Diverticulitis natural history, complications and 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.
- 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
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.
Peritonitis
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.
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.
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[4].
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.
- ↑ 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.