What are the primary causes of diverticulitis. How does diverticulitis differ from other gastrointestinal disorders. What are the most effective treatment options for managing diverticulitis. How can lifestyle changes help prevent diverticulitis flare-ups. Are there any long-term complications associated with untreated diverticulitis.

Understanding Diverticulitis: A Comprehensive Overview

Diverticulitis is a common gastrointestinal condition that affects millions of people worldwide. It occurs when small pouches (diverticula) that form in the lining of the digestive system, particularly in the colon, become inflamed or infected. This condition is part of a broader spectrum of diverticular diseases, which also includes diverticulosis – the presence of diverticula without inflammation.

The prevalence of diverticulitis increases with age, affecting approximately 50% of individuals over 60 years old. While it is not an autoimmune disorder like Crohn’s disease, diverticulitis shares some similarities with inflammatory bowel diseases, leading to ongoing research into potential connections between these conditions.

Key Facts About Diverticulitis

• Diverticulitis primarily affects the colon (large intestine)
• It is more common in Western countries with low-fiber diets
• Risk factors include age, obesity, smoking, and lack of physical activity
• Symptoms can range from mild to severe and may include abdominal pain, fever, and changes in bowel habits

The Pathophysiology of Diverticulitis: From Diverticulosis to Inflammation

To understand diverticulitis, it’s essential to first grasp the concept of diverticulosis. Diverticulosis is characterized by the formation of small, bulging pouches (diverticula) in the lining of the digestive tract, most commonly in the colon. These pouches develop when weak spots in the intestinal wall give way under pressure, allowing the inner lining to protrude through the muscular layer.

Diverticulitis occurs when these diverticula become inflamed or infected. This can happen due to various factors, including:

1. Fecal matter becoming trapped in the diverticula
2. Bacterial overgrowth within the pouches
3. Reduced blood supply to the area
4. Increased pressure within the colon

The inflammation process in diverticulitis involves the activation of the immune system, leading to the release of inflammatory mediators and the recruitment of white blood cells to the affected area. This immune response, while intended to combat potential infections, can also cause tissue damage and contribute to the symptoms associated with diverticulitis.

Is Diverticulitis Related to Autoimmune Disorders?

While diverticulitis is not classified as an autoimmune disorder, there are some interesting connections between diverticular disease and autoimmune conditions. Recent research has shown that individuals with diverticular disease may have a slightly increased risk of developing certain autoimmune disorders, such as inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis.

The exact nature of this relationship is not fully understood, but it’s believed that shared risk factors, genetic predispositions, and alterations in the gut microbiome may play a role in this association. However, it’s important to note that having diverticulitis does not necessarily mean a person will develop an autoimmune condition, and vice versa.

Recognizing the Symptoms: When Diverticulitis Strikes

Diverticulitis can present with a range of symptoms, varying in severity from mild discomfort to acute, debilitating pain. Recognizing these symptoms early is crucial for timely diagnosis and treatment.

Common Symptoms of Diverticulitis

• Abdominal pain, typically on the lower left side
• Fever and chills
• Nausea and vomiting
• Changes in bowel habits (constipation or diarrhea)
• Bloating and gas
• Loss of appetite
• Fatigue

In some cases, diverticulitis can lead to more severe complications, such as abscesses, fistulas, or peritonitis. These complications may present with additional symptoms like severe abdominal pain, high fever, and rapid heart rate.

When Should You Seek Medical Attention?

If you experience persistent abdominal pain, especially if accompanied by fever or changes in bowel habits, it’s important to consult a healthcare professional. Prompt medical attention can help prevent the progression of diverticulitis and reduce the risk of complications.

Diagnosing Diverticulitis: From Clinical Evaluation to Advanced Imaging

Accurate diagnosis of diverticulitis is crucial for appropriate treatment and management. Healthcare providers use a combination of methods to diagnose this condition.

Clinical Evaluation and Medical History

The diagnostic process typically begins with a thorough clinical evaluation and review of the patient’s medical history. The healthcare provider will ask about symptoms, their duration, and any factors that may exacerbate or alleviate them. They will also inquire about dietary habits, bowel movements, and any previous gastrointestinal issues.

Physical Examination

A physical examination is performed to assess abdominal tenderness, particularly in the lower left quadrant where diverticulitis commonly occurs. The doctor may also check for signs of infection, such as fever or elevated heart rate.

