Diverticulitis is a bowel condition where there is inflammation of the colon causing pain and fever. The underlying process is diverticulosis where the colon, over time, forms sock like projections or outpouchings. For most people diverticulosis does not cause a problem but for some the outpouchings can burst and cause abdominal pain. The pain is usually felt low down on the left side of the abdomen.
Western diets high in protein and low in complex carbohydrates contribute to slow bowel transit and a tendency towards constipation and straining. With time, in susceptible people, the chronic straining can produce the outpouchings in the colon. This is the basis of diverticular disease. Symptoms may never occur but pain arises when perforation of the pouches leaks bowel material into the abdomen.
When the disease is mild, bowel rest and oral antibiotics can settle the inflammation and symptoms can resolve in a few days. For more severe attacks hospitalisation is required. The diagnosis is confirmed with an abdominal CT scan. Intraveinous antibiotics are commenced and bowel rest commenced with iv fluids to maintain hydration. The inflammation settles rapidly in most but for those with worsening pain, an operation is required to remove the perforated segment of colon and bring out a temporary bag or colostomy.
Some patients suffer from recurrent attacks of inflammation. They require investigation with a colonoscopy to confirm the diverticular disease and to exclude colorectal cancer. Occasionally, selected patients benefit from laparoscopic or robotic anterior resection. This key hole surgery allows the diseased segment of bowel to be resected safely. A bag or colostomy is usually avoided when this surgery is undertaken electively rather than during a bout of severe inflammation.
Diverticulosis is not associated with an increased risk of colorectal cancer. Diverticulosis is not made worse with a diet rich in seeds or nuts. Indeed, a high fibre diet will actually reduce the formation of new diverticular outpouchings and reduce the chance of existing pouches becoming infected.