Diverticulitis: Imaging, Intervention and Surgery

DENNIS FOLEY

MEDICAL COLLEGE WISCONSIN

2006

2011

• COLONIC DIVERTICULA

• MURAL THICKENING

• MESENTERIC STRANDING

DIVERTICULITIS MICRO PERFORATION

Acute Diverticulitis

COLONIC DIVERTICULA

MURAL THICKENING

PERICOLONIC FAT STRANDING

EXTRA COLONIC GAS

EPIPLOIC APPENDAGITIS

Epiploic Appendagitis

TORSED EPIPLOIC APPENDAGE

CENTRAL FAT

SURROUNDING FAT STRANDING

NEGATIVE FOR COLON INFLAMMATION OR ISCHEMIA

EPIPLOIC APPENDAGITIS

SEGMENTAL ISCHEMIC COLITIS

TUBO OVARIAN ABSCESS

Acute Diverticulitis

DIFFERENTIAL DIAGNOSIS FOCAL COLITIS

PERFORATED CARCINOMA

SEGMENTAL ISCHEMIA

APPENDICITIS

SALPINGITIS

APPENDAGITIS

Diverticulitis: Hinchey Classification

1. CONFINED PARACOLIC ABSCESS

2. DISTANT ( PELVIC, RETROPERITONEAL ) ABSCESS

3. PURULENT PERITONITIS

4. FECULENT PERITONITIS

PERFORATED DIVERTICULIITS

HINCHEY CLASS 3/4

PERFORATED DIVERTICULUM HINCHEY CLASS 3/4

EXTRA PERITONEAL DIVERTICULAR PERFORATION

Colonic Perforation

INTRAPERITONEAL

EXTRAPERITONEAL PERIRENAL

PARARENAL

PRE SACRAL / PELVIC FLOOR

Diverticulitis Pericolonic Abscess

PERI COLONIC FLUID COLLECTION ASSOCIATED FINDINGS OF

DIVERTICULIITS OTHER POSSIBLE ETIOLOGIES

PERFORATED CARCINOMA INFLAMMATORY BOWEL DISEASE POST OPERATIVE

Percutaneous Abscess Drainage

CAUSE

LOCULATION

ACCESS

CLINICAL ISSUES PERITONITIS

BLEEDING

FISTULA

Pericolonic Abscess Drainage

ACCESS TRANS ABDOMINAL

TRANS GLUTEAL

TRANS RECTAL

DIVERTICULAR ABSCESS ANTERIOR PAFD INCOMPLETE DRAINAGE

TRANSGLUTEAL PCD

TRANS RECTAL PAFD

2 MONTH FOLLOW UP

Colovesical and Enterovesical Fistula

DIAGNOSIS CYSTOGRAPHY

WATER SOLUBLE ENEMA

CT CYSTOGRAPHY

COLOGRAPHY

ENTEROGRAPHY

Diverticulitis

CT IS KEY TO DIAGNOSIS AND MANAGEMENT OF OFTEN COMPLEX PATIENTS

BE AWARE OF THE DIFFERENTIAL DIAGNOSIS

DIFFERENT APPROACHES FOR PAFD PAFD AND SURGERY PLAY

COMPLEMENTARY ROLE IN PATIENT MANAGEMENT.