- Diverticulitis: description
- Diverticulitis: symptoms
- Diverticulitis: causes
- Diverticulitis: examinations and diagnosis
- Diverticulitis: treatment
- Diverticulitis: disease course and prognosis
At a diverticulitis (Diverticular disease) form protuberances in the intestinal wall - called diverticula - and become inflamed. This usually happens in the last, descending part of the colon. Diverticula are very common among older people in the industrialized nations and are inflamed by every fourth to fifth person affected. Here you will learn everything important about the causes, symptoms, course and treatment of diverticulitis.
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. K57
Dr. med. Mira Seidel
One risk factor for diverticulitis is a low-fiber diet. Avoid white-meal, fat and sugar-containing foods.
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
Diverticulitis is a condition in which bulges in the large or small intestine become inflamed. These protuberances refer to physicians as diverticulum; in several diverticula one speaks of diverticulosis. Intestinal diverticula are not pathological and cause no symptoms at first. In 90 to 95 percent of cases, they occur in the descending branch of the colon, especially at the point where the intestine makes an S-shaped bend (sigmoid or sigmoid colon). However, when the diverticula become inflamed, it can cause discomfort such as abdominal pain, fever, constipation and flatulence.
Doctors distinguish between different forms or stages of diverticulitis:
- In about 75 percent of cases, there is one acute uncomplicated diverticulitis in front. Although the diverticula can cause unpleasant discomfort, but do not lead to further complications and damage in the intestinal wall. Almost always a conservative diverticulitis therapy is possible - that is a treatment without surgery.
- At a acute complicated diverticulitis the inflamed protuberances cause further problems, e.g. Abscesses, fistulas, a bowel obstruction or a hole (perforation) in the intestinal wall. Then usually a diverticulitis operation is necessary to avoid serious health consequences.
- In people with one Chronic-recurrent diverticulitis the diverticula ignite again and again, causing permanent damage in the intestinal wall. The sufferers suffer from recurring pain, constipation and other symptoms.
Often, the inflammation is limited to the environment of individual diverticula (peridiverticulitis), but it can also spread to larger sections of the intestine (pericolitis).
Diverticulosis is not dangerous in itself but may develop into diverticulitis. Read more in the article Diverticulosis.
For more on the signs and symptoms of diverticulitis, see: Diverticulitis - Symptoms.
Many patients with diverticulitis suffer from it constipation, It is believed that a low-fiber diet promotes the development of diverticula. Fibers are mainly found in fruits, vegetables and whole grains - but significantly less in industrially produced white flour products such as bread and rolls, pizza, French fries and other highly processed foods. This thesis suggests that the proportion of people with diverticulitis has risen almost exponentially in the past 100 years - in line with changes in dietary habits.
Low-fiber diet makes the chair hard and firm. The internal pressure in the intestine is thus higher than when the stool is soft and supple. This pressure and the connective tissue, which is less elastic in old age, cause the mucous membrane of the intestine to bulge outward in some places: diverticula form.
Remains of stool residues in the diverticula, especially if the stool accumulates in constipation, the protuberances can ignite and it develops a diverticulitis. The inflammation can be limited to the diverticulum, but also spread to the surrounding intestine.
Diverticulitis: examinations and diagnosis
Important advice for the diagnosis of diverticulitis is given by the doctor medical history (Anamnese). He asks the patient where exactly the pain is and how it feels. Other symptoms such as fever and constipation are important clues; as well as the question of whether such an event has occurred before. Some people know that they have diverticula in the gut or have already undergone diverticulitis. Not infrequently, the doctor also randomly detects diverticulum as part of a colonoscopy.
Sometimes doctors can treat the inflammatory diverticulum as a hardened structure in the left lower abdomen grope, The palpation can be painful in diverticulitis. Physical examination also requires the doctor to snap the anus with his finger to detect changes in the rectum (digital-rectal examination).
In the blood test For example, diverticulitis often causes elevated levels of inflammation - for example, an increase in the number of white blood cells (leukocytes), an altered blood cell lowering rate (ESR), and an elevated C-reactive protein (CRP). An experienced examiner can also check the inflamed diverticulum Ultrasonic recognize. By means of computed tomography (CT) or magnetic resonance imaging (MRI) diverticulitis can be displayed much more accurately.
Sometimes the diagnosis of diverticulitis is one X-ray photograph of the abdomen when standing: If a diverticulum breaks, free air can enter the abdomen, which accumulates under the diaphragm and is clearly visible on the x-ray.
