BT05 MODERN MANAGEMENT OF COLONIC DIVERTICULITIS IN THE OBESE

Abstract

Colonic diverticulitis is a dietary disorder of the ageing Western population associated with a low intake of oral fibre. Symptoms develop in only 10% of patients and overall only 1% of patients experience a complication. CT scan is the investigation of choice, although CT fails to predict clinical outcomes in many cases. Uncomplicated diverticulitis is reliably managed by antibiotics in the great majority of cases. So much so that enthusiasm for elective surgical resection after two documented attacks is waning, particularly in the high risk patient i.e. obese. Complicated diverticulitis (abscess, peritonitis, fistulae, stricture or bleeding) that fails conservative management is traditionally treated by open Hartmann's rectosigmoidectomy. Alternatives to laparoscopy are particularly helpful in the obese where large incisions cause significant problems with pain management, patient mobilisation and wound breakdown with hernia. Endoscopic management of acute diverticular bleeding and stricture with obstruction is well described. Radiological management of diverticular abscess is widely available Laparoscopic washout for purulent peritonitis is new whilst laparoscopic resection for faecal peritonitis is proven. Technical aspects of colonic diverticular surgery in the obese will be discussed and our experiences with laparoscopic, colonoscopic and radiological management complicated diverticulitis will be presented.