Diverticulitis

Diverticulitis is inflammation of an abnormal pouch (diverticulum) in the intestinal wall. The condition of having diverticula is called diverticulosis. Sometimes, however, one or more pouches becomes inflamed or infected, causing severe abdominal pain, fever, nausea and a marked change in your bowel habits. Sometimes inflamed diverticula can cause narrowing of the bowel , leading to an obstruction . The sigmoid and transverse colon and the anterior surface of the ascending and descending colon are intraperitoneal. Disease is frequently mild when pericolic fat and mesentery wall-off a small perforation. A patient suffering from diverticulitis will have abdominal pain and tenderness, and fever. More extensive disease leads to abscess formation and rarely, with rupture, to peritonitis. These marble-sized pouches usually occur where blood vessels run through the intestinal wall. Diverticulitis can lead to some very serious conditions (see Outlook ) if it is not detected and treated promptly. About one-quarter of people with diverticulitis have complications, such as an abscess, fistula, or obstruction of the colon, that require surgery.

Most patients can be managed with conservative measures. Patients with mild symptoms and no peritoneal signs may be managed initially as outpatients on a clear liquid diet and broad-spectrum oral antibiotics with anaerobic activity. Reasonable regimens include amoxicillin and clavulanate potassium (875 mg/125 mg) twice daily, or metronidazole, 500 mg three times daily, plus either ciprofloxacin, 500 mg twice daily, or trimethoprim-sulfamethoxazole, 160/800 mg twice daily orally, for 7–10 days or until the patient is afebrile for 3–5 days. Symptomatic improvement usually occurs within 3 days, at which time the diet may be advanced. Patients with increasing pain, fever, or inability to tolerate oral fluids require hospitalization.

Patients with severe diverticulitis (high fevers, leukocytosis, or peritoneal signs) and patients who are elderly or immunosuppressed or who have serious comorbid disease require hospitalization acutely. Patients should be given nothing by mouth and should receive intravenous fluids. If ileus is present, a nasogastric tube should be placed. Intravenous antibiotics should be given to cover anaerobic and gram-negative bacteria. Single-agent therapy with either a second-generation cephalosporin (eg, cefoxitin), piperacillin-tazobactam, or ticarcillin clavulanate appears to be as effective as combination therapy (eg, metronidazole or clindamycin plus an aminoglycoside or third-generation cephalosporin [eg, ceftazidime, cefotaxime]).

Symptomatic improvement should be evident within 2–3 days. The antibiotics should be continued for 7–10 days, after which time elective evaluation with colonoscopy or barium enema should be performed.

Many people have small pouches in their colons that bulge outward through weak spots, like an inner tube that pokes through weak places in a tire. Although diverticula can form anywhere, including in your esophagus, stomach and small intestine, most occur in your large intestine. Diverticulitis develops from diverticulosis , which involves the formation of pouches ( diverticula ) on the outside of the colon . However, an earlier description in an editorial comment by Sir Erasmus Wilson (1840) can be found. About 10 percent of Americans over the age of 40 have diverticulosis. If the infection spreads to the lining of the abdominal cavity , ( peritoneum ), this can cause a potentially fatal peritonitis . Sometimes, however, one or more pouches becomes inflamed or infected, causing severe abdominal pain, fever, nausea and a marked change in your bowel habits. The rupture results in infection in the tissues that surround the colon. Most of the time, diverticulitis can be treated with dietary changes and if there is an infection with antibiotics Disease is frequently mild when pericolic fat and mesentery wall-off a small perforation. More extensive disease leads to abscess formation and rarely, with rupture, to peritonitis. In women, the uterus is interposed between the colon and the bladder, and this complication is only seen following a hysterectomy. This happens in 10 to 25 percent of people with diverticulosis. Also the affected part of the colon could adhere to the bladder or other organ in the pelvic cavity , causing a fistula , or abnormal communication between the colon and an adjacent organ.

Causes of Diverticulitis

Common causes of Diverticulitis :

• Aging with changes in collagen structure may lead to a weakening of the colonic wall.
• Colonic motility disorders, ingestion of corticosteroids, and use of nonsteroidal anti-inflammatory drugs may be predisposing factors in the development of diverticular disease.
• Hard stools, such as those produced by a diet low in fiber or slower stool "transit time" through the colon, can further increase pressure.
• If a diet is low in fiber, the colon must exert more pressure than usual to move small, hard stool.
• The sigmoid colon has the smallest diameter of any portion of the colon, and therefore the portion which would be expected to have the highest intraluminal pressure according to the laws of Laplace.
• Fiber is found in fruits and vegetables, whole grains, and legumes (dried beans, peas, and lentils).
• Diverticulitis is caused by inflammation, or (sometimes) a small perforation within a diverticulum.
• If the perforation is large, stool in the colon can spill into the abdominal cavity, causing an abscess or peritonitis.

Symptoms of Diverticulitis

Some common symptoms of Diverticulitis :

• Tenderness, cramps, or pain in the abdomen (usually in the lower left side but may occur on the right) that is sometimes worse when you move.
• Nausea and sometimes vomiting.
• Tenderness in your abdomen when wearing a belt or bending over
• Bleeding from your rectum
• Nausea
• Vomiting
• possible constipation or diarrhea
• Bleeding: Bright red or maroon blood may appear in the toilet, on toilet paper, or in your stool. Bleeding can be severe and often stops by itself.
• Pain in the abdomen, usually in the lower left side

Treatment of Diverticulitis

• Patients who are immunocompromised or who have debilitating comorbid conditions, such as diabetes and renal failure, fare worse.
• Acute diverticulitis tends to be more severe in people younger than 40 years, possibly due to delayed diagnosis, and in very elderly people.
• After the acute infection has stabilized, diverticulitis is treated by increasing the bulk in the diet with high - fiber foods and bulk additives such as Metamucil.
• Recurrent attacks or presence of perforation, fistula (abnormal tube-like passage), or abscess requires surgical removal of the involved portion of the colon.
• If cramps, bloating, and constipation are problems, the doctor may prescribe a short course of pain medication.
• Perforation of the colon leading to peritonitis
• You're more likely to be hospitalized if you have vomiting, a fever above 100 F, a high white blood cell count or are at risk of complications such as a bowel obstruction or peritonitis.
  

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