Diverticulitis

Diverticulitis is an inflammation of the diverticulum, which can lead to phlegmon of the intestinal wall, peritonitis, perforation, fistula, or abscessing. The initial sign is abdominal pain. Diagnosis is established with CT of the abdominal cavity. Treatment of diverticulitis includes antibiotic therapy (ciprofloxacin or cephalosporins of the 3rd generation along with metronidazole) and sometimes surgical treatment.

[1], [2], [3], [4], [5], [6], [7]

What causes diverticulitis?

Diverticulitis develops in the case of micro- or macroperforation of the mucous membrane of the diverticulum with the release of intestinal bacteria. Developing inflammation remains limited in about 75% of patients. The remaining 25% may develop an abscess, perforation into the free abdominal cavity, intestinal obstruction or fistula. Quite often, a bladder is involved in the fistula, but the small intestine, uterus, vagina, abdominal wall or even thigh may also be involved.

Diverticulitis occurs severely in elderly patients, especially those taking prednisolone or other drugs that increase the risk of infection. Almost all of the heaviest diverticulitis are localized in the sigmoid section of the gut.

Symptoms of diverticulitis

Diverticulitis is usually accompanied by pain, soreness in the left lower quadrant of the abdomen and fever. Peritoneal symptoms of diverticulitis may be caused, especially if abscessed or perforated. Fistula formation can be manifested by pneumouuria, vaginal feces, the development of phlegmon of the abdominal wall, perineum or thigh. In patients with intestinal obstruction, nausea, vomiting and bloating develop. Bleeding is uncharacteristic.

Diagnosis of diverticulitis

Clinical suspicion of diverticulitis occurs in patients with an established diagnosis of diverticulosis. However, since other diseases (eg appendicitis, colon or ovarian cancer) may have similar symptoms, a checkup is required. The most informative is CT with oral or intravenous contrast, however, the results obtained in approximately 10% of patients do not allow differentiating diverticulitis from colon cancer. For the final diagnosis, laparotomy may be necessary.

[8], [9], [10], [11], [12], [13], [14]

Treatment of diverticulitis

In uncomplicated course, the patient can be treated on an outpatient basis, observing rest, taking liquid food and oral antibiotics (eg, ciprofloxacin 500 mg 2 times a day or amoxicillin / clavulanate 500 mg 3 times daily with metronidazole 500 mg 4 times a day). Symptoms of diverticulitis usually disappear quickly. The patient gradually shifts to a soft, low-fiber diet and daily intake of psyllium seed preparations. After 2-4 weeks, the colon should be examined by irrigoscopy. After 1 month, a high-fiber diet can be resumed.

Patients with more severe symptoms (pain, fever, leukocytosis) should be hospitalized, especially patients taking prednisolone (a higher risk of perforation and general peritonitis). Treatment includes bed rest, hunger, intravenous transfusion of fluids and antibiotics (eg ceftazidime 1 g intravenously every 8 hours with metronidazole 500 mg IV every 6-8 hours).

Approximately in 80% of patients, treatment is effective without surgical intervention. When forming an abscess, it is possible to transcutaneously drain it (under the control of CT). In case of effectiveness of the procedure, the patient remains in the hospital until the symptoms disappear, and a sparing diet is prescribed. Irrigoscopy is performed more than 2 weeks after the resolution of all symptoms.

Surgical treatment of diverticulitis

Emergency surgical treatment of diverticulitis is necessary in patients with perforation into the abdominal cavity or general peritonitis, as well as in patients with severe symptoms that are not amenable to non-invasive treatments within 48 hours. Strengthening the pain syndrome, tenderness and fever are signs indicating the need for surgical treatment. Surgery should also be considered in patients with any of the following: two or more exacerbations of a diverticulitis with a mild course in the anamnesis (or one exacerbation in a patient younger than 50 years); constantly palpable painful voluminous formation; clinical, endoscopic, radiologic signs, indicative of cancer; dysuria associated with diverticulitis in men (or women who have suffered a hysterectomy), since this sign can be a harbinger of perforation in the bladder.

The involved portion of the large intestine is resected. In patients without perforation, abscessing or severe inflammation, the ends can be initially anastomosed. In other cases, patients receive a temporary colostomy followed by recovery of the passage after resolution of the inflammation and general improvement in the condition.