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(Acute Diverticulitis; Acute Colonic Diverticulitis)

Definition

A pouch that forms in the wall of the large intestine is called a diverticulum. When this pouch becomes infected or swollen, it is called diverticulitis.

Diverticulitis

Infected pouches along the colon.

Causes

It is not clear why the pouches form. It may be due to a constant build up of pressure when food moves too slowly through the bowel. This pressure increases and pushes along the sidewalls of the bowel creating pouches. Digested food or stool can become trapped in one of the pouches. This leads to swelling and infection.

The following may contribute to diverticulitis:

Low-fiber diet—Fiber softens stools and makes them pass through the bowel more easily
Increased pressure in the bowel from straining to pass a hard stool
Defects in the colon wall
Chronic constipation

Risk Factors

Factors that increase your chance of getting diverticulitis include:

Eating a low-fiber diet
Age: 50 or older
Previous episodes of diverticulitis
High-meat diet or high-protein diet
Chronic constipation
Smoking

Symptoms

Symptoms can come on suddenly. They vary depending on the degree of the infection.

Symptoms include:

Abdominal pain
Tenderness; usually in the lower left part of the abdomen
Swollen and hard abdomen
Fever
Chills
Poor appetite
Nausea
Vomiting
Diarrhea
Constipation
Both diarrhea and constipation
Cramping
Rectal bleeding

Diagnosis

The doctor will ask about your symptoms and medical history. A physical and rectal exam will be done. Finding the disease early is important. The pouch can break, releasing stool into the abdomen. This is a medical emergency that requires surgery.

Tests may include:

Your bodily fluids and waste products may be tested. This can be done with:
- Stool sample analysis
- Blood tests
Images may need to be taken of your bodily structures. This can be done with:

After the inflammation subsides, other tests may be performed to examine the colon, including:

Treatment

The goals of treatment is to:

Resolve the infection and inflammation
Rest the bowel
Prevent complications

Treatments include:

Medications

Antibiotics and other drugs are given to fight the infection. Pain medications and drugs are given to decrease the abdominal pain.

You may also be given medication to help control vomiting.

Fluids

For mild swelling, you can drink clear liquids for the first two to three days. For a more severe case, you will be admitted to the hospital, where fluids are given by IV. Antibiotics will also be given to you through IV.

Preventive Care

Changes in your diet can help prevent future attacks.

Increase the amount of fiber you eat by eating more fruits, vegetables, and whole grains
Supplement your diet with a fiber product, as advised by your doctor
Avoid laxatives and enemas
Avoid narcotic medications—they can slow down bowel movement and can cause constipation

Surgery

Surgery to remove the section of the bowel with pouches may be recommended if:

You have had multiple attacks during a two-year period
A pouch breaks and the contents spread into the abdominal cavity, which requires that the cavity be cleaned out

Surgery is also used to treat complications of diverticulitis, such as:

Abscess—occurs if the infected pouch fills with pus
Blocked bowel—scar tissue that forms and blocks movement of stool through the intestine
Fistula—occurs if the infection spreads and colon tissue attaches to another organ, such as the bladder or the uterus/vagina

When surgery is done on an elective basis, the surgeon will remove the part of the bowel that is diseased and connect the normal parts of the bowel back together.

When surgery is done on an emergency basis, the diseased part of the bowel will be removed. The healthy parts of the bowel will not be connected right away. Your bowel will need time to rest and heal. The upper part of the bowel will be attached to the abdominal wall. A port will allow waste to pass from the intestine to a bag outside of your body. If possible, the healthy bowel will be reconnected after 6-12 weeks.

If you are diagnosed with diverticulitis, follow your doctor's instructions.

Prevention

The following recommendations may help prevent diverticulitis by improving the movement of stool through the bowel and decreasing constipation:

Eat a balanced, high-fiber diet with plenty of fruits, vegetables, and whole grains
Drink plenty of water each day
Exercise regularly

RESOURCES

Academy of Nutrition and Dietetics http://www.eatright.org

American Society of Colon and Rectal Surgeons http://www.fascrs.org

National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov

CANADIAN RESOURCES

Dietitians of Canada http://www.dietitians.ca

Health Canada http://www.hc-sc.gc.ca

References

Conn HF, Rakel RE. Conn's Current Therapy. 2001. Philadelphia, PA: WB Saunders Co;2001.

Diverticular disease. American Society of Colon and Rectal Surgeons website. Available at: http://www.fascrs.org/patients/conditions/diverticular%5Fdisease/. Updated October 2012. Accessed March 5, 2013.

Diverticulitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 20, 2013. Accessed March 5, 2013.

Diverticulosis and diverticulitis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/index.aspx. Updated February 21, 2012. Accessed March 5, 2013.

Goroll AH, Mulley AG. Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2000.

Rosen P. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, MO: Mosby-Year Book, Inc;1998.

Weisiger R, Bilhartz L, Sleisenger MH, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: WB Saunders Co;1998.

2/9/2012 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Hjern F, Wolk A, Håkansson N. Smoking and the risk of diverticular disease in women. Br J Surg. 2011;98(7):997-1002.

Revision Information

Reviewer: Daus Mahnke, MD
Review Date: 09/2012 -
Update Date: 03/05/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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