Where is a diverticular abscess

The condition starts as diverticular disease, or diverticulosis, which develops slowly over time. Pockets within the lining of the colon pop up through the muscle layers of the colon. Earlier research found that about 10 to 25 percent of people with diverticulosis will develop diverticulitis in their lifetime. But for those who do experience a single episode of diverticulitis, he recommends being seen by a gastroenterologist as soon as possible. The disease is most common in Western countries and typically develops in people over age The symptoms usually begin when bacteria or stool get stuck in one of the colon pouches, leading to infection and inflammation.

Treatment for diverticulitis focuses on getting rid of infection, reducing inflammation, letting the colon rest, and preventing more severe complications. This is usually done with antibiotics, increased liquids, dietary changes, and rest. About 85 percent of people will respond to medical treatment of uncomplicated diverticulosis, while about 15 percent will require surgery.

In fact, diverticulitis accounts for about 4 percent of emergency room visits for abdominal pain. The following symptoms are signs of diverticulitis and should be taken seriously: This is dangerous because untreated diverticulitis can be life-threatening. When it comes to major complications, these are much less common — and age seems to play a major role. About 70 percent of people ages 80 and older have diverticulitis. Stassen, who explains that the older someone gets, the more likely they are to have a complication, like bleeding.

Severe complications can come on quickly, resulting in sudden pain. These include the following, which require immediate medical attention, like hospitalization or surgery: 2 , 7 , 13, Diverticulitis causes tiny tears, called perforations, in the bowel walls. These weaken the colon walls and, if they grow larger, can spill bowel contents into the abdominal cavity. This can lead to infection and inflammation in the abdomen, called peritonitis. Peritonitis is a medical emergency that requires immediate surgery to clear the abdominal cavity.

Part of the damaged colon may need to be removed. An abscess forms when a pocket in the bowel becomes infected and fills with pus. A phlegmon is the infected and inflamed area near the abscess. Both form along the wall of the colon as a result of diverticulitis. Abscess symptoms include sore abdomen, fever, nausea, and vomiting.

Up to 30 percent of people who develop acute diverticulitis one or more temporary attacks marked by infection or inflammation may also develop an abscess. A small abscess might be able to be treated successfully with antibiotics. A bowel obstruction is a blockage in the colon.

You can have a partial block or complete block of the large intestine. This narrowing process is called stricture formation. A complete block requires emergency surgery to clear the path, while a partial block can be surgically corrected at a later date. Symptoms include severe constipation, bloating , vomiting, and abdominal pain.

Rectal bleeding caused by diverticulitis is not incredibly common, happening in about 17 percent of those with chronic diverticulitis, which is an ongoing form of the disease that never clears up entirely. When it happens, it can be severe. Diverticular pouches can damage the blood vessels in the colon wall, resulting in bleeding. There are no symptoms of bleeding other than seeing red- or maroon-colored blood in the bowel movements.

In severe cases, a hospital stay, blood transfusion , and surgery may be required. A fistula is the formation of an abnormal pathway between two organs. In diverticulitis, a fistula typically connects the colon with either the bladder, the small intestine, or the vagina. Doctors may use colonoscopy to confirm a diagnosis of diverticulosis or diverticulitis and rule out other conditions, such as cancer External Link Disclaimer.

The goal of treating diverticulosis is to prevent the pouches from causing symptoms or problems. Your doctor may recommend the following treatments. Although a high- fiber diet may not prevent diverticulosis, it may help prevent symptoms or problems in people who already have diverticulosis. A doctor may suggest that you increase fiber in your diet slowly to reduce your chances of having gas and pain in your abdomen. Learn more about foods that are high in fiber.

Your doctor may suggest you take a fiber product such as methylcellulose Citrucel or psyllium Metamucil one to three times a day. These products are available as powders, pills, or wafers and provide 0. You should take fiber products with at least 8 ounces of water. Some studies suggest that mesalazine External NIH Link Asacol taken every day or in cycles may help reduce symptoms that may occur with diverticulosis, such as pain in your abdomen or bloating.

