Imaging Pearls ❯ Colon ❯ Diverticulitis
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- “The most frequent complication of DD is diverticulitis, and the second one is hemorrhage. Excluding ano-rectal diseases, hemorrhage secondary to DD is the second cause of bleeding of the lower gastrointestinal tract, but it is the main cause of massive bleeding up to 30 to 50% of cases. It is estimated that up to 15% of patients with DD in the colon will bleed at some point in their life, bleeding is usually painless and large, and is up to one-third of the cases massive and requires hospitalization and transfusion support.”
Colonic diverticular bleeding. Have we identified the risk factors for massive bleeding yet? Blancas Valencia JM Rev Esp Enferm Dig. 2017 Jan;109(1):1-2. - “It is estimated that up to 15% of patients with DD in the colon will bleed at some point in their life, bleeding is usually painless and large, and is up to one-third of the cases massive and requires hospitalization and transfusion support.” Colonic diverticular bleeding. Have we identified the risk factors for massive bleeding yet? Blancas Valencia JM Rev Esp Enferm Dig. 2017 Jan;109(1):1-2.
- “The natural history of colonic diverticula hemorrhage indicates that it is stopped spontaneously in 70 to 80% of cases, so treatment should be directed to support management, in 20 to 30% of cases specific medical treatment through endoscopic management with any of the available modalities such as: epinephrine injection, thermal or mechanical methods such as endoscopic clip or ligature, and in very few cases a radiological or surgical treatment will be necessary.”
Colonic diverticular bleeding. Have we identified the risk factors for massive bleeding yet? Blancas Valencia JM Rev Esp Enferm Dig. 2017 Jan;109(1):1-2. - “Once the initial episode of bleeding stops, most patients will not recur, and only 30% will present a second bleeding episode and in this rebleeding group the risk of a new bleeding episode is very high, so surgical treatment is recommended.”
Colonic diverticular bleeding. Have we identified the risk factors for massive bleeding yet? Blancas Valencia JM Rev Esp Enferm Dig. 2017 Jan;109(1):1-2. - Colonic Diverticular Bleeding: Risk Factors
• smoking
• alcohol consumption
• consumption of non-steroidal anti-inflammatory drugs (NSAIDs)
• antithrombotic drugs
• bilateral presence of colonic DD
• chronic degenerative diseases, such as hypertension, diabetes mellitus, ischemic heart disease and obesity
- At primary clinical presentation all patients showed clinical symptoms of recurrent urinary tract infections, 74.1% had pneumaturia and 53.7% fecaluria. Fistula detection rates were 94.8% for the poppy seed test, 58.7% for CT scanning, 19.4% for cystography, 38.6% for colon enema, 15.1% for cystoscopy and 9.6% for coloscopy. Of the patients 6 (11.1%) showed perioperative morbidity (3 pneumonia and 3 superficial wound infections) and mortality was 0%. After surgical intervention no recurring diverticulitis or fistulas were detected within a median follow-up period of 62 months (range 1-164 months).
Colovesical fistula caused by diverticulitis of the sigmoid colon: diagnosis and treatment Leicht W et al. Urologe A. 2012 Jul;51(7):971-4. - “Although rare, colovesical fistulas represent the most common form (65% of cases) of an acquired bladder–enteric fistula and most frequently occur between the recto-sigmoid and the bladder dome . Diverticular disease represents their major cause (two-thirds of cases), followed by colorectal carcinoma, whereas uncommon aetiologies include Crohn’s disease, bladder or uterine neoplasms, previous irradiation, female pelvic inflammatory diseases, periappendiceal abscesses penetrating trauma or foreign bodies.”
Multidetector CT cystography for imaging colovesical fistulas and iatrogenic bladder leaks Massimo Tonolini and Roberto Bianco Insights Imaging. 2012 Apr; 3(2): 181–187. - “Based on our experience, MDCT cystography should be recommended as the most effective and accurate technique for direct visualization or exclusion of both spontaneous enterovesical fistulas and bladder leaks or fistulas following instrumentation procedures, obstetric or surgical interventions.”
Multidetector CT cystography for imaging colovesical fistulas and iatrogenic bladder leaks Massimo Tonolini and Roberto Bianco Insights Imaging. 2012 Apr; 3(2): 181–187.
- Diverticular Disease: Facts
- Incidence of diverticulosis increases substantially with age
- Most common cause of hematochezia in the elderly
- Diverticular bleeding is usually arterial, and can be massive and severe
- Even if active bleeding is not visualized, the presence of many colonic diverticula should be suggestive of cause of bleeding
- “ There are limited data to support the recommendation to perform colonoscopy after a diagnosis of acute diverticulitis.”
Colonoscopy after CT Diagnosis of Diverticultis to Exclude Colon Cancer: A Systematic Literature Review
Sai VF et al.
Radiology 2012; 263: 383-390 - “ On the basis of a limited number of published studies, the pooled prevalence of colorectal cancer after a CT diagnosis of acute diverticulitis is 2.1%.”
Colonoscopy after CT Diagnosis of Diverticultis to Exclude Colon Cancer: A Systematic Literature Review
Sai VF et al.
Radiology 2012; 263: 383-390
- Right Sided Diverticulitis : Key Facts
- Uncommon but can simulate appendicitis
- Often younger femal
- Abscess not uncommon