What are the common symptoms of diverticulitis. How is diverticulitis diagnosed. What treatment options are available for managing diverticulitis. Can diet affect the risk of developing diverticulitis. What complications can arise from untreated diverticulitis.

Understanding Diverticulitis: A Common Digestive Disorder

Diverticulitis is a digestive condition that has become increasingly prevalent in the Western world since the 20th century. It falls under the umbrella of diverticular diseases, which affect the digestive tract. Diverticulitis occurs when small pouches (diverticula) that form in the lining of the colon become inflamed or infected.

This condition can lead to a range of uncomfortable symptoms and, in some cases, serious complications. Understanding the causes, symptoms, and treatment options for diverticulitis is crucial for managing the condition effectively and preventing long-term health problems.

Recognizing the Symptoms of Diverticulitis

Diverticulitis symptoms can vary in severity and may appear suddenly or develop gradually over several days. The most common symptoms include:

• Abdominal pain (typically in the lower left side, but can also occur on the right)
• Bloating
• Changes in bowel habits (diarrhea or constipation)
• Nausea and vomiting
• Fever and chills
• Blood in stool or rectal bleeding

Is abdominal pain always present in diverticulitis cases? While abdominal pain is the most common symptom, its location and intensity can vary. Most often, the pain is felt in the lower left side of the abdomen, but it can also occur on the right side.

When to Seek Medical Attention

If you experience persistent or severe abdominal pain, especially when accompanied by fever, chills, or changes in bowel habits, it’s important to consult a healthcare professional promptly. These symptoms could indicate a serious complication of diverticulitis or another underlying condition that requires immediate medical attention.

Unraveling the Causes and Risk Factors of Diverticulitis

While the exact cause of diverticular disease remains unknown, several factors have been identified that may increase the risk of developing diverticulitis:

1. Genetics
2. Diet low in fiber and high in processed foods
3. Decreased immune function
4. Obesity
5. Physical inactivity
6. Smoking
7. Changes in gut microbiome
8. Certain medications, such as steroids

How does diet influence the development of diverticulitis? A diet low in fiber and high in processed foods is believed to contribute to the formation of diverticula. Fiber helps promote regular bowel movements and prevents constipation, which can increase pressure in the colon and lead to the formation of pouches.

Potential Complications of Untreated Diverticulitis

While more than 75% of diverticulitis cases are uncomplicated, about 25% can develop serious complications if left untreated. These complications may include:

• Abscess: An infected pocket filled with pus
• Phlegmon: A less well-confined infected area
• Fistula: An abnormal connection between two organs or between an organ and the skin
• Intestinal perforation: A tear in the intestinal wall that can lead to peritonitis
• Intestinal obstruction: A blockage that prevents the passage of stool

Can diverticulitis lead to more severe health issues if not addressed promptly? Yes, untreated diverticulitis can result in serious complications that may require emergency surgery and lead to long-term health problems. Early diagnosis and appropriate treatment are crucial for preventing these complications.

Diagnosing Diverticulitis: The Road to Accurate Assessment

Diagnosing diverticulitis involves a combination of medical history review, physical examination, and various diagnostic tests. The process typically includes:

1. Medical history and symptom assessment
2. Physical examination, including abdominal palpation
3. Digital rectal exam to check for bleeding, pain, or masses
4. Imaging studies such as abdominal ultrasound, CT scan, or MRI
5. Blood tests to check for signs of inflammation or infection
6. Stool tests to rule out other infections
7. Colonoscopy (usually performed after acute symptoms subside)

Why is a colonoscopy often recommended after an acute episode of diverticulitis? A colonoscopy allows doctors to visually examine the inside of the colon, confirm the diagnosis of diverticulitis, and rule out other conditions with similar symptoms, such as inflammatory bowel disease or colorectal cancer.

Differential Diagnosis: Ruling Out Similar Conditions

Several conditions can mimic the symptoms of diverticulitis, making accurate diagnosis crucial. These may include:

• Irritable bowel syndrome (IBS)
• Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• Appendicitis
• Colorectal cancer
• Ovarian cysts or pelvic inflammatory disease in women

How do doctors differentiate between diverticulitis and other gastrointestinal conditions? Doctors use a combination of symptom assessment, physical examination, and diagnostic tests to distinguish diverticulitis from other conditions. Imaging studies, particularly CT scans, are especially helpful in identifying the characteristic signs of diverticulitis.

Treatment Approaches for Managing Diverticulitis

The treatment of diverticulitis depends on the severity of the condition and whether it’s classified as uncomplicated or complicated. Treatment options may include:

Uncomplicated Diverticulitis

• Dietary modifications (clear liquid diet followed by gradual reintroduction of solid foods)
• Oral antibiotics (if bacterial infection is suspected)
• Pain management
• Rest and monitoring

Complicated Diverticulitis

• Hospitalization for intravenous antibiotics and fluids
• Bowel rest (nothing by mouth)
• Drainage of abscesses
• Surgical intervention in severe cases

When is surgery necessary for diverticulitis? Surgery may be required in cases of severe or recurrent diverticulitis, especially if complications such as perforation, abscess, or fistula formation occur. The type of surgery depends on the specific situation and may involve removing the affected portion of the colon.

Dietary Considerations and Lifestyle Changes for Diverticulitis Management

Diet plays a crucial role in both preventing and managing diverticulitis. While dietary recommendations have evolved over time, current guidelines suggest:

• Increasing fiber intake gradually (aim for 25-30 grams per day)
• Staying well-hydrated
• Eating a variety of fruits, vegetables, and whole grains
• Limiting processed foods and red meat
• Avoiding extreme dietary restrictions unless advised by a healthcare provider

In addition to dietary changes, lifestyle modifications can help manage diverticulitis and reduce the risk of recurrence:

1. Regular exercise to promote healthy bowel function
2. Stress management techniques
3. Quitting smoking
4. Maintaining a healthy weight
5. Avoiding prolonged use of NSAIDs when possible

Can probiotics help in managing diverticulitis? While research is ongoing, some studies suggest that probiotics may help maintain a healthy gut microbiome and potentially reduce the risk of diverticulitis flare-ups. However, more research is needed to establish definitive recommendations.