Laboratory Tests

Blood tests are often ordered to check for signs of inflammation and infection. These may include:

• Complete blood count (CBC) to assess white blood cell levels
• C-reactive protein (CRP) test to measure inflammation
• Liver function tests
• Urinalysis to rule out urinary tract infections

Imaging Studies

Imaging techniques play a crucial role in confirming the diagnosis of diverticulitis and assessing its severity. Common imaging studies include:

1. CT scan: This is the gold standard for diagnosing diverticulitis. It can reveal the presence of diverticula, inflammation, and potential complications like abscesses or fistulas.
2. Ultrasound: While less commonly used, ultrasound can be helpful in certain cases, particularly for pregnant women or when CT scans are not available.
3. MRI: In some cases, especially when evaluating for fistulas or abscesses, an MRI may be recommended.

Colonoscopy

While not typically used during an acute episode of diverticulitis due to the risk of perforation, a colonoscopy may be recommended several weeks after the inflammation has subsided. This procedure allows for direct visualization of the colon and can help rule out other conditions like colorectal cancer.

Treatment Approaches: Managing Diverticulitis Effectively

The treatment of diverticulitis depends on the severity of the condition and the presence of any complications. Management strategies range from conservative approaches to surgical interventions.

Conservative Treatment for Mild Cases

For mild cases of diverticulitis, treatment often involves:

• Antibiotics to treat infection
• Pain relief medications
• A liquid or low-fiber diet to allow the colon to rest
• Gradual reintroduction of solid foods as symptoms improve

Most patients with uncomplicated diverticulitis can be treated on an outpatient basis with oral antibiotics and dietary modifications.

Hospital Treatment for Severe Cases

Severe cases of diverticulitis or those with complications may require hospitalization. Treatment in these cases may include:

• Intravenous antibiotics
• Bowel rest (nothing by mouth)
• Intravenous fluids for hydration
• Pain management
• Monitoring for potential complications

Surgical Interventions

Surgery may be necessary in certain situations, such as:

1. Recurrent episodes of diverticulitis
2. Complications like abscesses, fistulas, or bowel obstruction
3. Failure of conservative treatment

Surgical options include:

• Bowel resection: Removal of the affected portion of the colon
• Laparoscopic lavage: A minimally invasive procedure to clean the abdominal cavity
• Colostomy: In severe cases, a temporary or permanent opening may be created to divert stool from the affected area

Emerging Treatments

Research is ongoing into new treatment approaches for diverticulitis. Some emerging therapies include:

• Probiotics to modulate gut microbiota
• Anti-inflammatory agents to reduce colonic inflammation
• Mesenchymal stem cell therapy for fistula repair

Prevention and Lifestyle Modifications: Reducing the Risk of Diverticulitis

While not all cases of diverticulitis can be prevented, certain lifestyle modifications can help reduce the risk of developing this condition or experiencing recurrent episodes.

Dietary Changes

A high-fiber diet is often recommended to prevent diverticulitis. Fiber helps soften stool and promotes regular bowel movements, reducing pressure in the colon. Good sources of fiber include:

• Whole grains
• Fresh fruits and vegetables
• Legumes
• Nuts and seeds

It’s important to increase fiber intake gradually to avoid digestive discomfort. Adequate hydration is also crucial when increasing fiber consumption.

Physical Activity

Regular exercise can help maintain healthy bowel function and reduce the risk of diverticulitis. Aim for at least 30 minutes of moderate physical activity most days of the week. This can include:

• Brisk walking
• Swimming
• Cycling
• Yoga or stretching exercises

Maintaining a Healthy Weight

Obesity is a risk factor for diverticulitis. Maintaining a healthy body weight through a balanced diet and regular exercise can help reduce the risk of developing this condition.

Smoking Cessation

Smoking has been linked to an increased risk of diverticulitis. Quitting smoking can not only reduce this risk but also improve overall health.

Stress Management

While the direct link between stress and diverticulitis is not fully established, chronic stress can affect digestive health. Incorporating stress-reduction techniques such as meditation, deep breathing exercises, or counseling may be beneficial.

Long-Term Outlook: Living with Diverticular Disease

Understanding the long-term prognosis and potential complications of diverticular disease is crucial for patients and healthcare providers alike. While many individuals with diverticulosis never develop diverticulitis, those who do experience an acute episode may be at risk for recurrence.

