Recurrent Diverticulitis- Diagnosis and Treatment

What Is Diverticular Disease?

Diverticular disease is a disease that creates small sacs and pouches from the wall of the colon, and complications arise from the presence of those sacs. Many terms related to a diverticular disease can be confusing and deserve a definition. The individual sac is called the diverticula. Multiple pouches and sacs are diverticula. Simple diverticula within the colon but without complications are called diverticulosis. The presence of diverticulosis can lead to different complications like perforation diverticulitis, fistula, stricture, and bleeding.

What Is Recurrent Diverticulitis?

Recurrent diverticulitis occurs after nonsurgical acute attack management. Rarely do individuals after resection for sigmoid diverticulitis. Around 20 to 35 % of individuals have recurrent attacks of acute diverticulitis. The cause of the diverticular disease is unknown. The condition is connected with excessive alcohol use, low fiber intake, steroids, lack of exercise, obesity, and smoking. The mean age of getting diverticulitis is approximately 65 years, and life expectancy is 14 years.

Who Is Affected by Diverticulitis?

Diverticulitis is very common, and the proportion of the population with diverticulosis increases with age. This condition is uncommon at the age of 30 years, around 30 to 40 % of people aged 60 years of age have diverticulosis, and up to 50 to 80 % of 80 years aged people have diverticulosis. Around 10 to 20 % of individuals who have diverticulosis develop symptoms, around 10 to 20 % need hospitalization and only 1 % will need surgery.

What Are the Signs and Symptoms of Diverticulitis?

The most common complication of diverticulosis is diverticulitis. Diverticulitis is an inflammation of the colon and causes perforation of the individual sac. An estimated 10 to 20 % of individuals will develop diverticulitis. The signs and symptoms of diverticulitis are:

• Abdominal pain or pelvic pain.

• Fever.

• Abdominal tenderness.

• Constipation, less commonly, diarrhea.

• Nausea and vomiting.

• Pain can be constant for several days. Sometimes the right side of the abdomen is more painful.

Who Is at the Risk for Diverticular Disease?

The risk factors increase an individual's chance of getting a disease or problem. The risk factors for the diverticular disease include:

• Low Fiber Diet: In a low fiber diet, vegetables, fruits, and red meat intake can lead to a high risk of developing diverticular disease. Lack of fiber may increase the risk by three times, and adding fiber to the diet may help to protect the colon from diverticular disease.

• NSAIDs: Drugs like Ibuprofen can cause arthritis and are also an associated complication of diverticulosis.

• Alcohol: Excessive alcohol consumption may increase the risk of diverticulitis by 2- 3 times as compared to the general population.

• Age and Gender: Age and gender are risks of complications from diverticulosis. Women suffer from complications from diverticulosis later in life than men. The individuals who have been affected by age 50 years, will be more virulent from the disease.

• Immune Status:An individual's immune system is suppressed from medications and severe complications like colonic perforation.

How Is the Diagnosis Done for Diverticulitis?

Diagnosis of diverticulitis is done by a healthcare provider. To get the correct diagnosis a detailed medical history is taken, and symptoms related to the type of food and bowel movements are noted. A physical examination is done to check for symptoms of pain and tenderness. Other tests done to diagnose the condition are :

• Stool Sample: Is taken to check for the presence of bleeding and abnormal parasites and bacteria.

• A blood Test: Is taken to check for signs of infection, and the presence of WBC (white blood cells).

• Digital Rectal Examination: The lubricated gloved finger is gently inserted into the rectum to check for problems in the rectum and anus.

• Barium Enema: Liquid-containing barium is injected that coats the inside of the colon and helps the colon to be more visible in x-rays.

• CT Scan: Computed tomography scan is done to check for inflamed diverticula.

• Colonoscopy: A light-headed flexible tube is inserted in the colon to examine abnormal sores, ulcers, and growth that cause bleeding problems and pain.

• Sigmoidoscopy: A thin flexible tube with a lightheaded camera is inserted in the rectum to get a visual inspection of the sigmoid colon and rectum.

• Angiography: In this test arteries that supply blood to the colon are injected with a dye that is harmless and bleeding is checked.

What Is the Treatment Provided for Recurrent Diverticulitis?

There is no current treatment for preventing the recurrence of diverticulitis. Some studies have shown probiotics, Rifampicin, and 5-aminosalicylic acid act on diverticulitis recurrence.

Healthcare providers may prescribe oral antibiotics like Metronidazole, Ciprofloxacin Amoxicillin, and Clavulanic acid. Over-the-counter drugs are given till the symptoms subside. In severe conditions, intravenous IV antibiotics fluids are given and considered for surgery.

Surgery for diverticulitis is done under consideration:

• Abscesses: in this condition, the abscess is cleaned, and the affected part of the colon is removed by the surgery.

• Blockage or strictures: infections result in scars and strictures. Complete blockages require surgery.

• Perforation: this life-threatening condition requires immediate surgery to clean the cavity and remove the damaged part of the colon.

• Fistulas: Abnormal passageway connects with other organs. Most fistulas close on their own and others do not close and require surgery.

• Rectal Bleeding: mild bleeding stops on its own while surgery is needed if the attempts are failed. If bleeding is heavy emergency surgery is required.

How Is Recurrence of Diverticulosis Prevented?

Regular bowel movements should be followed to avoid constipation and straining, prevent diverticular disease, and reduce complications. To acquire this:

• Drink Plenty of Water: to compensate for fiber, plenty of fluids are required to maintain balance and keep the stool soft and help it move easily through the colon.

• Exercise Daily: A 30-minute physical exercise can help food pass through the intestine easily.

• Eat more Fiber: Fiber extracts more water from stools and makes them bulkier, softer, and more motile in the colon.

Conclusion

Sigmoid diverticulitis is a common condition that raises morbidity and mortality. Management of this recurrent diverticulitis with an indication of surgical intervention. The main target of uncomplicated diverticulitis is broad-spectrum antibiotic therapy. The complicated diverticular disease requires typical intervention to resect a diseased stricture colon, and life-threatening colonic perforation. Minimal-invasive surgery is used in the management of the disease and localized colonic perforation is managed by laparoscopic peritoneal lavage.