Diverticulitis (What You Need to Know Book 2)

Typical findings of acute diverticulitis in CT scans include bowel wall thickening, pericolic fat stranding, pericolic fluid, and small abscesses confined to the colonic wall as well as contrast extravasation, indicating intramural sinus and fistula formation. MRI is another possible diagnostic modality. Due to cost and no direct comparison of sensitivity or specificity, CT is usually preferred.

Diverticular disease prevention and treatment - Harvard Health

Radiographs of the abdomen will probably only show nonspecific abnormalities such as bowel gas; however, if the patient has an intestinal obstruction, air-fluid levels can be present. Endoscopy should be avoided in suspected acute diverticulitis due to an increased risk of perforation. It is recommended that a colonoscopy is performed approximately six to eight weeks after symptoms have resolved to rule out malignancy, inflammatory bowel disease, or possibly colitis if the patient has not had a recent colonoscopy. In the absence of these conditions, and if appropriate prompt follow-up can be established, acute diverticulitis can be managed on an outpatient basis.

The standard of outpatient care includes bowel rest, increase fluid intake, and oral antibiotic therapy single or multiple drug regimen that covers gram-negative rods and anaerobic bacteria.

Inpatient management of diverticulitis requires intravenous antibiotics, intravenous fluids, and pain management. Again, antibiotics should cover gram-negative rods and anaerobes and be given for three to 5 days before switching to oral antibiotics for a ten to day course. Bowel rest is preferred in patients requiring inpatient admission. Typically, defervescence and improvement in leukocytosis should be observed for two to four days of hospitalization, if not an alternative diagnosis or complications should be suspected.

Prompt surgical evaluation should be considered. Clinically, abscess formation should be suspected if fever and leukocytosis do not subside despite adequate intravenous IV antibiotics. Abscesses that are less than 2 cm to 3 cm can be treated conservatively with IV antibiotics.

Large abscesses should be drained percutaneously with CT guidance. Fistula formation is another complication of acute diverticulitis. Fecaluria is pathognomonic for colovesicular fistula.

Diverticulitis

Surgical repair of the fistula with primary anastomosis is the treatment of choice. Complete bowel obstruction is rare in acute diverticulitis. After recovering from diverticulitis, the patient must be examined to rule out a malignancy. Options for investigation of the colon include colonoscopy, CT scan or a barium enema.

Diverticular disease prevention and treatment

The patient should start a high-fiber diet, drink ample water, maintain a healthy weight and exercise. Having multiple episodes does not appear to increase the risk for complications directly. It may increase the risk of fibrosis, leading to stricture formation and subsequent obstruction. These patients may be referred for elective colectomy for symptom control. Acute diverticulitis has enormous morbidity and while there are no universal guidelines, expert opinion recommends a multidisciplinary approach for diagnosis and management.

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The disorder needs to be staged radiologically. In addition, the patient needs a dietary consult regarding a high-fiber diet. Nurses need to assist in educating the patient on following dietary restrictions. Finally, a general or colorectal surgery should determine the proximal levels of colon resection but the amount of clear proximal margin needed remains unknown. Because the risk of colon cancer in patients with acute diverticulitis is slightly increased, a screening program has to be established. However, in patients with recurrence, surgical excision of the diseased bowel is recommended, especially in patients over the age of One study showed no difference in postoperative morbidity between the two.

Introduction

To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls Publishing; Jan-. Show details Treasure Island FL: Other possible risk factors are obesity, lack of physical activity, and high consumption of red meat and fats. Scientists are also considering the potential role of low-grade chronic inflammation and connective tissue defects perhaps inherited.

You can't get rid of diverticulosis, but you can do things that may reduce the chance that it will progress to diverticulitis and other complications. Chief among them is eating a high-fiber diet. It hasn't been proved that fiber prevents diverticulitis, but evidence suggests that people who eat more fiber are less likely to develop the problem.

Fiber absorbs water as it passes through the intestine, producing bulky stools that move through more quickly, reducing the likelihood of constipation and the resulting pressure in the colon. When fiber is inadequate, stools are small and hard, and the colon must contract with greater force to expel them, putting extra pressure on the colon walls. A high-fiber diet should include a mix of whole grains, nuts, seeds, fruits, legumes such as dried beans , and vegetables. See "Fiber content of various foods. However, this idea has been disproved.

