Diverticular disease

Diverticula are small sac-like invaginations that protrude from the lumen of the intestine. They are very common in the large intestine or colon, especially in the left colon. The presence of diverticula in the wall of the intestine (colon) is called diverticular disease or diverticulosis.

Diverticular disease can present with episodes of inflammation of the diverticula, in these cases we speak of diverticulitis.

How is it produced?

Although the exact cause of diverticular disease is unknown, its appearance has been related to age (it is more frequent at older ages) and especially to the lack of fiber in the diet. The fiber remains in the colon and absorbs water which facilitates the passage of stool and defecation. Diverticula are caused by an increase in the internal pressure of the colon. When little fiber is taken, constipation can appear, which makes it easier for the intestinal musculature to strain, increase the pressure inside the colon and favor the formation of diverticula. Other factors related to diverticulosis are obesity and lack of physical activity.

In diverticulitis, an inflammation and infection of the diverticulum occurs, due to an erosion of the wall produced by an increase in intraluminal pressure or by retention of fecal material (feces) inside.

Symptoms

In most cases, diverticulosis is asymptomatic and is an accidental finding in complementary tests performed for another reason.

When symptoms appear, they are usually episodes of nonspecific abdominal pain, generally in the lower left part of the abdomen, which can be continuous or intermittent and is usually relieved with defecation and / or the expulsion of gases. Episodes of abdominal pain can be triggered by meals. Other symptoms that may appear include the sensation of abdominal bloating and changes in bowel habits (constipation or diarrhea). Sometimes a diverticulum can be injured leading to bleeding from the rectum (rectorrhagia).

Diverticulitis is a more serious condition and is characterized by constant abdominal pain in the lower left part of the abdomen, cramps, fever, nausea and vomiting, altered bowel habits (constipation / diarrhea), and abdominal distention. Inflammation of the diverticula can lead to fistulas (abnormal pathways) between the large intestine and other organs.

Diverticulitis can present important complications such as bleeding, localized infection (abscess) or generalized (peritonitis), narrowing of sections of the colon (stenosis) and fistulas (abnormal paths between two organs).

Diagnosis

The diagnosis of diverticular disease is based on a complete medical history, an abdominal-pelvic examination, and a series of imaging tests to confirm the presence of diverticula in the abdomen and rule out other diseases.

blood tests are usually normal in patients with diverticulosis. In diverticulitis, there may be an elevation in the white blood cell count indicative of infection.

It is usually indicated:

• Plain X-ray of the chest and abdomen: it can be useful to rule out other causes of abdominal pain and the existence of possible complications.
• Enema opaque: It is contraindicated in episodes of acute pain due to the risk of extravasation of material in the event of perforation.
• Colonoscopy: When there is no diverticulitis and the patient is stable. It allows the taking of a tissue sample (biopsy) from the wall of the intestine and to rule out other diseases (such as tumors or other inflammatory diseases).

When diverticulitis is suspected, the safest and most reliable tests are CT and abdominal ultrasound.

• Abdominal ultrasound allows to see the thickening of the wall and complications such as fistulas, abscesses (collections of pus) and their drainage by means of puncture with a needle.
• Abdominal CT is the method of choice for the diagnosis of diverticulitis and for monitoring its evolution and the appearance of possible complications.

Treatment

The best treatment of diverticulosis is the consumption of fiber (vegetables, fruits and whole grains). Thus, a diet rich in fiber should be advised and a sedentary lifestyle should be avoided. Fiber supplements (such as bran) may be indicated if the contribution of the diet is not sufficient. Abdominal pain is treated with pain relievers or antispasmodics.

The treatment of mild and uncomplicated diverticulitis consists of absolute diet, bed rest, administration of antibiotics and analgesics. When diverticulitis is more severe, complications are associated or if the patient has risk factors (such as advanced age or other associated diseases), hospital admission is necessary. In these cases, the patient may require the placement of a nasogastric tube and the administration of intravenous fluids, in addition to the other mentioned treatment measures.

Surgical treatment is reserved for the appearance of complications such as intestinal perforation and peritonitis, hemorrhage, fistulas, or repeated episodes of diverticulitis.

Resection of the affected bowel segment or removal of collections of pus (abscesses) may be necessary.

Prevention

Eating foods high in fiber is easy and reduces the symptoms and problems of diverticular disease.

Intensive Medicine Specialist