Diverticulitis results from inflammation of areas of weakness within the colon wall. This inflammation typically occurs in the sigmoid colon, which is near the end of the large intestine. These areas of weakness called diverticula can also cause bleeding, though inflammation and bleeding rarely occur at the same time. The weakness results from increased pressure within the wall of the colon, often from chronic constipation or lack of fiber within the diet. Most Americans over the age of 60 have evidence of diverticula, though not everyone develops inflammation of these (or diverticulitis).
The most common symptoms of diverticulitis are:
• Abdominal pain
• Fevers or chills
• Nausea and vomiting
The diagnosis and evaluation of diverticulitis can be separated into initial and follow up studies. Initially, a CT scan may be done to rule out other sources of abdominal pain, such as appendicitis. Alternatively, the diagnosis may be suspected on clinical symptoms alone and treated with a course of antibiotics. Once the inflammation in the colon has subsided, the underlying cause is investigated with a flexible endoscope or radiology contrast study through the rectum. A colonoscopy uses a small scope to visually examine the colon and rectum for polyps and tumors. It is a thin, flexible tube, with a tiny fiber-optic video camera and a light inside its tip. It is about the thickness of an adult finger. The tube is flexible and can be maneuvered to investigate the interior surface of the colon. The camera sends magnified images of the colon to a television screen.
With diverticulitis, the scope will show the areas of weakness or outpouchings within the colon wall. Your doctor will also make sure there was not another cause of your symptoms such as a colon polyp, inflammatory bowel disease, or cancer.
Treatment for Diverticulitis
The initial treatment of diverticulitis often involves antibiotic therapy. Some patients experience recurrent attacks of diverticulitis and require repeat treatment. Occasionally the diverticulitis can be severe enough to cause a perforation or hole in the colon causing spillage of feces or infection into the abdominal cavity. This requires emergent surgery to fix and often results in a temporary colostomy bag on the skin. Once the inflammation has decreased (usually about 2 months), this bag can be reversed. Alternatively, recurrent attacks of diverticulitis can cause narrowing of the colon due to scar tissue. In order to prevent ongoing attacks and worsening of these symptoms, some patients undergo elective removal of the colon. This type of surgery is often possible using a minimally invasive technique and rarely involves a bag. To learn more about treatment options for diverticulitis, call our office today.
Fore more information, visit the American Society of Colon and Rectal Surgeons website.