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What is sigmoid diverticulitis?

As Sigmoid diverticulum In medicine, bulges (diverticula) are called in a certain section of the intestine, the sigmoid intestine or S-intestine. The name of these diverticula is derived from the Latin name of this section of the intestine: Colon sigmoideum. For example, if stool buildup in a sigmoid diverticulum causes inflammation of the bulges, doctors speak of sigmoid diverticulitis.

Where are the S-bowel and sigmoid diverticula located?

In humans, the S-intestine lies on the left side in the abdominal cavity. It is an S-shaped connector between the “descending branch” (descending colon) of the large intestine and the rectum. By definition, sigmoid diverticula occur exclusively in this area of ​​the intestine. If the bulges are in another section of the intestine, the term "sigmoid diverticulum" does not apply. However, the sigmoid colon is by far the most common area affected by diverticula.

If there are multiple diverticula, it is referred to as diverticulosis (or, in the special case, sigmoid diverticulosis).

Who is most affected by sigmoid diverticula?

Sigmoid diverticula occur primarily in people over the age of 50. These bulges on the intestine develop in almost everyone in the western world. However, the finding of diverticulitis is not given in every affected person. Inflammation of the diverticula in the S-intestine does not always have to occur. Often those affected do not notice the sigmoid diverticulum or sigmoid diverticulosis and doctors usually discover the bulges purely by chance. Doctors often become aware of the sigmoid diverticula as part of routine intestinal examinations.

How are sigmoid diverticula discovered?

Sigmoid diverticula can be detected by colonoscopy, X-ray examinations of the intestine with contrast media, and also by computed tomography. These three types of examinations are particularly effective when sigmoid diverticulitis is suspected. The bulges on the S-bowel can be seen optically on the images of an X-ray examination and computed tomography as well as through a colonoscopy.

What is the trigger for sigmoid diverticulum?

The triggers for sigmoid diverticulum or sigmoid diverticulosis are not exactly known to this day. Research makes a low-fiber and low-fiber diet and the general lifestyle of the patient primarily responsible for the development of diverticula. Since the risk of diverticula increases with advancing age, doctors also see weak connective tissue as a development factor. Diverticula are generally far less common in Asia and Africa than in western industrialized countries. This, in turn, is due to the high fiber and high fiber diets in these countries. In Germany in particular, fewer vegetables, fruit and whole grains are eaten than in Asian and African countries. The formation of diverticula can also be promoted by the regular consumption of red meat, genetic factors, obesity and insufficient physical activity.

The symptoms of sigmoid diverticula

80 percent of patients with sigmoid diverticula do not notice the bowel bulges at all. These people are completely symptom-free. Symptoms only appear when the sigmoid diverticula become inflamed. In this case, the patient suffers from sigmoid diverticulitis. However, with inflammation of the diverticula, only 20 percent of those affected are confronted with sigmoid diverticula. Often, patients with sigmoid diverticulitis complain of the following symptoms:

How does sigmoid diverticulitis arise?

A patient can live with a sigmoid diverticulum or sigmoid diverticulosis for years without showing any symptoms. However, if one or more sigmoid diverticula become inflamed, the patient will be in pain and feel sick. This inflammation of the sigmoid diverticulum is primarily caused by bacteria in the intestine. If, for example, feces accumulate in a sigmoid diverticulum and form a fecal stone, this can lead to increased bacterial formation and sigmoid diverticulitis with the symptoms mentioned above.

Is Sigmoid Diverticulitis Dangerous?

Since sigmoid diverticulitis is inflammation in the intestines, the disease must be taken seriously. Inflammation is generally a burden for the body and, if left untreated, can lead to dangerous complications. These complications can even create a life-threatening situation for those affected. Urgent action is indicated by the doctor, especially in the case of the following complications from sigmoid diverticulitis:

  • Fistula formation (inflammatory ducts) and expansion of the inflammation to other organs
  • Rupture of the intestine (perforation of the intestine)
  • Inflammation of the peritoneum (peritonitis)
  • Abscess formation (encapsulated purulent inflammation)
  • massive bleeding at the sigmoid diverticulum

Fistula formation from sigmoid diverticulitis

If sigmoid diverticulitis is left untreated or if it recurs, a fistula can form in the abdomen. Doctors understand fistulas to be connections between the inflamed sigmoid diverticulum and other organs. The danger here is that the inflammation can spread from the sigmoid diverticulum to the organs connected by the fistula. Such organ inflammation can turn out to be a serious situation for the patient depending on the organ and severity.

Colon perforation from sigmoid diverticulitis

If the sigmoid diverticulitis is particularly severe, the bowel may perforate. The contents of the intestine enter the abdomen through such an intestinal perforation. In many cases, this leads to life-threatening peritonitis. If there is an intestinal rupture, the patient must undergo emergency surgery immediately. During the operation, the perforated piece of intestine is removed and the two ends of the intestine are then sewn together.

Pus formation from sigmoid diverticulitis

If pus forms in an enclosed area due to sigmoid diverticulitis, doctors speak of an abscess in the abdominal cavity. This pus must be removed with a puncture. For this, the doctor places a cannula through which the pus can drain. The puncture can also be performed as part of a diverticulum operation.

Bleeding from sigmoid diverticulum

If the patient reports about blood leakage through the anus, it must be carefully observed whether the bleeding through the sigmoid diverticulum continues. If this is the case, the bleeding must be stopped with the help of an endoscopic procedure (colonoscopy). The bleeding from sigmoid diverticula is mostly caused by ruptured arteries.

How is sigmoid diverticulitis treated?

Mild sigmoid diverticulitis can be treated very well with antibiotic therapy. A specific combination of antibiotics kills the bacteria that cause inflammation in the sigmoid diverticula. In most cases, the antibiotics give the patient an improvement in symptoms within a short period of time. Antibiotic therapy usually lasts seven to ten days and is administered intravenously (via the vein) and orally (by taking the medication). Depending on the severity of the sigmoid diverticulitis, inpatient or outpatient therapy is recommended. However, if antibiotics are ineffective, sigmoid diverticulitis is well advanced, or if there are complications from the inflammation, the patient must undergo surgery.

How is surgery for sigmoid diverticulitis?

Doctors recommend surgical removal of the sigmoid diverticulum or the entire S-bowel in the event of severe or repeated sigmoid diverticulitis, fistula formation and abscess formation. Surgery is inevitable if there is already an intestinal perforation or heavy, persistent bleeding. Such an operation is nowadays carried out using the so-called keyhole method and is considered to be minimally invasive. In some cases, surgery with an incision in the abdomen may still be necessary. Minimally invasive surgery only results in very minor injuries and scars. For these methods, endoscopic tools for laparoscopy are used. As soon as the surgeon has removed the S-bowel or the bowel bulge, the two loose bowel ends will be joined together again. Since the S-intestine is only a short piece of intestine (20 to 30 cm), these operations usually do not have any far-reaching consequences for the patient. Most patients are discharged from the hospital seven days after the operation.

Is an artificial anus necessary for a sigmoid diverticulum operation?

An artificial anus only needs to be placed after a sigmoid diverticulum operation if the intestine has been perforated. In most cases, an artificial anus is therefore not necessary.