COLONIC DIVERTICULAR DISEASE

DIVERTICULAR DISEASE OVERVIEW

A diverticulum is a pouch-like structure that can form in the muscular wall of the colon, particularly at points where blood vessels enter.

Diverticulosis affects men and women equally. The risk of diverticular disease increases with age. It occurs throughout the world but is seen more commonly in developed countries.

WHAT IS DIVERTICULAR DISEASE?

Diverticulosis — Diverticulosis merely describes the presence of diverticula. Diverticulosis is often found during a test done for other reasons, such as flexible sigmoidoscopy, colonoscopy, or barium enema. Most people with diverticulosis have no symptoms and will remain symptom free for the rest of their lives.

A person with diverticulosis may have diverticulitis, or diverticular bleeding.

Diverticulitis — Inflammation of a diverticulum (diverticulitis) occurs when there is thinning and breakdown of the diverticular wall. This may be caused by increased pressure within the colon or hardened particles of stool, which can become lodged within the diverticulum.

The symptoms of diverticulitis depend upon the degree of inflammation present. The most common symptom is pain in the left lower abdomen. Other symptoms can include nausea and vomiting, constipation, diarrhea, and urinary symptoms.

Diverticulitis is divided into simple and complicated forms.

• Simple diverticulitis, which accounts for 75 percent of cases, is not associated with complications and typically responds to medical treatment without surgery.
• Complicated diverticulitis occurs in 25 percent of cases and usually requires surgery. Complications associated with diverticulitis can include the following:

• Abscess — a localized collection of pus
• Fistula — an abnormal tract between two areas that are not normally connected (eg, bowel and bladder)
• Obstruction — a blockage of the colon
• Peritonitis — infection involving the space around the abdominal organ
• Sepsis — overwhelming body-wide infection that can lead to failure of multiple organs

Diverticular bleeding — Diverticular bleeding occurs when a small artery located within a diverticulum is eroded and bleeds into the colon.

Diverticular bleeding usually causes painless bleeding from the rectum. In about 50 percent of cases, the person will see maroon or bright red blood with bowel movements.

Is bleeding with a bowel movement normal? — It is not normal to see blood in a bowel movement; this can be a sign of several conditions, some of which are serious and require immediate treatment. Anyone who sees blood after a bowel movement should consult with their healthcare provider to determine if further testing or evaluation is needed.

DIVERTICULOSIS AND DIVERTICULITIS DIAGNOSIS

Diverticulosis is often found during tests performed for other reasons. The following are tests that may be recommended to diagnose diverticulosis:

• Barium enema – This is an x-ray study that uses barium in an enema to view the outline of the lower intestinal tract. This is an older test and has been largely replaced by computed tomography (CT) scan.
• Flexible sigmoidoscopy – This is an examination of the inside of the sigmoid colon with a thin, flexible tube that contains a camera.
• Colonoscopy – This is an examination of the inside of the entire colon.
• CT scan – A CT scan is often used to diagnose diverticulitis and its complications.

TREATMENT

Diverticulosis — People with diverticulosis who do not have symptoms do not require treatment. However, most clinicians recommend increasing fiber in the diet, which can help to bulk the stools and possibly prevent the development of new diverticula, diverticulitis, or diverticular bleeding. However, fiber is not proven to prevent these conditions.

Increase fiber — Fruits and vegetables are a good source of fiber . The fiber content of packaged foods can be calculated by reading the nutrition label

Seeds and nuts — Patients with diverticular disease have historically been advised to avoid whole pieces of fiber (such as seeds, corn, and nuts) because of concern that these foods could cause an episode of diverticulitis. However, this belief is completely unproven. We do not suggest that patients with diverticulosis avoid seeds, corn, or nuts.

Diverticulitis — Treatment of diverticulitis depends upon how severe your symptoms are.

Home treatment — If you have mild symptoms of diverticulitis (mild abdominal pain, usually left lower abdomen), you can be treated at home with a clear liquid diet and oral antibiotics. However, if you develop one or more of the following signs or symptoms, you should seek immediate medical attention:

• Temperature >100.1ºF (38ºC)
• Worsening or severe abdominal pain
• An inability to tolerate fluids

Hospital treatment — If you have moderate to severe symptoms, you may be hospitalized for treatment. During this time, you are not allowed to eat or drink; antibiotics and fluids are given into a vein.

If you develop an abscess of the colon, you may require drainage of the abscess (usually performed by placing a drainage tube across the abdominal wall) or by surgically opening the affected area.

Surgery — If you develop a generalized infection in the abdomen (peritonitis), you will usually require an emergency operation. A two-part operation may be necessary in some cases.

• The first operation involves removal of the diseased colon and creation of a colostomy. A colostomy is an opening between the colon and the skin, where a bag is attached to collect waste from the intestine. The lower end of the colon is temporarily sewed closed to allow it to heal
• Approximately three months later, a second operation is performed to reconnect the two parts of the colon and close the opening in the skin. You are then able to empty your bowels through the rectum.

In non-emergency situations, the diseased area of the colon can be removed and the two ends of the colon can be reconnected in one operation, without the need for a colostomy.

Surgery versus medical therapy — An operation to remove the diseased area of the colon may not be necessary if you improve with medical therapy. However, people who are treated with an operation are felt to be cured since only 15 percent of people develop further diverticulosis after surgery and only 2 to 11 percent of people need further surgery.

Thus, surgery may be recommended for people with repeated attacks of diverticulitis or if there are severe or repeated episodes of bleeding. The decision depends in part upon your other medical conditions and ability to undergo surgery.

