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WHY DISCUSS DIV.ITIS ? hospital admissions 2006-2009 (NL)
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WHY DISCUSS DIV.ITIS ?hospital admissions 2006-2009
(NL)
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•In the USA from 1998 to 2005 a 26 % increase in div-itis (mostly in18-44 year old group).
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•A diverticulum is an pouching out of the mucosa of the gut through the muscularis externa
•the diverticula are in fact pseudo-diverticula.
•Meckels diverticulum is a true diverticulum
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prevalence diverticula
40 year 5 %
60 year 30%
85 year 65 %
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Causes of diverticula
•low fibre diet
•to little mobility
•to little fluid in diet
•smoking
•obesitas (BMI> 22.5 !)
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inflammation of a diverticulum
•local changes of wall; hypertrofy (?)
•local neurological changes ( lower motility+higher pressure) (?)
•impaction of faeces in diverticulum -->necrosis of wall --> translocation of bacteria--> inflammation
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uncomplicated Diverticulitis
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investigation•history (comorbidity, immune
depressed, medication) ( no vomiting !)
•physical examination (temperature > 38.5C pain,tenderness, peritonitis?)
•total blood( leucocytosis) and CRP >50 mg/L
•this together gives an accurate diagnosis in 40 - 65 %
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In 75 % of the patients there is no diagnosis
possible without imaging.
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more investigation ?
•ultrasound ?
•CT scan ?
•endoscopy ??
•MRI??
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Ultrasound of diverticulitis
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sensitivity and specificity of US is 90 %
if US is inconclusive then CT
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CT scan
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sens. and specificity of CT is 95 and 99% resp
advantage of CT over US is that other diagnosis
can be made when there is no diverticulitis
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MRI ? expensive and time consuming
sens. and spec. 85 and 100 % resp.
no X rays
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How to treat uncomplicated diverticulitis?
treat the pain
mild laxans
(antibiotics only when infiltrates outside colon)
no hospitalization
no bedrest
no diet measures necessary
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uncomplicated means 0 and Ia in Hinchey
score
so: no suspicion of an abces, peritonitis,
perforation or bleeding
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chances for recidive after first episode
10 % chance in the first year and every year 3 %
(> 50 year)
total chance for recidive aprox 25 %
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complicated diverticulitis
Hinchey 1b, 11, 111,1V
5- 10 % of patients < 40 year
50- 80 % of complicated div-itis at first presentation
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start very quickly with IV antibioticsdrainage of abces > 5 cm ( CT or US guided
with needle or drain)
Hinchey 111 and 1V always operationbleeding :ENDOSCOPY with intervention or
embolisation(CT-angio) when profuse or when failure with
scope + units of blood of course when necessary
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operation Hinchey 111 and 1V
• deviating stoma• Hartmann procedure
• resection with primary anastomosis• laparoscopic lavage with drainage of
abdominal cavity
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deviating stoma
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Hartman procedure
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resection with primary anastomosis
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Laparoscopic lavage with drainage
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for today the end
thank for your attention