Complications of Diverticulitis… a pyogenic liver abscess!

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Diverticulitis:

  • Mean age of diagnosis 63 years old, but 16% of cases occur <age 45
  • Most common symptom is abdominal pain: 95% LLQ pain, 5% is RLQ pain (more common in Asian patients)
    • 10-15% of diverticulitis patients have dysuria, urgency, or frequency
  • In an otherwise healthy patients under the age of 70, uncomplicated diverticulitis without sepsis, significant leukocytosis, diffuse peritoneal signs, or fever >102.5 can be treated outpatient as long as the patient has access to close follow-up (3 days)
    • If symptoms and infectious markers have not improved in 3 days, abscess should be suspected and patient should be admitted and reimaged
  • Outpatient treatment of diverticulitis:
    • Antibiotics: Cipro and flagyl first line
    • No evidence for dietary restrictions, but most providers recommend clear liquid diet until symptoms improve
    • Colonoscopy 6-8w after symptoms resolved to screen for colorectal cancer
    • Prevention of recurrences:
      • High-fiber diet
      • No evidence for avoidance of nuts, seeds, or corn as was previously thought
  • Complications of acute diverticulitis: abscess, perforation, obstruction, and fistula (usually colovesicular)

Pyogenic Liver Abscess:

  • usually polymicrobial
    • EColi most common in Western world
    • Klebsiella most common in Asia (beware of hypermucoid variant)
    • Strep milleri group is common (anginosus, constellatus, intermedius)
    • Staph and strep pyogenes can occur after procedures such as embolization
  • Most common symptoms is fever 90%
    • Abdominal pain 50-75%
    • N/v, anorexia, weight loss, malaise
  • LFTs are no necessary elevated
  • Mainstays of treatment are percutaneous drainage vs. surgical drainage and prolonged course of antibiotics (4-6 weeks)

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