Diverticulitis is an inflammation of the diverticulum or the wall of the colon . Diverticulum is a saccular protrusion that can arise in different parts of the human body, but most often it occurs in the intestine.
Western countries have the highest incidence of this illness which ranges about 35% of the adult population. Diverticulum causes inflammation in 5-10% of patients. The disease occurs commonly among elderly people.
Diverticula form in the intestine as a consequence of the following combination of factors:
Diverticulitis is a result of genetic predisposition in 40%; and a consequence of the patient’s lifestyle in 60% of the cases. There are also risk factors that can be controlled:
The risk of the illness increases under the influence of other intestinal inflammatory diseases or in the case of helminthiasis.
Diverticulitis develops in the lower parts of the intestine. 80% of patients suffer from the sigmoid colon or the descending colon damage. Abdominal pain is the main sign of the disease.
It is peculiar with:
Diverticulitis is often accompanied by stool disorders. Constipation can be followed by periods of diarrhea. The stool becomes liquid.
10% of patients suffering from diverticulitis have signs of bleeding in the stool masses of a scarlet colour. Blood evidences the presence of erosions in the inflamed diverticulum, and may be the sign of possible complications. The appearance of blood in the faeces can be preceded by a brief acute pain in the abdomen.
Diverticulitis is followed by the intoxication syndrome as well as any other inflammatory processes. Intoxication is manifested by:
The more evident the intoxication syndrome is the worse the prognosis of the illness is. This means there is a high probability of surgical intervention required for the treatment of diverticulitis.
All clinical signs of diverticulitis are nonspecific. Therefore, the establishment of a correct diagnosis without additional examination is impossible.
The diagnostic process is done with the help of the next techniques:
Some patients undergo other methods of diagnostics, but they are contraindicated in the acute phase of inflammation because of the increased risk of intestinal perforation.
Such diagnostic procedures include:
Instrumental research methods can detect inflamed diverticulum, determine its location and size, and plan the tactics of surgical treatment, if needed.
Diverticulitis can occur with varying degrees of severity. The mild form of the disease is treated on an outpatient basis. The intensification of the inflammatory process requires admission to the hospital for therapeutic measures. Surgical treatment is also required in some cases.
Conservative therapy is based on a prescription of antibiotics. They destroy the pathogenic bacterial flora that has caused the inflammatory process. But after effective etiotropic treatment, diverticulitis may not disappear anywhere, so the development of diverticulitis may recur in the future. A doctor prescribes laxatives, antispasmodics, anti-inflammatory drugs for pathogenetic and symptomatic treatment.
Diet therapy. A patient is prescribed a special diet. The most rigid version of the diet means complete exclusion of food for several days. Fluid consumption increases up to 2-3 litres per day.
Surgical treatment is performed in less than 30% of patients. Surgery can be an emergency or a planned one. Emergency intervention is an immediate response in the case of complications of diverticulitis which include:
Indications for the planned surgical treatment of diverticulitis:
Surgical treatment presupposes the removal of the problematic part of the intestine. Surgery can be performed in an open manner or using laparoscopic measures. Modern German hospitals give preference to the less invasive laparoscopic operations. A doctor inserts a camera and the instruments into the abdominal cavity through the small incisions. Every move is monitored by an image that is projected onto the screen.
Diverticulitis is a dangerous disease that can result in a fatal outcome in the most unfavourable case. More than 10 thousand people die each year because of diverticulitis in Europe.
Nevertheless, life prognosis is favourable in most cases. Conservative treatment helps to get rid of the inflammation. Only 20-30% of cases require surgical intervention.
The risk of reoccurrence of the disease is about 25%. Conservative therapy becomes ineffective for the treatment of repeated diverticulitis. For example, medicines are effective only in 6% when administered for the third-time for the inflammation treatment. For those patients that do not respond to medication,then surgical treatment is required.
Surgery held in a well established modern hospital ensures a higher chance to completely recover and be healed. The diverticulum is removed during surgery from the intestine as a source of the inflammation.
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