Diverticulitis is an infection of the intestinal tract, most commonly of the colon. As the colon ages, its inner lining can begin to bulge through its wall, forming small pockets along the outside of the colon called diverticula. If the opening to a diverticulum becomes blocked by feces or food particles, it can become infected, leading to diverticulitis.
Risks
Diverticulitis risk increases with age because diverticulum formation increases with age. Both genders are affected equally. The Western diet perhaps presents the largest risk. The highly processed, low-fiber diet leads to harder stools, forcing the colon to work harder to expel stool and causing more diverticula to form.
Presentation
Patients form diverticula mainly in the sigmoid, which is usually on the left lower side of the abdomen. Therefore, diverticulitis patients usually have pain in that region. Other symptoms include fever, nausea, vomiting and change in bowel habits. With more severe disease, pain throughout the abdomen, decreased blood pressure and very high fever are found.
Testing
Blood work usually shows an increase in white blood cell count, which reflects infection, but is not necessarily diagnostic for diverticulitis. The most definitive test is the CT scan of the abdomen, which usually reveals inflamed diverticula and possibly abscess. In some cases, the CT scan will show that the diverticulum inflammation has affected adjacent organs such as the bladder or the uterus. A colonoscopy should be performed as well to rule out the possibility of other diseases such as cancer. However, it cannot be performed during an attack as it can easily perforate the colon.
Treatment
Patients with mild attacks can be treated with antibiotics by mouth at home. Most patients will easily resolve their symptoms and require no further treatment. Those with more severe abdominal pain, higher fevers or inability to tolerate food need hospitalization for intravenous antibiotics and fluids until symptoms subside. Surgery becomes an option for patients with severe disease or repeated attacks. Those who are severely ill and do not respond to intravenous antibiotics may need emergency surgery. This constitutes removal of the diseased segment of the colon and possibly creation of a temporary colostomy. Those who resolve their disease on intravenous antibiotics can have elective removal of the diseased colon segment with minimal risk for requiring a colostomy.
Complications
Recurrent attacks of diverticulitis can complicate this disease. Up to 20 percent of patients who suffer one attack of diverticulitis will have a recurrent attack. Younger patients are thought to have higher risk for recurrent attacks, but this remains a debatable notion in the medical literature. The narrowing of the colon, known as a stricture, is another complication. The stricture forms as a result of scarring from resolved inflammation. Patients with this will have difficulties defecating because the passageway for the stool is narrowed. Another significant complication is fistula formation. A fistula is an abnormal connection from one part of the body to another. With diverticulitis, the diseased area of the colon can erode into any adjacent organ, forming a fistula. Diverticular fistulas most commonly form between the colon and the bladder in men and between the colon and the vagina in women. In each case, patients will experience flatulence and possibly feces through either the opening to the bladder, known as the urethra, or the vagina.
