Living With Diverticulitis By Thorough Diagnosis
Living with diverticulitis can be a challenge as this disorder can erupt rather suddenly, manifesting itself in one or more severe attacks of infection and inflammation. If left untreated, diverticulitis can lead to serious complications including abscess formation, obstruction and bleeding.
Diverticulitis, however, is usually accompanied by severe abdominal pain, nausea, fever and a change in bowel habits. An elevated white blood cell count is usually present. The symptoms may mimic appendicitis, except that the pain is on the left rather than the lower right side.
Abscesses may form locally at the site of the diverticulum. If the diverticular abscess is not treated, it may spread to other organs, particularly the liver.
An abdominal CT scan is helpful to determine whether a diverticular abscess is present. Most cases of diverticulitis are mild and respond well to antibiotic treatment and "bowel rest'' during which intake of food is limited to clear liquids. It is frequently treated in the hospital with intravenous antibiotics and intravenous fluids. After the infection has stabilized, patients are advised to increase the bulk in the diet with high-fibre foods and over-the-counter preparations containing bulk additives.
Recurring attacks of diverticulitis, the presence of an intestinal perforation, or an abscess may require surgery with removal and-or drainage of the involved portion of the colon.
Since diverticulosis occurs so frequently in countries where a low-fibre diet is common, many physicians recommend diet modification to include whole-grain breads, cereals, fibrous fresh fruits and lots of vegetables, while avoiding low-fiber and refined foods, such as white flour, white rice and other processed grains.
Think diverticulitis if a patient presents with left lower quadrant abdominal pain, but be sure to rule out other possible diagnoses, Dr. Randy Crim advised at the annual meeting of the Texas Academy of Family Physicians.
Such pain usually results from appendicitis. Cancer should be ruled out in patients over age 50. Kidney stones, endometriosis, and pelvic inflammatory disease also should be considered.
Once other possibilities have been ruled out, differentiating diverticulitis from irritable bowel syndrome (IBS) is probably the biggest diagnostic challenge. Diverticulitis often can be distinguished from IBS based on how sick the patient seems. Patients with IBS don't look very sick, but those with diverticulitis may have fever and white blood cell counts above 15,000-20,000.
Urinalysis can identify infection and aid in diagnosis. An abdominal x-ray is needed in very ill patients to look for bowel perforation. In patients with chronic diverticulitis-type problems, a barium enema is the best diagnostic tool because it helps in evaluating strictures. ACT scan can reveal pericolonic inflammation, wall thickening, the presence of an abscess, and air in the bladder that is diagnostic of a colovesical fistula.
Colonoscopy can help rule out cancer and assess stricture after the acute phase of diverticulitis. In acute illness, however, the pressure that colonoscopy puts on the colon may cause perforation.
Patients with uncomplicated diverticulitis generally can be treated as outpatients with antibiotics and a high-fiber diet. Bran cereals or supplements, such as Metamucil and Citrucel, have been shown to re duce recurrence rates by up to 30%.