why discuss div.itis ? hospital admissions 2006-2009 (nl)
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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.
•Meckels diverticulum is a true diverticulum
prevalence diverticula
40 year 5 %
60 year 30%
85 year 65 %
Causes of diverticula
•low fibre diet
•to little mobility
•to little fluid in diet
•smoking
•obesitas (BMI> 22.5 !)
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
uncomplicated Diverticulitis
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 %
In 75 % of the patients there is no diagnosis
possible without imaging.
more investigation ?
•ultrasound ?
•CT scan ?
•endoscopy ??
•MRI??
Ultrasound of diverticulitis
sensitivity and specificity of US is 90 %
if US is inconclusive then CT
CT scan
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
MRI ? expensive and time consuming
sens. and spec. 85 and 100 % resp.
no X rays
How to treat uncomplicated diverticulitis?
treat the pain
mild laxans
(antibiotics only when infiltrates outside colon)
no hospitalization
no bedrest
no diet measures necessary
uncomplicated means 0 and Ia in Hinchey
score
so: no suspicion of an abces, peritonitis,
perforation or bleeding
chances for recidive after first episode
10 % chance in the first year and every year 3 %
(> 50 year)
total chance for recidive aprox 25 %
complicated diverticulitis
Hinchey 1b, 11, 111,1V
5- 10 % of patients < 40 year
50- 80 % of complicated div-itis at first presentation
start very quickly with IV antibioticsdrainage of abces > 5 cm ( CT or US guided
with needle or drain)
Hinchey 111 and 1V always operationbleeding :ENDOSCOPY with intervention or
embolisation(CT-angio) when profuse or when failure with
scope + units of blood of course when necessary
operation Hinchey 111 and 1V
• deviating stoma• Hartmann procedure
• resection with primary anastomosis• laparoscopic lavage with drainage of
abdominal cavity
deviating stoma
Hartman procedure
resection with primary anastomosis
Laparoscopic lavage with drainage
for today the end
thank for your attention