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| {{DiseaseDisorder infobox | | | __NOTOC__ |
| Name = Diverticulitis |
| | {{Diverticulitis}} |
| ICD10 = {{ICD10|K|57||k|55}} |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| ICD9 = {{ICD9|562}} |
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| OMIM = |
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| MedlinePlus = 000257|
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| eMedicineSubj = med |
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| eMedicineTopic = 578 |
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| DiseasesDB = 3876 |
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| MeshID = D004238 |
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| {{SI}}
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| {{CMG}}
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| {{Editor Help}} | | {{CMG}}; {{AE}} [[User:zorkun|Cafer Zorkun]] M.D., PhD.; {{MM}}; {{AEL}} |
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| ==Overview==
| | {{SK}} Colonic diverticulitis, Diverticulitis of large intestine |
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| '''Diverticulitis''' is a common [[digestive disease]] particularly found in the colon (the large intestine). Diverticulitis develops from [[diverticulosis]], which involves the formation of pouches ([[diverticula]]) on the outside of the [[colon (anatomy)|colon]]. Diverticulitis results if one of these diverticula becomes [[inflamed]] or infected. <ref>[http://medical.merriam-webster.com/medical/diverticulitis Diverticulitis] entry at [[Merriam Webster]]'s Medical dictionary</ref> The colon can become infected with craters of food stuck inside, which causes abdominal pain.
| | ==[[Diverticulitis overview|Overview]]== |
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| ==Epidemiology== | | ==[[Diverticulitis historical perspective|Historical Perspective]]== |
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| Diverticulitis most often affects middle-aged and elderly persons, though it can strike younger patients as well.<ref name="pmid17976749">{{cite journal |author=Cole CD, Wolfson AB |title=Case Series: Diverticulitis in the Young |journal=J Emerg Med |volume= |issue= |pages= |year=2007 |pmid=17976749 |doi=10.1016/j.jemermed.2007.02.022}}</ref> [[Central obesity|Abdominal obesity]] may be associated with diverticulitis in younger patients, with some being as young as 20 years old.<ref name="titleDisease Of Older Adults Now Seen In Young, Obese Adults">{{cite web |url=http://www.sciencedaily.com/releases/2006/09/060923104630.htm |title=Disease Of Older Adults Now Seen In Young, Obese Adults |accessdate=2007-11-19 |format= |work=}}</ref>
| | ==[[Diverticulitis classification|Classification]]== |
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| 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.
| | ==[[Diverticulitis pathophysiology|Pathophysiology]]== |
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| 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.
| | ==[[Diverticulitis causes|Causes]]== |
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| Peanuts and seeds may aggravate diverticulitis.<ref name="titleAvoid Certain Foods To Prevent Diverticulitis - Health News Story - KNSD | San Diego">{{cite web |url=http://www.nbcsandiego.com/health/4963158/detail.html |title=Avoid Certain Foods To Prevent Diverticulitis - Health News Story - KNSD | San Diego |accessdate=2007-11-19 |format= |work=}}</ref>
| | ==[[Diverticulitis differential diagnosis|Differentiating Diverticulitis from other Diseases]]== |
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| ==Causes== | | ==[[Diverticulitis epidemiology and demographics|Epidemiology and Demographics]]== |
| [[Image:Diverticula, sigmoid colon.jpg|thumb|left|Large bowel (sigmoid colon) showing multiple diverticula. Note how the diverticula appear on either side of the longitudinal muscle bundle (taenium).]] | |
| 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 assumption that a lack of dietary fiber, particularly non-soluble fiber (also known in older parlance as "roughage") predisposes individuals to diverticular disease is supported within the medical literature.<ref>[http://www.umm.edu/altmed/articles/diverticular-disease-000051.htm Diverticular disease<!-- Bot generated title -->]</ref>
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| <ref>[http://www.ohsu.edu/health/health-topics/topic.cfm?id=8464 Diverticular Disease: Oregon Health & Science University - Portland, Oregon<!-- Bot generated title -->]</ref>
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| It is thought that mechanical blockage of a [[diverticulum]], possibly by a piece of [[feces]] or food particles, leads to infection of the diverticulum.
| | ==[[Diverticulitis risk factors|Risk Factors]]== |
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| There is some evidence that a genetic component may be a causative factor.
| | ==[[Diverticulitis screening|Screening]]== |
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| ==Presentation== | | ==[[Diverticulitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| Patients often present with the classic triad of left lower quadrant pain, [[fever]], and [[leukocytosis]] (an elevation of the [[white blood cell|white cell]] count in blood tests). Patients may also complain of [[nausea]] or [[diarrhea]]; others may be [[Constipation|constipated]].
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| 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.
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| ==Symptoms== | |
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| ===Diverticulitis===
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| 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.
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| ===Diverticulosis===
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| 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.
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| ==Diagnosis== | | ==Diagnosis== |
| | | [[Diverticulitis history and symptoms|History and Symptoms]] | [[Diverticulitis physical examination|Physical Examination]] | [[Diverticulitis laboratory findings|Laboratory Findings]] | [[Diverticulitis CT|CT]] | [[Diverticulitis MRI|MRI]] | [[Diverticulitis ultrasound|Ultrasound]] | [[Diverticulitis x ray|X Ray]] | [[Diverticulitis other imaging findings|Other Imaging Findings]] | [[Diverticulitis other diagnostic studies|Other Diagnostic Studies]] |
| 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.
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| Patients with the above symptoms are commonly studied with a computed tomography, or [[CT scan]].<ref name="pmid17895789">{{cite journal |author=Lee KH, Lee HS, Park SH, ''et al'' |title=Appendiceal diverticulitis: diagnosis and differentiation from usual acute appendicitis using computed tomography |journal=Journal of computer assisted tomography |volume=31 |issue=5 |pages=763–9 |year=2007 |pmid=17895789 |doi=10.1097/RCT.0b013e3180340991}}</ref>
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| 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.
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| Other studies, such as [[barium enema]] and [[colonoscopy]] are [[Contraindication|contraindicated]] in the acute phase of diverticulitis due to the risk of perforation.
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| ===Histopathological Findings: Actinomycosis diverticulitis & abscess===
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| <youtube v=pvasI_yy3R4/>
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| ==Treatment== | | ==Treatment== |
| | [[Diverticulitis medical therapy|Medical Therapy]] | [[Diverticulitis surgery|Surgery]] | [[Diverticulitis primary prevention|Primary Prevention]] | [[Diverticulitis secondary prevention|Secondary Prevention]] | [[Diverticulitis cost-effectiveness of therapy|Cost-effectiveness of therapy]] | [[Diverticulitis future or investigational therapies|Future or Investigational Therapies]] |
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| 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 organism|anaerobic]] [[bacteria]] and [[gram-negative]] [[Bacteria|rods]]. However, recurring acute attacks or complications, such as peritonitis, abscess, or fistula may require surgery, either immediately or on an elective basis.
| | ==Case Studies== |
| | | [[Diverticulitis case study one|Case #1]] |
| 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.
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| 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.
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| ==Complications==
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| 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]].
| | ==External Links== |
| | * [http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/ Diverticulosis and Diverticulitis at National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)] |
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| 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.
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| * [[Bowel obstruction]]
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| * [[Peritonitis]]
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| * [[Abscess]]
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| * [[Fistula]]
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| * [[Bleeding]]
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| * [[Stenosis|Strictures]]
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| Diverticulitis can lead to bleeding; infections; small tears, called perforations; or blockages in the colon. These complications always require treatment to prevent them from progressing and causing serious illness.
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| ===Bleeding===
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| 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.
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| ===Abscess, Perforation, and Peritonitis===
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| 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.
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| 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.
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| 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.
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| ===Fistula===
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| 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.
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| 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.
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| ===Intestinal Obstruction===
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| 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.
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| ==References==
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| {{reflist|2}}
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| ==External links==
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| * [http://www.hmc.psu.edu/healthinfo/d/diver.htm Health and Disease Information on Diverticulitis] at [[Pennsylvania State University|Penn State University]]
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| * [http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/ Diverticulosis and Diverticulitis] at [[National Institute of Diabetes and Digestive and Kidney Diseases|NIDDK]]
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| * [http://www.mayoclinic.com/health/diverticulitis/DS00070 Diverticulitis] at [[Mayo Clinic]]
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| * [http://www.diverticulitis-diet.info/ Diverticulitis Diet Info] from Diverticulitis-Diet.info
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| {{SIB}}
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| {{Gastroenterology}} | | {{Gastroenterology}} |
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| [[Category:Digestive diseases]]
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| [[Category:Surgery]]
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| [[Category:Abdominal pain]]
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| [[Category:Hematology]]
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| [[Category:Gastroenterology]]
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| [[de:Divertikulitis]] | | [[de:Divertikulitis]] |
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| | [[Category:Surgery]] |
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| | [[Category:Gastroenterology]] |
| | [[Category:Emergency medicine]] |
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| | [[Category:Infectious disease]] |