Sigmoid Diverticulitis: Causes, Symptoms & Treatment
Sigmoid diverticulitis is an inflammation of small pouches in the sigmoid colon, the last section of the large intestine. It typically causes pain in the lower left abdomen and requires medical treatment.
Things worth knowing about "Sigmoid diverticulitis"
Sigmoid diverticulitis is an inflammation of small pouches in the sigmoid colon, the last section of the large intestine. It typically causes pain in the lower left abdomen and requires medical treatment.
What is Sigmoid Diverticulitis?
Sigmoid diverticulitis is an inflammation of diverticula – small pouches that form in the wall of the sigmoid colon, the S-shaped final section of the large intestine before the rectum. When these pouches become inflamed or infected, the condition is called diverticulitis. It is one of the most common causes of acute lower left abdominal pain in adults over the age of 40.
Causes and Risk Factors
Diverticula form when the colon wall bulges outward through weak spots. Several factors contribute to their development and subsequent inflammation:
- Low-fibre diet: Leads to hard stools and increased pressure within the colon.
- Physical inactivity: Negatively affects normal bowel function.
- Older age: The intestinal wall loses elasticity over time.
- Obesity: Increases the risk of diverticula formation and inflammation.
- Smoking: Impairs blood flow to the intestinal wall.
- Genetic predisposition: A family history of the condition is a known risk factor.
Symptoms
The typical symptoms of sigmoid diverticulitis include:
- Pain in the lower left abdomen, which may develop suddenly or gradually
- Fever and general feeling of illness
- Changes in bowel habits (constipation or diarrhoea)
- Nausea and vomiting
- Bloating and tenderness on abdominal palpation
In severe cases, complications such as abscesses, perforation (a hole in the bowel), fistulas, or peritonitis (inflammation of the abdominal lining) can occur and represent a medical emergency.
Diagnosis
Diagnosis is typically established through the following investigations:
- Physical examination: Tenderness in the lower left abdomen is characteristic.
- Blood tests: Elevated inflammatory markers (CRP, white blood cell count) support the diagnosis.
- Abdominal ultrasound: Often the first imaging method used.
- CT scan (computed tomography): The gold standard for diagnosing diverticulitis and assessing severity and possible complications.
- Colonoscopy: Performed after the acute inflammation has resolved to rule out other conditions such as colorectal cancer.
Treatment
Uncomplicated Diverticulitis
Mild cases of uncomplicated diverticulitis can often be managed on an outpatient basis:
- Antibiotics: Not always required for mild cases, but used when significant signs of infection are present (e.g., amoxicillin/clavulanate or ciprofloxacin combined with metronidazole).
- Dietary modifications and fluid intake: A temporary low-residue or liquid diet helps rest the bowel.
- Pain management: Analgesics such as paracetamol or metamizole are commonly used.
Complicated Diverticulitis
Severe cases or those with complications require hospital admission:
- Intravenous antibiotic therapy
- Abscess drainage under ultrasound or CT guidance
- Surgery: In cases of perforation, fistula, or recurrent severe episodes, surgical removal of the affected bowel segment (sigmoid resection) may be necessary.
Prevention and Lifestyle
After recovering from diverticulitis, lifestyle changes are important to reduce the risk of recurrence:
- High-fibre diet (vegetables, fruits, whole grains)
- Adequate fluid intake (at least 1.5 to 2 litres per day)
- Regular physical activity
- Weight management in cases of obesity
- Smoking cessation
References
- Strate LL, Morris AM. - Epidemiology, Pathophysiology, and Treatment of Diverticulitis. Gastroenterology, 2019;156(5):1282-1298. PubMed PMID: 30660732.
- Feingold D et al. - Practice parameters for the treatment of sigmoid diverticulitis. Diseases of the Colon & Rectum, 2014;57(3):284-294.
- World Gastroenterology Organisation (WGO) - Global Guidelines: Diverticular Disease, 2022. Available at: www.worldgastroenterology.org
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