Acute diverticulitis, and diverticulosis

A diverticulum is a sac like protrusion of the mucosa of intestines through a weakening of its muscle layers. Presence of one or more divertiula is known as diverticulosis. Diverticulosis is more common after the age of 40, females are more prone for this disease. The diverticula occur more in the colon and more so in the sigmoid colon. Consumption of high fiber diet seems to prevent occurance of diverticulosis. Most of the people with diverticulosis do not have any symptoms at all. Some people with diverticulosis may present with bowel disturbances like pain, loose motions or constipation. Some diverticula may get filled with fecal matter and get eroded resulting in bleeding. These diverticula may get infected sometimes and this is called diverticulitis.
Diagnosis: Diverticulosis can be diagnosed by colonoscopy and Barium enema radiography.
Management: Once diagnosed , the diverticulosis is managed by high fiber dietary supplimentation. Increased consumption of vegetables, whole cereals or fruits is useful. Low fiber diet is to be avoided. Addition of bulking agents like psyllium or methylcellulose may be necessary. Asymptomatic diverticulosis may not need surgery.
Diverticulitis: Inflammation of one or more of colonic diverticula is called diverticulitis. Diverticulitis presents with acute pain in abdomen. It may be associated with nausea or vomiting. Location of the pain depends on the segment of the colon involved, but usually it is in the left ileac fossa. Pre-existing diverticulosis clinches the diagnosis. Colonoscopy may be helpful in diagnosis. Increasing pain and fever may be indicators of impending complications like perforation, abscess formation, peritonitis or involvement of surrounding bowel in the inflammatory process. Most common complication of diverticulitis is opening of the diverticulum into some other part of the abdomen like urinary bladder, small intestine, uterus, vagina or out to the skin and this is called fistula formation.
Treatment: Low grade inflammation of intestinal diverticula can be treated at home. Antibiotic administration , IV fluid supplimentation and analgesics reduce inflammation rapidly. Solid food is introduced slowly and later converted into high fiber diet. If the symptoms are severe and do not subside with this treatment, hospitalization is necessary and the patient is given nothing by mouth, antibiotics are administered parenterally and IV fluids are given. Impending complications may necessitate surgery. Removal of pus , abnormal tracks and resection of the involved segment of bowel is the surgical treatment. In patients with poor general condition the surgical treatment is by resection of the bowel involved and exteriorization of the proximal segment of the bowel , to be re-anastomosed later.