From Florida Hospital Apopka

Senator John McCain has had a tough year, from a diagnosis of aggressive glioblastoma last summer to his recent surgery for diverticulitis. Never heard of diverticulitis? Here’s a look at this common, but potentially dangerous intestinal inflammation that often affects older adults.

What Is Diverticulitis?

“Diverticulitis is an infection of one or more diverticula – sac-like protrusions of the mucosa, or inner lining of the bowel,” explains Bruce Orkin, M.D., a board-certified colorectal surgeon with Florida Hospital Medical Group. These pouches develop from areas of weakness in the normally smooth colon wall. By age 70, half of all people will have some diverticula.

“The infection spreads around the colon, causing thickening of the wall and narrowing of the lumen (inside),” Dr. Orkin says. This can lead to pain, fever and in some cases, serious complications.

What is the Cause?

While the exact cause is not fully understood, most medical professionals agree that diet is an important factor. “People who eat a low-fiber diet have a much higher rate of developing the diverticular disease,” explains Dr. Orkin. Rates of diverticulitis are very high in the U.S., where the typical diet consists largely of high-fat, low-fiber foods. But diet isn’t the only issue.

“Other risk factors include decreased physical activity, smoking, constipation, obesity, steroid medication use, alcohol and frequent use of non-steroidal anti-inflammation medications (NSAIDs),” says Dr. Orkin.

What are the Signs and Symptoms of Diverticulitis?

In most cases, diverticulitis causes acute, sudden pain in the abdomen, usually in the lower left quadrant. Patients may experience nausea or vomiting, or come down with a fever. Diverticulitis frequently brings about changes in bowel movements, including constipation or diarrhea.

The disease often has varying symptoms, many of which may be confused with other ailments of the digestive system. Cecal (right colon) diverticulitis, for example, presents with severe pain in the right lower quadrant of the abdomen, similar to appendicitis. Diverticulitis can also cause inflammation of the peritoneum, the membrane that lines the abdominal cavity, leading to widespread pain throughout the abdomen.

How Common is Diverticular Disease?

Occasionally, diverticula will be present from birth, but most diverticula develop as we grow older. Approximately 50 percent of Americans over the age of 50 will develop diverticulosis – the presence of diverticular sacs, and 70 percent of people over the age of 80 will have these outpouchings.

Fortunately, not everyone who has diverticula will develop diverticulitis. “About 20 percent of people with diverticula develop symptoms,” says Dr. Orkin. “Only 10 percent of these require hospitalization, and less than 1 percent of all people with diverticula will need surgery.”

Diagnosing Diverticular Disease

Asymptomatic diverticula may be found by colonoscopy, lower GI contrast or barium studies, or CT scans. Symptomatic diverticulitis may be mild or severe. The diagnosis may be made based on physical exam, blood tests, and computed tomography (CT) scans.

When Diverticulitis Becomes Dangerous

Diverticulitis may result in a number of complications including localized abscesses along the colon wall, fistulas – holes between the colon and other organs such as the bladder, vagina or uterus, and strictures – narrowing of the bowel and blockage caused by intestinal scarring; Each may require surgery for repair and removal of the diseased intestine.

The most serious complication of diverticulitis is colon perforation – a blowout. This happens when the colon splits due to severe inflammation releasing fecal matter and bacteria into the abdominal cavity. This rapidly leads to peritonitis throughout the abdomen, a dangerous infection of organ membranes that can lead to widespread sepsis (infection throughout the body). In this uncommon but extremely dangerous situation, emergency surgery is required.

Signs that diverticulitis has become more serious include severe abdominal pain, chills, shaking rigors, weakness, headaches, and dizziness. If you feel any of these symptoms, contact your doctor or call 9-1-1, as it may be a medical emergency.

How is Diverticulitis Treated?

According to Dr. Orkin, diverticulitis is primarily treated with antibiotics. “Depending on the severity of the attack and how the colon looks on a CT scan, antibiotic pills and a liquid diet at home may be all that is needed,” he explains. “If the attack is more severe, hospital admission for bowel rest and intravenous antibiotics may be required.” Repeated episodes or complication require removal of the diseased segment of bowel.

Simple steps you can take to prevent diverticulitis include keeping hydrated, eating a high-fiber, low-fat diet, not smoking and staying physically active.

How Likely is Diverticulitis To Occur Again?

After one attack of diverticulitis that improves with antibiotics, one in three patients will have a second attack. That likelihood increases with every subsequent attack. After three episodes, the likelihood of a recurrence is 90 percent.

