Diverticulitis: How Many Attacks are Too Many?
[Pages:44]Diverticulitis: How Many Attacks are Too Many?
Rahul Narang, MD Colorectal Surgeon Assistant Professor of Surgery
BASICS
Pathophysiology Diverticular Disease
? Increased intraluminal pressure
? Sigmoid colon most commonly involved (95%) ? Smallest diameter ? Laplace's law: generates highest pressure
? Incidence of diverticular disease increases with age: ? 30% at age 60 ? 60-80% at age 80
Risk Factors
? Low fiber Diet ? Smoking ? Constipation ? Obesity ? NSAIDS
Complications
? Obstruction
? Bleeding
? Fistula
? Sepsis, Perforation
? May co-exist with IBD
Specimen showing blood in diverticulae
Clinical Classification
? Uncomplicated vs. Complicated ? Uncomplicated
? Pericolic soft-tissue stranding, colonic wall thickening, phlegmon
? Complicated: Acute diverticulitis + ? Abscess ? Obstruction ? Perforation ? Fistula
Significance of Diverticulitis
? Significant problem in Western Countries ? One of the most common causes of acute surgical admission ? 152,000 yearly hospitalizations ? Annual costs of diverticular disease estimated at $2.7 billion
per year
Sandler RS et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500-1511.
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