Diverticulitis (patient information)

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Overview
Diverticulitis is swelling (inflammation) of an abnormal pouch (diverticulum) in the intestinal wall. These pouches are usually found in the large intestine (colon). The presence of the pouches themselves is called diverticulosis.

What are the symptoms of Diverticulitis?

 * Abdominal pain, usually in the left lower abdomen but can be anywhere
 * Chills
 * Fever
 * Nausea
 * Vomiting
 * Weight loss

What are the causes of Diverticulitis?
Although not proven, the dominant theory is that a low-fiber diet causes diverticular disease. The disease was first noticed in the United States in the early 1900s, around the time processed foods were introduced into the American diet. Consumption of processed foods greatly reduced Americans’ fiber intake.

Diverticular disease is common in developed or industrialized countries—particularly the United States, England, and Australia—where low-fiber diets are consumed. The disease is rare in Asia and Africa, where most people eat high-fiber diets.

Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Some fiber, called soluble fiber, dissolves easily in water. It takes on a soft, jelly-like texture in the intestines. Insoluble fiber passes almost unchanged through the intestines. Both kinds of fiber help prevent constipation by making stools soft and easy to pass.

Constipation—or hard stool—may cause people to strain when passing stool during a bowel movement. Straining may cause increased pressure in the colon, which may cause the colon[[ lining to bulge out through weak spots in the [[colon wall. These bulges are diverticula.

Lack of exercise also may be associated with a greater risk of forming diverticula, although the reasons for this are not well understood.

Doctors are not certain what causes diverticula to become inflamed. The inflammation may begin when bacteria or stool are caught in the diverticula. An attack of diverticulitis can develop suddenly and without warning.

Who is at risk for Diverticulitis?
Risk factors for diverticulosis may include older age or a low-fiber diet.

How to know you have Diverticulitis?
To diagnose diverticular disease, the doctor asks about medical history, does a physical exam, and may perform one or more diagnostic tests. Because most people do not have symptoms, diverticulosis is often found through tests ordered for another ailment. For example, diverticulosis is often found during a colonoscopy done to screen for cancer or polyps or to evaluate complaints of pain or rectal bleeding.

When taking a medical history, the doctor may ask about bowel habits, pain, other symptoms, diet, and medications. The physical exam usually involves a digital rectal exam. To perform this test, the doctor inserts a gloved, lubricated finger into the rectum to detect tenderness, blockage, or blood. The doctor may check stool for signs of bleeding and test blood for signs of infection. If diverticulitis is suspected, the doctor may order one of the following radiologic tests:
 * Abdominal ultrasound. Sound waves are sent toward the colon through a handheld device that a technician glides over the abdomen. The sound waves bounce off the colon and other organs, and their echoes make electrical impulses that create a picture—called a sonogram—on a video monitor. If the diverticula are inflamed, the sound waves will also bounce off of them, showing their location.
 * Computerized tomography (CT) scan. The CT scan is a noninvasive x ray that produces cross-section images of the body. The doctor may inject dye into a vein and the person may be given a similar mixture to swallow. The person lies on a table that slides into a donut-shaped machine. The dye helps to show complications of diverticulitis such as perforations and abscesses.

When to seek urgent medical care
Call your health care provider if symptoms of diverticulitis occur.

Also call if you have diverticulitis and symptoms worsen or new symptoms develop.

Treatment options
Treatment for diverticulitis focuses on clearing up the inflammation and [infection]], resting the colon, and preventing or minimizing complications.

Depending on the severity of symptoms, the doctor may recommend bed rest, oral antibiotics, a pain reliever, and a liquid diet. If symptoms ease after a few days, the doctor will recommend gradually increasing the amount of high-fiber foods in the diet.

Severe cases of diverticulitis with acute pain and complications will likely require a hospital stay. Most cases of severe diverticulitis are treated with IV antibiotics and a few days without food or drink to help the colon rest. In some cases, surgery may be necessary.

If symptoms of diverticulitis are frequent, or the patient does not respond to antibiotics and resting the colon, the doctor may advise surgery. The surgeon removes the affected part of the colon and joins the remaining sections. This type of surgery—called colon resection—aims to prevent complications and future diverticulitis. The doctor may also recommend surgery for complications such as a fistula or partial intestinal obstruction.

Immediate surgery may be necessary when the patient has other complications, such as perforation, a large abscess, peritonitis, complete intestinal obstruction, or severe bleeding. In these cases, two surgeries may be needed because it is not safe to rejoin the colon right away. During the first surgery, the surgeon cleans the infected abdominal cavity, removes the portion of the affected colon, and performs a temporary colostomy, creating an opening, or stoma, in the abdomen. The end of the colon is connected to the opening to allow normal eating while healing occurs. Stool is collected in a pouch attached to the stoma. In the second surgery several months later, the surgeon rejoins the ends of the colon and closes the stoma.

Diseases with similar symptoms

 * colon cancer
 * inflammatory bowel disease
 * ischemic colitis
 * irritable bowel syndrome

Where to find medical care for Diverticulitis
Directions to Hospitals Treating Diverticulitis

Prevention of Diverticulitis
A high-fiber diet may prevent development of diverticulosis. Some doctors tell patients with a history of diverticulitis to avoid nuts and seeds in the diet. However, there is no evidence that this is helpful to prevent the disease.

What to expect (Outlook/Prognosis)
Usually, this is a mild condition that responds well to treatment.

Possible Complications

 * Abscess formation
 * Narrowing (stricture) in the colon or fistula formation
 * Perforation of the colon leading to peritonitis