Sigmoid diverticulitis

Definition

Definition

What is the Sigmoïd Diverticulitis?

The diverticula are small hernias or pockets which can be formed in the large intestine or the rest of your digestive tract, including the oesophagus, the stomach and the small intestine.

The diverticula are frequent, especially after 40 years.

When you have several diverticula colics, one speaks about diverticulose.

The diverticulite occurs when a diverticulum (seldom several) is ignited or infected, causing a severe abdominal pain

 

(classical appendicitis diagnoses on the left) a fever, nauseas?

  • The benign crises of diverticulite are treated by antibiotics, the rest and the change of your dietary habits.
  • Do the serious crises of diverticulite require a hospitalization and sometimes a surgical operation in urgency.?
  • The differed surgery – remotely of the crisis – can be to discuss with prophylactic aiming or to regulate a complication (stricture or fistula)

 

Symptoms and Causes

Symptoms

The signs and the symptoms of the diverticulite understand:

  • Abdominal pain of strong intensity and brutal appearance, localised in the left lower part of the abdomen (side and left iliac pit). Less frequently can the pain be light at the beginning, and worsen thereafter.?

  • ? Fever

  • Nauseas and vomiting

  • Distensions?

  • Disorders of the transit: Constipation, Diarrhoea?

Causes

The diverticula generally develop with the level of the points of anatomical weakness of your colon.

The mechanism which underlies occurred of complication is not clearly establishes.

One of the theories stipulates that the obstruction of the narrow opening (or collet) of the diverticulum can increase the pressure and reduce the contribution of blood in the area,

what leads to the ignition then with superinfection. ?

In the past, the doctors thought that the walnuts, the seeds, the popcorn, played a part in the appearance of a diverticulite.

 

Risk factors

  • Risk factors

  • Old: You have more risks to present a diverticulite, if you have more than 40 years: the reduction in the force and the elasticity of the intestinal wall, related to the age, could contribute to a diverticulite.

  • Food low in fibres: The diverticulite is rare in the countries where people follow a mode rich in fibres which contributes to maintain saddles soft. But this disease is current in the industrialized countries where the average food mode is high out of glucids refined and low in fibres.

  • Obesity and Lack of exercise: The ponderal overload increases the risks considerably to develop a diverticulite.

 

Complications

The serious crises of diverticulite require a hospitalization and sometimes a surgical operation in urgency

Peritonitis

  • can occur if the infected or ignited diverticula break, pouring the intestinal contents in your abdominal cavity. That can involve an ignition of the mucous membrane of the abdominal cavity (the peritoneum).

  • The peritonitis requires immediate care. It is a surgical urgency

Abscess

  • occurs around a perforated diverticulum. An abscess can be aspired by introducing, through the skin, a needle which is guided by echography or scanner (TDM). A drain is then placed to evacuate the contents of the abscess. This catheter can require to remain in place during the hospitalization. An antibiotic treatment will be also necessary. Once you will have been restored, a surgical operation of intestinal resection could be necessary (colectomy).

Enteric fistula

 

  • is an abnormal communication between your intestine (sigmoid) and various bodies (the bladder, the vagina, your abdominal wall).

Stricture sigmoïdienne

  • can be the cause of disorders of the transit or obstruction of the bowels. Although there does not seem to be direct link between the diverticulite and the cancer of the colon, it can return cancers more difficult to diagnose.

  • What seems to be a diverticulite can be a cancer of the colon; so remotely of a crisis of diverticulite, a coloscopy is recommended. The coloscopy is an examination which makes it possible to explore your colon and your rectum using a flexible tube provided with a tiny video camera (endoscope).

Réctorragie

  • is the emission, by the anus, of red blood not digested. Is it about a bleeding arte? riel having for origin the arterioles traversing the collet of the diverticula. The natural history overall is favorable: 70 does have the 80% of hemostase spontaneous and sometimes the haemorrhage is badly tolerated.

  • The angiography can allow the selective embolisation of the small artery of the diverticulum responsible for the bleeding and solve the problem.

  • The recourse to the surgery in urgency (segmentary colectomy or blind total colectomy) is a rare event.

 

sigmoidectomie à distance

Differed surgery

Left Colectomy or prophylactic sigmoidectomy after diverticulite.
 

The time between the surgery and the last push must be of in the 3 months month.

The potential benefit and the risks of this surgery are to be discussed on a case-by-case basis.

Indication in prophylactic Sigmoïdéctomy

After two scannographic pushes of sigmoïdite complicated with signs of gravity after a push engraves at the subject of less than 50 years.

 

Video colectomy

 

The left colectomy is the name of the procedure of resection of the lesions located on the left half of the transverse, colonist downward and sigmoid. The sigmoidectomy is the resection of the sigmoid one.
According to the degree of the ignition, the surgery will be traditional or by invasive mini way (laparoscopy = coelioscopy).

In traditional surgery, a large incision is necessary, while the left colectomy by laparoscopy is an mini-invasive intervention. It is carried out through three or four small incisions.

The operational time of a left colectomy is variable between 1:00 and 3.30 H according to the weight of the patient and the encountered difficulties.

A mobilization activates and an early refeeding facilitate recovery.

An intervention of colectomy by laparoscopy is in general a little longer. On the other hand, convalescence is much faster.

 

Technic of laparoscopic sigmoidectomy

Technic of sigmoïdectomy with 3 trocar