A pouch that forms in the wall of the large intestine is called a diverticulum. When it becomes infected or inflamed it is called diverticulitis.

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1 Diverticulitis (Acute Diverticulitis; Acute Colonic Diverticulitis) by Debra Wood, RN En Español (Spanish Version) Definition A pouch that forms in the wall of the large intestine is called a diverticulum. When it becomes infected or inflamed it is called diverticulitis. Diverticulitis Infected pouches along the colon Nucleus Medical Media, Inc. Causes It is not clear why the pouches form. Doctors believe a constant pressure is built up when food moves too slowly through the bowel. This pressure increases then pushes along the side walls creating pouches. Digested food or stool can become trapped in one of the pouches. This leads to inflammation and infection. The following may contribute to diverticulitis: Low-fiber diet Fiber softens stools and makes them pass through the bowel more easily Increased pressure in the bowel from straining to pass a hard stool Page 1 of 5

2 Defects in the colon wall Chronic constipation Risk Factors Factor that increases your chance of getting diverticulitis include: Eating a low-fiber diet Age: 50 or older Previous episodes of diverticulitis High meat or protein diet Chronic constipation Smoking Symptoms Symptoms can come on suddenly. They vary depending on the degree of the infection. Symptoms include: Abdominal pain Tenderness, usually in the left lower abdomen Swollen and hard abdomen Fever Chills Poor appetite Nausea Vomiting Diarrhea Constipation Both diarrhea and constipation Cramping Rectal bleeding Diagnosis The doctor will ask about your symptoms and medical history. A physical and rectal exam will be done. Finding the disease early is important. The pouch can break, releasing stool into the abdomen. This is a surgical medical emergency. Tests may include: Analysis of a stool sample to look for blood Blood tests to look for signs of infection, inflammation, and bleeding X-rays to look for a rupture CT scan or ultrasound to locate and determine the size of the inflamed pouch Once the inflammation subsides, other tests may be performed, including: Page 2 of 5

3 Barium enema injection of a dye into the rectum that makes your colon show up on an x-ray so the doctor can see abnormal pouches in your colon Flexible sigmoidoscopy a thin, lighted camera is inserted into the rectum to examine the rectum and the lower colon Colonoscopy a thin, lighted camera is inserted through the rectum and into the colon to examine the entire lining of the colon Treatment The goals of immediate treatment are to: Resolve the infection and inflammation Rest the bowel Prevent complications Treatments include: Medications Antibiotics and other drugs are given to fight the infection. Pain medications and drugs are given to decrease the abdominal pain. Fluids For mild inflammation, you can drink clear liquids for the first two to three days. For a more severe case, you will be admitted to the hospital, where fluids are given intravenously (IV). Antibiotics will be given to you through IV. If you have nausea and vomiting, a plastic tube may be inserted through your nose into your stomach. This will help with the vomiting and make you feel more comfortable. Preventive Care Changes in your diet can help prevent future attacks. Surgery Increase the amount of fiber you eat by eating more fruits, vegetables, and whole grains Supplement your diet with a fiber product, as recommended by your doctor Avoid laxatives, enemas, and narcotic medications that can lead to constipation Surgery to remove the section of the bowel with pouches may be recommended if: You have had multiple attacks during a two-year period A pouch breaks and the contents spread into the abdominal cavity (will require cleaning out the abdominal cavity) When surgery is done on an elective basis, the surgeon will remove part of the disease bowel and hook the normal bowel together Surgery is also used to treat complications of diverticulitis, such as: Abscess occurs if the infected pouch fills with pus Blocked bowel scar tissue that forms and blocks movement of stool through the intestine Fistula occurs if the infection spreads and colon tissue attaches to another organ, such as the bladder or the uterus/vagina When surgery is done on an emergency basis, the surgeon will remove the diseased bowel. Because of the serious Page 3 of 5

4 infection, the two ends of the bowel will not be hooked together. You will most likely end up with a piece of bowel coming out to your abdomen ( colostomy). After a period of 6-12 weeks, the surgeon will go back and hook the bowel back together. If you are diagnosed with diverticulitis, follow your doctor's instructions. Prevention The following recommendations may help prevent diverticulitis by improving the movement of stool through the bowel and decreasing constipation: Eat a balanced, high-fiber diet with plenty of fruits, vegetables, and whole grains Drink plenty of water each day Exercise regularly RESOURCES: American Dietetic Association American Society of Colon and Rectal Surgeons National Digestive Diseases Information Clearinghouse CANADIAN RESOURCES: Dietitians of Canada Health Canada REFERENCES: Conn HF, Rakel RE. Conn's Current Therapy Philadelphia, PA: WB Saunders Co;2001. Diverticulosis and Diverticulitis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: Accessed July 28, Diverticular Disease. American Society of Colon and Rectal Surgeons website. Available at: Accessed July 28, Goroll AH, Mulley AG. Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2000. Rosen P. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, MO: Mosby-Year Book, Inc;1998. Weisiger R, Bilhartz L, Sleisenger MH, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: WB Saunders Co; /9/2012 DynaMed's Systematic Literature Surveillance Hjern F, Wolk A, Håkansson N. Smoking and the risk of diverticular disease in women. Br J Surg. 2011;98(7): Page 4 of 5

5 Last reviewed September 2011 by Daus Mahnke, MD Last Updated: 2/9/2012 Page 5 of 5