Living with Diverticulitis: Long-term Outlook and Prevention Strategies

For many individuals, diverticulitis can be effectively managed with proper treatment and lifestyle modifications. However, it’s important to be aware of the potential for recurrence and take steps to minimize risk:

• Follow-up regularly with your healthcare provider
• Adhere to recommended dietary and lifestyle changes
• Be vigilant for signs of recurrence or complications
• Consider colonoscopy screening as recommended by your doctor

What is the likelihood of diverticulitis recurring after an initial episode? Studies suggest that about 20-30% of individuals who have had one episode of diverticulitis may experience a recurrence. However, adopting a healthy lifestyle and following medical advice can significantly reduce this risk.

Emerging Research and Future Directions

Ongoing research in the field of diverticular disease is exploring several promising areas:

1. The role of the gut microbiome in diverticulitis development and progression
2. Genetic factors that may predispose individuals to diverticular disease
3. Novel treatment approaches, including targeted therapies and minimally invasive surgical techniques
4. The potential use of anti-inflammatory agents in managing chronic diverticular disease

How might future research change the way we approach diverticulitis treatment? As our understanding of the underlying mechanisms of diverticulitis improves, we may see more personalized treatment approaches based on individual risk factors, genetic profile, and gut microbiome composition. This could lead to more effective prevention strategies and targeted therapies for managing the condition.

Diverticulitis in Special Populations: Considerations for Different Age Groups and Comorbidities

While diverticulitis can affect individuals of all ages, certain populations may require special considerations in terms of diagnosis, treatment, and management:

Diverticulitis in Younger Adults

Although traditionally considered a condition affecting older adults, diverticulitis is increasingly being diagnosed in younger individuals, particularly those under 50. In this population:

• Symptoms may be more severe
• There may be a higher risk of complications
• Genetic factors may play a more significant role
• Lifestyle factors such as diet and obesity are often important contributors

How does the management of diverticulitis differ in younger patients? Younger patients with diverticulitis may require more aggressive treatment and closer follow-up due to the potentially higher risk of complications and recurrence. Lifestyle modifications and dietary changes are particularly important in this age group.

Diverticulitis in the Elderly

Older adults with diverticulitis may face unique challenges:

• Higher risk of complications due to weakened immune systems
• Increased likelihood of comorbidities affecting treatment options
• Potential for atypical presentation of symptoms
• Greater risk of adverse effects from medications

What special considerations are necessary when treating diverticulitis in elderly patients? Treatment in elderly patients often requires a more cautious approach, balancing the need for effective management with the risks associated with aggressive interventions. Close monitoring and individualized care plans are essential.

Diverticulitis and Comorbidities

The presence of other health conditions can complicate the management of diverticulitis. Some important considerations include:

1. Cardiovascular disease: May affect surgical risk and medication choices
2. Diabetes: Can increase the risk of complications and affect wound healing
3. Immunosuppression: May lead to more severe infections and require more aggressive treatment
4. Obesity: Can complicate diagnosis and increase surgical risks

How do comorbidities influence the treatment approach for diverticulitis? The presence of comorbidities often necessitates a multidisciplinary approach to care, with close collaboration between gastroenterologists, surgeons, and other specialists to develop an optimal treatment plan that addresses both the diverticulitis and any coexisting conditions.

The Role of Imaging in Diverticulitis Diagnosis and Management

Imaging plays a crucial role in the diagnosis, staging, and management of diverticulitis. Various imaging modalities are used, each with its own advantages and limitations:

Computed Tomography (CT) Scan

• Considered the gold standard for diagnosing diverticulitis
• Provides detailed images of the abdominal structures
• Can identify complications such as abscesses or perforations
• Helps in staging the severity of the condition

Ultrasound

• Non-invasive and radiation-free
• Useful for initial screening, especially in younger patients or pregnant women
• May be limited by patient body habitus or bowel gas

Magnetic Resonance Imaging (MRI)

• Provides detailed soft tissue images without radiation exposure
• Particularly useful for assessing fistulas or complex cases
• May be less readily available and more time-consuming than CT

Why is CT considered the preferred imaging modality for diagnosing diverticulitis? CT scans offer high sensitivity and specificity for diagnosing diverticulitis, can accurately assess the extent of inflammation, and can identify potential complications. This comprehensive information is crucial for determining the appropriate treatment approach.

Follow-up Imaging

After an acute episode of diverticulitis, follow-up imaging may be recommended to:

1. Ensure resolution of inflammation
2. Detect any residual abscesses or complications
3. Guide decisions about the timing of colonoscopy
4. Assess for any underlying colorectal malignancy

How frequently should imaging be performed in patients with a history of diverticulitis? The frequency of follow-up imaging depends on the individual case and clinical course. Typically, a CT scan may be performed 6-8 weeks after an acute episode to confirm resolution. Further imaging is generally guided by symptoms or clinical concerns.

Symptoms, Causes, Diagnosis, Treatment, Surgery

Diverticulitis can cause digestive symptoms and abdominal pain. Some people may develop complications that require urgent medical care.

Although it was rare before the 20th century, diverticular disease is a very common health problem in the Western world. It’s a group of conditions that can affect your digestive tract.

The most serious type of diverticular disease is diverticulitis. It can cause uncomfortable symptoms and, in some cases, serious complications. If left untreated, these complications can cause long-term health problems.

Read on to learn more about diverticulitis, including its causes, symptoms, treatment options, and how your diet might affect your risk of developing it.

Diverticulitis can cause symptoms ranging from mild to severe. These symptoms can appear suddenly, or they can develop gradually over several days.

