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Diverticulitis of the Colon

Diverticulitis Colonic

Diverticulitis of the colon is a condition in which diverticula, sac-like protrusions in the colon, become inflamed. The etiology is not clearly understood, but it is thought that obesity, low fiber diet, and advanced age are predisposing factors.


Presentation

Diverticulitis of the colon is a condition that arises from inflammation of diverticula, which are outpouchings of mucosa and submucosa through weaknesses in the intestinal wall. These are symptomatic in only a minority of patients, and an even smaller minority develop diverticulitis [1] [2]. The occurrence of diverticula, and therefore diverticulitis, is thought to be related to lifestyle [3].

Clinical features and severity vary, and are dictated by the extent and location of the inflammation. Left lower quadrant pain and other gastrointestinal complaints such as nausea, vomiting, change in bowel habits, a loss of appetite, and fever may occur. Inflammation may progress to a localized abscess. The symptoms of colonic diverticulitis may be mistaken for other conditions that present similarly, including acute appendicitis, and certain renal and gynecological conditions.

Occasionally, urinary complaints such as dysuria and frequency may be reported. Macroperforations of the diverticula may occur, leading to peritonitis and possibly abscess formation in the thigh in cases of retroperitoneal perforations. An additional complication of diverticulitis of the colon is fistula formation with the bladder or vagina. Therefore these patients will present with additional signs of fistulae, such as fecaluria and a foul smelling vaginal discharge.

Some patients may experience a sub-acute disease course, with recurrent episodes of abdominal pain and decreased quality of life. In contrast, minimal clinical signs are present in those exposed to exogenous steroids, as well as in older patients.

