WHY DISCUSS DIV.ITIS ? hospital admissions 2006-2009 (NL) - презентация

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2 WHY DISCUSS DIV.ITIS ? hospital admissions (NL)

3 In the USA from 1998 to 2005 a 26 % increase in div-itis (mostly in18-44 year old group).

4 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

5 prevalence diverticula 40 year 5 % 60 year 30% 85 year 65 %

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12 Causes of diverticula low fibre diet to little mobility to little fluid in diet smoking obesitas (BMI> 22.5 !)

13 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

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17 uncomplicated Diverticulitis

18 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 %

19 In 75 % of the patients there is no diagnosis possible without imaging.

20 more investigation ? ultrasound ? CT scan ? endoscopy ?? MRI??

21 Ultrasound of diverticulitis

22 sensitivity and specificity of US is 90 % if US is inconclusive then CT

23 CT scan

24 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

25 MRI ? expensive and time consuming sens. and spec. 85 and 100 % resp. no X rays

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27 How to treat uncomplicated diverticulitis? treat the pain mild laxans (antibiotics only when infiltrates outside colon) no hospitalization no bedrest no diet measures necessary

28 uncomplicated means 0 and Ia in Hinchey score so: no suspicion of an abces, peritonitis, perforation or bleeding

29 chances for recidive after first episode 10 % chance in the first year and every year 3 % (> 50 year) total chance for recidive aprox 25 %

30 complicated diverticulitis Hinchey 1b, 11, 111,1V % of patients < 40 year % of complicated div-itis at first presentation

31 start very quickly with IV antibiotics drainage of abces > 5 cm ( CT or US guided with needle or drain) Hinchey 111 and 1V always operation bleeding :ENDOSCOPY with intervention or embolisation (CT-angio) when profuse or when failure with scope + units of blood of course when necessary

32 operation Hinchey 111 and 1V deviating stoma Hartmann procedure resection with primary anastomosis laparoscopic lavage with drainage of abdominal cavity

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34 Hartman procedure

35 resection with primary anastomosis

36 Laparoscopic lavage with drainage

37 for today the end thank for your attention