Recurrence Rates and Risk Factors

The risk of recurrent diverticulitis varies among individuals. Studies suggest that approximately 20-30% of patients who have had an episode of acute diverticulitis will experience a recurrence within 5 years. Factors that may increase the risk of recurrence include:

• Young age at first diagnosis
• Multiple diverticula
• Family history of diverticular disease
• Obesity
• Smoking
• Sedentary lifestyle

Potential Complications

While most cases of diverticulitis resolve with appropriate treatment, some patients may develop complications. These can include:

1. Abscesses: Pockets of infected fluid that form near the inflamed diverticula
2. Fistulas: Abnormal connections between the colon and other organs or the skin
3. Strictures: Narrowing of the colon due to scarring
4. Peritonitis: Inflammation of the abdominal lining, which can be life-threatening if left untreated
5. Bowel obstruction: Blockage of the intestine due to inflammation or scarring

Quality of Life Considerations

Living with diverticular disease can impact a person’s quality of life in various ways. Some individuals may experience:

• Chronic abdominal pain or discomfort
• Anxiety about potential flare-ups
• Dietary restrictions or concerns
• Limitations in social activities or travel

However, with proper management and lifestyle modifications, many people with diverticular disease can maintain a good quality of life and minimize the impact of the condition on their daily activities.

Ongoing Research and Future Directions

The field of diverticular disease research is continually evolving. Current areas of investigation include:

• Genetic factors influencing susceptibility to diverticulitis
• The role of the gut microbiome in disease development and progression
• Novel therapeutic approaches, including targeted anti-inflammatory treatments
• Improved diagnostic techniques for early detection and risk stratification

As our understanding of diverticular disease grows, it is likely that new prevention strategies and treatment options will emerge, potentially improving outcomes for patients with this condition.

Conclusion: Empowering Patients Through Knowledge and Management

Diverticulitis, while a common gastrointestinal condition, remains a complex disorder with various facets to consider. From its initial development as diverticulosis to the potential complications of acute inflammation, understanding the nuances of this condition is crucial for both patients and healthcare providers.

By recognizing the symptoms early, seeking prompt medical attention, and adhering to recommended treatment plans, individuals with diverticulitis can effectively manage their condition and reduce the risk of complications. Moreover, adopting lifestyle modifications such as a high-fiber diet, regular exercise, and stress management can play a significant role in preventing recurrences and maintaining overall digestive health.

As research in this field continues to advance, we can anticipate more targeted and personalized approaches to diagnosing and treating diverticulitis. This ongoing progress offers hope for improved outcomes and quality of life for those affected by this condition.

Ultimately, the key to living well with diverticular disease lies in a combination of medical management, lifestyle adaptations, and patient education. By staying informed and proactive about their health, individuals with diverticulitis can take control of their condition and work towards a healthier, more comfortable future.

Conditions | Gastroenterology

Colorectal Conditions

Colorectal diseases refer to conditions impacting the colon or rectum, including colorectal cancer, colon polyps, colitis, and Crohn’s disease. These conditions can range from mild irritations to serious illnesses.

Learn More

Crohns Disease

Crohn’s disease is an autoimmune disease of the digestive tract. Your body’s immune system should protect your body from sicknesses. But in Crohn’s disease, your immune system attacks the digestive tract by mistake.

Learn More

Diverticulitis

Diverticulosis [dahy-ver-tik-yuh-LOH-sis] is a condition that impacts about half of people over age 60. It causes small pouches (diverticula) to bulge out through weak spots on the digestive tract — most often on the colon (large intestine). They can also form on the esophagus, stomach, and small intestine.

Learn More

Esophagitis

Eosinophilic [ee-uh-sin-uh-FIL-ik] esophagitis [ih-SOF-uh-JAHY-tis], or EE, is an allergic reaction that causes inflammation (swelling) in the esophagus. The esophagus is the tube going from your mouth to your stomach. The inflammation can make the esophagus become more narrow and stiff. This can make swallowing difficult and cause food to get caught in your esophagus.

Learn More

Gluten Intolerance

Gluten intolerance is a disorder similar to celiac disease that makes it difficult to eat gluten, a protein found in rye, wheat, and barley. The treatment for gluten intolerance is a gluten-free diet, which can make your symptoms better.

Learn More

Hepatitis

Hepatitis is a disease that irritates the liver and causes it to swell.

