WHAT IS DIVERTICULAR DISEASE?
Diverticular disease is the general name given to the condition that creates small sacs or pouches from the wall of the colon and the complications that can arise from the presence of those sacs.
The presence of diverticulosis can lead to several different complications such as diverticulitis, perforation, stricture, fistula, and bleeding.
Diverticulitis is an inflammatory condition of the colon that is thought to be caused by perforation of one of the individual sacs. The most common symptoms of diverticulitis are abdominal pain and fever called simple diverticulitis.
Complications of diverticulitis include abscess formation and perforation of the colon with peritonitis. Peritonitis is infection that spreads freely within the abdomen.
Other complications of diverticulosis include bleeding, formation of a narrowing in the colon that does not easily let stool pass (called a diverticular stricture), or formation of a tract to another organ (called a fistula). When a fistula forms, it most commonly connects the colon to the bladder (colovesical fistula) . This causes patients to pass air when passing water (pneumaturia).
WHAT CAUSES DIVERTICULAR DISEASE?
The most commonly accepted theory as to why diverticulosis occurs is that high pressure within the colon, which may be caused by a diet low in fiber and high in red meat, causes weak areas of the colon wall to bulge out and form sacs. At the present time, it is not well understood how these sacs become inflamed and cause diverticulitis.
HOW IS DIVERTICULITUS DIAGNOSED?
Diverticulosis often causes no symptoms and is often diagnosed during tests such as screening colonoscopy. Diverticulitis is often characterized by fever and lower abdominal pain. A CT scan of the abdomen and pelvis is often used to confirm the diagnosis.
WHAT CAN BE DONE TO TREAT DIVERTICULAR DISEASE?
Most people with diverticulosis will not have symptoms. People with diverticulosis are advised to eat a diet high in fiber and fruits and vegetables and low in red meat. Most cases of diverticulitis can be treated with antibiotics either by mouth or by the intravenous (IV) route. Diverticulitis with an abscess may be treated with antibiotics and a drain placed under x-ray guidance.
Surgery for diverticular disease is indicated if there is:
Diverticulitis with a rupture in the colon that has resulted in pus or stool leaking into the abdominal cavity, resulting in peritonitis. Patients are usually quite ill and often require emergency surgery.
- An abscess that cannot be effectively drained.
- Diverticulitis that has caused a colonic stricture or fistula.
Surgery requires resection of the affected segment of colon (usually the sigmoid colon- sigmoid colectomy). In the emergency setting this may require a temporary stoma (colostomy or ileostomy).
