The commonest presenting symptom of diverticulitis is pain. Pain is usually left sided in the left lower quadrant region because this is the most common site for diverticula formation. Fever and other signs of systemic infection may be present if the disease progresses and leads to formation of localized abscess.

Other symptoms are:

• Nausea
• Vomiting
• Change in bowel habit
• Constipation
• Increased flatulence
• Diarrhea
• Bloated feeling [5]
• Bleeding 

The disease could mimic various types of gastrointestinal conditions because of the ability of diverticulosis to occur anywhere along the tract. On physical examination, there is:

• Localized abdominal tenderness in affected area
• If there is an abscess, a tender mass may be felt

• Pain

  If cramps, bloating, and constipation are problems, the doctor may prescribe a short course of pain medication. However, some pain medications actually cause constipation. [gastroenterologistpaloalto.com]

  If you have had recurrent episodes of abdominal pain, especially left lower quadrant abdominal pain, you may have experienced episodes of diverticulitis. [sassesurgical.com]

  This causes the pain associated with diverticulitis and can also lead to further complications such as the formation of an abscess or fistula. [news-medical.net]

  It begins with a pinching pain in the left lower abdomen. Around the pelvic bone and sometimes a little beneath, a throbbing and painful sensation begins to build. This pain can even extend into the lower back. [bodyecology.com]

  Symptoms include pain (usually in the lower left abdomen), fever and chills. Left untreated, it can worsen and may lead to abscesses, or bowel obstruction. [radiologyinfo.org]

• Inflammation

  The inflammation side, however, is not. “Out of 10 patients with diverticulosis, only about two will develop the inflammation,” Jain says. [wrvo.org]

  Colon resection may be needed in patients whose diverticulitis returns or those who experience a narrowing of the large bowel from repeated episodes of inflammation. top of page [radiologyinfo.org]

  The surgery may either be performed as an open procedure or a laparoscopic surgery, depending on the extent of the inflammation. [news-medical.net]

  Limit cheese in the diet once the inflammation has resolved to help prevent future attacks. The colon makes up the stretch of the intestinal tract between the small intestine and the rectum. [livestrong.com]

• Fever

  "If there is no fever, the preferred treatment is to manage minor attacks with rest, plenty of liquids, and non-narcotic pain medications," says Dr. Goldberg. [health.harvard.edu]

  However, more severe cases result in fevers, chills, severe abdominal pain, and vomiting. In fact, they can be life threatening due to peritonitis and sepsis. [sassesurgical.com]

  See your doctor immediately if you have: very severe abdominal pain a fever start vomiting feel very unwell have blood in your poo Diverticulitis diagnosis To diagnose diverticulitis, your doctor will talk to you and examine you. [healthdirect.gov.au]

  Fever. Abdominal tenderness. Constipation or, less commonly, diarrhea. When to see a doctor Get medical attention anytime you have constant, unexplained abdominal pain, particularly if you also have fever and constipation or diarrhea. [mayoclinic.com]

• Severe Pain

  Adequate fiber can protect against this painful colon condition. [health.harvard.edu]

  But when a pouch becomes inflamed it can cause: severe pain that comes and goes, usually in the lower left side of the abdomen mild episodes of constipation, although there may not be much change in bowel habits. [netdoctor.co.uk]

  Symptoms Pain in the lower left or occasionally the right portion of the abdomen is the most common symptom of diverticulitis. This pain may get worse over several days and may vary in severity. [nationaljewish.org]

  If you have severe pain or an infection, though, you may need to be treated in a hospital so antibiotics can be given intravenously (into a vein). [mhealth.org]

  In March 1989 I had severe pains in my lower abdomen and occasionally, blood in my stools. [bruno-groening.org]

• Anemia

  A blood laboratory revealed severe anemia increased CRP (11.21 mg/dl). The upper and lower gastrointestinal endoscopic examination revealed no significant changes. The colon was free from diverticulum. [ncbi.nlm.nih.gov]

  At times diverticulosis can result in severe hemorrhage and anemia. Altogether, these problems or advanced conditions associated with diverticular disease are prevented with minimally invasive, surgical removal of the affected portion of the colon. [sassesurgical.com]

