The Dangerous Twisted Bowel Needs Immediate Attention!
Twisted Bowel of complicated diverticular disease with a loop stoma and abdominal drainage, but without resection, carries a significantly higher mortality than primary resection and has largely been abandoned. The outcome of emergency surgery for complicated diverticular disease worsens with both increasing age and in the presence of significant co- morbidity.
In uncomplicated disease:
* Significant underlying colonic pathology, such as malignancy, has been excluded
* Dietary manipulation is vital. You need a high-fiber diet often with a pharmacological bulking agent
* Drink plenty
* Increasing fiber may exacerbate pain and bloating initially
* Persevere with diet, as pain and bloating usually improves
* Surgery carries risks and may not improve symptoms
In complicated disease:
* The first attack carries a 30 per cent chance of being readmitted within five years
* Elective surgery is advisable for young patients
* For 'older' patients, advising elective resection must be a balance between the risk of recurrent attacks and current symptoms against significant co-morbidity
* Patients with fistulae will require surgery
* Patients with abscesses are advised to undergo elective resection unless medically unfit
Patients with uncomplicated diverticular disease may present with an altered bowel habit often associated with colicky abdominal pain, flatulence and distension. These symptoms may be indistinguishable from the irritable bowel syndrome. Acute diverticulitis is characterized by left iliac fossa pain and is usually associated with features of acute inflammation: tachycardia, pyrexia, localized peritonism and a leucocytosis.
Acute diverticulitis may be complicated by localised abscess formation resulting from a perforation in an inflamed diverticulum. Such patients may present with swinging pyrexia and a tender mass. Bleeding sometimes occurs from vessels at the neck of a diverticulum and tends to be profuse. Diverticular disease cannot be held responsible for occult lower gastrointestinal bleeding leading to iron deficiency anaemia. Patients with a change in bowel habit, blood per rectum or recurrent abdominal pain will require outpatient investigation to determine the cause of their symptoms. Rigid sigmoidoscopy and barium enema or total colonoscopy are the mainstays of investigation.
Uncomplicated disease may be treated with a high-fiber diet and/or pharmacological bulking agents such as ispaghula husk. Pain due to smooth muscular spasm may be adequately relieved with antispasmodics such as mebeverine. The role of surgical resection in uncomplicated disease is controversial and should not be undertaken lightly.
Diverticula are grape-sized pouches of the intestinal lining protruding through the intestinal wall. If undigested food blocks the pouch's opening, bacteria within the pouch multiply, causing the diverticulum to swell. The swelling, in turn, can cause a tiny or large tear in the diverticulum. A tiny tear creates few problems. A large tear creates big problems. The condition has changed from diverticulosis to diverticulitis.
About one-third of those who have had a diverticulitis attack eventually take a trip to the operating room. I don't know all the facts of your case, and I hate to disagree with a doctor who does. However, if age and a multitude of diverticula are the only reasons keeping you from an operation, seek a second opinion. It is not a great idea to go around with inflamed diverticula. They can leak bacteria into the abdominal cavity - a serious condition. They can bleed profusely. I have to issue a reader warning. I am not talking about diverticulosis, a common condition. I'm talking about diverticulitis, inflammation of the diverticula.
Twisted bowel syndrome encompasses a medley of symptoms. Crampy abdominal pain is a prominent one. Bloating is another. Periods of constipation are interspersed between periods of diarrhea. The brain senses that the muscular walls of the digestive tract are contracting out of step. The brain acknowledges the tract's unruliness by flooding the abdomen with pain.