Some studies show that probiotics External NIH Link may help with diverticulosis symptoms and may help prevent diverticulitis. Probiotics are live bacteria like those that occur normally in your stomach and intestines. You can find probiotics in dietary supplements—in capsule, tablet, and powder form—and in some foods, such as yogurt.

For safety reasons, talk with your doctor before using probiotics or any complementary or alternative External NIH Link medicines or medical practices. Diverticular bleeding is rare. If you have bleeding, it can be severe. In some people, the bleeding may stop by itself and may not require treatment. However, if you have bleeding from your rectum —even a small amount—you should see a doctor right away. To find the site of the bleeding and stop it, a doctor may perform a colonoscopy.

Your doctor may also use a computerized tomography CT scan or an angiogram to find the bleeding site. An angiogram is a special kind of x-ray in which your doctor threads a thin, flexible tube through a large artery, often from your groin, to the bleeding area. If your bleeding does not stop, a surgeon may perform abdominal surgery with a colon resection. In a colon resection, the surgeon removes the affected part of your colon and joins the remaining ends of your colon together.

In some cases, during a colon resection, it may not be safe for the surgeon to rejoin the ends of your colon right away. In this case, the surgeon performs a temporary colostomy. Several months later, in a second surgery, the surgeon rejoins the ends of your colon and closes the opening in your abdomen.

If you have diverticulitis with mild symptoms and no other problems, a doctor may recommend that you rest, take oral antibiotics External NIH Link , and follow a liquid diet for a period of time. If your symptoms ease after a few days, the doctor will recommend gradually adding solid foods back into your diet. Severe cases of diverticulitis that come on quickly and cause complications will likely require a hospital stay and involve intravenous IV antibiotics.

A few days without food or drink will help your colon rest. If the period without food or drink is longer than a few days, your doctor may give you an IV liquid food mixture.

The mixture contains. Severe cases of diverticulitis will likely require a hospital stay. Your doctor may need to drain an abscess if it is large or does not clear up with antibiotics. Additional surgery may be needed to remove a small part of your colon if the surgeon cannot repair the perforation. Peritonitis requires immediate surgery to clean your abdominal cavity. You may need a colon resection at a later date after a course of antibiotics. You may also need a blood transfusion if you have lost a lot of blood.

Without prompt treatment, peritonitis can be fatal. Surgeons can correct a fistula by performing a colon resection and removing the fistula. Partial blockage is not an emergency, so you can schedule the surgery or other corrective procedures. Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon.

Alimentary Pharmacology and Therapeutics. If you have diverticulosis or if you have had diverticulitis in the past, your doctor may recommend eating more foods that are high in fiber.

The Dietary Guidelines for Americans External Link Disclaimer , —, recommends a dietary fiber intake of 14 grams per 1, calories consumed. For example, for a 2,calorie diet, the fiber recommendation is 28 grams per day. Some fiber-rich foods are listed in the table below. Source: U. Department of Agriculture and U. Department of Health and Human Services. December A doctor or dietitian can help you learn how to add more high-fiber foods External NIH Link to your diet.

Experts now believe you do not need to avoid certain foods if you have diverticulosis or diverticulitis. In the past, doctors might have asked you to avoid nuts; popcorn; and seeds such as sunflower, pumpkin, caraway, and sesame. Recent research suggests that these foods are not harmful to people with diverticulosis or diverticulitis.

The seeds in tomatoes, zucchini, cucumbers, strawberries, and raspberries, as well as poppy seeds, are also fine to eat. Even so, each person is different. You may find that certain types or amounts of foods worsen your symptoms. Clinical trials are research studies involving people. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses.

The area under ROC curve for the model using these factors was 0. Univariate analysis did not identify any statistically significant risk factors for failure of drainage treatment Table 3.

