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'{{Distinguish|Diverticulosis}} {{DiseaseDisorder infobox | Name = Diverticulitis | ICD10 = {{ICD10|K|57||k|55}} | ICD9 = {{ICD9|562}} | ICDO = | Image = | Caption = | OMIM = | MedlinePlus = 000257| eMedicineSubj = med | eMedicineTopic = 578 | DiseasesDB = 3876 | MeshID = D004238 | }} '''Diverticulitis''' is a common [[digestive disease]] particularly found in the colon (the large intestine). Diverticulitis develops from [[diverticulosis]], which involves the formation of pouches ([[diverticula]]) on the outside of the [[colon (anatomy)|colon]]. Diverticulitis results if one of these diverticula becomes [[inflamed]] or infected. <ref>[http://medical.merriam-webster.com/medical/diverticulitis Diverticulitis] entry at [[Merriam Webster]]'s Medical dictionary</ref> The colon can become infected with craters of food stuck inside, which causes abdominal pain. ==Causes== The development of colonic diverticulum is thought to be a result of raised intraluminal colonic pressures. The [[Sigmoid colon]] (Section 4) has the smallest diameter of any portion of the colon, and therefore the portion which would be expected to have the highest intraluminal pressure. The assumption that a lack of dietary fiber, particularly non-soluble fiber (also known in older parlance as "[[roughage]]") predisposes individuals to diverticular disease is supported within the medical literature.<ref>[http://www.umm.edu/altmed/articles/diverticular-disease-000051.htm Diverticular disease<!-- Bot generated title -->]</ref> <ref>[http://www.ohsu.edu/health/health-topics/topic.cfm?id=8464 Diverticular Disease: Oregon Health & Science University - Portland, Oregon<!-- Bot generated title -->]</ref> It is thought that mechanical blockage of a [[diverticulum]], possibly by a piece of [[feces]] or food particles, leads to infection of the diverticulum.{{Fact|date=October 2007}} [[Image:Diverticula, sigmoid colon.jpg|thumb|Large bowel (sigmoid colon) showing multiple diverticula. Note how the diverticula appear on either side of the longitudinal muscle bundle (taenium).]] There is some evidence that a genetic component may be a causative factor.{{Fact|date=June 2008}} ==Presentation== Patients often present with the classic triad of left lower quadrant pain, [[fever]], and [[leukocytosis]] (an elevation of the [[white blood cell|white cell]] count in blood tests). Patients may also complain of [[nausea]] or [[diarrhea]]; others may be [[constipated]]. Less commonly, an individual with diverticulitis may present with right-sided [[abdominal pain]]. This may be due to the less prevalent right-sided diverticula or a very redundant sigmoid colon. ==Symptoms== ===Diverticulitis=== The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause, then nausea, vomiting, feeling hot while having no fever, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications. Diverticulitis worsens throughout the day, as it starts as small pains and slowly turns into vomiting and sharp pains. In rare casesit smells like poop the tenderness can be the right side of the lower abdomen. This may appear to be [[appendicitis]] and only tests including a CT Scan will confirm it. ===Diverticulosis=== {{main| Diverticulosis}} Most people with diverticulosis do not have any discomfort or symptoms; however, symptoms may include mild cramps, bloating, and constipation. Other diseases such as [[irritable bowel syndrome]] (IBS) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis.{{Fact|date=June 2009}} ==Diagnosis== The [[differential diagnosis]] includes [[colon cancer]], [[inflammatory bowel disease]], ischemic [[colitis]], and [[irritable bowel syndrome]], as well as a number of urological and gynecological processes. Patients with the above symptoms are commonly studied with a computed tomography, or [[CT scan]].