Nonoperative Management of Complicated Diverticular Disease

David M. Schaffzin; W. Douglas Wong

doi:10.1055/s-2004-832698

Clinics in Colon and Rectal Surgery, Table of Contents

Clin Colon Rectal Surg 2004; 17(3): 169-176
DOI: 10.1055/s-2004-832698

Nonoperative Management of Complicated Diverticular Disease

David M. Schaffzin¹ , W. Douglas Wong¹

¹Memorial Sloan Kettering Cancer Center, New York, New York

Abstract

The complications of diverticular disease of the colon can be divided into those related to inflammatory conditions (diverticular abscess, fistula, and perforation) and those related to noninflammatory conditions (lower gastrointestinal hemorrhage and noninflammatory stricture or obstruction). Nonoperative management of uncomplicated diverticulitis includes bowel rest and antibiotics. For abscesses, percutaneous drainage by radiologic guidance often turns complicated diverticulitis to an uncomplicated condition. In very select instances, fistulas or even perforation may be managed without operation. Strictures may be dilated or stented. Diverticular hemorrhage may be controlled with colonoscopic and angiographic techniques. For colonoscopy, these include cautery, epinephrine injection, and endoclips. For angiography, these include arterial infusion of vasopressin and selective embolization of bleeding vessels. For both diverticulitis and diverticular bleeding, these nonoperative therapeutic modalities may be utilized as a bridge to surgery, or in select instances as a definitive therapy obviating the need for surgery.

KEYWORDS

Diverticulitis - diverticular bleeding - nonoperative management

Full Text

References

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W. Douglas WongM.D.

Memorial Sloan Kettering Cancer Center

1275 York Ave., C1067, New York

NY 10021

Email: Wongd@MSKCC.org