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Wednesday, 4 December 2013

Diverticulitis – The Complications

Diverticulitis is defined as a condition of inflammation of the small, bulging sacs or pouches of the inner lining of the intestine that bulge outward through weak spots as a result of small pieces of stool (feces) trapped in these pouches. In most cases, the disease is found in the large intestine (colon). According to the statistic, approximately, About 10 percent of Americans older than 40 have diverticulosis.
In the examination of the data fom January 2004 to June 2005 of 796 consecutive patients referred for total colonoscopy to 17 physicians included age, gender, presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding, showed that the prevalence of colonic diverticula increased from less than 10% in adults under 40 to about 75% in those over 75 years. Of these patients, nearly one third presented with right-sided involvement(1).
A. Complications
Diverticulosis and its complications, particularly diverticulitis, are extremely common in western countries. The major factor in the development of diverticulosis is a lack of adequate fiber intake. Diverticulitis may be complicated by abscess formation, fistula formation, peritonitis, or obstruction(19).
Other study indicated that diverticular disease is a common problem in the western population and sometimes leads to serious complications such as hemorrhage, bowel stenosis, obstruction, abscesses, fistulae, bowel perforation, and peritonitis. The severity of these complications can differ, and it is not always clear which procedure is indicated in each case and what measures should be followed before bringing the patient into the operating room(19a).
1. Bowel obstruction
there is a report of a neonate who presented with acute intestinal obstruction secondary to a large, mobile Meckel’s diverticulum which due to a direct compression effect on the adjacent small bowel caused mechanical intestinal obstruction(20). Other study reported the clinical case of a 65-year-old female patient with a diagnosis on hospital admittance of acute appendicitis and a intraoperative finding of diverticular disease of the small intestine, accompanied by complications such as intestinal perforation, bleeding and abdominal sepsis(21).
2. Peritonitis
Peritonitis is defined as an inflammation of the peritoneum, the thin tissue that lines the inner
wall of the abdomen covering most of the abdominal organs. According to the study of Thirty-eight patients (3.7%) were pathologically diagnosed with acute appendiceal diverticulitis among 1,029 cases of appendectomy. The mean age of patients in the diverticulitis group was significantly older than that of the appendicitis group (49.0 ± 15.2 years vs. 25.4 ± 14.2 years, P < 0.05). Mean duration of preoperative symptoms was longer in the diverticulitis group (3.6 ± 3.8 days vs. 1.8 ± 3.2 days, P < 0.05). The site of abdominal pain, fever, signs of localized peritonitis, accompanying gastrointestinal symptoms, and white blood cell count showed no differences between the two groupsby(22),
3. Abscess
According to the study by Westfälischen Wilhelms Universität, Münster, Normally colonic diverticulitis presents itself clinically with symptoms. Pyogenic liver abscess was the primary finding of a concealed perforation of sigma colon diverticulitis(23).
4. Fistula
Colouterine fistula is an extremely rare condition because the uterus is a thick, muscular organ. There is a report of an 81-year-old woman was referred to the emergency department with abdominal pain and vaginal discharge. Computed tomography showed a myometrial abscess cavity in the uterus adherent to the thick sigmoid wall. Upon contrast injection via the cervical os for fistulography, we observed spillage of the contrast into the sigmoid colon via the uterine fundus(24).
5. Bleeding
Colonic diverticular bleeding cases account for 30-40% of the lower gastrointestinal bleeding, among which, 3-5% appear to be massive bleeding, according to the study by Seoul National University Bundang Hospital(25).
6. Etc.
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/23350931
(19) http://www.ncbi.nlm.nih.gov/pubmed/16885691
(19a) http://www.ncbi.nlm.nih.gov/pubmed/21887565
(20) http://www.ncbi.nlm.nih.gov/pubmed/23242081
(21) http://www.ncbi.nlm.nih.gov/pubmed/23185148
(22) http://www.ncbi.nlm.nih.gov/pubmed/23323233
(23) http://www.ncbi.nlm.nih.gov/pubmed/7877429
(24) http://www.ncbi.nlm.nih.gov/pubmed/23346512
(25) http://www.ncbi.nlm.nih.gov/pubmed/23242017