Abscess diverticular

The importance of treatment with glucocorticoids and NSAIDs in the development of sigmoid diverticular abscess perforation has been the subject of a case-control study in 64 patients (38 women), median age 70 years (range 39-91) and 320 age- and sex-matched controls (154). Independently of rheumatic diagnosis glucocorticoid treatment was strongly associated with sigmoid diverticular abscess perforation (OR = 32 95% Cl = 6.4,159). 

Mpofu S, Mpofu CMA, Hutchinson D, Maier AE, Dodd SR, Moots RJ. Steroids, non-steroidal anti-inflammatory drugs, and sigmoid diverticular abscess perforation in rheumatic conditions. Ann Rheum Dis 2004 63 588-90. 

Diverticular disease affects 5-10% of Western people over the age of 45 the incidence rises to 80% in those over 80. Colonic dysmotility with increased intracolonic pressure, and diets high in refined carbohydrate and low in fibre are important pathogenic factors. Some patients experience abdominal pain from dysmotility whilst others remain asymptomatic. Infection of diverticula occurs in a minority, giving potential for rupture or abscess formation. 

Complications of diverticulitis include diverticular abscess, colovesical fistula, and perforation. An abscess that occurs in up to 30% of cases appears as a hypodense fluid collection with a contrast-enhancing rim and surroimding inflammatory changes. It may contain air or air-fluid levels [47]. A colovesical fistula is suspected when air is seen in the bladder and there is thickening of the bladder wall adjacent to a diseased segment of bowel [52]. Another complication of diverticulitis can be focal contained perforations. They appear as small extraluminal deposits of air or extravasation of oral contrast material. Pneumoperitoneum is a rare finding in patients with diverticulitis [47]. 

A 69-year-old woman presented with sudden onset of left facial drop, dizziness, slurred speech and impaired balance [35 ]. History included paroxysmal atrial fibrillation and a sigmoid diverticular abscess treated with ciprofloxacin and metronidazole. Cranial CT angiography and MRI showed no signs of ischaemia or haemorrhage but demonstrated symmetrically distributed lesions in the cerebellar dentate nuclei. A diagnosis of metronidazole-induced encephalopatiiy was suspected and the drug withdrawn. Patient made uneventful recovery. 

Gastrointestinal A case report of a 70-year-old woman who was on prednisolone (lOmg per day) for over 40years for asthma and presented with a subcutaneous abscess related to diverticular disease of the colon has been published [23 ]. This case illustrates how steroids can mask the disease process through immunosuppressive and anti-inflammatory actions and also highlights that diverticular abscess perforation is one of the many complications of CS therapy. 

Turner EJ, Raza SA. Long-term steroids and an extensive diverticular abscess. BMJ Case Rep 2012 2012. http //dx.doi.org/10.1136/ bcr.10.2011.4926. pii bcrl020114926. 

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