Common, according to the French National Society of Gastroenterology, colonic diverticulosis affects nearly 50% of French people over 70 years old. Colonic diverticula develop in the colon, and are most often asymptomatic and benign. In many people, they are discovered incidentally during an abdominal imaging test performed for a completely different reason. But sometimes, these abnormalities become complicated and cause symptoms. Additional examinations are then necessary and include an abdominal-pelvic scan and blood tests.
1. Definition and symptoms of colonic diverticulosis
Colic diverticulosis is characterized by the presence of diverticula in the colon. These correspond to small bags or hernias, which mainly form in the sigmoid colon (left colon). Although the causes of colonic diverticulosis are still unknown, its frequency increases with age. In Europe, it is common, according to the French National Society of Gastroenterology, and affects 30% of those over 60 and 50% of those over 70. Generally, colonic diverticula are benign and do not cause symptoms. They can be discovered by chance during a routine examination or carried out as part of another pathology. In the event of a complication (infection, perforation or narrowing of the colon), they can become inflamed or even cause hemorrhage. According to the Lyon Center for Digestive Surgery, colonic diverticulosis can then generate symptoms, in particular:
- unusual and severe abdominal pain;
- constipation, transit disorders;
- fever ;
- lower gastrointestinal bleeding;
- nausea and vomiting;
- a frequent urge to urinate (pollakiuria).
Without treatment, other symptoms may appear, highlighting serious complications (fistulas, stenosis, rectal bleeding, etc.), or causing peritonitis. In the absence of complications, colonic diverticulosis does not require special treatment.
2. Diagnosis of colonic diverticulosis
In most cases, colonic diverticulosis does not cause any particular symptoms. It does not cause pain or discomfort, and goes unnoticed. The person may discover it incidentally during a routine examination or carried out to diagnose another illness. But sometimes, colonic diverticula become inflamed, without being able to explain it, and cause complications. In this case, these are the symptoms that prompt the patient to consult their doctor. According to the High Authority of Health, to make and confirm the diagnosis of colonic diverticulosis, the latter carries out a clinical examination (medical history, patient interview, physical examination) and additional examinations:
- a colonoscopy: insertion of a colonoscope through the anus and inspection of the interior of the colon;
- a capsule endoscopy: insertion of a capsule (works like a small digital camera) and observation of the mucous membranes of the intestine;
- a barium enema: injection of an X-ray opaque contrast product called barium via a cannula inserted into the anus, and taking x-ray images of the abdomen;
- a computed tomography or CT scan;
- an abdominal-pelvic scan;
- an MRI (magnetic resonance imaging);
- blood tests: measurement of CRP (C-reactive protein) and creatinine, to assess the degree of inflammation.
3. Complications of colonic diverticulosis
In the majority of people affected by diverticula, the hernias remain benign, and there is no cause for concern. According to the Canadian Society for Intestinal Research, the phenomenon progresses to diverticulitis, that is to say inflammation of the diverticula, in 10 to 25% of cases. Complications of colonic diverticulosis may involve:
- diverticulitis: inflammation of the diverticula;
- perforation of the wall of the diverticula: which can cause abscesses, local peritonitis or generalized peritonitis;
- colonic stenosis: thickening of the digestive wall caused by repeated diverticulitis;
- fistulas: communication of the colon with a neighboring organ (bladder, small intestine, vagina);
- diverticular hemorrhage: exceptional complication involving blood loss from the anus (rectorrhagia).
Each year, complicated diverticulitis (abscess or perforation) concerns 9 new cases out of 100,000, according to the French National Society of Gastroenterology. They require rapid care and adequate treatment.
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Read also :
⋙ Diverticulitis: what causes this inflammation of the diverticula?
⋙ Sigmoiditis (diverticulitis): what are the symptoms and how to treat it?
⋙ Colonoscopy: 5 things to know before taking this exam