Some healthcare providers recommend surgery after the first attack of diverticulitis in people who are less than 40 to 50 years. The reason for this is that the disease may be more severe in this age group and there may be an increased risk of recurrent disease that will ultimately require surgery. Thus, having surgery at a young age could potentially eliminate the chances of developing worsened disease. The decision to undergo surgery ultimately depends upon your preferences.

In many cases, an elective operation can be performed laparoscopically, using small incisions, rather than the typical vertical (up and down) abdominal incision. Laparoscopic surgery usually allows you to recover more quickly and shortens the hospital stay.

After diverticulitis resolves — After an episode of diverticulitis resolves, the entire length of the colon should be evaluated to determine the extent of disease and to rule out the presence of abnormal lesions such as polyps or cancer. Recommended tests include colonoscopy, barium enema and sigmoidoscopy, or CT colonography.

Diverticular bleeding — Most cases of diverticular bleeding resolve on their own. However, some people will need further testing or treatment to stop bleeding, which may include a colonoscopy, angiography (a treatment that blocks off the bleeding artery), or surgery.

DIVERTICULAR DISEASE PROGNOSIS

Diverticulosis — Over time, diverticulosis may cause no problems or it may cause episodes of bleeding and/or diverticulitis. About 15 to 25 percent of people with diverticulosis will develop diverticulitis while 5 to 15 percent will develop diverticular bleeding.

Diverticulitis — Approximately 85 percent of people with uncomplicated diverticulitis will respond to medical treatment while about 15 percent of patients will need an operation. After successful treatment for a first attack of diverticulitis, one-third of patients will remain asymptomatic, one-third will have episodic cramps without diverticulitis, and one-third will go on to have a second attack of diverticulitis.

The prognosis tends to remain similar following a second attack of diverticulitis. Only 10 percent of people remain symptom free after a second attack. Subsequent attacks tend to be of similar severity, not increasing severity as previously believed.

To prevent diverticular disease of the colon is recommended
eat plenty of vegetables and fruits for life.

Diverticula would occur as a result of increased pressure within the lumen of the colon. Vegetable fibers, increasing fecal bulk, reduced pressure within the gut, avoiding the development of these dilations.

Colonoscopy of Diverticular Bleeding

The Endoscopic Sonata no 8 Pathetique

The Untold History of The Gastrointestinal Endoscopy Part 2 (2/6)

Programa Hola El Salvador TV 12 Divertículos del Colon Primera Parte.

Programa Hola El Salvador TV 12 Divertículos del Colon Segunda Parte.

La Asociación Americana de Nutrición recomienda la ingesta diaria de 20 a 35 gramos de fibra. Se recomienda el metamucil o su producto genérico el psillium el cual da de 4 a 8 gramos de fibra en un vaso de agua de 8 onzas. Esta enfermedad se ha relacionado a la poca ingesta de fibras en la dieta, por lo que se recomienda la ingesta abundante de fibras vegetales en la dieta cotidiana como prevención y tratamiento de esta enfermedad.

Usted debe de comer abundantes fibras vegetales; frutas, legumbres y verduras si usted puede comerse hasta la cáscara, lo blanco de las naranjas es preferible comerse las naranjas y no solo el jugo. Todo esto representa que su intestino grueso o colon necesita tener trabajo de lo contrario se debilita por la segmentación (teoría de segmentación). Los alimentos ingeridos con pocas fibras como los países conocidos como desarrollados o países occidentales las personas por lo general sus alimentos son escasos y las enfermedades del colon son muy frecuentes por lo general la mitad de la población adulta adolece de este padecimiento. Recuerde que usted tiene que comer estos alimentos en forma abundantes, para tener una vida saludable.

La gran mayoría de las personas que adolecen de este padecimiento por lo general nunca han sentido
alguna molestia y otros no se dan cuenta por que nunca se han practicado un chequeo médico formal
con equipos de avanzada ver video colonoscopia.

Question: Doctor are my diverticula curable?
Question: Doctor are my diverticula curable?
Answer: diverticula is a condition which there is structural damage to the large intestine that do not disappear by themselves or by drug treatment, the therapeutic approach is to prevent complications or the development of more diverticula.

Question: What symptoms cause diverticula?

Answer: The diverticula usually most people do not cause any symptoms in some cases can cause abdominal pain usually in the left lower quadrant (bottom left of the navel) in other cases, a rectal bleeding usually dark colored blood and sometimes can cause a true acute abdomen requiring hospitalization for complications of diverticulitis such as intra-abdominal abscess, perforation and peritonitis. EMERGENCY requiring surgery.

Question: in that occasions is necessary have surgery?
Answer: In some cases that there a severe attack of diverticulitis, in which can be much pain and infection of the abdominal cavity as a peritonitis your doctor may advise a surgery in which is removes a the diseased bowel, uniting the rest of intestine.

Endoscopic Image of diverticulae, It observed some holes that are the diverticulae, click on the image to download the video clip, wait to complete the download and press Alt and Enter to be apreciated in full screen.

 

Endoscopic Image of diverticula with a peri-diverticular fibrinoide exudade
which means that are diverticulitis.

Endoscopic image of a diverticula that which emerges dark blood, It caused
rectal hemorrhage. 

Same diverticula as above, A close out it observed a blood clot
in the diverticula hole.

Same case as above.

Muscular hypertrofia due to diverticular disease redness is observed Scattered Patches of dark erythematous mucosa are displayed in the image, however Small red fold in diverticular disease are common and related to strong muscular contractions associated with the high pressure segment in the sigmoid.