What is Acute Diverticulitis? The Symptoms and Treatment Options

By Dr Clinton Marlar

The Surgeons of The Surgical Clinic want everyone to know the signs and symptoms of a flare-up in your colon called acute diverticulitis. Colonic diverticula are small herniations through points of weakness in the muscular wall of the colon. These pouches usually happen near your rectum and primarily affect the sigmoid colon. When the colon is inflamed and infected, diverticulitis can occur. In this post, we will discuss what you need to do when these symptoms occur.

What Causes Acute Diverticulitis?

Acute diverticulitis develops when colonic wall herniations become inflamed and infected. This herniation is usually due to a blockage of the lumen or obstruction from stool, which can cause pressure on nearby tissues. Inflammation in the peritoneal cavity often occurs.

The most common causes of acute diverticulitis are fecal impaction, diarrhea, appendicitis, or obstruction by colon cancer. In the past, some foods were thought to cause diverticulitis, like nuts and seeds, beans, and fried foods. There has been no evidence that these foods can become lodged in diverticula and create inflammation.

The Surgical Clinic provides expert management for treating any type of case involving an inflamed and infected hernia in the abdominal cavity.

What Are Signs and Symptoms?

The most common symptoms of diverticulitis are:

• Left lower quadrant abdominal pain
• Fevers
• Chills
• Rectal bleeding
• Urinary urgency
• Altered bowel habits

Acute diverticulitis can present in various ways, from mild intermittent pain to chronic severe unrelenting abdominal pains. Fever and a change in bowel movements are common, along with constipation and diarrhea.

The symptoms of diverticulitis can also look like other problems. 

Acute diverticulitis can look like a bladder infection or appendicitis. In some cases, diverticulitis can be mistaken for irritable bowel syndrome or Crohn’s colitis disease. This is why it’s essential to see a doctor and rule out other intestinal diseases to ensure you are getting proper treatment.

How Do You Diagnose Acute Diverticulitis?

CT scan is the preferred diagnostic test for acute diverticulitis because it provides information on the severity of the disease and identifies complications. 

With overt peritonitis, a doctor may notice rigidity and tenderness upon examination of the stomach area. Laboratory testing often reveals leukocytosis and elevated inflammatory markers.

Risk Factors for Colon Inflammation

Risk factors for acute diverticulitis are varied and can be different for men and women.

• Age: The risk of developing diverticular disease increases with age. Around 50% of individuals over 60 years old have this condition.
• Gender: Men between 40 and 50 years old may be at a higher risk due to prostate enlargement. Older women are more affected than men. Hospitalization from the disease is more common in women, as well.
• Diet: People who consume high levels of meat produce more intestinal gas than others in their diet, leading to constipation and fecal impaction that leads to diverticulitis. Low fiber intake hasn’t been shown to prevent diverticulosis but may play a role in preventing diverticular disease from forming in the first place.

Complications of Diverticulitis

Diverticulitis can become a chronic condition, with inflammation and scarring leading to bowel blockages. The chance of recurrent attacks after a second episode of diverticulitis is greater than 50% and increases with each episode.

It is vital to get a prompt diagnosis and treatment, or else the disease can lead to complications. 

• The most common complication is a localized abscess, which can usually be treated successfully with percutaneous drainage and antibiotics.
• Acute complications include intestinal obstruction or perforation, which will require surgery to repair the damage done by either one.
• Other acute complications are related to infection such as abscesses (pus) and sepsis (blood poisoning). These may occur from blood clots traveling through the bloodstream and lodging themselves into other parts of the body like the lungs or brain. Septicemia has a 50% mortality rate if left untreated, so prompt medical attention is needed for these types of infections.
• Diverticulitis is the most common cause of fistula between the colon and bladder. Severe cases of perforation can present with generalized peritonitis; this requires immediate operative intervention. In cases like these, it’s generally unsafe to restore intestinal continuity because of the increased risk of anastomotic leak. The appropriate surgical treatment in the emergent setting often requires creating a temporary colostomy or diverting ileostomy.

What Are the Treatment Options?

The Surgical Clinic offers a variety of treatment options for diverticulitis – from conservative management to surgical intervention. The decision between one or another is based on your symptoms and medical history. You must be aware of all the potential outcomes before making any decisions about your care plan.

Uncomplicated cases can often be treated with oral antibiotics on an outpatient basis. Focal peritonitis or systemic symptoms usually indicate that hospitalization, intravenous antibiotics, and bowel rest are necessary. Patients who improve with antibiotics should be evaluated with a colonoscopy to exclude cancer which can mimic diverticulitis. 

Treatment Options for Acute Diverticulitis:

• Bowel rest is a technique to help the body recover from inflammation naturally.
• Antibiotics and IV fluids are often prescribed to reduce inflammation and infection. The infection can spread to the bladder or hip joint if left untreated.
• Surgical treatment may be necessary if the diverticulitis is severe or there are complications. Surgical treatment with elective colon resection should generally be considered for patients with recurrent diverticulitis or following recovery from complicated diverticulitis. Elective colon resection has a lower risk of morbidity compared to an urgent operation. It generally avoids the need for a colostomy and can usually be accomplished laparoscopically. Laparoscopic colon resection is associated with shorter hospitalization and more rapid recovery compared to open surgery. 

For more information, please contact one of our Tennessee clinic locations if you have questions or concerns. The surgeons at The Surgical Clinic can help diagnose any intestinal discomforts you feel and create a custom treatment plan. Leaving acute diverticulitis untreated can be dangerous, so don’t wait. Visit our locations page to find a surgical center near you!

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