Diverticulitis
Diverticulitis is a common disease of the bowel affecting particularly the large intestine.
Diverticulitis develops from diverticulosis, which involves the formation of pouches (diverticula) on the outside of the colon.
Diverticulitis results if one of this diverticulum becomes inflamed. In complicated diverticulitis, bacteria may subsequently infect the outside of the colon if an inflamed diverticulum bursts open.
If the infection spreads to the lining of the abdominal cavity, (peritoneum), this can cause a potentially fatal peritonitis.
Sometimes inflamed diverticula can cause narrowing of the bowel, leading to an obstruction.
In addition, the affected part of the colon could adhere to the bladder or other organ in the pelvic area, causing a fistula, or abnormal communication between the colon and an adjacent organ.
Diverticulitis most often affects middle-aged and elderly persons, though it can strike younger patients as well.
Causes of Diverticulitis
Its development is thought to be a result of raised intraluminal colonic pressures.
Low dietary fibre, particularly non-soluble fibre is a risk causative factor in diverticular disease.
It is thought that mechanical blockage of a diverticulum can lead to infection of the diverticulum.
Symptoms of Diverticulitis
Patients may experience:
Diverticulitis Diagnosis
Patients with the above symptoms are commonly studied with a computed tomography, or CT scan.
The CT scan is very accurate in diagnosing diverticulitis. It may also identify patients with more complicated diverticulitis, such as those with an associated abscess.
CT also allows for radiologically guided drainage of associated abscesses, possibly sparing a patient from immediate surgical intervention.
Treatment of Diverticulitis
Acute diverticulitis is usually treated with measures such as bowel rest, IV fluid resuscitation, and broad-spectrum antibiotics that cover anaerobic bacteria and gram-negative rods.
Recurring acute attacks and complications such as peritonitis, abscess, or fistula may require surgery.
Upon discharge, patients are placed on a high-fibre diet. There is evidence that this lowers the recurrence rate.
Likely Diverticulitis Complications
Likely complications include:
A fistula is an abnormal connection of tissue between two organs or between an organ and the skin.
When damaged tissues meet each other during infection, they sometimes stick together. If they heal that way, a fistula forms.
When diverticulitis-related infection spreads outside the colon, the colon's tissue may stick to nearby tissues. The organs usually involved are the bladder, small intestine, and skin.
The most common type of fistula occurs between the bladder and the colon and affects men more than women.
This type of fistula can result in a severe, long-lasting infection of the urinary tract. The problem can be corrected with surgery to remove the fistula and the affected part of the colon.