A case of Complicated Diverculitis

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Complicated diverticulitis which is perforated A/w diabetes and deranged KFTS as raised bul and sr creatinine and hypokalamia Diagnosis is indeed difficult at outset Skillfully done and managed Post operative fever was concern ET infection could have been avoided Well done dr

Thanx dr Dinesh Gupta
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Excellent presentation and management, Diverticulitis and it's complications are classified as per Hinchey classification Stage I disease: Phlegmon or localized pericolic or mesenteric abscess Stage II disease: Walled-off pelvic, intra-abdominal, or retroperitoneal abscess Stage III disease: Perforated diverticulitis causing generalized purulent peritonitis Stage IV disease: Rupture of diverticula into the peritoneal cavity, with fecal contamination causing generalized fecal peritonitis Treatment of diverticulitis is planned as per Hinchey classification and staging Early stage can be managed conservatively with antibiotics and if required Pigtail catheter drainage. Later stages surgical treatment is required.

Thank you
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Complecated diverticulitis with perforation leading to peritonitis is the prime challege to tackle as the pt is highly diabetic with hypokalaemia with emergency laparotomy. Nicely managed sir, really demads appreciation.

yes fortunately patient recovered well. Thanks doc
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A case of complicated Diverticulitis- timely and competently operated-as per the protocol by Dr Chothayi Nienu in curofy Expert Clinical case. Perforated colonic diverticular disease results in considerable mortality and morbidity. This There is existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition. . Several drug and dietary exposures have potential biological mechanisms for causing perforation. Of these only non-steroidal anti-inflammatory drugs have been consistently identified as risk factors in aetiological studies. The causes of perforated colonic diverticular disease remain largely unknown. Further aetiological studies, looking specifically at perforation, are required to investigate whether cause-effect relationships exist for both drug and dietary exposures. The identification of risk factors for perforation would allow primary public health prevention, secondary risk factor modification, and early prophylactic surgery to be aimed at people at high risk.

Nice elaborated Sir
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Completed diverticulitis. It's introduction ,case history , pt profile , physical examination,D /D , investigation routine , CECT whole Abdo , management , post operative and follow up nicely illustrated and discussed key findings are informative and refreshing educative. Thanks for sharing .

Thanks Dr C Nieue.
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Nice case presentation... Diverticulitis is an often missed, underdiagnosed problem usually encountered frequently.... Common cause of LGI Bleed in pts > 45-50 years....can also present with perforation which was well depicted...

VERY INTERESTING AND WONDERRFUL CASE OF ACUTE ABDOMEN WITH SUGAR AND HYPOKAENIA AND TACKLED ACCORDINGLY ...BUT ONE THING THIS ARTICLE TEACHES US THAT WE SHOULD NOT TAKE ACUTE ABDOMEN LIGHTLY AND HOW IT IS TACKLED ,EXAMPLE IS INFRONT OF US ........REALLY MIRACULOUS ....DR.RAJESH GOPAL.

True
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Diverticulitis with high blood sugar with high level of Creatinine & Urea with hypokalemia with acute onset of symptoms with emergency operative procedures following Sigmoidoscopy with perforation. Really managed nicely so complicated case & saved pt's life. U deserve appreciation.

Unusual presentation and excellent management Dr Neinu... great job... sometimes clinical scenarios can be real baffling I have had a Stage III diverticulitis mimicking a perforated sigmoid mass with accidental finding of Polycythaemia Rubra Vera on evaluation ... managed it conservatively ... I had a strong doubt about the repeat sigmoidoscopy report done elsewhere  in a span of 3 weeks suggesting  growth while as previous one was normal ... CT picked up perforated diverticulitis with localised small abscess & biopsy of suspected sigmoid mass ( actually was just edematous region ) showed inflammation only... treated for PRV by chemotherapy .. did well not needing any intervention for diverticulitis

yes it can be confusing clinically but thanks to the imaging diagnostic tools we have now
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