Diverticulitis

What is diverticulitis?

Diverticulosis (or diverticular disease) is where small pockets (diverticuli) form on the sides of the bowel wall. These pockets can become infected and cause diverticulitis. The most common site for diverticulitis is in the sigmoid colon, which is part of the left side of the large bowel. Less commonly diverticulitis can occur in the right colon or rarely in the small bowel.

What causes diverticulitis?

Diverticulitis is more common in Western countries which has led to the theory it is attributed to a low fibre diet. Interestingly, those from a Western country are more likely to have diverticular disease in the left colon and those from Asian countries in the right colon. This may suggest some genetic component as well.

Diverticular disease is very common in our population. It is more common after the age of 50 though we are increasingly seeing people in a younger age group.

What are the symptoms of diverticulitis?

The most common symptom from diverticulitis is pain. Typically the pain is in the left lower abdomen, though occasionally occur in the right side. During an acute episode of diverticulitis people may also have a fever and may experience either nausea and vomiting.

What investigations are required?

Those who have a first attack of diverticulitis will usually undergo a CT scan to confirm the diagnosis. Blood tests are performed to confirm the presence of inflammation and to help monitor progress.

Subsequent attacks of diverticulitis do not always require further scans if the symptoms are the same as a previous episode.

A colonoscopy will need to be performed if one has not already been completed within the last 2 years. This will usually be performed at least 6 weeks after the diverticulitis has resolved.

What is the management of diverticulitis?

This depends on the severity of the diverticulitis. Most attacks of diverticulitis can be managed with antibiotics either in hospital intravenously (through a drip) or at home with tablets. There is some evidence that mild attacks of diverticulitis do not even need antibiotics and will resolve on its own anyway.

Some will present to hospital very unwell with diverticulitis associated with a perforation. Emergency surgery in the form of a bowel resection may be required.

For those with recurrent or complicated diverticulitis there is sometimes a role for an elective bowel resection. This is usually a decision made balancing the number and severity of attacks, impact on quality of life and other medical problems.

What are the complications of diverticulitis?

Abscess

Diverticulitis can perforate and cause an abscess adjacent to the bowel. This can be treated with either antibiotics, drainage or surgery depending on the severity.

StrictuRes

Repeated attacks of diverticulitis can narrow the bowel and in extreme cases cause a bowel obstruction.

FistulaS

Chronic inflammation can cause a fistula (connection) to form between the bowel and other organs, commonly to the bladder. Symptoms of this are recurrent urinary tract infections and gas bubbles in the urine. This is a complication that will usually require surgery.

Bleeding

Diveticulitis or just the presence of diverticulosis can cause significant rectal bleeding. This is usually treated as an emergency in hospital through a combination of colonoscopy, radiology and surgery.

What surgery is required for diverticulitis?

Most diverticulitis occurs in the sigmoid (left side) colon. Surgery involves removing the diseased segment of bowel. In an elective setting this can usually be achieved without the need for a stoma. As an emergency this may not be possible and a stoma may be required.