- 15% of north American patients. Majority are pseudodiverticula
- medical management is mainstay for uncomplicated disease
- localized diverticulotomy can be performed for very localized and mild disease
Young patients:
- patients younger than 40 yo
- current textbooks suggest treating in same fashion as in older patients.
- elective resection is individualized to the patient but generally does not follow a single attack.
Immunosuppressed patient:
- included in his group are chronic alcoholics, transplant patients, chemotherapy patients.
- incidence is not higher but consequence of a complicated attack is more significant
- corticosteroids cause thinning of colonic wall, suppressed physical exam, attenuated inflammatory response
- are RA patients on methotrexate and IBD patients on biologics considered Immunosuppressed?
- prophylactic colectomy not needed if diverticulosis found but aggressive investigation and treatment of diverticulitis warranted.
Trivia:
- diverticulitis has replaced appendicitis as most common source of liver abscess of portal origin.
- recurrence of diverticulitis after colectomy in the range of 1-10%
- level of anastamosis is only identifiable risk factor.
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