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Healthy Living: What is Diverticulitis?

BANGOR, Maine (WABI) - What is Diverticulitis? How do we treat it?

Anthony Tannous, MD, October 16, 2018

Diverticulitis is a very common disease of the colon that occurs along a very wide spectrum of severity. In its milder forms, it can be treated in the clinic but when very severe it may require emergency surgery.
What is diverticulitis? And how do we treat it?
The last part of our gastrointestinal tract is the colon. The colon sometimes has small pouches in its wall, areas of weakness, called diverticula. The presence and number of diverticula is related to our genetics and diet. Many people have these pouches and have no symptoms. If they don’t cause any symptoms they don’t need to be treated. Occasionally they do however get inflamed, a condition called diverticulitis which does require treatment.
What are the symptoms of diverticulitis?
The most common symptom is abdominal pain. Our colon courses from the right lower abdomen to the upper abdomen then to the left lower abdomen and any part can be affected. The most common site is the sigmoid colon which is in the left lower abdomen which is why it’s the most common site of pain. Pain is often accompanied by fever, constipation, diarrhea and nausea with vomiting. If the pain is mild, it is reasonable to seek the consult of the primary care. If the pain is severe and has associated symptoms then presenting to the emergency room is advisable.
There are many tests your doctor may choose to perform to confirm the diagnosis but tests are not always needed if the pain is mild and typical and this is not the first episode. If you do have a test, it may include a CT scan of the abdomen and a blood count.
Treatment of diverticulitis may take several forms depending on the severity of the disease. In the mildest forms, where the pouch is simply inflamed and the symptoms mild, treatment is as simple as a course of oral antibiotics at home. For more severe symptoms or inflammation, you may need to be admitted for a short period of bowel rest and intravenous antibiotics.
In certain cases, the inflammation is so severe that is causes a hole to develop in the diverticulum which leads to bacteria going outside the colon. This may result in the formation of an abscess which, if it reaches a certain size, may need drainage through a tube. In these cases, along with the antibiotics, the drain may have to stay in place for a variable duration. When the infection is free floating in the abdomen and causes peritonitis or sepsis, emergent surgery is needed.
Ultimately, if the diverticulitis is recurrent, severe or poses considerable risk, most surgeons will advise removal of the part colon with the pouches in its wall. Depending on the overall condition, it may not be safe to reattach the colon to itself during first surgery resulting in a temporary ostomy bag. That ostomy will in most cases be taken down and reconnected to the colon in a second surgery, 3 to 6 months later.
Many patients ask how they can prevent diverticulitis. A large part is genetics but diet does play a role. If you are prone to diverticulitis then it is a good idea to eat a lot of fiber. Good sources of fiber include fruits, oats, beans, peas and green leafy vegetables. It is usually advised to wait until symptoms get better to start eating more fiber to prevent irritation of the inflamed colon.

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