Diverticulitis

Answer 1

Definition

Diverticulitis is swelling (inflammation) of an abnormal pouch (diverticulum) in the intestinal wall. These pouches are usually found in the large intestine (colon). The presence of the pouches themselves is called diverticulosis.

Causes, incidence, and risk factors

Small, protruding sacs of the inner lining of the intestine (diverticulosis) can develop in any part of the intestine. They are most common in the colon, especially the sigmoid colon, the lowest part of the colon.

These sacs, called diverticula, occur more often after the age of 40. When they become inflamed, the condition is known as diverticulitis. Diverticula are thought to develop as a result of high pressure or abnormal pressure in the colon. High pressure against the colon wall causes pouches of the intestinal lining to bulge outward through small defects in the colon wall that surround blood vessels.

Diverticulosis is very common. It is found in more than half of Americans over age 60. Only a small percentage of these people will develop the complication of diverticulitis.

Diverticulitis is caused by inflammation, or (sometimes) a small tear in a diverticulum. If the tear is large, stool in the colon can spill into the abdominal cavity, causing an infection (abscess) or inflammation in the abdomen.

Risk factors for diverticulosis may include older age or a low-fiber diet.

Symptoms

• Abdominal pain, usually in the left lower abdomen but can be anywhere
• Chills
• Fever
• Nausea
• Vomiting
• Weight loss

Signs and tests

Tests showing diverticulitis may include:

• Abdominal palpation
• CT scan
• High white blood cell count

Treatment

Acutediverticulitis is treated with antibiotics.

The involved portion of the colon may need to be removed with surgery if you have:

• Abscess
• Hole (perforation) in the colon
• Fistula(abnormal connections between different parts of the colon or the colon and another body area)
• Repeated attacks of diverticulitis

After the acute infection has improved, eating high-fiber foods and using bulk additives such as psyllium may help reduce the risk of diverticulitis or other symptoms.

Expectations (prognosis)

Usually, this is a mild condition that responds well to treatment.

Complications

• Abscess formation
• Narrowing (stricture) in the colon or fistula formation
• Perforation of the colon leading to peritonitis

Calling your health care provider

Call your health care provider if symptoms of diverticulitis occur.

Also call if you have diverticulitis and symptoms worsen or new symptoms develop.

Prevention

A high-fiber diet may prevent development of diverticulosis. Some doctors tell patients with a history of diverticulitis to avoid nuts and seeds in the diet. However, there is no evidence that this is helpful to prevent the disease.

References

Prather C. Inflammatory and anatomic diseases of the intestine, peritoneum, mesentery, and omentum. In: Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 145.

Answer 2

Definition

Diverticulitis is small, bulging sacs or pouches of the inner lining of the intestine (diverticulosis) that become inflamed or infected. Most often, these pouches are in the large intestine (colon).

Causes, incidence, and risk factors

No one knows exactly what causes the sacs, or pouches of diverticulosis to form. Eating a low-fiber diet is one of the most likely causes.

People who eat mostly processed food, as many Americans eat, do not get enough fiber in their diet. Processed foods include white rice, white bread, most breakfast cereals, crackers, and pretzels.

As a result, constipation and hard stools are more likely to occur - causing people to strain when passing stools. This increases the pressure in the colon or intestines and may cause these pouches to form.

Diverticulosis is very common. It is found in more than half of Americans over age 60.

Diverticulitis is caused by small pieces of stool (feces) that become trapped in these pouches, causing infection or inflammation.

Symptoms

People with diverticulosis often have no symptoms, but they may have bloating and cramping in the lower part of the belly. Rarely, they may notice blood in their stool or on toilet paper.

Symptoms of diverticulitis are more severe and often start suddenly, but they may become worse over a few days. They include:

• Tenderness, usually in the left lower side of the abdomen
• Bloating or gas
• Fever and chills
• Nausea and vomiting
• Not feeling hungry and not eating

Signs and tests

Your health care provider will examine you. Blood tests may be ordered to see if you have an infection.

Other tests that help diagnose diverticulitis may include:

• CT scan
• Ultrasound of the abdomen
• X-rays of the abdomen

Treatment

The treatment of diverticulitis depends on the severity of your symptoms. Some people may need to be in the hospital, but usually you can treat this problem at home.

To help with the pain, your doctor may suggest that you:

• Rest in bed and possibly use a heating pad on your belly
• Take pain medicines (ask your doctor which ones you should use).
• Drink only fluids for a day or two, and then slowly begin drinking thicker liquids and then eating foods.

The doctor may treat you with antibiotics.

After you are better, your doctor will suggest that you add more fiber to your diet and avoid certain foods. Eating more fiber can help prevent future attacks. If you have bloating or gas, reduce the amount of fiber you eat for a few days.

Once these pouches have formed, you will have them for life. If you make a few simple changes in your lifestyle, you may not have diverticulitis again.

Some foods can make your symptoms worse:

• AVOID beans and peas, coarse grains, coconut, corn or popcorn, dried fruits, skins on vegetables and fruits, tomatoes, strawberries, pickles, and cucumbers.
• Ask your doctor about eating nuts or seeds.
• Do not drink too much coffee, tea, or alcohol. They can make constipation worse.

Expectations (prognosis)

Usually, this is a mild condition that responds well to treatment. Some people will have more than one attack of diverticulitis.

Complications

More serious problems that may develop are:

• Abnormal connections that form between different parts of the colon or between the colon and another body area (fistula)
  • Abscess (pocket filled with pus or infection)
• Hole or tear in the colon (perforation)
• Narrowed area in the colon (stricture)

Calling your health care provider

Call your health care provider if symptoms of diverticulitis occur.

Also call if you have diverticulitis and:

• Blood in your stools
• Fever above 100.4 °F that dos not go away
• Nausea, vomiting, or chills
• Sudden belly or Back pain that gets worse or is very severe

References

Fox JM, Stollman NH. Diverticular disease of the colon. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 117.

Reviewed By

Review Date: 01/31/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; George F Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.