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WHY DISCUSS DIV.ITIS ? hospital admissions 2006-2009 (NL)

WHY DISCUSS DIV.ITIS ? hospital admissions 2006-2009 (NL). In the USA from 1998 to 2005 a 26 % increase in div-itis (mostly in18-44 year old group). A diverticulum is an pouching out of the mucosa of the gut through the muscularis externa the diverticula are in fact pseudo-diverticula.

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WHY DISCUSS DIV.ITIS ? hospital admissions 2006-2009 (NL)

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  1. WHY DISCUSS DIV.ITIS ?hospital admissions 2006-2009 (NL)

  2. In the USA from 1998 to 2005 a 26 % increase in div-itis (mostly in18-44 year old group).

  3. A diverticulum is an pouching out of the mucosa of the gut through the muscularis externa • the diverticula are in fact pseudo-diverticula. • Meckels diverticulum is a true diverticulum

  4. prevalence diverticula 40 year 5 % 60 year 30% 85 year 65 %

  5. Causes of diverticula • low fibre diet • to little mobility • to little fluid in diet • smoking • obesitas (BMI> 22.5 !)

  6. inflammation of a diverticulum • local changes of wall; hypertrofy (?) • local neurological changes ( lower motility+higher pressure) (?) • impaction of faeces in diverticulum -->necrosis of wall --> translocation of bacteria--> inflammation

  7. uncomplicated Diverticulitis

  8. investigation • history (comorbidity, immune depressed, medication) ( no vomiting !) • physical examination (temperature > 38.5C pain,tenderness, peritonitis?) • total blood( leucocytosis) and CRP >50 mg/L • this together gives an accurate diagnosis in 40 - 65 %

  9. In 75 % of the patients there is no diagnosis possible without imaging.

  10. more investigation ? • ultrasound ? • CT scan ? • endoscopy ?? • MRI??

  11. Ultrasound of diverticulitis

  12. sensitivity and specificity of US is 90 % if US is inconclusive then CT

  13. CT scan

  14. sens. and specificity of CT is 95 and 99% resp advantage of CT over US is that other diagnosis can be made when there is no diverticulitis

  15. MRI ? expensive and time consuming sens. and spec. 85 and 100 % resp. no X rays

  16. How to treat uncomplicated diverticulitis? treat the pain mild laxans (antibiotics only when infiltrates outside colon) no hospitalization no bedrest no diet measures necessary

  17. uncomplicated means 0 and Ia in Hinchey score so: no suspicion of an abces, peritonitis, perforation or bleeding

  18. chances for recidive after first episode 10 % chance in the first year and every year 3 % (> 50 year) total chance for recidive aprox 25 %

  19. complicated diverticulitis Hinchey 1b, 11, 111,1V 5- 10 % of patients < 40 year 50- 80 % of complicated div-itis at first presentation

  20. start very quickly with IV antibiotics drainage of abces > 5 cm ( CT or US guided with needle or drain) Hinchey 111 and 1V always operation bleeding :ENDOSCOPY with intervention or embolisation (CT-angio) when profuse or when failure with scope + units of blood of course when necessary

  21. operation Hinchey 111 and 1V • deviating stoma • Hartmann procedure • resection with primary anastomosis • laparoscopic lavage with drainage of abdominal cavity

  22. deviating stoma

  23. Hartman procedure

  24. resection with primary anastomosis

  25. Laparoscopic lavage with drainage

  26. for today the end thank for your attention

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