Potential symptoms of diverticular disease include:

• pain in your abdomen
• bloating
• diarrhea
• constipation

If you develop diverticulitis, you might experience:

• constant or severe pain in your abdomen
• nausea and vomiting
• fever and chills
• blood in your stool
• bleeding from your rectum

Abdominal pain is the most common symptom of diverticulitis. It will most likely occur in the lower left side of your abdomen. It can also develop in the right side of your abdomen.

If you develop any of the above symptoms, it may be a sign of a serious complication from diverticulitis or another condition. Call your doctor right away.

Diverticular disease develops when pouches form along your digestive tract, typically in your colon (large intestine). These pouches (diverticula) can become inflamed and infected, which may occur when feces or partially digested food blocks the opening of the diverticula.

Although there’s no single known cause of diverticular disease, several factors can increase the risk of developing diverticulitis, including:

• genetics
• diet
• decreased immune function
• having obesity
• physical inactivity
• smoking
• changes in the gut microbiome
• certain medications, such as steroids

More than 75 percent of diverticulitis cases are uncomplicated, leaving about 25 percent to develop complications.

These complications can include:

• abscess, an infected pocket that’s filled with pus
• phlegmon, an infected area that’s less well-confined than an abscess
• fistula, an abnormal connection that can develop between two organs or between an organ and the skin
• intestinal perforation, a tear or hole in the intestinal wall that can allow the contents of your colon to leak into your abdominal cavity, causing inflammation and infection
• intestinal obstruction, a blockage in your intestine that can stop stool from passing

To diagnose diverticulitis, your doctor will likely ask about your symptoms, health history, and any medications you take. They’ll likely perform a physical exam to check your abdomen for tenderness.

If they need more information, they may perform a digital rectal exam to check for:

• rectal bleeding
• pain
• masses
• other problems

Several other conditions can cause symptoms that are similar to diverticulitis. To rule out other conditions and check for signs of diverticulitis, your doctor might order one or more tests.

Tests can include:

• abdominal ultrasound, abdominal MRI scan, abdominal CT scan, or abdominal X-ray to create pictures of your gastrointestinal (GI) tract
• colonoscopy to examine the inside of your GI tract; although this takes place after a bout of diverticulosis
• stool test to check for infections, such as Clostridium difficile (C. diff)
• urine test to check for infections
• blood tests to check for signs of inflammation, anemia, or kidney or liver problems
• pelvic exam to rule out gynecological problems in people assigned female at birth
• pregnancy test to rule out pregnancy in people assigned female at birth

If you have diverticulitis, these exams and tests can help your doctor learn if it’s uncomplicated or complicated.

Using a colonoscopy to diagnose diverticulitis

If you have symptoms of diverticulitis, your doctor might encourage you to have a colonoscopy once the acute episode resolves. This procedure can help confirm a diagnosis of diverticulitis or another condition that causes similar symptoms, such as ulcerative colitis or Crohn’s disease.

During a colonoscopy, your doctor will thread a flexible scope into your rectum and colon. They can use this scope to examine the inside of your colon. They can also use it to collect tissue samples for testing.

To help you feel more comfortable during this procedure, you will be sedated beforehand.

In some cases, your doctor might learn that you have diverticula during a routine colonoscopy. If the diverticula aren’t inflamed, infected, or causing symptoms, you probably won’t need treatment.

The treatment that your doctor prescribes for diverticulitis will depend on how severe your condition is.

Uncomplicated diverticulitis can typically be treated at home. Your doctor might encourage you to make changes to your diet. In some cases, they might prescribe medications, including antibiotics.

If you develop complications from diverticulitis, you may need to visit a hospital for treatment. You may be given fluids and antibiotics through an intravenous (IV) line. Depending on the type of complication, you might need to undergo surgery or another procedure.

There are no particular foods that everyone with diverticulitis has to avoid. However, you might find that certain foods make your condition better or worse.

As your symptoms improve, your doctor might encourage you to eat more high fiber foods. Some studies have linked high fiber diets to reduced risk of diverticulitis. Other studies have examined possible benefits of dietary or supplemental fiber for diverticular disease but are still unsure of the role fiber should play.

Your doctor might also encourage you to limit your consumption of red meat, high-fat dairy products, and refined grain products. A large cohort study found that people who follow a diet that’s rich in these foods are more likely to develop diverticulitis than people who eat a diet rich in fruits, vegetables, and whole grains.

Diet can play a role in managing diverticulitis and your overall digestive health. Take a moment to learn about some of the foods that might affect your symptoms.

Dietary changes

To give your digestive system a chance to rest and recover, your doctor might suggest avoiding solid foods and following a clear-liquid diet for a few days.

If your symptoms are mild or have started to improve, you may be able to try eating low-fiber foods until your condition gets better. As your condition improves, your doctor will likely encourage you to add more high-fiber foods to your snacks and meals.

Medication

To reduce pain or discomfort from diverticulitis, your doctor might recommend over-the-counter pain medications, such as acetaminophen (Tylenol).

If they suspect you have an infection, they’ll likely prescribe antibiotics to treat it. These can include:

• metronidazole (Flagyl, Flagyl ER)
• amoxicillin
• moxifloxacin

It’s important to take your full course of prescribed antibiotics, even if your symptoms improve after the first few doses.

Other procedures

If you develop a complicated case of diverticulitis that can’t be treated through diet and medication alone, your doctor might recommend one of the following procedures:

• Needle drainage. In this procedure, a needle is inserted into your abdomen to drain an abscess of pus.
• Surgery. Surgeries may involve draining an abscess of pus, repairing a fistula, or removing infected segments of the colon.

If you experience multiple episodes of diverticulitis that can’t be effectively managed with dietary changes and medications, your doctor might recommend surgery. Surgery may also be used to treat complications from diverticulitis.

There are two main types of surgery used to treat diverticulitis.

Bowel resection with anastomosis

During a bowel resection with anastomosis, a surgeon removes infected segments of your colon and reattaches the healthy segments to each other.

