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]
Entire Body System
- 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]
Clinical manifestations of diverticulitis include lower left-side abdominal pain, abdominal distention, flatulence, fever, rectal bleeding, and constipation or diarrhea. [smartypance.com]
Constipation and fever are common symptoms. Pus may collect around the inflamed diverticulum, leading to the formation of an abscess, usually in the pelvis. [health24.com]
People who have increasing pain, tenderness, and fever also need surgery. The surgeon removes the involved section of the intestine. [msdmanuals.com]
- Weight Loss
The clinical symptoms are nonspecific from fever and weight loss to abdominal pain. [karger.com]
Other symptoms include nausea, loss of appetite, and weight loss. [msdmanuals.com]
However, this is often difficult because the clinical presentation consistently has the usual markers for infection, such as fever and back pain (~30% of cases). 2 Other generalized symptoms include nausea, weight loss, and abdominal pain. [pharmacytimes.com]
Other symptoms may include nausea, anorexia, malaise, weight loss, and groin swelling. Physical Exam Maneuvers manipulating the inflamed psoas compartment result in pain on the affected side. [unboundmedicine.com]
- Surgical Procedure
Fourteen of the 24 underwent a single-stage surgical procedure within 10 days of drainage. [ncbi.nlm.nih.gov]
In patients who present with abscess, almost one half will require surgery with 65% requiring a second, planned surgical procedure. [fallgeneralsurgery.com]
The surgical procedure performed for diverticulitis will vary depending on the exact circumstances surrounding each patient. In general, the colon is removed from the point of disease down to the top of the rectum. The colon may be reconnected. [ntxcolonandrectal.com]
Surgery to treat anal fistulas is generally a very safe operation and carries few risks, but (as with any surgical procedure) complications can occur. [cuh.nhs.uk]
- 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]
Specific symptoms of abdominal abscesses depend on the location of the abscess, but most people have constant discomfort or pain, feel generally sick (malaise), and often have a fever. [msdmanuals.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]
Other symptoms may include nausea, anorexia, malaise, weight loss, and groin swelling. Physical Exam Maneuvers manipulating the inflamed psoas compartment result in pain on the affected side. [unboundmedicine.com]
Gastrointestinal
- 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]
If you have significant abdominal pain, seek the advice of Dr. Fall. [fallgeneralsurgery.com]
When to see a doctor Call your doctor if you have: Severe abdominal pain Pain that is localised to one area of the abdomen and lasts longer than four hours Abdominal pain accompanied by a fever Stools that are dark red, black or tarry – this usually means [health24.com]
What Is the Medical Treatment For Mild Abdominal Pain Due To Diverticular Disease? There are some medications that can treat mild symptoms such as abdominal pain due to muscle spasm. [onhealth.com]
- Constipation
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]
Presents with constipation. LLQ pain, Fever, ↑ WBC, and may bleed Dignose with CT scan and no oral contrast CT will demonstrate fat stranding and bowel wall thickening. [smartypance.com]
The sigmoid colon is part of the lower large intestine and can become strained during constipation, potentially increasing the risk of diverticulitis. [everydayhealth.com]
- Left Lower Quadrant Pain
Her earlier history was essentially negative except for occasional pains in the left lower quadrant during the past five years. These pains were relieved by a bowel movement and were more severe when the patient was constipated. [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]
GI bleeding in adults Can present with abdominal pain in patients with chronic constipation Diverticulitis Low-grade fever Sigmoid colon most commonly affected → left lower quadrant pain Possibly tender, palpable mass (pericolonic inflammation ) Change [amboss.com]
- Intestinal Perforation
[…] diverticulosis, intestinal perforation, terminal ileum, ultrasonography 腹部超音波検査で診断された小腸憩室炎の1例を報告する.症例は79歳男性で,右下腹部痛と発熱のため来院した.右下腹部に限局した腹膜刺激症状を認め,症状からは急性虫垂炎,大腸憩室炎が疑われたが,腹部超音波検査,CT検査にて虫垂の腫大や上行結腸の炎症性変化は認めず,終末回腸に強い壁の肥厚性変化と小腸憩室,膿瘍形成を認めた.小腸憩室炎の腸間膜内穿破による腸間膜膿瘍 [jsum.or.jp]
