When the opening of a diverticle gets inflamed, it can get so swollen that the diverticle forms a closed chamber, where the bacteria of the colonic flora multiply. In other words, the diverticle is now infected, it is a diverticulitis. This can quickly turn into a diverticular abscess through the action of the E.coli bacteria. The wall of the diverticle can also rupture and this would lead to acute peritonitis, an acute abdomen.
Fortunately, the patient has mostly a lot of symptoms of pain and a high fever at the stage of diverticulitis and the physician can treat the patient in the hospital setting and with the help of antibiotics heal the diverticulitis thus avoiding the abscess stage and preventing bowel perforation and peritonitis.
Symptoms and diagnosis
Most of the time the diverticular disease is located in the sigmoid colon (left descending colon). In this case the patient presents with acute pain in the left lower abdomen. Associated with this is a fever. If the patient had a similar episode before, the physician likely would know that there is underlying diverticulosis and the diagnosis of diverticulitis can then be made fairly quickly. Other causes of abdominal pain and fever have to be ruled out such as acute appendicitis, ovarian cancer or colon cancer to name a few. Occasionally a pericolic abscess can develop with severe chronic diverticular disease. In time this can lead to bowel obstruction.
Milder cases are treated with antibiotics at home and repeat evaluation in the office setting. More severely ill patients are usually admitted to the hospital and intravenous fluids and antibiotics are given. Blood tests to follow the infections are done.
About 2 weeks after the acute phase is over, a Barium enema with contrast can be done or a colonoscopy, if this is available. A CT scan and/or ultrasound may be necessary to check for a pelvic abscess in case of persistent fever.
About 80% of patients can be treated conservatively, about 20% of patients need a surgical excision of the diseased segment of the colon or else a laparotomy to rule out more serious disease.
A patient with acute perforation and peritonitis will need the perforated piece of colon removed with a preliminary proximal and distal colostomy, which is attended to at a later stage (2 to 6 months later) through an end-to-end reconnection. The danger after peritonitis is the extensive scarring, which in future can lead to recurrent bowel obstructions, which often have to be attended to surgically again. Mixed into all of this is the constant worry in the elderly patient about colonic or other cancers. The physician will always have to do supplementary tests to rule out this possibility.
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