Small intestinal diverticulosis is defined as the occurrence of multiple pouch-like formations of the mucosa extending through the areas of weakness in the wall of the small intestine. These diverticula are considerably fewer in number in the small intestine as compared to the large intestine. The term diverticulum is an individual pouch while the term diverticula is used when there are more than one.
Epidemiology
The incidence of Diverticula of the duodenum in the United States is approximately five times that of the jejunum and ileum. The actual incidence of both is not known and they are frequently not manifest clinically. The duodenal diverticula are diagnosed in 6 to 22% of autopsy cases, and the jejunal diverticula are diagnosed in less than 0. 5% on upper gastrointestinal imaging and 0.3 to 1.3% in autopsy reports.
In comparison with other countries the incidence is similar with that of the U.S., and in terms of demographics there is no predilection towards any racial group. Duodenal and jejunoileal diverticula affect both sexes alike but jejunoileal diverticula are slightly more frequent in males.
Anatomy
Pathophysiology
Although the nature of this condition has been very much established, its actual cause still poses a great challenge to most researchers in the field. It is believed to develop from the problems of peristalsis, abnormal patterns of the stomach and bowel movement, and increased pressures into certain segments of the intestinal lumen.
Diverticula are usually initiated in areas of the mesenteric border, where the mesenteric vessels transverse the level of the small intestine. They are further divided into true and false. Diverticula that involve all the layers of the intestinal wall are known as true diverticula while those that involve only mucosal and submucosal layers are referred to as false diverticula. The best example of true diverticulum is Meckel’s diverticulum which is usually found at the mesentery which is a true diverticulum.
According to whether diverticula exist inside or outside of the muscular wall of the hollow viscus, they may be divided into intraluminal diverticula and extraluminal diverticula. Meckel’s diverticulum and intraluminal diverticula are acquired during fetal development and are therefore congenital. Extraluminal diverticula can be found in different sections of the small bowel and may be termed as duodenal, jejunal, ileal or jejunoileal diverticula.
Etiology
Increased Intraluminal Pressure: Structural and functional abnormalities of the small intestine can result in formation of the diverticula especially at sites which have thin muscular walls specifically at points where blood supply enters.
Altered Intestinal Motility: Abnormal contractions in the intestines or intestinal dyskinesis may also cause high pressure areas that then lead to formation of diverticula.
Aging: The intestinal wall loses its elasticity as people age, thereby raising the likelihood of developing diverticula.
Diet: Diverticulosis is attributed to a diet that lacks fiber but contains a lot of fat since it alters bowel movements and intraluminal pressure.
Genetics
Prognostic Factors
Asymptomatic Nature: Small intestinal diverticulosis is mostly mild and asymptomatic therefore manifesting itself in symptoms that lead to diagnosis in its early stages making it have a favorable prognosis if complications are not involved.
Age: The elderly are at a higher risk of developing adverse effects which determine outcome.
Complications: Complications such as bleeding, perforation, or infection may be fatal and may sometimes require surgery.
Comorbidities: There are comorbidities that can compound the development and the prognosis of diverticulosis.
Clinical History
Age Group
Older Adults: Small intestinal diverticulosis affects elderly people of over fifty years of age more frequently. The risk is, however, associated with age and hence complications are more common with this age group.
Physical Examination
Abdominal Palpation: May be tender particularly in the eventuality of inflammation or complication.
Abdominal Inspection: Abnormalities in bowel sounds like distention if one is having complications such as obstruction.
Peritoneal Signs: This may be due to inflammation of the uterus or actual perforation of the pelvic structures.
General Signs: Fever or other general symptoms of a systemic disease in case complications such as diverticulitis are present.
Age group
Associated comorbidity
Connective Tissue Disorders: Other conditions that might predispose persons to Diverticulosis includes the systemic sclerosis, which is characterised by the hardening of the connective tissues.
