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==Overview==
==Overview==
Diverticulitis natural history is not well understood, but some studies have shown the disease to take a benign course if left untreated. Diverticulitis can cause many [[complications]] that can sometimes be fatal. These [[complications]] include [[abscess]], [[Bowel perforation|perforation]], [[peritonitis]], and [[fistula]] formation. [[Prognosis]] of diverticulitis is excellent and conservative treatment is successful in 70 to 100 percent of patients.


==Natural History==
==Natural History==
The natural history of diverticulitis is still not well understood. However, some studies have shown the disease to take a benign course with a low [[incidence]] of complications if left untreated.<ref name="pmid17431721">{{cite journal| author=Salem TA, Molloy RG, O'Dwyer PJ| title=Prospective, five-year follow-up study of patients with symptomatic uncomplicated diverticular disease. | journal=Dis Colon Rectum | year= 2007 | volume= 50 | issue= 9 | pages= 1460-4 | pmid=17431721 | doi=10.1007/s10350-007-0226-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17431721  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18069157 Review in: J Fam Pract. 2007 Dec;56(12):992] </ref><ref name="pmid15115921">{{cite journal| author=Floch MH, Bina I| title=The natural history of diverticulitis: fact and theory. | journal=J Clin Gastroenterol | year= 2004 | volume= 38 | issue= 5 Suppl 1 | pages= S2-7 | pmid=15115921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15115921  }} </ref>


==Complications==
==Complications==
In complicated diverticulitis, [[bacteria]] may subsequently infect the outside of the [[Colon (anatomy)|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]].  
In complicated diverticulitis, [[bacteria]] may subsequently infect the outside of the [[Colon (anatomy)|colon]] if an [[inflamed]] diverticulum bursts open. If the [[infection]] spreads to the lining of the [[abdominal cavity]] ([[peritoneum]]), this can cause potentially fatal [[peritonitis]]. Sometimes, inflamed diverticula can cause narrowing of the [[bowel]], causing an [[obstruction]]. Also, the affected part of the [[Colon (anatomy)|colon]] could adhere to the [[Urinary bladder|bladder]] or other adjacent [[organ (anatomy)|organ]]<nowiki/>s, causing a [[fistula]]. These complications always require treatment to prevent them from progressing and causing serious illness.<ref name="pmid24430321">{{cite journal| author=Morris AM, Regenbogen SE, Hardiman KM, Hendren S| title=Sigmoid diverticulitis: a systematic review. | journal=JAMA | year= 2014 | volume= 311 | issue= 3 | pages= 287-97 | pmid=24430321 | doi=10.1001/jama.2013.282025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24430321  }} </ref>


Also, the affected part of the colon could adhere to the [[Urinary bladder|bladder]] or other [[organ (anatomy)|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.
===Abscess===
*[[Abscess]] formation may take place in cases of diverticulitis.<ref name="pmid14672782">{{cite journal| author=Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE| title=Spectrum of disease and outcome of complicated diverticular disease. | journal=Am J Surg | year= 2003 | volume= 186 | issue= 6 | pages= 696-701 | pmid=14672782 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14672782  }} </ref>
*The [[abscess]] can be detected by [[Computed tomography|CT scan]] and can be resolved with [[antibiotics]]. If the [[abscess]] persists, cutaneous drainage is recommended.


These complications always require treatment to prevent them from progressing and causing serious illness.
=== Perforation and peritonitis ===
 
*[[Gastrointestinal perforation|Perforation]] can lead to [[secondary peritonitis]] due to chemical irrigation by feces.<ref name="pmid3971809">{{cite journal| author=Nagorney DM, Adson MA, Pemberton JH| title=Sigmoid diverticulitis with perforation and generalized peritonitis. | journal=Dis Colon Rectum | year= 1985 | volume= 28 | issue= 2 | pages= 71-5 | pmid=3971809 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3971809  }} </ref>
===Bleeding===
*This is rare but may be fatal.
Rectal bleeding from diverticula is a rare complication. Doctors believe the bleeding is caused by a small blood vessel in a diverticulum that weakens and then bursts. When diverticula bleed, blood may appear in the toilet or in the stool. Bleeding can be severe, but it may stop by itself and not require treatment. A person who has bleeding from the rectum—even a small amount—should see a doctor right away. Often, colonoscopy is used to identify the site of bleeding and stop the bleeding. Sometimes the doctor injects dye into an artery—a procedure called angiography—to identify and treat diverticular bleeding. If the bleeding does not stop, surgery may be necessary to remove the involved portion of the colon.
 
===Abscess, Perforation, and Peritonitis===
Diverticulitis may lead to infection, which often clears up after a few days of treatment with antibiotics. If the infection gets worse, an abscess may form in the wall of the colon.
 
An abscess is a localized collection of pus that may cause swelling and destroy tissue. If the abscess is small and remains in the wall of the colon, it may clear up after treatment with antibiotics. If the abscess does not clear up with antibiotics, the doctor may need to drain it using a catheter—a small tube—placed into the abscess through the skin. After giving the patient numbing medicine, the doctor inserts the needle through the skin until reaching the abscess and then drains the fluid through the catheter. This process may be guided by sonography or x ray.
 
