Diverticulitis and Diverticular Disease - Medtick
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Diverticulitis and Diverticular Disease

What is it?

An intestinal condition that increase with age where small pouches (diverticula)are formed.

  • The formation of diverticula is thought to be linked to a low intake of fibre in the diet, which then may a person to prolonged colonic transit (stools moving slowly in the intestines), increased water resorption (water leaves the intestine and moves to circulation) and reduced stool bulk (small stools and hard stools)—all of which can increase pressure on the colon.
  • Diverticula generally occur in the colon, which is part of the large intestine mainly in sigmoid  part of the colon (large intestine that is connected to the rectum).
  • The sigmoid colon is located on the left side of the abdomen, which is why diverticulitis is often associated with abdominal pain on that side. In Asians descendants the pain is on the right hand side.

Diverticulitis

  • Small inflamed (hot, red and swollen) painful pouches (Diverticula) that appear like lumps that stick out at the side of large intestine (colon).
  • This is caused because stools enter these pouches and bad bacteria breed in these pouches.
  • The split is caused when a hard stool gets stuck in the colon and allows bacteria to multiply and spread causing infection and inflammation (hot , red and swelling in parts of the large intestine).
  • The colon can split causing a severe infection (Peritonitis).
  • These pouches can vary in number from a single diverticulum to hundreds.

Diverticular disease

  • When these pouches/lumps (Diverticula) are formed but are not inflamed or causing an infection.
  • Some persons show no symptoms even though they have the condition which can then lead to acute diverticulitis, perforation, and diverticular bleeding.
Both conditions are very common

Acute Diverticulitis

Clinicians should suspect acute diverticulitis in patients with constant, severe abdominal pain in the left lower quadrant presenting with any of the following:

  • A sudden change in bowel habit, associated with significant rectal bleeding or passage of mucus from the rectum
  • Fever
  • A history of diverticular disease and one of
    • tenderness in the left-lower quadrant
    • a palpable abdominal mass on examination
    • distension on examination.

Classification of Acute Diverticulitis

Acute diverticulitis can be further categorised according to severity.

Several classification systems are available, but the most commonly used system is the modified Hinchey classification (see Table 1).

Table 1: The Modified Hinchey Classification of Acute Diverticulitis

Stage Description
1 Diverticulitis involving a small or confined pericolic abscess
2 a Diverticulitis in which there is a distant abscess amenable to percutaneous drainage
b Diverticulitis in which there is a complex abscess with fistula
3 Perforated diverticulitis in which a peridiverticular abscess has perforated, resulting in generalised purulent peritonitis
4 Perforated diverticulitis in which there is free perforation associated with faecal peritonitis
  1. Williams S, Bjarnason I, Hayee B, Haji A. Diverticular disease: update on pathophysiology, classification and management. Frontline Gastroenterol 2023; 15 (1): 50–58.
  2. Sartelli M, Weber D, Kluger Y et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg 2020; 15 (1): 32.
  3. Hinchey E, Schaal P, Richards G. Treatment of perforated diverticular disease of the colon. Adv Surg 1978; 12: 85–109.

Diagnosis tests

Cause

  • As one gets older
  • Weak points in the colon (large intestine) muscles forming lumps/pouches
  • may be an imbalance of bacterial flora leading to diverticulitis (drinking good bacteria yogurts/live yogurts may help)
  • Poor diet: high sugar and low fibre diet- however this is debatable (One needs to increase their fibre intake if suitable)
  • High alcohol consumer
  • Smoking
  • Overweight or obese
  • Lack of exercise
  • High red meat consumption
  • Family history
  • History of constipation conditions

Syndromes

Medication

Symptoms

  • Abdominal pain and/or are constant violently vomiting or vomiting longer than two days (one day if a child)- mainly on the left hand side, In Asians pain moves to lower right hand side of abdomen)?
  • High temperature greater than 38°C (100°F) or over and/or chills and sweats longer than 72 hours?
  • Increase thirst, heavy sweating and need to urinate frequently?
  • Pain when urinating?
  • Change in bowel greater than three weeks i.e. going to the toilet more often or less often than usual?
  • Nausea feeling?
  • Constipation and sometimes diarrhoea?
  • Rectal bleeding?

Complications /Information to beware of/General tips:

Medical Emergency Condition

And/or do not wait, phone for an ambulance if have or develop:

  • Sepsis
  • Severe Dehydration symptoms
  • Peritonitis
  • Abdominal mass or perirectal fullness noted on examination or digital rectal examination, indicating a possible intra-abdominal abscess.
  • Abdominal rigidity and guarding on examination, which may indicate bowel perforation or peritonitis
  • Signs of a fistula into the bladder or vagina, such as pneumaturia (passage of gas mixed with urine – bubbled type urine), pyuria (cloudy or pus-type urine), or the passage of faeces through the vagina
  • Colicky/spasm abdominal pain, vomiting, abdominal distension, or absolute constipation, indicating possible intestinal obstruction.

This condition can lead to:

Small fistulas don’t usually cause symptoms. However, larger fistulas can become infected and cause symptoms, such as:

  • Constant, throbbing pain?
  • High temperature (fever) of 38C (100F) or above?
  • Blood or pus in your stools?
  • Foul smelling leakage of stools or mucus into your underwear?

During an Attack

  • Consider a liquid diet without fibre (this will reduce the amount of undigested food passing through the bowels so that you make smaller amounts of stool).
  • Keep hydrated

During Recovery

After Recovery

  • Gradually adding fibre back into your diet to normalize your bowel movements and avoid constipation.

Antibiotic use

  • Antibiotics will not be offered to people with uncomplicated, symptomatic diverticular disease;
  • It is advised on simple forms of analgesia—such as paracetamol—and tell the patient to return to the practice if symptoms worsen.
  • Patients should also be warned to avoid using because of the risk of diverticular perforation (bleeding):
  • Antibiotics (oral) offered oral antibiotics to a patient with uncomplicated acute diverticulitis who is
    • Systemically unwell (fever and wide range of symptoms)
    • Immunosuppressed
    • Has significant comorbidities and complications, but who does not meet criteria for referral to secondary care.
    • Most patients with uncomplicated diverticulitis recover following medical treatment and do not require surgical intervention.
  1. NICE. Diverticular disease: diagnosis and management. NICE Guideline 147. NICE, 2019. Available at: www.nice.org.uk/ng147
  2. Williams S, Bjarnason I, Hayee B, Haji A. Diverticular disease: update on pathophysiology, classification and management. Frontline Gastroenterol 2023; 15 (1): 50–58.
  3. Sartelli M, Weber D, Kluger Y et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg 2020; 15 (1): 32.

This condition may show similar symptoms to:

Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice

Detailed Information

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