Gastrointestinal Motility Disorders: Reduced intestinal peristalsis has been observed to be linked with diverticulosis.
Diabetes: These factors may modulate the course and treatment of the disease.
Associated activity
Acuity of presentation
Asymptomatic: Most are urological and are diagnosed coincidentally on a radiological investigation or on surgery for an unrelated pathology.
Symptomatic: Symptoms may be mild abdominal pain, bloating, and in some cases, experiencing of gastrointestinal bleeding. Severity of the symptom can therefore be indicated to be variable.
Differential Diagnoses
Chronic Pancreatitis
Upper Gastrointestinal Bleeding (UGIB)
Acute Pancreatitis
Small-Bowel Obstruction
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Dietary Modifications: More intake of fiber in the body also reduces the chances of having complications besides enhancing bowel movement. Ensuring that you have taken enough water so that the food that you are eating can be broken by the body and this will help in avoiding constipation.
Medical Management: Self-care medications include the use of analgesics without prescription such as the use of acetaminophen or non-steroid anti-inflammatory drugs. If diverticulitis or infection is assumed, then antibiotics may be used to treat the patient.
Management of Complications:
Diverticulitis: Antibiotic therapy with surgery as the possible last resort in complicated cases.
Obstruction: May need to be hospitalized and might even need surgery especially if other interventions are not helpful.
Surgical Intervention: In circumstances of complications like perforation, or recurrent diverticulitis, then surgical removal of the part of the colon involved may be required.
High-Fiber Diet: The consumption of daily fibre-rich foods including fruits, vegetables, whole grains, legumes assist in controlling and preventing diverticular complications from arising because they allow regular bowel movement hence lessening the pressure within the colon. Adequate Hydration: Staying hydrated helps with digestion and keeps constipation at bay, which is known to worsen diverticulosis. Regular Physical Activity: Physical activity maintains the peristaltic movement of the bowls thus reduces strain and incidence of constipations. Probiotics: Supplementation with probiotics is likely to enhance digestive health and, subsequently, the population density of good bacteria in the intestines, thus reducing inflammation. Stress Management: Minimizing stress by practices like yoga, meditation or mindfulness can alleviate bowel syndrome symptoms including bloating or discomfort as it normalizes bowel function.
Role of Antibiotics
Rifaximin: An antibiotic that acts on a wide range of bacterial organisms, not ordinarily absorbed in the body used for small intestinal bacterial overgrowth and acute diarrhea acquired during travel. This is because it could selectively bind on DNA – dependent RNA polymerase, belonging to the rifamycin class.
Metronidazole (Flagyl): It is active against anaerobic bacteria and protozoa and travel intracellular where its metabolites chelate DNA thus interfering with protein synthesis and resulting in cell death.
Clindamycin (Cleocin): It is active against aerobic and anaerobic streptococci but are not active against enterococcus. Mechanism of action entails the ability of the drug to attach itself to the 50S ribosomal subunit thereby preventing the formation of a peptide chain and consequently bacterial growth is prevented.
Ampicillin (Marcillin, Omnipen, Polycillin, Principen, Totacillin): This type of action focuses on bacteria at a period which is most involved in multiplication through interference with cell wall synthesis having bactericidal effects on susceptible microorganisms.
Amoxicillin: This is an antibiotic that is to some extent used in outpatient care: it inhibits bacterial cell wall mucopeptide synthesis in actively growing bacteria, which leads to bacterial death.
Ciprofloxacin: An antibacterial of the fluoroquinolone order which is active against pseudomonas, streptococci, MRSA staphylococcus epidermidis and many gram-negative organisms. It inhibits bacterial DNA replication thus frammg bacterial duplication in the body.
Imipenem and Cilastatin: It is administered in clinical conditions whereby other forms of treatment may not successfully manage the infection such as peritonitis. Impienem is rapidly hydrolyzed by beta-lactamase but cilastatin inhibits this enzyme and thus prevents the metabolism of imipenem.
