Diverticulitis (summary)
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Diverticulitis is one of the presentations of diverticular disease and is most often a complication of colonic diverticulosis. Differentiating one from the other is critical since uncomplicated diverticulosis is mostly asymptomatic and acute diverticulitis is a potentially life-threatening illness.
Reference article
This is a summary article for diverticulitis. However, we do have a more in-depth reference article:read morediverticulitis.
Summary
-
epidemiology
- complication of diverticulosis (so shares demographics)
- elderly patients most at risk
- 80% of 80
year olds-year-olds have diverticula
- 80% of 80
-
presentation
- left iliac fossa pain
- unremitting pain with associated tenderness
- possibly, an ill-defined mass (inflammatory phlegmon)
- as the disease progresses, symptoms become more generalised
-
pathology
- a diverticulum is an outpouching of colonic mucosa
- diverticula become obstructed and infected
- initially, this is localised
- as the disease progresses, abscess formation and peritonitis occur
-
radiology
- CT is the modality of choice for
investigationdiagnosis and assessment
- CT is the modality of choice for
-
treatment
- depends on the severity of the illness
- IV antibiotics and fluids to surgical treatments
- depends on the severity of the illness
Role of imaging
- confirmation of diverticula
- confirmation of active inflammation around diverticula
- assess for complications, e.g. perforation, abscess
- look specifically for fistula, e.g. with bladder
- identify other potential causes of symptoms
Radiographic features
On imaging, a non-complicatedUncomplicated diverticulitis is characterised by a
- focal fat stranding adjacent to a colonic diverticulum
, usually the sigmoid. A small amount of extraluminal fluid and gas locules may be present.CT is the modality of choice for the diagnosis and staging of diverticulitis. Appearances include:-
pericolic stranding,often disproportionate to the bowel wall thickening
-
- segmental thickening of the bowel wall
-
enhancementa small amount of extraluminal fluid
Complicated diverticulitis
- diverticular perforation
- air and fluid into the pelvis and peritoneal cavity
- abscess formation (seen in up to 30% of cases)
- may contain fluid, gas or both
- fistula formation
- gas in the bladder
- direct visualisation of a fistulous tract
-<p><strong>Diverticulitis</strong> is one of the presentations of <a href="/articles/diverticular-disease">diverticular disease</a> and is most often a complication of colonic <a href="/articles/colonic-diverticulosis">diverticulosis</a>. Differentiating one from the other is critical since uncomplicated diverticulosis is mostly asymptomatic and acute diverticulitis is a potentially life-threatening illness.</p><h4>Reference article</h4><p>This is a <a href="/articles/summary-article">summary article</a> for diverticulitis. However, we do have a more in-depth reference article: <a href="/articles/diverticulitis">read more</a>.</p><h4>Summary</h4><ul>- +<p><strong>Diverticulitis</strong> is one of the presentations of <a href="/articles/diverticular-disease">diverticular disease</a> and is most often a complication of colonic <a href="/articles/colonic-diverticulosis">diverticulosis</a>. Differentiating one from the other is critical since uncomplicated diverticulosis is mostly asymptomatic and acute diverticulitis is a potentially life-threatening illness.</p><h4>Reference article</h4><p>This is a <a href="/articles/summary-article">summary article</a> for diverticulitis. However, we do have a more in-depth reference article: <a href="/articles/diverticulitis">diverticulitis</a>.</p><h4>Summary</h4><ul>
-<li>elderly patients most at risk<ul><li>80% of 80 year olds have <a href="/articles/diverticula">diverticula</a>- +<li>elderly patients most at risk<ul><li>80% of 80-year-olds have <a href="/articles/diverticula">diverticula</a>
-<li>initially this is localised</li>- +<li>initially, this is localised</li>
-<strong>radiology</strong><ul><li>CT is the modality of choice for investigation</li></ul>- +<strong>radiology</strong><ul><li>CT is the modality of choice for diagnosis and assessment</li></ul>
-</ul><h4>Radiographic features</h4><p>On imaging, a non-complicated diverticulitis is characterised by a focal fat stranding adjacent to a colonic diverticulum, usually the sigmoid. A small amount of extraluminal fluid and gas locules may be present. </p><p>CT is the modality of choice for the diagnosis and staging of diverticulitis. Appearances include:</p><ul>-<li>pericolic stranding, often disproportionate to the bowel wall thickening</li>- +</ul><h4>Role of imaging</h4><ul>
- +<li>confirmation of diverticula</li>
- +<li>confirmation of active inflammation around diverticula</li>
- +<li>assess for complications, e.g. perforation, abscess</li>
- +<li>look specifically for fistula, e.g. with bladder</li>
- +<li>identify other potential causes of symptoms</li>
- +</ul><h4>Radiographic features</h4><p>Uncomplicated diverticulitis</p><ul>
- +<li>focal fat stranding adjacent to a colonic diverticulum<ul><li>often disproportionate to the bowel wall thickening</li></ul>
- +</li>
-<li>enhancement of the colonic wall </li>- +<li>a small amount of extraluminal fluid</li>
- +</ul><p>Complicated diverticulitis</p><ul>
-<li>direct visualisation of a fistulous tract</li>- +<li>direct visualisation of a fistulous tract</li>
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