Colonic Diverticulitis Complicated by Liver Abscess: Case Series and Review of Literature (original) (raw)
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Hepatic Abscess as Early Presentation of Perforated Diverticulitis
Journal of Medical Cases
A hepatic abscess is a rare condition which can have multiple etiologies, including biliary disease, intra-abdominal collections (appendicitis, diverticulitis, and inflammatory bowel disease), abdominal surgery, liver transplantation, and liver trauma. The diagnosis is primarily based on imaging findings of ultrasound and computed tomography scan. Management includes antibiotics and percutaneous drainage or surgical drainage of the abscess. Here, we present a case of a 43-year-old Hispanic female who initially presented with left lower quadrant and right upper quadrant abdominal pain for 1 week. She was found to have a hepatic abscess and pelvic abscess likely secondary to perforated diverticulum.
Cureus, 2023
Pyogenic liver abscess (PLA) is known as a pus-filled lesion found in the liver which can quickly become fatal if not found and treated in a timely manner. The most common group of bacteria found in PLA is the Streptococcus Anginosus Group (SAG). Patients with PLA usually present with fever and right upper quadrant abdominal pain which can at times be referred to the right shoulder owing to dermatomal involvement. We present a case where a patient with a past medical history significant for recent diverticulosis presenting with a left lower quadrant abdominal pain, fever, and hypotension and on further workup was found to have a PLA. Blood cultures and cultures from the abscess grew Streptococcus constellatus. This bacteria is part of the SAG group however, it is rarely found in PLA and bloodstream.
The Clinical Picture of Uncomplicated Versus Complicated Diverticulitis of the Colon
Digestive Diseases and Sciences, 2008
Purpose There is no consensus about the correct definition of uncomplicated diverticulitis (UD) in clinical practice. We evaluated therefore whether clinical picture of UD differs from complicated diverticulitis (CD). Fifty consecutive eligible patients (21 males, 29 females, mean age 63.6 years, range 47-75 years) were studied. Symptoms, the inflammatory indices, and Computerized Tomography (CT) scan of the abdomen were assessed at the time of admission. Results Thirty-nine patients classified were affected by UD and 11 patients by CD. CD patients showed more severe clinical picture than UD and required urgent Hospital admission. Conversely, most of the patients affected by UD were treated as outpatients. CD patients showed higher symptom scores than UD patients, except the parameter ''diarrhea''. All CD patients showed increases in all inflammatory indices. Conversely, all UD patients showed increased ESR, CRP and fibrinogen, but WBC and a1-acid glycoprotein were increased in only a few cases. CT scan in CD patients always showed signs of severe colonic and pericolonic inflammation. Conversely, UD patients often showed moderate localized signs of inflammation without complication. Conclusions Clinical, laboratory, and radiological findings may easily differentiate uncomplicated from complicated diverticulitis of the colon. This integrated approach may be helpful in clinical settings.
Multicentre study of non-surgical management of diverticulitis with abscess formation
British Journal of Surgery
Background Treatment strategies for diverticulitis with abscess formation have shifted from (emergency) surgical treatment to non-surgical management (antibiotics with or without percutaneous drainage (PCD)). The aim was to assess outcomes of non-surgical treatment and to identify risk factors for adverse outcomes. Methods Patients with a first episode of CT-diagnosed diverticular abscess (modified Hinchey Ib or II) between January 2008 and January 2015 were included retrospectively, if initially treated non-surgically. Baseline characteristics, short-term (within 30 days) and long-term treatment outcomes were recorded. Treatment failure was a composite outcome of complications (perforation, colonic obstruction and fistula formation), readmissions, persistent diverticulitis, emergency surgery, death, or need for PCD in the no-PCD group. Regression analyses were used to analyse risk factors for treatment failure, recurrences and surgery. Results Overall, 447 patients from ten hospita...
Colonic Diverticulosis: From Asymptomatic Form to Major Complications
Internal Medicine
Introduction This pathology is rare in patients younger than 40 years old (5%) and, in those older than 70 years old, almost 50% exhibit colonic diverticulosis. Most cases have mild symptoms and only 20% presents complications as: bleeding, bowel obstruction, abscess and secondary peritonitis.Aim. The aim is to analyse different types of complications in colonic diverticulosis and compare the data from literature to those in Argeș geographical area.Material and method. The medical records of 120 patients out of which 101 were admitted in gastroenterology department and 19 in general surgery department were analysed. Diagnosis methods: colonoscopy, computed tomography with contrast dye, simple abdominal radiograph for acute abdominal pain.Results. 40 patients (33.33%) with asymptomatic colonic diverticulosis, 28 patients (23.33%) moderate diverticulitis, 25 patients (20.83%) with moderate anorectal bleeding, 25 patients (20.83%) with secondary peritonitis, and 2 (1.68%) cases with co...
