In people over the age of 50, the presence of small pockets which protrude out from the wall of the colon called “diverticula” are very common. These pockets typically form where blood vessels enter the colon wall. These diverticula are usually asymptomatic; however, should they become inflamed, the term “diverticulitis” is used. It is unclear what causes diverticulitis; however, theories include increased pressure in the colon which then decreases blood flow. The most common symptom is abdominal pain usually in the left lower abdomen Fevers, diarrhea, nausea and vomiting are also present in many patients. About 75% of cases of diverticulitis are considered “simple” meaning that there are no complications. About 25% of cases of diverticulitis are considered “complicated” indicating there has been a perforation, abscess formation, or fistula (abnormal tract between two areas). Another complication of diverticular disease is bleeding which occurs when an artery located in a diverticulum erodes through the mucosa of the colon. This bleeding is typically “painless” and is more likely to occur on the right side of the colon than on the left side of the colon. If you see blood with your bowel movements you should see a Borland Groover provider to determine if further evaluation is required.
The diagnosis of diverticulosis is most commonly made by colonoscopy or during imaging of the abdomen with a CT scan. If you are found to have diverticulosis, it is likely your Borland Groover provider will recommend increasing the fiber in your diet; fiber supplements may also be recommended. Fruits and vegetables are an excellent source of fiber. For years, it was recommended to avoid seeds and nuts, however, there is no evidence that these foods are associated with diverticulitis.
Therapy depends on the severity of diverticulitis and whether any of the above discussed complications have occurred. As a general rule, if you have fevers or severe abdominal pain you should be assessed by a physician to determine if admission to the hospital is required. In almost all cases you will be given antibiotics and fluids. If there is a perforation or fistula surgery is likely. Some abscess can be successfully treated by inserting a drain through the abdominal wall into the abscess.
About 85% of patients with simple diverticulitis will respond to medical therapy with 15% requiring a surgical intervention, however, after a second or third episode of diverticulitis complications occur in nearly 60% of patients. For this reason most providers would recommend surgical removal of the involved colon after two confirmed episodes of diverticulitis. Some would advocate removing the involved colon after a single confirmed episode in those less than 40 years of age.
Additional patient resources:
National Library of Medicine
References
1. Acosta, J, Grebenc, M, Doberneck, R, et al. Colonic diverticular disease in patients 40 years old or younger. Am Surg 1992; 58:605.
2. Ambrosetti, P, Robert, JH, Witzig, JA, et al. Acute left colonic diverticulitis: A prospective analysis of 226 consecutive cases. Surgery 1994; 115:546.
3. Roberts, P, Abel, M, Rosen, L, et al. Practice parameters for sigmoid diverticulitis. The Standards Task Force American Society of Colon and Rectal Surgeons. Dis Colon Rectum 1995; 38:125.
4. Vignati, PV, Welch, JP, Cohen, JL. Long-term management of diverticulitis in young patients. Dis Colon Rectum 1995; 38:627.
