Diverticular Disease

Without the correct treatment (if any is required), serious cases of diverticular disease can lead to:

1) Infection: Infection occurs when bodily fluids or faeces becomes trapped in the diverticula and begin to stagnate. This provides an optimal environment for the growth of bacteria and consequently the development of infection.

2) Rectal Bleeding: Bleeding from the rectum can occur if diverticula present in the colon begin to bleed due to the bursting of a blood vessel.

Rectal bleeding will present in one of two ways:

a) Small amounts of blood will be present in the stool over a few days. This generally rectifies itself.

b) A large of blood is produced over a small amount of time due to the bursting of a blood vessel. The onset of this type of bleeding is generally painless, immediate and accompanied by the urge to defecate. This symptom is usually only present in those with extreme cases of diverticulitis and requires hospitalisation and possible surgery or the implementation of a device up through the rectum to burn the bleeding wound shut. In some cases the bleeding may stop spontaneously without the requirement of medical intervention.

3) Haemorrhage: The presence of rectal bleeding or bloody stools is generally indicative of internal bleeding or haemorrhage. Internal haemorrhage will present as red or burgundy coloured stools.

4) Fistulas: A fistula is an abnormal tunnel or connection between two organs that develops as a result of infection (in the case of diverticulitis this infection is present with the inflamed diverticula).

There are many areas in which fistulas can occur. The main areas affected by diverticular disease are the areas surrounding the bowel (the genitals and the anus).

Fistulas may link and of the surrounding organs or cavities with the bowel. The most common occurrences in individuals with a gastrointestinal are as follows:

a) Enterocutaneous: Pathway leading form the gut, to the area of infection and finally to the skin.

b) Enteroenteric: Any fistula involving the intestines.

c) Enterovaginal: A fistula creating a pathway to the vagina. Symptoms of this fistula include vagina discharge containing faecal matter. Feculent vaginal discharge can also be a results of a fistula developing between the sight of infection and the uterus.

d) Enterovesicular: A fistula creating a pathway form the site of infection to the bladder. Symptoms of the development of this type of fistula include frequent urinary tract infections, pneumaturia and the passing of gas from the urethra during urination.

In diverticular disease, the resultant fistulas are generally faecal or anal fistulas, meaning the fistula may cause faeces to pass through openings other than the anus. Fistulas are formed from abscesses (in this case the diverticula) which do not have a chance of healing due to being constantly filled with bodily fluids or stools. If these abscesses remain untreated they will consequently break through to the skin or another organ, creating a tunnel or connection between the two structures.

The types of fistulas that may develop include:

a) Blind fistulas- only one end of the fistula has an opening

b) Complete fistula- Both ends of the fistula are open

b) Horseshoe fistula- the anus is connected to the surface of the skin via a tunnel around the rectum.

d) Incomplete fistula- is only attached to one organ, generally the skin.

Symptoms of a fistula include pain, feeling ill, fever, tenderness or itching and severity will range depending on the location of the fistula itself.

5) Large Bowel Obstruction: This complication only occurs in a small amount of individuals suffering from diverticulitis as a result of the swelling due to inflammation on consequent development of scar tissue. Blockage due to inflammation will settle as the inflammation is treated, however blocking due to scar tissue remains. These blockages can occur as partial or total blockages. Partial blockages are not urgent, and therefore corrective surgery can be planned. Total blockages are urgent and must be addressed via surgery immediately.

6) Development of an Abscess: These are pus filled areas of infection and may form if initial infection remains untreated.

Due to the destruction of tissue by an abscess, small holes often develop, these are known as perforations, and allow the leakage of pus out of the colon into the abdominal area. Perforations may cause the individual to develop pain in the back or lower extremeties.

Whilst small abscesses may rectify themselves without the administration of antibiotics, large abscesses may have to be drained in order to allow for sufficient time and conditions to heal appropriately. Abscesses are drained via the insertion of a catheter. If drainage is not successful surgery may be required to clean the abscess.

If excessive amounts of infection leak out of the contaminated area into the abdominal cavity, peritonitis may occur in which case the individual will begin experiencing severe, generalised abdominal pain. Peritonitis refers to the infection of the walls of the abdominal and requires immediate surgery to clean the abdomen. Peritonitis can be fatal without treatment. Treatment involves an operation by which the abdomen is cleaned and infected parts of the colon are removed.

Tags: Diverticular Disease //