Surgical Resection: This is the most common approach to management of small intestinal diverticulosis when complications such as perforation, major hemorrhage, recurrent diverticulitis or obstruction are evident. To correct the problem, the specific part of the small intestine is then resected, hence eliminating the problem and preventing any complications that may be arising from the same.
Endoscopic Treatment: In some instances of bleeding diverticula, endoscopic approaches may be utilized to stop the bleeding. It is possible to decide on endoscopic operations – cauterization or clipping, if the bleeding from a diverticulum is observed.
Abscess Drainage: An abscess that results from diverticulitis may be treated by the process of drainage. Surgical intervention may involve percutaneous drainage under radiologic guidance in a bid to evacuate the abscess and to curb new infection or development of complications.
The various stages involved in the management of small intestinal diverticulosis include. In the preventive/asymptomatic phase, patient should be advised to engage in regular exercising and adopt high fiber diet to ensure that he/she does not develop complications. During symptomatic phase one, which is the mild symptomatic phase, the symptoms are addressed by improving the diet and using analgesics. Diverticulosis is further divided into acute complications where they deal with diet with antibiotics, hospitalization, or drainage if need be, like diverticulitis or obstruction. During the surgical intervention phase, patient must undergo operations such as intestinal resection for the severe complications. Last, the maintenance phase involves post-treatment management and sustained changes in diet to maintain a healthy intestine.
Small intestinal diverticulosis is defined as the occurrence of multiple pouch-like formations of the mucosa extending through the areas of weakness in the wall of the small intestine. These diverticula are considerably fewer in number in the small intestine as compared to the large intestine. The term diverticulum is an individual pouch while the term diverticula is used when there are more than one.
The incidence of Diverticula of the duodenum in the United States is approximately five times that of the jejunum and ileum. The actual incidence of both is not known and they are frequently not manifest clinically. The duodenal diverticula are diagnosed in 6 to 22% of autopsy cases, and the jejunal diverticula are diagnosed in less than 0. 5% on upper gastrointestinal imaging and 0.3 to 1.3% in autopsy reports.
In comparison with other countries the incidence is similar with that of the U.S., and in terms of demographics there is no predilection towards any racial group. Duodenal and jejunoileal diverticula affect both sexes alike but jejunoileal diverticula are slightly more frequent in males.
Although the nature of this condition has been very much established, its actual cause still poses a great challenge to most researchers in the field. It is believed to develop from the problems of peristalsis, abnormal patterns of the stomach and bowel movement, and increased pressures into certain segments of the intestinal lumen.
Diverticula are usually initiated in areas of the mesenteric border, where the mesenteric vessels transverse the level of the small intestine. They are further divided into true and false. Diverticula that involve all the layers of the intestinal wall are known as true diverticula while those that involve only mucosal and submucosal layers are referred to as false diverticula. The best example of true diverticulum is Meckel’s diverticulum which is usually found at the mesentery which is a true diverticulum.
According to whether diverticula exist inside or outside of the muscular wall of the hollow viscus, they may be divided into intraluminal diverticula and extraluminal diverticula. Meckel’s diverticulum and intraluminal diverticula are acquired during fetal development and are therefore congenital. Extraluminal diverticula can be found in different sections of the small bowel and may be termed as duodenal, jejunal, ileal or jejunoileal diverticula.
Increased Intraluminal Pressure: Structural and functional abnormalities of the small intestine can result in formation of the diverticula especially at sites which have thin muscular walls specifically at points where blood supply enters.
Altered Intestinal Motility: Abnormal contractions in the intestines or intestinal dyskinesis may also cause high pressure areas that then lead to formation of diverticula.
Aging: The intestinal wall loses its elasticity as people age, thereby raising the likelihood of developing diverticula.
Diet: Diverticulosis is attributed to a diet that lacks fiber but contains a lot of fat since it alters bowel movements and intraluminal pressure.
