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.
“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.
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.
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.
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.”
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.
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.
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.
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.”
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