Diverticulitis Overview & Treatment

Diverticulitis represents the infection of small pouches or pits in the large intestine (colon) known as diverticula. Many elderly patients will have diverticular disease and the majority will never have any adverse complications. However, for about a quarter of these patients, fecal matter passing through the large intestine may become lodged in these pits and trigger an infection. If left untreated, this can lead to a perforated colon, an abscess or obstruction of the bowel, each of which must be treated urgently. To fully understand diverticulitis however, we must discuss its precursor, diverticulosis.

What Is Diverticulosis?

Diverticulosis involves the development of small pouches along the smooth lining of the colon or large intestine. These are known as diverticula. We are not entirely sure who develops these pouches and why. For years we believed the Western diet – one low in fiber – was at least partly to blame. However, more recent research¹has brought into question whether a low fiber diet causes diverticulosis. In fact, this study showed a high fiber diet and frequent bowel movements may actually increase risk.

We do know diverticulosis risk increases as we age, and we suspect genetics may play a role as well. A sedentary lifestyle, excess weight and smoking can all contribute.

Typically, diverticulosis alone does not cause serious symptoms. If any, symptoms are usually mild and generalized – such as abdominal cramps, bloating and diarrhea. Diverticulosis, while not a problem in and of itself, can lead to diverticulitis if one or more of these pouches become inflamed or infected.

Symptoms of Diverticulitis

Acute diverticulitis will progress quickly, and patients will likely experience severe pain in the lower left quadrant of the abdomen within a day or two. Over time, the pain may fluctuate, but it will not go away without treatment. Other symptoms associated with diverticulitis are more generalized and can include:

• Constipation
• Fever
• Nausea and vomiting
• Diarrhea

These symptoms alone can represent several possible diseases, so an urgent visit to your medical team should be scheduled.

Diagnosing Diverticulitis

Every evaluation will include a comprehensive medical history. The goal is to both rule out other conditions with similar symptoms (such as intestinal ulcers and colitis) and to confirm the presence of diverticulitis. Diverticulitis has a very specific symptom profile (significant lower left quadrant pain) and therefore a preliminary diagnosis is often made very quickly. This diagnosis may be confirmed by one or more of several diagnostic testing options:

• Blood tests to check for infection
• Urine tests
• Colonoscopy
• Abdominal ultrasound
• CT Scan – The most effective and precise diagnostic imaging test for diverticulitis. CT can detect acute diverticulitis with a great deal of precision, and with a low false negative rate. Typically, patients will need intravenous and/or oral contrast to visualize the GI tract more clearly.
• Women of childbearing age will be tested to rule out pregnancy

Does Diverticulitis Lead to Colon Cancer?

Fortunately, diverticulosis and diverticulitis have not been shown to lead to colon or bowel cancer. However, there are instances in which diverticulitis occurs concurrently with colon cancer. Patients should follow their colonoscopy routine as prescribed by their primary care physician or specialist to ensure any precancerous or cancerous cells are found early.

Treatment for Diverticulitis

Diverticulitis, when mild, is known as uncomplicated diverticulitis and usual treatments include antibiotics, liquid diet and fluid therapy. Most patients see rapid improvement. For recurrent bouts of diverticulitis or for serious cases, known as complicated diverticulitis, the removal of part or all of the colon known as a colectomy is the only proven curative option.

A colectomy involves cutting away the infected portion of the large intestine. It may also be indicated if the disease has caused a narrowing of a portion of the colon or a fistula, either of which can create an intestinal blockage. In many cases, the two healthy segments of the colon are then stitched together in a process known as anastomosis. Some patients will require a temporary colostomy followed by a second surgery to reattach the intestine. Others with significant disease progression and inflammation may require a permanent colostomy.

¹Peery AF, Barrett PR, Park D, et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology. 2012;142(2):266–272.