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