Bowel resection with colostomy

In a bowel resection with colostomy, the surgeon removes infected sections of your colon and attaches the end of the healthy section to an opening in your abdomen, known as a stoma.

Both procedures can be performed as open surgery or laparoscopic surgery. Learn more about the types of surgery that can be used to treat diverticulitis.

Home remedies for diverticulitis mostly consist of making dietary changes, but there are a few other options that may be helpful for symptoms and digestive health.

Some home remedies for diverticulitis include:

• Probiotics. Although more research is needed, some studies have found that certain strains of probiotics might help relieve or prevent symptoms of diverticulitis.
• Aromatherapy. Certain essential oils have been shown to reduce pain, which could be beneficial for managing your symptoms.
• Acupuncture. Not only can acupuncture improve digestive issues like constipation, but some research also suggests that it could help treat chronic pain.
• Herbs. Several herbs possess powerful anti-inflammatory properties, including ginger, turmeric, and rosemary. However, more research is needed to evaluate the effects of these herbs on diverticulitis specifically.

Read more about the home remedies that might help you manage this condition.

Diverticular disease usually affects adults. In rare cases, babies are born with diverticula. When this happens, it’s known as Meckel’s diverticulum. If the diverticula become inflamed, it’s called Meckel’s diverticulitis.

In some cases, Meckel’s diverticulum doesn’t cause noticeable effects. In other cases, it can cause symptoms such as:

• abdominal pain
• nausea
• vomiting
• bloody stool
• bleeding from the rectum

If you suspect your child might have diverticulitis, make an appointment with their doctor. Learn about some of the strategies pediatricians can use to diagnose and manage Meckel’s diverticulum.

More research is needed to learn what causes diverticular disease, including diverticulitis. Currently, experts believe multiple factors play a part. Some potential risk factors may be modified through lifestyle changes.

For example, it might help to:

• try to maintain a moderate body weight
• eat a diet that’s high in fiber to help bulk up stools (however, in acute diverticulitis, you may want to avoid fiber)
• limit your consumption of saturated fat
• get enough vitamin D
• get regular exercise if possible
• try to avoid cigarette smoke

These prevention strategies can also help promote good overall health.

One of the main risk factors for diverticulitis is age. Older people are more likely than younger people to develop diverticulitis. It commonly occurs in men under 50 and women ages 50 to 70.

People who develop diverticula at a younger age may be more likely to experience diverticulitis. Younger people are also more likely to be admitted to a hospital if they have diverticulitis than older people.

According to a review of research published in 2018, other potential risk factors for diverticulitis include:

Family history

Studies have found that genetics play a role in diverticular disease, with some reports estimating that roughly 40 to 50 percent of the potential risk of diverticular disease is hereditary.

Low levels of vitamin D

Some studies suggest that people with higher levels of vitamin D might have a lower risk of getting diverticulitis. More research is needed to understand the potential link between vitamin D and diverticula.

Obesity

Several studies have found that people with higher body mass index (BMI) and larger waists are at increased risk of diverticulitis.

It’s possible that obesity raises the risk of diverticulitis by changing the balance of bacteria in your gut, but more research is needed to understand the role this plays.

Physical inactivity

Some studies have found that physically active people are less likely than inactive people to develop diverticulitis. However, this link still needs more research.

Using nonsteroidal anti-inflammatory drugs (NSAIDs) or smoking

Regular use of aspirin, ibuprofen, or other NSAIDs may raise your risk of diverticulitis.

People who smoke are also more likely than nonsmokers to develop diverticular disease, including diverticulitis.

According to a 2017 review of research, there’s no strong evidence that drinking alcohol raises your risk of this disease.

If you drink alcohol, your doctor will likely encourage you to drink in moderation only. Although alcohol consumption might not cause diverticulitis, drinking too much can raise your risk of many other health problems.

If you have diverticula that aren’t infected or inflamed, it’s known as diverticulosis.

In some cases, diverticulosis can cause symptoms such as pain in the abdomen and bloating. When that happens, it’s known as symptomatic uncomplicated diverticular disease (SUDD).

Diverticula can also develop in your bladder. This happens when the lining of your bladder forms pouches, poking through weak spots in your bladder’s wall.

Sometimes bladder diverticula are present at birth. In other cases, they develop later in life. They can form when your bladder outlet is blocked, or your bladder isn’t working properly due to illness or injury.

If you have bladder diverticula that becomes inflamed, it’s known as bladder diverticulitis. To treat bladder diverticulitis, your doctor might prescribe antibiotics and pain medications. They might also recommend surgery to repair the diverticula.

It’s also possible for diverticulitis in your colon to affect your bladder. In severe cases, you might develop a fistula between your colon and bladder. This is known as a colovesical fistula. Find out what this condition involves.

Diverticula can potentially form in your esophagus, too. This occurs when pouches develop in your esophageal lining.

Esophageal diverticula are rare. When they do develop, it’s usually slowly and over many years. As they grow, they can cause symptoms or complications such as:

• trouble swallowing
• pain when swallowing
• halitosis, or bad breath
• regurgitation of food and saliva
• pulmonary aspiration: breathing regurgitated food or saliva into your lungs
• aspiration pneumonia: developing a lung infection after breathing in food or saliva

If the diverticula become inflamed, it’s known as esophageal diverticulitis.

To treat esophageal diverticulitis, your doctor might prescribe antibiotics and pain medications. To repair the diverticula, they might recommend surgery. Get more information about your treatment options.

Diverticulitis is relatively common in the Western world. In most cases, it can be treated through short-term dietary changes and medication.

If complications develop, they can be serious. If you have complicated diverticulitis, your doctor will likely advise you to get treatment in a hospital. You might need to undergo surgery to repair damage to your colon.

If you have diverticulitis or questions about your risk of developing it, speak with your doctor. They can help you learn how to treat this disease and support your digestive health.

