A 72-year-old woman presents to the clinic to discuss surgical management of her long-standing diverticulosis. What would be an indication for a colectomy in this patient?
Many surgeons now will not advise colectomy even after two documented episodes of diverticulitis assuming the patient is completely asymptomatic and that carcinoma has been excluded by colonoscopy. Immunosuppressed patients are generally still advised to undergo colectomy after a single episode of documented diverticulitis. Medical comorbidities should be considered when evaluating a patient for elective resection, and the risks of recurrent disease should be weighed against the risks of the operation. Because colon carcinoma may present in an identical fashion to diverticulitis (either complicated or uncomplicated), all patients must be evaluated for malignancy after resolution of the acute episode. Colonoscopy is recommended 4 to 6 weeks after recovery. Inability to exclude malignancy is another indication for resection.
A 63-year-old woman presents to the ED with a 2-day history of left lower quadrant abdominal pain and is found to be febrile to 38.6°C. Her white blood cell (WBC) count is 15,000. On CT scan she is found to have colonic inflammation with an associated pericolic abscess. What is her Hinchey stage?
The Hinchey staging system is often used to describe the severity of complicated diverticulitis: Stage I includes colonic inflammation with an associated pericolic abscess; stage II includes colonic inflammation with a retroperitoneal or pelvic abscess; stage III is associated with purulent peritonitis; and stage IV is associated with fecal peritonitis.
A 68-year-old woman presents to the ED with a 2-day history of left lower quadrant abdominal pain and is found to be febrile to 39°C. Her WBC count is 12,000. On CT scan she is found to have colonic inflammation with an associated retroperitoneal abscess. What is her Hinchey stage?
A 62-year-old woman presents to the ED with a 2-day history of severe left lower quadrant abdominal pain and is found to be febrile to 39°C. On physical examination her abdomen is rigid. Her WBC count is 2 1,000. On CT scan she is found to have diverticula and gross intraabdominal free air and free fluid. She is taken to the operating room (OR) for an emergent exploratory laparotomy and she is found to have feculent material intraabdominally. What is her Hinchey stage?
A 58-year-old man presents to the clinic with a 2-month history of the sensation of urinating air. He has a history of diverticulitis, with his last episode requiring hospitalization being 6 months ago. What are the most common fistulas that develop in complicated diverticulitis?
Approximately 5% of patients with complicated diverticulitis develop fistulas between the colon and an adjacent organ. Colovesical fistulas are most common, followed by colovaginal and coloenteric fistulas. Colocutaneous fistulas are a rare complication of diverticulitis.
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