What is Acute Diverticulitis (Diverticulitis)?
Acute diverticulitis is a condition where a small, bag-like bulge in the wall of the colon, called a diverticulum, becomes inflamed due to a tiny tear. About 10% to 25% of people who have these bulges, a condition known as diverticulosis, can develop diverticulitis. The condition can be simple, meaning there are no additional problems, or it can be complicated, involving additional issues like the formation of an abscess, abnormal connection with another organ (fistula), blockage of the bowel, or a major tear (frank perforation). Even though diverticulitis was traditionally treated as an illness requiring surgery, nowadays it’s primarily treated with medication, even in severe cases.
What Causes Acute Diverticulitis (Diverticulitis)?
The likelihood of getting diverticulitis is increased by the same risk factors as diverticulosis. What you eat has a strong influence on this. Diets that are low in fiber, high in fat, or rich in red meat can raise the risk of both developing diverticulosis and possibly diverticulitis.
Being overweight and smoking are known to boost the chances of both diverticulitis and diverticular bleeding. Certain medications can also contribute to the risk of diverticulitis. These include nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and painkillers known as opiates.
However, it’s worth noting that statins, which are drugs used to lower cholesterol levels, may actually reduce the chances of symptomatic diverticulitis. Lastly, contrary to a common myth, eating nuts, seeds, or popcorn does not have any connection to an increased risk of diverticulosis, diverticulitis, or diverticular bleeding.
Risk Factors and Frequency for Acute Diverticulitis (Diverticulitis)
Diverticulosis is a condition often found in about 60% of people over 60 years of age. Out of these people, between 10% to 25% may develop diverticulitis. Hospitalizations for acute diverticulitis have increased by 26% and elective operations by 38% from 1998 to 2005, according to data from the Nationwide Inpatient Sample, a comprehensive inpatient care database in the United States.
There seems to be a higher likelihood that younger patients (ages 18 to 44) will be hospitalized than older patients (ages 45 to 74). This may be attributed to better and quicker diagnostics these days. Interesting to note, the side where diverticulosis occurs differs by ethnicity: in Western countries, it’s commonly on the left side, but for those of Asian descent, it’s more often on the right.
The average age for being admitted to the hospital with acute diverticulitis is 63, and it’s an equal-opportunity condition, affecting both males and females. However, it is more common in men under 50, and women between 50 to 70 years old. For those over the age of 70 with diverticulitis, they are more likely to be female.
Signs and Symptoms of Acute Diverticulitis (Diverticulitis)
Acute diverticulitis is a condition that impacts the digestive tract and its symptoms can differ based on its severity. Often, people with simple, or uncomplicated, diverticulitis experience pain in the lower left side of their abdomen, a common feature in Western countries. However, people of Asian descent frequently report pain on the right side of their abdomen. This pain may either be consistent or come and go. Abdominal pain might be accompanied by changes in bowel movements, such as diarrhea in roughly 35% of cases or constipation in about 50%. Nausea and vomiting are other symptoms that might surface, potentially caused by a blockage in the bowel. Fever is also not unusual in people who develop abscesses or experience a rupture. Additionally, if the inflamed part of the bowel is in direct contact with the bladder wall, it could lead to symptoms like painful urination, frequent urination, or an urgent need to urinate, referred to as sympathetic cystitis.
Furthermore, during a physical examination, tenderness will almost always be felt in the area of inflammation due to irritation of the peritoneum. Some people, around 20%, might have a noticeable mass if an abscess is present. Bowel sounds are typically quieter than normal but can also display normal activity. Indicators of inflammation in the peritoneum which includes rigidity, guarding, and rebound tenderness, are present if the bowel wall has ruptured. Contrarily, while fever is almost always present, low blood pressure and shock are rare.
- Lower abdominal pain (left-sided in Western nations, right-sided in people of Asian descent)
- Pain can be constant or intermittent
- Changes in bowel habits (diarrhea in 35% of cases, constipation in 50% of cases)
- Nausea and vomiting (possibly due to bowel obstruction)
- Fever (common in patients with abscesses or perforation)
- Urination issues (painful, frequent, urgent), if the inflamed bowel is in contact with the bladder wall
- Tenderness in the area of inflammation
- Potential mass (if an abscess is present)
- Quieter than normal bowel sounds (can also be normal)
- Signs of inflammation in the peritoneum if the bowel wall has ruptured
- Almost always fever present, but low blood pressure and shock are rare
Testing for Acute Diverticulitis (Diverticulitis)
When a doctor suspects you have acute diverticulitis – a condition causing inflammation in the digestive tract – they’ll base their diagnosis primarily on your symptoms and a physical exam. However, this method may not always be accurate. With incorrect diagnoses ranging from 24%-68% of cases, lab tests and scans are often needed to confidently confirm acute diverticulitis.
Lab tests can reveal elevated white blood cell counts or increased levels of inflammation markers like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These tests help to verify if your body is fighting an infection or inflammation.
For more precise evaluation, a radiological test, particularly a CT scan of the stomach and pelvic areas, is chosen. This type of scan is typically carried out with a special water-soluble oral or rectal contrast dye and a dye that’s injected into your veins, unless there’s a medical reason not to use them. Studies suggest that CT scans are incredibly reliable in diagnosing acute diverticulitis, with a success rate above 97%. They can reliably identify symptoms such as thickened bowel walls, inflamed fat surrounding the colon, fluid around the colon, smaller abscesses restricted to the colon’s wall, and leaks from blood vessels that suggest the formation of channels or abnormal connections within the bowel wall.
