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What is Diverticulitis?
The colon (large intestine) is a long tube-like structure that stores and then eliminates waste material left over after digestion of food in the small intestine takes place. Pressure within the colon causes bulging pockets of tissue (sacs) that push out from the colonic walls as a person ages. A small bulging sac pushing outward from the colon wall is called a diverticulum. More than one bulging sac is referred to in the plural as diverticula. Diverticula can occur throughout the colon but are most common near the end of the left colon, referred to as the sigmoid colon, in Western countries. In Asia, the diverticula occur mostly on the right side of the colon. The condition of having these diverticula in the colon is called diverticulosis.
Causes of Diverticulitis
The formation of pouches or sacs on the intestinal lining is called diverticulosis. It is found in more than half of Americans over age 60. However, no one knows exactly what causes the pouches to form.
Eating a low-fiber diet mostly made up of processed foods may be a cause. Constipation and hard stools are more likely when you do not eat enough fiber. Straining to pass stools increases the pressure in the colon or intestines, which may lead to the formation of these pouches.
Diverticulitis is caused by small pieces of stool (feces) that become trapped in these pouches, causing infection or inflammation.
Symptoms of Diverticulitis
The signs and symptoms of diverticulitis include:
- Pain, which may be constant and persist for several days. Pain is usually felt in the lower left side of the abdomen, but may occur on the right, especially in people of Asian descent.
- Nausea and vomiting.
- Abdominal tenderness.
- Constipation or, less commonly, diarrhea.
How are the diagnosis of diverticulitis made?
If suspected, the diagnosis of diverticular disease can be confirmed by a variety of tests. Barium X-rays (barium enemas) can be performed to visualize the colon. Diverticula are seen as barium filled pouches protruding from the colon wall.
Direct visualization of the inside of the colon and the openings of the diverticula can be done with flexible tubes inserted through the rectum and advanced into the colon. Either short tubes (sigmoidoscopes) or longer tubes (colonoscopes) may be used to assist in the diagnosis and to exclude other diseases that can mimic diverticular disease.
In patients suspected of having diverticulitis causing persistent pain, tenderness, and fever; ultrasound and computerized tomography (CT) examinations of the abdomen and pelvis can be done to detect inflammation of the tissues surrounding the ruptured diverticulum or collections of pus.
Treatment of Diverticulitis
Mild diverticulitis can be treated at home with rest, a liquid diet, and oral antibiotics (such as ciprofloxacin). Diverticulitis symptoms usually lessen rapidly. Some people may not need antibiotics for diverticulitis. After a few days, people can begin a soft, low-fiber diet for 4 to 6 weeks. After 6 to 8 weeks, people have a colonoscopy or a barium enema to evaluate the colon. After 1 month, a high-fiber diet can be started.
People with more severe diverticulitis symptoms such as abdominal pain, body temperature above 101° F (38.3° C), poor response to oral antibiotics, and other evidence of serious infection or complications are hospitalized. In the hospital, people are given fluids and antibiotics by vein (intravenously), kept on bed rest, and given nothing by mouth until the symptoms subside.
About 80% of people can be treated without surgery for diverticulitis. An abscess is drained with a needle inserted through the skin and guided by a CT scan. If drainage helps, people remain in the hospital until symptoms have been relieved and they have resumed a soft diet.
Possible Complications of Diverticulitis
More serious problems that may develop are:
- Abnormal connections that form between parts of the colon or between the colon and another part of the body (fistula)
- Hole or tear in the colon (perforation)
- Narrowed area in the colon (stricture)
- Pocket filled with pus or infection (abscess)