Diverticulitis is a complication occurring in patients suffering from diverticulosis. Diverticulosis is a disease in which there are sac-like protrusions from the wall of the gastrointestinal tract. The out pouchings occur at sites where the blood vessels pierce through the gut wall. These sites are considered weaker and consequently are more susceptible to formation of these out pouchings. The exact cause of the disease is unknown but it is thought to occur due to abnormal intestinal motility. Abnormally high-pressure areas develop inside the gut tube due to this motility problem which causes the inside wall of the tube to protrude through and results in the creation of pockets in the intestinal wall. These protrusions can arise from anywhere in the intestinal tract but they are most often seen in the lower left part of the colon known as the sigmoid colon. Diverticuli are generally not symptomatic and are rather common in middle age. It is when these diverticula become inflamed to due tearing that the condition is called diverticulitis and gives rise to symptoms.
Signs and Symptoms
Initial symptoms include fever and most often pain in the lower left portion of the abdomen. Rectal bleeding can occur when the blood vessels near the diverticula are damaged. Patients with diverticulitis sometimes develop complications and suffer from a wider array of symptoms. Nausea and vomiting can happen in patients that develop intestinal obstruction. This happens when the inflammation is so severe that it causes the walls of the gut to enlarge and the diameter of the inside of the gut tube to decrease which results in the blockage of feces. If there is an unremitting fever than abscess formation should be suspected. An abscess is the accumulation of pus in a contained space. A fistula is an abnormal communication between two organs, similar to a tunnel, and can also occur as a complication of diverticulitis. This “tunnel” can form between two portions of the intestines or even between the intestine and bladder which houses urine. The symptoms are will vary depending on the organs involved. If there is swelling and pain on applying pressure to the abdomen, perforation of the gut wall should be considered. Perforation can allow fecal matter and normal gut bacteria to spill into the surrounding abdominal cavity causing severe inflammation, pain, and can be fatal
Diagnosis of Diverticulitis
Evaluation begins with blood testing for indicators of inflammation and the quantities of different immune cells. Stool can sometimes be tested if there is a history of abnormal bowel movements. This is done to help rule out other diseases that may be suspected. An abdominal CT scan is performed to help confirm the diagnosis of diverticulitis.
Treatment of Diverticulitis
There is a range of treatment options available depending on the severity of the attack. Patients are started on antibiotics aimed at targeting the different species of gut bacteria. When these bacteria are contained within the confines of the intestinal wall they are not harmful to the human host but when they spread anywhere outside the gut they can be dangerous. If there is perforation of the intestinal wall the resultant condition is so severe that it requires surgery. Abscesses can usually be drained directly through the abdominal wall using needles, forgoing the need for surgery. In case of fistula formation surgery is required for removal because they do not close on their own. If the patient continues to experience frequent symptomatic episodes then surgical resection of the involved area of the bowel can be done.
After an initial attack, patients are usually advised to increase their intake of fiber. It is not clear what role fiber has on helping to prevent the development of the condition but it is thought that because fiber causes the smooth passage of stool, less pressure is generated in the colon decreasing the likelihood of diverticuli being formed. Evidence for this is unclear at the moment.