DRLUGO BLOG

Many patients are surprised to know they have diverticulosis and when they are diagnosed they worry about the condition.  I find that people use interchangeably the name diverticulosis and diverticulitis.  Diverticulosis is the presenceof small pockets in the intestine, diverticulitis is infection of these pockets.  Diverticulosis is most often diagnosed during a colonoscopy.  A barium enema can also be used to diagnose the condition.

drawing of cross section intestine with diverticuli   

actual pic during colonoscopy

Diverticulosis is a weakness of the colonic wall and it is felt that is the result of low fiber diets and the use or processed foods.  IT is mostly seen in people that are over 40 years of age and it is more common in the modern world where processed food is mostly consumed.  Diverticulosis is not a condition that should cause alarm or worry.  If you are told that the colon contains diverticula, is just for informational purposes.  You should include this in the medical history when asked.  If your doctor is aware of the presence of diverticula in your colon, then he/she can diagnose, faster, diverticulitis if it ever develops.

We recommend that people with diverticulosis adopt a high fiber diet and that way prevent or minimized the risks of diverticulitis.  This is know to correlate clinically.   There is also a general recommendation to avoid seeds or seed containing foods, but studies have failed to demonstrate a direct correlation of more attacks and the intake of seeds in the diet.  I recommend my patients to eat high fiber and not worry so much about avoiding things that they like to eat, even if these contain seeds (tomatoes, strawberries, pop-corn, etc)

Diverticulitis is a different story.  this is an infection of one of these pockets and this can be very serious.  It usually presents itself as L lower abdominal pain and sometimes with fever.  IT can also present with intermittent diarrhea and constipation associated or preceding the pain.   If you develop these symptoms, it is important that you seek medical assistant.  IT will most likely resolve with the appropriate diet and a short course of oral antibiotics if detected on time.  If left untreated, this can lead to a colonic perforation and eventual emergency surgery and a colostomy bag.  The current teaching is that two uncomplicated attacks of diverticulitis, should be followed with an elective L colon resection to avoid complications.  his has been questioned and is not necessarily and automatic sequence of events.  I believe that every patient is treated according to their general health, age and circumstances.  I do not think that it should be an automatic reaction for every patients that had two uncomplicated attacks.  You, the pt, should communicate with your doctor and discuss in detail the options.

If the pt has a catastrophic event, like a perforation of the intestine as a result of the diverticulitis, then surgery is indicated.  the best case scenario is when the infection i controlled with antibiotics.  sometimes even drainage of an abscess is done percutaneously, an then electively, possibly laparoscopically, the L colon is then removed at a later date.  This sometimes takes patience and good antibiotics to make it work, but the outcome is the best and avoidance of a colostomy is in itself a great benefit.

If you have any questions please visit my website www.drlugo.com, or ask me directly.   Than you!

RLUGO

1.pictures taken from Sabiston textbook 18th edition.

Tags: colon disease, colon surgeon, colon surgeon texas, constipation, diarhea, diverticulitis, diverticulosis, L lower abdominal pain