Diverticulitis

What is it?

A diverticulum is a small, out pouching of the colon. Diverticulitis is inflammation of the portion of the colon with diverticula; this condition is thought to be due to a small hole (perforation) in one of the diverticula which causes an inflammatory response in the wall of the large intestine and the surrounding tissues.

Why does it happen?

In the past, it was thought that blockage of one of the diverticula led to increased pressure that caused perforation; now it is believed that the wall of the diverticulum is eroded by increased pressure or food particles. This erosion leads to inflammation, irritation and damage to the cells which can lead to a hole forming. Because of the hole a small walled off infection (abscess) can form or if other organs are involved a fistula (a tract connecting two organs inappropriately) or a blockage can develop. If the infection or hole in the diverticulum cannot be contained, a large hole and widespread infection of the abdominal cavity (peritonitis) may result.

What are the symptoms?

The most common symptom is left lower quadrant pain. This occurs in 70% of patients. Sometimes there will be a mass present and distention of the abdomen. A fever and elevated white blood cell count are common as well.

How is it diagnosed?

The diagnosis is often made based on the patient’s symptoms and the findings on physical examination. Studies may be ordered to confirm the diagnosis. A CT scan may be ordered. A CT scan not only allows the diagnosis to be made, but also determines how severe the disease is and identifies complications. Finally, it provides information that will aid in choosing the best treatment options.

What are the complications?

• Perforation. This is a hole in the wall of the colon.
• Inflammation and infection of the abdominal cavity (peritonitis) can result from perforation.
• This requires antibiotics right away.
• Abscess. This is a walled off infection.
• Fistula. This is an inappropriate connection between the colon and another organ or the skin.
• Stricture or obstruction. Continued or repeated episodes of inflammation can cause stricture.

25% of people diagnosed with diverticulitis for the first time present with this complication and almost all require surgery. If no complications are present, 75% of these people respond to medical therapy.

How is it treated?

Initial treatment often begins with bowel rest and antibiotics.

Bowel rest means consuming things that do not require your intestines to work hard. Only clear liquids should be consumed to begin. In 2-3 days your symptoms should begin to improve and then you can start advancing your diet to more foods slowly as you tolerate.

Antibiotics are selected that attack bacteria that live in the gut.

Further studies or hospitalization should be considered if you:

• Have a high fever
• Have increased abdominal pain
• Cannot tolerate oral intake
• Are elderly
• Have other significant health problems or a weak immune system
• Have no improvement in 2-3 days of management at home

Inpatient (hospital) management may be more appropriate where IV antibiotics are given until symptoms begin to resolve.

Surgery to remove a portion of the colon, the area of diverticulitis, may be performed if there are recurrent episodes of diverticulitis or if any complications are occur, including perforation, abscess, fistula and stricture.

After the infection has cleared…

Six to eight weeks after symptoms improve; the colon should be examined with a colonoscopy to rule out other causes of the pain such as Crohn’s disease, colon cancer, ischemic colitis and others, in addition to evaluating the extent of the diverticulosis.

After being treated successfully and your symptoms are gone usually one third of patients will never have symptoms again. One third will have intermittent abdominal cramps without an infection and one third will go on to have a second attack of diverticulitis. Usually, recurrent attacks are not severe.

What can I do?

In the past, people with diverticulosis were told to avoid seeds, nuts and other whole pieces of fiber because it was thought that the undigested fragment could get stuck in a diverticulum causing an episode of diverticulitis. This thought has been unproven. You do not need to avoid these foods.

Typically a high fiber diet is recommended.

© Copyright 2012 GI Associates. S.C. All rights reserved.

Diverticuli are herniations of the colon mucosa through the muscular layer of the colon. This produces a small saclike swelling in the colon wall. Diverticulitis occurs when diverticuli become inflamed and infected. Small abscesses form and then rupture causing symptoms.

Diverticulitis occurs during the lifetime in about half of the individuals who have diverticuli. Roughly 3,000 cases per 100,000 individuals occur annually. It is not a contagious or cancerous condition. The prognosis is good with treatment, however, relapses do occur.

Symptoms of Your Diagnosis

The initial symptoms of diverticulitis are intermittent cramping and abdominal pain that becomes constant. The location of the pain is usually in the left lower abdominal area. Fever and chills can occur, as well as constipation or diarrhea. There is generally a loss of appetite and nausea. Examination may reveal tenderness and a mass over the painful area. An elevated white blood cell count is usually present. Complications of diverticulitis include bleeding, perforation or rupture, bowel obstruction and abscess formation.

Treatment

Treatment is generally outpatient unless the symptoms are severe and there are signs of widespread infection or complications. Bed rest, stool softeners, a liquid diet and oral antibiotics are the basis of outpatient treatment. If hospitalized, the treatment is similar. You are put at bed rest and intravenous fluids are given. Intravenous antibiotics are started and analgesics are given for pain control. Initially you may not be allowed to eat. As the symptoms resolve, your diet is slowly returned to a high-fiber, low-fat diet.

If the case is severe or complicated, surgical resection of the affected area of colon is an option. Surgical resection is a treatment option for frequent reoccurrences.

For More Information

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
www.niddk.nih.gov

Derived from Patient Teaching Guide, © Mosby, Inc. All Rights Reserved

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