  Constipation is more concerning when there is weight loss or anemia, blood is present in the stool, there is a history of inflammatory bowel disease or colon cancer in a person's family, or it is of new onset in someone who is older. [play.google.com]

  The colonoscopy may be done if people have complications (such as a perforation or abscess) or if they have risk factors for cancer (such as narrowed stool, bleeding, anemia, weight loss, or a family history of colon cancer). [merckmanuals.com]

  If a very small amount leaks out continually, it can still add up over time and cause mild anemia. Bleeding that doesn't stop always requires treatment. [medbroadcast.com]

• Abdominal Pain

  If you have had recurrent episodes of abdominal pain, especially left lower quadrant abdominal pain, you may have experienced episodes of diverticulitis. [sassesurgical.com]

  Physicians should be aware of their existence and the clinical suspicion should be raised, especially in the setting of acute abdominal pain where jejunal diverticulitis should be included in the differential diagnosis. [ncbi.nlm.nih.gov]

  Severe abdominal pain is a common complaint encountered by primary care and emergency room physicians. Caused by many conditions, including appendicitis and diverticulitis, severe abdominal pain may be a diagnostic challenge. [oadoi.org]

• Constipation

  You ask about the use of charcoal for diverticulosis: because constipation figures so prominently in the formation of diverticula, and because charcoal tends to be binding or constipating for many, I would choose to focus more on lifestyle issues than [charcoalremedies.com]

  The formation of a diverticulum begins with constipation. As the muscles of the large intestine contract to move hard stool, pressure levels inside the colon increase. [drdalepeterson.com]

  Digested material passes more quickly through the gut which decreases the chance of constipation. Insoluble fiber from grains and vegetables produces feces that is easier to pass. [livestrong.com]

  When this occurs, there may be thin or pellet-shaped stools, constipation, and an occasional rush of diarrhea. The problem then becomes a mechanical or structural one, and treatment is more difficult. [gicare.com]

• Nausea

  Patients with the sacs can tell if there is inflammation through pain in the lower left side of the abdomen, fevers, nausea and irregular bowel movements. [wrvo.org]

  Nausea and vomiting. Fever. Abdominal tenderness. Constipation or, less commonly, diarrhea. [mayoclinic.com]

  Diverticulitis symptoms may include extreme abdominal pain, commonly in the left lower quadrant, as well as nausea, vomiting or diarrhea. [livestrong.com]

  Also call if you have diverticulitis and you have: Blood in your stools Fever above 100.4°F (38°C) that does not go away Nausea, vomiting, or chills Sudden belly or back pain that gets worse or is very severe [account.allinahealth.org]

• Vomiting

  See your doctor immediately if you have: very severe abdominal pain a fever start vomiting feel very unwell have blood in your poo Diverticulitis diagnosis To diagnose diverticulitis, your doctor will talk to you and examine you. [healthdirect.gov.au]

  In addition, nausea, vomiting, diarrhea, or constipation are symptoms that may occur. In moderate to severe symptoms a person has more severe pain, can't keep any liquids down, and may have a fever. [nationaljewish.org]

  Also seek medical attention if you have a fever, the pain gets worse, and you have consistent vomiting or lack of bowel movements. [diet.lovetoknow.com]

  Blood chemistry to examine the levels of electrolytes in patients who have been vomiting. [symptoma.com]

  Diverticulitis symptoms may include extreme abdominal pain, commonly in the left lower quadrant, as well as nausea, vomiting or diarrhea. [livestrong.com]

• Rectal Bleeding

  One of these complications is rectal bleeding, also called diverticular bleeding. Diverticular bleeding occurs when there is chronic (long-term) injury to the small blood vessels near the diverticula. The other complication is diverticulitis. [my.clevelandclinic.org]

  We describe a 9-year-old boy with Williams syndrome who presented with rectal bleeding secondary to sigmoid diverticulitis. This case represents the youngest known patient with diverticulitis. [ncbi.nlm.nih.gov]

  Image Credit: Designua / Shutterstock Symptoms Some of the symptoms of diverticulitis include: Intermittent stomach pain Abdominal bloating High fever of 38ºC (100.4ºF) or above Rectal bleeding Diarrhea and constipation Causes and pathology Diverticula [news-medical.net]

