DIVERTICULAR DISEASE

Diverticular disease is a common process that affects about 50% of the people over 60,although the figure increases with age. It affects both men and women.

About a third of these patients are estimated to present symptoms, and only one out of three of them will require surgery due to the seriousness of the condition.

1. What does the diverticular disease consist of?

Diverticula are protrusions or pouches that are formed in the colon wall, normally in thesigmoid or left colon (95%). It is rarely found in any other part of the colon.

Diverticulitis appears when these diverticula becomes inflamed or areperforated.

2. What causes diverticular disease?

The development of the condition is probably related to the decrease of fiber intake in the diet, the pressure inside the colon, age, and the weakening of the colon walls.

3. What are its symptoms?

The main symptom of this disease is abdominal pain (normally on the left side). Diarrhea,nauseas and alterations of the intestinal transit may also occur. We can also observe mucus or blood in the faeces, but this occurs in very few patients affected withdiverticulosis and sometimes this makes it more difficult to make a differential diagnosisof other colon conditions such as inflammatory diseases, cancer, or irritable bowel syndrome.

Diverticulitis is the inflammation or infection of these diverticula and can produce one orseveral of the following symptoms: pain, fever, shivering, and alteration of the intestinaltransit. Sometimes, diverticulitis can develop complications like abscesses, fistulae of thevagina or bladder, or even a perforation of the colon, which requires an urgent surgicalintervention.

4. How is the diverticular disease diagnosed?

Your doctor will do a clinic checkup that includes anamnesis or patient interview and an exploration or physical examination.

Anamnesis and physical exploration: the patient will answer several questions related to the symptoms (if the same problem has occurred before, any relatedsymptoms, etc) and their health condition. The exploration consists on a visual inspectionof the anus and a later digital rectal examination and palpation of the abdomen.

Complementary explorations: they are a series of tests that visualize the diverticulaand give information on their extension and seriousness.

Colonoscopy: it is done with a long and flexible tube with a camera that permitsexploring the entire colon. It requires a previous preparation of the intestine andmay produce discomfort during the process.

Opaque enema: it also requires preparing the intestine. It is a special radiologicaltest that consists of introducing a contrast through the anus to fill the colon anddraw its surface (the mucosa). Then, X-ray images are taken in order to obtain a complete study of the colon and rectum.

Abdominal ultrasonography test: it is an innocuous test that does not requirepreparing the intestine. A probe is slid on the abdomen and permits obtainingimages of the interior that the doctor will interpret afterwards.

Abdominal scanner: it does not require any preparation either, but it is notinnocuous because it emits radiation. It consists on introducing the patient in an X-ray machine that takes pictures of the interior of the abdomen.

5. How is the diverticular disease treated?

Those cases with light symptoms are treated with diet, sometimes accompanied bymedicines to relieve the pain and to control the intestinal transit. It is convenient toincrease the intake of fiber in diet, drinking water, and restricting any food that increases the pressure inside the colon.

Diverticulitis requires a more comprehensive treatment. In light situations, it may not benecessary to stay in hospital. The normal treatment includes oral intake of antibiotics for7-10 days and diet restrictions to soften the stool and preserve the transit. More seriouscases require staying in hospital with digestive resting and intravenous intake of liquids,antibiotics, and analgesics. Most cases can be controlled with conservative methods,making surgery necessary only for the scarce cases in which serious complicationsappear.

6. When is surgery necessary?

Surgical treatment is indicated in recurrent diverticulitis and complicated cases that donot respond to the conservative treatment. Emergency surgery is necessary only in a reduced number of patients.

Elective surgery consists on resecting part of the colon (normally the sigmoid or leftcolon) and joining the rest of the colon to the rectum. In certain acute outbreaks with intra-abdominal infection with abscesses, drainage of that area can be performed placing a tube using radiological techniques, and then preparingthe patient for the surgical intervention already described. If the drainage is not effectiveor the situation gets more complicated with a severe -hemorrhage or a perforation, then it will be necessary to perform an urgent surgical intervention to resect the affected colonand join the proximal colon to the skin placing a pouch for the stool (colostomy). Thedistal part (rectum) is closed excluding that part of the intestine.

7. What are colorectal surgeons?

Colorectal surgeons are experts on surgical and non-surgical treatments for any condition in the colon or rectum. These professionals are specialized in colon and rectumpathologies after ending their formation as specialists in general and digestive surgery. They treat benign and malignant conditions, carry out studies for the early detection ofcertain illnesses, and proceed with the surgical treatment when this is indicated.

Fax: +34 91 750 04 55

General surgery appointment telephone number: +34 91 756 79 00. Ext:4136

Outpatient appointment telephone number: +34 91 756 79 00 / 902 10 74 71

Hospital telephone number: +34 91 756 78 00