View Full Version : Diverticulosis of the Colon(Etiology-Pathology-Clinical picture-Investigations-Treatment)

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05-03-2008, 05:21 AM
m Incidence: Old age patients.
m Aetiology: Muscular incoordination of the colon ® intraluminal pressure
® pulsion diverticula.
m Pathology:
- Sigmoid colon is the commonest to be involved.
- The diverticula are formed of mucosa only.
- The site of diverticulation is the site where blood vessels pierce the wall (weak points).
- As the diverticula are devoid of muscular covering the faecal matter will be accumulated ® infection (Diverticulitis).
m Clinical Picture:
1- Pre diverticular stage: constipation
2- Stage of diverticulosis: constipation
3- Stage of diverticulitis:
A- Sporadic diarrhea and constipation.
B- Palpable mass, which is; in the left iliac fossa, tender and formed of thickened wall of the colon.
C- Signs of complications:
1- Perforation ® localized or generalized pereitonitis.
2- Erosion of blood vessels ® bleeding / rectum.
3- Healing and fibrosis ® chronic intestinal obstruction.
4- Fistula formation. To skin, or to the urinary bladder which leads to increased frequency &pneumaturia.
What are the different causes of pneumaturia?
a- Fistula with viscus containing gas e.g. Colovesical fistula.
b- Infection with gas forming organism.
c- After cystoscopy and inflation of the bladder.
m Investigation:
- During diverticulitis:
· Barium enema is contraindicated
· Sigmoidoscopy is done but sometimes difficult to diff. it from Cancer.
- When infections is controlled:
· Barium enema® Saw teeth apperance in chronic diverticulitis. Filling defect in perforated diverticulum causing pericolic abscess.
m Treatment:
I- Uncomplicated cases: High residue dite, Laxitaves, Antispasmodics and Intestinal antiseptics.
II- Complicated cases:
Ś Acute diverticulitis (left sided appendicitis): Treated as appendicular mass with later on resection after proper preparation of the colon.
 Pericolic abscess: Extraperitoneal drainage and later resection.
Ž Perforated diverticulum with peritonitis: Exploration, peritoneal lavage and drains. Resection of the colon is done by one of the following options;
· One stage operation: Ontable resection and anastomosis with intraoperative colonic preparation.
· Two stage operation:
1- Exteriorizaton ended by double barrel colostomy.
2- Colonic preparation and closure of colostomy.
· Three stage operation:
1- Sealing of the perforation and proximal of colostomy.
2- Resection of the diseased segment and anastomosis.
3- closure of colostomy.
 Chronic diverticulitis: Resection after colonic preparation.
 Bleeding diverticular disease: Resuscitation till bleeding stop and later on colectomy. If bleeding continues urgent colectomy is needed.
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