Diverticulitis
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ž E. Cause has not been conclusively established
1. Associated with diets low in fiber and high in refined carbs
2. Other factors associated with increased risk – physical inactivity, constipation,
obesity, smoking, treatment with NSAIDs
F. Pathogenesis of diverticulitis is uncertain
1. Stasis or obstruction in the pseudodiverticulum may lead to bacterial
overgrowth and local tissue ischemia
2. Anaerobes are the most commonly isolated organisms
3. Gram negative aerobes (E coli) and Gram positive bacteria (strep) as well
G. “Complicated” diverticulitis is present when there is an abscess or phlegmon,
fistula formation, stricture disease, bowel obstruction or peritonitis
1. Only 1-2% of pts who present will have free perforation
2. High-grade colonic obstruction and small bowel obstruction can occur
1. Hinchey’s criteria
a. Stage 1 – small, confined pericolic or mesenteric abscesses
b. Stage 2 – larger abscesses, often confined to pelvis
c. Stage 3 – perforated diverticulitis
d. Stage 4 – free rupture
2. Risk of death <5% stage 1 or 2, 13% for stage 3, and 43% for stage 4
H. Percutaneous drainage
1. Size of the abscess is an important determinant of the need for
percutaneous drainage (>4 cm may be beneficial)
2. May allow for elective rather than emergency surgery, increasing the
likelihood of a successful one-stage procedure
3. If abscess contains pure feculent material, early surgical intervention usually
required