Diverticulitis

Diverticulosis is a condition in which the colon suffers from the presence of small, bulging sacs of tissue that press outward from the colon wall. The small pouches develop and bulge out through weak spots in the walls of the colon, typically on the left side of the abdomen—in the part of the colon called the sigmoid colon. The condition is more prevalent as people age, as pressure built up in the colon causes the bulging of tissue. Most people who have diverticulosis do not have any symptoms, but some have mild cramps, constipation, diarrhea, or bloating.

The small, balloon-like pouches are called diverticula, or diverticulum. If the diverticula become inflamed or infected, the condition is called diverticulitis. (This happens in about 10% to 25% of people with diverticulosis.)

Diverticulitis typically carries symptoms such as the following:

• Steady abdominal pain
• Tenderness to pressure in the lower abdomen
• Fever
• Nausea
• Vomiting
• Chills
• Cramping
• Change in bowel habits (constipation or diarrhea)
• Rectal bleeding
• Sharper pain with breathing or jarring movements such as walking.

These symptoms can lead to serious complications such as an abscess, perforation, or intestinal blockage from internal scarring. Sometimes inflamed diverticula can cause narrowing of the bowel, leading to an obstruction. Another rare but life-threatening complication called peritonitis can occur when diverticula rupture and leak infection into the abdominal cavity. There may be bleeding, which requires medical attention, and occasionally, surgery. Also, the affected part of the colon could adhere to the bladder or another organ in the pelvic area, causing a fistula-an abnormal connection between the colon and an adjacent organ.

Diverticulosis may be discovered occur during a routine colonoscopy; or the condition may be investigated if the symptoms present themselves. Barium x-rays and abdominal ultrasounds can also detect the presence of diverticula. People experiencing persistent symptoms of diverticulosis, or the passing of bloody, tarry, black stools, should call their doctor, as the complications of diverticulitis (or another disease of the colon) may be present. Proper diagnosis is necessary for successful treatment.

Diagnosis

The symptoms of diverticular disease can mimic other diseases, including irritable bowel syndrome, stomach ulcers, acute appendicitis, Crohn's disease, bladder infection, kidney stones, colitis, or tumors of the ovary or colon. Your doctor will ask about your medical history, bowel habits, and diet; and will conduct a physical examination, including a rectal examination with a gloved finger to detect tenderness, blockage, or blood.

Your doctor may press on your abdomen to check for tenderness. After the doctor removes the pressure-if inflammation is present and spreading, discomfort will remain. If you have sharper pain when you move, an abscess may have ruptured.

Treatment

Diverticulitis is treated with antibiotics and in most cases, the infection responds. In cases of severe infection with high fever and pain, excessive bleeding, or a lack of response to antibiotics, surgery may be necessary. If fever continues, you may have an abscess-a collection of pus-which can develop when a diverticulum becomes perforated and develops a hole. Your doctor will then consult with a surgeon to plan the next step: drainage (cleaning out the pus) or surgery.

Emergency surgery is required to treat peritonitis, the most serious potential complication of diverticulitis. The most common procedure, known as a colon resection, involves removing the part of the colon that contains diverticula and reattaching the ends. When done during emergencies, a colon resection is a two-stage process. First, a section of colon is removed, but because of infection, it is not safe to rejoin the ends. Instead, the surgeon creates a temporary hole, or stoma, in the abdomen and connects the colon to it, a procedure called a colostomy. A bag is attached to collect the stool. Later, a second operation is done to reattach the end of the colon, and remove the colostomy. Sometimes, if the situation is not an emergency, the surgery can be done all at once.
Prognosis

With proper treatment and a high-fiber diet, the outlook for people with diverticulosis and uncomplicated diverticulitis is excellent. Most people with diverticulosis never have symptoms. People who are hospitalized for diverticulitis, usually improve within two to four days after treatment begins. Up to 85% of patients recover with bed rest, liquid diet and antibiotics, and most never have a second episode of diverticulitis. About 90% of people who have a colon resection do not have symptoms return after the surgery.