The colon (large intestine) is a long tube-like structure that stores and then eliminates waste material. Pressure within the colon causes bulging pockets of tissue (sacs) that push out from the colonic walls as a person ages. A small bulging sac pushing outward from the colon wall is called a diverticulum. More than one bulging sac is referred to as diverticula.
Diverticula can occur throughout the colon but are most common near the end of the left colon called the sigmoid colon. The condition of having these diverticula in the colon is called diverticulosis.
A patient with diverticulosis may have few or no symptoms. When a diverticulum ruptures and becomes infected, the condition is called diverticulitis. A patient suffering from diverticulitis will have abdominal pain, abdominal tenderness, and fever. When bleeding originates from a diverticulum, it is called diverticular bleeding. A patient who suffers the consequences of diverticulosis in the colon is referred to as having diverticular disease.
More serious complications include:
- collection of pus (abscess) in the pelvis
- colon obstruction
- generalised infection of the abdominal cavity (bacterial peritonitis), and bleeding into the colon.
Usually by colonoscopy to exclude other causes such as polyps and cancers.
Medical treatment for diverticulitis Many patients with diverticulosis have minimal or no symptoms, and do not require any specific treatment. A high fiber diet and fiber supplements are advisable to prevent constipation and the formation of more diverticula.
Patients with mild symptoms abdominal pain due to muscular spasm in the area of the diverticula may benefit from anti-spasmodic drugs.
Surgery for diverticulitis Diverticulitis that does not respond to medical treatment requires surgical intervention. Surgery usually involves drainage of any collections of pus and resection (surgical removal) of that segment of the colon containing the diverticuli. Surgical removal of bleeding diverticula may be necessary for those with persistent bleeding.
Sometimes, diverticula can erode into the adjacent bladder, causing severe recurrent urine infection and passage of gas during urination. This situation also requires surgery. Sometimes, surgery may be suggested for patients with frequent, recurrent attacks of diverticulitis leading to multiple courses of antibiotics, hospitalizations, and days lost from work.
During surgery, the goal is to remove all, or almost all, of the colon containing diverticula in order to prevent future episodes of diverticulitis. There are few long-term consequences of resection of the sigmoid colon for diverticulitis, and the surgery often can be done laparoscopically, which limits post operative pain and time for recovery.