You may also have one or more of these symptoms:
They include:
The diverticulum is a sac-like protrusion of the colon wall. Diverticulitis can present in about 10% to 25% of patients with diverticulosis. Diverticulitis can be simple or uncomplicated and complicated. Uncomplicated diverticulitis is without any associated complications.
30: Diverticulosis of large intestine without perforation or abscess without bleeding.
Uncomplicated diverticulitis involves thickening of the colon wall and peri-colonic inflammatory changes. Complicated diverticulitis additionally includes the presence of abscess, peritonitis, obstruction, and/or fistula. Approximately 12% of patients with diverticulitis present with complicated disease.
Uncomplicated diverticulitis is defined as localized diverticular inflammation without complication, whereas complicated diverticulitis consists of inflammation associated with a complication such as abscess, fistula, obstruction, bleeding, or perforation.
Diverticulitis symptoms are more noticeable and include severe abdominal pain and fever. Diverticulitis can be acute or chronic. With the acute form, you may have one or more severe attacks of infection and inflammation. In chronic diverticulitis, inflammation and infection may go down but never clear up completely.
Uncomplicated diverticular disease is defined as the presence of diverticula in the absence of complications such as perforation, fistula, obstruction and/or bleeding.
Clinical manifestation of acute diverticulitis varies depending on the severity of the disease. Patients with uncomplicated diverticulitis typically present with left lower quadrant abdominal pain, reflecting that propensity of left-sided disease in Western nations.
Uncomplicated acute diverticulitis is defined as localized diverticular inflammation without any phlegmon, abscess, perforation, or fistula, whereas acute complicated diverticulitis (ACD) is defined as acute inflamed diverticula giving rise to phlegmon, abscess, fistula, or perforation [6].
If antibiotics are given for uncomplicated diverticulitis, consider amoxicillin/clavulanic acid or an oral cephalosporin plus metronidazole if the patient can take oral therapy. If intravenous therapy is needed cefazolin, cefuroxime, or ceftriaxone, all plus metronidazole or ampicillin/sulbactam alone can be used.
Acute diverticulitis develops when colonic wall herniations become inflamed and infected. This herniation is usually due to a blockage of the lumen or obstruction from stool, which can cause pressure on nearby tissues. Inflammation in the peritoneal cavity often occurs.
Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding. K57. 92 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM K57.
Diverticular disease grows more common with age. About 10% of people over age 40 will get diverticulosis, and 50% will get it after age 60. It affects nearly everyone over 80. There are two main types of diverticular disease -- diverticulitis and diverticular bleeding.
The main cause of diverticulosis in Western countries is thought to be due to a high-fat and low-fiber diet. Other possible causes of diverticulosis include: Straining to have a bowel movement from constipation. Genetics.
Your doctor is likely to recommend: Antibiotics to treat infection, although new guidelines state that in very mild cases, they may not be needed. A liquid diet for a few days while your bowel heals. Once your symptoms improve, you can gradually add solid food to your diet.
The most common causes of acute diverticulitis are fecal impaction, diarrhea, appendicitis, or obstruction by colon cancer. In the past, some foods were thought to cause diverticulitis, like nuts and seeds, beans, and fried foods.
Diverticulitis can be a serious, and even a potentially life-threatening complication. Health problems that can arise from diverticulitis include: Rectal bleeding. Abscesses and fistulas.
Diverticulitis is treated using diet modifications, antibiotics, and possibly surgery. Mild diverticulitis infection may be treated with bed rest, stool softeners, a liquid diet, antibiotics to fight the infection, and possibly antispasmodic drugs.
Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding 1 K57.92 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2 Short description: Dvtrcli of intest, part unsp, w/o perf or abscess w/o bleed 3 The 2021 edition of ICD-10-CM K57.92 became effective on October 1, 2020. 4 This is the American ICD-10-CM version of K57.92 - other international versions of ICD-10 K57.92 may differ.
The 2022 edition of ICD-10-CM K57.92 became effective on October 1, 2021.
As previously stated, approximately 15% of patients with acute diverticulitis develop complications. Twenty percent to 50% of patients develop recurrent episodes of diverticulitis. Having multiple episodes does not appear to increase the risk for complications directly. It may increase the risk of fibrosis, leading to stricture formation and subsequent obstruction. Some patients, approximately 20%, will experience chronic abdominal pain due to either irritable bowel syndrome or chronic low-grade diverticulitis. These patients may be referred for elective colectomy for symptom control. Elective operations for diverticulitis have increased by approximately 30% since 1998.
Diet appears to play a significant role. Low fiber, high fat, and red meat diets may increase the risk for development of diverticulosis and possible diverticulitis. Obesity and smoking are known to increase the potential for both diverticulitis and diverticular bleeding. Finally, exposure to some drugs including nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and opiates are associated with diverticulitis. Conversely, exposure to statin drugs may decrease the incidence of symptomatic diverticulitis. Despite a common popular belief, nuts, seeds, and popcorn are not associated with increased risk of diverticulosis, diverticulitis, or diverticular bleeding. [4][5]
Diverticulitis is the result of microscopic and macroscopic perforations of the diverticular wall. Previously, practitioners thought that obstruction of colonic diverticulum with fecaliths led to increased pressure within the diverticulum and subsequent perforation. They now theorized that increased luminal pressure is due to food particles that lead to erosion of the diverticular wall. This causes focal inflammation and necrosis of the region, causing perforation. Surrounding mesenteric fat may easily contain micro-perforations. This can result in local abscess formation, fistulization of adjacent organs, or intestinal obstruction. Ultimately, frank bowel wall perforations can lead to peritonitis and death without rapid diagnosis and treatment. [7]
Diagnosis of acute diverticulitis can be made clinically based on history and physical examination alone. However, clinical diagnosis can be inaccurate in 24% to 68% of cases. Hence, laboratory and radiological tests play an important role in the accurate diagnosis of acute diverticulitis. Laboratory tests may show leukocytosis and elevation of acute phase reactants such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The radiological test of choice for acute diverticulitis is CT of the abdomen and pelvis, preferably with water-soluble oral or rectal (if significant nausea and vomiting) contrast and intravenous contrast provided there be no contraindications. The sensitivity, specificity, and negative predictive value of a CT scan have been reported as greater than 97%. Typical findings of acute diverticulitis in CT scans include bowel wall thickening, pericolic fat stranding, pericolic fluid, and small abscesses confined to the colonic wall as well as contrast extravasation, indicating intramural sinus and fistula formation. [8]
Complicated diverticulitis requiring surgery may lead to death in approximately 5% of patients. Perforation of the bowel with resulting peritonitis increases the risk of death to 20%.
The most common fistula is colovesicular fistula which occurs in about 65% of cases. Fecaluria is pathognomonic for colovesicular fistula. Surgical repair of the fistula with primary anastomosis is the treatment of choice. Colovaginal, coloenteric, colouterine, colourethral, and colocutaneous are other possible fistulae seen in acute complicated diverticulitis.
Many cases studies reveal that the majority of patients treated for acute diverticulitis do not have a recurrence after initial medical treatment. However, in patients with recurrence, surgical excision of the diseased bowel is recommended, especially in patients over the age of 50. (Level V) Finally, the decision to perform laparoscopic or open surgery for managing acute diverticulitis remains debatable. One study showed no difference in postoperative morbidity between the two. [2][14](Level III) Randomized clinical studies are needed to determine which surgery and what type of surgery is ideal for patients with acute diverticulitis.