Medical Approach to Right Colon Diverticulitis with Perforation

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AbstractIntroductionCase PresentationDiscussionConclusionsConflicts of InterestReferencesCopyrightRelated Articles

We report a case of a 71-year-old female who presented with right lower quadrant (RLQ) abdominal pain and was diagnosed on CT scan with right-sided diverticulitis with perforation. She was admitted under the surgical service after consultation and received intravenous fluids, intravenous antibiotics, and pain medications as needed. The patient was discharged 2 days after admission in stable condition with follow-up with gastroenterology. The differential diagnosis of right lower quadrant abdominal pain is vast. Right-sided diverticulitis often presents in a manner similar to appendicitis. In the absence of peritonitis, conservative treatment may be possible. It is predictable that as the population ages, the incidence of right-sided diverticular disease will increase and will result in more presentations of acute right-sided diverticulitis to the emergency department (ED). The aim of this case report is to increase awareness of the incidence, pathophysiology, presentation, work-up (laboratory studies and imaging), and management (medical and surgical) of right-sided diverticulitis among emergency physicians.

1. Introduction

Right-sided diverticulitis shares some elements in common with left-sided diverticulitis; however there are distinct features in reference to the incidence, pathophysiology, presentation, and management. In this case report, we will discuss those elements, partly in the context of comparison and contrast to left-sided diverticulitis and in the context of a 71-year-old female who presented with right lower quadrant (RLQ) abdominal pain and was diagnosed with right-sided diverticulitis with perforation.

2. Case Presentation

A 71-year-old presented to the emergency department (ED) with a complaint of right lower quadrant (RLQ) abdominal pain of one-day duration. She reported an episode of acute pain twelve hours prior to presentation, described as sharp in nature, which then became a constant aching pain. She denied nausea, vomiting, melena, hematochezia, or hematemesis. Sometimes in the past several years, the patient had been advised on a routine colonoscopy that she had diverticulosis. She never had an episode of diverticulitis. She also had a history of possible irritable bowel syndrome. She had no history of abdominal surgery. There was no family history of inflammatory bowel disease or gastrointestinal malignancies.

The patient’s vital signs were as follows: heart rate of 99 beats per minute, respiratory rate of 18 breaths per minute, blood pressure of 143/76 mmHg, and a temperature of 97.9 degrees Fahrenheit, with a pain score of 6 out of 10. The physical exam showed diffuse right lower quadrant tenderness, with no rigidity, guarding. or rebound. Her white blood cell count was 12,900 per microliter with 77% neutrophils. Electrolytes and lipase were within normal limits. A computerized tomography (CT) scan of the abdomen and pelvis with oral and intravenous contrast showed an extension of contrast from the right posterior colon, cranial to the appendix. The appendix showed no evidence of inflammation, wall thickening, or dilatation. The axial and cranial views in tandem give a sense of the degree of extension of the contrast. The impression was of a perforated diverticulum or small contained rupture (Figures 1 and 2). Diverticula were noted throughout the colon.

The patient was seen in consultation in the ED by the surgical service. She was admitted to the hospital under the surgical service and received intravenous fluids, intravenous antibiotics (ertapenem, one gram intravenously daily), and pain medications as needed. A gastroenterology consultation was obtained.

The patient was discharged 2 days after admission in stable condition with follow-up with gastroenterology. Discharge medications included amoxicillin 500 mg three times per day for 7 days as per gastroenterology.

3. Discussion

The patient presented with right lower quadrant abdominal pain and tenderness that was demonstrated on CT scan to be due to right-sided diverticulitis with a perforated diverticulum.

3.1. Incidence of Right-Sided Diverticulitis

The incidence of right-sided diverticulosis and right-sided diverticulitis does not appear to be known [1]. It is noted in the literature to be rare [1–3]. As a general principle, diverticular disease increases with age. Diverticular disease is said to affect 50% of those aged 60 years and older and as many as 80% of the population aged 80 and older [4]. Many factors have been described as variables in the development, including dietary factors (such as decreased dietary fiber) as well as a lack of physical activity [5]. Genetics may play a part. This is evidenced by the fact that cecal diverticular disease has an incidence that is estimated to be 1 to 2% of surgical specimens in the North American population but approximately 43 to 50% of surgical specimens in studies of Asian populations [5]. The incidence of right-sided diverticulosis has been estimated by some to be approximately 8.5% of the population of western countries [6].

3.2. Pathophysiology

The pathophysiology of diverticulosis, right-sided or left-sided, is not yet completely understood. Such factors as colonic hypermobility, microflora content, and visceral hypersensitivity have been targets of research [5]. Other potential risk factors include aging, smoking, and alcohol intake [1]. Overall, most patients (80 to 90%) with diverticular disease are asymptomatic. Some cancers have been related to the development of diverticular disease, perhaps through the development of matrix metalloproteinase [5]. Multiple asymptomatic diverticula are a finding in older patients in association with carcinoma, while solitary diverticulum of the cecum may occur as a congenital lesion [6].

3.3. Presentation of Right-Sided Diverticulitis

Left-sided diverticulitis can present with left lower quadrant pain in association with such symptoms as nausea, vomiting, rectal bleeding, diarrhea, and fever.

Most patients with diverticula of the right side are asymptomatic [6]. Right-sided diverticulitis presents with right lower quadrant abdominal, nausea, and vomiting as well as other symptoms and thus can mimic appendicitis [1, 7–9]. Nirula and Greaney presented a series of 12 cases of right-sided diverticulitis over a 10-year period in a single hospital, in which the preoperative diagnosis of appendicitis was made in 11 cases. They recommended the consideration of right-sided diverticulitis when a normal appendix was found at the time of surgery for suspected appendicitis [10]. Violi et al. presented 20 cases of right-sided diverticulitis over a 22-year period. They conclude that right-sided diverticulitis should be considered in cases of atypical appendicitis presentations [11]. However, as well noted by Kahveci et al., the differential diagnosis of right lower quadrant pain “is vast” and includes not only acute appendicitis but also “ureteral colic, ectopic pregnancy, and a ruptured ovarian cyst.” [4]. Other forms of pathology may present with right lower quadrant pain and CT evidence of inflammation, including an inflammatory Crohn’s mass, ileocecal tuberculosis, or a perforated foreign body reaction [1].

