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    Colonic Diverticula

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    Ramesh Reddy

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    Colonic Diverticula

    Uploaded by

    Ramesh Reddy
    1 views24 pages

    Original Title

    COLONIC DIVERTICULA

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    1 views24 pages

    Colonic Diverticula

    Uploaded by

    Ramesh Reddy

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 24

    COLONIC DIVERTICULA

    Diverticula (hollow outpouchings)


    classified as-
    • Congenital
    • Acquired
    Etiology

    • Refined Western diet


    • Defcient in dietary fibre.
    • The combination of altered collagen structure with ageing, disordered
    motility and increased intraluminal pressure, most notably in the
    narrow sigmoid colon, results in herniation of mucosa through the
    circular muscle at the points where blood vessels penetrate the bowel
    wall.
    • The rectum has a complete muscular coat and a wider lumen and is
    thus very rarely afected.
    Radiology

    • Plain radiographs
    • Spiral CT
    • On identifcation of abscesses in stable patients, drainage, under
    interventional radiology guidance, may be carried out percutaneously,
    avoiding the need for laparotomy/laparoscopy.
    • Contrast studies and endoscopy are usually avoided for 6 weeks after
    an acute attack for fear of causing perforation.
    • Contrast examination or CT can demonstrate a fistula.
    Colonoscopy

    • Endoscopic assessment may demonstrate the necks of diverticula


    within the bowel lumen
    • A signifcant risk of endoscopic perforation
    • Biopsies may be taken if possible and corroboration with CT virtual
    colonoscopy or occasionally contrast enema is required.
    • Excluding a carcinoma may not always be possible and may represent
    an indication for resection.
    Management

    • Recommended a high-fbre diet and bulk-forming laxatives


    • Antispasmodics
    • Acute diverticulitis has been traditionally treated with intravenous
    antibiotics and bowel rest.
    • For disease complicated by a localized abscess, intravenous antibiotics
    and image-guided drainage is indicated
    Operative procedures for diverticular disease

    • The aim of EMERGENCY SURGERY is to control peritoneal infection


    • ELECTIVE SURGERY – FOR complications
    Operative procedures for diverticular disease

    • Traditionally laparotomy and thorough washout of contamination are


    performed and then a choice has to be made between a Hartmann’s
    procedure (sigmoid resection with formation of a left iliac fossa
    colostomy and closure of the rectal Stump) and resection with colonic
    washout and primary anastomosis (with consideration of a
    defunctioning
    STOMA

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