  Most people with diverticulosis don't have any symptoms from the condition unless they develop one of two complications: either rectal bleeding or inflammation, called diverticulitis. [sharecare.com]

• Muscle Spasm

  Treating Diverticular Disease If dietary changes are not sufficient, treatments for acute diverticulitis may also include oral or intravenous antibiotics, a liquid diet, bed rest, and medications to stop muscle spasms in the colon. [columbiasurgery.org]

  spasms, for infection and inflammation) Resting the colon, with liquid diet What You Should Expect You will receive a thorough diagnostic examination to evaluate if you have diverticulitis and if surgery is needed. [brighamandwomens.org]

  […] anti-mesenteric teniae of the colon and project between circular muscle rings–not through them May vary in size from tiny projections to several cm in size Have variable filling Associated spasm and numerous tics in sigmoid may make it impossible to [learningradiology.com]

  Resting the colon with a liquid diet plus a pain reliever or a drug such as propantheline (Pro-Banthine) to control muscle spasms. Preventing or minimizing complications with the proper diet. [freedieting.com]

  Symptoms of diverticulitis include muscle spasms and cramplike pains in the abdomen, especially in the lower left quadrant. Diagnosis is confirmed by barium enema (see barium test ), in which the diverticula are clearly shown. [medical-dictionary.thefreedictionary.com]

• Stroke

  Rare: CDC AHA News: El vínculo entre la depresión y las enfermedades del corazón tiene un doble sentido AHA News: Link Between Depression and Heart Disease Cuts Both Ways AHA News: Woman's Frozen Face, Garbled Speech During Zoom Call Were Signs of a Stroke [msdmanuals.com]

  Feet Carpal Tunnel Syndrome Diet and Nutrition Emergency Supplies Fall Prevention Fibromyalgia Fitness and Health Hearing Loss Home Health Care and Safety Industrial and Public Health Safety Occupational Health Safety Sight Impaired Sleeping - COPD Stroke [activeforever.com]

  It subjects patients to the unnecessary risks of abdominal surgery to remove the affected colon, impaired immunity, uncontrollable bleeding, ulcers, and strokes. [gutsense.org]

  Other risks of surgery include, but are not limited to, post-operative pneumonia, heart attack, stroke, blood clots in the legs, organ failure, and even death. [fascrs.org]

  Results from large cohorts describe the rate of serious complications from colonoscopy (eg, perforation, myocardial infarction, or stroke) to be around 0.1%–0.2% ( 52, 53 ), which could generate significant morbidity if performed on each of the estimated [doi.org]

• Pelvic Pain

  Pelvic floor dysfunction is a group of disorders that change the way people have bowel movements and sometimes cause pelvic pain. [fascrs.org]

  […] and acute pain Schwerk (1992) Dis Colon Rectum 35(11): 1077-84 [PubMed] Consider in women for evaluating additional Pelvic Pain causes (including pregnancy-related) Avoid Colonoscopy in acute disease Risk of worsening perforation Avoid Barium Enema in [fpnotebook.com]

Laboratory tests

They are used when the history and physical examination are inconclusive. They include:

• Complete blood count will show increased white blood cell count and reduced hemoglobin if bleeding is present.
• Blood chemistry to examine the levels of electrolytes in patients who have been vomiting.
• Renal function [6]
• Test for liver function and liver enzymes 
• Blood culture should be obtained before instituting antibiotics
• Pregnancy test  to rule out other conditions like extra-uterine pregnancy in a woman of childbearing age
• Urinalysis
• Urine culture

Imaging

• CT scan, when necessary, this is the imaging study of choice. Findings include inflammatory masses and bowel wall thickening.
• Contrast studies: Barium us contraindicated as there may be perforations and leakage of contrast into the peritoneal cavity could be disastrous. A water soluble contrast medium is preferred when a CT scan can’t adequately differentiate colon cancer from diverticulitis.
• Plain radiographs have no use in diagnosing this condition but may demonstrate associated obstruction and bowel perforation [7].
• Colonoscopy can be used after an acute episode to check the extent of the diverticulosis.

