the transverse colon, however, is a rare finding and a perforated diverticulum of thehepatic flexure is seldom considered in the differential diagnosis of acute abdomen.[sages.org]
  • abdomen References: [5] [8] [9] We list the most important complications.[amboss.com]
Night Sweats
  • Her systemic review was insignificant for fever, night sweat, diarrhea, blood in stool, loss of weight, and poor appetite. Fig. 1.[karger.com]
Meningism
  • Psoas abscess, osteomyelitis, cord and nerve root compression, meningitis, and hydronephrosis have all been documented. Infection is usually advanced at presentation and all but 1 patient was taking immunosuppressive drugs.[ncbi.nlm.nih.gov]

Workup

Colonic Stricture
  • Complications include diverticular haemorrhage, colonic diverticulitis (Table 2.2), abscess formation, perforation, fistula and colonic stricture formation (see Fig. 2.31).[europeanmedical.info]
  • A colonic stricture or fistula. A history of multiple attacks may result in a patient deciding to undergo surgery to prevent future attacks. Surgery for diverticular disease usually involves removal of the affected part of the colon.[fascrs.org]
  • Colonic Stricture: repeated bouts of diverticulitis with the ensuing inflammation can cause narrowing of the colon that results in an obstruction and difficulty in passing bowel movements.[athensherniaclinic.com]
  • A blocked colon (bowel obstruction) or a narrow spot in the colon (stricture). Infection that has spread through the blood to other parts of the body (sepsis).[northshore.org]
Pancreatic Necrosis
  • necrosis Occasionally, an abscess may be iatrogenic (post-surgery) Infective organisms that cause the abscess are mixed (aerobic/anaerobic)- most commonly E coli and Bacteroides Pain is usually a feature.[dundeemedstudentnotes.wordpress.com]

Treatment

  • Failure of initial treatment required urgent surgery in 8 patients with persistent symptoms during treatment with antibiotics alone (25 %) and in 21 patients (18 %) after initial percutaneous drainage (p 0.21).[ncbi.nlm.nih.gov]
  • BACKGROUND: Corticosteroids and non-steroidal anti-inflammatory drugs are widely used for the treatment of rheumatic conditions, but their gastrointestinal damage significantly limits their use.[ncbi.nlm.nih.gov]
  • Failure of initial treatment required urgent surgery in 8 patients with persistent symptoms during treatment with antibiotics alone (25 %) and in 21 patients (18 %) after initial percutaneous drainage ( p 0.21).[link.springer.com]
  • Abstract The primary aim of this study was to define predictors of computed tomography (CT)-guided percutaneous abscess drainage treatment failure in complicated diverticulitis.[ncbi.nlm.nih.gov]
  • Total parenteral nutrition and antibiotic treatment are required as is coordination between orthopedic surgeons, colorectal surgeons, and microbiologists.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis varies if complications develop and is particularly serious in the case of peritonitis. About 90% of people who have a colon resection do not have symptoms return after the surgery.[drugs.com]
  • […] gas and fluid into pelvis and peritoneal cavity abscess formation (seen in up to 30% of cases) may contain fluid, gas or both fistula formation (usually a chronic complication) gas in the bladder direct visualization of a fistulous tract Treatment and prognosis[radiopaedia.org]
  • Section 4: Prognosis and follow up Most patients with uncomplicated diverticulitis recover with antibiotics.[gponline.com]
  • Prognosis Approximately three quarters of patients with anatomical diverticulosis remain asymptomatic. Most complications of diverticulitis are associated with the initial attack, after which the disease tends to run a benign course.[patient.info]

Etiology

  • In conclusion, diverticular actinomycosis is a rare but often overlooked etiology for common conditions such as tuberculosis or carcinoma.[karger.com]
  • Etiology Caused mainly by lifestyle and environmental factors Increasing age Genetic factors Diet ( low-fiber, rich in fat and red meat) Obesity, low physical activity Cigarette consumption References: [2] [3] Classification Pathophysiology Diverticulosis[amboss.com]
  • The etiology and pathophysiology of diverticulitis is not fully understood and may vary among patients.[merckmanuals.com]
  • "Etiology and pathophysiology of diverticular disease" . Clinics in Colon and Rectal Surgery . 17 (3): 147–53. doi : 10.1055/s-2004-832695 . PMC 2780060 . PMID 20011269 . "Diverticulosis and Diverticulitis" . American College of Gastroenterology.[en.wikipedia.org]
  • Likewise, patients with diffuse abdominal pain of unknown etiology, septic patients, or patients demonstrating peritoneal signs on physical examination would require an immediate CT scan since this presentation is less likely to represent localized diverticulitis[consultant360.com]

Epidemiology

  • : [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Section 1: Epidemiology and aetiology Diverticular disease (or diverticulosis) refers to the presence of diverticulae within the GI tract.[gponline.com]
  • Epidemiology and pathophysiology of diverticular disease. Clin Colon Rectal Surg. 2009;22(3):141-146. Pelaez N, Pera M, Courtier R, et al.[consultant360.com]
  • Epidemiological evaluation of colonic diverticulosis and dietary fiber in Japan. Tohoku J Exp Med . 1993;171:145-151. 9. Heaton KW, Thompson WG. Exercise and diverticular disease. BMJ . 1995;310:1332. 10.[pharmacytimes.com]
  • As diverticulosis occurs in an older population such complications are serious events. [ citation needed ] Epidemiology [ edit ] The prevalence of diverticulosis progressively increases with age.[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology that causes symptoms is poorly understood Damage to the vasa recta vessels may result in inflammation It has also been thought that obstruction of the diverticula with faecal matter can cause an acute inflammatory reaction.[dundeemedstudentnotes.wordpress.com]
  • In The Large Intestine Physiology, Pathophysiology and Disease, pp. 13-35 [SF Phillips, JH Pemberton and RG Shorter, editors]. New York: Raven Press. West, AB (2008). "The pathology of diverticulitis".[en.wikipedia.org]
  • Etiology Caused mainly by lifestyle and environmental factors Increasing age Genetic factors Diet ( low-fiber, rich in fat and red meat) Obesity, low physical activity Cigarette consumption References: [2] [3] Classification Pathophysiology Diverticulosis[amboss.com]
  • Epidemiology and pathophysiology of diverticular disease. Clin Colon Rectal Surg. 2009;22(3):141-146. Pelaez N, Pera M, Courtier R, et al.[consultant360.com]
  • Pathophysiology In an aging bowel that has naturally become weakened in certain areas over time, the movement of stool within the lumen will cause an increase in luminal pressure .[teachmesurgery.com]

Prevention

  • Can Diverticular Disease Be Prevented? Diverticula are permanent once formed and can only be removed surgically. There is currently no treatment to prevent diverticular disease.[onhealth.com]
  • A normal fiber diet is advisable to prevent constipation and perhaps prevent the formation of more diverticula.[medicinenet.com]
  • Rectal bleeding Formation of a narrowing of the colon that prevents easy passage of stool (called a stricture) Formation of a tract or tunnel to another organ or the skin (called a fistula).[fascrs.org]
  • Diverticulitis The Best and Worst Foods for Managing or Preventing Diverticulitis Eating a diet high in fiber can help prevent diverticulitis. But it’s important to avoid fiber if you have the condition.[everydayhealth.com]
  • Prevention Once formed, diverticula are permanent, and there is no treatment available to prevent complications. However, the diet advised for home treatment may help prevent further diverticular formation or worsening of the condition.[health24.com]

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