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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]
  • Colonic diverticular abscess can have many unusual presentations, and multiple imaging modalities may be required to reveal the underlying pathology.[ncbi.nlm.nih.gov]
  • To present a case of lumbar spinal infection secondary to colonic diverticular disease, their management and outcome.[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]
  • 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]
  • A 26-year-old Nepali male presented to the ER with localized pain in the right lower abdomen and low grade fever of 3 days duration. There were no other constitutional, gastrointestinal or genitourinary symptoms.[currentsurgery.org]
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]
  • Diverticular disease does not cause weight loss, so if you are losing weight, seeing blood in your stools or experiencing frequent bowel changes, see your GP.[nhsinform.scot]
  • Lifestyle modifications and prevention Following treatment weight loss, rationalisation of certain medications and exercise are recommended as obesity is significantly associated with an increased incidence of both diverticular bleeding and diverticulitis[bjmp.org]
  • Prevention centers around lifestyle modification, including smoking cessation, weight loss, and the introduction of fiber into diet, although randomized controlled trials on fiber-enriched diets showed inconsistent results. 6 Similarly, modifications[ahcmedia.com]
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]
  • Acute diverticulitis typically presents with pain and tenderness over the left lower abdomen, and the patient may have pyrexia, malaise, anorexia and nausea.[emedmd.com]
Inguinal Hernia
  • We present a case of a diverticular abscess presenting as a left inguinal hernia. This is analogous to an Amyand's hernia in which an inflamed appendix is found in a right inguinal hernia.[ncbi.nlm.nih.gov]
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]
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]
  • 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]
  • 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]
  • 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]
  • Clinical manifestations of diverticulitis include lower left-side abdominal pain, abdominal distention, flatulence, fever, rectal bleeding, and constipation or diarrhea.[smartypance.com]
Left Lower Quadrant Pain
  • 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]
  • Review Topic QID: 102688 4 Inferior mesenteric artery 5 Superior hemorrhoidal artery M2 Select Answer to see Preferred Response PREFERRED RESPONSE 4 (M3.GI.51) A 68-year-old male presents to the emergency department with left lower quadrant pain and fever[medbullets.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]
  • Other causes of the acute abdomen that may not require surgery should be excluded, including pelvic inflammatory disease, ureteric calculus, and even pulmonary embolus. In these circumstances a CT scan is invaluable.[emedmd.com]
Hyperactive Bowel Sounds
  • bowel sounds Absent bowel sounds (perforation) Generalized abdominal pain with rebound and guarding (perforation) Urinary tract findings (colovesicular/colovaginal fistula) include suprapubic, flank, costovertebral tenderness; pneumaturia (air in urine[emedicine.medscape.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]
Pelvic Pain
  • The most common symptoms of diverticulitis are abdominal or pelvic pain, abdominal tenderness and fever called simple diverticulitis. There can be several secondary complications of an attack of diverticulitis.[fascrs.org]

Workup

  • See Workup for more detail. Treatment of diverticulitis The management of patients with diverticulitis depends on their presentation severity, presence of complications, and comorbid conditions.[emedicine.medscape.com]
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]
  • 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 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]
  • 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]

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]
  • 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]
  • 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 visualisation of a fistulous tract Treatment and prognosis[radiopaedia.org]
  • Prognosis and Prevention Fortunately, colon abscess drainage and treatment is uncommon but possible with proper care. Most people who experience a colon abscess and receive proper treatment resume all normal activities within a few weeks.[lacolon.com]
  • In this article arrow-down Epidemiology arrow-down Presentation arrow-down Differential diagnosis arrow-down Investigations arrow-down Management arrow-down Prognosis arrow-down Prevention Diverticula can occur throughout the gastrointestinal tract, but[patient.info]
  • Section 4: Prognosis and follow up Most patients with uncomplicated diverticulitis recover with antibiotics.[gponline.com]

Etiology

  • Etiology The etiology and pathophysiology of diverticulitis is not fully understood and may vary among patients.[merckmanuals.com]
  • In conclusion, diverticular actinomycosis is a rare but often overlooked etiology for common conditions such as tuberculosis or carcinoma.[karger.com]
  • […] and Pathophysiology The exact etiology of diverticular disease is not known.[ahcmedia.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]
  • Etiology Low alimentary fiber was first described as a possible etiologic agent for the development of diverticular disease by Painter and Burkitt in the late 1960s [6,7].[worldgastroenterology.org]

Epidemiology

  • : [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Epidemiology Diverticular disease is the most common colonic disease in western countries, and its prevalence increases with age.[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]
  • Review article: The pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Alimentary Pharmacology and Therapeutics. 2015;42:664. Pemberton JH, et al.[mayoclinic.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]

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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