• Colitis

  Ulcerative colitis is a chronic disease that affects the lining of the colon, according to the Crohn's & Colitis Foundation of America. [empowher.com]

  […] disease, infectious colitis, and pseudomembranous colitis. [doi.org]

  Ulcerative colitis : find out what the complications are. Bowel cancer : what are the causes? Irritable bowel syndrome (IBS) : the bowel and IBS. Last updated 07.04.2015 [netdoctor.co.uk]

  ‘Food sensitive colitis should be considered in infants and ischaemic colitis, diverticulitis, and colonic tumours in adults.’ ‘Fortunately, most people with diverticulosis never develop diverticulitis.’ [en.oxforddictionaries.com]

  The clinical manifestations, diagnosis, and treatment of diverticulitis, diverticular bleeding, and segmental colitis associated with diverticula (diverticular colitis) are discussed in detail, separately. [web.archive.org]

In patients with the acute uncomplicated type, conservative management achieves full remission in over 70% of cases. Some studies have shown that antibiotics worsen the inflammatory process. Conservative management includes:

• Clear liquid diet
• Resting the bowel
• IV fluids
• Managing the pain

Antibiotics, if used, are broad spectrum to cover aerobic and non-aerobic organisms. This could be a single or multi drug regimen. If diverticulitis is severe, as characterized by peritonitis and systemic signs of infection, hospitalization is required [8].

Surgery is indicated when there is a complication. Complications may include intestinal obstruction, presence of fistula, abscesses and peritonitis. At discharge, patient’s diet should be low in fat and high in fiber.

The following factors may worsen the prognosis:

• Coexisting medical problems
• The presence of complications
• Severity of the illness [4]

The cause if diverticula formation is yet unclear. There is however strong association with obesity, low fiber diet and constipation. When these pouches are present, there are now factors that could lead to inflammation and hence diverticulitis. Although the exact pathway by which diverticulitis occurs is unclear, there have been some postulations [2]:

• Collection of undigested food particles in the diverticulum
• Collection of fecal matter in the diverticulum
• Raised intraluminal pressure 
• Thickened food particles

Diverticulitis is mainly a disease of the elderly although it is now seen in younger age groups as well. The incidence increases with advancing age and 65% of people older than 85 years have diverticulitis. There is no sexual preference as the disease affects both sexes equally.

It is more common in industrialized countries compared to underdeveloped countries. This could be due to lifestyle and diet. It is seen more Caucasians and Asians than in blacks.

There are two ways by which diverticulosis is thought to occur. The first is erosion of the wall of the diverticula which leads to inflammation, necrosis and then perforation.
The second mechanism, which is also touted to be the commonest is obstruction of the diverticulum lumen. This obstruction is usually by undigested food particles or fecal matter. The obstruction then leads to distension due to mucus secretion within the diverticulum. Subsequently, the blood supply is compromised and this will cause perforations, both micro and macro, of the diverticulum[3].

Chronic diverticulitis could lead to fistula formation. Frequent bouts of diverticulitis can also cause intestinal obstruction when it causes scar formation which obstructs the colonic lumen.

In patients with risk for diverticulosis, and in those with asymptomatic types, the standard of prevention is a high-fiber diet [9].

In some people, there is some herniation of mucosa into the wall of the colon. This creates small pouches which are known as diverticula and the condition is known as diverticulosis. When one or more of this pouches get inflamed, it is called diverticulitis. Diverticulitis could be acute or chronic and it includes a wide range of conditions from asymptomatic forms to symptomatic forms [1].

Definition

Diverticulitis is a condition that results from inflammation of diverticula in the intestines. Diverticula are abnormal pouches that form on the walls of the intestines.

Cause

There is no clear cause. However, patients who have a high fiber diet, those who are obese, frequently constipated ones and older people tend to develop these pouches. When this pouches are present, they can be blocked by food or fecal particle which could lead to the processes causing diverticulitis.

Signs and symptoms

The commonest symptom of this disease is abdominal pain. It is usually on the left, like appendicitis but on the other side. Other symptoms include nausea, vomiting, diarrhea, increased flatulence, and constipation amongst others.

Diagnosis

Diagnosis is mainly by history and the examination by the doctor. Some laboratory tests like blood and urine tests may be done to check severity of the disease and the function of some organs in the body. Some imaging tests may also be carried out [10].

Treatment

For the mild type, treatment is conservative and patient may or may not require antibiotics. For the sever type, hospital stay would be necessary for close monitoring and patient may require surgery.

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