24 Questions
What is the primary goal of treatment in pericolic abscess?
To drain the abscess and resolve acute inflammation
What is the most common cause of massive lower gastrointestinal hemorrhage?
Diverticular disease
Which investigation has the highest diagnostic yield for detecting vesico-colic fistula?
Cystoscopy
What is the indication for a two-stage procedure in the management of fistula?
Extensive inflammatory process
What is the purpose of endoluminal wall stents in the management of intestinal obstruction?
To decompress the obstruction
What is the diameter of the abscess that requires US guided percutaneous drainage?
> 5 cm
What is the symptom of chronic intestinal obstruction?
Progressive constipation
What is the investigation of choice to diagnose colovesical fistula?
CT scan
What is the most common complication of chronic diverticulitis?
Acute inflammation
What is the typical demographic for uncomplicated diverticulosis coli?
Female > 40 years
What is the characteristic symptom of irritable colon syndrome in diverticulosis coli?
All of the above
What is the best diagnostic imaging modality for diverticulosis coli?
Barium enema
What is the pathophysiological mechanism underlying chronic diverticulitis?
Recurrent attacks of acute diverticulitis
What is the commonest location for hemorrhage in diverticulosis coli?
Right colon
What is the characteristic radiological feature of 'pre-diverticular state' on barium enema?
Saw teeth appearance
What is the purpose of sigmoidoscopy in the management of diverticulosis coli?
To exclude a neoplasm
What is the typical location of tenderness in a patient with diverticulitis?
Left lower quadrant
What is the primary goal of the Reilly sigmoid myotomy procedure?
To restore colonic lumen and reduce colonic pressure
What is the recommended dietary modification for patients with diverticulosis?
High residue diet
What is the primary concern when performing a barium enema or sigmoidoscopy in a patient with acute diverticulitis?
Perforation and peritonitis
What is the typical clinical presentation of perforation in diverticulitis?
Severe abdominal pain and toxaemia
What is the primary indication for surgical intervention in diverticulitis?
All of the above
What is the ideal surgical procedure for treating diverticulitis?
One-stage resection of the affected segment with end-to-end anastomosis
What is the diagnostic imaging modality of choice for evaluating perforation in diverticulitis?
Plain X-ray abdomen
Study Notes
Chronic Diverticulitis
- Result of recurrent attacks of acute diverticulitis, with a thickened and adherent colon wall.
- Complications include acute inflammation, perforation, chronic intestinal obstruction, fistula, and hemorrhage.
Complications
- Acute inflammation: most common complication.
- Perforation: leads to peritonitis, either localized (abscess) or generalized.
- Chronic intestinal obstruction: due to fibrosis and strictures.
- Fistula: external (colocutaneous) or internal (colovesical, colovaginal, or coloenteric).
- Hemorrhage: due to erosion of vasa recta, more common in the right colon.
Management
- Uncomplicated: females > males, >40 years old.
- Clinical picture: asymptomatic or irritable colon syndrome with 5 A's (abdominal distension, pain, abnormal stool frequency, form, and passage).
- Signs: thickened, tender, palpable colon.
- Investigations: barium enema, sigmoidoscopy, and CT scanning.
Treatment
- Uncomplicated: high-residue diet, antispasmodic drugs, and bulking agents.
- Complicated:
- Diverticulitis: Ochsner-Sherren regimen, antibiotics, and fluids.
- Perforation: surgical intervention, with Hinchey classification guiding treatment.
- Intestinal obstruction: conservative approach with endoluminal wall stents or surgical intervention.
- Fistula: one-stage or two-stage procedure with resection anastomosis and fistulectomy.
- Bleeding: diagnosis is challenging, and treatment involves identifying and treating underlying causes.
Learn about the long-term effects of recurrent acute diverticulitis, including thickened colon walls, complications, and potential outcomes. This quiz covers the pathology and consequences of chronic diverticulitis.
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