Acute diverticulitis is a gastrointestinal disorder characterised by inflammation in the diverticula, which are small pouches that can form in the large intestine (also known as the colon).
Diverticulosis is the emergence of small, bulging pouches or sacs (diverticula) in the lining of your digestive system, typically along the walls in the lower part of the large intestine. Most of the time, people with diverticulosis do not exhibit any symptoms.
However, sometimes, when one or more of the diverticula becomes inflamed or infected, diverticulosis develops into acute diverticulitis. It is essential for patients to seek immediate medical attention because, if left untreated, acute diverticulitis can result in serious life-threatening complications.
What causes acute diverticulitis?
The following factors can lead to acute diverticulitis:
Torn diverticula: One commonly accepted theory iswhen hard stools pass through and physically stretch the diverticula too much, a tear may form in the diverticula’s lining. The injury allows the diverticula to be infected by the existing bacteria populating the colon, thus causing acute diverticulitis.
Trapped stool: Faeces might become trapped inside the diverticula, allowing bacteria to rapidly proliferate in the large intestine. Thus, this may cause the diverticula to be inflamed and infected, leading to diverticulitis.
What are the symptoms of acute diverticulitis?
If you suffer from abdominal pain that persists for several days, do not ignore it. It could be a symptom of a serious condition, acute diverticulitis, that requires treatment.
Abdominal Pain/Cramping: A steady pain that often lasts a few days that might be situated at the right side of the abdomen for people of Asian descent, and the lower left-hand side for others.
Nausea and Vomiting: A feeling of discomfort or queasiness in the stomach, often leading to an inclination to vomit.
Change in Bowel Habits: Instead of regular bowel movements, you may experience bowel problems. Constipation as well as dry stool may indicate acute diverticulitis. However, diarrhoea or loose stools are also possible symptoms of acute diverticulitis.
Fever: The body's immune response to inflammation in the diverticula can lead to an elevated body temperature and chills.
Bloating: The patient may feel that the stomach is filled with gas.
Should I go to the A & E for acute diverticulitis?
If you suspect acute diverticulitis, it is important to immediately seek help from a general surgery clinic or call 995 to contact a nearby hospital’s Accident & Emergency (A&E) Department. This is because timely treatment is key to facilitating recovery and preventing serious complications.
ACE Specialist Surgery and Endoscopy Clinic offers 24/7 emergency services for acute diverticulitis cases. Patients experiencing acute diverticulitis symptoms can seek medical assistance from us at any time of the day, and we will try to schedule an appointment or urgent operation with our general surgeon as quickly as possible.
If left untreated, acute diverticulitis may result in a variety of complications.
Abscess: The infected diverticula can become surrounded by bacteria-filled pus (abscess). If the abscess is accompanied by perforation, or tearing, this allows pus to leak through the intestinal wall into the abdominal cavity, and may lead to the potentially fatal condition peritonitis.
Perforation: Diverticulitis results in small tears in the colon, which may eventually grow larger and cause content to be leaked into the abdominal cavity.
Fistula: An abnormal tunnel may develop and link the colon with adjacent organs, such as the bladder or vagina. The fistula allows bacteria to travel from one organ to the adjacent organ. This condition may lead to infection and a variety of urinary symptoms.
Stricture: Acute diverticulitis may cause a narrowing of the colon created by the scar tissue, the narrowing may impede stool from exiting the colon, therefore causing obstruction.
What are the risk factors for diverticulitis?
Ageing: While this condition can occur at any age beyond adulthood, the risk increases with advancing age. People over the age of 40, particularly those above 60, are more prone to developing acute diverticulitis.
Low-Fibre Diet: Insufficient dietary fibre can lead to constipation and hard stools, increasing the pressure in the colon, which may contribute to the formation of diverticula in the colon wall.
Constipation: Heightened pressure in the colon, often associated with exertion during bowel movements, may contribute to diverticulosis.
