b. Etiology. The tendency to have diverticulosis may be congenital or acquired
with acquired being the most common cause. Diverticulosis usually occurs in the
sigmoid colon as a result of the normal aging process from thirty to eighty-five years of
age. Diverticula (the plural of diverticulum) develop at the weak point where blood
vessels penetrate the wall of the colon. It is thought that the lack of bulk in American
and Western European diets is a factor in causing diverticula. Lack of bulk along with
high intraluminal pressure increases the tendency toward development of diverticula.
c. Complications. Patients have no symptoms until diverticula become
obstructed and inflamed. Diverticulitis is the name of the condition then. Diverticulitis
probably affects twenty to twenty-five percent of patients with diverticulosis.
d. Symptoms of Diverticulitis. Diverticulitis is common in persons over thirty-
five and in those who are obese. Diverticulitis pain is usually a dull pain in the lower left
quadrant of mid-abdominal region; the pain may radiate to the back. This pain may last
a few hours or a few days and then subside. Other symptoms include bowel
irregularity, constipation, diarrhea, rectal bleeding, fever, nausea, and vomiting. If there
is massive hemorrhage, gross or microscopic perforation of the diverticulum has
occurred. Inflammation of diverticula may affect the urinary bladder causing the patient
to urinate with increased frequency, experience pain or difficulty during urination, and
have gas or air in the urine (pneumaturia).
e. Treatment of Uncomplicated Diverticulitis. Follow this plan:
(1) Low residue diet. Avoid foods which leave a coarse residue such as
berries, nuts, and skins of fruits.
(2) Give bulk additives. If the patient tends to be constipated, give bulk-
forming substances such as Metamucil.
CAUTION:
Metamucil may cause bowel obstruction.
(3) Give anticholinergics. Give Donnatal, Librax, or Pro-Banthine to slow
down the motility and reduce the irritability of the colon.
f. Treatment of Complicated Diverticulitis. In cases of acute diverticulitis, the
patient should be on bed rest until surgical repair can be performed. Give antibiotics
and supportive therapy as for appendicitis. See paragraph 3-13e, treatment.
NOTE:
The usual case of diverticulitis is mild and responds well to dietary measures
and antibiotics.
MD0581
3-28
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