Small pouch-like formations called diverticula often develop in the lining of the intestines, especially the colon. Diverticula are common after the age of 40 and usually do not cause any problems. They may sometimes get infected and inflamed, a condition known as diverticulitis. This can cause abdominal pain, fever and other symptoms. Mild diverticulitis can be treated by conservative methods, but surgery is necessary for severe or recurrent diverticulitis.
Diverticula form in places within the colon that are naturally weak and succumb to pressure. Marble-sized pouches develop that bulge through the colon wall. Diverticulitis is inflammation or infection of the diverticula due to injury. It may be associated with increasing age, obesity, lack of exercise, smoking, a high-fat, low-fibre diet, and certain medications.
Diverticulitis is associated with severe abdominal pain and fever that can affect your normal functioning.
The colon or large intestine is part of the digestive system. It arches around the small intestine from the right side of the abdomen to the left. It has 3 segments, the ascending colon, the transverse colon and descending colon. Food from the small intestine ascends the colon on the right side of the abdomen, then passes through the transverse and descending segments, before it enters the rectum and is then expelled from the anus. The colon wall has an inner mucous layer surrounded by a submucous and then a muscular layer. Pressure within the colon can cause the mucous layer to herniate through a weak point in the muscular colon wall. This creates a pouch called a diverticulum or diverticula in plural. The condition of having diverticula is referred to as diverticulosis. Diverticula can develop in any part of the intestine but are usually found towards the end of the colon. Diverticulitis is infection or inflammation of the diverticula that can occur with injury.
Diverticulosis usually causes no symptoms, but may occasionally be associated with abdominal pain and blood in the stool. Diverticulitis is associated with more severe symptoms of abdominal pain, tenderness, fever, nausea, vomiting and constipation. Pain is usually felt in the left lower abdomen. You may have an acute attack which resolves completely or a chronic condition where infection and inflammation subside but continues to be present. Prolonged diverticulitis can lead to diarrhoea, constipation, abdominal bloating and bowel obstruction.
Since abdominal pain is common to many conditions, your doctor will make a careful investigation before diagnosing diverticulitis. Your symptoms are reviewed and a physical examination performed. Any abdominal tenderness is noted. Women undergo a pelvic examination. A pregnancy test may also be carried out. Other tests include blood and urine tests, liver tests, a stool test and a CT scan to visualise the inflamed diverticula and assess severity.
If diverticulitis goes untreated, it may lead to complications such as an abscess formation. An abscess may penetrate the colon wall and infect the surrounding abdominal cavity, a potentially fatal condition called peritonitis. Other complications include scar formation which can lead to blockage, severe bleeding and formation of a fistula (abnormal communication) between the infected diverticulum and a surrounding organ such as the bladder.
Your doctor will assess the severity of diverticulitis before deciding on the appropriate treatment. Mild diverticulitis can be treated at home with antibiotics, pain relievers and a liquid diet for a few days. Diverticulitis that is severe or complicated usually requires a hospital admission. Intravenous antibiotics are administered. A tube may be inserted to drain an abscess. Surgery may be necessary if you have multiple episodes of diverticulitis, your immunity is compromised, or you have complications such as an abscess, perforation, bowel obstruction or fistula. The two main procedures to treat diverticulitis include primary bowel resection or bowel resection with a colostomy.
During primary bowel resection, diseased segments of the colon are removed and healthy colon reattached to the rectum. Surgery may be performed through a large open incision or with a laparoscopic technique that uses a few small incisions.
A colostomy is performed if the colon has extensive inflammation and cannot be reattached. A small opening called a stoma is made in the abdominal wall and healthy colon is connected to it. Digestive remains from the colon pass out of the stoma into a bag. This allows the remainder of the colon time to rest and heal. Once inflammation has settled down, the colon may be reattached, and the stoma closed.
Before surgery to the colon, your doctor will perform a colonoscopy or barium enema as well as other imaging studies and tests. The anaesthesiologist will also meet you to perform an evaluation. Certain medications such as blood thinners are discontinued several days prior to the procedure to avoid excessive bleeding during surgery. As there is a high risk of infection with colon surgery, you will be started on antibiotics several days before the procedure. Laxatives are prescribed to help clear your bowels. You will be on a clear liquid diet the day before the procedure and will be advised not to eat or drink several hours before the procedure.
Following a bowel resection, you will be in the hospital for 4-7 days or longer. Your doctor will monitor you and evaluate bowel function. Only clear liquids are permitted at first. Solids should be gradually introduced as your bowels heal and become more functional. In case of a colostomy, you will be given instructions on how to care for the stoma site and colostomy bag. You should refrain from strenuous activity for at least 2 weeks after the procedure. Avoid smoking as it can delay the healing of tissues. The stoma may be closed in a few months if your colon has healed well. If the risk of reinfection is high, the stoma is permanent.
As a result of surgery, you should have less pain, improved bowel function and a decreased incidence of diverticulitis. You will have better outcomes if your condition was not severe enough to require a stoma and if the procedure was performed by laparoscopic methods. You should see your doctor if you have intense abdominal pain, bleeding from the incision sites, diarrhoea or constipation for several days, fever, nausea or vomiting.
Down-time, lifestyle or off-work duration
It usually takes 4-8 weeks to recover following surgery. To keep your colon healthy, increase fibre in your diet through fruits, vegetables and whole grains and drink plenty of fluids
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Research articles on Diverticulitis:
Mayl, J., Marchenko, M., & Frierson, E. (2017). Management of Acute Uncomplicated Diverticulitis May Exclude Antibiotic Therapy. Cureus, 9(5), e1250. http://doi.org/10.7759/cureus.1250
Carabotti, M., Annibale, B., Severi, C., &Lahner, E. (2017). Role of Fiber in Symptomatic Uncomplicated Diverticular Disease: A Systematic Review. Nutrients, 9(2), 161. http://doi.org/10.3390/nu9020161
Tursi, A. (2014). Efficacy, safety, and applicability of outpatient treatment for diverticulitis. Drug, Healthcare and Patient Safety, 6, 29–36. http://doi.org/10.2147/DHPS.S61277