Asymptomatic Nature: Small intestinal diverticulosis is mostly mild and asymptomatic therefore manifesting itself in symptoms that lead to diagnosis in its early stages making it have a favorable prognosis if complications are not involved.
Age: The elderly are at a higher risk of developing adverse effects which determine outcome.
Complications: Complications such as bleeding, perforation, or infection may be fatal and may sometimes require surgery.
Comorbidities: There are comorbidities that can compound the development and the prognosis of diverticulosis.
Age Group
Older Adults: Small intestinal diverticulosis affects elderly people of over fifty years of age more frequently. The risk is, however, associated with age and hence complications are more common with this age group.
Abdominal Palpation: May be tender particularly in the eventuality of inflammation or complication.
Abdominal Inspection: Abnormalities in bowel sounds like distention if one is having complications such as obstruction.
Peritoneal Signs: This may be due to inflammation of the uterus or actual perforation of the pelvic structures.
General Signs: Fever or other general symptoms of a systemic disease in case complications such as diverticulitis are present.
Connective Tissue Disorders: Other conditions that might predispose persons to Diverticulosis includes the systemic sclerosis, which is characterised by the hardening of the connective tissues.
Gastrointestinal Motility Disorders: Reduced intestinal peristalsis has been observed to be linked with diverticulosis.
Diabetes: These factors may modulate the course and treatment of the disease.
Asymptomatic: Most are urological and are diagnosed coincidentally on a radiological investigation or on surgery for an unrelated pathology.
Symptomatic: Symptoms may be mild abdominal pain, bloating, and in some cases, experiencing of gastrointestinal bleeding. Severity of the symptom can therefore be indicated to be variable.
Chronic Pancreatitis
Upper Gastrointestinal Bleeding (UGIB)
Acute Pancreatitis
Small-Bowel Obstruction
Dietary Modifications: More intake of fiber in the body also reduces the chances of having complications besides enhancing bowel movement. Ensuring that you have taken enough water so that the food that you are eating can be broken by the body and this will help in avoiding constipation.
Medical Management: Self-care medications include the use of analgesics without prescription such as the use of acetaminophen or non-steroid anti-inflammatory drugs. If diverticulitis or infection is assumed, then antibiotics may be used to treat the patient.
Management of Complications:
Diverticulitis: Antibiotic therapy with surgery as the possible last resort in complicated cases.
Obstruction: May need to be hospitalized and might even need surgery especially if other interventions are not helpful.
Surgical Intervention: In circumstances of complications like perforation, or recurrent diverticulitis, then surgical removal of the part of the colon involved may be required.
Gastroenterology
High-Fiber Diet: The consumption of daily fibre-rich foods including fruits, vegetables, whole grains, legumes assist in controlling and preventing diverticular complications from arising because they allow regular bowel movement hence lessening the pressure within the colon. Adequate Hydration: Staying hydrated helps with digestion and keeps constipation at bay, which is known to worsen diverticulosis. Regular Physical Activity: Physical activity maintains the peristaltic movement of the bowls thus reduces strain and incidence of constipations. Probiotics: Supplementation with probiotics is likely to enhance digestive health and, subsequently, the population density of good bacteria in the intestines, thus reducing inflammation. Stress Management: Minimizing stress by practices like yoga, meditation or mindfulness can alleviate bowel syndrome symptoms including bloating or discomfort as it normalizes bowel function.
Gastroenterology
Rifaximin: An antibiotic that acts on a wide range of bacterial organisms, not ordinarily absorbed in the body used for small intestinal bacterial overgrowth and acute diarrhea acquired during travel. This is because it could selectively bind on DNA – dependent RNA polymerase, belonging to the rifamycin class.
Metronidazole (Flagyl): It is active against anaerobic bacteria and protozoa and travel intracellular where its metabolites chelate DNA thus interfering with protein synthesis and resulting in cell death.
