Relief from Diverticular Disease
Managing Diverticular Disease
Stop The Pain. Manage Your Diverticular Disease And Live A Pain Free Life. No Pain, No Fear, Full Control Normal Life Again. Diverticular Disease can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows.
Infectious Causes of Sepsis Abscesses, mycobacterial infections (tuberculosis), pyelonephritis, endocarditis, wound infection, diverticulitis, cholangitis, osteomyelitis, IV catheter phlebitis, pelvic infection, cellulitis, infected decubitus ulcer, peritonitis, abdominal abscess, perirectal abscess, parasitic infections.
Hartmann's procedure - this is one of the most commonly used emergency operations for colorectal disease. Although this was initially devised for the elective treatment of proximal rectal tumours, it is now usually used in the emergency setting to treat conditions such as perforated diverticular disease (most commonly), perforated tumour, etc. The procedure itself is defined as resection of the sigmoid colon (and a variable length of proximal rectum if required) with the fashioning of a terminal end colostomy and closure of the rectal stump. The colostomy may be reversed at a later date by forming an end-to-end colorectal anastomosis. Non-acute presenting diverticular disease is usually treated surgically by either sigmoid colectomy or left hemicolectomy depending on the extent of the disease.
Other unusual causes of sub-acute appendicitis are granulomatous appendicitis (Crohn's disease, sarcoidosis, TB, schistosomiasis, but usually isolated and idiopathic), measles, CMV or secondary to ulcerative colitis. Periappendicitis or serosal inflammation without a mucosal or mural component should be noted as this may indicate inflammation emanating from another abdominopelvic organ, e.g., pelvic inflammatory disease (salpingitis) or colonic diverticulitis. In the older patient such an exudate must also be closely scrutinised for evidence of peritoneal spread of carcinoma cells.
Rarer conditions such as diverticula or urachal remnants are usually asymptomatic, although predisposing to stones and infection. Vesicocolic fistula due to colonic diverticulitis, Crohn's disease or malignancy can present with the unusual symptoms of passage of gas (pneumaturia)
Inflammation acute due to appendicitis or a perforated viscus (GU, diverticulitis), or granulomatous, e.g., tuberculosis, fungal peritonitis (chronic ambulatory peritoneal dialysis (CAPD)) or after previous surgery. CAPD can also be associated with the rare condition of fibrous or scle-rosing peritonitis.
Polycystic kidney disease is inherited in an autosomal dominant manner in which gradually enlarging renal cysts are associated with progressive renal impairment. It may present with chronic renal failure or be found during screening of relatives of patients with the disease. More unusually it can present with an abdominal mass, with hypertension or with rupture of an associated intra-cranial Berry aneurysm causing a subarachnoid haemorrhage. The renal failure most commonly manifests in middle age and might present with vomiting, nausea, anorexia, itching, fatigue, polyuria, etc. The cysts can bleed producing haem-aturia, become infected or be painful. There is an increased incidence of cardiac disease including valvular abnormalities, herniae and diverticular disease. It has a prevalence of 0.1 .
Differential Diagnosis Nephrolithiasis, appendicitis, cystitis, pyelonephritis, diverticulitis, salpingitis, torsion of hernia, ovarian torsion, ovarian cyst rupture or hemorrhage, bladder obstruction, prostatitis, prostate cancer, endometriosis, ectopic pregnancy, colonic obstruction, carcinoma (colon, prostrate, cervix, bladder).
Fiber in the diet, and lack of exercise, is more common, leading to increased use of laxatives, Periodontal disease, hemorrhoids, and diverticulosis (inflammation of the walls of the colon) may compound the digestive problems of older adults. Contributing to these functional changes are declines in stomach acid and intestinal secretions, an increase in body fat, changes in the liver and gall bladder, loss of teeth, and a 50 decline in taste buds.
Depression, diabetes, drugs, spinal dysfunction and urinary tract infection can all cause abdominal pain although the pain may be more subacute or chronic. Abdominal pain and even tenderness can accompany diabetic ketoacidosis. Drugs that can cause abdominal pain are listed in Table 30.4 . Spinal dysfunction of the lower thoracic spine and thoracolumbar junction can cause referred pain to the abdomen (Fig 30.1). The pain is invariably unilateral, radicular in distribution, and related to activity. It can be confused with intra-abdominal problems such as biliary disease (right-sided), appendicitis and Crohn's disease (right side), diverticular disease (left-sided) and pyelonephritis.
In general, specimens are measured, opened with blunt-ended scissors along the antemesenteric border and then blocked longitudinally (but see diverticular disease and tumour) following gentle washing out of faecal debris, pinning out with avoidance of unnecessary traction, and immersion in 10 formalin fixative for 48 hours. Photographs may be taken before and after dissection.
Pneumatosis coli submucosal gas cysts lined by macrophages and giant cells with overlying mucosal chronic inflammation or pseudolipomatosis. There is an association with volvulus, constipation, diverticulosis and chronic obstructive airways disease. Pathogenesis relates to retroperitoneal tracking of air into the bowel mesentery, abnormal luminal gas production linked to the increased intraluminal pressure seen in the above disorders, and introduction of gas during endoscopy. About 50 of cases resolve but recurrent or severe lesions may require colectomy of the involved segment. Obstructive enterocolitis continuous or segmental areas of inflammation or ulceration adjacent to or distant from an obstructing distal lesion, e.g., annular carcinoma or diverticulosis. Small bowel may also be involved with mimicry of Crohn's disease. A dilated, thinned caecal pouch can become ischaemic and perforate. Diverticulosis very common in Western society due to a low-fibre diet, high intraluminal...
The presence of a bowel obstruction in a patient with a history of cancer does not necessarily indicate recurrence. A small but significant percentage of patients will have a benign etiology of their obstruction. The rates described range from 3 to 35 , and represent adhesions, radiation enteritis, or benign diseases such as diverticulitis. Patients with true malignant bowel obstruction are well described in multiple case series in the literature, although different authors reach different conclusions from often similar data. Patients may have a short survival time and high morbidity rate after surgical intervention. This data leads some to believe that surgery is of little benefit in these patients, yet others cite up to 80 palliation of obstruction, often lasting until death. A recent Cochrane Review of surgery for the symptoms of bowel