Diverticular Disease

Diverticula are small, balloon-like pouches that protrude from the intestines. 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 harmless unless the diverticula become inflamed, infected, or perforated. This is called diverticulitis.

Advanced cases of diverticulitis can cause the following serious conditions:

• Formation of an anal fistula
• 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.

To keep diverticula from forming and leading to diverticulitis or more serious complications:

• Manage a heathy weight through diet and exercise
• Add more fiber to routine diet
• Stay hydrated
• Avoid smoking (smokers twice as likely to develop)
• Pay attention to medication side effects, particularly opiates, steroids, NSAIDS

Symptoms

Signs and symptoms associated with diverticulitis are:

• Pain and tenderness of the abdomen, usually lasting for several days
• Fever
• Constipation
• Nausea and vomiting

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 severity of symptoms.

• Mild symptoms – Antibiotics to treat infection, liquid or low-fiber diet while bowel heals, high fiber diet following recovery for prevention
• Severe symptoms – Hospitalization with intravenous antibiotics, drainage of abdominal abscess if formed

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.
• Bowel resection with 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.