Diverticular disease is a common condition, mainly affecting persons over the age of 50 years. Diverticulae are small out-pouchings from the gastrointestinal tract. When they occur in the large intestines, the condition is referred to as diverticular disease or diverticulosis. It is a benign condition that may exist for many years without symptoms. It is more common to find diverticulae on the left side of the colon than on the right. The most frequent complication of diverticulosis is diverticulitis. Diverticulitis is the term used to describe inflammation of the diverticulae.
Symptoms
The most frequent symptom of diverticulitis is left-sided lower abdominal pain. This may be accompanied by watery stools and a fever. The abdominal pain may be quite intense and is usually the reason most persons seek medical attention. The diagnosis is made from the history of symptoms, clinical examination findings and then confirmed by a CT scan of the abdomen. Diagnostic difficulty may arise when diverticulitis occurs on the right side of the colon. Quite often, persons with this occurrence, end up undergoing surgery to treat their disease as the condition is misdiagnosed as appendicitis or some other condition
Treatment
Treatment is usually conservative and involves the use of pain killers and antibiotics. This may be done in an outpatient or hospital setting, depending on the severity of the attack. More often than not, intravenous antibiotics are required, necessitating hospital admission. Occasionally, the condition may be severe enough to warrant surgical removal of a part of the colon.
Complications
Occasionally, complications may develop from diverticulitis. These complications include intra-abdominal abscess, diffuse intra-abdominal infection, fistulas and strictures. A fistula occurs when the inflamed diverticula ruptures into another organ. Most commonly a communication develops between the colon and the bladder, but other organs may be involved such as the vagina, skin or even the colon itself. When such a communication occurs, feces and air enter the other organ.
Stricture Formation
A stricture is narrowing of a segment of the colon due chronic scarring. This complication is usually seen months to years after an attack of diverticulitis. It may go unnoticed, or it may completely block the lumen of the bowel, resulting in bowel obstruction and the need for surgery.
Prognosis
The prognosis for diverticulitis is quite good as the vast majority of cases resolve with non-operative management.
References
- "Swartz Principles of Surgery;" Swartz, S. et al.; 1999
- "Sabiston Textbook of Surgery"; Townsend, C. et al.; 2002
