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What is diverticulitis (also designated as diverticular disease)?

diverticulitis, diverticular disease


Diverticulitis, as a term, may be quite new to some, but this is still one of the disorders associated with constipation. Same as with other disorders related to diets low in fiber and high in fat, diverticulitis is relatively rare in underdeveloped countries (where fiber forms a main component of the diet). It is very common among the Western population, affecting almost half of all individuals over the age of 60 years old. These individuals usually do not present with symptoms, in fact, only 20% of affected individuals develop indications of diverticular disease. There is no difference among males and females in terms of prevalence, but most males tend to exhibit symptoms at younger ages.

What is diverticulitis (also designated as diverticular disease)? There are actually two classifications of diverticula: first is the true diverticula, which is a herniation extending the entire length of the bowel wall, resembling that of a sac. The second, and the most common, is the false diverticula (or the pseudodiverticula), which will only involve (and limited to) a projection of the mucosa of the colon. Protrusions such as this compromise the integrity of the colonic wall, and this is usually due to high amplitude contractions in conjunction with stools that are lumpy and hard due to high fat content and less fiber. When a diverticulum becomes inflamed, it is designated as diverticulitis. This inflammation occurs because of retention of fecal matter within the diverticular “sac”, and if left untreated, this will result to compression of the nutrient artery within the vicinity, or even perhaps lead to its erosion, resulting to either of two conditions: perforation, or perhaps, bleeding.

One of the causes of hematochezia (the passage or defecation of bright red, bloody stools) is hemorrhage coming from a colonic diverticulum; however, only a fifth of patients with the disease condition will exhibit hematochezia. Individuals who tend to be hypertensive, who have atherosclerosis, and those who regularly use nonsteroidal anti-inflammatory agents (NSAIDS), have a significantly greater risk of developing bleeding. Fortunately, most bleeding episodes will resolve by itself, and spontaneously end upon resting the bowel.

In order to localize diverticular bleeding, colonoscopy may be an excellent option. Colonoscopy can be both diagnostic and therapeutic as well in cases like this, especially for cases with mild to moderate bleeding. For those with severe bleeding, angiography may be the best management option. All these of course are according to the discretion of the attending physician.

What are the common presentations that accompany diverticulitis? Fevers, abdominal pain localized in the left lower quadrant, anorexia, as well as obstipation, are among the conditions associated with acute uncomplicated diverticulitis (which comprise 75% of all cases). A number of patients can also have generalized peritonitis (inflammation of the peritoneum) which is highly suggestive of a perforation. Abdominal distention is not an rare sight; and laboratory examinations are most likely to reveal leukocytosis. A complicated diverticular disease (comprising 25% of all diverticular disease cases) will reveal either one or many of the following upon subjection to imaging modalities: abscess, stricture, perforation, or fistula.

Episodes of diverticulitis can closely mimic that of the irritable bowel syndrome (IBS), ovarian cyst, endometriosis, acute appendicitis, and pelvic inflammatory disease. Therefore it is very important to know and rule out these other conditions which may also require immediate medical attention. The time of discovery of the disease is very important in the determination of management, so symptoms of diverticulitis should not be taken lightly. Asymptomatic cases are usually managed by simple diet alterations, including the intake of a fiber-rich meal amounting up to 30 grams of fiber each day. Patients are also typically forbidden to ingest nuts or popcorn. For symptomatic cases, antibiotics along with instructions on bowel resting are among the management options of physicians. Surgical management is indicated for complicated cases.

Thus, diverticulitis should not be taken lightly. And prevention is still the best option! Why not start including fiber-rich foods in your diet today? It may save you the risk for spending money on medications and the emotional stress brought about by diverticulitis, someday!

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