Diverticulitis – Diverticulosis

Diverticular disease is the general term for a common condition that causes pouches or small blister-like growths (diverticula) to form in the wall of the large intestine (colon). Although these pouches can form anywhere in the large intestine, the most common part is in the sigmoid colon (the section of the large intestine before the rectum).


What is diverticulosis?

Diverticulosis is the presence of diverticula without complications or problems.

Diverticulosis can lead to more serious conditions, such as diverticulitis, perforation (formation of holes), the stricture of the large intestine from repeated episodes of inflammation (which disallows the easy passage of intestinal contents), fistulas and bleeding.


What is diverticulitis?

Diverticulitis is an inflammatory condition of the large intestine thought to be caused by perforation of one of the pouches (diverticula). Several secondary complications can result from an acute diverticulitis. When this happens, it’s called complicated diverticulitis.


Complications of diverticulitis

The main complications of diverticulitis are the following:

  • Abscess formation and perforation of the colon with peritonitis. An abscess is a collection of pus lodged in the body. Peritonitis is a potentially life-threatening infection that progresses rapidly and causes great morbidity.
  • Bleeding from the rectum
  • Stricture of the large intestine that prevents the easy passage of stool
  • Fistula, that is the formation of a communication path with another organ or with the skin. When a fistula forms, most commonly the colon communicates with the bladder. The colon may also communicate with the skin, uterus, vagina, or other part of the intestine.


What are the causes?

The most commonly accepted theory links diverticulosis to high pressure within the colon. This pressure causes swelling and pouching in the weak areas of the colon wall. A diet low in fiber and high in red meat may also play a role. Currently, the mechanism of inflammation of the pouches and the development of diverticulitis is not fully understood.


What are the symptoms?

Most patients with diverticulosis of the colon have no symptoms or complications. Patients with diverticulitis usually have abdominal pain, especially in the lower abdomen, as well as fever and often have rectal bleeding.


How is the diagnosis made?

Diverticulosis itself does not cause symptoms. It can be diagnosed during screening tests, such as a colonoscopy. An abdominal-pelvic CT scan can be used to confirm the diagnosis of diverticulitis.


What is the treatment?

Most people with diverticulosis have no symptoms. However, as a preventive measure, a diet high in fiber, fruit and vegetables and poor in red meat is recommended.

In most cases, diverticulitis can be treated with oral or intravenous (IV) antibiotics. Diverticulitis with abscess can be treated with antibiotics as well as fluoroscopy-guided percutaneous drainage.

Surgery for diverticular disease is indicated for the following:

  • Rupture in the colon that causes pus or feces to flow into the peritoneal cavity, resulting in peritonitis, which often requires emergency surgery.
  • Abscess that cannot be drained effectively. Severe cases of inflammation unresponsive to medical treatment, including IV antibiotics and hospitalization. Patients with immune system problems (e.g., related to organ transplant or chemotherapy).
  • Colon stricture or fistula. A history of multiple episodes of acute diverticulitis may lead a patient to the decision to undergo surgery to prevent future episodes.

Surgery for diverticular disease usually involves removing the affected part of the colon. The creation of a colostomy or ileostomy (a section of intestine that exits through the abdominal wall).

The decision about the type of surgery is made on a case-by-case basis.


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