Diverticulitis is a common digestive condition that affects the large intestine, also known as the colon. This condition arises when small pouches in the colon wall become inflamed or infected. The severity of the inflammation and the presence of additional health issues categorize diverticulitis into distinct forms, each requiring specific management strategies.
Understanding Diverticulitis
Small, bulging pouches, called diverticula, can form in the wall of the colon. The presence of these pouches is known as diverticulosis, which is common, especially in individuals over 50, and often causes no symptoms.
Diverticulitis occurs when one or more of these diverticula become inflamed or infected. This inflammation can lead to a range of digestive symptoms. The exact reason why diverticula become inflamed is not fully understood, but it is thought to involve factors like increased pressure within the colon or bacterial presence within the pouches.
Uncomplicated Diverticulitis
Uncomplicated diverticulitis is the more common form, accounting for about 80% of diverticulitis cases. This type involves localized inflammation of the diverticula without widespread infection or additional severe health problems. Symptoms include pain, typically in the lower left abdomen, which can be sudden or gradually worsen over several days. Other symptoms can include nausea, fever, tenderness in the abdomen, and changes in bowel habits such as diarrhea or constipation.
Diagnosis involves a physical examination to locate areas of pain. Blood tests check for signs of infection or inflammation, such as an elevated white blood cell count or C-reactive protein. A computed tomography (CT) scan confirms the diagnosis and assesses the extent of inflammation, showing localized bowel wall thickening and fat stranding. Colonoscopy is avoided during the acute phase due to perforation risk, but may be recommended several weeks after symptoms resolve to rule out other conditions.
Treatment for uncomplicated diverticulitis occurs at home, especially if symptoms are mild. A healthcare professional may recommend a liquid diet initially, gradually reintroducing low-fiber solid foods as symptoms improve. Once recovered, a regular high-fiber diet is encouraged.
Antibiotics may be prescribed, particularly for patients with co-existing health conditions, a weakened immune system, or severe symptoms like persistent vomiting. Oral antibiotics, such as ciprofloxacin and metronidazole, are used for 10 to 14 days. Most individuals with uncomplicated diverticulitis recover within about a week, with a high success rate for outpatient management.
Complicated Diverticulitis
Complicated diverticulitis involves inflammation of diverticula alongside additional severe health complications. Complications include abscess formation, a painful pocket of pus caused by infection. Perforation, a tear in the colon wall, can allow intestinal contents to leak into the abdominal cavity, leading to a widespread infection called peritonitis. Other complications include fistula formation, an abnormal tunnel between the colon and another organ, or intestinal obstruction, a blockage that hinders the passage of food, fluids, or stool. Bleeding from the diverticula can also occur, which may be severe.
Symptoms are generally more severe, including intense abdominal pain, often accompanied by a high fever, chills, and signs of systemic infection like an elevated white blood cell count. Nausea, vomiting, and abdominal distension are common. If peritonitis develops, symptoms may include severe abdominal tenderness, rigidity, and signs of shock such as low blood pressure and rapid heart rate.
Diagnosis relies heavily on a CT scan, which can precisely identify complications like abscesses, perforations, or fistulas. This imaging helps guide the more aggressive treatment strategies required. Hospitalization is almost always necessary for complicated cases, where intravenous (IV) antibiotics combat the infection.
For abscesses, a percutaneous drain may be inserted under CT guidance to remove the pus. Surgical intervention is often required for complications like perforation, obstruction, or fistulas, or if medical treatment fails. Surgical procedures can involve removing the affected part of the colon and reconnecting the healthy ends, or in more severe cases, creating a temporary colostomy to allow the colon to heal.
Why the Distinction Matters
Distinguishing between uncomplicated and complicated diverticulitis is important because it directly influences patient management and outcomes. Uncomplicated cases often respond well to outpatient treatment with rest, dietary adjustments, and sometimes oral antibiotics, resulting in a good prognosis. These cases resolve without the need for hospitalization or invasive procedures.
In contrast, complicated diverticulitis requires urgent and aggressive interventions, frequently involving hospitalization for intravenous antibiotics and potentially surgical procedures. The presence of complications like abscesses or perforations carries a higher risk of serious illness, extended recovery times, and even life-threatening conditions if not promptly addressed. Accurate diagnosis through clinical evaluation and imaging studies, especially CT scans, ensures appropriate care, preventing the progression to more severe outcomes and improving recovery.