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Diverticulitis (Inflamed Bowel Pouches) in the Elderly

What is diverticulitis?

Diverticulitis is an inflammation of small, sac-like pouches (diverticuli) of the inner surface of the large intestine (colon). These pouches tend to develop with age and therefore this condition is mainly seen in the elderly. Mild cases usually can be easily treated with medication. More severe cases require hospitalization and, in some cases even surgery. Untreated diverticulitis may lead to significant infection of the intestines and the surrounding organs. It could even lead to life threatening complications.

Symptoms of Diverticulitis

The formation of these sacs or pouches in the wall is known as divertulosis. The sac or pouch itself is called a diverticulum (plural ~ diverticula). Although diverticulosis is not associated with any symptoms, inflammation of diverticuli manifests itself primarily as abdominal pain. Diverticulitis is the term for inflamed diverticula. Abdominal pain starts suddenly and may be accompanied by fever and chills, digestive abnormalities like bloating or gas, tenderness in the lower left side of the abdomen and occasional bleeding from the rectum. Lack of appetite might also occur.

In cases where the infection spreads from the intestine, other regions like the small intestine, uterus, vagina, abdominal wall, and upper leg might also be affected. An abdominal CT scan is used to diagnose diverticulosis and diverticulitis. Colonoscopy is used to confirm the diagnosis. Blood tests might be done to confirm the presence of infections.

Diverticulitis Causes

The exact cause of diverticulosis is not known. However, lack of fiber in the diet is thought to be a contributory factor. Regular consumption of highly processed foods results in constipation and straining during defecation. This increases the pressure in the intestine and could result in the formation of the outpouches of the intestinal walls (diverticulosis). Occasionally, these pouches may become infected. Diverticulitis might lead to further complications that could be serious. Infection from diverticulitis might spread to other organs via fistulae (abnormal connections between the colon and the nearby tissues) and tears or holes in the wall of the colon (perforation).

Treatment

Treatment of diverticulitis depends on the severity of the problem.

Mild diverticulitis

If the diverticulitis is not severe, bed rest at home is advised. A liquid diet should be followed until the symptoms abate. In addition, oral antibiotics are prescribed to counteract the infection. As the symptoms abate, patients can shift to a soft-fiber diet. High-fiber solid diet can then be re-started after a month.

Severe diverticulitis

Patients with severe diverticulitis need to be hospitalized. Patients who are taking prednisone for treatment of severe allergies and inflammatory diseases are more prone to developing diverticulitis. Therefore, they are also advised hospitalization. Antibiotics are administered to these patients intravenously and they are given complete bed rest. Dietary modifications are the same as those described for less severe cases above.

Ruptured diverticulitis

In cases where the diverticuli have become perforated and the infection has spread to the peritoneum (a membrane that lines the abdominal cavity and covers most of the abdominal organs), immediate surgical removal of the affected part of the intestine (colon) is required. Surgery is also considered in patients who do not improve with medication and other non-surgical measures.


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