Clindamycin (Cleocin): It is active against aerobic and anaerobic streptococci but are not active against enterococcus. Mechanism of action entails the ability of the drug to attach itself to the 50S ribosomal subunit thereby preventing the formation of a peptide chain and consequently bacterial growth is prevented.
Ampicillin (Marcillin, Omnipen, Polycillin, Principen, Totacillin): This type of action focuses on bacteria at a period which is most involved in multiplication through interference with cell wall synthesis having bactericidal effects on susceptible microorganisms.
Amoxicillin: This is an antibiotic that is to some extent used in outpatient care: it inhibits bacterial cell wall mucopeptide synthesis in actively growing bacteria, which leads to bacterial death.
Ciprofloxacin: An antibacterial of the fluoroquinolone order which is active against pseudomonas, streptococci, MRSA staphylococcus epidermidis and many gram-negative organisms. It inhibits bacterial DNA replication thus frammg bacterial duplication in the body.
Imipenem and Cilastatin: It is administered in clinical conditions whereby other forms of treatment may not successfully manage the infection such as peritonitis. Impienem is rapidly hydrolyzed by beta-lactamase but cilastatin inhibits this enzyme and thus prevents the metabolism of imipenem.
Gastroenterology
Surgical Resection: This is the most common approach to management of small intestinal diverticulosis when complications such as perforation, major hemorrhage, recurrent diverticulitis or obstruction are evident. To correct the problem, the specific part of the small intestine is then resected, hence eliminating the problem and preventing any complications that may be arising from the same.
Endoscopic Treatment: In some instances of bleeding diverticula, endoscopic approaches may be utilized to stop the bleeding. It is possible to decide on endoscopic operations – cauterization or clipping, if the bleeding from a diverticulum is observed.
Abscess Drainage: An abscess that results from diverticulitis may be treated by the process of drainage. Surgical intervention may involve percutaneous drainage under radiologic guidance in a bid to evacuate the abscess and to curb new infection or development of complications.
Gastroenterology
The various stages involved in the management of small intestinal diverticulosis include. In the preventive/asymptomatic phase, patient should be advised to engage in regular exercising and adopt high fiber diet to ensure that he/she does not develop complications. During symptomatic phase one, which is the mild symptomatic phase, the symptoms are addressed by improving the diet and using analgesics. Diverticulosis is further divided into acute complications where they deal with diet with antibiotics, hospitalization, or drainage if need be, like diverticulitis or obstruction. During the surgical intervention phase, patient must undergo operations such as intestinal resection for the severe complications. Last, the maintenance phase involves post-treatment management and sustained changes in diet to maintain a healthy intestine.
Small intestinal diverticulosis is defined as the occurrence of multiple pouch-like formations of the mucosa extending through the areas of weakness in the wall of the small intestine. These diverticula are considerably fewer in number in the small intestine as compared to the large intestine. The term diverticulum is an individual pouch while the term diverticula is used when there are more than one.
The incidence of Diverticula of the duodenum in the United States is approximately five times that of the jejunum and ileum. The actual incidence of both is not known and they are frequently not manifest clinically. The duodenal diverticula are diagnosed in 6 to 22% of autopsy cases, and the jejunal diverticula are diagnosed in less than 0. 5% on upper gastrointestinal imaging and 0.3 to 1.3% in autopsy reports.
In comparison with other countries the incidence is similar with that of the U.S., and in terms of demographics there is no predilection towards any racial group. Duodenal and jejunoileal diverticula affect both sexes alike but jejunoileal diverticula are slightly more frequent in males.
Although the nature of this condition has been very much established, its actual cause still poses a great challenge to most researchers in the field. It is believed to develop from the problems of peristalsis, abnormal patterns of the stomach and bowel movement, and increased pressures into certain segments of the intestinal lumen.