Learn More

Hernias

A hiatal hernia is a condition in which the top of the stomach bulges through an opening in the diaphragm called the hiatus. The diaphragm is the large muscle that helps you breathe. The diaphragm separates the stomach from the chest. A hiatal hernia moves up into the chest and can cause pain and other symptoms.

Learn More

Irritable Bowel Syndrome

Normally, a healthy colon keeps its contents moving through it with a regular rhythm. With IBS, the rhythm of your colon speeds up, causing diarrhea, or slows down, causing constipation.

Learn More

Liver Disease

The liver is the largest organ in your body. It performs many important functions, but can be damaged by many different conditions, such as hepatitis, hemochromatosis, and fatty liver disease.

Learn More

Pancreatitis

Pancreatitis is a condition in which the pancreas is irritated or inflamed (swollen).

Learn More

Peritonitis

Peritonitis [PEH-ree-TUHN-eye-TIS] is an inflamed peritoneum, the part of your body that surrounds your organs. It is usually caused by an infection. Peritonitis is treated with antibiotics and often needs surgery to help heal the injury that let the infection in.

Learn More

Rectal Prolapse

Rectal prolapse is when the lowest part of the large intestine, called the rectum [REK-tum] slips out of the anus. It can make it difficult to hold in your bowel movements.

Learn More

A hypothesis: is diverticulitis a type of inflammatory bowel disease?

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. 2006 Aug;40 Suppl 3:S121-5.

doi: 10.1097/01.mcg.0000225502.29498.ba.

Martin H Floch 
¹

Affiliations

Affiliation

• ¹ Section of Digestive Disease, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.

• PMID:

  16885694

• DOI:

  10.1097/01.mcg.0000225502.29498.ba

Martin H Floch.

J Clin Gastroenterol.

2006 Aug.

. 2006 Aug;40 Suppl 3:S121-5.

doi: 10.1097/01.mcg.0000225502. 29498.ba.

Author

Martin H Floch 
¹

Affiliation

• ¹ Section of Digestive Disease, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.

• PMID:

  16885694

• DOI:

  10.1097/01.mcg.0000225502.29498.ba

Abstract

It is accepted by epidemiologists that diverticula formation in the colon is related to a deficiency in dietary fiber intake, but the cause of acute diverticulitis remains unknown. A hypothesis is presented that acknowledges from the literature that fiber deficiency is also related to an altered intestinal microecology with a change in the bacterial flora. It is hypothesized that the change in the flora with a decrease in their influence on the immune process permits a low-grade chronic inflammation in the mucosa, which is the first step in developing an acute infection of diverticula or diverticulitis. There is some evidence that the low-grade chronic inflammation is present in subjects with diverticula, which is the forerunner of acute diverticulitis. This hypothesis is strengthened by early reports that anti-inflammatory mucosal agents such as mesalamine and immune process regulators such as probiotics may improve diverticulitis.

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Diverticular disease – treatment in St.

Petersburg. Diverticular disease of the colon

Diverticular disease is a chronic disease that occurs due to the formation of a sac-like protrusion (diverticulum) in the intestinal wall, and, as a result, a congestive process and the development of inflammation.

Sometimes there is a single diverticulum, but, as a rule, most often people have multiple protrusions in one of the sections of the intestine.

Diverticula are divided into “true” and “false”, as well as “congenital” and “acquired”.

• True diverticula are most often congenital – due to a direct violation of the structure of the intestine. One of the features of a true diverticulum is that the walls of the diverticulum have all the layers characteristic of the intestine. True diverticula, for example, include Meckel’s diverticulum: a protrusion of the wall of the small intestine at the confluence of an unclosed embryonic vitelline duct into it as an anomaly of development.
• False diverticula are acquired and represent a bulging of the intestinal mucosa outward through thinned places in its muscular layer.

As a rule, acquired diverticula are multiple and rarely occur in a single number.
Diverticulosis is a change in the intestinal wall with the presence of multiple diverticula in it without inflammatory processes occurring in them and not manifesting themselves clinically.
If an inflammatory process develops in the diverticulum, they speak of diverticulitis and, as a result, the development of diverticular disease.

Incidence of diverticular disease

Of all the diseases of the colon, intestinal damage by diverticula is one of the most common in the modern world. The frequency of diverticular disease reaches an average of 20% in European countries; moreover, in older age groups of the population (60–80 years), the frequency increases, reaching 40–50%, and among patients over the age of 80, the incidence reaches 60–65%. In our country, diverticula of the large intestine are found in approximately 17-28% of gastroenterological patients. The frequency of the disease in men and women is approximately the same.