Lack of Physical Activity: Exercise can stimulate bowel movement, thus conversely, a sedentary lifestyle can contribute to constipation and heighten the risk of diverticular disease.
Obesity: Being overweight or obese (Body Mass Index>30) can increase the risk of developing acute diverticulitis.
Smoking: Studies have reported that smokers have a higher chance of developing acute diverticulitis.
How is acute diverticulitis diagnosed?
One of the possible diagnostic methods for acute diverticulitis is colonoscopy, a form of endoscopy that helps surgeons detect diverticulum and infections.
Physical Examination: A doctor will do a physical examination focusing on the abdomen, checking for symptoms like abdominal tenderness and pain.
Blood Tests: The utilisation of blood tests in diagnosing acute diverticulitis involves several markers that indicate inflammation and infection in the body:
White Blood Cell Count (WBC)
C-reactive Protein (CRP)
Procalcitonin
Computed Tomography (CT) Scan Provides detailed images of the abdomen and pelvis, aiding in diagnosing and assessing the severity of acute diverticulitis.
Colonoscopy: This is usually done 4 -6 weeks after an acute episode of diverticulitis has resolved with antibiotic therapy. Allows the surgeon to assess the state of the patient's colon, along with the presence of abnormalities such as diverticulum and rule out underlying tumor, and may be performed to rule out other conditions.
What are the treatment options for acute diverticulitis in Singapore?
Our general surgeon will make a diagnosis and recommend an appropriate treatment plan depending on the severity of your condition.
Non-Surgical Treatments
Antibiotics are prescribed for acute diverticulitis primarily to combat bacterial infection within the diverticular pouches of the colon.
Surgery is not required for mild cases of diverticulitis. Our surgeon may prescribe antibiotics and painkillers to alleviate the infection and keep the patient hydrated and nourished with an intravenous (IV) drip.
Surgical Treatments
For the treatment of severe acute diverticulitis, which is accompanied by complications, surgery will often be recommended.
Colectomy Surgery
Colectomy surgery involves removing the diseased portion of the large intestine through keyhole or the traditional open surgical methods.
Laparoscopic Colectomy: A type of keyhole surgery where the surgeon removes the diseased section of the large intestine, by using surgical tools guided by a camera, after making several small incisions in the patient's Abdomen. This surgical method usually results in a relatively short recovery time and minimises scarring.
Open Colectomy: While many patients prefer to undergo keyhole surgery, invasive colectomy, which involves a large abdominal incision, may be recommended when there are complications.
Stoma Surgery
When the large intestine needs some time to heal before it may be successfully reattached or too much of the large intestine is removed such that reattachment is not possible, stoma surgery may be employed.
Stoma surgery refers to removing the affected portion of the large intestine and creating an opening (stoma), which diverts stool away from the affected area to allow healing. This is colloquially known as ‘having a bag’ since a bag is attached to the skin of the patient's stomach to collect excretory products.
Ileostomy: The small intestine becomes connected to the abdominal wall through surgery.
Colostomy: The large intestine becomes connected to the abdominal wall through surgery.
Summary
In conclusion, acute diverticulitis, the emergence of abnormal small pouches or sacs (diverticula) along the large intestine’s walls, is often a medical emergency. This is because the serious condition often results in life-threatening complications if left untreated. Patients with acute cholecystitis should seek urgent medical attention as soon as possible to prevent complications.
Visit ACE Specialist Surgery and Endoscopy Clinic
ACE Specialist Surgery and Endoscopy Clinic is proficient in handling cases of acute diverticulitis. We are committed to providing swift and high-quality treatment for emergency cases of acute diverticulitis. Call us anytime, day or night, and we will strive to schedule an appointment or urgent surgery with our Senior Consultant Endocrine and General Surgeon, Dr Reyaz Singaporewalla, as quickly as possible.
Dr Reyaz has over 25 years of experience in general and endocrine-head neck surgery. He gained valuable experience and training in Minimally Invasive and laparoscopic surgery, and has a proven track record in effectively treating acute diverticulitis.