<ref name="pmid17895789">{{cite journal |author=Lee KH, Lee HS, Park SH, ''et al.'' |title=Appendiceal diverticulitis: diagnosis and differentiation from usual acute appendicitis using computed tomography |journal=Journal of computer assisted tomography |volume=31 |issue=5 |pages=763–9 |year=2007 |pmid=17895789 |doi=10.1097/RCT.0b013e3180340991 |doi_brokendate=2008-06-21}}</ref> The CT scan is very sensitive (98%) in diagnosing diverticulitis. In order to extract the most information possible about the patient's condition, thin section (5mm) transverse images are obtained through the entire abdomen and pelvis after the patient has been administered oral and intravascular contrast. Images reveal localized thickening and hyperemia (increased blood flow) involving a segment of the colon wall, with inflammatory changes extending into the fatty tissues surrounding the colon. The diagnosis of acute diverticulitis is made confidently when the involved segment contains diverticula. <ref>{{cite journal|journal=Radiographics|author=Horton KM et al.|title=CT Evaluation of the Colon: Inflammatory Disease|volume=20|issue=2|pages=399–418|date=March-April 2000|pmid=10715339}}</ref> CT may also identify patients with more complicated diverticulitis, such as those with an associated abscess. It may even allow for radiologically guided drainage of an associated abscess, sparing a patient from immediate surgical intervention. Other studies, such as [[barium enema]] and [[colonoscopy]] are [[Contraindication|contraindicated]] in the acute phase of diverticulitis due to the risk of perforation. ==Treatment== An initial episode of acute diverticulitis is usually treated with conservative medical management, including [[Acute_pancreatitis#Bowel_rest|bowel rest]] (i.e., no food taken by mouth), IV fluid resuscitation, and broad-spectrum [[antibiotics]] which cover [[Anaerobic organism|anaerobic]] [[bacteria]] and [[gram-negative]] [[Bacteria|rods]]. However, recurring acute attacks or complications, such as peritonitis, abscess, or fistula may require surgery, either immediately or on an elective basis. Upon discharge patients may be placed on a [[low residue diet]]. This low-fiber diet gives the colon adequate time to heal without needing to be overworked. Later, patients are placed on a high-fiber diet. There is some evidence this lowers the recurrence rate. In some cases surgery may be required to remove the area of the colon with the diverticula. Patients suffering their first attack of diverticulitis are typically not encouraged to undergo the surgery, unless the case is severe. Patients suffering repeated episodes may benefit from the surgery. In such cases the risks of complications from the diverticulitis outweigh the risks of complications from surgery. Most cases of simple, uncomplicated diverticulitis respond to conservative therapy with bowel rest and antibiotics.<ref>{{cite journal | last = Bogardus | first = Sydney | title = What do we know about diverticular disease? A brief overview| journal = Journal of Clinical Gastroenterology | year=2006 | month = August | volume = 40 Supplement 3 | pmid=16885691}}</ref> ==Complications== In complicated diverticulitis, [[bacteria]] may subsequently infect the outside of the [[Colon (anatomy)|colon]] if an [[inflamed]] diverticulum bursts open. If the [[infection]] spreads to the lining of the [[abdominal cavity]], ([[peritoneum]]), this can cause a potentially fatal [[peritonitis]]. Sometimes inflamed diverticula can cause narrowing of the [[bowel]], leading to an [[obstruction]]. Also, the affected part of the colon could adhere to the [[Urinary bladder|bladder]] or other [[Organ (anatomy)|organ]] in the [[pelvic cavity]], causing a [[fistula]], or abnormal connection between an organ and adjacent structure or organ, in this case the colon and an adjacent organ. * [[Bowel obstruction]] * [[Peritonitis]] * [[Abscess]] * [[Fistula]] * [[Bleeding]] * [[Strictures]] ==Epidemiology== Diverticulitis most often affects middle-aged and elderly persons, though it can strike younger patients as well.