Fever
  • A 75-year-old man with no relevant medical history visited our hospital complaining of a fever, which had lasted for 2 weeks.[ncbi.nlm.nih.gov]
  • Left lower quadrant pain and other gastrointestinal complaints such as nausea, vomiting, change in bowel habits, a loss of appetite, and fever may occur. Inflammation may progress to a localized abscess.[symptoma.com]
  • Symptoms Diverticulitis typically causes pain, tenderness, and fever, but unlike diverticulosis, diverticulitis does not generally cause gastrointestinal bleeding.[reliawire.com]
  • 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.org]
  • Those patients presenting in the acute setting with severe abdominal pain, fever, and radiographic documentation of perforation (complete penetration) may require an emergency operation.[uwhealth.org]
Chills
  • You may experience significant left, lower abdominal pain with additional symptoms of fever, chills, nausea, vomiting and change in bowels. Uncomplicated cases of diverticulitis can be treated with antibiotics and bowel rest.[dhat.com]
  • Diverticulitis : This occurs when the openings of diverticula in the wall colon are blocked by waste and become infected, causing severe pain and tenderness in the abdomen, possibly coupled with chills and fever.[colorectalconsultants.com]
  • You may also have fever, nausea, vomiting, chills, cramping, and constipation. In serious cases, diverticulitis can lead to bleeding, tears, or blockages. Your doctor will do a physical exam and imaging tests to diagnose it.[medlineplus.gov]
  • Symptoms of Diverticulitis Abdominal pain Fever Nausea Vomiting Chills Cramping or constipation Complications from Diverticulitis Bleeding Colon obstruction Abscess Fistula (an abnormal connection between the colon and another part of the body) Perforation[abileneendoscopy.com]
  • Other symptoms include cramping, nausea, vomiting, fever, or chills. It’s important that you contact your provider immediately if you experience these symptoms.[colonhealthatoz.org]
Abdominal Pain
  • The patients individually recorded their body temperature, grade of abdominal pain, number of times that analgesics were used, and number of stools daily. We checked whether the patients had adverse reactions such as abdominal pain or diarrhea.[ncbi.nlm.nih.gov]
  • Further tests are carried out to exclude other possible causes of abdominal pain, while monitoring for complications. These may consist of liver function tests, urinalysis, and urine microscopy and culture.[symptoma.com]
  • The patient complained of abdominal pain in the left upper abdomen and additional pain in the left shoulder. An antibiotic therapy using ciprofloxacin was already initiated owing to a urinary tract infection.[ncbi.nlm.nih.gov]
  • Six out of 8 patients with colon cancer reported rectal blood loss, significant weight loss or persisting abdominal pain after being treated for diverticulitis.[ncbi.nlm.nih.gov]
  • If the obstruction persists, abdominal pain and tenderness will increase and you may experience nausea and vomiting.[webmd.com]
Constipation
  • Constipation or diarrhea may also occur. A collection of pus can develop around the inflamed diverticulum, which leads to the formation of an abscess, usually in the pelvis.[reliawire.com]
  • CONSTIPATION What is constipation? Constipation is a symptom that has different meanings to different individuals.[ccrcfw.com]
  • Fiber prevents constipation by making the stool soft and easier to pass. Constipation makes the muscles in the colon work strenuously to move the hard stool, which increases pressure.[charlottegastro.com]
  • Diets low in fiber cause stool to be harder, and can lead to constipation. Constipation can cause repeated straining during bowel movements, and can increase the pressure in the colon, which can lead to the formation of diverticula.[onhealth.com]
  • Sometimes it causes mild cramps, bloating or constipation. Diverticulosis is often found through tests ordered for something else. For example, it is often found during a colonoscopy to screen for cancer.[medlineplus.gov]
Vomiting
  • Left lower quadrant pain and other gastrointestinal complaints such as nausea, vomiting, change in bowel habits, a loss of appetite, and fever may occur. Inflammation may progress to a localized abscess.[symptoma.com]
  • You may experience significant left, lower abdominal pain with additional symptoms of fever, chills, nausea, vomiting and change in bowels. Uncomplicated cases of diverticulitis can be treated with antibiotics and bowel rest.[dhat.com]
  • You may also have fever, nausea, vomiting, chills, cramping, and constipation. In serious cases, diverticulitis can lead to bleeding, tears, or blockages. Your doctor will do a physical exam and imaging tests to diagnose it.[medlineplus.gov]
  • Fever Nausea Vomiting Chills Constipation (less often, diarrhea) If diverticulitis is not treated promptly it can develop some very serious complications.[emedicinehealth.com]
  • If the obstruction persists, abdominal pain and tenderness will increase and you may experience nausea and vomiting.[webmd.com]
Nausea
  • Left lower quadrant pain and other gastrointestinal complaints such as nausea, vomiting, change in bowel habits, a loss of appetite, and fever may occur. Inflammation may progress to a localized abscess.[symptoma.com]
  • You may experience significant left, lower abdominal pain with additional symptoms of fever, chills, nausea, vomiting and change in bowels. Uncomplicated cases of diverticulitis can be treated with antibiotics and bowel rest.[dhat.com]
  • You may also have fever, nausea, vomiting, chills, cramping, and constipation. In serious cases, diverticulitis can lead to bleeding, tears, or blockages. Your doctor will do a physical exam and imaging tests to diagnose it.[medlineplus.gov]
  • Nausea is common after surgery. Be sure to take your pain medication on a full stomach. Stick to a soft, bland diet for the first few weeks after surgery. If necessary, call your doctor for prescription medication to aid with nausea.[oregonsurgical.com]
  • Nausea and vomiting. Fever. Abdominal tenderness. Constipation or, less commonly, diarrhea.[mayoclinic.org]
Diarrhea
  • We checked whether the patients had adverse reactions such as abdominal pain or diarrhea. RESULTS: No patients experienced serious adverse reactions. One patient had moderate abdominal pain and diarrhea soon after daiobotampito intake.[ncbi.nlm.nih.gov]
  • Constipation or diarrhea may also occur. A collection of pus can develop around the inflamed diverticulum, which leads to the formation of an abscess, usually in the pelvis.[reliawire.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.[gastrocny.com]
  • 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.org]
  • Diarrhea or constipation, lack of appetite, fever, and chills can sometimes be an indicator of a diverticular abscess.[lacolon.com]
Dysuria
  • Occasionally, urinary complaints such as dysuria and frequency may be reported. Macroperforations of the diverticula may occur, leading to peritonitis and possibly abscess formation in the thigh in cases of retroperitoneal perforations.[symptoma.com]
  • […] sigmoid colon (lower part of the large intestine) due to scarring High risk of serious complications Persistent tender mass in the abdomen May be cancer Endoscopy or x-rays showing suspicious changes in the sigmoid colon May be cancer Pain when urinating (dysuria[merckmanuals.com]
Foul Smelling Vaginal Discharge
  • Therefore these patients will present with additional signs of fistulae, such as fecaluria and a foul smelling vaginal discharge.[symptoma.com]

