Colic diverticulitis is defined by the presence of uncomplicated diverticulitis: there may be a few or several hundred.
The diverticulum of the colon is a hernia of the mucous membrane and the muscular mucous membrane of the colic through a dehiscence of the muscular layer, which corresponds to the precise point where the right vessels penetrate through the muscular layer. In more than XNUMX% of cases, diverticulitis develops on the sigmoid, the mobile part of the large loop-shaped intestine, which descends to the left side of the pelvic cavity and continues through the rectum.
La diverculite is the inflammation of one or more diverticula and may be accompanied by scarce rectorrhagia (diverticular hemorrhage).
Colonic diverticulosis is a disease the prevalence of which increases with age: it is around 5% before age 30, 30% around 60 and 50% after 70 years. Rare in developing countries, it is much more common in Western countries, where diets are lower in fiber.
Symptoms of the disease
Diverticulosis is generally asymptomatic. It is usually discovered during colonoscopy or barium enema. Abdominal pain and transit disorders can be attributed to other causes, often intestinal functional disorders. Diverticulosis does not require any particular follow-up, except the reintroduction of fibre into the diet.
La acute sigmoid diverticulitis is a common complication of diverticulosis due to diverticular inflammation. Its symptoms are as follows:
- sharp pain in the left iliac fossa, sometimes in the groin;
- rectal or bladder irritation syndrome (false needs);
- transit disorders: constipation or, more often, diarrhea with mucous emissions;
- rare rectal bleeding;
- constant fever and chills.
La Complicated acute diverticulitis often progresses to peritonitis and pericolic abscesses in 80% of cases. peritonitis and pericardial abscess.
• ThePeri-sigmoid abscess characterized by :
- a high fever with chills ;
- of tachycardia ;
- a grey and anxious face.
• The Diverticular perforation with peritonitis is the most serious and common complication of acute diverticulitis. It is characterized by:
- a major peritoneal syndrome with sudden onset contracture predominant in the left iliac fossa ;
- high fever ;
- sometimes a state of shock.
• The Fistulas are rare.
• The Sigmoid stenosis occurs after several diverticulitis. It manifests itself by:
- recent constipation ;
- abdominal pain or resolving occlusive episodes.
• Theacute occlusion is rare.
For acute sigmoid diverticulitis:
- medical treatment combines antibiotic therapy, analgesics, ice on the stomach and clinical monitoring;
- emergency surgical treatment may be indicated if the painful or febrile syndrome persists.
For complicated acute diverticulitis
• Peri-sigmoid abscess requires in most cases:
- antibiotic medical treatment with surgical monitoring ;
- cold surgical treatment.
• Diverticular perforation with peritonitis is operated urgently.
• The Fistulas must be operated on cold after antibiotic treatment.
• La Sigmoid stenosis must be operated on.
• Acute occlusion requires both medical (rehydration and antibiotic therapy) and surgical treatment.