Diverticulosis or diverticular disease is characterized by the presence of diverticula, which are small pockets protruding through the weakened wall of the colon. Diverticulosis is the most common colonic disease in Western countries and the likelihood of suffering from it increases with age.
Diverticulosis is either discovered incidentally, for example during a colonoscopy , or when a complication related to a diverticulum, such as diverticulitis or gastrointestinal bleeding occurs. In the absence of complications, this disease does not require any treatment.
Diverticulitis, a complication of diverticulosis
Diverticulitis is one of the complications of diverticulosis, and is caused by inflammation of a diverticulum. The inflamed diverticulum can rupture, cause an abscess or peritonitis .
Manifestations of diverticulitis include pain in the lower left quadrant of the abdomen, often associated with fever. In case of peritonitis, symptoms are more severe and may include septic shock.
The treatment of diverticulitis without abscess or perforation is based on antibiotics, administered either at home or in the hospital. Subsequently, a colonoscopy should be performed to rule out any other condition.
Surgery may be indicated for severe diverticulitis
In case of severe diverticulitis (with abscess, perforation or peritonitis), treatment with antibiotics alone is insufficient. It becomes necessary to perform a percutaneous drainage (by radiologists), or an emergency surgery with, in some cases, a colectomy and the creation of an ostomy . In the latter case and as a second step, a surgical reconnection of the colon to the rectum may be proposed.
Surgery may be indicated for recurrent diverticulitis.
When episodes of diverticulitis recur, sigmoidectomy, the removal of the terminal part of the colon, may be proposed. The operation is performed under general anesthesia and by laparoscopy . The terminal colon (the sigmoid), usually the most affected by diverticula, is removed and the remaining colon is then reconnected to the rectum. In some cases, this intervention must be performed by laparotomy . Finally, in case of stenosis or fistula, surgery may also become necessary.
Diverticular bleeding, another complication of diverticulosis
Diverticular bleeding is the other common complication of diverticulosis. A small artery located in a diverticulum sometimes erodes and bleeds into the colon, causing bloody stool. Treatment requires colonoscopy or interventional radiology (FR). Exceptionally, surgery may be necessary.
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