Back More
Salem Press

Table of Contents

Salem Health: Infectious Diseases & Conditions, 2nd Edition

Diverticulitis

by Debra Wood

Category: Diseases and conditions

Anatomy or system affected: Colon, gastrointestinal system, intestines

Also known as: Acute colonic diverticulitis, acute diverticulitis

Definition

A pouch that forms in the wall of the large intestine is called a diverticulum. When the diverticulum becomes infected or inflamed, the condition is called diverticulitis.

Causes

It is not clear why the pouches form. Experts believe that a constant pressure is built up when food moves too slowly through the bowel. This pressure is thought to increase, push along the side walls, and then create pouches. Digested food or stool can become trapped in one of the pouches, leading to inflammation and infection.

Factors that may contribute to diverticulitis include a low-fiber diet. Fiber is critical because it softens stools and makes them pass through the bowel more easily. Other causes include increased pressure in the bowel from straining to pass a hard stool, defects in the colon wall, and chronic constipation.

An example of diverticulitus can be seen circled in the lower left of the frame. Photo by James Heilman, M.D. via Wikimedia Commons.

Infect2e_p0338_1.jpg

Risk Factors

Factors that increase the chance of getting diverticulitis include eating a low-fiber diet or a high meat or protein diet, previous episodes of diverticulitis, and chronic constipation. Also, persons age fifty and older are at higher risk.

Symptoms

Symptoms can come on suddenly, and they vary depending on the degree of the infection. Symptoms include abdominal pain and tenderness, usually in the left lower abdomen; a swollen and hard abdomen; fever; chills; poor appetite; nausea; vomiting; diarrhea, constipation, or both; cramping; and rectal bleeding.

Screening and Diagnosis

A doctor will ask about symptoms and medical history and will perform physical and rectal exams. Finding the disease early is important to prevent the pouch from breaking and releasing stool into the abdomen. If this occurs, the patient will need emergency surgery. Tests may include an analysis of a stool sample to look for blood; blood tests to look for signs of infection, inflammation, and bleeding; X rays to look for a rupture; and a computed tomography (CT) scan or ultrasound to locate and determine the size of the inflamed pouch.

Once the inflammation subsides, other tests may be performed. These tests include a barium enema (injection of a dye into the rectum that makes the colon show up on an X ray so the doctor can see abnormal pouches in the colon); a flexible sigmoidoscopy (a thin, lighted camera is inserted into the rectum to examine the rectum and the lower colon); and a colonoscopy (a thin, lighted camera is inserted through the rectum and into the colon to examine the entire lining of the colon).

Treatment and Therapy

The goals of immediate treatment are to resolve the infection and inflammation, rest the bowel, and prevent complications. Treatment includes antibiotics and other drugs to fight the infection. Pain medications are given to decrease abdominal pain.

For mild inflammation, one should drink clear liquids for the first two to three days. More severe cases will require hospitalization so that fluids and antibiotics can be administered intravenously. To help with nausea and vomiting, a plastic tube may be inserted through the patient’s nose into his or her stomach. This will help decrease the vomiting and increase comfort.

Changes in diet can help prevent future attacks of diverticulitis. Diet changes include increasing the amount of fiber by eating more fruits, vegetables, and whole grains; supplementing one’s diet with a fiber product, as recommended by a doctor; and avoiding laxatives, enemas, and narcotic medications that can lead to constipation.

Surgery to remove the section of the bowel with pouches may be recommended if the patient has had multiple attacks during a two-year period or if a pouch breaks and the contents spread into the abdominal cavity (which will require cleaning out). When surgery is done on an elective basis, a surgeon will remove part of the diseased bowel and hook the normal bowel together. Surgery also treats complications of diverticulitis, such as an abscess, which occurs if the infected pouch fills with pus; a blocked bowel (scar tissue that forms and blocks movement of stool through the intestine); or a fistula, which occurs if the infection spreads and colon tissue attaches to another organ, such as the bladder or the uterus/vagina.

During emergency surgery, the surgeon will remove the diseased bowel. Because of the serious infection, the two ends of the bowel will not be hooked together. The patient will most likely have a piece of bowel coming out to the abdomen (colostomy). After six to twelve weeks, the surgeon will hook the bowel back together.

Prevention and Outcomes

The following recommendations may help prevent diverticulitis by improving the movement of stool through the bowel and decreasing constipation: eating a balanced, high-fiber diet with extra fruits, vegetables, and whole grains; drinking eight 8-ounce glasses of water every day; and exercising regularly.

Further Reading

1 

American Society of Colon and Rectal Surgeons. "Diverticular Disease." Available at http://www.fascrs.org/patients/conditions/diverticular_disease.

2 

Feldman, Mark, Lawrence S. Friedman, and Lawrence J. Brandt, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. New ed. 2 vols. Philadelphia: Saunders/Elsevier, 2010.

3 

Jacobs, D. O. "Clinical Practice: Diverticulitis." New England Journal of Medicine 357 (2007): 2057.

4 

Kapadia, Cyrus R., James M. Crawford, and Caroline Taylor. An Atlas of Gastroenterology: A Guide to Diagnosis and Differential Diagnosis. Boca Raton, Fla.: Pantheon, 2003.

5 

National Institute of Diabetes and Digestive and Kidney Diseases. "Diverticulosis and Diverticulitis." Available at http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis.

6 

Rakel, Robert E., Edward T. Bope, and Rick D. Kellerman, eds. Conn’s Current Therapy 2011. Philadelphia: Saunders/Elsevier, 2010.

7 

Strate, L. L., et al. "Nut, Corn, and Popcorn Consumption and the Incidence of Diverticular Disease." Journal of the American Medical Association 300 (2008): 907.

Web Sites of Interest

American College of Gastroenterology

http://www.acg.gi.org

American Dietetic Association

http://www.eatright.org

American Gastroenterological Association

http://www.gastro.org

American Society of Colon and Rectal Surgeons

http://www.fascrs.org

Dietitians of Canada

http://www.dietitians.ca

National Digestive Diseases Information Clearinghouse

http://digestive.niddk.nih.gov

See also: Duodenal ulcer; Enteritis; Gastritis; Infection; Inflammation; Intestinal and stomach infections; Norovirus infection; Peptic ulcer; Peritonitis; Viral gastroenteritis.

Citation Types

Type
Format
MLA 9th
Wood, Debra. "Diverticulitis." Salem Health: Infectious Diseases & Conditions, 2nd Edition, edited by H. Bradford Hawley, Salem Press, 2020. Salem Online, online.salempress.com/articleDetails.do?articleName=Infect2e_0177.
APA 7th
Wood, D. (2020). Diverticulitis. In H. B. Hawley (Ed.), Salem Health: Infectious Diseases & Conditions, 2nd Edition. Salem Press. online.salempress.com.
CMOS 17th
Wood, Debra. "Diverticulitis." Edited by H. Bradford Hawley. Salem Health: Infectious Diseases & Conditions, 2nd Edition. Hackensack: Salem Press, 2020. Accessed September 16, 2025. online.salempress.com.