Workup

The workup for diverticulitis includes:

  • Patient history.
  • Physical examination: This will elicit localized abdominal tenderness, abdominal distension, reduced bowel sounds and possibly an abdominal mass in cases of abscess formation. An acute abdomen due to peritonitis is another possible finding, presenting with generalized tenderness.
  • Biochemical studies: Findings include a raised white cell count, low red cell count (this occurs when there is gastrointestinal bleeding), electrolyte imbalance and renal dysfunction. Further tests are carried out to exclude other possible causes of abdominal pain, while monitoring for complications. These may consist of liver function tests, urinalysis, and urine microscopy and culture.
  • Ultrasound: This can be conducted with a barium enema. Barium enemas and similar investigations, however, are limited in their usefulness as they cannot adequately assess extraluminal processes, whereas diverticulitis displays mostly extraluminal inflammation.
  • Computerized tomography (CT) scanning: CT has a high sensitivity and specificity for diverticulitis, and is the preferred imaging modality [4] [5] [6]. In some cases, it is difficult to distinguish between diverticulitis and other abdominal causes of inflammation, even with CT scanning [7]. Typically, diverticulitis of the colon is indicated by thickening of the bowel wall, as well as by fat stranding. Complications such as fistulae, abscesses, hemorrhage, and intestinal obstruction can also be visualized.
Pneumoperitoneum
  • […] quadrant which is producing compression on the barium-filled sigmoid (red arrow), and there is evidence of extraluminal contrast (red arrow) from a perforated diverticulum, Conventional Radiography Sentinel loop or, less likely, LBO Air bubbles in abscess Pneumoperitoneum[learningradiology.com]

Treatment

  • The abdominal pain of this patient was worse 6 days before treatment, and the pain was almost relieved with initial daiobotampito treatment. CONCLUSIONS: Daiobotampito is a safe treatment option for early stage, acute diverticulitis.[ncbi.nlm.nih.gov]
  • Abstract The diagnosis and treatment of abdominal actinomycosis is difficult. We report a case of chronic diverticulitis of the sigmoid colon with stricture formation and obstruction, which was complicated by intramural actinomycosis.[ncbi.nlm.nih.gov]
  • Segmental resection of the transverse colon together with end-to-end anastomosis is the treatment of choice, except in the occasional instance of a large intra-abdominal abscess, when anastomosis may be deferred.[ncbi.nlm.nih.gov]
  • The surgical treatment of congenital diverticula (mostly situated in the caecum) with inflammation should be as conservative as possible to minimize the risk of postoperative complications.[ncbi.nlm.nih.gov]
  • Treatment after recovery from an attack of diverticulitis is aimed at preventing another attack.[reliawire.com]

