INTRODUCTION: – Diverticulitis is a common digestive disease which involves the formation of pouches (diverticula) within the bowel wall. This process is known as diverticulosis, and typically occurs within the large intestine, or colon, although it can occasionally occur in the small intestine as well. Diverticulitis results when one of these diverticula becomes inflamed.
CAUSES: – The causes of diverticulitis are poorly understood, with approximately 40% due to genes and 60% due to environmental factors. Obesity another risk factor.
PATH PHYSIOLOGY: – Diverticulitis is believed to develop because of changes inside the intestines including high pressures because of faulty contracting of the intestines.
They often evolve from age-related diverticulosis and its associated pathologies resulting from increased intraluminal colonic pressure, including bleeding, abscess, perforation, stricture, fistula formation or impacted fecal matter.
Most people with diverticulosis do not have any discomfort or symptoms; however, symptoms may include mild cramps, bloating, and constipation. Other diseases such as inflammatory bowel disease (IBD) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis.
DIAGNOSIS: – People with the above symptoms are commonly studied with computed tomography, or CT scan. The CT scan is very accurate (98%) in diagnosing diverticulitis. In order to extract the most information possible about the patient’s condition, thin section (5 mm) transverse images are obtained through the entire abdomen and pelvis after the patient has been administered oral and intravascular contrast. Images reveal localized colon wall thickening, with inflammation extending into the fat surrounding the colon. The diagnosis of acute diverticulitis is made confidently when the involved segment contains diverticulae. CT may also identify patients with more complicated diverticulitis, such as those with an associated abscess. It may even allow for radiologically guided drainage of an associated abscess, sparing a patient from immediate surgical intervention.
Most cases of simple, uncomplicated diverticulitis respond to conservative therapy with bowel rest.
People may be placed on a low residue diet. It was previously thought that a low-fiber diet gives the colon adequate time to heal. Evidence tends to run counter to this with a 2011 review finding no evidence for the superiority of low residue diets in treating diverticular disease and that a high-fiber diet may prevent diverticular disease. A systematic review published in 2012 found no high quality studies, but found that some studies and guidelines favor a high-fiber diet for the treatment of symptomatic disease.
If bacterial infection is suspected, antibiotics may be used Despite being recommended by several guidelines, the use of antibiotics in mild cases of uncomplicated diverticulitis is supported with only “sparse and of low quality” evidence, with no evidence supporting their routine use.
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.
• Bowel obstruction
Introduction, Causes, Path physiology, Diagnosis, Treatment and Complications of DIVERTICULITIS
Author: Naresh Kumar Dadhich