Diverticular Disease - Thesurgeons Pte Ltd

Diverticular disease is a condition that involves the formation of small bulges or sacs (known as diverticula) on the wall of the large intestine (colon), most commonly on the left side of the colon.

Diverticular disease is also a general term encompassing Diverticulosis (the presence of diverticula) and Diverticulitis (the inflammation and infection of diverticula).

DIVERTICULOSIS VS DIVERTICULITIS

Diverticulosis is a common occurrence (especially among older people) and typically does not present with symptoms, in which case treatment is not necessary. Among those with diverticulosis, 80-85% remain asymptomatic; whereas 15-20% will develop diverticulitis.

Diverticulitis occurs when one of more diverticula becomes inflamed and infected. In such cases, one may experience abdominal pain, diarrhoea or constipation, nausea, fever, mucus or blood in stools. Diverticulitis requires prompt medical attention to treat.

WHAT CAUSES THESE?

The main theory for the formation of diverticula is due to high pressure within colon, causing weakened areas of the colon wall to bulge out and form the sacs. Another possible contributing factor is having a diet low in fibre and high in red meats.

On the other hand, it is currently still unclear how diverticula become inflamed and infected (diverticulitis).

DIAGNOSING DIVERTICULAR DISEASE

After assessing your medical history and listening to your symptoms, it is important for your doctor to rule out other conditions (with some similar signs and symptoms first): irritable bowel syndrome, coaeliac disease, and colorectal cancer.

Tests for these conditions may involve blood tests, colonoscopy and/or a CT scan.

NON-SURGICAL TREATMENTS

Diverticulosis alone without any symptoms typically does not require any treatment to be done. However, as diverticulosis could lead to diverticulitis, your doctor may advise you to make dietary changes (i.e. consume a high-fibre diet) as a preventive measure.

When it comes to diverticulitis, however, mild cases can be treated with oral antibiotics; while serious cases may require hospitalisation, intravenous antibiotics, intravenous fluids, bowel rest or possibly even surgery.

WHEN IS SURGERY FOR DIVERTICULITIS NEEDED?

Surgical treatment is performed only in a very small group of cases; and usually involves removing the diseased section of the colon and reattaching the remaining ends back together.

Typical indications for surgery include:

Severe diverticulitis that did not respond to medications
Recurrent diverticulitis despite a high-fibre diet
Abscesses (a complication of diverticulitis) that failed to drain using a catheter
Development of complete blockages, fistula formation and peritonitis (a tear in the colon resulting in life-threatening infection)
Persistent rectal bleeding (aka “diverticular bleeding”)
Strong suspicion of cancer (after necessary imaging tests have been done)