Diverticulitis

Description

Diverticulosis refers to having diverticulum - small pouches in the colon. About 10 percent of Americans over the age of 40 have diverticulosis. It is more common as people age, and about half of all people over the age of 60 have diverticulosis. It is considered to be a deficiency disease of Western societies.

Diverticula of colon is a herniation of the colon mucosa through the muscular layer, usually at the site of a perforating artery, lying between two layers of serosa in the mesentery. They are more common in the sigmoid and distal colon and increase in numbers with age.

Diverticulitis is an abscess or peridiverticular inflammation initiated by the rupture of a mucosal microscopic abscess into the mesentery. Such infection may progress, fistulize into the genitourinary system, obstruct, or spontaneously resolve. Develops in about 5% of subjects with diverticulosis each year. Over a lifetime about half of patients with diverticulosis develop inflammation.

Causes

Although not proven, the dominant theory is that a low-fiber diet is the main cause of diverticular disease. The disease was first noticed in the United States in the early 1900s. At about the same time, processed foods were introduced into the American diet. Many processed foods contain refined, low-fiber flour. Unlike whole-wheat flour, refined flour has no wheat bran.

Diverticular disease is common in developed or industrialized countries--particularly the United States, England, and Australia--where low-fiber diets are common. The disease is rare in countries of Asia and Africa, where people eat high-fiber vegetable diets.

Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Some fiber dissolves easily in water (soluble fiber). It takes on a soft, jelly-like texture in the intestines. Some fiber passes almost unchanged through the intestines (insoluble fiber). Both kinds of fiber help make stools soft and easy to pass. Fiber also prevents constipation.

Constipation makes the muscles strain to move stool that is too hard. It is the main cause of increased pressure in the colon. This excess pressure might cause the weak spots in the colon to bulge out and become diverticula.

Diverticulitis occurs when diverticula become infected or inflamed. Doctors are not certain what causes the infection. It may begin when stool or bacteria are caught in the diverticula. An attack of diverticulitis can develop suddenly and without warning.

Conventional Labs

WBC count normal in diverticulosis, elevated with immature polymorphs in diverticulitis

Hemoglobin low if bleeding is a symptom

Sedimentation rate elevated in diverticulitis

Urine analysis may reveal WBC's, RBC's, pus cells in fistula formation

Urine culture - persistent infection in colovesical fistula

Blood culture - positive in diverticulitis with generalized peritonitis

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