Overview
Diverticula are pouch-like structures formed when the mucosa of the colon protrudes outward through a weak part of the intestinal wall. Poor drainage of diverticula can be complicated by diverticulitis, and it is easy to perforate after inflammation occurs. This disease is relatively common in Europe and the United States, rare in China. Diverticula of the colon are congenital and acquired, acquired is more common, mostly seen in the left side of the colon. Diverticula can be single or multiple.
Causes
1. Diverticula can occur at the weak points of the intestinal wall.
2. Constipation caused by low-fiber diet increases the pressure in the intestine.
3. When the passage is blocked, the contents of the diverticulum cannot flow into the intestinal lumen.
Symptoms
1. The disease occurs more often in middle-aged and elderly people aged 50 to 70, and there are more women than men.
2. Diverticula are mostly asymptomatic in most patients before inflammation occurs, and sometimes there can be mild symptoms, such as constipation, abdominal pain, abdominal distension and hidden pain and discomfort. Some patients have episodic abdominal pain, which may disappear or worsen after a period of time.
3. In acute diverticulitis, most of the symptoms are obvious. The left side or left lower abdominal pain is obvious, sometimes accompanied by nausea, vomiting, body temperature and white blood cell count is elevated.
4. The lesion adjacent to the bladder may produce bladder irritation symptoms such as urinary frequency, urgency and pain.
5. Repeated episodes can be chronic manifestations, such as intractable constipation, and some patients may have blood in the stool.
Examination
1. Laboratory examination
Elevated white blood cell count.
2. X-ray film
If there is free perforation, free gas under the diaphragm can be seen.
3. Abdominal B-mode ultrasound
Thickening of the bowel wall and presence/absence of peripheral abscess formation can be seen.
4. CT scan
CT scan can show inflammatory manifestations of pericolonic fat. Fistulae and abscesses can be seen in almost all cases and are extremely helpful in the diagnosis.
5. Barium enema
Diverticula are seen to be present or multiple diverticula are present. In cases of diverticulitis, the intestinal wall is irregular and the bowel is mildly and progressively narrowed. Diverticulitis is generally not suitable for examination when it is severe, so as to avoid inducing intestinal perforation.
6. Fiberoptic colonoscopy
Multiple diverticula can be seen and other disorders can be excluded, but fiberoptic colonoscopy has the possibility of inducing perforation, so diverticulitis is generally not suitable for fiberoptic colonoscopy when severe.
Diagnosis
1. Confirmation of the presence of diverticula.
2. Clinical basis for inflammatory reaction.
3. According to the location of the diverticulum, signs, clinical features, etc., prove that this inflammatory reaction is related to the diverticulum, or exclude other diseases other than diverticulum related to inflammation.
4. Elevated white blood cell count.
5. X-ray, barium enema, and CT examination may help in the diagnosis.
Treatment
1. Non-surgical treatment
(1) General treatment Keep the bowels clear and eat more high-fiber foods. When fistula or obstruction occurs, there should be continuous gastrointestinal decompression, fluid therapy and bed rest. Acute phase with pain flare-ups should be actively engaged in internal medicine treatment.
(2) Pharmacological treatment Broad-spectrum antibiotics with drugs effective against anaerobic bacteria, and intravenous rehydration and nutritional support. In mild cases, oral antibiotics can be given on an outpatient basis, and the intestinal tube should be rested.
2. Surgical treatment
Surgery is feasible in cases of poor drainage of abscess, diffuse peritonitis, persistent intestinal obstruction or fistula formation, hemorrhage, etc., which are ineffective with conservative treatment or recurrent hemorrhage in a short period of time.
Questions you may be concerned about
What is the reason for the pain even after the treatment of diverticulitis?
Diverticulitis pain after treatment indicates that it has not been cured, the treatment effect is related to the use of drugs and patient care.
1. Not cured: Diverticulitis can cause abdominal distension, abdominal pain and abnormal bowel movements. If you still feel pain after treatment, it means you are not cured and need to continue treatment.
2. The use of medication: If the medication is not appropriate, the effect will not be good, or even aggravated, the treatment effect is directly related to the use of medication.
3. Nursing care: If the nursing care is not proper, such as overeating, eating spicy and greasy excessively, it will easily aggravate the condition and cause pain.
After the treatment of diverticulitis of the colon still feel the pain may also have other reasons, it is recommended to go to the hospital in time, improve the examination to clarify the cause of the disease, give targeted treatment or standardized treatment.