Diverticulitis

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{{#if:October 2007||}} {{#if: | {{#if: | {{#if: K57.| {{#if: 562| {{#if: | {{#if: | {{#if: 3876| {{#if: 000257| {{#if: med| {{#if: | {{#if: |
Diverticulitis
Classification & external resources
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ICD-10 K57.}}
ICD-9 562}}
ICD-O: }}
OMIM [3] }}
DiseasesDB 3876 }}
MedlinePlus 000257 }}
eMedicine search | topic list | med/578 }} }}
MeSH {{{MeshID}}} }}
MeSH {{{MeshNumber}}}}}

Diverticulitis is a common digestive disease particularly found in the large intestine. Diverticulitis develops from diverticulosis, which involves the formation of pouches (diverticula) on the outside of the colon. Diverticulitis results if one of these diverticula becomes inflamed.

Contents

Causes

The development of colonic diverticulum is thought to be a result of raised intraluminal colonic pressures. The sigmoid colon (Section 4) has the smallest diameter of any portion of the colon, and therefore the portion which would be expected to have the highest intraluminal pressure. The postulate that low dietary fiber, particularly non-soluble fiber (also known in older parlance as "roughage") predisposes individuals to diverticular disease is supported within the medical literature.Template:Fact

It is thought that mechanical blockage of a diverticulum, possibly by a piece of feces or food particles, leads to infection of the diverticulum.Template:Fact

Presentation

Patients often present with the classic triad of left lower quadrant pain, fever, and leukocytosis (an elevation of the white cell count in blood tests). Patients may also complain of nausea or diarrhea; others may be constipated.

Less commonly, an individual with diverticulitis may present with right-sided abdominal pain. This may be due to the less prevalent right-sided diverticula or a very redundant sigmoid colon.

Symptoms

Diverticulitis

The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications.

Diverticulosis

Most people with diverticulosis do not have any discomfort or symptoms. However, symptoms may include mild cramps, bloating, and constipation. Other diseases such as irritable bowel syndrome (IBS) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis.

Diagnosis

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. Some patients report bleeding from the rectum.

Patients with the above symptoms are commonly studied with a computed tomography, or CT scan.[1] The CT scan is very sensitive (98%) in diagnosing diverticulitis. It may also identify patients with more complicated diverticulitis, such as those with an associated abscess. CT also allows for radiologically guided drainage of associated abscesses, possibly sparing a patient from immediate surgical intervention.

Other studies, such as barium enema and colonoscopy are contraindicated in the acute phase of diverticulitis due to the risk of perforation.

Treatment

An initial episode of acute diverticulitis is usually treated with conservative medical management, including bowel rest (ie, nothing by mouth), IV fluid resuscitation, and broad-spectrum antibiotics which cover anaerobic bacteria and gram-negative rods. However, recurring acute attacks or complications, such as peritonitis, abscess, or fistula may require surgery, either immediately or on an elective basis.

Upon discharge patients may be placed on a low residue diet. This low-fiber diet gives the colon adequate time to heal without needing to be overworked. Later, patients are placed on a high-fiber diet. There is some evidence this lowers the recurrence rate.

In some cases surgery may be required to remove the area of the colon with the diverticula. Patients suffering their first attack of diverticulitis are typically not encouraged to undergo the surgery, unless the case is severe. Patients suffering repeated episodes may benefit from the surgery. In such cases the risks of complications from the diverticulitis outweigh the risks of complications from surgery.

Complications

In complicated diverticulitis, bacteria may subsequently infect the outside of the colon if an inflamed diverticulum bursts open. If the infection spreads to the lining of the abdominal cavity, (peritoneum), this can cause a potentially fatal peritonitis. Sometimes inflamed diverticula can cause narrowing of the bowel, leading to an obstruction. Also, the affected part of the colon could adhere to the bladder or other organ in the pelvic cavity, causing a fistula, or abnormal connection between an organ and adjacent structure or organ, in this case the colon and an adjacent organ.

Epidemiology

Diverticulitis most often affects middle-aged and elderly persons, though it can strike younger patients as well.[2] Abdominal obesity may be associated with diverticulitis in younger patients, with some being as young as 20 years old.[3]

In Western countries, diverticular disease most commonly involves the sigmoid colon - section 4 - (95% of patients). The prevalence of diverticular disease has increased from an estimated 10% in the 1920s to between 35 and 50% by the late 1960s. 65% of those currently 85 years of age and older can be expected to have some form of diverticular disease of the colon. Less than 5% of those aged 40 years and younger may also be affected by diverticular disease.

Left-sided diverticular disease (involving the sigmoid colon) is most common in the West, while right-sided diverticular disease is more prevalent in Asia and Africa. Among patients with diverticulosis, 10-25% patients will go on to develop diverticulitis within their lifetimes.