To be certain that nothing more serious is at work, Dr. Orkin recommends follow-up testing after an attack. “After resolution of the initial episode of diverticulitis, the entire colon should be evaluated with a colonoscopy to confirm the diagnosis, and to make sure that other problems such as cancer, inflammatory bowel disease or ischemia are not present.”

4 COMMENTS

  1. What a shame it is, that a man like Donald Trump, as a Republican, got to be president, rather than an honorable Republican man, such as John McCain. I wish him prayers during his illnesses, and peace.

  2. My mother first became aware that she had diverticulitis after a surgeon visit and tests, and was told she needed immediate surgery, so she was scheduled surgery, and had it back in 2001. She recovered just fine, but then in 2005, she was very ill, her stomach was hurting her badly, and she could not swallow food, water, or medicine, and keep things down, as whatever went down, would come back up, and I begged her to let me take her to the ER. She refused, and said it was just a stomach virus, that she would be okay. This went on for 3 days, until I got somewhat aggressive with her, and showed off and cried, and said, “what do you want me to do, let you lie here in bed and die?” and I got to crying and showing off….well, after I calmed down, and then encouraged her that I would clean up the bedroom, and help her change her clothes, and help her fix up, (she was more worried about her looks than her illness) before I called the paramedics, she finally agreed to go to the hospital, and I called the ambulance, and off to the hospital she went, this after she had fussed at me, and told me, I wasn’t treating her right, which sent me into the living room crying my eyes out, as I was only trying to get her help…..the ER doctor soon discovered she had a strangulated bowel obstruction, she was sent to Altamonte Springs, had surgery, they removed a lot of her colon, and the surgeon said if it had been a day or more later, she would have died from gangrene that was starting to form in the pockets of bubbled weakened diverticulitis and if anything had of went into her lungs going down, she would have gotten pneumonia, and possibly died from that also. She was not allowed any water to drink in the hospital for about a month, just wet swabs to swab around in her mouth, and intravenous fluids. Her stomach was like a pregnant woman’s stomach when she headed into surgery, and was flat as a pancake after the surgery, as they pumped a whole bunch of fluids out of her. She was in the hospital about a month, then went into the nursing home, behind the old Florida Hospital here in Apopka, for several weeks to recover, got out and soon, we were going everywhere together having fun once again. The bowel obstruction was caused by the previous abdominal surgery she had for diverticulitis in 2001, and that had scarred over, healing wrongly, so said the surgeon. She later apologized to me, for saying I didn’t treat her right (somewhat, as she said that she shouldn’t have said that, I guess, is what she said) and she did not have to have a colostomy bag on her side, like she feared. The dumbest thing was, that I thought she had West Nile Virus, and that was my diagnosis. The surgeon had called me into a room, after her surgery, and told me she will be okay, and will survive this, and he was right. The only thing is she did die later on several months later, but I think it was from a stroke in her sleep, and she did have bronchitis, and she had an irregular heartbeat, and had been hiding that fact from us, and that she had several mini strokes, but she could not fool the doctors and their equipment and tests. I told her when she went into surgery,” Mama, I will be right here for you, when you get out of the operating room.” I always told her I loved her, before the surgery, and don’t worry, I will be right here waiting for you.” I guess I was such a bad daughter, in her mind, during this ordeal. What was I suppose to do? I wish she was still alive, so I could ask her, “Mama, why did you say that to me, that I didn’t treat you right, because all I was trying to do that day was to get you help?”….it still gets to me, when I think about that day, and I guess I will have to learn to get over it, as I have no choice. I was always by her side, at all of her hospital stays and surgeries…..right there waiting, when no one else was, so I was such a bad daughter, I guess. My Mama and me used to have our ups and downs, but our downs didn’t last hardly any time at all, a day at the most, and we were always together, and I really do miss her so much everyday, as we had a lot of fun together. She had a way about her though, that could make me feel guilty for my each and every breath….LOL, but she was my special and God-given mom and no one else’s, she was uniquely mine…..LOL Happy Mother’s Day up there in heaven, Mama, I love you.

  3. I see where Melania Trump is in the hospital at Walter Reed Medical Center, and has had surgery on a benign serious kidney condition. She will be in there about a week, to recover, and is expected to be fine. I hope she recovers completely, as Barron needs his mother.

  4. I wonder why “the Donald” wasn’t there at Walter Reed Hospital, to be with his wife, Melania, during her serious operation? Looks like he would have, at least, been there for her, after she was wheeled out of the operating room…. I read where he didn’t even wish Melania a Happy Mother’s Day either, just talked about how great his own mom was…..and Melania is the mother to his child, Barron! What a great guy Trump is….ha!

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