Laparoscopic Sigmoid Resection for Diverticulitis
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Laparoscopic Sigmoid Resection for Diverticulitis- Treatment of Left-Sided Colonic Diverticulitis (2020)
Colonic Diverticular Disease
Benign Disease- A 56-year-old healthy male patient presents to the emergency room because he has been experiencing left-sided abdominal pain for the past 4 days. He reports localized tenderness on examination. Screening colonoscopy performed 3 years prior was normal. His vital signs are 98% SpO2, heart rate of 112, blood pressure of 120/76, and respiratory rate of 14. White blood cell count is 16, and other lab results are normal. You obtain a computed tomography (CT) of the abdomen and pelvis, which shows the following abcesses: He was placed on IV antibiotics but failed to progress. Interventional radiology is unable to safely place a drain. What is the best next step?
- A 56-year-old man with a remote history of uncomplicated sigmoid diverticulitis presents with pneumaturia, fecaluria, and frequent urinary tract infections. Colonoscopy showed sigmoid diverticulosis. Computed tomography (CT) of the abdomen and pelvis showed air in the bladder. Cystoscopy showed 1.5 cm defect in the bladder. The best next step in the management of this patient is
- A 55-year-old patient underwent an emergency laparoscopic sigmoid colectomy with end colostomy for perforated diverticulitis. On the second postoperative day, you note the colostomy to be black with mucosal sloughing. He is otherwise stable, and his lab work is within normal ranges. What is the most appropriate next step?
- A 51-year-old immunosuppressed patient with a medical history significant for kidney transplant and chronic obstructive pulmonary disease presents to the emergency department with left lower quadrant abdominal pain. Computed tomography (CT) of the abdomen and pelvis demonstrates sigmoid diverticulitis with free fluid and spicules of free air in the pelvis. The patient is tachycardic, febrile, and diaphoretic, with lower quadrant abdominal tenderness. You decide to operate. What is the best next step in management?
- A 56-year-old patient with a BMI of 41 is transferred to your hospital after undergoing emergent sigmoid colectomy with colostomy for perforated diverticulitis. On postoperative day 3 she is found to have sloughed the distal portion of the ostomy due to necrosis and retraction of the stoma (see figure below). Bedside evaluation demonstrates ischemia that extends proximal to the fascia. The patient is currently hemodynamically stable. Computed tomography angiogram of the abdomen and pelvis demonstrates patency of the celiac and superior mesenteric arteries and no visualization of the the inferior mesenteric artery. What is the best next step in management?
Benign Disease- A 62-year-old man presents to the emergency department with acute-onset left lower quadrant abdominal pain. He is mildly tachycardic but is otherwise hemodynamically stable. On abdominal examination, he has diffuse peritonitis. Laparoscopy reveals sigmoid diverticulitis with purulent fluid throughout the abdomen without fecal contamination. What is the best next step in management?
- A 53-year-old male renal transplant recipient receiving tacrolimus and prednisone presents with acute sigmoid diverticulitis with specks of free air and a 5-cm pelvic abscess which is not amenable to percutaneous drainage. His vital signs are a temperature of 102.0°F (38.9°C), heart rate 105 beats/min, blood pressure 110/80 mm Hg, and white blood cell count 18,000/µL (18109/L). The best next step in management is:
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