Diverticular Diseases Overview

Diverticula are small, balloon-like pouches that protrude from the intestines. This is a condition called diverticulosis. Although they can form throughout the colon, they are most often found in the sigmoid colon (the portion of the large intestine closest to the rectum). They are usually benign and asymptomatic. The development of diverticula is more common with age. Diverticulitis is when the diverticula become inflamed, infected, or perforated.

Advanced cases of diverticulitis can cause the following serious conditions:

• Formation of a colonic fistula (a tunnel from the colon, commonly to the bladder or vagina)
• Blockage within the colon or small intestine
• Rectal bleeding
• Pus collecting within the diverticula
• Peritonitis, which occurs if the infected diverticula rupture or spill into the abdominal cavity

Causes

Diverticulitis tends to develop during middle age. It is commonly thought to be related to high pressure within the colon, causing the weak areas of the colon wall to bulge and form pouches. Diets low in fiber and high in red meat may also contribute. There can also be a genetic predisposition to this condition.

Symptoms

Signs and symptoms associated with diverticulitis are:

• Acute pain, pressure, and tenderness of the abdomen, usually lasting for several days
• Fever
• Constipation
• Nausea and vomiting
• Multiple and/or recurring attacks

Diagnosis 

Diagnosis can occur during a work-up of the patient’s symptoms, most commonly with a CT scan of the abdomen and pelvis. It is also detected during routine screening examinations, such as a colonoscopy.

Treatment

Treatment depends on the severity of diagnosis.

• Mild diverticulitis – Antibiotics to treat infection, liquid or low-fiber diet while the bowels heal, a high fiber diet following recovery for prevention is usually recommended
• Severe diverticulitis – Hospitalization with intravenous antibiotics, drainage of abdominal abscess if formed, sometimes emergency surgery is needed

Surgery may be needed if complications such as a bowel abscess, fistula, obstruction, or perforation have occurred. Surgery may entail:

• Primary bowel resection – Diseased segments of the intestine are removed and healthy segments reconnected. This is the primary treatment if the colon is not acutely inflamed at the time of surgery.
• Bowel resection with a temporary colostomy – Diseased segments of intestine are removed and an opening in the abdomen is connected to the healthy part of colon for waste to pass into a bag. A colostomy may be reversed in some cases after inflammation is reduced.