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Diverticulitis, diverticulosis, diverticular disease, diverticulum, colon diverticula

What is diverticulitis?

Diverticulitis originates from inflammation of diverticula in the colon. A diverticulum is a "glove-finger" type of extroversion, a kind of pouch, that is located in the wall of a hollow organ such as the esophagus, small intestine or colon. There are congenital diverticula, that is, present from birth, such as Meckel's diverticulum, found in the small intestine; and acquired, that is, formed after birth, often in adulthood. Colon diver ticula are, indeed, acquired. Acquired diverticula are usually formed as a result of increased pressure within the colon: there are, in the wall of the colon, areas of weakness that as intraluminal pressure increases (e.g., as a result of constipation: feces accumulate and the pressure on the walls of the colon increases...)they become exhausted and gradually turn into diverticula.

Typically, diverticula are mainly located in the last part of thelarge intestine(sigma and descending colon), but they can be found throughout the colon.

diverticulitis, diverticulosisI diverticula can be isolated but also present in large numbers, until they affect almost the entire wall of the colon: in this case, they may be completely silent and not give rise to the appearance of any symptoms (and then we speak of FUNNY), or associated with symptoms (DIVERTICULAR DISEASE). Diverticular disease can in turn be uncomplicated or complicated, and is classified as follows:

  • uncomplicated symptomatic disease: patients suffer from abdominal pain and often also defecation disorders
  • recurrent symptomatic disease (recurrent diverticulitis): symptoms occur multiple times and at often smaller time intervals between events
  • Complicated disease (complicated diverticulitis): the patient may eliminate blood with the stool (rectorrhagia), have major channeling disorders, fever, abdominal pain acute and intense. Not infrequently, hospitalization and a surgical intervention urgent.

The term DIVERTICOLITE denotes, as mentioned before, the occurrence ofacute inflammation of diverticula in patients with diverticular disease; 10% of the population under 40 years of age, 30-40% over 60 years of age, and 60% of those over 80 years of age suffer from it, with a slight prevalence of the female sex over the male sex. Patients typically recount a long history of constipation, and frequently present with acute abdominal pain, localized mainly in the left lower abdomen, fever , and significant channeling complaints.

diverticulitis, virtual colonoscopyLa diagnosis is based on both the clinic, which on the blood tests, than on some instrumental evidence, which must be chosen according to the symptoms presented by the patient.

  • In cases of NON COMPLICATED DISEASE, examinations normally include a colonoscopy and/or a virtual colonoscopy or CT-colonoscopy, which together, in addition to allowing a diagnosis to be made, allow diverticular disease to be discriminated from other diseases of the colon, such as cancer, colitis, and Crohn's disease.
  • In cases of RECURRENT DIVERTICOLITE, colonoscopy should be accompanied by a CT scan of the abdomen, which will provide insight into the location of the inflammatory process, its extension outside the colon, and the possible presence of other abdominal pathologies. In these cases, performing a virtual colonoscopy allows both the study of the colon and the abdominal cavity to be performed with a single examination, also reducing discomfort for patients.
  • In DIVERTICOLITE COMPLICATED colonoscopy is not indicated, because inflammation of the colon increases the risk of perforation. In these cases, a CT scan of the abdomen with contrast medium is performed.

diverticulitis, virtual colonoscopyOver the past decade, the methods of VIRTUAL COLONOSCOPY have been emerging as a highly sensitive and specific and much less invasive device for the study of colon disease. Virtual colonoscopy (or colon-TAC) is nothing more than one CT scan of the abdomen images of which are subsequently analyzed and combined with special software, which allows a three-dimensional view of the colon to be reconstructed. The sensitivity of this method is very similar to that of the colonoscopy traditional; with this technique it is possible to study, in addition to the colon, also all the abdominal organs, making it an optimal diagnostic test in cases of diverticular disease in general and of diverticulitis in particular.

Therapy of diverticulitis

Treatment of diverticular disease can be medical or surgical.

Medical therapy with antibiotics is indicated in cases of first attack of uncomplicated diverticulitis ; about 70% of treated patients will not present with subsequent attacks, and only 20% of patients may develop a complication in the future. In contrast, patients who present with recurrent attacks have about 60% risk of presenting with complications such as bleeding or perforation over time .

diverticulitis, rifaximinThe preventive use of antibiotics (Particularly rifaximin, Normix) for a few days each month is very common in our country, but there is no scientific evidence that it is useful, and therefore not recommended. Moreover, it would be a off-label use, or not included in the indications provided by the pharmaceutical manufacturer itself.

Patients destined for surgery are those who have had at least two documented attacks of symptomatic diverticular disease. It must be remembered that with each recurrent episode the patient is less and less responsive to medical therapy. There is no predictive sign or symptom that can give information about the onset or severity of a future attack. Several studies support the need forearly intervention in patients younger than 50 years of age. Often the diagnosis in these cases is misdiagnosed, and in two-thirds of them, the disease begins with a complication that immediately requires urgent surgical intervention.Elective surgery is therefore recommended as early as after the first diverticulitic episode, even if uncomplicated, on the basis of a likely greater natural "aggressiveness" of the disease itself in young individuals.

Diverticulitis surgery

Diverticulitis surgery involves theremoval of the section of intestine affected by the disease and the first portion of the rectum to eliminate the area of greatest resistance located at the transition between the sigma and the rectum itself, which is now recognized to be the cause of postoperative recurrences.

Surgical treatment of diverticulitis can be performed minimally invasively by laparoscopy, however, in this case requiring asurgical team with extensive experience in advanced laparoscopy.

 

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