The initial presentation of diverticulitis can include bleeding, diverticulitis, peridiverticular abscess, and perforation [5]. An inflammatory colonic mass of uncertain etiology that is ultimately diagnosed as right-sided diverticulitis may have an initial working diagnosis of a carcinoma [8]. Complications of right-sided diverticulitis include “phlegmon, intra-abdominal abscess, fistulas involving adjacent organs, and distant septicemia” [7].

3.4. Laboratory Studies

Leukocytosis may be present in diverticulitis, but a normal white blood count does not rule out diverticulitis. Electrolyte abnormalities due to vomiting or diarrhea may be seen on a basic metabolic panel. Blood cultures should be obtained in patients who have complicated disease. Because a right-sided ectopic pregnancy may present with right lower quadrant abdominal pain, pregnancy should be ruled out in a woman of childbearing years with such a presentation.

3.5. Imaging

CT scanning appears to be the best overall imaging modality in the diagnosis of possible right-sided diverticulitis [5, 7–9]. “CT gives clinicians the most information about location and involvement of adjacent or distant organs or structures when compared to other imaging modalities” [7]. It was for this reason that a CT scan was used as the imaging modality of choice in this case. The two most common CT findings in diverticulitis are wall thickening and pericolic fat stranding, often in the context of an identifiably inflamed diverticulum [4]. MRI is an alternative imaging strategy that may be used in pregnancy or if necrotizing fasciitis is a diagnostic possibility [7]. Some studies have looked at the role of ultrasound in the evaluation of right lower quadrant pain [5]. According to Little and Culver, “the limitation of ultrasonography is the difficult in determining…whether or not colonic involvement is present or whether the abscess has penetrated the abdominal wall” [7].

3.6. Management

Karatepe et al. note that medical treatment may be sufficient in many patients with diverticulitis without peritonitis. Medical management consists of antibiotics targeted to treat common bacteria found in the colon, intravenous fluids, and pain medication [6, 7]. Our patient did not have signs of peritonitis and was able to be managed medically, while being carefully observed by the surgical service.

3.7. Surgical Treatment

In the absence of perforation and peritonitis, conservative treatment may be possible [9]. “Patients are typically managed medically first until complications…are apparent or are imminent” [7]. Surgical treatment may be a diverticulectomy [6]. Hildebrand et al. present their experience with 12 cases of right-sided diverticulitis over an 8-year period and concluded that surgery is only indicated in complicated right-sided diverticulitis and that “resection of the inflamed colon is safe and can be performed by laparoscopy” [3]. However, a right hemicolectomy may be needed if the specimen reveals colonic cancer [6].

4. Conclusions

The differential diagnosis of right lower quadrant abdominal pain is vast, but, in general, right-sided diverticulitis presents in a manner similar to appendicitis. In the absence of peritonitis, conservative treatment may be possible, as was the case in the patient presented. It is predictable that as the population ages, the incidence of right-sided diverticular disease will increase and will result in more presentations of acute right-sided diverticulitis to the emergency department.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References

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Copyright

Copyright © 2017 James Espinosa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Doctor Baghdasaryan named 7 reasons why he may have pain in his right side

• Health

It is not always appendicitis if there is a stabbing or even a sharp pain in the right side. This is how other diseases can manifest themselves.

October 4, 202119

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Unpleasant sensations and pain in the right side first of all cause thoughts of appendicitis. However, there are many other pathological conditions that are characterized by this symptom. For example, stomach and intestine problems are often signaled this way.

– Pain in the right side can occur due to a whole “bouquet” of inflammatory processes in the gastrointestinal tract, explains proctologist Lev Baghdasaryan. – Most often, with these diseases, a person feels aching, moderate pain with gradually increasing intensity.

Pain in the center, radiating to the right – gastritis and gastric ulcer

Pain in the side can follow “ulcers” and “gastritis”. Patients with these diagnoses are very sensitive to what they eat. The pain may appear after a fatty, salty, spicy or long period without food.

– The pain is concentrated in the center of the abdomen, in the area of ​​the solar plexus, but can strongly radiate to the right, – the doctor explains. – Accompanied by heartburn, nausea, belching, vomiting.

If you suspect you have gastritis or an ulcer, have a gastroscopy done. Treatment is conservative in most cases, but if the ulcer is severely started, it can even lead to surgery, and even death – with perforation of the stomach wall.

Pain in right side at waist level – appendicitis

When the appendix becomes inflamed with accumulation of pus inside the appendix, a sharp pain appears – usually in the right side at the level of the waist – which may increase with movement.

– Appendicitis has many faces – the pain can be dull and sharp, weak and strong, ricochet from the navel to the sternum. But always on the right,” says Lev Baghdasaryan. – The pain is accompanied by nausea, there may be vomiting and diarrhea. The temperature rises. Inflammation develops rapidly, and if the inflamed process is not removed in time, complications are possible, including death.

Paroxysmal pain – inflammation of the intestines (enteritis and colitis)

Pain in the right side can be caused by bacterial and viral infections, microflora disorders or foreign objects entering the intestines.

– Patients complain of pulling or paroxysmal pain along the intestines, rumbling in the abdomen, bloating, blood and mucus in the stool, diarrhea, the expert clarifies. – These diseases can be accompanied by general weakness and even headaches.

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Pain in the lower abdomen or right side – diverticulosis

This is a pathological condition of the intestine, in which protrusions similar to a hernia form in its walls. Intestinal contents enter their cavities, inflammation occurs – diverticulitis.

