What Is Diverticular Disease Surgery?

Colonic diverticulosis refers to a pocket-like structure that protrudes outward through the muscular layer of the mucosa and submucosa of the colon. Its morphological characteristics are located between the mesentery and the two mesentery colons, protruding sacs from the colon wall or along the colon The band sides are arranged in a string. The sigmoid colon and descending colon are most commonly affected. Diverticula are divided into two types, true (congenital) diverticulum and pseudo (acquired) diverticulum. Congenital diverticulum, including the entire layer of the colon, is rare, and most of the colonic diverticulum is a pseudo diverticula without muscle layer, and it is caused by acquired factors.

Basic Information

English name

dlerticular disease of colon

Visiting department

surgical

Common locations

colon

Common causes

Less fiber in the diet, flour and refined sugar substitute for coarse foods

Common symptoms

Occasional abdominal pain, constipation, diarrhea, etc.

Causes of Colonic Diverticulopathy

The rapid spread of acquired colonic diverticulosis in Chinese and Western countries in the 20th century can be attributed to reduced dietary fiber consumption. The increased prevalence of diverticulosis and its complications in industrially developed countries is due to the use of flour and refined sugar in the diet to replace rough types of food.

Clinical manifestations of colonic diverticulosis

Colon diverticulosis

About 80% of patients with colonic diverticulosis are asymptomatic and were found by accident during X-ray barium imaging or endoscopy. Symptoms related to diverticulum are actually symptoms such as acute diverticulitis and bleeding; symptoms in uncomplicated patients such as occasional abdominal pain, constipation, and diarrhea are due to accompanying gastrointestinal motility disorders, and diverticulum Existence is just a coincidence. During the physical examination, there may be mild tenderness in the left lower abdomen, and sometimes the left colon may be stiffened with a hard tubular structure.

2. Acute diverticulitis

Acute diverticulitis is the most common complication of colon diverticulosis. There are varying degrees of localized abdominal pain during acute attacks, which can be stinging, dull and colic. Most of the pain is in the left lower abdomen, occasionally on the pubic bone, right The lower abdomen, or the entire lower abdomen. Patients often have constipation or frequent defecation, or both, and relieve pain after venting. Inflammation adjacent to the bladder can produce frequent urination and urgency. Nausea and vomiting can also be associated with the location and severity of inflammation.

3. Acute diverticulitis with abscess

The most common complication of acute diverticulitis is the occurrence of abscesses or loose connective tissue inflammation, which can be located in the abdominal cavity, pelvis, retroperitoneum or scrotum. A tender lump can often be touched during a digital examination of the abdomen or pelvic rectum, causing abscesses with signs of sepsis of varying degrees.

4. Acute diverticulitis complicated by diffuse peritonitis

When a localized abscess ruptures or diverticulum perforates into the abdominal cavity, it can cause purulent or fecal diffuse peritonitis. Most of these patients present with acute abdomen and toxic shock with varying degrees of severe infection.

5. Acute diverticulitis with fistula formation

Fistulas occur in about 2% of all patients with acute diverticulitis. Internal fistula may come from the adhesion of adjacent organs to the diseased inflammatory colon and adjacent mesentery, with or without abscesses. As the inflammatory process worsens, the abscess in the diverticulum decompresses on its own, rupturing to the adherent cavity organs, thereby forming a fistula.

6. Acute diverticulitis complicated by intestinal obstruction

Domestic diverticulosis causes complete colonic obstruction is rare, but partial obstruction due to edema, spasm and inflammatory changes of diverticulitis is common.

Colonic diverticulosis examination

Endoscopic, gas-barium double contrast enema, and CT scans of the abdomen and pelvis are helpful for diagnosis. Acute conditions should generally avoid endoscopy, because inflation can induce perforation or exacerbate existing perforations. Barium enema can be used to diagnose acute diverticulitis, but there is a danger of barium spilling into the abdominal cavity, which will cause severe shock and death. If a more urgent diagnosis is needed to guide the treatment, a water-soluble contrast agent enema can be used so that even if the contrast agent overflows into the abdominal cavity, it will not cause a serious reaction.

CT scans are non-invasive and generally confirm clinically suspected diverticulitis. Enhanced rectal imaging during scanning can make diverticulum abscesses or fistulas more sensitive than plain X-ray angiography. CT scans can also guide percutaneous drainage of abscesses.

Abdominal radiographs can show colonic obstruction secondary to sigmoid disease. A water-soluble contrast enema can confirm the diagnosis.

Colon Diverticulopathy Treatment

Medical treatment

Acute diverticulitis can be treated first with medical treatment, including fasting, gastrointestinal decompression, intravenous fluid replacement, broad-spectrum antibiotics, and strict clinical observation. Gastrointestinal decompression is generally used only when there is evidence of vomiting or colonic obstruction.

2. Surgery

Those who have the following conditions should be treated surgically: the first episode of acute diverticulitis does not respond to medical treatment; acute recurrent diverticulitis, even if the satisfactory results of medical treatment at the first episode, but should be considered when relapse Resection; <50 years old with a case of acute diverticulitis and successful medical treatment, selective surgery should be performed to avoid subsequent acute surgery; patients with immune deficiency can not arouse enough inflammation when diverticulitis occurs Sexual reaction is therefore a fatal disease. Perforation and rupture into the free abdominal cavity are very common. For this reason, patients who have had an episode of acute diverticulitis in the past should be treated with selective resection before long-term immunosuppressive treatment is required. Risk of recurrence of diverticulitis leading to various complications; Acute diverticulitis with abscess or loose connective tissue inflammation; Acute diverticulitis with diffuse peritonitis; Acute diverticulitis with fistula formation; Acute diverticulitis with colon Obstruction.