Is Diverticulitis Serious?

Diverticulitis causes symptoms and signs such as gas, bloating, nausea, vomiting, and abdominal pain.

Diverticulitis and diverticulosis are forms of diverticular disease, which occurs when diverticula, small pouches in the large intestinal (colonic) wall, are present. These pouches arise in the colon and push through weak spots in the colon's outer muscle layers. Inflammation of these diverticula are called diverticulitis.

Diverticulitis occurs when there is infection or inflammation of the diverticula.

Early symptoms and signs of diverticulitis include the following:

• Abdominal pain (most commonly in the left lower quadrant)
• Nausea
• Vomiting
• Constipation (may be severe)
• Fever
• Gas (flatulence)
• Bloating

A doctor may notice the following signs and symptoms on physical examination:

• Tympanic abdomen to percussion
• Abscess formation
• Abnormal or absent bowel sounds
• Generalized abdominal pain with rebound and guarding
• Urinary tract findings (such as fistula, air in urine, stool in urine)
• Vaginal discharge that contains pus

In Western countries, doctors believe the classic high-fat and low-fiber diet causes diverticulitis.

Increased pressure from constipation or increasing abdominal girth in obesity may also cause diverticulitis.

Doctors diagnose diverticulitis based on a medical history and physical examination.

Medical professionals may also order any of the following laboratory tests to aid in diagnosis:

• White blood cell count
• Hemoglobin level
• Electrolyte assays
• Renal function tests
• Liver enzyme and lipase levels
• Urinalysis
• Urine culture
• Blood cultures
• Stool test for blood
• A pregnancy test for females of childbearing age with abdominal pain

Doctors may order the following imaging tests:

• Computed tomography (CT) scanning of the abdomen
• Contrast enema, using water-soluble medium
• Abdominal radiographic (X-ray) series

Treatment for diverticulitis depends on the severity, the presence of any complications, and other underlying medical conditions.

Treatment for mild diverticulitis includes the following:

• Adhere to a clear liquid diet for 2-3 days and progress to a soft diet as tolerated.
• Take 7-10 days of oral broad-spectrum antibiotics if needed:
  • Ciprofloxacin (Cipro) plus metronidazole (Flagyl)
  • Trimethoprim-sulfamethoxazole (Bactrim) plus metronidazole (Flagyl)
  • Amoxicillin-clavulanate (Augmentin)
  • Moxifloxacin (Avelox) (for patients intolerant of both metronidazole and beta-lactam agents)
  • Acetaminophen (Tylenol) and antispasmodics for pain

In more severe cases, people may need hospitalization. If hospitalized, treatment may include the following:

• Clear liquid diet; progress to a soft diet as tolerated
• Intravenous (IV) or oral antibiotics
  • Beta-lactamase-inhibiting antibiotics such as piperacillin/tazobactam (Tazocin) and ticarcillin/clavulanic acid (Timentin)
  • Carbapenems such as ertapenem (Invanz)
• Abscesses less than 3 cm, which typically resolve with antibiotics
• Abscesses greater than 4 cm: Drain percutaneously
• Pain management
  • Morphine is preferred, though it may affect bowel tone and sphincters.
  • Acetaminophen and antispasmodics such as dicyclomine are first-line medications used to manage pain and cramping in mild to moderate disease.
• Elective surgical resection

Complications of diverticulitis include the following:

• Abscess (most common complication)
• Intestinal fistula
• Perforation
• Obstruction
• Generalized peritonitis (inflammation of the tissue that lines the wall of the abdomen)
• Sepsis (can be life-threatening)
• Stricture of colon

Most people with diverticulitis can recover completely following prompt treatment.

Immunocompromised patients (people with HIV, organ transplant recipients, those on long-term corticosteroids) have a greater chance of having complications and needing surgery, as well as a significantly higher illness and death rate due to sigmoid diverticulitis (when diverticula form in the wall of the sigmoid colon, which is the end portion of the colon, near the rectum).

The most effective way to prevent diverticulitis is with proper diet and exercise. Diverticular disease can be due to a low-fiber diet so consumption of fruits and vegetables, whole grains, and other high-fiber foods is the mainstay of prevention.