Diverticula are usually initiated in areas of the mesenteric border, where the mesenteric vessels transverse the level of the small intestine. They are further divided into true and false. Diverticula that involve all the layers of the intestinal wall are known as true diverticula while those that involve only mucosal and submucosal layers are referred to as false diverticula. The best example of true diverticulum is Meckel’s diverticulum which is usually found at the mesentery which is a true diverticulum.
According to whether diverticula exist inside or outside of the muscular wall of the hollow viscus, they may be divided into intraluminal diverticula and extraluminal diverticula. Meckel’s diverticulum and intraluminal diverticula are acquired during fetal development and are therefore congenital. Extraluminal diverticula can be found in different sections of the small bowel and may be termed as duodenal, jejunal, ileal or jejunoileal diverticula.
Increased Intraluminal Pressure: Structural and functional abnormalities of the small intestine can result in formation of the diverticula especially at sites which have thin muscular walls specifically at points where blood supply enters.
Altered Intestinal Motility: Abnormal contractions in the intestines or intestinal dyskinesis may also cause high pressure areas that then lead to formation of diverticula.
Aging: The intestinal wall loses its elasticity as people age, thereby raising the likelihood of developing diverticula.
Diet: Diverticulosis is attributed to a diet that lacks fiber but contains a lot of fat since it alters bowel movements and intraluminal pressure.
Asymptomatic Nature: Small intestinal diverticulosis is mostly mild and asymptomatic therefore manifesting itself in symptoms that lead to diagnosis in its early stages making it have a favorable prognosis if complications are not involved.
Age: The elderly are at a higher risk of developing adverse effects which determine outcome.
Complications: Complications such as bleeding, perforation, or infection may be fatal and may sometimes require surgery.
Comorbidities: There are comorbidities that can compound the development and the prognosis of diverticulosis.
Age Group
Older Adults: Small intestinal diverticulosis affects elderly people of over fifty years of age more frequently. The risk is, however, associated with age and hence complications are more common with this age group.
Abdominal Palpation: May be tender particularly in the eventuality of inflammation or complication.
Abdominal Inspection: Abnormalities in bowel sounds like distention if one is having complications such as obstruction.
Peritoneal Signs: This may be due to inflammation of the uterus or actual perforation of the pelvic structures.
General Signs: Fever or other general symptoms of a systemic disease in case complications such as diverticulitis are present.
Connective Tissue Disorders: Other conditions that might predispose persons to Diverticulosis includes the systemic sclerosis, which is characterised by the hardening of the connective tissues.
Gastrointestinal Motility Disorders: Reduced intestinal peristalsis has been observed to be linked with diverticulosis.
Diabetes: These factors may modulate the course and treatment of the disease.
Asymptomatic: Most are urological and are diagnosed coincidentally on a radiological investigation or on surgery for an unrelated pathology.
Symptomatic: Symptoms may be mild abdominal pain, bloating, and in some cases, experiencing of gastrointestinal bleeding. Severity of the symptom can therefore be indicated to be variable.
Chronic Pancreatitis
Upper Gastrointestinal Bleeding (UGIB)
Acute Pancreatitis
Small-Bowel Obstruction
Dietary Modifications: More intake of fiber in the body also reduces the chances of having complications besides enhancing bowel movement. Ensuring that you have taken enough water so that the food that you are eating can be broken by the body and this will help in avoiding constipation.
Medical Management: Self-care medications include the use of analgesics without prescription such as the use of acetaminophen or non-steroid anti-inflammatory drugs. If diverticulitis or infection is assumed, then antibiotics may be used to treat the patient.
Management of Complications:
Diverticulitis: Antibiotic therapy with surgery as the possible last resort in complicated cases.
Obstruction: May need to be hospitalized and might even need surgery especially if other interventions are not helpful.
Surgical Intervention: In circumstances of complications like perforation, or recurrent diverticulitis, then surgical removal of the part of the colon involved may be required.
