Diverticulitis is one of the common irritable bowel diseases. It is characterized by the formation of diverticula along the lining of intestinal wall. Diverticula can be described as the small pouches or sacs that may protrude through the intestinal walls. Development of diverticula is referred to as diverticulosis. When diverticula get infected or inflamed, it causes the symptoms like abdominal pain, tenderness, nausea, vomiting and high fever. This condition is known as diverticulitis.
How common is Right-sided Diverticulitis
Diverticula may be formed anywhere in the digestive system, including stomach, small intestine or esophagus. However, the large intestine or colon is the most common site to develop diverticula. In the Western countries, diverticulitis in the left side of the colon is more common. Right-sided diverticulitis is relatively uncommon. It is more prevalent in the Asian countries. About 45-50% cases of diverticulitis are of right-sided diverticulitis in the Asian countries. Also, right-sided diverticulosis is more commonly seen in younger patients. The right colon including cecum and ascending colon is affected.
Causes and Symptoms
Diverticulitis is more prevalent in the well-developed countries. The reason behind this may be their lifestyle and dietary habits. Dietary habits remarkably contribute in the development of this disease. Consumption of foods with less amount of fiber and high amount of processed foods is one of the major causes of diverticulitis. Fiber is an essential part of our regular diet. It helps to make the stool smooth and bulky, so that it can easily pass through the bowels. It helps to prevent constipation. The frequency of disease increases with advanced age. People after the age of 40 are more likely to develop this disease. With aging, the intestine becomes weak. The pressure inside the colon increases, when the stool passes through the weakened intestine. Obesity, lack of exercise and smoking can also increase the possibility of diverticulitis.
Pain in the lower right side of the abdomen is the most significant symptom of right-sided diverticulitis. The pain is usually relieved after passing flatulence or having bowel movements. Patients with diverticulitis may suffer from constipation or diarrhea. Other symptoms may include loss of appetite, nausea, vomiting as well as high fever and malaise. In the complicated cases of diverticulitis, there may be formation of fistula, abscess, infection, bleeding, obstruction, perforation and peritonitis.
Treatment for Right-sided Diverticulitis
The pain from right-sided diverticulitis may be misdiagnosed with appendicitis. Therefore, correct diagnosis is very important to give proper treatment. The diagnosis is done with the help of imaging tests like CT scan and laboratory investigations like blood count. The mild cases of diverticulitis can be treated with antibiotics like ciprofloxacin, cephalexin, metronidazole and doxycycline. The anti-spasmodic drugs like dicyclomine, chlordiazepoxide, hyoscyamine, scopolamine and atropine are prescribed to relieve pain and muscular spasm. The antimicrobial therapy includes anaerobic microorganisms like Bacteroides fragilis, Clostridium and Peptostreptococcus as well as aerobic bacteria like Klebsiella, Escherichia coli, Streptococcus, Proteus and Enterobacter. Along with medications, the patient is recommended to take only clear liquid diet that includes water, plain soda, clear gelatin, fruit juices without pulp and ice chips for 3-4 days in order to relax the bowels. Once the symptoms are reduced, low-fiber foods like cooked vegetables or fruits, low-fat milk and milk products like cheese and yogurt, fish, eggs and poultry can be taken. The symptoms are generally relieved within 3-4 days. Then, the sufferer can gradually switch to normal diet.
The patients, who don’t respond to oral antibiotics or have developed complications, need to be hospitalized to give oral antibiotics. Hospitalization is also recommended if the patient has highly elevated blood cell count, high fever, uncontrolled pain, abscess, fistula, partial bowel obstruction or perforation. Hospitalized patient should be given nothing by mouth. The patient is kept on IV fluids and IV antibiotics. Usually, the symptoms are improved within 48-72 hours. After that, the patient can be given oral antibiotics for 7-10 days. After complete recovery, high-fiber diet is recommended to prevent recurrent attacks of diverticulitis. Surgery is needed in case of serious complications like abscess, fistula, obstruction or perforation.