Diverticula, finger-like protrusions in weak areas of the intestinal wall, can occur anywhere along the digestive tract, but most commonly are found in the large intestine. Sometimes, diverticula become inflamed, a disease called diverticulitis, with attacks ranging from mild to severe leading to complications that may require hospitalization and even surgery.
Epidemiology
A review on diverticular disease published in the "American Journal of Gastroenterology" in 2008 reports that diverticular disease occurs in up to 60 percent of people more than 70 years old; 20 percent of patients with diverticula eventually have at least one episode of diverticulitis. Although most complications from diverticulitis can be treated conservatively, about 20 percent of patients will require surgery for definitive treatment.
Types
A publication by the National Institutes of Health, Diverticulosis and Diverticulitis, lists several types of serious complications from diverticulitis. Infection, including localized tissue involvement and abscess formation, is one of the most common manifestations of diverticulitis complications. If the inflammation of a diverticulum is severe enough, perforation may occur with resultant peritonitis, a serious infection of the lining surrounding the abdominal cavity. When inflamed diverticula are in contact with adjacent organs, such as the bladder or skin, an abnormal connection between the two structures, called a fistula, may form, which can lead to long-lasting, debilitating, infectious complications. Sometimes, if a diverticula ruptures as a consequence of inflammation, bleeding may result and bright-red blood may be seen in the stool or on toilet tissue. Repeated bouts of diverticulitis may lead to the formation of significant scar tissue that may obstruct the large intestine.
Causes
Diverticula form when weak areas in the intestine, usually the colon, bulge out in response to pressure such as straining when constipated. A low-fiber diet appears to be associated with the development of diverticula. It is not clear how diverticula become inflamed and infected. Fecal material may get trapped in the small pouches of the diverticula, which can cause inflammation and infection. Increased pressure within the large colon, such as that generated when straining, may precipitate diverticular rupture and perforation. Older age, low-fiber diets, physical inactivity and obesity are risk factors for the development of diverticulitis complications.
Symptoms
Abdominal pain, most commonly in the left lower abdomen, is the most common symptom of diverticulitis. The pain is usually sudden and severe, but may have a slow, progressive pattern with the intensity of pain fluctuating. Other symptoms of diverticulitis include fever, change in bowel habits, constipation, diarrhea, as well as nausea and vomiting. The combined presence of severe abdominal pain with fever and chills suggests severe infection necessitating hospitalization and perhaps surgery. Bleeding from the rectum is worrisome for a diverticular rupture as a result of severe inflammation.
Diagnosis
The diagnosis of diverticulitis complications begins with a careful history and physical examination revealing symptoms of diverticulitis and abdominal tenderness. Laboratory tests, including an elevated white blood cell count, may reveals signs of infection. Imaging studies, including abdominal ultrasound or CT scan, can help discern the underlying disease process, as well as identifying complications of perforation, infection and fistula formation. Once the inflammation has been treated, colonoscopy can be used to directly visualize the inside of the large intestine.
Prevention/Solution
Increasing fiber intake and physical activity along with weight loss may help decrease the risk of developing diverticulitis, as well as complications. Once diverticulitis is confirmed, treatment is always mandated focusing on alleviating the inflammation and infection and preventing complications. If complications develop, usually hospitalization is warranted. Infectious complications can often be managed with bowel rest and antibiotics. Complications of diverticulitis that do not respond to conservative therapy may require urgent surgery to remove the infected portion of bowel, which may require the creation of a temporary colostomy. Sometimes, an abscess can be drained by a radiologic procedure. Surgery is usually required for long-term complications of diverticulitis, including fistula formation and bowel obstruction from scar tissue, but often can be done on an elective basis.
