Diverticula are small pockets in the colon that develop over time as a result of high pressure inside the colon. It is thought that diet plays a significant role in the development of diverticulitis over time, with low-fiber diets resulting in high pressure inside the colon and subsequent diverticula.
About half of Americans have diverticula in their colon by age 60 and almost all by age 80. Diverticula are more common on the left side of the colon (or sigmoid colon) because the pressure in this part of the colon is higher. Although the majority of individuals have diverticula, only a small percentage of people ever develop diverticulitis (or inflammation of the diverticula). Diverticulitis occurs when stool becomes trapped in the diverticula allowing bacteria to overgrow and create inflammation in the wall of the colon.
What are the symptoms of diverticulitis?
Symptoms of diverticulitis can range from mild to moderate, unremitting pain in the left lower abdomen to severe pain, fever, nausea, vomiting and sepsis related to rupture of the diverticula and colon. In some patients with chronic inflammation of the colon due to diverticulitis an abnormal connection or “fistula” may develop between the colon and bladder or colon and vagina in women. Symptoms of a fistula include the feeling of passing gas or stool through ones urine or vagina.
How is diverticulitis diagnosed?
The diagnosis of diverticulitis can generally be made by a thorough evaluation and physical exam by your physician. The most accurate test to diagnose diverticulitis is a CT scan of your abdomen and pelvis.
How is diverticulitis treated?
Mild cases of diverticulitis can be managed with oral antibiotics and several days of dietary modifications. More severe cases associated with nausea, vomiting, or severe abdominal pain or cases that fail to improve with oral antibiotics may require hospital admission and intravenous antibiotics, bowel rest (nothing to eat or drink) and IV hydration, and evaluation by a colorectal surgeon.
If diverticulitis is associated with an abscess (collection of pus near your colon) a procedure called CT-guided drainage may be necessary where the interventional radiologists places a small needle through the skin under CT-guidance to drain the pocket of pus.
Surgery may be recommended if the condition has lead to severe sepsis, bowel perforation, large abscess that is not amenable to CT-guide drainage, in cases that fail to improve with antibiotic therapy or in repeat bouts of diverticulitis.
Surgical treatment of diverticulitis involves removal of the diseased portion of colon (most commonly the sigmoid colon). In elective or planned surgery, the colon can generally be reconnected or “anastomosed” to the rectum. Dr. Zaghiyan generally recommends minimally invasive surgery including laparoscopic or robotic-assisted techniques for elective diverticulitis surgery. In some cases, traditional open surgery may be recommended.
In patients who require emergency surgery due to perforation or abscess, a temporary colostomy may be necessary if it is felt to be unsafe to reconnect the colon due to severe inflammation or your overall clinical condition.