Repeated attacks of diverticulitis may require surgery to remove the affected portion of the colon. Bleeding in the colon may occur from a diverticulum and is called diverticular bleeding. This is the most common cause of major colonic bleeding in patients over 40 years old and is usually noticed as passage of red or maroon blood through the rectum.
Most diverticular bleeding stops on its own; however, if it does not, a colonoscopy may be required for evaluation. If bleeding is severe or persists, a hospital stay is usually required to administer intravenous fluids or possibly blood transfusions. In addition, a colonoscopy may be required to determine the cause of bleeding and to treat the bleeding.
Occasionally, surgery or other procedures may be necessary to stop bleeding that cannot be stopped by other methods. Intestinal blockage may occur in the colon from repeated attacks of diverticulitis.
In this case, surgery may be necessary to remove the involved area of the colon. Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition. Understanding Diverticulosis What is diverticulosis?
Who gets diverticulosis? What causes diverticulosis? What are the symptoms of diverticulosis? How is the diagnosis of diverticulosis made? What is the treatment for diverticulosis? Are there complications from diverticulosis? Esophageal diverticula Although diverticula can occur anywhere in the large bowel, they usually occur in the sigmoid portion of the colon.
They rarely occur below the peritoneal reflection and involve the rectum. Diverticula vary in diameter but typically are 3 to 10 mm in size. People who have colonic diverticulosis usually have several diverticula. The etiology of colonic diverticulosis is multifactorial and not entirely known. Several studies have suggested a correlation between symptomatic diverticular disease and environmental factors such as a diet low in fiber or high in red meat, sedentary lifestyle, obesity, smoking, and use of nonsteroidal anti-inflammatory drugs NSAIDs , corticosteroids, and opiates.
Other possible risk factors include heritable factors and alterations in the colonic wall structure and motility. Diverticula are possibly caused by an increase in intraluminal pressure, which leads to mucosal extrusion through the weakest points of the muscular layer of the bowel—areas adjacent to intramural blood vessels. The etiology of giant diverticula is unclear. One theory is that a narrow neck-opening leads to a ball-valve effect with intermittent obstruction of the opening causing the diverticulum to enlarge.
A very large giant diverticulum is often a true perforation of a smaller diverticulum that was contained and walled off and became lined mostly by granulation tissue.
Patients with diverticulosis sometimes develop nonspecific gastrointestinal GI symptoms, including abdominal pain, bloating, constipation, diarrhea, and passage of mucus from the rectum. Diagnosis is by colonoscopy, capsule endoscopy However, some specialists believe these symptoms are due to another disorder eg, irritable bowel syndrome Irritable Bowel Syndrome IBS Irritable bowel syndrome is characterized by recurrent abdominal discomfort or pain with at least two of the following characteristics: relation to defecation, association with a change in frequency Complications of colonic diverticular disease are more common among people who smoke, are obese, have HIV infection, or use NSAIDs or are undergoing cancer chemotherapy.
Diverticulitis Colonic Diverticulitis Diverticulitis is inflammation with or without infection of a diverticulum, which can result in phlegmon of the bowel wall, peritonitis, perforation, fistula, or abscess.
The primary symptom Segmental colitis associated with diverticular disease SCAD Segmental Colitis Associated With Diverticulosis SCAD Diverticulitis is inflammation with or without infection of a diverticulum, which can result in phlegmon of the bowel wall, peritonitis, perforation, fistula, or abscess.
It may be uncomplicated or complicated. Diverticular bleeding Diverticular bleeding Colonic diverticulosis is the presence of one or more diverticula in the colon. The degree to which the diverticulosis is causal is unclear.
The manifestations depend on the location and rate of bleeding. See also Varices The pathophysiology of diverticular bleeding is unknown, but several mechanisms are hypothesized, including.
Although most diverticula are in the distal left colon, half of diverticular bleeding occurs from diverticula in the proximal right colon. Patients with pancolonic diverticulosis have a higher incidence of bleeding. Diverticular bleeding manifests as painless hematochezia.
