DIVERTICULOSIS OF THE COLON
Who gets diverticulosis and why? RIGHT SIDED DIVERTICULOSIS • • • • • •
entirely different condition from left-sided diverticulosis True diverticula of the colon It is relatively common in Asians but rare in whites. it is thought to reflect a genetic predisposition Muscle abnormalities and inflammatory complications are uncommon Presents more commonly with bleeding
LEFT-SIDED DIVERTICULOSIS •
Prevalence of colonic diverticulosis is difficult to measure because most patients are asymptomatic. Prevalence of diverticular disease increases with age, from less than 10%in people younger than age 40 years to 50– 66% in patients older than age 80 years No sex differences seem to exist. In western countries, over 90% of patients withdiverticulosis have left-sided disease.
Why worry? • 15% to 20% go on to develop diverticulitis (two-thirds mild to moderate, onethird serious)
• and 5% to 10% develop bleeding (two-thirds mild to moderate, one-third lifethreatening). •
In all it accounts for 3,400 deaths in the United States each year while draining the economy of over $2.4 billion a year
Diverticulitis: Symptoms • Pain is the major symptom usually most pronounced in the lower left part of the abdomen, but other areas may be involved
• Fever is also very common, sometimes accompanied by chills.
• Urinary urgency, frequency, and discomfort to mimic prostatitis or a bladder infection
Other symptoms may include nausea,
appetite, and fatigue. Some patients have constipation, others diarrhea.
Diverticulitis: Diagnosis • tenderness over the inflamed tissues, typically in the lower left abdomen • less often swelling • white blood cell counts are usually elevated • best test is a CT scan of the abdomen, ideally performed after the patient receives contrast material both by mouth and intravenously.
• a month or two later, after treatment has quieted things down, the patient should have a colonoscopy
Diverticulitis: Therapy • mild-to-moderate diverticulitis-> antibiotics in pill form at home • severe inflammation or complications (see below>intravenous (IV) antibiotics in the hospital, and then finish up with pills at home. In most cases, seven to 10 days of antibiotics will do the trick.
• Bowel rest is also important for acute diverticulitis. For home treatment, that means sticking to a diet of clear liquids for a few days, then gradually adding soft solids and moving to a more normal diet over a week or two.
• Intravenous fluids can sustain hospitalized patients until they are well enough to switch to clear liquids en route to a full diet. • Because diverticulitis tends to recur, prevention is always part of the treatment plan. And for men with any form of colonic diverticular disease, that means a high-fiber diet and exercise and quitting
Diverticulitis: Complications • Abscess formation. Patients with
abscesses tend to be sicker - have higher temperatures- more pain- and higher white blood cell counts. Treatment involves antibiotics and bowel rest, but it also requires drainage of the abscess Peritonitis. Patients are critically ill with high fever- severe abdominal painand often low blood pressure. Prompt surgery and powerful antibiotics are required. Fistula formation. This complication is less common than abscess formation and less urgent than peritonitis, but it does require both surgery and antibiotics.
• Stricture formation. It's another
uncommon complication that can develop from recurrent bouts of diverticulitis.
Diverticulitis: Surgery typical indications : • • • • • •
Severe diverticulitis that does not respond to medical treatment Diverticulitis in patients with impaired immune systems Diverticulitis that recurs>4 times despite a high-fiber diet Abscesses that cannot be drained with a catheter Peritonitis, fistula formation, or obstruction Strong suspicion of cancer.