True about diverticulitis:a) Occurs at any ageb) Often incidental finding at operationc) Young patients have more aggressive diseased) Left sided colon involvement is more commone) Operation is not for all patients
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• Diverticulitis is the result of inflammation (perforation) of colonic diverticulum
• The term is somewhat misnomer because the disease is actually an extraluminal pericolic infection caused by the extravasation of feces through the perforated diverticulum.
Complications
• Recurrent periodic inflammation and pain
• Perforation leading to general peritonitis or local (pericolic) abscess formation.
• Intestinal obstruction: In the sigmoid (as a result of progressive fibrosis causing stenosis) and in the small intestine (caused by adherent loops of small intestine on the pericolitis)
• Hemorrhage: Profuse colonic hemorrhage in 17% of cases, often requiring blood transfusions.
• Bleeding in diverticulosis may be massive but in about 80% patients are self limited and stop spontaneously. These patients do not require surgery
• Fistula formation (vesicocolic, vaginocolic, enterocolic, colocutaneous): MC is vesicocolic
Clinical Features
• Mild cases: mDistension, flatulence and a sensation of heaviness in the lower abdomen
• Emergency: Persistent lower abdominal pain, usually in the left iliac fossa, with or without peritonitis, could be caused by diverticulitis.
• Fever, malaise and leukocytosis can differentiate diverticulitis from painful diverticulosis.
• The sigmoid colon is often palpable, tender and thickened.
• Any urinary symptoms may herald the formation of a vesicocolic fistula, which leads to pneumaturia (flatus in the urine) and even feces in the urine (fecaluria)