Complicated Diverticulitis: Complications, Severity and Treatment

Janet, 78, was diagnosed with diverticulitis for the first time ten years ago. After a few days of what she thought was the stomach flu, she experienced a sudden onset of bloody diarrhea. Janet was admitted to the hospital and given intravenous (IV) fluids and a blood transfusion. For the next two years, she had no symptoms. She was hospitalized again eight years ago for diverticulitis, three years ago for a diverticulitis bleed, and most recently for complicated diverticulitis with an abscess. Janet underwent surgery two weeks ago to drain the abscess and insert a drain. She was discharged home with instructions on how to care for the drain and a plan to receive IV antibiotics. Janet could not manage the infusions herself, and her husband could not assist her. He has Parkinson’s disease, and his tremor prevented him from helping with her care.

What is diverticulitis?

Diverticula are pouches that form in weak spots in the wall of the colon. The colon is the section of the gastrointestinal tract that is between the small intestine and the rectum. In most cases, diverticula do not cause any symptoms. They are also very common. Approximately one-third of people over the age of 45 have diverticulosis (diverticula that are not inflamed). When they become inflamed, symptoms may develop, which causes a condition called diverticulitis. About 10% to 25% of people with diverticulosis will develop diverticulitis. When diverticula become inflamed, they may cause the following symptoms:

• Abdominal pain (usually in the left, lower side)
• Rectal bleeding
• Constipation
• Diarrhea
• Fever
• Chills
• Nausea
• Vomiting
• Bloating

Sometimes a small blood vessel in the pouch becomes irritated and bleeds. If this happens, you may have a sudden gush of red or maroon-colored blood in your stool. Sudden bleeding can cause dizziness, weakness, or light-headedness. Contact us for help

What is complicated diverticulitis?

Diverticulitis is considered complicated when inflammation progresses into a more serious disease. Diverticulitis can lead to several complications, including:

Abscess

An abscess is a walled-off collection of blood and pus that develops as a result of a bacterial infection. Abscesses lie just outside the colon wall. Pain, nausea, vomiting, and fever are typical symptoms of an abscess. An abscess may need to be drained if it is large or does not improve while on antibiotics.

Fistula

A fistula is an abnormal passage or tunnel that connects two organs or an organ and the skin. Fistulas from the colon commonly connect with the bladder or the vagina. A fistula typically does not close on its own and is surgically repaired.

Obstruction

A bowel obstruction is a partial or complete blockage of the intestines that prevents stool from passing through the colon. A total blockage will require emergency surgery to remove the obstruction. A partial obstruction may need surgery as well.

Perforation

A perforation is when one pouch in your colon develops a hole or a tear. Surgery may be needed to repair the tear. If the tear cannot be repaired, a small amount of the colon may be surgically removed.

How serious is complicated diverticulitis?

Uncomplicated diverticulitis is usually treated medically, and the mortality rate is negligible. However, the mortality rate for those who develop complicated diverticulitis and require surgery is around 5%. The mortality rate rises to 20% in those who develop peritonitis, an inflammation of the membrane that lines the abdominal wall and covers the organs.

How long does it take to recover from complicated diverticulitis?

Most people with uncomplicated diverticulitis recover within seven to ten days. Those with complicated diverticulitis may require more time to heal depending on factors such as

• whether they have any other health conditions.
• their age.
• whether they develop an abscess, perforation, fistula, or obstruction.
• whether they need surgery.

How long can you live with severe diverticulitis?

Uncomplicated diverticulitis infrequently causes death. When it occurs, it is usually not diverticulitis that causes death. Instead, it is usually cardiovascular disease or an immune problem. Researchers evaluated the survival rate of 650 people with diverticulitis at 100 days. Their diagnosis and the percent alive at 100 days were

• Uncomplicated diverticulitis: 97%

Complicated diverticulitis with

• An abscess: 79%
• Infected peritonitis: 84%
• Fecal (stool in the abdomen) peritonitis: 44%
• Obstruction: 80%

Of those who survived 100 days, 96% were still alive five years later, and 91% were alive ten years later.

What is the best treatment for severe diverticulitis?

The severity of your symptoms will determine how you are treated. Treatment may include

• Antibiotics: Your doctor may prescribe antibiotics to be taken by mouth or through an IV.
• Diet: Complete bowel rest with IV fluids, a liquid-only diet, or a restricted diet are all options.
• Drain: If the abscess is uncomplicated, a thin tube may be used to drain the blood and pus from the abscess to outside the body.
• Surgery: Some people need emergency surgery to relieve an obstruction or treat peritonitis. Others need surgery weeks later to remove a bowel segment.

To prevent diverticulitis, eat plenty of fiber-rich foods, drink plenty of water, and exercise daily. All three of these will increase the rate at which stool moves through your colon, preventing constipation and straining.