Diverticulitis

Pathophysiology iNilM 1998:338 1521)

• Retention of undigested food and bacteria in diverticulum -»fecalith formation obstruction compromise of diverticulum s blood supply, infection, perforation

• Microperforation (localized infection) or macroperforation (abscess, peritonitis, obstruction)

Clinical manifestations

■ LLQ abdominal pain, fever, nausea, vomiting, constipation Physical exam

• Mild: LLQ tenderness. • palpable mass. • positive FOBT (-25%)

• Severe: peritonitis, septic shock

Diagnostic studies

• Plain abdominal radiographs to r o free air, ileus, or obstruction

• Abdominal CT (I") may show thickening of cobn (sigmoid); usually reserved for Pts who fail to respond to therapy or if suspect pericolic abscess

• Sigmoidoscopy colonoscopy contraindicated in acute setting because of T risk of overt perforation; colonoscopy recommended 2-6 wks after resolution to rule out neoplasm

Treatment

• Mild: PO antibiotics (FQ ♦ MNZ) and liquid diet x 7-10 d

NPO.IV fluids. NGT (if ileus)

IV antibiotics (GNR & anaerobic coverage): amp gent MNZ or piperacillin-tazobactam

• Abscess drainage percutaneously or surgically

• Surgery if medical therapy fails, free perforation, large abscess that cannot be drained percutaneously. recurrent disease {z2 severe episodes)

• If surgery deferred after 2nd attack, consider prophylactic Rx w mesalamine - rifaxtmin

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