Diverticulitis: a comprehensive review with usual and unusual complications
Insights into Imaging, 2016
Diverticulitis is characterized by inflammation of the outpouchings of the bowel wall. Imaging findings of diverticulitis include edematous thickening of the bowel wall with inflammatory changes within the adjacent mesenteric fat. Uncomplicated diverticulitis can be treated conservatively; however, complicated diverticulitis may not be responsive to medical treatment and life-threatening conditions may occur. In this review, we aimed to illustrate the ultrasonography (US) and computed tomography (CT) features of diverticulitis and its complications including perforation, phlegmon, abscess, ascending septic thrombophlebitis (phylephlebitis), bleeding, intestinal obstruction, and fistula. Teaching Points • Complications of diverticulitis may be highly variable. • It may be difficult to diagnose diverticulitis as underlying cause of severe complications. • MDCT is essential for the primary diagnosis of the acute diverticulitis and its complications.
JPMA. The Journal of the Pakistan Medical Association, 2014
To assess the morbidity and mortality associated with complicated diverticulitis in Pakistan. The retrospective case series was conducted at an urban tertiary care university hospital of Karachi, Pakistan, comprising data from December 1989 to November 2010. International Classification of Diseases codes for diverticular disease and diverticulitis with abscess, fistula, stricture, bowel obstruction and perforation were obtained from the medical record department. SPSS 19 was used for statistical analysis. A total of 60 (1.9%) cases with complicated diverticulitis were located from among 3170 records reviewed. Mean age was 62.7 +/- 13 years with male-to-female ratio being 36:24. In 37 (62%) patients, the diagnosis was established on computed tomography scan of the abdomen, followed by barium enema in 12 (20%) and colonoscopy in 11 (18%). Post-operative morbidity was observed in 24 (40%) and 7 (16%) expired within 28 days of surgery. Post-operative intra-abdominal sepsis, wound dehisc...
Spectrum of disease and outcome of complicated diverticular disease
The American Journal of Surgery, 2003
Background: Diverticular disease is a common entity. The presentation, investigations performed, and management are variable. Our objectives were to assess the presentation, extent of disease, and treatment of a cohort of patients with colonic diverticulitis. Methods: All patients with a diagnosis of diverticulitis over a 9-year period were reviewed. Patients were assessed as to age, sex, presenting symptoms, diagnostic studies, extent of disease, treatment, and outcome. Results: Over a 9-year period (1992 to 2001), 192 patients were admitted with a diagnosis of colonic diverticulitis. The mean age was 61 years (range 28 to 90); 113 of 192 (59%) were female. The mean duration of symptoms prior to presentation was 14 days (range 1 to 270 days). One hundred eighteen of 192 (61%) had a previous documented attack of diverticulitis. Of the investigations performed 128 of 192 (66.7%) had a computed tomography (CT) scan of the abdomen and pelvis, 37 of 192 (20%) underwent a contrast enema, 61 of 192 (32%) underwent colonoscopy and 2 of 192 (1%) underwent a small bowel series. The abnormal findings on the CT scan were as follows: diverticular abscess (16%), diverticulitis (37%), diverticulosis without inflammation (15%), free air (10%) and fistula (1%). The locations of the diverticular abscesses were: pelvic (36%), pericolic sigmoid (36%), and "other," which included interloop (28%). Preoperative abscess drainage occurred in 10 of 192 (5%), which were either percutaneous, 6 of 192 (3%), or transrectal, 4 of 192 (2%). Nine of 192 (6%) presented with a fistula, colovesical fistulae (3%), colocutaneous (1%), enterocolic (1%), or colovaginal (1%). Overall, 73 of 192 (38%) underwent surgery. All patients undergoing surgery had a resection of their colon. The operative findings were localized abscess in 16 of 73 (22%), purulent/feculent peritonitis in 12 of 73 (17%), and phlegmon in 10 of 73 (14%). Sixty-seven of 73 (92%) had a primary resection with anastomosis; 38 of 67 (56%) had a protecting stoma. Five of 73 (7%) patients were found to have an unsuspected carcinoma. Overall, 29 of 192 (15%) developed a complication related to diverticulitis. Morbidity was 15.1%, of which 34% was infection related. Four of 192 patients (2%) died. Conclusions: In our experience, most patients presented with abdominal pain predominantly in the left lower quadrant. The symptoms were present on average of 14 days, most were female (59%), and most patients had a previous attack of diverticulitis. The commonest investigation performed was a CT scan (66.7%); however, other investigations were performed, for example, barium enemas. The practice of resection and primary anastomosis for acute diverticulitis has an acceptable morbidity and mortality. For high-risk anastomoses, a covering loop ileostomy and not a Hartmann's procedure is preferred. Surgery remains safe for the majority of patients and is associated with resolution of symptoms. We believe that because of the high number of patients in our series who had a previous attack of diverticulitis, therapy should be focused on preventing recurrent and virulent attacks by earlier operative intervention.