What is Diverticulitis

Diverticulitis is a disease condition which results when the diverticula in the gastrointestinal tract become inflamed or infected.

  • The symptoms are pain as well as tenderness in the left side of the lower abdomen and fever.
  • Colon is the usual site of acute diverticulitis, especially the sigmoid colon.
  • CT scan and colonoscopy are the usual tests conducted to confirm the diagnosis.
  • Antibiotic therapy combined with a liquid diet and adequate rest may be sufficient to resolve the condition in mild cases of the disease.
  • When disease is acute with severe symptoms, patients may need hospitalization and intravenous administration of antibiotics. Occasionally, surgery may be necessary.

Diverticulitis is a condition which usually develops in those who are having diverticulosis. The last portion of the large bowel called sigmoid colon is the most usual location of diverticulitis. Since diverticulosis usually starts developing in people in their forties, the incidence of diverticulitis also is frequent in those above that age. The symptoms of the disease can be severe irrespective of the age of the person. However, older people are more prone to developing acute infections, and other complications due to diverticulitis, especially if they have lower immunity levels also, due to corticosteroids and certain other drugs taken. In some cases of acute diverticulitis, surgery may be necessary. Such surgeries are about three times more common in men compared to women in the age group below 50 years. However, this ratio is reversed in people above 70 years, surgeries being three times more frequent in women than in men of that age.

Symptoms and Diagnosis

Abdominal pain and tenderness to touch, usually felt in the lower abdomen on the left side, is often an indication of diverticulitis in the sigmoid colon. Fever is usually present, but bleeding from the rectum or blood in the stool is not a symptom normally encountered in diverticulitis.

When a person has a medical history of previously diagnosed diverticulosis, the typical symptoms are considered to be the sign of diverticulitis. Since there are several other disease conditions with similar symptoms, such as ovarian cancer, colon cancer, appendicitis, uterine fibroids etc., an accurate diagnosis of the condition is necessary. An ultra sound scan may be able to detect the possible cause of the symptoms.

 CT scan is a reliable test which can help diagnose diverticulitis as well as rule out other serious conditions like appendicitis. Colonoscopy is also a very useful viewing test which can confirm the diagnosis of diverticulitis but it is not performed when the disease is active with inflammation and infection.

 Once diverticulitis is successfully treated with antibiotics and other drugs, the large intestine is viewed through a flexible viewing tube called colonoscope, or, an imaging test called barium enema x-ray is conducted. These tests are not performed earlier due to the high risk of rupture or injury they can cause to the intestine when it is in an inflamed condition. However, these tests are useful in determining the severity and extent of the disease and to detect or rule out cancer of the colon.

Complications:  When the wall of the intestine becomes inflamed, it can lead to the development of abnormal channels known as fistulas which connect to other organs which are in contact with the affected parts of the intestine. For example, when a diverticulum which is in contact with the bladder gets inflamed due to a bacterial infection, it may rupture or start leaking exudates with a high bacterial content. The wall of the bladder picks up the infection and the tissue disintegration at the point of contact leads to the development of a channel between the intestine and the bladder. Fistulas are common between the sigmoid colon and the urinary bladder, especially in men. This disparity is due to the presence of uterus in women which lies between the colon and the bladder. Hence, women are equally prone to this condition if they have had hysterectomies done. Once the fistulas are established, the fecal matter as well as the intestinal bacteria can reach the bladder and cause infections there. Fistulas from the large intestine can open to other organs such as uterus, small intestine or vagina too. Some fistulas may have channels which open on the skin surface on the abdomen, chest or thigh.

Diverticulitis may lead to the development of other complications either related or unrelated to the digestive system. The intestinal complications include the rupture of the intestines and formation of abscesses and bleeding. Frequent episodes of diverticulitis may lead to the thickening of the intestinal wall, and scar tissue formation, which may result in obstructions to the passage of stool. Intestinal rupture almost always leads to life threatening peritonitis. Pus filled abscesses may develop, or fistulas may form connections to nearby organs such as urinary bladder and uterus.


A short period of rest with fluid diet and antibiotic therapy administered orally may be effective in resolving mild cases of acute diverticulitis. As the symptoms lessen and disappear, a diet of easily digestible soft foods low in fiber may be started. A stool softener such as psyllium husk should be taken daily with the low-fiber diet to facilitate easy movement of the intestinal contents. Normal diet with high fiber content can be resumed after a month.

When symptoms such as fever above101°F or 38.3° C and severe abdominal pain are present, it may indicate acute diverticulitis which may have to be treated with hospitalization and intravenous administration of antibiotic drugs. Oral nutrition is stopped to provide rest to the digestive system and fluids are given intravenously. The patient is advised complete bed rest till symptoms lessen. If the condition of the patient doesn’t show improvement, surgical intervention may be necessary. Two out of every ten cases of diverticulitis usually require surgery. Removal of the diseased section of the intestine may be sufficient in most cases, when the site of bleeding is identified. In a few cases, complete removal of the large intestine called subtotal colectomy may be unavoidable, especially when the bleeding site is not detected.

Intestinal rupture is a medical emergency which requires immediate surgery. The almost certain risk of developing peritonitis or inflammation of the abdominal cavity makes it a potentially fatal situation. The affected portion of the intestine is removed and the remaining colon is connected to an opening created on the abdominal wall by a procedure called colostomy. This is usually a temporary measure, for a short period of 2 to 3 months, after which the intestinal sections will be joined to each other by a second surgery.

All cases of diverticulitis do not necessarily need surgery, but people can opt for the surgical removal of the affected section of the intestine to get permanent relief from diverticular diseases. Abscesses can be drained from the outside with a needle guided by computed tomography, to avoid more invasive surgical interventions.

To treat a fistula that connects to another organ such as the urinary bladder, the portion of the intestine where it originates should be surgically removed. The opening in the other end of the channel should be surgically repaired.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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