A 72-year-old woman comes to the office for follow-up of chronic abdominal pain. She has had several episodes of left lower quadrant pain requiring hospitalization. Despite treatment, her symptoms continue to recur. Elective surgery is performed and a segment of resected and opened sigmoid colon is shown below. Which of the following most likely contributed to this patient's condition?

Question

A 72-year-old woman comes to the office for follow-up of chronic abdominal pain.  She has had several episodes of left lower quadrant pain requiring hospitalization.  Despite treatment, her symptoms continue to recur.  Elective surgery is performed and a segment of resected and opened sigmoid colon is shown below.  Which of the following most likely contributed to this patient's condition?

Quizplus · Accepted Answer

11ec160b_3940_c570_9249_871314848c41_MD0001_00 This patient's gross pathology demonstrates multiple sac-like outpouchings from the sigmoid colon, which is consistent with diverticulosis. Diverticulosis occurs due to excessive colonic contractions that cause increased intraluminal pressure; this forces the mucosa and submucosa to herniate through the muscularis at naturally weak areas where the vasa recta penetrate. It is an exceedingly common disorder, particularly in Western nations, and its incidence increases with age. Diverticulosis may be clinically silent, but up to 30% of patients develop complications, including diverticular bleeding and diverticulitis. Diverticular bleeding occurs with injury to the exposed vasa recta within the colonic lumen and typically presents with painless hematochezia. Diverticulitis is caused by trapped food particles or excessive intraluminal pressure within the diverticula, leading to focal necrosis and microperforation. Patients develop abdominal pain (usually in the left lower quadrant), fever, nausea and vomiting, and alterations in bowel habits (eg, diarrhea, constipation). Diverticulitis is typically managed with antibiotics and bowel rest; however, surgery may be required for recurrent disease. The risk for diverticular disease is increased by dietary factors, including diets high in red meat, high in fat, and low in fiber (Choice A). Other risk factors include obesity, physical inactivity, and smoking. (Choice B) Although previously thought to be associated with diverticular diseases, the ingestion of nuts, seeds, and popcorn is not correlated with increased risk of diverticulosis, diverticular bleeding, or diverticulitis. (Choice D) Helicobacter pylori infection is associated with peptic ulcer and gastric cancer but does not increase the risk of diverticular disease. (Choice E) Excessive alcohol intake is associated with liver cirrhosis and squamous cell carcinoma of the esophagus; it is not associated with diverticular disease. Educational objective: Colonic diverticulosis refers to multiple sac-like outpouchings within the sigmoid colon. Complications include diverticular bleeding and diverticulitis. Risk factors for diverticulosis include a diet high in red meat and fat and low in fiber, as well as obesity and physical inactivity. __________ References: Diagnosis and management of acute diverticulitis. (http://www.ncbi.nlm.nih.gov/pubmed/23668524)

A 72-Year-Old Woman Comes to the Office for Follow-Up of Chronic