Diverticulosis-Diseases

What do doctors call this condition?

Diverticular disease, diverticulitis

What is this condition?

In diverticulosis, bulging pouches (called diverticula) in the stomach or intestinal wall push through the surrounding muscle. Usually, the pouches are in the lower intestine, but they may develop anywhere from the top of the stomach (rare) to the anus. An inherited form, called Meckel's diverticulum, is the most common genetic disorder of the intestinal tract.

Diverticulosis takes two forms. In one, the pouches are present but don't cause symptoms. In the other, the pouches are inflamed and may cause potentially fatal intestinal blockage, infection, or bleeding.

What causes it?

Diverticulosis is most common in men over age 40. In these individuals, pouches probably result from straining, which pushes the intestines against weak spots in the gastrointestinal wall.

Lack of dietary fiber may be a contributing factor. Without adequate fiber, fecal matter solidifies and the bowel tunnel narrows, requiring higher abdominal pressure during bowel movements. This theory is supported by the fact that diverticulosis is most prevalent in industrialized nations, where processing removes much of the fiber from foods.

How the pouches become inflamed

Undigested food mixed with bacteria accumulates in these intestinal pouches and forms a hard mass. This condition restricts blood flow to the thin walls of the pouches, making them more susceptible to attack by the bacteria in the colon. Inflammation follows, possibly leading to perforation, abscess, peritonitis, obstruction, or bleeding. Occasionally, the inflamed segment may produce a fistula, or tunnel, by sticking to the bladder or other organs.

What are its symptoms?

Usually, diverticulosis produces no symptoms; however it may cause recurrent pain in the lower left abdomen that disappears after bowel movements or passing gas. The person may have alternating constipation and diarrhea and symptoms similar to those of irritable bowel syndrome - or may have both disorders at once. In rare cases, some elderly people develop bleeding in uninfected pouches, but this is easily controlled with medication.

A mildly infected pouch produces some pain in the lower left abdomen, mild nausea, gas, irregular bowel movements, and a lowgrade fever. A severely infected pouch can rupture and produce abscesses or infection in the abdominal cavity. Rupture, which occurs in about 20% of all cases, constitutes a medical emergency. The individual typically feels abdominal rigidity and pain in the lower left abdomen. Other symptoms of rupture include fever, chills, low blood pressure and, possibly, internal bleeding. Chronically infected pouches may cause growths and adhesions that narrow or obstruct the bowel. Symptoms of incomplete obstruction are constipation, ribbonlike stools, intermittent diarrhea, and abdominal distention. Increasing obstruction causes abdominal rigidity and pain, nausea, and vomiting.

How is it diagnosed?

Because it rarely produces symptoms, diverticular disease is often discovered coincidentally during a physical exam that includes an upper GI barium X-ray series. These X-rays show or rule out diverticulosis of the esophagus and upper bowel. A barium enema X-ray confirms or rules out diverticulosis of the lower bowel. A biopsy (tissue specimen obtained for study) can rule out cancer.

How is it treated?

Diverticulosis without symptoms generally doesn't need treatment. For pain, mild gastric distress, constipation, or difficult bowel movements, the doctor may prescribe a liquid or bland diet, stool softeners, and occasional doses of mineral oil to relieve symptoms and reduce the risk of severe disease. after the pain subsides, most people also benefit from a high-fiber diet, perhaps supplemented with a bulk medication such as Metamucil.

Treating infected pouches when there are no signs of perforation involves preventing constipation and combating infection. This typically includes rest, a liquid diet, stool softeners, a broad-spectrum antibiotic, and medication to control pain, relax smooth muscles, and control muscle spasms.

Additional treatments

If the infected pouches fail to respond to other treatment, surgery is used to remove the involved segment. Perforation, peritonitis, obstruction, or fistulae that develop from untreated pouches may require a temporary colostomy to drain abscesses and rest the colon. This procedure is later followed by reconstructive surgery.

People who hemorrhage need blood replacement and careful monitoring of fluid and electrolyte balance. The bleeding usually stops spontaneously. If it continues, the surgeon can insert a tube to deliver medication into the bleeding vessel.