Classification of diverticular disease

• Uncomplicated. This form is detected incidentally during X-ray or endoscopic examination of the intestine. In blood tests, as a rule, no changes are found. An examination must be carried out to assess the prevalence of intestinal damage, predict the course of the disease and choose a method for preventing complications or treatment.
• Complicated with acute inflammatory process (diverticulitis, diverticular infiltrate, diverticulum perforation, abscess, peritonitis), chronic inflammatory process, and bleeding. The chronic process includes situations when the inflammation cannot be eliminated within 6 weeks, or it occurs again. In severe cases, an infiltrate, narrowing of the intestine, or a fistula from a destroyed diverticulum may form.

Causes of diverticula

The occurrence of this disease does not have any specific cause. It is due to a combination of many factors. There is an opinion about the predisposition of some people to this disease due to congenital underdevelopment of the muscular layer of the intestinal wall. As a result, they develop diverticula with age or under the influence of any factors.

Congenital predisposition plays a role in people with hereditary connective tissue dysplasia syndromes (Marfan, Ehlers-Danlos syndromes, when there is a deficiency of collagen in the human body), a combination of diverticular disease of the large intestine with diseases associated with a decrease in elasticity and strength of the connective tissue (hernias) is also common. , varicose disease, visceroptosis, polycystic).
However, congenital inferiority of tissues is not the only reason for the occurrence of pathological changes in the intestinal wall.

The high incidence of diverticular disease in the elderly is associated with a gradual decrease in the tone of the colon wall as the body ages. Diverticular disease is a chronic disease that occurs due to the formation of a sac-like protrusion (diverticulum) in the intestinal wall, and, as a result of a congestive process, the development of inflammation in them. The muscular layer of the colon becomes thicker and less elastic. The supporting connective tissue loses its elasticity, and the intestinal wall becomes less extensible. Therefore, diverticula in people of the older age group appear more often than in young people.

It is also known that diverticula occur significantly more often with a decrease in plant fibers and fiber in the diet. Therefore, in vegetarians, diverticular disease is 3 times less common than in people who limit the intake of vegetables and fruits. Foods low in fiber poorly stimulate intestinal motility, slow down the movement of contents through the large intestine, which increases the absorption of water and, as a result, constipation develops. The retention of feces in the intestines, combined with a violation of the normal intestinal microflora, leads to inflammation and the progression of diverticular disease. This can also explain the more frequent occurrence of diverticula in the sigmoid colon (constipation in this case plays the role of a resolving factor).

The clinical picture in about two out of three cases is not accompanied by any complaints (asymptomatic diverticulosis), the pathology is detected by chance during endoscopic or X-ray studies. Most often, the first signs of diverticular disease are pain and functional disorders in the form of constipation or diarrhea. There are complaints of regularly recurring pain in the abdomen, more often in the left iliac region or lower sections, disappearing after defecation. Pains of varying intensity can exist for a long time – from several weeks to months. Increased pain is sometimes accompanied by fever, signs of intoxication may appear (dry mouth, nausea, tachycardia). Also, bloating and profuse gas separation, various dyspeptic disorders are often noted, which is sometimes hidden under the guise of irritable bowel syndrome.

Complications of diverticular disease of the colon

• Diverticulitis. This is an acute inflammation that occurs in diverticula in a quarter of patients with diverticulosis. Signs of the development of inflammation can be the appearance of pain and tension in the muscles of the anterior abdominal wall, fever, chills, bloating, stool disorders in the form of diarrhea or constipation.

• Diverticulum perforation. Against the background of the inflammatory process in the diverticulum, part of its wall may collapse, and the intestinal contents enter the abdominal cavity. At the same time, local or diffuse peritonitis develops. With perforation (rupture of the wall) of the diverticulum into the retroperitoneal tissue or the space between the sheets of the mesentery, infiltrates or abscesses appear.

• Bleeding. Occurs in approximately 25% of patients with diverticular disease. For many people, it may be the first and only manifestation of the disease. Usually bleeding is associated with ulceration of the wall of the diverticulum as a result of chronic inflammation. Also, in place of a fecal stone, a pressure sore may form with damage to the blood vessel. The intensity of bleeding can be different: from a slight admixture of blood in the feces (sometimes there is hidden bleeding, which is manifested by a gradual increase in anemia), to massive profuse bleeding, accompanied by collapse and even leading to death.

