Sigmoid diverticulitis is an acute inflammation of diverticulosis. Most episodes of acute diverticulitis can be treated with oral or intravenous medications. However, perforation and abscess formation are well described complications. Usually, patients develop fever, elevated white cell counts, pain in the left lower quadrant and perhaps a fullness in the left lower quadrant of the abdomen.
Other disease which may mimic acute sigmoid diverticulitis include:
1. Inflammatory bowel disease
2. Ischemic colitis
3. Colon cancer
4. Gynecologic diseases
5. Urologic diseases
Patients with sigmoid diverticulitis are usually treated with antibiotics. Bowel rest is also prescribed at that time. Most patients may be treated as an outpatient with oral antibiotics and close follow-up in the office. However, patients who have severe disease or complicated co-existing medical problems are usually admitted to the hospital and treated with intravenous antibiotics and pain medications.
Evaluation of an acute sigmoid diverticulitis includes either a sigmoidoscopy or barium enema. In some cases, a gastrografin enema, a variant of a barium enema, may be useful as well. CT scans of the abdomen and pelvis are also useful in order to evaluate the possibility that a perforation or an abscess has formed. If an abscess has formed, computer tomography may allow a drain to be placed into this area. However, in most situations, surgery is required.
Recurrent episodes of diverticulitis can result in strictures, abscess formation and fistulous tracts. With the development of these types of complications, a surgical approach is required.
Most patients will have the affected area surgically removed and the 2 ends of the colon placed back together at the same time. Placing 2 ends of the colon together is called an anastomosis. If perforation occurs, or there is significant infection present, a 2-stage surgical procedure may be performed by the surgeon. This is usually recommended by the surgeon and is based upon the patient's clinical condition.
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