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Diverticulosis – Complications, Symptoms and Treatment

Diverticulosis is a condition when pea-sized outpouchings develop in the gut wall, most likely in the colon. It is a widespread condition, though it often remains unrecognized. It is estimated that in Western countries 10% of people over 40 years of age develop diverticula. By the time they reach age 60 or 70 more than half the population can expect to have the condition.

The term diverticula, which gave the name to diverticulosis, refers to thin sacs that balloon out at weak spots along the gut wall. They usually form in areas where blood vessels enter to supply oxygen and nutrition to the intestinal muscles. Once the pouches develop, they stay permanently. Since the pouches are caused by pressure inside the intestine, they usually form in areas where the pressure is highest. Therefore, diverticula are most common in the sigmoid colon, the narrow section that is closest to the rectum, where muscle contractions in the intestinal wall generate the most pressure.

Many people with diverticulosis do not realize they have it because there are no symptoms. Diverticulosis is usually discovered incidentally during a gastrointestinal exam done for some other reason. But most people do not need to worry about it too much as only about 20% of them ever experience inflammatory complications, and out of this group, only about a third will develop rectal bleeding, which can be a potentially serious or even life-threatening condition.

Possible Complications of Diverticulosis

In some people with diverticulosis (circa 20%) one or more of the pouches become infected and develop an abscess. This condition is called diverticulitis. Diverticulitis develops when hard stool gets caught in pouches and interferes with the blood supply, allowing bacteria to grow and infect the tissue. Diverticular bleeding occurs when the infected pouch bursts. This condition can be life-threatening.

Either of these conditions (diverticulitis and diverticular bleeding) can lead to peridiverticulitis, fistula (openings into another organ), intra-abdominal abscess, obstruction of the colon or peritonitis. In peridiverticulitis, the infected material of a ruptured diverticulum reaches only tissues adjacent to the colon. In most cases, intravenous fluids and antibiotics can take care of this problem. However, surgery is usually needed to treat fistulas, intra-abdominal abscesses and obstruction of the colon. The leakage of infected contents into the abdominal cavity, called peritonitis, is a surgical emergency.

Contrary to fears of many patients, the presence of diverticula does not increase the risk of bowel cancer. However, extensive scarring could mask a tumor while diverticular bleeding could be mistaken for a precancerous polyp.

Symptoms and Diagnosis of Diverticular Disease

Diverticular disease is a term describing three closely related conditions – diverticulosis, diverticulitis and diverticular bleeding. Most people with diverticulosis have had this condition for years by the time the first symptoms occur. Symptoms vary from person to person and they usually surface only when the person develops diverticulitis or diverticular bleeding. Pain can be non-existent, or mild and occasional, or sharp and constant, resembling appendicitis. The most common symptoms include mild pain with abdominal discomfort that grows when the area is pressed, low-grade fever and tender swelling of the abdominal area, whereas bleeding is uncommon.

In order to confirm a diagnosis, your doctor will order a blood test to check for an elevated white cell count, which signals an infection. An x-ray can be used to show an outline of the bowel, with the diverticula clearly visible in profile. Other tests may include ultrasound testing, CT scanning, colonoscopy and sigmoidoscopy. If bleeding is present, your doctor may need to perform angiography, a procedure used to locate the site of bleeding.

Treatment of Diverticular Disease

For people who have no symptoms there is no need for any treatment. But if you start feeling pain, discomfort or swelling, you should see your doctor. In case of an attack of diverticulitis, the immediate treatment is to let the bowel rest and halt the infection with antibiotics. Most patients will have to stay in the hospital where nutrition will be given intravenously. First attacks of diverticulitis almost always respond to this treatment. Once you have recovered, you should start eating a high-fiber diet in order to prevent the further creation of diverticula and recurrence of diverticulitis. Avoid using laxatives and enemas.

Surgery

When intravenous diet and antibiotics do not improve the condition, or in people with recurring bouts of diverticulitis, it may become necessary to have the troublesome portion of the bowel removed. The remaining unaffected portions will be sewn together in a procedure called a resection.

Serious complications of diverticulitis can occur as a result of a tear or perforation of the intestinal wall, leading to intra-abdominal abscesses, fistulas, obstruction of the colon and even peritonitis. If this happens, surgery will be needed to remove the abscess or fistula, affected part of the colon and clean the abdominal cavity.

Sometimes it may become necessary to divert the intestinal contents away from the resected ends either temporarily or even permanently. This is done with a procedure called a colostomy (ostomy in general), in which the affected part of the colon is removed, an opening called stoma is created on the body’s surface and a portion of the colon is brought through the opening to allow stool exit the body. Though ostomy is a common procedure, if permanent, it requires many changes in affected individual’s lifestyle.

Where to Get More Information:
American Society for Gastrointestinal Endoscopy