Prognosis

  • Keywords Abdominal Abscess/etiology/radiography/surgery — Acute Disease — Adult — Aged — Colectomy — Diverticulitis, Colonic/etiology/radiography/surgery — Female — Humans — Male — Middle Aged — Prognosis — Tomography, X-Ray Computed Identifiers PMID:[archive-ouverte.unige.ch]
  • […] differentially in Stages II and III.For patients in Stage II, primary resection is the “elected” procedure, while Stage III usually calls for multi-stage resections, the incontinuity resection of the Hartmann type being the preferred method.Because of poor prognosis[jstage.jst.go.jp]
  • Van Halen performing "Eruption" [Youtube] EVH's prognosis in this case is promising, too, but when diverticulitis requires emergency surgery, it's no small thing.[theatlantic.com]
  • (See ‘Diverticular disease prognosis’ below.) Diverticulitis — Inflammation of a diverticulum (diverticulitis) occurs when there is thinning of the diverticular wall.[ohiogi.com]
  • Prognosis is worse for individuals who have other medical problems, particularly those requiring the use of steroid medications, which increase the chances of developing a serious infection. Prognosis is also worse in the elderly.[medical-dictionary.thefreedictionary.com]

Etiology

  • Its etiology is uncertain, but a congenital origin is widely accepted. Clinically it mimics appendicitis; at operation it is often indistinguishable from carcinoma. Roentgenogram after a barium enema is diagnostic.[ncbi.nlm.nih.gov]
  • The etiology is not clearly understood, but it is thought that obesity, low fiber diet, and advanced age are predisposing factors.[symptoma.com]
  • Keywords Abdominal Abscess/etiology/radiography/surgery — Acute Disease — Adult — Aged — Colectomy — Diverticulitis, Colonic/etiology/radiography/surgery — Female — Humans — Male — Middle Aged — Prognosis — Tomography, X-Ray Computed Identifiers PMID:[archive-ouverte.unige.ch]

Epidemiology

  • 抄録 The recent sharp increase in the number of people with diverticular disease, particularly in the Western industrial nations, necessitates the analysis of all epidemiological, pathogenetical, anatomical, and pathophysiological parameters of the disease.A[jstage.jst.go.jp]
  • Colonic diverticulosis and diverticular disease: Epidemiology, risk factors, and pathogenesis. . Accessed July 24, 2018. Tursi A, et al.[mayoclinic.org]
Sex distribution
Age distribution

Pathophysiology

  • 抄録 The recent sharp increase in the number of people with diverticular disease, particularly in the Western industrial nations, necessitates the analysis of all epidemiological, pathogenetical, anatomical, and pathophysiological parameters of the disease.A[jstage.jst.go.jp]
  • Review article: The pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Alimentary Pharmacology and Therapeutics. 2015;42:664. Pemberton JH, et al.[mayoclinic.org]

Prevention

  • Treatment after recovery from an attack of diverticulitis is aimed at preventing another attack.[reliawire.com]
  • These activities encourage regular bowel activity and help prevent constipation.[livestrong.com]
  • Fiber softens the stool and helps prevent constipation. It also can help decrease pressure in the colon and help prevent flare-ups of diverticulitis.[ucsfhealth.org]
  • Can Diverticular Disease Be Prevented? Diverticula are permanent once formed and can only be removed surgically. There is currently no treatment to prevent diverticular disease.[onhealth.com]
  • A normal fiber diet is advisable to prevent constipation and perhaps prevent the formation of more diverticula.[medicinenet.com]

References

Article

  1. Weizman AV, Nguyen GC. Diverticular disease: epidemiology and management. Can J Gastroenterol. 2011;25(7):385–389.
  2. Strate LL, Modi R, Cohen E, Spiegel BM. Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol. 2012;107(10):1486–1493.
  3. Tursi A, Papagrigoriadis S. Review article: the current and evolving treatment of colonic diverticular disease. Aliment Pharmacol Ther. 2009;30(6):532–546.
  4. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004;363(9409):631–639.
  5. Rafferty J, Shellito P, Hyman NH, Buie WD, Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006;49(7):939–944.
  6. Westwood DA, Eglinton TW, Frizelle FA. Routine colonoscopy following acute uncomplicated diverticulitis. Br J Surg. 2011;98(11):1630–1634.
  7. Ben Yaacoub I, Boulay-Coletta I, Julles MC, Zins M. CT findings of misleading features of colonic diverticulitis. Insights Imaging. 2011;2(1):69–84.

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Last updated: 2018-06-21 20:26