Infected diverticula may develop perforations. Sometimes the perforations leak pus out of the colon and form a large abscess in the abdominal cavity, a condition called peritonitis. A person with peritonitis may be extremely ill with nausea, vomiting, fever, and severe abdominal tenderness. The condition requires immediate surgery to clean the abdominal cavity and remove the damaged part of the colon. Without prompt treatment, peritonitis can be fatal.


===Fistula===
===Fistula===
A fistula is an abnormal connection of tissue between two organs or between an organ and the skin. When damaged tissues come into contact with each other during infection, they sometimes stick together. If they heal that way, a fistula may form. When diverticulitis-related infection spreads outside the colon, the colon’s tissue may stick to nearby tissues. The organs usually involved are the bladder, small intestine, and skin.
*[[Fistula]] formation is another complication of acute diverticulitis. It occurs between the [[colon]] and its adjacent structures, especially the [[bladder]] forming the colovesical [[fistula]].
 
*[[Genitourinary]] manifestations may present as [[dysuria]].<ref name="pmid3402284">{{cite journal| author=Woods RJ, Lavery IC, Fazio VW, Jagelman DG, Weakley FL| title=Internal fistulas in diverticular disease. | journal=Dis Colon Rectum | year= 1988 | volume= 31 | issue= 8 | pages= 591-6 | pmid=3402284 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3402284  }} </ref>
The most common type of fistula occurs between the bladder and the colon. This type of fistula affects men more often than women. It can result in a severe, long-lasting infection of the urinary tract. The problem can be corrected with surgery to remove the fistula and the affected part of the colon.
 
===Intestinal Obstruction===
Scarring caused by infection may lead to partial or total blockage of the intestine, called intestinal obstruction. When the intestine is blocked, the colon is unable to move bowel contents normally. If the intestine is completely blocked, emergency surgery is necessary. Partial blockage is not an emergency, so the surgery to correct it can be planned.


==Prognosis==
==Prognosis==
In patients with acute uncomplicated diverticulitis, conservative treatment is successful in 70 to 100 percent of patients and [[mortality]] is negligible.<ref name="pmid16741596">{{cite journal |vauthors=Rafferty J, Shellito P, Hyman NH, Buie WD |title=Practice parameters for sigmoid diverticulitis |journal=Dis. Colon Rectum |volume=49 |issue=7 |pages=939–44 |year=2006 |pmid=16741596 |doi=10.1007/s10350-006-0578-2 |url=}}</ref>


==References==
==References==

Latest revision as of 17:09, 24 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Diverticulitis natural history is not well understood, but some studies have shown the disease to take a benign course if left untreated. Diverticulitis can cause many complications that can sometimes be fatal. These complications include abscess, perforation, peritonitis, and fistula formation. Prognosis of diverticulitis is excellent and conservative treatment is successful in 70 to 100 percent of patients.

Natural History

The natural history of diverticulitis is still not well understood. However, some studies have shown the disease to take a benign course with a low incidence of complications if left untreated.[1][2]

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 potentially fatal peritonitis. Sometimes, inflamed diverticula can cause narrowing of the bowel, causing an obstruction. Also, the affected part of the colon could adhere to the bladder or other adjacent organs, causing a fistula. These complications always require treatment to prevent them from progressing and causing serious illness.[3]

Abscess

Perforation and peritonitis

Fistula

Prognosis

In patients with acute uncomplicated diverticulitis, conservative treatment is successful in 70 to 100 percent of patients and mortality is negligible.[7]

References

  1. ↑ Salem TA, Molloy RG, O'Dwyer PJ (2007). "Prospective, five-year follow-up study of patients with symptomatic uncomplicated diverticular disease". Dis Colon Rectum. 50 (9): 1460–4. doi:10.1007/s10350-007-0226-5. PMID 17431721. Review in: J Fam Pract. 2007 Dec;56(12):992
  2. ↑ Floch MH, Bina I (2004). "The natural history of diverticulitis: fact and theory". J Clin Gastroenterol. 38 (5 Suppl 1): S2–7. PMID 15115921.
  3. ↑ Morris AM, Regenbogen SE, Hardiman KM, Hendren S (2014). "Sigmoid diverticulitis: a systematic review". JAMA. 311 (3): 287–97. doi:10.1001/jama.2013.282025. PMID 24430321.
  4. ↑ Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE (2003). "Spectrum of disease and outcome of complicated diverticular disease". Am J Surg. 186 (6): 696–701. PMID 14672782.
  5. ↑ Nagorney DM, Adson MA, Pemberton JH (1985). "Sigmoid diverticulitis with perforation and generalized peritonitis". Dis Colon Rectum. 28 (2): 71–5. PMID 3971809.
  6. ↑ Woods RJ, Lavery IC, Fazio VW, Jagelman DG, Weakley FL (1988). "Internal fistulas in diverticular disease". Dis Colon Rectum. 31 (8): 591–6. PMID 3402284.
  7. ↑ Rafferty J, Shellito P, Hyman NH, Buie WD (2006). "Practice parameters for sigmoid diverticulitis". Dis. Colon Rectum. 49 (7): 939–44. doi:10.1007/s10350-006-0578-2. PMID 16741596.

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