Complications of diverticular disease

complication of diverticular disease

• perforation
  • 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

Reference:

1. Onur MR, Akpinar E, Karaosmanoglu AD, Isayev C, Karcaaltincaba M. Diverticulitis: a comprehensive review with usual and unusual complications. Insights into Imaging. 2017;8(1):19-27