Comparing Complicated and Uncomplicated Diverticulitis

Diverticulosis is a common condition in the elderly. The colon wall develops outpouchings known as diverticuli. Each diverticula represents a weakened area of the intestinal wall and has the potential to perforate. Diverticulitis occurs when one or more of the diverticula develops a microscopic or macroscopic (visible) perforation. This starts an inflammatory reaction in the bowel wall and surrounding tissue.

The perforation can then progress in one of two directions. The first potential is for the development of simple diverticulitis. In this form of diverticulitis the perforation is immediately walled off so that an abscess does not form and perotinitis (inflammation of the peritoneal wall of the inner abdomen) does not occur. The other direction a micro- or macro- perforation of colon diverticula may take is to develop into complicated diverticulitis.

Individuals who develop complicated diverticulitis will have an abscess (internal pocket of infection), a fistula (abnormal connection between bowel and skin or nearby organs) and/or peritonitis resulting from fecal contents spilling in to the abdominal cavity or from purulent fluid resulting from infection. In some of these individuals, persistent or recurrent inflammation can result in an intestinal stricture (narrowing) that creates the potential for bowel obstructions.

Nearly 25% of individuals diagnosed with diverticulitis for the first time will have the complicated form of diverticulitis, while 75% will have simple diverticulitis. Diverticulitis is diagnosed by a combination of history, physical and radiological imaging. Computed tomography or CT is the best imaging to investigate a patient with suspected diverticulitis. CT of the abdomen and pelvis can help rule out other causes of acute abdominal pain and can assist in distinguishing between complicated and uncomplicated diverticulitis.

Complicated diverticulitis almost always requires surgery, while uncomplicated diverticulitis usually responds to medical therapy alone. The surgical options in complicated diverticulitis range from a minor procedure involving the placement of a drain, to a more serious procedure involving open incision and exploration of the abdomen.

The medical management of uncomplicated diverticulitis involves resting the bowel by limiting all food intake, and treating the individual with specific antibiotics. Uncomplicated diverticulitis can often be treated on an outpatient basis but can require hospitalization. Approximately 70% of patients with uncomplicated diverticulitis will responds well to the regimen and will begin to see significant improvement in symptoms within two to three days.

If left untreated, diverticulitis can progress to a serious, even life-threatening condition. Any individual with signs and symptoms of diverticulitis should seek immediate medical care.