First, we must define the meaning of diverticulitis. Diverticulitis is nothing more than an inflammation, in this case, the inflammation of diverticula present in the colon.
But what is diverticula? Diverticula are small pouches that form in the wall of the large intestine, most commonly in its terminal portion, the sigmoid colon. Diverticula usually arise in the regions of the colon muscles where the blood vessels that irrigate their innermost layers penetrate. It arises due to weakness of the colon muscles, associated with increased pressure in the intestine over the years.
The main risk factors are age, which favors weakening of the bowel muscles, and a diet poor in fiber, which increases muscle work due to hardening of the stool and, consequently, increased pressure inside the intestine. Other known risk factors are obesity and a sedentary lifestyle.
Because of this, diverticula in the colon are quite common in the adult population and tend to develop with age. Currently, about 60% of individuals over 60 years of age have diverticula in the colon.
Given the presence of diverticula in the colon, we can say that the individual has diverticulosis or diverticular disease. Many people do not even know they carry the disease, as they go through life without symptoms. Among the individuals with diverticulosis, approximately 70 to 80% remain asymptomatic.
Among these, some patients sometimes discover that they have diverticulosis by chance, in routine exams (colonoscopies or other imaging tests). Asymptomatic patients do not need any specific treatment and can only be monitored and oriented in relation to the modification of dietary habits and inclusion of fibers in the diet, in order to prevent future complications.
In some patients, diverticulosis may be complicated by inflammation of the diverticula, causing an acute inflammatory condition known as acute diverticulitis.
Currently, it is believed that the main cause of acute diverticulitis crises is the obstruction of a diverticula by small pieces of stool or food, which favor the proliferation of bacteria inside it, causing inflammation. There is still no scientific evidence that specific food causes or ameliorates inflammation of the diverticula and the onset of diverticulitis.
The diagnosis is made through the reported symptoms, laboratory and imaging tests. Abdominal computed tomography is of great importance as it allows documentation of a crisis and detects possible associated complications, such as abscesses or perforation of the colon. An ultrasound can be done when a CT scan is not available.
Symptoms and Treatment of Diverticulitis
About 70 to 80% of patients who develop diverticulitis develop uncomplicated diverticulitis (or mild diverticulitis), which is characterized by pain (most commonly in the lower left abdomen), not very high fever, nausea, and changes in bowel habits (constipation or diarrhea). In the abdominal computed tomography scan there is usually only thickening of the sigmoid colon walls and eventually small amounts of free fluid in the abdomen.
The treatment for these mild cases of diverticulitis is clinical and involves intestinal rest (ie, liquid diet and no residue initially, followed by pasty diet and high fiber later). Oral antibiotics are often prescribed.
In cases of high fever and intense and diffuse abdominal pain, in addition to the inability to feed, we have severe diverticulitis. Treatment in these cases usually requires hospitalization for monitoring and intravenous antibiotic administration.
In 15 to 20% of patients with diverticulitis, more serious complications can be identified, such as abscesses, fistulas, perforation, stenosis, obstruction, peritonitis, and intestinal haemorrhage. After a first acute episode of diverticulitis about 30% of patients will present the symptoms again, particularly in the first year of evolution, and the 5-year recurrence rate may reach 54%.
When there is no response to the clinical treatment, or when complications such as those mentioned above arise, surgery for the removal of the sigmoid colon and upper segment of the rectum may be indicated.
What should we do, anyway?
Due to its complications, diverticulitis is a serious illness and can generate serious complications if not treated properly. The maintenance of healthy eating habits is essential for the prevention of acute attacks of diverticulitis. In case of symptoms such as those mentioned in the text, immediately seek a coloproctologist.
At Colono, we have experts trained to handle even the most challenging cases, ready to help you!