standard-title Diverticulitis

Diverticulitis

Diverticulitis


About the Condition

Diverticulitis

Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine (colon). Diverticula are common, especially after age 40, and seldom cause problems.

Sometimes, however, one or more of the pouches become inflamed or infected. That condition is known as diverticulitis (die-vur-tik-yoo-LIE-tis). Diverticulitis can cause severe abdominal pain, fever, nausea and a marked change in your bowel habits.

Mild diverticulitis can be treated with rest, changes in your diet and antibiotics. Severe or recurring diverticulitis may require surgery.

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Signs and Symptoms

The signs and symptoms of diverticulitis include:

  • Pain, which may be constant and persist for several days. Pain is usually felt in the lower left side of the abdomen, but may occur on the right, especially in people of Asian descent.
  • Nausea and vomiting.
  • Fever.
  • Abdominal tenderness.
  • Constipation or, less commonly, diarrhea.

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Risk Factors

Several factors may increase your risk of developing diverticulitis:

  • Aging. The incidence of diverticulitis increases with age.
  • Obesity. Being seriously overweight increases your odds of developing diverticulitis. Morbid obesity may increase your risk of needing more-invasive treatments for diverticulitis.
  • Smoking. People who smoke cigarettes are more likely than nonsmokers to experience diverticulitis.
  • Lack of exercise. Vigorous exercise appears to lower your risk of diverticulitis.
  • Diet high in animal fat and low in fiber, although the role of low fiber alone isn’t clear.
  • Certain medications. Several drugs are associated with an increased risk of diverticulitis, including steroids, opiates and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).

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Diagnostic Process

Diverticulitis is usually diagnosed during an acute attack. Because abdominal pain can indicate a number of problems, your doctor will need to rule out other causes for your symptoms.

Your doctor will likely start with a physical examination, including checking your abdomen for tenderness. Women, in addition, generally have a pelvic examination to rule out pelvic disease.

After that, your doctor will likely recommend:

  • Blood and urine tests, to check for signs of infection.
  • Pregnancy test for women of childbearing age, to rule out pregnancy as a cause of abdominal pain.
  • Liver function tests, to rule out other causes of abdominal pain.
  • Stool test, to rule out infection in people who have diarrhea.
  • CT scan, which can indicate inflamed or infected pouches and confirm a diagnosis of diverticulitis. CT can also indicate the severity of diverticulitis and guide treatment.

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Treatment Options

Complicated diverticulitis

If you have a severe attack or have other health problems, you’ll likely need to be hospitalized. Treatment generally involves:

  • Intravenous antibiotics
  • Insertion of a tube to drain an abscess, if one has formed

Surgery

You’ll likely need surgery to treat diverticulitis if:

  • You have a complication, such as perforation, abscess, fistula or bowel obstruction
  • You have had multiple episodes of uncomplicated diverticulitis
  • You are immune compromised

There are two main types of surgery:

  • Primary bowel resection. The surgeon removes diseased segments of your intestine and then reconnects the healthy segments (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open surgery or a minimally invasive (laparoscopic) procedure.
  • Bowel resection with colostomy. If you have so much inflammation that it’s not possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An opening (stoma) in your abdominal wall is connected to the healthy part of your colon. Waste passes through the opening into a bag. Once the inflammation has eased, the colostomy may be reversed and the bowel reconnected.

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