– The classic three symptoms of diverticulitis are pain in the left lower abdomen, fever and constipation, explains Lev Baghdasaryan. – But sometimes they can be similar to manifestations of other diseases: pain in the upper abdomen, as in exacerbation of gastritis or stomach ulcers, pain in the navel, rebounding to the back, as in acute pancreatitis, or pain in the right side, as in acute appendicitis.

Diverticulosis and diverticulitis are diagnosed by colonoscopy and abdominal ultrasonography. The inflammation is relieved by a course of antibiotics. With a complex course of the disease, surgical treatment is possible.

Colon Cancer Pain

– Colon cancer can be diagnosed at an early stage by having regular check-ups such as colonoscopy or MRI. Then accumulations of malignant cells are found even before the onset of pain and other symptoms, says the proctologist. – Those who neglect examinations need to listen especially carefully to their body, and if pain occurs, the color of feces changes, or stool disorders, immediately consult a doctor.

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Constant pulling pain in the right side – liver and gallbladder

Even minor malfunctions in the liver and gallbladder can lead to serious health consequences.

– If there is a regular pulling pain in the right side at the level of the waist, one can suspect that something is wrong in these organs, explains Dr. Baghdasaryan. – Such pain can indicate the development of cholelithiasis, cholecystitis, hepatitis and even cirrhosis of the liver.

Gallstone disease is a fairly common phenomenon. According to various studies, gallstones can be found in about one in ten adults.

– For a long time the disease is asymptomatic, and often the presence of “building materials” in the gallbladder is detected by chance, during a routine examination, and becomes a big surprise for a person. A dangerous complication of gallstone disease is a blockage of the bile ducts, warns Dr. Bagdasaryan.

When a stone in the duct blocks the free flow of bile, a person develops acute pain in the side . In this case, you need to urgently call the doctors and do the operation.

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Cholecystitis – inflammation of the gallbladder. Its most common cause is cholelithiasis. The stones accumulated in the cavity of the bladder irritate its walls, and eventually they become inflamed.

– The inflammatory process can be either acute, developing very quickly, or chronic, sluggish, says the doctor. – The most effective way to treat both cholelithiasis and cholecystitis is currently considered to be the removal of the gallbladder.

Hepatitis – acute infectious diseases of the liver, which often occur with serious complications.

– Hepatitis of any kind is characterized by severe but dull pain, as well as nausea, vomiting, high fever, diarrhea, weakness, sweating, joint pain. With similar symptoms, only a doctor can make a diagnosis based on the results of the tests, the doctor explains.

Cirrhosis of the liver is considered a disease of alcoholics, but this is not entirely true. It manifests itself most often with severe pain in the right side , which can ricochet to the right shoulder, neck or shoulder blade.

– Cirrhosis occurs as a result of rapid acute intoxication of the liver or prolonged exposure to toxins. Including alcohol, but not only, Lev Baghdasaryan draws attention. – Cirrhosis quickly flows into a chronic form, damage to liver tissues becomes irreversible. Treatment consists in maintaining the work of the liver in all available ways.

Read also

Even mild and slight pains in the right side cannot be ignored. In older people, dangerous pathologies of the abdominal organs can proceed in a blurred manner, without a pronounced pain syndrome.

Important

If abdominal pain has been going on for several hours, fever, nausea, vomiting, loss of appetite, stool disorders and other unpleasant symptoms, the only right decision is to visit a doctor.

Low back pain – kidney disease

Diseases of the kidneys can give pain on both sides, and on one side – on the right or left, depending on which kidney is affected.

Pyelonephritis – inflammation of the kidneys, which can be both acute and chronic.

– Patients usually complain of pain in the lumbar region. In chronic pyelonephritis, the pain is dull, aching. In acute or exacerbation of chronic, a person experiences severe pain, sometimes paroxysmal in nature, the expert says. Other symptoms include high fever, chills, general weakness, loss of appetite and nausea, as well as a racing pulse and dry mouth.

Urolithiasis may not manifest itself for a long time.

– When the pebbles grow up and begin to move, a person begins to experience acute attacks of pain in the lumbar region, the so-called renal colic, on the side where the affected kidney is located, – says the doctor. – Pain can occur both at rest and intensify with movement – it depends on the location of the stone. In addition to pain, this condition is characterized by frequent urination, possibly the appearance of blood in the urine.

Text author:Anna Maiskaya

Stomach ache causes – Clinic City Med Orenburg

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Learn more about the causes of abdominal pain, their accurate diagnosis and treatment

Cause stomach ache

Stomach pain causes

Feeling of pain in the abdomen and navel can be dull, widespread throughout the abdomen or burning, sharp and shooting, which usually have a clear localization. Abdominal pain occurs with various diseases and conditions.

What causes abdominal pain more often

Abdominal pain that begins near the navel and moves to the lower right part of the abdominal cavity may be a precursor to appendicitis – inflammation of the intestinal appendix. In most serious cases, surgery will be required to remove the appendix. With advanced appendicitis, the appendix may rupture. If you experience severe pain or tenderness in the right lower abdomen, abdominal pain when walking, nausea, vomiting or loss of appetite, fever, you should contact your doctor immediately.

Pain in the left lower abdomen may be a symptom of diverticulitis. Diverticulitis occurs when small, spherical capsules called diverticula form in the walls of the large intestine, which subsequently become infected and inflamed. Other symptoms of diverticulitis include fever, nausea, vomiting, chills, cramps, and constipation. Treatment for diverticulitis usually involves cleaning the colon of infection and inflammation. The doctor may prescribe antibiotics and/or pain medication, a liquid diet, and bed rest for several days. In some cases, treatment for diverticulitis requires a hospital stay. If complications occur, surgery may be needed. The best way to prevent diverticulitis is a fiber-rich diet. Dietary fiber promotes proper digestion and relieves pressure in the colon. Gradually increase the amount of fiber in your daily diet, drink plenty of fluids. Regular bowel movements can also help prevent diverticulitis. The accumulation of waste products of the digestive system entails an increase in pressure in the colon.

