Diverticular Disease | Complications of Diverticular Disease
Diverticular disease consists of three conditions that involve the development of small pockets in the wall of the colon or diverticulosis, diverticular bleeding and diverticulitis the active form of diverticular disease. Without the correct treatment, serious cases of diverticular disease can lead to: infection, bleeding, fistulas, obstructions and abscess.
1) Infection: bodily fluids or faeces becomes trapped in the diverticula and begin to stagnate. This provides ideal environment for the growth of bacteria and consequently the development of infection.
2) Rectal Bleeding: It can occur if diverticula present in the colon begin to bleed due to the bursting of a blood vessel.
Rectal bleeding due to diverticular disease can happen in one of two ways:
a) Rectal bleeding of small amounts of blood present in the stool over a few days. This kind of rectal bleeding generally rectifies itself.
b) Rectal bleeding where a large amount of blood is produced over a short 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 rectal bleeding is usually only present in those with extreme cases of diverticulitis and requires hospitalization and possible surgery or the implementation of a device up through the rectum to burn the bleeding wound shut. In some cases rectal bleeding may stop spontaneously without the requirement of medical intervention.
3) Fistulas: fistulas are abnormal tunnels or connections between two organs that develops as a result of infection in the case of diverticulitis the active form of diverticular disease.
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. Common occurrences of fistulas due to diverticular disease include:
a) Enterocutaneous: Pathway leading form the gut, to the area of infection and finally to the skin.
b) Enteroenteric: fistulas involving the intestines.
c) Enterovaginal: fistulas creating a pathway to the vagina. Symptoms of these fistulas include vagina discharge containing faecal matter. Feculent vaginal discharge can also be results of fistulas developing between the sight of infection and the uterus.
d) Enterovesicular: fistulas creating a pathway form the site of infection to the bladder. Symptoms of the development of this type of fistulas 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 fistulas may cause faeces to pass through openings other than the anus. Fistulas are formed from abscesses (in this case the diverticular) 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 due to diverticular disease include:
a) Blind fistulas- only one end of the fistula has an opening
b) Complete fistulas- Both ends of the fistula are open
c) Horseshoe fistulas- the anus is connected to the surface of the skin via a tunnel around the rectum.
d) Incomplete fistulas- are only attached to one organ, generally the skin.
Symptoms due to a fistula presence include pain, feeling ill, fever, tenderness or itching and severity will range depending on the location of the fistula.
4) Hemorrhage: Bleeding of the colon, sigmoid colon and/or rectum.
5) Large Bowel Obstruction: This complication only occurs in a small number of individuals suffering from diverticular disease (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 extremities. 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 the infection from an absence leaks out of the contaminated area into the abdominal cavity, peritonitis may develop. In such a case severe, generalized abdominal pain is experienced. Peritonitis refers to the infection of the walls of the abdominal and requires immediate surgery to clean the abdomen. Peritonitis is disease that can be fatal without treatment. Treatment involves an operation by which the abdomen is cleaned and infected parts of the colon are removed.
Diverticular disease is a particularly common condition of the Western world. It is generally thought to be related to the high pressures within the lumen of the bowel generated due to the low intake of fiber in the diet. Medical management of diverticular disease is generally with antibiotics and they are a successful treatment in most cases.
diverticular disease complications
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