Diverticulitis

Definition

Diverticulitis is swelling (inflammation) of an abnormal pouch (diverticulum) in the intestinal wall. These pouches are usually found in the large intestine (colon). The presence of the pouches themselves is called diverticulosis.

Causes, incidence, and risk factors

Small, protruding sacs of the inner lining of the intestine (diverticulosis) can develop in any part of the intestine. They are most common in the colon, especially the sigmoid colon.

These sacs, called diverticula, occur more often after the age of 40. When they become inflamed, the condition is known as diverticulitis. Diverticula are thought to develop as a result of high pressure or abnormal pressure distribution in the colon. High pressure against the colon wall causes pouches of the intestinal lining to bulge outward through small defects in the colon wall.

Diverticulosis is very common. It is found in more than half of Americans over age 60. Only a small percentage of these people will develop the complication of diverticulitis.

Diverticulitis is caused by inflammation, or (sometimes) a small tear in a diverticulum. If the tear is large, stool in the colon can spill into the abdominal cavity, causing an infection (abscess) or inflammation of the abdomen wall (peritonitis).

Direct risk factors for diverticulitis are not known. Risk factors for diverticulosis may include older age or a low-fiber diet.

Symptoms

• Abdominal pain, usually in the left lower abdomen but can be anywhere
• Chills
• Fever
• Nausea
• Vomiting
• Weight loss

Signs and tests

Tests showing diverticulitis may include:

• Abdominal palpation
• CT scan
• High white blood cell count

Treatment

Acute diverticulitis is treated with antibiotics.

The involved portion of the colon may need to be removed with surgery if you have:

• Abscess
• Hole (perforation)
• Fistula
• Repeated attacks

After the acute infection has improved, diverticulitis is treated by increasing the bulk in the diet with high-fiber foods and bulk additives, such as psyllium.

Expectations (prognosis)

Usually, this is a mild condition that responds well to treatment.

Complications

• Abscess formation
• Perforation of the colon leading to peritonitis
• Stricture or fistula formation

Calling your health care provider

Call your health care provider if symptoms of diverticulitis occur.

Also call if you have diverticulitis and symptoms worsen or new symptoms develop.

Prevention

A high-fiber diet may prevent development of diverticulosis. Many people, including doctors, tell patients with a history of diverticulitis to avoid nuts and seeds in the diet. However, there is no evidence that this is helpful to prevent the disease.

References

Goldman L, Ausiello DA. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.