• Intestinal obstruction. The cause of intestinal obstruction may be an inflammatory process around the diverticulum or adhesions, leading to deformation of the intestine and disruption of the movement of stool along it. In rare cases, invagination (screwing) of a part of the intestine with a diverticulum or spasm of smooth muscles may occur.

• Intestinal fistulas. May occur when a diverticulum is perforated and an abscess ruptures into a nearby organ (the so-called “internal fistulas”). Men are more likely to develop fistulas with the bladder, women – with the vagina. With the formation of an entero-vesical fistula, air or an admixture of feces may appear in the urine.

Diagnosis of diverticular disease

• Irrigoscopy is an x-ray examination in which the colon lumen is filled with a contrast suspension and its condition is assessed during filling and after bowel emptying.
• Colonoscopy can detect the presence of multiple diverticula, signs of inflammation or intestinal bleeding, and may also be helpful in detecting associated lesions such as polyps and cancer.
• MSCT (multispiral computed tomography). Appropriate for the differential diagnosis of diverticulitis and tumor lesions of the colon.

Treatment

The main goal of treating diverticular disease is to normalize bowel function, prevent disease progression and complications, and relieve exacerbations.

Diet

Since diverticular disease is much more common in people who restrict their dietary intake of vegetables and fruits, all patients with diverticulosis should use foods high in vegetable fiber and pectin. Wheat bran is very useful (especially coarse bran), which significantly reduces the pressure inside the intestine and accelerates the speed of movement of the contents through the intestine.

Be sure to exclude all foods that cause increased gas formation (legumes, lentils, grapes, sauerkraut, butter and yeast dough, onions) and constipation (blueberries, rice). It is also advisable to exclude seeds, fruits with a large number of grains and excessively coarse fiber (persimmon, pineapple, turnip, radish, radish).

Drug treatment

• In an uncomplicated course, the disease does not require the use of drugs. The need to take medication arises depending on the clinical manifestations.
• Antispasmodics are used for abdominal pain.
• When dysbacteriosis is detected, drugs that help restore normal intestinal microflora.
• With persistent constipation, drugs are taken to enhance the motility of the stomach and intestines: lactulose preparations, vaseline or olive oil orally or in microclysters.
• In case of diverticulosis with clinical manifestations of inflammation, it is necessary to use the whole range of therapeutic measures: laxative diet, antispasmodics; drugs that regulate the motor function of the intestine, and drugs that normalize the composition of the bacterial flora of the intestine.

Surgical treatment

The need for surgical treatment for diverticular disease can arise both urgently and in a planned manner. This happens when complications occur that can threaten a person’s life (bleeding, perforation, peritonitis).
Planned surgical treatment is always aimed at eliminating the threat of such complications. The choice of the operation method in each specific case depends on the prevalence of the process, inflammatory changes in the diverticula, the condition of the intestinal wall and surrounding tissues, the presence of inflammation outside the intestinal lumen or peritonitis. It is important to take into account comorbidities often observed in the elderly. As a rule, resection (removal) of the affected part of the large intestine is performed in a planned manner with simultaneous imposition of an anastomosis.
Surgical treatment in our Clinic is performed laparoscopically, which allows patients to quickly return to active life. A planned operation is always performed during the period of remission, 2-3 months after the removal of an acute attack of the disease. Colon fistulas are an indication for planned surgical treatment, since it is not possible to achieve their self-healing, and chronic inflammation leads both to the development of rough scars that disrupt the passage of intestinal contents, and to the development of chronic intoxication and a decrease in immunity. With the formation of intestinal-vesical fistulas, there is a threat of developing an ascending urinary tract infection and kidney damage.

• Surgical removal of fistulas is a complex surgical intervention requiring the participation of highly qualified specialists. In our clinic, when planning such interventions, if necessary, related specialists (urologists, gynecologists, endoscopists) are involved. In case of intestinal bleeding, conservative treatment (hemostatic therapy) is most often prescribed or endoscopic hemostasis is performed. The operation is performed only when conservative methods of treatment are ineffective.
• Surgical treatment of diverticulum perforation. If the operation is urgent, a colostomy may be used to reduce the risk of postoperative complications. Reconstructive surgery with closure of the colostomy and restoration of intestinal continuity is performed after the inflammatory process subsides (after about 3 months).