<ref name="pmid17976749">{{cite journal |author=Cole CD, Wolfson AB |title=Case Series: Diverticulitis in the Young |journal=J Emerg Med |volume= 33|issue= |year=2007 |pmid=17976749 |doi=10.1016/j.jemermed.2007.02.022 |pages=363}}</ref> [[Central obesity]] may be associated with diverticulitis in younger patients, with some being as young as 20 years old.<ref name="titleDisease Of Older Adults Now Seen In Young, Obese Adults">{{cite web |url=http://www.sciencedaily.com/releases/2006/09/060923104630.htm |title=Disease Of Older Adults Now Seen In Young, Obese Adults |accessdate=2007-11-19 |format= |work=}}</ref> In Western countries, diverticular disease most commonly involves the [[sigmoid colon]] - section 4 - (95% of patients). The prevalence of diverticular disease has increased from an estimated 10% in the 1920s to between 35 and 50% by the late 1960s. 65% of those currently 85 years of age and older can be expected to have some form of diverticular disease of the colon. Less than 5% of those aged 40 years and younger may also be affected by diverticular disease. Left-sided diverticular disease (involving the sigmoid colon) is most common in the West, while right-sided diverticular disease is more prevalent in [[Asia]] and [[Africa]]. 10-25% of patients with diverticulosis will go on to develop diverticulitis within their lifetimes. Nut, corn and popcorn consumption has not been proven to increase the risk of diverticulosis or diverticular complications. <ref name="Nut, Corn, and Popcorn Consumption and the Incidence of Diverticular Disease ">{{cite journal |author=Strate, L., Liu, Y., Syngal, S., Aldoori, W. and Giovannucci, E. |title=Nut, Corn, and Popcorn Consumption and the Incidence of Diverticular Disease |journal=[[Journal of the American Medical Association|JAMA]]| volume=300| issue=8|year=2008|pages=907–914 | url = http://jama.ama-assn.org/cgi/content/full/300/8/907 |doi=10.1001/jama.300.8.907}}</ref> ==Controversy== There is no scientific evidence that suggests the avoidance of nuts and seeds prevents the progression of diverticulosis to an acute case of diverticulitis, and as such the widely held belief that small undigestable foods like seeds becoming lodged in the diverticula appears to be nothing more than an 'old wives' tale.<ref name="titlePatient Information: Diverticular disease - UpToDate">{{cite web |url=http://patients.uptodate.com/topic.asp?file=digestiv/6237#12| title=Patient information: Diverticular disease |publisher=[[UpToDate]] |accessdate=2008-02-12 |format= |work=}}</ref> Further, in a survey of fellows of The American Society of Colon and Rectal Surgeons, although the majority of the surgeons responding to the survey favored adherence to a [[low residue diet]], half of them still saw no value in specifically avoiding seeds and nuts.<ref name="titleManagement of uncomplicated acute diverticulitis - Journal Article: Diseases of Colon & Rectum">{{cite journal |url=http://www.springerlink.com/content/f385544687u6g224/ |title=Management of uncomplicated acute diverticulitis |accessdate=2008-02-12 |volume = 42 | issue = 4 | date = April 1999 | doi = 10.1007/BF02234169 | pages = 470–475 | author = Steven Schechter, Joan Mulvey and Theodore E. Eisenstat |journal=Diseases of the Colon & Rectum}}</ref> ==References== {{reflist|2}} ==External links== * [http://www.hmc.psu.edu/healthinfo/d/diver.htm Health and Disease Information on Diverticulitis] at [[Penn State University]] * [http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/ Diverticulosis and Diverticulitis] at [[NIDDK]] * [http://www.mayoclinic.com/health/diverticulitis/DS00070 Diverticulitis] at [[Mayo Clinic]] {{Gastroenterology}} [[Category:Digestive diseases]] [[Category:Surgery]] [[Category:Abdominal pain]] [[de:Divertikulitis]] [[es:Diverticulitis]] [[fr:Sigmoïdite]] [[it:Diverticolite]] [[nl:Diverticulitis]] [[pl:Zapalenie uchyłków]] [[pt:Diverticulite]] [[fi:Divertikuliitti]] [[sv:Divertikulit]]'