DIVERTICULAR DISEASE
What is diverticular disease?
Diverticular disease is a common condition that affects the colon, characterized by the formation of small pockets called diverticula in the colon wall. While some people with diverticular disease may not experience any symptoms, the two most common problems associated with the condition are bleeding (diverticular bleeding) and infection (diverticulitis).
What are the symptoms?
Mild diverticulitis may present with abdominal pain, bloating or change in bowel habit such as constipation or diarrhoea.
More serious diverticulitis may present as acute abdomen (severe abdomen pain which may need emergency medical treatment)
Mild cases may involve blood that is mixed with the stool or coats its surface.
In more severe cases, the bleeding may occur in multiple episodes over a short period of time, leading to significant blood loss that can cause symptoms like fainting, dizziness, and low blood pressure (hypotension).
Is there any complication from diverticular disease?
Abscess: A collection of pus can form in the wall of the colon, causing pain, fever, and tenderness.
Perforation: If the infected diverticula burst, it can lead to a hole or tear in the colon, causing inflammation, infection, and even peritonitis.
Fistula: An abnormal connection between the colon and other organs or tissues, such as the bladder or vagina.
Bowel obstruction: Inflammation or scarring from diverticulitis can narrow the colon and cause a blockage, leading to abdominal pain, nausea, vomiting, and constipation.
Complications of diverticular bleeding depend on its severity. In mild cases, there may be no complications, but in severe cases, significant blood loss can cause anemia, shock, or even require surgery.
Is diverticular disease a risk factor for cancer?
Diverticular disease does NOT increase the risk of developing colon cancer, nor can it transform into colon cancer. However, the symptoms and imaging results of colon cancer can be very similar to those of diverticulitis. Therefore, it is essential to undergo a colonoscopy after recovering from diverticulitis to rule out the possibility of colon cancer.
How to treat diverticular disease?
Treatment options for diverticulitis vary depending on the severity of the condition.
- Mild cases can often be managed with rest, a clear liquid diet, and oral antibiotics.
- More severe cases may require hospitalization to administer intravenous antibiotics.
- If an abscess has formed, a small catheter may be inserted into the abscess for drainage.
- Surgery may be recommended in cases of recurrent or complicated diverticulitis that do not respond to conservative management. This may involve removing the affected portion of the colon, and it may be done through an open or laparoscopic approach.
Treatment for diverticular bleeding depends on the severity of the bleeding. In mild cases, bleeding may resolve on its own without medical intervention. However, in cases requiring medical attention, treatment options may include:
- Colonoscopy: An emergency colonoscopy can be performed to remove any blood in the colon and identify any actively bleeding diverticula. If a bleeding site is found, injection or clips may be used to stop the bleeding.
- CT Angiography: This specialized CT scan can be used to pinpoint the exact location of bleeding in the colon. If identified, angiography may follow, during which a guide wire is inserted through a small incision in the wrist or groin and guided to the bleeding site. Special coils may then be placed to stop the bleeding.
- Surgery: If bleeding persists despite efforts to locate the source, surgery may be required. In some cases, patients with multiple episodes of recurrent diverticular bleeding may undergo colectomy in an elective setting.
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