Diverticular Disease

Question 1

Another name for diverticular disease

What is it?

Answer 1

Diverticulosis - means the diverticula are present but diverticular disease means it is symptomatic

Presence of diverticula which are small outpouchings of the colonic mucosa and submucosa through the muscular layer due to high intramural pressures due to lack of dietary fibre.

Question 2

What is diverticulitis?

What is Meckel’s diverticulum?

Answer 2

One of these pouches becomes acutely inflamed (often infectious) and symptomatic

Congenital diverticulum which usually presents in infancy but can present in adults

Question 3

Presentation:

It’s usually asymptomatic or presents non-specifically. What non-specific symptoms may there be?

What may a minority of patients suffer from?

Answer 3

Pain
Bloating
Constipation with occasional diarrhoea

Diverticulitis
Painless PR bleeding

Question 4

Diverticulitis:

Where is the pain and what sign may you also see?

4 other symptoms

What may it come after?

How would a perforated diverticulitis present?

Answer 4

LIF and guarding

Diarrhoea
PR mucus or blood
Anorexia
N&V

Several months of altered bowel habit reflecting the underlying diverticulosis.

Sudden onset pain and peritonitis

Question 5

Complications:

You can get a fistula from perforation. Name the 2 types and describe them?

Name the 2 other complications of perforation.

What may form that could lead to bowel obstruction later on?

Answer 5

Colovaginal - a vaginal fistula that opens into the colon - presents with the passage of stool and flatulence through the vagina.

Colovesical - an abnormal connection between the colon and urinary bladder.

An abscess (usually palpable) - if not then it could be under the diaphragm at the splenic flexure. 
Peritonitis 

Strictures

Question 6

What age group tends to be affected?

Answer 6

Majority of people >50 yrs old
Also low fibre diet
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Question 7

Investigations:

Why do you do FBC?

Imaging used - 1

What should be done if the diagnosis is doubted or cancer is suspected?

Answer 7

Raised WCC indicating infection

CT abdo

Colonoscopy

Question 8

Management:

What should the patient be instructed to change if uncomplicated diverticular disease?

Answer 8

High fibre diet

Question 9

Management:

• If stable and at home
• When is hospital admission needed?
• What is classed as a small abscess and how is it managed?

Answer 9

ABs and oral fluids at home

Symptoms persist, transfusion needed or pain and hydration cannot be maintained

<3cm

IV ABs alone

Question 10

Management:

• What should be done if the abscess is too large?
• Indications for surgery

Answer 10

CT-guided aspiration either percutaneous or transrectal
Surgery if unsuccessful

Perforation and peritonitis
Sepsis
Fistula
Obstruction

Question 11

Management:

What does the surgery usually end up doing?

Answer 11

Leaves a temporary end colostomy and oversewn rectal stump using Hartmann’s procedure

Question 12

Management:

What classification can be used to help guide management for complicated disease?

Answer 12

Hinchey’s classification

Question 13

Management:

Lower GI bleed - 2

Bowel obstruction - 3

Answer 13

Endoscopic haemostasis
Angiographic embolisation

Stenting
Balloon dilation
Resection