Diverticulitis

What is Diverticulitis?

Diverticulitis is an inflammation of one or more diverticulum, which are pockets that form in the smooth wall of the intestine. The reason that diverticulitis develops has not been entirely confirmed, but it is believed to be because faeces becomes trapped within a diverticulum. Bacteria contained within the faeces starts to grow in number causing an infection. Infection usually appears in the sigmoid colon.

Diverticular diseaseis a related condition when the diverticula that protrude outwards from the wall of the large intestine causing discomfort or pain in the belly.

What are the symptoms of Diverticulitis?

The most prominent symptom of diverticulitis is pain, normally located in the lower left abdomen. This pain is normally continuous and may last for days at a time and can interfere with normal daily life.A change in bowel habits such as diarrhoea or constipation is also another common symptom ofdiverticulitis.

Some people notice a mild fever and vomiting or nausea.

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How can it be treated?

The treatment for diverticulitis that is normally recommended is rest and a course of antibiotics. Doctors may also recommend avoiding solid food and advise following a liquid diet. A case of diverticulitis may be treated at hospital as an inpatient or as an outpatient; this will depend on the severity of the symptoms. In some cases, surgery may be required.

Most people after their initial bout of diverticulitis will not have any further symptoms. If there is a further bout of diverticulitis, the risk of further attacks is increased and the risk of complications is also increased.

抗生素和休息通常足以帮助摆脱炎症和憩室炎的症状。如果这些治疗无效，感染可能会导致一些并发症。

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Complications associated with Diverticulitis

Abscess

脓肿是憩室炎最常见的并发症。脓肿是体内组织内含有脓液并被发炎组织包围的空洞，如果感染扩散到邻近组织，可能由受感染的憩室引起。如果憩室穿孔，释放出来的憩室内容物不是进入腹腔，而是被壁隔开，也可能会形成。

You may know that you have an abscess if you can feel a tender lump in the abdomen area and you have a persistent fever. Some small abscesses resolve by themselves, those that don’t are treated with continued antibiotics and bowel rest. Larger and persistent abscesses may need to be eliminated by drainage of the pus from the abscess which should reduce the inflammation and associated pain, this will be done in hospital. To drain, a tube will be inserted through the abdominal wall and a CT scan may be used to help locate the abscess.

重要的是要设法清除脓肿，因为如果脓肿破裂，可能会造成危险的感染。

Inflammatory mass (phlegmon)

A phlegmon is similar to an abscess, it contains pus but the pus is found in lots of small pockets that are spread within tissue that becomes a hardened mass of infection and inflammation. A phlegmon may be felt as a tender lump in the abdomen and is also painful.

There is a risk that tissues could adhere to a neighbouring piece of intestine. This adhesion could make the intestine kink and become blocked which would lead to vomiting and it could also be painful when food is forced through the narrow intestine. There can also be an irritation caused to the bladder which can lead to a more frequent need to urinate.

Phlegmon may have to be removed by surgery if it does not respond to antibiotic treatment

Fistula

A fistula is the formation of a tube or passage within the body, between an internal organ and the body surface or between two internal organs.

与憩室炎有关，瘘管可从发炎的结肠的任何部位发展而来。如果瘘管形成，它通常是在结肠和膀胱之间。瘘管是一个逐渐形成的过程，脓肿表面破裂，渗漏的脓液迅速被组织包围，形成一个突出的管。这个过程重复了很多次，管子里的脓液逐渐延伸，直到它到达另一个中空器官或皮肤表面。瘘管闭合后，瘘管保持开放，释放脓液。

如果在结肠脓肿和膀胱之间形成瘘管，那么尿液中可能会出现脓液或粪便。这会导致尿路感染。

Colon-bladder fistulas are more common in men. Women may however develop fistulas from the colon to the vagina, particularly if they have had a hysterectomy. Fistulas may also connect with the small intestine or with the skin surface.

To treat a fistula, an operation will be conducted to remove the section of the colon where the fistula has grown. Usually any holes created by the fistula will close on their own but larger holes may need to be sewn in order to close them.

Bowel obstruction

In very rare cases of diverticulitis, the intestine can become blocked. However,bowel obstruction并不一定意味着完全堵塞;肠管变窄，大团的粪便不能通过，但液体的粪便可以滴漏通过。

当粪便堵塞时，静止的粪便可能会促使细菌过度生长，从而导致感染。

A blockage in the large intestine may be caused by inflammation that swells the tissues that surround the colon; this consequently narrows the colonic space. The small intestine can also be affected by an obstruction. This will happen when the small intestine becomes kinked or twisted when incorporated into an inflammatory mass in the area of the sigmoid colon.

梗阻的症状是腹痛、腹胀和呕吐。要治疗肠梗阻，应吃流食。如果有几个阻塞，那么手术可能是必要的，以移除受影响的区域或扩大结肠。

Perforation of the bowel wall

憩室可以穿孔，这将使结肠的一些内容物进入腹腔空间。穿孔是一种罕见的情况，但当它发生时，它是危险的，因为它可能导致腹膜炎。

Peritonitis is inflammation of the peritoneum which is triggered by its infection by bacteria. The peritoneum is a membrane that lines the whole abdominal space and also the contained organs. If peritonitis does occur, an emergency operation will be required – the main signs to look out for are severe abdominal pain which can develop quickly.

Haemorrhage

A haemorrhage can be a very severe symptom which is a loss of blood from the back passage. A known cause for this has not yet been established, but it is known that a blood vessel which is normally present in the colonic wall becomes stretched over the dome of the diverticulum as the protrusion forms. This blood vessel ruptures during haemorrhage, either at the dome or at the neck of the diverticulum.

People who have right-sided diverticula have a greater likelihood of haemorrhage.

在没有炎症的情况下可能会出现出血，有时这可能是第一个迹象。当你有出血时，你通常可以去医院休息和监护。一旦出血停止，可以用肠道准备清洗肠道，以便通过结肠镜检查大肠。这将有助于确认出血从哪里来，并看看是否有其他原因导致出血。

Certain painkillers are suspected of increasing the risk of bleeding from diverticula. Please speak to your doctor before taking any over the counter medication.

Further Information

If you are experiencing any of the problems mentioned in this factsheet, you may wish to seek advice from your GP.

We also have information on Diverticular Disease and associated treatments, which you can find below.