diverticulitis: imaging, intervention and surgery · diverticulitis: imaging, intervention and...
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Diverticulitis: Imaging, Intervention and Surgery
DENNIS FOLEY
MEDICAL COLLEGE WISCONSIN
2006
2011
• COLONIC DIVERTICULA
• MURAL THICKENING
• MESENTERIC STRANDING
DIVERTICULITIS MICRO PERFORATION
Acute Diverticulitis
COLONIC DIVERTICULA
MURAL THICKENING
PERICOLONIC FAT STRANDING
EXTRA COLONIC GAS
EPIPLOIC APPENDAGITIS
Epiploic Appendagitis
TORSED EPIPLOIC APPENDAGE
CENTRAL FAT
SURROUNDING FAT STRANDING
NEGATIVE FOR COLON INFLAMMATION OR ISCHEMIA
EPIPLOIC APPENDAGITIS
SEGMENTAL ISCHEMIC COLITIS
TUBO OVARIAN ABSCESS
Acute Diverticulitis
DIFFERENTIAL DIAGNOSIS FOCAL COLITIS
PERFORATED CARCINOMA
SEGMENTAL ISCHEMIA
APPENDICITIS
SALPINGITIS
APPENDAGITIS
Diverticulitis: Hinchey Classification
1. CONFINED PARACOLIC ABSCESS
2. DISTANT ( PELVIC, RETROPERITONEAL ) ABSCESS
3. PURULENT PERITONITIS
4. FECULENT PERITONITIS
PERFORATED DIVERTICULIITS
HINCHEY CLASS 3/4
PERFORATED DIVERTICULUM HINCHEY CLASS 3/4
EXTRA PERITONEAL DIVERTICULAR PERFORATION
Colonic Perforation
INTRAPERITONEAL
EXTRAPERITONEAL PERIRENAL
PARARENAL
PRE SACRAL / PELVIC FLOOR
Diverticulitis Pericolonic Abscess
PERI COLONIC FLUID COLLECTION ASSOCIATED FINDINGS OF
DIVERTICULIITS OTHER POSSIBLE ETIOLOGIES
PERFORATED CARCINOMA INFLAMMATORY BOWEL DISEASE POST OPERATIVE
Percutaneous Abscess Drainage
CAUSE
LOCULATION
ACCESS
CLINICAL ISSUES PERITONITIS
BLEEDING
FISTULA
Pericolonic Abscess Drainage
ACCESS TRANS ABDOMINAL
TRANS GLUTEAL
TRANS RECTAL
DIVERTICULAR ABSCESS ANTERIOR PAFD INCOMPLETE DRAINAGE
TRANSGLUTEAL PCD
TRANS RECTAL PAFD
2 MONTH FOLLOW UP
Colovesical and Enterovesical Fistula
DIAGNOSIS CYSTOGRAPHY
WATER SOLUBLE ENEMA
CT CYSTOGRAPHY
COLOGRAPHY
ENTEROGRAPHY
Diverticulitis
CT IS KEY TO DIAGNOSIS AND MANAGEMENT OF OFTEN COMPLEX PATIENTS
BE AWARE OF THE DIFFERENTIAL DIAGNOSIS
DIFFERENT APPROACHES FOR PAFD PAFD AND SURGERY PLAY
COMPLEMENTARY ROLE IN PATIENT MANAGEMENT.