Diverticulitis

Symptoms include: Abdominal painTenderness, usually in the left lower abdomenSwollen and hard abdomenFeverChillsPoor appetiteNauseaVomitingDiarrheaConstipationBoth diarrhea and constipationCrampingRectal bleeding DiagnosisThe doctor will ask about your symptoms and medical history, and perform a physical and rectal exam. Early diagnosis is important because the pouch can break, releasing stool into the abdomen. This is a surgical medical emergency. Tests may include: Analysis of a stool sample to look for bloodBlood tests to look for signs of infection, inflammation, and bleedingX-rays to look for a rupture CT scan or ultrasound to locate and determine the size of the inflamed pouch Once the inflammation subsides, other tests may be performed, including: Barium enema injection of a dye into the rectum that makes your colon show up on an x-ray so the doctor can see abnormal pouches in your colon Flexible sigmoidoscopy a thin, lighted camera is inserted into the rectum to examine the rectum and the lower colon Colonoscopy a thin, lighted camera is inserted through the rectum and into the colon to examine the entire lining of the colon Treatment The goals of immediate treatment are to:

Resolve the infection and inflammationRest the bowelPrevent complicationsTreatments include: MedicationsAntibiotics and other microbe-fighting drugs are given to eliminate the infection. Pain medications and drugs are given to decrease the abdominal pain. Generally, once the antibiotics start to work, the pain will subside. FluidsFor mild inflammation, you can drink clear liquids for the first two to three days. For a more severe case, you will be admitted to the hospital, where fluids are given intravenously. Antibiotics will be administered to you via an intravenous line. If you have nausea and vomiting, a plastic tube may be inserted through your nose into your stomach. This will help with the vomiting and make you feel more comfortable. Preventive Care Changes in your diet can help prevent future attacks of diverticulitis. Increase the amount of fiber you eat by eating more fruits, vegetables, and whole grains.Supplement your diet with a fiber product, as recommended by your doctor.Avoid laxatives, enemas, and narcotic medications that can lead to constipation. Surgery Surgery to remove the section of the bowel with pouches may be recommended if: You have had multiple attacks during a two-year period.A pouch breaks and the contents spread into the abdominal cavity. (This will require cleaning out the abdominal cavity, as well.)When surgery is done on an elective basis, the surgeon will remove part of the disease bowel and hook the normal bowel together. Surgery is also used to treat complications of diverticulitis, such as:

Abscessoccurs if the infected pouch fills with pusBlocked bowelscar tissue that forms and blocks movement of stool through the intestineFistulaoccurs if the infection spreads and colon tissue attaches to another organ, such as the bladder or the uterus/vaginaWhen surgery is done on an emergency basis, the surgeon will remove the disease bowel. Because of the serious infection, the two ends of the bowel will not be hooked together. You will most likely end up with a piece of bowel coming out to your abdomen (colostomy). After a period of 6-12 weeks, the surgeon will go back and hook the bowel back together. Prevention The following recommendations may help prevent diverticulitis by improving the movement of stool through the bowel and decreasing constipation: Eat a balanced, high-fiber diet with plenty of fruits, vegetables, and whole grains.Drink eight 8-ounce glasses of water each day.Exercise regularly. RESOURCES: American Society of Colon and Rectal Surgeonshttp://www.fascrs.org National Digestive Diseases Information Clearinghousehttp://digestive.niddk.nih.gov CANADIAN RESOURCES: BC HealthGuidehttp://www.bchealthguide.org Health Canadahttp://www.hc-sc.gc.ca/index_e.html References: American Society of Colon and Rectal Surgeons website. Available at: http://www.fascrs.org .

Conn's Current Therapy . 2001. WB Saunders Co; 2001. Emergency Medicine: Concepts and Clinical Practice . 4th ed. Mosby-Year Book, Inc; 1998. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www2.niddk.nih.gov/ . Primary Care Medicine. 4th ed. Lippincott Williams & Wilkins; 2000. Sleisenger & Fordtran's Gastrointestinal and Liver Disease . 6th ed. WB Saunders Co; 1998. Last reviewed October 2007 by Daus Mahnke, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.