Abscess size has a drastic effect on the choice and success of treatment of diverticular abscesses. This reflects current international guidelines for the treatment of small diverticular abscesses [ 11 ]. Treatment with antibiotics alone decreased as abscess size increased. Percutaneous drainage combined with antibiotics as a treatment for abscess did not seem to be superior when compared to treatment by only antibiotics. Our data showed no differences in the failure rate, day mortality, need of emergency surgery, permanent stoma, recurrence, or length of stay even between the groups of matched patients.

Emergency surgery is not recommended as the first-line treatment for abscesses due to high mortality [ 1 , 3 , 11 , 14 ]. However, the excess mortality might be due to the factors unrelated to surgery such as comorbidities or sepsis. Selected patients might benefit from early operative intervention. Previous studies have usually excluded patients treated operatively as the first-line treatment. Only Devaraj et al. Neither reports the number separately for large abscesses.

In studies by Ambrosetti et al. These studies do not directly report abscess size for operated patients, but pelvic abscesses are generally larger than pericolic. Only a few studies compare the treatment of large abscesses between percutaneous drainage and antibiotics, and all of them are retrospective series.

Elagili et al. In the study, 32 patients were initially treated with antibiotics alone and with percutaneous drainage. The authors suggested that antibiotics without percutaneous drainage could be used as the initial treatment for selected patients even with large diverticular abscesses.

Garfinkle et al. The 73 patients in this retrospective study, of which 33 underwent percutaneous drainage, had low incidences of future emergency operations 2. Successful drainage did not seem to lower the complication rates or recurrences. A recently published article by Lambrichts et al. Of overall patients, Short-term failure rates for Hinchey Ib The choice of treatment strategy was not an independent risk factor for failure of treatment in multivariate analysis.

The pooled average for complication percentage of percutaneous drainage was 2. Majority of the complications were enterocutaneous fistulas or small bowel lesions and were treated conservatively [ 14 ]. Although limited by their retrospective nature and small cohort sizes, all the studies have comparable results. Percutaneous drainage offered no clear advantages in the short- or long-term success of the treatment.

However, retrospective studies are susceptible to selection bias. It is possible that physicians treated patients with a worse clinical condition more actively, and therefore, they were more likely to receive drain. Complications of percutaneous drainage are inevitable, as they are for any invasive procedure.

Therefore, the advantages and disadvantages should be carefully considered. Drainage does not seem to decrease treatment failure. There are several limitations to this study. This is a retrospective study with all the limitations inherent in the design. In most cases, the exact reason for placing drain cannot be assessed. Also, the sample size is relatively small. Most other studies comparing antibiotics treatment with percutaneous drainage have these same limitations.

Mild recurrences which were diagnosed and treated in primary care without CT imaging or need of hospitalization were not included in recurrences. Death or moving away from the referral area terminated follow-up. The rarity of large diverticular abscesses amenable for drainage presents difficulties for conducting prospective studies.

Seven patients with only percutaneous aspiration were included in the drainage group, and one might argue that these patients did not receive proper drainage. However, it is unclear whether aspiration is as effective as drainage [ 3 ].

As there is no evidence for drain irrigation regimes or discontinuation of the drainage [ 3 ], the drains are usually removed at our institution once the abscess is emptied and the drains do not produce pus anymore. In conclusion, percutaneous drainage combined with antibiotics is not superior to antibiotics only in terms of treatment failure, recurrence of diverticulitis, or incidence of elective sigmoid resections regardless of the abscess size.

Unless emergency surgery is needed, antibiotics could be considered as the primary treatment. Percutaneous drainage is an invasive procedure and does not seem to improve treatment results. Therefore, drainage should be considered when it is technically feasible and antibiotic treatment does not improve the patient. A prospective randomized study is needed to comprehensibly evaluate the advantages and disadvantages of percutaneous drainage in diverticular abscesses.

This will be challenging to commence because of the rarity of the disease and would probably need an international collaboration to be successfully carried out.

The datasets cannot be made publicly available, and restrictions apply to the availability of these data. Data can be requested from the authors and will require permission from the Helsinki University Hospital. Left colon acute diverticulitis: an update on diagnosis, treatment and prevention. Int J Surg. Article Google Scholar. Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights.