Diverticulitis natural history, complications and prognosis: Difference between revisions
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===Abscess=== | ===Abscess=== | ||
* Infection may occur in cases of diverticulitis. It usually resolve after few days treatment with antibiotics. However, if it may get worse and formation of abscess takes place in the wall of the colon.<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> | *Infection may occur in cases of diverticulitis. It usually resolve after few days treatment with antibiotics. However, if it may get worse and formation of abscess takes place in the wall of the colon.<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 the CT scan and it can be also resolved by the antibiotics and if it persists, cutaneous drainage is recommended. | *The abscess can be detected by the CT scan and it can be also resolved by the antibiotics and if it persists, cutaneous drainage is recommended. | ||
=== Perforation === | === Perforation and peritonitis === | ||
*Perforation occurs when the abscess rupture with some feces from the site of inflammation. It ruptures into the peritoneal cavity and can cause generalized peritonitis.<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> | |||
*It is unusual happens but it is fatal. | |||
==== | |||
===Fistula=== | ===Fistula=== | ||
*Fistula is another complication of the acute diverticulitis. It occurs between the colon and its relations specially the bladder forming colovesical fistula and genitourinary manifestations take place like 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> | |||
==Prognosis== | ==Prognosis== | ||
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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
Natural History
Natural history of diverticulitis is still not well understood. However, some studies showed a benign course if kept untreated with low incidence of complications formation.[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 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. These complications always require treatment to prevent them from progressing and causing serious illness.[3]
Abscess
- Infection may occur in cases of diverticulitis. It usually resolve after few days treatment with antibiotics. However, if it may get worse and formation of abscess takes place in the wall of the colon.[4]
- The abscess can be detected by the CT scan and it can be also resolved by the antibiotics and if it persists, cutaneous drainage is recommended.
Perforation and peritonitis
- Perforation occurs when the abscess rupture with some feces from the site of inflammation. It ruptures into the peritoneal cavity and can cause generalized peritonitis.[5]
- It is unusual happens but it is fatal.
Fistula
- Fistula is another complication of the acute diverticulitis. It occurs between the colon and its relations specially the bladder forming colovesical fistula and genitourinary manifestations take place like dysuria.[6]
Prognosis
- Overall, the prognosis of diverticulitis is excellent.
- In patients with acute uncomplicated diverticulitis, conservative treatment is successful in 70 to 100 percent of patients and mortality is negligible[7].
References
- ↑ 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
- ↑ Floch MH, Bina I (2004). "The natural history of diverticulitis: fact and theory". J Clin Gastroenterol. 38 (5 Suppl 1): S2–7. PMID 15115921.
- ↑ 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.
- ↑ 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.
- ↑ Nagorney DM, Adson MA, Pemberton JH (1985). "Sigmoid diverticulitis with perforation and generalized peritonitis". Dis Colon Rectum. 28 (2): 71–5. PMID 3971809.
- ↑ 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.
- ↑ 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.