Presentation
We here present a standard elective sigmoidectomy, after episodes of diverticulitis treated medically. [websurg.com]
Patients with GCD often present with abdominal pain (68%), vomiting (12%), and constipation (18%) (5). Other presentations may include abdominal distension, rectal bleeding, diarrhea, fever, and nausea. [ncbi.nlm.nih.gov]
Methods and Results: A fifty year old male previously healthy, presented with sudden severe epigastric pain of few hours duration. He had history of Helicobacter pylori three years prior to his presentation but he declined treatment and endoscopy. [sages.org]
Minimal pus was present intraoperatively in the paracolic gutters. [saudijgastro.com]
Here, we present a patient of perforated diverticulum in second part of the duodenum and its surgical management. [casereports.in]
Workup
Diagnostic workup is usually completed in the intensive care setting. Most patients stop bleeding, allowing elective surgery. Mesenteric angiography with infusion of vasoconstrictors can be used in persistent hemorrhage. [emedicine.medscape.com]
Results of the workup revealed a possible duodenal perforation, and the patient was transferred to our institution for continued care. On arrival, the patient complained of mild abdominal discomfort. She was afebrile. [jamanetwork.com]
Miehlke: In my opinion, a sigmoidoscopy also has no place in the primary diagnostic workup of acute diverticulitis, for the same reasons already mentioned. [karger.com]
On diagnostic workup, laboratory tests will be indicative but not specific for perforation. It seems that in most cases white blood cell count will be elevated with neutrophilia. [bmcgastroenterol.biomedcentral.com]
Treatment
Because of a stable clinical presentation, a laparoscopic treatment was offered. The cavity of the abscess is opened and cleaned. [websurg.com]
Early diagnosis is essential for successful treatment. To our knowledge, this is the first report of laparoscopic resection of a perforated duodenal diverticulum. [sages.org]
In general, the surgical approach was considered the treatment of choice. [synapse.koreamed.org]
Early surgical intervention is the treatment of choice but in selected patients non-operative management may be required. [casereports.in]
[…] for treatment failure 32. [bjmp.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]
What should you tell the family about the patient's prognosis? In general, the prognosis after an episode of uncomplicated diverticulitis is good. [infectiousdiseaseadvisor.com]
[…] antibiotics, low-fiber foods; for severe diverticulitis with high fever and pain, hospitalization, IV antibiotics Management-surgical Excision of bleeding diverticula or resection for persistent bowel obstruction or abscesses not responding to antibiotics Prognosis [medical-dictionary.thefreedictionary.com]
The prognosis in patients with diverticulitis depends on the severity of the illness, the presence of complications, and the presence of any coexisting medical problems. [emedicine.medscape.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
Etiological factors leading to diverticular perforation after coronary artery bypass grafting are discussed. The significance of pneumoperitoneum on the postoperative chest radiograph, which prompted diagnosis in these cases, is also discussed. [ncbi.nlm.nih.gov]
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]
The etiology and pathophysiology of diverticulitis is not fully understood and may vary among patients. [merckmanuals.com]
Epidemiology
[1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
This review appraises existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition. [pmj.bmj.com]
Back to Top Incidence and Epidemiology The incidence of diverticulosis in the Western world has progressively increased over the past century. [clevelandclinicmeded.com]
Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol. 2012 Oct. 107 (10):1486-93. [Medline]. Brandl A, Kratzer T, Kafka-Ritsch R, Braunwarth E, et al. [emedicine.medscape.com]
An epidemiologic, population-based study. Ann Surg. 1994;220(4):564-8. [ Links ] 4. Satya R, O'Malley JP. Case 86: Meckel diverticulum with massive bleeding. Radiology. 2005;236(3):836-40. [ Links ] 5. Tauro LF, Martis JJ, Menezes LT, Shenoy HD. [scielo.org.pe]
Pathophysiology
Inflammation of the diverticulum may be due to obstruction of the lumen, which is analogous to the pathophysiology of acute appendicitis. Progression of such inflammation may lead to perforation and peritonitis. [emedicine.medscape.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]
Although it generally remains silent but life threatening complications may arise making it an important structure for having a detailed knowledge of its anatomical and pathophysiological properties to deal with such complications. [wjes.biomedcentral.com]
Less is known regarding the pathophysiology behind diverticular inflammation and development of diverticulitis. [clinicaladvisor.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
Diet high in fiber increases stool bulk and prevents constipation, and theoretically may help prevent further diverticular formation or worsening of the diverticular condition. [medical-dictionary.thefreedictionary.com]
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]
How Can Diverticulosis Be Prevented? To prevent diverticular disease or reduce the complications from it, maintain good bowel habits. Have regular bowel movements and avoid constipation and straining. [webmd.com]
Morbidity has traditionally been reported to be worse in younger patients, but this has not been shown to be true. [ 9 ] Prevention [ 2 ] Dietary fibre may prevent development of diverticular disease but, once symptoms develop, the benefit from fibre [patient.info]
Lots of patients ask, “How do I prevent myself from getting diverticulitis?” Unfortunately, we don’t know why people get it. We think it’s from high pressure in the bowels and being constipated. [health.clevelandclinic.org]