perforation, a tear or hole in the intestinal wall that can allow the contents of your colon to leak into your abdominal cavity, causing inflammation and infection intestinal obstruction, a blockage in your intestine that can stop stool from passing [healthline.com]
Tears in the colon leading to bleeding or perforations may occur; intestinal obstruction may occur (constipation or diarrhea does not rule this possibility out); and peritonitis, abscess formation, retroperitoneal fibrosis, sepsis, and fistula formation [en.wikipedia.org]
[…] therapy of patients with established IAI due to intestinal perforation [ 684 ]. [liebertpub.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]
Infective complications according to duration of antibiotic treatment in acute abdomen. Int J Infect Dis 2004 ;8:155–162. Crossref, Medline, Google Scholar 619 Hughes MJ, Harrison E, Paterson-Brown S. [liebertpub.com]
Skin
- Night Sweats
Other symptoms may include: Constipation Discharge of pus from the rectum Fatigue, fever, night sweats, and chills Redness, painful and hardened tissue in the area of the anus Tenderness In infants, the abscess often appears as a swollen, red, tender [medlineplus.gov]
Her systemic review was insignificant for fever, night sweat, diarrhea, blood in stool, loss of weight, and poor appetite. Fig. 1. [karger.com]
Urogenital
- 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]
and a pelvic exam may offer additional information to help distinguish between abdominal and pelvic pain. [ahcmedia.com]
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]
X-Ray
- 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]
Stricture With Colonic Obstruction Colonic obstruction due to acute diverticulitis is uncommon. [clevelandclinicmeded.com]
Serum
- Neutrophilia
Any further features of inflammation, such as pyrexia or neutrophilia, may indicate diverticulitis. Pain is generally exacerbated by eating and diminished with defecation or flatus. [patient.info]
Laboratory
- Leukocytosis
An absolute neutrophilic leukocytosis and a shift to the left are noted on the CBC. [smartypance.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]
Fever and leukocytosis generally are present. Other commonly associated symptoms include nausea, vomiting, and constipation or diarrhea. [aafp.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]
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]
Treatment is the same in both cases, unless complications occur. Initial treatment Treatment for diverticulitis depends on how bad your symptoms are. [northshore.org]
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]
Children have a favorable prognosis with prompt diagnosis and treatment. Complications Inadequate treatment associated with unfavorable outcomes. About 40% of patients require >1 drainage procedure for full recovery ( 5 ). [unboundmedicine.com]
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]
What caused the abscess and a person's general medical condition affect the prognosis more than the specific nature and location of the abscess. [msdmanuals.com]
Etiology
Manifestation code identifies conditions for which it is important to record both the etiology and the symptom of the disease. [books.google.com]
Pyogenic psoas abscess: worldwide variations in etiology. World J Surg. 1986;10(5);834-843. Krobot K, Yin D, Zhang Q, et al. [pharmacytimes.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]
In cases of complicated diverticular disease, where a colonic fistula is present, a colonoscopy can confirm the site and etiology of the fistula. [clevelandclinicmeded.com]
Epidemiology
Section 1: Epidemiology and aetiology Diverticular disease (or diverticulosis) refers to the presence of diverticulae within the GI tract. [gponline.com]
[1] [2] Epidemiological data refers to the US, unless otherwise specified. [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]
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]
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]
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]
Pathophysiology and pathology [ ✎ edit | edit source ] In diverticular disease, the bowel wall is thicker due to much more elastic tissue between the muscle fibers [2]. [wikilectures.eu]
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]
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]
[…] or prompt treatment of STDs may prevent an anorectal abscess from forming. [medlineplus.gov]
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]