Relief from Diverticular Disease

Managing 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.

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New Diverticulitis Breakthrough Ebook

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New Diverticulitis Breakthrough Ebook Summary

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Author: Mark Anastasi
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Diverticulitis

By age 50, one third of adults have diverticulosis coli two thirds have diverticulosis by age 80. Ten to 20 of patients with diverticulosis will have diverticulitis or diverticular hemorrhage. Causes of diverticulosis include aging, elevation of colonic intraluminal pressure, and decreased dietary fiber. Eighty-five percent are found in the sigmoid colon. I. Clinical presentation of diverticulitis A. Diverticulitis is characterized by the abrupt onset of unremitting left-lower quadrant abdominal pain, fever, and an alteration in bowel pattern. Diverticulitis of the transverse colon may simulate ulcer pain diverticulitis of the cecum and redundant sigmoid may resemble appendicitis. Frank rectal bleeding is usually not seen with diverticulitis. Differential Diagnosis of Diverticulitis

Diagnostic evaluation

CT scan is the test of choice to evaluate acute diverticulitis. The CT scan can be used for detecting complications and ruling out other diseases. C. Contrast enema. Water soluble contrast is safe and useful in mild-to-moderate cases of diverticulitis when the diagnosis is in doubt. D. Endoscopy. Acute diverticulitis is a relative contraindication to endoscopy perforation should be excluded first. Endoscopy is indicated when the diagnosis is in doubt to exclude the possibility of ischemic bowel, Crohn's disease, or carcinoma.

Operative procedures

This procedure is usually performed as an elective procedure after resolution of the acute attack of diverticulitis. The segment containing inflamed diverticulum (usually sigmoid colon) is resected with primary anastomosis. A bowel prep is required. 2. Two stage procedure. This procedure is indicated for acute diverticulitis with obstruction or perforation with an unprepared bowel. The first stage consists of resection of the involved segment of colon, with end colostomy and either a mucous fistula or a Hartmann rectal pouch. The second stage consists of a colostomy take-down and reanastomosis after 2-3 months.

The Role of Microvascular Dysfunction and Tissue Ischemia in Chronic Intestinal Inflammation

Gut was not a generalized response to inflammation, as it was not demonstrated in vessels isolated from acute inflammation (i.e., diverticulitis) and uninvolved areas of IBD. This demonstrates that medications used to treat IBD patients at the time of surgery did not contribute directly to the microvascular dysfunction, and further substantiates that intrinsic, acquired alterations in the chronically inflamed and remodeled microcirculation underlie this pathophysiology.

Gastrointestinal Surgery

Acute appendicitis can provide a challenging diagnostic dilemma after transplantation. This diagnosis should be prominently considered when evaluating patients with abdominal pain and tenderness. Diverticulitis and or perforation of the sigmoid colon is also relatively common. Again, immunosuppressed patients may present with relatively advanced disease requiring emergent operation. When colon resection is required, fecal diversion using an end colostomy provides the most conservative, and therefore the most desirable approach. We usually wait at least 6-8 weeks before considering elective stoma closure in this population.

FDGPET in the Diagnosis and Initial Staging of Colorectal Carcinoma

Although there are false-positive findings such as abscesses, fistulas, diverticulitis, and adenomas, the identification of focal uptake should not be ignored. However, the impact on patient management is not high because most patients will undergo surgery anyway, and staging is usually performed with preoperative liver ultrasound and during surgery. PET results may have a role in changing the type of surgery (curative versus palliative or concomitant liver metastases resection).

Bowel Retraining for Constipation

Agents are reversible, and discontinuing the medication usually results in cessation of the constipation. Meal patterns such as meal omission, fast foods, ingestion of large amounts of constipating foods, and inadequate intake of fluids should be recognized and modified. These changes, with the addition of fiber, aid to retrain the bowel to promote regularity and homeostasis as well as deter the onset of disease such as diverticulosis and cancer.

