Diverticulitis of Colon: Symptoms, Diagnosis

Overview

Diverticulitis of colon is a condition that happens when a diverticulum (an abnormal pouch, typically found in the intestinal wall of the colon or large intestine) grows in the wall of the intestines, causing inflammation. Diverticulum may progress to a severe version called diverticula. It has been recognized that most cases of diverticulitis are found in the colon. However, it’s possible for a diverticulum to grow at any part of the digestive system. If left untreated, it may lead to a serious condition.

Over the past few decades, an increasing number of cases of colon diverticulitis have been reported, making it a major healthcare burden for western countries. According to the statistics, acute diverticulitis contributes to nearly 200000 hospital admissions and $2.2 billion of health care costs per year in America. Although elderly people are more likely to develop colon diverticulitis, younger adults may also develop diverticular disease. In fact, for some time, it was thought that younger patients and male patients were more likely to experience a more aggressive form of diverticulitis with an increased complication rate and higher recurrence.

Causes

The exact cause of colon diverticulitis is yet to be identified. However, it has been suggested that a diverticulum may become inflamed due to several factors. Possible factors may include:



  • Obesity
  • Smoking
  • Age 40 or older
  • A lack of exercise
  • Certain medications
  • A history of constipation
  • A reduction of blood flow to the pouch
  • A diet low in fiber and high in animal fat
  • A weakening in the intestinal wall due to pressure
  • Fecal matter trapped in a small opening in the abnormal pouch
  • Environmental and genetic risk factors

Symptoms

In most cases, colon diverticulosis causes belly pain or cramping. Symptoms may be slightly different depending on the severity and the cause of your condition. possible symptoms may include:



  • Fever
  • Bloating
  • Abdominal tenderness
  • Nausea and vomiting
  • Constipation or, less commonly, diarrhea
  • Constant and persistent pain lasting several days (It usually affects the lower left side of the abdomen. However, the right side of the abdomen could be more painful, especially in people of Asian descent.)

Complications

It may be great pain to have ordinary colon diverticulitis. However, it’s very likely that one may develop life-threatening complications. About one fourths of the affected people develop complications, which may include:



  • Weakness, higher temperatures, more pain, and higher white blood cell counts
  • A blockage in your colon or small intestine. The blockage is caused by scarring.
  • Abscess formation. An abscess is a walled-off collection of bacteria and white blood cells — pus. It occurs when pus collects in the pouch.
  • Peritonitis. It occurs when the infected or inflamed pouch ruptures, spilling intestinal contents into your abdominal cavity. It requires immediate care.
  • Fistula formation. An abnormal passageway (fistula) may form between sections of bowel or the bowel and bladder. It happens when the infection burrows into nearby tissues, such as another part of the intestinal tract, the urinary bladder, or the skin. If people develop this complication, they do require both surgery and antibiotics.
  • Stricture formation. Like fistula formation, it’s another uncommon complication that can develop from recurrent bouts of diverticulitis. Affected people must call on surgeons to correct the problem so fecal material can pass through without obstruction.

Diagnosis

In most cases, colon diverticulitis is diagnosed during an acute attack. Since abdominal pain can be associated with a number of problems or conditions, your doctor may order a series of tests and procedures to rule out other causes for your symptoms.



Medical History



You doctor will likely start with gathering your medical history. He’ll ask you about your diet, general health, meds you are on, and how often you have bowel movements.



Physical Examination



Having collected information about your medical history, the doctor may order a physical examination, including checking your abdomen for tenderness. During the examination, a digital rectal exam is also conducted. With a lubricated gloved finger, the doctor will gently check your anus for bleeding, pain, or other signs. Women generally will be recommended to undergo a pelvic examination as well to rule out pelvic disease.



Having finished the procedures mentioned above, the following tests are likely:



  • Blood and urine tests, to check for signs of anemia or inflammation
  • A stool test, to rule out infection in people who have diarrhea.
  • A liver enzyme test, to rule out liver-related causes of abdominal pain.
  • A pregnancy test for women of childbearing age, to rule out pregnancy as a cause of abdominal pain.
  • It’s worth mentioning that most doctors don’t notice cases of diverticulosis until they screen for other conditions. For instance, the pouches might show up in a colonoscopy, or an X-ray. In some cases, a CT scan is also applied to identify inflamed or infected pouches and confirm a diagnosis of diverticulitis. CT can also indicate the severity of diverticulitis and guide treatment.

Treatment

To put it simply, the main goal of treatment is to prevent it from causing further problems and to relieve your symptoms. depending on the severity of your symptoms, your doctor may recommend the following treatment options:



Mild Diverticulitis



If your symptoms are mild, you may be treated at home. Since bacteria are responsible for the inflammation, antibiotics are the cornerstone of diverticulitis treatment. In addition to antibiotics, you may be recommended to take an OTC pain reliever (e.g. Tylenol) or keep to a liquid diet for a few days while your bowel heals. Moreover, the doctor may also suggest high-fiber diet, fiber supplements, or fiber product like Citrucel or Metamucil. It’s important to check with your doctor before taking supplements of any kind.



Moderate and Severe Diverticulitis



  • Hospitalization

If you have an acute attack or are trapped with other problems, the doctor may suggest you be hospitalized. While you’re in hospital, you may be given intravenous antibiotics. If an abdominal abscess is formed, a tube will be inserted to drain the abscess.



  • Surgery

Doctors will recommend certain surgery if you have a complication (e.g. a bowel abscess, fistula or obstruction, or a puncture) in the bowel wall, have had multiple episodes of uncomplicated diverticulitis, or have a weakened immune system.

There are two main types of surgery: Primary bowel resection and bowel resection with colostomy. For the former one, the surgeon removes diseased segments of your intestine and then reconnects the healthy segments (anastomosis). If you have so much inflammation that it’s impossible to rejoin your colon and rectum, the surgeon will perform a colostomy.



  • Follow-Up Care

Your doctor may recommend colonoscopy six weeks after your recovery from diverticulitis, especially if you haven’t had the test in the previous year.
In addition to the treatment options mentioned above, your doctor may recommend surgery to prevent future episodes of diverticulitis. The decision is often based on the frequency of attacks and whether complications have occurred.

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Keywords: diverticulitis, colon diverticulitis

* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.