Gastroenterology
High-Fiber Diet: The consumption of daily fibre-rich foods including fruits, vegetables, whole grains, legumes assist in controlling and preventing diverticular complications from arising because they allow regular bowel movement hence lessening the pressure within the colon. Adequate Hydration: Staying hydrated helps with digestion and keeps constipation at bay, which is known to worsen diverticulosis. Regular Physical Activity: Physical activity maintains the peristaltic movement of the bowls thus reduces strain and incidence of constipations. Probiotics: Supplementation with probiotics is likely to enhance digestive health and, subsequently, the population density of good bacteria in the intestines, thus reducing inflammation. Stress Management: Minimizing stress by practices like yoga, meditation or mindfulness can alleviate bowel syndrome symptoms including bloating or discomfort as it normalizes bowel function.
Gastroenterology
Rifaximin: An antibiotic that acts on a wide range of bacterial organisms, not ordinarily absorbed in the body used for small intestinal bacterial overgrowth and acute diarrhea acquired during travel. This is because it could selectively bind on DNA – dependent RNA polymerase, belonging to the rifamycin class.
Metronidazole (Flagyl): It is active against anaerobic bacteria and protozoa and travel intracellular where its metabolites chelate DNA thus interfering with protein synthesis and resulting in cell death.
Clindamycin (Cleocin): It is active against aerobic and anaerobic streptococci but are not active against enterococcus. Mechanism of action entails the ability of the drug to attach itself to the 50S ribosomal subunit thereby preventing the formation of a peptide chain and consequently bacterial growth is prevented.
Ampicillin (Marcillin, Omnipen, Polycillin, Principen, Totacillin): This type of action focuses on bacteria at a period which is most involved in multiplication through interference with cell wall synthesis having bactericidal effects on susceptible microorganisms.
Amoxicillin: This is an antibiotic that is to some extent used in outpatient care: it inhibits bacterial cell wall mucopeptide synthesis in actively growing bacteria, which leads to bacterial death.
Ciprofloxacin: An antibacterial of the fluoroquinolone order which is active against pseudomonas, streptococci, MRSA staphylococcus epidermidis and many gram-negative organisms. It inhibits bacterial DNA replication thus frammg bacterial duplication in the body.
Imipenem and Cilastatin: It is administered in clinical conditions whereby other forms of treatment may not successfully manage the infection such as peritonitis. Impienem is rapidly hydrolyzed by beta-lactamase but cilastatin inhibits this enzyme and thus prevents the metabolism of imipenem.
Gastroenterology
Surgical Resection: This is the most common approach to management of small intestinal diverticulosis when complications such as perforation, major hemorrhage, recurrent diverticulitis or obstruction are evident. To correct the problem, the specific part of the small intestine is then resected, hence eliminating the problem and preventing any complications that may be arising from the same.
Endoscopic Treatment: In some instances of bleeding diverticula, endoscopic approaches may be utilized to stop the bleeding. It is possible to decide on endoscopic operations – cauterization or clipping, if the bleeding from a diverticulum is observed.
Abscess Drainage: An abscess that results from diverticulitis may be treated by the process of drainage. Surgical intervention may involve percutaneous drainage under radiologic guidance in a bid to evacuate the abscess and to curb new infection or development of complications.
Gastroenterology
The various stages involved in the management of small intestinal diverticulosis include. In the preventive/asymptomatic phase, patient should be advised to engage in regular exercising and adopt high fiber diet to ensure that he/she does not develop complications. During symptomatic phase one, which is the mild symptomatic phase, the symptoms are addressed by improving the diet and using analgesics. Diverticulosis is further divided into acute complications where they deal with diet with antibiotics, hospitalization, or drainage if need be, like diverticulitis or obstruction. During the surgical intervention phase, patient must undergo operations such as intestinal resection for the severe complications. Last, the maintenance phase involves post-treatment management and sustained changes in diet to maintain a healthy intestine.
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