The Diverticulitis Therapy Depends on which discomfort the person has and which structures are inflamed in the abdomen. Uncomplicated diverticulitis can be dealt with acutely with measures such as fasting and liquid diet, long-term with a fiber-rich diet and regular, physical exercise under control. Similarly, in diverticulitis, antibiotics (for example, metronidazole and ciprofloxacin) or anti-inflammatory agents such as aminosalicylates may be used. Anticonvulsant drugs such as metamizole and butylscopolamine can help with diverticulitis treatment.
Patients with diverticulitis who have severe pain or fever should be hospitalized in the hospital be treated. In many cases they are not allowed to eat. Instead, they get infusions and antibiotics. Often the diverticulitis therapy succeeds even without surgery. If the symptoms improve, you start to eat after about two to three days.
In cases of severe diverticulitis or complications, such as intestinal perforation (breakthrough of the intestinal wall), surgeons recommend removing the damaged bowel section. In the case of bowel perforation, surgery must be done as soon as possible. In other cases, doctors plan the surgery only after the inflammation has subsided, about six to eight weeks after the start of antibiotic therapy. However, the operation may also take place sooner if the symptoms do not disappear despite antibiotic infusions.
If an abscess (pus accumulation) has formed in the abdomen, it will be punctured with a needle and the pus drained as part of the diverticulitis therapy, depending on where exactly it is.
If one or more diverticulae have burst, the affected piece of intestine must be removed as soon as possible. Otherwise there is a high risk that the entire peritoneum inflamed (peritonitis). The peritoneum is a thin skin that lines the abdominal cavity from the inside.
Recurrent (chronic recurrent) diverticulitis should also be operated on.
Course of diverticulitis surgery
During surgery, the intestinal section is removed with the diverticula and the remaining intestinal ends sewn together again.
For diverticulitis surgery is a laparotomy required. In some clinics, surgeons remove the diseased bowel as part of a laparoscopy. In this so-called laparoscopic-assisted technique Nevertheless, a small abdominal incision is needed - unlike a purely laparoscopic surgery, such as a gall bladder removal. If diverticulitis has occurred during diverticulitis, this definitely requires open surgery.
In an emergency or a particularly serious inflammation sometimes an artificial bowel (anus praeter) is applied to temporarily relieve the intestinal suture. The artificial exit is usually relocated a short time later in a second operation. Sometimes the normal intestinal transit can not be restored. The intestine then ends at a hole in the skin. The chair gets into a pouch that is attached to the skin.
Complications of diverticulitis surgery
In about one percent of cases complications occur during diverticulitis surgery. For example, the new connection of the intestinal sections does not hold (anastomotic leakage) and it accumulates pus in the abdominal cavity (abscess). It is also possible that the surgical wound heals only delayed (wound healing disorder), or that later a break in the scar arises (incisional hernia). If diverticulitis requires emergency surgery, the risk of complications is much higher.
Tips against relapse
In 30 percent of patients, diverticulitis recurs after a while (relapse). However, the risk decreases when patients eat high fiber, drink a lot (at least 2 to 2.5 liters per day) and avoid constipation.
Physical exercise also gets the intestines going. The sport is easier and more fun when you lose excess pounds.After a diverticulitis surgery, you should not lift heavy loads (over ten kilograms) for about four to six weeks so that there is no scar fracture.
Why diverticula form in some people is not clear. A general connective tissue weakness, constipation and constipation seem to favor the outpourings of the intestinal wall and thus diverticulitis.
A healthy lifestyle prevents diverticula and the associated diverticulitis and reduces the risk of inflammation. With a few simple measures, keep your digestion going:
- Move Do it regularly, preferably two to three times a week, at least half an hour. Operate e.g. Endurance sports such as jogging or swimming.
- Drink It is sufficient (at least two liters a day), preferably mineral water or herbal tea.
- Nourish yourself high fiber with fruits, vegetables and whole grains, but less sugar and white flour products.
So you can protect yourself from diverticulitis with a few small lifestyle changes.
How to eat properly, if you have a diverticulitis or you want to prevent, read in the article diverticulitis - nutrition.
Read more about the investigations
- stool examination
Diverticulitis: disease course and prognosis
When inflamed diverticula break up (perforate) in diverticulitis, circumscribed buildup of abscesses (abscesses) may form in the abdomen. Diverticulitis can also spread to the peritoneum (peritonitis). Bleeding occurs in about five percent of patients with diverticulitis.
In addition, diverticulitis can cause a section of the intestine to compress so that its interior narrows (stenosis). If the intestinal contents are no longer transported via this bottleneck, intestinal obstruction (ileus) develops.
In the context of diverticulitis, it is also possible for connecting ducts to form between different sections of the intestine, intestine and bladder, or intestine and vagina. These so-called fistulas are very uncomfortable and often expensive to treat.
After a first diverticulitis, the risk of recurrence is 30 percent. The earlier in life one diverticulitis The more likely she or she has to be treated by surgery.
Read more about the therapies