Category Archives: Diverticular Disease
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.
Treatment
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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What Is Diverticulosis
Diverticulosis is an abnormal condition of the digestive tract characterized by the presence of several pouch-like outgrowths called diverticula on the intestinal wall. The large intestine is the most common location of diverticulosis.
- Muscular spasms of the intestinal wall may be causing the pouch-like bulges in areas of weakness.
- Diverticulosis may remain asymptomatic or the diverticula may bleed, resulting in bloody stools.
- Barium enema x-ray and colonoscopy help in diagnosing the condition.
- Following a diet high in fiber content and use of bulking agents like psyllium help in the management of the condition, by reducing the spasms.
The last portion of the large intestine called sigmoid colon is the usual location of diverticulosis but diverticula can occur elsewhere in the large bowel also. Diverticula may differ in size, the small ones measuring 1/10 of an inch in diameter but the larger ones may be 1 inch or more in diameter. Diverticulosis usually start developing after 40 years of age and the number of diverticula may increase as people get older. Almost everyone nearing 90 years of age may be having diverticulosis. Occasionally, a very large diverticula measuring up to 6 inches in diameter may develop in some people, but they often occur singly.
Causes
The muscular spasms of the large intestine, as it tries to move its contents forward, may be causing certain weak spots in the wall to bulge out and become pouch-like structures. The exact reason for the development of diverticula is still not understood clearly, but it is assumed that the strong muscular contraction of the intestinal wall may be causing this condition. The muscles usually have to contract extra hard to push small quantities of stool resulting from a diet that is deficient in fiber. The higher pressure produced during the stronger contraction of the intestine causes the ballooning out of the intestinal wall in spots where the wall is thinner or weaker. The points of entry of arteries that supply the wall of the intestine are the usual weak spots prone to the development of diverticula. People who have diverticulosis of the sigmoid colon are found to be having a thicker muscular layer on the wall of the colon. It is not clear why a very large solitary diverticulum develop in some people.
Symptoms
Diverticulosis is not a dangerous condition as long as it remains asymptomatic. Many people do not even realize that they have this condition until it is discovered during the diagnostic testing of some other intestinal disorder. However, when diverticula start bleeding, resulting in bloody stools, and when abdominal pain and cramping are present, the condition becomes serious. Diverticular bleeding can be heavy and may come out of the rectum even when the person is not defecating. Pieces of stool may get stuck in the diverticula, leading to inflammation, bleeding and infections. It may develop into a disease condition called diverticulitis. The artery nearer to the diverticula may get damaged in the inflammation. Diverticula may interfere with the normal bowel movements also.
Diagnosis
Disturbances in the bowel movements along with bleeding from the rectum and painful abdominal cramps are the usual symptoms which lead to further investigations and subsequent diagnosis. A viewing test called colonoscopy or an imaging test called barium enema x-ray may be conducted to detect diverticulosis. In colonoscopy, a flexible viewing tube called colonoscope is inserted into large intestine to view its interiors. But, if signs of inflammation such as severe pain and cramping are present, invasive procedures like colonoscopy are avoided, and a CT scan is done instead, to avoid the risk of rupturing the intestine.
Colonoscopy can identify the source of diverticular bleeding, but it may not be enough to attempt surgical repair if required. Other imaging tests such as radionuclide scans or angiography conducted after the intravenous administration of radioactive markers may be necessary to locate the exact spots of bleeding.
Treatment
The treatment focuses on decreasing muscular spasms of the intestine by bulking up the stool. A diet containing sufficient amounts of fruits, vegetables and unpolished cereals increase the fiber content and quantity of the stool. The larger bulk makes it easier for the muscular wall of the intestine to push the contents forward, reducing spasms as well as the pressure exerted on the wall. In addition to dietary modifications, bulking agents such as methylcellulose or psyllium may be taken too. Drinking plenty of water also helps in the smooth movement of stool.
Surgical intervention is not required when complications associated with diverticulosis such as infections, inflammation, severe bleeding or risk of rupture are not present. Slight diverticular bleeding may stop eventually without intervention. If bleeding continues, minimally invasive procedures using the colonoscope are often successful in stopping it. A drug is often injected into the bleeding site to form a clot which stems the bleeding. But if it recurs frequently or when the bleeding site could not be detected, partial or total removal of the large intestine may be required. But surgeries are done only when absolutely necessary.
A very large diverticulum may have to be surgically removed to prevent life threatening eventualities like severe infections and rupture.
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What is Diverticular Disease
What is Diverticular Disease ? Diverticular disease is a condition resulting from the formation of balloon-like pouches called diverticula bulging out through the wall of the digestive tract, and, from these diverticula getting inflamed.
Large intestine is the most common location of diverticula. However, they occasionally occur in the small intestine as well as in the stomach. For example, a very common congenital condition called Meckel’s diverticulum is a diverticular disease affecting the small intestine. It is a small bulge present in the small intestine at birth in about 3% of the general population.
Diverticula usually start developing in people who are middle aged. A number of diverticula may develop at different locations along the intestine and their presence is termed as diverticulosis. Inflammation of these diverticula is the disease condition called diverticulitis.