Because the bleeding vessel is an arteriole, the amount of blood loss is usually moderate to severe. Fresh blood or maroon-colored stool is the typical manifestation; rarely, right-sided diverticular bleeding can manifest as melena.
Diverticular bleeding usually occurs without concomitant diverticulitis. The remainder require intervention Treatment of diverticular bleeding Colonic diverticulosis is the presence of one or more diverticula in the colon. Patients who have had a diverticular bleeding episode have an increased risk of rebleeding. Niikura R, Nagata N, Shimbo T, et al : Natural history of bleeding risk in colonic diverticulosis patients: A long-term colonoscopy-based cohort study. Aliment Pharmacol Ther 41 9 —, Colonic diverticula are typically false.
We are all born without colonic diverticula, but many of us acquire them over a lifetime. In Western societies, half the population will have at least one, and usually a few dozen, by age These small outpouchings are much less common in lifelong vegetarians, and it is commonly thought but unproven that a high fiber diet helps prevent diverticula.
Most diverticula occur in the left colon; they also occur elsewhere, but not in the rectum. The common hypothesis is that relatively high pressures generated within the colon by muscular contractions force the inner mucosa to penetrate through the path of small blood vessels within the colon wall and to bulge beyond the serosa Figure 1.
The muscle layer along the site of left colon diverticula is commonly thickened, lending credibility to the notion of high intracolonic pressure. The result may be rows of bulges along the colon at the sites of the penetrating arteries. Why such this may occur in one-half the North American and European populations and not the other half is a mystery. Perhaps the great prevalence in Western populations is related to the relative lack of dietary fiber consumed by these populations.
Low dietary fiber results in small stools, and an undistended colon may generate more pressure within the colon. Whatever the cause, the presence of colonic diverticula — often discovered during the course of a barium enema x-ray, colonoscopy, or surgery — is almost always of no significance.
Most individuals who possess colonic diverticula are unaware of them. The condition of having colonic diverticula is called diverticulosis. Indeed, the usual method of discovery of diverticula is by chance. There is no evidence that the diverticula themselves cause any symptoms. It is hard to imagine how one could be aware of a few outpouchings in the large intestine. The myth that abdominal pain may be caused by diverticular disease is explained by coexisting painful conditions such as irritable bowel syndrome IBS.
One does not lead to the other. Diverticula are almost always innocent bystanders, and their presence is termed uncomplicated diverticular disease. Despite this, colonic diverticula can occasionally become the source of serious illness.
These few may bleed or perforate thus becoming complicated diverticular disease. Diverticulitis — For unknown reasons, a diverticulum, usually in the left colon, can become inflamed diverticulitis and sometimes burst leaking bacteria-rich feces into the abdominal cavity peritoneum. The result is usually confined to the surface of the adjacent colon producing an acute, sometimes devastating illness characterized by severe abdominal pain in the left lower part of the abdomen, fever and prostration.
The treatment usually consists of fluids, bed rest, and antibiotics. Some cases require hospital admission. Sometimes the infection fails to be localized along the colon wall and an abscess occurs. Patients with a pelvic or abdominal abscess are very ill, and the abscess fluid pus must be drained through a large needle directed by a radiologist, or sometimes by a surgeon.
In very severe cases, the colon above the abscess is brought out to the skin by a surgeon and the intestinal contents are temporarily collected in a bag. This is called a colostomy. Later, when the infection has settled down, the affected colon is removed and the colon rejoined. Rarely, there may be free perforation of intestinal contents into the peritoneum.
Peritonitis is life threatening and requires emergency surgery. Also rarely, a severe attack of diverticulitis may cause a narrowing of the colon that causes an obstruction. It also rarely may cause a passage from one segment of the colon to the small bowel, bladder, vagina, or skin. The latter phenomenon is called a fistula. These complications are rare and should not concern those who have uncomplicated diverticula.
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