Dispensary observation

Patients with diverticular disease should be regularly observed by a gastroenterologist or coloproctologist. Colonoscopy in the absence of complaints is performed at intervals of 1 time in 3 years.
If pain and other manifestations of the disease occur, the examination should be completed as soon as possible. With frequent periodic recurrences of diverticulitis, regular anti-relapse courses of treatment are indicated.

Forecast

The prognosis, as a rule, is favorable, if the disease is detected in a timely manner, the necessary preventive and therapeutic measures are started, provided that the patient complies with all the necessary recommendations.
However, if the need for prevention is ignored, diverticular disease can lead to the development of severe complications that threaten the life and health of the patient. Moreover, the disease is more common among older people who have a variety of concomitant diseases and lower body resistance.

Prevention

Among preventive measures, a varied and balanced diet is of primary importance. Due to the fact that a diet low in plant fibers predisposes to the formation of diverticula, in order to reduce the risk of developing the disease, it is necessary to include plant-based products in large quantities.
Since the timely detection of diverticula plays an important role, it is extremely important to undergo a preventive examination and regularly perform an endoscopic examination of the intestine.

symptoms, diagnosis, treatment of diverticulitis – Department of the State Hospital NCC No. 2 (CCH RAS)

Diverticula are areas of the intestine in which protrusion of tissues is observed. When inflammation of these areas occurs, intestinal diverticulitis begins. Inflammation is provoked by fecal masses that enter the diverticula and accumulate in them, irritating the walls and leading to the development of infection. Long-term malnutrition is considered the main cause of the onset of the disease. Adult patients usually suffer from diverticulitis – it develops in women and men over 60 years of age.

Causes of disease

The main factor that provokes the disease is malnutrition. This refers to the use of a large number of semi-finished products, low-quality food rich in fat and refined foods. Also, malnutrition includes reduced fiber intake. It is fiber in food that helps the proper movement of the masses through the intestines.

Localization of diverticulitis

The disease can affect different parts of the intestine:

• Diverticulitis of the small intestine – multiple protrusions of the mucosa through weak spots in the walls. In this zone, diverticula appear much less frequently than in the colon. The cause is believed to be a failure of peristalsis.
• Diverticulitis of the large intestine – masses up to two centimeters, often affecting elderly patients. The reason is malnutrition, the predominance of animal food over plant food.
• Sigmoid diverticulitis – a degenerative tissue disorder that appears as a result of a violation of peristalsis and vascular pathologies.

Symptoms of diverticulitis

When the disease begins, its symptoms in most cases are absent. Only when the disease passes into the chronic stage, there are signs by which it can be identified. Among the warning signs that indicate the presence of problems:

• Bloating, excessive flatulence.
• Traces of blood in the stool.
• Increased body temperature.
• Pain in the lower abdomen and back.
• Nausea, vomiting.
• Decreased appetite.
• Cold sweat.

Disease diagnosis

This serious complication requires immediate diagnosis, analysis of symptoms and treatment. The initial task of the doctor is to distinguish diverticulitis from stomach ulcers and irritable bowel syndrome. It all starts with questioning the patient, compiling a medical history, conducting an initial examination. Diagnostic methods that are used for suspected diverticulitis:

• Colonoscopy
• Sigmoidoscopy
• Irrigoscopy
• Computed tomography of the intestine
• X-ray of the intestines
• ultrasound
• Clinical analysis of urine and blood

Treatment of disease

There is a resolution of diverticulitis without special treatment due to the normalization of nutrition and diet. With a serious stage of the disease, how to treat it is determined individually and often in a hospital. In this case, the patient is given antibiotics and other supportive drugs. The operation is performed in order to separate the affected part of the intestine. Such a measure is required quite rarely:

• If the disease is severely advanced. There are fistulas, perforations, abscesses.
• When antibiotics do not help get rid of the problem.
• There is bleeding, peritonitis.

Risk of complications

Most of the complications of diverticulitis are associated with perforation, leakage of feces through the walls of the intestine:

• Abscess – removal of the affected part or puncture is required.
• Peritonitis is the spread of infection into the abdominal cavity. The operation is necessary to cleanse the abdominal cavity and remove part of the intestine.
• Intestinal obstruction – scarring resulting in partial or complete blockage of the lumen.