Diverticulitis
Key points
- Diverticulitis is inflammation of an abnormal pouch (diverticulum) in the intestinal wall, usually found in the large intestine (colon).
- Small protruding sacs of the inner lining of the intestine (diverticulosis) can develop in any part of the intestine.
- Tests such as colonoscopy, sigmoidoscopy, and barium enema are usually not performed if diverticulitis is suspected.
- Recurrent attacks or presence of perforation, fistula (abnormal tube-like passage), or abscess requires surgical removal of the involved portion of the colon.
Definition
Diverticulitis is inflammation of an abnormal pouch (diverticulum) in the intestinal wall, usually found in the large intestine (colon). The presence of the pouches themselves is called diverticulosis.
Causes, incidence, and risk factors
Small protruding sacs of the inner lining of the intestine (diverticulosis) can develop in any part of the intestine. They are most common in the colon, specifically the sigmoid colon. These sacs, called diverticula, occur with increasing frequency after the age of 40. When they become inflamed, the condition is known as diverticulitis. Diverticula are thought to develop as a result of high pressure or abnormal pressure distribution within the colon. High pressure exerted against the colon wall causes pouches of the intestinal lining to bulge outwards through small defects in the colon wall.
Diverticulosis is very common, being found in more than half of Americans over age 60. Only a small percentage of these people will develop the complication of diverticulitis. Diverticulitis is caused by inflammation, or (sometimes) a small perforation within a diverticulum. If the perforation is large, stool in the colon can spill into the abdominal cavity, causing an abscess or peritonitis.
Direct risk factors for diverticulitis are not known. Risk factors for diverticulosis may include older age or a low-fiber diet.
Symptoms
- Abdominal pain, usually in the left lower abdomen but can be anywhere
- Chills
- Fever
- Nausea and vomiting
Signs and tests
Tests showing diverticulitis may include:
- CT scan revealing thickening of the inflamed area
- Abdominal palpation showing left lower quadrant mass
- Elevated white blood cell count
Tests such as colonoscopy, sigmoidoscopy, and barium enema are usually not performed if diverticulitis is suspected.
Treatment
Acute diverticulitis requires antibiotic therapy.
Recurrent attacks or presence of perforation, fistula (abnormal tube-like passage), or abscess requires surgical removal of the involved portion of the colon.
After the acute infection has stabilized, diverticulitis is treated by increasing the bulk in the diet with high-fiber foods and bulk additives such as psyllium.
Expectations (prognosis)
Written and revised by
David Cohen, M.D.
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