Diverticulitis - a cause of lower abdominal pain

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Diverticulitis occurs when diverticulae (small pouches) of the large bowel become inflamed.

These small pouches are unheard of except in the "civilised", constipated Western cultures. The large bowel is wrapped up in muscle: the circular muscle is continuous but the longitudinal muscle is in three strips. Between these strips there is an area of weakness and the pouches herniate out here. The hernias are called diverticulae.

The trouble with these diverticulae is that faecal material can get stuck in them and cause a local bacterial overgrowth which stretches up the diverticulae causing symptoms of "left sided appendicitis".

Diagnosis

Clinically an acute attack of diverticulitis looks like a left side appendicitis. See Wikipedia:Diverticulitis. It may be diagnosed with a CT scan.

Diverticulosis is often diagnosed at colonoscopy or barium enema.

Treatment

The acute attack of diverticulitis is treated with antibiotics. The idea here is that one of the little pouches has become infected, which results in formation of an abscess. Antibiotics kill the bacteria which cause the abscess. The worrying complication is that this abscess may rupture the gut causing peritonitis. If I have a patient with a known episode of diverticulitis so that they clearly recognise the symptoms of an attack, I make sure they always have a supply of antibiotics to use should early symptoms arise.

Prevention

  • Eat the stoneage diet! Stone Age Diet - this is a diet which we all should follow
  • Do not allow yourself to become constipated - see Constipation
  • Feed the friendly bacteria bacteroides - bacteroides ferment vegetable fibre to short chain fatty acids which nourish the lining of the gut directly. Do not eat sugar and refined carbohydrate which feed the unfriendly microbes that result in disease.

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