Diverticular disease is a common disorder characterized by pockets in the wall of the colon called diverticula. In most cases, diverticula do not cause any symptoms, but they can sometimes become inflamed and / or infected, causing a condition called diverticulitis .
While about half of people over the age of 60 have diverticula in the colon, only 10-25% develop diverticulitis .
Diverticula generally occur in the colon, which is part of the large intestine. Most often, diverticula develop in the sigmoid colon, which is the last section of the large intestine connected to the rectum. The sigmoid colon is located on the left side of the abdomen, so diverticulitis is often accompanied by abdominal pain on that side.
Diverticula can occur in other parts of the colon, but this is less common.
Symptoms of diverticulitis
The most common sign of diverticulitis is abdominal pain, which is usually constant and can last for several days. In some cases, the pain can be severe. Rectal bleeding can occur, but not often with diverticulitis. Other symptoms can include :
- pain and tenderness in the abdomen (usually on the left side, can be severe)
- shaking chills
- diarrhea (sometimes)
- lack of appetite
- threw up
- rectal bleeding (rare)
It is not known why some people with diverticular disease develop diverticulitis. There are theories being studied, but researchers currently do not have definitive answers on what causes diverticulitis. It was thought that eating certain foods , such as seeds, nuts, or corn, could cause diverticulitis in people with diverticular disease, but this is no longer the case.
Recent studies in men have shown that eating more red meat may be associated with an increased risk of diverticulitis .
There is another theory that diverticulitis can occur when a hole (perforation) forms in the diverticulum. Bacteria normally found in the colon can pass through this small opening and cause inflammation.
Another theory is that there is a link to the cytomegalovirus (CMV) virus. CMV is common and can be passed from person to person through body fluids. When CMV is first infected, it can cause flu-like symptoms (fever, sore throat, fatigue, swollen lymph nodes), but can then go into a dormant stage. The virus can remain dormant in the body. However, in some cases, the virus can reactivate. It is believed that CMV reactivation may be associated with diverticulitis.
Other potential factors that can contribute to the development of diverticulitis include :
- accumulation of harmful bacteria in diverticula
- violation of the level of beneficial bacteria in the colon
- passive lifestyle
- of smoking
- non-steroidal anti-inflammatory drugs (NSAIDs)
- steroid medications
Diverticulitis is diagnosed by computed tomography (CT) scan of the abdomen.
CT is a type of X-ray that is taken with a contrast medium. The contrast dye is drunk and is also injected through a dropper. This is necessary to carefully visualize the structure of the colon and diagnose diverticulitis.
In some cases, additional testing may be required if there is a suspicion that other conditions or complications are associated with diverticulitis. They will be highly individualized based on the patient's condition and the doctor's preference.
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For patients with uncomplicated diverticulitis, which means there are no associated problems such as an abscess or fistula, treatment is usually done at home. Usually a liquid diet and rest are given along with antibiotics.
More complex diverticulitis, severe symptoms, or other conditions may require hospital treatment. Hospital treatment may include fasting (often not called oral or NPO), intravenous fluids, and antibiotics. Most patients recover quickly.
Surgery is usually only done when there is another serious problem, such as a colon perforation.
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In most older people, diverticula do not cause any symptoms, and only a small number of cases develop diverticulitis. It is not yet clear why the inflammation and / or infection of the diverticula occurs, but it is no longer believed to be the result of eating fibrous foods, but could be due to several factors .
Most cases of diverticulitis are not difficult and can be treated at home with rest and fluids, although antibiotics may also be prescribed at times. Very sick people will require hospital treatment with intravenous fluids and antibiotics. Other treatments may be required, but this will depend on the patient's health and the preferences of the healthcare team.