The document discusses a case of diverticulitis. It provides details on the patient's history, symptoms, and laboratory and imaging findings. For diagnosis, an abdominal CT scan is considered the best imaging method to confirm diverticulitis. Management depends on severity but typically involves antibiotics, sometimes percutaneous or surgical drainage for more severe cases. Diagnosis is made using abdominal CT scan showing colonic diverticula, bowel wall thickening or inflammation.

1. CASE B: DIVERTICULITIS
Presented by:
Arwa H. Al-
Onazyan.
ID: 215007943.

2. OUR CASE:
 Previous patient- manages to change her dietary pattern
and her complaints recede.
 Her bowel movements was 4 times a week.
 She used a high fiber diet and laxative.
 Now !
 A crampy pain in her left lower abdominal quadrant.
 Her appetite has diminished since 3 days.
 She had temperature ( 37.6 °C ).

3. LEARNING OBJECTIVES:
 Which additional laboratory studies and imaging
procedures do you request to come to a definitive
diagnosis ?
 Which treatment options do you consider ?

4. INTRODUCTION!
 Diverticulosis?
Diverticulitis?

5. DIAGNOSIS OF DIVERTICULITIS
Investigation
Physical
examination
History

6. LABORATORY STUDIES
 Complete blood count (CBC):
 Red blood cells > bleeding
 White blood cells (leukocytosis) < inflammation
• The absence of leukocytosis does not rule out diverticulitis, as 20-40% of
patients have a normal white blood cell count.
 Chemistries:
 Helpful in the patient who is vomiting, has diarrhea < electrolyte
abnormalities.
 CRP + ESR.

7. LABORATORY STUDIES
 The fecal occult blood test :
 Looks for blood in the stool.
 Liver tests and serum lipase + amylase:
 To exclude other causes of abdominal pain.
 Urinalysis:
 To exclude urinary tract infection.
 Pregnancy test:
 To rule out if the patient has ectopic pregnancy.

8. LABORATORY STUDIES
CBC:
- Increase WBC,
or normal.
- Decrease RBC.
Increase ESR, CRP
The fecal occult
blood test: show
blood in stool.
Liver tests and
serum lipase +
amylase:
Normal
Urinalysis:
No abnormality.
Pregnancy test:
Negative.

9. IMAGING STUDIES
 Abdominal CT scan :
 CT scan of the abdomen is considered the best imaging method to confirm the
diagnosis.
 It can help assess disease severity, the presence of complications, and clinical
staging.
 Possible CT findings include:
Colonic diverticula, bowel wall thickening, soft tissue inflammatory

10. ABDOMINAL CT SCAN

11. IMAGING STUDIES
 Contrast enema:
 Is not the imaging of choice.
 May be an option when CT scans do not absolutely
differentiate between diverticulitis and colonic carcinoma.
 Plain radiograph films:
 Not helpful in making the diagnosis of diverticulitis.
 Can demonstrate bowel obstruction.

12. IMAGING STUDIES
 Ultrasound examination:
 More available and cheap, but it’s less sensitive than CT.
 Colonoscopy:
Is not recommended in the acute setting given the risk of
worsening diverticulitis and bowel perforation.
 Used to evaluate the extent of diverticulosis.
 Used to rule out a malignancy.

13. QUIZ TIME!
Q1) In CBC there will be:
A- Elevated RBCs.
B- Decreased RBCs.
Q2) The best imaging study to confirm the diagnosis of
diverticulitis:
A- Colonoscopy.
B- X-rays.
C- Abdominal CT scan.

14. TREATMENT OF DIVERTICULITIS
 Varies with severity.
 Liquid diet, oral antibiotics for mild disease.
 IV antibiotics, npo for more severe disease.
 CT-guided percutaneous drainage of abscess.
 Sometimes surgery.

15. TREATMENT OF DIVERTICULITIS
 Mild (not very ill) cases:
• Treated at home with rest and liquid diet.
•Oral antibiotics eg:
• Ciprofloxacin 500 mg bid.
• Amoxicillin/clavulanate 500 mg tid.
• Metronidazole 500 mg qid.

16. TREATMENT OF DIVERTICULITIS
 More severe cases:
• Should be hospitalized.
• Should taking prednisone (patient at higher risk of perforation
and peritonitis).
• Bed rest, npo and IV fluids.
• IV antibiotics eg:
• Ceftazidime 1g IV .
• Plus metronidazole 500 mg IV.

17. TREATMENT OF DIVERTICULITIS
 CT-guided percutaneous:
• An abscess may respond to percutaneous drainage (CT
guided).
• If response is satisfactory, the patient remains hospitalized
until symptoms are relieved and a soft diet is resumed.
• A colonoscopy or barium enema is done ≥ 4 wk after
symptoms have resolved.

18. TREATMENT OF DIVERTICULITIS
 Surgery.
 Surgery is required immediately for patients with:
 Free perforation or general peritonitis.
 Severe symptoms that do not respond to nonsurgical treatment
within 48 h
 ≥ 3 previous attacks of mild diverticulitis (or one attack in a
patient < 50).
A persistent tender mass; clinical, endoscopic, or x-ray signs
suggestive of cancer.

19. SURGERY
 There are 2 types of surgery:
 Primary bowel resection:
 Removes diseased segments of colon and then reconnects the
healthy segments (anastomosis).
 Open surgery or a minimally invasive (laparoscopic) procedure.
 Bowel resection with colostomy:
 So much inflammation that it's not possible to rejoin colon.
 An opening (stoma) in the abdominal wall is connected to the
healthy part of colon.

20. SUMMARY
 Diverticulosis is the presence of multiple diverticula in the colon;
diverticulitis is inflammation of a diverticulum.
 Inflammation remains localized in about 75% of patients; the
remainder develop abscesses, free intraperitoneal perforation, bowel
obstruction, or fistulas.
 Diagnose using abdominal CT with oral and IV contrast.
 Management depends on severity but typically includes antibiotics
and sometimes percutaneous or surgical drainage.

21. ANY QUESTION?

23. REFERENCE
 Merk manual of diagnosis and therapy, nineteenth edition, page
(1222-1224).
 Kumar and Clark’s Clinical medicine, ninth edition, page (418-419).
 Shahedi, :. (2017). Diverticulitis Workup: Laboratory Studies,
Imaging Studies, Procedures. [online] Emedicine.medscape.com.
Available at: http://emedicine.medscape.com/article/173388-
workup#c6.