Enterourinary Fistula

Enterourinary fistulas are usually the result of underlying pathology involving the gastrointestinal or genitourinary tract. Pathologies such as diverticulitis, Crohn's disease, radiation enteritis, trauma, iatrogenic injury, bladder cancer, appendicitis, colon carcinoma, and gynecologic tumors are causes of enterourinary fistulas. The true incidence of enterourinary fistula is unknown, although the most frequent site of fistulization is between the bowel and the bladder. Most enterourinary communications involve the bladder and the colon. Although these colovesical fistulas often result from sigmoid diverticulitis (60 of enterovesical fistulas), only 2 of patients with diverticular disease develop colovesical fistula. Malignancy accounts for 20 of enterovesical fistulas. Colorectal adenocarcinoma may adhere and directly invade the bladder, leading to fistuliza-tion in 0.6 of patients.1,2 Moreover, cancer of the cervix, prostate, ovary, and lymphoma can also occasionally result in...

Mechanical obstruction

Approach Ileus

A closed-loop obstruction is a surgical emergency often caused by an internal small bowel hernia due to previous postoperative adhesions or distal colorectal occlusion (neoplasm or diverticulitis) with a competent ileocecal valve. Acute cecal distension to greater than 12 cm should prompt consideration of surgical decompression. A loop transverse colostomy, which may be performed under local anesthesia in an unstable patient, affords highly effective decompression and facilitates rapid stabilization of the patient in preparation for a delayed definitive procedure.

Treatment of Complex Rectovaginal Fistulas

Onlay Patch Cardiac

The choice of operative repair for complex rectovaginal fistulas is primarily dependent on the etiology. High fistulas secondary to hysterectomy, diverticulitis, or previous surgery are amenable to proctectomy with anastomosis. Low, recurrent fistulas are most appropriately treated with the gracilis transposition or Martius bulbocavernosus graft. If the fistula is associated with cancer, resection appropriate for that specific cancer is undertaken. Abdominoperineal resection or pelvic exenteration may be needed for extensive disease, whereas diversion via a colostomy may be needed for palliation in unresectable disease. If the fistula is secondary to radiation, highly symptomatic patients that are otherwise healthy are candidates for repair once recurrent neoplasm has been excluded by multiple biopsies. Temporary diversion is usually undertaken in association with repair that may be accomplished with muscle transposition if low, and with low anterior resection with anastomosis if...

Constipation

Laxatives should be avoided if there is any question that the patient has an intestinal obstruction, severe abdominal pain, or symptoms of appendicitis, ulcerative colitis, or diverticulitis. Most laxatives stimulate peristalsis. Laxative abuse from chronic use of laxatives is a common problem, especially with the elderly. Dependence can become a problem.

Bulkforming

Powdered bulk-forming laxatives come in flavored and sugar-free preparations and should be mixed in a glass of water or juice, stirred. The patient should drink it immediately, followed by a half to a full glass of water. Insufficient fluid intake can cause the drug to solidify in the GI tract, resulting in intestinal obstruction. Bulk-forming laxatives do not cause dependence and may be used by patients with diverticulosis, irritable bowel syndrome, ileostomy and colostomy.

Emollients

Emollients are contraindicated in patients with inflammatory disorders of the GI tract, such as appendicitis, ulcerative colitis, undiagnosed severe pain that could be due to an inflammation of the intestines (diverticulitis, appendicitis), pregnancy, spastic colon, or bowel obstruction.

Intestinal Lesions

Ingestion of NSAIDs has also been associated with colonic ulcers, large intestinal perforation and bleeding, complications of diverticular disease (perforation, fistulae and bleeding) and with relapse of inflammatory bowel disease (Bjarnason et al, 1993 Faucheron, 1999). In addition, over the past 10 years or so there have been an increasing number of anecdotal reports of NSAID-associated colonic strictures or NSAID-induced colonic diaphragm disease in patients receiving diclofenac, indomethacin, sulindac, phe-nylbutazone, ibuprofen, and etodolac (Eis et al., 1997 Ribeiro et al., 1998 Faucheron, 1999 Weinstock et al., 1999 Smith and Pineau, 2000).

Etiology

Any perineal infection can lead to the formation of a rec-tovaginal fistula. Perirectal abscesses, venereal diseases, or Bartholin's cysts may induce inflammation leading to low rectovaginal fistulas. High fistulas are most often caused by diverticulitis, although tuberculosis and lymphogranu-loma venereum have been reported.