caused by severe inflammation of bowel wall layers with subsequent necrosis and loss of intestinal wall integrity
almost always occurs on the left side
well contained perforations are usually small and self-limited and free air is usually detected locally, in non-contained perforation (1-2% of patients with acute diverticulitis), local abscess and fistula formation may occur with widespread intraabdominal free air
abscess
abscesses may be detected in up to 30% of patients with acute diverticulitis
remote site of absecess formation may occur e.g. - liver, adnexa, lung and rare localizations such as brain and spine
management depends on the size, location and overall condition of the patient
pylephlebitis
also called ascending septic thrombophlebitis, pylephlebitis is a condition characterised by infective suppurative thrombosis of either the portal vein or its branches, or both
most commonly involved are - thrombosis of the superior mesenteric vein (42%), followed by portal vein (39%), and finally, the inferior mesenteric vein (IMV) (2%)
other causes of pylephlebitis include: appendicitis, necrotizing pancreatitis, bowel perforation, pelvic infection and inflammatory bowel disease
bowel obstruction
is a rare complication, partial obstruction (due to wall oedema and peripheral inflammation or abscess formation) may occur
bleeding
lower GI bleeding is present in 5% of colonic diverticulosis
fistula
fistula formation occurs at a rate of around 14% fter an episode of acute diverticulitis
results from a breach in wall integrity of adjacent structures due to a diverticular abscess
fistula formation following diverticulitis may be associated with the following structures: urinary bladder, ureter, other adjacent intestinal segments, gallbladder, uterus, fallopian tubes, vagina, skin, and the perianal region
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