Pain in the navel is most often caused by diseases of the small intestine such as ileitis (inflammation of the intestinal wall), parasitic diseases such as tapeworms that can secretly live in the intestines for many years and reach a size of up to 2-3 meters. Also, one of the frequently diagnosed causes may be Crohn’s disease, or single ulcerative defects not associated with this disease, large or medium in size, penetrating deep into the submucosal layer of the wall of the small intestine.

Acute pain in the right hypochondrium, aggravated after eating, indicates the presence of gallbladder disease. Gallbladder diseases include stones and inflammation of the gallbladder (cholecystitis). If complications occur, gallbladder damage may have other symptoms, along with pain in the peritoneum. These include: jaundice (yellowing of the skin and whites of the eyes), severe fever, and chills. Sometimes people with gallstones experience no symptoms at all. With regularly occurring pain in the right hypochondrium, you should consult a doctor. Gallbladder pain attacks can be dealt with in a number of ways, ranging from simple waiting (observing symptoms for a while, no treatment) to taking medications and even surgery. You can also reduce the symptoms of gallbladder disease by reducing the amount of fat in your diet.

Abdominal pain relieved by a bowel movement and accompanied by diarrhea or constipation may be indicative of irritable bowel syndrome , a common gastrointestinal disorder of unknown cause. When irritable bowel syndrome occurs, the walls of the intestines contract too much, sometimes too little, sometimes too slowly, and sometimes, on the contrary, too quickly. Symptoms of this disease include: bloating, increased gas formation, mucous stools, a constant desire to empty the intestines.

This syndrome cannot be managed with surgery or drugs. However, worsening of the condition can be prevented by drinking plenty of water, increasing the amount of fiber in the diet, reducing the amount of caffeine consumed and increasing physical activity.

Sharp burning pain in the upper and middle parts of the abdomen (between the sternum and the navel) may indicate the presence of an ulcer . An ulcer is a sore that forms in the tissues of the stomach or upper intestine. There are many causes for an ulcer. Smoking, taking acetylsalicylic acid, ibuprofen, or other non-steroidal anti-inflammatory drugs may play a role. An ulcer can also form if the stomach cannot protect itself from the strong stomach acid. Helicobacter pylori, a bacterium that lives in the stomach, can also cause ulcers. Stress and spicy food cannot cause an ulcer. Heartburn alone cannot be indicative of this disease. Severe pain like heartburn can also be caused by a less serious condition called gastroesophageal reflux disease.

In women, abdominal pain may indicate problems with the reproductive system. Pelvic pain that occurs every month before menstruation may indicate endometriosis – a condition in which tissue particles from the uterus move through the fallopian tubes and end up on the ovaries, pelvis, bladder and other organs. Soreness in the lower abdomen can mean pelvic inflammatory disease (infection of the tissues of the uterus, fallopian tubes, or ovaries). In women of childbearing age, an ectopic pregnancy can also cause severe, sharp or stabbing pain in the abdomen, accompanied by vaginal bleeding, irregular menstruation, and pain that radiates to the shoulders. Ovarian cysts and uterine fibroids can also cause abdominal pain in women.

Other causes of abdominal pain include: urinary tract infections, food poisoning and allergies, hernia, kidney stones and lactose intolerance.

Why does cause pain in the abdomen?

In most cases, pain in the abdomen is caused by quite ordinary causes, such as emotional disorders, overeating or the flu. However, such pain symptoms can also be caused by more severe diseases. Only a doctor can clearly determine the cause of pain.

How abdominal pain manifests itself

If you experience mild pain that appears sporadically for less than 4 weeks, you can try to cope with the problem yourself.

It is recommended to consult a doctor for pain that appears episodically for more than 4 weeks.

Immediate medical attention is needed for the following conditions:

– pain accompanied by fever, jaundice, dark urine, severe nausea or vomiting, light pasty stools;
– sharp sharp stabbing pain in the abdominal cavity, accompanied by vaginal bleeding, irregular menstrual cycle, pain radiating to the shoulders;
– severe persistent pain in the peritoneum after injury;
– Sudden very severe pain lasting more than 2 hours
Urgent hospitalization is required if the following signs appear:
– Abdominal pain accompanied by sudden bright red rectal bleeding or vomiting with blood or a substance that looks like coffee grounds;
– dizziness, delirium, rapid pulse, cold clammy skin.

Diagnosis of abdominal pain

If you have abdominal pain, undergo an examination of the intestines using capsule endoscopy gastroscopy or take a stool or blood test at City Med Clinic Orenburg. If examinations show that you do not have a serious pathology, then mild abdominal pain that is not associated with a disease of the small intestine, an ulcer, diverticulitis, or gallbladder disease, can be treated at home. Give your body enough time to rest. To relieve pain, take simple painkillers or antispasmodics (drotaverine, paracetamol).

Treatment of abdominal pain in the City Med Clinic Orenburg

In our clinic, a gastroenterologist and an endoscopist deal with the treatment and examination of diseases of the gastrointestinal tract. Experienced specialists and modern diagnostic and treatment equipment will do everything necessary to not only remove the pain, but also eliminate the cause that caused these painful sensations.

REVIEWS

Pain in my stomach tormented me for 10 years. They even operated on adhesions, underwent capsule endoscopy, it turned out to be Crohn’s disease, the gastroenterologist cured in 3 months.

Ludmila Belyaeva

I was diagnosed with Crohn’s disease in Moscow 5 years ago, the treatment got better, but a year ago the pain reappeared, it was recommended to do it with a papule, but the price of 50 thousand went in Orenburg for 25! Thank you!

Svetlana Stepnova

Since the age of 35, I have been diagnosed with iron deficiency anemia of unknown origin, there is no effect of any other treatment. The general practitioner advised capsule endoscopy, it passed, Crohn’s disease was established. Now I’m going through treatment to get better.

Volkova Kristina

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