Abdominal ultrasound can also diagnose acute diverticulitis effectively with relatively high success rates, but your results may significantly depend on the proficiency of the person performing the ultrasound. Even though ultrasound examinations are lower in cost and easily accessible, they aren’t typically the first choice in diagnosing this condition. MRI scans are another possibility, but due to their cost and the lack of a straightforward comparison of their accuracy with CT scans, they’re generally not the first choice either. X-rays of the abdomen might reveal unrelated abnormalities, but if you have a blocked intestine, specific changes in gas levels might be detected.
Special note: Doctors usually steer clear of an examination called an endoscopy when they suspect acute diverticulitis because it could potentially cause a tear in your bowel. If you haven’t had a recent colonoscopy (a scan of the inside of the large intestine), it may be advisable to undergo one around six to eight weeks after your symptoms have disappeared. This is to make sure you don’t have conditions like cancer, inflammatory bowel disease, or colitis.
Treatment Options for Acute Diverticulitis (Diverticulitis)
When someone shows symptoms of acute diverticulitis, they can be treated at home or in a hospital. The American Society of Colon and Rectal Surgeons advises that anyone too sick to eat, anyone throwing up a lot, anyone showing symptoms of abdominal inflammation, anyone with a weakened immune system, or anyone who’s elderly should be looked after in a hospital. If these conditions don’t apply and quick follow-up care can be guaranteed, patients can be treated at home. Reports suggest a 94% to 97% success rate for home treatment.
Regardless of where they’re treated, people with acute diverticulitis are usually advised to rest their bowels, drink lots of fluids, and take oral antibiotics for 7 to 10 days. The antibiotics should kill gram-negative bacteria (rod-shaped bacteria that don’t stain well) and anaerobic bacteria (bacteria that can survive without oxygen). In the US, the standard antibiotics used include quinolones, sulfa drugs combined with metronidazole (or clindamycin if the patient is allergic to metronidazole), or amoxicillin-clavulanate.
If patients need to be admitted to a hospital, they’ll be given antibiotics and fluids intravenously, and also receive pain relief. Hospitalized patients should also rest their bowels. The goal is to see a drop in body temperature and a decrease in white blood cell levels within two to four days. If this doesn’t happen, other diagnoses or complications should be considered. A quick surgical evaluation might be needed in these cases.
About 15% of people with acute diverticulitis develop an abscess, or a pocket of pus. If antibiotics don’t lead to improvements and the patient has a fever and a sore lump in the abdomen, an abscess might be present. Abscesses smaller than 2 to 3 centimeters can usually be treated with IV antibiotics. Larger abscesses might need to be drained with the help of a CT (computed tomography) scan.
In less than 5% of cases, acute diverticulitis can lead to a fistula, which is an abnormal connection between body organs. This often requires surgery to fix. Other complications can include partial or complete bowel obstruction, which can sometimes be managed conservatively, and free perforation, which requires surgical intervention.
What else can Acute Diverticulitis (Diverticulitis) be?
If you’re experiencing abdominal pain, it could be due to a number of different conditions. These can include:
- Cholangitis (an infection in the bile duct)
- Cholecystitis (an inflamed gallbladder)
- Chronic mesenteric ischemia (poor blood flow to the intestines)
- Constipation
- Enterovesical fistula (an abnormal connection between the intestine and the bladder)
- Gynecological pain (pain relating to the female reproductive system)
- Inflammatory bowel disease (a group of inflammatory conditions affecting the colon and small intestine)
- Intestinal perforation (a hole in the wall of the intestine)
- Irritable bowel syndrome (a disorder affecting the large intestine)
- Large-bowel obstruction (a blockage in the large intestine)
These are just a few examples of the many possible reasons for your abdominal discomfort. If you have persistent or severe pain, you should definitely get checked out by a healthcare provider. They’ll be able to identify the cause and recommend the appropriate treatment.
What to expect with Acute Diverticulitis (Diverticulitis)
The future health condition of patients with diverticulitis relies on several factors including their age when first diagnosed, any existing health issues, and how severe the diverticulitis is. Generally, younger people may experience more health complications because they often don’t suspect that they have diverticulitis and as such, may get diagnosed late. Furthermore, patients who have weakened immune systems typically face higher health complications and risk of death.
Possible Complications When Diagnosed with Acute Diverticulitis (Diverticulitis)
- Pelvic abscess
- Intestinal perforation
- Bowel fistula
- Peritonitis
- Bowel obstruction
- Sepsis
- Bleeding from the rectum
Recovery from Acute Diverticulitis (Diverticulitis)
Once a patient has recovered from diverticulitis, it’s important to check if there is any presence of cancer. Testing the colon for this can be done through methods like colonoscopy, CT scan, or a barium enema.
For ongoing health, the patient should start eating a diet high in fiber, drinking lots of water, keeping their weight within a healthy range and also get regular exercise.
Preventing Acute Diverticulitis (Diverticulitis)
Eating a diet rich in fiber can help stop diverticulosis from developing.
