Editing Diverticular disease (section)

== '''Management of other complications''' ==

=== '''Obstruction''' ===

** Fibrosis of colonic wall,      leading to stricture
** Presents with insidious      symptoms and a partial obstruction
** Needs operation
*** Partial obstruction - aim       elective resection
*** Complete obstruction -       emergency surgery
** Consider cancer as similar      appearance on CT. Exclude with colonoscopy prior to OT if possible.

=== '''Fistula''' -  require surgery generally ===

** Occur due to development of      an abscess that decompresses into a neighbouring organ
** Colovesical fistula:
*** Most common type,       especially in men.
*** Generally to dome of       bladder.
*** Present with recurrent       UTIs, which are generally polymicrobial. Pneumaturia and faecaluria may       be present.
*** Rarely need an emergency       operation. If needing to do something emergently, probably better off       diverting as a bridge to elective resection.
*** Poppy seed test is       diagnostic in 95% (actually much better than cystoscopy or CT). CT shows       air in bladder in absence of prior instrumentation. Can generally be       seen on cystoscopy.
*** Settle sepsis, arrange       colonoscopy and flexible sigmoidoscopy (+/- ureteric stenting) and fix       with segmental resection. Don't need to do anything to close bladder       side usually. Leave IDC 72 hours.
*** Non-operative management is       usually a fruitless endeavour with the eventual development of       multi-resistant UTIs that have to be palliated.
** Colovaginal fistulae
*** Almost exclusively in       post-hysterectomy women
*** Present with vaginal       discharge and passing air per vagina
*** Can present immediately       after an acute perforation with sudden release of fluid from vagina,       which stops spontaneously in most cases. If it doesn't they could have a       diverting loop ileostomy, as a bridge to elective resection.
** Colocutaneous
*** Usually at site of a       previous percutaneous abscess drainage
*** Usually don't need       emergency surgery - investigate with colonoscopy and appropriate imaging       to exclude Crohn disease
*** Need to resect the colon       and tract with primary anastomosis
** Coloenteric
*** Usually require resection       and primary anastomosis

=== '''Bleeding''' ===

** See LGIB topic