Peanuts and seeds may aggravate diverticulitis.[4]

Famous sufferers

Cultural references

References

  1. {{#if:Lee KH, Lee HS, Park SH, et al |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Lee KH, Lee HS, Park SH, et al }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Lee KH, Lee HS, Park SH, et al }} }} }}{{#if:Lee KH, Lee HS, Park SH, et al |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2007 |{{#if: | ({{{month}}} 2007) | (2007) }} }} }}{{#if:Lee KH, Lee HS, Park SH, et al | . }}{{#if:Lee KH, Lee HS, Park SH, et al2007 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Appendiceal diverticulitis: diagnosis and differentiation from usual acute appendicitis using computed tomography] |Appendiceal diverticulitis: diagnosis and differentiation from usual acute appendicitis using computed tomography }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Journal of computer assisted tomography |. Journal of computer assisted tomography }}{{#if:31 | 31 }}{{#if:5 | (5) }}{{#if:763–9 |: 763–9 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if:10.1097/RCT.0b013e3180340991 |. doi:10.1097/RCT.0b013e3180340991 }}{{#if: |. ISSN {{{issn}}} }}{{#if:17895789 |. PMID 17895789 }}{{#if: |. Bibcode{{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  2. {{#if:Cole CD, Wolfson AB |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Cole CD, Wolfson AB }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Cole CD, Wolfson AB }} }} }}{{#if:Cole CD, Wolfson AB |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2007 |{{#if: | ({{{month}}} 2007) | (2007) }} }} }}{{#if:Cole CD, Wolfson AB | . }}{{#if:Cole CD, Wolfson AB2007 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Case Series: Diverticulitis in the Young] |Case Series: Diverticulitis in the Young }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:J Emerg Med |. J Emerg Med }}{{#if: | ' }}{{#if: | () }}{{#if: |: }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if:10.1016/j.jemermed.2007.02.022 |. doi:10.1016/j.jemermed.2007.02.022 }}{{#if: |. ISSN {{{issn}}} }}{{#if:17976749 |. PMID 17976749 }}{{#if: |. Bibcode{{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
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External links

{{#if:|}}{{#if:Esophagitis - GERD - Achalasia - Boerhaave syndrome - Nutcracker esophagus - Zenker's diverticulum - Mallory-Weiss syndrome - Barrett's esophagus|{{#if:|{{#ifeq:{{#if:EsophagusStomach/
duodenumHerniaNoninfective enteritis and colitisOther intestinalLiver/hepatitisAccessory digestiveOther/general|false|true}}|true|}}}}{{#if:Esophagus|}}{{#if:|}}}}{{#if:Peptic (gastric/duodenal) ulcer - Gastritis - Gastroenteritis - Duodenitis - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy|{{#if:Stomach/
duodenum|}}}}{{#if:Inguinal (Indirect, Direct) - Femoral - Umbilical - Incisional - Diaphragmatic - Hiatus|{{#if:Hernia|}}}}{{#if:IBD (Crohn'sUlcerative colitis) - noninfective gastroenteritis|{{#if:Noninfective enteritis and colitis|}}}}{{#if:vascular (Abdominal angina, Mesenteric ischemia, Ischemic colitis, Angiodysplasia) - Ileus/Bowel obstruction (Intussusception, Volvulus) - Diverticulitis/Diverticulosis - IBS
other functional intestinal disorders (Constipation, Diarrhea, Megacolon/Toxic megacolon, Proctalgia fugax) - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis (Radiation proctitis)|{{#if:Other intestinal|}}}}{{#if:Alcoholic liver disease - Liver failure (Acute liver failure) - Cirrhosis - PBC - NASH - Fatty liver - Peliosis hepatis - Portal hypertension - Hepatorenal syndrome|{{#if:Liver/hepatitis|}}}}{{#if:Gallbladder (Gallstones, Choledocholithiasis, Cholecystitis, Cholesterolosis, Rokitansky-Aschoff sinuses)

Biliary tree (Cholangitis, Cholestasis/Mirizzi's syndrome, PSC, Biliary fistula, Ascending cholangitis)

Pancreas (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst, Hereditary pancreatitis)|{{#if:Accessory digestive|}}}}{{#if:Appendicitis - Peritonitis (Spontaneous bacterial peritonitis) Malabsorption (celiac, Tropical sprue, Blind loop syndrome, Whipple's) postprocedural:Gastric dumping syndrome - Postcholecystectomy syndromebleeding:Hematemesis - Melena - Gastrointestinal bleeding (Upper, Lower)|{{#if:Other/general|}}}}{{#if:See also congenital|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|{{#if:|}}}}{{#if:|}}]]de:Divertikulitis

es:Diverticulitis nl:Diverticulitis pl:Zapalenie uchyłków pt:Diverticulite fi:Divertikuliitti

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