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Diseases & Conditions

Diverticulitis

DiverticulitisCausesDiagnosisMedicationsPreventionRisk FactorsSymptomsTreatment

What is DIVERTICULITIS?

It is a digestive disease that usually develops in the large intestine. When pouches (diverticula) are formed on the outer surface of the large intestine it is called diverticulosis. Diverticulitis occurs if any of these pouches get inflamed.

Causes of Diverticulitis

Diverticulitis is caused when the colon is subjected to excessive pressure. Sigmoid colon is the smallest part of the large intestine and is therefore understood to be under maximum pressure. The most well known reason for developing diverticulitis is a lack of non-soluble dietary fiber. Research has revealed that popcorn, corn and nuts help reduce the occurrence of diverticulitis in adult males.

Diagnosis of Diverticulitis

Physical examination and a study of the patient’s history and symptoms can help to narrow it down to diverticulitis. Blood tests help to confirm the diagnosis.

A hemogram will reveal if the patient has leukocytosis. But the nonexistence of leukocytosis does not mean the absence of diverticulitis.

A CT scan is the most excellent imaging method available to confirm the presence of diverticulitis. It is extremely accurate (98%) in confirming a diagnosis of diverticulitis.

Traverse images of the pelvis and abdomen are obtained after administering intravascular and oral contrast. Images of the colon reveal whether there is inflammation or fatty tissues around it. If diverticulae are observed, a diagnosis of advanced diverticulitis can be confidently made. Abscesses can also be drained without surgical intervention.

Colonoscopy and barium enema are not recommended when diverticulitis is in the advanced stage.

Medication for Diverticulitis

Anti-spasmodic drugs:

  • Chlordiazepoxide (Librax)
  • Atropine, Phenobarb, Scopolamine (Donnatal)
  • Dicyclomine (Bentyl)
  • Hyoscyamine (Levsin)

Antibiotics:

  • Ciprofloxacin (Cipro)
  • Metronidazole (Flagyl)
  • Cephalexin (Keflex)
  • Doxycycline (Vibramycin)

Prevention of Diverticulitis

Individuals who suffer from diverticular disease can decrease the risk of developing diverticulitis by making a high-fiber diet part of their life.

Risk Factors of Diverticulitis

  • Abscess (accumulation of pus due to infection)
  • Bowel obstruction (prevents the normal transition of the products formed during digestion)
  • Intestinal fistula
  • Peritonitis (the membrane that lines sections of the abdomen is inflamed due to infection)
  • Intestinal perforation
  • Bleeding
  • Sepsis and septic shock (infection which results in the decrease of tissue perfusion and delivery of oxygen)

Symptoms of Diverticulitis

  • Pain in the lower abdomen (left side)
  • Leukocytosis
  • Feeling hot
  • Diarrhea/constipation
  • Nausea
  • Cramping

Treatment for Diverticulitis

Treatment for diverticulitis involves putting the patient on broad-spectrum antibiotics and resuscitation by IV fluids. A diet that reduces bowel activity is prescribed on discharge from the hospital. After the colon is given enough time to heal, a diet high in fiber is advised.

Surgery may be necessary in acute cases where medication is not helping the patient. It can be elective or part of a medical emergency. When the intestine is ruptured resulting in infection, a surgery becomes inevitable. There are two procedures commonly followed during surgery. They are:

Primary bowel resection: The ruptured or diseased segments of the intestine are removed and reconnected with the healthy part of the intestine. It can be done laparoscopically or through colectomy after taking into consideration the medical condition of the patient.

Bowel resection with Colostomy: This surgery is undertaken only in very severe cases where rejoining the rectum and colon is too risky due to extreme inflammation of the intestines. The procedure involves making an opening in the wall of the abdomen and bringing the colon outside so that the waste can be removed. Once the inflammation is completely gone, the patient goes through another surgery in which the rectum and the intestine are rejoined thereby reversing the colostomy. It is most often a temporary measure but can be permanent if the infection is very severe.