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home - Colon - Miscellaneous - Diverticular Disease Surgery Written by Dr Sebastian Zeki
Methods GMP
Knows the physiology of intestinal absorption, secretion and motility SCE 1
Understands the biochemical processes occurring within the gut
lumen and at mucosal level

Has awareness of the factors controlling these processes – in
particular the neuro-endocrine influences

Understands the range of mechanisms by which diarrhoea can result
from disturbances in each of these processes

Knows the causes of both acute and chronic diarrhoea
Knows the range of investigations appropriate to determining the
cause of the patient’s diarrhoea and is aware of the range of
therapeutic possibilities

Makes a detailed clinical assessment of patients that present with
either acute or chronic diarrhoea

Recognises the potential need for urgent fluid replacement CbD,
Makes appropriate use of microbiology and other relevant laboratories in reaching a diagnosis

Shows ability to interpret results, reach a diagnosis and formulate a
treatment plan

Reacts appropriately to the urgency of the clinical presentation
Always shows sympathy and understanding especially when the
patient is distressed

Diverticular Disease Surgery

Surgery for Diverticular Disease — 30 % of patients with uncomplicated diverticulitis require surgical intervention during the initial attack.First attack of complicated diverticulitis or after two or more episodes of uncomplicated diverticulitis.Can do it laparoscopicallySurgical mortality rate is approximately 3%. The proximal margin is where the colon becomes soft and nonedematous.Diverticula proximal to the descending/sigmoid colon are unlikely to be symptomatic so dont need to remove all diverticThe distal resection margin is in the upper third of the rectum, where the taenia coalesce Intraoperative assessment — Contraindications to primary anastomosis:Faecal or purulent peritonitis.Associated medical conditions.Poor nutrition.Immunosuppression. Faecal/ purulent peritonitis :Resection, diverting colostomy and a Hartmann rectal stump.Mucous fistula often not possible if entire sigmoid removed so can mark rectal stump with suture and attach to ant abdo wall Post op progression of diverticulosis in the remaining colon occurring -15% Need for further surgery in only 5%. Indications Hinchey's classification of peritoneal contamination determines whether primary anastomosis advisable: Hinchey's classification:Stage I which is a pericolic or mesenteric abscess.Stage II which is a walled-off pelvic abscess.Stage III which is a generalized purulent peritonitis.Stage IV which is a generalized faecal peritonitis. Written by Dr Sebastian Zeki