Definition

Diverticulitis is an inflammation or infection of the diverticula. Small sacs known as diverticula can develop in the most profound layers of the digestive tract, typically manifesting in the large intestine (colon). Typically, this compartment remains trouble-free. Diverticula-associated disorders are predominantly manifest in industrialized nations. The incidence of this disease is 180 cases per 100,000 individuals. Approximately 18–20% of individuals with intestinal diverticula develop diverticulitis.

Causes

Typically, diverticula manifest along the wall of the large intestine. The tissue of the large intestine gradually loses collagen, which is essential for maintaining the organ's elasticity and flexibility. As the muscles weaken and the walls of the large intestine become more rigid, pouch-like pleats develop, which serve as a stimulus for the development of diverticula.

The etiology of diverticulitis remains uncertain; however, it is associated with injury to the wall of the diverticula. The accumulation of undigested food particles or dirt particles damages the diverticula walls by causing erosion. In addition, the accumulation of these particles leads to obstructions in the diverticula, resulting in their enlargement and the possibility of bacterial proliferation. Alterations in the bacterial population within the intestine can potentially lead to infection within the diverticula.

Risk factor

Diverticulitis frequently manifests in industrialized nations due to its correlation with dietary factors. The following foods have a significant risk of triggering diverticulitis:

• Low-fiber foods
• High-fat foods
• Red meat

In addition, these foods may also induce delayed bowel movements. Reduced peristaltic activity in the intestines leads to fecal accumulation and a decrease in the frequency of bowel movements, resulting in constipation. Diverticulitis primarily affects those who:

• Aged over 60 years.
• Smoking
• Overweight
• Lack of exercise
• long-term usage of analgesics including ibuprofen, steroids, and opiates

Concurrently, the consumption of statins, which are medications used to lower cholesterol levels, reduces the incidence of diverticulitis.

Symptoms

The symptoms of diverticulitis are dependent on the location of the diverticula, the severity of the condition, and the existence of any complications. Frequent complaints include the following:

• Pain. Diverticulitis typically causes a cramp-like pain in the lower left abdomen. Nevertheless, this pain might also manifest in the lower right abdomen, resembling the symptoms associated with appendicitis. The occurrence of this pain may be intermittent as a result of fluctuations in bowel motions.
• Excessive flatulence
• Fever
• Nauseous
• Vomiting
• Abdominal distension
• Hematochezia. This symptom manifests in patients who have experienced complications.

Diagnosis

The diagnosis of diverticulitis is generally confirmed through a series of examinations:

1. Physical examinations

Direct examination can provide findings such as abdominal pain, bloating, abnormalities in bowel sounds, as well as multiple signs of difficulties such as a tense abdomen, the detection of air or debris in the urine, and a palpable mass in the abdomen. The physical examination can be adequate for diagnosing diverticulitis, although the accuracy of the diagnosis can be improved by laboratory and imaging studies.

2. Laboratory examinations

The doctor usually performs additional evaluations, including:

• Complete blood count to identify leukocytosis, which indicates an elevated white blood cell count.
• Examination of erythrocyte sedimentation rate (ESR)
• CRP analysis
• Liver function, renal function, and pregnancy tests in women of reproductive age to eliminate the potential presence of alternative illnesses (differential diagnosis).
• Urinalysis
• Blood and urine cultures.
• Blood electrolyte check is required before imaging.

3. Imaging

The available imaging modalities include:

• Computed tomography scan, often known as CT scan. CT scans are highly safe for individuals with diverticulitis and may provide accurate results.
• Barium enema procedure. Contrast-enhanced examination is feasible, except in the presence of stomach pain. Contrast can also be utilized to identify complications of diverticulitis such as the presence of holes in the diverticula or the development of new connections between the intestines and other organs (fistulas). Hence, the contrast agent typically employed in this procedure is typically water-soluble.
• X-ray imaging. Abdominal X-rays can be used to identify the existence of air in the abdominal cavity, which may occur as a consequence of diverticulitis.

Management

The management of diverticulitis is strongly related to the severity of the infection, the presence of complications, and any underlying medical disorders. If diverticulitis presents without problems, pharmacological intervention may simply be adequate. Nevertheless, if diverticulitis leads to difficulties, it is advisable to consider performing surgery. The surgery can be immediately conducted, either immediately or within a few days, with precise objectives targeted at managing current complications.

1. Pharmacological 

Common preoperative medications administered to hospitalized patients typically include the following:

• Antibiotics
• Analgesics
• Laxatives
• Intravenous fluid

2. Surgical interventions

Meanwhile, surgery has several advantages. After surgery, a tube under the skin can drain an abscess. Other treatments involve severing the diverticulitis-afflicted large intestine. Reattaching the healthy intestine follows the cutting. If significant swelling prevents this, the doctor can perform a colostomy to directly collect waste in a bag. If the edema subsides, reattach the intestine. Laparoscopic surgery (minimal incisions) may speed wound recovery.

3. Dietary

Exercise and diet are additional diverticulitis treatments. A 2-3-day liquid diet is indicated for mild diverticulitis. However, in cases of moderate to severe diverticulitis, individuals would abstain from eating to allow the intestines to rest. Once the recovery period is reached, the diet can be prolonged based on the patient's capacity. This diet emphasizes a high-fiber diet. Once the recovery process is complete, normal activities can be performed without any disruptions.

Complications

Complications of diverticulitis can include changes in the structure of the intestine, including:

• Abscess formation (pus)
• Infection of the abdominal cavity (peritonitis). An abscess that develops has the potential to induce inflammation and create a perforation in the abdominal cavity. Peritonitis is a potentially fatal infection that requires urgent medical attention.
• Torsion or perforation of the intestinal mucosa
• Intestinal constriction, or stricture. The formation of scar tissue, which can obstruct gastrointestinal movements, causes constriction.
• A fistula is the development of an abnormal connection between two organs. Frequent in occurrence, this fistula connects the bladder to the large intestine and carries the risk of recurrent urinary tract infections. Nevertheless, this does not preclude the likelihood of this fistula developing between the epidermis or vagina of females and the large intestine.

Prevention

Diverticulitis can be prevented through the following procedures:

• Consume fiber-rich meals.
• Body weight control
• Regularly exercise
• Stop smoking.
• Routine medical checkups if you consume long-term diverticulitis-causing medicines

When to see a doctor?

Constant stomach cramps, nausea, vomiting, fever, chills, bloody stools, and anus hemorrhage require rapid medical intervention. This pain may manifest in the bottom right or lower left quadrant. Early identification of symptoms is essential to immediately provide treatment and prevent the onset of complications.

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