For people who can't or don't consume enough fiber in foods, supplements are available, including psyllium Fiberall, Konsyl, Metamucil, others , methylcellulose Citrucel, generic , and calcium polycarbophil FiberCon. It's important to take these supplements with adequate water — usually at least 8 ounces, preferably more, with each dose.

Women should aim for 25 grams of fiber per day 21 grams if you're over age Added fiber can have unpleasant side effects, such as bloating or gas. To minimize this problem, increase your daily intake gradually, by about 5 grams per week, until you reach your goal. And be sure to drink plenty of fluids. Regular exercise, especially aerobic exercise, can also help.

It speeds the movement of food through the colon, reducing the risk of constipation and the formation of hard, dry stools. Both fiber which is filling and exercise help combat obesity, which has been linked in several reports to the development of diverticulitis and diverticular bleeding. Considering how many millions of Americans have diverticulosis, it's remarkable that complications are so rare. However, they do occur and can be serious. Diverticulitis occurs when the wall of a diverticulum is eroded by pressure, trapped fecal matter, or both.

It is unclear what role dietary fibre plays in diverticulitis. Right-sided diverticula are micro-hernias of the colonic mucosa and submucosa through the colonic muscular layer where blood vessels penetrate it. People with the above symptoms are commonly studied with computed tomography, or CT scan. Images reveal localized colon wall thickening, with inflammation extending into the fat surrounding the colon.

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It may even allow for radiologically guided drainage of an associated abscess, sparing a patient from immediate surgical intervention. Barium enema and colonoscopy are contraindicated in the acute phase of diverticulitis because of the risk of perforation. Four classifications by severity have been published recently in the literature. The most recent and widely accepted is as follows [17]:. The severity of diverticulitis can be radiographically graded by the Hinchey Classification.

The differential diagnosis includes colon cancer , inflammatory bowel disease , ischemic colitis , and irritable bowel syndrome , as well as a number of urological and gynecological processes. In complicated diverticulitis, an inflamed diverticulum can rupture, allowing bacteria to subsequently infect externally from the colon.

If the infection spreads to the lining of the abdominal cavity the peritoneum , peritonitis results. Sometimes, inflamed diverticula can cause narrowing of the bowel , leading to an obstruction. In some cases, the affected part of the colon adheres to the bladder or other organs in the pelvic cavity , causing a fistula , or creating an abnormal connection between an organ and adjacent structure or other organ in the case of diverticulitis, the colon and an adjacent organ.

Most cases of simple, uncomplicated diverticulitis respond to conservative therapy with bowel rest. People may be placed on a low fibre diet. Evidence tends to run counter to this with a review finding no evidence for the superiority of low fibre diets in treating diverticular disease and that a high-fibre diet may prevent diverticular disease.

The use of antibiotics in mild cases of uncomplicated diverticulitis is supported with only "sparse and of low quality" evidence, with no evidence supporting their routine use. With CT scan evidence of abscess, fistula, or intestinal rupture with peritonitis, antibiotics are recommended and routinely used. Indications for surgery are abscess or fistula formation; and intestinal rupture with peritonitis. The timing of the elective surgery is determined by evaluating factors such as the stage of the disease, the age of the individual, the general medical condition of the individual, the severity and frequency of the attacks, and whether symptoms persist after the first acute episode.

In most cases, elective surgery is deemed to be indicated when the risks of the surgery are less than the risks of the complications of the diverticulitis. Elective surgery is not indicated until at least six weeks after recovery from the acute event. The first surgical approach consists of the resection and primary anastomosis.

This first stage of surgery is performed on patients if they have a well vascularized, nonedematous and tension-free bowel. The proximal margin should be an area of pliable colon without hypertrophy or inflammation. The distal margin should extend to the upper third of the rectum where the taenia coalesces. Not all of the diverticula-bearing colon must be removed, since diverticula proximal to the descending or sigmoid colon are unlikely to result in further symptoms.

Diverticulitis surgery consists of a bowel resection with or without colostomy. Either may be done by the traditional laparotomy or by laparoscopic surgery. During a colectomy, the person is placed under general anesthesia.

A surgeon performing a colectomy will make a lower midline incision in the abdomen or a lateral lower transverse incision. The diseased section of the large intestine is removed, and then the two healthy ends are sewn or stapled back together. A colostomy may be performed when the bowel has to be relieved of its normal digestive work as it heals. A colostomy implies creating a temporary opening of the colon on the skin surface, and the end of the colon is passed through the abdominal wall with a removable bag attached to it.