What is 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 and explain in detail?
• 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)