Diverticulitis

Diverticula are pouch-like bulges in the intestine. They are found mainly at the end of the large intestine and are benign. Diverticulitis occurs when diverticula become inflamed or infected.

The condition occurs primarily in people aged 50 and older and affects approximately 3 out of every 1,000 people each year.

Diverticulosis (the presence of diverticula) usually causes no symptoms. Sometimes cramps or bowel movement problems occur, similar to those seen in irritable bowel syndrome. Bleeding from a diverticulum can cause red blood in the stool. Diverticulitis is often accompanied by pain in the lower left abdomen. Pressing on the abdomen is painful. There is often a slight fever. You may feel sick or nauseous.

It is not known what causes diverticula to become inflamed. People who smoke, get little exercise, eat a low-fiber diet, are overweight, and take NSAIDs (pain relievers that can irritate the intestinal wall) seem to have a slightly higher risk of developing diverticulitis.

Diverticulosis is diagnosed through a radiological examination or a colonoscopy (examination of the colon). Your primary care physician may order a blood test to check for signs of inflammation. If severe diverticulitis is suspected, he or she will refer you to the hospital for an abdominal CT scan or an X-ray with contrast dye.

The primary care physician will assess the severity of the diverticulitis. He does this based on the following criteria: high fever, an abnormal abdominal exam, and elevated inflammatory markers in the blood. If these parameters are present, the doctor will refer you for hospitalization. There, you will be given intravenous antibiotics.

If the diverticulitis is not too severe, it can be treated at home with, if necessary, oral antibiotics and adequate fluid intake. Your doctor may prescribe acetaminophen for the pain. If this treatment does not result in sufficient improvement within 48 hours, your primary care physician will refer you to the hospital. 

If complications arise—such as an intestinal abscess, intestinal perforation, fistula formation, or inflammation in the abdominal cavity—surgery may be necessary. 

Young and middle-aged people who regularly experience exceptionally severe diverticulitis or who have complications may be treated with surgery. During this procedure, the affected portion of the colon is removed. This is usually done using keyhole surgery (laparoscopy).